态靶结合辨治青少年抑郁症思路探讨

基于态靶辨证理论,分析青少年抑郁症之“态”与“靶”及其“调态打靶”的可能思路。认为青少年抑郁症之病机主要为气机郁滞,郁积日久而致情志异常,是为“郁”态;久之郁火易上逆上亢,并累及他脏,可产生“逆”态与“虚”态。中枢五羟色胺能系统改变及中缝背核-中脑奖赏系统神经环路可作为青少期抑郁症调控的核心靶点与通路。临证时,“调态”应首先调心理之态,再调病证之态;“打靶”可打中枢五羟色胺能系统及其神经环路之靶。基于态靶辨证构建青少年抑郁症辨治新体系,将有助于阐明青少年抑郁症的宏观与微观防治机制。

基于中医四诊信息的糖尿病前期人群中医状态辨识研究

目的基于中医四诊信息,针对糖尿病前期患者开展中医状态辨识研究,形成糖尿病前期风险人群的中医辨识方法。方法基于医院和社区,纳入300例糖尿病前期人群,收集、整理其四诊信息,采用聚类分析等统计学方法分析其常见症状、舌脉、中医证候类型等。结果糖尿病前期人群中,一类多表现为形体肥胖,肌肉满实,可伴有颈部皮肤色黑,脘腹胀闷,心烦,口苦,大便干结,舌质淡红、舌苔白腻或厚腻,脉弦滑;另一类多表现为形体肥胖,肌肉松软,倦怠乏力,口淡无味或口中黏腻,纳呆,便溏,舌质淡、舌体胖大有齿痕、舌苔薄白或腻,脉濡缓。中医证候类型主要包括脾胃气滞证、肝郁气滞证、气阴两虚证、湿热证、痰湿证。结论糖尿病前期人群中医证候类型主要有5类,中医状态以“郁”为主,按病性分为虚实2类,即郁态偏实证和郁态偏虚证。以此为基础,可实现对糖尿病风险人群的早期识别,进而为早期干预和早期治疗奠定基础。

从肝玄府微癥结辨治肝癌癌前病变

我国原发性肝癌的死亡风险仍在逐渐升高,对肝癌的早期发现和早期诊治仍是防治肝癌的重要手段。肝癌癌前病变是慢性肝病炎癌转变进程中恶性转化的关键环节,主要是异性增生结节,故而肝癌前病变的及时防治可将肝癌治疗关口前移,中医药防治本病仍处于探索阶段。肝玄府理论的引入为本病防治提供了一个探索研究的方向,本文从肝玄府与气血津液的代谢着手,提出了肝玄府微癥结是肝癌癌前病变的基本病理状态,以开玄通络为基本治疗法则。癌前病变是多种病理因素夹杂的复杂状态,故在临床应用中提出“郁瘀态”“浊瘀态”“虚瘀态”3种常见的病理状态,旨在为本病的防治提供思路借鉴。

Cultivation of Black Fungus under Forest in Middle-high Altitude Areas

[Objective] The study was to solve the contradiction between fungus and forest during the production of black fungi, and to obtain relatively high economic benefits and ecological benefits. [Method] Black fungi were cultivated in forest with middle-high altitude of 500-1 600 m. The germination time of fungus stick, germination days of buds, growth days of fruiting body, commodity exterior, marketing effect and biological efficiency of black fungi were investigated. [Result] Compared with traditional cultivation, black fungus products cultivated under forest had the taste and flavor of wild black fungus. Fungus chaff wastage was directly decomposed by the roots in forest land, improving the soil structure of forest land. The need of moisture retention and the frequent access of administrative staff reduced the probability of forest fire occurrence. [Conclusion] Cultivation of black fungus under forest saves more than 70% fixed-asset investment on fungus shed, and the biological efficiency reached 12.2%.

基于“态靶理论”辨治代谢相关脂肪性肝病

代谢相关脂肪性肝病(metabolism-related fatty liver disease,MAFLD)基本病机为脾失健运,水谷运化失调,气血生化乏源,导致肝体不养,肝“用”不足。脾胃为气机升降之枢纽,中焦气机阻滞,不能助肝疏泄,则可致肝郁气滞,最终导致“土壅木郁”。根据“态靶理论”,可将MAFLD归纳为“郁壅、湿热、瘀虚”三态,着眼于患者临床表现与异常检查指标,分别辨识症靶和标靶,将“宏观辨证”与“微观打靶”相结合,探讨各态势阶段相应的靶方靶药:“郁壅态”患者选用健脾化湿之法,常用健脾渗湿汤或苓桂术甘汤加减;“湿热态”患者应以泻热解郁,利湿化浊为主;“瘀虚态”患者治疗当以健脾益肾,活血祛瘀为主。

Depression recognition using functional connectivity based on dynamic causal model

Dynamic casual modeling of functional magnetic resonance imaging（fMRI） signals is employed to explore critical emotional neurocircuitry under sad stimuli. The intrinsic model of emotional loops is built on the basis of Papez＇s circuit and related prior knowledge, and then three modulatory connection models are established. In these models, stimuli are placed at different points, which represents they affect the neural activities between brain regions, and these activities are modulated in different ways. Then, the optimal model is selected by Bayesian model comparison. From group analysis, patients＇ intrinsic and modulatory connections from the anterior cingulate cortex （ACC） to the right inferior frontal gyrus （rlFG） are significantly higher than those of the control group. Then the functional connection parameters of the model are selected as classifier features. The classification accuracy rate from the support vector machine（SVM） classifier is 80.73%, which, to some extent, validates the effectiveness of the regional connectivity parameters for depression recognition and provides a new approach for the clinical diagnosis of depression.

Association between the Epidermal Growth Factor Gene and Intelligence in Major Depression Patients

Objective To study the association between the epidermal growth factor(EGF) gene and intelligence in patients with major depression.Methods Intelligence measurement using Wechsler Adult Intelligence Scale(WAIS) was perfor-med on 120 unrelated patients with major depression and 46 control subjects.Blood was collected from all subjects for extraction of genomic DNA.Four single nucleotide polymorphisms(SNPs) in the EGF gene were genotyped using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF-MS).Results Mean scores of both score lang and score task,two subtests in WAIS,differed significantly between major depression patients and controls(P<0.0001).Quantitative trait analysis showed that the genetype of rs2250724 was closely associated with score lang and score task in major depression patients.The associations were still significant after 10 000 permutations.Conclusions Although preliminary,our results provide evidence for association between the EGF gene and intelligence in patients with major depression.Genetic variation in the EGF gene may increase the susceptibility of major depression.

Association between estrogen receptor β gene Rsa1 polymorphism and depressive disorder in peri-menopausal and menopausal women

Objective: To investigate estrogen receptor β (ERβ) gene Rsa1 polymorphism and concentration of estrogen, FSH and LH in serum in peri-menopausal and menopausal women with depressive disorder. Methods: Seventy-four peri-menopausal and menopausal women with depressive disorder met ICD-10 and CCMD-3 assessment criteria for depressive disorder were recruited. ERβ gene Rsa1 polymorphism was analyzed with PCR-RFLP. Serum levels of estrogen, FSH and LH were measured by magnetism-ELISA. Results: The respective frequency of ERβ gene Rsa1 polymorphism was no significant difference between women with depressive disorder and the healthy women (χ 2=1.106,P>0.05). The serum level of estrogen was lower in women with depressive disorder than in the healthy women (P<0.05). No difference was found for FSH and LH between two groups. Conclusion: ERβ gene Rsa1 polymorphism may be not associated with depressive disorder in the peri-menopausal and menopausal women. The serum level of estrogen is associated with depressive disorder in the peri-menopausal and menopausal women.

Dietary supplement of selenium-rich yeast may relieve lipopolysaccharide-induced growth depression in piglets via improving immune and antioxidant status

Selenium protects cells from oxidative damage and reduces lipopolysaccharide （LPS）-induced expression of inflammatory cytokines. Because inflammatory cytokines induce growth depression, we hypothesized that selenium-rich yeast （SeY） would inhibit growth depression caused by LPS. Twenty Meishan weanling pigs [28 （s.d. 2 d）, 7.6 （s.d. 0.3 kg） body weight （BW）] were used in a 2×2 factorial design （n=5）. The main factors were dietary Se sources [selenium-rich yeast （SeY） vs. sodium selenite （SSe）] with supplement level at 0.3 mg Se/kg, and immunological stress （LPS vs. saline）. The experiment lasted for 28 d. On d 14 and d 21, half of pigs in each dietary treatment were intramuscularly injected with either 50 μg/kg BW LPS or an equivalent amount of sterile saline. Blood samples were collected at 3 h post-injection. There were no interactions between dietary Se sources and immunological stress on growth performance. LPS depressed average daily gain （ADG） （d 14-21, P〈0.05; d 21-28, P〈 0.01）, and elevated feed to gain ratio （F/G） （d 21-28, P〈0.05）, while SeY elevated ADG （d 0-14, P〈0.05; d 21-28 and d 0-28, P〈0.01）, and decreased F/G （P〈0.01）. Interactions were observed on interleukin-1β（IL-1β） and interleukin-6 （IL-6） from serum samples of d 14 and d 21 （P〈0.01）, as well as superoxide dismutase （SOD） and insulin like growth factor （IGF-1） of d 21 （P〈0.05）. In conclusion, SeY relieved the growth depression of piglets immunologically stressed by LPS, which maybe resulted from the decreased externalization of inflammatory cytokines and improved antioxidant status.

仝小林院士辨治高血压病“三期五态”新视角

高血压病是一种常见的心血管综合征,中医药防治高血压病及其并发症需重视微观的病理生理变化。仝小林院士基于"态靶组方"理论,结合前期辨治高血压病经验,发展完善并构建了高血压病"三期五态"辨治方案,并从病理生理角度阐释"三期五态"的病机和辨治要点。"三期"即"病气血、病脉络、病脏腑",病理特点分别为脉挛急、脉僵硬和脏腑损。"五态"即壅态、水态、郁态、寒态、老态。壅以堵塞言,水以液体言,郁以情志言,寒以紧凝言,老以脉络病变言。同时提出不同"态"治疗的靶方、靶药:厚朴三物汤是治疗壅态的常用靶方,决明子、茺蔚子、生白术是常用靶药;当归芍药散、五苓散是治疗水态的靶方,茯苓、茺蔚子、益母草、车前子、葶苈子是治疗水态的靶药,尤其对于脉压差小者,茺蔚子、茯苓等有显著疗效;四逆散是治疗郁态的常用靶方,郁而化火加靶药夏枯草、钩藤、黄芩、菊花、生石决明;葛根汤、桂枝加葛根汤是治疗寒态的常用靶方,葛根、桂枝、独活、羌活是治疗寒态靶药;莪术、三七、浙贝母、海藻、天麻、盐杜仲、怀牛膝是治疗老态的常用药物,其中天麻、盐杜仲、怀牛膝对脉压差大者有显著疗效,黄芪、鸡血藤、水蛭、土鳖虫是治疗老态补虚通络软管的靶药。

Observation on clinical effect of tuina plus Western medication for functional dyspepsia due to liver qi stagnation and spleen deficiency

Objective：To observe the clinical effects of tuina plus Western medication for functional dyspepsia （FD） due to liver qi stagnation and spleen deficiency.Methods：A total of 72 patients in conformity with the inclusion criteria of FD were randomly divided into an observation group and a control group based upon the random number table,36 cases in each group.The control group was treated with mosapride citrate dispersible tablets,and the observation group was treated with the same tablets plus tuina.Before the treatment and 4 weeks after the treatment,the clinical symptoms,quality of life （QOL） and depression severity were observed by the scale,and were followed up two months later after the treatment for assessment of the clinical effects.Results：After the treatment and at the follow-up,the symptom scores of FD and the sores of Hamilton depression rating scale （HAMD） in both groups decreased,and the scores in Chinese version of quality of life questionnaire for functional digestive disorders （Chin-FDDQL） increased,with statistically significant differences in comparison with the same group before the treatment （all P〈0.05）.In comparison between the two groups at the same time point after the treatment,the scores of FD symptoms,HAMD and Chin-FDDQL were improved better in the observation group than those in the control group,with statistically significant differences （all P〈0.05）.The total effective rates at the follow-up were 91.7% in the observation group and 75.0% in the control group,without statistical difference between the two groups （P〉0.05）.The rate of clinical cure and remarkable effect was 66.7% in the observation group,higher than 41.7% in the control group,it is higher in the observation group than that in the control group,with a statistically significant difference between the two groups （P〈0.05）.Conclusion：Tuina plus Western medication is precise in the therapeutic effects for FD due to liver qi stagnation and spleen deficiency and can effectively relieve clinical symptoms,elevate the QOL and alleviate depression severity of the patients.Moreover,it＇s better than the treatment by Western medication alone in the long-term therapeutic effects.