Research progress of traditional Chinese medicine in the treatment of complications related to spinal cord injury

Spinal cord injury is one of the common neurological diseases in clinical practice.It has the characteristics of high incidence rate,high disability rate and high cost.It brings great pain and mental stress to patients.Spinal cord injury patients with neurological impairment,slow recovery,in the process of disease treatment is easy to produce a series of complications,such as respiratory complications,neurogenic bladder,spasm,deep vein thrombosis,pressure sores and so on.At present,western medicine and auxiliary equipment are mainly used in the treatment of related complications,but traditional Chinese medicine also plays a very important role.Traditional Chinese medicine is not only economical,cheap and has little side effects,but also can promote the functional rehabilitation of patients with spinal cord injury and reduce the incidence of complications.In this paper,through searching the literature reports on the treatment of spinal cord injury related complications with traditional Chinese medicine at home and abroad,we review the treatment of neurogenic bladder,spasm,venous embolism,neuropathic pain,neurogenic intestinal dysfunction,pressure sores,respiratory complications with traditional Chinese medicine,in order to provide reference for the clinical treatment of spinal cord injury related complications.

Traditional Chinese medicine manipulative reduction combined with percutaneous vertebroplasty for treating type Ⅲ Kummell's disease: A case report

BACKGROUND A patient with type Ⅲ Kummell’s disease had a ruptured posterior cortex of the fractured vertebral body, which caused spinal cord compression. An open surgery was considered the best choice of operation. However, the patient and her family refused open surgery and instead demanded a minimally invasive surgical treatment such as percutaneous vertebroplasty(PVP). After preoperative discussion, we finally adopted the novel therapy of traditional Chinese medicine manipulative reduction(TCMMR) combined with PVP.CASE SUMMARY A patient with type Ⅲ Kummell’s disease exhibiting bone block-induced spinal cord compression was admitted to our hospital. She suffered from a variety of medical disorders but refused open surgery, and instead asked for PVP surgery. TCMMR, in parallel with PVP, was used to restore the height of the compressed vertebral body and reduce the symptoms of spinal cord compression by the bone block in order to strengthen the vertebral body and prevent further collapse. The surgery was very successful. The height of the compressed vertebra was restored, and the symptom of spinal cord compression by bone block was reduced successfully via TCMMR. The fractured vertebra was solidified by the PVP. The pain visual analog score declined from preoperative 7 scores to postoperative 2 scores, and the Frankel spinal cord scale increased from preoperative D degree to postoperative E degree.CONCLUSION The new method has advantages in treating patients with type Ⅲ Kummell’s disease who cannot be treated with open surgery.

Gastrodin promotes the secretion of brain-derived neurotrophic factor in the injured spinal cord

Gastrodin, an active component of tall gastrodia tuber, is widely used in the treatment of dizziness, paralysis, epilepsy, stroke and dementia, and exhibits a neuroprotective effect. A rat model of spinal cord injury was established using Allen＇s method, and gastrodin was administered via the subarachnoid cavity and by intraperitoneal injection for 7 days. Results show that gastrodin promoted the secretion of brain-derived neurotrophic factor in rats with spinal cord injury. After gastrodin treatment, the maximum angle of the inclined plane test, and the Basso, Beattie and Bresnahan scores increased. Moreover, gastrodin improved neural tissue recovery in the injured spinal cord. These results demonstrate that gastrodin promotes the secretion of brain-derived neurotrophic factor, contributes to the recovery of neurological function, and protects neural cells against injury.

Effects of Jisuikang on hemorheology and inflammatory factors in rats following spinal cord injury

BACKGROUND： Trauma can damage the spinal cord or cauda equina to different degrees. Previous studies have verified that traditional Chinese medicine has effects on spinal cord injury via a variety of pathways. OBJECTIVE： To observe changes in hemorheology and inflammatory factors in spinal cord injury rats following treatment with the Chinese medicine Jisuikang, to verify the dose-dependent effect of Jisuikang, and to compare its effects with the effects of prednisone. DESIGN, TIME AND SETTING： A randomized study was performed at the Research Institute of Orthopedics, and Experimental Center of First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, China from September 2007 to March 2008. MATERIALS： Jisuikang powdered extract, composed of milkvetch root （30 g）, Chinese angelica （12 g）, red peony root （12 g）, earthworm （10 g）, szechwan lovage rhizome （10 g）, peach seed （10 g） and safflower （10 g） was provided by the Experimental Center, First Clinical Medical College, Nanjing University of Traditional Chinese medicine. Each gram of powdered extract was equivalent to 6.47 g crude drug. METHODS： A total of 72 Sprague Dawley rats were randomly assigned into 6 groups （n = 12）. Rat models of spinal cord injury were established using the occlusion method. Rats in the model group were treated with distilled water. Rats in the 25 g/kg, 12.5 g/kg, and 6.25 g/kg Jisuikang groups were given 25 g＆g, 12.5 g/kg, or 6.25 g/kg Jisuikang by gavage, for 14 days. Rats in the prednisone group received 0.06 g/kg prednisone by gavage, for 7 days. Rats in the normal group were given the same volume of distilled water. The volume of administration was 15 mL/kg. MAIN OUTCOME MEASURES： Rat serum interleukin-10, tumor necrosis factor- α （TNF-α ）, nitric oxide, nitric oxide synthase levels, malondialdehyde content, superoxide dismutase activity and whole blood viscosity were measured in each group. Spinal cord around the site of the model was collected. Half the spinal cord was used for histopathologic examination. The other half was used for measurement of nitric oxide and NOS levels, malondialdehyde contents, and superoxide dismutase activity. RESULTS： Superoxide dismutase activity was higher in the 25 g/kg Jisuikang group than in the model group Malondialdehyde contents, nitric oxide and NOS levels were lower in the 25 g/kg and 12.5 g/kg Jisuikang groups compared with the model group. Whole blood viscosity was lower in the 25 g/kg and 12.5 g/kg Jisuikang groups compared with the model group （P 〈 0.05-0.01）. Serum TNF- α content was lower in each Jisuikang group compared with the model group （P 〈 0.05-0.01）. Serum interleukin-10 levels were greater in the prednisone group and each Jisuikang group compared with the model group （P 〈 0.01）. Mild hemorrhage and necrosis in the rat spinal cord, and unclear neural cell swelling were seen in the 25 g/kg Jisuikang group： Severe hemorrhage and necrosis in the rat spinal cord, and distinct neural cell swelling were seen in the 12.5 g/kg Jisuikang group. Edema in the white matter was found in the 6.25 g/kg Jisuikang group. Pathological changes in the prednisone group were identical to the 25 g/kg and 12.5 g/kg Jisuikang groups. CONCLUSION： Jisuikang inhibits nitric oxide synthase expression, reduces nitric oxide and TNF-α levels decreases malondialdehyde content, increases interleukin-10 levels and superoxide dismutase activity, improves indices of hemorheology, and prevents secondary changes in spinal cord injury, resulting in relieving pathological changes in spinal cord tissue. The outcome was significant in the 25 g/kg Jisuikang group compared with the 12.5 g/kg Jisuikang group.

Panax notoginseng saponins improve recovery after spinal cord transection by upregulating neurotrophic factors

Saponins extracted from Panax notoginseng are neuroprotective, but the mechanisms underlying this effect remain unclear. In the present study, we established a rat model of thoracic（T10） spinal cord transection, and injected Panax notoginseng saponins（100 mg/kg） or saline 30 minutes after injury. Locomotor functions were assessed using the Basso, Beattie, and Bresnahan（BBB） scale from 1 to 30 days after injury, and immunohistochemistry was carried out in the ventral horn of the spinal cord at 1 and 7 days to determine expression of nerve growth factor（NGF） and brain-derived neurotrophic factor（BDNF）. Our results show that at 7–30 days post injury, the BBB score was higher in rats treated with Panax notoginseng saponins than in those that received saline. Furthermore, at 7 days, more NGF- and BDNF-immunoreactive neurons were observed in the ventral horn of the spinal cord of rats that had received Panax notoginseng saponins than in those that received saline. These results indicate that Panax notoginseng saponins caused an upregulation of NGF and BDNF in rats with spinal cord transection, and improved hindlimb motor function.

Extract of ginkgo biloba EGb761 inhibits cell apoptosis following spinal cord injury

The neuroprotective effects of ginkgo biloba extract have been shown in rats following spinal cord injury （SCI）. However, the precise protective mechanisms remain unclear. In the present study, low-acid water-soluble extract of ginkgo biloba EGb761 was used to treat rats with SCI. Xanthin oxidase, thiobarbituric acid, terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end labeling assay, and immunohistochemistry were utilized to detect lipid peroxidation, neural cell apoptosis, and inducible nitric oxide synthase activity in rats with SCI. Results revealed significantly increased superoxide dismutase activity, decreased malondialdehyde content, apoptotic index, and inducible nitric oxide synthase expression in SCI rats following EGb761 treatment. Therefore, EGb761 suppressed lipid peroxidation following SCI, relieved neural cell apoptosis, inhibited inducible nitric oxide synthase expression, and ultimately exerted protective effects on SCI.

基于应用型人才培养的中医外科学本科教学方法探讨

中医外科学是中医学的重要组成部分之一,具有很强的应用性、实践性。随着时代发展和社会要求,患者的医疗需求及对医疗质量的要求日渐提高。同时疾病治疗复杂化和疾病谱的改变,对广大中医药事业技术人员的专业素养提出更高的要求,培养符合中医药事业发展的应用型人才已是刻不容缓的任务。通过探讨不同的本科教学模式,突出中医外科特色教学,建立全面可行的应用型人才培养模式,培养新型应用型中医外科人才,为中医外科医疗事业提供人才保障。此文将从应用型人才培养目标、中医外科学教学现状、教学模式及考核体系等方面进行探讨,探索中医外科学本科应用型人才的培养模式,提升本科生医学知识储备、临床实践技能水平、人文素质及科研能力等综合能力,提高教学质量,培养合格人才。

脊髓损伤中西医结合康复临床实践指南

脊髓损伤(SCI)是指因脊髓损伤暂时或永久地导致脊髓功能异常的破坏性神经病理状态,可导致运动、感觉和自主神经功能障碍。基于循证医学原则制定SCI中西医结合康复临床实践指南可为临床医生提供一个全面、规范的治疗与康复框架。本指南从技术范围、规范性引用文件、术语及定义、SCI分类与临床诊断、康复评定、康复诊疗方案和常见并发症处理等方面进行规范制定,形成了科学、规范、统一的操作指南。其中康复评定主要包括感觉检查、运动检查、运动或感觉功能评级、生活质量评定、功能评定和心理功能评定(应激状态评估、认知功能评估、情绪状态评估);康复诊疗方案主要包括早期处理原则、药物治疗、物理治疗(肌力训练、平衡步态训练、有氧运动、电刺激和其他疗法)、作业治疗(关节活动度训练、日常生活活动训练、静息运动技能训练、上肢功能训练和轮椅技能训练等)、辅助器具、中药治疗[单药治疗(川芎嗪、丹参注射液、炙马钱子等)、复方治疗(丹参川芎嗪注射液、补阳还五汤、活血通督汤、二仙汤、益气活血汤和自拟汤药等)]、针灸治疗和其他治疗(新药治疗、细胞疗法、神经调节技术和脑脊接口技术);常见的并发症包括自主神经反射亢进、深静脉血栓、异位骨化、直立性低血压、压疮和尿路感染。本指南可为我国各级各类康复机构以及各级中医医院或综合医院的中医骨伤科、中西医结合骨科、针灸科、推拿科和康复医学科开展SCI临床诊断、康复评定、康复治疗和常见并发症处理提供指导,具有良好的临床适用性、安全性及有效性。

动态不确定因果图在中医诊断中的应用探讨

动态不确定因果图(DUCG)已成为中医药领域新兴的、先进的知识表示与推理模型。为更好地应用DUCG为中医临床提供诊断推理与决策支持,在归纳总结DUCG中医药领域研究与应用情况的基础上,分析现阶段DUCG在中医诊断中存在的主要问题,包括中医术语规范统一和中医药知识库质量问题、推理算法和模型建造的方法选择与设计问题、DUCG中医诊断模型的平台化和产品化问题等,并据此展开应用思路与方法探讨,提出应深挖DUCG的技术内涵,根据临床实际需求选择精准、高效的推理建模方法,建立符合中医药理论思想、具有中医特色的智能辅助诊断模型,加强DUCG协同研究平台及产品的开发应用。

中药脐疗治疗溃疡性结肠炎缓解期疗效观察

目的观察中药脐疗干预治疗溃疡性结肠炎缓解期临床效果。方法选取2021年1月至2023年3月在潍坊医学院附属高密市人民医院消化内科就诊溃疡性结肠炎缓解期患者,按照随机数表法分为治疗组、对照组,每组各35例。对照组口服美沙拉嗪肠溶片1.0 g,tid;治疗组同时给予中药脐疗“十味抗炎方”凝胶剂。采用改良Mayo评分评价溃疡性结肠炎严重程度;溃疡性结肠炎疾病活动指数评价疾病活动度;炎症性肠病生存量表评价生存质量;检查炎症因子白细胞介素-6、白细胞介素-8和肿瘤坏死因子-α;选择抑郁自评量表和焦虑自评量表评价患者心理情况。结果治疗组第5、6个月Mayo评分和疾病活动指数得分低于对照组,差异有统计学意义(P<0.05);治疗组第3、4、5、6个月炎症性肠病生存量表得分高于对照组,差异有统计学意义(P<0.05);治疗组第3、6个月炎症因子低于对照组,差异有统计学意义(P<0.05);治疗组第3、6个月抑郁和焦虑自评量表评分低于对照组,差异有统计学意义(P<0.05)。结论中药脐疗提升患者生活质量,改善预后,临床疗效优于对照组。

中西医结合康复对不完全性脊髓损伤的影响

目的探讨中西医结合康复对不完全性脊髓损伤(ISCI)患者的影响。方法选择64例不完全性脊髓损伤患者,采用随机数字表简单化分组法(余数法)分为观察组与对照组,各32例,对照组给予常规物理治疗+康复训练,观察组在对照组基础上联合针刺+中医特色功能训练。通过评估美国脊柱损伤学会运动评分(ASIA-MS)、疼痛视觉模拟评分(VAS)、日常生活能力评分(ADL)、10 m最快步行速度测试(10MWT)、6 min步行耐力测试(6MWT)、计时起立-行走测试(TUGT)、Berg平衡量表(BBS)变化情况,分析2组康复效果。结果康复治疗4周时,观察组ASIA-MS、ADL评分高于对照组(P<0.05),VAS评分低于对照组(P<0.05);治疗4周、6周、8周时,观察组10MWT均低于对照组(P<0.05),6MWT均高于对照组(P<0.05);观察组治疗8周时TUGT低于对照组(P<0.05);观察组治疗8周、12周时BBS评分高于对照组(P<0.05)。结论中西医结合康复治疗有利于不完全性脊髓损伤神经再生修复,促进患者步行能力、平衡能力提升。

Traditional Chinese Medicine comprehensive therapy for the improvement of motor function in spinal cord injury patients

OBJECTIVE: To study the effect of early comprehensive therapy of Traditional Chinese Medicine(TCM) on motor function of in patients with spinal cord injury.METHODS: Fifty-one standard spinal cord injury patients with paraplegia were randomly assigned to an experimental or control group. The experimental group received TCM comprehensive therapy, and the control group received modern Western Medicine(WM) treatment for 4 weeks. The motor score(MS), Barthel Index(BI) and American Spinal Injury Association(ASIA) grading were measured in both groups before and after treatment.RESULTS: After treatment, the MS and BI scores of the TCM comprehensive therapy group improved significantly(P < 0.01), and there was no significant difference in ASIA grading(P > 0.05). The differences between the experimental and control groups after treatment were not significant(P > 0.05).CONCLUSION: Early TCM comprehensive therapy is an effective method for improving motor function in patients with spinal cord injury.

中药单体治疗脊髓损伤后神经炎症:核转录因子κB信号通路的作用

背景:基于核转录因子κB通路探究神经炎症的靶向治疗越来越值得探究,中药靶点多、范围广、机制丰富及不良反应少等优点在治疗各类疾病时都具有十分巨大的潜力。目的:基于核转录因子κB信号通路,对近年研究中出现的山奈酚、红花黄、汉黄芩苷及雷公藤甲素等中药单体治疗脊髓损伤后神经炎症的研究进展进行系统的阐述与归纳。方法:以“脊髓损伤,炎症,抗炎,中药单体,单体化合物,NF-κB信号通路,黄酮,糖苷,酚类,酯类,生物碱”为检索词在中国知网数据库中进行检索;以“Spinal cord injury,inflammation,anti-inflammatory,traditional Chinese medicine monomer,monomeric compound,NF-κB signaling pathway,flavonoids,glycosides,phenols,esters,alkaloids”为检索词在PubMed数据库中进行检索,最终共纳入67篇文献进行综述分析。结果与结论:①核转录因子κB信号通路在神经系统中的作用复杂多样,能够调控中性粒细胞、小胶质细胞、星形胶质细胞和巨噬细胞等,介导损伤后炎症的发生与发展;②中药单体如汉黄芩苷对核转录因子κB抑制蛋白的降解、红花黄素对核转录因子κB信号通路磷酸化过程的抑制、山奈酚对核转录因子κB信号通路p65核易位的抑制等作用可以降低炎症反应对机体造成的影响,从而促进神经功能恢复;③核转录因子κB信号通路在损伤早期能够促进炎症反应和免疫细胞迁移活化,在损伤中后期能够促进损伤部位的修复和纤维化的发生等,适当的激活核转录因子κB信号通路具有促进炎症因子的释放、提高细胞的抗氧化能力及促进免疫细胞的活化等能力,但过度激活的核转录因子κB信号通路则容易导致慢性炎症的发生和持续、细胞凋亡受到抑制等;④未来的研究可以进一步探索如何准确调控核转录因子κB信号通路的活化水平、如何实现对神经系统炎症和损伤的精准干预展开,也可围绕中药单体的制备及中药单体对信号通路的作用机制展开,以期为神经系统疾病的康复和功能恢复提供更有效的治疗策略。

磁共振波谱在中医药研究中的应用进展

磁共振波谱(magnetic resonance spectroscopy,MRS)将磁共振数据应用于测定分子结构的谱学技术,为中医药领域的机制研究和发展提供了创新性的研究手段,有助于深化对中医药理论的现代化理解,推动中医药学科的持续发展。通过MRS技术可以探测脑内代谢物及体外鉴定体液或组织中存在的未知化合物,揭示中医药手段干预下的脑中枢机制。本研究聚焦于MRS技术概述、MRS技术与中医药领域结合的优势、MRS技术在中医药领域的应用研究现状等方面进行总结,并探讨MRS技术在中医药领域应用的既往研究空白与缺陷,以期为研究者提供有益参考。

落实四个回归一流本科专业建设探究

基于一流本科专业背景,国家全面实施“六卓越一拔尖”计划2.0,启动一流本科专业建设“双万计划”,各大高校开展了教育改革的探索和实践。此文以大连医科大学中西医结合学院教育教学改革研究为例,从“四个回归”着手,围绕人才培养制度、人才培养定位和目标、人才培养教学平台、教师队伍和教育保障机制5个方面构建中西医临床医学专业一流本科教育人才培养体系,推动教学管理和教学质量的提升,进一步探索如何实施一流本科教育的建设路径这一迫切问题。

中西医治疗脊髓损伤神经源性膀胱的研究进展

脊髓损伤多由外伤引起,其中并发症以神经源性膀胱多见,从而导致膀胱功能受损,并发泌尿系感染,甚至发展为尿毒症,进而危及生命。文章从中医和西医两方面切入,总结目前中西医治疗脊髓损伤后神经源性膀胱的措施,分析各自的优势和不足,为临床提供最佳的治疗方案。

基于“春夏养阳”理论指导运用脐疗法护理1例心力衰竭患者

本文总结1例基于“春夏养阳”理论指导的脐疗法在心力衰竭患者中的应用效果。基于中医辨证理论指导,运用因时施治原则,采取脐疗法隔姜灸联合穴位贴敷,配合生活指导、饮食指导、心理指导等综合干预,改善心力衰竭患者不适症状及伴随体征,提高患者的生活质量。

脊髓及神经根缺血再灌注损伤机制及中药防治作用的研究进展

脊髓缺血再灌注损伤是脊柱减压手术或胸腹主动脉手术严重并发症之一,一旦出现则会引起脊髓、神经功能障碍、下肢瘫痪等严重后果。由于其复杂的发生机制,尽管目前的治疗措施包括高压氧、脊髓缺血预处理等在内的防治手段,但仍无法从根本上阻断脊髓缺血再灌注损伤的发展。在临床上,脊柱减压术后也常出现神经根继发性损伤。通过调研大量文献,梳理并总结脊髓缺血再灌注损伤的发生发展过程中可能的生理病理机制,包括氧化应激、炎症反应、细胞凋亡及离子过载等,并类比脊髓的缺血再灌注损伤,提出了神经根缺血再灌注损伤的概念。通过梳理临床上应用的补气活血类中药,揭示中药通过多成分、多途径、多靶点发挥协同治疗作用优势及其抗氧化、抗炎、抑制细胞过度凋亡、干预钙过载等方面作用机制,以期拓展脊髓及神经根缺血再灌注损伤研究的基础机制和科学用药,为中药的临床诊疗提供全面的依据和新思路。

中药敷贴联合脐灸治疗老年性便秘的效果及对肠道菌群的影响

目的:探究中药敷贴联合脐灸治疗老年性便秘的效果及对肠道菌群的影响。方法:选取新余市中医院2021年7月—2022年10月收治的84例老年性便秘患者,随机分为两组,各42例。对照组用乳果糖治疗,观察组在此基础上行中药敷贴联合脐灸治疗。比较两组治疗效果、排便情况、肠道菌群。结果:观察组治疗总有效率较对照组高(P<0.05)。治疗14 d后,两组的每周排便次数、双歧杆菌、乳酸杆菌、粪便性状评分均较治疗前升高,且观察组均较对照组更高(P<0.05);两组大肠埃希菌较治疗前均降低,且观察组较对照组更低(P<0.05)。结论:中药敷贴联合脐灸可改善老年性便秘患者的粪便性状及肠道菌群,提高治疗效果。

藿香正气散配合脐疗治疗大肠湿热型溃疡性结肠炎临床观察

目的分析加味藿香正气散配合脐疗治疗大肠湿热型溃疡性结肠炎的临床效果。方法采用随机数字表法将莲花县人民医院于2019年1月—2021年12月收治的80例大肠湿热型溃疡性结肠炎患者分为参照组与观察组,各40例。参照组行常规西医治疗,观察组在参照组基础上行加味藿香正气散配合脐疗,对比两组炎性因子水平、中医证候积分、临床疗效、不良反应总发生率。结果治疗后,观察组腹痛、腹泻、脓血便、里急后重的中医证候积分均较参照组更低,差异均有统计学意义(P<0.05);观察组白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)水平较参照组更低,差异均有统计学意义(P<0.05);两组头晕、皮疹、肝功能异常等不良反应总发生率比较,差异无统计学意义(P>0.05);观察组治疗总有效率为92.50%(37/40),高于参照组的75.00%(30/40)(P<0.05)。结论给予大肠湿热型溃疡性结肠炎患者加味藿香正气散配合脐疗,不仅有助于缓解临床症状,还能够改善机体炎症反应,效果显著且安全可靠,值得临床推广应用。