A Meta-analysis of Dachaihu Decoction combined with western medicine in the treatment of acute pancreatitis with the TCM syndrome of liver qi depression and liver-gallbladder dampness-heat

Backgroud:To evaluate the clinical efficacy and safety of Dachaihu Decoction in the treatment of acute pancreatitis(AP)with the traditional Chinese medicine(TCM)syndrome of liver qi depression and liver-gallbladder dampness-heat.Methods:We searched randomized controlled trials of Dachaihu Decoction in the treatment of AP with the TCM syndrome of liver qi depression and liver-gallbladder dampness-heat from databases in CNKI,WanFang,VIP,Embase,PubMed,and Cochrane Library(from established to August 2019).All the retrieved documents were imported into the Noteexpress software for screening and management,and the included documents were evaluated for quality and data extracted.Statistical analysis was performed with RevMan(version 5.3).Results:A total of 132 articles were retrieved and 8 studies were included to analysis,including 679 patients.Quality evaluation of included studies suggested that the quality of the literatures is generally not high.Meta-analysis showed that the total clinical effective rate of AP was higher in the treatment group than in the control group[OR=5.00,95%CI(2.86,8.73)],and the difference was statistically significant(P<0.00001).The patient's abdominal pain relief time[MD=-0.57,95%CI(-0.86,-0.27),P=0.0002],bloating relief time[MD=-0.71,95%CI(-1.05,-0.37),P=0.04],time of serum amylase returning to normal[MD=-1.00,95%CI(-1.60,-0.40),P=0.001]and time of urinary amylase returning to normal[MD=-1.62,95%CI(-2.88,-0.37),P=0.01]all lower than the control group.But there was no statistically significant difference between the treatment group and the control group at the first defecation time[MD=-0.86,95%CI(-1.75,-0.03),P=0.06].The patient's serum TNF-a levels on the 3rd[MD=-28.53,95%CI(-49.57,-7.49),P=0.008]and 7th day[MD=-26.13,95%CI(-49.76,-2.50),P=0.03]in the treatment group were statistically lower in the treatment group than in the control group.Similarly,the patient's serum IL-6 levels on the 3rd[MD=-6.62,95%CI(-12.49,-0.75),P=0.03]and 7th day[MD=-11.98,95%CI(-22.25,-1.71),P=0.02]were also statistically lower in the treatment group than in the control group.No serious complications or adverse reactions were observed.Conclusion:Dachaihu Decoction combined with western medicine in the treatment of AP with the TCM syndrome of liver qi depression and liver-gallbladder dampness-heat can improve clinical efficacy compared with western medicine alone.In addition,the combination therapy method is safe and can be used for syndrome differentiation of AP patients in the clinic.

Dachaihu decoction ameliorates pancreatic fibrosis by inhibiting macrophage infiltration in chronic pancreatitis

AIM To explore the role of macrophages in chronic pancreatitis(CP) and the effect of Dachaihu decoction(DCHD) on pancreatic fibrosis in mice.METHODS Kun Ming mice were randomly divided into a control group, CP group, and DCHD group. In the CP and DCHD groups, mice were intraperitoneally injected with 20% L-arginine(3 g/kg twice 1 d/wk for 6 wk). Mice in the DCHD group were administered DCHD intragastrically at a dose of 14 g/kg/d 1 wk after CP induction. At 2 wk, 4 wk and 6 wk post-modeling, the morphology of the pancreas was observed using hematoxylin and eosin, and Masson staining. Interleukin-6(IL-6) serum levels were assayed using an enzyme-linked immunosorbent assay. Double immunofluorescence staining was performed to observe the co-expression of F4/80 and IL-6 in the pancreas. Inflammatory factors including monocyte chemoattractant protein-1(MCP-1), macrophage inflammatory protein-1α(MIP-1α) and IL-6 were determined using real time-polymerase chain reaction. Western blot analysis was used to detect fibronectin levels in the pancreas. RESULTS Compared with the control group, mice with 20% L-arginine-induced CP had obvious macrophage infiltration and a higher level of fibrosis. IL-6 serum concentrations were significantly increased. Double immunofluorescence staining showed that IL-6 and F4/80 were co-expressed in the pancreas. With the administration of DCHD, the infiltration of macrophages and degree of fibrosis in the pancreas were significantly attenuated; IL-6, MCP-1 and MIP-1α m RNA, and fibronectin levels were reduced. CONCLUSION The dominant role of macrophages in the development of CP was mainly related to IL-6 production. DCHD was effective in ameliorating pancreatic fibrosis by inhibiting macrophage infiltration and inflammatory factor secretion in the pancreas.

Effects of Xiangsha Liujunzi decoction drug serum on gastric antrum smooth muscle cells from rats with functional dyspepsia by regulating gastrointestinal hormones

Objective:To observe the effect and mechanism of Xiangsha Liujunzi decoction(XSLJZD)drug serum on gastric antrum smooth muscle cells(SMCs)in rats with functional dyspepsia(FD).Methods:Gastric antrum SMCs from rats with FD were isolated,cultured,and then divided into six groups as follows:control,model,domperidone,low-dose XSLJZD(LXSLJZD),medium-dose XSLJZD(MXSLJZD),and high-dose XSLJZD(HXSLJZD).Each group was administered the corresponding drug serum for intervention.Drug serum intervention conditions and proliferative activity of SMCs were tested by cholecystokinin octapeptide.Ghrelin,gastrin,somatostatin,and substance P(SP)levels were measured by ELISA.Somatostatin and SP mRNA expression was measured by real-time PCR.Results:A concentration of 10%drug serum for 24 h was decided to be the best intervention condition for later study.The mean optical density value in the model group was lower than that in the control group(P紏.001).Optical density values in the domperidone and HXSLJZD groups were higher than those in the model group(P?.025,P?.032,respectively).Gastrin,SP,and ghrelin levels in the model group were lower(P?.007,P?.037,P?.005,respectively),but somatostatin levels were higher,compared with those in the control group(P?.031).Gastrin,SP,and ghrelin levels in the domperidone,MXSLJZD,and HXSLJZD groups were higher than those in the model group(all P<.05).Somatostatin levels in the four drug-treated groups were lower than those in the model group(P?.002,P?.007,P?.001,P?.009,respectively).SP mRNA levels in the model group were lower than those in the control,domperidone,MXSLJZD,and HXSLJZD groups(P?.037 P?.016,P?.025,P?.002,respectively).Somatostatin mRNA levels in the model group were higher than those in the control and MXSLJZD groups(P紏.042,P紏.035).Conclusions:XSLJZD and domperidone drug serum effectively promote proliferative activity of gastric antrum SMCs in an FD model.The mechanism of this activity may be regulated by gastrointestinal hormones.

Effect of Dachaihu decoction on non-alcoholic fatty liver disease model rats induced by a high-fat high-sugar diet

Objective:To establish an animal model consistent with the occurrence and development of non-alcoholic fatty liver disease(NAFLD)with which to assess the effects of a classical traditional Chinese medicine formula known as Dachaihu Decoction(DD)on NAFLD.Methods:Sixty rats were randomized into four groups:control,model,pioglitazone hydrochloride(PH)and DD in equal.NAFLD was produced via administration of a high-fat high-sugar diet for 16 weeks in all but the control group.From the 13th week,a solution of PH or DD prepared with water was delivered via intragastric administration to the PH and DD groups;the remaining two groups received an equivalent volume of distilled water.Twelve hours from the last administration,we selected eight rats from each group in random.After anesthetization,the abdominal aorta blood and liver tissues were collected.The morphological changes were observed and the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),highdensity lipoprotein cholesterol(HDL-C),fasting plasma glucose(FBG),transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),toll-like receptor-4(TLR4),and nuclear factor-kappa B(NF-κB)were tested.Results:Compared with the control group,the levels of serum ALT,AST,TC,TG,LDL-C and FBG,and TGF-β1,TNF-α,TLR4,NF-κB in the model group all showed significant increases(P<.01).Compared with the model group,these same indicators in the PH and DD groups all showed remarkable decreases(P<.05).Conclusion:The efficacy of DD in NAFLD rats was shown to be effectively equivalent to that of PH,with demonstrated effects of DD that included reductions in hepatic steatosis and serum and hepatic lipid levels,and lowered blood glucose levels.We deduce that DD has an inhibitory effect on NAFLD induced by a high-fat high-sugar diet in rats.

Liujunzi decoction ameliorats cisplatin-induced anorexia via adjusting metabolic disorders in rats

OBJECTIVE Cisplatin is a formidable chemotherapy agent widely applying in antineoplastic treatments,but its side effects often limit the clinical usage.Metabolic disorders are one of the side effects induced by cisplatin,which closely relate to the onset of chemotherapy-induced anorexia(CIA)in cancer patients but lacks effective controls.Liujunzi decoction(LJZD)is a traditional Chinese formula that has a promising effect in treating CIA.However,whether LJZD ameliorates CIA through adjusting cisplatin-induced metabolic disorders remain unknow.The present study evaluated the mechanism of cisplatin-induced metabolic disorders,and the effect of LJZD in ameliorating these disturbances.METHODS 42 male Sprague-Dawley(SD)rats(180-220 g)were randomly divided into 3 groups:normal control group(distilled water+saline),model group(distilled water+cisplatin),LJZD group(4.8 g·kg^(-1)Liujunzi decoction ingredients+cisplatin).Intragastrical administered each drug twice a day(7∶00-19∶00)since day 0 for 4 d,animals were intraperitoneal injected with cisplatin 6 mg·kg^(-1)1 h after administration while normal control groups were injected with same volume of saline.On day 3,each group was anesthetized with pentobarbital sodium 45 mg·kg^(-1)(ip),and blood samples were collected from aorta abdominalis.Then the samples were analyzed using an LC-ESI-MS/MS system.Significantly regulated metabolites between groups were determined by VIP≥1 and absolute Log2FC(fold change)≥1.Identified metabolites were mapped to Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway database using Metaboanalyst 5.0(https://www.metaboanalyst.ca/).RESULTS A total of 133,77 and 32 differential metabolites were filtrated in control vs model,control vs LJZD and model vs LJZD groups respectively.Comparing to control,the levels of hexadecanoic acid(Log2FC=6.3153),linoleic acid(Log2FC=5.3478),and 8,11-icosadienoic acid(Log2FC=5.2342)significantly increased,and the levels of N-acetyl-L-tyrosine(Log2FC=-2.6283),cinnamic acid(Log2FC=-2.3381),N-acetylphenylalanine(Log2FC=-2.2501)significantly decreased in model group.The KEGG pathway enrichments of these metabolites indicated that,cisplatin-induced metabolic disorders by disturbing metabolism pathways such as linoleic acid metabolism,biosynthesis of unsaturated fatty acids,and phenylalanine metabolism,which suggested that the onset of CIA was partly associated with the metabolic disorders of linoleic acid,unsaturated fatty acids,and phenylalanine.Compared to control,treatment of LJZD significantly increased the levels of 4-hydroxytryptamine(Log2FC=12.0186),hexadecanoic acid(Log2FC=5.7412),linoleic acid(Log2FC=5.1877)and significantly decreased the levels of N-acetylmethionine(Log2FC=-1.7317),2-aminoethanesulfinic acid(Log2FC=-1.6578),N-acetyl-L-tyrosine(Log2FC=-1.5355).And comparing to the model group,4-hydroxytryptamine(Log2FC=12.0186),7,12-diketocholic acid(Log2FC=2.0998),N-acetylneuraminic acid(Log2FC=2.0560)markedly increased,and 3-hydroxy-3-methylpentane-1(Log2FC=-1.9202),5-dioic acid(Log2FC=-1.7166),N-isovaleroylglycine,hexanoyl glycine(Log2FC=-1.4958)markedly decreased in LJZD group.It was worth noting that,there were 23 differential metabolites filtrated both in control vs model and model vs LJZD groups,which were the key metabolites of LJZD in treating CIA.Among these 23 common metabolites,there were 16 metabolites excluding the control vs LJZD group,that was,LJZD had no effect in normal rats while being able to ameliorated cisplatin-induced metabolic disorders by regulating these 16 metabolites.Cisplatin-induced downregulation of 11 metabolites such as hydrocinnamic acid,(±)12(13)epoxy-9Z-octadecenoic acid,cinnamic acid were upregulated after LJZD treatment,and cisplatin-induced upregulation of imidazoleacetic acid,2′-deoxycytidine-5′-monophosphate and other 5 metabolites were downregulated by LJZD.The KEGG pathway analysis indicated that the linoleic acid metabolism,histidine metabolism,and pyrimidine metabolism were the most enriched metabolic pathway.Thus,cisplatin-induced metabolic disturbances mainly by disturbing linoleic acid metabolism,histidine metabolism,and pyrimidine metabolism,and LJZD interacted with these metabolic pathways to reduce metabolic disorders and thus ameliorated CIA.CONCLUSION Cisplatin-induced anorexia was closely related to the metabolic disorders of linoleic acid metabolism,biosynthesis of unsaturated fatty acids,and phenylalanine metabolism.The mechanism of LJZD in ameliorating CIA was in concerned with the metabolic adjustments,relating to the regulation of linoleic acid metabolism,histidine metabolism,and pyrimidine metabolism.

Clinical Practice Examples of Dachaihu Decoction

This paper mainly describes the experiences of clinical application of Dachaihu Decoction in treating chronic pelvic infection, coronary heart disease, insomnia, and hepatolithiasis.

Dachaihu decoction inhibits hypernutrition-induced liver metastasis from colorectal cancer by maintaining the gut vascular barrier

Background:Colorectal cancer(CRC)is the third most common malignancy and the second deadliest cancer worldwide.Metastasis to the liver,the most common metastatic site in CRC,is the leading cause of death in patients with CRC.Hyperlipidemia,which is common in patients with CRC,promotes CRC progression and metastasis.Hyperlipidemia is commonly observed in obese patients and is often induced by hypernutrition.The underlying mechanism of hypernutrition-induced hyperlipidemia in promoting CRC liver metastasis remains unclear,and there is an unmet need for effective and low-cost treatments for patients with CRC.Methods:A mouse cecum orthotopic CRC model combined with high-fat diet(HFD)feeding,was established to mimic liver metastasis in CRC in obese patients.The effects of Dachaihu decoction(DCHD),a traditional herbal medicine used to treat inflammation and nonalcoholic fatty liver disease,and of the conventional prescription medicine obeticholic acid(OCA)were evaluated.HFD-induced obesity,hyperlipidemia,and CRC liver metastasis were assessed,along with the histology and pathology of the liver and intestine and the expression of metabolic genes in these tissues.The effects of DCHD and OCA on HFD-induced outcomes were evaluated,and human umbilical vein endothelial cells(HUVECs)treated with bile acids(BAs)and DCHD were used to study the underlying mechanisms in vitro.Results:HFD-mediated obesity and hyperlipidemia promoted CRC metastasis,accompanied by disruption of the gut vascular barrier(GVB)and altered bile acid(BA)metabolism.DCHD decreased HFD-induced hyperlipidemia and liver metastasis in CRC,improving overall survival.Those effects of DCHD were equivalent to or better than those of OCA.DCHD regulated the expression of genes of BA metabolism and tight junctions(TJ)to prevent HFDinduced disruption of the GVB.In HUVECs,DCHD prevented the increases in intracellular Ca2t and accumulation of reactive oxygen species induced by primary conjugated BAs,assisting in the maintenance of redox homeostasis and preventing the downregulation of TJ proteins,thereby maintaining the integrity of the endothelial barrier.Conclusions:The data provide a link between hypernutrition and GVB disruption,which contributes to high liver metastasis in patients with CRC.DCHD may represent a novel therapy in CRC,and targeting abnormal lipid metabolism could be a promising therapeutic strategy for avoiding hypernutrition-associated CRC metastasis.

基于细胞铜死亡分析香砂六君子汤减少脾虚高脂血症大鼠肝脏组织脂质沉积的作用机制

目的从细胞铜死亡的角度分析中药香砂六君子汤减少脾虚高脂血症大鼠肝脏组织脂质沉积的作用机制。方法将18只健康SD大鼠随机均分为正常组、脾虚高脂血症组、中药组。脾虚高脂血症组和中药组采用游泳力竭和高脂饲料喂养的复合方法造模,正常组仅给予普通饲料。造模12周后,中药组进行香砂六君子汤(11.34 g·kg-1)灌胃干预,正常组与脾虚高脂血症组给予同体积0.9%氯化钠溶液灌胃,灌胃干预4周后检测各组大鼠血脂指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、肝脏脂积变化;PCR Array技术检测与铜死亡相关基因的表达。结果与正常组比较,脾虚高脂血症组血清中TC、TG、LDL-C水平显著升高(P<0.01),HDL-C水平显著降低(P<0.01);脾虚高脂血症组大鼠肝脏脂质沉积明显。与脾虚高脂血症组比较,中药组TC、TG、LDL-C水平显著降低(P<0.01),HDL-C水平显著升高(P<0.01);中药组大鼠肝脏脂质沉积明显减少。PCR Array共检测出11个铜死亡相关基因。与正常组比较,脾虚高脂血症组肝脏铜死亡差异表达基因7个;与脾虚高脂血症组比较,中药组肝脏铜死亡差异表达基因6个;脾虚高脂血症组与中药组铜死亡共同差异表达基因5个。脾虚高脂血症组与正常组、中药组与脾虚高脂血症组差异表达均发生上调≥1倍或下调≤1倍的基因3个,2种比较方法结果取交集,共同的差异表达基因为Dld和Gls,这2个基因均能够调控线粒体铜死亡水平。qPCR验证结果显示,Dld基因表达与PCR芯片结果一致。结论肝脏铜死亡相关基因(Dld、Gls)表达异常可能是血脂代谢异常的潜在机制,也可能是香砂六君子汤防治脾虚高脂血症的重要作用靶标。

六君子汤中理气药陈皮挥发性成分与胃肠动力调节关联性研究

目的从胃动力调节角度分析理气药陈皮挥发性成分在补气方剂六君子汤中的理气作用,比较不同陈化年份的陈皮挥发性成分对脾虚大鼠胃排空和小肠推进的影响,进而挖掘六君子汤中理气药陈皮挥发性成分与调节脾虚大鼠胃肠动力的关联性成分。方法采用GC构建15批不同陈化年份的陈皮药材挥发油类成分的指纹图谱,以胃排空和小肠推进为指标评价陈皮挥发性成分改善胃肠动力作用,采用偏最小二乘回归分析以及灰度分析法分析指纹图谱与调节脾虚大鼠胃肠动力相关性。结果陈皮挥发油成分均可促进胃排空及小肠推进,其在六君子汤中的增益作用强度以5、10年最佳。在15批不同陈化年份的陈皮药材挥发油类成分的GC图谱中,峰3、峰4、峰9为发挥胃肠道调节作用的可能药效成分。结论六君子汤中理气药陈皮挥发性成分通过增益脾虚大鼠胃动力达到理气补气之效,此增益作用为多种有效成分共同起效的结果。该研究初步揭示了六君子汤中理气药陈皮挥发性成分的理气作用与脾虚胃动力调节的关联性,为探索补气方剂六君子汤中陈皮理气作用的物质基础提供一种新思路。

浅析大柴胡汤在肝癌经动脉化疗栓塞术后并发栓塞综合征中的应用

经动脉化疗栓塞术是目前被公认为非手术治疗肝癌最常用的方法之一,栓塞综合征是原发性肝癌经动脉化疗栓塞术后的常见并发症,主要表现为术后发热、肝区疼痛、恶心呕吐、便秘、肝功能损害等。目前西医尚无特效的治疗方法,多以对症支持治疗为主。天津中医药大学第一附属医院方文岩教授临证三十余年,尤擅中西医结合治疗晚期恶性肿瘤及其并发症,对于肝癌的介入治疗及经动脉化疗栓塞术后并发栓塞综合征的临床处理颇有经验,深受患者好评。对肝癌患者的经动脉化疗栓塞术后并发栓塞综合征进行治疗,因患者体质不同,证型不一,当遵“知犯何逆,随证治之”之原则,灵活辨证处方。方教授认为肝癌的发生是以肝郁气滞为核心的长期缓慢病理改变的最终结果,认为肝瘀气滞、湿热内阻证是肝癌患者经动脉化疗栓塞术后并发栓塞综合征较为常见的证型之一。大柴胡汤出自《伤寒论》,有和解少阳、内泻热结之功,气血同治之妙。方教授认为肝癌以肝郁气滞为发病基础,患者常伴肝络瘀阻和神不内守的临床表现,病性总属本虚标实,运用大柴胡汤化裁治疗肝癌经动脉化疗栓塞术后并发肝瘀气滞、湿热内阻型的栓塞综合征效果显著。兹就方师临床应用思想试作浅析,并附验案一则,以期为经方在治疗恶性肿瘤方面的应用提供理论参考。

Mechanism underlying the effect of Liujunzi decoction(六君子汤)on advanced-stage non-small cell lung cancer in patients after first-line chemotherapy

OBJECTIVE:To further clarify the anticancer mechanisms of Liujunzi decoction(六君子汤)and provide possible targets for the treatment of advanced-stage nonsmall cell lung cancer(NSCLC)by re-analyzing differential gene expression profile of peripheral blood mononuclear cells(PBMCs)from Liujunzi decoctiontreated NSCLC patients receiving first-line chemotherapy.METHODS:The PBMC gene expression microarray data set GSE61926 was retrieved from a high throughput gene expression database.Differentially expressed genes(DEGs)were screened by paired sample t-test and the multiple ratio method.Gene ontology and Kyoto encyclopedia of genes and genomes(KEGG)pathway analyses were performed using the DAVID database.The protein–protein interaction(PPI)network was constructed using interaction gene library retrieval tools and Cytoscape software.RESULTS:A total of 162 DEGs were identified,with 67 upregulated genes and 95 downregulated genes.The functional distribution of Gene Oncology(GO)genes showed that DEGs were mostly concentrated in extracellular regions,calcium ion binding,and transcriptase activity.KEGG pathway analysis showed that cytokine–cytokine receptor interactions were significantly enriched.PPI network analysis screened out the top 10 central protein-coding genes with the highest nodal degree:IL2,PIWIL4,DICER1,PIWIL2,SAA1,XCL1,IL22RA1,ARHGAP11A,DCP1A,and GDNF.Among them,the central protein-coding gene with the highest node degree was IL2.In addition,the central protein-coding genes with high node degrees and high molecular complex detection(MCODE)scores were PIWIL4,DICER1,PIWIL2,and DCP1A,all of which are related to tumor development.CONCLUSIONS:One signaling pathway and 10 central protein-coding genes related to anticancer mechanisms were screened by re-analysis of GSE61926 data.IL2,PIWIL4,DICER1,PIWIL2,and DCP1 A may have important roles in the mechanism of Liujunzi decoction treatment against NSCLC.Our results suggest that the anticancer mechanism of Liujunzi decoction may be related to gene silencing by RNA and the biological processes of piwi-interacting RNA and other small RNAs.

大柴胡汤加减联合复方嗜酸乳杆菌片治疗功能性便秘患者临床疗效观察

目的探讨大柴胡汤加减联合复方嗜酸乳杆菌片治疗功能性便秘(FC)患者的临床疗效。方法根据随机数字表法将河南中医药大学第三附属医院2020年5月—2022年4月门诊治疗的70例FC患者随机分为两组,对照组(35例)服用复方嗜酸乳杆菌片治疗,治疗组联合大柴胡汤加减治疗。对比两组临床疗效、临床症状和便秘评分、胃肠道生活质量指数(GIQLI)、胃肠激素[P物质(SP)、胃动素(MTL)、胃泌素(GAS)]水平及不良反应。结果治疗组临床有效率(97.14%)高于对照组(80.00%)(P<0.05)。与治疗前相比,治疗后两组临床症状评分和便秘评分降低,胃肠激素水平和生活质量评分升高(P<0.05);与对照组相比,治疗组上述指标均优于对照组(P<0.05)。对照组与治疗组不良反应发生率(8.57%vs 5.71%)无统计学差异(P>0.05)。结论大柴胡汤加减联合复方嗜酸乳杆菌片治疗FC安全有效,且可减轻患者便秘症状,调节胃肠激素水平,提高生活质量。

基于数据挖掘探讨杨小军教授治疗功能性消化不良用药规律

目的探讨杨小军教授治疗功能性消化不良的用药规律,为临床用药提供参考和借鉴。方法收集杨小军教授治疗功能性消化不良的门诊病历,通过建立数据库进行数据挖掘。结果高频药物有陈皮、白术、半夏、茯苓、砂仁、太子参、柴胡、木香、枳壳、香附、白芍、鸡内金、川芎等。药味以甘、苦、辛为主,药性以温、寒、平为主,涉及药物主要归于脾、胃、肝、肺经。药物功效分类主要归为理气药和补虚药两大类。核心处方由香砂六君子汤合柴胡疏肝散加减组成。结论杨小军教授治疗功能性消化不良以辛开苦降、寒温并用、多脏同调、燮理气机、健脾和胃、疏肝解郁为特点。

脐灸联合香砂六君子汤对腰椎间盘突出症术后患者的影响

目的探讨脐灸联合香砂六君子汤对腰椎间盘突出症全麻术后的影响。方法本研究纳入2022年2月至2023年1月在河南中医药大学第一附属医院接受治疗的66例腰椎间盘突出症全麻术后患者,随机分为对照组和研究组,各33例。给予对照组术后常规治疗,给予研究组脐灸联合香砂六君子汤治疗,比较两组胃肠功能恢复时间,治疗前及治疗1、2、3 d的血清胃泌素(GAS),术后1、2周及2、6个月的视觉模拟评分(VAS)和日本骨科学会评分系统(JOA)评分。结果研究组肠鸣音恢复、排气及排便时间短于对照组(P<0.05)。治疗1、2、3 d血清GAS与治疗前比较均升高(P<0.05),且研究组高于对照组(P<0.05)。术后2周及2、6个月,研究组VAS评分低于对照组,JOA评分高于对照组(P<0.05)。结论脐灸联合香砂六君子汤治疗腰椎间盘突出症全麻患者,可快速恢复患者的胃肠功能,提升血清GAS水平,减轻患者疼痛,促进腰椎功能恢复。

归芍六君子汤联合中药漱口治疗耐药Hp相关性胃炎的疗效观察

目的探讨归芍六君子汤联合中药漱口治疗耐药幽门螺杆菌(helicobacter pylori,Hp)相关性胃炎的临床疗效和对Hp转阴率的影响。方法选择80例门诊治疗的脾胃虚弱证型Hp相关性胃炎患者,采用随机数字表法分为对照组(标准四联疗法)和治疗组(标准四联疗法联合归芍六君子汤和中药漱口)各40例。观察治疗前后两组的临床疗效、中医症状积分和Hp转阴率。结果治疗组总有效率(95%)高于对照组(72.5%)(P<0.05);治疗组Hp转阴率(90%)高于对照组(72.5%)(P<0.05);治疗后,两组主要症状积分和总积分较治疗前降低,且治疗组低于对照组(P<0.05)。结论归芍六君子汤联合中药漱口治疗Hp相关性胃炎,较单纯西药治疗可显著提高临床疗效和Hp转阴率。

大柴胡汤含药血清通过JAK2/STAT3信号通路抑制AR42J细胞炎症反应

目的探讨大柴胡汤含药血清对胰腺腺泡细胞炎症反应的防治作用及可能机制。方法HPLC法检测大柴胡汤中指标成分含量;采用雨蛙肽处理AR42J细胞复制急性腺泡细胞炎症模型,采用CCK-8方法检测大柴胡汤含药血清对细胞活力的影响;Western blot方法检测细胞内JAK2、STAT3及NFκB磷酸化程度;ELISA法检测IL-6和TNF-α含量。结果大柴胡汤中黄芩苷和芍药苷含量分别为13.02 mg/mL、7.19 mg/mL,大柴胡汤含药血清用量不超过20%;大柴胡汤含药血清降低炎性细胞上清液中TNF-α和IL-6含量,降低细胞内JAK2、STAT3及NFκB磷酸化作用,减轻细胞炎症反应;STAT3抑制剂cucurbitacin可减弱大柴胡汤的炎症抑制作用。结论大柴胡汤含药血清可减轻腺泡细胞急性炎症作用,其机制可能为抑制细胞内JAK2/STAT3信号通路进而降低NFκB活性,减少促炎性细胞因子合成。

中西医结合治疗儿童大叶性肺炎的临床研究

目的探讨中西医结合治疗儿童大叶性肺炎的临床效果。方法选取2021年6月至2023年7月宝鸡市妇幼保健院儿科收治的6~14岁大叶性肺炎患儿100例作为研究对象,采用随机数字表法将患儿分为对照组(50例)和治疗组(50例)。对照组男27例,女23例;年龄(9.03±1.42)岁;病程(8.75±1.76)d。治疗组男25例,女25例;年龄(9.28±1.69)岁;病程(8.46±1.63)d。对照组采用常规西医治疗,治疗组在对照组基础上采用口服麦门冬汤合六君子汤配合中医治疗。两组均治疗4周。比较两组临床疗效、症状消失时间(咳嗽持续时间、退热时间、肺部X线片影像好转时间)、实验室指标[白细胞总数(WBC)、C反应蛋白(CRP)、血沉(ESR)、降钙素原(PCT)和D-二聚体(D-dimer)]和肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、呼气峰值流量(PEF),用力呼出肺活量25%、50%、75%的瞬间流量(FEF25%、FEF50%、FEF75%),最大呼气中期流量(MMEF)]。采用独立样本t检验和χ^(2)检验。结果治疗组患儿治疗总有效率[96.00%(48/50)]高于对照组[84.00%(42/50)],差异有统计学意义(P<0.05)。治疗组患儿咳嗽持续时间[(7.13±1.55)d]、退热时间[(2.44±1.04)d]及肺部X线片影像好转时间[(12.34±1.83)d]均短于对照组[(10.73±1.79)d、(4.39±1.35)d、(16.68±2.46)d],差异均有统计学意义(均P<0.05)。治疗后,治疗组CRP[(8.79±3.75)mg/L]、ESR[(16.48±3.58)mm/h]、PCT[(0.48±0.27)μg/L]、D-dimer[(575.64±106.89)μg/L]水平均低于对照组[(11.37±4.97)mg/L、(19.16±3.86)mm/h、(0.69±0.23)μg/L、(798.46±113.78)μg/L],差异均有统计学意义(均P<0.05);治疗组FVC、FEV1、PEF、FEF 25%、FEF 50%、FEF 75%、MMEF均高于对照组(均P<0.05)。结论中西医结合治疗大叶性肺炎可显著提高患儿治疗总有效率,改善症状和肺功能,恢复生理指标。此方案有望为儿童大叶性肺炎的治疗提供新思路,值得在临床上推广应用。

加味香砂六君子汤对进展期结直肠癌化疗患者炎症反应的影响

目的:观察加味香砂六君子汤对进展期结直肠癌化疗患者炎症反应的影响。方法:选取进展期结直肠癌患者114例,采用简单随机法分为对照组57例和观察组57例。对照组按照NCCN指南给予对应的化疗方案治疗,观察组在化疗方案基础上给予加味香砂六君子汤治疗,均治疗3个周期。比较两组治疗前后Piper疲乏量表(RPFS)评分、卡氏(KPS)评分、中医证候评分和炎性因子水平差异,统计两组疗效和安全性。结果:治疗前两组RPFS评分、KPS评分、中医证候评分、炎性因子水平均无统计学差异(P>0.05)。治疗后,两组RPFS评分、中医证候评分下降,KPS评分升高,观察组RPFS评分、中医证候评分较对照组下降更明显,KPS评分较对照组升高更明显(P<0.05)。治疗后,观察组肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)、白细胞介素-10(IL-10)下降,白细胞介素-4(IL-4)升高(P<0.05)。对照组治疗前后炎性因子水平差异无统计学意义(P>0.05)。观察组总有效率高于对照组(P<0.05)。观察组不良反应总发生率明显低于对照组(P<0.05)。结论:加味香砂六君子汤可调节进展期结直肠癌化疗患者炎性因子水平,提高疗效。

基于微生物组和宿主转录组整合分析香砂六君子汤对ETEC诱导断奶腹泻仔猪回肠损伤的调控机制

本研究旨在探讨香砂六君子汤对产肠毒素大肠杆菌(entexotoxigenic Escherichia coli,ETEC)诱导的断奶仔猪腹泻的干预作用及其机制。将24头21日龄断奶仔猪随机分为空白组(CON)、模型组(MOD)和香砂六君子汤组(XS),连续14 d给XS组灌服香砂六君子汤(1 mL·kg^(-1),1 g·mL^(-1)),其余组灌服等量无菌水,第15天给MOD组、XS组仔猪按1 mL·kg^(-1)连续3 d灌服1011 CFU·mL^(-1) ETEC菌液,XS组继续灌服香砂六君子汤。分别记录各组仔猪腹泻评分,HE法检测回肠组织病理学变化,实时荧光定量PCR检测回肠组织IL-1β、IL-6、IL-8 mRNA水平,转录组学分析回肠组织RNA差异表达情况,微生物宏基因组学分析回肠菌群变化情况,Western blot检测回肠组织p-p38/p38、p-ERK/ERK、p-JNK/JNK蛋白水平。结果表明,灌服ETEC后,MOD组腹泻评分极显著高于CON组(P<0.01),回肠组织结构破坏,V/C值极显著下降(P<0.01),且IL-1β、IL-6和IL-8 mRNA表达量极显著升高(P<0.01),肠道菌群门水平上变形菌门极显著上调(P<0.01),厚壁菌门极显著下调(P<0.01),属水平上乳酸菌属下调,志贺菌属上调,回肠组织p-p38/p38和p-JNK/JNK比值显著或极显著升高(P<0.05或P<0.01)。与MOD组相比,XS组腹泻评分极显著下降(P<0.01),回肠组织结构完整,V/C值极显著升高(P<0.01),回肠组织IL-1β、IL-6和IL-8 mRNA表达量显著或极显著降低(P<0.05或P<0.01),肠道菌群门水平上变形菌门极显著下调(P<0.01),厚壁菌门极显著上调(P<0.01),属水平上乳酸菌属上调,志贺菌属下调,回肠组织p-p38/p38和p-ERK/ERK比值极显著降低(P<0.01)。肠道组织基因转录组学筛选出与炎症免疫相关的差异显著的10个基因,分别为TNFAIP8L2、TRIM67、CXCL2、EGF、NOX1、CCL28、FABP2、FABP6、IL1RAP和CEBPB。微生物组学筛选出各组可能的标志物种分别为CON组的Lactobacillaceae,MOD组的Shigella,XS组的Deinococcus和Eubacterium。综上所述,香砂六君子汤可有效缓解ETEC诱导的断奶仔猪腹泻,提高肠道菌群中有益菌的丰度,逆转ETEC诱发的菌群结构的改变,并可通过抑制MAPK信号通路的激活,从而缓解ETEC诱导的肠道炎性损伤。

宋银枝基于木郁土壅辨治更年期高血压的思路探讨

肝木与脾土互资互用,肝主疏泄、脾主运化协同配合是人体维持生命和机能的枢纽。若肝脾功能失调,肝失疏泄,脾失健运,出现木郁土壅的病理状态,则可影响肠道菌群的稳定性及神经系统的功能,出现脑-肠轴机制异常,从而导致更年期高血压的发生与发展。宋银枝教授基于多年临证体会,提出木郁土壅可致更年期高血压,并结合现代研究分析其病理机制,探讨采用疏肝运脾法防治更年期高血压的思路。疏肝运脾之具体措施包括“健运脾土,祛痰化浊”“疏肝解郁,补益气血”“未病先防,调摄心神”,方药可选六君子汤、半夏白术天麻汤、逍遥散等。通过疏肝运脾,可使肝气调达,情志舒畅;脾肠健运,肠道菌群保持稳态平衡,膏脂代谢正常,使血压波动在正常范围。治疗更年期高血压可从肝脾入手,疏肝运脾是调治更年期高血压的切入点和关键所在。