Efficacy and Safety of Jianpi Jieyu Decoction for Patients with Mild-to-Moderate Depression of Xin(Heart)-Pi(Spleen)Deficiency Syndrome:A Multi-centre Randomized Controlled Study

Objective:To evaluate the efficacy and safety of Jianpi Jieyu Decoction(JJD)for treating patients with mild-to-moderate depression of Xin(Heart)-Pi(Spleen)deficiency(XPD)syndrome.Methods:In this multi-center,randomized,controlled study,140 patients with mild-to-moderate depression of XPD syndrome were included from Xiyuan Hospital of China Academy of Chinese Medical Sciences and Botou Hospital of Traditional Chinese Medicine from December 2017 to December 2019.They were randomly divided into JJD group and paroxetine group by using a random number table,with 70 cases in each group.The patients in the JJD group were given JJD one dose per day(twice daily at morning and evening,100 m L each time),and the patients in the paroxetine group were given paroxetine(10 mg/d in week 1;20 mg/d in weeks 2-6),both orally administration for a total of 6 weeks.The primary outcome was the change of 17-item Hamilton Depression Rating Scale(HAMD-17)score at week 6 from baseline.The secondary outcomes included the Hamilton Anxiety Scale(HAMA)score,Traditional Chinese Medicine Symptom Scale(TCMSS),and Clinlcal Global Impression(CGI)scores at the 2nd,4th,and 6th weekends of treatment,HAMD-17 response(defined as a reduction in score of>50%)and HAMD-17 remission(defined as a score of 7)at the end of the 6th week of treatment.Adverse events(AEs)were also recorded.Results:From baseline to week 6,the HAMD-17 scores decreased 10.2±4.0 and 9.1±4.9 points in the JJD and paroxetine groups,respectively(P=0.689).The HAMD-17 response occurred in 60%of patients in the JJD group and in 50%of those in the paroxetine group(P=0.292);HAMD-17 remission occurred in 45.7%and 30%of patients,respectively(P=0.128).The differences of CGI scores at the 6th week were not statistically significant(P>0.05).There were significant differences in HAMD-17 scores between the two groups at 2nd and 4th week(P=0.001 and P=0.014).The HAMA scores declined 8.1±3.0 and 6.9±4.3 points from baseline to week 6 in the JJD and paroxetine groups,respectively(P=0.905 between groups).At 4th week of treatment,there was a significant difference in HAMA between the two groups(P=0.037).TCMSS decreased 11.4±5.1,and 10.1±6.8 points in the JJD and paroxetine groups,respectively(P=0.080 between groups).At the 6th week,the incidence of AEs in the JJD group was significantly lower than that in the paroxetine group(7.14%vs.22.86%,P<0.05).Conclusion:Compared with paroxetine,JJD was associated with a significantly lower incidence of AEs in patients with mild-tomoderate depression of XPD syndrome,with no difference in efficacy at 6 weeks.(Trial registration No.Chi CTR2000040922).

基于关联规则挖掘仝小林院士《脾瘅新论》用药规律

目的采用医案数据挖掘的方法对《脾瘅新论》中脾瘅虚损阶段医案的基本特征、用药特色、组方规律、药症关系等进行分析。方法收集《脾瘅新论——代谢综合征的中医认识及治疗》2004年1月—2016年12月脾瘅虚损阶段病例,采集医案中患者基本信息、临床症状体征、实验室检查、中西医诊断、治法、方药等。采用Epidata 3.1数据管理软件建立医案数据库,采用SPSS Modeler 14.2统计软件中提供的Apriori算法对药物与药物、药物与症状、药物与西医指标进行关联规则分析。结果(1)共纳入医案51个,所涉证型17种,频次≥3的前三位有痰瘀互结、胸阳痹阻,脾气虚弱、瘀血阻络,脾虚内热、经络湿寒;治法14种,频次≥3的前三位有通阳泄浊、豁痰宣痹,健脾益气、化痰通络,温阳益气、散寒通痹;处方15首,频次≥3的前三位有黄芪桂枝五物汤、瓜蒌薤白半夏汤、干姜黄芩黄连人参汤;共用药物83味,药物总频数476次,频次≥15的有黄连、黄芪、酒大黄、鸡血藤、生姜、黄芩、桂枝。(2)药物-药物关联规则按支持度≥15%,置信度=100%,分析出二阶关联规则7条,三阶关联规则7条,四阶关联规则6条,其中各关联规则排名第一的分别是:“黄芩→黄连”“干姜+黄芩→黄连”“白芍+桂枝+鸡血藤→黄芪”;药物-症状关联规则按支持度≥5%,置信度=100%,分析出二阶关联规则8条,三阶关联规则31条,四阶关联规则30条,其中各关联规则排名第一的是:“黄芪→肢体水肿”“桂枝+鸡血藤→肢体麻木疼痛”和“桂枝+鸡血藤+黄芪→肢体麻木疼痛”;药物-西医指标二阶关联规则按支持度≥5%,置信度=100%,分析出二阶关联规则5条,三阶关联规则16条,四阶关联规则16条,其中各关联规则排名第一的分别是:“秦皮→尿酸”“黄连+干姜→糖化血红蛋白”和“黄连+干姜+黄芩→糖化血红蛋白”。结论通过关联规则分析方法客观量化地展示了仝小林院士治疗脾瘅病虚损阶段医案的药物-药物、药物-症状和药物-理化指标的组合规律,脾瘅虚损阶段使用“态靶”辨证方法,药物组合以“小方”为特色,用药针对患者症状体征(“症靶”)及西医指标(“标靶”)。该研究可为进一步研究仝小林院士的学术思想和用药经验提供参考。

归脾丸联合温针灸治疗心脾两虚型慢性疲劳综合征的疗效

目的探讨归脾丸联合温针灸治疗心脾两虚型慢性疲劳综合征的疗效。方法选取2017年5月至2019年3月云南中医药大学第三附属医院收治的114例心脾两虚型慢性疲劳综合征患者,按数字奇偶法分为治疗组和常规组,每组57例。治疗组患者采用归脾丸联合温针灸进行治疗;常规组患者采用归脾丸治疗。比较两组患者的临床疗效、生活质量量表评分及疲劳量表评分。结果治疗组患者总有效率显著高于常规组(98.25%vs.82.46%,P<0.05),差异有统计学意义。治疗前,两组患者生活质量评分、疲劳量表积分比较,差异无统计学意义(P>0.05);治疗后,治疗组患者生活质量评分高于常规组,疲劳量表积分低于常规组,差异均有统计学意义(P<0.05)。结论温针灸联合归脾丸治疗,可明显提升心脾两虚型慢性疲劳综合征患者的治疗效果,以及患者生活质量。

阴阳五行圆运动与脾瘅辨治辑要

脾瘅源于《黄帝内经·素问》"有病口甘者,此五气之溢也,名曰脾瘅"。"圆运动"在河图中已有体现,与五行是融合的,不能分开;五行为病,皆病其不圆。阴阳二气,阳升阴降相互融合,并非单纯五行顺生平面图形,乃以"中土"为轴,四维之东方木气、南方火气、西方金气、北方水气为轮,螺旋上升,螺旋下降,河图乃一立体圆运动图。阴阳乃天地万物生长变化原始物质,圆运动与阴阳息息相关;脾土五行居中央,为上下气机升降之枢。故可从阴阳五行圆运动辨治脾瘅。脾瘅系嗜食肥甘厚味之果,亦为"消渴"之因。脾虚伏热乃脾瘅关键病机,亦为治疗根本。脾瘅之病,皆为病其不圆,阴阳失其平秘,治疗目的当为使运动复圆,阴平阳秘。脾虚伏热法当补脾胃之气,兼清伏热。脾虚肺消法当补脾肺之气,培土以生金。心脾两虚,阴火内盛,法当升浮阳气东垣补脾胃泻阴火升阳汤。脾瘅-脾胃自病-脾虚伏热;脾瘅-心脾同病子病及母-心脾两虚,阴火内盛;脾瘅-肝脾同病木郁克土-肝郁脾虚,湿热中阻;脾瘅-脾肾同病土虚水侮-脾肾阴虚。肝郁脾虚,湿热中阻,法当疏肝解郁,清热祛湿逍遥散加栀子、黄芩。脾肾阴虚,法当补脾肾之阴兼清伏热,肾气丸类方。阴阳五行圆运动理论与脾瘅发生、发展、病因病机及辨证分型诊治关联紧密。寻求脾瘅证型共性和根源,拿捏升降补泄,使疾病向愈。黄元御《四圣心源》理论看似简单,实则深奥,更需深入探究。更应具前瞻意识,运用治未病理念,引导患者养成健康生活习惯,现代医疗技术结合中医,更准确辨证,有效控制病情,提高患者生活质量,减轻社会负担。

宁心消痞方养心健脾辨治冠状动脉粥样硬化性心脏病伴发贫血

冠状动脉粥样硬化性心脏病多以活血化瘀为法,合并贫血却不适用。并发贫血应抓住本虚标实特点,养心健脾,针对不同致病因素,随证加减。宁心消痞方,黄芪30g,麦冬15g,五味子3g,川芎15g,丹参20g,半夏9g,陈皮15g,焦三仙各30g,海螵蛸30g,木香15g,砂仁6g,连翘15g,生甘草6g。附胸痹(心肾阴虚)、胸痹(心血瘀阻)验案二则。

基于心脾同治理论观察扶正养心汤对焦虑性失眠患者的临床疗效

目的:观察扶正养心汤治疗心脾两虚型焦虑性失眠患者的临床疗效,探索扶正养心汤治疗心脾两虚型焦虑性失眠的可能性机制。方法:在中医情志病门诊就诊患者中,选取的心脾两虚型焦虑性失眠患者50例,按照随机数表法分为观察组和对照组各25例,对照组给予艾司唑仑片,1 mg,1次/d,观察组在对照上基础上加服扶正养心汤,2次/d,共14天,分别在治疗前后,比较两组患者WBC、IL-6、IgA表达水平以及生活质量评分(SF-36)、匹兹堡睡眠质量量表(PSQI)评分、焦虑自测量表(SAS)评分、中医证候积分及治疗后总有效率。结果:治疗后,组内相比,两组患者WBC、IL-6、IgA表达水平均较前下降(P<0.05),两组患者PSQI评分、SAS评分均较治疗前降低(P<0.05),SF-36评分较前升高(P<0.05),观察组中医证候积分降低(P<0.05),对照组中医证候积分降低无统计学差异(P>0.05);组间相比,观察组WBC、IL-6、IgA较对照组降低更明显(P<0.05),SF-36较对照组提升更为明显(P<0.05),PSQI评分和SAS评分降低更明显(P<0.05),且总有效率更高(P<0.05)。结论:扶正养心汤可改善心脾两虚型焦虑性失眠患者睡眠质量、临床症状和生活质量;相较于单纯使用艾司唑仑,疗效更佳。可能与扶正养心汤可降低患者WBC、IL-6、IgA水平相关。