Biological basis of “depression with liver-qi stagnation and spleen deficiency syndrome”: A digital gene expression profiling study

Objective:To investigate the biological basis of“depression with liver-qi stagnation and spleen deficiency syndrome”.Methods:A digital gene expression profiling method was conducted to explore global changes in the mRNA transcriptome in a rat model of depression with liver-qi stagnation and spleen deficiency syndrome.Real-time quantitative polymerase chain reaction(q-PCR)was performed to verify the five genes most interest based on the Kyoto Encyclopedia of Genes and Genome(KEGG)analysis.Sini San,which disperses stagnated liver qi and strengthens the spleen,was administered to the model rats to observe whether it could reverse these genetic changes in the liver.Results:Forty-six differentially expressed genes were identified.Three of the five genes of most interestdHnf4a,Hnf4g and Cyp1a1dbased on KEGG analysis,were confirmed by realtime q-PCR.Sini San reduced the gene expression changes of Hnf4a,Hnf4g and Cyp1a1 in the rat model.Conclusions:Hnf4a,Hnf4g and Cyp1a1 are involved in“depression with liver-qi stagnation and spleen deficiency syndrome”.These findings indicate that depressed rats with liver-qi stagnation and spleen deficiency syndrome are at risk of liver diseases.Furthermore,our results will inform exploration of the etiology of depression and help in the development of effective therapeutic strategies.

Rat Models of Fatty Liver due to Liver Depression and Spleen Deficiency

[Objectives] To establish animal models of fatty liver due to liver depression and spleen deficiency that were suitable for activity discovery of traditional Chinese medicine( TCM) compounds,efficacy evaluation,new drug research and development and correspondence between prescription and syndrome of TCM. [Methods] A syndrome score scale that was suitable for evaluating the rat models was established according to the evolvement rules of etiology and pathogenesis of TCM and the modern clinical pathological mechanism. At the same time,bifendate pills and Sanqi Zhigan pills were selected as drug counterevidence for the models. Rats in model groups were given different proportions of high-fat and low-protein fodder and different concentrations of alcohol every day,and intraperitoneally injected with porcine serum twice a week. Drug groups were given with bifendate pills and Sanqi Zhigan pills( 8. 1 mg/kg,and 2. 7 g/kg) respectively for 14 consecutive days.During the experiment,general status,weight,daily fodder intake and daily water intake of the animals were observed,and TCM syndromes were scored. After the experiment,the levels of alanine aminotransferase( ALT),aspartate aminotransferase( AST),γ-glutamine transpeptidase( γ-GT),total cholesterol( TC),triglycerides( TG),low density lipoprotein-cholesterol( LDL-C),and high density lipoprotein-cholesterol( HDL-C) in serum were detected,and the pathological changes in liver tissue were observed. [Results] Compared with the control group,body weight,daily fodder and water intake of rats increased slowly in the model group,and the levels of ALT,AST,γ-GT,TC,TG and LDL-C increased significantly,while the level of HDL-C dropped. Pathological examination showed that steatosis and fat granule were observed in hepatocytes of rats in the model group. Behavioral observation found that main symptoms and minor symptoms of rats in the model group conformed to the syndrome manifestation of liver depression and spleen deficiency,which suggested that the three model groups were established successfully. Among them,three rats died in model group 1,and one rat died in model group 2. The manifestation of all the above lesions can be alleviated by drug counterevidence. [Conclusions]The animal model of fatty liver due to liver depression and spleen deficiency shows an obviously lower mortality and shorter duration and can be used for research of correlation between prescription and syndrome and its mechanism.

Study on the Characteristics of Gut Microbiota in Chronic Hepatitis B(CHB)Patients with Damp Heat Syndrome and Liver Depression and Spleen Deficiency Syndrome

Objective:This study was designed to explore the characteristics of gut microbiota in CHB patients with two most common traditional Chinese medicine(TCM)Syndromes—damp heat syndrome and liver depression and spleen deficiency syndrome.Methods:According to the diagnostic criteria of Western medicine,TCM and screening exclusion criteria,65 cases of CHB with damp heat syndrome and 28 cases of CHB with liver depression and spleen deficiency syndrome were finally included in the study.All the basic information was gathered and the fresh fecal samples were collected for 16S rDNA sequencing.16S rDNA of gut microbiota was sequenced using Illumina hiseq 2,500 high-throughput sequencing platform.Based on the optimized sequence,Operational Taxonomic Units(OTU)clustering analysis and taxonomic annotation were carried out.Results:The difference in relative abundance of gut microbiota was significant between damp heat syndrome and liver depression and spleen deficiency syndrome in CHB patients.Cyanobacteria was only found in damp heat syndrome.The relative abundance of Erysipelotrichia and Subdoligranulum were higher in liver depression and spleen deficiency syndrome,while the relative abundance of Rhodospirillales,Alphaproteobacteria and Lachnospira were higher in the damp heat syndrome.LDA Effect Size(LEfSe)analysis showed that Lachnospira,Olsenella and Subdoligranulum had significant difference in species among the two TCM syndromes.Conclusion:The different characteristics of gut microbiota in the two TCM syndromes of CHB patients may play an important role in syndrome formation of TCM,which provides a new field of vision for the accurate diagnosis and treatment of TCM.

Collection of Professor Lihong Zhu's Experience in Treating Postpartum Hypogalactia of Blood Deficiency and Liver Depression Type

Professor Lihong Zhu proposed the syndrome type of"blood deficiency and liver depression"in the clinical treatment of postpartum hypogalactia,and discussed its main etiology and pathogenesis as Yin blood deficiency and liver Qi stagnation,with blood deficiency as the basis and liver depression as the standard.She self-made"Shugan Shengru prescription/5*which was added and subtracted with symptoms,with remarkable clinical effect,and widened the thinking of diagnosis and treatment of postpartum hypogalactia.

Clinical Observation on Modified Huan'gan Lipi Decoction Combined with Acupuncture in Treating Spleen Deficiency and Liver Hyperactivity Type Tic Disorders

[Objectives]To observe the clinical efficacy of Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type tic disorders(TD).[Methods]Sixty patients with spleen deficiency and liver hyperactivity type TD were randomly divided into a treatment group of 40 cases and a control group of 20 cases.The treatment group received Modified Huan'gan Lipi Decoction combined with acupuncture,and the control group received Haloperidol Tablets.After 4 weeks of treatment,the Yale Global Tic Severity Scale(YGTSS)score,the total score of TCM syndrome and the clinical efficacy were compared between the two groups before and after treatment.[Results]After treatment,the total effective rate of 87.5%in the treatment group was higher than 80.0%in the control group(P>0.05);the total score of YGTSS and the total score of TCM syndromes in the two groups were compared within groups,P﹤0.01;between groups,P﹤0.01.The recurrence rates of the treatment group and the control group were 11.1%and 71.4%,respectively.The difference between the two groups was statistically significant(P﹤0.01).[Conclusions]Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type TD can significantly improve the patient's tic symptoms,and its long-term efficacy is stable.

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).

Effect and Mechanisms of Gong-Tone Music on the Immunological Function in Rats with Liver(Gan)-Qi Depression and Spleen(Pi)-Qi Deficiency Syndrome in Rats

Objective： To investigate the effects and mechanisms of Gong-tone music on the immunological function in rats with the Chinese medicine syndrome of Liver （Gan）-qi stagnation and Spleen （Pi）-qi deficiency （LSSD）. Methods： Twenty five male Wistar rats of SPF grade were randomly divided into 5 groups： normal group, model group, Xiaoyao Powder （逍遥散） group, Gong-tone group and combined group （the combination of Gong-tone and Xiaoyao Powder）, with 5 rats in each group. The rat model for the Chinese medicine syndrome of LSSD was induced by chronic bandage and irregular diet. The course of treatment was 21 days. After the treatment, the levels of serum gastrin and IgG were detected by enzyme-linked immunoabsorbent assay （ELISA）. Phagocytosis of macrophages was detected by the neutral red uptake assay and T cell proliferation was investigated by 3-（4,5-dimethylthiazolyl）-2,5-diphenyltetrazolium bromide （MTT） assay. Results： The serum gastrin, macrophage phagocytosis, IgG level and proliferation ability of T cells in the model group were significantly decreased compared with those in the normal group （P〈0.05）. Compared with those in the model group, the serum levels of gastrin, macrophage phagocytosis, IgG level and proliferation ability of T cells in Gong-tone, Xiaoyao Powder, and combined groups were significantly increased （P〈0.05）. The combined group was superior to either Gong-tone group or Xiaoyao Powder group. Conclusion： Gong-tone music may upregulate the immunological function and play a role in adjuvant therapy in the Chinese syndrome of LSSD.

基于“肝脾同调”阐析慢性肝病的中医治疗

慢性肝病是临床常见疾病,“郁、虚、湿、毒、瘀”是其核心病机,在疾病的不同阶段各有侧重,其中,以“郁、虚”为核心的肝脾失调是慢性肝病发生发展的关键。“肝脾同调”是治疗慢性肝病的基本治法,在慢性肝病不同阶段,其“肝脾同调”内涵同中有异。根据肝、脾生理病理特性,治脾明辨虚实,厘清轻重,活用运脾、健脾、温脾、醒脾、补脾等法;调肝体用并重,精准辨证,活用疏肝、缓肝、散肝、柔肝等法。临床上,治脾与调肝相辅相成,治调并举,常获良效。

基于“脾气散精”理论探讨慢性肝病的中医治疗

慢性肝病的发病与脾密切相关,“脾气散精”是《黄帝内经》对脾功能的高度概括,脾气散精功能障碍贯穿慢性肝病始终,脾失运化,生湿生痰,瘀血阻络为慢性肝病进展的关键因素。治疗时应将健脾作为慢性肝病的基本治法之一,并根据脾运的不同状态,配合运脾、醒脾、温脾等不同治法,以复脾气散精之能,病程中尤应抓住瘀血络阻这一关键病机,活血化瘀通络,防止慢性肝病进一步向肝积、鼓胀发展,使脾运得复,瘀阻得除,标本兼治。

从肝脾论治甲状腺良性结节研究进展

甲状腺结节为常见的内分泌系统疾病,多为良性结节。西医对于甲状腺结节缺乏有效的治疗措施,对于部分病情严重的患者可进行手术治疗,但相关并发症较多。中医认为,甲状腺结节的发生与患者情志失调密切相关,而情志畅达与肝脏气机调畅密切相关,患者情志抑郁可致肝气郁结,日久使得脾胃生化功能失调,肝郁脾虚则水液输布失常,痰气瘀结于颈前而发为“瘿病”,因此,从疏肝理气、健脾利水、化痰消瘀为基本原则,治疗甲状腺结节能取得良好的效果。

逍遥散联合水飞蓟素胶囊治疗肝郁脾虚证非酒精性脂肪性肝病临床研究

目的:逍遥散联合水飞蓟素胶囊治疗肝郁脾虚证非酒精性脂肪性肝病(NAFLD)的疗效。方法:选取90例肝郁脾虚证NAFLD患者,按随机数字表法分为对照组及治疗组各45例。2组行非药物措施,对照组予以水飞蓟素胶囊口服,治疗组在对照组基础上加逍遥散治疗。2组均连续治疗12周。比较2组临床疗效,比较2组治疗前后肝功能指标[谷草转氨酶(AST)、丙氨酸转氨酶(ALT)、谷氨酰转肽酶(GGT)]值、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)]值、血清TLR4/NF-κB信号通路相关蛋白水平[血清TOLL样受体4(TLR4)、髓样分化因子88(MyD88)、核转录因子-κB(NF-κB)]、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的变化。结果:治疗12周后,治疗组临床疗效总有效率为91.11%,对照组为73.33%,2组比较,差异有统计学意义(P<0.05)。治疗12周后,2组AST、ALT、GGT指标值均较治疗前下降(P<0.05),治疗组上述3项指标值均低于对照组(P<0.05)。治疗12周后,2组TC、TG、LDL-C水平均较治疗前下降(P<0.05),HDL-C水平均较治疗前上升(P<0.05);治疗组TC、TG、LDL-C水平均低于对照组(P<0.05),HDL-C水平高于对照组(P<0.05)。治疗12周后,2组血清TLR4、MyD88、NF-κB、IL-6、TNF-α水平均较治疗前下降(P<0.05),治疗组上述5项水平均低于对照组(P<0.05)。结论:逍遥散联合水飞蓟素胶囊对肝郁脾虚证NAFLD的疗效确切,可有效改善肝功能及血脂状况,调节血清TLR4-NF-κB信号通路,抑制炎症反应。

槐耳颗粒联合分子靶向药物治疗脾虚型原发性肝癌的临床疗效

目的 探讨槐耳颗粒联合分子靶向药物治疗脾虚型原发性肝癌(PHC)的临床疗效及对肝功能、免疫功能的影响。方法 回顾性分析2020年1月—2021年12月本院收治的PHC患者70例,按就诊先后顺序分为A组和B组各35例。两组患者均实施常规支持治疗。A组在常规治疗上使用分子靶向药物治疗,B组在A组的基础上联合槐耳颗粒治疗,两组患者皆进行4周的治疗。对两组治疗前后中医证候积分、生活质量、肝功能及免疫功能指标的变化实施观察,并评价两组临床疗效与安全性。结果 B组总有效率(97.14%)显著高于A组(80.00%)(P<0.05)。治疗前,两组中医症候积分比较,差异无统计学意义(P>0.05);两组中医症候积分在治疗后均降低,且B组积分低于A组(P<0.05);治疗前,两组患者的CD8^(+)、CD4^(+)和CD4^(+)/CD8^(+)比较,差异无统计学意义(P>0.05);治疗后,两组患者的CD8^(+)、CD4^(+)水平较治疗前显著降低;B组CD4^(+)/CD8^(+)水平较治疗前提高,A组CD4^(+)/CD8^(+)水平较治疗前降低,且B组的CD8^(+)水平低于A组,CD4^(+)与CD4^(+)/CD8^(+)水平高于A组(P<0.05)。治疗前,两组的AST、ALT和TBIL水平比较,差异无统计学意义(P>0.05);治疗后两组AST、ALT和TBIL水平显著减少(P<0.05),且B组明显低于A组(P<0.05)。B组不良反应发生率(11.42%)高于A组(8.57%),但两组高血压、手足综合征、皮疹、恶心呕吐及腹泻等不良反应比较,差异无统计学意义(P>0.05)。治疗后两组生活质量均上升,且B组生活质量优于A组(P<0.05)。结论 槐耳颗粒联合分子靶向药物治疗PHC患者疗效确切,可减轻患者临床症状,改善患者的肝功能以及免疫功能指标,安全性较高,可在临床推广。

汪龙德运用疏肝健脾法从脾胃论治干燥综合征经验

介绍汪龙德主任医师运用疏肝健脾法从脾胃论治干燥综合征的临床经验和学术思想。认为干燥综合征的关键病机是肝郁脾虚,发病部位在肝脾,属虚实夹杂证,临证强调运用疏肝健脾法为基本治法,使肝气畅达,疏泄正常,气行血行,则瘀血渐除,气机布散津液于全身;脾胃健运,气血津液化生有源,痰饮水湿自化,则清窍腠理得以濡润。辅以清热润燥、养血生津、活血祛瘀,标本同治,可获良效。并结合案例,介绍了疏肝健脾法治疗干燥综合征的应用,以期为临床诊疗提供参考。

从“虚瘀劫肝”论原发性肝癌中医药防治思路

理论创新是中医药发展的源泉,在新理论指导下形成的新方药或新诊治方案是中医药临床防治重大疑难疾病的新突破口。正邪交争,正不胜邪是慢性疾病持续进展的内在驱力和一般特性,慢性肝病持续恶性进展囊括了:肝纤维、肝硬化、肝癌等逐步恶化的病理进程。其在遵循中医“正不胜邪”基本病机的基础也必须有其特殊性和指向性,也可理解为在慢性肝病持续进展的病理状态下将一般性的病机进行指向性和特征性的阐发。肝正虚主要是指维持正常肝再生修复的相关机制和途径异常或紊乱,肝邪胜则是指肝损伤因素持续存在及其下游触发的恶性肝再生状态进行性亢进;而“瘀”作为正邪交争过程中产生的最主要病理产物也在不断推动疾病的恶性发展。在此基础上,从“虚瘀劫肝”论肝癌的病理新认识及补虚(补肾生髓、健脾)祛瘀(疏肝、柔肝、化肝)阻断慢性肝病持续恶性进展以防治肝癌的基本思路,期望有益于疑难肝脏病症的临床防治。

加味调肝汤联合西药治疗肝郁肾虚型月经过少疗效及对患者子宫内膜厚度的影响

目的:研究加味调肝汤联合西药治疗肝郁肾虚型月经过少临床疗效及对患者子宫内膜厚度的影响。方法:选取肝郁肾虚型月经过少患者共124例,采用随机数字表法分为观察组和对照组,其中对照组62例采用戊酸雌二醇(E2)、地屈孕酮治疗,观察组62例采用加味调肝汤联合戊酸雌二醇、地屈孕酮治疗。比较两组治疗效果、不良反应发生率,两组治疗前后中医证候积分、子宫内膜厚度、子宫血流阻力指数(RI)和卵泡期性激素水平。结果:观察组治疗总有效率为90.32%,较对照组总有效率75.81%高(P<0.05)。治疗前两组中医证候积分对比差异无统计学意义(P>0.05),治疗3个月后观察组上述积分较对照组更低(P<0.05)。治疗前两组卵泡期子宫内膜厚度、RI值比较,差异无统计学意义(P>0.05),治疗3个月后观察组卵泡期子宫内膜厚度较对照组更厚;RI较之于对照组更低(P<0.05)。治疗前两组卵泡期E2、FSH、LH水平比较无统计学差异(P>0.05);治疗3个月后观察组卵泡期性激素水平比对照组高(P<0.05)。观察组不良反应发生率为11.29%,与对照组的24.19%比较差异无统计学意义(P>0.05)。结论:加味调肝汤联合西药治疗肝郁肾虚型月经过少临床疗效比单用西药治疗效果更佳,能促进子宫内膜生长,降低RI值,调节卵泡期性激素水平。

退红舒缓中药面膜联合丹栀逍遥散治疗玫瑰痤疮患者的疗效及对其皮肤屏障功能、BDNF、TrKB表达的影响

目的探讨退红舒缓中药面膜联合丹栀逍遥散治疗肝郁脾虚型玫瑰痤疮患者的疗效及对其皮肤屏障功能、脑源性神经营养因子(Brain-derived neurotrophic factor,BDNF)、脑源性神经营养因子受体(Tropomyosin receptor kinase b,TrKB)表达的影响。方法选取2021年5月—2023年5月期间在湖南省中西医结合医院诊治的90例肝郁脾虚型玫瑰痤疮患者,采用随机数字表法分为对照组、中药组和联合治疗组,每组各30例。对照组患者外用退红舒缓中药面膜治疗,中药组患者口服丹栀逍遥散治疗,联合治疗组采用退红舒缓中药面膜联合丹栀逍遥散治疗,3组均持续治疗4周。观察比较3组患者临床疗效、不良反应情况,治疗前后中医证候积分、心理状态评分[汉密尔顿抑郁量表(Hamilton depression rating scale,HAMD)、汉密尔顿焦虑量表(Hamilton anxiety rating scale,HAMA)]、BDNF、TrKB蛋白和mRNA相对表达水平、炎症因子水平[白介素-4(Interleukin-4,IL-4)、白介素-17(Interleukin-17,IL-17)和白介素-37(Interleukin-37,IL-37)]。结果治疗后3组患者中医证候积分较治疗前降低,差异有统计学意义(P<0.05);且联合治疗组患者中医证候积分低于对照组和中药组,差异有统计学意义(P<0.05)。治疗后3组患者皮肤泛红、颜色评分和经表皮失水率较治疗前降低,角质层水平含量较治疗前升高,差异有统计学意义(P<0.05);且联合治疗组患者皮肤泛红、颜色评分和经表皮失水率低于对照组和中药组,角质层水平含量高于对照组和中药组,差异有统计学意义(P<0.05)。治疗后3组患者心理状态评分均较治疗前降低,差异有统计学意义(P<0.05);且联合治疗组患者心理状态评分低于对照组和中药组,差异有统计学意义(P<0.05)。治疗后3组患者BDNF、TrKB和BDNF mRNA、TrkB mRNA均较治疗前降低,差异有统计学意义(P<0.05),且联合治疗组患者BDNF、TrKB和BDNF mRNA、TrkB mRNA低于对照组和中药组,差异有统计学意义(P<0.05)。治疗后3组患者IL-4、IL-17和IL-37水平均较治疗前降低,差异有统计学意义(P<0.05);且联合治疗组患者IL-4、IL-17和IL-37水平低于对照组和中药组,差异有统计学意义(P<0.05)。治疗后联合治疗组临床愈显率为90.00%(27/30),较对照组63.33%(20/30)和中药组66.67%(19/30)明显升高,差异有统计学意义(P<0.05)。治疗期间,3组患者均未发生明显不良反应。结论退红舒缓中药面膜联合丹栀逍遥散治疗可以改善肝郁脾虚型玫瑰痤疮患者临床症状,提高皮肤屏障功能和心理水平,其机制可能与降低BDNF、TrkB表达有关。

俞募配穴针刺治疗肝郁脾虚型抑郁症的临床效果观察

目的:观察俞募配穴针刺治疗肝郁脾虚型抑郁症患者的临床疗效。方法:选取2022年1月至2022年12月福建中医药大学附属第二人民医院收治的肝郁脾虚型抑郁症患者100例作为研究对象,随机分为对照组和观察组,每组50例。对照组给予艾司西酞普兰口服治疗,持续用药1个月;观察组在对照组基础上联合俞募配穴针刺治疗,2 d治疗1次,持续治疗15次。比较2组患者治疗前后主要症状、抑郁程度、生命质量评分、血清5-羟色胺(5-HT)水平、肠道菌群、不良反应、复发率及临床疗效。结果:治疗后,观察组健康调查简表(SF-36)评分、血清5-HT水平、粪便标本乳酸杆菌及双歧杆菌数量高于对照组(均P<0.05),主要症状评分、汉密尔顿抑郁量表(HAMD-24)评分、粪便标本大肠埃希菌及肠球菌数量低于对照组(均P<0.05)。2组患者不良反应发生率比较差异无统计学意义(P>0.05)。观察组治疗后6个月复发率略低于对照组,但差异无统计学意义(P>0.05)。治疗后观察组总有效率高于对照组(P<0.05)。结论:俞募配穴针刺治疗肝郁脾虚型抑郁症患者疗效明确,可有效改善患者症状,减轻抑郁程度,提高生命质量,调节血清5-HT水平及改善肠道菌群分布,安全性高。

耳穴压豆干预在肝郁脾虚型乙肝患者中的应用效果

目的观察耳穴压豆干预在肝郁脾虚型乙肝患者中的应用效果。方法选取2023年1月至5月南昌市第九医院收治的80例自述睡眠质量下降的肝郁脾虚型乙肝患者为对象,按随机数字表法分为观察组和对照组,每组各40例。对照组接受常规护理干预,观察组在此基础上接受耳穴压豆干预,两组均干预14 d。干预前后使用匹兹堡睡眠指数评分(PSQI)、汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、诺丁汉健康调查问卷(NHP)、自制护理满意度调查表分别评价两组患者的睡眠质量、负性心理(HAMA、HAMD)、生活质量及护理满意度。结果干预后,观察组睡眠质量优于对照组,HAMA、HAMD、NHP各维度评分低于对照组,护理满意度优于对照组,总满意度高于对照组,差异有统计学意义(P<0.05)。结论耳穴压豆干预可改善肝郁脾虚型乙肝患者睡眠质量,对减缓负性心理,提高生活质量有积极意义,患者较为满意。

电针对肝郁脾虚型抑郁症大鼠HMGB1/RAGE/TLR4通路及小胶质细胞活化的影响

目的:探究电针对肝郁脾虚型抑郁症大鼠高迁移率族蛋白盒1/晚期糖基化终产物/toll样受体4(HMGB1/RAGE/TLR4)通路及小胶质细胞活化的影响。方法:将大鼠随机分为对照组、模型组、电针组及HMGB1激活剂组,除对照组外均构建肝郁脾虚型抑郁症大鼠模型。观测大鼠体重及行为学表现;采用HE染色法观察大鼠海马组织病理变化;采用免疫组化检测大鼠海马组织中钙接头蛋白1(Iba-1)、一氧化氮合酶(iNOS)的表达情况;采用蛋白免疫印迹(Western blotting)检测海马组织中HMGB1/RAGE/TLR4信号传导通路相关蛋白HMGB1、RAGE、TLR4的表达水平。结果:相较于对照组,模型组大鼠长期动作行为缓慢、脱毛、毛发粗糙、凌乱无光泽,排泄存在水样便,大鼠海马区神经细胞出现明显结构损伤,且大鼠体重及在旷场箱内运动的总路程减少(P<0.05),而在旷箱中央停留时间、休息时间以及海马组织中Iba-1、iNOS、HMGB1、RAGE和TLR4表达升高,差异有统计学意义(均P<0.05)。相较于模型组,电针组大鼠精神状态有所好转,海马区神经细胞损伤程度减轻,细胞形态良好且排列逐渐趋于有序,大鼠体重、在旷场箱内运动总路程提高,差异有统计学意义(均P<0.05)。结论:电针能够抑制肝郁脾虚型抑郁症大鼠小胶质细胞活化,其作用机制可能与抑制HMGB1/RAGE/TLR4通路有关。

自拟疏肝健脾方对肝郁脾虚证大鼠影响及其机制

目的观察自拟疏肝健脾方对肝郁脾虚证大鼠的影响及其可能的作用机制。方法慢性捆绑束缚法制备大鼠肝郁脾虚证模型。60只大鼠随机分为正常组,模型组,疏肝健脾方高、中、低剂量组,阳性对照组,每组10只,连续21 d每日束缚3 h,束缚前30 min大鼠灌胃给药。通过记录大鼠宏观表征观察一般情况,体质量和小肠推进率观察大鼠“脾虚”情况,脾指数和胸腺指数反映大鼠免疫水平。通过旷场实验观察大鼠抑郁情绪以及糖水偏好率观察大鼠欣快感共同反映“肝郁”的情况。ELISA法检测大鼠血清中皮质酮(corticosterone,CORT)、5-羟色胺(5-hydroxytryptamine,5-HT)、去甲肾上腺素(norepinephrine,NE)、多巴胺(dopamine,DA)的含量。结果与正常组比较,模型组大鼠体质量减轻(P<0.05),总活动距离明显减少(P<0.05),活动速度减慢(P<0.05),糖水偏好率、小肠推进率、脾指数均下降(P<0.05),CORT含量、NE含量均升高(P<0.05)。与模型组比较,疏肝健脾方各剂量组大鼠总活动距离及糖水偏好率均增加(P<0.05),疏肝健脾方低剂量组小肠推进率升高、脾指数上升(P<0.05),疏肝健脾方中、低剂量组活动速度增快(P<0.05),疏肝健脾方高、低剂量组CORT含量、NE含量均降低(P<0.05),5-HT和DA含量差异无统计学意义(P>0.05)。结论疏肝健脾方可以有效改善大鼠肝郁脾虚证,其机制可能与调控下丘脑-垂体-肾上腺(hypothalamic pituitary adrenal,HPA)轴功能相关。