Mechanism of'Invigorating Qi and Promoting Blood Circulation'Drug Pair Ginseng-Danshen on Treatment of Ischemic Heart Disease Based on Network Pharmacology

Objective:Using network pharmacology to explore the mechanism of the'invigorating qi and promoting blood circulation'drug pair Ginseng-Danshen(Salvia miltiorrhiza)on treatment of ischemic heart disease(IHD).Methods:The chemical constituents of ginseng and Danshen drug pair were identified by searching the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),and the potential targets of the pair were identified.The pharmacodynamics of the pair was analyzed using network pharmacology.The targets of IHD were identified by database screening.Using protein-protein interaction network,the interaction targets of Ginseng-Danshen on IHD were constructed.A"constituent-target-disease"interaction network was constructed using Cytoscape software,Gene Ontology(GO)term enrichment analysis and biological pathway enrichment analysis were carried out,and the mechanism of improving myocardial ischemia by the Ginseng-Danshen drug pair was investigated.Results:Seventeen active constituents and 53 targets were identified from ginseng,53 active constituents and 61 targets were identified from Danshen,and 32 protein targets were shared by ginseng and Danshen.Twenty GO terms were analyzed,including cytokine receptor binding,cytokine activity,heme binding,and antioxidant activity.Sixty Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathways were analyzed,including phosphatidylinositol 3-kinase-serine-threonine kinase(PI3 K-AKT)signaling pathway,p53 signaling pathway,interleukin 17 signaling pathway,tumor necrosis factor signaling pathway,and the advanced glycation end product(AGE)-the receptor for AGE(RAGE)signaling pathway in diabetic complications.Conclusion:The specific mechanism of Ginseng-Danshen drug pair in treating IHD may be associated with improving the changes of metabolites inbody,inhibiting the production of peroxides,removing the endogenous oxygen free radicals,regulating the expression of inflammatory factors,reducing myocardial cell apoptosis and promoting vascular regeneration.

Effects of Chinese herbs capable of replenishing qi, nourishing yin and activating blood circulation and their compatibility on differentially expressed genes of ischemic myocardium

This study was conducted to investigate the effects of Chinese herbs capable of replenishing qi, nourishing yin and activating blood circulation and their compatibility on differentially expressed genes of ischemic myocardium which were selected from differential expression profile we had established before, and to explore the underlying mechanism. The acute myocardial infarction (AMI) model was established by ligating the left anterior descending (LAD) coronary artery, then the model rats were randomly divided into the model group, the Metoprolol group, the replenishing qi nourishing yin (RN) group, the activating blood circulation (AB) group, and the replenishing qi, nourishing yin and activating blood circulation (RA) group. In addition, the normal group and the sham group were set up. The rats of medication groups were administered by intragastric gavage with corresponding drugs on the second day after operations, and the rats of the normal group and the sham group were given normal saline as the same time.Then the ischemic hearts were harvested on the 8th day after operation. The myocardial pathomorphological changes were observed under a light microscope. The mRNA changes of target genes such as COX5a and ATP5e were detected using Realtime fluorescence quantitative PCR (QPCR), and the activities of related enzymes were detected by colorimetric assay. The main results were as follows: the histological changes were observed by HE staining, and cardiocyte swelling, inflammatory cell infiltration and cytolysis were showed in regional ischemic myocardium of the model group, while the pathomorphological changes in all medication groups did not show obvious changes. Two genes related to energy metabolism, COX5a and ATP5e, were selected as the target genes which were downregulated at the mRNA level in the medication groups. The activities of correlative functional enzymes also decreased in the RA group compared to that in the model group accordingly (P<0.05). The results indicated that the abnormal expression of genes involved in energy metabolism pathways could be one of the molecular mechanisms of AMI. The compatibility of Chinese herbs capable of replenishing qi, nourishing yin and activating blood circulation affects the expression of energyrelative gene COX5a, ATP5e, which is probably the mechanism of myocardial preservation, and is more effective than single herb of replenishing qi and nourishing yin or activating blood circulation.

Invigorating Qi and Promoting Blood Circulation in Treatmentof Chronic Idiopathic Thrombocytopenic Purpura

Twenty patients of chronic idiopathic thrombocytopenic purpura (ITP) were treated with suchkind of Chinese herbal medicine as invigorating Qi and promoting blood circulation for 4-8 weeks. The ther-apeutic effect was observed and compared with that of the two control groups treated with prednisone and co-enzyme A respectively. In the TCM group, the number of patients with marked effect, good effect and im-provement were 2, 4 and 7, the total effective rate being 65% . This efficacy was higher than that of the co-enzyme group and lower than that of the prednisone group. The changes of antiplatelet IgG antibody and hap-toglobin were also observed in the meantime, and results showed that after TOM treatment, both of themwere decreased as disease improved.

Effect of Danggui Shaoyao San with Huangqi on adriamycin-induced nephrotic syndrome in rats

Objective:To determine the therapeutic effect of Danggui Shaoyao San with Huangqi on rats with nephrotic syndrome(NS)was discussed,and the scientific connotation of TCM treatment principle was elaborated,so as to provide experimental basis for its clinical application.Methods:The NS rat model was established by iv administration of adriamycin;The rats were divided into model group,Danggui Shaoyao San group,Danggui Shaoyao San with Huangqi group,Huangqi group and positive drug group,with 10 rats in control group;The best dosage ratio of Danggui Shaoyao San and Huangqi was screened by Excel;24 h urine protein was measured by BCA method;The electrolyte level was detected by automatic biochemical analyzer;In serum Urea nitrogen(BUN),Creatinine(SCr),Total cholesterol(TC),Triglyceride(TG),Total protein(TP),Albumin(ALB),Immunoglobulin M(Ig-M)and Immunoglobulin G(Ig-G)were detected by the kit;hematoxylin-eosin staining was used to observe the renal morphology;The Total water content(TBW),Extracellular water content(ECF)and Intracellular water content(ICF)were measured by experimental animal body composition analyzer.Results:Compared with the model group,the urine protein in the modified Astragalus group of Danggui Shaoyao Powder was significantly decreased(P<0.01);Urine electrolytes were significantly decreased and serum electrolytes were significantly increased(P<0.01);Serum BUN,SCR,TC and TG were significantly decreased(P<0.01),while TP,ALB,TBW and ICF were significantly increased(P<0.01);The levels of Ig-M and Ig-G were significantly increased(P<0.01),TBW and ICF were significantly increased,and ECF was significantly decreased(P<0.01);Histopathology showed that the pathological changes of renal tissue were obviously alleviated;The improvement of each index was better than that of Danggui Shaoyao San group and Huangqi group.Conclusion:Danggui Shaoyao San with Huangqi group can significantly improve the edema,proteinuria,blood lipid and immune function of NS rats,and the effect is better than that of Danggui Shaoyao San group and Huangqi group.It has the best therapeutic effect on NS,which indicates that Huangqi plays a key synergistic effect on Danggui Shaoyao San,which verifies the scientific connotation of"Yiqi Huoxue Lishui"in the treatment of NS.

基于调控免疫炎症微血管损伤的补气活血法治疗肺炎“瘥后防复”思路的提出

肺炎恢复期后遗症严重影响患者身心健康,存在二次感染的风险,且与基础病相互影响导致恶性循环。做好肺炎恢复期康复工作,减少后遗症并预防反复发作是疾病防治的首选。研究显示肺炎长期后遗症和反复发作的机制可能与持续的机体免疫抑制和全身微炎症状态及微血管损伤有关。团队根据传统中医理论,结合长期临床与基础研究,提出“气虚血瘀”是肺炎恢复期的核心病机。因此,团队提出补气活血法治疗肺炎“瘥后防复”的机制与调控免疫炎症微血管损伤有关,调控T淋巴细胞紊乱提高免疫、抑制炎症因子改善机体微炎症状态和抗氧化保护内皮细胞调控微血管损伤,阐明其内在机制将为中医药治疗呼吸系统重大感染性疾病提供理论依据,传承精华、守正创新。

脉通君安汤治疗气虚血瘀型冠心病心绞痛的临床疗效及转录组学研究

目的观察脉通君安汤治疗气虚血瘀型冠心病心绞痛的临床疗效,并通过转录组学方法初步阐明其可能的作用机制。方法将符合纳入标准的140例气虚血瘀型冠心病心绞痛患者依据随机数字法分为治疗组、对照组各70例,治疗期间对照组脱落3例。对照组予冠心病二级预防西医基础治疗,治疗组在对照组治疗基础上加服脉通君安汤,2组疗程均为8周。治疗前后评估2组患者中医证候积分、加拿大心血管学会(Canadian cardiovascular society,CCS)心绞痛分级、西雅图量表(Seattle angina questionnaire,SAQ)评分、焦虑自评量表(Self-rating anxiety scale,SAS)评分、抑郁自评量表(Self-rating depression scale,SDS)评分及不良反应,并基于性别、年龄、病程相匹配原则选取9例患者治疗前后外周血进行转录组学测序。结果治疗后,2组患者中医证候积分均明显下降(P<0.01),治疗组在改善胸痛、胸闷、气短、神倦乏力及总分方面优于对照组(P<0.05,P<0.01);治疗组CCS心绞痛分级总改善率优于对照组(P<0.05);2组治疗前后SAQ、SAS及SDS评分均显著改善(P<0.01),治疗组SAQ评分改善优于对照组(P<0.05,P<0.01)。转录组学结果显示,治疗前后具有显著差异表达的mRNA有862个,包括509个上调,353个下调;GO分析结果显示差异表达的mRNA生物学过程有666条,主要包括病毒基因表达、翻译启动、RNA分解代谢过程等,细胞组分112条,主要包括黏着斑、核糖体亚基、核斑点等;分子功能有94条,主要包括双链RNA结合、钙黏蛋白结合、转录共调节因子活性等;KEGG分析结果显示差异mRNA富集信号通路包括20条,主要包括甘油磷脂代谢通路、单磷酸腺苷激活的蛋白激酶(AMP-activated protein kinase,AMPK)信号通路、核糖体通路等。结论脉通君安汤能够改善气虚血瘀型冠心病心绞痛患者临床症状,其作用机制为多靶点多通路,可能与甘油磷脂代谢通路、AMPK信号通路、核糖体通路的调节相关。

单味中药有效成分治疗溃疡性结肠炎研究进展

研究表明,中药治疗溃疡性结肠炎不良反应少且复发率低,临床常用益气健脾、清热祛湿、活血化瘀、补血养阴类中药组方治疗,其主要药物的有效成分具有减轻炎症反应、修复黏膜损伤、调节肠道微生态、调节免疫反应等作用。本文对常用单味中药有效成分治疗溃疡性结肠炎的作用机制进行综述,为其临床治疗与中药新药研发提供参考。

基于中医血脉理论谈从脾论治糖尿病血管病变

糖尿病血管病变是糖尿病严重的慢性并发症之一,目前已成为糖尿病患者死亡和致残的主要原因,其巨额的医疗费用给家庭、社会带来沉重的经济负担。文章从血管与血脉的相关性出发,基于中医血脉理论,结合传统医学与现代医学观点,认为脾气虚,运化无力,气机不畅,脂浊不化,致痰浊、瘀血、热毒等病理产物壅滞血脉是糖尿病血管病变发生的重要原因,可累及多个靶器官。结合五脏一体观,从脾为四脏之长、脾与其他四脏的病变关系论述从脾论治糖尿病血管病变的理论依据以及古今医家从脾论治糖尿病血管病的临床思路,并将中西医思想融会贯通,突出从脾论治糖尿病血管病变的重要性。治疗上注重益气养阴、活血解毒、健脾化湿之法,为临床防治糖尿病血管病变提供新思路。

2型糖尿病性周围神经病合并胰岛素抵抗病案--仝小林院士教学查房实录

以广安门医院内分泌科中2型糖尿病性周围神经病合并胰岛素抵抗患者为例,邀请仝小林院士进行教学查房,对2型糖尿病性周围神经病合并胰岛素抵抗的中医辨治思路、疾病发展、诊疗要点进行阐述。仝院士在查房过程中强调辨别瘦型糖尿病和肥胖型糖尿病异同,把握疾病发展的不同趋势。糖尿病通常合并胰岛素抵抗,但瘦型糖尿病患者胰岛功能衰竭速度快,甚至初期便能表现出胰岛功能损伤,以脾虚为核心病机,在治疗中应注重补脾益气,从脾论治,运用态靶辨治体系,提高临床疗效。

李岚教授治疗小儿肺炎支原体肺炎经验

[目的]总结李岚教授辨证论治小儿肺炎支原体肺炎的临证经验。[方法]通过搜集整理住院病历、跟师侍诊病案,查阅相关古籍及文献资料,阐述李师对该病病因病机的认识,分析其诊疗思路,并附验案二则以资验证。[结果]李师认为,小儿肺炎支原体肺炎病因多责之于外感之风邪及小儿肺脾本虚,临床分期可分为初期、极期、恢复期三期。在治疗中,总体以宣肺开闭为基本治则,同时采用清热涤痰、活血化瘀、回阳救逆、扶正祛邪等治法,临床辨证施治,屡获佳效。验案一辨证为极期(心阳虚衰证),治法为回阳救逆,以参附龙牡救逆汤为主方,同时选用黄芪、茯苓补气健脾、扶正祛邪。验案二辨证为极期(痰热闭肺证),治法为清热涤痰、宣肺开闭,以麻杏石甘汤合千金苇茎汤为主方,考虑兼有瘀血阻滞,选用桃仁、丹参活血化瘀;在恢复期时,选用白术、太子参培土生金、健脾益气。[结论]李师辨证论治小儿肺炎支原体肺炎,灵活运用中医药治疗,解决小儿肺炎支原体肺炎极期高热难退、恢复期咳嗽咳痰迁延不愈等问题,疗效显著,其经验值得临床学习及推广。

齐元富教授益气补血法治疗癌因性疲乏经验谈

山东省中医院名老中医齐元富教授从医几十年积累了大量宝贵临床经验,在以益气补血法治疗癌因性疲乏方面颇有心得。他认为心、肝与癌因性疲乏密切相关,是诊治重点,并且以益气补血为治则,以标本兼治为目的,自拟方益气补血汤,在临床上取得了不错疗效。齐教授选择益气补血汤对症治疗,不仅针对患者的症状,同时兼顾其肿瘤术后的防治,用药精专,在使用益气补血汤原方基础上,灵活加减,附验案一则以佐证。

张建英教授从“不荣则痛”角度治疗脑震荡后遗头痛经验

脑震荡后遗症为神经外科常见疾病,由于头部遭受外界暴力,导致脑血管或神经组织损伤,进而引起脑肿胀、缺血等病理改变。临床多表现为遭受头部创伤2周后仍有头痛、头晕、乏力、失眠、食欲不振、健忘等症状,多数患者因头痛缠绵难愈,严重影响工作。西医对于本病尚缺乏有效的治疗方法,目前主要是对症处理,包括输液扩充血管、服用止痛药、营养神经及高压氧治疗等,虽然能在一定程度上减轻患者的症状,但效果不甚理想,容易复发,严重影响患者的工作生活。中医认为本病与气血瘀滞、髓海失养、经络不通有关,治疗上强调以“通”为顺,兼顾阳气。头为诸阳之会,阳气通达,气血调顺则髓海安和。张建英教授认为在此基础上,该病病久头痛缠绵难愈,属于临床难治杂病,在通调阳气基础上应抓住病久脾胃虚弱、气血亏虚的病机,脾胃为气血生化之源,脾主升清,清阳上升则利于湿瘀之邪的祛除。针灸可以改善血液循环及脑组织氧代谢,张教授在此基础上结合中医经典论述“凡刺有十二节……傍针刺者,直刺傍刺各一,以治留痹久居者也”的启发进行创新,采用双针温针灸,对于久病患者既提高了临床效果,又增加了治疗的安全性,并配合中药,温补气血,健脾养心,使脑髓充养,头痛自愈。

温阳通络调营卫法论治系统性硬化症

探讨温阳通络调营卫法在系统性硬化症(SSc)中的辨治及临床应用。SSc属于中医学“皮痹”范畴,主要病因病机为素体阳虚,营卫失和,风、寒、湿等邪气乘机侵袭,致气血凝滞、经络不通,肌肤失养,继则累及全身。此病临床症状复杂多变,多表现在皮肤病变及雷诺现象,亦可出现关节、消化道及脏器病变。阳虚与营卫不和皆为SSc的内因之一,痰浊瘀血阻滞、经络不通为其病理基础,临床应温阳通络调和营卫并治。

中医药防治化疗后骨髓抑制研究进展

中医药防治化疗后骨髓抑制的常用治法有补肾生髓法、健脾养血法、解毒活血法、益气养阴法、疏肝调肝法等,疗效确切,不良反应少,可改善患者生活质量。目前,研究仍存在以下不足:临床研究中符合循证医学原则的多中心随机双盲对照研究较少,中医辨证分型尚缺乏统一的标准和客观依据与规范;中医药防治化疗后骨髓抑制与西医治疗的结合应用还不够充分;关于中医药抗化疗后骨髓抑制在细胞、分子微观水平方面的研究有一定进展,但由于中药方剂成分复杂,明确具体机制存在较大困难,联合用药的协同效应以及治疗效果的科学证据还相对不足。今后,需进一步探索和研究中医药防治化疗后骨髓抑制的临床应用前景,提高临床研究质量,深入研究中医药抗化疗后骨髓抑制的作用机理。

温阳法治疗慢性心力衰竭研究进展

慢性心力衰竭病机以心气心阳衰之脏腑虚损为本,以感受六淫邪气久病成瘀血、痰湿、瘀毒等病理产物为实。综合各家经验,慢性心力衰竭辨证多以复合证为主,阳虚类证型最为常见。临床多采用温阳养心、温阳利水、温阳益气、温阳活血(通络)、益气温阳活血利水的内治法和艾灸、穴位贴敷、奄包热熨等外治法进行治疗,疗效确切。目前,温阳法治疗本病的研究局限于名老中医经验及临床个案报道,样本量有限,中心单一,缺乏治疗后临床随访以考量长期疗效,且各个医家对运用温阳法的组方用药不尽相同,方剂内含药物的作用机制未能完全明确。温阳法与其他治法组成的复合治法在治疗本病时也未有系统归纳和统一,故今后应展开多中心、大样本的中医药临床、动物及药理实验研究,注重追踪随访,对温阳类治法进行系统归纳,制定统一标准,并挖掘温阳类药物的作用机制,从而有力发挥温阳法治疗本病的优势。

活血和益气方药对心肌梗死后左心衰大鼠左心室重构影响的比较研究

目的 :对比观察活血、益气方药对心肌梗死 (心梗 )后左心衰大鼠左心室重构的影响。方法 :采用心梗后左心衰大鼠动物模型 ,比较观察由丹参、川芎、红花组成的活血注射液和由党参、黄芪组成的益气注射液对心梗后左心衰大鼠心脏形态学结构及胶原成分、心脏湿重 /体重、左心腔面积、心梗区左室壁变薄比、单位面积内心肌细胞核数等指标的影响。结果 :活血、益气注射液组较模型组心梗健存区心肌细胞周围胶原组织明显减少 ,心脏湿重 /体重比值变小 (P <0 0 5 ) ,单位面积内心肌细胞核数明显增多 (P <0 0 5 ) ,左心腔面积明显缩小 (P <0 0 5 )。结论 :无正性肌力作用的活血注射液与益气注射液对心梗后心衰大鼠左心室重构均有一定的抑制作用。

益气活血中药联合常规西药治疗冠心病心肌缺血气虚血瘀证临床研究

目的观察益气活血中药联合常规西药治疗冠心病心肌缺血气虚血瘀证的疗效。方法将124例冠心病心肌缺血中医证属气虚血瘀证患者随机分为治疗组(78例)和对照组(46例),治疗组采用常规西药+益气活血中药治疗,对照组仅用常规西药治疗。疗程6周。观察2组患者心电图、左心室功能和临床症状等变化情况。结果治疗组心电图∑ST、NST和左心室功能改善、心绞痛缓解情况明显优于对照组,且对胸闷、心悸、气短、乏力等改善作用显著(P<0.05或P<0.01)。结论益气活血中药联合西医常规治疗可明显提高冠心病心肌缺血气虚血瘀证的临床疗效。

通冠胶囊对冠心病介入术后气虚血瘀证患者的影响

目的观察益气活血中药通冠胶囊对经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后气虚血瘀证患者的影响。方法将100例成功施行PCI患者分为两组,每组50例。对照组手术前、中、后选用抗栓、抗凝等西药常规治疗。治疗组在对照组治疗基础上加用通冠胶囊,两组疗程均为1个月。于术前1天、术后3天和术后30天3个时间点观察以下项目:心绞痛疗效、主要中医证候、气虚证评分和血瘀证评分。结果治疗后治疗组心绞痛疗效96.0%(48/50例),对照组为92.0%(46/50例),组间差异无统计学意义(P>0.05)。PCI术后3天两组气虚证积分较术前有增加趋势,术后30天对照组较术前明显升高;术后3、30天两组血瘀证积分较术前明显降低(P<0.05)。治疗组术后30天气虚证积分和血瘀证积分较对照组均明显降低(P<0.05)。结论益气活血中药通冠胶囊能显著改善PCI术后患者气虚血瘀证表现。

鲜益母草胶囊和益母草流浸膏对血液系统影响的比较研究

目的 :观察鲜益母草胶囊对动物血液系统的作用 ,以求证其活血化瘀功效。方法 :运用自然出血法、毛细管凝血法、烫伤致瘀法、优球蛋白降解法和微循环观察法分别观察鲜益母草胶囊对大小鼠出血、凝血、血瘀、纤溶及微循环的影响 ,并与益母草流浸膏进行比较。结果 :鲜益母草胶囊对大鼠出血时间没有明显影响 ;高剂量鲜益母草胶囊能延长小鼠的凝血时间 ;能明显对抗烫伤大鼠血小板聚集活性的增高 :能明显缩短大鼠优球蛋白溶解时间 (EL T) ,提高纤溶活性 ;显著改善大鼠肠系膜微循环。结论 :与益母萆流浸膏比较 。

益气活血法对脑出血大鼠脑内凝血酶敏感蛋白-1及其受体CD36表达的影响

目的通过观察益气活血法对脑出血大鼠脑内损伤区凝血酶敏感蛋白-1(thrombospondin-1,TSP-1)及其受体CD36表达的影响,初步探讨益气活血法治疗脑出血的机制。方法将155只SD大鼠随机分为正常组、假手术组、模型组、益气活血组、益气组和活血组;用Ⅶ型胶原酶诱导脑出血大鼠模型,再对相应的组分别灌服补阳还五汤及该方的益气药组和活血药组,在不同的时间点取脑组织并用免疫印迹(Western-blotting)分析鼠脑TSP-1及CD36的表达。结果正常组和假手术组不同时间点TSP-1和CD36表达无明显变化。模型组TSP-1在脑出血后4 d达高峰,CD36分别在脑出血后4、28 d达高峰。益气活血组1 d TSP-1表达低于模型组(P<0.01),4 d TSP-1和CD36表达均低于模型组(P<0.01),28 d CD36表达高于模型组(P<0.01)。结论益气活血法有可能通过影响脑出血后损伤区TSP-1及其受体CD36的表达,降低其对血管新生的抑制作用,促进新生血管成形、成熟和脑组织修复。