Comparing the mechanism of four classic Gualou-Xiebai prescriptions for cardiovascular diseases with phlegm and blood stasis syndrome based on molecular network modeling

Background:Four classical Traditional Chinese Medicine prescriptions,namely Gualou Xiebai Baijiu decoction,Gualou Xiebai Banxia decoction(GLXBBX),Zhishi Xiebai Guizhi decoction(ZSXBGZ)and Danlou prescription(DL),have been frequently used for treatment of phlegm and blood stasis syndrome(PBSS)-related cardiovascular diseases.However,its therapeutic mechanism has not been clearly elucidated.This study aimed to explore PBSS and its molecular mechanism,clarify and compare the mechanisms of four prescriptions in treating PBSS-related diseases.Method:In this study,we collected four prescriptions’compounds,predicted therapeutic targets,and enriched pathways which were based on network pharmacology.Then,we analysed the commen and different mechanisms by combing the network of components,targets and pathways.Finally,molecular docking was engaged to assess the binding potential of key compounds and hub targets.Results:We showed that four prescriptions’intersection genes(VEGFA,SRC,EGFR,etc.)were commonly enriched in PI3K-AKT signaling pathway,HIF-1 signaling pathway,etc.In addition,platelet activation and cAMP signaling pathway were singly enriched from the GLXBBX through unique compounds 12,13-epoxy-9-hydroxynonadeca-7,10-dienoic acid and Cyclo(L-tyrosyl-L-phenylalanyl).These bioactive compounds may exert GLXBBX’s unique pharmacological pathways via involving in mediating PPARA,PTGER3,etc.Sphingolipid signaling pathway was singly enriched from the ZSXBGZ through unique compounds tetramethoxyluteolin,ergosterol peroxide,etc.These bioactive compounds could mediate ADORA1,ADORA3 and TNFRSF1A to regulate ZSXBGZ’s unique pharmacological pathways.AMPK signaling pathway was singly enriched from the DL through unique compounds kaempferol,evofolinb,ethyl acid and aureusidin.These bioactive compounds were involved in mediating the main targets of AMPK signaling pathway,such as TNF,TNFRSF1A,etc.Conclusions:Our research demonstrated that GLXB-prescriptions involved in almost all pathological stages of PBSS-related cardiovascular diseases by modulating high-frequency shared pathways and targets mainly through key compounds(quercetin,mandenol,sitosteryl acetate and luteolin,etc.),for example,participate in the process of atherosclerosis,lipid metabolism,inflammation,immune response,thrombosis,inhibit inflammatory factors and platelet aggregation,regulate immune function,vascular function,oxidative stress.In addition to common pharmacological efficacies,there could also be specificities among GLXB prescriptions due to different compounds.For example,GLXBBX tends to regulate the function of vascular and endothelial barrier,prevent thrombosis.ZSXBGZ tends to regulate lipid metabolism and protect the heart from lipid accumulation.DL tends to maintain energy homeostasis and improve inflammation.

Efficacy of Danlou Tablet in the Treatment of Coronary Heart Disease with Phlegm and Blood Stasis Syndrome and Its Effects on Serum Inflammatory Factors

[Objectives] To explore the efficacy of Danlou Tablet( DLT) in the treatment of coronary heart disease( CHD) with phlegm and blood stasis syndrome and its effects on serum inflammatory factors. [Methods]One hundred and ninety-seven patients with CHD and phlegm and blood stasis syndrome in our hospital from January 2016 to January 2018 were selected and randomly divided into two groups: control group( n =98) treated with aspirin plus atorvastatin,and research group( n =99) treated with DLT and aspirin plus atorvastatin for one month. The clinical efficacy and incidence of adverse reactions were observed. Serum secretory phospholipase A2( s PLA2),lipoprotein-associated phospholipase A2( LP-PLA2),oxidized low-density lipoprotein( ox-LDL),monocyte chemoattractant protein-1( MCP-1) and World Health Organization Quality of Life( WHOQOL-100) scores were compared before and after one month of treatment. [Results] The total effective rate was93. 94% in the research group,which was higher than that in the control group( 79. 59%,P < 0. 05);the levels of serum s PLA2,LP-PLA2,ox-LDL and MCP-1 in the research group were lower than those in the control group after one month of treatment( P < 0. 05). There was no statistical significance of the difference in the total incidence of adverse reactions between the research group and the control group( P > 0. 05).After one month of treatment,WHOQOL-100 scores were higher in two groups,which were higher in the research group than that in the control group( P < 0. 05). [Conclusions]DLT can significantly reduce the level of serum inflammatory factors,improve the quality of life in patients with CHD and phlegm and blood stasis syndrome.

Effect of Gualou Xiebai Banxia decoction combined with Danshen Decoction on clinical efficacy of unstable angina with phlegm and blood stasis syndrome

Objective:To observe the clinical efficacy and safety of Gualou Xiebai Banxia decoction combined with Danshen decoction on unstable angina(UA)with phlegm and blood stasis syndrome.Method:Eighty patients with UA were randomly divided into treatment group(40 cases)and control group(40 cases)by random number table.The control group was given conventional western medicine treatment,and the experimental group was given Gualou Xiebai Banxia decoction and Danshen decoction on the basis of the control group.Both groups were treated for 4 weeks.Before and after treatment,the angina attacks,dosage of nitroglycerin,traditional Chinese medicine syndrome score,quality of life score,blood lipid,coagulation index and clinical total efficacy were observed and recorded.Results:After 4 weeks of treatment,the attack times and duration of angina in the two groups were both decreased compared with those before treatment.And the treatment group was more significantly reduced than the control group,the difference was statistically significant(p<0.05);the consumption of nitroglycerin of the treatment group was 90.0%,which was better than 67.5%of the control group,the difference was statistically significant(p<0.05);the total effective rate of the treatment group was 90%,which was better than 65%of the control group,the difference was statistically significant(p<0.05);the traditional Chinese medicine(TCM)syndrome score of the experimental group was lower than that of the control group,the differences was significant(p<0.05).The improvement of low density lipoprotein(LDL-C),total cholesterol(TC)and prothrombin time(PT)in the experimental group was better than that in the control group(p<0.05).During the study,there were no obvious adverse reactions in both groups.Conclusion:Gualou Xiebai Banxia decoction combined with Danshen decoction can effectively relieve the attack of angina and the consumption of nitroglycerin,improve clinical symptoms,regulate blood lipid and blood flow state,and improve the quality of life of patients with UA,with good clinical efficacy and safety.

Study on Correspondence between Prescription and Syndrome and the Essence of Phlegm and Blood Stasis Syndrome in Coronary Heart Disease Based on Metabonomics

Studying the essence of a syndrome has been a key challenge in the field of Chinese medicine.Until now,due to limitations of the methods available,the progress towards understanding such complicated systems has been slow.Metabonomics encompasses the dynamics,composition and analysis of metabolites,enabling the observation of changes in the metabolic network of the human body associated with disease.Being from the point of view of the whole organism,metabonomics provides an opportunity to study the essence of a syndrome to an unprecedented level.Phlegm and blood stasis syndrome is the main syndrome associated with coronary heart disease（CHD）,which bring difficulties in clinical treatment due to difficulties associated with differentiation of symptoms and signs.The fundamental differences of material between the two also need to be interpreted.The authors consider that we can use the method of combining a disease（in this case CHD）with associated syndromes（phlegm and blood stasis syndrome）to select patients with phlegm and blood stasis syndrome of CHD,and utilize metabonomics to explore the essence of the syndrome by difference analysis of metabolite spectra.Meanwhile,we can study the syndrome in CM,observe the change regularity of metabolism spectra after the treatment of corresponding and non-corresponding prescription and syndrome,in order to validate the material fundament in the progress of syndrome formation and their differences.This will not only have great significance in enhancing the ability to identify syndrome of phlegm and blood stasis in CHD and to establish the clinical curative criteria,but will also offer a new approach of studying the essence for a syndrome using metabonomics.

Diagnostic Accuracy of Chinese Medicine Diagnosis Scale of Phlegm and Blood Stasis Syndrome in Coronary Heart Disease: A Study Protocol

Background Phlegm and blood stasis syndrome(PBSS) is one of the main syndromes in coronary heart disease(CHD). Syndromes of Chinese medicine(CM) are lack of quantitative and easyimplementation diagnosis standards. To quantify and standardize the diagnosis of PBSS, scales are usually applied. Objective: To evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. Methods: Six hundred patients with stable angina pectoris of CHD, 300 in case group and 300 in control group, will be recruited from 5 hospitals across China. Diagnosis from 2 experts will be considered as the "gold standard". The study design consists of 2 phases: pilot test is used to evaluate the reliability and validity, and diagnostic test is used to assess the diagnostic accuracy of the scale, including sensitivity, specificity, likelihood ratio and area under the receiver operator characteristic(ROC) curve. Discussion: This study will evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. The consensus of 2 experts may not be ideal as a "gold standard", and itself still requires further study.(No. ChiCTR-OOC-15006599).

Summary of 32 Patients with Cardiac Syndrome X Treated by TCM Therapy of Regulating Qi Relieving Chest Stuffiness and Promoting Blood Circulation

Objective： To evaluate the clinical effect of Liqi Kuanxiong Huoxue method （宽胸活血,LKH, traditional Chinese medicine, TCM therapeutic method for regulating qi, relieving chest stuffiness and promoting blood circulation） in treating patients with cardiac syndrome X （CSX）. Methods： The prospective, non-randomized controlled study was conducted on 51 selected patients with CSX, who were non-randomly assigned to 2 groups, the treated group treated with LKH in addition to the conventional treatment （32 patients）, and the control group treated with conventional treatment （19 patients） like nitrate, diltiazem hydrochloride, etc. The treatment course was 14 days. The changes of such symptoms as angina pectoris, TCM syndrome and indexes of treadmill exercise test before and after treatment were observed. Results： After treatment, such symptoms as chest pain and stuffy feeling and palpitation in the treated group were improved more than those in the control group （P〈0.05）; the total effective rate on angina pectoris and TCM syndrome in the treated group was better than that in the control group （P〈0.05）. The treadmill exercise test showed that the maximal metabolic equivalent （Max MET）, the time of angina onset and ST segment depression by 0.1 mV were obviously improved after treatment in both groups, but the improvement in the treated group was better than that in the control group respectively （P〈0.05）. Conclusion： The LKH method could reduce the frequency of angina attacks and improve the clinical condition of patients with CSX.

身痛逐瘀汤加味联合盐酸普拉克索片治疗痰瘀痹阻型不宁腿综合征的临床观察

目的观察身痛逐瘀汤加味联合盐酸普拉克索片治疗痰瘀痹阻型不宁腿综合征(RLS)患者的临床疗效。方法将50名痰瘀痹阻型RLS患者按照随机数字表法分为2组,对照组25例予盐酸普拉克索片治疗,治疗组25例在对照组基础上联合身痛逐瘀汤加味治疗。2组均治疗1周为1个疗程,治疗2个疗程后统计疗效,比较2组治疗前后国际RLS严重程度评分量表(IRLS)评分、匹兹堡睡眠质量指数量表(PSQI)评分及中医症状评分变化情况。结果治疗组总有效率92.00%(23/25),对照组总有效率60.00%(15/25),治疗组总有效率高于对照组(P<0.05)。与本组治疗前比较,2组治疗后IRLS评分、PSQI评分及中医症状评分均降低(P<0.05),且治疗组治疗后IRLS评分、PSQI评分及中医症状评分均低于对照组(P<0.05)。结论身痛逐瘀汤加味联合盐酸普拉克索片治疗痰瘀痹阻型RLS疗效确切,可有效改善患者临床症状及中医症状,改善患者睡眠质量,操作简便,临床疗效显著,安全性良好。

半夏白术天麻汤合通窍活血汤联合治疗痰瘀互结型高血压颈动脉斑块疗效及对中医证候积分和血脂代谢的影响

目的:观察半夏白术天麻汤合通窍活血汤联合治疗痰瘀互结型高血压(HTN)颈动脉斑块疗效及对中医证候积分和血脂代谢的影响。方法:选取我院2021年1月~2022年6月收治的HTN伴颈动脉斑块患者62例。按照随机数字表法将患者分为治疗组(n=31)与对照组(n=31),两组均予以基础治疗,对照组以西药服用治疗,治疗组以西药+半夏白术天麻汤合通窍活血汤治疗,比较治疗后临床疗效,治疗前后中医症候积分、血压监测、血脂水平、超声检查[颈动脉内膜-中层厚度(IMT)、Grouse积分]、实验室指标[同型半胱氨酸(Hcy)、C反应蛋白(CRP)]。结果:治疗4个疗程后,治疗组临床疗效为28/31(90.32%)较对照组22/31(70.97%)更高(P<0.05);两组中医证候积分、收缩压(SBP)、舒张压(DBP)、低密度脂蛋白(LDL-C)、总胆固醇(TC)、甘油三酯(TG)、IMT、Crouse积分、血清Hcy、CRP水平均降低(P<0.05),且治疗组降幅高于对照组(P<0.05);两组高密度脂蛋白(HDL-C)均升高(P<0.05),且治疗组升幅高于对照组(P<0.05)。结论:半夏白术天麻汤合通窍活血汤联合治疗痰瘀互结型HTN伴颈动脉斑块可通过调节血脂代谢及血压水平,有效促进斑块消除,进而改善患者临床症状。

慢性心力衰竭气虚血瘀证潜在亚组人群特征探索研究

目的探索慢性心力衰竭(CHF)气虚血瘀证潜在亚组人群,为心力衰竭的中医精准辨治提供客观依据。方法收集126例CHF气虚血瘀证患者的19种症状/体征指标和21种生化指标,利用R和Python软件进行K-mediods聚类算法分析,以轮廓系数确定最佳的聚类数目。组间比较,连续变量采用Kruskal-Wallis检验,分类变量采用Pearson's chi-squared检验或者Fisher's exact检验。结果CHF气虚血瘀证患者被聚类为3组,组间比较发现,气喘、不寐、颈脉怒张、纳差、畏寒5个症状/体征以及NYHA分级、氨基末端脑钠肽前体(NT-proBNP)、红细胞比容、尿素氮4个临床指标差异具有统计学意义(P<0.05)。第1组人群整体各症状/体征发生频率和临床指标严重程度相对较低;第2组人群以颈脉怒张发生频率较其他组高为特征,且促甲状腺激素、总胆固醇及低密度脂蛋白有偏高趋势,血小板有偏低的趋势;第3组人群以畏寒、纳差、不寐的发生率较其他组显著升高为特征,伴随尿素氮增高、红细胞比容降低。结论CHF气虚血瘀证潜在3种亚型,分别是气虚血瘀证本证型、气虚血瘀兼痰浊型、气虚血瘀兼阳虚型。

益气复脉方治疗气虚血瘀、痰瘀互阻型室性期前收缩的临床疗效

目的:观察益气复脉方治疗气虚血瘀、痰瘀互阻型室性期前收缩的临床疗效。方法:选取2021年8月—2022年8月在北京中医药大学东方医院住院治疗的室性期前收缩病人60例,按照随机数字表法分为对照组和治疗组。在常规治疗基础上,治疗组采用益气复脉方(颗粒剂)治疗,对照组采用颗粒安慰剂治疗。评估并比较两组治疗前后室性期前收缩数量变化,中医证候积分及中医单项症状心悸、气短、神疲乏力、胸闷、胸痛、痰浊、自汗、食少纳呆积分变化。结果:治疗后,治疗组室性期前收缩数量较治疗前减少,且治疗组少于对照组,差异有统计学意义(P<0.05)。治疗后,两组中医证候总积分较治疗前降低,且治疗组低于对照组,差异均有统计学意义(P<0.001)。治疗后,两组心悸、气短、神疲乏力、胸闷、胸痛、痰浊、自汗、食少纳呆的症状积分均较治疗前降低,且治疗组低于对照组,差异均有统计学意义(P<0.05)。治疗后,治疗组总有效率高于对照组,差异有统计学意义(77.8%与24.0%,P<0.05)。结论:益气复脉方可减少气虚血瘀、痰瘀互阻型室性期前收缩病人室性期前收缩次数,改善中医证候。

益气活血祛痰方治疗支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证的研究

目的评价益气活血祛痰方联合西医治疗慢性持续期支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证患者的临床疗效。方法选择2016年1月—2021年6月于泰州市第四人民医院就诊的80例慢性持续期支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证患者,根据随机数字表分成对照组及观察组各40例,对照组给予常规治疗及持续气道正压通气,观察组在对照组治疗基础上给予益气活血祛痰方水煎液口服,2组均持续干预3个月。观察2组患者治疗前后中医证候积分(包括气喘、咳嗽、咳痰、打鼾、憋醒、日间嗜睡、倦怠乏力)、哮喘控制测试问卷(ACT)评分、圣乔治呼吸问卷(SGRQ)评分、Epworth嗜睡量表(ESS)评分、匹兹堡睡眠指数(PSQI)评分、肺功能指标[呼气峰值流速(PEF)、第一秒用力呼气容积占预计值百分比(FEV_(1)%预计值)、第一秒用力呼气容积与用力肺活量比值(FEV_(1)/FVC)]、多导睡眠图参数[呼吸暂停低通气指数(AHI)、快速眼动睡眠期(REM)、氧减指数(ODI)、动脉血氧饱和度(SaO_(2))、最低SaO_(2)、觉醒指数]、炎症相关指标[血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)水平和呼出气一氧化氮(FeNO)水平]变化,统计2组总体治疗效果及不良反应发生情况。结果2组治疗后中医证候积分、SGRQ评分、ESS评分、PSQI评分、AHI、ODI、觉醒指数及血清CRP、IL-6、TNF-α、VEGF水平和FeNO水平均较治疗前明显降低(P均<0.05),且观察组上述各项指标均明显低于对照组(P均<0.05);2组治疗后ACT评分、PEF、FEV_(1)%预计值、FEV_(1)/FVC、REM、SaO_(2)、最低SaO_(2)均较治疗前明显升高(P均<0.05),且观察组上述各项指标均明显高于对照组(P均<0.05)。观察组治疗3个月后的总有效率明显高于对照组[92.5%(37/40)比82.5%(33/40),P<0.05],治疗期间不良反应发生率明显低于对照组[10.0%(4/40)比27.5%(11/40),P<0.05]。结论益气活血祛痰方联合西医治疗支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证患者的效果优于单纯西医治疗,在减轻患者临床症状,控制哮喘发作,改善肺功能和睡眠质量方面具有明显优势,其作用机制可能与抑制炎症反应相关。

急性期缺血性中风血瘀证患者中医护理的应用效果观察

目的探索活血化瘀中医护理方案对急性期缺血性中风血瘀证患者的应用效果。方法选择2023年12月—2024年5月中国中医科学院西苑医院脑病科住院的缺血性中风血瘀证患者82例,采用随机信封法分为2组,对照组给予常规治疗及中风急性期中医护理方案,观察组在对照组的基础上,根据患者不同血瘀类型给予理气活血、补气活血、祛痰活血、温阳活血中医护理方案,干预时长为2周,对比干预前后2组中医证候分级量化表得分、美国国立卫生研究院卒中量表(NIHSS)得分、日常生活活动能力(ADL)及血瘀证得分。结果干预结束,2组ADL得分(Z=-2.24,P=0.025)、中医证候分级量化表得分(Z=3.102,P=0.036)、NIHSS得分(Z=2.27,P=0.023)、血瘀证得分(Z=-3.309,P=0.036)比较,差异均有统计学意义。结论活血化瘀中医护理可改善缺血性中风血瘀证患者的血瘀状况、神经功能缺损、日常生活活动能力、中医治疗结局。

淋巴瘤证型及其“痰瘀”证素与趋化因子及凝血指标的相关性研究

目的分析淋巴瘤证型和主要病性证素“痰瘀”与常见趋化因子及其受体、凝血指标的相关性,初步探讨淋巴瘤“痰瘀”证素的现代科学本质。方法选择198例淋巴瘤患者,统计并分析不同证型患者趋化因子及受体(CXCL2、CXCR2、CXCL8、CXCL12、CXCR4)和凝血指标(PT、APTT、FIB、FDP、D-D)水平差异;并采用二元Logistic回归分析探讨“痰”、“瘀”与上述各指标的相关性。结果CXCL2、CXCR2、CXCR4、CXCL8、PT、APTT、FIB、FDP、D-D在不同证型中均有差异(P<0.05),在痰瘀互结证型的表达水平高于其他证型(P<0.05);CXCL12在不同证型之间的水平差异无统计学意义(P>0.05)。痰、瘀是淋巴瘤最主要的病性证素,其中CXCR2、CXCR4、D-D、FIB对“痰”有影响,D-D与“瘀”有密切相关性。结论淋巴瘤证型、“痰瘀”证素与常见趋化因子及其受体、凝血指标具有明确相关性,趋化因子和凝血功能异常可能是淋巴瘤“痰瘀”证素相关的生物标志物。

降脂膏联合瑞舒伐他汀钙片治疗颈动脉易损斑块痰瘀互结证

目的探讨降脂膏联合瑞舒伐他汀钙片治疗颈动脉易损斑块痰瘀互结证临床疗效。方法按照随机数字表法将120例颈动脉易损斑块痰瘀互结证患者分成对照组与观察组,各60例。对照组采用瑞舒伐他汀钙片治疗,观察组在对照组基础上联合降脂膏治疗。观察2组治疗前后眩晕、头痛、耳鸣、肢体疼痛或麻木、胸胀中医证候积分、颈动脉超声相关指标IMT值、颈动脉斑块面积、颈总动脉收缩期Vmax、舒张期Vmin、颈总动脉RI、血清学指标肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、hs-CRP、血脂水平、凝血指标凝血酶原时间(PT)、D-二聚体、凝血酶原国际标准化比(INR)水平变化,比较2组治疗总有效率及安全性。结果观察组治疗后各项中医证候积分、IMT值、颈动脉斑块面积、颈总动脉RI、TNF-α、IL-6、hs-CRP、TG、TC、LDL-C、PT、D-二聚体、INR水平均低于对照组(P<0.05),颈总动脉收缩期Vmax、舒张期Vmin、HDL-C水平及治疗总有效率均高于对照组(P<0.05);2组治疗期间均无明显不良反应发生。结论降脂膏联合瑞舒伐他汀钙片能够显著缓解颈动脉易损斑块痰瘀互结证症状,降低血脂指标、血液高凝态、炎症因子,改善颈动脉血流速度。

王文萍从痰瘀论治肺癌经验

王文萍教授认为,肺癌病机为痰瘀互结,临证以活血化瘀、调畅气机为主,软坚散结、化痰祛瘀为辅,方用血府逐瘀汤合二陈汤化裁治疗肺癌,同时注重对患者进行心理疏导,减轻其精神压力,以达到标本兼治的目的。本文从病因病机、治法治则、遣方用药总结王文萍教授治疗肺癌的临证经验,并附验案一则,以期较为全面地分析王文萍从痰瘀论治肺癌的学术思想。

温胆汤加减治疗气虚血瘀痰阻型缺血性脑卒中急性期的疗效及对NT-proBNP、ICAM-1和MCP-1的影响研究

目的:探讨温胆汤加减治疗气虚血瘀痰阻型缺血性脑卒中急性期患者的疗效,以及对N末端脑钠肽前体(NT-proBNP)、细胞间黏附分子-1(ICAM-1)和单核细胞趋化蛋白-1(MCP-1)水平的影响。方法:以2021年5月至2022年5月该院收治的气虚血瘀痰阻型缺血性脑卒中急性期患者100例为研究对象,根据随机数字表法分为对照组和观察组,每组50例。对照组患者给予常规治疗,观察组患者在对照组的基础上给予温胆汤加减治疗。比较两组患者的临床疗效,NT-proBNP、ICAM-1和MCP-1水平,美国国立卫生院卒中神经功能缺损评分量表(NIHSS)评分、改良Rankin量表(mRS)评分及中医证候积分。结果:治疗1个月后,观察组患者的总有效率为94.00%(47/50),显著高于对照组的80.00%(40/50),差异有统计学意义(P<0.05)。治疗1个月后,观察组患者NT-proBNP、ICAM-1和MCP-1水平显著低于对照组,血液流变学各指标(血浆黏度、血低切黏度、血高切黏度、纤维蛋白原和红细胞压积)水平显著低于对照组,差异均有统计学意义(P<0.05)。治疗7 d、1个月后,观察组患者的NIHSS评分低于对照组;治疗1个月后,观察组患者的mRS评分、中医证候积分低于对照组,差异均有统计学意义(P<0.05)。结论:温胆汤加减治疗气虚血瘀痰阻型缺血性脑卒中急性期患者的效果较好,可显著降低NT-proBNP、ICAM-1和MCP-1水平,促进血液流通和疾病的恢复,提高患者的生活质量。

基于“三因四证”调整免疫炎症状态的中医药治疗心血管疾病研究述评

动脉粥样硬化是心血管疾病发生发展的重要病理基础,物质代谢异常和免疫炎症反应是其发生发展的重要原因,由此导致的免疫炎症状态贯穿其病理始终。本文以“病”(心力衰竭)为切入点,结合心脉相关理论,总结气、血、水“三因”病机与免疫炎症状态的相关性。心气、心血、心水异常可出现在心力衰竭的不同阶段,持续的免疫炎症状态贯穿心力衰竭始终。同时,岭南地区常年湿热的气候环境因素及人群气虚、阳虚和湿热体质与免疫炎症状态发生密切相关,“积湿生热”及“湿自热生”的湿热相互转化机制使得岭南地区心血管疾病的病机以气虚痰浊夹瘀多见。在此基础上,痰、瘀、湿、热等伏匿机体的多种病理产物在疾病发展过程中累积,久酿而成内生伏毒,由此总结性归纳将痰、瘀、湿、毒“四证”与免疫炎症状态紧密联系。本文用“病—证—治”关联视角探讨中医药防治心血管疾病,融合治未病思想,从理论到应用,从基础到临床,以期为进一步制定和实施中医药诊疗方案提供理论指导。

益肾通脉膏方对脉络膜前动脉区脑梗死(肾虚血瘀痰阻证)神经功能恢复的疗效及血清脑源性神经营养因子的影响

目的探讨益肾通脉膏方在肾虚血瘀痰阻证脉络膜前动脉(anterior choroidal artery,AchA)区脑梗死患者中的应用效果。方法选取2021年12月—2023年9月泰安市中医医院收治的80例肾虚血瘀痰阻证AchA区脑梗死患者为研究对象,以治疗方法的不同分为两组,各40例。对照组行阿司匹林肠溶片治疗,观察组在对照组基础上增加益肾通脉膏方治疗。对比两组临床疗效、神经功能、日常生活能力、血清脑源性神经营养因子(brain derived neurotrophic factor,BDNF)水平及不良反应发生情况。结果观察组治疗总有效率为92.50%(37/40),高于对照组的75.00%(30/40),差异有统计学意义(χ^(2)=4.501,P<0.05)。治疗前,两组美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、Barthel指数(Barthel Index,BI)、改良Rankin量表(Modified Rankin Scale,mRS)评分、BDNF水平比较,差异无统计学意义(P均>0.05)。治疗后,观察组NIHSS评分、mRS评分、BI、BDNF水平均优于对照组,差异有统计学意义(P均<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论益肾通脉膏方能够减轻肾血瘀痰阻证AchA区脑梗死患者的神经功能损伤,提升日常生活能力,调节血清BDNF水平,且无严重不良反应。

化痰通络颗粒治疗不同中医证型稳定型心绞痛的疗效观察

目的:探讨化痰通络颗粒治疗不同中医证型稳定型心绞痛(SAP)的疗效差异。方法:纳入219例瘀证SAP患者,并根据中医证型分为气虚血瘀组53例、痰瘀互结组63例、气滞血瘀组56例、痰浊闭阻组47例,另纳入50例瘀证SAP患者为对照组。所有患者均接受常规治疗,除对照组外,其余患者均在常规治疗基础上予化痰通络颗粒治疗,连续治疗4周。观察治疗前后中医证候疗效、心绞痛情况、心功能、脂代谢、凝血功能。结果:治疗后,气虚血瘀组、痰瘀互结组、气滞血瘀组、痰浊闭阻组患者疗效均优于对照组(P<0.05),且痰瘀互结组和痰浊闭阻组患者疗效均优于气虚血瘀组和气滞血瘀组(P<0.05)。治疗后,5组患者心绞痛症状积分均低于治疗前(P<0.05),且气虚血瘀组、痰瘀互结组、气滞血瘀组、痰浊闭阻组患者心绞痛症状积分均低于对照组(P<0.05),痰瘀互结组、痰浊闭阻组患者心绞痛症状积分均低于气虚血瘀组和气滞血瘀组(P<0.05)。治疗后,5组患者左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)均低于治疗前,射血分数(EF)、每搏输出量(SV)均高于治疗前(P<0.05),且痰瘀互结组、痰浊闭阻组患者LVEDD、LVESD均低于对照组,EF、SV均高于对照组(P<0.05)。治疗前痰浊闭阻组、痰瘀互结组患者总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)水平均高于气虚血瘀组、气滞血瘀组、对照组;治疗后,5组患者TC、TG、LDL均低于治疗前,HDL均高于治疗前(P<0.05)。治疗后,5组患者纤维蛋白原(FIB)、凝血酶时间(TT)均低于治疗前,活化部分凝血活酶时间(APTT)均高于治疗前,且痰瘀互结组、痰浊闭阻组患者FIB、TT水平均低于气虚血瘀组、气滞血瘀组和对照组(P<0.05)。结论:化痰通络颗粒治疗不同中医证型的稳定型心绞痛均有一定效果,联合西医治疗应用优于单独西医治疗,且其更适用于痰瘀互结证和痰浊闭阻证两种证型。

半夏白术天麻汤加减联合康复训练治疗风痰瘀阻型急性脑梗死合并H型高血压临床研究

目的:观察半夏白术天麻汤加减联合康复训练对风痰瘀阻型急性脑梗死合并H型高血压患者神经功能及生活质量的影响。方法:将182例风痰瘀血型急性脑梗死合并H型高血压患者按照随机数字表法分为对照组和观察组,每组各91例。两组均接受西医基础治疗,对照组给予康复训练治疗,观察组在对照组治疗的基础上联合半夏白术天麻汤加减。比较两组患者的临床疗效及治疗前后中医证候积分、美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分、世界卫生组织生活质量评定简表(world health organization quality of life-bref,WHOQOL-BREF)评分、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、同型半胱氨酸(homocysteine,Hcy)水平变化情况。结果:观察组有效率为94.51%,明显高于对照组的75.82%,差异具有统计学意义(P<0.05)。两组患者治疗后中医证候积分、NIHSS评分低于本组治疗前,WHOQOL-BREF评分高于本组治疗前,且治疗后组间比较,差异具有统计学意义(P<0.05)。两组患者治疗后HCY、SBP、DBP水平低于本组治疗前,且观察组治疗后低于对照组(P<0.05)。结论:半夏白术天麻汤加减结合康复训练治疗风痰瘀阻型急性脑梗死合并H型高血压,临床疗效确切,可促进患者神经功能的恢复,提高患者的生活质量。