浅谈疏肝滋阴法治疗抑郁症

抑郁症是常见精神科疾病。中药治疗抑郁症的理论及临床研究报道日益增多。本文通过病因病机的探讨,认为本病可为情志因素引起肝的疏泄功能下降,形成肝郁;肝失疏泄,影响及心、脾、肾,导致机体精、血、津液的亏虚,而成阴虚之候;反之,阴虚势必影响肝主疏泄,继而形成肝郁阴虚之证。故而临证时,应注意采用滋阴疏肝法以治疗本病。福建省自然科学基金(No.13141240); 厦门市科技计划项目(No.3502Z20133007

应用散剂破解中药“良药苦口”的思考

苦涩不适的口感已成为阻碍中医药发展亟待解决的问题。散剂具有汤剂随证加减的灵活性及良好的临床疗效。此外,散剂用量少,服用方便,能极大消除汤剂苦涩口感。随着中药超微粉与粒子设计等技术的应用,将有力地推动散剂品质提升,使得散剂有可能破解中药良药苦口之瓶颈。国家自然科学基金资助项目(No.81403331,No.81503529,No.81673660);;福建省自然科学基金资助项目(No.2014J01363);;福建省科技计划引导性项目(No.2016D012);;厦门市科技惠民计划项目(No.3502Z20174028

茵陈蒿汤防治大鼠非酒精性脂肪性肝炎的实验研究

目的:探索茵陈蒿汤对模型大鼠非酒精性脂肪肝的干预作用。方法:30只雄性Wistar大鼠随机分成正常组、模型组和茵陈蒿汤防治组,模型组和中药防治组给予高胆固醇高脂肪饮食喂养共12周以复制非酒精性脂肪性肝炎模型,中药防治组同时给予茵陈蒿汤灌胃12周。12周后处死大鼠收集标本,检测血清ALT、AST活性、TC含量,肝组织TG含量,对肝脏组织进行HE染色。结果:茵陈蒿汤能有效地减轻大鼠体重和肝重,明显减轻模型大鼠血清炎症损伤的病理状态,改善肝组织脂肪变性的病理状态。结论:茵陈蒿汤能够有效防治非酒精性脂肪性肝炎的病理损伤

Treatment of HBeAg Positive Chronic Hepatitis B by Xiaoyao Powder Combined with Interferon-α: a Clinical Observation

目的研究逍遥散联合α干扰素(InTErfErOn-AlPHA,Ifn-α)治疗HbEAg阳性慢性乙型肝炎疗效及对生活质量的影响。方法 193例经肝穿刺活检证实的HbEAg阳性慢性乙型肝炎患者,按照随机数字表法分为单药治疗组(94例)和联合治疗组(99例),单药治疗组给予Ifn-α1b,50μg/次,皮下注射,每周3次;联合治疗组在单药治疗组的基础上,配伍逍遥散口服,两组疗程均为24周。通过评价两组AlT复常率、HbEAg阴转率、HbEAg转换率、HbV dnA阴转率、完全应答率、部分应答率以及症状积分变化等观察逍遥散联合Ifn-α疗效;采用慢性肝病问卷(CHrOnIC lIVEr dISEASE QuESTIOnnAIrE,CldQ)评分进行生活质量评定;观察两组患者的不良反应发生率。结果联合治疗组在AlT复常率、HbEAg阴转率、HbV dnA阴转率、完全应答率、部分应答率、中医症状积分、中医症状总有效率、CldQ评分和不良反应发生率方面均优于单药治疗组(P<0.05,P<0.01)。结论逍遥散可提高Ifn-α治疗HbEAg阳性慢性乙型肝炎的中医症状疗效、抗病毒疗效,改善生活质量,减少Ifn-α不良反应。Objective To study the efficacy of Xiaoyao Powder( XYP) combined with interferon alpha( IFN-α) in treating HBeAg positive chronic hepatitis B( CHB) patients and the effect on their quality of life( QOL).Methods Totally 193 patients with HBeAg-positive CHB confirmed by liver biopsy were randomly assigned to 2 groups,Group A( 94 cases) and Group B( 99 cases).IFN-α1b was subcutaneously injected to patients in Group A at the dose of 50 μg,thrice per week.Those in Group B additionally took XYP.The therapeutic course for all was 24 weeks.Clinical efficacy was observed by assessing ALT restoration rate,HBeAg negative rate,HBeAg conversion rate,HBV DNA negative rate,complete response rate,partial response rate,and symptoms integral.The evaluation of QOL was performed by using chronic liver disease questionnaire( CLDQ) score.Adverse reaction occurrence rate was observed in the two groups.Results Better effects were obtained in Group A on ALT restoration rate,HBeAg negative rate,HBV DNA negative rate,complete response rate,partial response rate,TCM symptoms integral,the total effective rate of TCM sysmptoms,CLDQ score,and adverse reaction rates,showing statistical difference when compared with Group B(P <0.05,P <0.01).Conclusion XYP could elevate the efficacy of TCM symptoms of HBeAg-positive CHB patients and anti-viral effect,improve their QOL,and reduce adverse reaction of IFN-α.福建省卫生厅青年科研课题基金资助项目(No.2012-2-105

Essence of tongue diagnosis of HE Meng-yao

岭南,指中国五岭以南的地区,相当于现在广东、广西及海南全境。因气候炎热潮湿,人群多脾胃虚弱,病多阳虚、痰湿。从晋代以后,当地医家以中原医学为基础; ,结合岭南特殊气候和人群体质特点,逐渐形成独具风格的岭南医学流派。何梦瑶作为岭南名医之一,其医术高明,医学著作颇丰,极大地促进了岭南医学的发展。; 《医碥》是其代表作之一,亦是其学术思想的精髓,为现代研究何梦瑶学术思想和岭南医家流派的主要古籍。其中所记载的舌诊方法,至今仍具有临床实用意义。Lingnan, Chinese refers to the south of the five ridges area, which is; equivalent to the current Guangdong province, Guangxi province and; Hainan province. All due to the hot and humid climate, majority of local; people are with spleen and stomach deficiency, most of the clinical; manifestation are yang deficiency and dampness. After the Jin dynasty,; based on the traditional Chinese medicine of central plains, the local; doctors gradually formed their unique medical schools, combining with; the characteristics of the local climate and peoples constitutions. As; one of the famous specialists in the south of the five ridges, HE; Meng-yao, greatly promote the development of local medical health level.; Yibian is one of his famous masterpieces, which is also the essence of; the his medicine. Records of tongue diagnosis in this book are still; practical in clinical.国家自然科学基金资助项目; 福建中医药大学校管课题; 福建省科技计划引导性项

Efficacy of Zaozhu Yinchen Recipe for Treating Non-alcoholic Steatohepatitis and Its Effect on Free Fatty Acid and TNF-α

目的观察皂术茵陈方治疗非酒精性脂肪性肝炎(non-alcoholic steatohepatitis,NASH)患者的临床疗效,并探讨其对游离脂肪酸(free fatty acid,FFA)及TNF-α的影响。方法采用随机数字表法将120例NASH患者分为治疗组及对照组,每组60例。治疗组予中药皂术茵陈方,每日1剂;对照组予水飞蓟宾葡甲胺片200 mg口服,每日3次,两组均治疗24周。分别于治疗前后通过检测血清ALT、AST活性及TC、TG水平;行腹部CT计算肝脾CT比值;应用肝组织病理检查评价非酒精性脂肪性肝病活动度积分(NAFLD activity score,NAS)及纤维化程度以评价临床疗效;并检测血清FFA及TNF-α含量。结果与本组治疗前比较,两组治疗后血清ALT、AST、TC、TG、FFA、TNF-α水平、肝组织NAS积分及症状体征积分均明显降低,肝纤维化程度明显改善(P<0.05,P<0.01),且治疗组降低更明显(P<0.05)。治疗24周后,治疗组肝纤维化分期总有效率及临床总有效率分别为80.00%(48/60)、85.00%(51/60),明显高于对照组[60.00%(36/60)、73.33%(44/60)],两组比较,差异有统计学意义(P<0.05,P<0.01)。结论皂术茵陈方可改善NASH患者的临床疗效,其作用可能与抑制血清FFA及TNF-α水平有关。Objective To observe the efficacy of Zaozhu Yinchen Recipe(ZZYCR) on non-alcoholic steatohepatitis(NASH) patients, and to explore its effect on serum free fatty acid(FFA) and tumor necrosis factor α(TNF-α).Methods Totally 120 patients with NASH were randomly assigned to the treatment group(60 cases,treated with ZZYCR, one dose per day) and the control group(60 cases, treated with Silibin Meglumine Tablets, 20 mg each time, thrice per day). The therapeutic course for all was 24 weeks. Serum levels of ALT and AST activities, TC and TG levels were detected before and after treatment. Peritoneal CT was performed in all patients, and CT ratios of liver and spleen calculated. NAFLD activity score(NAS) and degree of hepatic fibrosis were assessed using pathological examinations of liver tissue, and efficacy also evaluated. Serum contents of FFA and TNF-αwere also detected. Results Compared with before treatment in the same group, activities of ALT and AST, serum levels of TC, TG, FFA, and TNF-α, NAS, scores of symptoms and signs all obviously decreased, degree of hepatic fibrosis was obviously improved in the two groups(P < 0. 05, P < 0. 01). These changes were more obviously seen in the treatment group(P < 0. 05). After 24-week treatment, the total effective rate and total clinical efficacy were 80. 00%(48/60 cases) and 85. 00%(51/60 cases) in the treatment group, obviously higher than those in the control group [60. 00%(36/60 cases) and 73. 33%(44/60 cases) respectively], with significant difference(P < 0. 05, P < 0. 01). Conclusion ZZYCR could improve the clinical efficacy of NASH patients, and its mechanism might be associated with inhibiting serum levels of FFA and TNF-α.国家自然科学基金资助项目(No.81503529,81274155);; 福建省自然科学基金面上资助项目(No.2014J01374);; 福建省卫生厅中医药项目(No.wzpw201308);; 厦门市科技计划项目(No.3502Z20134020

八神汤治疗腹泻型肠易激综合征的临床观察

目的:观察八神汤治疗腹泻型肠易激综合征的疗效及对生活质量的影响。方法:将105例腹泻型肠易激综合征患者按照随机数字表法分为治疗组(53例)和对照组(52例)。治疗组采用八神汤治疗;对照组口服匹维溴铵片,50Mg TId。两组疗程均为4周。观察两组治疗前后症状积分、生活质量评分、中医症状疗效及安全性评价。结果:治疗组主要症状积分改善程度优于对照组;治疗组中医症状疗效总有效率为86.54%,对照组中医症状疗效总有效率为66.0%,治疗组中医症状疗效优于对照组(P<0.05);治疗组治疗后CldQ各项积分改善程度优于对照组(P<0.01)。结论:八神汤是治疗腹泻型肠易激综合征行之有效的方法,值得进一步推广。福建省卫生厅青年科研课题(No.2012-2-105

皂术茵陈方治疗非酒精性脂肪性肝炎的临床观察及其对肠道菌群的影响

目的评价皂术茵陈方调节肠道菌群治疗非酒精性脂肪性肝炎(NASH)的临床疗效及其作用机制。方法选取福建中医药大学附属厦门市中医院肝病中心门诊就诊的NASH患者80例,采用随机数字表法分为治疗组(40例)和对照组(40例)。治疗组予中药皂术茵陈方治疗,对照组予以枯草杆菌二联活菌肠溶胶囊治疗,两组疗程均为12周。评价治疗前后两组患者的症状、体征积分以及血清ALT、AST活性;检测两组患者血清内毒素水平以及肠道菌群变化。结果治疗12周后,治疗组的临床总有效率达87.5%(35/40),较之对照组的65%(26/40)有统计学意义(χ~2=7.966,P<0.05);两组患者ALT、AST活性以及血清内毒素水平较治疗前均有明显下降(P<0.05),且以治疗组的ALT、AST活性下降值大于对照组(t=2.254,t=2.325,P<0.05);两组患者肠道菌群中的双歧杆菌、乳酸杆菌、拟杆菌数量较治疗前显著升高,而肠球菌、肠杆菌显著降低(P<0.05)。结论皂术茵陈方具有改善肝功能、治疗NASH的临床疗效,其作用机制与调节肠道菌群紊乱、恢复肠道微生态平衡、减轻肠源性内毒素血症相关。国家自然青年科学基金资助项目(No.81503529);;福建中医药大学临床专项校管课题基金(No.XB2016080

皂术茵陈方治疗非酒精性脂肪性肝炎40例临床研究

目的:观察皂术茵陈方治疗非酒精性脂肪性肝炎的临床疗效。方法:将78例患者单盲法随机分为治疗组40例和对照组38例;治疗组予中药皂术茵陈方治疗,对照组采用水飞蓟宾葡甲胺片(西利宾安)治疗;两组均治疗2个月。检测治疗前后患者血清谷丙转氨酶(AlT)、谷草转氨酶(AST)活性、血清总胆固醇(TCH)、甘油三酯(Tg)含量;比较患者肝脏b超变化以及症状、体征积分等临床疗效。结果:经过2个月治疗,治疗组的临床总有效率达87.50%,较之对照组的73.68%,差异有统计学意义(P<0.05);两组治疗后症状、体征积分、肝脏b超改善情况、血清AlT、AST活性、血清TCH、Tg含量均较各自治疗前显著改善;较之对照组,治疗组上述改善更加显著(P<0.05)。结论:中药皂术茵陈方对改善非酒精性脂肪性肝炎有较好的临床疗效,可明显改善患者肝功能、血脂、b超影像指标及临床证候。国家自然科学基金(No.81274155); 福建省卫生厅中医药项目(No.wzpw201408); 厦门市重大科技计划项目(No.3502Z20100006

Clinical Research of Kangshi Kangxian Recipe Treating on Hepatic Fibrosis of Chronic Hepatitis B

目的观察康氏抗纤方治疗慢性乙型肝炎肝纤维化的临床疗效,探讨其对肝组织N-花生四烯酸氨基乙醇(; arachidonoylethanolamine,AEA) 、2-花生四烯酸甘油( 2-arachidonoylglycerol,2-AG); 、大麻素受体1( cannabinoid receptor 1,CBR1) mRNA、大麻素受体2( cannabinoid receptor; 1,CBR2); mRNA含量变化的影响。方法将110例慢性乙型肝炎肝纤维化患者按随机数字表法分为治疗组和对照组,每组55例。治疗组予中药康氏抗纤方联合恩替卡韦分; 散片治疗,对照组用恩替卡韦分散片单药治疗,两组均治疗48周。判定两组临床疗效,检测血清ALT水平,HBV; DNA、HBsAg、HBsAb定量,肝组织病理、肝硬度变化,肝组织AEA、 2-AG含量和CBR1、CBR2; mRNA表达水平。结果与对照组比较,治疗组的临床总有效率、HBsAg阴转率、肝组织纤维化分期疗效有效率均高于对照组(chi~2 =; 4.453,4.152,6.364,均P < 0.05); 。与本组治疗前比较,治疗后两组患者肝纤维化瞬时弹性测定值、AEA、2-AG含量及CBR1、CBR2 mRNA表达均降低(均P <; 0.05),且治疗组降低更明显(均P < 0.05); 。肝组织病理显示:治疗后治疗组肝小叶结构基本完整,肝细胞轻度水样变性,汇管区纤维组织无增生,局部少量淋巴细胞浸润,炎症及纤维化较对照组明显改善。; 结论康氏抗纤方具有提高慢性乙型肝炎肝纤维化患者的临床总有效率、HBsAg阴转率、肝组织纤维化分期疗效有效率,其作用机制可能与调节内源性大麻素系统; 有关。Objective To observe the clinical effect of Kangshi Kangxian Decoction (; KSKXD) in treating on patients of hepatic fibrosis of chronic hepatitis; B ( CHB),and to explore the mechanisms of KSKXD by regulating the; contents of arachidonoylethanolamine ( AEA),2-arachidonoylglycerol (; 2-AG),cannabinoid receptor 1 ( CBR1 mRNA) and cannabinoid receptor 2 (; CBR2 mRNA) in the liver tissue. Methods Totally 110 patients with; hepatic fibrosis of CHB were assigned to the treatment group and the; control group according to random digit table,55 cases in each group.; The treatment group was treated with Chinese herb KSKXD combined with; Entecavir,and the control group was treated with Entecavir. Both of the; two groups were treated for 48 weeks. The clinical efficacy of the two; groups was determined. The serum ALT levels,HBV DNA, HBsAg and HBsAb; quantification,liver pathological changes,liver stiffness; changes,contents of AEA and 2-AG,mRNA expression of CBR1 and CBR2 in the; liver tissue were detected. Results The total effective rate,HBsAg; negative conversion rate,hepatic fibrosis staging and curative effect; rate of the treatment group were higher than those of the control group; (chi~2 = 4.453,4.152,6.364,allP <0.05). After treatment,the; instantaneous elasticity of liver fibrosis,the contents of AEA and; 2-AG,the mRNA expressions of CBR1 and CBR2 in the liver tissue in the; two groups were decreased compared to those of the same group before; treatment (P < 0.05),and the treatment group had better effect than that; of the control group (P < 0.05). The pathological changes in the; treatment group after treatment indicated the liver lobules; integrity,mild hydropic degeneration of liver cells,periportal fibrous; tissue hyperplasia,local small lymphocytic infiltration,which fibrosis; and inflammation were better than those of the control group.; Conclusions KSKXD was effective in the treatment of hepatic fibrosis of; CHB, which improved total effective rate,HBsAg seroconversion rate and; liver fibrosis stage efficiency. And its mechanism maybe related to the; regulation of the endocannabinoid system.国家自然科学基金资助项目; 福建省科技计划引导性项目; 厦门市科技惠民项目; 福建中医药大学临床专项校管课题基