葛根芩连汤临床应用概述

正葛根芩连汤是汉代张仲景所著《伤寒论》中的名方,为表里同治的代表方剂,主要用于下利又伴随着表证发热的协热利。该方沿用至今,在推求主证病机及药理作用研究的基础上,其加减应用在治疗各种疾病的过程中,取得较好的效果,其安全性高,是一个值得临床推介的方剂。     

葛根芩连汤联合暖脐散治疗54例细菌感染性腹泻患儿的临床研究

目的:探讨葛根芩连汤联合暖脐散治疗小儿细菌感染性腹泻的应用价值。方法:选取2017年1月～2018年1月我院108例细菌感染性腹泻患儿,按照随机数字表法分为观察组与对照组,每组54例。对照组给予葛根芩连汤治疗,观察组给予葛根芩连汤+暖脐散治疗。对比两组临床疗效及症状改善情况。结果:观察组治疗总有效率96.30%(52/54)高于对照组85.19%(46/54)(P0.05);观察组治疗3 d后大便次数少于对照组,止泻时间及粪常规正常时间短于对照组(P0.05)。结论:葛根芩连汤联合暖脐散治疗小儿细菌感染性腹泻疗效显著,可有效缓解腹泻症状,促进疾病转归。     

葛根芩连汤对颈动脉硬化患者睡眠质量影响的研究

目的分别使用葛根芩连汤和安定对颈动脉硬化失眠患者进行治疗,研究两者在改善患者睡眠质量方面的差异。方法将112例颈动脉硬化失眠症患者随机分为2组,治疗组给予葛根芩连汤,对照组给予安定2.5 mg,共治疗6周。采用《匹兹堡睡眠质量指数量表》(PSQI)评定睡眠质量;《治疗副反应量表》(TESS)评定药物干预后出现的不良反应。结果安定组患者睡眠质量,入睡时间及PSQI总分均有显著改善。葛根芩连汤组患者睡眠质量,入睡时间,睡眠效率,安眠药物,日间功能及总分均较治疗前有极显著改善。与安定组比较,葛根芩连汤组患者睡眠质量,睡眠效率,安眠药物,日间功能及总分均有显著改善。治疗副反应方面,葛根芩连汤组在行为毒性、植物神经系统、其他及总分方面显著优于安定组。结论中医药治疗重视颈动脉硬化患者具有毒热内盛的特点,从根本上调整人体阴阳的盛衰,在改善颈动脉硬化失眠患者的睡眠质量方面具有更好的疗效。     

桃红四物汤、葛根芩连汤联合盆底康复训练对子宫直肠综合征患者临床疗效的影响

目的探讨桃红四物汤、葛根芩连汤联合盆底康复训练对子宫直肠综合征患者临床疗效的影响。方法选取2017年9月至2019年2月在我院接受治疗的气滞血瘀型子宫直肠综合征患者108例为研究对象,随机将其等分为对照组和观察组,对照组采用常规西药治疗,观察组采用桃红四物汤、葛根芩连汤联合盆底康复训练。比较两组患者临床治疗效果。结果观察组临床治疗效果优于对照组,差异有统计学意义(P<0.05)。结论桃红四物汤、葛根芩连汤联合盆底康复训练可有效提高子宫直肠综合征盆底康复治疗患者的临床疗效,值得推广。     

葛根芩连微丸与硝苯吡啶治疗肠易激综合征临床研究

目的:对肠易激综合征应用葛根芩连微丸与硝苯吡啶的治疗进行对照研究观察腹泻、腹痛或腹泻与腹胀等症状改善情况。方法:病例随机分为治疗组和对照组,两组具有可比性,P >0.05。治疗组口服葛根芩连微丸,每次3g,每日3次;对照组口服硝苯吡啶,每次5mg,每日3次,治疗3周后,观察2组临床症状和体征。结果:治疗组总有效率92.7%,对照组为72.2%,2组差异显著,P <0.05。结论:葛根芩连微丸对IBS的治疗效果优于硝苯吡啶。     

葛根芩连汤联合益生菌治疗溃疡性结肠炎的疗效及睡眠状态分析

目的:探讨对溃疡性结肠炎患者联用葛根芩连汤和益生菌治疗对临床疗效和睡眠状态的影响。方法:选取2020年2月至2020年6月谷城县人民医院收治的溃疡性结肠炎患者82例作为研究对象,按照数字单双号法随机分为对照组和观察组,每组41例。对照组患者单用益生菌进行治疗,观察组患者则在使用益生菌的基础上加用葛根芩连汤进行治疗,然后比较2组患者的最终治疗效果以及睡眠状态。结果:观察组溃疡性结肠炎患者的治疗总有效率、匹兹堡睡眠质量指数(PSQI)评分、红细胞降沉率以及C蛋白反应等指标均明显优于对照组患者,差异有统计学意义(P 0.05)。结论:针对来院就诊的溃疡性结肠炎患者,在使用益生菌治疗的基础上加用葛根芩连汤,治疗总有效率极高,可有效改善患者的睡眠状态,值得在各大医院广泛推荐使用。     

复方葛根芩连汤加减治疗急性菌痢74例

目的 :为了探索治疗急性菌痢的有效方法 ,解决滥用抗生素所导致的菌群失调等问题。方法 :观察组 74例以复方葛根芩连汤加减治疗 ,对照组 60例全部予抗生素治疗 ,疗程同为 3～ 5d ,2组临床资料没有差别。结果 :观察组治愈率、有效率明显高于对照组 ,2组对比经统计学处理 ,差异有高度显著性 (P <0 .0 5或 0 .0 1 )。结论 :复方葛根芩连汤加减治疗急性菌痢 ,疗效显著     

中药汤剂联合丙戊沙坦治疗湿热型DN的临床观察

目的探讨葛根芩连汤加减治疗湿热型糖尿病肾病的效果。方法选择某院内科2014-05—2016-05收治的70例湿热型糖尿病肾病患者,按照随机数字表法分为观察组和对照组,各35例,对照组给予西药常规治疗,观察组在对照组治疗基础上给予中药葛根芩连汤,观察两组治疗效果。结果观察组总有效率为91.4%,对照组为71.4%,组间比较,P0.05;经治疗后观察组BUN、Scr、FBG各项指标均优于对照组,组间比较,P0.05;治疗后两组中医证候积分均明显下降,与治疗前比较,P0.05;治疗后观察组和对照组的中医证候积分分别为(17.3±2.2)分、(33.8±4.9)分,观察组明显下降,组间比较,P0.05。结论葛根芩连汤联合缬沙坦治疗湿热型糖尿病肾病能够改善患者的临床症状,提高治疗效果     

葛根芩连口服液与香连丸治疗急性菌痢的疗效比较

共 5 6例急性菌痢患者 ,按随机原则分为 2组 ,观察组 3 0例采用葛根芩连口服液治疗 ,对照组 2 6例采用香连丸治疗。治疗后 2组显效率、有效率比较无显著性差异 (P >0 .0 5 ) ,但各临床症状起效时间和消失时间比较 ,则有显著性差异 (P <0 .0 1 ) ,观察组明显短于对照组。说明葛根芩连口服液与香连丸治疗急性菌痢疗效相仿 ,但在各临床症状的改善时间上具有明显的优势     

葛根芩连汤治疗热症

葛根芩连汤方剂出自张仲景《伤寒论》一书中,主治表证未解、协热下利之证,全方组合甚为精密。主药葛根辛甘平,具有解肌发表、生津止渴等作用。辅以黄芩黄连苦寒,加强泻火解毒、清热燥湿之力;佐以甘草协和诸药,共组成解肌清热,泻火解毒之剂。笔者临症用于一般热性疾病有良好的效果。现将典型病例笔录于下,以供临床参考。     

清热燥湿类经典方剂治疗溃疡性结肠炎的研究进展

溃疡性结肠炎(ulcerative colitis，UC)在中医中可划分为“休息痢”“肠澼”“泄泻”等病，病理性质为本虚标实，活动期证型以大肠湿热为主，缓解期以脾虚湿恋为主。活动期病机为湿热蕴于肠道，气血搏结，损伤肠络脂膜，大肠传导失司，致使泄泻、便下黏液脓血。所以对于活动期的患者，临床上应以清热燥湿法为主要治法治则。芍药汤、白头翁汤、葛根芩连汤、黄芩汤等经典方剂都具有清热燥湿、行气活血之功，是治疗活动期UC的代表方剂，且大量的基础实验探究了清热燥湿类复方对UC的治疗作用机制，广泛的临床观察也证实清热燥湿类经典方剂对UC具有良好的治疗效果，故在此归纳总结清热燥湿类经典方剂在治疗溃疡性结肠炎方面的研究进展。     

浅析九味羌活汤治疗头痛理论渊源及验案举隅

九味羌活汤出自元代王好古的《此事难知》。方中药物配伍顾及到六经,对于不同经脉受邪引起的头痛均具有良好的作用。该文分析了九味羌活汤方药配伍的意义以及“分经论治”理论治疗头痛关键性作用,创新性阐释了九味羌活汤治疗头痛的理论渊源,并列举2则验案加以说明临床疗效。     

李燕宁小柴胡汤加减治疗疑难杂症验案

小柴胡汤最早见于《伤寒杂病论》,其作为“和法”的代表方,以其疗效显著、理论独特,受到中医学者及临床医家的青睐。并因其制方巧妙、功能独特、适用广泛,成为现代经方研究的热点。李燕宁教授为山东省名老中医,医学博士,博士生导师,国家二级教授,应用小柴胡汤深得堂奥、屡有显效。李燕宁教授即善用《伤寒论》小柴胡汤条文,又善于分析临床各类疾病病机,实践中强调治病应抓主症,并详察病因病机实情而随证加减衍化,方能灵活用之。基于李燕宁教授临床案例,对李燕宁教授运用小柴胡汤加减及其合方治疗各种疑难疾病案例观察,分析小柴胡汤临床应用病因病机、加减及合方运用,为扩展小柴胡汤加减临床应用及疗效提供经验支持和理论依据。     

血脂异常的“痰瘀虚”中医病机内涵和临床应用

通过梳理古代文献,并结合临床实践,阐述“痰瘀虚”三种证候要素在血脂异常治疗中的应用原理与方法,提出以下观点:“痰、瘀、虚”为血脂异常的主要证候要素,痰证贯穿动脉粥样硬化病程的始终,瘀证继发于痰证从而痰瘀互结,脾肾亏虚为虚证内涵。另外,血脂异常在生理功能、发病机制方面均与痰湿有关,现代生物标志物的研究客观化地呈现了中医论治血脂异常的本虚标实内涵。标实应燥湿化痰、活血化瘀,本虚则分为两类:气虚阳虚治以参苓白术散、麻黄附子细辛汤,阴虚血虚治以养阴清肺丸和一贯煎。以“痰瘀虚”理论指导血脂异常调护,当以淡泊节欲、顾护脾胃、惜养肾精为要。     

Temperature Rise Caused by Shear Wave Elastography,Pulse Doppler and B-Mode in Biological Tissue: An Infrared Thermographic Approach

The aim of this study was to determine the interest in and relevance of the use of infrared thermography, which is a non-invasive full-field surface temperature measurement technique, to characterize the heterogeneous heating caused by ultrasound in biological tissue. Thermal effects of shear wave elastography, pulse Doppler and B-mode were evidenced in porcine tissue. Experiments were performed using a high-frequency echography Aixplorer system (Supersonic Imagine, Aix-en-Provence, France). For all three modes, ultrasound was applied continuously for 360 s while the temperature at the sample surface was recorded with a Cedip Jade III-MWIR infrared camera (Flir, Torcy, France). Temperature changes were detected for the three modes. In particular, “heat tunnels” crossing the sample were visualized from the early stages of the experiment. Heat conduction from the transducer was also involved in the global warming of the sample. The study widens the prospects for studies on tolerability, potentially in addition to classic approaches such as those using thermocouples.     

Adjuvant therapy with traditional Chinese medicine in a heart failure patient complicated by hospital-acquired pneumonia: A case report

ObjectiveWe report a case of congestive heart failure complicated by hospital-acquired pneumonia that was successfully treated with traditional Chinese medicine (TCM) and antibiotics.Clinical features and outcomeA 33-year-old man with a history of heart failure developed pneumonia during hospitalization. After the standard antibiotic therapy for 3 days, he continued to experience persistent fever and progressive cough with purulent sputum. Broad spectrum antibiotics did not relieve the fever or the purulent sputum; therefore, the patient requested TCM for integrated therapy, and was subsequently treated with a regiment of “clearing heat and damp excreting” decoction according to TCM theory. After three days of TCM combination therapy, the pneumonia patches significantly improved on chest X-ray. His sputum was obviously decreased in amount and the fever was complete remission in the 5^th day of TCM adjuvant therapy.ConclusionIntegrated therapy with a “clearing heat and damp excreting” decoction may have improved hospital-acquired pneumonia in a patient comorbid with congestive heart failure. The anti-pyretic, anti-inflammatory, antitussive and diuretic effects of TCM may be responsible for the observed improvement. Further experimental studies are warranted to confirm the efficacy and mechanism of TCM action in the treatment of pneumonia.     

天麻钩藤饮加味治疗老年高血压阴虚阳亢证的临床效果及对脉压差的影响

目的 研究天麻钩藤饮加味治疗老年高血压阴虚阳亢证的临床效果及对脉压差的影响.方法 选取西安大兴医院2020年3月至2020年10月门诊及住院的73例老年高血压阴虚阳亢证患者,根据随机数字表法将其分为对照组(37例)和观察组(36例).对照组给予西医降压治疗,观察组在对照组基础上给予自拟天麻钩藤饮加味治疗.比较两组的临床疗效、中医证候疗效、收缩压、舒张压、脉压差、中医证候积分及不良反应发生情况.结果 观察组的治疗总有效率高于对照组(P<0.05).观察组的中医证候总有效率高于对照组(P<0.05).治疗后,两组的收缩压、舒张压、脉压差均降低,且观察组的收缩压、脉压差均低于对照组(P<0.05).治疗后,两组的中医证候各项积分均降低,且观察组低于对照组(P<0.05).两组的不良反应总发生率比较,差异无统计学意义(P>0.05).结论 天麻钩藤饮加味治疗老年高血压阴虚阳亢证的临床效果显著,可有效降低患者的血压、脉压差,缓解临床症状,改善预后,值得临床推广应用.     

清胰汤对重症急性胰腺炎治疗价值的系统评价

目的 用循证医学的方法评价清胰汤辅助治疗重症急性胰腺炎的疗效。 方法 检索1966年到2007年7月间发表的有关清胰汤辅助治疗重症急性胰腺炎疗效的随机对照临床试验。按入选和排除标准，有9项临床试验纳入本研究，由2名评价者对入选研究中有关试验设计、研究对象的特征、研究结果等内容独立进行摘录，用RevMan4.2 软件进行分析。 结果 清胰汤灌胃灌肠辅助治疗组的腹痛缓解时间（WMD=-24.72，95%CI: -35.06～-14.37，P＜0.01）、住院天数（WMD=-9.81，95%CI:-16.23～-3.39，P＜0.01）、病死率（OR=0.27，95%CI: 0.15～0.50，P＜0.01）均明显低于对照组，差异有统计学意义，并发症发生数两组尚无统计学差异（OR=0.31，95%CI:0.07～1.42，P=0.13）。 结论 中药清胰汤辅助治疗能显著缩短重症急性胰腺炎患者的腹痛缓解时间、住院天数，明显降低病死率。     

From Defibrillation Theory to Clinical Implications

Background: Our defibrillation theory claims that the mean voltage threshold is a hyperbolic function of pulse duration and that voltages below rheobase should be avoided as being counterproductive. Truncation of the pulse just at rheobase level yields minimal stored energy thresholds. To verify or falsify this theory, animal experiments were carried out. Material and Methods: In two animal experiments, 212 defibrillation thresholds in 22 swine were determined with different biphasic pulses of which 92 were optimally truncated in phase 1. Step‐up test procedure was used with the first successful shock defined as “threshold.” Results: Experimental proof is gained that truncation according to “rheobase condition” shows lowest stored energy. A ranking order of stored energy thresholds demonstrates that (1) lower output capacitances reduce needed energy, and (2) pulse durations shorter or longer than optimal increase needed energy. The voltage–pulse‐content threshold is linearly correlated with pulse duration. Conclusions: Truncation above or below rheobase increases the stored energy threshold. Voltage averaged during pulse duration is a hyperbolic function of pulse duration. The stored energy is reduced with decreasing output capacitance. The experimental results do not only fully verify our theory, they also suggest clinical implications: (1) the current usage of the “constant tilt concept” in implantable cardioverter defibrillator (ICD) should be abandoned in favor of “optimal truncation concept,” (2) an algorithm developed for calculating optimal truncation proved to be useful so that incorporation into ICD for automatic adjustment is recommended, and (3) the output capacitance should be reduced from about 100 μF to 60 to 70 μF. (PACE 2010; 33:814–825)