祛风胜湿法治疗变应性鼻炎的理论与临床依据

变应性鼻炎(AR)发病机制涉及变应原、免疫细胞、免疫球蛋白、炎性介质之间的层级急慢性反应,而且具有一定的异质性,对现有治疗方案的反应也不尽相同,部分患者临床效果不佳。中草药治疗AR不仅能改善临床症状,而且具有良好的安全性,已成为临床治疗AR的经常选项。由于古代医籍中关于鼻鼽的描述与AR的临床表现非常接近,其主要病因病机为外感风寒、肺中虚冷、邪郁化热生风。所以,现代中医认为鼻鼽包括变应性鼻炎、变应性鼻窦炎及血管舒缩性鼻炎。根据鼻鼽(包括AR)的病因病机及临床特点,应当属中医风病范畴。但现代中医辨证AR偏重于脏腑虚损,忽视风邪的辨证,与临床治疗必用风药的现实形成较大反差,甚至导致临床研究不重辨证的反常现象。文章从中医治疗AR必用风药的现象出发,结合传统中医论述和现代风病理论研究成果,提出AR属于中医外感风病范畴,风邪是主要病邪,临床辨证应突出风邪,祛风胜湿法是关键治法。并根据临床治疗AR所用经典名方大多源自《伤寒论》,且都是以风药为主、治疗外感病的处方,并且效果良好,推断风药具有的"祛风止痒"功效可减轻或阻断鼻黏膜的变态反应,达到止痒、止嚏的目的;"祛风胜湿"功效可减轻鼻黏膜水肿,起到止涕、通塞的作用。现代研究也发现,以风药为主的经典名方和临床用于AR治疗的风药大多具有良好的抗炎、抗过敏、调节机体免疫功能等作用,说明祛风胜湿法及其指导下的风药治疗AR不仅符合中医传统理论,而且具有现代科学依据。     

中医药治疗变应性鼻炎临床研究评述

该文针对近年来中医药领域治疗变应性鼻炎（AR）的临床研究进行评述,AR是耳鼻喉科常见病及多发病,该病常见表现有鼻塞、打喷嚏、流清涕及鼻痒等,是鼻黏膜的慢性炎症性疾病。AR是中医药治疗耳鼻咽喉头颈疾病的优势病种,属于中医“鼻鼽”的范畴。其发病病因及病机在古代有着深厚的理论基础,现代医家根据古代文献、理论基础并结合自身经验,分为脏腑辨证与六经辨证,其中关于脏腑辨证的阐述较多,大多医家认为AR与脏腑功能失调有关,主要以肺脾肾三脏为主。临床研究大致分为单纯中药治疗、中西医结合治疗及中医外治法等,这些疗法在治疗AR的临床疗效方面均具有优势。其中单纯中药治疗在改善AR患者症状及鼻腔体征、降低相关量表评分、减少鼻分泌物嗜酸性粒细胞计数（EOS）等方面具有显著优势,且远期疗效确切;中西医结合治疗一般为中医药疗法结合西医常规治疗,可优势互补,各取所长;中医外治法包括针刺、艾灸、穴位埋线、穴位贴敷、中药鼻冲洗等,其安全简便,更易被患者接受,疗效较好。最后总结中医药治疗AR的临床研究现状,并从规范中医药临床研究方案、精准凸显中医药治疗优势及结合前沿探索中医药疗效机制3个方面提出建议,以期为后续临床研究提供更...     

从风的形成原理探析鼻鼽的病机与辨治

通过分析古代鼻鼽相关文献,认为鼻鼽生于风的这一认识可能与风的形成原理密切相关.古人认为"风"的形成原理为"冷热交通",而风的特点与鼻鼽的临床表现具有相似之处.因此,立足于风形成的原理与特征,从隐喻认知的角度,通过分析自然界中"风"的特点、形成原因和影响因素,探求鼻鼽的病因病机与辨治.提出"寒热对立"是鼻鼽发病之根本病机...     

严道南从虚论治变应性鼻炎经验

<正>严道南系南京中医药大学教授,主任医师,博士研究生导师。从事中医耳鼻喉科教学、临床、科研工作30余年,对变应性鼻炎(AR)治疗有深入的研究及丰富的临床经验。AR即过敏性鼻炎,是机体接触变应原后由IgE介导的鼻黏膜非感染性炎性疾病,属中医学鼻鼽、鼽嚏范畴。《素问玄机原病式》说:"鼽者,鼻出清涕也;     

田理教授运用补肺通窍汤治疗变应性鼻炎经验举隅

变应性鼻炎(Allergic Rhinitis,AR),又称过敏性鼻炎,属于中医"鼻鼽"范畴。本病具有治愈率低、易复发的特点,田理教授认为本病的基本病机为"肺气不足,窍络瘀阻"所致,其治法当以"补肺益气,活血通窍"为主,予自拟方"补肺通窍汤"加减治疗,其临床疗效佳。     

胡兰贵教授用清暑益气膏治疗慢性单纯性鼻-鼻窦炎的经验

<正>胡兰贵教授长期从事中医内科疑难疾病临床研究及治疗,是全国优秀中医临床人才,擅长运用中医经典理论治疗疑难杂病,临证突出"抓主症,用经方""以脉为根"的辨证思维特点,擅长运用膏方,治疗各种疑难病证。现将胡教授运用清暑益气膏治疗慢性单纯性鼻-鼻窦炎的经验总结如下。     

过敏性鼻炎中医研究进展

<正>过敏性鼻炎(allergic rhinitis,AR)是发生在鼻黏膜的变态反应性疾病,以突然和反复发作的鼻痒、喷嚏、鼻塞、鼻流清涕等为主要症状,属中医"鼻鼽"范畴。中医治疗AR有较好疗效,综述如下。     

再谈中医药防治HIV/AIDS的特色与优势

艾滋病作为一种新发传染病,祖国医籍中没有明确的记载,医家们根据其临床表现、发病特点归属于中医"瘟疫"、"伏气温病"、"虚劳"的范畴,并对艾滋病的中医病因病机、证候分布及演变规律、临床干预、诊疗方案进行了大量的研究,取得了一定的成果。随着中医药防治艾滋病基础和临床研究的不断深入,针对其中医病因病机复杂性、临床表现的特殊性、证候分布多样性的特点,更加凸显中医"治未病"的早期干预、"个体化"的辨证论治、"易感性"的体质学说、"全身性"的整体观念的特色和优势,通过对艾滋病中医基础研究评述,运用中医传统理论从以上4个方面探讨中医药防治艾滋病的特色和优势,为更好发挥中医药在艾滋病防治中的作用提供理论指导。     

浅谈胡定邦从风论治变应性鼻炎

变应性鼻炎(AR)属于中医“鼻鼽”范畴,症状以鼻痒、打喷嚏、流清涕为主,近年来AR发病率逐年上升,症状加重,病程延长,严重影响患者生活质量,西医免疫、脱敏疗法具有局限性,中医药治疗具有较好疗效,胡定邦教授临证50余载,治疗AR经验丰富,认为其发生与风邪关系密切,从风论治具有较好的疗效,治疗上强调祛风为要,注重肺肝同治,未病先防,也会结合现代药理研究加入一些抗过敏、祛风湿类药物以提高临床疗效。     

中医药诊治变应性鼻炎概况

变应性鼻炎(AR)是耳鼻咽喉科常见变态反应性疾病,反复发作,迁延难愈。西药虽可迅速有效控制症状,但难以根治。本病类似中医"鼻鼽",历代医家对其病因病机的分析,仍在指导临床诊治,诊断标准、病因病机、辨证分型等研究取得了长足发展,使用玉屏风散、鼻鼽汤、鼻鼽冲剂、针灸配合刮痧、滴鼻剂多种手段辨证施治,疗效满意。未来有待于统一诊断治疗标准、开展多中心临床试验研究。     

A comparison on the metabolic profiling of the Mexican anxiolytic and sedative plant Galphimia glauca four years later

Ethnopharmacological relevance

Galphimia glauca has a long traditional use, and continues to be used in Mexico as a natural tranquilizer for the treatment of Central Nervous System disorders as well as for other illnesses.

Aim of the study

In 2005 the initial use of metabolic profiling to populations of Galphimia glauca resulted in two of the six collected populations being producers for galphimines, the markers for sedative and anxiolytic activities. The aim of this investigation was to confirm the previously established metabolic profile, as well as the previous in vivo results on mice. Additionally in this study we wanted to investigate potential anti-inflammatory properties.

Materials and methods

Four years later, we collected samples in the five localities designated for the first-stage investigation in 2005, and in two new locations. Metabolic profiling was carried out by means of ¹H NMR spectroscopy and multivariate data analysis applied to crude extracts from wild plant specimens. HPLC analysis was performed to confirm and quantify the presence of galphimines. Two neuropharmacological in vivo assays on mice were employed to study anxiolytic (elevated plus maze test) and sedative (sodium pentobarbital-induced hypnosis model) activities in the extracts. Anti-inflammatory activity was determined by using the tetradecanoylphorbol acetate-induced mouse ear inflammation model (TPA).

Results and conclusions

The results for the 2009 collected species were similar to the 2005 collection, confirming the metabolic profiles and that galphimines are consistent good markers for CNS activity. Galloylquinic acid levels varied between the years without, as of yet, known effects. In vivo anti-inflammatory activity was similar for all plants and thus not linked with galphimines, requiring further studies to identify the active compound(s). Areas of collection affect neuropharmacological activities but not anti-inflammatory action.     

模拟灸在艾灸临床试验中的应用现状与进展探析

近年来,随着艾灸的临床应用日趋广泛,针对艾灸研究的临床试验也日益增多,但是在随机对照临床试验（RCT）中,艾灸的阴性对照—模拟灸的设立成了临床试验的一大难题。本文通过梳理国内外艾灸RCT中模拟灸的设立方法,从艾灸产生的热效应、光辐射效应以及艾烟效应三方面来评价和阐述模拟灸模型的设计及应用方法,以期为今后艾灸RCT中建立一种理想可行的模拟灸模型提供思路     

电针对APP/PS1双转基因老年性痴呆模型小鼠认知能力及海马NMDARs表达的影响＊

目的 研究电针是否通过调节老年性痴呆模型小鼠海马N-甲基-D-天冬氨酸型谷氨酸受体（NMDARs）的表达，保护认知能力，探讨电针防治老年性痴呆的作用机制。方法 16只6月龄雄性APPswe/PS1 dE9（APP/PS1）双转基因小鼠作为老年性痴呆动物模型，采用随机数字表法分为痴呆模型组及电针治疗组，每组8 只；以同月龄C57BL/6J 野生型小鼠8 只为对照组。选用百会穴、印堂穴及水沟穴，电针治疗 20 min/次，隔日干预1次。治疗4周后，运用Morris水迷宫测试观察电针治疗对实验小鼠认知能力的影响，以Western Blot法检测小鼠海马NMDARs表达水平。结果 痴呆模型组小鼠逃避潜伏期较对照组增加，第Ⅲ象限平台穿越次数及停留时间均减少；海马NMDAR1及NMDAR2B的蛋白表达水平下降。与痴呆模型组比较，电针治疗组逃避潜伏期明显减少；NMDAR1及NMDAR2B的表达增加。结论 电针可改善老年性痴呆模型小鼠学习记忆能力，其机制可能与增加海马NMDARs表达有关。     

DNA barcoding of the Mexican sedative and anxiolytic plant Galphimia glauca

Ethnopharmacology relevance

Galphimia glauca (Malpighiaceae) is a Mexican plant popularly used as a tranquilizer in the treatment of nervous system disorders, although it is also used to treat other common illnesses.

Aim of the study

The aim of this investigation is to find out if populations of Galphimia glauca collected in different regions and ecosystems in Mexico actually belong to the same species by using the contemporary technique of DNA barcodes. Our previous metabolic profiling study demonstrates that different collections of this plant obtained from various geographical areas exhibited diverse chemical profiles in terms of the active compounds named Galphimines. We expected the DNA barcodes apart from indicating the different species of Galphimia would indicate the active populations.

Materials and methods

We employed matK, rpoC1 and rbcL DNA barcodes to indicate the different species. Furthermore to investigate the possible impact of the several different ecosystems where the seven populations were collected, thin layer chromatography was employed to create a partial chemical profile, which was then compared with the metabolic profiles obtained by ¹H-NMR and multivariate data analysis.

Results and conclusions

This study showed that the seven populations here analyzed contain at least three different species of the genus Galphimia, although each individual population is homogeneous. Interestingly our TLC analysis clearly showed that the active populations displayed a distinctively unique chemical profile. This work also showed that the use of DNA barcodes combined with chemical profile analysis is an excellent approach to solve the problems of quality control in the development of Galphimia-based medicines as well as for any breeding programs for this species.     

益气养阴方加马齿苋对糖尿病大鼠海马CA1区神经元一氧化氮合酶表达的影响

目的探讨益气养阴方加马齿苋对糖尿病大鼠海马CA1区神经元一氧化氮合酶（NOS）表述的影响。方法腹腔内注射链脲佐菌素（STZ）制作糖尿病大鼠模型，于造模后1月末以NADPH-d酶组化法观察益气养阴方加马齿苋对大鼠海马CA1区神经元NOS表达的影响。结果益气养阴方加马齿苋防治组大鼠比糖尿病组大鼠NOS表达增加（P〈0．05）。结论益气养阴方加马齿苋可以有效防治糖尿病大鼠海马CA1区神经元退行性变化。     

Chemical and biological characterization of polysaccharides from wild and cultivated roots of Vernonia kotschyana

Ethnopharmacological relevance

In Malian traditional medicine the roots of Vernonia kotschyana are used for treating gastric ulcer and gastritis. In 2006, 9000 kg of roots from Vernonia kotschyana were used to produce Gastrosedal, an ameliorated traditional medicine in Mali. Harvesting from the wild, the main source of raw material, is causing a growing concern of diminishing populations of the plant, and Vernonia kotschyana is now being cultivated in several areas around Mali. In the current study the structures and bioactive properties of isolated polysaccharides from wild and cultivated Vernonia kotschyana were compared.

Materials and methods

Pectin- and inulin-type polysaccharides were isolated from the roots of cultivated and wild Vernonia kotschyana. The isolated polysaccharides were investigated regarding their chemical compositions, and for their abilities to fixate human complement and activate macrophages from a mouse macrophage cell line.

Results

No significant differences in the carbohydrate composition of the fractions isolated from the cultivated versus the wild roots were observed. A previously reported pectic arabinogalactan Vk2a was found in both the cultivated and the wild roots in this study, and exhibited potent complement fixation activity, and a moderate activation of macrophages.

Conclusions

The present study has shown that the cultivated roots of Vernonia kotschyana contain the same types of bioactive polysaccharides as the wild roots. It is therefore preliminarily feasible for the cultivated roots of Vernonia kotschyana to be used as a herbal medicine to replace the wild roots.     

中药及复方减少阿尔茨海默病氧化损伤研究探析

阿尔茨海默病（Alzheimer''s disease，AD）是一种常见的神经系统变性性疾病。氧化应激在AD疾病发生与发展中起着重要作用，从健康人到AD疾病中，抗氧化系统与氧化系统失衡逐渐加重，调节氧化应激水平对AD疾病的进程有积极的意义。中药及复方可通过提高体内抗氧化酶活性，减少自由基生成，来减少Aβ聚集，从而减轻炎症反应及细胞毒性。本文通过综述中药及复方减少AD氧化损伤的研究进展，为临床防治AD提供依据。     

电子瘫痪治疗仪配合通络液治疗急性脑梗死86例疗效观察

目的:观察电子瘫痪治疗仪配合通络液治疗急性脑梗死的临床疗效。方法:将148例急性脑梗死患者随机分为2 组。对照组62例,采用常规西药治疗;治疗组86例,在对照组治疗基础上加用电子瘫痪治疗仪并配合应用通络液。主要观察临床疗效、神经功能缺损评分并检测治疗前后及血液流变学各项指标。结果:总有效率治疗组为91.86％,对照组为79.03％,2组比较,差异有显著性意叉(P<0.05)。而且治疗组治疗后血液流变学各项指标及神经功能缺损评分均有明显改善。结论:电子瘫痪治疗仪配合通络液对急性脑梗死患者的血液流变学各项指标有明显改善,与常规治疗合用临床疗效更显著。     

Ethnomedicinal plants used for treating epilepsy by indigenous communities of sub-Himalayan region of Uttarakhand,India

Ethnopharmacological relevance

Although many plants are claimed to possess anticonvulsant/antiepileptic (AC/AE) properties, but there is very little information available about plants used by various ethnic communities in different parts of India to treat epilepsy, one of the most common disorders of central nervous system (CNS); this communication provides significant ethnomedicinal information on the plants used by indigenous communities: Bhoxa, Tharu and nomadic Gujjars of sub-Himalayan region, Uttarakhand, India to treat epilepsy, so that it could be used as a baseline data for studying chemical constituents and biological activities of these promising plants.

Aims of the study

To record herbal preparations used by the presently studied communities for treating epilepsy and discuss AC/AE properties of the recorded plants.

Research strategy and methods

Ninety one traditional healers (29 Bhoxa, 35 Tharu and 27 nomadic Gujjars) in sub-Himalayan region of Uttarakhand, India were interviewed to collect information on herbal preparations used by them for treating epilepsy. For each recorded species the use value (UV) and fidelity level (FL) was calculated.

Results

A total of 24 plants belonging to 24 genera and 22 families were used by the presently studied communities in 26 formulations to treat epilepsy. According to FL and UV values, most preferred species for the treatment of epilepsy by Bhoxa community are Ricinus communis L. and Datura stramonium L.; by nomadic Gujjar community are Martynia annua L., Bacopa monnieri (L.) Wettst. and Ricinus communis L.; and by Tharu community are Allium sativum L., Asparagus racemosus Willd. and Achyranthes aspera L. Eight plants viz., Allium sativum L., Boerhavia diffusa L., Cassia fistula L., Clerodendrum viscosum Vent., Datura stramonium L., Inula cappa DC., Oroxylum indicum (L.) Kurz and Pavetta indica L. recorded in the present survey have been reported for the first time in treatment of epilepsy by these indigenous communities in India. Five out of these eight newly reported plants viz., Cassia fistula L., Clerodendrum viscosum Vent., Inula cappa DC., Oroxylum indicum (L.) Kurz and Pavetta indica L. have not been pharmacologically evaluated yet for their possible AC/AE properties.

Conclusions

Detailed research on the listed plants and their derivatives may be undertaken to provide new alternative treatments and therapeutic uses for epilepsy or other diseases of CNS. We hope that this article will stimulate further investigations into natural products for new AC/AE agents from the recorded ethnomedicinal plants.