由复方中单一组分微小效应引发的对中西医结合理论的思考

“霰弹理论”认为中药作用机制和途径表现为多向性、多层面、多靶点的药理学特点 ,这些特点决定了中药复方中任何一种单一组分均可具有微小的生物学效应。在药物组分之间的相互作用中 ,除了少数已证明具有受体效应的组分外 ,多数组分是微效组分 ,即 :中药药效 =A B C …N个微小效应的累加作用。对某一组分不能忽略其生物学的微小效应 ,也不能采用简单的检测手段和数学统计方法分析微小效应。采用细胞培养的方法结合数学概率论将组分的微小生物学效应合并成机体的整体的生物学效应 ,可以解决实验医学与中医结合中遇到的理论与实际相脱节、实验研究结果与临床效果相背离等问题。     

川芎嗪及其配伍对犬肺动脉高压血流动力学的影响

目的 探讨川芎嗪等药物对动力性肺动脉高压犬血流动力学影响。方法 利用幼犬肺动脉高压模型,经ＳｗａｎＧａｎｚ导管输入川芎嗪及其配伍观察其对体、肺循环血流动力学影响。结果 单用川芎嗪可降低肺动脉压,但作 弱,川芎嗪与黄芪,参麦等配伍后,降低肺动脉压作用增强,且降低体动脉压作用不及肺动脉压显。结论 川芎嗪与黄芪、参麦合用,对肺循环有较好选择性。     

Engagement with arts and culture activities in the Danish general population: Longitudinal associations with new onset or persistent depression and mental wellbeing

Objectives

International literature suggests that arts and culture activities may benefit mental health, however, such survey studies conducted in the Danish population are scarce. Further, studies have investigated the associated risk for incident depression, but not for persistent depression. The objective of the current prospective study was to assess associations of engagement in arts and culture activities with incident/persistent depression and also mental wellbeing among Danish adults in the general population.

Design

Observational prospective study.

Methods

Data stem from a Danish nationally representative panel study of 5000 adults (aged 15+ years) conducted in 2019 and 2020, which was linked to Danish register data. An exposure variable was constructed for frequency of attending concerts, theatres, museums, and cinemas. Validated scales were used to assess the presence of depression (PHQ-8) and levels of mental wellbeing (SWEMWBS). Binary logistic regression analyses were conducted to assess the risk of incident depression (among participants free of depression at baseline), as well as the risk of persistent depression (among participants with depression at baseline), while multinomial logistic regression was used to assess odds for moderate and high mental wellbeing (low as base outcome) while adjusting for baseline values.

Result

In terms of incident depression, quarterly engagement in arts and culture activities (compared to never) was associated with an OR of .43 (95%CI .23–.80), while 8 times or more was associated with an OR of .53 (.29–.97). In terms of persistent depression, quarterly engagement was associated with an OR of .30 (.10–.90), while 8 times per year or more was associated with an OR of .26 (.07–.92). Similar to the patterns for incident/persistent depression, associations with moderate mental wellbeing showed higher odds for quarterly engagement and 8 times per year or more. Quarterly engagement was also associated with higher odds for high mental wellbeing but did not reach statistical significance.

Conclusions

The results support the involvement of the cultural and creative sectors in health strategies. Mental health promotion initiatives as well as arts and culture sectors may encourage the general public to engage in arts and culture activities with frequencies of at least once per quarter.     

The ACT heroin trial: intellectual, practical and political challenges

An array of intellectual, practical and political challenges will be faced both if the Australian Capital Territory "heroin trial" does or does not eventuate. The intellectual challenges include the development of new methodologies and analytical tools for some of the outcome measures; the further development of a research process which involves all the relevant disciplines and interest groups; and capitalizing on an unprecedented opportunity to investigate the pharmacokinetics of heroin. The practicalities of setting up a trial also present a number of challenges, as does incorporating a health development approach. Political challenges include getting a sensible decision made about the trial, avoiding capture of the debate by supporters or opponents of drug law reform and avoiding unrealistic expectations. The major challenge if the trial does not go ahead is to implement other well-considered proposals which can be carefully evaluated.     

从中医理论探索方药的作用机理

主要以所承担过的科研课题的研究思路及研究结果为依据,论述从传统中医理论探索方药作用机理的重要性。文中从养阴生津方药治疗热瘀证的作用、血分证中运用活血化瘀法的作用、辛开苦降法的作用及解表法的作用等方面论述从中医的特有理论出发,可以在探索方药作用机理时提供思路、开拓新的研究领域。同时,中医传统证治理论也要不断发展、提高,在运用传统证治理论研究方药作用机理时,不能完全被其所束缚,随着对证治理论认识的发展,对方药作用机理的认识也必然会出现一个飞跃。     

《伤寒论》方临床运用刍议

对如何正确使用《伤寒论》方进行了讨论 ,围绕方证相应、方证病机、方药性能以及剂量等问题提出了自己的看法 ,认为方证相应中特别要善于处理抓主证、一方多证、知常达变 ;分析病机和深谙方药功能是加深对原文理解和拓展方剂应用范围的关键 ;剂量是方剂的组成部分 ,衡器虽然发生了变化 ,但其药物间的剂量比例不可变     

麻醉性镇痛药使用及依赖性发生的调查

本文调查分析１所大型综合性医院１９８９－１９９４年麻醉性镇痛药使用情况,平均年消耗量为２９６４５±ｓ５５９１ＤＤＤｓ。年开支金额逐年增加,１９９４年为１９９０年的４４０％。内科用量占全院的５５．３％,二氢埃托啡片１９９１年猛增至１０万片以上,卫生部下达文件后下降。门诊麻醉镇痛药用量占４．９％,其处方量占总处方量的０．３５％。主要使用单位是急诊科,占７０．２％。男女患者比为２．４：１;２６－４５ａａ组占４５．６％。药物利用指数０．２９－０．７０,使用不当者主要是二氢埃托啡,发现２人发生依赖性。４３名癌痛患者很少按“三阶梯止痛疗法”给药。根据存在的问题,本文提出相应的建议。     

试论乌梅丸以气味配伍组方

乌梅丸出自《伤寒论》厥阴病篇，其为历代医家推崇的关键在于紧扣病机，方证对应，组方合理，配伍精当。本文从酸辛苦甘，刚柔相济；清上温下，攻补兼施；辛开苦降，土木两调3个方面讨论了乌梅丸按照气味配伍组方的特点。     

复方配伍实验研究的问题与展望

以经方的配伍研究为切入点，从实验设计方法、药理学研究、药物化学研究三个角度总结了经方配伍现代实验研究的现状，对中药复方配伍研究的思路与方法进行探讨。提出在实验设计中应突出中医理论的指导；必须选择多项评价指标，谨慎解释实验结果；实验条件必须标准化；药理研究须与物质基础研究相结合；动物研究须与临床研究相结合。     

活血益气药不同剂量配伍对心梗后心衰大鼠心脏系数及功能的影响

目的 :观察相同种类活血益气药的不同剂量配伍对心梗后心衰大鼠心脏系数、功能的影响。方法 :采用左冠脉结扎术致心梗后心衰大鼠模型 ,分别用活血益气方 (全方活血药量占全方 75% )、益气活血方 (活血药量占全方25% )、气血方 (活血药量占全方 50%)于术后 4周给药至 8周 ,每日灌胃 ,以卡托普利作为阳性药。用阻抗法观察给药前后大鼠心脏功能、心脏系数的变化。结果 :心梗后心衰大鼠经 4周给药治疗后 ,心功能每搏输出量 (SV)、心输出量 (CO)、心脏指数 (CI)值都明显升高 (P<0.01) ;同时 ,活血益气方 (活血药量占全方 75 % )、气血方 (活血药量占全方50% )对模型动物治疗后心脏系数改善与假手术组相似 (P>0.05) ,而益气活血方 (活血药量占全方 25% )、卡托普利与假手术组比较 ,对其无改善 (P<0.01)。结论 :活血益气药通过改善心梗后心衰模型大鼠心脏系数及功能 ,达到治疗心衰作用 ;同时 ,方剂配伍中多量活血药的应用 (活血药 /益气药为 75%和 50%)可以较明显改善心衰大鼠的组织学指标心脏系数。