段迎喜“升脾”学术思想探微

脾胃之气的充足和清气的正常升发对人体生命活动具有决定意义,饮食、劳倦、情志、外感对脾胃的损伤往往影响中焦脾胃清阳的生成及升发,脾胃病以本虚为主,多由虚致实,虚实兼有,病机关键为升降失常,脾气不升。肝对人体气机具有升宣调畅作用,脾气的升清有赖于肝气升发促进。在补中益气的同时,要补肝益气。同时,肾精气充盈,元气方能充沛,肾阳又主气化,肾精不封、肾气不固者必致肾气下陷。治疗须温肾壮阳、升阳举陷。脾胃中气不足,气机郁滞而化火,并脾之清气下流而生泄泻,相火乘其土位更加耗伤中焦清阳之气。段老师特别注重脾气生长、升发,只有清阳升发,脾气上升,元气才能充沛,阴火才会收敛潜藏。治疗时运用辛甘之药以补益中气,借升阳风药以助肝胆之用,补其中而升其阳,升浮变通,使生长之气健旺。段老师善于运用甘温之品,温补中气,升发清阳。     

子午流注择时循经刮痧干预1级原发性高血压(肝阳上亢型)患者的疗效观察

目的观察子午流注择时循经刮痧干预1级原发性高血压(肝阳上亢型)患者的疗效。方法选取60例初诊为1级原发性高血压(肝阳上亢型)患者,随机分为观察组和对照组各30例,研究中失访2例,最终纳入并进行数据分析的患者共58例。对照组给予常规生活方式干预,观察组在对照组的基础上根据子午流注理论于辰时(7:00~9:00)实施循经刮痧疗法,疗程为4周。比较两组患者干预前、干预第1天、干预第7天、干预第14天、干预第28天、干预结束后第15天的血压及中医证候积分变化情况。结果干预后观察组的收缩压水平与对照组相比,差异有统计学意义(P<0.05);干预后观察组的中医证侯积分下降明显,与对照组比较,差异有统计学意义(P<0.05)。结论运用子午流注理论择辰时循经刮痧干预肝阳上亢型高血压患者,可有效降低收缩压水平,明显改善临床症状,提高生活质量。     

Impact of pharmaceutical price controls on the cost of cardiovascular drugs: does essentiality matter?

ABSTRACT

Background

With the goal of improving the affordability of medicines, governments across the globe have instituted various forms of price controls. Since 2013, India has been regulating the prices of drugs included in its national list of essential medicines (NLEM). Here we evaluate the cost variations among available cardiovascular drugs and perform cost-analysis comparing essential and non-essential drugs.     

艳山姜挥发油通过调控巨噬细胞CD36和ABCA1表达抑制泡沫细胞的形成

目的:观察艳山姜挥发油对氧化低密度脂蛋白(ox-LDL)诱导巨噬细胞转化为泡沫细胞的抑制作用,并探索其机制。方法:使用佛波酯(PMA,100μg·L^-1)诱导人白血病单核细胞(THP-1)24 h后形成巨噬细胞,实验分为4组,分别为空白组(无血清RPMI 1640),模型组(80 mg·L^-1ox-LDL),艳山姜挥发油低剂量组(80 mg·L^-1ox-LDL+4μg·L^-1艳山姜挥发油),艳山姜挥发油高剂量组(80 g·L^-1ox-LDL+20μg·L^-1艳山姜挥发油)。噻唑蓝(MTT)比色法检测艳山姜挥发油对巨噬细胞的活性的影响,蛋白免疫印迹法(Western blot)检测巨噬细胞中白细胞分化抗原36(CD36)和三磷酸腺苷结合盒转运体A1(ABCA1)的表达,酶联免疫吸附测定(ELISA)检测巨噬细胞内胆固醇酯含量,油红O染色法检测巨噬细胞中脂质小滴的含量。结果:艳山姜挥发油对巨噬细胞无毒性。与空白组比较,模型组的巨噬细胞内脂滴和胆固醇酯的含量显著增加(P<0.01),CD36蛋白表达显著上升(P<0.01),ABCA1蛋白表达无显著变化;与模型组比较,艳山姜挥发油显著抑制巨噬细胞中脂滴和胆固醇酯的含量(P<0.01),下调CD36的蛋白表达(P<0.01),上调ABCA1蛋白的表达(P<0.01),艳山姜挥发油可抑制巨噬细胞向泡沫细胞的转化。结论:艳山姜挥发油对ox-LDL诱导的巨噬细胞向泡沫细胞的形成具有抑制作用,该药理作用与艳山姜挥发油下调巨噬细胞CD36和上调ABCA1蛋白的表达有关。     

针药结合治疗特发性震颤病案举隅

特发性震颤,又名原发性震颤,属于常见的锥体外系疾病,在震颤病症患者中多见,约60%患者有家族史,为单一症状性疾病,姿势性震颤为本病的唯一临床表现,罕见静止性震颤,其震颤常见于手,其次为头部,极少为下肢,西医多认为本病与小脑橄榄核节律紊乱有关,治疗尚无特效方法。中医学认为特发性震颤属“颤证”范畴,多因肝肾不足,肝风内动,筋脉失养所致,因肝主风,风为阳邪,阳主动,肝木气太过克脾土,脾主四肢,四肢者诸阳之末,木气鼓之,故动,治疗当滋补肝肾、抑木扶土、益气养血、调补阴阳为主,兼以熄风通络。本例在临床上运用针刺结合三甲复脉汤加减治疗,短期内取得明显疗效。     

Tremor and Quality of Life in Patients With Advanced Essential Tremor Before and After Replacing Their Standard Deep Brain Stimulation With a Directional System

ObjectivesPatients with essential tremor treated with thalamic deep brain stimulation may experience increased tremor with the progression of their disease. Initially, this can be counteracted with increased stimulation. Eventually, this may cause unwanted side-effects as the circumferential stimulation from a standard ring contact spreads into adjacent regions. Directional leads may offer a solution to this clinical problem. We aimed to compare the ability of a standard and a directional system to reduce tremor without side-effects and to improve the quality of life for patients with advanced essential tremor.Materials and MethodsSix advanced essential tremor patients with bilateral thalamic deep brain stimulation had their standard system replaced with a directional system. Tremor rating scale scores were prospectively evaluated before and after the replacement surgery. Secondary analyses of quality of life related to tremor, voice, and general health were assessed.ResultsThere was a significantly greater reduction in tremor without side-effects (p = 0.017) when using the directional system. There were improvements in tremor (p = 0.031) and voice (p = 0.037) related quality of life but not in general health for patients using optimized stimulation settings with the directional system compared to the standard system.ConclusionsIn this cohort of advanced essential tremor patients who no longer had ideal tremor reduction with a standard system, replacing their deep brain stimulation with a directional system significantly improved their tremor and quality of life. Up-front implantation of directional deep brain stimulation leads may provide better tremor control in those patients who progress at a later time point.     

中药配方精油——一种中药入药新形式的思考

饮片是中医临床用药的主体,随着中医用药现代化,中药配方颗粒逐步发展并初具规模。虽有中药注射剂、口服液等的加工形式,但只占中药市场的少部分,并以内服为主。而脂溶性成分口服时,溶出受限,吸收相对较少,且具有刺激胃肠道的副作用,造成患者耐受性低。虽有水提、醇提等加工制成的外用制剂,但多为粗制剂,且剂量随意,在一定程度上造成了脂溶性成分的浪费。而中药的脂溶性成分大多具有较好的生物活性,如五味子乙素、丹参酮、绿原酸甲酯等,但却没有合适的药用形式。若想"药"尽其用,就必须对中药的脂溶性成分进行系统研究,在提取、分离和收集工艺均相当成熟的基础上,研发以脂溶性成分为主的,药理药效确切的,又利于其吸收的药用形式。中药精油具有抗衰老、抗痴呆、抗氧化等多种活性,已广泛应用于临床、药妆、保健品等领域。但单方精油作用有限,配伍既可增强药效、降低毒性,也可扩大精油应用范围。因此,可将中药配方精油作为中药入药新形式,并以外用为主、内服为辅,以弥补中药外用多为粗制剂、剂量随意的不足和内服吸收少、刺激胃肠道的劣势,满足临床用药需求,更快、更准、更好、更强地发挥脂溶性成分的药效。     

PA型紫苏的种植密度研究

常用中药紫苏叶和紫苏叶油的基原植物应为PA型紫苏。课题组对全国紫苏资源全面调查后发现,PA型紫苏资源十分紧缺。而PA型栽培紫苏都属株型矮小、叶片轻薄的回回苏变种,单株叶片产量较低。该研究以2份药用PA型紫苏为材料,在5个种植密度(D1,2 500株/亩;D2,5 500株/亩;D3,8 500株/亩;D4,11 500株/亩;D5,14 500株/亩,1亩≈667 m^2)下种植。选取叶型、株型、产量、挥发油含量和挥发油成分构成等17个性状记录和研究。结果表明,随密度增加,叶型、株型变窄、变小,落叶增加,单株叶产量降低,而叶亩产量增加,且达到D4后基本稳定。叶挥发油提取率在种植密度D2~D5较D1高约0.1%,各个密度下紫苏醛相对含量无显著差异。各个密度下紫苏醛相对含量无显著差异。2份PA种质的耐密植特性有较大差异,与其株型的特征有关,尤其收敛型株型更能适应密植环境。为达到高叶亩产量,推荐以D4(株行距15 cm×40 cm)密度下种植;而综合叶产量、叶型、株型,推荐以D2(株行距30 cm×40 cm)密度下种植。落叶节数、二级分枝数,株型可作为PA型紫苏种质耐密性评价的特征,收敛株型可作为紫苏种质高产育种的评价指标。该研究为PA型紫苏适宜种植的密度提供参考,并为进一步研究不同紫苏的耐密植特性奠定基础。