基于中医古籍文献的升降散应用溯源及探析

通过对中医古籍中有关升降散论述的文献梳理,全面探讨其内涵。本方是在大黄、僵蚕为雏形的基础上增加蝉蜕、姜黄而成方,几经易名,终在杨璿《伤寒瘟疫条辨》中为后人所熟知。本方广泛用于治疗瘟疫,以丸剂、散剂为主,方便携带,便于服用;重用大黄旨在祛邪、逐秽;应用时视人之体质强弱和量其毒之轻重而判断用药多寡,并辅以米酒、生蜜等以顾护正气。杨璿将其由治疗“热疫”的专方扩展为治疗“表里三焦大热”的通用方剂,扩大了本方治疗疾病范围。     

外源性神经节苷脂相关性吉兰—巴雷综合征的发病机制及诊治研究进展

吉兰―巴雷综合征（GBS）是一种以快速进行性四肢麻木无力为特点的急性炎性脱髓鞘性多发性多神经根神经病。随着外源性神经节苷脂在临床的广泛应用，该药引起的副作用也逐渐显现，外源性神经节苷脂相关性GBS是其最严重的并发症，临床上主要表现为轴索型GBS，以四肢弛缓性瘫痪为首发症状，表现为急性、严重且快速进展的周围神经受累，较其他轴索型GBS病情重，恢复时间长，预后差。目前发病机制尚不明确。静脉注射人免疫球蛋白是其具有循证医学证据的治疗方法，目前已取代血浆置换成为GBS首选治疗方法，推荐剂量为0.4 g/（kg·d），连续静滴5 d，大剂量激素治疗的效果还有待进一步探讨。早发现、早诊断、尽早停用外源性神经节苷脂、及时应用人血免疫球蛋白冲击治疗和康复治疗，可改善预后。     

“龙虎交战”针法针刺八脉交会穴对偏头痛患者头痛天数及血清CGRP表达的影响＊

目的 观察“龙虎交战”针法针刺八脉交会穴对无先兆偏头痛（Migraine without aura，MO）患者头痛天数及外周血降钙素基因相关肽（Calcitonin gene related peptide，CGRP）表达水平的影响。方法 按照头痛程度将90例MO受试者区层随机分为治疗Ⅰ组、治疗Ⅱ组和对照组各30例。治疗Ⅰ组施以“龙虎交战”针法针刺八脉交会穴（外关和足临泣），治疗Ⅱ组施以平补平泻针法针刺八脉交会穴（外关和足临泣），对照组施以平补平泻针法针刺非经非穴点，每次留针30分钟，5次/周，共治疗20次。于治疗前、治疗结束4周后的随访分别记录三组患者头痛天数的变化情况以判定疗效，并采集患者治疗前、治疗结束4周后随访的肘部静脉血用ELISA法检测血清中的CGRP含量的变化。结果 ①各组治疗前患者的头痛天数无显著差异（Ｐ > 0.05），治疗Ⅰ组、治疗Ⅱ组和对照组治疗结束4周后随访的头痛天数较治疗前均显著降低（Ｐ < 0.05）；治疗Ⅰ组头痛天数的降低显著优于治疗Ⅱ组和对照组（Ｐ < 0.001），治疗Ⅱ组头痛天数的降低显著优于对照组（Ｐ < 0.05）；②3组治疗前CGRP的表达无显著差异，治疗Ⅰ组、治疗Ⅱ组治疗结束4周后随访CGRP的表达较治疗前均显著下降（Ｐ < 0.001），对照组治疗结束4周后随访CGRP的表达较治疗前差异无显著性（Ｐ > 0.05）；治疗Ⅰ组CGRP治疗结束4周随访的表达较治疗Ⅱ组和对照组均显著下降（Ｐ < 0.01），治疗Ⅱ组CGRP的表达较对照组显著下降（P < 0.01）。结论 ①八脉交会穴施以“龙虎交战”针法针刺能明显改善MO患者的头痛天数，同时降低MO患者血清CGRP的表达水平，这可能是针刺八脉交会穴治疗MO的机制之一；②非经非穴点的针刺效应无持续性，而八脉交会穴的针刺效应具有持续性；③八脉交会穴可以充分发挥复式针刺手法的治疗效应，提示我们在临床上治疗疾病时不仅要注意腧穴配伍，恰当的针刺手法更是提高临床疗效、事半功倍的关键。     

益母草中阿魏酸对含益母草中成药质量标准影响的探讨

目的：建立HPLC/TQ-MS测定益母草中阿魏酸含量的方法并测定不同产地益母草中阿魏酸含量，评价益母草中阿魏酸对中成药调经止痛片及新生化颗粒的质量影响，为制定含有益母草并以阿魏酸为定量指标的中成药质量标准提供参考。方法：采用薄层色谱法及UPLC-Q/TOF定性鉴别及分析益母草中阿魏酸，采用HPLC/TQ-MS定量分析10批不同产地益母草中阿魏酸含量。基于定量分析结果及处方用量探讨益母草中阿魏酸含量对其中成药质量标准的影响。结果：薄层鉴别及UPLC-Q/TOF定性分析结果显示，10批不同产地益母草中均含有阿魏酸。HPLC/TQ-MS定量分析结果显示，益母草中阿魏酸含量在0.004 2%~0.006 5%之间。结论：益母草与当归、川芎等含有阿魏酸的药材配伍且其用量较大时，益母草中阿魏酸含量会对其质量评价产生一定的影响。     

Vacuum myofascial therapy device for non-specific neck pain. A single blind randomized clinical trial

ObjectivesThis study aimed to investigate the efficacy of a vacuum myofascial therapy device (VT) for improving pressure pain thresholds (PPTs), range of motion (ROM), neck pain-related disability, pain, and quality of life in patients with non-specific neck pain.MethodsA randomized controlled trial in which thirty-eight participants with non-specific neck pain (NP) were randomly assigned to either an experimental (VT) or a comparison physical therapy program (PTP) group. The VT group (n = 19) received five sessions of treatment with a vacuum myofascial therapy device while the PTP group (n = 19) received five sessions of massage, ultrasound therapy (US), and transcutaneous electric nerve stimulation (TENS) over two weeks. The outcome measures were the numerical pain rating scale (NPRS), range of motion, quality of life (SF-12), neck disability Index (NDI), and PPTs at the end of treatment and at one-month follow-up.ResultsAlthough both groups experienced improvements in pain, neck disability, range of motion, and pressure pain, these only were statistically significant in the VT group. At one-month follow-up, the VT group still showed improvements in pain, neck disability, and range of motion.DiscussionVacuum myofascial therapy applied with a device offers similar results to other vacuum-based techniques such as cupping therapy. Moreover, in this device the parameters are digitally controlled, which allows for the precise reproduction of treatment.     

复方蜥蜴散对慢性萎缩性胃炎模型大鼠血清NO及iNOS水平影响的实验研究

目的:观察复方蜥蜴散对慢性萎缩性胃炎(Chronic atrophic gastritis,CAG)模型大鼠血清NO及iNOS水平的影响,探讨其治疗CAG的作用机制。方法:采取55℃热盐水、2%水杨酸、20mmol/L脱氧胆酸钠三个致萎缩因素配合饥饱失常造成CAG模型。将实验动物分为正常对照组,模型对照组,维酶素组,复方蜥蜴散高、中、低剂量组。检测大鼠血液中NO和iNOS水平及观察胃黏膜组织学方面的改变。结果:模型组大鼠NO和iNOS水平明显高于正常组(P<0.01),病理组织学上也有较大改变,而经复方蜥蜴散治疗1个月后,NO和iNOS水平恢复正常,胃黏膜病理组织学改善明显。结论:复方蜥蜴散可以逆转萎缩胃黏膜的病理改变,发挥保护胃黏膜的作用。     

阿拉善黄鼠疫源地动物鼠疫预报的数学模型

根据我国阿拉善黄鼠鼠疫自然疫源地1981～1993年鼠疫监测资料，采用多元逐步曲线回归分析，建立了预报阿拉善黄鼠鼠疫流行的数学模型，其拟合率为100%，并得出影响鼠疫流行的主要因子为黄鼠密度和巢蚤指数。     

Potential-dependent action ofAnemonia sulcata toxins III and IV on sodium channels in crayfish giant axons

Effects of toxins III and IV (ATX III and IV) from the sea anemoneAnemonia sulcata on the Na current of crayfish giant axons were studied. Both toxins slowed the inactivation of Na channels, producing a maintained Na current during a depolarizing voltage pulse. Using the intensity of the toxin-induced maintained current as an index for the fraction of Na channels to which toxin is bound, the toxin association and dissociation kinetics were analyzed. The dissociation rate of ATX III was increased by two orders of magnitudes by depolarizing the membrane from –70 to –40mV. This increase of the dissociation rate caused a marked decrease in the binding rate of ATX III to Na channels in the same potential range. ATX IV exhibited association and dissociation kinetics that had a potential dependency quite similar to that of ATX III in spite of different ionic charge distribution in these two toxins. The results support the view that the potential-dependent kinetics of these toxins are not due to an electrostatic interaction between the ionic charges of toxins and the membrane potential but result from a modulation of the binding energy depending on the gate configuration of the Na channel.     

苦参碱对人单核细胞内三磷酸腺苷结合盒转运体A1及胆固醇酯的影响

目的观察苦参碱对人单核细胞胆固醇和三磷酸腺苷结合盒转运体A1(ABCA1)表达的影响。方法用TBARS法检测细胞内MDA,油红O染色法检测泡沫细胞的形成,荧光分光光度法检测细胞内总胆固醇、游离胆固醇和胆固醇酯含量,RT-PCR和Western blot检测ABCA1mRNA与蛋白的表达。结果单核细胞经佛波脂(PMA)及ox-LDL共同孵育后,细胞内积聚的总胆固醇、游离胆固醇、胆固醇酯及脂质过氧化产物均明显增多(P<0.05),有大量泡沫细胞形成,而ABCA1蛋白、mRNA水平明显减少(P<0.05);苦参碱干预组显著缓解上述变化,细胞内胆固醇酯减少,ABCA1 mRNA、蛋白表达明显增加(P<0.05)。结论苦参碱可能通过增强ABCA1的表达和降低细胞内胆固醇聚积而发挥抗动脉粥样硬化的作用。