王净净从风、痰、瘀、虚论治中风经验

介绍王净净教授从风、痰、瘀、虚论治中风的经验。王教授认为中风的病因病机多为风、痰、瘀、虚夹杂,相互作用为病,内风为致病关键,痰瘀贯穿疾病始终,久病气血必虚,治疗以祛风通络、化痰祛瘀、补虚固本为主,临床创立"中风方"治疗中风,取得了较好疗效。现附验案1则,以资佐证。     

天麻钩藤饮加味治疗偏头痛临床观察

目的:观察天麻钩藤饮加味治疗肝阳上亢型偏头痛的临床疗效。方法:将符合诊断标准的60例患者随机分为两组各30例。治疗组予天麻钩藤饮加味治疗,对照组予盐酸氟桂利嗪胶囊治疗,15天为1个疗程,共治疗2个疗程,观察两组头痛次数、临床症状的变化。结果:治疗组总有效率为90.00%,对照组为66.67%,两组比较差异有统计学意义(P﹤0.05);治疗后,治疗组头痛次数及头痛积分均明显改善,与对照组比较,差异有统计学意义(P﹤0.05)。结论:天麻钩藤饮加味治疗肝阳上亢型偏头痛疗效较好。     

温胆汤加味治疗脑卒中后抑郁焦虑共病疗效与安全性的随机对照研究

目的观察加味温胆汤治疗脑卒中后抑郁焦虑共病(PSCAD)的临床疗效。方法将80名患者随机分组,分为中药组(40例)和对照组(40例)。对照组口服盐酸帕罗西汀片20 mg/d,中药组加服加味温胆汤,一日2次。共治疗6周。治疗前后对2组患者用汉密尔顿抑郁量表(HAMD)24项版、汉密尔顿焦虑量表(HAMA)量表、血清BDNF水平、临床疗效评定,以不良反应量表(TESS)评估安全性。结果治疗2周后,中药组HAMD评分低于对照组(P0.05),治疗4周后,中药组HAMA评分低于对照组(P0.05);治疗6周后,患者血清BDNF水平均较治疗前升高(P0.05),中药组高于对照组(P0.05)。治疗6周后,中药组有效率(80.0%)高于对照组(62.53%)(P0.05);两组均未出现严重不良反应,中药组与对照组比较,失眠、肌强直、震颤、食欲减退等不良反应少(P0.05)。结论加味温胆汤治疗脑卒中后抑郁焦虑共病是一种安全有效的疗法。     

王净净从虚、痰、瘀、毒论治难治性癫痫经验

本文总结王净净教授治疗难治性癫痫经验。王教授认为难治性癫痫的病因病机多为虚、痰、瘀、毒交夹,治疗主以益气补肾、祛痰化瘀、解毒止痫,其实质是扶正气、祛顽邪、安神定窍,临床取得较好效果。     

益心泰对心肌梗死后大鼠RAAS调节作用的研究

急性心肌梗死（AMI）是常见的危急重症,具有发病急、并发症多、病死率高等特点。AMI后心室重构是心肌对损伤及心脏超负荷的一种反应,可导致左心室进行性扩张和变形,使心肌梗死患者心室功能严重受损,并发症增多,死亡率明显增加,而RAAS的激活作为心室重构的主要促发因素,对心室重构的影响已成为共识。因此抑制RAAS激活,改善心室重构,成为防治研究的重点。     

王净净教授临证常用药对举隅

王净净教授系湖南中医药大学博士生导师,曾任湖南省第二批老中医药专家学术经验继承工作指导老师,现任全国第五批老中医药专家学术经验继承工作指导老师、湖南省中西医结合学会常务理事.王老师从事教学、科研与临床近四十年,临床上擅长诊治中医脑病及内科疑难杂病,如,中风、痹证、眩晕、头痛、癫痫以及情志不遂引起的失眠、郁证等疾病,并且在用药方面善于运用中药药对,加减灵活,疗效确切.     

Effect of acupuncture plus Tai Ji Quan on the recovery of neurological function and depression state in post-stroke depression patients

Objective

To observe the therapeutic efficacy of acupuncture plus Tai Ji Quan (Tai Chi) in recovering the neurological function and treating depression state in post-stroke depression patients, together with a 12-month follow-up.

Methods

A total of 105 eligible post-stroke depression patients were randomized into an acupuncture plus Tai Ji group (53 cases) and a control group (52 cases) based on their visiting sequence. The patients all received routine treatment and rehabilitation training for stroke. In addition, the control group was given oral administration of citalopram hydrobromide tablets, 1 month as a course of treatment, for 3 courses in total. Meanwhile, the acupuncture plus Tai Ji group received acupuncture and practiced Tai Ji Quan, for 1 month and 12 months respectively. Before the intervention, after 1-month intervention and 12 months later, the National Institute of Health stroke scale (NIHSS), Barthel index (BI) and Hamilton depression rating scale (HAMD) were adopted for efficacy evaluation.

Results

Prior to the intervention, there were no significant differences in HAMD, NIHSS and BI scores between the two groups (all P>0.05); after 1-month intervention, there were significant between-group differences in NIHSS, BI and HAMD scores (P<0.05 or P<0.01); the 12-month follow-up revealed significant between-group differences in NIHSS, BI and HAMD scores (all P<0.01). In the treatment of stroke, the total effective rate was 84.4% in the acupuncture plus Tai Ji group, significantly higher than 68.9% in the control group (P<0.05); in the treatment of depression, the total effective rate was 86.7% in the acupuncture plus Tai Ji group, significantly higher than 77.8% in the control group (P<0.05).

Conclusion

Acupuncture plus Tai Ji Quan can produce a significant efficacy in improving the limb motor function and depression in post-stroke depression patients.

     

血塞泰对急性脑梗死风痰瘀阻证患者hs-CRP的影响

目的:探讨血塞泰治疗急性脑梗死风痰瘀阻证患者的临床疗效及作用机理。方法:将符合纳入标准的急性脑梗死患者60例,随机分为两组,每组30例。对照组给予常规西药治疗,治疗组在对照组治疗的基础上加血塞泰,4 w为1个疗程。观察治疗前后两组病例中医证候积分、神经功能缺损评分、hs-CRP水平的变化。结果:两组病例治疗后中医证候积分、神经功能缺损评分、hs-CRP水平均较本组治疗前降低(P<0.01),且治疗组治疗后上述指标低于对照组(P<0.05)。结论:血塞泰对脑梗死风痰瘀阻证临床疗效肯定,可改善症状、体征;其机制可能与降低hs-CRP水平有关。     

益心泰丸抗心肌梗死后大鼠心室重构作用及机理研究

目的:探讨炎性细胞因子系统对心肌梗死后心室重构的影响及益心泰丸对心室重构干预作用。方法:制备心肌梗死大鼠模型。随机分成模型组、益心泰组开博通组、复方丹参滴丸组和假手术组。除模型组和假手术组以蒸馏水等量灌胃,其余各组分别给予相应药物灌胃,用药4周后分别检测心室重构指标及血浆中TNF-α、IL-6含量。结果:与假手术组比较,模型组心脏重量、心脏指数增加(P<0.01);与模型组比较,益心泰组、复方丹参滴丸组和开博通组心脏重量、心脏指数降低(P<0.01)。与假手术组比较,模型组血浆中TNF-α、IL-6含量明显升高(P<0.01),与模型组比较,益心泰组、复方丹参滴丸组和开博通组TNF-α、IL-6含量均有下降(P<0.01)。而益心泰组、复方丹参滴丸组和开博通组心脏指数、TNF-α、IL-6差异无统计学意义(P>0.05)。结论:益心泰丸可能通过调节炎性细胞因子水平,在一定程度上干预了心肌梗死后心室重构。     

参丹饮对不稳定型心绞痛患者血栓调节蛋白和内皮素-1的影响

目的：探讨参丹饮治疗不稳定心绞痛（UA）时对血管内皮功能的影响。方法：90例UA患者随机分成中医组、西医组、中西医结合组各30例,治疗组予中药参丹饮,西药组予常规西药治疗,中西结合组前两组治疗均给予。分别比较3组心绞痛分级、中医证候积分,测定治疗前后血栓调节蛋白（TM）、内皮素（ET-1）水平。结果：用药后3组UA患者心绞痛均明显改善,组间比较无显著性差异（P〉0.05）。中医证候积分、TM、ET-1水平用药后各组均有显著降低（P〈0.05）。在降低TM、ET-1方面,中医组、西医组与中西医结合组比较均具有显著性差异（P〈0.05）。结论：参丹饮能通过降低血浆TM、ET-1水平,保护不稳定型心绞痛患者的血管内皮功能。