试论五脏以肝为贵

本文从肝的生理病理对心、肺、脾（胃）、肾的影响,阐述五脏以肝为贵的实际意义,主要在于肝的疏泄功能,肝主疏泄、似有调节内脏功能正常化的作用,值得深入研究;五脏贵肝理论对脏腑证治,可以拓展思路,以提高疗效。     

养肝护肝:调畅情志重饮食

春天,是万物生长、草木欣欣向荣的时节。中医认为,春天在五行中属木,而人体的五脏之中肝也是属木性,因此,中医认为“春气通肝,春天是肝旺之时,最适宜养肝”。养肝先要畅情志中医讲“肝主疏泄”,就是疏通气机和宣泄情绪,肝疏泄功能出现异常会影响人的情绪;反之,心情的好坏也会影响到肝。所以,保持良好的心情是养肝血的一个好方法。孩子天真无忧,不太容易因为情绪不好使肝出现问题,而中青年和老年人则有很多忧虑烦恼,需多加注意肝脏的疏泄功能。     

肝失疏泄与妇科之疾

肝为人体五脏之一，具有疏泄、藏血、藏魂、主筋、通目、其华在爪之生理功能；其属水通于春气，性喜条达而恶抑郁。由于肝脏具有此特性，在中医发病学上占有极其重要的地位，因而有“百病皆生于气也”之说。肝脏疏泄功能正常与否，不仅能影响气机的调畅，使以上诸功能均可能发生异常，且能累及全身各经络、脏腑，出现错综复杂的各种症候，正由于肝脏具有喜条达而恶抑郁的特性，故与妇女的生理、病理关系甚为密切。若肝的疏泄功能失常则可引起经、孕、产、乳诸疾，早在叶天士医家就证明了这一点，“女子以肝为先天”，就说明了肝在妇女一身中…     

女性易“肝郁”中药调治好

<正>什么叫"肝郁"?"肝郁"系中医病名,又称肝气郁结,是指肝失疏泄、气机郁滞,导致以情志抑郁、胸胁或少腹胀痛等为主要表现的证候。当人的情志郁闷、心情不爽或伤肝动气,阻碍了肝气升发或疏泄,就容易引起"肝郁"。女人为何"肝郁"多中医认为,"肝主情志",女人多情感丰富、多愁善感,当面对各种纷扰琐事或家庭矛盾时,女性比男性更易发火、生闷气、忧伤等,容易出现肝郁气滞、气血失和,进而引发一系列病证。现代医学观点认为,女性"肝郁",与女性雌激     

“肝失疏泄致脑老化”的情绪心理学解读

脑老化相关疾病如痴呆等引起的认知功能下降甚至障碍,严重影响老年人的独立生活能力,给家庭和社会带来沉重负担,已成为全世界共同的医学乃至社会问题。中医学认为,肝主疏泄,调畅情志,若情志不畅则影响肝的疏泄功能,气机失于调达,以致诸病丛生。因此,"肝失疏泄致脑老化"可以视为不良情绪损伤认知功能的问题。《景岳全书》载曰:"痴呆症……,或以郁结,或以不遂,或以思虑,或以惊恐而渐痴呆。"认为不良情绪可以导致痴呆;《辨证录·呆病门》亦曰:"呆病之成,必有其因。大约其始也,起于肝气之郁……",明确指出肝气郁滞可能是健忘、痴呆的始动因素。传统中医学把情志分属五脏,认为"五志伤五脏",但现代临床和文献研究认为,当今社会条件下情志致病的基本方式是多种情志刺激交织组合,首先伤肝。肝失疏泄,气机运行失调,影响精气血津液的生成、运行和输布,导致气血匮乏或痰阻血瘀,气血无以上供于脑,导致脑失濡养,生机下降而逐渐老化。"肝失疏泄致脑老化"是中医情志病因学说的重要体现。情绪心理学是研究情绪的一个心理学分支。从现代科学的角度认识情绪,对身心疾病的研究有重要价值。情绪心理学认为情绪是机体对客观存在的反应,它和认知一样都是脑的功能。情绪作为一种状态,经常存在于脑的活动过程中,为认知提供操作的背景,影响注意的集中,记忆的储存、提取以及思维加工。不同的情绪维度对认知的影响各异。研究发现,负性情绪下的智能操作质量不如正性情绪,高焦虑、抑郁者具有较低的处理速度、注意转移和抑制能力。弗洛伊德认为焦虑、抑郁都是由心理能量压抑所引起,这与中医肝郁的肝失疏泄有着异曲同工之妙。这些研究成果说明,与"肝失疏泄"相关的负性情绪可以降低认知功能。生理应激是构成情绪反应不可或缺的部分。肝脏象的现代研究认为,肝主疏泄调畅情志的过程是神经-内分泌-免疫网络调节机体的过程,涉及中枢、外周的多个层次、靶点及环节的变化。长期存在的负性情绪引起神经递质、糖皮质激素等神经化学物质分泌的紊乱,从而影响中枢神经的结构和功能。于艳红认为这种由情志刺激引起的神经化学物质含量和功能的改变是导致脏腑气机紊乱而致病的主要微观机制。焦虑、抑郁个体,以及对负性情绪敏感的高神经质人群存在神经-内分泌-免疫功能紊乱,可能"肝失疏泄"引起认知功能衰退的重要机制。研究认为负性情绪是认知功能衰退的危险因素。神经质是与情绪相关的人格维度,高神经质者往往情绪调节不良,容易感受负性情绪,存在"肝失疏泄"的状态。据调查,高神经质人群的认知功能比低神经质者下降更快,患痴呆的风险更高。可见长期负性情绪引起肝失疏泄,影响认知功能,加速脑老化是在人群中确实存在的医学现象。这些研究成果支持"肝失疏泄致脑老化"理论。中医学是中华民族医疗智慧的结晶,从现代科学角度对传统中医理论进行发掘和探索有助于中医的现代化,使中医焕发新的生机,从而更好地为人类健康事业服务。     

章真如论肝胆病经验

文章从三个方面对章老关于肝胆论——肝主疏泄论的理论形成,临床特点,治疗原则和临床运用进行了经验总结,指出了肝主疏泄在肝的生理功能上的重要性,据朱丹溪《格致余论》"司疏泄者肝也"之理论,结合四诊,参照八纲、脏腑、气血辨证,具体分析,辨证论治,总结出疏肝利胆,补血,养阴益气的治疗方法,以达到疏泄肝胆,条畅气机,使气机升降相宜,气血和顺的治疗目的。临床运用证实,该理论方法在肝胆疾病上能取得良好的治疗效果。     

中医基本理论讲座 脏象学说——肝

祖国医学中的肝在认识上范围较广,除了肝脏外,还包括了血管、中枢神经和植物神经、消化等系统的部分功能在内。其主要功能有以下几方面:一、肝主巯泄:主要是指肝具有使本脏以及其它脏腑功能的气机流畅的作用。如对脾胃的腐熟和运化,对胆汁的排泄,对冲任脉的调和等,均有密切的关系。由于肝的疏泄功能,除作用于本脏外,还能作用于其它脏腑,因此在临床上肝失疏泄的病变,除本     

“结节体质”只因爱生气?

近年来,随着人们健康意识的提高及各职工体检的普及,被CT提示有肺结节,B超提示有甲状腺结节、乳腺结节等的人数越来越多。有人认为结节多是爱生气引发肝气郁结所致,一旦肝气郁结,人就容易形成“结节体质”。其实,这只说对了一部分。中医认为,结节的形成主要与气结、痰凝、血淤有关。其中,气结与肝的关系最密切,而肝主管疏泄,即肝气具有疏展、升发的生理功能,就是说肝气的疏泄,直接关系到人体气机的升降与调畅。     

消黑眼圈不能光指望药物

正黑眼圈是眼眶周围或眼睑下方颜色青暗,它的病机大致可分为两类:一类以淤滞为主,一类以亏虚为主。淤滞为主的黑眼圈多因为肝脾不调。在五脏中肝主疏泄,脾主运化,疏泄就是把机体的气血疏散通达,运化是让气机疏松而不板结,可见肝和     

运用“肝主疏泄”理论辨治男子不射精症

根据祖国医学“肝主疏泄”具有舒畅气机,进而舒畅男子射精功能的理论,结合中医整体观念,患者体质情况,针对不射精的病因进行辨证论治.凡辨证属于肝失疏泄而郁结者,采用疏泄法为主,活血通络为辅,再根据其兼有血瘀精闭,脾肾阳虚,精血亏虚等不同情况,分别配合化瘀通络,健脾温肾,补肾填精等法,可使肝气舒,郁结解,气血畅,精气通而愈.     

健康体检者354名体重指数与脂肪肝关系的研究

目的：了解健康体检者脂肪肝与体重指数（BMI）的关系。方法：根据BMI判断标准与脂肪肝的超声诊断标准，对检出的脂肪肝患者与其BMI进行相关性分析。结果：在354名被检者中，共检出脂肪肝55例，检出率15.54％，其中男性检出率显著高于女性（P〈0.01），脂肪肝检出率随年龄增加而逐渐升高；BMI≥25者检出率51.95％，18≤BMI〈25者检出率5.42％，两者差异有统计学意义（P〈0.01）；BMI分布与脂肪肝检出率之间存在显著正相关（r=0.868，P〈0.01）。结论：脂肪肝与BMI之间呈正相关，控制体重是防止脂肪肝的重要措施。     

健康查体者体重指数与肝酶及脂肪肝关系的探讨

目的：探讨健康查体者体重指数（BMI）与肝酶及脂肪肝的关系。方法选取笔者所在医院2014年1~5月的107例健康查体者,测量其身高、体重、肝功能,行肝脏彩超检查。根据BMI进行分组,对每组肝酶及脂肪肝情况进行分析。结果3组肝酶指标比较显示仅超重者和肥胖者ALT、GGT与正常组的ALT、GGT比较差异有统计学意义,其余指标比较差异无统计学意义;3组脂肪肝患者的情况比较差异均有统计学意义。结论超重者和肥胖者的ALT、GGT与正常组比较均升高,其余指标比较无异常,对于因肥胖导致的脂肪肝,ALT及GGT变化最早、最敏感,随着体重指数的增加,脂肪肝患病率越来越高,脂肪肝程度越来越严重。     

Anti-arthritic effect and subacute toxicological evaluation of Baccharis genistelloides aqueous extract

This work studies the potential subacute toxicological effects of the aqueous extract of Baccharis genistelloides (AEBg) and demonstrates a new anti-arthritic therapeutic effect. The treatment of the collagen-induced arthritis (CIA) group with 4.2 mg/kg AEBg induced an important decrease (75%) in CIA severity in all animals, while the 42 mg/kg dose treated only 50% of animals. After AEBg treatment, no significant differences were observed in body weight, aspect, color and relative weight of liver, kidneys, thymus or lungs between CIA groups. CIA and healthy AEBg groups treated with both doses did not show genotoxic effects to liver and kidney cells by the Comet assay, compared to its own control group. The augmented AST in the CIA group, compared to healthy control one was regularized by the AEBg treatment with 4.2 mg/kg but not with 42 mg/kg. No other significant difference was found on serum biochemical parameters, as well as on spontaneous or stimulated lymphocyte proliferation between CIA groups. The treatment of healthy animals with AEBg 4.2 mg/kg did not change the aspect, color or relative weight of kidneys, liver or lungs but reduced the body weight, the thymus and popliteal lymph node (PLN) relative weight and serum glucose and triglyceride levels. Concluding, our results indicate an anti-arthritic effects of AEBg without liver and kidney subacute toxicity and hypoglycemic and hypotriglyceridemic actions on healthy animals.     

Effect of chronic intoxication with (+)-amphetamine on its concentration in liver and brain and on (14C) leucine incorporation into microsomal and cytoplasmic proteins of rat liver

Rats were treated with increasing concentrations of (+)-amphetamine sulphate in drinking water for 90 days. The ingested dose of amphetamine was found to increase from 16 mg kg^?1 on the first day up to 90 mg kg^?1 on the 32nd day of treatment. The rats were maintained on the highest dose regime for a further 58 days without any deaths, which showed that tolerance to the overall toxicity of the drug developed. The concentrations of [³H]amphetamine in liver and brain of chronically treated rats were significantly higher than those of controls. Chronic treatment with amphetamine significantly reduced body and liver weight of rats, but did not influence the relative liver to body weight. A marked inhibition of [¹⁴C]leucine incorporation into liver microsomal and cytoplasmic proteins was observed after 90 days of treatment with amphetamine. The relation between inhibition of microsomal protein synthesis and the increase of amphetamine concentrations in liver and brain is discussed.     

Wood creosote, the principal active ingredient of seirogan, an herbal antidiarrheal medicine: a single-dose, dose-escalation safety and pharmacokinetic study

STUDY OBJECTIVE: To assess the safety, tolerability and pharmacokinetics of escalating single doses of wood creosote, an herbal antidiarrheal and antispasmodic agent. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Clinical research center. SUBJECTS: Forty (32 men, 8 women) healthy volunteers aged 19-42 years. INTERVENTION: By random assignment, 22 men and 8 women received escalating single doses of wood creosote (45, 90, 135, 180, and 225 mg) and 10 men received placebo (for each of the five dose levels, 6 subjects received active substance and 2 subjects received placebo). MEASUREMENTS AND MAIN RESULTS: Vital signs, laboratory tests, and electrocardiograms were assessed; no dose-related or clinically significant changes were noted. Serial blood samples were obtained to determine the pharmacokinetics of four major active components of wood creosote: total (conjugated plus free) guaiacol, creosol, o-cresol, and 4-ethylguaiacol. The most common adverse events were mild headache and dizziness, with no dose-related trends being apparent. Area under the concentration-time curve from time zero to infinity increased in a dose-proportional manner for total guaiacol, creosol, and o-cresol and was not assessed for total 4-ethylguaiacol owing to lack of data at the low dose level. No apparent differences by sex were noted for any of the four active components. All four components were rapidly eliminated. CONCLUSION: Single oral doses of wood creosote up to 225 mg were safe and well tolerated in healthy men and women. Also, the doses of wood creosote were rapidly absorbed, conjugated, and eliminated. Such a rapid onset and short duration of action would appear desirable in the treatment of acute nonspecific diarrhea.     

Cellular distribution and handling of liver-targeting preparations in human livers studied by a liver lobe perfusion.

We developed and tested a novel method for perfusing parts of human liver to study uptake and handling of drug-targeting preparations. These preparations, designed for the treatment of liver fibrosis in man, have been extensively studied in animals, but little is known about the uptake and handling by human livers. Human liver tissue was obtained from livers procured from multiorgan donors and from cirrhotic livers of patients. To assess tissue viability, perfusate glutamate-oxalacetate-transaminase (GOT), glutamate-pyruvate-transaminase (GPT), and lactate dehydrogenase (LDH) levels were determined. To assess tissue functionality, the uptake of taurocholic acid and phase I and II metabolism of lidocaine and 7-hydroxycoumarin were determined. Uptake of a drug-targeting preparation was studied with Dexa(10)-HSA, which is designed for targeting of dexamethasone to nonparenchymal cells in the liver. During a 90-min perfusion period, no elevation of either GOT, GPT, or LDH was found. Both healthy control livers and cirrhotic livers showed phase I and II drug metabolism and functional taurocholic acid uptake. Studies with Dexa(10)-HSA revealed that 60 min after administration, 40% of the dose had been taken up by control livers and only 5% by cirrhotic livers. In control livers, Kupffer and endothelial cells had taken up Dexa(10)-HSA, whereas in cirrhotic livers only Kupffer cells were responsible for the uptake. Viability parameters and liver function tests clearly showed the applicability of this method. In the perfusion set-up, we showed uptake of the drug-targeting preparation Dexa(10)-HSA by healthy and cirrhotic human liver tissue, although the distribution patterns differed. This demonstrates the need to study new concepts in (diseased) human tissue.     

A comparison of the toxicity to laboratory mice and pipistrelle bats Pipistrellus pipistrellus of exposure to remedially-treated timber

Many species of bats roost in roof spaces and can come into contact with pesticides used to treat roof timbers against rot. As part of a study to develop a test with laboratory mice which could be used to predict the likely toxicity of pesticides to bats, the toxic effects on pipistrelle bats Pipistrellus pipistrellus and laboratory mice (CFLP outbred-strain) of exposure to dieldrin-treated timber were compared. Dose (amount of dieldrin applied to the wood surface) — response (mortality) studies demonstrated that pipistrelle bats were 30 times more sensitive to dieldrin-treated wood than laboratory mice. However, dieldrin residues in the brain and liver of animals which had been poisoned were significantly higher in bats than mice. These residue data suggest that bats may be inherently less sensitive to dieldrin poisoning than mice and so it is likely that the 30-fold greater sensitivity of bats than mice to dieldrin-treated timber was a result of greater rate of uptake, per gram body weight, of the active ingredient from the wood surface and/or slower clearance from the body. The importance of differences in exposure and the reliability of residue data as an indicator of differences in inherent sensitivity to a chemical are discussed in terms of their importance when considering inter-species variation in toxic response.     

Multiple-dose escalation,safety, and tolerability study of wood creosote,the principal active ingredient of seirogan,an herbal antidiarrheal medication,in healthy subjects

Seirogan, an herbal medicine containing wood creosote (CAS 8021-39-4), a mixture of simple phenolic compounds, has been marketed for the past century in Asia for the treatment of acute diarrhea and associated symptoms, such as abdominal discomfort and cramping. The present study was designed to assess the safety and tolerability of an anticipated acute antidiarrheal dosing regimen. Sixty healthy males were randomized into five groups of 12 subjects each (9 wood creosote; 3 placebo) to receive 45-, 90-, 135-, 180-, and 225-mg tablets every 2 hours for five doses. Serial sitting and standing vital signs, ECG rhythm strips, and continuous telemetry monitoring were obtained predose and for 24 hours after the first dose. Clinical laboratory tests and 12-lead resting ECGs were obtained predose and 24 hours postdose. Of the subjects, 27% (12/45) receiving wood creosote and 27% (4/15) receiving placebo reported adverse events. The most common adverse events were altered taste and somnolence, reported more often with 180- and 225-mg doses. Wood creosote had no clinically significant effects on vital signs, ECG intervals or interpretations, or clinical laboratory tests. No clinically significant or serious dysrhythmias were reported on continuous telemetry monitoring. It was concluded that oral doses of wood creosote 45 to 225 mg every 2 hours for up to five doses were safe and well tolerated in 45 healthy subjects. Wood creosote doses ranging from 45 to 135 mg per dose, which are commonly administered antidiarrheal doses in Asia, were associated with minimal side effects.     

小剂量奥氮平与奋乃静治疗肝移植术后精神障碍的对照研究

目的：观察小剂量奥氮平治疗肝移植术后精神障碍的疗效及安全性。方法选取肝移植术后2周内出现精神障碍患者78例,随机分为观察组（39例）和对照组（39例）。两组均在手术后给予相同基础药物治疗。观察组给予奥氮平片2．5 mg,每晚1次口服,每2 d增加2．5 mg,总剂量不超过10 mg。对照组给予奋乃静片1 mg,每晚1次口服。每2 d增加1 mg,总剂量不超过4 mg。分别在治疗前、治疗2周后,进行简明精神病（科）量表（ BPRS）、不良反应量表（ TESS）评分及体质量测定。结果观察组治疗前BPRS评分为（72．11±8．16）,治疗2周后为（52．30±6．14）,差异有统计学意义（P＜0．05）。观察组治疗前BPRS 评分为（71．26±8．01）,治疗2周后为（65．50±7．22）,差异无统计学意义（P＞0．05）。治疗后,两组BPRS评分比较,差异有统计学意义（ P＜0．01）。两组均不良反应轻微,并可自行缓解。结论小剂量奥氮平治疗肝移植术后精神障碍疗效明确,安全可靠,有一定的临床应用价值。     

水飞蓟宾联合柴胡舒肝丸治疗非酒精性脂肪性肝病的临床观察

目的 观察水飞蓟宾联合柴胡舒肝丸治疗非酒精性脂肪性肝病的临床效果,探讨其对肿瘤坏死因子-α[（TNF-α）的影响.方法 非酒精性脂肪性肝病患者分别给予水飞蓟宾（单独用药组）、水飞蓟宾联合柴胡舒肝丸（联合用药组）治疗,比较治疗前后的TC、TG、LDL、ALT、AST、γ-GT、TNF-α水平.另选30例健康成年人（健康对照组）,检测其血清TNF-α水平作为参考.结果 治疗后,两组的TC、TG、LDL、ALT、AST、γ-GT水平均明显降低,联合用药组明显低于单独用药组（P＜0.05）;与健康对照组比较,两组的TNF-α水平明显增高,经治疗后两组的TNF-α水平均明显降低（P＜0.05）;单独用药组总有效率为81.0％,联合治疗组为93.1％,两者比较,差异有统计学意义（P＜0.05）.结论 水飞蓟宾联合柴胡舒肝丸治疗非酒精性脂肪性肝病效果显著,患者的TNF-α明显增高,TNF-α可能参与非酒精性脂肪性肝病的病理生理过程.