慢性肾脏病肠道菌群失调的病理机制、治疗策略及中药的干预作用

肠道菌群失调是中、晚期慢性肾脏病(chronic kidney disease,CKD)进展至尿毒症的高危因素之一,其特征就是益生菌减少、能产生尿毒素的条件致病菌(产尿素酶菌群、产内毒素菌群以及产代谢毒素菌群)增多。"肠-肾轴(gut-kidney axis)"学说和"慢性肾脏病-结肠轴(chronic kidney disease-colonic axis)"概念的核心观点认为,失调的肠道菌群通过加剧尿毒素蓄积和诱导全身性微炎症反应等途径加重肾脏的损伤。初步的临床试验和动物实验的结果显示,以乳酸菌和双歧杆菌制剂为代表的益生菌和以菊粉、低聚半乳糖为代表的益生元,还有鲁比前列酮、活性炭吸附剂等都可以针对CKD患者体内失调的肠道菌群,通过减轻尿毒素蓄积和抑制全身性微炎症反应等途径而改善肾功能。不仅如此,一些经口服或肠道给药的单味中药、中药复方还有中药提取物(大黄素等)在一定程度上也能调节肠道细菌,保护肠道上皮屏障,减轻尿毒素蓄积,延缓CKD进展。其中,大黄类经方——大黄甘草汤(浓缩颗粒TJ-84)改善肾衰竭动物模型体内尿毒素蓄积的靶点不是肾脏,而可能是"肠道菌群所启动的肠-肾轴"。基于此,针对中、晚期CKD患者肠组织中肠道菌群相关的病理因素(紧密连接蛋白、辅助性和调节性T细胞等)的干预性研究可能是今后的重点发展方向之一。     

Pregnancy and herbal medicines: An unnecessary risk for women's health—A narrative review

The indiscriminate use of herbal medicines to prevent or to heal diseases or even the use for questionable purposes such as weight loss has received both interest and scrutiny from the scientific community and general public alike. An increasing number of women put their own and the unborn child's health at risk due to a lack of knowledge about the phytochemical properties and adequate use of herbal medicine (phytomedicines or herbal supplements) and lack of communication with their healthcare provider. The purpose of this narrative review was to summarize the use of herbal medicines during pregnancy and their potential toxic effects to highlight the importance of caution when prescribing herbal medicines or supplements for women, because, in addition to suffering interactions and a great amount of information obtained in preclinical predictive studies, assessment of nephrotoxicity, neurotoxicity, hepatotoxicity, genotoxicity, and teratogenicity of traditional medicinal herbs still remains scarce in the clinical setting.     

结合肠肾轴理论探讨中医药从结肠治疗慢性肾脏病的研究思路

慢性肾脏病（CKD）正日益成为全球性的社会问题,延缓CKD 的进展具有重要经济和社会意义。近年研究发现,结肠是产生尿毒症毒素的重要器官之一,肠源性尿毒素与CKD 的预后密切相关,因此国外学者提出了延缓CKD 进展的肠-肾轴理论（The Theory of Gut-kidney Axis）,成为研究的热点。中药结肠给药治疗CKD 在临床广泛应用,大量的临床报道提示其可延缓肾衰进展,但临床研究质量偏低,限制了其进一步推广应用。本研究在广东省中医院肾病科学术带头人——黄春林教授应用通腑泄浊法治疗CKD 思路的指导下,结合最新肠肾轴理论,开展了一系列探索性研究,并提出了进一步临床和实验研究的思路,为日后开展高质量的临床研究,获得高级别的临床证据提供数据和方法学基础。     

Pharmacological and immunological effects of individual herbs in the Food Allergy Herbal Formula-2 (FAHF-2) on peanut allergy

It was previously shown that a Chinese herbal formula, Food Allergy Herbal Formula 2 (FAHF-2) composed of nine herbs, blocked peanut-induced anaphylaxis in a murine model. The current study was designed to investigate the pharmacological actions of individual herbs comprising FAHF-2 on peanut-induced anaphylactic reactions in a murine model of peanut allergy and to determine if all nine herbs are necessary to prevent an anaphylactic reaction, or if a simplified formula containing fewer herbs would be equally effective. Some individual herbs reduced peanut-induced anaphylactic symptoms but no single herb offered full protection from anaphylactic symptoms equivalent to FAHF-2. The herbs had highly variable effects on histamine release, as well as peanut-specific serum IgE and IgG2a levels. The herbs also had variable effects on IL-4, IL-5 and IFN-gamma levels. A simplified formula comprising the most efficacious tested individual herbs showed only partial efficacy and was not able to reproduce comparably the effects of FAHF-2, suggesting that component herbs of FAHF-2 may work synergistically to produce the curative therapeutic effects produced by the whole formula, which appears to be the best option for future clinical trials.     

基于中医传承辅助平台的现代中医药治疗心悸的用药规律分析

应用中医传承辅助平台(V2.5)软件,分析中国期刊全文数据库(CNKI)中通过中医药治疗心悸的组方用药规律,为进一步挖掘现代中医药治疗心悸及深度研发提供参考,以期更好的指导临床。搜集CNKI中关于现代中医药治疗心悸所载处方,完成中医传承辅助平台录入,建立中医药治疗心悸的方剂数据库,采用该软件集成的改进互信息法、复杂系统熵聚类等数据挖掘方法,对数据库所录药物使用频次及其高频药物的四气、五味、归经分布进行分析,明确核心用药及其应用特点,分析其处方规则及用药经验。整理出治疗心悸的545首方剂,涉及247味中药,通过分析,发现心悸处方中药物多为温热药性,心、脾二经所占药物比重较大,说明治疗以养心、健脾为主;发现用药频次居前的11味中药与常用药对用药模式中的高频药物完全一致,故认为这11味药即为核心用药;发现处方中核心用药组方为桂枝甘草龙骨牡蛎汤并演化出9首治疗心悸的新处方。客观呈现了心悸的处方用药规律,为指导临床提供了极为有效的借鉴。     

Herb-drug enzyme-mediated interactions and the associated experimental methods: a review

OBJECTIVE: To review the interactions between herbs and widely used drugs and summarize the associated experimental methods.METHODS: Definite herb-drug interactions were obtained by searching Pub Med, other large overseas databases and summarizing new researches from China. We summarize some methods to assess the interaction between herbs and drugs involving microsomal, cell culture and animal experiments, and clinical trials, classifying this method as single ingredient herbs, crude herb extracts, andherbal formulae.RESULTS: Many herbs interact with drugs through a complex cytochrome P450 and/or P-glycoprotein mechanism. Herb-induced enzyme inhibition and/or induction may result in enhanced and / or decreased plasma, tissue, urine and bile drug concentrations, leading to a change in a drug's pharmacokinetic parameters and resulting in the improper treatment of patients and potentially severe side effects. Use of an appropriate method for comprehensively assessing herb-drug interactions can minimize clinical risks. Different methods were used by researchers to assess the pharmacological changes of drugs in vivo and in vitro and the mechanisms of the interactions from microsomal, cell culture and animal experiments, and clinical trials are discussed in this review.CONCLUSION: Co-medication with herbs can result in changes in pharmacological effects of many drugs. This review describes the assessment of single-ingredient herbs, crude herb extracts, and herbal formulae. When choosing a research method to investigate herb-drug interactions, the properties of the drugs and herbs should be considered.     

中药治疗骨关节炎的处方用药研究

目的：归纳分析中药治疗骨关节炎处方的用药特点。方法：检索1989~2006年间各类医学期刊,获取治疗骨关节炎的方剂;统计方剂不同功效类别药物的使用频数;比较内服方剂和外用方剂用药的差异。结果：共有494首方剂纳入研究。215个内服方剂中,补益药30味1074次、祛风寒湿药31味908次、活血化瘀药22味727次;279个外用方剂中,祛风寒湿药28味1425次、活血化瘀药22味850次、补益药13味236次。内服、外用方剂中的补益、祛风寒湿、活血化瘀类药物以及常用药物,在使用上存在着不同。结论：治疗骨关节炎的方剂以补益、祛风寒湿、活血化瘀类别药物为主要组成药物;内服方剂多使用补益、祛风寒湿类药物,而外用方剂则多使用祛风寒湿、活血化瘀类药物。     

Topical Herbal Formulae in the Management of Psoriasis: Systematic Review with Meta‐Analysis of Clinical Studies and Investigation of the Pharmacological Actions of the Main Herbs

This systematic review and meta‐analysis of randomized controlled trials (RCTs) examined the topical use of multi‐herbal formulations for the management of psoriasis vulgaris. Studies were identified from PubMed, Cochrane library, EMBASE, and the Chinese databases CNKI and CQVIP. Methods were according to the Cochrane Handbook and meta‐analyses used RevMan 5.1. Nine studies met the inclusion/exclusion criteria. The comparisons were with placebo and/or anti‐psoriatic pharmacotherapy (APP) with two studies having three arms. The pooled meta‐analysis data indicated the topical herbal formulae improved overall clinical efficacy (defined as 50% improvement or greater) when compared with: topical placebo (plus oral herbal co‐intervention); topical APP alone; and topical APP (plus pharmaceutical co‐intervention). Improvement was evident in Modified Psoriasis Area and Severity Index (PASI) score when topical herbal formula was compared to placebo (plus oral herbal co‐intervention). No serious adverse events were reported. The most commonly used herbs were Sophora flavescens root and Lithospermum erythrorhizon root. Experimental studies reported that these herbs and/or their constituents have anti‐inflammatory, anti‐proliferative, anti‐angiogenic, and tissue repair actions. These actions may at least partially explain the apparent benefits of the topical multi‐herbal formulations in psoriasis. Copyright © 2013 John Wiley & Sons, Ltd.     

《中医方剂大辞典》中含栀子方剂用药规律分析

栀子为药食两用的物品,不仅在中医临床中经常使用,在食品与保健食品中也应用广泛。《中医方剂大辞典》是中医方剂的集大成者,为方剂与中药的开发研究提供了良好素材。该文基于中医传承辅助平台(TCMISS),分析《中医方剂大辞典》中含栀子方剂组方规律,为栀子的临床应用及深度研发提供参考。应用TCMISS将含栀子方剂构建数据库,使用该软件的频次统计、关联规则等数据处理方法,分析含栀子方剂中的常用药物、组合规律、核心组合。共纳入方剂3 523首,涉及中药1 725味,设支持度352(10%)、置信度90%,共得到在含栀子方剂中出现频次较高的药物组合57对,核心组合用药较为集中,组方法度清晰;主治疾病18种。其中,栀子常与清热解毒、祛风解表、活血行气、活血化瘀之品联用,主以黄疸、伤寒、头痛等为治疗病症。     

中药延缓慢性肾功能衰竭进展的机制和效果

中药延缓慢性肾功能衰竭(chronic renal failure,CRF)进展的机制主要是指中药改善肾小球硬化和肾间质纤维化的作用,譬如,通过影响肾小球血流动力,减轻足细胞损伤,抑制转化生长因子-β表达,调整脂质代谢紊乱来改善肾小球硬化;通过减轻巨噬细胞浸润,抑制肾小管上皮细胞转分化,降低尿蛋白毒性来改善肾间质纤维化等.中药延缓CRF进展的临床效果主要体现在改善肾功能和某些并发症等方面,其治疗方法包括中药复方口服、中药保留灌肠、中药复方口服联合中药保留灌肠以及结肠透析联合中药保留灌肠等.另外,对于晚期CRF患者所出现的钙/磷代谢失衡、微炎症状态以及尿毒症毒素蓄积,中药也有一定的改善作用.     

中药方剂有效成(组)分配伍研究

方剂通过配伍提高临床疗效,组分配伍是中药方剂配伍的新形式。组分配伍以中医学理论为指导,其目标是能够按照中医理论辨证用药,并且具有较高的安全性,临床适应证明确且针对性好,成分及作用机理相对清楚,质量稳定可控,能够产业化推广。因此,组分配伍必须要建立标准组分的配伍方法,并根据实验设计确定主要组分,剔除有毒组分,还要建立组分剂量配比的方法。组分配伍模式有从有效方剂的饮片配伍深入到组分配伍,直接组分配伍及单味药的标准组分配伍几类,组分配伍的作用方式仍然是多组分、多靶点、整体综合调节。有效组分配伍的意义在于确保临床用药剂量准确和安全有效,提高疗效,节省药材,减少毒副作用。通过上述工作创制成分清楚,机理明确的现代中药。现代对中药化学及其药理作用的研究结果为有效组分配伍提供了科学依据,现代医药学面临的多基因复杂性疾病靠单一成分难以获得最佳疗效为有效组分配伍新药提供了新机遇。因此,从传统有效复方中寻找最佳配伍,从成分清楚的单味标准组分中按中医理论组合最佳配伍,突破以临床经验积累作为中药研制的一贯模式,相信可以为中医学术进步及产业发展起到积极的推动作用。     

木部类、果部类和草部类药食同源中药安全性评价研究进展

药食同源中药是我国古人通过长期实践总结的既可以药用又可以食用的物质。虽然药食同源中药的活性成分、药理作用已有大量文献报道,但有关其安全性方面的报道相对较少。中国古代本草著作,尤其是食物类本草著作记载了大量的药食同源中药,并对来源、品种、功效、禁忌、用法与用量等进行了系统的概述。通过系统地查阅和整理相关文献资料,对木部类、果部类及草部类药食同源中药的安全性或不良反应进行综述,为其食疗和保健研究提供依据。     

蒙药本草研究概述

本文对蒙药本草研究进行了总结,探讨分析了以下蒙药的研究方向：食疗植物药材的开发、药用植物药用部位的扩增、与其它传统药物的对比研究、与农学结合研究野生药材的引种、筛选、栽培、蒙药本草的历史沿革、传统制剂学的本草考证。     

Investigation of the effects of Chinese medicine on fibroblast viability: implications in wound healing

Diabetes mellitus has been a clinical problem for hundreds of years. Over 194 million people suffer from this disease worldwide. Improper control of diabetes may result in diabetic foot ulcer or even amputation. Granulation formation is an important issue essential for ulcer healing. The CRL-7522 fibroblast cell line and primary fibroblasts from a diabetic foot ulcer patient were used to model the wound healing enhancing activities of two clinically efficacious Chinese herbal formulae, Formula 1 (F1) and Formula 2 (F2) and their component herbs. Results showed that the two formulae and four of their component herbs, Radix Astragali, Radix Rehmanniae, Rhizoma Alismatis and Rhizoma Atractylodis Macrocephalae significantly enhanced CRL-7522 cell viability. However, these component herbs showed compromised effects on the viability of primary fibroblasts cultured from the ulcerous tissue of a diabetic patient. Interestingly, F1 and F2 enhanced the viability of primary cultured fibroblasts from the diabetic patient even in the face of insulin resistance. These results further support the previously reported clinical efficacies of the two formulae on healing diabetic foot ulcers.     

蒙药本草研究概述

本文对蒙药本草研究进行了总结,探讨分析了以下蒙药的研究方向：食疗植物药材的开发、药用植物药用部位的扩增、与其它传统药物的对比研究、与农学结合研究野生药材的引种、筛选、栽培、蒙药本草的历史沿革、传统制剂学的本草考证。     

中药治疗椎动脉型颈椎病用药频次的归纳分析

目的:归纳分析中药治疗椎动脉型颈椎病处方的用药特点。方法:检索2003年1月~2008年12月间各类医学期刊,获取治疗椎动脉型颈椎病的方剂;统计方剂中不同功效类别药物的使用频次;比较内服方剂和外用方剂用药的差异。结果:共有85个方剂纳入研究。69个内服方剂中,补益药26味283次、活血化瘀药20味216次、解表药17味167次;16个外用方剂中,活血化瘀药18味62次、祛风湿药16味54次、解表11味42次。内服、外用方剂中的补益、活血化瘀、祛风湿以及常用药物,在使用上存在着不同。结论:治疗椎动脉型颈椎病的方剂以补益、活血化瘀、解表、祛风湿类别药物为主要组成药物;内服方剂多使用补益、活血化瘀类药物,而外用方剂则多使用活血化瘀、祛风湿类药物。     

本草基因组学

中医药学对世界医药学发展作出了巨大贡献,随着现代科学技术的发展,特别是人类基因组计划的提出和完成,对人类疾病的认识和治疗开启了全新篇章。在此背景下,笔者将组学技术引入中药学研究,提出本草基因组学(Herbgenomics)学科概念,即利用组学技术研究中药基原物种的生物遗传信息及其调控网络,阐明中药防治人类疾病分子机制的学科,从基因组水平研究中药及其对人体作用的前沿科学。主要内容涉及结构基因组、功能基因组、蛋白质组、转录组、代谢组、表观基因组、宏基因组、药用模式生物、基因组辅助分子育种、DNA鉴定、中药合成生物学、中药基因组学、生物信息学及数据库等理论与实验技术。本草基因组学为中药药性研究提供理论基础,为中草药次生代谢产物的生物合成和代谢工程提供技术支撑,为中药配伍研究提供科学依据,指导药物开发及合理用药,为实现个体化精准医疗提供重要信息和技术保障,为中药道地品种改良和基因资源保护奠定基础,推动中药农业的科学发展,对培养多学科人才充实到传统药物研究具有引领作用。本草基因组学正促进前沿生命科学技术应用到中药领域,对中药现代化进程具有重大战略性科学意义。     

台湾地区中医药资源特色及现状

台湾地区中药资源生长丰富,极具地方特色,民间中草药应用广泛。台湾地区医疗以西医医院为主,中医在医疗比例中占比不高。本研究浅析了台湾地区中药资源的特色及现状、中医资源的特色及现状,深入了解台湾地区中医药资源,促进基于浓缩中药制剂、地方特色草药的新药研究和开发,进一步推动两岸中医药事业的振兴与发展。     

中医治疗咳嗽变异性哮喘的选方用药规律分析

目的 :探寻现代临床中药治疗咳嗽变异性哮喘的组方用药规律。方法 :检索中国期刊全文数据库、万方数据库中治疗咳嗽变异性哮喘的相关临床文献,筛选出符合纳入标准的临床随机对照试验,运用中医传承辅助平台系统对处方中所用药物进行频次及关联规则的分析,提取出高频用药及高关联规则的药组。结果:最终所纳入的169首处方所涉及178味药物中,提取出8个临床常用药物(支持度25%,置信度0.8)和4味临床核心药组(支持度30%,置信度0.8)。结论:中医治疗咳嗽变异性哮喘,清肺热、敛肺气、养肺阴以治本,化痰止咳、疏风润燥、平喘止痉以治标。     

网络靶标:中药方剂网络药理学研究的一个切入点

目前中药研究的一个重点和难点问题是理解中药方剂复杂化学体系与病证复杂生物系统的相互作用.作者通过多年研究,从网络药理学、系统生物学角度对该问题提出“网络靶标”这一新的概念与方法.网络靶标概念指的是将病证生物分子网络当作靶标,由此设计和预测最佳的药物干预方式.网络靶标方法旨在将病证、方药映射于生物分子网络,然后在网络上对病证与方药的关系进行机制性的计算、分析与预测,以期发现药效物质及其作用机制,阐释方剂配伍规律与方证关联,并进行组方用药的理性设计.该文概述作者课题组在网络靶标方法及其在中药方剂中的应用进展,希望能为中药方剂的网络药理学研究提供参考.