柴胡加龙骨牡蛎汤在现代医学中的应用

柴胡加龙骨牡蛎汤源于《伤寒论》,具有和解少阳,通阳泻热,重镇安神,通调津液的作用,用于精神分裂症、癫痫、小儿舞蹈症、小儿惊痫、食厥、热厥等证,病机属于肝胆之气不调者,均有较好疗效.查阅大量文献,古人除用本方治疗伤寒下后烦惊谵语证外,还治癫、狂、痫、多梦、少寐等.今人则推而广之,将柴胡加龙骨牡蛎汤用于现代医学中儿童自闭症、梅尼埃病、心脏病、眩晕、精神失常,妇科、消化、内分泌、肿瘤科等多种疾病中,临床上均取得很好的疗效,值得推广.     

柴胡加龙骨牡蛎汤治疗失眠的研究进展

失眠是一种临床常见的精神类疾病,目前临床的主要治疗方式是药物治疗,镇静催眠药的临床疗效显著,但大多数药物具有嗜睡、头昏、乏力等不良反应.传统中药治疗失眠的方法源远流长,具有独特的优势,柴胡加龙骨牡蛎汤在治疗失眠及其伴随症状方面具有一定的临床疗效,其副作用较少.本研究通过对近10年柴胡加龙骨牡蛎汤治疗失眠的机制及临床应用...     

柴胡加龙骨牡蛎汤治疗心悸病的研究进展

柴胡加龙骨牡蛎汤属仲景经方,出自《伤寒论》第107条.近年来,该方的临床应用已扩展至心血管、生殖、内分泌、消化等多个领域,且疗效确切,尤其在心悸病的治疗上效果显著.然而目前尚缺乏对柴胡加龙骨牡蛎汤治疗心悸病相关文献的系统性整理及归纳分析.本文对柴胡加龙骨牡蛎汤各组分的现代药理学研究以及该方治疗心悸病的研究进展进行综述.     

柴胡加龙骨牡蛎汤治疗中风后抑郁临床观察

目的探讨柴胡加龙骨牡蛎汤治疗中风后抑郁的临床疗效。方法回顾分析70例患者的临床资料。结果治疗组35例中,显效26例,有效6例,无效3例,总有效率90%;对照组35例,显效21例,有效5例,无效9例,总有效率74%。治疗组与对照组比较,总有效率差异有统计学意义P<0.05,治疗组优于对照组。结论应用柴胡加龙骨牡蛎汤治疗,疏肝解郁,调理情志,以调气为先,治疗抑郁症疗效确切,优于单纯西医治疗,值得临床应用。     

柴胡加龙骨牡蛎汤治疗心律失常的临床效果

目的 观察柴胡加龙骨牡蛎汤治疗心律失常的效果。方法 选取2021年4月—2022年3月福州市第八医院收入的心律失常患者92例,通过随机排列法分为单药组和汤剂组,各46例。汤剂组给予柴胡加龙骨牡蛎汤治疗,单药组给予常规西药治疗,2组均持续治疗4周。比较2组疗效,治疗前后症状积分、左室舒张末期容量(LVEDV)、左室舒张末期内经(LVEDD)、左室射血分数(LVEF)、P-R间期、心率、QRS间期、可溶性ST2受体(sST2)、半乳糖凝集素-3(Gal-3)、同型半胱氨酸(Hcy)及不良反应。结果 汤剂组总有效率为91.30%,高于单药组的73.91%(χ²=4.842,P=0.028)。治疗4周后,2组心悸不安、脘胁胀满、胸闷、烦躁易怒积分,LVEDV、LVEDD,sST2、Gal-3、Hcy水平均低于治疗前(P<0.05或P<0.01),心电图P-R间期、QRS间期均短于治疗前,心率低于治疗前,且汤剂组短/低于单药组(P<0.01);LVEF高于治疗前,且汤剂组高于单药组(P<0.01)。汤剂组不良反应总发生率为8.70%,低于单药组的26...     

柴胡加龙骨牡蛎汤治疗失眠症30例临床观察

目的近代,随着工业化,城市化的加速发展,致使越来越多的人患失眠症,严重影响人们的生活,工作和身心健康。因此,对失眠症处理不当既是一个医疗问题,也是一个社会问题。因此,选择失眠作为研究的对象,不仅有重要的理论研究价值,对中医临床医学的发展也有重要意义。方法将30例失眠症患者给予柴胡加龙骨牡蛎汤加减治疗。一周为一个疗程,共四个疗程。结果 30例患者治疗前、后SPIEGEL量表的评分减分率有显著性差异;治疗四个疗程后,减分率≥75%。结论柴胡加龙骨牡蛎汤治疗失眠症疗效肯定。     

柴胡加龙骨牡蛎汤对PTZ点燃型癫痫大鼠脑内氨基酸含量的影响

为了研究柴胡加龙骨牡蛎汤抗癫痫的作用机理，本实验观察戊四唑（PTZ）点燃型癫痫大鼠，服用柴胡加龙骨牡蛎汤治疗后，脑内氨基酸含量的变化。结果表明：PTZ点燃型癫痫大鼠脑内兴奋性氨基酸谷氨酸（Glu）天冬氨酸（ASP）及抑制性氨基酸甘氨酸（Gly）显著升高；而抑制性氨基酸γ－氨基丁酸（GABA）、丙氨酸（Ala）显著降低。经柴胡加龙骨牡蛎汤治疗后γ－氨基丁酸（GABA）、丙氨酸（Ala）含量明显升高，而Glu、ASP、Gly降低不显著，提示癫痫的发作及柴胡加龙骨牡蛎汤抗癫痫的作用可能与脑内ASP、Glu及Gly、GABA、Ala的变化有关。     

柴胡加龙骨牡蛎汤加减治疗外阴痛验案三则

<正>外阴痛是以灼痛、刺痛、触痛或刺激为特征的慢性外阴不适,仅指原因不明者。目前多采用外用药物、抗抑郁药、抗癫痫药、生物反馈与物理疗法、病灶内注射、手术切除等治疗方法,疗效不确切,且伴随一定痛苦与不良反应。笔者从少阳病论治,应用柴胡加龙骨牡蛎汤加减治疗外阴痛,现择其中验案三则,共飨同道。1病案资料1.1肝经湿热之阴痛患者赵某,女,32岁,2020年6月14日初诊：外阴灼热痛反复发作5年,伴经前乳房胀痛、经期前后下肢酸楚感,面部色斑累累,平素胁肋部易有不适感,     

柴胡加龙骨牡蛎汤治疗气郁质失眠症30例临床观察

目的:观察柴胡加龙骨牡蛎汤治疗气郁质失眠症的临床疗效.方法:选取2014年1月～2015年11月我院中医科收治的60例气郁质失眠症患者为研究对象,以随机数字表法均分为观察组和对照组,对照组给予常规西药治疗,观察组给予柴胡加龙骨牡蛎汤治疗,观察两组临床疗效及治疗后不良反应情况.结果:治疗后观察组临床疗效86.67％较对照组的63.33％显著高,差异具有统计学意义(P＜0.05);治疗后观察组不良反应总发生率6.67％较对照组的30.00％显著低,差异具有统计学意义(P＜0.05).结论:柴胡加龙骨牡蛎汤对气郁质失眠症临床疗效显著,安全可靠,具有较广泛的应用前景.     

柴胡加龙骨牡蛎汤治疗稳定型心绞痛伴焦虑症状患者的临床效果分析

目的探讨柴胡加龙骨牡蛎汤治疗稳定型心绞痛伴焦虑症状的临床效果。方法60例稳定型心绞痛伴焦虑症状患者,随机分为对照组与实验组,各30例。对照组给予常规西药(阿司匹林肠溶片、阿普唑仑片、单硝酸异山梨酯片)治疗,实验组在此基础上给予柴胡加龙骨牡蛎汤治疗。观察比较两组患者治疗后心绞痛、心电图及中医证候疗效;治疗前后胸闷、胸痛症状评分;治疗前后焦虑评分。结果治疗后,实验组心电图、心绞痛及中医证候总有效率分别为96.7%(29/30)、90.0%(27/30)、86.7%(26/30),均明显高于对照组的80.0%(24/30)、66.7%(20/30)、63.3%(19/30),差异均有统计学意义(P<0.05)。治疗前,实验组胸闷、胸痛症状评分为(11.34±3.54)分,与对照组的(11.26±3.39)分比较差异无统计学意义(P>0.05)。治疗后,实验组胸闷、胸痛症状评分为(5.11±2.16)分,明显低于对照组的(7.30±3.08)分,差异具有统计学意义(P<0.05)。治疗前,实验组Zung焦虑自评量表评分为(19.63±5.01)分,与对照组的(18.97±4.75)分比较差异无统计学意义(P>0.05)。治疗后,实验组Zung焦虑自评量表评分为(10.69±3.64)分,低于对照组的(15.27±3.92)分,差异具有统计学意义(P<0.05)。结论柴胡加龙骨牡蛎汤在稳定型心绞痛伴焦虑症状患者治疗中效果显著,其不仅能够有效改善患者胸痛、胸闷等临床症状,还可缓解患者焦虑情绪,值得临床推广。     

Effect of antidepressant drugs on the hypothalamic-pituitary-adrenal axis activity and glucocorticoid receptor function

Hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis is the main biochemical change, besides disturbed monoaminergic neurotransmission, observed in the patients suffering from a major depression. High incidence of depression in Cushing's syndrome as well as antidepressant effects of adrenocortical enzyme inhibitors in major depression support hypothesis that hyperactivity of HPA axis may be involved in pathogenesis of depression.     

Alterations in the hypothalamic-pituitary-adrenal axis in a proposed animal model of depression with genetic muscarinic supersensitivity.

Rats from the Flinders Sensitive Line (FSL) and Flinders Resistant Line (FRL), which have been bred for differences in sensitivity to cholinergic agonists, were killed by decapitation under quiet, nonstressful conditions and the concentrations of corticotropin-releasing factor (CRF) in various brain regions, the concentrations of CRF receptors in the anterior pituitary, and plasma ACTH and corticosterone concentrations were determined. A first study revealed that the cholinergically hypersensitive FSL rats exhibited lower concentrations of CRF in the median eminence, locus ceruleus, and prefrontal cortex, but no such changes in some 13 other brain regions. In this first study, the FSL rats had significantly lower plasma ACTH concentrations. However, there were no differences in plasma corticosterone concentrations between the two groups. A second study confirmed the results of the first study and revealed that the density of anterior pituitary CRF receptor binding sites was elevated in the FSL rats. The observed pattern of alterations in these measures of HPA axis activity suggest that the cholinergically supersensitive FSL rats may possess diminished HPA activity.     

Influence of psychological variables on the activity of the hypothalamic-pituitary-adrenal axis

Psychobiology is the discipline that attempts to integrate the impact of environmental and psychological variables on biological systems. This paper focuses on the psychobiology of the hypothalamic-pituitary-adrenal (HPA) axis and illustrates several processes that influence the response of the HPA axis. The interaction of the developing rodent or primate with their primary care giver has permanent long-term effects on the HPA axis. Manipulations that alter maternal behavior during critical periods of development permanently modify the HPA axis. The HPA axis can be programmed to be hypo-responsive or hyper-responsive as a function of time and length of maternal separation. In the adult organism, the HPA response to stress is highly dependent on specific psychological factors such as control, predictability, and feedback. In primates, social variables have been shown to diminish or exacerbate the HPA stress response. During the post-natal period of development, the mother appears to actively inhibit the pups' HPA axis. Different aspects of maternal behavior regulate different components of the HPA system.     

芍药苷对胶原诱导型关节炎大鼠下丘脑-垂体-肾上腺轴的影响

目的探讨芍药苷治疗胶原诱导型关节炎(CIA)是否与调节下丘脑-垂体-肾上腺(HPA)轴有关。方法 Wistar大鼠右足趾皮内注射牛Ⅱ型胶原(CⅡ)和弗氏完全佐剂制备CIA大鼠模型,7 d后大鼠背部和尾根部皮下注射CⅡ加强免疫1次。初次免疫后第14天ig给予地塞米松2 mg.kg-1或芍药苷25,50和100 mg.kg-1,每天1次,连续28 d。初次免疫后第14,21,28,35和42天观察CIA大鼠的足爪肿胀度和关节炎指数的变化。给药结束后第2天大鼠摘眼球取血,放射免疫法检测血浆促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)和皮质酮(CS)含量;制备血清,用ELISA法检测白细胞介素4(IL-4)、干扰素γ(IFN-γ)、IL-1β、肿瘤坏死因子α(TNF-α)和抗CⅡ抗体含量。结果与正常对照组相比,模型对照组大鼠关节红肿,关节炎指数升高(P<0.01),血中CRH、CS、抗CⅡ抗体、IFN-γ、IL-1β和TNF-α水平明显升高(P<0.01),IL-4水平下降(P<0.01),ACTH无明显改变。ig给予芍药苷50和100 mg.kg-1可抑制CIA大鼠关节肿胀,降低关节炎指数(P<0.05),在第42天关节炎指数由模型对照组的6.4±0.7降至5.6±0.5和5.4±0.7(P<0.05);使模型对照组血清IFN-γ由(21.3±2.5)ng.L-1降至16.6±1.3和(16.1±1.9)ng.L-1(P<0.01),IL-1β由(37.3±4.2)ng.L-1降至32.1±2.9和(31.2±4.1)ng.L-1(P<0.01),TNF-α由(53.9±7.9)ng.L-1降至39.4±6.8和(31.3±6.1)ng.L-1(P<0.01),抗CⅡ抗体由(2.13±0.32)ng.L-1降至1.35±0.58和(1.10±0.42)ng.L-1(P<0.01),IL-4由(26.6±3.0)ng.L-1升至41.9±3.1和(49.1±4.2)ng.L-1(P<0.01);能使血浆CRH的水平由模型对照组的(2.3±0.5)μg.L-1升高至4.9±1.0和(5.3±1.1)μg.L-1(P<0.01),CS由(33±10)μg.L-1升高至47±9和(51±13)μg.L-1(P<0.01),ACTH水平亦有明显升高(P<0.01)。结论芍药苷治疗CIA可能与调节PHA轴有关。     

小补心汤总黄酮对获得性无助小鼠的抗抑郁作用及其对HPA轴功能的影响

目的采用小鼠获得性无助模型评价小补心汤总黄酮(XBXT-2)的抗抑郁作用,并探究在应激状态下,XBXT-2对下丘脑-垂体-肾上腺轴(HPA)功能的调节作用。方法采用电脑程序控制的穿梭箱条件反射系统,给予不可逃避的足底电击诱导获得性无助模型,经过穿梭箱回避程序筛选,将成功诱导无助行为的小鼠分为模型组、度洛西汀(Dlx,20mg·kg-1)组和XBXT-2(25,50 mg·kg-1)组,灌胃给药4 d,每日采用条件性回避反应测试程序,测定小鼠的逃避失败次数和逃避潜伏期。行为学检测结束后,采用酶联免疫吸附试验法检测血清皮质酮(CORT)和促肾上腺皮质激素(ACTH)水平、蛋白印迹法检测海马糖皮质激素受体(GRα/β)蛋白和脑源性神经营养因子(BDNF)的表达水平。结果亚慢性给予XBXT-2(25,50 mg·kg-1)可明显减少获得性无助小鼠逃避失败次数和(或)逃避失败潜伏期,在行为学有效基础上,亦可明显降低获得性无助小鼠血清CORT和ACTH水平,上调海马GRα/β蛋白和BDNF的表达。结论 XBTX-2在小鼠获得性无助模型中具有抗抑郁作用,作用机制可能与其抑制HPA轴功能亢进有关。     

刺五加提取液对慢性疲劳模型大鼠下丘脑-垂体-肾上腺轴的调节作用

目的：观察刺五加提取液对慢性疲劳（chronic fatigue,CF）大鼠的行为和下丘脑-垂体-肾上腺（HPA）轴的影响,探讨其抗疲劳机制。方法：30只大鼠随机分为5组：对照组,CF组,刺五加提取液50、100、200 mg/kg组。除对照组6只大鼠外,其余24只大鼠用跑台训练法建立CF模型。各组大鼠分别灌胃给予生理盐水,生理盐水,刺五加提取液50、100、200 mg/kg,每天给药1次,共21 d。测定各组大鼠给药后力竭时间;放射免疫分析法（RIA）检测促肾上腺皮质激素释放素（CRH）、促肾上腺皮质激素（ACTH）和皮质酮的血浓度,实时（real-time）PCR法检测下丘脑促皮质素释放激素受体1（CRHR1）mRNA表达。结果：刺五加提取液100、200 mg/kg大鼠跑台致力竭时间比CF组明显延长（P＜0.01）。CF模型大鼠CRH、ACTH和皮质酮的血浓度显著升高（P＜0.01）,下丘脑CRHR1 mRNA表达上调（P＜0.01）。刺五加提取液50、100、200 mg/kg可部分逆转由CF引起的CRH、ACTH及皮质酮血清浓度升高（P＜0.05,P＜0.01）和CRHR1 mRNA表达的上调（P＜0.05,P＜0.01）。结论：刺五加提取液的抗疲劳作用可能与抑制HPA轴功能亢进,改善CRHR1偶联的信号通路有关。     

The effect of inhaled corticosteroids on hypothalamic-pituitary-adrenal axis

Objectives:

The aim of this study was to compare systemic effects of high-dose fluticasone propionate (FP) and beclomethasone dipropionate (BDP) via pressurized metered dose inhaler on adrenal and pulmonary function tests.

Materials and Methods:

A total of 66 patients with newly diagnosed moderate persistent asthma without previous use of asthma medications participated in this single blind, randomized, parallel design study. FP or BDP increased to 1 500 μg/d in 62 patients who had not received oral or IV corticosteroids in the previous six months. Possible effects of BDP and FP on adrenal function were evaluated by free cortisol level at baseline and after Synacthen test (250 μg). Fasting plasma glucose and pulmonary function tests were also assessed. Similar tests were repeated 3 weeks after increasing dose of inhaled corticosteroids to 1 500 μg/d.

Results:

No statistically significant suppression was found in geometric means of cortisol level post treatment in both groups. After treatment in FP group, mean forced expiratory volume in one second (FEV1) and mean forced vital capacity (FVC) values improved by 0.17 l (5.66% ± 13.91, P=0.031) and 0.18 l (5.09% ± 10.29, P=0.010), respectively. Although FEV1 and FVC improved in BDP group but was not statistically significant. Oral candidiasis and hoarseness were observed in 6.5% patients receiving BDP, but hoarseness was found in 3.2% patients in FP group (P=0.288).

Conclusions:

The results indicate that safety profiles of high doses of BDP and FP with respect to adrenal function are similar, but FP is more efficacious than that of BDP in improving pulmonary function test.KEY WORDS: Adrenal cortex function tests, adrenal insufficiency, asthma, beclomethasone dipropionate, fluticasone     

Effect of Ginkgo biloba extract EGb 761 on the nonspecific and humoral immune responses in a hypothalamic-pituitary-adrenal axis activation model

We evaluated the immune response of healthy control and stressed Wistar rats submitted to hypothalamic-pituitary-adrenal (HPA) axis activation. Rats were treated with Ginkgo biloba extract (EGb 761) orally (100 mg/kg per day for 7 days). EGb 761 stimulated the digestion index of peritoneal and alveolar macrophages (PM and AM) of stressed rats. Likewise, the cellular immune response measured using the delayed-type hypersensitivity response to sheep red blood cells (SRBC) and the humoral immune response (measured through an anti-SRBC response), were also restored in stressed rats. Thus, this G. biloba extract possesses immunostimulatory activity in addition to its broad spectrum of pharmacological effects.     

The effects of antidepressants on the hypothalamic-pituitary-adrenal axis

Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis has been found in some psychiatric disorders, especially in older patients with severe depression. Altered feedback inhibition, as demonstrated by increased circulating cortisol and nonsuppresssion of cortisol following administration of dexamethasone, may be to blame. Two glucocorticoid receptors control the HPA axis, the mineralocorticoid receptor (MR) and the glucocorticoid receptor (GR). MR regulates normal HPA fluctuations and the GR regulates in times of stress. Long-term antidepressant treatment in humans has been shown to upregulate both GR and MR in the brain, whereas short-term treatment has been shown to downregulate GR and MR. After 6-9 weeks of treatment GR function returns to normal, and the MR stays upregulated. Chronic antidepressant treatment in rodents has been shown to reduce HPA activity, even in the absence of GR or MR upregulation. These effects of antidepressants on HPA regulation may be attributed in part to regulation of the multidrug resistance protein transporter, P-glycoprotein. Finding relationships between antidepressant action and HPA regulation leads to the conclusion that the disruption of the HPA may be more a contributing factor to depression than other biological abnormalities.     

Orexins in the regulation of the hypothalamic-pituitary-adrenal axis

Orexin-A and orexin-B are hypothalamic peptides that act via two G protein-coupled receptors, named orexin type 1 and type 2 receptors (OX1-Rs and OX2-Rs). The most studied biological functions of orexins are the central control of feeding and sleep, but in the past few years findings that orexin system modulates the hypothalamic-pituitary-adrenal (HPA) axis, acting on both its central and peripheral branches, have accumulated. Orexins and their receptors are expressed in the hypothalamic paraventricular nucleus and median eminence and orexin receptors in pituitary corticotropes, adrenal cortex, and medulla. Whereas the effects of orexins on adrenal aldosterone secretion are doubtful, compelling evidence indicates that these peptides enhance glucocorticoid production in rats and humans. This effect involves a 2-fold mechanism: 1) stimulation of the adrenocorticotropin-releasing hormone-mediated pituitary release of adrenocorticotropin, which in turn raises adrenal glucocorticoid secretion; and 2) direct stimulation of adrenocortical cells via OX1-Rs coupled to the adenylate cyclase-dependent cascade. The effects of orexins on catecholamine release from adrenal medulla are unclear and probably of minor relevance, but there are indications that orexins can stimulate in vitro secretion of human pheochromocytoma cells via OX2-Rs coupled to the phospholipase C-dependent cascade. Evidence is also available that orexins enhance the growth in vitro of adrenocortical cells, mainly acting via OX2-Rs. Moreover, findings suggest that the orexin system may favor HPA axis responses to stresses and play a role in the pathophysiology of cortisol-secreting adrenal adenomas.