Literature-based analysis on relationship of symptoms,drugs and therapies in treatment of intestinal diseases

Objective

To evaluate clinical articles published in the past 30 years using the Traditional Chinese Medicine (TCM) theory of the lung being connected with large intestine to treat intestinal diseases. We also analyzed the relationship between symptoms, drugs and therapies with data-excavating technology to aid management.

Methods

After retrieving relevant clinical articles, we set up a database, used Microsoft Structured Query Language Server 2005 Analysis Services as a data-excavating tool, and applied the association rule to study the relationship between the symptoms, drugs and therapies of intestinal diseases.

Results

The key symptoms of dyschesia, constipation, abdominal fullness, fatigue and pale tongue could be treated with Kuxingren (Semen Armeniacae Amarum), Huangqi (Radix Astragali Mongolici) and Gualou (Fructus et Semen Trichosanthis) to invigorate Qi and moisten the intestine. Among these agents, Kuxingren (Semen Armeniacae Amarum) was used most frequently. Clearing Fu-organs was the most prevalent therapy for abdominal fullness, dyschesia, constipation and red tongue. Clearing Fu-organs could be achieved with Kuxingren (Semen Armeniacae Amarum) and Gualou (Fructus et Semen Trichosanthis), whereas Qi could be invigorated using Huangqi (Radix Astragali Mongolici), Gancao (Radix Glycyrrhizae), Baizhu (Rhizoma Atractylodis Macrocephalae) and Kuxingren (Semen Armeniacae Amarum). Moistening the intestine was possible with Kuxingren (Semen Armeniacae Amarum), Huomaren (Fructus Cannabis) and Jiegeng (Radix Platycodi). Also, moistening the lungs was done with Kuxingren (Semen Armeniacae Amarum), ventilating the lungs with Kuxingren (Semen Armeniacae Amarum) and Gualou (Fructus et Semen Trichosanthis), and nourishing the lungs with Huangqi (Radix Astragali Mongolici), Gancao (Radix Glycyrrhizae) and Kuxingren (Semen Armeniacae Amarum). These data demonstrated that Kuxingren (Semen Armeniacae Amarum) was a key agent.

Conclusion

Our analyses of the literature showed clear relationships between symptoms (constipation, dyschesia, abdominal fullness), drugs [Gualou (Fructus et Semen Trichosanthis), Kuxingren (Semen Armeniacae Amarum), Huangqi (Radix Astragali Mongolici)] and therapies (moistening the intestine, clearing Fu-organs, invigorating Qi, ventilating the lungs).     

香砂养胃胶囊的质量标准改进研究

目的:改进香砂养胃胶囊的质量控制标准。方法:修定木香、厚朴、广藿香的薄层鉴别项目,增加陈皮、枳实中橙皮苷的含量测定项目。结果:改进后的薄层鉴别方法专属性强且效率更高,用一个薄层方法即能鉴别木香、厚朴两种药材;广藿香的薄层鉴别结果斑点清晰;采用正交试验优化并最终建立了陈皮、枳实中橙皮苷的HPLC含量测定方法;参照药典方法,改原有的厚朴酚单指标HPLC质控方法为厚朴酚、和厚朴酚双指标HPLC质控方法。结论:改进后的方法快速、专属性强、准确,能够更有效的控制香砂养胃胶囊的质量。     

三化汤通腑祛风治疗脑中风理论溯源及研究进展

三化汤来源于《素问病机气宜保命集》,由厚朴、枳实、大黄、羌活四味中药组成,具有通行气血、调畅气机、通腑开结、开通玄府之功,主治中风病"便溺之阻格",为通腑法治疗中风病的代表方,其功效显著.从中医理论、临床应用及实验研究三个方面综述了经典名方三化汤治疗缺血性脑中风近年来的研究进展.通过对进展进行总结分析,为三化汤治疗缺血...     

枳实药对的临床应用

从传统中医理论和现代药理两方面归纳了枳实的性味，归经和临床应用。分析了枳实分别与枳壳、陈皮、厚朴、槟榔、桔梗、竹茹、紫菀、栝楼、柴胡、白术、白芍、赤芍、肉桂、生姜、黄连、大黄等组成16个药对的临床应用价值。     

Meta-analysis of Traditional Chinese Medicine in treating functional dyspepsia of liver-stomach disharmony syndrome

Objective

To systematically assess the clinical effectiveness of traditional Chinese medicine (TCM) in the treatment of functional dyspepsia (FD) of liver-stomach disharmony syndrome by meta-analysis.

Methods

Random controlled trials (RCTs) were retrieved from databases, including Pubmed, China national knowledge infrastructure, Wanfang Data, VIP Information, and the Cochrane Library. Trials were selected according to inclusion criteria. The effects of traditional Chinese medicine (TCM) versus prokinetic agents in the treatment of functional dyspepsia (FD) of liver-stomach disharmony syndrome were compared by meta-analysis. RevMan 5.0.24 was used for data analysis. The effective rate was assessed by odds ratios (ORs), and 95% confidence intervals (Cls) were calculated. The cure rate was analyzed by the Peto OR. Simple statistical analysis was chosen to assess the frequency of prescribed Chinese herbs in treating this syndrome.

Results

Thirteen trials were included, involving 1153 patients, and these were of poor methodological quality. Twelve studies mentioned the effective rate and cure rate. TCM therapy showed a better clinical effect rate compared with that with prokinetic agents [OR: 3.2, 95% CI (2.27, 4.51)]. The TCM group also had a better cure rate than that in the group of prokinetic agents [Peto OR: 2.26, 95% CI (1.61, 3.18)]. With regard to the frequency of Chinese herbs used in these 13 trials, Baishao (Radix Paeoniae), Chaihu (Radix Bupleuri), and Gancao (Radix Glycyrrhizae) were mostly prescribed, followed by Xiangfu (Rhizoma Cyperi), Zhishi (Fructus Aurantii Immaturus), Zhiqiao (Fructus Aurantii), Foshou (Citrus medica var.sarcodactylis), and Chenpi (Pericarpium Citri Reticulatae). No serious adverse effects were reported.

Conclusion

TCM therapy shows a superior effective rate and cure rate compared with those in prokinetic agents in the treatment of FD of liver-stomach disharmony syndrome. However, further strictly designed RCTs are required because of the poor quality of included trials.     

国医大师段亚亭运用温肾活血方治疗慢性心力衰竭经验

国医大师段亚亭教授认为,心肾阳虚为心力衰竭(简称心衰)之本,而瘀血阻滞为其标,间或夹杂水湿、痰饮,治疗以温补心肾为主要治则,活血化瘀应贯穿治疗始终.段老认为临证需四诊合参,中西医结合,拟定温肾活血方治疗慢性心衰,并随证加减.胃肠道瘀血,食欲较差予焦/炒山楂、焦/炒神曲、焦/炒麦芽、焦/炒鸡内金以醒脾开胃;长期情绪抑郁者...     

中西医结合治疗粘连性肠梗阻65例疗效观察

目的：观察中西医结合治疗粘连性肠梗阻的临床疗效。方法：将117例患者随机分为2组。对照组52例，予西医保守治疗；治疗组65例，在对照组治疗基础上予中药复方大承气汤（组成：生大黄、芒硝、枳实、厚朴、炒莱菔子、桃仁、赤芍）胃管注入。并子大承气汤（组成：枳实、生大黄、厚朴、芒硝）滴注灌肠。结果：总有效率、治愈率治疗组分别为90．77％、75．38％，对照组分别为71．15％、55．77％。2组比较，差异均有显著性意义（P〈0．05）。结论：中西医结合治疗粘连性肠梗阻可显著提高临床疗效。     

从量效关系探讨《伤寒杂病论》厚朴用药规律

目的：分析《伤寒杂病论》中厚朴的量效关系及配伍用药规律,以更好地指导临床。方法：总结归纳《伤寒杂病论》中含有厚朴的条文,采用SPSS 23.0统计软件分析厚朴剂量与相关因素之间的关系。结果：符合筛选条件含厚朴方剂共11首,占全书总方剂数的9.73%。二元相关性分析显示,厚朴单次用量与药味数、用水量、与剩余水量、单次服用水量和服用次数无明显相关性(P>0.05)。单因素逻辑回归分析显示,厚朴是否为主药与厚朴单次用量、用水量有相关性(P<0.05)结论：厚朴以配伍用药为主,未单独使用,多应用在阳明经证,从量效关系发现,厚朴是否为主药与厚朴单次用量、用水量有相关性。厚朴对于虚实类疾病通过配伍均可达到治疗效果,从药物作用气机的升降浮沉角度,厚朴在体内作用以降为主。厚朴小剂量使用,配伍麻黄、杏仁、生姜、桂枝等可治疗呼吸系统疾病,大剂量配伍半夏、人参、生姜、枳实等可治疗消化系统疾病。     

基于数据挖掘的中医药治疗新型冠状病毒肺炎用药规律研究

新型冠状病毒肺炎(COVID-19)疫情发展迅速,危害严重,目前尚无特效药,而中医药在此疫情中发挥了积极的作用。该研究通过收集国家、各省、自治区和直辖市发布的诊疗方案,及中国知网、万方、维普三大数据库相关文献报道,全面系统整理现代中医治疗COVID-19的处方,并通过中医传承辅助平台V2.5,确定处方中用药的四气、五味、归经、使用频次、药物之间的关联规则及形成的新处方等。最终纳入有效处方96首,其中四气主要集中在温、寒、平,五味主要集中在苦、辛、甘,归经主要集中在肺、胃、脾经;使用高频次药物为甘草、杏仁、生石膏等;高频次药物组合为生石膏-杏仁,生石膏-甘草,甘草-杏仁等;核心组合有葶苈子-杏仁-生石膏,藿香-生姜-厚朴,麦冬-杏仁-黄芩等;形成新处方葶苈子、杏仁、生石膏、藿香、生姜、厚朴,麦冬、杏仁、黄芩、五味子、西洋参等。从药性到高频药物及新处方可以看出,我国现代中医治疗COVID-19的整体治则为扶正祛邪,兼顾气阴。     

席德治临证治疗咳嗽处方分析

目的总结席德治先生治疗咳嗽的中药运用经验。方法收集席德治先生治疗咳嗽医案95则,按中医证型分类,建立医案资料库,统计所用中药的类别,及各类别中药总使用频次、不同证型中各类别中药的使用频次;每张处方平均药味及剂量。结果①共用137味中药,归属于15类,出现频次居前5位者为化痰药、补虚药、清热药、止咳平喘药、解表药。②风热犯肺证常用药物为:象贝母、牛蒡子、甘草、桔梗、前胡、桑叶等;痰热壅肺证常用药物为:象贝母、杏仁、桔梗、甘草、黄芩、牛蒡子等;肺阴亏虚证常用药物为:象贝母、北沙参、甘草、杏仁、桔梗等;肺气亏虚证常用药物为:象贝母、甘草、北沙参、白术、杏仁等;肝火犯肺证常用药物为:象贝母、杏仁、忍冬藤、茯苓、黄芩、败酱草等。③每张处方平均药味数(13.5±1.2)个,总剂量(147.67±22.17)g。结论席德治先生临证治疗咳嗽,重视"痰"这一病理因素及病机证候要点,注重化痰与清热,用药轻灵。     

厚朴枳实配伍对大鼠胃动力的影响

目的:考察厚朴枳实配伍及不同煎煮时间对大鼠胃动力的影响。方法:SD大鼠ip左旋精氨酸(L-Arg)6 d建立大鼠胃动力异常模型。胃动力异常大鼠连续5 d分别ig给予厚朴提取物(10 g.kg-1)、厚朴枳实配伍提取物(20 g.kg-1),ip西沙必利(0.004 2 g.kg-1)、观察其对L-Arg所致胃动力异常大鼠胃动力的改善作用。结果:大鼠ip L-Arg造成大鼠胃动力减缓、血浆胃动素减少。厚朴、厚朴枳实配伍提取液能有效抑制L-Arg引起的大鼠胃动力下降(P<0.05)和胃动素的下降(P<0.05),厚朴与阳性药物西沙必利之间无显著性差异,厚朴枳实配伍与厚朴、西沙必利之间有显著性差异(P<0.05)。厚朴、厚朴枳实配伍、西沙必利组的胃残留率分别为(69.3±13.7)%,(60.7±12.9)%,(70.1±12.9)%,;胃动素分别为(85.4±11.2),(93.1±10.4),(86.3±12.4)nmol.L-1。厚朴枳实煎煮90 min较煎煮60,30 min大鼠胃残留率低(P<0.05),胃动素含量高(P<0.05)。煎煮90,60,30 min胃残留率分别为(47.7±12.8)%,(59.8±12.1)%,(62.7±11.8)%;胃动素分别为(102.3±10.6),(92.9±10.1),(89.6±11.2)nmol.L-1。结论:厚朴、厚朴枳实配伍提取液能显著改善L-Arg所致的大鼠胃动力障碍,厚朴枳实配伍后作用要优于单一厚朴。两者配伍以煎煮90 min为宜。     

党中勤从肝辨治胆石症

党中勤教授治疗胆石症多从肝辨治,以正本清源,确立"疏肝利胆、理气通腑、清热利湿、消石排石"的治疗大法,自拟"利胆排石方"作为治疗胆石症的基础方.临证时,党教授常根据患者具体临床表现和病情发展转归不同阶段,辨证与辨病相结合,灵活加减运用.若结石直径较大者,加牡蛎、半边莲、石见穿等;右胁疼痛较甚,或放射至后背疼痛者,加徐长...     

厚朴三物汤拆方及其药量变化的实验研究

目的：厚朴三物汤拆方分析基础上,对厚朴三物汤、厚朴大黄汤、小承气汤进行比较研究。方法：取混有碳末的药物煎液给小鼠灌胃,计算碳末推进率;将家兔小肠标本浸入台氏液中,滴加药物煎液,描记平滑肌收缩曲线。结果：厚朴三物汤显示出明显的推进作用（推进率83.45%);滴加各药物后,平滑肌收缩强度及频率都明显降低,以厚朴三物汤最为突出,结论：配伍后的厚朴三物汤提高了大黄、枳实,厚朴各药的推进作用;三方中以厚朴三物汤对小肠平滑肌影响最大。     

健脾降逆消痞方治疗肝动脉栓塞化疗术后消化道毒副反应32例疗效观察

目的:观察健脾降逆消痞方对肝动脉栓塞化疗术后消化道毒副反应的治疗效果。方法:将62例经皮股动脉穿刺肝动脉灌注化疗栓塞治疗术(TACE)后有明显消化道毒副反应的患者随机分为2组,治疗组32例以健脾降逆消痞方(由赭石、党参、白术、茯苓、旋覆花、法半夏、厚朴、炒麦芽、干姜、黄连、枳实、甘草组成)治疗;对照组30例静滴胃复安、口服吗丁啉治疗。结果:健脾降逆消痞方能明显减轻消化道毒副反应症状,与对照组比较,差异有非常显著性意义(P<0.01)。结论:健脾降逆消痞方治疗肝动脉栓塞化疗术后消化道毒副反应安全有效,未发现不良反应。     

枳实胶囊对急性冠脉综合征患者血栓前状态危险因子的影响

目的 观察枳实胶囊对急性冠脉综合征(ACS)患者血栓前状态危险因子的影响.方法 67例ACS患者随机分成枳实组(34例,给予常规治疗加枳实胶囊)和常规组(33例,给予常规治疗),另设健康对照组(对照组)30名.患者分别于入院时及用药3周后空腹肘静脉取血,测定血小板聚集率、红细胞变形指数、红细胞聚集指数、血小板表面P-选择素(CD62p)、D-二聚体(D-Dm)、血清一氧化氮(NO)、血浆内皮素-1(ET-1)、氧化低密度脂蛋白(Ox-LDL). 结果 与对照组比较,ACS患者红细胞聚集指数、D-Dm、CD62p、ET-1、Ox-LDL水平明显升高,NO水平明显下降;治疗后枳实组与常规组NO明显上升,血小板聚集率、红细胞聚集指数、CD62p、D-Dm、ET-1、Ox-LDL明显下降(P＜0.05或P＜0.01);与常规组比较,枳实组血清NO明显上升,红细胞聚集指数、D-Dm、ET-1、Ox-LDL水平明显降低(P＜0.05或P＜0.01).结论 枳实能改善ACS患者内皮功能,降低血小板聚集率、红细胞聚集指数,增强抗氧化功能.     

小承气汤的研究概况

小承气汤源自《伤寒论》,由大黄(酒洗) 4两、厚朴(炙,去皮) 2两、枳实(大者,炙) 3枚组成,常用于治疗阳明腑实轻证,被收录于《古代经典名方目录(第一批)》,具有较高的临床应用价值。目前对小承气汤的化学成分、药理作用、临床应用等方面已有较多研究,但处方历史沿革不清、剂量换算不明,这些都对经典名方小承气汤的临床合理应用及其复方制剂的研发造成了一定的困难。笔者拟对小承气汤处方历史沿革、药味基原、饮片炮制方法、剂量换算和现代研究等方面进行综述,以明确该复方的历史脉络,为经典名方小承气汤的中医临床运用及其现代科学研究提供依据。     

卢尚岭大剂量用药经验总结与思考

卢尚岭教授临证常重用益母草、土茯苓、丹参、葶苈子、石菖蒲、附子、川乌、枳实、生地黄、麦冬、蜈蚣等药物,每取佳效。其用药主要以长期临床实践经验为依据,同时也因病位高下、病性虚实、病势急缓而异。单味药治病,也常取大剂奏效。从卢老的用药经验可知,大剂量用药需熟谙药性,有胆有识。人体生理功能的改变、疾病病情的需要、药物性状的古今差异可能是增加大剂量用药需求的影响因素。     

9种市售药材中重金属含量调查

目的:调查9种市售药材中重金属含量,为建立药材中重金属专用检测方法提供参考。方法:利用原子吸收分光光度计和原子荧光光谱仪测定36批次药材中铜、镉、汞、铅的含量,比较不同市场药材中重金属含量差异。结果:各药材中铜含量排序为金银花青蒿、木通、丹参、白芥子、栀子厚朴天麻茯苓;镉排序为金银花、青蒿、白芥子、栀子木通、厚朴天麻丹参、茯苓;汞排序为金银花栀子青蒿厚朴白芥子、天麻、茯苓、丹参、木通;铅排序为厚朴白芥子、栀子、金银花、青蒿、木通天麻、丹参茯苓。在36批药材中,铜元素全部合格;1批金银花药材中汞元素超标,超标率25%;3批药材中铅元素超标,厚朴、白芥子中铅元素超标率分别为50%和25%;镉元素有7批药材均超标,青蒿、金银花超标率75%,栀子25%。不同市场购买的药材中重金属含量差异并不显著。结论:调查的4种重金属元素中镉元素污染较严重,应加强重视。金银花在9种药材中重金属污染最严重,可作为后续重金属相关研究的首要研究对象。