浅论桂枝汤化裁辨治不寐

本文针对不寐之“阴阳虚衰,营卫(阴阳)失和,导致阳气不能入阴而不寐”的病机.归纳分析张仲景经方和调营卫,扶正补虚治疗“不得眠”的论治思想,及其在临床中的运用.期有助于提高临床运用经方治疗不寐之认识.     

电针对缺血性脑损伤大鼠海马齿状回突触传递活动的影响

[目的]观察电针对实验性脑缺血大鼠海马齿状回(DG)突触传递活动的影响。[方法]Wistar大鼠60只,随机分为 基础组和高频刺激(HFS)组,每组又分为假手术组(手术暴露双侧颈总动脉,但不阻断血流)、脑缺血模型组(丝线牵拉 法阻断双侧颈总动脉)及针刺组(造模并加用电针治疗)。采用在体记录突触传递长时程增强(LTP)的电生理学方法,观 察电针对海马齿状回基础突触活动的影响;高频刺激组动物均在造模后给予HFS诱发LTP,然后观察电针对HFS诱导海马 齿状回LTP的影响。[结果]假手术组120min内群峰电位(PS)幅值无明显变化;模型组10min时PS幅值开始下降,与同 时间点假手术组比较具有显著性差异(P<0.01),随后逐渐回升接近假手术组水平;针刺组在造模前、后分别给予电针刺 激,造模后10 min PS幅值未出现明显下降,随后逐渐上升,与同时间点模型组比较均有显著性差异(P<0.05或P< 0.01)。在给予HFS诱导出LTP后,假手术组PS幅值显著增大,并维持3 h无明显减弱;模型组在HFS 30 min后诱发LTP; 针刺组在HFS后30min给予电针刺激,HFS后60min的PS幅值逐渐增高,其中HFS120min和180min的PS幅值与同时间点 模型组比较均有显著性差异(P<0.05或P<0.01)。[结论]电针可增强缺血性脑损伤大鼠海马齿状回的基础突触传递活 动和HFS所诱导的LTP。这可     

电针任脉腧穴对脑缺血大鼠海马星形胶质细胞的调节效应

目的：观察电针任脉腧穴对于局灶性脑缺血大鼠损伤侧海马星形胶质细胞的转归是否有特异性的正面影响。方法：实验于2004—06／2005-06在中山大学北校区人体解剖教研室完成。Wistar雄性大鼠42只，以随机数字表随机分为假手术组（n=6）、电针组（n=18）和模型组（n=18）。①假手术组：麻醉后仅暴露右侧颈总动脉，不插入尼龙线，手术后不针刺。②电针组：制备大脑中动脉闭塞模型，2h后再灌注。造模成功后第2天开始施加电针任脉腧穴。③模型组：造模方法同电针组，造模成功后并不针刺。各组大鼠相应于造模后7，14，28d麻醉下处死取脑。在激光共聚焦显微镜（Olympus FV 500）下观察并计算各组大鼠损伤侧海马胶质纤维酸性蛋白／神经元特异性烯醇化酶免疫荧光双标及胶质纤维酸性蛋白、神经元特异性烯醇化酶阳性细胞。结果：实验动物42只均进入结果分析，中途无脱落。④电针组与模型组造模后7d的胶质纤维酸性蛋白／神经元特异性烯醇化酶荧光双标及胶质纤维酸性蛋白阳性细胞数并无差异（P〉0．05），假手术组胶质纤维酸性蛋白阳性细胞数明显较少（P〈0．01），3组神经元特异性烯醇化酶双标细胞数两两相比，差异均无统计学意义（P〉0．05）。②造模后14d，电针组的胶质纤维酸性蛋白／神经元特异性烯醇化酶荧光双标细胞数明显多于模型组（P〈0．01），而胶质纤维酸性蛋白细胞数则明显少于模型组（P〈0．01），两组神经元数量差异并无统计学意义（P〉0．05）。③造模后28d，电针组神经元特异性烯醇化酶阳性细胞数及胶质纤维酸性蛋白／神经元特异性烯醇化酶荧光双标细胞数均明显较模型组多（P〈0．01），而胶质纤维酸性蛋白细胞数则明显较模型组少（P〈0．01）。④假手术组可见散在分布的胶质纤维酸性蛋白阳性的星形胶质细胞，胞体较小。突起细长；模型组与电针组缺血侧海马均可见大量胶质纤维酸性蛋白呈强阳性的星形胶质细胞，突起变粗，变短。3组均可见卵圆形、多角形或扇形的神经元；模型组与电针组偶见极少数的胶质纤维酸性蛋白／神经元特异性烯醇化酶双标细胞，丽假手术组则未见。结论：电针任脉腧穴可调节脑缺血后大鼠海马增殖的星形胶质细胞，抑制其过度增殖。促进其多潜能化。有利于脑缺血后的神经修复。     

Clinical observation on electroacupuncture plus tuina for chronic tension-type headache

Objective

To observe the clinical efficacy of electroacupuncture (EA) combined with tuina for chronic tension-type headache (CTTH).

Methods

A total of 97 CTTH cases were randomly allocated into an observation group (n=52) and a control group (n=45). Patients in the observation group were treated with EA plus tuina based on pattern identification, whereas patients in the control group were treated with oral amitriptyline and oryzanol. Patients in both groups were treated for 8 weeks. A follow-up was conducted 3 months after the treatment. The intensity, duration, and frequency of the headache were recorded and compared before and after the treatment. Additionally, the patients’ psychological state and quality of life (QOL) were compared between the two groups.

Results

There were intra-group statistically significant differences in headache intensity score, headache duration, and headache frequency after the treatment and during the follow-up compared with those before the treatment (all P<0.05); and there were between-group statistically significant differences during the same time frame (all P<0.05). The Hamilton depression scale-17 items (HAMD-17) and Hamilton anxiety scale (HAMA) scores were significantly reduced in both groups after the treatment or during the follow-up (all P<0.01); and there were no between-group statistical significances during the same time frame (all P>0.05). The World Health Organization quality of life-BREF (WHOQOL-BREF) scores were significantly reduced in both groups after the treatment or during the follow-up (all P<0.05); and the scores in the observation group were significantly lower than those in the control group (all P<0.05) during the same time frame. The total effective rate was 88.0% in the observation group, versus 71.4% in the control group, showing a significant difference (P<0.05).

Conclusion

EA combined with tuina can significantly decrease the frequency of chronic tension-type headache, alleviate headache intensity, shorten headache duration, and improve the patients’ wellness. It is better than amitriptyline plus oryzanol.

     

不同刺法对急性脑梗塞患者CRP水平影响的临床研究

目的:探讨醒脑开窍针法、头体针法、头针法及体针法4种不同刺法在不同时间段对急性脑梗塞(ACI)患者血清C反应蛋白(CRP)水平的影响,并观察4种针法对ACI神经功能恢复的影响.方法:选择2005年6月～2006年6月深圳市中医院针灸科、急诊科急诊住院ACI患者126例,随机分为4组,包括醒脑开窍针刺法组(32例),头体针结合组(31例),头针组(31例)和体针组(32例),4组患者在常规对症治疗的基础上,分别加用醒脑开窍针法、头体针、单纯头针和单纯体针4种针法,分别在第1天治疗前、第3、7、15天观察各组患者血清CRP水平的变化,并对各组患者进行临床疗效评定.结果:在第1天治疗前,醒脑开窍针刺法组(1组)、头体针组(2组)、单纯头针组(3组)和单纯体针组(4组)4组患者血清CRP水平元明显差异(P＞0.05);第3、7、15天时,1组、2组的血清CRP水平明显低于3组和4组,差异有统计学意义(P＜0.01),而1组与2组相比,CRP水平无显著差异(P＞0.05).第15天时,4组临床疗效评定比较,1组的有效率为96.9%,与2、3、4组相比,差异有统计学意义(P＜0.01);第30天时,4组有效率分别为96.9%、93.5%、71.0%和68.75%,1组与3、4组相比,差异有统计学意义(chi2=6.09,9.27,P＜0.05,P＜0.01),2组与3、4组相比,差异有统计学意义(chi2=5.42,6.28,P＜0.05),1、2组相比,临床疗效差别无统计学意义(chi2=0.00,P＞0.05).结论:醒脑开窍针刺法及头体针结合法较单纯头针或单纯体针法能显著减少急性脑梗塞的炎症反应,而醒脑开窍针刺法对急性脑梗塞早期的神经功能恢复有明显优势.     

针刺治疗慢性疼痛所致抑郁症的临床观察

目的:通过研究证实针刺治疗慢性疼痛所致抑郁症的有效性及优势。方法:针刺治疗组、西药组分别接受针刺、抗抑郁药进行抗抑郁治疗。两组患者均采用汉密尔顿抑郁量表(HAMD)和疼痛模拟评分(VAS)分别在治疗前及治疗后第1、2、4周末进行评定。结果:1.针刺组治疗前后HAMD、VAS评分、HAMD减分率比较均有极其显著性差异(P&lt;0.01)。2.西药组治疗前后HAMD、VAS评分、HAMD减分率比较均有极其显著性差异(P&lt;0.01)。3.治疗后1W,针刺组和西药组组间比较HAMD评分*、HAMD减分率*及VAS评分**均有显著性差异(*P&lt;0.01,**P&lt;0.05)。4.治疗后2W、4W针刺组和西药组组间比较HAMD、VAS评分、HAMD减分率无显著性差异(P&gt;0.05)。5.治疗前后针刺组无不良反应,西药组有不良反应发生。结论:针刺治疗慢性疼痛所致抑郁症有确切疗效,疗效和西药组相当,起效较西药组快,无副作用,无不良反应。     

中药饮片实行定量小包装的做法和体会

中药饮片小包装改革,改变了传统抓药和称量的习惯,改进了中药调剂方法,提升了工作效率,改变了中医院中药房与整个中医院的建设不协调的状况。通过中药饮片的小包装设计,使中医药服务工作能够做到让群众知情,让群众选择,公开透明,增长了市民的中医文化科学知识。     

EFFECT OF ELECTROACUPUNCTURE ON SYNAPTIC PLASTICITY OF HIPPOCAMPAL NEURONS IN CEREBRAL ISCHEMIA RATS

Objective: To observe the effect of electroacupuncture (EA) on synaptic structure of hippocampal nerve felts and synaptophysin(SYN)expression in rats with cerebral ischemic injury. Methods: Sixty Wistar rats were randomized into sham-operation group, cerebral ischemia (CI) group and EA group, each of which was further divided into 1week (W) and 5W subgroups. Cl injury model was established by occlusion of the bilateral common carotid arteries. "Baihui"(百会 GV 20), "Dazhui" (大椎 GV 14), "Renzhong"(人中 GV26) and "Guanyuan"(关元 CV 4) were punctured and stimulated electrically. The brain tissue sections containing hippocampus region were stained with immu nohistochemical technique and observed under light microscope and transmission electronic microscope. Results: After CI, the ischemic injury as degeneration of the presynapse compositions, decrease of the synaptic numeral density, and low expression of SYN were observed in hippocampal CA1 area. By the 5th week after CI, the neonatal synapses of CI and     

补肾祛瘀汤对血栓性疾病ET、APCR、NO和血脂的影响

目的：观察补肾祛瘀汤对血栓性疾病血清内皮素（ET）、活化蛋白C抗体（APCR）、一氧化氮（NO）、血脂的影响。方法：将60例血栓性疾病患者随机分为治疗组和对照组，每组各30例。两组患者在急性期均使用肠溶阿司匹林抗血小板治疗，治疗组口服补肾祛瘀汤，对照组用尿激酶静脉滴注治疗，比较两组治疗前后上述指标数值的变化。结果：两组治疗后ET、NO均升高（P〈0．05），治疗组与对照组比较，有统计学意义（P〈0．05）。且治疗组对血脂有改善作用，也有统计学意义。结论：补肾祛瘀汤对血栓性疾病患者的ET、APCR有降低作用，对NO有升高作用，对血脂有改善作用，没有毒副作用。     

微创保胆内镜取石术加中药治疗胆囊结石的临床观察

采用微创手段于右肋下胆囊区建立取石通道 ,利用纤维胆道镜取除胆囊结石 ,术后服用中药防石 I号。治疗 6 5例胆囊结石患者 ,结石取净率 1 0 0 %,胆绞痛消失率 97%,胆囊收缩功能进一步改善 ,术后 3～ 6个月复查 B超未发现胆囊结石复发。