中药镇痛实验的研究进展

随着科技的进步,人们在分子和细胞水平、神经递质等多方面,对疼痛病理的认识不断深入,中药镇痛研究取得了新的进展,并以动物疼痛模型为基础筛选和研究了中药镇痛活性成分及其作用机制,为新型镇痛药的创制开发提供了科学依据。本文总结了中药镇痛实验研究中常见的动物疼痛模型,着重探讨了镇痛机制相关物质及其测定,以期为今后中药镇痛研究提供参考。     

中药面膜联合煎剂内服治疗寻常性痤疮72例疗效观察

目的观察中药面膜联合煎剂内服治疗寻常性痤疮临床疗效。方法将137例痤疮患者随机分为72例中药治疗组和65例西药对照组,中药治疗组采用内服中药痤疮煎剂联合中药面膜外用治疗;西药对照组采用口服美满霉素片0.1g,1日2次,维生素B620mg,1日2次,外涂0.1%维A酸霜。结果中药治疗组有效率86.11%,西药治疗组有效率为66.15%,两组比较,差异有统计学意义(P0.01)。结论中药面膜联合煎剂内服治疗寻常性痤疮,有疗效短、见效快、无副作用、治愈率高且不易复发等优点,疗效明显优于西药对照组,值得临床推广应用。     

A double-blind placebo-controlled pilot study of sublingual feverfew and ginger (LipiGesic™ M) in the treatment of migraine

(Headache 2011;51:1078‐1086) Background.— Therapeutic needs of migraineurs vary considerably from patient to patient and even attack to attack. Some attacks require high‐end therapy, while other attacks have treatment needs that are less immediate. While triptans are considered the “gold standard” of migraine therapy, they do have limitations and many patients are seeking other therapeutic alternatives. In 2005, an open‐label study of feverfew/ginger suggested efficacy for attacks of migraine treated early during the mild headache phase of the attack. Methods/Materials.— In this multi‐center pilot study, 60 patients treated 221 attacks of migraine with sublingual feverfew/ginger or placebo. All subjects met International Headache Society criteria for migraine with or without aura, experiencing 2‐6 attacks of migraine per month within the previous 3 months. Subjects had <15 headache days per month and were not experiencing medication overuse headache. Inclusion required that subjects were able to identify a period of mild headache in at least 75% of attacks. Subjects were required to be able to distinguish migraine from non‐migraine headache. Subjects were randomized 3:1 to receive either sublingual feverfew/ginger or a matching placebo and were instructed but not required to treat with study medication at the earliest recognition of migraine. Results.— Sixty subjects treated 208 evaluable attacks of migraine over a 1‐month period; 45 subjects treated 163 attacks with sublingual feverfew/ginger and 15 subjects treated 58 attacks with a sublingual placebo preparation. Evaluable diaries were completed for 151 attacks of migraine in the population using feverfew/ginger and 57 attacks for those attacks treated with placebo. At 2 hours, 32% of subjects receiving active medication and 16% of subjects receiving placebo were pain‐free (P = .02). At 2 hours, 63% of subjects receiving feverfew/ginger found pain relief (pain‐free or mild headache) vs 39% for placebo (P = .002). Pain level differences on a 4‐point pain scale for those receiving feverfew/ginger vs placebo were ?0.24 vs ?0.04 respectively (P = .006). Feverfew/ginger was generally well tolerated with oral numbness and nausea being the most frequently occurring adverse event. Conclusion.— Sublingual feverfew/ginger appears safe and effective as a first‐line abortive treatment for a population of migraineurs who frequently experience mild headache prior to the onset of moderate to severe headache.     

Successful treatment of restless leg syndrome with the traditional herbal medicines Dangguijakyak-san and Shihogyeji-tang: A case report (CARE-compliant)

Rationale:Dopamine replacement is currently the standard treatment for restless leg syndrome (RLS); however, various adverse effects are associated with long-term therapy, and the benefits disappear upon discontinuation. To overcome these limitations, interest in traditional East Asian medicine has increased.Patient concerns:A 72-year-old Asian woman originally admitted for an intracerebral hemorrhage presented with complaints of an unpleasant sensation throughout the body that appeared at night.Diagnoses:The patient was diagnosed with chronic persistent RLS based on the 2012 Revised International Restless Leg Syndrome Study Group Diagnostic Criteria.Interventions:The patient was treated with extracts of the traditional herbal medicines Dangguijakyak-san (DS) and Shihogyeji-tang (ST). After 47 days of therapy, all herbal medicines were discontinued, and symptoms had not returned by the last follow-up 244 days after the initial treatment.Outcomes:One week after initiating herbal treatment with DS and ST, the RLS symptoms began to improve, and the total hours of sleep had increased from 2 to 9 hours by day 21, with a Korean version of the international restless legs scale score of 11 points. On day 36, ST was discontinued, given the continued improvement of symptoms. On day 47, symptoms had disappeared (Korean version of the international restless legs scale score: 0), and sleep disturbances caused by RLS had completely resolved. After day 47, DS was also discontinued. There were no adverse effects associated with the administration of DS and ST, and the symptoms had not recurred by the last follow-up on day 244.Lessons:In this case, RLS related symptoms, which had been present for approximately 60 years, were improved using only the traditional herbal medicines DS and ST (without dopamine replacement), and no symptoms recurred for 244 days. This case suggests that if replacement therapy is difficult or not desired, herbal medicinal therapies may be an effective alternative. This also suggests that the effect of herbal medicine on RLS might be semi-permanent. Further investigations, including clinical trials, are needed to confirm these effects.     

Oral ginseng formulae for stable chronic obstructive pulmonary disease: a systematic review

Ginseng alone or combined with other herbs has been increasingly used for chronic obstructive pulmonary disease (COPD). This review aims to evaluate the effectiveness and safety of oral Ginseng formulae for stable COPD. Four English databases and three Chinese databases were searched to identify randomized controlled trials. Methodological quality was assessed by Cochrane risk of bias and Jadad's scale. Data were analyzed using Review Manager 5.0. Twelve studies overall of low quality, involving 1560 participants were included. Results of three studies showed a mean difference (MD) of 0.30 (95%CI 0.02 to 0.58) for forced expiratory volume in 1 s (FEV(1)) improvement of Ginseng formulae versus placebo control. Findings of three studies revealed an MD of 9.43 (95%CI 3.64 to 15.21) of FEV(1) % predicted between Ginseng formulae and placebo control. Quality of life (Qol) measured by St. George's Respiratory Questionnaire was improved (MD -10.32, 95%CI -14.99 to -5.65) with Ginseng formulae plus pharmacotherapy versus pharmacotherapy alone in one study. There were no severe adverse events reported. Ginseng formulae for stable COPD patients show promising evidence of lung functions and Qol improvement. However, the degree of benefit is uncertain due to potential risk of bias of the included studies.     

骨科弹道式冲击波配合中药熏洗治疗软组织劳损

背景：目前采用骨科弹道式冲击波治疗软组织劳损较为普遍,但与中药熏洗配合治疗的报道甚少。 目的：观察骨科弹道式冲击波配合中药熏洗治疗软组织劳损的临床疗效。 方法：将912例软组织劳损患者采用骨科弹道式冲击波配合中药熏洗治疗。采用目测类比定级法评定患者痛点受压时的疼痛强度。 结果与结论：经骨科弹道式冲击波配合中药熏洗治疗1周后,患者疼痛下降明显,第2周时测类比定级法评分变化不明显。2周以后,患者疼痛强度与治疗前比较明显下降(P < 0.05)。跟痛症与网球肘、屈指肌腱腱鞘炎比较,患者疼痛强度下降缓慢(P < 0.05)。结果证实,骨科弹道式冲击波配合中药熏洗治疗软组织劳损疗效显著。     

子宫内膜异位症腹腔镜保守手术后口服散结镇痛胶囊与米非司酮的临床疗效比较

目的:比较子宫内膜异位症腹腔镜保守手术后口服散结镇痛胶囊及米非司酮的疗效。方法:回顾分析2006年9月至2008年6月我院为51例子宫内膜异位症患者行腹腔镜手术的临床资料,术后分为散结镇痛胶囊组(A组)29例,米非司酮组(B组)22例。结果:A组总有效率72.4%,B组72.7%,差异无统计学意义(P0.05)。A组不孕患者1年内受孕率31.3%,B组30%,差异无统计学意义(P0.05)。一年内复发率A组27.6%,B组27.3%,差异无统计学意义(P0.05)。A组副反应发生率低于B组(P0.05)。结论:散结镇痛胶囊与米非司酮用于子宫内膜异位症腹腔镜术后的辅助治疗效果明显,但散结镇痛胶囊无米非司酮的副作用、点滴状出血及肝肾损害,对内分泌影响小,月经能正常来潮,患者依从性好,且用药期间不影响受孕。     

郭氏中药治疗中度地方性氟骨症X线改变的随机对照试验

目的:观察中度地方性氟骨症患者骨骼损害的X 线表现特点以及郭氏中药疗法治疗前后X线的变化情况.方法:2007年12月至2009年8月,采用区组随机化方法,借助中央随机系统将114例中度氟骨症患者随机分为治疗组和对照组,其中治疗组60例,男26例,女34例,年龄39～60岁,平均(51.68±4.98)岁;对照组54例,男30例,女24例,年龄39～60岁,平均(52.15±4.86)岁.两组均采用基础治疗,包括补充钙剂和汤药准备阶段.补充钙剂采用口服钙尔奇D 600 mg,每日1次,连服3个月.汤药准备阶段服用调节胃肠功能,促进消化吸收中药汤剂,服用3 d.治疗组药物采用郭氏马钱汤,口服,分2次服用,每次200 ml,连续服用8周;8周后改服骨康宁胶囊,规格为每粒0.44 g,每次2粒,每日3次,连续服用4周,疗程为12周.治疗后随访24周,总观察期36周.对照组药物采用汤药和胶囊安慰剂,服药方法和疗程与治疗组相同.治疗结束后,由7位骨科及放射学专家,采用事先根据地方性氟骨症X线征象和分度标准(WS192-2008)设计的专家评价表(包括骨质硬化、骨质疏松软化、骨周关节改变及混合改变的发生和改变情况),评价治疗前后X线的情况并进行统计处理.结果:地方性氟骨症的各种X线征象在114例中度氟骨症的X线片中均可见发生.骨质硬化:前臂4例,小腿7例,骨盆4例,腰椎4例;骨质疏松软化:前臂23例,小腿23例,骨盆5例,腰椎8例;混合改变:前臂6例,小腿9例,骨盆10例,腰椎1例;骨周关节改变:前臂107例,小腿47例,骨盆28例,腰椎19例.对照组治疗前后各部位X线片上的各种表现对比均无变化.治疗组仅有2例在骨周及关节改变情况发生治疗前后的变化,1例表现为小腿骨间膜骨化情况较治疗前好转,另1例表现为骨盆左髋臼外侧骨周增生消失.治疗组其余病例治疗前后各部位X线表现对比无变化.两组治疗前后X线变化情况的差异无统计学意义(P>0.05).结论:郭氏中药疗法在氟骨症的放射学方面无明显改善作用.     

化痰祛湿法治疗椎动脉型颈椎病的实验研究

目的:通过对椎动脉血流速度、血液黏度、脑凋亡细胞以及凋亡相关蛋白的检测,为化痰祛湿法治疗椎动脉型颈椎病及作用机制提供实验依据.方法: 60只雄性日本大耳兔,随机分为生理盐水组(A组)、盐酸氟桂利嗪组(B组)、小剂量温胆汤组(C组)、大剂量温胆汤组(D组)、合用组(E组,盐酸氟桂利嗪加大剂量温胆汤)和正常喂养组(F灌胃,生药含量为1 g/ml;D组:温胆汤按20 ml·kg-1d-1灌胃,生药含量为2 g/ml;E组:盐酸氟桂利嗪0.8 mg·kg-1d-1加生药含量为2 g/ml的温胆汤20 ml·kg-1d-1(盐酸氟桂利嗪溶于温胆汤中,保证总量20 ml·kg-1d-1).治疗前后分别测定椎动脉血流速度、血液黏度指标,测定完毕后处死并检测脑凋亡细胞和凋亡相关蛋白.采用SPSS 11.5软件包进行统计学分析.结果: 各组动物模型建立满意,E组对家兔椎动脉血流速度、血液黏度的改善最为理想,且脑细胞凋亡指数及凋亡相关蛋白的表达水平最低.结论:在常规治疗椎动脉型颈椎病的基础上加用化痰祛湿法能更好的改善椎动脉血流速度和血液黏度,其作用机制可能和减少脑细胞凋亡有关.