王净净从虚、痰、瘀、毒论治难治性癫痫经验

本文总结王净净教授治疗难治性癫痫经验。王教授认为难治性癫痫的病因病机多为虚、痰、瘀、毒交夹,治疗主以益气补肾、祛痰化瘀、解毒止痫,其实质是扶正气、祛顽邪、安神定窍,临床取得较好效果。     

基于中医传承辅助平台分析历代治疗痫证方剂的组方规律分析

目的:应用中医传承辅助平台(V2.5)分析和总结历代治疗痫证方剂的组方用药规律,为临床运用中医药治疗痫证提供参考依据。方法:收集历代治疗痫证方剂相关的文献,运用中医传承辅助平台建立方剂数据库,并应用中医传承辅助平台中集成的数据挖掘方法,分析方剂用药规律。结果:对历代治疗痫证773首方剂记录进行了分析,用药频次居前者有朱砂、人参、牛黄、麝香、全蝎、甘草、黄芩、大黄、天麻和防风等,并发现核心药物组合22个,挖掘出新处方共11个。结论:历代治疗痫证方剂用药以补虚安神、豁痰开窍、息风止痉、祛邪解毒为主。     

Effect of acupuncture plus Tai Ji Quan on the recovery of neurological function and depression state in post-stroke depression patients

Objective

To observe the therapeutic efficacy of acupuncture plus Tai Ji Quan (Tai Chi) in recovering the neurological function and treating depression state in post-stroke depression patients, together with a 12-month follow-up.

Methods

A total of 105 eligible post-stroke depression patients were randomized into an acupuncture plus Tai Ji group (53 cases) and a control group (52 cases) based on their visiting sequence. The patients all received routine treatment and rehabilitation training for stroke. In addition, the control group was given oral administration of citalopram hydrobromide tablets, 1 month as a course of treatment, for 3 courses in total. Meanwhile, the acupuncture plus Tai Ji group received acupuncture and practiced Tai Ji Quan, for 1 month and 12 months respectively. Before the intervention, after 1-month intervention and 12 months later, the National Institute of Health stroke scale (NIHSS), Barthel index (BI) and Hamilton depression rating scale (HAMD) were adopted for efficacy evaluation.

Results

Prior to the intervention, there were no significant differences in HAMD, NIHSS and BI scores between the two groups (all P>0.05); after 1-month intervention, there were significant between-group differences in NIHSS, BI and HAMD scores (P<0.05 or P<0.01); the 12-month follow-up revealed significant between-group differences in NIHSS, BI and HAMD scores (all P<0.01). In the treatment of stroke, the total effective rate was 84.4% in the acupuncture plus Tai Ji group, significantly higher than 68.9% in the control group (P<0.05); in the treatment of depression, the total effective rate was 86.7% in the acupuncture plus Tai Ji group, significantly higher than 77.8% in the control group (P<0.05).

Conclusion

Acupuncture plus Tai Ji Quan can produce a significant efficacy in improving the limb motor function and depression in post-stroke depression patients.

     

Effect of combining acupuncture and auricular point sticking on heart rate variability in patients with post-stroke depression

Objective

To investigate the effect of combining acupuncture and auricular point sticking on heart rate variability (HRV) in patients with post-stroke depression (PSD).

Methods

A total of 80 cases with PSD were randomized into a treatment group and a control group. The control group was intervened by oral administration of paroxetine hydrochloride, whereas the treatment group received acupuncture plus auricular point sticking base on the same oral administration. The Hamilton depression rating scale (HAMD) and HRV were measured before and after treatment in both groups.

Results

The individual and global scores of HAMD significantly dropped after 8 weeks of treatment in both groups (all P<0.05). In the treatment group, anxiety/somatization factor, sleep disturbance, hopelessness factor, cognition factor and global score were significantly different from those in the control group (all P<0.05). The 24 h standard deviation of all normal-to-normal R-R interval (SDNN), standard deviation of 5-minute average of normal R-R intervals (SDANN), root mean square of successive differences (RMSSD), percent of differences between adjacent normal R-R intervals >50 ms (PNN50) and high frequency (HF) were increased while low frequency (LF) and LF/HF decreased significantly after 8 weeks of treatment in both groups (P<0.05). All items in the treatment group were significantly different from those in the control group (all P<0.05).

Conclusion

Combining acupuncture and auricular point sticking can enhance the conventional medical treatment for HRV in patients with PSD.

     

柴胡疏肝散加味治疗脑卒中后焦虑障碍的临床疗效及其对心率变异性的影响

目的　观察柴胡疏肝散加味治疗脑卒中后焦虑障碍患者临床疗效及其对心率变异性（HRV）的影响。方法　根据纳入、排除标准选取2015年9月－2017年2月于湖南中医药大学第二附属医院脑病门诊及住院部诊断为脑卒中后焦虑障碍的患者90例,随机分为中药组（45例）和对照组（45例）。对照组口服氢溴酸西酞普兰片,中药组在对照组基础上加用柴胡疏肝散加味,两组均治疗6周。比较两组治疗前、治疗2周、治疗4周、治疗6周汉密尔顿焦虑量表（HAMA）、精神性焦虑因子、躯体性焦虑因子评分,治疗后临床疗效,治疗前、治疗6周HRV〔时域指标：24 h内全部窦性心律（NN）R-R间期标准差（SDNN）,24 h内每5 min NN R-R间期平均值标准差（SDANN）,24 h内相邻R-R间期差值的均方根（RMSSD）,24 h内相邻NN R-R间期差值>50 ms占百分比（PNN50）。频域指标：低频功率（LF）,高频功率（HF）,LF/HF〕。结果　治疗方法与时间在HAMA评分及其因子评分上存在交互作用（P<0.05）;时间在HAMA评分及其因子评分上主效应显著（P<0.05）;治疗方法在HAMA评分、精神性焦虑因子评分上主效应显著（P<0.05）;治疗方法在躯体性焦虑因子评分上主效应不显著（P>0.05）。治疗4、6周中药组患者HAMA评分、精神性焦虑因子评分低于对照组（P<0.05）。治疗2、4、6周两组患者HAMA评分、精神性焦虑因子评分低于治疗前（P<0.05）,治疗4、6周两组患者躯体性焦虑因子评分低于治疗前（P<0.05）。中药组患者临床疗效优于对照组（P<0.05）。治疗6周,中药组患者SDNN、SDANN、PNN50、HF高于对照组（P<0.05）;治疗6周,中药组患者LF、LF/HF低于对照组（P<0.05）。结论　柴胡疏肝散加味治疗脑卒中后焦虑障碍疗效确切,可改善HRV。     

柴胡疏肝散合四物汤加减预防性治疗月经周期性偏头痛32例临床观察

目的:观察柴胡疏肝散合四物汤加减预防性治疗月经周期性偏头痛的临床疗效。方法:选取肝郁血虚型月经周期性偏头痛患者64例,随机分为治疗组与对照组,每组32例。2组均于月经前10d开始服药,均以10d为1个疗程,连续服用3个疗程,于治疗后4、12周各随访1次。观察2组头痛VAS评分、发作次数及时间。结果:与治疗前比较,治疗后4、12周2组头痛VAS评分下降、头痛发作次数减少、发作时间缩短,差异均有统计学意义(P0.01,P0.05),且治疗组改善优于对照组(P0.05)。结论:柴胡疏肝散合四物汤预防性治疗月经周期性偏头痛可明显缓解头痛,减少发作次数,缩短发作时间,其疗效优于口服氟桂利嗪胶囊治疗。     

逍遥散加味治疗癫痫共病抑郁障碍的临床研究

目的观察逍遥散加味治疗癫痫共病抑郁障碍患者的临床效果。方法选择于2016年1月至2017年10月期间,就诊并符合纳入标准的癫痫共病抑郁障碍的患者作为研究对象,共60例。依照随机分组原则,将患者平均分成两组,分别为治疗组和对照组。在常规抗癫痫治疗的基础上,治疗组给予逍遥散加味,对照组给予阳性药物帕罗西汀,给药2个月后,观察两组患者治疗前后的临床疗效,根据汉密尔顿抑郁量表评定临床治疗效果。结果治疗后治疗组总有效率为83.3%,显著高于对照组的63.3%(P0.05);治疗后两组HAMD总评分与治疗前比较,HAMD总评分均下降(P0.05),且治疗组下降优于对照组,差异有统计学意义(P0.05);治疗后治疗组SERS评分低于对照组(P0.05)。结论逍遥散加味治疗癫痫共病抑郁障碍疗效确切,值得临床推广应用。