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小陷胸湯臨床應用及藥理研究近況

健(jian)康生活(huo) 2023-09-21 12:41:37

[摘要(yao)(yao)] 參(can)閱近5年(nian)來小(xiao)陷(xian)胸湯(tang)相(xiang)關文獻資料,對(dui)其(qi)(qi)治療(liao)消化系(xi)統、呼(hu)吸系(xi)統和(he)心血(xue)(xue)管(guan)系(xi)統疾(ji)(ji)病的(de)臨床應(ying)用進(jin)(jin)行綜述(shu),簡(jian)要(yao)(yao)概述(shu)了小(xiao)陷(xian)胸湯(tang)對(dui)慢(man)性萎縮(suo)性胃炎、功能性消化不良、腫瘤、動(dong)脈粥樣硬化、心肌(ji)缺血(xue)(xue)等疾(ji)(ji)病的(de)藥(yao)理(li)研究進(jin)(jin)展(zhan)情(qing)況,并淺(qian)析(xi)了小(xiao)陷(xian)胸湯(tang)的(de)進(jin)(jin)一步研究方向,為(wei)其(qi)(qi)更好的(de)應(ying)用提(ti)供參(can)考(kao)。

[關鍵詞] 小(xiao)陷胸湯;臨床(chuang)應用;藥理研(yan)究;文獻(xian)綜述

小(xiao)陷胸湯出自《傷(shang)寒(han)論》,為東漢(han)名醫(yi)張仲景(jing)所(suo)創,由瓜(gua)蔞、黃連、半夏(xia)三(san)味(wei)藥(yao)(yao)組成,其(qi)在《傷(shang)寒(han)論》中原治(zhi)表(biao)證,誤用攻下,邪熱(re)內陷、痰熱(re)互結心下致(zhi)成小(xiao)結胸病(bing)。長期的臨床(chuang)實(shi)踐(jian)已經證明(ming),《傷(shang)寒(han)論》之方劑既可用治(zhi)傷(shang)寒(han)病(bing),又可用治(zhi)雜病(bing),具有很高的實(shi)用價值。筆者查(cha)閱了近5年來臨床(chuang)應(ying)用及藥(yao)(yao)理(li)研究方面相關文獻,加以(yi)總結,使其(qi)為人類醫(yi)學做出更大(da)的貢獻。

1 小陷胸湯在臨床方面的研究

1.1 小陷(xian)胸(xiong)湯應(ying)用于消化系統疾病

曲群英等(deng)[1]通(tong)過加(jia)(jia)味(wei)治療(liao)(liao)慢(man)(man)性(xing)(xing)(xing)(xing)胃(wei)(wei)(wei)(wei)炎(yan)(yan)(yan)致胃(wei)(wei)(wei)(wei)脘痛68例(li)(li)(li)(li)(li)(li),治療(liao)(liao)結果:共(gong)治療(liao)(liao)68例(li)(li)(li)(li)(li)(li),其中,治愈23例(li)(li)(li)(li)(li)(li),好轉(zhuan)30例(li)(li)(li)(li)(li)(li),無效(xiao)15例(li)(li)(li)(li)(li)(li),有(you)效(xiao)率(lv)(lv)為77.92%。范丹(dan)陽等(deng)[2]應用(yong)小(xiao)陷(xian)(xian)(xian)胸湯(tang)加(jia)(jia)味(wei)治療(liao)(liao)慢(man)(man)性(xing)(xing)(xing)(xing)糜(mi)爛(lan)性(xing)(xing)(xing)(xing)胃(wei)(wei)(wei)(wei)炎(yan)(yan)(yan)82例(li)(li)(li)(li)(li)(li),治愈46例(li)(li)(li)(li)(li)(li),有(you)效(xiao)30例(li)(li)(li)(li)(li)(li),無效(xiao)6例(li)(li)(li)(li)(li)(li),總有(you)效(xiao)率(lv)(lv)為92.68%。姜卓[3]運用(yong)小(xiao)陷(xian)(xian)(xian)胸湯(tang)加(jia)(jia)味(wei)治療(liao)(liao)慢(man)(man)性(xing)(xing)(xing)(xing)胃(wei)(wei)(wei)(wei)炎(yan)(yan)(yan)83例(li)(li)(li)(li)(li)(li),取得滿意療(liao)(liao)效(xiao),治愈45例(li)(li)(li)(li)(li)(li),有(you)效(xiao)30例(li)(li)(li)(li)(li)(li),無效(xiao)8例(li)(li)(li)(li)(li)(li),有(you)效(xiao)率(lv)(lv)為90%。周玉(yu)來等(deng)[4]用(yong)小(xiao)陷(xian)(xian)(xian)胸湯(tang)加(jia)(jia)味(wei)治療(liao)(liao)蘊胃(wei)(wei)(wei)(wei)型(xing)慢(man)(man)性(xing)(xing)(xing)(xing)胃(wei)(wei)(wei)(wei)炎(yan)(yan)(yan)68例(li)(li)(li)(li)(li)(li),其中,充血(xue)滲出性(xing)(xing)(xing)(xing)胃(wei)(wei)(wei)(wei)炎(yan)(yan)(yan)43例(li)(li)(li)(li)(li)(li),扁平糜(mi)爛(lan)型(xing)胃(wei)(wei)(wei)(wei)炎(yan)(yan)(yan)8例(li)(li)(li)(li)(li)(li),隆(long)起糜(mi)爛(lan)型(xing)胃(wei)(wei)(wei)(wei)炎(yan)(yan)(yan)3例(li)(li)(li)(li)(li)(li),萎縮型(xing)胃(wei)(wei)(wei)(wei)炎(yan)(yan)(yan)3例(li)(li)(li)(li)(li)(li),出血(xue)型(xing)胃(wei)(wei)(wei)(wei)炎(yan)(yan)(yan)3例(li)(li)(li)(li)(li)(li),返流型(xing)胃(wei)(wei)(wei)(wei)炎(yan)(yan)(yan)7例(li)(li)(li)(li)(li)(li),皺襞增生型(xing)胃(wei)(wei)(wei)(wei)炎(yan)(yan)(yan)1例(li)(li)(li)(li)(li)(li),痊(quan)愈35例(li)(li)(li)(li)(li)(li),好轉(zhuan)22例(li)(li)(li)(li)(li)(li),無效(xiao)11例(li)(li)(li)(li)(li)(li)。羅(luo)毅[5]在“小(xiao)陷(xian)(xian)(xian)胸湯(tang)臨床(chuang)運用(yong)”中用(yong)小(xiao)陷(xian)(xian)(xian)胸湯(tang)加(jia)(jia)味(wei),治療(liao)(liao)胃(wei)(wei)(wei)(wei)潰瘍、慢(man)(man)性(xing)(xing)(xing)(xing)膽(dan)囊炎(yan)(yan)(yan)急(ji)性(xing)(xing)(xing)(xing)發(fa)作、胃(wei)(wei)(wei)(wei)食(shi)管(guan)(guan)反流病等(deng),收到較好療(liao)(liao)效(xiao)。楊松月(yue)等(deng)[6]用(yong)小(xiao)陷(xian)(xian)(xian)胸湯(tang)加(jia)(jia)味(wei)治療(liao)(liao)急(ji)性(xing)(xing)(xing)(xing)食(shi)管(guan)(guan)炎(yan)(yan)(yan)87例(li)(li)(li)(li)(li)(li),痊(quan)愈76例(li)(li)(li)(li)(li)(li),有(you)效(xiao)6例(li)(li)(li)(li)(li)(li),無效(xiao)5例(li)(li)(li)(li)(li)(li),總有(you)效(xiao)率(lv)(lv)為94.5%。鄭昱[7]用(yong)小(xiao)陷(xian)(xian)(xian)胸湯(tang)合白(bai)虎湯(tang)加(jia)(jia)味(wei)治療(liao)(liao)胃(wei)(wei)(wei)(wei)食(shi)管(guan)(guan)反流病,共(gong)30例(li)(li)(li)(li)(li)(li),痊(quan)愈15例(li)(li)(li)(li)(li)(li),好轉(zhuan)11例(li)(li)(li)(li)(li)(li),無效(xiao)4例(li)(li)(li)(li)(li)(li),總有(you)效(xiao)率(lv)(lv)為86.67%。徐人安[8]用(yong)加(jia)(jia)味(wei)小(xiao)陷(xian)(xian)(xian)胸湯(tang)散(san)劑治療(liao)(liao)膽(dan)石(shi)癥43例(li)(li)(li)(li)(li)(li),治愈8例(li)(li)(li)(li)(li)(li),顯效(xiao)27例(li)(li)(li)(li)(li)(li),有(you)效(xiao)6例(li)(li)(li)(li)(li)(li),無效(xiao)2例(li)(li)(li)(li)(li)(li)。

趙曉敏等[9]以(yi)加味小(xiao)(xiao)陷(xian)(xian)(xian)胸(xiong)(xiong)(xiong)湯(tang)治(zhi)療(liao)功能性(xing)(xing)消化不良(liang)32例(li)(li)(li)(li)(li)(li)(li)(li),結(jie)果(guo):顯效(xiao)(xiao)20例(li)(li)(li)(li)(li)(li)(li)(li),有效(xiao)(xiao)10例(li)(li)(li)(li)(li)(li)(li)(li),無效(xiao)(xiao)2例(li)(li)(li)(li)(li)(li)(li)(li),總(zong)有效(xiao)(xiao)率為93.8 %。孫勁松等[10]用(yong)加味小(xiao)(xiao)陷(xian)(xian)(xian)胸(xiong)(xiong)(xiong)湯(tang)治(zhi)療(liao)慢性(xing)(xing)糜爛性(xing)(xing)胃(wei)炎34例(li)(li)(li)(li)(li)(li)(li)(li),治(zhi)愈22例(li)(li)(li)(li)(li)(li)(li)(li),有效(xiao)(xiao)9例(li)(li)(li)(li)(li)(li)(li)(li),無效(xiao)(xiao)3例(li)(li)(li)(li)(li)(li)(li)(li),總(zong)有效(xiao)(xiao)率為91.18%。聶丹麗等[11]用(yong)小(xiao)(xiao)陷(xian)(xian)(xian)胸(xiong)(xiong)(xiong)湯(tang)治(zhi)療(liao)非酒精(jing)性(xing)(xing)脂肪肝30例(li)(li)(li)(li)(li)(li)(li)(li),其中,合(he)并(bing)高血壓(ya)病(bing)9例(li)(li)(li)(li)(li)(li)(li)(li),2型(xing)糖尿病(bing)8例(li)(li)(li)(li)(li)(li)(li)(li),收(shou)到較好療(liao)效(xiao)(xiao)。鄭昱[12]用(yong)大(da)柴胡(hu)湯(tang)合(he)小(xiao)(xiao)陷(xian)(xian)(xian)胸(xiong)(xiong)(xiong)湯(tang)治(zhi)療(liao)急性(xing)(xing)胰腺炎患者43例(li)(li)(li)(li)(li)(li)(li)(li),痊愈31例(li)(li)(li)(li)(li)(li)(li)(li)(72.1%),顯效(xiao)(xiao)9例(li)(li)(li)(li)(li)(li)(li)(li)(20.9%),有效(xiao)(xiao)2例(li)(li)(li)(li)(li)(li)(li)(li)(4.7%),無效(xiao)(xiao)1例(li)(li)(li)(li)(li)(li)(li)(li)(2.3%),總(zong)有效(xiao)(xiao)率為97.7%。黃彥德等[13]用(yong)小(xiao)(xiao)陷(xian)(xian)(xian)胸(xiong)(xiong)(xiong)湯(tang)加減(jian)治(zhi)療(liao)胃(wei)十二指腸(chang)潰瘍69例(li)(li)(li)(li)(li)(li)(li)(li),結(jie)果(guo):痊愈49例(li)(li)(li)(li)(li)(li)(li)(li),好轉15例(li)(li)(li)(li)(li)(li)(li)(li),未愈5例(li)(li)(li)(li)(li)(li)(li)(li)。

1.2 小陷(xian)胸湯(tang)應用于呼吸系統(tong)疾病

李(li)建漢[14]用(yong)小(xiao)陷胸湯(tang)加(jia)減合麻杏甘石湯(tang)治(zhi)(zhi)療(liao)喘息型慢(man)性支氣(qi)管炎30例(li),治(zhi)(zhi)療(liao)組治(zhi)(zhi)愈(yu)(yu)23例(li),好轉3例(li),未(wei)愈(yu)(yu)4例(li),總有效(xiao)率為86.7%。劉(liu)渝生等(deng)[15]用(yong)小(xiao)陷胸湯(tang)加(jia)減治(zhi)(zhi)療(liao)喉癢咳嗽(sou)64例(li),結果(guo):痊(quan)愈(yu)(yu)(臨床癥狀全部消失)59例(li),其中1個療(liao)程(cheng)后(hou)治(zhi)(zhi)愈(yu)(yu)32例(li),2個療(liao)程(cheng)治(zhi)(zhi)愈(yu)(yu)27例(li),痊(quan)愈(yu)(yu)者最短時間為3 d,其余經(jing)治(zhi)(zhi)療(liao)2個療(liao)程(cheng)后(hou)咳嗽(sou)等(deng)癥狀明(ming)顯緩解,未(wei)愈(yu)(yu)5例(li),治(zhi)(zhi)愈(yu)(yu)率為92.19%。

1.3 小陷胸湯應用于心血管系統疾病

左建國[16]用(yong)加(jia)(jia)味小(xiao)陷(xian)胸(xiong)(xiong)湯(tang)聯合(he)辛(xin)伐他汀治(zhi)(zhi)(zhi)(zhi)療(liao)(liao)高(gao)脂血(xue)(xue)(xue)(xue)癥(zheng)(zheng)42例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),其(qi)中(zhong),高(gao)三酰甘油(you)血(xue)(xue)(xue)(xue)癥(zheng)(zheng)15例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),高(gao)膽固醇血(xue)(xue)(xue)(xue)癥(zheng)(zheng)8例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),混合(he)型(xing)高(gao)脂血(xue)(xue)(xue)(xue)癥(zheng)(zheng)19例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)。其(qi)中(zhong),合(he)并(bing)腦動(dong)脈硬化癥(zheng)(zheng)者(zhe)(zhe)5例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),高(gao)血(xue)(xue)(xue)(xue)壓者(zhe)(zhe)10例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),結(jie)果:顯(xian)效(xiao)(xiao)24例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),有(you)效(xiao)(xiao)16例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),無(wu)效(xiao)(xiao)2例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),總(zong)有(you)效(xiao)(xiao)率為(wei)95.2%。劉東方等[17]在常(chang)規(gui)西醫(yi)治(zhi)(zhi)(zhi)(zhi)療(liao)(liao)基礎上配(pei)合(he)小(xiao)陷(xian)胸(xiong)(xiong)湯(tang)治(zhi)(zhi)(zhi)(zhi)療(liao)(liao)心(xin)(xin)(xin)房纖顫30例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),結(jie)果收到較(jiao)好(hao)療(liao)(liao)效(xiao)(xiao)。李景君等[18]用(yong)加(jia)(jia)味小(xiao)陷(xian)胸(xiong)(xiong)湯(tang)治(zhi)(zhi)(zhi)(zhi)療(liao)(liao)不穩(wen)定型(xing)心(xin)(xin)(xin)絞(jiao)痛(tong),選(xuan)擇符合(he)診斷標(biao)準的不穩(wen)定型(xing)心(xin)(xin)(xin)絞(jiao)痛(tong)患者(zhe)(zhe)30例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),心(xin)(xin)(xin)絞(jiao)痛(tong)危(wei)(wei)險度(du)分層,其(qi)中(zhong),低危(wei)(wei)險組(zu)7例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),中(zhong)危(wei)(wei)險組(zu)15例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),高(gao)危(wei)(wei)險組(zu)8例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),心(xin)(xin)(xin)絞(jiao)痛(tong)分級(ji),其(qi)中(zhong)Ⅰ級(ji)3例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),Ⅱ級(ji)4例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),Ⅲ級(ji)8例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),Ⅳ級(ji)15例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),以中(zhong)醫(yi)證候療(liao)(liao)效(xiao)(xiao)及前(qian)后(hou)(hou)心(xin)(xin)(xin)電圖(tu)NST(ST段(duan)升高(gao)的心(xin)(xin)(xin)電圖(tu)數(shu))、∑ST(胸(xiong)(xiong)導聯心(xin)(xin)(xin)電圖(tu)ST段(duan)抬高(gao)總(zong)毫伏數(shu))變化為(wei)指標(biao),總(zong)有(you)效(xiao)(xiao)率為(wei)90%。葛林等[19]用(yong)小(xiao)陷(xian)胸(xiong)(xiong)加(jia)(jia)味方治(zhi)(zhi)(zhi)(zhi)療(liao)(liao)急性(xing)心(xin)(xin)(xin)肌(ji)(ji)梗(geng)(geng)死(si)62例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),治(zhi)(zhi)(zhi)(zhi)療(liao)(liao)結(jie)果,有(you)胸(xiong)(xiong)痛(tong)者(zhe)(zhe)45例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),胸(xiong)(xiong)痛(tong)消(xiao)失時(shi)間(jian)(jian)(jian)為(wei)(1.62±1.41)h;治(zhi)(zhi)(zhi)(zhi)療(liao)(liao)前(qian)后(hou)(hou)心(xin)(xin)(xin)電圖(tu)ST恢(hui)(hui)(hui)(hui)復(fu)時(shi)間(jian)(jian)(jian),有(you)ST段(duan)抬高(gao)者(zhe)(zhe)58例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),在24 h內恢(hui)(hui)(hui)(hui)復(fu)至等電位者(zhe)(zhe)45例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),占(zhan)77.58%,ST段(duan)恢(hui)(hui)(hui)(hui)復(fu)時(shi)間(jian)(jian)(jian)為(wei)(14.3±20.3)h;治(zhi)(zhi)(zhi)(zhi)療(liao)(liao)前(qian)后(hou)(hou)CPK酶(mei)峰(feng)值(zhi)恢(hui)(hui)(hui)(hui)復(fu)時(shi)間(jian)(jian)(jian),有(you)CPK增高(gao)者(zhe)(zhe)45例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),峰(feng)提前(qian)者(zhe)(zhe)24例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),占(zhan)53.33%,酶(mei)峰(feng)時(shi)間(jian)(jian)(jian)(16.4±4.8)h,酶(mei)恢(hui)(hui)(hui)(hui)復(fu)時(shi)間(jian)(jian)(jian)為(wei)(3.4±1.4)h。趙玉(yu)珍[20]以小(xiao)陷(xian)胸(xiong)(xiong)湯(tang)加(jia)(jia)味,瓜蔞15 g、半夏10 g、黃連6 g、石菖蒲10 g、郁金10 g、白芍20 g、丹參20 g、元胡10 g、川芎6 g,2劑,水煎(jian)服(fu),每日1劑,分2次服(fu),服(fu)完2劑后(hou)(hou),胸(xiong)(xiong)悶(men)、胸(xiong)(xiong)痛(tong)減(jian)輕,上方加(jia)(jia)減(jian)治(zhi)(zhi)(zhi)(zhi)療(liao)(liao)20 d,無(wu)胸(xiong)(xiong)悶(men)、胸(xiong)(xiong)痛(tong),復(fu)查心(xin)(xin)(xin)電圖(tu)示:V2~V6 T波基本(ben)正常(chang)。張磊(lei)等[21]用(yong)小(xiao)陷(xian)胸(xiong)(xiong)湯(tang)加(jia)(jia)味治(zhi)(zhi)(zhi)(zhi)療(liao)(liao)急性(xing)心(xin)(xin)(xin)肌(ji)(ji)梗(geng)(geng)死(si)42例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),前(qian)壁(bi)(bi)及側壁(bi)(bi)心(xin)(xin)(xin)肌(ji)(ji)梗(geng)(geng)死(si)21例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),下壁(bi)(bi)和后(hou)(hou)壁(bi)(bi)心(xin)(xin)(xin)肌(ji)(ji)梗(geng)(geng)死(si)16例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),伴陳(chen)舊性(xing)心(xin)(xin)(xin)肌(ji)(ji)梗(geng)(geng)死(si)5例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),并(bing)發(fa)高(gao)血(xue)(xue)(xue)(xue)壓病(bing)11例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),糖(tang)尿病(bing)8例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),以前(qian)后(hou)(hou)CPK酶(mei)峰(feng)值(zhi)恢(hui)(hui)(hui)(hui)復(fu)時(shi)間(jian)(jian)(jian)為(wei)指標(biao),擬CPK酶(mei)在發(fa)病(bing)后(hou)(hou)15 h到達峰(feng)值(zhi)為(wei)酶(mei)峰(feng)提前(qian),有(you)CPK增高(gao)者(zhe)(zhe)36例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)。酶(mei)峰(feng)提前(qian)者(zhe)(zhe)19例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),占(zhan)52.77%,酶(mei)峰(feng)時(shi)間(jian)(jian)(jian)(16.4±4.8)h。酶(mei)恢(hui)(hui)(hui)(hui)復(fu)時(shi)間(jian)(jian)(jian)(3.4±1.4)h,取得(de)了較(jiao)好(hao)療(liao)(liao)效(xiao)(xiao)。戴娟(juan)[22]用(yong)升陷(xian)湯(tang)合(he)小(xiao)陷(xian)胸(xiong)(xiong)湯(tang)加(jia)(jia)味治(zhi)(zhi)(zhi)(zhi)療(liao)(liao)急性(xing)冠脈綜合(he)征32例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),結(jie)果:顯(xian)效(xiao)(xiao)13例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),有(you)效(xiao)(xiao)16例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li),無(wu)效(xiao)(xiao)3例(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)。

1.4 小陷胸湯應用于其他系統疾病

王亞(ya)平等(deng)[23]用加味小陷胸湯干預濕(shi)熱(re)困脾(pi)型糖耐(nai)量受損30例(li),結(jie)果(guo):痊愈(yu)1例(li),顯效(xiao)9例(li),有效(xiao)10例(li),無效(xiao)10例(li)。仝(tong)小林運用小陷胸湯治(zhi)療(liao)單純性肥胖,結(jie)果(guo)收到較好療(liao)效(xiao)[24]。

2 小陷胸湯的實驗研究

2.1 大鼠的實(shi)驗(yan)研究(jiu)

2.1.1 對實(shi)驗(yan)性(xing)慢(man)性(xing)萎(wei)縮(suo)性(xing)胃(wei)(wei)炎大鼠血(xue)清胃(wei)(wei)泌素(su)、胃(wei)(wei)黏(nian)膜(mo)前(qian)列腺素(su)E2的(de)(de)影響 張秋霞等[25]通過動物實(shi)驗(yan)來驗(yan)證四逆散與小陷胸(xiong)湯(tang)相(xiang)合對于CAG的(de)(de)影響,將大鼠隨機分為6組(zu)(zu):正(zheng)常組(zu)(zu)、模(mo)型(xing)組(zu)(zu)、高(gao)劑(ji)量組(zu)(zu)(0.89 g/kg)、中劑(ji)量組(zu)(zu)(0.49 g/kg)、低劑(ji)量組(zu)(zu)(0.17 g/kg)、維酶(mei)素(su)陽(yang)性(xing)對照組(zu)(zu)(0.89 g/kg),每組(zu)(zu)12只大鼠,結果(guo):四逆、陷胸(xiong)湯(tang)合方能提高(gao)實(shi)驗(yan)性(xing)慢(man)性(xing)萎(wei)縮(suo)性(xing)胃(wei)(wei)炎大鼠血(xue)清胃(wei)(wei)泌素(su)、胃(wei)(wei)黏(nian)膜(mo)前(qian)列腺素(su)E2(PGE2)的(de)(de)含量。

2.1.2 小陷胸(xiong)湯(tang)治(zhi)療功能(neng)性(xing)消(xiao)化(hua)不良(liang)的實驗研究 王渝等[26]、劉建平等[27]通(tong)過動(dong)物實驗,從胃(wei)動(dong)力(胃(wei)排空率(lv))、胃(wei)腸神經遞(di)質(zhi)一(yi)氧化(hua)氮(NO)、胃(wei)腸激(ji)素胃(wei)動(dong)素(MOT)的角度研究此方治(zhi)療功能(neng)性(xing)消(xiao)化(hua)不良(liang)(FD)的作用機制(zhi)。結果:小陷胸(xiong)湯(tang)能(neng)提高FD大鼠胃(wei)固體排空率(lv),減輕NO對胃(wei)排空的抑制(zhi)。

2.1.3 加味小(xiao)陷胸湯(tang)抗腫瘤(liu)作(zuo)用的(de)實驗(yan)研(yan)究 黃金玲[28]通過動物實驗(yan)觀(guan)察了其(qi)對小(xiao)鼠(shu)移(yi)植性(xing)腫瘤(liu)S180和(he)艾氏腹水(shui)癌(EAC)生長抑制(zhi)作(zuo)用,及其(qi)對荷(he)S180小(xiao)鼠(shu)單核-巨噬(shi)(shi)細(xi)(xi)胞(bao)(bao)系吞噬(shi)(shi)功(gong)能(neng)、自然殺傷(NK)細(xi)(xi)胞(bao)(bao)活(huo)性(xing)的(de)影響。結(jie)果顯(xian)示,加味小(xiao)胸湯(tang)對小(xiao)鼠(shu)移(yi)植性(xing)腫瘤(liu)S180有一定抑制(zhi)作(zuo)用,能(neng)明顯(xian)延(yan)長荷(he)瘤(liu)小(xiao)鼠(shu)存活(huo)時間,并能(neng)明顯(xian)促進荷(he)瘤(liu)小(xiao)鼠(shu)非特異性(xing)細(xi)(xi)胞(bao)(bao)免疫功(gong)能(neng)。

2.1.4 對實驗(yan)性(xing)肺間質(zhi)纖維(wei)化(hua)(hua)大(da)(da)鼠(shu)(shu)血清中(zhong)透(tou)(tou)明(ming)(ming)質(zhi)酸(suan)與血清中(zhong)Ⅳ型膠(jiao)(jiao)原(yuan)影(ying)響的實驗(yan)研究(jiu) 閻醒予[29]依據中(zhong)醫理論和臨床觀(guan)察,通(tong)過動(dong)物(wu)實驗(yan)探討(tao)抵(di)當(dang)湯(tang)(tang)合(he)小陷胸(xiong)湯(tang)(tang)化(hua)(hua)裁方(fang)對實驗(yan)性(xing)肺間質(zhi)纖維(wei)化(hua)(hua)大(da)(da)鼠(shu)(shu)血清中(zhong)透(tou)(tou)明(ming)(ming)質(zhi)酸(suan)及Ⅳ型膠(jiao)(jiao)原(yuan)水平的影(ying)響。結果(guo)表明(ming)(ming),抵(di)當(dang)湯(tang)(tang)合(he)小陷胸(xiong)湯(tang)(tang)化(hua)(hua)裁方(fang)能(neng)明(ming)(ming)顯降(jiang)低(di)肺間質(zhi)纖維(wei)化(hua)(hua)大(da)(da)鼠(shu)(shu)血清中(zhong)透(tou)(tou)明(ming)(ming)質(zhi)酸(suan)及Ⅳ型膠(jiao)(jiao)原(yuan)含量(liang),因而(er)提示本方(fang)是(shi)通(tong)過影(ying)響細胞外基(ji)質(zhi)的合(he)成(cheng)而(er)治療(liao)肺間質(zhi)纖維(wei)化(hua)(hua)的。

2.1.5 小(xiao)陷胸(xiong)(xiong)湯(tang)加(jia)(jia)味對實驗(yan)性(xing)高(gao)(gao)脂(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)癥(zheng)大(da)(da)鼠(shu)血(xue)(xue)(xue)(xue)脂(zhi)(zhi)(zhi)(zhi)的影響 毛煒(wei)等[30]為觀察小(xiao)陷胸(xiong)(xiong)湯(tang)加(jia)(jia)枳殼水提液(ye)對實驗(yan)性(xing)高(gao)(gao)脂(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)癥(zheng)大(da)(da)鼠(shu)血(xue)(xue)(xue)(xue)清總(zong)膽固醇(chun)(TC)、三酰甘油(you)(TG)、高(gao)(gao)密(mi)度脂(zhi)(zhi)(zhi)(zhi)蛋白膽固醇(chun)(HDL-C)和低密(mi)度脂(zhi)(zhi)(zhi)(zhi)蛋白膽固醇(chun)(LDL-C)的影響,用(yong)48只雄性(xing)SD大(da)(da)鼠(shu)適(shi)應性(xing)喂養1周后,隨機選取12只大(da)(da)鼠(shu)作為正常(chang)組,其余36只大(da)(da)鼠(shu)參照文(wen)獻報道的方法建立實驗(yan)性(xing)高(gao)(gao)脂(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)癥(zheng)模(mo)型(xing),隨機分為小(xiao)陷胸(xiong)(xiong)湯(tang)組、立普妥組和模(mo)型(xing)組,分別施加(jia)(jia)干預因素,連續灌胃給藥12周后,采血(xue)(xue)(xue)(xue),檢測TC、TG、HDL-C和LDL-C。結果(guo)表明(ming),小(xiao)陷胸(xiong)(xiong)湯(tang)加(jia)(jia)枳殼能夠降低實驗(yan)性(xing)高(gao)(gao)脂(zhi)(zhi)(zhi)(zhi)血(xue)(xue)(xue)(xue)癥(zheng)大(da)(da)鼠(shu)血(xue)(xue)(xue)(xue)TC和LDL-C。

2.1.6 小陷胸湯(tang)加(jia)味方(fang)(fang)對動(dong)脈粥樣硬化大(da)鼠(shu)炎(yan)性(xing)因(yin)(yin)(yin)子(zi)的(de)影響 李娜等(deng)[31]通過實(shi)驗(yan)動(dong)物觀(guan)察(cha)了小陷胸湯(tang)加(jia)味方(fang)(fang)對動(dong)脈粥樣硬化(AS)模型(xing)大(da)鼠(shu)的(de)干(gan)預(yu)作用。結果顯(xian)示,小陷胸湯(tang)加(jia)味方(fang)(fang)能(neng)降(jiang)(jiang)低AS大(da)鼠(shu)的(de)血脂及血液流變(bian)學(xue)各指標(P<0.01),且(qie)能(neng)明顯(xian)抑(yi)制AS大(da)鼠(shu)主動(dong)脈內皮(pi)細胞超敏C反應蛋白(hs-CRP)表達(da),減少細胞間黏(nian)附分子(zi)-1(ICAM-1)和血管細胞黏(nian)附分子(zi)-1(VCAM-1)mRNA的(de)表達(da)(P<0.01),在降(jiang)(jiang)低炎(yan)癥因(yin)(yin)(yin)子(zi)表達(da)方(fang)(fang)面優于辛伐(fa)他(ta)汀,小陷胸湯(tang)加(jia)味方(fang)(fang)能(neng)夠(gou)有效改善AS模型(xing)大(da)鼠(shu)血脂、血液流變(bian)學(xue)、血清(qing)炎(yan)癥因(yin)(yin)(yin)子(zi),起(qi)到干(gan)預(yu)AS炎(yan)癥機制的(de)作用。

2.2 兔的(de)實驗研(yan)究(jiu)

2.2.1 對(dui)(dui)兔心肌缺血(xue)(xue)(xue)再(zai)(zai)灌(guan)注(zhu)(zhu)損(sun)(sun)傷(shang)(shang)一(yi)氧化氮、一(yi)氧化氮合酶的(de)影響 劉(liu)煒等[32]用小(xiao)陷胸湯加(jia)味方(fang)(fang)對(dui)(dui)兔心肌缺血(xue)(xue)(xue)再(zai)(zai)灌(guan)注(zhu)(zhu)損(sun)(sun)傷(shang)(shang)的(de)模型進行干預,探(tan)討(tao)小(xiao)陷胸湯加(jia)味方(fang)(fang)對(dui)(dui)心肌缺血(xue)(xue)(xue)再(zai)(zai)灌(guan)注(zhu)(zhu)損(sun)(sun)傷(shang)(shang)的(de)作(zuo)用機制,結果表明,小(xiao)陷胸湯加(jia)味方(fang)(fang)具有提高一(yi)氧化氮合酶(NOS)活(huo)性,增加(jia)心肌NO含量的(de)作(zuo)用,從(cong)而(er)減輕(qing)心肌缺血(xue)(xue)(xue)再(zai)(zai)灌(guan)注(zhu)(zhu)損(sun)(sun)傷(shang)(shang)的(de)程度。

2.2.2 對兔心(xin)肌缺(que)(que)血(xue)(xue)(xue)再(zai)灌注損(sun)(sun)傷(shang)血(xue)(xue)(xue)清(qing)(qing)(qing)丙(bing)二醛、超(chao)氧(yang)化(hua)物(wu)歧(qi)化(hua)酶的(de)影響 劉玉(yu)潔等[33]將32只(zhi)健康日本大(da)耳白(bai)兔隨機(ji)分為假手術組、模型(xing)組和小陷胸(xiong)湯加味方低、高(gao)劑量(liang)組各8只(zhi)。結扎左(zuo)冠狀動脈前降支30 min,再(zai)灌注120 min后立即(ji)右心(xin)房取血(xue)(xue)(xue),分離血(xue)(xue)(xue)清(qing)(qing)(qing),觀(guan)(guan)察(cha)(cha)血(xue)(xue)(xue)清(qing)(qing)(qing)超(chao)氧(yang)化(hua)物(wu)歧(qi)化(hua)酶(SOD)活性(xing)(xing)和丙(bing)二醛(MDA)含(han)量(liang)。結果表明(ming),小陷胸(xiong)湯加味方能(neng)減輕(qing)實驗兔急性(xing)(xing)心(xin)肌缺(que)(que)血(xue)(xue)(xue)再(zai)灌注損(sun)(sun)傷(shang)的(de)程(cheng)度(du),這與臨床(chuang)觀(guan)(guan)察(cha)(cha)結果相符(fu),其作用機(ji)制與提高(gao)SOD活性(xing)(xing)、降低MDA含(han)量(liang)有(you)(you)關。提示其能(neng)明(ming)顯減輕(qing)氧(yang)自由基所(suo)致的(de)細胞損(sun)(sun)傷(shang),保護缺(que)(que)血(xue)(xue)(xue)再(zai)灌注心(xin)肌組織,可有(you)(you)效防治心(xin)肌缺(que)(que)血(xue)(xue)(xue)再(zai)灌注損(sun)(sun)傷(shang)。

3 小陷胸湯的應用展望

小陷胸湯組方(fang)(fang)精煉,三(san)藥(yao)配(pei)伍相得益彰,臨床療(liao)效(xiao)顯著,安全(quan)性高,具有(you)較高的臨床應用價(jia)值(zhi),但目前(qian)(qian)小陷胸湯主要用于(yu)消化系(xi)統(tong)(tong)疾病,尤(you)其是(shi)胃炎(yan)、胃脘痛、咳喘,藥(yao)理研究也集中在(zai)這方(fang)(fang)面。除(chu)上(shang)述外,處方(fang)(fang)中單味黃(huang)連(lian)對(dui)心(xin)血管系(xi)統(tong)(tong)有(you)顯著性影(ying)響(xiang),黃(huang)連(lian)中的主要成分(fen)小檗堿具有(you)廣譜抗心(xin)律失(shi)常(chang)作用,通(tong)過(guo)靜注給藥(yao)可降低動脈壓(ya)(ya)(ya),尤(you)其是(shi)舒(shu)張壓(ya)(ya)(ya),且與劑量呈正相關(guan)。據臨床報道,停用各種降壓(ya)(ya)(ya)藥(yao)物1周后(hou),口服黃(huang)連(lian)素片,每次0.4~0.6 g,每日3次,療(liao)程4周。治(zhi)療(liao)后(hou)分(fen)別描(miao)記(ji)心(xin)電(dian)圖、驗血尿常(chang)規、血脂等(deng)進(jin)行療(liao)效(xiao)評價(jia)。結果顯示,治(zhi)療(liao)42例,總有(you)效(xiao)率為73.8%,尤(you)其對(dui)Ⅰ、Ⅱ期高血壓(ya)(ya)(ya)療(liao)效(xiao)最好,可見(jian)黃(huang)連(lian)有(you)很好的降壓(ya)(ya)(ya)作用,但目前(qian)(qian)小陷胸湯尚未(wei)見(jian)用于(yu)治(zhi)療(liao)高血壓(ya)(ya)(ya)的相關(guan)報道,此方(fang)(fang)面值(zhi)得去發(fa)掘和探討。

目前小陷胸(xiong)湯在臨(lin)床(chuang)方面,主治病(bing)證(zheng)缺乏統一標準,原方的加減隨意性較大,不(bu)(bu)利于(yu)處方的進一步優(you)化。藥(yao)理(li)方面則(ze)需(xu)(xu)要加強方證(zheng)相(xiang)關性研究,不(bu)(bu)能脫離病(bing)證(zheng)進行(xing)單獨的藥(yao)物研究,同時應注重劑(ji)型改革(ge),研制出高效、速效、長效并且服(fu)用(yong)、攜(xie)帶、生產、運(yun)輸、儲藏方便的新制劑(ji),從而更好地滿足(zu)臨(lin)床(chuang)需(xu)(xu)要。

隨著現代醫學(xue)的分(fen)子(zi)(zi)藥(yao)(yao)理、受體(ti)藥(yao)(yao)理學(xue)和分(fen)子(zi)(zi)免疫學(xue)的發展(zhan),把傳統方劑和現代醫學(xue)有機地結合起來,可以使我們更好地掌(zhang)握小陷胸湯(tang)的藥(yao)(yao)理、藥(yao)(yao)效(xiao)以及藥(yao)(yao)代動(dong)力學(xue)特征以及深入到分(fen)子(zi)(zi)或基因(yin)水平探討其作用機理,故對其研究還有待進(jin)一步發展(zhan),以使這個古代經(jing)典方劑在臨(lin)床上發揮更大(da)的作用。

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本文來源:中(zhong)國(guo)醫(yi)藥(yao)導(dao)報 ? ? 作者:韓瑞偉(wei)

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