補中(zhong)益(yi)氣湯為主(zhu)治脾(pi)(pi)虛(xu)(xu)(xu)伴發(fa)熱(re)證候(hou)的代表(biao)方劑。為了(le)探討其甘溫除熱(re)機制(zhi),陜西(xi)中(zhong)醫學(xue)院(yuan)藥理教研室(shi)觀(guan)察了(le)補中(zhong)益(yi)氣湯對(dui)脾(pi)(pi)虛(xu)(xu)(xu)發(fa)熱(re)家兔體溫、腦(nao)(nao)脊液(ye)(ye)PGE2(前列腺素(su)E2)和(he)(he)丘(qiu)腦(nao)(nao)下(xia)部(bu)-視前區組(zu)(zu)織cAMP(環磷酸鳥(niao)苷)含(han)(han)量(liang)的影響。發(fa)現補中(zhong)益(yi)氣湯可降低脾(pi)(pi)虛(xu)(xu)(xu)發(fa)熱(re)模(mo)型升高的PGE2和(he)(he)cAMP的含(han)(han)量(liang)。研究人員將家兔隨機分(fen)為對(dui)照組(zu)(zu)、脾(pi)(pi)虛(xu)(xu)(xu)組(zu)(zu)、脾(pi)(pi)虛(xu)(xu)(xu)發(fa)熱(re)組(zu)(zu)和(he)(he)補中(zhong)益(yi)氣湯大、小劑量(liang)組(zu)(zu)(10克(ke)(ke)/千克(ke)(ke)、5克(ke)(ke)/千克(ke)(ke)),每(mei)組(zu)(zu)12只(zhi)。對(dui)照組(zu)(zu)不做任何處理,其余(yu)各組(zu)(zu)動物肌注(zhu)利血平(ping)復制(zhi)脾(pi)(pi)虛(xu)(xu)(xu)模(mo)型。除脾(pi)(pi)虛(xu)(xu)(xu)組(zu)(zu)外,其余(yu)三組(zu)(zu)耳緣靜(jing)脈注(zhu)射傷(shang)寒(han)、副傷(shang)寒(han)三聯疫苗致(zhi)熱(re),復制(zhi)“氣虛(xu)(xu)(xu)邪侵(qin)”型家兔脾(pi)(pi)虛(xu)(xu)(xu)發(fa)熱(re)模(mo)型。待脾(pi)(pi)虛(xu)(xu)(xu)癥狀(zhuang)明(ming)顯(xian)后(hou)灌胃補中(zhong)益(yi)氣湯。各組(zu)(zu)每(mei)天(tian)灌胃給藥(或(huo)常水)兩次,連續3天(tian)。各組(zu)(zu)一半(ban)動物每(mei)30分(fen)鐘測(ce)肛門(men)溫度(du)1次,連續測(ce)定(ding)8小時。末次給藥10分(fen)鐘后(hou),測(ce)定(ding)肛門(men)體溫作為基礎(chu)體溫,另(ling)一半(ban)動物在發(fa)熱(re)高峰期(qi)(致(zhi)熱(re)后(hou)約(yue)兩小時)測(ce)定(ding)腦(nao)(nao)脊液(ye)(ye)PGE2含(han)(han)量(liang)和(he)(he)丘(qiu)腦(nao)(nao)下(xia)部(bu)-視前區組(zu)(zu)織cAMP含(han)(han)量(liang)。
結果表(biao)明(ming),脾(pi)(pi)虛(xu)組基礎(chu)體溫(wen)(wen)較對照組明(ming)顯(xian)偏(pian)低;脾(pi)(pi)虛(xu)發熱組靜脈注射三聯(lian)疫苗后,經過(guo)1.5小(xiao)時的(de)潛(qian)伏(fu)期,進(jin)入(ru)發熱期,發熱曲線呈雙(shuang)峰熱型(xing),體溫(wen)(wen)回落較慢,持續(xu)時間(jian)長,體溫(wen)(wen)升(sheng)高峰值(zhi)(zhi)(最高體溫(wen)(wen)-基礎(chu)體溫(wen)(wen))較脾(pi)(pi)虛(xu)組明(ming)顯(xian)升(sheng)高,二者差異有顯(xian)著性意(yi)義;補中益氣湯大、小(xiao)劑量組雙(shuang)峰熱型(xing)不(bu)明(ming)顯(xian),兩組體溫(wen)(wen)升(sheng)高峰值(zhi)(zhi)明(ming)顯(xian)低于脾(pi)(pi)虛(xu)發熱組,二者差異具有顯(xian)著性意(yi)義。
脾(pi)(pi)虛(xu)發熱組(zu)動(dong)物(wu)腦脊液(ye)PGE2和丘腦下部-視前區(qu)組(zu)織(zhi)cAMP含(han)量(liang)較(jiao)脾(pi)(pi)虛(xu)組(zu)明(ming)顯(xian)(xian)(xian)升(sheng)高,二(er)者差異(yi)均(jun)有顯(xian)(xian)(xian)著(zhu)性意義;補(bu)中益氣(qi)湯大劑(ji)量(liang)組(zu)動(dong)物(wu)腦脊液(ye)PGE2含(han)量(liang)較(jiao)脾(pi)(pi)虛(xu)發熱組(zu)明(ming)顯(xian)(xian)(xian)降低;補(bu)中益氣(qi)湯大、小劑(ji)量(liang)組(zu)動(dong)物(wu)丘腦下部—視前區(qu)組(zu)織(zhi)cAMP含(han)量(liang)明(ming)顯(xian)(xian)(xian)低于脾(pi)(pi)虛(xu)發熱組(zu),二(er)者差異(yi)具有顯(xian)(xian)(xian)著(zhu)性意義。
研究(jiu)人員認(ren)為(wei),補(bu)中(zhong)(zhong)(zhong)益(yi)氣(qi)湯(tang)對實驗性(xing)家兔脾(pi)虛發(fa)熱(re)(re)有較明顯(xian)的解(jie)熱(re)(re)作用(yong),表現(xian)在能(neng)抑制(zhi)(zhi)體(ti)溫升高(gao),緩解(jie)熱(re)(re)勢,縮短熱(re)(re)程。解(jie)熱(re)(re)機制(zhi)(zhi)可(ke)(ke)能(neng)與(yu)降低腦脊液PGE2和(he)丘(qiu)腦下(xia)部(bu)-視前(qian)區(qu)組織(zhi)cAMP含量有關。PGE2是體(ti)內(nei)重要的活性(xing)物(wu)質(zhi),在中(zhong)(zhong)(zhong)樞神經系(xi)統能(neng)導致發(fa)熱(re)(re)反應,丘(qiu)腦下(xia)部(bu)-視前(qian)區(qu)組織(zhi)cAMP能(neng)促(cu)進(jin)腦內(nei)PGE2的生物(wu)合成。補(bu)中(zhong)(zhong)(zhong)益(yi)氣(qi)湯(tang)方中(zhong)(zhong)(zhong)黃芪、人參、當歸、白(bai)術(shu)等甘(gan)溫補(bu)益(yi)之(zhi)品,可(ke)(ke)增強(qiang)機體(ti)免(mian)疫功能(neng),在多味甘(gan)溫藥中(zhong)(zhong)(zhong)佐以柴胡(hu)、升麻,起解(jie)熱(re)(re)、鎮靜和(he)抗病原體(ti)等作用(yong)。可(ke)(ke)見,補(bu)中(zhong)(zhong)(zhong)益(yi)氣(qi)湯(tang)可(ke)(ke)能(neng)影響多個環(huan)節而起解(jie)熱(re)(re)作用(yong)。
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