桂枝作用于人体的部位偏上焦,肉桂则更偏于下焦,枳实薤白桂枝汤是用于治疗胸痹的名方,病位在上焦,故选桂枝较为恰当,若兼见下焦阳虚病证时,可酌情选用肉桂.枳实薤白桂枝汤中桂枝的功效为引枳实、厚朴入上焦以平冲逆,合瓜蒌以振胸阳,合薤白以散结气.历代医家受瓜蒌薤白白酒汤、瓜蒌薤白半夏汤二方病机的影响,皆以胸阳不振、痰浊上凝作为枳实薤白桂枝汤证的病机,但该证以胸满气结、气逆抢心为主,痰浊之象并不明显,故其病机应为阳虚气逆.药物煎煮方法中,桂枝与瓜蒌、薤白皆是轻煎,意在取其气味,而非重其功效,盖枳实、厚朴虽有下气降逆之力,却无入上焦之能,故须以桂枝轻清之气为引;上焦阳虚,无力镇摄阴霾之气上冲,故须桂枝、瓜萎辛甘化阳,使阳气得充、胸阳得振;气结不去,胸中痞满难除,故须桂枝、薤白辛温相须,使结气得散.本方以桂枝为使,则逆者得降;辛甘相合,则虚者得补;辛温相须,则结者得散,体现了张仲景严谨的用药思路,也凸显了其煎煮方式的灵活性及对方药功效的影响.

目的 比较瓜萎薤白半夏汤(GXB)不同提取部位对缺血缺氧心肌细胞的保护作用,初步探寻该经典方剂干预胸痹、心痛的物质基础.方法 称取瓜蒌240 g、薤白90g、半夏120 g,50％乙醇回流提取,分别用石油醚、氯仿、醋酸乙酯、水饱和正丁醇、水5种不同极性溶剂萃取,得到相应提取部位,及药渣水煎液部位.培养大鼠原代心肌细胞,制备缺血缺氧模型,给予系列浓度(100、10、1、0.1、0.01 mg/mL)的GXB 6种提取部位及瓜蒌皮注射液(阳性对照,100、50、25、5、1 mg/mL).MTT法检测细胞存活率,倒置显微镜观察细胞形态变化,生化试剂盒检测培养液中肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)活性.结果 与对照组比较,模型组细胞凋亡、坏死明显,细胞存活率显著降低,细胞培养液中CK、CK-MB的活性显著升高(P＜0.05);质量浓度均为0.1 mg/mL的GXB水饱和正丁醇部位、水溶性部位及药渣水煎部位可以显著逆转缺血缺氧心肌细胞的生长状态、存活率以及培养液中CK、CK-MB活性(P＜0.05);石油醚、氯仿及醋酸乙酯部位处理的细胞,与模型组无明显差异.结论 GXB的水饱和正丁醇、水溶性及药渣水煎部位对缺血缺氧损伤的心肌细胞具有显著的保护作用.

目的 探讨瓜萎薤白半夏汤对扩张型心肌病(DCM)患者心功能及血清Ⅰ型前胶原羧基端肽(PICP)、血清Ⅲ型前胶原羧基端肽(PⅢNP)的影响.方法 将98例DCM患者随机分为观察组和对照组各49例,2组均给予常规治疗,在此基础上对照组给予曲美他嗪治疗,观察组在对照组治疗基础上联合瓜蒌薤白半夏汤治疗,均连续治疗12周.观察2组临床疗效及治疗前后左室舒张末期内径(LVEDd)、心排血量(CO)、左室射血分数(LVEF)以及血清PICP、PⅢNP水平.结果 观察组总有效率显著高于对照组(P＜0.05);治疗后2组LVEDd和血清PICP和PⅢNP水平均显著低于治疗前(P均＜0.05),CO、LVEF均显著高于治疗前(P均＜0.05),且观察组各指标改善情况显著优于对照组(P均＜0.05).结论 瓜萎薤白半夏汤能够有效改善DCM患者心功能,降低血清PICP和PⅢNP水平,提高治疗效果.

目的 观察参芪瓜萎薤白半夏汤、消渴汤联合西药对冠心病合并糖尿病患者生存质量的影响.方法 将120例冠心病合并糖尿病患者随机分为西药组与中西医结合组.分别对两组患者进行基本干预,西药组患者在此基础上采用盐酸二甲双胍缓释片及单硝酸异山梨酯片口服,中西医结合组患者在西药组的治疗基础上服用参芪瓜萎薤白半夏汤合消渴汤加减,连续治疗45 d,对两组患者治疗前后对疾病生存质量进行差异性分析.结果 两组患者治疗后生存质量均有显著改善(P＜0.05),且中西医结合组的改善程度明显优于西药组(P＜0.05).结论 参芪瓜蒌薤白半夏汤、消渴汤联合西药治疗冠心病合并糖尿病,能够提高患者生存质量.

[目的]总结韩新民教授运用瓜蒌薤白半夏汤治疗小儿叹气的经验.[方法]通过跟随韩新民教授临诊,记录相关医案、分析典型病例,总结归纳韩新民教授诊治小儿叹气的临证思路和效验方药,并举验案一则以佐证.[结果]韩新民教授认为叹气患儿多为虚实夹杂之证,脾肺气虚、胸阳不振,兼挟有痰浊实邪,对证施治之时,运用通阳益气、豁痰散结、活血化瘀法,方选瓜萎薤白半夏汤,常常能收到较好疗效.[结论]韩新民教授治疗小儿叹气有独到的学术思想和临床经验,方选瓜蒌薤白半夏汤在临床实践中行之有效,值得推广应用.

目的:观察瓜蒌薤白半夏汤加味联合西药常规治疗高同型半胱氨酸血症的临床疗效.方法:103例高同型半胱氨酸血症患者随机分为对照组51例和观察组52例.对照组予叶酸、维生素B6、甲钴胺等西药常规治疗.观察组在对照组基础上加用瓜蒌薤白半夏汤加味治疗.观察比较两组患者治疗前和治疗4周、8周、12周后血浆同型半胱氨酸水平变化.结果:治疗4周、8周、12周后,两组患者血浆同型半胱氨酸水平均较治疗前显著降低(P＜0.05),且观察组各时点血浆同型半胱氨酸水平均低于对照组(P＜0.05).结论:瓜萎薤白半夏汤加味联合西药常规治疗高同型半胱氨酸血症的效果优于单纯西药治疗.

目的:分析痰瘀同治方治疗冠心病心绞痛的用药规律.方法:检索中国生物医学文献数据库,中国知网、万方数据库、维普数据库所收录的痰瘀同治方治疗心绞痛医案,建立数据库,运用频数统计与关联规则(apriori算法、复杂系统熵聚类)分析痰瘀同治方中常用药物配伍、组方与证治规律.结果:共选取符合标准的医案115首,所用中药共132味.瓜萎、丹参、薤白、川芎、半夏、黄芪、茯苓、当归、陈皮是治疗冠心病心绞痛医案痰瘀同治方中出现频次较高的药物;其药物四气以温、平、寒药为主,五味以苦、甘(淡)、辛为主,药物归经以归心经、肝经、脾经为主;痰瘀同治方治疗心绞痛频次较多的药对为瓜萎与薤白或半夏、瓜蒌与丹参、丹参与川芎或黄芪及半夏与茯苓或陈皮;出现频率最多的3味药物组合为瓜萎、薤白与半夏或枳壳;核心组方为瓜萎薤白半夏汤、川芎当归散、茯苓川芎汤与黄芪丹参汤等化裁而成.结论:现代临床医者应用痰瘀同治方治疗冠心病心绞痛的配伍用药规律为化痰药、活血化瘀药与补益气血药、理气药、祛湿药的结合为主;治法治则为活血化瘀,理气化痰,养心通脉.

Objectives:To study the characteristics of serum metabonomics in coronary heart disease (CHD) patients diagnosed as phlegm or blood stasis pattern and explore effects of formula-pattern correspondence treatment.Methods:A total of 102 stable CHD patients were enrolled and divided into phlegm group (P group,n=52) and blood stasis group (BS group,n=50) according to pattern identification.Gualou Xiebai Banxia Decoction (瓜萎薤白半夏汤,GXBD) and Xuefu Zhuyu Decoction (血府逐瘀汤,XZD) were used as drug interventions.Relevant indicators of metabonomics were observed by ultra performance liquid chromatography mass spectrometry (UPLC-MS) and pattem recognition.Results:Levels of amino acids and phosphatidylethanolamine (PE) in the CHD group were much higher than those in healthy control group,while the levels of unsaturated fatty acids,sphingosine,Lyso,phosphatidylcholine (PC) were significantly lower (P＜0.01).Most of the differential metabolites between the CHD and the healthy groups were also common metabolites of phlegm and blood stasis.7(Z),10(Z)-hexadecadienoic acid and DPA were decreased in the P group and increased in the BS group.According to the quantity of retraced metabolites,improvement in metabonomics by formula-pattem correspondence was superior to that without correspondence in the BS group.Based on the varieties of metabolites,GXBD could improve the levels of docosapentaenoic acid (DPA),sphingomyelin (SM) (d34:1),and L-Lactic acid and XZD could ameliorate the levels of sphingosine and Vit E in the P group.In the BS group,GXBD could improve vitamin E level and XZD could make improvements in the levels of octadecanoic acid,phosphoglycerol,and SM (d34:1).Conclusions:Phlegm and blood stasis in CHD patients present specific differential metabolites,and share common metabolites.Remarkable differences have been displayed in pathological properties and severity of phlegm and blood stasis.Patients with phlegm are more likely to have lipid metabolism disorders.However,in patients with blood stasis,problems mainly lie in glucose,protein and fat metabolism and the injury of vascular cell membrane is relatively severe.The metabolic disorder is more complicated in blood stasis pattem than that in phlegm pattem.Compared with non-correspondence,improvement of differential metabolites is more comprehensive and targeted in formulapattem correspondence with a better effect.

目的 观察瓜蒌薤白半夏汤合黄芪消渴汤联合西药治疗冠心病合并糖尿病的临床疗效.方法 将120例冠心病合并糖尿病病人随机分为西药组和中西医结合组,西药组采用盐酸二甲双胍缓释片及单硝酸异山梨酯片治疗,中西医结合组在西药组治疗基础上加用瓜萎薤白半夏汤合黄芪消渴汤加减,连续治疗45 d,比较两组治疗前后中医证候积分、血糖及血脂.结果 治疗后两组疗效中医积分、临床疗效、血糖及血脂较治疗前均有显著改善(P＜0.05),且中西医结合组改善程度明显优于西药组(P＜ 0.05).结论 中西医结合可改善冠心病合并糖尿病病人临床症状,提高临床疗效.

冠心病为本虚标实之证,正虚为本,表现为气血阴阳的不足,邪实为标,表现为气滞、痰阻、血瘀、寒凝等.心脉痹阻是冠心病基本病机特点,可由气滞血瘀、心肾阳虚、气阴两虚、痰湿阻滞等所致,治疗上逐痹通脉贯穿始终,并根据病因和病证不同,相应采取益气活血、益气温肾、益气养阴、化痰祛湿等治法.在方药应用上,重视瓜蒌、薤白应用,强调宽胸散结通阳以行血脉,强调气滞当调,血瘀宜逐,气阳虚当补,阴虚当滋,痰阻应豁,力求“病皆与方相应”“证皆与法相应”.