目的:观察芪附理中灌肠方对脾肾阳虚型溃疡性结肠炎模型大鼠肠黏膜机械屏障的影响，探讨其作用机制。方法:将70只雄性SD大鼠按随机数字表法分为空白组、模型组、美沙拉嗪组及芪附理中灌肠方高、中、低剂量组，空白组10只，其余各组12只。除空白组外，其余各组采用苦寒泻下法（大黄煎剂）合并三硝基苯磺酸（TNBS）/55%乙醇复合法诱导法制备UC大鼠模型。造模成功后，空白组和模型组灌肠生理盐水1 ml，芪附理中灌肠方高、中、低剂量组灌肠芪附理中汤药液3.00、1.50、0.75 g/kg，美沙拉嗪组灌肠美沙拉嗪溶液0.03 g/kg，1次/d，连续干预14 d。14 d后进行疾病活动指数（DAI）评分，采用HE染色观察结肠病理组织，免疫组化染色和Western blot法检测结肠组织闭合蛋白（Occludin）及连接黏附分子A（JAM-A）蛋白表达。结果:HE染色结果显示，模型组黏膜结构破坏，炎症细胞浸润，可见水肿和溃疡灶；美沙拉嗪组及芪附理中灌肠方各剂量组黏膜结构较完整，可见新生上皮炎症浸润、水肿、溃疡均有好转。与模型组比较，芪附理中灌肠方各剂量组DAI评分降低（ P<0.01），芪附理中灌肠方高、中剂量组结肠组织Occludin、JAM-A蛋白表达升高（ P<0.05）。 结论:芪附理中灌肠方可缓解UC大鼠症状及病理形态，其修复肠黏膜屏障的作用机制可能与上调Occludin、JAM-A蛋白表达有关。

盆腔炎性疾病为妇科常见病多发病,严重影响患者生活质量和心理健康.蔡连香教授在盆腔炎临证中善用药对,疗效显著,本文介绍了十组常用药对.黄芪—莪术,功擅益气活血,扶正祛邪并行,用于治疗正虚邪恋、气虚血瘀的盆腔炎;重楼—连翘,有清热解毒,抗炎止血之功,治疗盆腔炎辨证属湿热瘀毒者;桂枝—红花擅通行经络,温煦胞宫,用于盆腔炎辨证属寒湿瘀阻者;元胡—没药,功专活血化瘀、行气止痛,多用于治疗气滞血瘀型腹痛,口服和灌肠均可;徐长卿—蒲公英,可行气化瘀,消肿散结,口服或外用治疗湿热瘀结的慢性盆腔痛,或煎汤外洗治疗外阴诸病;威灵仙—石见穿,能活血化瘀,消肿止痛,外敷用于腹痛、癥瘕等证;马鞭草—忍冬藤,功擅通络活血,清热利水,常用于灌肠方;透骨草—生艾叶,擅祛风除湿,温经止痛,可单用或作引药用于外敷方治疗附件炎、输卵管性不孕;皂刺—路路通,辛散锐利,活血止痛,常用于灌肠或外敷,是治疗输卵管积脓及积水的要药;白芷—千年健专燥湿祛风,通络止痛,常用于治疗附件炎、输卵管积水、盆腔包裹性积液等疾病.文末附一临床病例,以飨同道.

OBJECTIVE:To investigate the efficacy and mechanism of Qifu Lizhong enema prescription(芪附理中灌肠方,QFLZ)on intervening ulcerative colitis(UC)rat model with TCM spleen and kidney Yang insufficiency syndrome.METHODS:Seventy-two male Sprague-Dawley rats were randomly assigned to six groups:normal model,mesalazine,and QFLZ high,medium,and low dose groups,each with 12 rats.After 3 d of adaptation feeding,all groups except the normal group were induced using rhubarb decoction in combination with trinitrobenzene sulfonic acid(TNBS)/55％ethanol to establish a UC rat model.Following successful modeling,the normal and model groups received daily saline enema,while the Chinese medicine and Western medicine groups received daily QFLZ and Mesalazine enema for 2 weeks respectively.The disease activity index score,hematoxylin and eosin staining,immunohistochemistry,and Western blotting were used to determine the expression of claudin 1,claudin 2,zonula occludens-1 protein(ZO-1),and F-actin proteins in each rat colon tissue following treatment.RESULTS:QFLZ significantly alleviated the structural disorganization in the form of epithelial glands in the intestinal mucosa of rats with UC and retarded the progression of the disease.The intestinal mucosal epithelial cells of UC rats showed decreased expression of claudin 1,ZO-1,F-actin(P＜0.05),claudin 2 appeared elevated(P＜0.05),which resulted in impaired TJ.Treatment with QFLZ resulted in elevated expression of claudin 1(P＜0.05),ZO-1(P＜0.05)and F-actin(P＜0.05)and decreased expression of claudin 2(P＜0.05),which allowed for repair of the intestinal mucosal TJ,which in turn served as a treatment for UC.CONCLUSIONS:The mechanism of repairing TJ function and repairing the intestinal mucosal barrier by QFLZ may be associated with up-regulation of claudin 1,ZO-1,and F-actin levels,and down-regulation of claudin 2 expression level.

目的 研究小承气合黄芪建中汤对术后早期炎性肠梗阻(EPISBO)大鼠胃肠激素及Cajal间质细胞(ICC)的影响.方法 将SPF级Wistar大鼠45只按照随机数字表法分为正常组、假手术组、模型组、中药组和肥皂水组,每组9只,采用肠管表面擦拭法建立EPISBO模型.造模术后第1天开始给药,中药组灌肠给药量为8.45g/(kg·d),肥皂水组予等体积0.2％肥皂水灌肠,每日1次,连续1周.干预结束后采集大鼠腹主动脉血及小肠组织;苏木精-伊红(HE)染色检测各组大鼠小肠组织病理变化;用酶联免疫吸附测定法(ELISA)检测大鼠血清胃动素(MTL)、血管活性肠肽(VIP)、干细胞因子(SCF)水平;免疫印迹法(Western blotting)检测大鼠小肠组织中c-kit蛋白表达;免疫荧光法检测大鼠小肠组织c-kit阳性ICC的表达.结果 成功建立EPISBO大鼠模型,HE染色见小肠绒毛破裂,结构不完整;血清MTL、SCF含量显著降低,VIP含量显著上升,小肠组织c-kit阳性ICC的荧光强度显著减弱,c-kit蛋白表达显著降低(P＜0.05).与模型组比较,中药组HE染色见肠黏膜绒毛损伤明显减轻;血清MTL、SCF含量显著升高,VIP含量显著降低;小肠组织c-kit阳性ICC的荧光强度显著增强;c-kit蛋白表达显著升高(P＜0.05).结论 小承气汤合黄芪建中汤能缓解EPISBO大鼠的肠黏膜损伤,促进术后胃肠动力的恢复,可能是通过调节胃肠激素、激活ICC而实现.