香砂六君子汤的药理作用及临床应用

香砂六君子汤的药理作用及临床应用 摘要,香砂六君子汤由人参、白术、茯苓、甘草、陈皮、半夏、砂仁、木香八味药组成。主治脾胃气虚,痰阻气滞证。本方在四君子汤补气的基础上合用行气化痰之品,具有益气化痰、行气温中之功。现代多用于治疗脾胃气虚夹有寒湿的多种消化系统疾病,诸如各种胃炎、消化道溃疡、十二指肠炎、消化不良以及其他系统疾病现有上述症状者。实验研究表明,香砂六君子汤在保护胃黏膜、促进胃动力、调节胃功能紊乱、止泻以及抗氧化等方面有着良好的作用[1]。 关键词,香砂六君子汤,药理作用,临床应用, 香砂六君子汤是调和脾胃的良方,可广泛应用于胃肠道疾病的治疗。本文采用文献整理与回顾,主要对香砂六君子汤的药理作用与临床应用进行研究与归纳。研究发现,香砂六君子汤能抑制胃粘膜瘀血、水肿等病理变化,对胃黏膜损伤有促进自愈的疗效,能调节免疫功能,改善胃肠道分泌,对胃肠道疾病的治疗有积极意义。香砂六君子汤治疗消化系统疾病的疗效已为临证所首肯,目前,它的药理作用主要与保护胃黏膜、调节胃肠动力、调节免疫神经内分泌等有关,其加味及配合西药还可治疗临床多种疾病,因此值得我们去深入研究。 香砂六君子汤出自《古今名医方论》,由清代新安医家罗美编撰,该书精选古今常用名方及方论编撰而成,共收方剂150余首,方论180余则。香砂六君子汤为引用柯琴之方论,柯琴乃清代伤寒学家。因此香砂六君子汤并不是新安医家的处方。方中用党参补脾益气为主药,辅以白术健脾燥湿,扶助运化,配以茯苓甘淡渗湿,健脾和胃,陈皮、木香行气止痛,半夏燥湿化痰,砂仁健脾化湿,温中止呕,炙甘草甘温益气,并可助诸药达补气健脾之功。诸药合用,补而不滞,温而不燥,消除痰湿停留,促进脾胃运化,是治疗脾胃病尤其是脾胃气虚证的要方[2]。香砂六君子汤历代古籍中同名异方颇多,龚廷贤的《万3.1 requirements. • no load test. According to the relevant provisions of the DL/T5019 check the running of machinery and electrical equipment provided, to be correct and reliable, stable operation, impact sound and no other anomalies. • static load test. According to the construction drawings and inspection machinery and metal structure bearing capacity of the hoist. Test load rated load in turn 70%, l00% and 125%. • dynamic load tests. According to the construction drawings, dynamic loading tests on the bodies to test the dynamic stiffness of the performance of the agencies and gantries. Test load rated load 100% and then 110%. Test agencies should be conducted separately, when there is a joint commissioning requirements, should be carried out according to the construction drawings and the instructions of the supervisor. Test, repeat to start, run, stop, forward, reverse motion, duration of at least 1h. Agencies should be flexible, stable and reliable work, limit switches, safety interlocks, anti-climbing device, the movements should be accurate and reliable, the parts should be free of cracks and other damage, the connection should not be loose. (3) civil works out the hoist and installation conditions installation 病回春》、张介宾的《景岳全书》、罗美的《名医方论》、汪昂的《医方集解》、张璐的《张氏医通》、陈念祖的《时方歌括》等书,俱载有香砂六君子汤。以上各书所载,方中均有人参、白术、获荃、甘草、半夏、陈皮、砂仁等七味[3]。《万病回春》方中加香附、白豆落、厚朴、木香等药以增行气之力;并用益智仁以温脾阳;生姜、大枣调和脾胃。主要用于治疗脾胃气虚气滞较甚之不思饮食,食后饱胀等症。景岳方中另加瞿香、生姜取其芳香化湿,和中止呕。主要用于治疗脾胃气虚,寒湿较甚之食少作呕,恶心胀满等症。罗氏《名医方论》方中加木香,行气止痛,并用生姜和脾胃。主要用于治疗脾胃虚滞,胃院胀痛明显者。而《时方歌括》方较罗氏方多用大枣配生姜以调脾胃,故其主治与罗氏方相仿。《张氏医通》方中加木香、乌梅、生姜、大枣而成。木香理气;乌梅收敛肺气,并有“涌痰”之功,与半夏配伍,一散一收,相反相成,可助半夏化痰之功效;生姜、大枣以调脾胃。主要用于治疗气虚,痰食气滞倦怠少食,咳嗽多痰,呕泻腹胀者。《医方集解》方中加入香附,行气止痛:并用生姜、大枣以调脾胃。主要用于治 现代医学研究表明,香砂六君子汤对人体多个疗脾胃虚滞兼肝气不舒,胃院胀痛牵及两胁者。 系统都有影响,能治疗多种疾病,现将近几年来对该方的药理作用研究和临床应用进展综述如下。 1. 药理作用 1.1 对消化系统的作用 香砂六君子汤能抑制胃粘膜水肿,充血及瘀血等病变,减轻细胞浸润及腺体增生性改变,能明显减少肠上皮化生的发生例数,但不能降低胃内胆酸含量[4]。它能促进胃液分泌,显著提高胃液游离酸度,总酸度和总的排出量,但对胃蛋白酶活性无显著影响。这对消化系统有明显的改善和促进作用。 1.2 对免疫系统的作用 脾胃气虚证患者T细胞减少,B细胞增多,其T、B细胞的数量比例与健康人呈比例失常3.1 requirements. • no load test. According to the relevant provisions of the DL/T5019 check the running of machinery and electrical equipment provided, to be correct and reliable, stable operation, impact sound and no other anomalies. • static load test. According to the construction drawings and inspection machinery and metal structure bearing capacity of the hoist. Test load rated load in turn 70%, l00% and 125%. • dynamic load tests. According to the construction drawings, dynamic loading tests on the bodies to test the dynamic stiffness of the performance of the agencies and gantries. Test load rated load 100% and then 110%. Test agencies should be conducted separately, when there is a joint commissioning requirements, should be carried out according to the construction drawings and the instructions of the supervisor. Test, repeat to start, run, stop, forward, reverse motion, duration of at least 1h. Agencies should be flexible, stable and reliable work, limit switches, safety interlocks, anti-climbing device, the movements should be accurate and reliable, the parts should be free of cracks and other damage, the connection should not be loose. (3) civil works out the hoist and installation conditions installation 现象。提示其细胞免疫功能降低而体液免疫功能提高。经香砂六君子汤治疗后,这种T、B细胞比例失常现象得到纠正,表明香砂六君子汤还具有把紊乱的免疫功能调整到正常状态的功效[4]。经香砂六君子汤治疗后,细胞的这些改变恢复到健康人的水平。 1.3 对胃肠分泌系统的影响 香砂六君子汤一方面能抑制胃酸及胃蛋白酶分泌,有利于反流性胃炎的治疗,另一方面可使胃壁结合黏液量增加,延缓H离子自胃腔向黏膜内的弥散,并阻止碳酸氢盐自上皮细胞表面向胃腔内的移行,从而保护胃黏膜,使其免受损伤[5]。此外香砂六君子汤能提高已减少的胃窦G细胞,从而改善胃肠道的内分泌机能。 1.4 对神经系统的影响 脾胃虚弱患者,血中Ach含量大多高于正常人,副交感神经多处于偏亢状态,许多植物神经功能紊乱患者常出现类似中医“虚寒胃痛”的病症,用香砂六君子汤治疗每获良效[6]。该方能显著对抗Ach、组织胺引起的胃肠道收缩,抑制胆碱能神经的兴奋性而发挥作用。它的作用机制可能是通过神经系统(胆碱能神经)和直接作用胃肠道平滑肌两方面实现的[7]。 2. 临床应用 2.1 功能性消化不良 功能性消化不消化科常见病、多发病,占胃肠病专科门诊患者的 50%。消化不良为多因素疾病,其发病机制尚不清,有学者认为可能与胃酸分泌、胃肠功能障碍、内脏感觉过敏、幽门螺杆菌感染、精神应激和环境等因素有关。香砂六君子汤中之党参、白术、茯苓、甘草组成四君子汤,有益气健脾之功,柴胡、香附可疏肝理气,运脾调中,香附辛散温通,调中宣滞,砂仁、半夏化湿行气,醒脾和胃,枳壳行气宽中除胀,莱菔子理气和胃降逆。诸药共用既能疏肝理气,调理气机,又能健运脾胃,使郁可疏、虚可补、滞可行、逆可降,从而恢复脾胃气机升降的协调状态,故而达到了治疗功能性消化不良的目的[8]。 3.1 requirements. • no load test. According to the relevant provisions of the DL/T5019 check the running of machinery and electrical equipment provided, to be correct and reliable, stable operation, impact sound and no other anomalies. • static load test. According to the construction drawings and inspection machinery and metal structure bearing capacity of the hoist. Test load rated load in turn 70%, l00% and 125%. • dynamic load tests. According to the construction drawings, dynamic loading tests on the bodies to test the dynamic stiffness of the performance of the agencies and gantries. Test load rated load 100% and then 110%. Test agencies should be conducted separately, when there is a joint commissioning requirements, should be carried out according to the construction drawings and the instructions of the supervisor. Test, repeat to start, run, stop, forward, reverse motion, duration of at least 1h. Agencies should be flexible, stable and reliable work, limit switches, safety interlocks, anti-climbing device, the movements should be accurate and reliable, the parts should be free of cracks and other damage, the connection should not be loose. (3) civil works out the hoist and installation conditions installation 2.2 胃炎 慢性浅表性胃炎的发病率,在各类胃病中居首位,肠上皮化生又被现代医学确认为胃癌的前期病变。HP感染与本病的发生也有密切的联系,临床上难以治愈。慢性浅表性胃炎的病程长,依据昔贤“久病属虚”的观点,探究其病理性质,突出一个“虚”字,即脾胃虚弱是其本,湿阻气滞为其标[9]。脾胃虚弱,脾阳不振,脾运失健,则湿从内生或气血生化来源不足,卫气不足,无以御外,寒湿诸邪入侵人体而致病。湿性黏滞,不易速除,常常病情迁延,反复发作故临床特点就是病程缠绵,反复发作[10]。治疗原则以健脾益气,行气化湿和胃为主,方中党参、白术、茯苓、甘草健脾益气,木香、陈皮、砂仁、制半夏行气化湿,开结和胃,伴气机郁结者加川楝子、延胡索、生白芍疏肝理气止痛,气郁化火加黄连、蒲公英清胃泻火[11]。现代药理研究香砂六君子汤可调节胃肠功能,增强胃肠蠕动,白术、茯苓均有促进胃肠蠕动之功效,香附、砂仁有抗 HP 的功效,HP 的降低有利于胃炎的治愈[12]。另外,胆汁返流性胃炎亦消化道的常见病、多发病,目前国内对其发病机理尚无令人信服的研究,对其诊断亦无统一的标准,在治疗上更无统一的和模式。香砂六君子汤具有健脾理气、燥湿化滞、和胃降逆的功效,经加味又能清热解毒、利胆排石、活血止痛[13]。临床多采用配合西药进行治疗,其疗效明显优于单纯中药或西药治疗。 2.3 消化性溃疡 消化性溃疡是指发生在胃和十二指肠的慢性溃疡,是人类的常见病,估计约有 10% 的人口一生中患过此病,其发病机制主要是由于对胃、十二指肠粘膜有损害作用的侵袭因素,与粘膜自身防御—修复因素之间失去平衡的结果,主要因素有幽门螺杆菌感染、胃酸和胃蛋白酶,非甾体抗炎药,遗传因素、应激和心理因素[14]。胃溃疡属中医学胃脘痛范畴,以肝脾(胃)为主要病变脏腑,其多由肝失疏泄,脾失健运,致脾胃虚弱,气机失常。该病反复发作,病程较长,病情缠绵不愈,久病必虚,中焦脾胃虚弱,运化失职,化源不足,不能荣养脏腑,不荣则痛。可3.1 requirements. • no load test. According to the relevant provisions of the DL/T5019 check the running of machinery and electrical equipment provided, to be correct and reliable, stable operation, impact sound and no other anomalies. • static load test. According to the construction drawings and inspection machinery and metal structure bearing capacity of the hoist. Test load rated load in turn 70%, l00% and 125%. • dynamic load tests. According to the construction drawings, dynamic loading tests on the bodies to test the dynamic stiffness of the performance of the agencies and gantries. Test load rated load 100% and then 110%. Test agencies should be conducted separately, when there is a joint commissioning requirements, should be carried out according to the construction drawings and the instructions of the supervisor. Test, repeat to start, run, stop, forward, reverse motion, duration of at least 1h. Agencies should be flexible, stable and reliable work, limit switches, safety interlocks, anti-climbing device, the movements should be accurate and reliable, the parts should be free of cracks and other damage, the connection should not be loose. (3) civil works out the hoist and installation conditions installation 见,脾虚气滞是本病之主要病机,故治宜补气行气之法。香砂六君子汤主治脾胃受损,气机不畅所致的脘腹疼痛。目前,已有大量的临床研究表明香砂六君子汤对消化性溃疡有很好的疗效,尤其是脾虚气滞型[15]。十二指肠溃疡实际是由于脾胃升降、纳化、燥湿等方面平衡失调所致。病久必虚,气虚日久,易见寒象,治当温脾健胃,散寒止痛,故以党参、白术、茯苓、甘草健脾益气,木香、陈皮、半夏辛燥和胃,高良姜、香附、砂仁散寒理气、和胃止痛,神曲消食和胃。诸药合用,共奏温脾健胃、散寒止痛之功[16]。香砂六君子汤有利于溃疡的修复,在溃疡愈合后还可防止和延缓复发。 2.4 抗抑郁 抑郁症在中医属于“郁症”范畴,以肝气郁结、痰火内郁、心神失养为主要病机,治则以理气为先,调中为本。香砂六君子汤中木香健脾消食,砂仁化湿温中,两者共有行气止痛作用;人参、白术、茯苓、甘草、陈皮、半夏为六君子汤,能益气健脾,和胃止呕。其理气健脾和胃功效可适用于“郁证”的治疗[17]。现代医学研究表明,香砂六君子汤活性部位为香砂六君子汤的正丁醇萃取部位,正丁醇部位含有人参总皂苷(含量为0.1% ~0.4% ),甘草酸及琥珀酸成分,而这几类成分均为抗抑郁活性植物成分[18]。抑郁症伴功能性消化不良,临床上常以消化道症状为突出表现,而抑郁情绪往往被掩盖,患者多在综合医院内科或消化科反复就诊,检查无器质性病变,按胃病用西药治疗效果不佳。现代医学认为抑郁症伴功能性消化不良的病理机制可能与脑内生物胺发生改变有关,香砂六君子汤能使功能低下的下丘脑-垂体-肾上腺皮质系统调整至近似正常水平,因而可提高中枢性去甲肾上腺素活性,使抑郁症状得以改善[19]。 2.5 化疗不良反应 化疗药物在杀伤肿瘤细胞的同时也对正常组织细胞有杀伤作用,对机体脏器的生理功能、免疫功能、骨髓造血功能有一定程度的破坏和抑制作用。临床上主要表现为恶心呕吐、3.1 requirements. • no load test. According to the relevant provisions of the DL/T5019 check the running of machinery and electrical equipment provided, to be correct and reliable, stable operation, impact sound and no other anomalies. • static load test. According to the construction drawings and inspection machinery and metal structure bearing capacity of the hoist. Test load rated load in turn 70%, l00% and 125%. • dynamic load tests. According to the construction drawings, dynamic loading tests on the bodies to test the dynamic stiffness of the performance of the agencies and gantries. Test load rated load 100% and then 110%. Test agencies should be conducted separately, when there is a joint commissioning requirements, should be carried out according to the construction drawings and the instructions of the supervisor. Test, repeat to start, run, stop, forward, reverse motion, duration of at least 1h. Agencies should be flexible, stable and reliable work, limit switches, safety interlocks, anti-climbing device, the movements should be accurate and reliable, the parts should be free of cracks and other damage, the connection should not be loose. (3) civil works out the hoist and installation conditions installation 纳差、腹泻、乏力、发热、白细胞减少、血小板减少等,致使患者的免疫功能和抗病能力下降,影响化疗的持续进行。因此,防治化疗所致的不良反应,对减轻病人的痛苦,提高有效率,保证病人的生存质量,显得尤为重要[20]。中医认为脾土为万物之母,脾胃居于中焦,理顺上下,对于人体整体的功能有着重要影响。恶性肿瘤患者正气本虚,化疗药物有如外邪侵袭,易伤正气,导致脾胃运化失司,津液不化,聚而为痰,痰浊中阻,中焦气机不畅,脾胃升降失司,使胃气上逆,故见恶心呕吐。治疗当以和胃降逆为大法,健脾化痰,降逆止呕,恢复中焦脾胃的升降功能,方用加味香砂六君汤。全方重在和胃降逆,舒畅气机,标本兼治,补而不滞,取得较好的止逆效果[21]。 香砂六君子汤能抑制胃粘膜瘀血、水肿等病理变化,减轻炎细胞浸润,减少上皮化生,能较好地拮抗胃粘膜的慢性损伤,促进胃液分泌,显著提高胃液游离酸度的排出量,增加已减少的胃窦C细胞,改善胃肠道的内分泌功能,还能调节细胞免疫及体液免疫功能。它还能抑制胃酸及胃蛋白酶分泌 ,有利于返流性胃炎的治疗,可延缓H离子自胃腔向黏膜内的弥散,并阻止碳酸氢盐自上皮细胞表面向胃腔内的移行,从而保护胃黏膜,使其免受伤。另外香砂六君子汤水煎液对胃黏膜出血有显著的治疗效果,对胃黏膜损伤有促进自愈的疗效,且呈时效关系,治疗作用快速、高效。 综上所述,香砂六君子汤是调和脾胃的良方。药理研究表明,该方能抑制胃粘膜水肿、充血及瘀血,促进胃液分泌,提高胃液游离酸度; 能对抗新斯的明或乙酰胆碱所致胃运动的亢进,抑制组胺和氯化钡所致的胃肠痉挛,能调节人体免疫功能,改善胃肠道的分泌机能。临床上常用于治疗消化不良、幽门螺杆菌相关性胃炎、消化性溃疡、抑郁症、化疗及术后恢复期等等。 3.1 requirements. • no load test. According to the relevant provisions of the DL/T5019 check the running of machinery and electrical equipment provided, to be correct and reliable, stable operation, impact sound and no other anomalies. • static load test. According to the construction drawings and inspection machinery and metal structure bearing capacity of the hoist. Test load rated load in turn 70%, l00% and 125%. • dynamic load tests. According to the construction drawings, dynamic loading tests on the bodies to test the dynamic stiffness of the performance of the agencies and gantries. Test load rated load 100% and then 110%. Test agencies should be conducted separately, when there is a joint commissioning requirements, should be carried out according to the construction drawings and the instructions of the supervisor. Test, repeat to start, run, stop, forward, reverse motion, duration of at least 1h. Agencies should be flexible, stable and reliable work, limit switches, safety interlocks, anti-climbing device, the movements should be accurate and reliable, the parts should be free of cracks and other damage, the connection should not be loose. (3) civil works out the hoist and installation conditions installation 参考文献, [1] 李冀,李浦媛,刘波.香砂六君子汤的实验研究进展[J].中医药信息,2008,25(2):33-34 [2]王健.香砂六君子汤之化裁运用[J].中国民间疗法,2008,8,35 [3]金永祜.香砂六君子汤同名异方辩[J].福建中医药,1988,19,2,,37 [4]郭辉,张启明,何颖.香砂六君子汤的药理作用及临床应用[J].中成药,1999,21(2):92-93 [5]文译辉,梁石,梁哲昭.香砂六君子汤水煎液对急性胃粘膜损伤的治疗作用[J].广东医学,2007,28,1,,30-32 [6]凤良元,鄂顺琴,邓先瑜.香砂六君子汤对动物胃肠功能的影响[J].中国中西医结合杂志,1992,12,1,,35-37 ,,30-31 [7]邓先瑜.香砂六君子汤调节脾胃功能的实验研究[J].中成药,1991,13,12 [8]杨远波.香砂六君子汤联合多潘立酮治疗功能性消化不良[J].甘肃中医,2009,22,12,,24-25 [9]刘逴慜,曹凡华,张勤兰.香砂六君子汤治疗浅表性胃炎伴肠上皮化生30例[J].福建中医药,2004,35,1,,37-38 [10]石伟.香砂六君子汤加味治疗慢性胃炎50例疗效观察[J].光明中医,2008,23,5,,619-620 [11]李云武.香砂六君子汤加减治疗慢性浅表性胃炎50例[J].福建中医药,2002,33,2,,31-32 [12]辛长青.香砂六君子汤加减治疗慢性胃炎65例[J].光明中医,2011,26,7,,1378-1379 [13]黄佐杰,戴学媛.香砂六君子汤加西药治疗胆汁返流性胃炎的疗效观察[J].中国中西医结合杂志,1995,15,4,:234-235 [14]孙翠芬.香砂六君子汤配合西药治疗消化性溃疡30例[J].光明中医,2011,26,10,,2076-2077 [15]毕珺辉,杨天仁.香砂六君子汤及其拆方队对脾虚胃溃疡模型大鼠胃蛋白-SOD-MDA水平的影响[J]. 3.1 requirements. • no load test. According to the relevant provisions of the DL/T5019 check the running of machinery and electrical equipment provided, to be correct and reliable, stable operation, impact sound and no other anomalies. • static load test. According to the construction drawings and inspection machinery and metal structure bearing capacity of the hoist. Test load rated load in turn 70%, l00% and 125%. • dynamic load tests. According to the construction drawings, dynamic loading tests on the bodies to test the dynamic stiffness of the performance of the agencies and gantries. Test load rated load 100% and then 110%. Test agencies should be conducted separately, when there is a joint commissioning requirements, should be carried out according to the construction drawings and the instructions of the supervisor. Test, repeat to start, run, stop, forward, reverse motion, duration of at least 1h. Agencies should be flexible, stable and reliable work, limit switches, safety interlocks, anti-climbing device, the movements should be accurate and reliable, the parts should be free of cracks and other damage, the connection should not be loose. (3) civil works out the hoist and installation conditions installation 南京中医药大学学报,2010,26,4,:280-282 [16] 董建华,胡玉珍,王继弟.香砂六君子汤配合洛赛克治疗十二指肠溃疡96例[J].山东中医杂志,1998,17,10,,462 [17]周本宏,黄付伟,刘敏.香砂六君子汤的抗抑郁活性部位筛选[J]中国医院药学杂志,2007,27,5,:609-612 [18]周本宏,刘敏,郭志磊.香砂六君子汤对抑郁性小鼠行为及海马神经元损伤的影响[J].中国中药杂志,2009,34,17,:2247-2250 [19]乔岩岩,马玉洁.香砂六君子汤治疗抑郁症伴功能性消化不良12例[J].中国中西医结合杂,2000,20,2,:152 [20]王进.香砂六君子汤对化疗不良反应的应用[J].医药论坛杂志,2004,25,5,,60-61 [21]黄争荣.加味香砂六君子汤治疗顺铂所致恶心呕吐的临床观察[J].福建中医药,2008,39,6, 3.1 requirements. • no load test. According to the relevant provisions of the DL/T5019 check the running of machinery and electrical equipment provided, to be correct and reliable, stable operation, impact sound and no other anomalies. • static load test. According to the construction drawings and inspection machinery and metal structure bearing capacity of the hoist. Test load rated load in turn 70%, l00% and 125%. • dynamic load tests. According to the construction drawings, dynamic loading tests on the bodies to test the dynamic stiffness of the performance of the agencies and gantries. Test load rated load 100% and then 110%. Test agencies should be conducted separately, when there is a joint commissioning requirements, should be carried out according to the construction drawings and the instructions of the supervisor. Test, repeat to start, run, stop, forward, reverse motion, duration of at least 1h. Agencies should be flexible, stable and reliable work, limit switches, safety interlocks, anti-climbing device, the movements should be accurate and reliable, the parts should be free of cracks and other damage, the connection should not be loose. (3) civil works out the hoist and installation conditions installation