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With the aging of the population, the incidence of cerebrovascular diseases has increased significantly. In Western medicine, statins, aspirin and antihypertensive drugs are often used to treat mild and moderate cerebrovascular stenosis. For severe cerebrovascular stenosis, interventional technique and drug therapy are often used. In the course of treatment, it is not rare to see the side effects such as hypersensitivity of western medicine and damage of liver function, and it is not rare to see the patients with poor effect of drug therapy alone or short-term restenosis after intravascular stent implantation. Professor Gao Li, in Department of Neurology, Xuanwu Hospital of Capital Medical University, combined the modern medical theory of cerebral vascular stenosis with the theory of traditional Chinese medicine. According to the clinical manifestations, imaging and ultrasonic examination results of patients, cerebral vascular stenosis was divided into three syndrome types, such as phlegm obstruction and blood stasis type (mainly thickening of inner and middle membrane), qi stagnation and fire melting type (mainly plaque) and mixed type (both membrane thickening and plaque). The methods of invigorating spleen and removing dampness, clearing phlegm and removing blood stasis, soothing liver and relieving depression, clearing away heat and resolving phlegm, cooling blood and activating blood circulation, and the combination of two prescriptions were used for treatment of cerebral vascular stenosis, respectively. Meanwhile, the related Western medicine was added at the same time, which achieved better effect.
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Cerebral hemorrhage has been regarded as a complex and refractory disease in neuroscience due to its diversification of etiology and complexity of pathophysiology. At present, the conservative treatment of Western medicine is only symptomatic treatment. There is no specific treatment for hematoma and local circulation disorders after cerebral hemorrhage. Surgical treatment, the effect has not been significantly improved. Cerebral hemorrhage belongs to the category of apoplexy in traditional Chinese medicine, which is also called hemorrhagic apoplexy in modern Chinese medicine. Although modern Chinese medicine treatment is based on differentiation of symptoms and signs, it has no obvious advantage over western medicine treatment. After years of clinical exploration and practice, Professor Gao Li has achieved good clinical efficacy in the diagnosis and treatment of cerebral hemorrhage with integrated traditional Chinese and Western medicine, showing a good prospect of integrated traditional Chinese and Western medicine treatment.
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Presently the four high characteristics and rejuvenation trends of cerebrovascular diseases are still the main problems that endanger the health of our people. Accordingly, Professor Gao Li has been committed to the discussion of risk factors for cerebrovascular diseases and the practice of using integration of traditional Chinese and western medicine for diagnosis and treatment of these diseases. In order to enable the majority of western medicine doctors to understand and accept his idea, Professor Gao Li combines traditional Chinese medicine (TCM) syndromes with modern etiology and pathology, classification of stages and types of cerebral infarction by Chinese and western medicine, the acute cerebral infarction patients are simplified innovatively into four TCM syndromes and appropriate treatments are given to them, so that the majority of traditional Chinese and western medicine doctors can comprehensively recognize the condition of this disease from macroscopic to microscopic points of view. By his above combination of traditional Chinese and western medicine reasoning, the patients obtained better curative effect. After multiple years of summary and accumulation of his experiences, Professor Gao Li has developed the distinct clinical and academic characteristics for the diagnosis and treatment of cerebral infarction.
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With the rapid development of the aging society and the sustainable increase of incidence of cerebrovascular diseases in China, the number of patients with various types of cognitive impairment is increasing year by year. No matter whether the causes of cognitive dysfunction are primary, vascular and other lesions leading to the impairment, the effect of conventional western medicine alone is not ideal for the treatment of the disease, especially the primary cognitive impairment. Practical experiences have proven that better clinical efficacy can often be achieved by using the idea and method of integrated traditional Chinese and western medicine for such treatment. We summarized and elaborated the Professor Gao Li's practical experiences in the diagnosis and treatment of cognitive impairment with integrated traditional Chinese and western medicine in Capital Medical University Xuanwu Hospital, in order to broaden the clinicians' thinking and enrich the means of treatment for this disease.
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Objective To observe the clinical efficacy of Naokang Ⅱ in patients with vascular cognitive impairment of none dementia after cerebral infarction.Methods A total of 100 consecutive patients with vascular cognitive impairment of none dementia after cerebral infarction diagnosed at the Neurology Clinic,Beijing Xuanwu Hospital,Capital Medical University from October 2012 to February 2014 were enrolled prospectively.Six of them did not complete a return visit because of not returning to the hospital in time,2 withdrew automatically,and finally,92 patients were enrolled in the study.According to the random number table method,they were divided into either an observation group (n=48) or a control group (n=44).The control group was treated with aniracetam,while the observation group was treated with aniracetam plus Naokang Ⅱ (Radix Polygoni Multiflori Preparata,Radix Rehmanniae Preparata,Radix Notoginseng,Acorus Calamus L.and Radix Polygalae) for 12 weeks.The differences of traditional Chinese medicine syndrome integral before and after treatment in both groups were compared.The effective rate and cognitive function improvement rate of traditional Chinese medicine syndromes before and after treatment in both groups were compared.Results The scores of traditional Chinese medicine syndrome integral before and after treatment in patients of the observation group were 28±5 and 15±4,respectively,those of the control group before and after treatment were 26±5 and 18±5,respectively.There were significant differences before and after treatment (the t values were 15.02 and 14.73,respectively,all P0.05).The total effective rate in the observation group (75.0% [36/48]) was higher than that in the control group (45.5% [20/44]).There was significant difference between two groups (χ2=7.023,P=0.008).The improvement rates of memory,orientation,judgment,and problem solving skills in the observation group (29.2% [14/48],27.1% [13/48],and 31.2% [15/48]) were higher than those in the control group (11.4% [5/44],9.1% [4/44],and 13.6% [6/44]).There were significant differences between the two groups (all P<0.05).No adverse reactions were observed in the two groups during the observation period.Conclusion Naokang Ⅱ combined with aniracetam for patients with vascular cognitive impairment of none dementia after cerebral infarction had a synergistic effect.
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Objective To investigate paired using tangerine peel and ternate pinellia tuber to regulate phosphatidylinositol 3-kinase (PI3K)and protein kinase B (p-Akt)signal pathways in rabbits in order to treat carotid atherosclerosis. Methods According to a random number table,20 rabbits were divided into 4 groups:a control,a model,a tangerine peel and ternate pinellia tuber,and a tangerine peel and ternate pinellia tuber+LY294002 (a PI3K/Akt signal pathway specific inhibitor)group (n=5 in each group). The rabbits in the control group were fed with basal diet,while those in other groups were given high-cholesterol diet and air drying of carotid artery intima were performed. After procedure,the rabbits in the tangerine peel and ternate pinellia tuber group and the tangerine peel and ternate pinellia tuber +LY294002 group were treated with the decoction of traditional Chinese medicine. Carotid atherosclerosis was observed via HE staining;the effect of tangerine peel and ternate pinellia tuber on the expressions of PI3K and p-Akt in rabbits with carotid atherosclerosis was observed by western blot. Results (1)the expressions of PI3K and p-Akt in carotid in the model group were 107. 0 ± 2. 6 and 113. 0 ± 1. 7,and those in the tangerine peel and ternate pinellia tuber group were 174. 7 ± 14. 5 and 186. 3 ± 18. 3. There were significant differences between the two groups (P <0. 01). After using PI3K/Akt signal pathway specific inhibitor LY294002,the expressions of PI3K and p-Akt (117. 0 ± 4. 0,127. 3 ± 4. 7)were lower than the tangerine peel and ternate pinellia tuber group. There were significant differences between the two groups (P <0. 01). (2)The tangerine peel and ternate pinellia tuber group had mild intimal hyperplasia and foam cell formation under the artery intima,however,they were better than those of the model group and the tangerine peel and ternate pinellia tuber+LY294002 group. Conclusion Tangerine peel and ternate pinellia tuber may play a role in the treatment of carotid atherosclerosis by upregulating the expressions of PI3K and p-Akt in vascular endothelial cells.
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Objective To observe the effect of tenuigenin on differentiation of hippocampal neural stem cells (NSCs). Methods NSCs isolated from newborn (within 24 h) Wistar rats hippocampus were cultivated in vitro with serum free and clone culturing technology. Tenui-genin of different doses (0, 1, 2, 4μg/ml) were added in the medium, and the proliferation and differentiation of the cells were identified with immunofluorescence staining. Results The neural spheres obtained from the hippocampi of newborn rats were positive for Nestin ex-pression, with the potential for further cloning and differentiation into neurons or glial cells. The incidence of neuron specific enolase and glial fibrillary acidic protein positive cells increased in all the tenuigenin groups compared to the control (P<0.05), while the Nestin positive cells decreased (P<0.05). Conclusion Tenuigenin may promote the differentiation of neural stem cell into nerve cell.
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Objective To study the application effect of quality management tool“quality control circle” in clinical probation of the course of traditional Chinese medicine (TCM) in western medicine colleges and universities. Methods The students of grade 2009 and grade 2010 majoring in clinical specialty in Capital Medical University were classified into the control group and the test group. The control group received traditional teaching methods and the test group received quality control circle activities in clinical probation of TCM. The statistical analysis about comprehensive quality and academic achievement of two groups were made after the clinical probation period. Results Both the theoretical and practical achievements in the test group were better than those in the control group (P<0.05). The students of the test group showed greater improvements in the learning enthusiasm, joy, confidence, communication and coordination, team cohesion and the ability of problem-solving than the control group (P<0.05). Conclusion The application of quality management tool “quality control circle” in clinical probation of TCM teaching can effectively improve students’ academic performance and learning ability, as well as their comprehensive quality.
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Objectives To observe the effect of Luoyutong capsule on neurological function following focal cerebral ischemia-reperfusion in rats and to preliminarily study the protective mechanism of Luoyutong capsule for focal cerebral ischemia-reperfusion in rats. Methods A rat model of middle cerebral artery occlusion (MCAO)was induced by the modified Longa method. After 1. 5 h of ischemia,reperfusion started. Ten male SD rats were selected as sham operation group,and forty male SD rats were randomly divided into 4 groups:Model (MCAO),Luoyutong moderate-dose (LYTM),Luoyutong high-dose (LYTH),and citicoline sodium (CS)groups (n=10 in each group). At day 3 and 7 after modeling,the neurological function of the rats was evaluated by using 12 neurological score and forelimb placing test. Western blotting was used to detect the expression levels of brain derived neurotrophic factor (BDNF),basic fibroblast growth factor (b-FGF),and phosphor/protein kinase (p-AKT/AKT)on the ischemic side of the rats and in the ipsilateral brain tissue at day 3 after modeling,as well as the expression level of Caspase-12 at day 7 after modeling in the ipsilateral brain tissue,and a comparison was performed among the groups. Results (1 )Neurological score:At day 3 after modeling,there was no significant difference between the 12 neurological score and the forelimb placing test score (all P>0. 05);At day 7 after modeling, there were obvious improvement in the LYTM,LYTH,and CS groups compared with model group (all P0. 05);the expression levels of proCaspase-12 and cleavage Caspase-12 in the CS group were obviously lower than those of the MCAO group (P<0. 05). Conclusion Luoyutong capsule may play a protective effect for focal cerebral ischemia-reperfusion injury in rats by promoting neural survival and regeneration,and this protective effect may be associated with the inhibition of neuronal apoptosis.
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Objective To research the influence of tangerine peel and pinellia ternata on the expression of VCAM-1 and MMP-9 in carotid atherosclerosis rabbits, and explore its mechanism. Methods Totally 25 male rabbits were divided into control group, model group and Chinese medicine group. Control group was treated with basic diet, model group and Chinese medicine group were treated with both high-fat diet and carotid artery intima-air drying technique. Chinese medicine decoction group was treated with tangerine peel and pinellia ternata decoction, as 10, 8, 6 mL/kg, for 4 weeks. Then the right carotid was cut and fixed, and pathological changes were observed by HE staining. The expressions of VCAM-1 and MMP-9 were observed by immunol histochemistry SABC method. Results Compared with control group, the expression of VCAM-1 and MMP-9 in model group was significantly increased (P<0.01). And compared with model group, tangerine peel and pinellia ternata decoction significantly restrained VCAM-1 and MMP-9 expression (P<0.05). Conclusion Tangerine peel and pinellia ternata could restrained VCAM-1 and MMP-9 expression in carotid atherosclerosis rabbits, suggesting that its mechanism may be related with inhibiting vascular inflammatory reaction and stabilizing plaques.
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Objective To investigate the factors influencing sleep disturbance and comorbid anxiety and depression after cerebral infarction.Methods A total of 216 patients with first onset of cerebral infarction were enrolled and divided into a post-stroke comorbid anxiety and depression (PSCAD) group, a pure anxiety group, a pure depression group and a non-anxiety and no-depression group. Smoking, alcohol intake, educational background, life or work pressure and exercise frequency were compared among the four groups along with ultrasound images of the carotid artery and brain blood vessels. The subjects' sleep quality was evaluated with the Pittsburgh sleep quality index (PSQI).Results The conditions studied showed no significant difference among the four groups. There were significant differences among the four groups in HAMA and HAMD scores. HAMD overall scores were higher in the PSCAD group than in the other three groups. HAMA overall scores were higher in the PSCAD group than in the pure depression group or the non-anxiety and no-depression groups. The PSCAD group showed significantly higher scores on all the dimensions and in their overall scores than those in the non-anxiety and no-depression group. Subjective sleep quality, sleep latency, sleep duration, sleep efficiency, day-time dysfunction and the overall PSQI score were all significantly higher in the PSCAD group than in the pure anxiety group. Sleep latency, sleep duration, day-time dysfunction and the overall PSQI scores were significantly higher in the PSCAD group than in the pure depression group. Age, life or work pressure, smoking, alcohol intake were the main factors influencing sleep quality in the PSCAD group.Conclusions The sleep quality of anxious and depressed patients after cerebral infarction is worse than that of those suffering only anxiety or depression alone, especially in terms of subjective sleep quality, sleep latency, sleep duration, sleep efficiency and day-time dysfunction. Age, life or work pressure, smoking and alcohol intake are the main factors influencing sleep quality in such comorbid individuals after cerebral infarction.
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@#ObjectiveTo investigate the anxiety and its effect on the sleep quality in patients with cerebral infarction and sleep-disordered breathing. Methods149 cerebral infarction patients were divided as 95 without sleep-disordered breathing and 54 with sleep-disordered breathing. They were evaluated with Hamilton Anxiety scale (HAMA) and Pittsburgh Sleep Quality Index (PSQI). ResultsPatients with sleep-disordered breathing showed higher HAMA overall score and factor scores of somatic anxiety and psychic anxiety（P<0.001）. In the factors of somatic anxiety, the scores of sensing, cardiovascular, gastrointestinal and autonomic nerve system were higher in patients with sleep-disordered breathing than those without sleep-disordered breathing （P<0.05）. In the factors of psychic anxiety, the scores of anxious mood, tension, fears, insomnia, depressed mood were higher in patients with sleep-disordered breathing（P<0.05）. PSQI overall score and all factor scores were also higher in patients with sleep-disordered breathing（P<0.001）. HAMA overall score as well as psychic anxiety and somatic anxiety scores were closely correlated with the PSQI overall score （P<0.001）. Somatic anxiety score was correlated with subjective sleep quality, sleep latency, sleep disturbance and daily dysfunction scores （P<0.05）. Psychic anxiety score was correlated with all the dimension scores of PSQI （P<0.01）. ConclusionCerebral infarction patients with sleep-disordered breathing appeared anxiety and worse sleep quality than patients without sleep-disordered breathing. Anxiety is closely related with sleep quality.
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@#Objective To investigate the relationship between carotid atherosclerosis （CAS） and cognitive impairment, stroke-specific quality of life of patients with cerebral infarction. Methods Patients enrolled were divided into mild-to-moderate CAS group and severe CAS group after carotid ultrasound. They were assessed with Mini Mental State Examination (MMSE) and Stroke Impact Scale (SIS) Version 3.0. Results The scores of attention/calculation, comprehension, and total of MMSE, the mobile ability and hand function dimensions of SIS were all lower in severe CAS group than in mild-to-moderate CAS group （P<0.05）. Conclusion Carotid atherosclerosis may further impair the cognitive function and quality of life of cerebral infarction patients.
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@#Objective To determine the clinical characteristics of comorbid anxiety and depression after cerebral infarction. Methods All the patients enrolled were divided into post-stroke comorbid anxiety and depression (PSCAD) group (84 cases) and the control group (121 cases). Their condition of smoke, alcohol intake, education background, carotid plaque and brain blood vessels were investigated, and they were evaluated with Hamilton Anxiety Scale (HAMA), Hamilton Depressive Scale (HAMD), Barthel index, and Mini-Mental State Examination (MMSE). Results There was not significant difference in condition of smoke, alcohol intake, education background, carotid plaque and brain blood vessels between these groups （P＞0.05）, but were in total scores and all the factors scores of HAMA and HAMD （P＜0.05）. PSCAD group showed more obvious anxious mood, depressive mood, tension, insomnia, cognitive impairment and autonomic nervous symptoms. Psycho-anxiety, soma-anxiety, despair, guiltiness, decreased interest were also more significant in the PSCAD group. The scores of MMSE and Barthel index were also impaired. Conclusion The cognitive function and daily living ability are worse in the patients with PSCAD. The prominent symptoms includes: anxious mood, depressive mood, tension, insomnia, cognitive impairment, autonomic nervous symptoms, soma-anxiety, despair, guiltiness, decreased interest.
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Objective To compare the sleep quality and traditional Chinese medical (TCM) syndrome between men and women with cerebral infarction. Method The patients with cerebral infarction enrolled were divided into men patients group and women patients group. After routine treatment of western medicine for 2 weeks, the sleep quality of patients were evaluated with Pittsburgh Sleep Quality Index (PSQI), and the TCM syndrome types were determined by the Diagnostic Criteria of Syndrome Differentiation of Stroke. Result The subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, day-time dysfunction and the overall PSQI scores were higher in the women patients group than that in the men patients group (P
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Objective To observe the survival quality of cerebral infarction patients in sub-acute seizure phase, who were in different TCM syndrome types. Methods The patients with cerebral infarction in acute seizure phase targeted to the inclusion criteria were divided into the heat group and non-heat group by TCM syndrome differentiation. After 4 weeks of routine treatment with western medicine, the survival quality of patients was evaluated with Health Questionnaire Short Form-36 (SF-36). Results In all dimensions of SF-36, the scores of social function, mental health, role-emotional dimensions in the heat group were obviously lower than those in the non-heat group (P
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Objective To compare the sleep quality of cerebral infarction patients with different types in sub-acute phase. Method The patients with cerebral infarction targeted to the inclusion criteria were divided into the phlegm-heat group and non-phlegm-heat group according to the syndrome differentiation of TCM. After routine treatment of western medicine for 4 weeks, the sleep quality of patients were evaluated with Pittsburgh Sleep Quality Index (PSQI) during the sub-acute phase. Result The scores of subjective sleep quality, sleep duration, sleep efficiency and overall PSQI score in the phlegm-heat group were obviously higher than that in the non-phlegm-heat group (P
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Objective To analyze the internal relationship between phlegm stasis syndrome (痰浊内阻证) and blood stasis syndrome (血瘀证) in cases with carotid atherosclerosis. Methods The clinical data of 136 patients with atherosclerosis accompanied by phlegm stasis and blood stasis syndromes were collected from the investigation table of the 4 diagnostic methods in traditional Chinese medicine(TCM); the principal components of the clinical data were statistically analyzed, and the correlative relationships of these principal components were studied. Results There were two principal components of phlegm stasis syndrome, which were tz1 and tz2. And tz1 cumulated 42.645% to phlegm stasis syndrome, which could be considered as phlegm stasis in limbs and tunnel; tz2 cumulated 24.898% to phlegm stasis syndrome, which could be considered as phlegm stasis in the body that might impair the 7 orifices (such as eyes, ears, nose and mouth). And they could also be considered as special markers of phlegm stasis syndrome of carotid atherosclerosis. There were three principal components of blood stasis syndrome, which were xy1, xy2 and xy3. And xy1 cumulated 37.197% to blood stasis syndrome, which could be considered as blood stasis in the artery and tunnel; xy2 cumulated 21.627% to blood stasis syndrome, which could be considered as the blood outside the vessels located in the body and could obstruct tunnel and could not nourish muscle and skin; then, xy3 cumulated 13.685% to blood stasis syndrome, which could be considered as the blood stayed in the brain and could not nourish brain and might reflect as a special marker of blood stasis syndrome of carotid atherosclerosis. There was significant positive correlative relationship between phlegm stasis syndrome principal component 1 and blood stasis syndrome principal component either 1 or 2 (P
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Objective:To research the improvement of Naokang Ⅱ in treating diabetic rat's cognitive impairment.Methods:Naokang Ⅱ was used to treat diabetes.The change of rat's ability of learning and memory function was tested by water maze.The percentage of neuron apoptosis was detected through flow cytometry.The expression of Caspase-3 and Bcl-2 proteins in hippocampal CA1 region was measured with immunohistochemistry.Results:Naokang Ⅱ could significantly reduce the swimming time to platform and the percentage of neuron apoptosis,and increase the expression of Bcl-2 and decrease the expression of Caspase-3 in hippocampal CA1 region of model rats.Conclusion:Naokang Ⅱ could improve diabetic rat's cognitive impairment by reducing hippocampus neuron apoptosis and increasing the expression of Bcl-2 and reducing the expression of Caspase-3 in the hippocampus.