CN108066651A - 一种用于治疗抗抑郁药所致盗汗的健脾养阴中药复方 - Google Patents
一种用于治疗抗抑郁药所致盗汗的健脾养阴中药复方 Download PDFInfo
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Abstract
本发明公开了一种用于治疗抗抑郁药所致盗汗的健脾养阴中药复方，包括：太子参13‑17份，黄芪18‑22份，茯苓10‑14份，白术10‑14份，远志10‑14份，甘草5‑7份，防风10‑14份，五味子10‑14份，地骨皮28‑32份，熟地黄10‑14份，佩兰10‑14份，煅龙骨18‑22份；还包括：墨旱莲10‑14份，浮小麦10‑14份；均为重量份。本发明复方可以有效治疗抗抑郁药所致盗汗，并可以有效增强抗抑郁药的抗抑郁作用。
Description
技术领域
本发明属于医药领域，涉及一种用于治疗抗抑郁药所致盗汗的健脾养阴中药复方。
背景技术
文拉法辛是目前最常用的一种抗抑郁药，其作用机制为5-HT及去甲肾上腺素再摄取抑制剂，盗汗是文拉法辛最常见的不良反应，发生率达14％，部分患者由于无法耐受该不良反应导致不能继续服药。目前研究表明，文拉法辛导致的盗汗多由于5-HT2A受体阻滞，导致延髓GABA功能下降，去甲肾上腺素增加所致，文献报道，采用可乐定、心得安或一些抗胆碱能药物可能可以改善该症状，但这类药物仍存在许多风险如对心脏的影响、记忆减退、便秘等问题。盗汗为寐时汗出，醒后自止，基本病机为阴阳失调或阴虚内热等。
发明人先前公开了一种自拟健脾养阴汤，治疗文拉法辛导致的盗汗疗效良好(刘兰英等，自拟健脾养阴汤治疗文拉法辛所致盗汗临床观察，浙江中西医结合杂志2017年27卷7期)。
发明内容
本发明是对先前中药复方的进一步优化，提供一种临床效果更好的用于治疗抗抑郁药所致盗汗的健脾养阴中药复方。
本发明的上述目的是通过下面的技术方案得以实现的：
一种用于治疗抗抑郁药所致盗汗的健脾养阴中药复方，包括：太子参13-17份，黄芪18-22份，茯苓10-14份，白术10-14份，远志10-14份，甘草5-7份，防风10-14份，五味子10-14份，地骨皮28-32份，熟地黄10-14份，佩兰10-14份，煅龙骨18-22份；还包括：墨旱莲10-14份，浮小麦10-14份；均为重量份。
优选地，所述的健脾养阴中药复方包括：太子参15份，黄芪20份，茯苓12份，白术12份，远志12份，甘草6份，防风12份，五味子12份，地骨皮30份，熟地黄12份，佩兰12份，煅龙骨20份，墨旱莲12份，浮小麦12份；均为重量份。
一种上述健脾养阴中药复方的汤剂：取太子参15g、黄芪20g、茯苓12g、白术12g、远志12g、甘草6g、防风12g、五味子12g、地骨皮30g、熟地黄12g、佩兰12g、煅龙骨20g、墨旱莲12g、浮小麦12g加150mL水煎煮即得。
上述健脾养阴中药复方在制备治疗抗抑郁药所致盗汗并增强抗抑郁药抗抑郁作用的药物中的应用。
君臣佐使是方剂配伍组成的基本原则，君指方剂中针对主证起主要治疗作用的药物；臣指辅助君药治疗主证，或主要治疗兼证的药物；佐指配合君臣药治疗兼证，或抑制君臣药的毒性，或起反佐作用的药物；使指引导诸药直达病变部位，或调和诸药的药物。
本发明复方的方解如下：
君：黄芪—补脾益气，固表止汗；
臣：太子参、白术—甘温补气，与黄芪相配，加强益气固表之力；
熟地—滋阴养血，增加补心养血之效；
佐：茯苓、远志、五味子、煅龙骨—宁心安神；
地骨皮、墨旱莲、浮小麦—除虚热止汗；
防风—防风走表而散风邪，合黄芪、白术以益气祛邪；
佩兰—芳香理气醒脾；
使：甘草—补气健脾，调和诸药。
心藏神而主血，脾主思而统血，思虑过度，心脾气血暗耗，脾气亏虚则体倦、食少，心血不足则见惊悸、怔忪、健忘、不寐、盗汗，方中以参、芪、术、草大队甘温之品补脾益气以生血，熟地补血养心，茯苓、远志宁心安神，五味子、煅龙骨安神敛汗，防风助黄芪固表止汗，地骨皮、墨旱莲、浮小麦除虚热止汗，佩兰芳香理气醒脾，与大量益气健脾药配伍，复中焦运化之功，防大量益气补血药滋腻碍胃；甘草调和诸药。
本发明复方可以有效治疗抗抑郁药所致盗汗，并可以有效增强抗抑郁药的抗抑郁作用。
具体实施方式
下面结合实施例具体介绍本发明实质性内容，但并不以此限定本发明的保护范围。
一、临床资料
1、一般资料
收集在浙江省立同德医院失眠抑郁专科门诊于2015年6月至2017年12月就诊的172例抑郁症患者，使用文拉法辛150mg或舍曲林100mg，每日一次，口服治疗抑郁症2周后出现盗汗，同时中医辨证为气阴不足证者。
将服用文拉法辛出现盗汗的97例随机分为文拉法辛+1号方治疗组(A组)、文拉法辛+2号方治疗组(B组)。A组44例，男11例，女33例，平均年龄(39.59±15.94)岁，盗汗平均病程(3.48±2.34)天；B组53例，男15例，女38例，平均年龄(47.17±13.57)岁，盗汗平均病程(3.98±2.07)天。两组年龄、性别、病程差异均无统计学意义(均P＞0.05)。
将服用舍曲林出现盗汗的75例随机分为舍曲林+2号方治疗组(C组)、舍曲林治疗组(D组)。C组49例，男19例，女30例，平均年龄(41.33±19.93)岁，盗汗平均病程(3.81±2.06)天；D组26例，男14例，女12例，平均年龄(42.58±19.82)岁，盗汗平均病程(3.54±2.27)天。两组年龄、性别、病程差异均无统计学意义(均P＞0.05)。
2、纳入及排除标准
纳入标准：(1)符合美国精神疾病诊断统计手册第4版(the diagnostic andstatis tical manual ofmental disorders-Fifth edition，DSMIV)重度抑郁发作诊断标准；(2)使用文拉法辛或舍曲林2周，出现盗汗症状，而用药前无类似异常出汗症状；(3)年龄16～70岁；(4)HDSS评分等级为3～4级；(5)符合《中医病证诊断疗效标准》中“盗汗”诊断标准，辨证为气阴不足证：夜寐盗汗，体倦乏力，气短，恶风，五心烦热，或兼午后潮热、两颧色红，口干少饮，舌淡有齿痕，苔薄白或少苔，脉细；(6)愿意服用中药治疗。排除标准：排除肺结核、风湿病、甲亢、感染性疾病等；未按要求进行治疗检查而无法判断疗效者。
二、治疗方法
A组和B组均继续予文拉法辛1次150mg，口服，1天1次；C组和D组均继续予舍曲林1次100mg，口服，1天1次；
A组同时加用如下组成的自拟健脾养阴汤(即发明人先前公开的药方，代号为1号方)：太子参15g、黄芪20g、茯苓12g、白术12g、远志12g、甘草6g、防风12g、五味子12g、地骨皮30g、熟地黄12g、佩兰12g、煅龙骨20g；
B组和C组同时加用如下组成的自拟健脾养阴汤(在1号方基础上增加墨旱莲和浮小麦，代号为2号方)：太子参15g、黄芪20g、茯苓12g、白术12g、远志12g、甘草6g、防风12g、五味子12g、地骨皮30g、熟地黄12g、佩兰12g、煅龙骨20g、墨旱莲12g、浮小麦12g；
给予1号方或2号方1天1剂，每次150mL，1天2次，温服。2周后观察疗效。
观察指标：采用Hyperhidrosis Disease Severity Scale(HDSS)量表评定盗汗程度：1级：出汗从来未被关注，也从来没有干扰日常活动。2级：出汗可以忍受，但有时会干扰到日常活动。3级：出汗勉强可以忍受，经常会干扰到日常活动。4级：出汗无法忍受，总是干扰到日常活动。应用汉密尔顿抑郁量(Hamilton rating scale for depression，HAMD)24项评定抑郁症状严重程度。
统计学方法：应用SPSS 22.0软件对数据进行统计处理，将所有数据输入计算机，建立数据库，检测数据分类变量用χ2检验，数值变量间采用t检验，P<0.05为差异有统计学意义。
三、结果
1、2号方对文拉法辛所致盗汗的影响
结果如表1所示，A组治疗后盗汗情况明显改善，与发明人先前公开的基本一致；B组治疗前HDSS各级所占百分比与A组无明显差异(P＞0.05)，B组治疗后HDSS评定显著优于A组，差异有统计学意义(P<0.05)。结果表明，2号方可以有效改善文拉法辛所致盗汗，效果优于发明人先前公开的1号方。
表1 A组和B组患者治疗前后HDSS量表评定结果
2、2号方辅助改善文拉法辛的抗抑郁作用
结果如表2所示，B组抗抑郁效果显著优于A组，差异有统计学意义(P<0.05)。结果表明，2号方辅助改善文拉法辛的抗抑郁作用。
表2 A组和B组患者治疗前后HAMD-24评分结果
3、2号方对舍曲林所致盗汗的影响
结果如表3所示，C组治疗后盗汗情况明显改善，HDSS评定显著优于D组，差异有统计学意义(P<0.05)。结果表明，2号方可以有效改善舍曲林所致盗汗。
表3 C组和D组患者治疗前后HDSS量表评定结果
4、2号方辅助改善舍曲林的抗抑郁作用
结果如表4所示，C组抗抑郁效果显著优于D组，差异有统计学意义(P<0.05)。结果表明，2号方辅助改善舍曲林的抗抑郁作用。
表4 C组和D组患者治疗前后HAMD-24评分结果
5、不良反应
各组治疗过程中未发现明显肝肾功能异常，无明显消化道不良反应。
本发明复方可以有效治疗抗抑郁药所致盗汗，并可以有效增强抗抑郁药的抗抑郁作用。
上述实施例的作用在于具体介绍本发明的实质性内容，但本领域技术人员应当知道，不应将本发明的保护范围局限于该具体实施例。
Claims (4)
1.一种用于治疗抗抑郁药所致盗汗的健脾养阴中药复方，包括：太子参13-17份，黄芪18-22份，茯苓10-14份，白术10-14份，远志10-14份，甘草5-7份，防风10-14份，五味子10-14份，地骨皮28-32份，熟地黄10-14份，佩兰10-14份，煅龙骨18-22份；其特征在于，还包括：墨旱莲10-14份，浮小麦10-14份；均为重量份。
2.根据权利要求1所述的健脾养阴中药复方，其特征在于，包括：太子参15份，黄芪20份，茯苓12份，白术12份，远志12份，甘草6份，防风12份，五味子12份，地骨皮30份，熟地黄12份，佩兰12份，煅龙骨20份，墨旱莲12份，浮小麦12份；均为重量份。
3.一种权利要求2所述健脾养阴中药复方的汤剂，其特征在于：取太子参15g、黄芪20g、茯苓12g、白术12g、远志12g、甘草6g、防风12g、五味子12g、地骨皮30g、熟地黄12g、佩兰12g、煅龙骨20g、墨旱莲12g、浮小麦12g加150mL水煎煮即得。
4.权利要求1或2所述健脾养阴中药复方在制备治疗抗抑郁药所致盗汗并增强抗抑郁药抗抑郁作用的药物中的应用。
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