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Article(id=1322926799285527154, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.10.038, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339927741, onlineDateStr=2026-10-30, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339927741, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339927741, creator=13701087609, updateTime=1793339927741, updator=13701087609, issue=Issue{id=1322926740955341011, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='10', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1760025600000', pubDateStr='2025-10-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339913834, creator='13701087609', updateTime=1793340753123, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930261259846420, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930261259846421, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=208, endPage=211, ext={EN=ArticleExt(id=1322926799524602483, articleId=1322926799285527154, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Role of Xinglou Chengqi Decoction（星蒌承气汤）in Improving Intestinal Microecology of Acute Cerebral Infarction and Its Efficacy, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the effect of Xinglou Chengqi Decoction（星蒌承气汤）in improving the intestinal microecology of acute cerebral infarction patients with phlegm-heat in Fu-organs syndrome.

Methods

A total of 60 acute cerebral infarction patients with phlegm-heat in Fu-organs syndrome who received the corresponding treatment in the hospital during May 2020 to June 2023 were selected as the subjects of this experiment，and were randomly divided into two groups.Both groups were treated with conventional western medicine，including lowering blood lipids，blood pressure and blood sugar，controlling underlying diseases，antiplatelet aggregation and neuroprotection.On this basis，the control group（30 cases）used aspirin enteric-coated tablets once a day and atorvastatin once a day orally.On the basis of conventional Western medicine treatment，the observation group（30 cases）was treated with Xingpu Chengqi Decoction，1 dose a day，taking twice in the morning and evening after decocting.Two groups were treated continuously for 14 days.The treatment efficacy of two groups was compared，and the improvement time of clinical symptoms such as limb weakness，aphasia，slurred speech and limb dysfunction before and after treatment was compared between two groups.Venous blood was collected on an empty stomach before and after treatment，and the levels of 5-hydroxytryptamine（5-HT），norepinephrine（NE），glutamicacid（Glu），doparnine（DA），brain-derived neurotrophic factor（BDNF）andγ-aminobutyric acid（GABA），the National Institutes of Health Stroke Scale（NIHSS）score，Barthel index score and modified Rankin score were compared between two groups before and after treatment.The numbers of bifidobacteria，lactobacillus，enterococci and yeast were compared between two groups before and after treatment.

Results

Dopamine，neurotransmitters norepinephrine，epinephrine，5-hydroxytryptamine The total effective rate in the control group（63.33%，19/30）was significantly lower than that（86.67%，26/30）in the observation group.The improvement time of clinical symptoms such as limb weakness，aphasia，slurred speech and limb dysfunction in the observation group was shorter than that in the control group（P<0.05）.The levels of DA，NE，adrenaline，5-HT after treatment in two groups were decreased and the decrease in the observation group was higher than that of the control group（P<0.05）.The modified Rankin score and NIHSSscore in two groups were lower than those before treatment.Barthel index scores in two groups after treatment were higher than those before treatment.The improvement of the observation group was better than that of the control group（P<0.05），and the levels of bifidobacteria，lactobacillus and enterococci in two groups increased compared with those before treatment，and the levels of yeast decreased compared with those before treatment，and the improvement in the observation group was better than that of the control（P<0.05）.

Conclusion

Xinglou Chengqi Decoction can improve the nervous function of acute cerebral infarction patients with phlegm-heat in Fuorgans syndrome，reduce the clinical symptoms and improve the therapeutic effect.Its mechanism of action may be related to regulating the secretion of neurotransmitters and maintaining the balance of brain-gut axis.

, authors=Huaqiang WANG, Suke LIN, Xinjun LEI, Liyan ZHU, authorsList=Huaqiang WANG, Suke LIN, Xinjun LEI, Liyan ZHU, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322926803169452678, articleId=1322926799285527154, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=星蒌承气汤在改善急性脑梗死肠道微生态方面的作用探讨及疗效观察, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

评价星蒌承气汤在改善痰热腑实证急性脑梗死肠道微生态方面的作用探讨及疗效观察。

方法

挑选2020年5月—2023年6月医院实施相应治疗的痰热腑实证急性脑梗患者共60例为试验对象，随机将其分为两组。两组患者全部实施常规西药治疗，包括降血脂、降血压、降血糖，控制基础疾病，抗血小板聚集以及神经保护等。在此基础上，对照组（30例）患者口服阿司匹林肠溶片，1次/d；阿托伐他汀，1次/d。观察组（30例）患者则另外加服星蒌承气汤予以治疗。比较两组疗效，治疗前后肢体无力、失语、吐字不清晰和肢体功能障碍等临床症状的改善时间；在治疗前后空腹采静脉血，采用酶联免疫吸附法检测5-羟色胺（5-hydroxytryptamine，5-HT）、去甲肾上腺素（norepinephrine，NE）、谷氨酸（glutamicacid，Glu）、多巴胺（dopamine，DA）、脑源性神经营养因子（brain-derived neurotrophic factor，BDNF）和γ-氨基丁酸（gama-aminobutyric acid，GABA）等神经递质水平；对比治疗前后两组Barthel指数具体的评分、NIHSS具体的评分和改良Rankin具体的评分情况；对比治疗前后两组双歧杆菌、乳酸杆菌、肠球菌、酵母菌的数量。

结果

对照组总有效率（63.33%，19/30）比观察组（86.67%，26/30）更低（P<0.05）；观察组患者肢体无力、失语、吐字不清晰和肢体功能障碍等临床症状的好转时间较对照组短（P<0.05）；DA、NE、肾上腺素、5-HT具体的浓度水平方面，治疗后两组全部出现了降低情况，且观察组较对照组更显著（P<0.05）；治疗后两组均下降，治疗后两组改良Rankin具体评分上升，且观察组改善幅度相较于对照组更高（P<0.05）；治疗后两组双歧杆菌、乳酸杆菌、肠球菌具体水平相较于治疗前全部上升，而酵母菌水平相较于治疗前全部下降，且观察组相较于对照组更显著（P<0.05）。

结论

星蒌承气汤可改善痰热腑实证急性脑梗死患者的神经功能，减轻临床症状，提高疗效，其作用机制可能与调节神经递质的分泌、维持脑肠轴的平衡有关。

, authors=王华强, 林素珂, 雷新军, 朱李艳, authorsList=王华强, 林素珂, 雷新军, 朱李艳, authorCompany=null, correspAuthors=null, authorNote=

王华强（1980-），男，山东荣成人，主任中医师，博士，研究方向：中西医结合脑血管病。

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王华强（1980-），男，山东荣成人，主任中医师，博士，研究方向：中西医结合脑血管病。

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王华强（1980-），男，山东荣成人，主任中医师，博士，研究方向：中西医结合脑血管病。

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issue=10, pageStart=88, pageEnd=91, url=null, language=null, rfNumber=［25］, rfOrder=24, authorNames=朱善军, 晏昭, 刘敏, journalName=基层医学论坛, refType=null, unstructuredReference=朱善军，晏昭，刘敏，等. 急性大面积脑梗死患者应用依达拉奉右莰醇注射用浓溶液治疗的临床效果分析［J］. 基层医学论坛，2024，28（10）：88-91., articleTitle=急性大面积脑梗死患者应用依达拉奉右莰醇注射用浓溶液治疗的临床效果分析, refAbstract=null), Reference(id=1322926811407065806, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, doi=null, pmid=null, pmcid=null, year=2024, volume=22, issue=7, pageStart=1327, pageEnd=1330, url=null, language=null, rfNumber=［26］, rfOrder=25, authorNames=高丽, 李文华, 谷丽丽, journalName=中西医结合心脑血管病杂志, refType=null, unstructuredReference=高丽，李文华，谷丽丽. 急性脑梗死病人血清miR-25表达水平及其对近期预后的预测价值［J］. 中西医结合心脑血管病杂志，2024，22（7）：1327-1330., articleTitle=急性脑梗死病人血清miR-25表达水平及其对近期预后的预测价值, refAbstract=null), Reference(id=1322926811495146191, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, doi=null, pmid=null, pmcid=null, year=2024, volume=22, issue=7, pageStart=1323, pageEnd=1326, url=null, language=null, rfNumber=［27］, rfOrder=26, authorNames=王东育, 韩小丹, 王磊, journalName=中西医结合心脑血管病杂志, refType=null, unstructuredReference=王东育，韩小丹，王磊，等. 通络化痰汤联合阿托伐他汀对急性脑梗死病人脑血流参数及认知功能的影响［J］. 中西医结合心脑血管病杂志，2024，22（7）：1323-1326., articleTitle=通络化痰汤联合阿托伐他汀对急性脑梗死病人脑血流参数及认知功能的影响, refAbstract=null), Reference(id=1322926811587420880, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, doi=null, pmid=null, pmcid=null, year=2024, volume=17, issue=10, pageStart=62, pageEnd=64, url=null, language=null, rfNumber=［28］, rfOrder=27, authorNames=刘群, 刘鹏辉, journalName=临床合理用药, refType=null, unstructuredReference=刘群，刘鹏辉. 替罗非班治疗急性进展性脑梗死的临床效果［J］. 临床合理用药，2024，17（10）：62-64., articleTitle=替罗非班治疗急性进展性脑梗死的临床效果, refAbstract=null), Reference(id=1322926811667112657, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, doi=null, pmid=null, pmcid=null, year=2024, volume=41, issue=4, 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caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数年龄/（岁，）性别/（例）病程/（h，）梗死部位/（例）糖尿病史/（例）高血压病史/（例）低密度脂蛋白/（mmol/L，）同型半胱氨酸/（μmol/L，）
男女前循环后循环
观察组3062.48±2.48181211.75±2.19131718153.13±0.2713.58±4.06
对照组3062.97±2.29151511.98±2.33161416133.40±0.2213.71±4.39
χ2/t值1.0260.6060.5090.0670.2710.2684.2460.119
P值 0.3070.4360.6120.7950.6020.605<0.0010.906
), ArticleFig(id=1322926806805914281, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, language=CN, label=表1, caption=

两组急性脑梗死患者基线资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数年龄/（岁，）性别/（例）病程/（h，）梗死部位/（例）糖尿病史/（例）高血压病史/（例）低密度脂蛋白/（mmol/L，）同型半胱氨酸/（μmol/L，）
男女前循环后循环
观察组3062.48±2.48181211.75±2.19131718153.13±0.2713.58±4.06
对照组3062.97±2.29151511.98±2.33161416133.40±0.2213.71±4.39
χ2/t值1.0260.6060.5090.0670.2710.2684.2460.119
P值 0.3070.4360.6120.7950.6020.605<0.0010.906
), ArticleFig(id=1322926806881411754, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数基本治愈显著改善有所改善无效总有效
观察组3011（36.67）12（40.00）3（10.00）4（13.33）26（86.67）
对照组309（30.00）5（16.67）5（16.67）11（36.67）19（63.33）
χ2值4.356
P值0.037
), ArticleFig(id=1322926806948520619, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, language=CN, label=表2, caption=

两组急性脑梗死患者临床疗效比较

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组别例数基本治愈显著改善有所改善无效总有效
观察组3011（36.67）12（40.00）3（10.00）4（13.33）26（86.67）
对照组309（30.00）5（16.67）5（16.67）11（36.67）19（63.33）
χ2值4.356
P值0.037
), ArticleFig(id=1322926807024018092, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数肢体无力好转时间失语好转时间吐字不清好转时间肢体功能障碍好转时间
观察组309.75±0.4210.06±0.519.82±0.7110.32±0.62
对照组3010.22±0.6111.42±0.3612.41±0.5311.97±0.44
t值3.47611.93316.01111.887
P值0.001<0.001<0.001<0.001
), ArticleFig(id=1322926807091126957, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, language=CN, label=表3, caption=

两组急性脑梗死患者临床症状改善时间比较（）

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组别例数肢体无力好转时间失语好转时间吐字不清好转时间肢体功能障碍好转时间
观察组309.75±0.4210.06±0.519.82±0.7110.32±0.62
对照组3010.22±0.6111.42±0.3612.41±0.5311.97±0.44
t值3.47611.93316.01111.887
P值0.001<0.001<0.001<0.001
), ArticleFig(id=1322926807158235822, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间去甲肾上腺素多巴胺5-羟色胺肾上腺素
观察组30治疗前110.74±11.52312.75±32.10385.47±28.9531.20±4.96
治疗后53.18±9.52ab198.76±21.18ab225.63±22.54ab22.31±3.22ab
对照组30治疗前105.68±10.74309.75±31.22379.85±30.1630.91±4.87
治疗后89.95±10.47a275.63±23.41a285.65±25.61a26.74±4.05a
), ArticleFig(id=1322926807229538991, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, language=CN, label=表4, caption=

两组急性脑梗死患者治疗前后神经递质指标比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间去甲肾上腺素多巴胺5-羟色胺肾上腺素
观察组30治疗前110.74±11.52312.75±32.10385.47±28.9531.20±4.96
治疗后53.18±9.52ab198.76±21.18ab225.63±22.54ab22.31±3.22ab
对照组30治疗前105.68±10.74309.75±31.22379.85±30.1630.91±4.87
治疗后89.95±10.47a275.63±23.41a285.65±25.61a26.74±4.05a
), ArticleFig(id=1322926807305036464, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间NIHSS评分Barthel指数评分改良Rankin评分
观察组30治疗前9.77±3.1558.95±6.892.96±1.25
治疗后4.13±2.09ab72.10±7.42ab1.26±0.91ab
对照组30治疗前9.91±2.6457.60±7.023.04±0.97
治疗后6.33±2.31a79.21±8.04a1.68±0.98a
), ArticleFig(id=1322926807359562417, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, language=CN, label=表5, caption=

两组急性脑梗死患者治疗前后NIHSS、Barthel指数以及改良Rankin评分对比（）

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组别例数时间NIHSS评分Barthel指数评分改良Rankin评分
观察组30治疗前9.77±3.1558.95±6.892.96±1.25
治疗后4.13±2.09ab72.10±7.42ab1.26±0.91ab
对照组30治疗前9.91±2.6457.60±7.023.04±0.97
治疗后6.33±2.31a79.21±8.04a1.68±0.98a
), ArticleFig(id=1322926807477002930, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间双歧杆菌乳酸杆菌肠球菌酵母菌
观察组30治疗前10.34±0.259.84±1.459.92±1.253.85±0.96
治疗后12.68±0.81ab11.75±3.29ab11.15±2.96ab3.29±0.19ab
对照组30治疗前10.51±0.199.71±1.389.86±1.103.92±0.88
治疗后11.42±0.41a10.69±2.67a10.34±2.31a3.58±0.52a
), ArticleFig(id=1322926807548306099, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926799285527154, language=CN, label=表6, caption=

两组急性脑梗死患者治疗前后肠道菌群菌落数水平对比（）

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组别例数时间双歧杆菌乳酸杆菌肠球菌酵母菌
观察组30治疗前10.34±0.259.84±1.459.92±1.253.85±0.96
治疗后12.68±0.81ab11.75±3.29ab11.15±2.96ab3.29±0.19ab
对照组30治疗前10.51±0.199.71±1.389.86±1.103.92±0.88
治疗后11.42±0.41a10.69±2.67a10.34±2.31a3.58±0.52a
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星蒌承气汤在改善急性脑梗死肠道微生态方面的作用探讨及疗效观察
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王华强 , 林素珂 , 雷新军 , 朱李艳
中华中医药学刊 | 省级项目平台 2025,43(10): 208-211
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中华中医药学刊 |省级项目平台 2025 , 43 (10) : 208 -211
星蒌承气汤在改善急性脑梗死肠道微生态方面的作用探讨及疗效观察
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王华强, 林素珂, 雷新军, 朱李艳
作者信息
  • 丽水市中医院，浙江 丽水 323000
作者简介:

王华强（1980-），男，山东荣成人，主任中医师，博士，研究方向：中西医结合脑血管病。

Role of Xinglou Chengqi Decoction（星蒌承气汤）in Improving Intestinal Microecology of Acute Cerebral Infarction and Its Efficacy
Huaqiang WANG, Suke LIN, Xinjun LEI, Liyan ZHU
Affiliations
  • Lishui Traditional Chinese Medicine Hospital，Lishui 323000，Zhejiang，China
出版时间: 2025-10-10 doi: 10.13193/j.issn.1673-7717.2025.10.038
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摘要
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目的

评价星蒌承气汤在改善痰热腑实证急性脑梗死肠道微生态方面的作用探讨及疗效观察。

方法

挑选2020年5月—2023年6月医院实施相应治疗的痰热腑实证急性脑梗患者共60例为试验对象，随机将其分为两组。两组患者全部实施常规西药治疗，包括降血脂、降血压、降血糖，控制基础疾病，抗血小板聚集以及神经保护等。在此基础上，对照组（30例）患者口服阿司匹林肠溶片，1次/d；阿托伐他汀，1次/d。观察组（30例）患者则另外加服星蒌承气汤予以治疗。比较两组疗效，治疗前后肢体无力、失语、吐字不清晰和肢体功能障碍等临床症状的改善时间；在治疗前后空腹采静脉血，采用酶联免疫吸附法检测5-羟色胺（5-hydroxytryptamine，5-HT）、去甲肾上腺素（norepinephrine，NE）、谷氨酸（glutamicacid，Glu）、多巴胺（dopamine，DA）、脑源性神经营养因子（brain-derived neurotrophic factor，BDNF）和γ-氨基丁酸（gama-aminobutyric acid，GABA）等神经递质水平；对比治疗前后两组Barthel指数具体的评分、NIHSS具体的评分和改良Rankin具体的评分情况；对比治疗前后两组双歧杆菌、乳酸杆菌、肠球菌、酵母菌的数量。

结果

对照组总有效率（63.33%，19/30）比观察组（86.67%，26/30）更低（P<0.05）；观察组患者肢体无力、失语、吐字不清晰和肢体功能障碍等临床症状的好转时间较对照组短（P<0.05）；DA、NE、肾上腺素、5-HT具体的浓度水平方面，治疗后两组全部出现了降低情况，且观察组较对照组更显著（P<0.05）；治疗后两组均下降，治疗后两组改良Rankin具体评分上升，且观察组改善幅度相较于对照组更高（P<0.05）；治疗后两组双歧杆菌、乳酸杆菌、肠球菌具体水平相较于治疗前全部上升，而酵母菌水平相较于治疗前全部下降，且观察组相较于对照组更显著（P<0.05）。

结论

星蒌承气汤可改善痰热腑实证急性脑梗死患者的神经功能，减轻临床症状，提高疗效，其作用机制可能与调节神经递质的分泌、维持脑肠轴的平衡有关。

星蒌承气汤  /  急性脑梗死  /  神经递质  /  脑肠轴  /  疗效
Objective

To evaluate the effect of Xinglou Chengqi Decoction（星蒌承气汤）in improving the intestinal microecology of acute cerebral infarction patients with phlegm-heat in Fu-organs syndrome.

Methods

A total of 60 acute cerebral infarction patients with phlegm-heat in Fu-organs syndrome who received the corresponding treatment in the hospital during May 2020 to June 2023 were selected as the subjects of this experiment，and were randomly divided into two groups.Both groups were treated with conventional western medicine，including lowering blood lipids，blood pressure and blood sugar，controlling underlying diseases，antiplatelet aggregation and neuroprotection.On this basis，the control group（30 cases）used aspirin enteric-coated tablets once a day and atorvastatin once a day orally.On the basis of conventional Western medicine treatment，the observation group（30 cases）was treated with Xingpu Chengqi Decoction，1 dose a day，taking twice in the morning and evening after decocting.Two groups were treated continuously for 14 days.The treatment efficacy of two groups was compared，and the improvement time of clinical symptoms such as limb weakness，aphasia，slurred speech and limb dysfunction before and after treatment was compared between two groups.Venous blood was collected on an empty stomach before and after treatment，and the levels of 5-hydroxytryptamine（5-HT），norepinephrine（NE），glutamicacid（Glu），doparnine（DA），brain-derived neurotrophic factor（BDNF）andγ-aminobutyric acid（GABA），the National Institutes of Health Stroke Scale（NIHSS）score，Barthel index score and modified Rankin score were compared between two groups before and after treatment.The numbers of bifidobacteria，lactobacillus，enterococci and yeast were compared between two groups before and after treatment.

Results

Dopamine，neurotransmitters norepinephrine，epinephrine，5-hydroxytryptamine The total effective rate in the control group（63.33%，19/30）was significantly lower than that（86.67%，26/30）in the observation group.The improvement time of clinical symptoms such as limb weakness，aphasia，slurred speech and limb dysfunction in the observation group was shorter than that in the control group（P<0.05）.The levels of DA，NE，adrenaline，5-HT after treatment in two groups were decreased and the decrease in the observation group was higher than that of the control group（P<0.05）.The modified Rankin score and NIHSSscore in two groups were lower than those before treatment.Barthel index scores in two groups after treatment were higher than those before treatment.The improvement of the observation group was better than that of the control group（P<0.05），and the levels of bifidobacteria，lactobacillus and enterococci in two groups increased compared with those before treatment，and the levels of yeast decreased compared with those before treatment，and the improvement in the observation group was better than that of the control（P<0.05）.

Conclusion

Xinglou Chengqi Decoction can improve the nervous function of acute cerebral infarction patients with phlegm-heat in Fuorgans syndrome，reduce the clinical symptoms and improve the therapeutic effect.Its mechanism of action may be related to regulating the secretion of neurotransmitters and maintaining the balance of brain-gut axis.

Xinglou Chengqi Decoction（星蒌承气汤）  /  acute cerebral infarction  /  neurotransmitter  /  brain-gut axis  /  curative effect
王华强, 林素珂, 雷新军, 朱李艳. 星蒌承气汤在改善急性脑梗死肠道微生态方面的作用探讨及疗效观察. 中华中医药学刊, 2025 , 43 (10) : 208 -211 . DOI: 10.13193/j.issn.1673-7717.2025.10.038
Huaqiang WANG, Suke LIN, Xinjun LEI, Liyan ZHU. Role of Xinglou Chengqi Decoction（星蒌承气汤）in Improving Intestinal Microecology of Acute Cerebral Infarction and Its Efficacy[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (10) : 208 -211 . DOI: 10.13193/j.issn.1673-7717.2025.10.038
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脑梗死又称为缺血性脑中风，是临床较为常见的脑血管疾病。主要因血栓或动脉狭窄导致脑组织部分区域突然失去血液供给，引发缺血缺氧性坏死，相应神经功能丧失，并发认知功能障碍，出现恶心呕吐、失语、神志不清、口眼歪斜等症状。急性脑梗死患者预后差，多数患者因后遗症很难重返社会，给患者的家庭带来了比较严重的负担[1]。近年相关的研究结果可以观察到，脑卒中（缺血性）的发病与预后和肠道微生态密切相关。对于急性脑梗死的治疗，临床多采用溶栓、抗血小板以及神经保护剂等方式，但西药治疗有严格的时间窗限制。现代医学中[2-3]，越来越多的医学专家关注到中医药对急性脑梗死的治疗效果，并通过基础实验研究证实，中医药可改善脑梗死患者早期神经恶化程度，改善神经细胞功能，减轻脑损伤，为急性脑梗死的治疗提供了新思路和新方法[4]。王永炎教授首创的星蒌承气汤在急性期缺血性脑卒中具有广阔的应用前景，鼠类实验证实，其有效成分可调节急性缺血性卒中小鼠脑-肠轴的免疫通路。本研究通过对60名患者的临床观察，探讨星蒌承气汤在改善急性脑梗死肠道微生态方面的作用。现报道如下。
1　资料与方法
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1.1　一般资料
挑选2020年5月—2023年6月在我院实施相应治疗的60例符合痰热腑实证辨证标准的急性脑梗患者为试验对象，依据随机对照原则，将两组患者分为观察组（30例）和对照组（30例），两组患者一般资料具有可比性。见表1。
1.2　诊断标准
1.2.1　西医诊断
符合中国2014版《急性缺血性脑卒中诊治指南》[5]和相关的脑卒中（急性缺血性）确诊标准：突然发病；局灶神经功能缺损（一侧面部麻木或半身肢体肌力减退、麻木不仁，失语或言语不利，口眼歪斜等），少数患者神经功能完全缺损；CT/MRI等影像学出现责任病灶或者症状/体征持续24 h以上未缓解；不包括非血管性病因导致的发病；脑CT/MRI排除脑出血。
1.2.2　中医证型标准
中医证型诊断依据《中医内科病症诊断疗效标准（试行）》[6]中痰热腑实证的标准制定：口舌歪斜，半身不遂，不语或者是言语謇涩，便干腹胀便秘，感觉减退或者是消失，苔黄腻，舌质黯红，脉弦滑或者是偏瘫侧弦滑而大。以便干便秘、黄腻舌苔、脉弦滑为3个基本指征。
1.3　纳入标准
符合痰热腑实证的辨证标准；经颅脑CT、磁共振成像检测确诊；发病病程≤72 h；所有患者均为首次发病；无溶栓或取栓指征；脑梗死发病之前未发生过感染；入组前未使用过免疫制剂、糖皮质激素治疗者；患者及家属知情同意并签字确认。该研究经我院伦理协会批准同意。
1.4　排除标准
不符合上述诊断标准者；合并严重心脑血管疾病的患者；合并脑外伤、脑肿瘤的患者；短暂性脑缺血发作者；出血性脑病；伴有恶性肿瘤及其他严重疾病者；合并肝肾、胃肠道及心脏疾病者；合并严重精神疾病者；有严重意识障碍，不能配合治疗者。
1.5　研究方法
两组患者均进行常规西药治疗。包括：降血脂、降血压、降血糖，控制基础疾病，抗血小板聚集以及神经保护等。在此基础上，口服阿司匹林肠溶片（拜耳医药保健有限公司生产；规格：100 mg/片；批准文号：国药准字J20080078），1次/d，1次1片；阿托伐他汀（辉瑞制药有限公司；规格：100 mg/片；批准文号：国药准字H19990258），1次/d。
观察组另外加服星蒌承气汤予以治疗。蒌承气汤药用：芒硝（冲服）6 g，胆南星6 g，全瓜蒌30 g，生大黄（后下）10 g，1剂/d，水煎服得400 mL，分早晚2次服用。
两组患者连续治疗14 d。
1.6　指标检测
比较两组治疗前后失语、肢体无力、吐字不清晰和肢体功能方面存在障碍等临床症状的改善时间；在治疗前后空腹采静脉血，采用酶联免疫吸附法检测 5-羟色胺（5-hydroxytryptamine，5-HT）、去甲肾上腺素（norepinephrine，NE）、谷氨酸（glutamicacid，Glu）、多巴胺（dopamine，DA）、脑源性神经营养因子（brain-derived neurotrophic factor，BDNF）和γ-氨基丁酸（gama-aminobutyric acid，GABA）等神经递质水平；对比治疗前后两组Barthel指数评分、NIHSS评分和改良Rankin评分情况；对比治疗前后两组双歧杆菌、乳酸杆菌、肠球菌、酵母菌的数量，比较两组治疗疗效，依据《中医内科病症诊断疗效标准（试行）》[6]中关于其疗效的评价标准制定，基本治愈：中医证候积分较治疗前降低≥95%，中医体征全部消失；显著改善：95%>中医证候积分较治疗前降低≥70%，中医体征较治疗前明显改善；有所改善：70% >中医证候积分较治疗前降低≥30%，中医体征较治疗前有所改善；无效：不符合上述标准者。
1.7　统计学方法
数据采用SPSS22.0软件分析，临床症状改善时间、神经递质指标、Barthel指数评分以及NIHSS评分、改良Rankin评分、肠道菌群菌落数等计量资料采用表示，两两间用t比较，治疗疗效方面则用率表示，采用χ2分析，检验标准α＝0.05。
2　结果
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2.1　临床疗效比较
此次试验结果可以观察到，对照组总有效率（63.33%）相较于观察组（86.67%）更低（P<0.05）。见表2。
2.2　临床症状改善时间比较
研究结果显示，观察组肢体无力、失语、吐字不清晰和肢体功能障碍等临床症状的好转时间较对照组短。组间结果比较显示，P<0.05，差异具有统计学意义。见表3。
2.3　治疗前后神经递质指标比较
由表4可知，治疗后两组DA、NE、肾上腺素、5-HT降低，且观察组相较于对照组更高（P<0.05）。
2.4　治疗前后NIHSS、Barthel指数以及改良Rankin评分对比
由表5可知，NIHSS评分和改良Rankin评分，治疗后两组下降，治疗后两组改良Rankin评分上升，且观察组相较于对照组更高（P<0.05）。
2.5　治疗前后肠道菌群菌落数水平对比
由表6可知，双歧杆菌、乳酸杆菌、肠球菌水平，治疗后两组上升，而酵母菌水平相较于治疗前下降，且观察组相较于对照组更高（P<0.05）。
3　讨论
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脑卒中作为临床容易出现的脑血管方面疾病，亦是造成我国居民寿命损失的第一病因[7-9]。据不完全统计，我国现存脑卒中患者1100多万人，且以每年新增200万人的速度在不断增长，随着人口老龄化的加剧，该病的发病率呈上升趋势发展。其发病率、致残率、病死率和复发率方面全部较高，给社会和家庭带来了比较沉重的负担[10-12]。脑卒中发病症状复杂多样，其与脑组织受到供血中断引起的损伤部位与面积有关。虽然医学界一直致力于其治疗方案的不断优化，但仍有部分患者治疗效果不佳，仍需探讨更多有效的治疗方案以满足临床需求[13-14]。
中医学认为，脑卒中为本虚标实之证，在发病的前3 d以标实为主。急性脑梗死的发病根本原因在于随着人体的逐渐老去，正气逐渐匮乏，风邪乘虚直中，中焦受阻，风阳痰火内闭神窍，痰热阻滞，腑气不通，上扰于脑互结为毒，发为该病。由此可见，风、火、痰、瘀互结是脑卒中发病后呈规律出现，贯穿整个脑卒中急性期，是辨证论治的关键所在[15]。星蒌承气汤是王永炎教授依据中风后风、火、痰、瘀互结的特点而创立，全方由全瓜蒌、胆南星、生大黄、芒硝4味中药组成，全瓜蒌具有清热涤痰、宽胸散结、润燥滑肠的功效，胆南星具有清热化痰、息风定惊的作用，和全瓜蒌合用，可增强清化痰热、散结宽中之效。生大黄可促进排便、凉血止血、逐瘀通经；芒硝润燥散结，可助大黄通腑导滞。全方诸药共用，可承顺失降胃气，使痰热从大肠下行，以调和气机，血行通畅，抗炎解毒[16-17]。
诸多基础实验证实[18-20]，星蒌承气汤对急性脑梗死患者的血液黏稠度有降低功效，且能改善急性期患者的各项生物指标和神经功能。研究表明[21]，星蒌承气汤治疗急性脑梗死的作用机制可能与抑制氧化应激反应、降低炎症反应、抗凋亡等作用有关。本研究中，NIHSS评分和改良Rankin评分方面，治疗后两组患者全部出现了下降情况，而改良Rankin具体评分方面，治疗后两组患者全部出现了上升情况，且观察组这些评分的改善幅度相较于对照组更高，表明星蒌承气汤可修复受损的神经细胞，对患者后期的康复和生存质量的改善大有裨益。另研究表明，观察组患者肢体无力、失语、吐字不清晰和肢体功能障碍等临床症状的好转时间较对照组短，表明星蒌承气汤可改善急性脑梗死患者的临床症状，逆转病情。这与李偲等研究结果具有一致性。
星蒌承气汤治疗急性脑梗死的疗效已被临床所证实，但是对其作用机制的探讨仍是临床研究的重点。近年来[22-23]，越来越多的专家和学者认为星蒌承气汤通过调节肠道和中枢神经系统发挥其对神经递质、内分泌和免疫系统等调节作用。即“微生物-肠-脑轴”。我们在临床中发现急性脑梗死患者常伴有大便干结、口臭、舌苔厚腻、情绪不稳等现象，因肠道微生物能调节5-HT、NE、Glu、DA、BDNF和GABA等神经递质，从而推测急性脑梗死痰热腑实证患者存在肠道微生物的异常。研究结果显示，多巴胺、神经递质去甲肾上腺素、肾上腺素、5-羟色胺具体的浓度水平方面，治疗后两组患者全部出现了降低情况，且观察组这些指标的改变幅度相较于对照组更显著，表明星蒌承气汤对急性脑梗死的治疗作用与其对神经递质的调节有关。现代药理学研究表明[24-26]，胆南星的主要活性成分为芹菜素，可一定程度上促进血管内皮细胞增殖，减轻细胞凋亡，减轻脑损失。大黄的有效活性成分大黄素可改善血脑屏障。
肠道菌群是脑肠互相连接的重要标志[27-28]。在健康人体中，菌群会处于平衡状态，但是对于急性脑梗死急性期的患者，肠道菌群会失衡。这一方面加重了炎症反应，另一方面肠道菌群的生态失衡也会影响神经递质的释放，形成不良循环[29-30]。本研究中，双歧杆菌、乳酸杆菌、肠球菌具体水平方面，治疗后两组患者相较于治疗前全部出现了上升情况，而酵母菌水平相较于治疗前全部出现了下降情况，且观察组这些菌群的改变幅度相较于对照组更高。表明星蒌承气汤可改善急性脑梗死患者的肠道菌群，维持脑肠轴的平衡。
综上所述，星蒌承气汤可改善急性脑梗死患者的神经功能，减轻临床症状，提高治疗疗效，其作用机制可能与调节神经递质的分泌、维持脑肠轴的平衡有关。
基金
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  • 浙江省中医药科技计划项目(2024ZR202)
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排序方式：
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丁子云，高红霞，任统伟. 益气活血通络汤联合重组组织型纤溶酶原激活物动脉溶栓对急性脑梗死的影响研究［J］. 中医药临床杂志，2023，35（12）：2405-2408.
［2］
张芳. 复方丹参滴丸联合丁苯酞治疗动脉粥样硬化性急性脑梗死患者的效果［J］. 中国民康医学，2023，35（24）：89-91，95.
［3］
陈红霞，高晓红，张玉秋. 银丹心脑通软胶囊联合双联抗血小板方案治疗急性脑梗死的临床研究［J］. 现代药物与临床，2024，39（4）：915-920.
［4］
李仁堂，宋孝祖，张玉镇. 安脑化瘀汤联合丹参注射液治疗急性脑梗死临床研究［J］. 新中医，2024，56（8）：70-74.
［5］
杨建波，汪毅明，王晓阳，等. 源于脉络学说的通心络胶囊对新疆地区急性脑梗死患者的神经功能及生活质量影响［J］. 新疆中医药，2024，42（2）：11-12.
［6］
马艳，王帅，李楠. 通心络胶囊应用于老年急性脑梗死中的效果及对患者脑循环的改善作用分析［J］. 罕少疾病杂志，2024，31（4）：17-18，26.
［7］
陈仕银，胡朋. 通腑息风汤对急性脑梗死患者的临床疗效［J］. 中成药，2024，46（4）：1413-1415.
［8］
蔺丽娟，祁丽霞，马金花. 偏瘫复原丸联合氯吡格雷治疗急性脑梗死恢复期的临床研究［J］. 现代药物与临床，2024，39（4）：906-910.
［9］
于瑞芸，高强，张超，等. 星蒌承气汤对急性缺血性中风小鼠中枢和外周免疫炎症的影响与肠道菌群有关［J］. 中华医学杂志，2023，10（4）：502-511，529.
［10］
李淑贞，陈欣华，黄慧敏. 丁苯酞联合重组人TNK组织型纤溶酶原激活剂治疗急性脑梗死的临床疗效［J］. 临床合理用药，2023，16（36）：45-48.
［11］
李依恒，丁涛. 星蒌承气汤治疗腔隙性脑梗死风痰上扰证临床观察［J］. 光明中医，2023，38（20）：3966-3969.
［12］
武云霞. 综合脑保护治疗在急性脑梗死中的应用研究［J］. 山东医学高等专科学校学报，2024，46（2）：98-100.
［13］
安惠娟. 丁苯酞联合阿替普酶溶栓治疗对急性脑梗死患者血清神经内分泌因子及神经功能的影响［J］. 临床医学，2023，43（12）：105-107.
［14］
崔娜，王小刚，董磊. 动脉粥样硬化型急性脑梗死患者颈动脉斑块特征及炎症因子与患者神经功能缺损程度的关系［J］. 中国医刊，2024，59（1）：105-108.
［15］
贺翔渝，张小林，贾燕燕，等. 阿托伐他汀钙联合血栓通对急性脑梗死患者神经功能恢复的影响［J］. 黑龙江医药科学，2024，47（2）：177-178，181.
［16］
田源，蒋烨，张亚军. 三氧自体血回输治疗急性脑梗死患者的临床效果［J］. 临床医学工程，2024，31（4）：447-448.
［17］
齐金花. 银丹心脑通软胶囊联合硫酸氢氯吡格雷片和阿司匹林肠溶片治疗急性脑梗死患者的效果［J］. 中国民康医学，2023，35（24）：86-88.
［18］
施金婵，张豪，宋昌军. 阿司匹林联合硫酸氢氯吡格雷治疗老年急性脑梗死临床疗效及对患者血清炎性因子的影响研究［J］. 贵州医药，2023，47（12）：1873-1874.
［19］
熊飞，王义，席三赢. 定狂逐瘀汤联合奥氮平治疗急性脑梗死后出现的脑血管病所致精神障碍的疗效分析［J］. 医药论坛杂志，2023，44（24）：81-85.
［20］
徐生辉，陈继杰，闻涛. 丁苯酞胶囊联合依达拉奉对急性脑梗死患者神经功能及血清VEGF、TMAO、TXA2水平的影响［J］. 检验医学与临床，2023，20（23）：3518-3521.
［21］
郑勇，程贝，陈亦辉，等. 星蒌承气汤联合丁苯酞治疗缺血性脑卒中疗效及对患者氧化应激、血液流变学的影响［J］. 陕西中医，2023，44（2）：191-194.
［22］
周尊奎，张文娟. 中医序贯疗法治疗急性缺血性中风（痰热腑实证）的临床观察［J］. 中国中医急症，2023，32（10）：1767-1769.
［23］
冯妹娇，姚佳敏，王丽香，等. 刮痧联合加味半夏白术天麻汤治疗风痰阻络型急性缺血性脑卒中的临床观察［J］. 中国民间疗法，2024，32（7）：56-59.
［24］
张金才，孙照芬，史福俊. 天麻素注射液联合尼莫地平治疗急性脑梗死的临床疗效及其对患者炎症因子、血管内皮因子的影响［J］. 实用心脑肺血管病杂志，2024，32（4）：51-55.
［25］
朱善军，晏昭，刘敏，等. 急性大面积脑梗死患者应用依达拉奉右莰醇注射用浓溶液治疗的临床效果分析［J］. 基层医学论坛，2024，28（10）：88-91.
［26］
高丽，李文华，谷丽丽. 急性脑梗死病人血清miR-25表达水平及其对近期预后的预测价值［J］. 中西医结合心脑血管病杂志，2024，22（7）：1327-1330.
［27］
王东育，韩小丹，王磊，等. 通络化痰汤联合阿托伐他汀对急性脑梗死病人脑血流参数及认知功能的影响［J］. 中西医结合心脑血管病杂志，2024，22（7）：1323-1326.
［28］
刘群，刘鹏辉. 替罗非班治疗急性进展性脑梗死的临床效果［J］. 临床合理用药，2024，17（10）：62-64.
［29］
王会品，张二锋，马骥. 炙黄芪-水蛭联合阿加曲班注射液治疗气虚血瘀型急性脑梗死的疗效观察［J］. 天津中医药，2024，41（4）：422-426.
［30］
黄鸿程. 益气通脉汤联合针刺治疗气虚血瘀型急性脑梗死临床观察［J］. 中国中医药现代远程教育，2024，22（9）：138-140.
2025年第43卷第10期
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doi: 10.13193/j.issn.1673-7717.2025.10.038
  • 首发时间：2026-10-30
  • 出版时间：2025-10-10
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浙江省中医药科技计划项目(2024ZR202)
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    丽水市中医院，浙江 丽水 323000
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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