Skip to main content

【Pharmacology】Adrenergic Agonists课本笔记

Adrenergic Agonists

Related link: 【Pharmacology】Adrenergic drug (adrenergic agonists)

The adrenergic drugs affect receptors that are stimulated by norepinephrine or epinephrine. Some adrenergic drugs act directly on the adrenergic receptor (adrenoceptor) by activating it and are said to be sympathomimetic.  block the action of the neurotransmitters at the receptors (sympatholytics), whereas still other drugs affect adrenergic function by interrupting the release of norepinephrine from adrenergic neurons. This chapter describes agents that either directly or indirectly stimulate adrenoceptors.

 

Direct-acting:

  • Albuterol
  • Clonidine
  • Dobutamine
  • Dopamine
  • Epinephrine
  • Formoterol
  • Isoproterenol
  • Metaproterenol
  • Methoxamine
  • Norepinephrine
  • Phenylephrine
  • Piruterol
  • Salmeterol
  • Terbutaline

 

Indirect-acting

  • Amphetamine
  • Cocaine
  • Tyramine

 

Direct and Indirect acting (Mixed action)

  • Ephedrine
  • Pseudoephrine


1. The Adrenergic Neuron

Adrenergic neurons release norepinephrine as the primary neurotransmitter. These neurons are found in the central nervous system (CNS) and also in the sympathetic nervous system, where they serve as links between ganglia and the effector organs. The adrenergic neurons and receptors, located either presynaptically on the neuron or postsynaptically on the effector organ, are the sites of action of the adrenergic drugs

The Adrenergic Neuron
Figure: Sites of actions of adrenergic agonists.
A. Neurotransmission at adrenergic neurons
B. Adrenergic receptors (adrenoceptors) 


2. Characteristics of Adrenergic Agonists

Most of the adrenergic drugs are derivatives of β-phenylethylamine 

Most of the adrenergic drugs are derivatives of β-phenylethylamine

Substitutions on the benzene ring or on the ethylamine side chains produce a great variety of compounds with varying abilities to differentiate between α and β receptors and to penetrate the CNS. Two important structural features of these drugs are the number and location of OH substitutions on the benzene ring and the nature of the substituent on the amino nitrogen.

 

A. Catecholamines

Sympathomimetic amines that contain the 3,4-dihydroxybenzene group (such as epinephrine, norepinephrine, isoproterenol, and dopamine) are called catecholamines. These compounds share the following properties:

1. High potency: Drugs that are catechol derivatives (with –OH groups in the 3 and 4 positions on the benzene ring) show the highest potency in directly activating α or β receptors.

2. Rapid inactivation: Not only are the catecholamines metabolized by COMT postsynaptically and by MAO intraneuronally, they are also metabolized in other tissues. For example, COMT is in the gut wall, and MAO is in the liver and gut wall. Thus, catecholamines have only a brief period of action when given parenterally, and they are ineffective when administered orally because of inactivation.

3. Poor penetration into the CNS: Catecholamines are polar and, therefore, do not readily penetrate into the CNS. Nevertheless, most of these drugs have some clinical effects (anxiety, tremor, and headaches) that are attributable to action on the CNS.

 

 B. Noncatecholamines Compounds

lacking the catechol hydroxyl groups have longer half-lives, because they are not inactivated by COMT. These include phenylephrine, ephedrine, and amphetamine. Phenylephrine, an analog of epinephrine, has only a single –OH at position 3 on the benzene ring, whereas ephedrine lacks hydroxyls on the ring but has a methyl substitution at the α-carbon. These are poor substrates for MAO and, thus, show a prolonged duration of action, because MAO is an important route of detoxification. Increased lipid solubility of many of the noncatecholamines (due to lack of polar hydroxyl groups) permits greater access to the CNS.  [Note: Ephedrine and amphetamine may act indirectly by causing the release of stored catecholamines.]

 

C. Substitutions on the amine nitrogen

The nature and bulk of the substituent on the amine nitrogen is important in determining the β selectivity of the adrenergic agonist. For example, epinephrine, with a –CH3 substituent on the amine nitrogen, is more potent at β receptors than norepinephrine, which has an unsubstituted amine. Similarly, isoproterenol, with an isopropyl substituent –CH(CH3)2 on the amine nitrogen, is a strong β agonist with little α activity.


D. Mechanism of action of the adrenergic agonists

1. Direct-acting agonists: These drugs act directly on α or β receptors, producing effects similar to those that occur following stimulation of sympathetic nerves or release of the hormone epinephrine from the adrenal medulla

2. Indirect-acting agonists: These agents, which include amphetamine, cocaine and tyramine, may block the uptake of norepinephrine (uptake blockers) or are taken up into the presynaptic neuron and cause the release of norepinephrine from the cytoplasmic pools or vesicles of the adrenergic neuron. As with neuronal stimulation, the norepinephrine then traverses the synapse and binds to the α or β receptors. Examples of uptake blockers and agents that cause norepinephrine release include cocaine and amphetamines, respectively.

3. Mixed-action agonists: Some agonists, such as ephedrine, pseudoephedrine and metaraminol, have the capacity both to stimulate adrenoceptors directly and to release norepinephrine from the adrenergic neuron

 

3. Direct-Acting Adrenergic Agonists

Direct-acting agonists bind to adrenergic receptors without interacting with the presynaptic neuron. The activated receptor initiates synthesis of second messengers and subsequent intracellular signals. As a group, these agents are widely used clinically.

A. Epinephrine

B. Norepinephrine

C. Isoproterenol

D. Dopamine

E. Dobutamine

F. Oxymetazoline

G. Phenylephrine

H. Methoxamine

 

Methoxamine [meth-OX-a-meen] is a direct-acting, synthetic adrenergic drug that binds primarily to α receptors, with α1 receptors favored over α2 receptors. Methoxamine raises blood pressure by stimulating α1 receptors in the arterioles, causing vasoconstriction. This causes an increase in total peripheral resistance. Because of its effects on the vagus nerve, methoxamine is used clinically to relieve attacks of paroxysmal supraventricular tachycardia. It is also used to overcome hypotension during surgery involving halothane anesthetics. In contrast to most other adrenergic drugs, methoxamine does not tend to trigger cardiac arrhythmias in the heart, which is sensitized by these general anesthetics. Adverse effects include hypertensive headache and vomiting.

 

 I. Clonidine Clonidine [KLOE-ni-deen] is an α2 agonist that is used in essential hypertension to lower blood pressure because of its action in the CNS .It can be used to minimize the symptoms that accompany withdrawal from opiates or benzodiazepines. Clonidine acts centrally to produce inhibition of sympathetic vasomotor centers, decreasing sympathetic outflow to the periphery

J. Metaproterenol Metaproterenol [met-a-proe-TER-a-nole], although chemically similar to isoproterenol, is not a catecholamine, and it is resistant to methylation by COMT. It can be administered orally or by inhalation. The drug acts primarily at β2 receptors, producing little effect on the heart. Metaproterenol produces dilation of the bronchioles and improves airway function. The drug is useful as a bronchodilator in the treatment of asthma and to reverse bronchospasm .

 K. Albuterol, pirbuterol, and terbutaline Albuterol [al-BYOO-ter-ole], pirbuterol [peer-BYOO-ter-ole], and terbutaline [ter-BYOO-te-leen] are short-acting β2 agonists used primarily as bronchodilators and administered by a metered-dose inhaler. Compared with the nonselective β-adrenergic agonists, such as metaproterenol, these drugs produce equivalent bronchodilation with less cardiac stimulation.

Onset and duration of bronchodilation effects of inhaled adrenergic agonists.
Figure: Onset and duration of bronchodilation effects of inhaled adrenergic agonists.

L. Salmeterol and formoterol Salmeterol [sal-ME-ter-ole] and formoterol [for-MOH-ter-ole] are β2-adrenergic selective, long-acting bronchodilators. A single dose by a metered-dose inhalation device, such as a dry powder inhaler, provides sustained bronchodilation over 12 hours, compared with less than 3 hours for albuterol. Unlike formoterol, however, salmeterol has a somewhat delayed onset of action  .These agents are not recommended as monotherapy and are highly efficacious when combined with a corticorsteroid. Salmeterol and formoterol are the agents of choice for treating nocturnal asthma in symptomatic patients taking other asthma medications.

 

4. Indirect-Acting Adrenergic Agonists

Indirect-acting adrenergic agonists cause norepinephrine release from presynaptic terminals or inhibit the uptake of norepinephrine

They potentiate the effects of norepinephrine produced endogenously, but these agents do not directly affect postsynaptic receptors.

A. Amphetamine

The marked central stimulatory action of amphetamine [am-FET-a-meen] is often mistaken by drug abusers as its only action. However, the drug can increase blood pressure significantly by α-agonist action on the vasculature as well as βstimulatory effects on the heart. Its peripheral actions are mediated primarily through the blockade of norepinephrine uptake and cellular release of stored catecholamines; thus, amphetamine is an indirect-acting adrenergic drug. The actions and uses of amphetamines are discussed under stimulants of the CNS . The CNS stimulant effects of amphetamine and its derivatives have led to their use for treating hyperactivity in children, narcolepsy, and appetite control. Its use in pregnancy should be avoided because of adverse effects on development of the fetus.

 B. Tyramine

Tyramine [TIE-ra-meen] is not a clinically useful drug, but it is important because it is found in fermented foods, such as ripe cheese and Chianti wine . It is a normal byproduct of tyrosine metabolism. Normally, it is oxidized by MAO in the gastrointestinal tract, but if the patient is taking MAO inhibitors, it can precipitate serious vasopressor episodes. Like amphetamines, tyramine can enter the nerve terminal and displace stored norepinephrine. The released catecholamine then acts on adrenoceptors.

 C. Cocaine

Cocaine [koe-KANE] is unique among local anesthetics in having the ability to block the Na+/K+-activated ATPase (required for cellular uptake of norepinephrine) on the cell membrane of the adrenergic neuron. Consequently, norepinephrine accumulates in the synaptic space, resulting in enhancement of sympathetic activity and potentiation of the actions of epinephrine and norepinephrine. Therefore, small doses of the catecholamines produce greatly magnified effects in an individual taking cocaine as compared to those in one who is not. In addition, the duration of action of epinephrine and norepinephrine is increased. Like amphetamines, it can increase blood pressure by α-agonist actions and β-stimulatory effects.

 

 Mixed-Action Adrenergic Agonists

Mixed-action drugs induce the release of norepinephrine from presynaptic terminals, and they activate adrenergic receptors on the postsynaptic membrane.

 

-Ephedrine and pseudoephedrine

Ephedrine [e-FED-rin], and pseudoephedrine [soo-doe-e-FED-rin] are plant alkaloids, that are now made synthetically. These drugs are mixed-action adrenergic agents. They not only release stored norepinephrine from nerve endings but also directly stimulate both α and β receptors. Thus, a wide variety of adrenergic actions ensue that are similar to those of epinephrine, although less potent. Ephedrine and pseudoephedrine are not catechols and are poor substrates for COMT and MAO; thus, these drugs have a long duration of action. Ephedrine and pseudoephedrine have excellent absorption orally and penetrate into the CNS; however, pseudoephedrine has fewer CNS effects.

 

Ephedrine is eliminated largely unchanged in the urine, and pseudoephedrine undergoes incomplete hepatic metabolism before elimination in the urine. Ephedrine raises systolic and diastolic blood pressures by vasoconstriction and cardiac stimulation. Ephedrine produces bronchodilation, but it is less potent than epinephrine or isoproterenol in this regard and produces its action more slowly. It is therefore sometimes used prophylactically in chronic treatment of asthma to prevent attacks rather than to treat the acute attack. Ephedrine enhances contractility and improves motor function in myasthenia gravis, particularly when used in conjunction with anticholinesterases .

 Ephedrine produces a mild stimulation of the CNS. This increases alertness, decreases fatigue, and prevents sleep. It also improves athletic performance. Ephedrine has been used to treat asthma, as a nasal decongestant (due to its local vasoconstrictor action), and to raise blood pressure. Pseudoephedrine is primarily used to treat nasal and sinus congestion or congestion of the eustachian tubes. [Note: The clinical use of ephedrine is declining due to the availability of better, more potent agents that cause fewer adverse effects. Ephedrine-containing herbal supplements (mainly ephedra-containing products) were banned by the U.S. Food and Drug Administration in April 2004 because of lifethreatening cardiovascular reactions. Pseudoephedrine has been illegally converted to methamphetamine. Thus, products containing pseudoephedrine have certain restrictions and must be kept behind the sales counter.]


Comments

Popular posts from this blog

【TCM diary】跟诊日记:德教会义诊-罗达盛医师(一)

 25/4/2025  居銮德教会义诊 - 罗达盛医师 (一)腰痛跟湿的关系 一位 Uncle 前来义诊,主诉腰酸背痛,食用生冷瓜果后症状加重。见舌色紫而偏干,脉弦。老师为其开立:柴胡疏肝散以疏解肝气,小柴胡汤以调理胃肠敏感,六味地黄丸以滋阴补肾(考虑其年高,顾护先天之本),藿香正气水以祛湿解暑、理气和中,并加用五苓散以利水渗湿。   对于前方药的配伍,我基本理解,但对加用五苓散的思路尚有疑惑,遂向老师请教。 老师解释道: 腰为肾之外府,肾之精气所灌注之处。肾主水液,主持调节全身水液代谢。若体内水湿过重(如脾虚运化失常、肾阳不足或外感湿邪),湿气困阻经络,气血运行不畅,腰部筋脉肌肉失养,遂致沉重、酸胀、隐痛之感。 湿气之于经络,犹如泥浆阻塞水道,气血难达,腰脊因‘粮食’(气血)不足而生酸痛沉重。 尤其马来西亚地处热带,气候常年湿热多雨,湿邪更易郁滞于体内,损伤脾阳,助生内湿。生冷瓜果之性寒凉,进一步伤及脾阳,加重水湿困滞,经脉瘀阻,故见腰背酸痛加剧。   故治疗此证,除疏肝理气、健脾和中、滋阴补肾外,尤应重视祛湿通络。此次加用五苓散,旨在利水渗湿、温阳化气,以助气血流通,祛除湿邪,从而缓解腰背酸痛之症。” 后续: 老师过目之后,进一步分享患者原本有胃胀、呃气等症状,曾投香砂六君子汤无效,后改用柴胡疏肝散、小柴胡汤合藿香正气水,始见效。三周前因食凉物致腰酸复发,胃中微不适。实为肝气不疏,脾虚湿聚, 加之患者素体肾湿邪乘虚内扰腰脊 所致。老师提醒 此例辨证要点为:舌面润滑,乃水湿内蕴之象,因此在前方基础上加用五苓散以加强利水,配合六味地黄丸以滋肾固本。 之前是有胃胀呃气等症候,医用香砂六君子无效后,老师调治,投以柴胡舒肝散、小柴胡汤合藿香正气才有起效。3星期前因食凉物致腰酸,胃微不舒。这实乃木不疏脾虚湿聚,丌生致腰酸。老师也提醒我此例临床辨症要点为舌面润滑为水湿之候,故照原方加五苓散增强利水化湿,六味地黄丸补肾。 经此一例,我深感此前对中医的理解尚浅,多停留在表面,未能真正做到“四诊合参”。中医治疗疾病,必须立足于中医基础理论,包括阴阳五行、脏腑经络学说及四诊八纲辨证。唯有通过精准辨证,方能确立治法,继而选择方药,从而环环相扣、切中病机,达到疗病之效。这正是中医“辨证论治”的核心价值所在。 在临床中,我常易受西医检验数据及其病名诊断...

【TCM diary】跟诊日记:德教会义诊-罗达盛医师(三)

  28/4/2025  居銮德教会义诊 - 罗达盛医师 ( 一)脚部糜烂 今天接诊了几位脚部溃烂的病人,老师分别处方了二妙散和当归拈痛丸,并建议患者自行购买赛霉安散用于外敷。 老师特别向我介绍了赛霉安散的成分与功效:该方由石膏、冰片、朱砂(水飞)组成,具有清热止血、收敛祛湿、化腐生肌的作用,广泛应用于多种皮肤和黏膜类疾病,包括口腔、鼻腔、咽喉溃疡,牙周炎性溃疡,以及皮肤碰伤、刀伤和慢性溃疡等。 对于今天遇到的两位老人家,脚部伤口长时间无法结痂收口,老师观察其脉象偏无力,判断可能属于正气亏虚、气血不足,生肌乏力的情况,因此建议加用补中益气汤。此方具有补中益气、升阳举陷之功,方中黄芪尤擅生肌收口,对于久不收口的慢性伤口有一定帮助。 老师还指出,许多伤口长期无法愈合,其中一个常见原因是包扎过于严密,导致伤口缺乏通风与氧气供应。虽然 “ 伤口不能碰水 ” 是防止感染的基本原则,但如果因此导致伤口长时间处于潮湿、封闭环境,也可能不利于组织修复。适当暴露在空气中,有助于干燥、结痂和加速愈合。 此外,一些患者因糖尿病影响血液循环及免疫功能,也会出现伤口愈合迟缓的现象,临床上应加以辨识与调理。                                 车祸后伤口糜烂不收口                        糖尿病伤口无法收口 (二)手指肿痛 今日接诊一例手指浮肿疼痛患者。初诊观察无明显红肿、灼热、剧痛等典型炎性表现,初步排除痛风性关节炎的可能。患者诉手指浮肿疼痛,屈伸乏力。追问病史,既往无高尿酸血症、高血压及糖尿病,仅胆固醇偏高。舌淡红,苔黄润,脉象濡。 老师原拟予舒筋活血汤,以活血通络、缓解筋脉拘急。然问诊中发现患者频频擤鼻,进一步追问得知近期伴有伤风表现。故调整处方如下:荆防败毒汤 180g 、小柴胡汤 90g 、半夏天麻白术汤 90g (药水)。 荆防败毒汤主治外感风寒湿邪,常用于发热、头痛、肢体酸楚等表证。该方除疏风解表、祛痰止咳外,...

【Neuro】23 rare behavioral and mental disorders

 A simple sort-out syndrome of 23 rare behavioral and mental disorders. All information obtain from the internet. 1. Capgras syndrome Syndrome : An irrational belief that someone they know or recognize has been replaced by an imposter. Associated:  Alzheimer’s disease, Schizophrenia, Brain injury 2. Fregoli delusion  Syndrome: A   mistaken belief that some person currently present in the deluded person's environment (typically a stranger) is a familiar person in disguise.  Associated: Alzheimer’s disease, Schizophrenia, Brain injury 3. Cotard syndrome Syndrome : A series of delusions that range from a belief that one has lost organs, blood, or body parts to insisting that one has lost one's soul or is dead. Associated: Dementia, Encephalopathy, Multiple sclerosis, Parkinson's disease, Stroke, Subdural bleeding, Epilepsy, and Migraine. 4. Reduplicative paramnesia Syndrome: Delusional belief that a place or location has been duplicated, existing in two o...

【方剂学练习题】 各论:第四章 清热剂

  一、填空题 1 .白虎汤主治 _______ 证。   ANS :气分热盛证   2 .竹叶石膏汤的组成是由白虎汤去 ______ 加 ______ 而成。         ANS: 知母 ;   竹叶   麦冬   半夏   人参   3 .竹叶石膏汤中麦冬与半夏用量比例为 ______ 。   ANS: 2:1 Note: 麦冬 ---------- 去心,一升( 20g )       半夏 ---------- 洗,半升( 9g )   4 .清营汤主治 ______ 证,其舌象为 ______ 。         ANS: 热入营分 ; 绛而干   5 .黄连解毒汤组成中除黄连外,还有 ______ ,该方体现了 ______ 之法。         ANS: 黄芩、黄柏、栀子 ;   苦寒直折   6 .普济消毒饮是治疗 ______ 的常用方剂,其功用是 ______ 。         ANS: 大头瘟   清热解毒,疏风散邪   7 .凉膈散中用量最大的药物是 ______ 。         ANS: 连翘   8 .凉膈散组成中包含有 ______ 承气汤的全部药物,其体现了 ______ 之法。         ANS: 调胃 ; 以泻代清   9 .被前人称之为“疮疡之圣药,外科之首方”的方剂是 ______ 。         ANS: 仙方活命饮 ...

【TCM diary】跟诊日记:德教会义诊-罗达盛医师(五)

 5/5/2025  居銮德教会义诊 - 罗达盛医师 (五)六味地黄丸 一位 68 岁的患者因跌倒后肩痛前来就诊,老师处方柴胡疏肝散合筋骨跌伤丸、六味地黄丸。我一如既往地认为,六味地黄丸是为了顾护患者体质、益肾固本。老师却追问:“除此之外呢?”我一时语塞,百思不得其解。老师笑着点拨:筋骨跌伤丸性属活血化瘀、消肿止痛,药性偏散;而年长患者肝肾渐亏、正气不足,为防其药性太散而伤正,故加六味地黄丸以滋阴潜阳、固护根本,取散中有收、攻中有补之意。 见我对六味地黄丸的理解仍偏狭,老师又举一例启发思考:一位 87 岁肩痛伴肢体麻木的患者,所用方为半夏天麻白术汤合镇肝熄风汤,并配伍六味地黄丸。六味地黄丸虽以滋阴补肾、顾护体质见长,但其中更蕴含“滋水涵木”之意——通过滋养肾阴,濡养肝阴,以平肝潜阳、调和风动,正契合本证肝肾同调的治则。   (六)天麻钩藤饮 VS 镇肝熄风汤 接着,老师提出一个思辨性问题:“这个患者是否可以改用天麻钩藤饮替代镇肝熄风汤?”我尝试分析其异同:天麻钩藤饮主治肝火上扰,方中用栀子、黄芩等清泄肝火,适用于肝火亢盛。而患者并未表现热象故不适宜使用。老师笑笑点头说,也要注意年龄大的患者不宜过于寒凉、攻下之品。而镇肝熄风汤则偏于肝阳上亢、因肾阴亏虚所致,其立法中存在明确的因果关系——肾虚不能制肝,致肝阳上亢、化风动扰。方中怀牛膝归肝肾经,入血分,性善下行,故重用以引血下行,并有补益肝肾之效为君。相比之下,天麻钩藤饮虽也含补肾药,但偏于平补肾气,且未必强调肝火与肾虚之间的因果链条。 此外,两方证候所对应的舌象亦有所区别:镇肝熄风汤适用于阴虚火旺之体,舌质多红、舌面偏干;而天麻钩藤饮则多用于夹湿之象,方中配伍茯神、杜仲、益母草等,具一定祛湿之功。此患者舌润,加之肢体的酸胀不适与痰有密切联系。若一味用镇肝熄风汤,恐不相宜,故原方以镇肝熄风汤为基础,加半夏天麻白术补脾燥湿、化痰熄风,以调和偏颇,契合实情。   (七)五行关系 咳嗽、干咳无痰、喉咙痛一个星期,曾有伤风史,现在已无鼻塞、流涕。舌苔腻,舌两旁有点紫。脉弦细滑。其舌脉提示有肝郁之症。但患者主诉是咳嗽,病位应属肺。故我的思路还是用桑菊饮、桑杏汤等治疗。定睛一看老师开方为柴胡疏肝散、小柴胡汤合白果定喘汤。“有一分恶寒便有一分表证”,其脉也无浮脉,说起外感病已转内。根据五行相生相克...

【方剂学】 涩肠固脱剂--真人养脏汤(原名纯阳真人养脏汤)

 涩肠固脱剂 适用于泻痢日久不止,脾肾虚寒,以致大便滑脱不禁的病证 代表方如真人养脏汤、四神丸等。   1. 真人养脏汤(原名纯阳真人养脏汤) 《太平惠民和剂局方》 ---- 涩肠固脱,温补脾肾 【用法】 上锉为粗末。每服二大钱( 6g ),水一盏半,煎至八分,去滓,食前温服。忌酒、面、生、冷、鱼腥、油腻(现代用法:水煎服)。   【运用】 本方为治泻痢日久,脾肾虚寒之常用方。 以大便滑脱不禁,腹痛喜温喜按,食少神疲,舌淡苔白,脉迟细为辨证要点。 原书注曰: “ 如脏腑滑泄夜起久不瘥者,可加炮附子三四片煎服。 ” 可资临证参佐。   组成:罂粟壳、诃子、肉豆蔻、肉桂、人参、白术、当归、白芍、木香、炙甘草   a. 组成 君:罂粟壳 ---------------- 去蒂萼,蜜炙,三两六钱( 9g ) ·          涩肠固脱止泻   臣: a. 诃子 ---------------- 去核,一两二钱( 9g ) ·          苦酸温涩,功专涩肠止泻   b. 肉豆蔻 ---------------- 面裹,煨 ,半两( 8g ) ·          温中散寒,涩肠止泻 ·          & 诃子:助君药以增强涩肠固脱止泻之功 ·          君臣相配,体现 “ 急则治标 ” 之法   佐: a. 肉桂 ---------------- 去粗皮,各八钱(各 6g ) ·          温肾暖脾,兼散阴寒   泻痢日久,气血亏虚 👇 b. 人参 ---...

【Pharmacology & 方剂学】Traditional Chinese Medicine (TCM) – Does its contemporary business booming and globalization really reconfirm its medical efficacy & safety?

Traditional Chinese Medicine (TCM) – Does its contemporary business booming and globalization really reconfirm its medical efficacy & safety? 笔记 1. Introduction 有几个国家同意中医 Promoting the globalization of TCM, Traditional Chinese medicine has been spread to 183 countries and regions around the world.  According to the World Health Organization,  103 member states have given approvalto the practice of acupuncture and moxibustion 29 have enacted special statutes on traditional medicine 18 have included acupuncture and moxibustion treatment in their medical insurance provisions  2. What's in the TCM bottle? The philosophy behind Chinese medicine is a melding of tenets from Buddhism, Confucianism, and the combined religious and philosophical ideas of Taoism.  TCM is based on the concept that illness occurs when a person's “internal Qi” falls out of balance.  Qi: the word the Chinese use to describe the un-measurable energies that theoretically permeate ev...

【方剂学练习题】 各论:第一章 解表剂

【方剂学练习题】 各论:第一章 解表剂 一、填空题 1 .麻黄汤和大青龙汤中,麻黄和桂枝的配伍比例分别是 _______ 、 _______ 。             ANS: 3:2 ; 3:1       解析:麻黄汤:麻黄 9g ;桂枝 6g             大青龙汤 : 麻黄 12g ;桂枝 6g   2 .桂枝汤证和麻黄汤证的脉象分别是 ______ 、 ________ 。         ANS: 浮缓 ; 浮紧       解析:桂枝汤:外感风寒表虚证             麻黄汤:外感风寒表实证   3 .桑菊饮的功用是 _______ ,主治 _______ 。         ANS: 疏风清热 , 宣肺止咳;风温初起   4 .以组方原则论,败毒散中人参属于 ______ 药;参苏饮中人参属于 ________ 药。         ANS :佐 ; 佐   5 .被称为“四时发散之通剂”的方剂是 _______ ;被称为“辛凉轻剂”的方剂是 _______ 。         ANS: 九味羌活汤 ; 桑菊饮   6 .银翘散中,为助君药发散外邪,透邪外出而加入辛而微温的两味药分别是 _______ 、 _______ 。         ANS: 荆芥穗 ; 淡豆豉       解析:风温之邪居卫,恐惟用辛凉难开其表,遂入辛而微温之 ...

【TCM & Western Medicine】阿片类药物(Opioids)& 中药

阿片类药物(Opioids) 是治疗中重度疼痛的首选药物。 其不良反应主要包括: 便秘 恶心呕吐 瘙痒 头晕 尿潴留 嗜睡 谵妄 认知障碍 呼吸抑制 Related link:  【Pharmacology】OPIOIDS 内容: 1. 癌性疼痛 2. 便秘 3. 阿片类成瘾慢性稽延症状 4. 参考文献 1. 癌性疼痛 是晚期恶性肿瘤最常见症状之一 被列为“第五生命体征” 生命四大体征:呼吸、体温、脉搏、血压 癌痛治疗的药物: 非甾体类抗炎药物 (Non-Steroidal Anti-Inflammatory Drug) 阿片类药物 (Opioids) 中医 癌性疼痛属“痛证”范畴 病因:正气亏虚、邪毒内侵 病机:“毒、瘀”壅塞经络 治疗:行气活血、化瘀解毒功效的中药组方外敷联合西药治疗 好处: 增强止痛效果 缩短止痛起效时间 延长镇痛时间从而减少爆发痛次数 提高患者的生活质量 一定的抗肿瘤作用 中药方: “双黄散结散” 全方具有清热解毒、散结止痛的作用。 君: a. 大黄 (Rhubarb) 苦寒泻热:荡涤胸腹之邪热 b. 黄柏 (Phellodendron amurense Rupr) 苦寒泻热:清下焦热 & 大黄:清热解毒散结 臣: a. 苦参 (Sophora flavescens) b. 蒲公英 (Dandelion Herb) 加强清热解毒之功 c. 三棱 (rhizoma sparganii) d. 莪术 (Curcuma) 破血逐瘀 佐使: a. 乳香 (frankincense) 行气舒筋 b. 没药 (Myrrh) 行气化瘀 & 乳香:活血定痛 c. 冰片 (Borneol) 通窍散火、消肿止痛 **现代研究亦表明,大黄、黄柏、冰片、乳香、没药、三棱、莪术、蒲公英等药物均有有很好的抑制肿瘤、止痛等作用。 另外一方: 川芎、白芷、姜黄、乳香、没药、肿节风、山慈姑、蚤休、麻黄、白芥子、王不留行 11味中药精细加工成粉并与凡士林调和而成膏状 功能:扶正气、消肿痛、活血化瘀,调畅经脉,透皮达里,引诸药直达病所。 好处: 避免了异体蛋白过敏现象 因其主要成分为植物 避免药物通过肝脏时的首过效应 其中药有效成分透过皮肤屏障,直接进入人体循环,无胃肠降解和胃肠刺激作用 治疗疼痛效果明显、持续时间长 无不良反...

【Beauty 】面部刮痧

 面部刮痧 作用: 促进血液循环 消除脸部水肿 紧致肌肤 注意事项: 刮痧后2小时不要洗脸 刮痧之后毛孔处于打开的状态。去洗脸的话会让寒气进入身体 手法 先做左边,因为气机是左升右降,从左开始是调节阳气,因此不论哪种按摩建议都要从左到右。 步骤 1. 涂抹一些油,轻轻按压 2. 开穴 从左至右轻揉各个穴位,跟着上图所示由承浆穴开始开穴,最后以印堂穴做结尾。 3. 刮淋巴 耳后顺着颈部 4. 额部刮痧 5. 眼部刮痧 眉毛和眼眶 6. 面部刮痧 迎香穴到太阳穴刮3次。 地仓穴到耳门刮3次。 承浆穴到听会刮3次。 一手按住额前,并用刮痧版的凹面去刮下颌,重复3次。 对准法令纹并刮到耳前,最后从颈部排出去,重复3次。 从嘴角出发至颧骨下方,停留在苹果肌并将刮痧版转向, 接着刮到太阳穴并重复3次。 7.颈部刮痧 疑问 1. 为什么要从承奖开始? 从承浆开始,是为“引气开门”;以印堂结束,是为“收气归神”。 承浆穴 是 任脉 上的穴位,具有“开关”性质。 宣通任脉、疏通下行之气 任脉是“阴脉之海”,主一身之阴,从下往上走,承浆作为任脉收尾,是开启整条任脉的“水龙头”之一,先打开它,有利于整条经脉气血流通。 引气上行,排浊生清 面部刮痧会产生向上提升的作用,先开承浆可以把体内浊气引导下行,从而避免“气堵于上”,减轻面部沉滞。 承浆为“百穴之始” (在部分刮痧法中) 有些手法认为它是面部开穴的“起始点”,先开此穴,犹如开门迎气,后续效果更佳 印堂穴 属督脉,又称“上丹田”,具有安神、聚气、提升精神的作用。 收气归元,安神定心 刮痧结束后以印堂为收尾,有“收气”之意,帮助把整个疏通后的气血归于中心、稳定神志。 印堂属上焦门户,最后激活提神 这是面部的“神气之门”,最后刺激它,有种“提气、醒神”的效果,让整个面部状态归于清明。 符合气血运行的方向:下→上→中收 这种走向符合中医“先开下,后通上,最后归中”的思路,利于气血顺畅、面部轮廓向上提拉。 “我们从承浆开始,是为了先打开下面的任脉,把气血引出来,整个面部才会通畅;最后在印堂结束,帮助收气安神,效果更稳定。” 2. 为什么刮淋巴 促进代谢废物的排除;提升免疫力,减少炎症(痘痘);加快面部轮廓紧致;经络气血更顺畅,排湿气 促进体内“代谢废物”的排出 淋巴系统像“体内垃...