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浙江大学学报（医学版）
浙江大学学报（医学版）  2022, Vol. 51 Issue (5): 523-533    DOI: 10.3724/zdxbyxb-2022-0351
专题报道     
开窍中药在神经病理性疼痛治疗中的作用研究进展
吴雪青,于捷,谈贝,陈忠
浙江中医药大学 浙江省神经药理学与转化研究重点实验室，浙江 杭州 310053
Research progress on mechanism of Chinese Kaiqiao herbs in management of neuropathic pain
WU Xueqing,YU Jie,TAN Bei,CHEN Zhong
Zhejiang Chinese Medical University, Zhejiang Provincial Key Laboratory of Neuropharmacology and Translational Medicine, Hangzhou 310053, China
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摘要：

临床应用上千年的开窍中药龙脑、麝香、石菖蒲、苏合香、樟脑的主要成分是脂环化合物，可用于治疗神经病理性疼痛。开窍中药的镇痛作用机制包括调控γ-氨基丁酸、 N-甲基- D-天冬氨酸等受体的表达，调节离子通道功能，抑制炎症反应、氧化应激、细胞凋亡，调控神经传递和神经元兴奋性，参与神经保护和神经功能修复等。未来可以从深入探索开窍中药在中枢系统镇痛中的作用机制、高质量快速筛选药物作用靶点、利用开窍中药特性研发靶向制剂等方面进行拓展。本文综述了上述传统开窍中药治疗神经病理性疼痛的机制研究进展，并提出了一些拓展研究的方向。
关键词： 开窍中药;  神经病理性疼痛;  龙脑;  石菖蒲;  麝香;  苏合香;  樟脑;  综述    
Abstract:

The Chinese herbal medicine for Kaiqiao, such as borneol, musk, grassleaf sweetflag rhizome, storax and camphor, have been prescribed in traditional Chinese medicine for thousands of years and now are widely used for neuropathic pain, the main components of which are annular compounds. Studies have shown that their analgesic mechanisms include regulating the expression of γ-aminobutyric acid, N-methyl- D-aspartic acid and other receptors; regulating ion channel function; inhibiting inflammatory response, oxidative stress and apoptosis; regulating neurotransmission and neuronal excitability; and participating in neuroprotection and neurological repair. It is suggested that the mechanisms of action of Kaiqiao herbs in central nervous system analgesia should be further explored; high-quality rapid screening of drug targets may be used, and the targeted agents using the characteristics of Kaiqiao herbs would be developed. This article reviews the research progress on the effect mechanism of traditional Kaiqiao herbs in the treatment of neuropathic pain to provide further research directions.
Key words: Kaiqiao herbs    Neuropathic pain    Borneol    Grassleaf sweetflag rhizome    Musk    Storax    Camphor    Review
收稿日期: 2022-06-27 出版日期: 2022-12-28
CLC:  R96  
基金资助: 浙江省自然科学基金（LD22H310003）; 浙江中医药大学基本科研能力提升项目（2021JKJNTZ010B）
通讯作者: 谈贝,陈忠   
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引用本文:

吴雪青,于捷,谈贝,陈忠. 开窍中药在神经病理性疼痛治疗中的作用研究进展[J]. 浙江大学学报（医学版）, 2022, 51(5): 523-533.

WU Xueqing,YU Jie,TAN Bei,CHEN Zhong. Research progress on mechanism of Chinese Kaiqiao herbs in management of neuropathic pain. J Zhejiang Univ (Med Sci), 2022, 51(5): 523-533.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2022-0351    或    https://www.zjujournals.com/med/CN/Y2022/V51/I5/523

图1  龙脑(A)、麝香(B)、樟脑(C)、石菖蒲(D)、苏合香(E)主要成分的化学结构
图2  常用开窍药在神经病理性疼痛治疗中的作用机制 开窍中药可通过抑制脑内一氧化氮合酶（NOS）、一氧化氮、肿瘤坏死因子（TNF）-α、白介素（IL）1β的表达或减少炎性小体、内质网应激、由超氧阴离子和羟自由基等引起的氧化应激，进而抑制小胶质细胞的活化以及星形胶质细胞活化引起的炎症反应，从而抑制中枢敏化，发挥镇痛作用. 开窍中药可通过直接或间接抑制 -甲基- -天冬氨酸（NMDA）受体的表达，调节神经元兴奋性，进而调控中枢参与镇痛. 开窍中药可通过调控瞬时受体电位（TRP）通道中的TRP香草酸受体（TRPV）1和TRPA1的表达，抑制神经传导. 氯离子内流可以引导γ-氨基丁酸（GABA）从抑制转为兴奋，开窍中药还通过激活GABA受体的抑制作用进而调节神经元兴奋性.
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