二金排石湯對人類離體輸尿管蠕動之影響

In Vitro Studies of ER-Jin Decalculous Decoction on Human Ureter

二金排石湯為目前最被中醫師所廣泛使用於治泌尿道結石的中藥方劑，其一般經驗皆謂有解痙、利尿及排石等作用，但其藥理學機轉則尚未有完整之文獻報告，本實驗乃針對其對輸尿管收縮之被應，從事體外之研究。由實驗結果顯示，人類輸尿管可被Norepinephrine誘導呈收縮頻率及強度增強之現象，在濃度為1×10^(-4)M時，收縮頻率可達平均每分鐘5.86±0.97次，其強度可達5.27±0.58公分高，此作用可被α1-腎上腺素性受體阻斷劑Prazosin所抑制，而1×10^(-4)M濃度之Prazosin可抑制它的收縮頻率到的65.65±4.74%，在2×10^(-4)M濃度之Prazosin則可達百分之一百抑制：而l×10^(-4)M濃度之Yohimbine 則能抑制24.82±3.60%，可見輸尿管的收縮與α-腎上腺素受體有密切關係。二金排石湯之水抽取液在40mg之劑量下，則可抑制收縮頻率達85.38±4.85%，強度則可這74.73±8.58%。二金排石湯可抑制Norepinephrine所誘導之輸尿管收縮頻率及張力強度，因此有助於解除因結石造成之輸尿管痙孿，及擴大管徑以利於結石之排出。其臨床上用於治療泌尿道結石可能與α-接受體之抑制有關。至於其他未明之藥理學機轉，正待進一步研究中。

The Er-Jin decalculous decoction (二金排石湯) is commonly used by the traditional Chinese physician to treat urolithiasis. The decoction consists of Lygodium japonicum(海金沙), Glechoma longituba (金錢草), Dianthus superbus (瞿麥), Achyranthes bidentata (牛膝), Akebia trifoliata (木通), Glycyrrhiza uralensis (甘草), Malva verticillata (冬葵子)，Amber (琥珀) and Talc (滑石). These agents together promote stone expulsion by their spasmolytic or diuretic action. However, its pharmacologic effects remain unclear. To investigate its mechanisms of action, we firstly studied its effects on human ureteral smooth muscle, in vitro. In this study, the presence of α1-adrenoceptor agonist, norepinephrine (NE), could reveal the stimulation of ureteral smooth muscle. The frequency and amplitude of ureteral constractions induced by NE at 1×10^(-4) M concentration were 5.86±0.95 per minute and 5.27±0.58cm in height, respectively. These NE-induced contractions were inhibited by α1-blocking agent, prazosin. The inhibition rate of prazosin was 65.65±4.74% at 1×10^(-4)M and 100% at 2×10^(-4)M. This NE-induced contraction was also inhibited by α2-blocking agent, yohimbine. The reducing effect of yohimbine was less than that of prazosin at the same concentration. The inhibition rate of yohimbine was 24.82±3.60%. This implied that the ureteral contractions may be closely related to the α-adrenoceptor closely. The inhibitory effects of water extracts of Er-Jin decalculous decoction at a 40 mg dose on the frequency and intensity of contractions induced by 1×10^(-4)M NE were 85.38±4.85% and 74.73±8.58%, respectively. The α-blocking-like effect of Er-Jin decalculous decoction may be used in the treatment of renal colic caused by kidney stone impaction. It decreased the frequency anf strength of the ureteral contractions and, thus, may assist in the dilitation of the ureteral lumen and facilitate calculous expulsion. Further study of the possible mechanisms of action of this ancient decalculous decoction, for the treatment of urinary calculi, is necessary, and are ongoing in our laboratory.