Research Progress of Tonifying Kidney and Promoting Blood Circulation in the Treatment of Steroid-induced Necrosis of Femoral Head

Osteonecrosis of the femoral head is a common disability disease of the hip joint in China,and osteonecrosis of the femoral head caused by hormone factors is the most common,which is related to the gradual increase in the utilization rate of glucocorticoids in recent years.It is a refractory disease in orthopaedics with a poor prognosis.For this disease,the treatment of traditional Chinese medicine has certain advantages.In view of this,the author reads,analyzes and summarizes its materials by searching China Journal full-text Database and Wanfang Database.This paper reviews the mechanism and clinical research progress of tonifying kidney and activating blood circulation in the prevention and treatment of steroid-induced osteonecrosis of the femoral head,hoping to provide help for the clinical treatment of hormone-related osteonecrosis of the femoral head.

Effect of Chinese Drugs for Supplementing Qi,Nourishing Yin and Activating Blood Circulation on Myocardial Perfusion in Patients with Acute Myocardial Infarction after Revascularization

Objective:To observe the effects of Chinese drugs for supplementing qi,nourishing yin and activating blood circulation on the myocardial perfusion in acute myocardial infarction(AMI) patients after revascularization.Methods:Eighty patients with anterior or inferior ventricular wall AMI,who had received revascularization by intravenous thrombolysis or coronary bypass,were randomized into the treated group and the control group equally,both treated with conventional Western medical treatment,but combined,resp...

Protective Effect of Chinese Herbs for Supplementing Qi,Nourishing Yin and Activating Blood Circulation on Heart Function of Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

Objective： To investigate the effects of Chinese herbs for supplementing qi, nourishing yin and activating blood circulation on heart function of patients with acute coronary syndrome （ACS） after successful percutaneous coronary intervention （PCI）. Methods： One hundred patients with ACS after successful PCI were randomly assigned to a Western medicine （WM） treatment group （WMG） and a combined treatment group （CMG） treated by Chinese herbs for supplementing qi, nourishing yin and activating blood circulation, besides Western medicine treatment, with 50 cases in each group. Both treatment courses were 6 months. The follow- up was scheduled at baseline, 6 months and 1 year after PCI, and New York Heart Association （NYHA） functional class, Chinese medicine （CM） symptom scores, blood stasis syndrome scores, and major adverse cardiovascular events （MACE） were observed, serum levels of N-terminal pro-brain natriuretic peptide （NT-proBNP） and hyper-sensitivity C-reactive protein （Hs-CRP） were measured, an echocardiogram was conducted to examine left ventricular ejection fraction （LVEF）, left ventricular end-diastolic volume （LVEDV）, left ventricular end-systolic volume （LVESV）, inter-ventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, and ventricular wall motion index （VWMI）. Results： Compared with the baseline, LVEF significantly increased （P〈0.01）, and CM symptom scores, blood stasis syndrome scores, VWMI, LVEDV, LVESV, NT-proBNP, and Hs-CRP all decreased （P〈0.01） in both groups at 6 months and at 1 year after PCI. There were no significant differences in all the above parameters at 1 year vs those at 6 months after PCI （P〉0.05）. VWMI, LVEDV, LVESV, NT-proBNP, Hs-CRP, LVEF, and CM symptom and blood stasis syndrome scores were all improved obviously in CMG than those in WMG （P〈0.05 or P〈0.01） at 6 months and at 1 year after PCI. There were no significant differences in NYHA functional class between CMG and WMG at different follow-up timepoints; it was notable that P value was 0.054 when comparing the cases of NYHA functional class between the two groups at 1-year follow-up. During the 1-year follow-up, 3 MACE and 11 MACE occurred in CMG and WMG, respectively; the MACE rate in CMG was lower than that in WMG （6% vs 22%, P〈0.05）. Conclusion： Chinese herbs for supplementing qi, nourishing yin and activating blood circulation could improve heart function, reduce the CM symptom scores and blood stasis syndrome scores, and decrease the incidence of MACE in patients with ACS after successful PCI.

Clinical Study on Effect of Chinese Herbal Medicine for Supplementing Kidney and Qi and Activating Blood Circulation in Treating Intrauterine Growth Retardation of Fetus

Objective: To explore the therapeutic effect and the possible working mechanism in using Chinese herbal medicine (CHM) for supplementing Kidney and Qi, and activating blood circulation in treating intrauterine growth retardation of fetus (IUGR). Methods: Fifty-five cases of IUGR were divided into two groups, 30 cases in the CHM group treated with CHM and the 25 in the control group treated with amino acids. The effect of CHM treatment was observed and compared with that of the control group, normal pregnancy group and non-treated IUGR group. Results: Body weight of the newborns in the CHM was markedly higher than that in the control group. Not only the maternal fundal height (FH) and the abdominal circumference (AC), but also the fetal growth parameters, including biparietal diameter, head circumference (HC), and femur length (FL) in the CHM group increased much faster than those in the control group. After CHM treatment, the maternal serum levels of estriol (E3) and human placental lactogen (hPL) approached to those in the normal pregnancy group, but the control group,in comparison with the normal pregnancy group, was significantly different. The umbilical venous plasma concentration of essential amino acids in both treated groups improved, but the improvement in the CHM group was more significant than that in the control group. No apparent adverse effect of CHM was observed in either mother or fetus.Conclusion: CHM for supplementing Kidney and Qi and activating blood circulation was more effective in improving placental function and enhancing amino acid transportation than amino acid

基于气阴两虚夹瘀运用五参汤治疗肺癌术后发热浅析

肺癌术后发热有非感染性发热与感染性发热之分,在气虚、阴虚、瘀血阻滞病理状态下形成热蕴状态,是为非感染性发热;而术中感染或外感风寒入里化热则形成感染性发热表现。其基本病机均可概括为气阴两虚夹瘀。五参汤具有益气养阴、清热解毒之功,为证属正气亏虚、外感邪毒者而设,用于肺癌术后发热契合其病机。

Effects of Chinese herbs capable of replenishing qi, nourishing yin and activating blood circulation and their compatibility on differentially expressed genes of ischemic myocardium

This study was conducted to investigate the effects of Chinese herbs capable of replenishing qi, nourishing yin and activating blood circulation and their compatibility on differentially expressed genes of ischemic myocardium which were selected from differential expression profile we had established before, and to explore the underlying mechanism. The acute myocardial infarction (AMI) model was established by ligating the left anterior descending (LAD) coronary artery, then the model rats were randomly divided into the model group, the Metoprolol group, the replenishing qi nourishing yin (RN) group, the activating blood circulation (AB) group, and the replenishing qi, nourishing yin and activating blood circulation (RA) group. In addition, the normal group and the sham group were set up. The rats of medication groups were administered by intragastric gavage with corresponding drugs on the second day after operations, and the rats of the normal group and the sham group were given normal saline as the same time.Then the ischemic hearts were harvested on the 8th day after operation. The myocardial pathomorphological changes were observed under a light microscope. The mRNA changes of target genes such as COX5a and ATP5e were detected using Realtime fluorescence quantitative PCR (QPCR), and the activities of related enzymes were detected by colorimetric assay. The main results were as follows: the histological changes were observed by HE staining, and cardiocyte swelling, inflammatory cell infiltration and cytolysis were showed in regional ischemic myocardium of the model group, while the pathomorphological changes in all medication groups did not show obvious changes. Two genes related to energy metabolism, COX5a and ATP5e, were selected as the target genes which were downregulated at the mRNA level in the medication groups. The activities of correlative functional enzymes also decreased in the RA group compared to that in the model group accordingly (P<0.05). The results indicated that the abnormal expression of genes involved in energy metabolism pathways could be one of the molecular mechanisms of AMI. The compatibility of Chinese herbs capable of replenishing qi, nourishing yin and activating blood circulation affects the expression of energyrelative gene COX5a, ATP5e, which is probably the mechanism of myocardial preservation, and is more effective than single herb of replenishing qi and nourishing yin or activating blood circulation.

基于玄府调控生殖轴理论探讨风药在月经病中的运用

风药具有风之轻扬上升、发散开泄、善行而无处不至的特性,能开通全身上下内外之玄府,是临床最常用的一类开通玄府药物。因此,在月经病中辨明病因、病位以及玄府闭塞的程度后,可用风药从多角度开通生殖轴玄府,达到理想的治疗效果。外感风寒型月经病祛风以通玄,常用药物有麻黄、桂枝、荆芥、防风、生姜等;气郁玄府型月经病理气以通玄,常用药物有柴胡、枳壳、青皮、香附、木香等;血瘀型月经病活血以通玄,常用药物有桂枝、川芎、荆芥、刺蒺藜、白芷、细辛、羌活、葛根等;痰湿型月经病化湿以通玄,常用药物有升麻、葛根、柴胡、羌活、独活等;虚实相兼型玄府病变补虚以通玄,常用药物有羌活、独活、防风、白芷等。通过正确的药物配伍,在月经病中灵活运用风药,可获良效。

新安医学流派伤科活血化瘀汤剂联合手术治疗踝关节骨折的临床研究

目的:观察新安医学流派伤科活血化瘀汤剂联合手术治疗踝关节骨折患者的临床治疗效果。方法:选取2022年1月—2023年3月芜湖市中医医院创伤骨科收治的65例骨折后期肢体肿胀患者作为研究对象。使用随机数表法将患者分为观察组35例和对照组30例。两组患者均接受踝关节骨折手术治疗。对照组患者采用常规手术治疗,观察组患者采用常规手术治疗联合术前及术后加减伤科活血化瘀汤剂口服治疗。比较两组患者术前及术后肿胀症状的缓解情况及视觉模拟评分法(VAS)评分,踝关节功能(kofoed)评分和等速肌力测试系统评分变化情况。结果:术后观察组患者VAS评分低于对照组,差异有统计学意义(t=0.003、0、0,P<0.05);术后观察组患者肿胀程度低于对照组,kofoed评分高于对照组,差异有统计学意义(t=0、0、0;t=0、0、0,P<0.05);术后3个月,观察组患者等速肌力测试系统评分幅度优于对照组,差异有统计学意义(t=0.005、0、0.001、0.032;t=0、0.002、0.012、0.002;t=0、0.005、0、0,P<0.05)。结论:新安医学流派伤科活血化瘀汤剂能够有效缓解踝关节骨折术后肢体肿胀和疼痛程度,对促进患者早日康复有显著疗效。

韩氏中医治疗慢性肝病验案2则

验方攻补汤治疗慢性肝病以疏肝健脾、活血消癥为治疗大法。临证时刻注意攻伐勿过,以健脾疏肝、攻补兼施为大法,重视健脾益气药物的运用,结合疏肝、柔肝、补肝、潜肝阳敛肝阴以防理气药香燥戕害肝体。慢性肝病病程较长,久病穷肾患者多表现为肝肾亏虚的症状,针对这种情况临床重视补肾药物的应用,常用补肾药物有巴戟天、菟丝子、枸杞子、熟地黄等,同时为防止此类药物滋腻碍胃多配伍炒白术、醋青皮等动化药物,以防呆滞。治疗慢性肝病慎用破血逐瘀药,以活血养血滋养肝体为要,治黄勿忘治血,活血以退黄,和肝理脾重视气机,辨病与辨证相结合,分型施治,久病补肾兼以清化。韩氏中医认为肝脾不和、肝郁脾虚是慢性肝病主要病因,故治疗时应时时注意和肝理脾、调畅气机,并注意疏肝解郁,把握病机灵活化裁,标本兼治。气机不通,肝脉瘀阻为慢性肝病的主要病机,治疗应注重理气活血化瘀以阻止和逆转肝硬化,临床时针对肝病患者本虚标实、虚中夹实的病理实质,时刻注意破血药度和量,勿妄用逐瘀之品。依据慢性肝病不同阶段,结合辨证施治,在采用攻补汤治疗的基础上分型施治。文章分析韩氏中医治疗慢性肝病验案2则,以期为相关研究提供参考。

健脾活血利水方联合异甘草酸镁治疗失代偿期肝硬化临床研究

目的:观察健脾活血利水方联合异甘草酸镁治疗失代偿期肝硬化的临床疗效。方法:将184例失代偿期肝硬化患者按照随机数字表法分为对照组和试验组,每组各92例。对照组在常规对症及保肝治疗治疗的基础上给予异甘草酸镁注射剂,试验组在对照组治疗的基础上给予健脾活血利水方治疗。比较两组患者生活质量评分、临床疗效及不良反应发生情况,检测两组患者治疗前后血清丙氨酸转氨酶(alanine transaminase,ALT)及天冬氨酸转氨酶(aspartateaminotransferase,AST)水平。结果:试验组情感功能、系统症状、腹部症状等评分高于对照组(P<0.05)。两组患者治疗后ALT及AST低于本组治疗前,且治疗后试验组低于对照组(P<0.05)。对照组有效率为80.43%,试验组有效率为96.74%,两组有效率比较,差异具有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:健脾活血利水方联合异甘草酸镁治疗失代偿期肝硬化,临床疗效确切,可提高患者的生活质量,改善其肝功能。

扶阳活血方治疗气滞血瘀型不能进行血运重建的冠状动脉粥样硬化性心脏病临床研究

目的:观察扶阳活血方治疗气滞血瘀型不能进行血运重建的冠状动脉粥样硬化性心脏病(Coronary atherosclerotic heart disease, CHD)的临床疗效。方法:将98例气滞血瘀型不能进行血运重建的CHD患者按照随机数表法分为研究组和对照组,每组各49例。对照组给予常规西医治疗,研究组在对照组治疗的基础上给予扶阳活血方治疗。比较两组患者的临床疗效及治疗前后中医证候积分、血液流变学指标以及血清生化指标[超敏C反应蛋白(hypersensitive C-reactive protein, hs-CRP)、同型半胱氨酸(Homocysteine, Hcy)、血管扩张刺激磷蛋白(Vasodilatory stimulating phosphoprotein, VASP)]及生活质量评分变化情况。结果:对照组有效率为77.55%,研究组有效率为93.88%,两组患者有效率比较,差异具有统计学意义(P<0.05)。两组患者治疗后中医证候积分低于本组治疗前,且治疗后研究组低于对照组,差异具有统计学意义(P<0.05)。两组患者血液流变学指标水平低于本组治疗前,且治疗后研究组低于对照组,差异具有统计学意义(P<0.05)。两组患者治疗后hs-CRP、Hcy水平低于本组治疗前,VASP水平高于本组治疗前,且治疗后组间比较,差异具有统计学意义(P<0.05)。两组患者治疗后生活质量评分低于本组治疗前,且治疗后研究组低于对照组,差异具有统计学意义(P<0.05)。结论:扶阳活血方治疗气滞血瘀型不能进行血运重建的CHD,可改善患者临床症状和血液流变学指标,减轻炎症状态,提高生活质量。

中西医结合治疗闭合性肋骨骨折并血气胸的价值

目的 观察中西医结合治疗方法在闭合性肋骨骨折合并血气胸中的诊疗意义。方法 抽取2019年7月-2022年7月本院收治的闭合性肋骨骨折并血气胸患者进行分组研究,利用数字表法随机将上述104例患者随机分成对照组与实验组,每组各52例。其中,对照组患者在治疗过程中实施常规治疗手段,同时给予艾瑞昔布片进行止痛治疗;实验组在对照组治疗基础上加入复元活血汤进行治疗,对比两组患者各项指标恢复所用时间以及疼痛程度和肺部通气功能在治疗前后的变化以及对比组间患者治疗有效率。结果 实验组患者经中西医结合治疗后,其各项指标恢复用时明显短于对照组患者,差异有统计学意义(P<0.05)。在疼痛评分比较中,治疗前两组患者疼痛评分相近,差异无统计学意义(P>0.05);治疗后,实验组患者疼痛评分显著低于对照组患者疼痛评分,差异有统计学意义(P<0.05)。在肺部通气功能指标对比中,实验组在治疗前与对照组各项肺部功能水平相近,差异无统计学意义(P>0.05);实验组患者治疗后肺部通气功能明显提高,与对照组之间形成显著差异,差异有统计学意义(P<0.05)。实验组治疗有效率显著高于对照组,差异有统计学意义(P<0.05)。结论 中西医结合治疗可以显著缩短闭合性肋骨骨折合并气血胸患者的气胸消失时间和血胸消失时间,以及将患者疼痛度明显降低,患者治疗效果、接受度更高。

活血法灌肠治疗溃疡性结肠炎的文献计量学研究及生信分析

目的:整合文献计量学方法探究活血法治疗溃疡性结肠炎的研究脉络、热点和发展趋势,基于网络药理学及分子对接技术共同探究了在活血法治则指导下加减少腹逐瘀汤治疗溃疡性结肠炎的潜在通路与物质基础。方法:检索中国知网(CNKI)数据库中从2002年1月至2022年12月基于活血治疗溃疡性结肠炎的相关文献,通过Citespace软件生成相关文献发文量、作者、研究机构与单位及关键词等的共现图谱,研究的热点,展开分析。以口服生物利用度(OB)≥30%与类药性(DL)≥0.18为筛选条件,在中药系统药理学平台(TCMSP)数据库获取加减少腹逐瘀汤主要活性成分及关键靶点,利用GeneCards、OMIM、PharmGkb、TDD和Drug Bank数据库获得溃疡性结肠炎主要靶点;绘制Venn图,构建主要成分–关键靶点网络图,绘制蛋白互作(PPI)网络;进行基因本体(GO)功能及京都基因与基因组百科全书(KEGG)通路富集分析,最后以分子对接来验证所得靶点。结果:研究纳入文献409篇,涉及主要作者268位,发文量前5名的作者为:张涛、王新月、于玫、安贺军、沈静,发文量居前5名的单位为:北京中医药大学、北京中医药大学东直门医院、成都中医药大学、广西中医药大学附属瑞康医院、南京中医药大学。其中105个关键词被纳入,高频词(≥7)合计8个,具有研究意义的聚类合计9个,近几年的热点主要聚集于分期论治、中医及中药灌肠的研究。通过筛选得到药物靶点3562个,基因靶点2718个,核心基因13个;加减少腹逐瘀汤治疗溃疡性结肠炎的活性成分是槲皮素(quercetin)、山柰酚(Kaempferol)、汉黄芩素(wogonin)等。GO功能富集分析得到生物过程(BP)2193个、细胞组成(CC)65个、分子功能(MF)165个;KEGG通路富集分析获得164条通路。主要活性成分与核心靶点均具有一定的结合活性,其中槲皮素与PTGS2靶点对接活性最好。结论:以可视化图谱的方式分析,基于活血治疗溃疡性结肠炎的发展现状及研究热点,探究中医治法的优势特色,并通过实际工作中以活血为立法作为出发点的加减少腹逐瘀汤进行生信分析,发现其可通过多成分、多靶点和多通路等协同发挥其治疗溃疡性结肠炎的重要作用。

基于通下活血法治疗视网膜静脉阻塞性黄斑水肿

[目的]探讨通下活血法治疗视网膜静脉阻塞性黄斑水肿(retinal vein occlusion-macular edema,RVO-ME)的病因病机及核心概要,以拓宽临床诊疗思路。[方法]在结合既往医家诊疗思路的基础上,进一步总结临床经验。深入探讨RVO-ME病因病机,进而提出通下活血法在RVO-ME中的辨证应用,并附医案一则予以佐证。[结果]热毒和血瘀两种病理产物的生成是RVO的发病关键,血不利则水不行,进一步发展成RVO-ME。治疗上当以通下活血为法,通则热毒自除,活则血瘀自散,应根据疾病的发展阶段,灵活掌握通下与活血的治疗侧重。本文所附病案,临证以大黄牡丹汤治疗,体现了通下活血法的核心要义,取得了较好的临床疗效。[结论]通下活血法符合RVO-ME的病因病机,临床上依据该理论采用大黄牡丹汤治疗RVO-ME,有望拓宽本病的中医治疗思路。

小建中汤方证辨析

文章从小建中汤的方源入手,回顾了历代医家对小建中汤的论述及其现代临床应用,总结出诸医家对此方的应用多着眼于中焦脾胃虚寒证,以其调补阴阳之力,达“建中”之功,现代临床多用于治疗胃肠道溃疡性、炎症性疾病属中焦虚寒或肝脾不和者,并从桂枝-白芍药对配伍的功用以及现代药理学研究阐释二者配伍之后解热、镇痛、抗炎、调气活血作用更为明显,并着重对小建中汤配伍白芍的意义进行阐述,且分析虚劳腹痛的主要病机是因虚致瘀,不通则痛,提出此方的功用除温中补虚、柔肝缓急之外,尚有通阳化瘀、调整气血的功效。

郭维琴教授益气泻肺汤治疗心力衰竭经验

心力衰竭是临床常见病,为各类心血管疾病发展的终末阶段。郭维琴教授认为心力衰竭的核心病机为气虚血瘀、阳虚水泛,并根据多年的临床实践与经验,总结出益气活血利水法治疗心力衰竭,自拟益气泻肺汤,且在不同基础病及合并疾病的情况下辨证论治,取得良好的临床疗效。

从乌蛇荣皮汤治验谈名老中医李可皮肤病辨治思想与应用

[目的]总结李可教授的皮肤病辨治思想,并阐发其临证应用。[方法]以《李可老中医危急重症疑难病经验专辑》中“乌蛇荣皮汤皮科治验录”篇为研究对象,解读乌蛇荣皮汤的制方背景及组成,并进行医案分析,阐述李老辨治皮肤病的思想精粹,并结合临床阐发自身应用乌蛇荣皮汤的经验。[结果]乌蛇荣皮汤由桃红四物汤加桂枝汤化裁而来,契合皮肤病血虚、血瘀、湿热和风毒等证候关键,具有清热利湿、活血通络、养血祛风之功,对多种皮肤病均有显著效果。李老的皮肤病辨治思想可总结为“见皮治皮,永无愈期”“皮病责风,治先从血”“皮病治肺,宣补表气”“积年痼疾,必蕴伏毒”“分清缓急,因势利导”“固护脾肾,辨别寒温”“随施小方,取其专用”以及“内外合治,效捷为要”八点,对皮肤病诊治具有很大启发。临证运用乌蛇荣皮汤又当控制药量、忌用毒药以及配合外治等。所举医案中,患者不慎感邪,病程迁延,辨为湿热毒蕴证,以乌蛇荣皮汤化裁治疗数月,多年顽疾得愈。[结论]李老对皮肤病的辨治具有独到见解,面对复杂疾病,能够做到理法明确,方药执简驭繁,病重药重,缓急有序,对皮肤病诊治具有积极指导意义。

唐远山教授治疗后循环缺血性眩晕经验举隅

后循环缺血性眩晕是一种临床常见内科疾病,具有反复发作,持续加重的特点,往往给患者生活带来极大不便,影响其生存质量。唐远山教授认为该病病机为营血虚滞于内,风阳上扰于外,肝脾肾三脏同病。治疗上以养血熄风与调气和胃并行,肝脾肾三脏同调;并强调病证结合及综合调护。附验案一则。

Combined acupuncture and Chinese herb decoction for 5 cases with graphospasm

Combined acupuncture and Chinese herb decoction were applied for 5 cases with graphospasm.Acupuncture included scalp acupuncture and body acupuncture.Using transcranial repeated needling,Baihui(百会GV20),Chorea-trembling controlled area,Emotional area,as well as Dazhui(大椎GV14),Fengchi(风池GB20),and Yingxiang(迎香EX-HN8)etc.were stimulated by proposed by Sun Shentian.Meanwhile,the patients took orally Chinese herb decoction,on the basis of the Siwu decoction(四物汤four substances decoction)addition and subtraction,relieve symptoms under syndrome differentiation.The treatment was carried out for 4 courses in total.One course consisted of 5 days,with an interval of 2 days between two courses.After treatment of 5 patients,2 patients were cured,2 patients achieved markedly effective response,and 1 patient achieved effective response.