Clinical observation on efficacy of compound of warming yang, descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with Yin-Yang deficiency and blood stasis syndrome

Objective:To observe the clinical efficacy of compound of owarming yang,descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome.Methods:Seventy-six patients of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome were randomly divided into observation group and control group,thirty-eight cases in each group.The control group was given conventional western medicine treatment,while the observation group took compound of owarming yang,descending turbidity and dredging collaterals orally on the basis of conventional western medicine treatment.The course of treatment covered for one month.Before and after treatment,we observed the scores of traditional Chinese medicine symptoms,indicators of renal function[serum creatinine(Scr),blood urea nitrogen(BUN),microalbuminuria(MALB)],indicators of glucose metabolism[fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbAlc)],indicators of hemorheology[plasma viscosity(PV),platelet aggregation rate(PAR),fibrinogen(FIB)],Cystatin-C(Cys-C),C-reactive protein(CRP)in the two groups.Results:After treatment,the clinical effect of the observation group was significantly better than the control group(P<0.05).The scores of traditional Chinese medicine symptoms,indicators of renal function(Scr、BUN、UAER),indicators of glucose metabolism(FPG、2hPG、HbAlc),indicators of hemorheology(PV、PAR、FIB),Cys-C and CRP in the two groups were decreased significantly compared with those before treatment(P<0.05),and the decrease in the observation group was superior to that in the control group(P<0.05).Conclusion:Compound of warming yang,descending turbidity and dredging collaterals has remarkable efficacy in treating of diabetic kidney disease patients with yin-yang deficiency and blood stasis syndrome by alleviating clinical symptoms,glucose metabolism,renal function and microcirculatory disturbance,and the mechanism related to alleviation of microinflammation.

江泳教授病证结合分人分型分期辨治带状疱疹

带状疱疹以剧烈疼痛为其特点,严重影响患者生活。西医治疗虽起效较快但使疼痛降低至初始程度一半时较易产生不良反应,且在预防及控制其并发症方面效果不佳。江泳教授以病为纲,认为带状疱疹以肝络血虚,热毒湿浊瘀滞肝络为其共性核心病机,结合患者不同证型的个性病机进行分型论治。江教授以“柔肝泻火,解毒除湿,通络止痛”为基本治则,创制“泻毒通络”方为基础验方,分人分型分期加减治疗带状疱疹,她认为病证结合辨治带状疱疹,可以最大化地优化临床疗效,更能发挥中医特色优势。

范伏元教授从“络脉不和”论治肺结节经验

范伏元教授基于络脉沟通内外、渗灌气血、联系脏腑的生理特点,从肺痹、肺积认识肺结节,以络脉不和为肺结节根本病机,从伏邪凝痰痹络、胃络不和痰瘀结为窠囊进行阐发,以“通络开痹,和荣散结”“和胃逐瘀,安神化浊”为核心治法,分别以疏风宣肺汤、加味温胆汤处方辨治,将宏观脏腑辨证调和诸脏与微观络脉辨证调和络脉营卫气血津液沟通渗灌相结合,临床疗效确切。

Correlativity between blood measures related to blood stasis blocking collaterals and gene expression of angiotensin-converting enzyme of renal cortex in diabetic rats and effect of stasis removing and collaterals dredging

OBJECTIVE: To investigate the correlativity between the changes of blood measures related to blood stasis blocking collaterals and gene expression levels of angiotensin-converting enzyme(ACE)and ACE2 ofrenal cortex in diabetic rats with stasis blocking collaterals syndrome, as well as the effectof stasis removing and collaterals dredging.METHODS: Male Sprague-Dawley rats were divided randomly into normal control group(C group),high-carbohydrate-fat control group(H group) and streptozotocin(STZ)-injecting group. The diabeticrats were induced from rats in the STZ-injecting groupby high-carbohydrate-fat diet combined with STZ intraperitoneal injection, with sustained high-carbohydrate-fat diet fed afterwards, and were further divided into model group(M group)and Chinese medicine of stasis removing and collaterals dredging group(Z group). Rats in the Z group were fed with stasis-removing-and-collaterals-dredging herbal granule suspension intragastrically daily for 16 weeks, while drinking water of corresponding volume was administrated to the rats in other groups. At the end of the 16 th week after successful establishment of models, the ultrastructures of glomeruli in different groups were detected by a transmission electron microscopy; and blood measures related to blood stasis blocking collaterals, including lipid profile and blood viscosity measures, were tested, as well as the relative gene expressions of ACE and ACE2.RESULTS: Changes in ultrastructures of glomeruli in the M group were characterized by lack of clarity in structure and occasional thickening of glomerular basement membrane and extensive fusion in foot processes. The correlation analysis showed that there were positive correlations between lipid profile, blood viscosity, and the ACE mRNA expression levels in the M group(P<0.05), except for cholesterol. And except for triglyceride, the blood measures were in negative correlation with the ACE2 mRNA expression levels in the M group(P<0.05).Compared with the C and H groups, the lipid profile, plasma viscosity and blood viscosity were significantly higher(P<0.01). All the above-mentioned measures were significantly improved in the Z group rats(P<0.05). ACE mRNA expression was significantly higher in the M group thanin the C group(P<0.05). ACE2 mRNA level was significantly lower in the M group than in the C and H groups(P<0.01)and its levelin the Z group was higher than that in the M group(P<0.01).CONCLUSION: Blood measuresrelated to blood stasis blocking collaterals had positive linear correlations with ACE mRNAexpression and negative linear correlations with ACE2 mRNA expression in the M group. Chinese recipe of stasis removing and collaterals dredging could play a renal protecting role for diabetic rats by reducing lipid profile and blood viscosity, down-regulating ACE mRNA expression and up-regulating ACE2 mRNA expression.

基于“结者散之”辨治肺结节痰瘀互结证

肺结节之病机为肺气亏虚,外邪入体,肺之气络、血络先后受邪,气络生痰,血络生瘀,气络之痰与血络之瘀搏结成块,发而为病。从《黄帝内经》“结者散之”理论入手,治以清肺通络、祛痰化瘀为主,佐以疏肝理气,健脾渗湿之法,为肺结节的中医辨证及组方思路提供一定的借鉴与参考。

基于络病学说探讨小儿慢性荨麻疹的辨治规律

慢性荨麻疹是儿科临床上常见皮肤病之一,属于皮肤黏膜血管反应性疾病,常反复发作,危害儿童的身心健康。其发病、演变及预后和络病学说密不可分。现从络病学说角度总结小儿慢性荨麻疹的基本病机为禀赋不耐,风邪搏于肌腠,营卫失和,络脉受损而发。初期治疗方法应以祛邪通络为主,以祛除风邪为要,同时可结合运用散寒、清热、解毒、除湿等法以疏经通络,祛内邪,通达络脉;结合心部于表理论,注重调理心;恢复期应以扶正养络为要,以固本扶正、祛邪兼顾。无论在早期或后期治疗过程常贯穿活血化瘀法。

基于“络瘀”理论探讨通法在房颤治疗的应用

黄帝内经创立经络学说,并将其分为“经脉”与“络脉”。络脉为经脉的横出别支,通过特殊的组织结构使气血津液散步于全身,贯通营卫、保障经气周流,为气血渗灌、沟通经脉、反应病候的重要结构。心房颤动(atrial fibrillation, AF)简称房颤,房颤以心房机械功能恶化为特征,伴有不协调心房电激活,是临床上常见的持续性心律失常。房颤中医归属心悸,其描述首见于《素问·玉机真藏论篇》:“真脾脉至,弱而乍数乍疏”。而“乍数乍疏”正是房颤脉的典型脉象特点。后有历代医家对心悸的诸多见解,其中清代医家王清任等认为心悸为血虚、瘀血致病,并发展了瘀血理论。中医理论认为,人体以通为常。“通法”有狭义和广义之分:狭义之通法指运用泻下、攻逐等法将胃、肠中的瘀堵积滞从魄门而解。如《素问·阴阳应象大论篇》:“其下者,引而竭之”,多用于正气尚存,邪实未除的病证;广义的“通法”包含甚广。凡是畅调气机、疏通血脉的方法都归其范畴。研究基于络病学说,认为房颤与络脉瘀阻相关。该文以“络瘀”理论为切入点,探析“通法”在房颤治疗的应用,从广义理解和运用通法,认为通法须究虚实,根据病机不同,治疗须分清标本虚实,各有所侧重。

通督益脑化痰法结合针刺治疗急性缺血性卒中吞咽障碍痰瘀阻络证疗效观察

目的探讨通督益脑化痰法结合针刺促进急性缺血性卒中吞咽障碍痰瘀阻络证患者康复效果。方法研究纳入112例急性缺血性卒中吞咽障碍痰瘀阻络证患者以随机数字表法纳入患者分为对照组(56例)、中医组(56例),给予对照组患者咽部肌肉电刺激治疗,给予中医组患者咽部肌肉电刺激结合通督益脑化痰法及针刺治疗,各组数据观察:治疗前后患者洼田饮水试验评分(water test score,WST)变化及功能性经口摄食量表(functional oral feeding scale,FOIS)评分变化、吞咽困难评价量表(dysphagia evaluation scale,VFSS)及标准吞咽功能评价量表(standard swallowing function evaluation scale,SSA)评分变化、治疗效果、并发症、治疗前后患者中医证候总积分及美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分变化、治疗,前后患者脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)及白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平变化、生活质量量表(generic quality of life inventory-74,GQOLI-74)评分变化。结果治疗前,各组患者WST评分、FOIS评分、VFSS评分、SSA评分、中医证候总积分以及NIHSS评分、BDNF、IL-6及TNF-α水平、GQOLI-74评分等指标比较,差异无统计学意义(P>0.05),治疗后各组患者WST评分、FOIS评分、VFSS评分、SSA评分、中医证候总积分以及NIHSS评分、BDNF、IL-6及TNF-α水平、GQOLI-74评分等指标均改善,中医组患者治疗后WST评分、FOIS评分、VFSS评分、SSA评分、中医证候总积分以及NIHSS评分、BDNF、IL-6及TNF-α水平、GQOLI-74评分等指标均优于对照组(P<0.05);中医组患者治疗总有效率高于对照组,并发症发生率低于对照组(均P<0.05)。结论通督益脑化痰法结合针刺疗法可较好促进急性缺血性卒中吞咽障碍痰瘀阻络证患者康复,患者治疗效果提升,吞咽功能及神经功能、生活质量均改善,且患者并发症率低,较为安全可靠,值得应用。

基于数据挖掘分析韩世荣治疗局限性硬皮病用药规律

目的:挖掘韩世荣治疗局限性硬皮病的用药组方规律,为总结与传承其学术思想提供参考。方法:选取2020年6月至2023年12月就诊于陕西省中医医院韩世荣门诊的患者处方,基于中医传承辅助平台软件(V3.5)规则对用药规律进行归纳分析。结果:共筛选有效处方122个,包括中药120味,药性以温、寒、平为主,药味以甘、辛、苦为主,归经以肝、脾、心经为主;高频使用药物(频次≥30)共26味,如当归、黄芪、桂枝、土鳖虫、白芍等;常用药物组合20个,如当归配黄芪、当归配桂枝等;核心处方以当归四逆汤加减组成。结论:韩世荣认为局限性硬皮病以“阳虚为本,寒湿瘀阻为标”,其病机在阳虚基础上,兼有寒凝、瘀阻、痰湿,治疗重点在疏通经络,以温阳通络为主,辅以行气、化瘀、化痰通络。

基于络病理论论治输卵管阻塞性不孕

输卵管是输送孕卵的中空管腔结构,络脉是经脉横行而出的分支,络脉“以通为用”的生理特点与输卵管的结构功能相符。输卵管阻塞主要由盆腔炎性疾病等原因造成输卵管拾卵、运送受精卵的功能障碍。其病变过程较长,初起为营卫气血失和,久则血伤入络,酿生痰湿、血瘀等有形之邪阻塞络脉,形成输卵管阻塞性不孕。络病即络脉的病变,其中包含络脉的功能障碍和结构损伤,同时也涵盖了由此引发的脏腑组织的病理变化。二者均以“不通”为主要病理特点,“通络”是治疗的主要原则。因此在论治输卵管阻塞性不孕时,以“络病”理论分析其发病机制,总属肾精不足、肝气失和、脾气不足,病变日久形成血瘀、痰湿、湿热等有形之邪阻于络脉,影响络脉正常的生理功能,继而引起输卵管结构或功能障碍,阻碍精卵结合,构成不孕。临床可基于“络病”理论角度辨证治疗确立治法,依据不同的致病原因采用不同的“通络”方法,在输卵管阻塞性不孕的治疗中发挥中医特色,兼顾整体与局部,疏通输卵管,提高受孕率。

"External main and internal auxiliary" treatment on refractory radiation proctitis

Radiotherapy is an essential method in the comprehensive treatment of malignant tumors.However,radiation proctitis(RP)is a common complication of pelvic tumors after radiotherapy.Due to RP's various etiology and complex pathogenesis,it is currently no standard for traditional Chinese medicine(TCM)treatment.Professor Yuan-hong Zhao believes that refractory RP,which is named chronic hemorrhagic radiation proctitis(CHRP),should be classified as"Intestinal Wind Bleeding"(Bleeding like a note before defecation,bright red blood,no swelling and pain in the anus)and"Intestinal Afflux"(Refers to the symptoms of pus and blood in the lower mucus,similar to ulcerative colitis,peptic ulcer and other diseases in modern medicine.)in TCM.The critical pathogenesis of CHRP lies in local stasis and collaterals injury of intestinal collaterals.In general,it is a syndrome of excess and scarcity.External treatment with TCM is the preferred treatment strategy for CHRP,and the primary way is to disperse blood stasis and detoxify and nourish the intestinal collaterals.

基于络病理论探讨乳腺增生症的辨治思路

乳腺增生症是中年女性最常见的疾病,既非炎症也非肿瘤,以乳房疼痛和乳房肿物严重影响女性的身心健康及生活质量,且有一定癌变风险。针对乳腺增生症,西医暂未发现有效的治疗方法,而中医药在治疗乳腺增生症方面,尤其具有自身特点和优势。近年来络病理论的兴盛为本病的临床治疗提供新思路,络病理论是中医重要病机学说,乳腺增生症的辨治与络病理论密切相关,目前少见从络病理论探讨乳腺增生症的辨治研究。文章从络病理论探讨乳腺增生症,认为乳腺增生症具有“久病入络、由气及血、络脉本虚”的病理特点,符合络病的疾病特征。文章通过文献溯源的方式梳理络病理论的发展历程,提出乳腺增生症始生、演进的基本病机为“气络不利,血络瘀阻”,由气及血,由浅入深,后期“络瘀-络损-络虚”。乳腺增生症微环境体现“浓、黏、凝、聚”的病理状态,文章结合络病理论与乳腺增生症的关联,提出乳腺增生症始生期、演进期以通为主,后期络虚通补的治疗大法。故就络病理论与乳腺增生症的辨治思路进行探赜,以期为临床治疗乳腺增生症提供新方法。

儿童大叶性肺炎从“玄府-络脉”理论辨治探析

“玄府-络脉”是遍布人体全身的细微结构,具有畅达气机、输布津液、运转神机、调和阴阳的作用。儿童大叶性肺炎发病率高,临床归属中医学“风温肺热病”范畴,热、毒、痰、瘀、虚是其主要病理因素,肺络凝滞、玄府郁闭、脉络失养是其病机关键。基于玄府-络脉理论,临床治疗急性期以解毒祛邪、开玄通府为主,恢复期注重充养脉络,同时化瘀通络贯穿始终,为儿童大叶性肺炎治疗提供新思路。

基于肾虚血瘀视角探讨老年性眼底病证治

老年性眼底病与衰老密切相关,肾虚、血瘀致衰得到医学界越来越多的关注。肾虚血瘀是老年性眼底病的病机核心,五脏虚损、肾为本是老年性眼底病发生的根本原因,目窍失养、血瘀为标是老年性眼底病发生的局部表现。老年性眼底病在中医整体观念的视角上,肾虚为本,目为标;从局部辨证出发,血瘀为发病的基本病理因素,络脉瘀阻为发病的病理基础,气血失和、目窍失养为发病的关键病机。由此提出老年性眼底病治疗原则为调补五脏,以肾为本;活血化瘀,剔络为要;祛邪扶正,通补兼施;为老年性眼底病的中医治疗提供新的思路。

从伏邪学说论治慢性萎缩性胃炎

慢性萎缩性胃炎(CAG)属于胃癌前疾病,具有发病隐匿、病程缠绵、容易迁延恶化等特点。广东省名中医刘凤斌教授多年诊疗CAG,认为CAG的病因、病程特性与伏邪致病过程密切相关,从伏邪学说论治CAG,遵循透邪外出、补益脾胃、祛瘀通络与清热养阴治疗原则,随证用药,疗效显著。

张嗣兰辨治脱疽经验

脱疽病因病机复杂,病程较长,致残率高。张嗣兰教授提出了“解毒破瘀并重,调气扶正并行”的重要理论,认为气机阻滞、血脉瘀阻、肢节失养是其基本病机,将其分为寒湿凝滞证、湿热毒盛证、气血亏虚证、血脉瘀阻证4种中医证型。临证时根据不同分型及临床表现采用不同治疗方法,以化瘀通络贯穿始终,辅以温阳、益气、补血、清热解毒之法,同时重视局部外治法。形成了内外同治、整体辨证与局部外治相结合的临床思辨特点。

从“浊毒伏络”探讨糖尿病心肌病

糖尿病心肌病(DCM)属于中医学消渴并发心悸、胸痹范畴。结合现代浊毒理论、络病理论及糖尿病心肌病的病理特点,认为“浊毒伏络”是DCM起病之本,心络受损是DCM演变之机,气血阴阳俱虚是DCM的最终结局。根据“浊毒伏络”理论和疾病分期特点,治疗方面提倡早期化浊解毒、中期搜剔通络、后期补虚固本。

从“益气通络法”论治视网膜中央动脉阻塞

视网膜中央动脉阻塞(CRAO)是眼科致盲的重症之一,中医学将其归属“暴盲”范畴。益气通络法根植于中医学经络理论,对中医眼科学疾病的治疗具有重要的指导意义。本病以气虚为本,脉络瘀阻为标,气虚血瘀是病机的关键。治疗上,需抓住“脉络瘀阻”这一根结,首当注重补气,予益气通络法。使得经络气血运行通畅,瘀去络通。用药方面,宜在补气的基础上随证加活血、养阴、温阳等中药。同时,结合针刺疏通经络气血。此外,临床诊疗不可拘泥于传统概念的治疗时间窗,充分发挥中医药治疗的优势,注重中药及针灸治疗。

疏血通注射液治疗急性冠脉综合征研究进展

疏血通注射液有活血化瘀,通经活络的功效,主要用于治疗瘀血阻络型急性脑梗塞。有研究表明,疏血通注射液治疗急性冠脉综合征(Acute coronary syndrome,ACS)有较好疗效,还可缩短经皮冠状动脉介入治疗术后患者康复时间,提高治疗有效率,降低再入院率,节约医疗成本。本文梳理了疏血通注射液治疗ACS相关理论及临床研究,对其治疗ACS的本草依据、药理作用、临床应用、治疗机制以及安全性、经济性等方面进行综述,希望为疏血通在治疗ACS中的运用提供一定的科学依据并拓宽其在心血管疾病中的研究思路。

基于“补-养-通”法探析黄褐斑治疗

黄褐斑是一种获得性色素沉着,是具有损美性的皮肤疾病。中西医治疗各有方法,但中医治疗具有独特的优势。黄莺教授认为黄褐斑发病有虚有实,常以肝肾亏虚为本,络脉瘀滞为标,治疗需标本层次分明,以“补-养-通”立法,即培补肝肾、养血益气以治本,通脉化瘀、消痰化滞以治标,结合中医外治技法,内服外治,常有奏效。