Regulating and tonifying spleen and kidney traditional Chinese medicine in the treatment of chronic uric acid nephropathy: A systematic review

Objective:To systematically evaluate the efficacy and safety of traditional Chinese medicine for regulating spleen and kidney.Methods:We developed a search strategy and then retrieved the database including CNKI,Wanfang data knowledge service platform,VIP journals resource integration service platform,PubMed,Embasefor randomized controlled trial of regulating spleen and kidney traditional Chinese medicine compared with conventional western medicine in the treatment of chronic uric acid nephropathy.The search deadline was set to June 30,2020.For the included literature,we applied the cochrane collaboration network risk bias assessment tool to evaluate the methodological quality,and evaluated the level of evidence according to GRADE standards.Quantitative data was analyzed by RevMan5.3 software,and trial sequential analysis method was used to analyze its efficiency.Results:A total of 709 cases in 10 articles were included.Compared with the control group,the related traditional Chinese medicine group improved the effective rate[RR=1.45,95%CI(1.32,1.58)],reduced the level of UA[MD=-36.24,95%CI(-41.03,-31.45)],BUN[SMD=-1.27,95%CI(-1.47,-1.07)]and SCR[MD=-36.33,95%CI(-55.79,-16.87),P=0.0003],the difference between the two groups was statistically significant(P<0.05).There was no evidence that a significant adverse reaction occurred.The results of TSA analysis showed that the Chinese medicine group had definite evidence for improving the efficiency.According to the GRADE evaluation criteria,the efficiency,UA,BUN and SCR outcome indicators were extremely low-quality evidence.Conclusions:Traditional Chinese medicine for regulating spleen and kidney in the treatment of chronic uric acid nephropathy improved efficiency,reduced the level of UA,BUN,SCR.Meanwhile,the therapy was proved to be safe.Nevertheless,the conclusions need further high-quality evidence to support.

Theoretical Discussion on Treatment of Cubital Tunnel Syndrome Based on Theory of Liver,Spleen and Kidney

Cubital tunnel syndrome is a disease in which ulnar nerve is compressed by its surrounding tissues,and its main clinical manifestations are pain,sensory disturbance and dyskinesia.Its incidence rate is the second highest among peripheral nerve entrapment diseases,and it is one of the common clinical diseases.The theory of liver,spleen and kidney can guide the treatment of cubital tunnel syndrome with traditional Chinese medicine and acupuncture.By discussing the traditional Chinese medicine(TCM)pathogenesis and treatment principles of cubital tunnel syndrome,it provides modern medical theoretical support for TCM treatment of cubital tunnel syndrome.

Tonifying Kidney, Lung, and Spleen Combined with Western Medicine for Stable Chronic Obstructive Pulmonary Disease: A Systematic Review

Introduction:This study aimed to evaluate the clinical effectiveness and safety of tonifying kidney,lung,and spleen(TKLS)combined with Western medicine for stable chronic obstructive pulmonary disease(COPD).Materials and Methods:Randomized controlled trials(RCTs)of TKLS for stable COPD were searched from four databases including Pub Med,the Cochrane Library,China Biology Medicine,and China National Knowledge Infrastructure from inception to December 2017.Two reviewers independently screened the literature,extracted the data,and assessed the risk of bias in the included studies.Rev Man5.3 software was used for meta-analysis.Results:Fourteen RCTs involving 1339 patients with stable COPD were included.Five of the included articles described the specific method of randomization,1 of them was double-blind method research,and 1 of them was single-blind method research.Compared with the conventional Western medicine(CWM)group,the use of TKLS,if combined with CWM demonstrated significantly improved effective rate(relative risk=1.25,95%confidence interval[CI]:1.18–1.33,P<0.00001),decreased traditional Chinese medicine syndrome score(mean difference[MD]-5.72,95%CI:-8.31 to-3.14,P<0.0001),Decreased St George's Respiratory Questionnaire total score(MD-7.39,95%CI:-10.46 to-4.31,P<0.00001),increased 6-min walk distance in meters(MD 78.46,95%CI:60.18–96.73,P<0.00001),increased forced expiratory volume 1%(MD 6.49,95%CI:3.64–9.33,P<0.00001),increased CD4(MD 9.84,95%CI:6.73–12.94,P<0.00001),CD8(MD-1.84,95%CI:-3.62 to-0.06,P=0.04)and CD4/CD8(MD 0.26,95%CI:0.20–0.32,P<0.0001),and increased immunoglobulin M(MD 0.15,95%CI:0.10–0.20 P<0.00001)..Conclusions:For stable COPD,TKLS combined with CWM is superior to CWM alone with regard to clinical effectiveness,symptoms,and quality of life.The above conclusion needs to be validated by further well-designed,multicentric,large-scale,double-blinded RCTs.

裘生梁健脾祛湿兼补脾阳治疗痞满临床经验

[目的]总结裘生梁主任中医师采用健脾祛湿兼补脾阳法治疗痞满的临床思路。[方法]通过日常跟诊学习及医案收集,结合相关资料,总结裘师从健脾祛湿兼补脾阳治疗痞满的经验,并附临床验案以佐证。[结果]因生活环境、工作节奏快及饮食不节的原因,现代人脾胃易损伤,导致中焦气机不利形成痞满,临床上裘师常采用健脾祛湿、兼补脾阳的方法治疗痞满,效果显著。文中所举医案中,患者因脘胀反复、大便黏滞前来就诊,裘师辨为脘痞之脾虚湿盛证,治以健脾祛湿、温运脾阳、消食安神之药,治疗后病情好转明显。[结论]裘师从健脾祛湿兼补脾阳法治疗痞满,治疗效果显著,值得临床分享学习。

“虚-瘀-毒”理论下的补脾逐瘀解毒方治疗慢性萎缩性胃炎患者的效果及其对胃蛋白酶原、炎症因子水平的影响

目的探讨“虚-瘀-毒”理论下的补脾逐瘀解毒方治疗慢性萎缩性胃炎患者的效果及其对胃蛋白酶原(PG)、炎症因子水平的影响。方法选取86例慢性萎缩性胃炎患者作为研究对象,随机将其分为对照组和研究组,每组43例。对照组行常规治疗,研究组在对照组基础上增加“虚-瘀-毒”理论下的补脾逐瘀解毒方,两组均治疗8周。比较两组患者临床疗效、中医证候积分、PG和炎症因子水平。结果治疗8周后,研究组总有效率和PGⅠ、PGⅡ水平均高于对照组,胃脘胀痛、胸肋疼痛、乏力、嗳气分值和白细胞介素-6、肿瘤坏死因子-α、C反应蛋白、肿瘤特异性生长因子水平均低于对照组(均P<0.05)。结论“虚-瘀-毒”理论下的补脾逐瘀解毒方能够有效地减轻慢性萎缩性胃炎患者的临床症状,改善胃黏膜损伤情况,减轻炎症反应,提高治疗效果。

Effects of Bushenyiqihexue Formula on the Endometrial Gland Apoptosis in Mice with Blastocyst Implantation Dysfunction

Objective: To observe the effects of Bushenyiqihexue Formula (补肾益气和血方 Formula for Tonifying the Kidney, Replenishing qi and Harmonizing Blood, FTKRQHB) on the endometrial gland apoptosis in the mice with blastocyst implantation dysfunction. Methods: The mice with the first-day pregnancy were divided into the control, model and treatment groups, with 30 in each group, and blastocyst implantation dysfunction was induced by subcutaneous injection of mifepristone in the mice of the model and treatment groups. The pregnancy rate and implantation number of blastocysts were measured and the expressions of proliferating cell nuclear antigen (PCNA), Bax, Bcl-2, and activated caspase-3 were detected in all the three groups. Results: The model group had significantly depressed pregnancy rate, implantation number of blastocysts and apoptosis index, and elevated proliferation index of endometrial gland as compared with the control group (P<0.05 or P<0.01). Administration of FTKRQHB (the treatment group) resulted in significant increases in pregnancy rate, implantation number of blastocysts and apoptosis index of the endometrial gland, and a significant decrease in the proliferation index of the endometrial gland as compared with the model group (P<0.05 or P<0.01). The differences in the four indexes between the treatment group and control group were not significant statistically. The Bax and activated caspase-3 expressions in endometrial gland in the model group became significantly lower than that of the control group (P<0.01), whereas those in the treatment group were significant higher than that of the model group (P<0.01). However, the Bax and activated caspase-3 expressions in endometrial gland were similar in both treatment and control groups. Conclusion: Promoting the increases in Bax and activated caspase-3 expressions in the endometrial gland and bringing into balance between apoptosis and proliferation of the glandular cells at the implantation window phase by FTKRQHB may contribute to the effects of promoting the establishment of endometrial receptivity and improving blastocyst implantation dysfunction.

Study of Different Patterns of Immuno-Modulatory Mechanism byTonifying Kidney and Invigorating Spleen Drugs

Objective: To observe the acting pattern on the immune system by Kidney tonifying (KT) drugs. Methods: Three composite recipes were used on the 7- and 14-day corticosterone rat model to study the effect of recipes on the different patterns of immuno-modulatory and neuro- endocrinological systems. Results:The immune system of Spleen Invigorating(SI) group was well protected in either 7- or 14-day experiments,with the SI recipe showing no effect on the neuroendocrine system. It suggested that SI recipe might have direct action on immune system. On the other hand, KT group with no effect on neuroendocrine-immune (NEI) system in 7-day experiment, but showed a remarkable protective effect of the whole NEI system in 14-day experiment. Conclusion: The results indicated that KT recipe acts on the neuroendocrine system first, and then influence the immune system. It means that the action took place through down pathway of NEI network.

全国名中医尤昭玲基于补脾养宫辨治薄型子宫内膜的经验

全国名中医尤昭玲根据胞宫功能与特性,提出“胞宫生殖双环”,明确胞宫与五脏、奇经八脉的关系,并基于脏腑经络联系,探讨薄型子宫内膜的中医病机与治则。薄型子宫内膜归属于“痿病”,可称“胞痿”,病机为胞宫精血亏虚,络脉瘀滞,胞膜痿而不长。治疗上,遵循治痿独取阳明;先天为体,后天为用;火土交互,心脾同治,重在健脾益气生血,宣络调膜。临证常用养膜方为基础方,以“肉”补脾,芳香走窜,理脾宣络,以通为补。为薄型子宫内膜等胞宫痿病的诊治提供思路与借鉴。

蔡氏补肾填精方治疗卵巢储备功能减退肝肾阴虚证的临床研究

目的:观察蔡氏补肾填精方治疗肝肾阴虚证卵巢储备功能减退(DOR)的临床疗效。方法:选取2018年9月至2020年12月中国中医科学院西苑医院妇科收治的肝肾阴虚证DOR患者60例作为研究对象,按照分层区组随机法分为卵巢储备功能下降患者及卵巢早衰患者,每组30例,其中卵巢储备功能下降患者含观察组20例、对照组10例,卵巢早衰患者含观察组20例、对照组10例,观察组给予蔡氏补肾填精方治疗,对照组给予西药戊酸雌二醇片/雌二醇环丙孕酮片治疗,以3个月经周期为治疗周期,比较患者治疗前后的中医证候评分及疗效、血清卵泡刺激素(FSH)、血清黄体生成素(LH)、血清雌二醇(E_(2))、血清抗米勒管激素(AMH)水平以及卵巢窦卵泡计数(AFC)、双侧卵巢平均体积及卵巢间质血流阻力指数。结果:观察组患者的FSH、LH水平较治疗前降低(均P<0.05),E_(2)及AMH治疗前后差异均无统计学意义(均P>0.05)。观察组、对照组中医证候评分较治疗前降低,且观察组中医证候疗效优于对照组,差异有统计学意义(P<0.01)。观察组、对照组患者其他血清学指标、超声指标,治疗前后以及2组组间比较,差异均无统计学意义(均P>0.05)。结论:蔡氏补肾填精方能明显改善DOR患者的临床症状,调节性激素水平,值得临床推广和应用。

续断种子方对小鼠精子发生发育及c-kit蛋白表达的影响

目的观察续断种子方对无精子症模型小鼠睾丸精子发生发育及c-kit蛋白表达的影响,探讨其相关作用机制。方法白消安和环磷酰胺腹腔注射建立无精子症小鼠模型。实验小鼠按随机数字表法分为对照组、模型组、麒麟丸组和续断种子方高、中、低剂量组。各治疗组予相应药物灌胃,对照组和模型组小鼠予等体积生理盐水,每日1次,连续8周。HE染色检测小鼠附睾精子质量,电镜观察睾丸组织显微、超微结构,免疫组化法检测睾丸组织c-kit蛋白表达。结果模型组偶见散在精子,睾丸生精上皮不同程度破坏,精原细胞、精母细胞线粒体空化明显,部分线粒体嵴消失,核膜局部破损,c-kit免疫组化结果显示棕黄色阳性表达的细胞散在;续断种子方高剂量组、麒麟丸组、对照组小鼠附睾精子浓度较高,睾丸生精上皮见精子、精子细胞、精母细胞,线粒体空化少,可见丰富的高尔基体、内质网结构,c-kit免疫组化结果显示棕黄色阳性表达的细胞灰度大。结论续断种子方可有效促进睾丸生精上皮的精子发生发育,增加精子数量,达到健脾益肾、活血生精之效。

健脾通络方治疗痰瘀互结型高血压病临床研究

目的:观察健脾通络方治疗痰瘀互结型高血压病的临床疗效及对血管内皮功能的影响。方法:将120例高血压病患者随机分为对照组和治疗组各60例。两组均口服苯磺酸氨氯地平片和(或)培哚普利片,治疗组加用健脾通络方,每天1剂,两组治疗28 d后观察临床疗效,并比较两组患者治疗前后24 h动态血压、中医证候积分、一氧化氮(ON)、内皮素-1(ET-1)、血栓素B2(TXB2)及6-酮-前列腺素F1α(6-keto-PGF1α)的变化。结果:治疗组的中医证候疗效优于对照组(P <0. 05);两组患者的24 hD BP、dS BP、dD BP、nD BP、中医证候积分、ON、ET-1、TXB2、6-keto-PGF1α指标治疗后均有改善(P <0. 05或P <0. 01),而治疗组改善优于对照组(P <0. 05)。结论:健脾通络方治疗痰瘀互结型高血压病的临床疗效可靠,具有良好的降压,保护血管内皮功能。

补肾、健脾、益气和血方药延缓衰老作用的比较研究

探讨补肾、健脾、益气、和血各类方药延缓衰老作用的异同点。从神经内分泌、免疫功能、抗自由基、血小板聚集以及肝蛋白质、肺cAMP含量等方面选择与衰老有关的指标，同步测试比较研究上述各类方药对自然衰老大鼠的延缓衰老作用。结果表明：上述各类方药均能提高自然衰老大鼠脾脏IL-2活性，肝蛋白质含量，脑、肝SOD含量，降低肝LPO、血清E2和血小板聚集。但补肾组对延缓老年大鼠垂体-性腺功能、益气组对延缓脑功能衰老的作用最为广泛而明显;和血组对提高老年鼠肺cAMP含量有明显作用。各组方药均能提高肝蛋白质含量.但作用机理不同。

补肾健脾方联合孕激素保胎效果分析

目的通过比较补肾健脾方联合孕激素治疗和单纯孕激素治疗对反复自然流产(recurrent spontaneous abortion,RSA)患者的保胎有效率和成功率,分析补肾健脾方联合孕激素的保胎效果。方法采用非随机对照的临床研究方法,收集2009年1月至2012年1月在我院门诊就诊的有RSA史的先兆流产患者348例,符合RSA和肾虚诊断标准者共159例,以是否自愿接受中药辨证治疗,分为治疗组(n=74例)和对照组(n=85例)。治疗组给予补肾健脾方联合孕激素治疗,对照组给予单纯孕激素治疗,两组均干预治疗至超过既往最大流产孕龄的2周,治疗过程中有6例脱落(治疗组2例,对照组4例);治疗后随访监测血孕酮水平,比较治疗前及治疗2周后两组血清孕激素的变化,观察用药后有无不良反应;评价治疗至超过既往最大流产孕龄2周时的保胎有效率,并随访其后的保胎成功率、不同孕周胚胎或胎儿的存活率。结果保胎治疗前治疗组孕酮值为(22.42±6.92)ng/mL,对照组孕酮值为(21.60±7.6)ng/mL,两组比较差异无统计学意义(P=0.489);保胎治疗2周后治疗组血孕酮值为(31.15±9.44)ng/mL,对照组为(22.52±10.53)ng/mL,两组比较差异有显著统计学意义(P<0.001);治疗组65例保胎有效(90.3%),对照组61例保胎有效(75.3%),两组比较差异有统计学意义(P<0.05);治疗组51例保胎成功(70.8%),对照组43例保胎成功(53.1%),两组比较差异有统计学意义(P<0.05);两组比较孕12～37周胎儿的存活率,差异有统计学意义(P<0.05);用药后随访两组均无明显不良反应。结论补肾健脾方联合孕激素治疗对有RSA史及肾虚的先兆流产患者的保胎有效率和保胎成功率均优于单纯孕激素治疗,保胎治疗2周后血孕酮值水平较单纯孕激素治疗组上升明显,孕12～37周的胎儿存活率明显高于单纯孕激素治疗组,补肾健脾方联合孕激素保胎安全有效。

补肾健脾方治疗白细胞减少症疗效观察

目的:观察补肾健脾方治疗白细胞减少的疗效。方法:将94例白细胞减少症患者随机分为3组。中药组32例,给予补肾健脾方125mL口服2/天;成药组28例,地榆升白片3片口服3/天+利血生片20mg口服3/天;中西组为中药组+成药组。对比3组的临床疗效。结果:总有效率及3组治疗后外周血白细胞计数比较,中西组、中药组优于成药组(P<0.05),而中西组与中药组疗效无显著性差异(P>0.05)。结论:单用中药组与中西组疗效相当,且疗效肯定,无不良反应,并且经济,值得推广使用。

1658例骨关节炎患者健脾化湿、补肾通络方药运用的队列研究

目的:随访骨关节炎出院患者健脾化湿、补肾通络方药的运用情况,分析中医药治疗与终点事件发生的相关性。方法:采用队列研究设计,电话随访(随访时间:2016年10月1日至2016年11月30日)安徽中医药大学第一附属医院2012年1月1日至2016年6月30日住院骨关节炎患者,记录其出院后口服中成药、中药汤剂的种类和服用时间,以及再发入院、关节外病变、手术治疗、全因死亡终点事件的发生情况,终点事件采用χ~2检验、logistic回归分析中医药(刘健教授常用的健脾化湿代表药茯苓、薏苡仁、陈皮,祛风补肾代表药威灵仙、川芎、桑寄生,活血通络代表药丹参、桃仁、红花以及院内制剂新风胶囊、黄芪清热除痹胶囊、颈椎活血胶囊、五味温通除痹胶囊)治疗与终点事件发生的相关性。结果:共随访骨关节炎患者1904例,完成随访患者1658例,失访率12.92%。暴露组(出院后口服中成药和中药汤剂≥28 d)1318例,服用频次较多的中成药依次为新风胶囊、新癀片、黄芩清热除痹胶囊等,中药汤剂依次为独活寄生汤、四妙散、二陈汤、身痛逐瘀汤等。各暴露组终点事件总发生99例,其中非暴露组48例(14.12%),低暴露组25例(12.25%),中暴露组16例(5.48%),高暴露组10例(1.22%),其发生率对比差异有统计学意义(P﹤0.05)。结论:终点事件的发生与中药服用时间存在相关性,其中成药新风胶囊以及薏苡仁、红花等健脾化湿、补肾通络方药可降低骨关节炎患者终点事件的发生。

甲亢方对实验性甲亢大鼠垂体、胸腺和脾脏病理改变的影响

目的:观察甲亢方对甲亢模型大鼠垂体、胸腺和脾脏病理变化的影响。方法:将50只大鼠随机分为正常组、甲亢模型组、甲亢方中剂量组、甲亢方高剂量组、西药对照组(每组12只),除正常组外,4组大鼠每天按75μg/100g体重灌服优甲乐(左甲状腺素钠)造成大鼠甲亢模型,给予不同剂量甲亢方内服,并没西药对照组,第21天处死大鼠并用光学显微镜观察模型大鼠垂体、胸腺和脾脏病理变化。结果:甲亢方能改善甲亢模型大鼠垂体、胸腺和脾脏组织病理变化,其中高剂量组垂体、胸腺和脾脏组织结构基本同正常组。结论:甲亢方能够显著改善甲亢大鼠垂体、胸腺和脾脏组织病理变化。

补肾健脾消积方联合XELOX方案治疗大肠癌根治术后患者的临床研究

目的:观察补肾健脾消积方联合XELOX方案应用于大肠癌根治术后患者的临床疗效。方法 :将58例予以大肠癌根治术的患者随机分为观察组和对照组,每组各29例,两组均采用XELOX方案化疗4个疗程,观察组在化疗基础上服用补肾健脾消积方。观测两组T细胞亚群[CD3^+、CD4^+、CD8^+、CD4^+/CD8^+、自然杀伤细胞(natural killer cell,NK)]、癌胚抗原(carcinoembryonic antigen,CEA)和CA199、卡氏功能状态评分(Karnofsky performance score,KPS),并进行比较来评估补肾健脾消积方对大肠癌术后化疗患者的免疫功能影响。结果:两组化疗后CD3^+、CD4^+、CD4^+/CD8^+、NK数量均上升,观察组上升更显著(P<0.05),而CD8^+无明显变化;两组CEA与CA199均下降,观察组下降更显著(P<0.05);观察组患者KPS评分改善优于对照组(P<0.05)。结论:补肾健脾消积方能增加大肠癌患者化疗耐受性,提高患者的免疫功能和生活质量,是大肠癌患者术后行化疗合适的辅助用药。

健脾益肾方对慢性肾功能衰竭大鼠ob基因表达的影响

目的探讨健脾益肾方对 5 6肾切除慢性肾衰竭大鼠ob基因表达的影响 ;方法采用Northernblot检测 5 6肾切除慢性肾衰竭大鼠obmRNA表达。结果实验第 4、8周模型组大鼠腹部脂肪obmRNA表达均较正常组减弱 (P <0 .0 1 ) ;第 4、8周健脾益肾方各组均能增强obmRNA表达水平 ,与模型组比较差异具有显著性 (P <0 .0 1 ) ;结论健脾益肾方能明显增强慢性肾功能衰竭大鼠obmRNA表达 ,可能为其改善慢性肾衰竭患者营养不良的作用机制之一。

郑惠芳健脾补肾法辨治妇科疑难病经验

郑惠芳对于妇产科的疑难疾病,如崩漏、胎动不安、癥瘕、不孕等,均有丰富的治疗经验。健脾补肾之法通贯于妇科疑难病例治疗的始终,辨清标本虚实,切中内里病机,治疗时善于化裁经方,疗效颇为显著。并附医案以佐之。

补肾健脾养血活血方治疗血管性痴呆肾虚血瘀型的临床研究

目的观察补肾健脾养血活血方治疗血管性痴呆 (VD)肾虚血瘀型的临床疗效。方法选取该病患者 70例随机分成两组 ,中药治疗组 ( 4 0例 )给予补肾健脾养血活血方 ,西药对照组 ( 3 0例 )给予喜得镇 ,观察治疗前后血浆内皮素 (ET)、血清一氧化氮 (NO)、同型半胱氨酸 (HCY)、雌二醇 (E2 )、睾酮 (T)含量及MMSE、ADL评分变化。结果治疗组总有效率为 82 .5 % ,对照组为 60 % ,两组比较差异显著 (P <0 .0 5 ) ;两组HCY、NO、ET、ET NO、男E2 及E2 T、女E2 及E2 T、男T和MMSE、ADL及肾虚血瘀证候评分治疗前与治疗后比较差异有显著性或非常显著性 (P <0 .0 1或P <0 .0 0 1 ) ,治疗后两组间肾虚血瘀证候评分、E2 、E2 T、T及HCY差异有显著性或非常显著性 (P <0 .0 5 ,P <0 .0 1或P <0 .0 0 1)。结论补肾健脾养血活血方可显著改善VD患者临床症状和各项指标的测值。