A comparison of the effect of alendronate and You-Gui-Wan on osteoporosis in female rats with kidney-yang deficiency

Background:In traditional Chinese medicine,You-Gui-Wan(YGW)is typically used to treat osteoporosis associated with kidney-yang deficiency.However,there have been few mechanistic studies on the effectiveness of kidney-yang deficiency-type osteoporosis with YGW.To further clarify the role of YGW in the effect of osteoporosis with kidney-yang deficiency,the study analyzed the therapeutic advantages of YGW by comparing the therapeutic effects of YGW and alendronate(ALN)on osteoporosis with kidney-yang deficiency.Methods:SPF female SD rats were randomly divided into control,osteoporosis,osteoporosis with kidney-yang deficiency,osteoporosis with kidney-yang deficiency+YGW and osteoporosis with kidney-yang deficiency+ALN groups.Except for the control group,osteoporosis was induced by the removal of bilateral ovaries.After 12 weeks,rats with osteoporosis in the kidney-yang deficiency group had kidney-yang deficiency syndrome triggered by hydrocortisone for 14 days.Rats were treated with YGW or ALN for 12 weeks.The weights of rats were recorded.Hematoxylin-eosin staining staining was used to observe pathological changes in bone trabeculae,liver,spleen,and kidneys of rats.Depletion of the growth plate cartilage of rats in different groups was observed by safranine-O staining.The expression of osteoclast key indices(ACP)and osteoblast key indices(ALP)in the bone tissue of rats in the different groups was observed by immunohistochemical staining.The expression of bone resorption-related indicators(TRAP and NXT-1),bone formation-related indicators(BALP,BGP,and P1NP),and major indicators of kidney-yang deficiency(ACTH,T3,T4,cAMP,and cGMP)were observed using an ELISA detection kit.The expression levels of the main indices of liver function(ALT and AST)were detected in different groups.Results:The differences between the osteoporosis with kidney-yang deficiency group and osteoporosis group were that the weight of rats and the expression of ACTH,T3,T4,and cAMP decreased significantly,and the expression of cGMP increased in the osteoporosis with kidney-yang deficiency group.Moreover,both YGW and ALN effectively improved the symptoms of osteoporosis,including the injury of bone trabeculae and growth plates,as well as the expression of bone metabolism-related indicators.However,unlike ALN,YGW simultaneously ameliorated the expression of key indicators of kidney-yang deficiency and prevented weight loss in rats.In addition,YGW caused no obvious damage to the liver,spleen,or kidney,whereas ALN led to liver cirrhosis.Conclusion:The results reveal that YGW plays a crucial part in osteoporosis with kidney-yang deficiency,increases bone mineral density,and improves bone metabolism indicators,and is safe and efficient for the efficacy of osteoporosis with kidney-yang deficiency.YGW might have a better therapeutic effect on osteoporosis in patients with kidney-yang deficiency.Therefore,alendronate should be used cautiously in patients with osteoporosis and poor liver function.

Transcriptomic and metabolomic analysis of the effects of Zhenwu decoction on kidney yang deficiency pattern in chronic kidney disease

Objective:To explore the kidney yang deficiency pattern(KYDP)in a chronic kidney disease(CKD)rat model and the mechanisms underlying the effects of Zhenwu decoction(ZWD)by conducting tran-scriptomic and metabolomic analyses.Methods:Adriamycin(ADR)combined with hydrocortisone(HC)was used to induce CKD with KYDP in rats.ADR was injected into the tail vein twice.HC was injected intramuscularly for 8 weeks.ZWD was administered by gavage for 8 weeks.The general condition was observed,24-h urine protein was detected,serum corticosterone,triiodothyronine,thyroxine,TSH,testosterone,cAMP,and cGMP levels were determined,and pathological analysis was conducted.Transcriptomic and metabolomic analyses were conducted to screen differentially expressed genes(DEGs),differentially expressed metabolites(DEMs),and differentially expressed pathways(DEPs).The core DEMs and DEGs were input to Metab-oanalyst 5.0 to identify the pathways affected by ZWD.Results:In the HC group,KYDP symptoms were observed.Compared with control group,the levels of 24-h urine protein,TSH,and cGMP significantly increased(all P<0.01),and corticosterone,triiodothyronine,thyroxine,and cAMP significantly decreased(all P<0.01)in the HC group.After ZWD intervention,the levels of above-mentioned indicators could be reversed to some extent.Pathological analysis in the HC group revealed kidney lesions.DEGs in the ZWD group were mainly associated with pathways such as nucleotide synthesis and endocrine pathways.In the ZWD group,differences in biosynthesis of unsat-urated fatty acids and butanoate metabolism were observed.The following pathways were significantly affected by ZWD:arachidonic acid metabolism,valine,leucine,and isoleucine biosynthesis,linoleic acid metabolism,and alpha-linolenic acid metabolism.Conclusion:ZWD can be used to treat KYDP in CKD through regulating arachidonic acid metabolism,valine,leucine,and isoleucine biosynthesis,linoleic acid metabolism,and alpha-linolenic acid metabolism.

Observation of tongue picture and tongue and nailbed microcirculation before and after blood dialysis in 125 uremic patients with deficiency of kidney-yang

using a WZD—1 microcirculation microscope,we observed the tongue tipand nail-bed microcirculation of uremic patients with deficiency of kidney-yangbefore and after blood dialysis.The results showed that the pathological basis ofuremia with deficiency of kidney-yang may be microcirculation disturbance,in-crease of metabolites and water retention.The effusion from capillary loops intongue tip may be one of the pathogenetic factors of a swollen and jaggedtongue.The flow rate of blood in capillary loops in the nail-bed was apparentlyabnormal and markedly improved after blood dialysis.The weighted integral ofnail-bed microcirculation decreased from moderately abnormal (4.99±1.52) toapproximately normal (1.98±0.97) (P【0.01).Microcirculation seems to be a sensi-tive criterion for reflecting the pathologic changes of uremia with deficiency ofkidney-yang.

Efficacy of suspended moxibustion stimulating Shenshu(BL23)and Guanyuan(CV4)on the amygdala-HPA axis in rats with kidney-Yang deficiency symptom pattern induced by hydrocortisone

OBJECTIVE:To investigated the effects of suspended moxibustion stimulating Shenshu(BL23)and Guanyuan(CV4)acupoints on the amygdala and HPA axis in our rat model and elucidated the possible molecular mechanisms of moxibustion on kidney-Yang deficiency symptom pattern(KYDS).METHODS:Sixty male Sprague Dawley rats were randomly divided into a control group(n=12)and an experimental group(n=48).Rats in the experimental group were given intramuscular injections of hydrocortisone to establish a KYDS model.The 48 rats successfully modeled were then randomly divided into a model group(model,n=12),a carbenoxolone intraperitoneal injection group(CBX,n=12),a moxibustion group(moxi,n=12),and a moxi+CBX group(n=12).In the moxi,the Shenshu(BL23)and Guanyuan(CV 4)acupoints were treated with moxibustion for 14 d.After treatment,measures were taken of serum levels of corticosterone(CORT),adrenocorticotropic hormone(ACTH),and corticotropinreleasing hormone(CRH).The expression of mineralocorticoid receptors(MRs),glucocorticoid receptors(GRs),11beta-hydroxysteroid dehydrogenase type 1(11β-HSD1),CRH,and ACTH in the rats’amygdala,hypothalamus,or pituitary(as appropriate)was detected.Data were analyzed using one-way analysis of variance.RESULTS:Compared with those of the control group,the serum levels of CRH,ACTH,and CORT;the mRNA and protein expressions of MR,GR,and 11β-HSD1 in the amygdala;the mRNA and protein expressions of 11β-HSD1 in the hypothalamus;the CRH mRNA expression in the amygdala and hypothalamus;and the ACTH mRNA expression in the pituitary of the rats in the model group were all significantly decreased(P<0.05 or 0.01).After treatment with moxibustion,all the aforementioned observation indices except for 11β-HSD1 m RNA expression were ameliorated compared with those in the model group(P<0.05 or 0.01).CONCLUSIONS:Suspended moxibustion can effectively improve the serum levels of ACTH,CRH,and CORT and can up-regulate the mRNA and protein expressions of MR,GR,11β-HSD1,CRH,and ACTH in the amygdala and hypothalamus of KYDS rats.This may be one of the molecular mechanisms with which moxibustion alleviates KYDS.

独活桂辛方对腰椎间盘突出症(肝肾亏虚证)患者疼痛及腰椎功能的影响

目的观察独活桂辛方联合针刺、布洛芬缓释胶囊治疗腰椎间盘突出症(肝肾亏虚证)的临床疗效。方法将85例患者随机分为两组,观察组43例,予以独活桂辛方联合针刺、布洛芬缓释胶囊口服,对照组42例,予以针刺联合布洛芬缓释胶囊口服。疗程3周。结果观察组总有效率为92.68%,高于对照组的78.05%(P<0.05)。治疗后及随访时,两组患者中医症状积分、视觉模拟量表(VAS)评分、Roland-Morris功能障碍调查表(RMDQ)均较治疗前明显降低(P<0.05),观察组下降更明显(P<0.05);两组患者日本骨科协会腰椎(JOA)评分均较治疗前明显升高(P<0.05),观察组升高更明显(P<0.05)。治疗后,两组患者血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)水平均较治疗前明显下降,观察组下降更明显(P<0.05)。结论独活桂辛方联合针刺、布洛芬缓释胶囊可减轻腰椎间盘突出症(肝肾亏虚证)患者腰腿疼痛症状,降低血清IL-1β、IL-6、h-CRP水平,改善腰椎功能。

基于“动则生阳”理论探讨鸢尾素与慢性心力衰竭心阳虚证本质的联系

慢性心力衰竭(chronic heart failure, CHF)是各种原因导致的心脏疾病终末阶段,心阳不足是导致CHF恶化的关键病因。鸢尾素是一种肌动蛋白糖基化蛋白激素,是纤维连接蛋白Ⅲ型结构域5(fibronectin typeⅢdomain containing 5, FNDC5)的多肽切割产物,同时也是一种依赖于过氧化物酶体增殖物激活受体γ共激活物-1α(peroxisome proliferator-activated receptor γ coactivator-1α, PGC-1α)的肌细胞因子。在肌肉运动时,PGC-1α通过刺激FNDC5表达,增加鸢尾素释放并介导运动相关的效应。在这一过程中产生的鸢尾素可以增加线粒体产能和脂肪褐变产热,促进葡萄糖代谢和脂肪酸氧化。“动则生阳”理论源于《易经》,其指出“动”是化生阴阳万物的起源。对于CHF心阳虚证患者,运动可振奋其心阳,促进人体气血通畅,改善CHF症状,促进疾病向愈。“动则生阳”的本质可能是运动改善了CHF心阳虚证患者的“气虚”和“寒象”状态,可能与机体运动时产生的鸢尾素调控了能量代谢及线粒体产能有关。因此,推测缺乏鸢尾素可能是CHF心阳虚证的生物学内涵。

参松养心胶囊治疗老年冠心病室性早搏气阴两虚、心络瘀阻型患者临床观察

目的:观察参松养心胶囊对老年冠心病室性早搏气阴两虚、心络瘀阻型患者临床疗效、动态心电图室性早搏次数及中医证候积分的影响。方法:选择老年冠心病室性早搏气阴两虚、心络瘀阻型患者60例,按照随机数字表法分为对照组和观察组,每组30例。对照组给予口服酒石酸美托洛尔,观察组在对照组基础上口服参松养心胶囊。两组均连续治疗4周。观察两组治疗前后临床疗效,24 h动态心电图室性早搏次数及中医证候积分。结果:对照组有效率[73.33%(22/30)]高于观察组[96.67%(29/30)](P<0.05)。两组治疗后室性早搏次数均减少,观察组减少较对照组更明显(P<0.05)。与治疗前比较,两组心悸、悸动不安、神疲乏力、气短、五心烦热等中医证候积分均下降(P<0.05),且治疗后观察组上述指标改善优于对照组(P<0.05)。结论:参松养心胶囊能有效减少老年冠心病室性早搏患者的室性早搏次数,改善患者临床症状。

基于“玄府气液”理论治疗慢性难愈性溃疡

慢性难愈性溃疡是“虚”“瘀”两种致病因素相互交织、相互作用的结果,“虚”“瘀”贯穿疾病发展的始终。而“玄府开阖失司,气液代谢失调”是本病迁延难治的病机关键。刘丽芳教授综合运用煨脓生肌、阳和通玄、托里消毒诸法开玄府、调气液,令玄府开阖有司,气液代谢调和,临床疗效满意,附验案一则加以阐明。

和阳消瘿汤联合优甲乐治疗脾气亏虚型桥本甲状腺炎疗效及对甲状腺激素、甲状腺自身抗体水平的影响

目的:观察和阳消瘿汤联合优甲乐治疗脾气亏虚型桥本甲状腺炎的疗效及对甲状腺激素、甲状腺自身抗体水平的影响。方法:选取2020年5月~2022年5月期间于我院接受治疗的脾气亏虚型桥本甲状腺炎患者114例为研究对象,按照随机数字表法分为观察组与对照组,其中57例对照组患者给予优甲乐治疗,57例观察组患者在以上对照组基础上给予和阳消瘿汤。比较两组治疗前后甲状腺激素[游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)]、甲状腺自身抗体水平[抗甲状腺球蛋白抗体(TG-Ab)、甲状腺过氧化物酶抗体(TPO-Ab)]及中医证候积分的变化,并对其疗效及安全性进行客观评价。结果:治疗前两组各项指标比较无明显差异(P>0.05),治疗后TG-Ab、TPO-Ab、TSH及中医证候积分均降低(P<0.05),FT_(3)、FT_(4)均升高(P<0.05),且治疗后观察组TG-Ab、TPO-Ab、TSH、中医证候积分低于对照组(P<0.05),FT_(3)、FT_(4)高于对照组,差异有统计学意义(P<0.05);观察组总有效率为91.23%,明显高于对照组的71.93%(P<0.05),但两组不良事件发生率相比差异无统计学意义(P>0.05)。结论:和阳消瘿汤联合优甲乐治疗脾气亏虚型桥本甲状腺炎,与单纯优甲乐治疗相比,在调节甲状腺激素、降低自身抗体水平、纠正临床症状上优势明显,且疗效及安全性可靠。

基于R语言探析吕晓东教授治疗喘证及从虚实辨证施治用药规律

目的基于R语言和IBM SPSS Statistics 23,整理并探析吕晓东教授治疗喘证处方的组方用药规律,并从虚实入手分析喘证辨证治疗异同,为喘证中药治疗提供新思路。方法筛选2019年11月—2022年11月就诊于辽宁中医药大学附属医院吕晓东教授门诊的喘证病例,采用R语言进行数据挖掘分析。结果筛选出133个处方,183味中药,累计使用总频次为2686次,使用频次排名前10的中药主要为解表药与化痰止咳平喘药,性味归经得出药性以寒、温为主,药味多为甘、苦、辛,主归肺、肝经。相关系数最高为温阳解表药对,关联分析得出核心药物为杏仁、桔梗、麻黄,其中杏仁-桔梗为最高频使用药对,聚类分析以疏肝理气药、宣肺平喘药、温阳滋肾药、散瘀祛邪药为主。结论吕晓东教授治疗喘证善于基于理肺加以辨证施治,如配合疏肝、滋肾、化里邪、调阴阳之法。以杏仁、桔梗、麻黄为核心药物组方,以解表药、化痰止咳平喘药为主,在此基础上实喘证加入平肝熄风药、清热药、活血祛瘀药,虚喘证加滋肾填阴药、温里补阳药,总结归纳出实喘善从表里同治调气机、虚喘善从阴阳入手补本虚,为临床治疗提供参考。

玉屏风散对肺气虚型变应性鼻炎豚鼠模型IL-4、IL-12、TNF-γ表达水平及鼻腔黏病理变化的影响

目的探讨玉屏风散对肺气虚型变应性鼻炎(allergic rhinitis,AR)豚鼠的作用机制。方法将40只健康杂色英国种豚鼠,随机分为空白组、模型组、玉屏风组、氯雷他定组。除空白组外,其余各组均以鸡卵清蛋白(ovalbumin,OVA)与烟熏法建立肺气虚型AR模型。造模成功后,玉屏风组、氯雷他定组分别予玉屏风散[4.52 g/(kg·d)]、氯雷他定片(0.903 mg/kg)灌胃,空白组及模型组予等体积生理盐水灌胃,处理15 d后,取各组豚鼠血清及鼻腔黏膜。经HE染色法观察鼻腔黏膜细胞形态,ELISA与免疫组化法检测豚鼠血清中白细胞介素-4(interleukin-4,IL-4)、白细胞介素-12(interleukin-12,IL-12)、γ干扰素(interferon-γ,IFN-γ)等细胞因子表达水平。结果HE染色发现,模型组细胞形态结构明显紊乱,玉屏风组、氯雷他定组细胞形态结构异常状态相对减轻。ELISA结果显示,与空白组比较,模型组、玉屏风组、氯雷他定组豚鼠血清中IL-4、IL-12表达水平升高(P<0.05),IFN-γ表达水平降低(P<0.05);与模型组比较,玉屏风组、氯雷他定组豚鼠血清IL-4与IL-12含量降低(P<0.05),氯雷他定组IFN-γ表达水平升高(P<0.05)。免疫组化染色显示,与空白组比较,模型组豚鼠鼻腔黏膜IL-4、IL-12表达明显降低(P<0.05),IFN-γ表达明显升高(P<0.01);与模型组比较,玉屏风组与氯雷他定组IL-4表达明显降低(P<0.05),氯雷他定组IL-12表达明显降低(P<0.05)。结论玉屏风散可能通过影响IL-4、IL-12、IFN-γ水平,改变鼻腔黏膜细胞形态治疗肺气虚型AR。

金刚丸联合骨化三醇治疗肾阳亏虚型老年骨质疏松症的临床研究

目的探讨金刚丸联合骨化三醇治疗肾阳亏虚型老年骨质疏松症的临床疗效及安全性。方法选取湖南省中医药研究院附属医院门诊接受治疗的72名肾阳亏虚型骨质疏松的老年患者,采用分层随机化方法随机分为对照组(骨化三醇治疗)和治疗组(金刚丸联合骨化三醇治疗),每组36例。治疗持续8周。比较两组患者的临床疗效、视觉模拟评分法(visual analogue scale,VAS)评分、骨密度、骨代谢指标、成骨相关基因水平、炎症因子水平、生活质量、中医证候积分和安全性。结果治疗组总有效率为91.7%,高于对照组的69.4%(P<0.05);与对照组比较,治疗组VAS评分显著降低(P<0.05),全髋、腰椎及股骨颈骨密度均增加(P<0.05),治疗组骨形态发生蛋白2(bone morphogenetic protein 2,BMP2)RNA表达水平、骨碱性磷酸酶(bone alkaline phosphatase,BALP)、骨钙素(osteocalcin,BGLAP)水平、健康状况调查问卷(36-item short-form,SF-36)评分升高(P<0.05),抗酒石酸酸性磷酸酶5b(tartrateresistant acid phosphatase 5b,TRACP-5b)水平、miR-133aRNA表达水平、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平、白细胞介素-6(interleukin-6,IL-6)水平及中医临床症状评分降低(P<0.05)。结论金刚丸联合骨化三醇可能通过上调BALP、BGLAP、BMP2,下调TRACP-5b、miR-133a、TNF-α及IL-6,改善患者骨密度、骨代谢、炎症状态及生活质量,能有效显著提高“肾阳亏虚证”肾阳亏虚型老年骨质疏松症患者的治疗效果。

基于卵巢颗粒细胞功能探讨调周法治疗卵巢储备功能减退的临床研究

目的:基于卵巢颗粒细胞功能探讨中医药调周法对卵巢储备功能减退(diminished ovarian reserve,DOR)患者体内抗穆勒氏管激素(anti-mullerian hormone,AMH)水平的影响及临床疗效。方法:对60例DOR肾虚证患者给予中医药调周法治疗,观察治疗前后患者血清性激素各项水平[AMH、雌二醇(estradiol,E_(2))、黄体生成素(luteinizing hormone,LH)、卵泡刺激素(follicle stimulating hormone,FSH)]和临床疗效。结果:治疗前后E_(2)、LH、FSH水平比较差异无统计学意义(P>0.05);治疗后AMH水平较治疗前升高(P<0.05),中医证候积分较治疗前减少(P<0.05),总有效率为86.7%(52/60);治疗期间均无明显不良反应。结论:中药调周法通过提高AMH、FSH水平来提升DOR肾虚证患者卵巢储备功能,调整月经周期,增加月经量,改善临床症状。

“新八髎”针刺联合督脉刺络放血拔罐治疗慢性荨麻疹的临床研究

目的:探究“新八髎”针刺联合督脉刺络放血拔罐治疗慢性荨麻疹的临床研究。方法:将2021年1月—2022年6月期间就诊的血虚风燥型慢性荨麻疹患者随机分为观察组和对照组,各60例。对照组接受督脉刺络放血拔罐治疗,观察组接受“新八髎”针刺联合督脉刺络放血拔罐治疗,均连续治疗3个月。比较两组临床疗效和治疗后12个月时的复发情况,比较治疗前和治疗后12个月时的中医症候积分、荨麻疹控制情况[荨麻疹控制评分(UCT)]、炎症因子水平和生活质量[中国版慢性荨麻疹生活质量问卷(CU-Q2oL)]评分。结果:观察组的总有效率显著高于对照组(P<0.05),观察组的复发率显著低于对照组,差异具有统计学意义(P<0.05)。治疗后12个月时,两组患者的中医症候积分、CRP、IL-4、IL-17和CU-Q2oL评分较治疗前显著降低,且观察组低于同期对照组,差异有统计学意义(P<0.05);两组患者的UCT评分较治疗前显著提高,且观察组高于同期对照组,差异有统计学意义(P<0.05)。结论:“新八髎”针刺联合督脉刺络放血拔罐治疗血虚风燥型慢性荨麻疹具有显著的疗效,可以有效缓解症状,降低患者体内炎症因子的水平,显著改善患者的生活质量,有效避免复发情况。

复方地黄颗粒对帕金森病阴虚动风证大鼠多巴胺能神经元生物学功能的影响

目的探讨复方地黄颗粒对帕金森病(PD)阴虚动风证大鼠多巴胺(DA)能神经元生物学功能的作用。方法采用6-羟基多巴胺(6-OHDA)脑立体注射法制备PD阴虚动风证动物模型,成模大鼠随机分为模型组、美多芭组(150 mg/kg)和复方地黄颗粒低、中、高剂量组(1.75、3.5、7 g/kg),分别给予相应药物进行干预,正常组、假手术组及模型组给予生理盐水,共灌胃28 d,观察各组大鼠一般情况及神经行为学,HE染色观察黑质组织病理改变,透射电镜技术观察损毁侧黑质内DA能神经元的线粒体结构,免疫组化、Western blot及RT-qPCR法检测DJ-1、IP3R、GRP75、VDAC1表达。结果与正常组、假手术组比较,模型组大鼠旋转圈数增加(P<0.01),游泳评分降低(P<0.01),悬挂时间减少(P<0.01),黑质神经元数量减少,形态受损,黑质内神经元出现线粒体肿胀变性,线粒体嵴消失等损伤,损伤侧黑质DJ-1、IP3R、GRP75、VDAC 1 mRNA和蛋白表达降低(P<0.01);与模型组比较,美多芭组及复方地黄颗粒各剂量组大鼠旋转圈数减少(P<0.01),游泳评分升高(P<0.01),悬挂时间增加(P<0.01),线粒体形态结构损伤减轻,损伤侧黑质DJ-1、IP3R、GRP75、VDAC 1 mRNA和蛋白表达均升高(P<0.05,P<0.01),复方地黄颗粒高剂量效果与美多芭相当(P>0.05)。结论复方地黄颗粒可能通过调控DJ-1、IP3R、GRP75、VDAC1表达促进内质网-线粒体稳态,减轻线粒体损伤,维持DA能神经元生物学功能。

潜阳封髓法辨治前列腺癌雄激素剥夺治疗后状态

前列腺癌是中老年男性常见的恶性肿瘤,雄激素剥夺疗法常贯穿前列腺癌患者治疗始终,该治疗虽抑制肿瘤发展,但带来一定不良反应,严重影响患者生存质量。患者雄激素剥夺治疗后临床出现潮热盗汗、乏力纳差、畏寒肢冷等虚候,可归属于中医学“虚劳”范畴。通过探讨前列腺癌雄激素剥夺治疗后的中医病证机制,认为其证候表现为阴精亏虚、虚阳浮越,病位在肾,病理性质为阴阳俱虚并见,前列腺癌内分泌治疗后以填补肾精、潜阳封髓为基本治疗原则。

基于“肝-脑-目”轴探讨中医药论治干眼

“肝”“脑”“目”三者在生理及病理上相互联系,形成了“肝-脑-目”轴交互体系。其关系存在多向交互串扰,影响干眼的发生发展。应用脏腑辨证理论从生理和病理两个层面对“肝-脑-目”轴的内涵进行阐述,并提出“肝-脑-目”轴的3种失衡状态及其与干眼发病的关系,且肝、肾与目的关系为“肝-脑-目”轴理论之关键。提出清肝疏肝以畅“肝-脑-目”轴、益精生髓以充“肝-脑-目”轴、补肝肾阴以理“肝-脑-目”轴的中医药治疗干眼思路,以期为临床治疗干眼提供参考。

补肾疏肝宁心汤联合针刺治疗肾虚肝郁型绝经综合征

目的 探讨补肾疏肝宁心汤联合针刺疗法在治疗肾虚肝郁型绝经综合征中的临床效果。方法 选取2021年1月-2023年3月铜陵市中医院肾虚肝郁型绝经综合征患者60例作为研究对象,将患者随机分为观察组与对照组,2组患者各30例。观察组患者予补肾疏肝宁心汤联合针刺治疗,对照组患者予西医常规治疗。对治疗前后各个患者Kupperman症状评分、PSQI睡眠指数以及性激素水平的变化进行统计学分析。结果 治疗3个月时、停药3个月时,2组的Kupperman症状评分及PSQI睡眠指数均较治疗前下降,观察组的Kupperman症状评分及PSQI睡眠指数与对照组比较,差异具有统计学意义(P <0.05)。在治疗3个月以及停药3个月时各组患者性激素水平较治疗前均有改善(P <0.05)。对照组患者停药3个月后LH、FSH上升,E2下降;观察组患者各项指标相对更稳定,与对照组比较,差异具有统计学意义(P <0.05)。结论 补肾疏肝宁心汤联合针刺疗法能显著改善肾虚肝郁型绝经综合征患者的潮热出汗、失眠、焦虑等症状,改善绝经综合征患者的Kupperman症状评分及PSQI睡眠指数,提高生活质量,具有临床意义,值得推广使用。

加味健肾方治疗特发性膜性肾病脾肾两虚证患者的疗效及对PLA2R的影响

目的 观察加味健肾方治疗脾肾两虚型特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者的疗效及对磷脂酶A2受体(phospholipase A2 receptor,PLA2R)滴度的影响。方法 选取2021年1月至2022年7月在柳州市中医医院门诊或住院治疗的IMN患者60例,采用简单随机抽样法将其分为对照组和治疗组,每组各30例。对照组患者单纯给予基础治疗,治疗组患者给予加味健肾方+基础治疗。比较两组患者治疗前后的血尿素氮(blood urea nitrogen,BUN)、血清肌酐(serum creatinine,SCr)、血清白蛋白(albumin,ALB)、24h尿蛋白定量、PLA2R滴度,评价两组患者的治疗效果。结果 治疗组患者的治疗总有效率显著高于对照组(χ^(2)=60.000,P<0.001);治疗后,治疗组患者的水肿、脘腹胀满、倦怠乏力、腰膝酸软评分均显著低于对照组(P<0.05);治疗组患者的24h尿蛋白定量、PLA2R滴度均显著低于对照组,ALB显著高于对照组(P<0.05)。结论 加味健肾方可显著改善脾肾两虚型IMN患者的临床症状,提高血清ALB水平,降低24h尿蛋白定量及PLA2R滴度。

《辅行诀》与《脏腑标本虚实寒热用药式》中肝木疾病临床表现及治疗用药的异同点分析

目的《辅行诀》与《脏腑标本虚实寒热用药式》均采用五脏虚实辨证作为理论架构,本文比较两者关于肝木疾病辨证用药的异同点,为“汤液经法图”的现代应用和理论融入提供依据。方法收集《辅行诀》与《脏腑标本虚实寒热用药式》关于肝木疾病辨证论治章节的临床症状表现和治疗药物信息,数据标准化后拆分成独立的语义概念进行比较,计算相符度。最终拆分成24个独立症状与《辅行诀》比较并计算相符度,用药药味依据“汤液经法图”五味补泻五脏规律进行定味和标记,并计算与补肝泻肝缓肝的“辛酸甘”味相符度。结果《脏腑标本虚实寒热用药式》肝木疾病包含24个症状,其中17个症状与《辅行诀》相符,相符度为70.8%,共有症状包括头痛、多怒、两胁肿痛等,《脏腑标本虚实寒热用药式》独有症状如卵缩、寒热虐等。同时,《脏腑标本虚实寒热用药式》包含76个肝木病治疗中药,其中辛味、酸味和甘味药总和占比为71.05%。结论《脏腑标本虚实寒热用药式》与《辅行诀》关于肝木疾病临床症状和治疗药物的认识有许多相同之处,相似度高达70%,两者可能具有相同的起源。五脏虚实+五味补泻辨证论治体系具有真实历史背景和临床实践价值。