Discussion on the Application of Ascending and Descending Property of Traditional Chinese Medicine in Compatibility of Clinical Prescriptions

Through the method of literature mining,the classics of traditional Chinese medicine,materia medica works,medical cases and documents are studied.Based on common prescriptions for the treatment of diseases such as abnormal Zang-fu viscera and qi movement,dysfunction,etc.,and combined with the theory of ascending and descending property of traditional Chinese medicine,the application of ascending and descending property of traditional Chinese medicine in clinical prescription compatibility and the factors affecting the application are summarized.The ascending and descending properties of traditional Chinese medicine have been widely used in prescription compatibility for the clinical treatment of impairment of purifying and descending function of the lung,spleen and stomach's ascending and descending disorders and heart-kidney noninteractionpatte.

China Association of Chinese Medicine Paper notice for seminar on clinical application of TCM classic prescriptions and herbs in the treatment of emotional diseases

Hosted by ChinaAssociation of Chinese Medicine,and organized by World Journal of Integrated traditional and western Medicine,seminar on clinical application of TCM classic prescriptions and herbs in the treatment of emotional diseaseis planned to be held in Yichang,Hubei province from June 22nd to 24th.

Clinical Study of Acupoint Application of Jiezi Fangxiao Ointment Combined with Pingchuan Prescription in the Treatment of Pediatric Asthma

[Objectives]To study the clinical effect of Acupoint Application of Jiezi Fangxiao Ointment combined with Pingchuan Prescription in the treatment of pediatric asthma.[Methods]A total of 40 children with asthma admitted to the First Affiliated Hospital of Heilongjiang University of Chinese Medicine from July 2017 to September 2018 were selected as the research subjects,and divided into control group and observation group according to random classification method,with 20 cases in each group.Among which the control group was given routine symptomatic treatment,the observation group was treated with Acupoint Application of Jiezi Fangxiao Ointment combined with Pingchuan Prescription on the basis of the control group.After 4 weeks of continuous treatment,the clinical efficacy was observed and the changes of traditional Chinese medicine symptom scores,forced expiratory volume in the first second(FEV1),maximum expiratory flow(PEF),forced vital capacity(FVC),peripheral blood eosinophils(EOS)and interleukin-17(IL-17)were compared between the two groups before and after treatment.[Results]After treatment,the traditional Chinese medicine(TCM)scores such as asthma,cough,expectoration,chest tightness,dyspnea and wheezing sound of lungs in the two groups were significantly improved,and the improvement in the observation group was superior to that in the control group.The difference was statistically significant(P<0.05).FEV1,PEF and FVC in the two groups were significantly improved after treatment,and the improvement in the observation group was superior to that in the control group.The difference was statistically significant(P<0.05);after treatment,the levels of EOS and IL-17 decreased in both groups,and the improvement in the observation group was superior to that in the control group,the difference was statistically significant(P<0.05).[Conclusions]The clinical effects of Acupoint Application of Jiezi Fangxiao Ointment combined with Pingchuan Prescription in the treatment of infantile asthma were obvious,which can significantly improve the TCM symptoms scores,pulmonary function and immune function of patients.

The clinical application of Yanghe Decoction

Yanghe Decoction is a representative prescription of such prescriptions as warming up the yang and dissipating the cold.It has the functions of warming the blood and dispelling cold and stagnation.Yanghe Decoction has effects on many diseases.The principle of this kind of disease is blood deficiency and yang,and the clinical manifestation is cold stagnation.Such diseases often occur in multiple systems and in multiple aspects.This article summarizes the compatibility of Yanghe Decoction and its clinical application by reviewing the related literature analysis in recent years,and provides a broad idea for the application of Yanghe Decoction.

Clinical efficacy of Chinese herbal compound in the treatment of infertility with kidney deficiency:A meta-analysis

Objective:Based on the current evidence system to evaluate the effect of traditional Chinese medicine compound on the clinical efficacy of infertility patients with kidney deficiency.Methods:Search the China Knowledge Resources Database(CNKI),Chinese Science and Technology Journal Database(VIP),China Academic Journal Database(Wanfang),PubMed,EMBASE,Ovid.The included studies are randomized controlled trials.The experimental group is Chinese medicine compound or Chinese medicine compound combined with western medicine,and the control group is western medicine.Two reviewers independently extracted and evaluated the literature data according to the Cochrane manual standards,and used Rev Man5.3 software for data synthesis and Meta-analysis.Results:32 studies were selected,a total of 2715 cases of infertility patients.The clinical pregnancy rate of the experimental group and the control group[n=29,OR(95%CI)=2.47(2.07,2.96),P<0.00001],the clinical total effective rate[n=20,OR(95%CI)=3.77(2.83,5.03),P<0.00001],TCM syndrome score[n=14,MD(95%CI)=4.34(3.08,5.61),P<0.00001],ovulation rate[n=20,OR(95%CI)=2.21(1.85,2.63),P<0.00001],the occurrence rate of two-way BBT[n=11,OR(95%CI)=2.65(2.02,3.48),P<0.00001].The GRADE scoring results show that the level of evidence is low and very low.Conclusion:Traditional Chinese medicine compound can increase the clinical pregnancy rate and clinical total effective rate of infertility with kidney deficiency syndrome,improve the scores of Chinese medical syndromes,increase its ovulation rate and the occurrence rate of BBT bidirectional type,and confirm the clinical efficacy of Chinese medicine compound from the perspective of evidence-based medicine.

《伤寒论》临证价值刍议

《伤寒论》临证思想研究者众多,已逐渐形成较为完善的伤寒学研究体系,然尚存不足之处,如对此书临床价值认识不全面、疫病诊治重温病轻伤寒、经典理论应对当代疾病及经方运用存在的问题等。提出《伤寒论》为百病立法,治伤寒亦治杂病;疫病诊治重温病轻伤寒,实则寒温相互羽翼;经典研究可借鉴西医思维,应对疾病须以中为基;目前经方运用重方药略理法,亟待构建规范体系等观点,为中医经典临床研究提供思路。

中重度宫腔粘连应用中医临床决策系统效果分析

[目的]探讨中医临床决策系统在治疗中重度宫腔粘连(intrauterine adhesion,IUA)中的应用及效果。[方法]采用随机对照试验进行前瞻性研究,选择2022年1月至12月在杭州市某三级甲等中医院行宫腔镜下子宫粘连松解术的中重度IUA患者,根据是否通过中医优势病种临床决策系统进行辨证论治分为对照组(51例)、决策系统组(53例)、临床医师组(54例),比较3组患者治疗前后月经量改善、美国生育协会(American Fertility Society,AFS)评分、子宫内膜厚度、子宫内膜血流参数、中医伴随症候疗效。[结果]治疗后3组患者月经量比较,决策系统组、临床医师组较对照组均有显著改善,差异有统计学意义(P<0.05),决策系统组与临床医师组差异无统计学意义(P>0.05)。治疗后3组患者宫腔AFS评分比较,决策系统组、临床医师组较对照组显著下降(P<0.01),决策系统组与临床医师组差异无统计学意义(P>0.05)。治疗后3组患者子宫内膜厚度显著增加,子宫内膜血流参数显著下降,差异有统计学意义(P<0.01),但治疗前后组间差异均无统计学意义(P>0.05)。治疗后3组患者中医伴随症候疗效比较,临床医师组较对照组、决策系统组明显改善,差异有统计学意义(P<0.05),对照组与决策系统组差异无统计学意义(P>0.05)。[结论]中医临床决策系统用于中重度IUA的治疗可显著改善患者月经量,降低术后AFS评分,防止粘连再发生。

经典名方真武汤的历史沿革及临床应用规律

目的 考证真武汤的历史沿革和应用规律,为其深入研究提供精准的文献参考。方法 以真武汤为关键词,从《中华医典》检索、整理该方1991年1月以前的古籍。以真武汤、Zhenwu decoction、Zhenwu tang为主题词从中国知网、万方数据服务知识平台、维普网和Pub Med中获取2002年1月至2022年12月的临床研究文献。考证真武汤的处方来源、药物组成、剂量、炮制、功能主治、病证要素和应用规律。结果 纳入古籍92部,真武汤首载于《伤寒论》,由茯苓、芍药、白术、附子、生姜组成。剂量以茯苓三两、芍药三两、白术二两、附子一枚、生姜三两居多。在炮制方面,芍药以生白芍为主,白术以炒用为主,附子以熟附子为主。在应用规律方面,真武汤主要治疗少阴病和太阳病,涉及的症状有腹痛、小便不利、四肢疼痛、大便自利等,脾肾阳虚、阳虚水泛、心肾阳虚是临床应用真武汤的辨证要点。真武汤的应用涉及心血管、泌尿、消化等多系统,包括心力衰竭、糖尿病肾病、肾病综合征等疾病。结论本研究体现了真武汤的传承性、稳定性、有效性和安全性,为其研发提供了科学、客观的文献依据。

蒙药乌兰—13味汤方源考证及研究概况

蒙药乌兰—13味汤(WL—13)最早记载于《通瓦嘎吉德》,之后收录于1998年版《中华人民共和国卫生部药品标准》(蒙药分册)中。WL—13由栀子、诃子、川楝子、土木香、山柰、悬钩木、苦参、茜草、紫草、紫草茸、枇杷叶、金莲花、橡子等13种单味药材配伍组成,具有清血热的功效,主治血热盛行、头痛、目赤、高血压、成熟热与未成熟热、感冒、白脉病、肺热、鼻出血、皮疹、中暑、风湿、类风湿等诸疾,具有良好的潜在研究价值。本综述探析了WL—13的历史沿革、方解、临床应用及实验研究进展,以期为该药的现代化研究提供理论支撑。

方证辨证下比较思维在中医住院医师规范化培训的运用

目的探讨方证辨证下运用比较思维新型教学模式,培养学生掌握方证的概念和建立以方证为核心的临床辨治思维。方法选取广西中医药大学附属瑞康医院2019级住院医师规范化培训(以下简称“住培”)医师及专硕并轨住培医师50人,分为5组,每组10人,均采用方证辨证下比较思维的教学方法教学。经过1年的学习后,对5组学生进行考核,每个学生需选取1例患者并独立完成整个诊治过程;考核涉及问诊能力及体格检查技能,要求写出处方,并阐述病证、方证及比较思维过程;最后进行评分并且跟踪观察疗效1个周期。结果在方证辨证教学模式下,运用比较思维教学方法培训后,学生的方证辨证能力明显优于培训前(P<0.05)。结论新型方证辨证教学模式下,运用比较思维教学方法培养学生掌握方证的概念和建立以方证为核心的临床辨治思维,能提高其临床诊疗效果,符合当代医学教育改革趋势和目标要求。

基于网状Meta分析对8个经典名方治疗不稳定型心绞痛的临床疗效评价

目的:运用网状Meta分析方法系统评价8种经典名方联合西医常规治疗不稳定型心绞痛(UAP)的临床疗效,并分别进一步比较不同经典名方治疗实证和虚证(包括虚实夹杂)2大证型的疗效。方法:检索并筛选中文科技期刊数据库(CCD)、中国生物医学文献数据库(CBM)、中国国家知识基础设施数据库(CNKI)与中国学术期刊数据库(CSPD)等数据库中关于8个经典名方(血府逐瘀汤、补阳还五汤、四妙勇安汤、丹参饮、炙甘草汤、枳实薤白桂枝汤、瓜蒌薤白半夏汤、化痰祛瘀通脉汤)联合西医常规治疗UAP的随机对照试验(RCT),检索时限从各数据库建库至2022年1月14日,采用Stata 16.0软件进行网状Meta分析。结果:共纳入60个RCT,总计5088例UAP患者,涉及9种干预措施。其中,UAP属实证的有41个RCT,UAP患者共3432例,涉及5种干预措施;虚证或虚实夹杂共13个,共1130例患者,涉及4种干预措施。网状Meta分析结果提示,枳实薤白桂枝汤+西医常规治疗总有效率最优,UAP属实证者,四妙勇安汤+西医常规治疗最佳;虚证或虚实夹杂者,补阳还五汤+西医常规治疗最佳;心电图改善方面,四妙勇安汤疗效最佳;枳实薤白桂枝汤+西医常规在降低超敏C反应蛋白(hs-CRP)改善炎症反应方面更优。结论:与西医常规治疗UAP比较,枳实薤白桂枝汤联合西药常规治疗疗效较显著。但仍需要纳入更多高质量的RCT证实。

案例教学法在临床实习睡眠呼吸暂停低通气综合征的应用

探究案例教学法在临床实习睡眠呼吸暂停低通气综合征的应用价值。方法:选取于2022年7月份至2023年6月份在我院呼吸内科实习学生共66名,采用随机分组法,每组33例。传统讲授法用于对照组,案例教学法用于观察组。观察两组实习学生考核成绩和实习综合能力。结果:观察组实习学生考核成绩高于对照组,观察组实习学生实习综合能力优于对照组(P<0.05)。结论:在内科临床实习带教中使用案例教学法,有助于提升实习生考试成绩,促进实习学生综合能力的提升,有助于提高学习兴趣,值得在以后教学工作中推广。

从阴虚痰瘀阻络论治慢性咽炎的临床应用

慢性咽炎是咽黏膜、黏膜下及淋巴组织的慢性炎症,以咽干、咽痒、咽部异物感、咳嗽、恶心干呕为主要临床症状,具有病程长、易反复发作、迁延难愈等特点。西医治疗本病以去除病因、对症用药为主,但实际用药效果受到患者个体差异与其他干扰因素的影响。中医治疗讲究辨证治疗,多从阴虚、阳虚、痰瘀、气虚诸型论治,根据证型特点确定治则,并结合患者的临床表现、中医证候特点,予以辨证加减治疗。本文就慢性咽炎中医治疗的研究进展做一简要综述,并重点对从阴虚痰瘀阻络论治思想的临床应用进行分析。

改良隔药脐灸联合敷贴序贯治疗小儿厌食症(脾气虚证)的临床观察

目的:探究与分析改良隔药脐灸联合敷贴序贯治疗小儿厌食症(脾气虚证)的临床疗效及对预后复发的影响。方法:选取我院2019年2月至2022年3月收治的小儿厌食症(脾气虚证)120例患儿,采取随机数字表法将其随机分为3组,每组各40例,对照组采用中药制剂厌食贴外敷治疗;治疗A组在对照组的基础上加用传统隔姜脐灸治疗;在对照组的基础上治疗B组加用改良隔药脐灸治疗,3组患儿均连续治疗4周,对比3组患儿的临床疗效、治疗前后主症积分和次症积分,同时对比3组治疗后4周、8周及12周的复发率。结果:治疗B组、治疗A组、对照组临床总有效率分别为95.00%(38/40)、80.00%(32/40)、62.5%(25/40),治疗B组临床总有效率均高于治疗A组和对照组(P<0.05)。3组患儿治疗后主症积分及次症积分均较治疗前降低,治疗B组患儿治疗后主症积分及次症积分均低于治疗A组、对照组,治疗A组患儿治疗后主症积分及次症积分均低于对照组,差异均有统计学意义(P<0.05)。随访8周时,治疗B组复发率[2.50%(1/40)]低于对照组[20.00%(8/40)],随访12周时,治疗B组复发率[2.50%(1/40)]低于治疗A组[17.50%(7/40)]和对照组[30.00%(12/40)],差异均有统计学意义(P<0.05)。结论:改良隔药脐灸与敷贴序贯联合治疗小儿厌食症(脾气虚证)可获得显著的临床疗效,促进改善患儿的临床症状及体征,同时在短期时间内有效避免了疾病的复发,具有较高的应用价值。

栀子药理作用及临床应用研究进展

栀子为茜草科植物栀子Gardenia jasminoides Ellis的干燥成熟果实,味苦,性寒,归心、肺、三焦经,具有泻火除烦、清热利湿、凉血解毒的功效,外用可消肿止痛。栀子属于我国药食两用资源,应用历史悠久,在我国多地种植生产,品种多样,使用范围广泛,药理作用显著,表现出较高的研究价值。国内外研究表明栀子具有解热、抗炎、降压、调脂、降血糖等功效,且对肝脏、血管、神经等都具有保护作用。该文通过对栀子的相关文献进行总结归纳,从中药栀子的品种资源分布及其活性成分含量影响因素、药理作用与多种成分之间的联系、古代医学专著中相关古方在临床的应用等方面阐明栀子优质资源分布、生物活性以及复方应用的研究,对栀子单药和复方配伍在未来更好的应用进行展望,以期为栀子后续相关研究和开发提供参考。

中医舌诊客观化研究进展

该文对舌诊的发展进行简要介绍,阐述了舌诊图像信息的采集、预处理以及分析技术等舌诊客观化研究及近5年的关于舌诊客观化在呼吸系统、循环系统、消化系统、泌尿系统、内分泌系统等方面临床应用进行综述,旨在为舌诊客观化研究提供参考,为舌诊的深入全面发展提供新思路。

中医优势病种临床决策支持系统在“混合痔”中医病历质量控制中的应用

目的:运用中医优势病种临床决策支持系统,提升中医辨证分型的准确性,提升中医病历书写理法方药的一致性,提高中医病历书写质量,提高中医诊疗服务质量。方法:采集2023年3—5月运用中医优势病种临床决策支持系统的混合痔病例163例和2022年3—5月未运用中医优势病种临床决策支持系统的混合痔病例176例,回顾性调查分析两组的方药使用量、中医辨证分型准确性、中药饮片的用药记录、病历书写的理法方药一致性。结果:两组方药使用人次、人均开方次数、人均辨证次数、方药病历记录比较,差异均无统计学意义(P>0.05)。智慧医疗辨证论治组方药内容与病历记录一致性比例[95.45%(147/154)]高于传统医疗辨证论治组[90.36%(150/166)],但差异无统计学意义(P>0.05)。智慧医疗辨证论治组的病历记录中患者病象与疾病证型一致比例[96.75%(149/154)],证型、治则治法、方药三者一致比例[86.14%(143/166)],辨证证型变更比例[56.49%(87/154)]均高于传统医疗辨证论治组的86.14%(143/166)、77.77%(129/166)和7.22%(12/166),差异均有统计学意义(P<0.01或P<0.05)。结论:使用中医优势病种临床决策支持系统有助于规范中医辨证思路,培养中医思维模式,提升病历书写者理法方药的逻辑性,有利于提高中医诊疗服务质量。

补肾健脾通络方治疗老年衰弱综合征临床疗效观察

目的观察补肾健脾通络方治疗老年衰弱综合征临床疗效及安全性。方法研究纳入2021年1月—2022年6月收治的老年衰弱综合征患者共计102例,以随机数字表法将患者分为对照组与观察组,每组51例,对照组患者采取临床常规治疗,观察组患者采取常规治疗结合补肾健脾通络方治疗。观察各组数据:治疗总有效率、治疗前后患者中医证候总积分变化及Fried表型衰弱量表(frailty phenotype,FP)评分变化及白介素-6(interleukin 6,IL-6)、超敏C反应蛋白(C-ReactiveProtein,hs-CRP)水平变化、握力变化及起立-行走计时测试(Timed Up and Go test,TUG)变化、5次坐立试验(five-times-sit-to-stand test,FTSST)变化、步速变化、体质指数(Body Mass Index,BMI)变化及四肢骨骼肌质量指数(appendicular skeletal muscle mass index,ASMI)变化、简易精神状态评分(Mini-mental State Examination,MMSE)变化、匹兹堡睡眠指数(Pittsburgh sleep quality index,PSQI)评分变化、日常生活能力(Activity of Daily Living,ADL)评分变化、微型营养评估(mini nutritionaal assessment,MNA)评分变化、患者治疗满意度、不良反应。结果观察组患者治疗总有效率比对照组高[96.08%(49/51)vs84.31%(43/51)],P<0.05;治疗前,各组患者中医证候总积分、FP评分、IL-6、hs-CRP水平、握力、TUG测试结果及FTSST测试结果、步速、BMI、ASMI、MMSE评分、PSQI评分、ADL评分、MNA评分比较,P>0.05,治疗后各组患者中医证候总积分、FP评分、IL-6、hs-CRP水平、握力、TUG测试结果及FTSST测试结果、步速、BMI、ASMI、MMSE评分、PSQI评分、ADL评分、MNA评分均改善,观察组患者治疗后中医证候总积分、FP评分、IL-6、hs-CRP水平、握力、TUG测试结果及FTSST测试结果、步速、BMI、ASMI、MMSE评分、PSQI评分、ADL评分、MNA评分均优于对照组患者,P<0.05;观察组患者治疗满意度高于对照组[98.04%(50/51)vs84.31%(43/51)],P<0.05;观察组与对照组不良反应率均较低,且可自行缓解,P>0.05。结论补肾健脾通络方治疗老年衰弱综合征临床疗效显著,能缓解衰弱综合征患者的临床症状,抑制患者机体炎性反应,增加肌肉质量,改善睡眠,提高生活质量,且无不良反应,较为安全可靠,值得应用。

逍遥散及其类方治疗干眼的研究进展

近年来,干眼发病率不断上升,越来越多人的生活质量因干眼受到影响。逍遥散以疏肝养血之效治疗眼病历史悠久,近年来在干眼治疗中的应用也逐渐增多。本文总结了以逍遥散为基础进行加减化裁的方剂在治疗普通干眼、围绝经期干眼、糖尿病性干眼、睑板腺功能障碍型干眼中的临床应用进展,发现逍遥散及其类方在治疗各种类型的干眼上疗效显著,其作用机制包括调节相关炎症因子、影响性激素、增加杯状细胞数量、减少角膜上皮细胞凋亡等,在临床上有重要的应用价值。

Sugemule-10:Source of prescription and modern clinical application

Sugemule-10,one of the traditional Mongolian medicine(TMM)formulae,is derived from Four Medical Classics(Vol.4)and composed of 10 Mongolian medicines.It is used to treat kidney cold,low back pain,urinary obstruction,kidney/bladder stones,and is the main prescription for kidney cold.The current research on Sugemule-10 is mostly focused on its clinical efficacy,and few papers are available upon its historical changes.Therefore,we systematically reviewed Sugemule-10 from the aspects of prescription source,prescription interpretation,efficacy evolution,and modern clinical applications.