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.

Effect of Soothing Gan(Liver) and Invigorating Pi(Spleen) Recipes on TLR4-p38 MAPK Pathway in Kupffer Cells of Non-alcoholic Steatohepatitis Rats

Objective: To investigate the mechanism of inflammatory-mediated toll-like receptor 4(TLR4)-p38 mitogen-activated protein kinase(p38 MAPK) pathway in Kupffer cells(KCs) of non-alcoholic steatohepatitis(NASH) rats and the intervention effect of soothing Gan(Liver) and invigorating Pi(Spleen) recipes on this pathway. Methods: After 1 week of acclimatization, 120 Sprague-Dawley male rats were randomly divided into 8 groups using a random number table(n=15 per group): normal group, model group, low-dose Chaihu Shugan Powder(柴胡疏肝散, CHSG) group(3.2 g/kg), high-dose CHSG group(9.6 g/kg), low-dose Shenling Baizhu Powder(参苓白术散, SLBZ) group(10 g/kg), high-dose SLBZ(30 g/kg) group, and low-and highdose integrated recipe(L-IR, H-IR) groups. All rats in the model and treatment groups were fed with a high-fat diet(HFD). The treatments were administrated by gastrogavage once daily and lasted for 26 weeks. The liver tissues were detected with hematoxylin-eosin(HE) and oil red O staining. Levels of liver lipids, serum lipids and transaminases were measured. KCs were isolated from the livers of rats to evaluate the mRNA expressions of TLR4 and p38 MAPK by real-time fluorescence quantitative polymerase chain reaction, and proteins expressions of TLR4, p-p38 MAPK and p38 MAPK by Western blot. Levels of inflammatory cytokines including tumor necrosis factor α(TNF-α), interleukin(IL)-1 and IL-6 in KCs were measured by enzyme-linked immunosorbent assay. Results: After 26 weeks of HFD feeding, HE and oil red O staining showed that the NASH model rats successfully reproduced typical pathogenesis and histopathological features. Compared with the normal group, the model group exhibited significant increases in body weight, liver weight, liver index, serum levels of total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol, and aspartate aminotransferase as well as TC and TG levels in liver tissues, and significant decrease in serum level of high-density lipoprotein cholesterol(P<0.05 or P<0.01), while those indices were significantly ameliorated in the H-IR group(P<0.05 or P<0.01). Higher levels of TNF-α, IL-1 and IL-6 in KCs were observed in the model group compared with the normal group(P<0.01). Significant decreases in TNF-α, IL-1 and IL-6 were observed in the H-SLBZ, H-IR and L-IR groups compared with the model group(P<0.05 or P<0.01). The m RNA expressions of TLR4 and p38 MAPK and protein expressions of TLR4, p38 MAPK and p-p38 MAPK in KCs in the model group were significantly higher than the normal group(P<0.01), while those expression levels in the L-IR and H-IR groups were significantly lower than the model group(P<0.05 or P<0.01). Conclusions: Inflammation in KCs might play an important role in the pathogenesis of NASH in rats. The data demonstrated the importance of TLR4-p38 MAPK signaling pathway in KCs for the anti-inflammatory effect of soothing Gan and invigorating Pi recipes.

Effects of Soothing Liver and Invigorating Spleen Recipe on Lipid Metabolism Disorders in Kupffer Cells of NAFLD Rats by LXRα/SREBP-1c Signal Pathway

Objective To investigate the mechanism of lipid metabolism disorders in Kupffer cells （KCs） of non-alcoholic fatty liver disease （NAFLD） rats mediated by LXRα-SREBP-lc pathway and the interference of soothing liver and invigorating spleen recipe （SLISR） on it. Methods SD male rats were randomly divided into five groups： normal, model, soothing liver recipe （SLR）, invigorating spleen recipe （ISR）, and soothing liver and invigorating spleen recipe （SLISR） groups. The rats in treatment groups were administered for 8 weeks. The liver tissue was stained with H＆E and oil red O. The levels of hepatic lipid and blood lipid were measured by biochemical analyzer. KCs were isolated from the livers of rats to evaluate the expression of LXRα, SREBP-1 C, and FAS mRNA by real-time fluorescence quantitative PCR tests; LXRα, SREBP-1C, and FAS proteins were measured by Western blotting. Results The H＆E and oil red O staining results showed that the model rats successfully reproduced typical pathogenetic and histopathological features of NAFLD. The levels of hepatic lipid and blood lipid in the model rats were dramatically increased. Compared with the model group, the values of hepatic lipid and blood lipid in the treatment groups were significantly ameliorated （P〈 0.05, 0.01 ）. The yields of purified KCs from each rat were 2×10^7-3×10^7. The viability of KCs was higher than 95%, with the purity over 90.18%. Compared with the model group, the expression of LXRα, SREBP-1C, and FAS mRNA and proteins was decreased in all treatment groups, especially in the SLR group （P〈 0.05）. Conclusion SLISR may protect liver against injury included by lipid metabolism disorders in KCs through LXRα/ SREBP-1 c signaling pathway, which may be an important mechanism for the prevention and treatment of NAFLD.

Controlled observation on the efficacy of acupuncture and western medicine on diarrhea-type irritable bowel syndrome

Objective To compare the difference in the therapeutic effects on diarrhea- type irritable bowel syndrome （D-IBS） between acupuncture based on soothing the liver and strengthening the spleen and western medicine. Methods Seventy cases were randomized into an acupuncture group and a western medicine group, 35 cases in each one. In the acupuncture group, the conventional acupuncture was applied at Tianshu {天枢 ST 25）, Zusanli （足三里 ST 36）, Shangjuxu {上巨虚 ST 37）, Sanyinjiao （三阴交 SP 6）, Taichong （太冲 LR 3） and so on. Electric stimulation was supplemented at bilateral ST 25. The treatment was given once a day, 3-4 treatments in a week. In the western medicine group, pinaverium bromide （dicetel） was prescribed for oral administration, 50 mg each time, three times a day. Four weeks made one session in the two groups. Separately, before treatment and after 1 session treatment, the integral of clinical symptom and the score in the scale of the quality of life measure for irritable bowel syndrome （IBS-Q OL） were observed for the patients in the two groups. The efficacy and recurrence rate were assessed in the two groups. Results The symptom integral and IBS-QOL score in the two groups were improved significantly after treatment Call P〈0.01）, and the improvements in the acupuncture group were superior to that in the western medicine group （P〈0.01）. The effective rate was 94.3% {33/35） in the acupuncture group, which was superior to 77.1% （27/35） in the western medicine group （P〈0.01）. In 3 months, the recurrence rate was 36.4% （12/33） in the acupuncture group, which was lower apparently than 72.0% （18/25） in the western medicine group （P〈O.01）. Conclusion Acupuncture therapy based on soothing the liver and strengthening the spleen achieves the superior efficacy on D-IBS as compared with western medication, pinaverium bromide. This therapy improves apparently the quality of life of the patients and is lower in recurrence rate.

汪龙德运用疏肝健脾法从脾胃论治干燥综合征经验

介绍汪龙德主任医师运用疏肝健脾法从脾胃论治干燥综合征的临床经验和学术思想。认为干燥综合征的关键病机是肝郁脾虚,发病部位在肝脾,属虚实夹杂证,临证强调运用疏肝健脾法为基本治法,使肝气畅达,疏泄正常,气行血行,则瘀血渐除,气机布散津液于全身;脾胃健运,气血津液化生有源,痰饮水湿自化,则清窍腠理得以濡润。辅以清热润燥、养血生津、活血祛瘀,标本同治,可获良效。并结合案例,介绍了疏肝健脾法治疗干燥综合征的应用,以期为临床诊疗提供参考。

Treatment for non-alcoholic steatohepatitis with type 2 diabetes by traditional Chinese medicine:a case report and experience

Non-alcoholic fatty liver disease and type 2 diabetes are common comorbidities or target organ damage,which can lead to adverse metabolism and increased risk of cardiovascular and cerebrovascular diseases.In the management plan of non-alcoholic fatty liver disease and type 2 diabetes,there is no drug with significant efficacy or both.The dialectical idea of traditional Chinese medicine has a good curative effect and significant advantages in treating metabolic disorders.The author now reviewed a case of non-alcoholic steatohepatitis combined with type 2 diabetes.In this case,the method of invigorating the spleen and eliminating turbidity was effective,which effectively prevented the progression of liver disease in the patient,and T2DM was alleviated by maintaining within the standard range after the use of insulin was stopped.It can be said that“killing two birds with one stone”,more fully reflects the advantages of traditional Chinese medicine in the integrated treatment of metabolic-related diseases.

张忠德运用平调五脏法辨治阻塞性睡眠呼吸暂停低通气综合征的经验

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种常见的睡眠呼吸障碍性疾患,易引起多器官、多系统损害;可归属中医学的“鼾证”。全国名中医张忠德教授以平调五脏法辨治阻塞性睡眠呼吸暂停低通气综合征,强调五脏“失衡”的发病机理;认为肺气失于宣降是OSAHS的发病之基础;“脾胃失于运化,痰湿内生”是OSAHS的关键致病因素,“心肾之阳虚,肝血之不足”是OSAHS的发病之根本。发病过程中五脏之间阴阳气血此消彼长,从而导致疾病的发展。辨证治疗以“平”为度,通过“平调”的思维,以“健脾、宣肺、温心肾、养肝血”为治则,五脏同调,从而达到各脏器间的动态平衡,起到治疗疾病的目的。

升阳泻湿法治疗非酒精性脂肪性肝病初探

非酒精性脂肪性肝病是目前的多发病,为多因素所致,严重影响公共健康,目前对于该病的证治报道较多。该病的临床表现多数不典型,病机证候复杂,笔者汲取李东垣理论思想中升发脾之清气,以及黄元御理论思想中泻湿疏木的治法,把二者进行优化组合,拟定了升阳化湿,培土疏木为治疗大法运用于临床,立足于“湿”,分为“湿浊内蕴”和“脾虚湿困”2个证型,驭繁就简,取得了理想的临床疗效。

基于形气神三位一体生命观论治卵巢早衰性不孕

形气神三位一体生命观是古人对人体生命的基本认知。卵巢早衰(premature ovarian failure,POF)是卵巢功能丧失的终末阶段,是困扰当代育龄期妇女生活、生育的一大难题。中医认为,人是形、气、神三位一体的有机整体,形、气、神三者中的任何一者发生异常都可能直接导致疾病的发生并影响另二者的功能。该文从肾精亏虚及脾失健运导致形体失常、少阳枢机不利而致气机失调、肝气郁结而致神机失守3个方面来认识卵巢早衰性不孕的发病机制,并基于恢复形气神三位一体正常态的治疗思想,采用补肾健脾以补形、运转枢机以理气、疏肝养血以安神之法指导卵巢早衰性不孕的中医治疗。基于“形气神三位一体生命观”论治卵巢早衰性不孕,可深化对卵巢早衰不孕的病因病机认识,充分发挥中医调经种子的优势。

基于“土虚木郁”探讨腹泻型肠易激综合征与溃疡性结肠炎共同发病机制及证治

腹泻型肠易激综合征(IBS-D)与溃疡性结肠炎(UC)是临床较为常见的消化系统疾病,二者虽在疾病性质上有所不同,但在临床症状表现、发病机制及治疗策略等方面有诸多类似之处。基于对中医古籍的研究及临证经验的总结,众多中医学者认为“土虚木郁”是此二者疾病共同的发病机制,治疗时从肝脾论治往往可取得满意的临床疗效。多项现代医学研究表明中医“土虚木郁”与脑肠互动异常、肠道菌群-胆汁酸轴失衡等IBS-D和UC共同的病理生理学改变密切相关。该文基于中医“异病同治”理念及现代医学研究进展,以“土虚木郁”为切入点,探讨IBS-D和UC共同的发病机制及临床证治。

谢晶日教授运用“疏郁通降”法治疗胃食管反流病经验撷英

阐述谢晶日教授运用“疏郁通降”法治疗胃食管反流病的经验,谢晶日教授临床治疗胃食管返流病的常用治法有疏肝理气、抑酸止痛、通畅腑气、和降胃气及固护脾胃,通过运用以上治疗方法,临床上可以减少胃食管反流病的发生率,提高患者生活质量,并附验案1则。

基于网络药理学和分子对接探讨健脾疏肝方治疗非酒精性脂肪性肝病的作用机制

目的:运用网络药理学和分子对接的方法,探索健脾疏肝方治疗非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)的潜在机制。方法:利用中药系统药理学数据库与分析平台(traditional Chinese medicine systems pharmacology,TCMSP)和已发表的文献筛选健脾疏肝方的活性化合物和潜在作用靶点,利用人类基因数据库(GeneCards)、在线人类孟德尔遗传数据库(online mendelian inheritance in man,OMIM)和药物靶标数据库(therapeutic target database,TTD)筛选NAFLD的相关靶点,预测健脾疏肝方治疗NAFLD的潜在靶点。利用STRING数据库和Cytoscape软件构建共同靶标的PPI网络。利用DAVID数据库及微生信云平台进行基因本体(gene ontology,GO)和京都基因与基因组百科全书(kyoto encyclopedia of genes and genomes,KEGG)通路富集分析。最后利用AutoDock Vina和Pymol软件对核心靶点和主要活性化合物进行分子对接。结果:共筛选出117个活性化合物和279个潜在靶标,其中槲皮素(Quercetin)、木犀草素(luteolin)、豆甾醇(Stigmasterol)、山柰酚(kaempferol)为健脾疏肝方主要活性化合物。PPI网络显示白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子(tumor necrosis factor,TNF)、信号转换器和转录激活因子3(signal transducer and activator of transcription 3,STAT3)、前列腺素内过氧化物合酶2(prostaglandin-endoperoxide synthase 2,PTGS2)和血管内皮生长因子A(vascular endothelial growth factor,VEGFA)是关键靶蛋白。KEGG通路富集分析结果显示,癌症、TNF、乙型病毒性肝炎、MAPK、PI3K-Akt及NAFLD信号通路可能是健脾疏肝方干预NAFLD的潜在机制。分子对接结果表明,健脾疏肝方主要活性化合物与核心靶标具有良好的结合能力。结论:健脾疏肝方可以通过多组分、多靶点及多通路起到干预NAFLD的作用。

基于土壅木郁理论探讨铁死亡与代谢相关脂肪性肝病的关系

代谢相关脂肪性肝病(MAFLD)作为一种常见肝病,发病机制复杂,但多与机体代谢障碍有关,如高脂血症、肥胖、胰岛素抵抗等。脾的运化功能与机体代谢的关系已被多次证实,中医学也认为MAFLD虽病位在肝,但与脾密切相关。现代研究发现以铁代谢紊乱为基础的铁死亡在MAFLD向炎症、纤维化进展中起到重要作用。本文基于传统医学的土壅木郁理论,从铁死亡发生过程中铁代谢及脂质过氧化物聚集机制分析中医学的肝与脾在MAFLD发生发展中的作用,提出健脾疏肝可通过抑制铁死亡从而起到防治MAFLD作用的新途径。

从肝脾论治视网膜静脉阻塞继发黄斑水肿

根据肝脾与目的关系,从肝脾两脏生理上相互为用、病理上相互传变的特点出发,分析肝郁脾虚在视网膜静脉阻塞继发黄斑水肿(Macular edema secondary to retinal vein occlusion,RVO-ME)发生发展中的作用,结合疾病临床特点,认为RVO-ME的病机本质为肝郁脾虚,以致痰湿等病理产物堆积,形成肝郁脾虚-痰湿瘀血-肝郁脾虚的恶性循环,致使机体正虚邪实形成黄斑水肿。因此文中从肝脾理论出发,以疏肝健脾为主要治疗原则,以期丰富RVO-ME的中医病机理论和临床辨证施治证据。

基于数据挖掘的功能性消化不良中医证型分布及用药规律研究

目的探究功能性消化不良的中医辨证分型及用药规律,为该病的中医治疗提供参考。方法检索中国知网(CNKI)、万方数据库(Wangfang)、维普数据库(VIP)、PubMed、Web of Science数据库中有关中医药治疗功能性消化不良的临床研究文献,收集中药复方,建立数据库,使用Excel 2019、Clementine 12.0和SPSS 21.0对功能性消化不良的中医证型、中药使用频次、功效分类、性味归经进行频次统计,并对高频药物进行关联规则分析、因子分析和聚类分析。结果共纳入文献428篇,提取处方442首,涉及中药225味,高频药物24味,其中党参、茯苓、陈皮、柴胡的使用频次最多,功效分类以补虚药、理气药最为常见,药性以温为主,药味以苦、辛、甘为主,多归脾、肺、胃经;关联规则分析得到20种药物组合,因子分析提取了9个公因子,聚类分析可将药物分为4类。功能性消化不良肝胃不和证最多,对其进行关联规则分析得到12种药物组合,因子分析提取了3个公因子,聚类分析可将药物分为2类。结论中医临床治疗功能性消化不良以益气健脾、疏肝行气药为主,甘温补虚、辛开苦降,辨证配伍化湿、解表、清热等药物。

基于“湿热蕴毒”探讨宫颈高危型人乳头瘤病毒感染“炎-癌转化”的中医药干预思路

“炎-癌转化”是宫颈由高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)感染发展至宫颈癌的重要机制之一。持续性宫颈HR-HPV感染作为宫颈癌的重要诱因,其引起的局部非可控性炎症微环境是宫颈癌发生的内在机制。“炎-癌转化”的宏观及微观病理过程均与中医“湿热蕴毒”的病机演变相契合,湿热聚结为“炎-癌转化”的驱动因素;湿热久蕴致脾虚肝郁为其病机演变特征;湿热久稽,肝脾失调,瘀滞蕴结胞门,终成“癌毒”。持续性宫颈HR-HPV感染所致的“炎-癌转化”进程主要责之于中医的湿、热、虚、毒病理因素。调控持续性宫颈HR-HPV感染炎性微环境为宫颈癌防治的重要途径。临证时以清热燥湿、健脾疏肝为核心治法,攻伐有道、内外同调,以截断“炎-癌转化”的进程。基于“湿热蕴毒”探讨持续性宫颈HR-HPV感染“炎-癌转化”进程,可为中医防治宫颈癌及中医药干预“炎-癌转化”提供思路。

疏肝健脾法治疗活动期甲状腺相关眼病并发干眼症的临床研究

【目的】探讨疏肝健脾法治疗活动期甲状腺相关眼病(TAO)并发干眼症的疗效,为临床治疗提供参考依据。【方法】将108例活动期TAO并发干眼症肝郁气滞证患者随机分为观察组和对照组,每组各54例。2组患者均给予维持Graves病的常规治疗,在此基础上,对照组给予激素冲击疗法(注射用甲泼尼龙琥珀酸钠静脉滴注)治疗,观察组在对照组的基础上联合中药疏肝健脾方治疗,疗程为12周并复诊随访至6个月。观察2组患者治疗前后临床活动性分级评分(CAS)、突眼度、眼表疾病指数(OSDI)评分、角膜荧光素染色(FL)评分、泪液分泌试验(SIT)和泪膜破裂时间(BUT)的变化情况,并评估2组患者的临床疗效。【结果】(1)疗效方面,治疗6个月后,观察组的总有效率为94.44%(51/54),对照组为74.07%(40/54),组间比较(χ2检验),观察组的疗效明显优于对照组(P<0.05)。(2)活动性、突眼度和OSDI方面,治疗后,2组患者的CAS评分、OSDI评分和突眼度均较治疗前降低(P<0.01),且观察组的降低幅度均明显优于对照组(P<0.1)。(3)泪液分泌功能方面,治疗后,2组患者的SIT、FL评分、BUT均较治疗前改善(P<0.01),且观察组的改善幅度均明显优于对照组,差异均有统计学意义(P<0.01)。【结论】疏肝健脾法治疗活动期TAO并发干眼症肝郁气滞证患者具有较好的临床疗效,可有效减轻突眼度,延长泪膜破裂时间,增加泪液分泌,促进角膜上皮修复,改善视功能,提高生活质量。

王济华治疗风湿病经验

王济华教授认为,风湿病的基本病机为人体阴阳失调,正气亏虚,外感风寒湿邪,表邪入里郁而化热,导致痹阻关节、肌肉、筋骨,病情日久多见肝肾不足、气血亏虚、脾虚湿胜、痰瘀交阻等。王教授治疗风湿病常个体化分辨患者风寒湿之偏重、阴阳气血之盛衰,遵循轻微解表发汗,兼顾温经止痛,重视健脾化湿、热痹当清、调补气血、虫类药化瘀剔络、滋补肝肾等治痹要点,组方精妙、配伍严谨、疗效肯定,可有效缓解关节炎症,减轻症状,改善患者生活质量。王济华教授强调,对于沉寒痼冷痹阻络脉,一般温药不能奏效,必用附子、乌头之品,用药时需要注重辨证准确、炮制方法得当、用量适度,且需在正确配伍的前提下间断运用,密切观察,以防蓄积中毒,而达到增效减毒的目的。

从疏肝补肾健脾论治高泌乳素血症

高泌乳素血症是一种内分泌紊乱性疾病,可影响男女的生殖功能,属中医“乳泣”等范畴。笔者导师曹振健认为,本病应以肝郁、肾虚、脾虚为辨证要点,采用疏肝、补肾、健脾为治疗原则,同时兼顾气滞、血瘀、痰湿等病理因素。其据此拟定清乳汤(柴胡、炒白芍、生麦芽、香附、当归、黄芪、白术、茯苓、续断、桑寄生、菟丝子、女贞子、甘草),并归纳出肝气郁结、肝郁化火、气滞血瘀、肝肾阴虚、脾肾阳虚、肝郁脾虚、脾虚痰湿7种临床常见证型,治疗在主方基础上进行加减,探索中医药治疗高泌乳素血症的临床方法。

基于“双枢同调”论柴平汤在内伤杂病中的应用

“百病生于气”,气机的升降出入不畅往往是内伤杂病产生的关键,其中脾胃为三焦升降之枢纽,少阳为内外阴阳出入之枢纽,基于肝脾二者在生克五行和中土五行中存在相生相克的复杂关系,应用“双枢同调”的治疗原则,以柴平汤加减治疗内伤杂病,疏肝健脾,调畅人体气机,恢复人体阴平阳秘,对于临床上多种内伤杂病的治疗具有较好疗效。