Clinical Observation of Zhuang Medicine Yangxue Xiaozheng Decoction in Treating the Combined Endometriosis of Dampness and Blood Stasis in Guangxi

Objective:To explore the clinical effects of Zhuang Medicine Yangxue Xiaozheng Decoction in treating the combined Ems of dampness and blood stasis in Guangxi;Methods:100 patients with endometriosis treated in Lili Clinic of Famous Doctor,Guangxi International Zhuang Medicine Hospital from Mach 2016 to May 2017 were chosen as the research object.According to the random grouping method,patients were randomly divided into the treatment group(The Zhuang Medicine Yangxue Xiaozheng Decoction(ZYF)Group)and the control group(Chinese patent medicine SanJieZhenTongJiaoNang(SJZT)group with 50 cases in each group.After treatment,the TCM syndrome score,changes in pelvic mass size,hepatocyte growth factor(HGP)levels,and clinical effects before and after treatment were evaluated.Results:After two courses of treatment,the total effective rate of patients in the ZYF group was 88%,which were significantly better than 70%of the SJZT group.The difference was statistically significant(P<0.05).Conclusion:With a significant effect on patients with the combined Ems of dampness and blood stasis in Guangxi,Zhuang Medicine Yangxue Xiaozheng Decoction can improve the uterine cavity mass and reduce serum HGP level.

吴志洲辨证论治尿石症经验

尿石症病因病机为下焦湿热、肾气虚弱或病久血瘀等,病位在肾与膀胱,其形成过程复杂,往往虚实夹杂,为本虚标实之证。本病的“实”一般包括湿热、气滞和血瘀,“虚”一般是指肾阴虚、肾阳虚或气血两虚。吴志洲教授临证强调结合病程,常把尿石症辨证分为三型进行论治:湿热蕴结证、气血瘀滞证、肾气不足证。尿石症初期病位在肾与膀胱等贮存尿液的器官,尿石症的治疗当重视利尿,吴教授在这个阶段以清热利湿、通淋排石为法,常以张仲景的五苓散或猪苓汤作为基本方施治,观其舌苔脉象,随症加减,或配以清热之品,或参以滋阴之药,或佐以活血化瘀药配合治之,常用药物有金钱草、猪苓、茯苓、白茅根、小蓟、泽泻、泽兰、车前子、阿胶、滑石等。吴教授临证用药注意顾护肾气、做到消中寓补、标本兼施,方选知柏地黄丸,金匮肾气丸等,还要注重健脾和养肺,分别采用健脾化湿、清养肺金等法,常以参苓白术散、补肺汤等合方共治。吴教授临证治疗尿石症,注重通调气血,无论有无瘀血征象,均可在补肾利尿化石排石的基础上,佐以通调气血以加强祛石或化石作用。一是可以加大疏散溶解结石之力,二是可以松解结石与组织间的粘连,有利于结石的排出与消散。方选逍遥散、桂枝茯苓丸、血府逐瘀汤等。此外,吴教授还提倡辨病辨证应与现代医学相结合,重用单味化石排石药物,临证常大剂量应用,如黄芪、金钱草、海金沙、鸡内金等。

Efficacy of Modified Qufeng Runmian Powder(加减祛风润面散)on Acne Vulgaris with Syndromes of Dampness and Blood Stasis:A Multicenter,Randomized,Double-Blind,Placebo-Controlled Clinical Trial

Objective:To evaluate the efficacy and safety of a Chinese medicine(CM)Modified Qufeng Runmian Powder(加减祛风润面散,MQFRMP)for the treatment of acne vulgaris with CM syndromes of dampness and blood stasis.Methods:In this multicenter,randomized,double-blind,placebo-controlled clinical trial,220 acne vulgaris patients with CM syndrome of dampness and blood stasis were included and randomly assigned using a central area group random design to receive either MQFRMP or the placebo,with 110 cases in each group.MQFRMP or a placebo at 145 g/bag were administered once daily for 4 weeks,respectively.The primary index of efficacy was the effective rate according to the acne severity score(ASS).The secondary indices of efficacy included the changes in the dermatology life quality index(DLQI)score,VISIA scores(spots,pores,brown spots,porphyrins and red areas)and skin assessment(skin p H,sebum amount and hydration)according to a SOFT skin multianalyzer.Results:(1)Follow-up:a total of 204 patients completed the follow-up,with 103 in the treatment group and 101 in the control group.(2)Effective rate:the total effective rate of the treatment group was significantly higher than the control group[83.5%(86/103)vs.31.7%(32/101),P<0.01)]with 95%confidence interval of 39.3%–66.4%.(3)DLQI:DLQI scores were significantly decreased the treatment and control groups(both P<0.01),but the treatment group was more obvious than the placebo group(P<0.01).(4)VISIA scores:the scores of spots,brown spots and red areas in the treatment group decreased compared with baseline(P<0.05).In the control group,the scores of brown spots and pores decreased compared with baseline(P<0.05).The improvement was more obvious in the treatment group than in the control group for all items(P<0.05).(5)Skin assessment:the p H and sebum score in the both groups decreased drastically compared with the baseline(all P<0.01),however,the improvement was more obvious in the treatment group than in the control group(P<0.01).The hydration amount in the two groups showed no statistically significant difference compared with the baseline(both P>0.05).(6)Safety:two cases of mild drug allergy were observed in the treatment group.Conclusion:MQFRMP was effective and safe for the treatment of acne vulgaris with syndromes of dampness and blood stasis.(No.ChiCTR1900020479).

基于“坚者削之,结者散之”治疗消化道息肉理论探析

消化道息肉主要是指胃肠道息肉,目前本病临床上最常用的治疗方法为内镜下治疗,虽见效快,但并发症较多,且治疗后仍有较高的复发率。中医药对于预防本病复发有一定的优势,本课题组通过总结古今相关文献以及结合临床实践研究,认为消化道息肉的核心病机多以脾虚气滞为本,而脾胃气机壅滞进一步产生湿、痰、瘀等病理因素为标,故紧扣病机,根据“坚者削之,结者散之”理论,提出“消散法”辨治消化道息肉,临证时需灵活变通,随症加减,以期为中医药治疗消化道息肉提供新的见解。

国医大师张志远治疗隐匿性肾小球肾炎经验

总结张志远教授辨证治疗隐匿性肾小球肾炎的经验。认为该病的形成多由湿热为患,初起湿热在气,则形成蛋白尿;湿热不解,日久内扰血分,伤及脉络,则形成血尿。将该病分为湿热下注、瘀血阻络、脾肾亏虚3种证型,治疗分别以通便利湿、化瘀活血、补肾健脾为主,临证疗效好。

基于“血不利则为水”理论探讨RVO-ME形成的病机与辨治

本文基于“血不利则为水”理论阐释视网膜静脉阻塞继发黄斑水肿(RVO-ME)的中医病机和辨证治疗,认为RVO-ME的关键病机在于“血不利则为水”,因“血”病“水”。若细思忖,究其根源,“血不利”乃引起ME的中间环节,“为水”是“血不利”的病理产物,产生的主要原因在于脾、肾、肝等脏腑功能失调,血分、水分、气分功能紊乱。根据疾病特点对本病进行分期治疗,前期以急性出血为主,侧重以活血化瘀、兼以利水。病程较长时眼底水肿明显,故活血与利水并重,并基于脏腑功能失调与老年人易患本病的特点,健脾补肾疏肝以达到恢复气血,共奏消除ME、恢复视力之功。

Intra-set correlation analysis of medical records of thyroid cancer treated by traditional Chinese medicine Master ZHOU Zhongying

Objective Based on intra-set correlation analysis, this paper deconstructs the clinical medical records of traditional Chinese medicine(TCM) Master ZHOU Zhongying in treating thyroid cancer, and analyzes the experience in “mechanism-syndrome-medicine-prescription” for thyroid cancer.Methods Through Medcase data processing platform, based on Frequent Pattern(FP)-Growth enhanced correlation analysis algorithm, the medical records of Professor ZHOU Zhongying for the treatment of thyroid cancer from June 1, 2001 to February 28, 2015 were analyzed within the set.Results This study involved 43 medical records, 43 patients, and 167 visits. After processing intra-set correlations, 28 groups of highly correlated symptoms, 21 groups of highly correlated tongue images, 10 groups of highly correlated pulse conditions, 28 groups of highly correlated pathogenesis, 34 groups of highly correlated herbs, and 26 groups of highly correlated western medicine diagnosis were selected. Professor ZHOU Zhongying treats thyroid cancer according to syndrome differentiation. Symptoms with more association rules included neck swelling, neck pain, cough, and dry mouth;tongue images with more association rules included dark purple tongue, dark red tongue, and fissured tongue;pulse conditions with more association rules were wiry pulse, thready pulse, small pulse, and slippery pulse;the pathogenesis with more association rules was phlegm and blood stasis, damp-heat accumulation,and impairment of both Qi and Yin;herbs with more association rules were Chaihu(Bupleuri Radix), Zeqi(Sun Euphoribiae Herb), and Tiandong(Asparagi Radix);western medicine diagnosis with more association rules included thyroid cancer, insomnia, and chronic gastritis.Conclusion Thyroid cancer mostly presents as deficiency in origin and excess in manifestations. The basic pathogenesis is phlegm and blood stasis, damp-heat accumulation, and impairment of both Qi and Yin, which are closely related to liver, kidney, and spleen. Professor ZHOU Zhongying adopts both attack and supplement approaches as the general treatment principle, with a strong emphasis on regulating Qi and relieving depression, eliminating phlegm and resolving stagnation, eliminating dampness and turbidity, clearing fire and destroying poison, moistening dryness and softening hard mass, invigorating Qi and nourishing Yin, and paying attention to nourishing liver and kidney, invigorating spleen and stomach,while protecting the heart and lungs.

何永生教授基于虚、瘀、湿治疗慢性肾炎经验

慢性肾小球肾炎简称慢性肾炎,临床表现以血尿、蛋白尿、水肿、高血压为主,中医学认识其证候最早。何永生教授临床30余载,治疗该病经验独到,认为慢性肾炎病机不离虚、瘀、湿,在临床诊治中,通过补益肺脾肾、补血通络祛瘀、健脾淡渗利湿,辨证施治,取得了良好临床疗效。

Evaluation of the Therapeutic Effect of Contrast-Enhanced Ultrasound on Different Types of Knee Osteoarthritis in the Elderly

Objective: To evaluate the curative effect of the Traditional Chinese Medicine (TCM) external therapy on knee osteoarthritis patients with different TCM constitutions using musculoskeletal ultrasonography and contrast-enhanced ultrasonography, and to explore the application value of contrast-enhanced ultrasonography in knee joint diseases. Methods: A total of 57 patients diagnosed with knee osteoarthritis in Shaanxi University of Traditional Chinese Medicine from December 2019 to May 2021 were collected, and they were divided into qi stagnation and blood stasis type group (23 cases) and cold-dampness obstruction type group (34 cases) according to the traditional Chinese medicine method. All patients were given acupuncture combined with TCM fumigation and washing. All patients underwent musculoskeletal ultrasonography and contrast-enhanced ultrasonography before and after treatment, observed and recorded relevant data, and compared the treatment effects between the two groups. Results: 85.96% (49/57) of knee osteoarthritis (KOA) patients had suprapatellar bursa effusion, 42.1% (24/57) had iliotibial band bursae effusion, some of which had poor sound transmission, and thickened synovium was seen in most effusions, 33.33% (19/57) had osteophyte formation. Compared with before treatment, the depth of suprapatellar sac effusion in the Qi stagnation and blood stasis type group decreased after treatment (P Conclusion: Musculoskeletal contrast-enhanced ultrasonography was used to quantitatively evaluate the efficacy of TCM external therapy on KOA for different TCM constitutions. Dynamic observation of synovial lesions of knee osteoarthritis provides a valuable imaging method for evaluating the efficacy of traditional Chinese medicine.

除湿化瘀汤内服外用治疗慢性前列腺炎湿热瘀滞型临床研究

目的:观察除湿化瘀汤内服外用治疗慢性前列腺炎湿热瘀滞型的疗效。方法:108例随机分为联合治疗组、单纯中药组及成药对照组各36例,联合治疗组用除湿化瘀汤熏蒸加内服,单纯中药组用除湿化瘀汤内服,成药对照组给予前列舒通胶囊。结果:总有效率联合治疗组91.67%(33/36),单纯中药组69.44%(25/36),成药对照组72.22%(26/36),3组比较差异有统计学意义(P<0.05)。3组治疗后各项评分均降低(P<0.05),联合治疗组评分更低(P<0.05),单纯中药组治疗后与成药对照组比较差异无统计学意义(P>0.05)。3组最大尿流率与平均尿流率均提升,联合治疗组较单纯中药组及成药对照组升幅更大(P<0.05)。结论:中药内服联合熏蒸治疗慢性前列腺炎湿热瘀滞型效果较好。

宫颈高危型人乳头瘤病毒感染患者中医体质类型分布研究

目的:分析宫颈高危型人乳头瘤病毒(high risk human papilloma virus,HR-HPV)感染患者中医体质类型分布特点,为中医药调理体质防治宫颈HR-HPV感染提供依据。方法:选择2019年1月至2020年12月就诊于河南中医药大学第一附属医院妇科门诊及体检中心的420例宫颈HR-HPV感染者作为观察组,选择420例同时段宫颈HR-HPV检测阴性者为对照组。分析两组中医体质类型分布情况、观察组不同年龄段中医体质类型分布情况、观察组不同HR-HPV基因型别中医体质类型。结果:观察组中医体质分布依次为:痰湿质(30.50%)>湿热质(19.00%)>平和质(15.50%)>阳虚质(14.80%)>气虚质(10.00%)>阴虚质(5.90%)>瘀血质(2.70%)>气郁质(1.70%);对照组中医体质分布依次为:平和质(73.30%)>湿热质(8.40%)>阴虚质(5.70%)>痰湿质(4.50%)>气虚质(4.30%)>阳虚质/瘀血质(1.80%)>气郁质(0.20%)。两组中医体质类型比较,差异具有统计学意义(P<0.05),其中,痰湿质、湿热质、阳虚质、气虚质,两组间比较,差异具有统计学意义(P<0.001)。观察组体质类型居前三位的是痰湿质、湿热质、阳虚质,占全部体质类型的64.30%。对照组平和质324例,占比73.50%,观察组平和质81例,占比15.50%,两组间比较,差异具有统计学意义(P<0.001)。观察组中,痰湿质、阳虚质、阴虚质主要见于46~55岁,湿热质、气虚质、气郁质主要见于36~45岁,组间比较差异具有统计学意义(P<0.05)。两组宫颈HR-HPV16、18型和非16、18型中医体质比较,差异无统计学意义(P>0.05)。结论:痰湿质、湿热质、阳虚质为宫颈HR-HPV感染人群的易感体质;痰湿质、湿热质、阳虚质与年龄具有相关性,痰湿质多见于36~45岁,湿热质、阳虚质多见于46~55岁,HR-HPV基因型别与中医体质类型之间无明显相关性。

慢性心力衰竭气虚血瘀证潜在亚组人群特征探索研究

目的探索慢性心力衰竭(CHF)气虚血瘀证潜在亚组人群,为心力衰竭的中医精准辨治提供客观依据。方法收集126例CHF气虚血瘀证患者的19种症状/体征指标和21种生化指标,利用R和Python软件进行K-mediods聚类算法分析,以轮廓系数确定最佳的聚类数目。组间比较,连续变量采用Kruskal-Wallis检验,分类变量采用Pearson's chi-squared检验或者Fisher's exact检验。结果CHF气虚血瘀证患者被聚类为3组,组间比较发现,气喘、不寐、颈脉怒张、纳差、畏寒5个症状/体征以及NYHA分级、氨基末端脑钠肽前体(NT-proBNP)、红细胞比容、尿素氮4个临床指标差异具有统计学意义(P<0.05)。第1组人群整体各症状/体征发生频率和临床指标严重程度相对较低;第2组人群以颈脉怒张发生频率较其他组高为特征,且促甲状腺激素、总胆固醇及低密度脂蛋白有偏高趋势,血小板有偏低的趋势;第3组人群以畏寒、纳差、不寐的发生率较其他组显著升高为特征,伴随尿素氮增高、红细胞比容降低。结论CHF气虚血瘀证潜在3种亚型,分别是气虚血瘀证本证型、气虚血瘀兼痰浊型、气虚血瘀兼阳虚型。

舌诊在慢性肝病中的应用刍议

舌诊作为中医特色诊法之一,在肝病的诊治与预防中具有重要意义。慢性肝病患者在不同的病理阶段有不同的舌象改变。舌色可反映肝病轻重缓急,如缓解期多见淡红舌,发作期多见红绛舌,而严重肝病多见青紫舌;舌形可反映肝病形气神,其中长条舌、圆柱舌是慢性肝病的常见舌形,舌缘肿大或者肝积舌多代表慢性肝病中的占位性病变;舌苔与肝病轻重及疾病预后有关,还可辅助诊断慢性肝病的细菌感染情况。此外,舌象在慢性肝病的临床用药指导中也具有重要意义,可多方面、多角度指导临床。

从“湿热、血瘀、脾虚”辨治糖尿病合并肛瘘

与普通肛瘘相比,糖尿病合并肛瘘在临床中更需要特别关注。本文基于中医典籍,结合现代研究及临床经验,从“湿热、血瘀、脾虚”角度探析糖尿病合并肛瘘的辨治,认为“湿热、血瘀、脾虚”为糖尿病合并肛瘘的核心病机,脾虚为本,湿热为标,随着病程进展各有侧重。起病初期,以湿热为主,病程中后期,多以脾虚为主,血瘀贯穿全程。治疗应辨清虚实,随证遣方用药。

基于“三因四证”调整免疫炎症状态的中医药治疗心血管疾病研究述评

动脉粥样硬化是心血管疾病发生发展的重要病理基础,物质代谢异常和免疫炎症反应是其发生发展的重要原因,由此导致的免疫炎症状态贯穿其病理始终。本文以“病”(心力衰竭)为切入点,结合心脉相关理论,总结气、血、水“三因”病机与免疫炎症状态的相关性。心气、心血、心水异常可出现在心力衰竭的不同阶段,持续的免疫炎症状态贯穿心力衰竭始终。同时,岭南地区常年湿热的气候环境因素及人群气虚、阳虚和湿热体质与免疫炎症状态发生密切相关,“积湿生热”及“湿自热生”的湿热相互转化机制使得岭南地区心血管疾病的病机以气虚痰浊夹瘀多见。在此基础上,痰、瘀、湿、热等伏匿机体的多种病理产物在疾病发展过程中累积,久酿而成内生伏毒,由此总结性归纳将痰、瘀、湿、毒“四证”与免疫炎症状态紧密联系。本文用“病—证—治”关联视角探讨中医药防治心血管疾病,融合治未病思想,从理论到应用,从基础到临床,以期为进一步制定和实施中医药诊疗方案提供理论指导。

陈华教授从“阴虚瘀热”论治小儿反复呼吸道感染经验总结

[目的]总结陈华教授从“阴虚瘀热”论治小儿反复呼吸道感染的经验。[方法]通过随师临证,总结整理病案资料,阐释陈师治疗小儿反复呼吸道感染的临床经验及方药特色,并通过临床验案加以佐证。[结果]陈师认为,小儿反复呼吸道感染病因为风、痰、瘀、虚,病机为肺脾两虚,痰瘀阻络,迁延不愈,瘀热互结,创新性地提出从“阴虚瘀热”辨治小儿反复呼吸道感染,总结出重视风邪,祛风解表;三因制宜,滋阴清瘀;详辨虚实,巧用和法;顾护中焦,健运脾胃的诊治经验。验案为反复呼吸道感染患儿,辨为阴虚感冒,兼痰瘀阻滞证,陈师分期论治,滋阴清瘀治法贯穿疾病治疗的中后期,迁延期养阴退热、化痰祛瘀,恢复期养阴退热、健脾益气,疗效显著。[结论]陈师继承浙派中医儿科特色,从“阴虚瘀热”辨治小儿反复呼吸道感染,疗效显著,对指导临床有较高实用价值。

血热型寻常性银屑病辨治思考

在审证求机的中医思维指导下,发现血热型寻常性银屑病的“血热”只是表象,其背后隐藏着不同的病因病机,风热蕴毒入血、肝经郁热入血是其主要的两种证候,故确立以解毒和疏肝解郁治本、以清热凉血治标的总原则,可选翘根犀角地黄汤解毒凉血、丹栀逍遥散疏肝解郁,随证治之。

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。

基于虚痰浊瘀论治伴有胰岛素抵抗的肥胖症

当今,伴有胰岛素抵抗的肥胖症已成为主要代谢性疾病之一。中医学理论认为,虚、痰、浊、瘀在伴有胰岛素抵抗的肥胖症患者的发生、发展及病理改变中具有重要作用。其以脾虚为发病内在基础,由此而生的痰浊、血瘀既是疾病发展中的病理产物,亦是加速疾病进展的病理因素,随着疾病的发展过程表现出不同的特性,直接或间接损伤机体。基于伴有胰岛素抵抗的肥胖症“虚-痰-浊-瘀”的疾病发展过程,提出“补虚健脾化痰”“清热化痰降浊”“化浊祛瘀除湿”等相应对策,为中医药辨治肥胖提供思路。

基于“内热-气血津液不归正化-脉积”探讨糖尿病大血管并发症病因病机

大血管病变是糖尿病患者致残、致死的主要原因之一。中医药治疗效果确切,但理论发展相对滞后。传统的消渴病理论未能与大血管并发症联系起来以指导现代中医临床诊疗,缺少原发病与并发症之间的“桥梁性”理论。因此,基于临床实践、文献梳理和科学研究,文章提出了“内热-气血津液不归正化-脉积”的观点,认为糖尿病大血管病变早期以壮火为枢,煎灼水谷为陈气,中期以阴火为枢,引动陈气为痰瘀,晚期以虚火为枢,固化痰瘀为癥积。在治疗上,以除热消积为治疗原则,依据内热的偏重以及“陈气-痰瘀-癥积”的动态演变灵活用药。早期清透壮火,除陈气,中期调理气火,除痰瘀,晚期补虚除热,消癥积,冀为临床防治提供新的思路与方法。