Meta-analysis of Therapeutic Efficacy of Purgation and Catharsis Method for Treating Severe Pneumonia

[Objectives]To make a systematic evaluation on the therapeutic efficacy of purgation and catharsis method combined with western medicine in treatment of severe pneumonia.[Methods]The literatures were retrieved from China Knowledge Infrastructure(CNKI),Chinese science and technology journal full-text database(VIP database,VIP),Wanfang Data,the Chinese biomedical database,PubMed,Embase,and the Cochrane Library.The retrieval time was set to the period from the creation of the database to June 2020.The randomized controlled trial(RCT)was conducted on the comparison between the purgation and catharsis method combined with western medicine and the western medicine alone in the treatment of severe pneumonia.The literature information was extracted and the methodological quality of the included literature was evaluated according to the bias risk assessment tool developed by the Cochrane Collaboration.Meta-analysis was performed with the aid of RevMan 5.3 software for the patient response rate,acute physiology and chronic health evaluations II(APACHE II),clinical pulmonary infection score(CPIS),oxygenation index(OI),procalcitonin(PCT),mechanical ventilation time,etc.[Results]A total of 20 articles were included,involving a total of 1661 patients,and the literature quality was low.Meta analysis results showed that compared with the treatment by western medicine alone,the purgation and catharsis method combined with western medicine can further improve the response rate[RR=1.21,95%CI(1.14,1.27),P<0.00001],and reduce the APACHE II score[WMD=-5.92,95%CI(-7.94,-3.89),P<0.00001],reduce CPIS score[WMD=-1.41,95%CI(-1.70,-1.12),P<0.00001],increase oxygenation index[WMD=39.52,95%CI(29.39,49.65),P<0.00001],reduce PCT level[WMD=-2.85,95%CI(-3.68,-2.01),P<0.00001],shorten the mechanical ventilation time[WMD=-13.00,95%CI(-16.51,-9.48),P<0.00001].[Conclusions]Within the scope of the study included,the purgation and catharsis method combined with western medicine in the treatment of severe pneumonia can further reduce the pulmonary infection,reduce PCT levels,increase oxygenation index,and improve vital organ functions,thereby improving clinical efficacy,shortening the mechanical ventilation time(MVT),and reducing the economic burden of patients.

Research progress of heat-clearing and dampness-removing method to improve the inflammatory microenvironment of gout

Gout is a metabolic bone and joint disease caused by purine metabolism disorder.The disturbance of inflammatory microenvironment caused by monosodium urate(MSU)deposition is an important pathological mechanism of gout occurrence and development.In the understanding of Traditional Chinese medicine(TCM),the interaction of"dampness","heat"and"stasis"is the main pathogenesis of gout,and the method of clearing heat and removing dampness is the main treatment method of TCM for gout.In recent years,studies have found that heat-clearing and dampness-removing method can improve the TCM symptom score of gout patients,especially in the body tiredness,dry mouth and dry throat,short yellow urine,thirsty,etc.,which are the characteristics of dampness and heat syndrome,this may be related to the fact that the TCM heat-clearing and dampness-removing method in the treatment of gout removes the appearance of dampness and heat,improves the inflammatory microenvironment of gout and restores the normal metabolic function of human body.This paper deeply explores the specific mechanism of TCM heat-clearing and dampness-removing method to improve the inflammatory microenvironment of gout,which can provide new ideas for the diagnosis and treatment of clinical gout.

Simultaneous determination of chlorogenic acid and baicalin in heat-clearing and detoxicating oral liquid by NIRS

The calibration model for simultaneous deter-mination of chlorogenic acid and baicalin in heat-clearing and detoxicating oral liquid was built by partial least squares and near infrared spectroscopy, and the method of spectral pre-treatment was discussed. Building model from calibration set obtained good results, and vali-dated by prediction. According to heat-clearing and detoxicating oral liquid from 30 batches of 6 factories, the correlation coefficient of chloro-genic acid and baicalin model are 0.9993 and 0.9923, The root mean square error of cross validation (RMSECV) are 0.467 and 0.480, and the standard Error of prediction (SEP) of chloro- genic acid and baicalin are 0.356 and 0.370 re-spectively. The correlation coefficients in pre-diction set are 0.9997 and 0.9969, prediction results are accurate and reliable. This method can be applied in rapid analysis of heat- clearing and detoxicating oral liquid, and it is fit for on-line detection and has a wide application prospect.

分消走泄法对代谢综合征患者代谢、应激、炎症状态的影响

目的探讨国医大师路志正“分消走泄法”治疗代谢综合征的临床疗效及对患者代谢、应激、炎症状态的影响。方法收集我院2018年3月-2020年4月湿热型代谢综合征患者200例,并随机分为对照组(盐酸吡格列酮)和试验组(祛湿降浊方),比较2组患者的疗效、治疗前后的中医症状评分、代谢相关指标[三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、谷丙转氨酶(alanine transaminase,ALT)、谷草转氨酶(glutamic oxaloacetic transaminase,AST)、空腹血糖(fasting blood glucose,FBG)、尿酸(uric acid,UA)]、应激和炎症相关指标[谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)、总抗氧化能力(total antioxidant capacity,T-AOC)、髓过氧化物酶(myeloperoxidase,MPO)、丙二醛(malondialdehyde,MDA)、白介素-6(interleukin-6,IL-6)、人单核细胞趋化蛋白-1(monocyte chemotactic protein-1,MCP-1)、脂联素(adiponectin,ADP)、脂蛋白(lipoprotein,LP)]。结果与对照组比较,试验组的总有效率明显增高(P<0.05)。治疗前,2组的主症评分、次症评分、中医症状总分、代谢、应激、炎症相关指标差异无统计学意义(P>0.05);治疗后,与对照组比较,试验组主症评分、次症评分、中医症状总分、TG、TC、ALT、FBG、UA、MPO、MDA、IL-6、MCP-1、LP均降低(P<0.05),HDL-C、GSH-Px、T-AOC、ADP均增高(P<0.05)。结论路志正“分消走泄法”可用于治疗MS,可明显改善湿热型MS患者的症状、代谢、应激、炎症状态,值得临床推广。

基于“三焦分消”理念分析三仁汤“异病同治”治疗溃疡性疾病的临证思路

溃疡性疾病是临床中的常见病、多发病,亦是中医优势病种之一。异病同治是中医辨证论治的精髓,其核心是“证同则治同,证异则治异”,若不同的疾病在发展过程中,出现了相同的病机与证候,即可采用同一方法进行治疗。三仁汤是治疗温病湿热证的代表方剂,可通过宣上、畅中、渗下将湿热之邪由三焦分消走泄而去。溃疡性疾病包括口腔溃疡、胃溃疡、溃疡性结肠炎等病,临证之际,“有是证用是方”,若疾病证属湿热蕴结,投以三仁汤治之,疗效颇佳。从疾病“异病同治”的角度出发,基于“三焦分消”理论初步探讨三仁汤在溃疡性疾病中的临床运用,以期为溃疡性疾病的临床治疗提供参考。

通补法对腹腔镜术后胃肠功能恢复的影响

目的 观察通补法对腹腔镜术后胃肠功能恢复的效果。方法 采用前瞻性研究设计选取2022年1月—2022年12月威海市中医院收治的180例腹腔镜患者,随机分为对照组(常规护理)、中药汤剂组(口服中药)、联合组(中药口服、揿针、拔罐),各60例。观察术后胃肠蠕动恢复时间,恶心呕吐程度,腹胀情况。结果 联合组术后0~6 h和6~12 h恶心呕吐发生例数少于中药汤剂组(P<0.05)和对照组(P<0.05);联合组术后胃肠蠕动恢复时间短于中药汤剂组和对照组;联合组恶心呕吐分级、腹胀程度分级均轻于对照组(P<0.05)和中药汤剂组(P<0.05)。结论 通补法理论指导下的中医治疗对腹腔镜术后胃肠功能恢复作用显著,可减轻患者症状,提高生活质量。

Effect of clearing heat and detoxification method on macrophages polarization in patients with acute myocardial infarction and heat toxin syndrome after intervention

Objective:To evaluate the effect of heat-clearing and detoxifying method on the macrophages polarization in patients with acute myocardial infarction with heat toxin syndrome after intervention.Methods:Sixty patients with acute myocardial infarction and undergoing percutaneous coronary intervention with heat toxin syndrome were randomly divided into a control group and a test group with 30 cases each.The control group was given conventional treatment,and the test group was given Huanglian Jiedu Decoction,the representative of the method of clearing heat and detoxification,orally on the basis of the control group.The intervention time of both groups was 2 weeks.Comparing The Seattle Angina Pectoris Scale(SAQ)before and after treatment,creatine kinase(CK),creatine kinase MB isoenzyme(CKMB),high-sensitivity troponin I(hs-TnI),and Lipoprotein-associated phospholipaseA2(LPPLA_2)),the phenotype ratio of M1 and M2 macrophages,and observe the adverse reactions.Results:After treatment,the SAQ scores of the two groups of patients were improved,and the levels of CK,CK-MB,hs-TnI,and LP-PLA_2 decreased significantly.The scores of AS,AF,TS,and DP in the SAQ of the test group were all higher than those of the control group,and the hs-TnI and LP-PLA_2 were better than those of the control Group(P<0.05 or P<0.01).After treatment,the proportion of M1 type macrophages in the two groups of patients'macrophages decreased significantly(P<0.05 or P<0.01),the ratio of M2 type macrophages increased(P<0.05),and the M1/M2 ratio decreased.The ratio of M1/M2 in the test group of the control group was significantly lower than that of the control group(P<0.01).There were no obvious adverse reactions in both groups.Conclusions:The method of clearing heat and detoxifying has a definite effect on patients with acute myocardial infarction of heat toxin syndrome after interventional operation.It can reduce myocardial damage,improve myocardial function,and reduce inflammation.And it is safe for clinical treatment without any increasing risk of bleeding or other risk of cardiovascular events.

基于通下活血法治疗视网膜静脉阻塞性黄斑水肿

[目的]探讨通下活血法治疗视网膜静脉阻塞性黄斑水肿(retinal vein occlusion-macular edema,RVO-ME)的病因病机及核心概要,以拓宽临床诊疗思路。[方法]在结合既往医家诊疗思路的基础上,进一步总结临床经验。深入探讨RVO-ME病因病机,进而提出通下活血法在RVO-ME中的辨证应用,并附医案一则予以佐证。[结果]热毒和血瘀两种病理产物的生成是RVO的发病关键,血不利则水不行,进一步发展成RVO-ME。治疗上当以通下活血为法,通则热毒自除,活则血瘀自散,应根据疾病的发展阶段,灵活掌握通下与活血的治疗侧重。本文所附病案,临证以大黄牡丹汤治疗,体现了通下活血法的核心要义,取得了较好的临床疗效。[结论]通下活血法符合RVO-ME的病因病机,临床上依据该理论采用大黄牡丹汤治疗RVO-ME,有望拓宽本病的中医治疗思路。

王有鹏教授从湿论治寒地儿童咳嗽变异性哮喘经验

咳嗽变异性哮喘是我国儿童慢性咳嗽的首要病因,发病率逐年增高,对儿童成长发育及社会活动都造成了巨大的困扰。文章总结王有鹏教授调治寒地儿童咳嗽变异性哮喘的辨治思路及用药经验。王教授认为寒地儿童咳嗽变异性哮喘可从湿邪论治,主要思路有三:一为疏风祛湿,开宣肺气;二为运脾建中,以杜生痰之源;三为分消走泄,布展气机,使湿热分解而化。临证治疗中多应用分消走泄法以调和偏颇,因势利导给邪以出路,湿祛则痰无以生,热势自孤,以期为咳嗽变异性哮喘临床中医诊疗拓宽新思路。

辛开苦降法治疗慢性非萎缩性胃炎的理法探析

随着生活方式的变化,人们饮食不合理、长期饮酒、精神压力大等现象较为普遍,导致慢性非萎缩性胃炎越发常见。李东垣指出“内伤脾胃,百病由生”,脾胃病一直受历代医家的重视。在治疗脾胃病中,中医医家重视脾胃气机升降理论,立足于脾胃气机升降协调,以辛开苦降为治疗大法。临床上,以辛开苦降治疗慢性非萎缩性胃炎取得了显著疗效。

《广瘟疫论》“下不厌早,汗不厌迟”思想探析

瘟疫类疾病是人类健康的巨大挑战,中医药拥有数千年与瘟疫抗争的经验,在此过程中形成了一些具有指导意义的思想。依据瘟疫类疾病致病的性质、受邪途径、传变方式的不同提出“下不厌早,汗不厌迟”的瘟疫辨证论治思想,历经数百年的检验而逐步成型,成为后世瘟疫类疾病治疗的指导。挖掘该经典理论指导下的理、法、方、药,有利于发挥中医优势,促进疫情防控。中医药辨证论治在疫情防控和疾病救治过程中发挥了重要作用,深入剖析温病时疫的辨证论治思想,能够为中医药防治疫情提供思路参考,结合古人智慧,借助现代技术,发挥中医优势,最终战胜疫情。

腹内感染时内毒素介导的免疫细胞学反应与通里攻下法的影响

采用酶联免疫吸附实验、放射免疫测定和间接免疫荧光等方法,现察了58例外科腹内感染患者血浆内毒素(LPS)、肿瘤坏死因子(TNF)及前列腺E_2(PGE_2)在病程中的演变规律及对机体的损伤作用。分析了通里攻下法的应用对上述病理生理学改变和患者预后的影响。结果表明,治疗组异常指标的改善早于对照组,TNF的检出率和含量下降较快,内毒素减毒率提高和并发症发生率减低。并探讨了通里攻下法药理效应产生的理论基础和可能的作用机理。

温下法与温涩法对溃疡性结肠炎患者结肠表皮生长因子含量的影响

目的:探讨温下法与温涩法在溃疡性结肠炎(UC)损伤修复方面的不同作用机制。方法:采用二步免疫组化法检测治疗1个月前后温下组(29例)、温涩组(27例)和对照组(27例)患者结肠组织表皮生长因子(EGF)的表达水平,比较3组治疗前后结肠组织EGF的变化。结果:温涩法与温下法都能较好地促进结肠EGF表达,而温涩法疗效更优,对照组未见明显改变。结论:温下法与温涩法能够增加UC患者体内EGF的含量,进而可能通过EGF对黏膜屏障的保护作用促进黏膜损伤的修复。而温涩法作用优于温下法,表明温涩法在促进损伤修复方面疗效较优。

通腑法论治中风病急性期

中风病,现代医学称之为脑卒中,是导致我国居民死亡的首要原因。中医对中风病的认识历史悠久,并形成了其独特的诊疗体系。临床中风病急性期患者常见腑实便秘的症状,并且腑实消长随着病势顺逆的变化而变化。近年来,通腑法在中风病急性期中的作用日益受到临床重视,本文拟对通腑法治疗中风病急性期的研究进展进行概述,为通腑法治疗中风病急性期的继承与发展提供可靠的理论依据。

不同浓度中药保留灌肠对预防甘露醇肾损害的临床疗效观察

[目的]探讨采用不同浓度中药保留灌肠,预防脑卒中患者静脉滴注甘露醇引起急性肾损害的临床疗效。[方法]将符合纳入标准的30例患者随机分为试验组15例和对照组15例,两组颅压升高患者应用甘露醇为主要脱水剂,并采用相同剂量中药保留灌肠30min,每日1次。试验组采用50 mL高浓度液保留灌肠,对照组采用200 mL常用浓度液保留灌肠。通过检测两组患者治疗前、治疗第5天及治疗10 d血肌酐、尿素氮、血清胱抑素C进行疗效评估,并对患者接受中药保留灌肠的舒适程度进行比较。[结果]试验组发生甘露醇肾损害1例,发生率6.67%,对照组1例因脑水肿加重死亡,发生甘露醇肾损害2例,发生率为13.33%,差异无统计学意义(P>0.05)。两组患者治疗过程中各项肾功能指标情况相似(P>0.05)。两组患者接受灌肠后舒适程度比较,试验组优于对照组(P<0.05)。[结论]通腑泄浊法保留灌肠能有效预防静脉滴注甘露醇后急性肾损害,且使用高浓度、液体量较少的中药保留灌肠药疗效肯定,患者接受程度、依从性、感觉舒适度更高,值得深入探讨。

危重症急性胃肠损伤与温下法研究

胃肠功能在危重症医学中起着至关重要的作用,胃肠道作为全身炎症反应综合征的触发器和始动器,是脓毒症以及多脏器功能障碍的中心器官,因此胃肠功能受到越来越多的关注和研究。ESICM针对重症患者的胃肠功能衰竭,提出了急性胃肠损伤的概念,应作为今后研究的基础。本文通过对危重症患者胃肠功能衰竭的中医文献研究,发现虚证和虚实夹杂证的证候表现较为突出,脏腑辨证多定位在脾、胃和肠腑,病理因素以寒、气、虚为主。根据笔者多年的临床经验,中药以温下通腹、救逆固脱为大法,助于改善患者的胃肠功能。故寻求中医药治疗方法或者联合中医药治疗手段,并深入研究其作用机制,是危重症患者胃肠功能研究的优势和可能的突破口。

“下法”在现代中医临床中的应用

"下法"是中医治则治法理论体系中的重要治疗大法之一。现代中医学工作者将下法广泛地应用于消化系统、神经系统、循环系统以及妇科、儿科、皮肤科等多种疾病的治疗中,既丰富了下法的理论内涵,又拓展了下法的临床应用范围。其中,下法在各系统急症、危重症和痛症,以及以"热"以"积"为主要特点的病症治疗中更具优势。从气机的角度来看,下法的病机辨证特点是有形之邪淤(瘀)滞,影响人体局部或整体的气机通畅。而下法可以消除人体各部淤(瘀)滞,条畅气机,促进人体恢复健康。同时,临床使用下法应灵活结合他法,亦须中病即止,以免戕伐正气。

攻下法在肠道肿瘤中应用探析

目的:探析攻下法在肠道肿瘤中的应用。方法:通过概述攻下法的概念及应用,明辨肠道肿瘤的治则及病因病机,阐述攻下法与肠道肿瘤间的联系,阐发攻下法在肠道肿瘤治疗上的意义。结果与结论:攻下法在肠道肿瘤治疗中应用广泛,辨证地使用攻下法是中医药治疗肠道肿瘤的特色,也是取得疗效的关键。

温下法和温涩法对UC大鼠结肠EGF含量的影响比较

目的 :观察温下法和温涩法对UC大鼠结肠EGF含量的影响。方法 :建立TNBS 乙醇大鼠溃疡性结肠炎模型后分别灌喂温脾汤和真人养脏汤进行实验性治疗 ,然后于 1周、2周、4周三个时间点测定结肠EGF含量变化。结果 :温脾汤组结肠EGF在UC整个病种中呈上升趋势 ,而真人养脏汤组始终保持较低水平 ,甚至在UC早期低于正常水平。结论 :温脾汤能更好地促进EGF含量的增加 ,即温下法比温涩法能更好地通过肠黏膜保护作用机制 ,减轻UC黏膜的损伤和炎症。