Liver or kidney:Who has the oar in the gluconeogenesis boat and when?

Gluconeogenesis is an endogenous process of glucose production from noncarbohydrate carbon substrates.Both the liver and kidneys express the key enzymes necessary for endogenous glucose production and its export into circulation.We would be remiss to add that more recently gluconeogenesis has been described in the small intestine,especially under high-protein,lowcarbohydrate diets.The contribution of the liver glucose release,the net glucose flux,towards systemic glucose is already well known.The liver is,in most instances,the primary bulk contributor due to the sheer size of the organ(on average,over 1 kg).The contribution of the kidney(at just over 100 g each)to endogenous glucose production is often under-appreciated,especially on a weight basis.Glucose is released from the liver through the process of glycogenolysis and gluconeogenesis.Renal glucose release is almost exclusively due to gluconeogenesis,which occurs in only a fraction of the cells in that organ(proximal tubule cells).Thus,the efficiency of glucose production from other carbon sources may be superior in the kidney relative to the liver or at least on the level.In both these tissues,gluconeogenesis regulation is under tight hormonal control and depends on the availability of substrates.Liver and renal gluconeogenesis are differentially regulated under various pathological conditions.The impact of one source vs the other changes,based on post-prandial state,acid-base balance,hormonal status,and other less understood factors.Which organ has the oar(is more influential)in driving systemic glucose homeostasis is still inconclusive and likely changes with the daily rhythms of life.We reviewed the literature on the differences in gluconeogenesis regulation between the kidneys and the liver to gain an insight into who drives the systemic glucose levels under various physiological and pathological conditions.

Regulating and tonifying spleen and kidney traditional Chinese medicine in the treatment of chronic uric acid nephropathy: A systematic review

Objective:To systematically evaluate the efficacy and safety of traditional Chinese medicine for regulating spleen and kidney.Methods:We developed a search strategy and then retrieved the database including CNKI,Wanfang data knowledge service platform,VIP journals resource integration service platform,PubMed,Embasefor randomized controlled trial of regulating spleen and kidney traditional Chinese medicine compared with conventional western medicine in the treatment of chronic uric acid nephropathy.The search deadline was set to June 30,2020.For the included literature,we applied the cochrane collaboration network risk bias assessment tool to evaluate the methodological quality,and evaluated the level of evidence according to GRADE standards.Quantitative data was analyzed by RevMan5.3 software,and trial sequential analysis method was used to analyze its efficiency.Results:A total of 709 cases in 10 articles were included.Compared with the control group,the related traditional Chinese medicine group improved the effective rate[RR=1.45,95%CI(1.32,1.58)],reduced the level of UA[MD=-36.24,95%CI(-41.03,-31.45)],BUN[SMD=-1.27,95%CI(-1.47,-1.07)]and SCR[MD=-36.33,95%CI(-55.79,-16.87),P=0.0003],the difference between the two groups was statistically significant(P<0.05).There was no evidence that a significant adverse reaction occurred.The results of TSA analysis showed that the Chinese medicine group had definite evidence for improving the efficiency.According to the GRADE evaluation criteria,the efficiency,UA,BUN and SCR outcome indicators were extremely low-quality evidence.Conclusions:Traditional Chinese medicine for regulating spleen and kidney in the treatment of chronic uric acid nephropathy improved efficiency,reduced the level of UA,BUN,SCR.Meanwhile,the therapy was proved to be safe.Nevertheless,the conclusions need further high-quality evidence to support.

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.

Professor Fengjie He’s Experience in Treating Polycystic Ovary Syndrome of Kidney Asthenia and Liver Depression

Polycystic ovary syndrome is a common reproductive endocrine metabolic disease in clinic.Professor Fengjie He has accumulated rich clinical experience in the process of diagnosis and treatment of the disease.He believes that the key to the pathogenesis of the disease is the dysfunction of the reproductive axis of“kidney-Tiangui-Chongren-uterus,”which is based on kidney deficiency and involves the liver and spleen.Clinically,patients with kidney deficiency and liver depression are common.The treatment takes tonifying the kidney and regulating the menstrual cycle as the main method,and the clinical effect is very effective.

Effectiveness of tonifying-kidney and regulating-liver therapy on diminished ovarian reserve: a systematic review and Meta-analysis of randomized controlled trials

OBJECTIVE: To evaluate the effectiveness of the Traditional Chinese Medicine tonifying-kidney and regulating-liver therapy on diminished ovarian reserve(DOR).METHODS: The literature was comprehensively searched up to August 2019 using four Chinese and three English electronic databases to extract randomized clinical trials(RCTs) comparing Traditional Chinese Medicine tonifying-kidney and regulating-liver prescriptions(combined with hormone therapy or not) with Western Medicine. Data quality evaluation was conducted using the Cochrane risk of bias tool. Meta-analysis was conducted using Revman 5.3 software with effect estimates presented as mean difference(MD), risk ratio(RR), and95% confidence interval(CI).RESULTS: A total of nine RCTs with 512 participants were extracted and eligible for Meta-analysis.There were no significant differences between Chinese medicine and Western Medicine on basal serum follicle-stimulating hormone(FSH) level(MD0.11, 95% CI-0.52 to 0.74, 392 participants, seven trials), anti-Müllerian hormone level(MD 0.48, 95%CI-0.62 to 1.58, 95 participants, two trials), and the FSH and luteinizing hormone ratio(MD 0.01,95% CI-0.95 to 0.96, 115 participants, two trials).Chinese medicine was more effective at improving Traditional Chinese Medicine symptom scores(TCMSS)(MD-2.39, 95% CI-3.83 to-0.94, 160 participants, three trials), effective rate of TCMSS(RR1.18, 95% CI 1.02 to 1.36, 160 participants, three trials), antral follicle count(AFC)(MD 0.55, 95% CI 0.05 to 1.04, 155 participants, three trials), and FSH levels at 3 months post-treatment(MD-4.77, 95% CI-6.09 to-3.45, 137 participants, two trials).CONCLUSION: Compared with Western Medicine,tonifying-kidney and regulating-liver therapy is more effective at relieving symptoms and improving AFC and FSH at 3 months post-treatment.

Research Progress on Chemical Constituents and Pharmacological Effect of Semen Cuscutae

In this paper,by summarizing the literature in recent years,it is considered that the chemical constituents of S.cuscutae are mainly flavonoids.The main pharmacological effects include improving osteoporosis,improving ovarian function,improving drug-induced reproductive toxicity,regulating spermatogenic cell apoptosis,resisting liver fibrosis,resisting inflammation,improving cardiovascular function,protecting fetus,protecting synapses and so on.By summarizing the chemical constituents and pharmacological effects of S.cuscutae,this study aims to better study the mechanism of anti-osteoporosis based on the fact that S.cuscutae has the function of tonifying liver and kidney.

从“虚瘀劫肝”论原发性肝癌中医药防治思路

理论创新是中医药发展的源泉,在新理论指导下形成的新方药或新诊治方案是中医药临床防治重大疑难疾病的新突破口。正邪交争,正不胜邪是慢性疾病持续进展的内在驱力和一般特性,慢性肝病持续恶性进展囊括了:肝纤维、肝硬化、肝癌等逐步恶化的病理进程。其在遵循中医“正不胜邪”基本病机的基础也必须有其特殊性和指向性,也可理解为在慢性肝病持续进展的病理状态下将一般性的病机进行指向性和特征性的阐发。肝正虚主要是指维持正常肝再生修复的相关机制和途径异常或紊乱,肝邪胜则是指肝损伤因素持续存在及其下游触发的恶性肝再生状态进行性亢进;而“瘀”作为正邪交争过程中产生的最主要病理产物也在不断推动疾病的恶性发展。在此基础上,从“虚瘀劫肝”论肝癌的病理新认识及补虚(补肾生髓、健脾)祛瘀(疏肝、柔肝、化肝)阻断慢性肝病持续恶性进展以防治肝癌的基本思路,期望有益于疑难肝脏病症的临床防治。

从发病机制探讨多囊卵巢综合征所致闭经

基于肝脾肾三脏,从肝郁气滞,脾虚痰湿,肾虚精亏及冲任二脉剖析多囊卵巢综合征所致闭经病机;此外,从遗传、环境污染、精神压力、胰岛素抵抗等因素简述现代医学发病机制;以肝气郁滞,疏泄不及,横逆己土作为切入点,浅析脾虚及肾,肾虚血瘀的发展历程。此外,从五行生克制化方面阐明了肾在该病中的主导地位,从肝郁、脾虚、肾亏的中医理论探讨了多囊卵巢综合征致闭经发病过程和病变特点,确立了疏肝理气、健脾燥湿、补肾填精的主要治法,同时对兼有痰浊内生、瘀血阻络者,提出化痰降浊,通络化瘀的治法。

中医药防治化疗后骨髓抑制研究进展

中医药防治化疗后骨髓抑制的常用治法有补肾生髓法、健脾养血法、解毒活血法、益气养阴法、疏肝调肝法等,疗效确切,不良反应少,可改善患者生活质量。目前,研究仍存在以下不足:临床研究中符合循证医学原则的多中心随机双盲对照研究较少,中医辨证分型尚缺乏统一的标准和客观依据与规范;中医药防治化疗后骨髓抑制与西医治疗的结合应用还不够充分;关于中医药抗化疗后骨髓抑制在细胞、分子微观水平方面的研究有一定进展,但由于中药方剂成分复杂,明确具体机制存在较大困难,联合用药的协同效应以及治疗效果的科学证据还相对不足。今后,需进一步探索和研究中医药防治化疗后骨髓抑制的临床应用前景,提高临床研究质量,深入研究中医药抗化疗后骨髓抑制的作用机理。

Strategies for Activating Blood Circulation-Regulating Gan(Liver)-Tonifying Shen(Kidney) Sequential Therapy of Endometriosis-Associated Infertility

Endometriosis(EM) is a major cause of infertility and has a complex pathogenesis,which brings severe challenges in both clinical treatment and scientific research.Current clinical research focuses on the difficult problem of improving the pregnancy rate of EM patients.Our studies found that Chinese medicine has significant advantages in terms of improving the pregnancy rate of EM patients.

从“水寒木郁”辨治乳腺癌相关抑郁状态

总结乳腺癌相关抑郁状态的治疗思路与方法,认为乳腺癌相关抑郁状态发生的重要病机在于“水寒木郁”,阳虚水寒乃病之根本,肝木郁结乃病之肇始,水寒则不能温养肝木,木郁则条达之性失常,木郁则不能生火,君火不明,心神失养。并由此提出主张温肾燮肝,注重温补肾阳以培元,同时不忘燮理肝木以解郁,以期肝肾同治。

张晓丹治疗更年期综合征经验

张晓丹教授认为,更年期综合征的基本病机是脏腑功能紊乱,肾气虚衰,肾精亏乏,心肾不交,肝失疏泄,使得机体血行不畅,气机阻滞,气血失衡,阴阳不调。张教授认为,该病的治疗重在补肾滋阴,补肾不忘交通心肾,调补肝脾以资化源,多用补肾滋阴、调补肝脾法、激素替代疗法治疗更年期综合征,常用药物有熟地黄、山茱萸、牡丹皮、枸杞子、山药、茯苓、泽泻、菟丝子、仙茅、淫羊藿、杜仲、巴戟天。伴有烘热汗出者加五味子、生龙骨、生牡蛎、浮小麦收敛止汗;伴有五心烦热者加地骨皮、青蒿、鳖甲清虚热;伴有口燥咽干、皮肤瘙痒者加沙参、石斛、麦冬、玉竹滋阴润燥;心烦易怒者用百合、郁金、墨旱莲等;心悸者加茯神、远志等;失眠多梦者加夜交藤、合欢皮、酸枣仁等。

从肝论治多发性硬化思路探讨

多发性硬化是以中枢神经系统炎症脱髓鞘改变为特征的自身免疫性疾病。历代医家认为脾肾亏虚是本病的基本病机,多从脾肾论治,少有从肝论治者。从肝论治多发性硬化的理论基础主要来自于肝主疏泄、主筋、主目。肝主疏通、宣泄,体现在畅达气机、调脾胃运化、助气血化生、促气血运行、舒畅情志等方面;且肝滋养筋脉、开窍于目。多发性硬化属肝气郁结者,选逍遥散合柴胡疏肝散为基础方,疏肝解郁、通调气机兼补益脾胃;多发性硬化肝血亏虚者,选补肝汤加减以补肝血、养肝体兼以柔肝缓急;晚期多发性硬化肝肾亏虚者以六味地黄丸加减补肝肾、养血益髓兼以通经止痛。

教育-鼓励-工作-运动-评估干预联合补肾调肝法在肾移植术后的应用效果及对生活质量的影响

目的研究探讨教育-鼓励-工作-运动-评估干预联合补肾调肝法在肾移植术后的应用效果及对生活质量的影响。方法选取2020年1月—2022年1月医院收治的102例肾移植术患者分为观察组、对照组,每组51例。两组患者均行进行肾移植术,对照组术后以补肾调肝法治疗,观察组以教育-鼓励-工作-运动-评估干预联合补肾调肝法治疗。综合评估两组患者的中医证候积分、负性情绪、康复依从性、生活质量评分、护理满意度等指标。结果干预后,观察组主要中医证候积分包括面浮肢肿、神疲乏力、面色萎黄、食少便溏等积分均低于对照组(P<0.05)。干预后观察组患者负性情绪评分包括汉密尔顿焦虑量表-14(HAMA-14)、汉密尔顿抑郁量表-17(HAMD-17)评分均低于对照组(P<0.05)。干预后观察组康复依从性包括按时服药、规律休息、规律饮食、康复训练、定期复查等比例均高于对照组(P<0.05)。观察组干预后SF-36生活质量、护理满意度高于对照组(P<0.05)。结论教育-鼓励-工作-运动-评估干预联合补肾调肝法在肾移植术后的应用效果显著,能够改善患者主要中医症候,降低患者康复期间的负性情绪,提高患者的康复依从性和生活质量,改善患者的护理满意度。

从冲任论卵巢癌术后复发转移

卵巢癌病在胞宫冲任,手术损伤导致冲任气血亏虚以致功能失调,成为卵巢癌术后复发转移之前提条件;加之术后未净之癌毒潜匿于机体,以伏邪形式存在,共同导致了卵巢癌术后复发转移。结合手术导致激素分泌紊乱、机体免疫功能降低的生物学特点,归纳“冲任失调”为卵巢癌术后复发转移之病机。基于此,提出“清补冲任”为防治卵巢癌术后复发转移的基本原则,治疗当辨明局部与整体之关系,以冲任为枢纽,肝肾同调。

疏肝补肾结合调经促孕针刺治疗卵巢早衰临床观察

目的观察疏肝补肾结合调经促孕针刺治疗卵巢早衰的临床疗效。方法纳入医院收治的65例卵巢早衰患者(2022年1月—2022年8月收治)进行随机分组研究,将患者以随机数字表法分为对照组(32例)与治疗组(33例),对照组患者口服坤泰胶囊治疗,治疗组患者口服坤泰胶囊治疗,并结合疏肝补肾法+调经促孕针刺法治疗,两组数据观察:治疗效果、治疗前后患者中医证候各项积分(闭经或月经紊乱、阴道干涩、烦躁易怒、性欲减退等)变化、卵巢体积与子宫体积、子宫内膜厚度变化、性激素水平变化、免疫功能指标变化、抑郁自评量表评分(SDS)变化、不良反应。结果治疗组患者治疗总有效率(93.94%,31/33)显著高于对照组患者(75.00%,24/32),P<0.05;治疗前,各组患者中医证候各项积分(闭经或月经紊乱、阴道干涩、烦躁易怒、性欲减退等)、卵巢体积与子宫体积、子宫内膜厚度、促黄体生成素(luteinizing hormone,LH)以及促卵泡生成素(follicle-stimulating hormone,FSH)、雌二醇(estradiol,E_(2))等性激素水平、免疫功能指标(CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))、SDS评分等比较,P>0.05,治疗后各组患者中医证候各项积分(闭经或月经紊乱、阴道干涩、烦躁易怒、性欲减退等)、卵巢体积与子宫体积、子宫内膜厚度、LH及FSH、E_(2)、免疫功能指标(CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))、SDS评分均改善,治疗组患者治疗后中医证候各项积分(闭经或月经紊乱、阴道干涩、烦躁易怒、性欲减退等)、卵巢体积与子宫体积、子宫内膜厚度、LH及FSH、E_(2)、免疫功能指标(CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))、SDS评分均优于对照组,P<0.05;各组均未见严重不良反应,P>0.05。结论疏肝补肾法结合调经促孕针刺法治疗卵巢早衰临床疗效显著,患者症状及卵巢功能、免疫功能及心理状态均改善,无不良反应,安全可靠。

张珍玉治疗痛经用药规律研究

目的:挖掘张珍玉治疗痛经的用药规律,以期为临床诊治痛经提供思路与方法。方法:收集张珍玉治疗痛经的医案158份,对处方中的药物进行规范化处理;应用Excel 2010软件对处方中药物的频次、类别进行描述性统计;应用SPSS Modeler 18.0软件对高频药物进行关联规则分析;应用SPSS 23.0软件对高频药物进行聚类分析。结果:共纳入处方158首,涉及药物63味。药物频次前5位为柴胡、砂仁、炒白芍、人参、当归,补虚药与行气药是使用频次最高类别的药物。关联规则分析高频药物显示二项药物配伍前3位为郁金-柴胡,香附-柴胡,木香-柴胡;三项药物配伍前3位为郁金-香附-柴胡,郁金-炒白术-柴胡,郁金-人参-柴胡;四项药物配伍前3位为郁金-香附-炒白术-柴胡,郁金-香附-人参-柴胡,郁金-香附-当归-柴胡。聚类分析分为3类药物。结论:张珍玉辨治痛经首从肝脏入手,疏肝养血,体用同调;兼以益气健脾,肝脾同治;辅以补肾调经,调补阴阳。

谢晶日教授运用以调代补法论治胃癌经验撷菁

胃癌患者脏腑气血阴阳偏颇较重,气滞、瘀血、痰浊等病理产物导致中焦失衡进一步加重,过度补益或急于祛邪均欠稳妥。谢晶日教授认为凡癌肿均为本虚标实之证,正气渐亏而邪气愈盛,此时应结合胃癌患者发病共性与不同时期发病特点,以人为本,以和为度,顺应脾胃生理病理特性,平其亢逆,以期达到脾胃中和的理想状态。谢师结合“肝脾论”思想提出以调代补法,以此法指导临床每获佳效。现对其运用以调代补法治疗胃癌经验进行探析。

补肾疏肝活血调周法治疗卵巢功能减退症的效果评价

目的观察补肾疏肝活血调周法在改善卵巢功能减退症患者临床症状方面的有效性。方法选取60例卵巢功能减退症患者,按照奇偶数法分为对照组(奇数,采用常规西药疗法)与观察组(偶数,采用补肾疏肝活血调周法),每组30例。对照组采用常规西药方案,观察组采用补肾疏肝活血调周方案。对比两组临床效果。结果与对照组相比,观察组治疗后的卵巢功能较优(P<0.05)。治疗后,观察组烦躁易怒、失眠健忘、腰膝酸软以及头晕耳鸣症状评分分别为(0.72±0.31)分、(0.68±0.32)分、(0.67±0.34)分、(0.67±0.34)分,均低于对照组的(1.15±0.34)分、(1.06±0.41)分、(0.96±0.32)分、(0.93±0.27)分(P<0.05)。结论补肾疏肝活血调周法可以促进卵巢功能减退症患者临床症状的改善以及提高卵巢功能,临床效果确切,具有较高的推广价值。

调肝、补肾、健脾方药对慢性心理应激大鼠单胺类神经递质影响的比较研究

目的:观察慢性心理应激反应大鼠血浆和下丘脑多巴胺(DA)、5-羟色胺(5-HT)、肾上腺素(E)、去甲肾上腺素(NE)的变化及调肝、补肾、健脾方药对其影响。方法:Wistar大鼠按体重随机分为6组,即对照组(C),模型组(M),调肝中药(加味四逆散)组(C1),人参总皂甙组(C2),补肾中药(肾气丸)组(C3),健脾中药(四君子汤)组(C4)。采用束缚限制活动空间的方法造成慢性心理应激大鼠模型,所有药物灌胃给药。采用电化学高效液相色谱分析方法检测血浆和下丘脑DA、5-HT、E、NE含量。结果:应激大鼠血浆和下丘脑DA、5-HT含量明显降低(均P<0.01),血浆NE、E含量明显升高(均P<0.01),而下丘脑NE含量无明显变化。血浆5-HT/NE、5-HT/E及下丘脑5-HT/NE均明显降低(均P<0.01)。加味四逆散可以升高应激大鼠下丘脑和血浆中DA、5-HT含量(均P<0.01),并能降低血浆中NE、E含量(均P<0.01),升高下丘脑和血浆5-HT/NE以及血浆5-HT/E(P<0.05或P<0.01)。肾气丸、四君子汤及人参总皂甙虽然对有些指标有影响,但对心理应激的整体调节作用不如加味四逆散。结论:加味四逆散对慢性心理应激大鼠血浆和下丘脑单胺类神经递质的代谢紊乱均有良好的调节作用,调肝、补肾、健脾治法方药中以调肝治法方药的综合调治作用最为显著。