Clinical Nursing Intervention of Moxibustion on Abdominal Distension Symptoms in Heart Failure (Heart and Kidney Yang Deficiency and Blood Stasis Blocking Collaterals Syndrome)

Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.

Clinical observation on efficacy of compound of warming yang, descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with Yin-Yang deficiency and blood stasis syndrome

Objective:To observe the clinical efficacy of compound of owarming yang,descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome.Methods:Seventy-six patients of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome were randomly divided into observation group and control group,thirty-eight cases in each group.The control group was given conventional western medicine treatment,while the observation group took compound of owarming yang,descending turbidity and dredging collaterals orally on the basis of conventional western medicine treatment.The course of treatment covered for one month.Before and after treatment,we observed the scores of traditional Chinese medicine symptoms,indicators of renal function[serum creatinine(Scr),blood urea nitrogen(BUN),microalbuminuria(MALB)],indicators of glucose metabolism[fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbAlc)],indicators of hemorheology[plasma viscosity(PV),platelet aggregation rate(PAR),fibrinogen(FIB)],Cystatin-C(Cys-C),C-reactive protein(CRP)in the two groups.Results:After treatment,the clinical effect of the observation group was significantly better than the control group(P<0.05).The scores of traditional Chinese medicine symptoms,indicators of renal function(Scr、BUN、UAER),indicators of glucose metabolism(FPG、2hPG、HbAlc),indicators of hemorheology(PV、PAR、FIB),Cys-C and CRP in the two groups were decreased significantly compared with those before treatment(P<0.05),and the decrease in the observation group was superior to that in the control group(P<0.05).Conclusion:Compound of warming yang,descending turbidity and dredging collaterals has remarkable efficacy in treating of diabetic kidney disease patients with yin-yang deficiency and blood stasis syndrome by alleviating clinical symptoms,glucose metabolism,renal function and microcirculatory disturbance,and the mechanism related to alleviation of microinflammation.

基于气络学说运用芪归通络口服液联合艾灸治疗气虚血瘀型慢性疲劳综合征的临床观察

【目的】观察基于气络学说,运用芪归通络口服液(广东省第二中医院院内制剂,由黄芪、当归、三七、赤芍、牛膝、鸡血藤、丹参、地龙等中药组成)联合艾灸治疗气虚血瘀型慢性疲劳综合征(chronic fatigue syndrome,CFS)的临床疗效。【方法】采用回顾性研究方法,根据治疗方法的不同将60例气虚血瘀型CFS患者分为观察组和对照组,每组各30例。对照组给予艾条温和灸神阙穴治疗,观察组在对照组的基础上联合芪归通络口服液治疗,疗程为4周。观察2组患者治疗前后中医证候积分、疲劳量表-14(FS-14)评分、血清免疫球蛋白IgA、IgM、IgG含量及皮质醇(COR)水平的变化情况,并评价2组患者的临床疗效和安全性。【结果】(1)疗效方面,治疗4周后,观察组的总有效率为96.67%(29/30),对照组为80.00%(24/30),组间比较,观察组的临床疗效明显优于对照组(P<0.05)。(2)量表评分方面,治疗后,2组患者的中医证候积分、FS-14评分均较治疗前明显降低(P<0.01),且观察组对中医证候积分、FS-14评分的降低作用均明显优于对照组(P<0.01)。(3)实验室指标方面,治疗后,2组患者血清IgA、IgG水平以及观察组血清IgM、COR水平均较治疗前明显升高(P<0.01),且观察组对血清IgA、IgM、IgG及COR水平的升高作用均明显优于对照组(P<0.05或P<0.01)。(4)安全性方面,治疗过程中,2组患者均未发生明显不良反应。【结论】基于中医气络学说,以正虚络阻为CFS核心病机,运用补虚通络法,采用芪归通络口服液联合艾灸治疗气虚血瘀型CFS患者疗效确切,能明显缓解患者的临床症状,提高患者的免疫力水平,调节患者的神经-内分泌-免疫(NEI)网络。

基于“久病入络”理论探讨“从虚而始,因虚致瘀,瘀痹骨络”的激素性股骨头坏死核心病机观

激素性股骨头坏死(Steroid-induced osteonecrosis of femoral head, SONFH)是骨科常见疾病,随着激素应用率提升其发病率也逐年增加。随着“久病入络”理论的研究不断深入,特此提出“从虚而始,因虚致瘀,瘀痹骨络”为激素性股骨头坏死发病病机,强调药邪是SONFH的致病因素,肝脾肾三脏亏虚是SONFH发病基础,脏腑亏虚,功能减退,血行涩滞导致SONFH进展,瘀血痹阻骨络是SONFH的病机关键,以期建立“从虚而始,因虚致瘀,瘀痹骨络”的特色辨治体系,为中医药治疗SONFH提供理论基础。

胫骨横向骨搬移微创导板技术联合桃红四物汤治疗糖尿病足溃疡的疗效分析

目的 观察胫骨横向骨搬移微创导板技术联合桃红四物汤治疗糖尿病足溃疡(diabetic foot ulcer,DFU)的疗效。方法 选取自2021年1月至2022年12月在湖南中医药大学第一附属医院四肢关节科拟进行胫骨横向骨搬移手术的50例DFU患者为研究对象,随机分为观察组与对照组,各25例。对照组采用胫骨横向骨搬移微创导板技术结合常规基础治疗;观察组在对照组基础上,术后第1天开始服用桃红四物汤,均连续治疗4周。比较治疗前和治疗后3个月两组患者的疼痛视觉模拟量表(visual analogue scale,VAS)评分、患肢皮肤温度、10 g尼龙丝检查评分、踝肱指数以及溃疡创面面积、愈合时间,评估临床疗效。结果 治疗3个月后,观察组临床有效率为92%,高于对照组的76%(P<0.05);观察组溃疡创面愈合时间较对照组明显缩短(P<0.05);两组患者的VAS评分、患肢皮肤温度、10 g尼龙丝检查评分、踝肱指数均较治疗前明显改善(P<0.05),且观察组上述各项指标较对照组改善更明显(P<0.05)。结论 胫骨横向骨搬移微创导板技术联合桃红四物汤治疗DFU的临床疗效显著,创伤小,创面愈合快,可明显缓解患肢疼痛,加速溃疡创面修复。

冯俊运用剔络化瘀法治疗视网膜血管瘤样增生经验

视网膜血管瘤样增生(RAP)属于湿性年龄相关性黄斑变性的一种特殊类型,其基本病变为新生血管形成。临床上往往采取对症治疗,但预后较差。冯俊深入研究古代医家的相关论述,结合多年临床应用经验,基于中医“络病理论”思想,阐述了络病与RAP的内在联系,提出了RAP属中医络病,认为“瘀阻脉络、水湿内停”为其主要病机,在治疗上采用剔络化瘀法,即应用虫类药与活血化瘀药物搜剔络脉、活血化瘀,兼顾利水渗湿,并调补全身气血,畅通眼底络脉,从而达到充养目系、固本明目之效。在其临床实践中该法疗效显著,为临床治疗RAP提供了新方法、新思路。

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。

基于络病理论探讨“肾虚络瘀”病机观在老年慢性肾脏病中与细胞自噬不足相关性

以中医络病理论为指导,结合现代临床与基础研究,提出老年慢性肾脏病(chronic kidney disease,CKD)主要病机为“肾虚络瘀”,年老肾虚气化不足,致湿浊、血瘀阻滞肾络,其病理过程与衰老过程中细胞自噬不足、病理产物清除减少损伤肾脏具有相同的病机演变格局,补虚通络法通过调控细胞自噬发挥肾脏保护作用,延缓老年CKD进展。通过探讨老年CKD“肾虚络瘀”的科学内涵,进一步从分子水平解释老年CKD的作用机制及靶点,为该病的中医治疗及其机制研究提供新的研究思路和科学依据。

基于络病理论的辛香通络方治疗气滞血瘀型痛经的临床效果

目的评估自拟辛香通络方治疗气滞血瘀型痛经的临床效果。方法选取2021年12月至2022年12月收治的90例气滞血瘀型痛经患者为研究对象,随机将其分为辛香通络方组和对照组,各45例。辛香通络方组接受辛香通络方治疗,对照组接受散结镇痛胶囊治疗。比较两组的治疗效果。结果辛香通络方组的治疗总有效率为93.33%,明显高于对照组的77.78%,差异具有统计学意义(P<0.05)。结论辛香通络方治疗气滞血瘀型痛经效果显著,具有明显的优势。

涤痰汤合桃红四物汤加减治疗痰瘀阻络型脑梗死恢复早期临床观察

目的:观察涤痰汤合桃红四物汤加减治疗痰瘀阻络型脑梗死恢复早期的临床疗效。方法:选取符合纳入标准的痰瘀阻络型脑梗死恢复早期患者96例,采用随机数字表法分为两组各48例。对照组予常规对症治疗及个体化康复综合训练,治疗组在对照组基础上予涤痰汤合桃红四物汤加减治疗。比较两组神经功能缺损程度、中医证候积分、神经损伤因子水平、脑血流动力学指标水平。结果:治疗后,两组卒中量表(NIHSS)评分、中医证候积分、各项神经损伤因子水平、各项脑血流动力学指标水平均较治疗前改善(P﹤0.05),且治疗组改善幅度均优于对照组(P﹤0.05)。结论:涤痰汤合桃红四物汤加减对痰瘀阻络型脑梗死恢复早期脑神经的保护作用较好,可有效改善脑血流动力学。

Correlativity between blood measures related to blood stasis blocking collaterals and gene expression of angiotensin-converting enzyme of renal cortex in diabetic rats and effect of stasis removing and collaterals dredging

OBJECTIVE: To investigate the correlativity between the changes of blood measures related to blood stasis blocking collaterals and gene expression levels of angiotensin-converting enzyme(ACE)and ACE2 ofrenal cortex in diabetic rats with stasis blocking collaterals syndrome, as well as the effectof stasis removing and collaterals dredging.METHODS: Male Sprague-Dawley rats were divided randomly into normal control group(C group),high-carbohydrate-fat control group(H group) and streptozotocin(STZ)-injecting group. The diabeticrats were induced from rats in the STZ-injecting groupby high-carbohydrate-fat diet combined with STZ intraperitoneal injection, with sustained high-carbohydrate-fat diet fed afterwards, and were further divided into model group(M group)and Chinese medicine of stasis removing and collaterals dredging group(Z group). Rats in the Z group were fed with stasis-removing-and-collaterals-dredging herbal granule suspension intragastrically daily for 16 weeks, while drinking water of corresponding volume was administrated to the rats in other groups. At the end of the 16 th week after successful establishment of models, the ultrastructures of glomeruli in different groups were detected by a transmission electron microscopy; and blood measures related to blood stasis blocking collaterals, including lipid profile and blood viscosity measures, were tested, as well as the relative gene expressions of ACE and ACE2.RESULTS: Changes in ultrastructures of glomeruli in the M group were characterized by lack of clarity in structure and occasional thickening of glomerular basement membrane and extensive fusion in foot processes. The correlation analysis showed that there were positive correlations between lipid profile, blood viscosity, and the ACE mRNA expression levels in the M group(P<0.05), except for cholesterol. And except for triglyceride, the blood measures were in negative correlation with the ACE2 mRNA expression levels in the M group(P<0.05).Compared with the C and H groups, the lipid profile, plasma viscosity and blood viscosity were significantly higher(P<0.01). All the above-mentioned measures were significantly improved in the Z group rats(P<0.05). ACE mRNA expression was significantly higher in the M group thanin the C group(P<0.05). ACE2 mRNA level was significantly lower in the M group than in the C and H groups(P<0.01)and its levelin the Z group was higher than that in the M group(P<0.01).CONCLUSION: Blood measuresrelated to blood stasis blocking collaterals had positive linear correlations with ACE mRNAexpression and negative linear correlations with ACE2 mRNA expression in the M group. Chinese recipe of stasis removing and collaterals dredging could play a renal protecting role for diabetic rats by reducing lipid profile and blood viscosity, down-regulating ACE mRNA expression and up-regulating ACE2 mRNA expression.

范伏元教授从“络脉不和”论治肺结节经验

范伏元教授基于络脉沟通内外、渗灌气血、联系脏腑的生理特点,从肺痹、肺积认识肺结节,以络脉不和为肺结节根本病机,从伏邪凝痰痹络、胃络不和痰瘀结为窠囊进行阐发,以“通络开痹,和荣散结”“和胃逐瘀,安神化浊”为核心治法,分别以疏风宣肺汤、加味温胆汤处方辨治,将宏观脏腑辨证调和诸脏与微观络脉辨证调和络脉营卫气血津液沟通渗灌相结合,临床疗效确切。

从“血不利则为水”探讨慢性下肢静脉性水肿的血脉辨证

从“血不利则为水”的角度探讨慢性下肢静脉性水肿的中医证治,认为“血瘀水停”是慢性下肢静脉性水肿的重要病机,气病尤其是脾肾阳虚是发病的根本原因。临证在重视治血、治水和治气的同时要兼顾治络,以经方为本,活用虫类药和藤类药,补气兼顾温阳,活血兼顾逐瘀,通络兼顾养络。

柳国斌教授从“寒凝血瘀”论治血栓闭塞性脉管炎的经验

本文对柳国斌教授治疗血栓闭塞性脉管炎的学术思想进行总结。柳教授提出阳虚寒凝是血栓闭塞性脉管炎的始动病机,而后形成瘀血、脉络闭阻等病理环节,故将本病的病机概括为“寒凝经脉,瘀血阻络”,其提出以“温经散寒,活血通络”为治疗法则,遣方用药注重扶阳,认为机体的阳气充足后,气血得以运行顺畅,瘀血等病理因素随之消散。柳教授强调只有抓住病机才能抓住治疗的关键,在复杂的疾病中找出矛盾所在,才能取得良效。现将柳教授临证经验总结如下,并附验案1则,为治疗血栓闭塞性脉管炎提供思路。

基于“结者散之”辨治肺结节痰瘀互结证

肺结节之病机为肺气亏虚,外邪入体,肺之气络、血络先后受邪,气络生痰,血络生瘀,气络之痰与血络之瘀搏结成块,发而为病。从《黄帝内经》“结者散之”理论入手,治以清肺通络、祛痰化瘀为主,佐以疏肝理气,健脾渗湿之法,为肺结节的中医辨证及组方思路提供一定的借鉴与参考。

基于“络病学说”探析视网膜动脉阻塞的诊疗

视网膜动脉阻塞(RAO)是眼科危急重症,主要表现为无痛性视力下降,发病率较高,预后不佳。目前,西医治疗RAO仍无法获得满意的疗效,中医治疗RAO具有独特的优势,而络病理论的发展又为该病的诊疗提供了新的视角。本文基于络脉与视网膜微小动脉解剖与功能的一致性,试将络病学说应用于RAO的诊疗,提出本病的发病基础为络虚不荣,病机关键为邪瘀阻络。在通络原则指导下,治疗上可应用辛味、虫类、藤类药祛邪通络,补益药通补络虚,辅以穴位针刺,为RAO的诊疗提供新思路。

痰瘀阻络型缺血性中风与生化检验指标相关性分析

目的探讨痰瘀阻络型缺血性中风与生化检验指标的关系。方法回顾性收集2021年1—12月首都医科大学附属北京中医医院针灸科收治的痰瘀阻络型缺血性中风患者71例(A组)、非痰瘀阻络型缺血性中风患者55例(B组),另选取同期本院治未病中心参与体检的70例健康受试者(C组)。测定分析3组受试者血清生化指标。绘制受试者工作特征曲线分析评价各检验指标的诊断价值。结果诊断痰瘀阻络型缺血性中风排名前5的曲线下面积(AUC)指标分别为总蛋白、白蛋白、载脂蛋白A1(ApoA1)、高密度脂蛋白胆固醇(HDL-C)和胱抑素C,曲线下面积(AUC)分别为0.930、0.912、0.811、0.802和0.754。诊断非痰瘀阻络型缺血性中风的排名前5的AUC指标分别为白蛋白、总蛋白、ApoA1、小而密低密度脂蛋白胆固醇(sdLDL-C)和胱抑素C,AUC分别为0.962、0.908、0.879、0.831和0.830。总胆固醇、低密度脂蛋白胆固醇(LDL-C)、sdLDL-C、总胆红素对非痰瘀阻络型缺血性中风的诊断价值显著高于对痰瘀阻络型缺血性中风的诊断价值(Z=-2.083,P=0.037;Z=-2.705,P=0.007;Z=-3.056,P=0.002;Z=-2.264,P=0.024)。结论总胆固醇、HDL-C、LDL-C、ApoA1、sdLDL-C、胱抑素C、总胆红素、总蛋白、白蛋白单个指标检测对缺血性中风的中医辨证分型具有一定的参考价值,但不建议将总胆固醇等脂类检验指标作为缺血性中风的中医辨证分型依据。总胆红素可能对缺血性中风痰瘀阻络型的辨证分型提供帮助和用药参考。

经方六君子汤加减对新发2型糖尿病伴脾气壅塞、痰瘀阻络型肥胖的干预作用

目的 探讨经方六君子汤加减对新发2型糖尿病伴脾气壅塞、痰瘀阻络型肥胖患者的临床效果。方法 选择2023年1月-2023年9月南京市六合区中医院收治的60例新发2型糖尿病合并肥胖患者随机分为观察组和对照组各30例。对照组予德谷门冬双胰岛素、盐酸二甲双胍治疗,观察组在对照组的基础上加用经方六君子汤加减治疗。比较两组治疗前后中医证候积分、腰围、体质量、身体质量指数(BMI)、空腹血糖(FBG)、餐后2 h血糖(2 hPBG)、糖化血红蛋白(HbA1c)、血脂四项(甘油三酯[TG]、总胆固醇[TC]、低密度脂蛋白[LDL]、高密度脂蛋白[HDL])、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及不良反应。结果 治疗后,观察组总有效率明显高于对照组(P<0.05);两组中医证候积分、腰围、体质量、BMI、FBG、2 hPBG、HbA1c、TG、TC、LDL、HDL均明显改善(P<0.05),观察组均优于对照组(P<0.05)。治疗期间两组均出现低血糖1例,对照组腹泻1例,对症处理后好转,未出现明显血常规、肝肾功能异常。结论 新发2型糖尿病合并肥胖患者中加用经方六君子汤加减较单用德谷门冬双胰岛素联合盐酸二甲双胍片疗效更显著,可改善患者中医证侯积分、糖脂代谢相关指标等,不良反应少,效果满意。

基于“脾在味为甘”理论扭转特发性肺纤维化“肺虚络瘀”病机观初探

特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)由于预后极差、治疗手段有限等成为全球范围内较为重要的健康问题之一,给人们带来了巨大的经济和社会负担,因此如何有效治疗IPF已成为亟待解决的重大难题。IPF发病在肺,“脾”“肺”互为母子关系,肺脏盛衰受脾脏影响,文章通过脾藏象理论阐释特发性肺纤维化“肺虚络瘀”病机观,明晰“脾在味为甘”科学内涵,“脾喜甘味-甘易伤脾-甘能补脾”为“脾在味为甘”生理、病理、治疗基础的关键轴,“甜味觉受体-肠道菌群-IPF”为“脾在味为甘”干预疾病进程的病理链条。通过经脉、五行、气血、痰瘀角度论述从脾治疗IPF的理论基础,依据甘味“甘补”“甘和”“甘缓”的特性补虚荣络、寓通于补、缓攻延效从而改善IPF患者预后,将中医理论和西医机制结合为临床特发性肺纤维化辨证施治与遣方用药开辟新思路与新方向,对延缓疾病进程有着重要意义。

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。