风类药物治疗心血管疾病

心血管疾病发病与风邪密切相关,发病形式、证候特征大都表现为风性。风类药质轻气清,疏解宣透,多具有辛、散、窜、透、动等特点。冠心病络滞风阻,治以温阳散寒,祛风通络,辛散祛风、活血祛风;心律失常本虚标实,本为气血不足,阴阳亏损;标为气滞、血瘀、痰浊、水饮,治以辛散祛风、平肝熄风、解毒祛风、活血祛风、养血祛风、搜络祛风。高血压肝风内扰,风阳上亢,平肝熄风类、理气熄风;无风不作眩,平肝熄风、理气熄风;无虚不作眩,补肾祛风、养血祛风;无瘀不作眩,活血祛风、辛散祛风、理气祛风。风类药治疗心血管疾病疗效显著,重视风邪与心血管疾病发病的关系,能有效预防和治疗心血管疾病发生和发展。

基于“风胜湿”理论探讨风药在类风湿关节炎(尪痹)中的应用

类风湿关节炎(尪痹)是一种以全身关节疼痛为主要特征的自身免疫性疾病,病因病机尚未明确,目前认为主要与遗传、内分泌、环境等因素有关,治疗主要以缓解疼痛、对症支持为主。中医学将本病归属于“痹病”范畴,认为内因与外因共同作用导致本病的发生,风、寒、湿是其重要病因。中医针对病因病机,运用整体观念,辨证论治,对于本病的治疗具有一定优势。文章旨在基于“风胜湿”理论探讨风药在类风湿关节炎治疗中的应用,为临床提供理论依据。

基于“风-肾络-玄府”浅述藤类风药在糖尿病肾病中的应用

糖尿病肾病病位在肾,结合现代医学对于肾脏微观结构的认识,认为肾络-玄府共同维持其气血津液的渗灌、运行、互渗。风者,百病之长,从“风-肾络-玄府”探析糖尿病肾病之“因、机、证、治”,认为风扰肾络-玄府为其首要致病因素,肾络闭阻,玄府失司为其主要病机,并基于此结合西医对于糖尿病肾病的临床分期以探析其病机变化,辨证论治,引入“藤类风药”以其“舒展、蔓延、盘旋”之性祛风开玄,通络化滞,辨证用药以缓解症状,提高临床疗效,为中医治疗糖尿病肾病提供思路与方法。

路志正教授“风类”药应用心法

风类药能行能散,路志正教授善于运用风类药调理脾胃,并治疗内科疑难杂症,取得了满意效果。本文通过祛风升清、升阳止泻、发散火郁、熄风通络、祛湿降浊等五个方面分别加以说明,体现了路老用药轻灵活泼、圆机活法的辨证特点。

藤类风药在糖尿病并发症中应用体会

糖尿病并发症复杂而多变,其发病与消渴日久、正虚邪留,久病入络、痰凝血瘀,化生风邪有关,治疗当以活血祛风、化瘀通络贯穿始终,但糖尿病并发症为疑难顽症,非一般祛风通络所治,在糖尿病并发症中引入藤类风药,临床效果独特,验证了《本草便读》所言:"凡藤蔓之属,皆可通经入络,此物善治风疾。"从而拓展了糖尿病并发症的治疗及用药思路。

试述藤类风药在消渴痹证应用中的点睛之处

消渴痹证由慢性高血糖和微血管病变引起的以"凉、麻、痛、痿"为特点的对称性多神经病变,病机与消渴日久,阴伤气耗,正虚邪恋,久病入络、瘀血阻滞有关,而阴虚、血瘀、糖毒皆能化生风邪,治疗时应在益气活血、化瘀通络法(或中药)的基础上加上治"风"药。但消渴痹证为顽疾,非一般治"风"药可达,结合络脉学说、脉络-血管系统病的同一性及取象比类思维,引入"凡藤蔓之属,皆可通经入络,善治风疾"的藤类风药治疗消渴痹证,临床效果独特。一则作为引经药,引药物直达脉络;一则加强祛风通络止痛之功,实为点睛之处。

藤类风药治疗咳嗽病应用举隅

张效科教授在临床诊治咳嗽病中,多从外感、内伤这两点切入以辨识病因病机,治疗上多配伍藤类风药,治外感咳嗽取其辛散风邪之功,风去者脏自安,治内伤咳嗽取其引药达络以祛络病之邪之功,常用清风藤、海风藤、络石藤等来组方,往往获得意想不到的良效。

Statistical Analysis of Regularity of Pesticide Residues in Vegetables Produced in Inner Mongoli

[Objective]The paper was to study regularity of pesticide residues in vegetables produced in Inner Mongolia.[Method]Mathematical statistic analysis was carried out on 6 800 samples of veggies,fruits,leguminous vegetables,nuts and seeds produced in Inner Mongolia.[Result]The dominated vegetables in Inner Mongolia were green leafy vegetables,solanaceous vegetables and melon vegetables,and their yields accounted for 70%of the total vegetables production.Since 2003,with the rapid increase of detected vegetable numbers,the status of vegetable quality safety had entered into a new stage of sustainable steady after a rapid decline or periodic fluctuation,and the differences in safety levels were obvious,of which the range of exceeding standard rate of pesticide residues in solanaceous vegetables,melon vegetables and leguminous vegetables(about 55%of the total vegetables)was under 2%,with average values of 1.1%,1.6%and 3.1%,respectively.They belonged to stable type.The exceeding standard rate of pesticide residues in green leafy vegetables and Chinese cabbage group(about 30%of total vegetables)presented a decreasing trend year by year,wondering in the range of 7%-10%.They belonged to main risk type.The time period of exceeding standard of pesticide residues in root vegetables and cole vegetables was under predictable,and its exceeding standard rate in some years was over 5%(amplitude variation is over 15percentage points).They belonged to random risk type.The kinds of pesticides,which exceeding standard rate in vegetables were relatively intensive,presented variance in different vegetable species.70%of the pesticides belonged to intermittent over-limits and the probability was below 5%.About 20%tradition pesticides often exceeded standard and their probabilities were over 30%.The exceeding standard of organophosphorus and carbamates pesticides in vegetables presented a decreasing tend,while the risk of some new pesticides containing nitrogen element and high effective pyrethroids showed an increasing tendency.[Conclusion]The paper provided decision making services for agricultural management departments.

Treatment of dyslipidemia in the elderly

Dyshpidemia is a well-established risk factor for atherosclerosis. Treating dyslipidemia in elderly patients requires specific knowledge and understanding of common dyslipidemias and the relative safety of various pharmacologic agents in the presence of possible multiple comorbidities. Lifestyle modification remains the first step in the treatment of dyslipidemia; however, it can be difficult to sustain and achieve acceptable compliance in the elderly and it is best used in combination with drug therapy. Statins are widely accepted as the first-line therapy. Several recent studies have demonstrated that statins are safe and effective in the elderly. However, it is important to note that there is very limited data regarding the effects of dyslipidemia treatment on morbidity and mortality in patients over 85 years of age. In summary, the clinicians must recognize that the presence of dyslipidemia in the elderly poses substantial risk of coronary events and stroke. The available evidence has demonstrated that in most elderly patients who are at increased risk for cardiovascular morbidity and mortality, treatment of dyslipidemia with appropriate therapy reduces the risk, and when used carefully with close monitoring for safety, the treatment is generally well tolerated. With increasing life expectancy, it is critical for physicians to recognize the importance of detection and treatment of dyslipidemia in the elderly.

Bisphosphonate use and gastrointestinal tract cancer risk:Meta-analysis of observational studies

AIM:To perform a meta-analysis of observational studies to further elucidate the relationship between oral bisphosphonate use and gastrointestinal cancer risk.METHODS:Systematic literature search was conducted in MEDLINE,EMBASE,and the Cochrane Library to identify studies through January 2011.Search terms were "bisphosphonates" or trade names of the drugs,and "observational studies" or "cohort studies" or "case-control studies".Two evaluators reviewed and selected articles on the basis of predetermined selection criteria as followed:(1) observational studies(casecontrol or cohort studies) on bisphosphonate use;(2) with at least 2 years of follow-up;and(3) reported data on the incidence of cancer diagnosis.The DerSimonian and Laird random effects model were used to calculate the pooled relative risk(RR) with 95% confidence interval(CI).Two-by-two contingency table was used to calculate the outcomes not suitable for meta-analysis.Subgroup meta-analyses were conducted for the type of cancer(esophageal,gastric and colorectal cancers).Sensitivity analyses were performed to examine the effect sizes when only studies with long-term follow-up(mean 5 years;subgroup 3 years) were included.RESULTS:Of 740 screened articles,3 cohort studies and 3 case-control studies were included in the analyses.At first,4 cohort studies and 3 case-control studies were selected for the analyses but one cohort study was excluded because the cancer outcomes were not categorized by type of gastrointestinal cancer.More than 124 686 subjects participated in the 3 cohort studies.The mean follow-up time in all of the cohort studies combined was approximately 3.88 years.The 3 casecontrol studies reported 3070 esophageal cancer cases and 15 417 controls,2018 gastric cancer cases and 10 007 controls,and 11 574 colorectal cancer cases and 53 955 controls.The percentage of study participants who used bisphosphonate was 2.8% among the cases and 2.9% among the controls.The meta-analysis of all the studies found no significant association between bisphosphonate use and gastrointestinal cancer.Also no statistically significant association was found in a meta-analysis of long-term follow-up studies.There was no negative association between bisphosphonate use and the incidence of esophageal cancer in the overall analysis(RR 0.96,95% CI:0.65-1.42,I 2 = 52.8%,P = 0.076) and no statistically significant association with long-term follow-up(RR 1.74,95% CI:0.97-3.10,I 2 = 58.8%,P = 0.119).No negative association was found in the studies reporting the risk of gastric cancer(RR 0.89,95% CI:0.71-1.13,I 2 = 0.0%,P = 0.472).In case of colorectal cancer,there was no association between colorectal cancer and bisphosphonate use(RR 0.62,95% CI:0.30-1.29,I 2 = 88.0%,P = 0.004) and also in the analysis with long-term follow-up(RR 0.61,95% CI:0.28-1.35,I 2 = 84.6%,P = 0.011).CONCLUSION:Oral bisphosphonate use had no significant effect on gastrointestinal cancer risk.However,this finding should be validated in randomized controlled trials with long-term follow-up.

Application of Huangqi Guizhi Wuwu Decoction in Orthopaedics and Traumatology

The Huangqi Guizhi Wuwu Decoction(HQGZWWT)is composed of Huangqi(Astragali Radix),Shaoyao(Paeoniae Radix Alba),Guizhi(Cinnamomi Ramulus),Shengjiang(Zingiberis Rhizoma Recens),and Dazao(Jujubae Fructus)which has various pharmacological anti-inflammatory,analgesic,antioxidant,antitumor,lipid-lowering,and immunity-regulating activities.It has certain advantages in the treatment of orthopaedic diseases,such as cervical spondylosis,scapulohumeral periarthritis,lumbar disc herniation,knee osteoarthritis,rheumatoid arthritis,myofascial pain syndrome,etc.,with outstanding clinical efficacy,few adverse reactions,and high patient compliance.However,modern pharmacological researches on the whole prescription of HQGZWWT are insufficient and the therapeutic targets are not clear which needs further exploration.Besides,this prescription cannot treat ll orthopaedic diseases,so we should adhere to the thinking of four diagnostics in traditional Chinese medicine(TCM),select prescriptions based on syndrome differentiation,closely follow the pathogenesis,innovate and expand its scope of application,reflect the application advantages of this prescription in orthopaedics and traumatology and improve the total clinical efficiency.

从“玄府-络脉”论治糖尿病周围神经病变

糖尿病周围神经病变归于中医消渴病痹证范畴,其病机属本虚标实,以脏腑亏虚为本,瘀血痰毒阻络为标。玄府、络脉皆为维系周身气血津液有序运行的微观结构,也是瘀血、痰、毒产生的关键病位,故基于中医"玄府-络脉"理论,提出玄府开阖失司、络脉瘀滞不通为糖尿病周围神经病变的基本病机。玄府郁闭,精微不布,化生糖毒,发为糖尿病,诸邪滋生进一步加重玄府闭塞,成为糖尿病周围神经病变的始发环节,日久内生毒邪、损伤络脉为其病机关键所在。糖尿病周围神经病变属宿病顽疾,病邪痼结难解,非一般之药可解。临证组方时借藤类风药以"开玄通络",玄府开、络脉通、瘀痹除,则诸症皆除,临床获效颇丰,为从中医微观结构层次认识及治疗糖尿病周围神经病变提供新思路。

Therapeutic Efficacy Observation on Acupuncture plus Medication for Rheumatoid Arthritis

Objective： To observe the clinical efficacy of acupuncture plus medication for rheumatic arthritis （RA）. Methods： A total of 80 RA cases were randomized into an observation group and a control group, 40 in each group. Cases in the observation group received antirheumatic agents and acupuncture therapy, whereas cases in the control group received antirheumatic agents alone. The therapeutic efficacies were observed after 3 sessions of treatment. Results： After the treatment, patients in the observation group had significant improvement in their morning stiffness time, average grip of both hands, joint tenderness and joint swelling, showing statistical significances （P〈0.01）; symptoms of patients in the control group were also remarkably improved （P〈0.01, P〈0.05）. Compared with the control group, the improvements in joint tenderness and average grip of both hands in the observation group were more significant （P〈0.05）. After treatment, the Health Assessment Questionnaire （HAQ） points were significantly improved in both groups, erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） in both groups were remarkably reduced （P〈0.01, P〈0.05）; however, compared with the control group, the CRP decrease in the observation group was more significant （P〈0.05）. Conclusion： Acupuncture plus antirheumatic agents can effectively increase the RA patients＇ activities of daily living （ADL） and thus improve their quality of life.

Meta-analysis of the effect of statin use and pancreatic cancer risk

Statin has been proposed to have a capacity to reduce the risk of pancreatic cancer,while the obtained results are not consistent.To gain a clearer picture of the relationship between statin use and pancreatic cancer,the present meta-analysis took into consideration data from eight cohort studies,ten case-control studies and three RCTs.We searched all relevant studies on the effect of statin use on the risk of pancreatic cancer using PubMed,Embase and the Cochrane library database from inception to July 30,2018.The following search terms were used:(1)statin("statins","statin","3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors","atorvastatin","cerivastatin","fluvastatin","lovastatin","pravastatin","rosuvastatin","simvastatin");(2)pancreatic cancer("cancer","neoplasm","malignancy").We manually examined the references of the relevant articles and reviews to identify additional studies.A total of 21 studies,published between 2001 and July 2018 and involving 1148680 cases and 2177842 controls,fulfilled the selection criteria.The pooled results revealed a significant relationship between statin use and pancreatic cancer risk(OR=0.84,95%CI 0.72-0.98,P=0.000,I^2=84.30).However,lipophilic statins(OR=1.07,95%CI 0.97-1.18,P=0.651,I^2=0.0%)had no significant effect on the risk of pancreatic cancer.In contrast,short-term statin use(OR=0.72,95%CI 0.54-0.96,P=0.000,I^2=80.1%)and long-term statin use(OR=0.70,95%CI 0.54-0.92,P=0.000,12=79.8%)significantly reduced pancreatic cancer risk.Notably,the high heterogeneity among the selected studies was eliminated by excluding the three studies that focused on restricted populations.Statin could significantly reduce the risk of pancreatic cancer.