The Comparative Study on Two Models of Syndrome Differentiation of the Hand, Foot and Mouth Disease: An Investigation Analysis of the Signs and Symptoms on 2325 Cases

Objective To realize the characteristics of "zheng" differentiation-treatment for hand, foot and mouth disease(HFMD), a new methodology of syndrome differentiation for different stages of HFMD has been explored. Methods Total of 2 325 cases with HFMD were recorded by distributing them into exterior syndrome stage, interior syndrome stage, severe syndrome stage and recovered syndrome stage, respectively, and the main symptoms and subsidiary symptoms of different stages of HFMD have been observed. The major and minor pathogenesis of HFMD in different stages were obtained, and compared with the "2010 Guideline for the Diagnosis and Treatment of HFMD". Results It was found that the major pathogenesis of exterior stage was defined as "the invation of the wenevil to the defender of the body with the collaterals got involved ", and the minor as "qi deficiency"; in interior stage, "the fury of Gan-Yang" was the main pathogenesis, and "qi in chaos and qi deficiency" was the minor; in severe syndrome stage, "the damage of heart, liver and lung" was the main pathogenesis, and "qi in chaos" was the minor; and the pathogenesis of recovered stage was "qi-yin deficiency". Compared with the "2010 Guideline for the Diagnosis and Treatment of HFMD", it showed that "the obstruction of the fei-pi qi by the mixture of shi-re evil" and "the mixture of shi-re" in vivo was quite difficult to be explained in completely different context in the general situation; in the severe stage, the TCM clinical characteristics of syndrome differentiation might lose; in the early acute severe cases, the phenomenon that xin-yang and fei-qi almost ran out was difficult to be observed, then, the line between the severe and the acute severe became vague.Conclusions The theory of syndrome differentiation by stages of HFMD was reasonable in the actual situation of clinical description on HFMD which was expected to be further tested and widely applied in the "zheng" differentiation-treatment of HFMD in the future.

Research Survey of Animal Model of Hepatic Fibro-sis Integrated with Western Medicine Diseases and Traditional Chinese Medicine^TCM~)Syndrome

Although the animal models of hepatic fibrosis developed by former researchers have pathological changes of hepatic fibrosis, they do not include charac- teristics of important TCM syndromes such as stagnation of qi, deficiency of qi, liver depression, phlegm-dampness and blood stasis because of single-factor model- ing. Animal models of hepatic fibrosis and animal models integrated disease and syndrome were reviewed, and several new types of integrated disease and syndrome animal models constructed by multiple-factor modeling method were evaluated, under the guidance of etiological theory of TCM. This kind of hepatic fibrosis model animals has dual characteristics of disease and syndrome. It is consistent with pathological characteristics of hepatic fibrosis in western medicine when replicating the basic characteristics accorded with TCM syndrome. Thus, the pathogenesis and pathogenic process of clinical disease and syndrome formation is simulated more ac- curately, providing a new platform and pathway for studying hepatic fibrosis disease with integrated traditional Chinese and western medicine.

HOW TO MASTER THE DIFFERENTIATION OF SYNDROMES AND THE SELECTION OF ACUPOINTS QUICKLY

Differentiation of syndromes can be done by three steps:First to differentiate thenature of disease,second to differentiate the location of disease,third to analyse comprehensively thenature and location of disease.Depend on complete differentiation of syndromes,the acupoints are selected.Three cases are analysed to explain how to dominate preceding contents.

ACUPUNCTURE TREATMENT ON 40 CASES OF IRRITABLE COLON SYNDROME ACCORDING TO DIFFERENTIATION OF SYMPTOMS AND SIGNS

Irritable intestinal tract syndrome was classified and treated with acupuncture according to differentiation of symptoms and signs.Of the 40 cases treated,28 were cured,11 improved,and 6 ineffective.The total effective rate was 85％.The syndrome was classified into fourtypes:weakness of the spleen and stomach,disharmony of the liver spleen,Yang deficiency ofthe spleen and kidney,and retention of dampness and heat.There was no statistically significant difference in therapeutic effects among the four types of syndromes.However,the curative effect in theacupuncture group was better than that in the medication group,and the difference was of statisticalsignificance.

Effects of TCM Nursing Based on Syndrome Differentiation on Pulmonary Function and Quality of Life in Patients with Acute Exacerbation of COPD

[Objectives] To investigate the effects of TCM nursing based on syndrome differentiation on pulmonary function and quality of life in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). [Methods] A total of 92 patients with AECOPD who came to Nanchong Chinese Medicine Hospital from March 2022 to February 2023 were selected for the study, and the intervention group (TCM nursing based on syndrome differentiation, 46 cases) and the conventional group (basic nursing, 46 cases) were selected for the study, and the pulmonary function and quality of life of the two groups were compared. [Results] Before nursing, there was no significant difference in levels of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and percentage of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) between the intervention group and conventional group ( P >0.05). After 3 months of nursing, the levels of FVC, FEV1 and FEV1/FVC in the intervention group were higher than those in the conventional group ( P <0.05). Before nursing, there was no significant difference in the scores of health, emotion and social functions between the two groups ( P >0.05). At three months of nursing, the scores of health, emotion, and social functions in the intervention group were higher than those in the conventional group ( P <0.05). [Conclusions] The implementation of TCM nursing based on syndrome differentiation in patients with AECOPD can effectively improve the pulmonary function and quality of life of patients, and has significant clinical implementation value.

益气活血方调控METTL3/HAND2/TGF-β1信号轴对冠心病气虚血瘀证大鼠的影响

目的观察益气活血方调控METTL3/HAND2/TGF-β1信号轴对冠心病气虚血瘀证大鼠的影响。方法将48只雄性SD大鼠随机分为假手术组、模型组、益气活血方组和西药(单硝酸异山梨酯)组,每组12只。除假手术组外,其余各组采用左冠状动脉前降支结扎结合游泳力竭法制备冠心病气虚血瘀证大鼠模型。造模结束后,益气活血方组及西药组灌胃干预28d。观察大鼠一般状况,采集心电图,超声心动图检测大鼠心功能,血液流变学检测血瘀程度,HE染色观察心肌组织形态,免疫组化法检测心肌组织甲基化转移酶3(METTL3)、转化生长因子(TGF)-β1、Smad2、Smad3表达,RT-PCR和Western blot检测心肌组织METTL3、心脏神经嵴衍生物表达蛋白2(HAND2)、TGF-β1、Smad2、Smad3mRNA和蛋白表达。结果与假手术组比较,模型组大鼠出现精神萎靡、行动迟缓、嗜睡、体质量降低等气虚表现,心电图ST段显著抬高,左室射血分数(LVEF)、左室短轴缩短率(LVFS)下降(P<0.01),左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室舒张末期内径(LVEDd)、左室收缩末期内径(LVEDs)升高(P<0.01),红细胞聚集指数、卡松黏度及全血黏度升高(P<0.01);心肌细胞肿大、坏死,心肌纤维排列紊乱,心肌组织有炎性细胞浸润,心肌组织METTL3、TGF-β1、Smad2、Smad3mRNA和蛋白表达均升高(P<0.05,P<0.01),HAND2 mRNA和蛋白表达均降低(P<0.01)。与模型组比较,益气活血方组和西药组大鼠精神状态明显改善,心电图ST段明显回落,LVEF、LVFS升高(P<0.01),LVEDV、LVESV、LVEDd、LVEDs下降(P<0.05,P<0.01),红细胞聚集指数、卡松黏度及全血黏度下降(P<0.01);心肌纤维排列整齐,心肌细胞结构及形态改善,炎性细胞浸润减少,心肌组织METTL3、TGF-β1、Smad2、Smad3 mRNA和蛋白表达降低(P<0.05,P<0.01),HAND2mRNA和蛋白表达升高(P<0.05,P<0.01)。结论益气活血方能减轻冠心病气虚血瘀证大鼠心肌组织病理损伤,提高心功能,抑制炎症反应,其作用机制可能与调控METTL3/HAND2/TGF-β1信号轴有关。

Can TCM Treatment be Performed on the Basis of Differential Diagnosis of the Diseases Instead of the Syndromes?

Great advances have been achieved in the integration of western and traditional Chinese medicine (TCM).More and more TCM physicians in their practice accept the term 'differential diagnosis of the diseases' instead of the syndromes since western medicine has been introduced into the TCM circle.

Differentiating and Treating Gynecological Diseases based on the Theory of Collateral Diseases

The collateral disease theory is a unique component of the theoretical system of traditional Chinese medicine(TCM),which is currently applied to all kinds of diseases related to the collaterals.With the in-depth study of collaterals theory by many practitioners,its advantages in differentiating and treating gynecological diseases are gradually embodied.Based on the theory of collaterals disease,we discussed the pathogenesis,syndrome differentiation and treatment of gynecological diseases,concluded that the deficient collaterals under nourishment and the stagnant and blocked uterine collateral are the important pathogenesis of gynecological illness.Then we pointed out that invigorating the spleen and tonifying the kidney,and unblocking collateral and dissipating stasis are important treatment methods.We discussed the application of collateral disease theory in Tianjin HA's gynecology,and provided certain theoretical basis and clinical reference for the treatment of gynecologic diseases.

Long-term Effect of TCM Decoctions in Treatment of Nephrotic Syndrome

Fifty-seven cases of nephrotic syndrome were treated with TCM decoctions as accessory treatment for prednisone and cyclophosphamide, and the effects were observed in a follow-up period of 5-15 years. The long-term complete remission rate of 68.4% and recurrence rate of 26.3% in the treatment group were respectively higher and lower than those in the control group (P

Prof. Zhou Xuewen's Experience in Treating Superior Mesenteric Artery Syndrome

Prof. Zhou Xuewen (周学文), a veteran TCM doctor,is an expert in treating miscellaneous internaldiseases. I have the honor to follow him and havebenefited from his teaching. The following is hisexperience in treating superior mesenteric arterysyndrome that I would like to introduce below.

Professor Chen Xianhai's experience of herb pairs in the treatment of pulmonary diseases

According to the theory of traditional Chinese medicine,based on the four properties and five flavors of traditional Chinese medicines,the lifting and lowering theory and channel tropism,Professor Chen combined with the theory of traditional Chinese medicine and constitution identification to prescribe for patients and used herb pairs to treat many kinds of pulmonary diseases.And he has achieved good clinical effect by"treatment methods selection according to syndromes".His experience in medication and compatibility mechanism are worthy of further exploration and promotion by scholars.

A Validated Model for the Imaging Diagnosis of Cystic Lung Disease

Rationale and Objectives: Cystic lung disease may be accurately diagnosed by imaging interpretation of specialist radiologists, without other information. We hypothesized that with minimal training non-specialists could perform similarly to specialist physicians in the diagnosis of cystic lung disease. Methods: 72 cystic lung disease cases and 25 cystic lung disease mimics were obtained from three sources: 1) a prospective acquired diffuse lung disease registry, 2) a retrospective search of medical records and 3) teaching files. Cases were anonymized, randomized and interpreted by 7 diffuse lung disease specialists and 15 non-specialist radiologists and pulmonologists. Clinical information other than age and sex was not provided. Prior to interpretation, non-specialists viewed a short PDF training document explaining cystic lung disease interpretation. Results: Correct first choice diagnosis of 85%-88% may be achieved by high-performing specialist readers and 71%-80% by non-specialists and lower-performing specialists, with mean accuracies in the diagnosis of LAM (91%, p Conclusion: With specific but limited training, non-specialist physicians can diagnose cystic lung diseases from CT appearance alone with similar accuracy to specialists, correctly identifying approximately 75% of cases.

Implementation status quo of traditional Chinese medicine nursing program for advantaged diseases

With the promulgation of the traditional Chinese medicine(TCM)nursing program for advantaged diseases,its application in the clinic has drawn wide attention.TCM nursing program can actively promote the clinical development of TCM syndrome differentiation and nursing.This article introduces the implementation status quo of the TCM nursing program for advantaged diseases in clinical practice,summarize the existing problems in the implementation and put forward measures to promote its perfection.Finally,the article discusses and looks forward to the TCM nursing program for advantaged diseases.Provide theoretical basis and reference for medical workers to effectively promote the application and implementation of TCM nursing programs for advantaged disease.

卫气营血辨证精髓层次辨治探析

探讨完善卫气营血辨证体系的可能性。温病血分证的临床表现多样、病机复杂,结合课题组前期研究和精学说、髓学说,分别针对温病极后期出血、脏器功能衰竭、神志异常和痉厥的发病特征,认为宜将传统的血分证再细分为以血的生成、运行、功能等发生障碍为主的血分证,以脏器功能衰竭为主的精分证和以神志、神经异常症状为主的髓分证。采用“卫气营血精髓”六阶段辨治,不仅拓展温病病机层次递进规律,加深对温病各期,尤其是极期、后期病机本质的再认识,推动立法遣方趋于精准化,更有助于认识多种外感、内伤疾病共同的转化演变规律,从而提高诊疗效果。

基于证素辨证理论的情志病证动物模型评价的理论构想及实现路径探究

现阶段情志病证理论发展滞后及针对性药物开发落后的主要原因即是缺乏合适有效的动物模型,其中模型评价又是情志病证动物模型制备中关键及难点。中医药理论中证素辨证理论与动物行为学中行为要素理论深为契合,有望带来相关领域理论变革及方法学进步。基于此背景,系统梳理并厘清情志病证动物模型评价的理论构想,即借助中医证素辨证理论的思维模式为指导,尝试建立完整的模型评价体系。并指出基于证素辨证理论的情志病证动物模型评价的实现路径,即自然状态下行为要素采集及时序分析、应激状态下异常行为表型鉴定分析、模型动物证候判别的等效转换。

五体合五脏辨证思维在中医骨伤教学的应用

辨证论治是中医骨伤教学的重要内容,也是临床诊疗的关键环节。目前,五体辨证和五脏辨证均应用广泛,但骨伤研究生临床实践多进行单一辨证,难以灵活运用两种辨证思维。文章拟重点阐述“五体合五脏”辨证思维在中医骨伤教学中的具体应用,基于“五体”(皮、肉、筋、骨、脉)和“五脏”(肺、脾、肝、肾、心)的关系,深入分析二者疾病传变规律和防治原则,培养学生司外揣内、未病先防、既病防变的中医思维,提高其辨证能力和临床诊疗水平。

Clinical treatment of myasthenia gravis with deficiency of spleen and kidney based on combination of disease with syndrome theory

OBJECTIVE: To study the use of Jianjining in the treatment of myasthenia gravis (MG) patients with a deficiency of both spleen and kidney via the theory on the combination of disease with syndrome. METHODS: Sixty MG patients with a deficiency of both spleen and kidney were randomly divided into an treatment group (n=30) treated with Jianjining granules and Western Medicine (prednisone or pyridostigmine bromide) and a control group (n= 30) treated with Jianjining granules. The dosage of the three drugs was reduced over the course of treatment. After 3 and 6 months of treatment, the curative effect was evaluated with the muscle weakness severity scale (MWSS). RESULTS: The MWSS score after treatment declined significantly in both groups. The score in the treatment group was much lower than that in thecontrol group (P<0.05). The total effective rate was 63.33% (19/30) in the treatment group and 36.67% (11/30) in the control group after 3 months of treatment, and 80.00% (24/30) and 50.00% (15/30), respectively, after 6 months of treatment. The obvious and total effective rates in the treatment group were much higher than those in the control group (P<0.05). After 6 months of treatment, there were no obvious differences (P>0.05) in the obvious and effective rates between the 2 groups. However, the total effective rate in the treatment group was much higher than that in the control group (P<0.01). CONCLUSION: Using the theory on the combination of disease with syndrome, we found that the curative effect of Jianjining and Western Medicine on MG patients with deficiency of both spleen and kidney is worth further exploration.

Disease-Syndrome Combination Clinical Study of Psoriasis:Present Status,Advantages,and Prospects

Psoriasis is an immune-abnormal,chronic,proliferative skin disease determined by polygenic inheritance and induced by a number of environmental factors.It causes worldwide concern because of its high-prevalence,harmful and incurable characteristics.Over the years,Chinese medicine（CM） treatment of psoriasis has accumulated a wealth of clinical experience.Disease-syndrome combination, which achieves more satisfactory clinical effect,is the basis to highlight the special CM advantages in treating psoriasis.In this paper,we review the advantages of treating psoriasis with the combination of disease and syndrome,analyze the prospects of research on treating psoriasis combining disease with syndrome.We also make a point that there are several key points for the clinical research of combination of disease and syndrome.It can be expected that carrying out clinical research on the combination of disease and syndrome will help improve the clinical efficacy of medical treatment of psoriasis,which will be the main direction of research in the future.

缺血性脑卒中痰热腑实证大鼠模型的建立与评价

背景:中医药在治疗缺血性脑卒中痰热腑实证中具有丰富的经验和独特的优势,为深入挖掘中医药对该病的治疗靶点和治疗机制,建立稳定、可靠的缺血性脑卒中痰热腑实证病证结合动物模型是关键。目的:探讨缺血性脑卒中痰热腑实证大鼠模型的建立方法及评价体系。方法:采用随机数字表法将60只SD大鼠随机分为4组:空白对照组(n=12)、缺血性脑卒中组(n=18)给予普通饲料喂养25 d,病证结合组(n=18)、痰热腑实证组(n=12)给予高脂饲料喂养25 d;第26天,空白对照组、缺血性脑卒中组灌胃给予生理盐水,病证结合组、痰热腑实证组灌胃给予自体粪便混悬液,连续灌胃3 d(灌胃期间继续给予高脂饲料);灌胃结束后,缺血性脑卒中组、病证结合组采用线栓法建立缺血性脑卒中模型,记录各组大鼠饮食量、饮水量、体质量、体温、粪便性状、鼻分泌物、喉中痰鸣、舌象等表征变化。造模结束后24 h,进行神经功能缺损评分、舌象表征、血脂水平检测、脑组织及颈动脉形态学观察以及血清胃动素和生长抑素水平检测。结果与结论:(1)与空白对照组比较,病证结合组大鼠呼吸急促、精神萎靡、烦躁、行动迟缓,鼻周可见大量分泌物、可闻及厚重的喉中痰鸣,饮食量、饮水量下降,体质量、体温及舌下脉络评分升高,粪便粒数、Bristol评分及粪便含水率降低;血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇及生长抑素水平升高,胃动素水平降低,神经功能缺损评分升高,颈动脉发生显著病理改变,脑组织显示明显缺血形态学改变。缺血性脑卒中组仅能造成缺血性脑组织病理改变,不能复制出痰热腑实证的证候特征。痰热腑实证组能复制出典型的中医证候特征,但不能构建出缺血性脑卒中的脑组织病理改变。(2)结果表明,高脂诱导结合线栓法及自体粪便灌胃的多因素复合造模方法,可建立缺血性脑卒中痰热腑实证病证结合动物模型。