Study on the Characteristics of Gut Microbiota in Chronic Hepatitis B(CHB)Patients with Damp Heat Syndrome and Liver Depression and Spleen Deficiency Syndrome

Objective:This study was designed to explore the characteristics of gut microbiota in CHB patients with two most common traditional Chinese medicine(TCM)Syndromes—damp heat syndrome and liver depression and spleen deficiency syndrome.Methods:According to the diagnostic criteria of Western medicine,TCM and screening exclusion criteria,65 cases of CHB with damp heat syndrome and 28 cases of CHB with liver depression and spleen deficiency syndrome were finally included in the study.All the basic information was gathered and the fresh fecal samples were collected for 16S rDNA sequencing.16S rDNA of gut microbiota was sequenced using Illumina hiseq 2,500 high-throughput sequencing platform.Based on the optimized sequence,Operational Taxonomic Units(OTU)clustering analysis and taxonomic annotation were carried out.Results:The difference in relative abundance of gut microbiota was significant between damp heat syndrome and liver depression and spleen deficiency syndrome in CHB patients.Cyanobacteria was only found in damp heat syndrome.The relative abundance of Erysipelotrichia and Subdoligranulum were higher in liver depression and spleen deficiency syndrome,while the relative abundance of Rhodospirillales,Alphaproteobacteria and Lachnospira were higher in the damp heat syndrome.LDA Effect Size(LEfSe)analysis showed that Lachnospira,Olsenella and Subdoligranulum had significant difference in species among the two TCM syndromes.Conclusion:The different characteristics of gut microbiota in the two TCM syndromes of CHB patients may play an important role in syndrome formation of TCM,which provides a new field of vision for the accurate diagnosis and treatment of TCM.

Study on the Expression of Organic Anion Transporting Polypeptide (oatp2a1) in Rat with Spleen Deficiency Syndrome and the Exploration of Clinical Significance

Objective: to explore the mechanism of transportation and transformation of dampness by the way of the expression of organic anion transporting polypeptide (oatp) superfamily member 2a1 (oatp2a1) mRNA in rat with spleen deficiency syndrome and the significance in transportation and transformation of dampness. Methods: 32 wistar male rats were divided randomly into four groups: normal group (n = 6), normal + AA group (n = 6), spleen deficiency group (n = 10), Spleen deficiency + AA group (n = 10). After reserpine-induced spleen deficiency model was made, intragastric administration of aristolochic acid (AA) was adopted for three days, the expression of oatp2a1 mRNA were detected in the tissues of lung, liver, kidney, stomach, small intestine and large intestine in four groups by using Fluorescent Quantitative-Polymerase Chain Reaction (FQ-PCR). Results: the expression of oatp2a1 mRNA in above six tissues could be detected. The ex-pression of oatp2a1 mRNA in liver tissue of rat with spleen deficiency syndrome was up-regulated compared to normal group (P = 0.035, P < 0.05), the expression of oatp2a1 mRNA in small intestinal tissue of rat with spleen deficiency syndrome was down-regulated compared to normal group (P = 0.004, P < 0.01), the expression of oatp2a1 in intestinal tissue in normal + AA group is down-regulated compared to normal group (P = 0.032, P < 0.05). Conclusions: oatp2a1 might be one of the material basis involved in transportation and transformation of dampness. The changes of expression of oatp2a1 mRNA in small intestine, liver tissue suggests that small intestine, liver might play an important role in the transportation and transformation of dampness in the state of spleen deficiency. We further concluded that the function of spleen’s governing transportation and transformation of dampness was not only including the function of the gastrointestinal, but also part of the liver function in some degree, which needs to be further studied.

Abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type

Objective:To explore the abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type.Methods:The 30 healthy individuals included in the method were from the Physical Examination Center of Anhui Provincial Hospital of Traditional Chinese Medicine,and the 60 rheumatoid arthritis patients included were from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine.The disease activity score of patients with rheumatoid arthritis was evaluated using VAS score and DAS28 score,joint symptoms and spleen deficiency syndrome score were evaluated using graded quantification method,immune inflammation indicators were detected using relevant instruments,inflammatory cytokines were detected using ELISA method,macrophage markers were detected using FCM method,and pathway gene expression was detected using RT-qPCR;Evaluate the predictive effect of circ-CBLB and miR-486-5p on disease activity in rheumatoid arthritis using ROC curves.Results:(1)miR-486-5p,CD14^(+)CD86^(+),ESR,CRP,RF,Anti CCP Ab,IL-6,TNF in patients with rheumatoid arthritis-αThe levels of circ-CBLB,CD14^(+)CD163^(+),IL-4,and IL-10 were significantly higher than those of healthy individuals;(2)The expression level of circ-CBLB in patients with rheumatoid arthritis is positively correlated with CD14^(+)CD163^(+),and negatively correlated with miR-486-5p and CD14^(+)CD86^(+);The expression level of miR-486-5p is negatively correlated with CD14^(+)CD163^(+)and positively correlated with CD14^(+)CD86^(+);There is a negative correlation between CD14^(+)CD86^(+)and CD14^(+)CD163^(+);ESR is negatively correlated with circ-CBLB,and positively correlated with miR-486-5p,CD14^(+)CD86^(+),CRP;CRP is negatively correlated with circ-CBLB,CD14^(+)CD163^(+),and positively correlated with CD14^(+)CD86^(+),ESR;(3)The expression level of circ-CBLB in patients with rheumatoid arthritis is negatively correlated with joint tenderness,morning stiffness,lack of qi and lazy speech,and postprandial abdominal distension score;The expression level of miR-486-5p is positively correlated with the scores of joint tenderness and decreased appetite.(4)The ROC curve shows that in terms of circ-CBLB,ESR,CRP,VAS,and DAS28 AUC are 0.662(P=0.032),0.658(P=0.035),0.516(P=0.830),and 0.791(P=0.000),respectively.In terms of miR-486-5p,ESR,CRP,VAS,and DAS28 AUC were 0.566(P=0.385),0.511(P=0.883),0.592(P=0.223),and 0.727(P=0.003),respectively.Conclusion:The abnormal expression of circ CBLB and miR-486-5p in peripheral blood mononuclear cell of patients with rheumatoid arthritis of spleen deficiency and dampness excess type is related to inflammatory polarization markers,immune inflammation,disease activity,joint symptoms and spleen deficiency syndrome of rheumatoid arthritis,and the low expression of circ CBLB and high expression of miR-486-5p have certain predictive value for disease activity of rheumatoid arthritis.

The prescription rule analysis of the New Theory on Spleen Dampness Syndrome by Academician TONG Xiaolin

Objective To analyze the basic characteristics,drug features,prescription rules,and drug-symptom relationships of patients in the splenic deficiency and impairment stage,by data mining of medical records under the New Theory on Spleen Dampness Syndrome(Pi Dan Xin Lun,《脾瘅新论》).Methods Medical records listed in the“New Theory on Spleen Dampness Syndrome-Under-standing and Treatment of Metabolic Syndrome from the Perspective of Traditional Chinese Medicine”,and which were diagnosed with the spleen dampness syndrome at the splenic de-ficiency and impairment stage,during January 2004 and December 2016 were selected.These patients’data,including basic information,clinical symptoms,laboratory examination res-ults,traditional Chinese medicine(TCM)and western medicine diagnoses,treatment meth-ods,prescriptions,etc.,were collected.The collected data were subsequently compiled into a medical record database using the Epidata 3.1 data management software,followed by the use of Apriori algorithm provided in the SPSS Modeler 14.2 statistical software to investigate the association rules between drug-drug,drug-symptom,and drug-western medicine indices.Results(i)A total of 51 medical records were included,involving 17 types of syndromes.Among them,the top three with frequency≥3 included“Phlegm and blood stasis,and thoracic obstruction”“Deficiency-weakness of the spleen Qi,and static blood blocking collat-erals”,and“Deficiency-weakness of the spleen Qi,and static blood blocking collaterals”.Al-ternatively,of the 14 treatment methods,the top three treatments with frequency of≥3 in-cluded“Activating Yang and eliminating turbidity,and removing phlegm and dredging chan-nel blockage”“Strengthening the spleen and benefiting Qi,and eliminating phlegm to activ-ate the channels”,and“Warming Yang and benefiting Qi,and expelling cold to remove ob-structions”.Among the 15 prescriptions,the top three used with frequency≥3 included Huangqi Guizhi Wuwu Tang(黄芪桂枝五物汤),Gualou Xiebai Banxia Tang(瓜蒌薤白半夏汤),and Ganjiang Huangqin Huanglian Renshen Tang(干姜黄芩黄连人参汤).Lastly,of the 83 drugs used for a total of 476 times,those with frequency≥15 included Huanglian(Coptid-is Rhizoma),Huangqi(Astragali Radix),Jiudahuang(Wine-processed Rhei Radix et Rhizoma),Jixueteng(Spatholobi Caulis),Shengjiang(Zingiberis Rhizoma Recens),Huangqin(Scutellariae Radix),and Guizhi(Cinnamomi Ramulus).(ii)For the drug-drug associations,under the criteria of support≥15%and confidence=100%,seven second-order association rules,seven third-order rules,and six fourth-order roles were identified.The top-ranking rule of each was“Huangqin(Scutellariae Radix)→Huanglian(Coptidis Rhizoma)”“Ganjiang(Zingiberis Rhizoma)+Huangqin(Scutellariae Radix)→Huanglian(Coptidis Rhizoma)”,and“Baishao(Paeoniae Radix Alba)+Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatho-lobi Caulis)→Huangqin(Scutellariae Radix)”,respectively.Alternatively,the drug-symptom associations were analyzed under the criteria of support≥5%and confidence=100%,which derived eight second-order association rules,31 third-order rules,and 30 fourth-order rules.The top-ranking association rule of each order was“Huangqi(Astragali Radix)→Limb ed-ema”“Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatholobi Caulis)→Limb numbness and pain”,and“Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatholobi Caulis)+Huangqi(As-tragali Radix)→Limb numbness and pain”,respectively.Similarly,the drug-western medi-cine index associations were investigated under the criteria of support≥5%and confidence=100%,and five second-order association rules,16 third-order rules,and 16 fourth-order rules were identified.In this category,the top-ranking association rule of each order was“Qinpi(Fraxini Cortex)→Uric acid”“Huanglian(Coptidis Rhizoma)+Ganjiang(Zingiberis Rhizoma)→Glycated hemoglobin”,and“Huanglian(Coptidis Rhizoma)+Ganjiang(Zing-iberis Rhizoma)+Huangqin(Scutellariae Radix)→Glycated hemoglobin”,respectively.Conclusion Through association rule mining,this study objectively and quantitatively demonstrated the drug-drug,drug-symptom,and drug-physicochemical index associations of patients with the spleen dampness syndrome at the splenic deficiency and impairment stage treated by Academician TONG Xiaolin.The results indicated that treatment for these patients adopted the“state-target”syndrome differentiation method.The drug combination was characterized by“small prescriptions”,targeting both the patient’s symptoms and signs(syndrome target)and western medicine indices(treatment target).This study could provide references for future research on the academic thoughts and medical experience of Academi-cian TONG Xiaolin.

Screening the effective components in treating dampness stagnancy due to spleen deficiency syndrome and elucidating the potential mechanism of Poria water extract

Poria is an important medicine for inducing diuresis to drain dampness from the middle energizer.However,the specific effective components and the potential mechanism of Poria remain largely unknown.To identify the effective components and the mechanism of Poria water extract(PWE)to treat dampness stagnancy due to spleen deficiency syndrome(DSSD),a rat model of DSSD was established through weight-loaded forced swimming,intragastric ice-water stimulation,humid living environment,and alternate-day fasting for 21 days.After 14 days of treatment with PWE,the results indicated that PWE increased fecal moisture percentage,urine output,D-xylose level and weight;amylase,albumin,and total protein levels;and the swimming time of rats with DSSD to different extents.Eleven highly related components were screened out using the spectrum-effect relationship and LC-MS.Mechanistic studies revealed that PWE significantly increased the expression of serum motilin(MTL),gastrin(GAS),ADCY5/6,p-PKAα/β/γcat,and phosphorylated cAMP-response element binding protein in the stomach,and AQP3 expression in the colon.Moreover,it decreased the levels of serum ADH,the expression of AQP3 and AQP4 in the stomach,AQP1 and AQP3 in the duodenum,and AQP4 in the colon.PWE induced diuresis to drain dampness in rats with DSSD.Eleven main effective components were identified in PWE.They exerted therapeutic effect by regulating the AC-cAMP-AQP signaling pathway in the stomach,MTL and GAS levels in the serum,AQP1 and AQP3 expression in the duodenum,and AQP3 and AQP4 expression in the colon.

吴志洲辨证论治尿石症经验

尿石症病因病机为下焦湿热、肾气虚弱或病久血瘀等,病位在肾与膀胱,其形成过程复杂,往往虚实夹杂,为本虚标实之证。本病的“实”一般包括湿热、气滞和血瘀,“虚”一般是指肾阴虚、肾阳虚或气血两虚。吴志洲教授临证强调结合病程,常把尿石症辨证分为三型进行论治:湿热蕴结证、气血瘀滞证、肾气不足证。尿石症初期病位在肾与膀胱等贮存尿液的器官,尿石症的治疗当重视利尿,吴教授在这个阶段以清热利湿、通淋排石为法,常以张仲景的五苓散或猪苓汤作为基本方施治,观其舌苔脉象,随症加减,或配以清热之品,或参以滋阴之药,或佐以活血化瘀药配合治之,常用药物有金钱草、猪苓、茯苓、白茅根、小蓟、泽泻、泽兰、车前子、阿胶、滑石等。吴教授临证用药注意顾护肾气、做到消中寓补、标本兼施,方选知柏地黄丸,金匮肾气丸等,还要注重健脾和养肺,分别采用健脾化湿、清养肺金等法,常以参苓白术散、补肺汤等合方共治。吴教授临证治疗尿石症,注重通调气血,无论有无瘀血征象,均可在补肾利尿化石排石的基础上,佐以通调气血以加强祛石或化石作用。一是可以加大疏散溶解结石之力,二是可以松解结石与组织间的粘连,有利于结石的排出与消散。方选逍遥散、桂枝茯苓丸、血府逐瘀汤等。此外,吴教授还提倡辨病辨证应与现代医学相结合,重用单味化石排石药物,临证常大剂量应用,如黄芪、金钱草、海金沙、鸡内金等。

Interleukin-12 and interferon-γacting on damp-heat of spleen-stomach syndrome triggered by helicobacter pylori

OBJECTIVE: To investigate the expression of and interleukin-12(IL-12) and interferon-γ(IFN-γ) in relation to the pathology of damp-heat of spleen-stomach syndrome(DHSS) induced by Helicobacter pylori(H. pylori) infection.METHODS: In total, 114 individual gastric mucosal specimens including 83 DHSS, 19 spleen-qi deficiency syndrome(SQD) and 12 from healthy volunteers(CON) were collected by gastroscopy. To explore the relationship between the two syndromes and H. pylori infection, individual samples were tested using rapid urease and methylene blue tests. Hematoxylin and eosin stained sections were examined to grade for the degree of inflammation and inflammatory activity, and expression of IL-12 and IFN-γ was investigated by immunohistochemistry.RESULTS: Statistically significant differences in the degree of inflammation and inflammatory activity were observed between the groups of specimens:DHSS, SQD and CON(P < 0.05). Additionally, greater intestinal metaplasia(IM) and dysplasia were observed in the DHSS group, especially those with H.pylori infection. Expression of both IFN-γ and IL-12 was higher in DHSS samples infected with H. pylori than in uninfected samples and in the CON(P <0.05) but not in the SQD(P > 0.05) groups. Intriguingly, in gastric specimens exhibiting IM and dysplasia, IL-12 translocated from the nucleus into the cytoplasm.CONCLUSION: Our findings suggest that IL-12 and IFN-γ are involved in DHSS pathology, but not in SQD, acting as healthy-Qi. DHSS is not just the consequence of those two cytokines but results from the cross-talk between a number of cytokines and/or other proteins, which may warrant further investigation in DHSS patients infected with H. pylori.

脐灸疗法联合枳朴六君子汤治疗脾虚湿滞型泄泻的临床效果

目的:探讨脐灸疗法联合枳朴六君子汤治疗脾虚湿滞型泄泻的临床效果。方法:选择2021年2月—2023年7月于盐城市中医院门诊就诊的脾虚湿滞型泄泻患者92例,采用随机数字表法分成常规组与联合组,每组46例。常规组采用双歧杆菌三联活菌肠溶胶囊治疗,联合组采用脐灸疗法联合枳朴六君子汤治疗。观察两组患者的中医证候积分、主要症状评分、贝克抑郁量表评分、临床疗效、不良反应发生情况。结果:治疗后,联合组患者中医证候积分、主要症状评分与贝克抑郁量表评分均低于常规组(P<0.05);联合组患者治疗总有效率高于常规组(P<0.05);两组不良反应总发生率差异无统计学意义(P>0.05)。结论:脐灸疗法联合枳朴六君子汤能够改善患者血清学指标及肠黏膜屏障功能,降低中医证候积分,提高患者免疫功能及临床疗效,安全性较高。

慢性肾脏病3~5期(非透析患者)脾肾亏虚证与湿浊证舌象特征研究

目的研究两种不同证型慢性肾脏病患者的舌象特征数据,探析两类患者舌象特征的差异,通过融合现代计算机视觉技术,提高中医临床辨证客观性。方法采集辽宁中医药大学肾病科门诊2022年9月—2023年9月80例患者舌象,并提出舌象分区模型,通过观察两种证型患者舌色、舌型、苔色、苔质、舌下络脉等,并结合数据分析其HSV色度空间参数,进而获取两种证型患者舌象特征信息。结果脾肾亏虚型患者以淡红舌为主,多伴齿痕、白苔,舌下脉络增粗、迂曲、颜色加深不明显;湿浊型以红舌为主,多伴齿痕、点刺、厚腻苔、舌下络脉增粗、迂曲、颜色加深明显。结论分区模型可以量化不同证型患者的舌象特征,并在一定程度上提高舌诊的准确性和辩证的参照性。

黄连汤合柴龙逆萎汤联合四联疗法治疗慢性非萎缩性胃炎伴糜烂临床研究

目的:观察黄连汤合柴龙逆萎汤联合四联疗法治疗慢性非萎缩性胃炎(CNAG)伴糜烂的临床效果。方法:选取2020年6月—2023年6月于安阳市中医院治疗的144例肝胃不和兼脾胃湿热型CNAG伴糜烂患者,采用随机数字表法分为对照组和观察组各72例,2组均采用常规四联疗法治疗,观察组加用黄连汤合柴龙逆萎汤加减治疗。2组均治疗4周。治疗前后评估2组患者的中医证候评分,检测血清炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-8(IL-8)]水平及胃功能指标[胃泌素-17(G-17)、胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)],评估胃黏膜糜烂评分、慢性炎症评分,统计治疗期间不良反应发生情况。比较2组的临床疗效。结果:治疗4周后,观察组总有效率高于对照组(P<0.05)。2组中医证候主症积分、次症积分、总积分及胃黏膜糜烂评分、慢性炎症评分均较治疗前降低(P<0.05),观察组以上5项评分值均低于对照组(P<0.05)。2组TNF-α、IL-1β、IL-8、PGⅡ水平均较治疗前降低,G-17、PGⅠ水平均较治疗前升高,差异均有统计学意义(P<0.05)。观察组TNF-α、IL-1β、IL-8、PGⅡ水平均低于对照组(P<0.05),G-17、PGⅠ水平均高于对照组(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在四联疗法基础上加用黄连汤合柴龙逆萎汤治疗肝胃不和兼脾胃湿热型CNAG伴糜烂患者能够有效缓解症状,提高临床疗效,减轻机体炎症及胃黏膜糜烂程度,安全性较高。

加味半夏泻心汤联合盐酸西替利嗪片递减法治疗慢性自发性荨麻疹(脾虚湿热证)疗效观察

目的观察加味半夏泻心汤联合盐酸西替利嗪片递减法对慢性自发性荨麻疹(脾虚湿热证)的临床疗效。方法选取2021年1月至2022年6月达州市中西医结合医院确诊的慢性自发性荨麻疹(脾虚湿热证)70例,采用随机数字表分为治疗组与对照组,每组各35例。对照组给予西替利嗪片递减法治疗,治疗组在对照组基础上联用加味半夏泻心汤。两组总疗程为6周。在治疗第4周及第6周开始时,观察两组病人盐酸西替利嗪片使用情况,并于第6周治疗结束后,观察两组病例的临床疗效、西替利嗪片使用总量、荨麻疹活动度评分(UAS)及皮肤生活质量指数(DQLI)评分、血清总免疫球蛋白E(IgE)值、不良反应。并于治疗结束后8周统计复发情况。结果研究实际完成60例,两组各30例。治疗第4周及第6周开始时,治疗组盐酸西替利嗪片使用间隔时间明显高于对照组(治疗组西药减量速度高于对照组)(P<0.05)。6周后,治疗组治愈率为53.33%(16/30),对照组治愈率为20%(6/30);治疗组治愈率明显高于对照组(P<0.05);治疗组病人西替利嗪片使用总量明显低于对照组(P<0.05),治疗组UAS及DQLI评分比对照组低(P<0.05);不良反应两组无差异。疗程结束以后8周随访,复发率治疗组比对照组显著降低(P<0.05)。结论加味半夏泻心汤联合盐酸西替利嗪片递减法治疗慢性自发性荨麻疹(脾虚湿热证)临床疗效确切,可明显缩短病程,降低复发率。

“劳淋病”古代中医药文献记载及现代治疗现状

“劳淋病”常因劳倦而发,迁延不愈,是临床常见难治性疾病,其现代医学病名对应的是复发性尿路感染。现代医学的主流治疗劳淋的抗生素疗法仍存在诸多局限性,中医药疗法历史悠久、潜力巨大、优势显著。本文通过整理中国古代关于淋证的记载以及近年来中医药治疗劳淋的相关文献,从历代文献记载、现代医家对于劳淋的认识、中医验方、中医外治法等方面进行概括总结,对未来研究进行展望,以期为劳淋的临床治疗提供些许参考。

热敏灸治疗脾气虚弱型慢性疲劳综合征临床研究

目的:观察比较热敏灸与常规温和灸治疗脾气虚弱型慢性疲劳综合征的疗效。方法:选取2023年5—12月广州中医药大学附属广东中西医结合医院收治的70例脾气虚弱型慢性疲劳综合征患者,按随机数字表法分为治疗组(35例,脱落4例)和对照组(35例,脱落4例)。2组均给予健康宣教,治疗组在健康宣教基础上给予热敏灸治疗,对照组在健康宣教基础上给予常规温和灸治疗。2组均为2 d 1次,治疗12次(共24 d)。评价2组临床疗效,比较2组治疗前后的疲劳量表FS-14评分、慢性疲劳综合征临床症状积分总分以及各子项目评分、中医证候积分。结果:治疗组总有效率为93.55%(29/31),高于对照组74.19%(23/31)(P<0.05)。治疗后,2组疲劳量表FS-14评分、中医证候积分较治疗前降低(P<0.05),且治疗组疲劳量表FS-14评分、中医证候积分低于对照组(P<0.05)。治疗后,2组慢性疲劳综合征临床症状积分总分以及各子项目评分较治疗前降低(P<0.05),且治疗组慢性疲劳综合征临床症状积分总分及肌肉疼痛、关节疼痛、头痛、睡眠障碍、劳累后疲劳不适持续时间、疲劳评分低于对照组(P<0.05)。结论:热敏灸和常规温和灸均可以改善脾气虚弱型慢性疲劳综合征患者的临床症状,缓解脾虚情况,热敏灸疗效优于常规温和灸。

田耀洲教授辨治慢性萎缩性胃炎经验采撷

慢性萎缩性胃炎(CAG)是消化系统常见病,具有病情反复、缠绵难愈的特点。病理主要以胃腺体的萎缩、伴或不伴有肠上皮化生或异型增生为特征。肠上皮化生和异型增生属于癌前病变,与胃癌的发生关系密切,积极控制CAG患者的临床症状,延缓其病理进展或逆转其病理变化,有利于改善患者的生活质量、减轻经济负担及预防胃癌发生。田耀洲教授认为此病属本虚标实,脾胃虚弱是本,气滞、湿郁、瘀血为标,虚、滞、湿、瘀相互胶结推动着疾病的进展,在辨证上推崇微观与宏观相结合,用药上推崇中西医结合,并擅用经方与药对,精准辨治与用药。田教授开创的自拟方剂芪芝方,疗效显著,可有效改善脾胃湿热型CAG的临床症状。今将田教授辨治CAG之经验及自拟方剂分享给大家,以期为临床辨治CAG提供参考借鉴。

国医大师杨春波辨治脾胃湿热证胃肠病经验

杨春波教授为全国第3届国医大师,擅长运用“脾胃湿热”理论诊治胃肠系统疾患。杨老认为,脾胃湿热由内外因素共同作用而成,应从“三因制宜”角度辨识脾胃湿热证胃肠病的个体化病因病机及临床特征。针对脾胃湿热证胃肠病的辨治用药,杨老以清化湿热、调气舒络为总治则,创制“清化饮”为基本方,并结合辨析寒热、分利三焦、顾护正气、扶正防邪等辨治心得立方。作者结合杨老临床验案,阐述杨老辨治脾胃湿热证胃肠病的临证经验,以期对指导临床诊治有所裨益。

补肾强督清化汤联合依那西普治疗肾虚湿热证强直性脊柱炎患者的疗效观察

目的探讨补肾强督清化汤联合依那西普治疗肾虚湿热证强直性脊柱炎的疗效。方法选取2021年2月-2023年2月期间在山东省临沂市中医医院风湿病科就诊的肾虚湿热证强直性脊柱炎患者86例,按随机数字表法分为对照组和治疗组,每组各43例。对照组予依那西普治疗,治疗组在对照组基础上加用补肾强督清化汤。持续用药12周。观察两组患者治疗前后中医证候积分、炎症反应指标[红细胞沉降率(Erythrocyte sedimentation rate,ESR)、血清白细胞介素4(Interleukin-4,IL-4)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、C反应蛋白(C-neactveprotein,CRP)]水平、疾病活动度[Bath功能指数(Bath andylosing spondylitis function index,BASFI)、Bath强直性脊柱炎活动性指数(Bath ankylosing spondylitis metroloty index,BASDAI)],临床疗效及不良反应情况。结果治疗后两组患者中医证候积分均较治疗前明显降低,差异有统计学意义(P<0.05);且治疗组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者ESR、IL-4、TNF-α及CRP水平均较治疗前降低,差异有统计学意义(P<0.05);且治疗组ESR、IL-4、TNF-α及CRP水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者BASFI、BASDAI评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组BASFI、BASDAI评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后治疗组临床总有效率95.35%(41/43)明显高于对照组79.07%(34/43),差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应发生情况比较,差异无统计学意义(P>0.05)。结论补肾强督清化汤联合西药治疗肾虚湿热证强直性脊柱炎能够有效减轻炎症反应,缓解临床症状,其临床疗效确切,且无明显不良反应。

苍术健脾、燥湿的作用机制及研究进展

综述苍术健脾、燥湿的作用机制及研究进展。古代医家常用苍术治疗多种疾病的脾胃湿证。苍术有效成分能改善胃排空及小肠推进率;可增加胃泌素、胃动素等,促进胃酸分泌,增加胃肠动力;可降低血管活性肠肽水平,抑制肠蠕动亢进。苍术能双向调节胃肠功能紊乱,且还能改善胃黏膜的异常形态,减轻胃组织损伤,改善肠组织异常结构。苍术燥湿的主要有效成分为挥发油,可导致体液丢失,血黏度增加,影响唾液腺分泌,引起口干,降低肾脏水通道蛋白2的表达量。苍术及其提取物能降低大鼠胃、大肠、尿液中水通道蛋白含量,通过多脏器调节体内水液代谢。故苍术能从影响脏器形态、胃肠道激素水平、水通道蛋白表达等多方面达到健脾、燥湿的功效。

2型糖尿病湿热困脾证合并血脂紊乱胰岛功能变化及其影响因素分析

目的探讨2型糖尿病湿热困脾证合并血脂紊乱患者胰岛功能变化及其影响因素。方法选择2020年1月—2020年12月医院收治的2型糖尿病湿热困脾证患者100例,根据美国ATPIII评估标准将其分为血脂紊乱组62例与血脂正常组38例。比较各组SF-36积分、胰岛素分泌功能(Homeostasis model assessment-β,HOMA-β)、胰岛素抵抗水平(Homeostasis model assessment-IR,HOMA-IR)、胰岛素敏感指数(Insulin sensitivity index,ISI)、空腹C肽和空腹胰岛素。应用单因素和多因素分析法研究血脂异常的相关因素。结果高甘油三酯组与混合型高脂组空腹胰岛素水平显著高于高胆固醇组与血脂正常组,差异有统计学意义(P<0.05)。高甘油三酯组空腹C肽水平显著高于高胆固醇组,差异有统计学意义(P<0.05)。混合型高脂组与高甘油三酯组的ISI水平低于高胆固醇组(P<0.05)。高甘油三酯组HOMA-β水平明显高于高胆固醇组与血脂正常组,差异有统计学意义(P<0.05)。高甘油三酯组及混合型高脂组HOMA-IR水平显著高于高胆固醇组,差异有统计学意义(P<0.05)。两组患者在躯体疼痛、整体健康、活力、社会功能和精神健康维度方面比较,差异有统计学意义(P<0.01)。多因素Logistic分析显示,喜食油腻、吸烟史、腰围和空腹胰岛素是2型糖尿病湿热困脾证患者血脂异常的危险因素,有氧运动是2型糖尿病湿热困脾证患者血脂异常的保护因素(P<0.05)。结论不同血脂紊乱类型对胰岛功能的影响并不相同,应针对相关因素积极预防,降低胰岛分泌负担,促使胰岛功能恢复。

基于文献研究及德尔菲法构建寻常型银屑病脾虚湿蕴证的诊断标准

【目的】采用文献研究、专家主观经验评价及数理统计分析三者结合以构建寻常型银屑病脾虚湿蕴证的诊断标准。【方法】通过文献研究构建寻常型银屑病脾虚湿蕴证相关症状、体征备选条目池,运用德尔菲法对全国32位专家进行4轮问卷调查,分析专家对各备选条目意见的集中程度及协调程度。第三轮调查根据各条目的权重系数将诊断指标分为主症及次症,形成多个证候诊断判断条件选项,再通过第四轮专家调查,明确脾虚湿蕴证的诊断模式及诊断条件。【结果】根据专家意见集中程度、变异系数对各证候诊断备选条目进行筛选,经同类合并,形成诊断指标24个,形成主症3个(纳呆食少、便溏、舌淡胖边有齿印),次症21个(如腹胀、口淡不渴、形体肥胖、嗜睡、倦怠乏力、脉细滑、脉濡、大便完谷不化、皮损颜色淡红等)。第四轮专家调查确认了“病位脾”“病性气虚”“病性湿”为诊断的必要条件;银屑病脾虚湿蕴证的诊断条件确定为:(1)具有3个主要症状;(2)具备2个主要症状+任2个次要症状。【结论】所构建的寻常型银屑病脾虚湿蕴证的诊断标准包含主症及次症,条件要求明确,易于临床操作,具有较好的临床适用性。

健脾利湿解毒方治疗慢性结肠炎脾虚湿毒证疗效研究

目的:观察健脾利湿解毒方治疗慢性结肠炎脾虚湿毒证的临床疗效。方法:选取120例确诊为慢性结肠炎脾虚湿毒证的患者,采取随机数字表法分为观察组以及对照组,每组60例。对照组采取口服复方嗜酸乳杆菌片治疗,观察组在对照组治疗的基础上采取口服健脾利湿解毒方治疗,疗程均为3个月。治疗完成后比较两组治疗前后中医证候积分及脑肠肽[血管活性肠肽(VIP)、5-羟色胺(5-HT)、P物质(SP)、生长抑素(SS)]、炎症因子[C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-17(IL-17)]和粪便钙卫蛋白(FC)水平。比较两组总有效率及不良反应发生情况。结果:治疗后,观察组总有效率高于对照组(P<0.05);治疗后,两组中医证候积分均较治疗前降低,组间相比,观察组水平更低(均P<0.05);治疗后,两组VIP、5-HT、SP、SS、CRP、TNF-α、IL-17水平以及FC水平较治疗前降低,组间相比,观察组水平更低(均P<0.05)。两组均无不良反应。结论:健脾利湿解毒方可改善慢性结肠炎患者各项症状,抑制脑肠肽水平及炎性反应,且临床安全性高、无明显不良反应。