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.

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.

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。

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。

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。

以络病理论为指导的“通法”在银屑病治疗中的运用

银屑病是一种常见的慢性炎症性皮肤病,因其慢性、复发性的特点成为临床难治性疾病。“通法”在中医治法中占据重要地位,内涵丰富,包罗万象,运用“通法”论治络病,为临床医家治疗多种疑难杂病提供了新的治疗角度和治疗思路,在皮肤科以络病理论为基础的“通络法”被广泛应用于多种慢性顽固性皮肤病的治疗。文中对络脉的形象、生理、病理特点进行了简要剖析,从病位、病理因素、病机发展角度系统阐述了银屑病发生发展过程中的络脉病变机制,包括皮肤与络脉的关系、银屑病与络病的共同病理因素、久病入络的疾病发展规律,并在此基础上对通络法治疗银屑病的理论依据进行具体探讨和介绍,总结概括为驱除病邪、引药达所、维护气血3种治疗目的在临床中的具体应用及其理论指导基础。以期为研究银屑病病因病机、指导临床治疗、完善用药结构尽绵薄之力。

从“营卫失调,毒损脉络”探讨类风湿血管炎的病机与辨治

类风湿血管炎病位在脉络。营卫失调,卫不偕营,卫气壅遏,宣通不畅,湿热瘀化毒,毒损脉络是类风湿血管炎的核心病机。发病初期,以调和营卫为主,同时运用苦寒清热解毒药,荡涤毒邪,既病防传;急性期注重清热解毒通络,使营卫调和,降低疾病危重程度,防止对多系统、多脏器的损害;慢性期治宜调补营卫,益气养血通络,清解余毒,使受损脉络得以修复。调和营卫、清热解毒通络宜贯穿疾病的始终。

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。

基于络病理论论治输卵管阻塞性不孕

输卵管是输送孕卵的中空管腔结构,络脉是经脉横行而出的分支,络脉“以通为用”的生理特点与输卵管的结构功能相符。输卵管阻塞主要由盆腔炎性疾病等原因造成输卵管拾卵、运送受精卵的功能障碍。其病变过程较长,初起为营卫气血失和,久则血伤入络,酿生痰湿、血瘀等有形之邪阻塞络脉,形成输卵管阻塞性不孕。络病即络脉的病变,其中包含络脉的功能障碍和结构损伤,同时也涵盖了由此引发的脏腑组织的病理变化。二者均以“不通”为主要病理特点,“通络”是治疗的主要原则。因此在论治输卵管阻塞性不孕时,以“络病”理论分析其发病机制,总属肾精不足、肝气失和、脾气不足,病变日久形成血瘀、痰湿、湿热等有形之邪阻于络脉,影响络脉正常的生理功能,继而引起输卵管结构或功能障碍,阻碍精卵结合,构成不孕。临床可基于“络病”理论角度辨证治疗确立治法,依据不同的致病原因采用不同的“通络”方法,在输卵管阻塞性不孕的治疗中发挥中医特色,兼顾整体与局部,疏通输卵管,提高受孕率。

卢敏教授从“虚、瘀、毒”论治股骨头缺血性坏死的经验

股骨头缺血性坏死属于中医学“骨蚀”“骨痿”“骨痹”“髋骨痹”范畴。卢敏教授认为股骨头缺血性坏死病机为本虚标实,其特点为“虚、瘀、毒”并存,故在临证时多注重扶正固本,卫外解毒,活血化瘀,通络止痛。卢敏教授针对股骨头缺血性坏死的不同伴随症状,采取不同的康复策略,予以个体化治疗,改善肢体的活动功能,缓解疾病症状,延缓疾病进展,对于提高患者的生活质量起到积极作用。

基于调气解毒学说论治玄府络脉并病之肺结节

肺结节的检出率逐年增加,但目前仍缺乏对于恶性结节的早期干预措施,中医药将其纳入“治未病”理念中“既病防变”范畴,多从痰瘀互结于肺认识其发生发展,但对于其发于细微,单发多发不定等方面仍缺乏论述。现从气机升降失调导致的玄府络脉并病入手,探讨肺结节的主要病机,并基于花宝金教授的调气解毒学说提出调气扶正、开玄通络、逐痰祛瘀以解细微之邪的论治思路。

儿童大叶性肺炎从“玄府-络脉”理论辨治探析

“玄府-络脉”是遍布人体全身的细微结构,具有畅达气机、输布津液、运转神机、调和阴阳的作用。儿童大叶性肺炎发病率高,临床归属中医学“风温肺热病”范畴,热、毒、痰、瘀、虚是其主要病理因素,肺络凝滞、玄府郁闭、脉络失养是其病机关键。基于玄府-络脉理论,临床治疗急性期以解毒祛邪、开玄通府为主,恢复期注重充养脉络,同时化瘀通络贯穿始终,为儿童大叶性肺炎治疗提供新思路。

从伏邪学说论治慢性萎缩性胃炎

慢性萎缩性胃炎(CAG)属于胃癌前疾病,具有发病隐匿、病程缠绵、容易迁延恶化等特点。广东省名中医刘凤斌教授多年诊疗CAG,认为CAG的病因、病程特性与伏邪致病过程密切相关,从伏邪学说论治CAG,遵循透邪外出、补益脾胃、祛瘀通络与清热养阴治疗原则,随证用药,疗效显著。

张嗣兰辨治脱疽经验

脱疽病因病机复杂,病程较长,致残率高。张嗣兰教授提出了“解毒破瘀并重,调气扶正并行”的重要理论,认为气机阻滞、血脉瘀阻、肢节失养是其基本病机,将其分为寒湿凝滞证、湿热毒盛证、气血亏虚证、血脉瘀阻证4种中医证型。临证时根据不同分型及临床表现采用不同治疗方法,以化瘀通络贯穿始终,辅以温阳、益气、补血、清热解毒之法,同时重视局部外治法。形成了内外同治、整体辨证与局部外治相结合的临床思辨特点。

基于肾虚血瘀视角探讨老年性眼底病证治

老年性眼底病与衰老密切相关,肾虚、血瘀致衰得到医学界越来越多的关注。肾虚血瘀是老年性眼底病的病机核心,五脏虚损、肾为本是老年性眼底病发生的根本原因,目窍失养、血瘀为标是老年性眼底病发生的局部表现。老年性眼底病在中医整体观念的视角上,肾虚为本,目为标;从局部辨证出发,血瘀为发病的基本病理因素,络脉瘀阻为发病的病理基础,气血失和、目窍失养为发病的关键病机。由此提出老年性眼底病治疗原则为调补五脏,以肾为本;活血化瘀,剔络为要;祛邪扶正,通补兼施;为老年性眼底病的中医治疗提供新的思路。

从“浊毒伏络”探讨糖尿病心肌病

糖尿病心肌病(DCM)属于中医学消渴并发心悸、胸痹范畴。结合现代浊毒理论、络病理论及糖尿病心肌病的病理特点,认为“浊毒伏络”是DCM起病之本,心络受损是DCM演变之机,气血阴阳俱虚是DCM的最终结局。根据“浊毒伏络”理论和疾病分期特点,治疗方面提倡早期化浊解毒、中期搜剔通络、后期补虚固本。

基于肠道微生态探讨活血化瘀法治疗糖尿病性肾小球硬化

肾小球硬化是糖尿病肾病的主要病理特征之一,也是其进展的重要原因。肠道菌群及其代谢产物可通过血流动力学、炎症反应、氧化应激等多种途径影响肾小球硬化。中医学认为,肾络瘀阻是糖尿病性肾小球硬化的关键病机,活血化瘀法应贯穿治疗始终。研究发现,“瘀”与肠道菌群之间存在联系,应用活血化瘀药物可改善肠道微生态紊乱,达到延缓糖尿病性肾小球硬化的目的。本文以此为中心进行论述,探讨活血化瘀法改善肠道菌群及糖尿病性肾小球硬化的作用机制,为临床相关治疗提供参考。

从“益气通络法”论治视网膜中央动脉阻塞

视网膜中央动脉阻塞(CRAO)是眼科致盲的重症之一,中医学将其归属“暴盲”范畴。益气通络法根植于中医学经络理论,对中医眼科学疾病的治疗具有重要的指导意义。本病以气虚为本,脉络瘀阻为标,气虚血瘀是病机的关键。治疗上,需抓住“脉络瘀阻”这一根结,首当注重补气,予益气通络法。使得经络气血运行通畅,瘀去络通。用药方面,宜在补气的基础上随证加活血、养阴、温阳等中药。同时,结合针刺疏通经络气血。此外,临床诊疗不可拘泥于传统概念的治疗时间窗,充分发挥中医药治疗的优势,注重中药及针灸治疗。

疏血通注射液治疗急性冠脉综合征研究进展

疏血通注射液有活血化瘀,通经活络的功效,主要用于治疗瘀血阻络型急性脑梗塞。有研究表明,疏血通注射液治疗急性冠脉综合征(Acute coronary syndrome,ACS)有较好疗效,还可缩短经皮冠状动脉介入治疗术后患者康复时间,提高治疗有效率,降低再入院率,节约医疗成本。本文梳理了疏血通注射液治疗ACS相关理论及临床研究,对其治疗ACS的本草依据、药理作用、临床应用、治疗机制以及安全性、经济性等方面进行综述,希望为疏血通在治疗ACS中的运用提供一定的科学依据并拓宽其在心血管疾病中的研究思路。

冯俊治疗视网膜动脉阻塞之中医理论探微

视网膜动脉阻塞(RAO)是导致急性无痛性单眼视力丧失的主要疾病,分为视网膜中央动脉阻塞、视网膜分支动脉阻塞、睫状视网膜动脉阻塞、视网膜毛细血管前小动脉阻塞,是眼科危急重症,被称为“视网膜卒中”“眼中风”,致盲率极高。其归属于中医学“暴盲”的范畴,在中医脏腑辨证和气血理论的指导下,冯俊经过30余年的临床经验总结,提出脏腑失调,气血不和,致脉络瘀阻,目失血养为RAO的病因病机,并创新性地总结出“剔络化瘀、养血明目”的基本治疗原则,为临床治疗RAO提供了新的中医诊疗思路。