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.

Risk factors of postoperative cerebral hyperperfusion syndrome and its relationship with clinical prognosis in adult patients with moyamoya disease

Background To investigate the incidence,risk factors,and clinical prognosis of cerebral hyperperfusion syndrome(CHS)after superficial temporal artery-middle cerebral artery anastomosis combined with encephalo-duro-arterio-synangiosis(STA-MCA/EDAS)in adult patients with moyamoya disease(MMD).Methods The clinical data of 160 adult patients with MMD treated by STA-MCA/EDAS from January 2016 to January 2017 were retrospectively analyzed.According to CHS diagnosis,MMD patients were divided into CHS and non-CHS group.Univariate and multivariate analysis of risk factors and Kaplan-Meier curve of stroke-free survival for CHS were performed.Results A total of 12 patients(7.5%)developed postoperative CHS,of which 4 patients(2.5%)presented with cerebral hemorrhage.Univariate and multivariate analysis showed moyamoya vessel on the surgical hemisphere(OR=3.04,95%CI=1.02-9.03,P=0.046)and left operated hemisphere(OR=5.16,95%CI=1.09-21.34,P=0.041)were independent risk factors for CHS.The other variables,such as age,gender,presentation,hypertension,diabetes,smoking,mean mRS score on admission,modified Suzuki stage and pre-infarction stage on surgical hemisphere,and bypass patency,had no association with postoperative CHS(P>0.05).At final follow-up with average 38 months,there were 18 out of 133 patients(13.5%,4.91%per person year)presented with newly developed complications.There was no significant difference between newly developed complications,mean mRS scores,and Kaplan-Meier curve of stroke-free survival in patients with and without CHS(P>0.05).Conclusion The concentration of moyamoya vessels and left operated hemisphere was independent risk factors for CHS,which could not affect the clinical prognosis if treated timely and properly.The current study offers a new perspective of moyamoya vessels and supporting data for choosing MMD candidates on cerebral revascularization.

基于病证结合特点的绝经后骨质疏松症动物模型分析

绝经后骨质疏松症(PMOP)病证结合动物模型在中医药研究中应用较多,但建立方法各式各样且缺乏统一的评价标准。文章从中医学和现代医学临床角度出发,就目前PMOP模型动物选择、构建方法和模型动物与临床吻合度进行对比,结合病证结合动物模型构建思路,从PMOP病证结合动物模型的构建和进一步完善评价方法进行归纳总结,以期为PMOP实验研究提供新思路。

基于治未病理论灸药同治对实体恶性肿瘤化疗患者骨髓抑制的预防作用

目的:基于治未病理论探讨灸药同治对实体恶性肿瘤化疗患者骨髓抑制的预防作用。方法:选取2019年1月至2022年1月于武汉科技大学附属武汉亚心总医院接受治疗的实体恶性肿瘤化疗患者120例作为研究对象,采用随机数字表法分为对照组和观察组,每组60例。对照组常规接受化疗,观察组化疗前连续3 d给予灸药同治(艾灸+加味八珍汤)。比较治疗前、化疗后7 d 2组患者中医证候积分、血常规[血红蛋白(Hb)、白细胞计数(WBC)、血小板计数(PLT)、中性粒细胞计数(NEUT)]、生命质量[卡诺夫斯凯计分(KPS)、中国癌症患者生命质量(QOL_(2))调查问卷],比较化疗后7 d 2组患者骨髓抑制情况[发生率、严重程度、重组人粒细胞集落刺激因子(rhG-CSF)使用情况]。结果:化疗后7 d,2组患者中医证候积分升高,但观察组低于对照组(P<0.05);Hb、WBC、PLT、NEUT、KPS评分及QOL_(2)评分降低,但观察组高于对照组(均P<0.05);观察组骨髓抑制发生率、rhG-CSF使用率低于对照组,0、Ⅰ度比例高于对照组(均P<0.05)。结论:基于治未病理论,灸药同治能够改善实体恶性肿瘤化疗患者临床症状及血常规,提高患者生命质量,减少骨髓抑制的发生。

百合地黄汤及其类方在肿瘤治疗中的应用

肿瘤进展及化疗、放疗、手术各种治疗过程中患者常发生的不适症状(例如抑郁、心烦、食欲时好时坏、呕吐、口苦、小便色黄、身体虚弱)与百合病类似。仲景病证结合思路也适用于肿瘤治疗。例如,百合地黄汤加减治疗非小细胞肺癌及放射性肺炎、百合类方治疗肿瘤相关性抑郁焦虑、百合知母汤加减治疗乳腺癌术后心烦夜寐难安及肿瘤并发出血,百合滑石散加减治疗直肠癌术后抑郁兼小便灼热、百合滑石代赭汤加减治疗胃癌。以百合地黄汤为主方的病证结合思路在运用到肿瘤治疗时需注意明辨证型,抓住主症,病证结合。此外,对于百合地黄汤的其他类方(百合鸡子汤、百合洗方、栝蒌牡蛎散)目前虽未见肿瘤临床文献报道,但亦可应用于今后临床实践中,从而提高患者生活质量。

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。

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.

胃癌前病变病证结合动物模型研究进展

中医药在胃癌前病变(precancerous lesions of gastric cancer,PLGC)诊疗中发挥着重要作用,病证结合动物模型是进行PLGC相关实验研究的前提。文章从模型动物选择、胃癌前病变疾病模型和病证结合模型三方面,对近年来PLGC病证结合模型的制备方法进行了归纳分析,介绍了脾胃虚弱、胃阴不足、肝胃气滞、脾胃湿热和胃络瘀血5个常见PLGC病证结合模型的造模方法,并对当前模型制备中存在的问题提出了思考与展望。

病证结合骨质疏松模型大鼠骨骼的生物力学性能分析

背景:肾虚是骨质疏松症的最主要病机,对肾阳虚、肾阴虚与骨质疏松的关系研究有利于病证结合临床诊疗模式的发展。目的:评价右归丸对肾阳虚、肾阴虚大鼠股骨生物力学性能的影响差异,从生物力学角度论证骨质疏松症病证结合、因证施药的科学性。方法:手术摘除60只雌性SD大鼠双侧卵巢建立骨质疏松模型,10周后将大鼠随机分为肾阴虚组(n=30)和肾阳虚组(n=30),肾阳虚组臀部肌肉注射氢化可的松注射液,肾阴虚组灌胃甲状腺片混悬药液,1次/d,连续14 d。造模结束后,每组取20只灌胃右归丸混悬液,1次/d,连续12周,剩余10只作为对照不灌胃。灌胃结束后使用Micro-CT扫描测量股骨微结构参数,在力学试验机上对股骨分别进行三点弯曲、有限元仿真、股骨头压缩及表面压痕分布实验。结果与结论:①Micro-CT扫描显示,与肾阴虚组比较,肾阴虚+右归丸组股骨骨密度、骨体积分数、骨表面密度、骨小梁数量、骨小梁分离度升高(P<0.05);与肾阳虚组比较,肾阳虚+右归丸组股骨骨体积分数、骨表面密度、骨小梁数量及骨小梁厚度升高(P<0.05);②三点弯曲实验显示,与肾阳虚组相比,肾阳虚+右归丸组股骨弹性模量、最大抗弯强度和弯曲断裂强度均降低(P<0.05),韧性提高(P<0.05);③有限元仿真显示,右归丸能显著提高肾阳虚组大鼠股骨抗骨折能力,对肾阴虚组大鼠不产生明显作用;股骨头压缩实验显示,右归丸可增强肾阳虚组大鼠股骨头抵抗形变的能力,但右归丸对肾阴虚组和肾阳虚组大鼠股骨头表面性能的影响无显著区别;④结果表明,右归丸可增强肾阳虚骨质疏松骨骼生物力学性能,但对肾阴虚骨质疏松骨骼无显著影响。

病证结合动物模型宏观表征指标评价方法研究进展

动物实验在中医药的发展中起重要作用,病证结合动物实验更是实现中医药现代化的必经之路。近年来,随着病证结合动物实验的不断发展,动物模型的建立与评价体系均在不断完善,然而其模型的宏观指标评价仍有很大不足,多数实验仅通过观察法来判断动物的宏观体征,常具有主观性且缺乏科学性。因此,通过文献综述方法系统地整理了目前病证结合动物模型各证候宏观表征评价指标的进展,并提出各宏观指标定量评价模式,认为此模式为动物实验发展路上的可行且必要途径,同时结合实验室行为学设备等来探索证候定量的测量方法,以期通过专业的仪器设备来评价证候指标,进而解决动物实验模型指标评价的关键问题,完善宏观指标评价标准,推动病证结合动物实验进一步的发展。

脾虚证动物模型研究述评

中医界运用现代科学方法进行相关研究已有多年历史,在病证动物模型上颇有收获。本文对脾虚证动物模型发展历程进行回顾,对动物选择、造模方法、评价指标、消化系统病证结合模型进行总结和评论。模型动物多选用以大鼠为代表的小型啮齿类。目前,多基于病因病机造模,而较少使用化学药物与物理因素造模,复合因素造模法最常见。评价指标则分为中医证型指标、与“脾”功能和特性有关量化指标,以及方剂反证。功能性腹泻/消化不良为代表的脾虚证病证结合模型是目前研究的重心。脾虚证动物模型研究成绩斐然的同时仍存在许多不足,如缺乏脾虚证模型行业标准和共识,评价指标缺乏系统性和整体性,脾虚理论的现代阐释缺乏统一,学界亟需解决上述问题以促进发展。

中医热证动物模型构建及评价方式现状研究

辨证论治是中医的主要特色,“证”体现的是疾病发生发展进程中不同阶段病理的本质。建立对应疾病的证候模型对挖掘证候的本质,探索中医药研究的规范化、客观化、科学化均具有重要价值。“热证”是中医辨证中极具代表性的基础证型,其病证结合动物模型的制备和研发对于药理实验研究、寒热证实质研究及中医病证结合动物模型的研发尤为重要。本文从模型制备方法、客观指标评价等方面对中医热证动物模型的制备现状及研究进展进行相关述评。

基于病证结合的冠心病动物模型制备研究进展与思考

冠心病的临床研究和动物实验研究一直是心血管领域的常见病。病证结合动物模型体现了中西医结合的理念,不仅有西医的疾病特点,而且借助中医思维用不同实验方法来表现独特的中医证候特点,是中医药研究冠心病预防和治疗的有效工具。文章对常用冠心病中医证候的动物模型建立方法进行总结,并以冠心病痰瘀互结证动物模型为例提出思考。

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。

代谢综合征合并冠心病案——仝小林院士教学查房实录

以广安门医院内分泌科1例代谢综合征合并冠心病患者为例邀请仝小林院士进行教学查房,对代谢综合征合并冠心病的中医辨治思路、疾病发展、诊疗要点进行阐述。强调辨别脾瘅与消瘅异同,把握疾病发展的不同趋势,脾瘅易合并大血管、微血管并发症,消瘅则微血管并发症多见。注重脉络并治,从肝论治,注重运用态靶辨治体系,减少西药的使用。

基于解痉多肽表达化生病证结合的小鼠模型探讨胃癌前病变脾胃虚实证候的本质

目的为了构建病证结合的小鼠模型及进行胃癌前病变(gastric precancerous lesions,GPL)脾胃虚实证候的本质研究。方法采用他莫昔芬(tamoxifen,TMXFR)诱导构建解痉多肽表达化生(spasmolytic peptide expression metagenesis,SPEM)小鼠模型,并在SPEM模型基础上分别模拟构建脾胃湿热证、脾气虚证模型,结合TMXFR诱导的SPEM模型具有自恢复的特性,以TMXFR组及生理盐水处理组作为对照组,监测小鼠一般情况,HE染色检测SPEM模型的构建及恢复情况,ELISA检测小鼠血清胃泌素水平,PCR检测各组小鼠胃黏膜中miR-7a-5p含量,免疫组化检测各组小鼠胃黏膜中白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-13(interleukin-13,IL-13)表达。结果病证结合的脾胃湿热证、脾气虚证组较TMXFR组、SPEM组织恢复明显延迟;脾胃湿热证较对照组及TMXFR组的胃泌素表达异常升高(P<0.05),SPEM模型组小鼠胃黏膜中miR-7a-5p较对照组水平降低(P<0.05),病证结合的脾胃虚实组miR-7a-5p表达较TMXFR有下降趋势;病证结合的脾胃虚实组IL-1β表达较TMXFR组、对照组升高(P<0.05),脾胃湿热证、脾气虚证组中IL-13表达有升高趋。结论此项研究结果侧面证实了在癌前病灶已形成的前提下,虽无幽门螺杆菌感染,在外感湿热之邪、进食肥甘厚腻、饥饱失常、过劳伤脾等诱因下,机体可突破自身代偿修复能力,延缓SPEM恢复甚至使GPL进一步进展。这可能跟miR-7a-5p介导炎症因子IL-1β使得Th1/Th2细胞失衡相关,但具体机制尚待进一步研究。

基于中西医临床病证特点的免疫性血小板减少动物模型分析

原发免疫性血小板减少(ITP)是一种出血性疾病,发病机制目前尚不明确,为了进一步探究ITP发病机制和临床新药的研究,故通过查阅大量国内外关于免疫性血小板减少模型的相关文献,参照中西医病因病机和临床疾病诊断标准,总结分析ITP相关动物模型特点和与临床吻合度。发现应用最为广泛的是抗血小板血清诱导法,其临床吻合度与病证结合脾不统血、气不摄血模型吻合度均较高,模型造模方式简单,可重复性强。但大多数模型将西医作为评价指标,模型无法完全模拟ITP完整发病过程和状态,缺少中医证候描述,在模型发展仍需进一步完善。

基于“新八纲”辨治慢性肝病

对唐旭东教授“脾胃病辨证新八纲”(简称“新八纲”)在慢性肝病领域的应用进行总结,认为慢性肝病当从“脏腑-气血-虚实-寒热”4个维度次第辨证:脏腑之辨,调肝理脾为主,兼顾他脏他腑;气血之辨,知其有余不足,病位深浅轻重;虚实之辨,正虚血瘀为本,损益邪正偏盛;寒热之辨,肝胆湿热多见,勿忘厥阴肝寒。在此基础上以通降理论为治疗立法,执简驭繁,全阶段指导慢性肝病遣方用药,可取得较好疗效。

基于中西医临床病症特点的肠易激综合征动物模型评价

肠易激综合征(IBS)是一种以慢性或者反复性腹痛同时伴随着排便异常或排便习惯变化为特点的功能性胃肠道疾病。目前IBS动物模型吻合度较高的为多因素联合的病症结合模型,但此类模型多为中药灌胃合并某证型,多因素造模方法在IBS复杂的病因病机方面也存在一定的局限性。而更完善的动物模型可以有助于临床研究和筛选治疗药物。构建更加符合中西医临床病症特点的动物模型尤为重要。基于IBS的中西医临床病症特点,对现有的IBS模型进行归纳分析,评价动物模型和临床的吻合度,分析其优缺点。完善动物模型评价标准,结合中医优势联系各建模方法的相互作用,结合环境、遗传、生活方式等因素,是未来IBS动物模型的发展方向。