Comprehensive effects of traditional Chinese medicine treatment on heart failure and changes in B-type natriuretic peptide levels: A meta-analysis

BACKGROUND Heart failure(HF),a common cardiovascular condition,is characterized by significant morbidity and mortality.While traditional Chinese medicine(TCM)is often used as a complementary approach in HF management,systematic evalua-tions of its impact on clinical outcomes,TCM syndrome scores,and B-type natriuretic peptide(BNP)levels are lacking.This study fills this gap through a comprehensive analysis of randomized controlled trials(RCTs)focusing on TCM for HF treatment.It encompasses an assessment of methodological quality,a meta-analysis,and an evaluation of evidence quality based on established standards.The results offer crucial insights into the potential advantages and constraints of TCM in HF management.RCTs on TCM for HF treatment published since the establishment of the database were searched in four Chinese and English databases,including China National Knowledge Infrastructure,Wanfang,VIP Information Chinese Science and Technology Journal,and PubMed.Methodological quality was assessed for the included studies with the Cochrane risk-of-bias assessment tool,and the meta-analysis and publication bias assessment was performed with the RevMan5.3 software.Finally,the quality of evidence was rated according to the GRADE criteria.RESULTS A total of 1098 RCTs were initially retrieved.After screening,16 RCTs were finally included in our study,which were published between 2020 and 2023.These RCTs involved 1660 HF patients,including 832 in the TCM group[TCM combined with conventional Western medicine(CMW)treatment]and 828 in the CWM group(CWM treatment).The course of treatments varied from 1 wk to 3 months.TCM syndrome differentiation was analyzed in 11 of the included RCTs.In all included RCTs,outcome indicators included comprehensive clinical outcomes,TCM syndrome scores,and BNP levels.The meta-analysis results showed significant differences between the TCM and CWM groups in terms of comprehensive clinical outcomes[risk ratio=-0.54;95%confidence interval(CI)=-0.61,-0.47;P<0.00001],TCM syndrome scores[weighted mean difference(WMD)=-142.07;95%CI=-147.56,-136.57;P<0.00001],and BNP levels(WMD=-142.07;95%CI=-147.56,-136.57;P<0.00001).According to the GRADE criteria,RCTs where"TCM improves clinical comprehensive outcomes"were rated as low-quality evidence,and RCTs where"TCM reduces TCM syndrome scores"or"TCM decreases BNP levels"were rated as medium-quality evidence.CONCLUSION TCM combined with CWM treatment effectively improves comprehensive clinical outcomes and diminishes TCM syndrome scores and BNP levels in HF patients.Given the low and medium quality of the included RCTs,the application of these results should be cautious.

Effect of Traditional Chinese Medicine inImproving Hot Flashes Symptom ofBreast Cancer

Breast cancer (BC) is the most common malignant tumor in women. Around 50% of BC receptor-positive patients are hormone-dependent cases, and it is necessary for them to use endocrine after operation. Through inhibition of estrogen level

Systematic evaluation on curative effects of traditional Chinese medicine retention enemas for patients with radiation proctitis

Objectives： To systematically evaluate the curative effects of traditional Chinese medicine retention enemas for patients with radiation proctitis. Methods： Reports on randomized controlled trials （RCTs） on traditional Chinese medicine retention enemas in the treatment of radiation proctitis were searched in the Cochrane Library, PubMed, EMBASE, EBSCO, ISI, CNKI, V1P, WanFang Data and CBM databases. The publication dates were from inception to May 2014, and a literature screening, data extraction, quality evaluation and cross checks were inde- pendently conducted by two reviewers in accordance with the inclusion and exclusion criteria. A meta- analysis was then carried out using RevMan 5.3 software. Remits： In total, 14 RCTs were included, and of these, only 10 RCTs involving 702 patients were included in the meta-analysis. The meta-analysis showed that the total efficacy of traditional Chinese medicine retention enemas was higher for patients with radiation proctitis compared with that in control group, RR - 4.83, 95% C1 （2.98, 7.84）, P 〈 0.000 01 ; the results from four studies indicated that the improvement of clinical symptoms due to traditional Chinese medicine retention enemas was higher than that of the control group. Conclusions： The implementation of traditional Chinese medicine retention enemas could improve the total efficacy of treatment and provide relief in patients with radiation proctitis.

Effects of ginger moxibustion combined with Chinese medicine iontophoresis on patients with primary dysmenorrhea

Objective:To observe the effects of Ginger moxibustion combined with iontophoresis with traditional Chinese medicine on the improvement of symptoms, serum platelet activating factor (PAF) level and uterine artery pulsation index in patients with primary dysmenorrhea.Methods 114 patients with primary dysmenorrhea who were treated in our hospital from August 2017 to February 2019 were divided into two groups according to the different treatment schemes. 57 patients in the control group were treated with ibuprofen capsules, and 57 patients in the study group were treated with Ginger moxibustion combined with iontophoresis with traditional Chinese medicine. After three menstrual cycles of treatment, the curative effect was evaluated and the improvement of symptoms was counted. PAF, PAF-AH and platelet adhesion rate were compared, uterine artery hemodynamics was measured, and levels of serum hs-CRP and IL-6 were measured.Results The overall response rate of the study group was significantly higher than that of the control group (P < 0.05). After treatment, the scores of different symptoms in the two groups were significantly lower than those before treatment (P < 0.05), and the scores of different symptoms in the study group were significantly lower than those in the control group (P < 0.05). After treatment, PAF and platelet adhesion rate in the two groups were significantly lower than those before treatment (P < 0.05), PAF-AH was significantly higher than that before treatment (P < 0.05), and PAF and platelet adhesion rate in the study group were significantly lower than those in the control group (P < 0.05), PAF-AH was significantly higher than that in the control group (P < 0.05). After treatment, the pulsation index, resistance index and peak systolic-diastolic ratio in the study group were significantly lower than those before treatment (P < 0.05), and the pulsation index, resistance index and peak systolic-diastolic ratio in the study group were significantly lower than those in the control group (P < 0.05). After treatment, the levels of serum hs-CRP and IL-6 in the two groups were significantly lower than those before treatment (P < 0.05), and the levels of serum hs-CRP and IL-6 in the study group were significantly lower than those in the control group (P < 0.05).Conclusions Ginger moxibustion combined with iontophoresis with traditional Chinese medicine is helpful to improve the overall response rate of primary dysmenorrhea treatment, reduce the score levels of different symptoms, rationally improve PAF, PAF-AH, platelet adhesion rate, and the pulse index, resistance index, peak systolic-diastolic ratio are decreased significantly, and serum hs-CRP and IL-6 levels tend to be normal.

Analysis of the application of Chinese medicine nursing technology in obstetrics

目的:分析中医护理技术在产科的应用价值。方法:以产科的204 例患者为研究,将其随机分为中医组与参照组(n = 102)。参照组患者接受常规护理,中医组患者接受中医护理,比较两组患者的焦虑抑郁评分及患者对护理的满意状态评分。结果:护理前组间评分比较无差别,护理后,中医组在焦虑、抑郁评分改善方面,数值降低幅度显著高于参照组,具有统计学显著性(P < 0.05)。中医组患者的综合护理满意率为99.02%,参照组患者的综合护理满意率为80.39%,差异具有统计学意义(P < 0.05)。结论:中医护理技术在产科的应用,有助于改善患者的负性情绪,提升患者的总体满意率,护理干预价值较高。

Combination of symptoms, syndrome and disease: Treatment of refractory diabetic gastroparesis

AIM:To assess effect of combination of symptoms,syndrome and disease on treatment of diabetic gastroparesis with severe nausea and vomiting.METHODS:Professor Tong Xiaolin’s clinical electronic medical records of patients who were treated between January 1,2006 and October 1,2012 were used as a database.Patients who met the inclusion criteria were enrolled.General information(name,sex and age),symptoms and blood glucose levels were obtained from the clinic electronic medical record,which was supplemented by a telephone interview.The patient-rated Gastroparesis Cardinal Symptom Index(GCSI)was used to evaluate the severity of the symptoms of gastroparesis.The effects of the treatment were assessed by the change in the severity of the symptoms of gastroparesis and the change in blood glucose between the baseline levels and the post-treatment levels at 1,2,4,8 and 12 wk.RESULTS:Forty-five patients had a mean GCSI nausea and vomiting severity score of 4.21±0.67 and a total GCSI score of 2.77±0.63 before treatment.There was a significant improvement in the nausea and vomiting score at every return visit compared with the baseline score(1 wk:3.02±1.04 vs 4.18±0.71,P<0.001;2wk:2.32±1.25 vs 4.16±0.73,P<0.001;4 wk:2.12±1.26 vs 4.12±0.73,P<0.001;8 wk:1.79±1.09vs 4.24±0.77,P<0.001;12 wk:0.69±0.92 vs 4.25±0.70,P<0.001).Twenty-five of the 45 patients had complete resolution of vomiting during the observation period(mean time to resolution was 37.9±27.3 d).The postprandial fullness and early satiety subscale,bloating subscale and total GCSI scores were also improved.Finally,the blood glucose levels improved after treatment,although the change was not significant.CONCLUSION:Use of the combination of symptoms,syndrome and disease to treat diabetic gastroparesis with refractory nausea and vomiting may be a new treatment option.

自拟健脾除积方联合信迪利单抗及化疗对晚期非小细胞肺癌患者的影响

目的:探讨自拟健脾除积方联合信迪利单抗及化疗对晚期非小细胞肺癌患者疾病控制率、中医症候积分及不良反应的影响。方法:选取2020年10月—2022年10月在我院就诊的102例晚期非小细胞肺癌患者,随机分为观察组和对照组,每组各51例,对照组在吉西他滨+顺铂化疗的基础上给予信迪利单抗,观察组在对照组基础上联合自拟健脾除积方治疗。比较两组患者临床疗效、治疗前后中医症候积分、肿瘤标志物水平及不良反应。结果:观察组有效率和疾病控制率明显高于对照组(P<0.05);观察组和对照组治疗后中医症候积分均显著低于治疗前;治疗后,观察组中医症候积分显著低于对照组(P<0.05)。两组治疗后血清铁蛋白(SF)、鳞状细胞癌抗原(SCCA)及癌胚抗原(CEA)水平均显著低于同组治疗前,观察组SF、SCCA、CEA水平均显著低于对照组。观察组白细胞计数减少、恶心、呕吐症状总发生率显著低于对照组(P<0.05)。结论:自拟健脾除积方联合信迪利单抗对晚期非小细胞肺癌患者治疗效果较好,可改善患者中医症候,具有较高的安全性。

谢氏刺营微创疗法联合西药治疗小儿急性扁桃体炎

目的探讨谢氏刺营微创疗法联合西药治疗小儿急性扁桃体炎(AT)的临床效果。方法选取2021年8月至2023年8月萍乡市人民医院收治的104例AT患儿作为研究对象,采用随机数字表法分为对照组(52例)和观察组(52例)。对照组采用常规西药治疗,观察组在对照组方法的基础上加用谢氏刺营微创疗法治疗,比较两组的临床疗效、中医证候积分、实验室指标、临床症状改善情况及不良反应。结果观察组的治疗总有效率高于对照组,差异有统计学意义(P<0.05)。两组患儿治疗前的中医证候积分及C反应蛋白(CRP)、中性粒细胞百分比(N%)、白细胞(WBC)、降钙素原(PCT)水平比较,差异无统计学意义(P>0.05);观察组治疗后的中医证候积分及CRP、N%、WBC、PCT水平均低于对照组,差异有统计学意义(P<0.05)。观察组的发热、扁桃体肿大、咽痛消失时间均短于对照组,差异有统计学意义(P<0.05)。两组均未见明显不良反应。结论谢氏刺营微创疗法联合西药治疗小儿AT效果较佳,利于改善临床症状,促进症状消退,减轻炎症反应,安全性好,值得推广。

Effect of Traditional Chinese Medicine for Treating Human Immunodeficiency Virus Infections and Acquired Immune Deficiency Syndrome:Boosting Immune and Alleviating Symptoms

To respond to the human immunodeficiency virus （HIV）/acquired immune deficiency syndrome （AIDS） epidemic in China, the integration of antiretroviral therapy （ART） and traditional Chinese medicine （TCM） has important implications in health outcomes, especially in China where the use of TCM is widespread. The National Free TCM Pilot Program for HIV Infected People began in 5 provinces （Henan, Hebei, Anhui, Hubei, and Guangdong） in 2004, and quickly scaled up to 19 provinces, autonomous regions, and municipalities in China including some places with high prevalence, 26,276 adults have been treated thus far. Usually, people with HIV infection seek TCM for four main reasons： to enhance immune function, to treat symptoms, to improve quality of life, and to reduce side effects related to medications. Evidences from randomized controlled clinical trials suggested some beneficial effects of use of traditional Chinese herbal medicine forHIV infections and AIDS. More proofs from large, well-designed, rigorous trials is needed to give firm support. Challenges include interaction between herbs and antiretroviral drugs, stigma and discrimination. The Free TCM Program has made considerable progress in providing the necessary alternative care and treatment for HIV-infected people in China, and has strong government support for continued improvement and expansion, establishing and improving a work mechanism integrating Chinese and Western medicines.

“筋揉骨正”中医特色疗法在股骨粗隆间骨折术后康复中的应用

目的:基于“筋揉骨正”理论观察中医特色康复疗法在股骨粗隆间骨折患者术后康复中的应用效果。方法:回顾性分析天津中医药大学第二附属医院2021年6月至2022年6月收治的股骨粗隆间骨折住院患者84例,按照治疗方法不同分为对照组和观察组,每组42例。对照组采用Intertan或PFNA髓内钉固定手术治疗,观察组在其基础上结合中医特色三期辨证治疗。比较2组疗效、中医证候积分、髋关节功能、骨强度及并发症。结果:观察组治疗总有效率高于对照组,观察组治疗后的各项中医证候积分均低于对照组,差异有统计学意义(P<0.05)。观察组治疗后的Harris髋关节评分和骨密度值高于对照组,差异有统计学意义(P<0.05)。2组感染、下肢深静脉血栓、关节僵硬、压疮等并发症发生率差异无统计学意义(P>0.05)。结论:基于“筋揉骨正”理论采用中医特色康复疗法治疗股骨粗隆间骨折术后康复效果显著,可以提高患者髋关节功能和骨密度,安全性良好。

耳部全息铜砭刮痧联合耳穴埋豆对社区肝阳上亢型高血压患者的干预效果评价

目的观察耳部全息铜砭刮痧联合耳穴埋豆对社区肝阳上亢型高血压患者的干预效果。方法选取2023年1月—6月厦门大学附属第一医院思明区中华道社区卫生服务中心参与慢病管理的肝阳上亢型高血压患者76例,按照随机数字表法分为对照组及研究组,各38例。对照组给予口服降压药物及常规高血压慢性病管理,研究组在对照组基础上采用耳部全息铜砭刮痧联合耳穴埋豆治疗。对比分析两组干预前后血压水平和中医症候总积分。结果干预后,两组患者收缩压和舒张压均较干预前下降,且研究组患者收缩压明显改善效果优于对照组,差异有统计学意义(P<0.01)。干预后,两组患者中医证候评分均较干预前降低,且研究组中医证候评分低于对照组,差异有统计学意义(P<0.01)。结论耳部全息铜砭刮痧联合耳穴埋豆对社区肝阳上亢型高血压患者的血压水平控制及中医症候的改善具有明确效果,对提高社区高血压慢性病管理质量具有重要促进作用,值得社区推广运用。

中西医结合治疗腰椎间盘突出术后残余症状临床疗效的Meta分析

目的:应用Meta系统评价在常规西医治疗(抗感染、消肿、营养神经等)基础下加入中医疗法对腰椎间盘突出症(lumbar disc herniation,LDH)患者术后残余症状的临床疗效。方法:检索知网、万方、维普、Pubmed等中英文数据库中有关中西医结合对治疗腰椎间盘突出术后残余症状临床疗效的相关文献,研究方法均为随机对照试验(randomized controlled trial,RCT),检索时间2018年1月1日至2023年9月1日。文献质量评估依照Cochrane偏倚风险评价工具,RevMan5.3软件进行分析。结果:共纳入10篇文献,737例患者,Meta分析结果示:治疗组的总体临床疗效高于对照组(RR=1.19,Z=5.22,P<0.00001),疼痛视觉模拟评分(visual analogue scale,VAS)、腰椎功能障碍评分(oswestry dability index,ODI)均低于对照组(SMD=-1.30,Z=14.29,P<0.00001;SMD=-1.71,Z=12.40,P<0.00001),日本骨科协会腰痛疾病疗效评分高于对照组(SMD=1.66,Z=15.74,P<0.00001)。结论:中西医结合治疗能够改善腰椎间盘突出患者的术后残余症状,进一步减轻疼痛,改善生活质量。

耳针疗法辅助治疗急性期周围性面瘫疗效观察

目的观察耳针疗法辅助治疗急性期周围性面瘫的临床疗效。方法将94例急性期周围性面瘫患者按照随机数字表法分为2组,对照组47例采取常规西医治疗,治疗组47例在对照组基础上联合耳针疗法治疗。2组均治疗4周。比较2组治疗效果,比较2组治疗前后面部神经传导速度、红外热成像(前额区、耳周区、口角区、颧区及患侧全区温度)、面瘫改良Portmann评分、面部残疾指数躯体(FDIP)评分、免疫炎性指标[免疫球蛋白(IgA)、IgM、IgG、白细胞介素6(IL-6)、IL-21]水平及世界卫生组织生活质量测定量表简表(WHOQOL-BRFF)评分变化情况,治疗后随访1年,统计对比2组复发率。结果治疗组总有效率95.74%(45/47),对照组总有效率80.85%(38/47),治疗组临床疗效优于对照组(P<0.05)。2组治疗1、2、3、4周面部神经传导速度均较本组治疗前升高(P<0.05),且治疗组治疗1、2、3、4周均高于对照组同期(P<0.05)。2组治疗1、2、3、4周前额区、耳周区、口角区及患侧全区温度均较本组治疗前升高(P<0.05),且治疗组治疗1、2、3、4周均高于对照组同期(P<0.05);2组治疗1、2、3、4周颧区温度均较本组治疗前升高(P<0.05),但2组组间同期比较差异无统计学意义(P>0.05)。2组治疗1、2、3、4周改良Portmann、FDIP评分均较本组治疗前升高,且治疗组治疗1、2、3、4周均高于对照组同期(P<0.05)。2组治疗后血清IgA、IgM、IgG、IL-6、IL-21水平均较本组治疗前降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05)。2组治疗后WHOQOL-BRFF各维度评分均较本组治疗前升高(P<0.05),且治疗组治疗后均高于对照组(P<0.05)。2组复发率比较差异无统计学意义(P>0.05)。结论采用耳针疗法辅助治疗急性期周围性面瘫患者,能显著提高治疗效果,进一步改善患者面部肌群恢复情况,有效改善患者面部温度、神经功能及面部神经传导速度,且能有效抑制免疫炎性损伤,降低复发率,有助于改善患者预后。

中医药团体标准评价体系的应用研究:以90项中药团体标准为例

目的 评价中医药行业具备代表性的社会团体发布量较大的学科类别标准,并发现标准存在的问题。方法 在“中医药标准与指南信息服务平台”上,通过文献调研法和目的性抽样法选取中华中医药学会发布的中药类标准。使用中医药团体标准评价体系(System of Consortium Standards Rating and Evaluation of Traditional Chinese Medicine, SCORE-TCM)工具对这些标准的制定主体、文本编写、技术内容、推广应用和实施效益五个维度进行评价。结果 中华中医药学会发布的团体标准数量最多,占76.20%(1 710/2 244)。其中,中药标准占比最高,达52.98%(906/1 710)。本次评价的90项标准中,评分中位数为7.53,最大值8.94,最小值5.93,极差3.01(满分10分)。不同标准类别的评分有所差异,例如中药临床应用标准和中药材商品规格等级标准评分较高,中位数分别为8.16和8.07,而中药材GAP(Good Agricultural Practice)技术标准评分较低,中位数为6.28。此外,标准推广应用和实施效益评分呈逐年降低趋势。结论 中华中医药学会发布的中药团体标准对中药产业全链条起到一定的支撑作用,但质量不均一,且在标准的推广应用和实施效益方面仍有较大提升空间。SCORE-TCM工具可用于中药团体标准评估,为今后开展更广泛的中药团体标准评价提供了有效工具。未来可进一步探索在SCORE-TCM工具的评分细则中纳入“标准年龄”因素,助力解决标准制定后便“束之高阁”而不使用的问题。

基于SCORE-TCM的中医药团体标准抽样评价方案设计

目前,各社会团体积极参与中医药标准的制定和发布,特别是“十四五”以来,中医药团体标准化工作更是迎来了提质增效的关键阶段。深入评估社会团体发布的中医药标准质量,是推进中医药团体标准工作的关键环节和重点任务。前期已研制并形成了中医药团体标准评价体系(System of Consortium Standards Rating and Evaluation of Traditional Chinese Medicine, SCORETCM)。在上述背景下,本研究通过专家共识法,设计了一套基于SCORE-TCM的中医药团体标准抽样评价方案,应用场景为对于特定社会团体发布的标准,或各团体发布的特定技术类别的标准进行快速评估。该方案涵盖了标准抽样、材料收集、标准评价、结果解读的完整流程,为中医药团体标准的抽样评价工作提供了参考方案。

中医药团体标准评价体系(SCORE-TCM)解读

本文全面解读了中医药团体标准评价体系(System of Consortium Standards Rating and Evaluation of Traditional Chinese Medicine,SCORE-TCM)。SCORE-TCM是结合定性与定量评价,全面评估中医药团体标准在制定主体、文本编写、技术内容、推广应用和实施效益等几方面特征的综合评价工具。文中详述了SCORE-TCM的构建目的、定义和构建过程,解释了评价指标体系中的各项指标,并对每项指标的评价材料进行介绍。本文旨在帮助中医药团体标准的制定者、第三方评价机构和其他相关方更好地理解SCORE-TCM各评价条目的含义,更有效地运用于中医药团体标准的自评价或第三方评价,SCORE-TCM将为《中医药团体标准管理办法》的贯彻实施,以及中医药团体标准的高质量发展提供技术支持。

中国急性ST段抬高型心肌梗死患者院前应用硝酸甘油或中成药对症状改善及梗死相关动脉血流影响的比较研究

目的:比较中国急性ST段抬高型心肌梗死(STEMI)患者院前应用硝酸甘油或中成药对症状改善及对梗死相关动脉(IRA)血流的影响。方法:依托中国急性心肌梗死注册研究于2013年1月1日至2014年3月31日期间,纳入全国108家医院7 d内发病且明确报告院前使用或不使用硝酸甘油或中成药的13064例STEMI患者(已排除共用两类药物患者),其中5280例患者接受了急诊冠状动脉造影。对比使用两类药物对患者症状缓解及IRA的TIMI血流分级水平的影响,其中症状缓解包括完全缓解(症状消失)和部分缓解(不同程度缓解)。结果:13064例患者中,2892例(22.1%)院前应用了硝酸甘油或中成药,其中1149例(8.8%)使用了硝酸甘油,1743例(13.3%)使用了中成药,10172例院前未用药。应用硝酸甘油或中成药的患者,6 h内到达医院的比例(57.4%vs.60.8%vs.50.3%,P<0.0010),与使用院前急救系统的比例(11.8%vs.12.2%vs.9.5%,P=0.0004)均高于未用药的患者。使用硝酸甘油的患者部分缓解比例高于使用中成药的患者(33.8%vs.25.1%,P<0.0010)。多因素Logistic分析显示,使用硝酸甘油较使用中成药完全和部分缓解的可能性较高(OR=1.331,95%CI:1.129~1.569,P=0.0007)。使用硝酸甘油或中成药的患者与未用药患者的院内死亡率相似。在接受急诊冠状动脉造影的患者中,使用中成药或硝酸甘油及未用药患者IRA的TIMI血流达到2~3级的比例分别为21.6%、15.8%和19.3%(P=0.0405)。多因素Logistic回归分析显示,与未用药患者相比,使用中成药患者的TIMI血流达到2~3级水平无明显优势(OR=0.856,95%CI:0.705~1.040,P=0.1171),使用硝酸甘油的患者TIMI血流达到2~3级水平可能性降低(OR=0.666,95%CI:0.495~0.895,P=0.0071)。结论:中国约有22.1%的STEMI患者院前单用硝酸甘油或中成药,含服硝酸甘油对症状改善作用优于中成药,与未用药患者相比,应用这两类药物的患者的TIMI血流未见明显改善。

间者并行,甚者独行——国医大师皮持衡辨治慢性肾衰临证思路发微

慢性肾衰病机复杂,症候繁多,混淆疑惑,辨证难明,此为“疑”;多脏腑虚损,气血阴阳不调,津液输布失常,病理产物相兼为病,处方不定,此为“难”。因其病情复杂性和多变性,且单一治法容易顾此失彼,故临床不可简单的扶正或祛邪,应有计划有层次多角度多途径施治。皮持衡教授从事肾病研究四十余年,认为慢性肾衰为本虚标实之证,治疗需紧扣病机、标本兼顾、病证结合、中西合参,以调阴阳平衡。皮持衡教授认为“间者并行、甚者独行”理论可有效指导临床,根据该理论采取扶正与祛邪交替给药的治疗方法,使药物既各自独行,又并行其治,既用药精专,又无犯虚虚实实之弊,取效颇佳,值得借鉴。现将皮老临证思路稍作探析,并结合医案进一步佐证,以飨同道。

中医药治疗晚期大肠癌的临床效果研究

目的探讨中医药治疗晚期大肠癌的临床效果。方法回顾性选取2015年1月至2022年12月于南京中医药大学附属苏州市中医医院就诊的338例晚期大肠癌患者为研究对象。按照治疗方法不同将患者分为中医组(180例)和中西医组(158例),中医组以中医综合治疗为主,未采用任何化疗、靶向治疗及免疫治疗;中西医组以化疗为主,配合中医综合治疗。2个月为1个周期,2组均连续治疗2个周期。观察2组在主要临床症状、Karnofsky功能状态(KPS)评分、临床疗效及无进展生存期(PFS)方面的差异。结果2组性别分布、年龄、发病部位、病理类型、分化程度、分期、转移部位、KPS评分、中医证型比较差异均无统计学意义(均P>0.05)。治疗后中医组乏力、纳差、腹胀、腹痛、便秘、便溏发生率均低于中西医组(均P<0.05);中医组KPS评分改善优于中西医组,差异有统计学意义(P<0.001)。中西医组总有效率高于中医组[84.8%(134/158)比73.3%(132/180)],差异有统计学意义(P<0.05)。中西医组PFS较中医组延长了3个月,差异有统计学意义(Log-rankχ^(2)=4.729,P=0.030)。结论通过中医综合治疗或中医综合治疗联合化疗均可以提高临床效果、改善临床症状和KPS评分、延长PFS。单纯中医治疗可以更好地改善临床症状和KPS评分,而中西医联合治疗在延长PFS方面具有优势。

基于TabNet的周仲瑛教授辨治甲状腺功能亢进病机预测模型及用药规律研究

目的以周仲瑛教授治疗甲状腺功能亢进(甲亢)的临床病案为研究对象,探索运用基于神经网络的TabNet模型发现甲亢的诊疗规律,为传承名老中医学术思想、辅助临床诊疗提供方法参考。方法基于周仲瑛教授及其团队的临床甲亢诊疗医案,构建标准化、结构化训练数据,研究基于注意力机制和稀疏特征选择机制的算法,通过输入标准化临床表现,标准化舌象、脉象构建病机预测模型,分析核心症状、病机和药物以及三者之间的联系。结果通过训练好的预测模型对肝郁、肝火、痰饮、肾虚、阴虚、瘀血6个病机进行预测,与决策树、随机森林等经典算法构建的多标签分类模型相比,本模型分类和预测指标均较好。通过决策树算法进行挖掘,总结6个核心病机对应中药社团:醋柴胡、夏枯草、牡蛎、炙鳖甲、玄参、天冬、麦冬等。结论在临床医案数据上运用TabNet算法,构建基于临床表现、舌象和脉象的病机预测模型,可有效地预测核心病机,进而发现“症-机-药”之间的联系,为名老中医学术思想的传承和临床辅助诊疗决策提供方法学参考。