Research Progress of Tonifying Kidney and Promoting Blood Circulation in the Treatment of Steroid-induced Necrosis of Femoral Head

Osteonecrosis of the femoral head is a common disability disease of the hip joint in China,and osteonecrosis of the femoral head caused by hormone factors is the most common,which is related to the gradual increase in the utilization rate of glucocorticoids in recent years.It is a refractory disease in orthopaedics with a poor prognosis.For this disease,the treatment of traditional Chinese medicine has certain advantages.In view of this,the author reads,analyzes and summarizes its materials by searching China Journal full-text Database and Wanfang Database.This paper reviews the mechanism and clinical research progress of tonifying kidney and activating blood circulation in the prevention and treatment of steroid-induced osteonecrosis of the femoral head,hoping to provide help for the clinical treatment of hormone-related osteonecrosis of the femoral head.

Supplementing Qi and activating blood circulation method to treat vertebrobasilar dolichoectasia with posterior circulatory watershed infarction:a case report of two patients

Vertebrobasilar dolichoectasia(VBD),a rare posterior circulation vascular variant disease,is an important risk factor for many acute cerebrovascular diseases.An insufficient understanding of VBD often leads to misdiagnose.Two cases of VBD that were initially diagnosed as posterior circulation watershed infarction are reported here.Absence of common causes of stroke including hypoperfusion,blood system diseases,carotid and aortic dissection,and eosinophil elevation,the symptoms of the 2 patients met the diagnostic criteria of VBD.Both patients displayed symptoms that were in line with the Traditional Chinese Medicine(TCM)syndrome pattern of"Qi deficiency and blood stasis".Accordingly,they were comprehensively treated with Supplementing Qi and activating blood circulation method.The clinical manifestations of the 2 patients were remarkably improved and no recurrence of watershed infarction was found in a 1-year follow-up.A detailed medical history and laboratory examination are capable of improving diagnostic accuracy of VBD.TCM treatment based on syndrome identification might be a promising candidate for VBD management.

Clinical Factors Affecting Platelet Growth in the Treatment of Aplastic Anemia by Tonifying Kidney and Generating Blood

Objective:To investigate the influence of kidney-tonifying and blood-generating method on platelet(PLT)growth in the treatment of aplastic anemia(AA)and analyze the characteristics of the clinical factors affecting PLT growth.We enrolled patients treated from September 2018to March 2021 in the China Academy of Traditional Chinese Medicine(TCM)Xiyuan Hospital,China Academy of TCM hospital gate 19sub-center.We enrolled 128 AA patients,for whom the inclusion criteria were:treatment is given priority to with kidney and heart's-blood method,on the basis of western medicine treatment for kidney fill party avoid Fried instant particles,stay for 3 months for a period of treatment,taking two consecutive period of treatment,changes in the PLT were observed,and the clinical characteristics of AA patients,such as PLT growth and recovery from baseline value,were analyzed.Materials and Methods:A total of 128 AA patients from 19 branches of Xiyuan Hospital,China Academy of Chinese Medical Sciences and Guang'anmen Hospital,China Academy of Chinese Medical Sciences treated from September 2018 to March 2021 were enrolled.The treatment was based on the kidney-tonifying and blood-generating method and lasted for 3 months as a course of treatment.The changes in the number of PLT in patients were observed,and the clinical characteristics of AA affecting PLT growth and recovery from baseline value were analyzed.Results:After 6 months of treatment following the kidney-tonifying and blood-generating method,PLT increased from the baseline values in 75 cases,including 21 cases of AA with normal PLT recovery and 54 cases of AA without normal PLT recovery.There were 53 cases of AA in whom PLT did not increase from the baseline.Analysis of the general data showed that patients with lower Karnofsky Performance Status(KPS)score were more likely to experience PLT growth or even return to normal after therapy(P<0.05).The results of routine blood analysis showed that when hemoglobin(HGB)was≥60 g/L and the reticulocyte(RET)proportion was≥0.3%before treatment,PLTs were more likely to increase,even returning to normal in some patients(P<0.05).Analysis of bone puncture results before treatment showed that when the proliferation of nucleated cells was low or extremely low in bone puncture examination,with the proportion of granulocytes<40%,and the proportion of erythroid cells<20%,the treatment method was more effective at increasing PLT count(P<0.05).Analysis of the chromosome karyotype results before treatment showed that when the chromosome karyotype was normal,PLTs were more likely to increase or even return to normal after treatment(P<0.05).Analysis of T-lymphocyte subsets before treatment showed that when CD3+human leukocyte antigen(HLA)-DR+proportion was≥30%,PLTs were more likely to increase or even return to normal(P<0.05).Conclusions:AA patients with a low KPS score,higher HGB≥60 g/L,RET proportion≥0.3%,low or extremely low proliferation of nucleated cells,granulocytes proportion<40%,erythroid proportion<20%,normal chromosome karyotype,CD3+HLA-DR+≥30%,should be treated with a kidney-tonifying and blood-generating method.Such patients are more likely to show PLT growth and the values may even return to normal.

Tonifying Qi and activating blood circulation in terms of Traditional Chinese Medicine: their effects in patients with myocardial infarction

OBJECTIVE: To investigate the effects of tonifying Qi and activating blood circulation(SQABC), a method in Traditional Chinese Medicine(TCM), on end-point events in patients with myocardial infarction(MI) in this retrospective cohort study.METHODS: Clinical data were obtained from the medical records of patients with acute MI(AMI),both during hospitalization and follow-up, and included general demographic information(age, gender, and contact information), TCM regimens used,and end-point events.RESULTS: A total of 1596 patients with AMI were enrolled to this study, but data of only 1210 casesare accessible till follow-up. We classified the patients based on the exposure levels of SQABC.When comparing the results between all exposure and non-exposure groups, significant differences were identified, both during hospitalization and follow-ups. During hospitalization, cardiac death(4.40% vs 21.55%, P < 0.05) and cardiac shock(3.04% vs 11.62%, P < 0.05) were significantly lower in the exposure group than the non-exposure group. Similarly, during the follow-up, cardiac death(12.04% vs 20.49%, P < 0.05), acute heart failure(7.27% vs 11.81%, P < 0.05), composite endpoint of reinfarction and stroke(9.11% vs 15.28%,P < 0.05), and rehospitalization due to angina(25.49% vs 34.38%, P < 0.05) were significantly lower in the exposure group than the non-exposure group.CONCLUSION: Our findings suggest that SQABC can significantly benefits the subjects in the management of high-risk AMI in them.

苏筋通络方结合“行气活血”针刺法治疗急性踝关节扭伤临床观察

目的观察苏筋通络方结合“行气活血”针刺法治疗急性踝关节扭伤临床效果。方法将医院创伤骨科门急诊就诊的102例急性踝关节扭伤患者(2020年5月—2022年7月)纳入研究,以随机数字表法将患者分为两组,每组51例,对照组采取西医常规治疗,观察组采取西医常规治疗同时结合苏筋通络方及“行气活血”针刺法治疗。数据比较:临床治疗效果、中医症状(踝关节疼痛肿胀、皮下瘀斑、关节活动受限等)积分变化、踝关节跖屈活动度与背伸活动度变化、视觉模拟评分(Visual Analogue Scale,VAS)变化、美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分变化、血清疼痛物质(神经生长因子、神经肽、P物质)水平变化、白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-1β(Interleukin-1β,IL-1β)、超敏C反应蛋白(Hypersensitive C-reactive protein,hs-CRP)变化。结果观察组患者与对照组患者治疗总有效率相比[98.04%(50/51)vs86.27%(44/51)],P<0.05;治疗后各组患者中医症状(踝关节疼痛肿胀、皮下瘀斑、关节活动受限等)积分、踝关节跖屈活动度与背伸活动度、VAS评分、AOFAS踝-后足评分、神经生长因子、神经肽、P物质、IL-6、IL-1β、hs-CRP等指标均改善,观察组患者治疗后中医症状(踝关节疼痛肿胀、皮下瘀斑、关节活动受限等)积分、踝关节跖屈活动度与背伸活动度、VAS评分、AOFAS踝-后足评分、神经生长因子、神经肽、P物质、IL-6、IL-1β、hs-CRP等指标均明显优于对照组患者,P均<0.05。结论苏筋通络方结合“行气活血”针刺法治疗急性踝关节扭伤临床效果显著,患者经治疗后临床症状显著改善,疼痛缓解,踝关节功能改善,值得应用。

国医大师张大宁教授以膏方辨治阴虚型慢性肾脏病经验总结

慢性肾脏病逐渐成为临床最常见的慢性疾病之一,严重影响了人民群众的身体健康,国医大师张大宁教授作为中医肾脏病的奠基人,在长期的临床实践中,最早提出了“肾虚血瘀论”并首创“补肾活血法”,同时将补肾活血法融入膏方之中来治疗阴虚型慢性肾脏病。文章总结了张大宁教授利用膏方治疗慢性肾脏病的经验,供读者参考。

基于调控免疫炎症微血管损伤的补气活血法治疗肺炎“瘥后防复”思路的提出

肺炎恢复期后遗症严重影响患者身心健康,存在二次感染的风险,且与基础病相互影响导致恶性循环。做好肺炎恢复期康复工作,减少后遗症并预防反复发作是疾病防治的首选。研究显示肺炎长期后遗症和反复发作的机制可能与持续的机体免疫抑制和全身微炎症状态及微血管损伤有关。团队根据传统中医理论,结合长期临床与基础研究,提出“气虚血瘀”是肺炎恢复期的核心病机。因此,团队提出补气活血法治疗肺炎“瘥后防复”的机制与调控免疫炎症微血管损伤有关,调控T淋巴细胞紊乱提高免疫、抑制炎症因子改善机体微炎症状态和抗氧化保护内皮细胞调控微血管损伤,阐明其内在机制将为中医药治疗呼吸系统重大感染性疾病提供理论依据,传承精华、守正创新。

张勉之教授基于补肾活血法论治尿酸性肾病

尿酸升高是肾功能异常的独立危险因素,肾脏损伤也会导致患者尿酸排泄异常。尿酸性肾病的病因病机以禀赋素薄,脾肾亏虚为病理基础,饮食不节,湿瘀侵袭为发病机制。张勉之教授在以国医大师张大宁教授创立的补肾活血法为根本治疗大法的前提下,依据潜伏期、发作期、缓解期体现出的不同证型辨证施治,疗效满意。

骨质疏松症“亏瘀致痿”的理论构建及临床应用

骨质疏松症(OP)是一种以增龄性骨量降低,骨微结构破坏,骨脆性增加且易骨折的代谢性骨病。该病好发于绝经后女性和中老年男性,起病隐匿,多数患者在骨折后才被确诊,造成了大量的医疗资源消耗。浙江中医药大学附属第三医院姚新苗教授研究团队基于“肾主骨”“肾气虚损”等基础理论,创新性提出了OP“亏瘀致痿”的致病理论,认为OP的病机是亏虚瘀互结、夹杂致痿。在该理论指导下,认为应采用“补肾健脾活血法”对OP患者进行辨证论治。补肾健脾活血法主要包括虚瘀同治;补肾为本、健脾为要;筋骨并重3个方面。该研究团队开展了一系列临床与基础研究,从不同角度阐释“亏瘀致痿”理论指导下OP康复策略的科学内涵。

费伯雄学术思想浅论骨肿瘤证治思路

本文在费伯雄的“醇正和缓,平淡和调”思想基础上的创新与发挥,阐述了中医对骨肿瘤的认识,将“固本清源”、“脾肾同治”“、费氏活血化瘀法”等应用于骨肿瘤辨证体系,对于“龙火汤”“立极汤”“后辛汤”“新定拯阴理劳汤”等进行创新应用,使其内涵与意义更符合现代中医药辨治肿瘤病的特点。在临床上灵活地按照肿瘤病发生发展的不同阶段分成了四期演变,并从病因、病机与治则方面辨治骨肿瘤发热以及骨肿瘤相关性失眠,在费伯雄学术思想指导下为临床骨肿瘤的诊治提供新思路。

Efficacy and safety of a sequential treatment with clearing heat and eliminating phlegm and tonifying Qi and activating blood circulation in treating acute ischemic stroke: study protocol for a randomized controlled trial

OBJECTIVE:To investigate the short-term efficacy and safety outcomes following a sequential treatment with clearing heat and eliminating phlegm(CHEP)formula and tonifying Qi and activating blood circulation(TQABC)formula in patients with acute ischemic stroke(AIS)within a 72 h time window.METHODS:In this randomized,multicenter,doubleblinded,placebo-controlled trial,500 participants will be randomly assigned in a ratio of 1∶1 to the CHEP+TQABC group or control group.In addition to guidelinebased standard medical care,participants in the treatment group will receive the CHEP formula for the first 5 consecutive days followed by the TQABC formula for another 10 consecutive days,while those in the control group will receive CHEP formula placebo and TQABC formula placebo consecutively.The primary outcome measure will be the comparison of the change in the National Institutes of Health Stroke Scale score from baseline to 15 days after randomization.The secondary outcome measures will include the scores on the modified Rankin Scale,Barthel Index,Patient-Reported Outcomes,TCM symptom pattern(Zheng-hou)evaluation Scale,and the incidence of in-hospital complications.Safety assessment will include the physical examination,laboratory detection,any adverse events or serious adverse events,and the proportion of any complications during hospitalization.DISCUSSION:The results of this study will provide objective and scientific data with which to assess the efficacy and safety of a sequential treatment based on“integrating disease and symptom pattern”for patients with AIS.

补肾活血法联合血液透析治疗慢性肾衰竭的Meta分析

[目的]对补肾活血法联合血液透析治疗慢性肾衰竭的文献进行Meta分析。[方法]计算机检索中国期刊全文数据库(CNKI)、万方数据库知识服务平台(WangFang)、Pubmed、EmBase等数据库,筛选补肾活血法联合血液透析治疗慢性肾功能不全的随机对照试验,检索时间为自建库起至2022年9月7日。运用Cochrane风险偏倚评估工具进行文献质量评价,应用Review Manager 5.3软件进行Meta分析,使用Stata14.0软件进行Egger检验,以评估发表偏倚,若存在发表偏倚则进一步运用非参数剪补法评估偏倚对结果的影响。运用GRADEprofiler3.6软件对本研究涉及结局指标进行证据质量评价。[结果]纳入14篇相关研究文献,共1316例患者,试验组660例,对照组656例。Meta分析结果显示,补肾活血法联合血液透析在降低血肌酐(Scr)、尿素氮(BUN)水平、中医证候积分方面优于单纯血液透析组,提高肌酐清除率(Ccr)、有效率方面联合组优于单纯血液透析组,差异具有统计学意义,但证据质量有待提高。两组的不良反应发生率未见统计学差异。发表偏倚检验及非参数剪布法结果提示血Scr、BUN指标存在偏倚,但偏倚结果对结果未造成影响。[结论]研究证明补肾活血法联合血液透析治疗慢性肾衰竭疗效显著,可以降低Scr、BUN、中医证候积分,提高Ccr水平,且未见不良反应增加。但需要更多高质量、大规模的研究来进一步验证。

基于隐结构模型结合关联规则探讨冠脉微血管疾病中医“症-证-药”规律

目的系统挖掘冠状动脉微血管疾病(Coronary microvascular disease,CMVD)中医常见症状、证候要素、临床辨证分型及用药规律,为量化CMVD临床辨证标准、规范中医临床证候诊断及疗效评价、指导临床用药提供参考依据。方法分别检索中国知网(CNKI)、万方数据库(Wanfang)、维普中文期刊(VIP)、中国生物医学文献服务系统(SinoMed)自建库至2023年5月16日有关中医药治疗CMVD的相关文献。提取纳入文献相关信息建立数据库并对症状、证素、证型、中药进行频数统计,分别采用Latern 5.0与Rstudio软件构建隐结构模型进行综合聚类与关联规则分析,探讨中医药治疗CMVD的症状特点、证素分布、常见证型及用药规律。结果共纳入107篇文献,涉及证型36个,证素17个,症状121个,中药143种,推测出CMVD的主要证候要素为血瘀,其次为气虚、气滞、痰浊、阴虚和阳虚;主要证型为气虚血瘀证,其次为心血瘀阻证、气滞血瘀证、痰瘀互结证、气阴两虚证等;用药以川芎、丹参、当归、黄芪为主;按功效分类主要为活血化瘀药、补虚药、理气药。结论CMVD病位在心,与肝、肾相关,属本虚标实之证,血瘀贯穿本病发展的始终;治疗以活血化瘀、通络止痛为主,并结合辨证选用补中益气、疏肝理气、祛痰散结等治法。

红三七炮制工艺优化及其补血活性研究

目的优化红三七炮制工艺,并评价其补血活性。方法在单因素试验基础上,以蒸制温度、蒸制时间、烘干温度、烘干时间为影响因素,三七皂苷R1,人参皂苷Rg_(1)、Rb_(1)、Rk_(3)、Rh_(4),20(R)-人参皂苷Rg_(3)总含量为评价指标,Box-Behnken响应面法优化炮制工艺。建立乙酰苯肼(APH)-环磷酰胺(CTX)联合诱导的小鼠贫血模型,比较红三七、熟三七补血活性差异。结果最佳条件为蒸制温度130℃,蒸制时间4 h,烘干温度60℃,烘干时间48 h,总皂苷含量为8.326%,RSD为0.087%。药理活性表明,不同炮制工艺对三七补血活性有影响,红三七的补血活性优于熟三七。结论该方法稳定可行,可用于红三七的规范生产。

补肾活血法治疗围绝经期综合征验案举隅

围绝经期综合征(Perimenopausal syndrome,PMS)是指女性在绝经前后出现的一系列躯体及心理精神的症状,多由激素的波动或减少引起卵巢功能逐渐减退所致的妇科常见疾病。作者有幸在跟随杨慧老师出诊学习的过程中,发现老师治疗PMS基于肾气、天癸、冲任理论,以补肾活血为治疗法则,自拟归肾逐瘀汤为基础方,根据辨证论治随证加减,屡奏效验,感触颇深。文章采纳门诊经典医案,探析杨慧老师对于PMS的诊疗经验,以期丰富中医药治疗妇科疾病的思路。

Clinical Study on Effect of Chinese Herbal Medicine for Supplementing Kidney and Qi and Activating Blood Circulation in Treating Intrauterine Growth Retardation of Fetus

Objective: To explore the therapeutic effect and the possible working mechanism in using Chinese herbal medicine (CHM) for supplementing Kidney and Qi, and activating blood circulation in treating intrauterine growth retardation of fetus (IUGR). Methods: Fifty-five cases of IUGR were divided into two groups, 30 cases in the CHM group treated with CHM and the 25 in the control group treated with amino acids. The effect of CHM treatment was observed and compared with that of the control group, normal pregnancy group and non-treated IUGR group. Results: Body weight of the newborns in the CHM was markedly higher than that in the control group. Not only the maternal fundal height (FH) and the abdominal circumference (AC), but also the fetal growth parameters, including biparietal diameter, head circumference (HC), and femur length (FL) in the CHM group increased much faster than those in the control group. After CHM treatment, the maternal serum levels of estriol (E3) and human placental lactogen (hPL) approached to those in the normal pregnancy group, but the control group,in comparison with the normal pregnancy group, was significantly different. The umbilical venous plasma concentration of essential amino acids in both treated groups improved, but the improvement in the CHM group was more significant than that in the control group. No apparent adverse effect of CHM was observed in either mother or fetus.Conclusion: CHM for supplementing Kidney and Qi and activating blood circulation was more effective in improving placental function and enhancing amino acid transportation than amino acid

补肾活血法预防芳香化酶抑制剂所致骨丢失的机制

目的探讨补肾活血法预防芳香化酶抑制剂(aromatase inhibitors,AIs)所致骨丢失的关键靶标和通路。方法将小鼠随机分为假手术组、模型组和给药组,模型组和给药组去势后予以10μg/d来曲唑溶液皮下注射构建绝经后AIs所致骨质疏松动物模型,给药组同时予以黄芪补肾活血汤(HQD)19.24 g/(kg·d)灌胃预防骨丢失,假手术组与模型组予以等量生理盐水灌胃。给药三个月后取小鼠股骨进行骨密度检测验证造模效果,并借助TMT蛋白组学测序分析获取其组学特征。结果与假手术组相比,模型组小鼠骨小梁结构疏松紊乱,数量减少,证明造模成功。与模型组相比,给药组骨小梁粗大致密,数量增多,证明补肾活血法预防作用显著。模型组与假手术组相比,上调蛋白275个,下调189个;给药组与模型组相比,上调蛋白286个,下调蛋白898个。三组对比后共有18个交集蛋白,分别为Ptbp1、Epx、Ear1、Ear2、Col6a5、Mta2、Alox15、Lztfl1、Ccl6、Diaph2、Wfdc21、Smarcb1、Strip1、C19orf12、Pex14、Akr1b7、Fahd1、Nr1d2。差异蛋白主要参与了细胞发育和分化的调节、脂质代谢、核酸内切酶活性等生物过程,并在铁死亡、花生四烯酸代谢通路、肌钙蛋白细胞骨架调节、PI3K-AKT等信号通路显著富集。结论补肾活血法可有效预防AIs所致骨丢失的发生,其关键靶标和作用机制可能与Ptbp1、Alox15及铁死亡、PI3K-AKT等通路相关。

陈以平“斡旋三焦”治疗特发性膜性肾病经验

特发性膜性肾病的根本病机与三焦气化失司密切相关。三焦不通则全身水液输布排泄障碍,痰湿、瘀血内生,病理产物堆积,郁久化热,进而导致肺、脾、肾三脏俱损。因而使三焦通在特发性膜性肾病的治疗中尤为重要,故陈以平教授通过“斡旋三焦”治疗本病,并创益气活血化湿专方。“斡旋三焦”通过益气活血化湿治疗大法实现三焦气机通畅。此法旨在通过补益肺脾肾之气、清热化湿、活血化瘀,促进气的推动、温煦、固摄及气化等功能的恢复,使三焦功能归常,从而促进疾病向愈。附验案1则。

从“肾虚血瘀”理论论治老年眼病

随着我国人口老龄化的加速,老年眼病呈高发趋势,其引发的视觉异常和低视力会严重影响患者的生活质量。在众多治疗老年眼病的方法中,国医大师张大宁提出的“肾虚血瘀”理论为临床诊治老年眼病提供了新视角。老年眼病病位主要在肾,多因肾虚不能涵目,虚则致瘀,瘀阻清窍所致。肾虚为本,血瘀为标,两者相互依存,互为因果。本文探讨了“肾虚血瘀”理论在老年眼病诊疗中的临床应用价值,提出补肾活血法可作为老年眼病的基本治疗方法,予以补肾活血之常用方药,既滋补一身元气,又攻除有形之邪,攻补之力相敌,实现补而不留瘀,祛瘀不伤正。

血管数量对小血管网计算流体力学的影响

背景:力学因素会影响血管内皮细胞的成血管能力,血管数量变化如何影响微血管流体力学性能还有待阐明。目的:基于计算流体力探讨血管数量对小血管网流体力学的影响。方法:利用ANSYS 19.0软件Geometry模块构建3种不同血管数量的小血管网三维模型,在Mesh模块进行网格划分,属性设定小血管网管壁为无滑移的刚性壁,血液为层流、黏性、不可压缩的牛顿流体,设定血液密度、入口血液流速等物理信息,采用Navier-Stokes(NS)方程组进行计算。分析比较在不同血管数量的情况下,小血管网不同部位流体力学性能差异。结果与结论:血液流线、血液流速及质量流量在小血管网内均呈现出、入口处大,血管网中间交接处小;血管数量越多,小血管网各部位血液流线越稀疏,血液流速、质量流量、管壁剪切力随血管数量增加均呈下降趋势。血管数量会改变小血管网内流体力学环境。计算流体力学可以反映出小血管数量变化对血液流体力学性能的影响,为基于成血管-成骨偶联的补肾活血法治疗骨内灌注不足引起的相关骨骼疾病(骨折不愈合、骨缺损、骨质疏松症等)提供新的思路。