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.

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.

Predictive value of alarm symptoms in Rome IV irritable bowel syndrome:A multicenter cross-sectional study

BACKGROUND Irritable bowel syndrome(IBS)is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria.Alarm symptoms have long been applied in the clinical diagnosis of IBS.However,no study has explored the predictive value of alarm symptoms in suspected IBS patients based on the latest Rome IV criteria.AIM To investigate the predictive value of alarm symptoms in suspected IBS patients based on the Rome IV criteria.METHODS In this multicenter cross-sectional study,we collected data from 730 suspected IBS patients evaluated at 3 tertiary care centers from August 2018 to August 2019.Patients with IBS-like symptoms who completed colonoscopy during the study period were initially identified by investigators through medical records.Eligible patients completed questionnaires,underwent laboratory tests,and were assigned to the IBS or organic disease group according to colonoscopy findings and pathology results(if a biopsy was taken).Independent risk factors for organic disease were explored by logistic regression analysis,and the positive predictive value(PPV)and missed diagnosis rate were calculated.RESULTS The incidence of alarm symptoms in suspected IBS patients was 75.34%.Anemia[odds ratio(OR)=2.825,95%confidence interval(CI):1.273-6.267,P=0.011],fecal occult blood[OR=1.940(95%CI:1.041-3.613),P=0.037],unintended weight loss(P=0.009),female sex[OR=0.560(95%CI:0.330-0.949),P=0.031]and marital status(P=0.030)were independently correlated with organic disease.The prevalence of organic disease was 10.41%in suspected IBS patients.The PPV of alarm symptoms for organic disease was highest for anemia(22.92%),fecal occult blood(19.35%)and unintended weight loss(16.48%),and it was 100%when these three factors were combined.The PPV and missed diagnosis rate for diagnosing IBS were 91.67%and 74.77%when all alarm symptoms were combined with Rome IV and 92.09%and 34.10%when only fecal occult blood,unintended weight loss and anemia were combined with Rome IV,respectively.CONCLUSION Anemia,fecal occult blood and unintended weight loss have high predictive value for organic disease in suspected IBS patients and can help identify patients requiring further examination but are not recommended as exclusion criteria for IBS.

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.

Study on Correspondence between Prescription and Syndrome and the Essence of Phlegm and Blood Stasis Syndrome in Coronary Heart Disease Based on Metabonomics

Studying the essence of a syndrome has been a key challenge in the field of Chinese medicine.Until now,due to limitations of the methods available,the progress towards understanding such complicated systems has been slow.Metabonomics encompasses the dynamics,composition and analysis of metabolites,enabling the observation of changes in the metabolic network of the human body associated with disease.Being from the point of view of the whole organism,metabonomics provides an opportunity to study the essence of a syndrome to an unprecedented level.Phlegm and blood stasis syndrome is the main syndrome associated with coronary heart disease（CHD）,which bring difficulties in clinical treatment due to difficulties associated with differentiation of symptoms and signs.The fundamental differences of material between the two also need to be interpreted.The authors consider that we can use the method of combining a disease（in this case CHD）with associated syndromes（phlegm and blood stasis syndrome）to select patients with phlegm and blood stasis syndrome of CHD,and utilize metabonomics to explore the essence of the syndrome by difference analysis of metabolite spectra.Meanwhile,we can study the syndrome in CM,observe the change regularity of metabolism spectra after the treatment of corresponding and non-corresponding prescription and syndrome,in order to validate the material fundament in the progress of syndrome formation and their differences.This will not only have great significance in enhancing the ability to identify syndrome of phlegm and blood stasis in CHD and to establish the clinical curative criteria,but will also offer a new approach of studying the essence for a syndrome using metabonomics.

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.

Symptoms of spinal dysfunction mimicking systemic diseases(Ogundana Syndrome):a review of 35 cases treated with manual therapy over 30 years

Objective and Method:Symptoms manifesting in other parts of the body signaling the existence of spinal dysfunction(Ogundana Syndrome)in patients(N=35,age range 20-56yrs;mean age 36yrs)diagnosed to have systemic diseases but treated with manual therapy were identified after a 30 year case note review.Results:Incipient parkinsonism(general edema and expressionless mask face),stroke(weakness of one side of the body),tinnitus(headache with noise in one or both ears),breast cancer(breast pain)and dyspnea(difficulty in breathing)were some physician diagnoses and clinical symptoms presented.One percent rate occurrence was noted affecting significantly more females(74%)than males(26%,P<0.001).This involved people with family history of back pain(66%)engaged in low income occupations(farming 40%,trading 25%,artisans 15% and civil servants 20%).Symptoms got better after vertical oscillatory pressure therapy to appropriate spinal regions.Duration of treatment was influenced by duration of spinal dysfunction prior to therapy and age of younger patients.Conclusion:One percent of patients with spinal dysfunction misdiagnosed to have systemic diseases due to misleading symptoms are finally referred for physiotherapy of manifesting symptoms.Manual therapy to the appropriate vertebro-geographic region(s)relieves the symptom(s)without prejudice to existing diagnosis.

Assessment of Clinical Effect of Therapy Combining Disease with Syndrome on Rheumatoid Arthritis

Objective： To observe the effectiveness and safety of a therapy combining disease with syndrome on rheumatoid arthritis. Methods： Eighty patients with rheumatoid arthritis belonging to syndrome of damp-heat obstruction were randomly divided into a treatment group and a control group according to stratified blocked randomization method.Forty cases in the control group orally took Loxoprofen Sodium Tablet and Leifumite Tablet and the other 40 cases in the treatment group orally took a Chinese medicine for 12 weeks as a course of treatment. ACR therapeutic effect was used as the standard for evaluating the total therapeutic effect. Results： After l 2 weeks of treatment, there was a statistical difference （P〈0.01） in the improvement of VAS score, morning stiffness time, number of swelling joints, index of swelling joints, number of joints with tenderness, index of joints with tenderness, average grip strength of both hands, DSA28 score, HAQ, patient＇s assessment, physician＇s assessment, ESR, CRP and RF in both groups. The improvement of morning stiffness time, number of swelling joints, index of swelling joints, grip strength, HAQ and patient＇s assessment in the treatment group was much better than that in the control groups with statistical difference （P〈0.05）. ACR20, ACR50 and ACR70 was 27.5% （11/40）, 37.5% （15/40） and 22.5% （9/40） respectively in the treatment group and 40% （16/40）, 27.5% （11/42） and 10.0% （4/40） respectively in the control group with statistical difference （P〈0.05） in the superiority of the treatment group over the control group. The incidence of adverse reaction in the control group was higher than that in the treatment group （P〈0.05）. Conclusion： Definite therapeutic effect and high safety can be achieved in using the therapy combining disease with syndrome to treat rheumatoid arthritis belonging to syndrome of damp-heat obstruction.

Chronic gastrointestinal symptoms and quality of life in the Korean population

AIM： To evaluate the prevalence of chronic gastroin- testinal symptoms and their impact on health-related quality of life （HRQOL） in the Korean population. METHODS： A cross-sectional survey, using a reliable and valid Rome I] based questionnaire, was per- formed on randomly selected residents, between 18 and 69 years in age. All respondents were interviewed at their homes or offices by a team of interviewers. The impact of chronic gastrointestinal symptoms on HRQOL was assessed using the Korean version of the 36-item Short-Form general health survey （SF-36）. RESULTS： Of the 1807 eligible subjects, 1417 （78.4%： male 762; female 655） were surveyed. Out of the respondents, 18.6% exhibited at least one chronic gastrointestinal symptom. The prevalence of gastro- esophageal reflux disease （GERD）, defined as heart- burn and/or acid regurgitation experienced at least weekly, was 3.5% （95% CI, 2.6-4.5）. The prevalence of uninvestigated dyspepsia, irritable bowel syndrome （IBS） and chronic constipation based on Rome Ⅱ criteria were 11.7% （95% CI, 10.1-13.5）, 2.2% （95% CI, 1.5-3.1）, and 2.6% （95% CI, 1.8-3.5） respectively. Compared with subjects without chronic gastrointesti- nal symptoms （n = 1153）, those with GERD （n = 50）, uninvestigated dyspepsia （n = 166） and IBS （n = 31） had significantly worse scores on most domains of the SF-36 scales. CONCLUSION： The prevalence of GERD, uninvesti- gated dyspepsia and IBS were 3.5%, 11.7% and 2.2% respectively, in the Korean population. The health- related quality of life was significantly impaired in subjects with GERD, uninvestigated dyspepsia and IBS in this community.

Neurological complications of hematopoietic cell transplantation in children and adults

Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.

Relationship of functional gastrointestinal disorders and psychiatric disorders: Implications for treatment

This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome （IBS）, discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of [BS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints （fibromyalgia, temporomandibular joint syndrome）, heart （non-cardiac chest pain）, vascular （post-menopausal syndrome）, and brain （anxiety, depression）. Host IBS patients do not have psychiatric illness per se, but a range of psychoform （psychological complaints in the absence of psychiatric disorder） symptoms that accompany their somatoform （physical symptoms in the absence of medical disorder） complaints. It is not correct to label IBS patients as psychiatric patients （except those more difficult patients with true somatization disorder）. One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IBS, because the psychoform symptoms that sound similar to those seen in psychiatric disorders may not have the same significance in patients with IBS.

The conflict on posttreatment Lyme disease syndrome: a clinical mini review

Is Borrelia burgdorferi responsible for the persistence of symptoms after the standard successful course of antibiotics in Lyme disease patients?This highly controversial issue,concerning the underlying mechanism of posttreatment Lyme disease syndrome(PTLDS),still seems to be a matter of intense conflict of opinion.PTLDS is the manifestation of nonspecific symptoms including fatigue,musculoskeletal pain,dysesthesias,and neurocognitive deterioration after the standard antimicrobial therapy administered to patients suffering from Lyme disease.In this article,we review the conflicting views and published highlights of recent human studies regarding PTLDS.

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。

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。

基于数据挖掘的胆石症动物模型特点及应用分析

目的对现有胆石症动物模型进行整理归纳,探索可更好反映中西医临床病证特点,满足中医药临床与基础研究发展需要的动物模型。方法检索中国知网、万方、维普、SinoMed、PubMed等数据库,对国内外胆石症相关实验研究的动物模型进行搜集和整理,对模型的动物种类、造模方法、造模周期、检测指标和阳性药等数据进行统计和分析。结果纳入的128篇文献中,胆石症模型的动物种类以豚鼠、家兔和C57BL/6小鼠为主。使用最多的造模方法为高脂饲料法,饲料喂养周期集中在8周。高频检测指标为成石率、总胆固醇、磷脂、总胆红素、总胆汁酸等。较多使用的干预方式为中药复方、西药和单味中药或提取物,西药干预以熊去氧胆酸(Ursodeoxycholic acid,UDCA)为主,中药干预以中药复方为主,还包括针灸、运动、饮食等其他干预方式。实验设立阳性对照药多为UDCA。结论随着胆石症动物模型的不断完善和发展,目前有较多种造模方法都较好地模拟了胆石症中西医临床表现特点,但也存在一定局限性。该文分析结果可为胆石症模型的选择、应用和完善提供参考。

疾病与症状结合教学在膀胱癌教学中的实践应用探讨

目的探究与分析疾病与症状结合教学在膀胱癌教学中的实践应用。方法选取中国医科大学附属第四医院自2020年5月—2022年3月接受膀胱癌教学的医学生90名,按照随机数字表法分为对照组与观察组,每组各45名,对照组采取常规教学法,观察组采取疾病与症状结合教学,对比2组医学生对知识的掌握情况评分、医学生的沟通能力、带教老师对医学生的满意度评分。结果观察组临床思维能力评分、健康教育评分、临床操作评分、理论考核评分及总分分别为(20.54±2.02)分、(20.99±2.54)分、(19.32±2.61)分、(20.01±3.02)分、(81.98±4.12)分,观察组与对照组相比临床思维能力评分、健康教育评分、临床操作评分、理论考核评分及总分均较高,医学生对其工作态度、工作能力、劳动纪律、事故差错以及合计评分均较高,差异有统计学意义(P<0.001)。观察组教学后与对照组教学后相比医学生的基本语言沟通能力、基本非语言沟通能力、运动沟通技巧能力、协调沟通网络能力及总分均较高,差异有统计学意义(P<0.05)。结论疾病与症状结合教学在膀胱癌教学工作中的应用能够明显提高教学效果,医学生的沟通能力明显提高,带教老师对医学生教学工作的满意程度较高。

隐源性机化性肺炎的中医临床表现、证候及病位特征的回顾性研究

目的分析隐源性机化性肺炎(COP)患者的中医临床表现、证候及病位特征。方法选择2015年4月—2022年3月首都医科大学附属北京中医医院诊断的COP患者56例,对其中医四诊信息及辨证资料进行回顾性分析。结果56例患者中常规体检时发现的无症状者2例,余首发症状共7种,以咳嗽和喘憋为最常见症状;其次为咳痰,气短和发热。56例患者共涉及21种症状,其中,喘、咳嗽、汗出、咳痰、胸闷和气短为主要症状,出现频率均超过50%。与未合并纤维化患者比较,合并纤维化患者胸闷比例低(P<0.05);与未服用糖皮质激素患者比较,服用糖皮质激素患者汗出、渴而多饮和腰膝酸软比例高(P<0.05,P<0.01)。56例患者中舌淡最多,白苔为最主要舌苔,脉弦和脉滑为最主要脉象,出现频率均超过50%。与未合并纤维化患者比较,合并纤维化患者中脉弦的比例低(P<0.05);与未服用糖皮质激素患者比较,服用糖皮质激素患者中脉弦、脉滑和脉数的比例高(P<0.01,P<0.05)。56例患者中48例为虚实夹杂证,5例为虚证,3例为实证。虚证以气虚为主,其次为阴虚、阳虚。结合脏腑辨证,证候类型出现频率最高的是肺气虚,其次是肾阴虚、脾气虚,出现频率均超过30%。虚证以两证或三证同时出现,主要为肺脾气虚兼夹肾阴虚证和脾气虚兼夹肾阴虚占比较高。实证以寒饮停肺、痰湿阻肺、气郁伤肺和瘀阻肺络为主,出现频率均超过25%。证型组合主要为痰湿阻肺兼夹气郁伤肺和寒饮停肺兼夹瘀阻肺络证。与未合并纤维化患者比较,合并纤维化患者中肾阳虚证、瘀阻肺络证的比例高(P<0.05,P<0.01),气郁伤肺证的比例低(P<0.01);与未服用糖皮质激素的患者比较,服用糖皮质激素的患者肾阴虚证的比例高(P<0.01),肺阳虚证、瘀阻肺络证的比例低(P<0.05)。56例患者病位分布以肺居多,其次为肾、脾和胃。其中,与未服用糖皮质激素患者比较,服用糖皮质激素患者病位在肾、脾的比例高(P<0.05,P<0.01)。结论COP中医临床症状以肺系症状为主,证候类型虚实夹杂,主要病位为肺脏。服用糖皮质激素患者易出现汗出、口渴多饮、腰膝酸软等肾阴亏虚证候,病位在肾、脾比例高;未合并纤维化患者胸闷、脉弦多见,证候类型多见实证。

基于国医大师郭子光“人-症-病-证”体系探析慢性萎缩性胃炎临床辨治路径

慢性萎缩性胃炎(Chronic Atrophic Gastritis,CAG)中常见的肠上皮化生、异型增生属于胃癌前状态。中医在逆转肠上皮化生及异型增生方面具有治疗优势。笔者系国医大师郭子光教授学术传承人,在郭师学术思想指导下,初步提出基于“人-症-病-证”体系慢性萎缩性胃炎临床辨治路径。以病为纲,抓住CAG“脾气胃阴亏虚,湿热瘀阻胃络”的共性核心病机;兼顾个性,结合患者不同证型的个性病机。以“益气养阴,清热燥湿,和胃通络”为基本治则,创制了“益胃复萎”方这一验方,基于此方,分型分期加减论治。病证结合,最大化地优化临床疗效,更能发挥中医特色优势。

基于《黄帝内经》病证结合思想探讨疾病循证病机-证治体系研究模式

深度挖掘《黄帝内经》病证结合思想,《黄帝内经》首开辨病论治之先河,在此基础上,又将辨病与脏腑辨证、病因辨证、经络辨证及六经辨证有机结合,开启了病证结合思想的萌芽,为后世病机、证候、治则治法理论的发展奠定了坚实的理论基础。基于病机、证候、治法、方药之间的内在联系性与统一性,提出病证结合是循证病机-证治体系的立论基础,循证病机-证治体系以疾病为研究基础,以病机为核心要素,以临床疗效为评价标准,“基于疗效,评价病机”是构建疾病循证病机-证治体系的关键。在疾病循证病机-证治体系的构建过程中,借鉴循证医学系统评价的方法,通过“以方测证、验证病机”的方式,为循证病机-证治体系的构建提供思路。

基于hACE2转导建立SARS-CoV-2 spike假病毒感染病证结合的小鼠病毒肺炎模型

目的建立与评价一种安全、经济、有效的病证结合小鼠新冠病毒感染肺炎模型。方法30只KM种小鼠随机分为空白组、对照组及实验1组、实验2组、实验3组,每组各6只。每天把KM小鼠置于模拟寒湿环境中4 h,将表达hACE2的重组腺相关病毒(pAAV-hACE2)采用改良悬挂法气管内给药转导至肺组织,继以新型冠状病毒(SARS-CoV-2)spike假病毒采用相同的气管内给药方式造模。观察各组小鼠一般情况,检测体重变化、肺指数、血清炎性因子及肺部病理变化。结果免疫组化法显示h ACE2在小鼠肺组织中有效表达;在寒湿环境中给予SARS-CoV-2 spike假病毒后,实验组小鼠表现出类似疫毒犯肺证候的体征;且同样喂养条件和时间下,与空白组和对照组小鼠比较,实验组小鼠出现体重下降;实验1、2、3组小鼠出现肺指数显著增大(P<0.05或P<0.01),血清炎性因子白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)显著升高(P<0.01),肺组织病理改变明显。结论本研究成功建立了一种安全、经济、有效的病证结合小鼠新冠病毒感染肺炎模型。