Advances in Research of Treatment of Angina Pectoris in Coronary Heart Disease from the Method of Dredging Collaterals with Pungent

The angina pectoris in coronary heart disease belongs to the category of"chest impediment"in traditional Chinese medicine,and belongs to the syndrome of root deficiency with tip excess.Its main pathogenesis is obstruction of the heart collaterals,and treatment mainly adopts dredging collaterals and relieving pain.Based on the treatment principles of dredging collaterals with pungent,aiming at the etiology,pathogenesis and disease characteristics of angina pectoris in coronary heart disease,this article systematically analyzes the Method of Dredging Collaterals with Pungent including the methods of dredging collaterals with pungent moisture,dredging collaterals with pungent warm,dredging collaterals with pungent aroma,and dredging collaterals with insect type drugs,to provide ideas for the treatment of angina pectoris in coronary heart disease.

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.

Observation on the Therapeutic Effect of Heatclearing and Dampness-eliminating Dredging Collaterals Combined with Papaya Antirheumatic Pills on Treatment of Damp-heat Obstructive Ankylosing Spondylitis

Objective:Therapeutic effect of heatclearing and dampness-eliminating dredging collaterals combined with papaya antirheumatic pills on treatment of damp-heat obstructive ankylosing spondylitis.Methods:A total of 200 patients with ankylosing spondylitis who were treated in our hospital from January 2018 to October 2019 were selected as the research objects and randomly divided into 2 groups,each with 100 patients.The control group was treated with leflunomide+papaya antirheumatic pills,and the observation group was treated with self-drafted recipe of heat-clearing and dampness-eliminating,the curative effect,visual analogue score(VAS),barthel AS function index(BASFI)score,biochemical indicators and adverse reactions between the two groups were compared.Results:After 12 weeks of treatment,the efficacy of the observation group was higher than that of the control group.The pain score,BASFI score,and biochemical index were lower than those of the control group,and the differences were statistically significant(P<0.05);There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Heat-clearing and dampnesseliminating dredging collaterals combined with papaya antirheumatic pills is effective in the treatment of damp-heat obstructive ankylosing spondylitis,which is beneficial to reduce the degree of pain and inflammation of the affected area,helps patients remain active,and improves activities of daily living.

Systemic Lupus Erythematosus Complicated with Femoral Head Ischemic Necrosis Treated by Chinese Medicine Therapy for Activating Blood and Dredging Collaterals Method

Objective：To observe the effect and mechanism of Chinese medicine therapy for activating blood and dredging collaterals（ABDC） on treating systemic lupus erythematosus complicated with avascular necrosis of the femoral head（SLE-ANFH）.Methods：Thirty-four patients（51 joints） with SLE-ANFH were assigned by a random number table to two groups：22 patients（32 joints） in the treatment group and 12 patients （19 joints） in the control group.All received Western medical conventional treatment for anti-inflammation and immunosuppression,but an additional Chinese medicine decoction prescribed based on ABDC principle was administered to patients in the treatment group.The observation on the patients＇ condition and therapeutic effect lasted for 3 years.Results：The patients＇ conditions in the two groups,as assessed by Association for Research Circulation Osseous（ARCO） staging,were similar before treatment.After treatment,comparison between groups showed significant difference（P0.05）,and the raised Harris functional scores in the treatment group were higher than that in the control group（P0.01）.The post-treatment symptom improving rate in the treated group was 72.73%,which was higher than that in the control group（50.00%,P0.05）.Moreover,the former was superior in improving hematologic and hemorrheologic parameters in terms of prolonging activated partial thromboplastin time,lowering whole blood middle/low shear viscosity,and plasma viscosity（P0.05 or P0.01）. Two patients in the control group but none in the treatment group received hip joint replacement operation during the observation period.Conclusions：Chinese medicine ABDC therapy could effectively alleviate clinical symptoms and improve joint function of patients with SLE-ANFH.The mechanism may be related to its effects on improving high coagulation manner and trend for getting embolism.

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.

针刺对肩周炎患者生存质量改善及临床效果研究

目的研究针刺治疗后肩周炎患者的临床疗效和生存质量改善情况。方法严格按照纳入排除标准选择2022年3月—2023年3月收治的80例肩周炎患者进行研究,按照等比例随机数字表法分为两组,对照组40例采用口服药物+功能锻炼治疗,研究组40例采用经络别通法针刺治疗,治疗1个疗程后观察比较两组临床疗效、肩关节功能、日常生活能力、炎症因子水平以及疼痛恢复情况。结果研究组治疗总有效率(97.50%,39/40)显著高于对照组(77.50%,31/40),差异有统计学意义(P<0.05);均未发生严重安全事件,仅少数患者发生不良反应,差异无统计学意义(P>0.05)。治疗前,两组肩关节评分量表(CMS)分值、疼痛程度、简化生活质量量表(ADL)评分和炎症因子水平比较差异均无统计学意义(P>0.05);治疗后,研究组CMS分值、ADL评分高于对照组,疼痛状况(PPI)分值、视觉模拟疼痛(VAS)分值、疼痛分级指数(PRI)分值、C反应蛋白(CRP)、白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平低于对照组,差异有统计学意义(P<0.05)。结论经络别通法针刺治疗肩周炎疗效显著,可显著改善疼痛,从而改善患者生存质量,相关作用机制可能与降低炎症因子水平,恢复肩关节功能相关。

河南孟州卢氏温阳通脉学术流派与临证经验

河南孟州卢氏温阳通脉学术流派是河南中医学术流派的典型代表之一,创立者卢昭在多年的临床实践中形成了以温中祛寒、通络回阳为治则;温补心阳、温补脾阳、温补肾阳为方法的温阳通脉学术思想。第二代传承人卢作斌擅长在温阳通脉学术思想指导下,使用附子、干姜、吴茱萸、当归、黄芪、白术、香附、川芎、丁香、续断、茯苓等药物,以化瘀通经、温经散寒、温阳止痛等法,治疗闭经、崩漏、不孕、痛经等妇科疾病及中医内科杂症。第三代传承人卢敬业擅长诊治中医内科、妇科、儿科等疑难杂症,并积极传承中医临床经验,培养基层中医药人才。第四代传承人卢海涛擅长治疗心脑血管及肝胃病。第五代传承人卢晓峰擅长治疗类风湿关节炎、强直性脊柱炎等风湿骨关节病、肝胃病、中风后遗症,以及眩晕、头痛等疾病。学派以卢氏“本仁堂”药铺为依托,临证诊病,阴阳为纲;治病疗疾,注重扶阳;宗师仲景,推崇经方;回阳救逆,重用附子;兼辨阴证,综合而治,特长显著,流派特色鲜明,在治疗胸痹心痛、风寒湿痹、骨痹及妇科疑难杂症方面具有独特经验。

归芪活血胶囊对神经根型颈椎病大鼠炎性损伤和微循环血流的影响

目的:探究归芪活血胶囊(GQ)对神经根型颈椎病(CSR)大鼠的治疗效应及机制。方法:观察CSR大鼠自发痛、热痛阈、步态评分、前肢和颈部体表微循环状态、脊髓病理结构及超微结构变化、脊髓p38磷酸化情况以及血清白细胞介素-1β(IL-1β)、IL-6以及肿瘤坏死因子-α(TNF-α)。结果:GQ高、中剂量在干预第14天时可显著升高CSR模型大鼠的热痛阈(P<0.05),降低其步态评分和自发痛评分(P<0.05,P<0.01);GQ各剂量均可改善CSR大鼠脊髓炎症水肿变化,显著增加尼氏(Nissl)染色阳性细胞数目(P<0.05),恢复髓鞘和线粒体正常形态,且GQ中剂量效果较明显;GQ高、中剂量可显著升高CSR大鼠颈部和前肢皮肤血流灌注量(P<0.05),对前肢远端血流灌注量的改善程度优于芬必得组(P<0.01);与模型组比较,GQ中剂量可降低CSR大鼠脊髓p38磷酸化比率。结论:GQ可以缓解CSR大鼠热痛觉过敏和步态不稳的程度,改善脊髓炎症病理变化,恢复前肢和颈部体表血流灌注量,且GQ中剂量在改善CSR大鼠炎症损伤方面更有优势。

基于络病理论探讨益气养阴通络法治疗糖尿病肾脏病

糖尿病肾脏病为本虚标实之证,本虚为气阴两虚,标实为瘀血、痰浊,治疗宜益气养阴通络,益气用黄芪、党参、太子参,养阴用生地黄、熟地黄、铁皮石斛、黄精等补络脉之不足,行络脉之气血。气阴亏虚于内,水不涵木,则易生风动风,此为内风;本虚于内,易受外邪侵扰,此为外风。外风宜散,内风宜熄,临床常用僵蚕、生龙骨、生牡蛎平熄内风;穿山甲、乌梢蛇、海风藤、牛蒡子等散外风。祛痰通络用半夏、瓜蒌、白芥子以消肾络之痰浊。散结通络常用醋鳖甲、醋莪术等通络消积。络病日久,瘀血阻滞络脉,凝聚成形,络熄成积,痼结难解,此时单用草木之品难以奏效,常配伍虫类药以搜剔化瘀通络,常在丹参、川芎的基础上配伍地龙、全蝎、水蛭等虫类药。益气养阴药配伍祛风通络药、祛痰通络药、散结通络药以及化瘀通络药,有益气养阴、通畅肾络之效。

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。

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。

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。

基于PI3K/AKT/mTOR信号通路探讨化瘀通络灸促血管性痴呆大鼠髓鞘再生的作用机制

目的观察化瘀通络灸对血管性痴呆(vascular dementia,VD)大鼠胼胝体磷脂酰肌醇3激酶(phosphatidylinositol 3 kinase,PI3K)/蛋白激酶B(protein kinase B,AKT)/哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)信号通路的影响,探讨化瘀通络灸促VD大鼠髓鞘再生的作用机制。方法经Morris水迷宫筛选后,随机选取12只大鼠纳入假手术组,剩余大鼠复制VD模型成功后,随机分为模型组、艾灸组、艾灸+LY294002组,每组12只。艾灸组予以化瘀通络灸干预,艾灸+LY294002组在化瘀通络灸干预的基础上予以PI3K抑制剂LY294002腹腔注射,采用Longa评分法评价各组大鼠神经功能损伤程度,Morris水迷宫实验检测各组大鼠学习记忆能力,Western blot法检测各组大鼠PI3K/AKT/mTOR信号通路相关蛋白的表达水平,神经髓鞘固蓝染色法观察各组大鼠胼胝体髓鞘的形态,透射电子显微镜观察各组大鼠髓鞘超微结构。结果与假手术组比较,模型组和艾灸+LY294002组大鼠的Longa评分显著升高(P<0.05),逃避潜伏期显著延长(P<0.05),PI3K/AKT/mTOR通路相关蛋白表达水平显著降低(P<0.05),胼胝体内髓鞘纹理不清,排列混乱,边缘呈空泡或空网状改变,髓鞘线圈样结构离散,部分膨出和崩解,有髓神经轴突数量显著减少(P<0.05);与模型组和艾灸+LY294002组比较,艾灸组大鼠Longa评分显著下降(P<0.05),逃避潜伏期显著缩短(P<0.05),PI3K/AKT/mTOR通路相关蛋白表达水平显著提高(P<0.05),胼胝体内髓鞘结构有所恢复,排列整齐,边缘结构较为致密,有髓神经轴突数量显著增加(P<0.05)。结论化瘀通络灸可能通过激活PI3K/AKT/mTOR通路,修复VD大鼠损伤髓鞘并促进其重塑,恢复脑白质功能。

从络论治慢性肾脏病研究进展及王祥生经验撷菁

基于络病理论探索慢性肾脏病(CKD)的发病机制及治疗策略。查阅中医从络病学论治CKD的相关文献,总结王祥生教授临床运用络病理论治疗CKD经验。肾络不通是CKD的重要病机,肾络不通详而辨之可见瘀血阻络、湿浊阻络、毒邪阻络、风邪阻络等,通络之法辨证以通络,常用药物包括虫类、藤类、祛湿泄浊类,另有中医外治法辅助通络。从络论治的理论体系为CKD提供了系统的中医诊疗思路。

基于络病学说探讨小儿慢性荨麻疹的辨治规律

慢性荨麻疹是儿科临床上常见皮肤病之一,属于皮肤黏膜血管反应性疾病,常反复发作,危害儿童的身心健康。其发病、演变及预后和络病学说密不可分。现从络病学说角度总结小儿慢性荨麻疹的基本病机为禀赋不耐,风邪搏于肌腠,营卫失和,络脉受损而发。初期治疗方法应以祛邪通络为主,以祛除风邪为要,同时可结合运用散寒、清热、解毒、除湿等法以疏经通络,祛内邪,通达络脉;结合心部于表理论,注重调理心;恢复期应以扶正养络为要,以固本扶正、祛邪兼顾。无论在早期或后期治疗过程常贯穿活血化瘀法。

浅探络脉学说论治视网膜色素变性

视网膜色素变性(RP)是具有遗传异质性的视网膜营养不良性眼病。视网膜血管纤细,属于中医络脉,络脉与目有着密切的联系。该文对络脉的生理、病理特点进行概述,以络脉理论作为着眼点,论证络脉病变与RP发病机制的相关性,证实从络脉治疗RP的可行性。基于络脉易滞易瘀的特点,络病的病机变化实质为“不通”,故“络以通为用”适用于络病的治疗原则。

活血通络类方剂治疗糖尿病肾脏疾病的研究进展

糖尿病肾脏疾病(DKD)是导致慢性肾脏病和终末期肾病的首要病因,严重危害人类健康。中医认为血瘀是贯穿DKD全病程的重要病机,多项研究拟定了多个活血通络类方治疗DKD患者,其临床症状好转、蛋白尿减少、肾功能保护、治疗有效率提高和疾病进展延缓等方面均有成效。

仝小林院士治疗高龄肺部感染后心力衰竭急性加重验案一则

肺部感染诱发心力衰竭是老年患者常见的危重症,早期症状不明显,诊断较为困难,死亡率高。仝小林院士从审机论治和态靶辨治的角度,气血并重理心肺,攻补兼施衡阴阳,巧用虫药通络脉,在现代医学常规治疗的基础上运用子龙宣白承气汤加减方对该病取得了显著疗效,四付药即扭转了患者的心衰危象,并改善了肺部感染和肾功能。

疏肝通络针刺法联合帕罗西汀治疗卒中后抑郁症临床疗效及对神经递质、细胞因子表达水平的影响

目的通过随机对照研究,研究疏肝通络针刺法联合帕罗西汀治疗卒中后抑郁症(PSD)患者的临床疗效观察及对神经递质、细胞因子表达水平的影响。方法利用随机数字表法将医院2022年7月—2023年1月收治的90例PSD患者分为研究组(45例,疏肝通络针刺法+帕罗西汀)和对照组(45例,帕罗西汀);对比两组临床疗效,治疗前后抑郁情况[抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD)]、生活质量,治疗前后神经递质[同型半胱胺酸(Hcy)、5-羟色胺(5-HT)、多巴胺(DA)、去甲肾上腺素(NA)]、细胞因子[白细胞介素-1(IL-1)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)]等水平,记录不良反应情况。结果治疗8周后,总有效率研究组高于对照组(P<0.05);两组HAMD、SDS评分均下降(P<0.05),且研究组均低于对照组(P<0.05);研究组生活质量量表评分均高于对照组和治疗前(P<0.05);两组Hcy、IL-1、TNF-α均降低,且研究组低于对照组(P<0.05);两组5-HT、DA、NA及IL-10均升高(P<0.05),且研究组均高于对照组(P<0.05);研究组不良反应总发生率低于对照组(4.44%vs 17.78%,χ^(2)=4.050,P<0.05)。结论对PSD患者给予疏肝通络针刺法联合帕罗西汀治疗,可获得更好地治疗效果,可有效缓解患者抑郁情绪,调节神经递质、细胞因子水平,且不良反应较少。