Budd-Chiari syndrome:Etiology,pathogenesis and diagnosis

Budd-Chiari syndrome is a congestive hepatopathy caused by blockage of hepatic veins. This syndrome occurs in 1/100 000 in the general population. Hypercoagulable state could be identified in 75% of the patients; more than one etiologic factor may play a role in 25% of the patients. Primary myeloproliferative diseases are the leading cause of the disease. Two of the hepatic veins must be blocked for clinically evident disease. Liver congestion and hypoxic damage of hepatocytes eventually result in predominantly centrilobular fibrosis. Doppler ultrasonography of the liver should be the initial diagnostic procedure. Hepatic venography is the reference procedure if required. Additionally liver biopsy may be helpful for differential diagnosis. The prognosis of the chronic form is acceptable compared to other chronic liver diseases.

Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine

Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-23% of the population across the world. The percentage of patients seeking health care related to IBS approaches 12% in primary care practices and is by far the largest subgroup seen in gastroenterology clinics. It has been well documented that these patients exhibit a poorer quality of life and utilize the health care system to a greater degree than patients without this diagnosis. The pathophysiology of IBS is not clear. Many theories have been put forward, but the exact cause of IBS is still uncertain. According to the updated ROME III criteria, IBS is a clinical diagnosis and presents as one of the three predominant subtypes: (1) IBS with constipation (IBS-C); (2) IBS with diarrhea (IBS-D); and (3) mixed IBS (IBS-M); former ROME definitions refer to IBS-M as alternating IBS (IBS-A). Across the IBS subtypes, the presentation of symptoms may vary among patients and change over time. Patients report the most distressing symptoms to be abdominal pain, straining, myalgias, urgency, bloating and feelings of serious illness. The complexity and diversity of IBS presentation makes treatment difficult. Although there are reviews and guidelines for treating IBS, they focus on the efficacy of medications for IBS symptoms using high-priority endpoints, leaving those of lower priority largely unreported. Therefore, the aim of this review is to provide a comprehensive evidence-based review of the diagnosis, pathogenesis and treatment to guide clinicians diagnosing and treating their patients.

Progress in the pathogenesis and treatment of rheumatoid arthritis with sleep apnea hypopnea syndrome

Objective:Sleep apnea hypopnea syndrome (SAHS) is a common sleep disorder, which is manifested as a reduction in tidal volume or apnea during sleep, which results in intermittent hypoxia and tissue hypoxia and induces oxidative stress and inflammatory responses. Rheumatoid arthritis (RA) is a systemic disease contributing to hyperplasia of synovial membrane, cartilage erosion and joint damage. Fibroblast like synoviocytes (FLS), which make up the lining of the synovial membrane, are believed to play a role in the pathogenesis of RA. RA is a series of inflammation-like responses that induce joint damage and dysfunction and impair patients' life quality. This article first introduced the basic features of RA and analyzes the pathogenesis of RA with SAHS. Then the relationship between RA and SAHS was investigated. Finally, the progress in the treatment for RA with SAHS was reviewed emphatically.

Expert consensus on the diagnosis and treatment of myofascial pain syndrome

Myofascial pain syndrome(MPS)is characterized by myofascial trigger points and fascial constrictions.At present,domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS.Due to the lack of specific laboratory indicators and imaging evidence,there is no unified diagnostic criteria for MPS,making it easy to confuse with other diseases.The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS.This article reviews relevant domestic and foreign literature on the definition,epidemiology,pathogenesis,clinical manifestation,diagnostic criteria and treatments of MPS.The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors,including pain physicians to manage patients with MPS.

A review of the treatment of ankylosing spondylitis from liver and kidney

Ankylosing spondytitis is a kind of arthropathy of rheumatic immune disease. The pathogenesis of ankylosing spondytitis is not very ctear in current medicat research. Because of the recurrence of the disease and the prolongation of the disease, the quality of tife of the patients has been seriously affected. Traditional Chinese medicine has tong known its etiotogy and pathogenesis, and it is very effective in ctinicat treatment. Based on the theory of traditional Chinese medicine and modern physicians' understanding of its etiotogy and pathogenesis, and starting from the function and characteristics of tiver and kidney, this paper explores the basis of treating ankylosing spondytitis from tiver and kidney, with a view to providing new ideas for the ctinicat treatment of ankylosing spondytitis.

The Usage Evolution of Syndrome and the Production of the Term Differentiation of Syndromes in the Ancient Literature

Syndrome stood for disease name and symptom in the ancient medical literature prior to the Tang Dynasty.With the development of pathogenesis theory,the meaning pathogenesis of syndrome came into being and the term differentiation of syndromes came into existence in the Song,Jin and Yuan Dynasties,hence differentiation of syndromes gradually became a diagnostics term of differentiating pathogenesis.

Cyclical vomiting syndrome: Recognition, assessment and management

Cyclical vomiting syndrome(CVS) is a functional, debilitating disorder of childhood frequently leading to hospitalization. Affected children usually experience a stereotypical pattern of vomiting though it may vary between different individuals. The vomiting is intense often bilious, and accompanied by disabling nausea. Identifiable precipitating factors for CVS include psychosocial stressors, infections, lack of sleep and occasionally even food triggers. Often, it may be difficult to distinguish episodes of CVS from other causes of acute abdomen and altered consciousness. Thus, the diagnosis of CVS remains largely one of exclusion. Investigations routinely done during the work-up of a child with suspected CVS include both blood and imaging modalities. Plasma lactate, ammonia, amino acid and acylcarnitine profiles as well as urine organic acid profile are indicated to exclude inborn errors of metabolism. The treatment remains challenging and targeted at prevention or shortening of the attacks and can be considered as abortive, supportive and prophylactic. Use of nonpharmacological therapy is also part of the management of CVS. The prognosis of CVS is variable. More insight into the pathogenesis of this disorder as well as role of non-pharmacological therapy is needed.

Differentiating and Treating Gynecological Diseases based on the Theory of Collateral Diseases

The collateral disease theory is a unique component of the theoretical system of traditional Chinese medicine(TCM),which is currently applied to all kinds of diseases related to the collaterals.With the in-depth study of collaterals theory by many practitioners,its advantages in differentiating and treating gynecological diseases are gradually embodied.Based on the theory of collaterals disease,we discussed the pathogenesis,syndrome differentiation and treatment of gynecological diseases,concluded that the deficient collaterals under nourishment and the stagnant and blocked uterine collateral are the important pathogenesis of gynecological illness.Then we pointed out that invigorating the spleen and tonifying the kidney,and unblocking collateral and dissipating stasis are important treatment methods.We discussed the application of collateral disease theory in Tianjin HA's gynecology,and provided certain theoretical basis and clinical reference for the treatment of gynecologic diseases.

Traditional Chinese Medicine etiology and pathogenesis of acquired immune deficiency syndrome in simian immunodeficiency virus-infected Chinese rhesus macaques

OBJECTIVE： To investigate the traditional Chinese Medicine （TCM） etiology and pathogenesis of ac- quired immune deficiency syndrome （AIDS） by 18-month observation of Chinese rhesus macaques infected with simian immunodeficiency virus （SIV） mac239. METHODS： Thirty-five healthy Chinese rhesus ma- caques were divided into a model group （n=30） and a control group （n=5）. The model was estab- lished by inoculating monkeys intravenously with SIVmac239. Changes in TCM symptoms after SIV in- fection within 18 months were then observed and recorded. Routine blood tests, SIV viral load, T-lym-phocyte subsets, plasma triiodothyronine （T3）, tet- raiodothyronine （14）, adrenocorticotropic hormone （ACTH） and cortisol （Cor） were tested periodically during the experiment. RESULTS： During the acute infection period of SIV, model monkeys temporarily showed clinical symp- toms such as diarrhea, dysphoria and slight weight loss. Decrease percentages of CD4~ T-lymphocytes were observed but levels of T3, 14, Cot, and ACTH were relatively unchanged. Monkeys in the model group during the early and middle periods of infec- tion showed no obvious symptoms, except few monkeys exhibited transient diarrhea and reduced food intake. All variables at this stage showed nor- mal fluctuations. In the middle period model group monkeys showed chronic and persistent diarrhea, weight loss, reduced food intake and low levels of 13 and Cot. In the late period, symptoms including emaciation, weight loss, listlessness, crouching in corners and low levels of T3appeared. CONCLUSION： The results suggest that the rhesus monkey SIWSAIDS model can be applied to re- search on TCM etiology and pathogenesis of AIDS. According to this model, the etiology of disease is the SIV virus. The pathogenesis manifests as the in- vasion of SIV virus, incubation of the virus, balance between virus and healthy ＂Qi＂, damage to spleen and kidney as the disease progressed, exhaustion of vitality and finally the failure of five zang and six fu organs.

Pathogenesis and Individualized Treatment for Postural Tachycardia Syndrome in Children

Objective： Postural tachycardia syndrome （POTS） is one of the major causes of orthostatic intolerance in children. We systematically reviewed the pathogenesis and the progress of individualized treatment for POTS in children. Data Sources： The data analyzed in this review are mainly from articles included in PubMed and EMBASE. Study Selection： The original articles and critical reviews about POTS were selected for this review. Results： Studies have shown that POTS might be related to several factors including hypovolemia, high catecholamine status, abnormal local vascular tension, and decreased skeletal muscle pump activity. In addition to exercise training, the first-line treatments mainly include oral rehydration salts, beta-adrenoreceptor blockers, and alpha-adrenoreceptor agonists. However, reports about the effectiveness of various treatments are diverse. By analyzing the patient＇s physiological indexes and biomarkers before the treatment, the efficacy of medication could be well predicted. Conclusions： The pathogenesis of POTS is multifactorial, including hypovolemia, abnormal catecholamine state, and vascular dysfunction. Biomarker-directed individualized treatment is an important strategy for the management of POTS children.

慢性萎缩性胃炎的中医辨治思路与对策

慢性萎缩性胃炎(CAG)是临床上公认的胃癌前疾病,中医药治疗CAG具有明显的优势及鲜明的特色。从CAG病因病机等方面的研究入手,对中医药治疗CAG提出治本独取阳明,补虚泻实,顾护脾胃,升降气机,调气和血,祛瘀通络,祛邪解毒,甘平凉润,和胃护络的辨治思路与对策,以期进一步提高中医药治疗CAG的临床疗效。

从“阳化气,阴成形”探讨慢性咳嗽之因机证治

慢性咳嗽是以咳嗽为主症或唯一症状、病程持续8周以上的呼吸系统疾病。慢性咳嗽病因复杂,病程较长,病势缠绵,且极易复发。西医诊断该病过程繁琐,治疗手段有限,而中医药以整体观念和辨证论治思想为指导,在缓解临床症状、预防疾病复发方面具有独特优势。该文以“阳化气,阴成形”为抓手,分析阴阳在慢性咳嗽因机证治全周期的重要意义,认为慢性咳嗽之病机关键为“阳化气,阴成形”功能失衡,以肺之气血失和、阴阳虚损为本,阳化而气行不畅、周流有碍,阴变而凝结停滞、壅塞肺络为标。治疗上,需要补肺、脾、肾阴阳之不足,泄气滞、水湿、痰饮、瘀血、热毒之有余,以恢复“阳化气,阴成形”之平衡。具体用药方面,主张以偏纠偏,以药物气味之偏性纠正人体阴阳之偏颇。另附典型医案二例,加以验证说明,以期为中医药防治慢性咳嗽提供新的诊疗思路和方法。

中医治疗弱精子症的进展概述

弱精子症是临床常见的男性不育症,由多项因素共同导致。中医对弱精子症的病因病机有充分认识,且理论清晰,可采用分型施治、五脏分治、经络论治等多种方法治疗,对有明确病因以及无明确病因的弱精子症均有良好的治疗效果。上述治疗方法的实施涉及到对弱精子症患者证候类型的认知、特定药物的选择、针刺技术的使用等多项内容,总体呈现出方法多、疗效优的特点,对提高弱精子症的总体疗效、拓展弱精子症的认知深度发挥了积极的作用。本文即从中医对弱精子症的诊断与治疗进行简单总结。

国医大师周仲瑛融贯古今创建病机理论新体系学术思想述要

概述了国医大师周仲瑛教授以创建中医病机理论新体系为核心学术思想的探索历程、学术意义,对其理论内涵进行解读。作为中医高等教育教材建设的开拓者,周仲瑛教授创建了中医内科脏腑辨证纲要,坚持不懈开展病机理论创新研究,取得丰硕的学术成果,充实、发展了中医理论学术体系。在对外感热病和内伤急难症临床诊疗过程中,系统创建了瘀热论、癌毒论等病机新理论,据此立法用药能够提高临床疗效,感悟出辨识病机是辨证论治的关键环节。周仲瑛教授晚年以整体观为指引,提出“病机十三条”,构建了中医病机辨证新体系,突出复合病机、病机要素因果链对临床复杂性病证的指导价值,形成以“审证求机,活化辨证”思想为灵魂的理论。该理论突破了从单一病机或固定证型辨证论治的僵化思维,以整体观思想重构了中医理论框架,是现代中医学的一次重大学术创新。

张德英从痰论治痤疮验案举隅

[目的]总结张德英教授从痰证角度治疗痤疮的特色及经验。[方法]通过跟随张教授门诊临证学习,整理张教授治疗痤疮的病案,选取三则典型验案,结合中医经典理论,分析、总结张教授对痰证理论的独到见解及临床经验。[结果]张教授从当今人们的体质状况及痤疮发病特点出发,指出痤疮的病因病机为痰热或痰火上犯头面胸等处,局部肉腐而发病。根据痰浊生于中焦脾胃,为土家实邪,在治疗上可以通过泻土降浊、繁木制土、化土生金的方法达到化痰的目的,再加以清热药物,从而清化上焦痰热之邪,使痤疮得以治愈。同时需注意到五行相互关系,痰浊太盛则易克伐肾水而致肾虚,在治疗上祛痰降浊为先,痰浊去除后再补益肾水方可有效,甚或有些患者不需补肾,而肾自慢慢恢复。[结论]张教授对痰证理论认识独特,指出痤疮病机多为痰火或痰热郁于肌表,肉腐而成。治疗当以清化痰热为主。痰为土家之邪,化痰之法除泻土之外,根据五行理论,还有繁木制土、生金消土之法,其临床疗效显著,值得临床推广应用。

霍乱证治考析

霍乱以临床特征得名。历代医家出于“司外揣内”“审证求因”等中医思维习惯,对于表现为“挥霍缭乱”特点的病症,多归为“霍乱”范畴进行论述。文章考察历代中医相关文献,发现霍乱有真霍乱、类霍乱之分,病因病机有寒热之辨、干湿之别以及亡阴损阳之变,论治又有温中散寒燥湿、清热化湿解暑、回阳固脱、理气解郁诸法,不乏化瘀以助回阳、解毒理血辟秽等治疗创见,对于诊治现代临床常见的急性胃肠炎、功能性胃肠病、肠梗阻、糖尿病酮症酸中毒、心肾功能衰竭以及应激性吐泻皆有重要的借鉴意义,学者切莫忽视。

基于“心受气于脾”论治类风湿关节炎累及心脏病变

类风湿关节炎累及心脏病变属于复合病证,根据其发病过程与临床表现,可归属于中医学“脏痹-心痹”。心痹为痹证日久缠绵不愈,复感风、寒、湿邪,向内传入于心所致。该文基于“心受气于脾”理论探讨其病因、病机与治疗。通过梳理古代文献,发现类风湿关节炎累及心脏病变的病因为脾气不足,卫阳不固,外感风、寒、湿邪气侵入机体,瘀血顽痰阻滞发为心痹。其病机为脾气不足,营卫虚弱;脾阳不足,痰浊内生;脾失健运,痰瘀互结。现代研究表明,细胞免疫失调、血脂异常以及血凝与类风湿关节炎合并心脏病变关系密切,这与中医病机一致。在治疗时选用补益卫阳,和营通痹;温阳散寒,化痰逐饮;益气活血,健脾祛痰之法,代表方剂分别为黄芪桂枝五物汤、苓桂术甘汤、赤茯苓汤。该文提出“心受气于脾”理论,为临床治疗类风湿关节炎累及心脏病变提供思路与指导。

急性胰腺炎的急诊救治新进展

急性胰腺炎(acute pancreatitis,AP)是引起急性腹痛的常见病因之一,其病情可分为轻症急性胰腺炎(MAP)、中重度急性胰腺炎(MSAP)及重症急性胰腺炎(SAP),其中SAP的发病率约为25%。SAP病情危重,常合并多脏器功能障碍,病死率高达30%。AP的病因在我国以胆源性、高脂性和酒精性居多,其发病机制主要包括胰蛋白酶原的异常激活、病理性钙离子(Ca 2+)信号、线粒体功能紊乱等。AP的治疗目前以补液、抗炎等内科综合治疗和内镜、穿刺等微创治疗为主。与传统手术治疗相比,近年来出现的如升阶梯治疗策略等新的治疗方法具有显著优势。因此,充分了解AP患者的相关危险因素及发病机制,应用不同方法对患者严重程度进行评估,以采取有效方式进行治疗,能明显改善患者预后。

乳腺增生症的中西医认识及治疗研究进展

乳腺增生症(hyperplasia of mammary gland,HMG)中医病名为乳癖,是一种乳腺组织增生的疾病,其中医基本病机为情志失常,病机以肝内气机郁滞为主,兼有脾肾不足等,由此导致气滞、血瘀、痰凝。气、血、痰、瘀于乳络互结。西医病因病理尚未完全明确。西药目前尚无特异性疗法,中药治疗具有良好效果。文章将对乳癖的中西医病因病机进行论述,并结合临床案例及经验总结中医药治法治则及常用药物,以临床为角度基础,提出治疗乳癖的方法,并为乳癖病因病机的研究与探讨提供新思路。

基于“脾主运化,在体合肌”理论探析T2DM肌少症骨骼肌细胞铁死亡发病机制及辨证论治

2型糖尿病(Type 2 diabetes mellitus,T2DM)伴随的衰老性疾病是目前糖尿病领域研究热点,肌少症现已成为T2DM继微血管和大血管病变之外的第三大类并发症,能够导致骨折、失能、活动障碍等多种不良事件的发生发展。脾属土,居中焦,主运化,在体合肌。脾之健运、精气得布、肌肉充养,方可发挥正常生理功能。近年研究表明,骨骼肌细胞铁死亡在T2DM肌少症发病机制中具有重要作用。基于“脾主运化,在体合肌”理论,从中医学“脾失运化、精气亏虚、湿浊困阻、肌肉失养”病机观及现代医学“骨骼肌细胞铁死亡”病理机制的角度对T2DM肌少症发病机制进行探讨,归纳T2DM肌少症从脾论治的中医防治原则,为丰富脾藏象理论内涵以及中医药防治T2DM肌少症基础研究和临床试验提供理论支撑。