Analysis on the traditional Chinese medicine syndromes and Six-Meridian Pattern Identification of coronavirus disease 2019

Zhongjing Zhang’s Shang Han Lun(Treatise on Cold-induced Diseases,an ancient Chinese medical book written by Zhongjing Zhang in the Eastern Han Dynasty)was pioneering to conduct the Six-Meridian Pattern Identification,which provided later generations with a theoretical basis for the treatment of Exogenous Febrile Diseases.The coronavirus disease 2019 belongs to the category of“Pestilence”(the general term for virulent infectious epidemic diseases)in“Febrile Diseases”(the general term for acute externally contracted diseases caused by Warm Pathogens,with fever as the chief manifestation,also known as Warm Diseases)and the treatment of coronavirus disease 2019 is mostly based on the Triple Energizer Pattern Identification(the a categorization of Pattern Identification according to the theory of the Triple Energizer)or Defense,Qi,Nutrient and Blood Pattern Identification(the categorization of Febrile Diseases Pattern Identification according to the theory of Defense,Qi,Nutrient and Blood which indicates the stages of the clinical course with corresponding pathological changes).Although the theory of Cold-induced Diseases(the condition caused by Cold,manifested as chills and fever,absence of sweating,headache and floating-tense pulse)and the theory of Febrile Disease seem to be entirely distinct with each other,Zhongjing Zhang’s theory contained Triple Energizer Pattern Identification or Defense,Qi,Nutrient and Blood Pattern Identification,and Triple Energizer Pattern Identification or Defense Qi,Nutrient and Blood Pattern Identification also contained Zhongjing Zhang’s Six-Meridian Pattern Identification(the categorization of Pattern Identification according to the theory of the Six Meridians,applied to the diagnosis of acute Febrile Diseases at different stages,and also useful for the Pattern Identification of other diseases).The basic principles and therapeutic methods of Cold-induced Diseases and Febrile Diseases are intertwined.Therefore,this paper will combine the two theories to analyze the traditional Chinese medicine syndromes of coronavirus disease 2019,and try to use Six-Meridian Pattern Identification to guide the treatment of this disease.

孙克伟教授辨证论治肝病的经验探析

孙克伟教授在长期临床诊治中总结发现,多种肝病殊途同归,提出“补脾土,疏肝解郁”“逐湿邪,热无所依”“补先天,解毒袪邪”“调气血,瘀滞得化”“温脾阳,截断逆挽”的学术经验,临床应用效果显著。该文将从以上五法探析孙克伟教授辨证论治肝病经验,旨在为肝病中医诊疗提供参考和借鉴。

基于数据挖掘探究中医内治法治疗掌跖脓疱病处方用药规律

[目的]基于数据挖掘方法分析中医内治掌跖脓疱病的处方用药规律。[方法]检索中国知识基础设施工程数据库(China National Knowledge Infrastructure,CNKI)、万方数据知识服务平台数据库(Wanfang Data Knowledge Service Platform)、中文科技期刊数据库(China Science and Technology Journal Database)、中国生物医学文献数据库(China Biology Medicine disc,CBMdisc)自建库至2023年6月关于掌跖脓疱病的中医治疗文献,筛选符合纳入标准的处方,进行标准化处理,采取药物功效归类、频次分析、性味归经分析,以及关联规则分析、熵聚类分析的方法进行数据挖掘,分析用药规律。[结果]掌跖脓疱病的中医内治多选用清热解毒、清热凉血、清热燥湿类药物;最高频出现的中药为土茯苓、生地黄、甘草;性味归经以味苦、性寒,归肝胃二经为主;用药模式关联规则分析中,频次较高的前三位为“生地黄-牡丹皮”“土茯苓-甘草”“金银花-连翘”;组合模式规则分析中,“牡丹皮→生地黄”“连翘→金银花”“白鲜皮→土茯苓”置信度较高;基于熵聚类方剂组方规律分析获得28个潜在核心组合及14个新方。[结论]中医内治掌跖脓疱病常以清热祛湿为立法核心,选苦寒之药,归经以肝胃二经为主。处方中土茯苓、生地黄的运用,关联配伍中生地黄与牡丹皮、土茯苓与白鲜皮、金银花与连翘的使用极具临床及科研价值。挖掘数据中潜在的、隐性的药物组方规律,可推导出祛湿热兼凉血解毒的核心组合,为中医内治掌跖脓疱病的临床研究与遣方用药提供参考。

中药治疗胃食管反流病的研究进展

胃食管反流病是消化内科的常见病,目前西医治疗主要以抑酸为主,但对于气体反流、非酸反流、内脏高敏感患者的疗效欠佳,抑酸不能调节反流本身,并可能因其强力抑酸作用造成不良反应。因此,阻止反流、调整和改善胃肠动力、降低内脏敏感性才是治本之策。中药在胃食管反流病的治疗中具有明显优势,中医重视整体辨治,通过多成分、多靶点干预,可显著改善患者食管动力、控制气体和非酸反流、降低内脏敏感性、调节不良情绪、减少不良反应及复发率。本文从临床上常见的胃食管反流病的辨证分型入手,对近年来中药治疗胃食管反流病的研究概况加以综述。

Effect of Chinese Medicine Treatment Based on Pattern Identification on Cellular Immunophenotype of Myelodysplastic Syndrome

Objective： To observe the influence of treatment based on Chinese medicine pattem identification on cellular immunophenotype of the myelodysplastic syndrome （MDS）. Methods： Sixty patients with MDS were randomly and equally assigned to the treatment group and the control group using a randomized digital table. Thirty patients in each group included 3 risk levels （low, moderate and high risks） with each level 10 patients according to the international prognostic scoring system. The control group was given conventional therapy which was also used in the treatment group. While the treatment group was given Zuogui Pill （左归丸） and Yougui Pill （右归丸） for low risk patients; Qingwen Baidu Decoction （清瘟败毒饮） and Bazhen Decoction （八珍汤） for moderate risk patients; Gexia Zhuyu Decoction （膈下逐瘀汤） and Qinghao Biejia Decoction （青蒿鳖甲汤） combined with Shiquan Dabu Decoction （十全大补汤 ） for high risk patients. After the treatment, the differences of overatl response rate and immunophenotype （CD13, CD14, CD15, CD33 and CD34） of each group were analyzed. Results： The overall response rate of the treatment group was significantly higher than the control group in low risk and moderate risk patients （P=0.029）, there was no statistical differences of overall response rate between the treatment group and the control group in high risk patients （P=0.089）. The expressions of CD13, CD14, CD33 and CD34 in all three risk levels of the treatment group were obviously decreased after the treatment, while CD15 in all three risk levels of the treatment group was obviously increased after the treatment （P〈0.05 or P〈0.01）. Meanwhile, the difference values of CD13 and CD33 in low risk level of the treatment group, CD33 and CD34 in moderate risk level of the treatment group as well as CD34 and CD15 in high risk level of the treatment group, were all greater than the control groups and they were statistically significant （P〈0.05 or P〈0.01）. Conclusions： It shows a better therapeutic effect if the MDS patients treated with Chinese medicine pattern identification in addition to conventional therapy. Since the treatment may inhibit the malignant clones and improve the dysmaturity of granulocyte differentiation, it is a feasible option in clinical practice.

Incorporating Pattern Identification of Chinese Medicine into Precision Medicine:An Integrative Model for Individualized Medicine

On 20 January, 2015, U.S. President Obama announced an ambitious plan called ＂Precision Medicine （PM） Initiative＂, aiming to deliver genetics- based medical treatments. PM has shown a promising prospect by tailoring disease treatments and preventions to individuals. However, a predominantly genetics-based method restricts its benefit and applicability in most chronic and complex diseases. Pattern identification （PI） is one of the representative characteristics of Chinese medicine implying the concept of holism and individualized treatment. It is another classification method taking environmental, psychosocial and other individual factors into account. Integrating PI with disease diagnosis of Western medicine will provide a strong complement to genetics-based PM, thus establish an integrative model for individualized medicine. PI provides new perspectives for PM, not only in clinical practice, but also in new drug development and clinical trial design. It is for sure that the integrative approach will ultimately lead to a safer, more convenient and effective patient-centered healthcare and most patients will benefit in the era of PM.

Current Research and Future Directions in Pattern Identification： Results of an International Symposium

A symposium on pattern identification（PI）was held at the Korea Institute of Oriental Medicine（KIOM）on October 2,2013,in Daejeon,South Korea.This symposium was convened to provide information on the current research in PI as well as suggest future research directions.The participants discussed the nature of PI,possible research questions,strategies and future international collaborations in pattern research.With eight presentations and an extensive panel discussion,the symposium allowed participants to discuss research methods in traditional medicine for PI.One speaker presented the topic,＇Clinical pattern differentiation and contemporary research in PI.＇Two speakers presented current trends in research on blood stasis while the remaining five other delegates discussed the research methods and future directions of PI research.The participants engaged in in-depth discussions regarding the nature of PI,potential research questions,strategies and future international collaborations in pattern research.

The 7th Pong Ding Yuen International Symposium on Traditional Chinese Medicine cum the 10th Anniversary of the Full-time Bachelor of Chinese Medicine Programme Was Successfully Organized by the School of Chinese Medicine,the University of Hong Kong

The School of Chinese Medicine, the University of Hong Kong has organized the 7th Pong Ding Yuen International Symposium on Traditional Chinese Medicine cum the 10th Anniversary of the Full-time Bachelor of Chinese Medicine Programme on 1 December, 2012, and 2 December, 2012, in Li Ka Shing Faculty of Medicine, the University of Hong Kong.

甘麦百黄汤治疗气阴两虚型2型糖尿病伴失眠的疗效及对血清5-羟色胺、白细胞介素1β水平的影响

目的 观察甘麦百黄汤治疗气阴两虚型2型糖尿病伴失眠的疗效及对血清5-羟色胺(5-HT)、白细胞介素1β(IL-1β)水平的影响。方法 将116例气阴两虚型2型糖尿病伴失眠患者按照随机数字表法分为2组,对照组58例予盐酸二甲双胍片治疗,治疗组58例在对照组治疗基础上加服甘麦百黄汤。2组均1周为1个疗程,治疗4个疗程。比较2组临床疗效;比较2组治疗前后血糖空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)和空腹胰岛素(FINS)水平变化;比较2组治疗前后睡眠指标实际睡眠总时间、睡眠潜伏期、快速动眼(REM)潜伏期、夜间觉醒次数和觉醒总时间变化;比较2组治疗前后5-HT、IL-1β水平变化;比较2组治疗前后中医证候评分变化。结果 治疗组总有效率91.38%(53/58),对照组总有效率77.59%(45/58),治疗组临床疗效优于对照组(P<0.05)。2组治疗后FPG、2 hPG、HbA1c和FINS水平均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后实际睡眠总时间、快速动眼(REM)潜伏期均较本组治疗前升高(P<0.05),睡眠潜伏期、夜间觉醒次数和觉醒总时间均较本组治疗前降低(P<0.05);治疗后治疗组实际睡眠总时间、REM潜伏期均高于对照组(P<0.05),且睡眠潜伏期、夜间觉醒次数和觉醒总时间均低于对照组(P<0.05)。2组治疗后5-HT水平均较本组治疗前升高(P<0.05),IL-1β水平均较本组治疗前降低(P<0.05);治疗后治疗组5-HT水平高于对照组(P<0.05),IL-1β水平低于对照组(P<0.05)。2组治疗后中医证候各项评分均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。结论 甘麦百黄汤治疗气阴两虚型2型糖尿病伴失眠效果肯定,可调节患者血清5-HT、IL-1β水平,降低血糖,改善临床症状。

Standardization and Future Directions in Pattern Identification Research: International Brainstorming Session

An international brainstorming session on standardizing pattern identification（PI） was held at the Korea Institute of Oriental Medicine on October 1, 2013 in Daejeon, South Korea. This brainstorming session was convened to gather insights from international traditional East Asian medicine specialists regarding PI standardization. With eight presentations and discussion sessions, the meeting allowed participants to discuss research methods and diagnostic systems used in traditional medicine for PI. One speaker presented a talk titled ＂The diagnostic criteria for blood stasis syndrome： implications for standardization of PI＂. Four speakers presented on future strategies and objective measurement tools that could be used in PI research. Later, participants shared information and methodology for accurate diagnosis and PI. They also discussed the necessity for standardizing PI and methods for international collaborations in pattern research.

应用太赫兹光谱技术快速无损鉴别中草药品种

确定中药品种是确保中药材质量的第一关。为探索中草药品种的快速鉴别方法,本文应用太赫兹光谱技术结合模式识别方法对6种中草药进行分类鉴别。采集了白附片、大黄、党参、陈皮、麦冬、天麻等6种常用中草药,共得到420组太赫兹光谱数据,在0.2~1.5 THz波段分别采用支持向量机(SVM)、主成分分析(PCA)和支持向量机相结合、线性判别分析(LDA)结合支持向量机等方法对6种中药材进行了定性鉴别分析。结果表明,太赫兹光谱数据结合线性判别分析和支持向量机建立的LDA-SVM中草药品种识别模型最优,模型准确率达100%,对未知样本的鉴别准确率达98.41%。本文的LDA-SVM模型具有较好的鉴别能力,能快速准确地鉴别出中药材的品种,为中草药的质量控制提供了又一鉴别手段。

基于“态靶辨证”的腰椎间盘突出症诊疗策略

基于仝小林院士“态靶辨证”理论,结合熊辉教授多年临床诊治与科研经验,以腰椎间盘突出症(lumbar disc herniation,LDH)为例,整合中西医学,构建LDH“态靶辨证”诊疗策略。LDH“调态”方面,抓住核心病机,认为该病“偏态”可参考“慢病十态”理论,将湿态与寒态、热态分别合并,LDH辨态分为“寒湿态、湿热态、郁态、瘀态、壅态、老态、虚态、燥态、瘠态”9态,推荐调态经验方药。“打靶”方面,基于现代医学对LDH发病机制的认识,提出LDH的病靶为“腰椎间盘退变”、症靶为“腰腿痛”、标靶为“炎症因子升高”。通过对LDH态靶医学的系统梳理,构建LDH的“态靶辨证”诊疗策略体系,以期为临床诊治LDH提供参考,推广并传播“态靶医学”。

清肺化痰活血方经皮穴位透入治疗老年非重症肺炎痰热壅肺型临床研究

目的观察清肺化痰活血方经皮穴位透入治疗老年非重症肺炎痰热壅肺型的临床疗效。方法将120例老年非重症肺炎痰热壅肺型患者按照随机数字表法分为2组,对照组60例予西医常规治疗,治疗组60例在对照组治疗基础上加清肺化痰活血方经皮穴位透入治疗,2组均治疗10天。比较2组疗效;比较2组治疗前后降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)变化;比较2组治疗前后中医证候积分(TCMSSS)、临床肺部感染评分(CPIS)、肺炎严重程度指数(PSI)评分变化。结果治疗组总有效率93.3%(56/60),对照组总有效率80.0%(48/60),治疗组疗效优于对照组(P<0.05)。2组治疗后PCT、CRP、WBC均较本组治疗前降低(P<0.05),治疗后治疗组PCT、CRP、WBC均低于对照组(P<0.05)。2组治疗后TCMSSS、CPIS、PSI评分均较本组治疗前降低(P<0.05),治疗后治疗组TCMSSS、CPIS、PSI评分均低于对照组(P<0.05)。结论清肺化痰活血方经皮穴位透入治疗老年非重症肺炎痰热壅肺型,可减轻患者症状,减轻炎性反应,提高临床疗效。

An Innovative Method to Accommodate Chinese Medicine Pattern Diagnosis within the Framework of Evidence-Based Medical Research

Pattern diagnosis is an integral aspect of Chinese medicine （CM）. CM differentiates biomedical diseases into patterns, based upon the patient＇s symptoms and signs. Pattern identification （PI） is used to diagnose, direct the treatment principle and determine the treatment protocol. Most CM research has used fixed formula treatments for Western-defined diseases with outcomes measured using objective biomedical markers. This article presents an innovative method used in a randomised controlled pilot study using acupuncture for participants with hepatitis C virus. Each participant＇s CM patterns were identified and quantified at baseline which directed the treatment protocol for the treatment group. Data identified that while each participant expressed different patterns at baseline all participants displayed multiple patterns. Six patterns showed some expression by all 16 participants; Liver （Gan） yin vacuity expressing a group aggregate mean percentage of 47.2, binding depression of Liver qi 46.9, and Liver Kidney （Shen） yin vacuity 45.1. Further sub category gender grouping revealed that pattern ranking changed with gender; Liver yin vacuity （male 53.4%, female 51.93%）, binding depression of Liver qi （male 50.0%, female 42.86%） and Liver Kidney yin vacuity （male 42.9%, female 47.96%）. The quantification of CM patterns described in this article permitted statistical evaluation of presenting CM patterns. Although this methodology is in its infancy it may have potential use in the integration of PI with rigorous evidence based clinical research. Biomedical markers often do not relate to symptom/signs and therefore this innovative measure may offer an additional CM evaluation methodology and further CM PI understanding.

Inter-observer Reliability of Indicators and Decision of Pattern Identification Using Diagnostic Flowchart with Traditional Korean Medicine

Objective： To evaluate the consistency of patterns and pattern identification（PI）, and the improvement in the diagnosis of blood stasis after the standard operating procedures（SOPs） were enhanced by using a diagnostic flowchart. Methods： A total of 358 subjects who were admitted by the Jaseng Hospital of Korean Medicine between June 2013 and December 2014 were included in the study. Each patient was independently diagnosed by two experts from the same department. In 2014, the SOPs included the use of a diagnostic flowchart for each indicator. Inter-observer consistency was assessed by simple percent agreement and by the kappa and AC1 statistics. Results： The improvements in inter-observer agreement for the indicators（for al patients） and PI were greater in 2014 than in 2013. In 2013, the j-value measure of agreement between the two experts ranged from ＂poor＂（κ=–0.051） to ＂good＂（κ=0.968）. The AC1 measure of agreement between the experts was generally high for the indicators and ranged from –0.010 to 0.978. In most cases, agreement was considerably lower when it was assessed by the j-values compared with the AC1 values. In 2014, the j-value measure of agreement on the indicators（for the subjects） general y ranged from poor to good, with the values ranging from –0.007 to 0.994. Moreover, the AC1 measure of agreement between the experts was general y high for al of the indicators and ranged from ＂moderate＂（AC1=0.408） to ＂excel ent＂（AC1=0.996）. Conclusions： In four examinations, there was moderate agreement between the clinicians on the PI indicators of blood stasis. To improve clinician consistency（e.g., in the diagnostic criteria used）, it is necessary to analyse the reasons for inconsistency and to improve clinician training.（Trial registration No. KCT0000916）

近红外光谱技术用于白芷类中药的鉴定研究

探讨将近红外光谱技术应用于白芷类中药中的鉴定研究,利用近红外光谱提供的内在成分信息,结合模式识别技术,对白芷类中药进行了鉴定。结果表明,本方法具有简便、快捷、重现性好等优点。

石韦的X射线衍射Fourier指纹图谱鉴定研究

目的 建立中药材石韦的新鉴定分析方法。方法 采用粉末 X射线衍射 Fourier指纹图谱鉴定法。结果 通过对 3个石韦对照品和 17个石韦中药材进行实验、计算分析 ,获得了石韦的标准 X射线衍射 Fourier指纹图谱及特征标记峰值。结论 表明 X射线衍射 Fourier指纹图谱鉴定法可用于中药材石韦的鉴定。

中药材白芍的X射线衍射Fourier谱鉴定

目的 建立中药材白芍的新鉴定分析方法。方法 采用粉末 X射线衍射 Fourier谱鉴定法。结果 通过对1个白芍对照品、1个白芍标本和 3个白芍中药材进行实验、分析 ,获得了白芍的标准 X射线衍射 Fourier图谱及特征标记峰值。结论 X射线衍射

中药组效关系辨识方法学与计算理论研究思路与策略

对中药化学组成和药效作用机制进行系统辨析 ,阐明中药复杂组效关系是中药学科领域的重大难题。开展中药复杂组效关系辨识方法学和计算理论研究 ,对于中医药基础理论创新发展及现代中药创制具有重大科学意义和学术价值。在获取中药化学分析数据和药效检测数据基础上 ,使用药物信息学方法 ,寻找发现关键药效组分 ,并通过多组分药效预测模型对药效组分配伍进行优化设计 。

基于电子鼻的中药材鉴别新方法研究

目的:运用德国Airsense公司制造的便携式电子鼻PEN3提取中药材挥发的气味信息来建立气味指纹图谱,以实现岭南道地药材的鉴别。方法:选取传感器稳定后的合适实验数据,分别应用主成分分析(PCA)和线性判别分析(LDA)这两类模式分析方法识别苍术、佛手、高良姜、广陈皮、广木香、化橘红、香薷、徐长卿、阳春砂等9种岭南道地药材。结果:数据实验表明,采用LDA分析法的识别率达到100%。而采用PCA分析法时,图中每类样品主要呈带状分布,其集中度远不如LDA分析法,且香薷和阳春砂出现部分样本点交叉分布的现象。结论:采用电子鼻系统PEN3及LDA分析方法能够很好地鉴别不同品种的中药材,具有一定的实际意义和应用价值。