Clinical relevance of Chinese syndrome factors and thromboelastography levels in patients with phlegm-heat and fu-organ excess syndrome

Objective:Syndrome differentiation is a unique part of traditional Chinese medicine(TCM).Syndrome factors play an important role in the diagnosis and treatment of TCM syndromes.Thromboelastography(TEG)intuitively reflects the blood status of patients with acute ischemic stroke(AIS)and is important in the treatment and prognosis of AIS.To identify the relationship between TCM syndrome factors and TEG in AIS patients and standardize TCM syndrome differentiation and treatment objectives,we designed a prospective cohort study of 103 AIS patients.Methods:We used the diagnostic criteria for AIS in the Chinese Guideline for Diagnosis and Management of Acute Ischemic Stroke 2010.Diagnosis of phlegm-heat and fu-organ excess syndrome was based on the TCM Scale for the Syndrome of Phlegm-heat and fu-organ Excess.The ischemic Stroke TCM Syndrome Factor Diagnostic Scale was used to identify and diagnose syndrome factors.General information,scores of syndrome factors and values of TEG parameters of all enrolled patients were recorded.Results:There were significant differences in internal fire and phlegm-dampness scores between patients with and without phlegm-heat and fu-organ excess syndrome(P<.05).In patients with phlegm-heat and fu-organ excess syndrome,internal fire was negatively correlated with TEG parameters R and K(P<.05)and positively correlated with alpha Angle and coagulation index(P<.01).There were no significant correlations between the two syndrome factors and MA(P Z.058)and LY30(P>.05)or between both syndrome factors and TEG parameters in patients without phlegm-heat and fu-organ excess syndrome.Conclusion:The syndrome factor internal fire is a potential predictor of increased platelet function and fibrinogen activity in AIS patients with phlegm-heat and fu-organ excess,and a potentially important predictor of blood hypercoagulability in TCM.

A multicenter randomized, double-blind, placebo-controlled trial to evaluate the safety and efficacy of rhubarb in treating acute exacerbation of chronic obstructive pulmonary disease of the syndrome type phlegm-heat obstructing the lungs

Objective:To observe the clinical efficacy and safety of oral administration of the traditional Chinese herb rhubarb to treat acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Method:This was a multicenter randomized double-blinded placebo controlled study that took place in 7 provinces of China that enrolled 244 patients(aged 18e80 years)who had acute exacerbation of COPD with the traditional Chinese syndrome pattern of phlegm-heat obstructing lung.Participants were divided into experimental and control groups.The experimental group received 4.5 g of rhubarb granules twice daily and the control group received placebo granules.Both groups also received conventional Western therapy consisting of oxygen therapy,an antibiotic,expectorant,and a bronchodilator.Treatment lasted 10 days.Symptom scores for cough,sputum volume and color,wheezing and chest tightness before treatment and on days 3,5,7,and 10 during the treatment were recorded.Lung function,arterial blood gas and levels of serum inflammatory factors,interleukin-4(IL-4),interleukin-8(IL-8),and interleukin-10(IL-10)and tumor necrosis factor-alpha(TNF-a),before and after treatment were measured.Results:The sample size of the full analysis set(FAS)was 244 participants,and the sample size of per protocol set(PPS)was 235.Following 10 days’treatment,symptom scores of the experimental group were markedly lower than those of the placebo group(FAS:mean difference
1.67,95%CI:e2.66 to
0.69,P Z 0.001;PPS:mean difference
1.55,95%CI:
2.56 to
0.54,P Z 0.003).Lung function in the experimental group was significantly higher than in the placebo group(FEV1,FAS:mean difference 0.12,95%CI:0.06 to 0.18;P<0.001;PPS:mean difference 0.12,95%CI 0.05 to 0.18;P<0.001.FVC:FAS:mean difference 0.16,95%CI:0.06 to 0.26;P Z 0.002;PPS:mean difference 0.16,95%CI 0.05 to 0.26;P Z 0.003.FEV1%,FAS:mean difference 5.95,95%CI:3.36 to 8.53;P<0.001;PPS:mean difference 5.92,95%CI 3.28 to 8.56;P<0.001.).PaO2,PaCO2,as well as serum inflammatory factors were also improved when compared to the placebo group.There were no significant differences in the incidence rate of adverse reaction between the two groups.Conclusions:Compared with placebo,rhubarb granules significantly reduced symptom scores,improved blood oxygen level,controlled systemic inflammatory response,without significant adverse effects.Thus,rhubarb may be a beneficial adjuvant method for treating the phlegm-heat obstructing the lung syndrome pattern of AECOPD.

Medication rules in treating phlegm-heat syndrome of acute ischemic stroke based on data mining

Objective:To analyze the medication rule of Traditional Chinese Medicine(TMC)in treating acute ischemic stroke(AIS)with phlegm-heat syndrome based on date mining.Methods:All clinical studies of TMC treatment for phlegm heatexcess pattern stroke at acute stage were searched from SinoMed,CNKI,VIP,Wanfang,Pubmed.The retrieval time was from the establishment of each database to 27 April 2020.Establish database through"Ancient and Modern Medical record Cloud platform(V2.2.3)"software.SPSS20.0 and SPSS Modeler 18.0 software was used to explore clustering analysis and drug association rule analysis of high frequency drugs.Results:60 articles were finally included and 59 prescriptions were collected.The result shows that the commonly used drugs are mostly warm and cold,and the taste is mainly sweet and bitter.The main distribution of meridian tropism is stomach,liver and spleen.In these prescriptions,the frequently used drug pairs were“Trichosanthis fructus”,“Rhei radix et rhizoma”and so on.The association analysis results showed that“Arisaema cum bile-Rhei radix et rhizoma”had the highest correlation.The clustering analysis figured out 2 groups of the herbs.Conlusion:The TCM treatment of AIS should be based on the drugs of clearing heat,resolving phlegm and dredging viscera.Because most of these drugs are bitter and cold,we should pay attention to taking care of the spleen and stomach while expelling evil.

Fahr’s Syndrome Discovered at Adulthood Revealing the Pseudohypoparathyroidism

Fahr’s syndrome is a rare clinicopathological entity, defined by the presence of intracerebral calcifications not arteriosclerotic, bilateral and symmetric at the level of the basal ganglia, whose main etiology is dysparathyroidism, rarely pseudohypoparathyroidism. Hypocalcemia and hyperphosphatemia despite normal or high levels of parathyroid hormone are the result of resistance to the action of parathyroid hormone. The clinical profile is not specific but dominated by neuropsychiatric symptoms. We report the case of a 30-year-old patient with type pseudohypoparathyroidism revealed one year ago by Fahr’s syndrom. The diagnosis made by convulsion history since the age of 5 years resistant to treatment, the disturbance of metabolism disorders, and the presence of intracerebral calcifications. The vitamin D and calcium supplementation have contributed to the stabilization of the disease.

从痉证论治阵发性交感神经过度兴奋综合征

阵发性交感神经过度兴奋综合征(PSH)是一种与中重度脑损伤相关的临床综合征,以同时发生的肌张力障碍及交感神经功能亢进为临床表现。目前针对PSH的临床治疗侧重于西医对症处理,中医整体观念与辨证论治思维可以兼顾多证,能够对西医治疗进行有效补充。通过临床观察发现,在西药对症治疗基础上联合中药及针灸等中医疗法有助于提高疗效,减少不良反应,同时缩短病程。但由于从发现到逐步认识PSH的时间较短,因此对其病位、病因、病机、分型及中医治疗尚无系统认识。PSH发作时的肌张力障碍表现为四肢肌张力高、角弓反张等,发作表现符合中医痉证范畴,故文章试从痉证论述PSH的中医辨治,以期为PSH的中医治疗提供理论基础。

基于体质学说探讨阳明急下三证

《伤寒论》第252条、第253条、第254条所论病证被称为阳明急下三证,三证病因均为阳明热实,但相同的病因所致症状及转归不同,与患者体质密切相关。原文第252条突出了“目中不了了,睛不和”症状,为患者平素肝肾阴虚,是阴虚体质,热病后津液更伤,损及肝阴,全身筋脉失养,易导致痉病,治疗可在大承气汤基础上加栝楼桂枝汤。原文第253条主要突出了汗多之症,为患者平素易自汗,是气虚体质,热病后气津两伤,虚热内生,中气不足,易转归为劳复病,治疗应先下后清补,清补用竹叶石膏汤。原文第254条主要突出了腹满痛症状,为患者平素气机不畅,是气郁体质,热病后邪热进一步阻滞气机,加重气滞程度,易转变为热厥,可用大柴胡汤下之。

运脾颗粒联合推拿手法治疗小儿慢惊风的效果研究

目的探讨对小儿慢惊风患儿采取运脾颗粒+推拿手法治疗后获得的临床效果。方法选取2020年2月—2022年5月临沂市中医医院收治的56例小儿慢惊风患儿为研究对象,依据随机数表法分为两组,其中参照组(28例)采用运脾颗粒治疗,研究组(28例)在参照组的基础上联合推拿手法治疗。对比两组治疗总有效率、血清因子水平[谷氨酸(Glutamate,Glu)、γ-氨基丁酸(γ-aminobutyric Acid,GABA)、脑源性神经营养因子(Brain-derived Neurotrophic Factor,BDNF)]、中医证候积分。结果研究组患儿治疗总有效率(96.43%)高于参照组(71.43%),差异有统计学意义(χ^(2)=6.487,P<0.05)。治疗后,研究组患儿GLU、GABA、BDNF水平均优于参照组,差异有统计学意义(P均<0.05)。治疗前,两组患儿中医证候积分对比,差异无统计学意义(P>0.05);治疗后,研究组患儿中医证候积分低于参照组,差异有统计学意义(P<0.05)。结论临床对小儿慢惊风患儿采用运脾颗粒+推拿手法治疗效果显著,可改善血清因子水平,降低中医证候积分,促进小儿慢惊风患儿的良好预后。

刘茂才治疗登革热后继发痉证的经验

介绍全国名中医刘茂才教授诊治登革热后继发痉证的经验。刘茂才教授认为,登革热患者出现高热、腹泻等症状,经治疗后热退,但逐渐出现了项背强直、四肢抽搐、口噤、角弓反张等痉证表现,此时气阴两虚兼有痰湿、瘀血等留滞络脉,已成虚实夹杂之证,其病机之根本为阴虚风动;治疗以滋水涵木、养阴熄风为原则,在养阴熄风的基础上随证加减、灵活处方,同时不忘泻下通腑。养阴熄风临证用药可选钩藤、羚羊角、白芍、玄参、生地黄、麦冬、沙参、山茱萸肉等,通腑可用承气汤类方。

Evaluation by Survival Analysis on Effect of Traditional Chinese Medicine in Treating Children with Respiratory Syncytial Viral Pneumonia of Phlegm-Heat Blocking Fei Syndrome

Objective:To objectively evaluate the clinical effect of traditional Chinese medicine in treating children s respiratory syncytial viral pneumonia(RSVP) of phlegm-heat blocking Fei(肺) syndrome(PHBFS). Methods:A single-blinded multi-center,blocked,randomized and parallel-controlled method was adopted.The clinical study was carried out on 206 children with RSVP-PHBFS who were assigned to two groups,108 in the test group treated through intravenous dripping of Qingkailing Injection(清开灵注射液) in combination of or...

The Use of Repeated Measures Analysis of Variance to Study the Effect of Phlegm-Heat Syndrome on Neurological Deficits in Patients with Stroke~

Objective： To explore the effect of phlegm-heat syndrome on the degree of neurological deficit and provide some data support for the correct recognition of the relationship between phlegm-heat syndrome and neurological deficits in stroke patients. Methods： Clinical information were collected on 294 patients with acute ischemic stroke （AIS） whose syndrome and National Institute of Health stroke scale （NIHSS） score were checked at baseline （within the first 3-day admission） and at 7, 14, 28, and 90 days after admission to our clinical research centre. We explored the effect of phlegm-heat syndrome on the degree of neurological deficit following stroke by applying a repeated measures analysis of variance. Results： Stroke patients with phlegm-heat syndrome had higher NIHSS score than patients without the syndrome （P〈0.01）, and there appeared to be a decrease in NIHSS score over time in all patients （P〈0.01）. Conduslons： Phlegm-heat syndrome in patients who have suffered stroke has an effect on the degree of neurological deficiency. Disappearance of phlegm-heat syndrome may improve the degree of neurological deficit observed in stroke patients.

止动颗粒治疗痰热内扰型儿童多发性抽动症临床观察

目的探讨止动颗粒治疗痰热内扰型儿童多发性抽动症的临床疗效。方法选取2021年6月—2022年6月驻马店市中医院儿童保健科接诊的60例痰热内扰型多发性抽动症患儿,按照随机数字表法分为对照组和治疗组,每组30例。对照组患儿口服盐酸硫必利片,治疗组患儿口服自拟方止动颗粒,比较2组临床疗效及耶鲁综合抽动严重程度量表(YGTSS)评分、中医证候积分及随访复发率等情况。结果2组患儿治疗后YGTSS各评分和中医证候各积分较治疗前明显降低(P<0.01),且治疗组治疗后评分改善程度优于对照组,差异有统计学意义(P<0.01)。治疗组的复发率低于对照组,差异有统计学意义(P<0.01)。结论自拟方止动颗粒治疗痰热内扰型多发性抽动症儿童具有明显的临床疗效,复发率低,值得临床借鉴应用。

高热惊厥合并抗利尿激素异常分泌综合征的研究

【目的】 探讨高热惊厥 (FC)是否会合并抗利尿激素异常分泌综合征 (SIADH) ,FC在 1次病程中再发惊厥是否与合并SIADH有关。 【方法】 测定 74例FC患儿 (其中在病程中无再发惊厥者 46例 ,有再发惊厥者 2 8例 )及 60例有发热但无惊厥的单纯上呼吸道感染者的血钠、尿钠、血和尿渗透压。 【结果】 在 74例FC患儿中检出合并SIADH者 18例 ,单纯上感组中未检出合并SIADH者。合并SIADH的FC患儿 66.67%发生再次惊厥 (12 /18) ,未合并SIADH的FC患儿发生再次惊厥者仅为 2 8.5 7% (16/5 6)。差异有非常显著性 (χ2 =8.40 46,P <0 .0 1)。 【结论】 高热惊厥可以合并SIADH ,合并SIADH的高热惊厥患儿在病程中发生再次惊厥的危险性高于未合并SIADH者。

癫癎持续状态致MODS的发生率及其相关因素分析

目的探讨全身性惊厥性癫癎持续状态(GCSE)致多器官功能障碍综合征(MODS)的发生率及其相关因素。方法回顾分析126例GCSE患者临床资料和辅助检查资料。结果126例GCSE患者中,年龄2～69岁,癫癎病程6个月～30年。GCSE发作后30min～6.5h入院。符合GCSE继发MODS诊断者31例,占24.60%,通过逐步回归分析筛选出影响GCSE继发MODS发生的独立因素是GCSE持续时间、病因、治疗时机、发热和年龄。结论GCSE继发MODS与GCSE持续时间长短、隐源性发作、治疗时间早晚、持续发热和高龄有关。

论柯琴“痉之属燥”说

柯琴因《内经》“病机十九条”“燥症独无”而强调燥邪致病 ,并针对《伤寒论》中“痉病”提出“痉之属燥”的理论 ,其理论具有特殊意义 ,突出了内伤燥邪致痉 ,蕴含了保阴存津思想 ,在病因学。

胡天成驱虫药治疗抽动症

胡天成认为抽动症病位多在肝,与心、脾、肺、肾有关,涉及风、热、痰、湿、虚等,肝风与此病关系密切;实证多属湿热内蕴、痰热内蕴、脏腑积热等;虚证多属气虚、血虚、脾胃虚弱等。无论虚实,均可导致五脏功能失司,邪气壅滞,影响肝木疏泄,肝风内动。胡天成教授治疗善用槟榔、鹤虱、雷丸、榧子、芜荑等驱虫药,祛除五脏六腑壅滞之邪。附验案2则。

刘卓“文静汤”治疗小儿多发性抽动症

刘卓教授认为小儿多发性抽动症可归属"慢惊风""抽搐"等范畴,与"肝风""痰火"关系密切;脾常不足,脾主运化水湿,开窍于口,饮食伤脾,或久病体虚,脾失健运,痰浊内生,痰阻心窍,心神被蒙,则脾气乖戾,喉发异声。肝风夹痰走窜于经络,因此出现抽动的症状。运用文静汤加减与饮食情志治疗,疗效显著,值得推广。

佘继林教授中医治疗小儿多发性抽动症经验撷萃

简要从病因病机、理法方药等方面介绍佘继林教授治疗小儿多发性抽动症经验。本病病机为本虚标实,发作期多表现为实证,治以平肝熄风、清心泻火、滋阴清热,缓解期多表现为虚证为主,治以健脾养血、滋阴潜阳、柔肝熄风、滋补肝肾为主,在药物治疗的同时,佘教授还注重心理行为干预治疗。同时佘教授认为本病患儿多与过敏有关,每与季节交替时发作次数增加,感冒后加重,在治疗中经常加用祛风抗过敏的药物,五脏辨治的同时注重从肺调治,增强体质,改善患儿过敏状态。

小儿惊泻论治

对小儿惊泻的临床特征、病因病机、辨证分型及治疗作了简要的阐述,认为“肝常有余,脾常不足”,既是小儿的生理特点,亦是小儿惊泻的病理基础。恰遇惊恐是惊泻的诱因,亦是必然的致病条件。脾虚肝旺为惊泻的主要病机,治疗以扶土和疏木为原则,但需分清肝旺为主受惊,横逆犯脾致泄者与以脾弱受惊,肝木乘脾致泄者之不同而有所侧重。疏肝以柔,扶脾以运,药质宜轻、药味宜薄,药汁清淡,易于入口,轻灵之品既能鼓舞脾胃之气,又可调整脾胃功能。

清肝息风汤辅助治疗多发性抽动症临床研究

目的研究自拟清肝息风汤辅助治疗多发性抽动症的疗效。方法将100例符合标准的多发性抽动症患者随机分为治疗组和对照组各50例(实际完成研究治疗组47例,对照组46例),2组均给予盐酸硫必利片口服,治疗组在西药治疗的基础上合用自拟清肝息风汤口服,疗程为3个月,观察治疗前后中医证候疗效、临床疗效耶鲁抽动症整体严重度量表(YGTSS)评分,并观察不良反应量表(TESS)总分。结果治疗后,治疗组中医证候疗效、YGTSS评分改善明显优于对照组(P<0.05),TESS总分明显低于对照组(P<0.05)。结论自拟清肝息风汤治疗多发性抽动症,具有较好的疗效,安全性高。

淡漠型甲状腺功能亢进症中医症因考辨

中医无淡漠型甲亢之病名,但根据其临床所表现的明显消瘦、心悸、乏力、神经质或神情淡漠、嗜睡、厌食、呕吐、腹泻、头晕、昏厥等主要症状和肢体震颤等体征,多归属于我国古医籍所载的"瘿劳"、"瘿病"、"虚劳"、"羸瘦"、"心悸"、"怔忡"、"郁证"、"多寐"、"呕吐"、"泄泻"、"痉证"、"痿证"、"眩晕"、"厥证"等范畴。虽然淡漠型甲亢的临床表现涉及中医众多病证,但从其疾病的整体发病情况来看,辨证总不离于脾肾两虚、阳气亏耗之证。