Polycystic Ovary Syndrome-Related Infertility Based on the Theory of“Liver and Kidney Homology”

Polycystic ovary syndrome(PCOS)is an endocrine disorder caused by hypothalamic-pituitary-ovarian(HPO)axis dysfunction.In the field of gynecology and reproduction,PCOS has emerged as both a research hot spot and a challenging area of study.According to Chinese medicine,this disease is related to kidney deficiency,phlegm and dampness obstruction,blood stasis and interconnection,Chong pulse impassability,the lack of Ren pulse,and the loss of uterine nourishment,all of which affect the normal development and maturation of eggs as well as the duration at which menstrual blood stores.In this paper,based on the theoretical basis of“liver collects blood,regulates the flow of qi,and is the master of drainage,”we explore the rationality of the treatment of this disease from the perspective of“liver and kidney have the same origin”and the development of PCOS-related infertility in relation to dysfunctional internal organs.We also explore the feasibility of treatment from the perspective of“liver and kidney homology,”expand the ideas for treatment,as well as develop and innovate the application of organ identification in PCOS in relation to infertility.

Analysis of Famous TCM Doctor Zan Qiang's Experience in the Treatment of Perimenopausal Osteoporosis

The purpose of this study was to analyze the clinical experience of Zan Qiang,a famous doctor of Traditional Chinese Medicine in Shaanxi province,in the treatment of perimenopausal osteoporosis.Zan believed that the main etiology and pathogenesis of perimenopausal osteoporosis were "deficiency of kidney essence,decreased marrow and bone",deficiency of liver and kidney"and"stasis caused by deficiency".Although it is a chronic physiological disease,and the pathological process is irreversible,the treatment groups of"tonifying kidney and filling essence","tonifying liver and tonifying kidney"and "tonifying deficiency and promoting blood circulation" can significantly improve the symptoms of patients,slow down the progress of the disease and improve the quality of life of patients.

Treatment of Polycystic Ovary Syndrome from the Theory of "Yigui Homology"

Traditional medicine believes that emotional,room labor and other factors lead to the lack of blood circulation after the weather,and the consumption of Yin blood is too much,which can lead to the deficiency of blood essence.Over time,the deficiency of menstrual blood can not nourish the kidney essence,leading to abnormal pregnancy.The liver is congenital for women,and the kidney is congenital.The disharmony of liver and kidney is the key factor of women's disease.Starting from the"homology of Yi and GUI",this paper analyzes the main etiology and pathogenesis of the disease from three aspects:deficiency of blood essence,imbalance of Zang and Xie,and Yin not controlling Yang.Following the principle of simultaneous treatment of liver and kidney,starting from the three methods of "regulating and tonifying liver and kidney,tonifying kidney and activating blood circulation,and balancing yin and Yang",the liver and kidney are reconciled,and pregnancy is sometimes the best choice.The main purpose is to benefit PCOS patients.

Polycystic liver disease: Classification, diagnosis, treatment process, and clinical management

Polycystic liver disease(PLD)is a rare hereditary disease that independently exists in isolated PLD,or as an accompanying symptom of autosomal dominant polycystic kidney disease and autosomal recessive polycystic kidney disease with complicated mechanisms.PLD currently lacks a unified diagnostic standard.The diagnosis of PLD is usually made when the number of hepatic cysts is more than 20.Gigot classification and Schnelldorfer classification are now commonly used to define severity in PLD.Most PLD patients have no clinical symptoms,and minority with severe complications need treatments.Somatostatin analogues,mammalian target of rapamycin inhibitor,ursodeoxycholic acid and vasopressin-2 receptor antagonist are the potentially effective medical therapies,while cyst aspiration and sclerosis,transcatheter arterial embolization,fenestration,hepatic resection and liver transplantation are the options of invasion therapies.However,the effectiveness of these therapies except liver transplantation are still uncertain.Furthermore,there is no unified strategy to treat PLD between medical centers at present.In order to better understand recent study progresses on PLD for clinical practice and obtain potential directions for future researches,this review mainly focuses on the recent progress in PLD classification,clinical manifestation,diagnosis and treatment.For information,we also provided medical treatment processes of PLD in our medical center.

Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis

AIM To evaluate the differences in acute kidney injury(AKI) between acute-on-chronic liver failure(ACLF) and decompensated cirrhosis(DC) patients. METHODS During the period from December 2015 to July 2017, 280 patients with hepatitis B virus(HBV)-related ACLF(HBV-ACLF) and 132 patients with HBV-related DC(HBV-DC) who were admitted to our center were recruited consecutively into an observational study. Urine specimens were collected from all subjects and the levels of five urinary tubular injury biomarkers were detected,including neutrophil gelatinase-associated lipocalin(NGAL), interleukin-18(IL-18), liver-type fatty acid binding protein(L-FABP), cystatin C(CysC), and kidney injury molecule-1(KIM-1). Simultaneously, the patient demographics, occurrence and progression of AKI, and response to terlipressin therapy were recorded. All patients were followed up for 3 mo or until death after enrollment. RESULTS AKI occurred in 71 and 28 of HBV-ACLF and HBV-DC patients, respectively(25.4% vs 21.2%, P = 0.358). Among all patients, the levels of four urinary biomarkers(NGAL, CysC, L-FABP, IL-18) were significantly elevated in patients with HBV-ACLF and AKI(ACLF-AKI), compared with that in patients with HBV-DC and AKI(DC-AKI) or those without AKI. There was a higher proportion of patients with AKI progression in ACLF-AKI patients than in DC-AKI patients(49.3% vs 17.9%, P = 0.013). Fortythree patients with ACLF-AKI and 19 patients with DC-AKI were treated with terlipressin. The response rate of ACLFAKI patients was significantly lower than that of patients with DC-AKI(32.6% vs 57.9%, P = 0.018). Furthermore, patients with ACLF-AKI had the lowest 90 d survival rates among all groups(P < 0.001).CONCLUSION AKI in ACLF patients is more likely associated with structural kidney injury, and is more progressive, with a poorer response to terlipressin treatment and a worse prognosis than that in DC patients.

Outcomes of liver transplantation in patients with hepatorenal syndrome

Hepatorenal syndrome(HRS) plays an important role in patients with liver cirrhosis on the wait list for liver transplantation(LT). The 1 and 5-year probability of developing HRS in cirrhotic with ascites is 20% and 40%, respectively. In this article, we reviewed current concepts in HRS pathophysiology, guidelines for HRS diagnosis, effective treatment options presently available, and controversies surrounding liver alone vs simultaneous liver kidney transplant(SLKT) in transplant candidates. Many treatment options including albumin, vasoconstrictors, renal replacement therapy, and eventual LT have remained a mainstay in the treatment of HRS. Unfortunately, even after aggressive measures such as terlipressin use, the rate of recovery is less than 50% of patients. Moreover, current SLKT guidelines include:(1) estimation of glomerular filtration rate of 30 m L/min or less for 4-8 wk;(2) proteinuria > 2 g/d; or(3) biopsy proven interstitial fibrosis or glomerulosclerosis. Even with these updated criteria there is a lack of consistency regarding longterm benefits for SLKT vs LT alone. Finally, in regards to kidney dysfunction in the post-transplant setting, an estimation of glomerular filtration rate < 60 mL /min per 1.73 m2 may be associated with an increased risk of patients having long-term end stage renal disease. HRS is common in patients with cirrhosis and those on liver transplant waitlist. Prompt identification and therapy initiation in transplant candidates with HRS may improve post-transplantation outcomes. Future studies identifying optimal vasoconstrictor regimens, alternative therapies, and factors predictive of response to therapy are needed. The appropriate use of SLKT in patients with HRS remains controversial and requires further evidence by the transplant community.

Acute kidney injury and hepatorenal syndrome in cirrhosis

Acute kidney injury(AKI)in cirrhosis,including hepatorenal syndrome(HRS),is a common and serious complication in cirrhotic patients,leading to significant morbidity and mortality.AKI is separated into two categories,non-HRS AKI and HRS-AKI.The most recent definition and diagnostic criteria of AKI in cirrhosis and HRS have helped diagnose and prognosticate the disease.The pathophysiology behind non-HRS-AKI and HRS is more complicated than once theorized and involves more processes than just splanchnic vasodilation.The common biomarkers clinicians use to assess kidney injury have significant limitations in cirrhosis patients;novel biomarkers being studied have shown promise but require further studies in clinical settings and animal models.The overall management of non-HRS AKI and HRS-AKI requires a systematic approach.Although pharmacological treatments have shown mortality benefit,the ideal HRS treatment option is liver transplantation with or without simultaneous kidney transplantation.Further research is required to optimize pharmacologic and nonpharmacologic approaches to treatment.This article reviews the current guidelines and recommendations of AKI in cirrhosis.

基于“肝脾同调”阐析慢性肝病的中医治疗

慢性肝病是临床常见疾病,“郁、虚、湿、毒、瘀”是其核心病机,在疾病的不同阶段各有侧重,其中,以“郁、虚”为核心的肝脾失调是慢性肝病发生发展的关键。“肝脾同调”是治疗慢性肝病的基本治法,在慢性肝病不同阶段,其“肝脾同调”内涵同中有异。根据肝、脾生理病理特性,治脾明辨虚实,厘清轻重,活用运脾、健脾、温脾、醒脾、补脾等法;调肝体用并重,精准辨证,活用疏肝、缓肝、散肝、柔肝等法。临床上,治脾与调肝相辅相成,治调并举,常获良效。

微波消融在潜在可切除的结直肠癌伴同时性多发肝转移中的临床应用

目的分析微波消融在初始评估为潜在可切除的结直肠癌伴同时性多发肝转移中的临床效果。方法选取2018年10月1日至2020年10月1日河北北方学院附属第一医院普通外科、北京中医药大学东直门医院中西医肿瘤微创医学中心、河北医科大学第四医院外二科收治的潜在可切除的结直肠癌伴同时性多发肝转移患者,统计其一般资料、病理特征、治疗方式和临床疗效,根据治疗方式,分为转化治疗+腹腔镜结直肠癌根治术+肝病灶切除组(手术切除组)和转化治疗+腹腔镜结直肠癌根治术+肝病灶微波消融组(微波消融组),比较两组患者相关手术指标(手术时间、术后肛门首次排气时间、住院时间等)和术后并发症(吻合口狭窄、吻合口出血、切口感染等),同时进行生存期随访,包括总生存期和无疾病生存期,绘制生存曲线,分析两种治疗方式的临床疗效。结果共纳入潜在可切除的结直肠癌伴同时性多发肝转移患者198例,经FOLFOX或FOLFIRI方案行新辅助化疗成功后66例,其中,手术切除组30例,均达到了根治效果,微波消融组36例,共消融57个肿瘤;54个肿瘤在第1次消融后达到完全消融(94.74%),后经再次消融后均达到无疾病证据;微波消融组患者手术时间、术中出血量、术后首次排气时间、进流质饮食时间、住院时间及住院费用均显著少于手术切除组(P均<0.001);微波消融组患者术后视觉模拟评分法疼痛评分显著低于手术切除组(P<0.001),切口感染(P=0.740)、吻合口漏(P=1.000)、吻合口狭窄(P=1.000)等并发症两组比较差异均无统计学意义;总生存时间(P=0.191)和无疾病生存时间(P=0.934)两组患者差异无统计学意义;结论对于初始评估为潜在可切除的结直肠癌伴同时性多发肝转移患者,经转化治疗后两组均安全、有效,且有着相似的生存结局,但微波消融组在术后恢复、经济及耐受性方面更具优势,建议临床推广。

Simultaneous liver and kidney transplantation： analysis of a single-center experience

Background Simultaneous liver and kidney transplantation （SLKT） has been proven to be a favorable treatment for combined renal and hepatic end-stage disease. However, recipients receiving SLKT have a long medical history, poor general condition that is often accompanied by anemia, hypoalbuminemia, coagulopathy, water-electrolyte imbalance and acid-base disorders. This study aimed to explore the indications, surgical techniques, therapeutic experience, prevention and treatment of postoperative complications of SLKT. Methods The clinical data of 22 SLKTs cases performed at the First Affiliated Hospital of Sun Yat-sen University from January 2001 to December 2008 were retrospectively studied. Indications for SLKT, surgical techniques, perioperative fluid management, immunosuppressive regimen and experience in prevention and treatment of postoperative complications were analyzed. Results All operations were successfully performed. Postoperative complications occurred in 13 cases （59.1%）, including pleural effusions （7）, intra-abdominal bleeding （2）, biliary complications （2）, repeated upper gastrointestinal bleeding （1）, and acute liver graft rejection （1）. All complications were treated conservatively. In this study, there were five deaths during follow-up, in which three perioperative deaths occurred due to serious conditions. Mortality at 3 months was 13.6%. The one and three year patient survival rate was 81.3% and 73.9% respectively. Conclusions SLKT is an effective therapy for end-stage liver disease with chronic renal failure or severe damage to renal function. It is a complex surgical procedure, causing a large disturbance of circulation and fluid balance, and more postoperative complications. The SLKT surgical techniques selected are based on the experience of surgeons, the anatomy of the recipient and primary diseases. It is essential to use the correct perioperative fluid management, reasonable immunosuppressive regimen, and prevention and treatment of postoperative infections, to improve the long-term patient survival after SLKT.

抑阳缓阴法在外障眼病中的临床应用

“抑阳缓阴法”用于治疗强阳抟实阴所致“瞳神紧小”疾病,即强阳之邪与实阴肾水相抟。喻京生基于临床认为,眼科诸多外障眼病因强阳抟实阴而导致,强阳不可拘泥为心包相火之阳,可理解为内、外之阳,如机体阳盛,或有火热之邪上犯,或机体内郁之邪而化火;目内神水为肾之津液所化,肾精充实,未见枯耗之象,实阴也可是素体阴盛或有寒湿之邪囚困;因而表现为机体阴阳俱盛,二者相争失衡,究其本为“阴阳失调”;故在治疗上以“抑阳缓阴”为根本大法,肝肾同治以调和阴阳,同时加以上疏、外散以祛风邪,下渗、内清以消湿热等治疗之法,对季节性过敏性结膜炎、病毒性角膜炎等疾病治疗效果甚佳。

当归芍药散临床运用举隅

目的通过赵曼丽教授应用当归芍药散的临床验案举隅,分析当归芍药散的病机及方证特点,扩大当归芍药散的临床应用范围,拓展临床诊疗思路。方法分析当归芍药散的方药组成及证治,结合验案阐述其临床运用的症状、体征特点及病机要点。结果临床病机为肝脾不调或血水互结,兼见面色萎黄或有黄褐斑、脐周压痛或有条索状物、腹主动脉搏动明显、心下部有振水音等症状或体征者皆可应用当归芍药散,疗效显著。结论抓住病机,方证结合,是确保临床疗效的关键。

基于数据挖掘分析卢秉久教授辨治代谢相关脂肪性肝病经验

目的:基于真实世界的临床病例数据挖掘及分析卢秉久教授辨治代谢相关脂肪性肝病的发病特征与用药经验。方法:采集并记录电子病历以建立医案数据库;使用频次频率分析患者的一般资料(性别、年龄、体重指数、彩超及合并病情况)、中医证候要素(主诉症状、舌象及脉象)、中药药味及作用功效;采用Apriori算法对统计得出的高频药物进行关联分析并绘制网络图;运用聚类分析、复杂系统熵聚类、熵层析聚类分析等高级别数据挖掘方法对高频药物进行聚类分析,并以树状图将数据结果可视化展示;基于数据挖掘结果探索代谢相关脂肪性肝病的发病特点,挖掘处方用药规律,总结名家诊治经验。结果:共纳入329例病例,发病以中年人居多,93.01%的患者BMI超过正常水平。高脂血症、高血压病、2型糖尿病、心脑血管疾病及高尿酸血症为高频合并病。出现频次最高的舌脉要素分别为淡红舌、白腻苔及沉脉。纳入处方329首,涉及中药164种,高频药物共12味,以补虚药占比最高。关联分析得出18个核心药组,系统聚类得出6类新处方。结论:卢秉久教授认为代谢相关脂肪性肝病的病位在肝脾,主要表现为本虚标实,“浊瘀”是发病的关键病理因素,治疗应以“祛湿化浊、活血通脉”为总则,对重要兼证以“肝胃同调、肝心同治、气机畅达”等为指导思想。

基于“肝心同治”防治冠心病合并抑郁的机理及机制预测研究

目前,双心疾病已经成为现代社会影响人类健康的主流问题之一,而冠心病合并抑郁是双心疾病的重要部分。冠心病、抑郁分属中医胸痹、郁证,二者彼此影响、互相加重。《灵枢》载“心藏神,脉舍神……心气虚则悲,实则笑不休”,强调了心的病变会引起神志、情绪的变化,同时,情绪的刺激也会影响心脏。可见,心血管疾病与情志病是密不可分的,而调节情志,也离不开对气机的调达和疏泄。胸痹患者心脉不畅,肝失疏泄,痰瘀互结,气机郁滞加重,因此引发情志的改变。情志失调、郁证和胸痹三者密切相关。早在仲景时期,便有以肝论治心病的记载,心肝在血脉运行和精神情志等方面相关密切。课题组前期发现,“心”与“肝”的状态失衡是导致疾病进展的主要因素,结合导师临床经验以“肝心同治”为指导而组方的定心方(人参10 g,丹参20 g,柴胡10 g,郁金15 g,三七10 g)在临床上对于治疗冠心病合并抑郁具有重要意义。中医药复方治疗冠心病合并抑郁具有整体调节、多靶点、多机制、多途径、低毒性及个体化等特点而具有独特优势。为解决“肝心同治”中医防治冠心病合并抑郁的机制主要集中于炎症和内皮损伤等局限而不深入的瓶颈问题,基于对“肝心同治”理论的探讨,结合现代科学技术,旨在为防治冠心病合并抑郁提供新的思路与机制预测。

基于数据挖掘探讨谭新华治疗勃起功能障碍用药规律

目的基于数据挖掘技术探讨名老中医谭新华教授治疗勃起功能障碍用药规律。方法收集2020年1月-2022年6月于湖南中医药大学第一附属医院谭新华教授门诊207例勃起功能障碍患者首诊病案,建立标准化医案数据库。应用古今医案云平台2.4.3进行证型频次、药物频次、药物属性统计及关联规则分析、聚类分析和复杂网络分析。结果共收集207首中药处方,高频证型以肝肾亏虚证(61次)、肝郁肾虚证(43次)为主,涉及中药124味,高频药物有茯苓(148次)、甘草(142次)、淫羊藿(134次)等,药性多为平、温,药味多甘、辛、苦,归经以肝经、肾经、脾经为主。关联规则得到4个常用药对,聚类分析得到5类药物组合,复杂网络分析提示核心中药处方以四君子汤、赞育丹为基础加减。结论谭新华教授治疗勃起功能障碍多从肾、肝、脾论治;用药主张肝肾同治,药用中和,强调标本兼顾、补虚泻实;治法以补肾健脾、疏肝理气、活血通络、清热利湿为主。

从冲任论卵巢癌术后复发转移

卵巢癌病在胞宫冲任,手术损伤导致冲任气血亏虚以致功能失调,成为卵巢癌术后复发转移之前提条件;加之术后未净之癌毒潜匿于机体,以伏邪形式存在,共同导致了卵巢癌术后复发转移。结合手术导致激素分泌紊乱、机体免疫功能降低的生物学特点,归纳“冲任失调”为卵巢癌术后复发转移之病机。基于此,提出“清补冲任”为防治卵巢癌术后复发转移的基本原则,治疗当辨明局部与整体之关系,以冲任为枢纽,肝肾同调。

从“乙癸同源”论治耳石症复位后残余头晕

传统中医学中并无耳石症复位后残余头晕(RD)之病名,据其特点可归类为中医学“眩晕病”范畴。于顾然教授,江苏省中医院名中医、博士生导师,从医30余载,在中医药治疗脑病领域取得多项研究成果。笔者幸而跟随于顾然教授学习,现就于师治疗RD临床经验,进行粗浅探讨。本文从“乙癸同源”理论出发,探讨RD病因病机、临床辨证,以期完善诊疗思路,提高诊疗水平。

黄永生心肝同治理论在冠心病心绞痛中的应用

冠心病是一种临床常见慢性疾病,文章通过生理病理、气血、情志三方面阐释心肝同治在冠心病心绞痛中的作用,并以此为理论基础探讨黄永生教授对这种临床复杂病症的认识,执简驭繁运用权变之法管理冠心病心绞痛病程中肝脏的作用,即在健脾、益气、滋肾基础上,分别加以柔肝、疏肝、泻肝、暖肝及养肝之法;以调理肝脏贯穿于治疗冠心病的始终。

基于心肝相关理论探讨心力衰竭辨治

心力衰竭总属本虚标实之证,以心阳虚为本,气滞、痰饮、瘀血等病理因素相互搏结为标。肝为心之母,母病及子当先治其母,故辨治心力衰竭时可在温阳利水基础上加疏肝活血、理气化浊药物。高血压是导致心力衰竭的主要原因,也是其最常见的并发症之一,心力衰竭患者更应注意对血压的控制,可在治疗基础上加平肝熄风、清心泻火药物。高血压病程日久者,可见肝肾不足,阴阳两虚之证,需心肝同治,在温阳利水基础上兼滋水涵木、滋阴利水。心力衰竭患者多伴有情志异常,而情志异常与心肝脾密切相关,故在治疗上,应合理运用疏肝理气、解郁安神药物,一则舒畅肝郁,调达气机,助利水药通调水道,助温阳药升阳有道;二则解心神思绪,防诸气凝郁,水道不通,病情反复。

运用柴胡加龙骨牡蛎汤治疗心悸病医案一则

柴胡加龙骨牡蛎汤为汉代张机(字仲景)所创,用于治疗伤寒误下,邪入少阳之证。古代医家多以此方治疗不寐、郁证、狂证、癫痫等精神、神经系统疾病,鲜有此方论治心悸病的记载。通过观察现代人日常生活和工作发现,生活节奏快、工作压力大是现代都市人普遍的特点,因此尤易出现焦虑、紧张、担忧等异常情绪,长此以往,首先会影响人们的气机运行。气郁首先犯于肝脏,肝气郁滞,气机不畅,则无力运行血液,心脏失于气血的濡养而发为心悸;此外肝气郁滞,日久化火,肝火上扰心神,加之气血涌盛,扰乱心神而致心神不宁,故在临床上治疗心律失常时,沈琳教授多主张心病从肝论治,心肝同治。在运用柴胡加龙骨牡蛎汤时,沈琳教授坚持方证辨证这一核心要点,领悟张机“但见一症便是,不必悉具”的核心思想,牢牢把握“胸满烦惊心悸”为关键点,临床但见因焦虑、受惊、疲累或寐差等所致心悸烦躁来诊者,以柴胡加龙骨牡蛎汤寒温并用,攻补兼施,肝胆调和,热祛魂安,使错杂之邪得以解除,其中以忧思、紧张等情志不悦为突出表现者,系气郁有热,魂神不定之象,以柴胡加龙骨牡蛎汤加减投之,取其疏肝清热,安神定悸之意,再配伍情志疏导,每每效如桴鼓。