Regulating and tonifying spleen and kidney traditional Chinese medicine in the treatment of chronic uric acid nephropathy: A systematic review

Objective:To systematically evaluate the efficacy and safety of traditional Chinese medicine for regulating spleen and kidney.Methods:We developed a search strategy and then retrieved the database including CNKI,Wanfang data knowledge service platform,VIP journals resource integration service platform,PubMed,Embasefor randomized controlled trial of regulating spleen and kidney traditional Chinese medicine compared with conventional western medicine in the treatment of chronic uric acid nephropathy.The search deadline was set to June 30,2020.For the included literature,we applied the cochrane collaboration network risk bias assessment tool to evaluate the methodological quality,and evaluated the level of evidence according to GRADE standards.Quantitative data was analyzed by RevMan5.3 software,and trial sequential analysis method was used to analyze its efficiency.Results:A total of 709 cases in 10 articles were included.Compared with the control group,the related traditional Chinese medicine group improved the effective rate[RR=1.45,95%CI(1.32,1.58)],reduced the level of UA[MD=-36.24,95%CI(-41.03,-31.45)],BUN[SMD=-1.27,95%CI(-1.47,-1.07)]and SCR[MD=-36.33,95%CI(-55.79,-16.87),P=0.0003],the difference between the two groups was statistically significant(P<0.05).There was no evidence that a significant adverse reaction occurred.The results of TSA analysis showed that the Chinese medicine group had definite evidence for improving the efficiency.According to the GRADE evaluation criteria,the efficiency,UA,BUN and SCR outcome indicators were extremely low-quality evidence.Conclusions:Traditional Chinese medicine for regulating spleen and kidney in the treatment of chronic uric acid nephropathy improved efficiency,reduced the level of UA,BUN,SCR.Meanwhile,the therapy was proved to be safe.Nevertheless,the conclusions need further high-quality evidence to support.

Rules of Ren Shunping's prescription for trearing Spleen Deficiency and Qi Stagnation Syndrome of Functional Dyspepsia Based on Data Mining

Objective:To explore the medication rules of Professor Ren Shunping treating spleen deficiency and qi stagnation syndrome of functional dyspepsia,so as to provide reference for clinical prevention and development of new drugs.Methods:The 144 Chinese herbal formulas considered as active prescribed by professor Ren Shunping for the first time treating the patients with spleen deficiency and qi stagnation syndrome of functional dyspepsia were collected,entered into TCM inheritance auxiliary platform(V2.5),and then mined by some data mining methods of the software,such as the association rules and unsupervised entropy hierarchical clustering.Results:This study involved 144 Chinese herbal formulas,including a total of 56 Chinese herbal medicines.Of these Chinese herbal medicines,the herbs of cold and warm nature,and pungent,bitter and sweet in flavors were used in a quite high frequency,all of which act on spleen,stomach,lungs,large intestine,liver and gallbladder meridians.One core Chinese herbal formula was excavated,composed of patchouli,perilla stem,radix bupleuri,scutellaria,ginger pinellia,codonopsispilosula,magnolia bark,tangerine peel,large-headed atractylodes,immature bitter orange,wood incense,fructus amomi,inula britannica chinensis,ginger,medicated leaven,fried rice and fried malt based on the association rules.And a total of 17 groups of core used drugs and 2 groups of new Chinese herbal formulas undiscovered were mined based on unsupervised entropy hierarchical clustering.Conclusion:In treating spleen deficiency and qi stagnation syndrome of functional dyspepsia,professor Ren is good at treating spleen deficiency and qi stagnation syndrome of functional dyspepsia from the perspective of"tong jiang",using the"five-in-one"strategy of strengthening the spleen,evacuating the liver,coming down qi from the stomach,dispersing lung,and bowel-reflexing to treat patients as a whole.And the herbal medicines were light in dose,lovely and mild in nature for the formulars.At the same time,he paid attention to the combination of syndromes and symptoms,and flexible arbitration.

Spleen Function and Anxiety in Chinese Medicine: A Western Medicine Perspective

This article aims to illustrate the function of the Spleen in Traditional Chinese Medicine (TCM) in the context of modern medicine. TCM has been practiced since ancient times in China for the prevention and/or treatment of diseases. Yet, the complete understanding of its theoretical basis in relation to clinical practice from the modern medicine perspective is still lacking. According to TCM theory, the Spleen, as one of the five Zang (i.e., visceral organs), plays an important role in various physiological functions, including digestion and absorption of nutrients, regulation of water retention and excretion, facilitation of blood perfusion to skeletal muscle and on the optimal functioning of the immune system. Clinical applications of herbal formulations for the treatment of Spleen dysfunction (i.e., Spleen deficiency—a decline in Spleen function) and their pharmacological activities are described. The view point of TCM on how emotions (or Qing Zhi) can influence the body function is introduced. The relationship between anxiety and Spleen function has been analyzed by reviewing relevant research studies in modern medicine. These findings suggest that the cause/consequence relationship between anxiety and Spleen function may be bi-directional.

Study on the Characteristics of Gut Microbiota in Chronic Hepatitis B(CHB)Patients with Damp Heat Syndrome and Liver Depression and Spleen Deficiency Syndrome

Objective:This study was designed to explore the characteristics of gut microbiota in CHB patients with two most common traditional Chinese medicine(TCM)Syndromes—damp heat syndrome and liver depression and spleen deficiency syndrome.Methods:According to the diagnostic criteria of Western medicine,TCM and screening exclusion criteria,65 cases of CHB with damp heat syndrome and 28 cases of CHB with liver depression and spleen deficiency syndrome were finally included in the study.All the basic information was gathered and the fresh fecal samples were collected for 16S rDNA sequencing.16S rDNA of gut microbiota was sequenced using Illumina hiseq 2,500 high-throughput sequencing platform.Based on the optimized sequence,Operational Taxonomic Units(OTU)clustering analysis and taxonomic annotation were carried out.Results:The difference in relative abundance of gut microbiota was significant between damp heat syndrome and liver depression and spleen deficiency syndrome in CHB patients.Cyanobacteria was only found in damp heat syndrome.The relative abundance of Erysipelotrichia and Subdoligranulum were higher in liver depression and spleen deficiency syndrome,while the relative abundance of Rhodospirillales,Alphaproteobacteria and Lachnospira were higher in the damp heat syndrome.LDA Effect Size(LEfSe)analysis showed that Lachnospira,Olsenella and Subdoligranulum had significant difference in species among the two TCM syndromes.Conclusion:The different characteristics of gut microbiota in the two TCM syndromes of CHB patients may play an important role in syndrome formation of TCM,which provides a new field of vision for the accurate diagnosis and treatment of TCM.

Research progress of traditional Chinese medicine in the prevention and treatment of dyspepsia following spleen stomach weakness

Dyspepsia is a clinical syndrome caused by gastric motility disorder,including gastroparesis and esophageal reflux disease.Dyspepsia of spleen stomach weakness type is the most common TCM syndrome type in clinic.TCM has unique advantages in the prevention and treatment of spleen stomach weakness dyspepsia.This paper summarizes the research progress of TCM in the prevention and treatment of spleen stomach weakness dyspepsia in recent years,discusses its mechanism and advantages,and analyzes the existing problems,so as to provide research ideas and directions for TCM to further prevent and treat the disease and improve human quality of life.

Potential Mechanism and Application of Strengthening the Spleen, Clearing Heat and Dampness in Treatment of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease(GERD)is one of refractory digestive disease in clinic characterized by high prevalence,complex and recurrent symptoms.Traditional Chinese medicine(TCM)has a significant effect on the treatment of GERD.Spleen deficiency and damp-heat syndrome becomes one of the main syndrome patterns of GERD adapting with the changes of modern lifestyle.Although the therapy of strengthening the spleen,clearing heat and dampness is widely used in treatment of GERD,further studies still need to be conducted.The article comprehensively analyses the theoretical basis,mechanism and clinical efficacy of the therapy in order to provide more ideas for clinical treatment.

健脾祛痰法治疗血脂异常研究概况

血脂异常在我国普遍存在,中医药干预血脂异常越来越得到人们的重视。中医学认为脾主运化水谷精微,脂质亦需要脾的运化功能布散周身。脾气虚则脾失健运,清气不升,浊阴独留,生湿生痰;痰湿进一步阻碍气机,影响脾胃运化,使脾虚更甚,加重脂浊,浸润血脉。近年来健脾祛痰法被越来越多地应用于血脂异常的防治中,且在临床中收到不错的疗效。

国医大师张磊从脾胃论治耳鸣经验探析

国医大师张磊教授善从脾胃论治耳鸣,认为脾胃功能失调,中焦升降失司,气血生化乏源,升清降浊无力,上窍无以濡养是其主要病机。此病源头为脾胃虚弱失养,痰湿化热困脾,临证时将其证候分为脾气虚弱、痰湿中阻、脾虚肝郁等证型。治疗从脾胃着手,调畅中土,以后天之精濡养全身脏腑,使正气充盈清窍,邪不侵犯人体,而耳鸣自愈。

从“有诸内者必形诸外”及体质论治小儿慢性荨麻疹

慢性荨麻疹因其反复发作、瘙痒难耐的特点严重影响患儿的身心健康,属于儿科临床难治病证。慢性荨麻疹虽属于外科范畴,侯江红教授认为“内之症或不及其外,外之症则必根于其内也”,治疗时不可拘泥于外治之法,必当思外而揣内,究其内在本因。考虑小儿好发该病,多责之于乳食所伤,侯教授指出小儿慢性荨麻疹的发生多由脾胃不和导致,因此临床辨证可从脾胃湿热型、气虚热盛型、营卫失和型入手,治疗采用培土生金法健运脾胃、调补肺脾、调和肺脾,以扶正固表、调和营卫、解表透疹。体质形成由脏腑盛衰偏颇所决定,因此亦认为体质因素是荨麻疹治疗与预防的重要病机,其中高敏偏颇体质患儿易出现荨麻疹、易咳嗽、哮喘等非健康倾向,故将调理高敏体质作为防治的重点,有效减少了患儿荨麻疹的复发率。此外还注重治养兼顾,讲求医患配合,从饮食、运动、作息、家长行为心理等方面改变养护观念,避免家长过度就医对患儿造成过度用药,通过非药物干预的方法来有效调动患儿自身免疫功能,亦增进了医患之间的信任。文章附案例一则,详细介绍侯江红教授治疗小儿慢性荨麻疹临证经验,以期为临床相关治疗提供参考。

基于脾肺同治探讨复发性脓疱疮发病机制及治疗思路

脓疱疮是一种儿童常见的感染性皮肤病,具有一定的传染性。因小儿稚阴稚阳的生理特点,素体娇弱、禀赋不耐,或正气相对不足,肌肤娇嫩,腠理不固,加之难以控制搔抓,皮疹更易播散,出现疾病反复发作,邪毒久羁,迁延难愈。小儿肝常有余,脾常不足,而脾为后天之本,脾肺两脏相互配合,互通互用,共同调节脏腑功能。因此可通过健脾固本,补益肺气,脾肺相协,共调脏腑,以促进疾病的恢复。故而在临证治疗脓疱疮反复发作中,特别对于儿童患者,更应时刻谨记顾护脾胃、补益肺气、脾肺同治的重要性。

四合汤对脾胃虚弱证慢性萎缩性胃炎的影响

目的 探究加味四合汤对脾胃虚弱型慢性萎缩性胃炎的疗效。方法 选取2020年8月—2023年6月河南省永城市人民医院门诊收治的脾胃虚弱证慢性萎缩性胃炎患者120例,根据随机数字表法分为观察组和对照组,每组60例,观察组采用加味四合汤治疗,对照组采用西药治疗,比较2组中医证候积分、胃镜下黏膜表现、组织病理结果的改变。结果 观察组疗效明显优于对照组,差异具有统计学意义(P<0.05)。结论 加味四合汤对脾胃虚弱证慢性萎缩性胃炎患者疗效显著,能有效改善患者临床中医证候、症状、胃镜黏膜表现、组织病理的变化,部分患者黏膜腺体萎缩出现逆转。

基于数据挖掘王晓燕教授治疗儿童抽动障碍脾虚肝亢证用药规律

目的运用数据挖掘技术分析并总结王晓燕教授治疗儿童抽动障碍脾虚肝亢证的用药经验。方法收集王教授门诊治疗的脾虚肝亢证抽动障碍患儿,运用中医传承辅助平台(V 2.5)建立数据库,对数据库中处方予频次分析、关联规则分析和复杂系统熵聚分析。结果共收集122首方,涉及中药64味,用药频次前11位分别为麸炒白术、麸炒苍术、炙甘草、炒白芍、蝉蜕、柴胡、陈皮、炒莱菔子、炒酸枣仁、炒僵蚕、珍珠母。药物四气以温寒药居多,五味以苦辛甘为主,归经以肝脾肺居多。药物组合频次超过115次的共30组。得到潜在核心组合6组,潜在新方3首。结论王教授治疗儿童抽动障碍脾虚肝亢证用药以寒温并举,辛苦兼施为主,主张肝脾同调,土木并举,选用自拟方柴术调肝理脾汤为基础加减治疗。

芒针联合中医辨证干预肝郁脾虚型溃疡性结肠炎临床疗效观察

目的评价芒针疗法联合中医辨证干预肝郁脾虚型溃疡性结肠炎的有效性和安全性。方法选择肝郁脾虚型溃疡性结肠炎患者64例,按照随机数字表法将其分为两组,分别为治疗组和对照组,治疗组根据中医辨证,给予芒针治疗,配合培土疏郁汤口服;对照组口服美沙拉嗪缓释颗粒。比较两组治疗前后的中医证候积分及治疗后临床有效率。结果治疗后,治疗组中医证候积分低于对照组,差异有统计学意义(P<0.01);治疗组的临床总有效率高于对照组,差异有统计学意义(P<0.05)。结论芒针疗法联合中医辨证干预肝郁脾虚型溃疡性结肠炎较单纯西药口服更具有优势,值得临床推广。

四神丸治疗溃疡性结肠炎研究进展

四神丸是治疗脾肾泻的经典方剂,具有温肾暖脾、涩肠止泻功效。临床治疗溃疡性结肠炎脾肾阳虚证常以四神丸为基础方加减联合中医其他治法或中西医结合治疗,疗效显著。药理学研究显示,四神丸可能通过调控相关信号通路蛋白表达,调节炎症因子、抑制炎症反应,调节自噬,调节肠道菌群、改善肠黏膜通透性、修复肠黏膜屏障,调节细胞能量代谢,抗氧化应激,调节细胞免疫功能等治疗溃疡性结肠炎。本文对四神丸治疗溃疡性结肠炎研究现状进行整理、归纳,为进一步研究其作用机制及临床应用提供参考。

慢性萎缩性胃炎肝胃气滞证和脾胃虚弱证患者血清代谢组学特征研究

【目的】基于非靶向代谢组学技术,分析慢性萎缩性胃炎(chronic atrophic gastritis,CAG)肝胃气滞证和脾胃虚弱证患者的代谢组学特征,发现与CAG患者中医证型相关的血清代谢差异物,为中医辨证客观化提供参考依据。【方法】纳入60例CAG患者,其中肝胃气滞证及脾胃虚弱证各30例。收集2组患者空腹肘静脉血5 mL,采用超高效液相色谱-质谱技术检测血清代谢物含量,采用主成分分析(PCA)、正交偏最小二乘法判别分析(OPLS-DA)和聚类分析等多元统计方法筛选CAG肝胃气滞证和脾胃虚弱证患者之间的差异代谢物,最后利用KEGG数据库对筛选的差异代谢物进行代谢物通路分析。【结果】通过比较CAG肝胃气滞证和脾胃虚弱证患者血清代谢物,发现CAG肝胃气滞证和脾胃虚弱证之间N-乙酰基甘氨酸、组胺、O-磷酸丝氨酸、硒甲基硒代半胱氨酸、甲基间酪氨酸等氨基酸衍生物和酪氨酸-亮氨酸-苯丙氨酸、组氨酸-丙氨酸-谷酰胺-赖氨酸、L-天冬酰胺基-L-脯氨酰-L-丝氨酸、L-异亮氨酸-L-异亮氨酸等小肽类物质代谢具有显著性差异。【结论】CAG肝胃气滞证和脾胃虚弱证患者之间存在氨基酸代谢差异,N-乙酰基甘氨酸、甲基间酪氨酸、O-磷酸丝氨酸等代谢物可能是区别CAG肝胃气滞证和脾胃虚弱证的潜在生物标志物。

基于肿瘤相关巨噬细胞糖代谢重编程探讨胃癌“脾虚瘀毒”病机理论科学内涵

胃癌“脾虚瘀毒”病机理论认为,脾为气血生化之源,脾虚为致病内在依据,亦是胃癌病机根本,贯穿始终,瘀毒于脾虚基础上渐生,为重要病理因素。在胃癌病变过程中,肿瘤细胞与肿瘤微环境中多种代谢物质,以糖代谢重编程为主发生代谢改变,重构肿瘤相关巨噬细胞表型及功能,该过程与“脾虚瘀毒”病机理论相契合。本文聚焦肿瘤微环境糖代谢重编程驱动肿瘤相关巨噬细胞表型重塑,探讨胃癌“脾虚瘀毒”病机理论科学内涵,为中医药治疗胃癌的理论及临床研究提供参考。

基于升清降浊理论从脾胃论治高尿酸血症

高尿酸血症是一种以血尿酸升高为特征的代谢性疾病,临床上大部分患者处于无症状的亚健康状态,少数人可因尿酸盐沉积在关节或肾脏引起痛风。中医认为,高尿酸血症可归属为“血浊”的范畴,系本虚标实之证,核心病机为脾胃升清降浊功能失常,痰湿瘀浊阻滞脉道,浊毒内蕴。临床治疗以固本祛邪、复常升降为基本思路,以升清降浊、通利气机为为基本法则,固护脾胃,恢复其升清降浊之功,贯穿治疗始终。同时在高尿酸血症发病的不同阶段分期论治,灵活加减用药。无症状期予以运脾化湿,注重气化;急性期予以清热利湿,祛瘀泄浊;慢性期(间歇期)治以健脾补肾,化瘀通络。临床辨证施治时,药味甘苦辛并用,归经以脾胃为主,升清降浊,气血同调,尤其重视恢复人体气机通畅;祛瘀渗湿,导浊邪下泄;健脾补肾,调理五脏。临证时注重辨病与辨证相结合,调补脾胃,复其升降为主,选方用药时尤重健运脾胃,复脾胃枢机之功,升清阳降浊阴,擅用土茯苓与萆薢、薏苡仁与苍术、荷叶与山楂、车前草与玉米须、川芎与丹参等药对,体现了固本祛邪、升降相因、气血兼顾的用药特点,使气机通畅,清升浊降,恢复血液清净纯和的状态。笔者在临床上发现,基于升清降浊理论从脾胃论治高尿酸血症在降低患者血尿酸及改善症状上显示出了较好的疗效。

基于“象思维”考辨脾脏之名与实

基于中医藏象学说和“象思维”理论,结合脏腑解剖、生理功能、病理特点探讨脾之具象、外象、意象、原象、病象的属性与特点。考脾之名“脾”“裨”“散膏”“膵”等,辨脾之实为胰腺与现代医学脾之总提;考脾之形态与解剖“扁似马蹄”“形如刀镰”“脾与胃以膜相连”,辨脾之原始特征;考脾之五色、五液、五志、五神,辨脾之现象特征;考脾之“牝藏”“至阴”“孤脏”五行“谏议之官”,辨脾之本源实体;考脾之静兼、运化、燥湿,辨脾之物用整体;考脾病、脾急,脾经之病,探讨脾之病变规律,辨胰腺肿瘤“积聚”“痞气”“伏梁”之病变部位。依据“候之所使,道之所生”的内经思维方式,五维一体阐释脾(中医学)、胰腺(Pancreas)、脾(Spleen)的区别联系,并考辨脾之藏象。

基于肠道屏障探讨“脾主为卫”在溃疡性结肠炎发病与治疗中的作用机制

溃疡性结肠炎(UC)是一种以肠道屏障受损为特点,表现为直肠黏膜的持续性炎症反应、溃烂以及反复发作的炎症性肠病。脾与肠道屏障有密切联系,“脾主为卫”的功能失调是UC的重要病机,然而对UC中“脾主为卫”功能失调的微观机制尚不清楚。肠道屏障与“脾主为卫”的功能异曲同工,肠道屏障的破坏与UC互为因果,从肠道屏障的角度可以为中医“脾主为卫”理论做出新的科学阐释。现代医学尚缺乏对UC的有效治愈方法,药物治疗仍存在不良反应大、停药后加重、易复发等缺点。而中医基于“脾主为卫”理论的益气健脾治法可有效恢复肠道屏障功能,促进黏膜愈合,且无上述不良反应,对于促进UC的愈合以及防止其复发具有重要的临床价值。

刘凤斌对慢性萎缩性胃炎“炎-癌”转化的病机探索与辨治思路

慢性萎缩性胃炎(chronic atrophic gastritis,CAG)是临床上常见的难治性胃病,属于胃癌前病变。刘凤斌教授及其团队历经30余年的探索和实践,提出“脾虚为本,气血湿为标,瘀毒为变”是CAG“炎-癌”转化的病机演变特点。脾胃虚弱为CAG发病的始动因素,贯穿疾病始终;气滞、血瘀、湿阻为CAG“炎-癌”转化的触发和加重因素;瘀毒的形成是CAG进展和转变的关键。辨治应遵循“证镜结合,分期论治”的原则,辨病和辨证相结合,宏观和微观辨证相补充;健脾扶正需贯穿始终。CAG早期阶段(胃黏膜以轻中度萎缩伴或不伴轻度肠上皮化生),其病机以脾胃虚弱为本,伴有气滞、湿阻、血瘀病理因素,治疗以健脾清热、理气活血为基本治法;CAG晚期阶段(胃黏膜重度萎缩伴或不伴中重度肠上皮和/或轻中度上皮内瘤变),基本病机为脾胃虚弱、痰瘀互结、胃络瘀毒,治疗以扶正散结、通络解毒为基本治法,从而构筑中医药阻断胃“炎-癌”转化的整体防线。