The prescription rule analysis of the New Theory on Spleen Dampness Syndrome by Academician TONG Xiaolin

Objective To analyze the basic characteristics,drug features,prescription rules,and drug-symptom relationships of patients in the splenic deficiency and impairment stage,by data mining of medical records under the New Theory on Spleen Dampness Syndrome(Pi Dan Xin Lun,《脾瘅新论》).Methods Medical records listed in the“New Theory on Spleen Dampness Syndrome-Under-standing and Treatment of Metabolic Syndrome from the Perspective of Traditional Chinese Medicine”,and which were diagnosed with the spleen dampness syndrome at the splenic de-ficiency and impairment stage,during January 2004 and December 2016 were selected.These patients’data,including basic information,clinical symptoms,laboratory examination res-ults,traditional Chinese medicine(TCM)and western medicine diagnoses,treatment meth-ods,prescriptions,etc.,were collected.The collected data were subsequently compiled into a medical record database using the Epidata 3.1 data management software,followed by the use of Apriori algorithm provided in the SPSS Modeler 14.2 statistical software to investigate the association rules between drug-drug,drug-symptom,and drug-western medicine indices.Results(i)A total of 51 medical records were included,involving 17 types of syndromes.Among them,the top three with frequency≥3 included“Phlegm and blood stasis,and thoracic obstruction”“Deficiency-weakness of the spleen Qi,and static blood blocking collat-erals”,and“Deficiency-weakness of the spleen Qi,and static blood blocking collaterals”.Al-ternatively,of the 14 treatment methods,the top three treatments with frequency of≥3 in-cluded“Activating Yang and eliminating turbidity,and removing phlegm and dredging chan-nel blockage”“Strengthening the spleen and benefiting Qi,and eliminating phlegm to activ-ate the channels”,and“Warming Yang and benefiting Qi,and expelling cold to remove ob-structions”.Among the 15 prescriptions,the top three used with frequency≥3 included Huangqi Guizhi Wuwu Tang(黄芪桂枝五物汤),Gualou Xiebai Banxia Tang(瓜蒌薤白半夏汤),and Ganjiang Huangqin Huanglian Renshen Tang(干姜黄芩黄连人参汤).Lastly,of the 83 drugs used for a total of 476 times,those with frequency≥15 included Huanglian(Coptid-is Rhizoma),Huangqi(Astragali Radix),Jiudahuang(Wine-processed Rhei Radix et Rhizoma),Jixueteng(Spatholobi Caulis),Shengjiang(Zingiberis Rhizoma Recens),Huangqin(Scutellariae Radix),and Guizhi(Cinnamomi Ramulus).(ii)For the drug-drug associations,under the criteria of support≥15%and confidence=100%,seven second-order association rules,seven third-order rules,and six fourth-order roles were identified.The top-ranking rule of each was“Huangqin(Scutellariae Radix)→Huanglian(Coptidis Rhizoma)”“Ganjiang(Zingiberis Rhizoma)+Huangqin(Scutellariae Radix)→Huanglian(Coptidis Rhizoma)”,and“Baishao(Paeoniae Radix Alba)+Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatho-lobi Caulis)→Huangqin(Scutellariae Radix)”,respectively.Alternatively,the drug-symptom associations were analyzed under the criteria of support≥5%and confidence=100%,which derived eight second-order association rules,31 third-order rules,and 30 fourth-order rules.The top-ranking association rule of each order was“Huangqi(Astragali Radix)→Limb ed-ema”“Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatholobi Caulis)→Limb numbness and pain”,and“Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatholobi Caulis)+Huangqi(As-tragali Radix)→Limb numbness and pain”,respectively.Similarly,the drug-western medi-cine index associations were investigated under the criteria of support≥5%and confidence=100%,and five second-order association rules,16 third-order rules,and 16 fourth-order rules were identified.In this category,the top-ranking association rule of each order was“Qinpi(Fraxini Cortex)→Uric acid”“Huanglian(Coptidis Rhizoma)+Ganjiang(Zingiberis Rhizoma)→Glycated hemoglobin”,and“Huanglian(Coptidis Rhizoma)+Ganjiang(Zing-iberis Rhizoma)+Huangqin(Scutellariae Radix)→Glycated hemoglobin”,respectively.Conclusion Through association rule mining,this study objectively and quantitatively demonstrated the drug-drug,drug-symptom,and drug-physicochemical index associations of patients with the spleen dampness syndrome at the splenic deficiency and impairment stage treated by Academician TONG Xiaolin.The results indicated that treatment for these patients adopted the“state-target”syndrome differentiation method.The drug combination was characterized by“small prescriptions”,targeting both the patient’s symptoms and signs(syndrome target)and western medicine indices(treatment target).This study could provide references for future research on the academic thoughts and medical experience of Academi-cian TONG Xiaolin.

Abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type

Objective:To explore the abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type.Methods:The 30 healthy individuals included in the method were from the Physical Examination Center of Anhui Provincial Hospital of Traditional Chinese Medicine,and the 60 rheumatoid arthritis patients included were from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine.The disease activity score of patients with rheumatoid arthritis was evaluated using VAS score and DAS28 score,joint symptoms and spleen deficiency syndrome score were evaluated using graded quantification method,immune inflammation indicators were detected using relevant instruments,inflammatory cytokines were detected using ELISA method,macrophage markers were detected using FCM method,and pathway gene expression was detected using RT-qPCR;Evaluate the predictive effect of circ-CBLB and miR-486-5p on disease activity in rheumatoid arthritis using ROC curves.Results:(1)miR-486-5p,CD14^(+)CD86^(+),ESR,CRP,RF,Anti CCP Ab,IL-6,TNF in patients with rheumatoid arthritis-αThe levels of circ-CBLB,CD14^(+)CD163^(+),IL-4,and IL-10 were significantly higher than those of healthy individuals;(2)The expression level of circ-CBLB in patients with rheumatoid arthritis is positively correlated with CD14^(+)CD163^(+),and negatively correlated with miR-486-5p and CD14^(+)CD86^(+);The expression level of miR-486-5p is negatively correlated with CD14^(+)CD163^(+)and positively correlated with CD14^(+)CD86^(+);There is a negative correlation between CD14^(+)CD86^(+)and CD14^(+)CD163^(+);ESR is negatively correlated with circ-CBLB,and positively correlated with miR-486-5p,CD14^(+)CD86^(+),CRP;CRP is negatively correlated with circ-CBLB,CD14^(+)CD163^(+),and positively correlated with CD14^(+)CD86^(+),ESR;(3)The expression level of circ-CBLB in patients with rheumatoid arthritis is negatively correlated with joint tenderness,morning stiffness,lack of qi and lazy speech,and postprandial abdominal distension score;The expression level of miR-486-5p is positively correlated with the scores of joint tenderness and decreased appetite.(4)The ROC curve shows that in terms of circ-CBLB,ESR,CRP,VAS,and DAS28 AUC are 0.662(P=0.032),0.658(P=0.035),0.516(P=0.830),and 0.791(P=0.000),respectively.In terms of miR-486-5p,ESR,CRP,VAS,and DAS28 AUC were 0.566(P=0.385),0.511(P=0.883),0.592(P=0.223),and 0.727(P=0.003),respectively.Conclusion:The abnormal expression of circ CBLB and miR-486-5p in peripheral blood mononuclear cell of patients with rheumatoid arthritis of spleen deficiency and dampness excess type is related to inflammatory polarization markers,immune inflammation,disease activity,joint symptoms and spleen deficiency syndrome of rheumatoid arthritis,and the low expression of circ CBLB and high expression of miR-486-5p have certain predictive value for disease activity of rheumatoid arthritis.

Observation on Therapeutic Effects of Electroacupuncture on Polycystic Ovary Syndrome of Kidney Deficiency and Phlegm Dampness Type and Oxidative Stress Level

Objective:To observe the clinical effect of electroacupuncture on improving polycystic ovary syndrome(PCOS)of kidney deficiency and phlegm dampness type and serum oxidative stress level.Methods:There were 68 patients with polycystic ovary syndrome were randomly divided into observation group(34 cases)and the control group(34 cases),The observation group was treated by electroacupuncture,while the control group was treated by placebo electroacupuncture.Combined with the evaluation of menstrual cycle,menstrual color,quality,quantity and TCM symptom integral index,the difference of curative effect between the two groups was observed,and the levels of peripheral blood,sex hormones,insulin resistance and oxidative stress were detected before and after treatment for 3 months.Results:The total effective rate in the observation group was better than that in the control group(P<0.01);After intervention,serum LH,FSH,E_(2) and LH/FSH in the observation group were significantly different from those before intervention.The D values of serum LH,FSH,LH/FSH and E_(2) before and after intervention were significantly different between the two groups(P<0.01);Comparing the level of androgen,the serum A4 and T in the observation group were significantly different from those before intervention(P<0.01);After intervention,there was a significant difference in serum A4 and T between the two groups(P<0.01),and there was a significant difference in D value between the two groups before and after intervention;There was a difference in insulin resistance in the observation group before and after intervention(P<0.05),and there was a significant difference in D value between the two groups before and after intervention(P<0.01);After the intervention,the serum SOD,MDA,ROS in the observation group were significantly different from those before the intervention;After intervention,the results of serum SOD and ROS in the observation group were significantly different from those in the control group;There was no significant difference in serum MDA results.There were significant differences in SOD,MDA,ROS between the two groups before and after intervention.Conclusion:Electroacupuncture can improve oxidative stress injury,insulin resistance and hyperandrogenism in PCOS patients.

Study on the Expression of Organic Anion Transporting Polypeptide (oatp2a1) in Rat with Spleen Deficiency Syndrome and the Exploration of Clinical Significance

Objective: to explore the mechanism of transportation and transformation of dampness by the way of the expression of organic anion transporting polypeptide (oatp) superfamily member 2a1 (oatp2a1) mRNA in rat with spleen deficiency syndrome and the significance in transportation and transformation of dampness. Methods: 32 wistar male rats were divided randomly into four groups: normal group (n = 6), normal + AA group (n = 6), spleen deficiency group (n = 10), Spleen deficiency + AA group (n = 10). After reserpine-induced spleen deficiency model was made, intragastric administration of aristolochic acid (AA) was adopted for three days, the expression of oatp2a1 mRNA were detected in the tissues of lung, liver, kidney, stomach, small intestine and large intestine in four groups by using Fluorescent Quantitative-Polymerase Chain Reaction (FQ-PCR). Results: the expression of oatp2a1 mRNA in above six tissues could be detected. The ex-pression of oatp2a1 mRNA in liver tissue of rat with spleen deficiency syndrome was up-regulated compared to normal group (P = 0.035, P < 0.05), the expression of oatp2a1 mRNA in small intestinal tissue of rat with spleen deficiency syndrome was down-regulated compared to normal group (P = 0.004, P < 0.01), the expression of oatp2a1 in intestinal tissue in normal + AA group is down-regulated compared to normal group (P = 0.032, P < 0.05). Conclusions: oatp2a1 might be one of the material basis involved in transportation and transformation of dampness. The changes of expression of oatp2a1 mRNA in small intestine, liver tissue suggests that small intestine, liver might play an important role in the transportation and transformation of dampness in the state of spleen deficiency. We further concluded that the function of spleen’s governing transportation and transformation of dampness was not only including the function of the gastrointestinal, but also part of the liver function in some degree, which needs to be further studied.

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.

Screening the effective components in treating dampness stagnancy due to spleen deficiency syndrome and elucidating the potential mechanism of Poria water extract

Poria is an important medicine for inducing diuresis to drain dampness from the middle energizer.However,the specific effective components and the potential mechanism of Poria remain largely unknown.To identify the effective components and the mechanism of Poria water extract(PWE)to treat dampness stagnancy due to spleen deficiency syndrome(DSSD),a rat model of DSSD was established through weight-loaded forced swimming,intragastric ice-water stimulation,humid living environment,and alternate-day fasting for 21 days.After 14 days of treatment with PWE,the results indicated that PWE increased fecal moisture percentage,urine output,D-xylose level and weight;amylase,albumin,and total protein levels;and the swimming time of rats with DSSD to different extents.Eleven highly related components were screened out using the spectrum-effect relationship and LC-MS.Mechanistic studies revealed that PWE significantly increased the expression of serum motilin(MTL),gastrin(GAS),ADCY5/6,p-PKAα/β/γcat,and phosphorylated cAMP-response element binding protein in the stomach,and AQP3 expression in the colon.Moreover,it decreased the levels of serum ADH,the expression of AQP3 and AQP4 in the stomach,AQP1 and AQP3 in the duodenum,and AQP4 in the colon.PWE induced diuresis to drain dampness in rats with DSSD.Eleven main effective components were identified in PWE.They exerted therapeutic effect by regulating the AC-cAMP-AQP signaling pathway in the stomach,MTL and GAS levels in the serum,AQP1 and AQP3 expression in the duodenum,and AQP3 and AQP4 expression in the colon.

Preventive online and offline health management intervention in polycystic ovary syndrome

BACKGROUND Polycystic ovary syndrome(PCOS) is characterized by hyperandrogenism, hyperinsulinemia, ovarian polycystic changes, and irregular ovulation, often occurring in women of childbearing age for whom it can be a cause of infertility. Hypothalamus-pituitary-ovarian axis dysregulation is important in the pathogenesis of PCOS and the associated chronic excess of sex hormones can lead to cardiovascular and cerebrovascular diseases, diabetes, and malignancies such as endometrial cancer, and breast cancer. At present, most scholars agree that lifestyle interventions in conjunction with drug treatment can help PCOS patients achieve their goals of successful pregnancy and childbirth.AIM To investigate the clinical effect of an online and offline(O2O) preventive health management model on PCOS with kidney deficiency and phlegm dampness.METHODS A total of 82 patients with PCOS of the kidney deficiency and phlegm dampness type who were admitted to Beijing Luhe Hospital Affiliated to Capital Medical University from April 2019 to June 2020 were randomly divided into two groups. The treatment group was treated with oral Diane-35 for 3 mo and received preventive O2O medical health management for 6 mo(including eating and living, exercise, drug management). The control group was treated with oral Diane-35 for 3 mo and completed outpatient health education. The traditional Chinese medicine(TCM) syndrome score, acne score, hair score, sex hormone level and clinical effects were compared between the two groups before and after the intervention. RESULTS After treatment, the TCM syndrome score, acne score, and serum luteinizing hormone/follicle stimulating hormone level were significantly lower in the treatment group than in the control group(P < 0.05). After 3 mo of treatment, the TCM syndrome curative effect index in the treatment group was 97.30% compared to 54.05% in the control group(P < 0.05), whereas the total treatment effect in the treatment group was 91.89%, compared to 54.05% in the control group(P < 0.05).CONCLUSION An integrated therapeutic approach incorporating medication, TCM methods and social media is more effective than standard treatment for PCOS.

Study on the Resolving Phlegm Effect of D-Limonene in Mice with Spleen Deficiency and Phlegm-Dampness Syndrome

Objective:According to Traditional Chinese Medicine theory,spleen deficiency and phlegm-dampness syndrome(SDPDS)are caused by abnormal water metabolism in the body because of spleen dysfunction.The purpose of this article was to evaluate the efficacy of D-limonene(DL)in resolving phlegm in mice with SDPDS from the perspective of regulating the level of aquaporin 3(AQP3).Methods:The model of SDPDS was induced in mice using the multifactor modeling method,which combines internal and external dampness.An artificial climate box was used to create a humid environment,whereas the irregular diet was caused by different feeding methods on odd-even days.The mice were divided into blank control,model group,DL low-dose,DL high-dose,and positive groups.The mice were modeled and treated for 7 day.Levels of gastrin and amylase(AMS)in the serum,mucus secretion in the trachea,and AQP3 in the tissue near the gastric cardia.Results:DL significantly reduced mucus secretion in the trachea(P<0.001).It also increased the level of AMS in the serum(P<0.01)and decreased the level of AQP3 in the gastric tissue(P<0.01).Conclusions:Mice with SDPDS exhibited disturbed water metabolism and significantly increased AQP3 levels.DL can restore the levels of AQP3 and plays an important role in resolving phlegm.This study may also help expand the efficacy of natural drugs containing DL and improve the utilization of natural drug resources.

脐灸疗法联合枳朴六君子汤治疗脾虚湿滞型泄泻的临床效果

目的:探讨脐灸疗法联合枳朴六君子汤治疗脾虚湿滞型泄泻的临床效果。方法:选择2021年2月—2023年7月于盐城市中医院门诊就诊的脾虚湿滞型泄泻患者92例,采用随机数字表法分成常规组与联合组,每组46例。常规组采用双歧杆菌三联活菌肠溶胶囊治疗,联合组采用脐灸疗法联合枳朴六君子汤治疗。观察两组患者的中医证候积分、主要症状评分、贝克抑郁量表评分、临床疗效、不良反应发生情况。结果:治疗后,联合组患者中医证候积分、主要症状评分与贝克抑郁量表评分均低于常规组(P<0.05);联合组患者治疗总有效率高于常规组(P<0.05);两组不良反应总发生率差异无统计学意义(P>0.05)。结论:脐灸疗法联合枳朴六君子汤能够改善患者血清学指标及肠黏膜屏障功能,降低中医证候积分,提高患者免疫功能及临床疗效,安全性较高。

慢性肾脏病3~5期(非透析患者)脾肾亏虚证与湿浊证舌象特征研究

目的研究两种不同证型慢性肾脏病患者的舌象特征数据,探析两类患者舌象特征的差异,通过融合现代计算机视觉技术,提高中医临床辨证客观性。方法采集辽宁中医药大学肾病科门诊2022年9月—2023年9月80例患者舌象,并提出舌象分区模型,通过观察两种证型患者舌色、舌型、苔色、苔质、舌下络脉等,并结合数据分析其HSV色度空间参数,进而获取两种证型患者舌象特征信息。结果脾肾亏虚型患者以淡红舌为主,多伴齿痕、白苔,舌下脉络增粗、迂曲、颜色加深不明显;湿浊型以红舌为主,多伴齿痕、点刺、厚腻苔、舌下络脉增粗、迂曲、颜色加深明显。结论分区模型可以量化不同证型患者的舌象特征,并在一定程度上提高舌诊的准确性和辩证的参照性。

加味苓桂术甘汤联合限食对脾虚痰湿型糖尿病脑病大鼠海马组织PI3K/Akt/mTOR通路的影响

目的:研究加味苓桂术甘汤联合限食对脾虚痰湿型糖尿病脑病(DE)大鼠海马组织PI3K/Akt/mTOR通路的影响。方法:建立脾虚痰湿型糖尿病脑病大鼠模型,将大鼠随机分为正常对照组、DE组、脾虚痰湿DE组、限食组、加味苓桂术甘汤组、加味苓桂术甘汤联合限食组和二甲双胍组,药物干预4 w。给药后测量体质量、空腹血糖、血脂;Morris水迷宫检测大鼠学习记忆能力;Western blot检测各组海马组织PI3K、Akt、mTOR蛋白表达。结果:加味苓桂术甘汤联合限食可显著降低脾虚痰湿型糖尿病脑病大鼠体质量、空腹血糖、血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平(P<0.05或P<0.01);改善Morris水迷宫实验成绩(P<0.05);升高海马组织PI3K、Akt蛋白表达(P<0.01),降低mTOR蛋白表达(P<0.01)。结论:加味苓桂术甘汤联合限食能改善脾虚痰湿型糖尿病脑病大鼠糖脂代谢,增强学习记忆能力,其机制可能与调节PI3K/Akt/mTOR通路有关。

基于“坚者削之,结者散之”治疗消化道息肉理论探析

消化道息肉主要是指胃肠道息肉,目前本病临床上最常用的治疗方法为内镜下治疗,虽见效快,但并发症较多,且治疗后仍有较高的复发率。中医药对于预防本病复发有一定的优势,本课题组通过总结古今相关文献以及结合临床实践研究,认为消化道息肉的核心病机多以脾虚气滞为本,而脾胃气机壅滞进一步产生湿、痰、瘀等病理因素为标,故紧扣病机,根据“坚者削之,结者散之”理论,提出“消散法”辨治消化道息肉,临证时需灵活变通,随症加减,以期为中医药治疗消化道息肉提供新的见解。

加味半夏泻心汤联合盐酸西替利嗪片递减法治疗慢性自发性荨麻疹(脾虚湿热证)疗效观察

目的观察加味半夏泻心汤联合盐酸西替利嗪片递减法对慢性自发性荨麻疹(脾虚湿热证)的临床疗效。方法选取2021年1月至2022年6月达州市中西医结合医院确诊的慢性自发性荨麻疹(脾虚湿热证)70例,采用随机数字表分为治疗组与对照组,每组各35例。对照组给予西替利嗪片递减法治疗,治疗组在对照组基础上联用加味半夏泻心汤。两组总疗程为6周。在治疗第4周及第6周开始时,观察两组病人盐酸西替利嗪片使用情况,并于第6周治疗结束后,观察两组病例的临床疗效、西替利嗪片使用总量、荨麻疹活动度评分(UAS)及皮肤生活质量指数(DQLI)评分、血清总免疫球蛋白E(IgE)值、不良反应。并于治疗结束后8周统计复发情况。结果研究实际完成60例,两组各30例。治疗第4周及第6周开始时,治疗组盐酸西替利嗪片使用间隔时间明显高于对照组(治疗组西药减量速度高于对照组)(P<0.05)。6周后,治疗组治愈率为53.33%(16/30),对照组治愈率为20%(6/30);治疗组治愈率明显高于对照组(P<0.05);治疗组病人西替利嗪片使用总量明显低于对照组(P<0.05),治疗组UAS及DQLI评分比对照组低(P<0.05);不良反应两组无差异。疗程结束以后8周随访,复发率治疗组比对照组显著降低(P<0.05)。结论加味半夏泻心汤联合盐酸西替利嗪片递减法治疗慢性自发性荨麻疹(脾虚湿热证)临床疗效确切,可明显缩短病程,降低复发率。

温肾化痰方联合西药治疗对肾虚痰湿型PCOS伴IR不孕症患者性激素、糖代谢、排卵率、妊娠率、疗效及不良反应的影响

目的 分析温肾化痰方联合西药治疗对肾虚痰湿型多囊卵巢综合征(PCOS)伴胰岛素抵抗(IR)不孕症患者性激素、糖代谢、排卵率、妊娠率、疗效及不良反应的影响。方法 选取2022年12月至2023年7月河南省中医院生殖医学科门诊收治的61例肾虚痰湿型PCOS伴IR不孕症患者作为研究对象,随机分为试验组(31例)和对照组(30例)。对照组给予盐酸二甲双胍片、来曲唑片进行治疗,试验组在此基础上加用温肾化痰方治疗,两组均治疗3个月经周期。观察治疗前后患者血清睾酮(T)、促黄体生成素(LH)、卵泡刺激素(FSH)水平、LH/FSH比值、体质量指数(BMI)、空腹血糖(FBG)、空腹胰岛素(FINS)、稳态指数模型(HOMA-IR)、排卵率、妊娠率和疗效情况,并进行安全性评估。结果 治疗前两组BMI、HOMA-IR、LH/FSH比值及血清T、LH、FSH、FBG、FINS水平比较,差异均无统计学意义(P>0.05);治疗后,两组BMI、HOMA-IR、LH/FSH比值及血清T、LH、FBG、FINS水平低于治疗前,血清FSH水平高于治疗前,且试验组BMI、HOMA-IR、LH/FSH比值及血清T、LH、FBG、FINS水平低于对照组,血清FSH水平高于对照组,差异均有统计学意义(P<0.05)。试验组治疗的总有效率、排卵率、妊娠率高于对照组,不良反应总发生率低于对照组,差异均有统计学意义(P<0.05)。结论 温肾化痰方联合常规西药治疗肾虚痰湿型PCOS伴IR不孕症疗效优于单用常规西药,可提高排卵率及妊娠率,改善女性性激素及糖代谢指标水平,缓解IR,改善中医临床症状,且安全性良好。

大肠息肉患者病例特点和中医证型分布及其与焦虑抑郁的关系

【目的】探讨大肠息肉患者的流行病学特征、中医证型分布及焦虑抑郁情况。【方法】选取2022年1月至2023年12月期间在广州中医药大学东莞医院内镜中心行结肠镜检查或治疗的大肠息肉患者200例(息肉组)和肠道未见异常者100例(非息肉组),收集2组患者的相关病历资料,对大肠息肉患者进行中医辨证分型,并对其流行病学特征包括性别、年龄、体质量指数(BMI)、烟酒史等进行问卷调查和记录,同时进行医院焦虑抑郁量表(HAD)评分,以评估其焦虑、抑郁状态。【结果】(1)流行病学特征方面,息肉组与非息肉组患者的性别、年龄、BMI、吸烟、饮酒等一般情况比较,差异均有统计学意义(P <0.05或P <0.01)。具体表现为,息肉组以男性为主(63.5%),而非息肉组以女性为主(58.0%),说明相比女性患者,男性患者更易患大肠息肉;年龄方面,息肉组以51~60岁年龄段为主(36.0%),非息肉组以41~50岁年龄段为主(38.0%),说明息肉组的平均年龄较非息肉组大;另外,息肉组的肥胖(BMI≥28.0 kg/m2)、吸烟、饮酒人数占比均较非息肉组高。(2)息肉情况方面,大肠息肉多发病于左半结肠,占息肉组的53.5%;腺瘤性息肉占所有息肉病理类型的57.0%;肠息肉大小以<1.0 cm为主,占所有息肉的81.5%;单发性肠息肉占45.5%,多发性肠息肉占54.5%,说明大肠息肉仍以多发为主。(3)中医证型分布方面,200例大肠息肉患者中,脾虚湿滞证93例(46.5%),大肠湿热证59例(29.5%),肝郁气滞证27例(13.5%),湿瘀阻滞证21例(10.5%)。不同性别、年龄、BMI和饮酒情况的大肠息肉患者中医证型分布比较,差异均无统计学意义(P> 0.05);而不同吸烟情况的大肠息肉患者中医证型分布比较,差异有统计学意义(P <0.05)。不同发病部位、息肉数目、病理类型的大肠息肉患者中医证型分布比较,差异均无统计学意义(P> 0.05);而不同息肉大小的大肠息肉患者中医证型分布比较,差异有统计学意义(P <0.05),其中,息肉大小<1.0 cm者脾虚湿滞证及大肠湿热证的比例明显高于≥1.0 cm者,湿瘀阻滞证的比例明显低于≥1.0 cm者。(4)焦虑、抑郁状态方面,息肉组患者HAD量表的焦虑、抑郁状态评分均高于非息肉组,差异均有统计学意义(P <0.01)。进一步分析发现,对于大肠息肉患者而言,除息肉大小的焦虑状态评分外,不同发病部位、发病数目、病理类型与焦虑状态、抑郁状态评分以及息肉大小与抑郁状态评分均无关,差异均无统计学意义(P> 0.05)。另外,不同中医证型的焦虑、抑郁状态评分比较,差异也均无统计学意义(P> 0.05)。【结论】(1)大肠息肉的中医证型分布以脾虚湿滞证、大肠湿热证为多,其中医证型分布与焦虑抑郁及肠息肉的发病部位、数目、病理类型无关,而与息肉大小具有一定的相关性;(2)焦虑抑郁可能是大肠息肉发病的危险因素,但大肠息肉的发病部位、发病数目、病理类型与焦虑抑郁无关,息肉大小可能与焦虑具有一定的相关性。(3)性别、年龄、吸烟、饮酒可能是大肠息肉发病的危险因素。

基于“主客交”理论分期论治上气道咳嗽综合征

基于“主客交”理论,上气道咳嗽综合征的病机为肺脾气虚,风邪客于肺脾,痰浊上扰,风痰搏结,合而为病,故治疗以宣肺化痰、培土生金为法则。急性期治客,客去交易解,风热者疏风清热解表,药用连翘、金银花、菊花、蒲公英等;风寒者散之宣之,药用防风、荆芥、苍耳子、白芷、紫苏叶、辛夷等;缓解期治交,交去主客分离,药选陈皮、半夏、竹茹、瓜蒌、干姜、细辛、贝母、知母等;恢复期治主,主安邪不易犯,治应培土生金、健脾化痰,药选茯苓、白术、苍术、山药等。

免疫治疗对晚期胃癌中医证型演变规律的影响

目的:观察免疫治疗对晚期胃癌(gastric cancer, GC)患者中医证型演变规律的影响。方法:共纳入58例晚期GC患者,其中腹膜转移组38例,无腹膜转移组20例,收集患者的一般资料、临床病理学特征及治疗前后中医证型。运用χ~2检验评估各项指标间的相关性,运用Kaplan-Meier法评估各种证型无进展生存期(progression-free survival, PFS)。结果:58例GC患者治疗前中医证型以痰湿凝结证、肝胃不和证为主,两种证型PFS比较,差异无统计学意义(P>0.05);治疗后以气阴两虚证、脾胃虚寒证为主,两种证型PFS比较,差异无统计学意义(P>0.05)。腹膜转移组治疗前主要证型为肝胃不和证、痰湿凝结证、气滞血瘀证;治疗后主要证型为脾胃虚寒证、气阴两虚证、气血亏虚证。无腹膜转移组治疗前主要证型为气阴两虚证、痰湿凝结证、脾胃虚寒证;治疗后主要证型为气阴两虚证、脾胃虚寒证、气血亏虚证。腹膜转移组治疗前肝胃不和证与痰湿凝结证肿瘤原发部位、分化程度、组织学、分期比较,差异并无统计学意义(P>0.05)。58例晚期GC患者PFS为(5.19±2.95)个月,其中腹膜转移组PFS为(4.22±2.77)个月,无腹膜转移组PFS为(7.02±2.40)个月,两组PFS比较,差异具有统计学意义(P<0.05)。将58例GC患者肝胃不和证、痰湿凝结证、气滞血瘀证归为实证,气阴两虚证、脾胃虚寒证、气血亏虚证归为虚证。实证与虚证PFS比较,差异无统计学意义(P>0.05)。结论:肝胃不和证和痰湿凝结证在晚期腹膜转移患者中多见,且生存期更短,免疫治疗可改善晚期GC患者中医证型的分布规律,加强对晚期GC患者中医证型的关注,并进行及早干预,有助于提高患者的生存期。

毫火针联合清补化痤饮治疗脾虚湿热证痤疮的临床疗效观察

【目的】观察毫火针联合清补化痤饮治疗脾虚湿热证痤疮的临床疗效和安全性。【方法】将2023年5月至2024年3月于广州中医药大学第七临床医学院就诊的70例脾虚湿热证痤疮患者,按随机数字表法随机分为观察组和对照组,每组各35例。2组患者均给予健康宣教,对照组给予毫火针联合盐酸多西环素片口服治疗,观察组给予毫火针联合清补化痤饮口服治疗,疗程均为6周。治疗6周后,评价2组临床疗效,观察2组患者治疗前后痤疮综合分级系统(GAGS)评分与面部痤疮特异性生活质量量表(Qol-Acne)评分的变化情况,以及中医证候积分的情况。比较2组患者治疗前后皮肤屏障功能指标经表皮水分丢失(TEWL)含量、皮肤水分含量、皮脂含量的变化情况。并评价2组的安全性及不良反应的发生情况。【结果】(1)治疗后,2组患者的GAGS评分明显改善(P<0.05),且观察组在改善GAGS评分方面明显优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的Qol-Acne评分均明显改善(P<0.05),且观察组在改善自我感知、情感功能、自我评估3个方面明显优于对照组,差异有统计学意义(P<0.05),观察组在改善社会功能方面稍优于对照组,但差异无统计学意义(P>0.05)。(3)治疗后,2组患者的TEWL、皮肤水分、皮脂含量均明显改善(P<0.05),且观察组在改善TEWL、皮肤水分、皮脂含量方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者的中医证候积分明显改善(P<0.05),且观察组在改善中医证候积分方面明显优于对照组,差异有统计学意义(P<0.05)。(5)观察组总有效率为94.29%(33/35),对照组为74.29%(26/35)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。(6)观察组和对照组的不良反应发生率比较,差异无统计学意义(P>0.05)。【结论】毫火针联合清补化痤饮治疗脾虚湿热证痤疮,能明显改善患者的临床症状,从而提高患者生活质量,疗效显著,且安全性好。

苍术健脾、燥湿的作用机制及研究进展

综述苍术健脾、燥湿的作用机制及研究进展。古代医家常用苍术治疗多种疾病的脾胃湿证。苍术有效成分能改善胃排空及小肠推进率;可增加胃泌素、胃动素等,促进胃酸分泌,增加胃肠动力;可降低血管活性肠肽水平,抑制肠蠕动亢进。苍术能双向调节胃肠功能紊乱,且还能改善胃黏膜的异常形态,减轻胃组织损伤,改善肠组织异常结构。苍术燥湿的主要有效成分为挥发油,可导致体液丢失,血黏度增加,影响唾液腺分泌,引起口干,降低肾脏水通道蛋白2的表达量。苍术及其提取物能降低大鼠胃、大肠、尿液中水通道蛋白含量,通过多脏器调节体内水液代谢。故苍术能从影响脏器形态、胃肠道激素水平、水通道蛋白表达等多方面达到健脾、燥湿的功效。

慢性心力衰竭气虚血瘀证潜在亚组人群特征探索研究

目的探索慢性心力衰竭(CHF)气虚血瘀证潜在亚组人群,为心力衰竭的中医精准辨治提供客观依据。方法收集126例CHF气虚血瘀证患者的19种症状/体征指标和21种生化指标,利用R和Python软件进行K-mediods聚类算法分析,以轮廓系数确定最佳的聚类数目。组间比较,连续变量采用Kruskal-Wallis检验,分类变量采用Pearson's chi-squared检验或者Fisher's exact检验。结果CHF气虚血瘀证患者被聚类为3组,组间比较发现,气喘、不寐、颈脉怒张、纳差、畏寒5个症状/体征以及NYHA分级、氨基末端脑钠肽前体(NT-proBNP)、红细胞比容、尿素氮4个临床指标差异具有统计学意义(P<0.05)。第1组人群整体各症状/体征发生频率和临床指标严重程度相对较低;第2组人群以颈脉怒张发生频率较其他组高为特征,且促甲状腺激素、总胆固醇及低密度脂蛋白有偏高趋势,血小板有偏低的趋势;第3组人群以畏寒、纳差、不寐的发生率较其他组显著升高为特征,伴随尿素氮增高、红细胞比容降低。结论CHF气虚血瘀证潜在3种亚型,分别是气虚血瘀证本证型、气虚血瘀兼痰浊型、气虚血瘀兼阳虚型。