Theoretical Discussion on Treatment of Cubital Tunnel Syndrome Based on Theory of Liver,Spleen and Kidney

Cubital tunnel syndrome is a disease in which ulnar nerve is compressed by its surrounding tissues,and its main clinical manifestations are pain,sensory disturbance and dyskinesia.Its incidence rate is the second highest among peripheral nerve entrapment diseases,and it is one of the common clinical diseases.The theory of liver,spleen and kidney can guide the treatment of cubital tunnel syndrome with traditional Chinese medicine and acupuncture.By discussing the traditional Chinese medicine(TCM)pathogenesis and treatment principles of cubital tunnel syndrome,it provides modern medical theoretical support for TCM treatment of cubital tunnel syndrome.

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.

Clinical trial with traditional Chinese medicine intervention ''tonifying the kidney to promote liver regeneration and repair by affecting stem cells and their microenvironment'' for chronic hepatitis B-associated liver failure

AIM:To study the clinical efficacy of traditional Chinese medicine(TCM)intervention"tonifying the kidney to promote liver regeneration and repair by affecting stem cells and their microenvironment"("TTK")for treating liver failure due to chronic hepatitis B.METHODS:We designed the study as a randomized controlled clinical trial.Registration number of Chinese Clinical Trial Registry is Chi CTR-TRC-12002961.A total of 144 patients with liver failure due to infection with chronic hepatitis B virus were enrolled in this randomized controlled clinical study.Participants were randomly assigned to the following three groups:(1)a modern medicine control group(MMC group,36patients);(2)a"tonifying qi and detoxification"("TQD")group(72 patients);and(3)a"tonifying the kidney to promote liver regeneration and repair by affecting stem cells and their microenvironment"("TTK")group(36patients).Patients in the MMC group received general internal medicine treatment;patients in the"TQD"group were given a TCM formula"tonifying qi and detoxification"and general internal medicine treatment;patients in the"TTK"group were given a TCM formula of"TTK"and general internal medicine treatment.All participants were treated for 8 wk and then followed at 48 wk following their final treatment.The primaryefficacy end point was the patient fatality rate in each group.Measurements of various virological and biochemical indicators served as secondary endpoints.The one-way analysis of variance and the t-test were used to compare patient outcomes in the different treatment groups.RESULTS:At the 48-wk post-treatment time point,the patient fatality rates in the MMC,"TQD",and"TTK"groups were 51.61%,35.38%,and 16.67%,respectively,and the differences between groups were statistically significant(P<0.05).However,there were no significant differences in the levels of hepatitis B virus DNA or prothrombin activity among the three groups(P>0.05).Patients in the"TTK"group had significantly higher levels of serum total bilirubin compared to MMC subjects(339.40μmol/L±270.09μmol/L vs 176.13μmol/L±185.70μmol/L,P=0.014).Serum albumin levels were significantly increased in both the"TQD"group and"TTK"group as compared with the MMC group(31.30 g/L±4.77g/L,30.72 g/L±2.89 g/L vs 28.57 g/L±4.56 g/L,P<0.05).There were no significant differences in levels of alanine transaminase among the three groups(P>0.05).Safety data showed that there was one case of stomachache in the"TQD"group and one case of gastrointestinal side effect in the"TTK"group.CONCLUSION:Treatment with"TTK"improved the survival rates of patients with liver failure due to chronic hepatitis B.Additionally,liver tissue was regenerated and liver function was restored.

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.

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.

Renal aspergillosis after liver transplantation: Clinical and imaging manifestations in two cases

Renal aspergillosis(RAsp)is a rare complication in liver transplant(LT)recipients.Here we report RAsp in two LT recipients.In both patients,RAsp occurred more than 90 d after allogenetic orthotropic LT,and all the clinical findings were unspecific.RAsp involved unilateral kidney in Case one and bilateral kidneys in Case two.Both computed tomography(CT)and magnetic resonance imaging(MRI)revealed renal abscesses,with progressively enhanced walls and separationsand unenhanced alveolate areas after contrast agent administration.On unenhanced CT images they showed inhomogeneous hypo-attenuation.On fat-suppressed T2-weighted images(T2WIs),the walls and separations of the abscesses showed slightly low signal intensity and the central parts of the lesions showed slightly high signal intensity.Both on CT and MRI,there were some hints of renal infarction or chronic ischemia.Both cases were treated by radical nephrectomy followed by adjuvant antifungal treatment.They all recovered well.

Hepatorenal syndrome: Update on diagnosis and treatment

Acute kidney injury(AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome(HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice.

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。

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.

基于“脾气散精”理论探讨慢性肝病的中医治疗

慢性肝病的发病与脾密切相关,“脾气散精”是《黄帝内经》对脾功能的高度概括,脾气散精功能障碍贯穿慢性肝病始终,脾失运化,生湿生痰,瘀血阻络为慢性肝病进展的关键因素。治疗时应将健脾作为慢性肝病的基本治法之一,并根据脾运的不同状态,配合运脾、醒脾、温脾等不同治法,以复脾气散精之能,病程中尤应抓住瘀血络阻这一关键病机,活血化瘀通络,防止慢性肝病进一步向肝积、鼓胀发展,使脾运得复,瘀阻得除,标本兼治。

从肝脾论治甲状腺良性结节研究进展

甲状腺结节为常见的内分泌系统疾病,多为良性结节。西医对于甲状腺结节缺乏有效的治疗措施,对于部分病情严重的患者可进行手术治疗,但相关并发症较多。中医认为,甲状腺结节的发生与患者情志失调密切相关,而情志畅达与肝脏气机调畅密切相关,患者情志抑郁可致肝气郁结,日久使得脾胃生化功能失调,肝郁脾虚则水液输布失常,痰气瘀结于颈前而发为“瘿病”,因此,从疏肝理气、健脾利水、化痰消瘀为基本原则,治疗甲状腺结节能取得良好的效果。

Determining the Electrical Conductivity of Rat Cadaveric Liver,Spleen,and Kidney to Estimate Early Postmortem Interval

Previous research has found that electrical conductivity(EC),an important index to predict meat freshness and shelflife,is very promising for estimating the late postmortem interval(PMI).However,whether it has potential use in the early PMI has not been fully studied yet.To test this possibility in the present study,EC of three internal organs of rat liver,spleen,and kidney were determined within 24 postmortem hows,and then,EC changes at different PMIs were carefully analyzed.The overall results showed that EC of liver and spleen increased significantly with PMI while EC of kidney had minor changes during the same period.Specifically,significant linear positive correlations between EC of liver and spleen and PMI were found and the coefficients of their regression functions were R^(2)=0.98 and R^(2)=0.95,respectively.It can be concluded that determination of EC in certain internal organs such as liver and spleen may be a potential tool in the early PMI estimation.However,more researches on its influencing factors are needed to facilitate its final use in practice.

中西医结合治疗肝郁脾虚型乙型肝炎肝纤维化的研究进展

乙型肝炎病毒(HBV)是引起肝纤维化(HF)及肝硬化的最常见原因之一。虽然针对HBV引起的HF行病因治疗可以取得较好的病毒学应答,但HF仍然存在并不断进展,故抗HF的用药仍值得商榷。近年来,中医在其独有的辨证论治基础上治疗HF已获得一定的临床效果,中西医结合治疗慢性乙型肝炎HF已成为一大热点。研究表明肝郁脾虚型慢性乙型肝炎HF出现相对较早,主要见于HF早期(S1)以及肝组织病理分级G1、G2,是中医控制并逆转HF的重要节点。本文综述近十年中药复方联合恩替卡韦、阿德福韦酯、干扰素、替诺福韦抗病毒药物治疗肝郁脾虚型慢性乙型肝炎HF的研究进展,为临床用药与新药研发提供更多参考。

徐莲薇运用膏方从肝脾论治多囊卵巢综合征经验介绍

介绍徐莲薇教授运用膏方从肝脾论治多囊卵巢综合征的临床经验。徐莲薇教授认为多囊卵巢综合征的病机本质为本虚标实,应从肝、脾、肾论治,健脾填精养血以资其“本”,化痰疏肝消瘀以祛其“实”。冬令膏方依辨证化裁用药严谨,剂型易服方便可坚持,故临床可收良效。

吴敏教授从脾肺肝论治儿科常见疾病的临证经验

儿科常见疾病种类繁多,吴敏教授认为,脾、肝、肾与儿童常见疾病的发生与发展关系密切。根据儿科常见疾病的病机,吴敏教授主张以肝、肾、脾来论治儿科常见疾病,达到良好临床疗效。通过分析典型病例,梳理疾病特点与机制、治疗方法,以为儿科常见疾病的中医论治提供参考,同时亦为吴敏教授治疗经验的推广打下基础。

国医大师王晞星从“木土并治”角度论治功能性消化不良经验

功能性消化不良(FD)是一种常见的无器质性改变的功能性胃肠疾病,主要表现为餐后饱胀不适、早饱感、上腹痛或有烧灼感等,易反复发作。根据其临床表现,FD与中医“胃痞”“痞满”等相似。FD病位在胃,与肝脾密切相关,情志及心理障碍因素与本病的发生也关系密切。王晞星教授从“木土并治”角度出发,认为治疗FD应当“以肝为本、顾护脾胃”,治以疏肝健脾、和胃降逆,以复中焦气机。笔者通过临床跟师随诊,发现从“木土关系”角度论治FD临床疗效显著。

疏肝消痞安神方联合常规西药治疗肝郁脾虚型功能性消化不良伴焦虑的临床效果

目的 观察疏肝消痞安神方联合常规西药治疗肝郁脾虚型功能性消化不良(FD)伴焦虑的临床效果。方法 选取2022年6—11月安徽中医药大学附属六安市中医院接受治疗的肝郁脾虚型FD伴焦虑患者60例,按照随机数字表法分为对照组和观察组,每组30例。对照组患者采用常规西药治疗,观察组患者在对照组基础上采用疏肝消痞安神方治疗,2组患者均持续治疗4周。比较2组临床疗效,治疗前及治疗4周后中医证候积分、汉密尔顿焦虑量表(HAMA)评分、尼平消化不良生活质量指数(NDLQI)评分,不良反应及随访3个月疾病复发率。结果 观察组总有效率为93.33%,显著高于对照组的73.33%(χ^(2)=4.320,P=0.038)。治疗4周后,2组各中医证候积分、HAMA评分低于治疗前,NDLQI评分高于治疗前,且观察组降低/升高幅度大于对照组(P<0.05或P<0.01)。观察组不良反应总发生率为6.67%,与对照组的10.00%比较,差异无统计学意义(P=1.000)。观察组随访3个月疾病复发率为14.29%,低于对照组的45.45%(χ^(2)=5.937,P=0.015)。结论 疏肝消痞安神方联合常规西药治疗能提高肝郁脾虚型FD伴焦虑患者的临床疗效,能更有效地缓解患者临床症状,改善焦虑情绪,降低疾病复发率,提高生活质量,且安全性较高。

基于五运六气探讨胃癌患者先天运气禀赋特点及治疗策略

目的:通过探索胃癌患者的先天五运六气分布特征,归纳其运气禀赋特点并以此探讨胃癌的治疗策略。方法:选取胃癌患者668例作为研究对象,探索分析其出生日期在岁运、主气、客气、司天在泉、运气相合等运气学特征上的差异,探讨胃癌患者发病的先天运气禀赋特征,并依此提出相应治疗策略。结果:出生于木运不及和水运太过之年、主运为少商、客运为太宫、太阳寒水客气、阳明燥金司天/少阴君火在泉的胃癌患者比例最高,岁运、主运、客运、客气、司天在泉分布的差异无统计学意义(P>0.05)。将属性相同的客运进行组合,客运属性为土的胃癌患者比例最高,客运属性为木的胃癌患者比例最低,客运属性分布的差异有统计学意义(P<0.05)。出生于阳明燥金主气的胃癌患者比例最高,出生于少阳相火主气的胃癌患者比例最低,主气分布的差异有统计学意义(P<0.05)。此外,考虑到一甲子年(即60年)中运气相合分布并不平均,因此将胃癌患者出生日期的运气相合分布与一甲子中运气相合分布进行比较,出生于顺化年、天刑年的胃癌患者比例显著升高,出生于小逆年的胃癌患者比例显著降低,运气相合分布的差异具有统计学意义(P<0.0001)。结论:胃癌患者的先天运气禀赋以肝郁脾虚、燥、寒为主要特点,治疗上当以平肝和胃为主,辅以滋阴润燥、顾护阳气、针药并用。

从肝脾论治儿童性早熟

性早熟是儿科常见的内分泌系统疾病之一。文章以肝脾两脏的生理和病理功能为基础,结合儿童独特的生理特点,阐明性早熟的病因病机,主张有目的性地从肝、脾论治以及肝脾同治诊治该疾病,总结相应的治法方药,以期为临床运用中医药有效防治性早熟提供助益,发挥中医药防治该疾病的独特优势。