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.

Summary and Prospect of Treating Ulcerative Colitis by Warming the Kidney and Strengthening the Spleen

The method of warming the kidney and strengthening the spleen is widely used in the treatment of ulcerative colitis (UC) with significant curative effect.This paper reviews the relevant literature in recent years.

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.

巢国俊应用“扶阳消阴,培本通络”法治疗视网膜色素变性经验

介绍巢国俊教授诊治视网膜色素变性临床验案。阳气为人之根本,视网膜色素变性患者本质为脾肾阳虚,阳虚气化不足导致阴邪内生,阴盛则寒,内生阴邪加之外寒之邪,寒性凝滞,进而影响阳气的通达及气血的运行,气血不能到达、濡养视网膜周边,故有夜盲之象。临床诊治视网膜色素变性应当以阴阳为纲,补虚扶本,兼顾气血,遵循“病在阳者,扶阳抑阴”,先温补脾肾之阳,固守先后天之本,扶阳消阴,散邪通络,阳气通达,阴实消散,气血畅通,则视物夜盲改善。

从“温督启阳”理论探讨针灸治疗绝经后骨质疏松症的研究进展

绝经后骨质疏松症以脾肾阳虚居多,针灸疗法在绝经后骨质疏松症的治疗中具有显著优势,针灸通过调理脾肾、温阳督脉功能,达到治疗骨质疏松症的临床目的。笔者通过综述中医学针灸古籍有关绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的理论溯源,阐释祖国医学中PMOP的病因病机,以现在普通针灸、温针灸、电针、督脉灸、穴位埋线、穴位注射和火针等具体治疗方法,基于“温督启阳”理论从绝经后骨质疏松症的病因病机出发,从“督脉调节全身气血、先后天相互滋生”角度将针灸治疗机制与骨代谢相结合,为针灸治疗绝经后骨质疏松症提供新的治疗思路。

Tonifying Kidney, Lung, and Spleen Combined with Western Medicine for Stable Chronic Obstructive Pulmonary Disease: A Systematic Review

Introduction:This study aimed to evaluate the clinical effectiveness and safety of tonifying kidney,lung,and spleen(TKLS)combined with Western medicine for stable chronic obstructive pulmonary disease(COPD).Materials and Methods:Randomized controlled trials(RCTs)of TKLS for stable COPD were searched from four databases including Pub Med,the Cochrane Library,China Biology Medicine,and China National Knowledge Infrastructure from inception to December 2017.Two reviewers independently screened the literature,extracted the data,and assessed the risk of bias in the included studies.Rev Man5.3 software was used for meta-analysis.Results:Fourteen RCTs involving 1339 patients with stable COPD were included.Five of the included articles described the specific method of randomization,1 of them was double-blind method research,and 1 of them was single-blind method research.Compared with the conventional Western medicine(CWM)group,the use of TKLS,if combined with CWM demonstrated significantly improved effective rate(relative risk=1.25,95%confidence interval[CI]:1.18–1.33,P<0.00001),decreased traditional Chinese medicine syndrome score(mean difference[MD]-5.72,95%CI:-8.31 to-3.14,P<0.0001),Decreased St George's Respiratory Questionnaire total score(MD-7.39,95%CI:-10.46 to-4.31,P<0.00001),increased 6-min walk distance in meters(MD 78.46,95%CI:60.18–96.73,P<0.00001),increased forced expiratory volume 1%(MD 6.49,95%CI:3.64–9.33,P<0.00001),increased CD4(MD 9.84,95%CI:6.73–12.94,P<0.00001),CD8(MD-1.84,95%CI:-3.62 to-0.06,P=0.04)and CD4/CD8(MD 0.26,95%CI:0.20–0.32,P<0.0001),and increased immunoglobulin M(MD 0.15,95%CI:0.10–0.20 P<0.00001)..Conclusions:For stable COPD,TKLS combined with CWM is superior to CWM alone with regard to clinical effectiveness,symptoms,and quality of life.The above conclusion needs to be validated by further well-designed,multicentric,large-scale,double-blinded RCTs.

Study of Different Patterns of Immuno-Modulatory Mechanism byTonifying Kidney and Invigorating Spleen Drugs

Objective: To observe the acting pattern on the immune system by Kidney tonifying (KT) drugs. Methods: Three composite recipes were used on the 7- and 14-day corticosterone rat model to study the effect of recipes on the different patterns of immuno-modulatory and neuro- endocrinological systems. Results:The immune system of Spleen Invigorating(SI) group was well protected in either 7- or 14-day experiments,with the SI recipe showing no effect on the neuroendocrine system. It suggested that SI recipe might have direct action on immune system. On the other hand, KT group with no effect on neuroendocrine-immune (NEI) system in 7-day experiment, but showed a remarkable protective effect of the whole NEI system in 14-day experiment. Conclusion: The results indicated that KT recipe acts on the neuroendocrine system first, and then influence the immune system. It means that the action took place through down pathway of NEI network.

郑玉玲自拟附桂管食通方治疗晚期食管癌经验

郑玉玲教授认为晚期食管癌患者正气虚衰,邪气极盛,肝脾胃肾虚衰,尤以脾肾阳虚为重,致顽痰死血结聚于食管,发为癌病;脾肾阳虚、顽痰痼血为其核心病机,“虚、痰、瘀”为主要发病因素,以温补脾肾、消痰逐瘀为治疗原则,并自拟附桂管食通方,收到较好临床疗效。本文总结郑玉玲运用附桂管食通方治疗晚期食管癌的经验,并附验案。

温补脾肾法对脾肾阳虚型UC大鼠JAK2/STAT3-SOCS6信号通路相关蛋白及基因表达的影响

目的:观察以温补脾肾法为指导的理中汤合四神丸对脾肾阳虚型溃疡性结肠炎(UC)大鼠模型病变结肠组织中JAK2、STAT3、p-STAT3、SOCS6蛋白及基因表达的影响。方法:采用病证结合造模方法复制脾肾阳虚型UC模型,成模大鼠随机分为模型组、柳氮磺砒啶组(SASP组)、理中汤合四神丸高、中、低剂量组,16只/组,同时设16只大鼠作为空白组。空白组与模型组给予蒸馏水灌胃,各治疗组给予对应的药物及剂量灌胃治疗,连续21 d。HE染色观察大鼠结肠黏膜组织病理变化;免疫组化法检测大鼠结肠黏膜组织中JAK2、STAT3、p-STAT3、SOCS6蛋白表达情况;RT-qPCR检测大鼠JAK2、STAT3、SOCS6mRNA表达情况;ELISA检测大鼠组织和血清中TGF-β1、ICAM-1含量。结果:与空白组相比,模型组大鼠结肠黏膜组织JAK2、STAT3、p-STAT3蛋白表达显著升高(P<0.01),JAK2、STAT3、p-STAT3蛋白着色深,表达呈强阳性,SOCS6蛋白表达显著降低(P<0.01),SOCS6蛋白着色浅,表达呈弱阳性。JAK2、STAT3 mRNA表达显著升高,SOCS6 mRNA表达显著降低(P<0.01),组织和血清中TGF-β1含量显著降低(P<0.01),ICAM-1含量显著升高(P<0.01);与模型组相比,中药高、中剂量组及SASP组JAK2、STAT3、p-STAT3蛋白表达显著降低(P<0.01),JAK2、STAT3、p-STAT3蛋白着色浅,表达呈弱阳性,SOCS6蛋白表达显著升高(P<0.01),SOCS6蛋白着色深,表达呈强阳性。JAK2、STAT3 mRNA表达显著降低(P<0.01),SOCS6 mRNA表达显著升高(P<0.01),组织和血清中TGF-β1含量显著升高(P<0.01),ICAM-1含量显著降低(P<0.01)。结论:以温补脾肾法为指导的理中汤合四神丸可能通过抑制JAK2/STAT3-SOCS6信号通路的激活,调节免疫系统平衡,修复受损结肠黏膜,达到治疗UC的目的。

周华教授基于分期辨证论治心房颤动的经验

心房颤动是常见的心律失常之一,临床上具有较高的发病率、致残率和死亡率。周华教授认为心房颤动属本虚标实证,本虚以气血阴阳亏虚为主,标实以痰饮、瘀血为主。治疗上强调应分期论治,分初期、中期、后期三期论治。初期心之气阴两伤是其发病关键,治疗以益气养阴为主;中期心脾两虚致痰瘀互结,治疗当化痰祛瘀兼以健脾;后期伤及肾气致心肾阳虚是疾病迁延不愈和恶化的重要原因,治疗以温阳补肾。

基于五脏相关论治难治性胃食管反流病

难治性胃食管反流病成因繁多,临床上仅以常规方法从胃和食管论治本病,难收佳效。五脏相关是中医学整体观念的重要内容。基于五脏相关理论,从脾、肺、肝、肾、心辨治出发,分析各脏与难治性胃食管反流病病机的关系,基于建中理脾、宣降肺气、抑木扶土、温阳益肾、益火养心的原则,指导难治性胃食管反流病的临床治疗,常可速达病所,祛除顽疾,可为临床诊疗提供借鉴。并附验案1则加以阐明。

张东岳治疗慢传输型便秘用药规律探析

目的:通过数据挖掘方法探讨张东岳治疗慢传输型便秘的处方思路及用药规律,为临床治疗慢传输型便秘提供参考。方法:收集整理2016年1月至2021年12月张东岳诊治慢传输型便秘的首诊中药处方,运用中医传承计算平台(V3.0)软件进行药物组方规律分析。结果:共纳入处方556首,涉及中药91味,药物总频次8670次。用药以补虚药为主,其次为化痰止咳平喘药和理气药;四气频数分布以温、平、寒为主;五味分布中甘、苦、辛味居多;归经以脾、肺、大肠、肝经为主;关联规则分析得到63个常用药物组合;k-means聚类分析得到核心药物组合5组。结论:张东岳治疗慢传输型便秘用药以补虚为主,寒温并用;主张多脏调變,重视健脾益肺、润燥助运;善用仁类,柔润滑利;因人制宜,临床效果显著。

温中补肾法合灸疗贴治疗脾肾阳虚泄泻的临床研究

目的 探讨温中补肾法合灸疗贴治疗脾肾阳虚型泄泻的临床疗效。方法 随机选取2021年8月—2022年8月广西壮族自治区江滨医院收治的80例脾肾阳虚型泄泻患者为研究对象,根据随机数表法分为对照组和治疗组,各40例。对照组给予双歧杆菌四联活菌片,治疗组给予温中补肾法联合灸疗贴治疗,比较两组的治疗效果。结果 治疗组中医临床证候积分及肠易激综合征症状严重程度量表(Irritable Bowel Syndrome Symptom Severity Scale,IBS-SSS)积分均低于对照组,差异有统计学意义(P均<0.05);治疗组总有效率为97.5%,高于对照组的72.5%,差异有统计学意义(χ^(2)=9.804,P<0.05)。结论 温中补肾法合灸疗贴能明显改善脾肾阳虚型泄泻患者的临床症状。

王苹从脾论治崩漏经验

崩漏可见于月经来潮后各年龄阶段的女性,但常见于青春期初潮及围绝经期女性,王苹教授认为,不同阶段的崩漏治疗侧重点不同,但在临证中应始终贯彻“从脾论治”的学术思想。脾虚气陷,统摄失司,或忧思伤脾者,方选黄土汤以甘温建中,补气养血;气机郁滞者,在健脾益气的同时常配伍使用柴胡、香附、陈皮、木香等药,肝气郁结,久而化热者,方选泻心汤加减以健脾疏肝,清热止血;冲任不固者,在健脾补肾,固冲止血的同时配伍菟丝子、补骨脂、女贞子、墨旱莲、淫羊藿、山茱萸等药;情志郁结,气机不畅者,方选桂枝茯苓丸以健脾止血,活血化瘀。王苹教授治疗崩漏以中焦为切入点,健脾益气摄血,疏肝补肾,调理气血以恢复正常月经周期,取得良好的疗效。

数据挖掘分析颤证用药规律的研究概述

对运用数据挖掘方法分析颤证用药规律的相关文献进行分析与总结,以了解颤证用药规律的数据挖掘研究现状。白芍对治疗颤证具有重要作用;治疗颤证常用的温性药物有当归、熟地黄、川芎、红花、鸡血藤、黄芪、白术、山茱萸、肉苁蓉、杜仲、半夏、厚朴、木瓜、石菖蒲、五味子等;治疗颤证常用补益肝肾类及平肝息风类药物;顾护脾胃,治颤酌加健脾和胃之药。参考文献36篇。

温脾补肾方煎服辅助治疗对早中期慢性肾衰竭患者中医证候积分及氧化应激反应的影响研究

目的:探究温脾补肾方煎服辅助治疗对早中期慢性肾衰竭(CRF)脾肾阳虚型患者中医证候积分及氧化应激反应的影响。方法:选取2019年1月—2021年10月长葛市中医院收治的84例早中期CRF脾肾阳虚型患者作为研究对象,按随机数表法分为A组和B组,每组各42例。B组接受常规西药治疗,A组在B组的基础上联合温脾补肾方煎服辅助治疗。对比两组患者总有效率、治疗前后肾功能指标[尿素氮(BUN)、血清肌酐(SCr)、24 h尿蛋白定量(24 h Upro)]、中医证候积分、炎性因子指标[白细胞介素-18 (IL-18)、细胞间黏附分子-1 (ICAM-1)、白细胞介素-6 (IL-6)]、氧化应激指标[活性氧(ROS)、超氧化物歧化酶(SOD)、总抗氧化能力(TAC)]水平。结果:A组总有效率高于B组,差异有统计学意义(χ^(2)=6.574,P<0.05)。治疗3个月后,A组食少纳呆、气短懒言、畏寒肢冷、腰酸膝软中医证候积分均低于B组,差异有统计学意义(t=13.986、4.830、6.378、10.835,P<0.05)。治疗3个月后,A组BUN、SCr、24 h Upro水平均低于B组,差异有统计学意义(t=6.798、6.879、29.345,P<0.05)。治疗3个月后,A组血清IL-18、IL-6、ICAM-1水平均低于B组,差异有统计学意义(t=13.397、6.517、14.675,P<0.05)。治疗3个月后,A组血清ROS水平低于B组,血清SOD、TAC水平均高于B组,差异有统计学意义(t=7.954、13.772、6.334,P<0.05)。结论:温脾补肾方煎服辅助治疗早中期CRF脾肾阳虚型患者效果显著,可有效促进患者肾功能改善,减轻其机体氧化应激反应、微炎症状态,促进其临床症状改善。

温补脾肾法治疗慢传输型便秘临床观察

目的探讨温补脾肾法治疗慢传输型便秘(STC)的临床效果及对肠神经兴奋性递质P物质(SP)、神经降压素(NT)、胃泌素(GAS)的影响。方法选择九江市中医医院肛肠科收治的STC患者60例作为研究对象,按随机原则分成治疗组(中药温通汤煎服联合中药热奄包外敷)和对照组(枸橼酸莫沙必利片口服)各30例,均治疗、观察1个月,通过症状积分法分析治疗效果,进行疗效指标的观察。结果治疗前2组的症状积分及血清SP、NT、GAS含量差异均无统计学意义(P>0.05);治疗后治疗组患者的症状积分低于对照组(P<0.01),血清SP、NT、GAS含量均高于对照组(P<0.01或P<0.05);总有效率96.67%(29/30)高于对照组的80.00%(24/30)(P<0.01)。结论温补脾肾法治疗STC患者能显著改善临床症状、提升肠神经兴奋性递质含量、提高临床效果。

朱辟疆治疗慢性肾小球肾炎经验

慢性肾小球肾炎病程较长,病情缠绵难愈,临床治疗十分棘手。朱辟疆教授从事肾脏疾病诊治工作近50余年,临床经验丰富,朱教授认为本病主要责之脾肾虚损,而瘀血、浊邪、痰湿、毒热等病理因素贯穿病变始终,治疗注重温补脾肾为主,兼顾清利湿热、活血祛瘀、解毒祛浊之法,注重预防和调护工作,避免疾病的复发,在临床获效颇丰。

健脾益肾温阳法对妊娠早期亚临床甲状腺功能减退症TSH、TP0-Ab影响的临床研究

目的:研究健脾益肾温阳法对妊娠早期亚临床甲状腺功能减退症患者的临床效果。方法:100例妊娠合并亚临床甲状腺功能减退患者随机分为对照组和观察组(各50例),对照组患者在常规治疗基础上给予左旋甲状腺素钠片治疗,观察组患者在对照组治疗基础上给予健脾益肾温阳方治疗,两组疗程均为3个月。于入院时和分娩前1周,采用电化学发光法测定甲状腺功能指标,包括TSH、FT3、FT4、抗甲状腺过氧化物酶自身抗体(TPOAb);观察并记录治疗过程中高血压、糖代谢异常、胆汁淤积并发症发生情况;观察并记录两组患者的妊娠结局,包括剖宫产、早产、产后出血、出生后低体质量和新生儿窒息;于新生儿出生后6个月,采用婴幼儿发育量表(BSID)评估新生儿发育情况。结果:分娩前1周,观察组TSH水平和TPOab阳性率显著低于对照组(P<0.05),FT3和FT4显著高于对照组(P<0.05);观察组孕妇高血压、糖代谢异常、胆汁淤积并发症发生率显著低于对照组(P<0.05);观察组剖宫产、早产、产后出血、胎儿生长受限、出生后低体质量和新生儿窒息发生率显著低于对照组(P<0.05);观察组婴儿BSID、MDI和PDI评分均显著高于对照组(P<0.05)。结论:健脾益肾温阳法可以有效改善妊娠亚临床甲状腺功能减退患者甲状腺功能,显著降低妊娠并发症发生率,降低妊娠不良结局,促进胎儿发育。

疏肝调脾法与温脾补肾法序贯治疗腹泻型肠易激综合征肝郁脾虚证躯体症状的远期疗效评价

目的:观察评价疏肝调脾法与温脾补肾法序贯治疗腹泻型肠易激综合征肝郁脾虚证的远期疗效。方法:腹泻型肠易激综合征(D-IBS)肝郁脾虚证患者90例,按随机数字表法分为3组:匹维溴铵+蒙脱石散组(西药对照组)、疏肝调脾组与序贯治疗组,每组患者30例。西药对照组给予匹维溴铵50 mg+蒙脱石散3 g,每日3次,疗程8周;疏肝调脾组治予疏肝调脾方,疗程8周;序贯治疗组前4周治法同疏肝调脾组,后4周治予温脾补肾方。3组在治疗前进行腹痛与腹胀、腹泻评分,治疗结束时、结束后3、6、12个月再进行症状评分及单症状与综合疗效评价。结果:治疗结束时,3组腹痛与腹胀评分及腹泻评分均显著低于治疗前(P<0.01);序贯治疗组的腹痛与腹胀评分显著低于西药对照组(P<0.05);疏肝调脾组与序贯治疗组的腹泻评分显著低于西药对照组(P<0.05或P<0.01);西药对照组、疏肝调脾组与序贯治疗组的综合疗效总有效率分别为60.0%、93.3%、96.7%,具有显著性差异(P<0.01);治疗结束后3月,疏肝调脾组与序贯治疗组的腹痛与腹胀、腹泻评分显著低于治疗前及西药对照组(P<0.01);西药对照组、疏肝调脾组与序贯治疗组的综合疗效总有效率分别为13.3%、80.0%、86.7%,具有显著性差异(P<0.01);治疗结束后6月,疏肝调脾组与序贯治疗组的腹痛与腹胀、腹泻评分显著低于治疗前及西药对照组(P<0.05或P<0.01);序贯治疗组的腹痛与腹胀、腹泻评分显著均低于疏肝调脾组(P<0.05或P<0.01);西药对照组、疏肝调脾组与序贯治疗组的综合疗效总有效率分别为6.7%、43.3%、90.0%,具有显著性差异(P<0.01);治疗结束后12月,序贯治疗组的腹痛与腹胀、腹泻评分显著均低于治疗前、西药对照组及疏肝调脾组(P<0.01);西药对照组、疏肝调脾组与序贯治疗组的综合疗效总有效率分别为0、0、66.7%,具有显著性差异(P<0.01)。结论:疏肝调脾法与温脾补肾法序贯治疗腹泻型肠易激综合征肝郁脾虚证具有良好的改善躯体症状的远期疗效。