基于脏腑风湿理论态靶辨治梅尼埃病医案一则

梅尼埃病是一种慢性内耳疾病,临床表现为反复发作的眩晕、听力丧失、耳鸣及耳内饱满感,常伴有焦虑抑郁等精神症状,其确切病因尚不明晰,一般认为与内淋巴积水相关。结合脏腑风湿理论和态靶辨证体系,探讨梅尼埃病的中医诊治方法,通过一则典型病例的治疗过程,观察葛根汤加减方治疗梅尼埃病的思路与疗效。治疗时基于态靶辨治体系,紧扣寒湿虚态,结合态靶同调药物靶向改善患者症状,疗效明显,且需注意药物剂量对临床疗效的影响。

妙招护肠胃 轻松过新年

随着冬季的来临，我们的身体也会因季节的变化出现一些问题，特别是胃部。那么冬天里胃肠易出现哪些不适症状？冬天对胃肠最大的影响是什么？不同胃肠状况如何选择适宜的食物、冬天腹泻并非都需要吃泻药、冬季“热”食易引发哪些疾病？本期我们特别邀请了广安门中医院的两位专家，他们是广安门中医院消化内科的周斌大夫、广安门中医院食疗营养部主任王宜老师和我们谈谈冬季如何进行胃肠护理。

病证结合模式及临床运用探索

病、证关系研究是当前中西医结合研究的热点和关键。病证结合的临床研究模式来自半个多世纪中西医结合医学实践的总结,是两种医学体系交叉融合的良好切入点,是较为成功的中西医结合临床研究模式,体现了中医学整体思维、意象思维、辩证思维与现代医学科学唯物论的结合，体现了中医学宏观整体与现代医学微观局部的结合。

论血脂异常与浊毒

文章旨在探讨血脂异常浊毒的成因与防治。通过文献分析,结合临床实践,总结浊毒的形成与演变贯穿于血脂异常始终。浊乃津液不归正化而有痰饮水湿之异,毒有外来之毒与内生之毒之别。血脂异常浊毒形成与生活方式、自然因素、社会心理因素有关。浊毒黏滞,易阻滞气机,痰瘀互结;浊毒流注,致病广泛,变化多端;浊毒伤正,易损肝脾;浊毒秽浊,易蒙闭清窍;浊毒易从化,兼夹他邪。防治以调摄生活,防浊毒之生;调节脏腑,杜浊毒之变为原则。这些观点可为血脂异常、脂肪肝的防治研究提供参考。

白藜芦醇诱导肿瘤细胞凋亡的机制

白藜芦醇(resveratrol,Res)是一种天然可食用的多酚类化合物,主要来源于葡萄、浆果、花生以及虎杖等多种植物的块根提取物,其中虎杖在我国具有悠久而重要的药用历史。近年大量报道表明,Res具有一定的抗氧化、抗炎和抗肿瘤作用。然而其诱导肿瘤细胞凋亡的分子机制尚未完全阐明。据近年来诸多研究结果,本文对白藜芦醇诱导肿瘤细胞凋亡的分子机制作一简单综述,以供研究者参考。

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.

World Federation of Acupuncture-Moxibustion Societies Clinical Practice Guideline on Acupuncture-Moxibustion:Non-Specific Low Back Pain recommendation summaries

Clinical Practice Guideline on Acupuncture and Moxibustion:Nonspecific low back pain was revised and released by the Standards Working Committee of World Federation of Acupuncture-Moxibustion Societies(WFAS)on October 9,2023.This is the first clinical practice guideline(CPG)on acupuncture and moxibustion for nonspecific low back pain approved by an international academic organization,which provides the evidence-based recommendations and practical therapeutic protocols for international acupuncture practitioners.This CPG was developed by following Grades of Recommendation,Assessment,Development,and Evaluation(GRADE)methodology,and the Principles of the World Health Organization Handbook for Guideline Development.The guideline development group(GDG)from different countries,with different professions,played a critical role in the formulation of clinical questions,recommendations,and therapeutic protocols.Recommendations are the key content of a CPG and the direct answers to clinical questions.Hence,this article focuses on the recommendations of this CPG.The recommendations were formulated using the modified Delphi method and the GRADE grid rules,based on the updated systematic reviews of clinical evidence.A total of seven recommendations for ten clinical questions were formulated in this CPG,including one conditional recommendation for either the intervention or the comparison based on very low quality of evidence,and six conditional recommendations for the intervention based on very low quality of evidence.

健康结局指标效应量决策阈值制定方法指南

临床循证决策过程中需要基于最佳证据,综合考虑干预措施利弊大小、证据确信度、成本与可行性等因素。通过制定患者健康结局指标效应量决策阈值(decision threshold of effect size,DTES),能够帮助利益相关者理解干预措施利弊大小、评估证据确信度和解读研究结果。MERGE工作组充分借鉴国际经验,通过小组讨论、半结构化访谈、专家共识和试点应用,开发了一套包括8个步骤的健康结局指标DTES制定方法指南,包括:必要性评估、组建工作组、遴选患者重要结局、基于最佳证据制作情景示例、设计专家函询问卷、分析专家涵询结果、面对面专家共识以及推广应用与后效评价。DTES指南的开发,以期为利益相关者制定不同领域健康结局指标的DTES提供方法指导。

Acupuncture for diarrhea-predominant irritable bowel syndrome:A randomized control study

Objective:To verify the effectiveness of acupuncture for diarrhea-predominant irritable bowel syndrome(IBS-D).Methods:Sixty-five patients with IBS-D were randomized into an acupuncture group(33 cases)and a sham-acupuncture group(32 cases).In the acupuncture group,Tiānshū(天枢ST25),Zhōngwǎn(中脘CV12),Zúsānlǐ(足三里ST36),Shàngjùxū(上巨虚ST37),Gōngsūn(公孙SP4),Fēnglóng(丰隆ST40),Zhāngmén(章门LR13)and Yīnlíngquán(阴陵泉SP9)were selected and stimulated with routine acupuncture technique,once every two days,3 times weekly,for 8 weeks consecutively,24 times in total.In the shamacupuncture group,the sham-acupoints were selected,0.5 cun or 1 cun superior,inferior,lateral or medial to the corresponding points separately.The blunt-tip needles were used to stimulate only the skin surface of each point.The treatment frequency and courses were the same as the acupuncture group.Before treatment,in 4 weeks of treatment,after treatment and in follow-up,the changes in the score of IBS symptom severity scale(IBS-SSS),Bristol stool form scale and defecation satisfaction were observed in the patients of two groups.After treatment,the effectiveness was assessed in the two groups.Results:In 4 weeks of treatment,after treatment and in follow-up,IBS-SSS score,Bristol stool form scale and defecation satisfaction were all lower than those before treatment in either group(all P<0.01).Bristol stool form scale in the acupuncture group was lower than that in the sham-acupuncture group in4 weeks of treatment,after treatment and in follow-up,while,IBS-SSS score and defecation satisfaction were lower than the sham-acupuncture group in follow-up(all P<0.05).Conclusion:Acupuncture can effectively relieve diarrhea and improves defecation satisfaction in the patients with IBS-D.

Longitudinal directional movement of Alcian blue in Gephyrocharax Melanocheir fish: Revealing interstitial flow and related structure

Background:Observing interstitial fluid(ISF)is very difficult because interstitial structure collapses and ISF disappears after tissue fixation.Additionally,ISF is colorless,and interstitial flow is weak in vivo.In order to view the interstitial flow,special dye and animal model was chosen to explore the movement characteristic of interstitial flow and related structure.Methods:The Gephyrocharax Melanocheir(GM)fish,a special animal with translucent body,were placed into 0.03 g/L tricain solution for anesthesia.20-25μL Alcian blue(AB)solution which can stain acid mucopolysaccharide immobilized by the collagen net in connective tissue was injected into each fish at a single point with a rate of 2 μL/min via a micro-injection pump.The process of infusion and the movement of the AB in fish were record by a digital camera.The(fresh)frozen sections of AB tracks tissue were performed to observe the morphological feature.Results:Several blue tracks were observed which were formed by longitudinal directional movements of AB solution.For back lateral track,the velocity and length of the movements were significantly fast and longer on the direction toward head than that toward tail(P<0.01).For lateral middle track,the result was opposite,namely toward tail(P<0.01).This phenomenon indicated an inherent ISF flow according to Darcy's law.Morphological study showed these tracks were just in septa composed by connective tissue.The stained blue septa formed various shapes as interstitial space for ISF flow and connected with one another like a net.The finding can help us to understand the essence of meridian in traditional Chinese medicine(TCM).Conclusions:The dynamic asymmetry of the AB tracks revealed interstitial flow in the GM fish body.It implied an inherent interstitial flow along particular pathway formed by septa which may be a key to understand the nature and value of meridians and collaterals in health care.

Effect and mechanism study on transcutaneous auricular vagus nerve stimulation for functional dyspepsia model rats

Objective:To explore the effect and its possible mechanism of the intervention of transcutaneous auricular vagus nerve stimulation(taVNS)for the functional dyspepsia(FD)model rats.Methods:Of the 25 male SD rats,6 rats were set as blank group,the other 19 rats were established to be the functional dyspepsia(FD)model by iodoacetamide intragastric administration,and 18 FD models were successfully established.The 18 model rats were randomly divided into a model group,a shamtaVNS group,and taVNS group,with 6 rats in each group.There was no intervention applied to the rats in the blank and model groups.Whereas,the rats in sham-taVNS group received stimulation to the rim of auricular concha of both sides,and those in taVNS group received stimulation to the cavity of auricular concha of both sides,for 30 min each time,once a day,7 days in succession.After the intervention,the gastric sensitivity of the rats in each group under different pressure conditions in the stomach,the expressions of serum brain-gut peptide motilin(MTL),cholecystokinin(CCK),glucagon-likepeptidel(GLP-1),and inflammatory factors IL-4,IL-10,and IL-1βwere detected.Results:(1)Gastric sensitivity:compared with the blank group,the gastric sensitivity of the model group was higher(P<0.05).Compared with the model group,the gastric sensitivity of the taVNS group was lower(P<0.05).Compared with the sham-taVNS group,the gastric sensitivity of the taVNS group was lower(P<0.05).(2)Expression of brain-gut peptide:compared with the blank group,MTL was lower,CCK and GLP-1 were higher in the model group(all P<0.05).Compared with the model group,MTL was higher,CCK and GLP-1 were lower in the taVNS group(all P<0.05).Compared with the shamtaVNS group,CCK and GLP-1 were lower in the taVNS group(both P<0.05).(3)Expression of inflammatory factors:compared with the blank group,IL-4 and IL-10 were lower and was higher in the model group(all P<0.05).Compared with the model group,IL-10 was higher and IL-1βwas lower in the shamtaVNS group(all P<0.05),while IL-4 and IL-10 were higher and IL-1βwas lower in the taVNS group(all P<0.05).Compared with the sham-taVNS group,IL-4 and IL-10 were higher and IL-1βwas lower in the taVNS group(all P<0.05).Conclusion:TaVNS can reduce the gastric sensitivity of FD model rats by peripheral anti-inflammatory action and regulating the abnormal secretion of brain-gut peptide.

Acupuncture versus oral medicine for women with diminished ovarian reserve:A cohort study

Objective:To observe whether electro-acupuncture(EA) is better in improving hormone levels among women with diminished ovarian reserve(DOR) compared with oral medicine [Chinese herbs with or without hormone replacement therapy(HRT)] that is often used in gynecology clinics in China.Methods:Eligible participants entered the EA group or medication group according to their preferences.Participants in the EA group received EA treatment,and participants the medication group received herbal decoction alone or combined with HRT.Reproductive hormone levels of the participants were tested before and during treatment in both groups.Results:A total of 80 women with DOR were screened and 57 cases were included(29 in the EA group and 28 in the medication group) in the final analysis.The differences in the change from baseline between the EA and medication group in mean follicle-stimulating hormone(FSH) levels were-6.6(95% Cl,-17.03 to 3.72),(P=0.848) and-7.09(95% CI,-15.86 to 1.66),(P=0.539) at weeks 12 and 24,respectively.The proportion of women with regular FSH levels in the EA and medication group was 51.3% vs 32.1% at week 12(P=0.134) and 51.3% vs 25.0% at week 24(P=0.038).Conclusion:EA might influence regulating the levels of FSH,luteinizing hormone(LH),estrogen and the FSH/LH ratio,and no difference was found between the effects of EA and oral medicine in changes of reproductive hormone levels.

Clinical practice guidelines of using acupuncture for low back pain

Based on extensive accumulated evidence and using the Grading of Recommendations Assessment, Development and Evaluation（GRADE） system, we have developed clinical practice guidelines for the use of acupuncture to treat low back pain（LBP）. In the guidelines, we considered the objective and scope of this guide, the diagnostic criteria and syndrome differentiation standards of traditional Chinese medicine and western medicine for LBP, the treatment principles of acupuncture, intervention opportunities for acupuncture, and recommendations for use of different acupuncture therapies for acute/subacute and chronic LBP.

Questionnaire of clinical questions for Clinical Practice Guideline of Acupuncture-Moxibustion:Non-specific low back pain

The questionnaire aims to collect clinical questions for the Clinical Practice Guideline of AcupunctureMoxibustion:Non-Specific Low Back Pain.This questionnaire is consisted of single-choice questions,multiple-choice questions,ranking questions,and open questions.Readers are recommended to complete the open questions by using patients,intervention,comparator and outcome(PICO)framework,referring to the examples.The survey would take about 30 min to finish,and the answers from participants would greatly contribute to the formation of Clinical Practice Guideline of Acupuncture-Moxibustion:Non-Specific Low Back Pain.

Effects of transcutaneous auricular vagus nerve stimulation on intestinal ligandins in a rat model of functional dyspepsia

Objective:Transcutaneous auricular vagus nerve stimulation(taVNS) can relieve the symptoms of functional dyspepsia(FD) and improve the quality of life of patients,however,the mechanism underlying this effect remains unclear.Therefore,this study aimed to investigate the effects of taVNS on the expression of intestinal mucosal ligandins.Methods:This study was conducted on 24 specific Spathogen-free Sprague-Dawley rats(12 males and12 females).The rat model of FD was established by tail-clip stimulation.After FD was established successfully,all rats were randomized to either the normal group(n=6),model group(n=6),taVNS group(n=6),or sham-taVNS group(n=6).After two weeks of the respective intervention,the score of their general conditions,3 h food intake,gastric emptying rate,and the histology of gastric antrum tissues were observed to evaluate modeling success,and then the effect of taVNS was evaluated.Western blotting was used to assess the expression of the tight junction ligandins-ZO-1 and occludin-and the adhesion ligandin-β-catenin-in the duodenum.The effect of taVNs on the expression of intestinal mucosal barrier ligandins-ZO-1,occludin,and β-catenin-in FD rats was preliminarily investigated.Results:When the model-induced period was finished,the manifestations of FD in the model group rats were mental exhaustion,reduced activities,decreased score of the general conditions,and decreased3 h food intake,compared to the normal group rats.In addition,minimal eosinophil infiltration,without any mucosal erosion or ulcer,was observed in the gastric antrum mucosa.At the end of the study,the mental state of the FD rats improved,and their activities and gastric emptying rate increased in the taVNS group rats.Compared to the normal rats,the duodenal mucosa had less expression of the tight junction ligandins ZO-1 and occludin,but β-catenin expression remained unchangedin the model rats.The expression of the tight junction ligandins ZO-1 and occludin were increased in the duodenal mucosa of model rats after the taVNS intervention.Conclusion:TaVNS can improve the gastric motility and mental state of rats with FD.It may play a therapeutic role by improving the expression of the tight junction ligandin ZO-1 and occludin in the duodenal mucosa,while also repairing the duodenal mucosal barrier.

Effect of electroacupuncture for reducing the frequency of recurrent cystitis:A case report

Introduction:Recurrent cystitis,defined as at least two episodes within six months or three episodes within one year,presented among about one fifth to one-third of women with history of cystitis or urinary tract infection(UTI) according to previous studies.However,the use of antibiotics can only resolve the urinary symptoms but not reduce the frequency of urinary symptoms recurrence,and meanwhile increasing rates of adverse effect of repetitive antimicrobial therapy and bacterial antimicrobial resistance became clinical concerns.This case report aims to present a case of recurrent cystitis treated by electroacupuncture(EA) in reducing recurrent frequency,amount of antibiotics used and urinary symptoms.Case presentation:A 42-year-old woman diagnosed with recurrent cystitis for five years presented mainly with recurrent dysuria,urine frequency and urgency.She received EA treatment 3 to 5 sessions a week and 30 min per session from August 2019 to August 2020 with 3-month suspension due to Coronavirus Disease 2019(COVID-19).During the treatment,both the frequency of recurrent urinary episode and symptoms were reduced.Although there was some fluctuation,the mean frequencies of daytime voiding reduced dramatically from 17.7 to 8.3,and night-time voiding from 4 to 1,and the number of voiding with moderate urgency was reduced from 17.7 to 2.3,and severe urgency dropped from 2.7 to 0.The patient’s scores of overactive bladder symptom score(OABSS) and overactive bladder questionnaire short form(OAB-q SF) were also improved.The postvoid residual urine volume(PVR) reduced from 42 mL to less than 10 mL Conclusion:This case of individual effect of EA for a woman with frequent recurrent cystitis suggested a plausible benefit of EA on reducing frequency,amount of antibiotics used and symptoms of recurrent cystitis,but further research is necessary to proof the efficacy and effectiveness among a wider population.