王自平教授毓麟珠加减治不孕方

【组方】①人参,白术,茯苓,炙甘草,当归,川芎,白芍,熟地黄,菟丝子,杜仲,鹿角霜,川椒,仙灵脾,香附,何首乌,黑栀子,生地黄。②人参,白术,茯苓,炙甘草,当归,川芎,白芍,熟地黄,菟丝子,杜仲,何首乌,黑栀子,生地黄。③人参,白术,茯苓,炙甘草,当归,川芎,菟丝子,杜仲,鹿角霜,川椒,仙灵脾,白芥子。④人参,白术,茯苓,炙甘草,当归,川芎,菟丝子,杜仲,丹参,苍术,鹿角     

地黄饮子治疗糖尿病的临床体会

地黄饮子首见于<黄帝素问宣明方论>,由熟地黄,巴戟天、山茱萸,石斛,肉苁蓉,附子,官桂,茯苓,麦门冬,石菖蒲,远志,生姜,薄荷,大枣等组成.功用滋肾阴、补肾阳,开窍化痰,主治瘖痱证.笔者用其治疗2型糖尿病并发症疗效甚佳,今介绍如下.     

二十四节气养生

立冬立冬:11月7日,冬季开始,万物闭藏。立,建始也,冬,冬也,万物收藏也,立冬之日,水始冰,地始冻,一切变化都表明,冬季就要来临。由于我国南北纬度之差,故     

香菇辅助治疗慢性乙肝1例

患者,女,33岁.1982年时发现肝功能不正常,经治痊愈.1992年再次发病,化验结果HBsAg、HBeAg、Anti-HBc均为阳性,ALT 55 IU/L,TTT 12IU/L.临床症状表现为全身乏力,食欲不振,胁肋胀痛,尿黄,面黄.服用中药汤剂:虎杖20 g,木香6 g,栀子10 g,郁金10 g,茵陈20 g,连翘20 g,蜂房10 g,紫草10 g,丹参15 g,黄芪15 g,甘草3 g,板蓝根15 g,龙胆草12 g,生薏米10 g,白花蛇舌草20 g.随症加减治疗3个月后,ALT与TTT均正常,HBsA g( ),Ant-iHBe( ),Anti-HBc( ),症状消失,随即停药.1996年又出现与1992年相同的情况,继续服用中药汤剂治疗3个月后,化验结果为小三阳,ALT、TTT均正常,症状消失,随即停止用药.     

罗铨教授诊治高血压病经验

高血压病是当今临床常见病、多发病,随着生活水平的提高,饮食结构的改变,社会竞争压力加大,人口老龄化,加之遗传环境等诸多因素的影响,发病率逐年上升,由于该病为终身性疾病,治疗周期长,支出费用高,在其病程发展过程中可能出现诸多的危重表现,如心律失常,中风,诸多靶器官损伤,致残、致死病例屡见不鲜,为有效控制病情,防止病情的发展加重,加强对本病的科学认识、积极合理治疗尤为重要.     

少腹逐瘀汤治疗盆腔炎56例

盆腔炎临床表现为下腹疼痛,伴发热或高热、寒颤、头痛、食欲不振,下腹包块及局部压迫刺激感.腰酸胀痛,白带多,月经不调,经量时多时少,夹瘀血块.或排尿困难,尿频急,或腹泻,里急后重,排便困难.笔者近年来用少腹逐瘀汤治疗盆腔炎56例,取得较满意效果,现总结如下.     

丁香、郁金同用出现不良反应1例

患者男性,32岁,司机,因胃脘疼痛、恶心呕吐(吐粉红色胃内物),心悸气短,乏力汗出,泻下清稀水样便,于2007年7月6日入我院治疗.入院查体:体温37.2℃脉搏112次/min,呼吸32次/min,血压12/6Kpa,神志清楚,精神极差,大汗淋淳,呼吸急促,肺呼吸音正常,心率112次/min,律齐无杂音,心音低而弱,肝脾未及,肾区无叩痛,肠鸣音亢进,腥肌张力稍高,ECG心动过速.     

《删补名医方论》之真武汤

治少阴水气为患,腹痛下利,四肢沉重疼痛,小便不利,其人或咳或呕,或小便利而下利者。用此加减。 组成白尤二两,茯苓二两,白芍二两,大附予一枚（炮）,生姜二两（切）,以上五味,以水八升,煮取三升,去滓,温服七合,日三服,若咳者,加五味子半升,细辛干姜各一两,若小便利者,去茯苓,若下利,去芍药加干姜二两,若呕,去附子加生姜,足成半助。     

小柴胡汤临床应用举隅

1 气虚感冒 李某,男,63岁,退休教师.2003年4月7日就诊,患者3天前受凉感冒,发热恶寒,鼻塞流清涕,身体酸痛不适,自服"克感敏"、"新康泰克"、"双黄连"片后大汗出热退,但恶寒加重,精神困倦,食欲不振,时流清涕,肩背部及双上肢酸痛,咳少许白色稀痰,咽喉干痛,舌质淡红、苔薄腻,脉弦细.辨证为少阳枢机不利,正气内怯,营卫失和,寒湿滞表.治疗当和解少阳,扶正祛邪,散寒驱湿通络.拟以小柴胡汤加味:柴胡10 g,黄芩10 g,半夏15 g,生姜15 g,大枣15 g,甘草10g,潞党参15 g,桔梗10 g,陈皮10 g,羌活10 g,白芷10 g,葛根15 g,桑枝30 g.水煎服,每日1剂,药进3剂即愈.     

关于风劳臌膈 金匮学习笔记之一

一、中风与痹金匮中风历节篇:“夫风之为病,当半身不遂,或但臂不遂者,此为痹,脉微而数,中风使然”,由於中风为中枢神经病变,即今之脑溢血,以半身不遂为主症,是内因,而痹为风寒湿三气杂至合而为痹,即今之偻麻质斯,以但臂不遂为主症,是外因,故仲景於中风篇首条指出,辨明中风与痹症之不同。(按     

Evidence-based Chinese medicine for rheumatoid arthritis

Chinese medicine (CM) has long been adopted for treatment of rheumatoid arthritis (RA). CM approaches RA as it does for other diseases by holistic treatment, focusing on the whole body condition, and giving a variety of applications in accordance with the stage and symptoms of the disease. For seeking the best evidence of CM in making decisions for the care of RA individual patients, a number of clinical studies have been conducted in China to gain credibility with the researchers' unremitting efforts. But the heterogeneity in many of these clinical trials and the low quality of design in some previous studies present an obstacle to the meaningful systematic reviews (SR) and meta-analysis. Some favorable results in improvement of response to biomedicine and reduction of severe adverse reactions of conventional RA therapy should be carefully interpreted and need further research. Fortunately, more appropriate quality assurance and control of CM researches are raised for the implementation of CM in RA therapy to pave the evidence-based way. Guidelines for the diagnosis and treatment of RA recommend evidence to the clinicians. In future, randomized controlled trials (RCT) with smart and flexible design as a good approach to evaluate the effectiveness will be widely used in CM for RA clinical study, with better research methods suitable for certain CM clinical researches. The development of evidence-based CM for RA will be full of challenge and opportunity, but we have full confidence.     

芪苈强心胶囊治疗慢性心力衰竭系统评价的再评价

[目的]对芪苈强心胶囊治疗慢性心力衰竭的系统评价进行方法学质量和结局指标证据级别的评价。[方法]检索中文全文期刊数据库(CNKI)、万方数据库(Wanfang Data)、中国生物医学文献数据库(SinoMed、PubMed)、The Cochrane Library和Embase数据库,收集芪苈强心胶囊治疗慢性心力衰竭的系统评价,检索日期为建库至2019年4月。由两名研究者独立提取资料并根据AMSTAR2评分量表及GRADE评价体系对所纳入系统评价的方法学质量和结局指标证据级别进行评价。[结果]研究共纳入15篇系统评价。AMSTAR 2方法学质量评价结果显示,全部系统评价均为低质量。GRADE证据级别评价结果显示:15篇系统评价包含12个结局指标,共64个证据个体。其中有1个高等质量(占比1.6%),9个中等质量(占比14%),25个低等质量(占比39%),29个极低等质量(占比45.3%)。[结论]芪苈强心胶囊治疗慢性心力衰竭具有良好的疗效,系统评价的方法学质量较低,证据级别总体较低。建议系统评价应按照严格的程序进行研究,规范报告研究结果。     

Systematic reviews of acupuncture — are there problems with these?

In recent years, many systematic reviews of the clinical efficacy of acupuncture have been conducted. Almost every review found major problems with the quality of the clinical trials, making it difficult to draw clear conclusions about efficacy. The present paper explores a number of important issues involved in the design and conduct of systematic reviews of acupuncture. Examples are pointed out of mistakes in inclusion-exclusion criteria and problems with judgements about adequacy of test treatment in some reviews. More importantly, problems are identified with the criteria by which study quality is scored, especially with the Jadad summary scale, that appear to bias against finding acupuncture to be effective. Examples are also identified where the conclusions of systematic reviews appear to have been misstated by others summarizing findings of those reviews, thereby undermining the conclusions of those broader reviews. These findings suggest that the methodologies of systematic reviews of acupuncture need to be improved and that many systematic reviews need to be redone using improved methods.     

Medicinal use of potato-derived products: conclusions of a rapid versus full systematic review

Vlachojannis et al reported a systematic review on the medicinal use of potato-derived products. The authors identified five trials for inclusion in the review, including one study on the treatment of burns. Based on this RCT the review authors concluded that potato peel is not recommended for burns. As the authors of a rapid review on the use of potato peels for burns, we read this systematic review with great interest. Although the concept of rapid review is rising, accelerating the review process might introduce bias and its conclusions may be subject to change once a systematic review is available. Since this rapid and systematic review were done at similar times, we explored if the results were consistent. We identified three trials on the use of potato peels. Two of these trials were not mentioned in the systematic review. The evidence indicates that sterile potato peel dressings are better than gauze alone during the healing phase.While there is no evidence of an antibacterial effect, we concluded that potato peels promote healing. Potato peel dressings might be the best available dressing in resource poor countries. Because systematic reviews have a major impact it is crucial that systematic reviews meet specified quality criteria. Therefore we draw attention to adherance to the PRISMA statement.     

中文期刊发表的中医药系统综述或Meta-分析文章的质量评价

目的评价中文期刊发表的中医药系统综述／Meta-分析的质量。方法电子检索中国期刊全文数据库（CNKI）、中文科技期刊数据库（VIP）和万方数据库,鉴定所有中医药包括中医、中药、中西医结合、针刺及针灸的系统综述（系统评价）或Meta-分析报告,按照国际Meta-分析报告标准《QUOROM声明》中的18项条目及相关信息提取资料,评价指标主要包括有无具体目的、资料来源、资料提取方法、纳入研究的质量评价、定量资料综合等。结果鉴定了共82篇中医药系统综述文章,排除重复发表和不符合纳入标准的6篇,最终纳入76篇进行质量评价,涉及51种疾病。其中,疗效评价70篇,以中药疗效评价为主,针灸疗效的9篇。大多数系统综述以随机对照试验为纳入研究,描述了资料来源;而26篇仅检索了中文资料库,对资料提取和分析的方法描述过于简单,70％（53／76）评价了纳入研究的质量。所有系统综述均未采用流程图表示研究的选择、纳入与排除过程。结论能够达到国际标准的高质量中医药系统综述／Meta-分析很少,其方法学描述不足,难以得到重复．研究者尚需要严格的方法学培训．     

中国老年医学系统评价/Meta分析的方法学与报告质量评价

[目的]评估中国老年医学领域系统评价或者Meta分析的方法学与报告质量,为规范中国老年医学领域同类循证研究提供根据与借鉴。[方法]由两位研究者独立检索中国知网(CNKI)、维普中文期刊数据库(VIP)、万方数据库(Wan Fang)和中国生物医学文献数据库(CBM)数据库自建库至2016年5月所发表的中国老年医学系统评价或者Meta分析文献,利用AMSTAR量表和PRISMA量表对最终纳入文献进行评价。[结果]纳入的193篇文献中,65篇为系统评价,128篇为Meta分析。方法学与报告质量的问题主要表现为检索不全面,偏倚风险评估未得到相应重视,研究中的资助来源未详细说明等。[结论]中国老年医学系统评价或者Meta分析的文献数量较多,但质量还有待提高。建议老年医学研究者能够提升循证研究能力,严格遵照规范报告格式撰写文献。     

疏血通治疗中风的系统评价/Meta分析的方法学质量评价

目的:应用系统评价和Meta分析的首选报告项目(PRISMA)条目及多系统评估量表(AMSTAR)对疏血通注射液治疗中风的Meta分析/系统评价的方法学及报告质量进行评价。方法:检索万方医药期刊数据库、中国生物医学文献期刊、维普中文科技期刊全文数据库、中国知网和Pub Med数据库,筛选疏血通治疗中风的系统评价/Meta分析文献,时间截至2015年5月。采用PRISMA条目及AMSTAR量表对纳入的研究进行方法学与报告质量评价。结果:10篇研究符合纳入标准。PRISMA报告质量平均得分为22分,其中严重缺陷1篇。AMSTAR量表平均分6分。主要存在问题有在前期方案注册、文献的选择性偏倚、资料提取和评价文献科学性方面的偏倚、未报告资金来源方面。结论:疏血通治疗中风的Meta分析/系统评价的方法学及报告质量相对完全。但仍需要完善方案设计,对前瞻性文献质量控制,报告资金来源,对方法学质量规范化。     

Reporting guidelines of Chinese medicine: Current situation and future development

ObjectiveReporting research is as important a part of a study as its design or analysis. Reporting guidelines (RGs) provide structured advice on how to report research studies clearly and adequately. This study aimed to review the development of RGs of Chinese medicine (CM) and to provide recommendations for improvement.MethodsThrough a systematic search of the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network and electronic databases up to January 1, 2022, we identified a total of 15 RGs of CM, and further summarized their characteristics and applications. In addition, we reviewed the development of international RGs and analyzed its impact for CM.ResultsCompared with the generic RGs, the reporting standards of CM have been rapidly developed over the last 10 years, of which 57% were issued in recent 3 years (2019–2021). Currently, the system of RGs of CM has been established, especially for clinical trials, including various CM interventions and covering the guidelines from trial registration, protocol, results publication to the evidence synthesis and clinical practice guideline. However, the application of RGs of CM is suboptimal.ConclusionIt is necessary to take further measures to promote practical application, improve journals’ endorsement, and establish quality monitoring procedures for RGs of CM in the future.     

中药汤剂治疗功能性消化不良系统评价的AMSTAR2质量评价及GRADE证据分级

目的评价中药汤剂治疗功能性消化不良系统评价的方法学质量及结局指标的可信度。方法检索中国知识资源总库(CNKI)、中国学术期刊数据库(万方数据)、中文科技期刊数据库(维普网)、中国生物医学文献数据库(CBM)、PubMed、Embase、Cochrane Library,收集公开发表的关于中医药治疗功能性消化不良的系统评价/Meta分析,检索范围为建库至2019年2月1日。由2名研究者独立进行文献筛选、提取资料,采用AMSTAR2量表评价纳入文献的方法学质量,采用GRADE系统对结局指标进行证据质量分级。结果最终纳入8篇系统评价/Meta分析。AMSTAR2量表显示,8篇文献方法学均为极低质量;GRADE评级显示,1个结局指标为高等级,5个结局指标为中等级,11个结局指标为低等级,5个结局指标为极低等级。结论目前中药汤剂治疗功能性消化不良系统评价方法学质量较低,结局指标可靠程度相对较低,需要更多准确、高质量的临床证据,从而指导功能性消化不良的中医治疗。     

中药质量标志物与“网通虹势”代谢规律

中药复方疗效是建立在单味中药基础上按中医药基础理论依法遣药组方治病的结果,其作用体现多成分、多靶点、综合效应的特点,其物质基础研究不易,质量标准难以建立,质量标志物难确定,无法严格监控中药加工全过程中的质量,且中药标志物的确定对中药药效物质研究、中药材鉴别及中药制药工程等影响深远;中药与生物体的"网通虹势"代谢规律将中药多成分的零散作用规律视为同母核群体的整体作用,可沟通微观单成分个体与宏观成分群整体,揭示中药在生物体内代谢物质、信息交流基本规律,进而揭示中药复方对人体的作用规律。通过系统分析中药质量标志物对中药开发的指导作用及其与"网通虹势"代谢规律的关系,尝试为中药质量标志物的确定提供思路。