温肾宣痹汤治疗膝关节骨性关节炎的临床疗效观察

目的 观察口服温肾宣痹汤治疗膝关节骨性关节炎的临床疗效。方法 选取2018年9月～2019年12月江苏省中医院骨伤科门诊80例膝关节骨性关节炎患者作为研究对象,随机分成两组,治疗组40例,口服温肾宣痹汤加减治疗,对照组40例,口服痹祺胶囊治疗。两组经治疗2个疗程后,评估临床疗效,观察治疗后总有效率、视觉模拟疼痛评分(VAS)及WOMAC(包括疼痛、僵硬、活动度、有效性)评分方面的情况变化。结果 ①中医诊疗标准方面,治疗组总有效率92.50%,对照组75.00%,差异有统计学意义(P0.05);②两组患者VAS评分均降低,较治疗前差异有统计学意义(P0.05);治疗组VAS评分明显低于对照组,差异有统计学意义(P0.05);③与治疗前比较,两组患者在疼痛、僵硬、日常活动度、WOMAC总分方面均有改善,差异有统计学意义(P0.05),其中治疗组改善明显;尤其在疼痛评分方面,治疗组明显优于对照组,差异有统计学意义(P0.05),其他指标组间比较差异均无统计学意义(P0.05)。④两组在WOMAC评分改善方面比较差异无统计学意义(P0.05),但治疗组总有效率87.50%,明显高于对照组72.50%。结论 温肾宣痹汤治疗寒湿痹阻型膝关节骨性关节炎疗效确切,可显著缓解疼痛,改善膝关节活动度,总有效率优于痹祺胶囊,值得临床推广应用。     

从太阴中风病传血痹论治特发性震颤

[目的] 总结从太阴中风病传血痹论治特发性震颤(essential tremor,ET)的诊疗思路。[方法] 通过整理搜集文献、跟师临证,搜集临证验案及观察疗效,总结从太阴中风病传血痹论治ET的辨证思路、治则治法,并附验案佐证疗效。[结果] ET属中医“颤病”范畴,其病因不外“风”与“虚”。周天梅主任认为,血痹病的病机与ET病机高度重合,为太阴中风,津亏血弱,虚邪内中,水饮内停,临证以解表散寒、养血和营为法,以桂枝汤为主方,在辨证论治基础上,灵活应用药物加减治疗。对营血亏虚者,常用濡养津血之药补养气血;对阳明里热者,投以清热生津、顾护津液之药;对水饮内停者,用淡渗除饮、泄越水气等法,临床疗效显著。[结论] 周师从太阴中风病传血痹治疗ET,其方药精简,疗效确切,加深了对ET病因病机与治法的认识,为临床治疗ET提供了新的思路。     

The relationship of three-dimensional joint space width on weight-bearing CT with pain and physical function

Limitations of plain radiographs may contribute to poor sensitivity in the detection of knee osteoarthritis and poor correlation with pain and physical function. Three-dimensional (3D) joint space width (JSW), measured from weight-bearing computed tomography (CT) images, may yield a more accurate correlation with patients’ symptoms. We assessed the cross-sectional association between 3D JSW and self-reported pain and physical function. Five hundred twenty eight knees (57% women) were analyzed from Multicenter Osteoarthritis Study participants. An upright weight-bearing CT scanner was used to acquire bilateral, weight-bearing, fixed-flexion images of the knees. A 3D dataset was reconstructed from cone beam projections and JSW was calculated across the joint surface. The percentages of the apposed medial tibiofemoral joint surface with JSW less than 2.0 and 2.5 mm, respectively, were calculated. Pain and physical function were measured using Western Ontario and McMaster Universities Osteoarthritis Index. Participants who reported greater pain severity tended to have a greater joint area with JSW less than 2.0 mm (P = .07 for the highest vs the lowest tertile). Participants who reported greater functional limitations had a greater joint area with JSW less than 2.0 mm (P = .02 for the highest vs the lowest tertile). There appears to be an association between the medial tibiofemoral area with JSW less than 2.0 mm and pain and physical function.     

旷惠桃教授治疗干燥综合征临床经验

介绍湖南省名老中医旷惠桃教授治疗干燥综合征的临床经验,认为该病属中医学"燥痹"范畴。旷教授认为燥痹之标为燥热,病机则在于气血阴津亏虚,燥、热内生,脏腑诸窍失养,临床多见肺胃阴虚、肝肾阴虚证,故而临床治疗重在滋补肺胃肝肾,脏腑兼顾,随证加减。并附验案1则,以资佐证。     

痹证的中医治法及常用治痹中药的功效与运用比较

目的：探讨痹证的中医治法及常用治痹中药的功效与运用比较。方法：①总结前人对痹证病因与治法的论述；②选择常用治痹中药32味，按祛风止痛、散寒止痛、胜湿止痛、舒经通络、养血活血、益肝柔筋、健脾补肾和补火助阳等不同功效分成12组进行比较。结果：治风痹以祛风为主，兼以散寒除湿。佐以养血活血；治寒痹以散寒为主，兼以疏风燥湿，佐以补火助阳；治湿痹以除湿为主，兼以祛风散寒，佐以健脾益气；治顽痹在祛风散寒除湿的基础上参以活血祛瘀，补肝益肾。结论：中医药治疗痹证颇具优势。     

从《金匮要略》历节病的辨治探讨类风湿性关节炎的治疗思路

类风湿性关节炎是一种病因不明的自身免疫性疾病,在中医学属痹证范畴。结合《黄帝内经》和《金匮要略》对痹证的认识,提出类风湿性关节炎与《金匮要略》所述历节病最为相符,并根据历节病的病因病机以及仲景遣方用药特点,探讨类风湿性关节炎的治疗思路。     

兔风寒湿痹证型颈椎病模型的建立

目的：模拟自然界不同强度风寒湿刺激，建立中医风寒湿痹证型颈椎病动物模型。 方法：选择24只8月龄雄性新西兰白兔，随机分为正常对照组以及轻、中和重度刺激组。基本刺激条件是6级风力（10．8～13．8m／s），（5±0．5）℃，100％湿度，按轻、中、重度刺激组的不同要求，分别给予32、64和128h的间断重复刺激，每日刺激4h。HE染色，光学显微镜下观察椎间盘组织形态改变，放射免疫法检测前列腺素E2（prostaglandin E2，PGE2）、6-酮-前列腺素F1α（6-ketone—prostaglandin F1α，6-K—PGF1α）和血栓素B2（thromboxane B2，TXB2）含量，免疫组织化学ABC法检测Fas和Bcl-2表达情况，逆转录-聚合酶链反应法检测白细胞介素-1β（interleukin-1β，IL-1β）、肿瘤坏死因子α（tumor necrosis factor α，TNF—α）和转化生长因子β（transforming growth factor β，TGF—β）mRNA表达情况。 结果：轻、中度刺激组椎间盘髓核收缩，重度刺激组纤维疏松断裂，软骨终板增厚。与正常对照组比较，轻度刺激组椎间盘组织PGE2有所升高，中度和重度刺激组PGE2、6-K—PGF1α和TXB2升高，IL-1β、TNF—α mRNA和Fas表达明显增加，TGF—βmRNA和Bcl-2表达明显降低。重度刺激组Fas表达进一步增加，Bcl-2表达进一步降低。 结论：中、重度风寒湿刺激可以导致家兔颈椎间盘明显退变，可用于建立风寒湿痹证型颈椎病动物模型。     

热痹颗粒剂治疗类风湿关节炎湿热痹阻证临床疗效分析

目的:观察热痹颗粒剂治疗类风湿关节炎(RA)湿热痹阻证的临床疗效,为临证用药提供科学的依据。方法:将60例辨证属于湿热痹阻证的活动期RA患者,采用随机、阳性药平行对照的方法分组。实验组口服热痹颗粒剂每次2.0g,1日3次;对照组口服乐松,每次60mg,1日3次。两组疗程均为4周。结果:实验组与对照组均能改善主要症状,体征及理化指标,两组疾病疗效和中医证候疗效比较差异无显著性意义。结论:热痹颗粒剂能消肿、止痛、改善关节功能,且无明显毒副作用。     

温针治疗膝痛48例临床观察

目的：观察针灸临床中采用温针治疗膝关节疼痛中医辨证分型为痛痹一型的治疗效果。方法：取血海、梁丘、阿是穴1～2个为主穴，采用温针灸治疗，取辅穴根据临床症状随证加减，单纯针刺留针，每治疗10次为1个疗程计算。结果：温针治疗48例痛痹型膝关节痛的病例疗效明显，有效率达91．7％。结论：温针是治疗痹讧膝痛的有效治疗方法之一，治疗方法简单安全，应在针灸临床中广泛开展。     

Rat‐bite fever identified by polymerase chain reaction detection of Streptobacillus moniliformis DNA

A 74‐year‐old woman presented with erythema of the extremities, a high fever and arthralgia after being bitten by a rat. The patient was diagnosed as having rat‐bite fever based on the symptoms and clinical course, as well as the polymerase chain reaction detection of Streptobacillus moniliformis DNA in the crust of the bite site. This is the first case to be diagnosed using polymerase chain reaction on a crusted skin lesion specimen. Although clinical symptoms initially remitted with minocycline therapy, they relapsed. Subsequent administration of piperacillin sodium resulted in complete disappearance of the high fever and arthralgia.