章庆云治疗脾胃病经验浅探

介绍章庆云先生治疗脾胃病的学术思想及用药经验。临床辨治脾胃病以气血同调、宣化分利、肝胃同治、清肝利胆、降胃平肝为特色,并举验案1则。     

加味温经汤联合阿仑膦酸钠片治疗肾阳亏虚型绝经后骨质疏松症临床研究

目的:观察加味温经汤联合阿仑膦酸钠片治疗肾阳亏虚型绝经后骨质疏松症(PMOP)的临床疗效。方法:选取150例肾阳亏虚型PMOP患者,按随机数字表法分为对照组和观察组各75例。对照组给予口服阿仑膦酸钠片治疗,观察组在对照组基础上加服加味温经汤,2组均治疗6个月。对比2组总体疗效、治疗前后碱性磷酸酶(ALP),血钙(Ca)、磷(P),雌二醇(E2),促卵泡雌素(FSH),促黄体生成素(LH)水平,记录治疗过程中不良反应发生情况。结果:观察组总有效率96.0%,对照组总有效率80.0%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组ALP水平均较治疗前降低(P<0.05),血Ca含量均较治疗前增加(P<0.05);观察组ALP水平低于对照组(P<0.05),血Ca含量高于对照组(P<0.05)。治疗后,2组E2水平均较治疗前升高,FSH及LH水平均较治疗前降低,差异均有统计学意义(P<0.05);观察组E2水平高于对照组,差异有统计学意义(P<0.05)。2组血常规异常、肝肾功能异常、消化道症状、皮肤过敏发生率比较,差异均无统计学意义(P>0.05)。结论:加味温经汤治疗肾阳亏虚型PMOP,能有效改善患者的临床症状和性激素水平,用药安全性高。     

Iron-deficiency and dopaminergic treatment effects on RLS-Like behaviors of an animal model with the brain iron deficiency pattern of the restless legs syndrome

BackgroundBrain iron deficiency (BID), especially for the substantia nigra (SN), without peripheral iron deficiency (ID) has been well documented as a ubiquitous finding for restless legs syndrome (RLS) patients. This close association suggests the biology of RLS BID can produce RLS symptoms. Association, however, cannot establish such a direct relationship. Instead, the BID of RLS could be experimentally produced to determine if it then produces significant RLS-like biological or behavioral features. Forward genetics approach led to identification from the BXD strains the BXD40 females (BXD40f) as a putative animal model for the RLS BID. The BXD40f on an iron-sufficient diet have a lower iron in the VMB (containing the SN) during the active but not inactive period. This was not found for the other BXD strains evaluated. The BXD40f on an ID diet uniquely have even greater reduced VMB but not peripheral iron, matching the RLS BID pathophysiology. A prior report found that the BXD40f on an iron-sufficient diet had an RLS-like behavior of increased activity occurring only in the last part of the active period that was not present in the other strains without the low VMB iron. This increased activity matches the circadian pattern of symptoms in RLS patients with increased urge or drive to move in the last part of the day. This study asks first: if you decrease the VMB iron by an iron deficient diet do the RLS-like behaviors worsen; and second will the dopaminergic treatments effective for RLS also reduce the worsened RLSlike behaviors.MethodsIn sum, 13 BXD40f mice post weaning were randomly assigned for 100 days to either a iron-sufficient diet (n = 6) or an ID diet (N = 7). They were then evaluated for 24-h activity in their home cage using implanted G2 EMitter telemetry device. At 3 h before the end of the active period IP doses were given every other day of either: saline (vehicle only), 12.5 mg levodopa, 25 mg levodopa, 0.5 mg quinpirole, or 1 0.0 mg quinpirole.ResultsThe ID compared to irons-sufficient diet produced earlier onset of the RLS-like behavior matching the earlier onset of symptoms with increasing severity of RLS. The dopaminergic treatments significantly reduced the RLS-like behavior. Added analyses of the RLS-like behaviors as decreased resting times showed similar results to activity increases.ConclusionsThese data demonstrate both that The BXD40f provide a useful animal model of RLS and also strongly support the hypothesis that the biology of RLS BID can produce RLS symptoms.     

Update on patient blood management 2019

Preoperative anaemia is common and is associated with adverse outcomes. Furthermore, it puts patients at risk for allogeneic blood transfusions which in turn may be associated with adverse outcomes. Diagnosis and treatment of anaemia is one of the tenets of patient blood management (PBM), along with reduction in unnecessary transfusions and use of hemostatic agents to reduce bleeding among multiple others. Effective PBM is multi‐disciplinary, multi‐modal, timely, personalized and patient‐centred. I will discuss recent updates in PBM with emphasis on treatment of preoperative anaemia, restrictive transfusion triggers and use of tranexamic acid. I will also briefly discuss the barriers to PBM implementation and start conversation about how to improve patient engagement.     

从肝脾论治成年女性特应性皮炎

目的:特应性皮炎的发病及治疗存在很大的异质性,在治疗方面特别强调个体化治疗,本文主要总结成年女性特应性皮炎的治疗思路和方法。方法:基于肝脾两脏的生理、病理及成年女性特应性皮炎的临床表现,深入分析其病因病机及治疗方法。结果:女性成年特应性皮炎患者常肝脾同病,肝郁脾虚湿蕴和肝郁脾虚血弱是成年女性特应性皮炎的常见证型,临床可采用疏肝健脾祛湿法和疏肝健脾养血法进行治疗。典型病例中采用肝脾同调法不但可以改善患者的皮疹,也可有效缓解瘙痒和不良情绪。结论:肝脾同调法是治疗成年女性特应性皮炎的有效方法。     

新型冠状病毒(COVID-19)感染性肺炎现代中医诊疗建议方案与探讨

自2019年12月以来,以我国湖北武汉地区为中心,以人群集散辐射传播为特点,全国各地病例陆续出现增加。疫情发源地罹患患者早期以身热不扬、干咳气促、身楚乏力为主要症状,以脉濡缓、舌苔厚腻、胸部X线检查显示炎性反应性改变为特征的新型冠状病毒(COVID-19)感染性肺炎为主的新型传染病。疫情传入地的患者早期症状由于地域的不同,有所差异。各地传统中医、现代医学先后集体或个人出台了相关诊疗方法和建议方案。作为现代中医,按照习近平主席:“遵循中医发展规律,传承精华,守正创新”和“中西并重”的指示精神。为规范这一新型传染病“瘟疫”的认知和诊疗,综合相关资料,根据疫情演变规律,结合个人经验与体会,特此探讨COVID-19感染性肺炎的诊疗建议方案。     

“两阶段三部曲”在结直肠癌辅助化疗期的应用＊

辅助化疗有助于改善高危II/III期结直肠癌患者的生存。然而，辅助化疗的不良反应影响患者的生活质量，严重的不良反应甚至可能导致化疗的延期或终止，使得患者不能从辅助化疗中获益。中国中医科学院西苑医院杨宇飞教授根据多年临床经验，创新性提出辅助化疗期的“两阶段三部曲”，即补肾健脾序贯疗法，第1阶段应用自拟六君安胃方健脾和胃，针对化疗导致的胃肠道反应；第2阶段运用芪菟二至方健脾益肾，针对化疗导致的骨髓抑制；以及辛凉解表感冒方，针对化疗期间的外感。临床应用取得了显著的疗效。文章详细阐述“两阶段三部曲”提出的背景及其主要内容。     

Using structural equation modelling to understand the contributors to anaemia among young Burkinabe children

Anaemia is a persistent problem among young Burkinabe children, yet population‐specific information on its determinants is scant. We used baseline data from an evaluation of Helen Keller International's Enhanced Homestead Food Production Program (n=1210 children) to quantify household‐, mother‐, and child‐level factors associated with anaemia in Burkinabe children aged 6‐12 months. We used structural equation modelling to assess a theoretical model, which tested four categories of factors: (a) household food security and dietary diversity, (b) household sanitation and hygiene (latrine and poultry access and bednet ownership), (c) maternal factors (anaemia, stress, cleanliness, and health, hygiene and feeding knowledge and practices), and (d) child nutrition and health (iron deficiency (ID), retinol binding protein (RBP), malaria, and inflammation). The model also included household socio‐economic status, size, and polygamy; maternal age and education; and child age and sex. Results showed that ID, malaria, and inflammation were the primary direct determinants of anaemia, contributing 15%, 10%, and 10%, respectively. Maternal knowledge directly explained improved child feeding practices and household bednet ownership. Household dietary diversity directly explained 18% of child feeding practices. Additionally, RBP, child age and sex, and maternal anaemia directly predicted child haemoglobin. Our findings suggest that program effectiveness could be increased by addressing the multiple, context‐specific contributors of child anaemia. For young Burkinabe children, anaemia control programs that include interventions to reduce ID, malaria, and inflammation should be tested. Other potential intervention entry points suggested by our model include improving maternal knowledge of optimal health, hygiene, and nutrition practices and household dietary diversity.