基于仝小林院士脏腑风湿理论探讨新型冠状病毒肺炎康复期的中药治疗

仝小林院士将新型冠状病毒肺炎定名为"寒湿疫"，并以此理论为基础制定了初期、中期、重症期及恢复期的中医治疗方案，同时基于仝院士学术理论体系中的"脏腑风湿"理论，根据恢复期 "余毒未清，正虚邪恋"的病机特点，探讨其符合具备脏腑风湿行成3个基本要素：即外受寒湿裹挟戾气为必要外因；脏腑内虚为重要基础；邪疫伏留胶着，正邪交争为致病关键。故在辨证施治中可应用脏腑风湿理论以调理脾胃，化湿透邪，补益肺脾，顾护阳气，养阴生津。     

王兴臣教授对新型冠状病毒肺炎中医病因病机的认识

王兴臣教授为全国第二批优秀中医临床人才,山东省名中医药专家,山东中医药大学中西医结合临床专业博士研究生导师,全国名老中医药专家学术经验继承工作指导老师,山东中医药大学第二附属医院新冠肺炎防控专家组专家。自疫情发生以来,始终战斗在抗疫第一线,对新冠肺炎进行了深入的思考,对本病中医病因病机潜心做出文献梳理,结合现代医学的认识,认为新冠肺炎为新冠病毒在伏气、时气的共同作用下致病,伏气是最重要的疫病致病因素,伏气、时气均与中医气化理论密切相关,而体质强弱决定本病的预后转归。故本文主要从伏气、时气、正气三个方面分析新冠肺炎中医病因病机,以期为中医瘟疫病的预测与防治、减少危重症的发生提供参考。     

输尿管镜下钬激光碎石联合排石汤治疗输尿管结石临床研究

目的:观察自拟排石汤联合输尿管镜下钬激光碎石治疗输尿管结石的临床疗效。方法:将120例确诊为输尿管结石患者行输尿管镜下钬激光碎石,术后常规予以西药抗感染、解痉、止痛等对症处理,并随机分成3组,每组40例,A组采用排石汤治疗,每次100 m L,日2次,共服2周;B组每天睡前口服α-受体阻滞剂盐酸坦洛新胶囊,每粒0.2 mg,每次2粒,每日3次;C组术后常规处理,嘱多饮水、多运动,每日尿量大于2 500 m L。所有患者观察终点为4周,记录患者下尿路刺激症、肉眼血尿、尿路感染、腰痛或下腹痛等情况,每周复查B超,第1周、第4周增加尿路平片。结果:1周后A组、B组、C组结石清除率分别为72.5%、50.0%、45.0%,其中A组的结石清除率显著高于B组、C组。从排石时间看,A组也要快于B组、C组,而2周、3周、4周结石清除率并没有统计学差异。A组术后4周尿路刺激症、肉眼血尿、尿路感染、腰痛或下腹痛症状较B组、C组明显减少(P0.05),有统计学意义。结论:输尿管镜下钬激光碎石术后运用中药排石汤剂治疗可以明显提高输尿管结石清除率,提高排石速率,缓解下尿路刺激症症状、腰痛等不适症状。     

基于近红外光谱技术快速定性鉴别广陈皮模型的建立

目的采用近红外光谱技术(NIRS)建立广陈皮的定性分析模型,以建立快速鉴别广陈皮药材的方法。方法采集广陈皮与川陈皮的NIRS图,通过标准正交变量变换(SNV)预处理后采用聚类分析方法建立广陈皮与川陈皮鉴别模型,并进行模型内验证和模型外验证,建立了广陈皮定性分析模型。结果在4 000~10 000 cm-1广陈皮和川陈皮能够较好地区分,内部验证的准确率高达100%,外部验证准确率达到90.91%。结论采用近红外光谱技术对广陈皮样品进行鉴别是可行的。     

郑寿全《医理真传》贵“中”思想浅探

通过分析郑寿全《医理真传》,认为郑氏虽为"火神派"的代表,虽然擅用姜、附、桂,但是其更加重视中土脾胃,即贵"中"。贵"中"思想更能代表郑氏的学术思想。提出贵"中"思想可以使我们更加全面地认识和继承郑氏的学术思想。     

《何氏虚劳心传》的用药规律分析

目的：分析《何氏虚劳心传》的用药规律,探讨虚劳的病机和治法特点。方法使用频数表对《何氏虚劳心传》治疗虚劳的21首方剂中所列药物的分类、使用频次、归经进行统计分析。结果虚劳的用药频次以补虚药最高,归经以肾膀胱经、肺大肠经、脾胃经为多。结论虚劳的基本病机在于阴虚,治疗注重补肾、健脾胃、生活调摄。     

秦艽清虚热的质疑与探析

质疑秦艽清虚热的功效。从秦艽功用沿革及历代医家对秦艽的认识,总结秦艽功效为主传尸骨蒸、除日晡潮热骨蒸、治小儿疳积骨蒸,而秦艽的除骨蒸作用不能等同于清虚热,秦艽并不具备治疗阴虚发热的特质,其在治疗阴虚发热方剂中的作用与其性用平和、辛散苦泄通利有关,而它本身并无直接的清退阴虚发热的功用。     

Effects of Jian Pi Qu Shi Formula on intestinal bacterial flora in patients with idiopathic membranous nephropathy: A prospective randomized controlled trial

BackgroundThe incidence of idiopathic membranous nephropathy (IMN) has recently increased remarkably. Immune dysfunction caused by disordered intestinal flora might be an important factor affecting IMN. The Jian Pi Qu Shi Formula (JPQSF) shows promise in treating IMN. Here, we sequenced 16S rRNA genes to compare intestinal flora between patients with IMN and healthy persons. We also conducted a randomized controlled clinical trial to further compare the intestinal flora of patients with IMN treated with traditional Chinese medicine (TCM) and western medicine (WM).MethodsAmong 40 patients with IMN treated at Department of Nephrology in Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine between July 2016 and December 2018, we compared 30 of them with 10 healthy persons (controls). The IMN group was randomly assigned to receive JPQSF (TCM) or immunosuppressant WM therapy in (n = 15 per group) for 6 months. Intestinal microbiota diversity was analyzed using alpha diversity and beta diversity. Intestinal flora that significantly differed between the groups was analyzed using MetaStat. The effects and safety of the therapies were determined based on the values for plasma albumin, 24-h urine protein excretion, serum creatinine, urea nitrogen, estimate glomerular filtration rate (eGFR), complete blood count, and liver enzymes. All data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) 20.0 statistical software.ResultsBaseline characteristics did not significantly differ between the IMN and healthy groups, or the TCM and WM groups. After six months of treatment, 24-h urinary protein significantly declined in the TCM and WM groups (before and after treatment: 3.24 ± 1.74 vs. 1.73 ± 1.85 g, P < 0.05 and 3.94 ± 1.05 vs. 1.91 ± 1.18 g, P < 0.05, respectively). Plasma albumin was significantly increased in the TCM group (before vs. after treatment: 32.44 ± 9.04 vs. 39.99 ± 7.03 g/L, P < 0.05), but did not significantly change in the WM group (31.55 ± 4.23 vs. 34.83 ± 9.14 g/L, P > 0.05). Values for urea nitrogen, serum creatinine, and eGFR did not significantly change in either group. The alpha diversity index for intestinal flora differed between the IMN and healthy groups, and the TCM and WM groups. Comparisons of multiple samples (beta diversity) revealed differences in intestinal flora between the IMN and healthy groups, and the TCM and WM groups. The Metastat analysis findings showed that the main genera that differed between the IMN group before treatment and the healthy group were Christensenellaceae_R-7_group, Bifidobacterium (77), Dorea, Escherichia-Shigella, Parabacteroides, Bifidobacterium, and Coprococcus_3. After TCM therapy, the main differential genera were Butyricimonas, Bacteroides, Alistipes, and Lachnospira, and after WM therapy, these were Ruminococcus_2, Lachnospiraceae_ND3007_group, Lachnospira, Bifidobacterium, Alistipes, and [Eubacterium]_ventriosum_group.ConclusionPatients with IMN might have disordered intestinal flora, and JPQSF can regulate intestinal flora in patients with IMN.     

Two-stage maxillary distraction osteogenesis using a modified external device: clinical outcome and complications

Rigid external distraction is currently used to correct severe maxillary hypoplasia. The purpose of this retrospective study was to present the clinical results and complications of a two-stage surgical approach using a modified external distraction system that consists of maxillary distraction and then maxillary fixation. We treated eight patients with cleft lip and palate in this way from 2016 to 2018. Lateral cephalograms taken before the first operation, after distraction, two weeks after the second operation, and one year after treatment were used to examine maxillofacial morphology. Velopharyngeal function was evaluated by a speech therapist. The mean movements of the maxilla forwards and downwards at Point A were 12.0 mm and 8.0 mm at the completion of distraction and those at Point B were 5.0 mm backwards and 9.7 mm downwards. Mouth opening was limited at this time, and was relieved after maxillary fixation. The mean relapse one year postoperatively was 24.3% horizontally and 52.5% vertically. Velopharyngeal function was unchanged by the operation. We conclude that the method has advantages that include the short duration of wearing distractors and increased acceptance by patients. The modified external device advanced the midface sufficiently.