叶进教授从乙癸同源辨治女童青春期疾病经验撷要

乙癸同源又称"肝肾同源"，作为中医五行学说的重要组成部分，历来受到医家重视，在发展完善的过程中被用来治疗诸多病证。叶进教授作为江苏省中医院儿科生长发育专科创始人，在诊治儿童青春期内分泌疾病方面有着丰富的临床经验，临证发现小儿青春期相关疾病从"乙癸同源"角度进行辨治可以取得满意疗效。     

Intermittent fasting and changes in Galectin-3: A secondary analysis of a randomized controlled trial of disease-free subjects

Background and aimsIntermittent fasting reduces risk of interrelated cardiometabolic diseases, including type 2 diabetes and heart failure (HF). Previously, we reported that intermittent fasting reduced homeostasis model assessment of insulin resistance (HOMA-IR) and Metabolic Syndrome Score (MSS) in the WONDERFUL Trial. Galectin-3 may act to reduce insulin resistance. This post hoc evaluation assessed whether intermittent fasting increased galectin-3.Methods and resultsThe WONDERFUL Trial enrolled adults ages 21–70 years with ≥1 metabolic syndrome features or type 2 diabetes who were not taking anti-diabetic medication, were free of statins, and had elevated LDL-C. Subjects were randomized to water-only 24-h intermittent fasting conducted twice-per-week for 4 weeks and once-per-week for 22 weeks or to a parallel control arm with ad libitum energy intake. The study evaluated 26-week change scores of galectin-3 and other biomarkers. Overall, n = 67 subjects (intermittent fasting: n = 36; control: n = 31) completed the trial and had galectin-3 results. At 26-weeks, the galectin-3 change score was increased by intermittent fasting (median: 0.793 ng/mL, IQR: ?0.538, 2.245) versus control (median: ?0.332 ng/mL, IQR: ?0.992, 0.776; p = 0.021). Galectin-3 changes correlated inversely with 26-week change scores of HOMA-IR (r = ?0.288, p = 0.018) and MSS (r = ?0.238, p = 0.052). Other HF biomarkers were unchanged by fasting.ConclusionA 24-h water-only intermittent fasting regimen increased galectin-3. The fasting-triggered galectin-3 elevation was inversely correlated with declines in HOMA-IR and MSS. This may be an evolutionary adaptive survival response that protects human health by modifying disease risks, including by reducing inflammation and insulin resistance.Trial registrationClinicaltrials.gov, NCT02770313 (registered on May 12, 2016; first subject enrolled: November 30, 2016; final subject's 26-week study visit: February 19, 2020).     

基于数据挖掘的叶天士治疗郁证用药规律探析

[目的]探析叶天士治疗郁证的组方用药规律。[方法]采用数据挖掘方法,对《临证指南医案·郁》中38则医案中的药物进行频数、药效和性味归经的描述性分析,并对其中26味高频药物进行关联规则分析和聚类分析,总结叶氏治疗郁证的临床经验。[结果]共得到处方45首,药物93味,高频药物共26味,主要有茯苓、牡丹皮、当归、郁金、白芍、生姜、栀子、甘草等,常用的药物组合包括“甘草-当归”“薄荷-茯苓”“白芍-甘草-当归”等。药效以补虚药最多;药性以寒、温、平为主;药味苦、甘、辛多见;归肺、心、肝、脾经最多。聚类分析将高频药物分为7组,涉及理气化痰、益气生血、滋阴清热、利水安神等剂。[结论]叶氏治疗郁证主张调畅情志,辨别虚实,善用寒温药物配伍;重视肝脾同调,且疏肝养肝并行;重视理气,多法泻火,气血并治。总结提炼其治疗郁证的学术思想,对临床上郁证的治疗具有参考价值。     

3种银杏叶制剂治疗冠心病心绞痛的成本—效果分析

目的:比较3种银杏叶制剂治疗冠心病心绞痛的成本-效果。方法:将103例符合诊断标准的冠心病心绞痛患者按照不同的用药方案分成A组(34例)、B组(35例)、C组(34例)。A、C组分别给予生产厂商及规格不同(2mL vs.5mL)的舒血宁注射液20mL、B组给予银杏达莫注射液20mL,3组均静脉滴注,qd,治疗14d后观察疗效,并进行成本-效果分析。结果:3组心绞痛改善总有效率分别为70.59%、91.43%、73.53%。成本分别为5207.86元、3575.46元、5065.06元,成本-效果比分别为7377.62、3910.60、6888.43。结论:与A、C组比较,B组治疗方案成本-效果比更优。     

叶天士运用小方的特点

叶天士为清代著名医家.叶氏之方药味虽少,但其理颇深.小方药味精简,便于研究.叶氏运用小方具有“学有根柢,效法仲景”“博采众长,善用古方”“论药处方,尤重气味”“重视脏腑,分经用药”“病有套法,辨证施治”等特点.叶氏处方中以6味者居多,其次为8味,用药达10味及10味以上者不多.     

叶柏教授治疗克罗恩病经验

叶柏教授认为,克罗恩病应从“脾虚湿热瘀毒”论治,认为脾虚为发病之本,标实有湿、热、瘀、毒不同,提出健脾扶正、益气温中以治其本,化湿清热、活血解毒以治其标,早期以标实证为主,清化活血解毒,还需顾护胃气;后期本虚为主时补益脾胃,佐以清化活血解毒;标本并重时则标本兼顾,扶正祛邪并施.并注意生活调摄、慎防外邪,以及汲取外科经验,内外兼顾.     

叶天士“在卫汗之可也”探析

《温热论》中有关卫气营血4个阶段的治法,是叶氏在研究温病过程中的重大成果。其中,温病邪在卫阶段,若不辨之,动辄则用汗法解表,往往可致伤阴助邪,变证蜂起。通过对叶天士在卫汗之可也的解读,正确认识温病肺卫阶段的证、治规律和特点,有着重要的理论意义和临床意义。     

通塞益脑液治疗急性缺血性中风及其微循环作用

通过临床研究观察了通塞益脑液治疗急性缺血性中风的临床疗效及作用机理.结果表明,通塞益脑液与有效对照组药物低分子右旋糖酐加维脑路通片疗效相似,以及通塞益脑液具有改善微循环的作用.     

叶进教授治疗儿童青春期疾病经验

叶进教授认为青春期发育是机体阴阳趋于平衡的过程,针对此期发生的疾病应调理阴阳,以平为本。由于青春发育过程具有时间上的延续性,治疗需要较长时间,在辨体质、调体质时,用药以轻、清为原则,旨在时时顾护儿童娇嫩之脏腑。指出儿童本就处于生长发育过程中,阴生阳长是必然趋势,治疗时把握总体趋势并且顺势而调,常常可以获得满意疗效。附案例1则,以资验证。     

叶天士《临证指南医案》论治慢性咳嗽经验探析

《临证指南医案》中关于"久咳"、"久嗽"医案共34例,体现了叶天士治疗慢性咳嗽的学术思想及用药特点:以中医整体观出发,以"五脏六腑皆令人咳,非独肺也"为指导,治病力求治本,用药重视药物性味,善用经方。