对肾阳虚证诊断标准层次性的探讨

通过对肾阳虚证诊断标准的理论研究,结合临床运用需要,认为肾阳虚证的诊断标准可以分为三个层次：教材、临床科研的肾阳虚诊断标准,临床医生的肾阳虚诊断标准和特殊疑难病证的肾阳虚诊断标准。这三个层次各有侧重,层层递进,构成一个完整的肾阳虚证诊断体系。可以更好更完整地反映辨证论治规律,从而提高整体辨证水平。     

肾阳虚辨证因子的聚类分析探讨

目的用聚类分析法研究肾阳虚证辨证因子客观化、标准化的方法和思路。方法通过肾阳虚评分量表收集300例肾阳虚证病例,用SPSS软件包进行分析,对出现率较高的症状进行聚类分析,寻找对肾阳虚证候诊断的贡献度。结果临床调查发现肾阳虚证辨证因子出现的频率高低不同,筛选出25项频率高的辨证因子进行聚类分析,发现舌、脉、主症聚类有明显规律。修订了原量表中的主症,最终确定为:畏寒、肢冷、腰背发冷、腰膝酸痛。结论发现对肾阳虚辨证贡献度较大的25项辨证因子;聚类分析结果证实舌象、脉象及主症聚类关系最为密切,与文献资料结合,对肾阳虚证的主症进行了修订,为实现肾阳虚证的客观化、标准化探索新的方法和思路。     

基于“心肾相关”理论探讨“肾阳虚证”的病机及治疗

"肾阳虚证"是中医学脏腑辨证的重要证型之一,为此从理论到临床上的研究层出不穷,一直深受中医界的广泛重视。从"心肾相关"理论研究肾阳虚证,认为"肾阳虚证"的病因病机与心之生理功能异常有关,并可将"肾阳虚证"分为肾阳虚心火旺证和肾阳虚心阳虚证两种证型,根据证型特点采用以交通心肾为基础的清心降火和温养心阳两种治法进行治疗。     

类风湿关节炎肺间质病变中医证型与肺部高分辨CT和肺功能的关系

目的:探讨类风湿关节炎肺间质病变中医证型与肺部高分辨CT和肺功能的关系。方法:收集207例类风湿关节炎肺间质病变患者的临床资料,根据中医辨证分为肺肾气阴两虚证、肺肾气虚证、肺脾气虚证和肾阳虚证4个证型,对各个证型与肺部高分辨CT和肺功能的相关性进行研究。结果:207例患者中肺肾气阴两虚证最多(45.9%),肾阳虚证最少(11.1%)。对各个证型在肺HRCT不同阶段的比例数比较发现:在肺HRCT 1期阶段,肾阳虚证肺肾气虚证肺脾气虚证肺肾气阴两虚证;在肺HRCT 2期阶段,肾阳虚证肺肾气阴两虚证肺脾气虚证肺肾气虚证;在肺HRCT 3期阶段,肺肾气阴两虚证肺脾气虚证肺肾气虚证肾阳虚证。肺功能方面:在肺功能轻度下降阶段,肾阳虚证肺脾气虚证肺肾气虚证肺肾气阴两虚证;在肺功能中度下降阶段,肺肾气阴两虚证肺肾气虚证肺脾气虚证肾阳虚证;在肺功能重度下降阶段,肺肾气阴两虚证肺肾气虚证肺脾气虚证肾阳虚证。结论:肺肾气阴两虚证是RA-ILD的主要证候类型,肾阳虚证最少见;肺肾气阴两虚证多见于肺HRCT的2期和3期阶段,肺功能的中、重度下降阶段,程度最重;肾阳虚证多见于肺HRCT的1期和2期阶段,肺功能的轻、中度下降阶段,程度最轻。     

Hsa-miR-3074在肾阳虚证中的表达差异性研究

目的探讨miR-3074-3p的表达对肾阳虚证发生的影响。方法采集14例肾阳虚证患者和10例健康者外周静脉血,取其白细胞,使用TRIzol法提取RNA并进行质量检测。将该样本的总RNA逆转录合成cDNA,通过实时定量PCR检测,分析miR-3074-3P的相对表达量。结果miR-3074-3p在肾阳虚证组中相对于健康对照组表达上调。结论miR-3074-3p在肾阳虚证患者基因表达中相对于健康人上调明显,其作用机制需进一步研究证实。     

高效抗逆转录病毒治疗艾滋病致血液毒性反应中医证候分析

目的了解高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)艾滋病致血液毒性反应的主要证候特点及差异。方法采用横断面调查的方法,收集HAART治疗后出现血液毒性反应的216例患者四诊信息,归纳证候学特点并分析其差异。结果 216例中主要中医证候为气血两虚证(142例,占65.7%)和脾肾阳虚证(74例,占34.3%);气血两虚证中医症状积分明显低于脾肾阳虚证(P<0.05);气血两虚证组CD4+T细胞计数高于脾肾阳虚证组(P>0.05),两证患者血清病毒载量比较,差异无统计学意义(P>0.05)。气血两虚证组患者生活质量较脾肾阳虚证者高,但差异无统计学意义(P>0.05)。结论 HAART致血液毒性反应的主要证候有气血两虚证和脾肾阳虚证,气血两虚证病情相对较轻,不同证候患者生活质量、CD4+T细胞及病毒载量差别不明显。     

肾阳虚证程度辨证刍议

总结肾阳虚证程度辨证的6个层次 ,由轻到重依次分为隐性肾阳不足 ,生理周期性肾阳不足 ,临床性肾阳虚证 ,肾阳虚衰、阳损及阴 ,肾阳虚衰、虚阳外浮 ,肾阳虚衰、虚阳亡脱 ,以期为最终实现中医量化研究而抛砖引玉。     

肾阳虚证免疫功能相关基因筛选及其表达分析

目的以基因芯片技术从基因表达角度分析肾阳虚证与免疫功能的关联性。方法筛选出符合中医肾阳虚证诊断标准的患者4例,健康对照4例,提取mRNA,经标记、杂交、清洗、芯片扫描、图像的采集与数据分析等过程,获得基因表达数据,通过SAM芯片数据分析软件筛选肾阳虚证显著表达基因。结果筛选到70条显著表达基因,其中与免疫相关的有18条。结论肾阳虚证患者存在免疫功能异常,免疫功能基因的异常表达是肾阳虚证发生的分子基础之一。     

基因芯片技术研究针灸对肾阳虚证骨关节炎患者免疫相关基因表达的影响

目的:探讨针灸对肾阳虚证骨关节炎患者免疫相关基因表达的影响。方法:用基因芯片技术检测肾阳虚证骨关节炎患者及正常人的基因表达谱,以及针灸治疗显效者的治疗前后基因表达谱的变化。结果:通过基因表达谱芯片筛选出与肾阳虚骨关节炎免疫相关的基因13条,肾阳虚骨关节炎患者与正常人相比表达下调4条,上调5条。经温针治疗显效的4例患者治疗前后的基因芯片比较结果显示:NM000265、NM001838基因普遍上调,NM_001784基因普遍下调,其他基因表达无规律性变化。结论:肾阳虚证骨关节炎的发生涉及免疫相关基因表达的异常,针灸可能通过诱导或阻遏这些基因的表达发挥效应。     

肾阳虚证程度辨证刍议

总结肾阳虚证程度辨证的6个层次,由轻到重依次分为隐性肾阳不足,生理周期性肾阳不足,临床性肾阳虚证,肾阳虚衰、阳损及阴,肾阳虚衰、虚阳外浮,肾阳虚衰、虚阳亡脱,以期为最终实现中医量化研究而抛砖引玉。     

丽参注射液对老年女性冠心病肾虚患者性激素双向调节的初步研究

本研究观察了丽参注射液治疗前后老年女性冠心病肾虚患者雌二醇（Ｅ２）、睾酮（Ｔ）及Ｅ２／Ｔ比值的变化。结果：治疗前与对照组比较，Ｅ２、Ｅ２／Ｔ肾阳虚组明显降低，肾阴虚组明显升高（Ｐ均＜０．０１）；肾虚两组比较亦差异显著（Ｐ＜０．００１）。３组Ｔ比较差异均不显著（Ｐ＞０．０５）。治疗后随着肾虚症状改善，Ｅ２、Ｅ２／Ｔ肾阳虚组明显回升（Ｐ＜０．０５），肾阴虚组明显下降（Ｐ＜０．０１），均接近对照组，Ｔ两组均无显著变化。提示：绝经期后冠心病肾虚患者阴阳失调与性激素紊乱有关，主要表现在生物活性作用强的Ｅ２水平的升高或降低；人参既可调整阴阳改善肾虚症状又可逆转性激素变化，对Ｅ２有很好的双向调节作用，有助于人体内环境雌雄性激素的平衡。     

从下丘脑-垂体-甲状腺轴研究肾阳虚证的现状及思考

肾阳虚证下丘脑-垂体-靶腺(肾上腺、甲状腺、性腺及胸腺)轴的功能紊乱.文章从动物实验和临床研究两方面综述了肾阳虚证在下丘脑-垂体-甲状腺轴方面的研究进展,并针对下步研究肾阳虚证提出一些看法.     

丽参注射液对老年女性冠心病肾虚患者性激素双向调节的初步研究

本研究观察了丽参注射液治疗前后老年女性冠心病肾虚患者雌二醇（Ｅ２）、睾酮（Ｔ）及Ｅ２／Ｔ比值的变化。结果：治疗前与对照组比较，Ｅ２、Ｅ２／Ｔ肾阳虚组明显降低，肾阴虚组明显升高（Ｐ均＜０．０１）；肾虚两组比较亦差异显著（Ｐ＜０．００１）。３组Ｔ比较差异均不显著（Ｐ＞０．０５）。治疗后随着肾虚症状改善，Ｅ２、Ｅ２／Ｔ肾阳虚组明显回升（Ｐ＜０．０５），肾阴虚组明显下降（Ｐ＜０．０１），均接近对照组，Ｔ两组均无显著变化。提示：绝经期后冠心病肾虚患者阴阳失调与性激素紊乱有关，主要表现在生物活性作用强的Ｅ２水平的升高或降低；人参既可调整阴阳改善肾虚症状又可逆转性激素变化，对Ｅ２有很好的双向调节作用，有助于人体内环境雌雄性激素的平衡。     

蛇床子素和蛇床子总香豆素对肾阳虚大鼠血清甲状腺激素和促甲状腺激素的影响

采用醋酸氢化可的松造成肾阳虚模型大鼠，以它床子素和蛇床子总香豆素给药，测定大鼠血清促甲状腺激素和三种甲状腺激素Ｔ３，反Ｔ３及Ｔ４的浓度。结果，肾阳虚模型大鼠与正常大鼠比较，ＴＳＨ，Ｔ３，ｒＴ３和Ｔ４都显著降低；     

蛇床子素和蛇床子总香豆素对肾阳虚大鼠血清甲状腺激素和促甲状腺激素的影响

采用醋酸氢化可的松造成肾阳虚模型大鼠，以蛇床子素（ｏｓｔｈｏｌ，ＯＳＴ）和蛇床子总香豆素（ｔｏｔａｌ－ｃｏｕｍａｒｉｎｓ，ＴＣＲ）给药，测定大鼠血清促甲状腺激素（ＴＳＨ）和三种甲状腺激素Ｔ３、反Ｔ３（ｒＴ３）及Ｔ４的浓度。结果，肾阳虚模型大鼠与正常大鼠比较，ＴＳＨ、Ｔ３、ｒＴ３和Ｔ４都显著降低（Ｐ均＜０．０１）；用药大鼠与肾阳虚模型大鼠比较，上述４项指标都有显著性提高（Ｐ＜０．０１或Ｐ＜０．０５）。提示ＯＳＴ和ＴＣＲ可以提高肾阳虚模型大鼠的腺垂体－甲状腺轴功能。     

Curculigo orchioides (Xian Mao) modifies the activity and protein expression of CYP3A in normal and Kidney-Yang Deficiency model rats

Aim of the study

In Chinese medicine clinics, traditional Chinese herbs are used to treat disorders of Yin and Yang balance, including Kidney-Yang Deficiency. The activity of the hepatic cytochrome P450 3 A (CYP3A) is closely associated with body status. The aim of the present study is to investigate CYP3A enzymatic activity and CYP3A4 protein expression using a Kidney-Yang Deficiency rat model and furthermore to investigate the intervention effects of the Pungent-hot herb Xian Mao. This work contributes rationale for personalized medicine and enhances our understanding of herb–drug interactions.

Materials and methods

Rats were randomly divided into three groups: the model group, the Xian Mao group and the intervention group (model rats treated with Xian Mao). The model rats were given an intramuscular injection of hydrocortisone for 14 days, and the control rats were given normal saline. The Xian Mao group consisted of normal rats treated with Xian Mao by oral gavage for 7 days. The intervention group was given Xian Mao for 7 days after treatment with hydrocortisone. The activity of CYP3A was detected by using the erythromycin-N-demethylase method. CYP3A4 protein expression level was detected by Western-blot.

Results

CYP3A enzymatic activity in the Kidney-Yang Deficiency rat was decreased by 44% compared to normal animals. The relative CYP3A4 protein expression level of the Kidney-Yang Deficiency rat (mean value 0.663±0.188) was 20% lower than that of normal rat (0.830±0.199). The in vitro data showed that CYP3A activity was significantly (P<0.001) inhibited (decreased by 59%) by Xian Mao concentrations of 1 mg/mL. The in vivo data also showed that CYP3A activity was significantly decreased in the rats treated with the three doses of Xian Mao. The CYP3A4 protein expression was significantly decreased by Xian Mao treatment at the high and intermediate doses (30 and 20 g/kg, respectively) compared with the normal group. However, the intervention group (the Kidney-Yang Deficiency rat treated with Xian Mao at 20 and 30 g/kg) showed an increased CYP3A activity and CYP3A4 protein expression compared with the herb-untreated model rats.

Conclusion

CYP3A enzymatic activity and CYP3A4 protein expression could be inhibited by Xian Mao. The CYP3A activity and CYP3A4 expression in the Kidney-Yang Deficiency model rat were lower than that of normal rat but this deficiency could be rescued by treatment with Xian Mao.     

彭州小鱼洞乡299例寒证（肾阳虚证）证候调查报告

在彭州小鱼洞乡义诊中,采用自拟寒证、肾阳虚证量表调查了299例就诊病例,发现高寒环境是寒证（肾阳虚证）发生的重要诱因,其症状体征的分布状态在病因、病位、病性、病势上均有其地域的特点,集中表现为肢冷、畏寒、冷痛等,并多伴见头晕目眩、腰膝酸软、咳喘、胃脘痞满等肺系和脾系症状。     

Syndrome differentiation in traditional Chinese medicine in chronic aplastic anemia; T-lymphocyte subpopulation in peripheral blood and erythrocyte C3b receptors]

In this paper, the Syndrome Differentiation in TCM and the determination on T-lymphocyte subpopulation and RBC C3b receptor were carried out by using indirect SPA assay and RBC C3b receptor ring test among 51 chronic aplastic anemia patients. Result: The OKT3, OKT4 and OKT4/OKT8 ratio in groups of Kidney-Yin Deficiency group were lower, while the OKT8 was higher than that of controls. In the group of both Kidney-Yin and Yang Deficiency, OKT4 and OKT4/OKT8 ratio were lower. and the value of OKT8 is higher than that of controls. The OKT8 in the Kidney-Yang Deficiency group was higher. and the ratio of OKT4/OKT8 was lower than that of controls. The OKT8 in the Kidney-Yin Deficiency group among three groups increased higher than that of other two groups. while the OKT4/OKT8 ratio reduced. The OKT4/OKT8 ratio in the group of both Kidney-Yin and Yang Deficiency was higher than that of Kidney-Yang Deficiency group. Among the three groups, the rosette rates of RBC C3b receptor were lower than controls. The above-mentioned data were statistically significant. These characteristic changes could be used as a reference of microcosmic Syndrome Differentiation and also a guide for how to apply the immunosuppressant and immunopotentiator.     

卵巢早衰的中医辨证分型治疗临床观察

目的：探讨中医辨证论治,中药多系统、多环节的整体调节对卵巢早衰的作用。方法：对卵巢早衰患者进行中医辨证分型为：肾阳虚弱型,肝郁肾虚型,阴火血虚型。用中药多系统、多环节的整体调节对患者进行2-12个月的治疗。结果：患者临床症状及体征消失或改善,血清激素测定促卵泡生成素（FSH）、促黄体生成素（LH）下降,月经较前有规律。结论：采用中药治疗主要通过抑制特异性免疫损伤及消除某些缺陷,可使卵巢内残存的少数滤泡得以复苏,进而恢复和改善卵巢功能。