刍议“肝为五脏之贼”

刍议“肝为五脏之贼”河南省三门峡市人民医院（４７２０００）张跃华，杨林，周若梅《素问·举痛论》说：“百病生于气也。”《医门八法》中云：“诸病多生于肝”。岳美中曰：“中医所称之肝，其生理复杂，其病理亦头绪纷繁，所以有‘肝为五脏之贼’，‘肝病如邪’等说法...     

基础治疗加肝病治疗仪治疗乙型肝炎肝纤维化及代偿期肝硬化

目的:观察基础治疗联合DSG-Ⅱ型肝病治疗仪治疗乙型肝炎肝纤维化及代偿期肝硬化的临床疗效.方法:将109例乙型肝炎肝纤维化及代偿期肝硬化患者随机分为治疗组69例,对照组40例.治疗组患者采用基础治疗联合肝病治疗仪;对照组患者采用基础治疗,包括常规保肝、降酶、抗病毒等方法.结果:治疗后两组患者在症状方面均得到明显改善,治疗组优于对照组(P＜0.05).在改善肝功能、肝纤维化指标方面,治疗组优于对照组(P＜0.05).在改善门脉内径方面两组比较,差异无显著性意义(P＞0.05).结论:肝病治疗仪对乙型肝炎肝纤维化及代偿期肝硬化患者在改善症状、肝功能及肝纤维化指标方面疗效显著,可在临床推广应用.     

以肝肿大为特征的肝淀粉样变性1例

病例：患者女,55岁,因＂上腹胀痛5个月,加重1个月＂于2010年8月12日收治入院.患者5个月前无明显诱因下出现持续性上腹胀痛伴纳差,1个月前症状加重,伴乏力、厌油、食欲减退.至我院门诊检查示总胆红素26.4μmol/L,直接胆红素10.4 μmol/L,GGT 425.54 U/L,ALP 624.7 U/L.肝炎病毒血清学、血清自身抗体、免疫球蛋白、补体均阴性.腹部彩超示肝体积明显肿大,脾脏轻度肿大.患者曾有血吸虫疫区生活史,否认传染病史、系统性疾病史、食物和药物过敏史.入院查体：体温36.9 ℃,脉搏93次/min,呼吸19次/min,血压147/78 mm Hg（1mm Hg=0.133 kPa）.     

治疗慢迁肝 当重视肝脾肾

笔者认为慢性肝炎的病机可以概括为“起于肝,损及脾,本于肾”,并认为若能在此相关理论指导下进行治疗,常可获得较好的疗效。兹分述如下,谨供参考。肝脾病变相关 治肝当须实脾众所周知,急性肝炎多因“温热蕴于肝胆”所致,以邪气盛为主要表现;慢性肝炎则由于病程迁延日久,耗伤肝气,劫夺肝阴,而成肝虚之证。张仲景在《金匮要略》中从人体脏腑相关的整体观出发,论述了肝病的治疗原则:如“见肝之病,知肝传脾,当先实     

肝性脑病的诊疗研究进展

肝性脑病（hepatic encephalopathy，HE）是严重的肝功能失调或障碍引起的、以代谢紊乱为基础的中枢神经系统失调的综合征。HE是肝病患者常见的并发症和死亡原因，现将其诊疗研究进展综述如下。     

骨髓干细胞定向分化为肝样细胞的研究进展

近年来研究表明,在适宜的微环境下,骨髓干细胞不但可以分化为骨、软骨、脂肪、肌细胞和各种血细胞,而且还可以跨越胚层向外胚层起源的神经元细胞及内胚层起源的肝细胞、胰岛细胞等分化,称为"可塑性(plasticity)"或"横向分化(transdifferentiation)".本文就骨髓干细胞分化为肝样细胞及其临床治疗肝系疾病做一综述.     

基于“肝肺同治”理论辨治艾滋病肝咳北大核心CSCD

艾滋病患者承受着较大的精神压力,因肝气郁滞所导致的艾滋病肝咳日益增多,具有反复发作,病程较长,疑难复杂的特点。“肝肺同治”理论强调治疗咳嗽从肝肺入手,注重调畅气机。本文从五行相制、经络相连、升降相因等方面论述“肝肺同治”理论基础,基于此理论阐述了艾滋病肝咳以“虚、郁、痰、瘀”为主要病理因素,以气血亏虚、气机郁滞为关键病因病机,以本虚标实,虚实夹杂为主要病证特点,提出了应用疏肝理气祛痰法、清肝泻肺化痰法、疏肝涤痰化瘀法、滋补肝肾兼补肺法治疗气滞痰湿阻肺证、气郁痰热壅肺证、肝郁痰凝血瘀证、肝肾阴虚兼肺虚证等4种艾滋病肝咳常见证型,以期进一步扩大艾滋病咳嗽的治疗范围,为艾滋病咳嗽的治疗提供一种新思路。     

八宝丹治疗肝脏疾病的临床与基础研究

<正>厦门中药厂生产的八宝丹胶囊起源于明代,目前公开的组方成分中以牛黄为君,以蛇胆、羚羊角为臣,以珍珠、三七为佐,以人工麝香为使^[1]。临床上主要应用于肿瘤、肝胆疾病、炎症疾病、免疫系统疾病等方面^[2]。近年来,八宝丹在肝病领域的临床及基础研究较热。其治疗肝病的主要功效是清利湿热、活血解毒、祛黄止痛。其组成药物多入心肝两经。君药牛黄清热解毒、保肝利胆,可显著降低肝炎患者的谷丙转氨酶;臣药蛇胆及羚羊角清热解毒,可起到抗病毒、免疫调节、增强免疫之效;佐药珍珠及三七散瘀止血定痛,具有免疫促进、抗肿瘤、促进胆红素代谢、抗肝纤维化等作用;使药人工麝香通经活血,具有抗炎、提高肝酶活性、改善肝脏微循环之效^[2]。鉴于八宝丹胶囊在肝病的临床及基础研究成果,现综述如下。     

趣谈“以形治形,以脏补脏”

<正> 中医的"脏器疗法"源远流长民间广泛流传着"吃啥补啥"一说,如"吃猪肺补肺"、"吃羊肝补肝"、"吃草鱼眼明目"等等。其实,它源泉于中医"以形治形,以脏补脏"的食疗观,中医称为"脏器疗法"。追溯古昔,据认为2500年前春秋末期越王勾践发明的"卧薪尝胆",是最早利用     

中药以肝星状细胞为靶点的抗肝纤维化研究进展

肝纤维化的形成主要是由于肝炎病毒、酒精、药物与毒物、血吸虫、代谢和遗传、胆汁郁积、自身免疫性肝病等多种损伤因素长期慢性刺激肝脏，使肝窦内肝星状细胞（HSCs）活化，胶原等细胞外基质（ECM）代谢失衡，生成大于降解，促使肝脏ECM沉积与组织结构重构。而HSCs活化和功能改变是肝纤维化发生发展的关键，对HSCs的干预无疑将成为防治肝纤维化的核心措施之一。     

Plasma Concentration of Endothelin-1 Does Not Reflect Renal Vasoconstriction as Estimated by Duplex Ultrasonography in Cirrhosis

Endothelin, a potent vasoconstrictor, is thoughtto play a role in liver cirrhosis-related functionalkidney failure. Our aim was to investigate thecorrelation between renal vasoconstriction, as detected by a Doppler ultrasound technique, and plasmaconcentrations of endothelin in cirrhotic patients.Fifty cirrhotic patients underwent Doppler examinationsto detect renal vasoconstriction. The plasmaconcentration of endothelin was measured in 10 patients whoexhibited vasoconstriction of the renal microvesselsdiagnosed by Doppler waveform analysis and was comparedto that of patients in whom there was no sign of such vasoconstriction. No difference wasobserved in the plasma concentration of endothelinbetween patients in whom renal vasoconstriction wasdiagnosed and those in whom it was not. Our resultssuggested that the circulating endothelin does notreflect renal vasoconstriction, at least in the earlyphase of the functional renal failure associated withcirrhosis of the liver.     

Angiomyolipoma of the liver: A collective review

This review summarizes the clinical and pathological findings of 52 cases of hepatic angiomyolipoma to discern and establish the most pertinent clinical and pathologic characteristics of the tumor. The disease was symptomatic in 60% of the patients. Abdominal pain or distress was the most common symptom, appearing in 37% of the patients, followed by malaise and upper abdominal mass or hepatomegaly. Of the 52 patients, only three (5.8%) showed associated tuberous sclerosis. Antemortem diagnosis of the tumor has been made with increasing frequency with the recent advent of computed tomography (CT) and ultrasound (US). The tumor was usually visualized as a hyperechoic mass by US imaging and as a low density mass less than -20 Housefield units by CT, and was hypervascular on angiography. The tumor was usually yellow to light tan, depending on the amount of fat tissue. Histologically, the tumor was characterized by an admixture of mature fat cells, blood vessels, and smooth muscle cells, with occasional foci of extramedullary hematopoiesis. The aumount of smooth muscle component varied and often exhibited hypercellularity, pleomorphism with occasional bizarre giant cells, and moderate mitotic activity. These features are considered conducive to an erroneous diagnosis of malignant tumor. However, since no malignant counterpart has been reported, it can easily be accurately differentiated histologically, if one is aware of the entity and can identify the three components of the tumor; blood vessels, smooth muscle cells, and fat. With regard to the histogenesis of angiomyolipoma, primitive mesenchymal cells around blood vessels may be the precursor cells.     

Qualitative methodologies II: a brief guide to applying interpretative phenomenological analysis in musculoskeletal care

In this paper, we conclude our two-part series discussing how readers of Musculoskeletal Care might employ qualitative methods. In the first paper of the series, we focused upon some issues surrounding the distinctions and similarities between qualitative and quantitative approaches, and outlined the origins, typology and limitations of qualitative methods. We introduced one particular qualitative research process which readers may find useful: interpretative phenomenological analysis (IPA). In this paper, we provide a guide to applying IPA via the design of an interview, a methodology with which it is particularly suited. We discuss some specific interview and interviewing processes and also some necessary ethical issues, including personal protection and participant well-being. We also discuss how to proceed through analysis while considering questions about the generalizability, reliability, validity and application of results. Finally, we question the overall direction of qualitative research, which we hope will fuel debate among readers.     

结核分枝杆菌与巨噬细胞的相互作用研究概述

结核分枝杆菌是一种胞内感染菌,巨噬细胞是其寄生场所。巨噬细胞是机体内抗菌免疫的主要效应细胞,通过直接杀伤和/或分泌多种细胞因子,对结核分枝杆菌具有抗原呈递、免疫杀伤等作用;结核分枝杆菌则可通过阻止吞噬体与溶酶体的融合逃避巨噬细胞的免疫监视和攻击。深入研究结核分枝杆菌对巨噬细胞免疫杀伤和免疫逃避机制,对研究宿主抗结核免疫机制以及设计新型结核病疫苗有深远意义。     

COVID-19 and the liver: A brief and core review

Coronavirus disease 2019 has a wide range of clinical spectrum from asymptomatic infection to severe infection resulting in death within a short time. Currently, it is known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) does not only cause a respiratory tract infection but a more complicated disease that can lead to multiple system involvement including the liver. Herein, we evaluate the epidemiology, the impact of liver injury/ dysfunction on disease prognosis, the pathophysiological mechanisms and management of liver injury. More than one-fourth of the patients have abnormal liver function tests, mostly a mild-to-moderate liver dysfunction. Liver injury is significantly associated with a poor clinical outcome. Direct cytotoxic effect of SARS-CoV-2, the immune response (“cytokine storm”), the complications related to the disease, and drugs used in the treatments are the pathophysiological mechanisms responsible for liver injury. However, the exact mechanism is not yet clearly explained. The binding of SARS-CoV-2 to the angiotensin-converting enzyme 2 receptors and entering the hepatocyte and cholangiocytes can cause cytotoxic effects on the liver. Excessive immune response has an important role in disease progression and causes acute respiratory distress syndrome and multi-organ failures accompanied by liver injury. Treatment drugs, particularly lopinavir/ritonavir, remdesivir and antibiotics are a frequent reason for liver injury. The possible reasons should be meticulously investigated and resolved.     

浅析艾滋病的告知义务

告知义务是医务人员医疗行为中的重要环节。艾滋病的特殊性,使得实际工作中会面临多种多样的生物及社会问题。结合医学、法律、人文等相关内容,在艾滋病的预防与治疗方面,研究医疗行为——告知理论与实务,以期开创医患新境界,提高医务人员职业素养。     

第四届全国脂肪性肝病学术会议纪要

由中华医学会肝病学分会脂肪肝和酒精性肝病学组与中国工程院医药卫生学部联合主办,第三军医大学大坪医院和上海交通大学新华医院共同承办的“第四届全国脂肪性肝病学术会议”于2011年7月21-24日在重庆举行。大会主席庄辉院士和范建高教授,执行主席陈东风教授。来自中国香港、中国台北、新加坡以及中国内地20余个省市的500余名代表参会。全会包括1个主题演讲（脂肪肝和酒精性肝病学组10周年回顾）、5个继续教育讲座、20个专题报告、52篇论文书面交流、10篇口头发言（王万东、徐承富和潘勤博士获优秀论文奖）,1场疑难病例讨论、两场卫星会议,以及全国18家脂肪肝诊治中心专家交流会和中国脂肪性肝病诊疗协作组会议。曾民德、唐朝枢、李伟道等资深教授分别在会上作重要讲话或点评。现将此次会议的主要内容概括如下。     

Clinical Yi-guan decoction for liver cirrhosis: A protocol for systematic review and meta analysis

Background:At present, Liver Cirrhosis (LC) is common in most later liver and gallbladder diseases that its morbidity and mortality seriously affect human health. The limitation and effectiveness of western medicine on LC have become a huge clinical challenge. However, a large number of clinical studies have shown that Yi-guan decoction has become a complementary treatment for LC. Therefore, this systematic review will aim to explore the safety and feasibility of Yi-guan decoction in the treatment of LC.Methods:We will conduct a comprehensive literature search in Medline, PubMed, Cochrane Database of Systematic Reviews, Embase, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure, Wang Fang Database, Chinese Scientific Journal Database from inception to December 2020 without any language restriction, In addition, relevant literature will be searched manually. The main subject terms searched: “Yi-guan decoction” “cirrhosis” “LC”. Data entry will be performed by 2 researchers separately. Primary outcomes will be concluded: Liver function indicators: Total bilirubin, Alanine transaminase, Aspartate aminotransferase, etc. Secondary outcome indicators: Total effective rate, Nutrition index, Survival analysis, Adverse events; All randomized controlled trials collected in this study will be evaluated and rated using the Cochrane risk-of-biasassessment tool. Meta-analysis will be performed using RevMan 5.4.0 software. The heterogeneity test will be conducted between the studies, P < .1 and I² > 50% are the thresholds for the tests. Using solid effect model or random effect model will be based on its heterogeneity value.Results:This systematic review provides a theoretical basis for Yi-guan decoction to treat LC, we will report this result soon.Conclusion:This study will explore Yi-guan decoction can will be used as one of the non drug therapies to prevent or treat LC.Trial registration number:INPLASY2020120114.