针药并用治疗强直性脊柱炎37例

强直性脊柱炎（ankylosing spondylitis，AS）是一种病因复杂、病程较长、致残率较高的难治性风湿病，多发于青年男性。目前西医对AS尚无有效治疗方法，中医治疗有明显的优势。笔者有幸跟随国家级名老中医张吉教授学习，受益匪浅。2004-2005年期间张吉教授采用针药并用治疗AS37例，取得较好疗效，现总结报告如下。     

冠心病介入术后再狭窄危险因素及中医证候要素分析

目的 探讨冠心病介入术后再狭窄的危险因素及中医证候要素特点.方法 对100例冠心病介入术后再狭窄患者进行中医证候判定,以43例冠心病介入术后未狭窄患者作对照,用非条件togistic回归分析等统计学方法进行相关危险因素的分析.结果 冠心病介入术后再狭窄患者常见证候要素有血瘀、气虚、阴虚、痰浊、阳虚等.吸烟、糖尿病、高脂血症、血瘀证、痰浊证、气虚证是冠心病介入术后再狭窄的独立危险因素.结论 中西医结合综合干预包括避免主动或被动吸烟,控制糖尿病和高脂血症;运用中医活血化瘀、化痰通络、益气方药可能是防治冠心病介入术后再狭窄的正确有效途径.     

冠心病血瘀证转录组学研究——病证结合生物标志物研究思路与方法

中医证候的生物学基础研究是影响中医学发展与创新的重大科学问题,证候相关生物标志物及中药干预调控网络的研究对于在证候标准规范的基础上进一步提高诊断效能和临床疗效具有重要意义。因此,在前期冠心病证候标准规范研究的基础上,本项目组以冠心病心绞痛血瘀证为切入点,从分子生物水平对证候进行了深入研究。第一,通过采集累计312例患者外周血基因信息,运用差异显示法、实时定量聚合酶链式反应(Real-time polymerase chain reaction,Real-time PCR),斑点杂交法,高通量芯片,测序等方法,确立了冠心病血瘀证长链非编码核糖核酸-微小核糖核酸-信使核糖核酸(long noncoding ribonucleic acid-micro ribonucleic acid-messenger ribonucleic acid,lncRNA-miRNA-mRNA)3个层面的潜在生物标志物。第二,在前期筛选出的差异基因的基础上,运用生物信息学分析结合细胞功能学验证的方法,构建了冠心病血瘀证基因miRNAmRNA以及lncRNA-miRNA-mRNA 2个水平的调控网络。第三,基于血瘀证差异基因及调控网络,通过累计202例活血化瘀中药干预冠心病心绞痛血瘀证患者的随机对照试验,治疗前后共计400余人次的基因检测,以及活血化瘀中药处理相关细胞模型的体外实验,从基因-蛋白-功能3个层面研究中药作用机制,从分子水平揭示了活血化瘀中药干预冠心病血瘀证的基因调控网络机制。本研究将相关的分子生物学技术及生物信息学方法引入证候的生物学基础研究,建立了一套证候相关生物标志物的研究方法,为证候实质的研究提供了新思路。     

近现代著名中医成才研究

目的研究近现代著名中医学家的成才之路。方法收集《名老中医之路》记载的96名名中医和30名国医大师共计122名(含4名重合者)名中医的学医历程,分别从地区分布、成才途径、成才年龄、成才前学医时间、影响最大的书籍、是否从经方入手等方面进行分析总结整理。结果名中医多分布在江苏(21.31%)、浙江(11.48%)等省;成才途径以拜师学习(40.98%)、继承家学(22.95%)为主;成才前学医时间可统计者最多为10~15年(32.81%),其次是6~10年(26.56%);成才年龄主要集中在21~30岁之间(57.58%);名中医中有65.98%(64/122)者将《伤寒论》列为影响最大的书籍。结论本研究为中医院校的人才培养提供有益借鉴。     

Effects of Panax Notoginseng Saponins on Homing of C-kit~+ Bone Mesenchymal Stem Cells to the Infarction Heart in Rats

Objective:To investigate the effects of panax notoginseng saponins(PNS) on homing of C-kit+ bone mesenchymal stem cells(BMSCs) to the infarction heart.Methods:The acute myocardial infraction(AMI) model was established in 140 Wistar rats,105 model rats survived after operation,and the model rats were randomly divided into five groups,21 rats in each group:Western medicine group mobilized by subcutaneous injection of human granuloctye colony stimulating factor(G-CSF) 50 μg·kg-1·d-1;sham operation group and a model group treated by subcutaneous injection of normal saline 50 μg·kg-1·d-1;Chinese medicine group mobilized by intraperitoneal injection of Xuesaitong(血塞通)(ingredients of PNS) 150 mg·kg-1·d-1;integrative medicine group mobilized by subcutaneous injection of G-CSF 50 μg·kg-1·d-1 and intraperitoneal injection of Xuesaitong 150 mg·kg-1·d-1.Except for the sham-operated group,each group was divided into three sub-groups by three time points of 1 d,7 d and 14 d.G-CSF was injected once a day for 7 d.Xuesaitong was injected once a day until the rats were killed.The flow cytometry was used for detection of C-kit + cells in the peripheral blood in different time points,and immunohistochemical method was used for detection of the changes of C-kit + cell and Ki-67+ cell numbers in the marginal zone of AMI.Results:Twenty-four hours after the operation,C-kit + cells had a slight increase in the model group compared with the sham operation group(P>0.05).The peripheral blood C-kit+ cells in the integrative group increased significantly compared with the other groups on 7 d and 14 d(all P<0.05).Meanwhile the expression of C-kit + cells and Ki-67+ cells in the marginal zone of AMI in the integrative group increased significantly compared with the Chinese medicine group,the western medicine group and the model group on 1 d,7 d and 14 d(all P<0.05),and the cells in the integrative group decreased significantly on 14 d compared with that on 7 d(P<0.05).Conclusion:PNS can cooperate with G-CSF to mobilize C-kit+ BMSCs from the marrow into the peripheral blood and promote them "homing" to the infarction heart.     

Logistic Regression Analysis of Syndrome Essential Factors in Patients with Unstable Angina Pectoris

Objective: To explore the correlation between common syndrome essential factors and the symptoms and signs of unstable angina (UA). Methods: Eight hundred and fifteen patients with UA confirmed by coronary angiography were identified from several centers. Common syndrome essential factors were selected on the basis of expert experience. The correlations between common syndrome essential factors and symptoms and signs of UA were analyzed using binary logistic regression analysis. Results: The common syndrome essential factors in unstable angina were blood stasis, qi stagnation, phlegm turbidity, heat stagnancy, qi deficiency, yin deficiency, and yang deficiency. Symptoms such as chest pain, hypochondriac distention, ecchymosis, dark orbits, dark and purplish tongue, and tongue with ecchymosis and petechiae were significant diagnostic features of "blood stasis". Aversion to cold and cool limbs, weakness in the waist and knees, and clear abundant urine were significant diagnostic features of "yang deficiency". These results were in accordance with the understanding of traditional clinical Chinese medical practice. Conclusion: This clinical study analyzed the correlations between common syndrome essential factors and the symptoms and signs of unstable angina. The results provide the basis for establishing diagnostic criteria for syndrome essential factors.     

真武汤治疗顽固性心力衰竭验案采撷

笔者在“读经典,做临床”的学习中,尝试以《伤寒论》真武汤治疗老年顽固性心力衰竭,取得满意疗效。现举医案两则供同道参考。
　　1真武汤合升陷汤加减治疗风湿性心脏病心力衰竭
　　案例1：患者,女,72岁,2012年11月7日初诊。患者30年前因劳累出现喘憋,于当地医院就诊,被诊断为风湿性心脏病,未及时治疗。9年前因“喘憋”就诊于北京某医院,被诊断为“风湿性心脏病,二尖瓣狭窄,窦性停博”,给予安装心脏起搏器。2009年10月曾于住院期间行冠脉造影术未见异常,遂在全麻低温体外循环下行二尖瓣置换＋三尖瓣成形术,置换27号二尖瓣生物瓣,手术顺利。出院诊断“风湿性瓣膜病,二尖瓣重度狭窄,二尖瓣轻度关闭不全,三尖瓣中度关闭不全,心脏扩大,心房颤动,起搏心律,永久起搏器植入术后,心功能Ⅱ～Ⅲ级(NYHA分级)”。出院后服用华法林钠、地高辛、开博通、酰胺心安等治疗。现一直服用阿替洛尔片12.5 mg,2次/d;华法林钠1.5 mg,每晚1次。2010年查B超：左心房内径仍大,左心室不大,室间隔及左室游离壁厚度正常,二尖瓣位生物瓣瓣架固定,瓣叶回声纤细,启闭正常,未见明确异常回声附着,余瓣膜形态、启闭未见异常。右心腔内探及起搏器电极导线回声,心包腔内未探及明显液性暗区,二尖瓣位生物瓣舒张期峰值流速正常,跨瓣平均压约8 mm Hg(1 mm Hg＝0.133 kPa),未见瓣周漏,三尖瓣微量返流。超声印象：二尖瓣位生物瓣置换术后,生物瓣未见异常。半个月前,患者由于劳累,出现喘憋加重,全身乏力。刻下：喘憋,动则气喘,上楼即气喘大发作,全身乏力,偶有头晕,无头痛,夜间时有心慌,几乎每夜发作1次,口干口渴,喜饮水,无口苦,无咳嗽,晨起偶有咳痰,色灰白质稠,少汗,纳可,食后无腹胀,眠安,大便干、一二日一行,小便可。查体：精神萎靡,面色?白,体形中等,双侧颈静脉怒张,舌黯红,舌体胖、有齿印,苔薄白,脉沉,双下肢无水肿。辅助检查：N端前脑钠素531 pg/mL。西医诊断：①风湿性心脏病,二尖瓣狭窄置换术后,心律失常,永久性房颤,起搏器置入术后,慢性心力衰竭,心功能3级;②2型糖尿病;③胆囊结石。西医治疗：继续原先治疗方案不变。中医诊断：喘证,辨为阳虚水泛血瘀,大气下陷证。治以温阳利水、活血化瘀、益气升陷。方以真武汤合升陷汤、栀子大黄汤加减：附子(先煎1 h)10 g,茯苓60 g,白术30 g,白芍10 g,生姜6 g,黄芪30 g,知母10 g,柴胡15 g,桔梗15 g,升麻10 g,栀子10 g,酒大黄3 g,枳壳15 g,丹参30 g。7剂,每日1剂,水煎服,分2次早晚服用。     

古方治疗外感病三则

者通过不断研读经典,加深了对古方的认识,并在临床工作中试用古方,取得了较为满意的疗效.现举运用古方治疗外感病验案3则,以供同道参考. 1 典型病例 1.1 银翘散加减治疗风热感冒 案例1:患者,男,20岁,2012年6月5日就诊.主诉:咽痛、头痛2 d.现病史:咽痛,咳嗽,吐黄痰,头胀痛,以太阳穴痛为主,全身乏力,无恶心,无呕吐,大便二日一行,舌苔薄黄,脉浮数.既往史:慢性咽炎.中医诊断:外感风热.治以发散风热,银翘散加减.方药:金银花15 g,连翘12 g,桔梗8 g,淡竹叶6 g,甘草10 g,荆芥穗8 g,淡豆豉10 g,炒牛蒡子8 g,芦根15 g,桑叶10 g,苦杏仁10 g.     

基于网络药理学的地榆升白片对白细胞减少症的作用机制研究

目的:通过网络药理学方法探索地榆升白片治疗白细胞减少症的潜在作用机制。方法:采用中药系统药理学数据库和分析平台(TCMSP)、TCM-MESH数据库、ETCM平台筛选出地榆升白片的活性成分,利用Swiss ADME平台预测活性成分的潜在靶点。利用GeneCards、OMIM、Disgenet等数据库检索白细胞减少症相关靶点。利用Cytoscape 3.7.1构建"活性成分-靶点"网络,利用BioGenet分别构建药物与疾病靶点的蛋白质相互作用(PPI)网络,并提取交集网络以获得地榆升白片治疗白细胞减少症的关键靶点。通过Metascape对关键靶点进行GO和KEGG富集分析。结果:得到地榆升白片有效成分11个、药物靶点109个、白细胞减少症疾病靶点1204个,最终获得地榆升白片作用于白细胞减少症的关键靶点167个,KEGG通路48条。结论:地榆升白片治疗白细胞减少症主要成分为槲皮素、地榆皂苷、山柰酚,关键靶点为FUS、CUL5、NPM1、HNRNPA1,关键的生物学进程和通路包括细胞周期、DNA修复、细胞凋亡、河马通路等。     

茵陈蒿汤临床应用经验

茵陈蒿汤出自《伤寒论》《金匮要略》。茵陈蒿汤作为治疗黄疸的第一方,临床运用此方应把握其六个关键点：一为阳黄专方,其核心病机是湿、热、瘀互结,枢机不利,致使脾胃肝胆功能异常,郁结于肌肤而发黄;二为亦谷疸专方,因饮食水谷不节,肆食肥甘厚腻、辛辣之品,致脾寒胃热,脾胃运化失权,出现腹满,大便干,小便难,饱食则烦躁且头晕的谷疸表现;三为遵循原方相对剂量,重用茵陈,剂量应高于大黄、栀子用量,至少30 g以上,大黄常用6～28 g,栀子常用12～16 g;四为方证辨证抓主证,茵陈蒿汤的主要方证为但头汗出,身黄,巩膜黄染,大便干;五为经方叠用,结合患者临床症状,将茵陈蒿汤与栀子豉汤、栀子干姜汤、调胃承气汤等合用;六为病后调护与转归方运用,病后恢复期可辨证选用三仁汤、茵陈四苓汤、归芍六君子汤等方剂。本文通过论治茵陈蒿汤临床运用经验,以期为临床治疗提供一定参考。