总结在院前急救中采用针灸救治急症的经验,认为针灸具有携带方便、操作简便、价格低廉、疗效可靠、无不良反应等优点,将其应用于院前急救可减少药物的使用,为进一步救治赢得时间,且能提高急救效果、改善急症预后.通过科普宣传、培养院前急救医生等措施,加强针灸在院前急救中的应用,对提升院前急救的整体水平具有一定的现实意义.
目的 回顾性分析结肠滴注大承气汤在有创机械通气患者中的应用效果.方法 选取首都医科大学附属北京中医医院重症医学科2016年1月-2020年9月收治的有创机械通气患者73例,根据病程中是否使用大承气汤结肠滴注分为治疗组31例与对照组42例.对照组采用抗感染、化痰、雾化吸入及营养支持等常规治疗及护理,治疗组在对照组治疗基础上,予中药大承气汤结肠滴注治疗,治疗3d.对比2组14d生存率、治疗前后急性胃肠损伤(AGI)评分、氧合指数、分泌物性状评分、感染相关指标[体温、C反应蛋白(CRP)、降钙素原(PCT)].结果 2组14d生存率比较,差异无统计学意义(P＞0.05).治疗第3天,治疗组AGI评分低于对照组(P＜0.05).治疗第3天,治疗组氧合指数较治疗前升高(P＜0.05),对照组氧合指数与治疗前比较差异无统计学意义(P＞0.05),且2组间氧合指数比较差异无统计学意义(P＞0.05).治疗第3天,2组分泌物性状评分均较治疗前降低,但差异均无统计学意义(P＞0.05),治疗组分泌物性状评分较对照组明显降低(P＜0.05).治疗前后,2组感染相关指标比较差异无统计学意义(P＞0.05).结论 使用大承气汤结肠滴注能有效改善有创机械通气患者的氧合指数及体温,调节分泌物性状,同时还能改善胃肠功能障碍.
小儿外感热病是儿科的常见病,也是中医治疗的优势病种.北京中医医院儿科自建院以来涌现了祁振华、周慕新、滕宣光、宋祚民、温振英、王应麟、佘继林等名老中医,他们在治疗小儿外感热病方面疗效卓著,在辨治思路上一脉相承,均以清热透邪为治法主线,在加减用药方面又各有侧重,一脉相承中又不断创新.北京中医医院儿科名老中医强调小儿外感热病常传变迅速、易从热化,治疗以清热透邪为主要治法,兼以导滞泻热、平肝息风、育阴凉血等,同时注重顾护脾胃,临床疗效显著.
肝性脊髓病是多种肝脏疾病终末期的一种少见的神经系统并发症,其特征性临床表现为双下肢慢性、进行性、对称性、痉挛性截瘫,基于"肝肾同源"理论,按照"标本兼顾、体用同调、阴阳分治"的原则辨证论治肝性脊髓病,临床效果显著.
Objective To explore the clinical efficacy of the method of removing obstruction, clearing away toxin and removing blood stasis in the treatment of severe mycoplasma pneumonia with the syndrome of toxic heat obstructing the lung.Methods A total of 200 patients with severe mycoplasma pneumonia who were hospitalized in Beijing Children’s Hospital from January 2019 to December 2021 were enrolled and divided into treatment group and control group of 100 cases in each one according to random number table method. The control group was treated with conventional western medicine for 10-14 days as total courses,and the treatment group was treated with traditional Chinese medicine by stages on the basis of western medicine. The curative effect,time of fever,cough,wheezing and lung rales disappearing, D-dimer, lactate dehydrogenase（LDH）, lesion absorption, incidence of atelectasis,obstructive bronchitis and gastrointestinal dysfunction before and after treatment were compared between the two groups. Results After one week of treatment, the clinical effective rate in the treatment group was higher than that in the control group（P=0. 029）. After 4 weeks of treatment, the clinical cure rate and effective rate of the treatment group were higher than those of the control group, but the difference was not statistically significant（P＞0. 05）; during the 12-week follow-up, the clinical cure rate of the treatment group was higher than that of the control group（P=0. 009）. Compared with the control group, the disappearance time of fever,cough and pulmonary rales in the treatment group was significantly shortened（P＜0. 05）. There was no significant difference in disappearance time of wheezing between the two groups（P＞0. 05）. After one week of treatment, the level of D-dimer and LDH was significantly decreased（P＜0. 05）,and the level of D-dimer in the treatment group was lower than that in the control group（P＜0. 05）,and there was no significant difference in LDH level between the two groups（P＞0. 05）. The complete absorption rate of lesions in the treatment group was higher than that in the control group（P＜0. 05）. The incidence of atelectasis, obliterative bronchitis, and gastrointestinal dysfunction was significantly reduced（P＜0. 05）. Conclusion The treatment of severe mycoplasma pneumonia with integrated traditional Chinese and western medicine has obvious advantages in promoting the relief of clinical symptoms with better effect than western medicine only.
Objective To observe the curative effect of Qing’s palace bone setting manipulation of pulling, poking, rubbing and twisting methods（QPM）in the treatment of lateral epicondylitis（LE）on the basis of the theory of combining dynamic with static and taking activity as the dominant factor.Methods A total of 64 patients with LE who received treatment in Wangjing Hospital of China Academy of Chinese Medical Sciences from October 2020 to December 2021 were selected and randomly divided into manipulation group and control group with 32 cases in each group. Both two groups shad got related education and elbow exercise guidence. The manipulation group were treated with the QPM method 3 times a week for 4 weeks;and the control group was applied with Diclofenac Diethylamine Emulgel and wore elbow padsonce a dayfor 4 weeks. The visual analogue scale（VAS）score, the hospital for special surgery（HSS）elbow joint score and the elbow tenderness threshold of two groups were obtained before treatment, immediately and 2 months after complete treatment so as to compare the clinical efficacy between two groups.Results The VAS score, HSS score, and elbow tenderness threshold of immediately and 2 months after complete treatment in two groups were significantly improved than before treatment（P＜0. 05）. Significant improvements were observed in VAS score, HSS score and tenderness threshold immediately and 2 months after complete treatment in the manipulation group compared with the control group（P＜0. 05）. Compared with instant after complete treatment, there was no significant difference in the VAS score of 2 months after complete treatment in the manipulation group（P＞0. 05）, but the VAS score of 2 months after complete treatment in the control group was significantly was increased,the HSS score and the tenderness threshold were significantly decreased（P＜0. 05）and the HSS score and the tenderness threshold were significantly decreased（P＜0. 05）.Conclusion Based on the theory of combining dynamic with static and taking activity as the dominant factor, QPM method has a good clinical effect oneasing the pain and improving function of elbow joint than applying nonsteroidal antiinflammatory drugs（NSAIDs）externally.
腺样体肥大(adenoid hypertrophy,AH)是腺样体淋巴组织受到刺激形成的病理性肥大,可引发鼻-鼻窦炎、分泌性中耳炎、咽喉炎症等.本病的中医病位在颃颡,局部辨证认为颃颡功能不利致局部气血失调是本病发生的关键;整体辨证重在强调小儿脏腑功能失调,分析得出肺、脾(胃)、肝三脏气机调节失常是局部气血失调的根本原因,即局部辨证包含于整体辨证之中.临证需兼顾局部与整体辨证,以整体辨证为基础,采取分期论治,急性期治以疏散表邪,缓解期辨证调节脏腑虚实;以局部辨证为辅,化痰散结、活血化瘀贯穿本病治疗始终.
Objective To investigate the clinical characteristics of Chinese medicine and western medicine in 45 patients with advanced gastric cancer who received second-line and follow-up treatment based on the clinical data of these patients. Methods Patients with advanced gastric cancer who met the criteria for inclusion in the subject were divided into first-line treatment,second-line treatment and follow-up treatment according to the treatment methods. Through the comparison between groups and literature research, the clinical characteristics of Chinese and western medicine in patients with second-line and follow-up treatment were summarized. Results The male-to-female ratio of 45 patients with advanced gastric cancer who received second-line and subsequent treatments was about 3∶1, the average age was（57. 53±12. 96）years, the average BMI was（21. 51±3. 89）kg/m~2,and the average hemoglobin was（111. 58±17. 82）g/L,serum albumin is（38. 78±5. 52）g/L, KPS score was concentrated at 80 points and above, and the degree of differentiation was mainly poorly differentiated. The primary tumor was mostly in the proximal stomach, and the distant metastasis was the most common single organ metastasis, there was no statistically significant difference compared to the first-line treatment patients（P＞0. 05）; while adenocarcinoma accounted for 95. 56%, and the average survival time was（440. 80±177. 42）days, which was significantly higher than that of the first-line treatment patients（P＜0. 05）. The TCM evidence elements showed the characteristics of pathological combinations of spleen, liver and spleen, and spleen and kidney, and their corresponding pathological combinations were Qi deficiency with phlegm-dampness,Qi deficiency,Qi stagnation with phlegm-dampness, and Qi deficiency with Yin deficiency. Conclusion The pathological sites of 45 patients with advanced gastric cancer receiving second-line and follow-up treatment were mainly spleen, liver and kidney in TCM, and the pathological elements showed a combination of deficiency and excess, so it is advisable to use the treatment method of supporting the anti-pathogenic Qi and eliminating the pathogenic factors in a reasonable way. Compared with the first-line treatment patients, the western medicine characteristics of the second-line and follow-up treatment patients are mainly adenocarcinoma,but signet ring cell carcinoma is rare.
更年期聚合性痤疮病机为"脏虚为本,瘀滞为标",即以肾精不足、冲任失调、天癸相火过旺引起脏虚为本,以瘀血内停为标,治疗应标本兼治,在解毒化湿、散瘀消痤的同时,将补肾气、散瘀血贯穿治疗始终,自拟菟仙芪黄育嗣汤滋阴潜阳,散瘀消痤.
闭塞性细支气管炎是儿童常见的弥漫性肺疾病,其主要病因是感染,严重影响儿童生长发育.闫慧敏教授认为痰、瘀是闭塞性细支气管炎的致病因素,气道闭塞、脾失健运贯穿该病发生发展的全过程.本病病位在肺、脾、肾三脏,临证中将其分为急性期、迁延期、稳定期进行辨证施治.急性期痰热互结,壅闭于肺,治以清热化痰、宣畅肺气,用药须顾护脾胃,方选桑白皮汤合平胃散化裁;迁延期痰瘀阻肺、脾胃气虚,治以健脾化痰、活血化瘀,方选香砂六君子汤合血府逐瘀汤化裁;稳定期肺、脾、肾三脏不足,治以培土生金、补肾固精,偏阳虚者予参苓白术散合金匮肾气丸化裁,偏阴虚者予麦门冬汤合六味地黄丸化裁.
目的 探讨以体质辨识为基础的中医健康管理对糖尿病前期患者血糖控制效果及健康促进生活方式的影响.方法 将126例糖尿病前期患者,采用随机数字表法分为观察组和对照组各63例,2组以阴虚质、湿热质、痰湿质纳入研究,其余6种体质患者未纳入研究,实际入组观察组41例、对照组43例.对照组给予常规健康管理,观察组采取以体质辨识为基础的中医健康管理方法.比较2组干预后患者血糖控制效果和健康促进生活方式得分.结果 中医健康管理后观察组患者空腹血糖、餐后2h血糖、糖化血红蛋白均低于对照组,差异有统计学意义(P＜0.05);观察组健康促进生活方式量表各维度得分均明显高于对照组,差异有统计学意义(P＜0.05).结论 以体质辨识为基础的中医健康管理可有效改善糖尿病前期患者的血糖水平,对提高其健康促进生活方式具有重要意义.
Objective To explore the distribution law of syndrome of allergic rhinitis（AR）in children with two weeks of disease duration by cluster analysis.Methods Retrospective analysis was used on the initial medical records of 270 children with allergic rhinitis who visited the outpatient department of Beijing Children’s Hospital affiliated to the Capital Medical University from July 2021 to July 2022. The four diagnostic information of symptoms,signs, tongue and pulse manifestations of traditional Chinese medicine was collected, and a database was established. Based on cluster analysis, the distribution law of TCM syndromes of AR was discussed.Results The most common clinical symptoms and signs in 270 children with allergic rhinitis were nasal congestion, nasal discharge, nasal itching, sneezing, dry stool, cough, hot sensation in the center of hand, foul odor in the mouth, poor appetite, susceptibility, yellow face,preference for meat paste, eating too much, red tongue,and foul stool. According to the statistics of cluster analysis, it can be classified into two syndrome types, that is syndrome of accumulation of heat in the lung and stomach, deficiency syndrome of lung and spleen. Conclusion Syndrome of heat accumulation in the lung and stomach and deficiency syndrome of both lung and spleen are mainly two types of allergic rhinitis（AR）in children with two weeks of disease duration, and the proportion of syndrome of heat accumulation in the lung and stomach is more significant.
In the spring of 2023, Beijing enters a high incidence period of influenza,and children’s influenza will be dominated by influenza A virus. Compared to the previous years,the influenza season this year is postponed,considering it is relatedto the warmer climate in this spring and increased personnel mobility. Influenza belongs to the category of "wind and febrile pathogenic facotrs" in traditional Chinese medicine. At the initial stage, it is mainly manifested as the syndrome of exterior heatin thelung and it can not only be transmitted interiorly to qi and nutrient level, but also to the pericardium reversibly. Compared to adult influenza,children usually have higher fever than adults, and the gastrointestinal symptoms are more common. Laryngitis, otitis media,bronchitis and necrotizing encephalopathy are also more commonly complicated than adults. Children suffer from longer cough and physical recovery times than adults in the recovery period. In terms of syndrome differentiation in traditional Chinese medicine, the syndrome type of wind heat invading defensive qi is more seen in children with mild condition,the syndrome of excessive lung and stomach heat, and the syndrome of dampness suppressing the defensive qi. Syndrome of inverse transmission of pathogenic heatto pericardiumis mostly found in severe children. In the recovery period,the main symptoms were caused byresidual pathogenic factors not being cleared and lung and stomach yin damaged. The prognosis is goodin most children with influenza in spring. Attention should be paid to the occurrence of complications. Early and effective medication can prevent the occurrence of syndrome change and endangered syndrome.
糖尿病肾病(DN)是糖尿病患者常见的微血管并发症,DN中晚期糖基化终产物(AGEs)与其受体(RAGEs)的结合导致疾病发生和发展,可以基于中医伏邪理论阐释其作用机理.研究发现AGEs-RAGE轴及其后续级联反应与中医学伏邪对疾病进展作用的特点相似,即发病初期的"隐匿性"以及疾病后期的"爆发性".本文基于伏邪理论,论述DN的发病机制,总结不同性质的伏邪在疾病进展中的作用,并对DN进行分期辨证论治,以及阐释中医药治疗DN的作用机制.
张洪春教授根据支气管扩张症患者免疫低下、气道黏液高分泌状态、细菌长期定植的特点,以调节免疫、杜绝生痰之源、廓清气道痰液、改善气流受限为切入点,结合其自身临床经验总结出支气管扩张症中医辨治方案.张教授将本病病程分为急性期、缓解期2个阶段;按照临床特征,分为"痰、热、毒、瘀、虚"5个病理状态,其中"虚"和"瘀"贯穿病程始终;治疗时需分期辨证,明辨虚实,未病先防,既病防变.
近年来小儿咳嗽变异性哮喘(CVA)的发病率呈逐年上升趋势,笔者认为,中医的风咳与西医的CVA特点相似,可从风咳辨治CVA.风邪犯肺是风咳的主要病因,肺气失宣、气道挛急是风咳的主要病机,祛风解痉、宣肺止咳是风咳的总治则.风咳初期,应从咳嗽论治,以祛风解痉、宣肺止咳、滋阴利咽为主;风咳后期应从"哮证"论治,治以祛风平喘、化痰化瘀为主.
目的 基于数据挖掘探讨张锡纯治疗急性外感热病的用药特色.方法 从张锡纯《医学衷中参西录》中提取治疗急性外感热病的方药,运用"中医传承计算平台v3.0"的关联规则和聚类分析等方法,统计并分析药物的四气、五味、归经及功效,挖掘常用药、对药、角药、核心组合.结果 共纳入处方92张,涉及中药88味,用药频次排名居前10位的中药是甘草、石膏、山药、白芍、党参、知母、玄参、连翘、生地黄、滑石;涉及药物中寒性药物最多,甘味药最多,归经以肺、胃、脾经为主;使用频次最高的对药为甘草-山药,使用频次最高的角药为甘草-山药-白芍.聚类分析:将k值设定为3时,在92张处方中最多的类方核心组合为石膏-甘草-山药-知母-连翘,相关方剂数为47个;将k值设定为5时,在92张处方中最多的类方核心组合为石膏-甘草-山药-党参-白芍-玄参,相关方剂数为27个.结论 张锡纯治疗急性外感热病寒温并重,注重培护正气,临证组方重视祛邪不伤正,重用石膏,擅用山药,为中医药治疗急性外感热病提供了思路.
目的 观察针药并用治疗胃食管反流病(GERD)肝胃郁热证患者的临床疗效及作用机制.方法 将82例GERD肝胃郁热证患者随机分为观察组、对照组各41例.对照组予常规临床治疗方案,观察组加予丹栀逍遥散联合针刺治疗,2组疗程均为8周.比较2组临床疗效、上消化道内镜疗效;比较2组治疗前后中医证候积分,反流性疾病问卷(RDQ)评分,血清胃肠激素[胃泌素(GAS)、胃动素(MTL)、血管活性肠肽(VIP)]、蛋白酶激活受体2(PAR2)以及辣椒素瞬时受体电位阳离子通道亚家族Ⅴ成员1(TRPV1)水平.结果 与对照组比较,治疗后观察组上消化道内镜炎症总有效率、临床总有效率均高于对照组,RDQ评分、中医证候积分降低,血清GAS、MTL水平升高,血清VIP、PAR2、TRPV1水平降低,差异均有统计学意义(P＜0.05).结论 针药并用辅助西医治疗GERD肝胃郁热证临床疗效较好,其作用机制与调节胃肠激素水平和降低食管高敏感性有关.
辛温药在古医籍中广泛应用于疫病的防治,而对辛温药治疫的机理缺少系统解读.中医学认为疫病病机为正气不足,外感毒邪,兼夹秽浊、热毒等而发病.本文参考古代本草著作,整理具有治疫作用的辛温药,从"辛能行散,温能助阳"的性味理论出发,归纳出辛温药在治疫过程中发挥温通阳气、消导阴浊、开通心窍功效.疫病病机复杂,种类多样,通过明晰辛温药治疫机理,在治疗中辨证地应用辛温药味,不断丰富和发展中医药治疫理论.
Objective To study the therapeutic effect of optimized TCM hot ironing compress technique on cancer pain and the quality of life.Methods Using random number table method, 98 patients with malignant tumor were randomized into control group and observation group. The control group got intervention with traditional TCM hot ironing compress and the observation group with optimized TCM hot ironing compress. The pain score, quality of life, adverse events and satisfaction with care in patients with cancer pain were observed.Results After the intervention, the pain score of the observation group was lower than that of the control group, and the difference was statistically significant（P＜0. 01）. Compared with before treatment, the EORTC QLQ-C30 score of quality of life in the observation group was improved（P＜0. 05, P＜0. 01）, and the EORTC QLQ-C30 score and nursing satisfaction in the observation group were higher than those in the control group（P＜0. 05）.Conclusion The optimized TCM hot ironing compress technique can obviously relieve cancer pain and further improve the quality of life of patients.
