Background: Some patients with chronic obstructive pulmonary disease (COPD) benefit from glucocorticoid (GC) treatment, but its mechanism is unclear.Objective: With the help of the Gene Expression Omnibus (GEO) database, the key genes and miRNA-mRNA related to the treatment of COPD by GCs were discussed, and the potential mechanism was explained.Methods: The miRNA microarray dataset (GSE76774) and mRNA microarray dataset (GSE36221) were downloaded, and differential expression analysis were performed.Gene Ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed on the differentially expressed genes (DEGs).The protein interaction network of the DEGs in the regulatory network was constructed with the STRING database, and the key genes were screened through Cytoscape.Potential downstream target genes regulated by differentially expressed miRNAs (DEMs) were predicted by the miRWalk3.0database, and miRNA-mRNA regulatory networks were constructed.Finally, some research results were validated.Results: ① Four DEMs and 83 DEGs were screened; ② GO and KEGG enrichment analysis mainly focused on the PI3K/Akt signalling pathway, ECM receptor interaction, etc.; ③ CD2, SLAMF7, etc. may be the key targets of GC in the treatment of COPD; ④ 18 intersection genes were predicted by the mirwalk 3.0 database, and 9 pairs of miRNA-mRNA regulatory networks were identified; ⑤ The expression of miR-320d-2 and TFCP2L1 were upregulated by dexamethasone in the COPD cell model, while the expression of miR-181a-2-3p and SLAMF7 were downregulated. Conclusion:In COPD, GC may mediate the expression of the PI3K/Akt signalling pathway through miR-181a-2-3p, miR-320d-2, miR-650, and miR-155-5p, targeting its downstream signal factors.The research results provide new ideas for RNA therapy strategies of COPD, and also lay a foundation for further research.

Objective We aimed to observe the clinical efficacy of treating medium-risk solid pulmonary nodules based on patient’s pathogenesis state.Methods A prospective randomized controlled study was conducted to select patients with medium-risk solid pulmonary nodules who were admitted to either Dongfang Hospital of Beijing University of Chinese Medicine or Beijing Shijitan Hospital Affiliated to Capital Medical University from September 2020 to July 2022（128 cases in total）. The patients were randomly divided using the random number table method into the experimental group（85 cases） and the blank control group（43 cases） at a 2:1 ratio. We diagnosed patients with（ⅰ） single state: qi deficiency, yin deficiency, yang deficiency, qi stagnation, and dampness-heat state,（ⅱ） combined state, or（ⅲ） a general state: if the patients did not meet any of the diagnosis criteria. Patients in the experimental group were treated with additional Sanjie basic prescription（Processed pinellia, Arisaema with bile, Balloon flower, Tuckahoe, Raw oyster, Radix notoginseng） according to the state at the time of consultation, while patients in the blank control group were not treated. Each course took 3 months, and patients received one or two courses. Lung CT scans were carried out after 3 and 6 months, and treatment efficacy was evaluated based on the reduction rate of the maximum diameter area of pulmonary nodules combined with the density and morphological changes.Results In total, 115 patients completed the study（77 patients in the experimental group and 38 patients in the blank control group）. The total clinical effective rates for the experimental group at 3 and 6 months were 51.95% and 49.02%, respectively, which were higher compared to 7.89% and 8.57%, respectively for the blank control group（P＜0.01）. The maximum diameter of solid pulmonary nodules in the experimental group decreased compared with the baseline value, while it increased in the blank control group.Conclusion Under the condition of limited traditional syndrome differentiation and treatment, the treatment of medium-risk solid pulmonary nodules based on overall pathogenesis state received certain clinical efficacy.

北京中医药大学东直门医院于2018年12月9日收治1例脓毒症患者.该患者为长期服用毒品者,即阿片类药物中毒者,患者近6个月来无明显诱因出现胸闷喘憋、汗出,不欲饮食,未予重视及诊治;近10?d来,胸闷喘憋、纳差加重,伴呼吸困难、周身乏力、头晕恶心,以"胸闷喘憋6个月,加重10?d"入院,诊断为阿片类药物中毒后脓毒症.入院4?h后患者出现心搏骤停,给予胸外按压、除颤、血管活性药物等措施后抢救成功.后姜良铎教授结合患者当前症状和体征,给予抗感染、化痰平喘、改善脑循环、清热解毒、回阳救逆、豁痰开窍治疗,并基于中医状态学说辨证论治,给予中药进行治疗.经治疗患者症状改善,取得一定的临床疗效,这为今后此类患者的救治提供了经验.

目的 分析慢性阻塞性肺疾病(COPD)E组患者中医证型分布情况及急性加重的相关因素.方法 回顾性收集161例COPD患者一般资料[包括性别、年龄、体重指数(BMI)、病程、吸烟史、既往史],中医四诊信息辨证分为痰热壅肺证、痰浊阻肺证、痰瘀阻肺证、肺脾气虚证、肺肾两虚证,改良版英国医学研究委员会呼吸困难问卷(mMRC)调查,COPD患者自我评估测试(CAT)评分,肺功能[包括第一秒用力呼气容积(FEV1)、第一秒用力呼气容积与用力肺活量的比值(FEV1/FVC)],GOLD分级,及患者上一年的急性加重情况.采用Logistic回归模型进行多因素回归分析,确定COPD E组患者相关因素.分析E组不同中医证型患者急性加重分布情况.结果 161例患者中E组患者80例(49.69％),非E组患者81例(50.31％).E组患者中23例(28.75％)有2次急性加重病史、35例(43.75％)有3次急性加重史、22例(27.5％)有3次以上急性加重史;痰热壅肺证13例(16.25％),痰浊阻肺证6例(7.5％),痰瘀阻肺证8例(10％),肺脾气虚证22例(27.5％),肺肾两虚证31例(38.75％).两组比较,吸烟史、病程、中医证型、中医证候积分、mMRC评分、CAT评分差异有统计学意义(P＜0.05).161例患者中共有107例完成了肺功能检查,两组患者FEV1、FEV1/FVC和GOLD分级差异具有统计学意义(P＜0.05).多因素回归分析显示,中医证型、中医证候积分、CAT评分对COPD患者成为E组有统计学意义(P＜0.05).E组不同中医证型患者急性加重次数分布情况差异有统计学意义(P＜O.05),过去一年有2次急性加重的患者以痰热壅肺证、肺脾气虚证为主,3次急性加重的以肺脾气虚证、肺肾两虚证为主,超过3次加重次数的以肺肾两虚证多见.结论 COPDE组患者以肺脾气虚证、肺肾两虚证最为多见,本虚是引起急性加重次数增多的主要原因,中医证型、CAT评分是其主要相关因素.

临床发现,肺结节患者常并发甲状腺结节、乳腺结节等肺外结节,此类患者常伴有焦虑、抑郁等不良情绪及睡眠障碍.本文基于"形神一体观"探讨焦虑、抑郁等五志失调影响气机运行及脏腑功能与肺结节并发肺外结节的关系.五脏藏五神、化五志,五志失调导致人体气机逆乱,湿、痰、瘀聚集而化生结节;五志失调日久损伤脏腑气血、耗伤五脏真元,湿、痰、瘀结聚久而化毒成癌.肺结节并发肺外结节是五志失调及机体内环境失调在人体局部的反映,为形神共病,亦是湿、痰、瘀聚集的靶点.治疗应形神同调、气血同治,以补虚散结、解毒抑癌为主;配合精神疏导、调畅情志,以达到形神安和,则疾病可愈.

中医药学是中华文明的瑰宝,传承创新发展中医药是新时代中国特色社会主义事业的重要内容.就中医药如何"守正",提出应始终以提高临床疗效为目的,继承中医文化精华,把握中医理论内核,提高临床水平;实现中医药"创新",可以从理论创新、研究方法创新、技术手段引进、人才培养模式改革等方面进行,在创新中形成新特色、新优势,走中医药特色道路,最终实现中医药事业的高质量发展.

中医学界目前在新型冠状病毒感染中医病名、病因、病机、证治上均有了初步的认识.但作为一种新发传染病,尚有许多问题需要深入思考与探讨.姜良铎教授就本阶段新型冠状病毒感染疫情进行了深入分析与总结,认为新发传染病有必要确立中医病名,统领本病的因机证治.病因病原可分而论之,寒温可同时出现于一体的同一时机,核心病机为温邪上受,首先犯肺,肺气受伤,气不摄津,气不流津,成湿成痰,阻遏气机.潜在病机可出现气随津脱,或出现气阴两伤致肺痿.

结缔组织病相关间质性肺病常涉及多脏腑、多系统病变,多累及肺、关节、肌肉和皮肤.三焦膜系理论认为三焦由人体脏腑包膜、间质和淋巴等构成,是水液运行、气机升降出入和气化的通道,可联络周身.认为三焦膜系是结缔组织病相关间质性肺病的核心病位,上焦膜系通过间质和胸膜连接肺,易于感邪和留邪,多种免疫疾病均易导致肺间质病变.据此提出肺肾亏虚是结缔组织病相关间质性肺病的内因,痰瘀阻滞是其病理产物;治疗当以疏利三焦为核心,结合不同兼证进行加减配伍.

新型冠状病毒奥密克戎感染常以发热为初始症状,疫毒从口鼻而入,首先犯肺,大多数患者发热1～3d热退后常见咳嗽;少数人发热持续4～5d以上,常出现病毒性肺炎.初起轻症时常表现为外寒内热证、湿热犯肺证;发展至重症肺炎时常见疫毒入肺证,湿热蕴肺、正虚痰瘀证;疫毒耗伤正气,恢复期以气阴亏虚为主.根据发热时间、热势、舌脉症状等辨证施治,以清热化湿解毒为主,肺炎期注意扶正化痰活血.

目的 观察从状态论治中危纯磨玻璃肺结节(pGGNs)的临床疗效与安全性.方法 将141例pGGNs患者随机分为治疗组92例及对照组49例.治疗组给予基础散结方结合辨中医状态加味处方口服,每日1剂,以3个月为1个疗程,治疗3个月后复查CT,临床判定为治愈、中危转为低危结节者、转而手术切除者无需进行第2个疗程治疗,其余患者完成第2个疗程的治疗.对照组患者不予任何治疗,仅于3、6个月时定期随访.两组患者均于入组时及入组3、6个月检查胸部CT,根据胸部CT所示肺结节最大径计算肺结节面积,于入组3、6个月根据肺结节面积减小率判定临床疗效,并进一步探讨治疗组入组6个月不同中医状态pGGNs患者的临床疗效差异;入组时及入组3、6个月分别计算Mayo风险概率.研究期间记录不良事件发生情况及检测安全性指标.结果 研究过程中治疗组脱落8例、对照组脱落7例,最终共完成126例观察,其中治疗组84例,对照组42例.入组3个月,治疗组临床疗效总有效率为46.15％(30/65),对照组为12.50％(4/32);入组6个月,治疗组总有效率为45.71％(32/70);对照组为10.00％(4/40).两个时间点治疗组临床疗效均优于对照组(P＜0.01).入组3、6个月治疗组结节面积较入组时均显著减小(P＜0.01),而对照组各时间点结节面积差异无统计学意义(P＞0.05).与本组入组时比较,治疗组患者入组3、6个月Mayo风险概率均显著减小(P＜0.01),而对照组入组6个月Mayo风险概率增加(P＜0.05).治疗组84例患者中气虚状态15例,阴虚状态7例,阳虚状态5例,气郁状态20例,湿热状态32例,无偏颇状态5例;不同中医状态患者入组6个月临床疗效总有效率分布差异有统计学意义(P＜0.05),两两比较气郁状态总有效率(13/20,65.00％)高于湿热状态总有效率(8/32,25.00％,P＜0.00833).两组患者入组后血常规、尿常规、肝功能、肾功能均未发生明显变化,未出现不良事件.结论 从状态论治中危纯磨玻璃肺结节能够有效减小肺结节面积,降低肺结节增长的恶性风险,且安全性较好.

培土生金法来源于五行学说,由《黄帝内经》提出,经过张仲景及金元四大家等医家的发展,至今其内涵实质已非常丰富.采用培土生金法治疗社区获得性肺炎(CAP)可获得良好疗效.在不同人群、不同疾病状态下,罹患CAP的患者可能会出现相同或不同的脾胃虚损的表现.轻者大多出现食少纳差、乏力倦怠等症状,可选用四君子汤或六君子汤加减以健脾益气.对于合并慢性疾病的老年CAP、重症CAP及耐药菌感染的CAP患者,脾胃气虚甚至阳虚的表现则更加明显,在健脾益气的基础上要重视温阳健脾,可选用黄芪、党参、附子、干姜等药物.儿童CAP的脾虚症状多由湿邪、热邪或食积所致,治疗时对症选用莲子、芡实、白扁豆、天花粉等药物.

肺癌是我国及世界上发病率和死亡率较高的恶性肿瘤之一,以外科手术根治性切除治疗为主,复发转移是肺癌患者治疗失败乃至死亡的重要原因之一,现代医学对其治疗以外科手术、放疗、化疗为主.三焦膜性管道论认为三焦是人体器官的包膜、淋巴、间质组织等组成的膜性四通管状通道,上下流通连接心肺等五脏六腑,内外流通连接卫表肌腠皮肤筋骨,为气与水液运行的通道,具有调控水液和气机运行、气化产生护卫精微的作用.本文基于三焦膜性管道论,认为三焦膜性管道为肺癌复发转移的通道,三焦郁滞促进癌毒停滞,癌毒随痰饮瘀血停滞于三焦膜性管道中运行布散内伏,通过三焦膜性管道流于全身各处,从而形成机体各处的转移灶,并总结其基本病机为三焦郁滞、正虚伏毒,治疗以疏利三焦、扶正抗癌为原则,重在"通、化、调","通"即通畅三焦气机,"化"即恢复三焦气化功能,"调"即调理脏腑气血、解毒抑癌,为中医学防治肺癌复发转移提供了新的思路与方法.

肺结节是肺部影像学的表现,患者缺少典型的呼吸系统症状,如咳嗽、咳痰、气喘等,在评价中医药治疗肺结节疗效时,无法使用以症状为主的中医证候评分评价体系,因此建立肺结节中医药临床疗效评价体系具有必要性和紧迫性.本文遵循国内外权威肺结节诊疗指南,在开展的大量临床研究实践基础上,总结提出了肺结节中医药临床疗效评价方法.本评价方法以总有效率为主要疗效指标,即综合考虑肺结节横截面积变化率和(或)直径变化、恶性征象变化,将疗效分为治愈、显效、有效、稳定、进展5个等级,总有效率(％)=(治愈例数+显效例数+有效例数)/总例数×100％;次要疗效指标包括平均直径变化、平均横截面积变化、危险度转化率、Mayo模型计算的恶性概率变化;以3、6个月为评价周期.建立以结节直径或横截面积变化为主的多维度疗效评价体系,有利于为中医药治疗肺结节的临床研究提供规范化、系统化及高循证级别的证据.

肺结节作为新兴的肺系疑难疾病,诊疗策略仍处于研究完善阶段,患者常无症状,传统中医辨证困难,胸部CT作为最常用的检查手段可延伸望诊.西医处理策略以定期随访为主,恶性者即手术切除,中医药在西医随访期干预意义重大.文章探讨肺结节的中医药诊疗策略,强调从大小、良恶性质、数目、危险因素等辨识结节,抓住肺结节气滞津停、痰瘀阻络的核心病机,从状态综合治疗,提高中医药诊治疗效,防止癌变发生.

膀胱过度活动症(overactive bladder,OAB)相当于中医学之尿频或小便数,气郁和阳虚是此病之病机两端.气郁膀胱,开阖失度,故尿频而作;气郁日久,邪客参合,故病证错杂.然治病求本,法当透邪解郁为先.气郁在肝,病在膀胱,见尿频而数,治则疏肝解郁,则州都自安.且若少阴病逆,阳气内郁,则州门闭之无力,下焦决渎之机开阖紊乱,治则舒畅调达气机以开郁散结.四逆散由柴胡、白芍、枳实、甘草四药组成,具有透邪解郁、调和肝脾之效.此方乃是治疗肝气郁滞、肝脾不和、阳气内郁之基础方,其加减化裁可广泛用于治疗肝郁气滞引起的各种病症,亦为临床上辨治该病提供一定诊疗思路.

结节病是一种累及多脏器的免疫相关复杂疑难疾病,其病理学特征为非干酪样坏死性上皮样细胞肉芽肿.肺及胸部淋巴结最易受累,约占临床发病的90％,又称肺结节病.三焦膜系理论认为三焦由人体器官的包膜、淋巴和间质组织等构成,是气机升降出入和气化的场所,亦是水液运行的通道,可完成人体气、水液和护卫精微在周身的运行和布散.本课题组在临床实践中总结认为,肺结节病的病位主要在肺,基本病机是正气虚弱为本,痰瘀互结为标,三焦膜系郁滞、气化不利、痰瘀流窜为变.肺结节病在元气亏虚的基础上,出现三焦膜系气机、气化不利,导致出现痰瘀互结和脏腑功能受损,痰瘀阻滞三焦膜系,随膜系流窜至周身.治疗肺结节病的原则是疏利三焦、化痰散结、益气活血."通""化""调"是治疗的关键,"通"即通畅三焦,"化"即促进气化,"调"即调理气血.本课题组在临床中常用通化方治疗肺结节病.元气亏虚、三焦郁滞、痰瘀互结是肺结节病的核心,临床运用通化方可有效治疗肺结节病.

三甲复脉汤出自清代吴鞠通《温病条辨》,系治疗温病后期,热邪深入下焦,真阴耗伤,虚风内动之主方.姜良铎教授在临床上常应用此方思路加减治疗失眠症,为探求其疗效作用机制,笔者运用文献研究、经验总结等研究方法,从失眠病因病机、临床思路探讨等多个方面论证了其治疗失眠症的有效作用.分析结果显示,应用三甲复脉汤从调和营卫、调理脏腑、调畅神机3个方面治疗失眠症,能够起到滋补肝肾、潜阳熄风、镇惊安神的作用,临床中常能取得不错的疗效.

PurposeJinwei decoction can enhance the anti-inflammatory effect of glucocorticoid (GC) on chronic obstructive pulmonary disease (COPD) by restoring the activity of HDAC2. But the upstream mechanism of Jinwei decoction on HDAC2 expression is not clear. ObjectiveTo explore whether Jinwei decoction can enhance the anti-inflammatory effect of GC on COPD through microRNA21 (miR-21) by network pharmacology. MethodsThe TCMSP database was used to screen active ingredients and target genes of Jinwei decoction, and miRWalk2.0 was used to predict downstream target genes of miR-21. COPD-related genes were identified by searching GeneCards and OMIM databases; Venny 2.1 was used to screen intersection genes; Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways of intersection genes were analyzed by R software. Protein-protein interactions (PPIs) were analyzed by Cytoscape 3.7.2 software to identify core genes. Finally, interactions between main compounds and potential targets were verified by molecular docking. ResultsTwo hundred ninety-two active ingredients, 316 Jinwei drug targets, 10170 miR-21 target genes, 6617 COPD target genes, and 184 intersection gene were identified. Eleven core proteins of PPI networks may be involved. GO enrichment analysis showed that oxidative stress, regulation of inflammatory response, hormone transport, and histone modification were involved; KEGG pathway enrichment analysis concentrated in the PI3K-Akt, mitogen-activated protein kinase (MAPK), HIF-1, neutrophil extracellular bactericidal network, and other signaling pathways. ConclusionJinwei decoction can regulate histone deacetylase-2 activity and enhance the anti-inflammatory effect of GC on COPD by modulating miR-21. Its mechanism of action may be related to its effect on the PI3K Akt, MAPK, and TNF signaling pathways and neutrophil extracellular trap formation through miR-21.

姜良铎教授为国家级名老中医,从事临床工作多年,其在治疗失眠方面具有独到的诊疗思路与用药经验,疗效显著.姜教授认为"不和"是失眠病机的纲要,辨治失眠常从辨识"状态"入手,治疗上以"通调"为治疗大法,具体治法则以调畅三焦为主.探析姜良铎教授辨治失眠的经验,对启迪和激励后人将前人临床经验及学术思想进行传承与创新具有重要意义.

早在《黄帝内经》中就有"正气存内,邪不可干,避其毒气"的防疫思想."正气"指的是人体抵御病邪的能力.人体正气充足,外邪不容易侵入.在疫情流行期间需要注意什么呢?