目的 观察清热除湿汤治疗带状疱疹肝经郁热证的临床疗效与安全性.方法 选取带状疱疹肝经郁热证患者56例,随机分为治疗组29例和对照组27例.治疗组给予中药清热除湿汤口服,每日1剂;对照组予盐酸伐昔洛韦片(每次0.3g,每日2次)、甲钴胺片(每次0.5mg,每日3次)、维生素B1(每次10 mg,每日3次)口服,两组疗程均为7天.于治疗前、治疗后记录症状或体征积分,治疗后判定临床疗效;于治疗前、治疗后、30天随访时、90天随访时记录疼痛视觉模拟法(VAS)评分,并记录两组患者水疱停止出现时间、全部结痂时间、全部脱痂时间、疼痛减轻时间、疼痛消失时间;观察并记录试验过程的不良事件发生情况,并检测肝功能、肾功能、血常规、尿常规.结果 治疗组临床疗效总有效率(82.76％)高于对照组(54.17％),差异有统计学意义(P＜0.05).两组患者VAS评分治疗前后差值、30天随访时与治疗前差值、90天随访时与治疗前差值比较差异均有统计学意义(P＜0.05),治疗组优于对照组.30天随访时治疗组后遗神经痛发生率为0,对照组为20.83％(5/24,P＜0.05),90天随访时治疗组后遗神经痛发生率为0,与对照组的4.17％(1/24)比较差异无统计学意义(P＞0.05).两组患者水疱停止出现时间、全部结痂时间、全部脱痂时间比较差异无统计学意义(P＞0.05).两组患者疼痛减轻时间、疼痛消失时间比较,治疗组短于对照组(P＜0.05).治疗期间两组均未出现严重不良反应,肝功能、肾功能及血常规、尿常规均未见异常.结论 清热除湿汤口服治疗带状疱疹肝经郁热证可明显减轻疼痛、促进皮疹愈合、缩短病程、减少后遗神经痛的发生,且安全性良好.

Objective:To investigate the effect of Taohong Siwu Decoction on the postherpetic neuralgia（PHN） model in rats.Methods:Sixty male SD rats were divided into a control group, a model group, and a treatment group according to the random number table method, with 20 rats in each group.The PHN model was induced in rats in the model group and the treatment group.After modeling, the rats in the treatment group received Taohong Siwu Decoction at 5 g/（kg·d） by intragastric administration.The differences in various indicators were compared.Results:The mechanical pain thresholds of the model group and the treatment group were lower than those of the control group 1 d, 7 d, and 14 d after intervention（P＜0.05）,and the mechanical pain thresholds of the treatment group were higher than those of the model group 7 d and 14 d after intervention（P＜0.05）.The levels of IL-1β,IL-4,and TNF-α in serum and spinal cord of the model group and the treatment group were higher than those of the control group（P＜0.05）,and those of the treatment group were lower than those of the model group（P＜0.05）.The levels of IL-2 in serum and spinal cord of the model group and the treatment group were lower than that in the control group（P＜0.05）,and that in the treatment group was higher than that in the model group（P＜0.05）.The levels of CD3 + ,CD4 + ,and CD4 + /CD8 + in the model group and the treatment group were lower than those in the control group（P＜0.05）,and those in the treatment group were higher than those in the model group（P＜0.05）.CD8 + and TGF-β levels in the model group and the treatment group were higher than those in the control group（P＜0.05）,and those in the treatment group were lower than those in the model group（P＜0.05）.The expression levels of EphrinB2 and EphB2 proteins in the spinal cord of the model group and the treatment group were higher than those in the control group（P＜0.05）,and those in the treatment group were lower than those in the model group（P＜0.05）.Conclusion:Taohong Siwu Decoction has a remarkable effect on the PHN rat model, which is worthy of attention.

药对配伍以中医药基本理论为依据,是方剂中药配伍的初级模式,更是由繁琐的组方原则向简化更迭的一种研究方向,既是单味药物的深入研究,又是复杂方剂的前期基础,起到连接中药与方剂之间的桥梁作用.合理、恰当的药对配伍,体现的不仅是一首方剂的框架,更是体现方剂功效主治的基础.吾师王莒生教授临证时擅长从众多经方之中精选药对配伍,治疗多种皮肤病效果颇佳.本文将王教授临床中利用赤芍、白芍药对治疗皮肤病的用药体会总结如下.

目的 观察芍药苷各组抑制B16黑素细胞氧化损伤的分子机制.方法 体外细胞实验分为对照组、模型组、不同浓度芍药苷干预组.采用流式细胞仪检测细胞凋亡率,Hoechst 33342观察凋亡细胞的核变化,激光共聚焦显微镜观察细胞线粒体膜电位,底物荧光法检测Caspase-3/9的活性,Western blot法测定细胞凋亡Bcl-2、Cyt-c蛋白的表达.结果 ①与正常对照组相比,模型组凋亡率明显增高(P＜0.01);Caspase-3/9的活性显著增高;Cyt-c蛋白表达量升高;Bcl-2蛋白表达量降低.②与模型组相比,芍药苷各组凋亡率明显降低(P＜0.01);Caspase-3/9的活性降低,Cyt-c蛋白表达量降低,Bcl-2蛋白表达量升高,均以芍药苷高剂量组最好.结论 该文揭示了线粒体信号转导通路可能是芍药苷干预氧化应激诱导B16黑素细胞凋亡的调控机制之一.

目的:探讨滋补肝肾方组方配伍抑制B16黑素细胞氧化损伤的分子机制.方法:研究共分6组:正常对照组、模型组、祛风组、养血组、补肝肾组、全方组.采用流式细胞仪检测细胞凋亡率,Hoechst 33342观察凋亡细胞的核变化,激光共聚焦显微镜观察细胞线粒体膜电位,底物荧光法检测Caspase-3/9的活性,Western Blot法测定细胞凋亡B淋巴细胞瘤-2基因(Bcl-2)、细胞色素c(Cyt-c)蛋白的表达.结果:①与正常对照组比较,模型组凋亡率、Caspase-3/9活性显著增高(P＜0.01),线粒体膜电位、Bcl-2蛋白表达显著降低(P＜0.01),Cyt-c蛋白表达量升高(P＜0.01).②与模型组比较,滋补肝肾含药血清各组凋亡率显著降低(P＜0.01,P＜0.05),线粒体膜电位降低得到改善,Caspase-3/9活性降低(P＜0.01),可使Cyt-c蛋白表达量降低,Bcl-2蛋白表达量升高(P＜0.01).结论:线粒体信号转导通路可能是滋补肝肾含药血清干预氧化应激诱导B16黑素细胞凋亡的调控机制之一,全方组抑制氧化应激效果最好,体现了中医治疗白癜风、综合作用的优势.

目的:研究加味除湿胃苓合剂治疗脂溢性脱发疗效及对患者微量元素、激素水平的影响.方法:选取98例脂溢性脱发患者随机分为观察组与对照组,各49例.对照组给予非那雄胺治疗,观察组在对照组基础上加服加味除湿胃苓合剂,两组均持续治疗3个月.比较两组临床疗效、自觉症状改善情况,并检测头发中微量元素锌(Zn)、铜(Cu)、铁(Fe)、钙(Ca)及血清激素水平,观察不良反应发生率.结果:观察组总有效率为91.84％高于对照组69.39％(P<0.05).治疗后观察组瘙痒、鳞屑、油腻、脱发症状评分低于同组治疗前及对照组治疗后(均P<0.05).治疗后观察组Fe、Zn、Ca、Cu水平高于同组治疗前及对照组治疗后(均P<0.05).治疗后观察组睾酮水平低于同组治疗前及对照组治疗后,雌二醇水平高于同组治疗前及对照组治疗后(均P<0.05).两组均未发生严重不良反应.结论:加味除湿胃苓合剂治疗脂溢性脱发可改善自觉症状和激素水平,提高头发中微量元素含量.

Objective To investigate the effects of serum from healthy individuals obtained following moxibustion at the “Jiudianfeng” point on melanocytes in vitro . Methods Ten healthy adults (five male and five female) were treated by moxibustion at the “Jiudianfeng” point for 30 minutes once daily for 3 months. The effects of treatment with serum obtained following moxibustion on melanocyte proliferation, melanin content, tyrosinase activity, cell cycle progression, and c-kit mRNA and protein expression were assessed in vitro before and after moxibustion for 1, 2, and 3 months. Results Exposure to sera from healthy adults following moxibustion therapy promoted melanocyte proliferation, melanin synthesis, tyrosinase activity, and c-kit mRNA and protein expression in vitro . Melanin synthesis and tyrosinase activity increased in the first 2 months following moxibustion and a synchronous decline was observed during the third month. Serum also promoted melanocyte entry into the G1 phase of the cell cycle. Conclusions Serum treatment following moxibustion at the “Jiudianfeng” point promoted melanocyte proliferation and melanin synthesis. Further exploration of this intriguing phenomenon is essential. Keywords c-kit , “Jiudianfeng” point , melanocyte , moxibustion , serum , melanogenesis , cell cycle , viability

寻常型天疱疮是一种自身免疫性疾病,多发于中老年人,病情重、病程长、愈后差、容易复发.该病是皮肤科疑难重症之一,目前治疗该病的主要西药为皮质类固醇激素、免疫抑制剂、免疫球蛋白及生物制剂,大部分患者在一段时间内能有效控制病情,但减药或停药过程中易出现病情反复,且长期使用激素和免疫抑制剂产生的不良反应及并发症成为该病患者的主要死亡原因.

ObjectiveTo investigate the effects of serum from healthy individuals obtained following moxibustion at the “Jiudianfeng” point on melanocytes in vitro. MethodsTen healthy adults (five male and five female) were treated by moxibustion at the “Jiudianfeng” point for 30 minutes once daily for 3 months. The effects of treatment with serum obtained following moxibustion on melanocyte proliferation, melanin content, tyrosinase activity, cell cycle progression, and c-kit mRNA and protein expression were assessed in vitro before and after moxibustion for 1, 2, and 3 months. ResultsExposure to sera from healthy adults following moxibustion therapy promoted melanocyte proliferation, melanin synthesis, tyrosinase activity, and c-kit mRNA and protein expression in vitro. Melanin synthesis and tyrosinase activity increased in the first 2 months following moxibustion and a synchronous decline was observed during the third month. Serum also promoted melanocyte entry into the G1 phase of the cell cycle. ConclusionsSerum treatment following moxibustion at the “Jiudianfeng” point promoted melanocyte proliferation and melanin synthesis. Further exploration of this intriguing phenomenon is essential.

目的 观察滋补肝肾方中滋补肝肾药、活血药、祛风药及全方对氧化损伤后的黑素细胞活性、凋亡率、线粒体膜电位及释放凋亡蛋白的调节作用,探讨滋补肝肾方的作用机制.方法 以B16黑素细胞为研究对象,用过氧化氢刺激造成黑素细胞氧化损伤模型.根据组方规律将滋补肝肾方中的药物拆分为滋补肝肾组、活血组、祛风组,采用冻干粉溶液作用细胞.MTT比色法观察各组黑素细胞的生长抑制;流式细胞仪技术分析DNA含量,确定凋亡细胞所占比例;线粒体膜电位检测试剂盒(JC-1法)检测线粒体膜电位变化;Western blot法检测凋亡蛋白.结果 滋补肝肾方全方组(200μg/mL、100 μg/mL)、活血组(100 μg/mL)可升高氧化损伤后细胞活性,以全方组作用最为明显.全方组细胞凋亡率低,在保护黑素细胞免受氧化损伤方面比其他组效果更明显.与对照组相比,50 μg/mL全方组、200 μg/mL滋补肝肾组、50 μg/mL滋补肝肾组Bcl-2蛋白表达升高(P＜0.05),说明全方组、滋补肝肾组抗凋亡作用明显.Capase 9、Capase 3、CytC模型组与各药物组蛋白表达差异无统计学意义(P＞0.05).25 μg/mL祛风组、12.5 μg/mL祛风组AIF蛋白与模型组相比差异有统计学意义(P＜0.05).50 μg/mL全方组、50 μg/mL滋补肝肾组、50 μg/mL活血组、25 μg/mL祛风组、12.5 μg/mL祛风组Bax蛋白与模型组比较差异有统计学意义(P＜0.05).除全方组、滋补肝肾组外,其余各药物组Smac蛋白表达与模型组比较差异有统计学意义(P＜0.05).结论 滋补肝肾方及其拆方可抑制黑素细胞氧化损伤,可能通过线粒体通路发生作用,提示白癜风临床治疗当补血活血、滋补肝肾、祛风共用.

目的:从多角度总结、挖掘王莒生治疗银屑病的用药规律,从而总结其学术思想.方法:收集2012年8月至2016年7月在北京中医医院门诊治疗的符合银屑病诊断标准患者205例,纳入治疗银屑病研究的处方505张,借助MATLAB矩阵实验室软件,进行统计分析,利用Pajek可视化复杂网络分析软件,对药物进行网络分析.结果:505张处方共应用中药108种,统计出高频的前30味药物及常用的剂量范围,其中白芍、楮桃叶是使用率较高的两味药,其他高频药物为清热解毒凉血药、祛湿药、祛风药;总结高频使用的药对配伍,并总结出王莒生治疗银屑病的基本经验方剂楮药凉血汤及加减应用.结论:王莒生治疗银屑病重视热毒致病,强调从肝论治,药物以清热凉血解毒为主.

Background: Published research evidence evaluating the use of topical and oral formulae in psoriasis is lacking. The purpose of this study was to evaluate the efficiency and safety of Hang xue huo xue decoction (LXHXD) in treating psoriasis vulgaris (PV) of blood heat syndrome. Material and methods: A total of 50 eligible patients with PV were randomized 3:2 into two groups (A and B). The patients in group A received LXHXD while those in group B received a placebo for 6 weeks. PASI was recorded at baseline, and after 2, 4, and 6 weeks of treatment, and 6 weeks after treatment. Serum IL-17a and IL-1 beta levels were determined before and after treatment. Conclusions: LXHXD is effective and safe in the treatment of psoriasis vulgaris. LXHXD can significantly reduce the symptoms of skin lesions in patients with psoriasis, effectively reduces the PASI score and peripheral blood IL-17a concentration and has only mild side effects. It can be used as a treatment for psoriasis.

目的:客观评价楮芍凉血汤加减治疗银屑病血热证的临床疗效、安全性.方法:以2014年5月至2016年5月在首都医科大学附属北京中医医院门诊就诊的寻常型银屑病血热证患者46例为研究对象,分为治疗组30例,对照组16例,治疗组采用楮芍凉血汤加减治疗银屑病血热证,对照组予以安慰剂治疗,两组疗程均为6周,治疗后比较临床疗效.结果:46例银屑病血热证的患者,一般情况评价基线是齐平无差异,两组患者的性别比例、年龄构成、病程长短基本符合男性多于女性,青壮年居多,病程多为慢性病程的规律,治疗组治疗安全可靠,两组药物均能改善患者皮损总的状况,疗效治疗组明显高于对照组;中医症状两组均得到改善,治疗组优于对照组.结论:楮芍凉血汤加减治疗银屑病血热证临床疗效可靠,安全可行.

寻常型银屑病( PV)是一种较常见的慢性炎症性、增生性疾病,根据临床表现分为进展期、静止期、退行期. 病情反复,缠绵难愈,严重时皮损泛发全身,大量脱屑,皮肤干燥、肥厚、瘙痒,给患者的身心健康带来严重影响. 中医皮肤科赵炳南将PV(白疕)临床辨证为血热证(相对应于进展期)、血瘀证(相对应于静止期)、血燥证(相对应于退行期),分别给予清热凉血活血、活血化瘀行气、养血滋阴润肤治疗,创立了凉血活血汤、活血散瘀汤以及养血解毒汤,多年的临床应用和研究证实了其有效性和科学性[1,2].

Paper found the close relationship between psoriasis with liver storing blood and mental,and the important factor of psoriasis increase and recurrence is that liver controlled conveyance and dispersion leading to rage or depression,which is based on overviewing ancient literature on clinical research three aspects such as liver and skin disease of relationship,psoriasis and liver of relationship and liver and psoriasis.Many clinical experts focus on studying ‘liver’ basic physiological functions and analyzing the relationship between psoriasis and liver function.Emotional therapy fully play the characteristics of TCM to treat the psoriasis using many ways of coordinating liver,such as clearing liver,dispersing liver,conveyancing liver,softening liver and nursing liver.Meanwhile,thanks to corresponding five zang-viscera and five flavors,psoriasis patients’ dietetic contraindication should combine with nature and flavor of food ‘reasonable diet with the five flavours of food’ to maintain the body.

Objective To explore the effects of problem-based learning (PBL) method on the efficiency of teaching of Chinese medicine dermatology based on medical records. Methods Undergraduate students who were in the same grade were divided into experimental group and control group. The experimental group was taught with the PBL method based on medical records. Teachers selected medical records, combed knowledge points, designed questions and carried out teaching in response to questions. The control group was taught with traditional teaching method. The teaching efficiency of two groups was evaluated by using test scores and questionnaire survey. Results The scores of syndrome differentiation scores, medication scores, and the overall score of experimental group were better than those in the control group. Compared with the control group, learning initiative, ability to involve in the teaching and master knowledge, and ability of logical analysis and communication of experimental group were all improved remarkably. Conclusion PBL method based on medical cases is beneficial for the improvement of the level of diagnosing and treating skin diseases based on syndrome differentiation and ability of solving problem.

Prof.Wang Jusheng uses the Chinese herbal medicines flexibly in clinical treatment.Prof.Wang prefers Su Qin Sang Xing Shao for cough,adding taoren and weilingxian for chronic cough;danggui and bixie combined with qinjiu and tufuling for itching rashes and hyperuricemia;baishao combined with mugua and gancao for cervical spondylosis;ganjiang and huanglian for blood glucose regulation.Prof.Wang Believes that the clinical cases are very complicated,with the mixture of cold,heat,deficiency and excess.The selection of herbal medicines and the determination of treating principles are on the basis of pathogenesis and differentiation,in which,the modern pharmacology is considered carefully.The dosage selection is optimized in terms of individual patients and situations.The formulas are modified according to the patients′ body constitutions and disorder differentiation and are used flexibly.The excellent effects are achieved on intractable diseases through careful differentiation,pathogenesis analysis,rational combination of drugs and dosage selection.

带状疱疹是由病毒所致的一种急性疱疹性皮肤病,中医称之为"蛇串疮""缠腰火丹""蜘蛛疮"等.本病与风、湿、热、毒等邪气有关,肝火及脾肺湿郁于内,毒邪乘虚侵于外,是本病之因;经络阻隔,气血凝滞是发病之理. 治以利湿解毒、通络止痛,通常是中药辨证内服配合外用药. 本文重点从外治方面进行综述,以飨同道.

首都医科大学附属北京中医医院"五味所禁"是《黄帝内经》里的重要饮食原则,皮肤作为人体的肌肤屏障,皮肤的病变是内在的反映,饮食偏嗜会对脏腑造成相应的病变;同时饮食不节也会引起内在病变,从而导致皮肤方面的病变.食物同药物一样,也具有辛、咸、苦、甘、酸五味,皮肤病患者的饮食禁忌要与食物的性味密切结合;同时,皮肤病患者饮食禁忌并不是绝对的禁止,《黄帝内经》中"无令多食"则是其具体体现,传统典籍中对饮食的禁忌也有待进一步考证,"谨和五味",禁忌有度,才可以"长有天命".

Objective To observe the clinical effect of pricking blood therapy in treating acute stage of herpes zoster patients with heat stagnation in liver channel syndrome and to study the possible mechanism.Methods Totally 104 acute stage of herpes zoster patients of heat stagnation in liver channel type were randomized into treatment group and control group,52 cases in each group.The control group was given oral herbs and basic acupuncture treatment.In addition to the treatment of the control group,blood-letting therapy was given in the treatment group.Seven days were one course in both groups.After the pain was completely disappeared,the treatment stopped.Preset treating time was 7 to 28 days.Patients' skin lesions healing and pain relief in both groups were examined.The changes of blood plasma β-endorphin level before and after treatment was detected.Results The vesiculation stopping time,incrustation starting time,total incrustation time,decrustation starting time,time of pain starting to relieve and pain disappearing in the treatment group was shorter than those in the control group (P ＜ 0.05).After 30 days,the incidence of neuralgia in both groups was 3.85％ (P ＞ 0.05).After treatment,the increase of blood plasma β-endorphin level in the treatment group was higher than that in the control group (P ＜ 0.05).As for the comprehensive curative effect evaluation,the total effective rate of the control group and the treatment group was 86.54％ and 92.31％ respectively,with significant difference (P ＜ 0.05).Conclusion Pricking blood therapy might promote the healing of herpes zoster lesions and relieve the pain,increase of the level of patient's blood plasma β-endorphin might be one of the mechanisms.