目的 梳理黄连温胆汤方剂研究现状及热点,为后续研究提供思路和参考.方法 计算机检索中国知识资源总库(CNKI)、中文科技期刊数据库(VIP)、中国学术期刊数据库(万方数据)、中国生物医学文献数据库(CBM)建库至2021年12月31日发表的黄连温胆汤相关文献.提取文献发表时间、作者、作者单位及关键词等信息,并对作者单位、关键词进行预处理,采用VOSviewer软件进行关键词共现研究、聚类分析,构建关键词时间叠加网络.结果 初检得到文献4323篇,经筛选,最终纳入1664篇.涉及2665位作者,来自黑龙江中医药大学、南京中医药大学、河南中医药大学等864家研究机构;纳入文献包含关键词1226个,共出现5242次,研究涉及3个主要临床研究方向:神经-精神系统疾病(失眠、抑郁)、消化系统疾病(慢性胃炎、胆汁反流)、循环代谢系统疾病(高血压病、2型糖尿病、代谢综合征、冠心病),涉及1个主要基础研究方向:经验传承(名医经验、医案研究).研究前沿包括高血压病、半夏白术天麻汤、高脂血症、网络药理学、信号通路、同型半胱氨酸等方面.结论 黄连温胆汤的研究集中于神经-精神系统、消化系统、循环代谢系统等内科疾病临床研究和名医经验传承方面,其中循环代谢疾病是近年研究热点.网络药理学、信号通路等方面可能成为黄连温胆汤方剂研究新热点.

中医学讲求形神一体观,其中"五神"理论最能反映人的精神思维活动.记忆作为精神思维活动的重要环节,与"五神"密切相关.基于古今文献中"五神"理论,提出健忘的发生主要是由于心神、脾意、肾志的失养,与肝魂、肺魄紊乱亦有一定的联系,且各有其临床表现及治法.临床可从"五神"辨治健忘,以为健忘的治疗提供新的思路.附验案1则以佐证.

目的 对双丹明目胶囊治疗2型糖尿病视网膜病变(DR)肝肾阴虚、瘀血阻络证的安全性和有效性进行再评价.方法 采用单臂、自身前后对照、多中心临床试验研究方法,在62家医院收集2,353例肝肾阴虚、瘀血阻络型DR患者,予双丹明目胶囊每次4粒,每日3次,疗程16周,以7个方位彩色眼底照相检查(微血管瘤、出血灶、渗出)、最佳矫正视力(BCVA)评分、中医证候积分和单项症状评分等指标综合评价疗效,同时检测血、尿、便常规及心电图、肝肾功能等安全性指标.结果 (1)BCVA:与基线比较,用药8周、16周后,受试者的视力改善均有统计学意义(S8周=397,580.00,S16周=787,220.00,均P=0.000),视力改善、自觉症状评分上升幅度均与治疗疗程呈正相关,可改善不同病程的DR患者的视力.(2)眼底检查:与基线比较,治疗16周后,眼底检查中微血管瘤、出血灶、渗出改善,病灶数量减少差异,均有统计学意义(S微血管瘤=64,063.00,S出血灶=44,634.50,S渗出=31,700.50,均P=0.000);眼底病变分级的下降无论基线糖化血红蛋白水平及病程长短,治疗后差异均有统计学意义(P＜0.05).(3)中医证候和单项症状评分:可改善DR中医证候和单项症状评分,中医证候积分治疗前后进行比较,差异有统计学意义(S=-624,162.50,P=0.000),对视物模糊(S=96,125.00,P=0.000)、双目干涩(S=187,296.50,P=0.000)的症状改善明显,均有统计学意义.(4)安全性评价:无药物相关严重不良反应(SAE)发生,与药物相关的不良反应主要为轻度腹部不适.结论 双丹明目胶囊治疗2型糖尿病视网膜病变(肝肾阴虚、瘀血阻络证)安全有效.

目的 探索规范化教学查房模式,评估其教学效果.方法 将某院2014级中医学五年制实习生共112人作为研究对象,2019年8月27日-2019年9月30日55位学生作为对照组,2019年10月8日-2019年11月11日57位学生作为试验组.学生入科第2～4周,试验组根据规范化的教学查房设计方案进行每周1次教学查房,对照组按照传统方法进行每周1次查房.学生入科第5周进行学生教学查房满意度调查和出科考核.结果 试验组学生对教师教学的总满意度明显高于对照组(Z=-7.063,P＜0.05).试验组学生出科考核成绩明显高于对照组(t=10.541,P＜0.05).结论 规范教学查房,可以明显改善教学查房效果,提高临床实践教学质量.

国内高等中医药院校与国外知名大学合作办学,是中国中医药高等教育走向世界、进入国外主流教育阵地、推动中医药国际化的主要途径.疫情全球化背景下,远程教学是国际教育的必然选择.中医内科学课程针对新加坡南洋理工大学双学位班学生特点,通过不断尝试,探索出中医内科学国际教育可采取远程教学手段,以多元化教学结合多点反馈模式进行授课,并结合非标准化答案考试的形成性评价体系,培养学生中医临床思维能力.

Objective:To evaluate the effect of direct observation of procedural skills (DOPS) and outcome assessment supported by Questionnaire survey and WeChat in assessment of surgical internship by undergraduates of traditional Chinese medicine(TCM)program.Methods:Improved DOPS evaluation form was formulated. From June 2018 to December 2019, 180 students in the Department of Surgery of the Second Clinical Medical College, Beijing University of Chinese Medicine, were selected to conduct a DOPS assessment of surgical clinical skill in the early, middle and later stages. The results of each assessment were statistically analyzed and given real-time feedback by Questionnaire survey and WeChat. Students at early and later stages were asked to fill in the satisfaction questionnaire.Results:The scores of late DOPS assessment (5.44±0.13) were higher than those of early DOPS assessment (4.20±0.21) and middle DOPS assessment (4.44±0.13), ( P<0.01). For the satisfaction of DOPS assessment results, the scores from teachers were (7.33±1.51), (7.52±1.33), (8.52±0.53), and the students were (6.72±1.55), (7.22±1.40), (8.21±1.09) respectively in the early, middle and later stages. The score of later stage was higher than that of middle stage and that of middle stage was higher than that of early stage ( P<0.01). The results of the questionnaire survey among the students in early and later stage indicated that the contribution to improve teaching results was recognized with the highest score in the later stage [4.81±0.42], which was higher than that in the early stage [4.50±0.61] ( P<0.01). Conclusions:The application of the improved DOPS supported by a network Questionnaire and WeChat platform in the examination of surgical clinical skills has been recognized by teachers and students, which contributes to the improvement of surgical clinical operation skills of student.

目的 探讨从痰论治失眠的组方用药规律,以指导临床用药.方法 检索《中华医典》数据库中的名方及医案部分中的全部古籍数据,收集整理治疗失眠症痰证的方药信息.对常用中药进行频次统计.基于关联规则分析治疗组方规律.基于聚类分析及因子分析提取主方.结果 在91首方剂中,共统计出133味中药,频次≥13的药物有20味,其中半夏频次最高,高达60次.治疗痰证失眠症常用中药以温性为主,共295次.治疗痰证失眠症常用中药以甘味为主,共446次.治疗痰证失眠症常用中药中,脾胃经用药频次最高,共496次.对91首方剂中频次≥13的中药进行因子分析,利用因子系数筛选出7个公因子,关联规则分析得到治疗痰证失眠症的药物组合14组.聚类分析生成聚类分析树状图,结合临床实际,提取4组聚类结果.治疗痰证失眠以理气、化痰、安神为基本治则,用药以甘温类药物为主,辛开苦降调畅气机,温胆汤和安神定志丸为两大主方,根据临床病情变化,随证加减可取得更好的临床疗效.结论 通过分析《中华医典》中从痰论治失眠的组方用药规律,为临床从痰论治失眠提供参考依据.

目的 分析353例缺血性中风患者发病季节与证候要素、危险因素的关系.方法 选取2015年2月-2019年2月作者所在医院脑病科收治的缺血性中风急性期患者353例,分析不同发病季节与其证候要素、常见危险因素的关系.结果 痰湿证患者夏季发病率较高,内风证、内风+痰湿+血瘀组合证患者秋季发病率较高,内火证及内风+痰湿组合证患者冬季发病率较高.年龄≤65岁具有脑卒中家族史者夏秋季发病风险增加,合并高血压者秋冬季发病风险增加,合并颈动脉狭窄者冬季发病风险增加;年龄＞65岁合并高血压者夏季发病风险增加,饮酒嗜好者秋季发病风险增加,合并血脂异常时冬季发病风险增加.结论 缺血性中风患者发病季节规律与证候要素及危险因素均相关.

为全面提高临床实践教学质量,我院从教和学两方面推进精细化管理.通过制定实践教学规范、加强临床师资队伍、加强实习带教过程管理、拓展实践教学空间和时间以及实施刚柔相济的实习管理,构建了有效的实践教学质量管理体系.开展以实践教学的五个环节—教学查房、教学病例讨论、科室小讲座、实习生考勤和出科考核为着力点的过程管理和以问题为导向的专项管理以及为学生安排各种临床技能的强化训练课程、实行实习生"考研假"制度、开展实习形成性评价、按照"查重-评阅-答辩"三部曲对学生论文进行考核等改革举措,取得了令人欣慰的实效.

目的 探索舒肝颗粒治疗乳腺增生症的最佳有效剂量.方法 采用随机、双盲、安慰剂对照的方法,在5个中心纳入乳腺增生症肝郁气滞证患者240例,随机分为常规剂量组90例、高剂量组90例、安慰剂组60例,分别给予舒肝颗粒常规剂量(相当于原药材5 g)、高剂量(相当于原药材10 g)、安慰剂治疗3个月经周期.观察治疗后乳房疼痛最痛一日数字评分法(NRS)评分和乳房明显疼痛天数(NRS≥3的天数)下降值,触诊乳腺靶肿块大小变化值和治疗后单项症状消失率.结果 治疗3个月经周期后乳房疼痛最痛一日的NRS评分、乳房明显疼痛天数、触诊靶肿块大小和各单项症状消失率,舒肝颗粒高剂量组和常规剂量组均优于安慰剂组(P ＜0.05或P＜0.0125),但高剂量组和常规剂量组之间差异均无统计学意义(P＞0.05或P＞0.0125). 结论 舒肝颗粒常规剂量,即每次5 g、每日2次口服,为治疗肝郁气滞证乳腺增生症的最佳有效剂量.

Objective To explore the dynamic evolution of syndrome elements of ischemic stroke at different time points. Methods Patients with ischemic stroke in hospital was selected as the research object, and the syndrome elements were collected at admission, day 14 and day 30. Correlation analysis was used to set up complex network, and the core algorithm of hierarchical structure was used to extract core relationship network of ischemic stroke. Dynamic evolution of the syndrome elements at different time points was analyzed. Results 60 cases of patients with ischemic stroke were included, and the syndrome factors were mainly including wind, sputum and blood stasis. Phlegm syndrome and blood stasis syndrome were the main symptom at day14 and,day 30 after stroke. The manifestation of the disease at admission was mainly characterized by the change of the condition, the restlessness of expression, the peak of the disease, the high viscosity blood stasis, the fine pulse or the pulse count. The main symptoms at day 14 were slip-pery or soggy pulse, and wiry pulse, dark purple tongue. The main symptoms at day day 30 were hypervis-cosity syndrome, slippery or soggy pulse, dark purple tongue, wiry pulse. Conclusion The syndromes of ischemic stroke show dynamic evolution at different times, and phlegm syndrome and blood stasis syndrome run through the course of disease, and appear gradually with the progress of disease course.

文章通过对现阶段北京中医药大学第二临床医学院《西医外科学》课程特点、教学实际和形成性评价的应用情况进行概括分析和利弊探讨,为进一步完善丰富形成性评价模式、提高日常评价反馈的及时性和双向性,在"互联网+"时代引入电子网络平台、即"微信联合问卷星"的方式,作为评价手段和媒介,对提高学生学习效果和兴趣,增加师生互动,摸索新型教育和评价方式提出应用价值探索.

为了促进学生自主学习与自我评价并能为教师教学质量反馈有效信息,提升学生专业理论素养和科研能力,通过在西医外科学课程中阶段性地引入小组综述撰写与答辩的初步实践,依据问卷调查结果,提示小组综述在外科教学形成性评价中有较高应用价值,可操作性强,符合形成性评价的核心内涵,是有效的教学评估手段,结合传统的终结性评价,有助于教学方法的改进.

目的 通过研制《中医专业学位硕士研究生临床带教教师评价表》,以全面、客观地评价我院专业学位硕士生临床带教教师带教质量.方法 用自编《中医专业学位硕士研究生临床带教教师评价表》对东方医院2013、2014、2015级参加住院医师规范化培训的专业学位硕士、科室教学秘书、科主任进行问卷调查,评价东方医院住院医师规范化培训临床带教教师的带教意识、水平和质量.结果 调查表各因素的Cronbach'sα系数均较高,在0.798-0.885之间.评价表总平均分为85.75,总分为"优"的问卷有718份,占问卷总数的71.66%,问卷总分为"不合格"的有35份,占总问卷数的3.49%.结论 本研究的调查表具有良好的信度,该调查表的结果具有较高的可靠性.我院规培研究生对带教教师整体满意度较高,我院规培带教教师整体水平较高.

ObjectiveTo explore the application effect of clinical comprehensive skills training center learning in the teaching of diagnostics. Methods 56 students of 2011 grade who signed the informed consent in our hospital were grouped into experimental group and control group randomly. Students in the experimental group received the class in the clinical comprehensive skills training center, while the control group in traditional classroom. The curriculum were randomly selected, 56 students were performed with written examination. At last, we made comparative analysis on the examination score and questionnaire results between the two groups, as well as conducted comparison and assessment on the teaching quality of the two groups. Results Compared with students in control group, students received clinical comprehensive skills training center learning performed significantly better on questions of active classroom atmosphere(P=0.0086),broaden their knowledge(P=0.0076),improve the clinical ability(P=0.0057);or exam pass rates had no significant differences between groups. The results of the diagnostic studies in the clinical skills training center of the teaching group were significantly better than that of the traditional classroom teaching group(P=0.000).There were no statistically significant differences between the two groups.Conclusion The teaching effect of diagnostics in the clinical comprehensive skills training center was significantly better than that in the traditional classroom.

Objective To evaluate the teaching effect of situational teaching method in clinical teaching of cardiovascular disease. Methods A total of 56 clinical medical students were randomly divided into two equal groups, test group with seminar teaching method and control group with traditional teaching method. After the end of the course, the two forms of theoretical examination and questionnaire survey were evaluated. Results Scores of theoretic test in test group were significantly higher than thosein control group (P<0.05). There were signiifcant differences in scores at learning interest, learning atmosphere, clinical thinking ability, communication ability, expression ability of comprehensive analysis and independent thinking ability of survey between two groups (P<0.05). Conclusion Situational teaching method can improve students' learning interest and learning ability, which is helpful to the cultivation of students' comprehensive quality.

Objective To evaluate the influence of various factors,including the TCM pattern factors, on the recurrence of patients with ischemic stroke.Methods A retrospective analysis was underwent for 246 cases of discharged patients with ischemic stroke been treated in Dongfang Hospital of Beijing Univer-sity of Chinese Medicine from July 2004 to November 201 4.Based on their medical records,the patients suffered with ischemic stroke were followed up.A multivariate analysis of the factors was performed by u-sing the Cox proportional hazard regression model.The information of prognosis,including recurrence and death,was collected.Results The recurrence rate of patients with cerebral multiple infarcts was 4.328 times higher than those suffered with cerebral single infarct.1 4 days after admission,risk of recur-rence for the patients with phlegm pattern was 3.463 times higher than that for the patients without phlegm pattern.Furthermore,the risk of recurrence for the patients at the acute stage taking Chinese medicine decoction was only 49.3% of the patients who didn't take.Conclusion Cerebral multiple in-farcts,and phlegm pattern were the independent recurrence factors,and the Chinese medicine decoction was the protective factor at the acute stage.

Objective To systematically evaluate the efficacy of Chinese Medicine( TCM) on the long-term activities after ischemic stroke. Methods By means of Cochrane systematic review, randomized controlled trials( RCTs) on TCM treating acute ischemic stroke were collected. The Modified Rankin Scale (mRS) and Bathel-Index (BI) were used to evaluate the long-term activities of daily life after ischemic stroke. Rates of recurrence and mortality in the trials were also observed. Results 9180 publications were searched and a total of 24 RCTs were included finally. According to the Meta analysis, significantly lower mRS score and higher BI score were seen in the TCM group compared to that of in the control group and western medicine group. Conclusion Improvement of the long-term activities of daily life might be got through the treatment of TCM, which also may reduce the mortality rate and the incidence of secondary stroke. Furthermore, to reveal the advantages of TCM in treating ischemic stroke,we should improve the design of RCTs and pay more attention to the long-term follow-up results.

<正>医院制剂是名医、名院、名科建设的基础,是医院专科特色和学术特色的体现。继2005年国家食品药品监督管理局颁布《医疗机构制剂注册管理办法(试行)》及《医疗机构制剂配制监督管理办法》之后,2010年8月,卫生部、国家中医药管理局、国家食品药品监督管理局联合出台的《关于加强医疗机构中药制剂管理的意见》,对简化申报程序中使用历史溯及、

医疗机构中药制剂临床试验的质量管理是规范化研发医疗机构中药制剂的重要环节。在制定有针对性的中药制剂研发策略基础上,借鉴中药新药临床试验质量管理方法,将ISO9000质量管理体系所倡导的PDCA循环质量管理方法应用于院内制剂临床试验的质量管理,设计中药制剂临床试验质量控制体系要素,初步建立起中药制剂临床试验质量管理模式,并通过中药制剂示范性研究验证和评价,进一步完善中药制剂临床试验质量管理模式,提高中药制剂注册研发质量。