As the only blood vessels that can directly be seen in the whole body, pathological changes in retinal vessels are related to the metabolic state of the whole body and many systems, which seriously affect the vision and quality of life of patients. Timely diagnosis and treatment are key to improving vision prognosis. In recent years, with the rapid development of artificial intelligence, the application of artificial intelligence in ophthalmology has become increasingly extensive and in-depth, especially in the field of retinal vascular diseases. Research study results based on artificial intelligence and fundus images are remarkable and provides a great possibility for early diagnosis and treatment. This paper reviews the recent research progress on artificial intelligence in retinal vascular diseases (including diabetic retinopathy, hypertensive retinopathy, retinal vein occlusion, retinopathy of prematurity, and age-related macular degeneration). The limitations and challenges of the research process are also discussed.

目的:探索针刀、电针治疗对早期膝骨关节炎(KOA)兔模型关节软骨细胞结构及Ⅱ型胶原的表达情况.方法:30只新西兰兔按体质量随机分为空白组(6只)及KOA造模组(24只),KOA造模组应用改良Videman法制动4周建立早期KOA兔模型.干预结束后,对兔股骨内侧髁软骨进行免疫荧光双标染色(激光共聚焦显微镜观察),应用ELISA法检测兔血清、关节液CTX-2的含量.结果:①治疗后针刀组、电针组血清(P =0.091,P=0.657)、关节液(P =0.066,P=0.032)CTX-2含量降低.②治疗后针刀组、电针组细胞核(P =0.058,P=0.051)、F-actin骨架蛋白(P =0.184,P=0.220)和Ⅱ型胶原(P =0.168,P=0.236) IOD表达降低,但差异无统计学意义.结论:针刀、电针对早期KOA兔模型膝关节软骨细胞及Ⅱ型胶原蛋白代谢具有一定保护作用,但效果不如塞来昔布.

齐鲁杜氏皮肤湿热流派基于"寒凉派"刘完素的"火热论",秉承其六气皆能化火之说,继承高秉钧的"疡科三部病机学说",重视湿热与伏邪发病,发展完善湿热致病理论,创建了皮肤湿热学说.流派创始人杜锡贤教授带领流派主要传承人刘翠娥、宋业强、赵颖、范玉、史传奎、唐志坤、张春红等及各代弟子秉承并完善流派的学术思想,即承于刘完素之"火热论",在整体辨证审治的基础上,做到标本兼顾、内外并治、中西结合,善于从湿热之病机论治皮肤病,善悟药性,巧用对药,在扶正祛邪的同时顾护脾胃.代表著作有《皮肤病中医辨治》《皮肤病中药外治疗法》《疔疮痈毒中西医特色治疗》等.

儿童肥胖多数为单纯性肥胖,中医治疗有明显优势."阳化气,阴成形"出自《素问·阴阳应象大论篇》,从"阳化气,阴成形"角度对儿童单纯性肥胖症的诊治进行阐述."阳化气,阴成形"失调是肥胖症的关键病机.从"阳化气,阴成形"辨证分析儿童各阶段肥胖症,用扶阳化阴法指导儿童单纯性肥胖症的防治,包括生活调护、中药治疗、综合外治等.结合临床病案对从"阳化气,阴成形"论治儿童单纯性肥胖症的诊疗经验进行介绍.

反向型银屑病是发生于特殊部位的银屑病.湿热潜证广泛存在于反向型银屑病的发生发展过程中,湿热之邪为外感因素,因人体质从化与合病是发病基础,肝经湿热、脾虚湿蕴是病机关键,疾病日久耗伤肝血,患者情志不畅肝气失调,影响气血运行,导致恶性循环,疾病缠绵难愈.据此,临床上从肝论治,治宜畅肝健脾,清热利湿,透转渗利,注重保津,养血化瘀,搜邪护正,方收良效.附验案1则以佐证.

丹毒是一种以患处皮肤突然鲜红成片,色如涂丹,灼热肿胀为主要表现的急性感染性疾病.近年来丹毒患者日益增多,本病不加以及时处理,容易发展成重症.中医治疗主要包括内治法和外治法,中医内治主要以清热解毒为原则;中医外治法主要以膏药、中药药浴、中药湿敷和针刺治疗为主,起效迅速,疗效显著;中西医结合治疗丹毒可以取长补短,具有疗效确切、副作用少、复发率低等优势.本文拟从中医病因病机、中医内治、中医外治和中西医结合治疗等方面对近年来丹毒的治疗经验及论述加以整理,以期为丹毒的临床治疗提供一定的参考.

当归芍药散,出自张仲景《金匮要略》中的"妇人妊娠病"和"妇人杂病"篇."妇人腹中诸疾痛,当归芍药散主之";"妇人怀娠,腹中?痛,当归芍药散主之".此为张仲景肝脾调和法的代表方剂,后世妇科调经常用方逍遥散亦化裁于此,是妇科常用方剂之一. 肝藏血,主疏泄,主气、主血,脾主运化水湿,气、血、水既为组成人体的基本物质,亦可成为人体的致病因素.若脏腑功能失调,或气病及血,或血病及气,或气滞水停,或血水相搏,或三者合而为病,气、血、水失调.当归芍药散组方严谨,配伍得当,动静结合,不寒不热,主要用于肝脾不和,气郁、血滞、湿阻之证.方中血分药芍药为君药,养血柔肝,缓急止痛,当归、川芎行气活血,共为臣药,配以白术、茯苓、泽泻这三味气分药,健脾益气,利水化湿,使肝血充足而气机条达,脾气健运而湿邪除去,全方共奏肝脾调和、气血水同调之功.

“汗法”系中医治病八法之首,具有解表祛邪、宣通腠理等功效,在皮肤病治疗中应用较为广泛,但至今尚缺乏对“汗法”治疗皮肤病系统的认知与分类整理.该文通过搜集与疏理相关文献,从理论和临床两个方面探究“汗法”在皮肤病治疗中的应用特点与进展.理论上,认为皮肤病病位在肌表,发病机制多属营卫不和,而“汗法”可调和营卫、开通玄府,正是治疗皮肤病的主要理论依据,此外亦对“汗法”的用药规律和使用法度加以说明,旨在为临床提供更有效的指导.临床上,基于“汗法”有狭义汗法与广义汗法之分,提出汗法治疗皮肤病不只局限于辛温发汗,还需重视“广汗法”的应用,利用广汗以布展气机,调和阴阳,故该文对调营发汗、清热发汗、辛凉发汗、利湿发汗、温阳发汗、养阴发汗等广汗法及相应方药进行了分类与综述,以期为临床实践提供参考.

玄府作为人体气血津液运行、输布及代谢的重要通路,重在开阖有度.寻常型银屑病病机为素体本虚,又逢外邪侵袭,搏于肌表,气血津液不能正常代谢而致玄府郁闭.辛味药能发表、散结、行气、活血、开窍,有开通玄府的作用.玄府郁闭导致的血热、血瘀、血燥均可应用辛味药能散、能润、能行的特性治疗,使邪气得除,气血调和,疾病向愈.

OBJECTIVE To observe the curative effect of joint administration of acupuncture, western and herbal medicines and bamboo-jar-cupping in the treatment of locomotor dysfunction in patients with apoplexy (acute phase) of wind-phlegm blocking meridian-collateral type in acute stroke patients, and its influence on some relevant laboratory indexes. METHODS A total of 100 cases of acute stroke patients of wind-phlegm blocking meridian-collateral type were recruited, and equally and randomly divided into control group and treatment group according to the random number table. The patients of both groups received treatment of conventional western medicines (for anti-platelet aggregation, blood-lipid regulation, arterial plaque-stabilization, cerebral cell protection and blood pressure-lowering), Chinese herbal medicines (for promoting blood circulation to dredge the meridian-collaterals), and acupuncture of Neiguan (PC6), Chize (LU5), Zusanli (ST36), Binao (LI14) and Sanyinjiao (SP6); and in addition, the patients of the treatment group also treated by cupping with bamboo-jar (kept for 10 min). The treatment was conducted once a day for 2 weeks. After the treatment, the National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer assessment (FMA), Barthel Index (BI), and traditional Chinese medicine (TCM) syndrome score were used to assess the state of neurofunction, locomotor function, daily living ability, and TCM symptoms. The contents of serum C-reactive protein, D-dimer and blood homocysteine were detected using radical immunodiffusion, immunoturbidimetry, and enzymic methods, respectively. RESULTS After the treatment, of the 50 and 50 cases in the control and treatment groups, 5 and 6 were cured, 7 and 18 experienced marked improvement, 23 and 20 were effective, and 15 and 6 ineffective, with the effective rate being significantly higher in the treatment group (88.0%) than in the control group (70.0%, P<0.05). Self-comparison showed that the FMA and BI scores were significantly increased (P<0.01), and the NIHSS score and TCM syndrome score notably decreased in both groups ( P<0.01) in comparison with their own pre-treatment. Comparison between the two groups showed that the FMA and BI scores were obviously higher in the treatment group than in the control group (P<0.05), whereas the NIHSS score and TCM syndrome score as well as the C-reaction protein content evidently lower in the treatment group than in the control group (P<0.05, P<0.01). CONCLUSION Joint administration of acupuncture, western and Chinese herbal medicines and cupping can promote the recovery of nerve function, improve locomotor function, activities of daily living and quality of life, and reduce inflammatory state in acute stroke patients with wind-phlegm blocking collaterals.

目的:探讨对于自然分娩的产妇采取两种不同分娩方式后实施护理的临床应用.方法:随机选择在2019年1月到2021年1月期间来我院自然分娩的产妇102名,根据接生方法的不同分成两组,探讨产妇通过会阴无保护接生和传统接生法后的不同护理方式的临床应用效果.结果:会阴无保护接生组护理后的会阴撕裂情况明显优于传统接生组护理后结果,护理满意度显著高于传统接生组,两组间结果均存在显著差异.结论:会阴无保护接生护理具有积极的临床意义,值得进一步推广和应用.

伏邪是潜藏于人体逾时而发的病邪,有病发于内、郁而化热等特点,银屑病初起即见里热征象,这与伏邪致病特点相似,故认为伏邪的内伏外发与银屑病的发生发展存在某种联系.通过搜集相关文献资料并结合临床经验,深入探究伏邪理论发展过程,从伏邪的角度分析银屑病发病机制,得出伏邪与银屑病在病因病机、皮损表现、分期特征三个方面关系最为密切.并总结出热邪是银屑病最主要的伏邪,贯穿疾病始终,热邪或因外感引动而发病,或因热邪积聚,超过阈值而自发.无论以上何种方式致病,其血热内蕴,不断蒸腾津液,耗伤气血,皆可进一步转化成血瘀、血虚、血燥等,使得病情呈阶段性发展.治疗上则以温病学中"斑疹"的治疗大法"透法"为主线,将其贯穿于银屑病三期治疗当中,意在通过"透法"疏通气机,透除郁热.此外,根据各期伏邪致病特点与临床表现的不同,分别提出"进行期重在透邪""静止期重在清邪""退行期重在扶正透邪"的具体治疗原则.基于伏邪理论探讨寻常型银屑病分期论治,以期为临床治疗银屑病提供有力的理论依据和有效的治疗方法.

[目的]观察滋肾育胎丸合滋癸益经汤治疗早发性卵巢功能不全(POI)的临床疗效,为"治疗POI应当大补气血精而非单纯滋阴补肾"的诊疗思路提供事实依据.[方法]将90例POI患者随机分为观察组46例和对照组44例.2组患者均给予滋癸益经汤治疗,在此基础上,观察组合用滋肾育胎丸治疗,对照组合用维生素E治疗,3个月为1个疗程,连续治疗2个疗程.观察2组患者治疗前后月经情况评分、中医症候评分、改良Kupperman评分、血清性激素[促卵泡刺激素(FSH)、雌二醇(E2)、黄体生成素(LH)及抗缪勒氏管激素(AMH)]水平以及子宫附件彩超指标的变化情况,评价2组患者的综合疗效.[结果](1)治疗过程中,观察组脱落1例,对照组脱落5例,最终共84例完成试验,其中观察组45例,对照组39例.(2)疗效方面,治疗6个月后,观察组总有效率为68.9％(31/45),对照组为51.3％(20/39),观察组的综合疗效优于对照组,差异有统计学意义(P<0.05).(3)月经情况评分方面,治疗6个月后,观察组除了周期及经期外,其余月经情况评分均较治疗前明显改善(P<0.05),对照组在经色、经质、痛经、经前乳胀、腰膝酸软上的评分也较治疗前明显改善(P<0.05),但2组患者对各项月经情况评分的改善作用均无显著性差异(P>0.05).(4)中医症候评分和改良Kupperman评分方面,在治疗3、6个月后,2组患者的绝大多数症候评分、改良Kupperman评分及其总积分较治疗前改善(P<0.05或P<0.01),且观察组在治疗3、6个月后对中医症候总积分和改良Kupperman总积分的改善作用均明显优于对照组(P<0.05或P<0.01).(5)血清性激素方面,治疗3、6个月后,2组患者血清性激素水平均较治疗前有不同程度改善,其中FSH、LH水平较治疗前下降,E2、AMH水平较治疗前上升;且观察组在改善FSH、LH水平方面均优于对照组(P<0.05).(6)彩超指标方面,治疗3、6个月后,2组患者的子宫大小、子宫内膜厚度、双侧卵巢体积和卵巢窦卵泡数(AFC)等均较治疗前改善(P<0.05或P<0.01),且观察组患者在改善AFC方面明显优于对照组(P<0.05).[结论]相比维生素E,滋癸益经汤合用滋肾育胎丸可更有效缓解POI患者的临床症状,改善月经情况,调节性激素水平.论证了治疗POI应当在补肾的基础上大补气血精,并确定了以补肾填精、益气养血为主要治法,以滋癸益经汤合滋肾育胎丸为基本的治疗方案.

目的 观察中药养血祛风饮联合黑豆洗方治疗手慢性湿疹的疗效.方法 选择45例手慢性湿疹患者,随机分为两组,观察组24例予内服中药养血祛风饮,外用黑豆洗方治疗;对照组21例予外用丁酸氢化可的松乳膏、多磺酸粘多糖乳膏治疗.6周后观察疗效.结果 观察组愈显率为75.0％,对照组愈显率为47.6％,差异具有统计学意义(P<0.05).结论 中药内外同治手慢性湿疹疗效确切.

Background: Knee osteoarthritis (KOA) is a chronic degenerative joint disease, leading to pain and functional limitation in the elderly. The non-pharmaceutical therapy is recommended firstly by different guidelines for KOA management strategies. In China, there are various forms of non-pharmaceutical treatments for KOA, which are considered beneficial in relieving KOA pain. However, there is no consensus on which is the optimal non-pharmaceutical regimens. Thus, present network meta-analysis aims to assess the comparative efficacy of available Chinese non-pharmaceutical therapies, especially in pain management. Methods: PubMed, EMBASE, Cochrane library, Web of Science, China national knowledge infrastructure, VIP, Wan Fang will be systematically searched their inception to April 2020. Randomized controlled trials that compared the effect of non-pharmaceutical therapies on pain control in KOA will be included, including traditional acupuncture, electroacupuncture, warming needle, fired needle, acupuncture followed by moxibustion, moxibustion and massage. The primary outcome was the knee pain levels, and secondary outcome was the comprehensive indicators. Risk of bias assessment of the included studies will be performed according to the Cochrane risk of bias tool. The pairwise and network meta-analysis will be performed by STATA 14.0 and GeMTC softwares. Results: This study is ongoing and will be submitted to a peer-reviewed journal for publication. Conclusion: This study will provide a comprehensive evidence on the effects of Chinese non-pharmaceutical therapies for pain control in KOA. PROSPERO registration number: CRD42018106575

目的 对1987～2017年公开发表的原发性骨质疏松相关中医药文献的关键词进行定量分析,以期探索研究热点与研究趋势的变化规律.方法 检索万方、CNKI、维普数据库,运用社会网络法分析高频关键词和治疗方法的共现关系并实现可视化.结果 检索出6324篇文献,清洗后余2679篇.共有20个高频关键词,其中补肾疗法、补肾中药、老年和老年性骨质疏松症的中间中心度较高、接近中心度和点中心度较低,且处于共现网络图中的核心区域与边缘区域之间.补肾和活血化瘀是未来研究的趋势,但也应该应关注其他治疗方法.结论 老龄化、补肾和活血化瘀是未来原发性骨质疏松相关中医药研究领域的研究热点和发展趋势,但也应该关注其他治疗方法.

目的 对1987—2017年公开发表的原发性骨质疏松相关中医药文献的关键词进行定量分析,以期探索研究热点与研究趋势的变化规律.方法 检索万方、CNKI、维普数据库,运用描述性统计方法分析关键词热值.结果 检索出6324篇文献,筛选后剩余2679篇,文献的总体趋势是波浪式上升的.高热关键词共有21个,可分为三类:主要以大鼠为实验对象的实验研究、主要以老年人为研究对象的临床研究、以补肾为主的中药治疗,研究热点涵盖范围较广并具有明显的阶段性,但关键词及名词术语的规范性不足,缺少数据挖掘相关的研究.结论 随着我国人口的快速老龄化,未来原发性骨质疏松相关中医药相关研究需求趋于增大.数据挖掘相关研究未来应成为其研究热点,中医药研究相关关键词及名词术语亟须规范.

目的:基于荟萃分析(Meta分析)方法,系统评价坤泰胶囊联合激素替代治疗(hormone replacement therapy,HRT)用于卵巢早衰的疗效及安全性.方法:检索中国期刊全文数据库、维普数据库、万方数据库、中国生物医学文献数据库和PubMed数据库,检索时限为建库至2018年12月31日,收集坤泰胶囊联合HRT用于卵巢早衰的随机对照临床研究文献(研究组患者使用坤泰胶囊联合HRT;对照组患者单纯使用HRT),采用"偏倚风险评估工具"进行质量评价,运用RevMan 5.3软件对患者治疗前后的卵泡刺激素(FSH)、黄体生成素(LH)和雌二醇(E2)水平,症状积分,总有效率和不良反应发生情况进行Meta分析.结果:最终纳入15篇文献,涉及1343例患者.Meta分析结果显示,与单纯使用HRT比较,坤泰胶囊联合HRT能明显降低卵巢早衰患者的FSH水平(MD=-7.13,95％CI=-8.08～-6.19,P<0.00001)、LH水平(MD=-5.43,95％CI=-6.99～-3.88,P<0.00001),明显提高E2水平(SMD=1.14,95％CI=0.73～1.54,P<0.00001),明显降低症状积分(MD=-4.42,95％CI=-5.55～-3.28,P<0.00001),明显提高治疗总有效率(OR=3.53,95％CI=2.53～4.94,P<0.00001)和安全性(OR=0.56,95％CI=0.31～1.01,P=0.05),差异均有统计学意义.结论:坤泰胶囊联合HRT有明显优势,能在一定程度上改善卵巢早衰患者的临床症状,减少不良反应,提高安全性,可以作为较好的辅助搭配治疗.

脓疱型银屑病包括泛发性和掌跖脓疱型,其中泛发性脓疱型银屑病是银屑病的一种特殊类型,中医学多认为此系湿热蕴久,兼感毒邪,郁久成脓而发.西医学多认为此病病因不明确,发病迅速,治疗难度大且极易复发.本研究将近年来泛发型脓疱型银屑病治疗的研究进展做一综述.

慢性荨麻疹是好发于任何部位、年龄、季节的炎性过敏性皮肤病,围绝经期慢性荨麻疹患者在临床中占有一定比例.作者通过阅读文献书籍及临床跟师学习,分析肝与围绝经期慢性荨麻疹的关系,并以四逆散为基础方辨治.从病因病机、辨证要点、选方用药、验案等方面探讨其辨治优势,为临床治疗围绝经期慢性荨麻疹提供参考.