文章总结了蔡鸿彦教授基于"大气下陷"理论治疗慢性阻塞性肺疾病(COPD)的学术思想及临床经验.蔡鸿彦教授认为本病为本虚标实证,并依据"大气下陷"理论提出,大气不足,上焦阳弱,为本病的发病基础;大气虚弱,宣降失司,为本病的起病之根;大气下陷,饮停痰阻,为本病的核心病机;大气虚脱,阴阳失维,为本病的危重之候.依此确立益气升阳、豁痰降气、止咳平喘贯穿疾病治疗始终的基本原则,用于临床,达到控制疾病进展,改善临床症状,提高患者生存质量的目的.

小气道隶属于肺络系统中的气络部分,小气道结构功能的病变影响整个肺络系统以及肺生理功能的正常发挥.小气道阻塞是慢性阻塞性肺疾病的早期阶段,吸烟是其主要的危险因素之一.结合"毒"邪理论和络病学说,认为烟草烟雾是本病的使动因素,烟雾对小气道的影响包括介导气道炎症反应、黏液分泌和气道阻塞以及肺内组织损伤.烟毒伤络过程包括:留滞气络积蕴成毒阶段、成毒络损阶段和络损内生新毒阶段.治疗强调排毒通络、益气养阴,初期留滞气络积蕴成毒阶段宜清肺润络排毒,烟雾积聚成毒络损阶段宜益气通络排毒,络损内生新毒阶段宜逐瘀化痰通络.

Everolimus (RAD001) is a mTOR inhibitor and is widely used for the treatment of gastric cancer (GC). Evidence suggests that Rhein has anticancer effect on GC. But the synergistic effect and mechanism of RAD001 and Rhein combination on GC is not clear. The current study aims to clarify the combination of RAD001 and Rhein in GC treatment. We found Rhein dose-dependently repressed MGC-803 cell viability (50% inhibition concentration (IC50) value = 94.26 μM). Rhein (80 μM) significantly suppressed GC cell proliferation and invasion. RAD001 dose-dependently repressed MGC-803 cells viability (IC50 value = 45.41 nM). The combination of Rhein and RAD001 repressed MGC-803 cells viability, invasion, and proliferation compared to the administration of Rhein or RAD001 alone. Protein levels of epithelial-mesenchymal transition (EMT)-related molecules E-cadherin, N-cadherin and Vimentin expressions were significantly affected by the combination of Rhein and RAD001. The combination of Rhein and RAD001 significantly facilitated cell apoptosis and up-regulated expressions of cell apoptosis and cycle-related protein p53, cyclin-dependent kinase 4 (CDK4) and cyclin D1 compared to the administration of Rhein or RAD001 alone. Moreover, the combination of Rhein and RAD001 repressed the expressions of phosphorylation-phosphoinositide-3-kinase (p-PI3K), p-protein kinase B (p-AKT) and p-mammalian target of rapamycin (p-mTOR). Finally, the combination of RAD001 and Rhein significantly decreased tumor weight and volume, suppressed the expressions of p-PI3K, p-Akt and p-mTOR, and repressed cell proliferation marker Ki-67 expression, which exerted synergistic cancer prevention in GC in vivo. Overall, the combination of Rhein and RAD001 exert synergistic cancer prevention in GC via PI3K/Akt/mTOR pathway.

网站读者暖暖的雪留言说:现在年轻人中颈椎病特别多见,如何知晓自己的颈椎是否健康?自己的颈椎病属于哪种分型?如何有效治疗和呵护自己的颈椎? 答暖暖的雪: 颈椎病属于一种骨骼退行性病变.随着年龄增长,人的椎体在发生退化的同时,椎间盘也会出现相应的改变,如椎体增生、椎间盘膨出,突向椎管内,就会压迫神经、血管,甚至脊髓,产生相关症状.因而患者多见于中老年人.但近年来年轻人中患颈椎病的亦不鲜见.原因是颈椎退行的早晚快慢轻重因人而异,如果曾有外伤史,或长期处于不良姿势或受到潮湿寒冷刺激,就会加快加重颈椎的退化,甚至出现严重症状.

Objective: To understand how alpinetin regulates the IL-6/STAT3 signaling pathway through Nrf2/HO-1 to regulate tight junction proteins and improve the intestinal-epithelial-barrier function in mice with ulcerative colitis.Methods: Sixty-six male C57BL/6 mice were collected, and 11 mice were randomly selected as the blank control group. On the morning of the 8th day following successful modeling, the mice were killed, and their anus-to-ileocecal tube was removed for testing. The mRNA and protein expression levels of tight junction proteins [occludin, heme oxygenase-1 (ZO-1), claudin-2], IL-6/STAT3-signaling-pathway-related indicators [interleukin-6 (IL-6), signal transducer and activator of transcription 3 (STAT3)], Nrf2/HO-1-related indicators [transcription factor NF-E2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1)], and oxidative-stressrelated indicators [malondialdehyde (MDA), superoxide dismutase (SOD)] were compared for each mice group.Results: The mRNA and protein expression levels of ZO-1 in the zinc protoporphyrin group were considerably lower than the levels for the alpinetin concentration groups (P < 0.05). The expression levels of STAT3 and IL-6 mRNA and proteins in the model group were significantly higher than the levels for the blank control group (P < 0.05). The expression levels of STAT3 and IL-6 mRNA and proteins in the alpinetin concentration groups were considerably lower than the levels for the model group (P < 0.05). The expression levels of IL-6 mRNA and protein in the zinc protoporphyrin group were substantially higher than the levels for the alpinetin concentration groups (P < 0.05). The MDA levels of mice in the 60mg/kg A alpinetin and 100mg/kg A alpinetin groups were significantly lower than the levels for the model group, and the SOD levels were considerably higher than the levels for the model group (P < 0.05). The expression levels of Nrf2 mRNA and proteins for the model group were significantly lower than the levels for the blank control group (P < 0.05). The expression levels of HO-1 mRNA and proteins in the zinc protoporphyrin group were significantly higher than the levels for the alpinetin concentration groups (P < 0.05).Conclusion: The mechanism by which alpinetin improves intestinal-epithelial-barrier function in ulcerative colitis mice might be induced, in part, by activating Nrf2/HO-1, inhibiting the IL-6/STAT3 signaling pathway, and regulating tight junction proteins.

肺癌是最常见恶性肿瘤之一,其发病率、死亡率高,且呈上升趋势.咳嗽是其最常见症状之一,也多为首发症状,且肺癌的咳嗽各具特点,临证时黄金昶教授通过抓主证的方法进行辩治,取得较好的临床效果.本文疏理肺癌患者常见的咳嗽类型,总结黄金昶教授治疗肺癌患者咳嗽的临床经验.黄金昶教授指出了肺癌患者临床最常见的九种咳嗽,包括因痒作咳,卧则咳嗽,动则咳剧,饮热呛咳,因痰而咳,剧烈阵咳,咳痰无力,脏结实咳,慢性咳嗽等,并分析相关病因病机,提出相应的治疗方案.黄金昶教授治疗肺癌咳嗽经验独到,疗效显著,值得学习与临床推广.

Triptolide is the main bioactive constituent isolated from the Chinese herb Tripterygium wilfordii Hook F., which possesses a variety of pharmacological properties. MicroRNAs (miRNAs/miRs) are short non-coding RNAs that regulate gene expression post-transcriptionally. miRNAs are implicated in several intracellular processes, whereby their dysregulation contributes to pathogenesis of various diseases. Thus, miRNAs have great potential as biomarkers and therapeutic targets for diseases, and are implicated in drug treatment. Previous studies have reported that specific miRNAs are targeted, and their expression levels can be altered following exposure to triptolide. Thus, miRNAs are emerging as crucial mediators in the pharmacological activities of triptolide. The present review summarizes current literature on miRNAs as target molecules in the pharmacological activities of triptolide, including antitumor, anti-inflammatory, immunosuppressive, renal protective, cardioprotective, antiangiogenesis activities and multiorgan toxicity effects. In addition, the diverse signaling pathways involved are discussed to provide a comprehensive understanding of the underlying molecular mechanisms of triptolide in the regulation of target miRNAs.

目的 观察针灸联合中药治疗卵巢癌恶性腹腔积液的临床疗效及对腹腔积液、Karnofsky功能状态评分(KPS)的影响.方法 选取卵巢癌恶性腹腔积液患者62例,依随机数字表法分为观察组和对照组,每组31例.所有患者均进行腹腔灌注化疗,对照组采取中药(六味地黄丸+六君子汤+己椒苈黄丸加减)治疗,观察组在对照组基础上联合针灸治疗,均治疗1个月.对比分析两组临床疗效及腹腔积液引流次数、KPS评分变化及不良反应发生情况.结果 观察组总有效率高于对照组(P<0.05);观察组引流腹腔积液次数少于对照组,差异有统计学意义(P<0.05);两组治疗前临床症状综合评分比较差异无统计学意义(P>0.05),治疗后两组临床症状综合评分比治疗前均有下降(P<0.05),且观察组治疗后低于对照组(P<0.05);两组治疗前KPS评分比较差异无统计学意义(P>0.05),两组治疗后KPS评分比治疗前均有上升(P<0.05),且观察组治疗后KPS评分高于对照组(P<0.05);观察组不良反应发生率低于对照组(P<0.05).结论 针灸联合中药治疗卵巢癌恶性腹腔积液的疗效明显,可改善患者的临床症状并降低腹腔积液引流次数,提高其生活质量,具有较高安全性.

生命在于运动.但运动也要讲科学.冬季气候寒冷,老年人在锻炼时要特别注意以下6个问题. 1.大道至简,外出活动必待日光 晒太阳是最简单又易行的提升体质的方法.对于虚寒体质的中老年人群来说,在阳光下活动,可以起到驱寒除湿、增强体质的效果.阳光不仅可以带走身体的寒气,还能加速钙质吸收,帮助预防骨质疏松.所以,一边晒太阳一边活动是提升体质的好方法.

目的 探讨氩氦刀联合肝动脉栓塞化疗(TACE)在不可手术的中晚期肝癌患者中的疗效.方法 选择我院2012年6月-2015年6月144例肝癌患者为研究对象,以随机数表法分为观察组与对照组,均72例.对照组采用TACE治疗,观察组在对照组基础上采用氩氦刀介入治疗.比较两组患者临床疗效、治疗后生存情况和不良反应总发生率.结果 观察组总有效率77.78％显著高于对照组54.17％,差异有统计学意义(P＜0.05).两组患者治疗后生存情况采取Log-Rank检验,生存率相当,差异无统计学意义(P＞0.05).观察组不良反应总发生率12.50％与对照组8.33％比较,差异无统计学意义(P＞0.05).结论 氩氦刀联合TACE在不可手术的中晚期肝癌患者治疗中,疗效可靠且安全性较高,值得临床应用.

Emodin is an active monomer extracted from rhubarb root, which has many biological functions, including anti-inflammation, antioxidation, anticancer, and neuroprotection. However, the protective effect of emodin on nerve injury needs to be further elucidated. The purpose of this study is to investigate the effect of emodin on the neuroprotection and the special molecular mechanism. Here, the protective activity of emodin inhibiting H 2 O 2 -induced apoptosis and neuroinflammation as well as its molecular mechanisms was examined using human neuroblastoma cells (SH-SY5Y cells). The results showed that emodin significantly enhanced cell viability, reduced cell apoptosis and LDH release. Simultaneously, emodin downregulated H 2 O 2 -induced inflammatory factors, including IL-6, NO, and TNF- α , and alleviated H 2 O 2 -induced oxidative stress and mitochondrial dysfunction in SH-SY5Y cells. In addition, emodin inhibited the activation of the PI3K/mTOR/GSK3 β signaling pathway. What is more, the PI3K/mTOR/GSK3 β pathway participated in the protective mechanism of emodin on H 2 O 2 -induced cell damage. Collectively, it suggests that emodin alleviates H 2 O 2 -induced apoptosis and neuroinflammation potentially by regulating the PI3K/mTOR/GSK3 β signaling pathway.

目的 基于"形寒寒饮伤肺"理论,提出慢性阻塞性肺疾病核心病机"寒饮伏肺",中医辨证治疗应"不远温",制定了内外合治的特色诊疗方案并验证疗效.方法 选择慢性阻塞性肺疾病160例,采用随机对照方法分为研究组及对照组,研究组选用内外合治诊疗方案,对照组选用西医常规治疗方法.结果 2组中医证候疗效比较,研究组有效率为93.42％,对照组有效率为87.84％,组间比较差异具有统计学意义(P<0.05),研究组在改善肺功能(FEV1、FEV1占预计值％、FEV1/FVC)、增加6分钟步行距离等方面优于对照组(P<0.05).结论 内外合治诊疗方案,对改善慢性阻塞性肺疾病患者中医证候及肺功能等均有一定疗效.

OBJECTIVE:To observe the clinical efficacy of adjuvant therapy of moxibustion combined with Wenyang Lishui formula for peritoneal effusion of ovarian malignant tumors. METHODS:Sixty patients with peritoneal effusion of ovarian malignant tumors were randomly divided into an observation group and a control group, 30 cases in each group. The patients in the control group were treated with intravenous infusion of paclitaxel liposome at the first day and cisplatin at the 2nd to 4th day, 21 days as a course of treatment, and 4 courses were given. Based on the treatment of the control group, the patients in the observation group were treated by moxibustion combined with Wenyang Lishui formula. Moxibustion was applied at Mingmen (GV 4), Pishu (BL 20), Shenshu (BL 23), Shenque (CV 8), Guanyuan (CV 4), Zigong (EX-CA 1), Zhongwan (CV 12), Shuifen (CV 9), Qihai (CV 6) and Zhongji (CV 3), each acupoint for 30 min, once a day for 12 weeks. Wenyang Lishui formula was taken twice orally, one dose a day, 2 weeks as a course of treatment, and 6 courses were given. The levels of , , and / in peripheral blood were measured before and after 12-week treatment in the two groups. The changes of peritoneal effusion volume and Karnofsky performance status scale (KPS) score before and after treatment were compared between the two groups, and the clinical efficacy of the two groups was evaluated. RESULTS:The symptom improvement rate was 96.7% (29/30) and overall effective rate was 86.7% (26/30) in the observation group, which were significantly superior to those in the control group [80.0% (24/30) and 56.7% (17/30), P<0.05]. After treatment, the levels of , and / in peripheral blood were significantly increased in the observation group (P<0.01), there was no significant difference in the control group before and after treatment (P>0.05), and the increase in the observation group was significantly higher than that in the control group (P<0.05). After treatment, the volume of peritoneal effusion in the two groups was decreased (P<0.01), and the reduced volume in the observation group was higher than that in the control group (P<0.05). After treatment, KPS scores were increased significantly in both two groups (P<0.01), and the increase in the observation group was higher than that in the control group (P<0.05). The incidence rate of adverse reactions in the observation group was lower than that in the control group [23.3% (7/30) vs 53.3% (16/30), P<0.05]. CONCLUSION:Moxibustion combined with Wenyang Lishui formula could effectively improve the immune function, reduce the volume of peritoneal effusion, improve the symptom improvement rate, overall effective rate and the quality of life, and reduce the incidence of adverse reactions in chemotherapy of patients with peritoneal effusion of ovarian malignant tumors.

目的 观察火针围刺联合氩氦刀冷冻消融治疗软组织肉瘤的临床治疗效果.方法 选择50例软组织肉瘤患者作为观察对象,采用随机数字表法分为对照组、观察组,每组25例.对照组患者接受单独的氩氦刀冷冻消融治疗,观察组患者接受火针围刺联合氩氦刀冷冻消融治疗.对比两组患者治疗近期疗效及治疗前后免疫功能、疼痛程度变化情况.结果 观察组近期总有效率为68.0％(17/25),高于对照组的36.0％(9/25),差异有统计学意义(P<0.05);治疗后两组患者免疫功能指标CD3﹢、CD4﹢、CD4﹢/CD8﹢水平均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05);治疗后两组患者免疫功能指标CD8﹢水平低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后观察组环境领域、社会关系领域、心理领域及生理领域评分均明显高于对照组,差异有统计学意义(P<0.05).结论 火针围刺联合氩氦刀冷冻消融治疗软组织肉瘤的临床疗效显著,能有效减轻患者的疼痛等症状,减少或消除病灶,改善机体免疫功能.

卵巢癌是妇科三大恶性肿瘤之一.著名肿瘤内科专家、北京中医药大学教授、博士生导师黄金昶教授对卵巢癌的治疗有丰富的经验.黄金昶教授认为,卵巢癌的病因病机为气滞血瘀,肝经寒凝,痰湿蕴结,热毒内结,同时肾气亏虚,肝、脾、肾脏腑功能失调是致病关键.强调卵巢癌的治疗应当注重病证结合,灵活结合经典与现代检查手段,在临床工作中形成了肿瘤辨证体系,疗效颇佳.

1,6-O,O-Diacetylbritannilactone is a natural sesquiterpene lactone isolated from Inula britannica that has displayed cytotoxic effects against several human cancer cell lines. In this study, a selective and sensitive liquid chromatography-tandem mass spectrometry (LC-MS-MS) method was developed for determination of 1,6-O,O-diacetylbritannilactone in rat plasma. Chromatographic separation was achieved on an Agilent C18 column (4.6 mm × 75 mm, 3.5 μm) with methanol and water (80:20, v/v) as the mobile phase. An ESI source was applied and operated in positive ion mode; selected-reaction monitoring was used for quantification using target fragment ions m/z 373.2→312.9 for 1,6-O,O-diacetylbritannilactone and m/z 331.2→144.1 for the IS. Calibration plots were linear in the range of 1.5-1350 ng/mL for 1,6-O,O-diacetylbritannilactone in rat plasma. Intra- and inter-day precisions were <8.5%, and the accuracy ranged from -2.7 to 12.8%. The LC-MS-MS method was successfully applied in a pharmacokinetic study of 1,6-O,O-diacetylbritannilactone in rats.

目的 探究原发性肝癌患者行Hepa载药微球栓塞联合射频消融治疗的疗效.方法 选取110例原发性肝癌患者,随机分为观察组(n=55)和对照组(n=55).观察组应用Hepa载药微球栓塞联合射频消融治疗,对照组进行手术切除治疗.在治疗后的7天进行生化检查,评价2组患者的肝脏功能并进行对比,统计2组患者在治疗后2个月、4个月和6个月的治疗有效率并进行对比.结果 观察组治疗后7天肝脏功能明显好于对照组(P＜0.05);治疗后的2个月、4个月和6个月观察组的治疗有效率明显高于对照组(P＜0.05).结论 相对于手术切除原发性肝癌患者,采用Hepa栽药微球栓塞联合射频消融治疗疗效良好,对于肝脏功能的损害较小,治疗过程出血少,恢复快,对于临床治疗原发性肝癌有重要的意义.

Objective:To observe and analyze the clinical efficacy of 36 cases of primary hepatic carcinoma ( PHC) treated with puncturing liver meridian combined with loading microspheres.Methods:A total of 36 cases with PHC in our hospital from Sep-tember 2015 to May 2016 were enrolled as control group and received intervention microspheres treatment measures,with the basic research object for the observation group and the control group in the combined acupuncture and Chinese medicine treatment of 36 patients were included in our hospital during the period from June 2016 to February 2017 were of primary hepatocellular carcino-ma.The blood routine,liver function and adverse reactions of the two groups were observed and analyzed.Results:After treat-ment,the decrease of white blood cells and red blood cells,platelets of observation group was significantly better than the control group,and the difference was statistically significant (P<0.05);The improvement of liver function of patients in the observation group after treatment was significantly better than the control group ( P<0.05);The clinical efficacy of the observation group was 88.89%(32/36),which was higher than that of the control group (69.44%,25/36),and the difference was statistically signifi-cant (P<0.05);the incidence of adverse reactions in observation group was significantly lower than the control group (P<0.05).Conclusion:Acupuncture puncturing liver meridian combined with drug loaded microspheres in the treatment of primary liver cancer has a significant clinical efficacy with high safety,fewer adverse reactions,and it is worthy of clinical promotion.

目的传承李时珍药学学术思想和医药文化,继承国医大师金世元调剂技术经验,发展完善大黄调剂技术。方法系统整理《本草纲目》中有关大黄调剂的记载,结合《中国药典》（2015版）,梳理李时珍关于大黄药物释名、临床应用等方面的记载,对比金世元教授在大黄药物释名、处方审核、处方应付、发药交代等调剂技术方面经验。结果 1李时珍在《本草纲目》中关于大黄释名、临床应用等的记载充分体现了其辨证用药学术思想。2金世元教授提出的大黄处方审核、处方应付、发药交代等调剂技术与临床证候密切相关。结论金世元教授传承李时珍辨证用药学术思想,发展完善了大黄调剂技术,为大黄临床调剂提供了科学借鉴。

Objective To observe the effects of Mahuang ( Herba Ephedra ) and Wuweizi ( Fructus Schisandrae) combined with dexamethasone ( DXM) on expression of angiogenic factors and inhibitors in rats with idiopathic pulmonary fibrosis ( IPF) .Methods Wistar male rats of SPF level ( n=106 ) were divided randomly into sham operation group , model group, Mahuang group, Wuweizi group, Mahuang+DXM group , Wuweizi+DXM group and DXM group .The model of IPF was established by using instilla-tion of bleomycin (7 mg/kg) except for the sham operation group .Each group was administered intra-gastrically of corresponding drug .All rats were sacrificed on the 7th and 28th day via abdominal aorta blood-letting, and the pathological changes of lung tissue were evaluated with HE staining and the expres -sion of hypoxia-inducible factors 1α( HIF-1α) , platelet derived growth factor ( PDGF) , pigment epitheli-um-derived factor ( PEDF) and endostatin in rat serum were also measured with ELISA .Results Com-pared with the sham operation group , the expression of HIF-1α,PDGF, PEDF and endostatin in model group significantly increased (P<0.01);the HIF-1αcontent on the 28th day was higher than that on the 7th day, and the PEDF and endostatin content were lower than that on the 7th day.The expression of HIF-1αand PDGF significantly decreased in Mahuang group and Wuweizi group compared with the model group, and the expression of PEDF and endostatin increased (P<0.05).Compared with Mahuang group on the 28th day,the expression of HIF-1αand PDGF on the 7th day increased markedly, but the expres-sion of PEDF and endostatin on the 28th day was lower than those on the 7th day.In the Wuweizi group the changes in the expression of HIF-1α,PDGF, PEDF and endostatin were opposite to Mahuang group.The expression of HIF-1αand PDGF significantly decreased in Mahuang+DXM group and Wuweizi+DXM group compared with the model group ( P<0 .05 ) , and the expression of PEDF and endostatin increased . In Wuweizi+DXM group the HIF-1αcontent was significantly higher than those in DXM group while the PEDF content was significantly lower ( P<0.05 ) .Conclusion Regulatory factors on angiogenesis lose their balance in rats with IPF .Mahuang and Wuweizi could achieve inhibition of the expression of HIF-1αand PDGF, and selectively promote the expression of PEDF and endostatin .When combined with DXM, the selectivity might be weakened in different pathological stages .