风邪致病理论,是中医病因学的重要内容.其理论源于《内经》,后世医家对此更有发挥.风性轻扬、善行数变、风胜则动、为百病之长,是其主要特点.临床应用风药,常具有辛散祛风、息风止痉、升阳、祛湿、解郁等多种功效.对过敏性疾病、免疫相关疾病、发作性疾病等疾病从风论治具有重要意义,深入理解风邪特点及从风论治的治法,有利于提高中医临床疗效.

探讨新型冠状病毒疾病(COVID-19)的中医病因特征、病邪属性、病机特点,为临床辨证论治提供思路.检索中国知网(CNKI)与万方数据库中与COVID-19中医药相关的临床研究,理论探讨,国家及各省市、自治区、直辖市发布的中医诊疗方案等相关文献,对其中的病因病机、理论认识、临床症状体征、辨证分型、用药规律等,进行归纳、分析和总结.目前中医界对COVID-19的病因共识是感受"疫气",但在病邪属性方面则有寒、热之争或寒热混杂的认识,病邪有湿、毒、燥、火(热)、风、秽浊、郁等不同,对病机认识有湿、寒、热、毒、瘀、痰、滞、结、燥、秽浊、虚、闭、脱、喘等多样.将病因病机混论,寒热、燥湿等矛盾病邪或病机共融的现象比较普遍,缺乏理论体系的逻辑性,也不符合中医对外感病的病因、病机、病证分层认识与辨证的思维特点.治疗用药的主线是宣肺、清热、化湿、化痰、芳香辟秽,麻杏石甘汤为核心处方,辛温药主要是芳香、化湿、化痰、健脾之品,并不是温阳散寒之品,而且均为寒热并用,提示病因病机的复杂性.COVID-19属中医疫病(瘟疫)范畴,病因为"疫气",该疫气除具有"毒、秽浊"的基本属性之外,同时具有"湿、热、风"邪的特征;疾病过程中还产生了"痰、瘀、积滞"等次生病邪;病机演变过程以"郁、闭、虚"为特点.COVID-19所感疫气,不论从临床表现、传变规律(各阶段的辨证分型)、用药配伍等方面来看,病性属热的证据更多.

目的 探讨沙库巴曲缬沙坦对射血分数减低型心力衰竭患者(HF-REF)心力衰竭易损期影响.方法 96例HF-REF患者依据治疗方式分为A组(口服盐酸贝那普利)和B组(口服沙库马曲缬沙坦),比较2组患者的治疗有效率、明尼苏达心力衰竭生存质量表(MLHFQ)、N末端B型脑钠肽前体(NT-proBNP)、6 min步行试验、超声心动图指标[左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、左心室射血分数(LVEF)、舒张末期室间隔厚度(IVST)、舒张期左心室后壁厚度(LVPWT)、左心室质量指数(LVMI)、左心室收缩末内径(LVDd)]以及预后指标、不良反应等.结果 B组患者的治疗有效率明显高于A组差异有统计学意义(P＜0.05);2组患者治疗前NT-proBNP、6 min步行试验、超声心动图指标差异无统计学意义(P＞0.05),治疗后B组患者的NT-pro BNP、6 min步行试验、IVST、LVPWT、LVMI、LVDd、LVEDV、LVEF、MLHFQ评分优于A组患者,差异均有统计学意义(P＜0.05);B组住院时间少于A组患者,心力衰竭再住院率、出院后心血管不良事件发生率低于A组患者,差异均有统计学意义(P＜0.05).结论 沙库巴曲缬沙坦可改善HF-REF患者的临床症状,延缓或逆转心室重构,进一步降低心力衰竭住院率,并改善患者生活质量,安全有效.

变应性鼻炎(AR)发病机制涉及变应原、免疫细胞、免疫球蛋白、炎性介质之间的层级急慢性反应,而且具有一定的异质性,对现有治疗方案的反应也不尽相同,部分患者临床效果不佳.中草药治疗AR不仅能改善临床症状,而且具有良好的安全性,已成为临床治疗AR的经常选项.由于古代医籍中关于鼻鼽的描述与AR的临床表现非常接近,其主要病因病机为外感风寒、肺中虚冷、邪郁化热生风.所以,现代中医认为鼻鼽包括变应性鼻炎、变应性鼻窦炎及血管舒缩性鼻炎.根据鼻鼽(包括AR)的病因病机及临床特点,应当属中医风病范畴.但现代中医辨证AR偏重于脏腑虚损,忽视风邪的辨证,与临床治疗必用风药的现实形成较大反差,甚至导致临床研究不重辨证的反常现象.文章从中医治疗AR必用风药的现象出发,结合传统中医论述和现代风病理论研究成果,提出AR属于中医外感风病范畴,风邪是主要病邪,临床辨证应突出风邪,祛风胜湿法是关键治法.并根据临床治疗AR所用经典名方大多源自《伤寒论》,且都是以风药为主、治疗外感病的处方,并且效果良好,推断风药具有的“祛风止痒”功效可减轻或阻断鼻黏膜的变态反应,达到止痒、止嚏的目的;“祛风胜湿”功效可减轻鼻黏膜水肿,起到止涕、通塞的作用.现代研究也发现,以风药为主的经典名方和临床用于AR治疗的风药大多具有良好的抗炎、抗过敏、调节机体免疫功能等作用,说明祛风胜湿法及其指导下的风药治疗AR不仅符合中医传统理论,而且具有现代科学依据.

郭赛珊( 1938—) ,全国名中医. 北京协和医院"杰出贡献奖"获得者,教授,博士研究生导师,北京协和医院中医科主任,第三批全国老中医药专家学术经验继承工作指导老师. 从事中西医结合工作近50年,在糖尿病、妇科、男科及内科疑难病症方面积累了丰富的经验. 笔者有幸作为郭老的学术继承人,随师学习3年,获益良多. 本文特总结郭老治疗妊娠肝功能损害的临床经验,与同道共享.

目的 分析新疆地区原发性高血压疾病相关遗传基因,并探讨其与原发性高血压易感的相关性.方法 本文收集原发性高血压患者338例(维吾尔族1 75例,汉族163例)与健康人339例(各民族与高血压患者相匹配,分别为165例和174例)的血样,进行基因组DNA提取及质检,采用Massarray结合Taqman探针技术,对原发性高血压AGTR1、GNB3、ADD1、eNOS、EDN2、ADRB1六个基因位点进行基因分型,并通过统计分析确定基因综合评分风险模型,进行原发性高血压易感性评估.结果 六个基因上的变异位点均得到成功检测,均符合Hardy-Weinberg平衡定律.六个变异位点基因型及等位基因频率在两组分布均无统计学差异(P＞0.05);表明六个基因分别单独分析与原发性高血压易感性没有明显相关性.同时与血压正常者相比,原发性高血压患者基因综合评分是明显升高的(P＜0.05),说明六个基因综合评分与原发性高血压易感性相关.维吾尔族与汉族的原发性高血压(EH)基因综合评分并无显著差异,维吾尔族与汉族的正常血压(NT)基因综合评分亦无显著差异,但是同一民族下的原发性高血压基因综合评分大于正常血压的基因综合评分,这一结果表明民族因素不是影响新疆地区原发性高血压遗传易感性的因素.结论 原发性高血压相关单个基因单个变异位点与易感性无明显相关性,而综合分析六个相关基因可以预示原发性高血压易感性.同时不同民族高血压患病评分无显著差异表明在本研究条件下民族差异与原发性高血压遗传易感性没有明显相关性,本研究为原发性高血压的进一步研究提供了基础和依据.

郭赛珊教授治疗恶性肿瘤强调中西医结合,手术后注重益气养血、健脾补肾、扶正培本,恢复元气;放化疗期间注重扶正祛邪、健脾和胃,减轻放化疗的不良反应;放化疗休疗期间注重中药抗癌抑瘤,防止肿瘤复发和转移;肿瘤晚期注重培补正气、抑癌止痛,提高生活质量.

OBJECTIVETo grasp the clinical efficacy of acupuncture in the treatment of primary insomnia (PI), and analyze its future research directions.METHODSA total of 41 prospective randomized controlled trials (RCTs) were conducted in which the clinical efficacy of acupuncture for treatment of PI was compared with sedative and hypnotic drugs in recent six years by searching databases of CNKI, WANFANG database, PubMed, and BioMed Central (BMC), the aspects of diagnostic criteria, efficacy standards, observation time, control drugs, characteristics of acupoint selection and regularity were used to review and analyse.RESULTSAcupuncture treatment for PI was mainly based on acupoints in the head, combined with selecting the points according to the different syndrome, showing short-term efficacy and safety advantages, but it was not well-established in many aspects such as diagnostic criteria, efficacy evaluation, observation time, and control drugs.CONCLUSIONCurrent evidence shows that acupuncture treatment is effective, but it is necessary to add more stringent RCTs, and introduce objective monitoring indicators to strengthen the evidence and enhance the overall level of research.

Objective To optimize the extraction process of mixed volatile oil from Forsythiae Fructus, Saposhnikoviae Radix and Magnoliae Flos and inclusion process of β-cyclodextrin (β-CD). Methods With yield ratio of volatile oil as evaluation index, single factor experiments were used to study the extraction process of volatile oil;saturated aqueous solution was used, with inclusion rate of volatile oil as index, and orthogonal design was adopted to examine effects of charge ratio of volatile oil and β-CD, inclusion temperature and inclusion time on the inclusion process; X-ray scattering technique, infrared spectroscopy and scanning electron microscopy were used to characterize the inclusion compound. Results The optimum extraction process of volatile oil was soaking fine powder extracted 5 hours with 10 folds the amount of water. The optimum conditions of inclusion process were as follows:mixed ratio of volatile oil (mL) and β-CD (g) was 1:10; inclusion temperature was 50 ℃; the inclusion time was 2 h. X-ray scattering technique, infrared spectroscopy and scanning electron microscopy proved the inclusion compound had been formed. Conclusion Optimum extraction and inclusion processes are stable and feasible, and can provide research foundation for further research and development of preparation.

Objective To explore the illness attribution of patients with multiple somatic symptoms and their relationship with doctors. Methods This cross-sectional study was conducted from March to October, 2012, involving 150 participants who were recruited through convenience sampling from the outpatient clinics of Gastroenterology, Traditional Chinese Medicine, and Psychological Medicine of Peking Union Medical College Hospital. Based on somatic symptom scale of the patient health questionnaire (PHQ-15), the patients were divided into multiple somatic symptoms group (SOM+group, PHQ-15 score ≥ 10) and control group (SOM-group, PHQ-15 score Results The SOM+ group were more likely than the SOM-group to attribute their illnesses to psychological factors (16.0±4.3 vs. 13.5±4.9, P Conclusions Patients with multiple somatic symptoms attribute their illness to both psycho-social factors and physical factors. Relationship between doctors and these patients is difficult. Patients are likely to feel not being helped or given enough time, while doctors are likely to feel frustrated and time-consuming.

流行性感冒具有季节性、流行性、突然爆发、迅速扩散、病情较重的特点.由于病毒抗原的多变性,导致人类在预防流行性感冒特别是造成大流行的流行性感冒方面常常处于被动局面.文章通过对中医传统理论文献、名老中医经验及现代临床研究的分析、总结,提出从风毒论治流行性感冒的观点,既符合中医传统理论的思辨性特点,又具有丰富的临床实践经验和科学的临床研究证据的支持,对指导多变的流行性感冒的临床辨证论治具有较好的现实意义.

目的 了解北京协和医院中医门诊初诊患者失眠的发生率及对失眠的认知状况.方法 采用问卷形式,根据阿森斯失眠量表及自拟《中医科门诊患者睡眠状况调查表》进行临床横断面调查.结果 327例初诊患者中126例(38.5%)存在失眠问题,主动报告率为31.7%,阿森斯失眠量表评分及睡眠质量自评分是影响主动报告率的主要因素(P<0.05).结论 失眠在中医门诊初诊患者中具有较高的发生率,但主动报告率低.说明在日常门诊工作中,能主动认识到睡眠问题并寻求治疗者不足,更多的患者可能会因为各种原因忽略睡眠问题.因此,在日常门诊工作中,应该主动询问患者的睡眠情况,以免漏诊.

“咽痒咳嗽”是目前临床常见的一种咳嗽类型，突出特点为咳嗽因痒而发，咳必咽痒，先痒后咳，咳后痒减。因其发作机制、临床表现、治疗用药均有别于传统的急慢性咳嗽，目前学界尚无统一的诊断标准。在中医传统理论中，风咳符合该病的特征，风药具有的抗炎、抗变态反应作用，切中该病的发作机制--炎症导致咽(喉)部黏膜受损、感觉神经末梢暴露、局部敏感性增强、炎性介质刺激、诱发咳嗽，因而能取得良好的止痒、止咳效果。说明从风论治咽痒咳嗽不仅符合中医传统理论，也同时具有现代医学的依据。

目的 观察祛风胜湿方对变应性鼻炎小鼠血清免疫球蛋白E(IgE)及水通道蛋白5(AQP5)的影响.方法 以卵清蛋白(OVA)+氢氧化铝基础致敏、局部以OVA激发复制变应性鼻炎小鼠模型,将其分为正常对照组、模型组、祛风胜湿方组、氯雷他定组.灌胃给药14天,观察各组对变应性鼻炎小鼠血清IgE、AQP5及鼻黏膜组织病理形态学的影响.结果 与正常对照组比较,模型组小鼠血清IgE及AQP5均显著增高(P＜0.05);与模型组比较,各药物干预组的上述指标均显著降低(P＜0.05).结论 祛风胜湿方作用机制可能与其抑制IgE及AQP5表达有关.本实验为揭示中医“风能胜湿”与“祛风止痒”理论提供了实验数据支持.

To investigate the influence of continuous cropping on the yield and quality of Salvia miltiorrhiza and the action of ferti-lization.In this paper,different kinds of fertilizers were applied to sequential cropping land and the contents of active ingredients, yield of Salvia,and antioxidant activity were investigated.The results showed that continuous cropping reduced Salvia yield by 21 . 78% and decreased antioxidant activity significantly,but have little effect on contents of active ingredients.Using microbial fertil-izer increased yield by 21 .67% and improved antioxidant activity significantly,while has no impact on contents of active ingredi-ent.Continuous cropping reduce production and antioxidant activity,but have no effect on contents of active ingredients.Fertiliza-tion has a certain effect on reducing continuous cropping obstacle to some extend.

一天，诊室里来了一位中年女性，主诉干咳8个月。夜间平卧时为甚，咽痒且干，无发热、咽痛、胸痛及哮喘；口干，纳食可，无食物返流，大便干，日1次；夜寐可。曾在外院拍胸片、查血常规未见明显异常。在多家医院就诊，有诊断咽炎的、支气管炎的、慢性咳嗽的，但中西药治疗效果都不明显。曾在外院服中药效果不理想。经人介绍来到我的门诊。体查舌红偏暗，苔薄黄，脉弦。

咽痒咳嗽以咽痒与咳嗽并发、因痒而咳、咳停痒止为特征，与临床按病程划分的急、慢性咳嗽不同，其病程长短不一，很难按现行标准归类。北京协和医院中医科张晓阳副主任医师为我国已故著名中医学家、温病大师赵绍琴教授的亲传弟子，擅长治疗外感热病、慢性肾脏疾病、糖尿病、妇科疾病、变应性鼻炎、过敏性疾病等，在风病理论研究方面基础深厚，尤其擅长使用风药治疗多种疑难病。笔者有幸侍诊聆教，受益良多。现将张师治疗咽痒咳嗽的经验介绍如下。

The study is aimed to investigate the effect of plant growth regulators on yield and quality of the Salvia miltiorrhiza. The plant growth regulators was spraying on Salvia plants in July or August in field experiment, then the yield, ingredient content and the antioxidant activity were determined. The results showed that plant growth regulator 'Zhuanggenling' could increase the yield of Salvia with root-planting by 38.45%. Plant growth regulator 'Duoxiaozuo' could increase the yield of Salvia with seedling planting by 14.19%. Both plant growth regulator significantly reduced the antioxidant activity of Salvia in vitro, but they had no significant effect on active ingredient contents.

心房颤动(AF)是老年人最常见的心律失常之一[1],国内外研究表明60～ 80岁AF患病率为1.3％～15％,且高血压是老年人AF的主要病因之一[2-4].Hylek等[5]研究显示老年人AF并发脑卒中的病死率达到24％,且存活的患者多遗留有身体残疾.已有研究显示AF的发生与心房重构有关,然而心房重构的发生与炎症反应以及肾素血管紧张素醛固酮系统(RAAS)有着非常密切联系[6].本研究旨在通过观察替米沙坦对老年高血压伴阵发性AF患者左心房内径(LAD)、血清超敏C反应蛋白(hs-CRP)及AF复发影响,以探讨其预防老年高血压患者AF的可能机制.

目的:探讨RNA干扰抑制整合素连接激酶（integrin-linked kinase,ILK）对人视网膜色素上皮（human retinal pigment epithelium,hRPE）细胞增殖和迁移的影响。方法:体外培养hRPE细胞,设计并合成特异性人ILK的RNA干扰片段,阳离子脂质体转染入人视网膜色素上皮细胞,利用RT-PCR及Western blot半定量检测siRNA对ILK基因及蛋白表达的抑制作用,MTT方法检测转染前后siRNA对细胞增殖的抑制作用。损伤愈合实验和Transwell实验观察人视网膜色素上皮细胞迁移能力的改变。结果:培养的hRPE细胞存在ILK的基因转录表达,siRNA显著抑制hRPE细胞ILK的mRNA和蛋白表达（P＜0.01）。MTT、损伤愈合实验和Transwell实验提示转染ILK-siRNA后人视网膜色素上皮细胞的增殖、迁移能力有明显下降,与正常对照组相比有统计学差异（P＜0.05）。结论:特异性ILK-siRNA能有效抑制ILK在hRPE的mRNA和蛋白的表达并显著降低hRPE的增殖和迁移能力。