Objective To observe the clinical effect of acupoint application of Xiaoying Sanjie Prescription on benign thyroid nodules with the syndrome of qi stagnation and phlegm obstruction.Methods Eighty patients with benign thyroid nodules（syndrome of qi stagnation and phlegm obstruction）treated in the Department of Endocrinology of Dongfang Hospital Affiliated to Beijing University of Chinese Medicine from May 2019 to April 2021 were randomly assigned into a control group（n=40）and an observation group（n=40）according to the random number table method.The control group was treated with Xiaojin Tablets, and the observation group with Xiaojin Tablets combined with acupoint application of Xiaoying Sanjie Prescription（4 times a week, 4 h each time）.After 3 months of treatment, the clinical efficacy was compared between the two groups.The TCM syndrome score, thyroid maximum nodule diameter, thyroid function indicators[free triiodothyronine（FT3）,free thyroxine（FT4）,and thyroid-stimulating hormone（TSH）],and safety indicators such as blood routine, liver function, renal function, urine routine, and electrocardiogram were compared between before and after treatment as well as between the two groups.Results The total effective rate in the observation group was 73.5%（25/34）,which was higher than that（57.8%,22/38）of the control group（P＜0.05）.The treatment in both groups decreased the TCM syndrome score and thyroid maximum nodule diameter（P＜0.05）,and the observation group had lower TCM syndrome score and thyroid maximum nodule diameter than the control group（P＜0.05）.The FT3,FT4,and TSH levels showed no significant differences between the two groups as well as between before and after treatment（P＞0.05）.The incidence of adverse reactions had no significant difference between the two groups（P＞0.05）.Conclusion The acupoint application of Xiaoying Sanjie Prescription can significantly alleviate the clinical symptoms of patients with benign thyroid nodules（syndrome of qi stagnation and phlegm obstruction）and reduce the maximum diameter of nodules without compromising the thyroid function of patients and has high safety.Therefore, this therapy is worthy of clinical application.

腠理是《内经》提出的一个重要概念,目前对其具体部位、属性及治疗的研究仍存在不足.笔者通过研究认为腠理在部位上当属半表,为气血津液升降出入的通路,并与在里的脏腑关系密切,在人体气血虚弱或有基础病时,病邪可直接从腠理传入脏腑,引起较重的病证.在治疗上,腠理病一般从气血津液论治,不可滥用发表之药.此外,由于腠理部位及作用的特殊性,可为临床疾病预防方面提供思路.

过逸首先影响气机运行,气机的异常会进一步引起湿、热、食等的郁滞.此外,气滞血液运行缓慢而成瘀,《内经》提出"逸者行之",即用"行"的方法改善体内的各种瘀滞状态.笔者通过研究发现,糖尿病存在气机郁滞、气血瘀滞的病机.糖尿病的高血糖状态以及并发症的发生与血瘀关系密切."行"即调达气机,调畅气血,改善瘀滞.笔者结合通过研究总结"行法"的含义及其在糖尿病中的应用,具体治法包括、解诸郁,消滞气、升提气机、补益脾肾、调节情志、化瘀通络、推陈出新、补气活血、防治并发症等.

Objective. Microinflammation plays a crucial role in podocyte dysfunction in diabetic nephropathy, but its regulatory mechanism is still unclear. This study is aimed at discussing the mechanisms underlying the effect of miRNA-155 on podocyte injury to determine its potential as a therapeutic target. Methods. Cultured immortalized mouse podocytes and diabetic KK-Ay mice models were treated with a miR-155 inhibitor. Western blotting, real-time PCR, ELISA, immunofluorescence, and Luciferase reporter assay were used to analyze markers of inflammation cytokines and podocyte injury. Results. miRNA-155 was found to be highly expressed in serum and kidney tissue of mice with diabetic nephropathy and in cultured podocytes, accompanied by elevated levels of inflammatory factors. Inhibition of miRNA-155 can reduce proteinuria and ACR levels, diminish the secretion of inflammatory molecules, improve kidney function, inhibit podocyte foot fusion, and reverse renal pathological changes in diabetic nephropathy mice. Overexpression of miRNA-155 in vitro can increase inflammatory molecule production in podocytes and aggravates podocyte injury, while miRNA-155 inhibition suppresses inflammatory molecule production in podocytes and reduces podocyte injury. A luciferase assay confirmed that miRNA-155 could selectively bind to 3 ′ -UTR of SIRT1, resulting in decreased SIRT1 expression. In addition, SIRT1 siRNA could offset SIRT1 upregulation and enhance inflammatory factor secretion in podocytes, induced by the miRNA-155 inhibitor. Conclusions. These findings strongly support the hypothesis that miRNA-155 inhibits podocyte inflammation and reduces podocyte injury through SIRT1 silencing. miRNA-155 suppression therapy may be useful for the management of diabetic nephropathy.

《伤寒论》云:"但见一证便是,不必悉具".此处"证"指患者的症状体征.有医家认为,《伤寒论》内容精炼,所提及的每一个症状都可能是对其相应病机的提示."身重"在《伤寒论》中多次出现,本文以"身重"为出发点,分析其病因病机,可知其核心病机为一虚一实,虚者为阳气或津液绝对或相对不足,肢体筋肉失于温养,实者为水湿或者气机壅滞.而由于其病因和病理因素的不同,具体可分为十种证型,分别为:温病初起,风热伤及卫气、伤寒误下致津液损伤、表阳被郁而水湿壅滞经表、阳气不荣于外兼少阳枢机不利、阳亢阴伤之腰以上重痹、阳明胃腑积滞、三阳合病致经气壅滞、邪滞阳明经腑之间、少阴阳虚水泛和真气亏损.

AIMS:Diabetic kidney disease (DKD) is a major prevalent chronic microvascular complication of type 2 diabetes (T2D). However, the present diagnostic indicators have limitations in the early diagnosis of DKD. This study concentrated on the sensitive and specific biomarkers in early diagnosis of DKD by metabolomics.MATERIALS AND METHODS:In this cross-sectional study, we performed a UPLC-MS based nontargeted metabolomics assay to profile the urinary metabolites in patients with DKD. Principal Component Analysis (PCA) and orthogonal partial least square discriminant analysis (OPLS-DA) were used for screening out the metabolomic variables.KEY FINDINGS:A total of 147 urinary metabolites were identified and 5 metabolic pathways were correlated with DKD pathophysiology. Pantothenate and coenzyme A biosynthesis pathway alteration was found the most prominent in DKD subjects. 4 metabolites, including dihydrouracil, ureidopropionic acid, pantothenic acid (PA), and adenosine 3',5'-diphosphate involved in pantothenate and CoA biosynthesis were significantly down-regulated.SIGNIFICANCE:Our finding indicates that PA would be served as a novel predictive biomarker associated with DKD development and progression. Furthermore, our results provide a promising prospect that PA and CoA biosynthesis pathway can be potential therapeutic targets for DKD treatment.

目的:评价针灸治疗肝肾亏虚、痰瘀阻络型糖尿病周围神经病变(DPN)的临床疗效.方法:将100例患者随机分为观察组、对照组,每组50例,给予2组糖尿病基础治疗.观察组同时给予针灸治疗,每天治疗1次,每周治疗5天,休息2天,共治疗4周.对照组口服弥可保片,500μg/次,3次/d,服药4周.观察2组治疗前后密歇根糖尿病神经病变积分(MDNS)、双侧胫神经的感觉神经传导速度(SNCV)和运动神经传导速度(MNCV).结果:总有效率观察组为74.0％,对照组为62.0％,2组比较差异有统计学意义(P<0.05).空腹血糖(FBG)、餐后2小时血糖(2 h PBG)治疗前后2组组内比较,差异有统计学意义(P<0.05);治疗后组间比较差异也有统计学意义(P<0.05).MDNS积分及双侧胫神经运动神经传导速度、感觉神经传导速度治疗前后2组组内比较,差异有统计学意义(P<0.05);治疗后组间比较差异也有统计学意义(P<0.05).结论:针灸治疗DPN疗效确切,能明显改善DPN患者症状,提高下肢胫神经传导速度,疗效优于西药弥可保.

目的:客观评价穴位埋线法治疗气阴两虚、血瘀脉络证糖尿病周围神经病变(DPN)的临床疗效.方法:收治DPN患者120例,随机分为穴位埋线组和普通针刺组各60例,两组均进行糖尿病基础治疗.治疗组选取胰俞、气海、足三里、阳陵泉、太溪、太冲、三阴交、丰隆、曲池、外关等穴位埋线,对照组选取与治疗组相同的穴位进行普通针刺治疗.观察两组患者治疗前后密歇根糖尿病神经病变计分(MDNS)、双侧胫神经的感觉神经传导速度(SNCV)和运动神经传导速度(MNCV).结果:治疗后两组MDNS积分均较前降低(P<0.05),且治疗组MDNS积分降低幅度优于对照组(P<0.05),两组治疗后SNCV、MNCV均较治疗前提高(P<0.05).治疗后两组对比,治疗组SNCV和MNCV均优于普通针刺组(P<0.05).穴位埋线治疗组的总有效率优于普通针刺组(P<0.05).结论:穴位埋线与普通针刺对DPN的治疗均有疗效,相较于普通针刺方法,穴位埋线治疗DPN疗效确切,作用的持续时间长、不良反应少,补充了普通针刺穴位治疗作用时间短、依从性差的不足,适合DPN的临床治疗,值得推广.

Objective: To evaluate the clinical efficacy of the Baduanjin exercise prescription on type 2 diabetes with qi and yin deficiency syndrome, and to explore its mechanism. Methods: Randomized method is used in this clinical trial, patients who met the diagnostic criteria of type 2 diabetes mellitus, syndrome of deficiency of qi and yin syndrome were randomly divided into treatment group (the Baduanjin exercise prescription group) and control group (walking exercise group), each group was given corresponding treatment. The main observation index are HOMA-β and HOMA-IR index, fasting and postprandial blood glucose and glycated hemoglobin, TCM syndrome integral, blood lipid levels as a secondary index. The course of treatment was 12 weeks. Results: After treatment, in the treatment group, the HOMA-β increased, the HOMA-IR decreased, fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1C) decreased, which was significantly better than that in the control group (P<0.01). The total effective rate of the treatment group was 92.31％, which was better than that of the control group (76.92％, P<0.05). The scores of TCM syndromes and triglycerides were significantly lower than that of the control group (P<0.01). Conclusion: The Baduanjin exercise prescription can reduce the levels of FBG, HbA1C and triglyceride in type 2 diabetes mellitus, thereby improving the function of islet beta cells in type 2 diabetes mellitus.

目的评价蒙药珍宝丸干预糖尿病周围神经病变(DPN)痰瘀互阻证的临床疗效.方法将120例DPN患者随机分为治疗组和对照组各60例,两组患者均进行糖尿病基础治疗,包括饮食控制、运动治疗、药物控制血糖及对症治疗.治疗组口服珍宝丸,每次3.0g,每日2次,对照组口服硫辛酸胶囊,每次0.6g,每日.1次,两组疗程均为24周.观察两组患者治疗前后中医证候积分、密歇根糖尿病神经病变积分(MDNS)、双侧正中神经和腓总神经的感觉神经传导速度(SNCV)和运动神经传导速度(MNCV)以及血糖、血脂水平. 结果 与本组治疗前比较,治疗后两组中医证候积分、MDNS积分均明显降低(P＜0.05),且治疗组中医证候积分、MDNS积分显著低于对照组(P＜0.05).与本组治疗前比较,治疗组正中神经、腓总神经MNCV和SNCV明显提高(P＜0.05),与对照组治疗后比较,治疗组正中神经、腓总神经MNCV和SNCV明显提高(P＜0.05).两组治疗前后及治疗后血糖、血脂水平比较差异均无统计学意义(P＞0.05). 结论 蒙药珍宝丸能明显改善DPN患者症状,提高正中神经和腓总神经神经的传导速度.

问:皮外伤用土办法处理正确吗? 答:往伤口上撒泥土、香灰等土办法,医学上是绝对不建议的.泥土、香灰这些物质有很多细菌,涂在伤口上,很容易造成进一步感染.尤其是那些体质不好的、免疫力低下的老人、孩子,容易造成局部化脓性感染,甚至菌血症.泥土中含有一种叫氯化钙的物质,容易引起人体组织坏死,利于厌氧菌繁殖.

Tang-luo-ning (TLN) is a traditional Chinese herbal recipe for treating diabetic peripheral neuropathy (DPN). In this study, we investigated mitochondrial protein profiles in a diabetic rat model and explored the potential protective effect of TLN. Diabetic rats were established by injection of streptozocin (STZ) and divided into model, alpha lipoic acid (ALA), and TLN groups. Mitochondrial proteins were isolated from dorsal root ganglia and proteomic analysis was used to quantify the differentially expressed proteins. Tang-luo-ning mitigated STZ-induced diabetic symptoms and blood glucose level, including response time to cold or hot stimulation and nerve conductive velocity. As compared to the normal, there were 388 differentially expressed proteins in the TLN group, 445 in ALA group, and 451 in model group. As compared to the model group, there were 275 differential proteins in TLN group and 251 in ALA group. As compared to model group, mitochondrial complex III was significantly decreased, while glutathione peroxidase and peroxidase were increased in TLN group. When compared with ALA group, the mitochondrial complex III was increased, and mitochondrial complex IV was decreased in TLN group. Together, TLN should have a strong antioxidative activity, which appears to be modulated through regulation of respiratory complexes and antioxidases.

目的 观察糖络宁对糖尿病大鼠背根神经节线粒体DNA、8-羟基脱氧鸟苷(8-OHdG)及线粒体结构的影响.方法 选取14只SD大鼠作为正常组,其余SD大鼠采用链脲佐菌素制作糖尿病大鼠模型,造模成功后,将其随机分为模型组、西药组(α-硫辛酸)、中药组(糖络宁),共给药8周,给药结束后,检测线粒体DNA水平、8-OHdG水平,并运用电镜观察线粒体内部结构.结果 与正常组比较,模型组大鼠神经细胞线粒体DNA、8-OHdG水平明显增加(P＜0.01);与模型组比较,中药组与西药组神经细胞线粒体DNA、8-OHdG水平明显降低(P＜0.01).与正常组比较,模型组大鼠DRG线粒体肿胀明显,内部结构破坏严重,线粒体内特异结构嵴消失;而中药组大鼠DRG线粒体结构相对完整,线粒体嵴保存完好;西药组大鼠DRG线粒体也存在轻度肿胀,内部结构不完整,嵴显示不清楚.结论 糖尿病大鼠神经细胞中线粒体会发生明显改变,其内部结构严重破坏,DNA表达过度升高,DNA的氧化损伤也非常明显.糖络宁可明显减低线粒体DNA表达,减少氧化损伤,缓解线粒体结构的破坏,这是糖络宁治疗糖尿病周围神经病变的机制之一.

目的：探讨糖痹康对糖尿病周围神经病变大鼠细胞凋亡Drp1信号通路的作用机制。方法：使用60只高脂饲料喂养后小剂量链脲佐菌素（STZ）腹腔注射而诱发的2型糖尿病大鼠动物模型，8周造模成功后按体重随机分为模型组、α‐硫辛酸组、糖痹康低、中、高剂量组，另外单独设10只大鼠为正常组，模型组和正常组予蒸馏水灌胃，糖痹康组和α‐硫辛酸组分别予不同剂量糖痹康和α‐硫辛酸灌胃，每4周测一次体重、空腹血糖，16周后取大鼠一侧坐骨神经，采用实时荧光定量PCR法检测大鼠坐骨神经Drp‐1、Bax和Bcl‐2mRNA表达水平。结果：与正常组比较，模型组和各治疗组Drp‐1的表达水平明显升高，Bax表达显著增加，Bcl‐2表达显著减少；糖痹康高剂量组Drp‐1的表达水平比α‐硫辛酸组更低，Bax表达也更减少，而Bcl‐2表达则明显增加。结论：糖痹康可以抑制Drp1的表达水平，促进抗凋亡基因Bcl‐2的表达而抑制促凋亡基因Bax表达，从而具有抗Drp‐1信号通路的细胞凋亡作用，缓解DPN的进展。

Objective To observe the effects of Chinese herba1 compound Tangbikang on ROS, MDA, SOD, caspas-3, sciatic nerve ce11 apoptosis in rats with diabetic periphera1 neuropathy, and to exp1ore its neuroprotective mechanism against oxidative stress and apoptosis. Methods 60 high fat forage and sma11 dose of streptozotocin intraperitonea1 injection induced anima1 mode1s of type 2 diabetic rats, after 8 weeks, were random1y divided into mode1 group, a1pha 1ipoic acid group, Tangbikang 1ow, medium and <br> high dose groups according to body weight. Another 10 norma1 rats were set as norma1 group. Rats in mode1 group and norma1 group were given disti11ed water, whi1e Tangbikang groups and a1pha 1ipoic acid group were treated with different doses of Tangbikang and a1pha 1ipoic acid by gastric perfusion. Body weight and fasting b1ood g1ucose were measured every 4 weeks, one side of sciatic nerve of rats was taken out after 16 weeks, to detect ROS ( co1orimetric method﹚, MDA ( thiobarbituric acid method﹚, SOD( Xanthine oxidase method﹚. Enzyme-1inked immune adsorption method was used to detect the caspas-3 protein expression and TUNEL method to detect apoptosis. Results Compared with the norma1 group, SOD 1eve1 was significant1y decreased, MDA, ROS 1eve1s were significant1y increased, the expression 1eve1 of Caspase-3 protein was significant1y increased, and TUNEL positive ce11s increased significant1y in the other groups. Compared with the mode1 group, in the a1pha 1ipoic acid group and Tangbikang high dose group, ROS, MDA 1eve1s were significant1y decreased, SOD content increased obvious1y ( P<0. 05﹚, with no statistica1 significance between the two groups. TUNEL detection of a1pha 1ipoic acid group and Tangbikang high dose group compared with mode1 group, the number of positive ce11s decreased (P<0. 05﹚. Comparison of Tangbikang high dose group and a1pha 1ipoic acid group, the number of positive ce11s was s1ight1y more than a1pha 1ipoic acid group (P<0. 05﹚. Expression of protein Caspase-3 in a1pha 1ipoic acid group and Tangbikang high dose group in sciatic nerve tissue was significant1y 1ess than in the mode1 group (P<0. 05﹚, but there was no significant difference between the two groups ( P>0. 05﹚. Conclusion The Chinese herba1 compound Tangbikang can re1ieve the oxidative stress injury of diabetic periphera1 neuropathy, reduce the apoptosis of nerve ce11s, and de1ay the deve1opment of DPN by improving SOD 1eve1 and removing overabundant MDA, ROS.

慢性高血糖是2型糖尿病的主要特点,也是引起2型糖尿病并发症的核心因素.文章以高血糖为切入点,推断肝肾阴虚、糖毒内蕴是2型糖尿病的核心病机,因此自拟滋阴解毒降糖方来滋补肝肾之阴、清热解毒降糖治疗2型糖尿病,临证应用可有效降低血糖,改善症状.

Objective To observe the effect of Chinese herbal compound Tangluoning on 3 kinds of antioxidants mi-tochondrial dorsal root ganglion cells in diabetic rats. Methods There were 40 SD male rats, 7 of them were randomly select-ed as the control group, the rest 33 were used to establish the streptozotocin ( STZ) diabetic rat model, 29 rats of the model were randomly divided into model group with 9 rats, treatment group with 10 rats, Chinese medicine group with 10 rats, they were given saline, alpha lipoic acid and Tangluoning respectively, they was given the medicine for 8 weeks, mitochondria of rat manganese superoxide dismutase ( MnSOD) , glutathione peroxidase ( GPX) , catalase ( CAT) activity changes of the dor-sal root ganglion cells were observed. Results Compared with the control group, the model group rats’ mitochondrial Mn-SOD, GPX, the activity of CAT (U/mg protein) decreased significantly (32. 16 ± 4. 75 vs. 20. 17 ± 3. 31, 45. 67 ± 5. 64 vs. 30. 19 ± 4. 33, 2. 87 ± 0. 47 vs. 1. 24 ± 0. 34, P <0. 01);compared with the model group, treatment group and the tradition-al hinese medicine group’ s mitochondrial MnSOD, GPX, the activity of CAT were significantly improved (30. 78 ± 5. 27, 39. 10 ± 7. 67, 2. 56 ± 0. 31, 29. 14 ± 3. 79, 39. 43 ± 6. 23, 2. 49 ± 0. 28, respectively, P <0. 01). Conclusion It proved that the Tangluoning would significantly improve the 3 kinds of antioxidant activity in dorsal root ganglion mitochondria of dia-betic rats, which maybe the mechanism of Tangluoning for prevention and treatment of diabetic peripheral neuropathy.

目的:观察温肾健脾,化瘀通络法对糖尿病肾病(DN)临床期的疗效.方法:将符合标准的DN患者50例,随机分为治疗组(25例)和对照组(25例),两组均予饮食控制、降糖等基础治疗,同时口服福辛普利10 mg,每日1次;治疗组在此基础上予以温肾健脾,化瘀通络的中药,疗程为12周.对患者的24 h尿蛋白(UP)定量,血肌酐(SCr),内生肌酐清除率(CCr),中医证候疗效等进行评价.结果:治疗组总有效率为80.0％,对照组总有效率为56.0％.治疗组明显优于对照组(P＜0.05).两组治疗后24 h尿蛋白定量均明显降低(P＜0.05),组间比较,治疗组在降低24 h尿蛋白定量方面明显优于对照组(P＜0.05);治疗组治疗后SCr显著降低(P＜0.05),CCr显著升高(P＜0.05);治疗组在改善肾功能方面明显优于对照组(P＜0.05).结论:温肾健脾,化瘀通络法能够有效的缓解和治疗临床期糖尿病肾病.

患者女，65岁，主因间断口干、多饮、多尿3年，加重伴双下肢末端麻木6个月于2013年3月14日收入院。患者3年前体检时发现血糖高，先后口服阿卡波糖片、二甲双胍片降糖治疗，血糖控制不佳。1年前于我院在原方案的基础上加用胰岛素优泌林N（8 U）降糖治疗，目前血糖控制较差。6个月前出现双下肢末端麻木。既往体健，无药物及食物过敏史。入院诊断：2型糖尿病，糖尿病周围神经病变。入院后给予调整降糖方案，予硫辛酸注射液（丹沅，烟台只梦药业有限公司，批号：130102-23，规格：0．15g／支）0．6g 加入0．9％氯化钠注射液250 m L静脉滴注以抗氧化应激，1次／d；肌肉注射腺苷胺以营养神经对症治疗。2013年4月15日早9：00硫辛酸注射液按照说明书以最大速度每分钟50 m g滴速滴注，约30 s后患者即出现面目发红、胸痛、胸憋等症状，给予暂停硫辛酸注射液后上述症状约5 min逐渐消失，当时行心电图检查示：窦性心律，大致正常心电图；血压：120／80 m m H g （1 mmHg＝0．133 kPa）；呼吸20次／min ，心率80次／min ，此时患者未静脉滴注其他液体，故考虑此反应可能与滴注硫辛酸注射液的不良反应有关。

Diabetic peripheral neuropathy(DPN) is the most common chronic complication of diabetes, the incidence rate is as high as 60%. The latest foreign diagnostic criteria of DPN is made by the Toronto diabetic neuropathy experts group in 2010, and domestic diagnostic criteria has not been formally introduced, but a variety of scoring criteria are used for the evaluation of diabetic peripheral neuropathy. The ways of western medicine in treating DPN include the general blood glucose control, treatment for pathogenesis and the symptomatic treatment. The methods of Chinese medicine in treating DPN include the syndrome differentiation with traditional Chinese medicine, external treatment and acupuncture treatment, etc.