2019 年底暴发传染性极强的新型冠状病毒肺炎(简称新冠肺炎),对中国人民的生命和财产安全、家庭幸福造成巨大危害.据国家卫健委公布数据,截止2020 年4 月 1 日,累积确诊新冠肺炎患者达 82691名,累积治愈患者 76436 名,新增患者逐渐清零,突显了中西医结合防治举措的成效.但是,现存确诊仍有2934 名,据报道[1]发展到危重阶段的患者死亡率高达49％,救治工作仍旧刻不容缓.

2019年底突发的"不明原因肺炎"对武汉市、湖北省乃至全国人民而言是一场巨大的灾难,目前已经确定这是由新型冠状病毒感染导致呼吸系统及多器官功能衰竭的急性传染性疾病[1 ].

近代名医张锡纯,学验俱丰,善治阴虚,创制了别具一体的以食代药之粥、饮、饼等剂型,大大丰富了临床治疗手段. 以食代药,张氏于粥剂体验最深.谓早年“岁试津门”,患泄泻不适,服药无效,用“白粳米煮烂熟作粥”服之,泄泻遂愈.可证其初习医时,亦深谙以食代药之理.

[目的]研究温脾汤治疗单纯性动力不全性肠梗阻的临床疗效.[方法]58例单纯性动力不全性肠梗阻患者分为两组,对照组、治疗组均给予西医胃肠减压、补液、纠正酸碱平衡失调、抗感染、灌肠等保守治疗,治疗组在此基础上加用中药温脾汤治疗.[结果]治疗组的有效率为96.88%,对照组的有效率为34.62%,两组疗效差异有统计学意义(P<0.01).[结论]温脾汤治疗单纯性动力不全性肠梗阻能收到较满意的治疗效果,值得推广.

萎缩性胃炎与幽门螺杆菌(Hp)感染、免疫等因素有关,至今尚无特效药物,有关研究表明,与多个基因的调节有关[1],药物开发困难.有报道认为中医药对于萎缩性胃炎有效,但是辨证分型方案各不相同,治疗方法原则也不相同,效果不一.

[目的]分析56例肝源性溃疡的临床特点。[方法]以56例确诊为肝硬化门脉高压性胃病的腹痛、腹胀、反酸、嗳气、黄疸、脾大等为主要指标,结合胃镜诊断及溃疡灶分布特点进行分析。[结果]门脉高压性胃病好发于中老年人,溃疡以胃溃疡及复合性溃疡为主;临床症状以腹胀、腹痛为多见,易被肝硬化的症状掩盖。[结论]急诊胃镜检查有利于病因诊断,能鉴别出血原因,并能在胃镜下及时止血。在制酸、保护胃黏膜的基础上合用小剂量心得安有利于溃疡灶的愈合。

[Objective]To investigate the clinical characteristics of non-steroidal anti-inflammatory drugs(NSAIDs) related gastric and duodenal ulcer.[Methods] Clinical data of patients from Jan.2001 to Jan.2006 were collected.One hundred and thirty-eight patients were divided into two groups(A and B) according to the history of taking NSAIDs in one week before endoscopy.The symptoms and biopsy results between two groups were compared.[Results] There were forty-one patients with the history of taking NSAIDs(group A) and ninety-seven patients without the above history(group B).The average age in group A was 56.2 ys and patients' age older than 60 ys held 39.1 %,while those in group B were 41.6 ys and 12.4 % respectively,which had significant difference with group A(P0.05).Patients with fullness,heartbum and nausea in group A were more than group B,while those with abdominal pain in group B were more than group A(P0.05).The morbidity of gastric ulcer(GU) in group A was 80.5%(multiple 24.4 %) and duodenal ulcer(DU) was19.5 %(multiple 4.9 %),while those in group B was 48.5%(multiple 12.4%) and 51.5%(multiple 11.3%).Meanwhile,the percentage of active ulcer in group A was 63.4% and the ulcer with the diameter smaller than one centimeter was 80.5%,while those in group B was 42.3% and 62.9%,which had significant difference with group A(P0.01).Helicobacter pylori(Hp) positive rate in group B was obviously higher(81.3%) than that of group A(63.4%)(P0.05).[Conclusion] Physicians should be cautious to NSAIDs related peptic ulcer and strengthen the medical guidance of patients taking NSAIDs.More attention should be paid to prevent and reduce the side effect of NSAIDs.

[Objective]To study the mechanism of the prescription of strengthening spleen and replenishing Qi on promoting renovation of stomach mucosa and to observe the changes of mucosa epidermal growth factor receptor(EGFR) and the level of sera nitric oxide.[Methods] The rat model of gastric ulcer was induced by acetic acid.EGFR was revealed by immunohistochemical method(SABC),then the EGFRimage was analysed.Sera level of NO_3~-/NO_2~-was measured by the method of deacidizing and colour matching with copperized cadmium.[Results] The expression of mucosa EGFR in the model group increased compare with the control group(P(0.01),) and that in the Chinese medicine group increased more than that in the model group(P(0.01).)Sera level of NO_3~-/NO_2~-of model group was lower than that of control group(P0.01) and Chinese medicine group(P0.01).[Conclusion]Chinese medical prescription of strengthening spleen and replenishing Qi can promote renovation of stomach mucosa via EGFR and NO.

Objective To study the effect of Chinese herbal medicine Jianpi Yiqi granules on HSP 70 expression in patients with different pathological grades of chronic atrophic gastritis and its mechanism.Methods Pathological changes of chronic atrophic gastritis were graded, and HSP 70 expression was analyzed by enzyme-linked immunoadsorbent assay(ELISA).Results Before treatment,the contents of HSP 70in patients with mild and moderate chronic atrophic gastritis were significantly higher than that in control group (P0.05), but not so in patients with severe gastritis (P0.05).After treatment,the contents of HSP 70 were significantly higher groups in mild and moderate gastritis group (P0.01),and severe gastritis group (P0.05) than before treatment.Conclusions There were significant differences in levels of HSP 70 expression between patients with mild and moderate atrophic gastritis and patients with severe atrothic gastrits,which influences the therapeutic effect on such patients.The efficacy of Chinese herbal medicine Jianpi Yiqi granules may be related to promotion of HSP 70 expression.

[Objective]To compare the difference of IL1 and TNF-α among the groups of gastric,liver and colon carcinoma,and observe the changes of these two kinds of cytokines before and after chemotherapy.[Methods] Serum levels of IL-1 and TNF-α were measured by radio immunoassay(RIA) in 11 patients with gastric carcinoma,15 with liver carcinoma and 12 with colon carcinoma before and after chemotherapy respectively.The detailed procedures were operated according to the directions of related kit strictly.[Results] The expression of IL-1 and TNF-α in the patients with gastric carcinoma and liver carcinoma was 4 times higher than that of normal and the expression of patients with colon carcinoma was 2 times higher than that of normal respectively.There was statistical difference between the group of colon carcinoma and groups of gastric and liver carcinoma(P0.05). The expression of IL-1 and TNF-α was decreased remarkably after chemotherapy in the gastric carcinoma and liver carcinoma(P0.05).The IL-1 and TNFα was decreased after chemotherapy in the group of colon carcinoma,but there was no statistical difference.There was no statistical difference among these three groups either(P0.05).[Conclusion]The expression of IL-1 and TNF-α was associated with the level of inflammation mainly.The differences of inflammatory responses in different hosts consisted in the disparate promoter of inflammation,and colon carcinoma was related with the background and genetic gene of host.

Objective] To investigate the long-term effect of Helicobacter pyolri (Hp) on mucosal inflammation and intestinal metaplasia (IM) in Hp infected and none Hp infected gastritis.[Methods] HP infected gastritis (86 cases, as group A) and none HP infected gastritis (92 cases, as group B) were diagnosed by gastroscopy. Hp positive/negative transition, mucosal inflammation degree, IM rate and IM degree of the two groups were observed before and after the five-year-period trail.[Results] After five years, 61 cases were Hp positive (70.9%) and 25 cases Hp negative (29.1%) in group A. For the Hp positive cases in the both groups, inflammation degree mark before and after the trail showed no significant difference. For the Hp negative in group B and Hp positive in group A, there was no significant difference before and after the trail. Five years later, comparison of the inflammation degree mark and IM mark between the Hp negative in group B and Hp positive in group A showed notable difference ( P 0.01).[Conclusion] The longer Hp exists, the more serious the inflammatory degree and the higher IM rate. The inflammatory degree and the IM rate declined in no Hp infected gastritis and Hp negative gastritis after treatment.

Objective To study heat shock protein 70(HSP_(70)) expression in patients with peptic ulcer at different pathological stages and the influence of Helicobacter pylori (HP) on the expression.Methods HP eradication rate was investigated, and HSP_(70) was detected by enzyme linked immunosorbent assay.Results There were no significant differences in levels of HSP_(70) between negative and positive HP (P0.05),eradicated and noneradicated HP(P05),nor between active and healing stages(P0.05),but the levels of HSP_(70) in active and healing stages were significantly higher than that in scarring stage (P0.05).Conclusion There were different levels of HSP_(70) expression in patients with peptic ulcer at different pathological stages.HP might not be a direct factor for regulation and control of HSP_(70).

To investigate the effect of Omeprazole and Chinese herbs on reflux esophagitis(RE). Methods:Thirty patients diagnosed as RE by endoscopy were given Omeprazole 20mg once a day and oral prescription of Chinese herbs. Control group of 28 cases were treated only with Omeprazole 20mg once a day. After treated for 4 weeks, the two groups were checked with endoscopy. Results: Healing rate (by endoscopy) and total effective rate of the group treated with Omeprazole together with Chinese herbs were 60.0% and 96.7%, and those of control group were 50.0% and 78.6% respectively. The difference between the two groups was significant (P0.01), Conclusion: The effect of Omeprazole and Chinese herbs on RE was better than that of simple Omeprazole.

目的观察中药喷雾剂治疗复发性口腔溃疡的临床疗效,并检测治疗前后血清免疫学、肿瘤坏死因子α(TNF-α)、白细胞介素-1(IL-1)水平的变化.方法对34例口腔、舌体溃疡患者将中药喷雾剂用德国产百瑞压缩雾化吸入机喷雾治疗,5 d为一疗程,并与21例对照组进行比较.治疗前后进行血清免疫学检测,采用放射免疫分析法检测TNF-α、IL-1水平变化.结果治疗组总有效率88.3%,对照组为52.4%(P＜0.01).治疗后与治疗前的TNF-α、IL-1比较差异均有显著性意义(均为P＜0.05),治疗组与对照组比较差异有显著性意义(P＜0.01).结论口腔粘膜、舌体溃疡早期TNF-α、IL-1水平均有升高,治疗后随溃疡愈合而下降,但血清免疫学无明显变化.中药喷雾剂具有清泄心、胃之火,清热解毒,消炎止痛,促愈敛疡的作用,且疗效确切,价格低廉,使用方便,无副作用.

Objective: To study the therapeutic effect of spray made from Chinese medical herbs in treating oral ulcer. Methods: Eighty-six patients with oral ulcer were treated with the spray for 5 days at the dose of 5ml for 30 minutes per time, twice a day. White blood cell counts, classifications and serum immunological figures (IgG, IgM, IgA, IgE) were determined before and after the treatment. Results: The total effective rate was 89. 5 %. There was no statistical difference between serum immunological figures before and after treatment ( P 0. 05). Conclusion: Aerosol inhalation made from Chinese medical herbs could clear fire in heart and stomach, eliminate toxin and heat, regenerate tissue and promote healing of the ulcer. It was available to treat oral ulcer and had no side effect.

目的:探讨健脾益气中药对消化性溃疡(PU)患者幽门螺杆菌(HP)清除及热休克蛋白HSP60的影响.方法:临床观察HP清除率,运用斑点印迹技术[1]及免疫组织化学方法检测血清及胃黏膜HSP60.结果:清除率在中药组与三联组之间无明显差异(P＞0.05),HSP60含量在中药组较三联组显著增高(P＜0.01).结论:健脾益气中药对HP有清除作用,这种作用可能与免疫反应相关.

In order to investigate the mechanism of Xiaokuiling prescription (XKL) in the treatment of Helicobacter pylori (HP)-associated duodenal ulcer (DU) and the pathophysiologic role of heat shock proteins (HSPs) in the healing of ulcer, the expression of HSP72 and HSP B in gastric mucosa was detected by using SABC immunohistochemistry method and processed by micro-image analysis system. The method of Western blotting was used to measure the contents of HSP72 and HSP B in the tissue emulsion of gastric mucosa. The results were as follows: (1) HSP72 expression of the gastric mucosa in the treated group was obviously increased as compared with that in the control group (P < 0.05); (2) HSP B expression of the gastric mucosa in the treated group was significantly decreased as compared with that in the control group (P < 0.01). It was suggested that the increased expression of HSP72 and the elimination of HP might be related to the mechanism of action of XKL. HSPs might play an pathological and physiological role in the process of healing of gastric ulcer.

To investigate the effect of Jianpiyiqi prescription on the expression of heat shock proteins (HSPs) and the changes of HSPs in gastric-ulcerated rats, the rat model of chronic gastric ulcer was induced by acetic acid. The SABC immunohistochemical method was used to observe HSP70 of mucosa around the gastric ulcer. Imaging analysis was performed. Western dot blot was used to detect HSPs contents in the plasma and gastric mucosal homogenate in each group. The results showed that HSP70 contents of the mucosa around the gastric ulcer in the model group and ranitidine-treated group were increased as compared with control group (P < 0.01). Jianpiyiqi could increase the expression of HSP70 of the mucosa around the gastric ulcer further as compared with that in the model group and ranitidine-treated group (P < 0.01). The HSP70 contents in the serum and mucosa in the model group and ranitidine-treated group were increased as compared with control group (P < 0.01, P < 0.05 respectively). HSP70 of serum and mucosa in the Jianpiyiqi-treated group was higher than in the model group and ranitidine-treated group (P < 0.05, P < 0.01 respectively). It was concluded that HSP might play a role in the process of pathophysiology of gastric ulcer. Jianpiyiqi could enhance gastric ulcer-healing through the protective mechanism of HSPs.

Objective:To research the mechanism of chinese medical prescription Xiaokuiling on the healing of peptic ulcer.Method:The PGE 2 in plasm and gastric mucoas were measured by RIA; Immunohistochemical SABC kit,micro image analysis and the method of Western dot blot were used to measure HSPs.Results:The curative ratio and total effective ratio,integrated group was superior to Ranitidine group and XKL group(P 0 05 ),whreas ulcer index of integrated group was decreased evidently than those of Ranitidine gorup and XKL group(P 0 01 ).The level of PGE 2 and HSPs, XKL group and integrated group increased markly compared with Ranitidine group(P 0 01 ).Conclusion:The mechanism of XKL on accelerating ulcer healing is probably due to the effect of increased PGE 2 and HSPs.

消化系统多脏腑病变指消化系统二个或二个以上器官同时发生病变，如胃与十二指肠、结肠、肝、胆均同时有不同程度病变。本文就运用中医药疗法诊治消化系统多脏腑病变，探讨如下。