背景  功能性消化不良作为临床常见疾病，其指南及共识众多，但质量参差不齐。目的  了解功能性消化不良的临床指南与共识的现状，评价和分析其质量，为今后的临床决策和指南的修订及完善提供参考。方法  检索中国知网、万方数据知识服务平台、维普网、PubMed、Web of Science、OVID、Embase；同时补充检索国际指南协作网、英国国家卫生与临床优化研究所、苏格兰校际指南网络、美国国立指南库、医脉通、中华医学会等数据库；检索时间限定自建库至 2024-03-30。由经过培训并对条目理解一致的研究者独立使用 AGREE Ⅱ和 RIGHT 工具对纳入指南进行质量评价。结果  共纳入指南及共识 17 篇。AGREE Ⅱ评价结果表明，6 个领域的平均得分依次为范围和目的（71.49%±2.38%）、参与人员（42.48%±5.03%）、严谨性（36.00%±5.88%）、清晰性（60.29%±5.05%）、应用性（20.47%±2.69%）、独立性 50.00%（0，57.29%）；9 篇推荐等级为 B 级，8 篇推荐等级为 C 级，无 A 级文献。RIGHT 评价结果显示 7 大领域的平均报告率分别为基本信息（70.83%±3.03%）、背景（68.02%±2.98%）、证据 15.00%（10.00%，55.00%）、推荐意见（36.76%±3.21%）、评审和质量保证 0（0，6.25%）、资助与利益冲突声明和管理（25.37%±5.18%）及其他方面 16.67%（0，37.50%）。结论  功能性消化不良的临床实践指南及专家共识方法学及报告质量整体有待提升，建议严格按照 AGREE Ⅱ各领域要求及参考 RIGHT 清单撰写指南。

目的 借助网络药理学和分子对接探讨结晶汤治疗小儿膜性肾病活性成分的靶点和作用机制.方法 通过TCMSP、TCM Database@Taiwan和ETCM数据库筛选出结晶汤活性成分;再利用ETCM数据库和Swiss TargetPrediction数据库筛选出化合物靶点.通过GeneCards及OMIM数据库筛选出膜性肾病相关靶点;利用韦恩图筛选结晶汤治疗膜性肾病的共同潜在靶点;运用Cytoscape3.8.2构建药物-中药活性成分-交集靶点网络图,String数据库构建PPI网络图,Metascape数据库进行GO和KEGG富集分析,再利用Auto Dock Tools1.5.7、Auto Dock Vina和Pymol软件进行分子对接.结果 最后得出结晶汤治疗膜性肾病的核心成分为芥子酸、球松素、乔松素等,核心靶点有HSP90AA1、STAT3、SRC、EP300等.结晶汤主要作用于钙信号通路、环磷酸腺苷信号通路等生物学通路以减轻足细胞损伤以治疗膜性肾病.结论 初步揭示了结晶汤可通过多靶点、多途径治疗膜性肾病的作用机制,为筛选治疗膜性肾病的药物提供理论依据.

"卫气津营血精神"七纲理论由四川省十大名中医吴康衡教授在"卫气营血"理论基础上提出,系统总结了外感温热类疾病各个阶段的诊治方药.过敏性紫癜是儿科常见疾病之一,临床常表现出类似于温病的证候特点.本文探讨了以"卫气津营血精神"七纲理论治疗过敏性紫癜的方法,依据过敏性紫癜各个阶段的临床表现,将过敏性紫癜治法分为解表透卫、清热泻脾、凉润生津、清热透营、清热凉血、滋阴生精、补气养神七类,常用木贼宣痹汤、泻黄散、竹叶石膏汤、清营汤、五草五炭汤、加减复脉汤、清心莲子饮等方剂加减,进一步丰富"卫气津营血精神"七纲理论的临床应用.

刘完素创立河间学派，在河间学派学术思想影响下，张子和发展出“攻邪派”，朱丹溪分立“滋阴派”，金元四大家之中“河间学派”独占其三，影响可谓是极其深远。在河间学派一脉相承中，河间三家能推陈出新，发展自己的独特理论，同为传道授业解惑，现代中医教学应该发掘河间学派思想传承脉络中的过人之处，继承与创新，输出更多医学人才。本文从河间三家理论主要影响因素落笔，分析河间学派学术思想发展演变与传承，挖掘值得中医方剂课程教学借鉴的启示。

目的:应用中医传承辅助平台(V2.5)软件,分析常克教授治疗过敏性紫癜的用药规律.方法:收集2018年3月1日-2019年2月28日常克教授在成都中医药大学附属医院门诊治疗过敏性紫癜时的处方,将其录入到中医传承辅助平台软件,通过构建数据库进行数据挖掘,分析常教授治疗过敏性紫癜的用药规律.结果:共收集治疗过敏性紫癜处方219个,发现药性以寒为主,药味苦甘均用,归经多属太阴阳明;频次前5的药物为黄芩、茯苓、炒栀子、知母、连翘,频次前5的药对为茯苓-泽泻、金银花-连翘、连翘-栀子、黄芩-蒲公英、生石膏-炒栀子,根据药物关联规则演化得到3大核心药物群组和13个新处方.结论:常克教授治疗过敏性紫癜常选用苦寒药物进行组方,但亦重视甘温益气;同时善用风药,重视清利手阳明大肠,善以祛痰化瘀治疗紫癜性肾炎.

在治疗肾病综合征的激素大剂量应用阶段、激素减量撤药阶段、激素小剂量维持阶段以及停用激素后调理阶段四个阶段中,充分发挥中医药优势,辨证论治,能有效缓解激素治疗过程中的毒副反应,提高本病治愈率.但各医家临床治疗思路各成体系,很多治疗经验缺乏全面总结,故以中药分阶段治疗小儿肾病综合征(nephrotie syndrome,NS)为出发点,通过查阅近十年相关文献,总结近年来现代医家治疗原发性NS 的临床经验,大多数医家主要以温阳健脾,利水消肿为主,在激素大剂量运用治疗NS 时,加以滋阴降火,清热利湿;撤减阶段,注意益气温肾;小剂量维持阶段以及停药后,则注重固本培元,预防感染.以此为中药治疗小儿NS 治疗提供新思路.

目的:基于中医传承辅助平台管理系统(V2.5)分析常克教授治疗遗尿症的用药经验及规律.方法:通过回顾性研究方法,收集常克教授门诊治疗小儿遗尿症处方129首,应用软件构建常克教授治疗遗尿症的数据库,通过药物频次统计、规则分析及熵聚类等数据挖掘算法,分析其治疗遗尿症的用药规律.结果:共纳入129张处方,涉及药物234味,使用频次最高药物为茯苓,其次为麻黄、白术、石菖蒲等;通过药物关联规则显示频次最高为麻黄-黄芩;通过复杂系统煽层次聚类分析,生成新处方10个.结论:通过分析,发现常克教授治疗小儿遗尿疾病,以开窍醒神为要,并重视补益脾胃,亦佐以清热、利水渗湿之品,重视辨证,讲求因人而治.中医传承辅助平台对挖掘名老中医学术经验具有重要价值,可为临床治疗和科研提供新的参考与思路.

ETHNOPHARMACOLOGICAL RELEVANCE:Zhuyu pill (ZYP), an effective prescription of traditional Chinese medicine, is composed of Coptis chinensis Franch. and Tetradium ruticarpum (A. Jussieu) T. G. Hartley and has shown potential anticholestatic effects. However, its mechanism of action in treating cholestasis remains unclear. Since post-transcriptional control of mRNA by micro-RNAs (miRNAs) represents an important mechanism of gene regulation, it is promising to explore this in relation to ZYP and cholestasis. AIM OF THE STUDY:To confirm the anticholestatic effect of ZYP and to explore its potential biological mechanism. MATERIALS AND METHODS:In this study, a cholestasis rat model was induced by α-naphthyl-isothiocyanate (ANIT, 50 mg/kg) and treated with ZYP (low dose: 0.6 g/kg, high dose: 1.2 g/kg). Serum biochemistry indices and liver histopathology were used to evaluate the model and efficacy, and miRNA sequencing was used to measure differences in miRNA expression in the liver between the control, model, low-dose ZYP, and high-dose ZYP groups. To verify the accuracy of sequencing results and explore the potential anti-cholestasis mechanism of ZYP, RT-PCR was used to identify differentially expressed miRNAs and their target genes. RESULTS:Both high- and low-dose ZYP exhibited significant anticholestatic effects, with the high-dose showing better effects than low-dose ZYP. Additionally, four differentially expressed miRNAs, rno-miR-147, rno-miR-20b-5p, rno-miR-29b-3p, and rno-miR-3586-3p, were found to be upregulated in cholestasis and downregulated after ZYP intervention. Eight target genes of the above miRNAs, including ABCG8, CLOCK, PLEC, SLC4A2, NEB, ADAMTS12, TTN and FAM174B were inhibited in cholestatic rats, exhibiting up-regulated expression tendencies after ZYP intervention, and the expression tendencies were significant negatively correlated with serum biochemical indices. CONCLUSIONS:ZYP can significantly reduce liver biochemical indices and improve liver tissue damage in cholestasis rats through the regulation of miRNA expression in the liver, producing a positive regulatory effect on bile excretion-related genes.

目的 观察加味桔梗汤治疗肺经伏热型儿童过敏性鼻炎的临床疗效.方法 选取2019年1～12月成都中医药大学附属医院儿科门诊收治过敏性鼻炎患儿101例,随机分为观察组52例和对照组49例.观察组加味桔梗汤治疗,对照组给予开瑞坦治疗,疗程3周.初步评价两组患儿的疗效和安全性.结果 治疗3周后观察组鼻炎有效率为92.3％(48/52),显著高于对照组61.2％(30/49),差异有统计学意义(P<0.05).治疗3周后观察组肺经伏热证候有效率为92.3％(48/52),显著高于对照组79.6％(39/49),差异有统计学意义(P<0.05).观察组喷嚏、鼻塞、流涕、鼻痒、鼻黏膜肿胀、咽干、咽痒及咽红评分均低于对照组,差异有统计学意义(P<0.05).两组患儿治疗过程中均未出现不良反应.结论 加味桔梗汤治疗后患儿病情得到明显改善,临床疗效显著,且较为安全.

原发性遗尿症为儿科临床的常见病、多发病,病程长,复发率高.患儿遗尿若长期不能缓解,则降低其生活质量,是继父母离异、暴力后排名第3位的严重影响儿童心理的生活事件.中医目前大多从肾虚或寒进行论治,多采用补肾固涩之法为主,效者固多,然或有疗效不显,亦或有显效而反复者.笔者认为此病不仅有肾虚或寒之证,风、热、实等证亦有之,从实或热入手,探讨脑、肺、肝胆、脾胃、三焦及督脉其与遗尿的关系,试用风药为主来治疗此病,获得了一定的临床疗效,为治疗遗尿症提供了新方法和新思路.

Cholestasis is a clinical condition resulting from impaired bile flow. Currently, patients with cholestasis face several barriers in seeking diagnosis and treatment. Zhuyu Pill (ZYP) is an ancient classic formula of the Coptis-Evodia herb couples (CEHC), and has been used for cholestasis treatment in the clinic, however, its underlying biological activity in cholestasis remain to be clarified. In this study, an α-naphthyl-isothiocyanate (ANIT, 50 mg/kg)-induced rat model of cholestasis was treated with ZYP. Serum biochemical indices and histopathological evaluation was performed, together with the metabolomics analyses of feces and 16S rDNA sequencing of the fecal microbiota. We evaluated the anti-cholestatic activity of ZYP and investigated the mechanisms underlying its correlation with fecal microbiota and fecal metabolite regulation. The relationships between biochemical indices and changes in gene expression associated with liver injury, levels fecal metabolites, and composition of fecal microbiota were analyzed. The results showed that both high (1.2 g/kg) and low (0.6 g/kg) doses of ZYP could effectively improve biochemical parameters in the blood of cholestasis-induced rat models; the intervention effect of high dose ZYP was superior to that that of lower dose ZYP. Based on a metabolomics test of fecal samples, significantly altered metabolites in the ANIT and ZYP treatment group were identified. In total, 734 metabolites were differentially expressed, and whose biological functions were mainly associated with amino acid metabolism, steroid hormone biosynthesis, and bile secretion. In addition, sequencing of the 16S rDNA unit in fecal samples revealed that the ZYP could improve the fecal microbiota dysbiosis that ANIT had induced. Therefore, we conclude that ANIT altering of blood biochemical and metabolic profiles and of fecal microbiota could effectively be alleviated with ZYP treatment. This study contributes to the “TCM wisdom” applied in clinical diagnosis and treatment of cholestasis.

小儿过敏性咳嗽缠绵难愈,反复发作,极大影响了儿童学习和生活质量.张丰华副教授依据多年临床经验,结合蜀中(四川省)地理环境及小儿体质特点,将该病的病因病机概括为"风、痰、瘀、虚",发作期治以祛邪除痰、宣降肺气,缓解期治以固本截痰,临床疗效明显.

过敏性紫癜是儿科临床常见病,中医药对其有着较好的治疗效果.常克教授以"斑出阳明"立论,并结合四川气候特点,认为阳明湿热是导致该病发生的重要机制之一.在辨证上,尤其详析手足阳明经之别.笔者以手足阳明分列为其纲,以皮肤型、 肾型、 关节型、 腹型等临床分型为其目,梳理了常克教授对于该病湿热证型的整体诊疗思路及组方用药特点,以期对该病的中医诊疗有所裨益.

小儿咳嗽为六淫邪气或束肺气,或伤肺脏,或阻气机,致使肺失宣肃,气血痹于肺中,气机逆乱而发,加之热、痰、湿、瘀胶着缠绵难去,客肺而痹阻肺之气机,肺气不通,逆乱成咳.运用宣肺除痹法,分别从轻清宣痹除六淫、分解除痹化杂陈2个方面论述了小儿咳嗽的病机、治法、选方,并分析所选方证特点.附案例1则,以资验证.

方以"药"成,"量"为传秘,方剂之效全在于此.儿科用药,人多喜性平量轻,而畏峻险重剂.本文从实践从发,从古代儿科大家用药特点来说明药之"轻重",在于证之"轻重",当用则用,万不可固守成规,如此方能成为真正的医者.

目的:初步观察学龄期儿童多发性抽动症中医诊疗方案的临床疗效和安全性.方法:采用随机、对照、多中心的方法进行学龄期儿童多发性扮动症中医诊疗方案的临床研究.收集符合西医诊断标准的病例 240例,用 SAS随机分组,分为治疗组和对照组.治疗组根据中医诊疗方案予中药协定处方口服,对照组采用泰必利口服,总疗程 8周.对比两组患者治疗后耶鲁综合抽动严重程度量表(YGTSS)积分改善情况及疾病疗效和中医证候疗效,利用 SPSS 19.0软件对资料进行数据统计,分析中医诊疗方案的有效性及安全性.结果:240例患者中因失访共脱落 14例(治疗组6例,对照组 8例),完成观察 226例(治疗组 114例,对照组 112例).疾病疗效评价,在 4周时对照组显著优于治疗组(P＜0.01),8周时两组元明显差异(P ＞0.05).组内 YGTSS积分比较,P值均小于 0.05,结果提示两组在改善 YGTSS积分方面均有疗效.组间 YGTSS积分比较,4周时对照组显著优于治疗组(P＜0.01),8周时两组元明显差异(P ＞0.05).中医证候疗效,在4周及 8周治疗组痊愈率均显著优于对照组,差异有统计学意义((P ＜ O.01).出现不良反应者共 16例,治疗组5例,对照组 11例,两组不良反应发生率差异元统计学意义(P＞0.05).结论:学龄期儿童多发性抽动症的中医诊疗方案有效,无严重不良反应事件,依从性良好,值得进一步临床推广应用.

In order to discuss the TCM literature of water metabolism and dampness obstructed the middle-jiao, discusses the combination of clinical cases on pathological mechanism of spleen dampness obstructing spleen and kidney, and in the prophase of mature dampness obstructing spleen stomach syndrome animal model as the research platform, combined with modern research progress on pathological mechanism of spleen and kidney in traditional Chinese medicine.Regulation of hormone content through experimental detection of rat kidney typical water channel protein content and the production of urine, kidney related mechanisms of regulation of dampness obstructing spleen stomach syndrome of water metabolism, explore the dampness spleen and stomach injury will affect kidney function, is conducive to fully understand and grasp the original thinking in medicine, so as to promote the innovation and development of Chinese medicine the theory and clinical practice.

Renal hematuria,as one of the common clinical manifestations in many diseases,belongs to hematuria in TCM.Renal hematuria is difficult to treat,for it has complex etiols and mechanisms,and recurres frequently.Professor WU Kangheng is a national famous old doctor of TCM.He has engaged in clinical medicine,teaching,and researching for 60years.This paper introduces his clinical thinking,treatment and medication characteristics.The thinking of traditional and western medicine integration,disease and pattern,routine and flexible method combination is very useful to the clinicians.

Obhective:There are many factors of the source of syndrome of dampness in middle Jiao,the spleen deficiency is the main cause.The lung and spleen indistribution and excretion of body fluid is coordinated in the lung is based on lung as the source of waterunder the guidance of the theory,experimental study on the effect of the expression of syndrome of dampness in middleJiaoof Aquaporins in the lung,to reveal the lung and spleen in water metabolism and pathological correlation.Methods:Build a model of the syndrome of dampness in middle Jiao,simulating the three big etiological factors of retention of water and dampness:i.e.the functioning declination of spleen and stomach by exterior dampness luxus,interior dampness caused by intemperant diet,or stagnation of Qi caused by emotional depression.Measure the levels of AQP1,AQP4and AQP8in lung tissue and the changes of Chinese medicine after intervention by enzyme-linkedimmunosorbent assay (Elisa).Results:The expression of AQP1and AQP4was decreased in the model before and after modeling,but this difference is no significant.The expression of AQP8was significantly decreased in the model before and after modeling.The expression of AQP1 in all groups showed an upward trend.The expression of AQP8decreased obviously in the high dose and low dose groups of BuhuanjinzhengqiSan.The syndrome of dampness in middle Jiao,expression of Aquaporin in the lung is changed,and the prescription of Traditional Chinese Medicine forsyndrome of dampness in middle Jiaohas significant curative effect,have certain effect on the changes.Conclusion:There is a certain correlation between lung and spleen in water metabolism.Expression of Aquaporins in the lung,the change of the expression in syndrome of dampness in middle Jiao and the change of the expression in the intervention of Traditional Chinese Medicine,may be spleen governing transportation and transformation of water,"speen-qi on dispersing jing and the essence belongs to the lung" and one of the embodiment and the molecular basis of normal distribution function of liquid water.It suggests that the lung and spleen have some correlation in the metabolism of water.

研究平胃散对葡萄糖酵解途径的影响.方法:SPF大鼠雌雄各半,按体质量分层随机分为空白组,模型组,自然恢复组,平胃散20％乙醇提取物高、低剂量组,平胃散50％乙醇提取物高、低剂量组,平胃散95％乙醇提取物高、低剂量组,平胃散正丁醇提取物高、低剂量组,平胃散乙酸乙酯提取物高、低剂量组,平胃散水提取物高、低剂量组,每组10只.建立湿阻中焦证大鼠模型,检测各组大鼠血清中葡萄糖含量、肝脏中丙酮酸(PEP)的含量、丙酮酸激酶(PK)的活性.结果:与空白组比较,模型组大鼠血清中葡萄糖含量较高(P＜0.01),肝脏丙酮酸的含量偏高,但差异无统计学意义(P＞0.05),肝脏丙酮酸激酶活力升高(P＜0.01).经平胃散治疗后相较于空白组和自然恢复组血清中葡萄糖含量均有所下降,肝脏丙酮酸含量及肝脏丙酮酸激酶活力均有上升(P＜0.01或P＜0.05).结论:平胃散可能影响糖酵解途径中血清葡萄糖含量、肝脏中PEP含量及PK活性,且通过不同方法提取的平胃散进行试验检测,各组的葡萄糖、PEP含量及PK活性也存在差异.