目的 运用数据挖掘技术探讨田德禄教授治疗溃疡性结肠炎用药规律.方法 收集2020年9月-2022年10月田德禄教授治疗溃疡性结肠炎门诊病案,经筛选、整理后录入患者首诊处方.运用Excel2019对药物频次、药物功效分类和性味归经进行分析,采用SPSS Modoler 18.0软件对药物进行关联规则分析,使用Cytoscape3.8.0进行复杂网络分析,利用SPSS26.0对高频药物进行聚类分析,总结用药规律.结果 共纳入处方225首,涉及中药131味,筛选出高频药物38味.药性以温、平、微寒为主,药味以甘、苦、辛为主,归经多归脾经、胃经、肝经,药物功效以补虚药、清热药、消食药为主.关联规则分析得到20组药对,复杂网络分析显示核心处方由黄芪、连翘、赤芍、白芍等12味中药组成,聚类分析呈现6个类别.结论 田德禄教授认为溃疡性结肠炎证属本虚标实,强调从"内疡"论治,补泻兼施,寒热并用,重视调畅气血,消导肠道积滞.

目的 运用数据挖掘的方式,总结田德禄教授治疗胃食管反流病(Gastroesophageal reflux disease,GERD)的诊治思路及用药规律.方法 收集田德禄教授2019年1月—2021年3月期间田德禄教授门诊治疗GERD患者的病案,通过Microsoft Excel对药物性味、归经、频次进行统计分析,采用SPSS 26.0进行聚类分析,利用SPSS Modeler 18.0及Cytoscape 3.8.0进行中药关联规则及复杂网络分析.结果(1)田教授常用高频中药有焦三仙、紫苏梗、醋香附、麸炒枳实、陈皮等共36种,其中药性多为温、寒、平,药味以苦、辛、甘味为主,归经多属脾、胃、肝经.(2)田教授治疗本病常用药对有川贝母+海螵蛸、丹参+砂仁、黄连+制吴茱萸、黄连+姜厚朴等.(3)田教授治疗中常用紫苏梗、炒紫苏子、醋香附、麸炒枳实、焦三仙等组成的清降验方"实痞通"进行治疗.(4)田教授治疗中的常用药可聚类为实痞通、小柴胡汤、乌贝散、半夏秫米汤、消脂验方,三合汤,左金丸、连朴饮、四逆散.整理以上3类9方,可知田教授主要将本病辨证分为肝胃不和、肝胃郁热、中焦湿热及虚实错杂4个证候,并根据辨证随证选用化裁.结论 田教授治疗GERD用药以"清降"为治则,常用通降消导、疏肝和胃、调气和血,制酸降逆等药物,以清疏肝木,和中降逆.此外,田教授在诊治中还提出肝胃不和证+乌贝散、肝胃郁热证+左金丸、虚实夹杂证+失笑散的"三证三方"及以枳实,威灵仙,二丑等为代表的"通降三线药"用药经验,并将宏观辨证与内镜微观辨证相结合,配合辨证化裁用药.

目的 通过对田德禄老中医寒热并用的治法思路和用药规律进行挖掘整理,分享其寒热并用治疗消化病经验.方法 选择田德禄2018年1月—2020年12月在东直门医院寒热并用法治疗的80例患者为研究对象,观察其临床效果,并进行证型及核心药物统计,分析统计结果,总结其寒热并用治法的经验.结果 80例全部完成治疗,疗程最短2周,最长6个月,近期治愈9例、显效49例、有效21例、无效1例,总有效率为98.75％(79/80).辨为脾(虚)寒胃热36例,脾(胃)寒肝热16例,上热下寒15例,上寒下热8例,肝寒胃热5例.使用半夏泻心汤及类方40例,左金丸方16例,乌梅丸及类方12例,连理汤方9例,黄连汤方3例.结论 田德禄从脾、胃、肝、三焦出发,运用脏腑辨证理论,采用温中清胃、温中清肝、暖肝清胃、清上温下、温上清下的寒热并用治法,可以明显改善患者寒热错杂症状,提高中医传统治疗的效果.

溃疡性结肠炎(Ulcerative colitis,UC)为世界难治性疾病之一,临床易复发、难治愈.其归属中医学"久痢""休息痢"范畴,病机虚实夹杂,虚体表现在脾虚失于运化,实为湿热、寒湿、疫毒等邪气客于肠道,邪气与气血相搏结,大肠传导失司,脂络受伤,气血凝滞,瘀血内停,化腐成疡乃其核心病机.田德禄教授认为其可依照"内疡"辨治,病性属本虚标实,湿热寒湿毒邪为标实,脾之气阴两虚为本虚,久则损肝及肾,而瘀血贯穿始末.临证治疗中强调首辨虚实、脏腑同调,实者着重清热化湿、解毒化瘀,虚者重在益气养阴、健脾柔肝;并分期论治、抓住泻痢转化关键时期,"泻"在中焦宜分利脾胃之湿、"痢"在下焦宜调理脾肾之伤,若泻传痢,是脾传肾,谓之贼邪,难愈,若痢传泻,是肾传脾,谓之微邪,易瘳;另需补脾柔肝温肾,适度降低肠道敏感性,化瘀生肌,气血同调.田德禄教授并提出中医中药治疗本病的重点和优势均在于防复发,为临床辨证治疗及后续研究指明了方向.

随着社会环境及人们生活习惯改变,饮酒过量引起酒精性肝病出现肝硬化腹水的病情越来越常见.田德禄教授从"气血标本"论治酒精性肝硬化腹水患者,疗效显著.田老认为酒精性肝硬化为酒邪致病,酒毒属湿热之性,湿热痰浊、气滞、血瘀、水停为标实;酒邪损伤脾胃,脾胃虚弱为本虚,并创立具有调肝益气健脾,活血利水,清热利湿解毒功效的"慢肝消合剂",临床应用广泛.笔者师从田老治疗此类酒精性肝硬化腹水患者,基于中医气血论和标本论,多在病证结合辨证论治基础上,气血标本同治,调肝益气健脾,活血利水,化浊解毒,利湿清热,收效显著.现将从气血标本理论论治酒精性肝硬化腹水的体会总结如下.

功能性消化不良(FD)是临床上最常见的一种功能性胃肠病,中医药治疗FD具有明显的优势及鲜明的特色.文章从FD病因病机等方面的研究人手,对中医药治疗FD提出从胃论治,以通为要,以降为和,从肝论治,以调为顺,气血通调,从脾论治,以升为健,权衡虚实的辨治思路与对策,以期进一步提高中医药治疗FD的临床疗效.

田德禄教授是新中国成立后中医高等教育体系培育的最早一批中医学者,毕业后师从首位中医院士董建华教授,继承和整理了其在消化病领域的主要学术思想.在六十余年的临床、教学及科研工作中,既有继承,更有创新,在胃病[1]、肝病[2]及肠病[3]方面,提出了很多新颖观点,并形成了自己稳定而成熟的临床及学术风格.田德禄教授在胃病治疗方面,经验尤其成熟,诊断、治疗及调摄均有自己独到之处,临床疗效突出,现总结如下.

香苏散出自《太平惠民和剂局方》，由香附、紫苏叶、陈皮、炙甘草4味药组成，功能是散寒解表、理气消滞，主治外感风寒、内伤气滞，症见恶寒发热、头身疼痛、胃脘胀满、纳呆呕恶、苔白腻、脉浮紧。当代人嗜食肥甘厚味及烟酒摄入增多必然引起湿热内蕴，又加之工作生活压力大导致情志郁结化热，且二者常结合致病，因此致使当今胃病以实证、热证为多见，虚寒之证少见。针对此病因病机变化，北京中医药大学东直门医院田德禄教授以香苏散为基础，将方中苏叶换为苏梗，变解表为理气消胀，去方中炙甘草防其甘温壅滞胃气，加炒枳实、生薏苡仁、清半夏、茯苓、焦三仙、连翘等组成理气消胀合剂，将本方变为理气消胀、化痰和胃的方子，作为胃病治疗的基础方，治疗胃气壅滞引起的胃脘痞满胀闷、纳呆食少、嗳气吞酸、大便不畅等。临床用于多种内科病症的治疗，拓宽了本方临床使用范围，取得了较好的疗效。

OBJECTIVE:To observe the clinical efficacy and safety of Shuanghu Qinggan Granule ( , SQG) plus Yigan Yiqi Jieyu Granule (, YYJG) combined with lamivudine (LAM) on chronic hepatitis B (CHB) patients.METHODS:The study was a multicenter, randomized, double-blinded and parallel controlled trial. A total of 320 patients were randomly allocated into 2 groups equally: 160 patients (treatment group) were given SQG and YYJG combined with LAM; and 160 patients (control group) were given LAM plus Chinese herb placebo, respectively. Liver functions, hepatitis B envelop antigen (HBeAg) titer levels, and hepatitis B virus DNA (HBV-DNA) load were monitored.RESULTS:(1) In the 48th week, the treatment group showed superior HBeAg seroconversion rate than that in the control group (38.0% vs. 24.0%, P<0.05). (2) In the 48th week, the treatment group demonstrated lower HBeAg titer than that in the control group (P<0.05). (3) In the 12th, 24th, 48th week, there was no statistical significance in HBV-DNA response rate between the two groups. (4) In the 12th week, the level of glutamyl transpeptidase (GGT) was significantly decreased in the treatment group compared with the control group (P<0.05); in the 36th week, the levels of alanine aminotransferase and aspartate transaminase were significantly lower in the treatment group than those in the control group (P<0.05).CONCLUSION:The protocol of SQG and YYJG combined with LAM to treat CHB showed superior efficacy than LAM monotherapy.

Objective:To explore the distribution regularities of tongue picture by collecting and analyzing muti-center nationwide tongue picture of chronic hepatitis B (ALT≥2ULN)patients.Methods:A total of 1 003 chronic hepatitis B(ALT≥2 ×ULN) patients were recruited.Collecting the clinical manifestations of tongue by image recording and using the“Tongue Picture Acquisi-tion and Analysis System”which developed by Tsinghua University for data processing to analyze the Tongue Picture Feature of 1 003 chronic hepatitis B(ALT≥2 ×ULN)patients.Results:By analyzing the clinical data of 1 003 patients,the main tongue col-or of chronic hepatitis B (ALT≥2ULN)were:red,pale red,dark,and light white.The main tongue shape were:teeth prints, nourishing and moistening,swollen,tongue with ecchymosis,and blue and purple collaterals under tongue.The main coating color were:white and yellow.The main tongue coating were:thin fur,greasy fur,and thick fur.The tongue diagnosis feature of damp-ness-heat in the liver and gallbladder syndrome were:coating yellow,tongue red,tongue coating greasy fur,tongue shape nouris-hing and moistening,coating white,tongue coating thin fur,tongue coating thick fur.The tongue diagnosis feature of liver stagna-tion and spleen deficiency syndrome were:coating white,coating thin fur,tongue pale red,tongue red,tongue coating greasy fur, tongue shape swollen and teeth prints,tongue shape nourishing and moistening,and coating yellow.Conclusion:The pathological factors of tongue diagnosis feature of Chronic hepatitis B (ALT≥2 ×ULN)are mainly involved in qi deficiency,wetness hyperac-tivity type,and blood stasis.The tongue diagnosis feature of dampness-heat in the liver and gallbladder syndrome and liver stagna-tion and spleen deficiency syndrome were more consistent with the standard issued by academy,which can provide a good reference for future study.

功能性消化不良属中医"胃痞·实痞"范畴,以实证居多,也有虚实夹杂者。病位主要在胃,涉及肝脾肾。病因主要涉及饮食不节、情志不遂、脾胃虚弱。病机主要为胃气壅滞、失于和降。对于本病,叶天士从胃论治。董建华教授在生理上强调"降"字,在病理上强调"滞"字,在治疗上强调"通"字。秦伯未倡导从脾论治。上海中医药大学倡导从肝论治。田德禄教授坚持"内镜是中医望诊

Objective To discuss Professor TIAN De-lu’s medication laws in treatment of functional dyspepsia through proper statistical methods. Methods On ACCESS platform, the structural medical record template was established for collecting Professor TIAN De-lu’s therapeutic information in clinic. The information of all patients (875 medical records) was input into database according to standard writing format of outpatient medical record. The data mining was conducted at three levels—single medicinal, coupled medicinal and core combinations of common medicinal. Results The single medicinal used commonly by Professor TIAN De-lu are Zisugeng (Caulis Perillae), Zisuzi (Fructus Perillae), Xiangfu (Rhizoma Cyperi), Chenpi (Pericarpium Citri Reticulatae) and so on. The common coupled medicinal are Zisugeng and Xiangfu, Banxia (Rhizoma Pinelliae) and Huangqin (Radix Scutellariae), Huanglian (Rhizoma Coptidis) and Wuzhuyu (Fructus Evodiae) and so on. The core medicinal combinations include Zisugeng, Zisuzi, Xiangfu, Chenpi, Pugongying (Herba Taraxaci), Weilingxian (Radix Clematidis), Yujin (Radix Curcumae) and so on. All above-mentioned single medicinal, coupled medicinal and core medicinal combinations are commonly used by Professor TIAN De-lu and reflected his therapeutic thought and clinical experience. Conclusion The results of this study reflect the major medication laws and characteristics in treatment of functional dyspepsia by Professor TIAN De-lu.

<正>胃食管反流病是指胃内容物异常反流至食管致组织损伤而引起的疾病,其典型症状为烧心和反酸。近年来发病率明显上升。西医治疗以改变生活方式、给予抑酸、促动力药及手术等方法为主,短期疗效肯定,但停药或手术后很容易复发。我院田德禄教授专攻消化系统疾病近50年,对此有独特的认识和丰富的经验。笔者作为全国第四批名老中医学术继承人,有幸随师学习3年,所见本病病例多

田德禄(1938-),男,主任医师、教授、博士研究生导师,北京中医药大学东直门医院首席专家,全国第四批老中医药专家继承工作指导老师,享受国务院颁发的政府特殊津贴。师承著名中医学专家董建华教授。从事中医临床、教学、科研工作40余年,在中医内科,尤其在消化内科临床上形成了自己的独到的学术观点和方法。先后主持国家"七五"、"八五""中医药治疗慢性萎缩性胃炎临床及实验研究"。并指导并参与了多项国家级、部级及局级课题工作。主编及参编数十部中医学专著,发表论文80余篇。

<正>田德禄教授是中医脾胃学临床专家和中医内科学教育家,在临床、科研和教学方面卓有成效。执业50年来,坚持工作在临床一线,在中医内科,尤其在消化内科临床上形成了自己的学术观点。在酒精性肝病、慢性胃炎、消化性溃疡、胃癌前期病变、慢性结肠炎等疾病的治疗上,摸索和建立了一套诊治系统,并提出了许多切合临床的新颖观点,临床

<正>1病历摘要赵某,女,53岁。主因下腹痛、腹泻伴黏液脓血便30余年,加重20余天,于2010年3月19日入院。患者30年前无明显诱因出现下腹疼痛、腹泻伴黏液脓血便,每日腹泻3~4次,曾于北京中医医院就诊,考虑为溃疡性结肠炎,予中药口服及灌肠治

Objective To probe into the inhibiting action of Compound Biejiarangan Troche on alcohol hepatic fibrosis in rats. Methods Forty Wistar male rats were divided into control, model, Compound Biejiarangan Troche and Anfate treatment groups. Alcohol hepatic fibrosis model was established by intragastrical perfusion with mixture of alcohol-Pyrazole-coil oil and high-fat diet for sixteen weeks. After four weeks’ intervention, changes of hepatic fibrosis index, liver tissue pathology and expression of TGF-β1 in liver tissue were observed. Results The hepatic function of model rats were changed and abnormal, with obvious fibrosis in hepatic histopathology. After intervention for four weeks, HA decreased (P 0.01) in serum of Compound Biejiarangan Troche group and Anfate group compared with that of model group, and expression of TGF-β1 decreased in Compound Biejiarangan Troche group compared with Anfate group. Conclusion Compound Biejiarangan Troche has effect of inhibiting and reversing alcohol hepatic fibrosis in rats.

本项研究在前期酒精性肝纤维化中医证候特点的研究基础上,采用临床流行病学的原则和方法,明确诊断标准和排除标准,较全面地收集酒精性肝纤维化患者可能影响中医证候特点分布的实验室检查指标,对酒精性肝纤维化临床中医证候特点与实验室检查指标的关系进行探讨.