清肺健脾法是基于传承、实践,创新提出的治疗肺热脾湿证候鼻鼽的方法,本文梳理了肺热脾湿证候鼻鼽的发生,即湿热伏气是内在基础,肺热炽盛、脾虚湿聚,湿热胶结、上犯清窍是重要病机,指出其主要责之于肺,与脾相关,致病因素责之于热,兼湿邪胶结.故提出清肺健脾治法,具体药物分两个角度解析,一是主次用药,有君、臣、佐、使之别;二是性味上,分为性寒清肺热、淡渗健脾利湿、辛温疏风开窍三类.本方药经过多年实践和临床研究,证实安全有效,并且总结了肺热脾湿证候的辨证要点,便于在临床推广使用.整理了在诊治患者时,遇不同具体情况时在理论指导下常用的调整药物方法.最后,举病案示例.

原发性开角型青光眼是一种以视神经损伤和视野缺损为主要表现的不可逆致盲性眼病,其病因及发病机制复杂,目前西医的治疗无法完全阻断视神经损伤的进展.支楠教授是孔嗣伯的学术继承人,其将孔门"两纲六要"学说应用于眼科辨证,认为该病多以肝郁为先、湿热为障,致脾胃气机失调,治疗上以疏肝开郁和胃,清热利湿健脾为主调理脾胃气机升降.文章将结合典型病例,探讨支楠治疗原发性开角型青光眼学术思想.

孔嗣伯先生秉承家学,熟悟经旨,临床辨证提纲挈领,认为女性不孕症应首重冲任,冲任二脉欠和是主因.临床治以调和冲任收到较好效果,对湿邪下注、痰湿瘀滞、胞络欠通的患者,治以温阳化湿、通调醒塞,选药茯苓、薏苡仁、芡实、陈皮、小青皮、细辛、川椒目、乌药、橘核、沉香、小茴香、竹叶卷心、车前子;对肾阴不足、封藏失职、冲任失养、难以固胎者,柔肝益肾、滋养冲任以养胎元,选药生牡蛎、生海蛤、炒杜仲、桑寄生、山茱萸、墨旱莲、当归、花蕊石、红白鸡冠花、丹参、鸡血藤、益母草等.孔先生还认为不孕症患者常有冲任血瘀络阻,在温阳理气、柔肝益肾的同时,配合使用活血药可获奇效.

目的:评价平肝育阴清热方治疗睑板腺功能障碍导致蒸发过强且中医证属阴虚阳亢型干眼症患者的临床疗效及安全性.方法:连续的120例符合准的门诊患者被纳入试验,按照睑板腺功能的分级(1～3级)分别纳入轻中重三层,每层按照1∶1的比例随机分配为试验组或对照组.两组均予玻璃酸钠滴眼液治疗,1滴/眼/次,每日3次,试验组同时加服平肝育阴清热方配方颗粒,每日2次,两组均连续治疗8周.总体及分层比较两组患者治疗前后非侵入性泪膜破裂时间(NITBUT),角膜病变程度、睑板腺排出脂质难易度、睑板腺结构、眼部症状积分、眼表疾病指数(OSDI)量表得分及中医兼证证候积分.结果:纳入120例患者中脱落1例,剔除3例,116例纳入统计.治疗前后两组患者NITBUT,角膜病变程度,眼部症状积分,OSDI量表得分均表现为试验组优于对照组,差异具有统计学意义;睑板腺排出脂质难易度得分差异无统计学意义,试验组仅有优于对照组的趋势;两组治疗后中医兼证证候得分与治疗前相比差异均有统计学意义.全部纳入病例均无不良反应发生,无心电图或肝肾功能异常改变.结论:平肝育阴清热方可有效改善睑板腺功能障碍导致的蒸发过强,中医证属阴虚阳亢型干眼症患者的泪膜稳定性,眼干涩、灼热、眼痒、异物感等眼部症状及阴虚阳亢的中医症状,且以中重度患者改善效果更为明显;具有改善睑板腺功能的趋势,安全性佳,患者依从性较好.

肝癌属于中医学的"胁痛" "黄疸" "癥瘕" "臌胀"等范畴,《灵枢·邪气脏腑病形》曰:"肝脉急甚为恶言,微急为肥气,在胁下若覆杯."《难经》载:"脾之积,名曰痞气.在胃腕,腹大如盘,久不愈.令人四肢不及,发黄疸,饮食不为肌肤."手术切除是目前临床中治疗肝癌最有效的方法,但有些患者因广泛转移或有较多基础性疾病,年老体弱等诸多原因不能手术,往往需要中医治疗或中医结合放疗、化疗,术后对患者进行中医辨证治疗,能调节脏腑功能、促进机体恢复,调节机体免疫功能,控制复发转移.

This study aims to investigate the effectiveness and safety of Qingfeijianpi therapy for persistent allergic rhinitis (AR). A total of 101 patients with persistent AR were included into the study. These patients were randomly divided into 2 groups: treatment group, in which patients were given Qingfeijianpi decoction (1 dose/day for 4 weeks); control group, in which patients were given an oral dose of loratadine (tablet, 10mg/time, once per day for 4 weeks). A total of 96 patients completed the 16-week course of treatment. The nasal symptom and traditional Chinese medicine syndrome were scored to evaluate symptom improvement, and the Rhinoconjunctivitis Quality of Life Questionnaire was used to assess the quality of life of patients. Furthermore, the 4-week clinical treatment effect and 16-week follow up were evaluated. After the 4-week treatment, the mean difference in symptom score in the treatment group was similar to that in the control group. However, during the follow-up, the decrease in symptom score was better with the Qingfeijianpi therapy than with loratadine. Compared to loratadine, the Qingfeijianpi decoction exhibited a significant benefit in symptom improvement of persistent AR.

小儿喉乳头状瘤是由人乳头状瘤病毒感染的儿童喉部常见良性肿瘤,西医治疗以手术改善通气为主.中医药治疗小儿喉乳头状瘤疗效显著,支楠教授在临床中治疗过大量该类患儿,认为本病病位多责之于肺脾二脏,素体虚弱,感受疫毒之气,肺热痰湿,肺脾不足,病久及肝,肝气郁结,脾胃气滞为主要病机.治疗以清热宣肺,化痰散结利咽,健脾益肺,扶助正气为主,辅以疏肝和胃,调畅气机.文章将结合典型病例分析,探讨支楠教授治疗小儿喉乳头状瘤学术思想.

支楠教授与孔伯华老中医一脉相承,继承和发展了孔门学术思想与经验,善于将温热病辨证思想应用于临床常见病、疑难病的辨证中.孔老认为,外感温热病必先赖于体内之郁热伏气而后外感淫邪而成.清热疏风为基本治法,兼有清肺平肝、解毒利湿、生津和胃.临床细辨病势、病位、兼加、体质而遣方用药.

年龄相关性黄斑变性(AMD)分为干性和湿性两型,属常见的视网膜变性类疾病.笔者深入研习孔门医学关于AMD的治疗思路,结合自身临床体会,总结认为干性AMD以脾气亏虚或肝肾不足为常见证型,多伴血瘀;湿性AMD以肝脾肾亏虚为本,以气滞、湿浊、瘀血或痰瘀互结为标.治疗应当把握总则,细分不同,酌情用药.

孔门养生观是孔门医学的一部分,其源于儒学思想,结合以《黄帝内经》为代表的中医养生学思想,再融选孔门医学中对于人体体质、药膳等内容的独特理解,富含孔门特色,指导养生实践.

OBJECTIVE To observe the effects of Yu-nv-jian prescription on the treatment of hereditary hemorrhagic telangiectasia(HTT). METHODS Seven individuals over 25 years old with HTT who prospectively recruited from rhinology clinic and ward of Beijing Tongren Hospital during one year were treated by Yunvjian prescription for 5 weeks. The changes of nasal bleeding, the total nasal symptom score(TNSS) and the Mini-Rhinoconjunctivitis Quality-of-Life Questionnaire(MiniRQLQ) were recorded at baseline and evaluated every week. RESULTS All of the symptoms [nasal bleeding(6.5±2.2 vs 18.7±2.0) points, nasal symptom VAS score(4.4±1.3 vs 20.8±1.6) points, and MiniRQLQ(9.3±1.6vs 29.7±5.0) points(P0.05)] improved obviously after treatment, the total effective rate was 85.7%. In addition, we found that there was a correlation of the epistaxis with the nasal symptoms(R 2=0.8444), but no correlation of effective levels on epistaxis with nasal symptoms by Yu-nv-jian prescription treatment(R 2=0.3905). CONCLUSION Yunvjian prescription significantly improved the nasal bleeding symptoms of HTT and attenuated the telangiectasia.

目的 观察儿童鼻鼽发病特点及中医体质特征.方法 分别收集首都医科大学附属北京同仁医院南区儿科门诊≤15岁鼻鼽患儿86例及首都医科大学附属北京同仁医院耳鼻喉科变态反应中心9～15岁鼻鼽患儿133例,分别以致敏原皮肤点刺实验及临床症状明确诊断,以标准化中医体质量表评价患儿发病特点及其中医体质特征.结果 86例患儿中,变应性鼻炎(AR)占52.3％,非变应性鼻炎(NAR)占5.8％,病因不明病例占41.9％.133例患儿中,101例AR患儿中医体质分别是特禀质32.7％、阴虚质15.8％和湿热质13.9％,分布差异有统计学意义(P＜0.05);32例NAR患儿中医体质分别是特禀质21.9％、气虚质21.9％和阳虚质15.6％,分布差异有统计学意义(P＜0.05).结论 儿童患鼻鼽者AR居多,多伴有明显的家族病史、湿疹及哮喘病史;AR患儿中医体质以特禀质、阴虚质、湿热质为主;而NAR患儿以特禀质、气虚质和阳虚质表达为主.

Dr.Kong Si bo,is a veteran practitioner of traditional Chinese medicine,who has rich experience in treating curative effect of allergic rhinitis.Dr.Kong believes that allergic rhinitis belongs to Bi Qiu category of traditional Chinese medicine,and the interior reten-tion of damp heat is the main important pathogenesis of allergic rhinitis.Clearing heat and dampness and relieving stuffy nose is the gen-eral principles of treating damp heat of allergic rhinitis.As for clinical treatment,attention shall be paid to the integrated conception,mul-tiple factors to identify the damp heat position of meridians and collaterals including the viscera system.

Objective To observe the effects of Tang shen hua zhuo Recipe(TSHZR) in the treatment of patients fromⅣstage of diabetic nephropathy. Method One hundred patients withⅣstage DN were randomly assigned into the control group (n=50)treated by irbesartan alone and the treated group (n=50)treated by TSHZR combined with irbesartan for 6 months. All patients received diabetes fundamental drug. The urine albumin excretion rate was used as the assessment index of therapeutic effect,and fasting blood glucose,HbA1c,serum creatinine,blood urea ni-trogen and lipid profiles,were examined as well. Result According to the protocol complete observation of 98 cases, 48 cases in treatment group and control group of 50 cases. The clinical control rates were significantly differences observed among the two groups. After treatment the urine albumin excretion rate,the levels of triglyceride, total cho-lesterol and low density lipid cholesterol in treatment group all significantly lower than control group (P<0. 01), and the levels high density lipid cholesterol in treatment group significantly higher than control group (P<0. 01). Conclusion The results show that TSHZR can effectively improve Ⅳ stage of diabetic nephropathy, compared with irbesartan has more advantages.

目的 探究人的类糜蛋白酶过度表达对脂多糖(LPS)治疗的小鼠生存率及组织内类糜蛋白酶活性的影响.方法 4周龄的野生型(WT)小鼠和人的类糜蛋白酶转基因(Tg)小鼠分别采用不同剂量LPS(0.03、0.10、0.30mg/kg)治疗2周,即分为WT-0.03组(LPS 0.03 mg/kg,n=11)、WT-0.10组(LPS 0.10 mg/kg,n=11)、WT-0.30组(LPS 0.30 mg/kg,n=9)、Tg-0.03组(LPS0.03 mg/kg,n =10)、Tg-0.10组(LPS 0.10 mg/kg,n=9)、Tg-0.30组(LPS 0.30 mg/kg,n=6).结果 在LPS诱导的急性炎症中,Tg小鼠皮肤和心脏的类糜蛋白酶活性明显高于WT小鼠.0.10mg/kg LPS未降低WT小鼠生存率,但Tg小鼠死亡率为25％,0.30mg/kg LPS诱导WT小鼠和Tg小鼠生存率分别为87.5％和0％.结论 人的类糜蛋白酶异常升高可能会导致LPS诱导的小鼠死亡率增加.

Objective To explore the effects of combination of traditional Chinese medicine (TCM)and western medicine on a variety of allergen induced severe perennial seasonal allergic rhinitis patients who were treated invalidly with antihistamines and intranasal flixonase for more than two years.Methods 16 patients with moderate to severe allergic rhinitis who were uncontrolled with antihistamines and intranasal flixonase for one week were treated by combination with TCM of Xin-Yi-Qing-fei San or Gyokubeifu-san mixed formula for two weeks.Nasal symptoms,its effects on the quality of daily life,and telephone follow-up half a year later were evaluated.Mini Rhinoconjunctivitis Quality of Life Questionnaire (Mini-RQLQ) and Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ) were used to evaluate the quality of life.Results After 2 weeks combination-treatment,the nasal symptoms of congestion,rhinorrhea,sneezing,nasal itching,and nasal obstruction were significantly improved compared with combination-before [(52.0± 11.1)％,(69.1±5.3)％,(68.3±12.3)％,(55.5±10.0)％to (10.9±2.4)％,(8.9±3.2)％,(12.5±4.3)％,(13.2±5.3)％,respectively].The before and after treatment of nasal function of nasal minimum cross-sectional area (MCA),nasal cavity volume (V5) and nasal airway resistance (R75 and R150) respectively were (0.58±0.12)cm2,(0.38 ± 0.23) Pa/cm3 · s-1,(0.44 ± 0.32) Pa/cm3 · s-1,(3.50 ± 2.33) cm2 to (0.48 ± 0.23) cm2,(0.31 ±0.33) Pa/cm3 · s-1,(0.31 ±0.37)Pa/cm3 · s-1,(2.24± 1.03) cm2 (P＜0.01).In addition,findings of patients with nasal symptoms by half year follow-up were significantly better than those of before.Conclusion The interventionof TCM can effectively control the perennial and seasonal severe symptoms of patients with AR,and improve the quality of life of patients.

Objective To explore the relationship of spleen and stomach with pathogenesis of allergic rhinitis based on the clinical questionnaire.Methods 1 252 samples over 15 years old with rhinitis were collected for questionnaire survey,who visited in the center for allergic reaction,Beijing Tongren Hospital,Capital Medical University from May in 2011 to May in 2012,and 1 008 samples who had finished the questionnaire survey were divided an allergic rhinitis group(AR group,n=649) and a non-allergic rhinitis group(NAR group,n=359) by skin prick test and clinical symptoms.Results There are 209 patients(32.3%) with digestive system disease and 234 patients(36.1%) with neurosis in the AR group,while 136 patients(37.9%) and 179 patients(49.9%) respectively in NAR group.The both groups had a medical history with high incidence in digestive system disease and neurosis.Conclusion Spleen qi deficiency is the main mechanism of allergic rhinitis,and spleen and stomach is closely associated with pathogenesis of allergic rhinitis.

目的观察退热方对气分证发热治疗效果。方法将患者随机分为两组,观察组在气分证发热时,使用退热方(生石膏、薄荷、芦根、炒神曲)治疗;对照组在气分证发热时,使用酚咖片治疗。观察两组退热效果。结果观察组疗效显著优于对照组。结论退热方对气分证发热治疗疗效满意。

Objective To investigate whether aldosterone induces cell senescence in the kidney.Methods Rats were randomly separated to vehicle(n=10);aldosterone(0.75 μg·h-1;n=8);aldosterone + eplerenone(100 mg·kg-1·d-1;n=8);aldosterone + hydralazine(80 mg·L-1 in drinking water;n=10).Results Aldosterone induced rats for 5 weeks exhibited by increased expression of senescence-associated β-galactosidase、p53 and cyclin-dependent kinase inhibitor(p21),and decreased expression of SIRT1.While,rats also showed hypertension and increased urinary excretion rates of proteins and N-acetyl-β-D-glucosaminidase by aldosterone infusion.These changes were abolished by eplerenone,a mineralocorticoid receptor(MR) antagonist,but unaffected by hydralazine(80 mg/liter in drinking water).Conclusion These findings indicate that aldosterone induces renal senescence in proximal tubular cells via the MR and p21-dependent pathway,which may be involved in aldosterone-induced renal injury.

Allergic diseases are internationally recognized as diseases of high incidence rates. The publications about the clinical and experimental studies on treating allergic rhinitis and related allergic disorders by traditional Chinese medicine at home and abroad were retrieved, in order to identify its effectivity and defects and improve the clinical and experimental research on treating allergic rhinitis with TCM. It provided evidence for TCM in treating allergic rhinitis treatment orthonormally, scientifically and internationally.