目的 评价麦粒灸"中风七穴"治疗急性脑梗死(ACI)患者的疗效.方法 共纳入72例ACI患者,采用随机数字表法随机分为治疗组与对照组各36例,对照组采用临床常规护理及治疗,治疗组在对照组的基础上施加麦粒灸"中风七穴",治疗周期均为2周.评价两组治疗前后的美国国立卫生院神经功能缺损量表(NI-HSS)评分、Barthel评分、中风诊断与疗效评定量表评分、超敏C反应蛋白(hs-CRP)变化情况以及两组患者对护理满意度的总体评价.结果 治疗组总有效率明显高于对照组.两组治疗后NIHSS评分、Barthel评分、中风诊断与疗效评定量表评分及hs-CRP水平均优于治疗前(P＜0.05),且治疗组改善情况优于对照组(P＜0.05),治疗组护理满意度情况优于对照组(P＜0.05).结论 麦粒灸"中风七穴"联合常规护理及治疗能够明显改善ACI患者的神经缺损症状,抑制炎症因子反应,不仅提升了临床疗效,还提高了护理满意度.

Dry eye is a common ocular surface disease in clinical ophthalmology. Dry eye patients usually experience ocular discomfort such as dry eyes, and foreign body sensation. Dry eye belongs to the category of "white astringent syndrome" in Traditional Chinese Medicine（TCM）. Currently, the pathogenesis of dry eye is generally believed to be Yin injury caused by hyperactivity of fire which further turns into dryness by TCM scholars, and the clinical treatment mainly starts from Yin deficiency and dryness-heat. However, insufficient attention has been paid to the important role of pungent-warm herbs in the treatment of dry eye. Fu-yang theory is a characteristic theory of TCM, whose core academic idea is to pay attention to strengthening and protecting the body’s Yang Qi, erect the pole with fire, and make good use of Xinwen drugs such as dried ginger, aconite and cinnamon to cure chronic diseases. Based on Fu-yang theory and starting from the basic pathogenesis of dry eye, this paper briefly explores the clinical application of Xinwen drugs in the treatment of dry eye, in order to provide references for the clinical diagnosis and treatment of dry eye.

围绝经期抑郁是临床中常见的妇科精神类系统疾病,可归属于中医"郁症"范畴,历代医家多从阴虚肝郁论治,具有一定疗效.本文基于《素问·生气通天论篇》"阳气者,精则养神,柔则养筋"等理论思想,探讨阳气与抑郁之间的密切关系.从阳虚肝郁角度探析围绝经期抑郁,认为水寒木郁,阳郁神颓,郁热内生是部分围绝经期抑郁患者的主要病机,在临床上可予乌梅丸加减治疗,从而达到寒温并举、攻补兼施、气血双调的治疗效果.通过对乌梅丸"温阳解郁法"的理论探析,论述现代医家对"温阳解郁法"的再认识,提出乌梅丸仅是一种治疗阳虚肝郁导致围绝经期抑郁的代表方剂,谨守病机,勿失气宜,把握其"温阳解郁法"是其治疗的关键.并附验案一则,以飨同道.

慢性主观性头晕(CSD)是前庭功能障碍和精神性疾患之间交互反应而导致的一种具有身心交互作用的临床综合征,可归属于中医"眩晕"范畴,但与"郁证"密切相关.该类眩晕以肝、脾、肾病变为重点,并与肝的病变更为密切,故中医治疗主要以从肝论治、补气血、化痰瘀为主.但在中医临证辨治CSD时,发现患者除慢性眩晕症状外,多具有厥阴病寒热错杂的证候特点,故可从厥阴病的角度选用张仲景《伤寒论》中治疗"厥阴病"的主方乌梅丸进行论治.

本文章基于肺脏与月经的关系,探讨肺脏对月经的影响,在临床治疗痛经疾病的同时,不可忽略肺脏的重要性.通过论述历代医家对"形寒饮冷"导致痛经的认识,阐释《内经》"形寒饮冷则伤肺"的理论内涵,明确指出"形寒饮冷"是导致女性痛经主要原因之一,并重申"病在下,取之上"的证治思路.因此提出以小青龙汤为主的"蠲饮散寒法"治疗痛经,同时也要注意因长期"形寒饮冷"导致的"伏寒"藏肾的影响.通过对小青龙汤蠲饮散寒法的理论探析,论述现代医家对"蠲饮散寒法"的再认识,提出小青龙汤只是一种治疗"形寒饮冷"导致痛经的代表方剂,谨守病机,无失气宜,把握其"蠲饮散寒法"是其治疗的关键.并附验案一则,以飨同道.

随着社会老龄化以及影像检查技术的进步,脑血管疾病的发病率逐渐上升,以后循环缺血(posterior circulation ischemia,PCI)为主的恶性疾病所致的眩晕更加突出.但因本病临床表现多样,诊断标准难以量化,导致后循环缺血性眩晕早期难以确诊.因本病进展迅速,预后不良,及早识别和干预具有重要意义.本文对后循环缺血性眩晕的概念和早期识别方法的研究进展进行总结,希望有助于临床医师,尤其是急诊室、综合内科或基层医疗机构医师能早期识别和诊治.

通过查阅古籍,发现古人在论述的诸多中药中对瞳神散大宜忌的论述颇多.对于某些中药,古人认为其或补养肾精,或震慑浮阳,强调其具有"能敛瞳子散大""收散大之瞳神""收耗散之气"的效果,对于收敛瞳神有较好的作用;对部分中药亦有"瞳子散大者尤忌""瞳子散大者勿服"之类的用药提醒,认为很多中药或辛温走窜,或助火伤阴,为有瞳神散大征兆患者的禁忌用药.这些记载对医者临床用药有一定的指导及警示意义,值得引起重视.本文在浅析瞳神散大病因病机的基础上,列举了古籍中对瞳仁散大有适宜治疗作用的中药以及禁忌用药,浅析该药物对瞳神散大宜忌的中医机理,以期为中医眼科的临床用药提供一定的参考.

目的 观察麦粒灸"中风七穴"治疗后循环缺血性眩晕的临床疗效.方法 选取2018年9月—2019年12月于中国中医科学院眼科医院收治的60例后循环缺血性眩晕住院病人,采用随机数字表法分为治疗组和对照组,各30例.对照组采用常规西药治疗,治疗组在对照组的基础上施麦粒灸"中风七穴",百会、风池、大椎、肩井、曲池、间使每穴各灸三壮,足三里穴灸五壮,每日1次,从左到右,从上到下,依次灸之.两组均治疗14 d.观察两组治疗前后眩晕评估评分量表(DARS)评分、眩晕障碍评定量表(DHI)评分、眩晕病临床证候评价量表评分、超敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)水平变化;采用经颅多普勒超声(TCD)检测两组双侧椎动脉(VA)、基底动脉(BA)的平均血流速度和血管搏动指数;比较两组临床疗效.结果 治疗后,治疗组总有效率为90.00％,高于对照组的76.67％(P<0.05).治疗后,两组病人DARS评分、DHI评分及眩晕病临床证候评价量表评分均低于治疗前(P<0.01),且治疗组均低于对照组(P<0.05或P<0.01).治疗后,两组病人hs-CRP、Hcy水平均低于治疗前(P<0.01),两组间hs-CRP水平比较差异有统计学意义(P<0.05),两组间Hcy水平比较差异无统计学意义(P>0.05).治疗后,两组病人双侧椎动脉、基底动脉平均血流速度和血管搏动指数较治疗前均有明显改善(P<0.01),且治疗组改善程度均优于对照组(P<0.05或P<0.01).结论 麦粒灸"中风七穴"联合常规西药治疗能够明显改善后循环缺血性眩晕病人的眩晕程度、脑血流量,抑制炎症反应,提高临床疗效.

干眼是眼科疾病中发病率较高的一种慢性眼表疾病,容易反复发作,给人们的生活、工作和学习带来严重影响.中医针灸在治疗干眼方面发挥了其独特的优势,受到眼科工作者的广泛关注.实验研究发现针灸能够抑制炎症因子促炎活性反应、增加泪腺中乙酰胆碱的含量、抑制泪腺组织细胞凋亡、促进泪液中黏蛋白表达、改善性激素水平及泪腺代谢,从而促进泪液分泌达到缓解干眼的效果;临床研究运用针法、灸法以及针刺联合其他辅助疗法治疗干眼,疗效显著.本文通过参阅近5年针灸治疗干眼的相关文献,从实验研究与临床研究两方面,总结针灸治疗干眼的作用机制及疗效研究进展,同时指出针灸在实验及临床研究中存在的一些不足之处.

新型冠状病毒肺炎(NCP)疫情形势严峻,自2019年12月爆发至今,已由湖北武汉迅速蔓延至全国各地.这种新型冠状病毒(2019-nCoV)具有人群普遍易感性,主要通过呼吸道飞沫及密切接触而传播.在相对封闭的环境中长时间暴露于高浓度情况下存在经气溶胶传播的可能,则可能会导致病毒性结膜炎的发生,增加眼科门诊或急诊医务人员与疑似感染2019-nCoV患者接触的可能,增加眼科医务工作者职业暴露风险.此文就2019-nCoV特点及临床表现、眼科医务工作者分级防护、眼科门诊2019-nCoV防控、中西医结合临床防控建议进行阐述,以期减少2019-nCov高发期对眼科医护人员的感染,充分做好防护措施以及在诊疗过程中如何有效应对“新型冠状病毒性结膜炎”.

中风自古是难治疾病,现代多重视药物治疗.艾灸治疗中风在我国有悠久的历史,可以有效改善脑血流自动调节功能,现代也不乏临床研究.古代医家重视灸法在中风病防治中的作用.本文通过整理、归纳、总结古代和现代对艾灸治疗中风的经典与文献,进行古代和现代的对比论述,介绍艾灸在急性中风中的应用,说明艾灸的特色及有效性,同时提出目前临床研究中存在的问题,为临床深入研究提供指引.

目的:探讨偏头痛受风热侵袭后机体发生痛觉敏化的病理机制及芎芷地龙汤对模型的治疗机理.方法:使用热风及硝酸甘油协同诱导建立大鼠偏头痛风热证模型,观察2h内搔头次数,用免疫组化法测定三叉神经脊束核GLU、NR2B、nNOS表达情况.结果:偏头痛模型组、偏头痛风热证组2h内搔头次数明显增多,与正常组、风热组、中药治疗组相比,差异有统计学意义(P＜0.01);偏头痛模型组、偏头痛风热证组三叉神经脊束核尾部GLU表达、NR2B表达、nNOS表达均明显上调,与正常组、风热组、中药治疗组相比,差异有统计学意义(P＜0.01).结论:风热对正常机体无影响,而对硝酸甘油致偏头痛模型病理状态有显著影响,说明风热外袭致偏头痛痛觉敏化的发生,芎芷地龙汤能明显改善偏头痛动物模型的行为学症状,减少动物的阳性反应次数,减少三叉神经颈复合体中Glu、NR2B、nNOS表达.

Objective To study the effect of Xiongzhi Dilong decoction(XDD)on vasoactive substance in migraine with wind heat syndrome.Methods To establish migraine with wind heat syndrome model by combining exterior pathogen (hot wind)and GTN ad-ministration,examine the frequency of scratching head within 2 h,and survey the content of thromboxane B2 (TXB2 ),6 Keto PGF1α,calci-tonin gene related peptide(CGRP),endothelin(ET)in blood plasma by radioimmunoassay technology.Results The content of TXB2 ,ET and CGRP in plasma of migraine model was significantly higher than normal group and wind heat group,and the content of 6 Keto PGF1αwas significantly lower than normal group and wind heat group.The content of TXB2 ,ET and CGRP in plasma of migraine with wind heat syndrome moldel persistently increased,and The content of 6 Keto PGF1αpersistently decreased,which is significant difference compared to normal group(P<0.01),and is significant difference compared to migraine model group(P<0.05). The content of TXB2 ,ET,CGRP and 6 Keto PGF1αin plasma of Chinese medicine treatment group is recovered,which was signifi-cant difference compared to migraine with wind heat syndrome model and migraine model group(P<0.05).Conclusion There was no significant effect on normal organism which sufferd from wind heat,But there was significant effect on migraine model induced by Nitroglycerin,The vasoactive substance of Migraine model which was invaded by wind and heat was disbalance severely.XDD could ameliorate remarkably disbalance state of vasoactive substance in wind heat syndrome migraine model.

Objective:To observe the effects of CHSG powder on ERK and P-ERK in hippocampus of rats with liver-qi stagnation.Methods:The rats were divided into three groups:control,model and CHSG powder group.This animal model is made by the method of confining the rats'movement.The cell numbers of ERK1/2、P-ERK in CA1、CA3 and DG sections of hippocampus in different groups were observed by immunohistochemical method.Results:CHSG powder can significantly improve the cell numbers of ERK1/2、P-ERK in CA3 and DG sections of hippocampus.Conclusion:CHSG powder has antagonism against liver-qi stagnation by improving the cell numbers of ERK1/2、P-ERK in CA3 and DG sections of hippocampus.

Objective:To observe the acupuncture treatment on depression patients with two TCM syndromes,one is stagnation of liver-qi and deficiency of the spleen(GP),the other is the syndrome of double deficiency of the heart and the spleen(XP).Methods:We have selected 12 patients of GP and 8 patients of XP.Two groups were selected different points before acupunture treatment,every subject were checked using Hamilton rating scale for depression(HAMD)and measuring scale of TCM syndrome as a clinical evaluation.Results:The GP group showed conspicuous therapeutic effect but the XP group didn't.Conclusion:In the end of the 3 weeks' treatment ,performanced on above acupuncture points ,conspicuous therapeutic effects were found within the GP group but not within the XP group.

Objective To study the influences of Chaihushugan Powder on the ethological changes and levels of serum gastrin(GAS) and plasma motilin(MTL) in rat model of liver depression syndrome.Methods All rats were divided into the blank control group,the model group of liver depression syndrome and the Chaihushugan Powder group.The method combining die bound and lonely feeding was used to establish the rat model of liver depression syndrome.The changes of ethological indexes of immobility time in forced swimming test were observed after the administration of Chaihushugan Powder,and the levels of serum GAS and plasma MLT were detected by using radioimmunoassay.Results Chaihushugan Powder reduced the immobility time in forced swimming test,and increased the levels of serum GAS and plasma MTL in the rat model of liver depression syndrome.Conclusion Chaihushugan Powder has the effect of antagonizing liver depression and the mechanism may be related to that it can regulate the levels of serum GAS and plasma MTL.

通过总结《临证指南医案》中关于"络虚则痛"的病案,分析归纳叶天士对"络虚则痛"的发病病因、临床表现、证候诊断和治疗特色等规律,加深对络虚疼痛的理解,提高在临床中对于络虚疼痛的发病、诊断和治疗的规律性认识。

It's the disturbance in ascending and descending that induces the five kinds of depression syndrome and all these have close relation with abnormal weather in four seasons.Time regularity must be obeyed while treating the five kinds of depression syndromes.This has been specially emphasized in Chinese medicine and it's only one specific explaination of this treatment principle to treat the depression of wood(liver)by springing it.

Objective:To find the regularity of the non-linear dynamics of electroencephalogram within the depression patients with two TCM syndromes,one is stagnation of liver-qi and deficiency of the spleen(GP),the orther is the syndrome of double deficiency of the heart and the spleen(XP).Methods:We have selected 11 patients of GP,8 patients of XP and 11 normal testees(NM).The data of EEG under auditory tusk(the name of oneself,the name of others) were analyzed by the parameter of the correlation dimension(D2).Results: The three groups showed no conspicuous differents D2 at silence condition with the eyes closed.The D2 of XP under name calling condition is higher than mormal in both hemisphere.The GP group usually has the opposite level of D2 than NM between the right and the left hemisphere.There is a much lower level of D2 at F7 with all two groups of patients than normal groups.Conclusion:①The name calling can evocation the abnormal appearance of D2 with patients of depression.②Depression patients with different TCM syndrome has different D2 distribution.③The decreasing of the electric activity of rostrolateral prefrontal cortex may play an important role in inducing depression.

The reason of the superposition of five vital essences is the deficiency of five zang organs.It's the deficiency that induces stagnancy syndrome and then induces the superposition,and the syndrome turns to excess syndrome from a deficiency one.When one of the five zang organs is excessive,the emotion which controlled by it can be showed out.So one will become afeared because of the deficiency of liver-qi and irate because of the excess of liver qi;and one will feel sorrow when heart-qi is deficiency and euphoric when it's excessive.The emotion will change according to the different conditions(deficiency or excess) of the five zang organs.