慢性肾衰竭多久病致虚，气虚血弱，运行不畅，水湿、浊毒、瘀血内停致病，多属本虚标实之证。陈明教授基于“脾肾亏虚、浊瘀内阻”的病机，认为“扶正化瘀降浊通络法”是治疗慢性肾衰竭的重要治法，通过辨证论治，灵活选药，临床获益颇丰。本文系统阐述扶正化瘀降浊通络法的理论内涵，以期为中医药治疗慢性肾衰竭提供理论依据。

大黄廑虫丸出自于张仲景的《金匮要略》,具有补虚缓中、生新祛瘀的功效.该方已经广泛运用于多种疾病的临床治疗,并取得了肯定的疗效.多器官纤维化的研究表明大黄廑虫丸能够减缓心、肝、肾、肺等器官纤维化的发展进程,在临床和实验研究中均收获了良好的效果.该文通过综述大黄?虫丸治疗多器官纤维化的实验机制研究发现,虽然各器官纤维化发病部位不同,但其发病机制联系紧密,从中医角度来讲,这类疾病存在着共同病机,即均为"虚劳"状态,疾病日久导致病理产物"干血"的形成.从现代医学的角度来看,这类疾病均出现细胞外基质(ECM)沉积的病理改变,其发生发展都落脚在某些效应细胞[如肝星状细胞(HSC),胰腺星状细胞(PSC)等],并有着相同的细胞[如肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),IL-1β,α-平滑肌肌动蛋白(α-SMA)等]及某些关键通路[转化生长因子-β1(TGF-β1)/Smad,磷脂酰肌醇3-激酶(PI3K)/蛋白激酶B(Akt),脂多糖(LPS)旁分泌和自分泌机制等]参与其中.大黄?虫丸作为仲景治疗"虚劳干血"的经典方剂,治疗纤维化的作用可能是通过对上述机制的干预起到抑制ECM沉积,从而缓解疾病进程的作用.希望通过该综述为阐明大黄?虫丸治疗多器官纤维化的科学内涵提供文献支持,同时为进一步实验及临床研究奠定基础.

目的 分析会阴部坏死性筋膜炎(NF)合并糖尿病的临床特点并总结其治疗方法.方法 回顾性分析成都中医药大学附属医院2013-2017年期间收治的48例会阴部NF患者的临床资料,比较糖尿病和非糖尿病以及死亡和存活患者的临床特点、细菌培养结果及实验室指标如白细胞计数(WBC)、血小板(PLT)、C反应蛋白(CRP),血清钠离子(Na+)、钾离子(K+)、钙离子(Ca2+)及血糖水平.结果 48例患者中男28例,女20例;糖尿病患者29例,非糖尿病患者19例;细菌培养结果阳性36例,阴性12例;死亡10例,存活38例.①糖尿病和非糖尿病患者在性别、24 h内手术、入住ICU和死亡患者人数比例以及年龄、发病至入院时间和ICU住院时间比较差异均无统计学意义(P＞0.05).糖尿病组患者克雷伯菌感染率明显高于非糖尿病患者(P＜0.05);2组患者入院后第1、3及7天的CRP、WBC、PLT、Ca2+、Na+、K+水平比较差异均无统计学意义(P＞0.05).②死亡患者与存活患者的性别、24 h内手术比例以及年龄、发病至入院时间、ICU住院时间比较差异均无统计学意义(P＞0.05),死亡患者中入住ICU人数比例明显高于存活患者(P＜0.05);死亡患者和存活患者的细菌培养结果阳性率比较差异无统计学意义(P＞0.05);存活患者入院后第1和3天时的PLT均明显高于死亡患者(P＜0.05),其他实验室指标比较差异均无统计学意义(P＞0.05).结论 NF需要早诊断、尽早手术并进行多学科会诊,从而进行全方位的治疗;合并糖尿病的患者在早期经验性运用抗生素治疗时应考虑运用对克雷伯菌敏感的抗生素.

目的:观察活血通络汤防治兔激素性股骨头坏死(SANFH)的疗效及PDGF、BMP-2及Notch3的表达变化,并探讨相关机制.方法:将192只日本大耳兔随机分为预防+治疗组A、治疗组B、模型对照组C、空白对照组D,每组各48只.A、B、C三组均在第3周开始造模,造模周期6周.A组在造模前一周开始喂服中药;B组于造模时开始喂服中药饲料;C、D两组均喂服等量普通饲料.动态观察每组家兔的机能情况;于造模前、造模中、造模后相对应的时间点应用Elisa法、RT-PCR法检测家兔血中PDGF、BMP-2及Notch3的含量;并于造模结束后取股骨头做病理镜检观察骨细胞,计算空骨陷窝率.结果:①PDGF:第8周末时,A、B两组的含量均高于C组(P＜0.05),且A组高于B组(P＞0.05);②BMP-2:第8周末时,A、B两组的含量均显著高于C组(P＜0.01),且A组的下降趋势较B组缓和;③Notch3:在第8周末时,A、B两组的表达值均低于C组(P＜0.01、0.05),且A组低于B组(P＞0.05).结论:①SANFH的发生及骨坏死的进展与Notch3蛋白基因的表达呈正相关,而与PDGF、BMP-2的表达成反相关;②活血通络汤预防治疗SANFH的机制可能是通过抑制Notch3蛋白基因而上调PDGF、BMP-2的表达来刺激血管活性,改善股骨头血供并诱导BMSCs向成骨细胞分化增殖,促进骨修复而发挥预防治疗作用.

Objective:To study the effects of Huoxue Tongluo Decoction on Notchl,DLL3 and HERP1 in the process of steroid induced avascular necrosis of femoral head (SANFH) in rabbits.Methods:A total of 192 Japanese large-eared rabbits were randomly divided into prevention and treatment group (A),treatment group (B),model control group (C),blank control group (D),with 48 rabbits in each group.The A,B and C groups were modeled by HE Xi-jing modeling.Group A began to feed Chinese medicine feed at the second week,Group B began to take traditional Chinese medicine feed at the third week,and C and D group were fed the same amount of ordinary feed.At the end of second,fifth and eighth week,8 rabbits were selected randomly to test expressions of serum Notchl,DLL3 and HERP1,and the pathological examination of femoral head was performed to calculate the rate of empty bone lacuna.Results:There were statistically significant differences between the expression values of Notch1,DLL3 and HERP1 in different groups,and the analysis of the cava rate was statistically significant (P＜0.05,P＜0.01).Conclusion:Huoxue Tongluo Decoction can limit the expression of Notch1 and HERP1,down regulating the expression level of DLL3,to reduce the rate of empty lacunae,promote the repair of osteonecrosis.

股骨头坏死属于中医“骨痹”“骨蚀”的范畴,是骨科常见病、疑难病.中医认为该病的基本病机是肾虚精亏、痰瘀痹阻,应采用补肾健脾、活血通络的治疗原则.中医治疗该病手段多样,对于中早期的非创伤性股骨头坏死有显著优势.对近年来中医治疗非创伤性股骨头坏死的方法进行总结,为该病的临床治疗提供参考.

股骨头缺血性坏死是骨科常见的且难治病之一,在既往的治疗中单纯采用"补肾活血法"往往效果欠佳.近来发现脾脏亏虚,脾失健运在股骨头坏死的发生、发展中起着重要作用,故在临床实践中,以中医学理论为指导,以脾出发治疗股骨头坏死,在活血补肾的基础上兼以健脾祛痰,缓解病情、延缓其发展,在早中期疾病的治疗中取得较好的效果.

Objective To explore the echocardiography on the right heart function of patients with different duration of chronic cor pulmonale (CP).Methods 40 cases acute exacerbations CP and 40 cases remission period CP.And 40 cases healthy subjects were collected as the control group.The two and three-dimensional echocardiography tests were used to detect the right ventricular functions.Results The two-dimensional echocardiography test showed that S' in 3 groups had no difference (P＞0.05).Compared with the control group,the collapse index,FAC,TAPSE,TVE/TVA,TVE/Tve,and E peak deceleration time had decreased and the other indexes were increased in the CP group(P＜0.05).Compared with the remission period CP,the collapse index,FAC,TAPSE,TVE/TVA,TVE/Tve,and E peak deceleration time had decreased and the other indexes were increased in the acute exacerbations CP group(P＜0.05).The three dimensional echocardiography showed that rEDV and rESV in right ventricular inflow tract,right ventricular outflow tract and apex trabeculae in CP group were higher than those in the control group (P＜0.05).Compared with remission CP group,the rEDV and rESV of right ventricular inflow tract,right ventricular outflow tract and apex trabeculae were increased in the acute exacerbation CP group(P＜0.05).Conclusions Echocardiography can assess the morphology structure and function change of right ventricular of CP.

目的:通过研究活血通络汤在激素性股骨头坏死(SANFH)家兔造模过程中对AKP(碱性磷酸酶)、BGP(骨钙素)、TNF-α(肿瘤坏死因子α)的表达变化,来阐述活血通络汤预防性治疗激素性股骨头坏死的作用机制,为活血通络、补肾健骨法预防性治疗股骨头坏死提供理论依据.方法:将192只日本大耳兔随机分为4组,预防+治疗组A、治疗组B、模型对照组C、空白对照组D各48只,A、B、C组在第3周时均采用贺西京造模法制造激素性股骨头坏死模型.A组第2周开始喂服中药饲料,B组第3周开始喂服中药饲料,C、D组均喂服等量的普通饲料,并于第2、5、8周末开始随机抽取8只兔子检测血中AKP活性、BGP及TNF-仅的水平,并且观察股骨头一般形态,股骨头坏死率,计算空骨陷窝率等.结果:在2、5、8周末各组间比较:在血清AKP方面,在各周末C组均比D组高,而A均低于C组.在血清BGP方面,在各周末C均比D组低,而A、B组在第2、5周末时与C组比较无统计学意义,第8周末时,A、B组与C组比较,A、B组明显高于C组.在血清TNF-α方面,在各周末C组均比D组高.而A组在第2、5周末时与C组比较无明显差异,但第8周末时,A与C组相比较,A组明显低于C组.在骨陷窝率方面,C组的骨陷窝率整体呈上升趋势,B、C组均逐渐递增,但B组递增幅度小于C组.结论:活血通络汤能够抑制血中AKP的水平,降低TNF-α的表达,成骨细胞在活血通络汤的作用下,能够合成并分泌大量的BGP,参与成骨细胞形成新骨的过程,促进坏死组织的恢复.

Objective To analyze the application value of thyroid imaging reporting and data system(TI-RADS),contrast-enhanced ultrasonography(CEUS),and combined use of them in the differential diagnosis of benign and malignant thyroid nodules. Methods Eighty-seven patients with thyroid nodules treated in Chongqing Traditional Chinese Medicine Hospital from January 2015 to December 2016 were selected as the subjects.All the patients were examined by CEUS,TI-RADS and combined examination.Taken the operational and pathological results as the gold standard,we compared the sensitivity,specificity and accuracy of the 3 examination methods for the differential diagnosis of benign and malignant thyroid nodules.Results There were 117 thyroid nodules,95 benign nodules and 22 malignant nodules in 87 patients.The maximum diameter of nodules was 0.54-5.19 cm,and the average diameter was(1.50+0.76)cm.The sensitivity,specificity and accuracy of TI-RADS in the diagnosis of benign and malignant thyroid nodules were 45.45%(10/22),64.21%(61/95)and 60.68%(71/117),respectively.The imaging characteristics of benign and malignant thyroid nodules were significantly different in early enhancement, homogeneous enhancement,and peripheral ring enhancement images(P<0.05).The sensitivity,specificity and accuracy of CEUS in the diagnosis of benign and malignant thyroid nodules were 72.72% (16/22), 92.63% (88/95) and 91.45%(104/117) on early enhancement images;72.72%(16/22),74.73%(71/95)and 74.35%(87/117)on homogeneous enhancement images;and 95.45% (21/22)and 31.57%(30/95)and 43.58%(51/117)on peripheral ring enhancement images.The sensitivity,specificity and accuracy of TI-RADS combined with CEUS in the diagnosis of benign and malignant thyroid nodules were 90.90%(20/22), 95.78% (91/95)and 94.87%(111/117).Conclusion TI-RADS combined with CEUS can effectively improve the sensitivity,specificity and accuracy of the differential diagnosis of benign and malignant thyroid nodules.

目的 探讨非典型腰椎间盘突出症的发病原因、诊断及治疗,提高临床医生的关注度,减少误诊或漏诊的发生.方法 回顾性分析我院门诊2015年12月-2016年6月收治的以髋关节疼痛为主要表现的20例患者的临床资料.结果 所有患者均行腰部CT或MRI检查证实存在腰椎间盘多节段膨出或突出,采取非手术方式治疗均取得明显效果.结论 对于临床无明显急性腰部外伤史,仅表现为髋关节疼痛的患者(排除髋部疾病),可及早行腰部CT或MRI检查以明确诊断,对确诊为腰椎间盘突出症患者采取非手术治疗方式可取得显著疗效.

介绍江蓉星教授采用中西医结合治疗膝关节骨性关节炎的经验.江教授认为本病的病因病机以肝肾亏虚为本,风寒湿侵袭为标.临床采用中西医结合治疗,中医治疗在健脾益肾、柔肝补血的基础上加祛风、散寒、除湿、化瘀、温阳等驱邪之品,用骨关节炎Ⅰ号方随证加减;西医治疗应用玻璃酸钠及得宝松关节腔注射,以控制关节疼痛、肿胀.中西医结合能很好地发挥两者的优点,标本兼治,疗效显著.

Objective:To research the influences of Huoxue Tongluo Decoction on expression of AKP,Jagged1 in the prevention of steroid induced avascular necrosis of the femoral head (SANFH) in rabbits modeling process.Methods:One hundred and ninty-two Japanese rabbits were randomly divided into A (blank group),B (model group),C (treatment group),D (prevention group) groups,each group with 48 rabbits.In the third week,A,B,C groups began to use the HE Xi-jing modeling method,modeling cycle for 6 weeks and D group is blank group.The femoral head morphology and the dynamic change of AKP,Tagged 1 in serum during were observed at the end of second,fifth,and eighth week.Meanwhile,the femoral head was examined by optical microscope and ratio of empty lacuna was calculated.Results:The expression of Jagged1 was gradually increased in the four groups,where the expression of Jagged1 in model group was the highest,and there was no statistic difference between the A group and treatment group.The concertation of AKP showed gradual increase in the A group,B group and C group,and the concertation of AKP in A group was significantly lower than that in B and C group,especially the C group.The Bone lacuna rate showed a gradual increase in the B and C group,especially the C group,however,the Bone lacuna rate in A group showed a decreasing trend.Conclusion:Huoxue Tongluo Decoction effectively improves the hypoxic environment of femoral head ischemia,and thus effectively interfere with the formation of avascular necrosis of the femoral head that may be related to significantly down-regulate the expressions of Jagged1 and AKP,which are able to promote the angiogenesis,calcium content in bone,bone metabolism,reduce the loss of bone calcium and promote bone maturation.

骨关节结核病因主要包括正气亏虚、感染“痨虫”、外感邪气、饮食不节及痰浊、跌打损伤、情志内伤等;正虚体弱,感染痨虫,邪毒乘虚内侵,耗伤气血,致气机不畅、瘀血壅塞,化腐成脓蚀骨为该病基本病机.该病以本虚为主,感染“痨虫”是关键,六淫外邪、情志和跌打损伤是其常见的诱因.治疗上,扶正补虚、抗痨杀虫贯穿疾病始终.

目的:对针灸配合中药熏蒸治疗类风湿关节炎的具体方法以及疗效进行详细探究.方法:在本次研究中,选取2015年5月至2016年5月本院收治的60例类风湿关节炎患者参与本次研究,根据治疗方法不同,将60例类风湿关节炎患者分为对照组30例和观察组30例.对于对照组患者,采用中药熏蒸法进行治疗.对于观察组患者,采用中药熏蒸法治疗方法的基础上联合应用针灸治疗措施.结果观察,观察患者关节疼痛的VAS评分.结果:在对患者实施治疗前,两组患者的关节疼痛VAS评分没有明显差异,P>0.05.在对两组患者分别实施治疗后,两组患者疼痛VAS评分均明显降低,治疗前后差异具有统计学意义,P<0.05.另外,观察组患者的疼痛VAS评分明显低于对照组患者,组间差异具有统计学意义,P<0.05.结论:对类风湿性关节炎患者行针灸配合中药熏蒸治疗模式,可以有效的改善患者的疼痛程度,提高患者的治愈率,改善患者预后,值得推广和应用.

刘立华是万州区中医院主任医师，重庆市第2批老中医药专家学术经验继承工作指导老师，是重庆市名老中医专家传承工作室导师。从事医、教、研工作近50载，善用经方治疗各种疑难杂症，屡起沉疴。现将其应用六味地黄丸的部分临床经验总结如下。

目的 回顾以往针灸文献,总结火针的治病规律,以期用现代医学语言对该疗法的作用机制进行明确阐述.方法 以近10年来与火针疗法作用机制相关的文献为基础,从火针之温热的特点着手对该疗法的作用机制进行探讨.结果 该疗法可以改善血液循环、提高免疫、抗炎、抗癌、对神经及组织修复等.结论 火针被广泛应用于痹症、皮肤病、哮喘、癌症等疾病.

目的 对四川省2010年至2012年二级及其以上医疗机构的科研立项情况进行调查分析.方法 根据“四川省医院科技能力评价指标体系”自行设计四川省二级及其以上医疗机构的科技能力调查问卷袁,提取调查问卷表中关于科研立项的相关数据,并采用EXCEL、SPSS建立数据库,进行描述性分析和统计分析.结果 四川省共499家医疗机构,从机构等级来看,三级医院106家(21.24％),二级医院393家(78.76％);从机构类别来看,综合医院最多为282家(56.51％).课题立项情况:①2010年至2012年,课题立项总数逐年由1957项增加到2112项,课题立项增多,3年共计全省课题立项总数为5983项,其中国际级课题35项(0.58％);国家级课题686项(11.47％);省部级1139项(19.04％);市厅级课题数1418项(23.7％);县局级及其他2661项(44.48％).②2010年至2012年从医院等级看,三甲医院课题立项最多,达到4915项(82.15％),其院均立项数为84.74项,远高于其他等级的医院.课题经费情况,从医院等级看,全省共计73997.68万元,86.04％课题经费集中在三甲医院,得到的政府资金支撑的项目更多.从单位自筹经费的比例来看,等级越低的医院单位自筹的比例越高,所得到的政府资金支持越少;三甲医院(24.06％)与二乙及未评等医院(85.68％)差异巨大.省部级及以上经费也主要集中在三级医院,且其占经费总额的比重达71.03％.省部级及以上课题经费额所占的比例、平均项目经费,不同等级医院之间差异较大,三甲医院平均省部级及以上项目经费,远高于其他等级的医院.人均课题经费额,三甲医院远高于三乙医院,高于二级医院.结论 四川省的课题立项3年逐渐增加,且多集中在三甲医院.三甲医院的科研立项、科研经费均高于三乙医院及二级医院,符合目前医疗机构的评审要求.但三甲医院的项目多集中在省市级课题,国家级及国际级项目数很少,级别有待提高.

Objective To explore the clinical and echocardiographic features of atrial myxoma .Methods Eleven patients(6 fe‐male ,7 male) with atrial myxoma were included in the study .They all received echocardiography examination and the results were confirmed by pathological examination .Results The clinical manifestation included chest distress ,palpitation ,fever ,syncope ,cere‐bral infarction and arrhythmia .Physical signs included diastolic murmur ,systolic and diastolic murmurs and tumor plop .The atrial myxomas were all single tumor and mostly in left atrium .Ultrasonography features of atrial myxoma were slightly hyperechoic mass in atrium ,clear boundary ,lobulated part ,uniform internal echo .Most tumors have a pedicle attached to the atrial septum ,with the cardiac cycle swing ,concomitant with atrial enlargement and inferior vena cava widened .Conclusion Individual difference in clinical manifestations of atrial myxoma is great ,but the ultrasonic manifestation is typical .As the first examination ,ultrasound can be used as the preferred examination of the disease .

骨质疏松症相当于中医中的“骨痿”,绝经后妇女骨质疏松症与肝、脾、肾三脏关系尤为密切.肾虚、肝虚、脾虚、血瘀均可导致本病的发生.本病本虚标实,以本虚为主,需遵循补肾、健脾、活血调肝的治疗原则.对绝经后妇女骨质疏松症的病因病机及治疗方法进行阐述,丰富中医药对绝经后骨质疏松症的认识.