目的 基于网络药理学探讨雷公藤多苷片治疗支气管哮喘的作用机制.方法 通过文献检索雷公藤多苷片的主要化学成分,采用TCMSP、SwissTargetPrediction数据库查找其对应靶点,在OMIM、DrugBank、GeneCards、TTD数据库中得到哮喘相关靶点,预测雷公藤多苷片作用于哮喘的潜在靶点,构建蛋白互作网络及"化合物-靶点"网络,对核心靶点进行GO和KEGG分析,最后对预测靶标与其对应的成分进行分子对接验证.结果 获得雷公藤多苷片主要化学成分 22 种,对应靶点 691 个,筛选出与哮喘相关靶点 379 个,包括PIK3CA、APP、FPR2、CASR等 9 个关键靶点.KEGG分析得到与哮喘相关性较大的通路有 6 条,包括PI3K/Akt、MAKP、Ras、cAMP、Calcium和Chemokine信号通路.结论 雷公藤多苷片可能通过PIK3CA、APP、FPR2 等关键靶点干预PI3K/Akt、MAKP等信号通路对哮喘气道炎症反应和气道重塑等过程产生影响.

"一气周流"的基本理论体系为中土为枢,气机升降运转.基于"一气周流"理论,认为本病的主要病机为脾虚痰伏,斡旋失司;肝木郁滞,风盛气逆;肺金亏虚,痰瘀互结;肾虚不纳,命门火衰.中气失于斡旋为本病发生发展的关键.治疗上应以恢复中气升降为核心,可采用健运中土、祛风调肝、培土生金,化痰祛瘀、补肾固本等治法,促使一身之气运行流畅,则疾病自消.

目的:观察鼻鼽通窍方鼻喷雾剂治疗儿童变应性鼻炎(AR)肺经伏热证的临床疗效,并评价其安全性.方法:选取2021年3月～2022年1月就诊于成都中医药大学附属医院儿科门诊并诊断为变应性鼻炎肺经伏热证的60例患儿作为研究对象,随机分为治疗组(n=30)与对照组(n=30).治疗组使用鼻鼽通窍方鼻喷雾剂治疗,对照组使用糠酸莫米松鼻喷雾剂治疗,每日1次,两侧鼻腔各喷1掀,2周为1疗程,共治疗2个疗程.比较两组临床总疗效、鼻部症状总评分(TNSS)、鼻腔体征积分、中医次症积分.结果:治疗组临床总有效率80.00％,对照组临床总有效率96.67％;两组鼻部症状总评分(TNSS)、鼻腔体征积分、中医次症积分均明显下降,与同组治疗前比较,差异有统计学意义(P＜0.05);治疗组在改善咽痒、口干烦热、头痛等中医单项次症要优于对照组,差异有统计学意义(P＜0.05);在2个治疗疗程内及后续回访1周,两组均无不良反应出现.结论:鼻鼽通窍方鼻喷剂用于治疗AR患儿肺经伏热证,可有效改善鼻部症状、鼻体征、中医单项次症,疗效显著,具有临床意义.

Background Danlong Dingchuan Decoction has a definite effect in the clinical treatment of asthma. This study aimed to explore the material and molecular biological basis of Danlong Dingchuan Decoction in treating asthma through network pharmacology combined with animal experiments. Materials and Methods First, the chemical constituents of Danlong Dingchuan Decoction were screened from the Traditional Chinese Medicine Systematic Pharmacology Analysis Platform (TCMSP) and the Traditional Chinese Medicine and Chemical Composition Database. Literature reports on asthma targets were obtained from the Online Mendelian Inheritance in Man (OMIM), Therapeutic Targets Database (TTD), and other databases. Then, the protein-protein interaction network was constructed according to the matching results of Danlong Dingchuan Decoction and asthma targets. Furthermore, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed by the Database for Annotation, Visualization, and Integrated Discovery (DAVID). Finally, the interaction between the active compounds of Danlong Dingchuan Decoction and key targets was simulated using molecular docking. In animal experiments, ovalbumin was used to induce asthma in mice. After treating the mice by oral gavage administration of Danlong Dingchuan Decoction, the expression levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were detected in the lung tissue of the mice by enzyme-linked immunosorbent assay kit, whereas TLR4 mRNA expression was detected by quantitative reverse transcription-polymerase chain reaction. Results A total of 247 active compounds and 155 potential targets were obtained. Enrichment analysis showed that quercetin, xanthine, lysine, kaempferol, ß-sitosterol, and four other active compounds were the main components of Danlong Dingchuan Decoction; IL-6, TNF, CXCL8, VEGFA, MAPK3, IL-10, PTGS2, IL-1β, IL-4, and TLR4 were the potential targets for therapy. KEGG analysis showed that the cAMP signaling pathway, cGMP-PKG signaling pathway, NF-κB signaling pathway, and PI3K-Akt signaling pathway might play an important role in treating asthma. Molecular docking analysis showed that quercetin combined well with TNF, CXCL8, and TLR4. Animal experiments showed that Danlong Dingchuan Decoction effectively reduced the expression levels of TNF-α, IL-4, TGF-β1, IL-6, IL-8, and IL-1β in the lung tissue of asthmatic mice and inhibited TLR4 mRNA expression. Conclusions Danlong Dingchuan Decoction may act on key targets (such as IL-6, TNF, CXCL8, VEGFA, and MAPK3) with key active ingredients (such as quercetin, xanthine, lysine, kaempferol, and ß-sitosterol) to reduce the expression levels of IL-4, IL-6, IL-8, and other Th2 cytokines. This may be the mechanism by which Danlong Dingchuan Decoction reduces airway inflammation and treats asthma mediated by Th2 cytokines.

从经络联系、共同主气、同为"水源"及金水相生4个方面探讨了肺肾相关,指出哮喘"治肾"的可行性,并提出哮喘的基本病机是"肾阳虚-痰气交阻-痰瘀互结",进一步为哮喘以"肾阳虚"辨治提供理论依据.肾阳虚深刻地影响着哮喘的发病,是"伏痰""瘀血"形成的关键,"肾阳虚-痰气交阻"是哮喘发作的内在机制,"肾阳虚-痰瘀互结"关乎气道重塑和夙根,是哮喘难以根治的关键.温肾阳是哮喘的一种重要治法.

目的:金水六君煎是治疗哮喘肺肾不足证的临床常用方.本研究旨在通过网络药理学结合动物实验探讨金水六君煎治疗哮喘的物质基础及分子生物学基础.方法:在中药系统药理学分析平台(TCMSP)筛选金水六君煎化合物成分,从OMIM、TTD等数据库获取哮喘的相关靶点.根据韦恩图获取金水六君煎与哮喘的共同作用靶点并构建化合物-疾病共同靶点的蛋白互作分析(PPI)网络.用David数据库进行基因本体(GO)分析和京都基因与基因组百科全书(KEGG)通路富集分析.以分子对接形式模拟金水六君煎活性化合物与关键靶点间的相互作用.在动物实验中,以鸡卵清蛋白(OVA)诱导哮喘小鼠模型,经金水六君煎灌胃处理后,HE染色观察小鼠肺组织病理学变化,PAS染色观察气道上皮杯状细胞增生情况,ELISA法检测小鼠血清白细胞介素-6(IL-6)、IL-1β、IL-8的含量.结果:共筛选出金水六君煎活性成分312种,潜在作用靶点77个,关键有效成分包括豆甾醇、槲皮素、β-谷甾醇等,关键靶点包括IL-6、丝裂原活化蛋白激酶3(MAPK3)、CXCL8等.GO分析结果显示金水六君煎发挥治疗哮喘的生物学过程主要与参与RNA聚合酶Ⅱ启动子转录的正调控,调控炎症反应,参与细胞因子活性有关,KEGG分析显示TNF肿瘤坏死因子信号通路、Toll样受体信号通路、T细胞受体信号通路、NOD样受体信号通路可能在哮喘的治疗中起重要作用,分子对接结果显示槲皮素与IL-6结合良好.动物实验结果证实,与正常对照组相比,模型对照组小鼠气道炎性改变明显,PAS评分增加(P＜0.01),血清IL-6、IL-1β含量升高(P＜0.05);与模型对照组比较,泼尼松13.9mg/kg组、金水六君煎5、10、20g/kg组小鼠气道炎症减轻,泼尼松13.9 mg/kg组、金水六君煎5 g/kg组PAS评分显著降低(P＜0.01),血清IL-6、IL-1β含量明显降低(P＜0.05);金水六君煎10 g/kg组PAS评分降低(P＜0.05),血清IL-6含量减少(P＜0.05);金水六君煎20 g/kg组血清IL-6、IL-1β含量明显降低(P＜0.05).结论:金水六君煎可能通过豆甾醇、槲皮素、β-谷甾醇等关键活性成分作用于以IL-6、MAPK3、IL-8为代表的关键靶点,从而调控炎症反应,减少以IL-6、IL-8为代表的Th2型细胞因子分泌从而治疗哮喘.

目的:研究丹龙定喘汤对哮喘小鼠气道重塑及肺组织中高迁移率族蛋白B1(HMGB1)、α平滑肌肌动蛋白(α-SMA)、白细胞介素(IL)-6、IL-8和IL-1β水平的影响,初步探讨丹龙定喘汤防治哮喘气道重塑的作用机制.方法:将180只SPF级雄性BALB/c小鼠随机分为空白对照组,模型组,强的松组,丹龙定喘汤高、中、低剂量组,每组30只.除空白对照组外,其余各组小鼠均用卵清蛋白+氢氧化铝致敏,建立哮喘气道重塑模型.空白对照组、模型组给予0.9％氯化钠溶液,强的松组予醋酸泼尼松,丹龙定喘汤高、中、低剂量组分别给予高、中、低剂量丹龙定喘汤水煎溶液,连续灌胃给药42 d后,分别采集小鼠肺组织,行HE染色,观察肺病理组织学变化;采用IHC免疫组化法检测各组小鼠肺组织中HMGB1、α-SMA的表达情况;采用ABC-ELISA法免疫组化技术检测各组小鼠肺组织中炎症因子IL-6、IL-8和IL-1β的表达情况.结果:与空白对照组比较,模型组有明显气道重塑现象,α-SMA、HMGB1表达显著升高(P＜0.01),IL-6、IL-8、IL-1β含量均显著升高(P＜0.05);与模型组比较,各治疗组气道重塑均得到适当改善,α-SMA表达显著降低(P＜0.01);强的松组IL-6、IL-8、IL-1β含量显著降低(P＜0.05),丹龙定喘汤高剂量组HMGB1表达及IL-6、IL-1β含量显著降低(P＜0.01,P＜0.05);丹龙定喘汤中剂量组HMGB1表达及IL-6含量显著降低(P＜0.05);丹龙定喘汤低剂量组IL-6含量显著降低(P＜0.05),IL-1(3含量显著升高(P＜0.05).结论:丹龙定喘汤能降低肺组织中HMGB1、IL-6、IL-8及IL-1β的水平,减少促中性粒细胞性炎症因子释放,减轻气道中性粒细胞性炎症反应,降低肺组织中α-SMA的水平,减少气道胶原及基质沉积,减轻气道纤维化,从而改善气道重塑.

小儿厌食症是儿科常见病、多发病,治疗不当常影响儿童生长发育,给家庭精神和经济方面带来较大压力.田金娜教授认为小儿厌食症主要原因当属喂养不当,病变部位主要在脾胃与肝脏,与气机升降失司关系密切,治疗上在保证患儿日常调护的基础上,从"通、补、和"三法论治,临床常获良效.对田金娜教授临证经验进行了归纳论述.

"肺常不足"是对小儿生理和病理特点的高度概括.本文从生理和病理方面探讨了其内涵,从解剖生理和免疫学方面浅析了其与现代医学的联系,并据此阐述了"肺常不足"对临床用药和育儿保健的指导意义,以期提高临床疗效,减少疾病发生,促进小儿健康成长.

目的:为临床变应性鼻炎治疗提供新思路和新尝试,从而促进外治法的新发展、新研究.方法:梳理祖国医学、现代医学关于变应性鼻炎外治法的研究进展及临床医疗实践文献,对其临床应用进行深入探讨.本文主要从药物外治、器具外治、手法外治三个方面综述外治法治疗AR临床中的研究进展.结果:其中药物外治涵盖中药穴位贴敷、鼻腔内局部给药、药物足浴3个要点;器具外治包括针刺、耳穴贴压2个要点;手法外治主要论述推拿.结论:运用外治法治疗AR手段多样,疗效显著,值得推广.

中医古籍文献中无"紫癜性肾炎"的记载,据其特点,多将其归属于中医学"紫斑"、"葡萄疫"、"尿血"、"尿浊"、"虚劳"等病范畴.本文力图根据现代医学紫癜性肾炎的主要症状血尿、蛋白尿为核心改变,初步构建中医"紫癜劳"的命名,病因病机及辨证论治的框架.

上气道咳嗽综合征在祖国医学中属于“久咳”的范畴,刘小凡教授认为其病因主要为风、热、痰、瘀互结于体内,尤其重视痰、瘀二因,病位主要在鼻咽与肺.其病机关键在于风痰侵犯肺卫,日久郁而化热,循经上犯,致鼻窍不利,肺失宣肃,治疗大法以疏风散热、宣肺止咳、通窍化痰为主.刘小凡教授自创上咳方治疗该病,并随证加减,获得了良好的效果.

目的 研究中药复方哮宁口服液对哮喘模型小鼠血液代谢表型的影响,初步探讨哮宁口服液止咳平喘效应的作用机制.方法 将60只BALB/c小鼠随机分成空白组15只,造模组45只.造模组腹腔注射两次致敏后,随机均分为模型组、阳性组、中药组,每组15只.用1％OVA高频雾化吸入进行激发,每次激发哮喘前1h,模型组、空白组给予等容积生理盐水灌胃,中药组以哮宁口服灌胃,阳性组以普米克令舒雾化.治疗7天后,分析各组小鼠血清的代谢产物差异.结果 多元统计学方法分析结果显示,空白组、模型组、阳性组、中药组呈显著性分离,其中中药组的血清样本比模型组更靠近空白组.中药哮宁口服液中对血清中偏离的葡萄糖、3-磷酸甘油酸等物质具有明显的良性调节作用.结论 哮宁口服液对哮喘小鼠血清代谢物存在良性调节作用,其中葡萄糖、3-磷酸甘油可能为哮宁口服液治疗哮喘模型小鼠的关键代谢物.

目的 观察哮宁口服液对哮喘小鼠肺组织病理形态学变化的影响.方法 60只BALB/C雌性小鼠随机分为空白组、模型组、阳性组、中药组,采用卵清白蛋白与氢氧化铝致敏,并雾化吸入卵清蛋白激发制备哮喘模型.给药治疗7d后取各组小鼠右肺组织,显微镜下行组织病理形态学观察.结果 模型组、阳性组、中药组小鼠均不同程度地出现搔抓皮肤,呼吸加深加快,缩头弓背,毛发竖立等表现.给药治疗7d后,阳性组、中药组小鼠上述症状和体征基本消失.病理形态学显示:模型组气管壁增厚、分泌物、肺泡破坏减少及炎性浸润最严重,中药组、阳性组炎性细胞浸润、气管分泌物均有所减轻.各组小鼠肺组织病变程度由轻到重依次为空白组＜中药组、阳性组＜模型组.结论 哮宁口服液能改善哮喘小鼠模型的气道炎症,可能是其治疗哮喘的重要机制之一.

中医古代文献中无"肾病综合征"病名的相关记载,根据其临床症状属于中医学"水肿""尿浊""虚劳"等病证的范畴.本文力图以现代医学肾病综合征的主要症状浮肿、蛋白尿为核心改变,初步构建中医"尿浊性水肿"的命名、病因病机及辨证论治的框架.

医学生的临床实习是一个重要的学习阶段,在学习方法、内容、模式上与课堂理论教学相比均不尽相同.笔者认为中医儿科专业学生在临床实习前要做好充分的准备工作,进入临床后要理论联系实际,认真做好临床笔记,总结跟师经验,同时还应具备一定的临床沟通能力,掌握儿科病史收集的技巧,才能适应并顺利完成中医儿科学的临床实习任务.

哮喘气道重塑是当前医学研究的热点和难点,本文从小儿“体禀少阳”探讨祖国医学的阴阳平衡观在儿童哮喘气道重塑中的特点,以期挖掘儿童哮喘病新的治疗原则.

目的:探讨儿童感染性腹泻(Infectious diarrhea,ID)的临床特征及病原菌学流行病特点,为临床防治提供理论依据.方法:回顾性分析我院2010年2月至2014年2月收治并确诊的141例感染性腹泻患儿的粪便培养结果,观察并总结患者体内大肠埃希菌、痢疾杆菌、肺炎克雷伯菌病毒等常见致病细菌的分布情况.结果:儿童感染性腹泻四季均可发病,夏季发病率最高,春季最低;年龄为1月～3岁的患儿感染性腹泻细菌及病毒感染比例显著高于其他两组(P＜0.05);141例患儿中,细菌阳性23例(163％),病毒培养阳性94例(66.7％).各种病毒感染与患儿性别无关(P＞0.05).结论:小儿感染性腹泻四季均较常见,病毒感染比例高于细菌感染比例,应根据病原菌分布情况积极采取预防与控制措施.

According to the implementation of case-based teaching method in teaching TCM pediatrics,the importance of a reasonable set of typical cases is pointed out,through the classroom discussion,explanation to the understand the disease and theory,confirming the feasibility of case teaching method.

Objective To evaluate the efficacy and safety of Zhuli granule and Liquid in treat-infection of the upper respiratory tract with cough and expectoration.Methods The randomized controlled method was conducted.240 patients were randomly divided into the treatment group and control group,both groups were all treated for 7 days.The accumulated scores of clinical symptoms and physical sign,adverse effect were recorded before and after the treatment.The safety indexes,such as routine tests of blood,urine and stool,hepatic and renal function tests and electrocardiogram(ECG)were taken before and after the treatment.Results There is no difference effect of infection of the upper respiratory tract nor of Chinese medicine syndrome between the two groups..But of the effect of cardinal symptom of cough and expectoration:efficacy rate and total efficacy rate of PPS were 96.61%,81.90%in group A and B respectively.out time of cough and expectoration were(5.4±0.8)d,(9.3±0.8)d respectively.there were significant difference between the two groups(P < 0.05).No Obvious adverse effect was found in the trial.Conclusion Zhuli Granule and Liquid are effective and safe in treating infection of the upper respiratory tract.effect of cough and expectoration of Zhuli Granule were,without obvious adverse effect Zhuli Liquid.