大黄,别名将军、黄良、火参等,为蓼科植物药用大黄、唐古特大黄、掌叶大黄的干燥根和根茎,味苦,性寒,归大肠、胃、脾、心包经.大黄在临床应用的范围广泛、方法多样,针对不同的配伍、剂量和炮制方法可发挥泻下攻积、清热泻火、凉血解毒、止血、逐瘀通经、利湿退黄等功效,用于治疗因腑气不通、食积、热邪、痰湿、瘀血、肝郁所引起的多种疾病,均取得较好疗效.然大黄药力峻猛,掌握确切用法极为关键,否则有碍其发挥疗效.基于大黄的临床常用配伍,文章总结出以下运用规律:大黄在治疗腑气不通、食积时常配伍行气消食药、扶正温阳药;治疗热邪、痰湿时常配伍清热凉血药、化痰健脾药;治疗瘀血时常配伍活血化瘀药、行气止痛药;治疗肝郁时,常配伍疏肝柔肝药、健脾开窍药.运用大黄时,不同剂量、炮制方法及煎煮时间对应的功效各异.小剂量健胃,中剂量解毒,大剂量攻逐.生大黄峻泻,熟大黄缓泻,酒大黄升散走窜,大黄炭收敛止血,醋大黄活血化瘀.大黄生用,泻下功著.若取其清扬之气,薄其重浊之味,开水渍之须臾即可.文章从临床常用药物配伍和注意要点两大方面对大黄的研究现状进行汇总,提炼配伍规律及要点,以期为大黄的临床应用提供参考.

目的 分析总结陈彤云教授治疗黄褐斑的临床用药经验.方法 收集2017年9月～2019年7月首都医科大学附属北京中医医院陈彤云教授治疗的黄褐斑患者医案109诊次,从药物类别、药物性味、药物归经等方面进行总结分析.结果 用药类别方面,使用频率最高是补虚药及活血化瘀药,分别为40.99％及29.00％.药性方面,偏温热性药物占大多数(49.05％),平性药物占30.50％,偏寒凉性药物占20.44％.药味方面,苦、甘、辛味药的使用频率均明显高于其他药物,分别为29.07％、29.26％、28.75％.药物归经方面,药物归五脏经所占比例较大,约84.38％.诸脏经中,以肝经所占比例最大,其次为脾经、肾经.结论 陈彤云教授临床治疗黄褐斑以补虚及活血化瘀为主法,重视肝肾,兼顾脾胃,用药多以辛开、苦降、甘缓,擅用温、平性药.

目的 观察蒿秦化斑方对紫外线B(ultraviolet-B,UVB)诱导的HaCaT细胞光损伤的保护作用并探讨其可能机制.方法 建立300 mJ/cm2UVB辐射损伤HaCaT细胞的病理模型,使用蒿秦化斑方干预,实验分为空白对照组、UVB模型组及蒿秦化斑方高、中、低剂量组.使用MTT法测定蒿秦化斑方的安全性及HaCaT细胞的增殖;吸光度法测定HaCaT细胞中超氧化物歧化酶(superoxide dismutase,SOD)、过氧化氢酶(catalase,CAT)的活性和丙二醛(malondialdehyde,MDA)的含量;ELISA法检测HaCaT细胞细胞间粘附分子-1(intercellular adhesion molecule 1,ICAM-1)、血管细胞间黏附分子-1(vascular cell adhesion molecule 1,VCAM-1)、内皮细胞选择素(endothelium-selectin,E-selectin)、白细胞介素-10(interleukin-10,IL-10)、转化生长因子β(transforming growth facor-β,TGF-β)的含量.结果 与空白对照组比较,UVB模型组细胞增殖能力降低(P<0.05),与UVB模型组比较,蒿秦化斑方高、中、低剂量组细胞增殖能力均增强(P<0.05);与空白对照组比较,UVB模型组SOD、CAT活性降低(P<0.05),MDA含量增加(P<0.05);与UVB模型组比较,蒿秦化斑方高剂量组SOD、CAT的活性增强(P<0.05),MDA的含量降低(P<0.05).与空白对照组比较,UVB模型组ICAM-1、VCAM-1、E-selectin、IL-10含量均增加(P<0.05),TGF-β含量表达降低(P<0.05);与UVB模型组比较,蒿秦化斑方高剂量组ICAM-1、VCAM-1、E-selectin、IL-10的含量均降低(P<0.05),TGF-β 含量升高(P<0.05).结论 高剂量蒿秦化斑方能够通过增强抗氧化酶SOD、CAT的活性及减少脂质过氧化物MDA的产生抑制UVB诱导的HaCaT细胞氧化损伤,通过降低HaCaT细胞中炎症相关因子ICAM-1、VCAM-1、E-selectin、IL-10的表达抑制UVB诱导的HaCaT细胞炎症反应,通过细胞增殖和上调TGF-β的表达修复HaCaT细胞屏障功能,从而对UVB诱导的HaCaT细胞光损伤起到保护作用.

慢性萎缩性胃炎(CAG)及其伴发的肠上皮化生和上皮内瘤变与胃癌的发生关系密切,对CAG的有效治疗和逆转可有效预防胃癌的发生、降低胃癌发病率.中医辨证论治对CAG的治疗具有独特优势,因此建立CAG中医病证结合动物模型研究中医药的作用机制具有重要的意义.N-甲基-N’-硝基-亚硝基胍(MNNG)是目前确切的可致CAG动物模型最常用化学制剂,多因素诱导更符合临床中CAG的发生.文章总结了近年来MNNG负荷多因素致大鼠CAG中医病证结合动物模型的相关研究,为论证中医药在治疗CAG不同证型研究中提供基础.

Objective: To establish the disease and syndrome integrated animal model of chronic atrophic gastritis, which will benefit the implementation of basic research on chronic gastritis. Methods: Four comprehensive factors including N-methyl-N-nitro-nitrosoguanidine (MNNG), sodium salicylate, ranitidine and starvation were used in the experiment to make disease and syndrome integrated animal model of chronic atrophic gastritis. Animals were measured for body weight, holding power, 24h food intake, 24h water consumption and other macroscopic indicators. Rats phenotype were observed for syndromes determination. Rats stomach tissue was stained with hematoxylin-eosin (HE staining), and pathological changes were observed, and pathological results were analyzed. Results: The atrophic gastritis and the qi-deficiency and blood-stasis syndrome were developed in the 16th week, the model was established successfully. Conclusion: The four-factor comprehensive modeling method can be used to establish the animal model of chronic atrophic gastritis syndrome, which is worth promoting and applying.

目的:探索调气活血法治疗大鼠慢性萎缩性胃炎的疗效及其对胃酸分泌影响的机制.方法:采用N-甲基-N-硝基-亚硝基胍(MNNG)自由饮用的综合造模法复制大鼠慢性萎缩性胃炎动物模型,造模成功后,分别给予调气活血方、胃复春片、蒸馏水灌胃治疗8周,处死大鼠,收集大鼠胃酸,测胃酸pH值,取大鼠胃组织,苏木素-伊红染色(HE染色)观察病理变化,免疫组织化学方法检测胃黏膜质子泵(H,K-ATPase)、ezrin蛋白表达水平.结果:调气活血方可有效治疗大鼠慢性萎缩性胃炎,显著提高大鼠胃酸分泌水平,增加胃黏膜H,K-ATPase、ezrin蛋白的表达面积,与空白模型组和胃复春组比较,差异具有统计学意义(P＜0.01,P＜0.05).结论:调气活血法可能通过提高胃黏膜ezrin蛋白表达水平,促进了H,K-ATPase在壁细胞顶膜锚定,从而促进了壁细胞酸分泌,达到治疗大鼠慢性萎缩性胃炎和延缓疾病进展的作用.

目的:明确慢性萎缩性胃炎的证候分类,探索证候分类研究新方法.方法:基于多中心、大样本临床数据,联合运用因子分析优化方案及复杂系统熵聚类,对461例慢性萎缩性胃炎患者的证候分布进行统计分析.结果:慢性萎缩性胃炎临床常见证候类型共有5个,依次为脾胃虚寒证、肝胃郁热证、肝胃不和证、脾虚湿困证、瘀阻胃络证.结论:联合应用无监督统计学方法,能够更加客观阐释中医证候分布特点,所获得的证候分布也更符合临床实际.

病证结合的临床研究模式是当前中医临床治疗和研究最重要的模式之一.慢性胃炎中医证候内在物质基础涉及胃镜下胃黏膜表现、病理组织学、幽门螺旋杆菌(Hp)感染、炎性介质、胃肠激素、代谢、免疫、内分泌以及离子通道等多方面内容,具有多样性和复杂性的特点.系统生物学研究方法和数学建模联合实验方法验证为慢性胃炎中医证候物质基础研究提供了新的思路.同时中医证候的时空性、系统性及多层次性决定了慢性胃炎不同证候内在物质基础的复杂性,提示在研究方法和理念上需要进一步思考研究过程中遇到的核心问题.

目的:探讨慢性非萎缩性胃炎证候、证素分布规律及其与幽门螺杆菌(Helicobacter pylori,Hp)感染的关系,为证候规范化研究提供参考.方法:制定统一的临床病例观察表,采集慢性非萎缩性胃炎患者的一般情况、四诊信息、C13呼气试验、胃镜检查等各方面资料,分析慢性非萎缩性胃炎的中医证候分类与证素特点及其与Hp感染的关系.结果:类肝胃不和证、类肝胃郁热证、类脾胃虚弱证、类胃热内蕴证为Hp阳性慢性非萎缩性胃炎临床常见4个证型,其分布特点为类肝胃不和证、类肝胃郁热证＞类脾胃虚弱证＞类胃热内蕴证;Hp阴性慢性非萎缩性胃炎中医常见3个证型,其分布特点为类脾胃虚弱证＞类肝胃不和证＞类肝郁脾虚证.结论:建立了Hp相关性慢性非萎缩性胃炎证候分布的因子分析及系统聚类模型,揭示了Hp相关性慢性非萎缩性胃炎的中医证候特点,为临床治疗和疗效评价提供了一定的依据和可行的研究思路.

Objective To observe the morphology and migration of AGS cells impacted by shikonin at different concentrations and at different times so as to explore the concentration and time for the better in-hibitory effect of shikonin on AGS cell migration. Methods AGS cells were placed into 6 - pore plate for culture. When the adherence concentration was up to 70% to 80% ,the scratching method was used to build cell migration model. A control group( DMSO)and an experiment group were divided. In the experiment group,DMSO was used for shikonin hydrotropy and the diluted solutions were at the concentrations as 2 mM, 1. 5 mM,1 mM,0. 75 mM and 0. 5 mM separately. In 0 h,6 h,12 h and 24 h,separately,the cell morphology and migration were observed and photographed for the record. The cell migratory speed and inhibitory rate were calculated and compared between the two groups. Results Shikonin at high concentration induced the morphologic change of AGS cells. Shikonin inhibited AGS cell migration. When the terminal concentration was 2 μM,the inhibition was the most obvious. The inhibitory effects on AGS cell migration were different significantly at the same concentration but at different time points(P ﹤ 0. 05). The inhibitory effects on AGS cell migration were different significantly at the same time points but at different concentrations(P ﹤ 0. 05). Conclusion Shikonin at high concentration induces the morphological change and necrosis of AGS cells. Shikonin inhibits AGS cell migration and the inhibition is related to shikonin's concentration and the action time. When at the terminal concentration(2μM)and in 12 h of action,shikonin presents the most obvious in-hibition on AGS cell migration.

中医内科学是中医药专业的主干课程之一,是中医基础理论联系临床实践的一门重要的桥梁课程,亦是其他中医临床各科的基础,具有重要的学科地位,这门课程的教学质量更是会直接影响学生中医临床诊疗思维的树立和培养.自1956年创立"老四所"中医院校以来,中医内科学课程的教学内容和教学方法就在先辈们的不断实践和努力下日益完善.目前,其内容主要包括内科疾病的历史沿革、病因病机、证候特征、辨证论治及预防、康复和调摄规律几部分;方法学上近年来也提出了诸如案例式教学、PBL教学、启发式教学等方法,可谓是取得了不小的成果.

Medication experience of Professor Yang Jinxiang treatment of spleen-stomach disease as follows:①Smoothing and descend- ing treatment of stomach disease commonly used herb pairs:Xuanfuhua( Inula Flower),Daizheshi( Ruddle);Jiaobinlang( Scorch-fried Areca),Dafupi( Areca Peel );Xiangfu( Rhizoma Cyperi ),Zisugeng( Caulis Perillae ),Chenpi( Tangerine Peel );Yuzhizi( Akebia Fruit),Lvemei(Prunus Mume);②Professor Yang on the basis of syndrome differentiation often addition clearing damp-heat drugs, namely,clearing and inducing therapy,commonly used:Huoxiang( Agastache Rugosus),Peilan( Herba Eupatorii);Tongcao( Tetrapanax Papyriferus),Danzhuye( Lophatherum Gracile);Huanglian( Coptis Chinensis),Wuzhuyu( Fructus Evodiae);Chaihu( Radix Bupleuri), Huangqin( Radix Scutellariae),Qingbanxia( Rhizoma Pinelliae Preparata);③Professor Yang commonly used drugs of promoting blood circulation to remove blood stasis,namely,blood-activating therapy,drugs such as Chuanlianzi( Fructus Toosendan),Yanhusuo( Rhizo- ma Corydalis);Mudanpi( Cortex Moutan),Chishao( Radix Paeoniae Rubra);Danshan( Salvia Miltiorrhiza),Shashen( Radix Adenopho- rae).

Objective To explore the evolvement rule of TCM syndrome types of the transformation of chronic gastritis (CG):from chronic non-atrophic gastritis (CNAG),chronic atrophic gastritis (CAG) to precancerous lesions of gastric carcinoma (PLGC).Methods Based on gastroscopy and gastrobiop-sy,altogether 592 patients included from three hospitals affiliated to Beijing University of Chinese Medi-cine Dongzhimen Hospital,(Dongfang Hospital and Third affiliated Hospital)and Wangjing hospital of China Academy of Chinese Medical Sciences from September 2013 to February 2014,were diagnosed with CNAG (338 cases),CAG (134 cases)and PLGC (120 cases).By using Epidata 3.1 the database was established,then principal component analysis,factor analysis and Chi-square test were conducted by using software SPSS 17.0.Results There were nine common syndrome types in CNAG,and the&nbsp;three leading ones were syndrome of incoordination between spleen and stomach,syndrome of heat-stag-nation in liver and stomach,syndrome of incoordination between liver and stomach.There were ten syn-drome types in CAG,and the highest frequency was syndrome of incoordination between liver and stom-ach,then syndrome of static blood in stomach collaterals and syndrome of deficient cold of spleen and stomach.The highest frequency of three syndrome of ten in PLGC were syndrome of yin deficiency in stomach,syndrome of yang deficiency in stomach and syndrome of static blood in stomach collaterals. The frequencies of location factors of CNAG from high to low were stomach,liver and spleen,the same as those of CAG;the frequencies of nature factors from high to low were qi stagnation,heat,qi deficiency, dampness and yang deficiency,which were some different from those of CAG being qi stagnation,heat, yang deficiency,dampness,blood stasis,yin deficiency and qi deficiency.With the disease progression, the frequencies of location factors of PLGC from high to low were stomach,spleen and liver,while those of nature factors were heat,yang deficiency,yin deficiency,qi stagnation,blood stasis,dampness,and qi deficiency.The distributions of location factors as well as nature factors were significantly different dur-ing the whole procedure of CG progression,CNAG,CAG and finally PLGC.Conclusion During the procedure of:CNAG turned into CAG and into PLGC in the end,the evolvement characteristic of “sthe-nia transforming into asthenia and appearing yin deficiency and blood stasis gradually”was found.

Objective To observe the effects of different concentration of celastrol on cellular mor-phology and migration of AGS cells at different time points;to explore a better inhibitory effect of concentra-tion and time of celastrol on migration of AGS cells. Methods AGS cells were planted and cultured in 6 -well plate. When the adherent cell density reached 70 ~ 80% ,cell migration was manufactured by scratch ex-periment. Thereafter,cell morphology and cell migration were observed under microscope with different con-centration of celastrol of 5 μM、1 μM、0. 5 μM、0. 1 μM、0. 01 μM at indicated time points. Results 1. High concentration of celastrol cause severe changed in the cell morphology. 2. Celastrol inhibited AGS cell migra-tion,and its inhibitory effect on the migration velocity was concentration - dependent in a certain range. The higher the concentration of drug,the stronger effect it was. The same concentration of celastrol on AGS cells at different times had different effect inhibition of cell migration(P ﹤ 0. 05). At the same time the different con-centrations of celastrol on AGS cells had different effect inhibition of cell migration(P ﹤ 0. 05). Conclusion 1. High concentrations of celastrol cause changes in the cell morphology and cell apoptosis. 2. Celastrol in-hibited AGS cell migration,which is dependent on the concentration and action time. The inhibitory effect of celastrol on AGS cell migration is most obvious under final concentration of 1 μM at 12 h.

Objective:To systematically evaluate the efficacy of reinforcing qi ,promoting blood circulation and replenishing yin on treating chronic atrophic gastritis. Methods:Relevant Chinese and English literature of randomized clinical trials(RCTs) were reviewed via database. Trials were adopted if the Jadad scale score was 1 or more. Statistical heterogeneity between trials was evaluated by Revman 5.2. Heterogeneity of the in-cluded articles was tested to select proper effect models for calculation. Publication bias was investigated through visual inspection of funnel plots and Egger ’s regression model. Results:Nine RCTs including 846 patients were analyzed. The quality of RCTs are generally low. Compared with western medical treatment , reinforcing qi,promoting blood circulation and replenishing yin was better in improving the total effective rate of chronic gastritis. OR=4.57,95%CI (3.09~6.77). The difference was statistically significant (P<0.00001). Conclusion:Reinforcing qi,promoting blood circulation and replenishing yin may be superior to western medicines in improving total effective rate of patients with chronic atrophic gastritis. But more high quality research is needed to increase the strength of the evidence.

Objective Through literature study,this paper explores the distribution of syndromes and syndrome elements of chronic atrophic gastritis(CAG)for future specification of the syndrome elements. Methods The authors searched for the literature of CAG,built up a literature database by Epidata3. 1 soft-ware,and analyzed the data by SPSS19. 0 software. Results 152 documents were included in this paper and 19 083 cases were reported. 74 kinds of syndromes and 20 kinds of syndrome elements were found. From two respects of frequency and proportion of the literature,it was found that the frequent syndromes of CAG are Yang deficiency of the Spleen and Stomach,Yin deficiency of the Stomach,Disharmony of the Liver and Stomach,Heat and Dampness of the Spleen and Stomach,Blood Stasis of the Stomach. Major syndrome ele-ments of disease location are Stomach,Spleen and Liver. Major syndrome elements reflecting the nature of disease are Stagnation,Deficiency(qi deficiency and yang deficiency),Dampness,Heat and Blood Stasis. Conclusions This research initially reflected the most common distribution features syndromes and syn-drome elements of CAG and it can provide reference and basis for further identified standards of this disease.

目的 把握现阶段慢性萎缩性胃炎证候分布规律研究现状,为进一步开展该病的证候规范化、标准化研究提供有益指导.方法 全面检索中国期刊全文数据库(CNKI)、重庆维普(VIP)及万方数据库自建库至2013年12月31日关于慢性萎缩性胃炎证候分布规律相关研究,纳入相关文献31篇进行分析.结果 现阶段慢性萎缩性胃炎在流行病学资料、主要症状、常见证候类型及不同证候间微观辨证相关性方面取得了一定的成果.然而仍存在病例采集纳入排除标准不统一、病例来源地局限、样本量偏小、缺少相应的专家调研以及数据挖掘方法较单一的问题.结论 慢性萎缩性胃炎证候分布规律当进行多中心、大样本、以大课题为支撑的研究,多学会联合形成统一的证候诊断标准更是该病中医规范化研究得以顺利进行的关键.

Objective: To observe the effect of Yiqi Huayu Jiedu principle on the DNMT1 in chronic atrophic gastritis with dysplasia in rats. Methods: Wistar rats( n = 60) were randomly divided into modeling group( n = 50) and blank group( n = 10). After successful modeling the rest of rats( n = 30) were randomly divided into model group,Weimeisu group and Xiaopi granule group( each n = 10).Themodel group was give normal saline water,Weimeisu group was given Weimeisu turbid liquid and Xiaopi granule group was given the Xiaopi granule( once a day). After continuous treatment for 12 weeks,the method of Western blot was used for detecting DNMT1 protein in rats of all groups. Results: The expression of DNMT1 protein increased significantly in model group compared with blank group( P 0. 01),decreased in Xiaopi granule group compared with model group and Weimeisu group( P 0. 01,P 0. 05). The difference in the comparison between Xiaopi granule group and blank group had no statistical significance( P 0. 05). Conclusion: Chinese medicine Yiqi Huayu Jiedu can reverse the gastric mucosal dysplasia,this effect may be mediated by inhibit the expression of DNMT1.

Objective To explore the correlation of chronic atrophic gastritis( CAG) with Hp infection of spleen and stomach damp heat pattern /syndrome with cytotoxin- associated gene- a( Cag A),cyclooxygenase 2( Cox- 2) and gastric mucosa disorder. Methods Seventy cases of CAG,diagnosed via Hp determination,gastroscope and pathological examination were included. There were 30 cases for each of Hp positive and spleen and stomach damp heat pattern /syndrome and of Hp positive and spleen and stomach deficiency cold pattern /syndrome. Ten cases of Hp negative were included in the negative control group. ELISA was adopted to determine serum Cag A and Cox- 2 expressions. In association with pathological results,Cag A positive rate,Cox- 2 expression level and gastric mucosa disorder were compared and analyzed among groups. Results In CAG plus Hp infection spleen and stomach damp heat group,Cag A positive rate and serum Cox- 2 expression were higher than those in spleen and stomach deficiency cold group,and the results in the two groups were all higher than those in Hp negative group,indicating the significant difference( P 0. 05). The difference in gastric mucosa disorder severity was not significant between spleen and stomach damp heat group and the spleen and stomach deficiency cold group( P 0. 05),but the condition was mild in tendency in the spleen and stomach damp heat group. Conclusion Cag A and Cox- 2 are possibly involved in the formation of spleen and stomach damp heat pattern /syndrome in the patients of CAG and Hp infection.The spleen and stomach damp heat pattern /syndrome plays the important role in the early progression of CAG with Hp infection,which provides a certain evidence on the exploration of the effect mechanism of spleen and stomach damp heat pattern /syndrome in the progression of CAG.