糖尿病及其并发症总的演变规律为初期以热为主,气阴两虚贯穿始终,而并发症则阳虚或阴阳两虚多见,痰瘀为主要病理产物.糖尿病属中医消渴范畴,刘完素提出的"玄府郁闭"理论对消渴病防治有独到之处.玄府易郁易闭,易热易燥,易虚易萎的特性是证候演变的关键.并提出治疗糖尿病不应忽视开通玄府,重视辛开苦降法有益于提高临床疗效.

国家大力推行住院医师规范化培训的背景下,中医学专业“5+3”一体化学生并轨培养新模式成为培养医学专业学位研究生的重要举措之一.文章在分析中医学专业“5+3”一体化学生培养现状和存在问题的基础上,结合国内研究生教育和教学管理经验,提出完善管理考核制度、加强师资队伍建设、重视临床科研训练、加强医学人文教育等建议,旨在保证中医学专业“5+3”一体化学生并轨后的培养质量,并就如何提高临床医学人才培养质量提出对策.

中风,一般将其分为症状较轻的中经络与症状较重的中脏腑两类,区分二者最主要的是神志,即有神志症状的为中脏腑,无神志症状的为中经络.现代医学中所谓的中风,多是指内伤病症的类中风,以突然昏仆、半身不遂、舌蹇不语、口舌歪斜等为主要临床表现,并具有发病急促、变化快速的特点.该文从中风的中医认识沿革、针灸治疗方法、实验研究进展等方面分析和总结近年针灸治疗中风之中脏腑的研究进展,以期对临床治疗该疾病有所启发.

新冠肺炎(COVID-19)初愈后核酸“复阳”,本质为疾病恢复阶段,中医认为此属病后正气不充,余邪未尽所致,病因病机为肺脾不足、气阴两虚,并夹杂“湿”、“瘀”、“毒”等余邪.主张立足仲景“养慎”思想,确立“肃清余邪”、“补益虚损”、“外避邪风”、“摄生调养”、“内慎瘥复”的防治法则,以培护正气为要旨,为减少新冠肺炎核酸“复阳”提供防治思路.

为了追求更好的视觉质量,越来越多的人重视视疲劳病.同时随着用眼需求的大幅增加,加之各种不合理用眼习惯,导致出现视疲劳症状的患者增加.视疲劳的产生给患者的生活、工作带来诸多不适.本文综述目前对视疲劳产生原因及中医治疗的研究进展,分析视疲劳病的致病因素,一方面可以针对其病因进行治疗,另一方面通过对现代中医药治法的梳理,可以发挥中医药在本病的治疗优势,通过中西医治法的联合使用有助于提高临床对本病的诊疗效果.

缺血性视神经病变是临床上常见的疑难杂症,目前发病机制并不明确,国内外西医治疗手段包括服用糖皮质激素,局部注射植物神经调节剂及神经营养药物,高压氧舱辅助治疗及降眼压治疗,也有相关研究表明口服阿司匹林使健眼的发病率降低,西医治疗手段在急性期也取得了不错的疗效,但副作用较大,也存在较多的禁忌症,而中医在此病的治疗方面具有明显的优势,尤其是通过中医辨证后予以针灸结合中药及中成药取得显著的临床疗效,故本文将针灸相关治疗进展综述如下.

已有研究显示糖尿病与视网膜静脉阻塞密切相关,而视网膜静脉阻塞导致一系列的眼底病变,可使糖尿病视网膜病变造成的眼底改变被掩盖,所以,认识糖尿病视网膜病变合并视网膜静脉阻塞的临床特点及诊断要点,对疾病的早期诊断有利,可减少漏诊、误诊.本文通过归纳总结二者合并发病的临床特点,为疾病的早期诊断提供依据,做到早诊断,早治疗.

哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)是一种进化保守的丝氨酸/苏氨酸蛋白激酶,其生物学功能主要是参与细胞的增殖、生长及分化,从而调节机体的代谢过程.诸多国内外研究表明,mTOR是细胞凋亡及自噬信号转导通路的交汇点,营养、药物及氧化应激等多种刺激均可通过mTOR介导的信号通路对细胞的凋亡和自噬起到关键性的调控作用.目前,诸多研究已经证明,mTOR信号通路的改变与多种人类疾病的发病机制密切相关,如癌症、代谢紊乱(肥胖和2型糖尿病)、心血管和神经退行性疾病、与年龄有关的疾病和卵泡发育障碍等.近年来,越来越多的医家以该通路为切入点,以细胞凋亡和自噬为研究载体,研究了中医药对细胞凋亡和自噬的调节.其中包括中药单体、中成药、中药复方以及针灸等药物及物理疗法调控凋亡及自噬的实验研究.本文从mTOR信号通路入手,探讨了mTOR与细胞凋亡及自噬的关系,综述了中医药经mTOR途径调节细胞凋亡与自噬的最新进展,为中医药在该领域的深入研究提供了思路与参考.今后,中医药领域仍可以mTOR信号通路为依托,在中医基础理论的指导下对细胞凋亡和自噬的时效关系进行探索,为中医药在机体的作用机制提供新的现代医学的理论支持和作用靶点.

孤立性脉络膜血管瘤全身表现不明显,当病变未波及视网膜黄斑区而视力受损不明显时,它的症状与中心性浆液性脉络膜视网膜病变以及其他脉络膜肿瘤极为相似,在临床中极易误诊、漏诊.现就临床诊断的1例孤立性脉络膜血管瘤报告如下.

卵巢早衰(premature ovarian failure,POF)是指育龄期女性40岁之前出现闭经、月经紊乱、促性腺激素升高和雌激素水平降低,伴或不伴有围绝经期症状的内分泌疾病.吴教授认为,卵巢早衰以肾虚为主要病机,与肝脾密切相关,其主要治法为补益肾精,养血活血,佐以疏肝健脾理气、调养冲任,使残留卵泡复苏和发育,以恢复卵巢功能,助孕保胎.

Objective: To observe the opening effect of electro-acupuncture (EA) on blood-brain barrier (BBB) of recovered MCAO rats under different frequencies, and to discuss the opening regulation mechanism of BBB mediated by EA. Methods: Frequency research: One hundred and fifty healthy male SD rats were established MCAO model. The recovered rats were randomly divided into model group, EA 2Hz, 15Hz, 30Hz, 50Hz, 100Hz and sham operation group after 3 weeks of feeding. The rats brain water content and penetration amount of Evans blue were measured. Mechanism research: One hundred and eighty healthy male SD rats were established MCAO model. The recovered rats were randomly divided into model group, sham operation group, EA group, pseudo-EA group, EA+PKC inhibitor group after 3 weeks. The phosphorylation level of PKCβ1, mRNA expressions of P-gp, mdr1a and mdr1b were detected in the cerebral cortex. Results: The penetration amount of Evans blue in EA 2Hz and 100Hz groups were apparently higher than other groups (P＜0. 05). There was no significant difference on brain water content between the model group and the other 4 groups. Total PKCβ1 and the ratio of P-PKCβ1 and total PKCβ1 in the rat cerebral cortex increased significantly in the EA 2Hz group (P＜0. 05), and the IHS score in the P-gp immunized group was significantly decreased (P＜0. 05). The mRNA expressions of mdr1a and mdr1b in EA group were significantly decreased (P＜0. 05). The mRNA expression of mdr1a in EA+PKC inhibitor group was higher than that in EA group (P＜0. 05). Conclusion: Both 2Hz and 100Hz EA stimulation have a certain open effect on BBB in cerebral ischemia reperfusion contusion rats, and there is no obvious brain edema. EA-induced BBB opening may be achieved by promoting the phosphorylation of PKCβ1, down-regulating mRNA expression of mdr1a of P-gp, and inhibiting the expression of P-gp in the cerebral capillary endothelial cells.

介绍廖品东教授运用小儿推拿治疗泄泻的经验.其提出“谨守病机,虚实论治”,认为小儿泄泻的基本病机除脾虚湿盛外,关键在于大肠和小肠分清别浊的功能失调,以“实则泻之,虚则补之”创立小儿推拿泄泻方,临床运用,取得良效.附典型病案1则以验证.

[Objective] The objective of this study was to observe the influence of blood pressure variability on primary hypertension patients on Taichong(LR3) with different acupoints compatibility. [Method] We divided randomly 175 cases of primary hypertension patients into Taichong treatment group(LR3), Ligou treatment group(LR5), Neiguan treatment group(PC6), non-acupoint group, Taichong plus Ligou group(LR3+LR5), Taichong plus Neiguan group(LR3+PC6) and Taichong plus non-acupoint group. Each group treated with acupuncture, using mild reinforcing-reducing method after getting qi, needles were retained in acupoints for 30 min, 3 times a week, 12 times in total, and data of average deviation standard of 24h dynamic blood pressure was analyzed.[Results] Taichong plus Neiguan group, Taichong plus Ligou group were better than other groups on the regulation of 24h, the day and night standard deviation of average blood pressure (P<0.05);moreover, each single acupoint group and Taichong plus non-acupoint group were better than the non-acupoint group (P<0.05)[Conclusion] Acupuncture has a certain regulation of blood pressure, which has a certain specificity of consisting of acupoints, Taichong plus Neiguan or plus Ligou better than others.

Objective:To observe the difference of clinical efficacy of neck-shoulder synchronous traction with warm needle moxibustion and neck and shoulder traction alone on cervical spondylotic radiculopathy (CSR).Methods:Seventy patients with CSR were randomly divided into an observation group and a control group,with 35 cases in each group.The observation group was the group of neck-shoulder synchronous traction combinedwith warm needle moxibustion,in which the acupoint selections were Tianzhu (BL10),Fengchi (GB20),Bailao (EX-HN14),Dazhu (BL11),while the control group was the group of neck and shoulder traction alone.The two groups were treated every other day,3 times every week,a total of 12 times.The clinical evaluation scale of cervical spondylosis and headache numerical rating scale (NRS) were observed before treatment,end of treatment and 3 months follow-up,and the overall curative effect was calculated at the end of treatment.Results:After treatment,the effective rates of the observation group and the control group were 90.91％ and 54.29％,respectively.The curative effect of the observation group was better than that of the control group (P＜0.05).The scores of CASCS and NRS were all improved compared with those before treatment in the two groups (P＜0.05),with more apparent change of the neck shoulder pain,muscular tension and NRS scores in the observation group (P＜0.05).Conclusion:Neck-shoulder synchronous traction combined with warm needle moxibustion treatment of nerve root type cervical spondylosis can significantly reduce neck and shoulder pain,muscle tension and headache,and relieve upper limb numbness,skin sensory loss and other symptoms,which is better than simple shoulder and traction treatment.

Objective:To observe the anti-hypertension effect of different compatibility of acupoints on patients with essential hypertension.Methods:A total of 163 patients with essential hypertension were collected and randomly divided into the Taichong (LR3) group,the Ligou (LR5) group,the Neiguan (PC6) group,the non-acupoint group,the Taichong plus Ligou group (LR3+LR5),the Taichong plus Neiguan group (LR3+PC6) and the Taichong (LR3) plus non-acupoint group.The acupuncture was applied once every other day,3 times a week for 4 weeks continuelly,12 times in total.Twenty-four-hour ambulatory blood pressure was examined before and at the end of the treatment,and 4 weeks after the treatment.Results:Compared with non-acupoint group,LR3 group,PC6 group and LR3 plus non-acupoint group,the 24h dynamic change of systolic blood pressure on LR3+LR5 group and LR3+PC6 group decreased significantly after 12 times treatments (P＜0.05).Compared with non-acupoint group,the average systolic blood pressure during the day on all groups decreased significantly (P＜0.05),besides,the average systolic blood pressure at night on LR3+LR5 group and LR3+PC6 group also decreased significantly (P＜0.05).There was no difference of the change of 24h dynamic diastolic blood pressure among all groups after 12 times treatments.After the end of treatment,the change of 24h dynamic systolic blood pressure on LR3 group,LR3+LR5 group,LR3+PC6 group,LR3 plus non-acupoint group declined compared with that before treatment,the difference was statistically significant (P＜0.05).Follow-up 4 weeks,the change of dynamic systolic and diastolic blood pressure during the day,night and 24h on LR3 group and LR3+PC6 group declined compared with that before treatment (P＜0.05).Conclusion:Acupuncture has acupoint specificity,and the effect of acupoint compatibility is better than that of single and non-acupoint,acupuncture also has a long term effect on depressurization.

[目的]探讨不同经穴针刺对自发性高血压大鼠(SHR)的降压效应及累积效应.[方法]将105只SHR随机分为模型组、非穴组、内关组、太冲组、光明组、太溪组、蠡沟组,每组15只.各针刺组以毫针刺入相应穴位后,留针30 min,每日1次,共15次;模型组不予针刺.各组大鼠分别在针刺1、3、7、15d时进行血压测量.[结果]非穴针刺无明显降压作用.针刺3、7、15d时,太冲组、内关组、光明组SHR收缩压(SBP)、舒张压(DBP)、平均动脉压(MBP)下降幅度均显著大于模型组,差异有统计学意义(P＜0.05);针刺15d时,太冲组SBP降幅显著优于内关组、蠡沟组、太溪组、光明组,差异有统计学意义(P＜0.05);太冲组DBP、MBP降幅显著高于太溪组、光明组(P＜0.05),与内关组、蠡沟组大鼠DBP比较差异无统计学意义(P＞0.05).与治疗前比较,针刺1、3、7、15d时,太冲组SBP、DBP、MBP显著下降,差异均有统计学意义(P＜0.05),其中针刺15d时SBP降幅优于针刺1d、3d、7d,DBP、MBP降幅优于针刺1、3d,差异均有统计学意义(P＜0.05).[结论]针刺太冲穴对SHR血压的调节作用优于针刺内关、太冲、光明、太溪、蠡沟等单穴和“非穴”,且针刺降压作用具有一定的时间累积效应.

目的：观察针刺配合侧屈顶推法治疗神经根型颈椎病的疗效。方法：20例神经根型颈椎病患者采取针刺配合侧屈顶推法治疗，观察临床效果。结果：2个疗程后，治愈10例，显效6例，好转2例，无效2例，总有效率为90.0%。结论：针刺配合侧屈顶推法治疗神经根型颈椎病能明显缓解患者疼痛，较好地改善患者症状，安全、有效、经济。

林咸明教授认为小儿多发性抽动症是由心神失调引发脏腑功能紊乱,肝风内动,脾虚痰浊内生导致,主张治病求本,从神论治.在顾护肝脾、化痰息风止痉之余,综合运用“调神针法”和“调神六穴”,为小儿多发性抽动症的治疗提供了新的思路.

Objective To observe blood glucose values and serum insulin levels at different times after acupoint injection of insulin with PVP as a sustained release agent and analyze the correlation between them in SD Rats.Methods One hundred and forty-four male SD rats were randomized into groups A (acupoint injection of insulin alone), B (acupoint injection of sustained-release insulin) and C (control). At one hour after every group received an oral gavage of 40% glucose solution (2.2 g/kg), groups A and B were given point Zusanli injection and group C was not treated. In the three groups of rats, blood glucose values and serum insulin levels were measured at six time points: 0.5, 3, 6, 8, 10 and 24 hours after acupoint injection (in group C at the corresponding time points). In every group, the reaction of Point Zusanli region to the stimulation was observed by optical microscopy in at three time points: 3, 10 and 24 hours after acupoint injection.Results The glucose-lowering rate reached its peak at 3 hours after acupoint injection and then declined in groups A and B. The hypoglycemic effect tended to be stable at 6 hours after acupoint injection in group A and at 10 hours after acupoint injection in group B. The hypoglycemic effect was better in group B than in group A at 6 and 8 hours after acupoint injection (P<0.01). In group A, serum insulin reached its peak at 3 hours and tended to be stable at 6 hours after acupoint injection (P<0.05). Serum insulin levels were significantly lower in group B than in group A at four time pints: 0.5, 3, 6 and 8 hours after acupoint injection (P<0.05). An analysis of the correlation between rat serum insulin levels and the glucose-lowering rate showed a significant positive correlation in group A (P<0.01) and a low positive correlation in group B (P<0.05). In groups A and B of rats, clear stripes and complete structure of muscle fibers were seen with no obvious degeneration, necrosis and inflammatory reaction around point Zusanli at three time points: 3, 8 and 24 hours after acupoint injection; there were no obvious pathological changes compared with group C.Conclusions PVP as a sustained release agent can slow down the absorption rate of insulin in rat point Zusanli region. Meanwhile, it prolongs the continuous time of the hypoglycemic effect of insulin. There is a low correlation between serum insulin levels and the hypoglycemic effect, suggesting that acupoint injection with a sustained release agent can prolong the effect of acupoint injection of medicine.

《针灸大成·卷十》主要收录了数十篇小儿按摩歌赋,其中以《小儿按摩经》为代表,对后世小儿推拿的发展与运用有指导性意义.通过研读并结合现代临床运用,从小儿生理、病理特点,小儿望诊、小儿推拿的腧穴和操作方面探析《小儿按摩经》及相关内容对后世小儿推拿诊疗的影响.