目的 探讨化瘀通络方对糖尿病大鼠肾脏的保护作用及其对肾组织血管内皮生长因子(VEGF)表达的影响.方法 将SD大鼠随机分为正常组(10只)、模型组(8只)、中药组(8只)、西药组(8只),应用链脲佐菌素腹腔注射建立糖尿病模型,中、西药组分别给予化瘀通络方(每日0.904 g/kg)及厄贝沙坦(每日24 mg/kg)干预16周后,测定体重(BW)、右肾指数(RKI)、糖化血红蛋白(HbA1c)、24 h尿蛋白定量(24 h-UTP)、血清白蛋白(ALB)、血肌酐(SCr),光镜和电镜下观察肾组织形态学改变,免疫组化、实时荧光定量PCR法观察肾组织VEGF蛋白及mRNA表达.结果 与正常组比较,模型组RKI、HbA1c、24 h-UTP、肾小球基底膜厚度、VEGF表达明显升高,BW、ALB明显降低(P＜0.05);与模型组比较,中、西药组RKI、24h-UTP、肾小球基底膜厚度、VEGF表达明显减少(P＞0.05);两治疗组之间比较各指标差异无统计学意义(P＞0.05).结论 化瘀通络方可不依赖于血糖控制而延缓早期糖尿病肾病进展,效果与应用厄贝沙坦相似,其机制可能与抑制肾脏血管内皮生长因子的过度表达有关.

目的:观察"三字经流派"小儿推拿联合复方甘草片治疗成人痰热郁肺证慢性咳嗽的临床疗效.方法:将60例符合纳入标准的慢性咳嗽患者随机分为对照组和试验组各30例,对照组给予复方甘草片口服,3片/次,3次/天;试验组在对照组的治疗基础上辨证施治,采用以掐揉小横纹为主的三字经流派小儿推拿法治疗,每天1次,两组均连续治疗7天.采用痰热郁肺证中医症状分级量化和临床有效率比较治疗效果.结果:治疗后,两组均可以降低慢性咳嗽的主要临床症状积分(P＜0.05),且试验组对咳嗽频率、痰的质地、咳痰困难度和排痰量等单项指标的效果优于对照组(P＜0.05);试验组总有效率86.7％高于对照组66.7％,差异有统计学意义(P＜0.05).结论:三字经流派小儿推拿联合复方甘草片对于成人慢性咳嗽的相关症状改善和临床有效率,比单纯使用复方甘草片的效果更优.

目的探讨胚胎移植三胎妊娠后于孕早期行不同减灭数目减胎术对围产期母婴的影响。方法回顾性分析胚胎移植后三胎妊娠患者于孕早期行多胎妊娠减胎术后保留单胎和保留双胎共282例孕妇的资料,依据保留胎儿数将减胎组分为减至单胎组28例、减至双胎组254例。同时采用倾向性评分匹配法（PSM）与同期胚胎移植后未行减胎的单胎或双胎妊娠研究对象分别进行1∶3匹配。匹配完成后,共846例作为对照组,其中单胎对照组84例、双胎对照组762例。对4组患者的一般资料、妊娠结局、新生儿体质量及围产期并发症进行比较,并采用Logistic回归进一步做敏感性分析。结果 （1）减胎组的流产率、晚期流产率、围产期并发症发生率高于对照组（P均＜0.01）,平均分娩孕周短于对照组（P=0.01）,平均足月产儿体质量（P＜0.01）、足月产率（P=0.016）,剖宫产率（P=0.037）低于对照组;（2）减至单胎组剖宫产率低于减至双胎组（P=0.001）,平均分娩孕周长于减至双胎组（P＜0.01）,平均足月产儿体质量高于减至双胎组（P＜0.01）;单胎对照组流产率、早期流产率、足月产率、足月产儿及早产儿体质量高于双胎对照组（P均＜0.01）,早产率低于双胎对照组（P＜0.01）。结论妊早期行多胎妊娠减胎术并未增加早产、出生缺陷风险,但流产、围产期并发症及低体质量儿的发生风险增加。三胎妊娠后行多胎妊娠减胎术保留至单胎者比保留至双胎者,有更好的妊娠结局。

目的 解析真实世界京津冀地区溃疡性结肠炎患者的中医证候分布规律,为该病临床治疗提供借鉴.方法 基于国家中医临床研究基地(河北省中医院)建立的医院信息系统数据库,对京津冀地区5家三甲医院第一诊断为溃疡性结肠炎的住院患者之入院科室、中医证候分布、性别与年龄分层的中医证候分布等真实世界数据进行描述性分析.结果 共有286例患者纳入分析,京津冀地区溃疡性结肠炎的中医分布依次为浊毒内蕴证、脾虚湿阻证、肝郁脾虚证、瘀阻肠络证、脾肾阳虚证、寒热错杂证、热毒炽盛证.性别分层结果显示,男性以浊毒内蕴证最常见,女性以肝郁脾虚证最为常见.年龄分层分析结果显示,18岁以下患者以肝郁脾虚证多见,18～45岁患者以浊毒内蕴证多见,46～65岁患者以浊毒内蕴证多见,65岁以上患者以脾肾阳虚证多见.结论 京津冀地区溃疡性结肠炎患者总体以浊毒内蕴证最为常见,而不同性别、年龄分层证候分布特点各有不同.

在中医学体系不断创新完善和中医医疗质量不断提高的新形势下,“浊毒”作为一种新的病因病机概念而被提出,并得到国内外众多专家和学者的肯定与认同,是中医学术体系中的重要组成部分,是中医重大学术理论创新.浊毒学说是第三届国医大师李佃贵教授,总结50余年临床经验,结合现代生活饮食结构的改变,工作压力的加大,大气环境的变化等现代因素特点,逐渐概括而来的.它不单是名词的组合,更是千百年来从事中医药学研究的历代医家不断总结、不断创新、不断发展的结果[1].近年来,我们围绕浊毒学说开展了各项基础与临床研究,使理论不断完善,使疗效不断提高.现将浊毒学说相关内容浅述如下.

目的:总结李佃贵教授诊治萎缩性胃炎的临床经验.方法:采集李佃贵教授诊治的慢性萎缩性胃炎患者209例,1 085诊次,提取患者的一般资料及临床症状、中医证型、方剂应用、中药使用及配伍情况.建立数据库,采用“中医传承辅助平台系统(V2.5)”,通过频次统计、复杂网络分析等对数据进行挖掘.结果:慢性萎缩性胃炎患者常出现疼痛、胀满、嗳气、反酸、烧心、心烦、纳少、寐差、大便溏稀、大便秘结症.中医常见证型为浊毒内蕴、肝胃不和、脾胃湿热、肝胃郁热、饮食停滞、瘀血阻络、脾胃虚寒、胃阴亏虚等.常用治法为化浊解毒、解毒祛浊、养肝和胃、清利湿热、疏肝解郁、化食消积、活血化瘀、温中健脾等.常用的方剂为化浊解毒汤、芍药甘草汤、枳术丸、香苏饮、甘露消毒饮、丹参饮、黄连温胆汤、半夏泻心汤.常用的药物为黄连、茵陈、豆蔻等.复杂网络分析图显示,黄连、茵陈、豆蔻、莱菔子、厚朴、鸡内金、绞股蓝、枳实为核心处方,其中最核心的药物为黄连.结论:李佃贵教授基于浊毒学说论治慢性萎缩性胃炎是中医病因病机与治法的创新之一,值得进一步阐述、研究与应用.

目的 探讨生长激素(growth hormone,GH)在子宫内膜异位症(endometriosis,EMs)患者中的意义及其对卵巢黄素化颗粒细胞凋亡的影响.方法 选择进行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)助孕的EMs不孕患者(EMs组)40例,单纯输卵管因素不孕患者(对照组)40例,比较2组实验室指标及妊娠结局;放射免疫分析法检测2组取卵当日血清、卵泡液GH水平,密度梯度法提取颗粒细胞体外培养贴壁后,免疫细胞化学检测2组患者Bcl-2、Bax蛋白表达水平;将贴壁后EMs患者颗粒细胞按干预方式分为空白组和GH组,免疫细胞化学检测Bcl-2、Bax蛋白的表达水平.结果 EMs组血清、卵泡液GH水平和颗粒细胞Bcl-2表达水平低于对照组,EMs组Bax表达水平高于对照组,差异均有统计学意义(P＜0.05).GH组较空白组Bcl-2表达水平升高,Bax表达水平下降,差异有统计学意义(P＜0.05).结论 EMs患者的低GH水平可能引起颗粒细胞凋亡增加,从而影响卵母细胞质量及胚胎的发育潜能.一定浓度的GH可能改善EMs患者颗粒细胞凋亡状态.

目的 通过超声观察接受控制性促排卵方案(control ovarian stimulation,COS)助孕患者子宫内膜容受性及卵巢内卵泡储备影像学特点,分析超声评估对不孕患者妊娠结局的预测作用.方法 回顾性分析接受COS治疗的不孕症患者209周期的相关资料.根据妊娠结局分为妊娠组(30周期)和未妊娠组(未妊娠者中随机选取30周期),比较2组子宫内膜厚度、子宫内膜类型、子宫内膜容积、卵巢体积、窦卵泡数以及排卵前最大卵泡直径.根据内膜厚度分为＜8 mm、8～14 mm、＞14 mm组,根据内膜类型分为A型、B型、C型组,根据内膜容积分为＜2mL、2～4 mL、＞4 mL,根据卵巢体积分为＜3 cm3、3～6 cm3、＞6 cm3,根据窦卵泡数分为＜5个、5～15个、＞15个,比较各组妊娠率.结果 妊娠组子宫内膜厚度和内膜容积均大于未妊娠组,妊娠组子宫内膜形态A型较多,未妊娠组子宫内膜形态C型较多,妊娠组卵巢体积、窦卵泡数明显大于或多于未妊娠组,差异有统计学意义(P＜0.05);2组人绒毛膜促性腺激素日最大卵泡直径差异无统计学意义(P＞0.05).子宫内膜厚度8～14 mm组妊娠率明显高于＜8 mm、＞14 mm组,子宫内膜A型组妊娠率明显高于B型、C型组,子宫内膜容积＞4 mL组妊娠率明显高于＜2 mL、2～4 mL组,卵巢体积3～6 cm3组妊娠率明显高于＜3 cm3、＞6 cm3组,卵泡数5～15个组妊娠率明显高于＜5个、＞15个组,差异均有统计学意义(P＜0.05).结论 对于接受COS治疗的不孕患者,超声监测子宫内膜厚度8～14 mm、子宫内膜容积＞4 mL、子宫内膜类型A型、卵巢体积3～6 cm3、窦卵泡数5～15个时妊娠的概率更大.

目的:探讨推拿治疗生殖系统疾病的效应及机制.方法:收集以推拿手法治疗生殖系统疾病的相关文献,深入研究手法作用方向及作用机制,并对推拿治疗生殖系统疾病做一研究与展望.结果:推拿手法适用于不孕症、慢性盆腔炎、子宫肌瘤、早泄等疾病的治疗,临床多在腹部及脊柱部位操作.结论:推拿手法治疗生殖系统疾患疗效明确,其机制主要与调节生殖激素分泌、神经传导及脊柱结构有关.

目的 总结李佃贵教授应用化浊解毒法辨治慢性萎缩性胃炎的用药规律.方法 纳入2010年9月至2015年6月李佃贵教授门诊及住院132例慢性萎缩性胃炎患者,将患者临床信息录入分析平台,利用频数分析、高频药物归类分析、关联规则的组方规律分析、基于熵聚类的方剂组方规律分析,考察化浊解毒法与各药物间的配伍关系.结果 132例患者共用药物113种,其中频数统计显示,使用频数在100次以上者有22味,代表药物有黄连、茵陈、豆蔻、莱菔子、厚朴、鸡内金、绞股蓝、枳实等,高频药物归类分析由多到少依次为清热药、补虚药、化湿药、行气药、利水渗湿药等,关联规则的组方规律分析,药物组合出现28对.结论 李佃贵教授辨治慢性萎缩性胃炎以化浊解毒法为主,随证辅用清热解毒、益气健脾、芳香化湿、行气止痛、利水渗湿、活血化瘀以及消食和胃等药.

Objective To investigate the effects of bushen and shugan treatment on the protein and mRNA expression of HOXA10 in mouse womb. Methods 90 female mice were randomly divided into 6 groups: high and low dose bushen group; high and low dose shugan group;super stimulate ovulation control group (COH) and blank control group, with 15 mice in each group. The daily injection of saline was performed in each group for 8 d. All the mice in each group injected with PMSG in the 9th day and injected HCG after 48 h except the mice in control group. The female mice in each group was mated with the male mice, followed by observation of the pregnancy on the second morningand further drug treatment, high and low dose bushen group were given with 5.4 g/ml or 2.7 g/ml oral liquid filling kidney menstrual function party; high and low dose shugan group were given with 0.6 g/ml or 0.3 g/ml liver xiaoyao pill for suspension liquid, and the COH and the blank control group were injected with saline for 4 d. After sacrifice of the mice, immunohistochemistry and RT-PCR method was used to analyze HOXA10 expression in mouse uterus, and female progestational hormone expression level was compared.Results Expression of serum E2 and P in each treatment group was significantly higher than that of the blank control group and the COH group (P < 0.05), and the high dose group was superior to the low-dose group (P < 0.05). Comparison between the high dose groups had no statistical significance (P > 0.05). The HOXA10 gene expression in COH group was reduced as compared with blank control group (P < 0.05), whereas the expression of HOXA10 in the high-dose bushen group and the high-dose shugan group were increased compared with the COH group (P < 0.05). No statistically significant difference was seen between the high-dose bushen group and the high-dose shugan group (P > 0.05). Conclusion Bushen tiaojing recipe and xiaoyao pill can raise the ultra female serum progesterone level of mice, increase HOXA10 expression in uterus and improve the endometrial receptivity, thus promoting embryo implantation.

Objective To investigate the influence of bushen treatment and shugan treatment on Wnt pathway of endometrial cells in mice stimulated to ovulate. Methods 90 mice were randomly divided into 6 groups: high and low dose of bushen group; high and low dose of shugan group;Super ovulation stimulated control group (COH) and blank control group, with each group having 15 mice. Mice in each group were given saline daily by intraperitoneal injection for 8 continuous days. On the 9th day, each group, except for the blank control group, was injected with PMSG, and 48 h later, the mice were given HCG. All the mice were mated with male mice according to 1:1 ratio, and were filled the stomach after examining female vaginal in the next morning. Bushen high and low dose group were given oral liquid filling kidney menstrual function party of 5.4 and 2.7 g/ml, respectively, while shugan high and low dose group were given xiaoyao pill for suspension liquid of 0.6 and 0.3 g/ml, respectively. COH group and the blank control group were given saline for 4 days. The expression of Wnt7a and beta-catenin mRNA in all the mice were measured by RT-PCR. Results Compared with the blank control group, the expression of Wnt7a and β-catenin in the COH group were decreased (P <0.05). Compared with the COH group, the expression of Wnt7a and β-catenin in the bushen high dose group and the shugan high dose group were increased (P < 0.05). There was no statistically significant difference between these two high dose groups (P >0.05). Conclusion Bushen tiaojing recipe and xiaoyao pill can improve the endometrium tolerance of mice and promote embryo implantation. The mechanism is correlated to the increase in expression level of Wnt7a and β-catenin and activation of Wnt/β-catenin signal transduction pathway.

脾阴虚是中医藏象学说的一个重要组成部分,其病因病机和治疗有独特之处,但临床症状表现却特殊而复杂,易于其他症候混淆.故作者从中医古籍和临床两个方面着手,通过对脾阴和脾阴虚证候的认识,将其病因病机、证候特征及施治规律进行阐述,以期对脾阴虚证候诊治起到很好的指导作用.

Objective:To discuss the effects of Huoxue Huayu Tongluo Recipe on the renal tubular interstitial fibrosis in diabetic nephropathy rats and analyze the protective effect and possible mechanism of the traditional Chinese medicine in renal tubular injury and interstitial fibrosis in the renal.Methods:The time study was from January 2015 to December 2015.A total of 60 healthy male SD rats were given free access to water feeding one week adaptation and were randomly equally divided into normal group,model group and Huoxue Huayu Tongluo group.The model group and the Huoxue Huayu Tongluo group were given the large dose injection of streptozotocin (STZ) by intraperitoneal injection to set up the diabetic nephropathy model and Huoxue Huayu Tongluo group after the establishment of the model were given Huoxue Huayu Tongluo Recipe treatment.The changes of renal tubular interstitial fibrosis were recorded.Results:The rats in normal group were in good general condition,and the model group rats had significantly more urine,weight loss,more drink and more symptoms.Compared with the model group,the rats in the Huoxue Huayu Tongluo group removed stasis and dredged better.Compared with the normal group,the model group's 24 h urinary protein quantitative was significantly increased (P ＜ 0.05).Compared with the model group,Huoxue Huayu Tongluo group's was significantly reduced (P ＜ 0.05).Pathological study showed normal group rats glomerular structure clear and completed.Rats in the model group had glomerular capillary ball hypertrophy,basement membrane thickening with model group.Compared to model group,Huoxue Huayu Tongluo group pathological change were lighter.Immune group displayed the Ang Ⅱ and AT1R expressions in the normal group were mainly located in renal tubules.Compared with the normal group,model group and Huoxue Huayu Tongluo group's AngⅡ and AT1R expressions were increased significantly (P ＜ 0.05).Compared with the model group,Huoxue Huayu Tongluo group was decreased significantly (P ＜ 0.05).Conclusion:Huoxue Huayu Tongluo recipe can improve the general situation of the diabetic nephropathy rats,reduce the excretion of urinary protein in diabetic nephropathy rats and reduce the expression of renal tissue AngⅡ and AT1R,reduce impairment of the renal function,thereby slow effect on renal tubular interstitial fibrosis.

目的 探讨糖尿病肾病大鼠模型肾小管间质纤维化与瘀血阻络的相关性.方法 30只SD大鼠随机平分为三组-瘀血阻络型组(A组)、非瘀血阻络型组(B组)、正常组(C组),均予高糖高脂饲料喂养,A组与B组采用一次性腹腔注射链脲佐菌素(STZ)诱导建立糖尿病肾病模型,观察大鼠行为,分别测定随机血糖、24h尿微量白蛋白含量;取大鼠的肾皮质,病理切片染色观察肾小管间质的变化;也采用western blot检测各组大鼠肾组织TGF-β1的表达情况.结果 A组与B组的不同时间点的血糖明显高于C组(P＜0.05),A组与B组的组间对比无明显差异(P＞0.05).A组与B组的24h尿微量白蛋白定量分别为(24.20 ±4.10) mg/24h和(24.29±3.89) mg/24h,都明显高于C组的(5.93±2.14) mg/24h(P＜0.05).A组与B组的TGF-β1表达量明显高于C组(P＜0.05),同时A组的TGF-β1表达量也高于B组(P＜0.05).形态学观察显示相对于B组,A组的肾小球体积增大,基底膜增厚,系膜基质增多.结论 糖尿病肾病大鼠模型中瘀血阻络型的TGF-β1表达量相对比较高,伴随有肾小管间质纤维化,可导致大鼠病情恶化,也确认了糖尿病肾病瘀血阻络型的存在.

目的：探讨推拿功法少林内功和易筋经对在校大学生体质的影响。方法：以40名在校大学生为研究对象，按时练习少林内功和易筋经10周。比较其练功前后身体躯干柔韧度、握力、握力指数、腰背肌力、腰背肌力指数、背肌耐力、胸腹肌耐力、台阶试验指数、无氧阈值变化情况。结果：练功后大学生身体躯干柔韧度、握力、握力指数、腰背肌力、腰背肌力指数、背肌耐力、胸腹肌耐力、台阶试验指数、无氧阈值等体质指标均得到了增强（ P ＜0．05或P ＜0．01）。结论：长期坚持练习少林内功和易筋经，能够提高在校大学生的身体素质。

从浊毒概念、浊毒产生原因、浊毒病理属性、浊毒致病特点,以及浊毒施治规律等方面论述,阐明浊毒病机理论的相关内容,以期为迁延性难治性疾病的治疗提供新的病机学支持,为临床治疗浊毒病证提供新思路和新方法.

目的：研究耳针与灸法并用治疗膝骨性关节炎的临床疗效。方法：将96例患者随机分为两组。治疗组49例，采用耳针与灸法并用的方法治疗；对照组47例，口服氨基葡萄糖、双氯芬酸钠治疗。观察两组疗效，并进行评价。结果：治疗组总有效率为95．92％，对照组总有效率为80．85％，治疗组优于对照组（ P ＜0．05）。两组总体疗效、治疗前后VAS积分比较，治疗组明显优于对照组（ P ＜0．01或P ＜0．05）。结论：耳针与灸法并用治疗膝骨性关节炎疗效显著。

目的：：运用数据挖掘技术，研究陈志强教授治疗早中期慢性肾衰竭的用药规律。方法：收集经陈教授门诊应用中药处方诊治的早中期慢性肾衰竭病案，在完成病案信息规范化录入的基础上，运用多种计算机软件对处方药物进行频数统计、关联规则分析，并生成网络关系图。结果：研究共录入中药处方223条，涉及中药194味，频数超过5%的中药共70味。依性味、功用分为六类，频数由高到低为活血化瘀通经类、清热祛湿泄浊类、行气燥湿化痰类、益气健脾温阳类、补益脾肾之阳类、滋养肝肾之阴类，且前四类的关系最为密切，应用频数均高于70%。陈教授常采用同类中药多味联用的方式，前三类最多联用至五、六味，且前两类三味联用的比例高于50%。各类别均有至少2~3味密切程度很高。结论：陈志强教授治疗早中期慢性肾衰竭以活血化瘀、祛湿泄浊、益气扶正类中药为主，且均联用多药以达其功，并随证配合补阳或滋阴类中药。

Objective] To study the syndrome differentiation thought of Professor CHEN Zhi-qiang in treating chronic renal failure of ear-ly and middle stages by data mining. [Methods] Collect the cases of chronic renal failure in early and middle stages diagnosed and treat-ed by Professor CHEN Zhi-qiang using Chinese medicine therapy. Analysis of syndrome differentiation was guided by Professor CHEN Zhi-qiang. The frequencies and association rules of syndrome elements of every case, as well as the relations between syndromes and symptoms, were analyzed by multiple computer software. [Results] A total of 223 medical records were input, covering 11 syndrome ele-ments. Spleen-kidney Qi deficiency was the primary syndrome of deficiency, and blood stasis was the excess syndrome above all, with dampness obstruction in the second place. On this basis of it, over half were accompanied by spleen-kidney yang deficiency. Symptoms of fatigue, intolerance of cold, edema, pain in waist and lower extremities, insomnia, dull-red tongue, greasy tongue coating and fine pulse could be present in all three most common syndrome combinations. However, the special vital symptoms were used to identify cold and heat as well as Yin and Yang. [Conclusion] Professor CHEN Zhi-qiang regards that chronic renal failure of early and middle stages is mostly caused by spleen-kidney Qi deficiency and blood stasis and dampness obstruction, in addition, cold heat and Yin-Yang are identified.