目的 基于数据挖掘技术分析中医药治疗新型冠状病毒肺炎(corona virus disease 2019,COVID-19,以下简称"新冠肺炎")不同阶段中药处方用药的归经规律,归纳经络辨治思路,以期为今后中医药抗击新发突发传染病提供参考.方法 收集2020年1月16日至2020年11月11日国家及各省、自治区、直辖市卫生健康委、中医药管理局所发布的新冠肺炎诊疗方案,建立数据库,对所收集处方的中药归经进行描述性分析、关联规则分析和聚类分析.结果(1)药物归经情况统计显示,新冠肺炎初期药物归经频率最高的经络为肺经,极期为心经,恢复期为肺经;(2)关联规则分析显示,初期核心归经为肺、脾、胃经,极期为心、肝、脾、胃、肺经,恢复期为肺、脾、胃经;(3)聚类分析结果显示,初期药物归经可分为肺、脾、胃经和其他经,极期可分为心、脾经和其他经,恢复期可分为肺、脾、胃经和其他经.结论 中医治疗新冠肺炎初期以肺、脾、胃经为主,治宜宣肺化痰止咳、化湿运脾和胃;极期以心、脾经为主,兼顾肺、胃、肝经,治宜开窍醒神、扶正固脱,兼化痰止咳平喘、行气通腑、平肝息风;恢复期以肺、脾、胃经为主,治宜益气养阴、健脾和胃、清肺透邪,兼顾心经以调心安神.

目的:通过体内外实验观察固本畅枢法对肥胖糖尿病大鼠糖脂代谢的影响及胰岛 β 细胞MIN6凋亡的干预作用.方法:体内实验:高脂高糖喂养+小剂量链脲佐菌素(streptozocin,STZ)一次性腹腔注射复制肥胖糖尿病大鼠模型,连续灌胃给药4周,观察大鼠饮水、摄食、尿量及一般情况,检测模型大鼠的空腹血糖(fasting blood glucose,FBG)、空腹胰岛素(fasting insulin,FINS)、甘油三酯(triglyceride,TG)、总胆固醇(cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein,LDL-C)、高密度脂蛋、白胆固醇(high density lipoprotein,HDL-C)水平,观察胰腺、肝脏、肌肉、脂肪组织病理,采用TUNEL-DAPI共染色法检测各组大鼠胰腺 β 细胞凋亡情况,了解细胞凋亡形态学特征;体外实验:培养小鼠胰岛 β 细胞MIN6,采用流式细胞术定量分析MIN6细胞凋亡情况.结果:体内实验:固本畅枢法能减少糖尿病模型大鼠的饮水、摄食、尿量(P<0.01),差异有统计学意义;能降低FBG、FINS、TC、TG,升高HDL水平(P<0.05,P<0.01),差异有统计学意义;可修复胰腺、肝脏、肌肉、脂肪组织病理结构,使其形态更规则;能改善模型组大鼠胰腺 β 细胞凋亡时的细胞形态(P<0.01),差异有统计学意义);体外实验:固本畅枢法能减少模型组MIN6细胞的凋亡细胞数量.结论:固本畅枢法改善糖脂代谢紊乱,其作用机制与修复组织病理、抑制胰岛 β 细胞凋亡有关.

目的:探讨运用经络理论在甲状腺良性结节临床辨证论治中的规律.方法:检索1950-2020年在中国知网(CNKI)、万方数据知识服务平台、维普等数据库中关于中医药治疗甲状腺良性结节的文献,提取文献纳入的中药、取穴处方等数据,对高频药物归经、高频穴位、经络进行频次分析、关联分析及聚类分析,并对所涉及的经络进行网络可视化分析.结果:本研究共收集文献110篇,其中纳入文献的中药处方92首,穴位处方18首.涉及中药137味,其中使用频次大于5次的中药47味、穴位33个,共涉及14条经脉.药物归经频次最高的为足厥阴肝经;关联分析显示药物高频归经之间的关联度较好的为足厥阴肝经→手厥阴心包经;相关性较好的穴位有天柱、大杼、曲骨、内关.高频药物聚类可得到8种组合,核心取穴组合6个.结论:数据挖掘结果表明经络辨证论治甲状腺良性结节的经验如下:结合经络循行路线,遵循远部取穴及近部取穴相结合的原则,选取以"疏肝、化痰、化瘀"为主要功效的经络及穴位.

肥胖的发病率在逐年升高是一个严重的公共卫生问题.在肥胖的多种综合治疗方法中,中医治疗取得了显著效果,其多从痰湿辨证入手,但作用机制仍不明确.近年来,许多研究不仅发现痰湿和免疫系统之间存在密切关系,还揭示了免疫机制在肥胖发病过程中起重要作用.本文通过概述痰湿型肥胖的外周及肠道免疫机制,发现痰湿型肥胖者脂肪组织中I型免疫相关细胞增多,随其分泌的促炎因子增多表现为慢性低度炎症,肠道免疫机制则与肠道淋巴细胞、细胞因子、免疫球蛋白及菌群的调节失调相关.并进一步探讨化痰祛湿中药治疗肥胖的潜在机制,为从痰湿论治肥胖提供相关科学依据.

目的 观察白介素22(IL-22)及其受体(IL-22R1)在DM慢性皮肤溃疡(DU)边缘皮肤组织中的表达特征,探讨其与DU愈合的关系.方法 选取2013年8月至2015年8月于广州中医药大学第二附属医院内分泌科住院的T2DM患者9例,取自足部溃疡边缘皮肤组织(DU组);另选取皮肤科住院的非DM慢性皮肤溃疡组织12例患者皮肤溃疡存档蜡块,取自下肢皮肤组织(NDU组)为研究对象,以及骨科10例患者手术中多余下肢正常皮肤组织(NC组).HE染色观察皮肤组织学变化,免疫组织化学法观察IL-22及IL-22R1定位和表达,RT-PCR检测NC、DU组IL-22及IL-22R1 mRNA表达.结果 与NC组比较,NDU、DU组表皮层增厚(P<0.01),真皮层变薄(P<0.01).DU组IL-22呈弱阳性和阳性表达,IL-22R1呈弱阳性表达.与NC组比较,NDU、DU组IL-22、IL-22R1细胞阳性率降低(P<0.01).DU组IL-22细胞阳性率高于NDU组,IL-22R1细胞阳性率低于NDU组(P<0.01).DU组IL-22 mRNA、IL-22R1 mRNA表达低于NC组(P<0.01).结论 IL-22及IL-22R1参与DU发生及难愈合机制,具体信号通路及调节因子需进一步研究加以证实.

目的:观察痰湿质肥胖人群腹型肥胖相关指标与其外周血T辅助细胞(T helper cells,Th)亚群比例变化的相关性.方法:共入选61例病例,根据中医体质评判标准及体重指数(body mass index,BMI)分为痰湿质肥胖组32例及非痰湿质肥胖组29例,另纳入30名BMI正常且中医体质辨识为平和质的健康人作为平和质正常对照组.采用流式细胞仪单克隆免疫荧光法分选Th1、Th2细胞并计算其比值,生物电阻抗检测内脏脂肪面积,皮脂厚度计测量腹部皮下脂肪厚度,测量身高、腰围(WC)并计算腰臀比(WHR)、腰高比(WHtR)等腹型肥胖指标,进一步分析这些腹型肥胖指标与Th1/Th2比值的关联性.结果:痰湿质肥胖组的Th1细胞比率、Th1/Th2比值均显著高于非痰湿质肥胖组、平和质正常对照组(P＜0.05);痰湿质肥胖组、非痰湿质肥胖组的Th2比率均明显低于平和质正常对照组(P＜0.05).相关分析结果显示,痰湿质肥胖组的内脏脂肪面积、腹部皮下脂肪厚度、WC、WHR及WHtR分别与Th1/Th2比值呈正相关关系(r=0.509,r=0.714,r=0.788,r=0.491,r=0.778,P＜0.05).结论:痰湿质肥胖患者体内均存在明显的Th1/Th2细胞比率失衡且与腹部脂肪堆积及腹型肥胖程度明显相关.这可能是痰湿质人群具有更高的腹型肥胖患病率的原因之一.

目的 对范冠杰教授运用"动-定序贯八法"治疗糖尿病周围神经病变的临床医案进行数据挖掘分析,寻求其组方用药规律.方法 筛选并纳入范冠杰教授运用"动-定序贯八法"治疗的糖尿病周围神经病变门诊临床医案197例,应用中医辅助传承系统(TCMISS)V 2.5软件建立数据库,并进行相关数据挖掘.结果 共筛选出方剂370首,方剂中使用频次排名前10位的药物分别为丹参、甘草、牡丹皮、生地黄、茵陈、莪术、白芍、薏苡仁、薄荷、葛根;高频药对42条,核心组合38个,新处方4个.结论 通过对"动-定序贯八法"治疗糖尿病周围神经病变的临床医案中的药物之间关联性的定量描述,提取核心组合,并进一步发现符合动-定序贯组方规律的新处方及新组合,可为研发防治糖尿病周围神经病变的中药制剂提供参考.

肥胖2型糖尿病(T2DM)正成为危害人类健康的流行性疾病,其多由先天禀赋、情志、饮食、生活方式等因素导致脾失运化、肝失疏泄、气机不畅,水谷肥甘之物转变为痰湿脂质积聚体内所成.其中脾肝功能失调在本病发病过程中起重要作用,脾虚湿滞是肥胖T2DM存在的体质基础,气机不畅是其重要发病条件.临床辨治肥胖T2DM从脾虚及气机不畅入手,运用扶脾理肝法治疗肥胖T2DM是一种有益的探索.

Objective To observe the changes of CD4+T cell subsets in overweight or obesity patients with phlegm-dampness constitution (PDC) and its correlation with related indicators of lipid metabolism.Methods According to the criteria of traditional Chinese medicine (TCM) constitution and body mass index (BMI),93 patients were assigned to overweight or obesity PDC group (25 cases),non-obesity PDC group (24 cases),non-PDC overweight or obesity group (22 cases),and balance constitution healthy group (22 cases).The characteristics of lipid profile were observed.Th1 and Th2 cell proportions were determined by flow cytometry using monoclonal immunofluorescence method,and their correlations with related indices of lipid metabolism analyzed.Results Th1 cell proportion and Th1/rh2 ratios were more significantly higher in overweight or obesity PDC group than in other three groups (P ＜0.05).Th2 cell proportion was more significantly decreased in overweight or obesity PDC group than in balance constitution healthy group (P ＜0.05).But there was no difference in Th2 cell proportion between non-PDC overweight/obesity group or non-obesity PDC group (P ＞ 0.05).Correlation analysis showed that Th1/Th2 ratios were positively correlated with TC,TG,and LDL-C (r =0.678,0.663,0.604;all P ＜0.05),but negatively correlated with HDL-C (r =-0.423,P ＜0.05) in overweight or obesity PDC group.But there were no correlation between Th1/Th2 ratios or TC/TG/LDL-C/HDL-C in non-PDC overweight or obesity group,non-obesity PDC group,and balance constitution healthy group.Conclusions There was obvious imbalance of Th1/Th2 cell proportion in PDC patients,which was obviously correlated with the severity of dyslipidemia.It was especially significant in PDC overweight or obesity patients.

目的:利用中医传承辅助系统(TCMISS)软件对既往中医药治疗高尿酸血症的中药处方进行组方规律分析,为临床辨证及处方用药提供思路.方法:分别检索中国知网(CNKI)、万方、维普、中国生物医学数据库(CBM)4个数据库1989-2016年中药治疗高尿酸血症的相关文献,对符合标准的175篇文献中的181首处方录入中医辅助平台软件,分析处方中药物的使用频次及用药模式,挖掘药物核心组合和新处方.结果:对筛选出的181首中药处方进行分析,得出药物的使用频次、常用药物组合及药对,其中核心用药为苍术、黄柏、薏苡仁、牛膝、土茯苓、萆薢、威灵仙,挖掘出28个核心组合和14首新处方.结论:高尿酸血症常用的药物以利水渗湿药、清热药、补益药、活血化瘀药为主,治法以清热利湿,健脾渗湿,补益肝肾,兼以活血化瘀为主.

目的:对近30多年来国内关于中医药治疗早中期脾肾阳虚型糖尿病肾病的文献进行挖掘分析,寻求中医药治疗早中期脾肾阳虚型糖尿病肾病方剂的组方用药规律.方法:检索CNKI、万方、维普等数据库,筛选纳入有关中医药治疗早中期脾肾阳虚型糖尿病肾病的文献,建立数据库,并进行相关数据挖掘,分析其配伍及用药规律.结果:共筛选出治疗早中期脾肾阳虚型糖尿病肾病方剂47首,对其进行分析,方剂中出现频次较高的前10味药物分别为黄芪、丹参、山药、生地黄、山2萸、茯苓、当归、太子参、泽泻.挖掘出高频药对8个,核心组合2个,新处方6个.结论:本研究应用数据挖掘方法,系统总结了早中期脾肾阳虚型糖尿病肾病用药规律,为临床辨证论治和进一步的科学研究提供数据支撑.

Objectives To use visualization method to analyze the relevant literature about prevention and treatment of obesity type 2 diabetes mellitus (T2DM) with TCM; To understand research hot spots and development trends of this field. Methods Computers were used to retrieve prevention and treatment of T2DM with TCM in CNKI. CiteSpaceV was used to visualize the authors, research institutes and keywords, and discussed their research hot spots, research frontiers, major research groups and trends. KNS6.6 was used to quantitatively analyzed included literature distribution characteristics, core citations, etc., and conducted visual display. Results After screening, 130 articles were included, involving 257 researchers and 6 research institutes, among which, TONG Xiao-lin, DONG Liu, ZHOU Li-bo, etc. were the main researchers. Guang'anmen Hospital of China Academy of Chinese Medical Sciences is the most important research institute, followed by Beijing University of Chinese Medicine, Changchun University of Chinese Medicine and Guangzhou University of Chinese Medicine. The main research directions included the diagnosis and treatment of obesity T2DM, acupuncture and moxibustion treatment, the mechanism of TCM intervention in inflammation. This study predicted exploration of the TCM pathogenesis of obesity T2DM and the construction of TCM clinical pathway may be the future research trends and hot spots. Conclusion Through visualization analysis, the main research directions in the field in recent 20 years, research hot spots, evolution veins and development trends can be understood quickly and intuitively, providing a basis for further research.

Objective To analyze the literatures on diabetic nephropathy(DN)at the early and middle stage dif-ferentiated as qi and blood deficiency and blood stagnation treated with Chinese herbal medicines in recent over 30 years of China and explore the rules of the formula combination of the disease.Methods Retrieved from the databases of CNKI, Wanfang and VIP,the literatures on DN at the early and middle stage differentiated as qi and blood deficiency and blood stagnation treated with Chinese herbal medicines were screened and included.Using TCM inheritance supporting system (TCMISS)of 2.5 Software,the database was set up and the data were mined.Results A total of 211 formulas were col-lected and analyzed for the treatment of DN at the early and middle stage differentiated as qi and blood deficiency and blood stagnation.The top 10 herbs with high frequency in the formulas were astragalus membranaceus,salvia miltiorrhiza, Chinese yam,radix rehmanniae recen,cornus,poria cocos,angelica sinensis,radix pseudostellariae and rhizome alismatis.A total 23 pairs of high-frequency used herbs and core combinations as well as 8 new prescriptions were mined.Conclusion Through the quantitative analysis on the medicinal relevance,the invisible experiences are mined widely and deeply and the new formulas of TCM are discovered for the treatment of DN at the early and middle stage differentiated as qi and blood de-ficiency and blood stagnation.All of those provide the new clue for the development of relevant new drugs of TCM.

AIM To analyze the current situation,trends,hotspots,and evolution on the research of the relationship between obesity and phlegmdamp constitution by using visualized methods on related papers.METHODS Based on the original data of CNKI articles,this study analyzed the papers related to obesity and phlegm-damp constitution.The Cite Space V was used to depict and compare authors,research institutions and keywords.Visualized methods in CNKI website were adopted to analyze citations.All results were described with visualized graphs.RESULTS A total of 40 researchers were identified to conduct obesity and phlegm-damp constitution research.There were three key research teams,in which Qi Wang,LingRu Li,Ji Wang,Lu-Yu Zheng,and LingLing Yang were key authors.The four main research institutions were Beijing University of Chinese Medicine,Guangzhou University of Chinese Medicine,China Academy of Chinese Medical Sciences,and Shandong University of Chinese Medicine.The four institutions account for 46.97%(62/132) of the total.The main research trends involved correlation study,constitution classification,clinical trials,and epigenetics.Constitution classification and gene expression were the main research hotspots in recent years.CONCLUSION By using visualized methods,this study analysed the current achievements,future trends,hotspots,and future research direction on the relationships between obesity and phlegm-damp constitution.

Objective To explore the composition principles of prescriptions for simple obesity based on the analysis of medical literature issued in recently 30 years about Chinese medicine for simple obesity. Methods We collected literature of Chinese medicine in treating simple obesity from VIP, CNKI, Wanfang, CBM and CMCC/CMCI databases, and screened out the formulas for simple obesity to establish a formula database. And then the medication rules were figured out with the Traditional Chinese medicine Inheritance Support System version 2.5 (TCMISS 2.5) software. Results A total of 57 formulas were screened out. And the top 10 herbs with highest occurrence frequency in the prescriptions were Poria, Rhizoma Atractylodis Macrocephalae, Rhizoma Alismatis, Radix et Rhizoma Rhei, Fructus Crataegi, Radix Astragali, Radix Glycyrrhizae, Folium Nelumbinis, Pericarpium Citri Reticulatae and Semen Cassiae. After data mining, we got 13 high-frequency herb-pair combinations and 31 core combinations, and 8 new prescriptions were extracted. Conclusion The research has achieved the quantitative description of the relationship between the Chinese medicines, the extraction of the core combinations and the discovery of new Chinese medicine prescriptions for simple obesity. The results will provide references for the development of new Chinese medicines for the treatment of simple obesity .

糖尿病性胃轻瘫属于糖尿病慢性并发症之一,其发病机制主要涉及自主神经病变、胃肠道激素失调、微循环障碍等,早期症状以早饱、腹胀、便秘为主,病情甚者可出现反复恶心、呕吐不适,严重影响生活质量甚至诱发糖尿病性酮症酸中毒.本病在中医古籍中并无特定病名,根据其胃胀、恶心、呕吐的症状特点,可归入胃痞、痞满、痞气、心下痞、呕吐、反胃等范畴.现代中医学者在临床实践中进一步总结经验,并提出“消渴胃痞”的病名.综合临床相关的诊疗方案及文献报道,目前本病多责之以“脾、胃、肝”相关脏腑病变,治法以健脾、和胃为主,兼以益气、养阴、清热、祛湿、活血等.然而在糖尿病性胃轻瘫的顽固性恶心呕吐或急性呕吐者中,传统健脾和胃法重在长期固本调护,在迅速改善腹胀、呕吐等症状方面略显不足.赵玲教授师承著名中医学家吕仁和教授及栗德林教授的学术思想,并根据临床病证观察,在健脾和胃、降逆止呕等常规治法基础上,总结出通腑下气、理气解郁两类治法治疗本病,临床效果显著.现介绍如下.

目的 观察二甲双胍联合利拉鲁肽治疗2型糖尿病伴肥胖症的效果并总结护理体会.方法 收集2型糖尿病伴肥胖症患者106例,根据患者入院日期的单双号数分为对照组51例和观察组55例.对照组采用二甲双胍和甘精胰岛素治疗,观察组采用二甲双胍和利拉鲁肽治疗.两组患者的护理措施相同.结果 两组患者治疗后空腹血糖、糖化血红蛋白以及餐后2h血糖差异无统计学意义.但观察组患者的体质量控制效果显著高于对照组,不良反应发生率明显低于对照组(3.6％ vs 23.5％),P均＜0.05.结论 采用二甲双胍联合利拉鲁肽治疗2型糖尿病伴肥胖症能够有效控制体质量,不良反应发生率较低,配合有效的护理措施能够进一步保证治疗效果,值得推广应用.

"动-定序贯"理论是范冠杰教授基于临床实践总结出来的治疗糖尿病及其并发症的理论体系,我们在"动-定序贯"理论指导下,归纳总结出消渴肾病的病、证的核心病机及相应的中药药串,应用于临床,取得了令人满意的疗效.

Objective To explore the effect of Tangduqing granules(TG)on the expression of TGF-β1,Smad3 and Smad4 mRNA in kidney tissue of diabetic renal insufficiency(DRI) rats. Methods Thirty-two Wistar rats were randomized into normal control group, DRI model group and TG group. DRI rat model was induced by intragastric gavage of streptozotocin(STZ) and adenine. Both normal control group and DRI model group were given intragastric administration with equal volume of normal saline, and TG group was given intragastric administration with TG 4.32 g/kg·d-1. Two months later, renal function was detected, the pathological changes of kidney tissue were examined, and the renal expression of TGF-β1, Smad3 and Smad4 mRNA was detected by RT-PCR. Results Compared with DRI model group, the expression of TGF-β1, Smad3, Smad4 mRNA of TG group was significantly decreased(P<0.05), but the expression level was similar to that of the normal control group(P> 0.05). Conclusion Tangduq ing granules can obviously reduce the expression of TGF-β1, Smad3 and Smad4 mRNA in kidney tissue of DRI rats, which may be the therapeutic and renal protective mechanism of Tangduqing granules in DRI rats.

目的:总结当代名中医诊治糖尿病肾病(Diabetic nephropathy,DN)的临床经验,探讨DN的病因病机及辨治规律.方法:筛选30位名中医治疗DN的文献130篇对其证侯及用药进行聚类和频数分析.结果:DN病机以虚实夹杂为主,气阴两虚血瘀、脾肾两虚血瘀、脾肾阳虚和水湿瘀阻为常见证候;论治方法有辨证论治、分期论治和辨病论治,治法分为调理气血阴阳、补益脏腑、活血化瘀通络等8种;高频次药物是茯苓、黄芪、山药、山茱萸、白术、泽泻、丹参等.结论:DN是多因素共同致病,正气虚损、邪实壅结为主要病机,扶正固本、活血利水、祛湿泄浊综合运用为最常用治法.