本文通过四则医话记述了国医大师徐经世先生在诊疗过程的心得、 体会及感悟.徐经世先生在抗击新型冠状病毒肺炎过程中,倡导的"宜中则中,宜西则西"原则是当代历史条件下抗疫战斗发挥"中西医协同作用"的客观要求.肺结节的调治,须从整体观念出发,注重五脏相互制化的影响,不可"见肺治肺".肿瘤术后,当雪中送炭而非加霜,扶正是为祛邪创造条件.不定时大汗虚脱,辨证另辟蹊径,异病同治,痰热气滞非气虚.四则医话体现了徐老的诊疗思维和人文情怀,蕴含了中医四诊之美、辨证之美、 处方之美和发现之美,旨在启发后学领略徐老深邃的医学智慧、 丰厚的人文底蕴和求真、 崇善、 尚美的志趣,从而提升理论和临床水平,传承和弘扬中医药文化.

目的:对生姜的历代加工炮制方法进行整理归纳.方法:通过查阅医药古籍、本草文献及近现代相关法典资料,总结生姜历代加工炮制方法及国医大师徐经世对煨生姜的临床应用.结果:历代以来生姜炮制方法较多,有切制、捣绞取汁、焙制、炒制、煨制、面制、蜜制、黑豆制等.结论:生姜经过炮制,其炮制品药效各异,为达到更好的临床效果,中医师应通过辨证施治选用合适的炮制品种,并为现代开发新的生姜炮制方法提供参考.

目的:探讨针刺联合治肾化痰中药对肥胖型多囊卵巢综合征(PCOS)患者肠道菌群、糖脂代谢及炎症因子水平的影响.方法:选取100例肥胖型PCOS患者为研究对象,按照治疗方式不同分为观察组和对照组,每组各50例.对照组口服炔雌醇环丙孕酮片治疗,观察组在对照组基础上使用治肾化痰的中药联合针刺治疗.比较两组患者治疗前后糖脂代谢、炎症因子水平、肠道菌群数、肠道屏障功能指标的差异,分析肠道菌群与糖脂代谢、炎症因子及肠道屏障功能的相关性.结果:治疗前,两组肠道菌群、肠道屏障功能指标、糖脂代谢、炎症因子水平比较,差异无统计学意义(P>0.05).治疗后,观察组糖代谢指标空腹胰岛素(FINS)、空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)水平、脂代谢指标总胆固醇高(TC)、甘油三脂(TG)水平、肠杆菌与肠球菌菌群数、肠道屏障功能指标D-乳酸和二胺氧化酶(DAO)水平、白细胞介素-6(IL-6)、C反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α)较对照组低(P<0.05),高密度脂蛋白(HDL-C)水平、乳杆菌和双歧杆菌的菌群数较对照升高(P<0.05);肠杆菌、肠球菌与肠道屏障功能、糖代谢、炎症因子及TC、TG呈正相关(P<0.05),与HDL-C呈负相关(P<0.05);乳杆菌、双歧杆菌与肠道屏障功能、糖代谢、炎症因子及TC、TG呈负相关(P<0.05),与HDL-C呈正相关(P<0.05).结论:针刺联合中药对肥胖型PCOS患者有良好的治疗作用,可有效改善患者肠道菌群、肠道屏障功能、糖脂代谢和炎症因子水平.

国医大师徐经世根据左金丸配伍特点,以红豆蔻易吴茱萸,通过临床实践证明,具有醒脾消食,宣导瘀浊之效,借助黄连,通降胆火,保留了左金丸泻肝和胃的功效,而少了辛热伤阴之弊,亦增强了疏肝理气之功,更扩大了治疗适应症,其功胜于吴茱萸,创新出“假左金”理论.

国医大师徐经世认为,新型冠状病毒肺炎是以"湿阻热蕴,热极成毒"为主要病因病机,治疗宜分轻重,分期论治;同时还要遵循"因时、因地、因人"而异的治疗原则。早期轻症患者应注意"宣透",即恢复肺的宣发肃降之功能并透邪外出;重症患者当遵"邪之所凑,其气必虚"之旨,标本兼顾,扶正祛邪并施;危重患者则应区分闭证与脱证的不同,配合西医支持治疗,相互协同;恢复期患者则应注重饮食调养,劳逸有度,做好形神修养,实现自我康复。

目的:桑叶除了目前沿用的生桑叶、蜜桑叶和炒桑叶外,历史上还出现过多种炮制方法,该文主要对桑叶的古今炮制历史沿革进行探讨.方法:通过对大量本草、方书文献资料研究,阐述桑叶历代曾经出现的加工炮制方法以及国医大师徐经世对炒桑叶的临床应用.结果:历史桑叶炮制方法多样且不同炮制品功效各异,临床使用时对中药不同炮制品的恰当选用,会对临床疗效产生十分重要的意义.国医大师徐经世先生通过辩证施治,巧妙使用炒桑叶,在临床获得较好疗效.结论:历代桑叶炮制品种众多,各种炮制品功效均有所不同,对这些宝贵的经验我们应该加以整理与继承,充分利用现代科研手段以及临床实践进行验证,吸取精华并发扬光大.中医师临床选用不同炮制品对提高临床疗效意义重大,为进一步系统研究桑叶功效提供参考.

扶正安中汤是国医大师徐经世针对恶性肿瘤术后及放射治疗、化学治疗后中气受损、气机瘀滞创立的基础方,临床运用扶正安中汤化裁治疗各种恶性肿瘤术后患者,可较快恢复患者身体状况,有利于后续治疗和康复.

Objective To analyze Chinese medicine master XU Jingshi's medication rule of herbal paste in the treatment of subhealth by using data mining technology.Methods Prescriptions by Professor XU in treating 224 cases of subheahhy status with herbal paste were collected from medical records.Structured clinical diagnosis information collection system was used to record the diagnosis and treatment information.Prescription data was extracted for pretreatment.Complex network data mining were carried to analyze medicines use,couplet medicines use and core drug,respectively and all the drugs were studied by cluster analysis.Results Totally 224 patients with 828 symptoms visited 266 times,and 266 prescriptions and 153 herbs were used.The top five most common symptoms in subhealthy population were insomnia (151),fatigue (89),dry mouth (72),loose stool (61),and dry and uncomfortable eye (57).The top five most commonly used herbs were Shihu [Herba Dendrobii,石斛] (236),Yuanzhi [Radix Polygalae,远志] (235),Baishao [Radix Paeoniae albae,白芍] (226),Suanzaoren [Semen Zizyphi spinosae,酸枣仁] (207) and Gancao [Radix Glycyrrhizae,甘草] (198).The complex network map shows the 23 herbs including Yuanzhi [Radix Polygalae],Shihu [Herba Dendrobii],Baishao [Radix Paeoniae albae],Suanzaoren [Semen Zizyphi spinosae],Nyuzhenzi [Fructus Ligustri L ucidi,女贞子],Gancao [Radix Glycyrrhizae],Tianma [Rhizoma G astrodiae,天麻],Hehuanpi [Cortex Albiziae,合欢皮],Huanglian [Rhizoma Coptidis,黄连],Guizhi [Ramulus Cinnamomi,桂枝],etc.as the core drugs.There were 12 pairs of common used couplet medicines with support degree ＞ 60％ and confidence ＞ 85％.According to the cluster map and the clinical practice experience,7 prescriptions were formed.Conclusion Shihu [Herba Dendrobii] was the most commonly used medicinal herb in the treatment of subhealth with herbal paste by Professor XU Jingshi.The ingredients of core prescription also included Yuanzhi [Radix Polygalae],Baishao [Radix Paeoniae albae],Suanzaoren [Semen Zizyphi spinosae],etc.The herbs used were mainly sweet herbs.Professor XU paid more attention to regulating liver.

本文从理论到实践方面,对中医"心脾积热"理论运用于口腔粘膜病的治疗进行阐述.通过中医理论溯源整理和实际案例分析,对中医"心脾积热"病机理论指导临床治疗多种口腔粘膜病进行介绍.

TCM master XU Jing-shi gradually realized the occurrence and development of traditional Chinese medicine miscellaneous disease in more than 60 years of clinical practice, and proposed the reason of miscellaneous disease was stagnation and the treatment mainly focuses on the conditional function of the liver. Based on this, he put forward some methods, including relieving qi stagnancy in liver, regulating the spleen and stomach, notifying kidney water for clearing phase fire, promoting blood circulation to remove blood stasis, and harmonizing yin and yang for regulating the function of the liver. These methods are the general treatment of miscellaneous diseases. Actually, regardless of what happens to the organ, these methods can be used for the disease caused by stagnation.

国医大师徐经世认为伏邪是内伤发热的主要病因.主要病机为有热毒内伏, 邪及少阳; 情志内伤, 邪伏少阳; 邪伏阴分, 阴虚发热.治疗以转枢少阳, 益气养阴, 清热解毒, 处方用药以小柴胡汤为基础加减化裁.

目的:探讨临方炮制的合理性与临床意义.方法:结合临方炮制的法律依据,菊花炒制方法的文献查阅,我院炒菊花采用的临方炮制方法,以及国医大师徐经世善用炒菊花的医案进行分析.结果:临方炮制有利于中医辨证施治,灵活用药,提高方药临床疗效.结论:临方炮制品种是对常规炮制品种的补充,中医师了解和掌握中药炮制品的作用和临床应用对提高中医药的临床疗效有着十分重要的意义.

Objective To analyze the medication rules of Chinese medicine great master Prof.XU Jingshi in treating stomachache of stagnation of liver Qi and spleen deficiency type.Methods The medical records of Prof.XU Jingshi in treating stomachache of stagnation of liver Qi and spleen deficiency type were collected.The medical information was logged by structured information collection system for clinical diagnosis and treatment.Common symptoms,herbs of high frequency and core herb combinations were analyzed by data mining technology.Results Totally,85 patients were collected,157 clinical times,711 symptoms,103 herbs.Common clinical symptoms of stomachache patients were stomachache,belching and insomnia.Patients with insomnia were more than 40％.Herbs with the frequency larger than 50％ were Zhuru [Caulis Bambusae in Taenia],Chenpi [Pericarpium Citri Reticulatae],Lü'emei [Flos mume],Zhiqiao [Fructus Aurantii],Banxia [Rhizoma Pinelliae],Huanglian [Rhizoma Coptidis] and Suanzaoren [Semen Ziziphi Spinosae].Herbs used were mainly mild nature and sweet flavor,and mostly influnced the spleen,stomach,liver and gallbladder channels.Complex network diagram showed that core herbs were Zhuru,Chenpi,Lü'emei,Zhiqiao,Banxia,Huanglian,Suanzaoren and Baishao [Radix Paeoniae Alba].Chinese herb group association rules showed that herb groups included Zhuru-Chenpi,Lü'emei-Chenpi,Chenpi-Zhiqiao,Lü'emei-Zhiqiao,Lü'emei-Chenpi & Zhuru,Chenpi-Lü'emei & Zhuru and Zhuru-Chenpi & Lü'emei,etc.Conclusion Based on data mining technology,the authors found that when Prof.XU Jingshi treated stomachache of stagnation of liver Qi and spleen deficiency type,Zhuru,Chenpi and Lü'emei were mostly used.Herbs used by Prof.XU were mainly mild nature and sweet flavor,and mostly influnced the spleen,stomach,liver and gallbladder channels.

国医大师徐经世教授从事中医临床60多年,在处治内科杂病方面积累了丰富经验,在中医理论方面有很多创见与发挥.作者从和解表里、通达内外;降阳和阴、消痞散结;潜阳和阴、以期其平;和煦肝木、调理脾胃等四个方面,对徐经世教授临床运用“和法”治疗内科杂病的经验进行了总结.

痛泻要方是和解剂中调和肝脾的方剂,是临床治疗肝郁脾虚证的代表方.徐经世先生重视调节中焦脾胃肝胆气机,擅用疏肝健脾之法治疗内科杂症,临证喜用痛泻要方.文章论述导师灵活运用本方治疗湿疹、郁证、心悸、喘证的经验.

中医“治未病”理念是中医学理论的重要组成部分,其来源于日常生活实践.“治未病”起源于远古,雏形于《周易》,形成于《黄帝内经》.《黄帝内经》明确提出“治未病”的概念,并完善“治未病”的理论体系,后学者多有发挥.近年来国家对“治未病”的理论及临床实践越来越重视,“治未病”的理念得到广泛传播,民众对“治未病”的认知度和认同性有明显的提升.“治未病”是中医防治疾病的最高境界,中医“治未病”应当定位在防,要做到“法以阴阳,顺应天时”;“形神修养,自我心知”;“居住适宜,环境为要”;“饮食有调,注意偏盛”;“运动有度,贵在坚持”等,将疾病“关口前移”,“重心下沉”,与时俱进,焕发“治未病”理念的璀璨光辉.

目的:观察消化复宁汤对肝郁脾虚型慢性萎缩性胃炎患者的临床疗效.方法:入选的60例肝郁脾虚型慢性萎缩性胃炎患者完全随机分为对照组和治疗组,每组30例.对照组给予胃复春片干预,治疗组用消化复宁汤,治疗周期为3个月.观察患者治疗前后中医证候疗效及胃镜下黏膜炎症的变化情况.结果:对照组疗效总有效率为60.00％,治疗组总有效率为90.00％,两组比较差异有统计学意义(P＜0.05);对照组胃镜下黏膜炎症改善的有效率为53.33％,治疗组有效率为80.00％,两组比较差异有统计学意义(P＜0.05);试验过程中未发现不良反应.结论:消化复宁汤对肝郁脾虚型慢性萎缩性胃炎安全有效.

介绍徐经世治疗尪痹经验,认为尪痹的基本病机是寒湿流注,气血不和,筋骨受累,损及肝肾,寒湿困脾是尪痹的病机关键.选方用药上以经方为基础加减化裁,临证时要注意固护脾胃,“从中调治”应贯穿于治疗始终;同时注意辨病位用药,适当选用虫类药以提高疗效;注重精神调摄,调畅情志,以善其后.

围绝经期综合征是临床中严重影响患者生存质量的一种常见病、多发病,名老中医徐经世教授观察从“肝”论治,具有一定的特色和优势,且疗效明显,现将其经验总结于下,这将为围绝经期综合征的防治提供新方法及新思路.

采集徐经世教授诊治的胃脘痛患者102例、220诊次,提取患者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,采用名老中医数据处理系统,通过频次统计、复杂网络分析等对数据进行挖掘。结果显示,胃脘痛患者常见症状除胃脘痛外,出现频次最多的依次为睡眠欠佳、嗳气、反酸、胃胀;中医常见证型为肝郁脾虚、胃气不和、肝胃不和;常用治法为调肝和胃、开郁醒脾、扶木抑土;常用方剂为消化复宁汤、丹参饮、黄连温胆汤;常用药为竹茹、绿萼梅、枳壳。复杂网络分析图显示,竹茹、绿萼梅、黄连、枳壳、酸枣仁为核心处方,其中最核心药物为竹茹。