目的 探讨金刚藤对肝纤维化大鼠肝功能及肝纤维指标的影响.方法 将50只SD大鼠随机分为正常对照组、模型对照组、金刚藤低剂量组、金刚藤中剂量组、金刚藤高剂量组,每组10只.除正常对照组外,其余各组大鼠均给予腹腔注射40％四氯化碳制作肝纤维化模型,共11周.建模第8周开始,金刚藤低、中、高剂量组分别以金刚藤水煎液1 g/(kg·d)、2 g/(kg·d)、4 g/(kg·d)灌胃,其余两组以10 mL/kg的生理盐水灌胃,共28 d.末次灌胃后检测5组大鼠血清总胆红素、白蛋白、ALT、AST、透明质酸、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)和Ⅳ型胶原水平.结果 与正常对照组比较,模型对照组ALT、AST、总胆红素、透明质酸、LN、PCⅢ、Ⅳ型胶原水平升高,白蛋白水平下降(P<0.05);模型对照组、金刚藤低、中、高剂量组ALT、AST、总胆红素、透明质酸、LN、PCⅢ、Ⅳ型胶原水平依次降低,白蛋白水平依次升高(均P<0.05).结论 金刚藤水煎液可以改善四氯化碳诱导的肝纤维化大鼠肝功能及肝纤维程度,这可能与其减轻肝脏炎症反应,促进胶原纤维降解,减少细胞外基质在肝脏中沉积有关.

OBJECTIVE:To probe into the best preparation technology of Qufeng Annao oral liquid .METHODS:L9 (34 ) orthogonal experiment was adopted and the content of ferulic acid was set as the quality control index to inspect the effects of decocting time , decocting frequency , water addition and alcohol precipitation volume fraction on the preparation technology , so as to optimize and verify the preparation of Qufeng Annao oral liquid .RESULTS:The best preparation of Qufeng Annao oral liquid was twice decoction of 2 h for each time , with 10 times of water addition and 80％of alcohol precipitation volume fraction .CONCLUSIONS:This best preparation technology is reasonable , with a comparatively high content of ferulic acid , which is suitable for the preparation of Qufeng Annao oral liquid .

Objective The efficacy and safety of rectal instillation with formula for clearing heat, eliminating phlegm and relaxing bowel on treating encephalopathy complicated with pulmonary infection were evaluated by randomized controlled clinical trials. Methods Eighty eligible cases of encephalopathy complicated with pulmonary infection were randomly divided into treatment group and control group. Control group was given conventional treatment and treatment group was given rectal instillation treatment with formula for clearing heat , eliminating phlegm and relaxing bowel. The changes of index were observed before and after treatment in two groups including temperature,antifebrile time,white blood cell count,neutrophils ratio,C-reactive protein,procalcitonin, pneumonia severity index,and the efficacy score of TCM syndrome. Results Rectal instillation with formula for clearing heat and eliminating phlegm to relax bowel can be better improved encephalopathy complicated with pulmonary infection with syndrome of phlegm-heat obstructing in which the patients have yellow sputum, constipation,yellow urinary and other symptoms. It can reduce TCM syndrome score and level of serum calcitonin, relieve inflammation,enhanc antibacterial effect,and improve the clinical curative effect. Conclusions The curative effects of rectal instillation with formula for clearing heat and eliminating phlegm to relax bowel on treating encephalopathy complicated with pulmonary is definite which has no adverse reaction and safety use. It is worthy of further popularizing in clinic.

在留学生中推动中国传统文化的教育具有重要意义.中医学是中国传统文化的重要组成部分,当前西医院校留学生的中医学教学面临着学生学习兴趣低下,教学质量较低等困境,而实行翻转课堂有可能改变这一局面.随着“互联网+教育”的蓬勃发展,通过网络平台,综合应用微课视频教学、小组合作课堂展示、个人学习展示等方法,达到翻转课堂的效果,可能有利于教学过程中的师生互动,有利于提高学生学习中医学的学习兴趣和积极性.同时文章也估计了中医学实行翻转课堂可能给师生带来的挑战.

中药材砂仁为姜科植物阳春砂(A.villosum Lour)、绿壳砂(A.villosum Lour.Var.xanthioides T.L.Wu et Senjen)或海南砂(A.longiligulare T.L.Wu)的干燥成熟果实.阳春砂主产于广东、广西、云南、福建等地;绿壳砂主产于广东、云南等地;海南砂主产于海南及雷州半岛等地.于夏、秋间果实成熟时采收,晒干或低温干燥.用时打碎生用.砂仁亦称土密砂、缩沙蜜、缩砂仁、缩砂密,其味辛,其性温,归脾、胃、肾经,具有化湿行气,温中止泻,安胎之效,临床上主要用于湿阻中焦、脾胃虚寒吐泻、气滞妊娠恶阻及胎动不安等证,以砂仁为主或适当配伍可用于治疗各种妇科疾病.本文将近年来砂仁的现代药理研究及其在妇科疾病中的临床应用综述如下.

目的:探讨脑卒中及颅脑损伤患者肺部感染的病原体分布并分析其耐药性,为临床及科研工作提供理论依据.方法:回顾性分析2013年1月至2015年4月在广西医科大学第一附属医院中医脑病专科住院的1 238例脑卒中及颅脑损伤患者的临床资料.结果:1 238例脑卒中及颅脑损伤患者中发生肺部感染604例,发生率为48.8％;共分离出328株病原体,其中革兰阴性菌303株,占92.4％;革兰阳性菌17株,占5.2％;真菌8株,占2.4％.主要革兰阴性菌有3种,分别为铜绿假单胞菌、鲍曼不动杆菌及肺炎克雷伯杆菌,3种革兰阴性菌对氨苄西林的耐药率均为100％;主要革兰阳性菌只有1种,为金黄色葡萄球菌,其对苄青霉素、克林霉素及红霉素的耐药性较高,为92.3％～100％.结论:脑卒中及颅脑损伤患者肺部感染的病原菌以革兰阴性菌为主,主要有铜绿假单胞菌、鲍曼不动杆菌及肺炎克雷伯杆菌,呈多重耐药性,临床应谨慎合理应用抗菌药物,以期延缓患者的耐药性,改善患者预后.

目的 根据国家中医药管理局“十一五”重点专科(专病)工作计划和要求,对中西医结合颅脑损伤诊疗方案进行验证,确定其临床疗效和安全性,为进一步优化诊疗方案奠定基础.方法 采用非随机、多中心、治疗前后自身对照法,中、重型颅脑损伤患者,接受西医常规治疗,并按诊疗方案进行中医综合治疗.以3周为1个疗程,治疗并观察4个疗程,观察其治疗前后Glasgow (GCS)评分、日常生活活动能力评分、神经功能缺损程度评分及安全指标等,并进行疗效分析及安全性评估.结果 颅脑损伤方案能显著改善颅脑损伤患者GCS评分(中型)、神经功能缺损评分及日常生活活动能力评分,总有效率达58.1％,无安全不良事件发生.结论 颅脑损伤验证方案能够有效地改善颅脑损伤患者临床症状,是一套疗效可靠、安全的中西医结合综合治疗方案,值得临床推广.

月经病是指以月经的周期、经期、经量、经质或经色等发生异常及伴随明显不适为特征的疾病的统称.中医学认为月经的产生是女子发育到成熟年龄后,脏腑、天癸、气血、经络协调作用于胞宫的生理现象,与肝、脾、肾三藏关系密切.全国名老中医黄李平教授从事月经病的临床工作30余年,她主张治疗月经病以肝为主,肝脾肾三脏同治,并在长期的临床实践中总结出经验方——理平调经汤,临床随证加减,治疗月经病收到良好疗效,现举案2例以资说明.

目的 探讨气管切开插管大鼠肺组织病理及肺泡灌洗液肺泡表面活性物质相关蛋白A(SP-A)的变化情况.方法 将36只雄性SD大鼠采用随机数字表法分为空白对照组(A组)18只、气管切开插管模型组(B组)18只.于建立模型后24h、72 h、168 h分别取各组大鼠6只,并取右肺组织行病理切片检查,进行Smith评分评估肺组织损伤情况;取左肺肺泡灌洗液检测SP-A浓度.结果 肺组织病理结果显示B组大鼠在建模后24 h、72 h、168 h均有不同程度的水肿、肺泡及间质炎症、出血、肺不张等肺组织损伤,各时间点Smith评分均明显高于A组(P＜0.05),并随着时间的延长而增高(P＜0.05).B组大鼠肺泡灌洗液SP-A浓度在各时间点均明显高于A组(P＜0.05),且随气管切开插管时间的延长而降低(P＜0.05).结论 气管切开插管可导致水肿、肺泡炎症、出血、肺不张等肺组织损伤及肺部固有免疫功能紊乱,SP-A有保护肺组织作用,气管切开插管早期SP-A代偿性增高,随后逐渐下降.

目的 观察牛膝水提取物对重型颅脑损伤大鼠血清IL-2及神经细胞凋亡的影响,并探讨血清IL-2含量与神经细胞凋亡关系.方法 将SD大鼠随机分成对照组、模型组、牛膝高剂量组、牛膝中剂量组和牛膝低剂量组.于伤后6h给牛膝各用药组灌食牛膝水提取物,其余两组灌食等量0.9％氯化钠注射液.每日1次,连续7d,伤后第7日分别采集血标本及脑组织.采用ELISA及TUNEL原位法分别检测血清IL-2含量和损伤区神经细胞的凋亡.结果 (1)重型颅脑损伤大鼠血清IL-2含量明显降低,牛膝水提取物可以提高重型颅脑损伤大鼠血清IL-2含量,这一作用与剂量呈正相关关系.(2)重型颅脑损伤大鼠存在明显的神经细胞凋亡,用牛膝水提取物干预后不能改善神经细胞凋亡,高剂量反而加重脑组织的细胞凋亡.这一作用与血清IL-2含量升高相关.结论 牛膝水提取物能提高重型颅脑损伤大鼠血清IL-2的含量,血清IL-2含量升高会加重重型颅脑损伤大鼠脑细胞的凋亡.

目的：探讨金花茶对亚急性衰老大鼠抗氧化和抗凋亡的作用。方法拟建立大鼠亚急性衰老模型后，予高、低浓度金花茶灌胃干预。测肝脏和睾丸组织超氧化物歧化酶（SOD），丙二醛（MDA）含量及 bax、bcl－2 mRNA 表达水平。结果与衰老模型组对比，高、低浓度金花茶组肝脏和睾丸组织 SOD 含量和 bcl－2 mRNA 表达显著升高（P＜0．05），且 MDA 含量和 bax mRNA 表达明显下降（P＜0．05）。高、低浓度金花茶组间比较，上述指标有统计学差异（P＜0．05）。结结论金花茶可以提高 SOD 含量和降低 MDA 含量，通过上调 bcl－2和下调 bax 表达水平，减慢肝脏和睾丸细胞的凋亡，对延缓机体衰老有重要作用。

卒中相关性肺炎(stroke associated pneumonia,SAP)是指原无肺部感染的卒中患者罹患感染性肺实质(含肺泡壁即广义上的肺间质)炎症.卒中后肺炎的发生率为7％～22％,是卒中死亡的重要危险因素之一,并导致医疗费用的极剧增加[1-3].2003年Hilker等[4]首先提出了SAP的概念.为提高SAP的诊疗水平,我国于2010年发布了《卒中相关性肺炎诊治中国专家共识》[1].尽管目前西医诊治SAP已有规范的指南,但该病的控制在临床上仍有极大的困难,究其原因,主要与患者本身机体功能障碍、混合感染、耐药菌产生、不合理应用抗生素等有很大关系,这也为中医药在该病的治疗上发挥优势提供了契机.现就SAP的中医药治疗做如下综述.

Craniocerebral injury belongs to the category of injury interior syndrome and injury syncope in traditional Chinese medicine. Chinese medicine is widely used in clinical treatment of craniocerebral injury,which can help to improve the effect of treatment and promote patients recover. According to traditional Chinese medicine research literature and clinical practice experiences on craniocerebral injury in the past 30 years,after four rounds of expert consultation and modification,the authors formed a detailed traditional Chinese medicine protocol for the diagnosis and treatment of craniocerebral injury,including Chinese and western medicine diagnostic criteria,evaluation standard of curative effect,syndrome differentiation and treatment of Chinese medicine according to stages,acupuncture treatment,other therapies of Chinese medicine,application of equipments for Chinese medicine diagnosis and treatment,treatment with modern equipment,rehabilitation,massage and the management of complications.

目的:探讨颅脑损伤急性期血瘀证与神经元损伤标志物的关系.方法:采用临床流行病学方法对76例颅脑损伤急性期患者进行证候调查、证候量化评分、损伤程度(GCS评分)分级,抽取外周血酶免法测定神经元特异性烯醇化酶(NSE)的含量水平.结果:颅脑损伤急性期患者中医证型出现频次为气滞血瘀＞痰瘀交阻＞血瘀气虚＞瘀阻清窍＞规范外的其他证型＞肝肾亏虚;轻型患者中气滞血瘀证最为多见,中型患者中气滞血瘀、痰瘀交阻、血瘀气虚证较多,重型患者中痰瘀交阻、气滞血瘀、瘀阻清窍证位列前三;血瘀相关证型占84.21％.血瘀证患者的证候积分、NSE含量水平均高于非血瘀证患者,NSE含量水平有显著性差异(P＜0.05);重型患者的证候积分、NSE含量水平较轻、中型患者高,组间比较有显著性差异(P＜0.01);相关分析提示损伤程度与血瘀证证候积分、NSE含量水平呈正相关(P＜0.01).血瘀证不同证候类型的证候积分、NSE含量水平比较无显著性差异(P＞0.05).结论:急性期颅脑损伤患者以血瘀实证为主.血瘀证证候积分越高,颅脑损伤病情越重,NSE含量水平越高.

[目的]分析颅脑损伤患者中医临床证型的分布特点.[方法]采用临床调查表对748例颅脑损伤患者进行证候调查,统计分析中医证型在年龄、性别、损伤程度(GCS评分)、病程分期的分布特点.[结果]气滞血瘀型为颅脑损伤最多见的证型,其次为痰瘀交阻、血瘀气虚、瘀阻清窍、肝肾亏虚和规范外的其他证型.实证相关证型的男性发病较虚证相关证型更高,虚实两类证型在性别比的构成上有显著性差异(P＜0.0l).气滞血瘀、痰瘀交阻、瘀阻清窍、血瘀气虚以及规范外的其他证型分布峰值在20～39岁年龄段,肝肾亏虚型则在≥60岁的年龄段多见;气滞血瘀型多见于急性期、轻型患者,瘀阻清窍多见于急性期、重型患者,血瘀气虚和肝肾亏虚型多见于恢复期、中重型患者,痰瘀交阻型则多见于恢复期、重型患者,证型在年龄、损伤程度、病情分期的分布差异有统计学意义(P＜0.0l).[结论]瘀阻清窍、气滞血瘀、痰瘀交阻等实证证型多见于青壮年男性患者,肝肾亏虚多见于老年患者.急性期颅脑损伤患者无论病情轻重均以实证为主,而恢复期中重型患者虚实夹杂、实多虚少.

目的 观察中药怀牛膝及黄芪对重型颅脑损伤大鼠脑组织含水量及水通道蛋白4(AQP4)表达的影响,探讨其治疗重型脑损伤性脑水肿的机制.方法 SD大鼠65只,随机分为假手术组(5只),模型组(15只),怀牛膝治疗组(15只),黄芪治疗组(15只),怀牛膝及黄芪治疗组(15只),采用改良后Feencyg方法建立大鼠重型颅脑损伤模型.分别在1天,3天,7天3个时间点每组各取5只测定脑组织含水量、HE染色观察脑组织变化情况、并采用免疫组化方法检测脑组织AQP4的表达.结果 模型组大鼠重型颅脑损伤后各时间点脑组织含水量、损伤灶周围AQP4的表达均高于假手术组(P＜0.05),HE染色观察发现模型组的脑组织肿胀水肿明显;怀牛膝治疗组、黄芪治疗组各时间点脑组织含水量、AQP4表达水平与模型组无明显降低(P＞0.05),HE染色观察发现与模型组基本一样;怀牛膝及黄芪治疗组各时间点脑组织含水量、AQP4表达水平均比模型组有降低(P＜0.05),HE染色观察发现与模型组相比,脑组织水肿情况有所改善.结论 怀牛膝及黄芪治疗组可改善重型颅脑损伤后引起的脑水肿.其作用可能与抑制AQP4在损伤脑组织中的表达、减轻脑细胞损害有关.

Objective:To observe the effect of saflfower on the expression of skin vascular endothelial growth factor(VEGF) in mouse with scleroderma in order to explore the mechanism of safflower in anti-dermatofibrosis.Methods:The mouse models with scleroderma were induced with bleomycin and then treated respectively with physiological saline (the model group),penicillamine liquid (the penicillamine group),and low,middle,and high doses of safflower decoction (the low,middle and high dose groups) for 28 days.HE staining was used to observe the skin pathological changes and the measurement of dermal thickness was made. Immunohistochemisty was made to detect the VEGF expression.Results:The dermal thickness,ifber hyperplasia and VEGF expression in each model group increased,being statistically signiifcant compared with those in the control group(P<0.05).Compared with the model group,the dermal thickness and VEGF expression of the penicillamine group and all saflfower groups decreased(P<0.05);compared with the penicillamine group and the low-dose group of saflfower decoction,the dermal thickness and VEGF expression of the middle and high dose groups of saflfower decoction obviously decreased(P<0.05).Conclusion:Saflfower decoction could reduce the expression of VEGF in the skin of mice with scleroderma,which might be one of the mechanisms of saflfower in anti-dermatoifbrosis.

目的 观察红花对硬皮小鼠皮肤COL-Ⅰ、COL-Ⅲ表达的影响,探讨红花抗皮肤纤维化的作用机制.方法 采用博来霉素诱导建立硬皮小鼠模型,分别采用生理盐水(模型组)、青霉胺、低中高不同剂量红花水煎液内服治疗硬皮小鼠,共28 d.对照组小鼠背部皮下注射磷酸盐缓冲液.HE染色观察皮肤病理改变并测量真皮厚度,免疫组化检测COL-Ⅰ、COL-Ⅲ的含量表达.结果 造模各组硬皮小鼠真皮厚度增厚,纤维增粗、膨大,数量增多,排列紊乱,COL-Ⅰ、COL-Ⅲ的含量表达降低,模型组尤为显著,与对照组比较差异均有统计学意义(P＜0.05);与模型组比较,青霉胺和红花水煎液各剂量组药物干预后真皮厚度及COL-Ⅰ、COL-Ⅲ的表达均有不同程度降低,差异显著(P＜0.05);与青霉胺组比较,红花水煎液中、高剂量组真皮厚度及COL-Ⅰ、COL-Ⅲ的表达明显降低,差异有统计学意义(P＜0.05).结论 红花水煎液内服可降低硬皮小鼠皮肤COL-Ⅰ、COL-Ⅲ的表达,从而改善硬皮小鼠皮肤纤维化程度.

Objective To investigate the prognosis of patients with traumatic brain injury in the recovery period.Methods Data of 231 cases of convalescent patients with traumatic brain injury was selected,correlation factors of prognosis were analyzed with chi square test and Logistic regress analysis.Results Age,GCS score,intracranial hematoma,brain stem injury,and complications are related to prognosis,including age and GCS score and prognosis is most closely related.Conclusion The age,GCS score,intracranial hematoma,brain stem injury,and complications of convalescent patients is still important prognostic indicators,the comprehensive assessment and Integrative Medicine focus on measures to be taken.

In order to discuss the research progress on the application of method of promoting blood circulation to remove blood stasis on craniocerebral trauma,we retrieved relevant literature in recent years about the application of method of promoting blood circulation to remove blood stasis on craniocerebral trauma in ChianInfo,VIP database and summarized related mechanism and experience on treating craniocerebral trauma through method of promoting blood circulation to remove blood stasis.To indicate relevant literature reports in recent years,great progress has been made in the application and researches of method of promoting blood circulation to remove blood stasis on craniocerebral trauma and its bright prospect has been proved by clinical practice but some problems are still there.To guide the clinical application of method of promoting blood circulation to remove blood stasis on craniocerebral trauma according to the thinking of evidence-based medicine and syndrome differentiation of traditional Chinese medicine,and combined with the microscopic basis of blood stasis syndrome provided by modern science and technology as microscopic syndrome for making syndrome,more remarkable curative effect will be obtained.