中医通过藏腑、经络理论认识人体与疾病,解释针药起效的原理.药物归经理论出现于藏象学说与临床实践长时间探索之后,充分说明依托藏象学说的归经理论是解释有效方药临床现象的说理工具.藏象学说是中医学的核心内容,是中医认识人体正常功能、疾病变化的说理工具,与之对应的藏腑辨证是临床中使用最多的辨证方法.中医基础理论分会提出中医基础理论应当从描述现象向阐释本质转变[1].中医与西医虽方法不同,但所关注研究的都是人体及其生理功能与病理表现.功能决定于形态结构,形态结构决定了功能,功能与形态结构是相互依存的,所以,解剖脏器与功能藏象是可以沟通对话,更可以互补的.本文从生理功能与临床症状等层面探讨肝脏的中医藏象归属,文中"藏"指中医藏象,"脏"指解剖脏器.

代谢相关脂肪性肝病(MAFLD)是指符合超重/肥胖或2型糖尿病或代谢功能障碍的具有肝脏脂肪变证据的疾病[1],其发病率逐年升高,MAFLD相关肝硬化、肝细胞癌也逐年增多.疾病早期可无明显症状,多由体检发现,在疾病的不同阶段,临床可出现不同程度的胁痛、黄疸、肝脾大、腹水等症状.病证结合的诊疗模式指导中医临床实践多年,但中医整体观被割裂的弊端也逐渐显现,仝小林院士提出的"态靶因果"辨治方略可取长补短,能更好地指导MAFLD的中医临床诊疗.

幽门螺杆菌是重要的致病因子.我国居民幽门螺杆菌感染率约为54.76％,感染人数庞大,临床中抗生素过敏及不能耐受患者逐年增多,幽门螺杆菌抗生素耐药率也逐年增高.左金丸可清热泻火,降逆止呕,是临床常用方剂,也是临床治疗幽门螺杆菌感染使用频率较高的方剂.幽门螺杆菌感染与中医湿热证相关性大,本文从基础、临床方面梳理了左金丸治疗幽门螺杆菌感染研究、左金丸有效成份及其代谢研究,为机制研究奠定了基础,左金丸可通过抑制幽门螺杆菌尿素酶活性,抑制生物膜合成,调节胃部菌群,影响miRNA、分子网络调控等机制起到抑杀幽门螺杆病菌的作用.这将促进左金丸治疗幽门螺杆菌的临床应用.

现今胃癌前病变发病率高,对患者的身体健康及生活质量造成极大困扰.徐湘江教授基于对中医基础理论的研究及临床经验的积累,认为该病成因来自多方面,因此其治疗也不应拘泥于某一方面.徐教授通过从心论治、从肝论治、扶正祛邪、活血化瘀、抗幽门螺杆菌护胃除菌、食疗辅助等多角度对其综合论治,将辨病与辨证巧妙结合,做到中西合参,药食同用,力求治疗精准快速有效.

通过分析仝小林院士提出的"以病为参,以态为基,以症为靶,以因为先,以果为据"辨治方略的内涵,基于中医胃病临床实践,探索将"态靶因果"辨治方略应用于胃病的诊疗过程以提高临床疗效.参考西医认识把握胃病发展的全过程,抓住核心病机,提出胃病中医态的演变规律:滞瘀态→虚损态→癌毒态.滞瘀态可分为胃气壅滞证、寒邪凝滞证、湿热蕴滞证、饮食停滞证、瘀血阻滞证;虚损态可分为脾胃虚寒证、气阴两虚证、虚火灼胃证;癌毒态可分为胃癌早期热毒内蕴证、胃癌中期癌毒内结证、胃癌晚期气血不足证,可据此初步确立治法方药.针对胃病中医传统病因饮食情志及现代病因幽门螺杆菌、胆汁反流、动力紊乱,参考中药现代药理研究成果辨证选药治疗,重视对症用药,有效缓解临床症状,把握气血虚实传变,阻断疾病传变.

目的 探讨复方谷氨酰胺治疗重度急性胰腺炎的临床效果.方法 将2018年4月—2019年1月在河北省沧州中西医结合医院脾胃肝病科病房治疗的120例重度急性胰腺炎患者随机分为对照组和观察组各60例,对照组患者给予临床常规治疗,观察组则联合给予复方谷氨酰胺治疗,2组均治疗1周.观察2组治疗后临床疗效、T淋巴细胞亚群、肠道气体容量积分(GVS积分)、APACHEⅡ评分及血清炎性因子C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平变化.结果 观察组治疗后总有效率明显高于对照组(P<0.05);治疗后2组CD3+、CD4+、CD4+/CD8+比值均较治疗前明显升高(P均<0.05),CD8+则较治疗前明显下降(P均<0.05),观察组各指标变化幅度明显高于对照组(P均<0.05);治疗后2组GVS积分、APACHEⅡ评分及血清CRP、IL-6、TNF-α水平均较治疗前明显下降(P均<0.05),观察组各指标均明显低于对照组(P均<0.05).结论 复方谷氨酰胺用于治疗重度急性胰腺炎患者能有效抑制机体炎症反应,改善免疫功能,疗效确切.

目的:研究探讨卡西平对创伤性癫痫患者的疗效及安全性.方法:随机选取2014年11月至2016年8月期间该院收治的创伤性癫痫患者62例,按照随机平行的原则将这62例患者均分为对照组和观察组,各31例,对照组的31例患者进行丙戊酸钠缓释片治疗,观察组的31例患者进行卡西平治疗,观察和比较两组患者的临床疗效以及安全性.结果:观察组患者用药后有7例被控制,有8例显效,有11例有效,5例无效,总有效率为83.87％;对照组患者用药后有4例被控制,有6例显效,有9例有效,12例无效,总有效率为61.29％,观察组治疗总有效率明显高于对照组;观察组患者在接受治疗后共有5例出现不良反应不良反应发生率为16.13％;对照组患者在接受治疗后共有10例出现不良反应不良反应发生率为32.26％,对照患者的不良反应发生率明显高于观察组(P＜0.05)具有统计学意义.结论:卡西平对创伤性癫痫患者的疗效显著,安全性高,值得推广.

目的:探讨分析奥扎格雷钠联合灯盏花素治疗老年短暂性脑缺血发作的疗效.方法:随机选取2014年12月至2016年12月期间,我院收治的老年短暂性脑缺血患者82例作为研究对象,按照随机平行的原则将这82例患者均分为观察组和对照组,各41例,对照组的41例患者在常规治疗的基础上进行奥扎格雷钠治疗,观察组的41例患者在常规治疗的基础上进行奥扎格雷钠联合灯盏花素治疗,观察比较两组患者的治疗疗效.结果:观察组41例患者中有20例显效,19例有效,2例无效,总有效率为95.12％;对照组41例患者中有13例显效,14例有效,14例无效,总有效率为65.85％,观察组临床治疗总有效率明显高于对照组;观察组患者治疗后短暂性脑出血发作停止时间为42.58h(s=14.69),明显优于对照组患者治疗后短暂性脑出血发作停止时间56.87h(s=15.82),(P均<0.05)具有统计学意义.结论:奥扎格雷钠联合灯盏花素治疗老年短暂性脑缺血发作的疗效显著,值得推广.

目的:研究分析醒脑静注射液对急性脑出血患者血中细胞因子水平影响.方法:收集2014年12月-2016年12月期间我院收治的急性脑出血患者50例,按照随机平行的原则将这50例患者均分为观察组和对照组,各25例,对照的25例患者进行胞二磷胆碱注射液治疗,观察组的25例患者进行醒脑静注射液治疗,观察比较两组患者的病情变化.结果:观察组患者接受治疗后的神经功能缺损评分为(11.19±6.07),明显优于对照组神经功能缺损评分(18.94±7.67);观察组患者治疗后的 IL-1为(4.58±1.62),TNF-α为(35.89±5.24);对照组患者治疗后的 IL-1为(12.01±3.89),TNF-α为(52.84±5.67),观察组治疗后的 IL-1、TNF-α均优于对照组,(P均<0.05)具有统计学意义.结论:醒脑静注射液能够促进急性脑出血患者血中细胞因子水平的改善,值得推广.

目的 探讨益肝化湿饮治疗乙肝肝硬化的临床应用价值.方法 选取乙肝肝硬化患者56例,随机分为治疗组和对照组各28例,对照组给予西医常规治疗,治疗组在此基础上加用益肝化湿饮治疗,比较两组患者的临床疗效.结果 治疗组总有效率85.71%,对照组总有效率57.14%,治疗组患者的临床疗效优于对照组,差异具有统计学意义(P<0.05);治疗组的肝功能ALT、Alb、TBil指标变化明显优于对照组,具有统计学意义(P<0.05).结论 益肝化湿饮治疗乙肝肝硬化具有较好的临床疗效,值得在临床上推广应用.

肠易激综合征（irritable bowel syndrome ，IBS）是一种功能性肠病，罗马Ⅲ亚型分类标准将其分为腹泻型（IBS-D ）、便秘型（IBS-C ）、混合型（IBS-M ）及不定型（IBS-U ），其中以腹泻型发病率高。随着社会的发展，生活节奏的加快，此病在临床上越发多见。因其病因及发病机制尚不清楚，临床上西医多以对症治疗为主，疗效尚不尽人意。本人研究自拟参苓胃消胶囊治疗IBS-D ，取得良好效果，现报告如下。

“肝生于左,肺藏于右”首见于《素问·刺禁论》,其曰:“肝生于左,肺藏于右,心布于表,肾治于里,脾为之使,胃为之市……”.指肝与肺的功能特点而言,而非解剖结构而言.经曰:左肝右肺者,以肝之用在左,肺之用在右也.《素问今释》:“肝主生发,如自然界一样.左为东方,左升右降,肝气从左上升.所以叫肝生于左.肺主肃降主收敛.如自然界一样.右为西方.左升右降,肺气从右下降.所以叫肺藏于右”.肝居人体下焦,其主藏血,主筋,主疏泄,主荣目,主谋虑等生疏功能,其气必自下而行于上,其上行则为升.升乃肝之性也,凡是人体出现气机的上升,就等同于肝的存在.肺为华盖,居人体上焦,其气,主收、主肃降、主通调水道等生理功能,其气必自上而行之于下,其下行则为降.降乃肺之性也,故凡是人体出现气机的下降,就等同于肺的存在.

Objective To evaluate the clinical significance of Pokemon in serum in patients with hepatocellar carcinoma(HCC) who received transcatheter arterial chemoembolization(TACE).Methods Serum levels of Pokemon were detected with ELISA in hepatocellar carcinoma and normal people,and the clinical value of Pokemon was analyzed.30 patients were treated by TACE,and the expression of Pokemon at 1 day before treatment and at 1 week and 1 month after treatment were also examined,whereas the variation of target lesion was assessed by computed tomography.The correlation between the expression of Pokemon and the treatment effectiveness of TACE was analyzed.Results The serum level of Pokemon in HCC was(24.28 ± 12.51) ng / ml,whereas its expression level in healthy people was(1.40 ± 0.73) ng / ml.The expression of Pokemon in HCC was higher than that in the healthy people(P 0.05).The expression of Pokemon in 30 cases of HCC at 1 month after treatment was(10.94 ± 4.84) ng / ml,which was significantly lower than that at 1 day before treatment [(23.50 ± 10.74) ng / ml,P 0.05].The effective rate of TACE was 16.67%(5/30).The change of Pokemon expression was positively correlated with effective rate of TACE.Conclusion The high expression of Pokemon in HCC and its correlation with effective rate of TACE suggest that Pokemon may become a new marker to evaluate treatment effectiveness of TACE.

Objective: To investigate the expression and clinical significance of proto-oncogene Pokemon in serum of patients with hepatocellular carcinoma.Methods: The expression of Pokemon in 84 cases of hepatocellular carcinoma,40 cases of hepatic cirrhosis and 20 cases of healthy controls were detected by enzyme-linked immunosorbent assay(ELISA).Results: The serum level of Pokemon in HCC was higher than these in the hepatic cirrhosis and healthy people(P 0.05).The expression of Pokemon was closely related to the size of tumor and distant metastasis,but no correlation with AFP.Conclusion: Pokemon may become a new effective marker in the diagnosis of HCC,meanwhile the expression level of Pokemon may be useful to predict the size of tumor and distant metastasis.

功能性消化不良(FD)是临床上常见的一种功能性胃肠病,由于发病机制尚未完全阐明,迄今仍缺乏令人满意的治疗药物.笔者用参苓胃消胶囊治疗FD, 取得良好效果,现报道如下.

Objective To investigate the clinical symptom and stomach function of shenling weixiao on functional dyspepsia(FD).Methods A randomed,contrasted,opened,paralleled study was conducted.60 patients who met Rome Ⅱcriteria for FD were randomized into 2 groups.Domperidone was given to the control group,shenling weixiao and Domperidone was given to medical group for 2 weeks.At the end of medication,the clinical symptom and stomach function of FD was assessed.Results After 2 weeks treatment,both medical and control group have significantly improved the symptoms of abdominal pain,abdominal distention,early satiety,belching,anorexia and nausea in patients with functional dyspepsia(P0.05).The scores of the symptoms medical group before and after treatment were(11.12±3.73) and(6.63± 3.54).The scores of the symptoms control group before and after treatment were(11.73±3.64)and(8.04±3.43)(P0.05),there were significant differences in the total scores between pre-and post-treatment in each group.The improvement rate of symptoms in medical and control group was(45.98±19.44)% and(27.15±13.35)%,and significant differences.Medical and control group have improved gastric emptying and sensation,significant differences.Conclusions Shenling weixiao is a effective medicine for treatment of functional dyspepsia.

Objective:Observing the practical effects of Shugan Jiangni Decoction on Bile Reflux Gastritis and improving situation of endogastritis.Method:Choose 60 patients with Bile Reflux Gastritis(ganweibuhexing).All the cases are divided into 2 groups at rondom-treatment group and comparison group,30 for which respectively.The former group is given Shugan Jiangni Decoction and the later one is given Domperidone and Daxijujuepian.Result:Comparison of general effects between the treatment group and comparison group.The general effective rate in the treatment group is 93.33%.In comarison group,the general effective rate is 83.33%.There is obvious difference between the effeciecy of the two kinds of methods(P0.05).The former one is better than the latter one's.Conclusion:Method of shuganheweijiangni have positive effect on Bile Reflux Gastritis(ganweibuhexing)and can apparently improve the symptom and corporeity.