腺样体肥大是一种以儿童睡中打鼾、张口呼吸甚至腺样体面容为主要临床表现的慢性呼吸道疾病,其发病主要与儿童迥异于成人的脏腑功能特点、感受外邪、饮食不当、情志失宜等因素密切相关.诸病因沆瀣为患,致使肺金宣肃失司、脾土运化无力、肝木枢转艰涩,从而形成了痰湿、火热、血瘀、气郁的四大病理因素.根据腺样体肥大患儿的体质因素及临床表现,可归纳本病病机为肝郁热壅、痰瘀痹窍,治疗可以"痰、瘀、热、郁"为抓手,以疏肝清热、消痰化瘀、散结利窍为基本治法.基于本病病机并结合临床经验,以小柴胡汤为基础,拟定了治疗本病之验方"柴贝消腺方".方中诸药升降同施、气血并调、相辅相成,临证时随证化裁,屡获佳效.附验案1则以佐证.

儿童抽动障碍是起病于儿童或青少年时期的一种神经精神障碍性疾病,临床以一个或多个部位不自主、反复、突发、无节律运动和/或发声抽动为主要特征[1].本病常伴有注意缺陷多动障碍、强迫障碍、睡眠障碍、情绪障碍、品行障碍等表现,严重影响患儿的学习和生活.根据儿童抽动障碍的临床症状体征特点,可将其归于中医学"小儿肝风""小儿抽搐""筋惕肉瞤"等范畴.

难得的"五一黄金周"就要来了,每当节假日,宝爸宝妈都会精心准备,计划了带孩子出去旅游、开阔眼界,为此做足了各种攻略的功课. 陪孩子家人四处走走,看看大好河山……想想这是多么温馨的画面哦.可是往往是计划没有变化大,有可能出现孩子发热、咳嗽、腹泻、被虫子咬等各种坑,简直是防不胜防,搞得家长心力憔悴,疲于应对.在外人生地不熟,于是不得不草草结束旅行、早早打道回府了……

Background: Cough-variant asthma (CVA) is a special type of asthma, solely manifesting with coughing. Studies suggest that airway inflammation is associated with CVA pathogenesis. Amygdalin is found to have an anti-inflammatory potential, while how it affects CVA remains unexplored. Methods: Cytotoxicity delivered by various concentrations of LPS and amygdalin on BEAS-2B cells was determined by Cell Counting Kit-8 assay. CVA in vitro models were established via LPS exposure on BEAS-2B cells which underwent amygdalin pretreatment. Cell apoptosis was determined by flow cytometry. Production of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, and mucin 5AC (MUC5AC) in BEAS-2B cells was measured by ELISA and qRT-PCR. Expressions of TLR4, E-cadherin, N-cadherin, α-smooth muscle actin (SMA), vimentin, phosphorylated-p65 (p-p65), p65, phosphorylated-IκBα (p-IκBα), and IκBα in BEAS-2B cells were measured by qRT-PCR or Western blot. Results: LPS and high concentrations of amygdalin (over 600 μg/mL) decreased BEAS-2B cell toxicity. Exposure to LPS inhibited toxicity, enhanced apoptosis; and promoted production of TNF-α, IL-6, IL-8, and MUC5AC, increased the levels of N-Cadherin, α-SMA, vimentin, p-p65, and p-IκBα, and decreased the levels of E-cadherin and IκBα in BEAS-2B cells. Amygdalin pretreatment counteracted the effects of LPS on BEAS-2B cells. Overexpressing TLR4 reversed amygdalin-exerted effects in LPS-exposed BEAS-2B cells. Conclusion: Amygdalin attenuated airway epithelium apoptosis, inflammation and epithelial-mesenchymal transition through restraining the TLR4/NF-κB signaling pathway in CVA.

目的 基于现代文献探析当代医家治疗儿童咳嗽变异性哮喘风邪犯肺证的用药特点和组方规律.方法 以“咳嗽变异性哮喘”“中医”为主题词,检索1997年1月-2017年4月中国期刊全文数据库、维普中文科技期刊全文数据库、万方数据库中当代医家治疗儿童咳嗽变异性哮喘风邪犯肺证的处方.通过Excel 2010建立药物数据库,然后应用SPSS 16.O、WEKA 3.9以及PAJ EK 3.1等软件挖掘处方中的用药特点和组方规律.结果 研究最终纳入文献55篇,涉及中药处方55首,中药112味,药物总频数575次,使用频率≥10％的药物30味.处方中的核心配伍药物包括麻黄、地龙、甘草、蝉蜕、苦杏仁、黄芩、桔梗、百部和僵蚕等.结论 宣降肺气、止咳平喘是当代医家治疗儿童咳嗽变异性哮喘风邪犯肺证的核心用药治法.

Huanglong cough oral liquid (HL), an important traditional Chinese medicine prescription for treating pediatric cough variant asthma (CVA) in Nanjing hospital of traditional Chinese medicine for many years. In this study, a selective, accurate and sensitive ultra fast liquid chromatography extreme resolution coupled with mass spectrometer (UFLC-MS/MS) method was established and validated for the simultaneous determination of nine constituents including morusin, ephedrine, praeruptorin A, praeruptorin B, luteolin, rosmarinic acid, quercetin, amygdalin, caffeic acid in CVA rat plasma sensitized and challenged with ovalbumin and cinnamaldehyde. Plasma samples were prepared by protein precipitation with four-fold amount of methanol. UFLC separation was performed on a Thermo Scientific AcclaimTM RSLC 120 C18 column (2.1 mm × 100 mm, 2.2 μm) with mobile phase containing methanol and 0.1% formic acid-water by gradient elution in 8.1 min at total flow of 0.3 mL/min. The determination of target compounds in plasma was operated by multiple reaction monitoring (MRM) mode with positive and negative electrospray ionization (ESI) source. The correlation coefficients (r) of all compounds were from 0.9930 to 0.9994 in the linear range. Lower limit of quantification (LLOQ, ng/mL) was 0.81, 2.01, 2.11, 1.17, 1.04, 0.89, 0.67, 1.45 and 0.59 for morusin, ephedrine, praeruptorin A, praeruptorin B, luteolin, rosmarinic acid, quercetin, amygdalin and caffeic acid, respectively. Intra- and inter-day accuracy and precision, extraction recovery, matrix effect, carryover effect, dilution integrity, and stability were within the limits specified. The established method was effectively applied to a pharmacokinetic study of the nine compounds in CVA rat plasma following oral administration HL exact (7.5, 15, 30 g/kg).

目的:多发性抽动症(tourette syndrome,TS)是一种慢性神经精神障碍性疾病,临床表现为不自主的、反复的肌肉抽动引发的运动性抽动和发生性抽动,中医药治疗抽动症有明显优势.本文探讨玉屏风散对脂多糖(Lipopolysaccharides,LPS)联合1-(2,5-dimethoxy-4-iodo pheny l)-2-aminopropane(DOI)致大鼠抽动症(TS)的改善作用及其机制.方法:TS模型用ip DOI与LPS联合诱导的方法,分为5组:空白组、模型组、硫必利(15 mg·kg-1)组,玉屏风散高、低剂量(6.5、3.25 g·kg-1)组.末次给药24 h后做行为学检测.采用ELISA检测大脑纹状体、血清炎症因子白介素-6(interleukin-6,IL-6)、白介素-1β(interleukin-1β,IL-1β)、肿瘤坏死因子a(tumor necrosis factor-α,TNF-α).采用Western Blot技术检测纹状体TLR/NF-κB信号蛋白表达水平.采用免疫组化技术检测纹状体P-NF-κB P65蛋白表达.结果:玉屏风散能显著改善DOI联合LPS致抽动症大鼠的行为学征象,减少抽动症大鼠血清、纹状体炎症因子水平,抑制抽动症大鼠纹状体TLR/NF-κB信号激活.结论:玉屏风散能显著缓解DOI联合LPS诱导的大鼠抽动症,其机制与抑制纹状体TLR/NF-κB信号激活相关.

波粒二象性是量子力学中的一个重要概念.以相关原理为启示,从互补性原理、测不准原理、薛定谔方程、量子涨落、量子纠缠五个方面,分别阐述中医、西医在哲学指导思想和思维方式、具体疾病诊断、疾病预后、中药功效、防治疾病理念及药物配伍方面的必要性,以期为中西医结合学科的发展提供有益的参考.

本文主要从二陈汤的组方源流、二陈汤类方方证的构建、常用二陈汤类方的方证抓手、方证间的病机联系以及二陈汤类方应用举隅等方面,探讨了以方证相对论指导二陈汤类方运用的思路,以期为儿科临床医师提供有益的参考.

目的 系统评价单纯中药治疗儿童咳嗽变异性哮喘(CVA)的临床疗效和安全性.方法 计算机检索考克兰图书馆、PUBMED、EMBASE数据库、中国期刊全文数据库、中国生物医学文献数据库,中国科技期刊全文数据库以及中国万方数据库等数据库,检索的时间范围是自每个数据库建库到2017年11月,纳入所有单纯中药治疗儿童CVA的随机对照试验.由两位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果 最终纳入34个研究,共2 230例患者.Meta分析结果显示,与单纯使用西药相比,中药能显著提高儿童CVA的临床有效率[RR=1.20,95％CI(1.12,1.29),P＜0.000 01];降低复发率[RR=0.40,95％CI(0.21,0.77),P=0.005];减少不良反应发生率[RR=0.07,95％CI(0.04,0.13),P＜0.000 01],其差异均具有统计学意义.结论 基于当前的临床证据,本研究结果显示中药在临床有效性和安全性方面较单纯西药治疗有一定的优势.

The famous old traditional Chinese medicine (TCM) doctors' experience prescriptions embody their medication experience and academic ideology.The research on the development of those prescriptions is one of the important contents of the inheritance and development of TCM.In order to provide reference for readers,this paper expounds the connotation and the formation factors of those prescriptions,as well as the specific research ideas and so on.

The modernization is the requirement of the development of traditional Chinese medicine.Pediatrics of traditional Chinese medicine is one of the main subjects in clinical medicine.Facing the trend of the modernization of traditional Chinese medicine,pediatrics of traditional Chinese medicine needs further inheritance and innovation.In order to provide reference for readers,this paper expounds the necessity and the specific content of the modernization of Chinese medicine,as well as the contents of the author's scientific research history and so on.

Tourette syndrome (TS) is a neurological disorder characterized by highest familial recurrence rate among neuropsychiatric diseases with complicated inheritance. Recurrence of Tourette syndrome was frequently observed in clinical. Unexpectedly, the mechanism of recurrence of Tourette syndrome was failure to elucidate. Here, we first shown that lipopolysaccharide(LPS) may played an important role in the recurrence of Tourette syndrome. The TS model in rats was induced by DOI (the selective 5-HT2A/2C agonist 1-(2, 5-dimethoxy-4-iodophenyl) -2- aminopropane). The rats were randomly divided into 4 groups:(1)Control;(2) Control + LPS; (2)TS; (3)TS + LPS. The results demonstrated that the LPS treatment significantly increased stereotypic score and autonomic activity. LPS treatment also significantly increased inflammatory cytokines such as interleukin-6 (IL-6), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in serum and striatum. Also, highly expressed TLR4, MyD88, P-NF-κBp65, P-IκBα in TS rats were increased respectively by LPS treatment as indicted in western blot analysis and immunohistochemistry analysis. Thus, it was supposed that lipopolysaccharide(LPS) may played an important role in the recurrence of Tourette syndrome and its mechanism was related to TLR/NF-κB pathway.

基于气机升降理论,对小儿咳嗽变异性哮喘的发病脏腑特性、基本病机、治疗法则以及遣方用药等进行探讨,对小儿咳嗽变异性哮喘的临床治疗具有一定的指导价值.

咳嗽变异性哮喘是儿科临床常见病,是我国儿童慢性咳嗽主要原因之一.张骠擅长运用气机升降理论治疗小儿咳嗽变异性哮喘.张骠认为小儿咳嗽变异性哮喘的关键病机是风痰痹阻、肺热气逆,燮理肺脏及相关脏腑气机升降失衡是其治疗大法,黄龙合剂是治疗该病的有效专方.张骠临床运用气机升降理论论治该病,临床疗效显著.文章介绍了张骠治疗咳嗽变异性哮喘的经验,分析其辨证思路及立法、用药特点,可供读者借鉴.

Objective To study the anti-inflammatory ,anti-allergic effect of huanglong cough oral liquid .Methods Estab-lish carrageenan to toes swelling of rats' model ,measure and compare the different time points after inflammatory rats toes circumference ,anti-inflammatory effect of observation of huanglong cough oral liquid .The 2 .4-2 nitrochlorobenzene (DNCB ) back under the skin sensitization ,auricle of sensitive method to establish delayed-type hypersensitivity in mice model ,to ob-serve the allergy of huanglong cough oral liquid .Results Anti-inflammatory experiments show that the huanglong cough oral liquid diagonal inflammatory edema caused by carrageenan in rats foot claw has significant inhibitory effect ,can restrain the development of inflammation ,accelerate its faded ,and displays a certain amount-effect relationship .Allergy experiments show that ,compared with control group ,the yellow dragon oral liquid in each dose group can make the mouse ear swelling caused by DNCB significantly reduce .Conclusion Huanglong cough oral liquid has significant anti-inflammatory and anti-allergic effects .

目的 观察黄龙合剂治疗小儿咳嗽变异性哮喘(CVA)风热夹痰证的临床疗效及其对最大呼气流量(PEF)和T淋巴细胞亚群的影响,探讨其治疗小儿CVA的作用机制.方法 将60例CVA风热夹痰证患儿随机分为治疗组和对照组,各30例,分别予黄龙合剂、孟鲁司特联合特布他林口服,疗程均为2周.观察2组患儿的临床疗效及治疗前后PEF、T淋巴细胞亚群(包括CD3+,CD4+,CD8+以及CD4+/CD8+)水平的变化.结果 1)治疗组总有效率(96.67％)明显高于对照组(66.67％),差异有高度统计意义(P＜0.01).2)与同组治疗前比较,治疗后2组患儿在主症、次症、证候、病证总积分方面均显著降低,差异有高度统计意义(P＜0.01);治疗后,治疗组在主症、次症、证候及病证总积分改善情况方面明显优于对照组,差异有高度统计意义(P＜0.01).3)与治疗前比较,治疗后2组患儿PEF值均显著改善,差异均有高度统计意义(P＜0.01);治疗后2组间比较,差异无统计意义(P＞0.05).4)2组治疗后CD3+,CD4+,CD8+及CD4/+CD8+与同组治疗前比较(资料完整的共计15例),除治疗组CD3+、对照组CD8+之外,其余各T细胞亚群的表达均有改变,差异有高度统计意义(P＜0.01).治疗后,治疗组CD4+/CD8+的调节明显优于对照组,差异有统计意义(P＜0.05).结论 黄龙合剂能有效改善小儿CVA风热夹痰证的临床症状,可能是通过提高肺功能及调整机体细胞免疫紊乱达到治疗作用.

小儿咳嗽变异性哮喘是哮喘的一种潜在形式或特殊类型,以气道高反应为特征,临床上用抗生素治疗无效,用支气管扩张剂可缓解.随着对本病研究的不断深入,中医药在其治疗方面取得了很大的进步.针对近年来中医药治疗CVA的实验研究、机制研究和中医辨证治疗概况作一综述,以探讨咳嗽变异性哮喘的中医药治疗思路,说明中医治疗本病有着独特的优势和广阔的前景,并指出存在的问题及研究方向.

目的 观察息风平肝合益肺固卫方对小儿多发性抽动症(TS)阳亢风动、肺虚卫疏证的患儿治疗前后细胞免疫功能的影响,探讨其治疗小儿多发性抽动症的作用机理.方法 对31例阳亢风动、肺虚卫疏证TS患儿予以息风平肝合益肺固卫方治疗8周,分别检测TS患儿治疗前后和30例健康儿童T淋巴细胞亚群水平.结果 治疗组与健康对照组比较,CD3+、CD4+、CD4+/CD8+水平降低,CD8+水平上升,两组间差异有统计学意义(P＜0.01);治疗后CD,+、CD4+、CD4+/CD8+水平上升,较治疗前升高(P＜0.01),其中CD3+、CD4+已与正常体检儿童无差异.结论 TS的发病与机体的细胞免疫功能紊乱有关.息风平肝合益肺固卫方能有效地持续改善小儿多发性抽动症阳亢风动、肺虚卫疏证的临床症状,可能系通过调节细胞免疫功能达到治疗作用.