慢性夜咳是临床常见呼吸系统疾病,中医学认为慢性夜咳属于"咳嗽"范畴.笔者从中医时间医学、阴阳理论、六经辨证、脏腑辨证等角度认识慢性夜咳,认为慢性夜咳起于阴阳失调,发于少阳,止于太阴,病位在半表半里,病性属于寒热错杂,虚实夹杂,病机为少阳郁热,相火上炎,三焦不畅,气血失调,气机上逆.本病当从少阳论治,宜采用和解少阳、调畅气机、扶正祛邪之法.笔者以柴胡桂枝干姜汤疏肝温脾、交通寒热、扶正祛邪,升降散调畅气血、通达内外、恢复气机,经方联用治疗慢性夜咳,每获良效.

目的:探讨健脾温肾汤联合热补针法对腹泻型肠易激综合征脾肾阳虚证患者肠道微循环、脑肠肽及肠黏膜免疫屏障作用的影响.方法:选择76例腹泻型肠易激综合征脾肾阳虚证患者进行前瞻性研究,根据随机数字表法将纳入研究的病例分为治疗组和对照组各38例.两组患者均口服匹维溴铵片和双歧杆菌四联活菌片进行治疗,治疗组患者在此基础上联合健脾温肾汤和热补针法进行治疗.4周为1个疗程,两组患者均连续治疗2个疗程,统计疗效.对比两组患者治疗前后中医证候积分、血清5-HT含量、血浆NPY含量、血浆VIP含量、血清d-lactate含量、血清DAO含量.结果:治疗组总有效率为100.00％(38/38),对照组总有效率为89.47％ (34/38),治疗组优于对照组(P＜0.05).治疗后两组患者各项中医证候积分及总积分均低于治疗前(P＜0.05),且治疗组患者治疗后各项中医证候积分及总积分低于对照组(P＜0.05).治疗后两组患者血清5-HT含量明显低于治疗前(P＜0.05),且治疗组患者治疗后血清5-HT含量明显低于对照组(P＜0.05);治疗后两组患者血浆NPY含量明显高于治疗前(P＜0.05),且治疗组患者治疗后血浆NPY含量明显高于对照组(P＜0.05);治疗后两组患者血浆VIP含量、血清d-lactate含量、血清DAO含量均明显低于治疗前(P＜0.05),且治疗组患者治疗后血浆VIP含量、血清d-lactate含量、血清DAO含量均明显低于对照组(P＜0.05).结论:健脾温肾汤联合热补针法治疗腹泻型肠易激综合征脾肾阳虚证患者疗效较好,可有效促进患者肠道微循环,改善肠动力紊乱,调节脑肠肽分泌平衡,并促进肠黏膜免疫屏障功能恢复.

目的 观察穴位埋线联合中药治疗痰湿内盛型非酒精性脂肪性肝病的疗效.方法 选取215例痰湿内盛型非酒精性脂肪性肝病患者作为研究对象,分为A组(73例)、B组(72例)和C组(70例).A组采用2-0号羊肠线肌肉层穴位埋线联合自拟四生降脂汤治疗,B组采用2-0号羊肠线脂肪层穴位埋线联合自拟四生降脂汤治疗,C组采用自拟四生降脂汤治疗.观察3组治疗后疗效、中医症状评分及血清学指标水平.观察3组患者治疗前后肝脏B超评分及CT值.结果 A组总有效率为90.4％,明显高于B组及C组,差异均有统计学意义(P<0.05).3组治疗后腹胀、乏力、胁痛、肥胖及神疲评分均下降(P<0.05),A组上述指标低于B组及C组(P<0.05).3组治疗后血清总胆固醇(TC)、甘油三酯(TG)、谷丙转氨酶(ALT)及天冬氨酸氨基转移酶(AST)水平均下降(P<0.05),其中A组患者上述指标低于B组及C组(P<0.05).3组患者B超评分明显降低,肝CT值明显升高(P<0.05),其中A组患者B超评分低于B组及C组,肝CT值高于B组及C组(P<0.05).结论 穴位埋线在肌肉层联合自拟四生降脂汤治疗痰湿内盛型非酒精性脂肪性肝病的疗效显著,能够明显降低患者血脂指标,恢复患者肝功能.

目的 观察加味百合地黄汤联合耳针治疗2型糖尿病(T2DM)伴睡眠障碍的临床疗效.方法 将56例入选患者随机分为加味百合地黄汤联合耳针治疗观察组和佐匹克隆片联合耳针治疗对照组,进行为期28 d的治疗和观察,比较治疗前后匹兹堡睡眠质量指数量表(PSQI)、中医症状积分、汉密尔顿焦虑量表(HAMA)和糖化血清蛋白(GSP)的差异.结果 2组患者的睡眠质量均得到改善(P＜0.05);GSP和HAMA评分亦较治疗前下降(P＜0.05).观察组在改善PSQI因子睡眠质量、睡眠效率、日间功能障碍,烦燥易怒、口干咽燥、潮热盗汗中医症状积分及GSP水平方面优于对照组(P＜0.05).结论 中药联合耳针治疗T2DM伴睡眠障碍疗效肯定,值得推广.

恶性肿瘤作为临床常见的一种心身疾病,与情志因素密切相关.本文从中西医两个角度对肿瘤的发生与情志之间的关系进行介绍,对肿瘤、伴发症状,以及治疗中引发的各种情志变化进行阐述,并对情志影响恶性肿瘤的机理进行分析,对临床常用的干预方法进行总结.提示不良的情志会加剧肿瘤的进展,而良好的情志有助于病情的稳定乃至患者长期生存.

Objective To observe the clinical effect of Sisheng-jiangzhi-shugan decoction on the treatment of nonalcoholic fatty liver disease (NAFLD) of phlegm-wet resistance type.Methods 60 NAFLD patients with phlegm-wet resistance type were treated by Sisheng-jiangzhi-shugan decoction on the basis of basic treatment, continuously treatment for 3 months.The height, body mass, waist and hip circumference were measured,body mass index (BMI) and waist circumference/hip circumference ratio (WHR) were calculated.The blood lipid indexes including total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL-C), high-density lipoprotein cholesterol (HDL-C) were detected.The fasting plasma glucose (FPG) and fasting insulin (FINS) were detected, and the homeostasis model assessment insulin resistance index (HOMA-IR) was calculated.The liver function including alanine aminotransferase (ALT), aspartic aminotransferase (AST) and γ-glutamamide transferase (γ-GT) and the creatinine (Cr) of Kidney function were detected.Results After treatment with Sisheng-jiangzhi-shugan decoction, the clinical symptoms and signs were improved with different degree of the majority patients.The fecal viscous, swell and stuffy of the right rib and loss of appetite had most significant improvements.The WHR after 1,3 months treatment were reduced, and which after 3 months treatment was lower than that after 1 month treatment (P<0.01).The TC, TG, LDL-C and HOMA-IR after 1 and 3 months treatment were reduced (P<0.05,P<0.01), and the HDL-C was increased (P<0.01).The TC, TG, LDL-C and HOMA-IR after 3 months treatment were lower than that after 1 month treatment (P<0.05, P<0.01), and the HDL-C was higher (P<0.01).The total effective rate was 87.5%.Conclusion Sisheng-jiangzhi-shugan decoction canimprove the clinical symptoms and promote lipid metabolism on the treatment of NAFLD of phlegm-wet resistance type.

According to the theory of traditional Chinese medicine,the author concluded the mechanism of Chinese medicine in prevention and treatment of non-alcoholic fatty liver disease from three aspects:improving insulin resistance,inhibition of lipid peroxidation and reduce oxidative stress,on the base of the "two-hit" theory.And the author thought that Chinese medicine could have prevented and treated non-alcoholic fatty liver disease through intervening in the "two-hit" theory.

本院王京奇主任医师为北京市第四批老中医药专家学术经验继承工作指导老师、北京市中医药薪火传承“3＋3”工程带教老师，善治肝胆疾病、脾胃疾病、内伤杂病。王师谙熟经典，精于医理，勤于临床，擅用虫类药物治疗杂病，每收良效。笔者有幸侍诊，获益匪浅，现将王师运用虫类药物经验总结如下。

目的：益气健脾，化湿祛瘀法治疗脂肪肝。方法通过总结王京奇主任医师多年治疗脾虚湿盛、湿热瘀滞型脂肪肝经验，分析经验方四生汤（生黄芪、生山楂、生荷叶、生薏苡仁四味药组成），发现王京奇主任医师治疗脂肪肝疗效确切，效果显著，并通过典型病例加以验证。结论四生汤为王京奇主任医师继承名师的基础上经过化裁变化而创的经验方，治疗脂肪肝疗效确切，同时具有减肥、降脂等功效，对于慢性非传染性疾病的防治意义重大。

" Be in perfect sympathy with each other" is an idiom close representation of ancient China,in Chinese medicine theory,close relationship between liver and gallbladder,two in the internal organs,six gas aspects of interaction,mutual influence.The two viscera closely at the same time in the physiological aspect,in pathology is the mutual infiltration,mutual spread.The ancient and modern medicine were to be in perfect sympathy with each other,a detailed study is closely related to liver and gallbladder,according to the clinical experience of the proposed theoretical basis.

Objective To observe the clinical efficacy on irritable bowel syndrome(IBS)(diarrhea type)treated with the modified tongxie yaofang.Method 90 cases of IBS(diarrhea type)were randomized into a treatment group(45 cases)and a control group(45 cases).In the treatment group,the modified tongxie yaofang was prescribed according to the symptoms for oral administration.In the control group,Smecta was prescribed for oral administration.The improvements in the clinical common symptoms were observed in two groups.Results The statistical significant difference was not indicated in the common symptom score before treatment in the comparison between two groups(P0.05).In 4 weeks of treatment,the improvements in the common symptoms of the treatment group were superior to those of the control group,such as abdominal pain,diarrhea,anger or stress,distention in the chest and hypochondriac region,belching,poor appetite,borborygmus and flatus,presenting the statistical significant differences(P0.05).In 4 weeks of treatment,the total effect of the treatment group was markedly superior to that of the control group,presenting the statistical significant difference(P0.05).Conclusions Tongxie yaofang achieves the good efficacy on IBS(diarrhea type).It relieves remarkably the clinical symptoms,shortens the treatment time and has no adverse reactions.Hence,it deserves to be promoted clinically.

目的观察化痰活血汤治疗后循环梗死性眩晕的临床疗效。方法将60例后循环梗死性眩晕患者按随机数字表法分为治疗组和对照组各30例。在基础治疗的同时,治疗组口服化痰活血汤治疗,对照组口服盐酸氟桂利嗪治疗,疗程均为2周。结果治疗组治愈率43.33%,总有效率93.33%;对照组治愈率20.00%,总有效率86.67%,两组比较治疗组治愈率高于对照组,差异有统计学意义(P<0.05);治疗后两组胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)及TCD检测收缩期脑血流速度均有明显改善(P<0.05,P<0.01),治疗后治疗组TG、LDL-C及收缩期脑血流速度优于对照组,差异有统计学意义(P<0.05)。结论化痰活血汤治疗后循环梗死性眩晕治愈率高于西药盐酸氟桂利嗪。

目的观察柴胡疏肝散加味治疗功能性消化不良的临床疗效。方法将80例功能性消化不良患者随机分为治疗组和对照组各40例,其中治疗组口服柴胡疏肝散加味汤剂并随证加减,对照组口服吗丁啉,观察2组患者的临床常见症状改善情况。结果治疗组在上腹痛、腹胀、嗳气、恶心和呕吐、泛酸等常见症状改善方面优于对照组(P<0.05),在腹胀和烧心等症状的改善上,2组无显著性差异(P>0.05);治疗组临床总疗效优于对照组(P<0.05)。结论柴胡疏肝散加味治疗功能性消化不良有较好的疗效。

呃逆病位在膈,责之在胃,属本虚标实之证,分五型:痰热腑实,治宜通腑泻热,降逆止呃;胃火炽盛,治宜清火降逆,和胃止呃;胃阴不足,治宜滋养胃阴,和胃止呃;痰阻气机,健脾燥湿,化痰降逆.中风后呃逆较为顽固,配合针灸,以期尽快清除呃逆使中风病早日稳定.

<正>近年来随着人们生活水平的提高和饮食结构的改变,脂肪肝已经成为临床常见的病变,相当部分患者发展为脂肪性肝纤维化与肝硬化[1]。笔者在临床中观察了我院肝胆科协定方四生降脂方对脂肪肝的降脂作用。现总结如下。

[目的]观察生脉注射液治疗胸痹心痛(气阴两虚型)的临床疗效。[方法]采用随机表分组方法分为两组,其中治疗组86例,对照组42例,两组治疗均以2周为1个疗程,连续观察2个疗程。[结果]两组临床症状疗效比较:治疗组总有效率94.19%,对照组总有效率80.95%。两组比较有显著性差异(P<0.05)。两组心电图疗效比较:治疗组总有效率74.42%,对照组总有效率54.76%。两组比较有显著性差异(P<0.05)。[结论]生脉注射液在改善临床症状和对异常心电图改善方面,疗效均优于对照组。该药对胸痹心痛(气阴两虚型)有较好的疗效,是一种有效的改善心肌缺血、缓解心绞痛的药物。

目的 观察自拟方益肾健脑汤治疗轻度脑动脉硬化症患者的临床疗效.方法 将136例轻度脑动脉硬化症患者随机分为治疗组92例,对照组44例,其中治疗组口服益肾健脑汤并随证加减,对照组给予尼莫地平、吡拉两坦、血脂康等治疗,观察两组患者的血脂变化及临床症状改善情况.结果 治疗后治疗组的血脂改善明显优于对照组(P＜0.01);治疗后两组的临床症状均有改善,但治疗组效果优于对照组(P＜0.05).结论 自拟方益肾健脑汤对轻度脑动脉硬化症患者具有较好的降脂及改善症状的作用.

胃石证为中医"瘕"、"积聚"病证范畴.常因服食山楂、柿子、黑枣引起,出现上腹部不适、腹胀、嗳气、反酸、恶心或呕吐等症状,查体有上腹部压痛及包块.本次选择30例经上消化道气钡双重造影证实的胃石证患者,以软坚散结、润肠通腑为原则,采用中药及推拿方法治疗,取得较好效果.现总结报道如下.

血清总胆汁酸(TBA)的测定有利于慢性肝炎的监测,且可代替重复进行的活组织检查.近期对肝胆科36例患者的检测分析报告如下:

我们在2004年12月至2005年三朋采用北京伟力新世纪科技发展有限公司生产的WLGY-801型伟力电脑肝病治疗仪治疗慢性乙型肝炎30例,临床观察有一定辅助疗效,现报告如下: