目的:回顾性分析瓜蒌消痈汤联合无痛通乳手法治疗哺乳期乳腺炎的临床疗效.方法:总结我院2021年10月至2022年9月门诊就诊的哺乳期乳腺炎患者共35例,记录患者年龄、产次、生产方式、发病时间、治疗前后疼痛视觉模拟评分(VAS)、体温、肿块及皮肤红疹直径、血常规、C反应蛋白(CRP)、降钙素原(PCT)、乳汁细菌培养、B超,并进行统计分析.结果:治疗后乳房肿块及皮肤红疹直径明显缩小、体温下降、VAS下降(P＜0.01);患者的白细胞总数和中性粒细胞百分比、CRP、PCT均明显下降(P＜0.01);治疗后除2例表皮葡萄球菌感染患者未转阴外,其他患者乳汁细菌培养均转阴;复查所有患者B超均为哺乳期乳腺正常图像;所有病例均临床治愈,未见副反应.结论:瓜蒌消痈汤联合无痛通乳手法治疗哺乳期乳腺炎具有较好的临床疗效.

目的 通过探索围绝经期综合征(perimenopausal syndrome,PMS)中医证候的分布规律,为临床辨证拟方提供客观依据.方法 2017 年 7 月至 2021 年 8 月期间,共收录 236 例PMS患者,以问卷方式调查收集其症状、体征和舌脉等四诊资料,采用SPSS统计软件中的因子分析法进行证候要素分析并提取公因子,结合中医理论及临床实际予以分析解释.结果 共提取特征根值为 1.352、对总方差的累计贡献率为 78.272%的 4 个公因子,联系中医证候分型,分别代表类肝肾阴亏证、类肝郁化火证、类肾虚血瘀证和类心肾不交证.结论 从因子分析角度,浅析PMS中医证候分布规律,并与实际经验相佐证,从而为临床辨证拟方提供相应的参考依据.

[目的]利用网络药理学分析调经汤与克罗米芬治疗卵巢早衰(premature ovarian failure,POF)的机制差异,探讨调经汤治疗POF的可能机制.[方法]利用京都基因与基因组百科全书(Kyoto Encyclopedia of Genes and Genomes,KEGG)DRUG数据库、中药系统药理学数据库与分析平台(Traditional Chinese Medicine Database and Analysis Platform,TCMSP)挖掘克罗米芬的分子结构及调经汤潜在活性成分与药物靶点,通过人类基因数据库(Human Gene Database,GeneCards)、在线人类孟德尔遗传数据库(Online Mendelian Inheritance in Man,OMIM)、药物基因组学知识库(Pharmacogenomics Knowledgebase,PharmGKB),筛选POF的相关疾病靶点.将得到的药物靶点与疾病靶点进行匹配,得到药物-疾病交集靶点数据库,利用Cytoscape 3.8.0软件构建中药成分-靶点-疾病网络.使用STRING网站对得到的交集靶点进行蛋白互作分析,利用R语言进行基因本体(gene oncology,GO)分析和KEGG富集分析.[结果]克罗米芬的靶蛋白为雌激素受体,KEGG通路为雌激素信号通路.调经汤中共筛选出181个活性成分和2873个潜在靶点,POF靶点4597个.通过比对调经汤和POF的共同靶点,筛选出192个关键基因.这些共同靶点涉及的生物学过程主要是氧化物及氧化应激的反应、细胞对化学物应激刺激的反应和物质代谢反应等,发挥转录、结合等分子功能;生物学通路包括白细胞介素-17(interleukin-17,IL-17)、肿瘤坏死因子(tumor necrosis factor,TNF)、磷脂酰肌醇3激酶-蛋白激酶B(phosphatidylinositol 3 kinase-protein kinase B,PI3K-AKT)、丝裂原活化蛋白激酶(mitogen-activated protein kinase,MAPK)、叉头框转录因子O亚族(forkhead box transcription factor O,FoxO)、雌激素、Wnt信号通路等.[结论]调经汤与克罗米芬的共有通路为雌激素信号通路,但与克罗米芬相比,调经汤可通过多个靶点、多条通路起到治疗POF的作用.

目的:探讨医学人文在妇产科学混合式教学中的应用.方法:选取浙江中医药大学临床医学2013级本科为实验组(混合式教学),2012级为对照组(传统教学),研究在妇产科学中融合医学人文的教学效果.结果:实验组成绩明显优于对照组,差异有统计学意义(P＜0.05).患者满意度增加.结论:互联网改变了高校的教学手段和方法,通过妇产科学在线精品课程的建设,融合医学人文,发挥线上线下的混合式教学优势,提高学生学习积极性、高效性,提升教师教学的质量.

[目的]探讨以《伤寒论》蓄血证理论治疗子宫内膜异位症的可行性.[方法]通过跟师学习,结合《伤寒论》中蓄血证相关理论,从病机、证候、治疗几方面阐述子宫内膜异位症与蓄血证之间的相互关系,并列举验案加以分析佐证.[结果]从临床角度看,蓄血证与子宫内膜异位症有相似之处,离经之血瘀滞,瘀热互结下焦是其病因病机,以少腹硬满胀痛、血下则缓为主要临床表现.破结逐瘀是其治疗大法,以抵当汤为治疗主方.临证施治时,根据月经周期、患者体质,在破结逐瘀泻热基础上,佐以补肾、健脾、温经、解痉,并配合针灸治疗.文中所附子宫内膜异位症病案,皆为瘀热互结下焦,从蓄血证论治,以水蛭、地鳖虫祛瘀消散离经之血,以大黄、猫爪草等泻热解毒,并防止病灶的异常出血,取得较好疗效.[结论]以《伤寒论》蓄血证理论治疗下焦瘀热互结的一类疾病,如子宫内膜异位症等,疗效良好,值得临床推广应用.

[目的]观察三七重楼生化汤(Sanqi Chonglou Shenghua Decoction,SCD)对L929成纤维细胞增殖、黏附、迁移及愈合相关蛋白表达的影响,并探讨其机制.[方法]常规培养L929成纤维细胞,随机分为SCD低、中、高浓度组及对照组,SCD各浓度组予不同浓度SCD(1.25、2.5、5mg·mL-1),对照组予等体积培养基,以实时细胞分析技术(real time cellular analysis,RTCA)、细胞增殖检测试剂盒(cell counting kit-8,CCK-8)分别检测细胞增殖、黏附能力,划痕实验检测细胞迁移情况,Western blot检测血管内皮细胞生长因子(vascular endothelial growth factor,VEGF)、转化生长因子-β1(transforming growth factor-β1,TGF-β1)、细胞外调节蛋白激酶1/2(extracellular regulated protein kinases 1/2,ERK1/2)、磷酸化细胞外调节蛋白激酶1/2(phospho-extracellular regulated protein kinases 1/2,p-ERK1/2)蛋白表达.[结果]SCD促进成纤维细胞增殖,且呈动态变化.RTCA示:SCD干预12～24h,中、高浓度促进细胞增殖(P<0.01),但组间比较,差异无统计学意义(P>0.05).CCK-8结果示:SCD干预24h,低、中、高浓度组均促进细胞增殖(P<0.01).与低浓度组比较,中、高浓度组促增殖作用更显著(P<0.01).与中浓度组比较,高浓度组促增殖作用更显著(P<0.05).SCD促进成纤维细胞迁移.干预24h,中、高浓度组促进细胞迁移(P<0.05,P<0.01),且高浓度组促进作用更显著(P<0.01).干预36h,低、中、高浓度SCD均具有促进迁移的作用(P<0.05,P<0.01).与低浓度组比较,中、高浓度促进作用更显著(P<0.05,P<0.01).与中浓度组比较,高浓度组促进迁移作用更显著(P<0.01).SCD促进成纤维细胞黏附(P<0.01),但不同浓度间差异无统计学意义(P>0.05).SCD高浓度组可上调成纤维细胞VEGF、p-ERK1/2的表达(P<0.01),但SCD不影响TGF-β1表达(P>0.05).[结论]SCD可通过促进成纤维细胞增殖、黏附和迁移,并促进VEGF蛋白表达,从而发挥促进剖宫产瘢痕愈合的作用,其机制可能与ERK信号通路激活有关.

[目的]总结何赛萍教授从"结"论治妇科疾病的临床经验.[方法]通过跟随何赛萍教授临诊、学习何赛萍教授的著作,搜集妇科临证相关医案,结合中医理论与临床辨证论治原则,总结何赛萍教授从"结"论治妇科疾病的辨证思维方法及临床治疗经验,并列举一则验案予以佐证.[结果]何赛萍教授宗仲景"若五脏元真通畅,人即安和"的思想,认为妇科疾病的产生与气血不通、冲任失和密切相关,其中"结"是导致不通的重要因素,有寒结、热结、水结、气结、痰结、血结之分,分别治以温阳散寒通滞、清热祛瘀散结、通阳化气行水、疏肝理气解郁、软坚化痰散结、活血祛瘀之法.所附医案为下焦水结之盆腔囊性块,以清热利水为治,应用五苓散随症加减,临床效佳.[结论]何赛萍教授法宗仲景,从"结"论治妇科疾病,如月经病、癥瘕积聚、不孕等,疗效显著,其深刻经验值得进一步寻绎与总结.

通过“互联网+”的手段,将妇产科学所涉及的教学资源设计制作成在线、碎片化、共享的知识点,丰富教学形式、扩大教学范围,逐步完善妇产科学在线精品课程的建设.

目的:探讨基于妇产科学在线精品课程的混合式教学的应用.方法:选取浙江中医药大学临床医学2013级五年制本科作为混合式教学组,2012级作为传统教学组,对比分析在妇产科学的教学效果.结果:混合式教学组成绩明显优于传统教学组,差异有统计学意义(P＜0.05).结论:信息技术改变了高校的教学手段和方法,通过妇产科学在线精品课程的建设,结合线上线下的翻转课堂教学,发挥混合式教学的特点和优势,提高学生学习积极性和教师教学质量.

Objective To explore the clinical effects of zuogui soothing liver decoction on polycystic ovary syndrome(PCOS) infertility.Methods A total of 150 patients with PCOS in Gynecology Outpatient Clinic of in the Second Affiliated Hospital of the Second Affiliated Hospital of Zhejiang Chinese Medicine University for the first visit from June 2014 to March 2016 were selected.The random number table method was used to divide the subjects into control group and experiment group,each had 75 patients.The patients in the control group were treated with clomiphene,based on which the patients in the experiment group were treated with zuogui soothing liver decoction.When the number follicle≥ 3 with diameter> 1.4 cm,treatment would be stopped,and the treatment and observation period of the two groups should be within 6 months.The serum endocrine and reproductive hormone levels,ovulation and pregnancy status,clinical efficacy and the incidence of adverse reactions were compared between two groups.Results There was no significant difference in serum levels of luteinizing hormone(LH),follicle stimulating hormone(FSH) and testosterone(T) between two groups before treatment(P>0.05).The levels of serum LH,FSH and T of patients in experiment group after treatment were significantly lower than those in control group(P<0.05).After treatment,the levels of serum LH and FSH in control group were significantly lower than those before treatment,and the levels of serum LH,FSH and T in the experiment group were significantly lower than those before treatment(P<0.05).There was no significant difference in T levels in the control group before and after treatment(P>0.05).The prevalence of dominant follicle,ovulation rate and clinical pregnancy rate in the experiment group were significantly higher than those in the control group(P<0.05).There was no significant difference in the early abortion rate between two groups(P>0.05).The clinical curative effect of the experiment group was significantly better than that of the control group(P<0.05).There was no significant difference in the incidence of endometrial thinning and ovarian hyperstimulation syndrome between two groups(P>0.05).Conclusion The use of zuogui soothing liver decoction based on taking clomiphene can effectively lower the endocrine reproductive hormone level of patients with PCOS infertility and improve the rate of dominant follicles,ovulation rate and clinical pregnancy rate.Thus it has exact effects.

目的 观察膈下逐瘀汤联合复方对乙酰氨基酚片(Ⅱ)治疗原发性痛经的效果.方法 选择2014年6月至201 5年12月该院收治的气滞血瘀型原发性痛经患者70例为观察对象,按照入院时间先后将患者分为对照组和观察组各35例.对照组口服复方对乙酰氨基酚片(Ⅱ),观察组在其用药基础上给予膈下逐瘀汤.使用3个月经周期后比较两组疗效、不良反应及治疗前后痛经症状评分的变化.结果 观察组总有效率明显高于对照组,治疗后痛经症状评分明显低于对照组,差异有统计学意义;两组不良反应发生率比较差异无统计学意义.结论 膈下逐瘀汤联合复方对乙酰氨基酚片(Ⅱ)治疗原发性痛经效果较好,可快速缓解患者疼痛症状,且安全性高.

目的 探讨扶正化瘀法治疗子宫腺肌病的临床疗效.方法 分析该院妇科门诊2014年1-12月就诊的子宫腺肌病患者60例临床资料,随机分为2组,治疗组30例和对照组30例.治疗组围绕月经周期予以扶正化瘀法中药汤药口服治疗,对照组予以散结镇痛胶囊口服治疗.观察两组治疗前后的临床疗效总有效率、中医症状积分及痛经积分的变化等情况.结果 治疗后临床疗效总有效率治疗组93.34％,对照组的73.33％,两组比较,差异有统计学意义(x2=6.358,P＜0.05),治疗组疗效优于对照组.治疗组和对照组均可明显降低患者的中医症状积分、痛经积分(P＜0.01),但两组间治疗后差值比较,差异无统计学意义(P＞0.05).结论 扶正化瘀法治疗子宫腺肌病总体临床疗效确切,能明显缓解痛经症状,改善月经失调,解除患者痛苦,提高生活质量,值得推广.

AIM:To detect the expression of matrix metalloproteinases-9(MMP-9)and tissue inhibitor of metalloproteinase-1(TIMP-1)in endometrium after caesarian section,and the change of blood leukocyte count,neutrophil percentage,serum C-reactive protein(CRP)level,and to explore the mechanism of Chonglou Shenghua Tang for preventing lochiorrhagia after caesarian section(CS).METHODS:The prospective study was designed as randomized and single blind research from Jan 2011to Jan 2013.60women underwent caesarian section(CS)indicated by obstetric factors were enrolled from the2ED clinical medical college of Zhejiang Chinese Medical University and assigned into three groups:group of Chonglou Shenghua Tang:20cases were administered by Chonglou Shenghua Tang 100mL,per 12h14dafter CS;group of Classical Shenghua Tang:20cases were administered by Classical Shenghua Tang 100mL,per12h14dafter CS and group of placebo:20cases were administered by placebo 100 mL,per12h14dafter CS.The expressions of MMP-9and TIMP-1in endometrium were determined using immunohistochemistry at 16th days after CS,and blood leukocyte and CRP were detected at 5th days and 16th days after CS.RESULTS:The levels of MMP-9expression decreased gradually in Chonglou Shenghua Tang group,Classical Shenghua Tang group and placebo group at16th days after CS,respectively,with statistical significance(P0.05).The levels of TIMP-9expression and the ratio of MMP-9/TIMP-1increased gradually in Chonglou Shenghua Tang group,Classical Shenghua Tang group and placebo group at 16 th days after CS,respectively,with statistical significance(P0.05).Blood leukocyte count,neutrophil percentage and CRP increased gradually in Chonglou Shenghua Tang group,Classical Shenghua Tang group and placebo group at 5th days and 16 th days after CS,respectively,with statistical significance(P0.05).CONCLUSION:These results suggestthat reduced expressions of MMP-9,and increased TIMP-1,and reduced the ratio MMP-9/TIMP-1in endometrium and reduced inflammatory indexes in the blood may play important roles in Chonglou Shenghua Tang preventing lochia after cesarean section.

目的:观察三阴交穴位注射缩宫素对防治产妇产后出血的影响.方法:将400例产妇随机均分为A、B、C、D组.胎儿娩出后、胎盘娩出前,A组产妇于三阴交穴位处注射缩宫素10U;B组产妇不使用任何药物,单针刺于三阴交穴位;C组产妇于小腿内侧,当足内踝尖上3寸,非穴位处注射缩宫素10U;D组产妇于臀部肌肉注射缩宫素10U.观察4组产妇产后2h内、24 h内出血例数及平均出血量,并记录不良反应发生情况.结果:A组产妇产后2h内出血量在＜100 ml、100～200ml范围内的例数显著高于B、C、D组,产后出血量＞200 ml例数显著低于B、C、D组,差异有统计学意义(P＜0.05).A组产妇产后24 h内出血量＜200ml的例数显著高于B、C、D组,产后出血量在200～500ml、＞500ml的例数均显著低于B、C、D组,差异有统计学意义(P＜0.05).A组产妇产后2h内、24 b内平均出血量显著低于B、C、D组,差异有统计学意义(P＜0.05),而B、C、D组间比较,差异无统计学意义(P＞0.05).4组产妇治疗期间均未见明显不良反应发生.结论:三阴交穴位注射缩宫素能有效地减少产妇产后的出血量,安全性亦较好.

Objective To survey the efficacy of Chonglou Shenghua Tang for lochia ,and the expression of matrix metalloproteinases -9 (MMP-9 ) and tissue inhibitor of metalloproteinase -1 (TIMP-1 ) in endometrium after caesarian section .Methods 90 women underwent caesarian section(CS) according with inclusion criteria and exclusion criteria randomly divided into 3 groups ,including Chonglou Shenghua Tang group(30 cases) ,Shenghua Tang group(30 cases) and placebo group (30 cases) ,and were administered by Chonglou Shenghua Tang , Classical Shenghua Tang and placebo 100 mL ,per 12 hours for 14 days after CS respectively .the amount and duration of lochia rubra ,dura-tion of lochia were observed ,and the expression of MMP -9 and TIMP-1 in endometrium were determined using immunohistochemistry at 16th days after CS .Results The amount and duration of lochia rubra were statistically significant differences between the three groups , Chonglou Shenghua Tang group was significantly superior to the classical Shenghua Tang group and placebo group ( P<0.05) .The levels of MMP-9、TIMP-1 expression were no significant differences between groups before treatment .The levels of MMP -9 expression decreased gradually in Chonglou Shenghua Tang group ,Classical Shenghua Tang group and placebo group at 16th days after CS ,respectively ,with statisti-cal significance( P<0.05) .The levels of TIMP-9 expression and the ratio of MMP -9/TIMP-1 increased gradually in Chonglou Shenghua Tang group ,Classical Shenghua Tang group and placebo group at 16th days after CS respectively ,with statistical significance ( P<0.05 ) . Conclusion Taking Chonglou Shenghua Tang can reduce the amount and duration of lochia ,and can promote the repair of the endometrium .

陈少春主任中医师曾师从已故名医何子淮先生,从事中医妇科临床和科研40余年,学验俱丰,擅长治疗各种妇科疑难杂病,颇具疗效.笔者有幸侍诊左右,受益良多.现举陈师从心论治妇科病验案数则介绍如下.

导师陈少春师从已故国家级名中医何子淮,现任杭州市中医院主任医师,硕士生导师,浙江省中医学会妇科专业委员会委员.从事中医妇科临床医疗和科研工作40余年,擅长治疗各种妇科杂病.笔者有幸侍诊,受益颇多.陈师治疗妇科疾病,不拘泥于调补肝肾,更注重脾胃在妇科疾病中的重要作用.

章巧萍教授临证多年,治疗月经不调、闭经、痛经、不孕症、盆腔炎、带下、多囊卵巢综合征、尿路感染及内科常见病,颇具效验,今摘录其补肾活血法治验二则,以示同道.