Background: Slow transit constipation (STC) is a chronic gastrointestinal dysfunction that significantly impairs the quality of life for many individuals. This study aims to explore the role and mechanism of Benzoylmesaconine (BAC) in the treatment of STC.Methods: Rats were treated with loperamide (Lop) hydrochloride for 7 days to build the STC model. After that, they were given BAC concentrated solution and 0.2 g/L Mosapride via intragastric treatment. The rats' body weight was monitored, and their intestinal propulsion rate was determined using the intestinal charcoal powder propulsion assay. Pathological symptoms were assessed by hematoxylin-eosin (HE) staining. Additionally, the concentrations of 5-hydroxytryptamine (5-HT) in both serum and colon tissues were detected by enzyme-linked immunosorbent assay (ELISA). The expression levels of 5-HT receptor 3 (5-HT3R), 5-HT receptor 4 (5-HT4R) and Chlorogenic acid (CgA) were evaluated using immunohistochemistry (IHC) and immunofluorescence (IF), respectively. Moreover, the gut microbiota profiles of fecal samples were analyzed through 16S rRNA analysis. Results: BAC treatment improved the intestinal propulsion rate and pathological symptoms induced by Lop. In rats treated with Lop, the concentrations of 5-HT in both serum and colon tissues, and the expression levels of 5-HT3R, 5-HT4R (p < 0.05), and CgA were decreased. However, these levels were restored with the BAC and mosapride treatments. Additionally, BAC improved the decrease of intestinal microflora caused by Lop and changed the fecal microbial composition caused by Lop.Conclusions: BAC alleviated the symptoms of STC and improved the composition of intestinal microflora associated with STC. These findings suggest that BAC could be a potential treatment for functional bowel disease.

目的 采用病证结合评价方法对比研究3种阳虚型STC大鼠模型建立方法,为中医药防治提供理想的实验动物模型.方法 64只SD大鼠,分为空白组和模型组,采用盐酸洛哌丁胺结合0℃冰水复合灌胃法(M-1组)、盐酸洛哌丁胺联合大黄水煎液灌胃法(M-2组)、白醋与0℃冰水交替灌胃+盐酸洛哌丁胺灌胃法(M-3组),各16只,分别建立阳虚型STC大鼠模型,空白组(16只)给予等体积蒸馏水灌胃,造模期间观察大鼠一般情况,每周固定时间测定肛温、饮食量、自主活动量、粪便Bristol评分及含水率,模型建立后检测各组大鼠首粒黑便排出时间、肠道推进率,HE染色法观察大鼠结肠病理改变,PAS染色检测大鼠结肠黏液变化,ELISA法、免疫组化法检测结肠5-HT、VIP、SP含量及蛋白表达.结果 造模后各模型组大鼠均出现精神萎靡、倦怠懒动、弓背蜷缩等表现.造模期间各模型组大鼠出现死亡,死亡率依次为M-3组＞M-2组＞M-1组.与空白组相比,M-1组在造模第3周进食量、自主运动量明显降低(P＜0.01),造模第4周肛温、粪便含水率明显降低(P＜0.01),造模第5周粪便Bristol评分明显降低(P＜0.01);M-2组在造模第3周肛温明显下降(P＜0.01),进食量、自主运动量明显降低(P＜0.01),第6周粪便Bristol评分、含水率明显降低(P＜0.01);M-3组在造模第1周自主运动量明显降低(P＜0.01),造模第2周进食量明显降低(P＜0.01),造模第4周肛温、粪便Bristol评分、粪便含水率明显下降(P＜0.01);HE染色显示各模型组大鼠结肠无明显病理改变;与空白组相比,PAS染色发现各模型组大鼠结肠黏液层厚度明显减少,排序依次为M-3＜M-1＜M-2,同时各造模组大鼠首粒黑便排出时间增加、肠道推进率显著降低(P＜0.01),结肠5-HT、SP含量及蛋白表达显著下降(P＜0.01),M-1组结肠VIP含量及蛋白表达显著升高(P＜0.01).结论 3种造模方法均能建立阳虚型STC大鼠模型,但以盐酸洛哌丁胺联合0℃冰水灌胃法建立的大鼠模型具有死亡率低、安全性较好、阳虚证候表现稳定,大便性状改变明显,肠道动力障碍病理变化显著的优点,是阳虚型STC发病机制及相关中医药药物作用实验研究的理想模型.

湿邪致病缠绵易发、复杂多变,历代医家对其治法探讨颇丰.基于湿邪自身特性以及其与脾胃、气血津液之间的密切关系分析湿邪致瘀病机,以此探讨"治湿辅以活血"治法思路."治湿辅以活血"含义有三:湿易致瘀,治湿应有活血之考虑;湿病日久易具生瘀之患,适时酌情辅以活血,体现"既病防变"思想;治湿"辅"以活血,从瘀治湿是湿邪治法的组成部分.在此基础上,举隅分析历代医家"治湿辅以活血"方剂,如桂枝芍药知母汤、黄连汤、木香荜澄茄丸等.文末以典型病案一则探讨该治法临证体会,以供同道参考.

在国家大力支持中医药事业发展的时代背景下,中医思维培养问题得到普遍关注与重视.目前中医思维研究主要体现在中医思维特点、中医思维方法、中医思维模型等方面的研究,对中医思维培养的核心要素具体探讨较少.文章根据《本科医学教育标准-中医学专业(暂行)》提到的基本要求和办学标准,针对目前中医临床教育存在的普遍问题,主要从培养中医学生病史收集及展开能力、综合信息阐述分析病机能力、方药阐释能力、疾病走向动态把控能力四个方面进行论述,以期解决部分教育问题,拓展中医传承人才培养的具体方法和思路.

随着时代的发展,中医药高等教育遵循特有的人才成长规律,历经60余年的不断改革发展,培养了众多的中医药行业医务工作者和中医名家.院校教育作为中国中医药高等教育的主体,实现了由传统教育方式向现代教育方式的转变,初步形成了由院校教育为主体,多层次多类型协调发展的办学格局.通过充分发挥中医药院校教育优势,结合中医药人才的中医思维养成全过程,不断完善中医药教育体系的构建,构建以中医药优势为1个根本核心,多学科、多层次、多类型的复合型中医药人才培养模式,做好中医药院校高等教育的守正与创新.

Background: Chronic hepatitis B (CHB) is a very critical threat to public health worldwide, and is the primary cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Yinchenhao decoction (YCHD) is a classic prescription of traditional Chinese medicine for the treatment of jaundice. Despite the satisfactory clinical efficacy of YCHD in the treatment of CHB, the safety of YCHD is still uncertain. Therefore, we will provide a systematic review of YCHD in CHB treatments. Methods: The purpose of this review is to retrieve relevant literature on YCHD therapy for CHB in the electrical databases, including 4 Chinese databases (e.g., Wanfang database, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical database (CBM), Chinese Science and Technology Periodical database (VIP)) and 3 English databases (e.g., PubMed, Cochrane Library, and EMBASE). The literatures involved are from the establishment of the databases to January 2019. The primary outcomes are HBV-DNA, HBeAg, and ALT. We will calculate the data synthesis for meta-analysis using RevMan V.5.3 software if the results are suitable. Results: This study will offer a high-quality composite of existing evidence for YCHD in CHB treatment according to HBV-DNA quantitative detection, HBeAg qualitative detection, ALT levels, TCM syndrome evaluation criteria, status changes in quality of life assessment participants, and adverse events. Conclusion: This systematic review will provide evidence to assess the clinical efficacy of YCHD in the treatment of patients with CHB. PROSPERO registration number: PROSPERO CRD42019119720.

升阳益胃法创自李东垣,是其治疗内伤疾病的主要治法,后世也常用此法治疗多种内科杂病,此法主要在于恢复脾胃正常升降气机功能.本文介绍了升阳益胃法在治疗难治性呃逆中的运用,旨在为临床运用此法及治疗呃逆开拓新思路.临床治疗呃逆不可一味地使用降逆之品,应以调畅气机升降为主,气机运行畅通则呃逆止.同时临床还需注意病机是不断变化的,故治疗时要辨清此时的主要病机,预判疾病发展方向,才能更快更好地解除患者病痛.

文章基于国家973计划:“中药方剂理论框架结构研究”的研究成果,应用方剂理论框架对升阳益胃汤进行研究,以期更好的认识和运用升阳益胃汤,并可进一步佐证“方剂理论框架”是一种研究方剂的新方法.

Background: Chronic hepatitis B (CHB) is a very critical threat to public health worldwide, and is the primary cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Yinchenhao decoction (YCHD) is a classic prescription of traditional Chinese medicine for the treatment of jaundice. Despite the satisfactory clinical efficacy of YCHD in the treatment of CHB, the safety of YCHD is still uncertain. Therefore, we will provide a systematic review of YCHD in CHB treatments. Methods: The purpose of this review is to retrieve relevant literature on YCHD therapy for CHB in the electrical databases, including 4 Chinese databases (e. g., Wanfang database, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical database (CBM), Chinese Science and Technology Periodical database (VIP)) and 3 English databases (e. g., PubMed, Cochrane Library, and EMBASE). The literatures involved are from the establishment of the databases to January 2019. The primary outcomes are HBVDNA, HBeAg, and ALT. We will calculate the data synthesis for meta- analysis using RevMan V. 5.3 software if the results are suitable. Results: This study will offer a high- quality composite of existing evidence for YCHD in CHB treatment according to HBV- DNA quantitative detection, HBeAg qualitative detection, ALT levels, TCM syndrome evaluation criteria, status changes in quality of life assessment participants, and adverse events. Conclusion: This systematic review will provide evidence to assess the clinical efficacy of YCHD in the treatment of patients with CHB. PROSPERO registration number: PROSPERO CRD42019119720.

治疗水肿要注重调节肺、脾、肾、肝、三焦功能,鸡鸣散的主要功效是行气降浊、化湿通络,现代临床多用其治疗特发性水肿、肾性水肿、心源性水肿、肝源性水肿.由于各种疾病引起水肿的病机侧重不同,所以治疗时应根据水肿主要病机灵活加减运用,服药时间在"平旦鸡鸣时"效果最佳.

目的:观察附子理中汤灌肠对脾肾阳虚型溃疡性结肠炎(UC)大鼠结肠黏膜核因子-κB(NF-κB),血清肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)表达的影响.方法:48只SPF级Wistar大鼠共分为6组,分别为正常组、模型组、附子理中汤低、中、高剂量组及柳氮磺胺吡啶(SASP)组,每组8只:附子理中汤高、中、低剂量组分别为14.06,7.03,3.51 g·kg-1,柳氮磺吡啶组予柳氮磺吡啶0.46 g·kg-1;空白组及模型组以等体积生理盐水,每天给药1次,从造模后第3天开始用药,持续灌肠给药15 d.观察附子理中汤灌肠对脾肾阳虚型UC大鼠NF-κB,TNF-α及IL-1β表达的影响.结果:与正常组相比,模型组大鼠肠黏膜炎症面积和损伤评分明显升高,较模型组而言不同剂量附子理中汤组大鼠肠黏膜炎症面积和损伤评分明显下降(P＜0.05);与正常组相比,模型组大鼠肠黏膜NF-κB的含量以及血清TNF-α,IL-1β的含量明显增多(P＜0.05);与模型组比较不同剂量的附子理中汤均能不同程度降低大鼠肠黏膜NF-κB的含量以及血清TNF-α,IL-1β的含量(P＜0.05).结论:附子理中汤灌肠对脾肾阳虚型UC大鼠肠黏膜具有抗炎和修复作用,其机制可能与其抑制NF-κB的激活,下调TNF-α,IL-1β的表达有关.

感染幽门螺旋杆菌(HP)是幽门螺旋杆菌相关性胃炎主要致病原因.HP当属于中医毒邪范畴.脾胃气虚、脾胃失和是本病的基本病机.正气虚弱,无力祛除体内毒邪,致本病病情迁延.由此可见本病实乃本虚标实,治当标本兼顾.治疗应当以健脾益气为基础,在此基础上随证采用清热祛湿解毒、辛开苦降、理气活血、疏肝利胆等法.

剥脱性唇炎以唇红缘持续脱屑为特征的慢性浅表性炎症,是唇部发病率较高的疾病之一,有反复发作和缠绵难愈的特点,严重影响患者的生活质量.本文从中西医角度阐述了剥脱性唇炎发生的病因病理及治疗,着重提出了脾胃湿火是本病发生的关键病机,在病程过程中多兼心火,治疗上以泻脾祛湿为主,兼佐以清心降火,临床运用取得良好疗效.

中医学认为饮食不节是造成脾胃疾病的重要因素，而从现代医学的角度阐述两者之间关系的有关报道少之又少。本文试运用耗散结构理论，从生理、病理和治法三方面论述饮食与脾胃疾病关系的合理性和科学性。