"大肠主津"是指大肠传导糟粕、吸收糟粕中的多余水分的过程,大肠排泄糟粕有赖于"大肠主津"的生理功能.功能性便秘是脾胃系常见病,肠道微生态失衡是其重要发病机制.肠道微生态的中医本质与"大肠主津"存在一定的理论联系,具体体现在"阴阳平衡"和"整体观念".肠道微生态维持动态平衡,与中医学大肠吸收和分泌津液的功能关系密切;由肠道微生态失衡导致的功能性便秘,其机制与"大肠主津"理论亦紧密联系、互为相关.本文基于"大肠主津"中医理论,在深入阐述"大肠主津"与糟粕排泄、肠道微生态相关性的基础上,进一步阐明运用"大肠主津"理论调节肠道微生态、改善功能性便秘的思路,以期为功能性便秘的治疗提供新的理论依据和临床指导.

This meta-analysis compared the clinical outcomes between two alternative surgeries for patients with cervical spondylosis, namely anterior cervical discectomy and fusion (ACDF) without plate (ACDFWP) vs. anterior cervical disc arthroplasty (ACDA). We searched databases, including PubMed, EMBASE, Cochrane Library, Google Scholar, and Web of Science (firstly available-2019). A standard meta-analysis was performed with the included studies. A Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used for the evaluation of the study quality of nonrandomized-controlled trials (nRCTs), while a Risk of Bias (RoB) battery was used for randomized controlled trials (RCTs). Eight studies involving 640 patients were included. No significant difference was found in the indices of Neck Disability Index (NDI) score, Visual Analog Score (VAS), Japanese Orthopaedic Association (JOA) score, operative time, blood loss, Swallowing Quality of Life Score (SWAL-QL), and complications. Cervical alignment was significantly better in the ACDFWP than in ACDA (mean difference (MD) = -0.67, 95% confidence interval (CI) [-1.11, -0.23], P = 0.003, I 2 = 20%). Although the alternative ACDFWP was slightly superior in terms of the index of cervical alignment, the limited research on this subject present insufficient evidence. Further well-designed studies are warranted in the future.

OBJECTIVE:To examine the efficacy of Qinghuayin (, QHY) in rat chronic atrophic gastritis (CAG) models and explored the molecular mechanism of QHY in treating CAG.METHODS:In total, 65 Wistar rats were randomly divided into the control (= 10) and CAG groups ( = 55). CAG model rats were further divided into five groups: model ( = 10), vitacoenzyme ( = 10), low-dose QHY ( = 10), medium-dose QHY ( = 10), and high-dose QHY groups ( = 10). We analyzed histopathological changes using hematoxylin and eosin staining and measured interleukin (IL)-6 and IL-8 levels in serum using enzyme-linked immunosorbent assay (ELISA) (Boster Bio, Pleasanton, USA). In addition, gastrin (GAS), pepsinogen I (PGI), and PGII expressions were evaluated using ELISA. The protein and mRNA expression of toll-like receptor 4 (TLR4) and toll or interleukin-1 receptor domain-containing adaptor inducing interferon-β (TRIF) was detected by Western blotting and quantitative reverse transcription-polymerase chain reaction, respectively.RESULTS:Our results revealed that histopathological changes in CAG model rates could be restored by low-, medium-, and high-dose QHY. The changes in GAS and PGI/II expression demonstrated that QHY improved CAG. Serum IL-6 and IL-levels were decreased by QHY administration. TLR4 and TRIF were upregulated at the mRNA and protein levels in the model group but downregulated by QHY administration.CONCLUSION:We concluded that QHY could effectively improve the histopathological changes of the gastric mucosa induced by CAG in rats. The therapeutic mechanism of QHY may be related to inhibition of the inflammatory factors IL-6 and IL-8 and suppression of TLR4/TRIF mRNA and protein expression.

"脾为之卫"出自《灵枢·五癃津液别》,强调脾脏具有护卫机体、抵御外邪的功能.脾与胃水谷纳运、气机升降、燥湿相济的生理病理关系,是从"脾为之卫"论治胃癌前病变的基础.脾胃生理机能正常有赖于"脾为之卫"的功能正常.胃癌前病变虚、湿、瘀、滞等病理因素与脾"为卫"功能失常密切相关.临证辨治应以"脾为之卫"理论为指导,重视固护脾气、调理气机、散瘀舒络、祛湿除邪、固护胃阴等治则的应用,以及"辨病"与"辨证"思路的结合.

湿秘在古代典籍中多有提及,且在临床中常见,但在目前的教材及指南中论述较少,故明确湿秘的概念、常见类型、证候、治法、方药等,有助于拓宽便秘的诊治思路,提高临床疗效.该文结合古今文献及临床实践认为,湿秘是一种因湿邪阻滞气机而致大肠传化失司的特殊类型便秘.其基本病机为湿阻气滞,病位虽在大肠,但五脏的功能失调均可在其发病过程中起着一定的作用,尤需关注脾胃、肺、肾、肝等脏腑通过津液代谢与气机运动,对该病发生、发展及临床治疗所产生的重要影响.湿秘的治疗原则为祛邪扶正,以祛邪为先导,辅以扶正.临证时谨守"湿阻气滞"病机,确立祛湿理气为该病的基本治法.祛湿应根据湿邪性质及阻滞部位,湿困中焦者治以苦芳燥化,湿停下焦时治以甘淡渗利,阳虚湿滞者当温阳化湿,湿热滞中者治以清热祛湿,湿热弥漫三焦则需分清化浊;理气应立足于和中、调理肝肺气机.如兼夹邪气郁滞,需重视疏导邪滞.伴脾肾虚损时,则佐以运脾、温肾方药,以求标本兼治.

目的 观察复方胃炎合剂对慢性萎缩性胃炎癌前病变(precancerous lesions of gastric cancer,PLGC)脾虚痰湿热瘀证大鼠Sonic Hedgehog(Shh)通路相关基因表达的影响,并探讨其抑制PLGC进展的机制.方法 SPF级雄性Wistar大鼠随机分为空白组、空白+中药组、模型组、维酶素组、中药低剂量组、中药中剂量组和中药高剂量组,每组8只.造模组采用复合造模法构建PLGC脾虚痰湿热瘀证大鼠模型,造模成功后,各组予以相应干预,干预30 d后进行标本采集,采用HE染色检测大鼠胃黏膜病变情况,RT-qPCR检测胃组织Shh通路相关基因SHH、PTCH1、SMO、Gli1、Gli2、Gli3 mRNA的表达.结果 HE染色提示空白组和空白+中药组大鼠胃组织病理组织学正常,模型组大鼠胃黏膜萎缩,并可见肠上皮化生(intestinal metaplasia,IM)和上皮内瘤变(intraepithe-lial neoplasia,IN);维酶素组和中药各剂量组病理组织学可见不同程度改善,以中药中、高剂量组改善最为明显.与空白组比较,模型组大鼠SHH、SMO、PTCH、Gli1 mRNA表达量下降,Gli2、Gli3 mRNA表达量上升,差异均有统计学意义(P<0.05,P<0.01).与模型组比较,各治疗组大鼠胃组织SHH、SMO、PTCH、Gli1 mRNA表达量均上升,Gli2、Gli3 mRNA表达量均降低,其中空白+中药组、维酶素组、中药中剂量组、中药高剂量组SHH、SMO、PTCH mRNA表达差异有统计学意义(P<0.05,P<0.01),中药高剂量组大鼠胃组织Gli1 mRNA表达差异有统计学意义(P<0.05),空白+中药组、维酶素组、中药中剂量组、中药高剂量组大鼠胃组织Gli2 mRNA表达差异有统计学意义(P<0.01),中药各剂量组Gli3 mRNA表达差异无统计学意义(P>0.05).结论 复方胃炎合剂可通过激活Shh通路改善胃黏膜病变,从而抑制PLGC的进展.

国医大师杨春波乃中医世家第五代传人,从医近七十载,学验俱丰,对脾胃病诊治有独特的见解.文章通过对杨老治疗反流性食管炎验案进行分析,阐述杨老的临证思路与辨治方法,以期为反流性食管炎的治疗提供临床参考.

功能性便秘是临床常见的消化系统疾病之一,微生态学是近年研究热点,越来越多研究显示肠道微生态与功能性便秘关系密切.肠道微生态失衡是功能性便秘发生发展的重要病理基础,其机制可能与黏蛋白分泌异常、肠道动力紊乱等相关.本文基于肠道微生态,从脾、肺、肝对"清浊相干"理论在功能性便秘防治中的理论内涵进行探讨,认为肠道微生态是阐释中医防治功能性便秘机理的重要途径,"调理脾肺肝,升清降浊毒"应是中医防治功能性便秘的重要方法.

目的 探讨复方胃炎合剂对慢性萎缩性胃炎(CAG)模型大鼠JAK1/STAT3信号通路及炎性因子释放水平的影响.方法 随机将SPF级Wistar大鼠分为空白组、空白+中药组、模型组、维酶素组及复方胃炎合剂低、中、高剂量组,采用"饥饱失常+潮湿环境+高脂高糖饮食"造模方法构建病证结合CAG大鼠模型,采用HE染色观察大鼠胃黏膜病变情况,并运用Real-time PCR、ELISA法检测胃组织中JAK1、STAT3 mRNA及血清中TNF-α、IL-6、IL-8、IL-10的表达量.结果 HE染色提示,与空白组比较,模型组大鼠胃黏膜萎缩、减少,可见肠上皮化生及上皮内瘤变.大鼠胃黏膜组织JAK1、STAT3表达水平明显升高(P＜0.01);与模型组比较,中药各治疗组胃黏膜固有腺体萎缩及炎症程度均有明显改善,组织中JAK1、STAT3 mRNA与促炎因子TNF-α、IL-6、IL-8表达水平均有所下降,抗炎因子IL-10表达水平均有所上升(P＜0.05或P＜0.01).结论 复方胃炎合剂可能通过抑制JAK1/STAT3信号通路,调控炎性细胞TNF-α、IL-6、IL-8、IL-10的转录及释放,从而抑制CAG的进展.

脾胃湿热理论的完善,经历了历代医家的探索与实践.脾胃湿热理论萌发于秦汉时期,以《黄帝内经》为代表论述了脾胃与"湿邪""热邪"之间的关系.金元时期渐见雏形,众多医家进一步探讨了脾胃功能与"湿热"的相关性,期间朱丹溪首次提出"脾胃湿热"一词.明清至民国时期,温病学说的发展促进了脾胃湿热理论的衍变,关于湿热证发病机理的论述渐以脾胃为中心.建国后随着中医诊疗标准的不断更新,正式确定了"脾胃湿热证",并详细归纳总结其证候特点,对中医规范诊疗有重要意义.在当今社会,相关研究表明脾胃湿热证型多见,不仅局限于脾胃病系,还涉及多系统疾病,脾胃湿热致病特点及治疗倍受关注,脾胃湿热理论体系逐渐形成.脾胃湿热理论形成与发展的过程,凝集了众多医家的传承总结,其理论不断被充实,最终形成独立的以脾胃为中心的湿热理论体系,对推动中医脾胃学说的创新和进步有积极意义.

Chronic atrophic gastritis (CAG) is well-known related with multiple pathogenic factors and normally therapies comprised by western or Chinese medicines. The present study was designed to identify the bacterial community characterized by 16S rRNA amplicon sequencing and determine the modulate affection of bacterial composition response western and Chinese medicine Qinghuayin (QHY) as well as antibiotic on model rats. The result shown the overall structure alteration of bacterial appeared under medicine intervened, antibiotic caused a marked depletion in bacterial diversity and richness. The enrichments of Firmicutes (85.1-90.7%) in antibiotic-free converts into Bacteroidetes (30.7-34.6%) in antibiotic-added model rat were demonstrated. Firmicutes as the most dominant phylum in antibiotic-free treatments and significantly decreased till 21.9-68.5% in antibiotic-added treatments. Especially QHY-treated rats showed highest RA of Firmicutes (90.7%) and the amelioration of CAG using QHY attributed by beneficial bacterial enrichment, especially Ruminococcus, Lactobacillus and Bifidobacterium. In addition, alpha and beta diversity analysis also demonstrated the clear dispersion and aggregation that revealed the alteration and steady of bacterial community structures. In summary, QHY has potential application value in the treatment of CAG, which attributed to close relation with the modulatory of internal bacterial communities.

2019冠状病毒病(coronavirus disease 2019,COVID-19)是一种急性传染病,属中医学"疫病"范畴.首先,从COVID-19病因及临床症状分析,认为其乃疠气所致,其临床症状又多兼有湿邪致病的特性,故中医病名为"湿毒疫".从国内的研究现状出发,对文中涉及的COVID-19基本概念做了界定,指出"COVID-19"较"新型冠状病毒感染的肺炎"更能全面概括此次疫情的各个临床类型,为该病的病机分析奠定了基础.接着介绍了该病的主要病机为湿毒痹阻肺络,肺气宣降失常;病机特点为湿、毒、瘀、虚;病位主要在肺,可累及脾、心、肾.病势演变为邪盛正虚,如若不及早治疗,易发生内闭外脱之危象.以上论述皆为COVID-19的中医预防和治疗奠定了基础,只有正确认识其中医病因病机特点,才能更好地发挥中医药防治COVID-19的优势.先通过对传染源、传播途径、易感人群3个环节的分析,引出了COVID-19中医预防的3个关键步骤,即隔离、消毒、未病先防;然后通过对正邪关系及体质差异的论述,提出中医治疗COVID-19需平衡正邪之间的关系,做到"扶正不留邪,祛邪不伤正";且在辨证论治时需区别体质,做到先证而治,阻止疾病进一步病变;最后,对瘥后调护给出了建议,认为COVID-19患者初愈时要清淡饮食,避免滋腻伤胃,同时需健脾养胃,脾胃健则正气得复.

Objective: We designed and performed a network meta-analysis to compare the clinical outcomes among the 5 surgeries-anterior cervical corpectomy and fusion (ACCF), anterior controllable antedisplacement fusion (ACAF), laminoplasty (LP), laminectomy (LC), and posterior decompression with instrumented fusion (PDF)-for patients with cervical spondylosis related to the ossification of the posterior longitudinal ligament (OPLL). Methods: Databases, including PubMed, EMBASE, Cochrane Library, Google Scholar, and Web of Science (firstly available-2019) were selected for literature search. We performed a network meta-analysis with the included studies. A Newcastle-Ottawa scale was employed to assess the study quality of the included studies. Results: Total 23 studies with 1516 patients were included in our analysis. We found that ACCF achieved the most improvement in the Japanese Orthopaedic Association Scores and excellent and good recovery rate, ACAF achieved the best improvement of the improvement rate and lordosis. LP got the best operative time and blood loss. Conclusions: Our results suggested that both anterior (ACCF and ACAF) and posterior (LP, LC, and PDF) procedures have their strengths and weaknesses. Clinicians need to select the most appropriate surgery with a comprehensive consideration of the clinical condition of each patient with OPLL-related cervical spondylosis.

Abstract Objective: We designed and performed a network meta-analysis to compare the clinical outcomes among the 5 surgeries—anterior cervical corpectomy and fusion (ACCF), anterior controllable antedisplacement fusion (ACAF), laminoplasty (LP), laminectomy (LC), and posterior decompression with instrumented fusion (PDF)—for patients with cervical spondylosis related to the ossification of the posterior longitudinal ligament (OPLL). Methods: Databases, including PubMed, EMBASE, Cochrane Library, Google Scholar, and Web of Science (firstly available-2019) were selected for literature search. We performed a network meta-analysis with the included studies. A Newcastle-Ottawa scale was employed to assess the study quality of the included studies. Results: Total 23 studies with 1516 patients were included in our analysis. We found that ACCF achieved the most improvement in the Japanese Orthopaedic Association Scores and excellent and good recovery rate, ACAF achieved the best improvement of the improvement rate and lordosis. LP got the best operative time and blood loss. Conclusions: Our results suggested that both anterior (ACCF and ACAF) and posterior (LP, LC, and PDF) procedures have their strengths and weaknesses. Clinicians need to select the most appropriate surgery with a comprehensive consideration of the clinical condition of each patient with OPLL-related cervical spondylosis.

气机升降理论是中医基础理论之一,对认识人体生理、病理及临床组方用药有重要价值.气机升降有序是维持肠道微生态平衡必要条件,是人体"内稳态"的具体表现形式.肠道微生态在脾胃湿热证形成的病理机制中发挥重要作用,可影响脾胃、肝、肺气机升降,导致脾胃湿热证的发生发展.因此,可通过调畅气机改善肠道微生态失衡以治疗脾胃湿热证.本文基于气机升降理论,阐述脾胃湿热证与肠道微生态关系,有助于揭示脾胃湿热证的微观机制,为中医辨治脾胃湿热证提供新思路.

脾胃湿热证是慢性萎缩性胃炎的主要证型之一,该病的难治性与预后决定了其防治的重要性.从"治未病"理论的三个方面分析其对脾胃湿热证型的慢性萎缩性胃炎不同阶段中治疗的指导作用,论述"治未病"理念指导临床的意义及有效性.

基于中医"肺与大肠相表里"理论,结合西医学黏膜免疫研究进展,总结"肺肠合病"和肺、肠功能、黏膜免疫之间的病理生理关系.肺主宣降,使卫气布达周身肌表;大肠传化糟粕,使五脏安定.肺与大肠生理功能正常是抵御外邪的基础条件,两者功能失常是导致"肺肠合病"的根本原因.西医学认为"肺肠合病"与黏膜免疫密切相关,黏膜免疫中免疫球蛋白、细胞因子是"肺肠合病"的物质基础,其"选择性的归巢机制"则是"肺肠合病"的桥梁.运用"肺与大肠相表里"理论,探讨"肺肠合病"与黏膜免疫的关系,可为"肺肠合病"的临床治疗提供新思路.

目的:探讨清化饮联合四联疗法治疗Hp相关十二指肠溃疡的临床疗效及机制.方法:将120例Hp相关十二指肠溃疡患者随机分为治疗组和对照组,每组60例,两组均给予标准四联疗法及足程抑酸治疗,治疗组在对照组基础上加予清化饮口服治疗,比较两组临床疗效、电子胃镜及Hp根除率情况,检测治疗前后血清NLRP3、Caspase-1、IL-1β、IL-18水平.结果:剔除脱落及退出病例,治疗组在中医证候疗效、临床症状积分、电子胃镜的比较上均优于对照组(P＜0.05,P＜0.01);治疗组Hp根除率为93.0％,显著高于对照组的78.2％(P＜0.05);与治疗前比较,治疗后两组血清细胞焦亡相关因子NLRP3、Caspase-1、IL-1β、IL-18水平均显著降低(P＜0.01),且治疗组血清NLRP3、Caspase-1、IL-1β、IL-18水平低于对照组(P＜0.05,P＜0.01).结论:清化饮联合四联疗法治疗脾胃湿热型Hp相关十二指肠溃疡疗效确切,能有效改善临床症状,提高Hp根除率,其机制可能与下调NLRP3、Caspase-1、IL-1β、IL-18等细胞焦亡相关因子表达,进而抑制Hp感染及炎症反应有关.

新型冠状病毒肺炎(COVID-19)是急性呼吸道传染病,属于中医“疫病”范畴,病因为感受寒湿疫毒.作者结合COVID-19临床验案2则,探讨中西医两种不同的思维方式对COVID-19的认识和思考,阐明中医药干预在COVID-19防治中的优势,为中医药能更好发挥作用提供借鉴.

中医"治未病"理论是中医预防学说的理论总结,酌古斟今.文章分析了"治未病"理论的渊源及内涵,并结合慢性便秘共识意见具体条目,分别从饮食、情志、体质、针灸推拿及中药方剂,阐述慢性便秘诊疗过程中"治未病"理论的具体应用,探讨理论在慢性便秘共识意见中的实践价值,为慢性便秘的治疗提供经验借鉴.