ZHANG Xi-chun was a modern master of the convergence of Chinese and Western medicine, and he had many innovative ideas in medical theory, medical theory, and pharmacological interpretation, which were recorded in his masterpiece Records of Traditional Chinese and Western Medicine in Combination. In the area of external fever, he advocates the unification of cold-induced and warm diseases, the use of cold to unify warmth, and the differentiation of treatment into six meridians. He also varied the medication and created new prescriptions based on Shanghan Lun and the physical characteristics of the times and the people of the time. This complemented the shortcomings of the prescriptions for treating warm diseases in the Shanghan Lun. At the same time, he also focused on strengthening the spleen and stomach and supporting the righteousness, and advocated three factors in the use of medicine. He also emphasized the role of pulse diagnosis in grasping the interior and exterior, excess and deficiency,and the tendency of disease. It can be seen that ZHANG Xi-chun’s treatment of febrile disease of external origin is flexible in prescriptions, with the convergence of Chinese and Western approaches, and the use of the past for the present, which is of great clinical guidance and inspiration.

目的:观察大黄?虫丸对博来霉素致肺纤维化大鼠Rho/ROCK信号通路表达情况的影响,探讨其防治特发性肺纤维化(IPF)的作用机制.方法:将80只健康雄性SD大鼠随机分为空白对照组(Control组)、模型组(Model组)、吡非尼酮组(PFD组)、大黄?虫丸大剂量组(DHZC-H组)、大黄?虫丸中剂量组(DHZC-M组)、大黄?虫丸小剂量组(DHZC-L组).采用一次性气管内滴入博来霉素(5 mg/kg)复制肺纤维化大鼠模型;给药28 d后处死大鼠,行ELISA法检测TGF-β 1、TNF-α含量;RT-PCR法检测ROCK1、α-SMAmRNA表达;Western blot法检测p-RhoA、ROCK1、p-MLC蛋白表达.结果:与Model组比较,各治疗组TGF-β 1浓度和DHZC-L组TNF-α浓度显著降低(P＜0.01,P＜0.05);DHZC-L组TGF-β 1浓度显著低于PFD组(P＜0.05).与Model组和PFD组比较,DHZC-M组和DHZC-L组ROCK1、α-SMA mRNA相对表达量均显著降低(P＜0.01,P＜0.05).与Model组比较,大黄?虫丸各剂量组p-RhoA蛋白相对表达量以及各治疗组ROCK1、p-MLC蛋白相对表达量显著降低(P＜0.05,P＜0.01);且DHZC-L组p-RhoA、ROCK1、p-MLC蛋白相对表达量显著低于PFD组(P＜0.01).结论:大黄?虫丸可通过下调TGF-β 1介导的RhoA/ROCK1信号通路及减少α-SMA mRNA及TNF-α表达,起到抗炎抗纤维化作用.

温胆汤具有理气化痰、调胆和胃、健脾安神的功效,其所适病机为气郁生痰、痰气相搏,全方温凉兼并,是治疗痰证的基础方.肺主气司呼吸,又朝百脉主治节,气与水病,皆上扰于肺.呼吸系统疾病常以咳嗽、咯痰及喘息为主要症状,其中痰是重要的病理因素.临床上抓住温胆汤治疗痰热内扰、神志异常及脾胃失和的主症,将温胆汤类方与呼吸系统疾病联系起来,可取得较佳疗效.文章从温胆汤类方的源流及治疗呼吸系统疾病的机制入手,结合临床病例,探讨温胆汤类方在呼吸系统疾病中的运用.

目的:观察大黄?虫丸含药血清对转化生长因子-β1(TGF-β1)诱导后A549细胞RhoA/ROCK信号通路表达情况的影响,探讨其防治特发性肺纤维化(IPF)的作用机制.方法:正常培养并取对数生长期A549细胞,TGF-β1对其诱导48 h,电子显微镜下观察A549细胞的形态学变化;选择吡非尼酮作为阳性对照药,RT-PCR法检测TGF-β1、ROCK1、Collagen Ⅲ mRNA 的表达;Western Blot 法检测p-RhoA、ROCK1、α-SMA 蛋白的表达.结果:成功获取发生上皮细胞-间充质转化(EMT)的A549细胞;与模型组比较,各给药组Collagen Ⅲ mRNA表达均显著降低(P＜0.05,P＜0.01);与模型组比较,除大黄?虫丸大剂量组ROCK1 mRNA下调不明显外,其他各实验组TGF-β1 mRNA、p-RhoA蛋白、ROCK1 mRNA及其蛋白的表达均出现不同程度下调(P＜0.01).结论:大黄?虫丸可通过不同程度下调TGF-β1介导RhoA/ROCK1信号通路相关的EMT程度,起到抗纤维化作用,且与其剂量密切相关.

目的 基于"特发性肺纤维化患者存在肺络干血"假说,观察大黄麈虫丸含药血清对TGF-β1干预后A549细胞EMT及Smad2,Collagen Ⅰ表达的影响,探讨其防治特发性肺纤维化(IPF)的作用机制.方法 正常培养并取对数生长期A549细胞,TGF-β1对其干预48 h,电子显微镜下观察A549细胞的形态学变化;选择吡非尼酮作为阳性对照药,RT-PCR法检测EMT相关基因及Smad2 mRNA的表达;Western blot法检测Smad2、p-smad2、Collagen Ⅰ蛋白表达.结果 成功获取发生EMT的A549细胞;以Fibronectin mRNA表达情况判断EMT程度由高到低依次为:模型组(M),大黄(廑)虫丸含药血清大剂量组(D),大黄(廑)虫丸含药血清中剂量组(Z),西药组(P),大黄(廑)虫丸含药血清小剂量组(X),空白对照组(K);作为细胞外基质(EMC)重要成分,与M相比,Z与X中Collagen Ⅰ表达显著降低(P＜0.01),亦较接近K中表达(P＞0.05);与M相比,X中Smad2表达显著降低(P＜0.01),P与Z中Smad2表达降低(P＜0.05),且表达值均接近K(P＞0.05);与M相比,D、Z、X中Smad2 mRNA及p-smad2表达均显著降低(P＜0.01),但与K中表达值亦有显著差异(P＜0.01).结论 大黄(廑)虫丸对TGF-β1干预后A549细胞发生EMT程度及Smad2,Collagen Ⅰ的表达有影响,推测大黄(廑)虫丸对IPF的保护机制可能与不同程度阻断或逆转了TGF-β1/Smad2介导的EMT有关.

目的 基于"肺络干血"假说,研究搜剔肺络法代表方大黄?虫丸对博来霉素致肺纤维化大鼠肺功能及生存状态的影响.方法 将健康雄性SD大鼠随机分为空白组(A)、模型组(B)、吡非尼酮组(C)、大黄?虫丸大剂量组(D)、大黄?虫丸中剂量组(E)、大黄?虫丸小剂量组(F).除A组外各组采用气管内滴入博来霉素(5 mg/kg)复制大鼠肺纤维化模型.观察大鼠的生存状态,给药28 d后检测肺功能,分析用力肺活量(FVC)、第0.2秒用力呼气容积(FEV0.2)、0.2秒率(FEV0.2/FVC)、呼气峰流量(PEF)、最大呼气中期流量(FEF25～75％)、吸气阻力(Ri)、呼气阻力(Re)、肺顺应性(CL)的变化,并取肺组织通过HE、Masson染色观察病理变化.结果 B～E组大鼠死亡率相近,F组造模后无死亡;与A组相比,B 组 FVC、FEV0.2、CL 降低(P＜0.05),Ri、Re、0.2秒率升高(P＜0.05);与B组比较,C～F组Ri、Re降低(P＜0.05),CL升高(P＜0.05),E组、F组FVC、FEV0.2升高(P＜0.05),0.2秒率降低(P＜0.05),F组PEF升高(P＜0.05);病理可见B组大鼠肺泡结构破坏,炎细胞浸润,胶原大量沉积,纤维化改变明显,C～F组纤维化程度较B组减轻,以F组最为明显.结论 大黄?虫丸可改善博来霉素致肺纤维化大鼠肺功能指标及疾病状态,小剂量使用效果最佳,对肺纤维化大鼠的存活有保护作用.

目的 基于"特发性肺纤维化(IPF)患者存在肺络干血"假说,观察大黄?虫丸含药血清对TGF-β1干预后A549细胞增殖的影响,探讨其防治特发性肺纤维化的作用机制.方法 正常培养并取对数生长期A549细胞,5ng/mL的TGF-β1对其干预后,Masson染色观察上皮-间充质转化(EMT)过程;选择吡非尼酮作为阳性对照药,采用血清药理学和cck-8法观察不同浓度大黄?虫丸含药血清对TGF-β1干预后A549细胞增殖的影响.结果 成功获取发生EMT的A549细胞;24 h,OD值从高到低依次为:空白对照组(K组)、大黄?虫丸含药血清中剂量组(Z组)、大黄?虫丸含药血清小剂量组(X组)、模型组(M组)、大黄?虫丸含药血清大剂量组(D组)、西药组(P组);48 h,OD值从高到低依次为:K组、M组、Z组、X组、P组、D组;72 h,OD值从高到低依次为:K组、M组、D组、Z组、P组、X组.结论 大黄?虫丸含药血清对TGF-β1干预后A549细胞增殖率有影响,推测大黄?虫丸对IPF的保护机制可能与不同程度阻断或逆转了TGF-β1诱导的EMT有关.

在肺系疾病的防治过程中,中药膏方有独特优势,而颗粒剂膏方以便捷、质量稳定、便于调方等特点更适合临床应用.结合肺系疾病的特点,根据辨体-辨病-辨证的原则,在缓解期开具膏方,主要以补益肺脾肾、气血阴阳同调为主,兼顾化瘀祛痰,整体配伍呈现补而不滞、寒热同调、动静结合、以平为期的特点,达到扶正祛邪、调和阴阳的目的 ,从而降低疾病复发率.

Background Idiopathic pulmonary fibrosis (IPF) is a progressive, chronic, irreversible, and lethal interstitial lung disease (ILD) with unknown etiology occurring mainly in elderly. In recent years, the morbidity and mortality of IPF steady increase. However, there are currently no therapies that reverse fibrosis, the median survival time reported ranging from 2 to 5 years from diagnosis. The purpose of this systematic review and meta-analysis is to evaluate the effectiveness and safety of Chinese patent medicines as an adjuvant treatment in combination with Western medicines in the treatment of patients with IPF. Methods We will search electronic databases including PubMed, EMBASE, Cochrane Central, Web of Science, Chinese Biomedical Database (SinoMed), Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP information (CQVIP), and Wanfang database using keywords related to IPF and Chinese patent medicine. Search was also carried out on ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP) and the Chinese Clinical Trials Register (ChiCTR). Reference lists of literature included and relevant systematic reviews will be checked. Two independent reviewers will involved in screening studies, extracting data, and evaluating works. Any disagreements will be resolved by discussion or in consultation with a third reviewer. Data analysis will be conducted using the Review Manager software (version 5.4.1). The risk of bias of each study and the quality of evidence will be respectively assessed using Cochrane Risk of Bias tools and GRADE system. Discussion This review will integrate the current evidence and provide evidence regarding use of Chinese patent medicine as an adjuvant treatment in idiopathic pulmonary fibrosis to provide clarity regarding the potential benefits and best practice. Trial registration: PROSPERO CRD42021252806

间质性肺疾病是一大类难治性呼吸系统病症,属于中医"肺痹""肺痿"范畴.肺痹多实,肺痿偏虚,临床痹痿相兼、虚实夹杂的情况非常多见,其中肾精亏耗是本虚基础,邪气痹肺为发病之标.现代医学对本病肾精亏耗、邪气痹肺的病机内涵进行了深入研究,指出"肾虚""肺痹"与肺间质纤维化进程密切相关.滋肾填精通痹法针对"肾虚""肺痹"两个环节,采用动(宣通肺痹)静(滋肾填精)结合的配伍方法,动药可制约静药的滋腻,静药可防动药太过耗散,剂量上一般滋补的静药宜多用,而动药当以小剂宣通为宜,以使标本兼顾,外内合治,相得益彰.临床运用滋肾填精通痹法治疗间质性肺疾病取得了较好疗效,本文总结相关有效方剂如防己地黄汤、阳和汤、炙甘草汤,分别对应肾虚肺痹的不同情形,并结合临床病例,以期为中医药治疗间质性肺疾病提供思路.

目的 基于“肺络干血”假说,探究大黄(磨)虫丸对博来霉素致肺纤维化大鼠TGF-β1/Smad3信号通路的影响.方法 将60只健康雄性SD大鼠随机分为空白组(A)、模型组(B)、吡非尼酮组(C)、大黄(磨)虫丸大剂量组(D)、大黄鹰虫丸中剂量组(E)、大黄(磨)虫丸小剂量组(F),每组10只.除A组外各组采用气管内滴入博来霉素(5 mg/kg)复制大鼠肺纤维化模型.连续给药28天后处死大鼠,取肺组织行Masson染色观察病理变化,实时PCR检测转化生长因子-β1(transforming growth factor-β1,TGF-β1)、Ⅰ型胶原(Collagen Ⅰ)及Smad3蛋白的mRNA表达;Western blot法检测Smad3、p-smad3的蛋白表达水平.结果 病理:B组纤维化改变明显,F组纤维化程度为各用药组中最轻.PCR:较A组相比,B～E组大鼠TGF-β1、Smad3及Collagen Ⅰ的基因表达均显著升高(P＜0.01),F组Smad3、Collagen Ⅰ的基因表达显著升高(P＜0.01),TGF-β1的基因表达明显升高(P＜0.05);较B组相比,F组TGF-β1、Smad3的基因表达显著降低(P＜0.01),Collagen Ⅰ的基因表达明显降低(P＜0.05);较C组相比,F组TGF-β1的基因表达显著降低(P＜0.01),Smad3、Collagen Ⅰ的基因表达明显降低(P＜0.05).Western blot:与A组相比,B组Smad3蛋白表达明显升高(P＜0.05)、B～D组p-smad3蛋白表达均显著升高(P＜0.01),E组p-smad3蛋白表达明显升高(P＜0.05);与B组相比,E组Smad3、D组p-smad3蛋白表达明显降低(P＜0.05),E、F组p-smad3蛋白表达均显著降低(P＜0.01);与C组相比,F组p-smad3蛋白表达显著降低(P＜0.01).结论 大黄(磨)虫丸有抗纤维化的作用,可能与抑制TGF-β1/Smad3信号通路,减少细胞外基质沉积有关,小剂量使用效果最佳.

Objective: To optimize the experimental method of culturing Interstitial Cells of Cajal in Balb/c mouse stomach in vitro, and to provide a basis for further exploring its physiological and pathological mechanism. Methods: The gastrictissues of mice were removed under the sterile conditions, and the cells were digested and separated by enzymatic digestion. The cell suspension was inoculated in M199 medium containing Stem Cell Factor and passaged. The cell growth state of different time points was observed under the inverted microscope, and the ICC specific marker c-Kit (tyrosine kinase receptor) was used for immunofluorescence. Results: After cultured for 24 hours, the cells were almost adherent, fusiform or triangular with short protuberances. After 72 hours, the cell bodies became larger and the protuberances were elongated. After 5 days, between the cells connected to each other through projection, began to form a network structure. And after passage cells still maintain its inherent characteristics. Immunofluorescence showed that cells stained positive for c-Kit antibody. Conclusion: The ICC was successfully separated by enzymolysis. The number of cells was larger but not proliferating. After passage, the cell purity was better. After more than 3 weeks of stable culture, the cell morphology gradually changed and began to apoptosis.

本文以“病痰饮者，当以温药和之”为例，提出以《伤寒杂病论》中所涉及疾病的病机与治法要素为核心线索的研究思路。从本质上讲，痰饮病的形成主要归咎于体液代谢相关脏腑的气化功能异常及三焦水道不利两方面。对于痰饮病证的治疗，仲景提出了“病痰饮者，当以温药和之”的论治原则。其中“温药”的含义为以温药为主，根据具体情况而增加或减少适当、适量的药物；“和之”则有“观其脉证，知犯何逆，随证治之”的内涵。

清代医家尤怡《伤寒贯珠集》运用“六经为纲,治法为目,以方类证”的方法,对《伤寒论》的原文次序进行了重新编排和归纳,并对书中部分药物的炮制及煎煮方法做了改动或删减,为明清三派中依法论证派的代表性著作.该书认同《伤寒论》为临床全书的说法,对伤寒六经实质做出了阐释,认同伤寒六经提纲说且有所发展,并对“三纲鼎立”说做出了修正与发展.此外,其文中对于三阴病的论述,更是师古而不泥古,依古而又加以权变,做到了古为时用.

目的:通过观察半夏泻心汤及其拆方对大鼠胃肠平滑肌细胞增殖的影响,探讨其调节胃肠运动的作用机制.方法:提取大鼠胃肠平滑肌细胞,免疫组化方法鉴定后稳定培养;采用血清药理学和MTT法观察半夏泻心汤及其拆方各组对胃肠平滑肌细胞增殖的影响.结果:成功获取胃肠平滑肌细胞;24 h,仅甘补组、辛开苦降组OD值均高于空白组,且有统计学差异(P ＜0.05);48 h,全方组、辛开组、苦降组、苦降甘补组OD值高于空白组,且有显著性统计学差异(P＜0.01);72 h时,测得各用药组OD值均高于空白组,且具有显著性统计学差异(P＜0.01).结论:半夏泻心汤及其拆方各组的含药血清,可以不同程度的促进胃肠平滑肌细胞的增殖,推测其可能是半夏泻心汤调节胃肠运动的作用机制之一.