Background:Extracellular vesicles (EVs) have emerged as a valuable and promising research field in eye diseases. However, there are few bibliometric studies in this area. The purpose of this study was to employ bibliometric analysis to visualize the research hotspots and trends of EVs in eye diseases and provide researchers with new perspectives for further studies. Methods:Articles and reviews on EVs in eye diseases published between January 1, 2003 and December 31, 2022 were retrieved from the Web of Science Core Collection. Qualitative and quantitative analysis was performed using Microsoft Excel and CiteSpace software. Results:In total, 790 articles were included in the analysis. Over the past 2 decades, there has been a significant increase in the number of publications on the study of EVs in eye diseases. The United States, China, and Italy made the most significant contributions to this field. The Chinese Academy of Sciences was the most productive institution, and International Journal of Molecular Sciences published the most number of articles. Proceedings of the National Academy of Sciences of the United States of America had the highest citation frequency. Beit-Yannai E had the highest output and Thery C had the highest average citation frequency among authors. The analysis of keywords revealed that the neuroprotective effects of stem cell-derived EVs and biomarkers of eye diseases are current research hotspots and frontiers in this field. Conclusion:This study provides a scientific perspective on EVs in eye diseases and provides valuable information for researchers to detect current research conditions, hotspots, and emerging trends for further study.

目的 探讨腰椎骨边取穴针刺联合美式整脊治疗产后非特异性下腰痛(nonspecific low back pain,NLBP)的临床疗效.方法 选取2019年6月至2021年5月北京市东城区第一人民医院收治的产后NLBP患者70例,采用随机数字隐匿信封法分为对照组(35例,美式整脊常规治疗)与观察组(35例,美式整脊常规治疗联合针刺治疗).采用简明McGILL疼痛问卷(short-form McGill pain questionnaire,SF-MPQ)评估疼痛程度,包括疼痛分级指数(pain rating index,PRI)、疼痛视觉模拟评分(visual analogue scale,VAS)和疼痛强度(present pain intensity,PPI).采用日本骨科协会(Japanese Orthopaedic Association,JOA)下腰痛评分表和改良 Oswestry功能障碍指数(Oswestry disability index,ODI)评估日常生活能力.采用生活满意度指数A(life satisfaction index A,LSIA)评估生存质量.结果 治疗2周及4周后,两组患者PRI、VAS和PPI评分均较治疗前有显著下降,且治疗4周后PRI、VAS和PPI评分均低于治疗2周后,差异有统计学意义(P＜0.01);治疗4周后,观察组PRI、VAS和PPI评分均低于对照组,差异有统计学意义(P＜0.05).治疗2周及治疗4周后,两组JOA评分呈上升、ODI评分呈下降趋势(P＜0.001),且治疗4周后的JOA评分高于治疗2周后,ODI评分低于治疗2周后,差异有统计学意义(P＜0.05);治疗2周后,观察组JOA评分高于对照组,但差异无统计学意义(P＞0.05),ODI评分低于对照组,差异有统计学意义(P＜0.01);治疗4周后,观察组JOA评分高于对照组、ODI评分低于对照组,差异均有统计学意义(P＜0.05).治疗4周后,两组患者LSIA评分均较治疗前升高(P＜0.01),且观察组较对照组升高更显著(P＜0.05).结论 腰椎骨边取穴针刺联合美式整脊与单一美式整脊治疗对产后NLBP均有较好的镇痛效果,均能提升患者的日常生活能力,改善生存质量,但前者优于后者.

Objective: To investigate the effect of Wei's triple nine needling therapy on the N2-P2 wave of the flash visual evoked potential (FVEP) in rats of the of the transverse directional pulling model. Methods: Thirty-six Wistar rats were randomly grouped, nine were in normal control group without any treatment, and the remaining 27 were surgically modelled in the right eyes. Eighteen of these rats were randomly divided into a Wei's triple nine needling therapy group and a model group of nine rats each after the TON model was made using the transverse quantitative retraction method. The other 9 rats were sham-operated, and only the optic nerve was exposed without retraction. On the next day of modelling, the Wei's triple nine needling therapy group was treated with Wei's triple nine needling therapy for 20 minutes/1 time/1 day for 14 days. The model group, sham-operated group and normal control group were not intervened. Wei's triple nine acupoints were represented as follows: 1st link: "Jingming" (BL1) and " Chengqi" (ST1); 2nd link: "Sizhukong" (SJ23) penetrating "Taiyang" (EX-HN5); and the third: "Fengchi" (GB 20) and "Taichong" (LV3). The FVEP of each group was observed on 1d, 7d and 14d.The FVEP of each group was observed on 1d, 7d and 14d. Results: Compared with the model group, the N2 wave latency and P2 wave latency were shortened in the Wei's triple nine needling therapy on 1d (P < 0.05, P < 0.01); on 7d, their N2 wave latency was shortened (P < 0.01) and the N2-P2 wave amplitude was increased compared with the model group (P < 0.05); on 14d, their P2 wave latency was shortened (P < 0.05) and the N2-P2 wave amplitude was increased. There was no statistical difference in N2 wave latency, P2 wave latency and N2-P2 wave amplitude in the sham-operated group on 1d, 7d and 14d (P > 0.05). The delayed N2 and P2 wave latencies in the model group did not improve from 1d to 14d (P > 0.05) and the amplitude decreased throughout, showing a significant difference on 14d compared to 1d (P < 0.05). In contrast, the N2 wave latency in Wei's triple nine needling therapy group was not significantly different until 7d to 14d (P < 0.05); its P2 wave latency, although significantly delayed from 1d to 7d (P < 0.05), recovered on 14d and reached a level that was not statistically different from 1d and 7d (P > 0.05). There was also no significant decrease in N2-P2 wave amplitude between 1d and 14d in Wei's triple nine needling therapy group (P > 0.05). Conclusion: In this experiment, the TON rat model was successfully established by the transverse quantitative retraction method, and the treatment of TON rats with Wei's triple nine needling therapy reduced the P2 wave delay of the FVEP electrophysiological signal and increased the N2-P2 amplitude, which had a certain positive effect on the repair of optic nerve injury, probably related to its effect of improving the conduction function of the optic nerve and protecting the retinal ganglion cells that had not been degenerated and necrosed.

目的:观察"心脑同调"法电针对焦虑模型大鼠行为学及血清心房利钠肽(ANP)、促肾上腺皮质激素释放激素(CRH)、皮质酮(CORT)含量的影响,探讨针刺治疗焦虑障碍的效应及部分作用机制.方法:32只SD大鼠随机分为正常组、模型组、电针组和假针组,每组8只,制备焦虑大鼠模型.15 d后,采用高架十字迷宫实验与自发活动开场实验测试大鼠行为学变化,酶联免疫吸附试验法检测血清ANP、CRH、CORT的含量.结果:与正常组比较,模型组大鼠进入开臂次数百分比(OE％)、开臂停留时间百分比(OT％)明显降低(均P<0.01),水平得分、垂直得分明显下降(均P<0.05),血清ANP、CRH、CORT含量显著升高(均P<0.01);与模型组比较,电针组OE％、OT％值明显升高(均P<0.01),水平得分、垂直得分明显升高(均P<0.05),血清ANP、CRH、CORT含量显著降低(均P<0.01).结论:焦虑模型大鼠血清中ANP、CRH、CORT含量异常可能是导致其发病的机制之一;"心脑同调"法电针可能通过调节三者之间的紊乱状态而达到对焦虑障碍的治疗作用.

Background: The aim of this study was to compare the efficacy of different injected Traditional Chinese Medicines in the treatment of diabetic retinopathy (DR) and to provide a reference for the selection of adjuvant therapy for DR. Content: Related literature in multiple biological databases and websites was searched up to April 15, 2022, without language and publication time restrictions. A Bayesian network meta-analysis was used to analyze the included studies. Summary: Compared with conventional treatment, the combined use of injected Traditional Chinese Medicines, including astragalus, danhong, Ginkgo biloba extract powder, ginkgo leaf extract and dipyridamole (GLED), ligustrazine (LIG), mailuoning, puerarin, safflower, shuxuetong, safflower yellow sodium chloride, and xueshuantong (XST), can significantly improve the clinical effectiveness in patients with DR, while LIG, XST, and GLED can improve vision. The strength of the evidence ranged from high to very low. Outlook: In patients with DR, the combination of multiple injected Traditional Chinese Medicines is more effective than conventional treatment; some of these medicines may also improve visual acuity. This study may provide a good resource and reference for the selection of adjuvant therapy for DR.

格雷夫斯眼病(GO)是眼科和甲状腺科比较常见的疾病,因其导致眼部改变,轻则影响患者容貌,重则导致视力损害,患者生活质量受到明显影响,临床治疗比较棘手.周剑教授认为肝肺气机失常是GO发生发展的重要病机,擅长从肝肺气机升降理论出发,辨证分期治疗GO,临床思路清晰,用药准确.本文总结周剑教授长期辨证治疗GO的心得,并对临床典型案例加以阐述,以期为中医治疗GO提供借鉴.

目的 采用数据挖掘方法探索分析治疗视神经炎的中药复方用药思路及配伍规律.方法 以"中医""中药""视神经炎"为主题词,检索汇总中药内服治疗视神经炎的临床研究文献,提取收集其中的中药复方组成数据,应用中医传承计算平台3.0版本对中药数据进行频次统计、药物聚类及关联规则分析,并总结出核心处方.结果 共检索并筛选出目标文献96篇,包含218个治疗视神经炎的中药复方;涉及中药197味,共计频次2540次.其中,使用频率最高的中药依次为当归、茯苓、甘草、柴胡等,药物功效以养血、益气为主,中药四气分布主要在寒、温、平性,五味以苦、甘居多;归经以肝经、心经、肺经为主.结论 治疗视神经炎的复方药物以疏肝健脾、益气活血为主要功效,用药及配伍以补虚类、清热类药为主,佐以利水渗湿、活血化瘀药.

目的:观察"心脑同调"法电针对焦虑模型大鼠行为学及脑源性神经营养因子-酪氨酸激酶受体B(BDNF-TrkB)信号通路的影响,探讨针刺治疗焦虑障碍的疗效及相关作用机制.方法:将32只SD大鼠随机分为正常组、模型组、电针组和假针组,每组8只,制备焦虑大鼠模型.电针组电针"百会""风府""神门""内关"穴,假针组浅刺上述腧穴旁1 mm处,隔日1次,20 min/次,造模与治疗共计15 d.治疗结束后,采用高架十字迷宫实验与旷场实验测试大鼠行为学变化,酶联免疫吸附试验法检测血清BDNF水平,免疫组织化学法检测大鼠前额叶皮质BDNF、TrkB的表达水平.结果:与正常组比较,模型组大鼠进入开臂次数百分比(OE％)、开臂停留时间百分比(OT％)明显降低(P<0.01,P<0.05);与模型组比较,电针组OE％、OT％值明显升高(P<0.01);与电针组比较,假针组OT％值明显降低(P<0.05),OE％值有降低趋势,但差异无统计学意义(P>0.05).与正常组比较,模型组水平得分、垂直得分明显下降(P<0.05,P<0.01);与模型组比较,电针组水平得分、垂直得分显著上升(均P<0.01);与电针组比较,假针组水平得分、垂直得分显著降低(均P<0.05).模型组大鼠血清BDNF水平较正常组明显降低(P<0.01);电针组大鼠血清BDNF水平较模型组明显升高(P<0.05);假针组大鼠血清BDNF水平较电针组明显降低(P<0.05).与正常组比较,模型组大鼠前额叶皮质BDNF、TrkB表达水平明显降低(均P<0.01);与模型组比较,电针组大鼠前额叶皮质BDNF、TrkB表达水平明显升高(P<0.01,P<0.05);与电针组比较,假针组大鼠前额叶皮质BDNF、TrkB表达水平明显降低(均P<0.05).结论:焦虑模型大鼠BDNF-TrkB信号通路的异常表达可能是其焦虑的发病机制之一."心脑同调"法电针可能通过调控BDNF-TrkB信号通路而发挥抗焦虑作用.

Objective: To observe the effect of intradermal needle therapy on back-shu points of five zang organs in treating chronic fatigue syndrome (CFS) and provide evidence for the usage of unilateral back-shu point. Methods: Patients were randomly divided into bilateral back-shu point group, unilateral back-shu point group and non-acupoint group, remove shedding cases, each group remaining 30 patients. In bilateral back-shu point group, both sides of back-shu points of five zang organs were selected. In unilateral back-shu point group, only one side was selected, left or right alternately. The location where non-acupoint group inserted by intradermal needles were outward from the back-shu points, left or right alternately. Fatigue Scale-14 (FS-14) was used to evaluate the fatigue level and the scores' improvement of physical fatigue and mental fatigue revealed the therapeutic effect on body constituents and spirits of CFS patient. Results: After the 8-week intradermal needle therapy, the total effective rate was 83.33％ in the bilateral back-shu point group, which was 76.67％ in the unilateral back-shu point group and 50.00％ in the non-acupoint group. The curative effects of the two groups whose back-shu points of five zang organs were inserted by intradermal needles were better than the non-acupoint group(P<0.05). There was no significant difference in clinical efficacy between the bilateral back-shu point group and the unilateral back-shu point group (P>0.05). There were statistical differences in FS-14 questionnaires including total, physical and mental scores between before and after the treatment in both the two back-shu point groups(P<0.05). Only the scores of total and physical fatigue in decreased in non-acupoint group(P<0.05), which means it couldn't help to alleviate mental fatigue statistically(P>0.05). Conclusions: (1) The intradermal needle therapy on back-shu points of five zang organs for CFS has a satisfying clinical efficacy in curing tiredness. It can help to reduce both physical and mental fatigue for the patients. Hence, it can regulate both body constituents and spirits simultaneously. (2) Needling the unilateral acupoints can get similar clinical efficacy to the bilateral points. It reveals that we can cut cost by reducing the consumption of the amount of intradermal needles used on one side. (3) Both the groups of back-shu points get better clinical efficacy than the non-acupoint group dramatically. The reason of why the intradermal needle can treat CFS maybe that back-shu points of five zang organs can regulate the functions of five zang organs characteristically.

在中医文献中,"导气"一词最早见于《灵枢·五乱》:"五乱者,刺之有道乎……徐入徐出,谓之导气,补泻无形,谓之同精,是非有余不足也,乱气之相逆也."有学者[1]认为,针灸学之"导气"或移用于"道家或以导气养性"(《论衡·道虚》),与道家养生调息之徐徐呼吸的特性相似,是一种"徐入徐出",非补非泻,通过引导逆乱之气恢复如常以治疗"五乱"的针刺方法.笔者通过查阅近现代针灸名家的相关著述[2-3],发现"导气"或"导气法"一词的内涵已不限于治疗"五乱"的一种针刺方法,而是扩大为"调气"和"行气"并举的一类针刺操作方法.有医者[4-6]则将"导气法"与"行气法"等同,将其作为针刺调气的辅助手法以引导经气运行.与"徐入徐出"之导气针法的"调气"作用相比,引导经气运行之导气法可增强"气至针下"和"气至病所"的作用,进而提高针刺调气的效果.笔者不揣浅陋,试阐述对导气法理论及其针灸临床应用的思考,以期与同道共同探讨.

总结王沛教授论治膀胱癌经验.认为膀胱癌病机以肾之气阴亏虚为本、湿热瘀毒互结为标,确立以益气养阴为主、清热利湿活血为辅的治疗原则,强调分消走泄湿热邪气,补脾肾以扶助正气,固摄以防癌毒扩散,用虫类药松透病根,取得了较好的临床疗效.

目的 比较单用饮食指导、饮食指导联合耳穴治疗对无症状高尿酸血症(HUA)患者血尿酸(UA)控制的总体效果.方法 采用随机单盲对照试验,将60例受试者随机分成观察组与对照组,对照组给予单用饮食指导,观察组给予饮食指导联合耳轮刺络放血、耳穴压丸.比较2组干预前后血UA水平、不同性别患者血UA改善程度、血UA达标率等变化.结果 与干预前相比,干预后2组血UA均有明显下降,差异有统计学意义(P＜0.01);观察组优于对照组,差异有统计学意义(P＜0.05).观察组血UA达标率73.3％,高于对照组的40.0％,差异有统计学意义(P＜0.01);其中,观察组男性达标率高于对照组,但差异无统计学意义(P＞0.05).结论 2种干预方法降低无症状HUA患者血UA水平的疗效确切,且耳穴治疗联合饮食指导降低血UA水平优于单纯饮食指导.

目的 探讨视盘玻璃疣(optic disc drusen,ODD)眼底荧光血管造影(fundus fluorescein angiography,FFA)的影像特征.方法 回顾性分析2000年1月至2020年12月在北京中医药大学东方医院眼科确诊的11例(20只眼)ODD患者的临床资料,总结其FFA影像特征.结果 11例患者中10例患者(18只眼)存在视力下降或眼前黑影遮挡等临床表现,1例(2只眼)因体检发现视盘异常就诊.FFA检查结果显示,5例(6只眼)可见自发荧光;6例(11只眼)存在造影早期结节样弱荧光;1例(1只眼)存在视盘表面毛细血管扩张及染料渗漏;2例(3只眼)可见视盘表面或深层出血所致荧光遮挡;11例(20只眼)FFA晚期均有典型的视盘鼻侧结节样强荧光或视盘周围环状高荧光.20只眼中仅1只眼为埋藏型ODD,余19只眼均为浅表型ODD.结论 ODD患者的FFA影像结果具有特异性,有助于临床上明确诊断.

引经药,又称引经报使药,是指能引导其他药物的药力到达病变部位或某一经脉,起"向导"作用的药物.中药引经药性理论是历代医药学家遣方用药的经验总结,对临床合理应用中药起着十分重要的指导作用.眼睛具有"病位至高""结构复杂""脉络深邃"三大特性,临床上使药力直达病灶极为困难,故眼科用药尤其强调使用引经药.祁宝玉教授临床运用引经药经验丰富,治疗诸多疑难眼病疗效显著.本文围绕引经理论及引经药在眼病治疗中的应用,梳理归类药物特性及功效,总结分析祁教授眼科运用引经药的临床经验,以期为临床眼科疾病的治疗提供一些思路.

目的:探究针刺配合语言训练对脑卒中后构音障碍的影响.方法:选取2017年7月至2019年1月北京中医药大学房山医院收治符合纳入条件脑卒中后构音障碍患者114例作为研究对象,按照就诊顺序编号随机分为对照组和观察组,每组57例.对照组常规西医治疗并配合语言康复训练,观察组在对照组基础上加用针刺治疗,均同时治疗4周.观察2组声学/电声门图参数基频(FO)、基频微扰(Jitter)、振幅微扰(Shimmer)、谐躁比(HNR)、声门接触率(CQ)、喉发声空气力学指标、语音清晰度、篇章正答率、构音障碍综合性评价量表、血液流变学以及疗效.结果:2组Jitter、Shimmer、CQ、构音障碍综合性评价量、血液流变学治疗前均显著下降,差异有统计学意义(P<0.05),且观察组均显著低于对照组,差异有统计学意义(P<0.05);治疗后2组MPT、语音清晰度、篇章正答率较治疗前均显著升高,差异有统计学意义(P<0.05);观察组治疗有效率显著高于对照组,差异有统计学意义(P<0.05).结论:针刺配合语言训练能通过改善脑卒中后构音障碍言语和声学水平,促进血液循环,从而提高疗效,改善生命质量.

脐是人体腹部重要的解剖结构,脐痛属于腹痛范畴,腹腔内脏器病变引发肚脐痛.中医认为脐与五脏六腑、十二经脉等密切相关,脐痛既可能是内脏病症的临床症状,也可能是神阙穴作为腧穴对脏腑病症的病理反应.本文记录了1例脐痛患者针刺治疗的全过程,患者脐痛的部位恰处脾病在脐的病理反应点,辨证为寒邪中脾,脾阳不振,针刺取穴以足阳明经、足太阴经及任脉穴为主,收效圆满.笔者通过分析此脐中痛针灸有效临床案例,探讨作为临床症状及腧穴反应点的“脐中”与五脏中脾的相关性,与同道共享肚脐诊治五脏病症的个人体会.

文章所述急症,即指非创伤性急危重症,包括疾病急性发作期,其起病急骤,变化迅速,病症复杂,病情危重,具有"急速重危"特点.急症之治,虚实之辨更不能差以毫厘,临证之时,常恐攻实而伤正,补虚更助邪.然中医治病之本质,乃扶正祛邪,通过调动人体自身正气以对抗邪气,驱邪外出,而并非将疾病作为治疗对立面,故刘大新教授常言"急症亦勿忘扶正".临证中应及时辨别急症,把握病证之标本、顺逆,注重顾护正气;若一味攻邪,过则损及正气,正不胜邪,病情急剧恶化;更有甚者,本非急危重症,攻伐太过而成坏病.学生从急症之病因、病机及当代人体质特点,结合跟师体会,浅议急症辨识诊治之策.

中医作为中华传统文化中的瑰宝,为中华民族的繁荣昌盛发挥了不可替代的作用.西汉时期《黄帝内经》成书,之后《傩经》斜农本草经》《伤寒杂病论》等中医经典陆续问世,中医的理论体系不断完善.历朝历代医学教育机构对中医经典十分重视,在医学考试中对中医经典的考核也各有特点,笔者总结归纳历代中医经典的考核模式,对现代中医教育进行思考,并由此提出相关建议,以促进当代中医师的培养.

Challenging for breakthroughs and innovations by integrating theory with practice played an important role in raising the effect of TCM in the diagnosis and treatment for male infertility, as physicians of past generations treating it from kidney, liver, spleen and other zang-fu viscera. The governor channel, the conception channel, and the thoroughfare channel were three branches from the same source, the essence chamber in men, and it was closely related to the male reproductive activity. As a result, the treatment of male infertility from coordinating the governor channel, the conception channel, and the thoroughfare channel was worthy to make an intensive study.

Objective:Randomized single blind controlled trial was used to compare the effects of single needle acupuncture,the single use of anti-resistance training,or two therapies in combination for the treatment of senile degenerative lumbar instability.Methods:90 cases of patients were randomly divided into an acupuncture group,a rehabilitation group (anti-resistance training) and a combined group.All the treatments were given once daily for 20 days.Outcome measurements included lumbar joint mobility score,simplified MCGILL score,Japanese orthopaedic association (JOA) score,modified oswestry disability index (ODI) score,visual analogue scale (VAS) pre and post-treatment.Cost effectiveness analysis was also conducted.Results:All the 90 patients received the treatment and were included in the final analysis.After treatment,the MCGILL score,JOA score,modified ODI score and VAS were significantly changed within each group,and the difference was significant (P ＜0.01).However,there was no statistical difference of these scores between different groups (P ＞0.05).Compared with the rehabilitation group and the combined group,the cost effectiveness ratio of the acupuncture group was much better,and the difference was statistically significant (P ＜ 0.01).Conclusion:Acupuncture,anti-resistance training or the combined therapy may all have effectiveness in the treatment of senile degenerative lumbar instability,but on the basis of the same treatment effect,the cost of acupuncture is lower.