目的 基于真实世界运用大数据对宁波市名老中医治疗萎缩性胃炎(CAG)诊治规律研究.方法 名中医门诊收治的600例CAG患者,采用复杂网络算法对真实世界大数据挖掘处方,揭示其治疗过程中的辨证论治、遣方用药规律.结果 600例患者临床症状描述最高为胃脘胀满,占30.60％;中医证型分布为肝胃不和134例(22.37％),胃阴不足92例(15.24％),脾胃不和89例(14.83％),气滞湿阻86例(14.35％),脾胃气虚74例(12.33％),其他125例(20.88％).600份处方中出现甘草421次(68.90％),其中药味归经为脾4 561次,中药数96个;胃4 161次,中药数97个;肺3 616次,中药数90个.依据复杂信息网络分析图显示,四逆散合二陈汤加减为核心处方.结论 宁波地区CAG最常见的症状为胃脘胀满,中医证型最常见肝胃不和,处方高频药物依次为甘草、半夏、白芍及陈皮等,四逆散合二陈汤加减为核心处方,其中最核心的药物为甘草、半夏及白芍.

王邦才教授为国医大师钟一棠学术经验继承人、全国优秀中医临床人才、浙江省名中医,熟谙《伤寒论》及《金匮要略》,擅长运用经方治疗中医顽疾,继承而不拘泥古人,笔者跟师临证多年,获益颇丰,现择小柴胡汤证验案四则介绍如下: 一、胃心综合征 患者男,34 岁,2020 年12 月23 日就诊.

异病同治是指不同的疾病出现相同证候,采用同一种方法治疗.王邦才主任中医师将"异病同治"原则灵活运用于内科疾病的治疗,收效显著.现选其验案2则,介绍如下. 异病同治是指不同的疾病出现相同证候,采用同一种方法治疗.王邦才主任中医师将"异病同治"原则灵活运用于内科疾病的治疗,收效显著.现选其验案2则,介绍如下.

王邦才教授为国家优秀中医临床人才、浙江省名中医,从事中医内科临床、科研与教学工作近40年.笔者师从王邦才教授,跟师临诊3年,获益颇丰.现将王师运用滋阴泻火、化痰降逆法治疗梅核气的经验总结如下: 1 病因病机 梅核气又称"癔球症",多以咽部异物感如梅核梗阻,咯之不出,吞之不下.汉代《金匮要略·妇人杂病脉证并治》中:"妇人咽中如有炙脔,咯之不出,咽之不下."明《赤水玄珠》卷三:"梅核气者,喉中介介如梗状."现代医学属于功能性胃肠病范畴,具有易反复发作、病程长等特点,无吞咽困难,对食物摄入无明显影响.研究表明,精神心理因素、自身神经功能紊乱及食道感觉异常、食管动力障碍等均与梅核气的发生发展具有密切关系[1].历代医家多认为,其病机以肝郁气滞,久而痰结,痰气交阻于咽喉为主,多以《金匮要略》中辛开苦降、化痰散结之"半夏厚朴汤"为主方加减治疗,然临床乏效者常有[2].王师认为,梅核气的病机并不仅仅局限于肝郁气滞,痰气交阻于咽喉,也可由肝阴不足或气阴不足后痰气郁结所致,治疗上标本兼顾,可予滋阴清热为主,佐以理气化痰之剂进退.现举验案二则,以飨同道.

王邦才教授系浙江省名中医,浙江省"十三五"重点中医专科脾胃病科学术带头人,从医近四十载,熟读中医经典著作,临床治病,注重辨证,用药简洁,善用经方治疗中医急难病症,屡取佳效,病根如扫.笔者有幸跟师随诊,获益颇多,现选其运用经方治疗中医急难病症医案2则,以飨同道.

目的 探讨盐酸小檗碱(berberine hydrochloride,BBR)对高脂饮食诱导非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)生化指标、氧化应激状态、炎性水平、Nrf2 mRNA及Nrf2表达的影响.方法 大鼠随机分为4组:对照组(normal diet,ND)、模型组(high-fat diet,HFD)、盐酸小檗碱(berberine hydrochloride BBR)组和多烯磷脂酰胆碱(polyene phosphatidylcholine,PPC)组.高脂饲料喂养大鼠12周制备NAFLD模型,油红O染色观察大鼠肝细胞脂肪量.给药12周后取材,HE染色检测大鼠肝组织病理学变化;采用全自动生化分析仪检测谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C).酶联免疫吸附反应(ELISA)检测肝组织TNF-α、IL-6、IL-1β炎性因子表达水平以及ROS、MDA氧化应激水平.实时荧光定量PCR(qRT-PCR)检测肝组织Nrf2 mRNA表达.Western blot法检测肝组织核内Nrf2蛋白表达.高速成像流式细胞仪检测NRf2核转位水平.结果 盐酸小檗碱能够显著缓解肝组织脂肪变,减少炎性细胞浸润,降低NAS积分;降低ALT、AST、TC及LDL-c水平;降低肝组织TNF-α、IL-6、IL-1β水平;降低ROS、MDA表达;增加大鼠肝组织Nrf2 mRNA表达;增加大鼠肝组织核内Nrf2表达.结论 盐酸小檗碱能够缓解NAFLD,减轻炎症状态,可能与降低氧化应激水平,增高Nrf2核内表达有关.

慢性萎缩性胃炎病程缠绵,迁延难已,其中阴虚络瘀型病情尤为深痼,王邦才教授认为其根本病机为久病顽疾、胃阴伤损、络道枯涩、痰毒瘀滞、胃失濡养,终致胃膜萎缩,治疗必须以养胃阴为本,兼以通络化瘀解毒。自拟养胃和络饮滋养胃阴、化瘀通络,药味平简,但通补并施,合机中病,故临证多有效验。

大肠广基息肉是一种肠道病变,其在临床具有极高的发病率, 主要是源于人体结肠和直肠黏膜上皮层的赘生物,该疾病具有复发率高、发病隐匿等特点,给临床治疗增加了困难[1]. 近年来,随着我国人们饮食习惯的改变,进而导致我国大肠广基息肉患者不断增加,若治疗不及时,易影响其日常饮食和身心健康. 研究显示,多数大肠癌主要是由于大肠息肉中的腺瘤性息肉所致,因此,一旦发现大肠息肉,应及时将其切除,避免其发生病变. 目前临床上对于该疾病主要采用常规黏膜切除术治疗,但其具有复发率高、并发症多、安全性差等不足,导致其使用受到限制[2,3]. 本院对内镜下黏膜切除术治疗大肠广基息肉患者的临床疗效进行分析(2016年1月至2017年12月),并总结分析结果报告如下.

To explore the medication rules of herbal prescriptions for nonalcoholic fatty liver disease,and analyze the possible drug targets and interactions,in order to explore the mechanisms of the herbs. Randomized controlled trials of herbal prescriptions for treating nonalcoholic fatty liver disease were collected from CNKI,Wan Fang,VIP,Sino Med and PubMed databases. The properties,flavors and meridian tropism of herbs were analyzed by using systematic cluster analysis method with SPSS 19. 0 software. Subsequently,the association rules of herbs were analyzed by using Clementine 12. 0 software. Finally,the interactions between targets and relevant signaling pathways were analyzed by Traditional Chinese Medicine Systems Pharmacology Database(TCMSP),Search Tool for the Retrieval of Interacting Genes/Proteins(STRING) and Kyoto Encyclopedia of Genes and Genomes(KEGG). In the 88 prescriptions screened out,the commonly used herbs were Salvia miltiorrhiza,Bupleurum chinense,Alisma orientale,and Crataegus pinnatifida,and the potential signaling pathways were PPAR signaling pathway and calcium signaling pathway. The results showed that the main effects of herbal prescriptions were to improve blood flow/clear blood stasis,clear heatiness/dampness,promote digestion and strengthen spleen. And its mechanism of action may be achieved through the regulation of PPAR signaling pathway and calcium signaling pathway.

目的：观察在消化科住院医师规范化培训中应用PBL教学法的效果。方法2014年在该院消化科轮转的65名住院医师设为LBL教学组，2015年轮转的68名住院医师设为PBL教学组，通过满意度调查和出科考试平均成绩对比两组教学效果。结果 PBL教学组师生互评的满意度高于LBL教学组，但差异无统计学意义；PBL教学组出科考试的平均成绩明显高于LBL教学组，差异有统计学意义。结论在该院消化科住院医师规范化培训中使用PBL教学法，可有效地提高学员临床基础理论和实践操作技能水平。

[Objective]To observe the effect of Radix Curcumae and Notoginseng combined with folic acid on gastric precancerous lesion by clinical case study.[Methods]Ninety-six patients with premalignant gastric lesions(atrophy,intestinal metaplasia and low grade atypical hyperplasia)confirmed by gastroscopy and pathology were randomly divided into three groups.Radix Curcumae Group:received Radix Curcumae Granule and folic acid for treatment;Notoginseng Group:received Notoginseng Powder and folic acid for treatment;Folic Acid Group:received folic acid for treatment.All the patients received continuous treatment for 6 months.The symptom changes,drug combination during the treatment were noted.After treatment,all the patients underwent grastroscopy and pathology examination.The score changes of symptom and pathology were compared before and after treatment.[Results]Eighty-four patients finished 6 months treatment.The symptom scores of all three groups after treatment were significant decreased(P＜0.05).The symptom scores of Radix Curcumae group and Notoginseng group were lower than Folic Acid Group,while there was no statistical significance(P＞0.05).After treatment,the score of atypical hyperplasia,atrophy and intestinal metaplasia of all three groups were significantly decreased(P＜0.05).The score of atrophy,intestinal pathological in Radix Curcumae group and Notoginseng group were decreased greater than folic acid group,while the difference was not statistically significant(P＞0.05).No significant change of the inflammation score and activeness score in all of the three groups before and after treatment(P＞0.05).[Conclusion]Radix Curcumae and Notoginseng combined with folic acid are effective for patients with premalignant gastric lesions and can significantly reverse gland atrophy,intestinal metaplasia and low grade atypical hyperplasia in certain degree.

本文通过在中医住院医师规范化培训中引入PDCA循环,研究其在中医学教学培训管理中的流程、方法与作用,探索高效合理教学管理途径,以提高中医住院医师规范化培训的质量,对中医学的长远发展具有重要意义.

目的 探讨芷辛方镇痛作用的可能机制.方法 将70只SD大鼠随机分为空白组、模型组、西药对照组(盐酸曲马多,0.01 g/kg)、芷辛方高剂量组(芷辛方水煎浓缩制剂,9g/kg)、芷辛方正常剂量组(芷辛方水煎浓缩制剂,4.5 g/kg)、芷辛方低剂量组(芷辛方水煎浓缩制剂,2.25 g/kg)、中药对照组(五灵止痛胶囊,0.06 g/kg),每组10只.除空白组外,其余各组大鼠采用左侧后肢胫骨注射腹水瘤Walker 256细胞悬液的方法建立骨癌痛大鼠模型,在造模后14天开始灌胃给予相应药物,每日1次,连续7天.取大鼠脊髓L4-L5部位检测脊髓组织神经胶质纤维酸性蛋白(GFAP)、分化群11b (CD11b) mRNA、核因子κB (NF-κB)的表达.结果 模型组GFAP染色阳性细胞明显多于空白组、芷辛方正常剂量组和芷辛方高剂量组.模型组CD11b mRNA表达较西药对照组、芷辛方正常剂量、芷辛方高剂量组明显升高(P＜0.01),各药物治疗组比较差异无统计学意义(P＞0.05).模型组NF-κB表达高于空白组,芷辛方高剂量组NF-κB表达明显低于模型组(P＜0.01). 结论 芷辛方对骨癌痛大鼠镇痛作用的机制可能与抑制脊髓胶质细胞增殖活化和下调NF-κB蛋白有关.

目的:探讨中医配方理气暖胃止痛贴治疗儿童功能性腹痛临床研究及护理体会.方法:选择2013年1月—2014年1月本院门诊收治的功能性腹痛患儿60例,将其随机分为治疗组和对照组,每组30例,治疗组给予理气暖胃止痛贴配合相关护理措施,对照组给予培菲康以及山莨胆碱,治疗5d为1个疗效,两组患儿连续治疗3个疗程,比较两组患儿临床疗效、腹痛程度积分、腹痛发作积分以及远期疗效、药物不良反应.结果:治疗组治疗总有效率为93.33％,对照组治疗总有效率为73.33％,两组比较,差异具有统计学意义(P＜0.05);治疗前两组患儿腹痛程度以及腹痛发作评分无差异(P＞0.05),治疗后治疗组腹痛程度以及腹痛发作评分改善情况均显著优于对照组(P＜0.05);治疗结束后,两组患者均随访3个月,治疗组腹痛症状复发4例(13.33％),对照组腹痛症状复发16例(53.33％),两组比较,差异具有统计学意义(P＜0.05);治疗组患儿在治疗期间无明显药物不良反应,对照组患儿不良反应发生率为10.00％,两组比较,差异不具有统计学意义(P＞0.05).结论:中医配方理气暖胃止痛贴配合相关护理措施治疗儿童功能性腹痛其疗效显著,在改善患儿临床症状以及减少复发率方面较西药更具有优势,且用药安全无毒副反应,值得在临床工作中推广运用.

Aim: To discuss the clinical value of endoscopic submucosal dissection (ESD) for treating upper gastrointestinal lesions. Methods: A total of 52 patients who underwent ESD between May 2012 and May 2013 were retrospectively analyzed to assess the feasibility, safety and efficacy of ESD for treating upper gastrointestinal lesions. Results: Among 52 patients, 4 had esophageal lesions, 48 had gastric lesions. Postoperative pathology revealed that 40 were mucosal lesions, including esophageal papilloma (n = 2), cardiac hyperplastic polyps (n = 9), cardiac adenoma (n = 3), early gastric cancer (n = 2), high grade intraepithelial neoplasia (n = 3), low grade intraepithelial neoplasia (n = 5), gastric antral adenomatous polyps (n = 9), hyperplastic polyps (n = 5), and intestinal metaplasia (n = 2); and 12 were submucosal lesions, including esophageal leiomyoma (n = 1), esophageal gastrointestinal stromal tumor (n = 1), gastric heterotopic pancreas (n = 7), gastric body gastrointestinal stromal tumor (n = 2), and lipoma (n = 1). All the lesions were completely resected and were confirmed by pathologic examination. No severe bleeding occurred. Perforation occurred in two cases but was safely managed by conservative treatment. Conclusion: ESD is a safe, effective and recommendable treatment for upper gastrointestinal lesions. It can not only resect the lesions completely, but also provide accurate pathologic information. ? 2014 Baishideng Publishing Group Co., Limited. Allrights reserved.

目的研究参苓白术散与得舒特、培菲康联合应用治疗腹泻型肠易激综合征(IBS)的疗效。方法将105例患者随机分为实验组、中药对照组、西药对照组各35例。西药对照组用得舒特、培菲康,中药对照组用参苓白术散,实验组则联用参苓白术散和以上2种西药。结果实验组12周总的症状改善88.6%,中药对照组68.6%,西药对照组80.0%。实验组症状改善情况显著优于其他2组(P<0.05)。实验组分别与西药组、中药组停药4周后总症状严重程度比较P=0.036,差异均有统计学意义(P<0.05)。结论参苓白术散联合得舒特、培菲康治疗可明显改善腹泻型IBS患者症状,减少得舒特、培菲康停药后反跳,以达到远期巩固疗效的目的。