目的 观察芪术颗粒对四氯化碳(carbon tetrachloride,CCl4)诱导大鼠肝纤维化模型自噬的影响.方法 将40 只Wistar大鼠随机分为正常对照组、模型对照组、复方鳖甲软肝片组、芪术颗粒组,除正常对照组外其余各组均腹腔注射CCl4 建立肝纤维化模型,按照组别对应处理.4 周后取肝组织,Western blot法检测α-平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)及自噬相关基因3(autophagy-related gene 3,Atg3)、自噬相关基因Beclin1 介导的蛋白表达,Real-time PCR检测Atg3、Beclin1 基因表达,电镜下观察自噬情况.结果 与正常对照组比较,模型对照组大鼠肝α-SMA蛋白显著增多(P<0.01);与模型对照组比较,复方鳖甲软肝片组、芪术颗粒组肝α-SMA蛋白显著减少(P<0.05);与正常对照组比较,模型对照组大鼠肝Atg3 蛋白表达显著增加(P<0.01),Atg3 基因表达增加,Beclin1 蛋白及基因表达增加,自噬溶酶体和自噬体数量增多;与模型对照组比较,芪术颗粒组、复方鳖甲软肝片组Atg3 蛋白及基因表达降低(P<0.05),芪术颗粒组Beclin1 蛋白及基因表达降低(P<0.05),芪术颗粒组、复方鳖甲软肝片组组织中自噬溶酶体、自噬体数量减少.结论 芪术颗粒可通过抑制肝脏细胞Atg3、Beclin1 表达而影响自噬从而发挥其抗肝纤维化作用.

目的 观察姚乃礼经验方治疗慢性非萎缩性胃炎的临床疗效.方法 采用前瞻性病例系列研究设计,连续入组并观察自2018年12月1日-2021年10月31日在中国中医科学院广安门医院姚乃礼门诊就诊的慢性非萎缩性胃炎患者的就诊情况,收集并统计门诊患者的一般情况及疗效评价资料(主要症状积分、主要症状治疗情况、炎症指标、胃肠激素指标、胃肠道症状分级评分表、汉密尔顿焦虑量表、自评医疗成效MYMOP量表、不良事件统计).结果 共206例患者完成研究,其中男性99例,女性107例,年龄23～83岁,中位数41.5岁,病程范围为3～372个月,中位数为13个月;治疗后胃胀、胃痛、嗳气、反酸、腹胀、烧心、嘈杂等主要症状的症状积分较治疗前均有不同程度的减低,差异具有统计学意义(P＜0.01);与治疗前相比,患者白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死细胞因子-α(TNF-α)、胃泌素(GAS)水平及胃肠道症状分级评分表(GSRS)、汉密尔顿焦虑量表(HAMA)评分均显著下降,胃动素(MTL)、表皮生长因子(EGF)水平显著上升,差异具有统计学意义(P＜0.01).主要症状治疗总有效率均＞75％;患者的自评医疗成效问卷(MYMOP)治疗前后总得分比较,差异具有统计学意义(P＜0.01);本次临床研究期间患者均未出现不良反应.结论 姚乃礼使用经验方辨证治疗慢性非萎缩性胃炎,可显著改善胃痛、胃胀、嘈杂、嗳气等临床症状,使患者炎症指标、胃肠激素指标水平恢复正常状态,改善胃肠道症状及焦虑心理状态,且未见肝、肾功能等指标的异常及不良反应.

目的 通过"扎根理论"对文献资料进行分析,建立姚乃礼教授治疗胃食管反流病(GERD)学术思想的理论框架.方法 整理姚教授治疗GERD的临床医案,在数据库中检索相关文献,运用扎根理论的三级登录方法对这两部分原始资料进行编码分析.结果 初步建立了以"姚乃礼教授在GERD临床治疗过程中的思维认知"为核心,包含"姚教授对GERD疾病认识的思维要素""姚教授对GERD临床治疗模式的构成要素"和"姚教授临证思维中的特色要素"三方面的理论框架.结论 运用扎根理论成功建立姚乃礼教授治疗GERD学术思想的理论框架.

"寒"的中医学内涵丰富,"寒"与痞满的病因病机、症状证候密切相关.寒邪犯胃、脾胃阳虚、脾肾阳虚、肝经虚寒、寒热错杂是五种与寒邪相关的痞满常见证型,其治疗应抓住"寒"这一关键因素,分别采用温胃散寒、温中健脾、温补脾肾、暖肝散寒、温清并用结合消痞散结之法治疗,常可获良效.附验案1则以佐证.

[目的]比较分析新型冠状病毒肺炎(简称新冠肺炎)中医药预防方案不同用药途径的组方用药规律.[方法]检索2020年8月1日(含)前中文数据库(中国知网、万方数据库、维普数据库),国家及各省、自治区和直辖市卫生健康委员会,中医药管理局官方发布的新冠肺炎相关诊疗方案及国医大师、院士、知名中医专家等通过公开渠道发表的预防方案作为数据源,筛选文献、提取资料并建立数据库,运用频数统计、关联规则等方法,对核心药物及其归经、性味、组方规律、核心组合等进行分析.[结果]共纳入133个内服方剂,含中药141味,使用频次最高的药物是甘草,其次为黄芪、金银花、白术、藿香、防风、连翘、桔梗、苍术等;出现频次30次以上的药对分别为黄芪-防风、白术-防风、黄芪-白术、金银花-甘草、黄芪-甘草、黄芪-白术-防风、甘草-防风、白术-甘草、金银花-黄芪.纳入36个外用方剂,含中药51味,使用频次最高的是苍术,其次为艾叶、藿香、白芷、石菖蒲、佩兰等;出现频次最高的药对为艾叶-苍术,其次为艾叶-藿香、藿香-苍术等.从药性归经来看,内服和外用方剂均以温性药物使用最多,主要归肺、脾、胃经.[结论]新冠肺炎中医药预防方案以健脾益气、解毒化湿为主,内服与外用相结合.

自噬是指真核细胞内细胞器、蛋白质等在溶酶体中被降解及其降解产物被重新利用的过程,其对细胞的增殖、分化及稳态起着重要作用.近年来,自噬在肝纤维化中的作用受到越来越多的关注,干预自噬也许成为治疗肝纤维化的新方法.总结了自噬的过程、功能及在肝纤维化中作用,这些研究揭示了自噬对肝纤维化作用机制的复杂性,也启示未来需要找到干预自噬更加可靠、确定的机制和靶点,进而为治疗肝纤维化提供新途径.

目的 通过搜集文献分析中西医联合治疗结核病所致药物性肝损伤的发生情况,为临床合理用药提供参考.方法 通过计算机检索2000年1月至2019年7月国内外数据库(中国知网、万方数据知识服务平台、维普网、PubMed)公开发表的中西医联合治疗结核病的相关文献,纳入原发病为结核病,试验组为中西医联合抗结核药物治疗方案,对照组为西医抗结核药物治疗方案,文献中有肝损伤病例报告,肝损伤患者原发疾病、用药方法与剂量等资料的文献.通过阅读摘要和全文剔除不符合要求(非临床试验研究、文献回顾性研究、综述等)的文献、文献信息提供不完整或出现错误,以及质量较低或数据可信度差的文献,最终纳入22篇文献.采用SPSS 23.0软件对数据进行统计学分析,计数资料的比较采用x2检验,以P＜0.05为差异有统计学意义.结果 纳入的22篇文献中,结核病患者2561例.试验组的肝损伤发生率[12.05％(156/1295)]明显低于对照组[24.33％(308/1266)(x2=65.096,P＜0.001).其中试验组的初治方案、复治方案、耐药结核病方案患者肝损伤的发生率[分别为10.65％(23/216)、4.35％(3/69)、10.86％(19/175)]明显低于对照组[分别为25.12％(54/215)、13.04％(9/69)、26.75％(42/157)](x2=15.371,P＜0.001;x2=3.286,P=0.070;x2=13.940,P＜0.001).结论 与单纯西医抗结核药物治疗方案相比,中西医联合治疗方案能在-定程度上减少抗结核药物治疗所致药物性肝损伤的发生.

胃食管反流病(GERD)在我国很常见,其引起的一系列症状及并发症严重影响人们的生活质量,临床上合理的诊疗显得尤为重要.中华中医药学会脾胃病分会分别于2009年、2017年组织制定了《胃食管反流病中医诊疗共识意见》,对认识及诊治GERD具有重要意义.将2009年及2017年的共识意见内容进行对比分析,以明确GERD的诊治.

Umbilicus application to treat ascites caused by cirrhosis is a simple and effective characteristic therapy. This article analyzed the regularity of application traditional Chinese medicine (TCM) herbs on umbilicus to treat ascites caused by cirrhosis through TCM inherited auxiliary system. This study chose academic literatures related to TCM dressing umbilicus to treat ascites caused by cirrhosis in CNKI database, VIP database, Wanfang database over the past 20 years as the data source, and established database to analyze the core drugs and their channel tropism, property and flavor, compatibility law, and core composition,by means of frequency statistics, and association rules (Apriori method, complicated system entropy clustering). Finally, 92 prescription to treat ascites caused by cirrhosiss were screened out. These prescription includes 109 traditional Chinese medicines. And the analysis showed that there are 14 drugs with usage frequency of 10 and more than 10, 19 common drug pairs, 12 core drug combination. The drugs with high usage frequency include Kansui Radix, Borneolum Syntheticum, Pharbitidis Semen, Rhei Radix et Rhizoma, Moschus, Euphorbiae Pekinensis Radix, Natrii Sulfas, Cinnamomi Cortex, Genkwa Flos, Phytolaccae Radix, Arecae Semen. And the channel which are mostly invoivet includ lung meridian, spleen meridian and kidney meridian; while the property and flavor of the herbs used have the properties of cold and acrid; the common drug pairs include Pharbitidis Semen-Kansui Radix, Borneolum Syntheticum-Kansui Radix, Kansui Radix-Euphorbiae Pekinensis Radix, Kansui Radix-Moschus, Rhei Radix et Rhizome-Kansui Radix, Kansui Radix-Genkwa Flos, Borneolum Syntheticum-Pharbitidis Semen, Borneolum Syntheticum-Pharbitidis Semen-Kansui Radix, Kansui Radix-Arecae Semen; herbs with the function of expelling water and purgation used as main conponents, and resuscitation, promoting the circulation of Qi, and increaseing Yang used as auxilizy conponents.

Rationale: Currently, the mainstream treatment for gastric bezoars is endoscopic lithotripsy. This report describes traditional Chinese medicine (TCM) purgative cured a 62-year-old woman with a huge gastric bezoar accompanied by isolated esophageal venous aneurysms and multiple bleeding gastric ulcers. Patient concerns: A 62-year-old woman with several symptoms, including epigastric pain, nausea, and vomiting, hiccups, heartburn, and dark, loose stools. The patient showed abdominal tenderness, positive Murphy sign, hyperactive bowel sounds, a pale tongue with scalloped edges, greasy moss, and pulse moisten. A complementary examination revealed the presence of occult blood in the vomit. Diagnosis: The patient was diagnosed with isolated esophageal venous aneurysms, gastric bezoars, and multiple bleeding gastric ulcers. Gastroscopy revealed a 0.6 cm blue uplift, a smooth surface, and a regular and clearly defined dentate line. A large bezoar was observed in the stomach cavity with a dark red blood in the surface. The gastric angle showed multiple lesions, with their largest diameter being 2.5 cm, blood was oozing from these ulcers. Interventions: The patient was prescribed a TCM purgative combined with omeprazole enteric-coated tablets. Three days after admission, the patient was diagnosed with isolated esophageal venous aneurysms, gastric bezoars, multiple bleeding gastric ulcers. A specific herbal formula was prescribed to eliminate the bezoar. In addition, conventional western medicine was used for the patient, such as pantoprazole sodium intravenous infusion to inhibit gastric acid and sodium bicarbonate solution orally to soften the gastric bezoar. Outcomes: After 5 days, the patient had complete relief from all remaining symptoms, including stomach pain and hiccups. Follow-up gastroscopy revealed that the venous aneurysm and gastric bezoar had disappeared, and the ulcer had reduced in size to approximately 0.6 to 0.8 cm. The patient was discharged after recovery and did not relapse for 3 years. Lessons: TCM combined with conventional western medicine to treat huge gastric bezoars and its complications is effective and safe, and worth to be recommended as an alternative to endoscopic lithotripsy.