Background:Sepsis is a life-threatening disease with high mortality and a poor prognosis,partly due to a lack of effective treatments.Therefore,more effective treatments are urgently needed.Methods:Eight databases were searched for use of traditional Chinese medicine（TCM） for sepsis.A meta-analysis was performed using Stata 15.0 software.The 28-day mortality,length of hospital stay,and Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE-Ⅱ） score were the outcomes of this study.The Cochrane Collaboration tool for assessing risk of bias was used for quality assessment.Results:Ten studies with a total of 847 patients were included in this meta-analysis.Compared with the control group,the experimental group had lower 28-day mortality（relative risk [RR] 0.67;95% confidence interval [CI] 0.53 to 0.84;P=0.001）,shorter hospital stay（weighted mean difference [WMD]-2.17;95% CI:-3.2 to -1.14;P=0.000） and lower APACHE-Ⅱ score（WMD-2.164;95% CI:-3.236 to -1.091;P=0.000）.Conclusion:Our results demonstrate that TCM together with standard Western medicine was associated with significantly lower 28-day mortality,APACHE Ⅱ scores,and shorter hospital intensive care unit stays,suggesting that TCM might be an effective alternative treatment for sepsis.

新型冠状病毒奥密克戎( Omicron )变异株自2021年11月首次发现并传播以来,增速迅猛,已席卷全球,全球已有100 多个国家和地区发现奥密克戎变异株感染病例.新型冠状病毒肺炎(简称新冠肺炎)疫情发生以来,中医药在防治方面发挥了重要作用.为了有效指导临床防治,世界中医药学会联合会急症专业委员会、中国上海中医药大学急危重症研究所、美国中医药针灸学会组织国内外中医药防控新冠肺炎领域临床一线专家及相关学术机构与组织,在参照中华人民共和国国家卫生健康委员会、国家中医药管理局《新型冠状病毒肺炎诊疗方案(试行第九版)》基础上,结合新型冠状病毒奥密克戎变异株感染防治临床经验,就新型冠状病毒奥密克戎变异株感染中医药防治相关问题展开调研与讨论,并最终形成本共识.6

体外血浆脂蛋白过滤(delipid extracorporeal lipoprotein filter from plasma,DELP)是一种应用体外血浆脂类吸附过滤器(JX-DELP-I-200)将患者的自体血浆进行体外过滤的新型体外血浆净化技术.该项技术由上海江夏血液技术有限公司自主研发,先后在全国多家医院广泛应用于治疗脑梗死,疗效明显.笔者现结合自身多年临床实践,对DELP应用于脑梗死的临床救治进行综述,旨在为开展非药物治疗脑梗死提供参考和借鉴.

新冠肺炎属于中医学"疫病"范畴,根据中医疫病理论,在传承《温疫论》等中医药治疗传染病理论基础上,并借鉴国医大师朱良春教授和国医大师晁恩祥教授治疗传染病的学术经验,针对新冠肺炎中医证候特点,在2020年新冠肺炎爆发之初即提出"表里双解"之截断扭转法治疗新冠肺炎的学术观念,倡导以化湿透表泻毒和清热利湿泻毒之"表里双解",以截断扭转新冠病毒感染患者病势,通过武汉、上海疫情爆发期间新冠肺炎定点医院治疗轻症、普通型新冠肺炎结果显示,该疗法在缩短患者核酸转阴时间、阻断新冠肺炎向重症、危重症转化效果显著,为当今中医药治疗新冠肺炎和未来防治新发突发传染病提供了新的思路.

Abstract The Omicron variant of severe acute respiratory syndrome coronavirus 2 remains a global problem. Current data indicate that the Omicron variant causes mild clinical symptoms and few severe cases and deaths. Traditional Chinese medicine (TCM) has demonstrated definite efficacy and distinct advantages in the prevention and treatment of coronavirus disease 2019 (COVID-19). Thus, by focusing on the pathogenic characteristics of the Omicron variant, the Emergency Professional Committee of the World Federation of Chinese Medicine Societies, Emergency and Critical Care Institute of the Shanghai University of Traditional Chinese Medicine, and American Traditional Chinese Medicine Society have brought together clinical experts on the TCM prevention and control of COVID-19 to formulate an expert consensus on the prevention and treatment of Omicron variant infections based on the Diagnosis and Treatment Protocol for COVID-19 (Trial Version 9). This review provides a comprehensive Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main symptoms of interpretation of this expert consensus, covering topics such as discussing the pathogenic characteristics of the Omicron variant from the TCM perspective of “epidemic disease of pathogenic wind,” prevention plans for vulnerable populations, and stratified treatment plans for infected populations. We hope that this review can serve as a reference for the clinical prevention and treatment of the Omicron variant.

新冠肺炎自2020年爆发以来,中医药取得举世瞩目的救治效果,在全球疫情防控中发挥着重要作用,获得了 WHO的高度肯定.2021年11月新冠肺炎奥密克戎(Omicron)变异株首次出现并迅速传播,我国吉林、上海先后出现爆发并蔓延全国.为了更加有效应对奥密克戎变异株感染,世界中医药学会联合会急症专业委员会、中华医学会急诊分会中西医结合急救学组、中国医师协会急诊医师分会中西医结合急救医学学组、上海中医药学会急诊分会、上海中医药大学急危重研究所等学术机构组织奥密克戎新冠肺炎变异株一线救治专家,根据上海、吉林等奥密克戎感染地区患者中医临床症候,并结合国家《新型冠状病毒诊疗方案(试行第九版)》,就中成药应用相关问题展开调研与讨论,形成本共识,以期对当下新冠肺炎奥密克戎变异株感染乃至以后疫情防控起到临床指导作用.

感染性疾病是指由各种病原微生物引起的一类疾病,严重威胁着人类生命健康,造成了巨大的医疗负担.其病机复杂,证候多样,多属于中医"温热病"范畴,"通腑泻下"法为治疗感染性疾病的关键.锦红汤是已故名医顾伯华基于中医"六腑以通为用"理论创制的中药复方制剂,具有清热解毒、行气通腑、活血消肿的功效,对胰腺炎、胆道感染、脓毒症等各类感染性疾病效果确切,并能明显改善临床症状,减少抗生素的使用,降低细菌耐药.本文综述锦红汤在感染性疾病中的理论基础、临床应用及效应机制研究,包括调节炎症与免疫、抑制肠道细菌/内毒素移位、改善凝血、抑制肠道细胞凋亡等方面,以期为更好地应用此方提供依据.

甲型流行性感冒(以下简称甲流)是感染甲型流感病毒后引起的急性呼吸道传染病,其起病急、传染性强,但目前西医治疗有局限性.中医关于甲流的论述众多,中医药治疗甲流疗效显著.近年来越来越多的人研究中医药防治甲流,中医药治疗甲流的机制主要有调节病毒蛋白的表达、调节免疫反应、减少炎性因子的表达、调节信号转导通路等.研究中医药治疗甲流的研究进展,更有利于针对性预防和治疗.

中医药防治传染病具有数千年的历史,构建了较为完整的理论体系,积累了丰富的临床经验.认为新型冠状病毒肺炎(简称新冠肺炎)属于中医学“疫病”之“湿温”范畴.在总结前人疫病治疗经验的基础上,结合新冠肺炎中医临床特征及临床实践,提出基于“急性虚证”的新冠肺炎病机理论,并倡导“全程补虚”的新冠肺炎中医药治疗策略,针对轻症(无肺炎)、普通型(有肺炎)、危重症、恢复期四个阶段,分别采用补气化秽、培元截断、扶元救逆及益气养阴、降气平喘、活血化瘀之法,可为临床防治新冠肺炎提供思路.

目的 探讨《中华人民共和国药典》中治疗感冒的中成药的组方用药规律.方法 从《中华人民共和国药典》(2020年版)中筛选出治疗感冒的中成药,借助中医传承辅助平台(V2.5)软件对药物的使用频次、药物功效类别、性味归经、用药规律、新方组合挖掘等进行统计分析.结果 共得到中成药处方130首,涉及中药250味,其中使用频率较高的药物有甘草、桔梗、黄芩、连翘、金银花等;主要以清热药、解表药、化痰药为主;药性多以寒、温、平为主,药味以苦、辛、甘为主,归经以肺经为主,然后依次为胃经、脾经等.常用药对有"甘草-桔梗""陈皮-甘草""黄芩-连翘""连翘-桔梗""金银花-连翘"等;通过复杂系统熵聚类分析提取出2种不同的核心组合各6组,并挖掘出潜在新方6首.结论 通过对《中华人民共和国药典》(2020年版)中治疗感冒的中成药进行数据挖掘,总结出治疗感冒的中成药多用于风热感冒,其核心药物为甘草、桔梗、黄芩、连翘,以清热、解表、化痰为主要治则,兼以理气、平肝息风、补虚等进行配伍,临床可用银翘散、杏苏散等经典名方加减辨证治疗感冒.

目前深入探究新型冠状病毒肺炎(新冠肺炎)的发病机制和寻找有效的治疗方案是医学界的重要课题.中医药治疗新冠肺炎具有潜在优势.本文在古代医家治疗疫病的学术经验基础上,提出“截断扭转-扶正固本”防治策略,以期为中医药治疗新冠肺炎提供新的思路.

青霉素的发现有效控制了革兰氏阳性菌引起的感染,随后抗菌药物的研发进入了黄金时代,并对人类健康产生了巨大贡献.然而,随着近年来世界各国抗生素使用率的不断增高,病原菌为确保生存优势,驱动基因突变获得耐药性,并促使耐药基因转移传播,造成耐药菌发生率急剧增加.此外,目前新型抗菌素的研发速度远不及耐药菌的增加及传播速度,使得耐药危机愈发严重,并成为全球社会面临的最大威胁之一.与同类非耐药细菌感染相比,耐药菌感染呈现复杂性、难治性等特点,使患者面临更差的临床转归以及更高的死亡风险,给临床工作带来了严峻挑战.如果细菌耐药趋势未得到控制,将陷入无药可用的危机,因此亟需寻找有效替代手段对抗细菌的耐药性,减少耐药菌感染带来的危害.中药治疗感染性疾病有独特的优势,与现代抗菌药物相比,具有来源广、活性成分丰富、不易产生耐药性等特点,可能是筛选研发新型抗感染药物的重要来源,因而开发利用中药解决耐药菌感染问题大有可为.该文将从中药通过干扰耐药菌生化代谢以直接抑制或杀灭耐药菌、改善细菌耐药性以间接抑菌杀菌、维护机体平衡以整体调节治疗耐药菌感染等方面对近年来相关研究作一综述,以期为指导临床用药及中药新药研发提供参考.

脓毒症是机体应对感染失控反应所致威胁生命的器官功能障碍,其病死率居高不下,全球大约每年大约有530万患者死亡,故深入探究脓毒症的发病机制和寻找有效的治疗药物是目前医学界的重要课题.中医药治疗脓毒症具有潜在优势,本团队在继承朱良春国医大师、国家非物质文化遗产“顾氏外科”奠基人顾伯华教授学术经验基础上,通过临床实践,首次提出“从肠论治”截断扭转防治脓毒症策略,为中医药治疗脓毒症提供了新的思路.

痛风是临床常见的疾病,方邦江教授认为针对痛风各期应采取不同治则,急性期应泄化瘀浊、解毒除湿,缓解期和慢性期应补脾益肾、宣痹止痛,同时运用虫类药物搜风逐邪,还要注重全身调理,强调规律的生活和饮食习惯.

Objective To investigate the effect of Kuanxiong Lifei decoction on inflammatory factors in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and turbid phlegm obstructing lung syndrome. Methods Two hundred patients with AECOPD and turbid phlegm obstructing lung syndrome diagnosed by traditional Chinese medicine (TCM) differentiation visiting four hospitals of Longhua Hospital Affiliated to Shanghai University of TCM, Shanghai Seventh People's Hospital, Punan Hospital of Shanghai Pudong New Area, Gongli Hospital of Shanghai Pudong New Area were selected from May 2017 to March 2018, and they were divided into a test group and a control group by a random number table, 100 cases per group. The patients in the two groups were treated with routine western medicine according to the guidelines, and in the test group, additionally Kuanxiong Lifei decoction (components: pinellia ternate 15 g, allium macrostemon 12 g, ephedra 9 g, trichosanthes 30 g, poria cocos 15 g, almond 12 g, lumbricus 12 g, citrus peels 12 g, peach kernel 12 g , roasted licorice 6 g) was used for 10 days, the decoction was uniformly made by Chinese Medicine Pharmacy of Longhua Hospital, 1 dose daily, 2 times a day orally taken, warm 200 mL each time, 0.5 hours before or after meal. The efficacy was evaluated after treatment for 10 days. The level changes of white blood cell count (WBC), neutrophils (N), C-reactive protein (CRP), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) before and after treatment and the improvement of TCM syndrome scores and clinical efficacy were observed in two groups. Results After treatment, the levels of WBC, N, CRP, IL-8, TNF-α, TCM syndrome score of the patients in the two group were significantly decreased compared with those before treatment in the two groups (P < 0.05), and the above indexes in the test group were all significantly lower than those in the control group after treatment [WBC (×109/L): 6.58±1.41 vs.7.44±1.85, N: 0.58±0.08 vs. 0.64±0.08, CRP (mg/L): 7.3±1.8 vs. 9.6±1.7, IL-8 (ng/L): 23.5±6.2 vs. 27.8±9.8, TNF-α (ng/L): 9.45±2.18 vs. 10.25±1.67, TCM syndrome total score: 4.0 (3.0, 8.0) vs. 8.0 (5.0, 10.0), all P < 0.05]. The total effective rate of the test group was significantly higher than that of the control group [88% (88/100) vs. 84% (84/100), P < 0.05]. Conclusion Kuanxiong Lifei decoction can significantly reduce lung inflammatory factors, ameliorate overall symptoms and improve the prognosis of AECOPD patients with turbid phlegm obstructing lung syndrome.

糖尿病合并脑梗死是糖尿病最常见、最严重的血管并发症,致残、致死率高,严重威胁着人类健康,因发病机制尚不明确,越来越多国内外学者把目光关注到糖尿病脑梗死的基础和临床研究上.中医药治疗临床疗效显著,多靶点起效,副作用小,药物依赖性低,患者认可度高,社会需求量大,临床应用广泛.目前关于中药治疗糖尿病合并脑梗死的相关研究越来越多,但主要集中在疗效观察和单一作用机制等方面,缺乏对中药复方作用机制的深入研究和归纳总结.本文通过系统地查阅和整理国内外相关文献资料,对近5年来经临床观察与动物实验证实对糖尿病脑梗死确有疗效的中药复方的作用机制的研究进展进行分析,研究发现其作用机制主要涉及降压、降糖、降脂、促进血管再生、改善血管内皮功能、抗凝血、抗血栓、改善神经功能缺损、缩小梗死体积、改善血液流变性、抑制炎症反应、抑制血小板聚集、促进侧枝循环建立等方面,深入总结起效的作用机制及靶点,以期为进一步的临床治疗提供参考.