"滋阴除湿法"源于《内经》,书中曰:"太阴司天,湿淫所胜,则沉阴且布,雨变枯槁.……阴气不用,饥不欲食,咳唾则有血,心如悬,病本于肾"[1],阐述了脾肾与湿盛、阴虚之间的病机转归关系,为该治法的确立奠定了基础.

Objective:To observe the effects of Qufeng Xuanfei recipe on cough frequency, airway responsiveness, and related indexes of transient receptor potential vanilloid 4 (TRPV4)/P2X3 signal pathway in guinea pigs with increased cough sensitivity, and to explore its therapeutic mechanism.Methods:This was an experimental study.Using the random number table method, 25 SPF male healthy guinea pigs were randomly divided into blank group, model group, traditional Chinese medicine group, TRPV4 inhibitor group, and P2X3 inhibitor group, with five animals in each group.Except for the blank group, a guinea pig model with increased cough sensitivity was established in other four groups.After successful modeling, the blank and model groups were given normal saline, the traditional Chinese medicine group was given Qufeng Xuanfei Recipe, and the TRPV4 inhibitor group and P2X3 inhibitor group were given GSK2193874 and AF-353, respectively, for 7 days of intervention.The TRPV4 agonist GSK1016790A was used to measure the number of coughs of guinea pigs in each group.Pulmonary function test was used to detect airway resistance in guinea pigs.The expression levels of serum IL-6, IL-8, IL-1β, and TRPV4, P2X3 and SP in bronchoalveolar lavage fluid (BALF) were detected by ELISA, and the protein expressions of TRPV4, P2X3, and SP in lung tissue were detected by Western Blot.Results:Compared with the blank group, the number of coughs ([4.00±0.82] times vs [14.75±2.22] times, P<0.01), airway resistance (acetylcholine chloride: concentration of 400 mg/L [2.32±1.07] cmH 2O·s/L vs [6.50±2.03] cmH 2O·s/L, 800 mg/L[2.88±0.86] cmH 2O·s/L vs [9.47±3.52] cmH 2O·s/L), serum inflammatory factors (IL-6, IL-8, IL-1β: [16.32±0.17] ng/L vs [24.49±0.19] ng/L, [33.48±1.36] ng/L vs [59.33±2.15] ng/L, [10.71±1.22] ng/L vs [38.79±2.22] ng/L respectively), and the expressions of TRPV4, P2X3, and SP in BALF ([46.14±0.35] μg/L vs [91.62±0.25] μg/L, [78.37±0.35] μg/L vs [156.62±0.25] μg/L, [38.20±1.75] μg/L vs [79.84±2.45] μg/L respectively) and lung tissue ([0.34±0.01] vs [1.09±0.12], [0.28±0.09] vs [0.77±0.18], [0.26±0.04] vs [0.87±0.09] respectively) were all increased ( P<0.01) in the model group.Compared with the model group, the number of coughs ([2.00±0.82] times), airway resistance (acetylcholine chloride: concentration of 400 mg/L [4.01±0.43] cmH 2O·s/L, 800 mg/L [3.77±0.73] cmH 2O·s/L), serum inflammatory factors (IL-6, IL-8, IL-1β: [18.94±0.43] ng/L, [36.42±1.60] ng/L, [25.20±3.22] ng/L respectively), and the expressions of TRPV4, P2X3, and SP in BALF ([82.24±0.33] μg/L, [141.09±0.88] μg/L, [59.74±2.75] μg/L respectively) and lung tissue ([0.45±0.02], [0.38±0.09], [0.47±0.05] respectively) were reduced ( P<0.05 or P<0.01) in traditional Chinese medicine group. Conclusions:Qufeng Xuanfei Recipe can reduce cough sensitivity and airway responsiveness of model guinea pigs, which may be related to inhibiting TRPV4/P2X3 signaling pathway and reducing neurogenic airway inflammation.

摘要：尖锐湿疣是目前女性生殖道感染常见病、多发病。对于妊娠期妇女感染尖锐湿疣的治疗，因考虑孕妇自身及对胎儿的影响，对于治疗方法的选择应当慎重。通过阅读文献及临床治疗观察，治疗本病以外治法为主，尤以中西医结合治疗效果更佳。目前关于本病治疗方法的文献综述较少，故现对中西医结合的外治法治疗本病的现状作一综述，为临床治疗本病提供新方向。

目的:探讨中医药治疗慢性咳嗽的用药规律.方法:选取2009年2月至2017年12月北京中医药大学东方医院呼吸热病科咳嗽专病门诊收治的慢性咳嗽患者641例作为研究对象,通过因子分析及二元Logistic回归总结常用药物组合与证型的关联性,从而获得慢性咳嗽的治法及用药规律.结果:慢性咳嗽治疗主以祛风宣肺为主,常用药物有炙麻黄、黄芩、前胡、厚朴、炙紫菀、炙款冬花、细辛、青风藤等;兼湿热郁肺者,佐以清热化湿,常用药有薏苡仁、佩兰、白豆蔻、广藿香等;兼有肺阳亏虚者,佐以温阳健脾,兼寒饮伏肺者,佐以温阳化饮,此2证常用药有白术、茯苓、桂枝、炙甘草、细辛等;兼有痰湿阻肺者,佐治以理气燥湿、化痰止咳,常用药有紫苏子、紫苏梗、炒白芥子、炒莱菔子等;兼肺阴亏虚者,佐治以养阴清热、润肺止咳,常用药有麦冬、芦根、白茅根等.结论:慢性咳嗽以祛风宣肺为基本治法;遣方用药须兼顾宣降共施,寒温并用,肺脾同治.

目的 探索感染后咳嗽的中医证型证素分布规律.方法 采用流行病学回顾性研究方法,收集241例感染后咳嗽患者的中医证素,进行描述性统计.运用因子分析和"Q型"聚类分析结合方法进行非线性降维研究,提取主要病性及病位证素并加以总结分析.结果 利用因子分析共提取公因子8个,累计贡献率为62.454％.主要病性证素是风(63.48％)、湿热(48.55％)、寒饮(41.49％)、阳虚(21.99％);主要病位证素是肺(100％)、脾(73.86％)、咽(43.98％)、胃(26.14％),主要证型为风邪伏肺证(66.8％),湿热蕴肺证(61.8％),寒饮伏肺证(12.4％),痰湿蕴肺证(9.1％).通过聚类分析得:湿热病邪可单独聚为一类,湿热可与风邪相兼聚类,风邪与湿热及阳虚相兼为患者可聚为一类.结论 感染后咳嗽的主要病性证素为风、湿热、寒饮;主要病位证素为肺、脾、咽、胃;主要证型为风邪伏肺证、湿热蕴肺证及寒饮伏肺证.不同聚类方法所得结果与临床感染后咳嗽的复杂病机相合.

在新型冠状病毒肺炎治疗救护工作中,中医药以其延缓轻症患者病情发展、提升疑似患者免疫机能等方面的诸多优势和效果得以参与其中.本文结合武汉一线的临床实践,探讨武汉一线新型冠状病毒肺炎验案一例,提出了治疗过程中的重要治则,以期对临床有所裨益.

寒饮伏肺证是慢性咳嗽常见证候之一,该证型咳嗽可命名为寒饮咳嗽.寒饮咳嗽的病因病机主要在于外感或内伤等因素,导致肺脾阳虚,寒饮内伏,而为伏邪,复因形寒饮冷,内外合邪,致肺失宣降,肺气上逆而致咳嗽,且反复发作,迁延不愈.该病机具有内外合邪、兼夹风邪、脏腑相关、虚实夹杂的特点.临床表现主要以咳嗽,咽痒,遇冷易咳,痰涎清稀色白或呈泡沫,形寒背冷,舌淡胖,苔白滑,脉沉紧或弦滑为主症,可兼见胸闷、反酸烧心、胃寒、呕吐或干呕、口淡不渴、便溏等表现.病位主要在肺,兼及脾胃.病性属本虚标实,肺脾阳虚为本,寒饮之邪为标.临床治以疏风宣肺、温阳化饮为法,可取较好疗效.

咳嗽临床常见,特别是胸部影像检查无明显异常的慢性咳嗽,在我国专科门诊中,慢性咳嗽患者约占三分之一以上[1],全球患病率约为9.6％[2].其病因繁多,诊疗程序较复杂,临床疗效欠佳,反复发作的咳嗽给患者的工作、生活甚至心理上带来严重困扰,引起了国内外的广泛关注.近年来,针对慢性咳嗽相关机制的研究逐渐增多,其中,瞬时受体电位(transient receptor potential,TRP)家族的离子通道通过气道感觉神经导致咳嗽反射的机制探讨成为目前研究热点之一.TRPA1、TRPV1是TRP家族中研究较为透彻的成员,有研究表明,二者不仅在多种细胞中共表达[3],且可以共同致敏[4],存在通道联动关系.现就TRPA1/V1通道联动导致慢性咳嗽的作用机制进行探讨,以期为慢性咳嗽的深入研究及新药研发提供新的思路.