湿疹是临床常见的皮肤科疾病.环境毒邪是一种新兴中医病因学说.随着人们环保意识的提高,该病因在皮肤病发病中地位也逐渐上升.其致病,或暴戾强烈,或积久邪伏,与湿疹的发病特点相似程度高.本文基于"天人相应"理论,从环境毒邪与现代环境污染的相关性出发,通过分析环境毒邪的病因学特点及致病特点,探讨环境毒邪与湿疹发病之间的关系,提出湿疹的防治原则,以期为临床防治提供一定的理论依据.

目的:通过CiteSpace和VOSviewer对研究《金匮要略》的相关文献进行可视化分析,了解《金匮要略》的研究现状、研究热点、发展方向.方法:检索中国知网(CNKI)、万方数据库(Wanfang Data)、维普数据库(VIP)中2000年1月1日至2022年9月30日关键词为"金匮要略"的文献,并使用CiteSpace 6.1.R2与VOSviewer 1.6.18软件对文献的作者、机构、关键词等进行可视化分析.结果:初步检索共获得文献16 751篇,根据纳入标准、排除标准最终纳入文献8 067篇,年发文量整体呈上升趋势,年均发文量达351篇;刊载文献量排名前10的期刊累计发文1670篇,占文献总数约21.87%,并有6本期刊为CA、JST或中文核心期刊;作者分布较为分散,共有336位核心作者,共发表3061篇文献,核心作者尚未发挥良好的引领作用,部分作者间存在较为密切的合作关系;发文机构主要为中医药院校及其附属医院,部分机构间存在合作关系;热点关键词为经方、辨证论治、临床应用、病因病机等,共形成21个主要聚类,经方的临床应用与机制研究、经文的理论探讨、教学改革与英译研究等是该领域的主要研究方向.结论:目前该领域多从理论探讨、临床应用、机制研究、教学改革和英译研究等方面开展《金匮要略》的研究;未来循证医学评价、数据挖掘、名老中医经验传承与古籍整理或将持续受到关注.

荨麻疹是临床常见的皮肤变态反应性疾病,环境毒邪是中医基于环境污染提出的病因学概念.近年研究显示,荨麻疹不仅在发病率方面与环境污染之间有显著相关性,而且在发病机制方面与环境毒邪的病因病机、致病特点也有一定程度的相似性.故本文以环境毒邪理论为出发点,发现其致荨麻疹的病机特点有四:或郁闭皮毛,循经传肺使肺失宣降;或由口入胃,邪侵中焦使运化无权;或邪扰心神,情志暴躁使心肝热盛;又或毒邪伏蛰于里,伺机而动.根据其病因病机特点又提出以攻为用、祛其毒邪与攻补并用、扶正祛邪的治则治法,以期为环境毒邪所致荨麻疹的临床防治提供一定的理论依据.

血证作为临床常见病,其发病具有明显的季节性.四时主气不同,致病邪气有异,必然会产生不同的血证病变机制.探讨不同时令下的血证发病规律,对于丰富中医理论和指导临床实践具有重要意义.由于不同季节的时邪导致血证发病的机制不同,所以从时令角度辨证论治血证,对于预防和治疗血证具有积极意义.

BACKGROUND:Longdan Xiegan decoction (LDXGD) has been widely used in the treatment of eczema. In recent years, randomized controlled trials (RCTs) of LDXGD for the treatment of eczema have gradually increased. Most of the results show that LDXGD is effective in treating eczema. However, whether these conclusions are reliable or not requires meta-analysis.OBJECTIVE:This study aimed to systematically evaluate the clinical efficacy of LDXGD in the treatment of eczema.MATERIALS AND METHODS:Seven electronic databases, including PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, Chinese Biomedical Literature on Disc (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and Chinese Science and Technology Periodical Database (VIP) were systematically searched from their inception until January 2021. Risk of bias was assessed using criteria from the Cochrane Collaboration and meta-analysis was conducted on the screened literature data using Review Manage (RevMan 5.3). Then, to assess the quality of evidence, the GRADE criteria was adopted.RESULTS:14 RCTs with 1080 participants were identified. Meta-analysis indicated that compared with western medicine (WM), the cure rate and the total effective rate of LDXGD in treating eczema were higher. Meanwhile, the recurrence rate and the levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor (TNF-α) after treatment were lower. The adverse reaction was reported in 5 out of 14 studies without significant statistical difference. According to GRADE criteria, the quality of evidence was low for all outcomes except for the cure rate (moderate-quality evidence) and the total effective rate (moderate-quality evidence).CONCLUSION:The clinical efficacy of LDXGD in the treatment of eczema was more effective compared with the one of conventional WM alone. However, due to the limitation of the quality of the included studies, additional studies are required to further confirm these results.