气血和脏腑理论被广泛应用于多种临床疾病的治疗中.缺血性脑血管病各期病机演变与肝脾肾功能密切相关,从脏腑立论,本病根本病机是肝肾亏虚、脑窍失养,发病关键是肝失疏泄、气机逆乱,病理基础是脾虚失运、痰瘀内生.该病风、火、痰、瘀、虚各证候要素的变化又与气血的动态变化密不可分,故从气血立论,其病机又可概括为气血逆乱和气虚血瘀.本文基于气血和脏腑理论认为,缺血性脑血管病的治疗需结合气血与脏腑辨证,急性期急则治标,宜疏肝、清肝、平肝兼破血逐瘀;恢复期标本兼治,宜调肝健脾兼活血化瘀;后遗症期治病求本,宜补肝肾、健脾兼补气活血化瘀.

To estimate the diagnostic value of contrast-enhanced MR angiography (CE-MRA) in identifying residual brain arteriovenous malformations (AVMs) after treatment. We retrieved appropriate references from the electronic databases of PubMed, Web of Science, Embase, and Cochrane Library, and then evaluated the methodology quality of included references using the QUADAS-2 tool. We calculated the pooled sensitivity and specificity by applying a bivariate mixed-effects model and detected the publication bias using Deeks’ funnel plot. The values of I2 were used to test heterogeneity and meta-regression analyses were performed to search for the causes of heterogeneity. We included 7 eligible studies containing 223 participants. Compared with a gold standard, the overall sensitivity and specificity of CE-MRA in detecting residual brain AVMs were 0.77 (95

The efficacy and safety of edaravone for the treatment of amyotrophic lateral sclerosis (ALS) remain unclear. The aim of this meta-analysis was to provide evidence-based medical guidance and advice for the clinical application of edaravone in the treatment of ALS. PubMed, Embase, Chinese Biomedical Literature Database (CBM), Cochrane Library and Web of Science were searched through 09 March 2022 for randomized controlled trials (RCTs) on the safety and efficacy of edaravone versus placebo during follow-up of patients with ALS. A summary of the outcome measures with GRADE was performed. This study was registered on PROSPERO (ID: CRD 42022319997). Five RCTs with a total of 566 participants were included, and there was a significant difference (mean difference [MD] 1.33, 95

探析情志所致胃痛的发病机制,胃痛发病在胃,源于肝,主因情志失常,影响肝的疏泄功能.一是忧思恼怒致肝气郁结,气机阻滞,肝气疏泄不及,木郁克土,横逆犯胃;二是暴怒伤肝、肝郁化火,肝气疏泄太过横逆犯胃.肝气横逆犯胃致胃失和降,胃气上逆,即为"肝胃不和".基于"肝胃不和"理论,情志所致胃病分为肝气郁结和肝郁化火所致胃痛,治疗上应予疏肝和胃止痛和泄肝和胃止痛.

神经根型颈椎病是颈椎病中最常见的类型,属中医"脖项骨伤筋""筋痹"的范畴,已故中医骨伤科大师刘寿山认为其辨治应以气血为要,内外结合,其运用特色手法结合正骨紫金丹加减治疗,验效多年;经后辈观察,该法可有效改善神经根水肿相关的临床症状.文章总结了刘寿山辨治神经根型颈椎病的学术观点和经验,以供临床参考.

目的:系统评价氯吡格雷联合阿托伐他汀对脑梗死患者炎症反应、血液流变学和凝血功能等指标的影响,为更好地指导临床用药提供参考.方法:检索PubMed、the Cochrane Library、Embase、中国生物医学文献数据库、中国知网、维普数据库和万方数据库,收集从建库至2021年11月氯吡格雷联合阿托伐他汀治疗脑梗死的随机对照试验(对照组患者采用氯吡格雷或氯吡格雷+常规治疗,研究组患者在对照组基础上联合应用阿托伐他汀治疗),应用RevMan 5.4.1软件进行Meta分析及偏倚风险评估,应用GRADE系统进行证据质量评估分级.结果:共纳入24篇文献,研究组患者1107例,对照组患者1106例.Meta分析结果显示,研究组患者的超敏C反应蛋白(MD=-3.25,95％CI=-3.77～-2.73,P<0.00001)、肿瘤坏死因子 α(SMD=-1.31,95％CI=-1.51～-1.11,P<0.00001)、血浆黏度(MD=-0.42,95％CI=-0.60～-0.24,P<0.00001)、红细胞聚集指数(MD=-0.82,95％CI=-1.37～-0.26,P=0.004)、纤维蛋白原(MD=-0.99,95％CI=-1.85～-0.12,P=0.03)、D-二聚体(SMD=-2.38,95％CI=-3.52～-1.24,P<0.00001)和凝血酶原时间(MD=1.92,95％CI=1.22～2.62,P<0.00001)等指标水平均明显优于对照组,差异均有统计学意义;两组患者红细胞比容水平(SMD=-0.33,95％CI=-1.09～0.42,P=0.38)和活化部分凝血酶原时间(MD=1.22,95％CI=-1.81～4.26,P=0.43)的差异无统计学意义.GRADE系统评价显示,证据等级为低或极低质量,推荐强度为弱推荐.结论:当前证据表明氯吡格雷联合阿托伐他汀可以降低脑梗死患者的炎症反应,改善血液流变学水平和凝血功能.因纳入研究证据等级较低,上述结果具有一定的局限性,仍需更多高质量、高标准的研究进一步论证.

目的 对依达拉奉超适应症用药治疗病毒性脑炎的有效性及安全性进行循证医学评价.方法 检索中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普中文期刊全文数据库(VIP)、万方数据库、the Cochrane Library、PubMed和Embase数据库中有关依达拉奉治疗病毒性脑炎的随机对照试验(RCT);检索时间从建库至2021年11月3日.利用RevMan 5.4.1软件进行数据分析、Cochrane手册5.1.0风险偏倚评估工具进行偏倚风险评估、GRADE系统进行证据质量评估分级.结果 共纳入14项RCTs,包含1128例患者.Meta分析显示:试验组的有效率高于对照组[RR=1.20,95％CI(1.14,1.26),P＜0.000 01];并且较对照组能显著降低血清神经元特异性烯醇化酶(NSE)水平[SMD=-1.73,95％CI(-2.28,-1.18),P＜0.000 01]、血清S100B蛋白浓度[MD=-0.11,95％CI(-0.13,-0.10),P＜0.000 01]、脂质过氧化物(LPO)浓度[MD=-1.42,95％CI(-1.95,-0.89),P＜0.000 01]和美国国立卫生研究院卒中量表(NIHSS)评分[MD=-3.19,95％CI(-7.11,0.73),P=0.11],但血清过氧化氢酶(CAT)浓度[MD=0.98,95％CI(0.66,1.30),P＜0.000 01]则显著高于对照组;不良反应或并发症发生率与对照组比较差异无统计学意义[RD=-0.04,95％CI(-0.15,0.07),P=0.51].GRADE评估为低或极低质量证据,推荐强度为弱推荐.结论 当前证据表明依达拉奉超适应症治疗病毒性脑炎具有一定的有效性和安全性,但因纳入研究证据等级较低,样本量较少,故此结论仍需要更多高质量、高标准的研究证明.

现代人失眠大多与"五脏失和,浊毒郁闭"有关,临床可将失眠分为初期、进展期、终末期,根据五脏发病的主次及浊毒致病特点,分期辨证施治.初期肝郁及脾,治宜疏肝理气、健脾养血;进展期脾病及心,心肾不交,肺气郁闭,可分别治以健脾宁心、益气养血,交通心肾、滋阴除烦,补肺开郁、定魄宁神;终末期浊毒郁闭,治宜化浊排毒、通畅神明.重视五脏发病的主次以及"浊毒"在失眠中的潜在致病作用,为失眠患者提供新的治疗思路.附验案1则以佐证.

Objective: To systematically evaluate the effect of Xuesaitong injection combined with edaravone injection on hemorheology indexes in patients with acute cerebral infarction. Methods: Search CNKI, WanFang, VIP, SinoMed, PubMed, Cochrane Library and other databases, collect randomized controlled trials (RCTs) of Xuesaitong combined with edaravone in the treatment of acute cerebral infarction from the establishment of the database to November 2020, using RevMan 5.3 software Perform Meta analysis. Results: 10 RCTs were included, with a total of 834 patients, 417 in the experimental group and 417 in the control group. The results of Meta analysis showed that the experimental group was better than the control group in improving the whole plasma viscosity (MD=-0.73, 95％CI[ -0.83, -0.63], P<0.00001); in terms of improving the thrombosis coefficient, the test group is better than the control group (MD=-0.19, 95％CI[-0.22,-0.15], P<0.00001); In terms of platelet aggregation rate, the test group was better than the control group (MD=-0.21, 95％CI[-0.25,-0.17], P<0.00001). GRADE systematically evaluates whole plasma viscosity, thrombosis coefficient, and platelet aggregation rate, showing that the level of evidence is low or very low, and the strength of the recommendation is weak. Conclusion: Xuesaitong injection combined with edaravone injection has relatively satisfactory results in improving hemorheology indexes in patients with acute cerebral infarction, and there is no obvious safety problem. However, due to the small number of included studies and the total sample size, and the limitation of the quality of the included original studies, the results of this study need to be designed with strict, high-quality, large-sample, multi-center, and more internationally recognized clinical outcome indicators and efficacy experiments to verify, in order to obtain stronger evidence-based medicine.