Objective To mine the characteristics of traditional Chinese medicine（TCM） syndromes of coronary heart disease（CHD） from 2010 to 2021 through literature, and to summarize the evolution law of the TCM syndromes of CHD in 1970—2021 based on the previous study. Methods Databases including CNKI and VIP were searched for relevant literature on TCM syndromes of CHD published between July 1st, 2010 and June 30th, 2021, and the distribution characteristics of TCM syndromes and syndrome elements of the included literature were statistically analyzed. Based on the team’s previous research, the evolution law of TCM syndrome characteristics of CHD in 1970—2021 was summarized. Results A total of 129 papers involving 52 090 patients were eventually included, of which 107 papers reported compound TCM syndromes involving 36 224 patients. From 2010 to 2021, the top 10 clinical TCM syndrome types were internal obstruction of phlegm-turbidity（8519 cases, 23. 52%）,heart blood stasis obstruction（5094 cases, 14. 06%）, qi deficiency and blood stasis（5022 cases, 13. 86%）,both qi and yin deficiency（4432 cases, 12. 23%）, qi stagnation and blood stasis（2285 cases, 6. 31%）,yang qi depletion（1683 cases, 4. 65%）, heart qi insufficiency（1474 cases, 4. 07%）, cold congealing in the heart vessel（1271 cases, 3. 51%）, qi deficiency and phlegm stasis（1243 cases, 3. 43%）, and yin deficiency of heart and kidney（771 cases, 2. 13%）. A total of 102 965 cases of syndrome elements were extracted, including 10 syndrome elements, which were 27 825 cases of blood stasis（27. 02%）, 23 872 cases of qi deficiency（23. 18%）, 19 493 cases of turbid phlegm（18. 93%）, 11 249 cases of yin deficiency（10. 93%）, 5602 cases of yang deficiency（5. 44%）, 5584 cases of qi stagnation（5. 42%）, 3615 cases of heat（toxin）（3. 51%）, 2367 cases of cold congealing（2. 30%）, 2135 cases（2. 07%） of fluid rheum, and 1223 cases（1. 19%） of blood deficiency. Combined with the characteristics of TCM syndromes and syndrome elements of CHD from 1970 to 2010, the results showed that the proportion of internal obstruction of phlegm-turbidity syndrome and qi deficiency and blood stasis syndrome gradually increased from 1970 to 2021, and the proportion of heart blood stasis obstruction syndrome significantly increased during 1990 to 1999 and 2000 to 2010when compared to that in 1970—1989, but decreased during 2010 to 2021. The proportion of qi staganation and blood stasis syndrome in 1990—2021 was lower than that in 1970—1989. The total proportion of simple deficiency syndromes, including both qi and yin deficiency, heart qi insufficiency, and yang qi depletion, gradually decreased.The total proportion of excess syndrome elements such as turbid phlegm and blood stasis showed a significant increase trend, while that of deficiency syndrome elements such as qi deficiency, yin deficiency and yang deficiency gradually decreased. Conclusion The overall characteristics of the “weak pulse at yang and wiry pulse at yin” of CHD have not changed, and it is still the syndrome of deficiency in root and excess in branches. The syndrome elements of branch excess mainly manifested as turbid phlegm and blood stasis have gradually dominated. It shows a trend of phlegm with stasis regarding the TCM syndrome of CHD in the future.

总结张伯礼教授运用乳香-没药对药治疗顽痹的临证经验.认为顽痹以脉络瘀滞、痹阻不通为基本病机,乳香、没药相须为用可理气宣痹、活血定痛,除瘀滞之气血,通痹阻之经络,尤适用于顽痹之脉络痹阻.临证用乳香-没药对药配伍行气活血药物治疗胸痹,以逐瘀宣滞、散寒通脉;配伍益气活血、通经达络药物治疗中风病后期偏枯痿废日久,以疏利脉络、燮理气血;配伍四妙勇安汤治疗脉痹以行气化瘀,另对于迁延日久之脉痹可内外合治,在外洗中药中加乳香-没药对药以芳香透痹.同时强调乳香-没药对药的应用适应病症及注意事项.

冠脉痉挛是引起多种临床心血管疾病的病理生理状态,多以胸闷、胸痛等症为主,临床较为常见,但目前精准诊断较为困难,机制尚不明确.张伯礼教授临证经验丰富,指出临床上冠脉痉挛患者以心阳不足为本,血瘀为基,多病理因素(痰湿、气滞、肝郁等)兼夹致病,宽胸温阳当为第一要义.在辨治冠脉痉挛所致胸痹时当首辨标本虚实,分清轻重缓急,谨守病机,标本兼顾,随证化裁.

目的:基于网络药理学方法,探讨黄芪-熟地黄药对治疗骨质疏松症(osteoporosis,OP)的作用机制.方法:首先,借助中药系统药理学数据库与分析平台(traditional Chinese medicine systems pharmacology database and analysis platform,TCMSP)及UniProt数据库筛选黄芪-熟地黄药对的活性成分及作用靶点,利用Cytoscape 3.7.0软件构建并分析中药-活性成分-作用靶点网络.然后,通过GeneCards、OMIM和DisGeNET数据库筛选OP相关靶点,将两者相互映射后获得黄芪-熟地黄药对治疗OP的作用靶点,运用STRING数据库及Cytoscape 3.7.0软件建立并分析交集靶点蛋白质-蛋白质相互作用(protein-protein interaction,PPI)网络,筛选核心靶点.最后,分别利用Funrich 3.1.3软件和David 6.8数据库对核心靶点进行基因本体(gene ontology,GO)功能富集分析和京都基因与基因组百科全书(Kyoto encyclopedia of genes and genomes,KEGG)通路富集分析.结果:经筛选共得到黄芪-熟地黄药对活性成分19个,作用靶点117个,OP相关靶点3630个,中药-疾病交集靶点83个.经网络拓扑学分析后筛选出25个核心靶点,主要包括IL-6、JUN、VEGFA、TNF、TP53、MAPK1、MAPK8、IL-1β、EGF和PTGS2等.GO功能富集分析结果显示,核心靶点涉及到的生物过程主要包括影响类固醇受体通路、免疫反应和信号转导等;分子功能层面表明黄芪-熟地黄药对可能通过影响细胞因子、配体依赖性核受体和蛋白质丝氨酸/苏氨酸激酶等活性等分子途径发挥抗OP作用.细胞成分层面表明细胞外、核质等细胞组分可能与黄芪-熟地黄药对抗OP的机制有关.KEGG通路富集分析结果显示,核心靶点基因涉及到的信号通路主要与细胞增殖、分化,炎症和代谢相关通路有关.结论:黄芪-熟地黄药对治疗OP的作用机制呈多成分、多靶点和多通路的特性;可能通过影响机体成骨细胞和破骨细胞的增殖、分化,炎症反应和代谢等途径维持机体骨形成-骨吸收动态平衡,发挥抗OP的作用.

目的 梳理和总结中医手法治疗神经根型颈椎病的研究脉络、研究热点及发展趋势,为后续研究提供依据及可行性建议.方法 检索中国知识资源总库(CNKI)自建库至2020年12月4日手法治疗神经根型颈椎病相关文献,分析纳入文献年度发文量、高频被引文献,采用VOSviewer1.6.15和CiteSpace5.7.R2生成相关文献作者、发文机构、关键词的知识图谱,进行可视化分析.结果 共纳入文献1244篇,该领域研究自1982年开展并逐渐受到重视.涉及作者684名,其中核心作者13名,主要形成以朱立国、王平、詹红生、林定坤、孙武权为代表的5个作者集群;涉及研究机构544所,主要研究机构有中国中医科学院望京医院、天津中医药大学第一附属医院、广东省中医院、广西中医药大学、河南中医药大学等;涉及关键词730个,形成16个具有代表性的聚类.结论 目前中医手法治疗神经根型颈椎病研究热点集中于不同手法或联用其他干预措施的临床研究,手法量化、效应机制及循证评价是今后研究的发展趋势.

口腔溃疡是一种常见的发生于口腔黏膜的溃疡性损伤疾病,具有周期性反复发作的特点,缠绵难愈.引火归元法常用于治疗口腔溃疡虚火上炎之证,是阴平阳秘大法的具体应用.张伯礼教授临证经验丰富,在治疗口腔溃疡上颇有成效,现将张伯礼教授治疗口腔溃疡临证辨治思路、遣方用药经验整理报告,期冀领悟张伯礼教授临证思想.