目的 基于国家中药复方专利探讨非酒精性脂肪性肝病的用药规律.方法 以"非酒精性脂肪性肝病""中药""方剂"为关键词,检索专利数据库从建库至2021年7月公布的中医药治疗非酒精性脂肪性肝病的专利复方,运用古今医案云平台对专利复方进行用药统计、配伍分析、聚类分析及复杂网络分析.结果 共纳入专利127项,涉及药物317味,用药频次最高的是丹参,药性以温为主,药味以苦、甘、辛为主,多归肝、脾两经,药物功效以清热解毒、化浊降脂和利水渗湿居多,药物配伍以净山楂-泽泻、丹参-净山楂出现较多,得到3组中药聚类组合和1个核心组方.结论 中医专利复方治疗非酒精性脂肪性肝病以疏肝健脾、活血化瘀、清热解毒、化浊降脂等法为主,用药平和,标本兼治,其核心药物组成可为临床用药提供参考.

痞满乃因气机升降失常,中焦气机壅滞为病,升为阳,降为阴,升降失常即阴阳失调,与否卦象之义同.通过扭转乾坤,即调整阴阳,将否卦爻为泰卦,将脾胃功能恢复至阴阳平衡的状态则是治疗痞满的根本目的.李军祥教授认为造成"气机不通"的病因病机各异,不能仅着眼于气机升降本身.因此,治疗痞满一病,以恢复气机正常升降为基本,通过燮理脾胃升降、纳运、润燥、寒热、气血之阴阳,从而达到阴阳平衡的状态,即泰卦之象.

胃食管反流病(GERD)是临床常见疾病,西医目前尚无有效治疗方法,属中医优势病种之一.李军祥教授临证对中医"浊"致病颇有感悟,认为"浊"是GERD重要病机,从"浊气-浊邪-浊毒"认识其发生发展,以及从"浊"论治,可提高临床疗效.

目的:基于古今医案云平台系统分析李军祥教授治疗溃疡性结肠炎的用药规律.方法:随机收集近2年来李军祥教授有效治疗的171例溃疡性结肠炎患者中药处方(一患一方,不分首诊及复诊),将171份处方录入到古今医案云平台系统中,经过医案标准化处理后,建立标准化的数据库,通过频数统计以及数据挖掘方法,分析方剂数据库中各中药用药频率、四气、五味、归经分布及药物功效分布,以明确李军祥教授治疗溃疡性结肠炎的诊疗思路.结果:所采集的171张处方中,涉及药物112种,其中使用频次超过110次的药物有18种;运用关联法则分析药对得到核心处方:木香、苦参、黄连、炮姜、白术、青黛、炙甘草、陈皮、地榆炭、三七、白及、白芍;用药以寒、温两性为主,味多属苦、辛、甘,药物主归脾、胃、肝、大肠、肺、肾经.所用药物主要功效以清热祛湿、清热解毒、温脾补肾、凉血化瘀、行气活血为主.结论:从用药、性味归经、功效主治上体现了李军祥教授治疗溃疡性结肠炎时以脾胃为中心,兼及五脏论治;清温并用,注重阴阳平调;重视清热祛湿解毒,不忘调畅气与血;注重整体辨证论治以提高临床疗效.

BACKGROUNDPrimary duodenal tuberculosis is very rare.Due to a lack of specificity for its presenting symptoms, it is easily misdiagnosed clinically.Review of the few case reports and literature on the topic will help to improve the overall understanding of this disease and aid in differential diagnosis to improve patient outcome. CASE SUMMARYA 71-year-old man with a 30-plus year history of bronchiectasis and bronchitis presented to the Gastroenterology Department of our hospital complaining of intermittent upper abdominal pain.Initial imaging examination revealed a duodenal space-occupying lesion; subsequent upper abdominal contrastenhanced computed tomography indicated duodenal malignant tumor.Physical and laboratory examinations showed no obvious abnormalities.In order to confirm further the diagnosis, electronic endoscopy was performed and tissue biopsies were taken.Duodenal histopathology showed granuloma and necrosis.In-depth tuberculosis-related examination did not rule out tuberculosis, so we initiated treatment with anti-tuberculosis drugs.At 6 mo after the antituberculosis drug course, there were no signs of new development of primary lesions by upper abdominal computed tomography, and no complications had manifested. CONCLUSIONThis case emphasizes the importance of differential diagnosis for gastrointestinal diseases.Duodenal tuberculosis requires a systematic examination and physician awareness.