李冬云教授认为,多发性骨髓瘤便秘的基本病机为正虚为本,毒瘀为标,虚实夹杂.治疗上注重整体,倡导中西医结合治疗.主张分期辨证论治,善用枳术丸临证加减,治疗前期应解毒祛瘀,顾护胃气;治疗中期应健运脾胃,以补开塞;治疗后期应滋补肝肾,增液行舟.巧用中医外治,控制并发症.同时注重日常调摄,调护情志.审证求机,组方用药,取得了较好的疗效.附验案1 则,加以佐证.

介绍李冬云教授基于祛瘀生新法治疗恶性血液病化疗后骨髓抑制的经验.李冬云认为,恶性血液病化疗后骨髓抑制的基本病机为正虚为本,毒瘀为标,瘀血为病机的主要环节,因虚致瘀、因郁致瘀、毒瘀并存、脾肾亏虚,造成骨髓抑制,病情缠绵,多发变证.李冬云临证以祛瘀生新为治疗大法,通过解毒祛瘀、活血化瘀以祛除体内陈腐瘀血,通过疏肝理气、健脾益肾以促进新血的生成,同时注重患者情志的疏导和饮食的调护,使瘀去气血平,瘀去新血生.

Aims Previous studies suggested a significant relationship between four surrogate indexes of insulin resistance and subsequent type 2 diabetes mellitus (T2DM). But the association of longitudinal changes (denoted as -D) in CVAI (Chinese visceral adiposity index), LAP (lipid accumulation product), TyG (triglyceride-glucose), and TG/HDL-C (triglyceride/ high-density lipoprotein cholesterol) indexes with the risk of T2DM remained uncertain. We aimed to compare the changes in those four surrogate indexes for predicting T2DM in middle-aged and elderly Chinese. Methods We extracted data from the China Health and Retirement Longitudinal Study (CHARLS). Multivariate logistic regression models were used to estimate odds ratio (OR) with 95% confidence interval (CI) of incident T2DM with four surrogate indexes. The restricted cubic spline analysis was used to examine potential non-linear correlation and visualize the dose-response relationship between four indexes and T2DM. The receiver operator characteristic curve was used to compare the performance of the four indexes to predict T2DM. Results We enrolled 4,596 participants in total, including 504 (10.97%) with T2DM. Analysis results showed that four surrogate indexes were associated with T2DM, and the multivariate-adjusted ORs (95% CIs) of T2DM were 1.08 (1.00–1.16), 1.47 (1.32-1.63), 1.12 (1.00–1.25), and 2.45 (2.12–2.83) for each IQR (interquartile range) increment in CVAI-D, LAP-D, TG/HDLC-D, and TyG-D, respectively. Restricted cubic spline regression showed a non-linear correlation between four surrogate indexes and the risk of T2DM (p for non-linear < 0.001). From the ROC (receiver operating characteristic) curve, TyG-D had the highest AUC (area under curve), and its AUC values were significantly different from other three indexes both in male and female (all P < 0.001). Conclusion Compared with other indexes, TyG-D was a better predictor in the clinical setting for identifying middle-aged and elderly Chinese with T2DM. Monitoring long-term changes in TyG might help in the early identification of individuals at high risk of T2DM.

痰瘀相关理论首见于《内经》,基于中医学"津血同源"理论而产生.恶性淋巴瘤(ML)中医学称痰核、恶核、积聚等,临床以无痛性、进行性淋巴组织增生,尤以浅表淋巴结肿大为特点,病程较长,易复发.痰瘀是ML核心病机,应以痰瘀同治为原则,其中包含补气扶正、理气疏肝、脾肾同补、清热解毒4个方面,标本同治,气血同调.

目的 通过网络药理学方法研究夏枯草-半夏治疗弥漫大B细胞淋巴瘤(Diffuse large B-cell lym-phoma,DLBCL)的潜在分子机制.方法 首先利用中药系统药理学数据库和分析平台(Traditional Chinese medi-cine system platform,TCMSP)筛选夏枯草-半夏的活性成分及其对应的靶基因.其次,通过GeneCards、OMIM、TTD、DrugBank等数据库搜索DLBCL的疾病靶点,取交集后得到夏枯草-半夏治疗DLBCL的共同靶标基因,将共同靶标基因导入Cytoscape构建"夏枯草-半夏活性成分-DLBCL靶标基因"关系网络图.再通过PPI网络分析,筛选核心靶基因,进行基因本体论和京都基因与基因组百科全书通路分析.结果 夏枯草-半夏治疗DLBCL的主要活性成分有13种,包括槲皮素、β-谷甾醇、豆甾醇等;其作用的核心靶点包括AKT1、JUN、TP53、MAPK1、TNF等;其主要通过调节PI3K-Akt信号通路、TNF信号通路等信号通路发挥治疗DLBCL的作用.结论 夏枯草-半夏可通过多靶标、多途径发挥辅助治疗DLBCL的作用.