通腑开窍法中药保留灌肠在肝性脑病中的应用疗效显著,本文通过归纳总结近20年通腑开窍法中药保留灌肠在肝性脑病中的应用及临床疗效,为通腑开窍法在肝性脑病中的研究与应用提供参考,从而提高肝性脑病的防治水平,改善生活质量并减轻经济负担.同时,本文涉及目前通腑开窍法中药保留灌肠存在的问题,规范肝性脑病通腑开窍法中药保留灌肠在临床的运用,以期让传统的中医中药发挥优势,从而解决临床问题.

基于肝-大肠-脑相通理论,探讨大黄煎剂治疗肝性脑病的机制,以及煎药剂量、时间、温度的选择,灌肠时间、方式、药物加减的选择,为临床工作提供参考.

目前肝病的发病率仍较高,严重威胁民众健康,寻找多途径治疗慢性肝病是临床的迫切需求.壮药是颇具民族特色的传统药物,在治疗肝病方面具有一定的优势.本文对壮医药治疗肝病的机制进行综述,以期为深入研究壮医药在治疗肝病中的作用提供参考.

慢性乙型病毒性肝炎(CHB)是一类传染性强、流传范围广的慢性传染病,其主要病因是感染乙肝病毒.目前单纯运用西医治疗该病存在疗程长,有耐药风险,临床症状未能妥善处理等阻碍,同时CHB疾病不及时治疗或治疗不当,发展成为相关性肝硬化、原发性肝癌、肝衰竭的风险将增加.通过查阅文献发现,辨证运用疏肝健脾法结合抗病毒疗法治疗肝郁脾虚型CHB能够明显改善患者临床症状、肝功能指标,延缓肝纤维化进程.文章从疏肝健脾法结合抗病毒治疗的理论依据、临床疗效等方面进行综述,以期为CHB的临床治疗提供帮助.

肝衰竭是肝脏受损导致相应功能发生严重障碍或失代偿,是以凝血功能障碍、黄疸、肝肾综合征、肝性脑病、腹水等为主的一组复杂的临床综合征.目前单纯运用西医综合疗法治疗肝衰竭治疗难度高,预后较差,病死率高.因此寻求合理、有效且预后较为良好的治疗方案意义重大.研究通过查阅中外文献发现,辨证运用"扶阳培土"法结合西医综合疗法治疗肝衰竭阴阳黄治疗能够明显改善肝衰竭患者临床症状、肝功能、凝血功能、血浆内毒素及降低病死率.因此,从"扶阳培土"法结合西医综合疗法的理论依据、临床疗效等方面进行综述,以期为肝衰竭的临床治疗提供帮助.

ObjectiveTo investigate the mechanism of action of Xiaochaihu decoction in the treatment of hepatitis B based on network pharmacology. MethodsThe TCMSP database was used to obtain the main chemical components and action targets of the seven traditional Chinese medicines in Xiaochaihu decoction; the GeneCards and OMIM databases were used to obtain the targets associated with hepatitis B; the STRING online platform was used to construct a PPI network of potential targets, and R language was used to perform gene ontology (GO) functional enrichment analysis and KEGG pathway analysis; Cytoscape 3.7.2 was used to construct an “active component-core target” network and perform a topology analysis of this network; AutoDock vina and related software were used to perform molecular docking and visualized analysis of the active components with high value and the core targets in the network. ResultsA total of 193 main chemical components (including quercetin, kaempferol, wogonin, and naringenin) and 247 related targets were screened out, among which the key targets included RELA, MAPK1, TP53, ESR1, EGFR, and AKT1. A total of 2612 enrichment items were obtained by GO functional enrichment analysis, which were mainly involved in regulating the biological processes such as cell response to chemical stress, response to drugs, oxidative stress response, and lipopolysaccharide response. A total of 174 pathways were obtained by the KEGG pathway analysis, mainly involving hepatitis B, PI3K-AKT signaling pathway, and MAPK signaling pathway. Molecular docking results showed that the main active components had strong binding force to core targets, and the protein crystal complex had a stable conformation. ConclusionThis study preliminarily shows that Xiaochaihu decoction exerts a therapeutic effect on hepatitis B through multiple components, targets, and pathways.

广西是多个少数民族聚居的地区,因独特的自然地理环境和丰富的植被而具有中医药优势资源和浓厚的医药文化特色,有着牢固的中医药产业(包括壮、瑶、苗等民族医药)基础.本文从政策支持,加强中医药文化交流和宣传,加强中医药和壮、瑶、苗医药人才队伍建设,发展中医药和壮、瑶、苗药产业等角度剖析广西少数民族地区中医药产业的发展路径,以为振兴村级集体经济找到更好的模式.

目的:观察茵陈术附汤加减治疗乙型肝炎相关性慢加急性肝衰竭阴阳黄证的临床疗效.方法:将80例乙型肝炎相关性慢加急性肝衰竭患者按随机数字表分为对照组和治疗组各40例,对照组患者予西医综合治疗,治疗组患者在西医综合治疗基础上联合应用茵陈术附汤加减治疗,疗程为4周.观察比较治疗前后两组患者中医证候积分、肝功能(TBIL、ALT、ALB)、凝血酶原活动度(PTA),并评价疗效.结果:治疗组患者中医证候疗效优于对照组(P＜0.05);治疗后两组患者中医证候积分均较治疗前降低(P＜0.05),且治疗组患者治疗后中医证候积分低于对照组(P＜0.05).治疗组患者临床疗效优于对照组(P＜0.05);治疗后两组患者TBIL、ALT均低于治疗前(P＜0.05),ALB、PTA均高于治疗前(P＜0.05),且治疗组患者治疗后TBIL、ALT均低于对照组(P＜0.05),ALB、PTA均高于对照组(P＜0.05).结论:茵陈术附汤加减治疗乙型肝炎相关性慢加急性肝衰竭阴阳黄证具有较好临床疗效,能改善患者中医证候及肝功能.

BACKGROUND:Acute chronic liver failure (ACLF) is the most common type of liver failure. The clinical symptoms are complex and changeable, the treatment is difficult and the fatality rate is high. It has become an urgent problem to actively seek effective treatment means and improve the clinical efficacy of ACLF patients. Studies have shown that decreased intestinal barrier function and bacterial endotoxin translocation in ACLF patients are considered to be the key causes of enterogenic endotoxemia, and traditional Chinese medicine enema has certain advantages in adjuvant treatment of this disease. However, due to the lack of evidence, there is no specific method or suggestion, so it is necessary to carry out systematic evaluation on Traditional Chinese medicine enema for ACLF and provide effective evidence for further research.METHODS:We will search the following electronic databases from their inception to July 2020: Electronic database includes PubMed, Embase, Cochrane Library, Chinese Biomedical Database WangFang, VIP medicine information, and China National Knowledge Infrastructure. Primary outcomes: survival rates, TCM syndrome score.SECONDARY OUTCOMES:liver function (alanine aminotransferase, aspartic acid amino transferase, total bilirubin), blood coagulation function (prothrombin activity), adverse events. Data will be extracted by 2 researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0.RESULTS:The results of this study will systematically evaluate the effectiveness and safety of Traditional Chinese medicine enema for ACLF.CONCLUSION:The systematic review of this study will summarize the currently published evidence of Traditional Chinese medicine enema for ACLF to further guide its promotion and application.

目的:观察马鞭消水方联合壮医药线点灸治疗肝硬化腹水的临床疗效.方法:将60例肝硬化腹水患者随机分为实验组和对照组,每组30例.对照组采用常规西医综合治疗,实验组在常规西医综合治疗基础上加马鞭消水方联合壮医药线点灸治疗.比较两组临床效果.结果:治疗后,实验组总有效率为93.33％(28/30),对照组为70.00％(21/30),实验组高于对照组,差异有统计学意义(P＜0.05).结论:在西医常规治疗基础上加马鞭消水方联合壮医药线点灸治疗肝硬化腹水,可促进腹水的消退、肝功能的恢复,有效改善患者生存质量.

总结凉血解毒化瘀类中药及其复方治疗肝衰竭的机制,凉血解毒化瘀类中药及其复方治疗肝衰竭的机制包括抑制肝细胞凋亡、增强抗凋亡基因表达、减少肝细胞损伤、促进肝细胞再生、减轻肝细胞炎症、调节肠道菌群及改善凝血功能.