该文介绍康志媛教授运用当归芍药散加味治疗子宫腺肌病的临床经验.康志媛教授认为子宫腺肌病病程日久,多由正气亏虚所致,病机以瘀血阻滞为主,兼有气滞水停,非独在血,必气、血、水同病,病位多涉及肝、脾.临床治疗多以调和肝脾、行气活血利水为主,以缓消癥瘕,临证以当归芍药散加减以调和肝脾、气血同调、缓急止痛,临床疗效确切.

多囊卵巢综合征目前病因不明,可能与遗传、环境等密切相关,尚不可治愈,对女性一生内分泌及代谢系统危害极大.多囊卵巢综合征大多自青春期发病,因此,制订青春期正确的防治计划,对于阻断疾病的进展至关重要.本文以中医"治未病"思想为指导,从未病、欲病、既病等各阶段进行干预,以期减少多囊卵巢综合征的发病率.具体来讲,未病之时,注意养生调摄,从起居、饮食、运动及情志各方面树立健康的生活方式;在欲病阶段,及时调理体质以预防疾病的进展;在既病之时,则采取严格的生活方式调控及中西医药物治疗,促使疾病逆转;在稳定好转阶段,仍要防微杜渐,于生活之处细心调理,以期病不复发.

基于现代医家关于帕金森病的因机证治论述并结合自身临床经验,蒋健教授认为本病病机为本虚标实,本虚主要在于肝肾气血亏虚,标实主要在于痰湿瘀血阻络、内风发动,临床往往本虚标实同时存在,内风夹痰瘀多贯穿于帕金森病的发病始终.蒋健教授常用活络丹、逐风汤、刷痰丸化裁治疗本病,紧紧抓住补益肝肾、祛痰化湿、活血化瘀、舒筋活络、搜风剔络、熄风解痉止颤六大主线,善用虫类药,敢用大剂量,治风先治血,多原则灵活配伍,取得了较好疗效.

目的:通过调查问卷了解来华留学本科生关于思维导图教学模式在中医儿科学中的应用情况.方法:以80名来自上海中医药大学并同时参与思维导图教学方法复习猩红热课程的留学生们为调查对象,采用调查问卷的方法.通过SPSS 21.0进行统计,分析留学生们在中医儿科学思维导图教学模式下的应用情况.结果:大部分留学生认为思维导图教学对学习有辅助作用,并能很好适应该新模式下的教学方法.与传统教学模式相比,思维导图教学能够帮助加深记忆.超过87.7％的学生今后会使用思维导图方式来复习和巩固知识.结论:思维导图教学模式能够推进来华留学生本科生学习,巩固知识构架,提高学习热情.

目的 从代谢组学角度探讨轮状病毒肠炎湿热证患儿的粪便代谢组学特征.方法 收集20例轮状病毒肠炎湿热证患儿(RV湿热证组)和20例健康儿童(健康组)的粪便样本,采用超高效液相色谱-四极杆/静电场轨道阱高分辨质谱(UHPLC-Q Exactive HRMS)技术采集粪便代谢指纹谱,结合正交偏最小二乘-判别分析(OPLS-DA)的模式识别方法进行数据分析,寻找差异性内源性代谢物.结果 OPLS-DA模式识别可有效区分RV湿热证组与健康组,且模型可靠性高.筛选并鉴定出11种差异性代谢物,涉及咖啡因代谢、烟酸盐和烟酰胺代谢、卟啉和叶绿素代谢、不饱和脂肪酸代谢、花生四烯酸代谢、精氨酸和脯氨酸代谢、嘧啶代谢、色氨酸代谢,以及甘氨酸、丝氨酸和苏氨酸代谢等9条代谢通路.结论 轮状病毒肠炎湿热证患儿与健康儿童间存在差异性代谢产物,这些代谢化合物的异常表达可能是轮状病毒肠炎湿热证的重要发病机制,也是潜在的干预靶点.

目的:探讨玉屏风颗粒联合西咪替丁对过敏性紫癜患儿临床疗效及外周血免疫学指标的影响.方法:选取2017年1月至2019年12月我院68例过敏性紫癜患儿为研究对象,根据随机化原则将受试儿进行分组,其中对照组34例患儿仅接受西咪替丁治疗,研究组45例患儿在对照组的基础上口服玉屏风颗粒治疗,比较两组的治疗效果、治疗前后外周血免疫学指标水平变化及用药安全性.结果:研究组临床治疗总有效率显著高于对照组(P＜0.05),治疗前两组各免疫学指标及各炎性因子水平比较无统计学差异(P＞0.05),治疗后两组各免疫学指标及各炎性因子水平较治疗前均明显降低,且研究组显著低于对照组(P＜0.05),两组治疗期间不良反应发生率无差异(P＞0.05).结论:玉屏风颗粒联合西咪替丁可有效改善患儿的临床症状及外周血免疫学指标,疗效安全显著,值得在过敏性紫癜患儿治疗中应用及推广.

该文主要探讨郁证性咽(喉)病的因机证治.举凡梅核气、咽嗌不利、咽中热灼以及喉痹声喑等,皆可由七情不遂所致,病机涉及肝郁失疏、肝火灼烁、思虑伤及心脾以及痰涎瘀血阻滞.郁证性咽(喉)病通常伴有情志类临床表现及一系列纷繁复杂的躯体症状.治疗当重视疏肝解郁,养心安神;开郁顺气,化痰散结;及散血养荣,活血祛瘀等.现代医学咽异感症、癔症球、癔症性失音以及其他咽喉神经与精神性疾病可属郁证性咽(喉)病范畴,心理暗示及抗抑郁、抗焦虑治疗对上述病症有效.

目的 利用数据挖掘及文献研究,汇总分析溃疡性结肠炎(UC)中医药内服及灌肠治疗的方药规律.方法 检索中国知网学术期刊全文数据库、万方数据库、维普数据库收录的近10年公开发表的中医药治疗UC的临床研究文献,建立文献研究数据库,对涉及的方剂、中药的功效类别、频次频率等进行统计,再对核心用药进行关联规则和网络图的数据挖掘分析.结果 ①最终纳入相关文献339篇,涉及内服方剂50个,以乌梅丸使用最多,关联规则亦显示“乌梅-附子-黄连”强关联;常用药物167味,其中补虚药占31.11％、清热药占20.15％,使用频率在10％以上者有甘草、黄连、白术、白芍、党参、当归、木香、茯苓、黄芩、黄芪、白头翁、陈皮、乌梅等26味;关联规则显示健脾益气类中药强关联.②灌肠方剂16个,以白头翁汤使用最多,关联规则亦显示“白头翁-秦皮-黄柏-黄连”强关联;常用药物123味,其中清热药占39.17％、止血药占17.72％,使用频率在10％以上的中药有黄连、白及、黄柏、地榆、白头翁、黄芩、苦参、败酱草等17味;网络图显示“白头翁-黄连-黄柏-白及-地榆”强关联;中成药5种,锡类散使用最多.③黄连在内服和外用中药关联规则和网络图中均表现出与其他药物的强关联.结论 UC的中医药内服治疗重在健脾益气扶正、清热燥湿祛邪,以乌梅丸最为常用;局部灌肠治疗以清热解毒燥湿、收敛止血、化腐生肌为主,以白头翁汤及锡类散最为常用;综合内服和灌肠中药,最常用的药物是黄连.

Objective To explore the teaching methods and effects on learning outcome of pediatrics in traditional Chinese medicine for international undergraduates. Methods Forty Thai undergraduate students enrolled in 2014 of Shanghai University of Traditional Chinese Medicine were selected as teaching objects to carry out the teaching practice of"scarlet fever" in the five-hour course about pediatrics of traditional Chinese medicine. They were guided to complete the mind mapping of relevant knowledge points alone in the learning process and form a thematic learning mode under the guidance of mind mapping. Results Teachers use mind mapping as the leading tool to assist international undergraduates in building their knowledge framework. Although the expression and level of mind maps drawn through personal understanding will vary with students' abilities, compared with traditional theoretical teaching methods, image and interesting information of mind maps is more attractive to students, and helps to enhance students' memory and knowledge framework. Conclusions By using mind mapping method, the enthusiasm of overseas students in cross-cultural learning of TCM has been enhanced, the knowledge framework of TCM pediatrics has been consolidated, and the thinking ability of overseas students in China has been developed.

本文通过颤证的治疗案例,介绍蒋健教授对此病证的证候识别要点、观察组方原则及其用药经验.基于古今医家关于颤证因机证治论述并结合自身临床经验,蒋健教授认为震颤本质上为风病,风夹痰瘀是其最为常见的基本病机;治疗上重视联合运用祛痰除湿、活血化瘀、祛风熄风3原则为主进行治疗;观察组方三原可根据不同患者的不同情况灵活应用,每获良效.

文章通过案例进一步介绍蒋健教授用麻子仁丸治疗脾约证尿频、尿失禁的诊疗学术观点.蒋健教授认为:现代医学确有一些疾病可以表现出脾约证大便鞭和小便数的临床特点,凡是大便鞭和小便数在病机上存在某种程度因果关联的疾病,可按脾约证用麻子仁丸治疗;大便鞭和小便数偶然同时出现、并不存在因果关联的疾病,并不支持将之看作是脾约证;判断大小便有无因果关联只能通过用麻子仁丸治疗以后大便鞭与小便数同步改善来倒推.脾约证有时可但有小便数而并无大便鞭,其证据是对此用麻子仁丸治疗以后小便数能够得到改善.这个观点的临床意义在于,对小便数进行一般辨证论治难以取效时,毋忘脾约证的可能性而可试用麻子仁丸进行治疗.脾约证小便数除了小便次数增加外,还包括小便难以忍耐甚或遗尿、尿失禁.

结合蒋健教授治疗唇风的案例分析其治疗该病的临床经验.认为其病机为外感风燥热毒、内生脾胃湿热,以中药内服配合外敷法治疗唇风,常用药物分疏风散热、清热解毒(燥湿)、运脾化湿、滋阴润燥等不同类型.

本文通过验案介绍蒋健教授关于“郁证脾胃病”的临床经验及其学术观点.郁证性脾胃病的临床特征为:脾胃病类症状因情志致病因素引起,并兼有情志类、脾胃病类以及脾胃病以外纷繁多彩的躯体表现;无器质性胃肠疾病或以其不能合理解释患者症状;症状怪异不合常理;从郁论治或辅助从郁论治有效.郁证性脾胃病的治疗需遵从四个原则:从郁论治药物疗法和情志疗法相结合;解郁治本与郁证脏腑定位结合;从郁辨证论治与辨证论治相结合;从郁论治与从痰论治、从瘀论治相结合.郁证性脾胃病以郁证为本、脾胃病类表现为标,故从郁论治为治其本,针对脾胃病类症状的治疗为治其标.

"喉咳"为国医大师干祖望所提出的一种新的病证,以咽痒即咳、不痒不咳、痒止咳亦止为其临床特征.蒋健教授对此补充了以下主要学术见解:"喉咳"的外感病因为"6+1",即除了传统风寒暑湿燥火六淫外,更多由空气污染之"雾霾"所导致;诊断时勿忘询问患者是否伴有咽痒而咳的特点;提出治疗"喉咳"以抗过敏、养阴利咽、清热解毒及宣肺止咳为主,4种治疗原则可灵活组合.这些学术见解进一步丰富了"喉咳"的病脉症治.

By listing proven cases,this article analyzes on Professor Jiang Jian's innovative and unique clinical experience and academic thinking of the application of Ma Zi Ren Wan to release Straightened spleen pattern.Professor Jiang Jian raises a point that Straightened spleen pattern is a syndrome that the function of the spleen-stomach and its related viscera disorders so that the metabolism of body fluid disorders and body fluid can not be distributed to the intestine,but to the urinary bladder,leading to" constipation" and "frequent urination".Ma Zi Ren Wan can restore the function of body fluid in metabolism and correct the distribution of body fluid by moistening the intestine and promoting bowel movement.Whether the "constipation" and" frequent urination" appear at the same time is the most difference of general constipation.We should also distinguish the difference between "frequent urination" and strangury patterns.The most powerful evidence of diagnosing Straightened spleen pattern is that "constipation" and "frequent urination" at the same time are improved,or "frequent urination" is improved after trearment with Ma Zi Ren Wan.Straightened spleen pattern exists objectively,and the application of Ma Zi Ren Wan to release straigthened spleen pattern is effective.

By listing proven cases,in which Shaoyao Gancao Decoction was applied to treat spleen and stomach diseases such as esophageal hiatus hernia,stomach mucous membrane prolapse,borborygmus,regurgitation and salivating of Parkinson's disease,this paper discussed the clinical feasibility of treatment based on disease differentiation based on modern medicine pathological mechanism and modern pharmacological results.And this paper also pointed out that treatment on disease differentiation was a supplement to syndrome differentiation,and the combination could improve the clinical efficacy.

目前中医临床治疗阳萎多从补肾入手,但未必皆效.蒋健教授根据多年临床经验总结发现,阳萎非惟肾虚,亦关肝脉;治疗非惟补肾,亦需治肝,甚至必要时以治肝为主.本文结合古代文献、现代药理以及临床验案分析,介绍蒋健教授临证肝肾同治,以肝为主治疗阳萎的观点.

The characteristics of Jiang Jian's experience in treating pain syndrome with Shaoyao Gancao Decoction include:simultaneous use of Shaoyao (Radix Paeoniae Alba) and Gancao (Radix et Rhizoma Glycyrrhizae),large dose (30 g-60 g) of Shaoyao (Radix Paeoniae Alba),applicable for all cold,heat,deficiency and excess syndrome.According to Professor Jiang Jian,the spasmodic and neuropathic pain of the chest,hypochondrium,back,abdomen,four limbs,head and face striated muscle and visceral smooth muscle can be treated with the basic formula of Shaoyao Gancao Decoction.The formula can be compatibility of medicines can be modified based on the clinical pain nature and the whole symptoms of cold,heat,deficiency and excess.Professor Jiang points out that the causes of pain are complex,so the pathogenesis should be identified.For some abdominal pain caused by surgical emergency in modern medicine,the principle of "stopping pain when pain is seen" cannot be followed without careful consideration in case of covering up the disease condition and delaying the treatment time.Besides,Shaoyao Gancao Decoction is not effective on all kinds of pain.For the mild and moderate pain,it can achieves good effects while for the severe pain (like cancer pain),its effect is still limited.

目的:观察消疝汤治疗成人疝气的临床疗效.方法:选取2006年6月-2014年6月上海中医药大学附属曙光医院蒋健教授门诊收治的成人疝气患者25例,所有患者均给予刘氏自拟方“消疝汤”加减治疗.结果:25例患者中,明显缓解6例,基本缓解14例,稳定4例,未缓解1例,有效率为80.00％.20例疝囊有效回缩患者平均起效时间为服药后1.95周.消疝汤对仅痛不胀患者的疗效最为明显,有效率达100.00％;对胀痛兼见病例的缓解有效率为77.78％;对仅胀不痛患者的临床疗效相对偏弱,有效率为66.67％.18例疝囊胀痛有效缓解病例平均起效时间为服药后1.94周.结论:消疝汤治疗成人易复性疝气疗效确切.

通过案例介绍蒋健教授运用神效瓜蒌散合橘核丸治疗乳癖疼痛的临床经验.蒋健教授认为2方联用共奏疏肝理气、化痰软坚、活血止痛之功,契合乳癖肝郁气滞、痰瘀互阻的病机特点.在临床运用时,尚需根据临床表现判断气滞、痰凝、血瘀病机之偏甚,适当加用疏肝理气、化痰散结、活血祛瘀的药物,以图增效.