目的 挖掘中医药治疗慢性疲劳综合征(CFS)的组方用药规律,并探讨其核心配伍组"黄芪—党参—白术—当归"的潜在作用机制.方法 以中国知网、万方、维普等数据库收录的学术期刊文献为资料来源,使用Excel 2019进行文献收集和筛选,再应用古今医案云平台V 2.3,SPSS Statistics 26.0和SPSS Modeler 18.0软件,对标准化的中药进行频数与属性统计、关联规则、系统聚类和因子分析,运用网络药理学方法对核心配伍组进行KEGG通路分析,探讨其潜在作用机制.结果 在纳入的307个临床组方中,中药黄芪最为常见,药性以温、平为主,药味以甘、辛为主,归经中脾经最多.关联规则分析结果显示:14种关联强度较高的配伍组,"黄芪—党参—白术—当归"药物组合置信度最高,因子分析中提取得到7个公因子,系统聚类分析中将药物归为5大类.KEGG通路分析发现"黄芪—党参—白术—当归"核心配伍组富集到的主要生物学通路共166条,其中TNF信号通路、PI3k-Akt信号通路、HIF-1信号通路等通路与核心配伍组治疗CFS的关系较为密切.结论 CFS的中医药治疗以理气健脾、养血补虚为主,临床使用黄芪、茯苓、当归、白术等组合用药,并随证配伍补肾填精、理气解郁、养心安神之品."黄芪—党参—白术—当归"核心配伍组可能通过TNF信号通路、PI3 k-Akt信号通路、HIF-1信号通路等相关信号通路,作用于AKT1,MAPK8,IL6,MAPK1和JUN等靶点,从而发挥治疗CFS的作用.

思想政治教育与专业课程教学的全面深入融合,是构建全员全程全方位育人格局的重要途径.基于OBE(outcome-based education)理念,结合中医诊断学的课程特点及内容,课程组深入挖掘课程思政元素,凝练课程思政内涵,并通过教学实践,不断完善中医诊断学课程的思政建设,逐步建立了中医诊断学实训课程思政的教育模式.为增强学生的职业使命感,提升学生的医学人文素养奠定基础,以达到全面育人的目的.

目的 建立基于深度学习的人工智能模型,通过对胃良、恶性溃疡及正常黏膜病例图片的学习,使其对良、恶性溃疡病例具有较高的识别能力,从而在一定程度上提高内镜医师的诊断水平,为胃癌的早期诊断提供极大的助力.方法 按照纳入和排除标准,共纳入病例3 238例,其中恶性胃溃疡、良性胃溃疡及正常胃的病例数分别为:747例、761例及1 730例.采用随机原则将原始病例按照大致8∶1∶1的比例分为训练集(正常病例1 380例,良性胃溃疡病例614例,恶性胃溃疡病例596例)、验证集(正常病例179例,良性胃溃疡病例75例,恶性胃溃疡病例70例)和测试集(正常病例171例,良性胃溃疡病例72例,恶性胃溃疡病例81例).建立基于多图片输入的efficientNet-b4深度学习模型对训练集及验证集中的病例进行训练,然后与2名经验丰富的内镜医师一起对测试集的324例病例进行识别,得出相关统计学指标,从而比较人工智能与内镜医师的对胃正常黏膜及良、恶性胃溃疡病例识别的诊断水平.结果 经验丰富内镜医师1、经验丰富内镜医师2及人工智能对病例识别的整体准确率分别为:92.09％、91.36％及95.06％,人工智能对病例识别的整体准确率要明显优于经验丰富的内镜医师.对于正常病例的识别,人工智能的灵敏度为98.25％,略低于两位内镜医师的99.42％和100％,但其阳性预测值为100％,优于其中一位医师的97.14％,与另一位医师的100％结果一样;对于良性胃溃疡病例的识别,人工智能的灵敏度和阳性预测值分别为:91.67％和86.84％,均优于两位经验丰富的内镜医师;对恶性胃溃疡病例的识别,人工智能的灵敏度和阳性预测值分别为:91.36％和92.50％,均优于两名经验丰富的内镜医师;人工智能及两名内镜医师对于良、恶性胃溃疡病例识别的灵敏度及阳性预测值都要明显低于其对正常病例的识别.结论 通过深度学习的人工智能模型对胃正常黏膜及良、恶性胃溃疡病例的识别的误诊要低于内镜医师;在良、恶性胃溃疡病例的识别方面,人工智能模型的误诊和漏诊也要优于经验丰富的内镜医师.但人工智能对于正常胃黏膜病例的识别的漏诊要高于内镜医师,且其对于良、恶性胃溃疡病例识别的漏诊和误诊也均要高于其对胃正常黏膜病例的识别,还需要进一步的完善,以优化人工智能对良、恶性胃溃疡病例的识别能力.

疲劳是当代社会人类亚健康状态的最常见表现形式之一.它不易引起患者自身的关注,是严重影响人类生命质量的"隐形杀手".防治疲劳与人类的生命质量和工作效率密切相关,已引起医学界的广泛关注.中国早在东汉时期就有关于疲劳的中医学疗法记载,而中医疗法在不断的实践中得到了丰富与发展.本文以中医药治疗疲劳为切入点,对疲劳的中医发病特点、辨证分型进行考察,并搜集、梳理中医药治疗疲劳的内外治法,以期为中医药治疗疲劳方面的研究提供思路.

亚健康是介于健康和疾病的中间状态,因其没有器质性病变往往被漏诊而不能及时救治,迁延日久给人类生命和财产安全带来更大的危害.本文系统回顾了目前市面上可用的亚健康人群身心状况客观评测技术,并发现国内对于亚健康领域多偏重科研和教学,而市场反馈较好的多为海外研发产品.本文提出国内亚健康评估市场应进一步开发简、廉、快、验的客观诊断工具,为亚健康的防治贡献一份力量.

手诊是观察手部信息以判断人体健康状态的方法,手诊分区是开展手诊的前提及手诊法中的重要内容,在临床应用中十分广泛.本文对手诊分区法的原理进行探讨与解析,并对手诊具有代表性的七个学说:即鱼际络脉诊法、小儿食指络脉诊法、手诊九宫八卦分区法、星丘学说分区法、生物全息手诊法、皮肤纹理学及手诊三维诊法的分区内容与诊断特点进行探讨,以期推进手诊的传承与发展.

目的 本研究将对线上混合式教学模式的现阶段应用进行深入解析与讨论.方法 通过对融合课程"中医辨证论治学基础"混合式教学改革实例进行剖析,形成有针对性的教学与评价方案.结果 "中医辨证论治学基础"课程建立了完整的线上[重点内容讲授+问题解答+案例讨论+互动评价+大规模开放式在线课程(Massive open online course,MOOC)学习+小规模限制性在线课程(Small private online course,SPOC)讨论]混合式教学模式,并通过线上问卷星教学效果评价(整体试卷分析+案例题分析)、SPOC作业评价(教师评价+学生互评),形成了教师教学与学生学习评价的双向反馈机制.结论 线上混合式教学模式的应用,需要提高对学生主体自主学习意识的激发,更新教师教学方法、教学手段以适应新环境下的教学任务,并通过多元评价体系的引入及时有效地调整混合式教学模式下师生双方的教学体验.

手诊学是观察手部信息诊断疾病的中医特色诊法;手相学是观察手部信息进行命理预测的学说.两学说均需观察、分析手部特征,进而得出相应信息.今笔者以手诊学及手相学历史渊源为线,以取其精华、去其糟粕的研究态度探讨手诊学对手相学理论的借鉴,研究发现手相学对手诊学理论影响主要为:引入九宫八卦分区法;丰富纹路诊断内容;补充望色、望形的诊断理论.以期通此论述丰富、发展手诊学说,为研究者提供便利,进而指导临床应用.

目的 基于数据挖掘探讨徐荣谦教授治疗多发性抽动症的组方规律,以及以温胆汤为主方的疗效评价研究.方法 纳入东直门医院符合多发性抽动症诊断标准的首诊病例157例,基于关联规则分析用药规律.纳入30例符合《精神疾病诊断与统计手册》(DSM-IV-TR)的多发性抽动症患者,经徐荣谦教授辨证后开具以温胆汤为基础方的方药,收集并对比治疗前后患者的耶鲁综合抽动严重程度量表(yale global tic severityb scale,YGTSS)评分.结果 对157例患者选用方药关联结果进行分析,置信度及支持度较高的配伍主要集中在温胆汤的药物,多配合使用镇肝息风药物石决明、生龙齿、钩藤以及养心安神药物炒酸枣仁、蕤仁.30例患者治疗后YGTSS总分及各子项包括次数、频率、强度、复杂性、干扰、缺损的得分均低于治疗前,差异具有统计学意义(P<0.05).结论 以温胆汤为基础方治疗多发性抽动症具有较好的临床疗效.

结合古籍中的疫病医案,探讨疫病诊治的"误"与"正".从疫病性质的辨别、疫病真假寒热的辨别,湿温疫病的治疗中误用寒凉、误用辛温发汗、误用补益造成的坏证,以及谨防病重药轻、明辨疫病真假、合理认识"有故无殒"等方面结合医案例证进行阐释.以史为鉴,古今合参,以期为当前抗击新型冠状病毒传染病疫情的中医药诊治工作提供参考.

噪声性耳聋是伴随工业文明发展而出现的一种职业性疾病,中医古籍中鲜有相关的论述.目前,关于噪声性耳聋的中医病因认识并不统一,根据噪声性耳聋的发病特点,笔者认为噪声是一种毒邪.历代医家对毒邪不断探索,对毒邪的认识也愈加深入、全面.因此,文章从毒邪角度认识噪声,分析其与外毒、瘀毒的异同,以探讨噪声性耳聋的中医病因.

目的 探讨基于Faster R-CNN算法的深度学习与迁移学习技术在中医齿痕舌与裂纹舌局部特征提取识别中的应用效果. 方法 将500例受试者舌象图片使用LabelImg V 1.6软件进行齿痕舌与裂纹舌区域标注,划分训练数据集与测试数据集,通过Faster R-CNN的深度学习技术与迁移学习技术中的微调(finetune)方法构建模型,最后使用准确率、精确率、召回率对模型效果进行评价.结果 对于裂纹舌,模型识别真阳性99例,假阴性3例,真阴性45例,假阳性3例,准确率0.960、精确率0.971、召回率0.971.对于齿痕舌,模型识别真阳性60例,假阴性20例,真阴性69例,假阳性1例,准确率0.860、精确率为0.983、召回率0.750.模型宏观准确率0.910、宏观精确率0.977、宏观召回率0.860.图像识别结果显示,模型不受舌象中病理变化所在位置的影响,对舌象局部特征提取方面也具有较强的适应性特点.结论 基于深度学习与迁移学习的方法,可以较好地完成中医舌象局部特征辨识任务,具有较好的迁移能力.

Objective To study and compare the molecular mechanism of SiniSan (Cold-Limbs Powder) and Suanzaoren Tang (Spine Date Seed Decoction) in treatment of insomnia based on network pharmacology method.Methods A database of active compounds of Sini San and Suanzaoren Tang was established through searching the databases of Chinese medicinal compounds including traditional Chinese medicinal system pharmacology platform (TCMSP) , and the predictive analysis of the compounds was conducted by using machine learning algorithm.Based on the analyses of KEGG pathway, gene ontology (GO) enrichment and disease association of therapeutic target database (TTD) , Cytoscape software was used to construct complex network of active constituent-target-disease and topological analysis of the pharmacological mechanisms of Sini San and Suanzaoren Tang.Results There were 145 active constituents obtained from Sini San and among them saikoside and kaempferol had higher binding activities.There were 1 306 target proteins obtained and among them22 were significantly correlated to diseases, and 49 significant KEGG pathways and 72 significant GO enrichment pathways obtained from Sini San.There were 139 active constituents obtained from Suanzaoren Tang and among them jujuboside and timosaponin had higher binding activities.There were 1 386 target proteins, 52 significant KEGG pathways and 84 significant GO enrichment pathways obtained from Suanzaoren Tang.Conclusion The potential network pharmacological mechanisms and active constituents of Sini San and Suanzaoren Tang in insomnia treatment are studied at the molecular biology level through complex network graph calculation and bioinformatics analysis.The purpose is to provide new ideas for further revealing the mechanism of treating insomnia with Chinese medicinal based on principle of different treatments for the same disease.

Objective To study the cellular changes of colonic smooth muscle cells in rats with spleen-deficiency functional diarrhea treated with Pixu Sihao Fang (PXSHF, No.4 Formula for Spleen Deficiency) dosed serum.Methods Colonic smooth muscle cells from functional diarrhea spleen-deficiency rats were extracted for primary culture and then divided into the following six groups: normal control group, model group, PXSHF low-dose, medium-dose, and high-dose groups, and montmorillonite powder (Mnt) group.All the dosed serum groups were treated with 5% drug serum for 48 h.CCK-8 test for detecting the cell proliferation activity and QRT-PCR test for checking the expression of brain-gut petide mRNA were performed.Results OD value of the model group was significantly lower than that of the control group (P<0.01) in CCK-8 test while the OD value of the drug serum groups were significantly higher than that of the model group (P<0.01).QRT-PCR test showed that the CCK/VIP/SS mRNA expression of the model group was significant lower than that of the control group (P<0.05).Compared with the model group, the CCK/VIP/SS mRNA expression in each drug serum group presented with an increase tendency.CCK mRNA expression of the group treated with low-dose PXSHF dosed serum was higher than of the model group (P<0.05).VIP mRNA expression of the groups treated with PXSHF dosed serum were significantly higher than that of the model group (P<0.01).Conclusion PXSHF dosed serum can effectively promote the proliferation activity of the colonic smooth muscle cells.Changes in the expression of CCK, VIP and SS mRNA might be indicative of the role of brain-gut peptide in the development of functional diarrhea with spleen deficiency pattern.

对于进行特殊作业的人群，适应不良性疾病是一个不容忽视的问题。适应性不良疾病是机体为维持生存，对应激作最大变化适应，而在适应过程中所形成疾病。适应不良性疾病由各种刺激所引起，持续时间较长，不同患者表现也有差异，有以躯体症状为主，有以心理异常为主，也有以行为、躯体障碍为主，出现异常行为。与航天、航海相关适应不良性疾病的研究，探讨人体生命健康状态的稳定和调整，是保障人体特殊环境健康和军队战斗力的重要课题。随着我国航空与海洋探索的深入以及军事战略的转变，在航天、航海特殊环境下，产生的相关疑难疾病严重影响着其身心健康和军队战斗力。因此，探索这些特殊疾病的发病机制，寻求其防治技术与方法，保障机体特殊环境健康和军队战斗力，已成为航天、航海医学健康及军事战略的重大和特殊需求。兹就航天、航海适应不良性疾病相关健康问题的中医学探讨如下。

The author put forward the opinion of treating insomnia from phlegm,and combined with clinical cases,this paper discussed the necessity and effectiveness from the recognition of phlegm in traditional Chinese medicine(TCM) and the connotation and denotation of phlegm-induced insomnia.The deep analysis of the connotation of phlegm provided a new idea for the study of phlegm theory.

Objective:To explore the application of Wendan Tang in treating mind disease.Methods:The feasibility of Wendan Tang in the treatment of mind disease was analyzed starting with the practical utility of Wendan Tang analogous prescription in treating mind diseases in clinical and research work,from the origin of Wendan Tang,the main characteristic of Wendan Tang syndrome,and the key link of the pathogenesis of mind disease,and so on,and were demonstrated by taking examples of the ancient and modern physicians application of the prescription in clinical.Results:Wendan Tang treatment for mind disease not only conforms to the principle of syndrome differentiation and treatment of TCM,but also has certain biological mechanisms,which can reflect the academic characteristics of combination disease and syndrome,and correlation between formula and syndrome of the modern traditional Chinese medicine.Conclusion:In the future,further strengthen the study of Wendan Tang analogous prescription and syndrome in clinical and research work,and aim at specific disease for specific utility mechanism to establish clinical and experimental research related basis for development and promotion of new Chinese medicine on the basis of wendan tang.

通过对失眠病因“五脏致病”相关文献的回顾性分析,分别从理论研究和临床应用两部分梳理与其相关的学说,从而在不同水平上研究失眠的病机本质,以完善失眠“五脏致病”的理论构架.

随着经济发展和城市化进程的加快,我国城市中医药社区卫生服务建设取得了明显进展,在社区卫生服务中参与比重逐渐加大,群众接受率不断提高。但也存在着高水平中医药人才缺乏、中医药适宜技术应用少、中医社区卫生服务项目未能形成体系、文化氛围淡薄、缺少政策支持等问题。针对中医药参与社区卫生服务存在的问题,需要采取改善社区高水平中医药人才缺乏现状、推广中医适宜技术、形成中医药社区卫生服务项目体系、加强文化氛围建设、强化政策支持等措施,这对于在新形势下进一步推进医药卫生体制改革,提高群众卫生保健水平,促进卫生公平具有重要而深远的意义。

针对当前中医药在社区医疗中的发展现状,通过深入研究不同中医疗法在情志病治疗中的作用以及在社区中发展推广的方法,认为以社区常见疾病为载体有针对性地在医疗实践中应用中医药疗法,逐步建立规范的中医适宜疗法体系,使中医疗法深入人心,是推广中医药进社区的可行之路,也是中医药参与社区建设的可行之路。