Objective To explore the medication laws of Chinese medicine compounds in fumigation-washing treatment of external hemorrhoid and analyze new prescriptions. Methods The papers on the fumigation-washing treatment of external hemorrhoid with Chinese medicine were retrieved from China Science Periodical Database（ CSPD）, VIP database（ VIP）, and China Biology Medicine disc（ CBMdisc） from the establishment of databases to August 2021. The data analysis platform（ Traditional Chinese Medicine Inheritance Auxiliary Platform） was used to analyze the medication laws of the prescriptions. Results Through the analysis by the platform, 84 Chinese medicine compound prescriptions were screened out, including 111 Chinese medicines. The cold property was dominant in four properties, and the bitter flavor was dominant in five flavors. Liver meridian was the main meridian. The main drugs were qi-regulating drugs and blood-activating drugs. Conclusion The fumigation-washing treatment of external hemorrhoid with Chinese medicine compound preparations takes promoting blood circulation, relieving pain, astringent, and detumescence as the basic principle, which provides certain references for clinical treatment.

早期结直肠癌可通过内镜黏膜切除术(EMR)或内镜黏膜剥离术(ESD)治疗,但如果术后病理显示存在预后不良的危险因素,则需追加根治性手术.在结直肠癌根治手术中,提高转移淋巴结的检出率及清除率对判断肿瘤分期、改善预后等意义重大.纳米碳淋巴示踪技术能够对淋巴结进行染色定位,提高根治术中淋巴结的检出率.现报道1例内镜黏膜剥离术后追加纳米碳淋巴染色辅助下腹腔镜结肠癌切除术,治疗乙状结肠癌患者的诊疗经过,通过对此病例的分析,以期对临床工作有所帮助.

介绍全国名老中医朱秉宜运用"魄门亦为五脏使"理论论治老年性便秘经验.随着社会的发展,老年性便秘在全球发病率逐年递增,呈明显上升趋势,严重影响老年人的心理健康和生活质量.朱秉宜认为老年人的生理病理发生了很大的改变,尤其与高龄相关的如活动能力下降,伴有多种基础疾病,使用多种药物的副作用,饮食的改变都可能会导致便秘患病率的增加,老年性便秘与五脏相关,魄门功能的正常与否取决于五脏功能的正常与否.肝主疏泄之能、心乃传送之主宰、脾主运化之力、肺之传送之权、肾司开闭之职都与老年性便秘密切相关,提出疏肝、养心、运脾、宣肺、温肾的治疗原则,五脏同调,使机体升降出入正常,气血津液温煦濡润脏腑,取得令人满意的疗效.

目的 观察黄芩汤合四逆散加减联合西药治疗急性肠炎(肝郁脾虚夹湿热)患者的临床疗效.方法 患者65例随机分为两组,对照组给予诺氟沙星胶囊口服治疗,联合组在对照组的基础上给予黄芩汤合四逆散加减治疗.比较两组患者治疗前后的中医症状分级量化积分、炎症因子水平、肠道菌群(双歧杆菌、乳酸菌、肠杆菌和肠球菌)水平,并比较两组患者治疗后的临床症状体征改善情况.同时比较两组患者的临床疗效及治疗期间的不良反应发生情况.结果 联合组患者治疗后中医症状分级量化积分、炎症因子水平、肠道菌群水平及临床症状体征改善情况均显著优于对照组(P＜0.05).联合组的临床疗效总有效率为96.97％,显著高于对照组的81.25％ (P＜ 0.05),两组患者在治疗期间不良反应发生率差异无统计学意义(P＞0.05).结论 黄芩汤合四逆散加减联合西药治疗急性肠炎(肝郁脾虚夹湿热证)患者能显著提高临床疗效,改善各临床症状体征和相关指标水平,安全性好.

从脾胃角度探析慢性功能性便秘的病因病机和诊治策略.现代临床研究认为慢性功能性便秘的基本病机为脾虚气弱,肠运失司,结合运脾理论,以运脾通便为治则,用生白术70 g配伍枳实30 g为主方进行辨证论治,临床可获得较好的疗效.

Objective To evaluate the efficacy of lateral mucosal advancement flap for the treatment of anal fistula. Methods A total of 28 patients in the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2016 to December 2017 underwent lateral mucosal advancement flap were included in a retrospective study. Results 16 cases (57.1%) were cryptoglandular anal fistulas and Crohn′s disease was associated in 12 cases (42.9%). The length of follow-up was 10~33 months. Unhealed fistula occurred in 5 patients, giving an overall healing rate of 82.1%. No significant changes in Wexner score were observed (t=0.083, P>0.05). No mucosal flap necrosis and fecal incontinence was occured in the group. Conclusions Lateral Mucosal Advancement Flap is an effective and safe technique for anal fistula, especially for anal fistula in Crohn′s disease. Key words: Rectum; Anal canal; Anal Fistula; Lateral; Mucosal advancement flap

目的观察枳实、白术按不同剂量配伍治疗慢传输型便秘(slow transit constipation,STC)的临床量效关系.方法:将符合诊断标准的STC患者60例患者随机分为枳术低剂量组、枳术中剂量组和枳术高剂量组.枳术低剂量组给予枳实12g,生白术28 g;枳术中剂量组给予枳实21 g,生白术49 g;枳术高剂量组给予枳实30 g,生白术70 g.比较三组患者首次排便时间,记录三组患者治疗前后粪便性状积分、便秘症状评分(cleveland constipation score,CCs)和便秘患者生存质量估量评分(patient assessment of constipation-quality of life,PAC-QOL).结果:三组患者首次排便时间两两组间比较有显著差异,随生白术、枳实用量增大,时间明显缩短,差异有统计学意义(P＜0.05).三组患者治疗后粪便性状评分高于治疗前,且枳术高剂量组高于其他两组,差异均有统计学意义(P＜0.05).三组患者治疗后CCS、PAC-QOL评分低于治疗前,但枳术低剂量组治疗前后差异无统计学意义(P＞0.05);治疗后枳术高剂量组CCS、PAC-QOL评分低于其他两组,差异具有统计学意义(P＜0.05).结论:枳术3:7配伍在生白术剂量较大时(枳实21 g,生白术49 g)即能够有效改善STC患者的便秘症状,提高生存质量,而枳实30 g配伍生白术70 g改善程度更明显,临床疗效更显著.

目的 观察止瘁洗剂治疗慢性肛周湿疹的临床疗效.方法 将120例慢性肛周湿疹患者随机分为观察组和对照组各60例,治疗组采用江苏省中医院院内制剂止瘁洗剂坐浴外用,对照组采用高锰酸钾溶液坐浴外用,观察患者的临床疗效、复发率、治疗前后肛周瘙痒程度和生活质量,以及用药期间的不良反应.结果 观察组总有效率为96.67％,临床有效病例随访6个月后复发率22.4％;对照组总有效率为73.33％,临床有效病例随访6个月后复发率63.64％.各组指标结果存在统计学差异.结论 止瘁洗剂治疗慢性肛周湿疹疗效确切,复发率低,可明显改善患者的生活质量,且无明显不良反应.

目的 探讨血清视锥蛋白样蛋白-1(VILIP-1)、神经元特异性烯醇化酶(NSE)水平与急性缺血性脑卒中患者预后的关系.方法 选取109例急性缺血性脑卒中患者作为病例组,采用美国国立卫生研究院卒中量表(NIHSS)评定患者入院时神经功能缺损程度,应用头颅MRI计算脑梗死面积,采用改良的Rankin量表(mRS)评定患者预后情况,并于同期随机选取30例健康体检者为对照组.采用酶联免疫吸附法测定病例组和对照组血清VILIP-1水平,电化学发光法测定血清NSE水平.结果 病例组血清VILIP-1、NSE水平高于对照组(P均＜0.001).神经功能中度缺损、重度缺损者血清VILIP-1、NSE水平高于轻度缺损者(P均＜0.05),且重度缺损者高于中度缺损者(P＜0.05);中等面积脑梗死、大面积脑梗死者血清VILIP-1、NSE水平高于腔隙性梗死者(P均＜0.05),且大面积脑梗死者高于中等面积脑梗死者(P＜0.05).预后不良者血清VILIP-1、NSE水平高于预后良好者(P均＜0.05).VILIP-1对急性缺血性脑卒中预后诊断的受试者工作特征曲线(ROC)曲线下面积(AUC)为0.805,VILIP-1截断值为7.25 μg/L,灵敏度、特异度为0.85、0.81,准确度为0.76;NSE对急性缺血性脑卒中预后诊断的AUC为0.784,NSE截断值为20.61 ng/mL,灵敏度、特异度为0.79、0.86,准确度为0.75.结论 血清VILIP-1、NSE参与了急性缺血性脑卒中发病过程,且与急性缺血性脑卒中严重程度及预后密切相关,早期联合检测可作为病情判断和预后评估的重要指标.

血精症是男性泌尿生殖系统常见疾病,因其迁延难愈、反复发作,是中医男科疑难病症之一,瘀热病机是本病的一个重要病机.在周仲瑛教授“瘀热”病机理论的指导下,采用凉血化瘀止血的方法治疗血精症瘀热相搏证可取得良好治疗效果.“瘀热”病机理论可用来指导男科血精症的辨治.

Objective To investigate the protective effect of hydrogen-rich liquid on renal function in liver transplantation with the blocking period of vena cava. Methods 60 patients with liver transplantation were randomly selected and divided into con-trol group (group C, n= 30) and hydrogen-rich group (group H, n= 30). After induction of anesthesia, 250 mL of isotonic saline and hydrogen-rich liquid were injected via gastric tube respectively. During anesthesia induction (T0), new liver stage (T3) and post-oper-ation (T5), venous blood and urine samples of 2 groups were collected. urea nitrogen (BUN), serum creatinine (Cr), creatinine clearance rate, interleukin-18 (IL-18), cysteine protease inhibitors (Cystain C), renal injury molecule-1 (KIM-1) and neutrophil ge-latinase-related apolipoprotein (NGAL) were measured. Results Compared with the T0 phase, the levels of Cr and BUN increased and the creatinine clearance rate decreased in T3 and T5 phases in the two groups. At the same time, the serum Cr [ (116.7±14.8)μmol/ L vs (164.8±18.4) μmol/ L\] and BUN concentrations [(5.8±1.3) mmol/ L vs (8.0±2.7) mmol/ L\] and creatinine clearance rate [(86.3±18.4)mL/ min vs (73.2±20.1) mL/ min\] in the H group were better than those in the C group, and the difference was statistically significant (P<0.05). Compared with group C, the levels of IL-18, Cystain C, KIM-1 and NGAL in group H were not sig-nificantly different (P>0.05) in T0, but the expression levels of IL-18, Cystain C, KIM-1 and NGAL were significantly decreased in T3 and T5 (P<0.05). Conclusion Hydrogen-rich fluid has certain protective effect on renal function in liver transplantation with the blocking period of vena cava.

目的:研究中药痔瘘熏洗剂联合一期根治术治疗瘘管性肛周脓肿的临床疗效.方法:采用一次性根治术治疗60例瘘管性肛周脓肿患者,术后随机分为治疗组与对照组各30例.治疗组采用江苏省中医院自制的痔瘘熏洗剂熏洗治疗,对照组采用温水坐浴治疗.2组均治疗至愈合,愈合后随访1个月.于术后第3日评价2组患者疼痛及水肿情况,术后第20日评价临床疗效,比较2组患者创面愈合时间和疼痛、水肿消失时间.结果:术后第3日,治疗组疼痛评分、创缘水肿评分明显低于对照组(P<0.05).术后第20日,治疗组总有效率96.67%,明显高于对照组的80.00%(P<0.05).治疗组创面平均愈合时间(15.23±2.45)d,对照组创面平均愈合时间(18.03±3.17)d,治疗组愈合时间明显缩短(P<0.05).治疗组疼痛和水肿消失时间明显少于对照组(P<0.05).结论:瘘管性肛周脓肿一期根治术后使用痔瘘熏洗剂,在显著提高治愈率的同时,可减轻痛苦,缩短疗程,值得推广.

目的:从腑病脏治的思路治则,观察用益气养阴润肠法组方治疗慢传输型便秘(STC)临床疗效的评价,结合患者病情特点,对“腑病脏治”理论进行探讨,总结中医临床经验的推广与应用.方法:对30例便秘患者以益气养阴润肠法加减治疗.结果:治愈17例,明显改善12例,无效1例,总有效率达96.6％.结论:益气养阴润肠法组方对慢传输型便秘症状有显著的临床疗效.

目的:比较四君子汤加减联合化疗和单独使用化疗对结直肠癌患者在临床疗效、生活质量以及化疗不良反应方面的影响.方法:检索自建库到2015年10月比较四君子汤加减联合化疗方案和单独使用化疗对结直肠癌临床疗效、生活质量以及化疗不良反应的随机对照研究的中英文文献.应用RevMan 5.3软件评价纳入文献质量,并进行统计分析.结果:经严格筛选,最终纳入8篇随机对照文献,涉及483例患者,其中四君子汤加减联合化疗组245例,单独使用化疗组238例.Meta分析结果显示:在生活质量、化疗不良反应方面,两组结果差异有显著的统计学意义(P＜0.000 01),在临床疗效方面,两组差异无统计学意义(P=0.19).结论:四君子汤加减不仅可以降低结直肠癌患者的化疗不良反应发生率,而且可以改善其生活质量.

Chronic prostatitis is a common male disease, and its pathogenesis is not yet clear. Most scholars believe that oxidative stress and immune imbalance are the keys to the occurrence and progression of chronic prostatitis. Currently immunotherapy of chronic prostatitis remains in the exploratory stage. This article relates the active ingredients of 5 Chinese medicinal herbs (total glucosides of paeony, tripterigium wilfordii polglycosidium, curcumin, geniposide, and quercetin) for the treatment of chronic prostatitis and their possible action mechanisms as follows: 1) inhibiting the immune response and activation and proliferation of T-cells, and adjusting the proportion of Th1/Th2 cells; 2) upregulating the expression of Treg and enhancing the patient's tolerability; 3) suppressing the activation of the NF-kB factor, reducing the release of iNOS, and further decreasing the release of NO, IL-2 and other inflammatory cytokines, which contribute to the suppression of the immune response; 4) inhibiting the production of such chemokines as MCP-1 and MIP-1α in order to reduce their induction of inflammatory response. Studies on the immune mechanisms of Chinese medicinal herbs in the treatment of chronic prostatitis are clinically valuable for the development of new drugs for this disease.

Objective To investigate the clinical characteristics of perianal Crohn's disease (CD) with or without proctitis and compare the treatment effect of surgery combined with biological preparation.Methods The retrospective cohort study was conducted.The clinical data of 52 patients with perianal CD who were admitted to the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from June 2011 to October 2014 were collected.Thirty patients with inflammation involvement of the rectum and 22 patients without inflammation involvement of the rectum were respectively divided into the proctitis group and non-proctitis group.All the 52 patients underwent surgery combined with infliximab therapy.Observation indicators included:(1) clinical characteristics:gender,age,body mass index (BMI),lesion location,disease behavior,type of perianal lesions,history of perianal surgeries,CD activity index (CDAI),perianal disease activity index (PDAI),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),white blood cell (WBC),platelet (PLT) and albumin (Alb),(2) treatment and follow-up.Follow-up using outpatient examination was performed to evaluate the perianal lesions up to December 2015.Measurement data with normal distribution were described as-x ± s and comparison between groups was analyzed by the t test.Count data were described as the percentage,and comparison between groups was analyzed by the chi-square test and Fisher's exact probability.Results (1)Clinical characteristics:number of patients with BMI ＜ 18.5 kg/m2 and with normal BMI were respectively 17,13 in the proctitis group and 6,16 in the non-proctitis group.Lesions located at ileum,colon and ileocolon were respectively detected in 3,9,18 patients in the proctitis group and 9,4,9 patients in the non-proctitis group.CDAI≥ 150 and ＜ 150,CRP≥8 mg/L and ＜ 8 mg/L,ESR ＞ normal level and =normal level,Alb ＜ 35 g/L and between 35 g/L and 50 g/L were respectively detected in 23,7,25,5,24,6,12,18 patients in the proctitis group and 8,14,8,14,8,14,2,20 in the non-proctitis group,with statistically significant differences between the 2 groups (x2 =4.446,6.855,8.563,12.076,10.211,6.163,P ＜ 0.05).(2) Treatment and follow-up:all the 52 patients underwent more than 3 times infliximab therapies and perianal surgeries within 1 week after infliximab therapy.All the patients were followed up for a median time of 28 months (range,8-52 months).Thirty-four patients still underwent maintenance therapy of immunosuppressive agents and 18 didn't undergo maintenance therapy up to the end of follow-up.Twenty-two patients in the proctitis group and 12 patients in the non-proctitis group underwent maintenance therapy,with no statistically significant difference between the 2 groups (x2 =1.979,P ＞ 0.05).The total healed rate,improvement rate and unhealed rate of perianal lesion were 55.8％ (29/52),34.6％ (18/52) and 9.6％ (5/52),respectively.The number of patients with healed,improved and unhealed perianal lesions were 16,11,3 in the proctitis group and 13,7,2 in the non-proctitis group,respectively,showing no significant difference in treatment effects between the 2 groups (x2 =O.173,P ＞ 0.05).Conclusions Patients with perianal CD combined with proctitis have higher activity of intestinal inflammation and worse nutritional status compared with patients without proctitis.However,there is no significant difference in the type and activity of perianal lesion between patients with or without proctitis.Surgery combined with biological preparation could render better clinical outcomes in treatment of perianal CD with proctitis.

Based on years of clinical experience,the Chinese medicine great master ZHOU Zhongying has created a systematic pathogenesis theory of "blood stasis and heat".Under the guidance of Professor Zhou's theory,through analysis of the relating literature,and combined with the clinical practice,this paper discusses the pathogenesis,clinical manifestations,thoughts of differentiation and medication characteristics of blood stasis and heat in epididymitis and orchitis,with a case for illustration.It enriches the theory of "blood stasis and heat" and provides new insights for the treatment of epididymitis and orchitis based on syndrome differentiation.

4P医学模式是指预测性、预防性、个体化、参与性的新兴医学模式.慢性前列腺炎(CP)是成年男性常见疾病,但由于其难治性及反复性常常困扰泌尿男科医生.运用4P医学模式对慢性前列腺炎的患者进行全面个体化诊疗,对于医疗工作者能更全面的理解疾病的预测、预防,能让患者对CP的认识及预防有更深刻的了解,对减少复发率,减轻医疗负担都有其积极的作用.

谷云飞教授为南京中医药大学博士生导师,教授,南京中医药大学附属医院主任中医师,对肛周克罗恩病的早期诊断,原发病的治疗,手术时机的掌握,保护肛门功能的手术方式,中医药治疗经验丰富,注重“清源浚流”,取得了显著临床疗效.

谷云飞教授从事结直肠外科临床工作近30载,擅长诊治肛肠科疑难杂症,在中西医结合诊治克罗恩病(Crohn’s Disease,CD)肛瘘方面有独到见解。笔者随师学习期间,亲聆教诲,受益良多,现将谷教授诊治克罗恩病肛瘘的临床经验总结如下,以飧同道。