糖尿病是一组以长期高血糖为主要特征的代谢综合征,由胰岛素分泌不足或作用缺陷导致,以血中葡萄糖水平升高为生化特征,以多饮、多食、多尿、消瘦、乏力为临床表现的代谢紊乱综合群.糖尿病在中医学中属于"消渴病"、"脾瘅"等疾病的范畴.桑叶是采自桑科植物桑的干燥叶,使用历史非常的悠久,功效也十分多样.现临床主要用于风热感冒、肺热咳嗽、肝阳上亢和目赤肿痛等证候.《本草纲目》等书籍记载了其治疗消渴病的功效,随着现代技术和医学的发展,发现了桑叶可以有效改善胰岛素抵抗、改变葡萄糖吸收,并且对胰岛细胞有抗凋亡等多种作用,本文就桑叶治疗糖尿病的机制及临床研究进展进行综述.

目的 探讨慕课在消化科中医住院医师规范化培训教学改革中的作用.方法 选取2021年1月1日—2022年2月28日,在首都医科大学附属北京中医医院消化中心进行中医住院医师规范化培训的学员112人,随机分为对照组和观察组,各56人.对照组采用临床带教结合科内定期讲课的传统教学法,观察组在此基础上,同时实施慕课教学,培训时间均为1个月.观察2组学员在理论知识考核、腹腔穿刺、腹部查体、病历书写及对带教教师授课质量评价方面的差异.结果 观察组理论知识考核各单项得分及总分均高于对照组,差异有统计学意义(P＜0.05);腹部查体得分高于对照组,差异有统计学意义(P＜0.05);对带教教师授课质量评价中"准备充分、病例选择合理"等7项得分及总分均高于对照组,差异有统计学意义(P＜0.05).结论 将慕课应用于消化科中医住院医师规范化培训教育教学改革实践中,可有效提高学员的理论水平及专科查体技能,且获得了较高的教学满意度.

目的:观察调肝理脾方治疗伴无效食管动力(IEM)的胃食管反流病(GERD)疗效,并探讨其可能机制.方法:将69例伴IEM的GERD患者分为中药组(35例)和西药组(34例),中药组给予调肝理脾方中药颗粒同时服用奥美拉唑模拟剂,西药组给予奥美拉唑肠溶片同时服用调肝理脾方中药颗粒模拟剂.两组均连续治疗4周,随访期为3个月.分别比较治疗前后两组症状疗效及食管动力改善情况,随访3个月两组再服药人数及不良反应情况.结果:中药组及西药组症状疗效指标GerdQ量表评分在治疗2、4周后均较本组治疗前显著降低(P＜0.05).治疗4周后中药组在下食管括约肌(LES)静息压力、远端收缩积分(DCI)、IEM无效吞咽百分比方面均较治疗前显著好转(P＜0.05);中药组IEM恢复正常12例(占34.3％)显著优于西药组恢复正常例数[4例(占11.8％)](P＜0.05).随访3个月,西药组再服药人数比例高于中药组(P＜0.05).两组均未发生严重的不良反应.结论:调肝理脾方能有改善伴IEM的GERD患者食管动力,其症状疗效类似于奥美拉唑,且更少复发.作用机制可能与提高食管廓清功能和改善抗反流屏障有关.

目的:观察调肝理脾利咽方治疗具有咽喉反流症状的反流性食管炎(RE)和非糜烂性反流病(NERD)的不同临床疗效.方法:回顾性分析2018年2月至2020年2月运用调肝理脾利咽方联合质子泵抑制剂(PPI)治疗的具有咽喉反流症状的胃食管反流病(GERD)患者60例,根据内镜及24h食管pH-阻抗检查的结果分为RE组30例和NERD组30例.观察治疗前后两组反流症状指数评分(RSI)、咽喉反流主要症状评分、中医症状评分、中医症状疗效.结果:①治疗后两组RSI评分均较前有所降低(P＜0.05),两组评分改善无明显差异(P＞0.05).②治疗后两组咽喉反流主要症状均较前改善(P＜0.05),RE组持续清嗓、咽喉异物感症状较NERD组改善更明显(P＜0.05).③治疗后两组中医症状评分均较治疗前降低(P＜0.05),两组评分改善差异无统计学意义(P＞0.05).④RE组总有效率83.3％,NERD组86.7％,两组疗效比较差异无统计学意义(P＞0.05).结论:调肝理脾利咽方联合PPI可以有效地改善RE及NERD患者的咽喉反流症状;与NERD患者相比,调肝理脾利咽方对于RE患者咽喉异物感、持续清嗓症状有更好的临床疗效.

Objective Cervical osseous foraminal stenosis (COFS) results from the uncinate process and facet hyperostosis. Currently, the optimal surgical technique for the treatment of COFS remains controversial. Materials and Methods Patients with COFS presenting radiculopathy underwent posterior endoscopic cervical foraminotomy by the circumferential decompression technique. The neck disability index (NDI), the visual analogue scale (VAS), and the modified MacNab criteria were used to evaluate the outcomes. In addition, the range of motion (ROM) and the slippage distance between the operated vertebrae in flexion-extension position were measured to evaluate the stability of the cervical spine. Results There were 24 consecutive patients in the study. The mean follow-up period was 16.2 months (range: 12-26 months). The NDI and VAS scores for arm/neck pain improved significantly from preoperatively to the last follow-up. The satisfaction rate by modified MacNab criteria was 91.7% on the third postoperative day and 100% on the day of final follow-up. There were no significant differences in intervertebral ROM or slippage distance between the last follow-up and preoperatively (P = 0.968, P = 0.394). Arm pain occurred in one patient, and sustained fingers numbness in two patients, but these symptoms resolved at the last follow-up. Conclusions Posterior endoscopic cervical foraminotomy by the circumferential decompression technique is a safe and effective treatment for COFS. Moreover, it preserves the stability and physiological mobility of the cervical spine.

目的 探讨"新型线上巴林特小组"教学模式对临床实习生职业倦怠的影响.方法 选择在首都医科大学附属北京中医医院参加本科阶段临床实习的医学生40名,进行为期6周的"新型线上巴林特小组"教学活动.在教学活动前后邀请受试人员填写职业倦怠量表(MBI-HSS)、知觉心理压力量表(CPSS).结果 经过6周干预后,受试者职业倦怠量表总分显著下降(P<0.01),其中"情绪耗竭"因子分数显著下降(P<0.01).结论 "新型线上巴林特小组"教学模式对于改善医学生职业倦怠具有积极作用.

BACKGROUND:Gastroesophageal reflux disease (GERD) has a high prevalence worldwide, and its incidence is increasing annually. Modified Xiaochaihu Decoction (MXD) could relieve the symptoms of GERD, but the effects of MXD on GERD manifestations and relapse prevention need to be further explained. Therefore, we performed a prospective, double-blind, and double-simulation study. AIM:To verify the efficacy of MXD for GERD and its effect on esophageal motility. METHODS:Using randomization, double-blinding, and a simulation design, 288 participants with GERD were randomized to the treatment group and control group and received herbs (MXD) plus omeprazole simulation and omeprazole plus herbs simulation, respectively, for 4 wk. The GERD-Q scale score and esophageal manometry were measured at baseline, after treatment, and at 1 mo and 3 mo follow-up visits when medication was complete to evaluate recurrence indicators. RESULTS:The GERD-Q scale score in both groups decreased significantly compared to those before treatment (P < 0.01). However, no significant difference was observed between the two groups (P > 0.05). Esophageal manometry showed that participants with lower esophageal sphincter pressure reduction and the proportion of ineffective swallowing (more than 50%) improved in both groups from baseline (P < 0.01), especially in the treatment group (P < 0.05). The percentage of small intermittent contractions, large intermittent contractions, and increased pre-phase contractions in the treatment group significantly improved compared with baseline (P < 0.05) but did not improve in the control group (P > 0.05). There was no significant difference between the groups after treatment (P > 0.05). The percentage of weak esophageal contractility (distal contractile integral < 450 mmHg·s·cm), improved in both groups (P < 0.01), but no significant difference was observed between the groups after treatment (P > 0.05). The relapse rate in the treatment group was lower than that in the control group at the 1 mo (P < 0.01) and 3 mo follow-up (P < 0.05). CONCLUSION:MXD has a similar therapeutic effect to omeprazole in mild-to-moderate GERD. The therapeutic effect may be related to increased pressure in the lower esophageal sphincter and reduced ineffective swallowing.

目的 系统评价6种经典中药方剂单用或联合质子泵抑制剂(PPI)治疗胃食管反流病(GERD)的疗效.方法 检索中国知网、万方、维普、中国生物医学数据库、PubMed、Cochrane图书馆、Web of Science、Clinical Trails,收集6种方剂治疗GERD的随机或半随机对照试验.以NoteExpress筛选文献,提取资料后用偏倚风险评估工具RoB-2评价文献质量,并用Stata 15.1和ADDIS 1.16.8进行网状Meta分析.结果 纳入49项文献,4786例患者,13种干预措施.网状Meta分析示仅四逆散疗效低于PPI,半夏厚朴汤联合PPI、半夏泻心汤联合PPI疗效最佳;单用旋覆代赭汤、小柴胡汤、柴胡疏肝散疗效较好;半夏泻心汤联合PPI疗效优于半夏泻心汤具统计学意义.结论 推荐半夏厚朴汤联合PPI及半夏泻心汤联合PPI治疗GERD.

目的:应用数据挖掘技术对国家专利数据库中治疗胃食管反流病的中药配伍规律进行研究,为临床治疗、中药新药研发提供依据.方法:计算机检索中华人民共和国国家知识产权局网站建库至2020年8月1日治疗胃食管反流病的中药复方专利数据.采用中医传承辅助平台(V2.5)进行证候统计、四气五味归经统计、频次统计、关联规则、复杂网络、复杂系统熵聚类、无监督的熵层次聚类等分析.结果:最常见的主治证候为肝胃郁热证(45.16％),其次为肝胃不和证(37.63％);高频药物四气为温、寒;高频药物五味为苦、辛、甘;高频药物归经为胃、脾、肝、肺;高频单味药物有甘草(45.16％)、黄连(31.18％)、吴茱萸(26.88％)等;高频对药有“黄连-吴茱萸”(18.28％);高频角药有“黄连-柴胡-吴茱萸”(9.68％);通过关联规则发现的常用药物组合“黄连-柴胡→吴茱萸”(置信度0.90);通过复杂网络发现核心药物有吴茱萸、黄连、柴胡、甘草等;新处方有“白术、代赭石、茯苓、山药”“枳壳、吴茱萸、柴胡、茯苓、炙甘草”等.结论:对于胃食管反流病的临床治疗与新药开发过程中,可选择苦、辛、甘昧药物,着眼于五行生克制化,通过调整脾、胃、肝、肺之气机,达到治疗效果,代表组方有左金丸.

目的:研究不同中医证候的胃食管反流病(GERD)患者的食管动力及酸暴露特点.方法:选取2015年4月-2019年12月就诊的具有典型反流症状的189例患者,按照中医证候分为肝胃郁热证、胆胃郁热证、气郁痰阻证、中虚气逆证、脾虚湿热证5型,同时完成胃镜、食管高分辨率测压(HRM)、24 h多通路阻抗联合pH监测.记录相关数据,比较不同证候之间食管动力及pH阻抗结果之间的差异,采用SPSS 16.0软件进行统计分析.结果:上食管括约肌静息压(UESP)比较:气郁痰阻证UESP最低;远端收缩积分(DCI)积分、无效食管动力(IEM)例数、弱蠕动及失蠕动百分率比较:肝胃郁热证、胆胃郁热证DCI积分低于其他证候组,IEM例数、弱蠕动及失蠕动百分率高于其他证候组(P＜0.05);远端收缩延迟(DL)及食管胃连接部(EGJ)分型比较差异无统计学意义(P＞0.05);下食管括约肌静息压(LESP)比较:中虚气逆证LESP最低,其次为脾虚湿热证.在酸暴露方面:脾虚湿热证在DeMeester评分、总反流时间、总反流次数、总AET％、立位AET％、卧位AET％方面均高于其他证候组(P＜0.05);肝胃郁热证及胆胃郁热证在DeMeester评分、总反流时间、总AET％、立位AET％方面高于中虚气逆证(P＜0.05);食管近端反流总计、食管近端酸反流、食管近端弱酸反流比较,气郁痰阻证均高于其他证候组(P＜0.05).结论:不同中医证候的GERD患者的食管动力学指标存在明显差异,气郁痰阻证更多出现上食管括约肌屏障功能下降,肝胃郁热证及胆胃郁热证更多见食管体部蠕动功能障碍,中虚气逆证及脾虚湿热证更多的是EGJ抗反流屏障功能下降.在酸暴露方面,脾虚湿热证的酸暴露各项指标得分更高,气郁痰阻证在食管近端酸暴露各项指标得分更高.GERD中医证候与食管动力及酸暴露有一定相关性.

国际脂肪肝命名小组将"非酒精性脂肪性肝病"更名为"代谢相关脂肪性肝病"(MAFLD),并明确提出了其诊断标准,使得本病的诊断更加明确化、具体化.张声生教授根据"瘅"和"肝瘅"在古籍中的意义,以及"瘅"与代谢相关性疾病的关系,建议将MAFLD命名为中医的"肝瘅",并提出饮食不节、安逸过度、情志失调、痰湿体质、年老体衰是本病的主要病因,而其病位在肝,与脾、肾关系密切."郁""膏""热""虚""瘀"是其核心病机;"疏""消""清""散""补"是其主要治法;肝郁气滞证、膏浊壅肝证、肝胃郁热证、肝络瘀阻证、肝肾阴虚证是本病的主要证型,可选择四逆散、茵陈蒿汤、大柴胡汤、膈下逐瘀汤、一贯煎等为主要方药加减论治.

目的 回顾性分析排便障碍型便秘患者的生物反馈治疗临床应用特点,同时观察治疗频次、总治疗次数与疗效之间的关系.方法 选取2017年1月-2019年4月在我院消化科行生物反馈治疗的排便障碍型便秘患者155例,统计其基本信息、中医证候、治疗频次、总治疗次数及治疗前后便秘症状评分等资料.结果 155例排便障碍型便秘患者以中年女性多见,中医证型以虚证(64.5％)为主;可接受的治疗频率为1～4次/周,其中3次/周(55例,35.5％)的选择比例最高,其次是1次/周(47例,30.3％)、2次/周(47例,30.3％)、4次/周(6例,3.9％);总治疗次数为1～12次,以2～4次为主(84例,54.2％),其次为1次(38例,24.5％)、5～9次(25例,16.1％)、≥10次(8例,5.2％);治疗频率、总治疗次数与疗效均有显著相关性(P＜0.05);治疗频率与总治疗次数相关性显著(P＜0.05).结论 每周2次,治疗2～4次的临床选择率最高,且其疗效不低于本研究中的高频、多次组,可作为生物反馈治疗排便障碍型便秘时具体方案制定的参考依据.

胃食管反流病(gastroesophageal reflux disease,GERD)是消化科常见疾病,根据临床表现其应归属"吐酸""嘈杂""食管癉"范畴,该病病位在食管和胃,临床多从脏腑辨治,但该病与三焦功能密切相关,涉及上、中、下三焦,三焦逆乱、清浊失调致病,本文将从三焦病机及三焦治疗角度对GERD进行阐述,并浅析脏腑辨治与三焦辨治异同,为临床从三焦辨治胃食管病提供理论基础及思路.

Stroke is the leading fatal disease in China. This retrospective study aimed to explore the optimal acupuncture intervention time for long-term efficacy on motor dysfunction in patients suffering from acute ischemic stroke through 1-year of follow-up. Three hundred and nine patients collected at Longhua Hospital from January 2016 to December 2017 were classified into 3 groups based on the acupuncture intervention time, including groups A (within 2 days), B (within 3–7 days) and C (within 8–14 days). All patients had received standard treatment combined with acupuncture therapy. Specifically, acupuncture was performed at the acupoints including LI4 (Hegu), ST40 (Fenglong), DU20 (Baihui), and motor area of the scalp, followed by 2 electroacupuncture protocols based on different muscle tensions once a day for 5 days consecutively. The time-effect relationship was assessed using both the Fugl-Meyer Assessment (FMA) and the modified Barthel index (MBI) on the 90th day and 1st year, respectively. Meanwhile, the modified Rankin scale (mRS), high-sensitivity C-reactive protein (hs-CRP), and fibrinogen (FIB) were also measured during the 1-year follow-up. The favorable outcome rate was 74.4%. One-way univariate analysis of variance (ANOVA) revealed significant differences in FMA and MBI on the 90th day among the 3 groups ([Formula: see text] < 0.05), while no significant differences were observed in FMA, MBI or mRS at the 1st year between groups A and B. The levels of hs-CRP and FIB ([Formula: see text] < 0.05) were markedly reduced. Binary logistic regression analysis suggested that patients with atrial fibrillation (AF) (odds ratio (OR): 3.156), chronic kidney disease (CKD) (OR: 2.563), diabetes mellitus (DM) (OR: 2.174) or stroke history (OR: 1.883) were more inclined to recover poorly from nerve function deficit ([Formula: see text] < 0.05). Earlier acupuncture intervention may have a better long-term effect on motor dysfunction and inflammation during the 1-year follow-up. Moreover, acupuncture within 2 days is probably the optimal treatment time for early recovery on the 90th day.

乌梅丸出自《伤寒论》,是厥阴病代表方,建国之后,众多医家对乌梅丸之组方持“上热下寒、寒热错杂”论,笔者通过查阅文献,梳理了不同时期医家对于乌梅丸认识的差异,从脏腑辨证角度对乌梅丸“上热下寒、寒热错杂”病机提出疑问,并发现从肝阳虚的角度分析乌梅丸,则能解释其组方特点.乌梅丸“寒热错杂”病机是在肝脏阳气虚馁的脏寒基础上,又有相火内郁化热而成,其寒与热均与肝有关,无上下之分.临床应用乌梅丸需抓住脉、症两点:一是脉弦不任重按或弦而无力,二是出现肝经循行部位的症状,根据病证寒热虚实偏颇,调整药物,取温肝阳、益肝体、清郁火之法,可扩展乌梅丸的应用范围.

目的 研究反流高敏感(reflux hypersensitivity,RH)和非糜烂性反流病( non-erosive reflux disease,NERD)患者症状与食管功能特点.方法 选取于2017年11月至2019年3月在首都医科大学附属北京中医医院同时行胃镜、高分辨率食管测压以及食管腔内多通道阻抗联合pH监测的患者60例,根据症状及检查结果分为RH和NERD两组,每组各30例,比较两组患者GerdQ量表评分、食管测压和pH及pH-阻抗监测情况.结果 RH组患者阴性症状(上腹痛、恶心)的评分明显高于NERD组(即发生率明显低于NERD组),差异具有统计学意义(P<0.05).两组患者GerdQ总分以及阳性症状(烧心、反流)和阳性影响 [睡眠障碍、使用非处方(over the counter,OTC)药物]评分比较,差异无统计学意义(P＞0.05). RH组下食管括约肌(lower esophageal sphincter,LES)残余压明显低于NERD组(P<0.05),LES长度、LES静息压、上食管括约肌(upper esophageal sphincter,UES)、静息压、远端收缩积分(distal contractile integral, DCI)平均值、远端收缩延迟、提前收缩百分比、快速收缩百分比、大型蠕动中断百分比、小型蠕动中断百分比两组之间差异均无统计学意义(均P＞0.05). RH组总反流时间、反流次数,直立位反流时间、反流次数,仰卧位反流时间、反流次数,长反流次数,最长反流持续时间,总酸暴露时间占比和立位、卧位酸暴露时间占比,DeMeester评分,酸反流事件总计明显低于NERD组(P<0.05),两组弱酸反流和非酸反流事件总计差异无统计学意义(P＞0.05).结论 RH组患者上腹痛、恶心的症状发生明显少于NERD组;RH组LES残余压明显低于NERD组;RH组总反流时间、反流次数,直立位反流时间、反流次数,仰卧位反流时间、反流次数,长反流次数,最长反流持续时间,总酸暴露时间占比和立位、卧位酸暴露时间占比,DeMeester评分,酸反流事件总计明显低于NERD组.对于存在典型烧心症状、内镜及活检正常的患者,需行高分辨率食管测压、食管pH及pH-阻抗监测以明确诊断,采取针对性治疗以缓解症状.

目的:系统评价四逆散合左金丸治疗胃食管反流病的临床疗效.方法:计算机检索维普数据库(VIP)、中国知网(CNKI)、万方数据库、Pubmed、Embase、Cochrane,纳入以四逆散合左金丸治疗胃食管反流病的随机对照临床试验,检索时限均从建库至2019年7月27日,用改良Jadad质量评价表对纳入研究的文献方法学质量进行评价,用RevMan5.3软件进行分析.结果:共纳入13篇文献,合计936例患者,Meta分析结果显示,与单纯西药组比较,四逆散舍左金丸或联合西药治疗胃食管反流病在总有效率[OR=2.90,95％CI(1.82,4.63),P＜0.000,01]、复发率[OR=0.18,95％CI(-0.09,0.38),P＜0.000,01]方面具有一定的优势,差异均有统计学意义,而胃镜积分变化方面,差异无统计学意义[WMD=0.06,95％CI(-0.32,0.44),P=0.75].四逆散合左金丸联合西药在临床症状积分改善方面具有一定的优势,差异有统计学意义[WMD=-4.20,95％CI(2.04,6.36),P=0.000,1].结论:四逆散合左金丸或联合西药治疗胃食管反流病在总有效率、复发率方面优于单纯西药,胃镜改善方面与单用西药相当.四逆散合左金丸联合西药治疗胃食管反流病在改善临床症状方面优于单用西药.但由于纳入研究文献数量及质量有限,上述结论仍需开展大样本、高质量、多中心、双盲的随机对照试验研究进一步验证.

排便障碍型便秘常见于难治性便秘,是临床治疗难点.李乾构教授认为该病的基本病机为脾虚,常导致阳虚、气郁、湿浊的发生,治疗上以温补脾肾、理气解郁、祛湿导滞为主要治疗方法取得较好疗效.通过总结李乾构教授治疗排便障碍型便秘经验,分析从阳虚、气郁、湿浊角度论治该病的病机及辨证用药规律.

Background The results of the esophageal body motility differences between liquid and solid swallows from high-resolution manometry (HRM) studies are not consistent. The information of the frequency of ineffective liquid and solid bolus swallows in healthy individuals during HRM procedure is limited. The normative values of the HRM parameters of both liquid and solid swallows for Chinese population are lacking. Methods The esophageal HRM data of 101 healthy volunteers from multicenters in China were analyzed. The values of the HRM parameters were summarized and compared between liquid and solid swallows. The frequencies of ineffective liquid and solid swallows were summarized. Results Esophagus contracted stronger and slower in solid bolus swallows than water swallows with HREM. Ineffective water swallow (DCI < 450 mm Hg.s.cm) and ineffective bread swallow (DCI < 800 mm Hg.s.cm) were frequently seen in asymptomatic individuals. The adding of bread swallows to the HREM procedure might cause diagnostic change in about 15.8% (16/101) of the asymptomatic individuals. Conclusions The vigor and velocity of the esophageal peristalsis between liquid and solid bolus swallows are different. Ineffective water and solid bolus swallows are not rare. Adding solid bolus swallows brings diagnostic change, and it may be needed routinely for the HRM procedure.

[目的]评价调肝理脾方治疗胃食管反流病(GERD)的临床疗效.[方法]采取随机、双盲、阳性药物平行对照、多中心研究试验设计,将288例受试者随机分为试验组和对照组,每组144例.于治疗前及治疗后分别对2组患者进行反流性疾病问卷(Gerd-Q)评分、中医单项症状疗效评分、中医症状综合疗效评价,分别随访1个月、3个月.记录2组患者未再服药、维持服药、间歇服药、按需服药的人数并计算维持缓解的比例.[结果]研究共计脱落42例,试验组完成研究116例、对照组130例.试验组及对照组Gerd-Q评分在治疗2周、治疗4周均较本组治疗前降低(P＜0.01).2组间Gerd-Q评分在治疗2周、治疗4周差异无统计学意义(P＞0.05).2组在单项症状:烧心、反酸、上腹胀、情绪变化则加重、吐稀水、大便不成形、喜长出气、呃逆、上腹不适、咽部异物感、倦怠乏力、食欲不振、口干口苦等方面治疗4周后均有显著改善(P＜0.01).其中试验组在治疗喜长出气、呃逆、食欲不振方面优于对照组(P＜0.05).在中医症状综合疗效方面,试验组与对照组差异无统计学意义(P＞0.05).停药1个月、3个月2组间未再服药人数比例试验组分别优于对照组(P＜0.01,P＜0.05).[结论]调肝理脾方治疗胃食管反流病可以明显改善患者临床症状,其短期疗效相当于奥美拉唑,在缓解患者喜长出气、呃逆、食欲不振方面优于西药,根据随访1个月及3个月的数据,调肝理脾方维持缓解更好,更少复发.