目的:通过体内外实验观察固本畅枢法对肥胖糖尿病大鼠糖脂代谢的影响及胰岛 β 细胞MIN6凋亡的干预作用.方法:体内实验:高脂高糖喂养+小剂量链脲佐菌素(streptozocin,STZ)一次性腹腔注射复制肥胖糖尿病大鼠模型,连续灌胃给药4周,观察大鼠饮水、摄食、尿量及一般情况,检测模型大鼠的空腹血糖(fasting blood glucose,FBG)、空腹胰岛素(fasting insulin,FINS)、甘油三酯(triglyceride,TG)、总胆固醇(cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein,LDL-C)、高密度脂蛋、白胆固醇(high density lipoprotein,HDL-C)水平,观察胰腺、肝脏、肌肉、脂肪组织病理,采用TUNEL-DAPI共染色法检测各组大鼠胰腺 β 细胞凋亡情况,了解细胞凋亡形态学特征;体外实验:培养小鼠胰岛 β 细胞MIN6,采用流式细胞术定量分析MIN6细胞凋亡情况.结果:体内实验:固本畅枢法能减少糖尿病模型大鼠的饮水、摄食、尿量(P<0.01),差异有统计学意义;能降低FBG、FINS、TC、TG,升高HDL水平(P<0.05,P<0.01),差异有统计学意义;可修复胰腺、肝脏、肌肉、脂肪组织病理结构,使其形态更规则;能改善模型组大鼠胰腺 β 细胞凋亡时的细胞形态(P<0.01),差异有统计学意义);体外实验:固本畅枢法能减少模型组MIN6细胞的凋亡细胞数量.结论:固本畅枢法改善糖脂代谢紊乱,其作用机制与修复组织病理、抑制胰岛 β 细胞凋亡有关.

[目的]通过定性研究方法探索糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)患者中医药治疗意愿及影响因素,了解患者在诊疗过程中对于治疗方案的期望及需求,为DPN未来的中医药循证医疗决策提供意见及建议.[方法]基于扎根理论,采用目的性抽样法于2019年6月至12月选取广州两所三甲医院DPN住院患者进行半结构式定性访谈,采用三级编码及撰写备忘录的方法分析访谈资料.[结果]对14例DPN住院患者的访谈结果显示:DPN患者中医药治疗意愿及影响因素的核心范畴为"稳定病情",主要包括疾病认知、对中医的态度、医疗环境、人际关系、治疗期望5个范畴.患者希望病情经过治疗得以稳定,期望能够得到有效、持续、副作用小及便利舒适的治疗方式.患者对具有调理作用的中药汤剂存在一定偏好,并认同心理状态对疗效的影响,认为家人的陪伴及医患有效沟通是影响其顺利治疗的因素.[结论]未来在DPN的临床诊疗中应当结合患者对中医治疗措施的偏好和经验,建立具有中医特色的DPN慢病管理系统;关注患者的心理健康状态,促进患者疾病认知水平及医患关系的改进.同时将患者偏好纳入临床研究的范围内,在DPN临床实践指南推荐意见的形成过程中也应考虑患者对于干预措施及其安全性的意愿及看法.

目的:观察隔药饼灸对慢性支气管炎模型大鼠外周血中T细胞亚群含量的影响,探讨隔药饼灸防治慢性支气管炎的可能机制.方法:48只SD大鼠随机分为空白组、模型组、隔药饼灸组、核酪口服液组4组各12只,采用改良烟熏法复制慢性支气管炎大鼠模型,流式细胞术检测血清中T细胞亚群含量变化.结果:与空白组比较,模型组大鼠外周血中CD4+、CD8+、CD4+/CD8+明显降低;与模型组比较,隔药饼灸组、核酪口服液组CD4+、CD8+及CD4*/CD8+升高;与核路口服液组比较,隔药饼灸组CD4*、CD8+、CD4+/CD8+升高更明显.结论:隔药饼灸可能通过上调外周血中CD4+、CD8+T细胞亚群含量,提高CD4+/CD8+,起到对慢性支气管炎的防治作用.

目的:运用Meta分析的方法评价温针灸治疗膝关节骨性关节炎的临床疗效.方法:计算机检索Cochrane Library、PubMed、Web of Science、中国知网(CNKI)、维普全文数据库(VIP)、万方数据库(WF)中温针灸治疗膝关节骨性关节炎的临床随机对照试验文献,检索时间限定为建库至2017年10月,采用专人筛选文献和提取数据,采用RevMan 5.3进行Meta分析.结果:共纳入10篇文献,819例患者,Meta分析结果显示,温针灸治疗组与对照组比较,总有效率[OR =5.22,95％ CI(3.45,7.89),P＜0.00001],治愈率[OR =2.32,95％ CI(1.69,3.19),P＜0.00001],具有明显统计学意义.结论:温针灸治疗膝关节骨性关节炎的疗效肯定,但由于纳入的文献方法学质量不高,需要高级别的临床临床随机对照试验加以验证.

目的:观察隔药饼灸对慢性支气管炎大鼠p-p38MAPK、ICAM-1的影响.方法:将48只SD大鼠随机分成空白组、模型组、隔药饼灸组、隔纸垫灸组,每组12只.选用改良烟熏法建立大鼠慢性支气管炎模型,干预后,测定肺泡灌洗液中性粒细胞含量,各组大鼠ICAM-1 mRNA选用RT-PCR术测定、ICAM-1及p-p38MAPK蛋白选用Western blot检测.结果:与空白组比较,模型组中性粒细胞、p-p38MAPK、ICAM-1 mRNA及蛋白含量增高显著(P<0.01).与模型组比较,隔药饼灸组中性粒细胞数目减少(P<0.05),p-p38MAPK、ICAM-1 mRNA及蛋白含量显著降低(P<0.01).与隔纸垫灸组比较,隔药饼灸组中性粒细胞、p-p38MAPK蛋白、ICAM-1 mRNA及蛋白降低更明显(P<0.05).结论:隔药饼灸可通过减少p-p38MAPK蛋白含量、降低ICAM-1 mRNA及其蛋白水平,抑制中性粒细胞的释放,以改善炎性反应环境治疗慢性支气管炎.

目的 系统评价天芪降糖胶囊对糖尿病前期患者的糖尿病转化率、血糖、血脂、体重指数的影响.方法 计算机检索公认的中英文数据库,纳入天芪降糖胶囊治疗糖尿病前期的随机对照试验,检索时限为1970～2018年12月.经过文献筛选、资料提取、偏倚风险和证据质量评价后,采用RevMan 5.3进行Meta分析.结果 纳入7个研究,1061例患者.Meta分析结果显示,天芪降糖胶囊组的糖尿病转化率[OR=0.43,95％CI(0.32,0.58),P＜0.000 01]、空腹血糖[MD=-0.32,95％CI(-0.49,-0.16),P＜0.0001]、餐后2h血糖[MD=-1.24,95％CI(-1.86,-0.61),P=0.0001]均低于对照组.结论 天芪降糖胶囊能延缓糖尿病前期人群进展为糖尿病,但仍需大量、高质量的研究证实.

范冠杰教授在长期诊治消渴病的基础上总结、创立了“动-定序贯八法”.临证中运用“动-定序贯八法”之疏肝法有3个要点:①抓住辨证的核心症状,即性情易怒烦躁,或郁郁寡欢;女性月经不调,脉弦.②辨证过程中注意核心病机的发展变化,连贯有序.随着病情发展,可出现化热入营,心神不宁;气机阻滞也可导致血脉瘀阻;热藩血分,又可导致耗气伤阴.因此,在不同阶段,结合临床实际情况,需要联用“动-定序贯八法”之清营凉血、养心安神、活血化瘀、益气养阴之药串,把握前后变化的因果联系十分关键.③运用疏肝药串灵活加减.肝郁甚时,柴胡、薄荷加量;如患者合并血虚有阴伤倾向,而无明显湿滞时,可重用白芍以敛阴柔肝;血分郁热时,重用郁金、牡丹皮.疏肝法在临床运用时不可拘泥于固定的一方一药,又要在变中有守地动态把握规律辨证施药,这正是“动-定序贯八法”理论的本质.

目的:氮酮和冰片作为促透剂运用于药饼中对高脂血症兔进行隔药饼施灸,观察其对高脂血症兔血脂及炎性反应因子的调节作用.方法:将40只新西兰兔随机分为正常组、高脂模型组、无促透剂组、氮酮组和冰片组,每组8只.正常组普通饲料喂养,其余各组用高脂饲料喂养12周成高脂模型,成模后采用不同促透剂运用于隔药饼灸施灸4周后,检测兔血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及TNF-α、INF-γ的含量.结果:3个隔药饼灸组均显著降低高脂模型兔血清TC、TG、LDL-C的含量(P<0.05)、显著升高HDL-C的含量(P<0.05);氮酮组降低TC和TG、冰片组降低TC、TG、LDL-C的效果优于无促透剂组(P<0.05);冰片组降低TC、TG、LDL-C的效果优于氮酮组(P<0.05);3个隔药饼灸组均能显著降低高脂血症兔TNF-α及INF-γ的水平(P<0.05),且氮酮组和冰片组降低TNF-α、INF-γ的疗效优于无促透剂组(P<0.05),冰片组降低TNF-α的效果优于氮酮组(P<0.05).结论:隔药饼灸能有效调节高脂模型兔血脂及炎性反应因子水平,氮酮和冰片作为促透剂运用于药饼后施灸对实验性高脂模型兔血脂及炎性反应因子的调节作用更显著,且冰片组作用比氮酮组更优,值得进一步研究.

目的:通过Meta分析,评价长蛇灸及以长蛇灸为主治疗类风湿性关节炎(RA)的临床疗效.方法:计算机检索中国知网(CNKI)、维普中文科技期刊数据库(VIP)、万方数据及PubMed数据库,时间为自建库至2018年6月15日,检索长蛇灸及以长蛇灸为主治疗RA的临床随机对照试验(RCTs),采用RevMan 5.3进行Meta分析.结果:最终纳入10篇文献,共1287例患者.Meta分析结果显示,长蛇灸治疗RA总有效率优于对照组(P ＜0.00001),长蛇灸+针刺治疗该病总有效率优于对照组(P ＜0.00001),长蛇灸组类风湿因子(RF)、血沉(ESR)、C反应蛋白(CRP)显著低于对照组(P ＜0.00001).结论:长蛇灸及长蛇灸联合针刺治疗RA是有效的,且其疗效优于其他对照疗法,长蛇灸可降低RA患者RF、ESR、CRP水平,且优于其他对照疗法.但由于纳入的文献数量较少,且方法学质量不高,故上述结论尚需进一步验证.

目的:观察隔药饼灸对慢性支气管炎大鼠外周血中中性粒细胞(PMN)的影响,以阐明其作用机制,为隔药饼灸防治慢性支气管炎提供实验依据.方法:将48只SD大鼠随机分为空白组、模型组、核酪口服液组、穴位隔药饼灸4组,每组12只.观察大鼠的一般情况,用流式细胞术检测各组血清中中性粒细胞吞噬指数.结果:与模型组比较,穴位隔药饼灸和核酪口服液组PMN吞噬指数均有降低(P<0.05),且穴位隔药饼灸组降低效果更优(P<0.05).结论:穴位隔药饼灸能改善慢支大鼠肺与气管组织损伤情况并控制炎症,其机制可能是通过降低大鼠PMN吞噬指数,起到有效控制炎症作用.

目的 探讨氮酮和冰片作为促透剂运用于隔药饼灸对高脂血症合并动脉粥样硬化兔主动脉病理形态及血清炎症因子的影响.方法 选取40只新西兰纯种兔随机分成5组,每组8只,即正常组、模型组、无促透剂组、氮酮组和冰片组.高脂血症合并动脉粥样硬化兔模型造模成功后除正常组和模型组外,其余各组采用隔药饼灸干预,每日1次,连续4周.采用ELISA检测血清白细胞介素6(Interleukin 6,IL-6)、白细胞介素10(Interleukin 10,IL-10)含量;采用HE染色,光学显微镜下观察主动脉组织形态.结果 与正常组比,模型组IL-6水平显著升高、IL-10水平显著降低(P<0.01);与模型组比,无促透剂组、氮酮组及冰片组IL-6水平显著降低(P<0.01)、IL-10水平升高(P<0.05);与无促透剂比,氮酮组和冰片组IL-6水平显著降低(P<0.01)、IL-10差异无统计学意义(P>0.05);与氮酮组比,冰片组IL-6水平显著降低(P<0.01)、IL-10差异无统计学意义(P>0.05).主动脉组织镜检结果示:正常组无异常;模型组可见组织整体凌乱,管腔壁可见明显增厚,内皮坏死,有明显的脂质斑块及泡沫细胞;无促透剂组有内膜增厚,可见少量泡沫细胞,细胞排列较模型组稍好,脂质沉积明显较模型组减少,斑块不明显;氮酮组和冰片组无显著异常.结论 隔药饼灸对高脂血症合并动脉粥样硬化兔具有抑制炎症反应和抗动脉粥样硬化作用,在药饼中加入促透剂后施灸疗效更优,可能与药饼中药物透皮吸收增强有关,值得进一步临床应用和研究.

肥胖2型糖尿病(T2DM)正成为危害人类健康的流行性疾病,其多由先天禀赋、情志、饮食、生活方式等因素导致脾失运化、肝失疏泄、气机不畅,水谷肥甘之物转变为痰湿脂质积聚体内所成.其中脾肝功能失调在本病发病过程中起重要作用,脾虚湿滞是肥胖T2DM存在的体质基础,气机不畅是其重要发病条件.临床辨治肥胖T2DM从脾虚及气机不畅入手,运用扶脾理肝法治疗肥胖T2DM是一种有益的探索.

Objective To observe the effect of herbal cake-separated moxibustion on the content of tumor necrosis factor-α (TNF-α) protein and its mRNA in the lung tissue of rats with chronic bronchitis (CB). Methods Forty-eight Sprague-Dawley rats were randomly and equally divided into four groups, including blank group, model group, herbal cake-separated moxibustion group, and paper pad-separated moxibustion group. CB model rats were prepared by modified fumigation. The general status of rats after herbal cake-separated moxibustion was observed and compared with that in the other three groups. The expression of TNF-α mRNA in rat lung was measured by RT-PCR, and the protein expression of TNF-α in lung tissues was measured by Western blot.Results The pathological injury of lung and trachea of rats in herbal cake-separated moxibustion group and paper pad-separated moxibustion group was improved compared with that in the model group. Herbal cake-separated moxibustion and paper padseparated moxibustion can reduce the expression of TNF-α mRNA and TNF-α protein in the lung tissues of CB rats (P＜0.05), and the effect of herbal cake-separated moxibustion was better (P＜0.05). Conclusion Herbal cake-separated moxibustion can improve the general symptoms and airway inflammation of CB rats, possibly by down-regulating the expression of TNF-α protein and its mRNA.

Objectives To use visualization method to analyze the relevant literature about prevention and treatment of obesity type 2 diabetes mellitus (T2DM) with TCM; To understand research hot spots and development trends of this field. Methods Computers were used to retrieve prevention and treatment of T2DM with TCM in CNKI. CiteSpaceV was used to visualize the authors, research institutes and keywords, and discussed their research hot spots, research frontiers, major research groups and trends. KNS6.6 was used to quantitatively analyzed included literature distribution characteristics, core citations, etc., and conducted visual display. Results After screening, 130 articles were included, involving 257 researchers and 6 research institutes, among which, TONG Xiao-lin, DONG Liu, ZHOU Li-bo, etc. were the main researchers. Guang'anmen Hospital of China Academy of Chinese Medical Sciences is the most important research institute, followed by Beijing University of Chinese Medicine, Changchun University of Chinese Medicine and Guangzhou University of Chinese Medicine. The main research directions included the diagnosis and treatment of obesity T2DM, acupuncture and moxibustion treatment, the mechanism of TCM intervention in inflammation. This study predicted exploration of the TCM pathogenesis of obesity T2DM and the construction of TCM clinical pathway may be the future research trends and hot spots. Conclusion Through visualization analysis, the main research directions in the field in recent 20 years, research hot spots, evolution veins and development trends can be understood quickly and intuitively, providing a basis for further research.

针刺治疗是针具和手法的结合.在针刺得气后,为达到一定的治疗目的,往往需要施展一定的手法.“青龙摆尾”针刺手法源于明代医家徐凤的“飞经走气”四法之一,该手法自创立以来在针灸界影响颇大,深受后世医家的重视,许多医家根据临床实践在此基础上进行了创新.笔者通过查阅文献,总结历代医家对该手法的论述及现今临床运用情况,并提出自己的一些看法.

目的:通过Meta分析评价三伏贴治疗哮喘的临床疗效.方法:计算机检索中国知网、维普全文数据库、万方数据库、Cochrane Library、PubMed、Web of Science,时间为建库至2017年8月18日,检索所有有关三伏贴治疗哮喘的临床随机对照试验,采用Review Manager 5.3进行Meta分析.结果:最终纳入11篇文献,Meta分析显示三伏贴治疗哮喘治疗组与对照组比较,总有效率[OR =3.27,95％ CI(2.19,4.87),Z=5.82,P＜0.00001],最大呼气流量(PEF)[OR=0.28,95％ CI(0.08,0.47),Z=2.81,P=0.005＜0.05],第一秒用力呼气容量比用力肺活量(FEV1/FVC)[OR=7.28,95％ CI(5.97,8.60),Z=10.87,P＜0.00001],三者组间比较差异有统计学意义;第一秒用力呼气容量(FEV1)[OR=-0.05,95％ CI(-0.21,0.21),Z=0.01,P=0.99 ＞0.05],组间比较差异无统计学意义.结论:三伏贴治疗哮喘有效且优于其他诸如西药、针刺等疗法,可改善PEF、FEV1/FVC,但对FEV1无明显影响.由于纳入的文献数量较少,缺乏高质量临床RCT研究,文献可能存在发表偏倚,故上述结论有待进一步考证.

Objective:This paper analayzes Professor FAN Guan-jie's medication experience in treating acute gouty arthritis on the basis of data mining and concludes the differentiation ideas.Methods:One hundred and ninty cases with acute gouty arthritis were enrolled for database Construction.:The high frequency medicine are Coicis Semen,Smilacis Glabrae Rhizoma,Plantaginis Herba,Lilii Bulbus,Bolbostemmatis Rhizoma,Lonicerae Japonicae Caulis.The top 5 high-frequency herbs were heat-cleaning herbs,water-disinhbiting damp-transforming herbs,tonic herbs,blood-quickening stasistransforming herbs,wind-damp-dispelling herbs.Conclusion:The top 2 high-frequency nature of drugs were herbs with cold and warm characters.Sweet,Bitter,symplectic and light Herbs were the high-frequency flavour of drugs.Conclusion:The treatment of acute gouty arthritis from the theory of liver treatment has a better effect.

Objective To explore the composition principles of prescriptions for simple obesity based on the analysis of medical literature issued in recently 30 years about Chinese medicine for simple obesity. Methods We collected literature of Chinese medicine in treating simple obesity from VIP, CNKI, Wanfang, CBM and CMCC/CMCI databases, and screened out the formulas for simple obesity to establish a formula database. And then the medication rules were figured out with the Traditional Chinese medicine Inheritance Support System version 2.5 (TCMISS 2.5) software. Results A total of 57 formulas were screened out. And the top 10 herbs with highest occurrence frequency in the prescriptions were Poria, Rhizoma Atractylodis Macrocephalae, Rhizoma Alismatis, Radix et Rhizoma Rhei, Fructus Crataegi, Radix Astragali, Radix Glycyrrhizae, Folium Nelumbinis, Pericarpium Citri Reticulatae and Semen Cassiae. After data mining, we got 13 high-frequency herb-pair combinations and 31 core combinations, and 8 new prescriptions were extracted. Conclusion The research has achieved the quantitative description of the relationship between the Chinese medicines, the extraction of the core combinations and the discovery of new Chinese medicine prescriptions for simple obesity. The results will provide references for the development of new Chinese medicines for the treatment of simple obesity .

Objective:To study the characteristics of traditional Chinese medicine of surgical removal of thyroid nodules.Methods:The data of patients with thyroid nodules underwent surgical resection from January to August,2015 in Guangdong Province Traditional Chinese Medical Hospital were collected,including demographic information,pathological diagnosis,first dose of traditional Chinese medicine and so on.Results:The ratio of male to female ratio was 1:3.9 in 244 cases.There were 170 cases of benign nodules,with mean age (48.7±13.8) years old,74 cases of malignant nodules in malignant group,with mean age (42.0±12.7) years old.Cumulative use of Chinese medicine frequency 2697,widely used for heat clearing drugs,medicine,virtual medicine,drugs for resolving phlegm,regulating Qi,promoting blood circulation to remove blood stasis.Cluster analysis results show that Shengjiang (ginger),Dazao (jujube),Shengma (Cimicifuga),Huangqi (Astragalus) and Dangui (angelica) for a class,Dangshen (Codonopsis),Baizhu (Atractylodes,Chaihu (bupleurum root) for a class,Fabanxia (pinellia),Fuling (Poria),Zhiqiao (Fructus aurantii) for a class,Lugen (reed root),Danzhuye (lophatherum gracile),Dandouchi (light Douchi),Jinyinhua (honeysuckle),Bohe (mint),Lianqiao (forsythia),Niubanzi (buff),Jiegeng (Balloonflower root),Jingjie (Schizonepeta) for a class.Conclusion:The young and middleaged thyroid nodules are more prone to malignant transformation,need operation treatment,surgical resection of thyroid nodule patients after common wind heat and stagnation of phlegm evil invading in the head and neck,and clearing heat and relieving exterior phlegm throat is the main treatment.

目的:观察益气化痰活血法对气虚痰瘀型超重/肥胖2型糖尿病糖脂代谢及肥胖抑制素的影响,并探讨其作用机制.方法:86例超重/肥胖2型糖尿患者随机分为治疗组和对照组,各43例,治疗组采用益气化痰活血中药+基础治疗,对照组采用安慰剂+基础治疗;治疗前后分别检测空腹血糖、餐后2h血糖、空腹胰岛素、糖化血红蛋白、血脂、肥胖抑制素(obestatin),安全性指标(三大常规、肝肾功能),计算胰岛素抵抗指数(HOMA-IR),并详细观察患者症状、体征的变化以及药物的毒副反应.结果:治疗后治疗组中医疗效优于对照组(P＜0.05),可以明显改善少气乏力/懒言、口干不多饮、肢体麻木或刺痛等症状;治疗后与对照组比较,治疗组体质量指数、餐后2h血糖、糖化血红蛋白、胰岛素抵抗指数明显下降(P＜0.05),obestatin明显升高(P＜0.05),治疗组胆固醇、低密度脂蛋白显著下降(P＜0.01),高密度脂蛋白显著升高(P＜0.01);两组治疗后空腹血糖、甘油三酯比较差异无统计学意义.结论:益气化痰活血法可以改善治疗组患者糖脂代谢紊乱、胰岛素抵抗,提升obestatin水平,这可能是益气化痰活血中药复方发挥作用的途径之一.