脾瘅是因过食肥甘而致中满内热,并且以口甘为主症的一种代谢性疾病前状态.脾瘅病位在脾,病理基础在于火热熏灼.本文基于《黄帝内经》"备化"一词探究脾瘅火热根源,提出"备多-化少"这一病理过程为火热之源.脾瘅之始,因"备多"而纳化失衡,积而化火;随着火邪发展,因"化少"而精微不运,郁而化火.脾瘅之火亦可传至五脏,而引起不同的临床症状.临证以恢复脾之备化平衡为要,截断火邪发生、发展,同时可根据火热传变,分脏论治,有助于实现脾瘅火热的精准治疗.

目前,糖尿病是我国高发疾病之一,中国糖尿病患者约占全球糖尿病患者的四分之一,现代医学上的糖尿病属于中医"消渴病"范畴.《黄帝内经》中提及"脾主为胃行津液",其论述了消渴病发生的病机与病位,强调脾胃尤其是脾之运化在消渴病发生中的重要作用.脾胃为后天之本,各司其职,脾将胃腐熟饮食所形成的水谷精微转输至全身,若脾病不能为胃行津液,脾气上溢运化失常,脾热上溢,则发为消渴.脾阴作为脾的物质基础,是脾气和脾阳的生化来源,同时脾阴与脾阳相互制约共同完成脾的运化功能,只有保证脾阴的充足才能保证"脾主为胃行津液".因此,文章立足于"脾主胃行津液"提出消渴病早期的发生发展与津液的损伤、脾尤其是脾阴的正常与否密切相关的观点,从而以"甘润"为大法,与气药、血药等并用调治脾阴,以恢复"脾主为胃行津液"达到防治消渴病的目的.

目的:运用网络药理学的分析方法探讨吕仁和教授自拟的脾瘅降糖方在糖尿病前期中的作用靶点和机制.方法:筛选脾瘅降糖方中药物的活性成分,检索与成分相关的靶点数据;筛选2型糖尿病的相关基因靶点数据;对所筛选得到的靶点数据取其交集,分析得到蛋白质-蛋白质相互作用网络,并进行"脾瘅降糖方-糖尿病-靶点"富集分析,从而得到脾瘅降糖方对2型糖尿病调节作用的主要途径.结果:脾瘅降糖方主要有效成分为木犀草素、槲皮素、黄芩苷、谷甾醇、荜拨宁、栀子黄、甘草素、3'-甲氧基大豆苷元等;脾瘅降糖方治疗2型糖尿病的关键靶点为碳酸酐酶Ⅳ、丝苏氨酸激酶、丝裂原活化蛋白激酶、血管内皮生长因子A、多药耐药性蛋白、碳酸酐酶Ⅱ、碳酸酐酶Ⅰ等;脾瘅降糖方通过众多途径(包括:肾上腺素分泌、单萜类、omega-羟化酶、胰岛素分泌、神经活性配体-受体相互作用、HIF-1信号通路、环腺苷酸信号通路、AMPK信号通路等)对2型糖尿病有调节作用.结论:脾瘅降糖方能从多途径对机体进行调节,进而在糖尿病前期就阻断其发展,恢复机体健康.

Objective To compare and analyze the diagnosis and treatment basis of traditional Chinese and western medicine on pre-diabetes（PDM）in the new edition of the guide in China and abroad, providing references for optimizing the diagnosis and treatment of PDM with integrated traditional Chinese and western medicine.Methods The electronic databases and related guide websites in China and abroad were searched from January 2017 to July 2022,and the latest PDF version of the guide was downloaded to analyze and compare the diagnostic criteria, hazards, and intervention measures of PDM.Results Fifteen latest guidelines on PDM published in China and abroad were finally included.In terms of diagnostic criteria, the differences between domestic and foreign guidelines mainly lied in the definition threshold of fasting blood glucose and whether glycated hemoglobin was included as one of the diagnostic criteria.In terms of the harm of PDM,cardiovascular events gradually attracted the attention of all countries.In terms of intervention measures, the guides of all countries emphasized the importance of lifestyle intervention.On the basis of poor lifestyle intervention, hypoglycemic drugs could be combined.In China′s local guidelines, PDM were treated with characteristics of traditional Chinese medicine, giving full play to the advantages of its characteristics.Conclusion The diagnosis and treatment of PDM with integrated traditional Chinese and western medicine is an advantage in the field of“treating disease before its onset”.In terms of diagnosis, it is suggested that fasting blood glucose and glycosylated hemoglobin should be jointly diagnosed, which can further clarify the risk stratification of patients according to the numerical value.PDM is closely related to cardiovascular events, so we should actively screen out and treat cardiovascular risk factors.In the aspect of clinical intervention, it is emphasized that lifestyle intervention such as diet, exercise, and weight loss is the cornerstone.On the basis of poor intervention, hypoglycemic western medicine with strong evidence base and safety such as metformin and acarbose can be combined with syndrome differentiation and treatment based on the characteristics of traditional Chinese medicine.

Proportion is a common concept in mathematics,not only that it also occupies a very important position in physics,chemistry,biology and other disciplines. In daily life,the use of proportions can be seen everywhere. The proportional relationship has been recorded in Chinese culture for a long time,and it is reflected in astronomy,geography,and human culture. The theory of traditional Chinese medicine（TCM） is also rich in the application of proportional relations to explain the changes in the three Taos of heaven,earth and man and to guide the diagnosis and treatment of diseases. The use of proportional relationships to sort out the occurrence,development and prognosis of diseases can bring into full play the advantages of TCM and extract efficient treatment plans. This article intends to provide prescription drug ideas for clinicians to diagnose and treat diseases through simple sorting out,and to give full play to the advantages of traditional medicine of “simple,convenient and excellent”.

Chronic nephritis is a glomerular immune disease with different pathological manifestations caused by a variety of reasons.Its pathogenesis is complicated.Common triggering factors include infection (such as upper respiratory tract infection, acute gastroenteritis, etc. causing inflammatory response in the body), environmental factors and Some chemotherapy drugs, etc. Traditional Chinese medicine has a profound understanding of the treatment of chronic nephritis.By summarizing Professor Lv Renhe's theory of micro-disease in the kidneys and collaterals, this paper sorts out the main line of pathogenesis of chronic nephritis "evil-sickness-disease-disease".It is believed that the nature of the disease should be regarded as both deficiency and excess, and the disease location is in the three viscera of the lungs, spleen and kidney.The dysfunction of the lung, spleen and kidney is the key to the pathogenesis of chronic nephritis, which should be mainly based on the deficiency of the root, supplemented by the actual body.Deficiency of spleen and kidney qi is the main factor, and the main pathological products such as dampness, blood stasis, phlegm, heat, and poison are accumulated in the body, resulting in the manifestations of phlegm turbidity, blood stasis, dampness toxin, chronic disease, and constipation.The purpose is to explain that the main pathogenesis of Professor Lv Renhe's "Xie Fu -

李东垣在《脾胃论》中专设"脾胃胜衰"一章,较为全面地论述了其病因、病机、症状、治法及其与五脏、阴阳气血津液之间的关系,指出脾胃脏腑胜衰及五行乘侮均可伤及脾胃,影响正常功能的发挥.糖尿病前期可归属于中医"脾瘅"范畴,其病因为"数食甘美而多",饮食自倍,肠胃乃伤,强调脾胃受损在糖尿病前期发病中的重要性,病位关键脏腑即在于脾和胃,两者协调则纳化正常,若一方偏胜或偏衰,阴阳失衡,则会表现出不同的病理状态.因此,基于"脾胃胜衰论",提出胜衰失衡是脾瘅的核心病机.脾瘅不同阶段,病机变化有别,早期可表现为脾胃俱旺致中满壅实,中期可表现为胃强脾弱致中盛气虚,晚期则以脾胃俱虚、中弱不化为主.五行生克相关,余脏腑的病变也会影响人体正常的血糖代谢,导致脾瘅期的出现,提出脾瘅传变期,其病机在于五行乘侮致中衡不守.因此,恢复脾胃胜衰失衡成为治疗糖尿病前期的重要着力点,中医早期辨证干预与治疗,可以充分发挥"治未病"优势.

代谢性疾病病前状态,是多种代谢性疾病的基础病理状态,在临床上最客观的指标是理化指标的升高,但尚未达到代谢疾病确诊范围.在中医看来,其相当于古代文献论述的脾瘅,古今医家大多认为其病机在于热,在于肥美甘物的过多食用,且在当今社会环境影响下发现运动、情志等因素往往也能诱发该疾病的发生."热"并不是脾瘅单一的病理状态,从其引诱因素分析,可发现"郁""劳"在该病种有着重要临床指导意义.

师承教育作为古代中医传承的重要方式之一,使得中医学不断发展、名医辈出,千载不衰,有着其独特的优势.而在全新的教育理念与教学模式不断变化的今天,中医药人才培养的主要形式是院校教育,如何将传统师承教育的精髓吸纳融合于现代院校教育中,成为高等中医药院校及附属医院亟待解决的重要问题.故笔者在中医学习中,通过对传统师承教育培养模式的梳理,提出与院校教育所不同的6个方面,即"早、细、严、实、网、新",和大家共同讨论.

中华文化起源于古人对自然界的观察认识,关注的是在自然界规律总体框架下对万物的观察与解读.中医药体系以中华文化为养分,从对自然规律、药物认识到人体生长变化、疾病产生发展过程的解释中,均体现出对事物本质规律的关注,并最终对事物的趋向性发展作出解释.中医药人对这种趋向性的把握与中国传统文化中"势数"学说的思想息息相通.所谓"察势者智,驭势者赢",运用"势数"来认知人体的生理病理变化以及自然界对其的影响,能够合理有效地帮助医者厘清临床思路,判断疾病的全程发展,进而精准施以治疗措施.

吕仁和教授认为隐匿性肾小球肾炎初起多无明显症状,临床若仅依靠症状诊治易忽略病情进展,因此,应根据患者整体和局部临床表现,分三期论治本病.早期以祛邪为主,重在发散风热、祛风湿清热;中期扶正与祛邪兼顾,扶正以补益肺、肝、脾、肾为主,兼通活冲、任、督、带四脉,祛邪针对由气滞、血瘀、痰阻、食积、湿热壅滞等病机导致的病理产物,随证用药;晚期非大补不能救其虚,非通利不能解其闭,非软坚不能化其癥,故治以补益亏虚、通利二便、消癥化结、通利血脉.

目的:系统评价在生活方式干预的基础上使用耳穴贴压及耳穴贴压联合中药两种方式改善糖尿病前期的临床疗效.方法:收集耳穴贴压干预糖尿病前期的随机对照试验(RCTs),检索时间为建库至2021年5月,采用RevMan5.3进行耳穴贴联合中药改善糖尿病前期的Meta分析.结果:共纳入10篇RCT,涉及患者994例.根据不同干预措施进行亚组分析(耳穴贴压亚组、耳穴贴压联合中药亚组),结果显示:(1)耳穴贴压亚组在降低空腹血糖[MD=-0.57,95％CI(-0.86,-0.28),P=0.0001]、餐后2小时血糖[MD=-0.87,95％CI(-1.19,-0.58),P<0.00001]、糖化血红蛋白[SMD=-0.87,95％CI(-1.52,-0.22),P=0.008]方面优于对照组.(2)耳穴贴压联合中药亚组在降低空腹血糖[MD=-0.54,95％CI(-0.72,-0.36),P<0.00001]、餐后2小时血糖[MD=-1.15,95％CI(-1.73,-0.57),P=0.0001]、糖化血红蛋白[SMD=-0.78,95％CI(-1.05,-0.51),P<0.00001]方面优于对照组.敏感性分析显示结果稳定性较好.结论:无论是否联合中药,耳穴贴压对糖尿病前期的改善均优于对照组且疗效显著,两者结果无显著性差异.

人体的生命轨迹在不同的阶段具备不同的生理特性,在古籍文献记载中中医各家从阴阳气血各个方面的不同比例对人体进行了幼、少、壮、老四个阶段的概括,或是以六七之数阐释人体脏腑机能的盛衰变化,借以指导医家认识人体的变化及疾病产生的特点,除却这种生理上的特点,人体在生命轨迹上也表现出"势"的牵引,从生到亡,形似正态分布般的生命曲线,反映了人体合于自然的规律,因此人体的这种生命趋势是自然引导的结果,在临床活动中应该兼顾这种生命趋势,从而更加贴合人体生命轨迹进行辨证论治,帮助患者达到以平为期的生理状态.

摘要：导赤散是中医清心利水养阴的重要方剂，出自《小儿药证直诀》。本方由四味药组成，可清心养阴、利水通淋，既清心经之火，又导小肠之热，主治心经火热证或心火下移小肠，经配伍可扩大其应用范围。现拟从精神疾病、口腔疾病、泌尿系统疾病、皮肤疾病等方面，综述导赤散加减方的临床应用，从而为今后相关方剂的研究进展提供一定推动作用。

新时代中医培养在以院校教育为主的环境下,本科学习主要以基础知识为主,临床实践机会较少,因此见习跟诊就成为实践的一种重要方式.通过跟诊旨在让学生了解熟悉临床诊察疾病的方法及程序,积累临床跟师的体会与经验.通过对传统与现代环境下教育制度、教师主体以及学生态度问题的研究,分析现阶段学生临床跟诊中存在的一些问题,并从以上3个方面出发探索适合现代教育背景下的学生临床跟诊模式,进一步提高中医学生的基础知识水平和临床实践能力.

"势数"作为一特殊的名词,所表现出的不仅仅是对事物未来发展性质的趋向性概括,更多在于指导人们运用"势数"的观点去解决实际生活中的问题,中医诊治疾病的过程就是运用"势数"来解决临床疾病."势数"作为自然规律的一种体现方式,与中医学的产生本源相同,都是对自然规律的形象比拟,所以运用势数观点认识疾病的产生与发展,分析病因病机,将更有利于医者灵活把握病势发展规律,调和人体平和状态.

目的 应用数据挖掘方法归纳总结中医治疗糖耐量异常的用药特点及规律,以期进一步指导临床研究与实践.方法 检索中国知网、万方数据库、维普中文科技期刊全文数据库、中国生物医学文献数据库4大中文数据库自建库至2021年3月收载的中医药治疗糖耐量异常临床研究文献,纳入符合要求的文献后建立数据库,分别使用IBM SPSS Statistics 20.0及IBM SPSS Modeler 18.0软件对数据库进行频数分析和关联规则分析.结果 共纳入132篇文献,包含157味中药,其中高频药物有黄芪、茯苓、山药、苍术、白术、黄连等,按频次排序前30味药物主要为补虚药、清热药、解表药、理气药、化湿药、利水渗湿药、活血化瘀药、收涩药、止咳化痰平喘药9类,其中以补气药和清热药占比最大,分别为45.84％、36.78％,而补虚药则以补气药为主;系统聚类分析可归为6个聚类.结论 中医治疗糖耐量异常以清热养阴、益气活血为主,可为临床辨治糖耐量异常提供借鉴.

糖尿病(消渴病)可分为脾瘅期、消渴病期、消瘅期.脾胃的生理功能可归纳为"备化".脾瘅期为"备化过盛",消渴期为"备少化多",消瘅期为"无备无化".糖尿病的整个发病过程,是以脾热为核心,即从生理的脾常备化状态,发展为备化过盛的脾瘅,再进一步发展为备少化多的消渴病,最终发展至无备无化致五脏皆柔弱的消瘅.当进入并发症时期,则因个体的差异出现心、肾、肺、肝的损伤或兼有多种不同的表现.故临证应始终以恢复"脾常备化"为治疗目的 .

代谢性疾病病前状态是代谢成分异常聚集的状态,该状态是代谢性疾病的前期阶段,人体尚未达患病的诊断标准,却时刻威胁着人们的生命质量.国医大师吕仁和教授治疗代谢性疾病病前状态从脾出发,认为代谢成分异常聚集与中医"脾瘅"的脾热状态下输布不及、蓄积化浊相吻合,故提出代谢性疾病病前状态属于"脾瘅"范畴,过食肥甘厚味是其病因,共同病机是脾热.该阶段病情尚不严重,具有高度可逆性,是及时干预的关键阶段;同时因其临床表现并不典型,易被忽视,致使脾热产生的病理机制未能及时干预或清除,从而会发展成肥胖、高血压病、糖尿病、高脂血症、高尿酸血症、多囊卵巢综合征等一系列相关的代谢性疾病.此外脾瘅病位在脾,涉及部位广泛,一旦发病,合并症多,治疗上主张以清热为主,同时兼顾整体.基于此认识,从脾瘅理论探讨代谢性疾病病前状态的病机,以期更好地指导临床.

目的 系统评价丹参川芎嗪注射液联合血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)类药物治疗糖尿病肾病的有效性及安全性.方法 检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase、Cochrane Library、中国临床试验注册中心、ClinicalTrials.gov数据库,收集丹参川芎嗪注射液联合ACEI/ARB类药物治疗糖尿病肾病的随机对照试验,对照组采取基础治疗联合ACEI/ARB类药物治疗;观察组在对照组基础上加用丹参川芎嗪注射液治疗.检索范围为建库至2021年1月,采用RevMan 5.3软件进行Meta分析.结果 共纳入12篇随机对照试验.观察组干预糖尿病肾病的总有效率高于对照组,差异有统计学意义(相对危险度=1.21,95％置信区间:1.13～1.29,P＜0.001);观察组在改善患者血尿素氮、血肌酐、尿白蛋白排泄率等方面均优于对照组(均P＜0.05).2组均未见严重不良反应.结论 丹参川芎嗪注射液联合ACEI/ARB类药物干预糖尿病肾病疗效较好,安全性较高.