基于新型冠状病毒肺炎解读伤寒实质及寒温统一

既往研究认为,《伤寒论》为一切外感热病而设,为广义伤寒;且伤寒详于寒而略于温,温病详于温而略于寒,伤寒与温病为两种不同的理论系统,两者相辅相成,相得益彰,共同构成外感发热性疾病的两大证治体系。新型冠状病毒肺炎(简称新冠肺炎)虽属温病范畴,但运用《伤寒论》经方合方——“清肺排毒汤”等治疗取得显著疗效。有鉴于此,我们重新梳理伤寒与温病实质,以及两者之间的关系,认为:(1)《伤寒论》为狭义伤寒,伤寒本质可能为炎症,其六经辨证本质为人体对炎症反应不同阶段的描述,《伤寒论》为临床治疗急危重症的专著。(2)温病的本质同样可能为炎症,伤寒与温病同为感染性疾病导致的炎性损伤状态。(3)寒温存在能够统一的病理生理学基础,但因致病因素不同而致临床表现有所差别。伤寒的六经辨证,温病的卫气营血辨证与三焦辨证,同为人体对炎症反应的不同阶段的诊疗方法,但其背后蕴藏的方证辨证则为其共性特征。虽然辨病机的方法不同,但无论在病理生理还是方证辨证治疗上,伤寒与温病能够统一。因此,在新冠肺炎的中医认识上,不应拘泥于伤寒与温病的病名归属之争,可运用伤寒六经辨证与方证辨证进行治疗,且三阳合病为其重要病机。     

心律失常经方方证对应论治体悟

在方证对应原则指导下，运用经方治疗心悸取得良好疗效。并举验案2则以说明。     

Effect of Yiqi Yangyin Decoction(益气养阴方) on the Quality of Life of Patients with Unstable Angina Pectoris

<正>Objective:To observe the effect of Yiqi Yangyin Decoction(益气养阴方,YQYYD) on the quality of life(QOL) of patients with unstable angina pectoris(UAP).Methods:A total of 108 patients with UAP of qi-yin deficiency syndrome confirmed by coronary angiography were enrolled and assigned to the treated group(treated with YQYYD and conventional therapy of Western medicine) and the control group(treated with conventional therapy of Western medicine),by the use of the PROC PLAN of the SAS 6.12 software,in a prospective, randomized,controlled design.The clinical total effective rate,symptom score,QOL scale[Seattle Angina Questionnaire(SAQ)]and incidence of important clinical events were defined as the observation indices to evaluate the interventional effect of YQYYD on the QOL of patients with UAP of the qi-yin deficiency syndrome. Results:During the study,three cases dropped out in the treated group,one case dropped out in the control group,and 104 cases,including 51 cases in the treatment group and 53 cases in the control group,finished the trial.After four weeks of treatment,the total clinical effective rates in the treated group and the control group were 80.4%and 75.5%respectively,and there was no obvious difference between them(P0.05).However,the symptom score of the treated group(9.31±2.02) was significantly lesser than that of the control group(11.62±3.04,P0.05),and the total score of the QOL scale of the treated group(68.76±5.74) was significantly higher than that of the control group(61.06±3.31,P0.01).Among those in the treated group physical limitation, angina stability,angina frequency,and treatment satisfaction were significantly ameliorated when compared with the control group after treatment(P0.05,P0.01).The incidence of important clinical events in the treated group(3.9%) was lower than that in the control group(5.7%) during the 8-month follow-up period,but the difference was insignificant(P0.05).Conclusion:YQYYD could improve the clinical symptoms of patients with UAP of qi-yin deficiency syndrome and greatly improve their QOL.     

薛伯寿教授“和合”思想的临证体现

和合思想在中国哲学及文化中都具有非常悠久的历史,也是中医学基础理论及临床应用的重要体现。“和”有和谐、包容、合而为一之意,“合”为统一,把握大道之意。著名中医学家薛伯寿教授认为中医学大道至简,因此执简驭繁是临证关键。薛老在临床过程中,处处体现谨守和合思想。在遣方用药中,善于针对不同疾病多运用调和阴阳、表里分消、补泻同用、寒热并用、调畅气血、升降互用等治则综合运用。在方剂配伍以及用药剂量方面,认为中药配伍本身就是和合增效减毒思想的具体反映。药物配伍是通过有效整合药物的偏性,来纠正人体阴阳气血的偏盛偏衰。临床用药或从七情配伍,或遵脏腑配伍,或依性味配伍,随证而变,灵活组方施治。其他如待人谦和、与人为善,药物治疗与心理调节相辅相成等亦体现和合思想。     

Clinical Application of the TCM Classic Formulae for Treating Chronic Bronchitis

The principle of formulae corresponding to syndromes is an unique model described in the classics of traditional Chinese medicine (TCM) for treatment of diseases. Making the symptoms and signs as the therapeutic targets, in which the intuitive judgments and jumping characteristics are manifested.1-3     

基于病证结合模式探析线粒体疾病中医证候分布规

线粒体遗传病和线粒体相关疾病的临床表征涉及到中医病证多个方面,目前基于病证结合线粒体疾病中医证候研究较少。笔者通过分析线粒体疾病临床表征,从中医角度分析其所属证候特征并探讨其分布规律,认为线粒体疾病的临床表征,以中医气虚为主,涉及到五脏、气血以及经络病证的相关证候。     

基于病证结合方证对应模式干预冠心病心绞痛临床研究

目的:基于病证结合方证对应模式干预冠心病心绞痛,以探讨方证对应临床疗效。方法:84例经冠脉造影证实冠心病心绞痛患者,气虚血淤证和痰淤互阻证各42例,按照随机、双盲、双模拟的设计方法,分为方证对应、方证次对应、常规西药组3组,分别以参芍片和丹蒌片干预治疗4周,观察患者心绞痛疗效、中医证候疗效及相关理化指标的变化。结果:方证对应组心绞痛疗效、中医证候疗效和对理化指标(炎症因子、斑块因子)治疗前后比较明显优于方证次对应组及西药组(P<0.01)。结论:方证对应治疗不仅可以改善心绞痛疗效和中医证候疗效,而且可以改善客观指标,方证对应是取效的关键。     

《黄仕沛经方亦步亦趋录》评介

黄仕沛教授为当代中医名家,于经方致力尤勤,尤其服膺仲景方证之学。其经方专著《黄仕沛经方亦步亦趋录》通过大量经方治疗危急疑难重症病案展示出一位当代中医临床名家疗效卓著、屡起沉疴的大师风范,展示其学习、运用经方的关键与捷径——方证对应。     

丹蒌片治疗痰瘀互阻型冠心病心绞痛的疗效评价

目的 评价丹蒌片对痰瘀互阻型冠心病心绞痛患者的临床疗效。方法 从4个中心（中国中医科学院广安门医院、北京安贞医院、河南中医学院第一附属医院及湖北协和医院）选择66例痰瘀互阻型冠心病心绞痛患者,按随机数字表法分为丹蒌片联合西药治疗组（治疗组）及西药对照组（对照组）,每组33例。治疗组在西药常规治疗基础上加服丹蒌片1.5 g/次,每日2次;对照组在常规西药治疗基础上加服丹蒌片模拟剂,两组疗程均为28天。观察两组心绞痛疗效、心绞痛发作频率、持续时间、心绞痛积分、心电图ST段下移导联数、T波低平导联数、T波倒置导联数、硝酸甘油使用情况（包括服用硝酸甘油后心绞痛缓解时间、硝酸甘油用量）,比较两组治疗前后中医临床证候评分变化,包括胸闷、胸痛、胸闷痛持续时间、胸闷痛发作频率、气短 、疲乏、心悸 、自汗 、证候总评分。检测两组患者治疗前后超敏C反应蛋白(C-reactive protein,hs-CRP)、同型半胱氨酸(homocysteic acid,HCY)、可溶性CD40配体(soluble CD40 ligand,sCD40L)、白介素-6（interleukin-6,IL-6）、髓过氧化物酶(myeloperoxidase,MPO)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、血管细胞黏附分子-1(vascular cell adhesion molecular-1,VCAM-1)水平变化。结果 治疗组临床总有效率［81.2%(26/32)］,显著优于对照组［43.3%(13/30),P<0.05］。与本组治疗前比较,两组患者心绞痛发作频率、持续时间、心绞痛积分、ST段下移导联数、T波低平导联数、T波倒置导联数、心绞痛缓解时间、硝酸甘油用量、胸闷、胸痛、胸闷痛发作频率、hs-CRP、sCD40L、HCY、IL-6、MMP-9、MPO水平均降低,治疗组VCAM-1水平降低,对照组VCAM-1水平升高,差异均有统计学意义（P<0.01,P<0.05）。与对照组治疗后比较,治疗组心绞痛发作频率、疼痛持续时间、心绞痛积分、服用硝酸甘油后心绞痛缓解时间、硝酸甘油用量,胸闷痛持续时间、疲乏、证候总评分,hs-CRP、sCD40L、HCY、IL-6、MMP-9、MPO、VCAM-1水平均降低（P<0.01,P<0.05）。结论 丹蒌片可以改善痰瘀互阻型冠心病心绞痛患者临床症状,抑制炎症反应,具有稳定斑块及抗氧化作用。     

高血压病代谢紊乱及化浊平肝法的临床运用

高血压病是临床常见病,多发病,是致残和死亡的重要原因之一.随着社会经济的发展及生活方式的改变,高血压的危险因素也发生了显著的改变,使高血压病的中医学病机演变规律也发生相应改变.研究发现,代谢紊乱是现代高血压病的重要特征,亦是导致高血压病发病的重要环节.补充替代医学在高血压病的治疗中有显著治疗作用,中医药是其重要治法.浊邪(痰浊、瘀浊)内阻,肝阳上亢是以代谢紊乱为主高血压病的关键病机,临床上,运用化浊平肝治则治法治疗高血压病具有一定的临床推广价值.