Effects of the Clearing the Lung and Dissipating Phlegm Method in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Objective: The objective of this study is to evaluate the efficacy and safety of the clearing the lung and dissipating phlegm method in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD) and to provide evidence for the treatment of the disease. Materials and Methods: Literature was searched from the United States National Library of Medicine(PubMed), Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database(Wanfang), and the Full?Text Database of Chinese Scientific and Technical Periodicals(VIP).A comprehensive collection was made of randomized controlled trials(RCTs) before June 2018, in which the treatment groups used either the clearing the lung and dissipating phlegm formulas only or combined it with routine Western medicine therapy, and the control group adopted routine Western medicine therapy only for the acute exacerbation of COPD. The Cochrane risk of bias method was used to evaluate the quality of the literature. The data were analyzed and retrieved independently by two reviewers before meta?analysis was carried out with RevMan 5.3 software to evaluate the primary outcome measures, including the total clinical effective rate, and the secondary outcome measures such as the pulmonary function(forced vital capacity [FVC], forced expiratory volume in the 1 s [FEV1], percentage of FEV1 [FEV1%], and FEV1/FVC)and blood gases(PaO_2 and PaCo_2). Results: A total of 13 RCTs involving 990 patients(496 in the treatment group and 494 in the control group)were included in this study. Meta?analysis revealed significant difference in the efficacy of the group that adopted solely the routine Western medicine method and the group that combined the Western medicine with the clearing the lung and dissipating phlegm method. Outcome measures including the pulmonary function(FVC, FEV1, FEV1%, and FEV1/FVC) and the blood gases(PaO_2 and PaCo_2) were significantly improved as compared to the control group(P 0.00001). However, adverse effects in the treatment group using combined traditional Chinese medicine were not reported due to the short observation time of the study. Conclusion: The clearing the lung and dissipating phlegm method can improve the efficacy in the treatment of acute exacerbation of COPD, the outcome measures of the pulmonary function and the blood gases,as well as the life quality of the patients. However, due to the fact that the existing studies are generally of poor quality in which randomization and its implementation were not properly carried out, more high?quality RCTs are necessary to confirm the findings of this study.     

基于“祛邪为第一要义”从清热化湿论治新型冠状病毒肺炎

结合验案分析,基于"祛邪为第一要义"探讨新型冠状病毒肺炎从清热化湿论治的思路与方法。认为新型冠状病毒肺炎主要是属于"湿热"性质的疫病,治疗应强调清热化湿,以"祛邪为第一要义",辅以扶正。在中医祛邪与扶正理论指导下,通过宣肺平喘、通腑泻热、芳香化湿等治法,祛邪为主,肺肠合治,可以使发热减轻或消退,使大便通畅,从而截断病情进展,避免或减少危重症的发生及死亡的风险;通过清热化湿、疏肝健脾、凉血化瘀等治法,祛邪兼以扶正,肺与肝、脾合调,可以改善肝功能损伤,减少病情加重的风险;通过补气健脾等扶正治法,可以改善患者的精神和体力,促使病毒更快转阴,缩短病程,促进患者早日康复。     

新冠肺炎“动态清零”常态化下应急梯队护士体验的质性研究

目的 研究新型冠状病毒肺炎常态化疫情防控下应急梯队护士的真实体验。提出针对性改善护士的心理状况的方法和建议。方法 于2021年10月选取上海市静安区闸北中心医院应急梯队的护士11名为研究对象，对其进行半结构式面对面谈话，并采用Colaizzi七步分析法进行资料分析。结果 进入应急梯队的护士普遍存在着紧张焦虑，情绪低落，身心疲惫等心理问题。而执行完应急任务后的成就感，社会的认同，多方的理解支持，有利缓解心理压力。结论 通过对新型冠状病毒肺炎常态化疫情防控下应急梯队护士的真实体验的了解，护士普遍存在各种心理问题，需要给予针对性的干预措施，提高应急梯队成员的心理素质和应急能力。     

温病学理论指导下的新型冠状病毒肺炎诊治刍议

基于温病学理论,探讨新型冠状病毒肺炎的中医病因病机与诊治思路。温病学说源于明清之前的历代中医理论积累,经过长期的温热病防治实践而形成,其对于外感热病(包括烈性传染病)的病因病机、证治方药有着较为系统的论述,近年来在我国的新发传染病防治中发挥出积极的作用。温瘟相通,瘟疫病因多为热毒疫邪,表现为热证阳证,可按温病学中的卫气营血或三焦辨证分期论治,或治以吴又可、庞安时等的经方验方,这些因、机、证、治理论可试用于新型冠状病毒肺炎的中医诊疗。且肺与大肠相表里,胃肠道也是新型冠状病毒侵袭或繁殖的部位,采用中医清热通下之法,使邪从肠道而出,可能是减轻体内病毒感染与肺脏炎症的一种途径。     

清开灵注射液治疗脑血管性痴呆32例

目的观察清开灵注射液治疗脑血管性痴呆的疗效.方法将中医学辨证属于实证的64例脑血管性痴呆患者随机分为治疗组(清开灵注射液组)和对照组(脑复康组),治疗5周后,将两组治疗前后在智力障碍程度、肢体功能、血液流变学指标、中医证型疗效方面的变化进行比较.结果经治疗后治疗组和对照组相比较,智力障碍程度变化(有效率、MMSE、ADL积分)、肌力、步行能力改变有显著性差异,p＜0.05.而治疗前后组内及组间血流变指标虽有一定下降,但无统计学意义(p＞0.05).结论清开灵注射液对脑血管性痴呆患者,在改善智力障碍、肌力、步行能力方面有较好的疗效.     

中西医结合治疗肺心病心律失常40例疗效观察

为提高肺心病心律失常的临床疗效,采用中药清肺化痰活血剂配合抗菌素及氧疗法对40例肺心病并发心律失常患者进行了治疗观察,同时与单纯使用抗菌素及氧疗法治疗的40例患者进行对照。临床以心电图改善情况为观察指标,结果两组有效率分别为87.5％和67.5％。Ridit分析结果表明,治疗组疗效明显优于对照组,经显著性检验,两组差异显著(P<0.05)。     

益气清热活血方治疗慢性萎缩性胃炎及其癌前期病变的临床研究

目的 气虚血瘀热郁是慢性萎缩性胃炎及胃癌前期病变的病理基础,制定益气活血清热方,设胃宁冲剂为阳性对照组,观察该方对慢性萎缩性胃炎及其癌前期病变的临床疗效。方法 治疗组64例,对照组63例,3个月为1个疗程,服药2个疗程。结果 治疗组3个月、6个月有效率为75.0%、95.3%,均显著高于对照组的52.4%、63.5%（P＜0.01）;治疗组对胃镜、萎缩、肠化的疗效均显著高于对照组（P＜0.05）,而对炎症的改善作用2组差异无显著性。治疗后2组症状积分比较,治疗组痞满、纳差、嗳气、便溏积分及总积分均显著低于对照组（P＜0.05）;治疗后治疗组萎缩、肠化、异型增生积分均较治疗前显著下降（P＜0.01）,对照组萎缩、肠化积分也较治疗前显著下降（P＜0.05）,而治疗组积分又显著低于对照组（P＜0.05）。结论 益气活血清热方对慢性萎缩性胃炎及其癌前期病变有较好的临床疗效。     

鲜中药治疗急性白血病76例

目的 中药治疗急性白血病可以提高其疗效及患的生活质量。方法 针对急性白血病阴液亏虚、热毒炽盛的主要病机,选用大剂量甘寒养阴鲜中药为主组方,随证加减,辨证论治。结果 鲜中药治疗难治性白血病76例,完全缓解37例（48.7%),部分缓解14例（18.4%),未缓解25例（32．9％）,总缓解率达67．1％,获缓解的病例中,服药时间最短30天,最长180天,平均60．7天。结论 养阴清热鲜中药为主治疗急性白血病,辨证与辨病相结合。可提高缓解率,延长存活期,减轻化疗毒副作用,提高生活质量。     

益气活血通腑法对类2型糖尿病大鼠骨骼肌GLUT4表达的影响

目的：研究益气活血通腑中药(加味桃核承气汤)对类2型糖尿病大鼠的作用及骨骼肌葡萄糖转运蛋白4(GLUT4)mRNA表达的影响。方法：采用低剂量链脲佐菌素(STZ)腹腔注射加高热量饲料喂养导致大鼠类2型糖尿病模型，灌胃给药4周，检测糖耐量、空腹血清胰岛素及骨骼肌GLUT 4mRNA表达量的变化。结果：造模后大鼠注射葡萄糖后30、60、120min血糖显著升高，血清空腹胰岛素水平无明显变化，骨骼肌GLUT4 mRNA表达量显著降低。给药4周后，各药对空腹血清胰岛素水平和注糖后30、60min血糖无明显影响，但中药低剂量、二甲双胍、罗格列酮可使注糖后120min血糖下降；罗格列酮尚可降低空腹血糖。二甲双胍可使骨骼肌GLUT4mRNA表达量明显升高，中药高剂量可防止GLUT 4mRNA表达量的降低，但罗格列酮对GLUT4 mRNA表达量的降低无影响。结论：低剂量STZ腹腔注射加高热量饲料喂养可导致大鼠类2型糖尿病胰岛素抵抗样改变，益气活血通腑中药可改善此模型的糖耐量异常，其作用与增强其骨骼肌GLUT4基因表达，促进骨骼肌对葡萄糖的摄取和利用有关。