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基于古今文献的痰瘀互结证舌象解析

中华中医药杂志 2024年第7期39卷 3311-3315页

作者：黄玉燕佟旭卢红蓉张敏胡镜清中国中医科学院中医基础理论研究所北京100700 广州中医药大学第二附属医院省部共建中医湿证国家重点实验室广州510120

根据历代文献及现代学者的认识,痰瘀互结证舌象可兼见痰与瘀的舌象特征,大体可从舌质及舌下络脉诊瘀,从舌苔诊痰。由于存在瘀与痰轻重各异、寒化热化不同,兼挟的不同以及伤津与否,舌象有所不同。痰瘀互结证也可出现特殊的舌象,如舌质为... 详细信息

根据历代文献及现代学者的认识,痰瘀互结证舌象可兼见痰与瘀的舌象特征,大体可从舌质及舌下络脉诊瘀,从舌苔诊痰。由于存在瘀与痰轻重各异、寒化热化不同,兼挟的不同以及伤津与否,舌象有所不同。痰瘀互结证也可出现特殊的舌象,如舌质为蓝紫色,舌苔为灰黑苔、紫黑苔、霉酱色苔等。总体而言,痰瘀互结证舌质特点为舌色青、紫、暗,舌苔特点为腻而晦暗、厚而有根,舌下络脉特点为粗胀、迂曲。舌苔厚而有根是痰瘀之“结”的表现。痰瘀互结证的舌象既有两证素组合兼见的表现,又有“结”的特征表现,可以给痰瘀互结证作为一个整体证的研究以启示。

关键词：痰瘀互结证舌象舌质舌苔舌下络脉复合证文献研究

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火热证诊断条目筛选与构建

世界科学技术-中医药现代化 2024年第2期26卷 511-516页

作者：张佳乐吴珊杨燕陈南杰汪锦城胡镜清中国中医科学院中医基础理论研究所北京100700 中国中医药科技发展中心北京100027

目的通过对既往火热证相关诊断规范和火热证临床研究中的四诊信息进行系统分析,总结火热证四诊临床表征,为构建火热证临床诊断标准条目池提供基础。方法检索PubMed、CNKI、WANFANG、CQVIP、CBM等数据库发表的火热证临床研究及相关辨识规... 详细信息

目的通过对既往火热证相关诊断规范和火热证临床研究中的四诊信息进行系统分析,总结火热证四诊临床表征,为构建火热证临床诊断标准条目池提供基础。方法检索PubMed、CNKI、WANFANG、CQVIP、CBM等数据库发表的火热证临床研究及相关辨识规范,描述火热证的症状、舌脉四诊基本信息,并通过名义小组法结合专家咨询法对临床表征进行分析。结果检索火热相关证临床研究文献193条,通过规范化处理后,筛选出63个条目,主要症状为发热、大便秘结、脉数、小便短黄、躁扰不安、舌苔黄、面红、口渴。通过名义小组法,对条目进行优化处理,纳入火热证条目池的11个条目的组成为8个症状、3个舌脉。症状:怕热、面赤、大便秘结、局部红肿热痛(齿龈、咽喉肿痛,口腔溃疡等)、烦躁、口苦、口渴喜冷饮、近期病情波动。舌脉:舌质红、舌苔黄、脉数。结论火热证条目池重点突出“近期病情波动、局部红肿热痛(齿龈、咽喉肿痛,口腔溃疡等)”两个核心症状,在舌脉上以舌质红、舌苔黄、脉数为主,火热证条目池的筛选与构建,可作为未来火热证临床诊断标准研制的依据。

关键词：火热证诊断证候诊断标准条目池

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中医证候诊断标准研制现状与思考

中华中医药杂志 2024年第1期39卷 33-38页

作者：张佳乐张逸雯王孟秋江丽杰胡镜清中国中医科学院中医基础理论研究所北京100700 湖北中医药大学基础医学院武汉430065 省部共建中医湿证国家重点实验室(广州中医药大学第二附属医院) 广州510120 广东省新黄埔中医药联合创新研究院广州510000 中国中医药科技发展中心北京100027

对中医证候诊断标准的研究现状进行回顾,并探讨未来发展思路。在发展模式上,中医证候诊断标准是“证诊断标准”和“病证结合诊断标准”并行发展的两种模式。在制定方法上,运用到德尔菲法、层次分析法等多种循证医学研究方法。在应用模式... 详细信息

对中医证候诊断标准的研究现状进行回顾,并探讨未来发展思路。在发展模式上,中医证候诊断标准是“证诊断标准”和“病证结合诊断标准”并行发展的两种模式。在制定方法上,运用到德尔菲法、层次分析法等多种循证医学研究方法。在应用模式上,以病证结合诊断标准应用较为广泛,操作性强,更适于临床推广和使用。总体来说,中医证候诊断标准研究呈现出由浅入深、由点到面、由定性到定量的发展趋势,为中医临床诊断提供了较为客观、标准化的工具。未来中医证候诊断标准的发展主线或将以病证结合诊断标准为主,同时建立中医证候诊断标准的方法学规范,强化诊断性试验的应用;重视中医证候诊断标准中名词术语的规范化研究;随着诊断技术的进步,探索并构建微观诊断指标体系或是未来中医证候诊断标准的突破口。

关键词：中医证候诊断标准研制现状病证结合思路与方法

基于肠道菌群与冠心病的关系探讨“阴火”科学内涵

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世界中医药 2024年第9期19卷 1279-1285页

作者：崔雨婷张方圆许伟明李子贇胡镜清南京中医药大学附属医院南京210004 省部共建中医湿证国家重点实验室(广州中医药大学第二附属医院) 广州510120 中国科学院杭州高等研究院杭州310058 中国中医药科技发展中心北京100027 南京中医药大学针灸推拿学院养生康复学院南京210034 广东省新黄埔中医药联合创新研究院广州510530

肠道菌群与冠心病之间有密切的生理病理联系,肠道菌群结构及产物影响冠心病的发生发展。近年来,中医药领域高度关注肠道菌群对疾病的影响,而肠道菌群主要通过炎症损伤血管内皮、造成脂质代谢紊乱、促进血栓形成及氧化应激损伤血管内膜... 详细信息

肠道菌群与冠心病之间有密切的生理病理联系,肠道菌群结构及产物影响冠心病的发生发展。近年来,中医药领域高度关注肠道菌群对疾病的影响,而肠道菌群主要通过炎症损伤血管内皮、造成脂质代谢紊乱、促进血栓形成及氧化应激损伤血管内膜等机制影响冠心病,通过类比发现此机制与中医脾胃失调、元气失养、阴火内生病机过程相通。因此,从“阴火”理论可指导调节肠道菌群,进而治疗冠心病,这将为冠心病的中医药临床防治和科学研究带来新思路。

关键词：肠道菌群冠心病阴火元气失养炎症脂代谢脂多糖氧化三甲胺

Influencing factors on efficacy of summer acupoint application treatment for allergic rhinitis:a retrospective study

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Journal of Traditional Chinese Medicine 2012年第3期32卷 377-381页

作者： Jin Peng Xiaqiu Wu jingqing hu Yigong Fang Mingjie Zi Baoyan Liu Institute of Basic Research in ClinicalMedicine China Academy of Chinese Medical Sciences Beijing 100700 China Baoyan Liu China Academy of Chinese Medical Sciences Beijing 100700 China Institute of Acupuncture and Moxibustion China Academy of Chinese Medical Sciences Beijing100700 China Xiyuan Hospital China Academy of ChineseMedical Sciences Beijing 100700 China

OBJECTIVE:Allergic rhinitis(AR) is a common health *** acupoint application treatment(SAAT) is reported to effectively treat and prevent AR from seasonal *** the present study,we aimed to evaluate its effects,especially on the course of AR,through a retrospective ***:A cross-sectional multicenter study was performed based on patients treated between 2008 and 2009 in 13 clinical centers in China.A total of 1058 outpatients aged ≥2 years with documented AR and ≥1 year SAAT were eligible for enrollment.A case report form(CRF) was completed by both patient and *** CRF was designed to collect data on the patient's history of SAAT,AR condition,and self-reported health *** outcomes(dependent variables) were incidence and intensity of AR and concomitant medications *** were analyzed with ordinal logistic regression(OLR).RESULTS:Treatment course and seasonal pattern of AR were related to all dependent variables *** controlling for sample bias and confounding factors,the findings suggested that a 3-year treatment course had better efficacy(OR/incidence of AR:2.57,95%CI:1.76-3.76;OR/intensity of AR:2.17,95%CI:1.50-3.17;OR/concomitant medications:2.20,95% CI:1.50-3.23) compared with a 2-year or less treatment ***:The results showed that:1)the length of treatment course was positively associated with the efficacy of SAAT(the longer the treatment course,the better the efficacy);and 2)SAAT was more efficacious in treating seasonal AR than non-seasonal AR.

关键词： Acupoint sticking therapy Allergic rhinitis Cross-sectional studies Traditional Chinese Medicine

Analysis on the distinguishing features of traditional Chinese therapeutics and related statistical issues

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Frontiers of Medicine 2011年第2期5卷 203-207页

作者： jingqing hu Jie Qiao Deying Kang Baoyan Liu Center for Clinical Evaluation Guang’anmen HospitalChina Academy of Chinese Medical SciencesBeijing100053China Department of Clinical Epidemiology West China HospitalSichuan UniversityChengdu 610041China China Academy of Chinese Medical Sciences Beijing 100700China

Traditional Chinese medicine(TCM)is one of the rarely existing ancient traditional medicines that hold systematic theories as well as preventative and therapeutic methods for diseases in *** the 1950s,such research methods as mathematics,statistics,and data mining(DM)have been gradually introduced to TCM studies,making it more ***,the distinct features of TCM theories and diagnostic-model have constantly challenged the methodology of *** paper introduces the following scientific features of traditional Chinese therapeutics:1)its goal is to balance the functions and conditions of human body;2)it emphasizes on holism and individualization;3)it stresses the longitudinal regulation and evaluation mode,which is a circle of syndrome diagnosis,treatment and evaluation;4)the interventions of TCM are abundant,compound and natural;and 5)humanistic thought is *** statistical problems are raised based on these ***,complex statistical methods that can analyze subjective indexes and latent variables,multidimensional and multistage data,non-equilibrium designed studies,and longitudinal data are ***,comprehensive evaluation on multiple-target mechanism has been brought in by combination ***,there is a need to analyze how humanity and related cultural factors may influence the effect of ***,promoting implemented studies of statistics as well as carrying out the TCM scientific propositions have become the common expectations of both TCM and modern medicine.

关键词： traditional Chinese therapeutics feature statistic

Thinking and practice of accelerating transformation of traditional Chinese medicine from experience medicine to evidence-based medicine

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Frontiers of Medicine 2011年第2期5卷 163-170页

作者： Baoyan Liu Yanhong Zhang jingqing hu Liyun He Xuezhong Zhou China Academy of Chinese Medical Sciences Beijing 100700China Institute of Basic Research in Clinical Medicine China Academy of Chinese Medical SciencesBeijing 100700China Guang'anmen Hospital China Academy of Chinese Medical SciencesBeijing 100053China School of Computer and Information Technology Beijing Jiaotong UniversityBeijing 100044China

The gradual development of Chinese medicine is based on constant accumulation and summary of experience in clinical practice,but without the benefit of undergoing the experimental medicine *** Chinese medicine has formed a systematic and unique theory system through thousands of years,with the development of evidence-based medicine,the bondage of the research methods of experience medicine to Chinese medicine is *** rapid transition and transformation from experience medicine to evidence-based medicine have become important content in the development of Chinese *** to the features of Chinese medicine,we propose the research idea of“taking two ways simultaneously,”which is the study both in the ideal condition and in the real *** and constructing the theoretical basis and methodology of clinical research in the real world,and building the stage for research technique is key to the effective clinical research of Chinese *** by gradually maturing and completing the clinical research methods of the real world could we realize“taking two ways simultaneously”and complementing each other,continuously produce scientific and reliable evidence of Chinese medicine,as well as transform and develop Chinese medicine from experience medicine to evidence-based medicine.

关键词： Chinese medicine experience medicine evidence-based medicine real world

Clinical phenotype network： the underlying mechanism for perso- nalized diagnosis and treatment of traditional Chinese medicine

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Frontiers of Medicine 2014年第3期8卷 337-346页

作者： Xuezhong Zhou Yubing Li Yonghong Peng jingqing hu Runshun Zhang Liyun He Yinghui Wang Lijie Jiang Shiyan Yan Peng Li Qi Xie Baoyan Liu School of Computer and Information Technology and Beijing Key Lab of Traffic Data Analysis and Mining Beijing Jiaotong University Beijing 100044 China China Academy of Chinese Medical Sciences Beijing 100700 China School of Engineering and lnformatics University of Bradford BD7 IDP UK Institute of Basic Theory of Traditional Chinese Medicine China Academy of Chinese Medical Sciences Beijing 100700 China Guang 'anmen Hospital China Academy of Chinese Medical Sciences Beijing 100053 China Institute of Basic Research in Clinical Medicine China Academy of Chinese Medical Sciences Beijing 100700 China

Traditional Chinese medicine （TCM） investigates the clinical diagnosis and treatment regularities in a typical schema of personalized medicine, which means that individualized patients with same diseases would obtain distinct diagnosis and optimal treatment from different TCM physicians. This principle has been recognized and adhered by TCM clinical practitioners for thousands of years. However, the underlying mechanisms of TCM personalized medicine are not fully investigated so far and remained unknown. This paper discusses framework of TCM personalized medicine in classic literatures and in real-world clinical settings, and investigates the underlying mechanisms of TCM personalized medicine from the perspectives of network medicine. Based on 246 well-designed outpatient records on insomnia, by evaluating the personal biases of manifestation observation and preferences of herb prescriptions, we noted significant similarities between each herb prescriptions and symptom similarities between each encounters. To investigate the underlying mechanisms of TCM personalized medicine, we constructed a clinical phenotype network （CPN）, in which the clinical phenotype entities like symptoms and diagnoses are presented as nodes and the correlation between these entities as links. This CPN is used to investigate the promiscuous boundary of syndromes and the co-occurrence of symptoms. The small-world topological characteristics are noted in the CPN with high clustering structures, which provide insight on the rationality of TCM personalized diagnosis and treatment. The investigation on this network would help us to gain understanding on the underlying mechanism of TCM personalized medicine and would propose a new perspective for the refinement of the TCM individualized clinical skills.

关键词： personalized medicine complex network clinical phenotype network traditional Chinese medicine

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不同系统疾病痰瘀互结证主要症状及特点探讨

中国中医基础医学杂志 2024年第1期30卷 76-81页

作者：王孟秋张逸雯江丽杰胡镜清张佳乐黄燕何润铭赵越湖北中医药大学武汉430065 中国中医科学院中医基础理论研究所北京100700 省部共建中医湿证国家重点实验室/广州中医药大学第二附属医院广州510120 中国中医药科技发展中心北京100027 广东省新黄埔中医药联合创新研究院广州510000 南京中医药大学第三临床医学院南京210023 长春中医药大学长春130117

目的通过整理痰瘀相关证诊断标准的四诊信息,挖掘不同系统不同疾病痰瘀互结证的主要症状和相应特点,为构建普适性痰瘀互结证临床诊断标准提供基础。方法系统检索中国期刊全文数据库(CNKI)、中文科技期刊数据库(CCD)、中国学术期刊数据... 详细信息

目的通过整理痰瘀相关证诊断标准的四诊信息,挖掘不同系统不同疾病痰瘀互结证的主要症状和相应特点,为构建普适性痰瘀互结证临床诊断标准提供基础。方法系统检索中国期刊全文数据库(CNKI)、中文科技期刊数据库(CCD)、中国学术期刊数据库(CSPD)与中国生物医学文献数据库(CBM)、《中医病证诊断疗效标准》等收录的痰瘀相关证的标准、指南、共识,开展痰瘀相关证四诊信息的整理和条目筛选。检索日期为建库以来2021年10月1日。结果最终纳入包含痰瘀相关证诊断标准的文献208篇。其中,病证结合类诊断标准文献共174篇,包含呼吸、循环、神经等九大系统,共计68种疾病。将其按照不同系统疾病进行分类,结果提示虽同为痰瘀互结证,但不同系统痰瘀互结证的临床症状与所涉疾病的病变特点差异较大,而局部肿块、疼痛、麻木在多系统疾病痰瘀互结证的临床表现上具有一致性,且舌脉一致性高。结论痰瘀互结证是许多重大疾病尤其是慢性非传染性疾病的常见证候。其中,痰瘀互结证在不同系统疾病中,局部肿块、疼痛、麻木、舌脉等临床症状和体征一致性高,可以作为构建普适性痰瘀互结证诊断标准的基础。

关键词：痰瘀互结证诊断标准证候标准证候客观化证候诊断