Interpretation of Expert Consensus on Traditional Chinese Medicine Diagnosis and Treatment of Spleen Deficiency Syndrome(2023)
-
摘要: 《脾虚证中医诊疗专家共识(2023)》是2020年11月由中华中医药学会脾胃病分会在北京主导，联合全国50余家三级甲等医院、高等院校及科研机构共同修订并最终由国内权威期刊《中医杂志》公开发布的新一版中医证候专家共识，它呈现了3大重要特点：①细化与规范了脾虚证概念的表述及其所包含的脾气虚、脾阴虚、脾阳虚3个亚证的病证分类和代码及其ICD-11编码，以及脾虚证主症与次症程度和舌象体征的量化分级；②系统梳理了脾虚证诊疗标准的发展历程，挖掘整理了古代医家有关脾虚证诊治的重要论述，与时俱进体现了全国脾胃团队对脾虚证诊治相关病理生理改变、作用机制、临床疗效的现代生物学基础与量表研究的最新成果；③增加了脾气虚、脾虚湿蕴、脾阴虚和脾阳虚证典型舌质舌苔图像的客观示范展示。本共识突出实用性，以期进一步提高临床脾虚证的诊疗水平，为脾虚证诊疗及科学研究提供新的临床思维与决策参考，为了能更好地应用本共识，特进行解读。Abstract: Expert Consensus on Traditional Chinese Medicine Diagnosis and Treatment of Spleen Deficiency Syndrome(2023) is a new version of Traditional Chinese Medicine syndrome expert consensus jointly revised by the spleen and stomach diseases branch of the Chinese society of Traditional Chinese Medicine in Beijing in november 2020 and jointly released by more than 50 third-level and first-class hospitals, colleges and universities and scientific research institutions in China, and finally published by the authoritative domestic Journal of Traditional Chinese Medicine. It presents three important features: ①the concept of spleen deficiency syndrome and its classification and code of spleen Qi deficiency, spleen-Yin deficiency and spleen-Yang deficiency as well as their ICD-11 codes were refined and standardized, as well as the degree of main and secondary symptoms of spleen deficiency syndrome and the quantitative grading of tongue sign; ②this paper systematically combs the development process of diagnosis and treatment criteria for spleen deficiency syndrome, excavates the important discussions of ancient doctors on the diagnosis and treatment of spleen deficiency syndrome, and reflects the latest achievements of modern biological basis and scale research of the national spleen and stomach team on the pathophysiological changes, mechanism of action, and clinical efficacy related to the diagnosis and treatment of spleen deficiency syndrome in digestive system diseases; ③the objective demonstration and demonstration of the typical tongue coating images of spleen-Qi deficiency, spleen deficiency, spleen-Yin deficiency and spleen-Yang deficiency were increased. This consensus highlights practicability, in order to further improve the level of clinical diagnosis and treatment of spleen deficiency syndrome, and provide new clinical thinking and decision-making reference for the diagnosis and treatment of spleen deficiency syndrome and scientific research. In order to better apply this consensus, it is interpreted as follows.
-
-
[1] 中华中医药学会脾胃病分会. 脾虚证中医诊疗专家共识意见(2017)[J]. 中医杂志, 2017, 58(17): 1525-1530. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201717025.htm
[2] 中华中医药学会脾胃病分会. 脾虚证中医诊疗专家共识(2023)[J]. 中医杂志, 2024, 65(12): 1300-1308. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202412016.htm
[3] 国家市场监督管理总局, 国家标准化管理委员会. 中医临床诊疗术语第3部分: 证候[EB/OL]. (2021-11-26)[2023-10-01].
http://c.gb688.cn/bzgk/gb/sh-owGb?type=online&hcno=C71A9DAD24CB1252F-12439D1F045DA6A .[4] 广州中医学院脾胃研究组. 脾虚患者唾液淀粉酶活性初步研究[J]. 中华医学杂志, 1980, 60(5): 290-292. doi: 10.3760/j:issn:0376-2491.1980.05.017
[5] 全国中西医结合虚证与老年病研究专业委员会. 中医虚证辨证参考标准[J]. 中西医结合杂志, 1983, 3(2): 117-117. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFC198704032.htm
[6] 全国中西医结合虚证与老年病研究专业委员会. 中医虚证辨证参考标准[J]. 中西医结合杂志, 1986, 6(10): 598-598. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFC198704032.htm
[7] 中华人民共和国卫生部. 中药治疗脾虚证的临床研究指导原则[J]. 中国医药学报, 1988, 3(5): 71-72. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY198805028.htm
[8] 中华人民共和国卫生部. 中药新药临床研究指导原则(第一辑)[M]. 北京: 中华人民共和国卫生部, 1993: 91-95.
[9] 国家药品监督管理局. 中药新药临床研究指导原则(试行)[M]. 北京: 中国医药科技出版社, 2002: 361-364.
[10] 国家中医药管理局, 国家卫生健康委员会. 国家中医药管理局、国家卫生健康委员会关于印发《中医病证分类与代码》和《中医临床诊疗术语》的通知[EB/OL]. (2020-11-16)[2023-02-01].
https://www.gov.cn/zhengce/zhengceku/2020-11/24/content_5563703.htm .[11] Ji HJ, Kang N, Chen T, et al. Shen-ling-bai-zhu-san, a spleen-tonifying Chinese herbal formula, alleviates lactose-induced chronic diarrhea in rats[J]. J Ethnopharmacol, 2019, 231: 355-362. doi: 10.1016/j.jep.2018.07.031
[12] 王奕晨, 王萍, 唐旭东. 慢性萎缩性胃炎脾虚证及血瘀证与风险分层的相关性研究[J]. 中国中西医结合消化杂志, 2023, 31(5): 351-358. https://zxyxh.whuhzzs.com/article/doi/10.3969/j.issn.1671-038X.2023.05.07
[13] Tang XD, Lu B, Li ZH, et al. Therapeutic effect of Chang'an ⅠRecipe(Ⅰ)on irritable bowel syndrome with diarrhea: a multicenter randomized double-blind placebo-controlled clinical trial[J]. Chin J Integr Med, 2018, 24(9): 645-652. doi: 10.1007/s11655-016-2596-9
[14] Tang XD, Zhou LY, Zhang ST, et al. Randomized double-blind clinical trial of Moluodan for the treatment of chronic atrophic gastritis with dysplasia[J]. Chin J Integr Med, 2016, 22(1): 9-18.
[15] Zhu CY, Zhao LQ, Zhao JY, et al. Sini San ameliorates duodenal mucosal barrier injury and low-grade inflammation via the CRF pathway in a rat model of functional dyspepsia[J]. Int J Mol Med, 2020, 45(1): 53-60.
[16] Zhang SS, Zhao L, Wang H, et al. Efficacy of modified LiuJunZi decoction on functional dyspepsia of spleen-deficiency and qi-stagnation syndrome: a randomized controlled trial[J]. BMC Complement Altern Med, 2013, 13: 54.
[17] 连紫宇. 基于脂质代谢的溃疡性结肠炎脾气虚证生物学基础研究及参苓白术散防治机制初探[D]. 南京: 南京中医药大学, 2021.
[18] Wu YY, Zhong ZS, Ye ZH, et al. D-galacturonic acid ameliorates the intestinal mucosal permeability and inflammation of functional dyspepsia in rats[J]. Ann Palliat Med, 2021, 10(1): 538-548.
[19] Gu Z, Wang Q, He HY, et al. Genetic variations associated with spleen-yang deficiency pattern of non-alcoholic fatty liver disease: a candidate gene study[J]. Eur J Integr Med, 2020, 33: 101044.
[20] 戴亮. 脾虚证PRO量表的研制及其在病证结合疗效评价方法中的应用[D]. 上海: 上海中医药大学, 2021.
[21] 朱晓霞. 脾气虚证、脾胃湿热证、脾虚湿热证自测辨识量表的研制与评价[D]. 广州: 广州中医药大学, 2019.
[22] Hu L, Li HY, Chen WQ, et al. Ultrastructure characteristics of different Chinese medicine syndromes of helicobacter pylori-correlated gastric diseases[J]. Chin J Integr Med, 2019, 25(12): 917-921.
[23] Hu L, Chen WJ, Cheng M, et al. MUC1 and MUC5AC acting on helicobacter pylori-related deficiency and solid syndrome of spleen and stomach[J]. Evid Based Complement Alternat Med, 2018: 9761919.
[24] Dai YK, Zhang YZ, Li DY, et al. Interaction of cyclooxygenase-2 with helicobacter pylori induces gastric chronic nonresolving inflammation and the formation of syndrome of internal block of static blood in helicobacter pylori-related gastric diseases[J]. Evid Based Complement Alternat Med, 2020: 7340814.
[25] 代云凯. Hp相关胃病胃黏膜CDX-2基因多态性及其差异表达与不同证候关联的研究[D]. 广州: 广州中医药大学, 2021.
[26] Zhang L, Huang MX, Li DY, et al. The single-nucleotide polymorphism of miR-27a rs895819 and the expression of miR-27a in helicobacter pylori-related diseases and the correlation with the traditional Chinese medicine syndrome[J]. Evid Based Complement Alternat Med, 2022: 3086205.
[27] Shi Y, Zhu H, Li RL, et al. Effect of polysaccharides from Sijunzi decoction on Ca2+ related regulators during intestinal mucosal restitution[J]. Phytomedicine, 2019, 58: 152880.
[28] Zhang D, Zhu YP, Li ZJ, et al. The role of Astragalus Polysaccharides in promoting IEC-6 cell migration from polyamine-mediated Ca2+ regulation[J]. Int J Biol Macromol, 2022, 207: 179-192.
[29] 易杰, 李德新. 脾气虚与脾阴虚大鼠肝、脾组织蛋白激酶C活性变化的比较研究[J]. 中医杂志, 2003, 44(11): 851-853. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ200311033.htm
-
计量
- 文章访问数: 1113
- 施引文献: 0
下载: