2018年 · 第38卷第08期

The Book of Changes is the crystallization of ancient Chinese people's thoughts and wisdom. It is the theoretical root of natural philosophy and humanistic practice in traditional thought and culture. It is known as the "source of the great way" and has a profound influence on China's politics, economy, culture and other fields^[1]。 The Book of Changes believes that movement is a universal law of nature^[2]。 For example, "Yi Zhuan·Xici Shang" says: "Wealth is called great cause, daily renewal is called prosperous virtue, and life is called Yi." It also says: "Yi can not be far away as a book, and it can also be changed repeatedly as a dao, and it is constantly changing, circulating and flowing, and the upper and lower are impermanent, and the rigidity and softness can be changed. It can not be used as a canon, but only the change is suitable." It emphasizes that everything is in the process of dynamic movement. Traditional Chinese medicine inherited the view of movement in the Book of Changes, and improved the theory qualitatively in later generations, and established the theory of lifting and falling of human body qi^[3,4]。 For example, Zhang Zhongjing used the idea of one hexagram and six Yao in the Book of Changes to regard typhoid fever as a hexagram, and the transmission of the six meridians is the movement of the six Yao, which reflects the rise and fall of yin and yang caused by the struggle between good and evil.

With the changes of social environment and disease spectrum, the public's requirements for the effectiveness, safety and economy of TCM compounds are constantly increasing. Continuous development and innovation of the research on dose-response relationship of TCM compounds is an important way to realize the comprehensive benefits of good prescriptions. At present, the study of the dose-effect relationship between prescriptions and medicines has entered the exploration stage of scientific method system from the stage of experience accumulation and case analysis. Because prescriptions and medicines are used under the guidance of traditional Chinese medicine theory, they belong to a complex system with diverse effects, and the dose-effect relationship between prescriptions and medicines is affected by many factors, such as the application of four qi and five flavors, the compatibility of medicinal flavors and dosage selection, etc. Therefore, how to ensure the curative effect of prescriptions and medicines is fully exerted is a problem that needs attention at present. This paper summarizes the research progress of the dose-effect relationship of Chinese medicine compounds in recent years, and discusses the key scientific problems and strategies to be solved urgently, hoping to be beneficial to clinical application and the explanation of the scientific connotation of Chinese medicine theory.

functional gastrointestinal disease (FGID) refers to the presence of digestive tract symptoms but cannot be explained by organic lesions or biochemical abnormalities in blood tests. Clinically, non-erosive reflux disease, functional dyspepsia, IBS and functional constipation are the most common^[1]。 FGID is extremely common, with its prevalence and medical visit rates as high as 34.6% and 62.1% in the general population, which seriously affects the quality of life of patients. Its symptoms are related to various physiological and pathological changes, such as abnormal gastrointestinal motility, increased visceral sensitivity, dysregulation of brain-intestinal axis, inflammatory reaction, psychosocial factors and stress^[2]。

The Rome IV diagnostic criteria define functional gastrointestinal disease (FGID) as a group of diseases with predominant gastrointestinal symptoms^[1]。 Motility disorders, visceral hypersensitivity, mucosal and immune dysfunction, changes in intestinal flora, and abnormal processing function of central nervous system can cause FGID^[2]。 At present, FGID accounts for 40% ~60% of all gastroenterology outpatients. It is induced by diet, mental psychology, social factors and other factors, which affect the normal life, work and quality of life of patients. Since the birth of the Rome I diagnostic criteria in 1994, the gastroenterologists of the Rome Foundation have been devoted to the diagnosis and treatment of FGID for more than 20 years, and have achieved remarkable results. However, the treatment of FGID is still not ideal, it cannot relieve all the symptoms of patients, and the high recurrence rate bothers patients and clinicians. Traditional Chinese medicine has a long history of thousands of years in China, accumulated rich experience in the treatment of diseases, and played an irreplaceable role in the treatment of FGID^[3,4,5,6,7]。

In recent years, due to the popularity of endoscopy and the development and maturity of endoscopic ultrasonography, the detection rate of submucosal tumors (SMT) of digestive tract has increased greatly. Endoscopic resection of SMT has been widely concerned and recognized because of its advantages such as less trauma, less complications, fast recovery and low cost. Endoscopic minimally invasive treatment on the basis of improving the detection rate of SMT is an effective way to improve the quality of life of SMT patients, reduce the burden of family and society, and save national medical resources.

LIM-homeobox gene 2 (LIM-homeobox gene 2,LHX2) Belonging to the LIM homeobox gene family, identified for having a homeobox domain and a cysteine-rich LIM domain^[1]。LHX2 is located on chromosome 9 adjacent to c-Abl, and its abnormal expression is often triggered by chromosomal translocation^[2]。 The LIM homeobox gene family is involved in many important physiological processes, such as cell division, cell proliferation, specific cell differentiation and embryo development^[1,3,4,5]。 In addition to specific physiological functions,LHX2 is closely related to the occurrence and development of various tumors, such asLHX2 Promotes the proliferation and metastasis of breast cancer cells by inducing platelet-derived growth factor-B (PDGF-B)^[6]。 In addition, the LHX2 protein is overexpressed in a variety of tumors, including chronic myeloid leukemia, gastrointestinal cancer, pancreatic cancer, and kidney cancer^[2,7]。 However, there have been few reports of LHX2 expression in esophageal squamous cell carcinoma so far. Therefore, in this study, immunohistochemistry, real-time fluorescence quantitative PCR and Western blot were used to detect the expression of LHX2 in esophageal squamous cell carcinoma tissues and normal esophageal epithelial tissues, and the relationship between its expression level and clinicopathological parameters and prognosis of esophageal squamous cell carcinoma patients was analyzed, which laid a foundation for discovering new prognostic indexes of esophageal squamous cell carcinoma.

Gastric polyps are one of the precancerous lesions of gastric cancer. With the increase of the detection rate of gastric polyps, its etiology and pathogenesis have attracted increasing attention. Studies have found that bile reflux increases the risk of gastric polyps, and some gastric polyps may be related to bile reflux and bile acid stimulating gastric mucosal hyperplasia^[1,2,3,4]。 Most studies believe thatH.pyloriInfection was closely related to hyperplastic polyps, but not or negatively related to fundus polyps^{[5,6,7,8,9,10]}。 In addition, it has been reported that bile reflux can inhibitH.pylorigrow^[11,12,13]。 However, in the study of the mechanism of gastric polyps, bile reflux andH.pyloriThe relationship between infection and gastric polyp formation is not well defined at present. In this study, pathological examination, intragastric bile acid detection and polyp tissue were performed in patients with gastric polyps found by gastroscopyH.pyloriDetection, to explore fundus polyps and hyperplastic polyps and bile reflux andH.pyloriThe relationship of infection.

In recent years, with the increasing aging phenomenon and the progress of examination methods, the incidence of colonic diverticular disease in China is increasing year by year. The incidence of colonic diverticular disease is not only related to age, lifestyle habits, genes, bacterial flora, etc., but also related to sex^[1]。 It was found that colonic diverticular disease occurs in men, which may be related to the gender differences in the composition of bacterial flora and metabolic patterns, and the differences in lifestyle habits between men and women^[2,3,4]。 This study explored the influencing factors of colonic diverticulosis in men and women, respectively, which are reported as follows.

severe acute pancreatitis (SAP) has a dangerous onset, many complications and a high mortality rate. The early onset of SAP is the prevalent stage of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). In the recovery period, it will face local complications such as pseudocyst formation, peripancreatic infection, peripancreatic hemorrhage, pancreatic fistula, and pancreatogenic portal hypertension. The whole treatment process of SAP involves the collaborative diagnosis and treatment of internal medicine, surgery, critical care medicine, nephrology and other disciplines, and the collaboration of imaging intervention department is also required in minimally invasive intervention. A case of SAP complicated with abdominal hemorrhage and peripancreatic infection was retrospectively analyzed to explore its multidisciplinary collaborative diagnosis and treatment.

A 78-year-old female was admitted to the hospital on January 6, 2017 due to "repeated abdominal distension for more than 5 months". Five months ago, the patient developed paroxysmal distension and pain due to inappropriate diet, mainly under the xiphoid process and the right abdomen, without radiating pain, aggravated after bending and pressing, accompanied by nausea and vomiting, the vomit was yellow watery, accompanied by dizziness, no headache, little exhaust and defecation in the anus, and no relief after rest. Then he went to a local hospital and got better after symptomatic treatment such as antispasmosis and pain relief. Subsequently, the patient had paroxysmal abdominal pain from time to time after entering the ordinary diet, and there was an "air block" arching in the right lower abdomen during the attack. He was treated symptomatically in the local hospital many times, and his condition was prolonged. In July 2016, he underwent laparoscopic cholecystectomy due to "cholecystitis". He has a history of hypertension for more than 10 years. He has taken felodipine once a day for a long time and stopped the drug for more than 1 year. He claimed that his blood pressure could be controlled. Physical examination at admission: vital signs were stable, abdomen was flat and soft, and no gastrointestinal type was seen; Tenderness in the right upper and lower abdomen and under the xiphoid process, no rebound pain, not reaching the liver and spleen under the costs, negative Murphy's sign, negative mobile voicing, enhanced intestinal sounds, and percussion pain in the liver area. On January 6, 2017, the abdominal upright X-ray examination showed: local intestinal dilatation in the middle abdomen with air-liquid plane, suggesting the possibility of incomplete intestinal obstruction; Proposed incomplete intestinal obstruction (Figure 1)。 Give symptomatic treatment such as liquid diet and liquid rehydration. On January 9, 2017, abdominal ultrasound examination showed: intrahepatic calcification; After cholecystectomy, the upper common bile duct does not dilate; The right kidney is small in size; No obvious abnormalities were found in pancreas and spleen. On January 9, 2017, total abdominal CT scan + enhanced examination showed postoperative changes of gallbladder, exudative changes of abdominal mesenteric cavity, and partial tortuous dilatation of the branch of superior mesenteric vein; Local intestinal wall thickening in the left middle abdomen with proximal intestinal dilatation (Figure 2), considering incomplete intestinal obstruction of the small intestine; Multiple local calcifications in the body and tail of the pancreas; Intrahepatic calcification; A small amount of fluid in the pelvic cavity. On January 13, 2017, transoral enteroscopy showed that an oval, yellow, hard stool stone with a size of about 4 cm ×5 cm blocked the intestinal lumen in group 2 of jejunum (Figure 3)。 Therefore, small intestinal lithotripsy was performed on January 13, 2017. Because it was difficult to cut the fecal stones with the snare, it was first soaked in 5% sodium bicarbonate solution for 2 minutes, and then the fecal stones were trapped with the snare and cut in stages (Figure 4), the small intestinal lithotripsy was completed in about 15 minutes.

Polyprezinc is a new generation of gastric mucosal protectant, which is formed by chelating zinc and carnosine, and is widely used in the treatment of gastric ulcers in Japan. Polyprezinc protects gastric mucosa by inducing heat shock protein expression and antioxidant and anti-apoptotic effects. However, it was found that in addition to protecting the mucosa locally, polyprezinc can also inhibit the inflammatory response and eradicateH.pyloriAnd anti-fibrosis. By reviewing the relevant literature, the clinical application progress of polyprezinc, a gastric mucosal protective agent, in addition to the treatment of gastric ulcer is described.

IBS is one of the common functional gastrointestinal diseases in gastroenterology department. It is mainly characterized by abdominal pain associated with defecation, with changes in defecation frequency and/or abnormal fecal characteristics. Its symptoms are recurrent and lack of effective treatment, which causes huge economic and psychological burden to patients^[1]。 Currently, the treatment methods of IBS mainly include drug therapy, psychotherapy, lifestyle change and dietary therapy. Traditional diet therapy is one of the more representative treatment methods. It was originally proposed based on the dietary guidelines of the National Institute for Health and Care Excellence (NICE) in the United Kingdom. Its content covers advising patients to eat small meals frequently, avoid satiety, avoid intake of large amount of ethanol, coffee, beans, onions, etc. In recent years, clinical studies have found that restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) can effectively improve gastrointestinal symptoms in patients with IBS^[2]。 However, the short-term and long-term clinical efficacy, specific mechanism of action, efficacy predictors and potential risks of low FODMAP dietary therapy are still controversial, and the above issues will be reviewed.