《伤寒论》运用人参的经验

笔者以仲景原文及临床经验为据,对《伤寒论》运用人参的规律,从①六经类方,扶阳气辨证论治;②组方配伍,保胃气扶正祛邪;③五行生克,平阴阳治病求本三方面进行了论述。并介绍了四川省名老中医江欣然先生(1900～1974)运用人参复方治疗疾病的经验体会。如茯苓四逆汤(茯苓、红参、附子、甘草、干姜)具有温阳救脱,宁心安神作用,常用于治疗和挽救肺心病晚期所致的四肢厥冷、脉沉细欲绝之亡阳危重证候。运用理中丸(红参、干姜、炙甘草、白术)长期内服对肺心病有减少痰涎、巩固疗效之     

温成平教授论治银屑病经验

[目的]总结温成平教授对银屑病的辨治经验。[方法]从病因病机、辨证论治、临床验案等方面阐释温成平教授治疗银屑病的临床经验及方药特色。[结果]温师认为"毒、郁、瘀"为银屑病的病机关键,并将银屑病分为血热证、血燥证、阳郁证3型进行论治;进行期以血热证多见,病久热毒燔灼营阴、血虚津枯难以濡养肌肤以血燥证多见,并根据"天人相应"理论,认为季节因素尤其是寒冷是银屑病发病或加重的重要因素,提出"阳郁证"的辨治。临证还需重视活血,注意顾护脾胃。所举医案获得良好疗效。[结论]温成平教授对银屑病辨证独到,用药精当,疗效显著,对指导临床有实用价值,为银屑病的治疗提供了新思路。     

卢秉久教授配伍运用楮实子与枳椇子治疗酒精性肝病经验

[目的]总结卢秉久教授配伍运用楮实子与枳椇子治疗酒精性肝病的独到思想与经验方法。[方法]通过介绍祖国医学对酒精性肝病的认识和楮实子、枳椇子的功效特点,从验案两则出发,总结卢教授配伍运用楮实子与枳椇子治疗本病的学术思想与经验方法。[结果]本病系酒伤脾胃,致湿热内蕴,日久气血水相互搏结,终成正虚邪恋之势;楮实子滋肾清肝、助肾利尿;枳椇子利水消肿、善解酒毒,因此卢教授多配伍运用楮实子与枳椇子治疗本病。[结论]卢教授配伍运用楮实子与枳椇子治疗酒精性肝病疗效确切,值得学习借鉴与继承发扬。     

浅谈对痰证的辨治

承忠委老中医在痰证的治疗上有较为丰富的经验,特别对六淫所生之痰证治疗方面尤为独到、文章例举风、寒、燥、火、郁等痰的证、治和用药经验并各举一验案加以说明。     

马振华老中医治疗脾胃病验案举隅

[目的]介绍马振华老中医治疗脾胃疾病的经验。[方法]整理马振华老中医临证论治脾胃疾病的验案,并遴选验案3则,结合《内经》等中医经典论著及其理论,并结合吴门医派学术思想,阐释马老治疗脾胃疾病的验案,分析阐明马老注重调理全身气机、辨证施治的学术思想以及遣方用药的特色。[结果]烧心、胃胀、腹泻3则验案显示,马老在治疗脾胃疾病时,尤其注重全身气机的调理,从脾胃气机的升降、肺气的宣发与肃降以及肝气的疏泄3个方面论治。辨证与辨症相结合,因时因地制宜。擅长配伍运用调理气机、芳香化湿与辛开苦降之品。[结论]马振华老中医治疗脾胃疾病辨证论治、对全身气机调理的主张值得学习借鉴。     

闫小宁教授运用克银汤治疗血瘀型银屑病经验

[目的]总结闫小宁教授运用克银汤治疗血瘀型银屑病的临证经验,提高中医药治疗血瘀型银屑病的临床疗效。[方法]通过侍诊学习,整理、分析闫小宁教授治疗银屑病血瘀证的医案,从病因病机、临证拟方及配伍加减等方面探究闫小宁教授运用克银汤治疗血瘀型银屑病的临证经验,同时以两则验案佐证。[结果]闫小宁教授认为血瘀型银屑病的病因病机为风热毒邪聚结肌肤,或营血亏耗,生风生燥,导致气血凝滞而发病。针对此病因病机,采用凉血活血、解毒化瘀、养血消斑的治疗总则,并自拟克银汤治疗此病。所列两则医案均具体展示了上述辨证思路和用药特色。其中案一患者辨证为血瘀夹湿热证,治以凉血活血、清热利湿之法,投以自拟方克银汤加减治疗,疗效甚好。案二患者为典型血瘀证型银屑病,首诊以凉血活血、通络化瘀为主,经运用克银汤治疗后皮疹基本消退,故续用前方佐以滋阴之品巩固治疗。[结论]闫小宁教授运用克银汤治疗血瘀型银屑病的临床经验和独到的个人见解值得学习推广和深入探讨。     

俞景茂教授治疗小儿腺样体肥大验案三则

[目的]介绍俞景茂教授治疗小儿腺样体肥大经验。[方法]整理俞景茂教授临证论治小儿腺样体肥大验案,并遴选验案三则,以阐明俞老师辨证施治、分期治疗以及遣方用药特色,并系统论述俞景茂教授辨治小儿腺样体肥大疾病的独到经验。[结果]俞景茂教授在小儿腺样体肥大治疗中,一般分三阶段施治:初期治以疏风清热、散结消肿;中期治以养阴润肺、活血化瘀;后期治以益气固表,养阴清热。临证中常获佳效,所选验案也获得满意疗效。[结论]俞景茂教授对小儿腺样体肥大辨证论治、分期治疗以及攻补兼施、培固正气的主张值得学习借鉴。     

王哲教授运用神阙穴贴敷治疗产后汗出不止经验撷英

[目的] 探讨王哲教授应用神阙穴贴敷治疗产后汗证的临证经验，以期为中医外治法治疗产后汗证提供相关经验。[方法] 分析王哲教授对产后汗证的病因病机认识，阐明神阙穴贴敷作用机制、贴敷时间及注意事项等，并列举典型案例加以佐证。[结果] 王哲教授认为产后汗证的病因病机主要为产时耗伤气血，亡血伤津，致气血虚弱，阴血暴脱，虚阳外越，熏蒸汗出。针对其病因病机，采用益气养血、收敛止汗的原则，运用神阙穴贴敷治疗，可较大程度发挥神阙穴固本培元、调整阴阳及药物五倍子、煅牡蛎收敛止汗的功效，有助于产妇整体恢复，临床应用疗效显著。所举验案辨为气血虚弱、营卫失和证，选取益气固表方联合神阙穴贴敷治疗，以固本培元、收敛止汗为治则，使营卫调和，汗出自止。[结论] 王哲教授运用神阙穴贴敷外治法治疗产后汗证，方小精简，经济便捷，疗效突出，其经验值得借鉴。     

杨从鑫名老中医治疗汗证经验

汗证是中医临床常见病证,本文介绍杨从鑫名老中医诊治汗证经验,其认为病因病机主要为阳盛、阴胜格阳、阳虚、阴虚,并根据病机辨证分为表虚失固、阳明热盛、阴虚火旺、湿热内蕴,并分型治之。     

林胜友巧用麻杏石甘汤诊疗放射性肺损伤学术经验

[目的]探讨林胜友主任中医师运用麻杏石甘汤治疗放射性肺损伤疾病的临证经验。[方法]通过临床跟诊及患者反馈,收集相关资料,从放射性肺损伤的研究背景、治则治法、分证论治、用药特点等方面来论述相关学术经验及临床体会,并分析验案一例。[结果]林胜友主任中医师治疗放射性肺损伤以清法贯穿全程,兼以补、通二法,治要扶正祛邪,以平为期。临床上放射性肺损伤患者初起热毒炽盛,法当清肺泻火,方选麻杏石甘汤,日久不愈伤津耗气治酌选益气养阴、补肺健脾之法,久病及肾当阴阳兼顾则,平补肾脏,又各期均可夹痰夹瘀,临床当活血养血,通络利痰。[结论]运用麻杏石甘汤治疗放射性肺损伤疾病疗效确切,对于中医临床工作有一定指导意义。     

The pathophysiological and molecular basis of Bartter's and Gitelman's syndromes

Molecular defects affecting the transport of sodium, potassium and chloride in the nephron through the ROMK K⁺ channel, Na⁺/K⁺/2Cl^- cotransporter, the Na⁺/Cl^- cotransporter and chloride channel have been identified in patients with Bartter''s and Gitelman''s syndromes. Defects of the angiotensin II type I receptor and CFTR have also being described. These defects are simple (ie, most are single amino acid substitutions) but affect key elements in tubular transport. The simplicity of the genetic defects may explain why the inheritance of these conditions remains unclear in most kindreds (ie, not just recessive or dominant) and emphasises the crucial importance of the conformational structure of these channels. Application of this molecular information will allow the early genetic identification of patients with these syndromes and enable us to differentiate between the various disorders at a functional level. It may also identify a sub-group in which the heterozygous form may make patients potentially exquisitely sensitive to diuretics.


     

Gradenigo's syndrome

Gradenigo's syndrome, which is characterised by the triad of suppurative otitis media, pain in the distribution of the trigeminal nerve, and abducens nerve palsy may give rise to potentially fatal complications. Knowledge of the aetiology and appropriate investigations can lead to early diagnosis. A case is reported which illustrates this.     

Fournier's gangrene and its emergency management

Fournier's gangrene (FG) is a rare but life threatening disease. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes as well as long term alcohol misuse; however, it can also affect patients with non-obvious immune compromise. The nidus is usually located in the genitourinary tract, lower gastrointestinal tract, or skin. FG is a mixed infection caused by both aerobic and anaerobic bacterial flora. The development and progression of the gangrene is often fulminating and can rapidly cause multiple organ failure and death. Because of potential complications, it is important to diagnose the disease process as early as possible Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the death rate remains high.     

Management of non-Hodgkin's lymphomas

The non-Hodgkin''s lymphomas (NHL) are a heterogenous group of disorders characterised by malignant proliferation of lymphoid cells. The cellular origin is relatively well established with subtypes corresponding to the various stages of lymphocyte differentiation. The term encompasses a hotchpotch of conditions with very different morphological appearance, behaviour and clinical outcome. NHL comprise 2.4% of all cancers, with incidence increasing with age. The commonest presentation is with progressive lymphadenopathy, though extranodal manifestations are present in a significant proportion. The clinical behaviour ranges from a benign, indolent course to rapidly progressive disease; prognosis varies from weeks to many years. Treatment is correspondingly diverse, from `watchful waiting'' to high-dose chemotherapy with bone marrow stem cell transplantation. Cure is possible in an increasing number of patients and much interest currently lies in identifying patients with high-risk disease necessitating the use of intensive treatment regimens.


     

两种不同方法在黑热病诊断中的应用比较

目的:比较用骨髓检查和rK39试纸条2种不同方法对于临床黑热病现症患者检测的效果.方法:以rK39试纸条样品带区出现红色条带为阳性,骨髓检查中查到利什曼原虫为阳性,并比较两种不同方法对诊断黑热病的效果.结果:检测病例372例.354例做骨髓检查,阳性254例(阳性率(71.75%),阴性100例,未做18例(rK39均阳性);做rK39检测125例,阳性110(阳性率88.0%),阴性15(骨髓检查阳性13例);骨髓+rK39均做107例,双阳性51例,双阴性2例,骨髓阳性,rK39阴性13例,骨髓阴性,rK39阳性41例.结论:两种方法单一阳性检出率统计学差异有显著性,说明rK39试纸条法在诊断黑热病中更具有优势,该法快速、简便、敏感性和特异性高,费用相对低、患者痛苦小,更适于黑热病的诊断.骨髓检查做为病原学检查,是确诊实验,两者结果应互为参考.     

3''R,4''R-二取代角型吡喃香豆素的不对称合成

目的:寻找具有钙离子拮抗作用和乙酰胆碱酯酶抑制活性双重作用机制的早老性痴呆(Alzheimer′sDisease,AD)新型抑制剂。方法:间二苯酚为底物,AD-mix-β作不对称双羟基化试剂进行凯林内酯类香豆素的全合成;所有产物进行乙酰胆碱酯酶(AchE)抑制活性测试。结论:立体选择性地合成cis3′-R,4′R-二取代角型二氢吡喃香豆素,但AchE抑制活性明显低于cis3′-R,4′R-二取代线型二氢吡喃香豆素。     

抗菌肽PR39真核表达载体的构建及其在巨噬细胞中的表达和抗菌作用

目的 构建抗菌肽PR39的真核表达载体,转染后观察PR39在小鼠巨噬细胞RAW264.7中的表达及抗菌作用.方法 采用拼接PCR法合成抗菌肽PR39基因,克隆到真核表达载体pIRES2-GFP中,经鉴定后用阳离子脂质体转染小鼠巨噬细胞RAW264.7,通过RT-PCR和免疫荧光法检测目的 基因的表达,并对其抗菌活性进行初步检测.结果 成功构建了抗菌肽PR39的真核表达载体pIRES2-GFP/PR39,并能在小鼠巨噬细胞RAW264.7中表达抗菌肽PR39.表达抗菌肽PR39的巨噬细胞杀灭和清除胞内菌的能力明显增强.结论 抗菌肽PR39基因能够在小鼠巨噬细胞RAW264.7中表达并发挥抗菌作用.     

A rare case report of appendix and cecum in the sac of left inguinal hernia (left Amyand's hernia)

This case is a rare aspect of left inguinal hernia. The patient was a 60-years old man with left scrotal mass since childhood. In the operating room, the hernia sac was opened which included cecum and appendix that is called left Amyand‘s hernia. The patient underwent herniorrhaphy with Lichtenstein repair.