《伤寒论》寒热并用相反相成用药规律探讨

《伤寒论》寒热并用相反相成用药规律探讨徐刚（北京中医药大学九三级博士生１０００２９）主题词《伤寒论》，治则，中药配伍《伤寒论》创六经辨证，开中医辨证论治之先河，首次将理法方药融为一体，因证立法，以法统方，所载１１２方与《金匮》所载之方被后世尊为经方，...     

从桂枝汤的临床应用看中医的辨证论治

桂枝汤是仲景《伤寒论》开篇的第一首方,虽为太阳中风证而设,但其在外解肌调和营卫,在内调理气血阴阳.如伤寒名家柯韵伯说：“此为仲景群芳之魁,乃滋阴和阳,调和荣卫,解肌发汗之总方也”.故被历代医家所推崇,辨证加减用于各种外感及内伤杂病.纵然桂枝汤的临床应用很广泛,但其仍需在中医辨证论治理论指导下应用才可取得较好疗效.本文从桂枝汤的现代临床应用,辨证分析其治疗多种疾病的证型,浅谈在实践遣方用药中需坚持中医的辨证论治理论.     

《金匮》方证与肿瘤临床

辨证论治为中医学术之核心理念,《金匮要略》为中医学术之经典著作,指导临床,其效若神。然参《金匮》著作之原文,比辨证论治之理念,两者虽实合而难对,令学习者倍感困惑与无奈,其指导意义,顿然若失。笔者以为,研究《金匮》,应依辨证论治于"证"之规范要求,以《金匮要略》原文为基础,参考历代名家之阐释,对其条文进行重新编排衍义,以期学术理念与经典著作完美统一,以期便利学习者之研究、掌握与运用。肿瘤乃危重之疾,此名亦为中西医临床之习用,然质之《金匮》,非但未见其名,且《金匮》所论其它诸多病名,亦实为症名,以之指导现代中医临床,常感名实难副,故现代中医学术,应依据病与症的辨证关系,理直气壮坚守"以病论治"、"以症论治",总以辨证论治为核心的中医临床诊治观念,唯此方可解此困惑,坚定经典学习之信念,并为中医发挥自身优势、为中西医的融通提供理论与实践依据。国医大师何任先生提出的"不断扶正,适时祛邪,随证治之"十二字肿瘤诊治原则,对此已有深刻揭示。     

陈德润主任治疗脾胃病经验举隅

辨证论治是中医的特色,但辨证论治并非是僵化的程序。通过介绍陈德润主任治疗脾胃病5个难治之证医案,重点对陈老辨证强调准确、治法讲究法度、精于选方用药和重视对病人心里的疏导等经验详加分析,有助于启迪后学。      

中医辨证分型治疗乙型肝炎148例的中医辨证预防

阐述中医治疗乙型肝炎，关键在于突出中医特色，辨证论治，随证用药，多可囿于现代化验检查结果，但在辨证论治、分型用方的同肘，用一些现代化研究显示可靠药理作用的药物，能收到较好的疗效．     

论方证相应辨证与辨证论治的关系与价值

通过论述方证辨证与其他辨证方法之异同及方证辨证与辨证论治的关系,认为方证相应是辨证论治的重要环节,是中医辨证方法之化繁为简的表现;辨证论治包括方证相应,方证相应是中医辨证论治原则的体现.指出方证相应辨证能够充分发挥方剂的治疗作用,开拓和发展其临床应用范围,具有科学性、灵活性和实用性,对临床具有较大的实用价值.     

谈谈针灸临床的辨证论治(上)

“辨证论治”是祖国医学的两大特点之一。针灸是中医的一部份,和方药治疗同源异流,理同法异。因此辨证论治在针灸临床中也同样受到历代医家的重视。早在《黄帝内经》一书中就有“凡刺之真,必先治神,五脏已定,九候已备,后乃存针。”①和“凡刺之方,必别阴阳。”②以及“用针者,必先察其经络虚实……乃后取而下之”。的记载。明代《针灸大成》中《百证赋》、《通玄指要赋》、《玉龙歌》、《杂病歌》、《杂病穴法歌》等众多的歌赋,将辨证论治的精神寓意于临床实践之中,为中医临床的辨证论治树立了光辉典范。     

浅谈《伤寒论》中的证、方、药特点

浅谈《伤寒论》中的证、方、药特点刘春援（江西中医学院教务处南昌３３０００６）关键词《伤寒论》证方药特点《伤寒论》是一部辨证论治体系及理、法、方、药具备的临床经典著作，其对中医临床的指导意义是毋庸置疑的。本文仅就论中部分证、方、药特点，浅谈笔者的教、学...     

数据挖掘技术及其在中医遣方用药规律中的应用

传统的中医谴方用药是在其辨证治疗思维模式的指导下确立的，方随证出。先辨证，再论治。形成证-法-方-药的治疗体系。近年来，随着中医、西医、中西医结合在国内并存的局面出现，中医临床谴方用药模式出现多元化，辨病论治与辨证论治相结合，微观辨证与宏观辨证相结合成为主要模式。如何分析病、证、方、药之间的关系利规律，从药方证病的关系中分析其制方的思维模式，具有重要的意义。而解决这一问题的关键是要有科学技术的支持。数据挖掘技术是近年来迅速兴起的一门边缘科学，可以从海量的文献中发现潜在、隐藏的规律。     

基于网络药理学探讨病-证-方对应关系的研究思路

病-证-方对应关系是将中医的辨证论治体系与西医对疾病的诊断模式相结合,研究符合中医自身规律的临床疗效评价方法和标准。网络药理学在方法学上具有整体性和系统性的特点,而这一特点与传统中医整体观和辨证论治的原则相互吻合。运用网络药理学方法研究病-证-方对应关系,可以揭示疾病、证候、方药之间的内在联系及网络调控机理,从而更深入的把握辨证论治的精髓。     

中医学之承先启后 推陈出新

六十年科教,中国中医科学院、中医药大学、中医学院,中医教育的传承与创新,继承发掘,整理提高。培养科技人才,建立科学诚信,实现中医药现代化。为了探索中医药微观辨证学的发展趋势,在邪气、脏腑、病形理论及四诊辨证与主诉辨治法的推动下,结合运用现代科学检测,以阐明疾病证候的实质变化。完成了微观辨证学及其学科群崛起,为新世纪中医药学的和谐发展开辟了新的途径。     

Significant association between Nijmegen breakage syndrome 1 657de15 polymorphism and breast cancer risk

Many studies were published to evaluate the association between Nijmegen breakage syndrome 1 （NBS1） 657de15 polymorphism and breast cancer risk, but the results remained inconsistent. To derive a more precise estimation on the possible association,we performed a meta-analysis of previous published studies. Case-control studies on the association between NBS1 657de15 polymorphisms and breast cancer risk were included into this meta-analysis. We used the odds ratio （OR） with 95% confidence interval （95% CI） to assess the strength of the association. Ten studies with a total of 25,365 subjects were identified and included into this meta-analysis. Meta-analysis of those ten studies showed that there was a significant association between NBS1 657de15 polymorphisms and breast cancer risk （pooled OR = 2.66,95 % CI 1.82 - 3.90, P 〈 0.001 ）. The cumulative meta-analyses showed a trend of a more significant association between NBS1 657de15 polymorphisms and breast cancer risk as data accumulated by publication year. Thus, our meta-analysis suggests that there was a significant association between NBS1 657de15 polymorphisms and breast cancer risk, and NBS1 657de15 polymorphism results in an increased risk of breast cancer.     

Effects of Rosiglitazone on Adiponectin Expression in 3T3- L1 Adipocytes at High Levels of Both Testosterone and Insulin In Vitro Culture

Objective To evaluate effects of rosiglitazone （RSG） on the expression of adiponectin in mature adipocytes at high levels of both testosterone （T） and insulin in vitro culture. Methods Mouse 3T3-L1 preadipocytes were induced to be mature adipocytes and used in this study. According to RSG concentrations, the cells added with T （10^-5 mol/L） and insulin （10^-4 mol/L） were divided into 4 groups： free-RSG group （0 mol/L RSG, FR-TI）, low-dose group （10^-9 mol/L RSG, LR-TI）, middle-dose group （lO-7mol/L RSG, MR-T1） and high-dose group （10^-6 mol/L RSG, HR-TI）. Besides, the cells added with RSG without T and insulin were also divided into 4 groups： FR, LR, MR, and HR. These 8 groups were incubated for 42 h. Cell viability was determined by MTT assay. Expression of adiponectin was detected by Western blotting. Results The maximum viability in FR-TI group was observed at point of 42 h. The growth of the adipocytes was significantly inhibited in MR-TI group compared with FR-TI （P〈0.01）. The level of adiponectin in MR-TI group was higher than that in LR- TI group （P〈0.01）. However, with RSG increasing; HR-TI group showed the lowest level of adiponectin among three treatment groups （P〈0.01）. In addition, adiponectin expression in MR-TI group was significantly higher than that in MR group （P〈0.01）. Conclusion RSG could increase the expression of adiponectin in 3T3-L1 adipocytes under high levels of both T and insulin, but it acts in a narrow concentration range.     

表皮生长因子受体酪氨酸激酶抑制剂在非小细胞肺癌应用的瓶颈——获得性耐药

以表皮生长因子受体酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitor,EGFR-TKI）分子靶向治疗研究为肇始,转化性研究使基础实验和临床实践间的鸿沟迅速填平,改变着人们认识治疗肺癌的视角。无可否认,EGFR-TKI上市后极大地延伸了肿瘤学家治疗肺癌的手段,但不管从临床经验、临床研究数据、分子生物学层面还是文献计量学的角度,     

Liuwei Dihuang,a traditional Chinese herbal formula,suppresses chronic inflammation and oxidative stress in obese rats

OBJECTIVE： To investigate the anti-inflammatory, anti-oxidative stress, and adipokine-ameliorating effects of Liuwei Dihuang （LWDH）, a traditional Chinese herbal formula, in obese rats. METHODS： After 2 weeks of acclimation with free access to regular rodent chow and water, obese-prone-caesarean-derived （OP-CD） rats were fed a modified AIN-93G diet containing 60% energy from fat. Treatment was performed twice daily by gavage feeding with 500, 1 500, or 3 500 mg/kg body weight LWDH suspended in water （n=12 rats per group）. Twelve obese-resistant-CD （OR-CD） rats were fed the atherogenic diet and gavaged with water, and served as the normal control. Blood biomarkers of inflammation, oxidative stress and adiponectin were measured post-sacrifice and used to determine the treatment effect of LWDH and assess the suitability of OR/OP-CD rats for studying these parameters. RESULTS： After 9 weeks of treatment, LWDH lowered serum C-reactive protein （CRP） and tumour necrosis factor-α （TNF-α） levels. Serum interleukin-6 （IL-6） levels showed a tendency towards reduction, but were not significantly different from the OP-CD control. Liver superoxide dismutase （SOD） activity was increased in response to all three doses of LWDH, while the levels of reduced （GSH） and oxidized glutathione （GSSG） and thiobarbituric acid reactive substances （TBARS） were unchanged. Serum adiponectin levels were increased in response to oral administration of LWDH at the dose of either 500 or 1 500 mg/kg body weight. In addition, comparisons between OR-CD and OP-CD rats revealed differential, and for some biomarkers, conflicting characteristics of high-fat diet-fed OP-CD rats in reference to obese human subjects in terms of inflammatory and oxidative stress biomarkers and circulating adiponectin levels. CONCLUSION： The results show, for the first time, the anti-inflammatory, anti-oxidative stress and adiponectin-ameliorating effects of LWDH in obese rats. The suitability of the OP-JOP-CD rat model as     

益智健脑颗粒联合针灸对阿尔茨海默病大鼠学习记忆的影响

目的观察益智健脑颗粒联合针灸对阿尔茨海默病（Alzheimers disease,AD）大鼠学习记忆的影响。方法将大鼠随机分为假手术组（A组）、模型组（B组）、针灸组（C组）、益智＋针灸组（D组）各10只,B、C、D 3组分别以海马CA1区注射β淀粉样蛋白25-35（Aβ25-35）造模,A组注射等量的双蒸水,各组分别治疗20 d后行Morris水迷宫试验,观察大鼠学习记忆能力变化。结果B组较A组的平均潜伏期明显延长,差异具有统计学意义（P〈0.05）;与B组比较,C组、D组的平均潜伏期明显缩短,过台次数增多,差异具有统计学意义（P〈0.05,P〈0.01）;与C组比较,D组的潜伏期缩短,过台次数增多,差异具有统计学意义（P〈0.05）。结论益智健脑颗粒联合针灸能够提高Aβ25-35介导的AD模型大鼠的学习记忆能力。     

程丑夫教授论治情志病验案举隅

程丑夫是国家级名老中医,湖南中医药大学第一附属医院主任医师、教授、博士生导师,享受政府特殊津贴专家,出身于中医世家,从医40余年,经验丰富,对于内科系统及疑难杂症的治疗颇有心得,笔者有幸跟师学习,聆听教诲,受益匪浅,现将程师论治情志病的经典验案略陈一二。1思虑伤脾案患者肖某,女,27岁。初诊：2014年5月20日。半年前因婚变后出现忧心忡忡,多思多虑,近1月来反复腹部胀满,刻诊：腹胀,食后为甚,呃逆,无反酸,通气后可减轻,无腹痛,不欲食,夜寐不安,二便调。舌红苔厚白腻,脉弦,BP：110／70mmHg。     

常见舌象对证素辨别的贡献度

舌诊是中医诊察病情独具特色的诊法。舌象能较客观地反映疾病中机体的整体反应状态,是辨证的重要依据。各种舌象对各证素的判断具有不同的意义。     

补肾活血方对PCOS大鼠模型卵巢中PAI-1mRNA表达的影响

目的探讨补肾活血方对大鼠PCOS模型卵巢局部纤溶酶原激活物抑制因子-1（PAI—1mRNA）表达的影响。方法选用未成年24d龄SD雌性大鼠60只,随机分为模型组、克罗米酚组、补肾活血方高剂量组、补肾活血方低剂量组、正常对照组5组。用Bogovich法建立大鼠多囊卵巢病理模型。以克罗米酚为对照。用原位杂交法观察补肾活血方对多囊卵巢大鼠局部PAI—1mRNA的影响。结果模型组卵巢局部PAI—1mRNA存在卵泡膜间质细胞显著增高,用补肾活血方高、低剂量与克罗米酚药后,卵巢局部PAI-1mRNA的表达明显降低．差异具有统计学意义（P〈0．05、P〈0．01）。补肾活血方高剂量组与克罗米酚组比较,差异具有显著统计学意义（P〈0．01）;低荆量组与克罗米酚组比较差异无统计学意义（P〉0．05）,补肾活血方高、低剂量组比较,低剂量组卵泡膜间质细胞上PAI-1的基因表达增高更明显,但二者差异无统计学意义（P〉0．05）。结论PAI-1mRNA可能与多囊卵巢综合征的发病机制有关。以补肾活血立法的补肾活血方能降低多囊卵巢大鼠局部PAI—1mRNA的显著增高表达．降低PAI—1mRNA卵巢局部的作用。提示补肾活血方可能通过PAI—1mRNA途径促进卵巢排卵的机制。     

New Mechanism of Herb-herb Interaction between Ginseng and Trogopterus Based on CYPs in Rat Livers

The study was designed to investigate the potential mechanism of herb-herb interaction between ginseng and Trogopterus （Trg） based on Cytochrome P450 isozymes （CYPs） in rat livers. We estimated the influence on CYP1A2, CYP2E1, and CYP3A1/2 activity caused by ginseng and Trg used in combination. The CYP1A2 and CYP2E1 enzyme activity were induced by ginseng and Trg used in combination. And this induction effect was caused via inducing CYP1A2 and CYP2E1 protein expression which was supposed caused by inducing the gene expression of CYP1A2 and CYP2E1.