热症亡阳的治驗体会

温为阳邪,最易伤阴。在病理过程中,容易耗伤津液,常常会有亡阴的症状出现,故热症亡阴,古人早有了很全面的治疗方法,因而在处治上是比较容易的,但也有在热病过程中由于阳气素虚,汗出过多,不止亡阴,同时也会出现亡阳。如汗出肢冷、烦躁脉脱等一系列阳气外脱的症状,是温热病中或有的变例。比较亡阴更为险恶。治不如法,便会厥脱死亡。《伤寒论·阳明篇》211条云:“发汗多,若重发汗者,亡其阳,谵语,脉短者死、脉自和者不死。”这对热病亡阳早有提及,而历代医家很少研究,以为病本热邪,必伤阴液,故侧重救阴方面,而救阴与救阳的用药,基本上又是矛盾对立的,治疗稍差,生死立判。现把有关热     

试论仲景护阴八法

张仲景在《伤寒论》中指出:“寒为阴邪,易伤阳气”,所以治疗上以温阳法为主。但仲景也认识到寒邪易从热化,损耗阴津,或阳伤过甚,累及阴津,故治疗又当顾护阴液,兹将仲景护阴之法归纳如下。1 发汗顾阴法 桂枝加葛根汤证与葛根汤证均有项背强几几之状,此乃津液不足所致。前者是表证有汗,后者是表证无汗,治疗时都须采用既能解表又能升津布液的葛根,体现出仲景既要发汗解表,又要顾护阴津的治疗观点。     

联系临床读经典

《内经》、《伤寒论》、《金匮要略》等经典医籍因其言简意奥，某些篇章多生歧义，此时若联系临床斟字酌句，往往柳暗花明，解决许多问题。1其人短气但坐《伤寒论》48条：“二阳并病，太阳初得病时，发其汗，汗先出不彻，因转属阳明，续微自汗出，不恶寒。若太阳病证不罢者，不可下，下之为逆，如此可小发汗。……若发汗不彻，不足言，阳气拂郁不得越，当汗不汗，其人躁烦，不知痛处，乍在腹中，乍在四肢，按之不可得，其人短气但坐，以汗出不彻故也，更发汗则愈。何以知汗出不彻？以脉涩，故知也。”     

药后观汗的临床体会

药后观汗,是指医者不仅在辨证时要辨汗,而且在用药后,特别是用了发汗剂后要观察病者有汗、无汗和汗多、汗少或发汗后有何变证,这是使用发汗法后,所必须注意的。 发汗是通过药物的作用,使病邪随汗而解,只能适可而止,不能太过,也不能不及,太过则伤律耗气,不及则病邪余留。张仲景对此很为重视,在《伤寒论》中有许多论述,如桂枝汤方后就有详细的记述,不仅详谈了桂枝汤的煎服法,禁忌,还说明了桂枝汤服后,若其人微微汗出,是药到病所,     

论“汗”

“汗”有三种含义:其一、指生理性的汗液;其二、指病理性出汗与无汗的病证;其三、指发汗的方法。“汗”历来是中医诊疗疾病很重要的着眼点:如问诊中,“一问寒热二问汗”;在治法中,“汗法”为八法之一;故很有必要对汗的生理及其与脏腑、气、血、津液的关系;汗的病因、病理、证型及治疗;发汗法在临床上的广泛应用进行系统探讨,使为医者对汗有一个更全面更系统、更深刻的认识,以便更有效地指导临床诊疗。1汗液的生理汗液是五液之一,是体内津液经阳气蒸腾气化后从汗孔(玄府)排出之液体。《素问·阴阳别论》曰:“阳加于阴谓之汗”。《温病条辨》…     

表证药后护理三法

表证病人服发汗药后如何调养护理,仲景对此十分重视。主要强调药后发汗适度,酌情食粥,饮食禁忌等几方面。一、发汗适度:太阳病病邪在表,一般采用解表发汗祛邪的治法,但汗出以“遍身(执水)(执水)”为原则,切忌大汗淋漓,这就要求作好两方面的工作:一是服药后促使病人全身出汗;二是防止汗出太过。具体护理措施是,服药后采用喝热稀粥和加衣盖被的方法帮助病人保温发汗,汗出以遍身有湿润感为佳,一旦药物生效,就要停服,以达邪去正安的目的。对于服药后汗出过多者应予止汗,用“温粉”扑身止汗,防止大汗损伤阳气,甚至亡阳厥逆。二、酌情食粥:服发汗药后食粥与不食粥,食热粥与食冷粥,其目的是资助药力,顾护胃气。如服桂枝汤须喝热稀粥以鼓动胃气,益津酿汗;而服麻黄汤不需借助水谷津液,以免汗出不止。三、饮食禁忌:在服药期间禁食有碍病情式药效的食物,以配合治疗。《素问·热论》说:“病热少愈,食肉则复,     

《伤寒论》注重肾阳治法初探

“邪气盛则实,精气夺则虚”,三阳证正阳虽盛,然而邪气鸱张,必伐本坏真,法当祛邪以护真阳;三阴证阳衰阴盛,法当益火之原以消阴翳。故谨守病机,各司其属,治病求本,顾护元真是治疗六经病证的章则大法。发汗有度,以护肾阳寒为阴邪,易伤阳气,若寒邪极甚或失于表散,致使卫阳受损,邪气有飞渡少阴之虞。故寒伤于表,即应表散,使卫阳得因而无伤及少阴本源之优,实寓顾护肾阳之义。     

从《黄帝内经》阳气理论探析妇人月事

[目的] 从《黄帝内经》阳气理论出发,分析女子月经的生理过程及月经病的病因病机,探讨其临床辨证论治特色。[方法] 以阳气理论为纲,结合各家对其女子月经相关经文的注解,阐述《黄帝内经》对妇人月事正常生理之内涵,及其对月经后期、月经量少、闭经、崩漏、痛经等病理过程的辨证论治。 [结果] 阳气理论是《黄帝内经》的重要学术思想之一,在论述阴阳二者相反相成、互根互用时,以阳为主导,强调阳固阴秘、阳主阴从。在对女子月经初潮的发生及相应的生理变化、月经错后之经闭不月、非时而下之崩漏、阳被阴乘之痛经的病理变化的论述中,处处体现了“阳气为本”的阳气理论。因此,在月经病的辨证论治中,提倡无问其病在阴在阳,皆需时时固护阳气。[结论] 《黄帝内经》以阳气为女子月事发生、化生之根源,辨治时主张先谨察阴阳之所在,强调阳密固阴,阳生化长,从而调周整期,经汛如常。     

略谈《伤寒论》汗法运用

汗法在八法中首居其一。仲景著《伤寒论》,遵内经之旨,言及汗法者五十余条,详述汗法之适应证。对于汗法不拘泥于单纯表证,对经误治后表不解兼有它证者或表里同病研治须表解者,用以汗法。汗乃人体津液所化,仲景运用汗法,不但辨证准确,立法精当,用药谨严,并强调汗法应掌握发汗尺度,使精不伤,邪尽去;注意服药及饮食将息;注意汗法禁忌;不犯伤阳耗阴之弊。于此,每获事半功倍之效。本文仅就《伤寒论》中运用汗法,谈几点粗浅认识。     

内经辨“汗”研究

《黄帝内经》云：“阳加于阴谓之汗”,是指阳气鼓动、蒸化阴液外泄。汗液源于脏腑化生之阴液,阳气对阴液的温煦、鼓动和蒸化是汗液产生的动力。吴鞠通也在《温病条辨·论汗》中说：“盖汗之为物,以阳气为运用,以阴精为材料,汗也者,合阳气阴精蒸化而出者也”。中医注重辨证论治,早在《内经》中,就对有关汗出辨证论述详细,现综述如下。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…