日本对《伤寒论》最早版本的发掘与研究

1 现存版本的源流《伤寒论》的版本在中国主要是一个系统一个来源的版本,这就是《宋版伤寒论》和《成本伤寒论》。《宋版伤寒论》是以王叔和改编后的《伤寒论》为蓝本,至宋代作为国家的事业由高保衡、孙奇、林亿等医家进行了校订,其最终的结果即是现在的《宋版伤寒论》、《成本伤寒论》和《宋版伤寒论》来源上没有什么区别,即是以《宋版伤寒论》为蓝本,不过加了成无己注释而已,全名为《注解伤寒论》。两者简称《宋本》、《成本》。其实来源一处,都是根据青代王叔和改     

宋本《伤寒论》刊行后流传演变简史

宋本《伤寒论》指北宋治平二年(1065年)刊雕之本，所据底本为荆南国末主高继冲所献，笔者对该本所据古本逐代进行洄溯与考证，成《高继冲本伤寒论所据古本溯源》一文；本文所考者为宋本既刻后之流传与演变。两文合读，可得仲景《伤寒论》版本流传颠末之轮廓图景。     

《千金翼方》载录的《辨伤寒》考(上)

孙思邈《千金翼方》卷九、卷十载录的《伤寒论》称《唐本伤寒论》,又称《孙思邈本伤寒论》。犹如《宋本伤寒论》又称《赵开美本伤寒论》一样。《孙思邈本伤寒论》与《赵开美本伤寒论》都来源于一个共同的祖本,即均来自南朝梁阮孝绪《七录》著录的《辨伤寒十卷》。阮孝绪《辨伤寒十卷》与陈延之《小品方》著录的《辨伤寒》相关。《宋本伤寒论》受到世人高度崇信赞佩,关于它的研究已成滔滔江河之势,《唐本伤寒论》直至现在,对它的研究考证仅是涓涓细流,未被医家与学者周知。文章考证《千金翼方》成书时代及其流传,考证《伤寒辨》之特点与结构,比较《辨伤寒》与宋本《伤寒论》之异同。     

台湾故宫宋本《伤寒论》古今谈

宋本《伤寒论》实赵开美刻本。本文就今世台湾故宫宋本《伤寒论》概貌进行详述,并考证了台湾故宫本《伤寒论》转移至美国及回归台湾的过程。     

桂林古本《伤寒杂病论》之方药探析

桂林古本《伤寒杂病论》是张仲景《伤寒杂病论》现存最为详实齐全的一个版本。在方剂数量上,与宋本《伤寒论》和《金匮要略》所载方剂比较,桂林古本多出新方90方。桂林古本中亦存在与宋本所载方剂方名相同而药味不同的方剂,以及与宋本所载方剂方名不同而药味相同的方剂。在方名上,桂林古本不少方剂均直接以药物名称的直接组合命名。而从药名的角度考证,桂林古本与其他版本相比,某些中药称谓存在差异。桂林古本所载的方药具有一定的学术价值,可在今后的临床实践中验证其疗效。     

《伤寒论》传本、佚文考略

概要考察了张仲景《伤寒论》的《脉经》木、敦煌古医籍本、《千金要方》本、《千金翼方》本、《太平圣惠方》本、《金匮玉函经》本、宋本、《注解伤寒论》本等传本的情况、特点，以及《外台秘要》、《医心方》、《圣济总录》所收我的《伤寒论》条文及其特点。为研究《伤寒论》的版本提供参考。     

赵开美本《伤寒论》所附牒文考

明·赵开美刊刻的《伤寒论》所据底本为宋·元祜问国子监雕印的“小字本”《伤寒论》,在《伤寒论序》后有国子监牒文一则,此牒文为国子监刊刻“小字本”《伤寒论》而准尚书礼部的符。此牒文反映了宋国子监刊刻“小字本”《伤寒论》的原因以及所用费用等事宜,为后世研究《伤寒论》流传史提供了史料,后世学者研究《伤寒论》版本流传史也多以此牒文为基础的。由于现在流传的《伤寒论》多不附上此牒文,对此进行研究者也少,有的学者甚至对此牒文提出了疑义。对牒文进行全面研究不仅可以正本清源,对研究《伤寒论》版本及其流传史也大有裨益。     

宋本《伤寒论》访书记

“宋本伤寒论”原指北宋所刻大字本、小字本《伤寒论》。传至明代,仅有的一部小字本《伤寒论》被赵开美翻刻于《仲景全书》之后旋即亡佚,后世遂美称赵开美辑刻《仲景全书·伤寒论》为“宋本伤寒论”。本文所称“宋本伤寒论”指赵刻《仲景全书·伤寒论》,该书国内外仅存6部,笔者皆曾目睹手抚,并有较详笔记和照片。本文仅对台湾故宫博物院所藏《仲景全书·伤寒论》详加考证,以期对校勘研究者有所裨益。     

桂林古本《伤寒杂病论》条文辨析

桂林古本《伤寒杂病论》于民国时期问世,其结构体系完整,内容详实,逻辑严谨,但其真实性受到诸多学者的怀疑。与宋本《伤寒论》《金匮要略》的条文比较,桂林古本中的条文约3/5雷同,约1/5不同,另外1/5则为独有。桂林古本《伤寒杂病论》是对宋本《伤寒论》和《金匮要略》的补充和发挥,有其特定的学术价值。     

宋本《伤寒论》方例初考

讨论宋本《伤寒论》“方”字使用的体例特点,明确指出了宋本《伤寒论》方例的功用在于统计书中的所载方剂之数目;宋本《伤寒论》方例的特点在于“方”字的使用有着严格的规范。并进一步通过对宋以前高继冲本、《千金要方》本、康治本、康平本《伤寒论》的某些特点与宋本《伤寒论》方例的功用特点的对比分析得出宋本《伤寒论》方例的意义在于它是自古以来重方思想的一个小小缩影。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.