从精神疾病脑非对称性变异论中医气机升降理论(二)

脑偏侧化加速了人类进化,但这种因环境压力所致基因突变的结果,也增加了人类对各种精神疾病的易感性,某些神经、精神疾病患者的非右利手率较正常右利手人群高。近年来的许多研究表明,大脑半球功能偏侧化的变异可能是精神疾病发病的重要环节之一。抑郁发作时大脑半球活化平衡向右脑倾斜,偏执型精神分裂症这一平衡则向左脑过度倾斜,并与躁狂、冲动、暴力和反社会性人格障碍有关,而广泛性焦虑和创伤后应激障碍等则右半球过度活化,精神疾病脑偏侧化变异同时也改变了与情绪、语言信息处理和视-听注意偏向的半球优势特征。精神疾病半球非对称性假说与中医气机升降理论不谋而合,中医认为人体气机运动为左升右降、肝升肺降,气机升降逆乱导致各种病证的发生。本文拟从太极、阴阳、六气、八卦和五行学说,论述"气机升降"中医理论与人体功能偏侧化理论的同一性及其科学性,为揭示中医"气机升降"理论探索新的研究途径。     

从精神疾病脑非对称性变异论中医气机升降理论(四)

基于精神疾病脑功能非对称性假说,采用重复经颅磁刺激(r TMS)或经颅直流电刺激(t DCS)提高左半球活跃性和/或抑制右半球活跃性可治疗抑郁症;同样,通过r TMS抑制右半球活跃性可治疗焦虑障碍;反之,通过r TMS抑制抑郁症左半球活跃性则加重抑郁症状,通过r TMS兴奋焦虑障碍患者右半球活跃性则加重焦虑症状。r TMS和t DCS在改变半球活跃性的同时,也可改变与之相关的视-听注意偏向。针刺治疗抑郁症可发挥类似r TMS和t DCS的生物学效应,并且左、右单侧肢体经穴针刺增高或降低同侧半球运动皮层兴奋性的效应与人体气机左升右降方向一致,因此,无论在理论上还是和实践上,脑功能非对称性假说与中医气机升降理论不谋而合。     

墨西哥初级汉语习得者普通话上声感知的脑偏侧化

目的:观察学习汉语语音20 h的墨西哥汉语习得者普通话上声识别的脑偏侧化情况,讨论声调的言语信息量与脑偏侧化的关系.方法:用非随机任意抽样法抽取15名(男8名,女7名)以西班牙语为母语的墨西哥汉语习得者作为研究对象,年龄20～32(中位年龄24)岁.习得者学习汉语语音20 h后,用普通话的上声元音音节作为实验材料,用双耳分听技术对其进行普通话上声识别测试,分别计算正确反应时间和错误率.结果:学习汉语普通话语音20 h的墨西哥汉语习得者上声双耳识别的反应时间和错误率经Wilcoxon检测显示:左右耳(大脑左右半球)反应时间的差别无统计学意义(Z=-0.341,P=0.733);左耳(大脑右半球)的错误率显著低于右耳(大脑左半球)(Z=-2.091,P=0.036).结论:墨西哥汉语习得者的声调感知的脑偏侧化与声调所表示的言语信息量有关,墨西哥汉语习得者的声调音义范畴的建立是逐步建立起来的.     

从精神疾病脑非对称性变异论中医气机升降理论(三)

中医理论认为,"脑为元神之府",头为"诸阳之会",脑是精髓汇聚和神明生发之处,府精神明有赖于气机推动、经络调畅、脏腑做功、精血生养、升清降浊。情志为狭义之"神明",喜、怒、思(忧)、悲、恐(惊)七种情志活动,分属五行于心、肝、脾、肺、肾。"思"是认知过程,位于其余情绪之中央和归宿。情志与气机升降关系最为密切,喜、怒、惊主动为阳,气机升发外散;悲、忧、恐、思主静属阴,气机内收下沉。现代脑科学研究发现,人类在接受正性和负性情绪信息时左、右半球发生非对称性激活,其激活程度与情绪强度有关。情感性精神障碍和精神分裂症患者左、右半球激活程度的非对称性则发生过度、降低或反转的异常变化。中医"思(脾土)中心"论和"阴阳喜怒"学说与现代心理学认知与情绪的关系、情绪两极性等观点不谋而合。本文基于情志理论、气机升降理论、现代情绪心理学和脑研究成果,论述"情志—气机升降—半球间功能偏侧化"在精神疾病发病机理中的相关性,以扩大中、西医在精神病学领域的共识。     

握中央而运四旁治疗脏腑气机紊乱杂病

通过临床和理论文献研究,分析中医名家对脏腑气机紊乱杂病的治疗思路、用药特点及临床疗效。认为脏腑气机紊乱杂病的治疗,应采用"握中央而运四旁"的方法,即从调理脾胃中气入手,灵活运用左升肝脾,右降肺胃,上下交通心肾的方法调理脏腑气机,再观其脉证,知犯何逆,随证治之,使脏腑气机恢复升降有序的正常状态。     

论脾胃生理病理特点

<正> 脾胃生理特性与功能脾为脏属阴,胃为腑属阳。以气机升降而言,脾气主升而胃气主降。根据阴阳二气性质,阳气主升阴气主降,但脾胃之气升降与此相反。因为人体脏腑之气属阴者主升,属阳者主降,阴阳之气相互交感,才能发挥其生理功能,故脾气主升而胃气主降。从功能而论,胃主受纳水谷,纳则贵下行故胃     

中医对人体脏腑的认识 (之十) 漫谈五脏之间的关系 (二)

6.肺与肝肺主气,司呼吸,肝藏血司疏泄;肺主肃降,肝主升发。以上是两脏各自的主要生理功能及生理活动的特点。而两脏在生理上的联系,主要体现在人体气机升降的调节方面。“气机”,即气的活动,或者说是泛指功能活动。肝气的活动以升发为常,肺气的活动以肃降为顺。升降协调,相互为用,是人体气机调畅,气血调和的一个重要环节。中医有“左肝右肺之说,认为“肝生于左,肺藏于右”。这里左右并非指肝、肺的解剖位置,而是用来代表两脏气机的活动特点,也即“升者左行,降者右行”。因为,从阴阳学说的观点而言,气的运动是上升、下降地循环周流的。上升属…     

基于“魄门亦为五脏使”探讨五脏气机升降与魄门的关系

"魄门亦为五脏使"语出《黄帝内经》。脏腑气机中的肝升肺降,脾升胃降,心肾相交三对气机的升降,调节着全身的气机协调平衡,也直接影响魄门的功能。魄门的正常启闭,糟粕的传导又关系到五脏气机的升降,影响五脏的功能状态。     

淤胆型肝炎中医病因病机及治法探讨

淤胆型肝炎占黄疸型肝炎的2％-8％,西医西药在治疗本病时仍有一定的局限性。中医治疗本病时疗效显著。然而中医在理法方药方面冗繁多杂,故探讨淤胆型肝炎的中医病因病机及治法是必要的。脾胃气机升降失常是淤胆型肝炎的主要病机,故升脾降胃法可调理全身气机升降,进而调理肝胆气机升降,加速淤胆型肝炎的恢复。     

从圆运动理论治疗不寐

人体的气机通过降、沉、升、浮,如环无端不停地进行圆运动。人体中焦轴轮不利,气机升、降、浮、沉失和,脏腑阴阳失交,便会引起圆运动运转失常,从而产生不寐。治疗应以"复圆"为原则,顺应圆运动的规律,恢复人体气机、调整脏腑阴阳,阴平阳秘,气血调和,神安则寐。在临床上,可将不寐分为心阴不足证、肾阳亏虚证、肝阳不足证、脾胃失和证,其中,心阴不足证治以滋阴降火、安神定志,方选天王补心丹合交泰丸加减;肾阳亏虚证治以温补肾阳、宁心安神,方选附子汤合桂枝甘草龙骨牡蛎汤加减;肝阳不足证治以养肝镇惊、安神定志,采用"升肝降胆"之法,方选酸枣仁汤加减;脾胃失和证治以补阳泻阴、宁心安神,方选补脾胃泻阴火升阳汤加减。     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.