中国传统哲学之心象理论在中医学的应用(一)——心象理论诠释

“心象”是中国传统哲学中的一个重要概念,也是中医学的原创思维方式.通过从发生学、学术内涵等方面对心象理论的诠释,总结认为“心象”源于中国传统哲学的“心学”.“心象”可以定义为存在呈现于“心”的显现形式,包括“意象”神象”“情象”“梦象”“空明之象”“本体之象”等形式.     

论取象思维方式在中医藏象理论建构中的价值及其局限性

中医藏象类理论是中医基础理论体系中的核心内容,取象思维是中医藏象类理论的主要思维方式。在中医学的发展过程中这种以哲学指导临床的思维方式产生了巨大的价值。但也是因其受传统哲学观念影响,这种思维模式在临床实际应用中具有自身的局限性。     

象思维在中医学应用举凡

象思维源于《周易》,作为一种中国传统思维方法,广泛应用于古代中国的各个领域。中医学理论体系建立于中国传统思维方法的基础上,寻求中医学自身的发展规律,唯有援易入医。象思维作为一种方法论和认识论,其核心是以构建具体事物为载体,通过阴阳、五行、八卦等模型去推知抽象事物,目的在于宏观把握、执简驭繁,具有鲜明的整体性和全息性。本文通过《周易》、《黄帝内经》等经典的论述,结合岳美中、干祖望等多位名中医的临床案例,讨论象思维与藏象理论、中医诊断方法、病因病机、辨证论治、经络腧穴理论及中药应用的联系,以分析象思维在中医学中的具体应用。     

基于取象比类探讨中医理论构建的思维方法

取象比类是中医学认识人体生命活动、构建医学理论的基本思维方法,也是中医学素养的重要体现.中医理论是古人将临床经验通过取象比类思维方法的推理总结上升的综合认识.取象比类的理论内涵包括了现代科学逻辑中的综合与类比等思维方法.基于取象比类的思维方法以汉字、自然环境、人文环境3个方面为例探讨中医理论构建的思维方法,既能了解中华...     

浅析“象思维”与井穴的关系

取象比类是中医学认识脏腑生命活动规律的思维方式,即"象思维",其与经络标本、根结理论及五腧穴的命名均有密切联系。根结理论进一步发展形成五腧穴理论,而井穴作为五腧穴位于肢体末端的第一个穴位,是十二经脉阴阳交会、气血流注的起点,其概念的形成、定位及主治功效的确定必然受到"象思维"的影响。     

体质演化模型统一律

[目的]推导论述中医体质演化类型及统一认识规律。[方法]通过潜心研究中医理论承载的哲学思想,从太极图"哲学元素"潜在的公理、演化流程图及数学模型奇数律公式,系统研究其"哲学元素"的潜变规律,研究人体生理病理。以求发现中医学各科理论统一的结构规律。[结果]中医学各科理论统一的结构规律--中医理论统一律中,医理论衍生于古典"哲学元素"。哲学元素,既是思维模型,又潜含着数学模型,是哲理与数理的有机统一。中医学用统一的哲学思维模型、数学模型、数学模型奇数律公式,解释人体生理病理,构建中医学各科理论。[结论]中医学各科理论具有同构律,就是中医理论统一律。数学模型奇数律公式揭示出中医理论本质。中医各种体质类型潜演规律符合奇数演化律公式解释。     

从理法方药中管窥中医象思维理论

本文主要探讨象思维理论在中医理、法、方、药中的意义解释，从中医学理论出发，分析其相应内涵，并进一步阐释象思维在实际中的应用指导重要性。研究表明，象思维在中医学说涉及领域众多，不仅可用作诠释中医学相关理论和诊断方法，还可在一定程度上指导临床遣方用药。     

整体观在中医哲学中的地位与作用

中医学的精髓,是中医学理论的思维模式。而中医学理论的思维模式又是中医临床方法论的灵魂。在中医哲学中,整体性思维始终居于主导地位。相对于西医而言,整体观显然是中医学的主要特点和优点之一,其在中医哲学中具有世界观和方法论的意义,因而具有十分突出的地位和作用。1中医哲学中的整体观内涵中华民族有着悠久的历史和灿烂的文化,中医学就是在中华传统文化的大背景下产生的,而中华传统文化的核心是中国传统哲学,因此从本质上说,中医学是建立在中国传统哲学基础之上的。作为中国哲学的一个分支,中医哲学是由中医学和中国传统哲学相互交融…     

中医象数思维应用析例

象数思维是中医学的核心思维形式,在中医学的学术体系构建中具有非常重要的意义。以消渴病为例,将象数思维在消渴病中关于其病因、病机、病位的认识进行简单论述,探讨象数思维在中医学学习与临床中的重要意义。     

在中医学教学中培养学生的哲学思维至关重要

哲学是关于世界观和方法论的学说,它为人们认识自然、认识社会提供最根本的观念和方法。现代哲学思想是微观法和实证法,而中医学的基本理论是在 2000年前建立起的完整的理论体系——宏观的、模糊的阴阳五行哲学理念。因此,习惯于现代哲学观念的学生就很难理解中医学的理论。所以,在学习中医学过程中培养学生的哲学思维至关重要。 1首先要讲清现代哲学与中国古代哲学的异同。 特别要弄清阴阳五行学说的哲学内涵。阴阳学说是认识自然的方法论、辨证法,五行学说是认知自然的物质观,具有辩证唯物主义思想,而且比现代辩证唯物主义更具有内…     

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.     

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.     

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.