再论阴平阳秘不等于阴阳平衡

“阴平阳秘”可从一定角度用“平衡”来讨论，但它包含着许多非平衡的内容和不能用“平衡”来讨论的内容。为“阴阳平衡”所下的定义，无法用“平衡”定义健康，必须用“正常值”来界定，即用“正常”定义“健康”。“平衡”概念在医学领域的局限性早已被医学家们注意和指出，已经提出了比“平衡”更深刻、更符合人身实际的“内稳态”、“有序稳态”等新概念，这与“阴平阳秘”更为接近。     

阴平阳秘不等于阴阳平衡

“平衡”概念在哲学和科学上是多义的,“阴阳平衡”概念的使用者向未对其定义作过具体规定,因而带来理解上的歧义性和任意性;按中医经典理论,“阴平阳秘”反映着阴与阳的全部相互关系,是阴阳关系的最佳状态,从未使用过“平秘”概念,更不包含、亦未注出过“平衡”之意;“阴平阳秘”所反映的人身实际内容,既有平衡现象,也有非平衡现象,用“要么是平衡的”、“要么是非平衡的”这种“二择一”判断来论断生命,是不合实际的;“阴平阳秘”是人的有守稳态,反映着人的生命活动中物质、能量、信息流变的平衡与非平衡的全部复杂情况,把它概括为“阴阳平衡”,阉割了“阴平阳秘”的精髓和灵魂。     

从阴阳自和析阴平阳秘

“阴阳自和”是中医阴阳学说的一项重要内容，“自和”是阴阳固有的根本属性和规律，它是正常人健康生命活动的内在本质，“阴平阳秘”是“阴阳自和”的必然结果和最佳状态：“阴阳失调”是阴阳自和的水平下长，“阴阳离决”是阴阳自和的瓦解和破坏，养生和治病都要自觉运用“阴阳自和”的原理，促进“阴平阳秘”的最佳状态。     

中国传统健康观念的特色

“阴平阳秘,形与神俱”的生命观、“形神并重,动静适宜”的养生观、“顺应自然,避邪有时”的预防观、“阴阳失调,邪实正虚”的疾病观、“宏观考察,谨守病机”的诊断观、“整体调控,医患相保”的治疗观,是中国传统健康观念的主要特色,值得认真继承,发扬广大。     

从阴阳自和析阴平阳秘

“阴阳自和”是中医阴阳学说的一项重要内容。“自和”是阴阳固有的根本属性和规律,它是正常人健康生命活动的内在本质。“阴平阳秘”是“阴阳自和”的必然结果和最佳状态;“阴阳失调”是阴阳自和的水平下降;“阴阳离决”是阴阳自和的瓦解和破坏。养生和治病都要自觉运用“阴阳自和”的原理,促成“阴平阳秘”的最佳状态。     

试论“阴平阳秘”

《素问·生气通天论篇》曰;“阴平阳秘,精神乃治;阴阳离决,精气乃绝。”文中“阴平阳秘,精神乃治”一句,历代诸家注解,纷纭不一,聚讼难休。马莳注曰:“必彼之阴气得其和平,而此之阳气知所秘密,则精神乃治。”马注“秘”为“秘密”,     

试谈中医药治疗乙肝作用的定位

中医药治疗乙肝的作用普遍定位在抗病毒,病毒指标转阴,但至今却没有一种中医药疗法或中药制剂的抗乙肝病毒作用得到医学界公认。据此,认为中医药治疗乙肝作用的定位值得反思,这一定位是不切实际的。西药的抗病毒药物也难以产生,时至今日未见理想的抗乙肝药物问世。另外特异性消除病因的抗病毒疗法,不符合中医药治疗观。中医治疗乙肝病应按照中医理论定位在谋求乙肝病人机体功能的调整与回复达到“阴平阳秘”的自我稳态。     

试用临界慢化原理探讨常见未病状态——血糖失稳态

中医学使用阴平阳秘的相对平衡状态界定人的健康，即健康是人体这个开放复杂巨系统整体动态平衡的稳态。稳态失衡则进入狭义的未病状态，邪正相争，存在向愈与向疾的两种演化趋势，一旦扰动过强或干预不力，则系统持续失稳，突变形成疾病稳态。治未病理论作为一种重要的实践原则，贯穿中医预防、诊断、治疗、康复的临床过程始终，对于多种疾病未病人群的筛查与早期干预具有重要的指导意义。本文围绕生理意义巨大、病理影响广泛的血糖失稳态，详述其防治意义、筛查现状与干预方式，系统分析其作为多种重大疾病未病状态的临界慢化原理，阐释中医治未病方法论所蕴含的基于系统整体性与开放性的藏-象映射模型思维、基于系统动态发展的临界慢化模型思维，探讨基于中医四诊合参的未病状态识别与干预路径，以期为复杂性科学视域下的中医诊疗模式研究提供参考。     

基于“阴平阳秘”调控目标的系统性红斑狼疮疗效评价新指标的探索

[目的]探索系统性红斑狼疮疗效评价新指标.[方法]引入Pareto原理,结合负反馈理论,分析系统性红斑狼疮中医临床治疗的疗效评价方法.[结果]“阴平阳秘”概况了机体的健康特征,中医临床治疗的目标是机体逐步趋向于“阴平阳秘”,而负反馈机制的建立在这一过程中起着关键作用.因此,测定各种功能参数的变异系数是评价临床干预疗效的手段.[结论]系统性红斑狼疮患者的变异系数指标可应用于系统性红斑狼疮中医临床疗效的评价.     

再论阴平阳秘不等于阴阳平衡

“阴平阳秘”可从一家角度用“平衡”来讨论，但它包含着许多非平衡的和不能用“平衡”来讨论的内容。为“阴阳平衡”所下的定义，无法用“平衡”定义健康，必须用“正常值”来界定，即用“正常”定义“健康”。     

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.