中医外科的阴阳观探讨

人体气血、脏腑、经络均是寓于阴阳之中,中医外科虽以治外疾为主,但仍视人体为一个整体,历来重视内外结合,因此阴阳学说对于外科疾病的辨证论治有极大的指导意义。回溯阴阳学说在中医外科学的发展,探讨中医外科的阴阳观。     

阴阳学说在植物神经系统中的应用

阴阳学说在植物神经系统中的应用林传远（广东潼湖华侨农场５００２５０）阴阳学说是中医学的重要组成部分，它贯穿了中医生理、诊断、治疗、方药等方面，是中医临床诊断治疗的总纲。本文拟从阴阳学说的范围及其内容，来分析植物神经的解剖结构、生理功能及临床治疗原则。...     

金凤丽教授诊治月经后期经验总结及验案举隅*

金凤丽教授诊治月经后期疾病时，既遵循中医辨证论治的指导，重视月经周期的气血阴阳变化规律，又参考现代医学诊断方法和标准，坚持辨病辨证+辨月经阶段+辨年龄段综合分析的诊断思路；治疗既考虑病证特点，又兼顾周期特征和伴随症状，做到因病、因证、因人、因时制宜，遣方用药灵活变通，既发挥中医整体调治的优势，也常借用现代医学手段作为辅助，做到衷中参西、取长补短，临床总能取得良好疗效。     

浅表淋巴结病变的超声诊断

浅表淋巴结是指位于体表深筋膜层、距离皮肤约3．0cm以内的淋巴结群。淋巴结病变往往是局部和全身疾病的反应。超声对软组织具有良好的分辨力，随着科学技术的进步，超声对浅表淋巴结病变的检出和鉴别诊断，正逐渐得到临床的重视。     

从“阴阳反作”探讨“升降失常”类疾病诊治新思路

[目的] 基于“阴阳反作”理论，探讨中医疾病中“升降失常”类疾病的病机及其对应治疗方法。[方法] 通过总结“阴阳反作”中阴阳所对应的概念，就阴阳间的三种关系对“阴阳反作”理论进行进一步探讨，并分析“升降失常”类疾病的病因病机及其对应的治疗方法。[结果] 根据疾病表现，“升降失常”类疾病可以分为“阴之反作”“阳之反作”及“阴阳反作”三类，其中中风、2型糖尿病、糖尿病肾病、慢性肾脏病为“升降失常”类疾病的典型例子。在治疗上，这些疾病均可以调节升降关系作为治疗的核心，该类方法不但受到多名中医大家的推崇，临床也多得效验。[结论] 以“阴阳反作”作为部分内科疾病病机，以“升降失常”的视角审视临床内科疾病，可为临床治疗提供新思路、新方法。     

傅青主对中医外科的贡献

傅青主对中医外科的贡献青海省中医院贾鸿魁傅山，字青主，明末清初阳曲（今山西太原）人。著名妇科学家，撰《傅青主女科》对后世医家影响颇大。但对外科专著《青囊秘诀》一书，鲜有人知。今就该书对中医外科的贡献，简述如下。１疮疡辨证，首分阴阳：阴阳是人纲辩证的总...     

陈实功《外科正宗》辨证方法探析

陈实功撰《外科正宗》重视辨证,将"望、闻、问、切"的技能锤炼到"神、圣、工、巧"的层面,以八纲为基础,灵活运用脏腑辨证、经络辨证、病因辨证、气血辨证等诊治外科病证。临证时既重视整体又详辨局部,在脾胃辨证方面功绩卓著。辨治阴阳证、脓、瘰疬、乳岩、瘿瘤等病证,更是突破了前人的认识,提出了创新性诊断思路,促进了中医外科诊断学的发展。     

颈部淋巴结结核的诊断和治疗体会

口腔颌面外科临床中颈部淋巴结结核常能见到,但在诊断中易与颈部其它疾病相混淆,为防止误诊,滥治,故需引起临床医师的重视,使患者得到及时的诊断及满意的治疗效果。本文分析总结我科自2000年-2004年门诊和住院颈部淋巴结核53例及我们的诊治体会。     

龚居正《外科活人定本》学术价值浅析

中医外科著作《外科活人定本》共四卷。论治外科病证若干,集方药数十首。全书内容安排有序,结构严谨,论述清楚。强调辨病与病因病机,寒热、表里、虚实、阴阳辨证结合;该书论治外科病证,临床用药广泛,制方严密;提出内外兼治,膏丹丸散并举,临床针对性和实用性较强。从辨证的观点看,对于本书存在的不足和局限之处也应引起重视。     

祖国医学的预防思想——不治已病、治未病

祖国医学在长期发展过程中很重视未病先防的原则。早在《内经》中就提到“病已成而后治之，犹如渴而穿井，斗而手锥，不已完乎”。产生疾病的根本原因是机体阴阳失去平衡，中医重视在阴阳未失平衡时，注重调养、摄生，就是“治未病”的理论观点。“未病先防，即病防变”。是中医理论的精髓，这一观点体现中医在预防学中的特色。     

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.