失眠中医证型和方药分析

目的:对1987年6月至2007年6月中国期刊全文数据库(CNKI)收录的中医诊治失眠文献,通过频度分析总结证型和方药特点,以探讨失眠中医辨证论治规律.方法:对所选文献进行证型、方剂统计及药物整理分析,并总结归类,观察各药物、证型引用频次及所占比例.结果:失眠证型45个,痰火扰神、心脾气血虚、肝郁气滞、阴虚火旺、肝火炽盛和心肾不交为常见证型,占57.13%;证候病位主要在心和肝,虚证实证病机比例相同.共得方剂104首,补益剂、安神剂、清热剂、和解剂、祛痰剂和理血剂共占80.3%,疏肝解郁方和活血祛瘀方居常用方之列.用药206味,按功能归为41类,进一步合并为17大类,补虚、安神和清热类药物使用频次占57.0%,补虚药为第一位,主要是补气、补血和补阴药,清热药次之,其他泻实之药也较常用,安神药酸枣仁使用频次位于所有用药之首.结论:中医诊治失眠证型特点和方药规律的分析可为目前失眠辨证论治提供参考依据.对失眠要从多方面进行辨证,尤其应注意心肝、虚实并重;对失眠施治在运用补益、安神和清热剂的同时,特别要重视疏肝解郁和活血祛瘀方的选用.     

从毒论治顽固性失眠

顽固性失眠主要病位在脑,与心、肝、脾、肾等脏腑关系密切,属本虚标实之证,脏腑气血亏虚为其本,痰毒、火毒、瘀毒、郁毒等邪为其标,毒聚络损、神机不宁为其病理过程。治疗应标本兼治,根据主次缓急不同或以攻毒为主,或以扶正为主,铲剔浊毒,使邪祛神自安。     

从五脏俞作用机理谈五脏俞治疗失眠

通过对现代针灸临床文献的分析考察,五脏俞是脏腑之气输注于背腰部的腧穴,主治与其相应的脏腑、组织、器官疾病,而失眠与心、肝、脾、肾、胃、胆等脏腑组织密切相关,从中西医角度探讨了五脏俞的作用机理及其与失眠的关系。从而得出从五脏俞着手治疗失眠症可调整五脏所主功能从而起到安神定志、调和阴阳的目的。     

安神药和安眠药是一样的吗

问:我最近一段时间有些失眠、多梦,想吃点治疗失眠的药物,听朋友说有安神药和安眠药两种,请问安神药和安眠药是一样的吗?河南:李×李读者:安神药是以安神定志为主要功效的药物。其作用机理是通过调整脏腑功能,平衡脏腑间的关系而达到安神的目的。     

麦芽的特点及临床应用

麦芽生于土,具有滋养脾胃之功效,主运化而养五脏,调中焦而运四旁,功可消食健胃、回乳消胀、疏肝解郁、养心安神。临证中一可顾护胃气,以助运化;二可促进五脏六腑气血的恢复;三可调畅气机,以助血运,疏肝健脾;四可辅助增强原有方剂之功效。将麦芽伍于方剂之中,不仅可育养正气,抵御邪气,又可调治由肝、脾胃、心等脏腑病变诱发的脾胃诸病、月经不调、失眠、抑郁和各种杂证。     

当代新安医家王任之运用疏肝宁心安神法治疗失眠的经验

现今社会,随着生活节奏的加快及工作压力的增加等,失眠的患病率越来越高。通过总结《王任之医案》中王任之对失眠的论治,从病因病机及辨治特色两大方面介绍新安医家王任之治疗失眠的经验,王氏临证多从心、肝入手,重疏肝、宁心,方以潜镇介类、养心安神之品为主,善用对药酸枣仁、合欢花疏肝宁心以安神,并常佐以小麦、大枣补养心气,疗效明显。     

不同历史时期失眠方药的沿革

系统分析不同历史时期失眠方药的沿革 ,揭示失眠方剂的组方配伍规律 ,为提高临床失眠证的治疗提供参考。通过统计分析表明 ,补益、安神、清热药是构成历代失眠方的主要药物种类 ,安神药是治疗失眠证的特异性药物。不同历史时期失眠方药的发展演变 ,体现了中医治疗失眠证学术思想的不断完善。     

基于中医传承辅助系统挖掘名老中医治疗围绝经期失眠的用药规律

目的 应用中医传承辅助系统（V2.5）软件,研究名老中医治疗围绝经期失眠的处方用药规律。方法 研究《大国医经典医案诠解·病症篇·围绝经期诸证》《绝经前后诸证》《妇科病名医验案解析》三本医案中与围绝经期失眠相关的医案处方。通过中医传承辅助系统（V2.5）软件,分别对名老中医治疗围绝经期失眠的药物频次、性味归经及组方规律进行分析研究。结果 筛选出118首方剂,涉及中药212味,药物频次统计显示使用频次≥29次的药共计13味,性味归经统计显示中药以寒性药占比最多,主要归肝、心、肾经;提取出使用频次最高的龙骨、牡蛎药对;提取出4首治疗围绝经期失眠的候选新方。结论 名老中医治疗失眠,以肝、心、肾经药为多,以滋阴清热药为主,同时善用龙骨、牡蛎药对。新方组合提示,治疗围绝经期失眠,要重视对脏腑肝的调理,通过平肝阳、清肝热、解肝郁达到安神之效。     

杨少山运用膏方调治失眠症

杨少山老中医善于运用膏方调治失眠症,临证首先辨证论治,认为并非所有失眠症均适宜膏方调治,仅证属虚而热不胜者方可适当,绝不妄投;膏方调治失眠首先从脾论治,脾胃为气血生化之源,气机升降之枢纽,脾胃虚弱宜清补,且兼顾行气活血,使通补相兼,动静结合;同时亦应分析心肝肾等脏腑病变,重视五脏六腑之整体,并兼顾气候变化,使天人合一;认为寤寐的变化符合阴阳特性,其临证用药亦细分阴阳,故调治失眠症总的用药原则不离阴阳平衡.     

基于形神一体观探讨青少年失眠的防治策略

青少年失眠属于中医学"不寐"范畴,以脏腑功能失调,阴阳失衡,神明被扰为基本病机。"形神一体观"是《黄帝内经》阐述的重要观点之一。基于形神一体观,提出青少年应饮食有节,起居有常,不妄作劳,以养形安神,避免失眠的发生;针对青少年失眠患者,主要治以疏肝理气、清心降火、清胆和胃、健脾补肾,可辅以解郁安神、清心安神、重镇安神、养血安神之法。在辨证论治的基础上配合食疗、认知行为疗法及运动疗法,可使青少年失眠患者远期获益。     

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.