国医大师张琪运用解毒活血汤治疗肾衰竭经验

国医大师张琪教授学术上精于仲景学说,兼通金元四大家及温病学家学术理论,尤崇王清任之瘀血理论,对慢性肾脏疾病的治疗有较深造诣。他认为,急慢性肾衰竭皆由湿热毒邪入于血分,血络瘀阻所致。宜用清热解毒活血化瘀法治疗,以王清任解毒活血汤为最佳。并常于解毒活血汤中加入丹参、大黄清热解毒,化瘀泄浊,对急慢性肾衰竭有良好疗效。     

王清任化瘀理论的临床应用

王清任化瘀理论的临床应用辜小恒（江西省高安市中医院高安３３０８００）关键词王清任补阳还五汤助阳止痒汤血府逐瘀汤止泻固中汤癫狂梦醒汤临床应用王清任（１７８６～１８３１年），河北省玉田县人，是清代著名医学家。著有《医林改错》。王清任自创３２个方剂，修改古...     

王清任研究会成立暨全国首届王清任学术思想研讨会在玉田召开

一个以专门研究我国清代医学科学家王清任及其学说为主题的学术团体王清任研究会于 2 0 0 1年5月 18日在王清任先生的故乡河北玉田成立 ,全国首届王清任学术思想研讨会同时举行。来自国内2 6个省、市、自治区和新加坡、韩国等国家的 10 0余名代表出席了这次盛会。大会开幕式由王清任制药有限公司董事长兼总经理、王清任研究会常务副主任兼秘书长王宝华主持 ,王清任研究会主任委员、北京中医药大学教授钱超尘先生致开幕词。中国中医药学会、北京市中医药管理局、唐山市、玉田县等有关领导出席了大会 ,10多家新闻媒体代表到会进行了采访报道。…     

补阳还五汤用药及配伍特点

补阳还五汤用药及配伍特点齐向华，胡志强（附属医院内科２５００１１）关键词补阳还五汤；配伍特点补阳还五汤是王清任治疗半身不遂的一首著名方剂，延用至今，疗效经久不衰。本方的用药、配伍特点集中代表了王清任对中风病发病原因机理和传统气血理论的认识。补阳还五汤...     

补阳还五汤活用举隅

补阳还五汤活用举隅庄日喜广东医学院附属医院主题词补阳还五汤／治疗应用，高血压／中医药疗法，脑动脉硬化／中医药疗法。补阳还五汤是清代名医王清任所创，用以治疗半身不遂的有名方剂。将补气和活血化瘀结合运用是王清任对临床治疗法则的重要发展，基于这一原则，笔者...     

熊继柏教授运用补阳还五汤治疗疑难病证举隅

补阳还五汤出自清代名医王清任的<医林改错>,以气虚血瘀而立论,临床沿用至今,具有益气活血,逐瘀通络之功,是治疗气虚血瘀型半身不遂和痿证之名方.湖南省名中医熊继柏教授曾用本方加减治疗乳腺癌根治术后手足综合征、帕金森氏病和局限性硬皮病疗效满意,现介绍如下.     

浅析王清任妙用黄芪

王清任 (176 8— 1831年 )河北省五田县鸦江桥东村人。他是我国清代医家 ,著有《医林改错》一书。在该书中他除了对人体脏腑解剖进行了实事求是的研究以外 ,对气血理论及其制方均作了详尽阐述。王清任主张“治病之要诀 ,在明白气血 ,无论外感、内伤……所伤者无非气血。气有虚实……血有虚瘀。”在这一思想指导下 ,将气虚血瘀列为专门 ,创立了补阳还五汤、黄芪赤风汤、黄芪桃红汤、黄芪防风汤、黄芪甘草汤、止泻调中汤、保元化滞汤、助阳止痒汤、足卫和荣汤、身痛逐瘀汤等 1 0余首方剂 ,方中都以黄芪为主药。王氏对黄芪的运用 ,颇具特色 ,自…     

从补阳还五汤教学中体会气虚与血瘀的关系

中医基础理论、中医诊断学、中药学等学科是学习方剂学的基础,在方剂学的教学中又可以帮助学生对这些学科相关内容的理解得到进一步巩固和提高。本文以补阳还五汤教学中的体会为例,介绍如何使同学们深入理解气虚与血瘀的关系,在临床上如何灵活正确地运用此方。补阳还五汤出自清代名医王清任之手,王清任(公元1768-1831年),又名全任,字勋臣,直隶(今河北)玉田县     

周衡教授运用《医林改错》方验案举隅

周衡教授系湖南省名中医,从事中医教学与临床50余年,善于运用名方、经方治疗内科杂病,对于王清任的《医林改错》方有独到的见解.王清任《医林改错》[1]一书中的方剂在临床中得到广泛运用,并且获得了良好的临床效果,但是在临床运用中若不能完全领会王清任方剂的本义,应用将会受到局限.作者曾随周教授门诊实习,周师以验案启发的方式指导我们临床实习,现举隅如下.     

补阳还五汤加味应用举隅

补阳还五汤出自王清任的《医林改错》,具有补气活血通络之效.临床运用该方加味治疗斑秃、喘病、痛经等证,收到较好的疗效,拓宽了该方的临床应用范围.     

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.