吐法探微

1　理论概述吐法 ,是通过涌吐的方法 ,排出体内病邪的一种疗法。《诗·大雅·丞民》说“柔则茹之 ,刚则吐之”,是关于吐法的最早记载。《素问·阴阳应象大论》中“其高者 ,因而越之”一直奉为吐法的主要理论根据。汉朝张仲景精于伤寒 ,亦重视吐法 ,在《腹满寒疝宿食病脉证治篇》说 :“宿食 ,在上脘 ,当吐之 ,宜瓜蒌散。”通观仲景用吐法 ,规范严谨 ,病位局限于“胸中”“心中”“中脘”,宜实而忌虚 ,沿《内经》之理论 ,匡定了吐法治病的定势。南宋许叔微 ,恪守经方 ,尤有发挥。屡用吐法治中风风涎潮于上膈、气闭不通证。在《普济本事方》中…     

吐法在中医内科急症中的应用

吐者,涌吐上焦之邪也。吐法是通过涌吐,使停留在咽喉、胸膈、胃脘等部位的痰涎、宿食或毒物从口中吐出的一种治法。《内经·素问·至真要大论》曰:“其在高者,引而越之”就是吐法很早的应用。历代医家运用吐法者甚多。例如: 后汉·张机《伤寒论》云:“宿食在上脘者,当     

张子和运用吐法特点

吐法属中医治疗八法之一，“金元四大家”中以“攻下”闻名的张子和最擅用此法。其用吐法疗疾范围广、兼顾正气、形式多样，疗效显著，一吐而疾若失。就其吐法运用的特点作一归纳。     

择时服药方法介绍

择时服药,是在天人相应思想指导下,着眼于人体阴阳消长的昼夜变化节律,选择合理的服药时间,从而提高药物疗效的方法.早在《内经》中已出现吐法于“日未出时吐之”的记载.《重辑神农本草经》亦提出病在四肢血脉者,宜空腹而在旦;病在骨髓者,宜饱满而在夜”的服药法。尤其是宋代以     

从《伤寒论》学习"其高者引而竭之"的体会

1“其高者引而竭之”含义《素问·阴阳应象大论篇》中有“……其高者,因而越之,其下者,引而竭之……”。吴注:“高,胸之上也,越之,吐之也”;“下,脐之下也,或利其小便,或通其大便,皆引而竭之。竭,尽也”。《类经》释:“越,发扬也。谓升散之,吐涌之,可以治其上之表里也。……竭,祛除也。谓涤荡之,疏利之,可以治其下之前后也。”即病位在胸之上者,可用涌吐升散法向上泄越邪气,病位在脐以下的,引导邪气从前后二阴而出。如,张仲景用瓜蒂散治疗“……胸中痞硬,气上冲喉咽,不得息者,此为胸有寒当吐之,宜瓜蒂散”,即是体现了在“高以越之”;应用…     

消法的运用

消法,为中医治疗八法(汗、吐、下、和、温、清、补、消)之一。是根据《内经》所提“结者散之”,“留者攻之”、“客者除之”、“坚者削之”的治疗原则而定的。它含有消化、消散、消除、消失的意思。适用于饮食停滞,消化不良;瘿、瘤、瘰疬、症     

食痹与贲门失弛缓症

食痹之名首见于《内经》,是指进食后上腹闷痛,饮食不下,吐后乃快的症状。痹是阻闭不通的意思。秦伯未认为“《内经》痹病包括两种,一种指肌肉筋骨疼痛麻木,一种指脏腑机能障碍。”(《内经类证》)显然食痹属于后者,是脾胃病的一种。笔者复习有关文献及临床床所见,认为食痹与现代医学贲门失弛缓症颇者相似。现略呈管见以就正于同道。一、《内经》中说:“胃脉……其实而散者,当病食痹”。(《素问·脉要精微论》)“厥阴之复……甚则入脾,食痹而吐。”(《素问·至真要大论》)以后历代医家在临床实践中对食痹作了进一步阐述、     

恶阻治疗十三法

妊娠吐逆,谓之恶阻。“恶”者,恶心;“阻”者,阻其饮食。此名始于巢氏。《千金》谓之病阻;《产宝》谓之子病;《坤元是保》谓之病食;乡村父老则名恶食,嫌饭,病喜。名不同而所指则一。夫生殖之道,本乎自然,理应气血臻和,妊娠为何病此?盖以冲为血海,隶于阳明,上冲胃口而至咽喉,今血海莲花初结,血气未和,当泻之气不泻,每挟阳明之气上干清道,此呕逆、痞闷,恶食之所以成也。轻者不必服药,重者则须就医,治之者每以调气和胃,止呕降逆为法,然体有盛衰,     

“甘温除大热法”刍议

甘温除大热法，为元气虚发热而设，其理论渊源，始于《内经》而彰于东垣，如《内经》提出了“虚则补之”，“劳者温之”等治则，对内伤发热，明确提出了“温能除大热”；李东垣认为脾胃受损乃内伤发热之关键，阴火之生，根源在元气之不足，因此创制了补中益气汤等调补脾胃之方治疗内伤发热。后世薛己发展了东垣学术思想，提出阴虚补脾的方法。近代医家拓宽了该法的运用，使甘温除大热法不局限于气虚发热。     

辨证论治探源

《内经》是辨证论治之鼻祖。《内经》确定辨证论治的理论原则：“治之要极，无失色脉，用之不惑，治之大则”。《内经》建立了辨证方法的基本模型，以咳嗽为例析脏腑辨证施治；病因辨证，惯称辨证求因，在诊断学中多不论述，《内经》中虽无专论，其实际内容为病因辨证论治奠定了理论基础；《素问·热论》、《灵枢·经脉》篇又是六经和经络辨证的核心。《内经》关于辨证论治的思想异常丰富，不止一次的提出“同病异治”；特别强调“谨察阴阳所在而调之，以平为期”；要求做到“求其属”和“适事为故”等治疗原则、法则和方法。     

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.