吴鞠通《温病条辨》对《伤寒论》的继承与发展

吴鞠通作为温病学派的大家之一,在其代表作《温病条辨》中,不仅擅长应用经方,化裁经方,而且也擅长应用温热药物治疗疾病。同时《温病条辨》在理论上弥补和完善了《伤寒论》中的许多不足之处,可以说吴鞠通不仅继承,而且发展了仲景学说。     

孙思邈对《伤寒论》脾胃学术思想的研究

孙思邈在《千金翼方》九、十两卷中对仲景《伤寒论》进行了收载研究,其中对仲景脾胃学术思想的继承研究可以概括为以方类证、明治脾胃诸方适用范围,总结病状、明脾胃病证临床病证治疗,伤寒宜忌、指导临床合理治疗等三个方面。通过孙思邈的归类总结,阐扬了仲景脾胃学术思想,为后世继承运用仲景脾胃学术思想提供了便捷的门径;也为后世医家研究《伤寒论》脾胃学术思想提供了可资借鉴的方法。     

柯韵伯《伤寒论翼·制方大法》学术思想简介

伤寒论翼》为清·柯韵伯主要学术思想集中体现之作 ,是《伤寒来苏集》的重要组成部分。《伤寒论翼·制方大法》从辨证、立法、处方、选药等方面论述了仲景的辨证论治思想 ,主要表现为 :临证立法处方应“知其机得其情” ;“六经各有主治之方 ,而他经有互相通用之妙” ,“合是症 (证 )便用是方” ;独重桂枝、柴胡二方 ;重传变 ,重预防 ;六经为百病立法 ,同病异治 ,异病同治等。其学术思想极大地拓宽了后世医家的眼界和思路 ,为运用仲景学说指导辨证论治 ,为扩大经方的临床运用奠定了理论基础     

《金匮要略》虚劳病方探讨

仲景的方剂 ,历来被尊为经方 ,一因它是从东汉及以前大量经验方中精选的 ,具有卓效 ;二是仲景依据《内经》、《难经》等理论进行了合理改造 ,使理与法、方与证达到了高度契合 ,因而便于推广。所以 ,仲景的书叫做“方论” ,而不是一般的方书。陈延之的《小品方》 ,曾经与仲景方并驾齐驱 ,后来却湮没了 ,盖其有方无论 ,难以传承。基于此 ,本文从论与方两个方面 ,联系《金匮要略》虚劳病篇的几个具有代表性的方剂 ,探讨仲景立法用方的精妙之处。所谓虚劳病 ,是多种慢性衰弱性疾病的总称。劳伤既久 ,必然损及五脏 ,故《难经》有五损之说 ,并分立…     

仲景寒热并用方临床应用心得

仲景《伤寒杂病论》中所载方剂由于指征明确、疗效卓越,被后世尊称为＂经方＂。其中有些方剂组成较为复杂,往往寒热并用、清温同施,临床上适应证候比较复杂,较难掌握。但如能掌握方剂主治及临床指征,可以取得较好疗效。结合临床验案,本文就临床常用的仲景寒热并用方剂的组成特点、应用指征、临床具体应用及注意事项做简要探讨,为临床安全有效的应用该类复方提供思路与借鉴。下面就几首寒热并用方的临床应用做简单探讨。     

伤寒方名索义

《伤寒论》所载方剂，除去一般的某方加减而成的方剂外，还有94首。探求仲景对这94方是如何命名的，能使我们深入了解仲景制方的目的与用意，加深对经方的理解，对临床、教学、科研工作，必有所裨益。     

张仲景对《内经》五味理论的运用与发挥

本文从三个方面讨论了张仲景依味谴方的特点：１．全方一味为主，这些方往往有一个明显、单纯的治疗倾向，体现了“辛散、酸收、甘缓、苦坚、咸软”的原则。２．一方二味为主。这类方剂集中体现了仲景对《内经》“辛甘发散为阳，酸苦涌泄为阴”理论的运用与发挥。３．一方多味。针对复杂多变的病机，仲景更多的方是多种味，并衡量君臣佐使、轻重缓急而组方。进一步研究药味理论对于仲景学说及中医药理论的研究及发展都有一定的现实意义。     

《伤寒论》中甘草运用规律初探

甘草是临床运用最多的一味中药，其所宜忌，众说颇多，仲景《伤寒论》中甘草的运用规律。很能概括诸说，本文根据《伤寒论》的组方，结合甘草药性，对甘草运用的宜忌规律进行总结。治疗咽痛者，宜生甘草；补中益气，守中缓急，合化阴阳，祛痰止咳、调和诸药者，宜炙甘草，至于攻伐之剂，气机不利，补肾，治下焦水湿，违十八反者，每忌用炙甘草。     

小议张卿子《仲景全书》的形成和流传

张卿子《仲景全书》(以下简称张版《仲景全书》)是日本学者出于实用目的, 将赵开美《仲景全书》进行改编而成的, 此书以日本内阁文库所藏的《仲景全书》为底本, 增入《张卿子伤寒论》, 并对前言、目录部分进行调整, 于日本万治二年(1659)首次刊行, 是日本江户前中期《伤寒论》的主要传本。清代光绪年间此书传回国内, 经成都邓氏翻刻, 并增入《运气掌诀录》《伤寒明理论》。组成五种书目的张版《仲景全书》在清末民国时期流传。张版《仲景全书》在流传过程中, 曾被误认为是赵开美《仲景全书》。之后随着宋本《伤寒论》受到重视, 此书被与赵版相区分, 但是张版《仲景全书》在临床和文献两方面亦具有其独特的价值。     

基于《伤寒论》浅谈心悸

通过对《伤寒论》中心悸相关条文的分析,从心脏的气血阴阳失衡方面阐述心悸的病因病机,以及对仲景治疗心悸经方的分析,以期为临床心悸病的诊疗提供思路。     

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.