糖尿病慢性并发证"毒损络脉"病机探微

毒损络脉是糖尿病慢性并发证的主要病机。毒邪是致病因素,分外来邪毒和内生邪毒;久病入络,毒邪阻滞络脉及损伤络体致络病,其病机具体又分络脉阻滞和络虚不荣。     

小儿艾滋病病因病机探析

小儿艾滋病属中医伏气温病和温疫范畴.其主要病因为疫疠毒邪和精血匮乏.基本病机为疠、郁、瘀、虚,系统病机可概括为疫疠深伏,禀赋虚损;正虚邪恋,气滞血瘀;先天不足,后天失养;疠害邪犯,脏腑亏损;疠毒肆虐,阴阳虚竭.证候病机为疫疠潜伏,精血亏虚;正虚邪恋,痰瘀互结;脾肾气虚,化生无源;疠毒壅肺,气郁血瘀;疠郁心肝,闭窍动风;风热湿毒,浸淫肺脾;正不抵邪,阴阳虚竭.     

近三十年温病治毒法探讨

正温病治毒法是用于毒邪引起的温热疾病的治疗大法,据毒邪的特点将毒邪分为六淫化火之毒、疫疠之毒、温毒以及脏腑失调、内生热毒。根据其致病的病因病机将温病治毒法分为解毒法(包括清热解毒、清营解毒、凉血解毒、滋阴解毒、辟秽解毒)、泄热排毒法、开郁化毒法、扶正抗毒法。1毒在温病发病中的病因病机毒,通常亦被称作毒邪。常富业等~([1])在诠释毒的概念时指出毒与邪有所不同,邪气蕴结不解是成毒的重要环节。在温病学中毒有不同的涵义,它可指病     

癌毒病机辨治体系的构建

程海波教授团队传承国医大师周仲瑛教授“癌毒”学术思想,创建了癌毒病机理论。近年来,为推广癌毒病机理论的临床应用,进一步构建中医肿瘤癌毒病机辨治体系。提出癌毒病机辨证要点首辨特异性病邪:癌毒,重在辨癌毒的致病特性、兼夹病邪、致病部位、邪气盛衰;其次辨非特异性病邪:郁、风、寒、热、湿、痰、瘀等;最后辨正虚,主要辨脏腑的虚损、气血阴阳的亏虚。提出恶性肿瘤的基本病机为“邪毒蕴结、正气亏虚”,治疗原则为“祛邪解毒、扶正固本”。祛邪即为祛邪复衡,主要包括理气、祛风、散寒、清热、祛湿、化痰、祛瘀法等;解毒即为抗癌解毒,主要包括理气解毒、化痰解毒、祛瘀解毒、祛湿解毒、清热解毒、祛风解毒、温阳解毒、以毒攻毒等八法;扶正固本主要包括益气、养阴、补血、温阳法和调补脏腑法。癌毒病机辨治体系的构建,通过提出以癌毒病机为核心辨证分型,解决目前中医肿瘤按病种辨证分型繁杂难以掌握的难题;提出癌毒病机临床辨识的四个要点,实现癌毒辨识诊疗技术瓶颈的突破;提出抗癌解毒法的学术内涵,形成抗癌解毒八法;提出抗癌解毒中药分类,推动中医肿瘤辨治的临床精准用药。      

毒邪所致肾系疾病的病机探析

毒邪所致肾系病机是指毒邪侵犯肾脏系统导致肾系生理功能障碍,气血阴阳失调,脏腑形质发生异常的内在机理。本文将毒邪所致肾系病机概括为毒邪犯肾,毒损肾络,毒侵溺窍,毒邪犯骨以及肾虚毒滞五个方面。这对深入研究毒邪致病机理,明确其传变转归规律和辨证论治,有着重要意义。     

活动期强直性脊柱炎病因病机初探

强直性脊柱炎（AS）是以中轴关节慢性炎症为主的全身性、免疫性、致残性疾病。根据活动期AS的发病特点和临床表现,认为湿热毒邪痹阻经络,流注骨节是AS活动期的主要病机。禀赋不足,肾精亏虚;六淫病邪形成毒邪,热毒郁而不化,脏腑积热,内蕴伏毒;毒邪未除,湿热伤阴,阴液亏虚;热毒炽盛,血为热灼,必致瘀热,湿为热灼,痰瘀痹阻,痰瘀毒互结骨节均引起活动期AS。      

毒邪所致心系疾病的病机初探

毒邪所致心病病机是指毒邪侵犯心脏系统导致心的生理功能障碍,气血阴阳失调,脏腑形质发生异常的内在机制。本文将毒邪所致心系病机概括为毒气攻心、毒入营血、毒损心脉（络）、心经火毒下移小肠以及气阴两虚,温毒扰心6个方面。这对深入研究毒邪致病机理,明确其传变转归规律和辨证论治,有着重要意义。     

中医络病研究现状的思考

就近10年来的络病研究进行归纳分析,对络脉的实质、络病的病因和病机、络病的临床诊断标准、络病动物模型研制等方面的内容进行了探讨.认为对络脉实质的研究应"血络""气络"并重;结合现代医学理论进行内生毒邪与络病的相关性研究,可以深入揭示内生毒邪的本质及其与络病的病因病机演变的关系;络病的临床诊断标准还应制定一个众所公认的诊断标准;络病动物模型研究相对缓慢,在深度和广度上亟待进一步加强;慢性病大都符合中医"久病入络"的病因病机变化,从免疫学角度来研究络病可能是络病研究的又一切入点.     

毒邪可伏蕴为痫

本文从毒邪、伏邪的特点出发,结合痫病病因病机、临床特点,认为痫病属于"伏气"杂病,其伏邪为毒,风、痰、火、瘀凝成毒,五脏失调化生毒,毒邪内伏脑络,深潜伏藏,蕴聚胶结,引发痫病,并是痫病间歇发作、缠绵难愈的病理基础,进而提出"疗痫祛毒调与化"的治疗思路.     

关于毒邪及其辨治探讨

探讨了历代医家对于毒邪的认识 ,如何评价毒邪 ,以及如何辨治毒邪。结合现代临床研究进展 ,认为毒邪应为邪气亢极或邪气蕴结不解所致 ,其实质为他邪产生 ,有利于毒邪治疗的确立 ,也符合临床治疗实际。毒邪具有亢极或者蕴结的双面特性 ,而非完全亢烈性 ,尤其是在现代一些慢性病毒感染性疾病治疗中 ,针对邪气蕴结成毒的治疗十分重要。毒邪更非完全火热性。毒邪的辨治 ,首辨外感和内伤 ,外感邪毒可分为风毒、热 (火 )毒、寒毒、湿毒、疫毒、药食毒、虫兽毒、秽毒等 ,内伤邪气有瘀毒、痰饮毒、水毒等 ;次辨阴阳 ,认为临床阴阳之分寒热为关键 ,不能将解毒与清热解毒等同 ;把握解毒要领 ,如清毒、散毒、通毒、下毒等方法的合理运用。     

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.