杨上善《黄帝内经明堂类成》(残卷)考略

杨上善著述颇丰,医术类除《黄帝内经太素》三十卷外,尚有《黄帝内经明堂类成》(下简称《明堂》)十三卷。《明堂序》云:“《太素》陈其宗旨,《明堂》表其形见,是犹天一地二,亦渐通其妙物焉。”二者相为表里,相辅相成,注文互补,为姊妹篇。1《太素》《明堂》姊妹篇《明堂》是我国古代关于针灸理论、经脉理论、针灸宜忌等集经脉理论与针灸实践于一体的医学经典著作。医学何以谓之明堂?明堂一词,释义纷纷。大别有二,儒家谓天子发布政令之宫室(宫室建制失传);医家在采用“天子发布政令之宫室”说之同时,又称鼻或目为“明堂”。医经所以称为《明堂…     

古《明堂经》考析

古《明堂经》在宋以后即散佚不见。《汉书 .艺文志》无著录 ,然《隋书 .经籍志》、《旧唐书 .经籍志》、《新唐书 .艺文志》多有著录。最早援引《明堂经》者为晋 .皇甫谧《黄帝三部针灸甲乙经》,唐 .杨上善《黄帝内经明堂》及王焘《外台秘要》亦引用过 ,大部分内容尚保存于今存诸多古医籍中 ,其中有经脉及其发病 ,五脏重量及形象 ,六腑重量、长度及容量 ,五脏傍通诸项内容 ,脏腑经脉流注出入 ,腧穴 ,刺灸禁忌等。其成书年代似为东汉时期 ,其卷数据杨上善所见古《明堂经》应为三卷本。     

古籍今译的类型和语译古医籍的方法

本文例析了古籍令译的两种类型（即直译和意译）的特点，又从古医籍中，列举了大量例证、论述了语译古医籍的具体方法──即“对、换、留、删、补、调”六字决。为了解决阅读古医籍的困难，除了对原方中的难字，难词及难句进行注释和串讲以外，往往采取今译的方式，通过逐字逐句的今译，不但解释了词义，摆脱了古籍原著的文字烦难，而且对文章的语气，逻辑、连贯性等等，也都在译方中作了反映。使读者迅速全面地掌握原文的内容。因此，今译已成为进行中医古籍整理和研究的一个重要手段。本文旨在介绍古籍今译的两种类型之特点和语译古医籍的具体方法。     

杨上善《黄帝内经明堂类成》(残卷)考略(续)

自杨氏创始“循经取穴”编纂体例和针刺原则以后,后世医家多沿其例,至今此法仍为医家采用。此书之出现,推动了明堂学术之发展。公元752年(天宝12年),王焘(约公元670~755年)《外台秘要》成,卷39据《甲乙经》大量引用《黄帝明堂经》原文,并称此经为明堂学之正经。而在王焘前,甄权(约公元540~643)曾修《明堂图》,孙思邈(公元581~682)《千金要方》《千金翼方》屡引《明堂》之说,可见《明堂》之学在唐初的发展盛况。至王焘又将《明堂》列为专卷详加论述,尤可见明堂学影响之巨大。唐代明堂类著作,不限于《旧唐书·经籍志》、《新唐书·艺文志》所…     

敦煌《灸经图》古代俞穴考

敦煌《灸经图》是一部绘有腧穴图、普及灸法治疗的针灸古籍,是我国现存较早的灸法专著,也是存世最古的明堂图之一。这部明堂图现存于英国伦敦博物院图书馆,编号为S.6168与S.6262,为两残段。我国有文字可考、年代最早的明堂图见于唐代《千金要方》与《外台秘要》所引用的《明堂三人图》,该图系唐代针灸家甄权所作。隋唐医籍,传世甚少,而明堂图谱,更为罕见。敦煌《灸经图》写绘于唐代,诚可弥补这一阙如,诠释针灸疑难。 《灸经图》中有手通孔、脚五舟、手小指头、足小     

中医古籍书名诠释举隅

中医古籍,多以义名书,即概括书中主要内容而命名.观历代医籍,诸多书名,取义古奥,立题僻涩,既涵意幽深,又蕴理丰富,若不予考证诠释,则令人往往顾其名而难思其义.有鉴于此,兹于浩翰中医书海之中,采撷若干种书籍,对其书名略作诠释,聊供大家共同玩味.1 《肘后备急方》(晋·(?)洪) 简称《肘后方》,葛洪在自序中称为《肘后救急》,方中用药简、便、验、廉,可以随时采集应急;又卷帙有限,只录方86首,可以置于“肘后”随身携带备检,类似今日手册.“肘后”乃指肘腋之下,非指筒袖之中,古人包袱挂于肩上,下抵肘间之位置,六朝时又云“肘下”、“肘间”.《玉台新脉·定情诗》:“何以致叩之,香囊系肘后.”《晋书·周颙传》:     

神明与心肾关系的探讨

“神明”一词,一指人的精神意识活动,又泛指人体生命活动的外在表现。众所周知,神明统属于心,但笔者认为其与肾的关系亦不容忽视,故本文试从神明与心肾相关论方面略作初步探讨。祈望同道予以指正。1　神明与肾《明堂》谓:“肾者,引也,为言引水谷和利精神。”“引”者,不独“引水谷”,更能“和利精神”。大抵肾之气化功能正常则五脏六腑之精下藏之,精足持守则气化常行而不已。又肾藏先天之精,而脾化后天之精,两精相搏,神即随之始生。故《灵枢·本神》云:“两精相搏谓之神。”《灵枢集注·卷一》曰:“《平人绝谷篇》曰:神者,水谷之精气也。盖…     

古医籍内型辨识

句子是由词组成的,是语言交际中用以表达说话人(作者)的思想感情、目的和要求的基本意义单位。因此,辨识各类句型,对领悟文章的思想内容、篇章结构,特别是对提高句读与语法分析能力,具有重要意义。 不同句型,在现代汉语中,口语是靠说话人的语调来表示的;书面是恃标点符号来区分的,如“他是医生”这句话,加上句号(“他是医生。)是判断句;换上问号(“他是医生?)为疑问句;更以感叹号(“他是医生！”)即感叹句。而面对浩如烟海的古典医籍,我们今天既无从听到古医家的声音,书面上又无标点符号,那何以辨识呢?关键要弄清各类句型的定义、特点和标志。所谓标志,即各类句型中不同的语气词或结构。现仅以古今汉语差异较大的句型叙述之。     

“诵、解、别、明、彰”在《针灸医籍选读》教学中的应用体会

[目的] 激发学生学习针灸古医籍的热情和兴趣，提高阅读针灸古医籍的能力，使古代针灸医籍在新时代背景下焕发新的活力。[方法] “诵、解、别、明、彰”历来被视为学习中医经典的必经之路，基于《针灸医籍选读》课程特点，应用现代语言，重新解读该五步法，并应用于实际教学。[结果] 现代语言解读下的“诵、解、别、明、彰”五步教学法，课堂教学效果较好，可逐步引导学生对经典理论产生兴趣，激发学生学习针灸古医籍的热情，提高阅读针灸古医籍的能力。 [结论] 应用现代语言解读“诵、解、别、明、彰”经典学习五步法，可提高学生阅读针灸古医籍的能力，培养学生的临床思维能力，促进针灸经典理论的继承与创新。     

“(口父)咀”辨析

(口父)咀(fuju),咀嚼之意,用牙齿磨碎食物.咀.又音(Zui)“嘴”.《说文》:含味也.“(口父)咀”一词在古医籍中颇为常见,而后人对其义的理解多穿凿附会,或彼引抵忤.莫衷一是. 陶弘景《别录·合药分剂法则》     

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.