论辨证和辨体质关系

中医重视体质的研究由来已久,通过文献的研究,认为辨体质是建立在中医"因人制宜"基础之上的,相当于西医的个体化治疗,通过对文献的分析,归纳出辨证和辨体质的关系:辨体质提高辨证的准确度;辨体质是辨证的基础,在疾病预防中起重要作用;辨体质和辨证结合可以把握疾病规律;辨证包含辨体质;我们不难看出辨证和辨体质二者相辅相成,不可分割的关系,辨证论治是中医学诊病的主要特色,它的主要目标是"病",是对疾病过程中的某一阶断病理特点作为研究的主体,而辨体质的主要目标是"人",主要诊察形体、心理、地理环境等对人体的影响,即人对这些因素的反应。     

体质辨证刍议

主要阐述了5个方面问题。（1）体质辨证的内涵；（2）体质辨证是辨证论治的拓展；（3）体质辨证是中医整体病理观的重要体现；（4）颜德馨充分发挥了体质辨证学说；（5）体质辨证的临床应用。     

谈体质与临床的意义

阐述了体质对临床辨证的意义 ,体质是疾病产生的内因 ,不同的体质易感受不同的病邪 ;体质决定疾病的传变 ;体质对治疗用药有指导意义     

浅析三位一体的中医诊断思维模式

“辨体质—辨病—辨证”三位一体的中医诊断思维模式可追溯至张仲景的《伤寒杂病论》。就其本质而言 ,是先明辨体质类型 ,然后 ,在详审三阴三阳体系病变的基础上 ,进行“方剂辨证”,如阳明体质的人 ,易患阳明病 ,可表现为增液承气汤证 ;少阳体质的人 ,易患少阳病 ,可表现为加味逍遥散证 ;太阴体质的人 ,易患太阴病 ,可表现为理中汤证 ;少阴体质的人 ,易患少阴病 ,可表现为肾气丸证 ;厥阴体质的人 ,易患厥阴病 ,可表现为乌梅汤证等。由于体质和病证是相统一的 ,不能说是辨体质和辨病辨证相合 ,我们将它理解为“辨体质—辨病—辨证”三位一体…     

论高血压体质证候辨证中的年龄因素

分析了高血压体质的年龄构成,即肝郁体质为中青年高血压人群体质的主导特征;虚性体质为老年高血压人群体质的主导特征。详细剖析了年龄构成因素对高血压证候辨证的影响,认为气郁阳亢之标实是中青年高血压形成的病理基础,而脏腑亏损之本虚是老年高血压形成的病理基础,并认为基于年龄构成的高血压防治干预策略符合中医辨证思维观。     

《内经》体质理论发微

就<内经>体质与疾病、体质与辨证论治的有关理论进行了探讨.(1)探讨体质与发病的关系,从体质的角度来研究疾病的发生、发展、转归与预后;(2)探讨体质与辨证的关系,"辨体"、"辨质"固然重要,但其最终目的是为了强化辨证;(3)探讨体质与调理治疗的关系,从理论与治疗方法上的创新两方面,展现体质与论治的紧密结合.     

论小儿体质与体质辨证

本文认为小儿体质呈特殊性,表现为易感性、易变性、可塑性;小儿体质辨证可用以指导孕期保健、后天调摄、辨证施治及体质重建;并建议多学科研究小儿体质学说,开展小儿体质分型的流行病学调查,将体质分型与现代免疫学、血液流变学、现代遗传学等研究及疗效观察相结合,与西医体质学说作比较研究。     

吴光炯教授体质辨证经验介绍

介绍吴光炯教授体质辨证的经验。吴教授治学严谨,用多学科、跨学科知识研究中医中药,临证提出辨病、辨人、辨证相结合原则,并认为辨人的过程某种意义上说就是体质辨证过程,体质在疾病的发生、性质、转归及治疗用药上都起了重要作用,故临证需结合体质辨证,掌握患者体质特点,抓住疾病本质施治。     

何复东老中医“五辨论治”学术思想述要

"五辨论治"思想是何复东老中医根据"情志致病""六经辨证""八纲辨证""脏腑辨证""三因制宜"等中医传统辨治理论,结合"综合辨治"临床诊疗思维提出的,包括体质辨识(健康体质、气虚体质、血虚体质、阴虚体质、阳虚体质、精亏体质、阴寒体质、阳热体质、痰湿体质、瘀血体质、气郁体质、复杂体质),状态辨识(性别辨识、年龄辨识、摄生辨识),辨证、辨病(病位辨识、病因辨识、病性辨识、病势辨识、病程辨识)与辨症相结合的中医临床辨治体系。     

中医体质与辨证论治的相关性研究

阐述体质与辨证论治的相关性,着重在体质与病邪易感、从化,对病证演变、转归、预后,以及论治原则等方面进行论述。提出病证随体质而转化,体质是产生病证异同的关键,论治原则必须从于体质。体质是中医辨证施治的重要依据之一。      

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.