脑的内景与神经功能解剖的相关性

本文归纳叙述了脑奇恒府内景、脑髓海内景、脑九宫内景、脑气筋内景形象,并阐释其各自的功能作用。基于神经功能解剖的认识,认为坚持中国传统格物致知的“反观内照”方法,才能正确理解中医关于神经系统疾病的病位认识和脑病辨证论治的精神实质。中医关于神经系统疾病的临床优势和缺陷,全部体现在脑的“内景”思维方式上。     

脑藏象理论解析及分形构建探讨

基于中医基础理论的逻辑框架,利用分形理论,将脑藏象理论分为脑髓脑室-脑脏腑系统、脑脉脑络-脑经脉系统、官窍神窍-脑窍系统、泥丸九宫-脑神机系统、脑气脑血脑脊液-脑精气系统等5个方面,不仅脑的局部功能相互区别又相互关联,脑的局部功能与脑的整体功能也是相互区别又相互关联的。脑奇恒府整体功能结构高度完备,不仅调控全身机能、精神心理、认知能力等等;并且,对全身脏腑功能也有调控作用,全身脏腑对脑有反馈调节作用。这种区别于功能神经学及神经生理学的脑藏象理论,从整体观和分形观角度阐释脑功能的复杂性和实用性,形成一个中医药一体化语言系统平台,能够为中医脑科临床应用提供中医特有的思维策略,开拓新的治疗思路。     

老年痴呆合并震颤麻痹体会

脑为元神之府主神明,脑为奇恒之府主藏精气.正常人的思维、记忆、反应迅速等都是靠脑的精微物质来具体表现的.年老之人,肾气渐衰,阴精渐亏,不能上充于脑,脑髓消缩,加之情绪失调,或久病体虚,气血不能上充于脑.脑失濡养,脑髓萎弱,或脾气亏虚,易痰湿内蕴,痰塞阻络,久之郁火化热,蒙蔽清窍,扰乱神明.追根溯源,髓海的空虚,源于肾水、肾气的不足,不能上充,脑失奉养.肝主筋,肝失所养,则见手抖,步履艰难,而大脑是靠后天之水谷精微及肾精转化而得到补养的.据临床观察:虽说患者表现各异,由家属代述居多,追溯以往,多是由于失眠健忘,记忆减退,也有家庭因素,情绪不稳,思维锐减,发展到购物账目不清,情绪过于激动,时有手抖麻木,更为甚者,走路不稳,怕生人,需家人扶持,震颤麻痹之状.     

简述祖国医学对脑的认识

脑是人体保护最严密也是最重要的器官之一。前人对脑的认识,多散载于历代各种史料。现就医学者作中有关这一内容作初整步理,挂一漏万,谬误必多,请指正。一、脑的功能脑形似腑而功似脏,无表里配属关系,被称为“奇恒之府”。因“诸髓者皆属于脑”,故又称脑为“髓海”。且“上至脑,下至尾骶,皆精髓升降之道路”,说明脑髓与脊髓息息相通。从孙思邈“头者人之元首,人神之所注”,李时珍“脑为元神之府”,《东     

基于气络学说精气神理论论治衰老所致认知障碍

衰老以认知障碍为主要表现,随老龄化加剧,已然成为全球关注的热点问题。认为精为生命起源,气是生命动力,神是生命体现。以气络学说精气神理论为指导提出衰老所致认知障碍的关键病机及相应治法,肾精虚衰,脑髓失充为根本,元气亏虚,脑络失通为关键,脑神失养、神机失用为表现,治以补肾填精充脑髓,温扶元气通脑络,充养脑神运神机,以期对延缓和防治衰老所致认知障碍有所裨益。     

论脑为奇恒之府

奇恒之府,非脏非腑。脑居奇恒之府的首位,精气之所聚,主藏元神,统摄五脏六腑,四肢百骸。通过剖析脑为奇恒之府,沟通脑与脏腑经络的关系,希望在脏腑辨证的平台上建立脑病辨证体系。     

肾脑相关理论初探

在《内经》藏象理论中,五脏层次最高,六腑和奇恒之腑均以五脏为核心。脑属奇恒之腑,位于头颅腔之内。脑为髓之海,脑髓是脑功能活动的物质基础。肾属脏,为先天之本。肾藏精,生髓通脑,故肾生脑。肾生脑的物质基础是肾中精气。肾中精气的盛衰是五脏六腑、奇恒之腑生长壮老已的根本     

陈志刚教授基于脑髓-神-气体系治疗快速眼动睡眠行为障碍的经验撷要

快速眼动睡眠行为障碍（RBD）是以快速眼动（REM）期发生的肌肉迟缓丧失及异常行为为特征的疾病,主要表现为REM期肌肉失迟缓,出现与生动梦境相关的异常肢体活动。西医治疗方法主要包括氯硝西泮和褪黑素,但其治疗作用有限。中医方面对于本病的认识尚不明确,陈志刚教授结合临床经验,认为本病发病与肾相关,当从脑髓-神-气体系探讨核心病机。其中脑髓是基础结构,脑气是维持脑功能活动的物质之一,脑神是脑功能的外在体现,脑髓损伤,脑气不足,则神乱梦魇。本文基于脑髓-神-气体系,探讨本病中医病机,为中医药诊疗提供思路和参考。     

奇恒之府藏泻功能对防治椎间盘退变的意义

奇恒之府兼具有"藏"和"泻"两方面的功能,而椎间盘代谢的特点与奇恒之府藏泻机制相似。基于奇恒之府的部位大多是成体干细胞分布较密集之处,且髓核细胞具有类似干细胞多样分化的能力,因此认为成体干细胞符合奇恒之府所藏精微物质的特征,藏泻机制对防治椎间盘退变性疾病具有重要的指导意义和现实价值。     

论奇恒之腑辨证

《中医诊断学》的辨证方法中,没有谈及奇恒之腑辨证,而奇恒之腑是属于臧象学说的内容.我作为30年前全国中医诊断学师资班的学员,首倡"奇恒之腑辨证",值此"朱文锋学术思想暨纪念全国中医诊断学师资班30周年学术研讨会"之际,为了完善脏腑辨证的内容,便于临床应用,再论奇恒之腑辨证,以供同道参考.脑、髓、骨、脉、胆、女子胞(男子精室)为奇恒之腑,髓、骨在肾病辨证、脉在心病辨证、胆在六腑病辨证中已讨论,故奇恒之腑辨证重在讨论脑、胞宫、精室病辨证.     

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.