基于形神同调从心肝论治抽动障碍

抽动障碍的发病与心肝关系密切,肝风内动,筋脉挛急而致抽动,为形病;心血不足,心失所养,而致情绪障碍等,为神病,治疗时应注重"形神同调".从心肝出发,以治肝调形、养心安神为治则,发病初期重在调形,以疏肝行气息风为主,佐以安神;发作程度重,合并共患病,应调形安神并重,治宜泻火平肝,重镇安神;抽动缓解期以健脾滋肾、养心安神为...     

心神病证治思路

心神病是形神共病性疾病,其发生以脏腑虚实变化为基础,实者主要为气滞、郁火、痰热、血瘀,虚者主要为心、肝、肾阴血不足及阳虚,治疗首当虚实之异及虚实夹杂之处,分别采用相应的药物治疗,同时配合调神治神法。主要治疗方法包括:疏肝清火,镇静安神;活血化瘀,通脉安神;清热化痰,宁心安神;益阴制火,滋阴养神;温阳达郁,生阳化神以及形神共调。心神病的治疗当在辨证气血阴阳的基础上"杂合以治",强调疏肝理气,安神定志,重视形神共调,方获良效。     

顽固性失眠从肝论治

顽固性失眠临床从肝论治疗效较好。肝气郁滞扰动心神治宜疏肝安神；肝火上炎扰乱神志治宜清肝宁神；肝血不足血不养神治当养血安神；肝阴不足神志不定治当滋阴养肝安神定志。     

祝光礼教授治疗心血管疾病伴发失眠验案三则

心血管疾病已成为现代人的常见病、多发病,同时其伴发的失眠更是常见,严重影响患者的生活质量。祝光礼教授认为高血压病、良性室性心律失常及心衰伴发的失眠不同于一般失眠患者,应注意"急则治其标,缓则治其本"的原则,根据原发心血管疾病之不同及失眠持续时间长短,分别采用重镇安神或养心安神为主法,再结合具体情况运用平肝、补肾、益气、滋阴等法缓解原发心血管病,如此才能在临床取得较好疗效,并附三个病案以说明。     

论《内经》针刺之神及其在针灸推拿中的运用

对<内经>中"凡刺之真,必先治神"的理解,历来有诸多观点,大多数学者认为针刺治神指针刺时医者精神要高度集中,进针时,使医患双方入静,医者持针时庄重严肃,针刺过程中要善于安神、守神、调神,这样才能提高临床疗效,达到治疗效果.也有作者认为治神对刺后调养亦具有意义.笔者认为,治神之涵义除以上内容外,还应涵盖更广泛的内容,试叙述如下.     

关于中医对疼痛的理解与治疗

依据祖国医学理论:身体内外产生一种难以忍受的苦楚叫痛,痛而带有一些酸感叫做疼。脏腑、营卫、气血、精神任何一个方面对立统一受到干扰和破坏,某一局部会发生使人难于忍受的苦楚,这就是疼痛。文章通过阅读中医四大经典来进行归纳概述疼痛的病机不外"不通则痛""不荣则痛"以及"诸痛属心"等,根据不同的病机总结出相应的治疗方法:解表治痛法、祛湿治痛法、温通治痛法、通腑治痛法、缓急治痛法、活血治痛法、豁痰止痛法、补虚治痛法以及针对诸痛属心的一些安神定志之法来缓解治疗疼痛。     

浅析仲景辨治“神志病”

浅析张仲景辨治神志病，执其虚实两端，治在心肝两脏。实者疏肝为要，虚者养心为务。以奔豚汤疏肝清热，降逆止痛治奔豚气；半夏厚朴汤疏肝解郁，理气化痰治梅核气；柴胡加龙骨牡蛎汤疏肝泻热，重镇安神治烦惊。以百合地黄汤、百合知母汤养心安神，滋阴清热治百合病；甘麦大枣汤养心安神，益胃生津治脏躁。宗仲景法，用仲景方，临床治疗精神分裂症，老年性精神病，神经症，更年期忧郁症，癫痫性精神障碍等，每获良效。     

顾锡镇教授辨证治疗失眠经验研究

[目的]总结顾锡镇教授治疗失眠的临床经验。[方法]通过临床跟诊、聆听讲授,收集整理相关临床资料,从失眠的病因病机、治则治法等方面探讨顾教授治疗本病的经验,归纳用药特点及加减规律,并予典型病案分析。[结果]顾师认为,失眠辨证以实证多见,分肝气郁结证、肝郁化火证、痰热内扰证及瘀热证,治疗上分别以疏肝解郁、清肝泻火、清热化痰、凉血化瘀药物配伍重镇安神之品;虚证以心脾两虚证多见,治疗上以养心安神为主。所举验案中肝气郁结证,治以疏肝解郁、重镇安神,以柴胡疏肝散合龙骨牡蛎散加减治疗;肝郁化火证,治以清肝泻火、重镇安神,以丹栀逍遥散加减治疗;痰热内扰证,治以清热化痰、重镇安神,以菖蒲郁金汤加减治疗;瘀热证,治以凉血化瘀、重镇安神,以犀角地黄汤加减治疗;心脾两虚证,治以养心安神,以百合地黄汤加减治疗。以上验案均获得良好疗效。[结论]顾锡镇教授认为失眠辨证实多虚少,强调本病以重镇安神和养心安神为治疗大法,辅以疏肝、清火、化痰、祛瘀等,临床效果显著,值得借鉴。     

经方“双心”同治临证六法探析

现代医学将心血管疾病伴发心理疾病称作"双心"疾病。中医学理论认为心主血脉、心藏神,在对心脏、心神相关的疾病治疗上具有"双心"同治的特点。总结《伤寒杂病论》中张仲景治疗心脏、心神异常的"双心"同治之法,通过分析相关方证、病机、治法方药和临床应用经验,归纳出六种"双心"同治法,即温补心阳法、清心泄热法、解郁疏机法、温阳建中法、养阴安神法和温通回阳法,拓展了经方在"双心"疾病领域的应用思路。     

张仲景辨治情志病八法探要

将张仲景辨治情志病方法归纳为润养心肺,凉血清热;益气养血安神;养血平肝降逆;养血疏肝,健脾利湿;开结化痰,顺气降逆;补脾安神宁心;和解枢机;和解泻热,重镇安神等8法,以期为临床辨治情志相关性疾病提供借鉴。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.