邵迎新教授从气虚辨治甲状腺结节的经验

中国成年人甲状腺结节的患病率高达20%,西医主要是采取手术治疗和随访观察。中医称甲状腺结节为瘿瘤,一般从肝脾论治,认为是由于情志内伤引起肝失条达,或饮食失宜引起脾失健运,进而导致气滞、痰凝、血瘀,壅结颈前而为瘿瘤,治以理气活血,化痰消瘿。邵迎新教授认为本病的病因主要是先天禀赋不足即胎传,和/或后天饮食中碘的摄入不当,与情志相关但非主因。因先天不足或后天失调导致气虚,气虚推动无力使气血津液运行不畅,导致气痰瘀三者合而为患,积结颈前而发病。其基本病机是气虚生积、痰结血瘀,病机关键为气虚,由气虚导致气滞、痰凝、血瘀,日久痰瘀积结,形成瘿瘤。基本证型为正气亏虚、痰结血瘀证,治以益气化瘀,祛痰散结。临床证实从气虚辨治瘿瘤效果满意,为治疗甲状腺结节提供了新的思路,值得借鉴应用。     

益气化瘀法在甲状腺结节中的应用探讨

甲状腺结节包括甲状腺癌在全世界的发病率快速增长,可能与高碘以及自身免疫有关。治疗一般以外科手术为主,内科治疗主要为促甲状腺激素抑制治疗和放射性碘治疗,但是效果甚微且存在诸多副作用。中医学称甲状腺结节为“瘿瘤”,古时因缺碘导致的瘿瘤常用含碘高的昆布、海藻等化痰软坚药物为主,通过辨证论治以疏肝理气、活血化瘀、清热解毒、益气养阴等药物为辅。目前研究认为高碘是导致甲状腺结节的重要原因之一,含碘高的药物不宜应用。形成瘿瘤的根源是正气亏虚,脏腑功能失调,其病机关键是气滞、痰凝、血瘀。正虚宜扶正,通过健脾益气、疏肝理气调整脏腑以益气扶正;气滞则疏,痰瘀、血瘀须祛痰和活血以化瘀祛邪,两相结合简称益气化瘀。临床上应用中医的益气化瘀法治疗瘿瘤效果满意。     

甲状腺功能亢进症证治规律探讨

甲状腺功能亢进症初期多实,以气郁痰凝为主;中期虚实并见,阴虚与阳亢并重;后期以虚为主,以气阴两虚多见;末期虚中夹实,以脾肾两虚为主,痰阻水停瘀滞为次;并且气滞痰凝血瘀贯穿本病始末。其治法主要有疏肝解郁、滋阴潜阳、益气养阴、健脾祛湿、温肾利水、化痰活血散结等。同时身心调整,正确的饮食与生活起居习惯等是防止甲亢病情恶化的有效措施。     

甲状腺结节辨证分型标准的临床研究

目的：建立甲状腺结节中医辨证分型标准,为指导临床、进一步提高疗效以及建立综合的临床疗效评价体系奠定基础。方法：文献调研结合以甲状腺结节患者症状询问为主的问卷调查,提取证候要素,采用聚类分析及主成分分析方法,形成甲状腺结节的辨证分型模型,然后通过该领域专家咨询,建立甲状腺结节的临床辨证分型标准。结果：309例甲状腺结节患者的证候要素经聚类分析聚为5类,通过专家咨询修正,第2、4类（脾肾阳虚证、脾虚湿盛证）合并为脾。肾阳虚证,第1类为肝郁痰凝证,第3类为痰瘀互结证,第5类由“气阴两虚证”改为“阴虚内热证”。由主成分分析和专家平均排位情况确定每一类证型的主症和次症。这4种证型反映了甲状腺结节的临床基本证候。结论：甲状腺结节的临床基本证候为肝郁痰凝证、脾肾阳虚证、痰瘀互结证和阴虚内热证。     

健脾为本、分期论治桥本甲状腺炎

桥本甲状腺炎乃虚实夹杂之证,主要以脾气亏虚为本,气滞、痰凝、血瘀为标,病邪壅于颈前而发病,治以益气健脾、行气活血化痰为主,并且辨病与辨证相结合,分期论治。本病早期多属气郁痰阻、痰瘀互结之证,治宜标本兼治;甲状腺功能亢进期多属肝火旺盛或阴虚火旺之证,当以治标为主;甲状腺功能减退期多为脾肾两虚之虚证,当以治本为主。     

宋爱莉从痰瘀互结论治乳腺增生病经验

痰和瘀在血液流变学、微循环及血液生化等方面都有相同或相近的病理改变,认为痰瘀互结理论可阐释乳腺增生病的形成与发展机制。乳腺增生病为气滞、痰凝、血瘀结聚而成,属本虚标实证,肾虚冲任失调为其本,肝气郁结、痰凝血瘀为其标,病位在肝、脾、肾。根据乳腺增生病痰瘀互结的临床特点,以及偏于肝郁气滞、冲任失调、脾虚湿盛等不同证候表现,提出以行气活血、化痰散结治其标,疏肝理气、健脾胜湿、温补肝肾调摄冲任治其本。     

从“罢极之本”论治甲状腺结节

探讨从“罢极之本”论治甲状腺结节的临床意义,为甲状腺结节治疗拓展思路。通过查阅中医古籍和现代文献,搜集部分医家对“罢极之本”理论的学术观点,探讨“罢极之本”理论内涵,从“罢极之本”提炼甲状腺结节的病因病机、临证思路和用药特色,并附一则医案加以验证。从“罢极之本”探析甲状腺结节病机核心在于肝之体用和生理功能失常为先、肝脏维持脏腑生理功能失常为变,最终导致气滞、血瘀、痰凝壅结颈前发病,关键环节在于“罢极之本”职能特性失常,治疗方面特此提出“肝实者宜疏泄、肝虚者宜柔补”总则,通过疏肝解郁、疏肝活血、培土缓肝、柔肝养血、清肝泻火的不同遣方用药思路而达到散结消瘿的目的,所举验案为肝郁气滞、痰凝血瘀之甲状腺结节,以疏肝理气、化痰活血、软坚散结为治则,方选自拟疏肝散结消瘿方治疗,临床获效显著。从“罢极之本”论治甲状腺结节合理可靠,建立甲状腺结节特色辨治体系,可为今后中医药治疗甲状腺结节提供更为广阔的思路和方法。     

陈如泉教授治疗结节性甲状腺疾病验案3则

结节性甲状腺疾病是一类甲状腺内含有结节的甲状腺疾病统称。中医学认为本病属于"瘿病""瘿瘤"范畴。陈如泉教授在诊治甲状腺疾病方面积累了丰富的临床经验，形成独特的学术思想，文章重点列举其临床治疗结节性甲状腺疾病阳虚痰凝证、痰瘀互结证、肝郁化火证验案3则，为临床辨证论治结节性甲状腺疾病提供参考。     

基于中医理论探讨自噬在肿瘤转移中的作用机制

肿瘤转移是导致患者临床治疗失败继而死亡的主要原因,在恶性肿瘤转移中,正气亏虚是其内在根本原因,癌毒流注是必要条件,痰凝血瘀是其主要促使因素,因此恶性肿瘤转移当以扶正祛邪为主,并辅以活血化瘀、化痰散结,修复受损之络脉.自噬对肿瘤转移的双向调节作用与机体正气不足,邪气入侵,癌毒内生,痰瘀互结所致的病机有异曲同工之处."正虚...     

张蜀武教授运用温通法治疗慢性骨盆疼痛综合征的经验

张蜀武教授对慢性骨盆疼痛综合征辨证分型,认为该病中、后期多为寒证,临床上以血瘀寒凝、痰瘀寒凝、痰瘀寒凝为多见,采取温通法进行治疗,分别运用天台乌药散、少腹逐瘀汤和小金丸加减,多能收到良好的临床效果.     

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.