陈可冀院士治疗冠心病心绞痛学术思想与经验

陈可冀教授在其50年的中西医结合临床实践中,一向注重血瘀证及活血化瘀理论的研究,不仅从中医辨证论治的角度研究运用活血化瘀法治疗内科疾病特别是心血管疾病,而且致力于从现代科学的角度阐明了血瘀证的机制,为使用活血化瘀法治疗疾病提供科学依据.使用最为频繁的活血化瘀医方即血府逐瘀汤,此方是清代名医王清任创制的效验卓著、流传甚广的活血化瘀名方.陈可冀院长对此方进行多项基础及临床试验,研发制成多种中成药制剂,在精研活血化瘀的基础上,根据病人体质及兼挟证之不同加减变通,派生出理气活血、化痰活血、祛浊活血、养阴活血、益气活血、温阳活血、熄风活血、解毒活血等诸多不同治法,其加减变化之灵活,确为陈老师临诊病患时的一大特色.笔者有幸亲历教诲,现就感触较深的验案进行总结与大家分享.     

血瘀证微循环障碍与活血化瘀

血瘀证微循环障碍与活血化瘀中国人民解放军第２５１医院（０７５０００）袁长瑞临床实践中发现许多内外科疾病都存在着血瘀证症侯群或者说微循环障碍。早在１０００年前我国医学家就开始用活血化瘀法治疗血瘀证，到清末年间王清任又发展了活血化瘀法的临床应用。随着微...     

略谈王清任对《内经》治瘀法则的运用

略谈王清任对《内经》治瘀法则的运用浙江奉化市中医院（３１５５００）王建康王清任所著《医林改错》，主要记述了脏腑解剖所见和活血化瘀的治疗经验。他所创立的一系列活血化瘀方剂，在治瘀法则方面基本上都渊源于《内经》，是对《内经》多种化瘀方法的具体运用。试举...     

冠心病血瘀证亚型的中医方药论治研究进展

对冠心病血瘀证亚型进行归纳总结并提出方药运用原则与规律。冠心病血瘀证在临床上可见5种基本亚型:气滞血瘀型、阳虚血瘀型、气虚血瘀型、痰浊血瘀型与寒凝血瘀型。每个亚型间有着不同的病因病机与临床表现,每个亚型的辨证选方亦有所不同,在5种亚型的选方用药方面需辨清病因病机、灵活运用方药,虽都为血瘀证,治疗中均需活血化瘀大法,但病因不同,形成血瘀证的病机就各异,用药就存在差异。     

活血化瘀法治疗12例晚血腹水

近年来,笔者以活血化瘀法为主,随证加减,结合西药护肝,治疗晚期血吸虫病肝硬化腹水12例,收到了较为满意的疗效。活血化瘀基本方:丹参20g、桃仁12g、红花3g、当归15g、赤芍12g、柴胡10g、青皮6g、川芎10g、     

活血化瘀方JC734联合mFOLFOX-6方案治疗消化道肿瘤的临床研究

[目的]探索活血化瘀方JC734联合mFOLFoX-6方案化疗对胃肠肿瘤的治疗效果。[方法]纳入符合标准的80例胃肠肿瘤患者,其中单纯化疗组40例,联合用药组40例,联合用药组选用活血化瘀方JC734联合mFOLFOX-6方案治疗。对2组患者的疗效、肿瘤标志物的变化、凝血系统指标、脂质代谢指标进行评价。[结果]JC734联合mFOLFOX-6方案化疗治疗晚期肿瘤40例,经过5个疗程的治疗后,CR 6例,PR 13例,SD 16例,PD 5例,获益率为87.5%,该治疗方法不促进肿瘤转移,有治疗血栓和癌栓的作用,但对部分凝血酶原时间和PT-INR无明显影响,对血脂代谢有一定调控作用。[结论]活血化瘀方是治疗胃肠肿瘤一种有效的治疗方法,不促进肿瘤扩散,可能通过调理脂质代谢发挥抗肿瘤作用。     

血府逐瘀汤新用

血府逐瘀汤出自清·王清任《医林改错》 ,方由桃仁、红花、当归、川芎、赤芍、生地、柴胡、枳壳、甘草、牛膝、桔梗 11味药组成。该方活血化瘀、行气止痛 ,为治胸中血瘀、血行不畅常用方。现代医学多用于治疗冠心病、心绞痛、风湿性心脏病、胸部挫伤、肋软骨炎之胸痛以及脑震荡后遗症之头痛头晕、精神抑郁等症属于瘀血阻滞者。因其组方气血兼顾升降并用 ,不仅有行血分瘀滞 ,又能解气分之郁结 ,活血而不耗血 ,祛瘀又能生新 ,临床辨证用于治疗因郁、瘀所致的病证 ,均获良效 ,现举验案如下。1　肌痹　　闫某 ,男 ,2 9岁 ,司机 ,初诊 1999年 7月…     

张锡纯先生医理方药临证效验录

张锡纯先生医理方药临证效验录大同市第二中医院郭腾灵丘县医院王维张锡纯先生，是中国近代医学史上具有远见卓识和创新精神的医学家。一部《医学衷中参西录》是他毕生经验智慧的结晶。他博览群书，采撷众长，裁云剪霓，化古成新，自成一家之言。阐发医理，多有新见；遗方...     

从降糖三名方到消渴丸

治疗糖尿病的三张经典名方 祖国传统医学博大精深，其中有三张经典名方用于治疗消渴（即今糖尿病）。消渴方：出自《丹溪心法》一书。由金元四大家之一朱丹溪创立。由黄连末、天花粉末、牛乳汁、藕汁、生地汁、姜汁、蜂蜜组成，共搅拌成膏内服。     

应用可视光组织氧监测评价冠心病血瘀证舌诊的研究

目的 采用可视光分光光度计、舌分光定量与中医辨证分析,探讨血瘀证定量、活血化瘀药疗效评价及舌诊客观化研究的新思路。方法选择冠心病血瘀证患者20例,将冠心病血瘀证组参照中医证候诊断标准再分为气虚血瘀证组（10例）、气阴两虚证组（5例）、痰阻心脉证组（5例）。冠心痛血瘀证组以活血化瘀为主进行中西医结合治疗1个疗程（2周）。采用可视光分光光度计及舌诊用特注探针1根（非接触性）．测量舌、颜面皮肤的各部位血氧饱和度（SaO2）。结果健康组与血瘀证组之间SaO2比较,血瘀证组面皮肤SaO2有明显增高（P〈0．05）;血瘀证组与健康组相比,其SaO2均有降低倾向。血瘀证各证型组在各部位治疗前后比较,面部皮肤．气阴两虚血瘀证组有明显增高（P〈0．05）。但其他部位血瘀证治疗前后比较无统计学意义。结论可视光分光光度计可用以整体、连续、无创伤、动态摄取信息。其所测数据虽然来自体表,但能反映内在变化,亦即中医理论所提示“有诸于内,必形与外”。经用此仪器所得观察结果表明,该方法能一定程度反映冠心病血瘀证患者的病情轻重及活血化瘀治疗疗效。     

Blood Transfusion or Blood Substitution?

Blood transfusion has become a universally accepted, life-saving procedure in modern clinical medicine. In addition, specific blood fractions are widely used in the therapeutic treatment of haematological disorders. Problems are, however, encountered in conventional transfusion practice and in the clinical use of blood components. This paper outlines some of those problems and considers how plasma expanders and oxygen-carrying blood substitutes may be used to overcome some of them. The extent to which acceptable blood substitutes have been developed and tested in both animal and human studies is especially emphasized.     

Alternatives to Human Blood and Blood Resources

Biotechnology is increasingly providing alternatives to established transfusion products, with the promise of freedom from infectivity and unlimited supply. Such products must demonstrate a safety and efficacy at least as great as current products, and thereafter an improved cost-benefit ratio. Alternatives to established products may be categorised as:

• ? Alternatives made from blood donations.
• ? Substitutes (acting by distinct mechanisms).
• ? Recombinant analogs.
• ? Cellular therapies (including gene therapy).

This overview covers the current status in each of these categories, and likely trends in the near future. Recombinant therapeutic proteins are already established in certain indications, and are likely to be extended to a wider range of applications as the methods for bulk production are improved. Alternative products from donated blood should find niche indications, especially for acute therapy, but cellular therapy is unlikely to be widely implemented on this timescale, except as an adjunct in life-threatening indications. Substitutes are perhaps the most interesting category and are expected to have a major impact, particularly through the use of “poietins” to stimulate endogenous production of circulating cell populations.     

献血后穿刺部位局部淤血400例的预防

目的讨论献血后对穿刺部位进行合理护理对减少不良反应发生率影响。方法对400例献血者选择合适的采血静脉,使用三指按压法,注意采后止血措施。结果只有12例发生局部不良反应,占总人数的3%,无1例引起献血者投诉。结论完善采血技术可改善不良反应的发生率,减少献血者投诉。     

Adenine-Supplemented Blood

IgG in factor VIII preparations was studied as a possible cause of adverse reactions following infusion of hemophiliacs. Thin-layer immuno-gel filtration analysis of nine products from seven firms demonstrated aggregated and monomeric IgG at highly variable amounts and proportions. These factor VIII products contained from 20 to 700 mg IgG per 1000 IU of factor VIII; IgG-fibrinogen complexes were demonstrated by double-antibody testing. A relationship is suggested between aggregated IgG and/or IgG complexes in factor VIII concentrates and adverse clinical reactions. They may also partially explain abnormalities and aberrations of the immune system previously reported in hemophiliacs.     

Blood Kallikrein

Three chief components of the kallikrein-kinin system (kallikrein, kininogen, kininase) were studied in the blood of 42 patients with acute pancreatitis. Significant increase in content of kallikrein, decrease in level of kininogen, and increase of kininase activity were observed. The highest values for kallikrein, kininogen and kininase activity were found in patients in whom acute pancreatitis was accompanied by hemodynamic changes.     

Blood banks

Viral hepatitis is still one of the most common and severe complications of blood transfusions, with a high mortality rate. The incidence of viral hepatitis after blood transfusions has gone down, but it hasn't disappeared. In Mexico, the estimated risk of infection with HCV is 1 for every 103,000 units administered. The routes of transmission include infected whole blood (IgG), anti-D immunoglobulin and factor VIII. Mexico now has official regulations for blood transfusion. These laws gave place to a reduction of near 57% in the prevalence of infection among donors. The national prevalence of HCV in 2001 was estimated at 0.01 percent. Several tests, like PCR and core HCV antigen detection to determine AcHC, are being applied to guarantee the safety of national blood products.