靳三针疗法治疗烟雾病1例

通过病案的报告分析,认识烟雾病在中医学的病机属风、痰、瘀互结,络脉闭阻,清窍被蒙;治宜益气活血,疏通经络.阐述靳三针针刺疗法在烟雾病治疗中的作用及意义.     

清脑益智法方药对烟雾病脑血管壁细胞的影响

[目的]观察中药清脑益智方(QNYZ)对烟雾病脑血管平滑肌细胞增殖、蛋白质合成等的影响 ,探讨中医药治疗烟雾病的机制。[方法]使用烟雾病患者脑血管平滑肌细胞株和人血管内皮细胞 ,应用细胞计数器和5-溴脱氧尿嘧啶核苷 (BrdU)掺入记数观察。[结果]QNYZ在低浓度(100～200μg/mL)时仅部分抑制了血管平滑肌细胞(HCSMC)和脑血管平滑肌细胞 (HMSMC)的增殖 ,当QNYZ的浓度增加到500μg/mL以上(500～5000μg/mL),显示出了一个完全抑制HCSMC和HMSMC增殖的作用(P<0.01) ;对血管壁内皮细胞在低浓度(250μg/mL)及高浓度(500、1000μg/mL)时 ,对其增殖均无显著影响(P>0.05)。对平滑肌细胞内DNA合成的影响上 ,QNYZ组的BrdU掺入率低下(P<0.01),其中在HCSMC组 ,不同浓度(500、1000μg/mL)的QNYZ组间BrdU掺入率无显著差异 (P>0.05) ;而在HMSMC组 ,1000μg/mL浓度的QNYZ较500μg/mL的QNYZ可以显著降低BrdU掺入率 ,显示出一定的量效关系。[结论]QNYZ对内皮细胞 (EC)的生长无显著影响 ,同时又抑制了平滑肌细胞 (SMC)的增殖 ,起到了保护内膜完整性 ,维护内膜屏障的作用 ,从而可能在预防烟雾病脑血管事件中发挥一定的作用     

Huntington舞蹈病案

患者,男,59岁,于2010年11月1日就诊.主诉:肢体不自主舞蹈样动作7年余,加重半年.现病史:7年前无明显诱因出现四肢肢体扭动,遂就诊于天津总医院,诊断为Huntington舞蹈病.     

烟雾病合并缺血性脑卒中的中西医治疗现状

烟雾病(moyamoya disease,MMD)也称Willis环的自发性闭塞,是一种病因不明的脑血管疾病,其特征为颈内动脉及其近端分支的慢性进行性狭窄或闭塞[1]。烟雾病的常见临床表现各不相同,包括短暂性脑缺血发作(TIA)、缺血性中风、出血性中风和癫痫,其中短暂性脑缺血发作是最常见的初始临床表现(48.13%),其他初步表现包括梗死(22.62%)、出血(16.45%)和头痛(5.57%)。在中国北方和东北地区,缺血型占主导地位,而出血型则相对罕见[2]。该病于1957年由日本学者最先报道,其病例报告以日本最多,中国和其他亚洲国家次之。目前对于烟雾病的病因和发病机制尚不清楚,但普遍认为Willis环的主要分支(包括双侧颈内动脉末端)严重狭窄或闭塞是烟雾病的主要病变;由侧支血管形成的脑底异常血管网是继发于脑缺血的主要改变。本文就烟雾病的病因、发病机制,中西医诊疗研究进展做一综述。     

曲克芦丁脑蛋白水解物注射液联合阿司匹林肠溶片治疗烟雾病的疗效观察

目的探讨曲克芦丁脑蛋白水解物注射液联合阿司匹林肠溶片治疗烟雾病的临床疗效。方法新疆医科大学第一附属医院、新疆医科大学第二附属医院、新疆自治区人民医院2012年9月—2014年7月收治的烟雾病患者121例,随机分为治疗组（61例）和对照组（60例）。对照组在常规治疗的基础上口服阿司匹林肠溶片,0.1 g/次,1次/d。治疗组给予曲克芦丁脑蛋白水解物注射液10 mL加入250 mL生理盐水后缓慢静脉点滴,1次/d。两组均连续治疗30 d。评价两组的临床疗效,同时比较两组神经功能缺损（NIHSS）评分、颅内供血、双侧平均肌力、凝血酶原时间和血小板计数的变化情况。结果治疗组和对照组的总有效率分别为83.61%、56.67%,两组比较差异有统计学意义（P〈0.05）。治疗10 d、治疗后,两组NIHSS评分均较治疗前显著降低,同组比较差异有统计学意义（P〈0.05、0.01）;且治疗10 d、治疗后治疗组NIHSS评分显著低于对照组,两组比较差异有统计学意义（P〈0.05、0.01）。治疗10 d、治疗后,两组颅内供血均较治疗前显著增加,同时,患者双侧平均肌力均显著升高,同组比较差异有统计学意义（P〈0.01）;且治疗组这些观察指标的改善程度优于对照组,两组比较差异有统计学意义（P〈0.05、0.01）。结论曲克芦丁脑蛋白水解物注射液联合阿司匹林肠溶片对烟雾病有较好的临床疗效,能够促进患者神经功能缺损恢复,且不良反应少,值得临床推广。     

Case study on acupuncture treatment for Wilson disease: 针灸治疗威尔逊病病案一例

Wilson disease (WD), an autosomal recessive disease with abnormal copper metabolism, is caused by mutations in the ATP7B gene. The symptoms are characterized by liver, nervous system, and ocular manifestations related to the deposition of copper in the liver, lens nucleus, and cornea. The case reported in this article was a 30-year-old woman with high muscle tension, unable to stand or walk, low voice, and short-term memory loss. Brain MRI showed that patchy T1, long T2 signals, and high FLAIR presented signals in the basal ganglia thalamus area, subcortex, and brain stem. Low signal shadows were presented in magnetically sensitive bilateral basal ganglia region, callus, and cerebellar dentate nucleus. Ceruloplasmin was significantly reduced. With conventional treatments by western medicine, the symptoms were not alleviated. However, after the application of acupuncture-assisted treatment, the patient is capable with self-care ability, thus a desired effect was achieved. It is therefore suggested that acupuncture shall be applied to assist the treatment of WD to relieve symptoms and help patients regain self-care ability.     

从中医太阴病分析新型冠状病毒感染复阳典型病例

近期,中国新型冠状病毒肺炎(COVID-19)疫情防控工作中取得显著成效,但临床中一些患者出院后出现复阳现象,目前相关研究较少。对于以消化道症状为首发症状的COVID-19患者在出现复阳症时,可从伤寒太阴病脉症分析。文章认为这类患者素体脾阳虚为本,外感疫气之湿,胶着于太阴,酿成复阳,治疗当以温阳健脾为主。文章抛砖引玉,期待有更多研究关注COVID-19复阳患者及COVID-19康复期的治疗,以减轻患者心理压力,缩短住院治疗时间,减少社会压力及经济负担。     

国医大师翁维良教授治疗冠心病合并血友病验案分析

冠心病合并血友病属于难治性心血管疾病。血友病患者的冠心病发病机制尚不明确,冠心病的药物及外科手术治疗使本身具有出血特性的血友病患者出血风险大大提高,导致此类患者的治疗面临巨大挑战。针对此类患者,翁维良教授灵活应用活血药,疗效显著,冠状动脉狭窄程度及心绞痛症状明显减轻,生活质量显著提高,无出血及心血管不良事件发生。文章分析翁教授治疗冠心病合并血友病验案1则,该病例治疗前期以益气养血活血为主,以防活血出血,后期以活血化瘀为主,加用破血类药物增加逐瘀之力,同时重视疑难病患者的情绪管理和季节用药,整体治疗过程活血而未出血。通过探索翁维良教授对该病的辨证思路、治法选择、用药特点等,为该病的中医药治疗提供思路及参考。     

色素沉着案

患者,女,52岁.初诊日期:2010年5月24日.主诉:项背部色素沉着2年,加重半月.2年前无明显诱因出现项背部色素沉着,未诊治.半月前到医院就诊,给予局部穴位针刺后无效,后又接受针刺加后背穴位放血拔罐等治疗半个月,项背部色素沉着加重,伴面积扩大.     

呃逆案

Patient,male,41 years old,company manager,paid his first visit to the clinic on May 3,2010.Complaint:frequent episodes of hiccups for almost 3years.Medical history:due to work,the patient led anirregular life style for 3 years.He was busy with socialactivities,therefore,he spent a lot of time at banquetsand drank too much. Uncontrollable continualhiccups occurred immediately after a meal or invasionof cold.The slow and forceful hiccups lasted fordozens of minutes at most.He was emotionally     

不孕症案

患者,女,31岁.初诊时间:2009年7月15日.主诉:宫外孕后不孕4年.病史:12岁月经初潮,经期8天,周期30天.2002年结婚,2003年宫外孕(左输卵管旁).后避孕2年,停止避孕措施后,至今未怀孕.于2009年6月行输卵管造影术,结果显示:右侧输卵管不通,左侧输卵管造影剂聚集(输卵管积水?),原因待查.妇科医生诊为输卵管不通致不孕,建议实行试管婴儿助孕,该患者拒绝后,至针灸科求治.刻下症:神疲,倦怠,嗜睡,易腰酸,纳食可,夜寐欠安,二便尚调.     

骨坏死案

患者,男,47岁,公司主管.初诊日期:2010年2月27日.主诉:左膝关节酸痛2月,加重1周.病史:2月前在无明显诱因下出现左膝关节酸痛感,伸膝略受限,无弹响声,无红肿发热,每遇天气潮湿或饮酒之后酸痛感加重,否认有外伤史、服药史.     

乳痈案

患者,女,36岁。初诊日期:2018年1月4日。主诉:双侧乳房疼痛伴发热3 d。现病史:3 d前哺乳后出现乳房疼痛、恶寒发热、头身疼痛,最高体温39.6℃,脉搏106次/min,曾于广东省某医院乳腺科行手法排乳等治疗,症状未好转,遂至广东省中医院针灸科就诊。刻下症:双侧乳房肿胀疼痛、乳房外下象限触及硬结,推之可移,乳汁排出不畅,有压痛,皮色微红,恶寒发热,神倦,纳差,小便数,大便难,多矢气;舌尖红、苔薄黄,脉弦数。西医诊断:急性乳腺炎;中医诊断:乳痈(气滞热壅证)。     

妊娠恶阻案

Patient,female,26,public functionary,married,pregnant once but no birth.Date of first visit:May 4,2010.Main complaint:cessation of menstruation for 60 days accompanied with nausea and vomiting for half a month.Medical history:the patient was usually irritable and shorttempered,which was more obvious after pregnancy.Due to family argument about half a month ago,the patient had nausea,vomiting and poor appetite.She received some treatment at local hospital,but the symptoms were not obviously improved,then she was hospitalized at department of gynaecology in our hospital,and TCM herb drugs was prescribed.However,the herb drugs were spired out right after medicine intake,still no improvement was made.Present symptom:vomiting more than 10 times every day,which was acidwater,sometimes with blood;vomiting right after food intake;emaciation and weakness;dry mouth and lip;little urine,no defecation in 3 days;fever at 37.7 ℃,the tongue was red and its coating was little,the pulse was fast but weak.TCM diagnosis:pernicious vomiting.Western medicine diagnosis:hyperemesis gravidarum.Principle of treatment:to clear the liver and harmonize the stomach,to tonify qi and nourish yin.Selection of acupoints:main points included wèi (胃 CO4),nèifēnmì (内分泌 CO18),pízhìxià (皮质下 AT4),accompanying points were pí (脾 CO13),gān (肝 CO12),shénmén (神 门 TF4),dàcháng (大肠 CO7).Manipulation:after routine sterilization with 75％ ethanol cottonball on either side of ear,sensitive points were searched at selected acupoints by cotton swab with even and gentle strength.The seed of semen vaccariae was scalded in the boiling water and dried,then placed in the center of a piece of adhesive plaster,6 mm × 6 mm in size.     

心房纤颤案

患者,男,73岁.初诊日期:2010年4月2日.主诉:心慌1天.病史:有不稳定性心绞痛病史7年,每因劳累及情绪激动而发作心前区疼痛,休患或口服硝酸甘油可缓解.后渐出现心慌、气短,于某医院行H0lter检查,提示偶发室性及室上性期前收缩,偶发房颤伴差传,ST-T改变.