归脾汤临证举隅

归脾汤出自《济生方》。由党参、白术、茯神、黄芪、元肉、酸枣仁、木香、远志、当归、炙甘草组成。功能健脾养心、益气补血。主治心脾两虚气血不足之心悸健忘、失眠、食少体倦及脾虚不摄所致的各种出血症。临床运用十分广泛。笔者用该方治疗多种出血症,异病同治,疗效满意,现举     

国医大师阮士怡辨治胸痹

<正>国医大师阮士怡认为,胸痹属本虚标实之证,脾肾虚损为本,因其虚所产生的气滞、血瘀、痰凝为标。基于此,结合"坚者削之""结者散之"理论,创胸痹治疗大法"益肾健脾,软坚散结",通过多年临床实践及实验研究证实,该法对胸痹疗效甚佳。胸痹指因胸阳不振,阴寒、痰浊留踞胸廓,或心气不足,鼓动乏力,使气血痹阻、心失血养所致,以胸闷及发作性胸痛为主要表现的内脏痹病类疾病,等同于西医学"冠心     

炙甘草汤之麻仁辨析

炙甘草汤首见于《伤寒论》177条 ,“伤寒 ,脉结代 ,心动悸 ,炙甘草汤主之。”原方由炙甘草、生姜、人参、生地黄、桂枝、阿胶、麦门冬、大枣、麻仁、清酒组成。历代医家仁智有别 ,但对其不吝誉辞 :《千金翼方》用其治“虚劳不足 ,汗出而闷 ,脉结悸 ,行动如常 ,不出百日 ,危急者十一日死。”《外台秘要》记载其“疗肺痿涎唾 ,心中温温液液者。”喻嘉言赞其曰 :“此仲景伤寒门中之圣方也。”《医寄伏阴论》称其为“滋阴之祖方也”。可见历代诸家对本方的认识颇为精深 ,其适用病证逐渐扩大。目前临床上广泛用于心系疾病。但其中麻仁究为何药 ,…     

补中益气汤临床应用举隅

补中益气汤为临床常用方,出自<脾胃论>,是李杲根据<素问·至真要大论>"损者益之","劳者温之"之旨而制定,为补气升阳、甘温除热的代表方.方由黄芪、炙甘草、人参、当归、陈皮、升麻、柴胡、白术组成,具有补中益气,升阳举陷的功效,用于治疗脾胃气虚、气虚下陷及气虚发热等证.笔者运用此方治疗相关杂症,疗效满意,现介绍如下.     

逍遥散治验举偶

逍遥散载于<太平惠民和齐局方*卷九*治妇人诸疾>,由柴胡、当归、白芍、白术、茯苓、煨生姜、薄荷及炙甘草组成,为肝郁血虚之证而设,方中柴胡疏肝解郁,当归、白芍养血补肝柔肝,茯苓、白术、甘草健脾补中,煨姜和中,与当归、白芍同用有调和气血之功,薄荷少许助柴胡疏肝解郁之力,为疏肝健脾、和营养血常用方,主治因肝脾失调所致的肝郁脾虚、营血不足的病变.笔者从事临床以来,以本方为基础方加减,在治疗妇科及内科等疾病屡收奇效,现列举数例验案以供同仁参考.     

黄芪建中汤临床应用及实验研究进展

正黄芪建中汤(Huangqi Jianzhong Tang,HQJT)为仲景经方,出自《金匮要略》,具有温中补虚、缓急止痛之功效,治疗"虚劳里急,诸不足"。该方由黄芪、饴糖、炙甘草、桂枝、芍药、生姜、大枣7味药组成,全方用药精当,配伍严谨。有学者指出凡脾胃虚弱、阴阳两虚的内伤杂病,不论临床表现如何变化,只要切合病机,均可考虑选用本方~[1],可见其临床应用范围广泛。本文对黄芪建中汤的临床应用及     

升阳养血汤治疗干眼病

升阳养血汤出自清代刘耀先眼科专书《眼科金镜》,用于治疗“目病干涩症”中因劳瞻竭视,过虑多思所致者,其所描述症状“目病干涩、不爽利而视物昏花”类似于现代之干眼病,特别是常用电脑而导致的干眼病患者。笔者以该方治疗干眼病,取得一定疗效,报道如下。1临床资料     

基于营卫理论探讨系统性硬化症发病机制

系统性硬化症的病理改变以"皮-络-脏"损伤为主,病因病机为营卫失调、寒凝瘀阻,临床症状以"寒""胀""硬"为基本特点."寒"乃卫气温煦功能减退所致;"胀"乃营卫失调、痰凝血涩所致;"硬"则与营卫失调、日久致瘀有关.在系统性硬化症的治疗中,"温""补""通"应当贯穿始终,调和营卫当为治疗大法.临证时可以桂枝汤类方为基础化...     

玉屏风散合牡蛎散治疗气虚自汗55例

玉屏风散合牡蛎散治疗气虚自汗５５例广西百色市人民医院梁色兰（百色５３３０００）自汗为临床常见病，有因于气虚、血虚、阳虚所致者，亦有因于热炽阳明、暑伤气阴、血瘀等所致者，而临床以气虚所致者为多见。近年来，笔者采用玉屏风散合牡蛎散为基本方治疗气虚自汗５５...     

炙甘草汤及其加减方治疗“脉结代、心动悸”临床对照试验的系统评价*

[目的]系统评价国内炙甘草汤及其加减方治疗"脉结代、心动悸"的临床对照试验的疗效,为其进一步完善炙甘草汤临床研究设计提供理论依据.[方法]搜集炙甘草汤及其加减方临床对照研究试验,筛选合格文献,文献质量评价按Cochrane系统评价手册4.2.2版关于随机对照试验(RCT)的质量评价标准进行.[结果]检索到符合纳入标准的临床对照研究试验37篇.按照Cochrane评价标准,均属于C级.[结论]从现有研究来看,炙甘草汤及其加减方治疗"脉结代、心动悸"相对对照组而言更有优势.但是可供纳入的文献质量普遍不高.所以有待于进一步研究,希望能多出现大样本高质量的临床随机对照试验.     

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.