《医学纂要》治咳学术思想探析

总结刘渊《医学纂要》治疗咳嗽的学术思想。咳嗽的病因为外感与内伤,无论外感还是内伤咳嗽多伴有咳痰,刘氏在其《痰证辨》中详细阐述了如何辨痰论治咳嗽,对各种咳嗽咳痰的诊治均理法方药具备。其治疗咳嗽又结合岭南人"脾气虚弱兼有痰湿"的体质,因地制宜地辨证论治,提出"治表宜发散外邪,又佐以温解之药;治内伤宜养阴,又兼以纳气温化"的独到见解。     

孙一奎从“痰”论治内伤咳嗽医案解析

咳嗽是临床上常见的疾病,其发病多从外感、内伤而起,病情变化多端。明代新安医家孙一奎在治疗内伤咳嗽时从痰论治多有心得,他认为内伤咳嗽多由痰阻气滞,肺络受阻而致。病因或起于脾虚夹痰,或痰火相煽;或阴虚痰动,或痰生杂病、怪病。故治疗上均强调要从痰治疗,首重祛痰,效应桴鼓。对现在治疗内伤咳嗽具有很强的临床价值。     

从费伯雄内伤咳嗽辨治思路探讨肺癌咳嗽的治疗

目的：发掘《医醇賸义》中治疗咳嗽的经验和方法,为临床治疗内伤咳嗽,特别是晚期肺癌反复咳嗽提供新的思路。方法：运用频数描述结合聚类分析的方法,发掘费伯雄治疗咳嗽的用药特点和诊疗思路。结果：费伯雄治疗内伤咳嗽重视痰的病理因素,看重肺为娇脏的生理特点,着眼肺主肃降的生理功能。有痰咳嗽必先治痰,温开辛宣为主;无痰咳嗽养肺为先,甘润苦降为要;重视调理中焦气机,以脾胃升降辅肺之宣降;治疗咳嗽以肺为中心,善从五行乘侮,脏腑表里着眼。结论：肺癌咳嗽的治疗应充分借鉴费伯雄治疗内伤咳嗽的用药特点和思路,不断思考和实践。     

从邓铁涛五脏相关学说探析内伤咳嗽的病机

从五脏相关探析内伤咳嗽的病机,认为内伤咳嗽的基本病理因素为痰、瘀与火,与心、肝、脾、肺、肾各个脏腑系统有着密切的关系,相互影响.从五脏相关可以更全面地认识到内伤咳嗽的病机,体现了中医治疗内伤咳嗽的特色和优势.     

止咳嗽散加减治疗风寒咳嗽体会

咳嗽是指肺气上逆作生,咳吐痰液而言,为肺系疾病的主要症候之一.分别言之,有声无痰为咳,有痰无声为嗽,一般多为痰声并见,难以截然分开,故以咳嗽并称.此病分为内伤咳嗽和外感咳嗽,在我们东北冬季尤以风寒咳嗽为主,张景岳就曾有"六气皆令人咳,风寒为主"等语.笔者在此对外感风寒咳嗽的治疗加以论证.     

全蝎、蜈蚣、地龙在小儿咳嗽中的应用

咳嗽为肺系疾患的主要症状之一,一年四季均可发生,尤其是秋冬季多见。咳嗽在临床上有外感咳嗽与内伤咳嗽之分：在证型上,外感咳嗽包括风寒咳嗽、风热咳嗽。内伤咳嗽包括痰浊咳嗽、痰湿咳嗽、阴虚咳嗽、肺虚久咳。笔者应用复方全蝎、蜈蚣、地龙治疗咳嗽（主要适用于痉咳期）,如内伤咳嗽的痰热咳嗽及阴虚咳嗽,临床上辨证正确,配伍得法,无不得心应手。现将2006～2008年门诊170例咳嗽患儿资料统计分析如下。     

咳嗽治疗经验谈

咳嗽为临床常见的证候之一,属肺系疾病。病因不过外感与内伤两类,外感咳嗽有风寒、风热、燥热等,内伤咳嗽有痰湿、肝火、痰热、阴虚等。罗列历代诸家治咳名方不下数十个,然而临床中会碰到个别咳嗽患者,常法治疗无效,     

以聚类分析法分析阎洪臣教授治疗内伤咳嗽用药规律

目的 探讨阎洪臣教授治疗内伤咳嗽的用药规律.方法 通过聚类分析的方法对阎洪臣教授治疗内伤咳嗽病例进行收集及整理,将使用频数≥20次的药物,总使用频率达87.6％以上的39味中药进行R型聚类分析,以明确各药的主治功用及使用范围.结果 得到6个关系密切的聚类组,主要用于治疗痰热蕴肺、痰湿阻肺、肝火灼肺、肺脾气虚及外寒内饮证;得到10个对药对症治疗.结论 以聚类分析法分析阎洪臣教授用药规律,得出痰热、痰湿、肝火、肺寒等病理因素,为内伤咳嗽的病机关键.     

基于因子分析法的慢性咳嗽中医证候规律研究

<正>咳嗽是呼吸内科最多的主诉,据有关统计,在呼吸内科门诊中80%以上的患者都有咳嗽症状,慢性咳嗽患者占呼吸科门诊量的20%～30%[1-2]。慢性咳嗽归属中医"内伤咳嗽""顽咳""久咳"等范畴。目前中医药治疗慢性咳嗽缺乏相对规范的辨证分型标准。因此,为初步揭示慢性咳嗽的中医证候规律特点,本文通过文献研究,制定病例调查表,收集122例慢性     

刘建秋运用疏风肃肺方治疗咳嗽变异性哮喘风盛挛急夹痰热证

刘建秋教授运用疏风肃肺方治疗咳嗽变异性哮喘,证属中医风盛挛急夹痰热证,刘师认为,本病主要以风邪为患,痰郁成哮,痰饮内伏,风邪引触,痰气交结,阻塞气道而致,而咳嗽变异性哮喘的病性证素主要为"痰""热",故临床上以"风盛挛急夹痰热证"较为常见,本方药由刘师针对相应症状、药物配伍特点以及多年临床经验总结而得,以达疏风肃肺、解痉化痰之效,以此治疗咳嗽变异性哮喘。     

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.