论十怪脉

中医脉诊历史悠久,《内经》和《难经》屡有脉学记述。晋·王叔和著《脉经》总结24种脉象,后世医家对脉诊作了大量探究,但绝大多数都只在《脉经》的基础上进行发挥或增删。独元朝危亦林氏在其《世医得效方》中搜集记述10种危重症脉象,总称“十怪脉”十种怪脉中的部分     

中医脉诊现代实质探析

《内经》云 :“微妙在脉 ,不可不察。”中医脉诊是中医诊断学的精华之一 ,又是中医现代化的难点之一。近几十年的脉诊现代研究 ,在脉象客观化、规范化方面做了许多卓越的工作 ,但研究探讨脉诊现代机理的文章较少。本文试图结合现代医学生理及病理生理学理论 ,阐释脉诊的现代实质 ,借以抛砖引玉。1　脉诊机理的以往两种解释 [1]关于中医脉诊机理 ,以往主要有这样两种观点 :一种源于传统的中医脉学理论。如《素问·六节脏象论》云“心者 ,生之本也……其充在血脉”;《灵枢·邪客》说“宗气积于胸中 ,出于喉咙 ,以贯心脉……”;《灵枢·脉要精…     

浅谈中医脉诊认识方式的历史沿革

脉诊认识方式有直观概括、形象描述、要素分析、脉图示意、脉图描记,无论客观化方式如何,同一的目的都是把握脉象信息,完成脉诊以进行辨证治疗。由此方面而论,各种脉诊认识方式都是一种工具,是把握脉象信息以促成临床诊断治疗的工具。其中脉图描记作为一种脉诊认识的方式,在人们对把握脉象的迫切需要中应运而生,是脉诊认识的一种历史发展趋势。     

仲景脉法浅析

脉诊是中医诊断学中精华之一，在临床中有着重要的诊断意义。《内经》曰：“微妙在脉，不可不察。”一般而言，脉与证应当合参，各种疾病常有其主要脉象，如仲景《伤寒杂病论》中，太阳伤寒病的脉浮紧、少阴病的脉微细、百合病的脉微数、疟疾脉弦等。仲景脉法，有其独到之处，仲景往往用几种复杂的脉象结合起来以阐释病机，有时以脉象代替证候，有时还依据脉象来指导治疗，根据脉象推断病情、判断预后、制定禁忌等。现将仲景脉法浅析如下；1．以脉象阐释病机《金医·腹满寒庙宿食病》曰；“腹痛，脉弦而紧，弦则卫气不行，即恶寒，紧则不欲…     

中医脉诊客观化的研究进展

中医脉诊研究是指应用现代科学理论和技术对中医脉诊进行的实验研究。中医诊病非常重视脉诊 ,而各种脉象的辨别依据仅是医生的指下感觉 ,对其判断主观因素太多 ,不同脉象很难界定 ,故不同医者对同一脉象很难统一认识。随着科学技术的发展和应用 ,以及生物医学、数学、生物力学、生物物理学、计算机技术等向中医领域的渗透 ,脉诊客观化逐渐成为实验研究需要解决的首要问题。客观化的目的是为了临床应用和促进脉学理论的深入研究 ,而脉诊的临床应用和理论研究反过来又有利于脉诊客观化的实现。1　脉象的客观化描记公元 1 2 41年 ,施发的《察病…     

唐蜀华临证脉诊学术经验总结

介绍唐蜀华教授临证诊脉要点.他认为,诊脉操作要把握七要素:脉位、脉率、脉律、脉形、脉体、脉力、脉势;凭脉辨证需要综合四诊、权衡轻重取舍;心血管疾病诊治尤需继承发掘脉诊特色;传统脉象定义概念需明确详细,进一步规范化、客观化;现代中医发展脉诊需与现代科技融合.     

脉诊辨析

脉诊是医生运用手指切按患者体表动脉,探查脉象,用以了解病情、辨识病证的一种诊病方法.中医学对于脉诊,尤其是寸口诊脉极为重视,并使之成为临床的常规诊法.学习脉诊只有熟悉脉学的基本知识,掌握切脉的基本技能,反复实践,仔细体会,才能逐步识别各种脉象,并运用于临床.     

中医脉诊现代化研究述评

脉诊作为中医诊断的特色诊法初步实现了客观化和数据化。脉诊仪能够识别临床常见基本脉象的脉图特征,脉搏波参数的客观数据可以为脉图分类提供数据支持,脉图的获取与分析技术的优劣决定着评判的标准。脉诊仪,尤其是传感器的研究及更新,脉象采集的规范化以及脉图分析的准确性成为脉诊客观化和现代中医临床运用的重要前提。文章从脉诊现代化研究的3个方向：一是传感元件更新;二是脉图分析技术;三是脉诊临床应用,综合评述了中医脉诊现代化研究,提出脉诊现代化研究的趋势,研制符合中医脉象本身内涵、符合现代仪器要求的中医智能脉诊仪系统,融合中医诊疗数据与现代医学诊疗数据,在数据、诊断和疗效之间建立科学的对应关系,最终形成具有辨证论治内涵的智能医学诊疗决策系统。     

房颤脉的中医相关脉象研究

目的:规范房颤脉的相关脉象。方法:选取100例房颤病人以脉率的多少分为3组,即脉率>100次/min,脉率60～100次/min和脉率<60次/min者,诊其脉象与中医历代脉学著作记载的相关脉象如散脉、涩(短)脉及解索脉等一一进行对比分析。结果:房颤脉在常见的28病脉中相当于中医的散、涩(短)脉及怪脉的解索脉。结论:阵发性快速房颤脉,脉率>100次/min,相当于散(涩)脉与怪脉的解索脉;慢性持续性房颤脉,脉率60～100次/min,相当于涩(短)脉,脉率<60次/min,相当于涩结脉或涩结代脉等,此等脉象与期前收缩(早搏)而形成的结、代、促脉不同。     

试论涩脉的脉象

涩脉是往来艰难、如轻刀刮竹的一种脉象,主精亏、血虚、瘀滞和顽痰.涩脉与结脉、代脉为一类脉象,都是以迟缓为共同脉率,其性质均为阴.涩脉的脉象特点为脉率迟缓、脉形细小、脉律不齐、参伍不调,有如雨沾沙之脉感[1].笔者通过对100例涩脉患者脉象的研究,得出以下结论.     

张云鹏治疗杂病经验举隅

张云鹏（1930-）,主任医师,首届“上海市名中医”,“全国名老中医药专家学术经验继承工作优秀指导老师”,“全国优秀中医临床人才研修项目”上海市专家指导组成员,享受国务院政府特殊津贴。张主任从事中医理论研究及临床实践逾半个世纪,对中医内科常见病及疑难杂症的治疗有很源的造诣。笔者有幸跟师随诊,受益良多,现结合验案将其辨治自汗、斑秃、耳鸣等杂病的经验介绍如下。     

张柏林治疗慢性胃病常用对药介绍

张柏林主任医师从事中医内科临床、教学工作40余载,为第二批全国老中医药专家学术经验继承工作指导老师,天津市首批名中医,享受国务院政府特殊津贴。张师临证经验丰富,擅长糖尿病及消化系统疾病的中医药治疗,对于慢性胃炎、消化性溃疡、胃食管反流病、糖尿病性胃轻瘫的论治尤为得心应手,处方用药别具一格,疗效卓著。笔者随师临证,受益良多,现将其治疗慢性胃病常用对药小结如下。     

张菁辨治阻塞性黄疸验案1则

阻塞性黄疽是指由各种原因导致肝内外胆管机械性梗阻所致的黄疸,临床主要表现为目黄、身黄、小便黄,以及大便呈灰白色或白陶土样、皮肤瘙痒等,其中目睛黄染是黄疸的重要特征,可伴有上腹痛、发热等.     

张明权应用“蛇药方”治疗中医外科疾病验案3则

张明权(1924-)系浙江省嘉兴市第二医院中医科主任医师,曾师从上海名医丁济万、章次公先生,临床用药博采众方,不拘一格。20世纪50年代,嘉兴地区毒蛇咬伤病例较多,民间以马齿苋、蒲公英、大蓟根、五灵脂等为主药的"蛇药方"治疗,因其具有解毒止痛、活血消肿功效,无论外敷还是内服,对蝮蛇、五步蛇等毒     

章永红运用动物类药治疗恶性肿瘤经验探析

导师章永红教授系江苏省名中医,南京中医药大学教授、博士生导师,江苏省中医院肿瘤科主任医师。章师业医30余载,在辨治恶性肿瘤及疑难杂病方面临床经验丰富,尤其擅用动物类药,认为对于恶性肿瘤,只要辨证准确,适当运用动物类药常能取得意想不到的疗效。     

张琪对王清任学术思想的临床应用与创新

张琪教授是首届国医大师,学术上兼容并蓄,善于吸收各医家学术精华而自成一派;临证善于治疗内科疑难病,尤其是疑难肾病。笔者有幸成为同济大学＂中医大师人才传承培养计划＂学员,听张老授课、随张老临证,收益颇多。现就张老对清代名医王清任学术思     

DT-13, a saponin of dwarf lilyturf tuber,exhibits anti-cancer activity by down-regulating C-C chemokine receptor type 5 and vascular endothelial growth factor in MDA-MB-435 cells简

AIM： To investigate the anticancer activity of DT-13 under normoxia and determine the underlying mechanisms of action. METHODS： MDA-MB-435 cell proliferation, migration, and adhesion were performed to assess the anticancer activity of DT-13, a saponin from Ophiopogonjaponicus, in vitro. In addition, the effects of DT-13 on tumor growth and metastasis in vivo were evaluated by orthotopic implantation of MDA-MB-435 cells into nude mice; mRNA levels of vascular endothelial growth factor （VEGF）, C-C chemokine receptor type 5 （CCR5） and hypoxia-inducible factor 1a （HIF-1a） were evaluated by real-time quantitative PCR; and CCR5 protein levels were detected by Western blot assay. RESULTS： At 0.01 to 1 umol·L -1, DT-13 inhibited MDA-MB-435 cell proliferation, migration, and adhesion significantly in vitro. DT-13 reduced VEGF and CCR5 mRNAs, and decreased CCR5 protein expression by down-regulating HIF-1 a. In addition, DT-13 inhibited MDA-MB-435 cell lung metastasis, and restricted tumor growth slightly in vivo. CONCLUSION： DT-13 inhibited MDA-MB-435 cell proliferation, adhesion, and migration in vitro, and lung metastasis in vivo by reducing VEGF, CCR5, and HIF-la expression.     

Qingkailing injection for the treatment of acute stroke： a systematic review and Meta-analysis

OBJECTIVE: To evaluate systematically the clinical efficacy and safety of Qingkailing(QKL) injection in the treatment of acute stroke.METHODS: Searches for randomized controlled trials into acute stroke treated with QKL injection were performed in the China National Knowledge Infrastructure Database, China Science and Technology Journal Database, Wan fang Database,Chinese Biomedical Literature Database, PubMed and Cochrane Library, from January 1979 to March2013. Two reviewers independently retrieved the RCTs and extracted the information. The Cochrane risk of bias method was used to assess the quality of the included studies, and a Meta-analysis was conducted with Review Manager 5.2 software.RESULTS: A total of 13 studies with 1110participants were included. The quality of the studies was generally low. The Meta-analysis indicated that the combined use of QKL and Western Medicine was significantly superior to control group therapy in terms of the total effective rate. The relative risk(RR) in the acute cerebral hemorrhage(ACH) sub-group was 1.17 [95%confidence interval(CI)(1.08, 1.26), P=0.0001]. In the acute cerebral infarction(ACI) sub-group, RR was 1.27 [95% CI(1.14, 1.42), P0.0001], and in the ACH and ACI mixed sub-group, RR was 1.34 [95% CI(1.20,1.50),P0.00001]. Additionally, QKL promoted the absorption of hematoma [mean difference(MD)=﹣3.73, 95%CI(﹣4.48, ﹣2.98), P0.000 01],decreased neurological damage in ACI [MD=﹣5.60, 95% CI(﹣8.50, ﹣2.70), P=0.0002] and ACH[MD= ﹣ 4.08, 95% CI( ﹣ 8.00, ﹣ 0.16), P=0.04],promoted the recovery of awareness [RR=1.56, 95%CI(1.09, 2.21), P=0.01] and reduced the whole blood viscosity coefficient [MD=﹣ 0.75, 95% CI( ﹣1.47, ﹣0.03), P=0.04]. There were no adverse drug reactions reported in the included studies.CONCLUSION: Based on this systematic review,QKL combined with conventional therapy was effective compared with control treatment.However, because the articles used in the study were not of high quality, further studies should be conducted into the efficacy and safety of QKL in treating acute stroke.     

Hypercoagulability in cancer patients grouped by syndromes differentiated with the theory of abnormal hilit in traditional Uyghur medicine

OBJECTIVE： To investigate the relationship in ma- lignant-neoplasm patients of hypercoagulability between syndromes differentiated with the theory of abnormal hilit in traditional Uyghur medicine（TUM）. METHODS： A total of 248 patients with malignant tumors were enrolled. Based on the theory of TUM they were divided into two groups： abnormal Sav- da and abnormal Non-Savda（including abnormal Khan, abnormal Sepra and abnormal Belghem types）; fifty healthy volunteers were selected as controls. Platelet（PLT）, prothrombin time（PT）, plas- ma fibrinogen（FIB）, thrombin time（TT）, activated partial thromboplastin time（aPTT） and D-Dimer（D-D） were measured in both groups. RESULTS： Compared with the control and abnor-mal Non-Savda groups, in the abnormal Savda group the PLT count increased（P0.05）, the PT was lengthened（P0.01）, and the FIB significantly in- creased（P0.01）. D-Ds in the three groups were sig- nificantly different（P0.05）. No significant differ- ence was found inTT and aPTT values（P0.05）. CONCLUSION： Hypercoagulability existed in pa- tients with malignant tumors in the different types of TUM syndromes, especially in the abnormal Sav- da group; this was characterized by increased blood viscosity, platelet aggregation and thrombo- sis. D-D appears to be a significant predictor for the therapeutic effect of TUM in relation to malignant tumor therapies.     

Effects of feeding tyrosine and phenylalanine on the accumulation of phenylethanoid glycosides to Cistanche deserticola cell suspension culture

AIM： To investigate the effects of feeding phenylalanine （Phe） and tyrosine （Tyr） on the accumulation of total phenolic compounds and four phenylethanoid glycosides （PeGs） to a cell suspension culture of the parasitic plant Cistanche deserticola.METHOD： A cell suspension culture of C. deserticola was established and precursors of different concentrations were fed. In each group, the cell was sampled at the 24^th day after inoculation. The content of total phenolic compounds and four PeGs compounds were determined using the Folin-Ciocalteu method and an HPLC method, respectively.RESULTS： In the Phe fed cells, the maximum PeGs yield was achieved when Phe was fed at 1.5 mmol·L^-1 and the yield reached 1.13 times the control cell concentration. In the Tyr fed cells, the maximum yield of PeGs was 1.60 times of control when 0.75 mmol·L^-1 Tyr was fed to the cells. Furthermore, it was found that the salidroside yield was 4.01 times of control group when 5 mmol·L^-1 Tyr was fed.CONCLUSION： Tyr is a better precursor for PeGs accumulation compared with Phe, and the rate limiting enzymes might be involved in the Tyr branch.