从名老中医成长经历看名医的知识谱系

中医理论学习和研究的过程中,对先贤学术思想的传承是不可或缺的一部分,我们学习、总结、汲取教训,传承、发展、不断创新,才能不断推动中医事业的发展。对当代名老中医学术思想临证经验的继承不仅能丰富中医药学的理论体系,还能对中医学科的发展产生良好的推动作用。以人为对象的名老中医经验总结是对某位名老中医诊疗疾病的辨证思维方法、用药经验的最好传承方式,能最大程度地保证对名老中医经验的完整继承。笔者通过阅读75位名老中医成医道路及行医经历,总结他们学医启蒙的机缘、学习的过程、行医诊治的经验、研习的经典著作以及习医的体会等方面,以求探索出名老中医知识谱系形成的发展的规律,为后世医者传承经验提供学习的方向。     

名医学术思想形成发展规律探析

名老中医是当代中医药学术发展的杰出代表,体现了当前中医学术和临床发展的最高水平。学术思想是名老中医数十年经典研习、学术传承、临床实践、科研探索的智慧结晶,是名老中医临证诊疗的思想精髓。如何更好更快地学习、传承名老中医的学术思想,首先必须对名医学术思想形成与发展的规律进行研究。     

国家级名老中医学术思想传承研究的现状及对策分析

国家名老中医学术思想作为我国传统医学文化的典范,是中国传统文化的重要部分,传承名老中医学术思想在新时代具有特殊的意义。经文献研究发现因技术和经验的不足,我国名老中医学术思想的传承仍处于停滞不前的状态。结合现阶段名老中医学术思想的传承现状,提出完整保存原始资料,培训传承人员和建立典型数据库等方案,利用诸如因子分析、聚类分析等大数据研究手段,发掘名老中医学术思想的精髓,为中医药事业的发展和继承创新提供途径。     

名老中医传承研究综合信息管理平台的构建与实施

"十五"国家科技攻关计划"名老中医学术思想、经验传承研究"课题,建立了有中医特色的名老中医项目管理平台。"十一五"名老中医传承研究不断深化,在国家科技支撑计划中继续设立了"名老中医临床经验、学术思想传承研究"重点项目,对"十五"形成的名老中医信息采集模板与平台,进一步完善功能。以此为基础建立的名老中医临床经验学术思想综合信息管理平台具有采集、储存、挖掘、管理四大功能,目前已通过网络在全国多个省市得到应用,普遍提高了名医经验传承研究的效率。     

将名医经验传承融入高等教育的探讨

当今名老中医的学术思想、临床经验和技术专长是他们临床实践与理论的智慧结晶,代表着当前中医学术和临床发展的最高水平,是中医药学伟大宝库中的新财富,与浩如烟海的中医古籍文献相比,它更鲜活生动,更具有现实的指导性[1]。国家“十五”科技攻关计划——“名老中医学术思想、经验传承研究”课题组经过两年多的努力,做了大量的工作,整理、研究了名老中医的诊疗经验、学术思想、传承方法。成果包括采集临床病历21063份,整理典型医案3641份,撰写名老中医临证思辨特点、学术思想、成才之路等研究报告600余万字,录制名老中医诊疗与教学音像资料光盘730余张,并编纂了《当代名老中医典型医案集》200余万字。国家“十一五     

以守正创新为导向建设有特色与高水平名老中医传承工作室

名老中医传承工作室已成为传承和发展名老中医专家学术思想、临证经验,培养新一代中医药人才的重要载体和平台。文章对安徽中医药大学第一附属医院名老中医传承工作室建设指导思想、实践经验、成效等方面进行总结,对今后名老中医传承工作室的建设提出展望。     

名老中医学术思想传承研究的现状探析

大数据时代带来的不仅仅是数据的电子化,需要直面的问题是如何处理大数据。经系统文献梳理发现名老中医数据的来源、数据完整性、真实性等是目前名老中医学术思想传承停滞的原因。利用诸如以聚类分析、因子分析等分析方法,将名老中医的学术思想进行归纳总结反馈于临床,并基于真实世界的临床研究,或许会成为今后名老中医学术思想传承发展的重要方向。     

人工智能在名老中医学术传承中的应用探讨＊

中医药学是中华民族灿烂文化的重要组成部分,传承与创新相结合,是延续中医药事业的根本途径。名老中医的学术思想和临床经验在中医药发展中至关重要,其传承模式也随着时代发展而逐渐多元化。然而,大量隐性知识存在于中医临床诊疗过程中,极大地增加了名老中医学术传承的难度。人工智能技术目前在现代医学诊疗中已有了初步应用,它可以拓展人类局限的数据存储和计算分析能力。与人工智能相结合的中医传承模式,可以深度挖掘名老中医学术思想,为中医学的传承发展贡献力量。本文主要介绍名老中医学术传承现状,探讨并展望人工智能在名老中医学术传承中的应用以及前景。     

《上海中医药杂志》“名医传承”专栏征稿启事

为了配合国家科技部和国家中医药管理局"‘十五’国家科技攻关计划‘名老中医学术思想、经验传承研究’",总结和传承名老中医学术思想和临床诊疗经验,《上海中医药杂志》开辟了"名医传承"专栏,主要介绍名老中医独     

《上海中医药杂志》“名医传承”专栏征稿启事

为了配合国家科技部和国家中医药管理局"‘十五’国家科技攻关计划‘名老中医学术思想、经验传承研究’",总结和传承名老中医学术思想和临床诊疗经验,《上海中医药杂志》开辟了"名医传承"专栏,主要介绍名老中医独     

应用数据挖掘技术开展名老中医学术经验传承研究的全局设计实例

传统中医药学在数千年的发展过程中,逐渐形成了独具特色的理论和诊疗体系,与现代医学大相径庭的思维、理路、方法及技术在临床实践中同样发挥着巨大的、无可替代的作用。中医药学诊断和防治疾病的基本原则是辨证论治,即在中医理论指导下,通过对个体望、闻、问、切四诊合参,将所收集的资料、症状和体征进行分析综合,概括判断出证候,并以此为据确立治则、治法和处方用药。     

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.     

Capillary blood flow in patients with dysmenorrhea treated with acupuncture

OBJECTIVE; To observe capillary blood flow at acu- points during acupuncture treatment of primary dysmenorrhea and gain new insights into its anal- gesic mechanism. METHODS： Patients with primary dysmenorrhea were enrolled and randomly assigned to a treat- ment or control group. Subjects＇ symptoms were differentiated into various Traditional Chinese Medi- cine （TCM） syndromes and treated for 10 sessions with puncturing acupuncture or self-pressing right-hand Hegu （LI 4）, adding other acupoints based on syndrome. Laser speckle was used tocompare the change in the vasomotor amplitude and perfusion of the capillaries in Hegu （LI 4） be- fore and during the treatment. Each subject was re- quired to finish the period pain symptoms observa- tion form, verbal rating scales, numerical rating scale, pain rating index, face rating scale, Zung self-rating depression scale, Zung self-rating anxi- ety scale, and numerical rating scale before and af- ter treatments. RESULTS： After 10 sessions, the symptom scores, pain index （PI）, and visual analog scale （VAS） de- creased significantly in treatment group. The vol- ume of blood flow in Hegu （LI 4） declined slightly. No significant evidence supported that needling caused capillary contraction, but the capillary vaso- motor amplitude at Hegu （LI 4） increased remark- ably. CONCLUSION： Acupuncture can increase the capil- lary blood flow, thus promoting the flow of Qi and blood in terms of TCM theory, which facilitates pain relief.     

Characterization and evaluation in vivo of baicalin-nanocrystals prepared by an ultra-sonic-homogenization-fluid bed drying method简

AIM： To improve the absorption and bioavailability of baicalin using a nanocrystal （or nanosuspension） drug delivery system. METHODS： A tandem, ultrasonic-homogenization-fluid bed drying technology was applied to prepare baicalin-nanocrystal dried powders, and the physicochemical properties of baicalin-nanocrystals were characterized by scanning electron microscopy, photon correlation spectroscopy, powder X-ray diffraction, physical stability, and solubility experiments. Furthermore, in situ intestine single-pass perfusion experiments and pharmacokinetics in rats were performed to make a comparison between the microcrystals of baicalin and pure baicalin in their absorption properties and bioavailability in vivo. RESULTS： The mean particle size of baicalin-nanocrystals was 236 nm, with a polydispersity index of 0.173, and a zeta potential value of-34.8 mV, which provided a guarantee for the stability of the reconstituted nanosuspension. X-Ray diffraction results indicated that the crystallinity of baicalin was decreased through the ultrasonic-homogenization process. Physical stability experiments showed that the prepared baicalin-nanocrystals were sufficiently stable. It was shown that the solubility of baicalin in the form of nanocrystals, at 495 ug·mL-1, was much higher than the baicalin-microcrystals and the physical mixture （135 and 86.4 ug·mL- 1, respectively）. In situ intestine perfusion experiments demonstrated a clear advantage in the dissolution and absorption characteristics for baicalin-nanocrystals compared to the other formulations. In addition, after oral administration to rats, the particle size decrease from the micron to nanometer range exhibited much higher in vivo bioavailability （with the AUC（0-t） value of 206.96 ± 21.23 and 127.95 ± 14.41 mg·L-1·h-1, respectively）. CONCLUSION： The nanocrystal drug delivery system using an ultrasonic-homogenization-fluid bed drying process is able to improve the absorption and in vivo bioavailability of baicalin, compared with pure baicalin coarse powder and micronized baicalin.     

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