浅谈学习"医案"的重要性

祖国医学是一个伟大宝库,"医案"是宝库中璀璨的明珠,其始于西汉淳于意之<诊籍>,后历代医家多有"医案"传世,加之诸子百家流派纷呈,百家争鸣,医案内容更加丰富.     

从治疗大叶性肺炎谈到祖国医学对急性病的实用价值

1956年秋,一纯光荣地接受了“继承与发扬祖国医学遗产”的学习任务。由于自己当时是在一个大学附属医院里工作,素来对祖国医学较为陌生,因此当时有这种想法:认为祖国医学遗产,非常丰富,好象一个大宝库,要什么,有什么。我若是进了这痤宝库,一定首先要找我们急于需要的东西。具体些说,就是尽量学习西医目前无法解决或不易解决的问题,如“肝硬变”、“慢性肾炎”等的治疗办法。至于目前西医可以解决的疾病,如“大叶肺炎”等,则不必费很多时间去学习研究。这种不正确的看法,经过一年多的理论学习,     

《程正通医案》及其临床经验简介

遵照毛主席关于“中国医药学是一个伟大的宝库,应当努力发掘,加以提高”的教导,笔者对传抄本《程正通医案》作了初步整理,除曾介绍过数则治肾医案的经验于《广东医学·祖国医学版》1966年第1期外,今进而就抄本原委,以及程氏临床经验探讨,作一简介如下。程正通及其抄本医案笔者早年在整理乡先辈金子久医案的过程中,发现金氏生前曾在无锡某病家处得一手抄本程正通医案,业经雷少逸的学生程曦等注释     

医案史话

中国医药学是一个伟大的宝库,历代各家医案,就是反映祖国医药学精华部分的一个重要方面。现在,能看到的我国最早医案,是西汉名医淳于意的“诊籍”。其实,我国劳动人民在和疾病长期艰巨的斗争中,医案的记载,早在战国时期以前就开始了。     

医案研究刍议

医案,古称“诊籍”,又称病案,是中医临证的记录,体现了理、法、方、药的具体运用。古代医案的写作不拘形式,理论联系实际,突出心得体会和学术思想,是富有中医特色的经验结晶。历代医家在长期的临床实践中积累起来的大量医案,是祖国医药宝库中的精华部分,具有很高的研究价值。     

建议刊登医古文基础知识

编辑同志:祖国医学是座伟大的宝库。但是,这份珍贵遗产主要是用古文形式保存下来的,这就给我们古文基础比较薄弱的中、青年中医,学习医学古籍带来了很大困难。为此,我们建议贵刊在“中医教学”专     

岭南医学及其医案整理概况

岭南医学具有独特的地方特色和时代特点,是祖国医学宝库中重要的组成部分,本文概括性地介绍了岭南医学的一般情况以及近年来对岭南医案搜集整理的研究进展,为岭南医案的进一步挖掘整理提供有用的参考,期待岭南医案的整理研究工作能够提升其影响力并为当代中医临床提供指导.     

“脱疽”古代治疗述要

“脱疽”在祖国医学文献中早有记载,又称为“脱痈”,“脱骨疽”等。主要是指动脉闭塞或栓塞所引起的肢体坏疽性疾病。解放以后,我国以中医中药治疗“脱疽”取得显著成效,充分显示出其特色和优越性。为了发掘祖国医学宝库,对其中医传统疗法作一初步探讨,以供临床研究参考。     

争做新医学派 诗一首

通过学习祖国医学史,看到了光辉灿烂的祖国医学这个伟大的宝库对中国人民的贡献和对世界医学发展的重大影响,这确是我们中华民族的骄傲。而今,我能学习祖国医学,继承宝贵遗产,真是感慨万分。决心努力学习,做一个中西医结合的新医学派!     

中医古籍整理纵横谈——京津地区中医古籍整理第一次会议学术交流座谈摘要

施奠邦(中医研究院院长,京津片古医籍整理负责人):毛主席曾指出:“中国医药学是一个伟大的宝库,应当努力发掘,加以提高。”这遗产和宝,大部分蕴藏在古医籍中,因此,整理中医古籍,是发掘祖国医学宝库、继承和发扬祖国医学遗产的一个非常重要步骤。目前,中医队伍还存在着后继乏人乏术的问题,     

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.     

Combinatorial effects of conception and governor vessel electroacu- puncture and human umbilical cord blood-derived mesenchymal stem cells on pathomorphologic lesion and cellular apoptosis in rats with cerebral ischemia/reperfusion

OBJECTIVE： To investigate the combinatorial ef- fects of conception and governor vessel electroacu- puncture （EA） and human umbilical cord blood-de- rived mesenchymal stem cells （HUCB-MSCs） on pathomorphologic lesion and cellular apoptosis in rats with cerebral ischemia/reperfusion. METHODS： With the HUCB-MSCs isolated, cultured and identified and the models of cerebral isch- emia-reperfusion established, the HUCB-MSCs of passage three were intracranially transplanted andthe EA at conception and governor vessels was ap- plied. The pathomorphologic lesion by hematoxy- lin-eosin staining and the cellular apoptosis by ter- minal deoxynucleotidyl transferase-mediated nick-end labeling method around the ischemic fo- cus were observed. RESULTS： The cultured adherent HUCB-MSCs ex- hibited a spindle shape and expressed MSC-specif- ic markers, with the cell purity and proliferation rate significantly increasing after the primary pas- sage. HE staining showed that there were no patho- logical changes observed in the sham surgery group. However, in the PBS transplantation group, degeneration and necrosis of a great number of nerve cells were seen. In both the HUCB-MSCs transplantation group and the HUCB-MSCs trans- plantation ＋ EA group, reparative changes of the pathomorphism of the tissue were found. Both combination treatment and simple MSCs treat- ment were able to improve the pathomorphorlogic lesion following cerebral ischemia and reduce the abnormal TUNEL-positive numbers, with former better than latter. CONCLUSION： HUCB-MSCs improve pathological lesions and inhibit the cellular apoptosis around the cerebral ischemic area. EA at conception and governor vessels also improve pathological lesion and inhibit the cellular apoptosis in rats treated with HUCB-MSCs transplantation, which effects were superior to that of simple HUCB-MSCs trans- plantation.     

Curative effect of Xuebijing injection on severe pulmonary contu- sion

OBJECTIVE： To investigate the curative effects of Xuebijing （XBJ） injection, a Chinese patent medi- cine, on severe pulmonary contusion （PC）. METHODS： Sixty-three patients with PC were ran- domized to conventional therapy plus XBJ injec- tion （n=33） or conventional therapy alone （n=30）. Between groups differences in corticosteroid treat- ment, immune regulation therapy, hemofiltration, infusion volume, transfusion volume and antibiotic period were measured, as were intensive care unit（ICU）-free time, ventilation time, 28-day mortality rate and incidence of ventilation-associated pneu- monia （VAP）. Serum concentrations of procalcito- nin （PCT）, tumor necrosis factor-a （TNF-a）, interleu- kin （IL）-6, and 11_-10, white blood cell （WBC） counts and percentages of human leukocyte antigen DR/ CD14＋ （HLA-DR/CD14＋） peripheral blood mononu- clear cells were compared. Markers of ventilation were determined by blood gas analysis and ventila- tor parameters. RESULTS： WBC counts and serum concentrations of PCT, TNF-a, 11.-6 and IL-10 were reduced signifi- cantly more quickly, and CD14＋ percentage was in- creased significantly earlier, in the XBJ group than in the control group （P〈0.05 each）. The level of ven- tilation and oxygenation index were ameliorated earlier in the XBJ than in the control group （P〈 0.05）. XBJ treatment significantly reduced ICU-free time, ventilation time and incidence of VAP （P〈0.05 each）, but had no effect on 28-day mortality rate （P〉0.05）. CONCLUSION： XBJ treatment can shorten ICU-free and ventilation times and reduce the incidence of VAP, improving outcomes in patients with severe PC. XBJ may act by regulating inflammation and im- munity, alleviating systemic inflammatory response syndrome induced by trauma.     

Effects of Chinese herbs in children with Henoch-Schonlein purpura nephritis：a randomized controlled trial

OBJECTIVE： To research the curative effect of Chi- nese herbs for clearing away heat, promoting diure- sis, nourishing the kidney, and consolidating es- sence in children with Henoch-Schonlein purpura nephritis（HSPN） with internal accumulation of damp-toxin using randomized controlled observa- tions on large samples. To seek the mechanism of the therapy and its scope of indications. METHODS： Overall, 186 children with HSPN were randomly divided into two groups： treatment group（n=126） treated with Chinese herbs for clear- ing heat and promoting diuresis and a control group（n=60） treated with Western Medicine. The treatment was carried out for three courses of 4 weeks each. We recorded changes in patient urine routines, 24 h urinary protein, blood-coagulating series, immunoglobulin and T-cell subgroups, and improvements in main symptoms. We evaluated the alleviation of clinical symptoms and the im- provement of proteinuria, hematuria, and other lab-oratory test results. Finally, we analyzed the patient population suitable for this therapy according to the relationship between the grouping of patient body weight and curative effect. RESULTS： Damp-heat syndrome improved in the treatment group, with a significant difference in to- tal effective rate after a 4-week treatment（χ2= 13.5220, P=0.0002） and in curative rate after a 12-week treatment（χ2=6.3410, P=0.0118）, com- pared to those in the control group.The curative ef- fect in the treatment group was greater than that in the control group but there was no statistical dif- ference between the two groups. The curative ef- fect after a 4-week treatment of patients in the treatment group weighing 30 kg or less based on Traditional Chinese Medicine（TCM） signs and uri- nary protein was significantly greater than that in the control group. However, there was no statistical difference in the curative effect on urinary red cells and various indexes after a 12-week treatment be- tween the two groups. CONCLUSION： Therapy for clearing away heat, pro- moting diuresis, nourishing the kidney, and consoli- dating essence using TCM is effective in children with HSPN from internal accumulation of damp-toxin. The therapy is especially suitable for patients weighing 30 kg or less. The curative effect may be related to the improvement of immune function and blood-coagulation.