用辩证反治法治疗功能性子宫出血的体会

<正> 功能性子宫出血是妇科常见病之一,其主要症状是月经量增多,经期延长或不规则出血,而妇科检查并无明显的器质性病变,故称功能性子宫出血。由于长期和反复子宫出血,常引起严重贫血或体力衰弱,影响工作和学习,给患者带来很大痛苦。 功能性子宫出血属于祖国医学中的崩漏范畴。病势急,经血暴下者为溃,病势慢,经血淋漓不断者谓之漏,但大多数人认为崩漏不分。《济生方》记载“崩漏本乎一症轻者谓之漏下,甚者谓之崩中”,古人认为“漏者崩之渐,崩者漏之甚”,所见崩和漏仅是经血程度上有所不同,并无本质的区别,临床上也常见到同一病人崩漏交错发生,时而为崩,时而为漏,延绵时久而不得止者,崩漏可以不必细分。     

对“崩漏”辨证治疗的初浅体会

“崩漏”是妇科常见疾病,常影响妇女身体健康。功能性子宫出血属中医崩漏范畴。《内经》:“崩是指经水忽然暴下,漏是指月经淋漓不断。”《诸病源候论》说:“妇人月水非时而下,淋漓不断,谓之漏下,忽然暴下,谓之崩中。”崩与漏同属血证。它们之间可以互相转化。“久崩不止,气血耗竭,必致成漏,久漏日久,病势日进,亦将成崩”。其病因病机,可由于精神郁怒伤肝,肝郁化火,或房室伤肾,相火妄动,或素体虚弱,气血亏损,以及气虚不能摄血或血虚不能制约,致冲任损伤,不能固涩经血而成崩漏。     

益气化瘀止崩汤治疗崩漏96例的临床体会

目的通过观察口服中药益气化瘀止崩汤治疗气虚血瘀虚型崩漏的疗效.方法选择96例符合标准的崩漏患者,采用口服中药自拟益气化瘀止崩汤的治疗.结果治愈72例,好转19例,无效5例,总有效率达94.8%.结论益气化瘀止崩汤治疗崩漏效果显著.     

赵昌基老中医妇科治验

1 崩漏 崩漏是指经血非时暴下不止或淋漓不尽,前者称崩中或经崩;后者称漏下或经漏。因二者交替出现,故统称崩漏。崩漏既是妇科常见病,亦是疑难重症。故家父认为治疗本病必灵活掌握塞流、澄源、复旧三法。自拟其基本方为固冲止崩汤:党参、黄     

艾灸隐白配合中药治疗功能性子宫出血27例

目的:观察艾灸隐白穴配合止崩汤内服治疗功能性子宫出血的疗效。方法:27例病例均用艾灸隐白穴配合止崩汤加减治疗。结果:所有病例经治疗后治愈率为77.8%,总有效率100%。结论:艾灸隐白穴配合止崩汤加减治疗功能性子宫出血疗效确切,值得在临床上推广应用。     

固冲止崩汤联合妈富隆治疗更年期功能性子宫出血的效果观察

目的探讨更年期功能性子宫出血采用妈富隆联合固冲止崩汤治疗的临床效果。方法所选研究对象为本院收治的更年期功能性子宫出血患者,病例选择时间范围为2015年10月至2016年10月,共纳入病例数为92例。对于92例患者的一般资料,均通过回顾性分析的方法进行调查。将92例患者按照1:1比例,随机分为研究组(妈富隆+固冲止崩汤)与对照组(妈富隆)。对比两组治疗效果。结果研究组、对照组有效率分别为97.8%(45/46)、84.8%(39/46),差异显著(P0.05);治疗后,两组月经恢复正常时间、控制出血时间、子宫内膜厚度对比,差异显著(P0.05)。结论在更年期功能性子宫出血患者的临床治疗过程中,采用妈富隆与固冲止崩汤联合治疗的效果显著,值得推广应用。     

风花升阳治疗崩漏的体会

倡导风药升阳治疗崩漏者 ,应该说功在金元名家李东垣 ,在其所创的“升阳除湿汤”、“凉血地黄汤”等近 10首治疗崩漏的方剂中 ,都不同程度体现了这一点。至于其机理 ,李氏认为“用风胜湿 ,为胃下陷而气迫于下 ,以救其血之暴崩也”。证之临床却有良效 ,盖阴血为有形之物 ,应经而下 ,是阴中之阴 ,阴尽则阳生 ,经后一阳复生 ,蒸蒸而上 ,经血应而止 ,然崩漏不止者 ,正阳气不生 ,阳陷阴中 ,春升之令不行 ,有降无升。风药能胜湿 ,能升发脾胃清阳之气 ,行肝胆春升之令 ,正扶下陷之阳气 ,实止崩漏之妙法 ,与崩漏发生的病机切切相恰。我在临床治疗崩…     

安冲汤在月经不调治疗中应用现状

安冲汤为张锡纯所创的经效良方,全方共奏益气固冲,止血调经。气虚为妇科疾病的重要病机,气虚血失统摄,冲任不固,经血失去制约,可引起月经过多、经期延长、崩漏等多种疾病。临床以安冲汤治疗,效果显著。后世医家每每在其基础上临床加减用以治疗多种月经不调的病症。     

导师王翠霞教授治疗肾阴虚型崩漏经验总结

崩漏是妇科临床常见病,为妇科危急重证之一。其病机复杂,有虚有实或虚实夹杂,但临床上以肾阴虚型多见。导师循古籍结合临床经验认为肾阴虚型崩漏是以肾阴虚为本,血热血瘀为标的本虚标实证。其基本病机是：阴虚内热迫血妄行,冲任不固;气随血脱,热灼津液而致气虚血瘀。临床运用补肾滋阴、益气化瘀法治疗该型崩漏,疗效显著。     

国医大师许润三论治崩漏经验

<正>崩漏是妇科常见疑难急重病症,以经血非时暴下不止或淋漓不尽为特点,是月经周期、经期及经量严重紊乱的月经病,相当于现代医学排卵障碍性异常子宫出血~([1])。许润三教授认为崩漏的基本病机为肾虚、肝肾调节功能失调,以致冲任二脉不能制约经血。由于其临床以子宫不规则出血为主要表现,故出血期当急则治其标,以止血为要,血止     

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.