基于血痹及其病传理论探讨经方中芍药的配伍规律

[目的] 研究经方治疗血痹及其病传中芍药的配伍规律,为临床上应用芍药提供思路。[方法] 整理《金匮要略》《诸病源候论》《神农本草经》《证类本草》等中医古籍中对血痹和芍药的论述的记载,从文献研究的角度探讨血痹的病机和临床表现,分析芍药除血痹的功效,探讨芍药在血痹及其病传中发挥的作用,并结合临床案例进行分析。 [结果] 血痹包含津血亏虚、水饮充盛、风邪犯表三方面的病机,芍药除血痹的功效主要是和营除痹、化瘀除痹、利水除痹这三个方面。芍药配伍桂枝,突出和营除痹的作用,可用于治疗血痹本病;配伍饴糖,突出养营除痹的功效,可用于治疗血痹病传虚劳;配伍大黄,化瘀除痹,治疗血痹病传入里;配伍茯苓,利水除痹,治疗血痹病传累及水分。所举两则验案皆属于血痹病传,第一则病传入里,为太阴中风证及血瘀化火证,治以化瘀清热除痹,方拟桂枝加芍药汤;第二则累及水分,属营血不足、血瘀水停证,治以养营利水除痹,方拟当归芍药散改汤。两则验案均收获良效,进一步验证了芍药除血痹的功效。[结论] 芍药配伍不同药物能够突显不同功效,在血痹及其病传中使用得宜,可收良好疗效,值得进一步研究。     

张昱教授运用药对治疗慢性肾炎经验总结

[目的]总结分析张昱教授运用药对治疗慢性肾炎的经验。[方法]通过跟师临证,收集整理临证医案,查阅相关文献资料,总结张师治疗慢性肾炎的常用药对组成、配伍特色以及常用剂量,探讨药对的临床药理机制,并附验案一则加以佐证。[结果]张师认为“虚-风(内风、外风)-瘀-毒”为慢性肾炎的病因病机,临证时以扶正与祛邪为纲,在辨证论治的基础上灵活运用药对组合治疗。对于正气不足者,常用益气固表、健脾益肾等药对扶助正气;属于邪实者,针对风、瘀、毒不同致病因素,分别采用祛风、活血、解毒等药对以祛除邪气。所举医案,患者辨证为气虚血瘀兼风邪热毒,张师治以益气活血、搜风通络、祛风解毒等常用药对,收效甚佳。[结论]张师运用药对组合治疗慢性肾炎,其方药精简,配伍合理,疗效显著,可为临床用药提供新思路。     

风药在情志病治疗中的运用浅析

[目的]探讨风药在名医名方中的配伍特点及其在情志病治疗中的运用。[方法]选取东汉至明清时期各代医家的代表性方剂,分析风药在情志病治疗中的运用,并列举典型验案以佐证。[结果]风药除具有发散祛风之效外,在历代名医名方的配伍中尚具有疏肝理气、发散火郁、振奋心阳、运脾化湿、宣发肺气的作用,可广泛用于情志病的治疗。所举验案中肝郁化火之不寐,治以清肝解郁、疏透郁热;肺气失宣、上焦郁闭者,治以散邪通窍、宣降肺气,配伍风药治疗均获得良疗。[结论]名医名方中风药的配伍运用,以其独特功效为情志病诸如郁证、癫狂、不寐、痛泻、惊悸等的治疗开拓了遣方用药思路。     

基于《素问·痹论》探析沈津湛教授治疗痹证的证治规律

[目的] 总结沈津湛教授依据《素问·痹论》治疗痹证的临床思路与经验。[方法] 通过跟师临证学习，从沈师对《素问·痹论》原文的解读，对痹证病因、病机、病位、治法、用药、传变、预后等方面的理解运用，以及对固本培元派、温补学派诸位医家治痹经验的继承，总结整理沈师治疗痹证的临床经验与方药特色，并选取一则系统性硬皮病验案进行佐证。[结果] 沈师认为，痹证为风寒湿邪侵袭所致，其根本病因为正气虚弱，包括营卫不足、运行异常与精血亏损、阳气不足两方面，病位多在脾、肾。发病之初尚在五体，是治疗绝佳期，久而入络，转为脏腑痹，则为难治。治疗上，沈师主要继承固本培元派及温补学派多位医家的治痹思路，以脾、肾为核心，将扶正贯穿整个治疗过程。邪在肌表及痹证发作期，以除邪为先，祛风散寒除湿，通络止痛，兼以扶正；邪入经络、脏腑后，以养正为要，依据侵邪之偏重施以补剂，风盛补血，寒甚补火，湿重补气。所举验案乃阳虚寒甚之系统性硬皮病，沈师先治以温阳散寒、除痹止痛，四诊后主以养正温阳、补益气血，取得较好疗效。[结论] 沈师系统解读《素问·痹论》，认为治痹当“养正为要，除邪为先”，以温阳、益气、养血、除邪、止痛、通络六法治疗痹证，疗效尚佳，对临床有较好的指导作用。     

鲁贤昌教授治疗类风湿性关节炎经验

[目的]总结鲁贤昌教授中西结合治疗类风湿性关节炎的经验。[方法]跟随老师临诊学习,搜集鲁贤昌教授的临床医案,从对类风湿性关节炎病因病机的理解及诊治特点和用药规律等角度,总结其学术思想与临证经验,并附验案一则。[结果]鲁贤昌教授认为类风湿性关节炎属中医"痹证"范畴,其病因病机为正气虚衰,筋骨肌腠空虚,外加风寒湿邪侵犯机体,阻滞经络,气机运行不畅,久之形成痹证。治疗时衷中参西,证病结合,主要从温阳通痹、护脾胃等角度遣方用药,处方善用精当药对,同时重视西药及外治联合,临床效果明显。所举医案,充分应证了其上述学术经验。[结论]鲁贤昌教授中西结合、内外兼治类风湿性关节炎,用药特色鲜明,疗效确定,有较高临床参考价值,值得深入学习和推广运用。     

宣丽华教授脐针治疗贝尔麻痹经验

[目的]介绍宣丽华教授运用脐针疗法分期论治贝尔麻痹的临床经验。[方法]通过临床跟诊和访谈的方式从病因病机、分期治法和治疗特点各方面总结宣教授运用脐针治疗贝尔麻痹的经验,并附验案一则。[结果]宣教授认为贝尔麻痹的基本病机为正气亏虚,风邪侵袭,急性期主要矛盾为风邪入络而致经气阻滞治以祛风通络,脐针处方用山泽通气配合离位,恢复期正虚邪滞,或兼夹痰湿痹阻治当健脾益气、温阳化湿通络,处方选择健脾三针或生阳三针后遗症期因虚致瘀治疗以补益气血为要多选择健脾三针或四正位。施针时当安神定志进针定位宜精准选穴以一穴多义为佳。所举验案中患者诊断为急性期贝尔麻痹,证型为风热袭络治疗以脐针山泽通气、朱雀三针为基础方发病10d后加用下关穴等局部针刺共奏疏风泻热通络之效,见效快患、者恢复良好。[结论]宣教授运用脐针疗法治疗贝尔麻痹,谨守体虚受风之病机分期辨证论治,临床疗效可观,值得推广学习。     

丛品教授治疗喉痹经验

[目的]总结丛品教授诊疗喉痹的临床经验。[方法]从喉痹的病因病机、临床辨证及治疗体会方面论述丛品教授的临证思维和诊治特色,总结其常用方药配伍及加减化裁特色,并附验案举隅。[结果]丛品教授认为本病的病因病机中,应特别重视"风、热"之邪和肝、脾、胃三脏的功能失调。辨证上以症状为主、体征为辅并重视舌诊。根据以上病因病机形成了健脾和胃、疏肝理气、疏风清热、养阴生津、理气活血、化痰散结的治则治法,并运用外治法治疗难治性喉痹。在临床上收到良好疗效。[结论]丛品教授对喉痹的病因病机、辨证论治、遣方用药及外治法有其个人认识,在临床上收效良好,值得学习和应用。     

补肾活血中药联合耳穴压豆干预肾虚血瘀型胚胎移植不孕症患者的临床研究

[目的]分析和总结姚新苗教授采取"温阳祛瘀"法治疗足痹的临床经验和学术思想。[方法]通过跟师临诊,收集整理姚师治疗足痹的病案,对其病机病因、治疗原则及遣方用药之独特之处加以归纳总结,并列举验案两则予以佐证。[结果]足痹多由痹邪侵袭日久,迁延不愈,致阳气虚衰,阳虚则寒凝脉络,四肢末端气血瘀滞,脉道失于贯注温养,发为该病。姚师从"久病多虚"和"久病多瘀"的角度,选择温阳祛瘀的经方桂枝茯苓汤加减治疗,疗效显著。所举医案分别为久病及外伤术后,外邪侵踞,或虚瘀夹杂,以致阳气虚衰,或内生血瘀,虚、邪、瘀胶着不去,深入肌肤、骨节而致足痹,以桂枝茯苓汤合四味健步汤加减以温阳祛瘀通络,治疗后随访1年未见复发。[结论]姚师治疗足痹,以"温阳祛瘀"为治疗原则,首重扶正而兼顾祛邪,温阳祛瘀通络,为临床诊疗提供了新思路,值得推广。     

汪受传教授辨治儿童焦虑障碍经验

[目的] 总结汪受传教授辨治儿童焦虑障碍的临证经验。 [方法] 通过跟师侍诊,收集整理并记录分析汪师治疗儿童焦虑障碍的医案,查阅相关古籍和文献资料,阐述汪师对该病病位、病机的认识,分析其诊治思路,并附验案以佐证。 [结果] 汪师认为,焦虑障碍病位主要在心,不离乎五脏,主要由脏腑功能失调,心神失养或受扰所致,辨证时应首辨脏腑,次辨虚实,后辨兼夹,擅用调和脏腑、宁心安神法,随证以施治。所附验案初诊以实证为主,辨为痰火内扰,心肝失主,治以豁痰清心、安神定志;后转为肺脾气虚,心神失养,以虚证为主,治以益气化痰、养心安神,最终取得满意疗效。[结论] 汪师辨治儿童焦虑障碍,详辨病位,紧扣病机,重视痰火,以“调和脏腑,宁心安神”为基本治则,治效显著,其经验值得临床学习和推广。     

从太阴中风病传血痹论治特发性震颤

[目的] 总结从太阴中风病传血痹论治特发性震颤(essential tremor,ET)的诊疗思路。[方法] 通过整理搜集文献、跟师临证,搜集临证验案及观察疗效,总结从太阴中风病传血痹论治ET的辨证思路、治则治法,并附验案佐证疗效。[结果] ET属中医“颤病”范畴,其病因不外“风”与“虚”。周天梅主任认为,血痹病的病机与ET病机高度重合,为太阴中风,津亏血弱,虚邪内中,水饮内停,临证以解表散寒、养血和营为法,以桂枝汤为主方,在辨证论治基础上,灵活应用药物加减治疗。对营血亏虚者,常用濡养津血之药补养气血;对阳明里热者,投以清热生津、顾护津液之药;对水饮内停者,用淡渗除饮、泄越水气等法,临床疗效显著。[结论] 周师从太阴中风病传血痹治疗ET,其方药精简,疗效确切,加深了对ET病因病机与治法的认识,为临床治疗ET提供了新的思路。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.