连建伟教授从痰瘀辨治杂病临床经验探析

连建伟教授认为痰、饮、瘀三者因脏腑功能失调以至气血津液代谢失常而产生,痰饮日久可致血行不利而为瘀,痰瘀为杂病常见病理因素。通过梳理痰瘀和脏腑气化的关系,分析张仲景、叶天士痰瘀并治的临床实践,探析其学术渊源,并举妇科癥瘕、咳嗽、眩晕临床验案三则,以示其从痰瘀论治杂病经验。     

从虚,痰,瘀论治老年病

认为易虚、易痰、易瘀，为常见老年病的共同病基础，且虚为病之常同病痰，瘀为致病之变。指出应从虚痰瘀论治常见老年病。治虚以恢复脏腑取阴阳气血津液的功能，消除产生痰、瘀的要源；治痰治瘀以疏通为贵，应避免粘腻之品。     

从中医痰浊论回医脑病之中风

通过中医回医文献、临床研究等方面,对痰浊的形成及其病因病机、论治体系进行梳理。认为五脏失和与气血津液失常为痰浊基本机制,脾为生痰之源,肾为生痰之本,肺为储痰之器;肝郁气结、心之血脉瘀滞则津停凝结为痰浊;五脏皆生痰浊,其致病多属本虚标实。其次,中风多因体虚,与痰浊密切相关。回医痰浊理论与中风:四性、四液禀性衰败为痰浊病理根源;脑主脏腑,脑经主司全身脏腑经络,痰浊交阻脑经,脑元失养失用而发中风,化痰浊与通利脑经防治脑中风。为完善回医对中风的理论认知,丰富回医药治疗中风的手段与方法,提高临床疗效提供依据。     

从痰瘀论治骨性关节炎

骨性关节炎属于中医"痹证"、"骨痹"的范畴,以正气不足为本,痰瘀互结为标.痰浊、瘀血作为致病因子和病理产物,二者又可相互转化、相互胶结,在临床上常化痰祛瘀同治.因此,痰瘀相关学说及痰瘀互结、痹阻经络在骨性关节炎发病中的地位和作用逐渐受到学者的关注,下面就痰瘀与骨性关节炎的关系做一探讨.     

从毒论治神经系统疑难病症的思路及应用

总结李如奎教授从毒论治神经系统疑难病症的学术思想,并举验案2则予以说明。认为毒邪致病依其来源不同可分为外毒和内毒。内生之毒多因饮食或七情所伤,致脏腑功能失调,正常气血津液输布失常所致。在疾病发生、发展过程中产生的瘀血、痰浊日久,痰瘀互结,邪气蕴结不解可以转化为内毒。神经系统疾病多由内伤或外感六淫或毒素致病,脏腑功能失调形成的瘀、痰、毒等毒损元神或毒伤脑络是其基本病机;人老气衰,脏腑功能衰退,排毒乏力化生内毒。治疗应截断毒邪滋生途径,解毒排毒,祛毒护脑。     

基于"毛脉合精"与"毛脉失和"探讨脉的功能实现与脉病机理证治

脉是气血运行的通道.痰浊、瘀血等有形实邪停聚脉道,气血运行失常,脉道结构因而改变甚则闭塞不通,引起所支配脏腑失去气血濡养的一系列疾病称为"脉病"."毛脉合精"是脉通行气血、濡养脏腑官窍的重要前提,"毛脉失和"是脉病发生发展的初始阶段.论述从以下方面进行:首先,结合《黄帝内经》相关条文,拓展"毛脉合精"理论内涵,论证了其结构应包括皮毛、腠理、分肉、三焦等,功能应包含通行营卫、津液和调、津血渗化等核心内容;其次,在"毛脉合精"基础上结合玄府学说,论证了玄府通利是"毛脉合精"的重要条件;最后,探讨在"毛脉失和"的影响下,脉病痰瘀证之痰浊、痰结、痰瘀病机演变过程,为继承和发展中医脉病理论提供新的思路.     

李军教授从痰瘀论治眩晕经验浅谈

痰浊与瘀血皆为气血津液代谢异常而致,在生理上津血同源,在病理上痰瘀交结,变化多端。李军教授认为痰瘀为眩晕的基础病机,在辨证时,要识别痰瘀的主要特征,辨明痰瘀的主次轻重、兼夹证候,在其治疗中应重视从痰瘀论治。     

心与津液代谢

津液是人体正常体液的总称.津液代谢即津液生成、布散以及废浊之物排泄的全过程.传统理论论述津液代谢与脏腑关系时多涉及肺脾.肾、膀胱、大肠、小肠、三焦,少论及心.我们认为:心具有协调津液代谢过程中各脏腑密切协同的作用;在津液生成过程中,心主血合脉,在液为汗,津血同源,汗血同源,心与小肠表里,心直接参与、主导汗液生成,津血互生互化;在津液运行上,心行血亦能行津;在泄浊中,心在液为汗,肺主腠理开合,在尿液的排泄中,心行君主之令,肾司开合.心还直接关系水湿痰饮瘀血的生成、兼挟,心不行血可致津停化水、成饮、成痰,津停血瘀,血瘀津停,终致痰瘀互结.津液代谢失调的治疗应该考虑到心.     

从痰瘀论治骨性关节炎

骨性关节炎属于中医“痹证”、“骨痹”的范畴,以正气不足为本,痰瘀互结为标。痰浊、瘀血作为致病因子和病理产物,二者又可相互转化、相互胶结,在临床上常化痰祛瘀同治。因此,痰瘀相关学说及痰瘀互结、痹阻经络在骨性关节炎发病中的地位和作用逐渐受到学者的关注,下面就痰瘀与骨性关节炎的关系做一探讨。     

痰瘀相关学说与络病

络病多以络脉损伤为基础,气血瘀阻为特征,脏腑功能失调为临床表现。其基本病理变化多是络脉郁滞,并伴有痰、湿、瘀、毒等病邪的聚集。络脉是络病的中心环节,痰瘀互结是络脉损伤的基本演变过程。任何原因导致的络脉损伤均可引起气血运行障碍,从而加重痰浊、瘀血痹阻,二者相互影响,相互促进。     

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.     

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.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.