八纲辨证、六经辨证、卫气营血辨证联合辨治肾病

正中医辨证一直处于多元化,有纲领性的八纲辨证,有伤寒六经辨证、温病的卫气营血辨证、三焦辨证、内伤病的脏腑辨证,还有后来兴起的奇经辨证等。疾病千变万化,现代一些医家发现单纯的一种思路很难适应复杂疑难病的辨治,转而在统一性上下功夫,希望做到整体辨证,但是到现在为止还缺乏一个完整的思路,而笔者有意在肾病方面做一尝试,以六经为纲,结合温病、八纲理论辨治肾病。1肾相关生理肾病的发生与肺、脾、肾、三焦关系密切,三焦尤其重要,     

从六经辨治消渴病的思考

通过《伤寒论》中六经辨证的经典条文,结合《黄帝内经》脏腑经络理论,以及后世医家相关文献,论述六经及脏腑经络在消渴病发生发展过程中的证治规律。采用先辨六经,再辨脏腑,并将具有极高效验的经方与之紧密结合,进一步丰富消渴病的辨治内容。     

朱章志“首辨阴阳,再辨六经”论治糖尿病思路探讨

朱章志教授认为中医辨治糖尿病(DM)时不应拘泥于以往气阴两虚的简单分型,而应遵"首辨阴阳,再辨六经"的辨证纲领。朱教授根据六经辨证变化的规律,进一步将DM证型分为阳证三型和阴证四型,分别包括"阳明肺胃热盛,兼气阴两伤证"、"瘀热互结,兼气阴两伤证"、"少阳失枢,胆火内郁证",以及"太阴—阳明虚寒证"、"少阴阳虚寒湿证"、"少阴阴虚证"、"厥阴经脏虚寒证"。临床上朱教授立足"首辨阴阳,再辨六经"治疗DM,针对不同证型采用经方灵活论治,取得良好疗效,可为临床提高DM疗效提供思路。     

关于学习伤寒论辨六经病脉证并治八篇以外的一些意见——中医经典著作学习讲座(四)

引言伤寒论的主要内容是辨六经病脉证并治八篇,但这并不是说除了六经八篇以外就不需要学习了。伤寒论除了讨论六经证治八篇以外,还有那些东西呢?不妨再重复一次把书中的材料写在下面: 1.辨脉法和平脉法 2.伤寒例 3.辨痉湿喝脉证 4.辨霍乱病脉证并治 5.辨阴阳易差病脉证并治 6.辨汗吐下三法可不可这些内容,过去有许多学者认为不完全是张仲景原著中的材料,而有许多是晋王叔和在撰次伤寒论时根据自己的意见纂集和补充进去     

痰饮六经辨治初探

仲景在辨治杂病过程中,尽管强调脏腑经络,却在具体病证辨治中也潜涵六经辨治的思路。从六经角度出发,抓住六经的生理特点及基本病理改变,将痰饮所出现的复杂证候按六经辨治,相应治疗痰饮的方子也依六经归类。不仅在理论上加深了对痰饮的认识,更对临床辨证论治有一定的指导意义,为错综复杂的痰饮辨治开拓了一条清晰的思路。临床中以复杂证候为主诉的痰饮,须运用六经辨证辨明部位和性质,确立治法。在辨治痰饮时,要重视证治,而不拘泥于"六经",拓宽了痰饮的辨证方法,丰富了痰饮的治疗手段,并可直接指导临床用药,具有较高的探究价值和广阔的发展前景。     

论经方在辨治胃脘痛中的应用

以胃脘痛的成因、临床表现和《伤寒论》、《金匮要略》中有关内容为依据。结合现今医家运用经方治疗胃腕痛的实践经验,较深入地探讨了经方在辨治胃脘痛中的应用,分作肝胃气滞、瘀阻胃络等10个类型。详析其因机证治和临床运用,认为经方在辨治胃脘痛中应用广泛,疗效卓著,值得进一步推广应用与开发研究,并强调指出运用经方辨治胃脘痛应注重辨证施治、防止药物弊端、药疗调养并重,以提高疗效,防止病情复发。     

关于学习伤寒论辨六经病脉证并治八篇的一些意见——中医经典著作学习讲座(三)

第四题六经治法及方药一、辨六经病脉证并治八篇提出的治疗原则伤寒论辨六经病八篇是全书精华所在,其中所论述的虽然以“伤寒”为主要对象,而对一般疾病特别是多种急性热病在发展变化中的认识和处理具有普遍性的意义。在这八篇的原文中可以体会到一些重要的治病原则,这些原则适用於“伤寒”,也适用於多种其他疾病,现在来谈谈这些原则。 1.先辨证后施治:六经八篇每篇的标题如“辨太阳病脉证并治”等等,已经明显地指出在     

仲景经方在溃疡性结肠炎治疗中的辨证运用及探析

对仲景经方如何辨治溃疡性结肠炎的方法加以总结和探析,提出溃疡性结肠炎的中医辨证分型及其相应经方的选用原则,对提高经方治疗溃疡性结肠炎的疗效颇有临床参考价值.     

从经方天行病治法探讨新型冠状病毒肺炎辨治思路

[目的]总结经方治疗天行病的治法,探讨经方分期辨治新型冠状病毒肺炎(以下简称新冠肺炎)的思路。[方法]通过文献研究,总结《伤寒论》《金匮要略》及《备急千金要方》《外台秘要》等诸家经方论著之相关方药,提炼新冠肺炎经方四期辨治思路,并结合临床案例进行分析。[结果]经方辨治天行病以“解肌-涌泄”二法为主线。结合新冠肺炎“湿疫”的病证特点、寒湿蕴热的病机特点及经方治疗湿病的六经辨治规律,提出新冠肺炎“涌泄为主,兼及六经”的治疗原则及分期辨治规律。新冠肺炎分期治法规律及代表方:初期(太阳层面)应以散寒解肌、涌泄湿毒为法;典型期(阳明层面)应以酸苦涌泄、泻火解毒为法;重症期(少阳层面、厥阴层面)应分别以疏利三焦、涌泄通腑及凉血解毒、涌泄开窍为法;恢复期余邪未净、津亏胃弱,以甘凉养益、兼透余邪为法。所附两则典型期(阳明层面)医案经治疗转入恢复期(湿热未净),分别使用百痛壮热方和增损栀子豉汤,另一则为恢复期(余热未清)医案,使用竹叶石膏加生姜汤,都取得了良好疗效,验证了新冠肺炎的证候特点、治法及转归符合前述规律。[结论]经方对天行病的认识和治疗方药,可为新冠肺炎的防治研究提供文献与理论支持。     

浅谈寒温统一

温病学与伤寒学在学术上一脉相承,不可分割.虽然六经、卫气营血、三焦等名目,以及它们所归纳的证侯类型各不相同,但它们都是基于机体抗病强弱和病情进退轻重运用八纲制定的,同时它们之间还有由表及、由寒化热、由实致虚的一般规律.本文通过对寒温辨治体系的辨证、论治规律简要说明寒温的统一性.     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.