Professor Jun Li Treating Vascular Dementia from Mutual Conclusion of Phlegm and Blood Stasis

Professor Jun Li believes that the main etiology and pathogenesis of vascular dementia is the combination of phlegm and blood stasis.The symptoms include feeling faint and declined senses in organs of the head,caused by mystery reason.To cure phlegm and blood stasis simultaneously,the therapy promotes the notion of“resolving phlegm and stimulating the circulation of blood,liberate brain orifices,”and treatments with the addition and removal of“Naotaitong Decoction,”which has an amazing clinical curative effect.This paper examines Professor Jun Li’s theoretical foundations and ideas from the syndrome differentiation and treatment of phlegm and blood stasis,systematically examines the curative effect and mechanism of Naotaitong Decoction in the treatment of vascular dementia,and examines the prescription and medication of typical cases for readers,in the hopes of providing guidance to clinical diagnosis and treatment of this disease.

舌诊在慢性肝病中的应用刍议

舌诊作为中医特色诊法之一,在肝病的诊治与预防中具有重要意义。慢性肝病患者在不同的病理阶段有不同的舌象改变。舌色可反映肝病轻重缓急,如缓解期多见淡红舌,发作期多见红绛舌,而严重肝病多见青紫舌;舌形可反映肝病形气神,其中长条舌、圆柱舌是慢性肝病的常见舌形,舌缘肿大或者肝积舌多代表慢性肝病中的占位性病变;舌苔与肝病轻重及疾病预后有关,还可辅助诊断慢性肝病的细菌感染情况。此外,舌象在慢性肝病的临床用药指导中也具有重要意义,可多方面、多角度指导临床。

Diagnostic Accuracy of Chinese Medicine Diagnosis Scale of Phlegm and Blood Stasis Syndrome in Coronary Heart Disease: A Study Protocol

Background Phlegm and blood stasis syndrome(PBSS) is one of the main syndromes in coronary heart disease(CHD). Syndromes of Chinese medicine(CM) are lack of quantitative and easyimplementation diagnosis standards. To quantify and standardize the diagnosis of PBSS, scales are usually applied. Objective: To evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. Methods: Six hundred patients with stable angina pectoris of CHD, 300 in case group and 300 in control group, will be recruited from 5 hospitals across China. Diagnosis from 2 experts will be considered as the "gold standard". The study design consists of 2 phases: pilot test is used to evaluate the reliability and validity, and diagnostic test is used to assess the diagnostic accuracy of the scale, including sensitivity, specificity, likelihood ratio and area under the receiver operator characteristic(ROC) curve. Discussion: This study will evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. The consensus of 2 experts may not be ideal as a "gold standard", and itself still requires further study.(No. ChiCTR-OOC-15006599).

A Clinical Epidemiological Study of the Quantitative Diagnosis Scale of Blood Stasis Syndrome

Objective： To establish the diagnosis scale of blood stasis syndrome （BSS） and explore the idea and method of using scale to research the quantitative diagnosis of Chinese medicine （CM） syndrome. Methods： Combining the modern epidemiology, consulting the access of quality of life scale, and colligating multi-angle methods to make the scale. Results： The scale had relatively good reliability and validity and could be used to estimate the degree of stasis and analyse the curative effect. Conclusions： It was a reference for CM syndrome diagnosis that combines screening methods of scale entry with quantitative diagnosis to establish the quantitative diagnosis scale.

Objectified Study of Abdomen Diagnosis on Blood Stasis Syndrome

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不同系统疾病痰瘀互结证主要症状及特点探讨

目的 通过整理痰瘀相关证诊断标准的四诊信息,挖掘不同系统不同疾病痰瘀互结证的主要症状和相应特点,为构建普适性痰瘀互结证临床诊断标准提供基础。方法 系统检索中国期刊全文数据库(CNKI)、中文科技期刊数据库(CCD)、中国学术期刊数据库(CSPD)与中国生物医学文献数据库(CBM)、《中医病证诊断疗效标准》等收录的痰瘀相关证的标准、指南、共识,开展痰瘀相关证四诊信息的整理和条目筛选。检索日期为建库以来2021年10月1日。结果 最终纳入包含痰瘀相关证诊断标准的文献208篇。其中,病证结合类诊断标准文献共174篇,包含呼吸、循环、神经等九大系统,共计68种疾病。将其按照不同系统疾病进行分类,结果提示虽同为痰瘀互结证,但不同系统痰瘀互结证的临床症状与所涉疾病的病变特点差异较大,而局部肿块、疼痛、麻木在多系统疾病痰瘀互结证的临床表现上具有一致性,且舌脉一致性高。结论 痰瘀互结证是许多重大疾病尤其是慢性非传染性疾病的常见证候。其中,痰瘀互结证在不同系统疾病中,局部肿块、疼痛、麻木、舌脉等临床症状和体征一致性高,可以作为构建普适性痰瘀互结证诊断标准的基础。

张彬教授防治脑卒中学术思想初探

张彬教授长期致力于中医脑卒中临床,中医理论基础扎实,临床诊疗经验丰富,善于运用辨证理论治疗脑病科常见病、多发病;重视舌诊应用,提出运用四诊合参进行证候要素分析;察微审末,善于抓主症,秉“但见一症便是,不必悉具之”原则;重视痰瘀致病的治疗方法及中医经典,重视扶正固本、调整阴阳气血脏腑平衡,善用传统理论配伍中药膏方,临床疗效颇佳。

气虚血瘀证小鼠模型拓展望诊指标的应用与评价

目的 以气虚血瘀证为代表,探索拓展望诊指标,为开展模型动物证候诊断的可行性提供依据。方法 将30只小鼠分为空白对照组、气虚血瘀组、中药反证组,每组10只。气虚血瘀组与中药反证组小鼠采用饥饿、疲劳、寒湿法进行造模,持续20 d;中药反证组自造模第3天开始每日予中药黄芪-莪术浓煎液灌胃,空白对照组和气虚血瘀组同期每日予相同容积蒸馏水灌胃,连续18 d。持续观测小鼠一般状态和体质量变化;于造模结束后检测粪便含水率、觅食欲,并通过避风实验、机械痛阈、旷场实验观察各组小鼠行为特点,拍照并利用图片分析软件对小鼠舌色进行分析。结果 与空白对照组比较,气虚血瘀组与中药反证组体质量低(P<0.01);避风实验中,2、3区域停留时间短、跨域次数少(P<0.01);旷场实验中,总路程短、平均速度低、跨格次数少、静止时间长(P<0.01);舌色R、G、B值均低(P<0.01)。与气虚血瘀组比较,中药反证组体质量高(P<0.01);避风实验中,2、3区域停留时间长、跨域次数多(P<0.01);旷场实验中,总路程长、平均速度高、跨格次数多、静止时间短(P<0.01);舌色R、G、B值均高(P<0.05)。气虚血瘀组、中药反证组机械痛阈均低于空白对照组(P<0.01),2组间差异无统计学意义(P>0.05);气虚血瘀组、中药反证组粪便颗粒稀软、易夹断,含水率高于空白对照组(P<0.01),2组间差异有统计学意义(P<0.05)。结论 避风实验和机械痛阈指标,以及旷场实验、粪便含水率和舌色检测指标,可作为诊断小鼠气虚血瘀证的拓展望诊指标,而觅食欲不可作为其有效指标。

齐元富辨治甲状腺癌术后经验

齐元富教授认为甲状腺癌为本虚标实之病,是在人体正气不固、邪毒结聚的基础上,由颈前气滞、痰凝、血瘀日久而导致。齐教授临证总结出甲状腺癌术后常见的四种证型:肝郁气滞证、痰湿结聚证、痰瘀互结证、气阴两虚证。分别以疏肝行气、健脾化痰、散瘀解毒、益气养阴法治之,处方分别选择逍遥散、参苓白术散、消瘰丸、生脉散加减。附验案一则。

浅析痰瘀互结证治及诊治心脑血管疾病的应用

痰瘀互结证可归属于中医学津血同病的主要证型中,其理论形成与发展经历了相当漫长的历史演变过程。《黄帝内经》就已有“痰浊”“瘀血”“积证”等相关论述,后经过历朝历代医家不断阐明并发挥,至清朝已逐步发展完备,现在已作为中医学说的主要构成部分,应用于临证施治。痰瘀互结证治理论目前已被广泛应用于辨治各种临床疑难杂症,尤其多见于心脑血管疾病中。痰浊、瘀血原本作为独立的证候要素与病理产物,但在疾病的发生与转归中相互胶结,进一步加大疾病诊治难度。目前,痰瘀互结证相关证治研究已受到普遍关注。作者总结归纳痰瘀互结证的理论源流、病因病机及现代医学研究、临床论治,以期为临床诊治提供参考。

Diagnostic Indicators for Blood Stasis Syndrome Patients with Gynaecological Diseases

Objective： To investigate the important diagnostic indicators for blood stasis syndrome （BSS） in patients of childbearing age with gynaecological diseases. Methods： A partial least squared-discriminant analysis （PLS-DA） were applied to BSS symptoms data of patients with gynaecological diseases, and the diagnostic indicators used by doctors of Korean medicine （DKMs） among BSS patients with gynaecological diseases were also investigated. Results： A total of 103 patients of childbearing age with gynaecological diseases and 40 healthy controls were enrolled. Among the 103 patients, 63 （61.7%） and 40 （38.8%） were diagnosed with BSS and non-BSS, respectively, and BSS patients exhibited a more severe extent of disease. A score plot of PLS-DA showed clearly different patterns among the 3 groups. Based on the variable importance on projection of PLS-DA model, menstrual pains, dark lumps in the menstrual blood, ileocoecal tenderness and resistance, sharp pains, and sublingual varicosities were selected as the top five most important indicators. Moreover, more than 75% of DKMs chose dark lumps in menstrual blood, menstrual pain, and dark menstrual blood as the diagnostic indicators of BSS in patients with gynaecological diseases, and more than 49% of them also considered sharp pains, dark red tongue, sublingual varicosities, and tendency to bruise easily as diagnostic indicators of BSS. Conclusion： DKMs focused on menstrual symptoms and certain gynaecological symptoms to diagnose BSS patients of childbearing age with female diseases.

浅析温经汤加减治疗寒凝血瘀型抑郁症

抑郁症是一种常见精神疾病。其临床表现涉及感知、思维、情感、认知、行为等多方面异常,患者经常表现兴趣缺乏、不愿交往、情绪低落、悲观绝望……抑郁症在中医大多被归属于“郁证”范畴,目前中医临床上多从肝气郁结、气郁化火、痰气郁结、心神失养、心脾两虚、心肾阴虚等证型施治。此病具有高复发率、高致残率、高自杀率的特点,严重危害患者的身心健康,威胁家庭幸福。山西省中西医结合医院经典扶阳科赵杰教授临床运用经方治疗抑郁症和疑难病证方面有着独到的认识和丰富的实践经验,深明仲景医理、方术要旨,极为重视阳气在人体生命中的重要作用。秉承“阳虚致郁”之疾病观,重视脉诊,洞悉病机变化,临证加减化裁,古方今用,异病同治。赵杰教授着重强调平脉辨证,法随证变,方随法调,用药少而精,临床疗效显著,治愈率高且不良反应少,可明显减轻患者的躯体不适症状,提高患者的生活质量。他临证应用“温经汤”加减治疗寒凝血瘀型抑郁症取得了良好效果。文章结合案例,重点介绍了赵杰教授治疗寒凝血瘀型抑郁症的经验,为临床拓展新思路。

Recognition of Association Between Blood Stasis Syndrome and Traumatic Injury among Doctors of Korean Medicine:A Cross-Sectional Observation Study

Objective： To investigate the diagnostic indicators and herbal treatments for blood stasis syndrome（BSS） patients with traumatic injuries and to identify the association between BSS and traumatic injury in Korea. Methods： Two-hundred and four patients with traumatic injury were recruited from the Gangnam and Daejeon branches of Jaseng Hospital of Oriental Medicine between June 2014 and December 2014. Two independent doctors of Korean medicine（DKMs） determined the diagnosis of BSS or non-BSS based on the subjects＇ signs and symptoms. The scores assigned to BSS symptoms and DKMs＇ reasons for diagnosing BSS in patients with traumatic injury were investigated. Both medication and herbal prescription records from a 3-month period were collected for all patients diagnosed with BSS by both DKMs. Results： A total of 169 of 204（82.8%） patients received consistent diagnosis related to BSS by two DKMs. Among them, 54.4%（92 cases） were diagnosed with BSS, and 45.6%（77 cases） were not diagnosed with BSS. DKMs most frequently cited symptoms of recent traumatic injury as justifications for BSS diagnoses, and also selected pain-related indicators such as abdominal pain, sharp pain and nocturnal pain as important reasons in diagnosing BSS. In addition, an inconsistency in the pattern identification theory with respect to traumatic injury was observed. Although only 92 cases（54.4%） of patients were diagnosed with BSS, 77.6% of them were prescribed decoctions for BSS. Conclusions： DKMs considered traumatic injury could cause BSS, and utilized decoction for BSS in patients with traumatic injury without confirming a diagnosis of BSS because they assumed the main symptoms or pathologies of traumatic injury to be closely related to BSS.

建立急性缺血性中风气虚血瘀证诊断标准的方法学探讨

为探讨建立中风病证候诊断标准的方法 ,观察了 10 6例急性缺血性中风气虚血瘀证患者 ,对其证候指标 :舌、脉、症状进行了可靠性分析、主成分分析和聚类分析。根据统计分析结果并结合临床实际 ,初步提出急性期缺血性中风气虚血瘀证的诊断标准 ,包括辨病和辨证两个方面。辨病可见半身不遂、口舌歪斜、舌强语蹇或不语 ,CT检查符合缺血性中风改变 ;辨证必须有肢体瘫软、倦怠嗜卧、口唇紫暗 ,脉沉细等主症 ,并可兼见头痛而痛处不移、汗出、心悸、乏力、面色白 ,大便溏或二便自遗、舌背脉络瘀胀青紫或舌紫暗等次要症状。

血瘀证量化诊断及病证结合研究

目的 探讨血瘀证量化诊断的方法和血瘀证证候实质。方法 对临床预试验血瘀证症状体征及客观指标进行t检验和回归分析。结果 ( 1) 182例血瘀证与非血瘀证患者内皮素、一氧化氮、纤溶酶原激活物 t检验均有显著性差异。 ( 2 ) 170例血瘀证与非血瘀证患者血红蛋白、甘油三酯、总胆固醇、内皮素、一氧化氮、纤溶酶原激活物 6因素的逐步回归显示其贡献度的顺序为内皮素 >血红蛋白 >纤溶酶原激活物 >一氧化氮 ,甘油三酯及总胆固醇未能入选。 ( 3)对 6 0 1例患者血瘀证症状体征 4 0因素逐步回归分析 ,当F =6时选出的 18因素对血瘀证诊断贡献度最大 ,并得一回归方程。将数量化资料代入回归方程进行检验 ,总符合率为 94 .2 4 %。结论 通过多中心、前瞻性、大规模、随机对照的临床流行病学调查和临床试验 ,可以得出病证结合规范且量化的由症状、体征和客观指标构成的标准化中医证候。

血栓相关分子标志物在糖尿病血瘀证中的临床意义

以血浆α-颗粒膜蛋白(GMP—140)、组织型纤溶酶原激活剂(tPA)、纤溶酶原激活物抑制剂(PAI-Ⅰ)、凝血酶-抗凝血酶Ⅲ复合物(TAT)和血浆纤溶酶-α_2抗纤溶酶抑制物(PAP)、内皮素(ET)等血栓前状态分子标志物,探讨与糖尿病血瘀证的相关性。结果显示,糖尿病血瘀证患者存在着血小板活化、内皮细胞受损、纤溶酶的改变,其血MGMP—140、TAT、PAP、ET均高于非血瘀证和正常对照组。提示血小板活化、内皮细胞受损、凝血/纤溶平衡的改变有利于血瘀证的发生。糖尿病血瘀证的病理生理机制与血小板、内皮细胞、凝血、纤溶等改变皆有关。

糖尿病周围神经病变血瘀证的客观化研究

目的:探讨糖尿病周围神经病变(DPN)中医血瘀证的相关检验及对证候客观化的意义。方法:分DPN属血瘀证者(组),DPN非血瘀证者(组),无并发症、非血瘀证的糖尿病患者(组),正常组(组)4组进行观察。对、、组进行糖尿病其他血管并发症、中医症状、舌象、脉象观察,各组均进行血糖、糖化血红蛋白、血液动力学、甲襞微循环、血脂及眼底镜检查,将结果进行对照。结果:DPN血瘀证者多合并其他血管并发症,临床表现以麻木(86.1%),舌质暗(100%)、淡(80.6%)最多见,血液动力学、甲襞微循环、血脂指标及眼底异常率均高于其他组,组间比较差异有显著性(P<0.05或P<0.01)。结论:DPN血瘀证与血液动力学、甲襞微循环、血脂异常及眼底改变关系最为密切。

气滞血瘀与气虚血瘀辨证微观指标的观察分析

临床观察表明气滞血瘀和气虚血瘀两证在面、舌、甲、脉诊上各有一定的证候特征。面部血流图、舌甲微循环、脉图及心血管功能检测结果,两组病人除具有C/HS、h_4/h_1、RT增高,微循环红细胞聚集、瘀阻,流速减慢等“血瘀”共性之外,气滞血瘀病人出现HD、α/[α+β]、h_3/h_1、w/t等明显升高,AC降低,微血管襻痉挛,絮状血流等血液周围血管异常的现象,提示正常心输出量、高外周阻力是气滞血瘀证的病生特征;而气虚血瘀患者多有HS、HS/α[t_4—t_1]/t、t_1/t及反映心脏功能的4项指标(SV、CO、SI、CI)都明显低下,微血管襻短小、模糊、充盈度差等心功能减退,血液灌注不良的现象,提示低心泵、低心输出量是气虚血瘀证的病生特征。

肝病血瘀证与肝功能肝纤维化标志物的关系

测定３０例肝病血瘀证、３２例非血瘀证患者及２０例正常人肝功能和血清ＰＣⅢ、ＬＮ、ＨＡ含量。结果显示ＨＢＶ感染复制标志血瘀证与非血瘀证均表现较高的阳性率，两者比较无差异。Ｔ－ＢＩＬ升高及Ａ／Ｇ降低，血瘀证患者显著高于非血瘀证（Ｐ＜０．０５～０．０１）。血瘀证患者血清ＨＡ、ＬＮ含量明显高于非血瘀证患者及正常人，后两者无显著差异；ＰＣⅢ虽有上述变化趋势，但无统计学意义。提示：ＡＬＧ下降或倒置及血清ＨＡ、ＬＮ的含量。

运用循证医学对血瘀证诊断标准研究文献的评价

[目的]运用循证医学对血瘀证诊断标准研究文献的评价。[方法]参照循证医学及临床流行病学中有关诊断性试验的评价标准,拟定文献评价观察表。评价内容:包括研究文献的设计方案、样本的筛检、样本含量的估算、对照组的设立、随机化方法、盲法、诊断性试验的评价指标等。[结果]所有研究文献均没有设立标准诊断方法作为对照,对结果的判断均没有采用盲法,所提供的诊断性指标(敏感度、特异度、似然比等)不全面,对偏倚的控制没有描述等,采用同一血瘀证诊断标准的研究文献,其所得结论不完全相同,各研究文献所得结论与其所采用的诊断标准不完全吻合,也没有阐述血瘀证诊断标准指标数增减的理由。[结论]提示目前所使用的血瘀证诊断标准可能存在某些不足,有待进一步研究和完善;同时,各研究文献所得结论的差异,也有待进一步研究证实。