乳腺癌术后患者中医辨证分型的统计分析研究

中医学作为一门经验科学,有其自身一整套完整的理论体系.辨证论治是中医学的诊疗基础,而证候又是辨证论治的前提和基础.

辨证治疗先兆流产、习惯性流产90例临床观察

先兆流产及习惯性流产是妊娠病中的多发病及常见病,先兆流产即指妊娠28周以前阴道少量出血或伴有小腹隐痛,子宫口未开、羊膜囊未破,子宫大小与妊娠月份相符,妊娠试验阳性,有继续妊娠的希望.中医称为"胎漏"、"胎动不安".习惯性流产指自然流产连续发生3次或3次以上者,习惯性流产往往发生在同一孕期,其临床特征与一般流产相同,中医称为"滑胎"、"堕胎".二者病因比较复杂.近几年临床报道各种阴道炎及性病均可导致流产及早产.笔者用中医辨证分型法治疗此病,取得满意的疗效,现报道如下.

Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri-operative stage of coronary artery bypass graft (CABG). Methods: One week after operation, thirty-seven CHD patients, who received CABG of internal mammary artery or great saphena vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, with the pre- or post-operational EKG, color Doppler echocardiography were done during and after operation. The hemodynamic parameters were monitored. Results: In the CHD patients, 64.9% were differentiated as Qi-Yin deficiency, 67.6% were complicated with phlegm syndrome and 62.2% with blood stasis, suggesting that Qi-deficiency, phlegm and stasis are the basic pathogenetic factors in patients with CABG. Moreover, the peri-operative syndrome was correlated with the condition of coronary artery lesion, heart and lung functions before operation, and the extracorporeal circulation time during the operation. Conclusion: TCM SD conducting in peri-operative stage might be useful in exploring the patterns of syndrome alteration which provided a basis for preventing peri-operative complications and elevating success rate of operation.

Objective: To evaluate the efficacy of acupuncture in treating chronic non-specific low back pain. Methods: Ten patients with chronic low back pain were selected to receive 9 acupuncture treatments over a three-week period with point selection based on syndrome differentiation in Chinese medicine. The BROM Instrument for assessment of back range of motion; subjective evaluation with Visual Analog Scale of Pain (VASP) ratings, Oswestry Disability ratings, objective measurements including Algometry, and Flexion and Extension ratings to investigate the range of motion were used for comparing the large, medium and small effect sizes of baseline, treatment and follow-up phases. Results: Clinical significance of pain relief was shown in all parameters assessed. A large effect size was detected in VASP, Oswestry and Algometry. A small effect size was demonstrated in Flexion/Extension. Needling over short period time (3 weeks) could relieve the pain, but the muscular-skeletal function measured by BROM persists. To treat patients exclusively by needling for statistical purposes can not be justified, because by merely relieving pain, permanent improvement in function may not be achieved. Conclusion: Acupuncture offers an effective alternative for the clinical management of chronic low back pain, significant improvement in most of the parameters evaluated, but the functional improvement was not as satisfactory as pain relieving. Further study with larger sample size focuses on long-term efficacy and functional improvement for chronic low back pain is recommended.

Objective: To explore the clinical efficacy of Chinese and western integrative medicine (TCM-WM) in treating repeatedly recurrent chronic pyelonephritis (CPN) and its therapeutic mechanism. Methods: Ninety-one repeatedly recurrent CPN patients were randomly divided into 2 groups, the control group (45 cases) treated with sufficient amount of sensitive antibiotics and other WM, the treated group (46 cases) treated with above-mentioned WM complemented with TCM syndrome differentiation (SD). Results: In the treated group completely cured was 14 cases (30.4%), markedly effective 14 cases (30.4%), the total effective rate was 91.3%; while that of the control group was 4 (8.9%), 5 (11.1%), and 48.9% respectively, (P<0.05) and (P<0.01); the mean days of urinary bacteria and urinary routine negative conversion were in the treated group 19.6±12.6 days and 24.3±11.5 days, obviously shorter than those of the control group (35.6±14.6 days and 53.6±16.4 days), P<0.01; the various symptoms of the treated group improved or disappeared in a short time, while in the control group a few patients improved in a longer period (P<0.01); the various immune parameters improved in the treated group, while in the control group only IgA was elevated to some extent (P<0.05), in comparing these data, the difference was significant (P<0.01). Conclusion: The TCM-WM integrative treatment could obviously raise the clinical efficacy, accelerate the symptom improvement, and enhance the immune function.

Objective: To explore the diagnostic and therapeutic approach of integrated traditional Chinese and western medicine (TCM-WM) on infectious multiple organs dysfunction syndrome/multiple system and organ failure (MODS/MSOF) for elevating the successful rate of rescuing the patients. Methods: Diagnosis with western medicine and Syndrome Differentiation of TCM in 225 in-patients of acute infectious disease complicated with MODS/MSOF were conducted, and TCM treatment, based on western medical comprehensive treatment, was given to observe the effect and explore the mechanism of the TCM-WM therapy. Results: Up to the end of 1998, 161 cases of the 225 cases were successfully cured and 64 died, the mortality being 28.4%. Among them, 58 out of 140 cases of MSOF died, the mortality was accounted for 41.4%. In 106 cases conformed to the diagnostic criteria of MSOF proposed by Professor Knaus WA, USA, 52 cases were cured successfully and 54 died, the mortality being 50.94%. Conclusion:TCM-WM treatment could elevate the therapeutic effect in treating MODS, the mechanism might be through improving the hemodynamic and hemorrheologic condition of patients to relieve nail-fold microcirculation disorder; influencing the levels of cytokine and inflammatory mediator, so as to alleviate the systemic inflammatory reaction, it might also abate the inhibited condition of gastro-intestinal motility, alleviate the intestinal flora imbalance, prevent intestinal bacteria and endotoxin malposition, and protect cells from peroxidation.

Objective:To find the relationship between insulin-resistance and Syndrome Differentiation type (SDT) in hypertensive patients.Methods: Two hundred and nine patients of early stage hypertention with no complications of heart, brain or kidney were selected and classified into 4 types according to SDT, the Liver-Fire exuberant type (A), the Phlegm-Dampness abundant type (B), the Yin-Deficiency and Yang-Excess type (C) and the Deficiency of both Yin and Yang type (D). Their insulin sensitivity was examined and compared with that of 40 healthy subjects.Results:(1) Compared with the healthy subjects, all hypertensive patients had apparent insulin resistance (P<0.05).If the insulin sensitivity of healthy subjects was defined as 1.00, that of patients of type A, B, C and D were 0.54, 0.58, 0.65 and 0.80 respectively. (2) The insulin sensitivity of patients in the 4 SDT groups were compared and no significant difference was found in comparison between group A, B and C, while significant difference was found when the other three groups were compared with group D (P<0.05), the insulin sensitivity of type D was close to that of the healthy subjects. (3) The fasting blood insulin of type D was obviously lower and the insulin sensitivity of type D was obviously higher than that of the other three types as a whole (P=0.0001). (4) Multivariate regression analysis demonstrated that insulin sensitivity was closely correlated with SDT (P=0.0001). Conclusion: Insulin resistance is one of the pathological basis for SDT in hypertension.

To explore the relationship between the liver fibrosis criteria and TCM Syndrome type in patients suffering from non-alcoholic fatty liver. Methods: Seventy-nine patients with non-alcoholic fatty liver diagnosed by B ultrasonography were classified by TCM Syndrome Differentiation and their liver fibrosis criteria was determined and compared with those of the healthy subjects as control. Results: Levels of procollagen Ⅲ (PCⅢ), hyaluronic acid (HA), collagen Ⅳ(CⅣ) and laminin (LN) in the fatty liver group were significantly higher than those in the control group (P＜0.05, P＜0.01). In respect to the TCM Syndrome-types, PCⅢ, CⅣ and LN in patients of Phlegm-stasis combined type were significantly higher than those in patients of Spleen deficiency-Phlegm dampness Syndrome-type and Damp-Heat Syndrome-type (P＜0.05, P＜0.01), while HA in different groups was insignificantly different (P＞0.05). Conclusion: There was trend of liver fibrosis in fatty liver patients. It was indicated that the Phlegm-stasis combined Syndrome-type possibly was the main TCM pathologic factor of the increasing of fibrosis criteria for non-alcoholic fatty liver.

　　Psoriasis is a kind of chronic relaptic skin disease, and at present there are no appropriate therapeutical methods. From March 1998 to May 1999, we used the traditional Chinese and western medicine (TCM-WM) approach in treating this disease, and satisfactory result was obtained. We clinically observed this method in treating psoriasis, with hemorrheological examinations performed, and it is reported as follows.METHODSDiagnostic Standard　　According to the diagnosis standard in “Modern Dermatology” (chiefly edited by YANG Guo-liang, WANG Xia-sheng. Shanghai: Shanghai Medical University Press, 1996∶513-514), the patients were confirmed to suffer from psoriasis vulgaris; and according to TCM syndrome differentiation as blood stasis type.

　　Thirty-five patients of infantile purpura nephritis (IPN) were treated with integrated traditional Chinese and western medicine (TCM-WM) from January 1994 to December 1998, with good efficacy obtained, and following is the report.METHODSClinical Data　　All the 65 cases were inpatients, and conformed to the “Standards of the Diagnosis and Therapeutical Effect of Hematological Diseases” (edited by ZHANG Zhi-nan. Tianjin: Tianjin Science and Technology Press, 1999∶235-239). They were randomly divided into two groups: Treated group: 35 cases, 23 males, 12 females; aged 4-13 years, 7 years on average; disease course 4-18 days, the mean 10 days; mild type 19 cases (asymptomatic hematuria, proteinuria), nephritis syndrome type 13 cases (hematuria, proteinuria, edema, hypertension), and nephrotic syndrome type 3 cases (typical manifestation of nephrosis complicated with renal insufficiency). Control group: 30 cases, 20 males, 10 females; aged 3-14 years, 6 years on average; disease course 3-16 days, the mean 9 days; mild type 16 cases, nephritis syndrome type 10 cases, nephrotic syndrome type 4 cases. The clinical manifestation, sex, age, hospitalisation time of these 2 groups showed insignificant difference.Method of Treatment　　The control group: Adopting intravenous dripping of dexamethasone 0.3-0.5 mg*kg-1*d-1, consecutively for 5-7 days, which was then shifted to prednisone 1-1.5 mg*kg-1*d-1, altogether 2-3 weeks, with Vit C, persantin, chlorphenamine, calcium, etc., orally taken.　　The treated (TCM-WM) group, on the basis of the above-mentioned WM treatment, had also TCM syndrome differentiation performed, and were classified into 3 types:

In recent ten-odd years the pathogenetic regulation of female idiopathic precocious puberty was studied in our hospital, in terms of the function of hypothalamic-pituitary-gonadal axis (HPG axis) and the status of skeletal development as indicators. The therapy with Chinese herbal medicine (CHM) in predominance was formulated, according to our understanding of the regulation and Syndrome Differentiation of traditional Chinese medicine (TCM). It has been clinically verified that the therapy could successfully modulate the course of pubertal development and optimize skeletal development in children with precocious puberty. The mechanism of effectiveness of the drugs has been further studied focusing on the neuroendocrine regulation and gene expression with modern medical techniques.

康莱特注射液结合中医辨证对晚期肺癌生存质量及免疫功能的影响

康莱特注射液是浙江康莱特药业有限公司生产的抗肿瘤中药制剂,临床主要用于肺癌及消化道肿瘤的治疗.我科近年来应用康莱特注射液治疗晚期肺癌取得了一定的疗效,现将观察结果报告如下.

急性心肌梗死冠脉介入治疗前后中医辨证治疗思路与方法--附70例患者治疗分析

在对急性心肌梗死(AMI)的救治中,冠脉介入治疗有着不可替代的作用,在应用冠脉介入治疗手段干预的情况下,如何进行中医的辨证治疗是一个值得探讨的论题.作为率先在全国开展冠脉介入治疗的中医院,我们将近3年来在我院成功接受冠脉介入治疗和中医治疗的AMI患者的思路与方法总结于下.

There are three principles which need to be grasped in the clinical use of Chinese drugs in the treatment of hypertension: Combination of syndrome differentiation in TCM with disease-differentiation in western medicine; combination of the theory of TCM with the results of modern pharmacological researches; and combination of symptom improving, blood-pressure reducing with complications preventing measures.Use of Chinese Drugs Based on the Western Medical Stages of Hypertension Patients should be classified for clinical stages of hypertension according to western medical criteria before TCM treatment program is made. For instance, in hypertension patients, apart from high blood pressure, there may also be other symptoms such as headache, dizziness, distending sensation in the head, stiff sensation in the neck, dim eyesight, tinnitus, poor memory, inability to concentrate the mind, insomnia, disphoria, general weakness, numbness of the four limbs, and palpitation. In some patients, these symptoms may not always be directly related to hypertension. In these cases, treatment for reducing blood pressure may not be taken into consideration, and the treatment based on general differentiation of the symptoms may serve the purpose. Only after the differential use of Chinese drugs shows no obvious improvement of the symptoms and high blood pressure, the treatment will be aimed at hypertension per se. When Chinese drugs alone can not reduce blood pressure, western medicine is often used in combination to reduce blood pressure, blood lipids and uric acid, correct water-electrolyte metabolism, and improve blood rheology. The combined Chinese and western medical treatment can make up each other's deficiencies so as to give better therapeutic effects.

中医辨证治疗勃起功能障碍

勃起功能障碍(ED)是男科门诊常见病之一,中医称之为阳痿.笔者采用中医辨证施治,获得较好疗效,现将临床资料完整者72例报告如下.

Professor HAN Bi-ying is a chief doctor in the acupuncture department of Guang An Men Hospital of China Academy of Chinese Medical Science. She has been engaged in clinical practice for nearly 40 years and accumulated abundant clinical experience, especially in clinical syndrome differentiation. I am fortunate to follow professor HAN to practice acupuncture on weekends and learn from him. I now present her academic thoughts and clinical experience with proven cases for References.

《伤寒论》口渴辨治初探

在<伤寒论>中对"口渴"的称谓有很多,如"意欲饮水、渴、渴引浆水、饮水、燥渴、口燥咽干、欲饮水数升、舌上燥而渴、大渴、大烦渴、消渴"等等,都对口渴的轻重程度及其表现的不同性质特点作了描述.<伤寒论>中与口渴有关的条文多达50余条,其中以口渴为主症的条文就有33条,约占全书条文的十分之一,可见口渴在疾病过程中是比较常见的症状.

《伤寒论》的施治方法

<伤寒论>是我国第一部辨证论治的专书,其辨证准确、论治精当、施治方法完备.本文重点探讨了<伤寒论>的施治方法,将其归纳为药物法、针刺法、火法、水法、饮食法、静候调养法等六种.结合<伤寒论>原文对每种施治方法的具体内容进行了细致的探讨,既明确了每种施治方法的定义,又确定了其内容,更进一步阐述了其临床运用情况,为学习和运用<伤寒论>的施治方法提供了有益的资料和可靠的依据.

Traditional Chinese medicine nursing protocols for leukorrheal disease (pelvic inflammatory disease)

Leukorrheal disease is an ascending infection of the female genital tract,with high morbidity among reproductive age women.Antibiotics are usually used to treat leukorrheal disease in clinic,but they can lead to a variety of side effects if improper use or long-time use.In recent years,traditional Chinese medicine (TCM) has shown its unique advantages in the treatment of leukorrheal disease.This article mainly explored the key points of common syndromes,TCM nursing methods and health guidance of leukorrheal disease in order to further develop the advantages of TCM,improve its efficacy and standardized its nursing behavior.

Traditional Chinese Medicine Nursing Protocols for Diabetic Nephropathy

As a dreaded consequence of diabetes mellitus (DM),diabetic nephropathy (DN) accounts for about 40％ of end-stage renal disease (ESRD).It is a universal cause of ESRD,and can be considered as an independent risk factor for cardiovascular disease.In recent years,TCM has shown its unique advantages in the treatment of DN.As one of the chronic diseases caused by living styles,DN has the higher requirements for nursing.Nevertheless,TCM nursing based on syndrome differentiation can provide the personalized guidance for the patients with DN according to different syndrome patterns and symptoms.Therefore,this article mainly explored the key points of common syndromes,TCM nursing methods and health guidance of DN in order to further develop the advantages of TCM,improve its efficacy and standardized its nursing behavior.