黄丽娟教授从事临床、教学、科研工作40余年,在心血管疾病方面效验显著,特别是对慢性心力衰竭有独到的诊疗思路.黄丽娟教授认为,慢性心力衰竭基本病机是以气虚、阴虚、阳虚为本,痰湿、瘀血、水饮为标,病性多属虚实夹杂,以益气温阳、活血利水为基本治疗原则.治疗上主张衷中参西分期论治,将其分为早、中、晚、终末期,早期多为气虚血瘀证,治疗以生脉散合血府逐瘀汤加减益气活血;中期多为气阴两虚、心血瘀阻证,治疗以自拟强心1号方加减益气养阴、活血化瘀;晚期多为心脾肾阳气俱虚、血瘀水饮内停证,治疗以自拟强心2号方加减温阳利水、活血通脉;终末期多为气机逆乱、阴阳离决证.治疗以独参汤、四逆散加减回阳救逆、敛阴固脱.

冠心病是目前比较常见的疾病之一,具有较高的致死率,中医多认为其属于"心痛病".黄丽娟教授是国家级名老中医,根据患者不同时期病情虚实变化,治病求本,辨证施治.指出该病多为"本虚标实",急性发作时以邪实为主,"痰瘀互结",缓解期以正虚为主,且介入后再发心绞痛之本多为"阳虚阴凝",治疗时应"整体观念贯穿始终","调肝理脾与时俱进",坚持用"益气温阳""活血通脉""理气化痰"之法治之.

黄丽娟教授认为桥本氏甲状腺炎发病阶段及临床表现不同,临床可分为甲亢期、亚临床甲减期、甲减期,可归为中医"瘿病""瘿瘤""惊悸""震颤""水肿"等范畴.基本病机为气滞、痰凝、血瘀、阴虚或者阳虚.治疗上不同证型采取不同的治疗原则.肝郁化火证治以清热泻火疏肝,消肿散结;阴虚火旺证治以滋阴清热宁心,散结消瘿;痰瘀互结证治以理气活血,化痰散结;阳虚痰凝证治以温肾健脾,软坚散结.

对明代医家缪希雍《先醒斋医学广笔记》一书中的临床用药策略进行总结,归纳其用药策略有两个方面,一是以“随证施量”为原则,二是重视“服药时机”.前者包括重剂起沉疴、逐渐增量、逐渐减量、试探性给药、继守前方以及中病即止的方法;后者包括饥时服、空心服、临卧服、下午服、露一宿以及不拘时服的服药时机,均体现了缪希雍丰富而精湛的医学造诣.

目的 总结知母自汉代至今两千多年的临床剂量特点,为知母临床应用选择安全、合理、有效的剂量提供文献依据.方法 选取各朝代最具代表性的医学著作,采用EXCEL表格录入数据并建立各朝代知母临床用量数据库,统计知母在不同朝代出现的频次、最常用剂量、常用剂量范围上限、常用剂量范围下限、最大用量、最小用量以及平均用量,并对其进行数据分析.结果 统计结果发现,汉唐时期知母临床用量较大且用量范围较广,最大量可达82.8g.自宋代推行煮散之后,知母临床用量显著下降,但仍有大剂应用的医家.至现当代,知母的临床用量多限于药典所规定的范围,但也有超药典用量应用的报道,使得知母的临床应用长期以来呈现大小剂量并存的现象.结论 知母大剂量应用(≥30g)常见于白虎汤及其类方,主要用于瘟疫、温疟等急性热病的治疗,而通过辨证小剂量应用知母(≤6g)也会取得显著的临床效果.另外,汉唐时期知母常用于治疗痹证及水湿肿满等证,而此功效在宋代之后则应用较少.

The formation of traditional Chinese medicine formulations had a profound historical origin. Appropriate formulations were convenient for clinical application, and could make the drug have the best curative ef ect. The most popular modern Chinese medicine oral formulation in clinical practices was decoction. This paper studied oral formulations in i ve medical literature of the Qin and Han dynasties, and found that there were more pill and powder than decoction. Many famous doctors in the Qin and Han dynasties were traveling to treat patients, and pill and powder were easy to carry with and storage, as well as saving materials etc. Furthermore pill had the long-term therapy ef ects, and powder could make a rapid relief of illness. So pill and powder played an important role in the Qin and Han dynasties. In the eastern Han dynasty, the application of decoction increased in the writings(Treatise on Febrile Disease and Synopsis of Golden Chamber).

对《小品方》中83首汤剂进行研究,应用文献计量分析手段,总结出常用药物共12味,并分析其剂量分布情况.12味常用药物出现频次大于10次,9味药物的常用剂量值和平均剂量值在27.6g左右；常用剂量范围的下限值多为13.8g,上限值多为41.4g;剂量分布区间较为广泛,从3.45g至441.6g,剂量差值达438g,多数药物用量远远大于《中华人民共和国药典》规定.

The dosage of commonly used Chinese herbs in clinical practice has changed greatly in 2000years since the pre-qin dynasty period,and it is an important issue about the research on medicinal doseeffect relationship in TCM formulas. It should be the first thing to describe the changes of dosage of commonly used Chinese herbs in clinical practice in 2000 years so as to clarify the medicinal dose-effect relationship in TCM formulas. By applying the methods of literature research and data mining,the changes of dosage of commonly used Chinese herbs in clinical practice in 2000 years since the pre-qin dynasty period were calculated and described,the concept of dosage valley of Chinese herbs in clinical practice was proposed. The dosage valley was made with historical period as the length and clinical dosage range of commonly used Chinese herb as the width,to describe the changes of dosage of commonly used Chinese herbs in clinical practice. The significance of study on clinical dosage valley of commonly used Chinese herbs is reflected in three aspects: knowing the history of TCM formulas application,providing some documentary evidences for clinical medication,and understanding the information about history,geography,humanities and society. There are six factors which affect dosage valley,including personal knowledge and experience of doctors,characteristics of monthly,yearly climate and diseases,factor of academic schools,factors of economy,politics,geography or traffic,influence of science,impact of government management and regulation,et,al. The dosage valley of some Chinese herbs represented by Gegen( Radix Puerariae),Shigao( Gypsum Fibrosum) and Fuzi( Radix Aconiti Lateralis Preparata) in 2000 years,are statistically described in details. Some issues about the safety and effectiveness of Chinese herbs in clinical practice are proposed.

An initial discussion on the of medicine, method of taking medicine, and indications of medicine, in Wai Tai Mi Yao (The Medical Secrets of Official) was carried out to summarize the application and characteristics of Zhusan Prescriptions (Decoctions made from powder, in which the medicines are ground into coarse granules, boiled with water for a certain period of time and only the decoction is taken) of and before the Tang dynasty. In the Zhusan Prescriptions, the of medicine of each boiling is significantly smaller than that of decoctions, and the of each taking is also less than that of decoctions. Its three principles in adjusting the times of taking medicine are of dosage being in accordance with symptoms, severity of disease, and physique of an individual. And the indications are mostly the acute attacks of chronic diseases or the acute exacerbated stage.

方药的剂量泛指方药的用量,其本义是指一剂药物的用量.方药的服量是指服用的药量,包括每服量、日服量及总服量等具体内容.方药的剂量与方药的服量不同.一首方剂的剂量是重要的,而它的服量更为重要.服量是影响疗效的一个极为重要的因素.作用于人体的药量并不取决于方药的剂量,而是取决于方药的服量.一首方剂对量的规定给出了药物间的用量比,而服量则控制着该用量比的方药对人体的作用强度和作用时间.古代医家在服量控制方面有许多特色性的认识和方法,积累了丰富的经验.服量控制的总原则是随证施量,即以知为度、中病即止、逐渐增量、逐渐减量、累积获效.方药服量控制是保证临床疗效和安全用药的重要一环.

以《难经》关于人体器官重量的记载,与现代人体器官的大小及重量进行比较,将《难经》的"两"折算为现代计量单位,一两约在14.55～25.63g之间,平均19.63g。由于《难经》是成书于汉代的医学著作,故这一结果对于判断《伤寒论》"两"的量值具有重要参考价值。

On the basis of previous medical literature in Treatise on Cold Damage and Miscellaneous Diseases, this paper focuses on the oral dosage of decoction in Treatise on Cold Damage and Miscellaneous Diseases, and makes a conclusion that there are some different approaches of frequency for taking decoction, such as 3 times a day, twice a day, once a day, a single dose, day and night, 5 times a day, 6 times a day, 10 times a day, low dosage at short intervals. Among the above nine approaches, taking decoction of three times a day is in the majority in Treatise on Cold Damage and Miscellaneous Diseases. It is more reasonable than taking twice a day respectively in the morning and at night nowadays. The amount of each oral dosage is 1 sheng, 1.5 sheng, 8 ge, 7 ge, 6 ge, 5 ge , 8.3 ge , 6.7 ge, and 7.5 ge etc. Zhang Zhongjing took control of oral dosage from the following measures such as shortening the intervals of taking decoction and increasing dosage if ineffective, changing the dosage gradually according to the reaction after taking decoction, and ceasing taking the rest decoction if patient showed signs of being well. All these measures completely represent the principle of oral dosage according to symptoms.