By the author of 作者著
Vitamin E for Ailing and Healthy Hearts 维生素 E 用于病弱和健康的心脏
Dr. Wilfrid E. Shute's Complete ... Updated VITAMIN E BOOK 威尔弗里德·E·舒特博士的完整更新版维生素 E 书籍
For more than thirty years, Dr. Wilfrid E. Shute has led an ever increasing number of courageous doctors in the winning fight against America’s number one killer: heart disease. The major weapon in this Canadian doctor’s arsenal has been Vitamin E and its use in megavitamin dosages. 三十多年来，Wilfrid E. Shute 博士带领越来越多的勇敢医生，赢得了对美国头号杀手——心脏病的斗争。这位加拿大医生的主要武器是维生素 E 及其大剂量使用。
As a result of his efforts in books (Vitamin E for Ailing and Healthy Hearts has been the most wideread), articles, lectures and talks before lay and medical groups, more than thirty million Americans take Vitamin E regularly, and most at megavitamin dosage levels. 由于他在书籍（《Vitamin E for Ailing and Healthy Hearts》是最广为阅读的）、文章、讲座以及在普通大众和医学团体面前的演讲中的努力，超过三千万美国人定期服用维生素 E，而且大多数人服用的是大剂量维生素。
The inevitable results have been almost breathtaking. For the first time since World War II, the upward trend in heart attack rate among Americans has been stopped cold, sparing as many as 10,000 lives annually, according to newly released figures at the recent American Heart Association seminar (January, 1975, Marcos Island). 不可避免的结果几乎令人震惊。根据最近在美国心脏协会研讨会（1975 年 1 月，马科斯岛）发布的新数据，自第二次世界大战以来，美国人心脏病发作率的上升趋势首次被彻底遏制，每年挽救了多达 1 万条生命。
Not only have these 10,000 lives been saved but many other thousands have had their symptoms alleviated or relieved completely, and their lives prolonged. Dr. Shute makes very clear the responsibility of the thoroughly proven characteristics of the alpha fraction of Vitamin E in effecting this heartening trend. 不仅这 1 万条生命得以挽救，还有许多其他数千人症状得到缓解或完全消除，寿命得以延长。Shute 博士明确指出，维生素 E 中α组分的经过充分验证的特性对这一令人鼓舞的趋势负有责任。
The same principles of treatment apply to many other conditions and diseases that afflict mankind. Dr. Shute discusses the mode of action in each case, drawing on his experience in treating 35,000 cases if cardiovascular disease and on extensive literatuia published in medical journals throughout the wc-1d. 相同的治疗原则适用于许多其他困扰人类的状况和疾病。Shute 博士在每种情况下都讨论了作用机制，借鉴了他治疗 35,000 例心血管疾病的经验以及全球医学期刊中发表的大量文献。
For the concernel layman and physician, Dr. Shute examines each nn. ajor condition he has found responsive to Vitamin E, including not only heart conditions but diabetes and other circulatory dis-eases-even burns, the severest of which he has seen relieved in incredibly shori time without scars and other disfigurement. 对于关心的普通人和医生，Shute 博士检查了他发现对维生素 E 有反应的每一种主要疾病，包括不仅是心脏病，还有糖尿病和其他循环系统疾病——甚至烧伤，他见过最严重的烧伤在极短的时间内得到缓解，没有留下疤痕和其他畸形。
The lack of an effective alternative to alpha tocopherol treatment becomes apparent as Dr. Shute describes those various methods of treaiment that have been proposed, widely used and ultimately rejected. Using well-documented case studies and testimonies from medical li.erature, he reveals the ineffective results of many current drugs and treatments. Some of these, although still commonly used, are not only of no value, but can be essentially dangerous. 当 Shute 博士描述那些被提出、广泛使用并最终被否定的各种治疗方法时，缺乏有效替代α-生育酚治疗的方法变得显而易见。通过详尽的病例研究和医学文献中的证词，他揭示了许多现有药物和治疗方法的无效结果。其中一些虽然仍被普遍使用，不仅毫无价值，甚至可能本质上具有危险性。
The impressive array of quotations from articles by doctors excerpted from various medical journals show unmistakable evidence that there is at present, at least, no alternative to Vitamin E therapy, Dr. Shute writes. Equally impressive is his summary of papers by leading medical and surgical practitioners that completely support the original work of the Shute brothers. Shute 博士写道，从各种医学期刊中摘录的医生文章中令人印象深刻的引用阵列清楚地表明，目前至少没有替代维生素 E 疗法的选择。同样令人印象深刻的是他对领先的医学和外科专家论文的总结，这些论文完全支持 Shute 兄弟的原创工作。
An essential problem remains-the ever-present risk of heart attacks in the person not protected by Vitamin E. Environmental changes, changes in our eating habits, in our lifestyle and many other factors constantly increase the danger. This is why 一个根本性的问题依然存在——未受到维生素 E 保护的人随时面临心脏病发作的风险。环境变化、饮食习惯的改变、生活方式的变化以及许多其他因素不断增加这种危险。这就是为什么
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AUG 261976 1976 年 8 月 26 日
Dr. Wilfrid E. Shute's Complete Updated VITAMIN E BOOK 威尔弗里德·E·舒特博士的完整更新版维生素 E 书籍
Digitized by the Internet Archive in 2012 2012 年由互联网档案馆数字化
Dr. Wilfrid E. Shute's Complete Updated VITAMIN E BOOK 威尔弗里德·E·舒特博士的完整更新版维生素 E 书籍 615.3255625615.3255625
DR. WILFRID E. SHUTE’S COMPLETE UPDATED VITAMIN E BOOK 威尔弗里德·E·舒特博士的完整更新版维生素 E 书籍
Copyright ^((1))1975{ }^{(1)} 1975 by Wilfrid E. Shute 版权所有 ^((1))1975{ }^{(1)} 1975 归 Wilfrid E. Shute 所有
All rights reserved 版权所有
ISBN: 0-87983-088-3
Library of Congress Catalog Card Number: 75-7808 美国国会图书馆目录卡号：75-7808
Printed in the United States of America 美国印刷
Keats Publishing, Inc.,
36 Grove Street, New Canaan, Connecticut 06840 康涅狄格州新卡南格罗夫街 36 号，邮编 06840
CONTENTS 目录
Dedication … 6 献词 … 6
Foreword … 9 前言 … 9
The Heart Attack and You … 13 心脏病发作与您……13
Warning: Hospital Ahead … 21 警告：前方有医院……21
A Different Approach … 36 不同的方法……36
Vitamin E as a Vitamin … 48 维生素 E 作为一种维生素……48
A Question of Quantity … 56 数量问题 … 56
Conflict and Support … 69 冲突与支持 … 69
Alpha Tocopherol in the Body … 85 体内的 Alpha 生育酚 … 85
Angina and Rheumatic Heart Disease … 121 心绞痛和风湿性心脏病……121
Atherosclerosis and an Important Breakthrough … 132 动脉粥样硬化及一项重要突破……132
Intermittent Claudication … 146 间歇性跛行 … 146
Thrombophlebitis and Pulmonary Embolism … 153 血栓性静脉炎和肺栓塞 … 153
Hypertension, Strokes and Cerebral Hemorrhage … 161 高血压、中风和脑出血……161
Diabetes Mellitus … 169 糖尿病……169
Vitamin E Ointment in Burns and Other Conditions … 173 维生素 E 软膏在烧伤及其他情况中的应用……173
Tailoring the Dose … 181 调整剂量……181
The Healthy Heart … 187 健康的心脏……187
What of the Future? … 198 未来会怎样？……198
Appendix A Vitamin E as a Therapeutic Agent in Dermatology … 207 附录 A 维生素 E 作为皮肤病学中的治疗剂 … 207
Appendix B An Excerpt from an Article by Lady Phyllis Cilento … 210 附录 B 来自 Lady Phyllis Cilento 文章的摘录……210
Appendix C Is Commercialism Controlling 附录 C 商业主义是否在控制
The Controversy over Cholesterol? … 214 胆固醇争议？……214
Author’s Addendum … 217 作者补遗 … 217
Index … 219 索引 … 219
DEDICATION 献词
THIS BOOK IS AFFECTIONATELY DEDICATED to my wife Dorothy, whose involvement in Vitamin E therapy is not less than my own. Through the years she has observed its effects at first hand. She has seen pitifully burned little bodies healed, has exulted with me over the salvage of diabetic legs and has rejoiced over the improvement of cardiac cripples and their return to normal living. In addition, she has played an active role of her own. 本书深情献给我的妻子多萝西，她对维生素 E 疗法的投入不亚于我自己。多年来，她亲眼见证了其效果。她见证了被严重烧伤的小身体得到治愈，和我一起为糖尿病患者的腿部康复而欢欣鼓舞，也为心脏病患者的改善及其恢复正常生活而感到欣喜。此外，她还积极参与其中。
Besides sharing my joys and enthusiasms, my wife has taken an important, indeed essential, part in the development of the Shute Institute and in the enormous amount of secretarial work that has been required by the nature of my activities. 除了分享我的喜悦和热情，我的妻子在 Shute 研究所的发展以及由于我的活动性质所需的大量秘书工作中，发挥了重要且必不可少的作用。
If it had not been for her efforts, the Shute Institute might well have died aborning. She willingly left our comfortable and happy home in Guelph, Ontario, to accompany me to 如果不是她的努力，Shute 研究所很可能会胎死腹中。她心甘情愿地离开了我们在安大略省圭尔夫舒适而幸福的家，陪我一起去
London, Ontario, where the Institute was about to open its doors. When we found nothing there but a desk, a chair, a lamp, a telephone and a wastebasket into which all inquiries, after being answered with a form letter, were dumped, she joined me in arranging for the furnishing of the Institute (which was accomplished in ten days) and in setting up appointments for my patients. Living in what had been servants’ quarters of the home which now housed our clinic -the only ones available-and assisted only by a “nanny” brought from Guelph to look after our two little daughters, she took charge of the office, remaining until the Institute was a flourishing success. Fortunately for me, she is an expert stenographer, secretary and office manager. 安大略省伦敦市，研究所即将开门营业。当我们发现那里除了桌子、椅子、灯、电话和一个废纸篓（所有询问在用格式信回复后都被扔进里面）之外一无所有时，她和我一起安排了研究所的家具配置（十天内完成），并为我的病人安排了预约。我们住在曾经是仆人宿舍的房子里，这里现在是我们的诊所——这是唯一可用的地方——只有一位从圭尔夫带来的“保姆”帮忙照看我们的两个小女儿，她负责办公室工作，直到研究所成为一个蓬勃发展的成功机构。幸运的是，她是一位经验丰富的速记员、秘书和办公室经理。
When I decided to move to Port Credit, she again unhesitatingly moved with me to this suburb of Toronto-this in spite of a house she loved and a happy environment for herself and our two girls-one a fine student and figure skater, the other a fantastically successful swimmer. (Swimming, of course, was of great interest to my wife since she herself had represented Canada as a swimmer at the Olympics in 1928 and 1932.) 当我决定搬到 Port Credit 时，她再次毫不犹豫地跟我一起搬到了多伦多的这个郊区——尽管她非常喜欢那所房子和为她自己以及我们的两个女儿创造的幸福环境——一个是优秀的学生和花样滑冰选手，另一个是非常成功的游泳运动员。（游泳当然对我妻子来说非常重要，因为她本人曾代表加拿大参加 1928 年和 1932 年的奥运会游泳比赛。）
Since then, while caring for our children and our home unaided, she has taken care of my voluminous correspondence, often taking dictation in the early morning, at noon hour or late in the evening. She typed every word of the many articles I wrote for The Summary, a publication of the Shute Foundation, when in London, and every word of the manuscript of Vitamin E for Ailing and Healthy Hearts, which was published by Pyramid Books in 1969, and every word of the manuscript of this book as well. She has been a tower of strength, a wise critic and an understanding co-worker. 从那时起，在无助于他人的情况下照顾我们的孩子和家庭，她还负责处理我大量的信件，常常在清晨、中午或深夜听写。我写给《The Summary》（Shute 基金会的出版物）的许多文章的每一个字都是她打的字，当我在伦敦时，她还打了《Vitamin E for Ailing and Healthy Hearts》手稿的每一个字，该书于 1969 年由 Pyramid Books 出版，以及这本书的每一个字。她一直是我的坚强支柱，是一位明智的批评者和理解的合作者。
To my alter ego, then, Dorothy Prior Shute. 献给我的另一个自我，Dorothy Prior Shute。
I should also like to express my appreciation for the continuous help and support of my nursing staff-the nurses 我还要感谢我的护理团队——护士们的持续帮助和支持
at the Institute and those in my office in Port Credit-and especially Miss Ada Pascoe and Mrs. Ursulla Donaldson. 在研究所和我在 Port Credit 办公室的同事们——尤其是 Ada Pascoe 小姐和 Ursulla Donaldson 女士。
I must, of course, acknowledge the faith of my father and his inspiration, which was responsible for all three of his sons becoming doctors, and the unusual medical intuition and knowledge and truly scientific mind of my older brother Evan, who delivered my two girls and who involved me in the medical uses of Vitamin E. 我当然必须感谢我父亲的信念和他的启发，这使得他的三个儿子都成为了医生，以及我哥哥 Evan 那非凡的医学直觉、知识和真正的科学头脑，他接生了我的两个女儿，并让我参与了维生素 E 的医学应用。
FOREWORD 前言
THIS BOOK somehow had to be written. Two circumstances, particularly, have made it mandatory. One is the crying need for a useful therapy to combat the rapidly growing epidemic of heart disease. The other is the obvious sterility of most current approaches to the problem. Together they have made it essential to alert physicians and the public to the fact that real help for heart disease is available through the use of alpha tocopherol (Vitamin E) in megavitamin dosages. 这本书无论如何都必须写成。特别有两个原因使其成为必需。一是迫切需要一种有效的疗法来对抗迅速增长的心脏病流行。另一个是目前大多数治疗方法显然缺乏成效。两者共同促使我们必须提醒医生和公众，使用大剂量的α-生育酚（维生素 E）可以为心脏病提供真正的帮助。
The success of my first book, Vitamin E for Ailing and Healthy Hearts, has convinced me that such books are a far more effective method of reaching people-both physicians and the general public-than are papers in medical journals. Laymen, of course, rarely read medical journals. Probably a great many doctors are too busy to do more than thumb through many of them unless they are looking for a particular 我第一本书《维生素 E 与病弱及健康的心脏》的成功使我相信，这类书籍比医学期刊上的论文更有效地接触到人们——无论是医生还是普通大众。当然，外行人很少阅读医学期刊。可能许多医生也太忙了，除非寻找特定内容，否则也只是翻阅而已。
article. Most medical journals, moreover, are extremely conservative. Often they will condemn out of hand something new when it first appears. Later, when evidence for its effectiveness mounts, they may be too embarrassed to print it. 文章。此外，大多数医学期刊都非常保守。它们常常在新事物刚出现时就断然否定。后来，当其有效性的证据增多时，它们可能会因为尴尬而不愿刊登。
My reasons for addressing physicians will be readily apparent. Many doctors are now familiar with the role of alpha tocopherol in the treatment of heart disease, arteriosclerosis, burns and other conditions. Many now use it in their treatment of some of their patients. Many others, however, are not fully aware of the importance of this substance. Many, in fact, are laboring under the misapprehension that most of the claims for Vitamin E have not been substantiated. For the sake of their patients and themselves, it is extremely important that these physicians should become familiar not only with the claims for this substance but with the extensive and very solid evidence for them that is now available. 我向医生们讲话的理由显而易见。许多医生现在已经熟悉α-生育酚在治疗心脏病、动脉硬化、烧伤及其他疾病中的作用。许多人现在在治疗部分患者时使用它。然而，许多医生并未完全意识到这种物质的重要性。事实上，许多人误以为关于维生素 E 的大多数主张尚未得到证实。为了他们的患者和他们自己，这些医生不仅应熟悉关于这种物质的主张，还应了解目前可获得的广泛且非常确凿的证据，这一点极为重要。
I address laymen as well because I know from experience that those who come to understand the importance of what I have to say can be enormously effective in spreading awareness of it. I am especially concerned that, as parents and citizens, they should know the effects of some food processing techniques in removing important amounts of certain essential constituents from some foods. 我也向外行人讲话，因为我从经验中知道，那些开始理解我所说内容重要性的人，在传播这一意识方面可以非常有效。我特别关心的是，作为父母和公民，他们应该了解某些食品加工技术在去除某些食物中重要必需成分方面的影响。
But there is still another reason for talking to laymen. I hope that they will discuss this book with their doctors-if necessary, making sure that these doctors see the book so that they can evaluate it for themselves. Whether a physician reads this book and alerts his patients, or whether a layman reads it and alerts his physician, is all the same to me. What matters is that people must know what alpha tocopherol can do for them and for others before it is too late. 但还有另一个与外行人交谈的理由。我希望他们能与他们的医生讨论这本书——如果有必要，确保这些医生看到这本书，以便他们自己进行评估。无论是医生阅读这本书并提醒他的病人，还是外行人阅读后提醒他的医生，对我来说都一样。重要的是，人们必须在为时已晚之前知道α-生育酚（alpha tocopherol）能为他们自己和他人做些什么。
The immediate impetus behind the publication of this book is the publicity given recently to some of the research on the use of alpha tocopherol or mixed tocopherols in small 这本书出版的直接推动力是最近对使用α-生育酚或混合生育酚进行的一些研究所给予的宣传
doses. Much of this material, in my opinion, has the potential for causing incalculable damage. Although the authors are usually capable of discussing the actions of small amounts (five to thirty international units [IU]) of alpha tocopherol, they generally have no experience with or knowledge of the uses of this substance at megavitamin levels ( 150 to 3,000 IU) in the treatment of human disease states. According to these writers, large quantities of Vitamin E are effective only in treating a few rare human abnormalities, a “rare form of anemia in premature infants” and intermittent claudication-leg pain that is due to severe arteriosclerotic narrowing of arteries in the legs. 剂量。依我看，这些材料很可能会造成无法估量的损害。虽然作者们通常能够讨论少量（五到三十国际单位[IU]）α-生育酚的作用，但他们通常没有使用或了解这种物质在治疗人类疾病时以大剂量（150 到 3000 IU）使用的经验。根据这些作者的说法，大量维生素 E 仅对治疗少数罕见的人类异常有效，如“早产儿的一种罕见贫血形式”和间歇性跛行——由于腿部动脉严重动脉硬化狭窄引起的腿痛。
Such articles are especially dangerous in that doctors have been influenced since grammar school days to consider their teachers as infallible. This attitude prevails even in medical school. Thus, they are likely to accept as gospel what they are told by professors of nutrition or biochemistry, even though the working lives of these people may be far removed from clinical medicine. 这类文章尤其危险，因为医生从小学时代起就被影响，认为他们的老师是无误的。这种态度甚至在医学院中也普遍存在。因此，他们很可能将营养学或生物化学教授所说的话视为福音，尽管这些人的工作生涯可能与临床医学相去甚远。
I have therefore gone to some length to report in their own words what doctors have said about what they can do without Vitamin E therapy in the treatment of cardiovascular disease and to contrast with this what other doctors have reported in medical journals that they can do with Vitamin E therapy. I leave it to the good judgment of the doctors who read this book whether, in all conscience, they continue using the old “crisis” approach to heart disease or save their patients by the intelligent application of new medical procedures including especially the use of alpha tocopherol. 因此，我特意详细报道了医生们用他们自己的话说，在没有维生素 E 治疗的情况下，他们在治疗心血管疾病方面能做什么，并将此与其他医生在医学期刊中报道的他们通过维生素 E 治疗能做的事情进行对比。我将由阅读本书的医生们凭良心判断，是继续使用旧的“危机”心脏病治疗方法，还是通过包括特别使用α-生育酚在内的新医疗程序的智能应用来挽救他们的患者。
I should like to add two final notes about this book and its organization in the hope that they will facilitate reading. The first concerns the method of presenting information. The second deals with the handling of references. 我想补充两点关于本书及其组织方式的说明，希望能方便阅读。第一点涉及信息呈现的方法。第二点涉及参考文献的处理。
Since I have very consciously written this book both for 既然我非常有意识地写这本书是为了
physicians and for laymen, I have tried to present information in a way that will be sufficiently clear for the latter and, at the same time, appropriate for the former. Wherever a brief explanatory paragraph or a few parenthetical definitions not needed by physicians may appear, I would hope that my physician readers will simply skip quickly ahead. I would hope, also, that this method will allow readers who are laymen to proceed easily and quickly with material that might otherwise have seemed overly technical. 对于医生和外行人，我试图以一种对后者足够清晰、同时对前者也合适的方式呈现信息。无论何处出现简短的解释段落或一些医生不需要的括号内定义，我希望我的医生读者能够快速跳过。我也希望这种方法能让外行读者轻松快速地阅读那些本可能显得过于专业的内容。
Finally, in many publications, bibliographical references are grouped together in a special section at the back. This forces the serious reader to undertake the tedious and annoying task of turning continually away from the section he is reading to hunt for the supporting authorities elsewhere. In this book, such an arrangement has been avoided. Many of the publications mentioned in the text are referred to there in such a way that the reader will know instantly whose work is being discussed or quoted. Key sources are fully cited at the end of the chapters in which they are referred to. Additional references that I think may be useful appear at the end of Chapters 5 and 7. 最后，在许多出版物中，书目参考文献被集中归纳在书后的一个专门部分。这迫使认真阅读的读者不得不不断地离开正在阅读的章节，去其他地方寻找支持的权威资料，这是一项既乏味又令人恼火的任务。在本书中，避免了这种安排。文中提到的许多出版物都以一种方式引用，使读者能够立即知道正在讨论或引用的是谁的作品。关键资料在所引用的章节末尾有完整的引用。我认为可能有用的其他参考文献则出现在第 5 章和第 7 章的末尾。
1
THE HEART ATTACK AND YOU 心脏病发作与您
SOME YEARS AGO a patient of mine who was recovering from a myocardial infarction (in laymen’s language, a heart attack) remarked bitterly that he had led a clean life. This man was an athletic individual who had remained slim, who neither smoked nor drank and who got plenty of rest. Yet there he was, in the hospital, in spite of having avoided all the widely publicized pitfalls that are supposed to land you there. No question about it: he was angry. 几年前，我的一位正在从心肌梗死（通俗来说，心脏病发作）中恢复的病人愤愤不平地说，他一直过着清洁的生活。这个人是个运动员，保持着苗条的身材，不吸烟不喝酒，且休息充足。然而，他却躺在医院里，尽管他避免了所有那些被广泛宣传为会让人进医院的陷阱。毫无疑问：他很生气。
I had to tell this man something that surprised him: that although the precautions he had taken were believed by many doctors to be valuable, they could not prevent a heart attack if a person’s bloodstream contained an insufficient amount of one essential substance. Supplying this substance in adequate amounts would continue to be the most important part of his treatment. This substance, alpha tocopherol, 我不得不告诉这个人一些令他惊讶的事情：尽管许多医生认为他采取的预防措施是有价值的，但如果一个人的血液中缺乏一种必需物质，这些措施无法预防心脏病发作。补充足够量的这种物质将继续是他治疗中最重要的部分。这种物质是 alpha tocopherol，
constitutes the largest part, if not indeed the total amount, of the “antithrombin” (anti-clotting factor) in the human bloodstream. 构成人体血液中“抗凝血酶”（抗凝血因子）最大部分，甚至可能是全部。
The same statement applies to you, regardless of most of the efforts you may have made to stay healthy. Being slim and abstemious is fine. I certainly wouldn’t deny that. But please put aside, for the moment, any idea that this gives you any reason to expect protection against a “heart attack,” while you read some cold facts and figures. 同样的话也适用于你，无论你为保持健康付出了多少努力。保持苗条和节制固然好，我当然不会否认这一点。但请暂时放下任何认为这能保护你免受“心脏病发作”之苦的想法，先阅读一些冷冰冰的事实和数据。
The role of the antithrombin in such cases as this patient’s will be elucidated in Chapter 3, and the relative unimportance of rest, exercise, and the avoidance of tobacco and alcohol will be stressed in the same chapter. 抗凝血酶在像该患者这样的病例中的作用将在第三章中阐明，休息、锻炼以及避免烟草和酒精的相对不重要性也将在同一章中强调。
One difficulty in discussing the present epidemic of heart disease-and that is what today’s situation is-is that nobody expects it to hit him. That seems to be the way our psychology works. Whether you, reading this book, are a doctor or a layman, you probably find it easier to imagine another person being vulnerable to a heart attack than to picture such a thing in relation to yourself. It’s strange, when you think of it, that doctors are guilty of this kind of thinking, because this particular epidemic has hit the medical profession harder than most other groups! 讨论当前心脏病流行病的一个困难——这正是今天的情况——是没有人期望它会袭击自己。这似乎是我们的心理运作方式。无论你是阅读这本书的医生还是外行人，你可能更容易想象别人容易发生心脏病发作，而不是将这种情况与自己联系起来。仔细想想，这很奇怪，因为医生也有这种想法，而这场流行病对医疗行业的打击比对大多数其他群体都要严重！
Now I want you to pause for a few minutes to read some statistics and apply them consciously-first to yourself, then to your family and finally to your friends. 现在我希望你暂停几分钟，阅读一些统计数据，并有意识地先应用于自己，然后是你的家人，最后是你的朋友。
Statistics, I know, are dry. And huge figures, after a while, seem to convey very little meaning. We have all become so accustomed to reading about millions and billions today that the immensities they represent don’t really sink in. For this reason I’ll use percentages, rather than large numbers, as much as possible. 统计数据，我知道，很枯燥。而且巨大的数字，过一段时间后，似乎传达的意义很少。我们如今都习惯了阅读关于数百万和数十亿的内容，以至于它们所代表的巨大数量并没有真正被理解。出于这个原因，我将尽可能使用百分比，而不是大数字。
If you are a man over forty, your chances of dying of a myocardial infarction are better than 50 percent. Think about 如果你是一个四十岁以上的男性，你死于心肌梗死的几率超过 50%。想一想
it. No matter how daring a gambler you are, this is frightening. 不管你是多么大胆的赌徒，这都令人害怕。
Statistics of the last twenty years suggest that although men predominate still, the rate of infarction in women is increasing steadily. And not all of these women are in the older age group. On 6 September 1971, the Journal of the American Medical Association contained a report concerning “myocardial infarction in two sisters less than 20 years old.” The youngest proven infarction in a woman in my experience was in a twenty-five-year-old. 过去二十年的统计数据显示，尽管男性仍占主导地位，但女性的心肌梗死发病率正在稳步上升。而且，并非所有这些女性都属于老年群体。1971 年 9 月 6 日，《美国医学会杂志》刊登了一篇关于“两个不到 20 岁的姐妹心肌梗死”的报道。在我的经验中，最年轻的确诊女性心肌梗死患者年龄为二十五岁。
Equally startling-for I’m sure no one else has told you this-is the fact that this “disease” did not exist in 1900. Four cases of coronary thrombosis (heart attack resulting from obstruction of the coronary artery by a clot of blood) were the subject of an uncorroborated report in 1896 by Dr. George Dock (1). Coronary thrombosis remained almost entirely unknown, however, until it was described by Dr. J.B. Herrick (2) in 1912. 同样令人震惊的是——我确信没有其他人告诉过你——这个“疾病”在 1900 年并不存在。1896 年，乔治·多克医生（Dr. George Dock）曾报道过四例冠状动脉血栓形成（由血块阻塞冠状动脉引起的心脏病发作）（1），但这一报告未得到证实。然而，直到 1912 年，J.B.赫里克医生（Dr. J.B. Herrick）才描述了冠状动脉血栓形成（2），此病几乎完全不为人知。
Most doctors are totally unaware of this. But it is a fact that has been specifically noted by Dr. Paul Dudley White, one of the two original cardiologists in America. Dr. White once wrote that at the time he graduated from medical school in 1911 he had never heard of coronary thrombosis! Sadly enough, Dr. White himself not long ago became the victim of repeated vascular episodes, the last of which was fatal. 大多数医生对此完全不了解。但这是一个事实，曾被美国最早的两位心脏病专家之一保罗·达德利·怀特博士特别指出。怀特博士曾写道，他在 1911 年医学院毕业时，从未听说过冠状动脉血栓形成！遗憾的是，怀特博士本人不久前也成为反复血管事件的受害者，最后一次事件是致命的。
I would say that your chances of dying of a myocardial infarction in 1912 were infinitesimal. Even in 1930, myocardial infarction was “an old man’s disease.” Yet today more than a million people each year in the United States die of cardiovascular diseases (diseases of the heart and blood vessels) and coronary thrombosis is the leading cause of these deaths. 我想说，1912 年你死于心肌梗死的几率几乎为零。即使在 1930 年，心肌梗死也被认为是“老年病”。然而，如今美国每年有超过一百万人死于心血管疾病（心脏和血管疾病），冠状动脉血栓形成是这些死亡的主要原因。
Official statements concerning the magnitude of the epidemic are not hard to find. In 1968, the Inter-Society 关于疫情规模的官方声明并不难找到。1968 年，Inter-Society
Commission for Heart Disease Resources issued a startling report. The Commission stated that 600,000 persons die of heart disease each year in the United States. Of these about 27 percent are under sixty-five years of age. The Fall-Winter 1972 issue of the American Heart, a publication of the American Heart Association, placed the total number of Americans suffering from heart and blood vessel diseases at 27 million. About 80 percent of these are afflicted with hypertension, nearly 15 percent with coronary heart disease and nearly 6 percent with rheumatic heart disease. “Cardiovascular diseases,” says the American Heart, “claim more American lives than all other causes of death combined.” According to the same publication, heart attack claimed nearly 670,000 lives in 1969 and stroke-a common end result of hypertension (high blood pressure)-was responsible for about 207,000 more. 心脏病资源委员会发布了一份令人震惊的报告。委员会指出，每年美国有 60 万人死于心脏病。其中约 27%年龄在六十五岁以下。美国心脏协会出版的《American Heart》1972 年秋冬刊将患有心脏和血管疾病的美国人总数定为 2700 万。其中约 80%患有高血压，近 15%患有冠心病，近 6%患有风湿性心脏病。《American Heart》表示：“心血管疾病夺去的美国人生命比所有其他死因加起来还多。”根据同一出版物，1969 年心脏病发作夺去了近 67 万人的生命，而中风——高血压（高血压）常见的最终结果——则导致约 20.7 万人死亡。
Comparable figures for heart attack deaths in Australia, Canada and Germany, are 60,000,76,00060,000,76,000 and 105,000 respectively. These deaths represent more than 50 percent of the total number of deaths in Austrialia and Canada and roughly the same percentage of the total deaths in Germany. 澳大利亚、加拿大和德国心脏病死亡的可比数字分别为 60,000,76,00060,000,76,000 和 105,000。这些死亡人数占澳大利亚和加拿大总死亡人数的 50%以上，在德国的总死亡人数中也大致占相同的比例。
These, then, are the statistics. They probably won’t have much impact unless you apply them to yourself and your family and until you think carefully about the fact that coronary thrombosis has not always been with us. In fact, it’s a relatively recent phenomenon, as I have shown. 这些就是统计数据。除非你将它们应用到自己和家人身上，并且认真思考冠状动脉血栓形成并非一直存在这一事实，否则它们可能不会产生太大影响。事实上，正如我所展示的那样，这是一种相对较新的现象。
Another thought I want you to ponder long and well is that the medical profession has been unable to change this worsening picture. If there were a solution known to organized medicine, there would surely have been a significant drop in the death rate from coronary thrombosis, or at least a noticeable drop in its incidence, somewhere in the Western world. There has been, instead, a steady increase. 我还希望你认真深思的另一个想法是，医学界一直未能改变这一日益恶化的局面。如果有组织医学界已知的解决方案，西方世界某处冠状动脉血栓死亡率肯定会显著下降，或者至少其发病率会有所明显下降。相反，情况却在不断恶化。
The third thought I want to plant firmly in your mind at 我想牢牢植入你脑海中的第三个想法是
the outset is this. Up to the time this is being written, cardiologists have, for some strange reason, virtually always done everything wrong and never yet done anything right -an amazing situation which I shall explore in detail in a later chapter. Of course, I should add that there are quite a number of individual cardiologists who are now using what I know to be the correct method of preventing and treating coronary thrombosis. What I have said does apply, however, to cardiologists as a group-to the majority of people in the field. 一开始就是这样。直到本文写成时，心脏病专家出于某种奇怪的原因，几乎总是做错事，从未做对过任何事——这是一个令人惊讶的情况，我将在后面的章节中详细探讨。当然，我应该补充说，现在确实有相当多的心脏病专家正在使用我所知道的预防和治疗冠状动脉血栓形成的正确方法。然而，我所说的确实适用于作为一个整体的心脏病专家——即该领域的大多数人。
If you become a heart patient, you will get no help from the usual cardiologist, except perhaps an accurate diagnosis. (You will also be treated for symptoms and complications, of course, but this does not really amount to getting assistance with your basic problems.) Nonetheless, you may well have to undergo dangerous and uncomfortable major procedures or take drugs which often cause side-effects and complications. And eventually your cardiologist may conclude that he cannot do much for you. 如果你成为心脏病患者，通常的心脏病专家不会给你任何帮助，除了可能做出准确的诊断。（当然，你也会接受症状和并发症的治疗，但这并不是真正帮助你解决基本问题。）尽管如此，你很可能不得不接受危险且不舒服的大型手术，或服用常常引起副作用和并发症的药物。最终，你的心脏病专家可能会得出结论，认为他对你无能为力。
If a cardiologist believes that he cannot help you, he will sometimes refer you to a surgeon. In the surgeon’s office you may be advised to undergo the latest in a rather long and growing list of surgical procedures, all except the current one having been used for periods ranging from months to years on thousands of patients by many enthusiastic, highly skilled surgeons. Yet each of these procedures has been abandoned in turn-which means that it proved useless, that the suffering and pain or death of the patients was in vain. At least, that is what I believe any thinking man or woman-and certainly any thinking doctor-must now conclude. And the current operation, in my opinion, may well be the worst of the lot. 如果一位心脏病专家认为他无法帮助你，他有时会把你转介给外科医生。在外科医生的诊所里，你可能会被建议接受最新的一种手术，这种手术是在一长串不断增加的手术程序中最新的一种，除了当前的手术外，其他手术都曾被许多热情且技术高超的外科医生在成千上万的患者身上使用过，时间从几个月到几年不等。然而，这些手术程序都相继被放弃了——这意味着它们被证明是无效的，患者的痛苦、折磨甚至死亡都是徒劳的。至少，我相信任何有思考能力的人——当然也包括任何有思考能力的医生——现在都必须得出这个结论。而在我看来，目前的手术可能是所有手术中最糟糕的一种。
The results of drug therapy have been similarly disappointing. Although some drugs give temporary relief, not one-with the exception of digitalis, which I shall discuss 药物治疗的结果同样令人失望。虽然一些药物能暂时缓解症状，但没有一种药物能持久有效——除了洋地黄，我将在后文讨论。
later-has been shown to improve the basic condition of the heart: they are effective only in removing symptoms, or in treating complications. 后来已被证明能改善心脏的基本状况：它们仅在消除症状或治疗并发症方面有效。
In the next chapter I shall demonstrate that drug therapy, surgery and another popular prescription-extended bed rest-are unlikely to solve the underlying problems of heart attack victims. Indeed, none of these will prevent a heart attack or (if you have been lucky enough to survive your first) will prevent further attacks. 在下一章中，我将证明药物治疗、手术以及另一种流行的处方——延长卧床休息——不太可能解决心脏病发作患者的根本问题。事实上，这些方法都无法预防心脏病发作，或者（如果你足够幸运地活过了第一次发作）防止进一步的发作。
I know that these are pretty sweeping statements. Whether you are a physician or a layman, I do not expect you to accept them without definite support from the medical literature and from statements by medical school professors and certified specialists in cardiology. These will be presented as I proceed. 我知道这些说法相当笼统。无论你是医生还是外行，我都不指望你在没有医学文献明确支持以及医学院教授和认证心脏病专家的陈述的情况下接受它们。这些内容将在我接下来的讲述中呈现。
I shall also substantiate what I say with a number of examples and case histories. (You will find many others -six or seven dozen, in fact-in my earlier book, Vitamin EE for Ailing and Healthy Hearts.) 我还将用许多例子和病例历史来证明我的观点。（你会在我早期的著作《Vitamin EE for Ailing and Healthy Hearts》中找到更多类似的例子——实际上有六七十个。）
Some readers, I am sure, will already be convinced that what I am saying is true. They will have come to this conclusion because of their own experience or that of a family member or friend. If you are one of these, you may want to skip the next few chapters and go on to later sections of this book which will detail for you the very real help that has been available for the last twenty-seven years and that is now obtainable from a growing number of certified cardiologists and generalists in every civilized country in the world. For although the majority of doctors do not treat heart attack victims in the way I recommend, a great many now do. 我相信有些读者已经确信我所说的是真实的。他们之所以得出这个结论，是因为他们自己或家人、朋友的经历。如果你是其中之一，你可能想跳过接下来的几章，直接阅读本书后面的章节，这些章节将详细介绍过去二十七年来一直有效且现在在世界上每个文明国家越来越多的认证心脏病专家和全科医生那里都能获得的真实帮助。尽管大多数医生并不按照我推荐的方式治疗心脏病发作患者，但现在确实有很多医生这样做。
If you are interested in the reasons why this different approach to cardiovascular disease is not more commonly used, you will find some of the later chapters of this book very enlightening. This is so, even though what these chapters 如果你对为什么这种不同的心血管疾病治疗方法没有被更广泛使用的原因感兴趣，你会发现本书后面的一些章节非常有启发性。尽管这些章节内容如此，
contain amounts simply to a repetition of the experiences of very nearly every earlier pioneer in medicine-the experiences of Semmelweiss, Pasteur and Lister and, more recently, Banting and Best. The extremely important contributions of Dr. Carl J. Reich, Dr. Abraham Hoffer and Dr. Alan Cott, some of which I shall be discussing later, have also encountered the same kind of resistance. 包含的数量仅仅是几乎每一位早期医学先驱的经历的重复——塞梅尔维斯、巴斯德和李斯特，以及最近的班廷和贝斯特的经历。卡尔·J·赖希博士、亚伯拉罕·霍弗博士和艾伦·科特博士的一些极其重要的贡献（我稍后将讨论其中一些）也遭遇了同样的抵制。
Dr. Walter C. Alvarez (3) has summed up the situation very well. He states that in 1875, when Lister first spoke in the United States, physicians in the audience informed him that no surgeons in their home states used the method he had pioneered more than a decade before. And Alvarez recalls that in 1903 and 1906 Lister’s work was still being ignored by some great American surgeons of Alvarez’ acquaintance. It appears that the lessons of history must be relearned by each generation. 沃尔特·C·阿尔瓦雷斯博士（3）很好地总结了这一情况。他指出，1875 年，当李斯特首次在美国发表演讲时，听众中的医生告诉他，在他们所在的州，没有外科医生使用他十多年前开创的方法。阿尔瓦雷斯回忆说，在 1903 年和 1906 年，李斯特的工作仍被他认识的一些美国著名外科医生所忽视。历史的教训似乎必须由每一代人重新学习。
Please, reader, think carefully about what I shall tell you in this book. If you do not heed the information I shall give you, you have, as of now, no way of preventing a heart attack. 请读者仔细思考我将在本书中告诉你的内容。如果你不重视我将提供的信息，从现在起，你将无法预防心脏病发作。
In October 1970, the Medical Post quoted Dr. Bernard Lown, Assistant Professor of Cardiology at Peter Bent Brigham Hospital in Boston, to the effect that 65 percent of those who sustain a “heart attack” in the United States die instantly or are dead on arrival at the hospital. Other sources have put the percentage considerably lower but still, think for a moment about Dr. Lown’s statistic and what it means. Then think further about survival rates in the hospital. Depending on the statistics of different hospitals, your chance of dying if you reach the hospital alive may be as high as 40 percent, leaving you with a 21 percent chance of surviving the original attack. If you have already had a coronary thrombosis, you have no protection against another-and another is an altogether likely occurrence unless you do protect yourself, since you have already shown yourself to be susceptible 1970 年 10 月，《Medical Post》引用了波士顿 Peter Bent Brigham 医院心脏病学助理教授 Bernard Lown 博士的话，称美国 65%的“心脏病发作”患者会立即死亡或到达医院时已死亡。其他来源给出的比例要低得多，但仍然，请稍微考虑一下 Lown 博士的统计数据及其含义。然后进一步考虑医院内的存活率。根据不同医院的统计数据，如果你活着到达医院，死亡的几率可能高达 40%，这意味着你存活原发病发作的几率只有 21%。如果你已经患有冠状动脉血栓症，你对再次发作没有任何保护——除非你采取保护措施，否则再次发作是非常可能的，因为你已经表现出易感性。
to intravascular clotting (formation of blood clots in the vessels) which is the immediate cause of such attacks in most instances. 导致血管内血栓形成（血管内血块的形成），这是大多数情况下此类发作的直接原因。
Believe me, I do not enjoy telling you this. I certainly don’t want to alarm you unnecessarily, but I think it is better to know these things than not to know them. And I can offer you something positive: the information that there is a way to prevent heart attacks by providing the bloodstream with an adequate amount of a substance it requires which is known as alpha tocopherol or “Vitamin E.” I shall tell you what it is, how and why it works in this way, and why many doctors today are using it more all the time, or are at least willing to try it. 相信我，我并不喜欢告诉你这些。我当然不想无故让你惊慌，但我认为知道这些事情总比不知道要好。我可以给你一些积极的信息：有一种方法可以通过为血液提供足够量的一种物质来预防心脏病发作，这种物质被称为 alpha tocopherol 或“维生素 E”。我将告诉你它是什么，如何以及为什么它以这种方式起作用，以及为什么如今许多医生越来越多地使用它，或者至少愿意尝试它。
So please, read on and consider what I have to say. I know you won’t accept anything you read-whether it’s by me or anyone else-without evidence. And of course you shouldn’t. But do look at the evidence I shall present, and think about what it means. 所以请继续阅读并考虑我所说的内容。我知道你不会接受任何你所读到的东西——无论是我写的还是其他人的——没有证据。当然，你也不应该接受。但请看看我将呈现的证据，思考它的意义。
You may live longer because you did. 你可能会活得更久，因为你确实做到了。
REFERENCES 参考文献
Dock, G. Journal of the American Medical Association 113, 563, 1939. Dock, G. 美国医学会杂志 113, 563, 1939.
Herrick, J.B. Journal of the American Medical Association 59, 2015, 1912. Herrick, J.B. 美国医学会杂志 59, 2015, 1912。
DRUG THERAPY, BED REST AND SURGERY were mentioned in Chapter 1 as popular modes of treatment that are unlikely to solve the underlying problems of heart attack victims. I said that in general these methods don’t work and that I would support this statement with references to medical literature and authorities. This means that this present chapter is going to be mainly negative in tone, but I don’t see any way around that. After all, I can hardly expect any sensible person to accept new ideas unless I can first demonstrate that the old ones have to be replaced. 药物治疗、卧床休息和手术在第一章中被提及为流行的治疗方式，但这些方法不太可能解决心脏病发作患者的根本问题。我说过，通常这些方法不起作用，我将通过引用医学文献和权威资料来支持这一说法。这意味着本章的基调主要是负面的，但我认为没有其他办法。毕竟，除非我首先证明旧观念必须被取代，否则我很难指望任何理智的人接受新观点。
To help you to see what’s wrong with the usual kind of treatment, let me start by asking you to imagine that you are a heart attack victim who has been lucky enough to reach the hospital alive. Let’s assume that the doctor you get, on this occasion, is one who follows conventional procedures. Now let’s see what happens. 为了帮助你了解常规治疗方法的问题所在，让我先请你想象自己是一名幸运地活着到达医院的心脏病发作患者。假设这次你遇到的医生是遵循传统程序的医生。现在让我们看看会发生什么。
There are several kinds of treatment that may be given to you, depending mostly on the tradition of the hospital you’re in, the extent to which its practices are dominated by the views of the department heads-and what these views may be. Most or all of these will probably be familiar to you; they certainly will be, of course, if you are a doctor. 根据你所在医院的传统、各科室主任的观点及其影响程度，可能会给你提供几种不同的治疗方法。这些治疗方法大多或全部你可能都很熟悉；当然，如果你是医生的话，更是如此。
You may, for example, be placed in an intensive care unit or in a special version of this called a coronary care unit, and there hooked up to a monitor. You will be given morphine to decrease or remove the pain arising from the anoxic (oxygen-starved) heart muscle. (Besides morphine’s pain-killing function, its second job, according to the textbooks, is to “allay apprehension.”) 例如，你可能会被安置在重症监护病房，或者在其特殊版本——冠状动脉监护病房，并连接到监视器上。你将被给予吗啡以减少或消除因缺氧（缺氧）心肌引起的疼痛。（除了吗啡的止痛功能外，根据教科书，它的第二个作用是“缓解焦虑”。）
You may be kept in bed for six weeks or longer, with or without oxygen at the beginning of this period. In most hospitals the patient admitted following an acute coronary occlusion is put in an oxygen tent-which very likely has very little value, since the area of the heart causing the symptoms is the area deprived of blood supply by obstruction of the artery or arterial branch that had been supplying it-and oxygen, therefore, cannot get by the obstruction. Being put in an oxygen tent can distress the patient and is therefore useful chiefly in satisfying the relatives that something worthwhile is being done. 你可能需要卧床六周或更长时间，开始时可能有或没有吸氧。在大多数医院，急性冠状动脉闭塞后入院的患者会被放入氧气帐篷——这很可能几乎没有什么价值，因为引起症状的心脏区域是被阻塞的动脉或动脉分支所供应的区域，氧气因此无法通过阻塞。被放入氧气帐篷可能会使患者感到不适，因此主要是为了让家属觉得正在采取有意义的措施。
You may also be given oral or intravenous vasodilators, or both. These drugs tend to dilate the coronary artery, and some of them have a very brief action span. And you may be given anticoagulants (drugs which prolong the prothrombin time and so delay clotting in the blood). 你也可能会被给予口服或静脉注射的血管扩张剂，或者两者兼用。这些药物倾向于扩张冠状动脉，其中一些作用时间非常短暂。你也可能会被给予抗凝剂（延长凝血酶原时间，从而延缓血液凝固的药物）。
I shall have quite a lot to say about anticoagulants. But before I go into this, let me make one thing clear. Even though I am skeptical concerning the value of drugs in general to alter the basic, underlying condition of the heart, it is our custom now, in treating cardiac patients, to use all useful and sensible 我将会谈很多关于抗凝剂的内容。但在我开始之前，让我先澄清一件事。尽管我对药物在改变心脏基本、根本状况方面的价值持怀疑态度，但我们现在治疗心脏病患者的惯例是使用所有有用且合理的手段。
forms of treatment available, even though all the drugs except digitalis are for symptomatic relief. (As to digitalis, I shall, as I have said, deal with this in some detail in later chapters.) 可用的治疗方法，尽管除地高辛外所有药物都是用于缓解症状。（关于地高辛，正如我所说，我将在后面的章节中详细讨论。）
The one exception to this custom is anticoagulants. These we do not use. 唯一的例外是抗凝剂。我们不使用这些。
The history of the widespread use of anticoagulant drugs, of which there are several, begins with the publication in 1948 of a paper by Drs. I.S. Wright, C.D. Marple and D.R. Beck (1). They stated that anticoagulants, given for the first four weeks after acute myocardial infarction, reduced the mortality rate by approximately one-half. This report was immediately confirmed by others and the treatment was very quickly adopted by virtually all cardiologists and soon afterward by nearly all general practitioners. 抗凝药物的广泛使用历史始于 1948 年 I.S. Wright 博士、C.D. Marple 博士和 D.R. Beck 博士发表的一篇论文（1）。他们指出，急性心肌梗死后头四周使用抗凝药物，可将死亡率降低约一半。该报告立即得到了其他人的证实，这种治疗方法很快被几乎所有心脏病专家采用，不久后几乎所有全科医生也开始使用。
Following its introduction, many thousands of patients were subjected to this treatment. New laboratory facilities were set up and technicians were hired and trained to move around the wards taking blood samples, running prothrombin (clotting) times, entering figures on charts and keeping nurses and doctors busy adjusting patients’ doses. In many cases, anticoagulant therapy was continued for months or years after the patient left the hospital. These drugs caught on to such an extent that at one time a physician could actually be accused of malpractice for not using them! 在引入该治疗后，成千上万的患者接受了这种治疗。新的实验室设施被建立，技术人员被雇佣和培训，负责在病房内采集血样，进行凝血酶原时间测试，记录数据，并让护士和医生忙于调整患者的剂量。在许多情况下，抗凝治疗在患者出院后仍持续数月甚至数年。这些药物非常流行，以至于曾有医生因未使用它们而被指控医疗事故！
Yet in 1959, a report (2) concerning complications appeared in The Lancet. It said that among 217 patients treated with anticoagulants for up to three years, 105 had had a total of 194 bleeding episodes. Of these 139 were mild, 31 moderate and 24 severe. Three of the twenty-four died of hemorrhages. The scientist who analyzed the situation recommended that such treatment might best be restricted to “patients who can be expected to understand the dangers involved in this treatment and to recognize bleeding at the earliest possible moment.” 然而在 1959 年，《柳叶刀》上发表了一篇关于并发症的报告（2）。报告称，在 217 名接受抗凝治疗长达三年的患者中，有 105 人共发生了 194 次出血事件。其中 139 次为轻度，31 次为中度，24 次为重度。24 例重度出血中有 3 人因出血死亡。分析情况的科学家建议，这种治疗最好限制在“那些能够理解此治疗所涉及的危险并能在最早时刻识别出血的患者”身上。
In 1962 an editorial in the Canadian Medical Association Journal took note of reports which, it said, “cast doubt” on the value of anticoagulant therapy. “Among these, a retrospective survey and a large clinical trial in Copenhagen have tended to confirm the impression that mortality is practically identical in treated and control groups. . . . Apparently the mortality rate from myocardial infarction must be due mainly to causes that are unaffected by anticoagulants.” 1962 年，加拿大医学会杂志的一篇社论注意到一些报告，称这些报告“对抗凝治疗的价值提出了质疑”。“其中，一项回顾性调查和哥本哈根的一项大型临床试验倾向于确认这样一种印象：治疗组和对照组的死亡率几乎相同……显然，心肌梗死的死亡率主要是由于抗凝剂无法影响的原因造成的。”
The same editorial went on to mention other reported complications: cardiac rupture, hemopericardium (blood collecting inside the sac which encloses the heart) and subdural hematoma (blood collecting under the outer lining of the brain inside the skull). The possibility that “minor degrees of intracranial bleeding are probably not uncommon as a complication of this form of treatment” was also mentioned. It was suggested that among patients with acute myocardial infarction, only those with complicating venous thrombosis and/or pulmonary embolism (blood clot or clots in the lung) might eventually be considered as having “the only certain indications for the administration of anticoagulants.” 同一篇社论还提到了其他报道的并发症：心脏破裂、心包积血（血液积聚在包裹心脏的囊内）和硬膜下血肿（血液积聚在颅骨内脑的外层膜下）。还提到“轻度颅内出血作为这种治疗形式的并发症可能并不罕见”。有建议认为，在急性心肌梗死患者中，只有那些伴有静脉血栓形成和/或肺栓塞（肺部血块）并发症的患者，最终才可能被认为是“使用抗凝剂的唯一明确指征”。
Since then, many more articles have appeared, such as that in 1962 by Dr. Richards (3) in the British Medical Journal. Richards found that mortality “remained constant, at about 33 percent whether or not patients were given anticoagulants.” Drs. Liebow and Badger (4), writing in a 1963 issue of the Journal of Chronic Diseases, came to much the same conclusion. “The mortality rate in patients who did not receive anticoagulants,” they said, “was similar to the rate in those who did.” 从那时起，出现了更多的文章，例如 1962 年 Dr. Richards 在《British Medical Journal》上的文章（3）。Richards 发现死亡率“无论患者是否接受抗凝剂，均保持在约 33％的恒定水平。”Drs. Liebow 和 Badger（4）在 1963 年《Journal of Chronic Diseases》的一期中写道，得出了几乎相同的结论。他们说：“未接受抗凝剂的患者的死亡率与接受抗凝剂的患者的死亡率相似。”
In the following year an article by Drs. Brown and MacMillan in the Canadian Medical Association Journal stated that the use of heparin (an anticoagulant) in acute myocardial infarction and acute coronary insufficiency had been accepted without controlled clinical trial. Brown and MacMillan, in a 在接下来的一年，加拿大医学会杂志上布朗博士和麦克米兰博士发表的一篇文章指出，急性心肌梗死和急性冠状动脉功能不全中使用肝素（一种抗凝剂）是在没有受控临床试验的情况下被接受的。布朗和麦克米兰在一篇文章中提到，
study of their own, concluded that early intermittent intravenous heparin treatment did not cut mortality in patients with acute myocardial infarction. It also failed, they said, to “prevent impending myocardial infarction in patients with acute coronary insufficiency.” 他们自己进行的研究得出结论，早期间歇性静脉注射肝素治疗并未降低急性心肌梗死患者的死亡率。他们还表示，这种治疗未能“预防急性冠状动脉功能不全患者即将发生的心肌梗死。”
In 1965 the same authors discussed the literature on anticoagulants in the same journal. An abstract of that article summarizes it by saying that the authors’ experience with them has been disappointing and that their review of the literature “has failed to establish benefit when all patients with coronary artery disease are treated with anticoagulant drugs.” It was concluded that (after about eighteen years) there was a need for well-controlled studies of anticoagulant therapy. 1965 年，同一作者在同一杂志上讨论了抗凝剂的文献。该文章的摘要总结说，作者们对抗凝剂的使用经验令人失望，他们对文献的回顾“未能证明对所有冠状动脉疾病患者使用抗凝药物有益”。结论是（经过大约十八年）需要对抗凝治疗进行严格控制的研究。
In 1967, also in the Canadian Medical Association Journal, Dr. J.F. Mustard summed up the situation as to long-term therapy in the wake of myocardial infarcts in the following words: “Despite initial reports of a substantial benefit for treated patients, subsequent studies with adequately treated and control groups showed only a marginal benefit. There appears to be a moderate reduction in the frequency of new infarcts and some decrease in mortality.” He noted that in most of the studies, the benefits were evident only in patients under sixty and that the benefits must, in any case, be “evaluated against the complications . . . in particular, hemorrhage.” 1967 年，加拿大医学会杂志上，J.F. Mustard 博士总结了心肌梗死后长期治疗的情况，他说：“尽管最初有报告显示治疗患者有显著益处，但随后有充分治疗和对照组的研究仅显示出边际益处。新发梗死的频率似乎有适度减少，死亡率也有所下降。”他指出，在大多数研究中，益处仅在六十岁以下的患者中明显，而且这些益处无论如何都必须“与并发症……特别是出血”进行权衡评估。
At the thirty-ninth scientific session in 1967 of the American Heart Association, Dr. Arthur J. Seaman and colleagues at the University of Oregon reported the results of a ten-year double-blind study on the use of anticoagulants. These investigators recommended discontinuance of all long-term prophylactic (preventive) therapy with these drugs. 在 1967 年美国心脏协会第 39 届科学会议上，俄勒冈大学的 Arthur J. Seaman 博士及其同事报告了一项为期十年的抗凝剂双盲研究结果。这些研究人员建议停止所有长期预防性使用这些药物的治疗。
An editorial (5) in the British Medical Journal in 1970 reviewed the published reports and concluded: “The inherent 1970 年《英国医学杂志》上的一篇社论（5）回顾了已发表的报告并得出结论：“固有的
danger of this form of treatment, together with the absence of any evidence of benefit, indicates that the time has come to abandon the long-term use of anticoagulants after myocardial infarction.” 这种治疗方法的危险性，加上缺乏任何益处的证据，表明是时候放弃心肌梗死后长期使用抗凝剂了。
Perhaps the most complete recent summation is to be found in an editorial published in August 1970 in the Journal of the American Medical Association with the interesting title, “An Exercise in Futility.” It refers to a report (6) from an international review group with members from Sweden, Canada (including Brown and MacMillan), Denmark, the United States and the United Kingdom who were unable to reach any definite conclusions but agreed on the need for future controlled trials of anticoagulant drugs. 也许最近最完整的总结可以在 1970 年 8 月发表在《美国医学会杂志》上的一篇社论中找到，标题颇具趣味，名为“徒劳的尝试”。该文提到了一份来自一个国际评审小组的报告（6），该小组成员来自瑞典、加拿大（包括 Brown 和 MacMillan）、丹麦、美国和英国，他们未能得出任何明确结论，但一致同意未来需要对抗凝药物进行受控试验。
The editorial asks: “Is there really a need for such trials? . . . Surely, years of experience with thousands of patients should have led by now to unequivocal conclusions, had anticoagulants in fact, played an important prophylactic role.” It is concluded that additional studies might be “exercises in futility.” 社论问道：“真的有必要进行这样的试验吗？……多年来对数千名患者的经验，若抗凝剂确实在预防中起重要作用，理应早已得出明确结论。”结论是，额外的研究可能是“徒劳的尝试”。
Think of the number of years it took university professors, cardiologists and others to discover this! And think of the fact that this form of treatment is still being used at this moment in most hospitals! Surely doctors who do this must know by now that its usefulness has been seriously questioned and that there are definite dangers. Nevertheless, this treatment continues to be used! 想想大学教授、心脏病专家和其他人花了多少年才发现这一点！再想想这个治疗方法至今仍在大多数医院使用！医生们肯定早已知道其有效性已受到严重质疑，并且存在明确的危险。然而，这种治疗仍在继续使用！
Such a situation highlights a major problem in science. This is that the opinion of the majority is very often wrong. One suggested new treatment may be adopted quickly and readily, yet another that is just as effective or more so may be ignored. Worthwhile advances in medicine are too often adopted slowly by the minority and in too many cases meet immediate, unreasoning opposition from politically promi- 这种情况突显了科学中的一个重大问题。那就是多数人的观点往往是错误的。一种建议的新治疗方法可能会被迅速且轻易地采纳，而另一种同样有效甚至更有效的方法却可能被忽视。医学上的有价值进展往往被少数人缓慢采纳，并且在许多情况下会立即遭到政治上显赫人物的无理反对。
nent members of the medical profession and from doctors who are reluctant to admit that they don’t know everything about everything. If a report casts doubt on an accepted practice, it can be a long time before its message is fully implemented. 医学界的部分成员以及那些不愿承认自己对所有事情都不了解的医生。如果一份报告对一种被接受的做法提出质疑，其信息可能需要很长时间才能被完全采纳。
At the beginning of this chapter I mentioned that if you were a heart attack patient you might be kept in bed for six weeks or longer. Strict bed rest for six weeks, followed by a six-week gradual return to activity, was the treatment universally used until about 1951, and it is still used in many places. Many hospitals, however, now stress early ambulation-a much better approach. They’ll get you up after the first few days and send you home at the end of three weeks. But even in these hospitals, it’s customary to immobilize a heart attack victim in the intensive care unit or coronary care unit for the first few days. 在本章开头我提到过，如果你是心脏病发作患者，可能需要卧床六周或更长时间。严格卧床休息六周，随后六周逐渐恢复活动，是直到 1951 年左右普遍采用的治疗方法，至今在许多地方仍在使用。然而，许多医院现在强调早期活动——这是一种更好的方法。他们会在最初几天后让你起床，并在三周结束时让你出院。但即使在这些医院，通常也会在重症监护病房或冠状动脉护理病房将心脏病发作患者固定卧床几天。
Hospitals are proud of their intensive care units with their expensive equipment, their specially trained nurses and the nearness of emergency resuscitation teams. You have probably developed a high regard for their efficiency. You may therefore be surprised to learn that although many cardiologists have reported decreased death rates in such units, others have questioned their value. 医院为其配备昂贵设备、专门培训的护士以及紧急复苏团队的重症监护病房感到自豪。你可能已经对它们的效率产生了高度评价。因此，你可能会惊讶地得知，尽管许多心脏病专家报告了这些病房死亡率的下降，但也有一些人质疑它们的价值。
A report in a 1963 issue of Applied Therapeutics quotes a paper by Drs. Brown, MacMillan, Forbath and Mellagrani concerning such a unit in the Toronto General Hospital, a teaching hospital affiliated with the University of Toronto. The report states that an intensive care unit was set up “because of the distressingly high mortality ( 40 per cent) among patients with coronary thrombosis” in the hospital. Later that same year this same group (7) stated that the death rate had dropped to 36 percent, a statistically insignificant difference. 1963 年《应用治疗学》杂志上的一篇报告引用了布朗博士、麦克米兰博士、福尔巴斯博士和梅拉格拉尼博士关于多伦多总医院（多伦多大学附属教学医院）该病房的论文。报告指出，设立重症监护病房是因为医院中冠状动脉血栓患者的死亡率令人痛心地高达 40%。同年晚些时候，该团队（7）表示死亡率已降至 36%，这一差异在统计学上无显著意义。
At the Rigshospital in Copenhagen, according to Profes- 在哥本哈根的 Rigshospital，根据 Profes-
sor Tybjaerg Hanse, the mortality rate among those admitted to the coronary care unit actually rose from 31.4 percent to 40.4 percent. 在冠心病监护病房入院的患者中，死亡率实际上从 31.4%上升到了 40.4%。
Some, though not all, other reports are more favorable. But except for one study which claims a reduction from 33 to 19 percent through the use of a coronary care unit, the papers I have seen generally suggest an immediate mortality rate of 36 to 40 percent. 一些（但不是全部）其他报告更为乐观。但除了一项研究声称通过使用冠心病护理单元将死亡率从 33%降至 19%外，我所见的论文普遍表明即时死亡率为 36%至 40%。
In sharp contrast with these rates was the rate of 9.9 percent achieved in a study reported by Dr.S.A. Levine in the American Heart Journal in 1951 and in the Journal of the American Medical Association in 1952. (I have referred to Dr. Paul Dudley White as one of America’s two original cardiologists. Dr. Levine is the other.) In these papers back in 1951 and 1952 Dr. Levine wrote that by merely sitting coronary thrombosis patients up in comfortable armchairs as soon as they were out of pain, and by giving them bathroom privileges, he had dropped the death rate to 9.9 percent. 与这些比率形成鲜明对比的是，1951 年 Dr.S.A. Levine 在《American Heart Journal》和 1952 年《Journal of the American Medical Association》报道的一项研究中实现的 9.9%的死亡率。（我曾提到 Dr. Paul Dudley White 是美国最早的两位心脏病学家之一，Dr. Levine 是另一位。）在 1951 年和 1952 年的这些论文中，Dr. Levine 写道，仅仅通过在冠状动脉血栓患者一旦脱离疼痛后就让他们坐在舒适的扶手椅上，并允许他们使用洗手间，他就将死亡率降到了 9.9%。
Like many other great discoveries, this one was actually very simple! Dr Levine had difficulties, however, in gaining the cooperation of the patient’s physician, the residents, interns and nurses. The very title he used to introduce his findings, “The Myth of Bed Rest in the Treatment of Coronary Thrombosis,” suggests that he knew he was flying in the face of much well-established practice. 像许多其他伟大发现一样，这个发现实际上非常简单！然而，Levine 博士在获得患者的主治医生、住院医师、实习医生和护士的配合方面遇到了困难。他用来介绍自己发现的标题“冠状动脉血栓治疗中卧床休息的迷思”表明，他知道自己是在挑战许多已确立的惯例。
A Swedish study (8) reported in 1958 also achieved good results with this method. One group of 112 patients was treated in armchairs and given anticoagulants. Another one hundred patients were treated in armchairs but without anticoagulants. A third group of eighty was treated with bed rest and anticoagulants. The mortality rates were 10,15 and 26 percent respectively. (About half of the subjects had had previous myocardial infarctions, whereas Dr. Levine’s patients were a group in which about one-third had earlier 1958 年一项瑞典研究（8）也用这种方法取得了良好效果。一组 112 名患者在扶手椅中接受治疗并服用抗凝剂。另一组 100 名患者在扶手椅中接受治疗但未服用抗凝剂。第三组 80 名患者卧床休息并服用抗凝剂。死亡率分别为 10%、15%和 26%。（约一半的受试者曾有过心肌梗死，而 Levine 博士的患者中约有三分之一曾有过心肌梗死）
coronary, thrombosis in their histories.) 冠状动脉，病史中有血栓形成。)
The Journal of the American Medical Association, summarizing the Swedish report in 1959, stated that the purpose of the armchair in that study "was not to increase the effort of the patients, but, on the contrary, to ease the burden of the heart muscle . . . Armchair treatment seemed to constitute a good prophylactic measure against embolic complications 《美国医学会杂志》在总结 1959 年瑞典报告时指出，该研究中扶手椅的目的“不是增加患者的努力，而是相反，减轻心肌的负担……扶手椅治疗似乎构成了一种预防栓塞并发症的良好措施”。
The armchair treatment has been shown to be much superior to bed rest, and fortunately it is gaining headway in certain places-for example, in the Harper Hospital in Detroit. Other centers, rather than accept this radical change, have compromised on intensive care for the first few days with early ambulation and discharge within three weeks. 坐椅治疗已被证明远优于卧床休息，幸运的是，它在某些地方正在逐渐推广——例如，底特律的哈珀医院。其他中心则不愿接受这一根本性的改变，而是采取折衷方案：前几天进行强化护理，随后早期活动，并在三周内出院。
To the extent that early ambulation is now accepted as the correct treatment, the accepted treatment preceding it must have been wrong-not just not good, but very wrong. The statistics suggest, in fact, that it must have killed many coronary victims who would otherwise have survived. 在早期活动现已被接受为正确治疗的程度上，之前被接受的治疗一定是错误的——不仅仅是不好，而是非常错误。统计数据显示，事实上，这种治疗可能导致许多本可存活的冠心病患者死亡。
Similarly, it is obvious that the coronary care unit today is more effective in reassuring the patient’s family and friends than it is in treating the patient. It may well be that many of the arrhrythmias (irregularities in a person’s heartbeats) and cardiac arrests that are detected by their sophisticated equipment would not occur if only Dr. Levine’s simple but radical procedure were followed. 同样，显而易见的是，今天的冠心病监护病房在安慰患者的家人和朋友方面比治疗患者更有效。很可能，许多通过其先进设备检测到的心律失常（心跳不规则）和心脏骤停，如果仅遵循 Levine 医生简单但激进的程序，是不会发生的。
You will have noticed, by now, that I am less than enthusiastic about anticoagulants and bed rest. I am equally 你现在应该已经注意到，我对抗凝剂和卧床休息并不热衷。我同样...
skeptical about the value of surgery for heart attack victims. 对心脏病发作患者手术价值持怀疑态度。
Great advances in the fields of anesthesia and surgical technique have made it inevitable that surgeons would become involved with the heart. And the development of mechanical pumps and artificial valves and of the ability to lower the patient’s body temperature have made heart surgery progressively safer. Surgeons, accordingly, have devised many procedures for the correction of congenital anomalies, lesions caused by rheumatic fever, and coronary artery disease and its symptoms. They have had a distinct advantage in that they did not have the incubus of the doubleblind study hanging around their necks. None of the surgical procedures has ever been subjected to close “scientific” scrutiny before being proposed, carried out, reported and generally adopted! 麻醉和外科技术领域的重大进展使得外科医生不可避免地会涉及心脏手术。机械泵和人工瓣膜的发展以及降低患者体温的能力使心脏手术变得越来越安全。因此，外科医生设计了许多用于矫正先天性异常、风湿热引起的病变以及冠状动脉疾病及其症状的手术方法。他们有一个明显的优势，那就是没有双盲研究的束缚。没有任何外科手术在被提出、实施、报告和普遍采用之前，曾经接受过严格的“科学”审查！
Certainly heart surgery which corrects congenital anomalies constitutes a great victory for medicine. The ablation of persistent ductus arteriosis, for example, leads to complete recovery. (This is a condition in which a blood vessel connecting the pulmonary artery to the aorta fails to close off, as it should, before a child is born. Ablation is the procedure for correcting this.) 当然，纠正先天性异常的心脏手术是医学的一大胜利。例如，闭合动脉导管未闭的手术可以实现完全康复。（这是一种血管连接肺动脉和主动脉，在孩子出生前未能如应关闭的情况。闭合术是纠正这种情况的手术。）
Surgery for coronary artery disease, however, is something entirely different. 然而，冠状动脉疾病的手术则完全不同。
An editorial in the Journal of the American Medical Association for 27 July 1970 lists some of the procedures used during the preceding twenty-five years in surgery for coronary artery disease. Among them are: 1970 年 7 月 27 日《美国医学会杂志》的一篇社论列举了过去二十五年中用于冠状动脉疾病手术的一些程序。其中包括：
cervical ganglionectomy (removal of nerve cells near the upper end of the spinal cord in order to prevent certain impulses from reaching the heart muscle) 颈神经节切除术（切除脊髓上端附近的神经细胞，以防止某些冲动传达到心肌）
thyroidectomy or radioactive iodine thyroid 甲状腺切除术或放射性碘甲状腺治疗
ablation (two different methods of removing the thyroid gland in order to reduce metabolic demands on the heart muscle) 消融（两种不同的方法去除甲状腺，以减少心肌的代谢需求）
various procedures such as epicardiectomy (surgical removal of part of the outer sac surrounding the heart) and omental grafts (a procedure involving a membrane in the abdominal area) for the purpose of inducing collateral circulation (making it possible for other blood vessels to do the work of vessels in the heart that have been damaged). 各种手术程序，如心包切除术（外科切除包围心脏的外膜部分）和网膜移植术（涉及腹部区域膜的一种手术），目的是诱导侧支循环（使其他血管能够替代受损心脏血管的功能）。
Although the editorial notes a revival of interest in myocardial revascularization (surgical grafting to reestablish blood supply to the heart muscle) and encouraging reports on results of surgery, it also presents results of a study comparing surgically treated patients unfavorably with a group of medically treated patients, in spite of the fact that the patients in the latter group were more seriously ill. 尽管社论指出了对心肌血运重建（通过手术移植重新建立心肌血液供应）的兴趣复苏以及对手术结果的鼓舞性报道，但它也呈现了一项研究的结果，该研究将手术治疗患者与一组药物治疗患者进行了比较，结果对手术治疗患者不利，尽管后者组的患者病情更为严重。
Although 14 percent of the medically treated group, as compared with only 9 percent of the surgically treated group (patients who had had double arterial implantation) had myocardial infarctions during the ensuing two-year period, only 9 percent of the medically treated patients died during that time, as compared with 30 percent of the surgical group. Moreover, signs of improvement (as measured by exercise tolerance and electrocardiograms) were present in 88 percent of the medical as compared with only 20 percent of the surgical patients. (Drs. Russek and Zohman, who treated the “medical” group, used propranolol [Inderal], a drug that slows down the heart and reduces its need for oxygen, and isosorbide dinitrate, a drug that dilates the blood vessels and increases blood flow to the heart muscles, plus prescribed exercise.) 尽管在随后的两年期间，接受药物治疗组中有 14%的患者发生了心肌梗死，而接受手术治疗组（进行了双动脉移植的患者）中仅有 9%，但药物治疗组中只有 9%的患者在此期间死亡，而手术组则有 30%。此外，88%的药物治疗患者表现出改善的迹象（通过运动耐力和心电图测量），而手术患者中仅有 20%表现出改善。（治疗“药物”组的 Russek 博士和 Zohman 博士使用了普萘洛尔（Inderal），这是一种减慢心率并减少心脏需氧量的药物，以及硝酸异山梨酯，这是一种扩张血管并增加心肌血流的药物，外加规定的运动。）
It should be noted that each of the surgical procedures listed in this editorial was used on thousands of patients -and then abandoned for another procedure. Also, in contrast with the lengthy efforts involved before a new drug is approved, it would appear that new surgical procedures often are adopted with haste. This year’s “new operation” may be next year’s admitted failure. It is interesting also that the plethora of newspaper publicity that often accompanies surgical procedures-the naming of the surgeon, his picture in the paper, etc.-would lead to the expulsion of the purely medical man from his profession were he to court publicity in this manner. 应当注意的是，本社论中列出的每一种外科手术都曾用于数千名患者——然后被另一种手术取代。此外，与新药获批前所需的漫长努力相比，新外科手术往往被匆忙采用。今年的“新手术”可能就是明年的公认失败。同样有趣的是，外科手术常伴随大量报纸宣传——包括外科医生的姓名、照片等——如果纯粹的医学人员以这种方式追求宣传，将会被逐出其职业。
Like the physician, however, the surgeon readily-and without apology-abandons a mistaken procedure. The heart transplant procedure is a case-though only one case-in point. 然而，外科医生像医生一样，能够毫不犹豫且无须道歉地放弃错误的手术方法。心脏移植手术就是一个例子——虽然只是一个例子。
When it was announced amid world-wide fanfare that Dr. Christian Barnard had done the first transplant operation, many others rushed into the field, often without adequate preparation. The picture was really appalling. According to the Medical Post (6 May 1969), Dr. William R. Drucker, at that time Professor of Surgery at the University of Toronto and Surgeon-in-Chief of the Toronto General Hospital, told the annual conference of the Hospital Public Relations Officers Association of Australia that “many hospitals are carrying out heart transplants as publicity devices, without any intention of doing serious heart transplant research.” Heart transplants, he said, were causing jealousy and rivalry between hospitals. Dr. Norman Shumway stated in a 1970 issue of California Medicine that some surgeons displayed “almost irresponsible haste to get in on the acclaim.” He added that it was “almost a political thing.” 当世界范围内盛大宣布克里斯蒂安·巴纳德博士完成了首次移植手术时，许多其他人纷纷涌入这一领域，往往准备不足。情况确实令人震惊。根据《Medical Post》（1969 年 5 月 6 日）的报道，当时多伦多大学外科教授兼多伦多总医院首席外科医生威廉·R·德鲁克博士在澳大利亚医院公共关系官员协会年度会议上表示，“许多医院将心脏移植作为宣传手段，根本无意进行严肃的心脏移植研究。”他说，心脏移植引发了医院之间的嫉妒和竞争。诺曼·舒姆韦医生在 1970 年《California Medicine》杂志中指出，一些外科医生表现出“几乎是不负责任的急切，想要参与这场声誉争夺战。”他补充说，这“几乎成了一种政治行为。”
According to his wife, the first recipient, Dr. Philip Blaiberg, afterward lived a life of agony. Of the 594 days he 据他的妻子说，第一位接受者 Philip Blaiberg 医生此后过着痛苦的生活。在他 594 天的时间里
lived with a new heart, Blaiberg spent 248 in a Cape Town hospital fighting for his life. Of his days at home he spent ninety-five in bed. 带着一颗新心脏生活，Blaiberg 在开普敦的一家医院里与死神抗争了 248 天。在家中的日子里，他有九十五天卧床休息。
The first transplant was done on 3 December 1967. By August 1970 only Dr. Shumway’s surgical team was doing the operation and he was doing only ten a year. In all, 161 transplants were done, and nearly all the patients soon were dead. The cost of a single heart transplant was said to be 75 thousand dollars. 第一次移植手术于 1967 年 12 月 3 日进行。到 1970 年 8 月，只有 Shumway 医生的外科团队在进行这项手术，他每年只做十例。总共进行了 161 例移植，几乎所有患者很快都去世了。据说一次心脏移植的费用为七万五千美元。
At the time of writing, the “latest operation” is the coronary artery bypass technique developed in 1967 by surgeons in Cleveland and Milwaukee. Where a patient’s coronary artery has been narrowed by disease, a segment of the saphenous vein (a large vein in the leg) is connected to a diseased branch of the coronary artery above and below the narrowed area to serve as an alternate route for blood that would normally have passed through the coronary artery. The use of this technique has spread rapidly; it has been estimated that by early 1974 approximately a hundred thousand such operations had been performed. Opinion concerning the operation has not been unanimously favorable. 在撰写本文时，“最新手术”是 1967 年由克利夫兰和密尔沃基的外科医生开发的冠状动脉搭桥技术。当患者的冠状动脉因疾病而变窄时，会取一段大隐静脉（腿部的一条大静脉），连接到冠状动脉狭窄区域上下的病变分支，作为血液的替代通路，血液原本应通过冠状动脉流通。该技术的应用迅速普及；据估计，到 1974 年初，约有十万例此类手术已被实施。对于该手术的看法并非一致赞同。
At the annual convention of the American Medical Association in 1971, a distinguished cardiologist, Dr. Eliot Corday, stated that although about twenty thousand of these revascularizations had been done within the preceding year, there was a lack of information about survival which made it hard to be certain about the kinds of cases in which the operation should be recommended. 在 1971 年美国医学会年会上，一位著名心脏病专家 Eliot Corday 博士表示，尽管在前一年内大约进行了两万次此类血运重建手术，但关于生存率的信息缺乏，使得很难确定应推荐手术的病例类型。
Excerpts from Dr. Corday’s remarks were published as an editorial in the Journal of the American Medical Association (9). “We already know,” he says, “that one year after revascularization about 22 percent of vein grafts are occluded, 18 percent of patients have sustained a myocardial infarction, and cardiac function is worsened in 50 percent of those with previous 科尔戴医生的部分讲话摘录作为社论发表于《美国医学会杂志》(9)。“我们已经知道，”他说，“血运重建一年后，大约 22%的静脉移植物闭塞，18%的患者发生了心肌梗死，50%的既往患者心脏功能恶化。”
myocardial damage.” He goes on to note that “reliable statistics, which would enable us to determine if the new surgical procedures extend life, are not yet available for revascularization.” Corday pleads for establishment of registries to study survival and results other than decrease in pain reported by angina patients. (Since patients with angina pectoris-a condition whose name means, literally, pain in the chest-have been known to gain relief from placebos and sham operations, such reports cannot be considered hard evidence by which to judge the success of revascularization.) 心肌损伤。”他接着指出，“可靠的统计数据尚不可得，这些数据能让我们确定新的外科手术是否延长了生命，尤其是对于血运重建手术。”Corday 呼吁建立登记系统，以研究生存率和除心绞痛患者报告的疼痛减轻之外的结果。（由于心绞痛患者——这一病名字面意思是胸痛——已知通过安慰剂和假手术获得缓解，因此此类报告不能被视为判断血运重建成功的确凿证据。）
Later in 1972 Dr. David L. Brewer, Assistant Professor of Medicine at Duke University, reported that myocardial infarctions were common occurrences during coronary bypass surgery, with one in five patients undergoing the operation suffering a myocardial infarction on the table. 1972 年晚些时候，杜克大学医学助理教授 David L. Brewer 博士报告说，冠状动脉搭桥手术中心肌梗死是常见的情况，五分之一接受手术的患者在手术台上发生心肌梗死。
Also in 1972, doctors from the Montreal Heart Institute told the annual meeting of the Canadian Cardiovascular Society that following aorto-coronary surgery a high percentage of vessels become plugged up on the proximal side of the graft (the side closer to the origin of the vessel). A study had shown that occlusion occurred in 40 to 60 percent of coronary vessels not occluded (blocked) before surgery. Lack of clinical improvement, aggravation of symptoms and frequent occurrence of myocardial infarction following this operation are thus not difficult to understand! 同样在 1972 年，蒙特利尔心脏研究所的医生在加拿大心血管学会年会上表示，主动脉冠状动脉手术后，高比例的血管在移植物近端（靠近血管起源的一侧）发生堵塞。一项研究显示，手术前未堵塞的冠状动脉中有 40%到 60%发生了闭塞。因此，手术后临床无改善、症状加重以及心肌梗死的频繁发生并不难理解！
It is interesting, in light of this, to note that on 22 February 1972 the Medical Post published an article in which it was suggested that reoperation was safe and effective for failing vein bypass grafts. The “latest thing” in 1967 was the bypass operation. In 1972 the “latest thing,” presumably, was reoperation for failing bypass. 有趣的是，鉴于此，值得注意的是，1972 年 2 月 22 日《Medical Post》发表了一篇文章，建议对失败的静脉旁路移植物进行再手术是安全有效的。1967 年的“最新事物”是旁路手术。1972 年的“最新事物”，大概是对失败旁路进行再手术。
On 6 February 1974 a report appeared in my local newspaper in Florida, the Palm Beach Post, to the effect that Dr. John David Bristow of the University of Oregon was conducting a 1974 年 2 月 6 日，我所在佛罗里达州的地方报纸《棕榈滩邮报》刊登了一则报道，内容是俄勒冈大学的 John David Bristow 博士正在进行一项研究。
study designed to evaluate the coronary artery bypass. After nearly seven years and after a hundred thousand operations, a surgeon is trying to evaluate its effectiveness on another sixty patients! 一项旨在评估冠状动脉搭桥手术的研究。经过近七年和十万次手术后，一位外科医生正试图在另外六十名患者身上评估其效果！
On 4 March 1974 Time magazine carried a comment by Dr. Russek, now Professor of Cardiology at New York Medical College. Dr. Russek claimed, in the remarks quoted by Time, that drugs and other forms of medical care are far better treatment than surgery for most angina cases. He also stated that in his opinion more lives have been lost than saved through bypass surgery and that with “patients treated in one big city institution” there is a 66 percent probability of an unsuccessful result. Either they will suffer major complications or acquire a non-functioning graft or they will die on the table. He added that although deaths in the operating room may occur in fewer than 5 percent of cases, heart attacks, brain damage, hemorrhage, kidney failure or closure of the bypass were “not uncommon.” 1974 年 3 月 4 日，《时代》杂志刊登了现任纽约医学院心脏病学教授 Russek 博士的评论。Russek 博士在《时代》引用的言论中声称，对于大多数心绞痛病例，药物和其他形式的医疗护理比手术治疗要好得多。他还表示，依他看，通过搭桥手术失去的生命比挽救的还多，并且在“某大城市一家机构治疗的患者”中，手术失败的概率为 66%。患者要么遭受重大并发症，要么获得一个不功能的移植物，或者在手术台上死亡。他补充说，尽管手术室内的死亡率可能低于 5%，但心脏病发作、脑损伤、出血、肾功能衰竭或搭桥闭塞“并不罕见”。
British Medical Journal 1, 514, 1970. 英国医学杂志 1, 514, 1970。
The Lancet 1, 203, 1970.
The Lancet 2, 349, 1963. 柳叶刀 2, 349, 1963。
Helander, S. Acta Medica Scandinavica 162, 351, 1958.
Corday, E. Journal of the American Medical Association 219, 507, 1972. Corday, E. 美国医学会杂志 219, 507, 1972.
3
A DIFFERENT APPROACH 一种不同的方法
"FOR THE PAST TEN TO FIFTEEN YEARS," says Dr. “过去十到十五年，”博士说。
Eliot Corday, “a substantial number of patients have been following doctor’s orders and avoiding risk factors. Yet the death rate from coronary artery disease is as high now as it was fifteen years ago.” Eliot Corday，“相当多的患者一直遵循医生的指示，避免风险因素。然而，冠状动脉疾病的死亡率现在仍然和十五年前一样高。”
Dr. Corday, a cardiologist at the University of California at Los Angeles, is also a member of the National Heart Advisory Council. The comment quoted above appeared in the Los Angeles Times of 2 April 1973. The “risk factors” mentioned in the article are commonly cited ones: “high cholesterol levels, smoking and sedentary habits.” 加州大学洛杉矶分校的心脏病专家 Corday 博士也是国家心脏咨询委员会的成员。上述评论出现在 1973 年 4 月 2 日的《洛杉矶时报》。文章中提到的“风险因素”是常见的：“高胆固醇水平、吸烟和久坐不动的习惯。”
The doctor’s comments highlight a problem that bothers a lot of people who are concerned about their health. 医生的评论突出了一个困扰许多关注自己健康的人的问题。
From reading the last chapter, you will have gathered that treatment of people after they have had heart attacks 从阅读上一章中，你会了解到对心脏病发作后患者的治疗
leaves much to be desired. But what about the other obvious approach-prevention? Is the work being done there any better? 还有很大的改进空间。但另一种明显的方法——预防呢？那方面的工作做得好吗？
In the same interview, Corday summed up my own feelings about most of the research in the field of prevention. He said that as a researcher and a member of the Council he was familiar with the facts from the reports, and that these suggested to him that “we are on the wrong track.” He suggested telling patients to avoid the so-called “risk factors” while warning them there is no real proof that this will work. 在同一次采访中，Corday 总结了我对预防领域大部分研究的看法。他说，作为一名研究人员和理事会成员，他熟悉报告中的事实，这些事实让他觉得“我们走错了路”。他建议告诉患者避免所谓的“风险因素”，同时警告他们没有真正的证据证明这样做有效。
To think about prevention is always to think about causation. If a disease has been prevalent throughout medical history, this can be extremely difficult. But if a disease is relatively new, we have at least one good place to look for clues: the history of its emergence. 考虑预防总是意味着考虑病因。如果一种疾病在医学史上一直很普遍，这可能非常困难。但如果一种疾病相对较新，我们至少有一个很好的线索来源：其出现的历史。
I have mentioned Dr. Paul Dudley White’s statement that coronary thrombosis was unknown to him when he graduated from medical school in 1911. I have also given you the history of Dock’s early report and Herrick’s 1912 description. Further evidence that the present epidemic of cardiovascular disease is of quite recent origin is not hard to find. From 1926 to 1939, for example, deaths from coronary disease in Great Britain rose from forty-eight per million to 473 per million. In only thirteen years, a nearly tenfold increase! 我曾提到保罗·达德利·怀特博士的说法，他在 1911 年医学院毕业时对冠状动脉血栓形成一无所知。我还向你介绍了 Dock 早期报告和 Herrick 在 1912 年的描述。进一步的证据表明，目前心血管疾病的流行是相当近期的事情，这并不难找到。例如，从 1926 年到 1939 年，英国冠心病死亡率从每百万人中 48 人上升到 473 人。仅仅十三年，几乎增加了十倍！
The figures I have just quoted were mentioned in a 1946 address (1) by Sir Maurice Cassidy, who was Court Physician to King George VI. I refer to him not only because he happens to have set forth some startling information but because he went on to make a particularly acute observation. What he said was this: “The cause of coronary heart disease is still to seek . . . although an increasing number of investigators relate it to nutritional deficiency of long duration.” (Italics mine.) 我刚才引用的数据出自 1946 年由乔治六世国王的御医莫里斯·卡西迪爵士（Sir Maurice Cassidy）在一次演讲中提到的内容。我提到他不仅因为他提出了一些令人震惊的信息，还因为他做出了一个特别敏锐的观察。他说：“冠心病的原因仍在寻找中……尽管越来越多的研究者将其与长期的营养缺乏联系起来。”（斜体为我所加）
As I write today, Sir Maurice’s comment is nearly thirty years old. I believed in the importance and value of the ap- 当我今天写这段话时，Sir Maurice 的评论已经近三十年了。我相信……
proach he mentioned at that time, and I believe in it now. I am convinced now, as then, that looking for causes is even more important than looking for cures, and that the basic and most important cause of cardiovascular disease is precisely a “nutritional deficiency of long duration.” To explain why I think this, I shall first need to give those of you who are laymen a bit of background about the function of the heart and the proper role of clotting in the body. 他当时提到的方法，我现在仍然相信。我现在和当时一样坚信，寻找病因比寻找治疗方法更为重要，而心血管疾病的基本且最重要的原因正是“长期的营养缺乏”。为了说明我为什么这样认为，我首先需要给你们这些外行人介绍一下心脏的功能以及血液凝固在体内的正确作用。
The heart’s function is to take blood which has just passed through tiny blood vessels in the lung, and thus been exposed to oxygen, and to push this oxygen-bearing fluid through other vessels to all the living cells in the body. The heart also takes blood returning from these cells through the veins and pushes it into and through the lungs. The left side of the heart does the former, the right side the latter. Blood, of course, contains many nutritive substances in addition to oxygen, and many other factors that maintain the health of the cells and protect them against damage. 心脏的功能是接收刚刚通过肺部微小血管、因此暴露于氧气中的血液，并将这种携带氧气的液体通过其他血管推送到身体的所有活细胞。心脏还接收从这些细胞通过静脉回流的血液，并将其推入肺部并通过肺部。心脏的左侧负责前者，右侧负责后者。当然，血液除了含有氧气外，还含有许多营养物质以及维持细胞健康和保护细胞免受损害的多种因素。
The red cells in the blood, which actually carry the oxygen, pass through blood vessels which are, in many cases, very small. (In the smallest capillaries the cells must go through in single file.) Obviously there must be no clotting within the blood or the red cells will not be able to pass through the vessels. A clot anywhere within a blood vessel is therefore a catastrophe. Yet, under certain circumstances, blood must clot. 血液中的红细胞实际上负责携带氧气，它们通过许多情况下非常细小的血管。（在最小的毛细血管中，红细胞必须单列通过。）显然，血液中不能有凝块，否则红细胞将无法通过血管。因此，血管内任何地方的凝块都是灾难。然而，在某些情况下，血液必须凝固。
From time to time the body is subjected to various kinds of trauma (e.g., violent attack, accident, surgery) in which blood vessels are severed. When large vessels are involved, the blood flows out so rapidly that the victim will die very quickly unless proper first-aid measures are applied at once. More commonly, however, smaller vessels are involved, as in the case of the scratches, cuts and bruises we often see. If there were not a mechanism for the clotting of blood, the 人体不时会遭受各种创伤（例如，暴力袭击、事故、手术），导致血管被切断。当大血管受损时，血液流出非常迅速，除非立即采取适当的急救措施，否则受害者会很快死亡。然而，更常见的是小血管受损，比如我们经常看到的划伤、割伤和瘀伤。如果没有血液凝固的机制，...
result would be fatal even in these minor cases. Therefore, the blood must contain substances which can form a clot which will occlude the cut ends of vessels, the surgically tied-off ends of severed vessels or the ruptured vessels involved in bruising. 即使在这些轻微的情况下，结果也可能是致命的。因此，血液中必须含有能够形成血块的物质，以封闭血管的切断端、手术结扎的断裂血管端或瘀伤中受损的血管。
Fundamentally, then, the problem is this. Except for the response of clotting when blood vessels are ruptured or severed, the blood must always remain fluid. When clotting is necessary, this must be confined to the area involved. And coronary thrombosis can only be avoided when the blood in the coronary arteries remains fluid. 根本上，问题在于此。除了血管破裂或断裂时的凝血反应外，血液必须始终保持流动状态。当需要凝血时，凝血必须局限于受影响的区域。只有当冠状动脉中的血液保持流动状态时，才能避免冠状动脉血栓形成。
Since coronary thrombosis was almost unknown before 1912 , blood obviously did remain fluid up to that time. Only when it was needed to stop blood flow from a wound did the clotting factor spring into action. To me, the fundamental problem in all cardiovascular research is this: What has happened, since 1912, to change this? 由于 1912 年之前几乎没有冠状动脉血栓形成的记录，显然血液在那之前一直保持流动状态。只有在需要阻止伤口出血时，凝血因子才会发挥作用。对我来说，所有心血管研究的根本问题是：自 1912 年以来，发生了什么变化？
It is obvious that the cause of coronary thrombosis, a condition which is unique to the last sixty years or so, must be connected in some way with the clotting mechanism in the bloodstream. Either something must have been added to the bloodstream that has made a difference, or something must have been taken away. 显然，冠状动脉血栓形成的原因——这一状况大约在过去六十年内才出现——必定以某种方式与血液中的凝血机制有关。要么是血液中添加了某种东西导致了变化，要么是某种东西被去除了。
A number of environmental factors have been suspected, and some of these certainly may be involved to some degree. There are likely multiple factors in the increasing incidence of coronary thrombosis and myocardial infarction. It has been shown, for instance, that the hardness or softness of water may be a factor. Almost certainly the great increase in the use of refined starches, particularly white sugar, is a factor. A good case has been made for chlorination of drinking water as another. Certainly the use of literally thousands of additives in the processing of food, the great increase in pollution of air with heavy metals and the decrease in available clean water 许多环境因素被怀疑与此有关，其中一些因素在某种程度上确实可能参与其中。冠状动脉血栓形成和心肌梗死发病率的增加很可能是多种因素共同作用的结果。例如，水的硬度或软度可能是一个因素。几乎可以肯定的是，精制淀粉的使用大幅增加，特别是白糖，是一个因素。饮用水氯化作为另一个因素也有充分的论据支持。毫无疑问，食品加工中使用的成千上万种添加剂、空气中重金属污染的大幅增加以及可用清洁水的减少，都是相关因素。
are possible contributors. While possibly contributing, none of these factors can be of primary interest. Rather, the most likely basic explanation for the epidemic of heart disease we now have is the removal of some substance or substances from the environment and so from the bloodstream, substances essentially involved in the clotting mechanism. 可能是促成因素。虽然可能有贡献，但这些因素都不能成为主要关注点。相反，我们目前对心脏病流行的最可能基本解释是某些物质从环境中被移除，从而从血液中消失，这些物质本质上参与了凝血机制。
Obviously, before the epidemic, there must have been something in the bloodstream which controlled the clotting mechanism so that this essential process did not get out of hand, so that it was confined to the places and times where it was useful, indeed essential to life. As well as substances which activate and facilitate the clotting process, there had to be a chemical entity in the bloodstream to hold these in check. Long ago, scientists named this the antithrombin or anticlotting factor. 显然，在流行病爆发之前，血液中一定存在某种物质控制凝血机制，使这一重要过程不会失控，限定在有用且对生命至关重要的时间和地点。除了激活和促进凝血过程的物质外，血液中还必须有一种化学物质来抑制这些过程。很久以前，科学家将其命名为抗凝血酶或抗凝因子。
Today, we know that the natural antithrombin in the bloodstream is a chemical called alpha tocopherol. Although this knowledge has been applied by only a relatively few members of the medical profession, it has been available for many years. 今天，我们知道血液中的天然抗凝血酶是一种叫做α-生育酚的化学物质。尽管这一知识仅被相对少数医学专业人士应用，但它已经存在多年。
What kind of a chemical is alpha tocopherol? α-生育酚是一种什么样的化学物质？
Alpha tocopherol is one of a considerable number of organic compounds called vitamins which are needed if we are to live healthy lives and which, fortunately, can be found in foods. Alpha tocopherol is one of a group of compounds -the others being beta, gamma, delta, epsilon, eta and zeta tocopherol-which collectively are known as Vitamin E. It is an oil-soluble vitamin which is stored in fatty tissues of the body. α-生育酚是许多被称为维生素的有机化合物之一，这些化合物是我们健康生活所必需的，幸运的是可以在食物中找到。α-生育酚属于一组化合物——其他包括β、γ、δ、ε、η和ζ-生育酚——统称为维生素 E。它是一种脂溶性维生素，储存在体内的脂肪组织中。
It was shown more than twenty years ago that a female body stores three times as much Vitamin E as a male body of like age and development. For many years this was apparently sufficient to give women greater protection against coronary heart disease. Unfortunately, this is no longer as 二十多年前的研究表明，女性身体储存的维生素 E 是同龄同发育男性的三倍。多年来，这显然足以使女性对冠心病有更强的保护作用。不幸的是，这种情况不再如此。
true as it was, for reasons that I shall shortly explain. 这是真的，原因我将很快解释。
Some of you, of course, will be familiar with the history of vitamins. For those who are not, let me provide a few necessary items of information. 当然，你们中的一些人可能熟悉维生素的历史。对于那些不熟悉的人，让我提供一些必要的信息。
Vitamins are a group of compounds whose existence and importance began to be uncovered early in the twentieth century. What has been called the “vitamin hypothesis” was set forth in 1911 by Casimir Funk, a Polish-born biochemist. It has been clearly established that there are certain vitamin deficiency diseases: scurvy, beriberi and rickets, for example. Vitamins in tiny amounts prevent these diseases. Once such conditions develop, however, it is necessary to use much larger amounts in order to eradicate them. 维生素是一组化合物，其存在和重要性在二十世纪初开始被发现。被称为“维生素假说”的理论由波兰出生的生物化学家 Casimir Funk 于 1911 年提出。已经明确证实存在某些维生素缺乏症，如坏血病、脚气病和佝偻病。微量的维生素可以预防这些疾病。然而，一旦这些疾病发生，就需要使用大量维生素来根除它们。
The concept that very large quantities of a vitamin, or of a part of a vitamin, would act in quite a different way was first discovered by a small group of men following a gradual development of the concept by my father, Dr. James Shute, and my brother, Dr. Evan Shute, and myself. Our basic idea was and is that very large quantities would act as a chemotherapeutic agent having a powerful effect on specific degenerative diseases. Today this concept is usually spoken of as the therapeutic megavitamin approach to disease. 大量摄入维生素或维生素的一部分会以完全不同的方式起作用的概念，最初是由一小群人在我父亲詹姆斯·舒特博士、我兄弟埃文·舒特博士和我自己逐步发展这一概念的过程中发现的。我们的基本观点是，大量摄入维生素会作为一种化学治疗剂，对特定的退行性疾病产生强大的作用。如今，这一概念通常被称为疾病的治疗性大剂量维生素方法。
To see this in proper perspective, it is necessary to refer to certain events in medical history. 为了正确理解这一点，有必要回顾医学史上的某些事件。
Pasteur, Semmelweiss, Harvey, Jenner and others initiated the era in which bacterial infections and the conditions arising from them could be understood and dealt with. Over the years, methods have been developed to eliminate some of these hazards: vaccination, pasteurization, surgical cleanliness, antiseptics, sanitation techniques and the treatment of acute infections in the body with antibiotics. 巴斯德、塞梅尔韦斯、哈维、詹纳等人开创了一个时代，使人们能够理解和应对细菌感染及其引发的各种状况。多年来，人们开发了消除部分这些危害的方法：疫苗接种、巴氏消毒法、手术清洁、抗菌剂、卫生技术以及用抗生素治疗体内的急性感染。
The idea that resistance to a wide variety of infections, including some viral ones, might be increased and susceptibility to them thus decreased through the use of vitamins is more 通过使用维生素，抵抗多种感染（包括某些病毒感染）的能力可能增强，从而降低对这些感染的易感性的观点更加
recent. Also recent is the idea of the usefulness of vitamins in combating degenerative diseases. This is a whole new medicine-new since the middle 1940s and growing rapidly and successfully! 最近。最近还有一种观点认为维生素在对抗退行性疾病方面有用。这是一种全新的医学——自 20 世纪 40 年代中期以来出现，并且发展迅速且取得成功！
Today, with some exceptions, modern medicine has pretty well conquered most infectious diseases. Its progress against degenerative diseases, by comparison, has been meager. I believe that with megavitamin therapy we stand on the edge of a great new era in which there are giant steps for the first time being taken in the treatment of the viral infections and degenerative diseases which now produce countless tragedies every year. 如今，除了一些例外，现代医学已经基本上征服了大多数传染病。相比之下，它在对抗退行性疾病方面的进展却很有限。我相信，通过大剂量维生素疗法，我们正站在一个伟大新时代的边缘，首次在治疗病毒感染和退行性疾病方面迈出了巨大步伐，而这些疾病每年都会造成无数悲剧。
Vitamin E was isolated in 1922 by H.M. Evans and K.S. Bishop (2). In 1923, important work in the basic chemistry of Vitamin E was reported by B.J. Sure (3). My father’s and my brother’s concern with it began in 1933. Through work in obstetrics and gynecology and a research project based on this, they discovered that Vitamin E is an estrogen antagonist (a substance that neutralizes estrogen, the female sex hormone). Alpha tocopherol was synthesized in 1938 by P. Karrer and his associates (4) and became easily obtainable in synthetic form in 1941. 维生素 E 于 1922 年由 H.M. Evans 和 K.S. Bishop 分离出来（2）。1923 年，B.J. Sure 报道了维生素 E 基础化学的重要研究（3）。我父亲和我兄弟对它的关注始于 1933 年。通过产科和妇科的工作以及基于此的研究项目，他们发现维生素 E 是一种雌激素拮抗剂（一种中和雌激素——女性性激素的物质）。1938 年，P. Karrer 及其同事合成了α-生育酚（4），并于 1941 年以合成形式轻松获得。
The importance of our bold conception of large-quantity vitamin therapy was suddenly dramatized in 1945 when a summer project, suggested by Dr. Evan Shute and carried out by a medical student named Floyd Skelton, resulted in the discovery of the beneficial effects of a very high daily dosage of pure alpha tocopherol in cardiovascular disease. Estrogen was given to dogs to induce thrombocytopenic purpura (a hemorrhaging disease). The disease was then cured with alpha tocopherol in many times the quantity usually given to patients up to that time. Finally, the disease was prevented in dogs with the use of the same substance. 我们大胆提出的大剂量维生素疗法的重要性在 1945 年突然得到了体现，当时由 Dr. Evan Shute 建议、医学生 Floyd Skelton 执行的一个夏季项目，发现了每日服用极高剂量纯α-生育酚对心血管疾病的有益效果。通过给予狗雌激素诱发血小板减少性紫癜（一种出血性疾病），随后用远高于当时通常给患者剂量的α-生育酚治愈了该疾病。最终，使用同样的物质成功预防了狗的该疾病。
Dr. Evan Shute had used what was then considered a 埃文·舒特博士曾使用当时被认为是
large dosage of a potent product of wheat germ oil to treat an acquaintance with severe angina pectoris in 1936. The result was excellent in this one case. However, I was unable to obtain similar results in hospitalized cardiac patients in the same year. We both forgot this until our interest was revived by the application of Skelton’s research to a human patient with purpura whose cardiac symptoms were so severe that the surgeons and his attending physician were fearful that he would not survive an operation (the removal of the spleen). 1936 年，用大量高效的小麦胚芽油制品治疗一位患有严重心绞痛的熟人。这个病例的结果非常好。然而，同年我未能在住院心脏病患者中获得类似效果。我们都忘记了这件事，直到斯凯尔顿的研究应用于一位患有紫癜且心脏症状极为严重的患者身上，这位患者的外科医生和主治医师都担心他无法挺过脾脏切除手术，这才重新激发了我们的兴趣。
Administration of 300 international units (IU) of synthetic alpha tocopherol-a dosage range worked out by Evan Shute and Skelton on the basis of the quantity used on the dogs-led to a rapid disappearance of congestive heart failure in this patient and to a slower resolution of his purpura. 给予 300 国际单位（IU）的合成α-生育酚——这是 Evan Shute 和 Skelton 根据用于狗的剂量范围制定的——导致该患者的充血性心力衰竭迅速消失，紫癜则较慢缓解。
Once more I joined in this clinical research, since I had a large group of cardiac patients in my practice while Evan, an obstetrician and gynecologist, had relatively few. 我再次参与了这项临床研究，因为我在诊所里有大量心脏病患者，而 Evan 作为一名产科和妇科医生，患者相对较少。
The alpha fraction of Vitamin E was isolated and identified in 1948 by Drs. K.L. Zierler, D. Grob and J.L. Lilienthal, Jr. (5). In the American Journal of Physiology, where they reported their findings, Zierler et al. state that it is a vigorous antithrombin and that it is antithrombic in normal concentration in the bloodstream. In treating patients who have suffered intravascular clotting, alpha tocopherol has since been shown to dissolve fresh clots in the veins. In those of patients subjected to major surgery, its ability to prevent embolism and thrombosis has also been demonstrated. In peripheral arteries it probably does this even more rapidly. And it does this without interfering at all with the normal clotting mechanism in cases of laceration or other forms of trauma. 维生素 E 的α组分于 1948 年由 K.L. Zierler 博士、D. Grob 博士和 J.L. Lilienthal Jr.博士分离并鉴定（5）。他们在《美国生理学杂志》上报告了他们的发现，Zierler 等人指出，α组分是一种强效的抗凝血酶，并且在血液中的正常浓度下具有抗血栓作用。在治疗发生血管内血栓的患者时，α-生育酚已被证明能够溶解静脉中的新鲜血栓。在接受大手术的患者中，其预防栓塞和血栓形成的能力也得到了证实。在周围动脉中，它可能更迅速地发挥这种作用。而且在撕裂伤或其他形式的创伤情况下，它完全不会干扰正常的凝血机制。
It is clear, then, that alpha tocopherol must not be present in normal concentration in the bloodstreams of patients with coronary thrombosis and other conditions resulting from blood clots. But why? If blood remained fluid before 1912, 那么很明显，冠状动脉血栓形成和其他由血栓引起的疾病患者的血液中，α-生育酚的浓度一定不正常。但为什么呢？如果血液在 1912 年之前保持流动，
what has happened in the meantime? Since the substance we are talking about is a vitamin, we must ask what has happened to our food to cause such a deficiency to exist in so many people. 在此期间发生了什么？既然我们谈论的物质是一种维生素，我们必须问问我们的食物发生了什么，导致这么多人出现这种缺乏症。
There have been many changes in our environment since 1912: the multiplication of food additives, the removal of essential vitamins and minerals from food, the pollution of air, water and soil. But the greatest tragedy of all has been the removal of wheat germ from wheat, the stripping of flour and the “advances” that have been made in the manufacture of a basic staple food, bread. I am especially concerned with bread because this is the food which constitutes-or once constituted -our largest single source of natural Vitamin E. 自 1912 年以来，我们的环境发生了许多变化：食品添加剂的增多，食物中必需维生素和矿物质的去除，空气、水和土壤的污染。但最严重的悲剧是小麦胚芽从小麦中被去除，面粉被精炼，以及在制造基本主食面包方面所取得的“进步”。我特别关注面包，因为这是构成——或曾经构成——我们最大的天然维生素 E 单一来源的食物。
The great biochemist, Dr. Roger Williams, writes that commercial “enriched” bread-our modern staple-is very low in nutrients. Dr. Williams (6) has reported an experiment in which he fed rats on nothing but this bread. Within three months, death from malnutrition had claimed 40 out of 64 rats, and the rest were severely stunted in their growth. In a second group of 64 rats, which he fed the same bread supplemented with additional nutrients, 61 were “alive and growing” at the end of the same period. Dr. Williams, speaking to the National Academy of Science, had words of praise for prepared cat and dog foods. “We feed our cats and dogs better than we do our children,” he commented. 伟大的生物化学家罗杰·威廉姆斯博士写道，商业“强化”面包——我们现代的主食——营养含量非常低。威廉姆斯博士（6）报道了一项实验，他只用这种面包喂养老鼠。在三个月内，64 只老鼠中有 40 只因营养不良死亡，其余的生长严重受阻。在另一组 64 只老鼠中，他用同样的面包加上额外的营养物质喂养，结果在同一时期结束时，有 61 只“存活并且在生长”。威廉姆斯博士在向国家科学院讲话时，对预制的猫狗食品表示赞赏。“我们喂养猫狗的食物比喂养孩子的还要好，”他评论道。
Few people know what is done to most bread before it reaches the grocery store. First of all, the wheat germ is removed and with it 87 percent of seven vitamins including Vitamin E, 84 percent of bulk minerals and 88 percent of trace metals. What is left is ground into flour which is then bleached. This removes any trace of Vitamin E which is left. Some Vitamin B1 (thiamine) and Vitamin B2 (riboflavin), niacin and iron are added and the flour is then termed “enriched.” Incidentally, the iron added is sufficient to neutralize any Vitamin E that might still be there. (A better way to cut the 很少有人知道大多数面包在到达杂货店之前经历了什么。首先，小麦胚芽被去除，随之失去了包括维生素 E 在内的七种维生素的 87%，84%的大量矿物质和 88%的微量金属。剩下的部分被磨成面粉，然后进行漂白。这会去除任何残留的维生素 E。一些维生素 B1（硫胺素）、维生素 B2（核黄素）、烟酸和铁被添加进去，这种面粉被称为“强化”面粉。顺便说一句，添加的铁足以中和可能仍存在的任何维生素 E。（一种更好的方法是减少）
growing incidence of anemia is to restore adequate amounts of Vitamin E to our diets and to correct hypothyroidism, a condition about which I shall have more to say as we proceed.) 贫血发病率的增加应通过恢复饮食中足够的维生素 E 摄入量以及纠正甲状腺功能减退症来解决，关于这一状况，我将在后续内容中详细说明。
Bread is not the only food which has been changed in this way over the years. It was reported in 1969 in the Journal of Agriculture and Food Chemistry that the alpha tocopherol content of whole maize, wheat, oats and rice goes down by as much as 90 percent when they are made into breakfast cereals. “Such cereals,” says the report, “should be fortified to replace the loss. . . .” 多年来，不仅面包的成分发生了这种变化。1969 年《农业与食品化学杂志》报道，全谷物玉米、小麦、燕麦和大米在制成早餐谷物时，α-生育酚含量下降了多达 90%。报告指出：“这种谷物应当进行强化，以弥补损失……”
Vitamin E has also been almost completely removed from refined hydrogenated oils, soy and cottonseed oil margarines, cottonseed oil, mayonnaise and other items of this kind. Many commercially deep-fried foods do not contain as much Vitamin E as they might because of freezing and storing procedures which cause losses of this vitamin. And today there are more than three thousand additives present in foods, many of which contribute to the destruction of the normal activity of Vitamin E. 维生素 E 几乎已从精炼氢化油、大豆油和棉籽油人造黄油、棉籽油、蛋黄酱及其他类似产品中完全去除。许多商业油炸食品由于冷冻和储存程序导致维生素 E 的损失，含有的维生素 E 并不像预期的那么多。如今，食品中存在三千多种添加剂，其中许多会破坏维生素 E 的正常活性。
Nutritionists today recognize that Vitamin E is essential in the diet. Unfortunately, however, many people in this field-and many others-still derive a false sense of security from the belief that the diet of the average person in the developed countries of the world is so rich in Vitamin E that deficiencies are unlikely. As recently as July-August 1973, an issue of Nutrition Today carried a long and, in many other respects, excellent article on Vitamin E which stated that “it is so prevalent in nearly every food man consumes it is quite unlikely that a vitamin E deficiency could arise.” 营养学家今天认识到维生素 E 在饮食中是必不可少的。然而，不幸的是，这一领域的许多人以及其他许多人仍然错误地认为，发达国家普通人的饮食中维生素 E 含量丰富，因此缺乏维生素 E 的情况不太可能发生。就在 1973 年 7 月至 8 月，《Nutrition Today》杂志刊登了一篇关于维生素 E 的长篇文章，文章在许多方面都很出色，其中指出“维生素 E 几乎存在于人类食用的每一种食物中，因此维生素 E 缺乏症的出现相当不可能。”
The Food and Nutrition Board of the National Research Council (NRC) has estimated the adult requirement for alpha tocopherol to be between 20 and 30 IU per day. Because of changes in the processing of essential and basic foods over the last seventy years, it is very doubtful that many people 美国国家研究委员会（NRC）食品与营养委员会估计成人每日对α-生育酚的需求量在 20 至 30 国际单位之间。由于过去七十年中基本和必需食品加工方式的变化，许多人是否能够达到这一需求量是非常值得怀疑的。
today receive anything close to 30 IU per day, and surveys of Vitamin E levels in humans confirm that this must be a common situation. Typical diets in Great Britain, for example, have been estimated to contain less than 5 IU. Most commercial vitamin pills contain no Vitamin E. Many that do have a little also contain an iron compound that completely destroys the Vitamin E. There is none in most of the foods in the average American diet. Even in women, decreased intake of alpha tocopherol commonly depletes the stores of this important substance below the level effective in prevention. 今天每天摄入接近 30 IU 的人几乎没有，对人体维生素 E 水平的调查也证实这可能是普遍现象。例如，英国的典型饮食估计含量不到 5 IU。大多数商业维生素片不含维生素 E。含有少量维生素 E 的产品中，许多还含有一种完全破坏维生素 E 的铁化合物。大多数美国普通饮食中的食物几乎不含维生素 E。即使是女性，α-生育酚摄入量减少也常常使这种重要物质的储备低于预防所需的有效水平。
Let me suggest that you pause for a moment now to consider the application of this information in your own case. Studies in the United States have also indicated a greatly reduced intake of Vitamin E , much of which is not the active part, the alpha portion. Most citizens obtain 5 to 8 IU per day in their diets-the minimum quantity the Food and Drug Administration (FDA) says infants should have! If a physician prescribes a diet rich in polyunsaturated fats, he is dropping the already marked deficiency of Vitamin E way below critical level. If you consume such a diet, it reduces the antithrombin in your bloodstream and thus encourages, produces or precipitates clots in blood vessels. 让我建议你现在暂停片刻，考虑一下这些信息在你自身情况中的应用。美国的研究也表明，维生素 E 的摄入量大大减少，其中大部分并非活性部分，即α部分。大多数人每天从饮食中摄取 5 到 8 IU——这是食品药品监督管理局（FDA）规定婴儿应摄取的最低量！如果医生开出富含多不饱和脂肪的饮食，他实际上是在将维生素 E 本已明显的缺乏降至临界水平以下。如果你摄入这样的饮食，它会降低你血液中的抗凝血酶，从而促进、产生或诱发血管内的血栓。
Little wonder, then, that I am so deeply concerned for the future of many apparently healthy individuals, as well as for that of those who have already had heart attacks! In fact, the current state of our nutrition-which is very often malnutrition-is the only valid explanation so far advanced for the growing epidemic of clots and resulting heart attacks, in that the progressive removal of alpha tocopherol from the human diet since the turn of the century exactly parallels the onset of coronary thrombosis and the increase in intravascular clotting in other areas of the body. 难怪我如此深切地关心许多表面健康个体的未来，以及那些已经发生心脏病发作者的未来！事实上，我们当前的营养状况——往往是营养不良——是迄今为止对血栓和由此引发的心脏病发作日益流行的唯一合理解释，因为自本世纪初以来，人体饮食中α-生育酚的逐步减少，恰好与冠状动脉血栓形成的出现及身体其他部位血管内血栓的增加相对应。
Later, in Chapter 8, I shall discuss another way in which it is now believed that myocardial infarction may occur-without an antecedent thrombus or clot in the larger 稍后，在第 8 章中，我将讨论另一种现在被认为可能导致心肌梗死的方式——没有较大血管中先前形成的血栓或凝块
coronary vessels. What I have to say about prevention and treatment, however, is equally applicable in this second type of situation since in this, as you will see, the myocardium dies because it is deprived of oxygen. And oxygen deprivation is a necessary consequence of a low level of alpha tocopherol in the bloodstream. 冠状动脉血管。然而，我关于预防和治疗的内容同样适用于第二种情况，因为正如你将看到的，心肌因缺氧而死亡。而缺氧是血液中α-生育酚水平低的必然结果。
Alpha tocopherol, in fact, has been shown to have several other important effects on the individual cells of the body and on organs other than the heart. Actually, its value in the treatment and prevention of disease-alone or in combination with other vitamins and some of the amino acids and minerals that should be present in normal quantities in the human body-is just now beginning to be realized. Some of these will be mentioned in later chapters. Suffice it to say that alpha tocopherol therapy is changing many areas of medical treatment. 事实上，α-生育酚已被证明对身体的各个细胞以及心脏以外的器官具有多种重要作用。实际上，它在疾病治疗和预防中的价值——无论是单独使用还是与其他维生素以及人体内应有正常数量的一些氨基酸和矿物质联合使用——才刚刚开始被认识到。后续章节将提及其中一些内容。可以说，α-生育酚疗法正在改变许多医学治疗领域。
Little wonder, again, that I recommend megavitamin dosages of alpha tocopherol as the only means of restoring this essential substance in people whose bodies have been deficient in it for years! 难怪我再次推荐使用大剂量的α-生育酚作为恢复那些多年体内缺乏这种必需物质的人的唯一方法！
REFERENCES 参考文献
Cassidy, M. British Medical Journal 2, 782, 1946.
Evans, H.M. and Bishop, K.S. Journal of Metabolic Research 3,233,1923. Evans, H.M. 和 Bishop, K.S. 《代谢研究杂志》3,233,1923 年。
Karrer, P., Escher, R., Fritsche, H., Keller, H., Ringier, B.H. and Salomon, H. Helvetica Chimica Acta 21, 939, 1938. Karrer, P., Escher, R., Fritsche, H., Keller, H., Ringier, B.H. 和 Salomon, H. Helvetica Chimica Acta 21, 939, 1938。
Zierler, K.L., Grob, D. and Lilienthal, Jr., J.L. American Journal of Physiology 153, 127, 1948. Zierler, K.L., Grob, D. 和 Lilienthal, Jr., J.L. 《American Journal of Physiology》153, 127, 1948 年。
Williams, R. Nutrition Against Disease. New York: Pitman, 1971. Williams, R. 营养与疾病防治。纽约：Pitman，1971 年。
4
VITAMIN E AS A VITAMIN 维生素 E 作为一种维生素
TWO GROUPS OF SCIENTISTS are involved in research on Vitamin E. There is, unfortunately, very little-if anycommunication between members of these two factions. 两组科学家参与了维生素 E 的研究。不幸的是，这两派成员之间几乎没有任何交流。
One group is composed of professional researchers in physiology and biochemistry. Some of them are university teachers who do some research in addition to their teaching. Some are totally research-oriented. They use laboratory animals and follow the dictates of the NRC concerning recommended dietary requirements for Vitamin E: 5 IU for infants, 10 to 15 for children and 20 to 30 for adults. They adjust this dosage level to the sizes of their animal subjects. They study Vitamin E strictly as a vitamin-not as a therapeutic agent in the treatment of disease. 一组由生理学和生物化学的专业研究人员组成。他们中有些是大学教师，除了教学外还进行一些研究；有些则完全专注于研究。他们使用实验动物，并遵循 NRC 关于维生素 E 推荐膳食需求的指导：婴儿 5 IU，儿童 10 至 15 IU，成人 20 至 30 IU。他们根据动物体型调整剂量水平。他们严格将维生素 E 作为一种维生素来研究，而非作为治疗疾病的治疗剂。
This group has been very productive. Its members have published many papers in scientific journals and have estab- 该小组非常有成效。其成员在科学期刊上发表了许多论文，并已建立-
lished the biochemical properties of Vitamin E-as a vitamin-in this dosage range. I usually think of their field of interest as “little e.” 确立了维生素 E 作为维生素在此剂量范围内的生化特性。我通常将他们的研究领域称为“小 e”。
The other group consists mainly of clinicians, surgeons and others engaged in the practice of medicine who are using one of the tocopherols-alpha tocopherol-at megavitamin levels to treat humans. Dosages range from 75 to 100 IU a day for tiny premature infants with edema and hemolytic anemia to 2,000 to 3,200IU3,200 \mathrm{IU} for adult patients with cardiovascular or certain other kinds of disease. This group has also been very productive. They have turned out numerous papers which have been published in scientific journals throughout the civilized world. Their field of interest I call “Big E.” 另一组主要由临床医生、外科医生及其他从事医学实践的人组成，他们使用一种生育酚——α-生育酚——以超大剂量治疗人类。剂量范围从每天 75 到 100 国际单位，适用于患有水肿和溶血性贫血的极早产婴儿，到成人患者心血管疾病或某些其他疾病的 2000 到 3,200IU3,200 \mathrm{IU} 国际单位。这一组也非常有成效。他们发表了大量论文，这些论文已在全世界的科学期刊上刊登。我称他们的研究领域为“大 E”。
There is very little agreement between these two groups. Yet each makes important contributions to the advancement of science. 这两组之间几乎没有共识。然而，每一组都为科学的发展做出了重要贡献。
When I consider which is the more important of the two groups, I am reminded of something Albert Einstein once said in an address at the California Institute of Technology. “Concern for man himself and his fate,” said Einstein, “must always form the chief interest of all technical endeavors, concern for the great unsolved problems . . . .” This wise remark from a very good and wise man confirms me in my instinctive preference for physicians who successfully treat people over laboratory workers with their rats, chickens, sheep, rabbits and monkeys. 当我考虑这两组中哪一组更重要时，我想起了阿尔伯特·爱因斯坦在加州理工学院一次演讲中说过的话。爱因斯坦说：“对人类自身及其命运的关心，必须始终成为所有技术努力的主要关注点，对那些尚未解决的重大问题的关心……”这位非常优秀且睿智的人士的这句明智话语，使我更加坚定了本能的偏好，即更倾向于那些成功治疗人的医生，而非与老鼠、鸡、羊、兔子和猴子打交道的实验室工作人员。
This is not to minimize the usefulness of the laboratory group but merely to put their contributions into what I consider to be proper perspective. For I am about to embark now on a sketch of what the laboratory people have found out about Vitamin E and an outline of what clinicians have found and are applying in their work with patients. The latter will be the subject of the next chapter. The former I shall deal with now. 这并不是要贬低实验室团队的作用，而只是为了将他们的贡献置于我认为合适的视角中。因为我现在将开始概述实验室人员关于维生素 E 的发现，以及临床医生们的发现和他们在患者工作中应用的概况。后者将是下一章的主题。前者我现在来处理。
Just what, then, has the laboratory group to offer? 那么，实验室团队到底能提供什么？
These scientists have thoroughly investigated the chemical structure of Vitamin E as a vitamin and have established its role in the normal biochemistry and physiology of animals and humans. They have firmly established that E is essential for the normal functioning of every cell in the human body. This was a necessary first step in overcoming the resistance to Vitamin E on the part of the U.S. Food and Drug people. 这些科学家已经彻底研究了维生素 E 作为一种维生素的化学结构，并确定了它在动物和人体正常生物化学和生理中的作用。他们坚决确立了维生素 E 对人体每个细胞正常功能的重要性。这是克服美国食品药品管理局对维生素 E 抵制的必要第一步。
This piece of success has had considerable impact on our work. When we started using alpha tocopherol at megavitamin dosage levels, all bottles of the product had to carry on the label the statement that the need for Vitamin E in human nutrition had not been established. This changed in 1965 when the seventeenth revision of the U.S. Pharmacopeia included Vitamin E. Dr. Lloyd C. Miller, director of the revision, said that recent evidence compelled the recognition that “substantial quantities of this vitamin are essential to normal human nutrition.” This, of course, was inevitable although long delayed. It is curious how a substance can be of no value one day and the next be declared essential to normal human nutrition! 这项成功对我们的工作产生了相当大的影响。当我们开始以大剂量使用α-生育酚时，所有产品瓶子上的标签都必须注明“尚未确定维生素 E 在人类营养中的需求”。这一情况在 1965 年发生了变化，当时美国药典第十七次修订版将维生素 E 纳入其中。修订负责人 Lloyd C. Miller 博士表示，最新证据促使人们承认“这种维生素的大量摄入对正常人类营养是必不可少的”。当然，这种变化是不可避免的，尽管来得很晚。有趣的是，一种物质一天之内可能毫无价值，第二天却被宣布为正常人类营养所必需！
Dr. Robert E. Hodges, Professor of Medicine at the University of California at Davis, has stated in an article in Nutrah, a publication of the American Heart Association, not only that “Vitamin E is an essential nutrient in the human diet” but also that “the need for Vitamin E is increased by a high intake of polyunsaturated fatty acids.” 加州大学戴维斯分校医学教授罗伯特·E·霍奇斯博士在美国心脏协会出版物 Nutrah 的一篇文章中指出，“维生素 E 是人体饮食中必需的营养素”，并且“多不饱和脂肪酸摄入量高时对维生素 E 的需求也会增加。”
Dr. Hodges acknowledges that clinical evidence of deficiency may appear in persons who have some defect which limits their absorption of this vitamin. Unfortunately, he does not go on to comment upon the deficiencies that arise from insufficient intake and from individual variations in the absorption and excretion of the substance-what the great Dr. Roger J. Williams calls biochemical individuality. 霍奇斯博士承认，临床上缺乏证据可能出现在那些吸收这种维生素存在某种缺陷的人身上。不幸的是，他没有继续评论因摄入不足以及个体在吸收和排泄该物质方面的差异所引起的缺乏——这正是伟大的罗杰·J·威廉姆斯博士所称的生化个体性。
Dr. Hodges also does not mention something that I think is of equal importance. This is the type of Vitamin E available in the individual’s diet. Since alpha tocopherol is the most important member of the tocopherol group, it is important that the diet should contain this fraction. Wheat germ oil contains alpha and beta tocopherols; soybean oil contains alpha, gamma and delta tocopherols; cottonseed oil contains alpha and gamma forms; corn oil is rich in gamma tocopherol. But since only alpha tocopherol has, in sufficient strength, the characteristics that are needed in the treatment of disease, corn oil clearly contains only a relatively inert form of Vitamin E. Yet corn oil is the one, of all these fats, that we use most often. It appears in the majority of cooking oils and margarines. 霍奇斯博士也没有提到我认为同样重要的一点。那就是个体饮食中所含的维生素 E 类型。由于α-生育酚是生育酚类中最重要的成员，饮食中应包含这一成分。小麦胚芽油含有α和β生育酚；大豆油含有α、γ和δ生育酚；棉籽油含有α和γ生育酚；玉米油富含γ生育酚。但由于只有α-生育酚具有足够强度的治疗疾病所需特性，玉米油显然只含有相对惰性的维生素 E 形式。然而，在所有这些脂肪中，玉米油是我们使用最频繁的。它出现在大多数食用油和人造黄油中。
Many physiologists and biochemists have added to our knowledge of the role of Vitamin E in the whole body, individual organs and individual cells. Dr. Jefferson N. Roehm and Dr. Luigi DeLuca, with their associates at the Massachusetts Institute of Technology, have produced evidence that Vitamin A and Vitamin E help maintain lung health and protect against air pollutants. As a result of experiments with mice, four researchers at Duke University Medical Center produced evidence in 1964 that explorers going into space should be fortified by a preliminary high dosage of Vitamin E. Finally, Dr. A.L. Tappel, Professor of Food Science, Technology and Nutrition at the University of California at Davis, has suggested that Vitamin E may slow the aging process. (Dr. Albert Barber, Professor of Zoology at the same institution, says that “there is reason to believe that Vitamin E may be helpful in slowing down the aging process,” and a study by Dr. H.N. Marvin reveals that the “life span” of some body cells is lengthened by this vitamin.) 许多生理学家和生物化学家丰富了我们对维生素 E 在整个身体、各个器官和细胞中的作用的认识。麻省理工学院的 Jefferson N. Roehm 博士和 Luigi DeLuca 博士及其同事提供了证据，表明维生素 A 和维生素 E 有助于维持肺部健康并保护肺部免受空气污染物的侵害。1964 年，杜克大学医学中心的四位研究人员通过对小鼠的实验得出证据，认为进入太空的探险者应先服用高剂量的维生素 E 进行强化。最后，加州大学戴维斯分校食品科学、技术与营养学教授 A.L. Tappel 博士提出，维生素 E 可能减缓衰老过程。（同一机构的动物学教授 Albert Barber 博士表示，“有理由相信维生素 E 可能有助于减缓衰老过程”，而 H.N. Marvin 博士的研究显示，这种维生素能延长某些体细胞的“寿命”。）
Dr. Tappel received the Borden Award in Nutrition in 1973. This Award recognizes distinctive research emphasiz- Tappel 博士于 1973 年获得了 Borden 营养奖。该奖项表彰了卓越的研究成果—
ing the nutritional significance of any food or food component. Tappel was cited for his important, innovative and perceptive contributions relating to the mechanisms of lipid peroxidation (the oxidation of fats) in biological systems and to the factors that govern its occurrence and prevention. 评估任何食物或食物成分的营养意义。Tappel 因其在脂质过氧化（脂肪的氧化）机制及其发生和预防因素方面的重要、创新和有见地的贡献而被引用。
He has related the potential consequences of these peroxidation reactions to biochemical processes in foods and to cellular injury. The latter include the formation of age pigments observed in certain pathological conditions, the activation of lysosomal (cell dissolving) enzymes in disease states under particular nutritional and environmental conditions, and lung damage from air pollution. The possibility of preventing these phenomena by understanding the role of Vitamin E\min E and other antioxidants is a very important aspect of DrD r. Tappel’s work. 他将这些过氧化反应的潜在后果与食品中的生化过程及细胞损伤联系起来。后者包括在某些病理状态下观察到的年龄色素的形成，在特定营养和环境条件下疾病状态中溶酶体（细胞溶解）酶的激活，以及空气污染引起的肺损伤。通过理解维生素 E 和其他抗氧化剂的作用来预防这些现象的可能性，是 Tappel 工作中的一个非常重要的方面。
In an article in the July-August 1973 issue of Nutrition Today, Tappel states that Vitamin E’s most important activity takes place in the membranous parts of cells. “This is where its real fascination lies,” says Tappel, “for the clues to the activity of Vitamin E within the cells suggest that we are dealing with a substance of great potential.” 在 1973 年 7-8 月刊的《Nutrition Today》一文中，Tappel 指出维生素 E 最重要的作用发生在细胞的膜状部分。Tappel 说：“这正是它真正的魅力所在，因为维生素 E 在细胞内的活性线索表明，我们正在处理一种具有巨大潜力的物质。”
He explains that within the membranous parts of cells, Vitamin E interacts with the fatty substances (phospholipids, cholesterol and triglycerides) that are their most important constituents. Vitamin E apparently protects these substances against destruction as a result of oxidation. 他解释说，在细胞的膜状部分，维生素 E 与构成其最重要成分的脂肪物质（磷脂、胆固醇和三酸甘油脂）相互作用。维生素 E 显然保护这些物质免受氧化导致的破坏。
Tappel points out that Vitamin E acts in a similar way to protect Vitamin A from oxidation and that it joins with Vitamin A in performing its function within the membranous parts of the cells. Vitamin E also interacts, he says, with the trace element selenium and with methionine and cysteine-cystine, the sulfur amino acids. He also remarks on the observed resemblance between the action of Vitamin E and selenium. Tappel 指出，维生素 E 以类似的方式保护维生素 A 免受氧化，并且它与维生素 A 一起在细胞的膜状部分发挥作用。他还说，维生素 E 与微量元素硒以及含硫氨基酸甲硫氨酸和半胱氨酸-胱氨酸相互作用。他还提到维生素 E 和硒的作用表现出相似性。
Dr. Tappel comments that we now have a great deal of scientific data concerning the role of Vitamin E in nutrition and the effects of Vitamin E deficiency. “The very large number of symptoms that develop in Vitamin E-deficient animals indicates that this vitamin is very important to the function of most, if not all, of the tissues of the animal body.” Tappel 博士评论说，我们现在有大量关于维生素 E 在营养中的作用及维生素 E 缺乏影响的科学数据。“维生素 E 缺乏动物出现的众多症状表明，这种维生素对动物体内大多数甚至所有组织的功能都非常重要。”
On the subject of Vitamin E as a protection against damage to the lungs from air pollution, he states that since air pollution can produce damage to the lungs in the form of oxidation, “Vitamin E and the related protective systems now appear to be among the most important defensive systems. . . .” 关于维生素 E 作为防止空气污染对肺部损害的保护，他指出，由于空气污染可以通过氧化形式对肺部造成损害，“维生素 E 及相关的保护系统现在似乎是最重要的防御系统之一……”
Using rats, a number of researchers have investigated protection of the lungs by Vitamin E. It was discovered that the pollutants nitrogen dioxide and ozone can damage polyunsaturated fats within lung tissues by means of oxidation. It was also found that the animals could be protected against this damage by giving them large amounts of Vitamin E. Moreover, rats that had a Vitamin E deficiency suffered more damage from the ozone than rats that had received E beforehand. The research on nitrogen dioxide was done at the California State Department of Health, the work on ozone at the University of Southern California. 使用大鼠，许多研究人员调查了维生素 E 对肺部的保护作用。研究发现，污染物二氧化氮和臭氧可以通过氧化作用损害肺组织中的多不饱和脂肪。此外，给予动物大量维生素 E 可以保护它们免受这种损害。更重要的是，维生素 E 缺乏的大鼠比事先接受过维生素 E 的大鼠受到的臭氧损害更严重。关于二氧化氮的研究是在加利福尼亚州卫生部进行的，关于臭氧的研究则在南加州大学进行。
Dr. Tappel’s article outlines this research and the extension of it at the Battelle Institute and the University of California at Davis. It is now known, because of this follow-up work, that rats suffer less damage from ozone, as well as nitrogen dioxide, if they are given Vitamin E in generous quantities. Vitamin E gave this protection both in the nutritional and in the therapeutic range. Dr. Tappel comments: “Since so many of the basic features of these animal tests are similar to conditions affecting some humans, it does not seem unwarranted to speculate about the application of these results to the human.” This seems particularly significant in light of the fact Tappel 博士的文章概述了这项研究及其在 Battelle 研究所和加州大学戴维斯分校的延伸工作。由于这项后续研究，现在已知如果给予大剂量的维生素 E，大鼠受到臭氧和二氧化氮的损害会减少。维生素 E 在营养和治疗范围内都提供了这种保护。Tappel 博士评论道：“由于这些动物测试的许多基本特征与影响某些人类的情况相似，因此推测这些结果在人类中的应用似乎并非无根据。”鉴于这一事实，这一点显得尤为重要。
that at Davis the pollutants were used in quantities adequate to simulate city smog on a bad day. 在戴维斯，污染物的使用量足以模拟城市雾霾严重的那一天。
It is Dr. Tappel’s view that because of Vitamin E’s role as protector of polyunsaturated fats in the membranous parts of the cells, the need for this vitamin in the diet is related to dietary intake of these fats and the amounts of them already stored in the tissues. This, he says, is “a question of considerable importance to practicing physicians and dietitians in view of the emergent popularity of polyunsaturated fat food products.” Tappel 博士认为，由于维生素 E 在保护细胞膜部分的多不饱和脂肪中的作用，饮食中对这种维生素的需求与膳食中这些脂肪的摄入量及其在组织中已储存的数量有关。他说，这“对于临床医生和营养师来说是一个非常重要的问题，尤其是在多不饱和脂肪食品日益流行的情况下。”
People who are trying to avoid another coronary attack often are placed on diets in which there are more polyunsaturated than saturated fats. It would seem that these patients require an intake of Vitamin E that is commensurate with the amount of polyunsaturated fat they ingest. The amount, says Dr. Tappel, that has been offered as a guideline is 0.6 IU of Vitamin E per gram of polyunsaturated fats. People who have been on diets rich in polyunsaturates but who later go off them should realize that their need for this vitamin probably remains. Says Dr. Tappel: " . . . they still need to be concerned about the Vitamin E stabilization of the polyunsaturated fats stored in their adipose (fatty) tissues, since adipose tocopherol may be less efficiently stored than adipose polyunsaturated fats." 试图避免再次发生冠心病发作的人通常会被安排摄入多不饱和脂肪多于饱和脂肪的饮食。看来这些患者需要摄入与其摄入的多不饱和脂肪量相称的维生素 E。Tappel 博士说，作为指导的建议量是每克多不饱和脂肪摄入 0.6 IU 的维生素 E。那些曾经摄入富含多不饱和脂肪饮食但后来停止的人应意识到，他们对这种维生素的需求可能仍然存在。Tappel 博士说：“……他们仍需关注储存在脂肪组织中的多不饱和脂肪的维生素 E 稳定作用，因为脂肪组织中的生育酚（tocopherol）可能比脂肪组织中的多不饱和脂肪储存效率低。”
Later in this book, in Chapter 10, there is a diagram that shows the frightening application of this factor in the incidence of myocardial infarctions. The incidence rose slowly but steadily from 1912 to 1952, until cardiologists suddenly adopted the theory that decreasing the saturated and increasing the unsaturated or polyunsaturated fats in the diet was a possible way to prevent and treat coronary disease. As soon as this happened, there was a sudden rapid increase in the incidence of myocardial infarctions-and the increase continues to accelerate. 在本书后面的第 10 章，有一张图表显示了这一因素在心肌梗死发生率中的可怕应用。心肌梗死的发生率从 1912 年到 1952 年缓慢但稳定地上升，直到心脏病专家突然采纳了这样一种理论：减少饮食中的饱和脂肪，增加不饱和或多不饱和脂肪，是预防和治疗冠心病的可能方法。就在这发生之后，心肌梗死的发生率突然迅速上升——且这一增长趋势仍在加速。
The relationship of Vitamin E to the actual quantity of polyunsaturated fats will be referred to several times in this book in relation to the epidemic of coronary disease and the unwise acceptance by cardiologists of the kind of diet that has just been mentioned. 本书将多次提到维生素 E 与多不饱和脂肪实际含量的关系，涉及冠心病的流行以及心脏病专家对刚才提到的那种饮食的不明智接受。
Dr. Tappel says that Vitamin E is “one of the most hotly debated nutritional elements today.” (Italics mine.) He goes on to state that there is a lack of agreement, even, that E is a vitamin and that it has been labeled “a vitamin in search of a disease”-this in a Journal of the American Medical Association editorial. (In contrast, there can be no such debate about the use of the alpha fraction at megavitamin levels in treating disease-here it is no longer “nutritional.”) 塔佩尔博士说，维生素 E 是“当今最激烈争论的营养元素之一。”（斜体为我加。）他接着指出，甚至对于 E 是否是一种维生素都缺乏共识，并且它被称为“寻找疾病的维生素”——这是《美国医学会杂志》社论中的说法。（相比之下，关于使用α分数以超大剂量治疗疾病则没有这样的争论——在这里它不再是“营养性的”。）
Dr. Tappel traces the roots of the argument over the need for Vitamin E to the tendency of people to look for dramatic signs like cracked lips or bent backs as results of the absence of E. In fact, he says, ''Vitamin E inadequacy is manifested in subtle and more diffuse ways, the most serious being the increased destruction by lipid peroxidation." 塔佩尔博士将关于维生素 E 需求争论的根源归结为人们倾向于寻找诸如嘴唇干裂或背部弯曲等明显迹象，作为缺乏维生素 E 的结果。事实上，他说，“维生素 E 不足表现为更微妙和更广泛的方式，最严重的是脂质过氧化导致的破坏增加。”
The same article also contains the suggestion that there should be more research into the effects of Vitamin E on the aging process. (It is believed that lipid peroxidation is closely connected with that process.) 同一篇文章还建议应对维生素 E 对衰老过程的影响进行更多研究。（人们认为脂质过氧化与该过程密切相关。）
5
A QUESTION OF QUANTITY 数量问题
WHEN MY FATHER, my brother and I began giving our patients Vitamin E in relatively large doses back in the 1930s, we used what were then considered massive quantities of this substance in the form of a potent fresh wheat germ oil, cold pressed and kept refrigerated. To sustain pregnancies by combating abruptio placentae (premature detachment of the placenta from the wall of the uterus) my father and my brother Evan used quantities many times those which had ever been used before. And it was, similarly, with great quantities of wheat germ oil that in 1936 Evan successfully treated a patient with coronary insufficiency-the first case of cardiovascular disease to be approached in this way. 当我父亲、我兄弟和我在 1930 年代开始给我们的病人服用相对大剂量的维生素 E 时，我们使用的是当时被认为是大量的这种物质，以一种强效的新鲜小麦胚芽油的形式，冷压并冷藏保存。为了通过对抗胎盘早剥（胎盘从子宫壁的过早脱离）来维持妊娠，我的父亲和我的兄弟 Evan 使用的剂量是以前使用过的许多倍。同样，1936 年 Evan 用大量小麦胚芽油成功治疗了一名冠状动脉功能不全的患者——这是首次以这种方式处理心血管疾病的病例。
But wheat germ oil contains all the tocopherols-alpha, beta, gamma, delta, epsilon, eta and zeta-the entire Vitamin E complex. It was not until pure alpha tocopherol was first 但小麦胚芽油含有所有的生育酚——α、β、γ、δ、ε、η和ζ——整个维生素 E 复合体。直到纯α-生育酚首次出现，才开始...
produced synthetically in 1938 and then made available in 1941 that it was possible to use high levels of this especially potent fraction of the E complex at known strengths. 1938 年合成生产，1941 年开始供应，使得能够以已知浓度使用这种特别有效的 E 复合物成分的高剂量。
The first human patients treated with synthetic alpha tocopherol in large amounts were given 300 IU. This was ten times the maximum daily amount now listed by the NRC as the adult requirement. The results were dramatic and, in many cases, life-saving. There have actually never been better results in the more than 35,000 patients who have been treated by my father, my brothers, myself and the other doctors who later were associated with us in our work. 首批接受大量合成α-生育酚治疗的人类患者服用了 300 IU。这是 NRC 目前列为成人需求的最大每日剂量的十倍。结果非常显著，在许多情况下挽救了生命。在我父亲、我的兄弟们、我本人以及后来与我们合作的其他医生治疗的超过 35,000 名患者中，实际上从未有过更好的治疗效果。
In 1950, Dr. Alton Ochsner and his group (1) reported that they had successfully repeated some work we had done earlier using alpha tocopherol to dissolve freshly formed clots in the veins of the legs. (This is a condition known as thrombophlebitis, or phlebitis for short, which is rapidly becoming more common following surgery, childbirth and trauma.) Ochsner et al. also reported that alpha tocopherol was successful in preventing phlebitis. For both treatment and prevention they used 600 IU a day-twenty times the recommended maximum today. 1950 年，Alton Ochsner 博士及其团队（1）报告说，他们成功重复了我们早先使用α-生育酚溶解腿部静脉中新形成血栓的一些工作。（这是一种称为血栓性静脉炎，简称静脉炎的疾病，术后、分娩和外伤后这种情况迅速变得更为常见。）Ochsner 等人还报告说，α-生育酚在预防静脉炎方面也取得了成功。无论是治疗还是预防，他们每天使用 600 IU——是今天推荐最大剂量的二十倍。
Since then, with increasing knowledge of the action of alpha tocopherol and the experience of treating thousands of patients, our dosage levels have risen-occasionally to as high as 3,200IU3,200 \mathrm{IU} a day or more than one hundred times the NRC’s maximum. 从那时起，随着对α-生育酚作用的了解不断加深以及治疗数千名患者的经验积累，我们的剂量水平有所提高——有时高达每天 3,200IU3,200 \mathrm{IU} ，超过 NRC 最大剂量的一百多倍。
Obviously we are using a vitamin in quantities that are in a totally different range than that contemplated by the NRC. This is because our purpose is entirely different from what they have in mind. We use Vitamin E not as a vitamin (something you take in small quantities to supplement the foods you eat) but as a powerful chemotherapeutic agent in the treatment of disease. Because they respond well or at least partially to alpha tocopherol, we are now able to treat a whole group of 显然，我们使用的维生素数量与 NRC 所考虑的范围完全不同。这是因为我们的目的与他们所想的完全不同。我们使用维生素 E 不是作为维生素（即以少量摄入以补充饮食），而是作为治疗疾病的强效化学治疗剂。由于它们对α-生育酚反应良好或至少部分反应，我们现在能够治疗一整组疾病。
conditions heretofore untreatable or poorly dealt with, especially a number of degenerative diseases involving the cardiovascular system in its many anatomical areas. 以前无法治疗或难以处理的疾病，尤其是涉及心血管系统多个解剖区域的多种退行性疾病。
The conditions in which we prescribe alpha tocopherol are all of them states in which one or another of the known characteristics of this versatile and unique substance can be expected, on a purely rational basis, to be helpful. 我们开具α-生育酚的所有情况，都是基于纯理性的基础，预期这种多功能且独特物质的某一已知特性能够发挥作用的状态。
In this book, so far, I have dealt with only one of these characteristics: its ability to prevent the formation of the blood clots that are so often the cause of coronary thrombosis. As I have indicated just now, the same substance also has been shown to be effective against phlebitis. This is because in coronary thrombosis and phlebitis there is a common problem: a clotting mechanism that has somehow got out of control. 在本书中，到目前为止，我只讨论了这些特性中的一个：它防止血栓形成的能力，而血栓常常是冠状动脉血栓形成的原因。正如我刚才所指出的，同一种物质也被证明对静脉炎有效。这是因为在冠状动脉血栓形成和静脉炎中存在一个共同的问题：某种机制的凝血过程失控了。
Vitamin E has several other known effects upon the body. It has the ability to perform five other important jobs: 维生素 E 对身体还有其他几种已知的作用。它能够完成另外五项重要任务：
- reduce the oxygen requirement of the tissues and cells; - 减少组织和细胞的氧气需求；
decrease abnormal capillary permeability (cut down the ability of blood cells and serum to pass through the walls of small blood vessels); 降低异常毛细血管通透性（减少血细胞和血清通过小血管壁的能力）；
function as a capillary vasodilator (produce enlargement of the small blood vessels); 作为毛细血管扩张剂（使小血管扩张）；
promote collateral circulation (stimulate development of alternate routes through which blood can travel if a primary route becomes blocked); 促进侧支循环（刺激备用通路的发展，当主要通路被阻塞时，血液可以通过这些备用通路流动）；
promote epithelization (help form new skin). 促进上皮化（帮助形成新皮肤）。
I shall be telling you more about each of these functions in Chapter 7 and also in some of the later chapters in which I 我将在第 7 章以及后面的一些章节中向你详细介绍这些功能
shall deal with particular disease states individually. 将单独处理特定的疾病状态。
There are now in the world medical literature many hundreds of papers supporting the use of alpha tocopherol at megavitamin levels in treating a number of conditions related to difficulties of the types listed above. The following is a list of these and the number of supporting papers in each case. 目前世界医学文献中已有数百篇论文支持使用大剂量α-生育酚治疗与上述类型相关的多种疾病。以下是这些疾病及每种疾病支持论文的数量列表。
heart disease (132 papers); 心脏病（132 篇论文）；
phlebitis (57 papers); 静脉炎（57 篇论文）；
complications of diabetes mellitus (46 papers); 糖尿病的并发症（46 篇论文）；
lack of blood supply to the extremities due to arteriosclerotic narrowing of their arteries (35 papers); 由于动脉硬化性动脉狭窄导致四肢缺血（35 篇论文）；
Buerger’s disease-narrowing of blood vessels to extremities with inflammation of the vessel lining and a marked tendency to clotting (13 papers); 布尔格病——血管狭窄，影响四肢，伴有血管内膜炎症和明显的血液凝固倾向（13 篇论文）；
indolent ulcers-ulcers that seem unlikely to heal (60 papers); 惰性溃疡——似乎不太可能愈合的溃疡（60 篇论文）；
burns (30 papers). 烧伤（30 篇论文）。
There are applications in other fields as well: obstetrics and gynecology, ophthalmology and pediatrics, for example. Dermatology also contains a number of conditions in which Vitamin E has proved useful-conditions that were heretofore untreatable. 在其他领域也有应用：例如产科和妇科、眼科和儿科。皮肤科也包含许多维生素 E 已被证明有用的疾病——这些疾病以前是无法治疗的。
One of the earliest reports of this kind was that of Dr. H.D. Wilson (2) in 1964 in which he told of his successful treatment of epidermolysis bullosa dystrophica, a very unpleasant skin condition. In March 1973 a letter from Dr. Samuel Ayres, Jr. in Current News in Dermatology stated that Dr. Ayres and Dr. Richard Mihan had confirmed earlier (1950) 这类最早的报告之一是 1964 年 H.D. Wilson 博士（2）的报告，他讲述了他成功治疗表皮松解性大疱症（一种非常令人不快的皮肤病）的经历。1973 年 3 月，Samuel Ayres Jr.博士在《Current News in Dermatology》中的一封信中指出，Ayres 博士和 Richard Mihan 博士早先（1950 年）已证实了这一点。
results obtained by Dr. Milton Stout with alpha tocopherol in the treatment of another skin condition called pseudoxanthoma elasticum. Ayres and Mihan also reported successful treatment of epidermolysis bullosa with alpha tocopherol. 米尔顿·斯托特博士使用α-生育酚治疗另一种称为假黄色瘤弹性纤维症的皮肤病所取得的结果。艾尔斯和米汉也报告了用α-生育酚成功治疗表皮松解性水疱症。
Ayres reported “gratifying results” with alpha tocopherol in the treatment of other skin conditions including Raynaud’s phenomenon with gangrene, scleroderma, calcinosis cutis, Darier’s disease, several types of cutaneous vasculitis, subcorneal pustular dermatosis, and benign chronic familial phemphigus. Some cases of chronic ulcers, discoid lupus erythematosis and granuloma annulare have also responded. Ayres 报告称，使用α-生育酚治疗其他皮肤病症包括雷诺现象伴坏疽、硬皮病、皮肤钙化症、达里埃病、多种类型的皮肤血管炎、皮下脓疱性皮肤病和良性慢性家族性天疱疮，取得了“令人满意的结果”。一些慢性溃疡、盘状红斑狼疮和环状肉芽肿的病例也有反应。
Dr. Ayres’ letter to Current News in Dermatology reporting these results is reprinted in Appendix A by kind permission of the editor, Dr. Arthur G. Schoch. Ayres 博士致《Current News in Dermatology》的信件报告了这些结果，经编辑 Arthur G. Schoch 博士的友好许可，现收录于附录 A。
My brother Evan’s initial reports in the medical journals of the value of alpha tocopherol in treating threatened abortion have been supported by eighteen papers. There are fourteen papers supporting the use of alpha tocopherol in prevention of prematurity, nineteen on its role in the treatment of noneclamptic late toxemia (a type of blood poisoning that is a complication of pregnancy) and fifteen on dysmenorrhea (pain or difficulty in menstruating). On kraurosis (loss of skin elasticity) and senile vulvitis (inflammation of the external sex organs in older women) there are nine supporting papers. There are seven in the area of chronic cystic mastitis (an inflammation of the glandular tissue of the breast). 我兄弟 Evan 在医学期刊上关于α-生育酚在治疗流产威胁中的价值的初步报告得到了十八篇论文的支持。有十四篇论文支持α-生育酚在预防早产中的应用，十九篇论文论述其在治疗非子痫型晚期妊娠毒血症（一种妊娠并发症的血液中毒）中的作用，十五篇论文涉及痛经（经期疼痛或困难）。关于皮肤萎缩症（皮肤弹性丧失）和老年外阴炎（老年女性外生殖器炎症）有九篇支持论文。在慢性囊性乳腺炎（乳腺腺体组织炎症）领域有七篇论文支持。
In ophthalmology, there have been reports of alpha tocopherol being helpful in treating such eye conditions as interstitial keratitis, diabetic retinitis, hypertensive retinopathy, retinal arteriospasm and macular degeneration. References to nine journal articles dealing with these and similar topics will be found in a separate list following the bibliographic references at the end of this chapter. 在眼科学中，有报告称α-生育酚对治疗间质性角膜炎、糖尿病性视网膜炎、高血压性视网膜病变、视网膜动脉痉挛和黄斑变性等眼部疾病有帮助。关于这些及类似主题的九篇期刊文章的参考文献，将在本章末尾书目参考之后的单独列表中找到。
Alpha tocopherol has also been shown to be of value in α-生育酚也被证明具有价值
the treatment of edema (swelling) and hemolytic anemia (a condition in which red blood cells are destroyed) in premature infants. Drs. Ritchie, Fish, Grossman, and McMasters (3) reported in the New England Journal of Medicine in 1968 that among the infants they studied this condition was found to have associated with it a situation in which blood platelets are very numerous (thrombocytosis) and a low serum tocopherol level. “This syndrome,” they wrote, “cleared completely in response to oral Vitamin E therapy.” 治疗早产儿的水肿（肿胀）和溶血性贫血（一种红细胞被破坏的状况）。Ritchie 博士、Fish 博士、Grossman 博士和 McMasters 博士（3）于 1968 年在《新英格兰医学杂志》上报道，他们研究的婴儿中发现这种状况伴随着血小板数量非常多（血小板增多症）和血清生育酚水平低。“这种综合症，”他们写道，“对口服维生素 E 治疗反应完全清除。”
In the mobile home park in Lake Worth, Florida, where I now spend part of the year is a seventy-year-old man who is very active athletically and one of the best shuffleboard players. For four or five years he had nocturnal leg cramps at least once a night, induced if he stretched his legs out. After his first month on E , he has not had a single cramp in two years. 在我现在每年部分时间居住的佛罗里达州莱克沃思的移动房车公园里，有一位七十岁的老人，他运动非常活跃，是最好的掷盘球手之一。四五年来，他几乎每晚都会有一次夜间腿部抽筋，如果他伸直腿就会诱发。服用维生素 E 一个月后，他两年来一次抽筋都没有。
The results in this case are not an isolated instance. The Journal of the American Medical Association in January 1972 published two letters dealing with the treatment of leg cramps with alpha tocopherol. 这种情况下的结果并非孤立事件。美国医学会杂志在 1972 年 1 月发表了两封关于用 alpha tocopherol 治疗腿部抽筋的信件。
One letter, from Dr. Robert F. Cathcard III of San Mateo, California (4), referred to a 1969 paper by Samuel Ayres, Jr. and Richard Mihan (5) in which they reported the use of alpha tocopherol in the control of idiopathic night leg cramps. (Idiopathic is a word used to describe conditions whose cause or causes are unknown.) Dr. Cathcard says that he himself has treated almost one hundred patients with leg cramps and other types of idiopathic cramps and some with pain in the neck and lower part of the back with 300 IU of alpha tocopherol. He states: “I would second Ayres and Mihan’s observation that massive doses of tocopherol (alpha) are extremely effective in the control of idiopathic night cramps.” 加利福尼亚州圣马特奥的罗伯特·F·卡斯卡德三世博士（4）写来一封信，提到了塞缪尔·艾尔斯 Jr. 和理查德·米汉（5）于 1969 年发表的一篇论文，报告了α-生育酚在控制特发性夜间腿部痉挛中的应用。（特发性是用来描述病因不明的疾病的词。）卡斯卡德博士说，他自己用 300 IU 的α-生育酚治疗了近一百名腿部痉挛及其他类型特发性痉挛的患者，还有一些颈部和下背部疼痛的患者。他表示：“我赞同艾尔斯和米汉的观点，认为大剂量的生育酚（α）在控制特发性夜间痉挛方面极为有效。”
The other letter (6) is from Drs. Ayres and Mihan. It notes that their series of twenty-six nocturnal leg cramp cases included “restless legs” syndrome and rectal cramps. Alpha 另一封信（6）来自 Ayres 博士和 Mihan 博士。信中提到他们的二十六例夜间腿部抽筋病例包括“静止不安腿综合症”和直肠痉挛。Alpha
tocopherol had given “satisfactory relief in all cases.” A further series of seventy-six cases, they said, had included some with restless legs and rectal cramps and one athlete training for the Olympics whose work in running, swimming and weight lifting had been followed by severe cramps. They conclude by saying: “All of these patterns received prompt and gratifying relief from the oral administration of Vitamin E (d-alpha tocopherol acetate).” 生育酚在所有病例中都“提供了令人满意的缓解”。他们说，另外一组七十六个病例中，包括一些患有不安腿综合症和直肠痉挛的患者，还有一位为奥运会训练的运动员，他的跑步、游泳和举重训练后出现了严重的痉挛。他们总结说：“所有这些症状都通过口服维生素 E（d-α生育酚乙酸酯）得到了迅速且令人满意的缓解。”
The publication of these two letters elicited a wry comment from the editor of another medical journal. He suggested that had the subject of these letters been anything other than Vitamin E it would have warranted a complete major paper! 这两封信的发表引来了另一家医学期刊编辑的讽刺评论。他表示，如果这些信件的主题不是维生素 E，那它们本应成为一篇完整的重要论文！
It should be mentioned that Ritchie et al., working with tiny premature infants, used 75 to 100 IU of alpha tocopherol per day, which is a megavitamin level for such babies. In fact, it is fifteen to twenty times the 5 IU recommended dietary allowance of the NRC. Ayres and Mihan, in treating leg cramps, used 300 to 400 IU daily, occasionally 800. Ayres states that in the skin conditions he mentioned they have usually prescribed alpha tocopherol in doses of 400 to 800 IU per day. In some cases, he says, they have prescribed up to 1,600 or 2,000 IU per day. 值得一提的是，Ritchie 等人在治疗极早产婴儿时，每天使用 75 到 100 IU 的α-生育酚，这对于这些婴儿来说是超大剂量的维生素。实际上，这相当于 NRC 推荐膳食摄入量 5 IU 的十五到二十倍。Ayres 和 Mihan 在治疗腿部抽筋时，每天使用 300 到 400 IU，偶尔使用 800 IU。Ayres 表示，在他提到的皮肤病症中，他们通常开具每天 400 到 800 IU 的α-生育酚。在某些情况下，他说，他们开具的剂量高达每天 1,600 或 2,000 IU。
Dr. Ayres adds that he has encountered no untoward side-effects. However, if a patient has severe hypertension, serious cardiac impairment, or is a diabetic on insulin, Dr. Ayres recommends that physicians should start him on “much smaller doses such as 100 IU daily, which can be gradually increased over a period of weeks or several months.” 艾尔斯医生补充说，他没有遇到任何不良副作用。然而，如果患者患有严重高血压、严重心脏功能障碍，或是使用胰岛素的糖尿病患者，艾尔斯医生建议医生应从“每天 100 IU 这样较小的剂量开始，随后在数周或数月内逐渐增加。”
I shall go into the matter of dosage and hazards of this kind in more detail in Chapter 16. 我将在第 16 章中更详细地讨论剂量和此类危险问题。
The Shute concept that vitamins might be used in therapeutic doses to deal with hitherto hard-to-treat illnesses has also led to the use of other vitamins or portions of them in Shute 的观点认为维生素可以以治疗剂量用于处理迄今难以治疗的疾病，这也促使了其他维生素或其部分成分的使用
this way. Over the years, the megavitamin approach has been successfully extended to the treatment of schizophrenia, resistant allergies, virus infections, many dermatological problems and many, many other conditions. 多年来，巨量维生素疗法已成功扩展到治疗精神分裂症、顽固性过敏、病毒感染、许多皮肤病以及许多其他疾病。
Dr. Fred Klenner, Dr. Constance Spittle and many others have done extensive investigation into the therapeutic value of ascorbic acid (Vitamin C) in doses of one to five thousand milligrams (mg) daily. Dr. Spittle has demonstrated a reduction by 50 percent in the incidence of post-surgical thrombophlebitis through the use of large amounts of Vitamin C. Dr. Klenner has shown the value of Vitamin C in acute allergic reactions to insect stings and in a wide variety of conditions involving the cardiovascular system. This is not surprising since Vitamin C, like Vitamin E, is an antioxidant (though a water-soluble one). His most important discovery, however, has been the fact that Vitamin C is a potent therapeutic agent in otherwise intractable virus infections. 弗雷德·克莱纳博士、康斯坦斯·斯皮特尔博士以及许多其他人对抗坏血酸（维生素 C）每日一千至五千毫克剂量的治疗价值进行了广泛研究。斯皮特尔博士通过大量使用维生素 C，证明了术后血栓性静脉炎的发生率降低了 50%。克莱纳博士展示了维生素 C 在急性昆虫叮咬过敏反应以及涉及心血管系统的各种疾病中的价值。这并不令人惊讶，因为维生素 C 像维生素 E 一样，是一种抗氧化剂（尽管是水溶性的）。然而，他最重要的发现是维生素 C 在其他难治病毒感染中是一种有效的治疗剂。
At a 1973 meeting of the International College of Applied Nutrition, a veterinarian presented a paper on the use of intravenous ascorbic acid in the huge quantities first recommended by Dr. Klenner. The purpose, in veterinary medicine, is the treatment in dogs of a deadly virus disease, distemper. By the time dogs with this disease reach the veterinarian, there is usually little hope of recovery. Of those that survive, many are blind, deaf or both. Yet recovery is the rule with 51//2gm51 / 2 \mathrm{gm} of ascorbic acid intravenously followed by oral administration, and these dogs do not go deaf or blind. The results are so excellent that this veterinarian no longer hospitalizes the dogs. He simply gives the intravenous C and sends the dog and the appropriate amount of oral C home with the owner. 在 1973 年国际应用营养学院的一次会议上，一位兽医提交了一篇关于静脉注射抗坏血酸（维生素 C）的大剂量使用的论文，这种用量最初由 Dr. Klenner 推荐。在兽医学中，其目的是治疗犬类的一种致命病毒病——犬瘟热。当患有此病的狗到达兽医处时，通常几乎没有康复的希望。在幸存的狗中，许多会失明、失聪或两者兼有。然而，静脉注射 51//2gm51 / 2 \mathrm{gm} 的抗坏血酸，随后口服给药，康复是常态，这些狗不会失聪或失明。结果非常出色，以至于这位兽医不再将狗送入医院治疗。他只是给予静脉注射维生素 C，并将狗和适量的口服维生素 C 交给主人带回家。
Dr. Abraham Hoffer has been using megavitamin therapy, along with some traditional methods, in the treatment of early schizophrenia. He has had more recoveries and fewer recurrences than are usual among such patients when 亚伯拉罕·霍弗博士一直在使用大剂量维生素疗法，结合一些传统方法，治疗早期精神分裂症。他的康复病例比这类患者中通常的更多，复发也更少。
treated by conventional methods. In the United States he has acquired many co-workers and converts, in his native Canada little but criticism! 采用传统方法治疗。在美国，他获得了许多合作者和信徒，而在他的祖国加拿大却几乎只有批评！
Dr. Alan Cott has been using megavitamin therapy with success in treating children who are hyperkinetic (overactive) and who have learning defects or disabilities. 艾伦·科特博士一直成功地使用大剂量维生素疗法治疗多动症（过度活跃）且有学习缺陷或障碍的儿童。
Twelve years ago very few doctors were interested in hypoglycemia (low blood sugar). Now all that has changed. Two active organizations with rapidly increasing memberships are devoted chiefly, though not exclusively, to hypoglycemia. Patients with this condition are now being treated successfully with diet plus three essential vitamins, including 800 IU daily of Vitamin E. 十二年前，很少有医生对低血糖症感兴趣。现在这一切都改变了。两个活跃的组织，会员数量迅速增加，主要（但不限于）致力于低血糖症。患有这种病症的患者现在通过饮食加上三种必需维生素的治疗取得了成功，其中包括每天 800 IU 的维生素 E。
It is easy to demonstrate the unique effectiveness of VitaminE\min \mathrm{E}. It doesn’t take a highly trained medical specialist. Any intelligent doctor can do it-and many have done so. All that’s needed is one case, if it is the kind of condition in which there has never before been even one single successful instance of treatment by traditional methods. One case, as we have seen, was all that Milton Stout presented before the Los Angeles Dermatological Society, yet Samuel Ayres, Jr. refers to it in his Current News letter as “this astounding therapeutic accomplishment.” 很容易证明 Vita minE\min \mathrm{E} 的独特疗效。这不需要高度训练的医学专家。任何有智慧的医生都能做到——许多人已经做到了。所需的只是一个病例，如果这是那种传统方法从未有过哪怕一个成功治疗实例的病症。正如我们所见，米尔顿·斯托特在洛杉矶皮肤病学会前展示的仅仅是一个病例，然而塞缪尔·艾尔斯 Jr. 在他的《Current News》通讯中称其为“这一惊人的治疗成就”。
A salesman for a company that manufactures Vitamin E ointment once told me a story. And this tale has a certain pure scientific beauty to it. One spring day he acquired a severe sunburn while building a barbecue in his backyard. After dinner, he realized how badly burned he was and he started to apply the ointment, knowing that it was uniquely effective in treating sunburn. Suddenly he stopped, realizing that here was a chance to demonstrate to his doubting medical clientele along the west coast just what E could do. He began applying the ointment again, but confined it to half of the burned area. The next day there was no sign of sunburn on the half on which he had used the ointment but blisters as large as 一家生产维生素 E 软膏的公司的推销员曾给我讲过一个故事。这个故事具有某种纯粹的科学美感。一个春天的某天，他在后院搭建烧烤架时严重晒伤了。晚饭后，他意识到自己晒伤得很严重，开始涂抹软膏，因为他知道这种软膏在治疗晒伤方面有独特的效果。突然他停了下来，意识到这是一个向西海岸那些怀疑的医疗客户展示维生素 E 功效的机会。他又开始涂抹软膏，但只涂在晒伤部位的一半。第二天，涂抹软膏的那一半没有晒伤的迹象，而另一半则起了大水泡...
fifty-cent pieces all over the other half. He spent the week visiting his medical skeptics-a most successful week. 另一半全是五角硬币。他花了一周时间拜访他的医学怀疑者——这是非常成功的一周。
This story offers very dramatic proof of the efficacy of alpha tocopherol treatment. And the fact that this salesman proved his point-on his own burn-by using the ointment on only half of it serves to remind me of the discussion which has surrounded the nonperformance, by my brother Evan and myself, of what are called “controlled” studies -the kind of experiments which some of our critics have maintained are necessary to prove the effectiveness of alpha tocopherol therapy in the treatment of certain conditions. 这个故事非常有力地证明了α-生育酚治疗的有效性。事实上，这位推销员通过只在自己烧伤的一半使用该药膏来证明他的观点，这让我想起了围绕我和我兄弟 Evan 未进行所谓“对照”研究的讨论——一些批评者认为，只有通过这种实验才能证明α-生育酚疗法在治疗某些疾病中的有效性。
Controlled studies, of course, are ones in which the results of a new treatment in one group of subjects are compared either with those of some standard treatment or with those of a placebo or with those of nontreatment, in another group of subjects. If the subjects do not know to which group they have been assigned, such a study is also referred to as being “single-blind.” If the experimenters themselves also do not know until afterward which individuals have been assigned to which group, such a study is called “double-blind.” 对照研究当然是指将一组受试者中新治疗的结果与另一组受试者中某种标准治疗、安慰剂或无治疗的结果进行比较的研究。如果受试者不知道自己被分配到哪个组，这种研究也称为“单盲”研究。如果实验者本人直到事后也不知道哪些个体被分配到哪个组，这种研究称为“双盲”研究。
The object of all this is to provide a clear basis for comparison between the results of two different procedures or courses of action. Nevertheless, I have many reservations concerning the various types of controlled studies. 所有这些的目的是为了提供一个明确的基础，以便比较两种不同程序或行动方案的结果。然而，我对各种类型的对照研究有许多保留意见。
First of all, it is possible for their results to be misleading. In the early days of Vitamin E therapy, for example, several experiments were conducted which demonstrated that it was of no clinical value. The workers who did these experiments did not know that the product they were using contained only about one-seventh the quantity of active principle that they believed it to contain. Also, their tests were run for a relatively short time. They were terminated before an experimenter today would expect to see the effects. Yet these studies proved to a great many doctors, and cardiologists in particular, that Vitamin E was valueless. 首先，他们的结果可能具有误导性。例如，在维生素 E 治疗的早期，进行过几项实验，结果显示它没有临床价值。进行这些实验的研究人员并不知道他们使用的产品中活性成分的含量只有他们认为的约七分之一。此外，他们的测试时间相对较短，实验在今天的实验者预期看到效果之前就结束了。然而，这些研究使许多医生，尤其是心脏病专家，认为维生素 E 毫无价值。
Drugs are often difficult to study in this way unless the proper dosage is known beforehand. Moreover, some drugs-while of the utmost value when used correctly-can be dangerous when improperly used. And whether a drug is being used properly in a group of subjects can depend not only on knowing what dosage is generally correct but on making allowances for the marked biochemical individuality which can affect a subject’s response to a potent medication. 除非事先知道正确的剂量，否则药物通常难以以这种方式进行研究。此外，一些药物——在正确使用时极其有价值——但使用不当时可能是危险的。而且，药物是否在一组受试者中被正确使用，不仅取决于了解一般正确的剂量，还取决于考虑到显著的生化个体差异，这些差异会影响受试者对强效药物的反应。
Had digitalis, a most useful substance in treating some forms of heart disease, been subjected to a study in which the same dosage was given to a large number of patients, it would very likely have been thrown out at the outset. Digitalis works only within the specific dosage range appropriate to the individual patient. In subminimal levels it is virtually useless, and in overdosage it can kill. 洋地黄是一种在治疗某些形式心脏病中非常有用的物质，如果对大量患者给予相同剂量进行研究，很可能一开始就会被淘汰。洋地黄仅在适合个别患者的特定剂量范围内有效。剂量过低几乎无效，过量则可能致命。
Think, too, of the fate of insulin had it been subjected to such a double-blind controlled study. Here, the correct dosage level in the individual patient may vary as much as one to twenty. It would be very simple, in fact, using the knowledge we now have, to devise double-blind controlled studies that would prove insulin useless, useful, or extremely dangerous. 还要考虑一下如果胰岛素被置于这样的双盲对照研究中的命运。在这里，个别患者的正确剂量可能相差高达一比二十。事实上，利用我们现在掌握的知识，设计出能够证明胰岛素无用、有用或极其危险的双盲对照研究是非常简单的。
Where exactly the same treatment is to be given to all the subjects in one group in a double-blind experiment, considerations of biochemical individuality cannot be attended to. If Vitamin E is being studied, for instance, a patient whose condition might improve if his dosage were increased will not have the benefit of the increase so long as the study continues in strict accordance 在双盲实验中，如果对一组中的所有受试者给予完全相同的治疗，就无法顾及生化个体差异。例如，如果正在研究维生素 E，某位患者如果增加剂量可能会有所改善，但只要研究严格按照规定进行，他就无法享受到剂量增加的好处。
Where exactly the same treatment is to be given to all the subjects in one group in double-blind experiment, considerations of biochemical individuality cannot be attended to. If Vitamin E is being studied, for instance, a patient whose condition might improve if his dosage were increased will not have the benefit of the increase so long as the study continues in strict accordance with this plan. 在双盲实验中，如果对一组中的所有受试者给予完全相同的治疗，就无法考虑生化个体差异。例如，如果正在研究维生素 E，某位患者的病情可能会因剂量增加而改善，但只要研究严格按照该方案进行，他就无法享受到剂量增加的益处。
A further criticism of such an experiment would be concerned with patients who were not to be given Vitamin E. Our feelings and beliefs in this area would make it impossible for us to deny the benefits of alpha tocopherol therapy to patients who, in our view, would benefit from it-even if the purpose were to provide the kind of proof which seems to be demanded by a great many people. 对这种实验的另一个批评是关于那些不被给予维生素 E 的患者。我们在这一领域的感受和信念使我们无法拒绝给予那些在我们看来会受益于α-生育酚治疗的患者——即使目的是为了提供许多人似乎要求的那种证据。
We believe, in fact, that more controlled studies are done than are necessary, In many cases, all that is required is to make a comparison of the results of a good treatment such as alpha tocopherol therapy with the known course of a given disease-its mortality rate, the eventual cause of death, its total prognosis. Medical history provides a number of examples of the adoption of successful treatments on the basis of this type of evidence. The first really successful treatment of leprosy was rapidly adopted without a single control and after but a few obvious responses to the new therapy. Vaccination, inoculation for diphtheria and scarlet fever, insulin, the antiseptics, and chlorination-modalities of treatment which have conquered many of the most feared epidemics of the past-also were not subjected to controlled studies. It seems to me, therefore, that our use of comparison between the results of alpha tocopherol therapy and the known courses of a number of diseases has, in itself, produced results which are sufficiently convincing. Fortunately, the worship of the god of double-blind controlled experiment is of relatively recent origin. 事实上，我们认为进行的对照研究比必要的还多。在许多情况下，所需的只是将良好治疗（如α-生育酚疗法）的结果与某种疾病的已知病程——其死亡率、最终死因、总体预后——进行比较。医学史上有许多基于这类证据采用成功治疗方法的例子。麻风病的第一个真正成功的治疗方法在没有任何对照的情况下迅速被采用，仅凭对新疗法的几个明显反应。疫苗接种、白喉和猩红热的接种、胰岛素、防腐剂和氯化处理——这些曾征服过去许多最可怕流行病的治疗方式——也未经过对照研究。因此，我认为我们通过比较α-生育酚疗法的结果与多种疾病已知病程所得到的结果，本身已足够令人信服。幸运的是，对双盲对照实验这一“神”的崇拜还是相对较新的现象。
Let me summarize very simply by saying that considerations of this kind-along with many years of clinical experience in the use of alpha tocopherol in therapeutic doses -have led me to regard this therapy as being of proven value in the treatment of a wide variety of conditions. 让我简单总结一下，这类考虑——加上多年来在治疗剂量中使用α-生育酚的临床经验——使我认为这种疗法在治疗各种疾病方面具有公认的价值。
Over the years we have achieved substantial relief in 80 to 85 percent of our more than thirty-five thousand cardiovascular patients! 多年来，我们在三万五千多名心血管患者中取得了 80%到 85%的显著缓解！
REFERENCES 参考文献
Ochsner, A., DeBakey, M.E. and DeCamp, P.T. Journal of the American Medical Association 144, 831, 1950. Ochsner, A., DeBakey, M.E. 和 DeCamp, P.T. 《美国医学会杂志》144, 831, 1950 年。
Wilson, H.D. Canadian Medical Association Journal 90, 1315, 1964. Wilson, H.D. 加拿大医学会杂志 90, 1315, 1964.
Ritchie, J.H., Fish, M.B., Grossman, M. and McMasters, V. New England Journal of Medicine 279, 1185, 1968. Ritchie, J.H., Fish, M.B., Grossman, M. 和 McMasters, V. 新英格兰医学杂志 279, 1185, 1968。
Journal of the American Medical Association 219, 216, 1972. 美国医学会杂志 219, 216, 1972。
Ayres, S., Jr. and Mihan, R. California Medicine 111, 87, 1969. Ayres, S., Jr. 和 Mihan, R. California Medicine 111, 87, 1969.
Journal of the American Medical Association 219, 216, 1972. 美国医学会杂志 219, 216, 1972。
FURTHER REFERENCES (OPHTHALMOLOGY) 进一步参考资料（眼科学）
(In chronological order) （按时间顺序）
Stone, S. Archives of Ophthalmology 30, 467, 1943. (Interstitial keratitis.) Stone, S. 眼科学档案 30, 467, 1943 年。（间质性角膜炎。）
Carreros, R.J. Prensa Medica Argentina 37, 1764, 1947. (Keratoconus.) Carreros, R.J. 阿根廷医学报 37, 1764, 1947 年。（圆锥角膜。）
Dominguez. D.D. Presse Medicale 58, 972, 1950. (Retinal degeneration and myopic chorioretinitis.) Dominguez. D.D. Presse Medicale 58, 972, 1950。（视网膜变性和近视性脉络膜视网膜炎。）
Terzani, G. Policlinica Sezione Pratica 58, 1381, 1951. (Diabetic retinitis. Incidental improvement in other aspects of patients’ cardiovascular systems.) Terzani, G. Policlinica Sezione Pratica 58, 1381, 1951。（糖尿病性视网膜炎。患者心血管系统其他方面的偶然改善。）
Seidenar, R., Mars, G. and Morpurgo, M. Acta Gerontologica 1,55, 1951. (Arteriosclerotic hypertensive retinopathy.) Seidenar, R., Mars, G. 和 Morpurgo, M. 《Acta Gerontologica》1,55, 1951 年。（动脉硬化性高血压性视网膜病变。）
Cameron, A.J. Medical Press 144, 543, 1952. (Hypertensive retinitis.) Cameron, A.J. Medical Press 144, 543, 1952。（高血压性视网膜炎。）
Zampetti, C.A. Proceedings of the Third International Congress on Vitamin E, September, 1955. (Retinal artery spasm.) Zampetti, C.A. 第三届国际维生素 E 大会论文集，1955 年 9 月。（视网膜动脉痉挛。）
Raverdino, E. Proceedings of the Third International Congress on Vitamin E, September, 1955. (Macular degeneration of vascular origin.) Raverdino, E. 第三届国际维生素 E 大会论文集，1955 年 9 月。（血管性黄斑变性。）
Johuda, H.M. Journal of Clinical Ophthalmology 17, 797, 1963. (Central serous chorioretinitis.) Johuda, H.M. 临床眼科学杂志 17, 797, 1963 年。（中心性浆液性脉络膜视网膜炎。）
6
CONFLICT AND SUPPORT 冲突与支持
IT MAY SEEM STRANGE TO YOU-as it does to me -that the two groups we have been discussing should engage in very little communication with one another. It will appear even more puzzling, I am sure, when I come to describe in this chapter the actual hostility to the clinical investigators which has been demonstrated by the basic science group. All I can deduce is that somewhere along the line the latter have been encouraged to cooperate with some agencies apparently bent on suppressing the rapid spread of correct and effective alpha tocopherol megavitamin therapy among doctors and the knowledge of its success among the laity. 这对你来说可能显得很奇怪——对我也是如此——我们一直讨论的这两组人几乎没有相互交流。我相信，当我在本章描述基础科学组对临床研究人员表现出的实际敌意时，这种情况会显得更加令人困惑。我唯一能推断的是，在某个环节中，后者被鼓励与一些显然致力于压制正确有效的α-生育酚大剂量维生素疗法在医生中迅速传播以及其成功经验在普通民众中传播的机构合作。
To me, it appears that the prime reasons behind all this go back a good many years. Our basic findings have been reported to medical groups, including the Kansas City Academy of Medicine in 1947 and the Ontario Medical Association in 1953. However, the American Medical Associa- 对我来说，所有这些背后的主要原因似乎可以追溯到许多年前。我们的基本发现已向医学团体报告，包括 1947 年的堪萨斯城医学会和 1953 年的安大略医学会。然而，美国医学会—
tion in 1955 first accepted a presentation by us for its Annual Convention, then cancelled it. This may have been the result of pressure from some individuals or group within its membership. Having taken this action, the Association subsequently took a stand against us, and has avoided publicizing any evidence contrary to their stand, which might be interpreted that they were wrong in so vital a matter. 1955 年，tion 首次接受了我们为其年会提交的报告，但随后又取消了。这可能是由于其会员中某些个人或团体的压力所致。在采取这一行动后，该协会随后对我们采取了对立立场，并避免公开任何与其立场相悖的证据，以免被解读为他们在如此重要的问题上犯了错误。
Over the years this evidence, starting as a trickle, has grown to a deluge. Many curious incidents have occurred as a result. 多年来，这些证据从最初的涓涓细流，发展成了滔滔洪流。由此发生了许多奇异的事件。
The Association’s official organ, the Journal of the American Medical Association, for example, published in 1950 what was really a full confirmation of our basic claims when it printed Ochsner’s article(1) on the treatment of phlebitis with alpha tocopherol (while at the same time denouncing in an editorial the pioneers of this approach as quacks and charlatans). Is is possible that this slipped by because he used the words “alpha tocopherol” instead of Vitamin E"? (This editorial confusion may possibly have persisted. In the Journal’s Question and Answer column, authorities have several times over the years mentioned the application of alpha tocopherol in the treatment of human pathological conditions.) But it is our guess that the Journal has never forgiven Dr. Ochsner, since his subsequent papers have been published elsewhere, in the New England Journal of Medicine and Postgraduate Medicine, for example. 例如，该协会的官方刊物《美国医学会杂志》在 1950 年发表了 Ochsner 关于用α-生育酚治疗静脉炎的文章(1)，这实际上是对我们基本主张的全面确认（同时在社论中谴责采用这种方法的先驱者为骗子和江湖医生）。这是否可能因为他使用了“α-生育酚”一词而非维生素 E 而被忽视？（这种社论上的混淆可能仍然存在。在该杂志的问答栏目中，多年来权威人士多次提到α-生育酚在治疗人类病理状况中的应用。）但我们猜测该杂志从未原谅 Ochsner 博士，因为他后续的论文例如发表在《新英格兰医学杂志》和《研究生医学》上。
For doctors whose work has been denounced so thoroughly in such a prestigious publication, some of the other “press” we have had has not been too bad. Over the years interest in Vitamin E has grown and public knowledge and understanding of its value have accumulated, thanks in part to some of the helpful and accurate books and articles that have appeared. 对于那些在如此权威的刊物中被彻底谴责的医生来说，我们所获得的其他一些“媒体”报道还算不错。多年来，人们对维生素 E 的兴趣不断增长，公众对其价值的认识和理解也在积累，这在一定程度上得益于一些有益且准确的书籍和文章的出现。
Interest in E has mounted slowly since the publication in 自从……出版以来，对维生素 E 的兴趣逐渐增加
1954 of our first book, Alpha Tocopherol (Vitamin E) in Cardiovascular Disease (2), and the subsequent appearance of a version of this prepared for laymen, Your Heart and Vitamin E (3). Momentum has come, also, from the influence of our patients and that of the ever-increasing number of doctors who have tried Vitamin E for themselves and found that it helped their patients too. Patients, in turn, have formed the nuclei of widening circles of friends who could see the improvement in their condition. 1954 年，我们的第一本书《Alpha Tocopherol（维生素 E）在心血管疾病中的应用》（2）出版，随后还出版了为普通读者准备的版本《Your Heart and Vitamin E》（3）。动力还来自于我们的患者以及越来越多亲自尝试维生素 E 并发现它对患者有帮助的医生们。患者们反过来又成为了不断扩大的朋友圈的核心，这些朋友们都能看到他们病情的改善。
For quite a few years, also, Prevention magazine has carried information on the usefulness and effectiveness of VitaminE\min \mathrm{E} treatment. Its first owner and editor, the late J. I. Rodale, was one of the first patients seen after the opening of the Shute Institute for Laboratory and Clinical Medicine in London, Ontario, Canada in 1949. This magazine has a very large readership of people interested in their health, in preventing disease and avoiding “disaster medicine.” 多年来，Prevention 杂志也刊登了关于 Vita minE\min \mathrm{E} 治疗的有用性和有效性的信息。其第一任所有者兼编辑已故的 J. I. Rodale，是 1949 年加拿大安大略省伦敦市 Shute 实验室与临床医学研究所开业后接诊的首批患者之一。该杂志拥有大量关注健康、预防疾病和避免“灾难医学”的读者。
The reception of our work among doctors and laymen alike has improved most markedly, however, in the past ten years. In 1964 a medical writer named Herbert Bailey wrote a book entitled Vitamin E, Your Key to a Healthy Heart (4). This has sold thousands of copies to date and is in its eleventh printing. This book gave the factual story of Vitamin E and its vicissitudes. Following its success, five or six other writers have published books on Vitamin E for the popular market-most of them, in my opinion, pretty inadequate. Finally, in the late 1960s, Harald Taub, Managing Editor of Prevention, suggested that it was time for the publication of a new book on the subject by a physician-ideally, one closely associated with the beginnings of Vitamin E therapy. Since there is no one in this whole wide world who has seen the number of cardiovascular patients that I have seen and, of course, no one who has treated so many of them with alpha tocopherol, I was the logical one to do it. The result was the 然而，在过去十年中，我们的工作在医生和外行人中的接受度显著提高。1964 年，一位名叫 Herbert Bailey 的医学作家写了一本名为《Vitamin E, Your Key to a Healthy Heart》的书（4）。该书至今已售出数千册，并且已印刷到第十一版。这本书讲述了维生素 E 及其曲折经历的真实故事。继其成功之后，另外五六位作家为大众市场出版了关于维生素 E 的书籍——在我看来，大多数都相当不足。最后，在 1960 年代末，Prevention 杂志的执行编辑 Harald Taub 建议，是时候由一位医生出版一本关于该主题的新书——理想情况下，应由一位与维生素 E 疗法起始密切相关的人士来写。由于在全世界没有人见过我所见过的那么多心血管病患者，当然也没有人像我这样用α-生育酚治疗过这么多患者，所以我成为了理想的人选。结果是
publication in 1969 of Vitamin E for Ailing and Healthy Hearts (5) with Harald Taub. 1969 年与 Harald Taub 合著的《Vitamin E for Ailing and Healthy Hearts (5)》出版。
Reception of this book has been most interesting. Partly owing to its bibliography of some 125 of the seven hundred papers confirming the value of alpha tocopherol in the field of cardiovascular disease, and partly owing to its case histories illustrating the results obtained with alpha tocopherol and alpha tocopherol alone in cases in which there was otherwise no help, the book opened the eyes of those physicians who were curious enough to read it because of their own interest or at the suggestion of patients. 这本书的反响非常有趣。部分原因是它包含了约 125 篇文献目录，这些文献是七百篇确认α-生育酚在心血管疾病领域价值的论文中的一部分；部分原因是它通过病例历史展示了仅用α-生育酚在其他方法无效的情况下取得的效果，这本书让那些因自身兴趣或患者建议而好奇阅读的医生们大开眼界。
As a result of the publication of this book, we have had many requests for specific information from doctors, including several certified specialists in cardiology. Last year’s correspondence with this group alone fills three bulging folders! 由于本书的出版，我们收到了许多医生的具体信息请求，其中包括几位心脏病学认证专家。仅去年与这一群体的通信就装满了三个鼓鼓的文件夹！
But physicians, of course, have not been our only readers. The sale of the book in hard cover was phenomenal, and it continues to sell now that it is available in paperback. Of course, each book sold has alerted more than one person through family and friends. It would appear that there are now very few people who do not know first hand or have not heard of someone who has received worthwhile help through alpha tocopherol therapy. This is owing, in part, to our long record of success in treating patients and our very great numbers of patients and the number and variety of places from which they have come: from every state in the United States, from every province in Canada and from Australia, New Zealand, Ceylon, England, Ireland, Switzerland and Italy. I think that it is also partly owing to the favorable publicity we have sometimes enjoyed and to the effectiveness of the book. 但医生们当然不是我们唯一的读者。精装书的销量非常惊人，现在平装本上市后仍在持续销售。当然，每本书的销售都通过家庭和朋友让不止一个人得到了提醒。看来现在几乎没有人不知道或没有听说过有人通过α-生育酚疗法获得了有价值的帮助。这部分归功于我们在治疗患者方面长期的成功记录，以及我们庞大的患者数量和他们来自的众多不同地方：来自美国的每个州、加拿大的每个省份，以及澳大利亚、新西兰、锡兰、英格兰、爱尔兰、瑞士和意大利。我认为这也部分归功于我们有时享有的良好宣传以及这本书的有效性。
There is also much indirect evidence of the snowballing acceptance of alpha tocopherol therapy. The media have registered their amazement. Business Week (20 November 1971) contains an article entitled “Riding the Vitamin E Boom.” Comments this publication: “Suddenly this year, people are 还有许多间接证据表明α-生育酚疗法的接受度正在迅速增加。媒体对此表示惊讶。《商业周刊》（1971 年 11 月 20 日）刊登了一篇题为《乘着维生素 E 热潮》的文章。该刊评论道：“今年突然间，人们开始”
popping Vitamin E again like mad . . . . That’s why mutual funds are jostling each other to get shares of R.P. Scherer Corp.” Business Week goes on to explain that Scherer has about 75 percent of the world market in the type of capsules used to contain liquid vitamins and certain other pharmaceuticals. 疯狂地再次服用维生素 E……这就是为什么共同基金争先恐后地抢购 R.P. Scherer Corp.的股份。”《商业周刊》继续解释说，Scherer 公司在用于装液体维生素和某些其他药品的胶囊类型上占据了全球市场约 75%的份额。
An article by Robert Vare, (“All About Vitamin E,” Cosmopolitan magazine, November 1972) estimates that “as many as twenty million of us take E regularly and millions more get it with other vitamins in composite pills.” (I have pointed out elsewhere that the amounts contained in such composites are very small by my standards, but Vare’s point is nevertheless very good. Inclusion of E in such pills at least illustrates the fact that a lot of people are now aware of it.) 罗伯特·瓦雷（Robert Vare）在《Cosmopolitan》杂志 1972 年 11 月刊发表的一篇文章《关于维生素 E 的一切》中估计，“多达两千万的人定期服用维生素 E，还有更多的人通过复合维生素片摄取维生素 E。”（我在别处指出，这些复合片中所含的量以我的标准来看非常少，但瓦雷的观点仍然非常好。在这些药片中加入维生素 E 至少说明了现在有很多人已经意识到了它的存在。）
Articles on Vitamin E have been appearing in other unexpected places. For example, Moneysworth, a consumer newsletter, printed an article entitled “Now, The Vitamin E Craze” in its 27 May 1972 issue. “Americans,” it said, “are gobbling Vitamin E capsules the way kids guzzle gumdrops . . . .” Moneysworth goes on to state that the pharmaceutical industry is “understandably ecstatic” and that some retailers have seen a marked jump in sales of Vitamin E since 1969. The newsletter even quotes a comment on the phenomenon from the Wall Street Journal! 关于维生素 E 的文章开始出现在其他意想不到的地方。例如，消费者通讯《Moneysworth》在 1972 年 5 月 27 日的期刊中刊登了一篇题为《现在，维生素 E 热潮》的文章。文章中写道：“美国人像孩子们狂吃糖果一样狂吃维生素 E 胶囊……。”《Moneysworth》继续指出，制药行业“理所当然地欣喜若狂”，自 1969 年以来，一些零售商的维生素 E 销售额显著增长。该通讯甚至引用了《华尔街日报》对这一现象的评论！
A Canadian distributor of Vitamin E products not long ago produced files that showed that he received regular orders from 1,180 doctors who buy their supplies directly from him. From a similar company in California some seven thousand doctors buy Vitamin E directly. At recent meetings of the International Academy of Preventive Medicine-an organization that I shall tell you more about in Chapters 10 and 18-a show of hands demonstrates that at least three-quarters of the members are using E , and I remember that very few of them were doing so when I first addressed them a few years ago. 一家加拿大的维生素 E 产品分销商不久前制作的文件显示，他定期收到来自 1180 名医生的订单，这些医生直接从他那里购买供应品。来自加利福尼亚的另一家公司有大约七千名医生直接购买维生素 E。在最近的国际预防医学学会会议上——这是一个我将在第 10 章和第 18 章中详细介绍的组织——举手表决显示，至少有四分之三的会员正在使用维生素 E，而我记得几年前我首次向他们演讲时，使用维生素 E 的会员非常少。
All this favorable reaction has not gone unnoticed by the 所有这些有利的反应都没有被忽视
opposition. An early evidence of concern was the appearance of an unfavorable review of my book, Vitamin E for Ailing and Healthy Hearts, in the New England Journal of Medicine. (This is the same journal which on 23 July 1964 published a letter from Dr. Ochsner stating that he had “for a number of years . . . routinely prescribed alpha tocopherol . . . .” and that it is “a potent inhibitor of thrombin . . . and a safe prophylactic against venous thrombosis.”) The majority of the “scare” articles that have appeared, however, have been written by nutritionists or nonpracticing physicians who usually prefer to remain anonymous. For example, a lengthy treatment in the January 1973 issue of Consumer Reports was anonymous. 反对意见。早期关注的一个证据是《新英格兰医学杂志》上对我的书《维生素 E 与病弱及健康心脏》发表了一篇不利的评论。（这本杂志在 1964 年 7 月 23 日发表了 Ochsner 博士的一封信，信中称他“多年来……常规开具α-生育酚……”并且它是“一种强效的凝血酶抑制剂……且是预防静脉血栓形成的安全措施。”）然而，大多数出现的“恐慌”文章都是由营养学家或非执业医生撰写的，他们通常选择匿名。例如，1973 年 1 月《消费者报告》中的一篇长篇报道就是匿名的。
A statement that I feel I should single out for reply here is the one attributed in the Vare article to Dr. Frederick J. Stare, Chairman of Harvard’s Department of Nutrition: “Not one single reputable physician thinks that Vitamin E is worth a damn for anything. I don’t know of any illness in the United States which has ever been cured by the vitamin. Nor do I know of any disease that results from a lack of it.” 我觉得我应该特别回应的一句话是 Vare 文章中引用的哈佛营养系主任 Frederick J. Stare 博士的话：“没有一个有声望的医生认为维生素 E 有什么用处。我不知道美国有哪种疾病曾被这种维生素治愈过，也不知道有哪种疾病是由于缺乏它引起的。”
This is not the first nor the last pronouncement of this nutritionist to discredit megavitamin E therapy. He has used his widely syndicated newspaper column to bring up the subject only to condemn it on numerous occasions. Of course, Dr. Stare is wrong in his belief. Many reputable physicians -not theoretical nutritionists-are using this therapy with excellent results obtainable no other way. 这不是这位营养学家第一次也不是最后一次发表声明来否定大剂量维生素 E 疗法。他曾多次利用自己广泛发行的报纸专栏提起这一话题，目的只是为了谴责它。当然，Stare 博士的观点是错误的。许多有声望的医生——而非理论营养学家——正在使用这种疗法，并取得了其他方法无法获得的优异效果。
Dr. Alton Ochsner, head of the Ochsner Clinic in New Orleans-the “little Mayos of the South”-is one of the three most honored surgeons in America. He says that Vitamin E is a potent antithrombin and will dissolve fresh clots in the veins of the extremities and will prevent their formation in risk cases. In a paper entitled “Preventing and Treating Venous Thrombosis” which was presented before the fifty-second annual assembly of the Interstate Postgraduate Medical As- 新奥尔良 Ochsner 诊所的负责人 Alton Ochsner 博士——“南方的小梅奥”——是美国三位最受尊敬的外科医生之一。他说维生素 E 是一种有效的抗血栓剂，能够溶解肢体静脉中的新鲜血栓，并能预防高风险病例中血栓的形成。在一篇题为《预防和治疗静脉血栓》的论文中，他在州际研究生医学年会第五十二届大会上作了报告——
sociation and published in 1968 in the journal Postgraduate Medicine he states: “In addition, for 15 years I have used alpha tocopherol routinely in the treatment of patients who have been subjected to trauma of any magnitude. None of these patients have had pulmonary embolism. Tocopherol in the presence of calcium acts as an antithrombotic agent; only the alpha tocopherol has this property. It does not produce a hemorrhagic tendency and can be used safely. The physicians in our department of urology use it in treating patients who have had transurethral resection.” 该协会于 1968 年在《Postgraduate Medicine》杂志上发表，他指出：“此外，15 年来我一直常规使用α-生育酚治疗遭受各种程度创伤的患者。这些患者中没有发生肺栓塞。生育酚在钙的存在下具有抗血栓作用；只有α-生育酚具有这种特性。它不会引起出血倾向，可以安全使用。我们泌尿科的医生在治疗接受经尿道切除术的患者时也使用它。”
Drs. Ayres and Mihan published an account of the successful treatment of leg cramps and “restless legs” syndrome in 1969. Samuel Ayres, Jr. is Emeritus Clinical Professor of Medicine (Dermatology) at the University of California at Los Angeles (The Center for Health Sciences). Richard Mihan is Assistant Clinical Professor of Medicine (Dermatology and Syphilology) at the University of Southern California School of Medicine. They have used Vitamin E in the treatment of several dermatological conditions and have presented papers on this work before the American College of Physicians, the American Dermatological Association and the Pacific Dermatological Association. Ayres 博士和 Mihan 博士于 1969 年发表了关于成功治疗腿部抽筋和“静止腿综合症”的报告。Samuel Ayres Jr.是加利福尼亚大学洛杉矶分校（健康科学中心）医学（皮肤病学）名誉临床教授。Richard Mihan 是南加州大学医学院医学（皮肤病学和梅毒学）助理临床教授。他们在治疗多种皮肤病时使用了维生素 E，并曾在美国内科医师学会、美国皮肤病学会和太平洋皮肤病学会前发表相关论文。
Joshua H. Ritchie, M.D., Mathews B. Fish, M.D. and Moses Grossman, M.D. presented a paper at an annual meeting of the Society for Pediatric Research and at meetings of the Western Society for Clinical Research and the Western Society for Pediatric Research. This paper, as I have already noted, was published in the New England Journal of Medicine in 1968. They stated that they had successfully treated premature infants with widespread edema and anemia with Vitamin E (in our dosage range, please note). Joshua H. Ritchie 医学博士、Mathews B. Fish 医学博士和 Moses Grossman 医学博士在儿科研究学会年会上以及西部临床研究学会和西部儿科研究学会的会议上发表了一篇论文。正如我已经提到的，这篇论文于 1968 年发表在《新英格兰医学杂志》上。他们表示，他们成功地用维生素 E（请注意我们的剂量范围）治疗了患有广泛水肿和贫血的早产儿。
There are many, many more doctors of medicine in the United States and throughout the world-doctors as entitled to recognition and respect as are Ochsner, Ayres, Mihan, Fish 在美国及世界各地有许多许多医学博士——这些医生同样应当获得认可和尊重，就像 Ochsner、Ayres、Mihan、Fish 一样
and Grossman-who have used Vitamin E to cure and to treat abnormal conditions in humans. 以及 Grossman——他们使用维生素 E 来治愈和治疗人体的异常状况。
Such statements as Dr. Stare’s deserve censure for their sweeping generalities which may hinder development of a treatment which is safe in most, but not all, cases and extremely successful in prolonging lives, saving legs from amputation and obviating in many burn cases the necessity for skin grafting, recurrent pain and prolonged hospitalization. 像斯塔尔博士那样的言论因其笼统的概括而应受到谴责，这可能会阻碍一种在大多数情况下安全但并非全部情况下安全的治疗方法的发展，而这种方法在延长生命、挽救截肢的腿部以及在许多烧伤病例中避免皮肤移植、反复疼痛和长期住院方面极为成功。
Dr. Robert E. Olson of the St. Louis University School of Medicine presented a paper on Vitamin E at the Annual Scientific Meeting of the American Heart Association in 1972. This paper was released to the press and widely disseminated. It was reported in the press that Olson had stated that there was no evidence that large daily doses of Vitamin E could help anyone’s heart. He was quoted, however, as stating that the only proven clinical use of Vitamin E was in the treatment of intermittent claudication. Now this is a condition so completely analogous to the common conditions in the heart that are caused by abnormalities in the coronary artery blood supply that if Vitamin E works for intermittent claudication it simply must also work for coronary insufficiency! 圣路易斯大学医学院的 Robert E. Olson 博士在 1972 年美国心脏协会年度科学会议上发表了一篇关于维生素 E 的论文。该论文已向媒体发布并广泛传播。媒体报道说，Olson 表示没有证据表明大量每日服用维生素 E 能帮助任何人的心脏。然而，他被引用说维生素 E 唯一经过证实的临床用途是治疗间歇性跛行。现在，这种病症与由冠状动脉血液供应异常引起的常见心脏病状极为相似，如果维生素 E 对间歇性跛行有效，那么它也必然对冠状动脉功能不全有效！
The authors mentioned in this chapter as having published articles supporting Vitamin E therapy are merely representative of the many who have published their results in the treatment of human disease conditions with alpha tocopherol at megavitamin levels. Professor A.M. Boyd of the University of Manchester (England), Dr. H.T.G. Williams in Canada and lately Dr. Knüt Haeger of Sweden are impressive names in high places-all persons whose papers deserve to be considered even by Dr. Stare. 本章提到的发表支持维生素 E 疗法文章的作者，仅是众多在使用大剂量α-生育酚治疗人类疾病方面发表成果者的代表。英国曼彻斯特大学的 A.M. Boyd 教授、加拿大的 H.T.G. Williams 博士以及最近的瑞典 Knüt Haeger 博士，都是备受尊敬的重要人物——他们的论文即使是斯塔尔博士也应予以考虑。
In the past few years the basic science group has held a number of “international symposia on Vitamin E.” At one that was held by the New York Academy of Sciences in 1971 it 在过去的几年里，基础科学小组举办了多次“国际维生素 E 研讨会”。1971 年由纽约科学院举办的一次研讨会上，
was reported in Medical World News (24 December 1971) that for two days “international investigators” discussed the nutritional muddle but could come to no agreement concerning Vitamin E’s exact role in cellular metabolism. We heard of this by chance, after its program had been arranged. We did not attend because there were no papers of interest to us-that is, none that we considered to be of practical clinical value. 据《Medical World News》（1971 年 12 月 24 日）报道，两天内“国际调查员”讨论了营养混乱问题，但未能就维生素 E 在细胞代谢中的确切作用达成一致。我们是偶然听说此事的，因为会议日程已安排好。我们没有参加，因为没有对我们有兴趣的论文——也就是说，没有我们认为具有实际临床价值的论文。
In June 1973 Nutrition Today carried a notice concerning another of these meetings. This one was to be known as the “International Symposium on Vitamin E, Minneapolis, September 26-27.” The notice said that information could be obtained by writing to Dr. M.K. Horwitt at the Department of Biochemistry, St. Louis University School of Medicine. I wrote to Dr. Horwitt (29 June 1973) requesting information and asking if I could arrange to have an area adjacent to the meetings for a continuous presentation of a representative selection of our colored slides. 1973 年 6 月，《Nutrition Today》刊登了一则关于另一场会议的通知。这次会议被称为“国际维生素 E 研讨会，明尼阿波利斯，9 月 26-27 日。”通知中说，可以通过写信给圣路易斯大学医学院生物化学系的 M.K. Horwitt 博士获取信息。我于 1973 年 6 月 29 日写信给 Horwitt 博士，询问信息并请求是否可以安排在会议附近的一个区域，连续展示我们精选的彩色幻灯片。
The slides I refer to show the results of the treatment of acute thrombophlebitis, chronic varicose ulcerations, various ulcers, diabetic gangrene and other conditions. Not one of the cases presented in them had responded to what has heretofore been considered to be the “correct” treatment. These slides have been responsible for the “conversion” of many doctors in the California area and more recently for that of the majority of the members of the International Academy of Preventive Medicine and the International Academy of Metabology, and have strengthened the stand taken many years ago by the International College of Applied Nutrition. I thought it was only reasonable that since they establish the efficacy of megavitamin alpha tocopherol beyond any doubt, such a presentation would be enthusiastically received by the sponsors of the “International Symposium on Vitamin E.” 我提到的幻灯片展示了急性血栓性静脉炎、慢性静脉曲张性溃疡、各种溃疡、糖尿病性坏疽及其他疾病的治疗结果。幻灯片中展示的所有病例都未对迄今被认为是“正确”的治疗方法产生反应。这些幻灯片促使加利福尼亚地区的许多医生“转变”了看法，最近也促使国际预防医学学院和国际代谢学学院的大多数成员转变了看法，并且加强了多年前国际应用营养学院所持的立场。我认为既然这些幻灯片毫无疑问地证明了大剂量维生素α-生育酚的疗效，那么这样的展示理应受到“国际维生素 E 研讨会”主办方的热烈欢迎。
NOT SO! 不是这样的！
Dr. Horwitt replied (6 July 1973) that the number of Horwitt 博士回复道（1973 年 7 月 6 日），数量为
participants would be very limited and that “Only speakers and discussants who have recently conducted controlled experiments on the biochemistry and physiology of the tocopherols have been invited.” He also indicated that there would be no booths. I replied (8 July 1973) that an "international symposium on Vitamin E^('')E^{\prime \prime} should have a broader focus. All interested scientists-physicians as well as biochemists and physiologists-should be accommodated. Finally (1 August 1973) Dr. Horwitt refused me: “I regret that it would defeat our purpose to invite you to our symposium.” 参与者将非常有限，“只有最近进行过生物化学和生理学中生育酚的受控实验的发言人和讨论者被邀请。”他还表示不会有展位。我在 1973 年 7 月 8 日回复说，“关于维生素 E^('')E^{\prime \prime} 的国际研讨会应该有更广泛的关注点。所有感兴趣的科学家——包括医生、生物化学家和生理学家——都应被接纳。最后（1973 年 8 月 1 日），Horwitt 博士拒绝了我：“很遗憾，邀请您参加我们的研讨会将违背我们的目的。”
Even so, one paper of considerable clinical significance was presented at this “International Symposium on Vitamin E.” Somehow Dr. Knüt Haeger from the General Hospital at Malmo, Sweden was allowed to present his work on the treatment of intermittent claudication with Vitamin E. This was a controlled trial described in Vascular Diseases (6). In that experiment, twelve legs were amputated, only one belonging to a patient in the alpha tocopherol-treated group which represented 104 out of 227 subjects in the study. I shall describe this study in some detail in Chapter 11. 尽管如此，在这次“国际维生素 E 研讨会”上仍有一篇具有相当临床意义的论文被提交。来自瑞典马尔默总医院的 Dr. Knüt Haeger 被允许介绍他关于用维生素 E 治疗间歇性跛行的研究。这是一项在《血管疾病》(6)中描述的对照试验。在该实验中，共截肢十二条腿，其中只有一条属于接受α-生育酚治疗组的患者，该组在研究中共有 227 名受试者中的 104 名。我将在第 11 章中详细描述这项研究。
Medical people generally have had to accept Haeger’s study as definitive. And this leaves some of them with a real problem. How can a substance work to support and save ischemic tissue (tissue lacking a proper blood supply) in one area of the body and not have the slightest effect on exactly the same situation in other parts of the body? Curious, too, is the fact that Dr. Haeger’s paper seemed convincing when the same observations made by the Shutes and confirmed by Professor Boyd of the University of Manchester and in some thirty-one other papers failed to impress these same scientists. (Dr. Boyd reported success in the treatment of 1,345 patients with this condition in 1963 and his work includes a report on a controlled series.) 医学界普遍不得不接受 Haeger 的研究为权威结论。这使得其中一些人面临真正的问题。一个物质如何能在身体某一部位支持和挽救缺血组织（缺乏适当血液供应的组织），而在身体其他部位的完全相同情况下却毫无影响？同样令人好奇的是，Haeger 博士的论文似乎令人信服，而 Shutes 夫妇的相同观察结果以及曼彻斯特大学 Boyd 教授和其他三十一篇论文的确认，却未能打动这些科学家。（Boyd 博士在 1963 年报告了对 1345 名患有此病患者的成功治疗，他的工作包括一项对照系列的报告。）
Obviously, after twenty-seven years of noncommunica- 显然，在二十七年没有交流之后—
tion between the basic science group and the clinical medicine group (little e and Big E), communication between the two groups is impossible. To quote Dr. Horwitt, the biochemists, physiologists and nutritionists “'try to avoid thinking in terms of ‘cures’ but [strive] to obtain basic physiological data which may someday be useful.” At this date such a statement is palpably ludicrous. People in clinical medicine who have come to know the effectiveness of alpha tocopherol in relieving human suffering and lengthening lives find it difficult to retain such detachment. 基础科学组和临床医学组（小 e 和大 E）之间的沟通是不可能的。引用 Horwitt 博士的话，生物化学家、生理学家和营养学家“‘尽量避免以‘治愈’的角度思考，但[努力]获得将来可能有用的基础生理数据。”到目前为止，这样的说法显然是荒谬的。那些在临床医学中了解α-生育酚在缓解人类痛苦和延长寿命方面有效性的人，很难保持这种超然态度。
The Shute brothers do not maintain this detachment. Because they do not, there are several thousand people who have been directly helped, and who knows how many more thousands the world over who have been helped as a result of our work. We accepted Dr. Boyd’s results as confirming ours some ten years before the acceptance of Haeger’s work. Shute 兄弟并不保持这种超然态度。正因为如此，有数千人直接得到了帮助，更不用说全世界因我们的工作而受益的数以千计的人了。我们接受了 Boyd 博士的结果，认为这证实了我们的研究，这比 Haeger 的工作被认可早了大约十年。
At this point I cannot resist sharing with you the most recent episode in Dr. Fredrick Stare’s campaign against Vitamin E. He has a syndicated newspaper column in which he frequently states his position on the subject of Vitamin E therapy-one of complete and absolute condemnation. However, he has now had to admit, though ever so reluctantly, that “there are suggestions that large amounts of Vitamin E may help alleviate the situation” known as intermittent claudication, though he hastens to add, “but there is very little sound evidence that it does.” 此时我忍不住要与您分享弗雷德里克·斯泰尔博士最近一次针对维生素 E 的运动事件。他有一篇联合报纸专栏，经常在其中表达他对维生素 E 疗法的立场——完全且绝对的谴责。然而，他现在不得不勉强承认，“有迹象表明大量维生素 E 可能有助于缓解”被称为间歇性跛行的状况，尽管他急忙补充说，“但几乎没有确凿的证据表明它有效。”
You will remember that Dr. Robert E. Olson was widely quoted as saying that Vitamin E had no value in any cardiovascular condition-except intermittent claudication. This has put Dr. Stare in a difficult position since Olson is a fellow “nutritionist,” a pupil and a friend. Note the contrast in two of Stare’s columns, one week apart. 你会记得，罗伯特·E·奥尔森博士曾被广泛引用说维生素 E 在任何心血管疾病中都没有价值——除了间歇性跛行。这使得斯泰尔博士处于一个尴尬的境地，因为奥尔森是他的“营养学家”同行、学生和朋友。请注意斯泰尔两篇相隔一周的专栏之间的对比。
A column was published under his name in The Vancouver Sun, for 10 July 1974 headed "Vitamin E Use Under 1974 年 7 月 10 日，《温哥华太阳报》以他的名字发表了一栏题为“维生素 E 的使用”的专栏文章
Attack." In it he comments on two letters in The Lancet-one by Dr. M.H. Briggs of Australia and a later one by Dr. Sven Dahl of Sweden, and an article from Edinburgh (reference not given). The concluding paragraph of the column contains this statement: “There is no evidence, T.V. shows to the contrary, that any known illness of man is helped by extra Vitamin E, and there is increasing evidence that extra Vitamin E taken by so many gullible individuals may do harm.” 攻击。”文中他评论了《柳叶刀》上的两封信——一封来自澳大利亚的 M.H. Briggs 博士，另一封是瑞典的 Sven Dahl 博士的来信，以及一篇来自爱丁堡的文章（未给出参考）。该专栏的结尾段包含这样一句话：“没有证据表明，尽管电视节目显示相反，任何已知的人类疾病能通过额外补充维生素 E 得到帮助，而且越来越多的证据表明，许多轻信的人服用额外的维生素 E 可能会有害。”
Just one week later, his column carried an interesting question and answer-on the subject of Vitamin E-though Vitamin E was not headlined this time. The headline, rather, was “Pasteurized Milk Is Safe.” Here is the question and answer in full. 仅仅一周后，他的专栏刊登了一个关于维生素 E 的有趣问答，尽管这次标题并未提到维生素 E。标题反而是“巴氏杀菌牛奶是安全的”。以下是完整的问答内容。
Q. Dr. Robert E. Olson, Professor of biochemistry and medicine at St. Louis University was recently quoted in the papers as saying that the only type of disease found to benefit from large doses of Vitamin E is a cardiovascular ailment known as intermittent claudication. Does this disease affect the circulation of leg arteries, making walking difficult and painful? 问：圣路易斯大学生物化学和医学教授罗伯特·E·奥尔森博士最近在报纸上被引用说，唯一被发现从大量维生素 E 中受益的疾病是一种称为间歇性跛行的心血管疾病。这种疾病是否影响腿部动脉的循环，使行走变得困难和疼痛？
A. Dr. Olson is a good friend, a former student and staff member of Harvard’s department of nutrition and a bright physician who is very knowledgeable in nutrition. He has also done considerable basic research on Vitamin E. You are right in that a condition known as intermittent claudication is occasionally responsible for pain in the lower legs, particularly during walking. There are suggestions that large amounts of Vitamin E may help alleviate this situation, but very little sound evidence that it does. A. Olson 博士是我的好朋友，曾是哈佛营养系的学生和教职员工，他是一位非常有营养学知识的优秀医生。他还进行了大量关于维生素 E 的基础研究。你说得对，间歇性跛行这种情况偶尔会导致下肢疼痛，尤其是在行走时。有观点认为大量维生素 E 可能有助于缓解这种情况，但几乎没有确凿的证据证明其有效。
Is this a tiny crack in the position of the world’s Number One opponent of Vitamin E therapy? 这是世界头号反对维生素 E 疗法者立场上的一个小裂痕吗？
Near the opening of this chapter I outlined the growth in public awareness of alpha tocopherol and its effectiveness that has taken place since 1954. Following that, I gave you some idea of the positions taken by some of the skeptics in the “opposition.” Now let me conclude by telling you of a couple of pleasant encounters I’ve had recently with investigators from abroad. 在本章开头，我概述了自 1954 年以来公众对α-生育酚及其有效性的认识增长。随后，我向你介绍了一些“反对派”怀疑者所持的立场。现在让我以最近与几位来自国外的研究人员愉快的会面作为结尾。
We have known for many years that the clinical use of alpha tocopherol is world-wide. My brother Evan keeps a constant watch on the world medical literature in our field in order to prepare summaries of it for publication in the journal of the Shute Foundation, the nonprofit organization that operates the Shute Institute. (This journal, called simply The Summary, goes to many interested physicians and to medical libraries throughout the world-some twelve thousand copies per issue.) We also hear from patients living in many countries, and we receive letters from physicians all over the civilized world who are interested in and using Vitamin E. 多年来我们一直知道，α-生育酚的临床应用遍及全球。我的兄弟 Evan 持续关注我们领域的世界医学文献，以便为 Shute 基金会的期刊准备摘要出版。Shute 基金会是运营 Shute 研究所的非营利组织。（这本名为 The Summary 的期刊寄送给许多感兴趣的医生和全球各地的医学院图书馆——每期约一万二千份。）我们还收到来自许多国家患者的来信，以及来自世界各地对维生素 E 感兴趣并使用它的医生的信件。
Recently I was privileged to be a speaker at a medical convention in Las Vegas. On the same program was Dr. Hans Nieper from Germany. He is the authority, having done most of the original work, on the orotates-the magnesium and sodium salts of orotic acid. On an occasion when we were both on a panel discussing coronary heart disease, he corroborated my answers to the questions on alpha tocopherol treatment from the doctors in the audience. To my delight, he seemed very much surprised that there was any longer any question in anyone’s mind about its efficacy in cardiovascular disease. 最近我有幸在拉斯维加斯的一次医学大会上做演讲。与我同台的是来自德国的 Hans Nieper 博士。他是该领域的权威，完成了关于乳清酸盐——乳清酸的镁盐和钠盐——的大部分原创工作。在一次我们共同参加的关于冠心病的讨论小组中，他证实了我对观众中医生提出的关于α-生育酚治疗问题的回答。令我高兴的是，他似乎非常惊讶，居然还有人对其在心血管疾病中的疗效存在疑问。
On Dr. Nieper’s return to Germany he sent me a reprint of an article (in German) by von Rave et al. (7) showing that mesenchyme metabolism accelerations caused by toxin stimulation can be met by large Vitamin E doses and also that 在 Nieper 博士返回德国后，他寄给我一篇由 von Rave 等人（7）撰写的文章（德文版）的重印本，文章显示由毒素刺激引起的间充质代谢加速可以通过大量维生素 E 剂量来应对，并且还表明
proliferation of granulation tissue (new tissue formed in healing) is diminished. “These findings,” say the authors, “confirm clinical and other experimental observations that Vitamin E has a favorable effect in a great number of connective tissue diseases.” This, of course, confirms our many observations since using alpha tocopherol in this way. What interested me most was the bibliography. Forty-three scientific papers were quoted! 肉芽组织（愈合过程中形成的新组织）的增生减少。作者说：“这些发现证实了临床和其他实验观察，即维生素 E 对许多结缔组织疾病有有利影响。”这当然证实了我们自从以这种方式使用α-生育酚以来的许多观察结果。我最感兴趣的是参考文献，引用了四十三篇科学论文！
Shortly afterward I received an invitation to present a paper at a medical conference in Baden-Baden, Germany on the subject of coronary artery disease. Unfortunately I had to refuse because I had already accepted an invitation to present our work, in three parts, at a medical-dental meeting in Hawaii. I mention this to illustrate the world-wide interest in and acceptance of our work and to remind the reader that the majority of the clinical investigation into the effects of Vitamin EE has been a direct result of our original reports. 不久之后，我收到邀请，在德国巴登-巴登的一次医学会议上就冠状动脉疾病主题发表论文。不幸的是，我不得不拒绝，因为我已经接受了在夏威夷一次医牙学会议上分三部分介绍我们工作的邀请。我提到这点是为了说明我们工作的全球关注和认可，并提醒读者，大多数关于维生素 EE 效果的临床研究都是直接源于我们的原创报告。
Not too long ago, we had a visit from Lady Phyllis Cilento, a doctor from Australia and the wife of another doctor, Sir Raphael Cilento, head of the Public Health Service in that country. (The Cilentos have two sons and a daughter who are also physicians and a daughter, Diane, who is a well-known actress.) 不久前，我们接待了来自澳大利亚的医生菲利斯·西伦托夫人，她是另一位医生、澳大利亚公共卫生服务主管拉斐尔·西伦托爵士的妻子。（西伦托一家有两个儿子和一个女儿也是医生，还有一个女儿黛安，是一位著名的女演员。）
Three circumstances in Lady Cilento’s work in Australia both interested her and bothered her. First, she had had some practical experience in the use of alpha tocopherol to soften scar tissue and had seen its effects in restoring circulation to dead-looking toes. Secondly, she had become disturbed by the increasing number of deaths from coronary occlusions and the disablement of those who survived such attacks. Thirdly, she had searched the literature on Vitamin E and found it to be voluminous-yet ignored by some investigators. Lady Cilento 在澳大利亚的工作中有三种情况既引起了她的兴趣，也让她感到困扰。首先，她在使用α-生育酚软化瘢痕组织方面有一些实际经验，并见证了其在恢复看似死亡的脚趾血液循环方面的效果。其次，她对冠状动脉阻塞导致的死亡人数不断增加以及幸存者的残疾感到不安。第三，她查阅了关于维生素 E 的文献，发现文献数量庞大，但却被一些研究人员忽视。
This indomitable woman decided to “go in search of the truth about Vitamin E.” And so she set out on a long journey 这位不屈不挠的女性决定“去寻找关于维生素 E 的真相。”于是她踏上了一段漫长的旅程。
that brought her to our door, among others. 这使她来到我们门前，除此之外还有其他原因。
In many countries she found doctors who were using Vitamin E successfully: one practicing in Singapore; a leading heart specialist in Bavaria, Germany; one in England who had visited the Shute Institute and returned home to begin the use of E. This English physician told Lady Cilento that Vitamin E did all that we had claimed for it. “There is no doubt that it improves the circulation,” he told her. “Those with angina pectoris find that they can do much more without chest pain, and in my hands those who have survived a coronary thrombosis do not suffer a second attack.” 在许多国家，她发现有医生成功地使用维生素 E：一位在新加坡执业；一位德国巴伐利亚的心脏病专家；一位曾访问过 Shute 研究所并回国开始使用维生素 E 的英国医生。这位英国医生告诉 Lady Cilento，维生素 E 确实具备我们所宣称的功效。“毫无疑问，它能改善血液循环，”他告诉她。“患有心绞痛的人发现他们可以在没有胸痛的情况下做更多事情，而在我手中，那些曾经患有冠状动脉血栓的人不会再发生第二次发作。”
In Canada she went to research centers and then had a long visit with me and my brother Evan. Lady Cilento also took time to see Dr. Lambert, the noted Irish veterinarian who has done much work with E , and to tour the stud farm in Canada which has used Vitamin E to improve the performances of their brood mares and stallions and particularly their race horses. 在加拿大，她去了研究中心，然后与我和我的兄弟埃文进行了长时间的会面。Lady Cilento 还抽时间拜访了著名的爱尔兰兽医 Dr. Lambert，他在维生素 E 方面做了大量工作，并参观了加拿大的种马场，该场使用维生素 E 来提高母马和种马，特别是赛马的表现。
Lady Cilento did a careful job, took voluminous and detailed notes, and published a thorough report of her findings and conclusions in an Australian weekly magazine called Woman’s Day. The issue for 12 November 1973 carried the first of three parts of the report. (I know of no comparable weekly magazine in the United States or Canada. The issue to which I have referred consisted of 119 pages, beautifully and liberally illustrated with full-color as well as black-and-white photographs.) Lady Cilento 做了细致的工作，做了大量详尽的笔记，并在一本名为 Woman’s Day 的澳大利亚周刊上发表了她的发现和结论的详尽报告。1973 年 11 月 12 日的期刊刊登了该报告的三部分中的第一部分。（我不知道美国或加拿大有类似的周刊。我提到的那期杂志共有 119 页，配有精美且丰富的彩色及黑白照片。）
When she left on her tour, Lady Cilento undertook to try to discover the truth about Vitamin E and to report the full story, whether she found the claims for it true or false. In the article she says: " . . . I am convinced that the claims made for alpha-tocopherol are fully justified." She goes on to describe a variety of conditions in which she has seen it work. Finally, she lists in detail seventeen ways in which Vitamin E works in the body. 当她开始巡回演讲时，Lady Cilento 承诺尝试揭示关于维生素 E 的真相，并报告完整的故事，无论她发现的说法是真实还是虚假。在文章中她说：“……我确信对α-生育酚的所有主张都是完全合理的。”她接着描述了她见过维生素 E 起作用的各种情况。最后，她详细列出了维生素 E 在人体内发挥作用的十七种方式。
With her kind permission, I have included part of the 12 November 1973 article as Appendix B of this book. I should like to conclude this chapter now with some excerpts from it that we appreciated very much. 在她的友好许可下，我将 1973 年 11 月 12 日的部分文章作为本书的附录 B 收录。我想以我们非常欣赏的其中一些摘录来结束本章。
“Whenever I hear people ridiculing the claims of the Shutes,” writes Lady Cilento, “calling them ‘cranks’ and refusing to consider the possibility that Vitamin E may have a saving function in cardiovascular disease, I look again at the list of deaths from heart disease in Australia . . . . I am reminded of the many other occasions when life-saving innovations were delayed for years by the irrational conservatism of the medical Establishment . . . . To the list of [those] men who fought against conservatism and uninformed opinion, history must now add Evan and Wilfrid Shute . . . . Once Vitamin E jumps the barriers of prejudice, it may well be instrumental in saving the lives and sparing the suffering of many thousands . . . who will otherwise die.” “每当我听到有人嘲笑 Shutes 的主张，”Lady Cilento 写道，“称他们为‘怪人’，并拒绝考虑维生素 E 可能在心血管疾病中具有救助功能的可能性时，我会再次查看澳大利亚因心脏病死亡的名单……我想起了许多其他因医疗机构的非理性保守主义而延误多年的救命创新……历史现在必须将那些反对保守主义和无知观点的人名单中加入 Evan 和 Wilfrid Shute……一旦维生素 E 突破偏见的障碍，它很可能在挽救成千上万人的生命和减轻他们的痛苦方面发挥重要作用……否则这些人将会死亡。”
REFERENCES 参考文献
Ochsner, A., DeBakey, M.E. and DeCamp, P.J. Journal of the American Medical Association 144, 831, 1950. Ochsner, A., DeBakey, M.E. 和 DeCamp, P.J. 《美国医学会杂志》144, 831, 1950 年。
Shute, E.V. Your Heart and Vitamin E. Toronto: Cardiac Society, 1956. Shute, E.V. 你的心脏与维生素 E。多伦多：心脏学会，1956 年。
Bailey, H. Vitamin E, Your Key to a Healthy Heart. New York: Arc, 1964. Bailey, H. 维生素 E，你健康心脏的关键。纽约：Arc，1964 年。
Shute, W.E. with Taub, H.J. Vitamin E for Ailing and Healthy Hearts. New York: Pyramid, 1969. Shute, W.E. 与 Taub, H.J. 合著。《维生素 E 与病弱及健康的心脏》。纽约：Pyramid 出版社，1969 年。
Haeger, K. Vascular Diseases 5, 199, 1968. Haeger, K. 血管疾病 5, 199, 1968.
Von Rave, O., Wagner, H., Junge-Hülsing, G. and Hauss, W.H. Zeitschrift Rheumaforschung 30, 266, 1971. Von Rave, O., Wagner, H., Junge-Hülsing, G. 和 Hauss, W.H. 《Zeitschrift Rheumaforschung》30, 266, 1971 年。
7
ALPHA TOCOPHEROL IN THE BODY 体内的α-生育酚
THERE IS AN OLD MAXIM that applies to our critics: “A man convinced against his will is of the same opinion still.” Because I believe this to be true, I do not seek to convert our critics. I write now, instead, for interested and intelligent laymen and for doctors who have been in practice long enough to realize that their professors and the officers of their medical associations are not automatically all-knowing because of their exalted positions. I have every expectation that the summary I am about to present of some of the more important research on the treatment of cardiovascular disease in humans with alpha tocopherol will be accepted by such people as logically coherent and scientifically sound. 有一句古老的格言适用于我们的批评者：“一个被强迫改变主意的人，内心仍然持原观点。”因为我相信这是真的，所以我不试图去说服我们的批评者。我现在写作的对象是有兴趣且聪明的外行人，以及那些从医时间足够长，已经意识到他们的教授和医学协会官员并非因其崇高职位而全知的医生。我完全期望即将呈现的关于用α-生育酚治疗人类心血管疾病的一些重要研究总结，会被这样的人认为是逻辑连贯且科学可靠的。
Since a complete bibliography for this chapter would necessarily be enormous, only a partial one can, for practical reasons, be presented here. (See Chapter 5 for the numbers of 由于本章的完整参考书目必然非常庞大，出于实际原因这里只能呈现部分书目。（有关编号，请参见第 5 章）
supporting papers in each of the main areas.) At the end of the References for this particular chapter, therefore, you will find a special list of nineteen additional readings intended for those who wish to pursue the subject further. These reports will be particularly well worth studying to reinforce the information presented in this chapter. 支持各主要领域的论文。）因此，在本章参考文献的末尾，您将找到一份特别的十九篇额外阅读材料清单，供希望进一步深入研究该主题的人士使用。这些报告特别值得研究，以加强本章所呈现的信息。
Let us now think back to the list of functions of alpha tocopherol I gave you in Chapter 5. There was, first, the ability to safely dissolve fresh clots and to prevent their formation. In addition, I listed the ability to reduce the oxygen requirement of the tissues and cells, to decrease abnormal capillary permeability, to function as a capillary vasodilator, to promote collateral circulation and to promote epithelization. I shall now outline for you what we now know about each of these functions. 现在让我们回想一下我在第 5 章中给你列出的α-生育酚的功能。首先，它能够安全地溶解新鲜血块并防止其形成。此外，我还列出了它减少组织和细胞的氧气需求、降低异常毛细血管通透性、作为毛细血管扩张剂的功能、促进侧支循环以及促进上皮化的能力。现在我将为你概述我们目前对这些功能的了解。
1. Alpha Tocopherol as an Antithrombin 1. α-生育酚作为抗血栓剂
One of alpha tocopherol’s two most important functions is, as we have seen, its ability to dissolve fresh clots and to prevent their formation. (Its ability to dissolve fresh clots is particularly easy to demonstrate in peripheral veins.) In this it is unique both because of its effectiveness and its safety. α-生育酚的两个最重要功能之一，如我们所见，是其溶解新鲜血块和防止血块形成的能力。（其溶解新鲜血块的能力在外周静脉中尤为容易展示。）在这方面，它因其有效性和安全性而独一无二。
Alpha tocopherol is a potent antithrombin and is antithrombic in normal concentration in the bloodstream. As I explained in Chapter 3, this action of alpha tocopherol in its application to human medicine was first noted by our group in 1946. In 1948 a paper by Zierler and his group established that alpha tocopherol is vigorously antithrombic both in vivo and vitro (inside and outside of the living body) and that it is antithrombic in its normal concentration in human blood. α-生育酚是一种有效的抗凝血酶剂，在血液中的正常浓度下具有抗血栓作用。正如我在第三章中所解释的，α-生育酚在应用于人类医学时的这种作用最早由我们团队于 1946 年发现。1948 年，Zierler 及其团队发表的一篇论文证实，α-生育酚在体内和体外（活体内外）均具有强烈的抗血栓作用，并且在人体血液的正常浓度下具有抗血栓作用。
Perhaps the strongest and most persistent advocates of alpha tocopherol as a potent antithrombin are Dr. Alton Ochsner and his group. In 1950 Kay, Hutton, Weiss and Ochsner (2) described the use of 300 IU orally a day in the 也许最强烈且最持久支持α-生育酚作为强效抗血栓剂的是 Alton Ochsner 博士及其团队。1950 年，Kay、Hutton、Weiss 和 Ochsner（2）描述了每天口服 300 IU 的使用情况。
successful treatment of four cases of thrombophlebitis. Inflammation subsided and edema disappeared. In this same paper they advocated its use along with intravenous calcium gluconate in the prevention of thromboembolic phenomena. 成功治疗了四例血栓性静脉炎。炎症消退，水肿消失。在同一篇论文中，他们主张将其与静脉注射葡萄糖酸钙联合使用，以预防血栓栓塞现象。
In the same year Ochsner et al. (3) stressed its prophylactic use in the Annals of Surgery, and Ochsner, DeBakey and DeCamp (4) also pointed this out in the Journal of the American Medical Association. 同年，Ochsner 等人在《外科年鉴》中强调了其预防性使用，Ochsner、DeBakey 和 DeCamp 也在《美国医学会杂志》中指出了这一点。
In a letter to the New England Journal of Medicine in 1964, Ochsner (5) states that “alpha tocopherol is a potent inhibitor of thrombin that does not produce a hemorrhagic tendency and is therefore, a safe prophylactic agent against venous thrombosis.” He reiterated the same conclusions about the value of alpha tocopherol before the fifty-second annual assembly of the Interstate Postgraduate Medical Association, and his remarks there were published (6) in Postgraduate Medicine in 1968. In the absence of the prophylactic use of alpha tocopherol, there is a steady and frightening increase in thrombophlebitis and pulmonary embolism. 在 1964 年致《新英格兰医学杂志》的信中，Ochsner（5）指出“α-生育酚是一种强效的凝血酶抑制剂，不会引起出血倾向，因此是一种安全的静脉血栓预防剂。”他在州际研究生医学协会第 52 届年会上重申了关于α-生育酚价值的相同结论，他在会上发表的言论于 1968 年刊登在《研究生医学》杂志（6）上。在未使用α-生育酚进行预防的情况下，静脉炎和肺栓塞的发生率持续且令人担忧地增加。
It stands to reason that an antithrombic agent which dissolves fresh clots, which is antithrombic in normal concentration, and which is effective in preventing intravascular clotting must have a role in the treatment and prevention of a whole group of major medical catastrophes. For example, alpha tocopherol is uniquely useful in treating phlebitis, in preventing phlebitis and so preventing thromboembolism, in treating and preventing “strokes,” and in preventing the arterial and venous thrombosis complications of Buerger’s disease. 合乎情理的是，一种能够溶解新鲜血栓、在正常浓度下具有抗血栓作用且能有效预防血管内血栓形成的抗血栓剂，必然在治疗和预防一整组重大医疗灾难中发挥作用。例如，alpha tocopherol 在治疗静脉炎、预防静脉炎从而预防血栓栓塞、治疗和预防“中风”，以及预防 Buerger 病的动脉和静脉血栓并发症方面具有独特的作用。
2. Alpha Tocopherol as an Antioxidant 2. α-生育酚作为抗氧化剂
Alpha tocopherol’s second important function is its ability to decrease the need for oxygen in the tissues and organs of the body. This it shares at megavitamin levels with Vitamin C α-生育酚的第二个重要功能是它能够减少身体组织和器官对氧气的需求。在大剂量维生素水平下，它与维生素 C 具有相同的作用。
and with trace levels of selenium. Any two or all three of these can be used together. This action is of great usefulness whenever there is a decreased level of oxygen in tissue. It helps the cells to survive if the reduction is extreme and, in less dangerous situations, to function more normally. It has, therefore, very wide application in many apparently unrelated conditions. 并含有微量的硒。这三者中的任意两种或全部三种都可以一起使用。每当组织中的氧气水平降低时，这种作用非常有用。它帮助细胞在氧气极度减少时存活，在较不危险的情况下则帮助细胞更正常地运作。因此，它在许多看似无关的状况中有着非常广泛的应用。
When arteries are narrowed, the availability of oxygen is gradually decreased until it reaches the level at which the cells cannot carry out their normal metabolic functions. If the sclerosing (hardening) process continues, it may reach the point at which the cells can no longer survive and the result may be very serious-gangrene, myocardial infarction or brain softening, for example. 当动脉变窄时，氧气的供应逐渐减少，直到达到细胞无法进行正常代谢功能的水平。如果硬化过程继续，可能会达到细胞无法存活的程度，结果可能非常严重——例如坏疽、心肌梗死或脑软化。
When veins become unable to return blood to the heart at a normal rate, blood which has released a portion of its oxygen in the tissues stagnates there to some degree, and fresh blood and oxygen cannot reach the tissues. In some large varicosities the blood flow can actually be reversed. Edema of the extremities with interstitial fluid prevents the normal transport of oxygen and of the waste products of cell metabolism across the cell membrane. 当静脉无法以正常速度将血液送回心脏时，血液在组织中释放出部分氧气后会在一定程度上停滞，新的血液和氧气无法到达组织。在一些大的静脉曲张处，血流甚至可能发生逆转。肢体水肿伴有间质液，阻碍了氧气和细胞代谢废物通过细胞膜的正常运输。
Whatever the cause, the ability of alpha tocopherol in 300 to 3,200 IU a day to decrease the cell’s need for oxygen will help the individual cell and therefore the tissues in general to function more normally or even quite normally. Impending gangrene, cerebral softening or myocardial infarction can thus be prevented. The best evidence that this is so is in cases of intermittent claudication. Happily, the efficacy of alpha tocopherol in this situation is now clear. 无论原因如何，α-生育酚每天 300 到 3200 国际单位减少细胞对氧气的需求的能力，将有助于单个细胞，因此也有助于组织整体更正常甚至非常正常地运作。由此可以预防即将发生的坏疽、脑软化或心肌梗死。对此最有力的证据是在间歇性跛行的病例中。令人欣慰的是，α-生育酚在这种情况下的疗效现在已十分明确。
We have a large number of photographs of the results of alpha tocopherol treatment in many cases where the deterioration of blood supply, due either to narrowing of arteries or stagnation of blood in the venous system (or both), with or 我们有大量关于α-生育酚治疗效果的照片，涉及许多因动脉狭窄或静脉系统血液淤滞（或两者兼有）导致血液供应恶化的病例，伴或不伴
without accompanying intravascular clotting, has led to peripheral gangrene or to ulceration. In diabetic gangrene, the administration of alpha tocopherol helps the cells proximal to the dead cells to regain their normal function, and so to resist extension of the necrosis, and to initiate normal healing processes. Soon an area of demarkation appears and the living tissues literally slough off the dead tissues. 没有伴随血管内凝血，导致了周围性坏疽或溃疡。在糖尿病性坏疽中，给予α-生育酚有助于死细胞近端的细胞恢复正常功能，从而抵抗坏死的扩展，并启动正常的愈合过程。不久，出现一个分界区，活组织实际上脱落了死组织。
Without alpha tocopherol treatment, such cases inevitably result in amputation of the leg, usually above the knee, since only at this level is the blood supply sufficient to allow the flaps of the stump to heal and eventually, it is hoped, to bear the patient’s weight. Many such cases have been allowed to go on to complete self-amputation. The slides we show to medical audiences illustrate this. The results shown in our slides are unique in that no other agent could have saved these legs. 如果不进行α-生育酚治疗，这类病例不可避免地会导致截肢，通常是在膝盖以上，因为只有在这个部位血液供应才足够，使残肢的皮瓣能够愈合，并最终希望能够承受患者的体重。许多此类病例被允许自行完全截肢。我们向医学观众展示的幻灯片说明了这一点。我们幻灯片中显示的结果是独一无二的，因为没有其他药物能够挽救这些腿。
In the heart and brain the same action of alpha tocopherol provides a like result. The eye is an extension of the brain, the latter making up 2 percent of the body weight but demanding 25 percent of the body’s total nutrition. The vessels in the retina are readily visible through the dilated pupil since they are covered by a single layer of cells. As a result, all the pathological changes in the arteries, veins and capillaries can be seen and photographed. Hemorrhages, exudates, scars and other types of damage can also be observed. These changes can be reversed by alpha tocopherol. They can be treated even more rapidly and more completely by megavitamin doses of EE and CC. 在心脏和大脑中，α-生育酚的作用产生了类似的效果。眼睛是大脑的延伸，后者占身体重量的 2%，但需要身体总营养的 25%。视网膜中的血管通过扩大的瞳孔清晰可见，因为它们被一层细胞覆盖。因此，动脉、静脉和毛细血管中的所有病理变化都可以被观察和拍摄到。出血、渗出物、瘢痕及其他类型的损伤也可以被观察到。这些变化可以通过α-生育酚逆转。通过 EE 和 CC 的大剂量维生素治疗，这些变化可以更快、更彻底地得到治疗。
Alpha tocopherol is essential for the normal activity of all the cells in the body. Their integrity and function depend on adequate blood supply. When the oxygen supply is reduced by pathological changes in the blood vessels, alpha tocopherol will always decrease the oxygen need and in many cases allow the cells and tissues to behave normally. α-生育酚对身体所有细胞的正常活动至关重要。它们的完整性和功能依赖于充足的血液供应。当血管的病理变化导致氧气供应减少时，α-生育酚总是会降低氧气需求，并在许多情况下使细胞和组织表现正常。
Cells can be damaged and their metabolism critically affected by circulating toxins. This occurs in the heart in acute rheumatic fever and in the kidneys in acute glomerulonephritis (a kidney inflammation), and here the action of alpha tocopherol is of maximum value. When given at the onset of symptoms, it allows the heart and the kidney to handle the insult rapidly and completely. 细胞可能会被循环中的毒素损伤，其代谢也会受到严重影响。这种情况发生在急性风湿热的心脏以及急性肾小球肾炎（一种肾脏炎症）的肾脏中，而此时 alpha tocopherol 的作用价值最大。在症状出现时给予它，可以使心脏和肾脏迅速且完全地应对损伤。
In most pathological lesions for which alpha tocopherol is an adequate answer or is greatly helpful, its antithrombic and antioxidant mechanisms are the ones which lead to the initial improvement as, for example, in the treatment of fresh thrombophlebitis or in the healing of a heretofore intractable chronic ulceration of the leg. However, alpha tocopherol has other important actions which in other cases are the chief reason for its usefulness or the reason for an improvement in rate and degree of recovery. 在大多数病理病变中，α-生育酚是一个足够的或极为有帮助的解决方案，其抗血栓和抗氧化机制是导致初步改善的原因，例如在治疗新发血栓性静脉炎或愈合先前难治的慢性腿部溃疡时。然而，α-生育酚还有其他重要作用，在其他情况下，这些作用是其有用性的主要原因或恢复速度和程度改善的原因。
3. Alpha Tocopherol as a Controller of Abnormal Capillary Permeability 3. α-生育酚作为异常毛细血管通透性的调节剂
Another most important action of alpha tocopherol is its ability to restore capillary permeability to normal in areas of insult whether allergic or due to infection. It is this action of overcoming the allergic responses and preventing or reversing the damage that is responsible for the rapid and almost miraculous recovery of patients treated at or near the onset of acute nephritis or acute rheumatic fever. This statement should be amended. It is an absolute miracle to see an acute case of either of these conditions return to absolute normal in as little as twenty-four to forty-eight hours. Usually there is every evidence of complete recovery in a matter of days, often in only two or three. The only comparable experience is the witnessing of complete disappearance of all evidence of acute phlebothrombosis. α-生育酚的另一个最重要的作用是其能够使受损区域的毛细血管通透性恢复正常，无论是过敏反应还是感染引起的。正是这种克服过敏反应并防止或逆转损伤的作用，使得在急性肾炎或急性风湿热发作初期或接近发作时接受治疗的患者能够迅速且几乎奇迹般地康复。这一说法应予以修正。看到这两种急性病症的患者在短短二十四到四十八小时内恢复到完全正常状态，绝对是一种奇迹。通常情况下，几天内就能完全康复，往往只需两三天。唯一可比的经历是目睹急性静脉血栓形成的所有症状完全消失。
In a fresh case of acute nephritis or acute rheumatic fever 在急性肾炎或急性风湿热的新病例中
an infection, usually in the tonsil or throat, triggers a pathological reaction in the kidney in the one instance or the myocardium in the other. The tissues of the organ become waterlogged due to pathological changes in the small vessels and capillaries, and normal metabolism is critically impaired. Alpha tocopherol restores normal capillary permeability. The tissues return to normal and literally throw off the impending damage. Unfortunately, alpha tocopherol is less effective in the chronic stages of these conditions. 感染，通常发生在扁桃体或喉咙，引发肾脏或心肌的病理反应。由于小血管和毛细血管的病理变化，器官组织出现水肿，正常代谢受到严重影响。α-生育酚恢复了正常的毛细血管通透性。组织恢复正常，实际上摆脱了即将到来的损伤。不幸的是，α-生育酚在这些疾病的慢性阶段效果较差。
4. Alpha Tocopherol as a Capillary Vasodilator 4. α-生育酚作为毛细血管扩张剂
Alpha tocopherol also functions as a dilator of capillaries and therefore as a facilitator of the circulation of blood throughout the body. This action is of value in many conditions in which there is spasm in a vessel wall or a significant degree of vessel damage, acute or chronic. α-生育酚还具有扩张毛细血管的功能，因此有助于全身血液循环。这一作用在许多血管壁痉挛或血管损伤（急性或慢性）较严重的情况下非常有价值。
5. Alpha Tocopherol and Çollateral Circulation 5. α-生育酚与侧支循环
Alpha tocopherol speeds up the collateral circulation in two ways: by reducing any abnormal tendency to spasm and by increasing the size of the collateral channels. α-生育酚通过两种方式加速侧支循环：减少任何异常的痉挛倾向和增加侧支通道的大小。
It has been shown experimentally that alpha tocopherol increases the degree of development of collateral circulation and initiates this effect earlier than it would develop otherwise. This network of smaller vessels dilates to carry a larger volume of blood around the block to the vessels beyond. This may provide the necessary help to prevent death of an extremity. 实验证明，α-生育酚能够增加侧支循环的发育程度，并比其自然发展更早地启动这一效果。这些较小血管的网络扩张，以携带更多的血液绕过阻塞，流向远端的血管。这可能为防止肢体坏死提供必要的帮助。
This action of alpha tocopherol is probably the main reason for the observation made early in our experience, and corroborated so often since, that once definite improvement is experienced, it will continue slowly for a long time, usually months, often years. Unlike most treatment, which works to a α-生育酚的这种作用很可能是我们早期经验中观察到的主要原因，并且此后多次得到证实，即一旦出现明显改善，这种改善将会缓慢持续很长时间，通常是几个月，甚至多年。与大多数治疗不同，后者的效果是...
certain degree and then stops at that level or slowly declines, alpha tocopherol treatment usually continues to bring about improvement in patients. In heart patients this is evidenced not only by their clinical signs and increasing exercise tolerance, but also by the slow but steady improvement, even for years, in their electrocardiograms. The majority of cardiac patients are middle-aged and older. To see them keep on improving as they get older is a most gratifying experience. 在达到某种程度后停止或缓慢下降，α-生育酚治疗通常会继续带来患者的改善。在心脏病患者中，这不仅通过他们的临床症状和增加的运动耐力表现出来，还通过他们的心电图缓慢但持续的改善，甚至持续多年。大多数心脏病患者是中年及以上年龄。看到他们随着年龄增长持续改善，是一种非常令人欣慰的经历。
6. Alpha Tocopherol and Epithelization 6. α-生育酚与上皮化
Ulcerated and denuded wounds heal more rapidly with alpha tocopherol therapy, and the scar tissue does not contract and is not tender. For this reason, and because of its ability to limit cell death to those cells that have been killed by the burning agent, alpha tocopherol is the ideal treatment for burns. It will even act favorably on old scar tissue, reducing many scars even to the point of near disappearance. In old keloids, it takes away the itchiness that often accompanies the condition and reduces the redness. Keloids can be prevented by the prophylactic use of oral alpha tocopherol and application of topical (local) alpha tocopherol to the fresh wound. (A keloid is an overproduction of scar tissue in certain individuals. Keloids are more common in the races with heavy skin pigmentation.) 溃疡和剥脱的伤口在使用α-生育酚治疗后愈合更快，瘢痕组织不会收缩且不疼痛。正因为如此，加之其能够将细胞死亡限制在被烧伤剂杀死的细胞范围内，α-生育酚成为烧伤的理想治疗方法。它甚至对旧瘢痕组织也有良好作用，能使许多瘢痕几乎消失。在旧疤痕疙瘩中，它能缓解常伴随的瘙痒感并减轻红肿。通过口服α-生育酚的预防性使用以及局部涂抹α-生育酚于新鲜伤口，可以预防疤痕疙瘩。（疤痕疙瘩是某些个体瘢痕组织过度增生的表现。疤痕疙瘩在皮肤色素较重的种族中更为常见。）
Another action of alpha tocopherol must be men-tioned-namely, its general help by means of all the mechanisms we have discussed in the treatment of a large group of connective tissue diseases. 还必须提到α-生育酚的另一种作用——即通过我们讨论过的所有机制，在治疗大量结缔组织疾病中提供的一般性帮助。
The observation by ourselves and others that alpha tocopherol is of great use in many of the collagen diseases (diseases of the main protein constituent of the connective tissues and cartilage) confirms part of the mechanism of the unique characteristics of E-treated lesions. (The German 我们自己和其他人观察到，α-生育酚在许多胶原蛋白疾病（结缔组织和软骨的主要蛋白质成分的疾病）中非常有用，这证实了 E 治疗病变独特特性的部分机制。（德国
work by von Rave et al. has been cited previously.) von Rave 等人的工作已被先前引用。)
Finally, alpha tocopherol has the ability to combine with other vitamins, minerals and hormones. This was noted many years ago by veterinarians, notably Dr. H.C. Burns of the H.C. Burns Company of California, in the successful treatment and prevention of “white muscle disease” in lambs and calves. Alpha tocopherol was effective but selenium, a trace mineral, more so. Selenium alone, however, is toxic in the effective dose. A small quantity of alpha tocopherol plus the selenium was much more effective than either alone. In addition, the resulting material was nontoxic and 97 percent effective. 最后，alpha tocopherol 具有与其他维生素、矿物质和激素结合的能力。多年前，加利福尼亚 H.C. Burns 公司的兽医，特别是 Dr. H.C. Burns，在成功治疗和预防羔羊和小牛的“白肌病”中注意到了这一点。Alpha tocopherol 有效，但微量矿物质硒更有效。然而，单独使用硒在有效剂量下是有毒的。少量的 alpha tocopherol 加上硒，比单独使用任何一种都更有效。此外，所得到的物质无毒，且有效率达到 97%。
There are many such instances. Treatment of hypoglycemia, for example, is completely successful when three vitamins at the mega level are combined with the appropriate diet. One of these is 800 IU of alpha tocopherol. 有许多这样的例子。例如，低血糖的治疗在将三种维生素以大剂量与适当饮食结合时完全成功。其中一种是 800 IU 的 alpha tocopherol。
In Executive Fitness Newsletter for 20 November 1971 there is an account of a study reported at the Fifth Annual Convention on Trace Elements in Environmental Health at the University of Missouri. In this study, Dr. James P. Isaacs of the Johns Hopkins School of Medicine, Baltimore, followed twenty-five heart patients thirty-nine to seventy-five years of age who were classified as “poor risks.” Dr. Isaacs gave them a daily dietary supplementation that included Vitamin C (100 mg ), Vitamin E ( 100 IU ), a low-dosage vitamin and mineral formula and the trace elements copper, zinc and manganese. Every fourth month, for a month at a time, Vitamin B6 (100 mg ) was also given daily. All but one of these patients was still alive after six years and none of the survivors has had a recurrence of his heart problem or has gone back to the hospital because of heart disease complications. All, including the one patient who died, had experienced improved exercise tolerance. Beneficial side-effects noted were improvement in skin texture and appearance; augmentation of nail pliability, 在 1971 年 11 月 20 日的《Executive Fitness Newsletter》中，有一篇报道介绍了密苏里大学第五届环境健康微量元素年会上的一项研究。在这项研究中，来自巴尔的摩约翰霍普金斯医学院的 James P. Isaacs 博士跟踪了二十五名年龄在三十九至七十五岁之间、被归类为“高风险”的心脏病患者。Isaacs 博士每天给他们补充包括维生素 C（100 毫克）、维生素 E（100 IU）、低剂量维生素和矿物质配方以及微量元素铜、锌和锰的膳食补充剂。每隔四个月，连续一个月每天还补充维生素 B6（100 毫克）。六年后，除一名患者外，所有患者仍然存活，且幸存者中没有人心脏病复发或因心脏病并发症再次住院。所有患者，包括去世的那一位，都表现出运动耐力的改善。观察到的有益副作用包括皮肤质地和外观的改善；指甲柔韧性的增强，
growth rate and cuticle development; improvement in hair density and growth rate and scalp health; and improvement in gum color, texture and healing. It was also noted that “gums and teeth became more strongly attached.” 生长速度和角质层发育；头发密度、生长速度和头皮健康的改善；牙龈颜色、质地和愈合的改善。还注意到“牙龈和牙齿的附着更加牢固。”
An interesting part of this experiment is the effectiveness of the treatment with only 100 IU of EE and 100 mg of CC when these were combined with other substances. 这项实验的一个有趣部分是，当将 100 IU 的 EE 和 100 mg 的 CC 与其他物质结合使用时，治疗的效果。
The keystone of the research work done by the Shute group and their followers over the years was, as I have mentioned, the interest of my father, Dr. Richard James Shute, in the use of thyroid to neutralize excess estrogen in some of his patients. In 1933 he enthusiastically joined my brother Evan in combining the use of thyroid treatment with Vitamin E treatment. 正如我所提到的，多年来 Shute 团队及其追随者所做研究工作的基石，是我父亲理查德·詹姆斯·舒特博士对使用甲状腺素中和部分患者体内过量雌激素的兴趣。1933 年，他热情地与我兄弟埃文一起，将甲状腺治疗与维生素 E 治疗结合使用。
Estrogen and thyroid extract are antagonistic. Estrogen and alpha tocopherol are also antagonistic. And in people who are low in thyroid activity, cardiovascular damage is increased, both in rate of incidence and in degree. Strangely enough, all this was somehow understood empirically by my father who because of necessity was an industrial surgeon but by inclination was a general practitioner with a special interest in obstetrics and gynecology. 雌激素和甲状腺提取物是拮抗的。雌激素和α-生育酚也是拮抗的。在甲状腺功能低下的人群中，心血管损伤的发生率和程度都会增加。奇怪的是，我父亲出于必要成为了一名工业外科医生，但出于兴趣他是一名对产科和妇科特别感兴趣的全科医生，他以经验方式某种程度上理解了这一切。
The very real usefulness of E and thyroid (and male sex hormone, which is also an estrogen antagonist) in gynecological and obstetrical problems is the special field of my brother and I shall not, therefore, go into it except in a minor way. But I think it is important here to give you a brief summary of the relationship of Vitamin E, estrogen and thyroid. For one thing, this relationship represents the beginning, in an historical sense, of all of our work. For another, I believe that the relationship itself is an extremely significant one, and one which will continue to unlock many mysteries in medicine in the future, just as it has done for us in the past. For it has led us, I am certain, to what may well be the greatest discovery in medicine in this century. 维生素 E 与甲状腺（以及男性性激素，后者也是一种雌激素拮抗剂）在妇科和产科问题上的实际有效性是我兄弟的专长领域，因此我不会详细讨论，只会略作提及。但我认为这里有必要简要总结一下维生素 E、雌激素和甲状腺之间的关系。一方面，这种关系在历史意义上代表了我们所有工作的开端。另一方面，我相信这种关系本身极其重要，并且将继续揭示医学中的许多奥秘，就像它过去为我们所做的那样。因为我确信，它引领我们发现了本世纪医学上可能是最伟大的发现。
Let us look, for a moment, at the work of Dr. Paul Starr. He discussed subclinical hypothyroidism in an article in World Wide Abstracts of General Medicine (Volume 5) in 1962. This beautifully illustrated article points out that even mild degrees of chronic hypothyroidism, usually not recognized by the patient until he or she has been thoroughly questioned by a knowledgeable physician, lead to increased risk of arteriosclerosis, especially of the brain; myocarditis sufficient to produce heart failure; slow mentation, delayed comprehension, poor memory and loss of initiative; atherosclerosis (hardening of the arteries accompanied by fat deposits in their inner surfaces) with resulting angina pectoris; anemia, resembling either the primary or secondary form; somatic (bodily) muscle weakness, leading to orthopedic disability; anorexia (loss of appetite); constipation, even to the point of obstruction; fibrositis (painful inflammation of fibrous tissue) with body-wide pain resembling gout; and phlebothrombosis, with resulting embolism. 让我们暂时看看 Paul Starr 博士的工作。他在 1962 年发表于《World Wide Abstracts of General Medicine》（第 5 卷）的一篇文章中讨论了亚临床甲状腺功能减退症。这篇图文并茂的文章指出，即使是轻度的慢性甲状腺功能减退，通常患者在未经过有经验的医生详细询问前并不察觉，也会导致动脉硬化风险增加，尤其是脑部动脉硬化；足以引起心力衰竭的心肌炎；思维迟缓、理解延迟、记忆力差和主动性丧失；动脉粥样硬化（动脉内表面伴有脂肪沉积的硬化），导致心绞痛；类似原发性或继发性贫血的贫血；躯体肌肉无力，导致骨科残疾；厌食症（食欲丧失）；便秘，甚至达到梗阻程度；纤维炎（纤维组织的疼痛性炎症），伴有类似痛风的全身疼痛；以及静脉血栓形成，导致栓塞。
All this is interesting, since the person with hypothyroidism has an excess of estrogen and/or a deficiency of Vitamin E. 这一切都很有趣，因为甲状腺功能减退症患者体内雌激素过多和/或维生素 E 缺乏。
Some years ago the Journal of the American Medical Association published a leading article entitled, “The Amazing Prevalence of Hypothyroidism in the General Population.” It was a report on a statistical study in Chicago of apparently healthy adults. The conclusion was that 55 percent of females (apparently healthy, remember) and 45 percent of males were low in thyroid activity. 几年前，《美国医学会杂志》发表了一篇题为《普通人群中甲状腺功能减退症的惊人普遍性》的社论。这是一项在芝加哥对表面健康的成年人进行的统计研究报告。结论是，55%的女性（请记住，表面健康）和 45%的男性甲状腺活动低下。
It has been suggested that putting iron into bread would help us to deal with widespread anemia in women. Obviously this is not the ideal answer. Putting iron in bread decreases the availability of Vitamin E, and this could well precipitate severe cardiovascular disease-one of the consequences of hypothyroidism listed by Starr. However, correcting hypothyroidism in most of these women would remove the 有人建议在面包中添加铁，以帮助我们应对女性中普遍存在的贫血问题。显然，这不是理想的解决方案。在面包中添加铁会降低维生素 E 的可利用性，这很可能引发严重的心血管疾病——这是 Starr 列出的甲状腺功能减退症的后果之一。然而，纠正大多数这些女性的甲状腺功能减退症将消除这一问题。
cause of their anemia without reducing the existing Vitamin E supply in their bodies. This would be treating the cause, not the effect. 导致他们贫血的原因，而不减少他们体内现有的维生素 E 供应。这将是治疗原因，而不是症状。
There is now direct evidence of the dangers resulting from administration of estrogen (or conversely deficiency of thyroid or Vitamin E or both). 现在有直接证据表明使用雌激素（或相反地，甲状腺或维生素 E 缺乏或两者兼有）所带来的危险。
Dr. G.T. Mellinger (7) reported in 1967 that estrogen given to males with prostatic cancer significantly increased mortality from cardiovascular disease. This has been confirmed by the Veterans Administration Cooperative Urological Research Group, in an editorial (8) in the Medical Journal of Australia and in a letter from Dr. J.C. Bailar (9) in The Lancet in 1967. G.T. Mellinger 博士（7）于 1967 年报告，给予患有前列腺癌的男性雌激素显著增加了心血管疾病的死亡率。退伍军人管理局合作泌尿研究组、澳大利亚医学杂志上的一篇社论（8）以及 1967 年《柳叶刀》杂志中 J.C. Bailar 博士（9）的一封信均证实了这一点。
The administration of estrogens in the birth control pill has many deleterious side-effects, particularly, of course, in those women who are already high in estrogen because they are low in thyroid. In a report to the American College of Physicians, Drs. Weinberger, Collins and Luetscher of the Department of Medicine at Stanford University School of Medicine stated that hypertension developed in patients taking “the pill” after about one year (as high as 215/125 and not below 160//100160 / 100 ). Within one to four months after the therapy was stopped, the pressure dropped, and after six months it returned to normal in half the patients. (This was reported in the Medical Post for 6 May 1969.) 口服避孕药中雌激素的使用有许多有害的副作用，特别是对于那些由于甲状腺功能低下而体内雌激素水平已经较高的女性来说更是如此。在向美国内科医师学会提交的一份报告中，斯坦福大学医学院内科系的 Weinberger 博士、Collins 博士和 Luetscher 博士指出，服用“避孕药”的患者在大约一年后出现了高血压（最高可达 215/125 且不低于 160//100160 / 100 ）。停止治疗后一到四个月内，血压下降，六个月后有一半患者的血压恢复正常。（此报告发表于 1969 年 5 月 6 日的《Medical Post》杂志。）
Estrogen therapy for the inhibition of lactation in women who do not wish to nurse their babies is associated with a threefold increase in the incidence of puerperal (after-childbirth) thromboembolism. In women who have had operative delivery (cesarean section) and who are more than twenty-five years old, the incidence of puerperal thromboembolism is increased tenfold. 对于不希望哺乳的女性，使用雌激素疗法抑制泌乳与产后血栓栓塞的发生率增加三倍有关。在接受过剖宫产且年龄超过二十五岁的女性中，产后血栓栓塞的发生率增加十倍。
The Coronary Drug Project, a national collaborative study to evaluate long-term effects of five drug regimens, 冠状动脉药物项目，一项全国合作研究，旨在评估五种药物方案的长期效果，
including estrogens, reported that the group receiving 50 mg per day of estrogens experienced an excess number of nonfatal myocardial infarctions, pulmonary embolisms and cases of thrombophlebitis, compared with the placebo group. No overall trend in reducing mortality was evident to justify its use, according to the account of this project which appeared in 1970 in the Journal of the American Medical Association. 包括雌激素，有报告称每天服用 50 毫克雌激素的组别相比安慰剂组，非致命性心肌梗死、肺栓塞和血栓性静脉炎的病例数过多。根据 1970 年发表在《美国医学会杂志》上的该项目报告，没有明显的总体趋势显示其使用能降低死亡率，因此无法证明其合理性。
Finally, a report in M.D. of Canada in October 1973 on the Boston Collaborative Drug Surveillance Program-a study of a large number of women-revealed that among women taking oral contraceptive pills there was eleven times the incidence of idiopathic thromboembolism and double the incidence of gallbladder disease, when these women were compared with controls. 最后，1973 年 10 月《加拿大医学杂志》上关于波士顿协作药物监测计划的一份报告——一项针对大量女性的研究——显示，与对照组相比，服用口服避孕药的女性中，特发性血栓栓塞的发生率高出十一倍，胆囊疾病的发生率则是两倍。
Low thyroid, high estrogen, low Vitamin E equals a great increase in various cardiovascular lesions! 甲状腺功能低下、高雌激素、维生素 E 缺乏会大大增加各种心血管病变的风险！
Physiologically, estrogen compounds cause increased growth of the mammary ducts, with progesterone (another female hormone) stimulating the growth of alveolar tissue (the glands themselves) developed under the influence of estrogen. Patients with chronic cystic mastitis respond to 200 to 400 IU of alpha tocopherol a day for three successive months, according to a report by Dr. A.A. Abrams in the New England Journal of Medicine in 1965. 从生理学角度看，雌激素化合物促使乳腺导管的生长增加，而孕激素（另一种女性激素）则刺激在雌激素影响下发育的腺泡组织（腺体本身）的生长。根据 A.A. Abrams 博士在 1965 年《新英格兰医学杂志》上的一篇报道，慢性囊性乳腺炎患者连续三个月每天服用 200 至 400 IU 的α-生育酚会有反应。
My brother Evan and my younger brother, Dr. Wallace B. Shute, who is also an obstetrician and gynecologist, rarely give their gynecological patients estrogens. Menopausal symptoms in general respond better to alpha tocopherol or to thyroid or to both, and senile vaginitis (inflammation of the vagina in older women) usually responds much better to alpha tocopherol in suppository form. This is not surprising when it is remembered that more than half the women in the general population are already high in estrogen. Since 55 percent are hypothyroid, and many others probably have 我的哥哥 Evan 和我的弟弟 Wallace B. Shute 博士，他也是一名产科和妇科医生，很少给他们的妇科患者使用雌激素。更年期症状通常对α-生育酚或甲状腺激素，或两者联合治疗反应更好，而老年性阴道炎（老年女性阴道炎症）通常对α-生育酚栓剂的反应更佳。当记住普通人群中超过一半的女性体内雌激素水平已经很高时，这并不令人惊讶。由于 55%的人患有甲状腺功能减退症，许多其他人可能也有类似情况。
normal or near-normal thyroid function, there are probably not very many, relatively, who are hyperthyroid and who therefore could possibly benefit from estrogen therapy. 正常或接近正常的甲状腺功能中，可能相对来说甲状腺功能亢进的人并不多，因此他们可能从雌激素治疗中受益。
We are not alone in holding this opinion. The Medical Post for 20 February 1973 contained a report indicating that the Medical Letter had said routine use of estrogens to treat emotional symptoms of menopause has not been shown by “adequate evidence” to be beneficial. The Medical Letter also was quoted as stating that estrogens in fixed combinations with male hormones or with vitamins or sedatives have not been proved useful by “acceptable studies . . . for symptoms related to the menopause.” 我们并非唯一持有此观点的人。1973 年 2 月 20 日的《Medical Post》刊登了一则报道，指出《Medical Letter》曾表示，常规使用雌激素治疗更年期情绪症状尚无“充分证据”证明其有益。《Medical Letter》还被引用称，雌激素与雄激素、维生素或镇静剂的固定组合尚未通过“可接受的研究”证明对更年期相关症状有用。
In this brief summary of ways in which alpha tocopherol behaves in the body, I have attempted to sketch for you what some key investigations have revealed. As you can see, not all the evidence is in. The story is not yet complete. We are a lot farther along in our understanding of the various actions of alpha tocopherol, however, than we are in our understanding of the modes of action of some other long-accepted therapeutic agents. The Medical Post of 21 March 1972 carried an article on penicillin the first sentence of which is this: “Research workers at the Max Planck Institute in Tibingen, Germany, believe they are on the way to explaining how penicillin works.” 在这段关于α-生育酚在体内行为的简要总结中，我试图为您勾勒出一些关键研究所揭示的内容。正如您所见，所有证据尚未完全到位。故事还未结束。然而，我们对α-生育酚各种作用的理解，比对一些其他长期被接受的治疗剂的作用机制的理解要深入得多。1972 年 3 月 21 日的《Medical Post》刊登了一篇关于青霉素的文章，其第一句话是：“德国蒂宾根马克斯·普朗克研究所的研究人员相信，他们正在逐步解释青霉素的作用机制。”
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Ochsner, A., DeBakey, M.E. and De Camp, P.J. Journal of the American Medical Association 144, 831, 1950. Ochsner, A., DeBakey, M.E. 和 De Camp, P.J. 《美国医学会杂志》144, 831, 1950 年。
New England Journal of Medicine 271, 211, 1964. 新英格兰医学杂志 271, 211, 1964。
Postgraduate Medicine 44, 91, 1968. Postgraduate Medicine 44, 91, 1968。
Mellinger, G.T. Canadian Medical Association Journal 96,559, 1967. Mellinger, G.T. 加拿大医学会杂志 96,559, 1967。
Medical Journal of Australia 1,991,1971. 澳大利亚医学杂志 1,991,1971。
The Lancet 2, 560, 1967. 柳叶刀 2, 560, 1967。
SUGGESTED ADDITIONAL READINGS 建议的补充阅读材料
(In chronological order) （按时间顺序）
Hove, E.L., Hickman, K.C.D. and Harris, P.L. Archives of Biochemistry 8, 395, 1945. Hove, E.L., Hickman, K.C.D. 和 Harris, P.L. 生物化学档案 8, 395, 1945。
Butturini, V. Giornale di Clinica Medica (Bologna) 27, 400, 1946. (Electrocardiographic support.) Butturini, V. Giornale di Clinica Medica (Bologna) 27, 400, 1946。（心电图支持。）
Lambert, N.H. Veterinary Record 27, 355, 1947. (Heart disease in dogs and cats treated successfully. Ruling out the psychological aspect of the treatment of heart disease.) Lambert, N.H. Veterinary Record 27, 355, 1947。（成功治疗犬猫心脏病。排除心脏病治疗中的心理因素。）
Pin, L. Thesis. M. Lavergne, Paris, 1947. (“We can confirm the curative properties of alpha tocopherol.”) Pin, L. 论文。M. Lavergne，巴黎，1947 年。（“我们可以确认α-生育酚的治疗特性。”）
Zierler, K.L., Folk, B.P., Evzaguirre, C., Jarcho, L.W., Grob, D. and Lilienthal, J.L. Annals of the New York Academy of Sciences 52, 180, 1949. Zierler, K.L., Folk, B.P., Evzaguirre, C., Jarcho, L.W., Grob, D. 和 Lilienthal, J.L. 纽约科学院年鉴 52, 180, 1949。
Dedichan, J. Nordisk Medicin 41, 324, 1949. (Patients definitely benefited on Shute dosage.) Dedichan, J. Nordisk Medicin 41, 324, 1949。（患者在 Shute 剂量下确实受益。）
Galeone, A. and Minelli, M. Minerva Medica 46, 694, 1950. (“Electrocardiographic regression particularly significant.”) Galeone, A. 和 Minelli, M. Minerva Medica 46, 694, 1950。（“心电图回归特别显著。”）
Schmidt, L. Medical World 72, 296, 1950. (Fifty-one cases with satisfying response.) Schmidt, L. Medical World 72, 296, 1950。（五十一例满意反应。）
O’Connor, V.T. Medical World 72, 299, 1950. (Good results in sixty cases.) O’Connor, V.T. Medical World 72, 299, 1950。（六十例中取得良好效果。）
Enria, G. and Ferrero, R. Archivio per le Scienze Mediche 91, 23, 1951. (Marked and rapid development of collaterals around occluded vessels. Complements the preceding paper and explains continuing improvement over a long period in alpha tocopherol-treated patients.) Enria, G. 和 Ferrero, R. 《Archivio per le Scienze Mediche》91 卷，第 23 页，1951 年。（闭塞血管周围侧支血管的显著且快速发展。补充了前一篇论文，并解释了α-生育酚治疗患者长期持续改善的原因。）
Crump, W.E. and Heiskell, E.F. Texas State Journal of Medicine 48, 11, 1952. Crump, W.E. 和 Heiskell, E.F. 德克萨斯州医学杂志 48 卷，第 11 期，1952 年。
Telford, I.R., Wiswell, O.B., Smith, E.L., Clark, T.R., Jr., Tomashefski, J.F. and Cricuolo, D. Air University School of Aviation Medicine, Project No. 21-1201-0013, Report No. 4, May 4, 1954 (Randolph Field, Texas). Telford, I.R., Wiswell, O.B., Smith, E.L., Clark, T.R., Jr., Tomashefski, J.F. 和 Cricuolo, D. 空军大学航空医学学院，项目编号 21-1201-0013，报告编号 4，1954 年 5 月 4 日（德克萨斯州兰道夫基地）。
Puento-Dominguez, J.L. and Dominguez, R. Revista Espanola de Cardiologia 9, 30, 1955. (Induced infarcts in canine hearts with arteriographic evidence of increased vascularization in the ischemic areas due to alpha tocopherol.) Puento-Dominguez, J.L. 和 Dominguez, R. 《西班牙心脏病学杂志》9 卷，第 30 页，1955 年。（通过动脉造影显示缺血区域血管增生，诱导犬心脏梗死，归因于α-生育酚。）
Diaz, F.V. Progresos de Patol y Clinica 3,351, 1956. (The use of alpha tocopherol is of indisputable value in treating coronary disease.) Diaz, F.V. Progresos de Patol y Clinica 3,351, 1956。（α-生育酚在治疗冠心病中的使用具有无可争议的价值。）
Harman, D. The Lancet 2, 1116, 1957. (Interesting comment on use of highly unsaturated fats and consequent increase in body’s need for Vitamin E. These fats also inhibit enzyme action. Author on staff of Veterans Administration Hospital, San Francisco.) Harman, D. The Lancet 2, 1116, 1957。（关于使用高度不饱和脂肪及其导致身体对维生素 E 需求增加的有趣评论。这些脂肪还抑制酶的作用。作者为旧金山退伍军人管理局医院工作人员。）
Livingston, P.D. and Jones, C. The Lancet 2, 602, 1958. (One of the significant double-blind studies on peripheral vascular disease. Recommends at least three months’ trial.) Livingston, P.D. 和 Jones, C. 《柳叶刀》2, 602, 1958。（关于周围血管疾病的重要双盲研究之一。建议至少试用三个月。）
Sautter, H. Deutsche Medizinische Wochenschrift 83, 1514, 1958. (Reversed retinal arteriosclerosis and other eye pathologies with Vitamins A and E.) Sautter, H. Deutsche Medizinische Wochenschrift 83, 1514, 1958。（使用维生素 A 和 E 逆转视网膜动脉硬化及其他眼部病变。）
Jacques, W.H. Canadian Medical Association Journal 81, 129, 1959. (Eight hundred to sixteen hundred units of alpha Jacques, W.H. 加拿大医学会杂志 81, 129, 1959。（八百到一千六百单位的α）
tocopherol used in chronic polio patients with peripheral vascular lesions, with relief of symptoms in three to four weeks. Symptoms recurred if alpha tocopherol discontinued.) 用于慢性小儿麻痹症患者伴周围血管病变，三到四周内症状缓解。如停用α-生育酚，症状会复发。
Kawahara, H. Surgery 46, 768, 1959. (Alpha tocopherol used in venous thrombosis. Sixty-seven percent successful.) Kawahara, H. Surgery 46, 768, 1959。（α-生育酚用于静脉血栓形成。成功率为 67%。）
8
HEART ATTACKS: CAUSES, SURVIVAL AND PREVENTION 心脏病发作：原因、生存与预防
FOUR THOUSAND of the world’s leading cardiologists assembled recently in England at the Sixth World Congress of Cardiologists. There was much discussion of myocardial infarction and an “awareness” that it was “probably becoming more common”-rather an understatement, in my opinion, since its incidence has now, as we have seen, reached epidemic proportions. Disappointingly, the Congress yielded no new suggestions concerning effective treatment or prevention of this condition. 最近，来自世界各地的四千名顶尖心脏病专家齐聚英格兰，参加第六届世界心脏病学大会。大会上对心肌梗死进行了大量讨论，并“意识到”它“可能变得更为常见”——在我看来，这种说法有些轻描淡写，因为正如我们所见，其发病率现已达到流行病水平。令人失望的是，大会未能提出关于该病有效治疗或预防的新建议。
Considering the high incidence and the seriousness of myocardial infarction, there is surprisingly little in the usual treatments for it that is, in my assessment, of very much use to its victims. And again, considering the incidence and the seriousness, there is also surprisingly little concerning its underlying causes that is understood with complete certainty. 考虑到心肌梗死的高发率和严重性，令人惊讶的是，现有的常规治疗中，在我看来，对患者真正有用的内容却很少。同样，考虑到其发病率和严重性，对于其根本原因的了解也出奇地少，没有完全确定的认识。
Until very recently, for example, it seemed to be universally believed that in cases of myocardial infarction the proximate cause was a thrombus or, occasionally, some other kind of obstruction, in a branch of the coronary artery which blocks it off. It was accepted that the tissues of an area of myocardium, thus deprived of their essential blood supply, died, were absorbed and were replaced with scar tissue. It is now believed by some, however, that an infarction may in some cases precede development of the thrombus. In such cases the immediate cause of myocardial infarction would not be coronary thrombosis but acute myocardial hypoxia (deficiency of oxygen in the affected tissues of the heart). 例如，直到最近，人们普遍认为心肌梗死的直接原因是冠状动脉某一分支的血栓，或偶尔是其他类型的阻塞，导致该分支被堵塞。人们接受的观点是，因失去必要的血液供应，心肌某一区域的组织死亡，被吸收并被瘢痕组织取代。然而，现在有些人认为，心肌梗死在某些情况下可能先于血栓的形成。在这种情况下，心肌梗死的直接原因不是冠状动脉血栓形成，而是急性心肌缺氧（心脏受影响组织的氧气不足）。
How often this may happen is disputed. A 1971 editorial in the Canadian Medical Association Journal states that it may happen more often than some in the field have thought. And Drs. D.M. Spain and V.A. Bradess (1) have suggested in the journal Circulation that thrombosis is so often found at autopsy simply because the patient survived long enough after the infarction for thrombosis to develop in the coronary artery. 这种情况发生的频率存在争议。1971 年《加拿大医学会杂志》的一篇社论指出，这种情况可能比该领域的一些人所认为的更为常见。D.M. Spain 博士和 V.A. Bradess 博士（1）在《循环》杂志中提出，尸检中经常发现血栓形成，仅仅是因为患者在心肌梗死后存活的时间足够长，导致冠状动脉内形成了血栓。
It has, strangely enough, been found that narrowing to the point of complete occlusion of the coronary artery can occur without necessarily causing infarction. According to a paper by Dr. G. Baroldi (2) in the American Journal of Cardiology, this is because of well-developed anastomotic (communication) pathways around areas of coronary stenosis (narrowing) which have almost always been present when such cases have been examined. What is even more interesting is the converse-the idea that there is some mechanism in the heart muscle that can lead to its death independent of coronary thrombosis. This is intriguing because it fits in with some other interesting observations indicating that deficiency in certain natural antioxidants (Vitamins E and C) whose job it is to protect dietary unsaturated fatty acids may be at the root of this deadly mechanism. 奇怪的是，已经发现冠状动脉狭窄到完全闭塞的程度并不一定会导致梗死。根据 Dr. G. Baroldi 在《American Journal of Cardiology》上的一篇论文，这是因为在冠状动脉狭窄区域周围存在发育良好的吻合（交通）通路，这些通路在检查此类病例时几乎总是存在。更有趣的是相反的观点——心肌中存在某种机制，可以导致其死亡，而不依赖于冠状动脉血栓形成。这很引人注目，因为这与一些其他有趣的观察相符，表明某些天然抗氧化剂（维生素 E 和 C）的缺乏，负责保护膳食不饱和脂肪酸，可能是这一致命机制的根源。
Such a deficiency state has actually been found, both in animals and in men, by Dr. T.W. Anderson in cooperation with Malcolm D. Wilson, a pathologist, Anthony A. van Dreumel of the Veterinary Services Laboratory, Ontario Ministry of Agriculture and Food, and Richard E.C. Hutson of the Toronto East General Hospital. A paper on this in The Lancet (3) states that a singular correlation has been found between the microscopic lesions in the animal disease, nutritional muscular dystrophy, produced when dietary unsaturated fatty acids are inadequately protected by antioxidants, and the lesions found in middle-aged men who had died suddenly of acute myocardial infarction. According to The Lancet for 20 October 1973, the animal and human lesions were morphologically (structurally) indistinguishable. 这种缺乏状态实际上已经被 T.W. Anderson 博士与病理学家 Malcolm D. Wilson、安大略省农业和食品部兽医服务实验室的 Anthony A. van Dreumel 以及多伦多东区综合医院的 Richard E.C. Hutson 合作，在动物和人类中发现。《柳叶刀》(The Lancet)上的一篇论文(3)指出，在动物疾病营养性肌营养不良中，当膳食中的不饱和脂肪酸未被抗氧化剂充分保护时所产生的显微病变，与突然死于急性心肌梗死的中年男性所发现的病变之间存在显著相关性。根据 1973 年 10 月 20 日《柳叶刀》的报道，动物和人类的病变在形态学（结构上）无法区分。
I shall make reference later in some detail to work by Dr. H. Glatzel, who has shown that the incidence of myocardial infarction rose abruptly between 1951 and 1953 when the public became convinced that the use of polyunsaturated fats would protect against coronary disease or the recurrence of myocardial infarction after recovery from the initial attack. For the moment, just think of what this may mean in the population that is deprived of much of its dietary Vitamin E. Remember also what Dr. Tappel had to say on the same subject. He pointed out that Vitamin E was needed to protect unsaturated fats and noted that people who consume large quantities of polyunsaturated fats need an especially high E intake, even after giving up such a diet. 我稍后将详细提及 H. Glatzel 博士的研究，他表明在 1951 年至 1953 年间，随着公众相信多不饱和脂肪的使用可以预防冠心病或初次心肌梗死康复后的复发，心肌梗死的发生率突然上升。暂且想想这对缺乏大量膳食维生素 E 的人群意味着什么。还要记住 Tappel 博士在同一主题上的观点。他指出维生素 E 是保护不饱和脂肪所必需的，并且指出即使在放弃这种饮食后，摄入大量多不饱和脂肪的人仍需要特别高的维生素 E 摄入量。
Recently there has been support for-but not complete acceptance of-this new concept of myocardial infarction: that it will, at times, occur prior to the appearance of a thrombus. Dr. A.A. Tambe and his group (4) in a 1972 issue of the American Heart Journal have offered some new evidence in support of this concept, whereas in the same year a paper by Dr. D. Sinapius (5) a German pathologist, in Deutsche 最近，有人支持但尚未完全接受这一新的心肌梗死概念：即心肌梗死有时会在血栓出现之前发生。1972 年，《American Heart Journal》上，A.A. Tambe 博士及其团队（4）提供了一些支持这一概念的新证据，而同年，德国病理学家 D. Sinapius 博士（5）在 Deutsche 发表了一篇论文，...
Medizinische Wochenschrift reinforces the older idea of “a temporal and causal sequence of coronary artery thrombosis and myocardial infarction.” 医学周刊加强了“冠状动脉血栓形成和心肌梗死的时间和因果顺序”这一较早的观点。
Whatever the mechanism of the occurrence of myocardial infarction, the incidence of such attacks is steadily rising. Some patients have symptoms of coronary insufficiency or an embarrassed myocardium before the acute attack, in the form of vague precordial distress (discomfort in the heart region) often associated with eating or exertion. A fair proportion of these have been to their doctors. In the absence of electrocardiographic changes, most of these patients have not had their real problem diagnosed. However, only a minority of men who have an initial myocardial infarction-even a rapidly fatal episode-have had these earlier signs such as angina, hypertension, congestive failure, other cardiovascular disease or diabetes. 无论心肌梗死发生的机制如何，此类发作的发生率正在稳步上升。一些患者在急性发作前表现出冠状动脉功能不全或心肌受损的症状，表现为模糊的前胸不适（心脏区域的不适），常与进食或劳累有关。这些患者中有相当一部分曾就诊于医生。在没有心电图变化的情况下，大多数患者未能被诊断出真正的问题。然而，只有少数男性在首次心肌梗死时——即使是迅速致命的发作——曾出现过如心绞痛、高血压、充血性心力衰竭、其他心血管疾病或糖尿病等早期症状。
The percentages of immediate, early and late deaths from myocardial infarction vary so widely from report to report in the journals that it is difficult to give accurate survival figures. You will remember, for example, that I have quoted Dr. Bernard Lown of Boston as saying that 65 percent of infarction cases in the United States never reach the hospital or are dead on arrival. By contrast, Dr. Charles W. Frank (6) of the Albert Einstein College of Medicine stated in the Bulletin of the New York Academy of Medicine in 1968 that the initial attack is fatal in one-third of cases. Of all deaths, more than 85 percent occurred on the first day. 心肌梗死的即时、早期和晚期死亡率在各个期刊的报告中差异极大，因此很难给出准确的存活率数据。你会记得，例如，我曾引用波士顿的 Bernard Lown 博士的话，他说美国 65%的梗死病例从未到达医院或到达时已死亡。相比之下，Albert Einstein College of Medicine 的 Charles W. Frank 博士（6）在 1968 年《纽约医学科学院公报》中指出，初次发作的死亡率为三分之一。在所有死亡病例中，超过 85%发生在第一天。
Dr. G.E. Dimond (7) stated in 1961 that in a group of patients surviving one to two months after the initial attack, there was a 55 to 66 percent chance of living five years, and that 50 percent of second and 92 percent of third infarctions were fatal. A 1968 paper by Dr. Eve Weinblatt and associates (8) stated that 36 percent died in less than one month after the initial attack. The probability of surviving 41//241 / 2 years after the G.E. Dimond 博士（7）在 1961 年指出，在一组初次发作后存活一到两个月的患者中，存活五年的概率为 55%到 66%，第二次心肌梗死的死亡率为 50%，第三次心肌梗死的死亡率为 92%。Eve Weinblatt 博士及其同事（8）在 1968 年的一篇论文中指出，36%的患者在初次发作后不到一个月内死亡。存活 41//241 / 2 年的概率为
initial infarction was 52 percent (compared to Dimond’s 55 to 66 percent). The risk of a first recurrence was still high ( 41//241 / 2 years after the initial infarction) in comparison with the risk of a first infarction in the general population, underlining the ongoing effect of first myocardial infarction in later prognosis. 初次心肌梗死的发生率为 52％（相比 Dimond 的 55％至 66％）。与普通人群首次心肌梗死的风险相比，首次复发的风险仍然很高（初次心肌梗死后 41//241 / 2 年），这强调了首次心肌梗死在后期预后中的持续影响。
In other words, the factors that allowed the patient to have a first attack were still present, unaffected by any measure suggested as treatment or prevention by his physician. He remains at great risk. 换句话说，使患者首次发作的因素仍然存在，未受到其医生建议的任何治疗或预防措施的影响。他仍然面临很大风险。
The extent of the damage to the heart muscle in the initial attack, and consequently the chance of survival (or, if the patient lives, the degree of disablement) depends on many factors. Site of the occlusion and its rapidity are important. Then again, no two hearts have the same blood supply. Although the coronary arteries follow a general pattern in all hearts, there are many variations within this. Some people are born with an unusually good coronary tree. Some, however, have relatively poor or unevenly developed coronary blood supply, and some have inadequate vessels in one or two areas. Others are well endowed with collaterals-those smaller vessels which by their connections at different levels can carry blood around occluded or narrowed major vessels. 心肌在初次发作时的损伤程度，因此生存机会（或者如果患者存活，残疾程度）取决于许多因素。闭塞部位及其发生的速度很重要。此外，没有两颗心脏的血液供应是完全相同的。虽然冠状动脉在所有心脏中遵循一个大致的模式，但其中存在许多变异。有些人生来拥有异常良好的冠状动脉系统。然而，有些人的冠状动脉血供相对较差或发育不均匀，有些人在一两个区域的血管不足。还有些人拥有丰富的侧支血管——这些较小的血管通过不同层次的连接，可以绕过闭塞或狭窄的主要血管输送血液。
Similarly, the degree of arteriosclerosis in the rest of the blood vessels and the condition of nutrition in the rest of the heart are factors in survival. The resistance of the individual to the initial shock is still another factor, and the presence of other pathological conditions such as hypertension, valvular disease, lung disease or diabetes also has a bearing. All of these things may have an effect on the patient’s survival and on the degree to which he recovers if he does survive. 同样，其他血管的动脉硬化程度和心脏其他部位的营养状况也是生存的因素。个体对初始休克的抵抗力是另一个因素，此外，高血压、瓣膜病、肺病或糖尿病等其他病理状况的存在也有影响。所有这些因素都可能影响患者的生存以及如果存活下来，他的恢复程度。
There is variation in this aspect of the reports, just as there is in the survival statistics in the various studies. For example, in Dimond’s group the presence of hypertension 在报告的这一方面存在差异，就像各项研究中的生存统计数据存在差异一样。例如，在 Dimond 的团队中，高血压的存在
was associated with a poorer prognosis but the effect of overweight was not statistically significant. 与较差的预后相关，但超重的影响在统计学上不显著。
Something else that I consider very interesting is often stated as an afterthought in such papers. Frank, for example, adds that “serum cholesterol concentration did not relate to prognosis in the 21//221 / 2-year period after baseline examination. Men with values exceeding 260 mg percent did not have significantly higher infarction or death rates than those with values less than 220 mg percent.” 我认为非常有趣的另一点常常作为附带说明出现在此类论文中。例如，Frank 补充说：“血清胆固醇浓度与基线检查后 21//221 / 2 年期间的预后无关。胆固醇值超过 260 毫克百分比的男性，其心肌梗死或死亡率并不显著高于胆固醇值低于 220 毫克百分比的男性。”
Dr. Berthold Kern, one of Germany’s leading heart specialists, claims that obesity, a high cholesterol blood count and excessive cigarette smoking are not important causes of heart disease. (But he suggests that excessive agitation and aggravation and too little rest may be the important causes. That is interesting since Sir Maurice Cassidy, the King’s physician, long ago, stated that in his lengthy experience, stress did not appear to be a major factor in coronary disease!) 德国著名心脏病专家之一 Berthold Kern 博士声称，肥胖、高胆固醇血症和过度吸烟并不是心脏病的重要原因。（但他认为过度激动和烦躁以及休息不足可能是重要原因。这很有趣，因为国王的医生 Sir Maurice Cassidy 早在很久以前就指出，根据他的丰富经验，压力似乎并不是冠心病的主要因素！）
Differences of opinion, to the point of confusion, pervade almost every aspect of the field of cardiology. And in virtually all aspects of this field, the “authorities” have been in gross error. Their inability to get results is a matter of record. Let me illustrate. 在心脏病学领域的几乎每个方面，都存在着意见分歧，甚至混淆不清。而且在该领域的几乎所有方面，“权威”们都犯了严重错误。他们无法取得成果是有据可查的。让我来举例说明。
At a meeting in Baden-Baden, Germany, of the International Society for Combating Heart Disease, Dr. Kern said that in his opinion the forty billion dollars expended over the past forty years in research into the causes of heart disease had produced no really proved and practical results. 在德国巴登-巴登举行的国际心脏病防治学会会议上，Kern 博士表示，他认为过去四十年中用于研究心脏病病因的四百亿美元并未产生真正被证实且实用的成果。
And Dr. W. Stanley Hartroft, former Research Director of the Hospital for Sick Children in Toronto, has said: “Heart disease has us beat.” No progress, he said, had been made in fighting heart disease. He went on to note that doctors hand out advice on how to minimize the chances of heart disease-stop smoking, eat less animal fat, lose weight-yet 多伦多儿童医院前研究主任 W. Stanley Hartroft 博士曾说：“心脏病让我们束手无策。”他说，在抗击心脏病方面没有取得进展。他接着指出，医生们会给出如何减少心脏病风险的建议——戒烟、少吃动物脂肪、减肥——然而
have no proof that these measures are effective. 没有证据证明这些措施是有效的。
Finally, Ancel Keys, Ph.D., the man chiefly responsible for the nearly world-wide acceptance of the role of ingested animal fats, came to a meeting of the Second International Symposium on Atherosclerosis in Chicago in 1970, and had this to say: " . . . nothing has been altered in the slightest " by a quarter century of intensive work. “Despite systematic studies of the epidemiology of heart disease, there have been no advances whatever in the basic goal of prevention.” 最后，Ancel Keys 博士，这位主要促成摄入动物脂肪作用几乎被全世界接受的人，于 1970 年在芝加哥举行的第二届国际动脉粥样硬化研讨会上发表了如下言论：“……经过二十五年的深入研究，情况一点也没有改变。”“尽管对心脏病流行病学进行了系统研究，但在预防的基本目标上毫无进展。”
The mention of Dr. Keys, who is Director of Minnesota’s Laboratory of Physiologic Hygiene, brings me to the story of cholesterol. It is just impossible to assess the damage done by the anti-cholesterol theory. The amazing part of the history of this is the almost instant acceptance of the cholesterol idea as soon as it was promulgated by Keys, its effect on the treatment of thousands of patients restricted uselessly and unnecessarily in their diets, as well as on the dairy, poultry and meat-processing industries. All of this was to no avail. At one time, he even had airlines interested in sending in blood samples from their pilots. Yet all this money and effort produced no results of any value, by his own admission. 提到明尼苏达生理卫生实验室主任 Dr. Keys，就让我想起了胆固醇的故事。评估反胆固醇理论所造成的损害几乎是不可能的。这段历史中令人惊讶的是，胆固醇观念一经 Keys 推广，几乎立即被接受，其影响波及数千名患者的治疗，使他们的饮食被无谓且不必要地限制，同时也影响了乳制品、家禽和肉类加工行业。所有这些努力都是徒劳的。曾有一段时间，他甚至让航空公司有兴趣送交飞行员的血样。然而，正如他自己所承认的，所有这些资金和努力都没有产生任何有价值的结果。
Time magazine for 30 June 1967 reported the curious situation of the chairman of the AMA Executive Committee on Diet and Heart Disease. This was during the height of the Keys-inspired interest in cholesterol. Time said that in light of the many deaths of men under seventy from coronary artery disease, there had been considerable interest among doctors in establishing whether changes in diet could help. Could enough men be persuaded to try a low-fat diet and stay with it? 1967 年 6 月 30 日的《时代》杂志报道了美国医学会饮食与心脏病执行委员会主席的奇特情况。这正值基于 Keys 研究的胆固醇兴趣高涨时期。《时代》指出，鉴于许多 70 岁以下男性死于冠状动脉疾病，医生们对确定饮食改变是否有助于治疗产生了浓厚兴趣。是否能说服足够多的人尝试低脂饮食并坚持下去？
“At last week’s A.M.A. meeting, the Executive Committee on Diet and Heart Disease reported after a long-term pilot project involving 2,000 men aged 45 to 54 that it was indeed possible. The next step, said the committee, is to seek more “在上周的美国医学会会议上，饮食与心脏病执行委员会报告了一项涉及 2000 名 45 至 54 岁男性的长期试点项目，结果表明这确实是可能的。委员会表示，下一步是寻求更多”
conclusive proof by enlisting up to 100,000 men aged 40-59 in a new $50\$ 50 million study.” 通过招募多达 10 万名年龄在 40 至 59 岁的男性参与一项新的 $50\$ 50 百万研究，提供确凿的证据。
Forty thousand men on a low-cholesterol diet were to be compared with forty thousand other men for at least eight years! At a cost of fifty million dollars! A fascinating sidelight was the condition of the chairman, Dr. Irvine H. Page, aged sixty-six, who did not attend. Said Time: “Though he has kept slim, exercised often and followed his own low-fat regimen for years, he was recovering in Cleveland Clinic Hospital from a mild heart attack.” More significant still was the good doctor’s explanation of his heart attack. It wasn’t the cholesterol, it was his “drive and competitiveness”-not even stress or overwork. Perhaps in other cases it also has not been dietary fat. 四万名遵循低胆固醇饮食的男性将与另外四万名男性进行至少八年的比较！花费五千万美元！一个引人入胜的旁注是主席欧文·H·佩奇博士的状况，他六十六岁，没有出席。时代杂志说：“尽管他保持苗条，经常锻炼，多年来遵循自己的低脂饮食方案，但他正在克利夫兰诊所医院康复，因轻微心脏病发作。”更有意义的是这位好医生对他心脏病发作的解释。不是胆固醇，而是他的“动力和竞争心”——甚至不是压力或过度劳累。也许在其他情况下，心脏病发作也并非由饮食脂肪引起。
This brings us, naturally, to the American Heart Association which each year begs (and obtains) millions for heart research. It also puts out a booklet entitled Reduce Your Risk of Heart Attack whose preface states that “in the midst of the greatest abundance this country has ever known, Americans are faced with a baffling health problem.” This booklet has these suggestions to make-and I shall make some comments on them very shortly: 这自然使我们想到了美国心脏协会，该协会每年都会请求（并获得）数百万美元用于心脏研究。它还出版了一本名为《降低心脏病发作风险》的小册子，序言中写道：“在这个国家有史以来最富裕的时期，美国人面临着一个令人困惑的健康问题。”这本小册子提出了一些建议——我将很快对它们做出一些评论：
Reduce the saturated fat and cholesterol in the diet. 减少饮食中的饱和脂肪和胆固醇。
Reduce your weight if you are overweight. 如果你超重，请减轻体重。
Control high blood pressure. 控制高血压。
Exercise. 锻炼。
Eliminate cigarette smoking. 戒烟。
Control diabetes. 控制糖尿病。
Finally, the pamphlet suggests that a family history of heart attacks in middle age may be of interest to the man who wants to prevent one in himself. How, I wonder, is he to change his parentage? Also, how many heart attacks could 最后，小册子建议，中年时有心脏病发作家族史的人可能会对预防自己发生心脏病感兴趣。我想知道，他该如何改变自己的血统呢？另外，有多少次心脏病发作能够...
there be among a man’s ancestors, since there were no heart attacks prior to 1912 and very few prior to 1930? 一个人的祖先中会有吗，因为在 1912 年之前没有心脏病发作，1930 年之前也很少有？
As to the Heart Association’s suggestions, I can agree completely only with Number 3. It is true that since the introduction of potent anti-hypertensive drugs the death rate from hypertensive heart disease has decreased by 50 percent. However, this is an area in cardiology in which the failure to use successful therapeutic agents is all too common. (This will be discussed in Chapter 11.) 关于心脏协会的建议，我只能完全同意第 3 条。确实，自从强效降压药物问世以来，高血压性心脏病的死亡率已经下降了 50%。然而，在心脏病学领域，未能使用有效治疗药物的情况却非常普遍。（这将在第 11 章中讨论。）
As to number 2, I can only say that overweight has no relationship to heart disease directly. Reducing your weight, if you are overweight, can only help you indirectly, by reducing the many miles of extra vessels supplying the excess fat in the obese body, and therefore reducing the heart’s work to some degree. 关于第二点，我只能说超重与心脏病没有直接关系。如果你超重，减轻体重只能间接帮助你，因为这会减少供应肥胖体内多余脂肪的血管长度，从而在一定程度上减轻心脏的负担。
There is an obvious and definite connection between obesity and overeating in many cases, and this apparently begins in childhood with excessive consumption of starchy foods and sweetened products. (So many foods now contain refined sugar-a substance which has no nutritive value, just empty calories.) However, there is a much more important relationship-that between hypothyroidism and obesity. Most hypothyroids are obese-mostly because they do not burn up energy normally. And as pointed out so clearly by Paul Starr, hypothyroidism is associated with an increased incidence of cardiovascular diseases and anemia. This important relationship has been so universally missed or ignored by the profession in general. 在许多情况下，肥胖与暴饮暴食之间存在明显且确定的联系，这显然始于儿童时期对淀粉类食物和甜味产品的过度摄入。（现在许多食物都含有精制糖——一种没有营养价值、只有空热量的物质。）然而，有一个更重要的关系——甲状腺功能减退症与肥胖之间的关系。大多数甲状腺功能减退患者都是肥胖的——主要是因为他们不能正常燃烧能量。正如保罗·斯塔尔（Paul Starr）清楚指出的，甲状腺功能减退症与心血管疾病和贫血的发病率增加有关。这个重要的关系被整个专业领域普遍忽视或忽略了。
Simply expressed, obesity is often due to hypothyroidism and this is why it is associated with an increased incidence of cardiovascular disease. It is not obesity that increases the danger of heart attacks: it is the condition that leads to the obesity that is the culprit. Reduction in 简单来说，肥胖通常是由甲状腺功能减退引起的，这也是为什么它与心血管疾病发病率增加有关的原因。增加心脏病发作危险的不是肥胖本身，而是导致肥胖的病因。减少...
weight thus has really very little effect in reducing the danger of cardiovascular disease. 体重因此实际上对降低心血管疾病的危险几乎没有影响。
A recent confirmation of this was published in The Lancet by Dr. P.A. Bastenie et al. (9) and Dr. R. Calay et al. (10), who showed that preclinical (asymptomatic) hypothyroidism is not uncommon and that this condition increases significantly (by 21//221 / 2 times) the risk of coronary artery disease in women. 最近，P.A. Bastenie 博士等人（9）和 R. Calay 博士等人（10）在《柳叶刀》杂志上发表了一项确认研究，显示临床前（无症状）甲状腺功能减退症并不罕见，并且这种状况显著增加了女性冠状动脉疾病的风险（增加了 21//221 / 2 倍）。
As to Number 4 (exercise), I have many doubts. So far, it has been shown only that exercise, if indulged in sensibly and in moderation, does no harm to the person who has not yet had a myocardial infarction. It has not been shown to be useful to the patient who has had an infarction. It has initiated many fatalities among the latter and may well precipitate an attack a little earlier than would otherwise have occurred in some people. 关于第四点（锻炼），我有很多疑问。到目前为止，仅有证据表明，适度且理智地进行锻炼，对尚未发生心肌梗死的人无害。尚未证明锻炼对已经发生过心肌梗死的患者有益。锻炼在后者中引发了许多死亡病例，并且可能会使某些人的发作时间比原本预期的更早。
Following nationwide reports in Sunday magazine supplements of happy members of a coronary club jogging around an indoor track at the Cleveland Y.M.C.A., a similar program was initiated at the Y.M.H.A. in North York, a suburb of Toronto. Newspapers carried pictures of that cheerful group jogging along. The only trouble was that the instructor supervising their jogging and participating with them dropped dead of a heart attack! 继全国各地周日杂志增刊报道克利夫兰基督教青年会室内跑道上快乐的冠心病俱乐部成员慢跑后，多伦多郊区北约克的犹太青年会也启动了类似的项目。报纸刊登了那群愉快的人们慢跑的照片。唯一的问题是，监督他们慢跑并与他们一起参与的教练突发心脏病猝死了！
The Scientific Advisory Committee on Atherosclerosis of the Ontario Heart Foundation has issued a warning to the public and the medical profession to the effect that “physical training should always be initiated as a gradually increasing program of activity. . . . This is an individual problem, particularly in persons with known heart disease, in which case gradual, limited exercise may be beneficial or may be very harmful.” 安大略心脏基金会动脉粥样硬化科学咨询委员会已向公众和医疗界发出警告，指出“体育锻炼应始终作为一个逐渐增加的活动计划开始……这是一个个体问题，特别是对于已知患有心脏病的人，在这种情况下，逐渐进行有限的锻炼可能有益，也可能非常有害。”
The warning continues: “Generalizations that exercise is good or bad for patients with heart disease (or any other 警告继续说：“关于运动对心脏病患者（或任何其他患者）是好是坏的概括性说法
disease) are not possible and such patients should always consult their own physician about their problem.” 疾病）是不可能的，这类患者应始终咨询自己的医生关于他们的问题。
The Committee’s statement goes on to say it is not known whether life is prolonged by exercise. Daily exercise “within the limits of one’s ability” is approved, however, for healthy people and for “medically ‘selected’ patients with heart disease.” Selection criteria, which the Committee says “should be used cautiously,” were listed as follows: 委员会的声明继续指出，目前尚不清楚运动是否能延长寿命。然而，委员会认可健康人和“经过医学‘筛选’的心脏病患者”每天“在自身能力范围内”的锻炼。委员会表示“应谨慎使用”的筛选标准列举如下：
More than three months post infarct. 心肌梗死后三个月以上。
No heart failure. 无心力衰竭。
No heart enlargement radiologically. 放射学检查无心脏扩大。
No angina at rest. 静息时无心绞痛。
No recent increase in severity and frequency of exertional angina. 运动性心绞痛的严重程度和频率近期无增加。
No prolonged angina on effort which is not relieved in a few minutes by rest. 无持续性心绞痛，休息几分钟即可缓解。
Stable EKG pattern. 心电图稳定模式。
No serious arrhythmias at rest or after exertion. Patients with single infrequent ventricular ectopic beats or with paroxysmal atrial tachycardia (rapid heart beat of sudden onset) may be admitted to the program if the arrhythmia is not precipitated or aggravated by exercise. (Definition mine.) 静息或运动后无严重心律失常。对于偶发单一室性早搏或阵发性房性心动过速（突然发作的快速心跳）患者，如果运动不会诱发或加重心律失常，可纳入该项目。（定义为本人所述。）
Obviously, these criteria define a person with nearly complete recovery from an attack-a nearly normal person -the exception. I repeat then: the value of exercise in preventing attacks of coronary occlusion has not been established. 显然，这些标准定义了一个几乎完全从发作中恢复过来的人——一个几乎正常的人——这是例外。我再次强调：运动在预防冠状动脉闭塞发作中的价值尚未确定。
Cigarette smoking (Number 5) is often said to be a factor, but universal agreement on this is lacking. Remember, Dr. Berthold Kern, the German specialist, gave it as his opinion that excessive cigarette smoking was not a factor! I believe, however, that it is certainly an undesirable habit, one that can do no one any good-and one which by constricting 吸烟（编号 5）常被认为是一个因素，但对此并无普遍共识。请记住，德国专家 Berthold Kern 博士认为过度吸烟并不是一个因素！然而，我相信这无疑是一种不良习惯，对任何人都没有好处——而且通过收缩血管，...
peripheral blood vessels, could be mildly harmful. 外周血管，可能会有轻微的危害。
As to Number 6, the control of diabetes, I must agree that this is undoubtedly worthwhile in preventing deaths from diabetic coma or insulin reactions. But the usual methods of controlling diabetes apparently do not prevent the rapid, almost universal cardiovascular changes that are characteristic of this disease and thus are not a factor in preventing heart attacks. 关于第 6 点，糖尿病的控制，我必须同意这无疑有助于预防糖尿病昏迷或胰岛素反应导致的死亡。但通常的糖尿病控制方法显然无法防止这种疾病特有的快速且几乎普遍的心血管变化，因此在预防心脏病发作方面并不起作用。
As to Number 1, the comment about cholesterol, it may be worthwhile to point out that numerous experts have disagreed with the proponents of this idea ever since it was first put forward-but with very little effect. 关于第一点，关于胆固醇的评论，值得指出的是，自从这一观点首次提出以来，许多专家一直持不同意见——但几乎没有什么影响。
As early as 1960 Dr. Howard Sprague, a former president of the American Heart Association, told the annual meeting of the Canadian Heart Association to ignore the cholesterol fad. He reminded his audience that cholesterol is synthesized in every body tissue except the brain. In 1962 Dr. Philip L. White, Secretary of the American Medical Association’s Council on Foods, released to United Press International an official warning which was printed in nearly every newspaper on the North American continent. This was a statement calling the “anticholesterol fad” a wasted effort that could be dangerous. In The Lancet for 11 September 1965, the Research Committee announced that there was no significant reduction in mortality rate following the use of a low-fat diet in proven coronary artery disease. And in 1970 Drs. Shanoff, Little and Csima stated in the Canadian Medical Association Journal that neither the level of serum cholesterol nor that of the lipoprotein fractions (substances containing fats and proteins) is related to survival. (Anyone who is interested in further information on this should read the comments of Dr. Meyer Texon of New York in the 31 May 1971 issue of the Journal of the American Medical Association.) 早在 1960 年，美国心脏协会前主席霍华德·斯普拉格博士就在加拿大心脏协会年会上表示，应忽视胆固醇的流行趋势。他提醒听众，除了大脑外，胆固醇在身体的每个组织中都会合成。1962 年，美国医学会食品委员会秘书菲利普·L·怀特博士向国际联合新闻社发布了一份官方警告，这份警告几乎被北美大陆上的每一家报纸刊登。这份声明称“反胆固醇的流行”是一种浪费的努力，甚至可能是危险的。1965 年 9 月 11 日的《柳叶刀》杂志上，研究委员会宣布，在确诊的冠状动脉疾病患者中，采用低脂饮食并未显著降低死亡率。1970 年，Shanoff 博士、Little 博士和 Csima 博士在《加拿大医学会杂志》上指出，血清胆固醇水平及脂蛋白分数（含脂肪和蛋白质的物质）水平与生存率无关。（任何对此感兴趣的人应阅读 Dr. 的评论。） 纽约的 Meyer Texon 发表于 1971 年 5 月 31 日的《美国医学会杂志》。)
Another useful article on the cholesterol controversy is 另一篇关于胆固醇争议的有用文章是
one by Dr. E.R. Pinkney in Medical Counterpoint (1971). A condensation of this appears in an issue of The Summary and also in Appendix C of this book. 由 E.R. Pinkney 博士在《Medical Counterpoint》（1971 年）中撰写。其摘要刊登在《The Summary》的某一期以及本书的附录 C 中。
In the condensation there is the comment that although serum cholesterol level “has become the principal indicator of the health of one’s heart and blood vessels to both public and . . . medical profession,” we still do not know from “good clinical evidence that a diet-lowered serum cholesterol in any way prevents or modifies heart attacks or heart disease.” 在摘要中有这样一段评论，尽管血清胆固醇水平“已成为公众和……医学界判断心脏及血管健康的主要指标”，但我们仍然没有“良好的临床证据表明通过饮食降低血清胆固醇能以任何方式预防或改变心脏病发作或心脏病。”
It also points out that serum cholesterol is hard to measure because any stress, even a small one, can alter it. There is also the statement that serum cholesterol level only drops 3 for each 100 mg removed from the diet and that it has not been shown that as a result of reduction of serum cholesterol levels the cholesterol actually leaves the body! 它还指出血清胆固醇难以测量，因为任何压力，即使是很小的压力，都可能改变它。还有一种说法是，每从饮食中减少 100 毫克胆固醇，血清胆固醇水平只下降 3，而且尚未证明由于血清胆固醇水平的降低，胆固醇实际上会离开体内！
In addition, the condensation points out that there is “ample evidence that heating polyunsaturates tends to resaturate (or polymerize) the product and so defeats the very purpose for which polyunsaturates are promoted. Resaturation of the polyunsaturates by heating occurs in family cooking.” If, as so often happens, cooking oil is reused, “the degree of saturation becomes even worse.” 此外，摘要指出有“充分的证据表明，加热多不饱和脂肪酸往往会使其重新饱和（或聚合），从而违背了推广多不饱和脂肪酸的初衷。家庭烹饪中加热会导致多不饱和脂肪酸的重新饱和。”如果像常见的那样重复使用食用油，“饱和度问题会变得更严重。”
And let me quote here some other paragraphs from the same condensation that I think are particularly interesting: 让我在这里引用同一摘要中的其他一些段落，我认为它们特别有趣：
Heating an unsaturated oil (especially corn oil) to 200^(@)200^{\circ} for 15 minutes (far less than normal cooking temperatures and time) actually enhances atherosclerosis in animals. 将不饱和油（尤其是玉米油）加热至 200^(@)200^{\circ} ，持续 15 分钟（远低于正常烹饪的温度和时间）实际上会加剧动物的动脉粥样硬化。
In Kumerow’s study all his animals on a diet containing heated corn oil developed tumors, and only one of 96 survived the 40 month experimental period. None of the animals fed only fresh corn oil developed tumors; all survived. 在 Kumerow 的研究中，所有食用加热玉米油的动物都长出了肿瘤，96 只中只有一只存活了 40 个月的实验期。所有只食用新鲜玉米油的动物都没有长出肿瘤；全部存活。
Men on a high P.U.F.A. [polyunsaturated fatty acids] diet showed a 65 percent greater incidence of cancer than controls on a standard diet. The J.A.M.A. [Journal of the American Medical Association] reporting this finding also noted that those on the high P.U.F.A. diet also had 70 fatal atherosclerotic accidents as compared to only 48 such deaths in the controls; a similar ratio was found for myocardial and cerebral infarcts. 高多不饱和脂肪酸（P.U.F.A.）饮食的男性癌症发病率比标准饮食组高出 65%。《美国医学会杂志》（J.A.M.A.）报道了这一发现，还指出高多不饱和脂肪酸饮食组发生致命性动脉粥样硬化事故的次数为 70 次，而对照组仅为 48 次；心肌梗死和脑梗死的比例也类似。
Polyunsaturates may be a primary source of the radicals inside the cell that cause aging. 多不饱和脂肪酸可能是细胞内导致衰老的自由基的主要来源。
Recently the Canadian Medical Association Journal carried a report from overseas which highlighted a controversy over “risk factors” conducted in the columns of Medisch Contact, a Dutch publication. In March, 1974 Medisch Contact printed an article in which it was maintained that “large-scale screening and intervention in respect of risk factors for heart and vascular disorders” was not justified. In the opinion of the authors, such factors were not yet defined with sufficient clarity. The authors also stated, according to the Journal, that “there was so far no evidence that manipulating the risk factors would prevent coronary disease.” On 24 May 1974, the same Dutch publication carried rejoinders. 最近，加拿大医学会杂志刊登了一篇来自海外的报道，强调了荷兰刊物 Medisch Contact 专栏中关于“风险因素”的争议。1974 年 3 月，Medisch Contact 发表了一篇文章，认为“对心脏和血管疾病风险因素进行大规模筛查和干预”是不合理的。作者们认为，这些因素尚未被充分明确界定。根据该杂志，作者们还表示，“目前尚无证据表明操控这些风险因素能够预防冠心病。”1974 年 5 月 24 日，同一期荷兰刊物刊登了回应文章。
I find this exchange interesting because it illustrates the fact that many people in a number of countries now doubt the entrenched “cholesterol approach” to the prevention of coronary disease. 我觉得这段交流很有趣，因为它说明了许多国家的许多人现在开始怀疑根深蒂固的“胆固醇方法”在预防冠心病中的作用。
Even more significant is a United Press International report (Palm Beach Post 23 January 1975) concerning the results of a five-year governmental trial of five different cholesterolreducing drugs. More than eight thousand coronary patients were studied in the hope that the drugs would prove effective in reducing death rates and cutting the incidence of recurrent heart attacks. 更重要的是一则来自联合新闻国际社的报道（《棕榈滩邮报》1975 年 1 月 23 日），内容涉及一项为期五年的政府试验，测试五种不同的降胆固醇药物的结果。研究对象超过八千名冠心病患者，目的是希望这些药物能有效降低死亡率并减少复发性心脏病发作的发生率。
According to the UPI account, “three drug treatments were dropped early in the trial because they were doing more harm than good.” The remaining ones, according to the same account, “proved to be of no benefit when results of groups taking the drugs were compared with a group taking a dummy drug.” 根据 UPI 的报道，“三种药物治疗在试验早期被放弃，因为它们带来的害处大于好处。”根据同一报道，剩下的药物“在服用药物的组与服用安慰剂的组的结果比较中，证明没有任何益处。”
I am not surprised, of course, that this elaborate test by professional researchers has failed to demonstrate that use of these cholesterol reducers prevents recurrences. But I am wondering when researchers are going to give up completely on this line of inquiry. The director of the project was quoted as saying that the results applied only to older persons already having had heart attacks and not to primary prevention, and also that diet might still be helpful in lowering high cholesterol levels. 我当然不惊讶，这些专业研究人员进行的详尽测试未能证明使用这些降胆固醇药物能防止复发。但我想知道研究人员什么时候会完全放弃这条研究方向。该项目的负责人被引用说，结果仅适用于已经发生过心脏病发作的老年人，而不适用于初级预防，并且饮食仍可能有助于降低高胆固醇水平。
However, the final assessment of the value of the American Heart Association’s help for the person interested in preventing heart disease is perhaps most effectively made by borrowing some words once more from my favorite cardiologist, Dr. Eliot Corday. Commenting in the 1973 interview with a medical writer in the Los Angeles Times to which I have already referred, Dr. Corday noted that although for quite a few years many patients have been “avoiding risk factors,” this has not caused the death rate from coronary artery disease to decline. “Let’s tell our patients,” said Dr. Corday, “that we believe this advice should be followed but that we have no real proof that eliminating the risk factors will prevent progression of the disease.” 然而，对于那些有兴趣预防心脏病的人来说，评估美国心脏协会帮助价值的最终判断，也许最有效的方式是借用我最喜欢的心脏病专家 Eliot Corday 博士的一些话。在我之前提到的 1973 年他接受《洛杉矶时报》一位医学作家采访时，Corday 博士指出，尽管多年来许多患者一直在“避免风险因素”，但这并未导致冠状动脉疾病的死亡率下降。Corday 博士说：“让我们告诉患者，我们认为应该遵循这些建议，但我们没有真正的证据表明消除风险因素能阻止疾病的进展。”
Fortunately for the thousands of heart patients we have been able to help over the years, there is, and has been for some time, a better approach. And there are, of course, two aspects to this: first, treatment of heart attacks and prevention of recurrences, and second, prevention of initial attacks. 幸运的是，多年来我们已经能够帮助成千上万的心脏病患者，且一直以来都有一种更好的方法。当然，这其中有两个方面：首先是心脏病发作的治疗和预防复发，其次是预防首次发作。
As Dr. A. Ernest Mills first pointed out in a letter to me in 正如 A. Ernest Mills 博士在给我写的一封信中首次指出的那样
1947, the myocardial infarct patient given an adequate intake of Vitamin E immediately will develop the characteristic changes in the electrocardiogram, but to a diminished degree and with a more rapid and more complete return to normal than the patient who survives his attack without E . 1947 年，心肌梗死患者如果立即摄入足够的维生素 E，将会出现心电图的特征性变化，但程度较轻，且比未摄入维生素 E 的患者更快且更完全地恢复正常。
Emergency treatment should include intravenous and oral coronary dilators for the obvious reasons that any increase in coronary blood flow through the unobstructed portions of the coronary circulation and the dilatation of any collateral circulation present could minimize the area of anoxic myocardium and thus the extent of immediate shock. The relatively minor help so obtained may allow the patient to survive who might otherwise not do so. A further hope is that dilatation of the vessel involved in the thrombus before it becomes attached to the wall may allow the blood proximal to the clot to push it further into the artery and possibly break it up. That this does happen in peripheral arteries has often been demonstrated. In the case of myocardial infarction without preceeding thrombosis of the artery, vasodilation may also be helpful in flooding the anoxic muscle with an increased volume of blood. 紧急治疗应包括静脉和口服冠状动脉扩张剂，原因显而易见：通过冠状动脉循环中未阻塞部分的冠状动脉血流增加以及任何存在的侧支循环扩张，可以最大限度地减少缺氧心肌的面积，从而减轻即时休克的程度。通过这种相对较小的帮助，可能使本来无法存活的患者得以生存。另一个希望是，在血栓附着于血管壁之前，扩张受影响的血管可能使血栓近端的血液将其推入动脉更深处，甚至可能将其击碎。这种情况在外周动脉中经常被证明。对于没有先前动脉血栓形成的心肌梗死病例，血管扩张也可能有助于通过增加血液量来灌注缺氧的心肌。
The patient should be put to rest in bed in a sitting position since the heart works more efficiently in this position, and given morphine to decrease pain and “allay apprehension.” As soon as he is pain-free, he should be allowed up in an armchair with care that the seat is so arranged that the pressure on his thighs is evenly distributed and that the front of the cushion does not dig into the back of the thighs. As soon as he can swallow, he should be started on 1,600IU1,600 \mathrm{IU} of dl-alpha tocopherol and given at least that quantity daily. Bathroom privileges should be allowed from the beginning. When patients are so treated, the mortality rate will be under 10 percent. 患者应以坐姿卧床休息，因为心脏在此姿势下工作更有效，并给予吗啡以减轻疼痛和“缓解焦虑”。一旦无痛，应允许其小心地坐在扶手椅上，确保座椅布置使大腿受力均匀，且坐垫前端不压迫大腿后部。一旦能吞咽，应开始服用 1,600IU1,600 \mathrm{IU} 的 dl-α生育酚，并且每天至少给予该剂量。从一开始就应允许使用卫生间。如此治疗时，患者的死亡率将低于 10%。
After the first ten days the patient should be ambulatory. 在最初的十天之后，患者应能行走。
He should be ready for discharge by the end of the third week. Judging by recent reports, it may even be safe to increase activity after the second week, and many patients can return to work six weeks after the infarction. 他应该在第三周末准备出院。根据最近的报告，第二周后增加活动可能是安全的，许多患者在心肌梗死后六周可以恢复工作。
The main reason that used to be given for the six weeks of absolute bed rest-the prevention of aneurysm of the ventricular wall-does not apply, apparently, since the incidence of this is not increased by Levine’s armchair treatment. It may actually be diminished since the myocardium is probably better nourished when the patient is allowed to sit up. 过去给出六周绝对卧床休息的主要理由——预防心室壁动脉瘤——显然并不适用，因为 Levine 的扶手椅治疗并未增加这种情况的发生率。实际上，这种情况可能会减少，因为当患者被允许坐起来时，心肌可能得到更好的营养。
When the patient has had hypertension, the fall in blood pressure that occurs with the infarction makes it perfectly safe to use a full dosage schedule of alpha tocopherol. After recovery, the pressure usually does not rise again. If it does rise, it is rarely as high as its original level and can be treated as soon as it becomes necessary with the modern antihypertensive drugs. 当患者患有高血压时，心肌梗死引起的血压下降使得使用全剂量的α-生育酚完全安全。恢复后，血压通常不会再次升高。如果血压升高，通常也不会达到原来的水平，并且一旦有必要，可以用现代抗高血压药物进行治疗。
In the patient with normal blood pressure before the infarction, and whose pressure has inevitably dropped, the ability of alpha tocopherol to improve the tone of heart muscle can greatly help to speed up the return of pressure toward a normal range. 对于梗死前血压正常且血压不可避免下降的患者，α-生育酚改善心肌张力的能力可以大大帮助加快血压恢复到正常范围。
After discharge from the hospital, continuation of the same level of alpha tocopherol is usually all that is needed. Occasionally it will be obvious, then or at a later date, that a particular patient may well benefit still more from an increased level of dosage. 出院后，通常只需继续维持相同水平的α-生育酚即可。偶尔在当时或以后会明显发现，某些患者可能会从增加剂量中获得更多益处。
There is the general observation, made by all those familiar with alpha tocopherol therapy for myocardial infarction -and our experience is huge over the course of twenty-five years-that the patient who has had an infarction and has survived is almost fully protected from any later attack. 所有熟悉α-生育酚治疗心肌梗死的人都有一个普遍的观察——在我们二十五年的丰富经验中——曾经发生过梗死并存活下来的患者几乎完全免受后续发作的影响。
So much for treating heart attacks and preventing recurr- 关于治疗心脏病发作和预防复发就说这么多了—
ences. But what are the chances of avoiding an attack in the first place? 但首先避免遭受攻击的几率有多大呢？
The evidence that alpha tocopherol is prophylactic depends upon two observations. First, there is the definite proof first shown by Ochsner’s group and confirmed many times since, that in the case of venous thrombosis not only can the fresh clot be lysed (dissolved) but further episodes prevented. Ochsner and his associates have also shown, of course, that alpha tocopherol used prophylactically in a large series of surgical cases will decrease the incidence of venous clotting and, according to Ochsner, absolutely prevent the occurrence of pulmonary embolism. The second is the observation to which I have just referred-namely, that with alpha tocopherol therapy the patient who has had a myocardial infarction and survived is almost fully protected from recurrence. 关于α-生育酚具有预防作用的证据依赖于两个观察。首先，Ochsner 团队首次明确证明并多次确认，在静脉血栓形成的情况下，不仅可以溶解新鲜血栓，还能防止进一步发作。Ochsner 及其同事还表明，α-生育酚在大量外科手术病例中作为预防性使用，可以减少静脉血栓的发生率，并且据 Ochsner 称，能够完全防止肺栓塞的发生。第二个观察是我刚才提到的——即通过α-生育酚治疗，经历过心肌梗死并存活的患者几乎完全免受复发的影响。
There is, of course, direct proof of the prophylactic value in preventing coronary thrombosis in myocardial infarction in the papers of Boyd and Haeger. Both showed that there was a definite decrease in deaths in their series of patients being treated for intermittent claudication. 当然，Boyd 和 Haeger 的论文中有直接证据证明其在预防心肌梗死冠状动脉血栓形成方面的预防价值。两者都显示，在治疗间歇性跛行的患者系列中，死亡率明显降低。
By deduction, then, it is probable that the majority, though not all, who would take 800 IU of alpha tocopherol daily and faithfully would escape a myocardial infarction. This is probably true of all those who have blood pressures in the normal range and who have not had rheumatic fever. (The subject of how much alpha tocopherol can safely be given to persons with high blood pressure or chronic rheumatic heart disease-and under what circumstances-will be discussed in Chapters 9, 13 and 16.) 由此推断，大多数人（虽然不是全部）如果每天坚持服用 800 IU 的 alpha tocopherol，可能会避免心肌梗死。这对于所有血压处于正常范围且没有风湿热病史的人来说，可能都是正确的。（关于在何种情况下以及能安全给予高血压或慢性风湿性心脏病患者多少 alpha tocopherol 的问题，将在第 9、13 和 16 章中讨论。）
It would seem, however, in the light of increasing knowledge of the action of other vitamins, chelated minerals and thyroid hormone and of the deleterious effects of our increasingly polluted environment, the processing of our foods, the 然而，鉴于我们对其他维生素、螯合矿物质和甲状腺激素作用的认识日益加深，以及我们日益污染的环境、食品加工的有害影响，似乎有必要重新审视这一点，
removal of essential nutrients from them and the addition to them of so many chemical substances, that the expectation of prevention would be greatly enhanced by correction of these complicating factors. 去除其中的必需营养素并添加许多化学物质，通过纠正这些复杂因素，预防的期望将大大提高。
Baroldi, G. American Journal of Cardiology 16, 859, 1965.
Anderson, T.W. The Lancet 2,298,19732,298,1973. Anderson, T.W. 《柳叶刀》 2,298,19732,298,1973 。
Tambe, A.A., Demany, M.A., Zimmerman, H.A. and Mascarenhas, E. American Heart Journal, 84, 66, 1972. Tambe, A.A., Demany, M.A., Zimmerman, H.A. 和 Mascarenhas, E. 《American Heart Journal》，84，66，1972 年。
Sinapius, D. Deutsche Medizinische Wochenschrift 97, 433, 1972. Sinapius, D. 德国医学周刊 97, 433, 1972.
Frank, C.W. Bulletin of the New York Academy of Medicine 44, 900, 1968. Frank, C.W. 纽约医学科学院公报 44, 900, 1968。
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Bastenie, P.A., Vanhaelst, L., Bonnyns, M., Neve, P. and Staquet, M. The Lancet 1, 203, 1971. Bastenie, P.A., Vanhaelst, L., Bonnyns, M., Neve, P. 和 Staquet, M. 《柳叶刀》1, 203, 1971 年。
Calay, R., Kocheleff, P., Jonniaux, G., Sohet, L. and Bastenie, P.A. The Lancet 1, 205, 1971. Calay, R., Kocheleff, P., Jonniaux, G., Sohet, L. 和 Bastenie, P.A. 《柳叶刀》1, 205, 1971 年。
9
ANGINA AND RHEUMATIC HEART DISEASE 心绞痛与风湿性心脏病
TO HEAR MOST PEOPLE TALK-and to skim the mass media-one would often think that the only kind of heart disease is the “heart attack.” Certainly the occurrence of a myocardial infarction possesses a kind of stark drama-often, indeed, tragedy-and that is undoubtedly part of the reason, along with its ever-mounting incidence, that it receives so much public attention. It is all too easy, therefore, for most people to fail to grasp the plight of the four to five million men and women who suffer from angina pectoris and the 1.6 million victims of rheumatic heart disease. 听大多数人谈话——浏览大众媒体——人们常常会认为唯一的心脏病就是“心脏病发作”。心肌梗死的发生确实具有一种严峻的戏剧性——实际上，常常是悲剧——这无疑是它受到如此多公众关注的原因之一，加上其不断上升的发病率。因此，大多数人很容易忽视那四五百万患有心绞痛的男女以及 160 万风湿性心脏病患者的困境。
The term angina pectoris, as I have said, simply means pain in the chest. But of course a pain is a symptom, not a disease, and there are many underlying conditions which can produce such a symptom. The disease state known as angina pectoris, however, is a definite one with a definite cause: 正如我所说，心绞痛一词仅仅意味着胸痛。但当然，疼痛是一种症状，而不是疾病，许多潜在状况都可能引起这种症状。然而，被称为心绞痛的疾病状态是明确的，有明确的原因：
myocardial anoxia. The pain is referred from a heart muscle that is temporarily deficient in oxygenation. The deficiency may be in a small area of the heart or it may be a generalized deficiency. 心肌缺氧。疼痛源自暂时缺氧的心肌。缺氧可能局限于心脏的小区域，也可能是广泛性的缺氧。
Like coronary thrombosis, angina pectoris is a condition that has developed relatively recently in the long history of man. Dr. Michaeles, writing in the British Heart Journal in 1966, pointed out that Medieval and Renaissance physicians in England and Wales have left no description of a pain resembling it. He mentions a 1768 description of angina by Heberden, an English physician, but comments that the condition seems to have been very rare then and even later. 像冠状动脉血栓形成一样，心绞痛是在漫长的人类历史中相对较新出现的一种疾病。Michaeles 博士在 1966 年发表于《英国心脏杂志》上指出，中世纪和文艺复兴时期的英格兰和威尔士医生没有留下任何类似心绞痛的疼痛描述。他提到了 1768 年英国医生 Heberden 对心绞痛的描述，但评论说这种病症当时甚至后来都非常罕见。
In 1973 the Medical Post carried a quotation from a book by Dr. Austin Flint which was published in 1866 and entitled AA Treatise on the Principles and Practices of Medicine. Dr. Flint describes angina as a rare complaint, and he substantiates this statement by saying that there were only seven such cases in more than a hundred and fifty instances of organic heart disease that he had studied, and none at all in the cases of cardiac disease he had seen in the five years preceding the time at which he wrote. 1973 年，《Medical Post》刊登了一段摘自奥斯汀·弗林特博士于 1866 年出版的《Treatise on the Principles and Practices of Medicine》一书的引文。弗林特博士将心绞痛描述为一种罕见的疾病，他通过说明在他研究的一百五十多例器质性心脏病中只有七例是心绞痛，并且在他写作前五年所见的心脏病病例中完全没有心绞痛病例，来支持这一说法。
According to Michaeles, Sir William Osler (1849-1919), the great physician who described several cardiovascular diseases, saw no cases of angina pectoris in twelve years of clinical work. 据 Michaeles 所述，伟大的医生 Sir William Osler（1849-1919），他描述了几种心血管疾病，在十二年的临床工作中未见过心绞痛病例。
Just how serious is this condition that gets so little public attention and that is of such relatively recent genesis? What is the outlook for patients with angina pectoris? 这种很少受到公众关注且起源相对较近的疾病到底有多严重？心绞痛患者的预后如何？
Dr. William B. Kannel reported to the twentieth annual meeting of the American College of Cardiology that one in four men and one in eight women with angina pectoris can expect to have a coronary attack within five years. Thirty percent of those over age fifty-five will die within five years. 威廉·B·卡内尔博士在美国心脏病学会第二十届年会上报告说，四分之一的男性和八分之一的女性心绞痛患者预计将在五年内发生冠状动脉事件。超过五十五岁的人中有 30%将在五年内死亡。
Forty-four percent of the coronary deaths will be sudden. Abnormal electrocardiograms (EKGs) are ominous signs in angina pectoris: less than 50 percent of patients with such EKGs survive five years. Survival in men with uncomplicated angina pectoris is no better than in those with angina pectoris following in the wake of myocardial infarction. 44%的冠心病死亡是突发的。心绞痛中异常的心电图（EKG）是凶兆：不到 50%的此类心电图患者能存活五年。无并发症心绞痛男性的存活率不比心肌梗死后继发心绞痛者更好。
Many different treatments have been known to relieve pain of angina pectoris. 许多不同的治疗方法已被证实能缓解心绞痛的疼痛。
All doctors use nitroglycerine for relief of angina. Nitroglycerine, either under the tongue or orally, does reduce the length of the anginal attack in most cases, although an inert pill is often as effective. In spite of the widespread use of nitroglycerine and of the good results ascribed to it, there have been many papers which have denied its effectiveness. (When longer-acting but similar compounds are used, some patients report a definite decrease in the number of episodes.) 所有医生都使用硝酸甘油来缓解心绞痛。硝酸甘油，无论是舌下含服还是口服，在大多数情况下确实能缩短心绞痛发作的时间，尽管安慰剂往往同样有效。尽管硝酸甘油被广泛使用且被认为效果良好，但仍有许多论文否认其有效性。（当使用作用时间更长但类似的化合物时，一些患者报告发作次数明显减少。）
Dr. Russek, to whom I referred in Chapter 2, has treated 102 patients suffering from severe angina for six years with a combination of drugs-one which slows down the heart and reduces its need for oxygen, and one which dilates the blood vessels and increases blood flow to the heart muscle (without, however, altering the basic pathology). His patients experienced about the same mortality rate from heart attacks as is expected among apparently healthy people in the same age range. 我在第二章提到的 Russek 医生，六年来用一种药物组合治疗了 102 名患有严重心绞痛的患者——一种药物减慢心跳并减少心脏对氧气的需求，另一种药物扩张血管并增加心肌的血流量（但不改变基本病理）。他的患者心脏病发作的死亡率与同年龄段表面健康人群的预期死亡率大致相同。
A succession of operative procedures has been developed, each of which was at first said to yield 75 percent success with very low mortality. Unfortunately, it is hard to make a firm evaluation of these since angina has a trick of responding to placebos, both pharmaceutical and surgical. 一系列手术程序相继被开发出来，起初据说每种手术的成功率为 75%，且死亡率极低。不幸的是，很难对这些手术进行准确评估，因为心绞痛对安慰剂（无论是药物还是手术）都有反应的特点。
A sham operation in which the skin is incised under anesthesia and sewn up again will often relieve angina. And according to Dr. Eliot Corday, the 60 to 90 percent relief 在麻醉下切开皮肤然后缝合的假手术常常能缓解心绞痛。根据 Eliot Corday 博士的说法，缓解率为 60%到 90%。
reported by proponents of the coronary bypass operation must be compared with the 60 to 70 percent success of the sham operation. 冠状动脉搭桥手术的支持者报告的结果必须与假手术的 60%到 70%的成功率进行比较。
As Corday also points out, these surgical claims must also be compared with the 60 percent success reported by users of placebo pills (inert pills having no known therapeutic value). 正如 Corday 所指出的，这些外科手术的说法还必须与使用安慰剂（无已知治疗价值的惰性药丸）者报告的 60%的成功率进行比较。
A further difficulty is that the placebo pill used to make comparisons with the results of surgery or nitroglycerine or other forms of treatment is not really inert. It has been shown by extensive research that placebos, by affecting the autonomic nervous system, can cause many different symptoms such as coughs, pain, headaches and vomiting-and angina pectoris itself! It seems, therefore, that other methods of clinical investigation may be preferable. 另一个困难是，用于与手术、硝酸甘油或其他治疗方法的结果进行比较的安慰剂药丸并非真正无效。大量研究表明，安慰剂通过影响自主神经系统，可以引起许多不同的症状，如咳嗽、疼痛、头痛和呕吐——甚至心绞痛本身！因此，似乎其他临床调查方法可能更为可取。
It is our position that treatment for angina pectoris must include alpha tocopherol, for independently of whether or not it abolishes or even diminishes the symptoms it must increase the chances for survival. Alpha tocopherol, in fact, should and usually will abolish the symptoms, or at least greatly reduce the frequency and severity. In patients who develop angina following upon a myocardial infarction-a common situation in such recovery periods - the angina is usually relieved in from four to six weeks after initiation of treatment with alpha tocopherol. 我们的立场是，心绞痛的治疗必须包括 alpha tocopherol，因为无论它是否消除甚至减轻症状，它都必须增加生存的机会。事实上，alpha tocopherol 应该且通常会消除症状，或至少大大减少症状的频率和严重程度。在心肌梗死后出现心绞痛的患者中——这是恢复期常见的情况——在开始使用 alpha tocopherol 治疗后，心绞痛通常会在四到六周内缓解。
Acute rheumatic fever is a heart condition whose incidence is decreasing owing to the introduction of the sulfonamides and the antibiotics. Adequate, immediate treatment of streptococcal infections in the upper respiratory tract will prevent acute rheumatic fever. However, when the acute stage develops ten days to three weeks after tonsillitis or pharyngitis of other inflammation in this area, the antibiotics are of no value. Neither is anything else, except Vitamin E. Salicylates, cortisone and other drugs that are sometimes 急性风湿热是一种心脏疾病，其发病率因磺胺类药物和抗生素的引入而减少。对上呼吸道链球菌感染进行充分、及时的治疗可以预防急性风湿热。然而，当急性期在扁桃体炎或咽炎或该区域其他炎症后十天到三周内发展时，抗生素无效。除此之外，唯有维生素 E 有效。水杨酸盐、可的松及其他有时使用的药物均无效。
tried only treat symptoms and do not prevent the progression to heart damage and chronicity. 仅尝试治疗症状，无法防止心脏损伤和慢性病的发展。
The incidence of acute rheumatic fever could be greatly lowered if all streptococcal infections were adequately treated with antibiotics. However, acute rheumatic fever is often so mild that it is undiagnosed. It is also extremely difficult to make a firm diagnosis of rheumatic heart damage in the asymptomatic stage. When surgeons first found that they could open the human heart, they found that cardiologists’ diagnoses were “not often wrong but usually wrong,” to put it in words I have heard used by a prominent Canadian heart surgeon. Often it is only when a man or woman reports for an insurance examination or for one requested by an employer who has been sold on routine annual physicals that a lesion is picked up. Almost half of those who have rheumatic heart disease give no history of an acute episode and cannot believe that they have any heart lesion. 如果所有链球菌感染都能得到充分的抗生素治疗，急性风湿热的发病率可以大大降低。然而，急性风湿热常常症状轻微，以至于未被诊断出来。在无症状阶段，确诊风湿性心脏损害也极为困难。当外科医生首次发现他们可以打开人体心脏时，他们发现心脏病专家的诊断“不是经常错，而是通常错”，用一位著名加拿大心脏外科医生的话来说。通常只有当男性或女性参加保险体检或由已经接受常规年度体检的雇主要求体检时，才会发现病变。几乎一半患有风湿性心脏病的人没有急性发作的病史，且无法相信自己有任何心脏病变。
Where acute rheumatic fever does develop, its seriousness could be much reduced if it were treated adequately and immediately with alpha tocopherol. A difficulty, however, is the fact that such treatment must be prolonged. It is very difficult to persuade a good many patients with proven rheumatic lesions who are nevertheless asymptomatic to follow a course of treatment with alpha tocopherol which is expensive and which must be carried out daily, faithfully and continuously. 急性风湿热一旦发生，如果能及时且充分地用α-生育酚治疗，其严重程度可以大大降低。然而，问题在于这种治疗必须持续进行。说服许多已经确诊有风湿病变但无症状的患者坚持每日、忠实且持续地进行昂贵的α-生育酚治疗是非常困难的。
There is no more dramatic proof of the therapeutic action of alpha tocopherol than its effect on acute rheumatic fever. All signs and symptoms disappear in as little as forty-eight hours after treatment is begun. The only other comparable examples are in the treatment of acute nephritis and acute thrombophlebitis. 没有比α-生育酚对急性风湿热的治疗作用更具戏剧性的证据了。治疗开始后，所有的体征和症状在短短四十八小时内消失。其他类似的例子只有在治疗急性肾炎和急性血栓性静脉炎时才有。
With any other treatment, however, a large percentage in all three of those conditions go on to chronicity. In the case of 然而，使用任何其他治疗方法，这三种情况中都有很大比例会发展为慢性。就……而言
rheumatic fever, the proportion is about 80 percent. Many of these patients have recurrences of the acute phase, but the majority make an apparently complete recovery and have years of apparently normal health while the connective tissue lesions characteristic of the disease are continuing to develop and progress. Ultimately, valvular lesions start to produce symptoms. The chronic rheumatic heart patient is to be pitied, since once his symptoms develop the disease progresses slowly but inexorably and the patient becomes a chronic invalid. 风湿热，比例约为 80%。许多患者急性期会复发，但大多数患者表面上完全康复，并且在结缔组织病变持续发展和进展的同时，经历多年表面正常的健康状态。最终，瓣膜病变开始产生症状。慢性风湿性心脏病患者令人同情，因为一旦出现症状，疾病会缓慢但不可避免地进展，患者成为慢性病残。
Much can be done for these chronic cases. Obviously, however, the time to treat them is in the very early acute stages when the disease can be eradicated, the heart protected and chronicity prevented. 对于这些慢性病例，可以做很多事情。然而，显然，治疗的最佳时机是在疾病的早期急性阶段，此时可以根除疾病，保护心脏并防止慢性化。
The first symptoms of chronic rheumatic heart disease are usually shortness of breath or a pounding of the heart on exertion or excitement, a little more than usually experienced previously. Then a little typical unproductive cough begins, followed by a little orthopnea (discomfort that occurs whenever the patient tries to breathe unless he is sitting straight up or standing up). These patients respond beautifully to alpha tocopherol treatment, so well, in fact, that I have treated many without seeing them. 慢性风湿性心脏病的最初症状通常是在运动或兴奋时出现呼吸急促或心跳加速，比以前稍微严重一些。然后开始出现少量典型的无痰咳嗽，接着出现少量端坐呼吸（患者除非坐直或站立，否则呼吸时感到不适）。这些患者对 alpha tocopherol 治疗反应非常好，实际上，我已经治疗了许多患者而未曾见过他们。
For example, while on vacation in Florida some years ago, I received a telephone call from a friend in New York who wanted to see me at once. I knew that he had had rheumatic fever in childhood and that a mitral lesion had been found some years previously. Now he had developed serious early symptoms of mitral stenosis (narrowing of the opening of the mitral valve) and had just been investigated in the heart section of a university hospital. After cardiac catheterization (a diagnostic procedure in which a tube is passed into the heart through a vein or artery) he was told that he had a severe degree of mitral stenosis and that he would need an im- 例如，几年前我在佛罗里达度假时，接到了纽约一位朋友的电话，他想立刻见我。我知道他小时候得过风湿热，几年前发现有二尖瓣病变。现在他出现了严重的早期二尖瓣狭窄（即二尖瓣口狭窄）症状，刚在一所大学医院的心脏科接受了检查。经过心导管检查（一种通过静脉或动脉将导管插入心脏的诊断程序）后，他被告知患有严重的二尖瓣狭窄，需要进行手术——
mediate operation. They actually booked him for this operation. It was then that he called me. 调解手术。他们实际上为这次手术给他预约了。就在那时他给我打了电话。
I asked his symptoms and then asked if he was still working. He said he was. 我询问了他的症状，然后问他是否还在工作。他说他还在工作。
“Every day?” “每天？”
“Yes,” he replied. “是的，”他回答道。
I told him he didn’t need surgery and that he would be as well as he had been ten years before if he would take Vitamin E correctly. Here is where the right dosage schedule of a properly assayed and labelled product is absolutely crucial. The dosage is absolutely precise, 75 IU a day for a month with no obvious benefit, then 100 IU a day for a month with no obvious benefit, then 150 IU a day and a virtual guarantee that six weeks after beginning 150 IU he would be free of symptoms. 我告诉他他不需要手术，如果他正确服用维生素 E，他的健康状况会和十年前一样好。这里，正确剂量的合理检测和标记产品的用药时间表至关重要。剂量非常精确，先每天 75 IU，服用一个月没有明显效果，然后每天 100 IU，服用一个月仍无明显效果，接着每天 150 IU，几乎可以保证在开始服用 150 IU 六周后，他将无症状。
This is exactly what happened in this case (and in nearly all others of this type). Alpha tocopherol is almost 100 percent effective. My friend now lives a normal life. On the one occasion on which I have seen him since-a social one-he was completely asymptomatic and had been dancing all evening the night before. He now works on the third floor of a building and for sheer exhilaration takes the two flights of stairs two steps at a time! 这正是这种情况下发生的情况（以及几乎所有类似情况）。Alpha 生育酚的效果几乎是百分之百的。我的朋友现在过着正常的生活。自那以后我见过他一次——一次社交场合——他完全没有症状，前一晚整晚都在跳舞。他现在在一栋楼的三楼工作，为了纯粹的兴奋感，他一次跨两级楼梯上下两层楼！
There was something that my friend had not told me previously. This was that during his catheterization he had suffered a cardiac arrest. In spite of this he submitted, when he was called back to the hospital for a checkup eighteen months later, to another cardiac catheterization and once more suffered a cardiac arrest. He knew thedangers involved but by now was so interested in the clinical improvement in his condition that he wanted to know if there was definite evidence of this that would be revealed by catheterization. After this second catheterization he was told that he had mitral stenosis and that some day he would need corrective 有一件事是我的朋友之前没有告诉我的。那就是在他进行导管插入术时曾发生过心脏骤停。尽管如此，当他在十八个月后被召回医院进行复查时，他还是接受了另一项心脏导管插入术，并再次发生了心脏骤停。他知道其中的危险，但此时他对自己病情的临床改善非常感兴趣，想知道导管插入术是否能显示出明确的证据。第二次导管插入术后，他被告知患有二尖瓣狭窄，某天将需要矫正手术。
surgery. When he asked why he was originally an emergency but not any longer, no explanation of his excellent clinical status was forthcoming. (Of course the diagnostic murmur of mitral stenosis will always be present to some degree.) 手术。当他询问为什么他最初是紧急情况但现在不再是时，没有人解释他出色的临床状况。（当然，二尖瓣狭窄的诊断性杂音总会在某种程度上存在。）
Unlike patients with early symptoms of chronic rheumatic heart disease, rheumatic heart disease patients who have developed serious heart failure-and particularly those with auricular fibrillation (fast, irregular heartbeat)-are very difficult to manage. These patients need all the treatment of their complications that can be devised as well as the alpha tocopherol on the 75-100-150 IU regimen. If they are fibrillating, but not otherwise, they must have the dosage of a digitalis preparation that will regulate their apex heart rate (the rate obtained with a stethoscope at the apex of the heart). They may also need diuretics in the amount necessary to drop them to a basic weight and keep them there. 与早期慢性风湿性心脏病症状的患者不同，已经发展为严重心力衰竭的风湿性心脏病患者——尤其是那些患有心房颤动（快速、不规则心跳）的人——非常难以管理。这些患者需要尽可能多的并发症治疗，以及按照 75-100-150 IU 方案服用的α-生育酚。如果他们有心房颤动，但其他方面无异常，必须服用能够调节心尖心率（用听诊器在心尖处测得的心率）的地高辛制剂剂量。他们还可能需要适量的利尿剂，以使体重降至基本水平并维持在那里。
Such patients will usually show very worthwhile improvement and if they do, improvement will continue for many months. But they need frequent re-evaluations, particularly of their dosage levels of diuretics and digitalis. Most who initially need diuretics can reduce or eliminate them after four to six months of treatment, but it should be stressed that these patients respond slowly-a characteristic of Vitamin E treatment mentioned often before in relation to this condition and others, particularly intermittent claudication, as we shall see in Chapter 11. 这类患者通常会显示出非常显著的改善，如果有改善，改善将持续数月。但他们需要频繁的重新评估，特别是利尿剂和地高辛的剂量水平。大多数最初需要利尿剂的患者在经过四到六个月的治疗后可以减少或停止使用，但应强调的是，这些患者反应较慢——这是维生素 E 治疗的一个特点，之前在与本病及其他疾病，特别是间歇性跛行相关的讨论中多次提到，正如我们将在第 11 章看到的。
It is now more than two hundred years since William Withering wrote his treatise on the value of the foxglove in treating dropsy. Since that time, volumes have been written on the proper use of digitalis, yet it is one of the most misused and abused drugs in the pharmacopeia. 自威廉·威瑟林撰写关于毛地黄治疗水肿价值的专著以来，已经过去了两百多年。自那时起，关于地高辛正确使用的著作层出不穷，然而它仍是药典中最被误用和滥用的药物之一。
The Medical Post for 12 December 1972 carried an article that states that 33 to 50 percent of patients on digitalis are not being optimally managed. This is alarming after two hundred 1972 年 12 月 12 日的《The Medical Post》刊登了一篇文章，指出 33%到 50%的洋地黄患者未得到最佳治疗。这令人震惊，经过两百年后
years! There is such a narrow margin between therapeutic and toxic effects. It is mentioned in this Medical Post article that Dr. Thomas W. Smith of Harvard has stated that of 900 consecutive admissions to the Harvard Medical Service emergency ward, 135 were digitalized prior to admission and that among these the incidence of definite digitalis toxicity was 32 percent. An additional 6 percent had possible digitalis toxicity. 多年！治疗效果与毒性效果之间的差距非常小。该《Medical Post》文章提到，哈佛大学的 Thomas W. Smith 博士表示，在哈佛医务服务急诊病房连续接收的 900 名患者中，有 135 人在入院前使用了地高辛，其中明确的地高辛毒性发生率为 32%。另外 6%可能存在地高辛毒性。
The same article says that Dr. Roger W. Jelliffe, Associate Professor of Medicine at the University of Southern California School of Medicine, has reported the incidence of adverse reactions at 20 to 30 percent of hospitalized patients. Dr. Jelliffe’s team recently studied ninety patients who had been receiving digitalis by the conventional method and whose digitalis dosage subsequently was computed by a new computer-assisted method. Thirty-five percent of the patients had adverse reactions to the drug when their doctors used the conventional method. 同一篇文章指出，南加州大学医学院内科副教授 Roger W. Jelliffe 博士报告称，住院患者中不良反应的发生率为 20%到 30%。Jelliffe 博士的团队最近研究了 90 名通过传统方法接受地高辛治疗的患者，并随后采用一种新的计算机辅助方法计算地高辛剂量。当医生使用传统方法时，35%的患者对该药物出现了不良反应。
The use of digitalis and Vitamin E by the same patient requires constant surveillance. Vitamin E usually reduces the dosage level of digitalis needed by these patients, and the usual maintenance level used by most physicians is often too much, sometimes much too much. It must be remembered that digitalis is a highly selective poison-very useful and very dangerous. Today it has only one function of importance: the regulation of the apex rate in the patient with auricular fibrillation. There are so many more potent and safer diuretics that its usefulness as a diuretic can be ignored, and the general statement that digitalis increases the output of blood from the heart may well not be of much importance here. Digitalis should be given to the chronic rheumatic heart patient who is fibrillating-not otherwise. 同一患者同时使用地高辛和维生素 E 需要持续监测。维生素 E 通常会减少这些患者所需的地高辛剂量，而大多数医生通常使用的维持剂量往往过高，有时甚至过量。必须记住，地高辛是一种高度选择性的毒药——非常有用但也非常危险。如今，它只有一个重要功能：调节心房颤动患者的心尖率。由于有许多更有效且更安全的利尿剂，其作为利尿剂的作用可以忽略不计，且一般认为地高辛增加心脏血液输出的说法在这里可能并不重要。地高辛应给予慢性风湿性心脏病且出现心房颤动的患者，而非其他情况。
Digitalis intoxication is commonly seen in patients in our practice, especially when the family doctor insists on chang- 洋地黄中毒在我们的临床实践中常见，尤其是在家庭医生坚持更换药物时
ing our routines. Since diuretics as well as Vitamin E potentiate the action of digitalis, the latter is just too dangerous a drug and wholly unnecessary except in the fibrillator. 调整我们的日常程序。由于利尿剂和维生素 E 都增强地高辛的作用，后者是一种非常危险且完全不必要的药物，除非用于心房颤动患者。
A second-and also very important-point that must be made concerning the use of Vitamin E in chronic rheumatic heart disease is that dosage and schedule, as I have already said, must be handled with the utmost care and precision. Giving a chronic rheumatic heart disease patient 300 IU a day will lead to tremendous improvement in some cases within three to seven days. However, it will make many more such patients much worse, and that rapidly. If continued, it will kill them. Only in the rare case when the damage to the two sides of the heart is equal will the patient be able to tolerate and benefit from 300 IU a day. Since, in most cases, one side of the heart is more severely damaged than the other, even 300 IU will help the better side faster than the more damaged side and will thus throw the heart into worse imbalance. Incipient heart failure can be precipitated or, if there is already failure, it will be rapidly increased. Thus, the correct 75-100-150 IU schedule is of the utmost importance. The patient should be told that no improvement can be expected until he or she has been on 150 IU for four to six weeks. 关于维生素 E 在慢性风湿性心脏病中的使用，必须指出的第二个也是非常重要的一点是，剂量和用药时间表，正如我已经说过的，必须非常谨慎和精确地处理。给慢性风湿性心脏病患者每天服用 300 IU，在某些情况下三到七天内会带来显著改善。然而，这会使更多的患者病情迅速恶化。如果继续服用，甚至会致命。只有在极少数情况下，当心脏两侧的损伤程度相等时，患者才能耐受并从每天 300 IU 中受益。由于大多数情况下，心脏一侧的损伤比另一侧严重，即使是 300 IU 也会使较好的一侧恢复得比受损更严重的一侧快，从而导致心脏失去平衡。可能会诱发初期心力衰竭，或者如果已经存在心力衰竭，病情会迅速加重。因此，正确的 75-100-150 IU 用药方案极为重要。应告知患者，在服用 150 IU 四到六周之前，不应期待有任何改善。
All other precautions in the use of alpha tocopherol are also of special importance in these cases. Inorganic iron neutralizes alpha tocopherol if the two meet in the gastrointestinal tract. Iron in medicine form cannot be given, therefore, with Vitamin E. Since the blood level of Vitamin E is maintained much better when it is given in divided doses at least twice a day, this is the way it should be used. When iron must be given, the Vitamin E must all be given at one time and all the iron eight to twelve hours later. It should also be remembered that mineral oil absorbs Vitamin E and does not readily release it, whereas vegetable oils do release it readily. Mineral oil should be avoided. Another important consideration is the 在使用α-生育酚时的所有其他预防措施在这些情况下也尤为重要。无机铁如果在胃肠道中与α-生育酚相遇，会中和α-生育酚。因此，不能与维生素 E 同时服用药物形式的铁。由于维生素 E 的血液水平在分次服用（每天至少两次）时维持得更好，因此应采用这种方式使用。当必须服用铁时，维生素 E 应一次性全部服用，而铁则应在八到十二小时后服用。还应记住，矿物油会吸收维生素 E 且不易释放，而植物油则能较容易释放维生素 E，应避免使用矿物油。另一个重要的考虑是
fact that estrogens are Vitamin E antagonists and, since dosage is crucial in these cases, estrogen should be avoided. 雌激素是维生素 E 的拮抗剂，且在这些情况下剂量至关重要，因此应避免使用雌激素。
Very few patients are allergic to Vitamin E preparations.* When they are, one of the other forms can usually be used without a reaction. There are three forms: the so-called natural, its succinic acid salt, and the synthetic. 极少数患者对维生素 E 制剂过敏。* 当发生过敏时，通常可以使用其他形式而不会产生反应。维生素 E 有三种形式：所谓的天然型、其琥珀酸盐和合成型。
Although I have not had a long and therefore adequate experience in the simultaneous use of megadoses of ascorbic acid ( 3 to 5 gm or more a day), I have reason to suspect that Vitamin C should be used with caution in treating chronic rheumatic heart disease. Vitamin C apparently reinforces the action of E since C is a water-soluble antioxidant, and the 150 IU of Vitamin E, along with C, may therefore produce effects resembling those of using larger amounts of E . 虽然我没有长期且足够的经验同时使用大剂量的抗坏血酸（每天 3 到 5 克或更多），但我有理由怀疑在治疗慢性风湿性心脏病时应谨慎使用维生素 C。维生素 C 显然增强了维生素 E 的作用，因为 C 是水溶性抗氧化剂，150 IU 的维生素 E 连同 C 一起使用，可能产生类似于使用较大量 E 的效果。
It is curious that the chronic rheumatic cases respond to only 150 IU of E a day and that this may be the maximum needed. Nevertheless, we always try to give as much as 300 IU eventually, reaching that level only after months at a lower dosage. By contrast, coronary and -as we shall see in the next few chapters-peripheral vascular-cases need much more before full response is obtained-somewhere in excess of 800 IU a day and often as much as 2,400 to 3,200 IU a day. 有趣的是，慢性风湿病例每天仅需 150 IU 的维生素 E 即可产生反应，这可能是所需的最大剂量。然而，我们总是尽量最终给予多达 300 IU 的剂量，且只有在几个月的较低剂量后才达到该水平。相比之下，冠状动脉病例——正如我们将在接下来的几章中看到的——外周血管病例在获得完全反应之前需要更多的剂量——每天超过 800 IU，且常常高达 2400 至 3200 IU。
10
ATHEROSCLEROSIS AND AN IMPORTANT BREAKTHROUGH 动脉粥样硬化及一项重要突破
IT MAY WELL BE PREMATURE to announce now, in this book, another most important medical discovery. But I think that this new advance is so vital to the health of millions of people that I cannot resist giving you at least some background and basic information about it. It suggests a valuable adjunctive therapy to alpha tocopherol treatment and a universal use in the prophylaxis of the aging process in blood vessels. 现在在这本书中宣布另一项极其重要的医学发现可能还为时过早。但我认为这一新进展对数百万人的健康至关重要，因此我忍不住至少向您介绍一些背景和基本信息。它提出了一种对α-生育酚治疗有价值的辅助疗法，并可普遍用于预防血管老化过程。
As is so often the case with major discoveries, this one came about as a result of the more or less chance meeting of minds and pooling of knowledge of a small group of investigators-in this case, Dr. Frederick Klenner of Reidsville, North Carolina, Dr. Morgan Raiford of Atlanta and myself. And this is only one of the worthwhile consequences of the formation of an organization known as the Interna- 正如许多重大发现的情况一样，这次发现也是由于一小群研究人员的思想偶然碰撞和知识汇聚而产生的——在本例中，是来自北卡罗来纳州里兹维尔的弗雷德里克·克莱纳博士、亚特兰大的摩根·雷福德博士和我本人。而这只是一个名为 Interna-的组织成立所带来的诸多有益结果之一。
tional Academy of Preventive Medicine five years ago by a small group of doctors. 五年前由一小群医生成立的预防医学国家学院。
The objective of the Academy is to provide a platform for clinical investigators, biochemists and researchers in all sections of the healing arts who are interested in preventing degenerative diseases as well as in providing alternatives to acute disaster crisis medicine. Its activities include the organization of meetings twice a year which are open to all who are interested in the field of preventive medicine so that they may meet and hear the leaders in their field and participate with them in question-and-answer panel discussions. The organization has grown numerically beyond the fondest dreams of the organizers: it now has more than five hundred members. Speakers of the highest caliber have presented their works at these meetings and each meeting seems to surpass the previous ones. 该学院的目标是为临床研究人员、生物化学家以及所有对预防退行性疾病感兴趣的治疗艺术领域的研究者提供一个平台，同时也为急性灾难危机医学提供替代方案。其活动包括每年组织两次会议，向所有对预防医学领域感兴趣的人开放，使他们能够与该领域的领导者见面、聆听他们的演讲，并参与问答小组讨论。该组织的规模已超出创办者最美好的梦想：目前拥有五百多名会员。高水平的演讲者在这些会议上展示了他们的成果，每次会议似乎都超越了前一次。
At the meeting in Detroit in October 1972, a magnificent presentation on the action and clinical use of massive doses of ascorbic acid, orally and intravenously, was given by Dr. Klenner. The next day, just before I was to present my paper on the actions of alpha tocopherol, he came up to me, introduced himself and said, “If you want another testimonial, here’s one.” He handed me a four-by-five-inch piece of paper on which was written: 1972 年 10 月在底特律的会议上，Klenner 博士做了一个关于大量口服和静脉注射抗坏血酸的作用及临床应用的精彩报告。第二天，就在我准备发表关于α-生育酚作用的论文之前，他走过来，自我介绍说：“如果你还需要一个证明，这里有一个。”他递给我一张四乘五英寸的纸，上面写着：
Since Sept. 1, 1970 I have been taking 5000 to 6000 dalpha tocopherol along with 20 gm . Vit. C. At that time, I had classical heart failure being sensitive to Inderal (a drug that slows the heart and reduces its oxygen need). After two years, my heart is back to normal in size and EKG. (Definition of Inderal mine.) 自 1970 年 9 月 1 日起，我一直服用 5000 到 6000 单位的 dalpha 生育酚以及 20 克维生素 C。那时，我患有典型的心力衰竭，对 Inderal（一种减慢心跳并降低心脏需氧量的药物）敏感。两年后，我的心脏大小和心电图恢复正常。（Inderal 的定义由我提供。）
I asked him how much enlarged his heart had become 我问他心脏扩大了多少
and he said, “Maximum.” He added that he had a whole series of x-rays showing its steady enlargement and its return to normal size, and that the large intake of Vitamin C did not help his condition until he added the very large daily amount of d-alpha tocopherol. 他说：“最大值。”他补充说，他有一整套 X 光片显示其持续增大及恢复正常大小的过程，而且大量摄入维生素 C 并未改善他的状况，直到他每天补充非常大量的 d-α生育酚。
This was too good a result for Vitamin E alone, and so this complete recovery must have been due to both together. It has been established that Vitamin E protects Vitamin A and that Vitamin E also undergoes other important nutritional interactions, including interactions with the trace element selenium and the sulfur amino acids methionine and cysteine-cystine. 仅靠维生素 E 取得如此好的效果是不可能的，因此这次完全康复必定是两者共同作用的结果。已经确定维生素 E 可以保护维生素 A，维生素 E 还参与其他重要的营养相互作用，包括与微量元素硒以及含硫氨基酸甲硫氨酸和半胱氨酸-半胱氨酸的相互作用。
Dr. Klenner’s experience was most significant. Here was a clinical application of the interaction of Vitamin E and Vitamin C. Dr. John Barker, who has taken over my practice in Mississauga, Ontario, Canada, and I immediately began to apply this information to all our coronary and hypertensive heart disease patients as well as to our cases of peripheral vascular disease. Certainly they have done well. 克莱纳医生的经验最为重要。这是维生素 E 和维生素 C 相互作用的临床应用。约翰·巴克医生接管了我在加拿大安大略省密西沙加的诊所，我立即开始将这些信息应用于我们所有的冠心病和高血压性心脏病患者，以及我们的周围血管疾病病例。毫无疑问，他们的情况都有了好转。
Now for the interesting sequel, but first a basic explanation. 现在进入有趣的续篇，但首先做一个基本的解释。
Following the experimentation on dogs by the medical student Floyd Skelton under the direction of my brother Evan, our small group began to treat cardiac disease chiefly and a few peripheral vascular cases as well. We submitted our results to a meeting of a medical society and presented papers to medical journals. In our innocence, although we knew of the vicissitudes of other innovators in the medical world, we expected the interest of physicians and especially of cardiologists. 在我的兄弟 Evan 的指导下，医学生 Floyd Skelton 对狗进行了实验后，我们的小组开始主要治疗心脏病以及少数周围血管疾病。我们将结果提交给一个医学会的会议，并向医学期刊发表论文。尽管我们知道医学界其他创新者所经历的波折，但出于天真，我们仍期待医生，尤其是心脏病专家的关注。
Instead, we became involved in medical politics to a degree we had never dreamed possible. Even the disappearance of massive anasarca (spreading of fluids into connective tissue) and peripheral edema in our first three cases was 相反，我们卷入了医疗政治，程度之深是我们从未想象过的。即使在我们的前三个病例中，大面积水肿（液体渗入结缔组织）和周围水肿的消失也令人震惊。
ascribed by one cardiologist at the meeting of the Ontario College of Physicians and Surgeons to the forceful personality of the doctors treating these patients. This was a particularly interesting statement since one of these patients-the one with the most extreme fluid retention-had originally been his. Obviously he didn’t have a forceful personality! 安大略省医师与外科医生学院会议上一位心脏病专家将其归因于治疗这些患者的医生们强势的个性。这是一个特别有趣的说法，因为其中一位患者——那个液体潴留最严重的患者——最初是他的病人。显然，他并没有强势的个性！
Because of the opposition to our observations and reports on these cardiac patients and because of the life-saving qualities of the drug, we decided to fight the battle in the field of peripheral vascular disease, where results were measurable and visible. We decided, that is, not to engage in extensive studies on conditions like angina pectoris where placebos have often produced very good results and where even the diagnosis can be more difficult given the variety of conditions which can engender pain. 由于对我们关于这些心脏病患者的观察和报告的反对，以及该药物的救命特性，我们决定在外周血管疾病领域展开斗争，在那里结果是可测量和可见的。也就是说，我们决定不对如心绞痛等病症进行广泛研究，因为安慰剂在这些病症中常常产生非常好的效果，而且鉴于多种可能引起疼痛的情况，诊断本身也可能更加困难。
We decided, at any rate, to go ahead in peripheral vascular disease. We treated ulcers on the legs whether due to arterial or venous insufficiency or both. We treated diabetics who, because of the changes in their arteries due to their disease, had developed gangrene of toes or heels. We treated cases of Buerger’s disease, burns, osteomyelitis with draining sores and ulcers, and trauma that denuded large areas of the body, after multiple surgical grafting had failed. 无论如何，我们决定在周围血管疾病方面继续进行治疗。我们治疗腿部溃疡，无论是由于动脉或静脉功能不全，还是两者兼有。我们治疗糖尿病患者，这些患者由于疾病引起的动脉变化，已经发展成脚趾或脚跟的坏疽。我们治疗布尔格病、烧伤、伴有引流性溃疡和溃疡的骨髓炎，以及多次外科移植失败后导致身体大面积裸露的创伤。
Slides of these my brother and I have shown to many meetings-meetings of doctors and laymen alike. They have never failed to convince viewers of the unique value of alpha tocopherol. What viewers did with their knowledge was a matter for their consciences. Suffice it to say that as a result of our work and our publications, there are many, many physicians throughout the world using it just as we do and, of course, with the same results. It is impossible to know how many there are, since they obviously do not need to communicate with us. Details of our treatment have been published and distributed widely, however, and there are many 我和我兄弟曾在许多会议上展示过这些幻灯片——医生和外行人都会参加的会议。它们从未未能让观众信服 alpha 生育酚的独特价值。观众如何运用他们的知识则是他们良心的问题。只需说，由于我们的工作和出版物，世界各地有许多医生像我们一样使用它，当然，效果也相同。具体有多少人使用是不可能知道的，因为他们显然不需要与我们联系。然而，我们的治疗细节已被广泛发表和传播，且有许多。
confirmations through a few other reliable channels such as distributors of Vitamin E preparations and some of the professionals we have met at medical conventions. 通过其他一些可靠渠道确认，例如维生素 E 制剂的分销商以及我们在医学会议上遇到的一些专业人士。
The point here is that these slides of peripheral vascular cases demonstrate the effect of massive doses of alpha tocopherol, and alpha tocopherol alone, on tissues with reduced blood supply. Vitamin E is an oil-soluble antioxidant, Vitamin C is a water-soluble antioxidant, and it is known that they complement each other. However-and this is most important-although Vitamịn E has been shown to slow down or even halt the progress of atherosclerosis (hardening of the arteries, with deposits of fat on their inner surfaces), it does not always do so. Professor Boyd of the University of Manchester did tell Dr. Yousuf I. Misirlioglu of Switzerland that he observed decalcification (the opposite of hardening) of arteries in some of his patients due to the Vitamin E treatment of intermittent claudication. But now there is absolute proof that arteriosclerosis can be reversed and prevented. 这里的重点是，这些外周血管病例的幻灯片展示了大量α-生育酚（alpha tocopherol），且仅使用α-生育酚，对血液供应减少的组织的影响。维生素 E 是一种脂溶性抗氧化剂，维生素 C 是一种水溶性抗氧化剂，已知它们相辅相成。然而——这点非常重要——尽管维生素 E 已被证明可以减缓甚至阻止动脉粥样硬化（动脉硬化，内表面有脂肪沉积）的进展，但它并不总是有效。曼彻斯特大学的 Boyd 教授曾告诉瑞士的 Yousuf I. Misirlioglu 博士，他观察到一些患者因维生素 E 治疗间歇性跛行而出现动脉脱钙（硬化的相反现象）。但现在已有确凿证据表明，动脉硬化可以被逆转和预防。
This is a most significant medical discovery, and it will not only save countless lives, but make healthful living more common and longer lives more enjoyable. The work was done by Dr. Raiford, an ophthalmologist who is Director of the Atlanta Eye Clinic and Hospital in Atlanta, Georgia. 这是一个极其重要的医学发现，它不仅将挽救无数生命，还将使健康生活更加普遍，延长的寿命更加愉快。这项工作由眼科医生 Raiford 博士完成，他是佐治亚州亚特兰大亚特兰大眼科诊所和医院的主任。
The problem of atherosclerosis has been the subject of much research. It has been suggested that if arteriosclerosis could be prevented life could be greatly prolonged. In the words of Dr. S. Sherry (1): “Thrombosis has become the prime health hazard of the adult population of the Western World.” The answer, at least in part, to thrombosis has been known since 1946. Now it is to be hoped that the answer, at least in part, to atherosclerosis has been discovered. It is also to be hoped that the members of “the Establishment” will behave like scientists and develop its tremendous potential for the good of all mankind. 动脉硬化问题一直是许多研究的主题。有人提出，如果能够预防动脉硬化，寿命可能会大大延长。正如 Dr. S. Sherry（1）所说：“血栓形成已成为西方世界成年人口的主要健康威胁。”对血栓形成的部分答案自 1946 年以来就已为人所知。现在希望对动脉粥样硬化的部分答案也已被发现。也希望“权威机构”的成员能像科学家一样行事，开发其巨大的潜力，为全人类谋福祉。
The importance of arteriosclerosis can hardly be understated. The Medical Tribune for 12 July 1972 reported that severe coronary artery disease had been demonstrated angiographically (by means of radiographic study of the blood vessels) by Navy cardiologists in young asymptomatic, physically active men who volunteered to undergo cardiac catheterization because of a family history of coronary artery heart disease and hyperlipemia (an oversupply of fats in the blood). Approximately one in every two subjects, all under age forty and all performing the routine physical duties of Navy fliers or Marines, had “severe, diffuse coronary artery disease involving two or more vessels, with 50 percent or more occlusion.” This was reported to the American Medical Association meeting in San Francisco. 动脉硬化的重要性难以低估。1972 年 7 月 12 日的《Medical Tribune》报道，美国海军心脏病学家通过血管造影（利用放射线对血管进行研究）证实，在一些年轻、无症状、身体活跃的男性中存在严重的冠状动脉疾病，这些男性因家族有冠心病和高脂血症（血液中过多脂肪）史，自愿接受心脏导管检查。大约每两名受试者中就有一人，年龄均在四十岁以下，且都在执行海军飞行员或海军陆战队员的日常体力任务，患有“严重的、弥漫性的冠状动脉疾病，涉及两条或更多血管，闭塞率达到 50％或以上。”这一发现已在旧金山举行的美国医学会会议上报告。
According to Dr. J.N. Morris (2), writing in The Lancet in 1951, there had been no increase in the prevalence of coronary atherosclerosis in autopsy material at the London Hospital between 1907 (at which time there was no coronary thrombosis) and 1949 (at which time coronary thrombosis was nearing its epidemic status). But the years 1945 to 1953 presented an even more interesting picture. 根据 J.N. Morris 博士（2）1951 年在《柳叶刀》上发表的文章，伦敦医院的尸检资料显示，1907 年（当时没有冠状动脉血栓形成）到 1949 年（当时冠状动脉血栓形成接近流行状态）期间，冠状动脉粥样硬化的患病率并未增加。但 1945 年至 1953 年间的情况更为有趣。
At the Las Vegas meeting referred to earlier, Dr. Hans Nieper showed a most interesting slide. He kindly had sent to me the source paper in Arztliche Praxis for November 1971 from which this slide was taken. The author was Professor Dr. H. Glatzel, to whom I referred briefly in Chapter 8, but the graph was after that of Bansi and co-workers. 在前面提到的拉斯维加斯会议上，Hans Nieper 博士展示了一张非常有趣的幻灯片。他友好地将这张幻灯片所取自的 1971 年 11 月《Arztliche Praxis》期刊的原始论文寄给了我。作者是 H. Glatzel 教授博士，我在第 8 章中曾简要提及过他，但该图表是在 Bansi 及其同事的基础上绘制的。
The illustration shows the relationship between coronary artery sclerosis and myocardial infarction for the years 1945 to 1953, revealing that there was no real increase in the incidence of the sclerosis during this time. Actually, it had dropped in all but three of these years, yet the incidence of myocardial infarction rose (from very little in 1945) at a steady rate until an important change took place. This was the gen- 图示显示了 1945 年至 1953 年冠状动脉硬化与心肌梗死之间的关系，揭示在此期间硬化的发生率实际上并未真正增加。实际上，除三年外，其发生率都有所下降，然而心肌梗死的发生率（1945 年时非常低）却以稳定的速度上升，直到发生了一个重要的变化。这个变化是基因—
Relationship between coronary artery sclerosis 冠状动脉硬化的关系
eral acceptance by doctors of the suggestion that the fat in the diet should be changed to the polyunsaturated type, as in cooking oils and margarines, and that there should be a reduction in saturated fats in the diet. At this stage, the incidence of myocardial infarction rose abruptly, with the 1952 and 1953 figures being in the range of twelve times the 1945 statistics and the 1952 rate three times that of 1950 ! 医生普遍接受了这样一种建议，即饮食中的脂肪应改为多不饱和型，如烹调用油和人造黄油，并且应减少饮食中的饱和脂肪。在这一阶段，心肌梗死的发病率急剧上升，1952 年和 1953 年的数据是 1945 年统计数据的十二倍左右，1952 年的发病率是 1950 年的三倍！
This graph was extended to the year 1973 by Dr. Nieper and shown at the March 1974 meeting of the International Academy of Preventive Medicine. The incidence of myocardial infarction had continued to increase while the degree of coronary arteriosclerosis remained essentially unchanged. 这张图表由 Nieper 博士延伸至 1973 年，并在 1974 年 3 月的国际预防医学学会会议上展示。心肌梗死的发病率持续上升，而冠状动脉硬化的程度基本保持不变。
This graph illustrates what we have always known and have stated many times, that there is no causal relationship between coronary arteriosclerosis and myocardial infarction. Dr. Glatzel mentioned this in the article from which the graph was taken, pointing out that there was no relationship between the degree of coronary artery atherosclerosis and the clinical symptoms of coronary heart disease. There can be a very severe degree of atherosclerosis in humans who remain free of clinical symptoms. And conversely, there are cases of 这张图说明了我们一直知道并多次声明的事实，即冠状动脉硬化与心肌梗死之间不存在因果关系。Glatzel 博士在该图所取自的文章中提到，冠状动脉粥样硬化的程度与冠心病的临床症状之间没有关系。人体内可能存在非常严重的粥样硬化，但仍无临床症状。反之，也有一些病例
death with the diagnosis of coronary insufficiency and, at autopsy, the finding of nearly clear coronary arteries! 死于冠状动脉功能不全的诊断，尸检时发现冠状动脉几乎清晰无阻！
In Chapter 1 you will find this statement: “The third thought I want to plant firmly in your mind at the outset is this. Up to the time this is being written, cardiologists have, for some strange reason, virtually always done everything wrong and never yet done anything right . . . .” This graph illustrates this by providing one more example. This is one more tragedy that has occurred as a direct result of the inevitable acceptance by cardiologists and, through them, by the majority of physicians, of the wrong concepts. 在第一章中你会发现这样一句话：“我想在一开始就牢牢植入你脑海中的第三个想法是：直到本文写成时，心脏病专家出于某种奇怪的原因，几乎总是做错事，从未做对过任何事……”这张图表通过提供另一个例子来说明这一点。这又是一场悲剧，直接源于心脏病专家以及通过他们，大多数医生对错误观念的不可避免的接受。
And it is just amazing that the American Heart Association is totally unaware of this situation and continues to promote this tragic recommendation concerning polyunsaturated fats, and that the American College of Cardiology does the same. Not only that, but they have been, on occasion, willing to lend their official support to a company which manufactures a margarine which contains saturated and polyunsaturated fats, the latter in excessive amounts. 令人惊讶的是，美国心脏协会完全没有意识到这种情况，仍然继续推广关于多不饱和脂肪的这一悲剧性建议，美国心脏病学会也是如此。不仅如此，他们有时还愿意正式支持一家生产含有饱和脂肪和多不饱和脂肪（后者含量过多）的人造黄油的公司。
In regard to the recent evidence concerning the action of Vitamin E and Vitamin C in reversing atherosclerotic lesions-and I shall describe it for you very shortly-an interesting article appeared in the Medical Post of 8 February 1972. It referred to the British pathologist Dr. Constance Spittle who, in an article in The Lancet for 11 December 1971, had suggested that “atherosclerosis is a long-term deficiency of Vitamin C which permits cholesterol to build up in the arterial system.” She believes that cholesterol is mobilized from the arterial wall itself. 关于最近有关维生素 E 和维生素 C 在逆转动脉粥样硬化病变方面的作用的证据——我将很快为您描述——1972 年 2 月 8 日的《Medical Post》刊登了一篇有趣的文章。文章提到了英国病理学家 Constance Spittle 博士，她在 1971 年 12 月 11 日的《The Lancet》杂志中提出，“动脉粥样硬化是维生素 C 长期缺乏，导致胆固醇在动脉系统中积聚。”她认为胆固醇是从动脉壁本身动员出来的。
Back to the work of Dr. Morgan Raiford. The retina of the eye, as I have said earlier in this book, offers an unique area for the direct observation of blood vessels. Since the arteries and arterioles, veins and venules there are covered only with a thin transparent layer of tissue, one can see all anatomical 回到 Morgan Raiford 博士的研究。正如我在本书前面所说，眼睛的视网膜提供了一个独特的区域，可以直接观察血管。由于动脉和小动脉、静脉和小静脉仅被一层薄而透明的组织覆盖，人们可以看到所有的解剖结构。
details very clearly. As a consequence, pathological changes in the vessels can be clearly demonstrated. And now, with modern equipment, these changes can be photographed in color or in black and white. 细节非常清楚。因此，血管的病理变化可以清晰地显示出来。现在，借助现代设备，这些变化可以用彩色或黑白照片记录下来。
Dr. Raiford’s contribution to medical knowledge is his visual proof that the arteriosclerotic lesions in the vessels of the retina due to hypertension, to the aging process or to lesions characteristic of diabetes mellitus can actually be reversed by Vitamin E and Vitamin C, used together in doses of 1,200 IU of Vitamin E and 3 to 5 gm of Vitamin C. Raiford 博士对医学知识的贡献在于他通过视觉证据证明，高血压、衰老过程或糖尿病特有病变引起的视网膜血管动脉硬化病变，实际上可以通过联合使用维生素 E（1200 IU 剂量）和维生素 C（3 至 5 克剂量）来逆转。
Vitamin E favorably affects the results of blood vessel narrowing, as does Vitamin C to some degree. Both, together, reverse the basic pathology. 维生素 E 对血管狭窄的结果有积极影响，维生素 C 在某种程度上也有类似作用。两者结合使用，可以逆转基本病理。
Also, the condition known as xanthomatosis, in which there is a visible deposit of yellow-colored xanthoma cells in the eyelids, can be reversed and the deposits in them removed by the combination of Vitamins E and C. Until this discovery, surgical removal of the deposits was the only available treatment. 此外，被称为黄色瘤病的状况，即在眼睑中可见黄色黄色瘤细胞沉积，通过维生素 E 和 C 的联合使用可以逆转并去除这些沉积物。在此发现之前，手术去除沉积物是唯一可用的治疗方法。
There have been three previously published methods of combating arteriosclerosis, and very definite evidence that they have been successful. They should be described in detail. 以前已经发表过三种治疗动脉硬化的方法，并有非常明确的证据表明它们是成功的。它们应当详细描述。
There are now several centers in the United States at which intravenous chelation (a process by which calcium trapped in the walls of blood vessels is removed) is being done by means of a synthetic amino acid whose name is ee thylenediamine tetra acetic acid. It is universally referred to, of course, as EDTA. 目前美国有几个中心正在通过一种名为乙二胺四乙酸（EDTA）的合成氨基酸进行静脉螯合治疗（通过该过程去除血管壁中滞留的钙）。
The calcium disodium and disodium salts of this acid are very commonly used in a variety of foods to remove trace amounts of metal contamination which might be dangerous and which, in addition, impair the taste, odor or appearance of food, cause beverages to become cloudy, fruits and vegetables to become discolored and fats to spoil. Combined with 这种酸的钙二钠盐和二钠盐在各种食品中非常常用，用于去除可能有害的微量金属污染物，这些污染物不仅有害，还会影响食品的味道、气味或外观，使饮料变浑浊，水果和蔬菜变色，脂肪变质。结合使用
BHT and propyl gallate the EDTA salts help prevent oxidation. BHT 和没食子酸丙酯，EDTA 盐有助于防止氧化。
EDTA is used in many salad dressings, margarines, mayonnaises and sandwich spreads to prevent rancidity. It is also used in processed fruits and vegetables such as potatoes, peas, corn and mushrooms to prevent browning and in fruit juices to protect Vitamin C against oxidation. Other foods and beverages in which EDTA is used are canned shellfish, beer and soft drinks. EDTA 被用于许多沙拉酱、人造黄油、蛋黄酱和三明治抹酱中，以防止变质。它还用于加工的水果和蔬菜，如土豆、豌豆、玉米和蘑菇，以防止变色，并用于果汁中以保护维生素 C 免受氧化。EDTA 还用于罐装贝类、啤酒和软饮料等食品和饮料中。
This useful acid should be used very carefully in all these foods because if more than is necessary to trap the contaminating metals in them is used, it will trap also the calcium and other useful nutrients and prevent their utilization by the body. 这种有用的酸在所有这些食物中都应非常小心地使用，因为如果使用超过捕捉其中污染金属所需的量，它也会捕捉钙和其他有用的营养素，阻止身体利用它们。
The medical use of EDTA preceded its industrial use. Because of its unique ability to trap metal ions, it has been used intravenously to treat acute metal poisoning. It is safe because the body rejects it along with the trapped metal ions which are then excreted in the urine. As a result, another growing epidemic-lead and other heavy metal poisoning from contamination of the air by the automobile and by chemical plants-can be treated. EDTA 的医疗用途早于其工业用途。由于其独特的捕捉金属离子的能力，它被用于静脉注射治疗急性金属中毒。它是安全的，因为身体会排斥它以及被捕获的金属离子，这些金属离子随后通过尿液排出。因此，另一种日益严重的流行病——由汽车和化工厂污染空气引起的铅及其他重金属中毒——可以得到治疗。
The ability of EDTA to trap calcium in the walls of blood vessels and remove it has led to two other important uses -the treatment of some forms of arthritis and of arteriosclerosis which has reached the stage of calcium deposition in plaques. Removing the calcium by this process (intravenous chelation) leads, apparently, to a breakdown of the soft material in the plaque. My personal experience with this process has confirmed its value in treating peripheral arteriosclerosis and in restoring circulation to critically deprived legs and arms and to cerebral vessels. EDTA 能够捕捉血管壁中的钙并将其移除，这导致了另外两个重要用途——治疗某些形式的关节炎和已达到钙沉积斑块阶段的动脉硬化。通过这一过程（静脉内螯合）去除钙，显然会导致斑块中软性物质的分解。我的个人经验证实了这一过程在治疗周围动脉硬化以及恢复严重缺血的腿部、手臂和脑血管循环方面的价值。
The drawbacks of intravenous chelation are obvious. It requires extended treatment in hospital or in outpatient 静脉螯合的缺点显而易见。它需要在医院或门诊进行长时间治疗。
clinics or in specially equipped doctors’ offices where considerable extra space is needed. A further drawback is that careful chemical control is necessary, since the process depletes the body of some necessary factors which must be returned in adequate amounts by appropriate oral supplements. Its rapid acceptance, chiefly through the basic work of Doctors Carlos Lamar of Miami, Florida; Dr. Ray Evers, now of New Orleans, Louisiana; Dr. H. Rudolph Alsleben of Anaheim, California; and Dr. Hans Nieper of Germany, is the best measure of its success in the cardiovascular field. Properly used, it is a safe procedure. 诊所或专门配备的医生办公室中需要相当大的额外空间。另一个缺点是需要仔细的化学控制，因为该过程会消耗身体中的一些必要因素，必须通过适当的口服补充剂以足够的量补充回来。其迅速被接受，主要得益于佛罗里达迈阿密的 Carlos Lamar 医生、现居路易斯安那州新奥尔良的 Ray Evers 医生、加利福尼亚阿纳海姆的 H. Rudolph Alsleben 医生以及德国的 Hans Nieper 医生的基础工作，这是其在心血管领域成功的最好证明。正确使用时，这是一种安全的程序。
Very recently their successes have become known to a much larger group of physicians who have formed the American Academy of Medical Preventics and who have proceeded to pool their knowledge and learn as much as possible before equipping their offices with the expensive but necessary equipment for proper pre-treatment evaluation of the patient. (Each of the members of the AAMP has now added intravenous chelation to his treatment schedule.) 最近，他们的成功被更多的医生所知，这些医生组成了美国医学预防学会，并开始汇集他们的知识，尽可能多地学习，然后为他们的诊所配备昂贵但必要的设备，以便对患者进行适当的预治疗评估。（美国医学预防学会的每位成员现在都已将静脉螯合疗法加入了他们的治疗计划。）
An extensive review of the pertinent literature, a detailed exposition of the clinical uses and method of administration, and the precautions that must be observed is available from Paul H. Huff, 1506 Longview Drive, Fullerton, California, 92631. To those physicians who read this book and are interested in this technique, I can recommend this man as being one whose knowledge is profound and as a source of information. 有关文献的广泛综述、临床用途和给药方法的详细说明以及必须遵守的注意事项，可向 Paul H. Huff，地址：1506 Longview Drive, Fullerton, California, 92631 索取。对于阅读本书并对该技术感兴趣的医生，我推荐这位先生，他知识渊博，是信息的可靠来源。
The full report was printed as the leading article in the Summary for December 1967, and the evidence is certainly 完整报告作为 1967 年 12 月摘要的头条文章刊登，证据无疑是
convincing. The patients treated were mainly in the advanced stages since they all showed evidence of calcification in the media of the arteries. 令人信服。接受治疗的患者主要处于晚期阶段，因为他们都显示出动脉中层钙化的迹象。
Treatment consisted of 400 mg of mixed tocopherols (so-called natural Vitamin E), 400 mg of pyridoxine (Vitamin B6) daily before lunch and 100 mg of nicotinic acid (Vitamin B_(3)\mathrm{B}_{3} ) three times daily after meals, increasing to 300 mg three times daily, if tolerated. In addition, he eliminated certain foodstuffs and encouraged exercise-all this to increase fibrinolysis (chemical dissolution of fibrin, a coagulated protein). 治疗包括每日午餐前服用 400 毫克混合生育酚（所谓的天然维生素 E）、400 毫克吡哆醇（维生素 B6），以及每日三次餐后服用 100 毫克烟酸（维生素 B_(3)\mathrm{B}_{3} ），如耐受则增加至每日三次各 300 毫克。此外，他还戒除某些食物并鼓励锻炼——所有这些都是为了增加纤溶作用（纤维蛋白的化学溶解，一种凝固的蛋白质）。
Results were obtained in three to six months. X-rays demonstrated complete decalcification of vessels. The foodstuffs prohibited were those containing cholesterol plus coffee, beer, wine, cider and cigarettes. Gin, whiskey, vodka and tea were not prohibited. His work has also been published in The Lancet (3) and in the Medical Tribune in 1963. 结果在三到六个月内获得。X 光显示血管完全脱钙。禁止的食物是含有胆固醇的食物以及咖啡、啤酒、葡萄酒、苹果酒和香烟。杜松子酒、威士忌、伏特加和茶则不在禁止之列。他的工作还发表于《柳叶刀》(3)和 1963 年的《医学论坛》。
Dr. Hans Nieper has published an account of successful reversal of arteriosclerosis by the use of various salts of orotic acid. Hans Nieper 博士发表了一篇关于通过使用各种乳清酸盐成功逆转动脉硬化的报告。
There have been other successful and, incidentally, pretty well ignored methods of treatment designed to lessen the conditions arising from the gradual, progressive narrowing of arteries. The work of the Vascular Research Foundation deserves mention here. For the last forty years this group, of which Dr. Murray Israel is the Medical Director, has had success in reversing diabetic retinopathy and other arteriosclerotic lesions by the use of thyroid and megavitamin B components. 还有其他一些成功的治疗方法，顺便说一句，这些方法几乎被忽视了，旨在减轻由动脉逐渐、持续狭窄引起的病症。血管研究基金会的工作值得在此提及。在过去四十年里，该组织由医学主任 Murray Israel 博士领导，通过使用甲状腺和大剂量维生素 B 成分，成功逆转了糖尿病性视网膜病变和其他动脉硬化病变。
Another investigator interested in this field is Dr. Broda O. Barnes of Fort Collins, Colorado. He has produced quite definite evidence that thyroid deficiency plays an important role in the genesis of atherosclerosis and that thyroid therapy is effective in reducing morbidity and mortality in diabetes 另一位对此领域感兴趣的研究者是来自科罗拉多州福特柯林斯的布罗达·O·巴恩斯博士。他提供了相当明确的证据表明甲状腺功能不足在动脉粥样硬化的发生中起重要作用，且甲状腺治疗在减少糖尿病的发病率和死亡率方面有效。
mellitus. The role of thyroid deficiency in the development of hypertension has also been investigated by Dr. Barnes. It is interesting, thus, to see my father’s work on one aspect of hypothyroidism and its interrelationship with alpha tocopherol, Dr. Paul Starr’s work, the work of Drs. Klenner, Israel and Barnes and that of the Shute brothers all leading to progressively greater understanding and control of and ability to reverse arteriosclerosis. 糖尿病。Barnes 博士还研究了甲状腺功能减退在高血压发展中的作用。因此，看到我父亲关于甲状腺功能减退症某一方面及其与α-生育酚的相互关系的研究，Paul Starr 博士的工作，Klenner 博士、Israel 博士和 Barnes 博士的工作，以及 Shute 兄弟的研究，所有这些都逐步推动了对动脉硬化的理解、控制和逆转能力的提升，令人感到非常有趣。
A letter I received in February 1973, and which is reprinted in part below, shows how much was accomplished in one case, apparently by means of alpha tocopherol alone. 我在 1973 年 2 月收到的一封信，部分内容如下重印，显示出仅凭α-生育酚在一个病例中取得了多大的成就。
Twice in the early part of 1972 I had two very severe attacks of nausea, dizzyness which lasted approximately an hour after which I fell asleep and woke without any ill effects. But played it safe and stayed in bed the next day. 1972 年初，我两次严重出现恶心和头晕，持续约一小时，之后我睡着了，醒来时没有任何不良反应。但为了安全起见，第二天我还是卧床休息。
My doctor was unable to diagnose my illness and could offer no remedy against its re-occurrence. 我的医生无法诊断我的疾病，也无法提供防止其复发的治疗方法。
I am 76 years old-have had a slight heart condition for about ten years but nothing serious. I am retired. 我今年 76 岁，患有轻微的心脏病大约十年，但没有严重问题。我已经退休。
Talking to a friend who is an M.D. (but is not accessable as he does not live near me) and telling him of these two attacks, he suggested that I might take Vitamin E pills-400 IU a day-as he had had results which were good with patients who he thought might not be getting enough blood in their brains and Vitamin E supposedly helped keep the proper veins and arteries open in the neck allowing a sufficient supply of blood to reach the brain. 与一位医生朋友交谈（但他不住在我附近，无法联系），告诉他这两次发作，他建议我每天服用 400 IU 的维生素 E 片——因为他在一些他认为大脑可能供血不足的患者身上取得了良好效果，维生素 E 据说有助于保持颈部的静脉和动脉畅通，从而使足够的血液供应到大脑。
This I have done for the past five months and have had no more of these night attacks. 过去五个月我一直这样做，再也没有发生过这些夜间发作。
Have you had such cases and do you find the 你遇到过这样的情况吗，你发现……
supply of blood reaching the brain has been helped by taking 400 IU of Vitamin E daily? 每天服用 400 IU 维生素 E 有助于增加到达大脑的血液供应吗？
Isn’t it curious that the only suggestions for combating arteriosclerosis should involve vitamins, orotic acid salts and a synthetic amino acid? Truly, orthomolecular, megavitamin treatment appears to be the most important new discovery and promises to initiate an era of medicine-an era in which the ravages of civilization and aging can be somewhat ameliorated. 奇怪的是，唯一对抗动脉硬化的建议竟然涉及维生素、乳清酸盐和一种合成氨基酸？确实，正分子学的大剂量维生素治疗似乎是最重要的新发现，并有望开启一个医学时代——一个能够在一定程度上缓解文明和衰老破坏的时代。
Anyone interested in intravenous chelation will find that there is a new textbook in this field by H. Rudolph Alsleben, M.D. and Wilfrid E. Shute, M.D. entitled How to Survive the New Health Catastrophes. It was published in 1972 by Survival Publications Inc., 710 Euclid Avenue, Anaheim, California 92801. 任何对静脉螯合感兴趣的人都会发现，H. Rudolph Alsleben 医学博士和 Wilfrid E. Shute 医学博士合著了一本该领域的新教科书，名为《如何在新的健康灾难中生存》。该书于 1972 年由 Survival Publications Inc. 出版，地址是加利福尼亚州阿纳海姆市尤克利德大道 710 号，邮编 92801。
REFERENCES 参考文献
Sherry, S. Annals of Internal Medicine 69, 415, 1968 Sherry, S. 《内科年鉴》69, 415, 1968
ARTERIOSCLEROSIS CAN AFFECT vessels in any area of the body-the vessels supplying the brain, heart, kidney, other organs or extremities. It can be a very spotty disease, with one area of a vessel showing gross changes while neighboring areas are quite normal. However, this condition when well advanced usually affects several important areas, often well removed from one another. 动脉硬化可以影响身体任何部位的血管——供应大脑、心脏、肾脏、其他器官或四肢的血管。它可能是一种非常局部的疾病，某一血管区域显示出明显的变化，而邻近区域则相当正常。然而，当这种情况发展到较严重阶段时，通常会影响几个重要区域，这些区域往往相距较远。
Arteriosclerotic changes in the vessels of the legs commonly accompany serious changes in the coronary vessels supplying the heart. Often associated with these is a serious involvement of the vessels of the neck supplying blood to the brain. It is well to understand the gravity of the situation once the vessels to the legs have shown a sufficient degree of atherosclerosis to cause the beginning of the cramping pain in the muscles of the calves that is called intermittent claudication. 腿部血管的动脉硬化变化通常伴随着供应心脏的冠状动脉的严重变化。常常伴随这些变化的是供应大脑的颈部血管的严重受累。一旦腿部血管出现足够程度的动脉粥样硬化，导致小腿肌肉出现称为间歇性跛行的痉挛性疼痛，就应当认识到情况的严重性。
Drs. T.B. Begg and R.L. Richards (1) of the Western Infirmary, Glasgow, have reported on 198 cases of uncomplicated intermittent claudication followed for five to twelve years or to death. The overall mortality was 46.5 percent; the mortality at five years was 25 percent. Most of the deaths were due to cardiovascular disease, with myocardial infarction as the most common lesion. 格拉斯哥西部医院的 T.B. Begg 博士和 R.L. Richards 博士（1）报告了 198 例无并发症的间歇性跛行病例，随访时间为五至十二年或直至死亡。总体死亡率为 46.5%；五年死亡率为 25%。大多数死亡原因是心血管疾病，其中最常见的病变是心肌梗死。
Begg and Richards also described further aspects of this condition. Neither age nor the duration of the disease affected the prognosis, nor did the level of the occlusion or whether it was unilateral or bilateral. Elevated blood pressure or coexisting arteriosclerotic heart disease was more important. Begg 和 Richards 还描述了该病的其他方面。年龄和病程长短均不影响预后，闭塞的部位或单侧或双侧也无影响。血压升高或合并动脉硬化性心脏病更为重要。
The overall amputation rate was 7.1 percent. Most significant was the comparison of the ten-year survival rate of patients with intermittent claudication and those patients who had recovered from a myocardial infarction, or who had angina pectoris. The death rate for those with intermittent claudication was approximately the same as the latter group-those with angina and those who had recovered from an infarction. 总体截肢率为 7.1%。最重要的是间歇性跛行患者与心肌梗死康复患者或患有心绞痛患者的十年生存率比较。间歇性跛行患者的死亡率与后者——心绞痛患者和心肌梗死康复患者——大致相同。
Dr. W.B. Kannel and associates (2) have written that as a result of the Framingham study they concluded that there were twice as many deaths from cardiovascular disease when the patient had intermittent claudication as when he had no peripheral vascular symptoms. W.B. Kannel 博士及其同事（2）撰文指出，根据弗雷明翰研究的结果，他们得出结论：患有间歇性跛行的患者心血管疾病死亡率是无外周血管症状患者的两倍。
Another study of the prognosis of chronic arterial occlusion of the lower extremities was published by Drs. R.W. Hacker and R. Decker (3) in 1968. They analysed the results in 769 patients ( 703 men) over an eleven-year period. 1968 年，R.W. Hacker 博士和 R. Decker 博士（3）发表了另一项关于下肢慢性动脉闭塞预后的研究。他们分析了 769 名患者（703 名男性）在十一年期间的结果。
In the Hacker and Decker group, average age of onset was 51.6 years in men, 63.9 in women. Two stages are described. In Stage One, the complaints were pain induced by prolonged fixation in one position, easy fatigability and parasthesia (feelings such as numbness or burning). In Stage Two there was pain on walking. 在 Hacker 和 Decker 组中，男性的平均发病年龄为 51.6 岁，女性为 63.9 岁。描述了两个阶段。在第一阶段，症状为长时间固定一个姿势引起的疼痛、易疲劳和感觉异常（如麻木或灼烧感）。在第二阶段，行走时出现疼痛。
Diabetes mellitus was the most important pre-existing disease, and 97.9 percent of the men were smokers. Coronary insufficiency was present in 40 percent of those who had survived to age seventy; gangrene developed in 49.1 percent. During the eleven years 29.5 percent of the group died. The causes of death were cardiac failure, circulatory failure, myocardial infarction and cerebrovascular accidents. 糖尿病是最重要的既往疾病，97.9%的男性是吸烟者。70 岁及以上的幸存者中有 40%存在冠状动脉功能不全；49.1%出现了坏疽。在这十一年中，29.5%的人群死亡。死亡原因包括心力衰竭、循环衰竭、心肌梗死和脑血管意外。
Treatment for this disease has been varied. Vasodilators have been universally prescribed, but there is now ample evidence that they have no real value. (This has been confirmed by Haeger’s series.) Anticoagulants and lipolytics (substances causing the chemical decomposition of fats) are of little value, and surgical removal of arterial obstruction has seemed, in the opinion of some surgeons, the best approach. Yet, according to Dr. Robert L. Richards’ textbook on peripheral arterial disease, only 10 percent of patients with intermittent claudication require or benefit from surgical procedures. And Drs K. A. Myers and W.T. Irvine (4) reported in 1966 that lumbar sympathectomy (removal of all or part of a nerve in the lumbar region) did nothing to increase blood flow or to improve clinical response in the vast majority of patients. 这种疾病的治疗方法多种多样。血管扩张剂被普遍开具，但现在有充分的证据表明它们没有真正的价值。（这一点已被 Haeger 的系列研究证实。）抗凝剂和脂解剂（引起脂肪化学分解的物质）价值不大，而动脉阻塞的外科切除在一些外科医生看来似乎是最佳方法。然而，根据 Robert L. Richards 博士关于周围动脉疾病的教科书，只有 10%的间歇性跛行患者需要或从手术中受益。1966 年，K. A. Myers 博士和 W.T. Irvine 博士（4）报告称，腰交感神经切除术（切除腰部区域的全部或部分神经）对绝大多数患者既不能增加血流，也不能改善临床反应。
When the patient has come to amputation the mortality rates are “grim,” according to Drs. M.G. Otteman and L.H. Stahlgren (5). Their series consisted of 323 patients with an average age of sixty-seven. Three-fourths of them had cardiorespiratory disease and one-third were diabetics. Gangrene was present in 82 percent and serious local infection in one-third. One-third of these patients required amputation of both legs. The overall mortality was 39 percent with 10 percent dying of unrelated conditions more than thirty days after surgery. It could be that the enforced bed care of those with bilateral amputations hastened their deaths, since this may well be responsible for the onset of bronchopneumonia. Car- 当患者需要截肢时，死亡率是“严峻的”，根据 M.G. Otteman 博士和 L.H. Stahlgren 博士（5）的说法。他们的系列病例包括 323 名患者，平均年龄为六十七岁。其中四分之三患有心肺疾病，三分之一为糖尿病患者。82%的患者存在坏疽，三分之一有严重的局部感染。三分之一的患者需要双腿截肢。总体死亡率为 39%，其中 10%因与手术无关的原因在术后超过三十天死亡。双侧截肢患者被迫卧床休息可能加速了他们的死亡，因为这很可能导致支气管肺炎的发生。Car-
diorespiratory disease doubles the risk; the presence of diabetes did not increase it. 呼吸系统疾病使风险增加一倍；糖尿病的存在并未增加风险。
In 241 of the 323-nearly three-quarters of the patients-significant complications arose: stump infections, pneumonia, pulmonary emboli or myocardial infarctions. Consider these grim statistics when looking at the proven benefits of alpha tocopherol therapy. 在 323 名患者中，有 241 名——几乎四分之三的患者——出现了严重并发症：截肢部位感染、肺炎、肺栓塞或心肌梗死。考虑到这些严峻的统计数据，再来看 alpha tocopherol 治疗的确凿益处。
We now believe that there should be a combination of three procedures. 我们现在认为应该结合三种程序。
By far the most important of these-and the one now most completely confirmed-is the use of adequate quantities of an adequate preparation of alpha tocopherol. It must be remembered that there are now at least thirty-five papers in the medical literature confirming the excellent response of this condition to alpha tocopherol. 迄今为止，这些中最重要的——也是现在得到最充分证实的——是使用足量的适当制备的α-生育酚。必须记住，目前医学文献中至少有三十五篇论文证实了该病症对α-生育酚的良好反应。
Perhaps the first besides ourselves to present definite data on a large series was Dr. A.M. Boyd, Professor of Surgery at the University of Manchester, and his group (6, 7), who published their findings in 1949. In 1958 Drs. P.D. Livingstone and C. Jones (8) reported a double-blind controlled series in Sheffield, England. One group of patients was given 600 IU of alpha tocopherol a day for forty weeks, the other a placebo with an identical appearance. To avoid bias, the key to the test was not opened until all the results had been declared. Out of seventeen patients who were found to be in the alpha tocopherol-treated group, thirteen had significantly improved, as opposed to two of the control group of seventeen. Six months later none of the improved patients on Vitamin E had deteriorated, and improvement was reported by three controls given Vitamin E after the initial trial had terminated. 也许除了我们之外，最早提供大量明确数据的是曼彻斯特大学外科教授 A.M. Boyd 博士及其团队（6, 7），他们于 1949 年发表了研究结果。1958 年，P.D. Livingstone 博士和 C. Jones 博士（8）在英国谢菲尔德报告了一项双盲对照试验。一组患者每天服用 600 IU 的α-生育酚，持续四十周，另一组服用外观相同的安慰剂。为避免偏见，试验的关键代码直到所有结果公布后才被打开。在被确定为α-生育酚治疗组的十七名患者中，有十三人显著改善，而对照组的十七人中只有两人改善。六个月后，服用维生素 E 的改善患者中无人恶化，且在初次试验结束后，三名对照组患者服用维生素 E 后也报告了改善。
It is to be noted-as we have insisted from the beginning-that there is great individuality in the dosage of 需要注意的是——正如我们从一开始就强调的——剂量存在很大的个体差异
alpha tocopherol necessary to obtain a response. A doubleblind study such as this uses an average dose, adequate for the majority but probably not for all. Further, as these authors and the Boyd group have emphasized, large doses are necessary over a considerable period, at least three months, before satisfactory response is obtained. Boyd added one further important observation: that the E-treated patients had an increased survival. Obviously, the alpha tocopherol also helped the cardiac conditions associated with claudication in many instances, and preserved and prolonged life. He also noticed decalcification of the arteries in a few cases. These comments appear in a later Boyd paper (9) published in 1963. By this time his series of treated patients numbered 1,476 plus another 33 who were used in a blind controlled trial of alpha tocopherol. 获得反应所需的 alpha 生育酚。像这样的双盲研究使用的是平均剂量，适合大多数人，但可能并不适合所有人。此外，正如这些作者和 Boyd 团队所强调的，必须在相当长的一段时间内（至少三个月）使用大剂量，才能获得满意的反应。Boyd 还补充了一个重要观察：接受 E 治疗的患者生存率提高了。显然，alpha 生育酚在许多情况下也有助于改善与间歇性跛行相关的心脏状况，延长并维持生命。他还注意到少数病例中动脉的脱钙现象。这些评论出现在 Boyd 于 1963 年发表的后期论文（9）中。到那时，他治疗的患者系列已达 1,476 人，另有 33 人参与了 alpha 生育酚的盲法对照试验。
The most recent series of papers is that of Dr. Knüt Haeger and his group in Sweden. Dr. Haeger has contrasted the number of amputations in a group of patients treated with other medications against the number in a group treated with alpha tocopherol in a trial lasting quite a few years. I have referred to this study previously. The ratio was 11:1 in favor of alpha tocopherol. 最近的一系列论文是瑞典 Knüt Haeger 博士及其团队的研究。Haeger 博士对比了使用其他药物治疗的一组患者与使用α-生育酚治疗的一组患者在多年试验中的截肢次数。我之前提到过这项研究。比例是 11:1，α-生育酚组表现更好。
In this study thirty-seven patients were treated with vasodilators and forty-four others with an anticoagulant. Fortyfour more were treated for “a period long enough to permit conclusions of the value of [this] treatment” with a multivitamin preparation, and then were switched to alpha tocopherol. In addition, 104 patients were treated from the beginning with alpha tocopherol, initially 600 IU, later 300 IU. 在这项研究中，三十七名患者接受了血管扩张剂治疗，另外四十四名患者接受了抗凝剂治疗。还有四十四名患者接受了“足够长时间以得出该治疗价值结论”的多种维生素制剂治疗，随后改用α-生育酚。此外，104 名患者从一开始就接受α-生育酚治疗，最初剂量为 600 IU，后来为 300 IU。
The length of time individual patients were treated varied. The “minimum time of observation” (except for subjects who were switched from the multivitamin to the alpha tocopherol) was two years. In 69.2 percent of cases the period was longer than three years, however. Nineteen of the non-toco- 个别患者的治疗时间长短不一。“最短观察时间”（除那些从多种维生素转为服用α-生育酚的受试者外）为两年。然而，在 69.2%的病例中，观察期超过了三年。非生育酚组中有十九例—
pherol group died, compared with nine of the tocopherol group. Moreover, the alpha tocopherol group and the remaining patients showed other differences which Haeger classified as significant. Nearly four times as many on alpha tocopherol increased their walking distances and ten times as many of these more than doubled the distance they could walk without experiencing pain. Particularly noticeable was the amputation situation. The development of intractable pain and/or gangrene caused amputation of twelve legs, only one of which was in the original alpha tocopherol-treated group-again, a significant difference. 酚醇组死亡人数为十二人，而生育酚组为九人。此外，α-生育酚组和其余患者表现出其他差异，Haeger 将其归类为显著差异。服用α-生育酚的人中，几乎有四倍的人增加了步行距离，其中十倍的人步行无痛距离增加了一倍以上。截肢情况尤为显著。难治性疼痛和/或坏疽的发展导致十二条腿被截肢，其中只有一例来自最初接受α-生育酚治疗的组——这同样是一个显著差异。
In intermittent claudication, we have another example of a condition in which there has been no effective treatment until the advent of alpha tocopherol therapy, but which now yields to this therapy supplemented by megavitamin ascorbic acid and exercise. (The patient suffering from intermittent claudication is very hard to motivate to take regular daily walking exercises. He must walk daily as energetically as possible for an hour, resting when the pain becomes too great. In a treadmill study by Drs. O.A. Larsen and N.A. Lassen (11) reported in 1966, the walking distances increased by as much as three times after six months of exercise. Four of these patients improved to the point at which they could walk normally on the flat for as long as they wished without pain.) 间歇性跛行是另一种在α-生育酚治疗出现之前没有有效治疗方法的疾病，但现在通过这种治疗，辅以大剂量维生素 C 和锻炼，可以得到改善。（患有间歇性跛行的患者很难被激励进行规律的每日步行锻炼。他必须每天尽可能有力地步行一小时，疼痛过重时休息。1966 年，O.A. Larsen 博士和 N.A. Lassen 博士在一项跑步机研究中报告（11），经过六个月的锻炼，步行距离增加了三倍之多。这些患者中有四人改善到可以在平地上正常行走，且无痛苦，时间可长达他们愿意的时长。）
The rationale for the effectiveness of alpha tocopherol therapy in intermittent claudication remains the same as for its usefulness in other cardiovascular pathology-a decrease in oxygen need of the affected tissues, the prevention of thrombosis and the speeding up of the development of collateral circulation. Remember, there are more than thirty-five papers confirming the effectiveness of alpha tocopherol in the treatment of intermittent claudication. α-生育酚治疗间歇性跛行的有效性原理与其在其他心血管病理中的作用相同——减少受影响组织的氧气需求，预防血栓形成，加速侧支循环的发展。请记住，有三十五篇以上的论文证实了α-生育酚在治疗间歇性跛行中的有效性。
Alpha tocopherol may also slow up the arteriosclerotic process in the affected vessels or even slightly reverse it, as α-生育酚还可能减缓受影响血管中的动脉硬化过程，甚至略微逆转该过程，正如
noted by Boyd and as some retinal studies have suggested. However, as I pointed out in the last chapter, there is now greatly increased hope for the sufferer from arteriosclerosis, whatever its site, in the combination of Vitamin E and Vitamin C. The work which demonstrated this beyond cavil, as you will remember, used 1,200IU1,200 \mathrm{IU} of alpha tocopherol and 3 to 5 gm of ascorbic acid daily. Intravenous chelation with EDTA is also helpful and Vitamins A and D should probably be added. 正如 Boyd 所指出的以及一些视网膜研究所暗示的那样。然而，正如我在上一章中指出的，现在对于动脉硬化患者，无论其发生部位如何，结合使用维生素 E 和维生素 C 带来了极大的希望。你还记得，证明这一点无可置疑的研究每天使用了 1,200IU1,200 \mathrm{IU} 的α-生育酚和 3 到 5 克的抗坏血酸。静脉注射 EDTA 螯合剂也有帮助，可能还应添加维生素 A 和 D。
REFERENCES 参考文献
Begg, T.B. and Richards, R.L. Scottish Medical Journal 7/8, 341, 1951. Begg, T.B. 和 Richards, R.L. 《Scottish Medical Journal》7/8，341，1951 年。
Kannel, W.B., Skinner, J.J., Schwartz, M.J. and Shurtleff, D. Circulation 61, 875, 1970. Kannel, W.B., Skinner, J.J., Schwartz, M.J. 和 Shurtleff, D. 循环 61, 875, 1970.
Hacker, R.W. and Decker, R. Deutsche Medizinische Wochenschrift 93, 1343, 1968. Hacker, R.W. 和 Decker, R. Deutsche Medizinische Wochenschrift 93, 1343, 1968。
Myers, K.A. and Irvine, W.J. British Medical Journal 1, 879, 1966. Myers, K.A. 和 Irvine, W.J. 英国医学杂志 1, 879, 1966。
Livingstone, P.D. and Jones, C. The Lancet 2, 602, 1958. Livingstone, P.D. 和 Jones, C. 《柳叶刀》2, 602, 1958 年。
Boyd, A.M. Angiology 14, 198, 1963.
Larsen, O.A. and Lassen, N.A. The Lancet 2, 1093, 1966. Larsen, O.A. 和 Lassen, N.A. 《柳叶刀》2, 1093, 1966 年。
12
THROMBOPHLEBITIS AND PULMONARY EMBOLISM 血栓性静脉炎和肺栓塞
IN ADDITION TO THE EPIDEMIC of clots in the coronary arteries, there is now an epidemic of clotting in other major and minor vessels. 除了冠状动脉血栓的流行外，现在其他大血管和小血管中也出现了血栓流行。
To state it simply, as I have in Chapter 3, the blood inside all blood vessels must remain fluid at all times, except where there is localized rupture or severing of vessels. Then a thrombus must eventually plug the severed end to stop the loss of blood or, if the vessel is surgically tied off, a clot must form just proximal to the suture. In either case, the clot will be organized and replaced by scar tissue eventually. 简单来说，正如我在第三章中所述，所有血管内的血液必须始终保持流动状态，除非血管局部破裂或断裂。此时，血栓必须最终堵塞断裂的血管端口以阻止失血，或者如果血管被外科结扎，血块必须在缝合线近端形成。在任何情况下，血块最终都会被组织化并被瘢痕组织取代。
However, surgical procedures and many medical conditions, particularly those accompanied by prolonged bed rest, expose many patients to intravenous thrombosis with or without accompanying inflammation. Some operative procedures seem to be particularly likely to produce deep vein 然而，手术程序和许多医疗状况，特别是那些伴有长期卧床的情况，使许多患者暴露于静脉内血栓形成，伴有或不伴有炎症。一些手术程序似乎特别容易导致深静脉血栓。
thrombosis. Also, the pre-existence of varicose veins with slowing of the return flow of blood or in some areas actual retrograde flow, predisposes the patient to superficial intravenous clots. 血栓形成。此外，静脉曲张的存在伴随着血液回流减慢，或在某些区域实际出现逆行流动，使患者容易发生浅表静脉内血栓。
Usually, the term phlebothrombosis is used to denote the simple intravenous thrombus; the term thrombophlebitis suggests a clot in the vein surrounded by an inflammatory reaction. 通常，术语 phlebothrombosis 用于表示单纯的静脉内血栓；术语 thrombophlebitis 则指静脉内的血栓伴有炎症反应。
Using a sensitive test involving radioactive fibrinogen (a coagulant) to detect early thrombosis in the deep veins of the legs, Dr. V. Kakkar of London, England has demonstrated the condition in approximately 28 percent of surgical, 54 percent of orthopedic and 24 percent of urological patients and in 38 percent of patients with myocardial infarction. 使用一种涉及放射性纤维蛋白原（凝血剂）的敏感测试来检测腿部深静脉的早期血栓，英国伦敦的 V. Kakkar 博士在约 28%的外科患者、54%的骨科患者、24%的泌尿科患者以及 38%的心肌梗死患者中证明了该病症的存在。
Apart from the disturbance of tissues in the area of the involved vein, there is, of course, a definite risk that the thrombus or part of it will break loose, ascend to the right side of the heart and be passed into the pulmonary arteries. When it does, half the patients so afflicted die. 除了受累静脉区域组织的损伤外，血栓或其部分脱落、上升至心脏右侧并进入肺动脉的风险是明确存在的。当发生这种情况时，约有一半的患者会死亡。
That pulmonary embolism is increasing has been documented. It was reported (1) in 1963 that in two Oxford, England hospitals the incidence of pulmonary embolism increased five times in the period 1952 to 1961. In this series medical cases were more vulnerable than surgical ones. And the use of oral contraceptives increased the incidence of thromboembolic disease from an average of five cases per hundred thousand population in 1967 to forty-seven per hundred thousand in 1968, according to a report in the British Medical Journal by Drs. M.P. Vessey and R. Doll in 1969. 肺栓塞的增加已有记录。1963 年有报告指出，在英国牛津的两家医院中，1952 年至 1961 年间肺栓塞的发病率增加了五倍。在这组病例中，内科病人比外科病人更易受影响。根据 1969 年 M.P. Vessey 博士和 R. Doll 博士在《British Medical Journal》上的报告，口服避孕药的使用使血栓栓塞性疾病的发病率从 1967 年每十万人中五例增加到 1968 年的每十万人中四十七例。
Massive acute pulmonary embolism is very difficult to diagnose, the signs and symptoms being deceivingly nonspecific. Therefore, prophylaxis (prevention of the thrombophlebitis) is of the greatest importance. 大面积急性肺栓塞非常难以诊断，其体征和症状具有欺骗性且非特异性。因此，预防（防止血栓性静脉炎）具有极其重要的意义。
Many methods have been employed in attempts to pre- 许多方法已被采用以尝试预防—
vent the formation of thrombosis at surgery. Because previous studies had shown a risk of 39 percent in hip surgery, Dr. E.W. Saltzman and associates at Harvard Medical School (2) tested the relative effectiveness of four different regimens to prevent thromboembolism. Although their series was small, they were able to report in 1971 that by using aspirin and dextran they had reduced the incidence somewhat-from 39 percent to 12 to 14 percent-still a distressingly high proportion. Another drug, Persantin (dipyridamole), was not very effective and had to be discontinued because of neutropenia (a decrease in the neutrophile white blood cells), dermatitis or severe headache in some subjects. 防止手术中血栓形成。由于先前的研究显示髋关节手术的风险为 39%，哈佛医学院的 E.W. Saltzman 博士及其同事（2）测试了四种不同方案预防血栓栓塞的相对效果。尽管他们的样本量较小，但他们在 1971 年报告称，通过使用阿司匹林和右旋糖酐，血栓发生率有所降低——从 39%降至 12%至 14%，但仍然是一个令人担忧的高比例。另一种药物 Persantin（双嘧达莫）效果不佳，且因部分受试者出现中性粒细胞减少症（中性粒细胞白细胞减少）、皮炎或严重头痛而不得不停止使用。
Moreover, according to the Saltzman group, 3 to 4 percent of the patients treated with anticoagulants, aspirin or dextran had major bleeding complications and patients in the aspirin-treated group required almost twice as much transfused blood as those in the other three groups. 此外，根据 Saltzman 团队的研究，接受抗凝剂、阿司匹林或右旋糖酐治疗的患者中有 3%到 4%出现了严重出血并发症，而阿司匹林治疗组的患者所需输血量几乎是其他三组的两倍。
It was reported in 1972 by Dr. J. Bonnar and J. Walsh (3), two English surgeons, that British Dextran 70, administered during and immediately after operation for six hours (started with the anesthetic) produced a “highly significant” reduction in the frequency of thrombosis after abdominal and vaginal hysterectomy for benign conditions. 1972 年，英国两位外科医生 J. Bonnar 博士和 J. Walsh（3）报道，英国 Dextran 70 在手术期间及术后立即开始使用，持续六小时（从麻醉开始），显著降低了良性疾病腹部和阴道子宫切除术后血栓形成的发生率。
Another English group used pneumatic leggings to prevent thrombosis in surgical patients. The pneumatic leggings are placed over the feet and lower legs at the time of preoperative anesthesia and are left on until the patient is ambulatory. An electric pump inflates the leggings for one minute followed by one minute of relaxation. The incidence of deep vein thrombosis was 39 percent in those without malignancy who were not using the leggings as against 3 percent in those with the leggings. In cases of malignancy the leggings were of no benefit; about one-half of these patients developed thrombosis. 另一组英国团队使用气动护腿来预防外科患者的血栓形成。气动护腿在术前麻醉时套在脚和小腿上，直到患者能够行走才取下。电动泵使护腿充气一分钟，然后放松一分钟。未使用护腿且无恶性肿瘤患者的深静脉血栓发生率为 39%，而使用护腿者为 3%。在恶性肿瘤病例中，护腿无效；约有一半的患者发生血栓。
A 1968 report by Dr. A.M. Antlitz and associates (4) in the United States showed that 32 percent of pulmonary embolism occurred in the first four days after surgery and stated that routine anticoagulant therapy was of no benefit in preventing this. 美国 A.M. Antlitz 博士及其同事于 1968 年发表的一份报告（4）显示，32%的肺栓塞发生在手术后的前四天，并指出常规抗凝治疗在预防此类情况方面无益。
Thromboembolism is also a risk in obstetrical work. Maternal age, particularly over thirty-five years, and the need for assisted delivery, especially cesarean section, are the most significant factors. Here again, the dangers of estrogen are obvious since its use to inhibit lactation after delivery increases the risk. At age twenty-five and older, the incidence of thromboembolism is doubled if delivery is assisted, even if the patient is lactating. If lactation is suppressed, the risk is increased three times, even with a normal delivery, and at least six times, possibly twelve times, if delivery is assisted, according to a paper by Dr. V.R. Tindall (5) published in 1968. 血栓栓塞在产科工作中也是一种风险。孕妇年龄，特别是超过三十五岁，以及需要助产，尤其是剖宫产，是最重要的因素。在这里，雌激素的危险性再次显而易见，因为其用于产后抑制哺乳会增加风险。根据 1968 年 Dr. V.R. Tindall（5）发表的一篇论文，年龄在二十五岁及以上时，即使患者在哺乳，助产也会使血栓栓塞的发生率翻倍。如果抑制哺乳，即使是正常分娩，风险也会增加三倍；如果助产，风险至少增加六倍，可能达到十二倍。
The extent of the aftermath in the survivors of thromboembolism staggers the imagination. In the United States there are six to seven million patients with severe postthrombotic symptoms. In Sweden, 1.9 to 3.1 percent of the population are affected and 94 percent of these have sequelae (morbid consequences) with fully 20 percent developing leg ulcers. According to Dr. Haeger (6), the economic importance of these symptoms is higher than that of diabetes mellitus, rheumatism and traffic accidents combined. 血栓栓塞幸存者的后遗症程度令人难以想象。在美国，有六到七百万名患者患有严重的血栓后症状。在瑞典，1.9%到 3.1%的人口受到影响，其中 94%有后遗症（病理后果），其中有 20%发展成腿部溃疡。根据 Haeger 博士（6）的说法，这些症状的经济重要性高于糖尿病、风湿病和交通事故的总和。
The most common end results of phlebitis are edema, varicosities and ulcerations. Among 150 patients followed by Dr. G. Strenger (7) from five to more than twenty years after the initial illness, twenty-five had recurrences. (This was reported in the New York Journal of Medicine in 1962.) 静脉炎最常见的最终结果是水肿、静脉曲张和溃疡。在 G. Strenger 博士（7）随访的 150 名患者中，从发病五年到二十多年后，有二十五人复发。（此报告发表于 1962 年的《纽约医学杂志》。）
Apparently all this is virtually unnecessary. Thrombophlebitis and pulmonary embolism are almost completely preventable. We showed that fresh thrombi could be dissolved completely without the danger of pulmonary em- 显然，这一切几乎都是不必要的。血栓性静脉炎和肺栓塞几乎完全可以预防。我们证明了新鲜血栓可以完全溶解，而没有肺栓塞的危险——
bolism in 1946 but could not get this published until 1948. In the same year, as I have mentioned, Zierler and his associates showed that alpha tocopherol was vigorously antithrombic both in vivo and in vitro. Indeed, they proved that it was antithrombic when in normal concentration in human blood. 1946 年提出了代谢学说，但直到 1948 年才得以发表。同年，正如我提到的，Zierler 及其同事们证明了α-生育酚在体内外均具有强烈的抗血栓作用。事实上，他们证明了当α-生育酚在人体血液中的浓度正常时，它具有抗血栓作用。
Since then, there have been fifty-seven papers confirming our work, originating in various foreign countries and in the United States. Since using alpha tocopherol Ochsner has stated as recently as 1968 that he has had no cases of pulmonary embolism. 从那时起，有五十七篇论文确认了我们的工作，来自多个外国和美国。自从使用α-生育酚以来，Ochsner 最近在 1968 年表示他没有发生过肺栓塞病例。
Not only can fresh thrombophlebitis be melted away -and Ochsner reported in 1950 that he had done this -and pulmonary embolism prevented, but the sequelae can also be completely prevented. Moreover, in cases not so treated in time which therefore have gone on to chronicity with resulting decreased circulation and all that that implies, alpha tocopherol can very greatly diminish the signs and symptoms. Its use in such cases has also been widely confirmed-by Castagna and Impallomeni (8), Mantero et al. (9) and Sturup (10). Confirmation of this has also come from Drs. W.E. Crump and E.F. Heiskell (11), who also confirmed the Ochsner group’s results, as did Dr. Terrell Speed. 不仅新鲜的血栓性静脉炎可以被消融——Ochsner 在 1950 年报告他已经做到这一点——并且可以预防肺栓塞，后遗症也可以完全预防。此外，在未及时治疗而发展为慢性，导致循环减少及其相关症状的病例中，α-生育酚可以大大减轻体征和症状。Castagna 和 Impallomeni（8）、Mantero 等人（9）以及 Sturup（10）也广泛证实了其在此类病例中的应用。W.E. Crump 博士和 E.F. Heiskell 博士（11）也证实了这一点，他们还确认了 Ochsner 团队的结果，Terrell Speed 博士亦是如此。
Suffice it to say, by way of summary, that 总结来说，足够说明的是
Thrombosis, arterial or venous, is the Number One Killer in the medical world. 动脉或静脉血栓形成是医学界的头号杀手。
Arterial thrombosis, cerebral, coronary and peripheral, is increasing rapidly. 动脉血栓形成，包括脑动脉、冠状动脉和周围动脉，正在迅速增加。
Thrombophlebitis and pulmonary embolism are increasing rapidly. 血栓性静脉炎和肺栓塞正在迅速增加。
A complete answer to some of these problems and a worthwhile answer to most of the others has been known since 1946. 自 1946 年以来，对于其中一些问题已有完整的答案，对于大多数其他问题也有有价值的答案。
My own experience often illustrates how simple it all could be. On one occasion, a woman came up to me at a dog show and said she had seen me on television. She apparently had seen me on the Merv Griffin Show which had been taped in 1973 in which I, with others, had been discussing preventive medicine, the others being four very distinguished men, Drs. Carlton Fredericks, Linus Pauling, Roger Williams and William Yudkin. (The response of the public to this broadcast has apparently been enormous. It was presented on more than 560 television stations in the United States and Canada and has been repeated at least twice since its original exposure in October, 1973.) 我自己的经历常常说明这一切其实多么简单。一次，在一场犬展上，有一位女士走过来对我说她在电视上见过我。她显然是在 1973 年录制的《Merv Griffin Show》中见过我，当时我和其他几位非常杰出的医生——Carlton Fredericks 博士、Linus Pauling 博士、Roger Williams 博士和 William Yudkin 博士——一起讨论预防医学。（公众对这次播出的反响显然非常巨大。该节目在美国和加拿大的 560 多个电视台播出，并且自 1973 年 10 月首次播出以来至少重播过两次。）
The lady who mentioned this event to me said that she had had to stop indulging in her lifetime hobby of exhibiting show dogs because of disabling phlebitis. After hearing my presentation on television she had gone out to the kennel and taken away the dogs’ Vitamin E and taken it herself. She said she needed it more than they did! (Vitamin E is seen as essential to the health of show dogs in many kennels.) The result was great improvement in her legs and a return to active participation in the show ring. 提到这件事的女士说，她因为患有使人残疾的静脉炎，不得不停止她一生的爱好——展览表演犬。在听了我在电视上的讲解后，她去到犬舍，拿走了狗狗们的维生素 E，并自己服用了。她说她比狗狗们更需要它！（维生素 E 被许多犬舍视为表演犬健康的必需品。）结果是她的双腿有了很大改善，并重新积极参与了犬展。
This is but one of hundreds of such cases. The inference is obvious. This woman treated her serious, disabling condition herself so much better than her physician had been able to do. She used Vitamin E. He should have done so-he had no excuse for not doing so-but didn’t. 这只是数百个类似案例中的一个。推论显而易见。这位女性自己用维生素 E 治疗了她严重且致残的病情，效果远远好于她的医生。医生本应使用维生素 E——他没有理由不这么做——但他没有。
My younger daughter, who is a public health nurse, has quietly suggested Vitamin E treatment to friends when the occasion arose. Here are excerpts from a letter which tells of one such instance and which was in a nutrition magazine, without my daughter’s knowledge. 我的小女儿是一名公共卫生护士，在适当的时候曾悄悄向朋友们建议使用维生素 E 治疗。以下是她一封信的摘录，讲述了其中一次情况，这封信刊登在一本营养杂志上，且她本人并不知情。
I am 68 years young, have been troubled with a blood clot in my right leg and it was quite unbearable 我今年 68 岁，右腿一直有血栓困扰，情况相当难以忍受
at times as I am very active and on my feet almost all day long. 有时我非常活跃，几乎整天都在站着。
Through very good fortune I happened to rent a suite to a Miss Karen Shute-her father being the author of Vitamin E for Ailing and Healthy Hearts, Dr. W.E. Shute, M.D. I started Vitamin E at 800 IU per day since January 1st and in less than eight days the ache and fatigue had left me completely. I really was amazed at the results. 通过非常幸运的机缘，我租住了一套房间给一位名叫 Karen Shute 的小姐——她的父亲是《Vitamin E for Ailing and Healthy Hearts》的作者，W.E. Shute 博士，医学博士。我从 1 月 1 日开始每天服用 800 IU 的维生素 E，不到八天，疼痛和疲劳就完全消失了。我对这个结果感到非常惊讶。
However, before Easter, I ran out of my Vitamin E and two or three days later the old trouble returned, which was at least a good test, so am now convinced that I must take them regularly. I started again and am completely relieved once more. 然而，在复活节之前，我的维生素 E 用完了，过了两三天，旧毛病又复发了，这至少是一个很好的测试，所以我现在确信必须定期服用它们。我又开始服用了，现在完全缓解了。
Had it not been for Miss K. Shute, I would still be ignorant of this "miracle Vitamin E^('')E^{\prime \prime} and still suffering with my ailment. 如果不是 K. Shute 小姐，我现在仍然对这种“奇迹维生素 E^('')E^{\prime \prime} ”一无所知，仍在忍受我的疾病。
Mrs. Yvette R. Chapman, Powell River, B.C. 伊薇特·R·查普曼女士，鲍威尔河，不列颠哥伦比亚省。Canada 加拿大
A letter received in February 1973 reports as follows: 1973 年 2 月收到的一封信报告如下：
Your book Vitamin E for Ailing and Healthy Hearts has been read with great interest and personally have a phlebitis condition in both legs for a period of over 12 years I was ready to give Vitamin E its trial as after several hospitalizations and all the regular treatments, my legs were getting progressively worse. 您的书《Vitamin E for Ailing and Healthy Hearts》引起了极大兴趣，我本人双腿患有静脉炎已有超过 12 年。在经历了多次住院和所有常规治疗后，我的双腿状况日益恶化，因此我准备尝试使用维生素 E。
I have been on a dosage of 1800 units for a period of 3 months now and remarkedly there is less pain, little or none of the hot spots, and very slight edema compared to much edema by noon everyday. 我已经服用了 1800 单位的剂量三个月了，显著地疼痛减少了，几乎没有或没有热点，水肿也非常轻微，而以前每天中午水肿很严重。
All this while I have been under the care of . . . an 在此期间，我一直在……的照料下
internist who is beginning to show great interest in my progress. He has asked me to get any literature available on Vitamin E. 一位内科医生开始对我的进展表现出极大兴趣。他让我获取所有关于维生素 E 的相关资料。
REFERENCES 参考文献
Canadian Medical Association Journal 89, 1300, 1963. 加拿大医学会杂志 89, 1300, 1963。
Salzman, E.W., Harris, W.H. and DeSanctis, R.W. New England Journal of Medicine, 284, 128, 1971. Salzman, E.W., Harris, W.H. 和 DeSanctis, R.W. 新英格兰医学杂志，284，128，1971 年。
Bonnar, J. and Walsh, J. The Lancet 1, 614, 1972. Bonnar, J. 和 Walsh, J. 《柳叶刀》1, 614, 1972 年。
Antlitz, A.M., Valle, N.G. and Kosai, M.F. Southern Medical Journal 61, 307, 1968. Antlitz, A.M., Valle, N.G. 和 Kosai, M.F. 《Southern Medical Journal》61, 307, 1968 年。
Tindall, T.R. Journal of Obstetrics and Gynaecology of the British Commonwealth 75, 1324, 1968. Tindall, T.R. 英联邦妇产科杂志 75, 1324, 1968.
Haeger, Knüt. Angiology 18, 439, 1968.
Strenger, G. New York Journal of Medicine 62, 3424, 1962. Strenger, G. 纽约医学杂志 62, 3424, 1962.
Crump, W.E. and Heiskell, E.F. Texas State Journal of Medicine 41, 11, 1952. Crump, W.E. 和 Heiskell, E.F. 德克萨斯州医学杂志 41 卷，第 11 期，1952 年。
13
HYPERTENSION, STROKES AND CEREBRAL HEMORRHAGE 高血压、中风和脑出血
SOME TIME AGO, Time magazine, in reporting a New York Heart Association conference, presented an excellent summary of the status of hypertension. Time quoted Dr. George A. Perera of Columbia University, who had sifted the evidence and studied nearly three thousand patients with primary hypertension, as stating that he had reached a set of conclusions which included the following: 不久前，《时代》杂志在报道纽约心脏协会会议时，提供了关于高血压现状的优秀总结。《时代》引用了哥伦比亚大学的乔治·A·佩雷拉博士的话，他筛选了证据并研究了近三千名原发性高血压患者，表示他得出了一系列结论，其中包括以下内容：
Victims have many common characteristics, and eventually develop organic complications that cut their life expectancy by as much as 20 years. 受害者有许多共同特征，最终会发展出有机性并发症，使其预期寿命缩短多达 20 年。
Heredity is vital. “If either mother or father has it, you can bet your boots that at least one of any large family they produce will eventually become hypertensive; and if both parents have it, the majority of their offspring will be afflicted.” 遗传至关重要。“如果母亲或父亲有高血压，你可以打赌他们所生的大家庭中至少有一个人最终会患上高血压；如果父母双方都有，高血压患者将在他们的大多数子女中出现。”
Personality stress and diet do not cause the disease, though they may act as triggers for it. Pregnancy and the menopause have little to do with it. 个性压力和饮食不会导致该疾病，尽管它们可能成为诱发因素。怀孕和更年期与此关系不大。
In 1956, for the first time, it became possible to control the blood pressure in the majority of hypertensive patients with little discomfort or inconvenience. What was introduced in that year was the thiazide group of drugs. Hollander and Williams, and Dr. E.D. Freis and his group, soon found that chlorothiazide was as effective or more so in hypertension than diets severely restricted in salt, as well as being more acceptable to the patient. In addition, the chlorothiazide group of drugs gratly enhanced the action of other antihypertensive agents. 1956 年，首次能够在大多数高血压患者中控制血压，且几乎没有不适或不便。那一年引入的是噻嗪类药物。Hollander 和 Williams，以及 E.D. Freis 博士及其团队，很快发现氯噻嗪在治疗高血压方面与严格限制盐分的饮食同样有效甚至更有效，而且患者更容易接受。此外，氯噻嗪类药物大大增强了其他降压药物的作用。
Subsequently Freis was able to demonstrate that even moderate hypertension is dangerous and should and can be treated successfully. The results of a five-year, seventeen-hospital study established two main points: 随后，Freis 能够证明即使是中度高血压也是危险的，应该且可以成功治疗。一项为期五年、涵盖十七家医院的研究结果确立了两个主要观点：
Drug treatment for moderate hypertension reduced the death rate by more than 50 percent. 中度高血压的药物治疗使死亡率降低了 50%以上。
Drug treatment is 67 percent effective in preventing major complications which included, among others, strokes, congestive heart failure and kidney failure. 药物治疗在预防主要并发症方面的有效率为 67%，这些并发症包括中风、充血性心力衰竭和肾功能衰竭等。
Of course, these same conditions arise in normotensive people as well, but the increased danger in the patient with hypertension is very real. 当然，这些相同的情况也会出现在正常血压的人群中，但高血压患者面临的危险确实更大。
This is stressed here because one of the beneficial effects of alpha tocopherol on the human heart is its ability to improve the force of contraction of heart muscle, and this may increase the hypertension in roughly one-third of hypertensive patients with cardiac involvement. Small dosage ranges of alpha tocopherol tend to drop the blood pressure in hypertensive patients by decreasing the spasm of end vessels and 这里强调这一点是因为α-生育酚对人类心脏的有益作用之一是它能够改善心肌的收缩力，而这可能会使大约三分之一伴有心脏病变的高血压患者的高血压加重。小剂量范围的α-生育酚倾向于通过减少末梢血管痉挛来降低高血压患者的血压，且
so decreasing the peripheral resistance. 从而降低外周阻力。
In the early days of alpha tocopherol therapy of cardiac conditions, the hypertensive patient was often untreatable, since the dangers of a further elevation of his blood pressure outweighed the physicians’ desire to treat him with alpha tocopherol. Thus, an adequate dose of alpha tocopherol could not be given to correct angina, congestive failure, peripheral edema and certain other conditions in many patients. 在早期使用α-生育酚治疗心脏病时，高血压患者常常无法治疗，因为血压进一步升高的危险超过了医生用α-生育酚治疗的愿望。因此，许多患者无法给予足够剂量的α-生育酚来纠正心绞痛、充血性心力衰竭、周围水肿及某些其他疾病。
All this changed with the introduction of the chlorothiazides and other antihypertensive drugs. It is now possible in most cases by the judicious use of these drugs plus a carefully selected initial level of alpha tocopherol, raised as the hypertension comes under control, to reach an adequate and effective level of treatment. Caution is still advised. 随着氯噻嗪类和其他降压药的引入，情况发生了变化。现在，在大多数情况下，通过明智地使用这些药物，加上精心选择的初始α-生育酚水平，并随着高血压的控制逐步提高，可以达到足够且有效的治疗水平。但仍需谨慎。
In spite of constant warnings concerning the danger of large doses of alpha tocopherol in the hypertensive, this remains an area in which full realization of the problem seems very hard to impress on physicians. It is therefore noteworthy that the “authorities” on the use of antihypertensive drugs are having the same difficulties, even eighteen years after effective treatment was established. A survey (1) reported in the Journal of the American Medical Association in 1971 showed lack of interest in and neglect of the use of these drugs by physicians, and this was emphasized by an editorial (2) that appeared in the same issue. Says the editorial: “Although these facts seemingly have been well publicized to medical and nonmedical audiences, messages must have been jammed . . . [and] hypertensive patients who would have benefited from therapy were not receiving it.” 尽管不断有关于高血压患者大量服用α-生育酚的危险的警告，但这一问题似乎很难让医生们充分认识到。因此值得注意的是，即使在有效治疗确立十八年后，关于抗高血压药物使用的“权威”们仍然面临同样的困难。1971 年《美国医学会杂志》报道的一项调查（1）显示医生们对这些药物的使用缺乏兴趣和忽视，这一点在同一期刊登的一篇社论（2）中得到了强调。社论中写道：“尽管这些事实似乎已广泛向医学界和非医学界传播，但信息一定被阻塞了……那些本可从治疗中受益的高血压患者并未接受治疗。”
It must be emphasized as strongly as possible here that the hypertensive patient placed on alpha tocopherol therapy must have simultaneous treatment of his hypertension. Fortunately, just as the chlorothiazides are synergistic with (enhance the action of) other drugs, so alpha tocopherol usually enhances their effect, with excellent control of the blood pres- 必须在此尽可能强烈地强调，接受α-生育酚治疗的高血压患者必须同时接受高血压的治疗。幸运的是，正如氯噻嗪类药物与其他药物具有协同作用（增强其他药物的作用）一样，α-生育酚通常也能增强它们的效果，从而出色地控制血压—
sure and the cardiac condition. 确定和心脏状况。
Hypertension affects almost twenty-three million Americans. And hypertension is said to be the leading cause of strokes, which kill more than two hundred thousand Americans a year and thus are the third leading cause of death. 高血压影响着近两千三百万美国人。高血压被认为是中风的主要原因，中风每年夺去超过二十万美国人的生命，因此是第三大死因。
Interestingly enough, although deaths from coronary artery disease or myocardial infarction have increased rapidly in the last sixty years, there is every reason to believe that there has been no significant alteration in the incidence of cerebral hemorrhage or thrombosis during this period. This, of course, confirms the observations of Dr. J.N. Morris of England, Dr. Hans Nieper of Germany and others that there has been little change in the prevalence of atherosclerosis during the same sixty-year period. This is confirmed in a paper in The Lancet by Drs. T.W. Anderson and J.S. MacKay (3). 有趣的是，尽管冠状动脉疾病或心肌梗死导致的死亡在过去六十年中迅速增加，但有充分理由相信，在此期间脑出血或血栓形成的发病率并未发生显著变化。当然，这证实了英国的 J.N. Morris 博士、德国的 Hans Nieper 博士及其他人的观察，即在同一六十年期间，动脉粥样硬化的流行率几乎没有变化。T.W. Anderson 博士和 J.S. MacKay 博士在《柳叶刀》杂志上的一篇论文也证实了这一点(3)。
I should like to make three observations in passing. 我想顺便提出三点观察。
First, for those physicians who insist on double-blind controlled experiments, the article by Fries in the Journal of the American Medical Association in 1971 that I have already mentioned suggests they may never be justified. In a controlled trial of various suggested antihypertensive drugs the trial was terminated “after only 18 months of treatment because of the great difference in morbidity and mortality in the control vs. the treated patients.” Had this been a “double-blind” it would not have been discovered until the project had been completed that the deaths were occurring chiefly in the control group. 首先，对于那些坚持双盲对照实验的医生，我之前提到过的 1971 年发表在《美国医学会杂志》上的 Fries 文章表明，这类实验可能永远无法被证明是合理的。在一项针对多种建议的降压药物的对照试验中，试验在“仅仅治疗 18 个月后就被终止了，因为对照组与治疗组在发病率和死亡率上存在巨大差异。”如果这是一次“双盲”试验，直到项目完成后才会发现死亡主要发生在对照组。
Second, I should like to point out that the absence of an increase in the incidence of cerebral accidents, in contrast with the rapid and steady increase in coronary thrombosis and myocardial infarction, is further evidence that the oft-repeated concept that thrombosis occurs because of atherosclerotic changes in the vessel wall is just not so. 其次，我想指出的是，脑血管意外发病率没有增加，这与冠状动脉血栓形成和心肌梗死的快速且持续增加形成对比，这进一步证明了反复提及的“血栓形成是由于血管壁动脉粥样硬化变化引起”的观点是不正确的。
Finally, I should like to remind my readers of a factor in 最后，我想提醒我的读者注意一个因素
the hypertension picture that relates back to the estrogens, the work on which was actually the basis for all of our work on the use of alpha tocopherol. As we have already seen, estrogens and alpha tocopherol are antagonistic. This concept, long resisted by the profession, has now been largely confirmed by the increasing evidence that the oral contraceptives are responsible for an increase in hypertension and in intravascular clotting. The resulting hypertension is usually curable by stopping “the pill.” 与雌激素相关的高血压情况，实际上是我们所有关于使用α-生育酚研究的基础。正如我们已经看到的，雌激素和α-生育酚是拮抗的。这个概念长期以来被专业人士所抵制，但现在随着越来越多的证据表明口服避孕药导致高血压和血管内血栓的增加，这一观点已被广泛证实。由此产生的高血压通常通过停止“避孕药”即可治愈。
As for treatment of stroke victims, apparently there isn’t any-except for alpha tocopherol. According to the Medical Post (8 December 1970), Dr. H.J.M. Barnett, speaking at the annual meeting of the Ontario Chapter of the College of Family Physicians of Canada, had this to say: “As of this minute there is nothing, nothing, absolutely nothing that will improve cerebral blood circulation. I was at a meeting last month where all the experts from the world on cerebral circulation were gathered - 75 of them-and the unanimous conclusion was that everything [in this field] that was being pushed by the drug companies was absolutely worthless.” 至于中风患者的治疗，显然没有任何方法——除了α-生育酚。根据《Medical Post》（1970 年 12 月 8 日）的报道，加拿大安大略省家庭医师学院分会年会上，H.J.M. Barnett 博士表示：“截至目前，没有任何、绝对没有任何方法能够改善脑部血液循环。上个月我参加了一个会议，汇聚了来自世界各地的脑循环专家——共有 75 位——他们一致得出的结论是，制药公司推销的所有相关药物都是完全无效的。”
The patients we have seen over the past twenty-seven years have come, as I have said before, from many different and widely scattered places in the world as well as from those cities in which we practice. There has, therefore, been a predominance of chronic cases over acute, although we have had a great many of both. There has not been, proportionately, a large number of cerebral accident cases. They probably, on the whole, constitute the single group in which treatment with alpha tocopherol is least satisfactory. 正如我之前所说，过去二十七年来我们所见的患者来自世界上许多不同且分散的地方，也包括我们执业的那些城市。因此，慢性病例多于急性病例，尽管我们也接诊了许多急性病例。脑血管意外病例的比例相对较少。总体来看，这可能是使用α-生育酚治疗效果最不理想的单一群体。
In contrast with the person who has survived a myocardial infarction, who usually can be maintained for years in apparently normal health or nearly so, the help alpha tocopherol can give to the stroke patient is much more limited. The reason is obvious, of course. Since the various areas of the brain have their specific functions and pathways, once an area 与心肌梗死幸存者形成对比的是，心肌梗死幸存者通常可以维持多年看似正常或接近正常的健康状态，而α-生育酚对中风患者的帮助则要有限得多。原因显而易见。由于大脑的各个区域具有其特定的功能和通路，一旦某个区域
dies and liquifies, its functions are lost forever. In comparison the post-infarct patient is fortunate. As long as the walls of the chambers of the heart are intact and provided that the blood supply to the heart muscle that is left is adequate, the organ works as a whole unit. Even a large area of infarction, once healed, may not adversely affect the action of the whole organ. 细胞死亡并液化，其功能永远丧失。相比之下，心肌梗死后的患者则幸运得多。只要心脏腔室的壁完整，并且剩余心肌的血液供应充足，整个器官就能作为一个整体正常工作。即使是大面积的梗死，愈合后也可能不会对整个器官的功能产生不利影响。
Nevertheless, alpha tocopherol will help most stroke victims because of its two principal functions: reducing the oxygen need of living tissue and preventing fresh thrombi. Whether alpha tocopherol has the ability to remove a fresh thrombus in a cerebral artery if given at the onset of symptoms is certainly debatable, but it is quite possible that it does have this power. However, the brain cells are so sensitive to anoxia that it is certainly still a critical situation. In general, alpha tocopherol will help to this degree if the patient survives: the patient who is bedfast will improve to the point at which he can be promoted to a chair; the chair patient will usually be able to walk with help whether it be a cane or crutch; and the patient on cane or crutch can usually walk unaided. However, complete recovery is never possible, and it is pathetic to see a man who has been helped to a certain degree hope and struggle to achieve still further help from alpha tocopherol. 尽管如此，α-生育酚将帮助大多数中风患者，因为它有两个主要功能：减少活组织的氧气需求和防止新鲜血栓的形成。关于α-生育酚是否有能力在症状出现时清除脑动脉中的新鲜血栓，确实存在争议，但它很可能具备这种能力。然而，大脑细胞对缺氧极为敏感，因此情况仍然非常危急。一般来说，如果患者存活，α-生育酚将在以下程度上提供帮助：卧床不起的患者将改善到可以坐椅子的程度；坐椅子的患者通常能够借助拐杖或拐杖辅助行走；使用拐杖或拐杖的患者通常可以无需帮助行走。然而，完全康复是不可能的，看到一个在一定程度上得到帮助的人仍然希望并努力从α-生育酚中获得更进一步的帮助，令人感到悲哀。
The chance of recurrence, however, is greatly reduced by alpha tocopherol, although in severe cases this is not necessarily desirable from the point of view of the patient or his family. Some of these patients are pathetic in their need for constant care and supervision; some are so grossly unhappy, some are mere vegetables. 然而，复发的几率通过α-生育酚大大降低，尽管在严重病例中，从患者或其家属的角度来看，这未必是理想的。一些患者因需要持续的护理和监督而令人怜悯；有些极度痛苦，有些则几乎成了植物人。
Around the area of heart muscle that is deprived of blood supply in a heart attack, as around the area of softening in the brain after a stroke, is a zone of varying width in which the cells have almost, but not quite, died. This is commonly called the “zone of injury.” At the time of the attack or stroke it 在心脏病发作时心肌缺血的区域周围，正如中风后大脑软化区域周围，有一个宽度不等的区域，其中的细胞几乎但还未完全死亡。这通常被称为“损伤区”。在发作或中风时，
barely received enough blood from a neighboring artery to allow its cells to survive. Around this zone is another, also of varying width, which did get some blood from the blocked vessel but more of its supply from the adjacent vessels. This is usually called the “zone of anoxia.” It is these two zones which are helped by alpha tocopherol. If they are of considerable extent, then the patient will show definite and worthwhile clinical improvement. If they are relatively narrow, the improvement will be less obvious. 几乎只从邻近动脉获得足够的血液以维持其细胞存活。围绕这一区域的是另一个宽度不一的区域，它确实从阻塞的血管获得了一些血液，但更多的血液供应来自相邻的血管。这个区域通常被称为“缺氧区”。正是这两个区域受益于 alpha 生育酚。如果它们范围较大，患者将表现出明显且有价值的临床改善。如果它们相对较窄，改善则不那么明显。
Alpha tocopherol is effective in treating stroke patients in the way that I have just described where the lesion is an embolus or cerebral artery thrombosis. It is not effective in cases of cerebral hemorrhage, of course. This is one group of patients that no one likes to treat since the brain is so sensitive to depletion of oxygen, and brain tissue, once dead, is irreplaceable. α-生育酚在治疗我刚才描述的病变为栓塞或脑动脉血栓形成的中风患者时是有效的。当然，对于脑出血病例则无效。这是一类没人愿意治疗的患者，因为大脑对缺氧非常敏感，且脑组织一旦死亡便无法替代。
As in the myocardial infarct and the stroke caused by thrombosis, there are two zones surrounding the necrotic (dead) area of softening produced by a cerebral accident that are not functioning normally. One is called, once again, the area of injury, the other the area of anoxia. Again, alpha tocopherol improves the performance of the nerve cells in these two areas. When these areas are large and where they involve cells with important specific functions, the result of treatment can be worthwhile. The ideal situation consists of a small area of necrosis with a large zone of living but not functioning cells surrounding it. The most unsatisfactory group of patients are those with large areas of softening with minimal zones of injury and anoxia. 正如心肌梗死和由血栓引起的中风一样，脑部意外造成的软化坏死（死亡）区域周围有两个功能异常的区域。一个再次被称为损伤区，另一个是缺氧区。同样，α-生育酚能改善这两个区域神经细胞的功能。当这些区域较大且涉及具有重要特定功能的细胞时，治疗效果可能是值得的。理想的情况是坏死区域较小，周围有大片存活但功能不正常的细胞区。最不理想的患者群体是那些软化区域大而损伤区和缺氧区较小的患者。
The result that can usually be expected is, once again, the promotion of the patient to the next stage of improvement. If he is a bed patient, he will very likely be able to be cared for in a chair as well. His control of excretory functions will improve and he may be much easier to look after. The chair patient can usually learn to get around with help and crutches. The crutch 通常可以预期的结果是，患者将再次进入下一个改善阶段。如果他是卧床病人，很可能能够坐椅子接受护理。他的排泄功能控制会改善，照顾起来可能会容易得多。坐椅子的病人通常可以在帮助和拐杖的辅助下学会行动。拐杖
patient can usually graduate to a cane, and the man who uses a cane can usually discard it. 患者通常可以逐步改用手杖，而使用手杖的人通常可以最终舍弃它。
However, I have had so many of these “cerebral accident” patients under my care that I am used to the usual reaction: hope and happiness at first and an expectation of continuous improvement, which indeed occurs for some months but which so often falls short of the hoped-for end result. 然而，我照顾过这么多“脑血管意外”患者，以至于我已经习惯了常见的反应：最初的希望和快乐，以及对持续改善的期望，这种改善确实会持续几个月，但往往未能达到预期的最终结果。
Almost surely, vigorous and continuous physiotherapy, and especially brain-retraining techniques, could extend the degree of improvement, but this is difficult to obtain for the patient since hospitals and physiotherapists have long been conditioned to viewing these patients with pessimism, expecting them to suffer a recurrence and therefore not to be worth persistent efforts at rehabilitation. 几乎可以肯定，积极且持续的物理治疗，尤其是大脑再训练技术，能够延长改善的程度，但这对患者来说很难实现，因为医院和物理治疗师长期以来习惯于以悲观的态度看待这些患者，预期他们会复发，因此认为不值得坚持进行康复努力。
The protective action of Vitamin E in preventing a subsequent attack, then, is a double-edged sword. It prolongs the months or years during which the seriously handicapped patients must be cared for without offering additional help. This, of course, does not apply to the victim who recovers nearly completely from the cerebral accident, who is able to take care of himself normally and who has no diminution of his mental capacities. This patient should have 1,600IU1,600 \mathrm{IU} of alpha tocopherol a day, excepting always the patients with the two complications in which it is not safe to use so large a dose-hypertension and chronic rheumatic heart disease. 维生素 E 在预防随后的发作中的保护作用，是一把双刃剑。它延长了严重残疾患者必须被照顾的数月或数年时间，但并未提供额外的帮助。当然，这不适用于那些几乎完全从脑部意外中恢复过来、能够正常自理且精神能力没有减退的患者。除非患者患有两种不适合使用如此大剂量的并发症——高血压和慢性风湿性心脏病，否则该患者每天应服用 1,600IU1,600 \mathrm{IU} 的α-生育酚。
REFERENCES 参考文献
Journal of the American Medical Association 218, 1036, 1971. 美国医学会杂志 218, 1036, 1971。
Journal of the American Medical Association 218, 1043, 1971. 美国医学会杂志 218, 1043, 1971。
Anderson, T.W. and MacKay, J.S. The Lancet 1, 1136, 1968. Anderson, T.W. 和 MacKay, J.S. 《柳叶刀》1, 1136, 1968 年。
14
DIABETES MELLITUS 糖尿病
MY YOUNGER DAUGHTER has a co-worker in the public health unit of a western Canadian city who has a severe case of diabetes. All women diabetics go on to severe premature arteriosclerotic changes. This nurse had reached the stage at which she had gross symptoms of these changes in her eyes and her legs and feet. One toe had shown discoloration, and the blood supply of both legs and feet was seriously reduced. They were cold and numb and she had reached the so-called pregangrenous state. After my daughter told her some of the facts about alpha tocopherol, she started to take it and her condition has improved to an amazing degree. 我小女儿在加拿大西部某城市公共卫生部门有一位同事，患有严重的糖尿病。所有女性糖尿病患者都会出现严重的早发性动脉硬化变化。这位护士已经到了眼睛和腿脚出现明显症状的阶段。一个脚趾已经变色，双腿和双脚的血液供应严重减少。它们冰冷且麻木，她已进入所谓的坏疽前期状态。在我女儿告诉她一些关于α-生育酚的事实后，她开始服用这种物质，病情有了惊人的改善。
Remember that this woman is a very intelligent nurse, that she understands diabetes mellitus and that she has been constantly checked by physicians for many years. The simple addition of alpha tocopherol is, therefore, the sole reason for 请记住，这位女性是一位非常聪明的护士，她了解糖尿病，并且多年来一直接受医生的持续检查。因此，单纯添加α-生育酚是唯一的原因。
her improvement. Incidentally, she is one of the 30 percent of diabetics whose insulin requirements drop. She now takes about half of her former dose and she is much better controlled and stabilized than she was. 她的病情有所好转。顺便提一下，她是 30%胰岛素需求减少的糖尿病患者之一。她现在服用的剂量大约是以前的一半，病情比以前控制得更好、更稳定。
Elsewhere I have related the case of a woman doctor, English by birth and training, who practiced in Ireland. She developed diabetes mellitus, then hypertension, then angina and then had a myocardial infarction. She was treated in England for all these conditions but had to retire. A chance consultation about her dog with Dr. N.H. Lambert of Dublin, then president of the Irish Veterinary Association and a man who is very familiar with the actions of Vitamin E in his practice, led her to take an adequate dose of synthetic alpha tocopherol. The result was a disappearance of all angina, a return of her blood pressure to normal, a reduction of her insulin requirement and finally a return to active practice. 在别处我曾讲述过一位女医生的案例，她出生并接受培训于英国，在爱尔兰执业。她先后患上糖尿病、高血压、心绞痛，随后发生了心肌梗死。她在英国接受了这些疾病的治疗，但不得不退休。一次偶然的机会，她与都柏林的 N.H. Lambert 医生进行了关于她的狗的咨询，Lambert 医生当时是爱尔兰兽医协会主席，并且非常熟悉维生素 E 在临床中的作用，这促使她开始服用适量的合成α-生育酚。结果是所有心绞痛消失，血压恢复正常，胰岛素需求减少，最终她重返临床工作。
When this woman visited me she ended the consultation by asking why she, a physician acquainted with many other physicians, had had to learn the secret of successful treatment of her own case from her veterinarian! 当这位女士来访时，她在结束会诊时问我，为什么她作为一名认识许多其他医生的医生，却不得不从她的兽医那里学到成功治疗自己病情的秘诀！
I mention these two cases because they concern a nurse and a highly trained doctor, both of whom are familiar with diabetes and its serious consequences. 我提到这两个案例是因为它们涉及一位护士和一位受过高等训练的医生，两人都熟悉糖尿病及其严重后果。
Diabetes is another cardiovascular disease which is increasing rapidly worldwide. In some countries, reports the World Health Organization, the death rate is two or three times higher than it was ten years ago. 糖尿病是另一种心血管疾病，正在全球迅速增加。世界卫生组织报告称，在一些国家，死亡率是十年前的两到三倍。
Once again, the reasons that alpha tocopherol is useful in the treatment of diabetes are its specific actions in assisting the tissues that are affected by the blood vessel changes characteristic of the disease. Alpha tocopherol can decrease the oxygen need of tissues, it can prevent thrombosis and it can accelerate the development of collateral circulation. The 再次强调，α-生育酚在治疗糖尿病中的作用原因在于其特定的作用，帮助受疾病特征性血管变化影响的组织。α-生育酚可以减少组织的氧气需求，防止血栓形成，并加速侧支循环的发展。
decrease in insulin dosage in about one-third of the cases is an incidental benefit. 大约三分之一的病例中胰岛素剂量的减少是一种附带的好处。
There are now forty-six papers in the medical literature confirming the value of alpha tocopherol in the treatment of diabetes mellitus. 目前医学文献中已有四十六篇论文证实了α-生育酚在糖尿病治疗中的价值。
The vascular complications of diabetes involve brain, eye, heart, kidney and extremities. Insulin, hailed as a wonderful discovery in 1921, has saved many lives and has prolonged by many years comparatively normal health in the victims of this disease. It was not at first realized, however, that diabetes was not only an abnormality of carbohydrate metabolism but a disease affecting the whole cardiovascular system. The result, therefore, of the control of the former by insulin was the prolongation of life to the stage at which the seriousness of the cardiovascular changes became evident. These changes are usually generalized, and when the blood supply becomes decreased in the legs to a point at which symptoms begin, there is usually associated coronary or cerebral artery disease. 糖尿病的血管并发症涉及大脑、眼睛、心脏、肾脏和四肢。胰岛素作为 1921 年被誉为伟大发现，挽救了许多生命，并使该病患者的相对正常健康延长了许多年。然而，起初并未意识到糖尿病不仅是碳水化合物代谢的异常，还是一种影响整个心血管系统的疾病。因此，胰岛素对前者的控制结果是延长了生命至心血管变化严重性显现的阶段。这些变化通常是全身性的，当腿部的血液供应减少到出现症状的程度时，通常伴有冠状动脉或脑动脉疾病。
Diabetic gangrene leads to amputation, first of one leg and then the other. In one orthopedic service at the University of Miami School of Medicine, Dr. Augusto Sarmiento reported that of more than two hundred diabetic patients requiring amputation of an ischemic (blood-starved) leg about 50 percent required amputation of the remaining leg within two years. 糖尿病性坏疽导致截肢，先是一条腿，随后是另一条腿。在迈阿密大学医学院的一个骨科服务部门，Augusto Sarmiento 博士报告说，在 200 多名需要截肢的缺血（缺血）腿的糖尿病患者中，大约 50%在两年内需要截肢另一条腿。
This is a sad commentary on diabetic treatment with insulin and diet. In our practice we regularly salvage such legs even with the toes completely necrotic. We have saved legs in which the gangrene was infected and extended into the metatarsal area of the foot and in one case where the whole heel pad was involved. We have colored slides to prove the success of this treatment in such extreme cases. 这是对使用胰岛素和饮食治疗糖尿病的一个令人悲伤的评论。在我们的实践中，即使脚趾完全坏死，我们也经常挽救这样的腿。我们曾挽救过坏疽感染并扩展到足跖骨区域的腿，甚至有一例涉及整个脚跟垫。我们有彩色幻灯片证明这种治疗在如此极端病例中的成功。
All diabetics must have a measure of dietary control, and insulin if this is also necessary, that will keep the blood sugar within reasonable bounds. They also must have alpha tocopherol to prevent the serious effects of arteriosclerosis. And it begins to appear that of equal importance is 3 to 5 gm of ascorbic acid daily. 所有糖尿病患者必须进行一定的饮食控制，如有必要，还需使用胰岛素，以保持血糖在合理范围内。他们还必须摄取α-生育酚以预防动脉硬化的严重影响。同时，看来每天摄入 3 到 5 克抗坏血酸同样重要。
Until alpha tocopherol is added to the treatment of every diabetic patient, unnecessary loss of life, amputations, blindness, hypertension and myocardial infarction will continue to be the lot of more and more diabetics. 除非在每位糖尿病患者的治疗中加入α-生育酚，否则不必要的生命损失、截肢、失明、高血压和心肌梗死将继续成为越来越多糖尿病患者的命运。
15
VITAMIN E OINTMENT IN BURNS AND OTHER CONDITIONS 维生素 E 软膏在烧伤及其他情况中的应用
THAT EVERY CELL IN THE BODY must have Vitamin E is now firmly established. That the body needs many essential nutrients, amino acids, minerals and thirteen vitamins is now accepted by every biochemist. (The authority on this is Roger Williams, B.S., M.S., Ph.D., D.Sc. I recommend his book Nutrition Against Disease as a nutritional bible.) 现在已经确凿无疑，身体的每个细胞都必须有维生素 E。身体需要许多必需的营养素、氨基酸、矿物质和十三种维生素，这一点现在被每位生物化学家所接受。（权威是 Roger Williams，B.S.，M.S.，Ph.D.，D.Sc.，我推荐他的书《Nutrition Against Disease》作为营养学的圣经。）
That oxygen directly applied to damaged tissues can initiate and promote healing has also been well established. Hyperbaric oxygen applied locally can effectively shorten healing time in most chronic leg ulcers as well as in many decubitus ulcers. (Anyone who is interested in this form of treatment should consult the article by Dr. B.H. Fisher (1) in The Lancet.) 氧气直接应用于受损组织能够启动并促进愈合这一点也已被充分证实。局部应用高压氧可以有效缩短大多数慢性腿部溃疡以及许多褥疮的愈合时间。（任何对这种治疗方法感兴趣的人应查阅 B.H. Fisher 博士在《柳叶刀》上的文章（1）。）
Alpha tocopherol acts in a different manner to accomplish the same purpose, but has the advantage of acting not α-生育酚以不同的方式实现相同的目的，但具有不作用于...的优势
only locally as the pure oil or in an ointment base, but also systematically through the blood supply to the cell. It is not surprising, therefore, that by far the best treatment for burns is alpha tocopherol orally and by direct application. 不仅局部使用纯油或软膏基质，还通过血液供应系统性地输送到细胞。因此，毫不奇怪，治疗烧伤的最佳方法是口服和直接涂抹α-生育酚。
The efficacy of alpha tocopherol is well illustrated by the experience of one of my nurses. This twenty-four-year-old very blonde nurse lay out in the sun on the beach on the first beautiful spring day. She was clad in a relatively scant bathing suit. She fell asleep and overstayed a reasonable time of exposure to the sun. The result was an intense sunburn over her face and neck and all the areas not covered by the bathing suit. She attempted to work the next morning but was nauseated and weak. She was brought to me by her co-worker in the electrocardiograph and laboratory division of the Shute Institute. She was running a fever, had a severe headache and was a very sick-looking girl. α-生育酚的疗效通过我一位护士的经历得到了很好的说明。这位二十四岁的非常金发的护士在第一个美丽的春日里躺在海滩上晒太阳。她穿着相对较少的泳衣。她睡着了，晒太阳的时间超过了合理的限度。结果是她的脸部、颈部以及所有未被泳衣覆盖的部位严重晒伤。第二天早上她试图工作，但感到恶心和虚弱。她被她在 Shute 研究所心电图和实验室部门的同事带到我这里。她发烧，头痛严重，看起来非常虚弱。
Conventional treatment would probably have prescribed for her compresses of boric acid, doses of antihistamine, corticosteroid spray or cream and possibly painkiller medication. 传统治疗可能会为她开具硼酸敷料、抗组胺药剂量、皮质类固醇喷雾或乳膏，以及可能的止痛药。
We put this nurse in one of the side rooms, covered all the burned areas liberally with Vitamin E ointment and covered her with a sheet. Within minutes she fell asleep. Within an hour her temperature was normal and her headache had vanished. She got up and went back to work. 我们把这位护士安置在其中一个侧室，慷慨地用维生素 E 软膏涂抹所有烧伤部位，然后用一条床单盖住她。几分钟内她就睡着了。一小时内她的体温恢复正常，头痛也消失了。她起身回去工作了。
Our nurse did not develop a single blister and she did not peel. This is all the more remarkable since it was about twenty hours after the burn that treatment was initiated. 我们的护士没有起一个水泡，也没有脱皮。更为显著的是，治疗是在烧伤大约二十小时后才开始的。
Earlier I have related the unblind controlled experiment of a man familiar with the value of Vitamin E and Vitamin E ointment in treating burns. He applied the ointment to half the burn, and the difference between the two areas was obvious and striking. The owner of a company which wholesales Vitamin E products used the same technique on a severe 早些时候我曾讲述过一位熟悉维生素 E 及其软膏在治疗烧伤中价值的男子所做的非盲法对照实验。他将软膏涂抹在烧伤部位的一半，两个区域之间的差异明显且显著。一家批发维生素 E 产品公司的老板也用同样的方法处理了一处严重的烧伤。
barbecue burn on his thumb. The difference between the E-ointment-treated part of the burn and the other half was very obvious. 烤肉时拇指被烫伤。涂抹了 E 软膏的烧伤部位与另一半的区别非常明显。
As I write this, my wife has suggested that I mention her ninety-one-year-old mother who, apart from some loss of hearing, is able to do all that the average sixty-year-old can do. She swims miles every day in the summer and is in the pool at least once a day when we are in Florida. She should be long since dead, for she had hypertension for years, developed a bundle branch block and then the dyspnea of congestive failure. Control of her hypertension with diuretics and 2,400IU2,400 \mathrm{IU} of alpha tocopherol a day, however, keep her well and vigorous. 当我写这段话时，我的妻子建议我提到她九十一岁的母亲，除了听力有所下降外，她能够做所有普通六十岁人能做的事情。她夏天每天游几英里，在我们在佛罗里达时每天至少游一次泳。她本该早已去世，因为她多年来患有高血压，发展成了束支传导阻滞，随后出现了充血性心力衰竭的呼吸困难。然而，通过利尿剂和每天摄入 2,400IU2,400 \mathrm{IU} 的 alpha tocopherol 控制她的高血压，使她保持健康和充满活力。
Some six or seven years ago my mother-in-law accidentally upset a dish of boiling water on her foot which was in a sock and slipper. The whole dorsum was involved in a deep burn. Vitamin E ointment was applied within seconds, and today there is no visible trace of the burn. 大约六七年前，我的岳母不小心将一盘沸水泼到了穿着袜子和拖鞋的脚上。整个脚背都被严重烫伤。维生素 E 软膏在几秒钟内涂抹，今天已经看不到烫伤的痕迹。
Vitamin E has no equal for first- and second-degree burns and is a useful adjunctive therapy in third-degree burns. It has three unique characteristics. First, it lessens or takes away the associated pain a few minutes after application. Second, it keeps the burn from deepening, limiting the damage to the cells actually destroyed by the burning agent. Finally, it gives rapid epithelization and a scar that is not painful and does not contract. (Because it is antibacterial in vivo and in vitro, incidentally, it virtually removes the danger of infection.) 维生素 E 对于一度和二度烧伤无可比拟，是三度烧伤的有益辅助治疗。它有三个独特的特点。首先，涂抹几分钟后能减轻或消除相关的疼痛。其次，它防止烧伤加深，将损害限制在被烧伤剂实际破坏的细胞范围内。最后，它促进快速上皮化，形成的疤痕不疼痛且不收缩。（顺便说一句，由于其在体内外均具有抗菌作用，几乎消除了感染的危险。）
The majority of burn patients treated in this way do not need hospitalization. More important is the great reduction in the need for skin grafting. It is seldom necessary even in severe third-degree burns. Because the scars do not contract, there are no contraction deformities when the burns involve 采用这种方法治疗的大多数烧伤患者不需要住院。更重要的是，皮肤移植的需求大大减少。即使在严重的三度烧伤中，皮肤移植也很少必要。由于疤痕不会收缩，当烧伤涉及时不会出现收缩性畸形。
the axilla (armpit) or neck or groin. The color slides we show at medical conferences of the results of treating burns are unique and completely convincing. 腋窝（腋下）、颈部或腹股沟。我们在医学会议上展示的治疗烧伤效果的彩色幻灯片是独特且完全令人信服的。
The late Adelle Davis (2), reported remarkable case histories emphasizing the value of tocopherol in the healing of burns without scars. Vitamin E, in fact, is such a useful product for domestic burns and sunburns that many who are familiar with it keep a tube in several rooms in the house, especially the kitchen, and never travel without it. 已故的 Adelle Davis（2）报道了强调生育酚在无疤痕烧伤愈合中价值的显著病例史。事实上，维生素 E 对于家庭烧伤和晒伤是如此有用，以至于许多熟悉它的人会在家中多个房间，尤其是厨房，放一管，并且旅行时从不离开它。
Vitamin E ointment has many uses in addition to its major role in the treatment of burns.* It was first used in the treatment of ulcerations on the legs due to venous stasis (stagnation) or arterial insufficiency. These ulcers healed well with oral Vitamin E, but in most cases more rapidly with the addition of the local application of the ointment. However, the scars formed in these ulcer cases were surprising. They were the same size as the original ulcers, and they were soft, pliable and not tender. 维生素 E 软膏除了在烧伤治疗中的主要作用外，还有许多用途。* 它最初用于治疗因静脉淤滞或动脉功能不全引起的腿部溃疡。这些溃疡通过口服维生素 E 愈合良好，但在大多数情况下，局部涂抹软膏后愈合更快。然而，这些溃疡病例形成的疤痕令人惊讶。疤痕与原始溃疡大小相同，且柔软、有弹性且无压痛。
When Vitamin E ointment is used on scars following abdominal surgery they will often virtually disappear. The ointment is especially useful after radical mastectomy, particularly where there is superficial irritation due to radiation. It not only reduces the toxic reactions but soothes and heals the irritated areas. 当维生素 E 软膏用于腹部手术后的疤痕时，疤痕通常几乎会消失。该软膏在根治性乳房切除术后尤其有用，特别是在因放射治疗引起表面刺激的情况下。它不仅减少毒性反应，还能舒缓和愈合受刺激的区域。
Vitamin E ointment is also useful on acne scars and on scars about the face due to lacerations from windshield glass in automobile accidents. Not long ago my two-year-old grandson, standing up on the front seat of the car, was precipitated onto the rear view mirror. An elliptical piece of skin approximately 1 by 2 cm from his forehead was left on the mirror. 维生素 E 软膏对痤疮疤痕以及因汽车事故中挡风玻璃割伤面部的疤痕也有用。不久前，我两岁的孙子站在汽车前座上，不慎摔到后视镜上，额头上大约 1 乘 2 厘米的椭圆形皮肤留在了镜子上。
My grandson was seen very soon afterward by his local general practitioner. The doctor told my daughter to bring him the piece of skin. He washed it in saline and sewed it into the defect-an amazingly dextrous job on a two-year-old since he had, of course, to tease the contracted piece of skin back into approximately normal size and shape. 我孙子不久后被当地的全科医生看诊。医生告诉我女儿带来那块皮肤。他用生理盐水清洗后，将其缝合到缺损处——这在一个两岁孩子身上是一个令人惊叹的巧手活，因为他当然得把收缩的皮肤拉回到大致正常的大小和形状。
I chanced to arrive on the scene on the day the stitches were removed, and there was certainly grave doubt then that the patch would survive. It was raised in the center and quite inflamed around about half its periphery. As soon as the stitch holes sealed over, Vitamin E ointment was liberally applied with the result that although there was a very small area of superficial necrosis in the center, the cosmetic results six months later were excellent. The patch continues to improve and is now scarcely noticeable. The child’s physician does not know the ointment is being used, and my daughter happily relates this excellent physician’s surprise at the steady and unexpected improvement. 我恰好在拆线当天赶到现场，当时确实严重怀疑这块补片能否存活。补片中央隆起，周围大约一半边缘相当发炎。缝线孔一封闭后，便大量涂抹维生素 E 软膏，结果虽然中央有一小块浅表坏死，但六个月后的美容效果非常好。补片持续改善，现在几乎看不出来。孩子的医生不知道正在使用这种软膏，我女儿高兴地讲述了这位优秀医生对持续且意外改善的惊讶。
Vitamin E ointment has another specific use-namely, in the treatment of nerve root pain. Intercostal neuritis or neuralgia, sciatica and various cases of myositis (muscle inflammation) respond to Vitamin E inunction. Drs. Burgess and Pritchard of the Montreal General Hospital long ago reported that Vitamin E could be recovered at the periosteum of bones and joints shortly after the ointment was rubbed into the overlying skin. The ointment, rubbed in gently for ten minutes and followed by the application of heat for ten minutes over the nerve roots of the sensory nerves involved in a neuritis, will relieve the condition in a majority of cases. If it does not do so within one to three nights of application, however, it is unlikely to help. 维生素 E 软膏还有另一种特定用途——即治疗神经根痛。肋间神经炎或神经痛、坐骨神经痛以及各种肌炎（肌肉炎症）病例对维生素 E 涂抹有反应。蒙特利尔综合医院的 Burgess 博士和 Pritchard 博士早就报告说，维生素 E 在将软膏擦入覆盖皮肤后不久，可以在骨骼和关节的骨膜中被检测到。将软膏轻轻擦入十分钟，然后在涉及神经炎的感觉神经根部位敷以热敷十分钟，大多数情况下可以缓解病情。然而，如果在一到三晚的应用后没有效果，则不太可能有帮助。
A great many doctors, especially in Canada, have long scoffed at manipulation. They have given excellent reasons why manipulation cannot help and I expect that this has been 许多医生，尤其是在加拿大，长期以来一直嘲笑手法治疗。他们提出了手法治疗无效的充分理由，我想这一直是如此。
taught in every medical school, as it was in mine. However, there is now an association of trained physicians manipulating patients with the various neuritic lesions. Many surgeons attempt manipulation under anesthesia as do many in the new specialty of physical medicine. 在每所医学院都教授这门课程，就像我所在的医学院一样。然而，现在有一个由受过训练的医生组成的协会，专门对患有各种神经炎病变的患者进行手法治疗。许多外科医生以及许多物理医学新专业的医生都尝试在麻醉下进行手法治疗。
About 50 percent of patients who have had myocardial infarcts or angina often also have pains in the chest unrelated to coronary artery disease. The cervical root syndrome closely mimics heart pain. Many of these cases respond to manipulation. Dr. Paul Goodley described such a case at the fifth International Congress of Physical Medicine in 1968. His patient, a fifty-two-year-old longshoreman, had suffered serious neck injuries in a car accident. His severe pain of fifteen months duration was completely relieved by manipulation under anesthesia. Incidentally, this doctor of medicine was refused permission to do this manipulation in his hospital. 大约 50%的心肌梗死或心绞痛患者常常也会有与冠状动脉疾病无关的胸痛。颈根综合征与心脏痛极为相似。许多此类病例对手法治疗有反应。Paul Goodley 医生在 1968 年第五届国际物理医学大会上描述了这样一个病例。他的患者是一位 52 岁的码头工人，在一次车祸中颈部受了重伤。经过麻醉下的手法治疗，他持续了十五个月的剧烈疼痛得到了完全缓解。顺便提一下，这位医学博士在他的医院被拒绝进行这种手法治疗。
At the same meeting Dr. Janet Travell, Associate Clinical Professor of Medicine at George Washington University, and Dr. John Mennell, Associate Professor of Medicine and Rehabilitation at the University of Pennsylvania, reported on the virtues of manipulation. Manipulation can give instant relief from pain and from restriction of movement in some cases. 在同一次会议上，乔治华盛顿大学医学副临床教授 Janet Travell 博士和宾夕法尼亚大学医学与康复副教授 John Mennell 博士报告了手法治疗的优点。手法治疗在某些情况下可以立即缓解疼痛和运动受限。
Vitamin E ointment somehow does the same in most cases of sciatica, intercostal neuralgia, frozen shoulder and others of that type. Many cases of months or years duration respond. When they do not, we have for years sent patients for manipulation with excellent results, again in most cases. 维生素 E 软膏在大多数坐骨神经痛、肋间神经痛、冻结肩及类似疾病的病例中以某种方式起到相同的作用。许多持续数月或数年的病例都有反应。当无效时，多年来我们会将患者送去进行手法治疗，结果同样在大多数情况下非常好。
An interesting instance of Vitamin E-but not, apparently, E ointment-helping in a muscular condition, occurred in Chicago. Some years ago, a Chicago newspaper contained an account of an unusual case involving a ten-year-old boy whose leg muscles had become so hard, owing to calcium deposits, that they were described as “turning to stone.” The newspaper said that the boy’s doctors believed that “highly concentrated doses of Vitamin E” had helped him so that he 一个有趣的维生素 E 实例——但显然不是 E 软膏——在芝加哥帮助治疗了一种肌肉疾病。几年前，芝加哥的一家报纸报道了一个不寻常的案例，涉及一名十岁男孩，由于钙沉积，他的腿部肌肉变得非常坚硬，以至于被形容为“变成了石头”。报纸称，男孩的医生认为“高浓度的维生素 E 剂量”帮助了他，使得他...
could walk a few steps. They were, they said, expecting considerably more improvement. 能够走几步。他们说，他们期待有更大的改善。
In 1965 Drs. R.H. Brodkin and J. Bleiberg (3) reported that there can be allergic reactions to Vitamin E applied locally. We have noted this from the very beginning of its use and have warned all patients, for years, that about 10 percent of people cannot tolerate the full-strength ointment on open wounds or ulcers. Before it is applied to the whole area, Vitamin E should always be used on one corner of the ulcer or sore until it is evident that it does not cause a local reaction. We first published this caution in 1950. 1965 年，R.H. Brodkin 博士和 J. Bleiberg 博士（3）报告说，局部使用维生素 E 可能会引起过敏反应。我们从使用维生素 E 之初就注意到了这一点，并多年来一直警告所有患者，大约有 10%的人无法耐受在开放性伤口或溃疡上使用全浓度软膏。在将维生素 E 涂抹于整个区域之前，应始终先在溃疡或伤口的一角使用，直到确认不会引起局部反应。我们首次在 1950 年发表了这一警告。
The ointment is a 30 IU per gm of alpha tocopherol in a petroleum jelly base, and those who cannot tolerate a fullstrength ointment can often derive benefit without reaction from a half-strength dilution. If there is still reaction to the local application of the ointment, opening a capsule of the succinate preparation and scattering the powder over the ulcer can often be tolerated and can be very effective. 该软膏含有每克 30 国际单位的α-生育酚，基质为凡士林，那些不能耐受全浓度软膏的人通常可以从半浓度稀释剂中获益且无反应。如果局部涂抹软膏仍有反应，打开琥珀酸盐制剂的胶囊，将粉末撒在溃疡上通常可以耐受且效果显著。
We decry the use of Vitamin E for any nonmedical reason. We were horrified at its use as a deodorant. Had the companies concerned bothered to consult us, we could have told them that many users would show allergic reactions. However, our main objection arises from the fact that this substance is often in short supply as the result of its rapid acceptance for prophylactic and therapeutic use in medicine. It is a shame to see it wasted. 我们谴责任何非医疗原因使用维生素 E。我们对其作为除臭剂的使用感到震惊。如果相关公司曾咨询过我们，我们本可以告诉他们许多使用者会出现过敏反应。然而，我们的主要反对意见来自于这样一个事实：由于维生素 E 被迅速接受用于医学中的预防和治疗用途，这种物质常常供应不足。看到它被浪费真是令人惋惜。
The mechanism by which the Vitamin E ointment functions is quite unknown and very puzzling. New uses for it, however, keep cropping up constantly. Often we hear about them only by letter. In this connection, let me quote three paragraphs from a letter from a woman in a large mid-western city: 维生素 E 软膏的作用机制尚不清楚，且令人费解。然而，它的新用途不断涌现。我们常常只是通过信件得知这些用途。关于这一点，请允许我引用一位来自中西部大城市的女性来信中的三段话：
I was born with a hemangioma (birthmark) on my face. It covers my left eye, forehead, cheek, nose 我天生脸上有一个血管瘤（胎记）。它覆盖了我的左眼、额头、脸颊和鼻子。
and upper part of my left lip. 以及我左上唇的上部。
As my sister, who is a medical doctor, read your book on Vitamin E, she thought it would be advisable that I take Vitamin E. I started with 400 units for a period of 6 months, then increased to 600 , and since August 1973, to date I am taking 800 units per day. The reason my sister recommended that I take Vitamin E was because I had rheumatism when I was 15 years old. 当我的姐姐——一位医学博士——阅读了你关于维生素 E 的书后，她认为我服用维生素 E 是明智的。我开始服用 400 单位，持续了 6 个月，然后增加到 600 单位，自 1973 年 8 月起，到现在我每天服用 800 单位。我姐姐建议我服用维生素 E 的原因是我在 15 岁时患有风湿病。
During the first six months I was taking Vitamin E I did not notice any change on my hemangioma but suddenly I started noting that it was fading out little by little and right now it has faded out almost one centimeter all around the birthmark. At the same time that I was taking Vitamin E, my sister ordered from Canada Vitamin E ointment and I applied it on my face with a lamp (200 watts). I think the birthmark started disappearing since I started applying the ointment and taking the Vitamin E. I have applied 3 jars of ointment. 在服用维生素 E 的最初六个月里，我没有注意到我的血管瘤有任何变化，但突然间我开始注意到它一点点地褪色了，现在它已经在胎记周围褪色了将近一厘米。与此同时，我姐姐从加拿大订购了维生素 E 软膏，我用一盏 200 瓦的灯将软膏涂抹在脸上。我认为胎记从我开始涂抹软膏和服用维生素 E 时就开始消失了。我已经用了三罐软膏。
Davis, A. Here’s Health 11, 4, 1967. Davis, A. 这里是健康 11, 4, 1967。
Brodkin, R.H. and Bleiber, J. Archives of Dermatology 92, 76, 1965. Brodkin, R.H. 和 Bleiber, J. 皮肤病学档案 92, 76, 1965。
16
TAILORING THE DOSE 调整剂量
IF YOU ARE A DOCTOR and are interested in alpha tocopherol therapy for your patients, you will find in this chapter the information you will need in determining dosage levels for a variety of different kinds of cases. I would suggest that before reading it you should look back at Chapter 7 to review for yourself the material there describing the basic functions of alpha tocopherol and its role in the human body. 如果您是一名医生，并且对为患者进行α-生育酚治疗感兴趣，您将在本章中找到确定各种不同病例剂量水平所需的信息。我建议您在阅读本章之前，先回顾第 7 章，复习其中描述α-生育酚的基本功能及其在人体中的作用的内容。
Treatment with alpha tocopherol must be tailored to each patient’s needs. As with most other potent and useful medications, such as insulin, for example, the dosage level in different individuals with apparently the same signs and symptoms may vary widely. Our motto in this is, “Tailor the dose.” And we are constantly mindful of the concept of “biochemical individuality” which I have mentioned previ- α-生育酚的治疗必须根据每位患者的需求量身定制。正如大多数其他有效且有用的药物一样，例如胰岛素，不同个体即使表现出相同的体征和症状，剂量水平也可能差异很大。我们的座右铭是：“量体裁衣。”我们始终牢记我之前提到的“生化个体差异”这一概念。
ously in connection with Roger Williams. Obviously, too, there are certain precautions to be observed-again, as with any potent medication. 以前与 Roger Williams 有关。显然，也有某些预防措施需要遵守——同任何强效药物一样。
Because alpha tocopherol increases the efficiency of all tissues with its oxygen-sparing ability, it may increase the tone of heart muscle. This is important in hypertension and hypertensive heart disease. In about one-third of hypertensives, it may raise the level of already elevated blood pressure if appropriate antihypertensive drugs are not prescribed at appropriate dosage levels. Fortunately, alpha tocopherol seems to enhance the action of most antihypertensive drugs, and most patients with hypertension respond to treatment for this condition and, having done so, can then be given the same quantity of alpha tocopherol as though they were normotensive. 由于α-生育酚通过其节氧能力提高所有组织的效率，它可能增强心肌的张力。这在高血压和高血压性心脏病中非常重要。在大约三分之一的高血压患者中，如果未按适当剂量使用合适的降压药，α-生育酚可能会使已经升高的血压进一步升高。幸运的是，α-生育酚似乎增强了大多数降压药的作用，大多数高血压患者对这种治疗有反应，治疗后可以给予与正常血压者相同剂量的α-生育酚。
Inorganic iron destroys the activity of alpha tocopherol when they meet outside or inside the body. If iron must be given, ingestion of the two substances must be separated by eight to twelve hours. 无机铁在体内外与α-生育酚接触时会破坏其活性。如果必须服用铁，则两种物质的摄入时间必须间隔八到十二小时。
Estrogens and alpha tocopherol are antagonists. Moreover, in most conditions which require alpha tocopherol treatment, the use of estrogens is ineffective or actually contraindicated. 雌激素和α-生育酚是拮抗剂。此外，在大多数需要α-生育酚治疗的情况下，使用雌激素无效或实际上是禁忌的。
The effect of digitalis on the heart is enhanced by alpha tocopherol. In many patients, the optimum effect of digitalis may be demonstrated at a level between one-half and onefifth of the dosage used in the same patient before alpha tocopherol was used. Conversely, if the usual dosage of digitalis is not reduced when the patient is given the optimum dosage of alpha tocopherol, the patient may well be overdigitalized and experience all the symptoms of digitalis poisoning. 洋地黄对心脏的作用会被α-生育酚增强。在许多患者中，洋地黄的最佳效果可能在使用α-生育酚之前同一患者剂量的一半到五分之一之间表现出来。相反，如果在患者服用最佳剂量的α-生育酚时不减少洋地黄的常规剂量，患者很可能会出现洋地黄过量中毒，表现出所有洋地黄中毒的症状。
Digitalis should only be used in patients with auricular fibrillation to slow the heart rate to an optimum level. It is obviously impossible to gauge the effect of digitalis on the patient with normal sinus rhythm except when the symptoms of overdosage appear. 洋地黄应仅用于房颤患者，以将心率减慢到最佳水平。显然，除非出现洋地黄过量的症状，否则无法评估洋地黄对正常窦性心律患者的影响。
According to a report to the Japanese Rheumatism Society by Dr. Takefumi Morotomi and Dr. Sadao Kira, Vitamin E may have striking value for many rheumatoid arthritic patients who require treatment with steroids. Steroids have undesirable side-effects and the addition of Vitamin E allows a reduction of the steroid dosage to one-third with great reduction in side-effects. The doctors cite as a typical case that of a twenty-nine-year-old housewife with arthritis of elbows, arms, fingers and legs who improved on very high steroid doses but deteriorated and became scarcely able to walk on 15 mg of Prednisolene. With Vitamin E therapy added, just 3 mg of the steroid now permits her to be active to the point of enjoying folk dancing and bicycle riding. In addition to its value in increasing steroid activity, the physicians report, Vitamin E stimulates the circulation in the extremities and patients commonly tell of losing the “cold feeling” in their limbs. 根据 Takefumi Morotomi 博士和 Sadao Kira 博士向日本风湿病学会提交的一份报告，维生素 E 对许多需要使用类固醇治疗的类风湿性关节炎患者可能具有显著价值。类固醇有不良副作用，添加维生素 E 可以将类固醇剂量减少到三分之一，同时大大减少副作用。医生们举了一个典型案例：一位 29 岁的家庭主妇，患有肘部、手臂、手指和腿部关节炎，在使用非常高剂量的类固醇时病情有所改善，但在服用 15 毫克泼尼松龙时病情恶化，几乎无法行走。加入维生素 E 治疗后，仅需 3 毫克类固醇，她就能活跃到享受民间舞蹈和骑自行车的程度。医生们报告说，除了增强类固醇活性外，维生素 E 还能刺激四肢的血液循环，患者常常反映四肢的“冰冷感”消失了。
Incidentally, Drs. P.M. DeSanctis and G.A. Furey have reported in the Journal of Urology some interesting results in the treatment of Peyronie’s disease (a condition characterized by painful swelling of the male sex organ). With steroids alone, 85 percent were helped; with steroids and Vitamin E, 100 percent were helped. No other therapy was really useful. 顺便提一下，P.M. DeSanctis 博士和 G.A. Furey 博士在《泌尿学杂志》上报道了一些关于佩罗尼氏病（男性性器官疼痛性肿胀的一种疾病）治疗的有趣结果。单用类固醇，85%的患者得到了帮助；使用类固醇和维生素 E，100%的患者得到了帮助。没有其他疗法真正有效。
As indicated throughout this book, the use of polyunsaturated fats always increases the need for alpha tocopherol and serves no useful purpose in any case. If patients do not stop following this tragic fad, they will not get the full effect of alpha tocopherol treatment. 正如本书中多次指出的，使用多不饱和脂肪总是增加对α-生育酚的需求，而且在任何情况下都没有实际用途。如果患者不停止追随这一悲剧性的时尚，他们将无法获得α-生育酚治疗的全部效果。
Megavitamin ascorbic acid will enhance and improve the patient’s response to alpha tocopherol in retinal arteriosclerosis whatever the etiology and in peripheral vascular and coronary artery disease. However a large quantity of ascorbic acid must not be given to patients with chronic rheumatic heart disease. In this condition, the alpha tocopherol dosage is most critical, and the dosage schedule given later on in this chapter and in Chapter 10 must be adhered to strictly. 大剂量维生素 C 将增强和改善患者对视网膜动脉硬化中α-生育酚的反应，无论病因如何，以及在周围血管和冠状动脉疾病中也是如此。然而，慢性风湿性心脏病患者不得给予大量维生素 C。在这种情况下，α-生育酚的剂量尤为关键，必须严格遵守本章后面及第 10 章中给出的剂量方案。
Whereas results of treatment with alpha tocopherol in acute rheumatic fever, acute nephritis and acute thrombophlebitis will usually occur in a matter of days, improvement in coronary disease is rarely noted in less than ten days but is usually obvious in four to six weeks. If such a patient does not respond within six weeks, the dosage must be raised at sixweek intervals until he does respond or until it is obvious that he will not. I have seen patients greatly improve on 4,000IU4,000 \mathrm{IU} who showed no improvement on dosages of 800 to 3,200IU3,200 \mathrm{IU}. 而使用α-生育酚治疗急性风湿热、急性肾炎和急性血栓性静脉炎的效果通常在几天内显现，冠心病的改善则很少在不到十天内出现，但通常在四到六周内明显。如果这样的患者在六周内没有反应，剂量必须每六周增加一次，直到他有反应或明显不会有反应为止。我见过一些患者在 4,000IU4,000 \mathrm{IU} 上有显著改善，而在 800 到 3,200IU3,200 \mathrm{IU} 剂量下没有任何改善。
As has been mentioned by Boyd, Haeger and others, patients with intermittent claudication may show response only after three months of more of treatment. As a rule, peripheral vascular cases require large daily amounts of alpha tocopherol-more than is required in the average coronary case. 正如 Boyd、Haeger 等人所提到的，间歇性跛行患者可能只有在治疗三个月或更长时间后才会出现反应。通常，外周血管病例需要大量每日摄入α-生育酚——比一般冠心病病例所需的要多。
If a chronic rheumatic heart disease patient who has been on Vitamin E for years discontinues his treatment, he may seem as well as ever for some time. In contrast, coronary patients who stop their treatment with alpha tocopherol may have a recurrence of symptoms, or even an occlusion, after three days. The coronary patient must never decrease the level of dosage at which he received definite help nor ever stop for more than two days. If such a patient suffers an accident or is hospitalized for surgery, emergency or elective, he needs his alpha tocopherol more than ever and, if at all possible, must have it. It may be omitted on the day of the operation if absolutely necessary. Of course, as Ochsner has pointed out, all surgical patients should be given alpha tocopherol before and after surgery to prevent thrombophlebitis and pulmonary embolism. For the treated coronary patient, it is doubly important. 如果一位长期服用维生素 E 的慢性风湿性心脏病患者停止治疗，他在一段时间内可能看起来和以前一样健康。相比之下，停止服用α-生育酚治疗的冠心病患者可能在三天后出现症状复发，甚至发生血管闭塞。冠心病患者绝不能减少曾经获得明显帮助的剂量，也绝不能停药超过两天。如果此类患者发生意外或因手术（紧急或择期）住院，他比以往任何时候都更需要α-生育酚，并且如果可能的话，必须继续服用。手术当天如果绝对必要，可以暂时停用。当然，正如 Ochsner 所指出的，所有手术患者在手术前后都应给予α-生育酚，以预防血栓性静脉炎和肺栓塞。对于接受治疗的冠心病患者来说，这一点尤为重要。
Let me now summarize our treatment of various conditions and at the same time indicate the dosage range for alpha tocopherol in each one. 现在让我总结一下我们对各种病症的治疗，同时指出每种病症中α-生育酚的剂量范围。
Acute coronary thrombosis. Emergency use of such antispasmodics as intravenous papverine, amyl nitrate “bombs” to attempt to relieve the spasm and the pain, with nitroglycerine as necessary and at least 1,600IU1,600 \mathrm{IU} of alpha tocopherol as soon as possible. Levine’s armchair treatment with bathroom privileges as soon as the patient is free of pain, and ambulation after ten days. No anticoagulants ever and no polyunsaturated fats or inorganic iron. 急性冠状动脉血栓形成。紧急使用静脉注射的罂粟碱、亚硝酸异戊酯“炸弹”等解痉药，试图缓解痉挛和疼痛，必要时使用硝酸甘油，并尽快给予至少 1,600IU1,600 \mathrm{IU} 的α-生育酚。Levine 的扶手椅治疗法，患者无痛后允许使用浴室，十天后开始行走。绝不使用抗凝剂，也不使用多不饱和脂肪或无机铁。
Patients who have survived without the above treatment should be started on 800 to 1,200IU1,200 \mathrm{IU} a day and their status reviewed at six-week intervals. Patients should be maintained indefinitely on the quantity to which they responded. Nitroglycerine should be freely used and hypertension, if present, vigorously treated. 未接受上述治疗而存活的患者应开始每日服用 800 至 1,200IU1,200 \mathrm{IU} ，并每六周评估一次其状况。患者应长期维持在其有反应的剂量。应充分使用硝酸甘油，并积极治疗存在的高血压。
Peripheral vascular conditions. Patients are started on 1,600 IU a day and the dosage increased at six-week intervals. Careful cleanliness of feet and legs is observed in the arterial cases. Patients with varicose ulcers, burns and other open wounds are given 800 to 1,600IU1,600 \mathrm{IU} a day, with simultaneous use of alpha tocopherol ointment. As I have said, about 10 percent will show a local reaction to the ointment but may tolerate half-strength ointment or the succinate powder from a capsule. 周围血管疾病。患者开始服用每天 1600 IU 的剂量，并每六周增加一次剂量。动脉病例中注意脚和腿的清洁。患有静脉曲张溃疡、烧伤和其他开放性伤口的患者每天服用 800 至 1,600IU1,600 \mathrm{IU} ，同时使用α-生育酚软膏。如我所说，大约 10%的患者会对软膏产生局部反应，但可能耐受半浓度软膏或胶囊中的琥珀酸酯粉末。
Intermittent claudication. Patients should be forced to engage in regular walking exercises, to the utmost extent possible. This, along with 800 to 3,200IU3,200 \mathrm{IU} of Vitamin E, should yield excellent results in virtually every such patient. It is very worthwhile to add 2 to 5 gm of Vitamin C if the patient can tolerate it. 间歇性跛行。应尽可能强迫患者进行规律的步行锻炼。结合每天摄入 800 至 3,200IU3,200 \mathrm{IU} 的维生素 E，几乎每位患者都能取得极佳效果。如果患者能耐受，添加 2 至 5 克维生素 C 也是非常值得的。
Acute rheumatic fever. Alpha tocopherol dosage here is 800 to 1,200IU1,200 \mathrm{IU} a day. 急性风湿热。此处的α-生育酚剂量为每天 800 至 1,200IU1,200 \mathrm{IU} 。
Chronic rheumatic heart disease. Here alpha tocopherol dosage is 75 IU a day for four weeks with no obvious help, 100 IU a day for four weeks with no obvious help, then 150 IU level. Occasionally a patient may respond at the 100 IU level. (Most will continue to improve on 150 IU a day, and most will regress if given more. Occasionally, after a long time on 150 IU, it may be possible and desirable to very carefully increase the dosage by small increments to a maximum of 300 IU-but more than 300 IU should absolutely never be used.) 慢性风湿性心脏病。这里α-生育酚的剂量为每天 75 IU，服用四周无明显效果；每天 100 IU，服用四周无明显效果；然后增加到 150 IU。偶尔有患者在 100 IU 剂量时会有反应。（大多数患者在每天 150 IU 时会持续改善，大多数如果剂量增加则会退步。偶尔，在长期服用 150 IU 后，可以且有必要非常小心地逐步增加剂量，最高不超过 300 IU——但绝对不应超过 300 IU。）
Before a physician treats a chronic rheumatic heart disease patient with alpha tocopherol he should read carefully the part of this book that deals with this subject (Chapter 9). 在医生用α-生育酚治疗慢性风湿性心脏病患者之前，应仔细阅读本书中有关该主题的部分（第 9 章）。
I can summarize my beliefs about dosage in one sentence. The important thing in alpha tocopherol therapy is to give enough of a properly labelled and assayed product to do the job, and be sure to observe the restrictions outlined earlier and above. 我可以用一句话总结我对剂量的看法。α-生育酚治疗中重要的是给予足够的、经过正确标注和检测的产品以完成任务，并确保遵守前面和上文中列出的限制。
Recently two letters have appeared in The Lancet, both warning against overuse of Vitamin E and claiming that weakness and fatigue are common side-effects of excessive use of Vitamin E. The content of these letters has been disseminated throughout the United States in the press. I mention this here in order to deny categorically the truth of such statements. 最近《柳叶刀》上出现了两封信，均警告不要过度使用维生素 E，并声称虚弱和疲劳是维生素 E 过量使用的常见副作用。这些信件的内容已通过媒体在美国广泛传播。我在此提及此事，目的是断然否认这些说法的真实性。
Weakness and fatigue are never caused by megavitamin E . It has not been mentioned by a single patient or noted by us in one single patient in the more than twenty-five years of our experience with Vitamin E. 虚弱和疲劳绝不是由大剂量维生素 E 引起的。在我们二十五年以上的维生素 E 使用经验中，没有一位患者提到过，也没有我们观察到过这种情况。
In fact, by improving circulation and the ability of the tissues to make the fullest use of their oxygen supply, Vitamin E has exactly the opposite effect in humans and animals alike. 事实上，通过改善循环和组织充分利用氧气供应的能力，维生素 E 在人类和动物中具有完全相反的效果。
The doctor using Vitamin E therapy can with absolute safety ignore these “warnings.” 使用维生素 E 疗法的医生可以完全安全地忽略这些“警告”。
17
THE HEALTHY HEART 健康的心脏
THE PUBLISHERS CHOSE THE TITLE for Vitamin E for Ailing and Healthy Hearts. As a result, many readers must have expected to find in that book some specific mention of the quantity of E intake necessary for the healthy heart. Some of them wrote me to complain that they could not find this information. 出版商选择了《Vitamin E for Ailing and Healthy Hearts》作为书名。因此，许多读者一定期望在书中找到关于健康心脏所需维生素 E 摄入量的具体说明。他们中的一些人写信给我，抱怨找不到这方面的信息。
I think that it should be obvious to anyone who has read the whole book that no man, woman or child can assume that he or she has a healthy heart. In today’s world, Vitamin E deficiency can begin very early in life. And it can get worse as time goes on-very much worse. 我认为，任何读完整本书的人都应该明白，没有任何男人、女人或孩子可以假设自己拥有一个健康的心脏。在当今世界，维生素 E 缺乏可能从生命早期就开始。而且随着时间的推移情况会变得更糟——非常糟糕。
Arrayed against each one of us is our great industrialized civilization. No one wants to go back to the “good old days.” All of us appreciate the conveniences of modern living. However, there have developed serious dangers in our mode of 摆在我们每个人面前的是我们伟大的工业化文明。没有人想回到“美好的旧时光”。我们所有人都欣赏现代生活的便利。然而，我们的生活方式中已经出现了严重的危险。
life-air, water and soil pollution, to mention but a few obvious ones. 生活空气、水和土壤污染，仅举几例明显的例子。
More serious is the chemicalization of our foods. The promotion of soft drinks, sugar-containing foods and convenience packaging has changed our eating habits beyond recognition. The point has finally been reached at which most people buy from the supermarkets, and there is scarcely a single product in the store which hasn’t been chemically treated. Most milk, bread, canned foods, candy, ice cream and many other items are loaded with chemicals, many of which interfere with adequate nutrition. 更严重的是我们的食物被化学化。软饮料、含糖食品和方便包装的推广已经使我们的饮食习惯发生了难以辨认的变化。现在大多数人都从超市购买食品，几乎没有一种产品没有经过化学处理。大多数牛奶、面包、罐头食品、糖果、冰淇淋以及许多其他物品都含有大量化学物质，其中许多会干扰充足的营养摄入。
The Journal of the American Medical Association in 1970 published a report (1) of the Council on Foods and Nutrition to the American Medical Association Board of Trustees in which the woeful state of malnutrition and hunger in the United States is spelled out in detail. “Malnutrition producing physiological impairment seems to be common,” say the authors of the report. It was specifically stated in a Department of Agriculture report printed in the same journal (for 19 July 1971) that everyone should use nutritional food supplements. 1970 年，《美国医学会杂志》发表了一份由食品与营养委员会向美国医学会董事会提交的报告（1），详细说明了美国营养不良和饥饿的悲惨状况。报告的作者表示：“导致生理功能障碍的营养不良似乎很普遍。”同一期杂志（1971 年 7 月 19 日）刊登的农业部报告中明确指出，每个人都应使用营养补充食品。
It requires a real effort to obtain adequate nutrition today. It means avoidance of most of our “treats” and most of our desserts and careful selection and preparation of our fruits and vegetables. It may even mean the return to some of the ways of old-such as, when possible, our own home-raised vegetables and home canning. Most of all, it means finding someone who can give one a complete nutritional checkup and evaluation and then prescribe additions of the appropriate supplements. And such checkups are completely foreign to the medical training of virtually all presently practicing physicians and a far cry from the teachings offered under the heading of “nutrition” in most high schools and colleges. 如今要获得充足的营养需要付出真正的努力。这意味着要避免大多数“零食”和大多数甜点，仔细选择和准备我们的水果和蔬菜。甚至可能意味着回归一些旧时的方式——例如，在可能的情况下，自己种植蔬菜和家庭罐装。最重要的是，要找到能够进行全面营养检查和评估的人，然后开出适当补充剂的处方。而这种检查对于几乎所有现役医生的医学培训来说都是完全陌生的，也与大多数高中和大学中“营养”课程所教授的内容相去甚远。
Treating a “healthy heart” means recognizing the nearly 治疗“健康的心脏”意味着认识到几乎
complete removal of the essential antithrombin from our natural diets and the urgent need for its restoration in much greater quantities than ever needed before-at least 800 IU of alpha tocopherol a day in most adults (probably less in younger people). 完全去除我们天然饮食中的必需抗凝血酶，以及迫切需要以比以往任何时候都多得多的数量恢复它——大多数成年人每天至少需要 800 IU 的α-生育酚（年轻人可能需要更少）。
Supplementation must begin at birth, assuming the mother was taking enough to keep the baby’s level up to normal. It is probably the best insurance, along with Vitamin C, against crib deaths. 补充必须从出生开始，前提是母亲摄入足够的量以保持婴儿的水平正常。这可能是预防婴儿猝死综合症的最佳保障，连同维生素 C 一起。
Apparently not all infants have enough alpha tocopherol. An article (2) in the New England Journal of Medicine reports a case of coronary thrombosis with resulting death in a premature infant who died 18 hours after birth. “Coronary occlusion with myocardial infarction has been reported in several instances in patients of the ‘newborn’ and childhood age groups.” 显然并非所有婴儿都有足够的α-生育酚。《新英格兰医学杂志》上的一篇文章（2）报道了一例早产儿冠状动脉血栓形成导致死亡的病例，该婴儿出生后 18 小时内死亡。“在‘新生儿’和儿童年龄组的患者中，已有多例冠状动脉阻塞伴心肌梗死的报道。”
Babies should not have less than 30 IU a day, more as they grow older. It is only the newborn who have any chance of maintaining a normal level throughout life. 婴儿每天不应少于 30 IU，随着年龄增长应增加。只有新生儿有可能在一生中维持正常水平。
For the rest of us, it is too late to achieve a “healthy heart.” We have been deprived of an absolutely essential food element by the wonders of the modern technologies of the manufacturers of most of our flour, bread, cereals and other convenience foods. 对于我们其他人来说，实现“健康的心脏”已经太晚了。我们被现代技术的奇迹剥夺了一种绝对必需的食物元素，这些技术来自大多数面粉、面包、谷物和其他方便食品的制造商。
A startling example of this deprivation has come to light through investigative activities of the National Aeronautical and Space Administration (NASA). 通过美国国家航空航天局（NASA）的调查活动，揭示了一个令人震惊的营养缺乏例子。
A Canadian scientist, Dr. David Turner, who was one of the first developers of gas chromatography (an analytic process in which gases or vapors are separated) and who because of his expertise in the use of this process was associated with the astronaut program, stated in a television interview that the loss by the American spacemen of up to 20 percent of their red blood cells was probably caused by a lack of Vitamin E in 一位加拿大科学家，大卫·特纳博士，是气相色谱法（一种分离气体或蒸气的分析过程）的最早开发者之一，由于他在该过程使用方面的专业知识，他曾参与宇航员计划。他在一次电视采访中表示，美国宇航员红细胞损失高达 20%的原因很可能是缺乏维生素 E。
their food. As Turner said on television, he had been led to suspect that lack of E was the culprit because of his familiarity with the work of the Shute brothers-a familiarity he had acquired while working in London, Ontario. On Apollo Ten and subsequent flights the astronauts have had their freeze-dried foods fortified with Vitamin E and on these trips they have suffered no red cell loss. On the earlier flights in which red cell loss had occurred, the result was considerable fatigue. 他们的食物。正如特纳在电视上所说，他之所以怀疑缺乏维生素 E 是罪魁祸首，是因为他熟悉 Shute 兄弟的研究——这是他在安大略省伦敦工作时获得的熟悉。在阿波罗十号及随后的飞行中，宇航员们的冻干食品都添加了维生素 E，在这些飞行中他们没有出现红细胞流失。在早期发生红细胞流失的飞行中，结果是相当疲劳。
The civilian application is obvious. Freeze-dried convenience foods are coming into general use and they will have to have their Vitamin E restored or hemolytic anemia could become more prevalent. 民用应用显而易见。冻干方便食品正在普及，必须补充其维生素 E，否则溶血性贫血可能会变得更加普遍。
I received a letter about the astronauts’ diet from Houston, Texas in January, 1970. It was actually a copy of the one written to the Editor of Prevention and since it was meant for publication and information I shall give you excerpts from it: 1970 年 1 月，我收到了一封来自德克萨斯州休斯顿的关于宇航员饮食的信。实际上，这是一封写给《预防》杂志编辑的信的副本，既然它是为了发表和提供信息，我将摘录其中的内容给你：
My sister and I subscribe to Prevention and live by the Prevention system. She works at the Manned Spacecraft Center (NASA) near Houston, in the bio-medical division directly for the doctors, planning the diets of the astronauts. Because of her, Vitamin E, calcium and other supplements have been added to the diets of the astronauts. She constantly put your Prevention articles under the noses of the doctors until it brought results. You may give yourself credit for this. Dr. Shute was wondering how this came about (Vitamin E for Ailing and Healthy Hearts, Dec., 1969) so I’m enclosing a copy of this letter for him. 我和我姐姐都订阅《Prevention》杂志，并遵循《Prevention》系统生活。她在休斯顿附近的载人航天中心（NASA）生物医学部门工作，直接为医生服务，负责规划宇航员的饮食。多亏了她，维生素 E、钙和其他补充剂被加入了宇航员的饮食中。她不断把你们《Prevention》杂志的文章摆到医生面前，直到取得了效果。你可以为此自豪。Shute 博士想知道这是怎么发生的（《Vitamin E for Ailing and Healthy Hearts》，1969 年 12 月），所以我附上了这封信的副本给他。
My sister answers the phone at NASA “Food and Nutrition.” She was picked to work in Mission Control during the first landing on the moon. The 我姐姐在 NASA 接电话，接线处是“食品与营养”。她被选中在首次登月任务中在任务控制中心工作。
heartbeat, etc. of the astronauts was constantly monitored, and it is interesting to note that when they stepped on the moon their pulse rate almost doubled. 宇航员的心跳等生命体征被持续监测，有趣的是，当他们踏上月球时，脉搏几乎翻了一倍。
This is really not a new discovery although Dr. Turner apparently was not aware that the Aerospace Medical Association at a Miami meeting on 13 May 1964 decided that every explorer going out into space should be fortified with a diet high in Vitamin E. This was published in Aerospace Medicine for September 1964 but apparently ignored for some time. 这其实并不是一个新的发现，尽管特纳博士显然不知道 1964 年 5 月 13 日在迈阿密举行的航空航天医学协会会议上决定每个进入太空的探险者都应摄入富含维生素 E 的饮食。这一决定发表于 1964 年 9 月的《Aerospace Medicine》杂志，但显然被忽视了一段时间。
It is strange that while starvation has always elicited interest, malnutrition has, in the past at least, attracted almost no attention at all. In 1974, however, a new campaign was launched with considerable fanfare to improve the nutrition of the American consumer, particularly the young girl. Television spots are being used and a book entitled Food Is More Than Just Something to Eat is being distributed free to those who write in for it. This is part of a new Advertising Council campaign launched with the help of the United States government and the food industry. The book was prepared with help from the U.S. Department of Agriculture and the U.S. Department of Health, Education and Welfare. The campaign was launched by Virginia Knauer, Special Assistant to the President for Consumer Affairs. 奇怪的是，尽管饥饿一直引起人们的关注，但营养不良过去几乎没有受到任何关注。然而，1974 年，一场旨在改善美国消费者营养状况，特别是年轻女孩营养状况的新运动隆重启动。电视广告被广泛使用，一本名为《食物不仅仅是用来吃的》的书籍免费发放给写信索取的人。这是由美国政府和食品行业协助发起的新广告委员会运动的一部分。该书在美国农业部和美国卫生、教育与福利部的帮助下编写。该运动由总统消费者事务特别助理弗吉尼亚·诺尔发起。
Mrs. Knauer has been quoted as saying that the public needs to have a far greater awareness of nutrition and that poor nutrition is common in the United States. “The percentage of households that meet or exceed the U.S. Department of Agriculture’s definition of a good diet dropped from 60 to 50 percent between 1955 and 1965 . . . Even many relatively affluent individuals have poor diets.” Mrs. Knauer evinced concern about “the mounting cost of diet-related illnesses [and of] remedial education required to overcome diet-related 克瑙尔夫人曾表示，公众需要对营养有更高的认识，而在美国，营养不良很普遍。“在 1955 年至 1965 年间，达到或超过美国农业部对良好饮食定义的家庭比例从 60%下降到 50%……即使是许多相对富裕的人群，饮食也很差。”克瑙尔夫人对“与饮食相关疾病日益增加的成本以及为克服饮食相关问题所需的补救教育”表示担忧。
slowness in school. . . .” 在学校的迟缓……
This is at least a beginning. Another good sign is that nutrition is an area in which many doctors are now for the first time beginning to take an interest. 这至少是一个开始。另一个好迹象是，营养学是许多医生现在首次开始关注的领域。
Knowledge of nutrition has been hard to come by, since until very recently the subject was not a part of the medical student’s curriculum. As recently as 1970 there was no course in nutrition taught in any of our medical schools. All the doctor-to-be was taught was that there were three classes of foods-protein, carbohydrate and fat-and a few substances called vitamins that in minute quantities were essential for adequate nutrition. His knowledge of vitamins consisted of the information that their absence could cause some rather exotic conditions such as scurvy (a full-blown case of which he would never see), beriberi (which only a Southern doctor might occasionally run across) and rickets (also a rare disease since acceptance of the value of cod liver oil used prophylactically). He was taught that all the essential elements are contained in a “balanced diet”-whatever that might be. 营养知识一直难以获得，因为直到最近，这一学科还未被纳入医学生的课程。直到 1970 年，我们的医学院都没有开设营养学课程。准医生们所学的只是食物分为三类——蛋白质、碳水化合物和脂肪——以及一些被称为维生素的物质，这些物质虽只需极少量，却对充分的营养至关重要。他们对维生素的了解仅限于缺乏维生素会引发一些较为罕见的疾病，如坏血病（他几乎不会见到严重病例）、脚气病（只有南方医生偶尔会遇到）和佝偻病（由于预防性使用鱼肝油，这种病也较为罕见）。他们被教导所有必需元素都包含在“均衡饮食”中——无论那具体指什么。
Anyone who reads the daily paper comes across that statement-about the “balanced diet”-every week or so from some doctor somewhere. It just isn’t so, according to the report of the Department of Agriculture that was printed in the Journal of the American Medical Association-the doctors’ bible! 任何每天读报的人几乎每周都会从某个医生那里看到关于“均衡饮食”的说法。根据刊登在《美国医学会杂志》——医生的圣经！——上的农业部报告，这根本不是真的。
To point out the errors in this concept would take a book. Indeed, it did take a book-a very excellent one that I have referred to already. I mean, of course, Dr. Roger J. Williams’ Nutrition Against Disease. 指出这个概念中的错误需要一本书。事实上，确实需要一本书——一本我已经提到过的非常优秀的书。我指的当然是罗杰·J·威廉姆斯博士的《Nutrition Against Disease》。
A while ago I mentioned the desirability of a “nutritional checkup.” In light of that, it is unfortunate that at present your doctor may well be the last person to whom you can go for advice on nutrition. This deficiency in the medical curriculum has been well described by Dr. J.E. Monagle, an M.D. who is Senior Consultant in Clinical Nutrition, Task Force on 前些时候我提到了进行“营养检查”的必要性。鉴于此，目前你的医生很可能是你寻求营养建议时最后一个可以去的人，这实在令人遗憾。医学课程中这一缺陷已被临床营养高级顾问、工作组成员 J.E. Monagle 博士详细描述。
Community Health, Health Programs Branch at Ottawa, Canada. In the Canadian Doctor for April 1973 Dr. Monagle said that although “the rudiments of nutrition [are] presented in basic sciences the practical utilization of that knowledge in clinical care is virtually ignored.” He went on to describe a study at the Harvard School of Public Health in which the same tests on nutrition were given to graduating physicians, nurses, dietitians and high school students. “The physicians and nurses scored only marginally higher than the high school students.” Dr. Monagle noted that the Commission on Nutrition Education and Training of the International Union of Nutritional Sciences has urged that nutrition be made a part of the clinical teaching in all medical schools. 加拿大渥太华社区健康，健康项目分支。1973 年 4 月《Canadian Doctor》杂志中，Monagle 博士表示，尽管“营养学基础知识在基础科学中有所介绍，但这些知识在临床护理中的实际应用几乎被忽视。”他接着描述了哈佛公共卫生学院的一项研究，该研究对即将毕业的医生、护士、营养师和高中生进行了相同的营养测试。“医生和护士的得分仅比高中生略高。”Monagle 博士指出，国际营养科学联盟的营养教育与培训委员会已敦促将营养学纳入所有医学院的临床教学中。
During the last fifty years or so, the chemicalization of our foodstuffs has steadily diminished their nutritional content and added to them many chemicals whose functions are to prolong shelf life or to make the foods look more attractive or to make them taste better. (There are now between 2,500 and 3,000 synthetic flavors. Synthetic flavors and colors constitute about 80 percent of all food additives.) 在过去的五十年左右，我们的食品化学化过程不断减少了其营养成分，并添加了许多化学物质，这些化学物质的功能是延长保质期、使食品看起来更有吸引力或使其味道更好。（现在有大约 2500 到 3000 种合成香料。合成香料和色素约占所有食品添加剂的 80%。）
In the United States Senate in April 1971 hearings were held on “Chemicals and the Future of Man.” Here are the opening remarks of the Chairman, Senator Abraham Ribicoff: 1971 年 4 月，美国参议院举行了题为“化学品与人类的未来”的听证会。以下是主席亚伯拉罕·里比科夫参议员的开场白：
It is a common saying that we are what we eat. If this is true, then Americans are becoming a nation of processed, packaged, and preserved people. Last year, Americans bought more processed than fresh foods for the first time in our history. We spend more than 60 billion dollars for these convenience foods including such items as TV dinners, snack foods of all kinds, and frozen foods. 人们常说，我们就是我们所吃的。如果这是真的，那么美国人正逐渐成为一个加工、包装和保存食品的民族。去年，美国人购买的加工食品首次超过了新鲜食品。我们在这些方便食品上花费了超过 600 亿美元，包括电视晚餐、各种零食和冷冻食品。
With these foods we each consume every year more than four pounds of chemical preservatives, stabilizers, colorings, flavorings and other addi- 通过这些食物，我们每年摄入超过四磅的化学防腐剂、稳定剂、着色剂、香料和其他添加剂
tives. And the amount of these artifificial substances is increasing every year. Their use has doubled in the past 15 years, from 400 million pounds to more than 800 million pounds. Today, more than 3,000 chemicals are deliberately added to our foods. 这些人工物质的数量每年都在增加。过去 15 年中，它们的使用量翻了一番，从 4 亿磅增加到超过 8 亿磅。如今，超过 3000 种化学物质被故意添加到我们的食品中。
These developments raise three basic questions: (1) How much do we know about the hazards to human health from these chemicals? (2) How much assurance of chemical safety should we require? and (3) What must the Federal Government do to assure that the chemicals we absorb are safe?" 这些发展提出了三个基本问题：（1）我们对这些化学物质对人体健康的危害了解多少？（2）我们应要求多少化学品安全保障？（3）联邦政府必须做些什么以确保我们吸收的化学物质是安全的？
We know that a large number of these additives were inadequately tested, and one large group of them have been indicted as a primary, if not sole, cause of behavioral and learning disabilities in children. These abnormalities have increased steadily so that in California in the past ten to twelve years, the incidence of hyperkinesia and learning difficulties has risen from 2 percent to an average of 20 to 25 percent and, in some cases, to 40 percent of an entire school population. These figures are not related to the socioeconomic status of the child or to his Intelligence Quotient. 我们知道大量这些添加剂未经充分测试，其中一大类被指控为儿童行为和学习障碍的主要甚至唯一原因。这些异常现象持续增加，以至于在加利福尼亚州过去十到十二年中，过动症和学习困难的发生率从 2%上升到平均 20%至 25%，在某些情况下甚至达到整个学校人口的 40%。这些数据与儿童的社会经济地位或智商无关。
Dr. Ben Feingold of the Kaiser Foundation Hospital, Permanente Group, told the section on Allergy of the convention of the American Medical Association in 1973 that he had successfully treated, some hyperkinetic children with learning difficulties with the salicylate-free diet which eliminates 80 percent of the food additives, including artificial flavors and colors. At the time the paper was presented he had achieved “dramatic results” in fifteen to eighteen of twentyfive such children merely by removing artificial flavoring and coloring from their diets. When these substances were returned to their diets, these children returned to their former abnormal states. Since presentation of this paper Dr. Feingold 凯撒基金会医院 Permanente 集团的本·费因戈尔德博士在 1973 年美国医学会过敏学分会的会议上表示，他成功地用无水杨酸盐饮食治疗了一些患有学习困难的多动症儿童，该饮食消除了 80%的食品添加剂，包括人工香料和色素。在论文发表时，他仅通过从这些儿童的饮食中去除人工香料和色素，就在 25 名儿童中取得了 15 至 18 名的“显著效果”。当这些物质重新加入他们的饮食时，这些儿童又恢复了原来的异常状态。自论文发表以来，费因戈尔德博士...
has treated more than fifty such children successfully and reports that other physicians have duplicated his results. 已经成功治疗了五十多个这样的儿童，并报告说其他医生也复制了他的成果。
The eating habits of the average American school child, and probably even more significantly, the teenager, expose him to large quantities of these substances in hot dogs, cold cuts of meats, ice cream, soft drinks and ready-to-eat cereals. Artificial flavorings and colorings are contained, in fact, in 90 percent of processed foods. 普通美国学童的饮食习惯，甚至更重要的是青少年的饮食习惯，使他们暴露于热狗、熟肉片、冰淇淋、软饮料和即食谷物中大量的这些物质中。事实上，90%的加工食品中都含有人造香料和色素。
And think of the possible effects of these chemicals on adults. They may well be the reason that sales of tranquilizers and sedatives have skyrocketed in the last few years or even for the fact that the number of “unpremeditated” murders and the number of suicides have risen. 想想这些化学物质对成人可能产生的影响。它们很可能是近年来镇静剂和安眠药销量激增的原因，甚至可能是“非预谋”谋杀案和自杀人数上升的原因。
What we must do, and it seems a hopeless task, is to educate the younger generation to avoid the dangers as much as possible and supplement their diets where needed. That means the addition of vitamins, minerals and amino acids. All this is well drawn up for you, as I have suggested, in Dr. Williams’ book, Nutrition Against Disease and also in the various excellent books and scientific publications of Dr. Emmanuel Cheraskin. 我们必须做的事情，虽然看似无望，是教育年轻一代尽可能避免危险，并在需要时补充他们的饮食。这意味着添加维生素、矿物质和氨基酸。正如我所建议的，这些内容在 Williams 博士的《Nutrition Against Disease》一书中，以及 Cheraskin 博士的各种优秀书籍和科学出版物中都有详细说明。
The report of the Council on Foods and Nutrition which was published in the Journal of the American Medical Association in 1970 had a revealing title: it was known as the Report on Malnutrition and Hunger in the United States. It contains shocking revelations of the extent of both malnutrition and hunger, but although malnutrition is probably much more widespread than true hunger, it is “not as politically dramatic,” to put it in the words used in the report itself. Yet malnutrition producing physiological impairments seems to be common. Conditions such as iron deficiency, growth impairment and obesity are widespread. Alarming amounts of goiter and rickets have been reported recently. This report states that “practically all deficiency disorders seen could have been prevented had patients and physicians had a proper understand- 美国医学会杂志于 1970 年发表的食品与营养委员会报告标题耐人寻味：它被称为《美国营养不良与饥饿报告》。报告揭示了营养不良和饥饿的严重程度，尽管营养不良可能比真正的饥饿更为普遍，但正如报告中所述，它“在政治上没有那么戏剧性”。然而，导致生理功能障碍的营养不良似乎很常见。铁缺乏、生长受阻和肥胖等状况普遍存在。最近还报告了大量甲状腺肿和佝偻病。报告指出，“几乎所有观察到的缺乏症状本可以通过患者和医生具备适当的认识来预防——
ing of nutrition and diet.” Further, this report suggests that in spite of all this garnering of information, little if anything has been or is being done about the situation. 营养和饮食的理解。”此外，该报告指出，尽管收集了所有这些信息，但几乎没有或根本没有采取任何措施来应对这种情况。
The report has had no real effect. We still read every day of how adequate the American diet is and how, therefore, supplementation is the idea of a few crackpots and a waste of money. 该报告没有产生实际影响。我们每天仍然看到关于美国饮食多么充足的报道，因此补充剂被认为是少数疯子们的想法，是浪费钱。
Is it possible, then, to get “an adequately balanced and nutritious diet” in the supermarket? 那么，在超市里能否获得“一个足够均衡且有营养的饮食”呢？
I think that it is a queer commentary on our society today that almost the only source of supply for wholesome and nutritious foodstuffs is the health food store, whose proprietors and customers have long been held up to derision by many medical journals and many medical men. The natural food and organic farming people have long been stigmatized as crackpots and food nuts. It may well be that the shoe is on the other foot and that they are the only rational and sensible purveyors of food. 我认为，这对我们当今社会是一个奇怪的评论，几乎唯一提供健康有营养食品的来源是健康食品店，而这些店的业主和顾客长期以来一直被许多医学期刊和许多医生嘲笑。自然食品和有机农业的人们长期以来被贴上了怪人和食品狂热者的标签。很可能情况正好相反，他们才是唯一理性和明智的食品供应者。
How odd it is, too, that the essential vitamins and minerals needed to supplement our denuded diets are obtainable chiefly in these same health food stores! And how odd that although, as I have noted, there is now the beginning of a governmental effort to correct widespread malnutrition, the eating habits of the average child have long been condoned by the same government agencies who are also intent on preventing us from adding vitamin supplements to our woeful diets! 多么奇怪啊，补充我们被剥夺的饮食所需的基本维生素和矿物质，主要竟然只能在这些健康食品店里获得！更奇怪的是，正如我所指出的，虽然现在政府开始努力纠正普遍的营养不良，但普通儿童的饮食习惯长期以来却被同样的政府机构容忍，而这些机构又致力于阻止我们向可怜的饮食中添加维生素补充剂！
My older daughter Barbara is a speech therapist with preschool and elementary school patients. When I visited her last fall she showed me a seven-year-old child who was a real problem. He was hyperkinetic, had a very short attention span and exceedingly poor speech. She was helping him but not enough to suit her. 我大女儿芭芭拉是一名言语治疗师，主要服务于学龄前和小学阶段的患者。去年秋天我去看她时，她给我介绍了一个七岁的孩子，这个孩子确实很有问题。他多动症，注意力极其短暂，语言能力非常差。她在帮助他，但效果还不够理想。
I suggested that she should start the boy on 800 IU of alpha tocopherol until I could send her an article I had, writ- 我建议她让男孩开始服用 800 IU 的α-生育酚，直到我能寄给她一篇我写的文章，
ten by Dr. Alan Cott, a psychiatrist who had had success with such children using some of the megavitamins. The mother, a nurse, readily complied and by the time she had Dr. Cott’s literature the child had become “perfectly normal,” in the words of his mother and of the teachers in his school. He did not need further corrective therapy. 由精神科医生 Alan Cott 博士进行的十例治疗，他使用了一些大剂量维生素，对这些儿童取得了成功。孩子的母亲是一名护士，欣然配合，到她拿到 Cott 博士的资料时，孩子已经变得“完全正常”，正如他的母亲和学校老师所说。他不再需要进一步的矫正治疗。
Barbara has since achieved the same result with a second child. The third mother to whom she suggested Vitamin E went to her own doctor for advice and was told that she would only be throwing her money away. So this child will need tranquilizers, sleeping pills and many hours of my daughter’s professional help. 芭芭拉后来用第二个孩子也取得了同样的效果。第三位她建议服用维生素 E 的母亲去找自己的医生咨询，医生告诉她这只是浪费钱。因此，这个孩子将需要镇静剂、安眠药以及我女儿多小时的专业帮助。
It is interesting that these profound changes occurred on Vitamin E alone. (Dr. Cott had not used Vitamin E in his megavitamin treatment.) 有趣的是，这些深刻的变化仅发生在维生素 E 上。（科特博士在他的巨量维生素治疗中并未使用维生素 E。）
A newspaper report I saw not long ago quoted a prominent California lady as saying that people of her acquaintance who manage to look young and vital are often discovered to have been taking Vitamin E for years. Many athletes-including professional football players-are E users too. 我不久前看到一则报纸报道，引用了一位加利福尼亚著名女士的话，她说她认识的那些看起来年轻有活力的人，常常被发现多年来一直在服用维生素 E。许多运动员——包括职业橄榄球运动员——也是维生素 E 的使用者。
Among athletes, in fact, the fame of Vitamin E seems even to have penetrated the Iron Curtain. I read in the 24 May 1972 issue of the Medical Tribune that young Soviet skiers and cyclists were given E during a study of E blood and urine levels at the Nutrition Institute of the Soviet Academy of Medical Science and the Central Institute of Physical Culture. 事实上，在运动员中，维生素 E 的名声似乎甚至穿透了铁幕。我在 1972 年 5 月 24 日出版的《Medical Tribune》上读到，苏联营养科学院营养研究所和中央体育学院在进行维生素 E 血液和尿液水平研究时，给年轻的苏联滑雪运动员和自行车运动员补充了维生素 E。
Commented the Tribune on the results: “We don’t believe the Russians invented the electric light bulb-but are they among the first to demonstrate that increased physical activity raises requirements for Vitamin E?” 《论坛报》对结果评论道：“我们不认为俄罗斯人发明了电灯泡——但他们是否是最早证明增加体育活动会提高维生素 E 需求的人之一？”
REFERENCES 参考文献
Journal of the American Medical Association 213, 272, 1970. 美国医学会杂志 213, 272, 1970。
New England Journal of Medicine 263, 379, 1960. 新英格兰医学杂志 263, 379, 1960。
18
WHAT OF THE FUTURE? 未来会怎样？
THIS WAS THE TITLE of the last chapter in my last book! There I answered the question with a list of my hopes. Now, six years later, I can do better. For the future of alpha tocopherol therapy has, in the meantime, begun to take shape. The adoption of alpha tocopherol in the treatment of cardiovascular disease has been greatly accelerated since 1969, when my last book was published, in every state in the United States, in the British Isles, in Europe and in Australia and New Zealand. 这是我上一部书最后一章的标题！在那里，我用一系列希望回答了这个问题。现在，六年过去了，我可以做得更好。因为在这期间，α-生育酚疗法的未来已经开始成形。自 1969 年我最后一本书出版以来，α-生育酚在心血管疾病治疗中的应用在美国各州、英伦三岛、欧洲以及澳大利亚和新西兰得到了极大加速。
Today, more cardiologists are realizing that they have virtually nothing to offer if they don’t use alpha tocopherol and are at last investigating the claims for its use. Surgeons and family physicians are adopting alpha tocopherol treatment at a greater rate than the cardiologists. Now, even in articles blasting its use, they read admissions that it does work 如今，越来越多的心脏病专家意识到，如果不使用α-生育酚，他们几乎无计可施，并且终于开始调查其使用的相关主张。外科医生和家庭医生采用α-生育酚治疗的速度超过了心脏病专家。现在，即使是在抨击其使用的文章中，他们也读到了它确实有效的承认。
for humans in intermittent claudication, the anemias of premature infants and some other conditions. Obviously, since it works in these conditions, it is not an inert substance but is effective in treating very real pathological states in humans. As a result, they are motivated to investigate further. 对于间歇性跛行的人类、早产儿的贫血以及其他一些情况显然，由于它在这些情况下有效，它不是一种惰性物质，而是在治疗人类非常真实的病理状态方面有效。因此，他们有动力进一步进行研究。
The megavitamin way of using E-what I refer to as Big E , to contrast it with “little e ,” which is the use of E simply as a vitamin-is becoming more and more widespread. Big E is astonishingly and bewilderingly useful, and still more uses are being announced every year. 使用大剂量维生素 E 的方法——我称之为大 E，以区别于作为普通维生素使用的小 e——正变得越来越普遍。大 E 的效果令人惊讶且令人困惑，而且每年都有更多的用途被公布。
In addition to the steadily increasing number of doctors who find it useful, there is the size of the factories producing the concentrate and, especially, the millions of people using it daily. All these are a source of wonderment and joy to the Shute brothers who started it all. In Florida, where I now spend my winters, there is hardly a drug store in the state -and certainly no health food store-that doesn’t have a most prominent display featuring Vitamin E. One drug store has a display showing two very tall basketball players advertising the house brand in 1,000IU1,000 \mathrm{IU} capsules. It is difficult to assess the accelerated rate of acceptance of alpha tocopherol therapy with great accuracy, since there are so many companies wholesaling Vitamin E capsules, most of them also selling directly to physicians. But it is safe to say that there has been more progress made in the last five years than in the previous twenty. 除了越来越多的医生发现它有用之外，还有生产浓缩物的工厂规模，尤其是每天使用它的数百万人。所有这些都让最初创始的 Shute 兄弟感到惊奇和喜悦。在我现在度过冬天的佛罗里达州，几乎没有一家药店——当然也没有健康食品店——没有显著展示维生素 E。其中一家药店有一个展示，展示了两位非常高的篮球运动员，宣传该店品牌的 1,000IU1,000 \mathrm{IU} 胶囊。由于有许多公司批发维生素 E 胶囊，其中大多数也直接销售给医生，因此很难准确评估α-生育酚疗法接受速度的加快。但可以肯定的是，过去五年取得的进展超过了前二十年。
Invitations to present our work to professional groups are increasing in number. We have just no trouble at all in convincing the majority of those doctors who see our slides and learn of the literature that is available supporting our original claims. More and more doctors are hearing the message. As one young physician said when I lamented to him that his group was already using Big E and that I would prefer to address a group that was unfamiliar with it or skeptical, 邀请我们向专业团体展示我们的工作的人数正在增加。我们完全没有困难说服大多数看到我们幻灯片并了解支持我们最初主张的文献的医生。越来越多的医生正在听到这个信息。正如一位年轻医生在我向他抱怨他的团队已经在使用大 E，而我更愿意向不熟悉或持怀疑态度的团体演讲时所说的，
“But we are all like amoebas. We have our tentacles out in our professional lives. Through us, other doctors have to listen to our successes with it.” “但我们都像变形虫。在我们的职业生活中，我们伸出触手。通过我们，其他医生必须听取我们在这方面的成功经验。”
So it is with our patients. They have persisted in getting well against their doctors’ predictions. They have persisted in staying well and telling their friends how well Vitamin E works for them. Legions of them have solved their own problems after reading our papers or books. This we know from the literally thousands of letters we have received from some of them. 我们的病人也是如此。他们坚持康复，违背了医生的预测。他们坚持保持健康，并告诉朋友们维生素 E 对他们的效果有多好。成千上万的人在阅读了我们的论文或书籍后解决了自己的问题。我们从收到的成千上万封信中得知这一点。
Many, many people have taken alpha tocopherol on their own responsibility. It works as well for them, of course, as it does for many patients treated with alpha tocopherol prescribed by a doctor, provided they have the right dosage for their pathological condition and have neither of the complaints in which Vitamin E can be dangerous, namely an elevated blood pressure or chronic rheumatic heart disease. 许多人在自我负责的情况下服用了α-生育酚。只要剂量适合他们的病理状况，且没有维生素 E 可能带来危险的两种情况——高血压或慢性风湿性心脏病，它对他们的效果当然和许多由医生开具α-生育酚治疗的患者一样好。
Here is nearly all of one typical-not unusual-letter from such a patient, one I have not seen: 这里几乎是一封典型的——并不罕见的——来自这样一位患者的信件，我本人未曾见过：
Dear Dr. Shute: 亲爱的 Shute 博士：
May I introduce myself by saying that I have had a heart condition for nearly ten years, that I have read your book Vitamin E for Ailing and Healthy Hearts, and that I have been taking Vitamin E ( 1,200 IU) daily for the past seven months. To attempt to describe how I feel today almost defies description! 请允许我自我介绍，我患有心脏病近十年，读过您的著作《Vitamin E for Ailing and Healthy Hearts》，并且在过去七个月每天服用维生素 E（1200 IU）。要试图描述我今天的感受几乎难以言表！
I am 48 years old and suffered a myocardial infarction nearly ten years ago. After two months in the hospital, it was another six months before I was able to resume light activities. But this was not for long; a week later I experienced my second attack. In the years since then, I have had moments and times of considerable pain and distress. Next month, 我今年 48 岁，近十年前曾患心肌梗死。在医院住了两个月后，又过了六个月我才恢复轻度活动。但这并没有持续多久；一周后我经历了第二次发作。从那以后这些年里，我经历过许多痛苦和折磨的时刻。下个月，
November, will mark a year that I was forced to return to the States because of my heart condition. Upon arrival in the States, I was hospitalized for a month and a half. 十一月，将标志着我因心脏病被迫返回美国一周年。抵达美国后，我住院治疗了一个半月。
Treatment, from the first time I was hospitalized and in the years since then, has consisted of daily medication; anticoagulant therapy, coronary dilators and treatment for high blood pressure. 治疗从我第一次住院开始，并在此后的多年中，包括每日用药；抗凝治疗，冠状动脉扩张剂和高血压治疗。
Up until the time of my first heart condition, and in a very limited sense since then, my life had been quite active with a great part of it spent outdoors. Walking from 5 to 15 miles each day was common as there were no roads in the area that I was in. I had given up smoking and drinking (neither had ever been excessive) eight years before my first attack. Through necessity, because of scarcity, I had been on a relatively fat free diet-there were no dairy products available and even meat was a rare item. Rice was the main dish. My weight was not excessive-between slender and medium build. I had always enjoyed excellent health. 直到我第一次心脏病发作之前，在很有限的意义上，此后我的生活一直相当活跃，大部分时间都在户外度过。每天步行 5 到 15 英里是很常见的，因为我所在的地区没有道路。第一次发作前八年，我已经戒烟戒酒（两者都从未过量）。由于必需和物资匮乏，我一直保持相对无脂肪的饮食——没有乳制品，甚至肉类也很少见。米饭是主要食物。我的体重不过分——介于瘦弱和中等体型之间。我一直享有极好的健康。
It was quite a change after my first and succeeding heart attacks. It became impossible to even attempt to walk briskly or to climb a hill. And while I was not aware of the high blood pressure condition before, there was no question about it afterwards and I had this problem since then. Needless to say, I was a bit discouraged when discharged from the hospital this last time and again looking forward to a future of daily medication and limited activity. 在我第一次及随后的心脏病发作后，情况发生了很大变化。甚至连快步走或爬山都变得不可能了。虽然之前我并不知道自己有高血压，但之后毫无疑问我有这个问题，而且从那时起一直如此。不用说，这次出院时我有些沮丧，再次面对每天服药和活动受限的未来。
There has been an incredible change for the better in my heart and health since being introduced to your book and taking Vitamin E. I must truthfully admit that after finishing your book, I was still skep- 自从接触到您的书并开始服用维生素 E 以来，我的心脏和健康状况发生了难以置信的好转。我必须诚实地承认，在读完您的书后，我仍然持怀疑态度——
tical and had many unfounded reservations-that Vitamin E just wouldn’t work in my particular case despite your claims and the many examples given. Fortunately for myself, my hopes were stronger than the doubts and I began with small and gradually increasing dosages of Vitamin E. 我曾持怀疑态度，并有许多无根据的顾虑——认为维生素 E 在我这种特殊情况下根本不起作用，尽管你们有诸多主张和许多例子。幸运的是，我的希望战胜了怀疑，我开始服用少量并逐渐增加剂量的维生素 E。
And now the part that defies description. I can actually run again-not as fast and as far as in times past-but maybe the years have something to do with that! Angina pains are a stranger to me now. My blood pressure over the past five months has averaged 130/83. The first day that I started with Vitamin E, I put the half empty bottles of [drugs prescribed for some heart patients] and those for high blood pressure and tension in my luggage. I have not used any of these drugs since then. Aside from having my blood pressure taken at intervals, I had one Prothrombin time taken a couple of weeks ago (control 12.8; patient, 12.3 seconds). I cannot begin to describe the change in my spirit, morale and physical well being. Those who “remember me before” are astounded at the rapidity and completeness of change for the better. Actually, I feel more like I did 15 or 20 years ago! . . . 现在到了难以形容的部分。我实际上又能跑步了——虽然没有过去那么快和那么远——但也许这与年龄有关！心绞痛的疼痛现在对我来说是陌生的。过去五个月我的血压平均为 130/83。开始服用维生素 E 的第一天，我把那些为某些心脏病患者开具的药物以及治疗高血压和紧张的药物的半空瓶子放进了行李箱。从那以后我就没有再使用这些药物。除了间隔性测量血压外，几周前我还做了一次凝血酶原时间检测（对照 12.8 秒；患者 12.3 秒）。我无法用言语描述我的精神、士气和身体健康的变化。那些“记得我以前样子”的人都对我迅速且彻底的好转感到震惊。实际上，我感觉更像是 15 或 20 年前的自己！...
Words are so meager and inadequate to express the extent of my gratitude to you but may I express it with a sincere and humble thank you. What words can a patient say to a doctor after a decade of living with an “ailing” and now . . . a healthy heart! Again, with my gratitude, prayers and best wishes, 言语是如此贫乏和不足以表达我对您的感激之情，但请允许我以真诚而谦卑的感谢来表达。一个患者在经历了十年的“病痛”生活后，现在拥有一个健康的心脏，能对医生说什么话呢！再次表达我的感激、祈祷和最美好的祝愿，
It’s hard to add anything to a letter like that. This patient has said a lot. I am very proud to have received such a letter and very happy that our work has made it possible for such a letter to be written. 很难再为这样一封信添加什么内容。这位患者已经说了很多。我非常自豪能收到这样一封信，也非常高兴我们的工作使得写出这样一封信成为可能。
I am also, personally, very proud to be included in symposia and scientific sessions with such intellectual and knowledgeable greats as Linus Pauling, Roger Williams, Emmanuel Cheraskin, Fred Klenner, Morgan Raiford, William Miller, Lyle Baker and the man with the encyclopedic knowledge of nutrition, Carlton Fredericks and many, many others also very knowledgeable. These men are changing the face of medicine. 我个人也非常自豪能与林纳斯·鲍林、罗杰·威廉姆斯、埃马纽埃尔·切拉斯金、弗雷德·克莱纳、摩根·雷福德、威廉·米勒、莱尔·贝克以及拥有营养百科全书式知识的卡尔顿·弗雷德里克斯等智识渊博的伟人们一同参加专题讨论会和科学会议，还有许多其他同样博学的人士。这些人正在改变医学的面貌。
I am grateful to the men who have formed what is now the International Academy of Preventive Medicine, since they have provided a platform for the meeting of minds and the dissemination of knowledge of the new medicine. Their membership, which now exceeds 500, includes people from most states. 我感谢那些组建了现今国际预防医学学院的人们，因为他们为思想的交流和新医学知识的传播提供了一个平台。他们的会员现已超过 500 人，来自大多数州。
I am inspired by the movement to form a similar group in Canada, which is just getting under way. Most of its personnel have attended meetings of the Academy in the United States either as speakers or listeners. 我受到在加拿大组建类似团体运动的启发，该运动刚刚开始。其大多数成员曾作为演讲者或听众参加过美国学院的会议。
Gangrenous legs of diabetics are not all lopped off any more, and the use of Vitamin E ointment in burn cases as well as ulcers of all kinds, including bed sores, is rapidly being adopted by physicians across the country. With no particular fanfare or advertising of the ointment, sales are rapidly increasing. One convalescent and chronic-disease hospital in the East has been ordering the ointment not by the tube, not by the pound, but by the pail! 糖尿病患者的坏疽腿不再全部被截肢，维生素 E 软膏在烧伤病例以及各种溃疡（包括褥疮）中的使用，正迅速被全国各地的医生采纳。没有特别的宣传或广告，软膏的销量却在迅速增长。东部一家康复和慢性病医院订购软膏不是按管计，也不是按磅计，而是按桶计！
The heart transplant surgeon has virtually disappeared. 心脏移植外科医生几乎已经消失。
Indeed, I am exhilarated by the changes in the last six years. Yet in my happiness I am not disposed to be gentle with those who have opposed and criticized our work. My last 事实上，过去六年的变化让我感到振奋。然而，在我的喜悦中，我并不打算对那些反对和批评我们工作的人手下留情。我的最后一篇
book was gentle. This one is not! It is time that the opponents of Vitamin E therapy were deterred from further activity. It is time that the physician realizes that this treatment has come to stay. The time has come for the cardiologist to sit down and assess what he is doing for his patients, reconsider everything he has been taught, reconsider past recommendations and prescriptions, and consider the use of something which will help his patients’ hearts - an antioxidant, a dissolver and preventer of intravascular clotting, and so a prophylaxis against man’s killers. 这本书温和。这本书则不然！是时候让维生素 E 疗法的反对者停止进一步的活动了。是时候让医生意识到这种治疗已经成为常态。心脏病专家该坐下来评估他为患者所做的一切，重新考虑他所学的一切，重新考虑过去的建议和处方，并考虑使用某种能够帮助患者心脏的东西——一种抗氧化剂，一种溶解和预防血管内血栓形成的物质，从而预防人类的致命疾病。
I often wonder at the generosity of the American public. Each February the American Heart Association runs a campaign on radio and television and with volunteer door-to-door canvassers. These campaigns are run by professional fund raisers. In 1971 the American Heart Association allocated a record fifteen million dollars for research and in addition an estimated 8.5 million was allocated for research by state and community heart associations. 我常常对美国公众的慷慨感到惊讶。每年二月，美国心脏协会都会通过广播、电视以及志愿者挨家挨户的宣传活动开展一场运动。这些活动由专业的筹款人员组织。1971 年，美国心脏协会拨出了创纪录的一千五百万美元用于研究，此外，州和社区心脏协会还拨出了约八百五十万美元用于研究。
I am wondering when the generous American public is going to ask just what his millions of dollars contributed to this heart fund has netted. When will the average citizen become dissatisfied with the so-called basic research while he watches a type of heart disease unknown to Paul White at the time of his graduation in 1911 become the Number One killer of this generation? 我想知道慷慨的美国公众什么时候会问，他为这个心脏基金捐赠的数百万美元到底带来了什么成果。当普通公民在看到一种保罗·怀特（Paul White）于 1911 年毕业时尚未见过的心脏病类型成为这一代人的头号杀手时，什么时候会对所谓的基础研究感到不满？
The Medical Post for 12 January 1971 carried a report that should be interesting to my readers. It concerns the polyunsaturated fat diets so strongly recommended in the pamphlets put out by the American Heart Association. Some disturbing figures had turned up in “one of the largest and longest trials” of the antiatherosclerotic diet. Although those who had been on the diet had lower serum cholesterol and “few atherosclerotic episodes,” they discovered that the group on the diet 1971 年 1 月 12 日的《医学邮报》刊登了一篇报道，应该会引起我的读者兴趣。内容涉及美国心脏协会宣传册中强烈推荐的多不饱和脂肪饮食。在“最大且最长的抗动脉粥样硬化饮食试验之一”中出现了一些令人不安的数据。尽管遵循该饮食的人血清胆固醇较低且“动脉粥样硬化发作较少”，但他们发现该饮食组...
had “double the cancer mortality of controls matched for age, clinical condition and other parameters.” 其“癌症死亡率是与年龄、临床状况及其他参数匹配的对照组的两倍。”
Since such a diet is deficient in Vitamin E, that article bears an obvious relationship to another that also appeared in the Medical Post, this one on 22 September 1970. Dr. Albert Barber, Professor of Zoology at the University of California at Los Angeles, is stated to have said that since Vitamin E is believed to protect unsaturated fats in the cells of the body, a deficiency may leave the cells “vulnerable to destruction by an environmental carcinogen.” When the lipids in the cell membrane are destroyed by oxidation, “the membrane breaks up and the cell loses a growth-control factor.” Dr. Barber thinks that if his idea is borne out, E could be useful in preventing cancer. 由于这种饮食缺乏维生素 E，那篇文章显然与另一篇也发表在 Medical Post 上的文章有关，后者发表于 1970 年 9 月 22 日。据称，加利福尼亚大学洛杉矶分校的动物学教授 Albert Barber 博士表示，由于维生素 E 被认为能保护体内细胞的不饱和脂肪，缺乏维生素 E 可能使细胞“易受环境致癌物的破坏”。当细胞膜中的脂质被氧化破坏时，“膜会破裂，细胞失去生长控制因子。”Barber 博士认为，如果他的观点得到证实，维生素 E 可能有助于预防癌症。
Some work along somewhat similar lines was announced in the Montreal Star for 30 July 1973. According to the Star, two scientists at Sir George Williams University, Montreal, have been following a lead provided fifty years ago by the German physiologist Otto Warburg, who worked on the theory that lack of oxygen in a cell might lead to the formation of tumors. Professor Adolph E. Smith of Sir George Williams University was quoted as saying, “If a cell doesn’t get enough oxygen it is possible it may resort to a different way of life.” 1973 年 7 月 30 日的《蒙特利尔星报》宣布了一些沿着类似方向进行的工作。根据该报，两位来自蒙特利尔乔治·威廉姆斯大学的科学家一直在追踪德国生理学家奥托·瓦尔堡五十年前提出的一个线索，瓦尔堡研究了细胞缺氧可能导致肿瘤形成的理论。乔治·威廉姆斯大学的阿道夫·E·史密斯教授被引用说：“如果细胞得不到足够的氧气，它可能会采取另一种生活方式。”
It is interesting to note that the two scientists mentioned immediately above had published in a Swiss scientific magazine. Notice how often American and Canadian scientists publish their work in the English medical magazine The Lancet. Note also that the numerous papers mentioned here as presented to the various medical conventions, even the annual and specialist groups of the American Medical Association and the American Heart Association, seldom see the light of day in the medical journals put out by the American Medical Association or the American Heart Association. Perhaps 有趣的是，上面提到的两位科学家曾在一本瑞士科学杂志上发表过文章。注意美国和加拿大科学家们多频繁地在英国医学杂志《The Lancet》上发表他们的研究成果。还要注意，这里提到的许多论文虽然在各种医学会议上发表过，甚至包括美国医学会和美国心脏协会的年度及专业组会议，但很少在美国医学会或美国心脏协会出版的医学期刊上见到。也许
this is why the American Medical Association is faced with declining membership and revenues and has had to make a series of belt-tightening moves aimed at saving over one million dollars per year. Nine councils and committees have been dropped at a saving of $840,000\$ 840,000. Subscriptions to some of its magazines are no longer free. A variety of other moves have been undertaken to save funds and streamline the Association. It has just been announced by Dr. Philip L. White, chairman, that the A.M.A. Council on Foods and Nutrition has been placed on “inactive status” because of budget costs. 这就是为什么美国医学会面临会员和收入下降，不得不采取一系列紧缩措施，旨在每年节省超过一百万美元。九个理事会和委员会已被取消，节省了 $840,000\$ 840,000 。其一些杂志的订阅不再免费。还采取了各种其他措施以节省资金并简化协会运作。主席 Philip L. White 博士刚刚宣布，由于预算成本，A.M.A.食品与营养理事会已被置于“非活跃状态”。
Returning to the consideration of cancer and Vitamin E, it is worth reporting that all those concerned in my practice have remarked many times in the last few years that very, very few of our patients develop cancer. Vitamin E is certainly not the only factor, since the occasional patient does develop cancer, but again very, very few do. This is all the more remarkable considering the older age group into which most of our patients fall. 回到对癌症和维生素 E 的讨论，值得报告的是，在过去几年里，我的诊所中所有相关人员多次提到，我们的患者中极少有人患癌症。维生素 E 当然不是唯一因素，因为偶尔还是有患者会患癌症，但同样非常非常少。这一点尤为显著，考虑到我们大多数患者属于较高年龄组。
We have steered clear of any claim concerning cancer, and I mention it now only because of the three items above. 我们避免了任何关于癌症的声明，我现在提到它只是因为上述三项。
As I come to the end of this book, a final thought strikes me. Throughout the entire eighteen chapters I have never mentioned sex. And yet for years it was widely believed by people who knew very little about Vitamin E that it was “the sex vitamin.” This misconception arose, apparently, from the very real fact that it did help childless couples to have families. But no one familiar with Big E has ever claimed that it has aphrodisiac powers, least of all our group. The one book on the subject produces no evidence whatsoever. The author’s thesis is that people on Vitamin E often feel much better and that in better health, one may be a better performer! Let me add to that one observation directed at heart patients. They should be taking appropriate quantities of E because it’s a lot sexier to be ALIVE! 当我读到这本书的结尾时，最后一个想法浮现在我脑海。在整整十八章中，我从未提及性。然而，多年来，那些对维生素 E 知之甚少的人普遍认为它是“性维生素”。这种误解显然源于一个事实：它确实帮助无子女的夫妇拥有了家庭。但熟悉大 E 的人从未声称它具有春药功效，尤其不是我们这个团队。关于这个主题的唯一一本书也没有提供任何证据。作者的论点是，服用维生素 E 的人常常感觉更好，身体更健康，而身体更健康的人表现可能更好！我还想补充一点，针对心脏病患者的建议。他们应该摄取适量的维生素 E，因为活着本身就更有魅力！
APPENDIX A 附录 A
VITAMIN E AS A THERAPEUTIC AGENT IN DERMATOLOGY 维生素 E 作为皮肤病学中的治疗剂
Reprinted from Current News in Dermatology for March, 1973 by courtesy of Arthur G. Schoch, M.D., Ec’itor. 经 Arthur G. Schoch 医学博士、编辑许可，转载自 1973 年 3 月《Current News in Dermatology》。
Samuel Ayres, Jr. of Los Angeles, wrote us on request on “Vitamin E as a Therapeutic Agent in Dermatology.” We quote his letter in its entirety: 洛杉矶的 Samuel Ayres Jr.应我们的请求写信谈论“维生素 E 作为皮肤病学中的治疗剂”。我们全文引用他的信件：
Dr. Richard Mihan and I became interested in Vitamin E when Milton Stout presented before the Los Angeles Dermatological Society in 1950, a woman with pseudoxanthoma elasticum whose cutaneous and visual impairment were restored to near normal following administration of Vitamin E for a period of 1 year (Arch. Derm. 60:310, 1951). 理查德·米汉博士和我对维生素 E 产生了兴趣，起因是米尔顿·斯托特于 1950 年在洛杉矶皮肤病学会发表报告时介绍了一位患有假黄色弹性纤维症的女性，该女性在服用维生素 E 一年后，其皮肤和视力损伤几乎恢复正常（Arch. Derm. 60:310, 1951）。
This astounding therapeutic accomplishment in a hitherto untreatable disease led us to carry out a continuing 这一在此前无法治疗的疾病中取得的惊人治疗成就促使我们继续进行研究
clinical investigation among our private office patients with some highly gratifying results. We were able to confirm Stout’s results in 1 case of pseudoxanthoma elasticum. 在我们私人诊所的患者中进行临床调查，取得了一些非常令人满意的结果。我们能够在 1 例假黄色瘤弹性症中证实 Stout 的结果。
Another disease involving elastic tissues, epidermolysis bullosa, has also responded to large doses of Vitamin E. We have successfully treated 2 patients with the simplex type, confirming a previous report by H.D. Wilson (Can. Med. Assoc. J. 901:1315, 1964). Our findings have in turn been confirmed by Sehgal et al. (Dermatologica, 144:27, 1927), and by John Knox at the December 1972 convention of the American Academy of Dermatology, where he showed slides illustrating the clinical and histological response to Vitamin E in 3 cases of epidermolysis bullosa dystrophica. 另一种涉及弹性组织的疾病，表皮松解性水疱症，也对大剂量维生素 E 有反应。我们成功治疗了 2 例单纯型患者，证实了 H.D. Wilson（Can. Med. Assoc. J. 901:1315, 1964）之前的报告。我们的发现随后得到了 Sehgal 等人（Dermatologica, 144:27, 1927）以及 John Knox 在 1972 年 12 月美国皮肤科学会大会上的确认，他展示了 3 例表皮松解性水疱症营养不良型患者对维生素 E 的临床和组织学反应的幻灯片。
We have had gratifying results with Vitamin Ein a limited number of cases of other recalcitrant dermatoses of obscure etiology, including Raynaud’s phenomenon with gangrene, scleroderma, calcinosis cutis (Cutis, 11:54, 1973), Darier’s disease (in combination with Vitamin A), several types of cutaneous vasculitis, subcorneal pustular dermatosis, benign chronic familial pemphigus, and some cases of chronic ulcers, discoid lupus erythematosus and granuloma annulare. 我们在少数其他病因不明的顽固性皮肤病病例中使用维生素 E 取得了令人满意的效果，包括伴有坏疽的雷诺现象、硬皮病、皮肤钙化症（Cutis, 11:54, 1973）、达里埃病（与维生素 A 联合使用）、几种类型的皮肤血管炎、皮下脓疱性皮肤病、良性慢性家族性天疱疮，以及一些慢性溃疡、盘状红斑狼疮和环状肉芽肿病例。
As a beneficial side-effect it was noted that Vitamin E gave prompt relief to severe nocturnal leg cramps, which in turn led to a hobby of successfully treating various types of muscle spasms, including not only nocturnal leg cramps, but also intermittent claudication, exercise cramps, restless legs syndrome, etc., when the patient’s history revealed their presence (Calif. Med. 111: 87-91, 1969 and JAMA 219:216-217, 1972). 作为一种有益的副作用，观察到维生素 E 能迅速缓解严重的夜间腿部痉挛，这反过来引发了一种成功治疗各种类型肌肉痉挛的爱好，不仅包括夜间腿部痉挛，还包括间歇性跛行、运动痉挛、不安腿综合症等，当患者病史显示存在这些症状时（Calif. Med. 111: 87-91, 1969 和 JAMA 219:216-217, 1972）。
Vitamin E has several important functions including its antitoxidant effect in protecting unstable lipoprotein membranes of cells and intracellular organelles from peroxidative destruction, while at the same time promoting oxygen utiliza- 维生素 E 具有多种重要功能，包括其抗氧化作用，保护细胞和细胞内细胞器的不稳定脂蛋白膜免受过氧化破坏，同时促进氧的利用
tion in normal metabolic processes (Geriatrics 23:97, 1968 and Vitamins and Hormones 20:541, 1954). It also has vital relationships with certain enzymes, trace minerals such as selenium, with other vitamins. 在正常的新陈代谢过程中起作用（Geriatrics 23:97, 1968 和 Vitamins and Hormones 20:541, 1954）。它还与某些酶、微量矿物质如硒以及其他维生素有重要关系。
The question as to whether or not a certain individual is receiving the so-called minimum daily requirement of VitaminE\min \mathrm{E} is irrelevant. Adequate intake is only one aspect. Absorption and utilization are equally important and various factors of congenital or acquired origin may result in defective utilization of Vitamin E, which in turn may lead to a wide spectrum of pathological changes. We would emphasize, therefore, that we have employed Vitamin E not as a vitamin supplement, but as a potent therapeutic agent. In the conditions mentioned above, we have usually prescribed Vitamin E as d-alpha- tocopheryl acetate in doses from 400 IU to 800 IU daily, and in some cases up to 1600 or 2000 IU daily. We have encountered no untoward side-effects. Patients with severe hypertension, serious cardiac impairment, or diabetics on insulin should be started on much smaller doses such as 100 IU daily, which can be gradually increased over a period of weeks or several months. Simultaneous administration of iron inactivates Vitamin E. Vitamin E topically in the form of drops or a cream is also useful. 关于某个个体是否摄取了所谓的维生素 E 最低日需求量的问题是无关紧要的。充足的摄入只是一个方面。吸收和利用同样重要，先天或后天的各种因素可能导致维生素 E 利用不良，进而引发广泛的病理变化。因此，我们强调，我们使用维生素 E 不是作为维生素补充剂，而是作为一种强效的治疗剂。在上述情况中，我们通常以 d-α-生育酚乙酸酯的形式每日服用 400 IU 至 800 IU 的维生素 E，在某些情况下甚至达到每日 1600 或 2000 IU。我们未遇到任何不良副作用。患有严重高血压、严重心脏功能障碍或使用胰岛素的糖尿病患者应从较小剂量开始，如每日 100 IU，然后在数周或数月内逐渐增加。铁的同时服用会使维生素 E 失活。局部使用维生素 E 滴剂或乳霜也很有用。
We have had no experience with Vitamin E in progeria, but theoretically it should prove effective, if begun early in life. Hans Selye was able to induce a progeria-like syndrome in rats by feeding Vitamin D2 and he was able to block it simultaneously by administering Vitamin E (Am. Report to Distillation Products Industries 6:7, 1963). 我们在早老症方面没有使用维生素 E 的经验，但理论上如果在生命早期开始使用，应该会有效。Hans Selye 通过喂食维生素 D2 成功诱导出类似早老症的综合症，并且通过同时给予维生素 E 能够阻止该综合症的发生（美国蒸馏产品工业报告 6:7, 1963）。
The rarity of some of the dermatoses under consideration precludes the use of double blind controlled studies, but we hope that other dermatologists will try this simple, innocuous therapeutic agent in some of these recalcitrant dermatoses." 某些皮肤病的罕见性使得无法使用双盲对照研究，但我们希望其他皮肤科医生能在一些难治性皮肤病中尝试这种简单、无害的治疗剂。
APPENDIX B 附录 B
AN EXCERPT FROM AN ARTICLE BY LADY PHILLIS CILENTO 摘自菲利斯·西伦托女士的一篇文章
(Excerpted from an article which appeared in Woman’s Day, an Australian weekly magazine, for 12 November 1973.) （摘自 1973 年 11 月 12 日澳大利亚周刊《Woman’s Day》上的一篇文章。）
FACTS I FOUND 我发现的事实
At the beginning of this series I said that my aim was to discover the truth about Vitamin E. 在本系列开始时，我说过我的目标是发现关于维生素 E 的真相。
There is no question in my mind but that I have done this. From what I have seen and learnt overseas, coupled with my own experience and that of doctors like Reid Tweedie in Malaysia, Dr. R.T. of London, Mr. Lambert of Dublin, Dr. Beckmann of Germany and of Drs. Evan and Wilfrid Shute, I am convinced that the claims made for alpha-tocopherol are fully justified. 我毫无疑问地认为我已经做到了这一点。根据我在海外所见所学，加上我自己的经验以及像马来西亚的 Reid Tweedie 医生、伦敦的 R.T.医生、都柏林的 Lambert 先生、德国的 Beckmann 医生以及 Evan 和 Wilfrid Shute 医生的经验，我确信对α-生育酚的所有主张都是完全合理的。
With my own eyes I have seen pictures proving the almost miraculous effects of the vitamin on severe burns. 我亲眼见过一些图片，证明了维生素对严重烧伤几乎具有奇迹般的效果。
I have seen bent and stiffened fingers (Dupuytren’s contracture) extend and become almost normal in five weeks of treatment with alpha-tocopherol. 我见过弯曲和僵硬的手指（Dupuytren 挛缩）在五周的α-生育酚治疗后伸展并几乎恢复正常。
I have seen ulcers, eczema, gangrene disappear; I have seen wounds that had failed to respond to skin grafting healed with scarcely a scar, and I have seen new (collateral) circulation forming under the influence of alpha-tocopherol in animals, in which occlusion of a blood vessel has been artificially induced. 我见过溃疡、湿疹、坏疽消失；我见过那些对皮肤移植无反应的伤口几乎无疤痕地愈合；我还见过在动物体内，在人工诱导血管闭塞的情况下，α-生育酚影响下形成新的（侧支）循环。
I have seen angina cases lose their pain and circulation in the legs and feet restored, and I have seen coronary sufferers regain their vigor, their interest in life and their capacity for work. 我见过心绞痛患者疼痛消失，腿脚的血液循环恢复，也见过冠心病患者恢复活力，重新对生活产生兴趣并恢复工作能力。
At the end of this article I shall set out exactly the way Vitamin E has been shown to work in the body. However, firstly, I want to emphasize that Vitamin E is only one vitamin, and since all vitamins interact and balance one another, it works better in company with other vitamins such as A,BA, B, and C . 在本文末尾，我将详细说明维生素 E 在体内的具体作用方式。然而，首先，我想强调维生素 E 只是众多维生素中的一种，由于所有维生素相互作用并保持平衡，它与其他维生素如 A,BA, B 和维生素 C 一起作用效果更佳。
Also, as many of the diseases which Vitamin E benefits are caused by a number of factors, better results are obtained when alpha-tocopherol forms part of a general regimen of treatment. The other factors should not be neglected. 此外，由于维生素 E 有益的许多疾病是由多种因素引起的，当α-生育酚作为综合治疗方案的一部分时，效果更佳。其他因素也不应被忽视。
For example, in preventing coronary thrombosis or in rehabilitating a damaged heart, Vitamin E. though an essential factor, is more effective when aided by suitable exercise, balanced diet, no smoking, certain drugs and a tranquil mind, than when working alone. 例如，在预防冠状动脉血栓形成或康复受损的心脏时，维生素 E 虽然是一个必不可少的因素，但在适当的锻炼、均衡的饮食、不吸烟、某些药物和宁静的心态的辅助下，比单独作用时更有效。
Whenever I hear people ridiculing the claims of the Shutes, calling them “cranks” and refusing to consider the possibility that Vitamin E may have a saving function in cardiovascular disease, I look again at the list of deaths from heart disease in Australia. 每当我听到有人嘲笑 Shutes 的主张，称他们为“怪人”，并拒绝考虑维生素 E 可能在心血管疾病中具有救助作用的可能性时，我都会再次查看澳大利亚因心脏病死亡的名单。
Between 1950 and 1971 deaths from heart disease have climbed inexorably from 37,849 or 48.41 per cent of all deaths to 60,612 or 54.77 per cent of all deaths, despite the present methods being used and the millions of dollars being spent on research, which does NOT include Vitamin E. 在 1950 年至 1971 年间，心脏病死亡人数从 37,849 人（占所有死亡的 48.41%）无情地上升到 60,612 人（占所有死亡的 54.77%），尽管采用了现有的方法并投入了数百万美元进行研究，但这些研究并不包括维生素 E。
The Heart Foundation here in Australia has so far refused even to consider investigating the value of Vitamin E in cardiovascular disease or of making trials of its use. 澳大利亚的心脏基金会迄今为止甚至拒绝考虑调查维生素 E 在心血管疾病中的价值或进行其使用的试验。
I am reminded of the many other occasions when lifesaving innovations were delayed for years by the irrational conservatism of the medical Establishment: 我想起了许多其他场合，救命的创新因医学界非理性的保守主义而被延迟了多年：
How Lind was scoffed and attacked by his superiors and colleagues for 47 years after his discovery of the saving qualities of lemon juice for scurvy. 林德因发现柠檬汁对坏血病的救治作用后，遭到了上司和同事长达 47 年的嘲笑和攻击。
How it took 14 years and the necessities of war before the properties of penicillin were conceded and utilized. 青霉素的特性被承认和利用，花费了 14 年时间和战争的必要条件。
How I, myself, was ridiculed and dismissed as a crank by a distinguished medical teacher when in 1919 I advocated Vitamin D for cases of severe rickets. I was laughed at even though, at that time, the vitamin was curing starving babies in war-torn Vienna of this deforming disease. 1919 年，当我主张用维生素 D 治疗严重佝偻病病例时，一位著名的医学教师嘲笑我，把我当成怪人而不予理会。尽管当时这种维生素正在治愈战乱中的维也纳因营养不良而患此变形疾病的婴儿，我仍然被嘲笑。
And I am reminded of great men like Pasteur and his work on anthrax, Jenner and smallpox, Semmelweiss and childbed fever. 我想起了像巴斯德和他对炭疽病的研究，詹纳和天花，塞梅尔维斯和产褥热这样的伟人。
To the list of such men who fought the good fight against conservatism and uninformed opinion, history must now add Evan and Wilfrid Shute. 历史现在必须将埃文和威尔弗里德·舒特加入那些为反对保守主义和无知观点而英勇斗争的人名单中。
For I have seen what Vitamin E can do, and I am certain that it is destined to play as great a role in the reduction of coronary heart disease as Vitamin C has done in saving thousands of sailors from death by scurvy over the past 200 years. 因为我已经见证了维生素 E 的作用，我确信它注定将在减少冠心病方面发挥与维生素 C 在过去 200 年中拯救成千上万水手免于坏血病死亡一样重要的作用。
Once Vitamin E jumps the barriers of prejudice, it may 一旦维生素 E 突破偏见的障碍，它可能会
well be instrumental in saving the lives and sparing the suffering of many thousands of Australians who will otherwise die. 这将有助于挽救成千上万澳大利亚人的生命，减轻他们的痛苦，否则他们将会死亡。
HOW VITAMIN E WORKS IN THE BODY 维生素 E 在体内的作用机制
First and foremost it reduces the need of the tissue cells for oxygen, by preventing their destruction by over-oxidation with the formation of harmful products. Where the blood supply which carries oxygen to every cell is lessened, Vitamin E conserves that oxygen, and so the life and usefulness of the cells are preserved. 首先，它通过防止组织细胞因过度氧化而产生有害物质而被破坏，减少了细胞对氧气的需求。在血液供应减少，携带氧气到每个细胞的情况下，维生素 E 能够节约这些氧气，从而保护细胞的生命和功能。
It prevents clotting in blood vessels (thrombosis) but does not prevent normal clotting after an injury. 它能防止血管内血栓形成（血栓症），但不会阻止受伤后的正常凝血。
It also melts fresh clots and dissolves some old ones. 它还能融化新鲜的血块并溶解一些陈旧的血块。
It opens up new channels of blood supply when others are blocked and so improves circulation to a “half dead” area-such as in coronary occlusion. 当其他血管阻塞时，它会开辟新的血液供应通道，从而改善“半死”区域的循环——例如冠状动脉闭塞。
It dilates the smallest blood vessels, the capillaries, which actually bring the blood in contact with the tissues, and delivers oxygen and nourishment where it is needed most. This aids the healing of burns and ulcers. 它扩张最小的血管——毛细血管，毛细血管实际上将血液与组织接触，并将氧气和养分输送到最需要的地方。这有助于烧伤和溃疡的愈合。
It prevents the formation of hard scar tissue, softens old scars, prevents their contraction and so avoids deformities after burns and injuries. 它能防止硬疤痕组织的形成，软化旧疤痕，防止疤痕收缩，从而避免烧伤和伤害后的畸形。
It increases and sets free blood platelets when they are needed for normal clotting in wounds. 它在伤口正常凝血时增加并释放血小板。
It improves the action of insulin in diabetes and prevents many complications of this disease. 它改善了胰岛素在糖尿病中的作用，并预防了该疾病的许多并发症。
It regulates the use of proteins and fats in the body. 它调节体内蛋白质和脂肪的利用。
It stimulates the flow of urine and the action of kidneys and so reduces retention of fluid in the tissues (edema). 它刺激尿液流动和肾脏功能，从而减少组织中的液体滞留（水肿）。
It preserves the walls of the red-blood cells and prevents their destruction, especially when almost pure oxygen is breathed - as with premature babies in humidicribs and astronauts in space capsules. 它保护红细胞的细胞壁，防止其破坏，尤其是在吸入几乎纯氧的情况下——如早产儿在保温箱中和宇航员在太空舱中。
It increases the power and activity of muscle cells -heart muscle as well as ordinary muscles. 它增强了肌肉细胞的力量和活性——包括心肌和普通肌肉。
In the veterinary field Vitamin E improves the stamina and speed of racing dogs and horses, and improves the fertility of stud animals. 在兽医领域，维生素 E 提高赛狗和赛马的耐力和速度，并改善种畜的生育能力。
It improves the number and activity of the male sperm cells in the semen. 它能改善精液中男性精子细胞的数量和活力。
It normalizes the activity of the ovaries in women, improving the periods and preventing many menopausal symptoms such as excessive bleeding, dryness and irritation of the genital organs. 它能使女性卵巢的活动正常化，改善月经，预防许多更年期症状，如过度出血、生殖器官干燥和刺激。
It maintains the health and normal blood supply to the unborn baby in the early weeks of its life in the womb and prevents many types of miscarriages. This was first observed in the rat and other animals, but was later found to be equally valuable for the foetus (early unborn baby). 它维持未出生婴儿在子宫内生命早期几周的健康和正常血液供应，并预防多种类型的流产。这一现象最初在大鼠和其他动物中被观察到，但后来发现对胎儿（早期未出生婴儿）同样有价值。
Vitamin E assists the absorption and action of Vitamin A and other vitamins in the body. 维生素 E 有助于维生素 A 及其他维生素在体内的吸收和作用。
APPENDIX C 附录 C
IS COMMERCIALISM CONTROLLING THE CONTROVERSY OVER CHOLESTEROL? 商业利益是否在控制关于胆固醇的争议？
This is an abstract of an article by E.R. Pinkney which appeared in Medical Counterpoint for May 1971. The abstract appeared in The Summary, a publication of the Shute Foundation for Medical Research, London, Ontario, Canada. It is reprinted here with the permission of the Foundation. 这是 E.R. Pinkney 于 1971 年 5 月在 Medical Counterpoint 上发表的一篇文章的摘要。该摘要刊登在加拿大安大略省伦敦的 Shute 医学研究基金会出版的 The Summary 中。经基金会许可，现转载于此。
There is still no good clinical evidence that a dietlowered serum cholesterol in any way prevents or modifies heart attacks or heart disease. 目前仍无确凿的临床证据表明，降低血清胆固醇的饮食能以任何方式预防或改变心脏病发作或心脏病。
And yet for over twelve years a large number of physicians have attempted to control their patients’ serum cholesterol. 然而，十多年来，许多医生一直试图控制患者的血清胆固醇。
The World Heath Organization reports an increase in morbidity and mortality from atherosclerotic heart disease. By contrast, in Japan, the consumption of dairy products, eggs and saturated fats has increased greatly since 1955. But 世界卫生组织报告动脉粥样硬化性心脏病的发病率和死亡率有所增加。相比之下，自 1955 年以来，日本的乳制品、鸡蛋和饱和脂肪的消费大幅增加。但
that country had a 14 percent decrease in heart deaths for the same period. 该国同期心脏病死亡率下降了 14%。
There has been practically no change in the cholesterol consumed over the past 60 years. But in the same era the heart attack rate has climbed rapidly. 在过去的 60 年里，摄入的胆固醇几乎没有变化。但在同一时期，心脏病发作率迅速上升。
Those who believe in the relationship of serum cholesterol to coronary heart disease find that no test proved more helpful than an accurate total serum cholesterol. The measurement of serum cholesterol has become the principal indicator of the health of one’s heart and blood vessels to both public and the medical profession alike. 那些相信血清胆固醇与冠心病关系的人发现，没有哪种检测比准确的总血清胆固醇更有帮助。血清胆固醇的测量已成为公众和医学界判断心脏及血管健康的主要指标。
Any stress, small or great, can alter the level of serum cholesterol. 任何压力，无论大小，都能改变血清胆固醇的水平。
Advertising P.U.F.A.* as helpful for hearts is permitted-even in reputable medical journals, although there is not a bit of proof to back such claims. Simultaneously the Food and Drug Administration requires a most specific disclaimer of any positive relationship between the lowering of cholesterol and the prevention of coronary heart disease. Since 1959 the F.D.A. has threatened to prosecute any manufacturer who relates polyunsaturates to the prevention of heart disease but no action has been taken to this moment. The ads still appear. 广告允许将多不饱和脂肪酸（P.U.F.A.*）宣传为对心脏有益——即使是在有声望的医学期刊中，尽管没有任何证据支持这种说法。与此同时，食品药品管理局（F.D.A.）要求对降低胆固醇与预防冠心病之间的任何积极关系作出非常具体的免责声明。自 1959 年以来，F.D.A.威胁要起诉任何将多不饱和脂肪酸与预防心脏病联系起来的制造商，但至今尚未采取任何行动。广告仍然存在。
There is ample evidence that heating polyunsaturates tend to resaturate (or polymerize) the product and so defeats the very purpose for which polyunsaturates are promoted. Resaturation of polyunsaturates by heating occurs in family cooking. The degree of saturation becomes even worse if the fat or oil is reused, as is common household practice. 有大量证据表明，加热多不饱和脂肪酸会使其重新饱和（或聚合）产物，从而违背了推广多不饱和脂肪酸的初衷。家庭烹饪中多不饱和脂肪酸的重新饱和就是通过加热发生的。如果脂肪或油被重复使用（这是家庭常见的做法），饱和度问题会更加严重。
Heating an unsaturated oil (especially corn oil) to 200^(@)200^{\circ} for 15 minutes (far less than normal cooking temperatures and time) actually enhances atherosclerosis in animals. 将不饱和油（尤其是玉米油）加热至 200^(@)200^{\circ} ，持续 15 分钟（远低于正常烹饪的温度和时间）实际上会加剧动物的动脉粥样硬化。
In Kummerow’s study all his animals on a diet containing 在 Kummerow 的研究中，所有动物都采用含有…的饮食
heated corn oil developed tumors, and only one of 96 survived the 40 -month experimental period. None of the animals fed only fresh corn oil developed tumors; all survived. 加热的玉米油导致肿瘤，96 只中只有一只在 40 个月的实验期间存活。仅喂食新鲜玉米油的动物没有发生肿瘤；全部存活。
Men on a high P.U.F.A. diet showed a 65 percent greater incidence of cancer than controls on a standard diet. The J.A.M.A. reporting this finding also noted that those on the high P.U.F.A. diet also had 70 fatal atherosclerotic accidents as compared to only 48 such deaths in the controls; a similar ratio was found for myocardial and cerebral infarcts. 高多不饱和脂肪酸（P.U.F.A.）饮食的男性癌症发病率比标准饮食组高出 65%。报道这一发现的《美国医学会杂志》（J.A.M.A.）还指出，高多不饱和脂肪酸饮食组发生致命性动脉粥样硬化事件的次数为 70 次，而对照组仅有 48 次；心肌梗死和脑梗死的比例也类似。
Polyunsaturates may be a primary source of the radicals inside the cell that cause aging. 多不饱和脂肪酸可能是细胞内导致衰老的自由基的主要来源。
The serum cholesterol level falls only three mgm for each 100 mgm of cholesterol taken out of the diet. 血清胆固醇水平每减少摄入 100 毫克胆固醇，仅下降 3 毫克。
After 20 years of low fat diets and the spending of several hundred million dollars, there is still no convincing evidence for this idea that these fats matter. 经过 20 年的低脂饮食和数亿美元的投入，仍然没有令人信服的证据表明这些脂肪有影响。
Yet even the eminent National Heart and Lung Institute has lately published a set of guidelines for physicians. This recommends that certain individuals with an elevated serum cholesterol should use polyunsaturates. 然而，即使是著名的国家心脏与肺研究所最近也发布了一套针对医生的指南。该指南建议某些血清胆固醇升高的个体应使用多不饱和脂肪酸。
One cannot show that, subsequent to reduction of patient’s serum cholesterol values, the cholesterol itself actually leaves the body. 无法证明，在患者血清胆固醇值降低后，胆固醇本身实际上离开了身体。
AUTHOR'S ADDENDUM 作者补遗
SINCE THE COMPLETION of the majority of the work on this book, new statistics have become available which shed a somewhat different-and very interesting-light on death from heart disease in the American population. 自本书大部分工作完成以来，新的统计数据已经发布，这些数据为美国人口中心脏病死亡情况提供了一个有些不同且非常有趣的视角。
Although the total number of deaths per hundred thousand from heart disease has risen during the past couple of decades, it appears that deaths from heart disease and some other causes have been declining when measured on an ageadjusted basis-a statistical approach which takes into account the fact that the average age is increasing. 尽管过去几十年每十万人中心脏病死亡总数有所上升，但按年龄调整后的统计方法——一种考虑到平均年龄增长的统计方法——显示心脏病及其他一些原因导致的死亡率实际上在下降。
Then, on January 24, 1975, at an American Heart Association Seminar, Dr. Jeremiah Stamler announced that the heart attack rate among American men had started a downward trend for the first time. 然后，在 1975 年 1 月 24 日的美国心脏协会研讨会上，Jeremiah Stamler 博士宣布美国男性的心脏病发作率首次开始呈下降趋势。
Anyone who has read all the way through this book, 任何读完这本书的人，
should feel no surprise. The whole point of the book is the contrast between the ineffectiveness of orthodox treatment and prevention of cardiovascular disease, and the effective treatment and prevention of cardiovascular disease with adequate Vitamin E therapy. Thirty million Americans taking Vitamin E had to produce such a reduction, and the 10,000 lives saved in 1974 has to be just about that anticipated after six years of prophylactic EE in such a large section of the population. 不应感到惊讶。这本书的重点是正统治疗和预防心血管疾病的无效性，与通过足够的维生素 E 治疗有效治疗和预防心血管疾病之间的对比。三千万美国人服用维生素 E 必然带来了这样的减少，1974 年挽救的 1 万人生命几乎正是经过六年预防性 EE 后，在如此大的人群中所预期的结果。
If there is any other explanation, it has not been suggested so far. The last paragraph in my book Vitamin E for Ailing and Healthy Hearts reads as follows: 如果有其他解释，到目前为止还没有提出。我的书《Vitamin E for Ailing and Healthy Hearts》中的最后一段内容如下：
“My father saw few cases of coronary occlusion and few diabetics. I have seen thousands. There was no coronary thrombosis in 1900. There need be none in the year 1980. It’s up to you now.” “我父亲见过的冠状动脉闭塞病例很少，糖尿病患者也很少。而我见过成千上万。1900 年没有冠状动脉血栓形成。1980 年也不必有。这现在取决于你们了。”
Now, six years later, it seems that such a hope just could be within our grasp. 现在，六年过去了，这样的希望似乎就在我们触手可及之处。
Wilfrid E. Shute, B.A., M.D. Wilfrid E. Shute，文学士，医学博士
Lake Worth, Florida 佛罗里达州沃斯湖
February 22, 1975 1975 年 2 月 22 日
INDEX 索引
A
Aging 衰老
polyunsaturated fats and, 114, 216 多不饱和脂肪，114，216
retina and, 140 视网膜，140
vitamin E and, 51 维生素 E 和，51
Air pollutants, vitamin EE and protection against, 51, 53-54 空气污染物，维生素 EE 及其防护，51，53-54
Alcohol consumption, heart attack risk and, 13, 14 酒精消费、心脏病发作风险，13，14
Allergic reactions to vitamin E, 130131, 179, 185 维生素 E 的过敏反应，130131，179，185
Alsleben, H. Rudolph, 145 Alsleben，H. Rudolph，145
Ambulation after heart attacks, 27, 29, 117, 185 心脏病发作后的行走，27，29，117，185
Anemia 贫血
hypothyroidism and, 95 甲状腺功能减退症，95
incidence in women, 95, 96 女性发病率，95，96
vitamin E in, 45, 61, 75, 199 维生素 E，45，61，75，199
Angina pectoris, 123-124 心绞痛，123-124
chest pain in, 178 胸痛，178
described, 121-122 描述，121-122
diagnosis, 135 诊断，135
hypothyroidism and, 95 甲状腺功能减退症，95
incidence, 121 发病率，121
prognosis, 122-123 预后，122-123
vitamin E in, 124, 170, 211 维生素 E，124，170，211
Anticoagulants 抗凝剂
complications of therapy with, 23 , 24, 25 治疗并发症，23，24，25
in heart attacks, 22-26, 28, 185 在心脏病发作中，22-26，28，185
in intermittent claudication, 148, 150 间歇性跛行，148，150
mortality from heart attacks and, 23-24,25,2823-24,25,28 心脏病发作的死亡率，以及， 23-24,25,2823-24,25,28
questions on use of, 23,24,26-2723,24,26-27 关于使用的疑问， 23,24,26-2723,24,26-27
in thrombosis prevention, 155 在血栓预防中，155
Antioxidant function of vitamin E, 58, 86, 87-90, 182, 186, 208, 213 维生素 E 的抗氧化功能，58，86，87-90，182，186，208，213
Antispasmodics in coronary thrombosis, 185 冠状动脉血栓形成中的解痉药，185
Antithrombin. See also Blood coagulation 抗凝血酶。另见血液凝固
alpha tocopherol and 13-14, 40, 46, 86-87 α-生育酚和 13-14、40、46、86-87
coagulation and, 40, 46 凝血，40，46
myocardial infarction and, 13-14 心肌梗死，13-14
Armchair therapy for heart attacks, 28-29, 117, 118, 185 心脏病发作的沙发疗法，28-29，117，118，185
Arteriosclerosis. See also Atherosclerosis 动脉硬化。另见动脉粥样硬化
complications of, 88 并发症，88
hypothyroidism and, 95 甲状腺功能减退症，95
incidence of, 136-137 发病率，136-137
Ascorbic Acid. See Vitamin C 抗坏血酸。见维生素 C
Aspirin in thrombosis prevention, 155 阿司匹林在血栓预防中的应用，155
Atherosclerosis, 136-145 动脉粥样硬化，136-145
B vitamins for, 143 维生素 B，143
diet in therapy of, 143,215,216143,215,216 治疗中的饮食， 143,215,216143,215,216
hypothyroidism and, 95 甲状腺功能减退症，95
incidence of, 164, 214 发生率，164，214
intermittent claudication and, 146 间歇性跛行，146
intravenous chelation with EDTA in, 140-142, 145, 152 静脉注射 EDTA 螯合疗法，140-142，145，152
myocardial infarction and, 137-138 心肌梗死，137-138 页
orotic acid salts for, 143,145 乳清酸盐，用于，143,145
retinal, 89, 140, 183 视网膜，89，140，183
thyroid extract for, 143 甲状腺提取物，143
vitamin C for, 139, 140, 183 维生素 C，139，140，183
vitamin C plus E for, 139, 140, 152 维生素 C 加 E，139，140，152
vitamin E for, 139, 140, 142-143, 144, 152 维生素 E 用于，139，140，142-143，144，152
Ayres, Samuel, Jr., 59-60, 61-62, 64,
Ayres, Samuel, Jr. Cont. Ayres，Samuel，Jr. Cont.
75, 207
B
Bailey, Herbert, 71 贝利，赫伯特，71
Barnes, Broda O., 143, 144
Barnett, H. J. M., 165
Baroldi, G., 103
Beck, D. R., 23 贝克，D. R.，23
Bed rest. See Rest 卧床休息。参见 Rest
Begg, T. B., 147
Birth control pills, side effects of, 9697,165 避孕药，副作用，9697,165
Birthmarks, vitamin E for, 179-180 胎记，维生素 E 治疗，179-180
Blood coagulation 血液凝固
antithrombin and, 40, 46 抗凝血酶，40，46
causative factors in, 38-39 诱因，38-39
heart attacks and intravascular, 1920, 39 心脏病发作和血管内，1920 年，39
vitamin E and, 43-44, 57, 58, 86-87, 157, 213 维生素 E 和，43-44，57，58，86-87，157，213
Blood clots. See Thrombosis 血栓。见血栓形成
Blood pressure. See Hypertension 血压。参见高血压
Blood vessels. See Arteriosclerosis; Atherosclerosis; Thrombosis; Vasoconstriction; Vasodilation 血管。参见动脉硬化；粥样硬化；血栓形成；血管收缩；血管扩张
Bradess, V. A., 103
Brain. See also Stroke(s) 脑。另见中风
alpha tocopherol action on, 88, 89, 165 alpha tocopherol 的作用，88，89，165
hemorrhage, 167 出血，167
sensitivity to anoxia, 165,166 对缺氧的敏感性，165,166
softness, vitamin E and, 88 柔软度，维生素 E 和，88
Brown and MacMillan, study on anticoagulants, 24-25, 26, 27 Brown 和 MacMillan，关于抗凝剂的研究，24-25，26，27
Buerger’s disease, vitamin E and, 59, 87 布尔格病，维生素 E，第 59 页，第 87 页
Burns, vitamin E and, 59, 64-65, 76, 92, 174-176, 185, 203, 210, 213 烧伤，维生素 E，59，64-65，76，92，174-176，185，203，210，213
Bypass procedures in cardiovascular diseases, 33-35, 124 心血管疾病中的旁路手术，33-35，124
C
Cancer 癌症
dietary polyunsaturated fats and, 216 膳食多不饱和脂肪，216
vitamin E deficiency and, 205, 206 维生素 E 缺乏症，205，206
Capillary permeability, vitamin E and, 毛细血管通透性，维生素 E 和，
58, 86, 90-91
Cardiovascular disease 心血管疾病
causative factors, 13-14, 37-38, 103105, 106-119 致病因素，13-14，37-38，103-105，106-119
coronary atherosclerosis and, 137138 冠状动脉粥样硬化，137138
dietary fat and, 137-138, 139 膳食脂肪，137-138，139
environmental factors and, 39-40, 44-46 环境因素，39-40，44-46
hypothyroidism and, 111 甲状腺功能减退症，111
incidence of, 14-15,40-41,18914-15,40-41,189 发生率， 14-15,40-41,18914-15,40-41,189
interaction of vitamins C and E in, 133-134 维生素 C 和 E 的相互作用，133-134
intravascular clotting and, 19-20, 39 血管内凝血，19-20，39
mortality from, 14-15,15-16,19,3714-15,15-16,19,37, 96 死亡率来自， 14-15,15-16,19,3714-15,15-16,19,37 ，96
myocardial oxygenation and, 47 心肌供氧，47
nutritional deficiencies and, 37-38 营养缺乏症，37-38
prevention of, 13-14, 36-37, 42-43, 103-105, 106-119; vitamin E in, 13-14, 42-43, 217 预防，13-14，36-37，42-43，103-105，106-119；维生素 E 在其中，13-14，42-43，217
prognosis, 105-106 预后，105-106
recurrence of, 19-20 复发，19-20
results of vitamin EE discontinuance in, 184 维生素 EE 停用的结果，184 页
subclinical hypothyroidism and, 95 亚临床甲状腺功能减退症，95
therapy of. See Cardiovascular disease therapy 治疗。参见心血管疾病治疗
Cardiovascular disease therapy 心血管疾病治疗
anticoagulants in, 22-26, 26-27, 28, 185 抗凝剂，22-26，26-27，28，185
combination megavitamin therapy, 92, 93-94 联合大剂量维生素治疗，92，93-94
estrogens in, 96, 97 雌激素，96，97
surgery in, 17,18,21,29-35,123-17,18,21,29-35,123- 124 手术于， 17,18,21,29-35,123-17,18,21,29-35,123- 124
value of classical, 16-19 经典价值，16-19
with vitamin E, 13-14, 58, 165, 166167, 185, 198-199, 200-202, 217; dosage in, 49; evaluation of, 66; Lady Cilento on, 84,210-21384,210-213; physicians’ acceptance of, 76, 8182; recommendations on, 116118, 185 与维生素 E 相关，13-14，58，165，166-167，185，198-199，200-202，217；剂量，49；评估，66；Lady Cilento 关于， 84,210-21384,210-213 ；医生的接受度，76，81-82；建议，116-118，185
Cathcard, Robert F., III, 61 Cathcard，Robert F.，三世，61
Cerebrovascular accidents. See Stroke(s) 脑血管意外。见中风
Cervical ganglionectomy, use of, 30 颈神经节切除术的使用，30
Chemical structure of vitamin E, 42, 50 维生素 E 的化学结构，42，50
Chlorothiazides in hypertension therapy, 162, 163 氢氯噻嗪在高血压治疗中的应用，162，163
Cholesterol 胆固醇
atherosclerosis and serum, 139 动脉粥样硬化与血清，139
dietary fats and serum, 204-205, 216 膳食脂肪和血清，204-205，216
drug therapy for hypercholesteremia, 115-116 高胆固醇血症的药物治疗，115-116
heart attacks and serum, 107, 108109, 113-116, 214-216 心脏病发作和血清，107，108109，113-116，214-216
measurement of serum, 114,215 血清测量，114,215
synthesis in body, 113 体内合成，113
vitamin C and, 139 维生素 C，139
Cigarette smoking. See Smoking 吸烟。参见 Smoking
Cilento, Lady Phyllis, 82-84, 210-213 Cilento，Lady Phyllis，第 82-84 页，第 210-213 页
Circulation. See Collateral circulation; 循环。参见侧支循环；
Vasoconstriction; Vasodilation 血管收缩；血管扩张
Coagulation. See Blood coagulation 凝血。见血液凝固
Collagen diseases, vitamin E and, 60, 81-82, 92, 207-208 胶原疾病，维生素 E，60，81-82，92，207-208
Collateral circulation, vitamin E and, 58, 59, 60, 86, 88, 89, 91-92, 135136, 170, 183, 185, 213 侧支循环，维生素 E，58，59，60，86，88，89，91-92，135136，170，183，185，213
Buerger’s disease, 59, 87 布尔格病，59，87
gangrene, 89, 169, 171, 208, 211; See also Gangrene 坏疽，89，169，171，208，211；另见 Gangrene
intermittent claudication. See Intermittent claudication 间歇性跛行。参见 Intermittent claudication
leg cramps, 61-62, 75, 208 腿部抽筋，61-62，75，208
Raynaud’s syndrome, 208 雷诺氏综合症，208
Congenital anomalies, cardiac surgery in, 30 先天性畸形，心脏手术，30
Corday, Eliot, 33, 36, 37, 116, 123-124 Corday, Eliot，第 33、36、37、116、123-124 页
Coronary artery bypass, 33-35 冠状动脉搭桥手术，33-35
Coronary artery sclerosis, myocardial infarction and, 137-138 冠状动脉硬化，心肌梗死，137-138
Coronary thrombosis. See Cardiovascular disease; Heart attack(s); Thrombosis 冠状动脉血栓形成。参见心血管疾病；心脏病发作；血栓形成
Cott, Alan, 19, 64, 197 Cott，Alan，19，64，197
D
Davis, Adelle, 176 戴维斯，阿黛尔，176
Death. See Mortality from cardiovascular disease 死亡。参见心血管疾病的死亡率
Decker, R., 147-148
Dermatology. See Skin 皮肤病学。参见 Skin
Dextran in thrombosis prevention, 155 血栓预防中的右旋糖酐，155
Diabetes, 169-172 糖尿病，169-172
gangrene in, 89, 169, 171 坏疽，89，169，171
heart attack risk and, 106, 109, 112 心脏病发作风险，106，109，112
hypertension and, 172 高血压，172
incidence of, 170, 217 发生率，170，217
insulin plus diet in therapy of, 171 胰岛素加饮食治疗，171
intermittent claudication and, 147, 148 间歇性跛行，147，148
mortality from, 170 死亡率，170
retina in, 140 视网膜，140
thyroid hormone and, 143 甲状腺激素，143
vascular complications of, 171 血管并发症，171
vitamin C in, 140, 172 维生素 C，140，172
vitamin E in, 59, 89, 140, 169-172, 213 维生素 E，59，89，140，169-172，213
Diet. See Nutrition 饮食。参见 Nutrition
Digitalis 洋地黄
determination of dosage of, 66, 128129, 182 剂量的确定，66，128129，182
in fibrillation, 128, 129 在心房颤动中，128，129
in heart attacks, 23 心脏病发作中，23
potentiation of action of, 129 作用的增强，129
toxicity of, 129, 182 毒性，129，182
vitamin E and, 182 维生素 E，第 182 页
Dimond, G. E., 105, 106
Diuretics 利尿剂
action of digitalis and, 129 地高辛的作用，129
for heart failure, 128 用于心力衰竭，128
Dosage 剂量
need for research on, 66-67 对……的研究需求，66-67
of vitamin C,185 维生素 C 的，185
of vitamin E. See Dosage of vitamin E 维生素 E 的剂量。见维生素 E 的剂量
Dosage of vitamin E, 49, 56, 57 维生素 E 的剂量，49，56，57
in acute coronary thrombosis, 185 在急性冠状动脉血栓形成中，185
in atherosclerosis, 140,143,144,152140,143,144,152 在动脉粥样硬化中， 140,143,144,152140,143,144,152
in burns, 185 烧伤中，185
cautions in determination of, 62 测定中的注意事项，62
in dermatologic ointments, 62, 179, 185 在皮肤科软膏中，62，179，185
as dietary supplement, 54, 189 作为膳食补充剂，54，189
digitalis dosage and, 182 地高辛剂量，182
in edema, 49 在水肿中，49
estrogens and, 182 雌激素，182
in hyperkinesis, 196-197 在多动症中，196-197 页
in hypertension, 163, 168, 182, 200 在高血压中，163，168，182，200
individualization to patient, 181- 针对患者的个体化，181-
Dosage of vitamin E Cont. 186, 200 维生素 E 的剂量 续 186，200
for infants, 62, 189 婴儿用，62，189
inorganic iron and, 182 无机铁，182
in intermittent claudication, 149150, 185 间歇性跛行，149150，185
in nephritis, 184 在肾炎中，184
in peripheral vascular diseases, 185 在周围血管疾病中，185
in phlebitis, 159, 184 在静脉炎中，159，184
range of, 49 范围为，49
recommended dietary requirements, 48, 49-51 推荐的膳食需求，48，49-51
in rheumatic fever, 184, 185 在风湿热中，184，185
in rheumatic heart disease, 127, 128, 130, 131, 168, 183-184, 186, 200 在风湿性心脏病中，127，128，130，131，168，183-184，186，200
in rheumatoid arthritis, 183 类风湿性关节炎中，183
in strokes, 168 中风中，168
for ulcers and wounds, 185 用于溃疡和伤口，185
E
Edema 水肿
blood oxygenation and, 88 血液氧合，88
phlebitis and, 156, 159 静脉炎，156，159
vitamin E in, 49, 61, 75, 134-135, 213 维生素 E 见 49、61、75、134-135、213 页
EDTA in intravenous chelation for atherosclerosis, 140-142, 145, 152 静脉注射 EDTA 用于动脉粥样硬化的螯合治疗，140-142，145，152
Environmental factors in heart attacks, 39-40, 44-46 心脏病发作中的环境因素，39-40，44-46
Enzymes, vitamin E and, 209 酶，维生素 E 和，209
Estrogens 雌激素
hypertension and, 165 高血压，165
side-effects of therapeutic, 96-98, 156 治疗的副作用，96-98，156
thromboembolism and, 156 血栓栓塞，156
thyroid hormone and, 94-96 甲状腺激素，94-96
vitamin E and, 94-96, 131, 182 维生素 E 和，94-96，131，182
Ethylene diamine tetra-acetic acid (EDTA) in intravenous chelation for atherosclerosis, 140-142, 145, 152 静脉注射螯合治疗动脉粥样硬化中的乙二胺四乙酸（EDTA），140-142，145，152
Exercise 锻炼
heart attack risk and, 109, 111-112 心脏病发作风险，109，111-112
in intermittent claudication therapy, 151, 185 间歇性跛行治疗，151，185
myocardial infarction prevention and, 13, 14 心肌梗死预防，13，14
F
Fat(s). See also Cholesterol 脂肪。另见胆固醇
dangers of low-fat diets, 137-138, 139, 204-205, 216 低脂饮食的危险，137-138，139，204-205，216
heart attacks and consumption of, 54, 104, 107, 108-109, 113-116, 137-138, 139, 214-216 心脏病发作和消费，54，104，107，108-109，113-116，137-138，139，214-216
serum cholesterol and dietary, 204205, 216 血清胆固醇和饮食，204205，216
vitamin E and metabolism of, 52, 53, 54, 55, 208, 213 维生素 E 与代谢，52，53，54，55，208，213
Feingold, Benjamin, 194-195
Fertility, vitamin E and, 213 生育力，维生素 E，213
Fibrillation, management of, 128,129, 182 心房颤动的管理，128,129, 182
Fisher, B. H., 173
Food 食物
dangers of food additives, 193-195 食品添加剂的危害，193-195
nutrition and processing of, 39, 4446, 188-189, 193-194 营养与加工，39，4446，188-189，193-194
Freis, E. D., 162
G
Gallbladder disease, estrogen therapy and, 97 胆囊疾病，雌激素治疗，97
Gangrene 坏疽
arteriosclerosis and, 88 动脉硬化，88
in diabetes, 89, 169, 171 在糖尿病中，89，169，171
intermittent claudication and, 147 间歇性跛行，147
vitamin E in, 89, 169, 171, 208, 211 维生素 E，89，169，171，208，211
Glatzel, H., 104
Goodley, Paul, 178 Goodley，Paul，178
Gynecologic disorders 妇科疾病
estrogens for, 98 雌激素，98
vitamin E and, 60, 98, 213 维生素 E 和，60，98，213
H
Hacker, R. W., 147-148
Haeger, Knüt, 76, 78, 150, 151, 184
Hartroft, W. Stanley, 107
Heart 心脏
damage to, survival after heart attacks and, 106 心脏病发作后的损伤、生存率，106
function in circulation, 38 循环中的功能，38
vitamin E action on, 88, 89, 162, 182 维生素 E 的作用，88，89，162，182
Heart attack(s), 21; See also Cardiovascular disease 心脏病发作，21；另见心血管疾病
age distribution of, 14, 15, 189 年龄分布，14，15，189
ambulation after, 27, 29, 185 步行之后，27，29，185
anticoagulant therapy for, 22-26, 26- 抗凝治疗，22-26，26-
Heart attack(s) Cont. 27, 28, 185 心脏病发作 续 27, 28, 185
armchair therapy for, 28-29, 117, 118, 185 扶手椅疗法，28-29，117，118，185
bed rest in treatment of, 27, 28-29, 117, 118, 185 治疗中的卧床休息，27，28-29，117，118，185
causes of, theories on, 13-14, 37-38, 103-105, 106-119 原因，理论，13-14，37-38，103-105，106-119
complications of drug therapy for, 23, 24, 25 药物治疗的并发症，23，24，25
coronary artery thrombosis and, 103-105 冠状动脉血栓形成，103-105
criticisms of conventional treatment of, 21-35 对传统治疗的批评，21-35 页
dietary fats and, 54, 104, 107, 108109, 113-116, 214-216 膳食脂肪，54，104，107，108109，113-116，214-216
digitalis use in, 23 洋地黄的使用，23
early signs of, 105 早期症状，105
emergency treatment of, 117 紧急治疗，117
environmental factors and, 39-40, 44-46 环境因素，39-40，44-46
estrogen therapy and, 97 雌激素治疗，97
evaluation of risk factors in development of, 106, 107, 108-116, 214-216 发展中风险因素的评估，106，107，108-116，214-216
incidence of, 14,15,40-41,138,18914,15,40-41,138,189 发生率， 14,15,40-41,138,18914,15,40-41,138,189
intensive coronary care units and survival from, 27-28, 29 重症冠状动脉护理病房与生存率，27-28，29
intravascular blood clotting and, 1920, 39 血管内血液凝固，1920 年，39 页
mortality from, 14-15,15-16,19,23-14-15,15-16,19,23- 24, 25, 37, 96, 105-106, 164; See also Mortality from cardiovascular disease 死亡率， 14-15,15-16,19,23-14-15,15-16,19,23- 24, 25, 37, 96, 105-106, 164；另见心血管疾病死亡率
myocardial oxygenation and, 47, 88 心肌供氧，47，88
pain of, 178 疼痛，178
prevention of, 13-14, 36-37, 42-43, 103-105, 106-119 预防，13-14，36-37，42-43，103-105，106-119
prognosis after, 105-106 预后，105-106
prophylactic vitamin E in, 13-14, 4243, 89, 118, 119, 204, 217 预防性维生素 E，13-14，4243，89，118，119，204，217
recommendations on treatment of, 116-118, 185 关于治疗的建议，116-118，185
recurrence risk after, 19-20, 106 复发风险，19-20，106
serum cholesterol and, 107, 108-109, 113-116, 214-216 血清胆固醇，107，108-109，113-116，214-216
sex distribution of, 14, 40-41 性别分布，14，40-41
surgery after, 17,18,21,29-35,123-17,18,21,29-35,123- 手术后， 17,18,21,29-35,123-17,18,21,29-35,123-
124
survival probability after, 105-106 存活概率在 105-106 之后
therapeutic vitamin E for, 47, 116118, 198-199 治疗性维生素 E，47，116-118，198-199
zone of injury in, 166-167 受伤区域，166-167
Heart failure 心力衰竭
hypertension and, 162 高血压，162
management of, 128 管理，128
Heart transplant surgery, 32 心脏移植手术，32
Hemolytic anemia, vitamin E in, 49, 61 溶血性贫血，维生素 E，49，61
Hodges, Robert E., 50, 51 霍奇斯，罗伯特·E.，50，51
Hoffer, Abraham, 19, 63
Horwitt, M. K., 77-78, 79
Huff, Paul H., 142 哈夫，保罗·H.，142
Hyperkinetic children 多动症儿童
dietary management of, 194-195 饮食管理，194-195
megavitamin therapy for, 64 大剂量维生素治疗，64
vitamin E therapy for, 197 维生素 E 疗法，197
Hypertension 高血压
chlorothiazides for, 162, 163 氯噻嗪类药物，162，163
common factors in, 161-162 共同因素，161-162 页
diabetes and, 172 糖尿病，172
estrogens and, 96-97, 165 雌激素，96-97，165
heart attack risk and, 106, 109, 110 心脏病发作风险，106，109，110
prognosis of, 162, 164 预后，162，164
retinal atherosclerosis and, 140 视网膜动脉粥样硬化，140
risks in, 162, 164 风险见 162，164 页
thyroid hormone and, 144 甲状腺激素，144
treatment of post-infarction, 118 心肌梗死后治疗，118
vitamin E and, 162-164, 182 维生素 E，162-164，182
Hypoglycemia 低血糖
diet in treatment of, 64 治疗中的饮食，64
triple vitamin megatherapy of, 93 三重维生素大疗法，93
Infections 感染
capillary permeability in, 91 毛细血管通透性，91
vitamin C in, 63 维生素 C，63
vitamin E in, 91 维生素 E，91
vitamins and susceptibility to, 41-42 维生素与易感性，41-42
Insulin 胰岛素
adjustments of dosage in diabetes, 66, 170, 181 糖尿病剂量调整，66，170，181
value in treatment of diabetes, 171 治疗糖尿病的价值，171
vitamin E and action of, 170, 213 维生素 E 及其作用，170，213
Intensive coronary care units, mortal- 重症冠状动脉护理病房，死亡率-
ity from heart atacks and, 27-28, 29 心脏病发作的死亡率，27-28，29
Intermittent claudication, 146-151 间歇性跛行，146-151
Intermittent claudication Cont. 间歇性跛行 续。
anticoagulants in treatment of, 148, 150 抗凝剂在治疗中的应用，148，150
described, 146 描述，146
exercise in treatment of, 151, 185 治疗中的锻炼，151，185
incidence of, 147, 148-149, 150-151 发病率，147，148-149，150-151
pre-existing conditions and, 147 既有病症，147
prognosis of, 147, 148-149, 150-151 预后，147，148-149，150-151
prophylactic vitamin E in, 89 预防性维生素 E，第 89 页
surgery in treatment of, 148 手术治疗，148
vasodilators in treatment of, 148, 150 血管扩张剂在治疗中的应用，148，150
vitamin E in treatment of, 76, 78, 79, 80, 89, 149-150, 150-151, 184, 185, 199, 208 维生素 E 在治疗中的应用，76，78，79，80，89，149-150，150-151，184，185，199，208
Intravenous chelation with EDTA for atherosclerosis, 140-142, 145, 152 静脉注射 EDTA 螯合治疗动脉粥样硬化，140-142，145，152
Iron, alpha tocopherol and inorganic, 130, 182 铁，α-生育酚和无机，130，182
Isolation of alpha tocopherol, 42, 43 α-生育酚的分离，42，43
Jelliffe, Roger W., 129 Jelliffe，Roger W.，129
K
Kakkar, V., 154
Kannel, William B., 122-123, 147
Keloids, vitamin E and, 92-93 瘢痕疙瘩，维生素 E，第 92-93 页
Kern, Berthold, 107, 112
Keys, Ancel, 108 Keys, Ancel，108
Kidney 肾脏
hypertension and renal failure, 162 高血压和肾功能衰竭，162
vitamin E in diseases of, 90, 91, 125, 184 维生素 E 在疾病中的应用，90，91，125，184
vitamin E and function of, 213 维生素 E 及其功能，213
Kira, Sadao, 183
Knauer, Virginia, 191 Knauer，Virginia，191
Kumerow’s study on corn oil, 114 Kumerow 关于玉米油的研究，114
L
Lambert, N. H., 83, 170
Leg cramps, vitamin E and, 61-62, 75, 208 腿部抽筋，维生素 E，61-62，75，208
Levine, S. A., 28, 29, 185
Lung 肺
heart attack prognosis and pulmonary diseases, 106 心脏病发作预后和肺部疾病，106
vitamin A and function of, 51, 52 维生素 A 及其功能，51，52
vitamin E and function of, 51, 53 维生素 E 及其功能，51，53
vitamin EE in protection against pollutants, 51, 53-54 维生素 EE 在防护污染物中的作用，51，53-54
M
MacMillan and Brown, study on anticoagulants, 24-25, 26, 27 MacMillan 和 Brown，关于抗凝剂的研究，24-25，26，27
Manipulation for pain relief, 177-178 疼痛缓解的操作，177-178
Marple, C. D., 23
Mastitis, vitamin E and, 60, 97 乳腺炎，维生素 E，60，97
Megavitamin therapy. See also Megavitamin therapy with vitamin E 大剂量维生素疗法。另见维生素 E 大剂量疗法
cautions in dosages for, 62 剂量注意事项，62
defined, 41 定义，41
extension of use of, 63 使用范围的扩展，63
diet plus, in atherosclerosis, 143 饮食加上，动脉粥样硬化，143
future prospects for, 198-206 未来展望，198-206
in hyperkinetic children, 64 在多动症儿童中，64
in schizophrenia, 63, 64 在精神分裂症中，63，64
with vitamin C. See Vitamin C 与维生素 C 一起使用。见维生素 C
Megavitamin therapy with vitamin E. 维生素 E 的大量维生素治疗。
See also under specific condition, e.g., Rheumatic heart disease 另见特定情况，如风湿性心脏病
American Medical Association on, 70 美国医学会，第 70 页
dosages in. See Dosage of vitamin E 剂量见维生素 E 的剂量。
future prospects for, 198-206 未来展望，198-206
mass media on, 73 大众媒体，第 73 页
physicians’ criticisms of, 69-70, 74, 76, 79-80, 85 医生们的批评，69-70，74，76，79-80，85
physicians’ interest in, 199-200 医生的兴趣，199-200
physicians’ support of, 71, 74-76, 77-79, 81-84, 210-213 医生的支持，71，74-76，77-79，81-84，210-213
public acceptance of and interest in, 71-72, 73-74, 200-203 公众的接受度和兴趣，71-72，73-74，200-203
Mennell, John, 178 Mennell，John，178
Metabolism 代谢
of fats, 52, 53, 54, 55, 208, 213 脂肪，52，53，54，55，208，213
role of vitamin E in, 52-54, 55, 77, 85-99, 212-213 维生素 E 的作用，52-54，55，77，85-99，212-213
Mihan, Richard, 59-60, 61-62, 75, 207 Mihan, Richard，第 59-60 页，第 61-62 页，第 75 页，第 207 页
Mills, Ernest, 116-117 米尔斯，欧内斯特，116-117
Minerals, interactions of vitamin E with, 93, 209 矿物质，维生素 E 的相互作用，93，209
Miscarriage, vitamin E in prevention of, 60, 213 流产，维生素 E 在预防中的作用，60，213
Monagle, J. E., 192-193
Morotomi, Takefumi, 183
Morphine, for pain in heart attacks, 22,117 吗啡，用于心脏病发作时的疼痛，22,117
Morris, J. N., 164 莫里斯，J. N.，164
Mortality from cardiovascular disease, 14-15, 15-16 心血管疾病的死亡率，14-15，15-16
anticoagulant therapy and, 23-24, 25, 28 抗凝治疗，23-24，25，28
coronary artery bypass surgery and, 35 冠状动脉搭桥手术，35
estrogen therapy and, 96 雌激素治疗，96
heart damage and, 106 心脏损伤，106
increases in, 37 增加，37
intensive coronary care units and, 27-28, 29 重症冠状动脉护理病房，27-28，29
myocardial infarction, 14-15, 15-16, 19, 105-106 心肌梗死，14-15，15-16，19，105-106
Muscle cells, vitamin E and, 213 肌肉细胞，维生素 E，213
Mustard, J. F., 25
Myocardial infarction. See Cardiovascular disease; Heart attack(s) 心肌梗死。参见心血管疾病；心脏病发作
Myocardial revascularization, evaluation of, 31, 33-35 心肌血运重建，评估，31，33-35
N
Nephritis, vitamin E and, 90, 91, 125, 184 肾炎，维生素 E，90，91，125，184
Nerve root pain, vitamin E and, 177178 神经根痛，维生素 E，177178
Neuralgia and neuritis, vitamin E and, 177,178 神经痛和神经炎，维生素 E，177,178
Nieper, Hans, 81-82, 137, 138, 143, 164
Nitrogen dioxide, vitamin E and lung damage from, 53 二氧化氮、维生素 E 与肺损伤，53
Nitroglycerine in heart disease, 123, 185 硝酸甘油在心脏病中的应用，123，185
Nutrition 营养
adequacy of American diet, 195-197 美国饮食的充足性，195-197
atherosclerosis and, 143 动脉粥样硬化，143
in cardiovascular disease etiology, 37-38 在心血管疾病病因学中，37-38
dangers of low-fat diets, 137-138, 139, 204-205, 216 低脂饮食的危险，137-138，139，204-205，216
dietary fats and heart attacks, 54, 104, 107, 108-109, 113-116, 137138, 139, 214-216 膳食脂肪与心脏病发作，54，104，107，108-109，113-116，137-138，139，214-216
dietary treatment of diabetes, 171 糖尿病的饮食治疗，171
food additives and, 193-195 食品添加剂，193-195
food processing and, 39, 44-46, 188189, 193-194 食品加工，39，44-46，188-189，193-194
interest in, 191-193 兴趣，191-193
need for vitamin E in human, 48, 4951, 52-53, 55, 173, 183, 187, 189 人体对维生素 E 的需求，48，4951，52-53，55，173，183，187，189
physicians’ knowledge and training in, 192-193 医生的知识和培训，192-193 页
required amounts of vitamin E in, 48, 49-51, 55 维生素 E 的所需量，48，49-51，55
supplementation for space travel, 51, 189-191 太空旅行的补充，51，189-191
type of vitamin E in, 51 维生素 E 的类型，51
vitamin E deficiency symptoms, 55 维生素 E 缺乏症状，55
vitamin E intake and fat in diet, 54 维生素 E 摄入量和饮食中的脂肪，54
Obesity 肥胖
heart attack risk and, 107, 109, 110 心脏病发作风险，107，109，110
hypothyroidism and, 110 甲状腺功能减退症，110
Obstetrics, thromboembolism risk in, 156 产科，血栓栓塞风险，156
Ochsner, Alton, 57, 70, 74-75, 86-87, 119, 157, 184 Ochsner，Alton，57，70，74-75，86-87，119，157，184
Olson, Robert E., 76, 79, 80 奥尔森，罗伯特·E.，76，79，80
Ophthalmology, therapeutic vitamin E in, 60 眼科学，治疗性维生素 E，60
Orotic acid salts, for atherosclerosis, 143, 145 乳清酸盐，用于动脉粥样硬化，143，145
Oxygen need of tissues 组织的氧气需求
heart attacks and myocardial, 47, 103 心脏病发作和心肌梗死，47，103
results of deficiencies in, 205 缺乏症的结果，205
vitamin E and, 58, 86, 88-90, 182, 186, 208, 212 维生素 E 和，58，86，88-90，182，186，208，212
Oxygen therapy for heart attacks, 22 心脏病发作的氧气治疗，22
Ozone, vitamin E and lung damage from, 53 臭氧、维生素 E 与肺部损伤，53
P
Page, Irvine H., 109
Pain 疼痛
in heart attacks, 22, 117, 124, 185 在心脏病发作中，22，117，124，185
manipulation for, 177-178 操作，177-178
morphine for, 22, 117 吗啡用于，22，117
nerve root, 177-178 神经根，177-178
vitamin E and, 177-178 维生素 E，第 177-178 页
Perera, George A., 161-162
Peripheral circulation and vitamin E. 外周循环与维生素 E。
Peripheral circulation and vit. E Cont. 周边循环与维生素 E 续篇
See also Collateral circulation; Intermittent claudication; Thrombosis 参见侧支循环；间歇性跛行；血栓形成
Buerger’s disease, 59, 87 布尔格病，59，87
gangrene, 89, 169, 171, 208, 211 坏疽，89，169，171，208，211
leg cramps, 61-62, 75, 208 腿部抽筋，61-62，75，208
Raynaud’s syndrome, 208 雷诺氏综合症，208
Permeability of capillaries, vitamin E and, 58, 86, 90-91 毛细血管通透性，维生素 E，58，86，90-91
Peyronie’s disease, 183 佩罗尼氏病，183
Phlebitis 静脉炎
prevention of, 156 预防，156
results of, 156 结果，156
vitamin E and, 57, 58, 59, 70, 74-75, 87, 90, 91, 125, 156-159, 184 维生素 E 和，57，58，59，70，74-75，87，90，91，125，156-159，184
Phlebothrombosis, defined, 154; See also Thrombosis 静脉血栓形成，定义，154；另见血栓形成
Pinkney, E. R., 114, 214-216
Platelets, vitamin E and, 213 血小板，维生素 E，213
Prevention of cardiovascular disease, 13-14, 36-37, 42-43, 103-105, 106119 心血管疾病的预防，13-14，36-37，42-43，103-105，106-119
vitamin E in, 13-14, 42-43, 118, 119, 217 维生素 E，13-14，42-43，118，119，217
Protein metabolism, vitamin E and, 213 蛋白质代谢，维生素 E，213
Pulmonary embolism 肺栓塞
estrogen therapy and, 97 雌激素治疗，97
incidence of, 154, 156 发生率，154，156
prevention of, 154-156, 157; vitamin E in, 119, 184 预防，154-156，157；维生素 E 在其中，119，184
prognosis of, 154 预后，154
R
Raiford, Morgan, 139-140 Raiford，Morgan，139-140
Raynaud’s syndrome, vitamin E in, 60, 208 雷诺氏综合症，维生素 E，60，208
Reich, Carl J., 19 赖希，卡尔·J.，19
Rest 休息
in heart attack prevention, 13, 14 在心脏病发作预防中，13，14
in heart attack treatment, 18, 21, 2829, 117, 118 在心脏病发作治疗中，18，21，2829，117，118
Retinal blood vessels, megavitamin therapy and, 89, 140, 183 视网膜血管，大量维生素治疗，89，140，183
Rheumatic fever. See also Rheumatic heart disease 风湿热。另见风湿性心脏病
diagnosis of, 125 诊断，125
incidence of, 124 发生率，124
progression to chronicity, 125-126 发展为慢性，125-126
treatment of, 124-125 治疗，124-125
vitamin E in, 90, 91, 125, 184, 185 维生素 E，90，91，125，184，185
Rheumatic heart disease 风湿性心脏病
development of, 125-126 发展，125-126
diagnosis of, 125 诊断，125
digitalis plus vitamin E in, 129 地高辛加维生素 E，129 页
heart failure and fibrillation in, 128 心力衰竭和心房颤动，128
incidence of, 121 发生率，121
precautions in vitamin E use in, 129, 130-131 维生素 E 使用中的注意事项，129，130-131
results of discontinuing vitamin EE in, 184 停止服用维生素 EE 的结果，184
symptoms of, 126 症状，126
vitamin C in, 131 维生素 C，131
vitamin E dosage in, 127, 128, 130, 131, 168, 183-184, 185, 200 维生素 E 剂量，127，128，130，131，168，183-184，185，200
vitamin E plus steroids in, 183 维生素 E 加类固醇，183
Ribicoff, Abraham, 193-194 Ribicoff，Abraham，193-194
Richards, Robert L., 147, 148 理查兹，罗伯特·L.，147，148
S
Saltzman, E. W., 155
Scars, vitamin E and, 92-93 疤痕，维生素 E，第 92-93 页
burn scars, 175-176 烧伤疤痕，175-176
scar formation, 213 瘢痕形成，213
surgical scars, 176 手术疤痕，176
traumatic scars, 176-177 创伤性疤痕，176-177
Schizophrenia, megavitamin therapy of, 63, 64 精神分裂症，大量维生素疗法，63，64
Schoch, Arthur G., 60, 207 Schoch，Arthur G.，60，207
Sciatica, vitamin E in, 177, 178 坐骨神经痛，维生素 E，177，178
Seaman, Arthur J., 25 Seaman，Arthur J.，25
Selenium, vitamin E and, 52, 93, 209 硒，维生素 E 和，52，93，209
Sex distribution of heart attacks, 14, 40-41 心脏病发作的性别分布，14，40-41
Shute, Evan, 41, 42-43, 56, 60, 63, 79, 81, 94, 97, 134, 199 Shute，Evan，41，42-43，56，60，63，79，81，94，97，134，199
Shute, James 41,42,56,63,79,9441,42,56,63,79,94
Shute, Wallace B., 97 Shute，Wallace B.，97
Skelton, Floyd, 42, 43, 97, 134 斯凯尔顿，弗洛伊德，42，43，97，134
Skin: 皮肤：
dermatologic vitamin E ointment, 62, 179, 185 皮肤用维生素 E 软膏，62，179，185
dosage of vitamin E for, 62 维生素 E 的剂量，62
epithelization and vitamin E, 58, 86, 92-93 上皮化和维生素 E，58，86，92-93
vitamin E and burns, 59, 64-65, 76, 维生素 E 与烧伤，59，64-65，76，
Skin Cont. 皮肤续篇
92, 174-176, 185, 203, 210-211, 213
vitamin E and skin diseases, 59-60, 207-208 维生素 E 与皮肤疾病，59-60，207-208
vitamin E and ulcers, 59, 60, 89, 90, 173-174, 176, 185, 211, 213 维生素 E 与溃疡，59，60，89，90，173-174，176，185，211，213
Smith, Thomas W., 128-129 史密斯，托马斯·W.，128-129
Smoking 吸烟
heart attack risk and, 13, 14, 107, 109, 112 心脏病发作风险，13，14，107，109，112
intermittent claudication and, 148 间歇性跛行，148
Space travel, vitamin E in diet in, 51, 189-191 太空旅行，饮食中的维生素 E，51，189-191
Spain, D. M., 103
Stare, Frederick J., 74, 76, 79, 80
Starr, Paul, 95, 144 斯塔尔，保罗，95，144
Steroids plus vitamin E in rheumatoid arthritis, 183 类固醇加维生素 E 治疗类风湿性关节炎，183
Storage of vitamin E, 40 维生素 E 的储存，40
Stout, Milton, 60, 64, 207 斯托特，米尔顿，60，64，207
Stress 压力
heart attack risk and, 107 心脏病发作风险，107
serum cholesterol and, 215 血清胆固醇，215
Stroke(s) 中风
hypertension and, 162, 164 高血压，162，164
incidence of, 164 发生率，164
mortality from, 164 死亡率，164
recurrence of, 166, 168 复发，166，168
rehabilitation in, 167-168 康复，167-168
vitamin E in, 87, 165-166, 167-168 维生素 E，87，165-166，167-168
zone of injury in, 166-167 受伤区域，166-167
Surgery 手术
in cardiovascular disease, 17, 18, 21, 29-35, 123-124 在心血管疾病中，17、18、21、29-35、123-124
for intermittent claudication, 148 间歇性跛行，148
prevention of postoperative embolisms, 155-157 术后栓塞的预防，155-157
prophylactic preoperative vitamin E, 184 预防性术前维生素 E，184
vitamin E and surgical scars, 176 维生素 E 与手术疤痕，176
Synthesis of vitamin E, 42, 43, 56-57 维生素 E 的合成，42，43，56-57
Ulcers, skin 溃疡，皮肤
oxygen and healing of, 173 氧气与愈合，173
vitamin E and, 59, 60, 89, 90, 173174, 176, 185, 211, 213 维生素 E 和，59，60，89，90，173174，176，185，211，213
V
Vare, Robert, 73 瓦雷，罗伯特，73
Vasoconstriction, blood oxygenation and, 88 血管收缩，血液氧合，88
Vasodilation 血管扩张
in heart attacks, 22, 117 在心脏病发作中，22，117
in intermittent claudication, 148, 150 间歇性跛行，148，150
vitamin E and, 86, 91, 212-213 维生素 E，86，91，212-213
Venous thrombosis. See Thrombosis 静脉血栓形成。见血栓形成
Vitamin A 维生素 A
in atherosclerosis, 152 在动脉粥样硬化中，152
vitamin E and, 52, 134, 213 维生素 E 和，52，134，213
Vitamin C 维生素 C
antioxidant function of, 87-88 抗氧化功能，87-88
atherosclerosis and, 89, 139, 140, 183 动脉粥样硬化，89，139，140，183
in cardiovascular disease, 94, 133134 在心血管疾病中，94，133134
Vitamin C Cont. 维生素 C 续篇
deficiency, myocardial lesions and, 103-104 缺乏症，心肌病变，103-104
in diabetes, 172 在糖尿病中，172
in intermittent claudication, 151 间歇性跛行，151
retinal blood vessels and, 89,183 视网膜血管，89,183
in rheumatic heart disease, 131 在风湿性心脏病中，131
supplementation for infants, 189 婴儿补充剂，189
therapeutic action of, 63 治疗作用，63
vitamin E interaction with, 133-134 维生素 E 的相互作用，133-134
Vitamin D, in atherosclerosis, 152 维生素 D，在动脉粥样硬化中，152
Vitamin E deficiency diseases, 55 维生素 E 缺乏症，55
Vitamins. See also Megavitamin therapy and specific condition and/or vitamin 维生素。另见大剂量维生素疗法及特定状况和/或维生素。
action of, vitamin E and, 208, 213 维生素 E 的作用，208，213
food processing and vitamin deficiencies, 39, 44-46 食品加工与维生素缺乏，39，44-46
history of, 41 历史，41
infections and, 41-42 感染，41-42
W
Weinblatt, Eve, 105-106 Weinblatt, Eve，第 105-106 页
White, Paul Dudley, 15, 28, 37 怀特，保罗·达德利，15，28，37
Williams, Roger J., 44, 173, 181, 192, 195
Wilson, H. D., 59 威尔逊，H. D.，59
Wound healing, vitamin E and, 92-93 伤口愈合，维生素 E，92-93 页
Wright, I. S., 23 赖特，I. S.，23
(continued from front flap) （续自封面内侧）
Dr. Shute’s Complete, Updated Vitamin E bookinstructive, practical and at times angry-is a book that everyone in danger of developing a heart condition should read. And that includes more than half of us! 舒特博士的完整更新版维生素 E 书籍——具有指导性、实用性，有时甚至愤怒——是每个有心脏病风险的人都应该阅读的书。这其中包括我们超过一半的人！
This is an informative book, above all. One that demands to be read carefully, to be discussed and to be acted upon. It could be the most important book you will ever read. 这本书首先是一部信息丰富的著作。一本需要仔细阅读、讨论并付诸行动的书。它可能是你一生中读过的最重要的书。
About the author 关于作者
Wilfrid E. Shute, M.D., F.I.A.P.M., the world’s foremost authority on Vitamin E, has been a practicing physician for more than forty years, since his graduation from the University of Toronto Medical School. He has practiced in both the United States and Canada; and has been associated with the University of Chicago Clinics and St. Michael’s Hospital in Toronto. He was the co-founder and codirector of The Shute Institute for Laboratory and Clinical Medicine in London, Ontario, where he was chief cardiologist, leaving there after eight years to conduct his own private practice. In the course of thirty years, Dr. Shute has been responsible for treating more than 35,000 cardiac patients. Wilfrid E. Shute 医学博士，F.I.A.P.M.，是世界上维生素 E 领域的权威，自从毕业于多伦多大学医学院以来，已有四十多年的临床执业经验。他曾在美国和加拿大执业，并与芝加哥大学诊所及多伦多圣迈克尔医院有合作关系。他是位于安大略省伦敦的 Shute 实验室与临床医学研究所的联合创始人兼联合主任，担任首席心脏病专家，八年后离开该所，开始自己的私人诊所。在三十年的时间里，Shute 博士共治疗了超过 35,000 名心脏病患者。
Dr. Shute wrote the best-selling Vitamin E for Ailing and Healthy Hearts with Harald Taub; and has co-authored books and medical papers with his older brother Dr. Evan Shute and Dr. H. Rudolph Alsleben. He has achieved world-wide recognition as a top judge of dog shows in Canada and in this country and as a leading breeder of Doberman Pinschers. His wife Dorothy was a champion swimmer who represented Canada at the 1928 and 1932 Olympics. They have two daugh-ters-one a speech therapist and the other a nurse in public health. The Shutes presently divide their time between Canada and Lake Worth, Florida. 舒特博士与哈拉尔德·陶布合著了畅销书《维生素 E 与病弱及健康的心脏》；并与他的哥哥埃文·舒特博士及 H. 鲁道夫·阿尔斯莱本博士合著了书籍和医学论文。他作为加拿大及本国顶级犬展评委和多伯曼犬的领先饲养者，享有世界声誉。他的妻子多萝西是冠军游泳运动员，曾代表加拿大参加 1928 年和 1932 年奥运会。他们有两个女儿——一位是语言治疗师，另一位是公共卫生护士。舒特一家目前在加拿大和佛罗里达州沃斯湖之间分配时间。
The Heart Attack and You 心脏病发作与您
Warning: Hospital Ahead 警告：前方医院
A Different Approach 不同的方法
Vitamin E as a Vitamin 维生素 E 作为一种维生素
A Question of Quantity 数量问题
Conflict and Support 冲突与支持
Alpha Tocopherol in the Body 体内的 Alpha 生育酚
Heart Attacks: Causes, Survival and Prevention 心脏病发作：原因、生存与预防
Angina and Rheumatic Heart Disease 心绞痛和风湿性心脏病
Atherosclerosis and an Important Breakthrough 动脉粥样硬化及一项重要突破
Intermittent Claudication 间歇性跛行
Thrombophlebitis and Pulmonary Embolism 血栓性静脉炎和肺栓塞
Hypertension, Strokes and Cerebral Hemorrhage 高血压、中风和脑出血
Diabetes Mellitus 糖尿病
Vitamin E Ointment in Burns and Other Conditions 维生素 E 软膏在烧伤及其他情况中的应用
Tailoring the Dose 调整剂量
The Healthy Heart 健康的心脏
What of the Future? 未来会怎样？
*In the same summary it was stated that although all three groups were more or less comparable in the severity of patients’ infarctions, there was “a somewhat lower percentage of severe cardiac infarction in the armchair group receiving anticoagulants.” It was also noted that most of the patients who died had developed arrhythmias or heart block (a problem that affects transmission of the heartbeat from the upper to the lower part of the heart). The summary concludes with the comment that it was probably “sufficient to treat only the bad prognostic risks (those with arrhythmias, heart block, and cardiac failure) with anticoagulants.” *在同一总结中指出，尽管三组患者的梗死严重程度大致相当，但“接受抗凝剂治疗的坐椅组严重心脏梗死的比例略低”。还指出，大多数死亡患者出现了心律失常或心脏传导阻滞（影响心跳从心脏上部传导到下部的问题）。总结中评论说，可能“仅对预后不良的高风险患者（有心律失常、心脏传导阻滞和心力衰竭者）使用抗凝剂治疗就足够了。”
*However, see Chapter 15 for discussion of some allergic reactions to the ointment. *然而，关于对该软膏的一些过敏反应，请参见第 15 章的讨论。
For an account of the effectiveness of oral and local alpha tocopherol in more severe cases, see the chapter on burns in Vitamin E for Ailing and Healthy Hearts. 有关口服和局部α-生育酚在较严重病例中的效果，请参见《Vitamin E for Ailing and Healthy Hearts》中关于烧伤的章节。
