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The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure

视神经超声在颅内压增高诊断中的角色

Abdullah SadikGirisgin, ErdalKalkan, [...], and Mustafa Semiz

Additional article information

Abstract

Objective

To evaluate the convenience and utility of optic nerve ultrasonography (ONUS) in the evaluation of emergency patients with elevated intracranial pressure (EICP) due to traumatic or non‐traumatic causes.

Methods

This study was conducted between May 2005 and December 2005 in the emergency department of Meram Faculty of Medicine, Selcuk University. Patients with traumatic or non‐traumatic EICP were included in the study. Among these, 28 patients with EICP determined on cranial computed tomography (CCT) and a control group of 26 patients with no disease had the vertical and horizontal diameters of the optic nerves (ONs) of both eyes measured by ultrasonography (US). The measurements were done by wetting the closed eyelids and using a 7.5‐MHz linear probe.

Results

Horizontal and vertical diameters of both ONs of the 54 patients were measured and the averages calculated. The mean (SD) ON diameter for the group suspected of having EICP was found to be 6.4 (0.7) mm, and that for the control group to be 4.6 (0.3) mm. In the statistical analysis carried out between these two groups (t test), the difference was found to be significant at p<0.001.

Conclusions

In detection and follow‐up of EICP cases, such as cerebrovascular accident and trauma, ONUS is a practical, risk‐free, inexpensive, convenient and, if performed by experts, reliable method. As a result, although CCT may be more useful in diagnosis, ONUS may be more efficient in detecting EICP. In those cases where CCT and other conventional imaging methods are not available, ONUS

can facilitate the diagnosis and help in treatment.

Owing to the increased burden faced by emergency services, monitoring methods have become more extensively used to accelerate patient circulation both in diagnosis and treatment. Ultrasonography (US) in particular has become an inseparable component of the emergency services.1

由于急诊负担较重，超声已经成为急诊不可或缺的部分。

Patients with brain damage, which is most frequently based on traumatic and vascular causes and less frequently on intracranial mass or obstruction in the cerebrospinal fluid circulation, present to emergency services. Treatment in these patients depends on early diagnosis and hence on radiological monitoring, at the forefront of which is cranial computed tomography (CCT). Tomography, however, may not help in the early period in patients with elevated intracranial pressure (EICP), especially that resulting from vascular and traumatic causes. Furthermore, tomography is not available in every hospital, or this examination may sometimes not be performed because of instability in the patient's vital findings. In cases with EICP, dilation in optic nerve (ON) diameter and optic disc occurs, which may sometimes be observed during ophthalmoscopic evaluation.2,3,4 However, in most of these patients, the ophthalmoscopic evaluation is impossible or extremely difficult. As a result, in the last few years, optic nerve ultrasonography (ONUS) has been used more often in emergency services.5,6 In this study, the convenience and utility of ONUS were investigated in cases in whom EICP was likely to develop.

病人的脑损伤，常常是由于严重脑外伤，血管意外，少数由于颅内占位或脑脊液循环障碍引起。这些病人的治疗依靠早期放射学（CT）诊断。然而放射学在早期颅内压升高的病人中并不十分适用。尤其是那些血管性或创伤性的脑外伤。而且，影像学并不是所有医院都有的，或这项检查有时因病人的病情不稳不能进行。在颅内压增高的病人中，视神经直径的扩张，视盘的扩张，有时可以通过眼底镜观察。然而，大部分病人进行眼底镜是十分困难的。在这些年，视神经超声已经在急诊十分普遍。在此项研究中，视神经超声的便利性及功能性在颅内压有可能升高的病人中被调研。

EICP may be present in emergency department patients with head trauma, hypoxia, intracranialhaemorrhage and tumour complications. All of these groups may require rapid intervention.7,8 Early diagnosis of acute intracranial hypertension is essential to enable prompt, optimal treatment. The optic nerve sheath diameter (ONSD) is increased in EICP, and its measurement can be used to indirectly monitor increased intracranial pressure (ICP). 2,9

颅内压升高在急诊脑创伤，脑缺氧，脑出血，肿瘤病人出现，这些都需要快速介入。早期的诊断急性颅内压升高对于早期准确最佳治疗十分关键，视神经鞘直径在颅内压增高病人中增大，对于其的测量可以直接用于检测增高的颅内压。

Although CCT may be available in most emergency departments, it may be unavailable for the detection of early EICP.5 CT uses ionising radiation. Initial head CT scan characteristics show a linear relationship to baseline ICP.10

有时CT对于早期的颅内压增高并不十分有用。最初的头颅CT平扫特性显示了与基线ICP呈线性相关。

The findings of EICP in CCT include:

changes in vertical sizes;垂直大小的变化。

lessening in basilar cistern sizes;脑池的变小

narrowing or eliminating in sulci;沟回的狭窄或消失。

transfalcine herniation; and大脑镰下疝

changes in the rate of grey/white matter.10灰白质比的变化。

Ocular US can detect pathology reflecting disease states outside of the eye, whereas evaluation of ONSD can detect EICP.11

视神经超声能够在眼外进行并能够探测颅内压增高。

Materials and methods

Study design and setting

This study was carried out prospectively on patients admitted to the Department of Emergency Medicine, Meram Faculty of Medicine, University of Selcuk, Turkey, from May 2005 to December 2005 with the findings of EICP on CCT, based on traumatic or non‐traumatic causes during normal working hours. They were enrolled once an increased ICP was shown on CCT. The study group included 28 patients (21 (75%) men of mean age 35.5 years). The control group included 26 healthy volunteers (21 (80%) men of mean age 34 years). All 54 participants were white. The patients presenting at emergency services underwent standard examination and treatment; ONUS was planned for those patients with brain injury, intracerebralhaemorrhage, cerebral infarct and hypoxic brain with EICP findings on their CTT.

此项研究为前瞻性。病人为来赛库大学马兰医疗中心，2005 -5至2005- 12，CCT发现异常的病人。共有28病人，21男，7女。平均35.5岁。对照组为26健康志愿者，21男，平均34岁。所有54人均为白人，视神经超声在这些CCT发现的脑损伤，脑出血，脑梗塞，缺氧性脑病病人中进行。

Box 1: Causes of increased optic nerve sheath diameter (ONSD)

In patients without EICP 12

Optic neuritis视神经炎

Arachnoid cyst of the optic nerve视神经蛛网膜囊肿

Optic nerve trauma

视神经损伤

Anterior orbital or cavernous sinus mass

前海绵窦占位

In patients with EICP 13

Any tumour or space‐occupying lesions of the CNS

颅内占位性病变

Pseudotumourcerebri

颅内假瘤

Decreased CSF resorption (eg, venous sinus thrombosis, inflammatory processes, meningitis, subarachnoid haemorrhage)

脑脊液吸收减少（静脉窦栓塞，炎性，脑膜炎，蛛网膜下腔出血。

Increased CSF production (tumours)

脑脊液生成增加

Obstruction of the ventricular system

脑室阻塞

Cerebral oedema, encephalitis

脑水肿，脑炎

Craniosynostosis

颅缝早闭

Notes: CNS, central nervous system; CSF, cerebrospinal fluid; EICP, elevated intracranial pressure; ONSD, optic nerve sheath diameter

This study was conducted by a single US‐certified emergency medicine expert, who in addition has performed ONUS on more than 100 volunteers. For the US to be monitored, a 7.5 MHz linear US probe was used. The patient, his/her relatives and the control group were informed about the study and their consent was obtained. The control group included age‐and sex‐matched healthy volunteers.超声由单一有证的专家进行，有超过100人的经验，7.5MHZ线性超声探

头被使用。病人或病人家属被告知此项研究，取得同意。对照组的年龄性别匹配患者。

Methods and measurements

Patients with no EICP but with increased ON diameter were excluded from the study. Box 1 shows the causes of dilation in ON diameter in those with EICP.12,13 An ample amount of gel was applied to a 7.5 MHz‐linear US probe and then placed in a disposable plastic bag, thus preventing the feeling of discomfort in the eye due to the contamination and gel. The outer sides of the eyelids were wetted with water in order to facilitate penetration of the US waves. This method was more comfortable when compared with the standard method in which gel and probe are directly applied onto the eyelid, more reliable in terms of contagious diseases and more convenient in monitoring the ON vertically. With this technique, vertical and horizontal diametres of the ON in both eyes were measured four times.5 Since the measurements were done by a single person, concordance among them was good. ONSD was measured 3 mm behind the point where the ON entered the globe (fig 11).2,5,9

病人颅内压正常但视神经直径增大被排除。7.5mhz探头涂胶后放于一次性朔料袋中，防止因胶体及污染导致的眼部不适。眼睑表面用水涂湿来帮助超声波穿透。此方法比涂胶体更舒适，更有效防止污染性疾病及更方便垂直监测视神经。每个眼视神经被检测4次。由于同一人，同一性非常好。视神经直径在视神经入球之后3mm检测。

figure em40931.f1

Figure 1Optic nerve sheath diameter measured 3 mm behind the point where the optic nerve entered the globe.

Primary data analysis

The mean (SD) values of ONSD measurements were compared between EICP and control groups by two‐independent group t test, and a significant difference was determined between the two groups (t=24.131; p<0.001). All statistical analyses were performed using SPSS V.12.0 program.

视神经直径通过2组独立数据t检验。两组有显著性差异。所有数据分析通过spss 12.0进行。Sensitivity analysis

Since these measurements were done by one individual, the four ONSD values of both groups were evaluated in detail in terms of their concordance. In this evaluation, the concordance correlation coefficient formula, which is used in non‐categorical data, was applied.14

由于为同一人进行，两组的四个视神经直径通过非表格数据一致性系数方程检验检验同一性。equation image

The values in hand were examined accordingly (table 11).). A value >0.90 showed concordance among the measurements. In 5/6 evaluations this value was >0.90, and in only one evaluation

was it slightly <0.90, thus proving agreement between our measurements.

5/6值显示一致性，1/6显示轻度的不一致。

Table thumbnail

Table 1Concordance correlation coefficient*

Bland–Altman plots were used to demonstrate concordance between ONSD measurements. Figure 22 presents all possible pairwise concordance plots. The values, related with plots, as mean (2 SD) differences, are presented in table 22.. As seen in table 11 and fig 22,, Bland–Altman plots and the concordance correlation values agree on concordance between ONSD measurements. Differences between values were evenly distributed around the mean along the entire range of values.

Bland–Altman 绘图与一致性相关数值吻合。数值间差异在所有数值平均线周围分布。figure em40931.f2

Figure 2Bland–Altman plots. RHor, right horizontal; RVer, right vertical.

Table thumbnail

Table 2Mean (95% CI) and the confidence limits for Bland–Altman plots

Results

Characteristics of study subjects

The mean right eye ON horizontal diameter of these 28 patients was 6.3 (0.6) mm and the mean vertical diametre was 6.4 (0.6) mm; the mean left eye ON horizontal diameter was 6.4 (0.8) mm and the mean vertical diameter was 6.4 (0.8) mm. The average of all measurements of the ONs of 28 patients who had EICP according to CCT was 6.4 (0.7) mm.

28患者平均右眼水平直径为 6.3+-0.6mm，垂直直径为 6.4+-0.6mm，平均左眼水平为6.4+-0.8mm，平均垂直直径为6.4+-0.8m，CCT提示平均值为6.4+-0.7mm

The mean (SD) age of the 26 people in the control group was 33.4 (16) years. The mean right eye ON horizontal diameter of these 26 patients was 4.5 (0.2) mm and the mean vertical diameter was 4.5 (0.3) mm, whereas the mean left eye ON horizontal diameter was 4.7 (0.2) mm and the mean vertical diameter was 4.7 (0.3) mm. The average of all measurements of the ONs of this 26‐person group was 4.6 (0.3) mm (fig 33).

对照组平均右眼水平4.5+-0.2，垂直为4.5+-0.3，左眼为4.7+-0.2水平，1.7+-0.3垂直。CT显示平均直径为4.6+-0.3mm

figure em40931.f3

Figure 3Optic nerve diameters in each group. CCT, cranial computed tomography.

Main results

The ON diameter of all subjects in the control group was evaluated as normal, whereas the ON diameter of all patients with brain oedema in their CCT was wider. As seen in fig 33,, the mean diameters of optic nerves on CCT of patients with oedema were found to be higher than in controls.

CCT显示脑水肿的病人视神经直径显著比对照组大。

Limitations

While ONUS is quite useful for application in patients with high intracranial pressure, it does not give information about the aetiology. The study population included patients admitted to the emergency department during normal working hours only. Clear and precise limits cannot be seen in US, which can cause different results even with measurements calculated on the same ON. The possibility for error also occurs due to the small size of the measurements (ie, 1/10 mm). Other factors affecting the reliability of the technique are the experience of the person taking the ON measurements by means of US, the quality of the device and the movement of the patient. Possible reasons for an increase in ONSD without EICP should be kept in mind.

视神经超声限制：无法阐明病因。无法给予明确及精确的测量手段。受操作者经验，设备质量，患者移动影响。

Discussion

In previous studies, the first pathophysiological case reported to have developed after EICP has been cited as a case with oedema that occurred in the optic disc.3,4 The use of US in cases related to EICP has increased due to the expansion of US.5 Whereas US may not be as helpful as CCT in establishing the cause of intracranial lesions, it may be more successful in monitoring EICP in the early period.3

视神经超声与CT相比无法阐明颅内压升高原因，但能成功用于颅内压监测。

Hayreh,15 in his experimental study, noted that the first finding in EICP was dilation in the optic disc. His results support the finding of oedema on ONUS of all the patients in our study who had oedema in CCT. Later studies of Hayreh also support this.3,4 Compared with other evaluations, measurement of ON diameter is the quickest means for detecting EICP, and the easiest technique for this purpose in use today is US.

Hayreh发现颅内压升高最早的表现为视盘扩张。Hayreh后续的研究表明与其他方法相比，视神经直径的测量是发现颅内压增高最快的方法。同时现在实现这一目的最早的方法是超声。In the study carried out by Gangemiet al16 evaluating 40 patients with EICP syndrome due to various causes, ON was evaluated by means of the echographic technique. Their results showed that an increase in the ON diameter in EICP was observed earlier than any ophthalmoscopic finding.16 There are also other studies supporting this finding.11,17Gangemi et al16 used the echographic technique instead of US. Determination of increased ONSD can be considered superior to other techniques as an indicator of EICP, and increased ONSD emerges earlier than the other findings evaluated by ophthalmoscopy.16

甘格密对40病人进行回声像学研究，发现颅内压增高病人视神经直径增大声像比眼底镜更早被观察到。显示检测颅内压增高，视神经增大比任何眼底镜更早更好。

A relationship between the ONSD and ICP has been observed previously in a clinical setting as well. Normal ONSD measured by US has been reported to range from 4.7 to 5.0 mm.12,18 In the CCT of our study, there was a remarkable difference between the ONSD in patients with EICP findings and in the control group with no such findings. The mean (SD) of the four ON measurements (right vertical, right horizontal, left vertical and left horizontal) in the control group was 4.6 (0.3) mm vs 6.4 (0.7) mm in those with EICP (fig 33).). Measurements obtained in the control group are close to and support values reported in previous studies.

既往超声正常的视神经直径为4.7-5.0mm，我们研究中，对照组平均值为4.6+-0.3mm，颅内压增高组为6.4+-0.7mm。与既往的研究相符。

Many patients present to emergency services with EICP. CCT is first among the techniques used for detection of EICP, but it does not demonstrate early EICP findings. The first finding in an EICP case is dilation in ON diameter.3 As a result, ONUS can be more useful than CCT, perhaps not in diagnosis, but in detecting EICP. For unconscious patients with no diagnosis, ONUS can be very helpful in eliminating an EICP cause and in leading these patients to CCT. ONUS is radiation‐free and non‐invasive, and has certain features which increase its convenience—portability, easy application, low cost, repeatability on request, bedside application, short application time and applicability even in the presence of unstable vital findings.

视神经超声可比CT更早发现颅内压增高，对于昏迷的病人，先行视神经超声可排除颅内高压疾病，并且视神经超声无辐射，无创，可移动，方便实行，可重复，时间短，对于生命体征不稳病人仍可使用。但无法做出准确诊断。

ONUS can also be used in the evaluation of an increase in ICP before lumbar puncture is applied, in the occasions of disaster, in the early evaluation of EICP and in follow‐up when it is difficult to reach CCT. However, knowing when a lumbar puncture will be dangerous is very important, as these patients are not always scanned, especially in emergency departments in the rest of the world. It can also help to identify the first patients to be sent for CCT. In light of this information, we recommend ONUS as a very useful and practical method in the evaluation and follow‐up of ICP.

视神经超声可在腰穿前进行评估，防止腰穿导致脑疝的灾难结果。我们强烈建议视神经超声用于评估颅内压及颅内高压的长期监测。

Abbreviations

CCT - cranial computed tomography

EICP - elevated intracranial pressure

ICP - intracranial pressure

ON - optic nerve

ONSD - optic nerve sheath diameter

ONUS - optic nerve ultrasonography

US - ultrasonography

Footnotes

Competing interests: None declared.

Article information

Emerg Med J. Apr 2007; 24(4): 251–254.

doi: 10.1136/emj.2006.040931

PMCID: PMC2658229

Abdullah SadikGirisgin, ErdalKalkan, SedatKocak, BasarCander, Mehmet Gul, and Mustafa Semiz

Abdullah SadikGirisgin, ErdalKalkan, SedatKocak, BasarCander, Mehmet Gul, Sel?uk University, Meram Faculty of Medicine, Emergency Medicine Department Konya, Turkey

Mustafa Semiz, Sel?uk University, Faculty of Art and Science, Department of Statistics, Konya, Turkey

Correspondence to: Professor A S Girisgin

Selcuk University, Meram Faculty of Medicine, Meram Konya 42090, Turkey;

sgirisgin@https://www.wendangku.net/doc/0d184315.html,.tr

Accepted December 13, 2006.

This article has been cited by other articles in PMC.

Articles from Emergency Medicine Journal : EMJ are provided here courtesy of BMJ Group References

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峄山碑及译文

《峄山碑》全文及译文《峄山碑》是秦始皇二十八年（公元前219年）东巡时所刻，下面是小编为大家带来的峄山碑全文及译文，欢迎阅读。碑文皇帝立国，维初在昔，嗣世称王讨伐乱逆，威动四极，武义直方戎臣奉诏，经时不久，灭六暴强廿有六年，上荐高号，孝道显明既献泰成，乃降专惠，亲巡远方登于绎山①，群臣从者，咸思攸长追念乱世，分土建邦，以开争理功战日作，流血于野，自泰古始世无万数，陀及五帝，莫能禁止廼今皇帝，壹家天下，兵不复起灾害灭除，黔首康定，利泽长久群臣诵略，刻此乐石，以箸经纪注：①绎山：指峄山。皇帝日：“金石刻尽，始皇帝所为也。今袭号而金石刻辞不称，始皇帝其于久远也。如后嗣为之者，不称成功盛德。”丞相臣斯、臣去疾，御史大夫臣德。昧死言，臣请具刻诏书，金石刻因明白矣。臣昧死请，制日可。注释：皇帝立国，维初在昔，嗣世称王（维是发语词，不翻。嗣世，一代代，继承。这三句，是一句话。）讨伐乱逆，威动四极，武义直方（武义直方，就相当于说正义战争。）戎臣奉诏，经时不久，灭六暴强（戎臣，就是带兵的将领。灭六暴强即诛灭六国。）廿有六年，上荐高号，孝道显明

（皇帝二十六年，公元前221年。群臣上表，请求秦王称皇帝号。就叫上荐高号。这个孝道，是说秦国各代国君，均有统一之志，始皇帝的统一，乃是完成祖先之道。）既献泰成，乃降专惠，亲巡远方（溥惠，尃惠。溥就是普。我用的书里面，百度百科里面，都错成了专字。既献泰成，乃降尃惠，亲巡远方。应该是这样子才对。既，就是完成了的意思。泰成，就是大成。完成了统一大业。普惠，把恩泽给了所有的人。寴车巛，就是亲巡。从车和从辵，都是表示动作的形符。坐车出巡，就是车巛。）登于绎山①，群臣从者，咸思攸长（登上峄山，大家都发起了怀古之悠情。）追念乱世，分土建邦，以开争理（过去是乱世，起因于分土建国，就是封建制。所以，大家才会去争斗。）功战日作，流血于野，自泰古始（功战就是攻战。自太古以来就是如此。）世无万数，，阤yi3及五帝，莫能禁止（无数代以来，到五帝时代，都不能禁止。阤，延续。）廼今皇帝，壹家天下，兵不复起（如今统一了，不再打仗了。）灾害灭除，黔首康定，利泽长久（黔首，就是百姓。）群臣诵略，刻此乐石，以箸经纪（诵略，因为皇帝的功德是说不完的，所以，大臣说的，只是大略。是为诵略。经纪，就是法度，秩序。）以上内容，是始皇帝的刻辞。下面，是秦二世的内容。上面的是四言诗。下面的，是散文了。皇帝曰：‘金石刻尽始皇帝所为也，令袭号而金石刻辞不称始皇帝。其于久远也，如后嗣为之者，不称成功盛德。丞相臣斯、臣去疾、御史大夫臣德昧死言：‘请具刻诏书，金石刻因明白矣。’臣昧死请。制曰：“可’。” 译文皇帝立国，维初在昔，嗣世称王讨伐乱逆，威动四极，武义直方戍臣奉诏，经时不久，灭六暴强

峄山碑释文

峄山碑释文皇帝立国，维初在昔，维是发语词，不翻。嗣世称王，一代代，继承。这三句，是一句话。讨伐乱逆，威动四极，武义直方。武义直方，就相当于说正义战争。我们的战争是正义的。我们作战的对象，是乱逆戎臣奉诏，经时不久，灭六暴强。戎臣，就是带兵的将领。诛灭六国。廿有六年，上荐高号，孝道显明。皇帝二十六年，公元前221年。群臣上表，请求秦王称皇帝号。就叫上荐高号。这个孝道，是说秦国各代国君，均有统一之志，始皇帝的统一，乃是完成祖先之道。既献泰成，乃降专惠，亲巡远方。溥惠，尃惠。溥就是普。我用的书里面，百度百科里面，都错成了专字。既献泰成，乃降尃惠，亲巡远方。应该是这样子才对。既，就是完成了的意思。泰成，就是大成。完成了统一大业。普惠，把恩泽给了所有的人。寴车巛，就是亲巡。从车和从辵，都是表示动作的形符。坐车出巡，就是车巛。登于峄山，群臣从者，咸思攸长。登上峄山，大家都发起了怀古之悠情。追念乱世，分土建邦，以开争理。过去是乱世，起因于分土建国，就是封建制。所以，大家才会去争斗。功战日作，流血于野，自泰古始。功战就是攻战。自太古以来就是如此。世无万数，陀及五帝，莫能禁止无数代以来，到五帝时代，都不能禁止。阤，延续。乃今皇帝，壹家天下，兵不复起如今统壹了，不再打仗了。灾害灭除，黔首康定，利泽长久黔首，就是百姓。群臣诵略，刻此乐石，以著经纪经纪，就是法度，秩序。

诵略，因为皇帝的功德是说不完的，所以，大臣说的，只是大略。是为诵略。以上内容，是始皇帝的刻辞。下面，是秦二世的内容。上面的是四言诗。下面的，是散文了。皇帝曰，金石刻尽始皇帝所为也，今袭号，而金石刻辞不称始皇帝，其于久远也。如后嗣为之者，不称成功盛德。丞相臣斯，这是李斯。臣去疾，此人据说是姓杜。御史大夫臣德，此人史传无载。左丞相，右丞相，御史大夫，是政府首脑。当时的官制，这三位均是宰相。当时的制度，是宰相负责制。可以开府。就是可以自己组成一个行政班子。人员由宰相任命。不通过皇帝。当时的宰相，权利是很大的。皇帝基本就是个国家象征。秦始皇很厉害，所以他能管事儿。到了二世，就不管事了。事全交给宰相处理。汉朝的皇帝，其实也是不太过问事情的。政务交给宰相处理。皇权，相权，在中国历史上，是皇权越来越大，相权越来越小。昧死言，臣请具刻诏书金石刻，因明白矣。臣昧死请。制曰，可。这是皇帝说的。皇帝说，可以。昧死言，就是冒着因冒犯皇帝而可能被处死的危险，来进言。这是一种大臣上书的格式。因为皇帝总是对的，皇帝即是圣人。你对他说话，可能就是错的。这个峄山刻石就讲完了。简单的，跟现代汉语没什么区别的词就不用讲了。其实在战国后期，所有的人，不论是哪国的百姓，都是希望统一的。春秋战国之际的所有思想家，其思想都是要求统一的。无论是儒，墨，老庄，都要求统一。社会整体的愿望就是统一，结束战争。所以，如果不是秦国政治比较急功近利，他完全可以是一个好的帝国。

峄山碑全文及译文

峄山碑全文及译文文件排版存档编号：[UYTR-OUPT28-KBNTL98-UYNN208]

（维是发语词，不翻。嗣世，一代代，继承。这三句，是一句话。）讨伐乱逆，威动四极，武义直方（武义直方，就相当于说正义战争。）戎臣奉诏，经时不久，灭六暴强（戎臣，就是带兵的将领。灭六暴强即诛灭六国。）廿有六年，上荐高号，孝道显明（皇帝二十六年，公元前221年。群臣上表，请求秦王称皇帝号。就叫上荐高号。这个孝道，是说秦国各代国君，均有统一之志，始皇帝的统一，乃是完成祖先之道。）既献泰成，乃降专惠，亲巡远方（溥惠，尃惠。溥就是普。我用的书里面，百度百科里面，都错成了专字。既献泰成，乃降尃惠，亲巡远方。应该是这样子才对。既，就是完成了的意思。泰成，就是大成。完成了统一大业。普惠，把恩泽给了所有的人。寴车巛，就是亲巡。从车和从辵，都是表示动作的形符。坐车出巡，就是车巛。）登于绎山①，群臣从者，咸思攸长（登上峄山，大家都发起了怀古之悠情。）追念乱世，分土建邦，以开争理（过去是乱世，起因于分土建国，就是封建制。所以，大家才会去争斗。）功战日作，流血于野，自泰古始（功战就是攻战。自太古以来就是如此。）世无万数，，阤yi3及五帝，莫能禁止（无数代以来，到五帝时代，都不能禁止。阤，延续。）廼今皇帝，壹家天下，兵不复起

姜夔《续书谱》原文、译文2

【原文】用笔用笔不欲太肥，肥则形浊；又不欲太瘦，瘦则形枯；不欲多露锋芒，露则意不持重；不欲深藏圭角，藏则体不精神；不欲上大下小，不欲左高右低，不欲前多后少。欧阳率更结体太拘，而用笔特备众美，虽小楷而翰墨洒落，追踵钟、王，来者不能及也。颜、柳结体既异古人，用笔复溺于一偏。予评二家为书法之一变，数百年间，人争效之，字画刚劲高明，固不为书法之无助，而魏、晋之风规，则扫地矣。然柳氏大字，偏旁清劲可喜，更为奇妙，近世亦有仿效之者，则浊俗不除，不足观。故知与其太肥，不若瘦硬也。【译文】用笔不要太肥，太肥了字形就浑浊；也不要太瘦，太瘦了字形就憔悴；不要多露锋芒，锋芒太露，字就不稳重；不要深藏棱角，不见棱角，字就没有精神；不要上面大，下面小；不要左边高，右边低；不要先占地位多，后占地位少。欧阳询的书法，结体虽太拘束，但用笔独具众美，就是小楷，笔墨也潇洒利落，上追钟王，后来人是谁也及不上他的。颜柳结体，既与古人不同，用笔又陷于偏执。我说这两家书派是书法的变体，几百年来，人们争相效学，固然其笔画的刚劲高明，对书法艺术的发展不能说毫无帮助，可是魏晋人的风格规模，究已扫地无遗。至柳氏的大字偏旁，清劲可喜，更为奇妙，近代也有效学的，那就免不了俗和浊，变得毫不可观，所以说字与其写得肥，还不如写得瘦些好。【解读】这一段主要讨论书法用笔的肥瘦问题。关于这一问题，古代书家多有讨论。所谓“古肥而今瘦”，常与“古质而今妍”对举。诗圣杜甫关于开元之前书法“书贵瘦硬”的判断，常被人误解为所有的书法都应该以瘦硬为上。杜甫在其论书诗《李潮八分小篆歌》中，写到：苍颉鸟迹既茫昧，字体变化如浮云。陈仓石鼓又已讹，大小二篆生八分。秦有李斯汉蔡邕，中间作者寂不闻。峄山之碑野火焚，枣木传刻肥失真。苦县光和尚骨立，书贵瘦硬方通神。……吴郡张颠夸草书，草书非古空雄壮。在杜甫看来，使用枣木传刻《峄山碑》而使其点画丰肥，坏了风气，书风不古。诗中对仓颉石鼓文、秦相李斯、东汉蔡邕书法的赞叹，对李潮“小篆逼秦相”的赞叹和对当时著名书家张旭“草书非古”的贬斥都反映出杜甫崇尚“瘦硬”的观念。杜甫的这种观念在论及初唐褚薛书风的时候更为突出，如《寄刘峡州伯华使君四十韵》云：“学并卢王敏，书偕禇薛能。”《发潭州》赞曰：“贾傅才未有，禇公书绝伦。”杜甫书贵瘦硬说，主要是就初唐书风而言。“书贵瘦硬”在作为他自己的审美概括的同时，也是初唐书风的真实写照。众所周知，初唐欧、虞、褚、薛四家、盛中唐颜真卿书风、中晚唐柳公权书风代表了唐楷演变三阶段。正如康有为所说：唐世书凡三变，唐初，欧、虞、褚、薛、王、陆，并辔叠轨，皆尚爽健。开元御宇，天下平乐，明皇极丰肥，故李北海、颜平原、苏灵芝辈并驱时主之好，皆宗肥厚。元和后沈传师柳公权出，矫肥厚之病，专尚清劲，然骨存肉削，天下病矣。从此角度来说，唐代书法史似乎可以看作肥瘦的演变史。这与姜夔的看法基

书法的故事｜秦始皇用他的字统一了中国文字!

书法的故事｜秦始皇用他的字统一了中国文字！书法的故事秦代刻石统一规范的小篆书法小篆的形成及其特点李斯小篆是秦代产生的规范篆书，与大篆（古文、籀文等）相对而言，也叫秦篆。在小篆这种新型字体形成的过程中，值得重视的历史人物是李斯。李斯（？—前208），楚上蔡（今属河南）人，秦朝丞相，书法家。据《太平广记》引《蒙恬笔经》载，公元前221年秦王政（秦始皇）统一中国后，丞相李斯上奏章说：“上古时所创制的大篆，在社会上还很通行，但这些大篆字体毕竟是远古时期的产物，很多人不认识。现在删略大篆中繁琐的笔画，选取复合字体中的一部分，加工改造，变成小篆。”他的建议得到秦始皇的恩准。于是，李斯等人以西周以来秦系文字为基础统一全国文字，并以新造的小篆作为学童启蒙的识字课本和推广应用的楷模，从此与先秦大篆相对而言的小篆就成了秦代的通行书体。李斯擅长书法，宦官赵高以下的官员，都佩服李斯创造小篆的才华。当时刻在名山、碑碣、印玺、铜人上的文字，都出自李斯的手笔。他在书秦望山记功石时，竟然说：“我死后五百三十年，当会有一个人接替我的书迹。”可见他在书法艺术上的自信心和自豪感。小篆有什么特点呢？与大篆相比，小篆的特点表现为：线条圆匀，结构统一定型，字形呈纵势长方。秦始皇留下的六处七篇刻石秦峄山刻石（五

代徐铉摹刻本）从书法发展上看，秦代以小篆光耀史册。而小篆又以秦始皇在位十二年间留下的六处七篇记功刻石文字最值得称道。这六处七篇刻石是：峄山刻石、泰山刻石、琅琊台刻石、之罘刻石、东观刻石（刻于之罘）、碣石刻石、会稽刻石。《史记·秦始皇本纪》载，秦始皇统一中国后，第三年（前219）即率大臣，浩浩荡荡东巡，宣扬其威德盛治，到峄山、泰山、琅琊山等处刻石，以歌颂其功业。第四年再东巡，在之罘山留下之罘刻石、东观刻石。过了三年再东巡至碣石，面对苍茫大海，他喜气洋洋不可一世，又立石颂德。第十年（前210），始皇南巡，至会稽，再刻石彪炳其伟业，愿江山千秋永固。这四次巡游，刻石六处，文章七篇。二世皇帝即位后下了一道诏书，命令在始皇帝所刻石上加刻一段文字，说明这是始皇帝所刻，使后世不疑。六处七篇刻石，据说都出自李斯手笔。其中东观刻石、碣石刻石，历代都无著录。之罘一刻，原石也早已散佚，欧阳修所得拓本，是二世皇帝加刻的诏书21字，原文付阙（见欧阳修《集古录跋尾》卷一）。传世仅见久已失真的宋代《汝帖》本13字，风格与其他刻本差别很大。因此宋代流传的秦始皇刻石拓本仅峄山、泰山、琅琊、会稽四种，称为“秦四山刻石”。秦峄山刻石拓本局部放大《峄山刻石》，又名《峄山碑》，为始皇东巡第一刻。其前段是秦始皇颂赞文，刻于秦始皇二十八年（前219）；后段是秦二世诏书，刻于秦二世元年（前209）。

峄山碑全文及译文修订稿

峄山碑全文及译文 Document number【AA80KGB-AA98YT-AAT8CB-2A6UT-A18GG】

峄山碑及译文

峄山碑及译文 TTA standardization office【TTA 5AB- TTAK 08- TTA 2C】

《会稽刻石》文言文原文阅读答案翻译注释

《会稽刻石》文言文原文阅读答案翻译注释作品原文皇帝休烈（1），平壹宇内，徳惠攸长（2）。卅有七年（3），寴?天下，周览远方。遂登会稽，宣省习俗（4），黔首齐庄（5）。群臣诵功，本原事迹，追道高明（6）。秦圣临国，始定刑名（7），显陈旧章。初平法式，审别职任，以立恒常。六王专倍（8），贪戾慠猛（9），率众自强。暴虐恣行，负力而骄，数动甲兵（10）。阴通间使，以事合从（11），行为辟方（12）。内饰诈谋，外来侵边，遂起祸殃。义威诛之，殄熄暴悖（13），乱贼灭亡。圣德广密，六合之中（14），被泽无疆。皇帝并宇，兼听万事，远近毕清。运理群物，考验事实，各载其名。贵贱并通，善否陈前（15），靡有隐情。饰省宣义（16），有子而嫁，倍死不贞。防隔内外，禁止淫佚，男女絜诚。夫为寄猳（17），杀之无罪，男秉义程（18）。妻为逃嫁，子不得母，咸化廉清。大治濯俗，天下承风，蒙被休经（19）。皆遵轨度，和安敦勉（20），莫不顺令。黔首修絜，人乐同则，嘉保太平。后敬奉法，常治无极，舆舟不倾。从臣诵烈，请刻此石，光陲休铭（21）。注释（1）休烈：盛美的事业。（2）攸：原作“修”，据严可均辑校《全秦文》卷一所收申屠駉重刻会稽碑拓本改。“攸”在此作语气助词。（3）卅：原作“三十”，据《全秦文》会稽碑拓本改。（4）省（xǐng）：明白。（5）黔首：战国时期及秦代对国民的称呼。

齐：肃敬。（6）道：原作“首”，据《全秦文》会稽碑拓本改。高明：指秦始皇的所作所为。（7）刑名：原本指形（事实）和名（名称）。先秦法家把“名”引申为法令、名份、言论，主张“审合刑名”，“循名责实”，以明赏罚。（8）六王：指楚、齐、燕、韩、魏、赵六国之王。专：独断专行。倍：通“背”。（9）慠（aò）：同“傲”。（10）甲兵：甲胄和武器。（11）合从：即合纵，战国后期纵横家提出的六国联合抗秦战略。（12）辟：同“僻”。方：通“旁”。辟方：不正当。（13）殄（tiǎn）熄：灭绝，扑灭。（14）六合：天地及四方。（15）否（pǐ）：恶。（16）饰：文饰。省：通“眚”，过失。（17）寄猳（jiā）：借给别家传种的公猪，比喻进入他人家中淫乱的男人。（18）秉：操持。义：礼仪容止。（19）休：美。（20）敦：督促。（21）陲：流传。作品译文皇帝创业美且盛，境内平定大一统，德泽恩惠长又长。始皇三十有七年，亲自出巡游天下，视察周遍到远方。于是登上会稽山，宣布教化树风尚，国民肃敬又端庄。臣子个个颂功德，寻根求原明事迹，追述往事赞秦皇。秦皇天圣做国君，始立法令正名实，明确公布旧规章。首先统一总法式，审别官职明任务，从此办事有恒常。六王专横背信义，贪心乖戾又凶猛，个个带头想逞强。随心所欲施暴虐，自恃军力太骄狂，屡次出兵动刀枪。暗中通使搞离间，串联合纵拒秦国，所作所为不正当。掩盖内心怀奸计，公然外来侵我疆，天下从此起祸殃。秦国正义威力强，

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姜夔《续书谱》原文、译文2

用笔不欲太肥，肥则形浊；又不欲太瘦，瘦则形枯；不欲多露锋芒，露则意不持重；不欲深藏圭角，藏则体不精神；不欲上大下小，不欲左高右低，不欲前多后少.欧阳率更结体太拘，而用笔特备众美，虽小楷而翰墨洒落，追踵钟、王，来者不能及也.颜、柳结体既异古人，用笔复溺于一偏.予评二家为书法之一变，数百年间，人争效之，字画刚劲高明，固不为书法之无助，而魏、晋之风规，则扫地矣.然柳氏大字，偏旁清劲可喜，更为奇妙，近世亦有仿效之者，则浊俗不除，不足观.故知与其太肥，不若瘦硬也. 【译文】用笔不要太肥，太肥了字形就浑浊；也不要太瘦，太瘦了字形就憔悴；不要多露锋芒，锋芒太露，字就不稳重；不要深藏棱角，不见棱角，字就没有精神；不要上面大，下面小；不要左边高，右边低；不要先占地位多，后占地位少.欧阳询地书法，结体虽太拘束，但用笔独具众美，就是小楷，笔墨也潇洒利落，上追钟王，后来人是谁也及不上他地.颜柳结体，既与古人不同，用笔又陷于偏执.我说这两家书派是书法地变体，几百年来，人们争相效学，固然其笔画地刚劲高明，对书法艺术地发展不能说毫无帮助，可是魏晋人地风格规模，究已扫地无遗.至柳氏地大字偏旁，清劲可喜，更为奇妙，近代也有效学地，那就免不了俗和浊，变得毫不可观，所以说字与其写得肥，还不如写得瘦些好. 文档来自于网络搜索【解读】这一段主要讨论书法用笔地肥瘦问题.关于这一问题，古代书家多有讨论.所谓“古肥而今瘦”，常与“古质而今妍”对举.诗圣杜甫关于开元之前书法“书贵瘦硬”地判断，常被人误解为所有地书法都应该以瘦硬为上.杜甫在其论书诗《李潮八分小篆歌》中，写到：文档来自于网络搜索苍颉鸟迹既茫昧，字体变化如浮云.陈仓石鼓又已讹，大小二篆生八分.秦有李斯汉蔡邕，中间作者寂不闻.峄山之碑野火焚，枣木传刻肥失真.苦县光和尚骨立，书贵瘦硬方通神.……吴郡张颠夸草书，草书非古空雄壮. 文档来自于网络搜索在杜甫看来，使用枣木传刻《峄山碑》而使其点画丰肥，坏了风气，书风不古.诗中对仓颉石鼓文、秦相李斯、东汉蔡邕书法地赞叹，对李潮“小篆逼秦相”地赞叹和对当时著名书家张旭“草书非古”地贬斥都反映出杜甫崇尚“瘦硬”地观念.杜甫地这种观念在论及初唐褚薛书风地时候更为突出，如《寄刘峡州伯华使君四十韵》云：“学并卢王敏，书偕禇薛能.”《发潭州》赞曰：“贾傅才未有，禇公书绝伦.”杜甫书贵瘦硬说，主要是就初唐书风而言.“书贵瘦硬”在作为他自己地审美概括地同时，也是初唐书风地真实写照.众所周知，初唐欧、虞、褚、薛四家、盛中唐颜真卿书风、中晚唐柳公权书风代表了唐楷演变三阶段.正如康有为所说：文档来自于网络搜索唐世书凡三变，唐初，欧、虞、褚、薛、王、陆，并辔叠轨，皆尚爽健.开元御宇，天下平乐，明皇极丰肥，故李北海、颜平原、苏灵芝辈并驱时主之好，皆宗肥厚.元和后沈传师柳公权出，矫肥厚之病，专尚清劲，然骨存肉削，天下病矣. 文档来自于网络搜索从此角度来说，唐代书法史似乎可以看作肥瘦地演变史.这与姜夔地看法基本一致.姜夔认为，欧阳询用笔极好，但颜又偏肥，柳又偏瘦，学颜柳者更将其缺点发挥，写颜更肥，学柳更瘦，“不足观”.这对于今天地书法学习无疑也有着作用.我们是否应该思考：唐楷诸家是否是书法入门地唯一选择？如何学习本来就已经偏肥或者偏瘦地颜体、柳体呢？在姜夔地辩证中，我们可以知道，肥瘦本身并无高下，只是不能太过，太肥则“形浊”，太瘦则“形枯”；藏露本身并无轩轾，只是不能过于偏执，太露则“不持重”，太藏则“不精神”；上下、左右、先后关系均需合理安排. 文档来自于网络搜索 [姜夔《续书谱》原文、译文与解读（）] 【原文】草书草书之体，如人坐卧行立，揖逊忿争，乘舟跃马，歌舞擗踊，一切变态，非苟然者.又

横扫一切牛鬼蛇神》全文

一个无产阶级文化大革命的高潮，正在占世界人口1/4的社会主义中国兴起。在短短的几个月内，在党中央和毛主席的战斗号召下，亿万工农兵群众、广大革命干部和革命的知识分子，以毛泽东思想为武器，横扫盘踞在思想文化阵地上的大量牛鬼蛇神。其势如暴风骤雨，迅猛异常，打碎了多少年来剥削阶级强加在他们身上的精神枷锁，把所谓资产阶级的“专家”、“学者”、“权威”、“祖师爷”打得落花流水，使他们威风扫地。毛主席教导我们，在我国，在所有制的社会主义改造基本完成以后，阶级斗争并没有结束。“无产阶级和资产阶级之间的阶级斗争，各派政治力量之间的阶级斗争，无产阶级和资产阶级之间在意识形态方面的阶级斗争，是长时期的，曲折的，有时甚至是很激烈的。无产阶级要按照自己的世界观改造世界，资产阶级也要按照自己的世界观改造世界。在这一方面，社会主义和资本主义之间谁胜谁负的问题还没有真正解决。”我国解放16年以来无产阶级和资产阶级在意识形态领域内的阶级斗争，一直是十分激烈的。目前的社会主义文化大革命，正是这个斗争的继续发展。这场斗争是不可避免的。无产阶级和一切剥削阶级的意识形态是根本对立的，是不能和平共处的。无产阶级革命，是要消灭一切剥削阶级、消灭一切剥削制度的革命，是要逐步消灭工农之间、城乡之间、脑力劳动和体力劳动之间的差别的最彻底的革命，这不能不遇到剥削阶级最顽强的反抗。革命的根本问题是政权问题。上层建筑的各个领域，意识形态、宗教、艺术、法律、政权，最中心的是政权。有了政权，就有了一切。没有政权，就丧失一切。因此，无产阶级在夺取政权之后，无论有着怎样千头万绪的事，都永远不要忘记政权，不要忘记方向，不要失掉中心。忘记了政权，就是忘记了政治，忘记了马克思主义的

峄山碑全文及译文

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峄山碑及译文

《会稽刻石》文言文原文阅读答案翻译注释

峄山碑全文及译文精编版

姜夔《续书谱》原文、译文2

横扫一切牛鬼蛇神》全文

峄山碑全文及译文

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