试论《温病条辨》的“博涉知病、多诊识脉、屡用达药”

重读《温病条辨》(以下简称《条辨》),深感《条辨》辨证精湛,用药妥贴。追迹仲景,补《伤寒》之未备;师承人士,使叶氏经验规范化。南齐·褚澄《褚氏遗书·辨书》谓:“师友良医,因言而识变;观省旧典,假签以求鱼.博涉知病,多诊识脉,屡用达药,则何愧于古人.”本文试对《条辨》的知病、识脉、达药,略作探讨,敬祈指正。     

李孔定教授用药点兵九味记

<正>南齐·褚澄《褚氏遗书·辨书》云:"博涉知病,多诊识脉,屡用达药",为医家之最高境界。清·徐灵胎强调:"善用药者,即使沉重难治之疾亦可妙手回春,不善用药者,虽平淡之品亦能害人,任医者不可不察也!"可见用药对于疾病治疗之重要。历代名医之特色,无不体现在其用药处方之中。     

医家名言录

彼习业者专则精,不专则杂;察心者一则恒,不一则间。明·孙一奎《赤水玄珠》博涉知病,多诊识脉,屡用达药。明·江灌《各医类案》思贵专一,不客浅尝者问津;学贵沉潜,不容浮躁者涉猎。清·程国彭《医学心悟》     

“医不三世,不服其药”新解

文章对“医不三世,不服其药”的内涵进行考辨,提出中医传承应系统读经典、亲炙承家学和多方拜名师,经过“三折肱知为良医”的临床实践,方能登堂入室,体悟中医学之“至道”奥妙,成为“博涉知病,多诊识脉,屡用达药”,集神圣工巧技能于一身的高水平医生。“医不三世,不服其药”对现代中医守正传承同样具有参考借鉴价值。     

临证用药琐谈

古贤云“多诊识脉,屡用达药”。“识脉”“达药”,非一日之功,数10春秋处方用药,细心揣度药物进退的效验与否,随时总结心得,或可致“达药”之境,“识脉”亦当如斯。     

临证用药琐谈

古贤云“多诊识脉，屡用达药”。“识脉”“达药”，非一日之功，数十春秋处方用药，细心揣度药物进退的效验与否，随时总结心得，或可致“达药”之境，“识脉”亦当如斯。     

周慎斋脉诊特色探析

目的:探析周慎斋脉诊学术思想特色。方法:通过分析周慎斋《慎斋遗书》《医家秘奥》脉论原文,结合文献查阅的方法,从脉象、脉理和主病等方面梳理其脉诊学术思想。结果:慎斋先生重视“三部九候、人迎气口”脉诊诊法,灵活运用以脉辨神与力、以脉辨胃气胃阳、以脉辨气血精神等望色切诊之法;并将脉诊与脏腑、八纲、三焦等辨证方法结合,充分发挥脾胃学说,明确脾阴证治,重视肾与命门,最终将脉诊理论应用于临床,明辨病机,指导遣方用药。结论:慎斋先生脉诊理论融合脉象、脉理、主病以及治法方药来辨治疾病,临证经验丰富,为脉学理论的临床运用提供了重要的指导。     

张山雷脉学特色浅识

近代名医张山雷 ,医技精湛 ,名重医林 ,被誉为“海内三张”之一。张氏对诊断学 ,特别是在脉学方面有深刻的研究 ,并在临床证实践中积累了丰富的经验。所著《脉学正义》一书 ,是其研究脉学之心得 ,兹就张氏脉学特色作如下浅识。　　 1　对脉诊的认识　诊脉识病 ,可以知气血之虚实盛衰 ,断病机之寒热温凉 ;脉随病势而变迁 ,所谓脉症相合 ,如影随形。一般都认为先有其症而后有其脉 ,即有是症便有是脉。张氏的认识则更深一层 ,认为脉象相对于病症来说 ,应为疾病之征兆。医者诊察病症 ,患者皆已病状昭著 ,而后按脉之动静以辨其凶吉 ,但于病机萌动…     

六经辨治体系下的误诊挽治二则

六经辨证体系之精髓在于辨主病,审病机,方证相合,药精效宏。本文列举在六经辨治体系下的误诊挽治病案二则。一则太阳少阳合病误诊三阳合病挽治案,初诊舌脉误析,病机错判,药后效差;二诊参悟四诊,掌握病机,方证相合,药到病除。一则太阴下利重证轻判挽治案,初诊未经四诊合参,先入为主,误将太阴下利重证判为湿热实证,犯了以偏概全、主次颠倒错误;二诊虽辨证挽治,未虑中病即止,治之失度,太阴阳复太过,以至病转阳明,脉证由虚转实,经内外合治告愈。本文以主病及兼症的病机分析和遣方疗效为线索,探索《伤寒论》六经辨证的精意在临床中的现实指导意义。从抓住主病,掌握病机;脉证与六经传变两方面,推而广之论述了六经辨治在临床实践中依据六经病提纲,分清六经病主病,确定属经病证及合病并病,进而选方化裁的临证心得。     

张仲景辨治百合病思路探析

张仲景辨治百合病,首论百合病成因主症治则以识病立纲;次论百合病救误治法以警示后学谨防误诊误治;继论百合病正治法示人以规矩准绳;列举百合病变证治法教人以知常达变;给药方法内治与外治合用以增强疗效。     

基于“脑肠同调”治疗广泛性焦虑障碍伴便秘的中医研究进展

广泛性焦虑障碍（GAD）是一种以焦虑为主要表现的精神障碍，便秘是其常见伴随症状，两者互为因果。GAD伴便秘发病机制复杂，西医临床疗效欠佳，抗焦虑药物易加重或诱发便秘，而中医在整体观念的指导下，以“脑肠同调”治疗GAD伴便秘可兼顾“脑” “肠”多个靶点，打破焦虑与便秘的恶性循环。文章对“脑肠同调”治法的理论内涵与其在GAD伴便秘的应用进行梳理与总结，以期为临床中GAD伴便秘的多维度诊疗提供思路。     

子宫内膜功能亢进性疾病的“异病同治”诊治研究思路＊

笔者根据现代临床子宫内膜的病理演变过程结合中医“异病同治”理念，提出“子宫内膜功能亢进性疾病”概念，涵盖5种常见的子宫内膜疾病：无排卵性异常子宫出血（Abnormal Uterine Bleeding Ovulatory dysfunction，AUB-O），子宫内膜息肉（Endometrial Polyp，EP），子宫内膜异位症（Endometriosis，EMs），子宫腺肌病（Adenomyosis，AM），子宫内膜癌（Endometrial Carcinoma，EC）。基于文献的汇总，分析得到此类疾病的子宫内膜病理演变与中医病因病机的关联性，为寻找关键通路、创新性治疗此类疾病提供了重要的参考方向，对深化中医妇科学常见疾病的共性病因病机提供了理论依据和探索思路。     

对补充《温病学》病机理论及郁热病机的探讨＊

本文通过分析《温病学》教材内容，并结合中医经典论述及刘河间、吴又可、叶天士、吴鞠通、薛生白、杨栗山等医家对温病郁热病机的重视和辨证论治运用要领，认识到丰富补充《温病学》病机理论及郁热病机的必要性和重要性。同时，提出补充温病学病机理论及郁热病机的内容。     

阿德福韦酯致低磷骨软化症的6 例报道和病机探讨

目的：通过对6例服用阿德福韦酯后出现低磷骨软化患者的病情进展报告和中医证候分析，以中医“肝肾同源”理论探讨抗病毒药物所致肾损伤及骨软化症的病机及防治方法。方法：本研究对临床收治的6例无血缘关系的慢性乙肝患者,在接受阿德福韦酯治疗后出现了低磷骨软化症进行报道。同时对所有患者进行了中医症候分析。考虑低磷骨软化的发生与阿德福韦酯有关，故对抗病毒药物治疗肝炎后出现肾损伤及骨软化症的病情进展及预后进行分析，并进行文献回顾，对阿德福韦导致肾小管损伤的病机进行归纳。结合该病的中医证候进行结合分析，根据中医“肝肾同源”理论，及内经“肾主骨”的病机特点进行中医病机分析。结果：6例患者均为接受了阿德福韦酯10 mg天治疗48-84月后出现了低磷骨软化。每例患者均出现了骨密度的下降，血磷降低、碱性磷酸酶增高及不同程度的骨折影像学表现，且舌脉及中医证候分型为“肝肾亏虚”型，同时伴有“气滞血瘀”。我科拟诊“低磷骨软化”后，予罗盖全0.25 μg 2次·日-1，钙尔奇D 0.6 g/次/天口服，中性磷溶液口服，5例停用阿德福韦酯，1例因肝炎控制不佳继续服用阿德福韦酯，服用剂量减为10 mg·次-1，2日1次，治疗一年后骨痛症状消失，2年后生化检查及骨密度BMD均恢复正常，长距离行走自如。肝功能和乙肝病毒控制良好。同时对6例患者的中医证候分析，发现其主要都有肾精亏虚，并文献回顾。结论：乙肝经阿德福韦酯治疗患者的病情发展受中医“肝肾同源”理论影响，易出现肾功能损伤、低磷骨软化症，联合运用中医补肾活血中药对阿德福韦酯导致的低磷骨软化和肾功能损伤有防治作用。     

梁繁荣教授通阳调神针法治疗顽固性失眠临床经验＊

相比普通型失眠，顽固性失眠病程久、病情重、病因病机更为复杂，对患者的心理及生理健康均造成严重的损害。梁繁荣教授熟读经典，并与多年临床实践经验相结合，认为该病的基本病机仍在于“阴阳不和，神气失守”，其治疗贵在通达，阳气得以通达则阴阳得和，神气得守，故梁教授总结治疗经验并形成了治疗顽固性失眠的通阳调神针法。针法强调“通阳得理以阴阳平秘，调神得安以寤寐顺时，辨证取穴以补泻得当”；在手法选择上，除毫针针法外，亦多选择梅花针、艾灸等多种治疗方法以加强治疗效果；在穴位选择上，除辨证取穴外，亦着重背部阳经穴位、敏化穴位及局部调神穴位的选用。     

基于“一气周流”探讨糖尿病肾病病因病机

“一气周流”中“一气”为中气，是人体气机升降枢纽；“周流”指人身之气升降有序，周循不休。一气虚损，疾病百生。基于“一气周流”理论，根据糖尿病肾病（diabetic nephropathy, DN）病程进展演变，提出“虚→湿、瘀→毒→衰”病机演变规律，并详细论述糖尿病肾病发病机制，以中焦土气斡旋为目的，采用培中土、滋先天为治疗基础，兼顾利湿活血驱毒之法，助机体气机恢复周流运转，可更有效地治疗糖尿病肾病。     

Ethnobotany of the Alt Empordà region (Catalonia,Iberian Peninsula): Plants used in human traditional medicine

Ethnopharmacological relevance

This paper provides significant ethnobotanical information on pharmaceutical plant uses from a tourist and industrialised region, where some degree of acculturation exists, so that there is urgency in recording such data.

Aim of the study

To collect, analyze and evaluate the ethnobotanical knowledge about medicinal plants in a north-eastern Iberian region (Alt Empordà, 1358 km², 129,160 inhabitants).

Methodology

We performed 101 semi-structured interviews with 178 informants (mean age 69; 71% women, 29% men), identified the plant taxa reported and analyzed the results, comparing them with those from other territories.

Results

The informants reported data on 518 species. Of these, 335, belonging to 80 botanical families, were claimed as medicinal. This work is focused on human medicinal plant uses, which represent 98% of the pharmaceutical uses (3581 out of 3643 use reports). Around 800 medicinal uses, concerning 200 species, have not, or have very rarely been cited as medicinal; of these, 32 uses of 30 species have been reported by three or more independent informants.

Conclusions

The folk knowledge about medicinal plant use is still alive in the studied region, and a number of scarcely reported plant uses has been detected, some of them with promising phytotherapeutical applications.     

数据挖掘法探讨周珉教授治疗原发性肝癌用药规律及经验总结

[目的]数据挖掘法分析周珉教授治疗原发性肝癌的中医用药规律,探讨相关病机并进行经验总结。[方法]收集2016年2月—2018年5月周珉教授门诊期间治疗原发性肝癌的方剂,运用"中医传承辅助系统(V2.50)"进行数据挖掘,并结合周珉教授临床经验,进行原发性肝癌病机探讨及用药规律分析。[结果]共收集治疗原发性肝癌方剂176首,涉及中药235种,列出方剂中的高频药物及组合规律。[结论]总结原发性肝癌以"湿热痰毒、气阴两伤"为基础病机,"清热化湿、健脾养阴"治则贯穿原发性肝癌治疗始末,同时,根据疾病不同发展阶段及治疗措施,权衡"扶正"与"祛邪"的主次分配,斟酌应用"攻毒散结""行气化瘀"等治法,以达到改善患者生活质量、延缓疾病进展的目的。     

Pharmacological basis for the use of Borago officinalis in gastrointestinal, respiratory and cardiovascular disorders

AIM OF THE STUDY: In this study, we investigated the crude extract of Borago officinalis leaves (Bo.Cr) for its antispasmodic, bronchodilator, vasodilator and cardio-depressant activities to rationalize some of the traditional uses. MATERIALS AND METHODS: Bo.Cr was studied using different isolated tissue preparations including rabbit jejunum, trachea, aorta, and guinea-pig atria. RESULTS: Bo.Cr which was tested positive for flavonoids, coumarins, sterols and tannins produced a concentration-dependent relaxation of spontaneous and K+ (80mM)-induced contractions in isolated rabbit jejunum preparations, suggestive of Ca++ antagonist effect, which was confirmed when pretreatment of the tissue with Bo.Cr produced a rightward shift in the Ca++ concentration-response curves like that caused by verapamil. In rabbit tracheal preparations, Bo.Cr relaxed the carbachol (1microM) and K+-induced contractions. Verapamil also produced non-specific inhibitory effect. In rabbit aorta preparations, Bo.Cr exhibited vasodilator effect against phenylephrine and K+-induced contractions similar to verapamil. When tested in guinea-pig atria, Bo.Cr caused inhibition of both atrial force and rate of contractions. CONCLUSIONS: These results suggest that the spasmolytic effects of Bo.Cr are mediated possibly through Ca++ antagonist mechanism, which might explain the traditional use of Borago officinalis in hyperactive gastrointestinal, respiratory and cardiovascular disorders.     

Ethnopharmacological survey of medicinal plants in Jordan,Mujib Nature Reserve and surrounding area

Aim of the study

Medicinal plants are an important element of indigenous systems in Jordan. These resources are usually regarded as part of a culture's traditional knowledge. Therefore, the aim of this study is to collect information from local population concerning the use of medicinal plants of the Mujib region; identify the most important medicinal plants used; determine the relative importance of the species surveyed and calculate the informant consensus factor (F_ic) in relation to medicinal plant use.

Materials and methods

Qualitative tools were used for data collection and to record the interviewee's personal information and topics related to the medicinal use of specific plants. The collected data were used to calculate the F_ic and the plant use values.

Results and conclusions

Fifty-eight plants were identified to be still in use in traditional practice in Mujib. Our results showed that the highest use values were recorded for the species Artemisia sieberi Bess. and Silybum marianum (L.) Gaertn., while the highest F_ic was cited for digestive problems. Anthropologically, women were the primary gatherers while healers were reported to be both females, predominantly, and males; yet, herbalists are deficient in this local community.