生态哲学视野下的蒙医学探讨

蒙医学是以蒙古族为代表的北方游牧民族在长期的医疗实践中逐渐形成与发展起来的传统医学,是北方游牧民族同疾病作斗争的经验总结和智慧结晶,也是一门历史悠久,内容丰富的具有鲜明民族特色、地域特色的医学科学。古代朴素的生态哲学思想和“天人合一”的自然观是蒙医学形成和发展的理论基础,其生态哲学的特点可概括为整体观理论、辨证诊断理论和重病因治疗理论等方面。保护、弘扬和发展传统蒙医学,在“回归自然、崇尚绿色”的世界潮流中,将使之焕发出强大的生命力和广阔的发展前景。     

"治病求本"概念讨论

“治病求本”是中医治则理论体系中最高层次的治疗原则。通过分析各种对病“本”的认识,提出治病求本的概念可以描述为：治病求本,是指临床时寻求出病证的本质,然后针对其本质进行治疗。     

从"气一元论"浅析"八法"之规律

《经》曰：“百病生于气也”。张景岳明确指出：“盖气有不调之处,即病本所在之处也。“一有不调,则无所不病。”中医认为,“治病必求于本”,欲求其本,调气为先,邪在表,散而调之;邪在里,行而调之;寒者温而调之,热者清而调之,虚者补而调之,实者泻而调之。“各安其气,则无病不除,是皆调气之大法也。”总而言之,“八法”施方用药,暗合利气玄机于其中。法虽众而治则一也,即治病皆以“调气”为原则,所谓“大气一转,其结乃散”是也,“善医者,调其气而已”。     

病、证、症的概念及其相互关系

“病”、“证”、“症”是疾病的3个基本层次,辨病论治强调始发病因和病理过程,是通过局部治疗以改善整体;辨证论治则强调机体的整体反应特性,是通过整体治疗以改善局部.辨病论治是治病以治人,辨证论治是治人以治病.而对症治疗则是对某些突出症状的单纯性治疗,可减轻患者病痛,并有利于对“病”和“证”的治疗.     

"棍棒拍打"去淤血

用各种粗细不同的棍棒甚至桌脚等,敲打自己的身体,竟然也能够治病、养身。这简直是太可笑了!不过世界上好多事情就是这么神奇。台湾省高雄地区,就有这种“健身“方法,比如一位姓张的太太,就是“棍棒拍打治病”的爱好者。当初,张太太全身酸疼。一民间医师用一根小木棍,将她的整双手臂都打得一片淤青,说要将她的毒素逼出来。果然,张太太经这一阵打后,竟然是大喊舒服。没过几天,就觉得身上轻松了。据     

"异病同治"临床应用体会

应用阳和汤对痈证、历节、牙痛 3个不同疾病进行治疗 ,辨证均属阴寒凝滞 ,气血闭阻证 ,均采用温阳补血、散寒通脉之法 ,取得很好疗效 ,是中医“治病求本 ,异病同治 ,辨证论治”的具体体现。     

以患者为镜

“照镜子、正衣冠、洗洗澡、治治病”是党的群众路线教育实践活动的总要求.其中“照镜子”既是关键步骤,又是重要方法,目的是为了摆问题、找差距、明方向,为“正衣冠、洗洗澡、治治病”作准备.作为医生,服务的对象是患者,工作是否认真、用药是否合理、态度是否和蔼、病情是否好转,直接关系到患者是否满意.故,医生要以患者为镜,从患者身上照出自身的问题与不足.     

“棍棒拍打”去淤血

用各种粗细不同的棍棒甚至桌脚等,敲打自己的身体,竟然也能够治病、养身.这简直是太可笑了!不过世界上好多事情就是这么神奇.台湾省高雄地区,就有这种“健身”方法,比如一位姓张的太太,就是“棍棒拍打治病”的爱好。     

《伤寒论》"难治"刍议

凡医药之用,在治病之道.欲明治病之道,当须知病之可治与不可治,此乃医者临证之一大关.《伤寒论》乃一部治病之书,除了教人如何辨认三阳三阴病证及其相关治疗之外,亦会论及疾病之不治与死证.期间或言其"难治",则近乎不治或死之证.但有时言其"难治"时,则又示人以主病之方.其所谓"难治"者,可治乎?抑或不治乎?本文从治病之义,针药之用,生死之理等方面论及可治、不治与难治,藉此以论中医治病之道.     

"异病同治"2例

治病求本 ,是中医辩证施治的基本原则 ,《素问·阴阳应象大论》曰 :“治病必求于本”。疾病的发生、发展都是通过症状显现出来 ,只有充分地收集、了解疾病的各方面 ,进行综合分析才能透过现象看到本质 ,找出疾病的根本原因 ,确立正确的治疗方法。因此 ,“异病同治”法由此而生。1　病例报告例 1 ,患者 ,女 ,63岁。 5年前因外感高热后出现便秘 ,每周依靠泻药解大便 1次。 5+ 年中经中药、西药等治疗均无效果。查体 :全身情况好 ,腹软 ,无压痛 ,舌淡红 ,苔薄白 ,脉弦缓有力。直肠镜及大便常规检查无异常。例 2 ,患者 ,男 ,48岁。 1 0 + 年前病…     

“五经”和《黄帝内经》中“瘧、“蛊”词义探析

作为儒家经典的“五经”中有很多中医药学名词,如“瘧”和“蛊”。其中,春秋时期“瘧”有“暴病”、“寒疾”的含义,至战国时期则开始作为病症名词,称为“瘧疾”,“暴病”、“寒疾”的含义消失。《黄帝内经》中有专论论述疟疾。“蛊”的本义为毒虫,后引申为能够害人的毒虫,因而有了蓄蛊害人、蛊病、蛊毒、腹中虫之说。“蛊”在《周易》中为蛊卦,后人解释为“心神惑乱之疾”,在《左传》和《黄帝内经》中均有记载。     

江淹"恨人"心态解读

在刘宋元嘉之后偏畸的士林文化氛围中，江淹的“恨人”心态导源于他早年一直固守的儒家的“立功”理想。细绎江淹“恨人”心态的演化轨迹和情感内涵，可以看到此种心态是对中国古代文人悲情体验的高度概括。由于江淹诗赋的影响，“恨人”心态已经成为常见的古代文人悲情体验的文学意象之一。     

Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups

BACKGROUND: Debates over legalisation of physician-assisted suicide (PAS) or euthanasia often warn of a "slippery slope", predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period. METHODS: The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998-2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government-commissioned nationwide studies of end-of-life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. RESULTS: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. CONCLUSIONS: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.     

塔克拉玛干"沙漠人"心电图明尼苏达编码分析

目的研究塔克拉玛干“沙漠人”心脏电生理特点。方法224名“沙漠人”进行静息心电图检查,男133名,女91名,对照组为151名,男76名、女75名。对受检者12导联静态心电图进行明尼苏达编码,相关数据采用χ^2检验对率作趋势分析。结果（1）异常编码率：“沙漠人”组为103例（46％）,男73例,女30例。（2）左室高电压（3-1,3-3）“沙漠人”组为73例（32．6％）,（男55例,女18例）,对照组为19例（12．6％）,（男11例,女8例）。（3）高血压检出率,“沙漠人”为17例（7．6％）,对照组59例（39．6％）。（4）“沙漠人”中超重和肥胖者21例（9．6％）,对照组23例（23％）。（5）心律失常：“沙漠人”为20例（8．9％）,对照组为10例（6．6％）。结论“沙漠人”左室高电压的检出率明显高于对照组,但高血压,肥胖检出率并不高,可能与其特殊的生存环境,要求强体力活动,心脏泵血功能高导致心肌生理性肥厚、胸壁薄有关。     

“辨病”论说亚健康状态

人们一般都认为亚健康是非健康非疾病的中间状态;但有些学者却强调亚健康也是疾病。其实这二种提法并行不悖。因为日常生活中"病"的概念非常广泛,人们有时从"症"论病;有时从"证"或"征"论病;中医大多数场合是"症、证"合参论病。人们称谓的"疾病"有3类不同的概念。理解了3类"疾病"概念,那么亚健康是否为"疾病"的争论就显得无足轻重。借助3类"疾病"概念,能较通俗地界定已病(狭义疾病)状态与亚健康状态;为临床医学充实诊断标准。     

Disability, identity and the "expressivist objection"

The practice of prenatal screening for disability is sometimes objected to because of the hurt and offence such practices may cause to people currently living with disabilities. This objection is commonly termed "the expressivist objection". In response to the objection it is standardly claimed that disabilities are analogous to illnesses. And just as it would be implausible to suppose reduction of the incidence of illnesses such as flu sends a negative message to ill people, so it is not plausible to suppose prevention of disability sends a negative message to disabled people. The expressivist objection hinges, however, upon a view of the relationship between disability and self identity which sees disability as part of the identity of the disabled person, in a way in which illnesses such as flu cannot be. This possibility is generally not considered in critiques of the expressivist objection. In this paper, an "identity claim" to the effect that disabilities can be identity constituting is accepted and the force of the expressivist argument is reconsidered in the light of its acceptance. It is concluded that even when such an identity claim is accepted, the expressivist objection is still not morally compelling.     

“翻转课堂”在普通外科实习教学中的应用评价

目的 探讨“翻转课堂”在普外科实习生教学中的应用与实践。方法 川北医学院第二临床学院普外科20个实习小组（每组3~5人），以排列小组序号随机分为翻转组（45人）、传统组（40人），每组10个小组。翻转组采用翻转课堂教学模式（发放资料学生课前自学—学生、教师课中讨论—课后评价），传统组采用传统教学模式（学生课前预习—教师课中讲解—教师课后答疑）。教学结束，采用问卷法评估每位学生的参与度及完成度，以病史采集和病案分析得分评价教学效果。对比分析两组间参与度、完成度及教学效果。应用SPSS 23.0软件进行t检验和卡方检验。结果 翻转组参与度优于传统组[（17.45±1.83） vs. （15.57±1.52）]，差异有统计学意义（P < 0.05）；翻转组与传统组完成度比较差异无统计学意义。两组间病史采集得分比较差异无统计学意义；翻转组病案分析优于传统组[（87.30±6.06） vs. （81.50±5.88），P < 0.05]。调查问卷显示，约90%的学生认为翻转课堂能提高学习兴趣96%（43/45），提高自主学习能力89%（40/45），学习效果更佳；同时78%（35/45）的学生认为学习时间较长。结论 翻转课堂能提高普通外科实习学生教学参与度，提高学生学习兴趣，提高学生自主学习能力，提高学生病案分析思维能力。     

塔克拉玛干“沙漠人”心电图左室高电压特点及其相关因素

目的研究塔克拉玛干"沙漠人"心电图左室高电压特点及其相关因素。方法对368例"沙漠人"("沙漠人"组)和151例对照组进行静态心电图检查,相关数据采用χ2检验对率作趋势分析。结果 (1)左室高电压:"沙漠人"组为89例(24.2%),男性为63例(28.5%),女性26例(17.7%)。对照组为19例(12.6%),男性11例(14.5%),女性为8例(10.7%),2组差异有统计学意义(P<0.01),"沙漠人"组Sv1+Rv5明显高于对照组(P<0.01)。(2)"沙漠人"组高血压检出率明显低于对照组(P<0.01)。(3)"沙漠人"组左室高电压编码人中高血压检出率明显低于对照组左室高电压人中高血压检出率(P<0.01)。(4)左室后壁和室间隔的测定:"沙漠人"组左室高电压中仅1例有室间隔轻度增厚。结论 "沙漠人"心电图的左室高电压检出率较高,其QRS振幅高,时限狭窄,无ST段压低及T波倒置,与心律失常关系不密切。     

"Below the Line": The tobacco industry and youth smoking

Background

This paper provides a comprehensive account of how the tobacco industry, over time, has promoted its products to young people.

Method

A comprehensive search of tobacco industry documents relating to youth smoking was conducted using documents available on the World Wide Web through the Master Settlement Agreement.

Results

The documents provide evidence that the industry invested great time and resources in developing strategies to attract young people through Youth Smoking Prevention strategies (including education strategies) and marketing to youth. The results include information from published literature and direct excerpts from the tobacco industry documents.

Conclusion

The tobacco industry documents confirm that the tobacco industry has promoted and supported strategies that are ineffective in reducing smoking by youth, and opposed strategies that have proven to be effective. It is clear from the documents reviewed that the industry values the youth market and through a number of measures continues to promote its products to young people.     

发扬为人民服务的精神,做新时期医疗卫生战线上的楷模

1944年的9月8日,毛泽东为悼念因炭窑崩塌而牺牲的中央警备团的战士张思德发表了著名的<为人民服务>提出了为人民服务的思想.为人民服务有着丰富的思想内涵,反映了我国社会主义社会政治、经济、文化的客观要求,是社会主义道德建设的核心和道德要求的集中体现,也是新时期广大医务工作者必须坚持的基本行为准则.