基于“矛盾论”探究中医“核心病机观”

在前人病机学说的基础上,基于"矛盾论"思想,结合自身临床实践,系统总结"核心病机观"理论,包括核心病机观的历史沿革、具体内容、理论特性、内在关系,并以胃食管反流病为例具体介绍其在临床的应用。疾病内部的"基本矛盾"是促进疾病发生、发展的内在本质,自始至终都存在着的这个基本矛盾实际就是"核心病机"。相对于核心病机而言,在病情发展的过程中,可能会出现不同于核心病机的其他病机,其中起主要作用的可称之为"主要病机",主要病机表现为疾病发展过程中某一阶段的"主要矛盾"。同时需要注意在临床实际中,主要病机和核心病机有时是一致的,有时却是不一致的。在治疗过程中,要抓住疾病的核心病机,准确辨证论治,治疗主要病机必须服从于核心病机的治疗,最低限度的不去妨碍核心病机。     

卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

腹膜后纤维化致急性肾衰竭二例

我们收治了2例腹膜后纤维化致急性肾衰竭患者，现报告如下。患者 1，女，57岁，因“浮肿一周、无尿4d”来我院治疗。患者于一周前无明显诱因出现腰部不适，颜面部及双下肢浮肿，4d前开始出现无尿。查体：左腹可触及左肾；左肾区叩击痛（＋＋）、右肾区（-），双下肢中度凹陷性浮肿。     

《风湿性关节炎--一个值得磋商的病名》商榷

拜读“风湿性关节炎———一个值得磋商的病名”(中华风湿病学杂志 ,2 0 0 3,7:6 0 )一文 ,颇有同感。不知有多少关节痛的病人被误诊为“风湿性关节炎”而遭误治 !对“天气变化十分敏感”的关节炎不是风湿热的特征性表现的观点 ,亦非常赞同 ,但对“与天气变化较密切的关节炎多是骨关节炎”这一观点 ,说点粗浅看法。临床上 ,我们发现大量关节痛病人多有长居寒冷地、冷库工人、长期驾驶摩托车等受风寒史 ,每次关节痛发作与天气变化 (主要是阴冷下雨 )有密切关系 ,临床检查关节红肿不明显 ,实验室和影像学检查缺乏特异性改变 ,而且发病年龄作者…     

颈部硬膜外药物冲击分离法加斜角肌间沟阻滞治疗幻肢痛1例报告

幻肢痛是截肢后病人感到已失去的肢体依然存在,且某一部分仍有疼痛。幻肢痛的发病率为50～90%、有2%的病人幻肢发生剧烈的疼痛,性质呈闪电样,烧灼样。常在情绪激动或精神异常时发生。目前对幻肢痛的发生机制有多种学说,治疗方法较多,但效果各异。国内杂志报道也较少,现将我们治疗的1例患者报告如下:1病历资料患者,男,53岁,1991年因车祸致左臂丛神经损伤,在上海长征医院行右腓神经移植左臂丛神经修复术,术后出现左上肢疼痛,并向前臂手指放射,伴有上肢功能障碍及前臂轻度肌肉萎缩。由于剧烈疼痛严重影响患者生活、工作,于2001年行左上肢截肢术…     

骶管阻滞治疗慢性盆腔痛的镇痛价值

目的探讨骶管阻滞治疗对慢性盆腔痛镇痛的应用价值。方法将76例慢性盆腔痛患者分为两组，治疗组39例采用骶管阻滞治疗，对照组37例用芬必得治疗。结果治疗组患者疼痛明显缓解，且起效快、完全缓解及缓解持续时间长，与对照组比较差异有统计学意义（P〈0．01）。治疗组总有效率为97．4％，对照组总有效率为81．1％，治疗组疗效优于对照组（P〈0．05）；不良反应发生率治疗组5．1％，明显低于对照组的27％（P〈0．01）。结论骶管阻滞镇痛疗效优于芬必得，且无明显副作用，可作为临床治疗慢性盆腔痛一种新的治疗途径。     

综合治疗椎动脉型颈椎病60例

椎动脉型颈椎病主要表现为颈项强痛,偏头痛、眩晕、耳鸣、记忆力减退、视物模糊、猝倒,治疗以非手术的方法为主。笔者自2000~2003年对60例椎动脉型颈椎病患者进行综合治疗效果满意,现报道如下。1临床资料60例中,男24例,女36例;年龄最大64岁,最小28岁,平均46岁;病程最长8年,最短     

430例急性心肌梗死患者无痛性与有痛性的临床观察与护理

资料与方法 本组急性心肌梗死（AMI）430例，系1995年10月～2005年10月本院收住病人。随机选出有痛性350例，占81．39％，符合1979年世界卫生组织所定的AMI诊断标准；无痛性80例，占18．60％，发病特点是缺乏AMI早期的心前区胸骨后典型的疼痛，仅表现胃部一般性疼痛、恶心、呕吐者16例，头晕、晕厥者23例，颈肩、前臂、手指酸胀麻木者12例，嗜睡或烦躁者9例，下肢及腰部麻木疼痛者6例，貌似脑梗死的AMI14例，表现为短暂意识丧失、偏瘫和不同程度的意识障碍等。     

中药包热敷治疗跟病症30例

跟痛症是门诊一种常见病。一般分为跟下痛和跟后痛及跟骨病3个类型。因为本病具有自感症状与检查结果不相符的情况，故临床上易披忽视或单纯以封闭治疗。但该病影响人们的生活质量。且易反复，因此急需一种简单有效的治疗方法。经过临床实践。应用中药包热敷对该病的治疗效果肯定，现报道如下。     

棍棒按摩法配合三粒散外治跟痛症54例

跟痛症俗称足跟痛。为跟骨跖面多种组织慢性损伤所致．多发生于中老年人。其临床表现为足跟跖面疼痛，步行或站立时加重．局部无红肿．跟骨跖面内侧有一局限性压痛点，部分患者X线侧位片可见跟骨底面结节前缘有大小不等的骨刺。西医治疗多用痛点注射醋酸氢化可的松，配合鞋内放置橡皮或海绵足跟垫．这虽有一定疗效，但不甚理想。近几年来，笔者运用棍棒按摩法配合三粒散外治本症，收效满意，现总结报告如下。