中国古代哲学对《内经》的影响

《内经》的理论源于中国古代的哲学,并在很大程度上受到了自然哲学的指导和支配,形成了中医学的基本理论框架。试就唯物观与辩证法两方面对之进行分析。     

Factors influencing prescribing: an intern's perspective

OBJECTIVES: To examine the self-reported influences on intern prescribing practice. DESIGN: Qualitative interviews with a cross-sectional cohort. PARTICIPANTS AND SETTING: Ten interns practising in two urban teaching hospitals in New South Wales, Australia. RESULTS: The interns identified a number of factors that improve their confidence and perceived competence and allow them to extend their existing skills. These were approachable, available and up-to-date teachers (most often registrars and subspecialty nurses and pharmacists); timely, relevant and practical teaching (such as interactive bedside teaching); concise and widely accepted resources (such as prescribing pocket guides); and a constructive manner on the part of senior staff for dealing with prescribing errors. Interns also identified influences that are detrimental to confidence, conflict with their perceptions of appropriate prescribing and inhibit learning and skills acquisition. These were unapproachable, physically and mentally remote teachers (most often consultants); theoretical, inconsistent and irrelevant teaching (such as grand rounds or didactic education sessions); inconsistent and inaccessible resources; and a confrontational and accusatory way of dealing with prescribing errors. The added pressures of time, hospital hierarchies and the indirect influence of drug company promotion also impeded acquisition of good prescribing habits. CONCLUSIONS: At a critical time in skills development, interns encounter many forces that can potentially impact on prescribing practices in both positive and negative ways. Our data contribute to the understanding of the multifaceted learning environment of interns and may be useful in providing a foundation for prescriber education programmes tailored to the specific needs of junior doctors.     

孙外主学术思想探析

孙外主主任医师从事临床数十年,力主继承祖国医学的经典针法,倡导针灸处方规范化,并探索性地提出了“腧穴疲劳性”这一新观点,本文旨在探析其学术思想及专病专治的临床经验。     

《内经》痿证理论临床运用举隅5例

依据《内经》有关痿证的理论,指导临床治疗甲状腺功能亢进性肌病 ,腰椎结核性脓肿,颈椎病,脊髓空洞症,腰骶神经根损伤疾病引起的以肢体运动障碍为主要症状的病例,并述心得体会。     

缪刺考

At present, most physicians hold that Miu Ci is "left and right cross collateral prick-ing",but it does not conform to the original meaning of "Suwen·Miucilunpian"(Plain Questions ·Trea-tise on Miu Ci). Miucilanpian holds that Miu Ci is the extension and perfection of Ju Ci (contralateral me-ridian needling), which mainly pricks the collateral but is not limited to the collateral, as it also pricks the acupuncture point. As for the "left and right cross" point selection, it is one step in the procedure of the treatment in the process of contralateral collateral needling instead of being a principle.     

善胃系列方治疗胃癌前病变的相关基因蛋白表达试验研究*

[目的]观察中药善胃系列方对慢性萎缩性胃炎(CAG)伴有胃黏膜异型增生(Dys)和(或)肠上皮化生(IM)的治疗效果,并观察相关基因蛋白在治疗前后的表达情况.[方法]将确诊为慢性萎缩性胃炎伴胃黏膜异型增生和(或)肠上皮化生(IM)的患者154例,随机分为观察组106例,口服善胃系列方中药,根据辨证分型又分为3组血瘀热毒型(善胃Ⅰ号方)组34例,阴虚有热型(善胃Ⅱ号方)组43例,气阴两虚型(善胃Ⅲ号方)组29例;对照组48例,口服猴头菌片,连续治疗6个月,观察两组患者临床症状改善情况、胃镜所见及胃黏膜病理组织学改善情况;利用免疫组化方法观察服药前后胃黏膜组织中ras癌基因P21蛋白和抑癌基因P16蛋白的表达情况.[结果]观察组患者治疗后总有效率为83.96％;对照组患者治疗后总有效率为29.17％,两组有显著性差异,P＞0.01;观察组治疗后多数患者腺体萎缩程度、肠上皮化生、胃黏膜异型增生均有改善,P＜0.01;而对照组改善不明显;观察组明显优于对照组,P＜0.5;观察组治疗后癌基因蛋白P21显著降低,P＜0.05;抑癌基因蛋白P16表达显著提高,P＜0.05.[结论]中药善胃系列方对胃癌前期病变临床疗效确切,并通过降低P21的表达水平,提高P16的表达水平,在一定程度上使胃黏膜病理逆转.     

611张门诊抗菌药物不合理处方分析

目的了解该院门诊抗菌药物不合理使用情况，促进抗菌药物合理应用。方法随机抽取2003年度门诊处方8736张，对舍抗菌药物的处方进行逐一审查，并对不合理的抗菌药物处方进行统计分析。结果审查抗菌药物处方3993张，其中不合理处方611张（15．30％），主要在给药方案、联合用药等方面存在问题。结论应重视抗菌药物不合理应用的问题，提高抗菌治疗水平，减少细菌耐药性和不良反应的产生。     

本院门诊癌症患者麻醉处方分析

目的依据WHO“癌症三阶梯止痛疗法”指导原则,调查本院门诊对癌症患者麻醉药品使用情况。方法以DDD和DUI值为指标,对本院2004年1月至2005年5月门疹1 529张麻醉处方其中癌症患者所用1 160张麻醉处方进行统计分析。结果哌替啶注射液DUI值为1.59,盐酸吗啡缓释片为1.23,磷酸可待因片为0.91。结论本院癌症患者麻醉药品使用基本合理,但哌替啶的使用频率过高,与“癌症三阶梯止痛疗法”有一定差距。     

258例急性中风中医证型变化的观察及小复方辨证治疗在卒中单元中的疗效评价

目的:探讨卒中单元中急性中风病病因、证型分布、病机特点和中医小复方辨证治疗的疗效。方法:将符合诊断标准的病例随机分为对照组(102例)和治疗组(156例)。对照组给予西医常规治疗,治疗组在此基础上给予中医小复方辨证治疗,连续观察14~21天。观察证型分布与时间的关系。比较两组治疗前后的中医症状评分、美国国立卫生研究院卒中量表(NIHSS)和Barthel指数(B I)评分。结果:中风病发病随年龄增加而增加,高血压是最主要的相关疾病,肝阳暴亢是前三天的主要证型,以后逐渐减少,风痰瘀阻前三天略少于肝阳暴亢型,以后逐渐增多。肝阳暴亢、风痰瘀阻和痰热腑实三型在前21天占所有证型的95%左右。两组治疗后中医症状评分、NIHSS评分降低,B I评分升高。治疗后组间相比,治疗组在降低中医症状评分、NIHSS评分和提高B I评分与对照组比均有统计学意义。结论:实证是中风病急性期的主要证型,肝阳暴亢、风痰瘀阻和痰热腑实三型占有主导地位。从证型推出,肝阳暴亢化风可能是中风病“风、火、痰、瘀”级链反应的始动因子。以平肝泻火通络,活血化瘀、化痰通络,通腑化痰为治法的小复方,能降低中医症状评分和NIHSS评分,提高B I评分,为中医药在卒中单元中的作用提供了有益的证据。     

白藜芦醇和抗坏血酸对预防非典型肺炎方剂Ⅰ和Ⅵ所致小鼠外周血液淋巴细胞DNA损伤的保护作用

目的研究白藜芦醇和抗坏血酸对预防非典型肺炎方剂Ⅰ和Ⅵ致小鼠外周血液淋巴细胞DNA损伤的保护作用.方法采用单细胞凝胶电泳方法研究白藜芦醇和抗坏血酸对预防非典型肺炎方剂Ⅰ和Ⅵ致小鼠外周血液淋巴细胞DNA损伤的保护作用.结果白藜芦醇(50,100,200 mg/kg×3 d)和抗坏血酸(50,100,200 mg/kg×3 d)对方剂Ⅰ和Ⅵ(临床等效量×3 d)所致的小鼠外周血液淋巴细胞DNA损伤呈剂量依赖性的保护作用(P＜0.05).结论白藜芦醇和抗坏血酸能够保护预防非典型肺炎方剂J和Ⅵ对小鼠外周血液淋巴细胞DNA的损伤.