陆圻医术特色初探

[目的]探讨陆圻的医术特色。[方法]以文献学研究方法,整理陆圻医著《医林新论》和《恭寿堂诊集》,分别从医学理论、诊疗方法、方药运用、临证经验等方面总结陆圻医术特色。[结果]陆圻具有扎实的医学理论和丰富的临床经验,其医术特色为:取法诸家,师古不泥;望色为先,脉诊为重;寒热虚实,辨证施治;天行疾疫,推明运气;循因种子,广嗣有方;防病祛疾,饮食宜忌;初学戒行,以正医德。[结论]明末清初钱塘医家陆圻,医理崇尚经典而每多发挥,医术取法诸家而讲求实用,对后世钱塘医家学派的形成具有重要的影响。     

国医大师卢芳运用丹溪痛风方治疗痛风经验

[目的]总结国医大师卢芳教授运用丹溪痛风方治疗痛风的经验。[方法]通过跟师临诊、整理病案,介绍卢芳教授对痛风病因病机的认识,分析丹溪痛风方组成、方义,阐述丹溪痛风方在临床实践中的运用依据,并附临床医案验证。[结果]卢芳教授认为痛风病位在关节,湿热是导致肢体关节红肿痛、痛风发作的主要原因,痰瘀为其发病的根本原因。治疗上既要运用清热利湿之法,又需燥湿化痰、活血化瘀,故选用丹溪痛风方加减治疗。此方优势在于可以治疗湿热与痰瘀等复杂致病因素所致的痛风,而且运用丹溪痛风方结合经典方剂或自创方剂加减,能够对痛风进行个体化治疗。所举验案中患者辨为湿热蕴结、痰瘀互阻证,卢芳教授拟清热利湿、燥湿化痰、活血化瘀之法,采用丹溪痛风方与自创四藤二龙汤结合治疗,疗效显著。[结论]卢芳教授认为,丹溪痛风方可以治疗湿热与痰瘀等复杂致病因素所致的痛风,而且无论痛风各期均可运用。丹溪痛风方的现代应用,正是对丹溪治疗痛风的思想的传承和完善。     

陆小左针药并施治疗冠心病经验

陆小左教授认为冠状动脉粥样硬化性心脏病(冠心病)的病机为"不通、不荣、不平",在临证治疗中形成了"针药并施、多种治疗方法综合应用"的学术思想,常以自创"冠心病方"为基础方进行辨证加减,药物组成为桂枝、瓜蒌皮、薤白、厚朴、丹参、檀香、砂仁、党参、五味子、炙甘草、麦冬、生地黄、干姜、半夏,并结合针刺(针刺主穴为:内关、巨阙、膻中、心俞、厥阴俞,并根据病情辨证加减)以及耳穴调平(基本取穴:心、皮质下、交感、神门、肝、脾、肾、内分泌)、艾灸(主穴为:心俞、厥阴俞、膻中、巨阙、内关)、按摩等方法综合治疗冠心病,在临证中取得了良好疗效。     

Medicinal plant-based saponins targeting COVID-19 Mpro in silico

Background:Recently,the Chinese scientists Liu et al.demonstrated a crystallized form of severe acute respiratory syndrome coronavirus-2 main protease(M^pro),the best target of the drug,which was published in Nature in June 2020.Many components of herbs are determined as the potential inhibitors of coronavirus disease 2019(COVID-19)M^prosuch as quercetin,cirsimaritin,hispidulin,and flavonoids.Methods:Library of herb-based bioactive saponins are analyzed with 6LU7 M^prousing AutoDock tools 1.5.6,BIOVIA Discovery Studio 2017 R2,Chimera 1.13.1,and AutoDock Vina to evaluate their potency against COVID-19 M^pro.The conventional Western medicines,including hydroxychloroquine,chloroquine and nelfinavir,are used as positive controls for comparison.Results:Binding energies of 60 saponins with 6LU7 M^proare obtained in which approximately 34 saponins are more effective on COVID-19 M^prothan hydroxychloroquine,chloroquine,and nelfinavir.13 saponins exhibit high potency against COVID-19 M^produe to more binding energies than 10 kcal/mol.Conclusion:Further research on all effective saponins is needed to evaluate the real medicinal potential against COVID-19.     

A bystander programme to prevent domestic violence and abuse in UK general communities: evaluation of Active Bystander Communities

BackgroundViolence against women and girls is recognised as a global public health epidemic. Despite some UK media's recent attempt to de-legitimise bystanders, an increasing body of university campus-based research identifies bystander programmes as effective primary prevention of sexual violence. The evidence for domestic violence and abuse (DVA) bystander prevention specifically, and in community settings generally, is in its infancy. We aimed to evaluate the potential for effectiveness and feasibility of the first UK DVA bystander intervention within general communities—Active Bystander Communities (ABC).MethodsABC is predicated on progressing participants through the staged Model of Helping: noticing the event, identifying it as problematic, feeling responsible, and possessing the skills to act. Delivery is three 2 h trained facilitator-led sessions using varied pedagogy including media, active learning, and role play. Participants aged 16 years and over were recruited opportunistically from community organisations and stakeholders in community-facing roles. Programme effectiveness was measured with validated psychometric tools (recognised in extant literature as proxies for incidence where incidence cannot be measured) assessing DVA myth endorsement (self and others), behavioural intent (self and others), and bystander efficacy at baseline, immediately post-intervention, and at 4-month follow-up. The difference between pre scores and post scores were subject to a paired sample t test and Cohen's d. Bystander behaviours were captured with 17 qualitative post programme interviews and feasibility assessed via programme observation, participant attendance, and feedback. The University of Exeter gave ethical approval. Informed consent was obtained before intervention delivery.Findings70 participants attended ABC, and 83% (n=58) attended all sessions. 62 participants completed questionnaires before and after the intervention, and 37 completed 4-month follow-up. Behavioural intent (self and others), bystander efficacy, and DVA myth rejection scores (self) improved significantly immediately after intervention and at 4-month follow-up (p≤0·0001). Qualitative interviews identified the enacted bystander interventions across the violence continuum (calling out sexist jokes, identifying potential DVA, supporting victims, sharing knowledge). Participants’ high attendance reported high engagement with content and intent to recommend to others indicate feasibility.InterpretationABC shows promise as a community-level primary prevention strategy. This pilot is likely to be of great interest to practitioners and policy makers, and might help shape future community-based interventions. Further research using experimental study designs is required.FundingBristol City Council (intervention development), Devon County Council (intervention facilitation), and Public Health England South West and the University of Exeter (intervention evaluation).     

陆拯“调气解毒法”论治萎缩性胃炎的经验特色

陆拯主任中医师的学术思想体系极为注重毒理学说和脾胃学说,临证善治中医内、妇、儿等各科疑难杂病,对萎缩性胃炎的治疗经验颇具特色且疗效确切。"调气解毒法"是其论治萎缩性胃炎的主要方法之一,是针对萎缩性胃炎的病因病机特点而制定的治法。陆师通过辨毒邪作祟,析气机病变,创"毒证四层法",从病因、病机、治法三方面论述萎缩性胃炎中"调气解毒法"的具体施用,并示验案二则以说明临床应用。     

“孔最治痔”的讹传及其对当代针灸学的影响

"孔最穴治疗痔疮",长期以来作为当代针灸穴位临床应用新发现的代表,对国内外针灸学教科书及民众健康保健均产生了深远的影响。本文通过对其的层层剖析,用确凿的证据揭示:这一传承了几十年的"新发现"实源于阴差阳错的误传,既缺乏文献依据,也缺乏临床实践的证据。     

列缺穴治疗落枕疗效观察

目的观察列缺穴单穴和配伍及落枕后患者就诊的时间对治疗效果的影响。方法将84例患者随机分为单穴组与配伍组,按患者就诊时间单穴组42例分为24 h内21例,24 h外21例;配伍组42例,分为24 h内21例与24 h外21例。单穴组运用一侧发病取对侧列缺穴,双侧发病取两侧列缺穴;配伍组列缺穴加风池、大杼、天柱、天窗、肩中俞。两组均每天针刺1次,每次留针30 min。对发病后24 h内和24 h外就诊患者进行治疗1次、2次、3次的疗效观察。结果 24 h内就诊患者两组治疗效果1次治愈率为单穴组95.2%,配伍组100%;24 h外就诊者1次治愈率为单穴组28.6%,配伍组38.1%;3次治愈率单穴组76.2%,配伍组95.2%。结论 列缺穴治疗落枕疗效与发病后就诊时间及配伍有关。     

卢秉久教授治疗鼓胀例析

气滞血瘀、水湿内停的鼓胀,治宜行气化瘀,健脾化湿佐以止血。对于酒毒引起的鼓胀宜加枳椇子以"利大小便,解酒毒"。