1069例冠心病脏腑虚证的多中心前瞻性研究

目的:分析冠心病脏腑虚证的分布、组合及演变规律,探讨冠心病的病变脏腑特点。方法:采用多中心协作的方法,收集了1069例经冠脉造影证实的冠心病患者,采集其四诊信息,进行脏腑辨证,统计分析脏腑虚证的分布、组合及随冠心病发生发展不同病程(0-2年;2-5年;5-10年;10年以上)阶段的演变规律。结果:冠心病脏腑虚证以心虚证(占35.73%)、肾虚(占29.75%)、肝虚证(占12.44%)最为常见。虚证组合以两证组合最为常见(占37.89%),多为心、肾虚并见。在冠心病发生发展的各个病程阶段,心虚证(均>25%)、肝虚证(均>25%)、肾虚证(均>10%)出现频率始终最高。肾虚证所占的比例随病程的延长而逐渐增大。结论:冠心病的病变脏腑主要在心、肾,与肝密切相关,并且不同病程阶段病变脏腑侧重不同,肾虚的程度可能与冠心病的病程病情呈正相关,并提出治疗冠心病的心肾相关学说。     

五轮学说源流简识

五轮学说是中医眼科独有的辨治理论,自形成以来即有效指导眼科临床至今,历代不断丰富发展。简略回顾其形成、发展过程,分析其优缺点,并设想今后研究方向,希冀将这一独特的理论发扬光大,更好地服务于临床。     

支气管哮喘从五脏相关论治

从五脏相关理论,结合现代中医学研究成果与中医古籍论述,阐述了各脏腑在支气管哮喘发病过程中的生理病理及相互作用。认为肺脏是哮喘发病及整个病程的主病之脏,但与脾、肾、心和肝等脏腑密切关联,且相互影响。从五脏相关学说出发,提出治肺为治疗哮喘的必经之路,配合调理脾、肾、心、肝为哮喘治疗或预防复发的重要方法,更全面地认识和掌握哮喘的中医辨证论治方法,提高中医药治疗哮喘的疗效,并为哮喘的诊治提供一些新的思路。     

历代医家对疫病病因的认识

对疫病来说,不能正确把握＂六气＂病因,就难以在辨证论治中体现天人相应的中医本色。在疫病的病因问题上,只讲致病微生物是远远不够的,人体的抗病能力,致病微生物的传染力和生物学特性,都受制于自然大环境的变化条件。运用五运六气理论,把握好疫病的发生发展规律,能提高中医药防疫治疫的水平。     

Relationship between Oral Health-Related Quality of Life, Satisfaction, and Personality in Patients with Prosthetic Rehabilitations

Purpose: This study investigated the relationship between oral health‐related quality of life, satisfaction with dentition, and personality profiles among patients with fixed and/or removable prosthetic rehabilitations. Materials and Methods: Thirty‐seven patients (13 males, 24 females; mean age 37.6 ± 13.3 years) with fitted prosthetic rehabilitations and 37 controls who matched the patients by age and gender were recruited into the study. The Dental Impact on Daily Living (DIDL) questionnaire was used to assess dental impacts on daily living and satisfaction with the dentition. The Oral Health Impact Profile (OHIP) was used to measure self‐reported discomfort, disability, and dysfunction caused by oral conditions. Oral health‐related quality of life was assessed by the United Kingdom Oral Health‐Related Quality of Life (OHQoL‐UK) measure. Moreover, the NEO five‐factor inventory was used to assess participants’ personality profiles. Results: Prosthetic factors had no relationship to the DIDL, OHIP, and OHQoL‐UK scores. Patients with the least oral health impacts had better oral health‐related quality of life (p= 0.023, r =–0.37), higher levels of total satisfaction, and satisfaction with appearance, pain, oral comfort, general performance, and eating (p < 0.05, r =–0.79, –0.35, –0.59, –0.56, –0.58, and –0.50, respectively). Patients with better oral health‐related quality of life (QoL) had higher total satisfaction, satisfaction with oral comfort, general performance, and eating (p < 0.05, r = 0.34, 0.39, 0.33, and 0.37, respectively). Patients with lower neuroticism scores had less oral health impact (p= 0.006, r = 0.44), better oral health‐related QoL (p= 0.032, r =–0.35), higher total satisfaction, satisfaction with appearance, pain, oral comfort, and eating (p < 0.05, r =–0.58, –0.35, –0.33, –0.39, and –0.35, respectively). Conclusion: Patients’ satisfaction with their dentition and prosthetic rehabilitations has positive effects on oral health‐related QoL and oral health impacts and improves patients’ daily living and dental perceptions. Neuroticism might influence and predict patients’ satisfaction with their dentition, oral health impacts, and oral health‐related QoL. Satisfaction with the dentition might predict a patient's level of neuroticism.     

肺主治节的理论内涵及临床意义

＂肺主治节＂理论是中医藏象学说的重要内容,从中医理论的内涵出发＂肺主治节＂体现在：对＂心主血脉＂的＂治节＂,对人体正气的＂治节＂,对人体其他脏腑功能及津液代谢的＂治节＂,对生命节律的＂治节＂,对机体废物的＂治节＂。＂肺主治节＂实乃＂肺主气＂功能的扩大和延伸。深入探讨肺主治节理论,对于完善肺系疾病病因病机,指导肺系疾病的防治具有重要意义。     

从五脏与血瘀论治滑胎

中医认为,滑胎的发生以肾、脾、肝异常为主要病机。临证采用五脏辨证论治,或从瘀血论治,总的治则以补虚为主,尤以补肝肾脾为核心,佐以滋阴生津、清透虚热,达补肾健脾、益气养血、清热泻火之功。中药对人体的免疫功能有多环节、多靶点的积极影响,利于盆腔内环境的改善、促进宫体和胚胎的供氧供血及胚胎的种植与发育,达到保胎优生的效果。     

三门峡市2004～2013年5岁以下儿童生命监测结果分析

目的：分析河南省三门峡市2004～2013年5岁以下儿童死亡率、原因及发展趋势,提出干预措施。方法对2004～2013年死亡的1295例5岁以下儿童资料进行回顾性分析。结果5岁以下儿童死亡率从2004年的11．81‰下降到2013年5．26‰,各年度儿童死亡率呈下降趋势。2004～2013年新生儿死亡数占婴儿死亡数的78．65％～65．96％,婴儿死亡数占5岁以下儿童死亡数的90．82％～78．43％,1～4岁儿童死亡数占5岁以下儿童死亡数的9．20％～21．67％。结论早产或低出生体质量、出生窒息和肺炎是导致5岁以下儿童死亡的主要原因。巩固健全妇幼保健三级网络、加强围产期保健、提高产科技术水平、提高危重患者急救能力、普及妇幼保健知识等是降低5岁以下儿童死亡率的关键。     

“正统四象说”与“医家四象说”相关问题辨析

阴阳再分阴阳,则为“四象”。四季配“四象”分太少阴阳有两种方式：①“正统四象说”,以春为少阳,夏为太阳,秋为少阴,冬为太阴,广泛见于医家之外的各种典籍,故为“四象”说之“正统”。②“医家四象说”,以春为少阳,夏为太阳,秋为太阴,冬为少阴,仅见于医书之中。“正统四象说”和“医家四象说”,因为对阴阳的定义不同,故所观察到的阴阳变化规律有异,二者皆有道理。基于两种“四象”说,《内经》五脏与“四象”的配属方式也有两种,其中基于“正统四象说”的配属方法更为本源。     

论温养治痹

痹者,＂风寒湿三气杂至,合而为痹＂,＂所谓痹者,各以其时,重感于风寒湿之气也＂（《素问·痹论》）,强调外邪在发病中的重要性.风为百病之长,痹病属寒湿者居多.当今由于气候变化极端,不良生活习惯导致感受风寒湿机会增多：如春日湿冷、冬季阴冷时节爱美女士仍着薄衣短裙;炎炎夏季,人们或贪凉露宿,或空调低开,或风扇劲吹,或汗出当风、汗出入水中（冲凉、游泳等）,或酒后当风、酒后入水中,或产后贪凉受冷等致风寒湿乘虚而入.导致风湿类疾病发病率日益增高,据统计：我国类风湿性关节炎、强直性脊柱炎、骨性关节炎三病的患病人数已超过亿人.《素问·至真要大论》明确指出：＂寒者温之＂.因此中医治疗痹病应注重温养之法方可取效.