郁证发微(二十一)——郁证疲劳论

探讨郁证性疲劳的病脉证治。古代中医早已认识到疲劳之症除躯体疲惫劳倦外,更有神疲神困、精神短少的表现,均可为郁证的表现之一。郁证性疲劳看似气血不足,实乃悲忧过虑之果。盖心主神志,劳神则倦;肝主疏泄情志,为罢极之本;脾主四肢肌肉,思虑伤脾影响水谷精微化生。郁证性疲劳的治疗包括药物和(或)非药物治疗,应重视调摄情志对于防治郁证性疲劳的重要意义。     

从脾论治心肌缺血再灌注损伤无复流现象

缺血再灌注损伤无复流指局部缺血组织重新恢复血流后,缺血区反而不能得到充分血液灌注的现象,严重影响心肌梗死患者的预后。该病主要与内皮细胞损伤有关,目前尚缺乏有效的治疗办法。中医药可从多层面、多途径、多靶点治疗该病。初步分析了缺血再灌注损伤无复流现象的患病因素以及基本病机,并对从脾论治进行了深入探讨,为临床应用和基础研究提供理论依据。     

“痛风病”中医病因病机的隐喻分析

目的：剖析现代医学“痛风病”中医病因病机的隐喻特征及其隐喻认知多样性的根源。方法：在认知科学的背景下,运用隐喻理论对三位国医大师关于现代医学“痛风病”病因病机的认识进行分析。结果：现代医学“痛风病”病机理论是基于“痹”字相关的概念隐喻而建构的中医理论。结论:不同医家作为认知主体的独特性是造成“痛风病”隐喻认知多样性的重要原因。     

过敏性鼻炎的病因病机探赜——从毒辨识

过敏性鼻炎是临床常见的鼻黏膜非感染性慢性炎性疾病,目前尚无根治的有效治疗手段。近年来,随着环境气候及生活方式的改变,过敏性鼻炎发病率在全球范围内呈上升趋势,其发病受毒邪影响较深,无论是外毒还是内毒均可诱发并加重病情。文章从病因病机及防治角度初步探讨毒邪在过敏性鼻炎发病中的地位,以期为过敏性鼻炎的临床防治提供一定的理论依据。     

谢晶日教授从瘀论治大肠息肉的经验

[目的] 介绍谢晶日教授从“瘀”论治大肠息肉的经验,为大肠息肉的防治提供新的思路。[方法] 通过跟师临诊,揣摩精要,记录和整理谢晶日教授防治大肠息肉的相关医案,分析谢晶日教授对大肠息肉病机的认识以及从“瘀”论治大肠息肉的具体方法,并列举医案一则加以佐证。 [结果] 谢晶日教授认为,大肠息肉的生成离不开“瘀”,因此主张从“瘀”论治。气机不畅,湿聚成瘀,治宜肝脾同调、解郁化瘀;痰湿中阻,稽留成瘀,治宜健脾补中、除湿化瘀;气虚血阻,积久成瘀,治宜补虚通络、扶正化瘀。同时嘱患者养成良好的生活习惯,并注重情绪的疏导。文中所举验案谢晶日教授辨证为肝郁脾虚、郁滞成瘀,治宜疏肝健脾、解郁化瘀,最终收获良效。[结论] 谢晶日教授从“瘀”论治大肠息肉,临床效果颇为显著,不仅大大降低了大肠息肉的复发率,而且对恢复肠道功能、改善临床症状也具有独到作用,其经验值得学习和推广。     

“胎数落”病因病机及针灸诊疗思路探析

现代中医学认为复发性流产相当于中医学中的"滑胎""胎数落"。但我们在探究复发性流产的中医学病名起源中发现,"滑胎"一词最早的含义与当今所指的复发性流产不同,"滑胎"在清乾隆四年以前实为临产催生的方法,而"数堕胎""胎数落"才更接近复发性流产的含义。历代中医对"胎数落"在发病原因及发病机制方面的认识上有寒热之分、虚实之别,各有千秋,自成体系,尤其对自然流产频率的连续性即"应期而落"这一特点的认识相当精确。针灸在治疗"胎数落"时须做到明辨虚实,虚则益气血、补脾肾、调冲任,实则活血化瘀兼以理气通经。     

Rare case of external dental fistula of the submental region misdiagnosed as inverted follicular keratosis and thyroglossal duct cyst

IntroductionOdontogenic cutaneous sinus tract is a relatively rare occurrence that can be complicated to diagnose. The presence of a cutaneous lesion is often not even partly associated with a dental etiology because of the less frequency of occurrence in the case of dental symptoms. Consequently, the underlying dental cause is often missed leading to inappropriate diagnosis and treatment.Case presentationHere, we report the case of a 45-year-old man who presented with a persistent lesion of the cervical region. At the time of presentation, the lesion had been present for approximately one year with a gradual increase in size but no specific symptoms. The patient had previously undergone punch resection under local anesthesia, which resulted in a histopathological diagnosis of inverted follicular keratosis. A diagnosis was made of an odontogenic cutaneous sinus tract secondary to chronic apical periodontitis of the left mandibular second molar.DiscussionCutaneous sinus tract in the face and neck is most likely to develop intraorally. Root canal treatment or surgical extractions are the common treatment choices. A previously reported review of 137 cases found that 106 (77%) were treated by extraction and 27 (20%) were treated by surgical or conservative nonsurgical endodontic therapy.ConclusionEarly diagnosis of cutaneous sinus tract using proper aid is responsible for shortening the treatment duration and avoiding unnecessary treatment.     

Integrated molecular landscape of amyotrophic lateral sclerosis provides insights into disease etiology

Amyotrophic lateral sclerosis (ALS) is a severe, progressive and ultimately fatal motor neuron disease caused by a combination of genetic and environmental factors, but its underlying mechanisms are largely unknown. To gain insight into the etiology of ALS, we here conducted genetic network and literature analyses of the top‐ranked findings from six genome‐wide association studies of sporadic ALS (involving 3589 cases and 8577 controls) as well as genes implicated in ALS etiology through other evidence, including familial ALS candidate gene association studies. We integrated these findings into a molecular landscape of ALS that allowed the identification of three main processes that interact with each other and are crucial to maintain axonal functionality, especially of the long axons of motor neurons, i.e. (1) Rho‐GTPase signaling; (2) signaling involving the three regulatory molecules estradiol, folate, and methionine; and (3) ribonucleoprotein granule functioning and axonal transport. Interestingly, estradiol signaling is functionally involved in all three cascades and as such an important mediator of the molecular ALS landscape. Furthermore, epidemiological findings together with an analysis of possible gender effects in our own cohort of sporadic ALS patients indicated that estradiol may be a protective factor, especially for bulbar‐onset ALS. Taken together, our molecular landscape of ALS suggests that abnormalities within three interconnected molecular processes involved in the functioning and maintenance of motor neuron axons are important in the etiology of ALS. Moreover, estradiol appears to be an important modulator of the ALS landscape, providing important clues for the development of novel disease‐modifying treatments.     

胆总管探查取石术后下端梗阻未解除的原因分析及对策

目的探讨胆总管切开取石术后胆总管梗阻未解除的原因及处理对策。方法回顾性分析我院2005年1月-2013年8月23例胆总管取石+"T"型管引流术的患者临床资料,术后行"T"管造影提示胆总管下端仍阻塞。结果 23例患者经检查确诊胆总管下端嵌顿性结石12例,胆总管下端良性狭窄2例,胰头部病变9例(胰头癌6例,肿块型胰腺炎3例),通过再次处理,梗阻均得以解除,随访效果良好。结论少数胆总管结石术后的患者,即使术中取尽结石,术后胆总管仍梗阻,临床上常被认为是残余结石所致,而漏诊可能合并存在的其他病变。只有术前周密的诊查,术中仔细的胆道探查,术后胆总管不通畅的患者尽早行影像学检查排查,才能得到早诊断、早治疗。