基于文献的老年人群常见证候分布特征研究＊

目的 了解我国老年人中医证候分布特征，为中医药辨治老年人提供参考依据。方法 系统检索中国知识基础设施（CNKI）、中文科技期刊数据库（CCD）、万方数据资源系统数据库（CSPD），纳入研究对象为老年人的临床流行病学调查研究文献，对其调查目的、调查疾病及调查结果等进行描述统计。结果 ①最终纳入168篇文献，其中2010至2020年之间发表138篇（82.14%）；调查地区涵盖全国28个省市自治区，共纳入43948例老年人，累计覆盖340个研究中心；②主要研究结果显示，老年人中医证候阴虚阳亢证（10.05%）>血瘀证（9.5%）>痰浊（湿）证（8.91%）>阴阳两虚证（4.98%）>痰瘀互结证（4.96%）；单元证分布阴虚证（14.70%）>痰证（11.22%）>气虚证（7.15%）>肾虚证（4.72%）>血瘀证（4.18%）；涉及病变脏腑肾>肝>脾>肺>心。结论 根据统计结果，可以看出老年人证候分布虚证多于实证，虚证中又以阴虚证、气虚证最为多见，实证常见血瘀证、痰浊（湿）证等，且多见痰瘀互结证；老年人五脏皆损，其中又以肾、肝、脾功能失调最为突出。     

论《金匮要略》基本学术思想及辨病与辨证——从《脏腑经络先后病脉证第一》谈起

研究《金匮要略》的重点应该放在对于各种疾病的辨证论治上，而不是某些证或某些方。这里涉及到如何看待病与证以及辨病与辨证的关系。以《金匮要略》的基本学术思想立论，从四个方面阐述了在整体论思想指导下的辨证论治体系，首先注重的是病；辨证方法的确立是由在发病学上具有不同性质特点的疾病所决定的；四诊所得的各种临床信息是为了辨病然后辨证；只有正确把握病与证的关系，才有可能真正理解和掌握“治未病”的实质。     

论温病学学科的性质和发展方向

温病学核心理论卫气营血和三焦辨证是中医辨证学的重要内容，是临床各科的基础，其理法不仅可以辨治温病，而且可广泛应用于杂病的辨治；温病学学科应界定为基础中医学三级学科。温病学学科的发展方向应在现有研究的基础上，注重温病学理法辨治杂病的研究、温病学名家杂病辨治规律的研究、伤寒学与温病学移植渗透的研究、温病学理论和方法与现代医学理论和方法移植渗透的研究。温病学课程有待分化为：经典温病学、温病学派杂病学、中医传染病学、实验温病学。温病学的概念有待进一步讨论。     

A multi-systemic disease (lupus-like) preceding bronchioloalveolar carcinoma

Summary A patient with a multi-systemic disease (lupus-like) that preceded the onset of a bronchioloalveolar carcinoma is described, and a brief review of the literature is presented. We suggest that this tumor be listed among the neoplasms responsible for multi-systemic diseases with lupus-like characteristics.     

中医学发展有赖于对病证关系的再认识

提出就中医学辨证与辨病的关系,应该是方法与结果的关系.辨证必须以辨病为前提,证只有因病的存在才有自己的特殊性可言.而这时的病不能是传统意义上的以症状命名的"病",而必须是具有发展规律、表现出特定症状与相应阶段证候的"新"病.     

Transfusional iron overload in patients with myelodysplastic syndromes: A 10-year retrospective survey from a French general hospital

We retrospectively assessed the characteristics of 165 MDS patients from our institution having received at least 20 RBC units. In the vast majority of them various comorbidities (range: 1–6 per patient) were registered including mainly cardiovascular disorders. Serum ferritin was over 1000 μg/L in about half of tested individuals. A chelator agent was initiated in 43.6% of patients (mainly low-risk MDS). Transformation in AML occurred in 46 cases (27.8%). Overall, 112 patients died during follow up. The cause of death was documented in 65 cases and included mainly MDS or AML resistance to therapy. There was a context of bacterial or fungal-related sepsis in 35.3% of cases. We noticed a correlation between survival and number of RBC transfusions. Median OS from the 20th RBC unit was significantly prolonged among the chelated subgroup. Consequences of transfusional iron overload and chelation need to be clarified in MDS patients.     

Les syndromes parkinsoniens : de l’analyse sémiologique au diagnostic nosologique

Parkinsonism may include atypical clinical manifestations, which are warning signs for the clinicians and motivate further investigations to identify an etiology other than idiopathic Parkinson's disease. The dismemberment of pathological entities, the advances of morphological and functional imaging of the brain, and new insights into molecular biology have successively led to more precise clinical phenotype and mechanisms. Except for etiologies with specific treatment, such as Wilson's disease or Parkinsonism secondary to a lesion of basal ganglia, or the discontinuation of a culprit drug, the treatment of Parkinsonian syndrome is mainly based on a multidisciplinary approach, involving occupational therapist, physiotherapist, speech therapist, psychologist and social worker. L-Dopa may be tried but it is less effective in atypical Parkinsonian syndrome than in Parkinson's disease. Formal diagnosis, only achievable post-mortem, is not available during the lifetime of the patient. Although some additional tests provide undeniable assistance, the clinical approach remains an essential and critical step to avoid costly and unnecessary investigations.