余尚贞以六戊年麦门冬汤治疗高血压经验浅析

高血压病为临床最常见的慢性病,余尚贞根据多年临床经验辨证,结合开、阖、枢理论,以太阴阳明升降不和为病机,从太阴阳明入手论治高血压病,结合五运六气选方六戊年麦门冬汤,临床治疗多例,疗效甚佳。开、阖、枢理论源于内经,是对人体三阴三阳经生理功能、病理特点及其相互关系的概括,我们可从中窥得开、阖、枢理论之部分面貌,比如对太阴、阳明经的了解,并拓展中医在治疗高血压病方面的治疗思路。     

Impact and implementation of active case finding for tuberculosis in homeless populations: a systematic review

BackgroundIdentifying tuberculosis in homeless populations through active case finding (ACF) is recommended to address health inequalities and contribute to wider control strategies for tuberculosis. We aimed to assess the effectiveness of ACF.MethodsThis systematic review assessed studies on ACF done in countries with low or medium burden of tuberculosis across Europe, the USA, and Australia. We systematically searched EMBASE, CINAHL Plus, ASSIA, Pro-Quest, Scopus, and the Cochrane Library and grey literature for English language publications up to Jan 5, 2019 (no earlier date limit). We used concepts of “ACF”, “tuberculosis”, and “homeless person”. We identified studies that analysed ACF and reported on our outcome measures, in homeless populations, in low-burden and medium-burden countries. ACF screening included testing for latent tuberculosis infection (LTBI) or active tuberculosis affecting any site. Studies into outbreak control or other populations were excluded. Primary study outcomes were the effectiveness of ACF (using population measures of tuberculosis prevalence or incidence) and interventions to improve ACF uptake and completion of the diagnostic pathway. Secondary outcomes were yield of ACF, cost-effectiveness, and characteristics of participants.Findings21 studies met the inclusion criteria. Study heterogeneity precluded meta-analysis. Three time-trend analyses produced some evidence that ACF was effective, because it was associated with reductions in tuberculosis incidence, prevalence, or clustering. A modelling study also showed that ACF was more effective than passive case finding in reducing population tuberculosis burden. Material incentives have the strongest evidence for improving uptake of ACF, with mixed evidence for peer educators. Observational evidence shows professional support and mandatory screening might also enhance uptake, and additional community-based support improves completion of the diagnostic pathway. Across all studies, the yield of screening (defined as the proportion of screened individuals who test positive) ranged from 1·5% to 57% for LTBI (total 41 684 individuals screened), and 0–3·1% for active tuberculosis (total 91 771 individuals screened). ACF can be cost-effective; population prevalence and screening modalities are determinants of cost-effectiveness. Considering ACF participants, subgroups most likely to be diagnosed with tuberculosis appeared less likely to accept screening.InterpretationACF should be considered in both tuberculosis and homelessness strategies, with evidence-based interventions to improve implementation. Outcomes varied widely, meaning programmes must be tailored to local populations. Strengths of our study include generalisable results to homeless populations from diverse settings. Limitations include restriction to the English language, the fairly low grade of the evidence identified, and the low number of studies screening for LTBI or using newer screening tests.FundingThe South West Public Health Training Programme.     

清儒胡澍、俞樾校注《素问》的特点探析

清儒对《素问》曾进行过精审的校注,这些医籍成为中医传承与发展的重要载体。文章旨在分析清儒胡澍、俞樾校注《素问》的规律,进而总结出"综合考证、多维分析,引征广博,考辨严密精审,探微索隐、辨讹释疑正误,方法革新、从文献学角度校勘《素问》,说理精确、措词简明,文理与医理相结合"之校注特点,以期对今后中医古籍研究与整理具有启示性意义。     

于俊生运用防己黄芪汤加减治疗肾性水肿经验

于俊生教授善用经方治疗肾脏病,常将防己黄芪汤与其类方防己茯苓汤合用作为治疗肾性水肿的主方,收效颇佳。在主方运用中,于老师对方中防己、黄芪、茯苓三药的应用颇有心得;合方加减时,则以脾肾同治、气血水同治、和解少阳为治则,对证合方以达补肾健脾、活血利水、调畅枢机之目的。     

于志强教授“疏木调冲”法治疗乳癖经验

于志强教授,从事中医临床、科研工作四十余载,勤于临床,学验俱丰。于教授认为乳癖的发生多由冲任失调、肝木不疏引发,治疗当以"疏木调冲"为要务。并自拟"疏木调冲汤"配合针灸治疗乳癖,取得良好效果。     

“三焦”针法治疗顽固性呃逆1例

呃逆是临床中常见的一种膈肌痉挛病,是由各种原因引起的。治疗呃逆的方法很多,相比之下,针灸和中药在治疗本病上具有见效快、副作用小的特点。     

于睿教授从肝论治失眠

于睿教授认为,睡眠调控作用非常重要,神志之病与肝密切相关。肝失疏泄之机、条达之性,则气血失和,影响心神,导致神不安宁而病不寐,故治疗多从肝论治。据此将不寐分型辨治,肝气郁结-柴胡疏肝散加减,肝郁瘀阻-血府逐瘀汤加减,肝阳上亢-天麻钩藤饮加减,肝郁化火-龙胆泻肝汤加减,肝胃不和-暖肝煎合吴茱萸汤加减,肝肾阴虚-一贯煎合杞菊地黄丸加减。并强调择时服药、顺乎阴阳,有别于普通内服汤药早晚分服的服法,分别于午后和睡前服用。并主张身心并治,整体调理,药物治疗同时重视精神调摄、心理疏导和讲究睡眠卫生,指导患者合理饮食,适度参加锻炼,拓展兴趣范围,以丰富精神生活,从而促进失眠症的康复。     

金泽荣和中国文化名人的诗文交往

1905年朝鲜李朝王廷弘文馆纂辑所正三品通政大夫金泽荣流亡中国,在张謇的帮助下寓居南通,任翰墨林书局编校。金泽荣在南通出版了30余部著作,为保存祖国文化,同时也为翰墨林书局出版事业的发展繁荣作出了杰出贡献。案牍之余,金氏广泛结交中国文友,建立了深厚的友谊。这些人中有被胡适列举应该作传记的中国文化名人俞樾、张謇、严复、梁启超,屠寄、郑孝胥等。他们意气相投,诗文酬唱,书信往返,雅集宴饮,在中外文化交流史上写下了值得纪念的篇章。     

于年海教授运用通腹汤治疗炎性肠梗阻经验

介绍于年海教授对术后早期炎性肠梗阻病因病机的理论认识,及其运用中医中药治疗本病的临床经验总结。探讨通腹汤治疗炎性肠梗阻中医理论依据,以及中西医结合治疗本病的优势。     

腰椎间盘突出症推拿手法治疗理论探讨

腰椎间盘突出症是临床上常见病与多发病。在腰椎间盘突出症非手术疗法中,推拿是一项重要的治疗方法。推拿具有温通经络、缓解肌肉痉挛、放松止痛等作用。推拿手法治疗腰椎间盘突出症安全、有效。于天源教授从事推拿的临床与教学20余年,在腰椎间盘突出症的治疗方面积累了许多宝贵的经验,并在此之上,总结出一整套治疗腰椎间盘突出症的理论方法,疗效显著。本方法以经络理论为基础,注重穴位配伍,点、线、面结合,扩大治疗范围,增强治疗效果。为推拿治疗腰椎间盘突出症提供一种思路。