“风药”在泄泻中的运用

泄泻是临床常见病,多发病。是以排便次数增多、粪质稀薄或完谷不化,甚至泻出如水样为特征的病证。《内经》称本病证为＂鹜溏＂、＂飧泄＂、＂濡泄＂、等,且对本病的病因病机有较全面的论述,如《素问·生气通天论》曰：＂因于露风,乃生寒热,是以春伤于风,邪气留连,乃为洞泄＂。     

《伤寒论》中的和法在儿科临床的应用

在《伤寒论》各种病证中的方剂均体现了和法，和法是中医传统常用八法中比较特殊的治疗方法。“和”者，平也，缓也。它既没有明显的祛邪作用，也没有明显的补益作用，而是通过缓和、和解与调和疏解而达到气机调畅，使表里、寒热、虚实的复杂证候及脏腑阴阳气血的偏盛偏衰，归于至复。寒热并用，补泻兼施，表里双解，苦辛分消，调和肝脾、气血，达到中和作用，即新的平衡的目的。     

儿童哮喘发作期中医证型分布及用药规律的探讨

目的探讨儿童哮喘发作期临床证型分布特点与用药规律。方法纳入符合条件的儿童哮喘发作期患儿161例,以其证型及中药处方为研究点,使用SPSS 19.0统计学软件,探讨儿童哮喘发作期证型分布特点及中医用药规律。结果儿童哮喘急性期证型分布居于首位的是热性哮喘证,与其他证型相比有显著差异(P0.01),用药方面紫菀、款冬花、蝉蜕、僵蚕、桑白皮、化橘红、橘络、葶苈子、川贝母、炙枇杷叶、鱼腥草、大青叶为常用药物,类别方面以化痰止咳平喘药、清热药、理气药、平肝熄风药为主。结论儿童哮喘发作期中医证型以热性哮喘证为主,在临床用药过程中应以清热化痰、止咳平喘为主,同时兼用理气、平肝息风之药。     

郑军教授治疗小儿咳喘经验

咳喘是小儿常见的肺系疾病,如治疗不当,易迁延难愈,或反复发作。郑军教授认为,小儿咳喘常为寒热错杂,虚实交结,临症处方用药时切忌简单堆砌、拼凑;小儿咳喘虽变化多端,但主要病机为风、热、痰三邪所致,把握主要病机便可化繁执简。临床辨证主要证型为：风邪犯肺、痰热蕴肺、肺胃郁热、痰湿壅肺、肺热伤阴。运用治咳基本方加味治疗小儿咳喘,取得满意的疗效。     

小儿肺炎支原体感染后咳嗽发作时间与证候相关性初探

目的探讨小儿肺炎支原体感染后咳嗽发作时间与证候的相关性,为临床辨治本病提供参考依据。方法湖南中医药大学第一附属医院儿科2013年2月至2014年2月收治151例肺炎支原体感染后咳嗽患儿,对其临床资料进行整理,统计各证候的分布情况,分析证候与咳嗽发作季节、发作时辰的相关性。结果肺炎支原体感染后咳嗽以风热犯肺证、风寒袭肺证、肺气亏虚证多见;各证候发生无明显季节差异;咳嗽发作与时辰存在一定相关性;风寒袭肺证咳嗽发作有向戌时集中的趋势,但差异无统计学意义(P0.05),风热犯肺证咳嗽发作以清晨卯时、夜间戌时多见,肺气亏虚证咳嗽没有明显时辰规律。结论小儿肺炎支原体感染后咳嗽的发作具有一定的时间规律性,临床证候与发作时间具有一定相关性。     

三仁汤加减治疗小儿湿热咳嗽辨证论治体会

湿热证是南方地区的常见病证,亦是小儿咳嗽的常见证型之一,治疗需清热化湿并举,临床中运用三仁汤加减以清热化湿宣肺止咳,效果较佳,可酌情加化痰止咳之品提高临床疗效,结合小儿特殊的生理病理特点,可加消食导滞药物以健脾运脾,并嘱患儿节制饮食,忌辛辣、肥甘、生冷瓜果之品,以绝痰湿之源,否则湿热不能驱尽,则易导致症状复发。     

儿童过敏性紫癜肾炎143例中医辨证特点分析

目的总结过敏性紫癜肾炎患儿中医病机特点、中医证型分布规律,以指导临床辨证施治。方法对2006-01/2008-12辽宁中医药大学附属医院儿科住院143例过敏性紫癜肾炎患儿临床特点及舌象、脉象变化情况进行回顾性分析。结果湿热瘀阻型34例,向虚证转化17例(气虚、阴虚);下焦湿热型45例,向瘀证转化12例;脾虚湿盛型21例,向热证转化4例,向瘀证转化8例,向虚证转化2例;气虚血瘀型向热证转化3例;阴虚火旺型13例,向瘀证转化2例,向虚证转化2例。脾虚湿盛型复发率最高,血热妄行型复发率最低,其他证型间复发率相近。在肾损害出现时间上,各证型间差异有统计学意义。在治愈率上各证型间差异无统计学意义。结论湿、热、虚、瘀为过敏性紫癜肾炎的主要病机,在整个病情发展过程中,湿、热、虚、瘀四者既可单独存在,又可相互转化或兼夹为病;在治疗中清热除湿化瘀是其重要的治疗方法;应在过敏性紫癜1个月内多次检查尿常规,以早期发现肾损害。     

小儿手足口病中医证候特征及演变规律的研究

目的分析小儿手足口病的中医证候学特点,总结中医证候演变规律。方法在两个临床中心同时进行调查,采集手足口病的中医证候类型、四诊信息及相关因素,填写临床观察表,建立数据库;将纳入病例根据证候表现分为风热犯肺证、邪犯肺脾证、湿热毒盛证、气阴两虚证、邪陷心肝证、水凌心肺证和阴阳两竭证;跟踪观察患儿在入院当天（基线点）、用药后第3、5、7、10天的临床表现,确定各观察点中医证型;应用证候演变概率法对小儿手足口病中医证候在不同观察点的演变规律进行系统分析。结果小儿手足口病患儿症状以手足疱疹、口痛拒食及发热多见,与其他症状比较差异有统计学意义（P〈0.01）;风热证出现率多于其他证候,差异有统计学意义（P〈0.05）;初期以风热犯肺证、邪犯肺脾证为主;中期是由实证向虚证转移的关键时期;后期虽多见实证,但其持续存在概率均有所降低,并逐渐向气阴两虚证和正常转变。结论小儿手足口病证型分布以风热犯肺证最多,其次为邪犯肺脾证;其中医证候在不同观察点有着不同的演变规律。     

王素梅教授运用辛开苦降法治疗小儿咳喘经验撷萃

辛开苦降法是中医一种常用的、独特的治疗方法,可用于治疗各种寒热错杂、升降失常、虚实互见的病证。导师王素梅教授在多年临床中,从小儿的生理特点出发,将其应用于小儿咳喘等症,在治疗外感疾病的同时注重调理脾胃,升清降浊,颇见疗效。     

孙丽平教授治疗小儿多发性抽动症经验

小儿多发性抽动症是儿童时期起病的慢性神经精神障碍性疾病,发病率有逐年升高的趋势。现代医学对本病的病因和发病机制尚不十分明确。导师孙丽平教授认为,小儿多发性抽动症的病位在肝、脾,与心、肺、肾三脏关系密切,临床上以痰火扰神证型较为常见,病机关键为肝风挟痰扰神,治疗上注重从"心、肝、脾"三脏论治,以安神定志,疏肝化痰为治疗大法,创立调神铁落饮,并随证加味,在临床应用中取得较满意的疗效。     

儿童慢性肾脏病中西医治疗思路

目的儿童慢性肾脏病为临床常见疾病,对儿童及青少年的身心健康带来巨大伤害。近年来中西医结合治疗对儿童慢性肾脏疾病在提高患儿生活质量、延缓进展以及减轻经济负担等方面具有比纯西医治疗所不及的天然优势。本文就目前对慢性肾脏疾病的中西医定义、分型、治疗等方面的资料加以系统地归纳总结,以求为儿童慢性肾脏疾病的中西医治疗思路提供参考。     

The NCI-MATCH trial and precision medicine in gynecologic cancers

The Precision Medicine Initiative is a National Cancer Institute (NCI) driven interdisciplinary collaborative effort to test the feasibility of trials incorporating genomic profiling when choosing patient therapies. The goal of the initiative is to generate the scientific evidence needed to move the concept of precision medicine, or targeted therapy, into clinical practice. The rapid development and widespread availability of next generation sequencing provides access to information regarding an individual's tumor at various times during the course of their disease. Translating the aberrations specific to a patient's tumor into personalized treatment is the concept behind “basket” trials, and thus categorize patients' cancers based on the sequencing of the tumor, rather than the organ of origin. The NCI Molecular Analysis for Therapy Choice (MATCH) trial [NCT02465060] is a multi-site, collaborative effort between the NCI and several pharmaceutical companies that is beginning to clarify the significance of molecular alterations in tumors. This trial was designed to assign targeted treatment based on molecular alterations identified from a tumor biopsy obtained after study enrollment and determine the efficacy of this treatment. This review article will briefly discuss known genomic aberrations in gynecologic cancers, and then provide an overview of the NCI-MATCH trial with an update on accrual and recent interim analysis. We will also review current FDA-approved precision therapies for gynecologic malignancies, such as poly (ADP ribose) polymerase (PARP) inhibitors.     

A prospective, randomized trial of integrative medicine for women with ovarian cancer

Objectives

Despite increased use of integrative medicine in cancer therapy, little data exist on its efficacy. This prospective, randomized, pilot trial sought to evaluate the feasibility of combined modality integrative medicine (CM-IM) in women with ovarian cancer (OvCA) and evaluate its effects on quality of life (QoL), chemotherapy toxicity and immunologic profiles.

Methods

Women with newly diagnosed OvCA requiring chemotherapy were offered enrollment. Those randomized to the experimental arm received hypnosis, therapeutic massage and healing touch with each cycle of chemotherapy. The control arm received chemotherapy without CM-IM. All patients completed QoL questionnaires prior to cycles 1, 3 and 6, and 6-months after chemotherapy. Immunologic profiles were measured. Statistical analysis was based on intent-to-treat. Student's t-test and Fischer's exact-test were used to determine differences.

Results

Forty-three women enrolled. All women randomized to CM-IM were successfully treated. There were no statistical differences between the groups in age, stage, grade, histologic cell type, CA125 levels, or surgical cytoreductive status. There was no difference in overall QoL measurements. Re-hospitalization rates, treatment delays, anti-emetic use, and infection rates were similar. Immunologic profiles revealed no difference between arms for WBC or salivary IgA levels. Women receiving CM-IM had consistently higher levels of CD4, CD8 and NK cells, although this did not reach statistical significance.

Conclusions

Prospective clinical evaluation of integrative medicine for women with gynecologic malignancy is feasible. This first, pilot study of CM-IM in gynecologic oncology demonstrated no improvement in QoL or chemotherapy toxicity. Integrative medicine-associated improvements in immunologic profiles warrant further investigation.     

薏苡附子败酱散联合中药灌肠治疗慢性盆腔炎的效果观察

目的 研究薏苡附子败酱散联合中药灌肠治疗慢性盆腔炎的临床效果.方法 选取60例慢性盆腔炎患者,采用随机数字表法将其分为研究组与对照组,每组30例.对照组给予西医抗生素药物治疗,研究组在对照组基础上给予薏苡附子败酱散联合中药灌肠治疗.对比两组临床疗效、治疗前后中医证候评分及炎症指标.结果 研究组治疗总有效率为93.33％...     

Determinants of health-seeking behavior toward Chinese or Western medicine in Taiwan: An analysis of biobank research database

Background and purposeHealth-seeking behavior has a direct impact on individual's health. A proper understanding of patients' demographics and health factors is essential in constructing high-quality health care services toward Chinese or Western medicine. The objective of this study was to understand the tendency among Taiwanese to opt for either Chinese or Western medicine when both services are available.Materials and methodsThis study was based on the analysis of secondary data. A total of 13,151 individuals with an age of 30 years or more were selected from the Taiwan Biobank Research Database in Taiwan. Multiple logistic regression analysis was used to identify factors associated with health-seeking behaviors toward Chinese or Western medicine.ResultsAmong all the participants, 50.8% showed a greater tendency to seek Western medicine treatment, while 10.4% showed a preference for Chinese medicine treatment. Main drivers for a Chinese medicine health-seeking behavior were women, hypotension, low income, normal HbA1c, normal total cholesterol, and yang deficiency. The preference for Western medicine treatment was associated mainly with men, an older age, a married status, lower income, a lower education, an abnormal cholesterol level, and the absence of stasis.ConclusionHealthcare providers should understand the factors associated with health-seeking behavior and refer patients to their desired treatment.     

Personalized reproductive medicine on the brink: progress,opportunities and challenges ahead

Significant progress has been made in several fields of medicine towards personalizing treatment recommendations based on individual patient genotype. As the number of clinical and genetic biomarkers available to physicians has increased, predictive models able to integrate the contributions of multiple variables simultaneously have become valuable tools for medical decision making. Leveraging genotype information and multivariate predictive models holds the promise of bringing greater efficiency to, and reducing the costs of, fertility treatments. This work reviews the advances that have been made in genetic biomarker discovery and predictive modelling for fertility treatment outcomes. We also discuss some of the limitations of these studies for translation to clinical diagnostics and the challenges that remain.Personalized medicine holds the promise of allowing doctors to create ‘bespoke’ treatment recommendations for each patient based on multiple clinical variables such as age and hormone concentrations combined with the patient’s genetic sequence information. A number of challenges remain for the field of reproductive medicine to make the research discoveries necessary to usher in this new era of personalized fertility care. Here, we discuss some of these challenges and make recommendations for overcoming them.     

Proposal of practicing Japanese Kampo in menopausal medicine

Traditional Chinese Medicine (TCM) is now called “Kampo Medicine” in Japan. What is really needed for the treatment of human sickness and what is really wanted by sick people is medical care tailored to the particular patient, which respects the individual characteristics and personality of the patient. In Kampo medicine, therapeutic policy is determined on the basis of the physical constitution and condition of individual patients. For this reason, Kampo medicine is called “tailor-made medicine.” One characteristic of Kampo medicine is that it is aimed at treating conditions preceding disease. The diagnosis system of Kampo medicine therefore includes identification of the personality of each patient and correction of its distortion, if any. Women with undefined complaints in the climacteric period often have multiple symptoms. To identify the characteristics of each patient and to provide treatment tailored to each patient, SHO diagnosis is needed. This diagnostic process is unique to Kampo medicine and is not included in modern Western medicine. Making full use of the traditional diagnostic approach of Kampo medicine, SHO is determined and the patient's condition is understood from the standpoint of Kampo medicine. Optimum treatment is then provided on the basis of such understanding of the patient and his or her illness.

Kampo medicine is established as a science with art. Practicing Kampo medicine involves dealing with patients using a science with art and thus providing humane medical care to patients. Kampo medicine is thus of use to all the world.