《伤寒论》中的瞑眩现象

<正> 《尚书》云:“若药不瞑眩,厥疾弗瘳”。“瞑眩”二字,有愦乱之意,不是正气涣散,而是邪气愦乱,询可喜庆。瞑眩现象的出现,好象病势突然加剧,有似药物的不良反应。但药物反应,病增恶;而瞑眩后,宿疾除。《伤寒论》中关于瞑眩的条文第46条:“太阳病,脉浮紧,无汗、发热、身疼痛,八九日不解,表证仍在,此当     

王笑民辨证论治配合靶向药物治疗肺癌验案2则

靶向治疗药物吉非替尼与厄洛替尼可用于化疗失败后的晚期非小细胞肺癌的二、三线治疗.上述靶向药物的主要不良反应为皮疹和腹泻,有的患者因严重不良反应而停药.     

乌头的药后瞑眩与临床疗效

对于有毒的中药来讲,《尚书说命》有“药弗瞑眩,厥疾勿瘳”的观点。但究竟怎样才算“药后瞑眩”呢?“药后瞑眩”能否提高临床疗效?这是一个涉及较少的问题。笔者有感于此,参考有关文献结合个人体会,就乌头的药后瞑眩与临床疗效进行初浅的探讨,以望有益干临床。     

肺癌靶向药物相关毒副反应辨治体会

肺癌患者接受靶向治疗后可出现不同程度的不良反应,如皮疹、腹泻、肝功能异常等,严重者其靶向治疗进程会受到干扰。认为靶向药物具有湿浊、热毒的特性。应以清热凉血祛湿为法治疗皮疹,以理气健脾祛湿为法治疗腹泻及其他消化道反应,以活血法治疗肝功能损害。同时根据临床表现及疾病不同阶段灵活调整用药,往往可取得良好效果,从而提高患者对靶向治疗的依从性。     

王笑民辨证论治配合靶向药物治疗肺癌验案2则

靶向治疗药物吉非替尼与厄洛替尼可用于化疗失败后的晚期非小细胞肺癌的二、三线治疗。上述靶向药物的主要不良反应为皮疹和腹泻．有的患者因严重不良反应而停药。王笑民教授是首都医科大学附属北京中医医院肿瘤科主任医师．应用中药配合靶向药物治疗晚期非小细胞肺癌．不仅增强了靶向药物的疗效,延长了其耐药时间,而且预防或减轻了靶向药物的不良反应,现将验案二则总结如下。     

“瞑眩”病机探讨及病案举隅

"瞑眩"又称"好转反应",临床特点表现为突然发生、复杂、多样且短暂,反应过后原有病症迅速减轻乃至消失。其机理可能是:药物作用于人体,使紊乱的各个系统经过调节而达到平衡状态,是邪有出路的反应,是人体达到阴平阳秘的过程,是疾病向愈的佳兆。探讨瞑眩的病机并结合临床典型案例加以分析,指出瞑眩的临床表现不止一端,临证时需仔细体会方可判断治疗中新出现的症状是病情加重,还是治疗的不良反应,还是疾病向愈的"瞑眩反应"。     

谈谈瞑眩

<正> 瞑眩(m(?)n xu(?)n,又作眠眩)一词,出自《尚书·说命上》,其曰:“若药不腹眩,厥疾弗廖。”就是说,如果用药后不发生瞑眩现象的话,其病就不会痊愈。由此看来,眼眩当属一种治疗有效的反应。瞑眩在临床上虽不常见,但因其表现特殊,往往不被人所识,故有讨论的必要。本文拟结合国内外的有关资料,谈谈个人的认识。瞑眩的表现特点大家知道,服麻、桂而汗,服硝、黄而下,乃是药物本身的作用所为。而瞑眩则不     

药得奇效话“瞑眩”

“瞑眩”原指昏糊眩晕之意,语出《尚书·说命》“药不瞑眩,厥疾弗瘳”,其意是指病人服药后,若不产生昏糊眩晕的反应,则药物对顽证痼疾就很难奏效,现在即泛指服药后没有一定的药物反应,治疗效果则欠满意。历代医家对“瞑眩”现象均较重视,如东汉张仲景在《伤寒论》《金匮要略》中对此记载频多,如《伤寒论》46条曰:“太阳病,脉     

浅谈乌头的药后瞑眩

《尚书说命》曰:“药弗瞑眩,厥疾勿瘳。”但究竟怎样才算”药后瞑眩”?“药后瞑眩”能否提高临床疗效呢?对此,汉·张仲景曾有观察和记载。《金匮要略》有“乌头桂枝汤服后其知者,如醉状,得吐者,为中病。”近人王朝晖氏也发现有些病例服用乌头后,需要达到轻度中毒才有效,如出现口唇、舌体微麻,轻度头晕等,约半小时至1小时,药物的治疗效果也就充分发挥出来,而副作用即能自行消失。张谷才氏还说:“服乌头后,唇舌、肢体麻木,甚至眩昏、吐泻应当注意,若脉     

从“药弗瞑眩,厥疾弗瘳”探析“瞑眩”

通过分析瞑眩表现特点、发生机理与药物毒副作用的区别,指出瞑眩是包括药物、针灸等治疗领域在内的治疗过程中的一种反应现象,其发生具有突发性和短暂性的特点,症状表现多种多样。瞑眩现象发生后,其病均能迅速好转或快速痊愈。瞑眩反应尤其应与药物毒副作用相鉴别。当病情为瞑眩时要顺应病情,不要逆势而为;当病情为药物毒副反应时,更要诊断正确,采取急救措施,尤应避免轻易断为瞑眩而贻误治疗情况的发生。     

A good chew or good riddance—How to move forward in the regulation of khat consumption

Aims

To review the status of khat, the most recent plant based psychoactive substance to reach a global market, and consider policy making processes in general and the framework of drug control in particular.

Materials and methods

Desk review of literature on khat and wider drug policy processes.

Results

The risk assessment and classification of psychoactive drugs is a contested arena where political, economic and moral agendas collide, leaving countries that have banned khat, with significant social costs. To best manage the risks arising from the increasing availability of khat it is therefore suggested to draft a regulatory framework with clear objectives and guiding principles.

Conclusions

Given that medical risks of khat use are modest, the objective of the regulatory framework should be the protection of consumers and community. This is best achieved by establishing processes for the quality control of khat imports, and by regulating access and availability. It should therefore not be considered as a drug to be controlled but as a licit substance that needs to be regulated.     

某院2012年223例药品不良反应报告分析

目的：分析某医院药品不良反应（ADR）发生的情况及给患者带来的危害,分析其发生的原因并探讨相应的防治措施.方法：收集我院ADR报告223例,分别从患者年龄、ADR表现、药品种类、给药途径、关联性评价及转归等方面进行统计分析.结果：223例ADR报告涉及71种药品.其中,抗菌药物有32个品种,ADR 148例,占总例数的66.37％;其次为中药注射剂,有10个品种,ADR 28例,占12.56％.引起皮肤及附件损害的ADR最多（148例）,占总例数的66.37％;其次为消化系统反应（37例）,占总例数的16.59％.小于9岁的患者发生ADR的比例最高（105例,占47.09％）;其次为大于60岁的老年患者（29例,占13.01％）.结论：在婴幼儿及老年患者用药过程中应密切观察其不良反应,合理使用抗菌药物和中药注射剂,加强ADR监测,促进临床合理用药.     

基层医院万古霉素的合理使用

目的:为基层医院盐酸万古霉素的临床合理应用提供依据。方法:通过文献调研与临床调研的方法,归纳总结万古霉素临床使用中存在的一些不合理情况。结果:基层医院万古霉素存在不合理用药现象的病例占27.0%。结论:临床应强调对症用药,严格用法用量,以防不良反应产生,避免抗生素滥用。     

产超广谱β-内酰胺酶（ESBLs）大肠埃希氏菌的耐药调查及用药分析

目的：观察产超广谱β-内酰胺酶（ESBLS）大肠埃希氏菌的耐药特征及抗感染用药现状。方法：对43株产ESBLs大肠埃希氏菌进行耐药率统计和抗感染用药的回顾性分析。结果：产ESBLs大肠埃希氏菌对亚胺培南、关罗培能等敏感率均为100％,对其它抗菌药物耐药情况较为严重。43株产ESBLs大肠埃希氏菌感染病例中,单用抗菌药物25例,联用抗菌药物15例,未选用抗菌药物3例,其中最常用药物为头孢西丁。结论：ESBLS菌株给临床抗菌治疗带来了较大困难,因此临床医师及药学人员应对其有充分认识,合理使用抗菌药物,减少产EsBLS大肠埃希氏菌的出现和传播。     

天然产物与药物发现研究评述

天然产物是药物发现与筛选的物质基础,高效、快速的药物筛选技术是获得天然产物线索化合物的重要前提.本文从药物研发环境、药物研发面临的困难、现代化的药物筛选技术、获得类似物的方法等方面综述了天然产物药物发现与药物筛选的现状及开发前景.

Abstract：

Natural products were the material basis of drug discovery and drug screening, and high-performance techniques were the important prerequisite of earning hits. In this paper, we reviewed the current situation and future prospects of drug screening, including the pharmaceutical environment, the challenges facing drug discovery, the screening tools and the methods of generating analogs.     

住院患者呼吸道感染鲍曼不动杆菌39例分析

目的调查我院住院患者感染鲍曼不动杆菌的危险因素及耐药情况,为呼吸道感染病人预防该病菌感染提供依据。方法对39例住院病人呼吸道感染鲍曼不动杆菌进行分离培养,用美国德灵半自动细菌分析仪进行菌种鉴定及抗生素的药敏实验。结果39株鲍曼不动杆菌阿米卡星、舒巴坦、亚胺培南、左氧氟沙星的敏感率分别为79．49％、74．36％、56．41％、53．85％,该菌对唑啉头孢菌素耐药率达100％,对氨基糖苷类、头孢菌素耐药率较高。结论住院病人呼吸道感染常见致病菌以革兰阴性菌为主,鲍曼不动杆菌对高龄、严重基础疾病易感性高,且对多种抗菌药物耐药。     

浅析医院的中西药房药品管理

对于药品的管理,我国《药品管理法》和一些医院自己的规章制度中已经有明确的规定,但有时在实际的工作中,由于药剂工作人员自身的素质高低,出现药品管理的混乱时有发生。本文概述了在药房药品管理中存在的问题,并列举了药房药品管理的方法。     

Aamar-e-Advia (shelf-lives) of drugs in Unani system of medicine: A conceptual review

In an era of globalization and increased global demand for herbal medicines, it is essential to ensure the quality and consistency of drugs. Changes in the quality of an herbal product over time should be detectable. The assessments of chemical quality and therapeutic efficacy of herbal drugs are necessary to establish their shelf-lives. Thus, stability testing is needed to establish standards for herbal products. Unani medicine has its own conceptual framework for studying health and disease. The mode of treatment includes Ilaj bit Tadbeer (regimental therapy), Ilaj bil Ghiza (dietotherapy), Ilaj bil Dawa (pharmacotherapy) and Ilaj bil Yad/Jarahat (surgery) as a final option. Ilaj bil Dawa is the most used mode of treatment. The drugs include either crude drugs prepared from plant, animal and mineral sources, called Mufrad (single) drugs or various formulations prepared from these crude drugs, called Murakkab (compound) drugs. To date, stability studies have been carried out on compound drugs, whereas only a few single drugs had had their stability tested. These studies are needed to understand how the quality of an herbal drug varies over the time when it is prepared and consumed. This may also help to standardize procedures for manufacturing compound formulations ab initio. The present study reviews the concept of Aamar-e-Advia (shelf-lives) described in the literature of the Unani system of medicine. Further, various factors that are considered important to assess the shelf-life of Unani drugs are discussed in the context of contemporary protocols for shelf-life assessment.     

我院门诊与住院药房钙拮抗药的使用情况分析

目的：统计和分析我院钙拮抗药的应用情况,了解这类药物应用的变化情况及发展趋势。方法：利用计算机管理系统对我院2007年1月～2008年6月门诊和住院药房钙拮抗药的消耗金额、用药频率及排序进行全面统计和分析。结果：钙拮抗药的消耗金额中氨氯地平片、硝本地平缓释片和控释片分占前三位。结论：长效的硝苯地平类钙拮抗药使用发展空间较大,有良好的应用前景。     

Clinical observation of electroacupuncture in treating depression

Purpose To observe the curative effect of electroacupuncture in treating depression.Method Two hundred and ten subjects were randomly divided into electroacupuncture group and medication group.Results and conclusion The results were evaluated by an international depression scale in both groups. After one-course treatment, the average score markedly decreased in both groups, and a t-test showed that there was a significant difference in curative effect between before and after treatment in each group (P<0.001); but there was no such a difference between the two groups (P<0.05). Electroacupuncture can be compared favorably with amitriptyline, an antidepressant. However, taking amitriptyline will produce some side effects. Therefore electroacupuncture is especially suitable for those who cannot take medicine. Author: ZHANG Hong (1967-), male, attending physician Translator: XIAO Yuan-chun