试论柯琴“六经为百病立法”之说

文章通过柯琴“六经为百病立法”论述,从症候、辨证、论治等方面阐述该学说的合理性,指出了柯琴这一认识从本质上把握了《伤寒论》在临床的价值,为后世医家在临床实际中运用仲景方法辨证提供一个思路,对今天认识《伤寒论》是一部辨证论治的专著有一定启示。     

研读《伤寒》解缓脉

缓脉本是中医临床常用、常见脉象,但叔和以来的脉学著作,对其概念却多颇含混,即使是当代的中医院校教材,也令学者多生疑问,莫衷其是。研读了《伤寒论》中有关缓脉的论述,发现“缓”字确有缓慢和松弛两种含义。缓脉脉象的描述以“脉势纵缓”或“脉管壁松弛”最为妥当。     

Modified glasgow coma scale to predict mortality in febrile unconscious children

A prospective hospital based study was conducted in the Department of Pediatrics of the Kasturba Hospital, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha to predict the mortality in children admitted with fever and unconsciousness using the Modified Glasgow Coma Scale (MGCS) score. Forty eight children were admitted with fever and unconsciousness; cases of febrile convulsions, epilepsy and cerebral palsy were excluded. MGCS scores were assessed on admission and repeated at 12 hours, 24 hours, 48 hours and 72 hours after admission in each case. Diagnosis in each case was confirmed by history, examinations and investigations. All the cases were regularly followed up till death/discharge. The overall mortality was 29.1% (14/ 48) out of which 85% (12/14) died within the first 24 hours. Mortality was highest in the toddler age group and in patients with pyogenic meningitis. There was a significant association between death and MGCS scores on admission with a post test probability for discharge being only 10% with a score of less than 5 and 99% with a score of more than 10 respectively. MGCS scores on admission can be used to predict mortality in patients hospitalized with fever and unconsciousness. The scale is simple, easy, can be applied at bed side and does not need any investigations. Its application in developing countries with limited investigative and intensive care facilities can help the treating physician decide regarding referral and counseling the parents regarding the probable clinical outcome.     

对《伤寒论》预后诊断思想方法的研究

为提高临床诊断疾病的准确性和对治疗效果的判定,作者认真研读《伤寒论》对疾病病证的传变和预测疾病生死愈危,并对其方法进行了深入地研究,对现实临床实践具有重要的指导意义。     

从疾病演变史探“伤寒”原义

中国汉代曾流行一种虫媒病毒传播疾病“克罗米亚-刚果出血热”（新疆出血热）,其病程发展经过与伤寒传经过程表现极为相似,特别是在疾病转归方面,二者完全一致。“克罗米亚-刚果出血热”在当时被认作“伤寒”。这一疾病西域自古即有,由于生态环境与社会历史的变迁,促使这一疾病由西域传入中原。     

Decreasing the toxic potential of intravenous regional anaesthesia

In an attempt to reduce the dose of local anaesthetic agent during intravenous regional anaesthesia (IVRA) of the upper limb, we have used a forearm tourniquet in 12 adult volunteers. The volume of the forearm venous system was predetermined angiographically. We performed IVRA with three solutions of lidocaine (0.25, 0.375, 0.5 per cent) administered in a volume equal to the forearm venous system. Angiographic results indicate that: a forearm tourniquet provides adequate vascular isolation; the volume of the forearm venous system can be correlated with body weight; the progression of the fluid in the venous system follows a pattern that is similar for all patients with the small veins of the distal forearm and proximal hand being filled last. With this technique, lidocaine 0.5 per cent resulted in a dose of 1.5 mg.kg-1 and provided excellent analgesia. Lower concentrations were unsatisfactory. We conclude that the use of a forearm tourniquet allows reduction of the local anaesthetic dose to a non-toxic level and thus increases the safety of IVRA.     

Prognostic significance of febrile episodes in lung cancer patients receiving chemotherapy

The prognostic significance of neutropenic fever in lung cancer patients receiving chemotherapy with or without radiotherapy was investigated. Male patients and patients with squamous cell lung cancer had a higher incidence of febrile episodes than female patients and patients with other cell types, but the differences were not significant. Patients with a poor performance status had a significantly higher incidence of febrile episodes. An indwelling central venous catheter was an important risk factor for febrile episodes, indicating that bacteremia was one of the major causes of fever. The median survival time of the patients who developed febrile episodes during chemotherapy was significantly shorter than that of patients without fever (6.1 vs 12.0 months), whether or not cases of early death within 3 months were excluded (8.9 vs 13.1 months). The prevention of infectious complications during anticancer treatment by the use of rh G-CSF and the early initiation of antimicrobial chemotherapy, although the results are inconclusive, may be worthwhile.     

Economic aspects of empiric antibiotic therapy for febrile neutropenia in children with cancer

Several antibiotic regimens have been proposed worldwide for empiric treatment of febrile neutropenia in children with cancer, but none of them shows clear advantages in terms of clinical efficacy. Therefore, other parameters, including drug acquisition costs, should be considered in the selection of treatment. Children receive a "fraction" of a standard daily dose, and this fraction is generally calculated on the basis of body weight; therefore, the cost of each day of therapy is determined by the packages available for each single drug. We calculated the acquisition costs of various drugs proposed for the empiric treatment of febrile neutropenia in children with cancer, and then we estimated the daily cost of therapy referred to different patient weights. In general, the combination regimen with ceftriaxone plus aminoglycoside turned out to be less expensive than other regimens (including monotherapy with third-generation cephalosporins or carbapenems).     

“心下痞硬”小议

通过分析《伤寒论》中“心下痞硬”的方药规律及其原文字词内涵,归纳出“心下痞硬”的病机为“胃中空虚,寒气上逆”,进一步探索出“心下痞”“心下痞硬”及“结胸”在病机上表现为正气渐衰、邪气渐盛的一个动态过程,指出三者的共同病机为“胃中空虚,寒逆热陷”,从而对脾胃病的传变及治疗预后给予启发。