论辨证论治思维方法的形成

张仲景继承了《黄帝内经》等古典医籍的基本理论，结合当时人们同疾病作斗争的丰富经验，以六经论伤寒，以脏腑论杂病，提出了包括理、法、方药在内的辨证论治的原则，使祖国医学的理论与实践紧密的结合起来。以六经论伤寒，即把外惑热病在发展过程中各个阶段所呈现的各种综合症状，作为辨证论治的纲领。以脏腑论杂病，虽不以六经分征，而以病征分篇，但同样反映了辨证论治的精神。     

Syncope after effort

A 29-year-old man developed recurrent syncope following exertion. Cardiac investigations revealed no evidence of structural heart disease, but during exercise testing, in the recovery phase, he sustained a bradycardia and then asystole for a prolonged period. Before cardiac massage could be instituted a tonic-clonic fit occurred, and this initiated a return to sinus rhythm. His symptoms were abolished following the implantation of a dual-chamber pacemaker.     

Febrile seizures: treatment and prognosis

Recent epidemiologic data indicate that the vast majority of children with febrile seizures have a normal longterm outcome. A precise knowledge of the short- and long-term outcome with or without treatment, and short- and long-term side effects is an important prerequisite for assessing the various treatment strategies. We focus on the impact of short-term or prophylactic treatment on the short- and long-term outcome of various types of febrile seizures. There is universal agreement that daily prophylaxis with antiepileptic agents should never be used routinely in simple febrile seizures, but only in highly selected cases, if at all. Intermittent diazepam (DZP) prophylaxis at times of fever may or may not reduce the recurrence rate, but it does not appear to improve the long-term outcome as compared with short-term seizure control. The treatment may be used to reduce the recurrence rate for a small arbitrarily defined group with multiple simple febrile seizures, complex febrile seizures, especially focal, prolonged or both, febrile status, and when parental anxiety is severe. However, there is no evidence that treatment of simple febrile seizures can prevent the rare cases of later epilepsy, and many children with complex febrile seizures have a benign long-term outcome, even without treatment. Many prefer a "wait and see" policy. An attractive alternative is to treat new febrile seizures with rectal DZP in solution at seizure onset, given by the parents at home to prevent febrile status. Newer, less well documented short-term strategies include nasal, oral, or rectal administration of other benzodiazepines. Short-term seizure control of febrile status and careful parental counseling are the two most important targets of treatment.     

高热惊厥患儿视听诱发电位的研究

【目的】获得一组高热惊厥（febrile convulsion，FC）患儿的视听同步诱发电位的试验室参考值，与同时检测的听性脑干反应（auditory brainstem response，ABR）和闪光视觉诱发电位（flash visual evoked potentials，FVEP）进行对比，讨论视听同步诱发电位的特点，为临床早期同步发现并诊断婴幼儿视听功能障碍提供有力的电生理技术支持。【方法】30例1～3岁FC患儿，于惊厥24h内和惊厥一周后分别进行单独ABR、FVEP和视听同步诱发电位的检测。【结果】①2～3岁组FC患儿单独ABR各波的潜伏期、波问期及单独FVEP各波潜伏期均长=F其它年龄组；②同步ABR—FVEP各波在同步诱发后波形分化良好，潜伏期稳定，较单独ABR和单独FVEP检测波变得更易辨认；③2～3岁组FC患儿同步FVEP—ABR各波的潜伏期、波问期均长于其它组；④FVEP在同步诱发电位中占主导地位，对同步ABR潜伏期影响显著；⑤FC患儿同步ABR和同步FVEP的标准差较单独ABR和FVEP减小，同步ABR和FVEP的异常率较单独ABR和FVEP的异常率有明显提高。【结论】同步诱发电位可早期发现并诊断FC患儿视听功能障碍。     

1,6-二磷酸果糖对热性惊厥大鼠学习记忆和情感行为损害保护作用的研究

【目的】探讨1,6-二磷酸果糖(fructose-1,6-diphosphate,FDP)对大鼠热性惊厥性学习记忆和情感行为损害的保护作用。【方法】30只21日龄雄性SD大鼠随机均分为果糖干预(FDP intervention group,FD)、盐水对照(so-dium chloride solutin control group,NS)和热性惊厥组(febrile seizure group,FS)。水浴法建立热性惊厥模型;FD组于惊厥前30min腹腔注射FDP25mg/100g大鼠体重;而NS组腹腔注射相同体积的0.9%氯化钠溶液;FS组不予干预。观察各组在避暗试验(passive avoidance test,PAT)、Morris水迷宫(Morris water maze,MWM)及旷场试验(open field test,OFT)中学习记忆和情感行为的变化。【结果】FDP可使惊厥大鼠在PAT中的记忆潜伏期延长[FD组为(341.16±97.44)s,NS组为(227.62±92.19)s,FS组为(213.66±90.70)s,P<0.01],错误次数减少(FD组为1.84±1.27,NS组为4.97±1.18,FS组为5.06±1.38,P<0.01);在OFT中,FDP可增强反复惊厥大鼠的兴奋性(FD组得分为65.41±8.02,NS组为46.22±7.97,FS组为48.81±7.69,P<0.0 1),提高大鼠对陌生环境的适应能力(FD组后肢性站立的次数为36.29±5.06,NS组为18.72±4.71,FS组为20.06±4.96,P<0.01),改善大鼠的紧张情绪(FD组粪便粒数为5.62±2.76,NS组为10.79±2.91,FS组为11.43±3.01,P<0.01);在MWM中,FD组大鼠逃逸潜伏期缩短,搜寻策略改善。【结论】1,6-二磷酸果糖可以改善反复惊厥大鼠的学习记忆和情感行为,对惊厥性脑功能损伤具有保护作用。     

张仲景有关虚脉论述之浅析及实践

对《伤寒论》、《金匮要略》中所载十一条虚脉的经文予以归类,从辨证、病因病机、鉴别诊断、治疗原则、推测疾病预后等方面阐述虚脉的临床意义,并结合病案,介绍作者应用经验。     

儿童致死性病毒性脑病7例

目的探讨致死性病毒性脑病的临床和实验检查特点。方法回顾性分析7例致死性病毒性脑病患儿临床过程及预后,肝酶学、脑脊液常规改变,头颅CT改变。结果7例患儿均呈骤然高热、严重抽搐和迅速进入昏迷、肝酶显著升高。4例死亡,3例留有严重神经系统后遗症;血氨均正常;头颅CT均显示显著脑肿胀,可见对称性基底核低密度病变。结论高热、迅速发生抽搐和昏迷、肝功能损害的患儿,应警惕致死性病毒性脑病发生。     

湿温汗下润忌宜及儿科临床

<温病条辨>上焦篇湿温门云:"头痛恶寒,身重疼痛,舌白不渴,脉弦细而濡,面色淡黄,胸闷不饥,午后身热,状若阴虚,病难速已,名日湿温,汗之则神昏耳聋,甚则目瞑不欲言,下之则洞泄,润之则病深不解".     

张仲景生平暨《伤寒论》版本流传考略(续2)

考证张仲景里籍、名字、任长沙太守、王粲死因、建安当作建宁诸端，依据《辅行诀脏腑用药法要》证知《伤寒论》据《伊尹汤液》而成书。