张锡纯从脑论治痿证特色探析

[目的]探讨张锡纯从脑论治痿证的思路与特色。[方法]从中医文献整理、研究的角度,对张锡纯所著《医学衷中参西录》中从脑病角度论治痿证的相关论述、医案、具体药方进行系统分析,归纳和总结其痿证论治思路和特色。[结果]张锡纯汇通中西,以“肢体痿废”一症立论,结合现代医学对脑病的认识,创造性地提出脑贫血、脑充血两种病因均可导致肢体痿废,在此基础上以传统医学宗气不足、精髓不充、脏腑气血大热的观点诠释二者病机,立益气引血、镇肝熄风大法,创干颓汤、镇肝熄风汤、建瓴汤等,大大扩展了痿证的治疗思路。[结论]张锡纯衷中参西,从脑病角度论治痿证,对痿证理论的继承和发展作出重要贡献,于今日临床启发尤多。     

从经方的配伍应用探讨细辛宣营之功

[目的]阐发细辛宣营功效在经方配伍中的体现。[方法]追思传承,运用文献分析的方法,搜集整理《神农本草经》和《名医别录》等中医药经典对细辛的阐述,通过分析张仲景在《伤寒论》及《金匮要略》中运用细辛的情况,选用以当归四逆汤为代表的经典方剂,从经方的配伍应用中探讨细辛宣营的特点。[结果]在以历代医家对细辛的认知基础上,仲景在经方的配伍应用中对细辛宣营之功的运用分为四方面:第一,细辛可宣营而散寒解表,如当归四逆汤;第二,细辛可宣营而温化水饮,如苓甘五味姜辛汤;第三,细辛可宣营而通阳行痹,如三黄汤;第四,细辛可宣营而和血安胎,如白术散。[结论]细辛在经方的配伍应用中宣营之功体现为四方面,即散寒解表、温化水饮、通阳行痹、和血安胎,虽为辛热之品,只要合理搭配,即可宣营且不伤阴。     

内外合治小儿间质性肺炎临证撷菁

小儿间质性肺炎是儿科少见的呼吸系统疾病,归属中医肺炎喘嗽范畴,病因责之于外邪入侵、内脏虚损,病机以肺气郁闭为核心,临床可见痰热闭肺、痰热壅肺、肺脾气虚等证型。谢静副教授临床上基于内外合治,内以分期辨证论治,外取"简、便、廉、验"之功,发挥中医药优势,对小儿间质性肺炎进行有效防治。     

从五运六气辨识与防治新型冠状病毒肺炎

从五运六气理论推演天时气化,据实际气候指标拟定全国16方域六气气化数值。参合两者,提示本次新型冠状病毒何以发于己亥岁末之鄂,并据患者易见症状表现,辨识此肺炎乃风温夹湿之疫厉。然后分析其易感之地,以鄂湘赣为最,次则浙闽两广江苏,以其气化相近也;好发之人,以肺脾气虚湿盛者为甚,次则肝气失调、素体孱弱者,以其正虚邪凑也。进而推测疫情演化趋势,庚子岁半之前,疫情正烈;岁半而后,当衰减而泯灭。中医防治,当以出具防治方药为本,参考古今医家治疫理法,结合自家经验,拟定防治方药八帧。     

中医药辨治艾滋病的临床研究概况

对近年来中医药辨治艾滋病的临床研究概况进行综述。目前中医临床根据艾滋病患者的不同临床表现辨证主要分为气血双亏、热毒郁结、气阴两伤、瘀血内阻4型;临床上使用次数较多且临床效果较明显的治疗艾滋病的中药复方制剂有益艾康胶囊、五味灵芪胶囊、唐草片、复方三黄散、艾宁颗粒等;甘草、黄芪、黄芩、金银花、丹参、柴胡、白花蛇舌草、紫花地丁等8味中药皆已经被证实具有高效抗人类免疫缺陷病毒(HIV)活性的作用;清热解毒中药中的紫花地丁、穿心莲、牛蒡子、紫草、金银花、苦参、夏枯草、贯仲、狗脊、黄连、淫羊藿、蟛蜞菊已经被证明具有抑制HIV病毒复制的作用。     

Neuroimagerie de l’insight dans la schizophrénie : revue de la littérature

ObjectivesInsight in psychiatry has been defined and conceptualized in a number of ways but none of them was found to be self-explanatory. There has been an exponential rise in studies of insight, in part accelerated by the availability of several psychometric scales for measuring insight. Lack of insight has been associated in schizophrenia with low treatment adherence, a high number of relapses, increased number of hospital admissions, and subsequently poorer psychological and cognitive functioning. For this reason, there is considerable interest in understanding the underlying neural mechanisms of insight, which may have important implications for the development of future insight-oriented neuro-psychiatric treatment. Neuroimaging may be considered an important technique to help understand the anatomical, functional and metabolic neurocircuitry underlying poor insight in schizophrenia. Growing neuroimaging research provides evidence for underlying brain impairment in insight deficits in schizophrenia. In order to expose a panoramic view to the readers, this article reviews the neuroimaging studies conducted to date, which have investigated the neural bases of insight in schizophrenia.MethodsElectronic searches were performed in PubMed, PsycINFO, Sciencedirect and Web of Science databases, using the following keywords: Imaging; neuroimaging; Positron Emission Tomography (PET); spectroscopy; functional Magnetic Resonance Imaging (fMRI); structural Magnetic Resonance Imaging (MRI); Single Photon Emission Computed Tomography (SPECT); Voxel Based Morphometry (VBM); Diffusion Tensor Imaging (DTI); Computed Tomography (CT); Insight; schizophrenia; awareness of illness. Searches were also performed from the references of the systematic review articles on neurobiological correlates of insight in schizophrenia. Animal studies and single case reports were excluded. Twenty-five articles were selected for the present review. From these; 12 used structural MRI; 6 used VBM; 3 used fMRI; 2 used CT; 1 used DTI and 1 used VBM combined to DTI.ResultsThe search showed that studies in this area were published recently and that the neuroanatomic substrate of insight in schizophrenia has not yet been consolidated. This inconsistency could arise from the complex nature of insight and the use of a variety of insight assessments. Most of the studies analyzed in this review used structural neuroimaging techniques to assess brain abnormalities associated with poor insight. The functional neuroanatomy of insight has only recently been investigated and to our knowledge, there are only 3 studies that have examined brain activity with fMRI in relation to insight in schizophrenia.ConclusionThis review investigated the neural deficiencies underlying poor insight in schizophrenic patients. In spite of methodological differences among studies, results provide evidence of structural and functional brain abnormalities in frontal, parietal and temporal region related to insight deficits. Some studies have found a hemispheric asymmetry in relationship to poor in insight (the majority of brain abnormalities concern the right hemisphere). In addition, growing research indicated that the prefrontal cortex, particularly the dorsolateral prefrontal cortex, the anterior cingulated cortex, the insula, the precuneus and the cerebellum can also underlying insight in schizophrenia. It is interesting to mention that some authors have suggested that each dimension of insight can be specifically linked to certain brain structures. Taking together, data on the neuropsychological and neuroanatomical correlates of clinical insight suggested that lack of insight in schizophrenia could be conceived as a neurocognitive deficit, analogously to anosognosia in brain injury and dementia. On the contrary, to date, the neuroanatomical correlates of cognitive insight have been scarcely studied. Only two studies reported that Self-reflectiveness was positively related to gray matter volume of the right ventro-lateral prefrontal cortex, the BCIS composite index was positively correlated with total left hippocampal volume, and Self-certainty was inversely correlated with bilateral hippocampal volumes. However, it is important to note that neuroimaging research on cognitive insight in schizophrenia is in a preliminary, and the results on this are inconclusive. Further research is needed to better understand the causal relationships between brain abnormalities and degradation of insight in schizophrenia.     

Pantomography of Flat Layers

The effects of in vivo zinc deficiency and restricted food intake, on the in vitro synthesis of glycosaminoglycans of rib cartilage were studied in the rat. ³⁵S-sulfate and ¹⁴C-glucosamine were used as precursors. The glycosaminoglycans were separated on microcolumns and specific radioactivities determined for the different fractions.

Chemical analyses showed that zinc deficiency or reduced food intake did not cause any qualitative or quantitative changes in the glycosaminoglycans. The radioassays indicated that zinc deficiency and reduced food intake, alone or combined, caused a somewhat lowered synthetic rate of chondroitin sulfate. In the discussion it is underlined that it seems difficult to determine conclusively the importance of zinc for the formation of the mucopolysaccharides through further in vivo deficiency studies, because of the difficulties to control and evaluate the inanition factor.     

平顶山市2006～2010年居民户碘盐监测结果分析

目的分析平顶山市居民碘盐食用情况,为消除碘缺乏病(IDD)防治工作提供科学依据。方法 2006～2010年,在平顶山市,每年按照东、西、南、北、中抽取9个乡(镇),每个乡(镇)抽取4个行政村(居委会),每个行政村(居委会)抽取8户居民食用盐。采用直接滴定法检测碘盐。结果 2006～2010年共检测13 668份居民户食用盐,合格碘盐12 685份,不合格碘盐510份,非碘盐443份,碘盐覆盖率为96.54%(13 225/13 668)。碘盐合格率为96.94%(12 685/13325),合格碘盐食用率93.59%(12 685/13 668),非碘盐率3.24%(443/13 668)。结论平顶山市各县(区)居民户合格碘盐达到国家消除碘缺乏病(IDD)的控制标准,但有少数县(区)碘盐质量有待提高。在今后的工作中还应利用多种形式加大宣传IDD防治知识,对广大群众进行健康教育,增强自我防护意识,使他们能自觉抵制私盐,拒绝购买非碘盐。     

理气开郁法板块方镇痛作用的动态分析

目的：探讨理气开郁法中药板块方的镇痛作用特点。方法：将150只清洁级昆明种小鼠,按体重随机区组法分为15组,包括对照组,柴郁汤、芍甘汤、痛泻要方、金铃子散高中低剂量各组,吗啡和布洛芬组,采用45℃、50℃、55℃水浴引致小鼠疼痛模型,动态测定痛阈潜伏期,用药前测定基础痛阈。采用重复测量设计的方差分析。结果：柴郁汤、芍甘汤和痛泻要方的镇痛作用以高剂量更明显;柴郁汤对45℃、50℃、55℃水浴的痛阈潜伏期均有延长作用,柴郁汤高、中剂量在多个时间点上显示出较好的镇痛作用。结论：柴郁汤的镇痛作用较强,作用特点类似于中枢镇痛药或兼有中枢性镇痛作用;芍药甘草汤、痛泻药方、金铃子散属于作用于外周的镇痛药。     

晚发性维生素K缺乏性颅内出血外科治疗316例

目的探讨晚发性维生素K缺乏性颅内出血的外科治疗方法及疗效。方法回顾性分析天津市儿童医院神经外科自2000年1月至2013年12月收治并确诊的316例晚发性维生素K缺乏性颅内出血患儿的临床资料,分析手术治疗时机的选择,对比非手术治疗评价其临床治疗结果。结果316例患儿中符合外科手术指征的共167例,其中接受手术治疗的101例,平均住院时间(16±1.9)d,治愈75例,好转26例,治愈率74.3%;有手术指证但拒绝手术治疗的66例,平均住院时间为(28±1.8)d,放弃治疗10例,治愈5例,好转51例,治愈率8.93%。结论积极的手术治疗,能够明显提高晚发性维生素K缺乏性颅内出血患儿的抢救成功率,早期手术治疗较非手术治疗的患儿住院时间更少,治愈率更高。