厚朴排气合剂治疗腹部非胃肠吻合术后早期肠麻痹（气滞证）临床研究

目的观察厚朴排气合剂治疗腹部非胃肠吻合术后早期肠麻痹（气滞证）的临床疗效。方法采用随机对照的原则，将116例本病患者分为治疗组87例，对照组29例，治疗组口服厚朴排气合剂治疗，对照组口服西沙比利片治疗，24h后观察疗效。结果临床综合疗效总有效率治疗组为93．1％，对照组为86．2％，中医症状积分治疗前后差值治疗组为（21．94±7．08），对照组为（19．41±8．76），肛门排气症状改善治疗组平均起效时间为（13．49±4．71）h，对照组为（15．58±5．30）h，2组上述各指标比较，差异均无统计学意义（P〉0．05）。提示厚朴排气合剂对腹部非胃肠吻合术后早期肠麻痹（气滞证）有积极疗效，与西沙比利疗效相近。结论厚朴排气合剂有促进肛门排气，消除腹部胀满，减轻疼痛，以达到改善腹部非胃肠吻合术后早期肠麻痹的作用。     

齐秉慧辨治吐血经验探要

清代名医齐秉慧诊治吐血经验独特,主要表现在6个方面:①脾虚血停膈中为内因,治当辨寒热虚实;②吐血多兼咳喘,异病同治;③以脉辨病种、病位,脉症合参断生死:④法主甘药理脾健胃,善潜龙雷之火;⑤逆向思维、总结失治、误治经验;⑥博采众长,活法中病。     

Weakness after gastric bypass

Two patients underwent gastric bypasses and had uneventful hospital courses. In the early postoperative periods, both developed severe, protracted vomiting, weakness, and hyporeflexia. After thorough laboratory and clinical evaluations by neurologists, the patients were diagnosed with Guillain-Barré syndrome, although there were many atypical features. The clinical presentations of these patients are very similar to case reports of nutritional polyneuropathy associated with gastric partitioning. This paper addresses the difficulties of differentiating these two diagnoses.     

从嗓音疾病调查结果看"歌唱伤气"理论

目的:为探讨“歌唱伤气”理论的正确性。方法:采用整群随机抽样方法,对比调查了502名歌唱学生和200名非歌唱学生嗓音疾病、气虚证和气滞证、肺活量、声时及歌唱学生发病诱因等情况。结果:歌唱学生气虚和气滞证发生率明显高于非歌唱学生(P<0.01),且歌唱学生嗓音疾病患者气虚和气滞证、肺活量值、声时值均与歌唱学生无嗓音疾病者及非歌唱学生嗓音疾病患者有非常显著差异(P<0.01)。歌唱学生气虚和气滞证人数比例随练声时间增加而增多,超过60分钟以上者高于60分钟以下者,高音歌唱者高于中音及低音歌唱者,惯用硬起音者高于不惯用者,胸腹式联合呼吸者低于单纯胸式或腹式呼吸者(P<0.01)。结论:“歌唱”引起的“伤气”是嗓音疾病产生的主要原因,“歌唱伤气”理论具有正确性和科学性。     

中西医结合治疗糖尿病肾病临床观察

[目的]探讨益气活血中药糖肾冲剂(主要由黄芪、川芎、三七、葛根等中药组成)配合血管紧张素Ⅱ受体拮抗剂(厄贝沙坦)治疗糖尿病肾病(DN)的临床疗效。[方法]将80例DN患者随机分为糖肾冲剂加厄贝沙坦治疗组(简称治疗组)40例及厄贝沙坦对照组(简称时照组)40例,进行临床疗效观察,疗程8周。[结果]①两组血清肌酐(SCr)、尿素氮(BUN)均明显改善,尿白蛋白排泄率(UAER)均下降(P<0.01或P<0.05),且治疗组优于对照组(P<0.05);②治疗组尿β2微球蛋白(β2-M)及尿N-乙酰β-D氨基葡萄糖苷酶(NAG)均显著下降(P<0.01或P<0.05),而对照组则无明显变化。[结论]糖肾冲剂及血管紧张素Ⅱ受体拮抗剂联合应用治疗DN能明显提高临床疗效。     

益气活血法对老年糖尿病患者左心室收缩功能影响的研究

目的：前瞻性研究益气活血法对100例老年糖尿病患者左心室收缩功能的影响。方法：对糖尿病患者辨证分型为阴虚热盛型23例，气阴两虚型39例，阴阳两虚型14例，血瘀气滞型24例，均在原用药的基础上加用灯盏细辛注射液和牛脉注射液分别静脉滴注，疗程2周。同时以二维彩色多普勒超声心动图于治疗前后分别测定每搏心输出量（SV）、每分钟心输出量（CO）、射血分数（EF）。结果：组间比较发现益气活血法增加SV的顺序为：阴阳两虚型〉血瘀气滞型〉气阴两虚型〉阴虚热盛型；增加CO的顺序为：阴阳两虚型〉气阴两虚型〉血瘀气滞型〉阴虚热盛型；增加EF的顺序为：阴阳两虚型〉气阴两虚型〉血瘀气滞型〉阴虚热盛型。但气阴两虚型与血瘀气滞型之间CO、EF的差异均没有统计学意义。结论：临床针对老年糖尿病患者的左心收缩功能异常，无论辨证属于气阴两虚型、血瘀气滞型还是阴阳两虚型，都可因益气活血法治疗而获益；但辨证属阴虚热盛型者不提倡用益气活血法。     

Peripheral Polyneuropathy from Thiamine Deficiency following Laparoscopic Roux-en-Y Gastric Bypass

The neurologic form of beriberi has been described in multiple case reports following bariatric surgery for morbid obesity. Thiamine deficiency occurs due to marked emesis and/or altered absorption secondary to the reconfiguration of the gastrointestinal tract to achieve the malabsorption needed to achieve weight loss. This case report illustrates the typical presentation of a patient after gastric bypass, and highlights the symptoms that bariatric surgeons must detect and reviews the treatment.     

Fatigue,Weakness, and Sexual Dysfunction after Bariatic Surgery – Not an Unusual Case but an Unusual Cause

Background: Malabsorptive bariatic surgery for morbid obesity has been very effective in producing weight loss. However, patients may experience some degree of malnutrition, which may lead to various clinical symptoms, such as fatigue and weakness. Morbid obesity is often associated with impaired reproductive function, and weight loss generally improves sexual function in both sexes. However, women with extreme weight loss may experience secondary amenorrhea. In men, zinc deficiency may lead to impaired testosterone synthesis resulting in hypogonadism and impotency. Case Report: A 43-year-old male 5 years after jejunoileal bypass for morbid obesity performed in a foreign institution presented with a recent history of progressive fatigue, general weakness, and declining libido and potency. Unexpectedly, his symptoms were not related to the operation or to his weight loss but rather to a structural cause. Endocrine and radiologic evaluations revealed a cystic tumor in the sella turcica causing partial hypopituitarism and secondary hypogonadism. Conclusion: Long-term follow-up is mandatory in patients after bariatic surgery. Non-specific symptoms and findings should be further investigated. A loss of sexual activity and performance may have causes other than the previous bariatic operation.     

《理虚元鉴》中虚证治疗特色浅析

该书在虚证的病因认识、预防、治疗及预后方面都无不强调情志因素的重要性,同时提出了清金保肺原则。总结出虚证三大治疗总则,即清金保肺,无犯中州之土;培土调中,不损至高之气;金行清化,则水自流长,合金水于一致。     

益气活血法对老年糖尿病患者左心室舒张功能影响的研究

目的：研究益气活血法对100例老年糖尿病患者左室舒张功能的影响。方法：辨证分为4型：阴虚热盛型（YAEH）23例，气阴两虚型（DBQY）39例，阴阳两虚型（DBYY）14例，血瘀气滞型（QSBS）24例。用灯盏细辛注射液、生脉注射液分别静脉滴注，疗程2周。以彩色多普勒超声心动图于治疗前后分别测定左室舒张早期充盈峰值流速（VE）、左室舒张晚期充盈峰值流速（VA）、左室舒张早期充盈时间（ET），并计算VE／VA值。结果：益气活血法改善VE的顺序为DBYY〉DBQY〉QSBS〉YAEH；降低VA为DBQY〉DBYY〉YAEH，QSBS略有增加；增加VE／VA比值为DBYY〉DBQY，对YAEH影响较小，QSBS反降低；缩短ET为QSBS〉DBYY〉DBQY〉YAEH。但DBQY、DBYY、QSBS三者间ET差异没有意义。结论：老年糖尿病左心室舒张功能异常无论辨证属DBQY、DBYY还是QSBS，都可用益气活血法治疗而获益；但属YAEH者不提倡用益气活血法。