王左论脉症从舍及其临床治验

从标本缓急和虚实真假两方面系统总结王左教授对脉症从舍的认识，并附舍脉从症案及舍症从脉案以具体分析。     

王庆国巧用麻黄附子细辛汤治疗过敏性鼻炎经验

王庆国教授认为过敏性鼻炎其本在脾肾不足,而标在肺寒,当属本虚标实之证,治宜内外同治,表里兼顾。麻黄附子细辛汤温少阴之经而发太阳之表,温阳中兼发散,解表中兼补虚,共同发挥扶正祛邪,温经解表的作用,适用于阳虚内寒而兼外感寒邪之证,正合肺寒之机,故临证配伍不同基础方药治疗过敏性鼻炎疗效显著。     

王忠民辨治甲状腺功能减退症合并慢性盆腔炎经验

甲状腺功能减退症(简称"甲减")有明显的肾虚证候,而且多有胎儿期发病者,与肾虚关系极为密切。甲减常元气亏损,精血不足,神疲乏力、畏寒怯冷等,虚寒之象尤其明显,记忆力减退、毛发枯萎、性欲冷淡等,肾阳虚衰表现突出。肾为先天之本,阳气充足需要阴精支持,故在治疗时不可只顾补阳不滋其阴。再者,合并慢性盆腔炎(chronic pelvic inflammatory disease,CPID)后,日久不愈也会伤阴,因此,尽管阳虚为主,也要注意阴中求阳,不可过补阳气而伤及阴。此外,脾主运化与气血化生,属于后天之本,对提高抗病能力尤其重要。脾气虚弱,摄食量少或不当,后天营养不足,则气血易虚,肾阳虚衰,令脾阳不振,而脾气虚弱又会加重肾虚。脾主肌肉四肢,而甲减患者肌无力者占患者多数,并伴有感觉障碍,诸如手足麻木、肌肉痛、僵硬或痉挛等尤其常见,同时,约有32%~82%患者合并贫血。这种状况的出现,使甲减合并CPID的患者更会缠绵不愈,出现气血失调、月经紊乱、盆腔积液等症状。之外,甲减患者常有心动过缓,脉沉迟等证,属于心阳不振,符合"肾命不能蒸运,心阳鼓动无能"之势,临床常见,病程较久之甲减,常在肾阳衰微之后发生心阳不振,进而加重其寒象。因此,在治疗时需要注意这一变局。甲减阳虚为重,CPID以湿邪为著,两者合并常病程拖延。久治不愈则湿浊化痰,可出现黏液性水肿,腹部囊性包块,此"乃五脏瘀血、浊气、痰滞而成",因而治疗时要充分考虑这一病机。总之,治疗甲减合并CPID须注重在温补肾阳、助长肾气之时顾及滋补肾阴,在振奋脾阳中气、运化水湿之时考虑化瘀消浊。     

Association Between Serum Albumin Level and All-Cause Mortality in Patients With Chronic Kidney Disease: A Retrospective Cohort Study

BackgroundThe association between serum albumin and all-cause mortality (ACM) in patients with chronic kidney disease (CKD) is presently unclear.MethodsThe study subjects included 201 patients diagnosed with CKD, eliminating those with end-stage renal disease, who were admitted to our hospital from January 2014 to January 2015. The patients were divided into 4 groups according to serum albumin level (Q1: 1.60–3.88 g/dL; Q2: 3.89–4.13 g/dL; Q3: 4.14–4.43 g/dL, and Q4: 4.44–5.51 g/dL). The clinical outcome was ACM, and the difference was compared using odds ratio (OR) and 95% confidence interval (CI).ResultsAfter a median follow-up of 1480 days, 32 patients died (15.92%). The ACM was found to be 28.00%, 20.00%, 8.00%, and 7.84% in the 4 groups (P = 0.012). Pearson correlation analysis revealed a positive association between the serum albumin level and glomerular filtration rate (GFR) (r = 0.22, P = 0.001). Once the potential confounding factors were adjusted, the results indicated that decreased serum albumin was a risk factor for ACM (Q2 vs Q1: OR = 0.50, 95% CI: 0.17–1.47; Q3 vs Q1: OR = 0.12, 95% CI: 0.03–0.48; Q4 vs Q1: OR = 0.26, 95% CI: 0.07–0.98). The receiver operating characteristic curve indicated that the optimum threshold of serum albumin to predict ACM was 4 g/dL, and the area under the curve was 0.69 (95% CI: 0.60–0.79).ConclusionsDecreased serum albumin is a risk factor for ACM in patients with CKD, with the optimal threshold being 4 g/dL.     

王少华苦辛通降法治疗脾胃病经验

脾与胃同属中焦,互为表里,并以纳与化、升与降、燥与湿三种相反相成的特性,维持其生理功能。任何一方出现偏颇,都会影响对方。当脾或胃出现病变时,应根据其特性加以调整。苦辛通降法是运用苦寒和辛温两种不同性味的药物配伍治疗疾病的一种特殊方法,适用于脾胃病之太阴、阳明同病的证候,有寄开于泄,寓通于降,相反相成,互制互济的效果。临床上脾胃病中出现寒热错杂、升降失调时当以苦辛通降法治之。王少华取法张仲景治疗痞证之苦辛通降法,将其从治疗少阳误下痞证,发展为治疗脾胃病之太阴、阳明同病的证候,广泛用于临床上反流性食管炎、慢性胃炎、肠炎、胃神经官能症及溃疡性结肠炎等脾胃病,取得了良好的疗效。     

王会仍教授自拟“王氏止咳方”治疗慢性咳嗽的临床疗效观察

目的:观察"王氏止咳方"治疗慢性咳嗽的临床效果。方法:在呼吸内科门诊选择124例诊断为慢性咳嗽的患者,随机分为对照组和观察组,每组62例。对照组用西药常规治疗,观察组口服"王氏止咳方"加减治疗,观察两组的临床疗效。结果:经治疗后对照组总有效率为70.97%,观察组总有效率为91.94%,观察组总有效率明显优于对照组(P0.05)。结论:"王氏止咳方"加减治疗慢性咳嗽疗效明显,且无不良反应,值得临床推广应用。     

数据挖掘分析王晖治疗肺癌用药规律

<正>王晖主任中医师是第三批全国老中医药专家学术经验继承工作指导老师,享受国务院特殊津贴,拥有宁波市首个国家中医药管理局全国名老中医专家传承工作室,临床经验丰富,对肺癌的治疗有独到见解。笔者通过收集、整理王老师治疗的肺癌病例,采用数据挖掘的方法,分析处方中药物的使用频次、关联规则,摸索处方规律及用药经验,提炼经验为临床诊治打下前期基础。1资料与方法1.1研究对象及诊断标准按原发性支气管肺癌诊     

罂粟科植物罂粟、延胡索和岩黄连镇痛作用的研究进展

疼痛是人类的第五大生命体征,既是机体的一种自我保护,同时也是机体对伤害性刺激的预警。尽管阿片类药物具有显著的不良反应及成瘾性,但目前该类药物仍是治疗严重急慢性疼痛的主要治疗药物。本文整理了具有镇痛功效的罂粟科植物罂粟、延胡索和岩黄连,从古籍记载、主要活性成分、药理作用和临床研究几个方面对其进行综述,以期更科学地发掘具有镇痛强,成瘾性低,毒副作用小的药物。     

王居祥治疗胃癌经验

王居祥教授认为,胃癌的病机关键在于阳虚气结,其发病以脾胃虚寒为本,气机郁结为标,痰湿瘀血为病理产物,亦为促进病情发展的病理因素。治疗应扶正兼顾祛邪,扶正重在温补脾胃,益气养血,祛邪重视疏肝理气和胃,结合化痰软坚、清热解毒、活血化瘀等治法,扶正不留邪,祛邪不伤正。坚持中西医综合治疗结合个体化治疗的原则,强调长期调治。