“证体合辨”论治法治疗干燥综合征的理论思考

干燥综合征(Sj?gren’s Syndrome,SS)患者临床表现复杂多样,辨证论治法是治疗SS的重要治法,但辨证论治法存在"无证可辨"、侧重辨"病"而对"人"不够关注等不足。鉴于辨证论治法不能全面地把握SS患者的病变本质,为更好地治疗SS患者,提出"证体合辨"论治法治疗SS这一思路,并分析了"证体合辨"论治法治疗SS的必要性、可行性以及提出了实施"证体合辨"论治法的具体做法。     

PRO应用于中医临床疗效评价的哲学思考

PRO即patient reportoutcome直译为＂患者报告的临床结局＂,是一种直接来自于患者对于其健康状况的各个方面的反映,其中没有医生或其他任何人对于病人反应的解释。中医认为人和自然环境是一个整体,非常重视患者的主观感受,而PRO以患者为中心,主张判断一种疗法是否有效,而不是单纯的生物学指标或影像学改变,与传统中医有着极大的思想相关性。在中医理论的指导下,借用PRO量表的理念,可以为建立适合中医特色的疗效评价体系拓展新的思路。     

Prolapsed tongue papilloma cured by administration of the traditional Japanese (Kampo) herbal medicine,Keishibukuryogan-ka-yokuinin: A case report

Squamous papilloma is a benign mass lesion of the oral mucosa. For papillomas of the tongue, surgery is recommended owing to their malignant potential; however, certain complications may be associated with surgery. A traditional Japanese (Kampo) herbal medicine, Keishibukuryogan-ka-yokuinin (KBGY), has been used to treat viral warts and various skin diseases in Japan. Therefore, the effect of KBGY on papillomas is promising. A 49-year-old Japanese man presented with a wart on his tongue that was about 3 months old. He smoked 5 cigarettes per day. He did not drink alcohol. He had no history of malignant illnesses. He was taking alprazolam for panic disorder. The patient was diagnosed with a suspected papilloma of the tongue at the Department of Otolaryngology and was advised to undergo an excision biopsy to exclude malignancy. However, he refused owing to the fear of an invasive procedure. After informed consent was obtained from the patient, KBGY was prescribed. Three months later, the wart on his tongue spontaneously prolapsed. The histopathological diagnosis was squamous papilloma. There was no indication of malignancy, and the patient discontinued Kampo treatment. He has had no recurrence in the past 3 years. KBGY is a combination of Keishibukuryogan and yokuinin (adlay seeds). Keishibukuryogan may be beneficial for skin or oral mucosal remodeling, and yokuinin may have antiviral properties. The present case report suggests the use of KBGY as an appropriate complementary therapy for squamous papilloma.     

Cephalea,Lumbago und Tinnitus als psychosomatische Manifestation

Background

For three years, a 40 year-old male patient had been suffering from headache after having lost his job. His permanent pain could not be influenced by analgetic drugs. Additionally, he suffered from lower back pain and tinnitus (ringing in both ears). All these problems affected his general condition in a way that he didn't feel capable of looking for a new job.

Objectives

Improvement of pain and reduction of tinnitus, to enable the patient to find a new employment.

Methods

YNSA, ear and body acupuncture

Results

After ten treatments, there was no significant improvement of the headache and the lower back pain. There was also no change in general condition and regarding the tinnitus. The patient quit acupuncture after the tenth session, as he felt he could not relax in the busy surroundings of the outpatient service of the hospital. Within the following weeks the patient felt better little by little without any further treatment. Finally, the ringing in the ears only reoccurred in stressful situations. He found a new job and needed no consultations for 4 years until after an argument with his son, the headache reappeared.

Conclusion

For a positive reaction to manifest, chronic disease sometimes needs more than 10 treatments with acupuncture. Still, it may be justified to stop therapy, especially if the patient doesn't feel comfortable with it and longs for the end of the treatment series. A sudden improvement may as well happen within the weeks following the termination of therapy. There can be a delayed reaction causing the desired effect to manifest in a period of “no treatment”.     

Patientin mit Augenlidschwellung aus ungeklärter Ursache

A female patient with unclear swelling of the right lower eyelid was referred to the acupuncture outpatient service of a Viennese hospital. Diagnostic MRI showed signs of a sinusitis maxillaris on the same side as the edema, but it remained unclear if the sinusitis was the cause of the swelling. The patient showed no symptoms of sinusitis or allergy. WHO only advises acupuncture treatment to be administered to patients with a clear diagnosis. The application of the diagnostic criteria of TCM, however, may in certain cases allow for a successful treatment even if a diagnosis according to western medicine could not be previously established.     

Successful treatment of a hyperprolactinemic infertile woman with a pituitary microadenoma using hachimijiogan.

A hyperprolactinemic infertile woman with a pituitary microadenoma, who was resistant to bromocriptine as a method of bringing on pregnancy, succeeded in having a normal pregnancy and delivery with Hachimi-jio-gan treatment. This paper reports that the patient did not succeed in pregnancy in spite of 16 months of bromocriptine treatment, though her prolactin level gradually decreased and continued to be between 40-60 ng/ml with Hachimi-jio-gan treatment. Although the level of prolactin of the patient did not normalize, she, nevertheless, succeeded in having a normal pregnancy and delivery.     

血液净化中心常见的护理风险及干预对策

目的：研究并分析血液净化中心常见的护理风险与干预对策。方法：我院2009年12月1日～2012年12月1日期间共收治血液净化患者820例,将其作为主要研究对象并进行随机分组,对照组的410例患者遵循常规的血液净化程序、未进行护理风险分析与干预;观察组的410例患者在分析血液净化中心常见护理风险的基础上进行了积极干预,对比上述两组患者护理风险发生率。结果：观察组患者的护理风险发生率10.24%,对照组患者的护理风险发生率2.68%,二者之间的差异具有显著性,即P<0.05。结论：对于血液中心而言,护理人员方面、科室管理方法和患者方面均会导致护理风险事件的发生,对患者的血液进化过程进行积极的护理干预有助于降低血液净化中心的护理风险发生率,值得推广。     

Acupuncture For Severe Chronic Perineal Pain

Medical Acupuncture,2 0 0 4 ,1 5 ( 1 )A 4 2 - year- old m an(1.8m,80 kg) ,a postal em ployee,presented to our TCM-Centre,Elisabeth Hospital,Recklinghausen,Germ any,with severe chronic per-ineal pain and hyperhidrosis,especially head,forehead,hand plains,a…     

心理测验与神经衰弱辨证分型关系的探讨

对345例神经衰弱患者应用SCL－90症状自评量表和信虑自评量表（SAS）、抑郁自评量表（SDS）进行心理评定，探索3量表测定值与中医辨证分型的关系。结合临床症征，以上述3个量表的测验值中，焦虑评分高于抑郁评分者作为实证。结合临床症征，抑郁评分高于焦虑评分者作为虚证。无明显虚实症征者作为轻证。结果:（1）实证127例，虚证124例，轻证94例。除轻证SCL－90的人际关系、抑郁、偏执3项外，与常模差异均有非常显著性（P＜0.01）。（2）虚、实、轻证的评分结果与假说相符，有统计学差异（P＜0.01）。提示用3量表对神经衰弱的中医辨证进行相关对照及量化评定有一定的可行性。结合病史、症征，认为将实证定为风痰阻络、虚证定为气阴两虚较为合适。轻证临床虚实表现不典型，故另立一型，以待研究。     

慢性乙型肝炎HBeAg阴性患者乙肝病毒变异与中医辨证分型的关系

目的：探讨慢性乙型肝炎HBeAg阴性患者乙型肝炎病毒（HBV）变异状况与中医辨证分型的关系.方法：将84例慢性乙型病毒性肝炎HBeAg阴性患者按中医辨证分为5种证型,采用迈科锐HBV突变检测基因芯片,进行乙型肝炎病毒C基因启动子（BCP）和前C基因终止变异检测.结果：与HBeAg阳性组患者相比,HBeAg阴性患者HBV变异的发生与中医各证型无明显相关性;分为偏实证组和偏虚证组后,BCP区和/或前C区变异率偏实证组为34.5%,偏虚证组为65.5%,偏虚证组明显高于偏实证组.结论：BCP区和/或前C区变异与中医辨证分型存在相关性,实证变异率低于虚证.     

对《金匮要略》“脏躁”病名及相关问题的认识

脏躁属中医情志病的范畴,易发于女子,其病位主要在心肺,其基本病机为脏阴不足,神无所舍,魄无所归,以无故喜悲伤欲哭,数欠伸为辨证要点,至于条文中的“象如神灵所作”,只是强调了脏躁患者悲伤欲哭的无因性,并非指其证候的变化。因此,脏躁可定义为“因脏阴不足．心肺失养而致的以无故喜悲伤欲哭、数欠伸为主证的疾病”。     

艾灸治疗颞下颌关系紊乱综合征咀嚼肌群功能紊乱65例疗效观察

目的：对比艾条回旋灸及常规电针两种不同方法治疗颞下颌关节紊乱综合征。方法：用艾条回旋灸对咀嚼肌群功能紊乱以疼痛、张口受限为主要表现的3型疾病65例进行治疗,并和常规电针组55例对比。结果：两组治愈率、愈显率及治愈者所需疗次差异均无显著意义。结论：艾条回旋灸治疗本病可与常规电针治疗取得相同疗效。     

腧穴热敏化艾灸对慢性腹泻脾肾亏虚证患者胃泌素及胃动素的影响

目的观察腧穴热敏化艾灸治疗慢性腹泻临床疗效及其对血清胃泌素(gastrin,GAS)、血浆胃动素(motilin,MTL)水平的影响。方法选择中医辨证为脾肾亏虚型慢性腹泻患者60例,随机分为腧穴热敏化艾灸治疗组(治疗组,腧穴热敏化艾灸,每天1次)及肠泰合剂治疗组(对照组,口服肠泰口服液,每次10mL,每天3次),两组均治疗4周。另选取20名体检健康者作为健康对照组(健康组)。采用放射免疫法测定各组治疗前后血清GAS及血浆MTL水平。治疗结束后观察两组临床痊愈、显效、有效、无效例数及总有效率。结果治疗前两个患者组血清GAS水平均低于健康组,血浆MTL水平均高于健康组,差异均有统计学意义(P<0.05),患者组症状积分与健康组比较,差异无统计学意义(P>0.05)。治疗后两个患者组血清GAS水平升高,血浆MTL水平及症状积分降低,与本组治疗前比较,差异有统计学意义(P<0.05,P<0.01),治疗组治疗后症状积分低于对照组,差异有统计学意义(P<0.05),两组GAS及MTL水平比较,差异无统计学意义(P>0.05)。治疗组临床症状总有效率(93.3%)高于对照组(73.3%),差异有统计学意义(P<0.05)。结论腧穴热敏化艾灸治疗脾肾亏虚型慢性腹泻患者疗效较好,能调节患者血清GAS和血浆MTL水平,改善患者临床症状。     

影响偏瘫患者肢体功能恢复的相关因素分析

目的:寻找影响偏瘫肢体功能康复的主要因素。方法:312例脑卒中偏瘫患者接受综合康复治疗,选择10个可能对偏瘫肢体功能恢复有影响的因素,对48例治疗后肢体功能未改善的病例进行回顾性分析研究。结果:偏瘫肢体功能恢复与性别、病变部位无关,与年龄、病程、中风类型、言语障碍、心理障碍、合并疾病有关(P<0·05),与病灶特点、认知障碍关系最大(P<0·01)。结论:在制定治疗方案和判定预后时,应考虑这些方面的影响。     

经“类经络”现象1例报道

发现“类经络”现象l例。该患者在针刺三阴交穴后,双下肢出现沿肾经循行止于内侧胭窝横纹处的皮肤凹陷现象。双下肢对称,形态、粗细一致,该线条所经处皮肤凹陷,颜色与周围皮色相同,局部无酸、麻、痒、痛等异常感觉。留照片加以记录。     

参松养心胶囊治疗冠心病心律失常的临床效果研究

目的：研究参松养心胶囊治疗冠心病心律失常的临床效果。方法：以2012年1月～2012年12月我院治疗的冠心病心律失常患者共82例为研究对象,随机分为治疗组和对照组。对照组加用倍他乐克和胺碘酮治疗,治疗组在对照组的基础上,加用参松养心胶囊治疗。观察两组患者的疗效及不良反应。结果：治疗组对冠心病心律失常的治疗效果明显,显效23人,有效13人,总有效率为95.1%,高于对照组（78.0%）,差异有统计学意义。治疗组有1例患者出现腹胀症状,1例患者出现恶心症状,未影响继续服药治疗,无其它不良反应。结论：参松养心胶囊治疗冠心病心律失常的临床效果明显。     

月经病寒凝血瘀证与ET、NO的关系及加减温经汤对其影响

目的:探讨月经病寒凝血瘀证与血浆及经血内皮素(ET)和一氧化氮(NO)的关系及加减温经汤对其影响。方法:应用放射免疫分析法测定30例月经病寒凝血瘀证患者运用加减温经汤治疗后外周血浆及经血中ET、NO、雌二醇(E2)和孕酮(P)的变化,并设30例正常妇女对照组。结果:(1)患者组与正常组血浆相比,ET、NO、P含量变化不明显(P>0.05);血浆E2明显降低(P<0.05)。患者组治疗后血浆ET、NO、P与治疗前无明显差异(P>0.05);治疗后血浆E2明显升高(P<0.05)。(2)与正常组经血相比,患者组经血ET升高、NO降低、E2明显降低(P<0.05),经血P变化不明显(P>0.05)。治疗后较治疗前经血ET降低、NO增高、E2增高(P<0.05),治疗后经血P与治疗前无明显差异(P>0.05)。(3)患者组经血ET与E2呈负相关关系(r=-0.54,P<0.05),NO与E2呈正相关关系(r=0.61,P<0.05)。结论:月经病寒凝血瘀证的发生与血管舒缩因子ET、NO表达失衡有密切关系。     

疼痛患者对针灸信任度与针灸疗效关系的观察

目的初步了解针灸治疗疼痛的疗效是否受病人对针灸的信任度影响.方法共观察15例疼痛患者.以直观模拟标尺法让患者自我评价自己对针灸疗效的信任度(信任度VAS)以及疼痛程度(疼痛度VAS).记录针灸治疗前后患者的疼痛度VAS分数作为疗效评价的指标.结果治疗后疼痛度VAS平均降低(3.3±2.8)分(P＜0.05).患者的信任度VAS与其针灸治疗前后疼痛度VAS的变化率之间无明显的相关性(R=0.462,P=0.083).结论初步结果表明,疼痛患者对针灸的信任度与临床疗效之间无明显相关.     

临床气管切开术的应用与并发症的研究

气管切开术是比较常见挽救患者生命的手段,但并非绝对安全,他可以出现各个阶段的并发症。从本文中的病例临床结果可见,气管切开术手术中、术后及晚期并发症并非少见,严重的患者可因其并发症而丧失生命,气管切开术虽能挽救患者生命,但操作不慎即可导致严重后果。故应早期诊断其病变的性质、程度以及有效治疗,在施行气管切开术时均应做好各种不同段并发症的预防,并及时正确处理,是预防气管切开术并发症的重要措施。     

肝硬化合并胆囊结石行腹腔镜胆囊切除术的临床分析

目的：探讨肝硬化合并胆囊结石患者进行腹腔镜胆囊切除术（Laparoscopic cholecystectomy,LC）的临床应用价值。方法：对26例肝硬化合并胆囊结石患者行LC的临床资料进行了回顾性分析。结果：25例成功完成了LC,1例中转开腹,1例术后出血,无肝功能衰竭、胆道损伤等并发症发生,无死亡病例。结论：严格掌握手术适应证,充分掌握肝硬化合并胆囊结石的解剖特点,LC是一种安全可行的微创手术。