Perceptions and Controversies on Cholera in the Traditional Chinese Medicine Field in the Late Qing Dynasty

At the beginning of the initial cholera outbreak in China,Wang Qingren(王清任),after years of clinical trials,became an early representative who discovered the infectious characteristics and observed the course of cholera in the field of traditional Chinesse medicine(TCM).Kou Langao(寇兰皋)and Xu Zimo(徐子默),both medical practitioners,constructed a diagnosis and treatment system for cholera with cold patterns under the theory of typhoid.They represented“School of Cholera with Cold Patterns”(SCCP).In the 1860s,with the influence of Wang Shixiong’s(王士雄)studies on the nature of cholera under the theory of epidemic febrile disease,the“School of Cholera with Heated Patterns”(SCHP)prevailed thereafter.The two schools complemented each other in theories and contributed to the integrity of TCM in cholera diagnosis and treatment.By reviewing previous literature,books,clinical cases,and historical materials in medical field,this article aims 1)to summarise the influence of TCM on the cognitive development towards cholera in the late Qing dynasty;2)to explore the origin of the controversy between SCCP and SCHP from historical evidence;3)to summarize the historical lessons from the debate over cholera in TCM based on the principle of treatment based on pattern identification,and offer suggestions for the current prevention and treatment of new diseases using TCM.

The Eastern Cultural Signature of Traditional Chinese Medicine: Empirical Evidence and Theoretical Perspectives

Background: Holistic thinking, which is rooted in Eastern culture, is assumed to be the core of traditional Chinese medicine (TCM). Recently, such holistic thinking has been proposed to be applicable to Western medicine practices for alleviating serious side effects;however, the obscure and often ill-defined terms of TCM, such as qi, yin yang, and wuxing, pose considerable obstacles for further understanding TCM. In the present study, we explored whether and how TCM is actually related to the scientific construct of holistic thinking, to elucidate the particular cultural signature of TCM. Methods: A random sample of 101 college students majoring in TCM and 93 non-medical college students was recruited for the study. Two psychological scales—the Chinese Holistic Thinking Scale and the TCM Competence Scale were used respectively to measure the holistic thinking and participants’ ability to apply the TCM in practice. Results: We found that individuals who thought more holistically were better at applying TCM to modern medical problems. Interestingly, TCM was associated with holistic thinking in both TCM and non-medical students, suggesting that this association is intrinsic. Further exploration revealed that the association and variability facets of Eastern holistic thinking—which emphasize that the world is interconnected and ever-changing, respectively—significantly accounted for the individual differences in competence in utilizing TCM in practice. Conclusion: In short, our study provides the first empirical evidence linking TCM to the Eastern holistic thinking style, which not only deepens the understanding of TCM from a scientific perspective but also promotes dialogue between TCM and Western medicine for building safer and more effective health care systems.

The differences and similarities between regional ethnic medicine and traditional Chinese medicine in the prevention and treatment of cancer pain

REM and TCM are both important parts of traditional medicine in China,and they have their own characteristics in the understanding and prevention of diseases.This article compares the understanding,the theoretical prevention and treatment guidance and the clinical application of the REM and TCM on the cancer pain.

A real-world study of the differences in Traditional Chinese Medicine diagnosis and treatment rules for coronavirus disease 2019 between Northern and Southern China

OBJECTIVE:To explore the differences in Traditional Chinese Medicine(TCM)diagnosis and treatment rules for coronavirus disease 2019(COVID-19)between Northern and Southern China based on the real-world data from 982 COVID-19 patients.METHODS:All consecutive cases of COVID-19 admitted to the TCM department of designated COVID-19 hospitals in eight provinces and cities were retrospectively analyzed.Patients were divided into a Northern and a Southern group according to the location of the admitting hospital.The symptoms,syndrome elements,syndrome distribution and herbal treatments were analyzed.The core prescriptions were extracted using the multiscale backbone-based network comparison algorithm(msbNC).RESULTS:The distribution of syndrome elements showed that dampness was common in Northern and Southern China,wind and heat were more often present in the South,while fire toxin and spleen deficiency were more often encountered in the North.The distribution of syndromes showed that the South was dominated by heat dampness accumulating in the lung(55.69%),while the North was dominated by dampness-toxin stagnating in the lung(44.90%).The results of core prescription mining showed that dispelling dampness,dispersing wind,clearing heat and strengthening spleen were the common treatment methods in Northern and Southern China.For mild cases,Jinyinhua(Flos Lonicerae)and Lianqiao(Fructus Forsythiae Suspensae)were often used in the South to clear heat and relieve exterior symptoms,while Chaihu(Radix Bupleuri Chinensis)and Huangqin(Radix Scutellariae Baicalensis)were often used in the North to relieve muscles by expelling heat.For moderate cases,Chaihu(Radix Bupleuri Chinensis),Qinghao(Herba Artemisiae Annuae),and Shigao(Gypsum Fibrosum)were often used to clear heat of Tri-jiao Channel and stomach in the South,while Fuling(Poria),Chenpi(Pericarpium Citri Reticulatae),and Dangshen(Radix Codonopsis)were often used to invigorate spleen and remove dampness in the North.For severe cases,spleen invigoration and dampness removal as well as relaxing the bowels and discharging heat were often used in the North.CONCLUSION:There were certain North-South differences in terms of symptoms,syndrome elements and syndrome distribution of COVID-19,as well as differences in core prescriptions during different periods of the disease.The regional differences in the rules of TCM diagnosis and treatment for COVID-19 should be further considered in the process of optimization and revision of relevant treatment guidance.

基于双重差分法的DRG付费对中医医院的影响研究

目的:评估按疾病诊断相关分组(DRG)付费对中医医院住院患者例均总费用、费用结构、住院时长、出院人数及中医特色的影响。方法:以某中医类国家区域医疗中心为研究对象,使用双重差分回归模型(DID)分析付费改革政策实施前后医保患者(干预组)与非医保患者(对照组)的各项指标差异,通过平行趋势检验和安慰剂检验证实模型可靠性和稳定性。结果:例均住院总费用、病例数、住院天数、医疗服务收入占比、饮片收入占比等十一项指标的DID交互项系数显著(P<0.05),费用指标回归系数均小于0。饮片使用率、中医非药物疗法收入占比等四项指标DID交互项系数不显著(P>0.05)。结论:DRG付费政策显著降低付费病组例均总费用,其中耗材、医技费用下降显著,费用结构优化,中药饮片费用占比略微下降。应持续关注DRG付费对中医医院影响,进一步扩大样本范围,跟踪分析政策影响,全面评价DRG付费政策对我国中医医疗机构的影响。

浙派中医治疗痛经经验整理

[目的]总结1911年前浙派中医治疗痛经的经验,探究其特色。[方法]对浙派中医古籍文献中有关痛经的论述、病案等进行摘录整理,总结痛经病机及治疗特色。[结果]浙派中医治疗痛经以“气血失调”为主要病机,提倡以寒热虚实为纲的气血辨证法,从月经有无先后失期、经血色量如何、痛在经行前后三方面进行辨证。文献所记载的痛经证型共8种,分别为血气虚证、血虚有滞证、血虚有寒证、血虚有热证、冲任不足证、肝气郁滞证、气滞血瘀证、寒凝血瘀证,以“温通清化、调和血气”为治则。浙派中医发扬命门学说,擅用温药,记载痛经要药10味,分别为凌霄花、白芍、马鞭草、玄胡、京三棱、鹿角、阳起石、白头翁根、莲房、荷叶。[结论]浙派中医治疗痛经从“气血”立论,“温补”“清化”以治本,“调畅气血”为根本,以辨证论治、治病求本为宗。

陈华教授传承浙派中医儿科学术特色治疗小儿肺系疾病经验探析

[目的]总结陈华教授传承浙派中医儿科学术特色治疗小儿肺系疾病的经验。[方法]通过随师临证,研究浙派儿科学术特点,从病因病机、遣方用药等方面阐释陈师治疗小儿肺系疾病的临床经验及方药特色,并通过临床验案加以佐证。[结果]陈师诊疗小儿肺系疾病的经验可概括为融通中西,谨守病机;四望一听,尤重望诊;分期论治,善用和清;用药轻灵,顾护脾胃。所列案例为小儿急性上呼吸道感染的典型案例,急性感染期解表清里,迁延反复期益气养阴,缓解恢复期补肺健脾,疗效显著。[结论]陈师小儿肺系疾病的诊治经验,不仅有较高临床实用价值,更是对浙派中医儿科学术特色的传承和发展。

陈华教授从“阴虚瘀热”论治小儿反复呼吸道感染经验总结

[目的]总结陈华教授从“阴虚瘀热”论治小儿反复呼吸道感染的经验。[方法]通过随师临证,总结整理病案资料,阐释陈师治疗小儿反复呼吸道感染的临床经验及方药特色,并通过临床验案加以佐证。[结果]陈师认为,小儿反复呼吸道感染病因为风、痰、瘀、虚,病机为肺脾两虚,痰瘀阻络,迁延不愈,瘀热互结,创新性地提出从“阴虚瘀热”辨治小儿反复呼吸道感染,总结出重视风邪,祛风解表;三因制宜,滋阴清瘀;详辨虚实,巧用和法;顾护中焦,健运脾胃的诊治经验。验案为反复呼吸道感染患儿,辨为阴虚感冒,兼痰瘀阻滞证,陈师分期论治,滋阴清瘀治法贯穿疾病治疗的中后期,迁延期养阴退热、化痰祛瘀,恢复期养阴退热、健脾益气,疗效显著。[结论]陈师继承浙派中医儿科特色,从“阴虚瘀热”辨治小儿反复呼吸道感染,疗效显著,对指导临床有较高实用价值。

高氏流派从痰湿瘀阻论治少弱精子症

少弱精子症是临床常见病,也是男性不育的重要原因。目前中医治疗多从补肾入手,取得一定疗效。榆林高氏中医妇科流派认为,少弱精子症的发病与饮食、情志、劳逸失调密切相关。饮食不节,痰湿内盛,情志不畅,气滞血瘀,劳逸失调,损伤肾精。病位主要在脾,涉及肝、肾。病性“实多虚少”,以痰、湿、瘀实邪多见,肾虚精亏者较少。痰湿瘀阻为该病的主要病机,治法为“祛湿化痰,活血通络”,以自拟“生精汤”为主方,药物组成为陈皮、清半夏、茯苓等。此方特色鲜明,疗效突出,为中医临床提供更多思路和方法。

黄河文化视域下的中医骨伤流派研究

黄河流经不同地域,形成了各具特色的地域文化及中医药文化。黄河流域中医骨伤流派是中医学重要组成部分,千年来植根于黄河文化的沃土,结合当地地域特色,形成了各具特色的学术流派,推动了黄河流域骨伤科学的发展。通过文献资料研究黄河文化视域下各骨伤流派的历史渊源、特色及其对地方医学的贡献,探究黄河文化与学术流派的传承与发展,加深对黄河流域中医骨伤流派的认识,对推动中医骨伤科学发展,促进中医药传承与创新具有重要意义。

江苏地方医派传承发展张仲景学说刍议

仲景学说自明清开始出现北学南移,此与江苏地方医派关系密切。除刊刻《仲景全书》,精研仲景学术思想外,江苏医家结合当地气候、饮食及患者体质等因素,灵活变通《伤寒杂病论》的证治思路,促进了温病学派的诞生。此外,江苏地方医派秉承寒温一体理论,临证融伤寒、温病之长,同时将此思想融入中医教育中;并且借鉴西方院校教育模式,发展中医学校教育,开辟当代中医教育之先河。文章对江苏中医流派的学术及教育学思想进行了简单阐述,并对后续的中医药数字化科普工作进行了思考及展望,为中医流派的守正创新研究提供思路。

中医院校联合附属医院创新继续教育办学模式的研究——以天津中医药大学为例

中医在新型冠状病毒肺炎疫情防控救治中发挥了重要作用,使民众学习中医的热情空前高涨,中医院校通过联合附属医院创新继续教育办学模式、整合办学资源、弥补办学不足,可为地区提供更优质的中医药继续教育服务。文章将从中医院校继续教育的现状、中医院校继续教育的不足、中医院校联合附属医院开办继续教育的优势及如何创新继续教育办学模式四个方面进行研究。

中药穴位热熨敷的不同推熨频率对促进结肠癌根治术后患者胃肠功能恢复的影响

[目的]观察中药穴位热熨敷的不同推熨频率对促进结肠癌根治术后患者胃肠功能恢复的影响。[方法]选取2020年1月—2023年3月在广州中医药大学第一附属医院二外科住院的腹腔镜下结肠癌根治术后患者108例,随机分为试验A组、试验B组、对照组各36例。对照组采用常规护理方法,试验组在常规护理基础上实施子午流注理论指导下的中药热熨敷干预,试验A组的推熨频率为90~95次/min,试验B组的推熨频率为115~120次/min,从术后第1天开始,每日2次,直至肛门排气和排便。观察3组患者胃肠功能恢复、住院时间、中医证候积分变化情况以及不良反应发生情况,评价3组患者的临床疗效。[结果]干预后,试验B组术后肠鸣音恢复时间、首次肛门排气时间明显短于试验A组和对照组(P<0.05),试验B组首次排便时间和术后住院时间均明显短于对照组(P<0.05或P<0.01);3组患者中医证候积分的组间效应、时间效应及交互效应均有统计学差异(P<0.05);3组患者中医证候积分随时间推移均呈下降趋势,试验B组术后72 h的中医证候积分低于试验A组和对照组,且试验A组低于对照组(P<0.05);试验A组和试验B组的临床治疗总有效率均明显优于对照组(P<0.05)。[结论]中药热熨敷能有效促进结肠癌根治术后患者胃肠功能恢复,以推熨频率为115~120次/min的整体治疗效果更为显著。

Profiles of Traditional Chinese Medicine Schools

Many schools of academic doctrines have emerged throughout the development history of traditional Chinese medicine （TCM） due to geographic, time, Shicheng （mentor-apprentice system） and academic diversities. Classic TCM School, Classic Formula School and Febrile Disorder School, though all lacking a clearly demonstrable or continuous Shicheng relationship, are nevertheless so classified because of their consistency in reference to the classic TCM works. Each of the Four Famous Masters of Jin and Yuan Dynasties had its distinctively different academic doctrine, resulting in the establishment of individually integrated academic schools. The emergence of the Warming and Tonifying School in late Yuan and early Ming Dynasties was realized as a means to rectify the ill effects of the cool and cold medications prevalent at the time. On the other hand, the advent of the Warm Disease School and the rise of the Confluence School embodied the close relationship carried by TCM academic schools to contemporary historical background. Looking at this development history, it is evident that the development of TCM academic schools could flourish only if it allows dissenting, yet mutually tolerant, opinions. In present medical environment where TCM and Western medicine are of equal importance, Classic TCM Schools, TCM Modernization Schools and Integrative Medicine Schools should all receive emphasis to foster development.

按病种付费对中医优势病种住院费用的影响研究——基于PSM-DID法

目的:分析按病种付费对中医优势病种住院费用的影响,为中医按病种付费改革提供参考。方法:采用某中医医院实施按病种付费的高位肛瘘患者住院费用数据,经倾向得分匹配法(PSM)匹配后,进行双重差分(DID)回归分析,探讨按病种付费对中医优势病种住院费用的影响。结果:实施按病种付费后,高位肛瘘患者住院总费用下降了1067.63元、自付费用下降了656.66元、住院天数缩短了5.54天、西药费增长了406.55元、中成药费下降了126.80元。结论:在中医优势病种按病种付费过程中,应加强医保监督,持续完善、更新中医信息系统,扩大按病种付费的中医优势病种范围,突出中医临床路径优势,促进中医药传承创新发展。

Characteristics of Traditional Chinese Medicine Syndrome in Patients with Coronary Heart Disease at Different Disease Stages

Coronary atherosclerotic heart disease(CHD)has a high incidence,disability rate,and mortality rate,which severely affect people’s health,work,and life.Based on its clinical manifestations,traditional Chinese medicine(TCM)has classified CHD as“chest impediment”and“heart pain”for the treatment.The course of CHD is protracted,and the pathogenesis is complex and changeable.Moreover,different disease stages have different syndrome characteristics.Thus,this article aimed to summarize the classification and distribution characteristics of the TCM syndrome in various stages of CHD,such as before and after percutaneous coronary intervention therapy,disease progression,age,and complications,to provide references for the TCM clinical diagnosis and treatment of CHD.

基于数据挖掘探讨古今医家治疗乳腺癌的用药规律及差异

目的探讨古今医家运用中医药治疗乳腺癌的处方用药规律及差异。方法古方以鼎秀古籍全文检索平台、中医药基本古籍数据库(博古通儒)、古今医案云平台为检索来源;今方以中国知网数据库(CNKI)、万方数据库、维普数据库(VIP)为检索来源,筛选建库至2022年9月发表文章中涉及的治疗乳腺癌方剂。应用古今医案云平台对纳入方剂包含的中药进行频次、性味归经、关联分析、复杂网络分析和聚类分析。结果古今医家治疗乳腺癌使用频次靠前的中药均有当归、甘草、白芍、茯苓、白术,均为温、平、寒性,甘、苦、辛味药物应用较多,归经以脾、肝、肺经较多。古代医家治疗乳腺癌的高频药对为白芍—当归,现代医家治疗乳腺癌的高频药对为白术—茯苓。复杂网络分析显示,古代医家治疗乳腺癌的核心处方为“白术、茯苓、白芍、当归、川芎、人参、熟地黄、甘草”,现代医家治疗乳腺癌的核心处方为“白术、黄芪、茯苓、当归、白芍、柴胡、党参”。聚类分析显示,古代医家治疗乳腺癌相关高频药物共得到5个新方,现代医家治疗乳腺癌相关高频药物得到3个新方。结论古今医家治疗乳腺癌均遵循“扶正固本”的原则。在此基础上,古代医家侧重健脾益气,现代医家侧重疏肝健脾。

VDT作业光环境对不同体质设计师视健康的影响

为探究光环境、体质与视健康的交互作用关系,保护高风险体质者视觉作业安全。首先,对重庆地区9家建筑勘察设计企业进行光环境调研,测量72间视觉显示终端(VDT)办公室的水平作业面照度、相关色温、眼位照度等光环境参数,计算节律照明相关指标,并与标准进行比对;然后,对541名青年设计师进行中医体质辨识及视疲劳特征记录;最后,基于中医体病相关理论,分析环境光照下体质与近视、视疲劳的相关性,辨别视健康高风险体质。结果表明:青年设计师的体质类型以平和质为主,在9种体质中占比最高;偏颇体质中阳虚质占比最高,对近视、视疲劳的易感性显著高于平和质;工作场所长期日光暴露不足、节律刺激过低易诱发体质向阳虚质转变,增加视健康风险。

不同中医证候糖尿病脑病的中药防治研究进展

随着人们生活方式及饮食结构的变化,代谢性疾病逐年高发,并且其中枢神经系统发症,如糖尿病脑病日益受到人们的关注。糖尿病脑病的发病机制复杂且尚不明确,目前西医尚无有效治疗药物并且临床缺乏个性化治疗方案。中医学认为糖尿病患者阴阳两虚,久病入络,气机逆乱,肾精亏虚,故而浊毒内生,损伤脑络,发为脑病。参考文献及临床研究,总结归纳糖尿病脑病患者表现的常见证候类型:肾虚髓减证,脾肾两虚证,痰浊瘀阻证,肾虚瘀阻证,气阴两虚、瘀阻证。基于传统中医药理论的辨证论治可有效改善糖尿病患者的认知损伤及证候表现,实现临床个性化诊疗和精准用药,显著体现中药临床价值及优势。文章主要对目前临床辨证论治糖尿病脑病的中药复方及其机制进行了系统整理,以期为临床精准防治糖尿病脑病提供参考依据。

章氏伤科传承脉络及“和合”思想渊源探析

[目的]探析浙派中医章氏伤科传承脉络及“和合”思想的渊源,总结其学术特色,丰富和发展章氏伤科理论内涵。[方法]通过走访章氏伤科后人及传承人,搜集整理其现存手稿、验案等文献,查阅古代相关伤科医著,凝练总结其学术思想及特色。[结果]章氏伤科秉承道家文化之琼浆,汲取儒家思想之精华,上承佛家正骨之要术,中继民间疗法之特长,结合现代医学之技术,潜心医道两百年,济世情怀代相承,形成了以“和合”思想为核心,整体辨证、杂合以治、气血平调、筋骨互用、动静互补、防治结合、形神合一等理论体系为特色的中医骨伤学术流派。[结论]章氏伤科博采众长,守正创新,中西并重,形成了一套完整、独特的“和合”理论体系,总结其学术特色,对充实浙派中医骨伤流派学术内涵,推动中华民族“和合”文化建设,具有重要意义。