中国古代医疗文学研究的关键词及其发展路径

疾病叙事、身体书写、文学治疗是中国古代医疗文学研究中的三个关键词,构成彼此独立而又相互交融的三维视角。疾病叙事、身体书写已在文学研究领域广泛运用。介入古代文学领域,身体书写逐渐转换为一个与疾病书写紧密联系的关键词。文学治疗是医学与文学的天然融会,以人类学的全新视野拓展了古代文学的研究空间。文学地理学视角可以为医疗文学研究提供一个广阔视域,能够将区域医疗文化、区域创作环境、文学家治疗状况、文学文本与疾病的关联性整合为一个统一的研究议题。医疗文学研究需要以精神分析视角将生理与心理结合,目的在于探讨不同的涉医文本所包含的文化意蕴以及承载的文学疗愈功能。文化记忆研究为医疗文学创造重新阐释医疗文学的机遇,疾病记忆是中华文化史的组成部分,由此可以构成一个不断拓展的理论视野。

《兵部手集方》的历史文化考察——以其中两个验方为中心

《兵部手集方》由唐人薛弘庆据兵部尚书李绛所传药方整理而成,其中的“疗毒疮肿”方和“疗多年恶疮”方,对卢坦、李吉甫、武元衡等当代名人的疾病、治疗过程及验方疗效的叙述,虽极简洁,却不乏文学性。其中所蕴含的人事纠葛与中唐医疗发展状况,可补史籍及文人别集之不足。验方在后世及域外的广泛流传,与验方中的医疗叙事遥相呼应,是其特殊疗效的历史验证。在打通医疗、历史、文化乃至文学之壁垒的前提下,对两个验方予以细致考察,不仅有助于推进唐代医疗史和相关问题的研究,对于中唐医疗文学研究而言,也是一种有益的探索,值得予以重视。

Analysis of the hotspots and trends in traditional Chinese medicine immunomodulation research based on bibliometrics

Objective To analyze the intellectual structure,hotspots and trends of traditional Chinese medicine(TCM)in immune regulation research.Methods The data were extracted from the Web of Science Core Collection(WoSCC)and the China National Knowledge Infrastructure(CNKI)and verified by two experienced TCM researchers.The time of literature retrieval is up to 2020.CiteSpace 5.7.R1 and Microsoft Excel 2016 were used for the statistical analysis and bibliometric diagrams,including the co-occurrence network of authors,institutions,countries,keywords,references,dual-map overlays of journals and citation bursts,etc.Results A total of 12270 publications related to TCM in immune regulation were included.The annual number of publications has increased in this field.There was close cooperation of countries and institutions,while the distribution of scholars was scattered.China was the core of the cooperation network.The dual-map overlays analysis of journals showed that core and marginal fields had increased.The keywords and references analysis showed that network pharmacology,metabolism and cancer were the most high-frequency keywords with high-intensity bursts.Conclusion TCM in immune regulation has attracted wider attention,with multi-country,multi-field,multi-disciplinary and multi-level research developing toward informatization.Network pharmacology,metabolism and cancer may be the focus of future research in this field.

Intensity-modulated radiotherapy for breast cancer:a systematic review

Objective:The aim of this study was to assess the long-term effect of breast conservation with breast intensitymodulated radiotherapy (IMRT) for early-stage breast cancers.Methods:Pub Med,EMBASE,Cochrane Library,Chinese Biomedical Literature Database were searched to identify relevant original published trails,and the references of eligible studies were manually screened.Randomized controlled trails reported in any language,comparing breast IMRT with conventional radiotherapy (RT) in patients with early-stage breast cancer were eligible for inclusion.Two investigators independently assessed the quality of included trials and extracted data.The RevMan 5.0 software was used for statistical analysis.Results:Four trials involving 1440 patients were included.The results showed that in the IMRT group,the occurrence of acute moist dermatitis,the edema of the mammary gland and the occurrence of hyperpigmentation were lower than those of RT group,the pooled risk ratio value and 95% confidence interval were 0.28 (0.17-0.48),0.03 (0.00-0.21) and 0.06 (0.02-0.15) respectively.The use of IMRT did not correlate with pain and quality of life,but the presence of moist desquamation did significantly correlate with pain and reduced quality of life.Conclusion:The currently available evidence showed that IMRT significantly reduces the occurrence of moist acute dermatitis anywhere in the breast and alleviates the suffering of patients and improves the quality of life of patients.Future large-scale,high-quality,double-blind trials are needed.

Why do we have so much trouble treating anal fistula?

Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (e.g.Tuberculosis,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces.The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases.The problem with this single,yet effective,treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses,the patient will have varying degrees of fecal incontinence from minor to total.In an attempt to preserve continence,various procedures have been proposed to deal with the fistulas.These include: (1) simple drainage (Seton);(2) closure of fistula tract using fibrin sealant or anal fistula plug;(3) closure of primary opening using endorectal or dermal flaps,and more recently;and (4) ligation of intersphincteric fistula tract (LIFT).In most complex cases (i.e.Crohn’s disease),a proximal fecal diversion offers a measure of symptom-atic relief.The fact remains that an "ideal" procedure for anal fistula remains elusive.The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations.In essence,the price of preservation of continence at all cost is multiple and often different operations,prolonged disability and disappointment for the patient and the surgeon.Nevertheless,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist.Conversely,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.

Prof. Zhou Xuewen's Experience in Treating Superior Mesenteric Artery Syndrome

Prof. Zhou Xuewen (周学文), a veteran TCM doctor,is an expert in treating miscellaneous internaldiseases. I have the honor to follow him and havebenefited from his teaching. The following is hisexperience in treating superior mesenteric arterysyndrome that I would like to introduce below.

Radiotherapy combined with surgical treatment for gastric cancer:a meta-analysis

Objective:We carried out a meta-analysis to assess the effectiveness and safety of radiotherapy combined with surgery for gastric cancer.Methods:Randomized Clinical Trials (RCTs) in which radiotherapy (preoperative,intraoperative and postoperative),was compared with surgery alone in resectable gastric cancer were identified by searching Cochrane Library (Issue 2,2009),PubMed (Jan 1966-Jun 2009),EMBASE (Jan 1974-Jun 2009),Chinese Biomedical Literature Database (Jan 1978-Jun 2009),Chinese Science and Technology Periodicals Database (Jan 1989-Jun 2009),China National Knowledge Infrastructure (Jan 1994-Jun 2009) and Wanfang database (Jan 1997-Jun 2009) in English and Chinese languang.Two researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Our researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Results:Nine randomized controlled trials of 1 548 patients were selected for meta-analysis.Five randomized controlled trials were related with comparison of preoperative radiotherapy plus surgery with single surgery.Two randomized controlled trials were the comparative studies between surgery plus postoperative and single surgery.The meta-analysis results showed that:(1) compared with surgery alone,preoperative radiotherapy combined with surgery can increase 3 years (OR=1.78;95% CI 1.14-2.78,P=0.01),5 years (OR=1.67;95% CI 1.22-2.29,P=0.001),10 years (OR=1.64;95% CI 1.03-2.60,P=0.04) survival rate and resection rate (OR=2.15;95% CI 1.31-3.54,P=0.003);reduce the of tumor recurrence rate (OR=0.59;95% CI 0.37-0.92,P=0.02) and metastasis rate (OR=0.44;95% CI 0.27-0.73,P=0.001);(2) The tumor recurrent rates (OR=0.19,95% CI 0.03-1.14,P=0.07) and tumor metastasis rate (OR=0.09;95% CI 0.00-1.77,P=0.11) had no difference between single surgery group and peri-operative radiotherapy plus surgery group;(3) Postoperative radiotherapy compared with surgery alone had no significant effects on 1 year (OR=0.83;95% CI 0.60-1.15,P=0.26) and 3 years (OR=0.75;95% CI 0.51-1.11,P=0.15) survival rate compared with single surgery,but the 5-year survival rates (OR=0.57;95% CI 0.34-0.95,P=0.03) of the patients who received surgery alone was higher than those who received combined therapy.No difference of the tumor recurrence rate (OR=0.59;95% CI 0.33-1.05,P=0.07),tumor metestasis rate (OR=0.90;95% CI 0.51-1.59,P=0.71) and anastomotic leak (OR=0.98;95% CI 0.25-3.65,P=0.98) were observed between the two groups.Conclusion:Preoperative radiotherapy combined surgery is more rational and effective than surgery alone of gastric cancer.However,in terms of the clinical effects of perioperarive or postoperative radoiotherapy combined with surgery,much multicenter,largescale,high-quality,double-blind and rigorously designed studies would be needed than currently available in the future.

Heat-sensitive moxibustion for lumbar disc herniation:a meta-analysis of randomized controlled trials

OBJECTIVE:To assess the efficacy and safety of heat-sensitive moxibustion in the treatment of lumbar disc herniation(LDH).METHODS:Randomized controlled trials(RCTs) involving heat-sensitive moxibustion in the treatment of LDH were retrieved from the Chinese Biological Medical Literature database(1978-20011),Weipu database(1989-2011),Wanfang digital journal(1998-2011),China National Knowledge Internet(1979-2011),PubMed(1966-2011),EMBASE(1980-2011),and Cochrane Library(Issue 1,2011).Hand-search of the relevant journals from the Library of Jiangxi University of Traditional Chinese Medicine was also adopted for the collection of data.Data were extracted and evaluated by two reviewers independently with a specially designed extraction form.The Cochrane Collaboration's RevMan 5.0.20 software was used for data analyses.RESULTS:A total of 6 trials involving 580 patients were included.Meta-analysis showed that the total effectiveness rate in the heat-sensitive moxibustion group was significantly different when compared with conventional moxibustion [RR=1.19,95% CI [1.06,1.33)] and diclofenac sodium [RR=1.47,95% CI [1.17,1.85)],but similar to that of acupuncture.The cure rate in the heat-sensitive moxibustion group was significantly different when compared with conventional moxibustion [RR=1.58,95% CI(1.04,2.40)] and diclofenac sodium [RR=1.91,95% CI(1.01,3.60)],but similar with that of acupuncture.In terms of the Japanese Orthopaedic Association scores,significant differences were noted in subjective indices,objective indices,and daily life subscales.Two trials reported that there were no adverse events over the duration of treatment.CONCLUSION:Compared with conventional moxibustion,acupuncture,and diclofenac sodium,heat-sensitive moxibustion in the treatment of LDH is superior in efficacy.Further large-scale trials are required to define the role of heat-sensitive moxibustion in the treatment of this disease.

Effects of Duhuojisheng Tang and combined therapies on prolapse of lumbar intervertebral disc:a systematic review of randomized control trails

OBJECTIVE： A systematic review of the literature was conducted to evaluate the curative effect and safety of Duhuojisheng Tang on prolapse of the lumbar intervertebral disc. METHODS： The databases of PubMed, China Na- tional Knowledge Infrastructure （CNKI）, Chinese Sci- entific Journals Database （VlP）, Chinese Biomedical Literature Database （CBM） and Chinese Medical Ci- tation Index （CMCl） were searched up to January 30, 2012. Randomized controlled trials were select- ed to compare Duhuojisheng Tang with one ormore of the following treatments： traction, acu- puncture, massage, cupping and Western medical treatment. The quality-evaluating standard and the software RevMan 5.1 in Cochrane coordinative net were used to analyze the data. The effective index- es of the results were clinical curative rate, effective- ness of alleviating clinical symptoms and adverse reaction. RESULTS： Thirty-one randomized controlled trials of low quality, involving 3915 patients were system- atically evaluated. Statistical analyses showed that good curative effect was achieved in both the group using Duhuojisheng Tang alone and with combined therapies. CONCLUSION： Using Duhuojisheng Tang alone or combined with other therapies can effectively im- prove pain, leg-raising height and other clinical symptoms of patients with prolapse of lumbar in- tervertebral disc. Due to low methodological quali- ty of the articles, no exact recommendations can be made.

Traditional Chinese Medicine for the treatment of influenza: a systematic review and Meta-analysis of randomized controlled trials

OBJECTIVE: To justify the clinical use of Traditional Chinese Medicine(TCM) in the treatment of influenza.METHODS: MEDLINE, EMBASE, Chinese Biomedical Literature Database, China National Knowledge Infrastructure Database, China Science and Technology Journal Database, Wanfang Database and the Cochrane Database of Systematic Reviews were searched from thedate of inception until January 1,2013, for the literature on treatment of influenza with TCM.RESULTS: A total of 7 randomized controlled trials were identified and reviewed. Of these trials, 2 compared a(modified) prescription of TCM with oseltamivir and 5 compared a patent traditional Chinese drug with oseltamivir. Based on the Meta-analysis,compared to oseltamivir, the(modified) prescription had similar effect in defervescence [WMD=5.66, 95% CI(﹣32.02, 43.35), P=0.77] and viral shedding [WMD=﹣ 6.21, 95% CI(﹣84.19, 71.76), P=0.88], and the patent traditional Chinese drug also had similar effect in viral shedding [WMD=﹣ 0.24,95% CI(﹣4.79, 4.31), P=0.92] but more effective in defervescence [WMD=﹣4.65, 95%CI(﹣8.91, ﹣0.38),P=0.03].CONCLUSION: TCM has potential positive effects in the treatment of influenza.

aseudoarthrosis of medial tibial plateau fracture role of alignment procedure

Nonunion in tibial plateau fractures is very rare. Limited literature is available on Pubmed search on intraarticular tibial nonunion. Most of the cases reported have been following failed surgical treatment and none was neglected fractures. Three patients of isolated and neglected medial fibial plateau nonunion with almost similar demo- graphic profile are reported in this paper. All the three pa- tients were managed by minimally invasive compressionfixation using lag screws supplemented with limb realign- ment procedure of high tibial osteotomy. We discussed the injury mechanism, management and rehabilitation in such cases and reviewed the available literature regarding such a presentation.

Acupuncture therapy for angina pectoris:a systematic review

OBJECTIVE： To assess the effectiveness and safety of acupuncture therapy for angina pectoris. METHODS： Randomized controlled trials （RCTs） concerned with acupuncture treatment of angina pectoris were identified by searching Academic Source Premier, MEDLINE, Science Citation Index Expanded, and three Chinese databases （China biol- ogy medicine database, China national knowledge infrastructure, and VlP database for Chinese techni- cal periodicals）. The valid data were extracted in ac- cordance with our inclusion and exclusion criteria. The main outcomes of the included studies were synthesized using Revman 5.1. RESULTS： Twenty-one articles on 16 individual studies were included and evaluated as having high or moderate risk of bias according to the stan- dards of the Cochrane Collaboration. Meta-analysis indicated that acupuncture combined with conven- tional drugs （ACCD） was superior to conventional drugs alone in reducing the incidence of acute myocardial infarction （AMI） [0R=0.18, 95%CI （0.04,0.84）, P=0.03]. Moreover, ACCD was superior to con- ventional drugs in the relief of angina symptoms [0R=4.23, 95%C/（2.73, 6..56）, P〈0.00001], and im- provement of electrocardiography （ECG） [0R=2.61, 95%C/（1.83, 3.73）, P〈0.00001]. Acupuncture by it- self was also superior to conventional drugs for angi- na symptoms [0R=3.59, 95%C/（1.76, 7.92）, P=0.0004] and ECG improvement [0R=3.07, 95%C/（1.54, 6.10）, P=0.001]. ACCD was superior to conventional drugs in shortening the time to onset of angina relief [WMD=-1.40, 95% CI （-1.65, -1.15）, P〈 0.00001]. However, the time to onset was signifi- cantly longer for acupuncture treatment than for conventional treatment alone [WMD=2A3, 95%O （1.63, 3.23）, P〈0.000 01]. CONCLUSION： ACCD reduced the occurrence of AMI, and both acupuncture and ACCD relieved an- gina symptoms and improved ECG. However, com- pared with conventional treatment, acupuncture showed a longer delay before its onset of action. This indicates that acupuncture is not suitable for emergency treatment of heart attack. Owing to the poor quality of the current evidence, the findings of this systematic review need to be verified by more RCTs to enhance statistical power.

First rib fractures： not always a hallmark of severe trauma a report of three cases

According to medical literature, fracture of the first rib is quite rare and the bilateral condition is especially rare. This type of fracture is usually associated with severe intrathoracic trauma and other bony or neurovascular injuries, thus can be considered as a harbinger of major trauma. However here we present three cases of low velocity first rib fractures without any major trauma or multisystem injuries. All the three patients were treated conservatively and did well on simple analgesics and rest and had no early or late complications. It can be seen that not all the first rib fractures are associated with major trauma or multisystem injuries. There is a variant of first rib fracture with low velocity injuries which is not associated with any major complications in contrast to majority of first rib fractures associated with high velocity injuries. Causative factor of such injuries may be violent muscular contraction of scalenus anterior or serratus anterior, but not direct trauma.

Effect of Banxiaxiexin Tang on treatment of functional dyspepsia: a Meta-analysis of randomized controlled trials

OBJECTIVE: To evaluate the efficacy of Banxiaxiexin Tang compared with Western Medicine in the treatment of functional dyspepsia(FD) through Meta-analysis.METHODS: Literature was searched in the following databases: MEDLINE, Excerpta Medica Database, Chinese Medical Current Contents, China Science and Technology Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. Randomized controlled trials evaluating the efficacy of Banxiaxiexin Tang for the treatment of FD were selected according to certain standards including clear general situation of patients, specific diagnostic criteria, definite clinical outcomes, etc. Articles were evaluated with quality assessment standards in the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was conducted with RevMan 5.0.23 software.RESULTS: Ten articles with a total of 972 patients were included. The comparison of efficacy between Banxiaxiexin Tang and Western Medicine showed a combined effect size [OR=2.75, 95% CI(1.86-4.07)]andcombinedeffectofvalueofZ=5.07(P<0.000 01),suggesting a significant difference between the groups.CONCLUSION: Banxiaxiexin Tang was more effective thanWestern Medicine in treating FD.

“话疗”与“梦疗”:论汉赋中的治疗主题与祛疾机理

中国古代文学援医入文的传统源远流长。其中,赋体文学里出现的大量“赋疗”现象尤其值得注意。汉赋能够表述复杂的医治主题并发挥良好的祛病功效,与这一文体专属的主旨特征和表达模式密不可分:辞赋之“主文谲谏”所对应的“话疗”,以言语干预的手段为接受对象矫正紊乱或平衡矛盾;辞赋之“体物写志”所对应的“梦疗”,以梦境回忆的形式为创作主体解答困惑或偿补失落。“话疗”的成败取决于医、患彼此的互动;“梦疗”的得失受制于医、患之间的转换。唯有在体察辞赋文本的内外语境之后,方能从本质上理解和揭示辞赋的治疗原理,以期进一步挖掘赋体文学的医疗功能的前提与可能。

Meta-analysis on integrative medicine for the treatment of malignant ascites: a comparative study

OBJECTIVE: To compare the efficacy of integrated Chinese and Western Medicine with that of only Western Medicine for the treatment of malignant ascites.METHODS: All randomized controlled trials(January 2004 to March 2013) from the China National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, and Wanfang Database were searched with keywords. Meta-analysis was conducted by combining the odds ratios of the individual studies. Review Manager 5.0 was used for the analysis.RESULTS: One thousand one hundred and fifty-six patients from 19 randomized controlled trails were included. Of them, 630 patients were treated with integrated Chinese and Western Medicine(the integrative group), and 526 patients were treated with Western Medicine alone(the control group). The Meta-analysis showed that the total effective rate was 78.73% in the integrated group, and 59.13% in the control group. The effective percentage was sig-nificantly higher in the integrative group than that of the control group [OR = 2.85, 95% CI(2.16,3.74),P < 0.01].CONCLUSION: The short-term curative effect in the integrative group was better than that in the control group. Integrative medicine may be beneficial for malignant ascites.