Study on the Correlation between Syndrome Differentiation of Malignant Pleural Effusion Treated by External Treatment of Traditional Chinese Medicine and Immunohistochemistry of Biopsy Tissue Based on Medical Video-assisted Thoracoscope

Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavity and immunohistochemistry of biopsy tissue,to classify malignant pleural effusion according to syndrome differentiation,and to explore the scientific nature of its theory.Methods:From March 1,2014 to February 28,2015,40 cases of malignant pleural effusion were treated in Beijing Chaoyang Hospital affiliated to Capital Medical University.According to the proposed TCM diagnostic criteria for yin and yang syndrome differentiation,and collect age,gender,course of disease,clinical symptoms,tumor primary focus,histomorphological manifestations and immunohistochemical results and other related information,and carry out statistical data processing.Results:The positive syndrome was mainly metastatic lung adenocarcinoma,which accounted for the majority of all MPE cases,up to 75%.The immunohistochemical results of biopsy tissues were mainly CEA and TTF-1 positive;While pleural effusion caused by pleural mesothelioma was the main type of yin syndrome,and the results of immunohistochemistry combined with biopsy were mainly positive for D2-40,Calretinin,WT-1 and CK5/6.Conclusion:TCM syndrome differentiation of MPE based on internal thoracoscopy combined with biopsy immunohistochemical results has sufficient theoretical basis and certain scientific nature,and further clinical research is needed to verify its effectiveness and practicability in the future.

A Preliminary Study on Legitimacy Identification Standards for Unconventional Treatment Technologies in Traditional Chinese Medicine

Compared with western medicine with objective and standardized theories,traditional Chinese medicine(TCM)places more emphasis on subjective thinking.Moreover,there are several academic schools under TCM,and ancient secret prescriptions and proven prescriptions play important roles in TCM treatments.However,the drugs used by some academic schools and some ancient secret prescriptions and proven prescriptions often contradict mainstream theories,and some TCM treatment methods do not significantly conform to the methods that are considered safe by the Chinese Pharmacopoeia(2015 edition),medical textbooks and other canonical books.Despite the long history and abundant successful experiences of TCM treatments,controversies regarding these unconventional treatment technologies,specifically when these breach the safety standards of treatment,exist considering that several medical adverse effects are observed when performing these unconventional treatments.In view of this,distinguishing“welldefined technological breakthrough”from“medical fault”is considered necessary.This study discusses the issue and raises constructive suggestions on the corresponding identification standards for unconventional treatment strategies in TCM.

Healed and Crippled： The Effect of Global Medicine on African Indigenous Treatment and Care Approaches

Whereas global medicine and health care practices have improved the quality of people＇s lives, especially in the developing countries data abounds that local communities have been crippled by the same medical practises. Some societies in developing countries have become sources of specimen for clinical trials of biomedicine which is unaffordable to their citizens. This paper explores the neglect of traditional African medicinal innovations and research in favour of imported Western medicine perpetuated by the developed countries. The paper argues that global medicine and health care have neither utilized nor recognized the African Traditional Medicine （ATM） fully, despite the fact that cultures in developed world used and continue to utilize the indigenous medical knowledge. The paper further argues that instead of neglecting African Traditional Medicine, ATM and biomedicine can be more beneficial by blending them into a single system, through what we would call in this paper High-Performance Medical Research （HPMR）. This would allow participation of communities to achieve both socio-eeonomic and medical knowledge growth rather than being a monopoly and preserve of developed organizations in the North. This paper proposes that HPMR should be a systematic and scientific approach for enhancing local people＇s participation in the development of medical ventures. This paper draws on secondary data on traditional African therapeutic practices by some local communities in East Africa combined with literature review on medical practice in Western societies.

Study on the difference of payment time of medical insurance in China

Since medical insurance of our country developed, it is continued to deepen reform and became the basic form of the pcrfcct medical insurance system. However, regional differences still exist. The current medical insurance system of China＇s urban and rural structure background of two structures of serious, city residents, workers and rural residents is significantly difference in the payment period ,for this question ,the difference between our country will solve the basic medical insurance payment period, the relative level of regulating wages and medical people in our country and develop the medical insurance level, narrow the regional differences, reduce cost problem caused by population flow management, the basic medical insurance system for suggestions to improve the unified and promoting the social and economic level, people＇s medical security level, perfect improvement of physical insurance system of medical insurance according to the long-term sustainable development has a far-reaching significance.

Medications and medical care of the Buyi ethnicity in Buyimojingbooks:an investigation on its philosophical origin

Studies on various Buyimojingbooks of the minority group“Buyi”in China,combined with information collected through visits to Buyi doctors,revealed that six ideas mainly comprised Buyi treatment and therapeutic principles,i.e.,inviting,expelling,liberating,supplementing,transporting,and recovering.Based on these ideas,the medical philosophy and laws of medication use were investigated to reveal and sort out Buyi therapeutic and pharmaceutical systems to achieve the goal of inheriting and further developing Buyi culture of medicine.

Preliminary Discussion on Sand Therapy in Mongolian Medicine

Sand therapy of Mongolian medicine is one of traditional Mongolian medical treatments.It conducts heat energy to the human body through natural hot sand applied on the body,achieving the effect of preventing and curing disease.It is an external treatment method,characterized with easy operation,obvious curative effect and small side effects.Referring to the relevant literature of sand therapy in Mongolian medicine and combined with actual situation,the functions and use of sand therapy are summarized in this article,thereby providing theoretical basis and reference for research on sand therapy.

Discussion on the Management of Safe Medication in the Treatment of Internal Diseases of Traditional Chinese Medicine

Objective:To discuss the management of safe medication in the treatment of internal diseases in traditional Chinese medicine.Methods:124 patients with medical diseases were divided into experimental group and control group by random number table method,with 62 cases in each group.The experimental group implemented safe medication management,and the control group implemented routine medication management,all of which were treated for 4 consecutive weeks.The comparison of the improvement of the quality of life,the compliance rate of safe medication and the adverse drug reactions of the two groups after clinical treatment were compared.Results:After 8 weeks of treatment,there was a significant difference in clinical efficacy between the two groups of patients.In terms of quality-of-life scores,the scores of the experimental group were better than those of the control group.The living ability,condition,physical strength and other conditions of patients were significantly different.The t-values were 15.3427,14.0275,and 7.7113,respectively,and P<0.01 was statistically significant.The compliance rates of patients in the experimental group and observation group were 95.16%and 70.96%,respectively,with significant differences(P<0.05).In terms of the incidence of adverse drug events,the experimental group was 3.22%,which was significantly lower than the observation group's 8.06%(P<0.05).Conclusion:The implementation of safe medication management in the clinical treatment ofTCM internal diseases can improve the quality of life of patients to a certain extent,increase their safe medication compliance rate,and reduce the incidence of adverse medication events.The clinical application value is extremely high,and it can be widely promoted and applied.

An Innovative Approach towards Selecting Aerobic and Coordinative Exercises in Clinical Practice for Children and Young People with ADHD

A growing body of studies and systematic reviews show evidence of the beneficial effects of physical exercise on core symptoms of ADHD. Furthermore, studies indicate that physical exercise as an adjuvant can enhance the effects of medication in the treatment of ADHD. Aerobic and coordinative exercises improve executive functioning through their effect on neurocognitive domains that are implicated in ADHD. It is postulated that through their specific modus operandi, aerobic exercise, by raising cortical arousal levels, improves impaired alerting functions whereas coordinative exercises improve the regulation of inhibitory control through the involvement of a higher variety of frontal-dependent cognitive processes. The increasing use of routine neurocognitive testing with continuous performance tests (CPT), such as the QbTest, at clinical assessments for ADHD allows for an innovative approach to identify the assessment impairments in alerting function and inhibition control that are related to ADHD and accordingly choose aerobic or coordinative physical exercise in a more targeted fashion.

Analysis of novel coronavirus pneumonia treatment with Chinese herbal compound

Objective: To analyze the prescription law of TCM compound in the treatment of new coronavirus pneumonia, and provides reference for the clinical treatment of new coronavirus pneumonia. Methods: Collected Collected 24 novel coronavirus pneumonia related diagnostic and therapeutic plans issued by the National Health Council and the Chinese medicine authority from January 26, 2020 to March 8th ,the filtered solution involved in the formula, establishing database of traditional Chinese medicine compound prescription for the treatment of new crown pneumonia, the frequency of using frequency analysis methods of analysis and clustering analysis and association rules analysis to sort out data mining analysis of traditional Chinese medicine compound. Results: In this study, a total of 159 TCM compounds were included in the treatment of new crown pneumonia from the country and 23 provinces, municipalities and autonomous regions, involving 189 TCM compounds. A total of 62 high-frequency traditional Chinese medicines (frequency ≥ 11) were obtained, mainly including licorice, almond, ephedra, gypsum, Poria cocos, Huoxiang, etc The drug types are mainly heat-clearing drugs, vacuous drugs, moisture-curing drugs, and surfactant drugs. The main effect of the medicine was warm, cold, lukewarm and flat, the main effect of the medicine was bitter and bitter, and the main effect of the medicine was the lung, stomach and spleen. Cluster analysis results according to the performance of traditional Chinese medicine treatment of new crown pneumonia high frequency drugs into 7 classes;Association rule analysis results in 29 common drug pairs. Conclusion: In the treatment of pneumonia caused by new coronavirus infection with traditional Chinese medicine, the following characteristics are presented: the number of times of supplementing qi and Yin is more than that of attacking evil and maintaining health;The method of dispersing and solving the attack of wet, beneficial, wet, permeable and wet medicine fully embodies a variety of ways to drive away evil;In terms of drugs, heat-clearing drugs, deficiency drugs, dampness drugs and surface drugs are the main ones, highlighting that the basic treatment method is to dissolve dampness and detoxify, and replenish qi and Yin. In summary, this study can provide reference for guiding clinical drug use and developing new drugs.

Summary of Zhang Hongxing's Experience in Treating Refractory Angina Pectoris with Traditional Chinese Medicine

As a famous traditional Chinese medicine(TCM)expert in Shandong province and a famous veteran TCM expert in Dezhou city,Zhang Hongxing has been engaged in cardiovascular clinical work for more than 30 years.He has unique experience in the treatment of refractory angina pectoris.This paper comprehensively explains from the aspects of etiology and pathogenesis.His treatment is mostly based on syndrome differentiation,combined with the basic pharmacology of modem Chinese medicine to formulate prescriptions and drugs,and at the same time values the use of insect drugs.We hereby attach the clinical records,hoping to provide reference for clinical workers,which is conducive to the inheritance and development of famous Chinese medical academic experience.

医保支付方式由治病向健康转型—先期探讨研究

为系统讨论医保支付方式改革驱动由治病向健康转型的可能性和实践模式,以目标—发展重点透视矩阵作为分析框架,以慢性病为切入点,基于安徽省医共体慢性病打包支付的案例,探讨中国情境下的以健康为导向的医保支付方式改革的路径和方法。研究发现,伴随人口结构和社会需求的变化,在理念层面上,医保支付政策已体现出由治病向健康转型的态势,医保支付政策的内容、形式、载体趋向多样化。目前中国复合式医保支付框架已经建立,但改革内容和进展不平衡,尚未发挥向健康转型的激励引领作用。持续推进医保支付方式改革并对改革内容进行适应性调整,将是下一阶段工作的重点。

健康中国视角下医保基金与公卫资金统筹使用路径研究

医保基金和公卫资金的统筹使用是促进服务融合、持续推进“健康中国”建设的驱动力。依据协同优势理论与PCIC理论,本研究提出了推动医保基金与公卫资金统筹使用的三大路径,即理顺购买内容、优化购买方式和强化购买能力。基于上述路径视角的研究发现,目前国内统筹使用的探索实践已取得一定成效,但也存在资金来源不明确、购买服务范围不清晰、多主体考核激励协调性不足,与健康产出关联性不强、成本核算与健康测量考核能力不足、信息系统互联互通不足等问题。建议完善顶层设计,建立与健康结果相关的考核支付激励机制,实现资金扩容与信息化的动态建设。

价值支付视角下门诊按人头付费的理论内涵和改革建议

按人头付费是医保门诊统筹改革的核心任务之一。价值支付视角下按人头付费应具有控制医疗成本、提升服务质量、改善患者健康结果的价值目标,其核心要素包括:以整合型医疗卫生服务组织和基层家庭医生签约团队为供方主体,为特定疾病人群或签约人群提供连续性医疗服务;支付标的为固定时间范围内发生的医疗费用总额,通过合理设定人头基础费率和风险调整因子,建立以质量和健康结果为核心的绩效支付和结余分享、风险分担机制等,建立起支付方、供方、患者三方价值均衡且相容的激励约束机制。

《普济方》中医眼科外治法及外用处方考略

《普济方》是中国古代最大方书之一,于1406年由明朝周定王朱橚组织编撰,原书已散佚不全,现存版本为清初《四库全书》重新编次整理本。本文以1959年人民卫生出版社出版排印本《普济方》为研究对象,以《普济方》著者、成书、主要内容和特色价值为研究背景,概述明以前中医眼科外治法及外用药发展源流,重点探讨《普济方》中眼科外治法及外用方药收录情况、收方特色和学术价值。《普济方》广泛收集了明初以前眼科外治法及外用方药,其中有明确出处者729首,来源于51部自汉至明代的各类医籍,其中包含了10余部今已亡佚不存、或著者成书均已不详的稀有中医古籍。深入研究《普济方》所载中医眼科外治法及外用方剂,对认识古代中医眼科外治法的发展史,了解传统眼科外治技术的演变、眼科外用药的选择、眼科经典方剂和新药研发等方面都具有极为重要的学术意义和实践价值。

医保在三医协同发展与治理中的功能及作用:理论内涵与政策路径

本文在三医协同发展与治理框架下分析了医保战略购买引导资源配置的理论内涵及政策路径。医保引导资源配置是现代医学技术进步、医疗资源组织模式变革的必然要求,也是医保推动三医协同发展与治理的内在要求。医保推动三医协同发展与治理的政策路径包括:一是通过战略购买推动医药产业转向创新驱动,促进医药领域新质生产力的形成;二是通过分类分项预算,引导优化医疗资源的宏观配置;三是通过支付方式改革推动医院管理的现代化转型,从分解式管理走向战略管理。要实现上述目标,还需要治理模式的转型与治理能力的提升。

自拟除痤汤辨治痤疮

自拟除痤汤由桑白皮、枇杷叶、白花蛇舌草、虎杖、薏苡仁组成,具有配伍简单、药少力专的特点,诸药合用,可起到清肺泻脾、凉血解毒、除湿消痤之功效。临证加减治疗痤疮,具有较好的临床效果。附新病痤疮(邪实为主,肺经风热)、久病痤疮(邪实为主,热毒内蕴;邪正俱盛,热毒内蕴,痰湿瘀阻;正衰邪恋,热毒内蕴,气血不和)验案4则。

2019~2022版《医保药品目录》抗菌药物品种对比分析

目的对《国家基本医疗保险、工伤保险和生育保险药品目录》(以下简称《医保药品目录》)抗菌药物品规设置变化进行对比分析,以期更好地贯彻执行医保政策,促进临床合理应用。方法整理汇总2019~2022版《医保药品目录》中全身用抗菌药物,采用描述性分析方法,对比分析不同版本之间的差异。结果抗菌药物品规数及协议期谈判品种逐年增加;四版抗菌药物剂型以注射剂型、口服常释剂型为主(两者之和在79.14%~80.65%);限定支付条件药品2019版、2020版50种,在2021版增至54种,2022版锐减至44种;儿童抗菌药物专用药占比在3.76%~5.35%;《医保药品目录》涉及国家重点监控药物抗菌药物6个品种,9个品规。结论抗菌药物可及性和用药公平性得到进一步提升;需扩大《医保药品目录》抗菌药物限定支付条件,达到与说明书、临床诊疗指南一致;加大对儿童抗菌药物专用药的关注;加强涉及国家重点监控抗菌药物医保目录品种的管理。

基于数据挖掘分析中医药治疗自身免疫性肝病组方用药规律

目的:基于数据挖掘分析中医药治疗自身免疫性肝病的组方用药规律及特点。方法:检索中国知网、万方数据库、维普数据库中的文献,依照纳排标准对相关文献进行筛选整理,将处方信息录入中医传承辅助系统V3.0建立数据库,使用“统计分析、方剂分析、关联规则、聚类分析”等模块进行数据挖掘与分析。结果:共纳入符合要求的文献139篇,处方139首,涉及251味中药。药物出现频次前10位依次是柴胡、茵陈、黄芪、赤芍、白术、甘草、茯苓、当归、白芍、郁金;药性以寒性、温性为主;药味以苦味、甘味及辛味为主;归经主入肝经、脾经、肺经;功效前4位依次是补虚类、清热类、利水渗湿类、活血化瘀类。关联规则分析获得18组高频药物组合,排在前4位分别为柴胡-甘草、茯苓-白术、黄芪-白术、茵陈-赤芍。K-means聚类分析挖掘出新核心类方4首。结论:中医药治疗自身免疫性肝病的处方以补虚类、清热类、利水渗湿类、活血化瘀类药物为主,药物组合及类方分析体现出疏肝理气、益气健脾、清热利湿、活血化瘀等治疗方向。

中医医院开展DRG支付方式改革现状与思考

DRG支付方式改革是深化医药卫生体制改革的全新举措,也是中医药事业和中医医院高质量发展的重要手段。中医特色诊疗服务体系具有独特性,中医医院开展DRG支付方式改革面临诸多挑战。通过对中医医院DRG支付方式改革实施过程进行分析,发现中医医院仍面临DRG支付方式与中医辨证论治难契合、中医诊疗供给能力和应用范围有限、面临财务风险压力、中医特色诊疗难以发挥及信息化建设滞后等问题。中医医院需要从政策和医院管理两方面着手,结合中医优势病种,修改完善DRG支付方案,发挥中医特色诊疗优势,加快中医医院医保支付方式改革步伐,推动中医医院和中医药事业持续高质量发展。

中国医保支付体系改革25年:成就、问题与展望

医保支付体系和支付机制是决定医保制度运行和医保基金支付的核心规则,是关系到群众医疗服务的获得感和医保基金使用效率的关键所在。本文对我国建立基本医疗保险制度25年以来支付方式改革取得的成就进行了总结,对支付方式发展历程进行了回顾;在分析医保支付方式改革现状和目前存在的问题基础上,提出中国特色医保支付体系改革未来发展的五个取向,包括从后付制到预付制,从总额控制到总额预算,从西学中用到中西结合,从单一方式到多元复合,从数量支付到价值购买;最后,从联动机制、支付机制、支付政策和支付体系等四个方面对构建统一的中国特色医保支付体系改革前景提出政策建议。