中医与西医比较及中医科学性

中华医学博大精深,源远流长,是世界上唯一存续数千年而又拥有系统理论的医学.但是从20世纪初以来,由于不断受到排挤、压制和打击,中医的处境越来越艰难,所遭的非议越来越喧嚣,以至有人企图以"不科学"之名将其归于"迷信"或打入"另册".

我走过的中西医结合历程

中西医结合治疗乙型肝炎病毒相关性肾炎16例疗效观察

乙型肝炎病毒相关性肾炎(HBV-GN)是乙型肝炎病毒(HBV)感染后的主要肝外病变之一,该病为临床疑难杂症,目前尚无理想的治疗药物.近年来,我们采用益肾固精为主的中药治疗合用西药抗病毒、保肝治疗,取得满意疗效,报道如下.

中西医结合研究骨质疏松的思路与方法

骨质疏松发病机理与防治研究已成为中老年人保健的重要课题,并列为国家"九五"重点攻关项目.同时,由于发病机理尚不完全清楚,而带来的治疗方法多样性,缺乏特效性.因此,引起了中、西医和中西医结合研究者的极大兴趣,广泛地进行了研究.

中西医结合治疗骨折新概念

中西医结合治疗骨折已经历了30多年的历史,在它的发展过程中其基本概念已有了很大的改观。已由过去的以中医为主配合有限的西医治疗发展到中西各半相辅相成的治疗方式,基础理论研究方面由以往的以中医理论解释深入到利用现代医学的高新技术对其机理进行分析,使其更具有科学性。1　中西医结合治疗骨折基本概念转变　　中西医结合治疗骨折起源于闭合手法复位、小夹板固定、功能锻炼的整体原则。下肢长管状骨骨折可配合骨牵引治疗,持续牵引对位满意后行夹板固定,但随着经济、交通的发展,开放性损伤、多发性损伤已在骨伤科中占主导地位,单纯靠闭合复位和夹板固定已不能满足现代发展的需要,故原始中西医结合治疗骨折的基本概念必须转变。这种转变过程主要分为三步。1.1　开放性创伤患者不能采用夹板固定,为了适应这种改变,在治疗中开始采用外固定支架　这种改变是由原始中西医结合治疗的无血疗法向有血疗法的转变,较多的西医治疗成分开始融入中西医结合治疗骨折之中。中西医结合外固定支架固定是指外固定支架固定,待软组织条件允许、骨折对位稳定后(纤维连接、软骨骨痂连接),去除外固定支架改为夹板固定,此种治疗方式可缩短患者带架时间,减少感染发生,有利于患者功能锻炼。1.2　复位固定支架的应用　中西医结合治疗骨折的原始方法卧床时间较长,与AO系统卧床时间相比较已明显显示出这一大不足,已不能适应当今社会的发展。为克服这一弊病,复位固定支架在原外固定支架基础上被发明应用。此种支架大特点为既有固定作用又有复位作用,部分支架可在功能锻炼过程中利用生理应力使骨折复位(即固定过程中的复位)。此种疗法卧床时间明显减少,将复位和固定融为一体,有利于早期功能锻炼,并能在骨折断端产生一定的生理应力刺激,充分体现了中西医结合治疗骨折的基本原则。具有代表性的复位固定支架包括平衡固定牵引器,抓髌器,锁骨固定带鹰嘴钩,踝钳复位固定器等。1.3　有限手术的融入　中西医结合治疗四肢长管状骨骨折已接近系列化,但对于特殊部位的骨折,单靠手法复位、外固定已不能达到满意的疗效,为了克服这种局限性,有限手术配合手法治疗开始融入中西医结合治疗骨折方法中,使中西医结合治疗骨折产生了质的飞跃,并使其更具有特色。　　跟骨骨折是一种致残率较高的损伤。骨折后慢性疼痛率高达80%以上,经过深入研究发现跟骨宽度的变化及Bohler′氏角的改变是跟骨骨折治愈后慢性疼痛的主要原因。为减少术后慢性疼痛的发生,现采用经皮撬拨复位配合跟骨靴固定、弹性踏轮练功,取得了满意的疗效。这是一种兼具中医“金针拨骨”和“西医内固定”的有血疗法,是有限手术的体现。利用此种方法治疗的骨折还包括桡骨小头骨折、胫骨平台骨折、内踝骨折并发翻转移位等关节内骨折。2　中西医结合治疗骨折基础理论研究2.1　骨折愈合模式的研究　中西医结合治疗骨折愈合过程被归为二期愈合,即大量外骨痂形成,并把大量外骨痂形成原因考虑为相对固定所引起。近年来,通过大量动物实验采用血管灌注、电镜观察发现,切开复位内固定与中西医结合治疗骨折大差别在于切开复位组早期由于骨皮质外侧血运的破坏,产生外侧近1/4的骨皮质萎缩,这种皮质萎缩的修复往往需要5～6周,基本上与骨折愈合同步,而骨折周围血肿因无成骨细胞进入而形成纤维疤痕。中西医结合治疗骨折组则无皮质萎缩,骨折周围血肿依靠骨外膜的成骨细胞侵入形成外骨痂,因此中西医结合治疗骨折的骨折愈合模式应定义为无外侧骨皮质萎缩的情况下伴有大量外骨痂形成。2.2　中药机理研究　国内骨伤科及海外华人群居区有大量的骨伤方剂的应用现已超过3000种,这些方剂广为民间所接受。通过对不同方剂抽样观察动物实验发现,所有方剂治疗骨折均有一共同特点,即早期促进骨折周围血液循环、扩张血管、加速血肿的机化;中期促进成骨细胞的生成及转化,对成骨细胞的影响可能为血运增加、供氧量增强所致。可将各种方剂分为两大类:①温和型。此种剂型挥发性及渗透性均较弱,作用起效慢,但持续时间较长,对皮肤刺激性小。②强力型。此类剂型挥发性及渗透性均较高,起效快,患者感觉强烈但持续时间短,对皮肤刺激性较大。　　开放感染骨折的煨脓长肉研究。生肌膏对感染创面作用机理的实验研究表明:①生肌膏的抗感染作用不在于直接杀菌、抑菌,而是调动机体的局部免疫功能;②生肌膏激活巨噬细胞,加强其趋化性,抑制其移动,增强其吞噬作用,这是生肌膏启动了巨噬细胞表面的膜受体后引起的。该研究方法先进、数据完整、科学性强,而且对其作用原理提出了新论点,可初步作为中医“煨脓长肉”学说的机理之一

中西医结合治疗急性颅脑损伤的临床体会

我们收治了35例因车祸等原因造成颅脑损伤病人,在一般西药治疗基础上,加用中药血府逐瘀汤配合低能量He-Ne激光血液内照射治疗,取得明显疗效,报告如下.

中西医结合治疗SARS所致肺纤维化61例疗效分析

SARS所致的肺纤维化是该病恢复期一个较为常见而严重的问题,为了探讨有效的防治方法,我们对61例SARS所致的肺纤维化患者的治疗情况和临床特点进行了初步分析,现总结如下.材料与方法

中西医结合治疗SARS的临床疗效分析

自2002年11月底中国广东地区暴发流行传染性非典型肺炎(infectious atypical pneumonia,IAP)以来,全球多个国家,尤其是中国大陆、东南亚等地都出现了暴发流行.2003年2月底美国疾病预防控制中心(CDC)将其命名为严重急性呼吸综合征 (severe acute respiratory syndrome, SARS) .

中西医结合治疗功能性子宫出血病46例疗效观察

功能性子宫出血病简称"功血”,概括了中医的崩漏、月经先期、月经过多、经期延长等病证.现将1994年后治疗的78例疗效观察报告如下.

中西医结合治疗扩张型心肌病45例临床观察

扩张型心肌病(DCM)是一种以左心室扩张和收缩功能减退为特征的心肌病.多数学者研究表明:DCM的发生与持续的病毒感染及由此导致的心肌自身免疫损伤有关.现代医学以血管紧张素转换酶抑制剂、β-受体阻滞剂、血管紧张素Ⅱ受体拮抗剂、利尿剂、强心剂等为基本的治疗方案,虽然远期生存率有所改善,但由于本病病理生理复杂,临床表现不一,上述治疗方法效果欠佳.笔者在常规西药治疗基础上加用心肌活力饮治疗DCM 45例,并与单纯西药组44例作对比,随访1年取得满意疗效,现将结果报告如下.

中西医结合治疗传染性非典型肺炎(SARS)45例临床分析

自从2002年11月广东省首次报告传染性非典型肺炎(SARS)以来,现本病已在世界20多个国家内流行蔓延.根据世界卫生组织专家研究,现初步认定其病原体为新的或称变异型冠状病毒,本病目前尚无特效疗法,故各地区依据发病特点及病理过程采取了不同的处理方法,统一的治疗方案尚待确立.广州中医药大学第一附属医院自2003年2月2日至2003年4月30日共收治传染性非典型肺炎(SARS)病人45例,运用中西医结合的疗法,取得了较好的临床疗效.现对收治病例的临床中西医结合疗效及转归等进行初步分析总结如下.

糖尿病肾病中西医诊治中的几个问题

糖尿病肾病(DN)是糖尿病微血管病变的严重并发症之一,无论是在1型还是2型糖尿病患者中都有着较高的发病率,是决定糖尿病预后的重要因素,随着糖尿病发病率的逐年上升,目前已经成为终末期肾功能衰竭的首位病因,所以关于糖尿病肾病的防治近20年来一直是糖尿病治疗中的重要一环.

Objective: To explore the diagnostic and therapeutic approach of integrated traditional Chinese and western medicine (TCM-WM) on infectious multiple organs dysfunction syndrome/multiple system and organ failure (MODS/MSOF) for elevating the successful rate of rescuing the patients. Methods: Diagnosis with western medicine and Syndrome Differentiation of TCM in 225 in-patients of acute infectious disease complicated with MODS/MSOF were conducted, and TCM treatment, based on western medical comprehensive treatment, was given to observe the effect and explore the mechanism of the TCM-WM therapy. Results: Up to the end of 1998, 161 cases of the 225 cases were successfully cured and 64 died, the mortality being 28.4%. Among them, 58 out of 140 cases of MSOF died, the mortality was accounted for 41.4%. In 106 cases conformed to the diagnostic criteria of MSOF proposed by Professor Knaus WA, USA, 52 cases were cured successfully and 54 died, the mortality being 50.94%. Conclusion:TCM-WM treatment could elevate the therapeutic effect in treating MODS, the mechanism might be through improving the hemodynamic and hemorrheologic condition of patients to relieve nail-fold microcirculation disorder; influencing the levels of cytokine and inflammatory mediator, so as to alleviate the systemic inflammatory reaction, it might also abate the inhibited condition of gastro-intestinal motility, alleviate the intestinal flora imbalance, prevent intestinal bacteria and endotoxin malposition, and protect cells from peroxidation.

On Oct. 20-22, 2001, a commemorating meeting for the 20th anniversary on the founding of Chinese Association of Integration of Traditional and Western Medicine (CAIM) and the start publication of Chinese Journal of Integrated Traditional and Western Medicine (CJIM) was held in Xi'’an, 436 participants from various provinces and districts, as well as Taiwan province attended the meeting. Rapid development and outstanding achievements were summarized by Prof. Wei BEI-hai, Vice-President of CAIM. Since 1981, CAIM has held 12 international and 380 national academic conferences, 62,000 member-times participated the meetings, the CAIM member increased from 13,000 to 52,000 in 20 years. There are 57 integrated hospitals, over 30 integrated institutes, 10 integrated journals, 35 specialty committees nationwide. Some well-known scholars delivered special lectures, such as Prof. XU Xiao-jie of Peking University (“Chemistry and Chinese Medicine”), Prof. HOU Can from Sun Yat-sen University of Medical Sciences (“Unified Medicine of Post-Gene Era”), Prof. Yang Sze Piao of Taiwan Association of Integrated Medicine (“Education of New Generation Chinese Medical Practitioner of Taiwan”) and other 5 scholars'’ lectures. Deputy Director of Editorial Board CHEN Dong-yan reported that CJIM ( Chinese edition) has published 21 volumes, particularly the citation frequency listed 1st among 2 804 scientific journals in China 1999, indicating the quality of this journal is high. Prof. WANG Wen-jian of Shanghai has been elected as Vice President of CAIM, and Prof. ZHAO Jian-xiong elected as member of director board of CAIM. Prof. SHE Jin, on behalf of State Administration of TCM (SATCM), delivered a speech entitled “4 Famous Veteran TCM Practitioners in Beijing and Integrated Medicine” to congratulate the convening of the meeting. Academician of Chinese Academy of Sciences, President of CAIM Prof. CHEN Ke-ji chaired the meeting, he said, “Past 20 years was the developing and rapidly expanding 20 years under the governmental policy of ‘integrating Chinese and western medicine’ despite many difficulties have been conquered”, he strengthened in his opening speech, “This meeting would inspire the huge passion of engaging in integrating both medicines as well as creating in clinical practice, strive to rally together Chinese and western practitioners, to promote academic exchange of integrated medicine at home and abroad, so as to realize the modernization of Chinese medicine, enrich the world medicine and contribute to the health of mankind”.

Objective: To explore the curative effect of integrated traditional Chinese and western medicinal (TCM-WM) therapy on incipient diabetic nephropathy (DN).Methods: One hundred patients with incipient DN were randomly divided into two groups, the treated group (50 cases) was treated with TCM-WM therapy, which was carried out by using Jiangtang Jianshenling (JTJSL) capsule, a Chinese preparation for supplementing Qi and nourishing Yin, on the basis of effectively controlling blood glucose with western medicine. The 50 patients in the control group were treated with western medicine alone. The course of treatment was three months. Changes of symptoms, signs and related laboratory parameters were observed before and after treatment.Results: The total effective rate in the treated group was 90% while that in the control group 58%, the difference between the two groups was significant (P<0.05). The related parameters including 24 hrs urinary albumin excretion, blood sugar, microalbuminuria, blood and urine β2-microglobulin, blood lipids and hemorrheologic parameters were all improved after treatment in the treated group (P<0.05 or P<0.01).Conclusion: The curative effect of TCM-WM was better than that of western medicine alone in treating incipient DN.

To observe the effect of Shuangcao Tuihuang Granule-1 (SCTH-1) in treating severe jaundice of acute icterohepatitis and to study its mechanism. Methods: Thirty-four patients with severe jaundice of acute icterohepatitis were treated with conventional western medicine and SCTH-1, the therapeutic effects were analyzed and compared with that in the control group (treated with western medicine alone). In the animal experimental studies, the influences of SCTH-1 on acute liver injury, liver superoxide dismutase (SOD) and serum ALT and AST in mice were monitored. Results: The markedly effective rate in the treated group and the control group was 73.5% and 59.1% respectively, and the effective rate was 23.5% and 40.9% respectively. The markedly effective rate in the treated group was obviously higher than that in the control group (P＜0.05). Experimental study showed that SCTH-1 could reduce the level of serum transaminase and liver tissue damage in mice with acute liver damage. In addition, SCTH-1 could raise the activity of liver SOD (P＜0.05). Conclusion: SCTH-1 could accelerate the jaundice subsidence, improve the liver function and ameliorate the liver injury, its mechanism was possibly correlated with raising SOD activity and scavenging oxygen free radicals.

　　Psoriasis is a kind of chronic relaptic skin disease, and at present there are no appropriate therapeutical methods. From March 1998 to May 1999, we used the traditional Chinese and western medicine (TCM-WM) approach in treating this disease, and satisfactory result was obtained. We clinically observed this method in treating psoriasis, with hemorrheological examinations performed, and it is reported as follows.METHODSDiagnostic Standard　　According to the diagnosis standard in “Modern Dermatology” (chiefly edited by YANG Guo-liang, WANG Xia-sheng. Shanghai: Shanghai Medical University Press, 1996∶513-514), the patients were confirmed to suffer from psoriasis vulgaris; and according to TCM syndrome differentiation as blood stasis type.

　　From February 1995 to March 1999, compared by 108 patients treated by western medicine, 120 patients suffering from chronic eczema on their hands have been treated by the authors with modified Weiling Decoction (WLD) and the therapeutical effects observed. The results are reported as follows.METHODSClinical Data　　All the patients who suffered from eczema on hands were outpatients and were tested by local squamous fungus culture before treatment, with the results negative, and conformed to the diagnostic standards of eczema in “Clinical Dermatology”(2nd edition, Nanjing, Jiangsu Science and Technology Press. 1999∶512-515). The patients were divided into the treated group and the control group. There were 120 patients in the treated group, 56 males and 64 females, their age ranging from 24 to 64 years, mean age 44 years; the illness course were 1-12 years, mean course 6.5 years, 35 of the patients were accompanied with eczema on other parts of the body or nail change. At the same time there were 108 patients in the control group, 46 males and 62 females; their age ranging from 18 to 56 years, mean age 37 years; the illness course ranging from 3 to 10 years , mean course 6.5 years, 38 of the cases were accompanied with eczema on other parts of the body or with nail change. Statistical analysis indicated that the two groups were comparable.

　　Thirty-five patients of infantile purpura nephritis (IPN) were treated with integrated traditional Chinese and western medicine (TCM-WM) from January 1994 to December 1998, with good efficacy obtained, and following is the report.METHODSClinical Data　　All the 65 cases were inpatients, and conformed to the “Standards of the Diagnosis and Therapeutical Effect of Hematological Diseases” (edited by ZHANG Zhi-nan. Tianjin: Tianjin Science and Technology Press, 1999∶235-239). They were randomly divided into two groups: Treated group: 35 cases, 23 males, 12 females; aged 4-13 years, 7 years on average; disease course 4-18 days, the mean 10 days; mild type 19 cases (asymptomatic hematuria, proteinuria), nephritis syndrome type 13 cases (hematuria, proteinuria, edema, hypertension), and nephrotic syndrome type 3 cases (typical manifestation of nephrosis complicated with renal insufficiency). Control group: 30 cases, 20 males, 10 females; aged 3-14 years, 6 years on average; disease course 3-16 days, the mean 9 days; mild type 16 cases, nephritis syndrome type 10 cases, nephrotic syndrome type 4 cases. The clinical manifestation, sex, age, hospitalisation time of these 2 groups showed insignificant difference.Method of Treatment　　The control group: Adopting intravenous dripping of dexamethasone 0.3-0.5 mg*kg-1*d-1, consecutively for 5-7 days, which was then shifted to prednisone 1-1.5 mg*kg-1*d-1, altogether 2-3 weeks, with Vit C, persantin, chlorphenamine, calcium, etc., orally taken.　　The treated (TCM-WM) group, on the basis of the above-mentioned WM treatment, had also TCM syndrome differentiation performed, and were classified into 3 types:

Professor XU Jian-zhong was born in a family of traditional Chinese doctor in Beijing, August, 1930. His native place is Putian, Fujian Province. Prof. XU has engaged for more than 40 years in clinical medicine since he was graduated from Shanxi Medical University in 1954. From 1958 to 1961, he was released from work to attend the TCM Learning Class for Doctors of Western Medicine for 3 years and granted the first grade prize by the Ministry of Health at graduation. Since then, the integration of traditional Chinese and western medicine (TCM-WM) has been the cause he devoted himself to. Now, he is Chief Doctor in Xiyuan Hospital, China Academy of Traditional Chinese Medicine, visiting professor of postgraduate education Department of China Academy of TCM, and Director of Specialty Committee of Respiratory Diseases, Chinese Association of Integration of Traditional and Western Medicine (CAIM).