目的：分析线上线下混合案例展示培训教学方法在中医住院病历理法方药一致性病历质量改进中的应用效果。方法：对全院实习医师、规培医师、住院医师、进修医师、主治医师进行理法方药线上线下结合混合培训，采用具体案例分析演示教学法进行演示教学，教学结束后，每月通过电子病历系统，对某三甲中医院的环节病历进行理法方药专项质控，观察培训前后住院病历理法方药一致性相关数据，评价培训效果。结果：经过线上线下混合案例展示培训教学，某中医院住院病历理法方药书写逐步规范，全院住院病历理法方药一致率逐步提高，全院理法方药一致率由培训前67.02%逐步上升到培训后的80.22%。结论：线上线下混合案例展示培训教学方法，有助于规范中医病历书写者理法方药书写逻辑，提高中医住院病历理法方药一致率。

吕文良教授认为慢性乙型肝炎(Chronic hepatitis B,CHB)因疫毒内伏,其基本病机为肝脾肾失调、湿热内蕴、毒损肝络,治疗过程中强调清热利湿、祛邪解毒应贯穿疾病的始终,扶助正气是疾病治疗的关键;同时以治未病思想为指导,截断病势,重视整体调养,尤重调神.辨病与辨证相结合治疗慢性乙型肝炎,疗效显著,并附典型医案一则.

目的 了解临床医师对重点专科中医住院病历书写的认知与需求,寻求针对性解决方案,以便提高重点专科中医住院病案的管理质量.方法 制定某医院重点专科中医住院病案质量评价调查问卷,于2018年1月1日-2018年12月31日对全院120名住院医师、主治医师进行调查,对结果分析汇总,了解临床医师对重点专科中医住院病案书写的认知与需求.结果 超过60％的医师认为,虽然病案书写任务繁重,但应严格要求;超过90％的医师认为专科病案书写有助于诊疗思维的梳理与提高、对重点专科建设与优势病种的诊疗具有积极意义.超过66％的医师认为应在病案首程中病例特点、辨病辨证依据、鉴别诊断、诊疗计划、上级医师查房方面,突出专科及中医特色.书写难点主要集中在鉴别诊断、辨病辨证依据、专科查体、理法方药一致性.结论 临床医师对重点专科中医住院病案书写的重要性认识统一、难点清楚、需求明确,可从加强信息化技术支持、提高一线医师的临床水平、加强病历书写专项培训方面,提高重点专科中医住院病历的质量.

瞑眩反应是疾病趋愈的一种祛邪反应,古今医家对其发生机制的观点不一.文章收集、整理瞑眩反应相关文献,总结古、今对瞑眩反应成因的看法,介绍吕文良教授从引阳入阴论瞑眩的经验,以期为临床对其进一步探索提供参考.吕文良教授认为久病之体,宿邪内伏,湿热痰瘀交阻而脏腑经络不通,致卫阳独行于外,不得入阴,机体阴阳失交,而瞑眩反应是机体借助药物作用,引阳入阴,使阴阳复交、正气渐盛,疾病自去而成的一种佳兆.

从百合汤的出处、药物剂量、功效出发,阐析百合汤的方义、主治,在此基础上,介绍姚乃礼主任使用该方的临床经验,并列举医案,说明姚师使用该方治疗脾胃阴虚兼有气滞的脘腹胀痛,以及兼有情志抑郁及焦虑的阴虚气滞的脘腹胀痛的经验.

现代多认为慢性肝病的病机为湿热疫毒内蕴,治疗时重用苦寒之品以清热解毒.吕文良教授深入分析其病因病机,认为慢性肝病的病理性质为本虚标实;主张在辨证论治的基础上,治疗以调和气血为主,尤应重视益气,同时佐以清热、利湿、解毒等法.黄芪为临床常用药物,尤擅于补气.黄芪通过其益气作用可扶正祛邪、健脾、补益肝气、活血利水,对各种慢性肝病都具有治疗作用,且在其临床各阶段均可使用.故吕教授在治疗慢性肝病常灵活运用黄芪,并与清热解毒、活血利水等药配伍,以达到标本兼治的目的.吕文良教授善用黄芪辨治慢性肝病的经验,为临床治疗提供了新的治疗思路.

近年来,SARS、禽流感、埃博拉病毒等各种急性传染病频繁流行,常导致患者出现体温升高,甚至高热,严重危及患者生命.而西医治疗此类外感高热常疗效欠佳,而中医药在外感高热治疗方面有其独特的优势.该文探讨了麻黄、石膏、人参在治疗外感高热中的应用,结合疾病的病因病机及病理改变,系统分析了这3味药在外感高热不同阶段的作用机理及组方治疗,以期为外感高热的中医药治疗提供更多参考和依据.

单纯性尿频,虽疾病简单,但严重影响患者的生活质量,给患者身心带来极大困扰.目前临床治疗多从肾入手,或为肾阴不足,虚火于内,影响膀胱气化;或为肾阳不足,肾失封藏,膀胱失约.本文介绍吕文良主任医师使用黄芪建中汤,从调整肺、脾、肾三脏气化入手,治疗单纯性尿频,立法治疗与众不同,效果显著,值得临床参考,故介绍于此.

玉屏风散组方为黄芪、白术和防风,具有扶正固表的作用,临床应用广泛,极具开发应用价值.通过查阅近年来有关玉屏风散防治肝病的相关文献,对玉屏风散各组分的肝病防治相关机制、全方防治肝病的临床应用与药理研究进行概括与总结,证实其在肝病的防治中具有调节免疫、抗氧化、抗纤维化;抗肿瘤的作用.

《伤寒论》作为方书之祖,对后世中医临床的发展产生深远的影响,值得不断学习与思考.《伤寒论》中关于身痒的论治涉及两处,分别是微邪郁表,不得小汗透达所致之身痒;以及久病伤津,不能作汗所致之身痒.本文就前者,从小汗法出处、治疗身痒的机理、伤寒小汗法三方区别、临床应用要点、临床研究等方面对小汗法治疗身痒进行探讨,以期对临床身痒的治疗有所裨益.

Objective The relevant literature on the treatment of liver cirrhosis ascites in recent ten years is summa-rized. The progress in the treatment of cirrhotic ascites in recent years is described. Methods Through the retrieval of CNKI and Wanfang database, 125 literatures were collected and analyzed. To eliminate duplicate documents and described the etiology, pathogenesis and treatment of traditional Chinese medicine. Results The pathogenesis of liver cirrhosis ascites is qi deficiency. The influence of qi stagnation, water stop and blood stasis.The currently Chinese medicine treatment includes three aspects: therapy based on sydrome differentiation, basic prescription with modified, and Chinese medical external treatment. Conclusion Chinese medicine in the treatment of liver cirrhosis ascites have advantage and efficacy, but rigorous evidence based medical research and normative experimental studies are still lacking, it still needs to be further studied.

对药是临床上常用的相对固定的配伍形式,可由两味或三味药组成,在方剂配伍中常相辅相成以增强疗效及减弱毒副作用.吕老师在慢性肝病的诊治过程中,在辨证用药的同时,结合辨病用药,所选药物精炼,配伍严谨,疗效显著,有效的阻断了“慢性肝炎-肝纤维化-肝硬化-肝癌”这一进展过程,为辨证与辨病相结合治疗慢性肝病提供了一定的指导和借鉴作用.

Objective To analyze the defects in TCM medical record connotation quality, to explore the appropriate preventive measures, in order to improve the quality of medical records writing, guarantee medical quality and safety.Methods A hospital level medical record quality inspection team was formed to randomlycheck the medical records with all wards in the TCM hospital. A total of 228 medical records in 19 wards were checked. According to the basic requirements of writing basic norms of TCM medical records, and the quality check list of inpatient medical records in a hospital, the connotation and quality of TCM medical records were reviewed, and thedefects were analyzed and summarized. Results The connotation quality defects of inpatient medical records in a hospital were summarized. The problem is mainly concentrated in the Look, listen, question and feel the pulse --four ways of diagnosis, differentiation of symptoms and signs, differential diagnosis of Chinese Medicine, tentative diagnosis, Uniformity of prescription and prescription, modification of treatment and prescription to syndrome differentiation, the syndrome of primary disease treated with proprietary Chinese medicine dialectical, and Doctors' rounds of higher levels, lack of TCM content, Lack of guidance. Among them, the higher physician rounds, the connotation and guidance of TCM are not prominent, accounting for 44.98%.Conclusion We should improve the understanding of the medical staff of medical record quality, through special training and guidance, strengthen the physician teaching consciousness, strengthen the process of quality control department and hospital departments self-examination, give appropriate incentives, but also hope that the country as soon as possible introduce TCM hospital medical record quality control standard for evaluation, in order to strengthen the quality management of medical records, improve the quality of medical records writing in traditional Chinese medicine.

Objective To improve the quality of medical records through the study of the evaluation standard of medical records of Chinese hospitals. Methods To review the quality control situation of hospital medical records in a hospital from 2006 to 2010, and use questionnaire survey and interview method were applied to solicit the opinions of clinicians to discuss the quality evaluation criteria of TCM medical records. Results In the past five years, there were 5,876 cases of medical records and 13.85% of the quality defects of TCM, which focused on four diagnostic information, discrimination basis of disease differentiation, rational prescription drugs, and superior physician''s inspection. Recycling effective questionnaire 249, the survey found that more than 85% of physicians agreed that a hospital''s current medical record quality evaluation standard, writing case of junior doctors pay attention to is practical, the superior doctors pay more attention to the connotation of the medical record and the value of academic research. Conclusions The operation of medical record quality control of traditional Chinese medicine should be centered around the nucleus of medical security system, establish a unified national standards, highlighting connotation characteristics of traditional Chinese medicine, on the basis of guarantee the quality of medical records, balance the weight of each inspection project, make evaluation criterion to be more relevant to clinical practice.

The physiology of the liver is closely related to Qi and blood.The main cause of autoimmune hepatitis are the insufficient blood of liver,the clogged Qi of liver,the weakness of spleen and stomach,and the lack of Qi and blood.It has a significant effect by professor LYU to treat autoimmune hepatitis with harmonizing Qi and blood,and harmonizing liver and spleen.

Cirrhosis develops from liver fibrosis and is the severe pathological stage of all chronic liver injury.Cirrhosis caused by hepatitis B virus and hepatitis C virus infection is especially common.Liver fibrosis and cirrhosis involve excess production of extracellular matrix, which is closely related to liver sinusoidal endothelial cells (LSECs).Damaged LSECs can synthesize transforming growth factor-beta and platelet-derived growth factor, which activate hepatic stellate cells and facilitate the synthesis of extracellular matrix.Herein, we highlight the angiogenic cytokines of LSECs related to liver fibrosis and cirrhosis at different stages and focus on the formation and development of liver fibrosis and cirrhosis.Inhibition of LSEC angiogenesis and antiangiogenic therapy are described in detail.Targeting LSECs has high therapeutic potential for liver diseases.Further understanding of the mechanism of action will provide stronger evidence for the development of anti-LSEC drugs and new directions for diagnosis and treatment of liver diseases.

If applied properly,the decoction with wind drug has a significant effect on antidiarrheal.The paper analyses the mechanism of antidiarrheal decoction with wind drug.It was discussed from the aspectsofrelieving the exterior,shengyang,shengshi,liver-regulating and spleen-strengthening,combined with the research results of modern pharmacology on wind medicinesingle drug.The author also summarizes the clinical application points of wind-drug in order to provide some references for the clinical application.

溃疡性结肠炎是一种病因不明的慢性非特异性肠道炎症,中医药治疗本病存在一定的优势与特色.陶夏平主任医师在长期的临床工作中积累了丰富的经验,他认为本病的主要病机为脾虚失运、湿热蕴结肠腑,其中气滞血瘀为局部的病理变化,寒热错杂是病理属性,肝强脾弱是病机关键;辨治中应分缓急、辨脏腑、顾兼症,治疗上宜权衡虚实、气血并调,同时注重患者的情志因素,身心并调.

姚乃礼教授为中国中医科学院广安门医院主任医师,博士生导师,第四、五批全国老中医药专家学术经验继承导师。从事中医临床、科研、教学40余载,擅长运用经方治疗肝、胆、脾、胃及内科疑难病证。笔者有幸能侍诊左右,受益良多,现将姚教授运用当归芍药散治疗脂肪肝经验总结如下。

络病理论是中医学重要的病机学说.基于络病理论探讨慢性萎缩性胃炎(CAG)的中医病机,提出了“脾虚络阻毒损”为CAG的基本病机,“脾虚”“络阻”“毒损”是CAG病机演变中的基本因素,多表现为脾胃亏虚→胃络瘀阻→毒损胃络的病机演变规律.其中脾胃亏虚是CAG的始动因素、发病之本;胃络瘀阻是CAG致病的关键条件;毒损络脉是CAG发展为癌前病变的重要因素.本病的表现较为符合络病发病的特点,通过络病理论可以更好地阐明CAG的病机特点,更加深入了解CAG的病机演变规律.