中医诊断学课程的内容可概括为诊法与辨证两大部分,因此,对其MOOC(Massive Open Online Course)的建设与实践分为中医诊断学MOOC(上)和中医诊断学MOOC(下)两部分进行.基于混合式学习和探究性学习的先进理念,以及望、闻、问、切四诊的教学目标和教学内容特点,首先将导论及四诊部分内容碎片化,重新梳理为118个知识点,制成118个短小授课视频,并设计了非视频内容(如作业、讨论、考试等),形成中医诊断学MOOC(上)的课程内容,在中国大学MOOC平台免费开课8轮,选课人数17万余人,实现了课程的校内、校外共享与应用,促进优质教学资源的共享,并为全面开展翻转课堂提供支撑.

杨毅玲教授从事中医诊断教学及临床研究工作30余年,对“消渴病”治疗的继承与发展.杨毅玲教授认为现代人的饮食、生活节奏都较从前发生了变化,消渴病的病因不仅仅是过去传统中医学认为的“气阴两虚”.杨毅玲教授认为“痰浊”是现代消渴病之主要病因之一.经过长期临床实践及经验总结认为:现代人的消渴病与脾胃功能失调有关,故提出健脾化浊,和胃消痞,疏肝解郁为治疗法则.

通过分析研究相关文献和临床实践,发现肝脾两脏与抑郁症发病关系密切,且肝脏和脾脏在生理上相辅相依,在病理上相互影响,肝脾之病常常互为因果而酿成肝脾同病之疾,重视肝脾同调对抑郁症的防治有重要意义.

目的 观察血府逐瘀汤加减方治疗不宁腿综合征患者的临床疗效.方法 根据计算机制定的随机号将不宁腿综合征患者234例随机分为治疗组(119例)和对照组(115例),分别采用中药血府逐瘀汤加减方与西药盐酸普拉克索治疗,疗程4周,观察两组治疗前及治疗后第1、2、3、4周末不同时间点国际不宁腿综合征自评量表(IRLSSG)、匹茨堡睡眠质量指数量表(PSQI)、汉密尔顿焦虑量表(HAMA)、17项汉密尔顿抑郁量表(HAMD17)、健康状况问卷(SF-36)、治疗药物副作用量表(TESS)等评分的变化,以判断两者的临床疗效.结果 治疗组总有效率为81.3％ (87/107),优于对照组67.3％(70/104,P＜0.05).在第4周末时,治疗组IRLSSG评分显著低于对照组(P＜0.01),PSQI因子的睡眠质量、入睡时间、睡眠时间、催眠药物、日间功能评分及总分均较对照组显著改善(P ＜0.05,P＜0.01),HAMA评分显著低于对照组(P＜0.01).两组治疗后HAMD17评分比较差异无统计学意义(P＞0.05),治疗组于第4周末时其生理机能(PF)、生理职能(RP)、躯体疼痛(BP)、总体健康(GH)、生命活力(VT)、社会功能(SF)、情感职能(RE)、精神健康(MH)评分和总分均较治疗前显著升高(P ＜0.05,P＜0.01),且其PF、BP、VT和SF的评分较对照组升高更加显著(P＜0.05),但两组总分比较差异无统计学意义(P＞0.05).结论 血府逐瘀汤加减方治疗不宁腿综合征有较好的临床疗效,同时能改善不宁腿综合征患者的睡眠、焦虑、抑郁和生活质量.

指甲是人体的荧光屏,如果能够及早掌握这些疾病所发出的早期信息,就可以预防和治疗疾病,保证身体健康.通过临床实践,发现指甲的颜色和形态与脏腑疾病关系密切,甲诊对临床诊断疾病有着重要的意义和价值.

目的 分析“案例式教育”对中医学大学生研究能力的培养方法与意义.方法 通过“案例式教育”历史背景的分析,结合“中医临床技能实训教学团队”的经验总结,对病案教育方法进行解析.结果 通过侍诊病例与阅读医案,大学学生以及中医师可进行辨证论治技能的自我训练、知常达变本领的自我培养及从医案中吸收各家的经验特长.结论 “病案式教学”是中医教育不可分割的一部分,其可以丰富学生的临床经验,增强学生今后临床工作的信心,达到教学相长的目的.

"四诊"技能培训是中医诊断学课程的组成部分.基于行为主义和建构主义的学习理论,结合"四诊"技能培训的特点,构建了望诊、切诊"刺激—反应—强化—重复—形成"的培训模式及问诊"情境模拟—主动思考—交流互动"的培训模式,两种模式的建立旨在帮助学生掌握诊查方法的规范化操作,对所涉及的知识点有正确认知和有效辨识,并促进学生辨证思维能力的形成和拓展,从而达到掌握中医四诊技能并能应用于中医临床和构建辨证思维能力的目的.

Objective Through the investigation of Traditional Chinese Medicine Constitution classification in the elderly of Chaoyang District Sanlitun community in over 65 years old in Beijing, to analyze the physical characteristics of the elderly and those with high blood pressure, diabetes, coronary heart disease, physical type of hyperlipidemia population characteristics, so as to provide a reference for traditional Chinese constitutional dialectical in health management, disease control older, traditional Chinese medicine health care, advocacy education and other aspects. Methods According to the Chinese Medical Association of Traditional Chinese Medicine Traditional Chinese Constitution Classification and Determination, the outpatient physical identification embodiment of traditional Chinese medicine was used. Results 13. 8%of the total number were gentleness survey, eight kinds of biased constitution was 86. 2%. People of four kinds slow patient had different types (P<0. 05). Conclusion This investigation revealed the physical characteristics of the elderly of Sanlitun community, which consisted of four kinds of chronic disease group types of constitution. In the future work according to different physical crowd health education and guidance, it improved their physique, prevented the happening and development of related diseases, and improved the quality of life of the elderly.

目的 研究抗抑郁治疗对老年高血压合并抑郁障碍患者血压的影响及其改善生活质量的临床疗效.方法 老年高血压合并抑郁障碍患者304例,随机分为治疗组156例和对照组148例,分别给予盐酸曲唑酮和盐酸曲唑酮模拟药,2组治疗4周,观察治疗前和治疗后第1、2、3、4周患者血压、17项汉密尔顿抑郁量表(HAMD17)、汉密尔顿焦虑量表(HAMA)、健康状况问卷(SF36)和治疗药物副作用量表等评分的变化,判断2组的临床疗效.结果 治疗组第3、4周末HAMD17评分较对照组显著降低,治疗组抑郁治疗的有效率优于对照组(79.9％ vs 28.3％,P＜0.05);治疗组的目标血压达标率显著高于对照组(76.4％ vs 44.9％,P＜0.01).治疗组HAMA评分第3、4周末较对照组显著下降(P＜0.01);2组SF-36总分及各项评分治疗第4周末较治疗前均有显著提高(P＜0.05,P＜0.01),治疗组生理功能、躯体疼痛、生命活力、社会功能和健康变化等的改善优于对照组(P＜0.05).结论 抗抑郁治疗有助于改善老年高血压合并抑郁障碍患者的血压和生存质量.

According to the long-term clinical practice and experience,professor Yang Yiling concluded that the development of palpitation was related to the function disorders of spleen and stomach and proposed that invigorating spleen and supplementing qi,nourishing yin and blood,promoting blood circulation to remove meridian obstruction and tranquilize mind had good effect.

目的:通过对悲伤相关文献的研究分析,描述其中医症状名词术语使用现状,研究其中医辨证特点.方法:通过检索北京中医药大学研发的中医古代方剂数据库中与悲伤描述相关的古文文献,提取与悲伤术语和辨证相关的记述,分别统计术语和辨证意义,录入数据库并进行统计分析.结果:古代医家描述悲伤情绪的术语有57种,频次出现较高的术语是忧愁(14,9.8％)、忧恚(9,6.3％)、悲伤不乐(8,5.6％).悲伤情绪脏腑病位主要在心(70,68.0％)、肾(13,12.6％)、肝(11,10.7％),气血津液辨证病位主要在气(33,73.7％),病因主要为风(39,63.9％)、寒(13,21.3％),病性主要辨证为虚(58,64.4％)、阳(14,15.6％)、阴(12,13.3％).结论:古代文献关于悲伤名词术语具有丰富的表述方式,术语的个体化特点明显,变异度较大,悲伤的术语表述繁杂而不规范,术语程度深浅不同,表述较为笼统,术语内涵不清晰的特点.悲伤的辨证意义也与古代传统五志的划分存在差异.

金匮肾气丸主治肾气不足和肾阳不足诸证.笔者经过多年临床实践对金匮肾气丸的临床应用也积累了丰富的经验,特别是用于治疗老年顽固性睡眠障碍、甲状腺功能减退、老年抑郁症、老年便秘等疑难疾病疗效突出,文章现将其经验介绍如下,以供同道分享.

目的 了解老年缺血性中风患者的中医体质特点.方法 采用中医体质量表对178例缺血性中风的老年患者进行中医体质调查,并对正常老年组的体质进行比较.结果 缺血性脑中风老年患者出现频率最多的体质类型依次为气虚质、血瘀质,其次为阳虚质和痰湿质,与正常组比较两者差异显著;体质类型分布与性别有明显相关性;不同年龄组出现频率最多的偏颇体质分布如下:60～69岁组,血瘀质(16次,24.62％)、气虚质(15次,23.08％);70 ～79岁组气虚质(28次,31.82％)、血瘀质(17次,19.32％)、阳虚质(15次,17.05％);80岁以上组,血瘀质(17次,39.53％)、气虚质(16次,37.21％).结论 老年人急性缺血性中风患者的中医体质分布有一定规律性且不同年龄组老年人的体质有一定的差异性.

Objective To study the efficacy of traditional Chinese medicine ( TCM) on chronic insomnia and impro-ving their quality of life in elderly patients.Methods 437 elderly patients with chronic insomnia were assigned to two groups, the test group included 223 cases treated with TCM according to syndrome differentiation and control group included 214 cases treated with Estazolam.And then the scores of Pittsburgh sleep quality index (PSQI),short form 36 health survey questionnaire (SF-36),Hamilton depress scale (HAMD,and Hamilton anxiety rating scale (HAMA) were recorded and compared between be-fore and after the treatment.Results The scores of PSQI,HAMD,and HAMA after treatment were significantly reduced compa-ring with those before treatment (P<0.001).The efficacy rates (82.9%) of test group was higher than that (67.3%) of control group (P<0.001).And Traditional Chinese medicine can improve the social functioning and quality of life in elderly patients with chronic insomnia.The common adverse reactions,such as drowsiness,dizziness,dry mouth,constipation,in test group were less than in control group(P<0.05).Conclusion Traditional Chinese medicine has better efficacy and less side effects than Estazolam on insomnia and it can improve the social functioning and quality of life in elderly patients.

痈疽是中医诊断教材中局部望诊的重点内容,由于目前各版本教材中界定不尽一致,使课堂教学歧义颇多,鉴于此,本文从历代疡科主要著作着手,对痈疽的阴阳病性、鉴别要点、相关现代疾病以及疽的疼痛特点进行分析,冀以对该部分的教学有所裨益.

Objective:To study the differences of health condition among university students with different personalities so as to provide evidence for the study of influence factors of health condition. Methods :With homemade health questionnaire,Beck anxiety inventory(BAI),Beck depression inventory(BDI) and Eysenck personality questionnaire(EPQ-RSC) as measuring tools,a field investigation was conducted in 308 students who came from different universities,including Beijing University of Chinese Medicine,Shandong University of Traditional Chinese Medicine and Shanxi College of Traditional Chinese Medicine. Built a database on the platform provided by the research team of 973 Project,made statistical analysis by SPSS 17.0,and analyzed the health condition of testees with different personalities. Results :1Among the 308 students,there were 66 lowly neurotic individuals(male:21,female:45) and 61 highly neurotic individuals(male:26,female:35). 2Among lowly neurotic individuals,the total score of P scale in EPQ-RSC is(47.21±8.61),the E scale(56.97±8.62),the N scale(34.17±1.13),the L scale(54.13±9.64). The score of health questionnaire is(7.75 ±6.58),with high frequency symptoms of aversion to cold,foreign body sensation in throat and dry mouth. The total score of BAI is(22.74±2.28),with high frequency items of dyspepsia or abdominal discomfort,nervousness and dizziness. The totalscore of BDI is(0.68±1.11),with high frequency items of lassitude,compunction and melancholy. Low neurotic individuals share the personality of stabilized-extroversion. 3Among highly neurotic individuals,the total score of P scale in EPQ-RSC is(49.48±9.22),the E scale(44.80±10.47),the N scale(58.58±6.53),the L scale(47.64±7.74). The score of health questionnaire is(13.48±9.21),with high frequency symp toms of aversion to cold,dry mouth,lassitude and dry eyes. The total score of BAI is(27.28±5.46),with high frequency items of fearing of happening of bad things,nervousness,dyspepsia or abdominal discomfort and inability to relax. The total score of BDI is(3.70±3.65),with high frequency items of melancholy,compunction and lassitude. Conclusion:Testees with different personalities have different health condition. Low neurotic people have less and slighter discomfort. The level of depression and anxiety are lower than those of highly neurotic people. Highly neurotic people have more kinds of discomfort and the discomforts are more serious. Among highly neurotic people,introverted individuals are more than that in lowly neurotic people.The level of anxiety and depression of highly neurotic people are higher than that of lowly neurotic people.

Objective:To summarize the syndrome differentiation of TCM psychiatric symptom status through analyzing the modern literature.To provide the fundamental certification of standardizing the technical terminology and exploring the standard of TCM psychiatric symptom.Methods:The database which contained the related literature of TCM psychiatric symptom was searched.By using Excel table,the database of TCM psychiatric symptom was founded,and statistical analysis was carried out by SPSS 17.0.Results:Various differences existed in the technical terminology of TCM psychiatric symptom,on account of the ambiguous connotative meaning and lacking of academic consensus degree of the TCM psychiatric symptom.The significance of syndrome differentiation on TCM psychiatric symptoms was uncertain,which relied on the syndrome differentiation thoughts of physical syndromes.The minority clinical pattern was psychiatric symptom syndrome differentiation,of which was significantly important.However,it only can be recognized by somatic syndrome differentiation.Conclusion:The technical terminology of TCM psychiatric symptom requires progressive regulation.The significance of TCM psychiatric symptoms awaits deeper probe and research.

中医辨证论治学基础课程是在以证为核心、以证统法、以法统方的思想指导下,对中医诊断学课程中“辨证”的内容与方剂学内容进行重新整合设计,将理、法、方、药熔为一炉,系统介绍有关辨证论治基础理论与方法,为我校中医学专业五年制本科生开设的一门新课程.为便于学生掌握中医临床辨证分析及处方用药一贯性的规律,从教学内容、教学方法、教材和团队等方面进行了课程建设,并通过两轮教学实践,获得了良好的教学效果.

九年制岐黄国医实验班是北京中医药大学中医学专业首次推出以9年直博为特色的教学实验班,在全国尚属首例,也是我校学制最长、培养要求最高的班级.通过9年的学习,直接获得博士学位,最终目标为培养从事中医医疗、预防、保健等工作的中医药临床精英人才.为了实现这一目标,中医诊断学课程的教授面临着更大的挑战,无论从教学大纲的制定、教学时数的安排、教学方法的采用和教学内容的教授上,我们都进行了深入探索、改革和提高,具有不同于其他学制(如五年制、八年制)的教学特色,通过2届的教授和教学研究,均取得了良好的教学效果,达到了预期的中医诊断学教学目标和要求,为探索如何培养中医高精尖人才进行了有益尝试,积累了一定的经验.

TCM constitutional study is a practical discipline to research human constitutional characteristics,types,laws of difference and relationship among constitutional types,health and diseases based on TCM philosophy and physiology theory including yin-yang theory,five phase theory,essential qi theory,viscera and bowels,meridian,essence,qi,blood,fluid and humor.Along with the development of preventive treatment of disease and individual diagnosis and treatment,TCM constitutional study has been introduced into the research of insomnia.The authors expounded comprehensively the causes and pathogenesis of insomnia from the relative discussions of TCM constitutional study.The purpose is to find out the special laws of onset,change and prognosis of insomnia in population with the same constitutional type for guiding clinical practice.