中醫(yī)急診學(xué)的源流和發(fā)展

1、中醫(yī)急診學(xué)源流和發(fā)展 The originanddevelopmentof the emergency of Traditional Chinese Medicine方邦江 教授Prof. FANG Bangjiang上海中醫(yī)藥大學(xué)從屬龍華醫(yī)院Longhua hospital affiliated to Shanghai university of traditional Chinese medicine 第1頁(yè)方邦江教授 介紹教授/主任醫(yī)師、醫(yī)學(xué)博士博士生導(dǎo)師搶救科主任中華醫(yī)學(xué)會(huì)急診分會(huì)常務(wù)委員中華中醫(yī)藥學(xué)會(huì)急診分會(huì)副主任委員世界中醫(yī)藥聯(lián)合會(huì)急診分會(huì)會(huì)長(zhǎng)中國(guó)中西醫(yī)結(jié)合學(xué)會(huì)搶救醫(yī)學(xué)專業(yè)委員會(huì)副

2、主任委員第2頁(yè)Introduction of Prof. Fang Professor, MDDoctoral tutorDirector of Emergency department Member of the standing committee in Emergency Branch of the Chinese Medical Association Deputy committee director of Emergency Branch of China Association of Traditional Chinese Medicine President of Emerge

3、ncy Branch of the World Federation of Chinese Medicine Deputy committee director of Emergency Branch of the Integrated Traditional Chinese and Western Medicine 第3頁(yè)中醫(yī)急診學(xué)歷史源流The historical originof the emergency of Traditional Chinese Medicine第4頁(yè)黃帝內(nèi)經(jīng)奠定了中醫(yī)急癥理論基礎(chǔ)雛形Huangdi Neijing established an initial

4、theoretical foundation of the emergency science of TCM.黃帝內(nèi)經(jīng)中詳細(xì)記載了中醫(yī)急癥相關(guān)病名、臨床表現(xiàn)、病因病機(jī)、診治關(guān)鍵點(diǎn)及預(yù)后，從而奠定了中醫(yī)急診醫(yī)學(xué)理論基礎(chǔ)。It recorded the related disease names, the clinical manifestations, etiologyandpathogenesis, diagnosis and treatment, prognosis in detail of the TCM emergency.第5頁(yè)傷寒雜病論推進(jìn)中醫(yī)急癥理論發(fā)展Treatise on Fe

5、brile and Miscellaneous Diseasespromoted the development of the theory of the TCM emergency.張仲景以當(dāng)初傷寒熱病為基礎(chǔ)，創(chuàng)建了中醫(yī)學(xué)辨證論治學(xué)術(shù)思想，奠定了中醫(yī)急診學(xué)辨證救治體系。Zhang Zhongjing created the academic thoughts of treatment based on syndrome differentiation，which established a system of syndrome differentiation and treatment.第6

6、頁(yè)晉唐時(shí)期至明清主要貢獻(xiàn)The significant contributions from Jin and Tang Dynasty to Ming and Qing Dynasty.晉葛洪肘后備急方總結(jié)了魏晉南北朝時(shí)期治療內(nèi)、外、婦、兒、五官科急癥經(jīng)驗(yàn)，拓寬了急癥范圍，發(fā)展了給藥路徑，創(chuàng)建了腸吻合術(shù)。Ge Hong from Jin Dynasty written the Zhouhou Beiji Fang. He summarized the medical experience of treating the acute diseases of internal, surgical,

7、 gynecological, pediatric and ENT medicine. He broaden the scope of acute diseases and developed the route of administration. He also created the intestinal anastomosis.第7頁(yè)隋代巢元方編著諸病源候論，其中急癥病證占四分之一多。Chao Yuanfang from Sui Dynasty written the book Treatise on the Causes and Manifestations of Diseases.

8、 There are more than a quarter of pages recorded the acute syndromes and diseases.第8頁(yè)唐孫思邈在千金要方和千金翼方中明確提出“備急方”，27首專供搶救，如“倉(cāng)公散”“還魂散”。Sun Simiao from Tang Dynasty written the book Qianjin Yao Fang and Qianjin Yi Fang. He presented 27 prescriptions of emergency, e.g. Canggong San and Huanhun San.第9頁(yè)金元四大家

9、深入豐富和發(fā)展了急癥理論和治療方法。The four eminent physicians in Jin and Yuan period enriched and developed the theory and treatment of the acute diseases.第10頁(yè)溫病學(xué)說(shuō)形成和發(fā)展最終奠定了中醫(yī)急診醫(yī)學(xué)理論體系The formation and development of the theory of epidemic febrile disease finally established the theoretical system of TCM emergency.第

10、11頁(yè)中醫(yī)藥在急危重癥中應(yīng)用歷史悠久The Traditional Chinese Medicine has a long history in treating the critical and acute diseases. 第12頁(yè)幾千年來(lái)，中醫(yī)學(xué)形成了完整系統(tǒng)理論體系。在沒有當(dāng)代醫(yī)學(xué)介入漫終年代中，一切急、慢性疾病皆診治于中醫(yī)藥。The Traditional Chinese Medicine has formed a complete theoretical system for thousands of years. In the time without the western

11、medicine, the acute and chronic diseases are all diagnosed and treated with TCM.第13頁(yè)中醫(yī)藥在救治急危重癥、保障中華民族生命健康中起著不可磨滅貢獻(xiàn)，中醫(yī)急癥是中醫(yī)學(xué)精華之所聚。Traditional Chinese Medicine plays an indelible contribution to the treatment of acute and critical diseases. It protects the life and health of the Chinese people. It is

12、the essence of the Traditional Chinese Medicine. 第14頁(yè)華佗創(chuàng)制麻沸散Doctor HUA Tuo created Mafeisan (One kind of anesthetic medicine)第15頁(yè)晉代葛洪肘后備急方口對(duì)口吹氣法 Doctor GE Hong in Jin Dynasty introduced artificial respiration in the book “Zhouhou Beiji Fang”第16頁(yè)唐代孫思邈創(chuàng)造蔥管導(dǎo)尿法Doctor SUN Simiao in Tang Dynasty introduce

13、d catheterize technology by scallion stem.第17頁(yè)扁鵲救治尸厥扁鵲乃使弟子子陽(yáng)厲針砥石，以取外三陽(yáng)五會(huì)。有間，太子蘇。乃使子豹為五分之熨，以八減之齊和煮之，以更熨兩脅下。太子起坐。 更適陰陽(yáng)，但服湯二旬。而復(fù)故。故天下盡以扁鵲能生死人。扁鵲曰：“越人非能生死人也，此自當(dāng)生者，越人能使之起耳。” 節(jié)選自史記扁鵲倉(cāng)公列傳 第18頁(yè)Doctor Bian Que treated syncope Doctor Bian Que told his student Zi Yang to sharpen the needle and to acupoint Baih

14、ui. In a moment the prince was revived. Doctor Bian Que ordered his student Zi Bao to prepare drugs ironing, plus agents boiling mixture, alternating in two sash iron deposition. Then the prince was able to sit up.Then regulated the balance of yin and yang and told the prince to take the herbal deco

15、ction for 20 days. Finally the prince regained his health. -From “The records of the historian Bian Que Cang Gong biography” 第19頁(yè)張仲景救治自縊記載 1700多年前漸漸抱解，不得截繩，上下安被臥之一人以腳踏其兩肩，手少挽其發(fā)，常弦弦勿縱之 一人以手按揉胸上，數(shù)動(dòng)之一人摩捋臂脛屈伸之若已僵，但漸漸強(qiáng)屈之，并按其腹如此一炊頃，氣從口出，呼吸，眼開，而猶引按莫置平臥體位開放氣道連續(xù)胸外心臟按壓舒展胸廓，助力呼吸腹部按壓助以通氣和血液回流不可中止心臟按壓，直至復(fù)蘇成功第20頁(yè)

16、Doctor ZHANG Zhongjing saved hanging Golden Chamber Synopsis recorded 1700 years ago Supine position Open the airway Continuous chest compressions Stretch Chest to Help breathing Press the abdomen to help ventilation and blood return Do not interrupt cardiac massage until successful resuscitation第21

17、頁(yè)中醫(yī)藥在急危重癥領(lǐng)域中發(fā)展 The development of Traditional Chinese Medicine in Emergency.第22頁(yè)吳咸中院士利用中醫(yī)藥方法治療急腹癥天津南開醫(yī)院吳咸中院士建立了“中醫(yī)辯證與西醫(yī)辨病相結(jié)合”臨床研究方法，確定了以“通里攻下法”為代表“急腹癥八法”治療法則大黃制劑在急性胰腺炎中應(yīng)用。第23頁(yè)Academician WU Xianzhong treated acute abdomen with TCMAcademician Wu in Tianjin Nankai Hospital established the “Chinese and

18、 Western medicine dialectical combination of disease differentiation” methods. He determined the “purgative Law” as the representative of “acute abdomen Eight” treatment rules.Rhubarb preparation was used in treating the acute pancreatitis. 第24頁(yè)王今達(dá)教授利用中醫(yī)藥方法治療膿毒血癥天津搶救醫(yī)學(xué)研究所王今達(dá)教授（我國(guó)危重病醫(yī)學(xué)創(chuàng)始人）創(chuàng)建血必凈注射液臨床用

19、于膿毒血癥治療廣泛用于膿毒癥、多器官功效障礙綜合征、急性呼吸窘迫綜合征、慢性肺源性心臟病心功效不全、重癥急性胰腺炎等各種危急重癥第25頁(yè)P(yáng)rof. Wang Jinda treated sepsis with TCMProfessor Wang Jinda (the founder of Critical Care Medicine in China) from Tianjin Institute of Emergency Medicine developed Xuebijing injection for the treatment of sepsis.The injection is wi

20、dely used in sepsis, MODS, acute respiratory distress syndrome, chronic pulmonary heart disease heart failure, severe acute severe pancreatitis and other critical diseases.第26頁(yè)毒熱證血虛證血瘀證Sepsis惡化活血化瘀法扶正固本法 清熱解毒法瘀毒互結(jié)祖國(guó)醫(yī)學(xué)針對(duì)膿毒血癥內(nèi)因治療 “三證三法”Toxic heat第27頁(yè)血必凈在膿毒血癥中作用步驟Sepsis, Diffuse intravascular coagulati

21、on, DIC, Septic shock第28頁(yè)朱培庭教授利用中醫(yī)藥方法治療急性膽道感染、膽石病 在總結(jié)顧伯華、徐長(zhǎng)生教授經(jīng)驗(yàn)基礎(chǔ)上，靈活應(yīng)用“理氣解郁、清熱解毒、通里攻下” 基本治法。感染較重者，尤其注意采取清熱解毒與通里攻下并進(jìn)，扶正與驅(qū)邪相結(jié)合標(biāo)準(zhǔn)。Summed up the experience of Professor Gu Bohua and Xu Changsheng, Prof. Zhu used the basic method of“regulateing qi stagnation, detoxification, purgative method”. For heav

22、y-infected patients, using the principles combined with clearing away heat, toxic material and purgative, strengthening body resistance and eliminating evil.第29頁(yè)朱培庭教授利用中醫(yī)藥方法治療急性膽道感染、膽石病 清熱解毒可填補(bǔ)單用抗生素不足，還含有減毒作用；通里攻下，可改進(jìn)呼吸功效，降低毒素吸收，增加膽汁流量和松弛括約肌。臨床使用后可顯著降低手術(shù)率。 Detoxification way can not only compensates

23、 for the disadvantage of antibiotics, but also has an effect of reducing poisonousness. Purgative method can improve respiratory function as well as reduce the absorption of toxins. It can also increase the bile flow and relax the sphincter. By using these ways the rate of surgery can be significant

24、ly reduced .第30頁(yè)唐漢鈞教授利用中醫(yī)藥方法治療毒蛇咬傷 中西醫(yī)結(jié)合治療毒蛇咬傷是優(yōu)勢(shì)與特色之一。季得勝蛇藥是含有代表性臨床治療毒蛇咬傷藥品。We have advantages and characteristics to treat snakebite with integrated Chinese and Western medicines. Ji Desheng Chinese drugs for snakebite is a representative to treat such kind of disease.第31頁(yè)唐漢鈞教授利用中醫(yī)藥方法治療毒蛇咬傷 當(dāng)前我院每年救治大約100例蛇傷病人，除一例因送院時(shí)間晚、救治無(wú)效死亡外，其它千余例病人全部被搶救成功，已經(jīng)成為上海市和華東地域著名治療毒蛇咬傷?？啤urrently our hospital treat about 100 patients of snakebite every year. All the patients were rescued except one died for too late to hospital. We have been famous for treating snakebite and become the snakebite specia