Raising the Academic Authority of Clinical Experience: The Department of Internal Medicine at Keijo Imperial University and Its Periodical Imsangnaegwahak.

This paper examines the periodical Clinical Internal Medicine published by the Department of Internal Medicine at Keijo Imperial University in colonial Korea. Previous studies on medical research at Keijo Imperial University have primarily focused on preclinical departments such as anatomy, hygiene, pharmacology, and microbiology which produced knowledge that supported Japan's imperialistic expansion. This approach has overlooked the research contributions of clinical departments, often viewing the roles of preclinical and clinical departments through a dichotomy between research versus clinician training. However, Clinical Internal Medicine demonstrates that the Department of Internal Medicine at Keijo Imperial University was actively engaged in research. By analyzing the purpose and content of Clinical Internal Medicine, this paper reveals that its publication was an effort by the Department of Internal Medicine to address the demand for practical knowledge among clinicians practicing outside the university. At the same time, it reflects a commitment to enhancing the academic value of clinical experience and critiques the blind pursuit of experimental medicine in the Japanese medical community in the 1920s and 1930s. The case of the Department of Internal Medicine at Keijo Imperial University illustrates the transformation of clinical experience into "worthy" academic knowledge in colonial Korea. Based on these findings, this paper provides insights into the role of clinical departments at Keijo Imperial University in research and post-graduation education.

Clinical factors associated with invasive pulmonary aspergillosis in patients with severe fever with thrombocytopenia syndrome: analysis of a 6-year clinical experience.

Background: Invasive pulmonary aspergillosis (IPA) typically occurs in immunocompromised individuals. Severe fever with thrombocytopenia syndrome (SFTS) patients are typically characterized by fever, thrombocytopenia, and leukopenia. These patients typically present with dysregulation of cellular and humoral immunity, which may predispose them to IPA. Our study aimed to identify risk factors for SFTS-associated invasive pulmonary aspergillosis (SAPA) and evaluate its associated prognostic impact. Methods: We conducted a cohort study between January 2017 and December 2022 in a tertiary hospital in Wuhan City, China. All SFTS patients hospitalized in our department who formally consented were divided into a SAPA group and a non-SAPA group according to whether they were coinfected with aspergillosis or not. The independent risk factors for the SAPA group were determined by multivariate logistic regression. Receiver operating characteristic (ROC) analysis was used to assess the statistical value of parameters to predict SAPA patients. The survival analysis was carried out using the Kaplan-Meier (KM) method. Results: Of the 269 hospitalized SFTS patients enrolled in the study, 118 (43.87%) cases were diagnosed with SAPA with an average age of 65.71 ± 9.7 years. Multivariate logistic regression analysis revealed that age, neurological complications, serum severe fever with thrombocytopenia syndrome virus (SFTSV) RNA loads, the white blood cell (WBC) count, platelet (PLT) count, albumin (ALB) and globulin (GLB) concentrations, and cardiac troponin I (cTNI) were complementary risk factors for the development of IPA in SFTS patients. The risk score is calculated as 5 times age, plus 6 times neurological complications, plus 10 times RNA (log), plus 5 times WBC, minus 5 times PLT, minus 5 times ALB, plus 5 times GLB, and plus 6 times cTNI. ROC curve analysis showed that the area under the receiver operating characteristic (AUROC) curve represented a risk score of 0.837 (95% CI: 0.789-0.885, p < 0.001) for predicting IPA in SFTS patients. The average length of hospitalization in the SAPA group was more prolonged than non-SAPA. SAPA and non-SAPA groups had significantly different mortality rates: 25.42% (SAPA) and 3.97% (non-SAPA) (p < 0.05). Conclusion: SFTS patients with IPA have high morbidity and mortality. Early monitoring of neurological complications, SFTSV RNA loads, WBC, PLT, ALB, GLB, and cTNI in SFTS patients may be useful in predicting the occurrence of IPA.

Nurses' experience of prehospital sepsis assessment: a qualitative study.

BACKGROUND: Sepsis is a frequent cause of global deaths with time critical diagnosis and treatment impacting outcomes. Prehospital emergency nurses are pivotal in assessment that influences timely diagnosis. AIM: To gain a deep understanding of nurse's experiences when caring for those with suspected sepsis. DESIGN AND METHODS: A qualitative study using semi-structured interviews and inductive content analysis according to the Elo Kyngäs method. FINDINGS: Early identification of sepsis by prehospital emergency nurses (n = 13) was augmented through a combination of clinical experience and the implementation of practice guidelines. There were three key components to practice improvement a) clinical experience, b) continuous education and c) explicit guidelines. CONCLUSIONS: Identification of sepsis in the prehospital environment can shorten the time to treatment for patients with sepsis. Early identification can be achieved by continuous education in the Emergency Medical Service (EMS), ensuring experienced personnel and including the EMS in medical guidelines.

Towards evidence-based practice 2.0: leveraging artificial intelligence in healthcare.

Background: Evidence-based practice (EBP) involves making clinical decisions based on three sources of information: evidence, clinical experience and patient preferences. Despite popularization of EBP, research has shown that there are many barriers to achieving the goals of the EBP model. The use of artificial intelligence (AI) in healthcare has been proposed as a means to improve clinical decision-making. The aim of this paper was to pinpoint key challenges pertaining to the three pillars of EBP and to investigate the potential of AI in surmounting these challenges and contributing to a more evidence-based healthcare practice. We conducted a selective review of the literature on EBP and the integration of AI in healthcare to achieve this. Challenges with the three components of EBP: Clinical decision-making in line with the EBP model presents several challenges. The availability and existence of robust evidence sometimes pose limitations due to slow generation and dissemination processes, as well as the scarcity of high-quality evidence. Direct application of evidence is not always viable because studies often involve patient groups distinct from those encountered in routine healthcare. Clinicians need to rely on their clinical experience to interpret the relevance of evidence and contextualize it within the unique needs of their patients. Moreover, clinical decision-making might be influenced by cognitive and implicit biases. Achieving patient involvement and shared decision-making between clinicians and patients remains challenging in routine healthcare practice due to factors such as low levels of health literacy among patients and their reluctance to actively participate, barriers rooted in clinicians' attitudes, scepticism towards patient knowledge and ineffective communication strategies, busy healthcare environments and limited resources. AI assistance for the three components of EBP: AI presents a promising solution to address several challenges inherent in the research process, from conducting studies, generating evidence, synthesizing findings, and disseminating crucial information to clinicians to implementing these findings into routine practice. AI systems have a distinct advantage over human clinicians in processing specific types of data and information. The use of AI has shown great promise in areas such as image analysis. AI presents promising avenues to enhance patient engagement by saving time for clinicians and has the potential to increase patient autonomy although there is a lack of research on this issue. Conclusion: This review underscores AI's potential to augment evidence-based healthcare practices, potentially marking the emergence of EBP 2.0. However, there are also uncertainties regarding how AI will contribute to a more evidence-based healthcare. Hence, empirical research is essential to validate and substantiate various aspects of AI use in healthcare.

Longitudinal integrated clerkships from start to finish: A medical curriculum innovation.

Stellenbosch University embarked on a renewal of its MBChB programme guided by an updated set of core values developed by the multidisciplinary curriculum task team. These values acknowledged the important role of (among others) context and generalism in the development of our graduates as doctors of the future for South Africa. This report describes the overall direction of the renewed curriculum focusing on two of the innovative educational methods for Family Medicine and Primary Health Care training that enabled us to respond to these considerations. These innovations provide students with both early longitudinal clinical experience (now approximately 72 h per year for each of the first 3 years) and a final longitudinal capstone experience (36 weeks) outside the central tertiary teaching hospital. While the final year experience will run for the first time in 2027 (the first year launched in 2022), the initial experience has got off to a good start with students expressing the value that it brings to their integrated, holistic learning and their identity formation aligned with the mission statement of this renewed curriculum. These two curricular innovations were designed on sound educational principles, utilising contextually appropriate research and by aligning with the goals of the healthcare system in which our students would be trained. The first has created opportunities for students to develop a professional identity that is informed by a substantial and longitudinal primary healthcare experience.Contribution: The intention is to consolidate this in their final district-based experience under the supervision of specialist family physicians and generalist doctors.

Psychiatric Mental Health Nurses' Perceptions and Experiences of Inpatient Mental Health Care Safety Culture in Saudi Arabia.

BACKGROUND: Although patient safety culture is gaining attention globally, more studies are needed to investigate its relevance to the nursing care of mental health (MH) patients. AIMS: This study aimed to illustrate the perceptions and experiences of nurses who work in inpatient mental health care (IMHC) concerning the patient safety practices that are employed to avert safety hazards encountered during the provision of care in IMHC settings. METHODS: Eighteen postgraduate students working as MH nurses in nonprofit hospitals comprised the study sample. The participants had a minimum of 2 years' nursing experience in IMHC settings. Each participant was interviewed individually using a guided interview technique. The inductive data underwent thematic analysis. RESULTS: Patient protection and a safety perspective were the overarching themes that emerged from the data. Three principal themes and 9 subthemes were illuminated: (a) patient care safety knowledge and background, (b) improving MH care, and (c) development of MH nursing care. CONCLUSIONS: The findings of this investigation may assist in providing guidance for the further research into and development of a patient safety culture appropriate for IMHC nursing practice, including increased structured educational experiences, judicious risk assessment, assignment of staff to include a mixture of skills and experience levels during assignments, use of standardized handoff procedures, engagement with multidisciplinary care providers, blame-free reflective information sharing and mentoring, and attention to the built environment with consideration of patient and staff safety needs.

[Clinical experience of Tianxiong Granules in treatment of hypertension based on treatment principle of supressing Yang and promoting blood circulation].

Hypertension is the most common chronic disease in clinics and has become the most common risk factor for cardiovascular diseases. Because of its high incidence rate, disability rate, and mortality, it has attracted worldwide attention. Despite continuous progress in modern medicine in the treatment of hypertension with new antihypertensive drugs such as Zilebesiran, a nucleic acid drug that acts on microRNA, direct renin inhibitors, and renal sympathetic blockade, the control rate is still not ideal. How to effectively prevent and control hypertension has become one of the urgent clinical challenges to be solved. Traditional Chinese medicine(TCM) has a long record of treating hypertension and has accumulated rich experience, including theoretical understanding, effective single medicine, compound medicine, traditional Chinese patent medicines, and classic famous prescriptions. In TCM, hypertension belongs to the categories of diseases such as dizziness and headache. Previous literature and clinical studies have found that hypertension has key pathogenesis such as fire syndrome, fluid syndrome, deficiency syndrome, and blood stasis syndrome. Among them, the hyperactivity of liver Yang is closely related to blood pressure fluctuations, blood pressure variability, inflammation, and sympathetic activity stimulation. Internal obstruction by blood stasis is closely related to the damage of target organs such as the heart, brain, and kidneys in hypertension. Therefore, the two key pathogenesis of liver yang hyperactivity and internal obstruction by blood stasis run through the entire process of hypertension. Previous studies have found that the effective empirical formula Tianxiong Granules, based on the principles of suppressing Yang and promoting blood circulation, originated from the classic formula Xiongqiong Tianma Pills in Yu Yao Yuan Fang. It is composed of Gastrodiae Rhizoma, Chuanxiong Rhizoma, Puerariae Lobatae Radix, Achyranthis Bidentatae Radix, and Cyathulae Radix and has significant therapeutic effects in the treatment of hypertension. The clinical indications include headache, dizziness, bloating, strong neck, and weak waist and legs. At the same time, it may be accompanied by poor speech, thirst, normal or loose stools, soreness in the waist and legs, lower limb pain, muscle and pulse spasm, menstrual and abdominal pain, dark red tongue, strong pulse strings, or straight and long pulse strings that pass through the mouth of an inch. In the combination rule, it can be used according to the different pathogenesis stages of hypertension patients. In the fire syndrome stage, it is often combined with Tianma Gouteng Decoction and Chaihu Jia Longgu Muli Decoction. In the fluid syndrome stage, it is often combined with Banxia Baizhu Tianma Decoction. In the deficiency syndrome stage, it is often combined with Liuwei Dihuang Pills and Shenqi Pills. In terms of dosage, it is important to focus on the main symptoms and adjust the dosage of key drugs based on blood pressure values. Some drugs can be used in sufficient quantities. By analyzing the compatibility of Tianxiong Granules, clinical application indications, combined formula experience, and dosage application experience, we provide effective treatment methods and more options for TCM to treat hypertension with Yang hyperactivity and blood stasis syndrome.

Nursing students' and faculty's experiences of first medication administration: A phenomenological inquiry.

BACKGROUND: Learning medication administration is essential for nursing students, but the first time can be stressful and shape their clinical development. Previous research primarily focused on student knowledge and technical aspects. PURPOSE: This phenomenological study helped explore the lived experiences of nursing students and faculty during student's first medication administration in the clinical setting to gain a deeper understanding of their thoughts, feelings, and perspectives. METHOD: Semi-structured interviews were conducted with female student and faculty informants (N = 12). Using a phenomenological study, data were analyzed using van Manen's hermeneutic six-step research activity method. RESULTS: Five overarching themes were found: administrating medication, (un)preparedness for complexities in the clinical environment, transformative experience, overcoming fears, and reaping the rewards. CONCLUSION: First-time medication experiences are greater than an exercise in skill proficiency and may be improved if faculty provides more structured learning experiences and take sufficient time for student preparation in relating medication knowledge to the skill, technology usage, and supporting students' attitudes toward nurse-patient interactions. These are essential aspects of the medication administration learning process as nursing programs shift toward competency-based education. Clinical faculty also need support in their role as educators and to be facilitated to find this time, considering their multiple responsibilities.

The Lived Experiences of Saudi Nursing Students in Digital Clinical Experience: A Phenomenological Study.

Background Novel digital methods of simulation are gaining popularity in nursing education in light of the limited access to clinical placement and expensive high-fidelity simulation technologies. Aim The aim of this study is to explore the lived experiences of Saudi nursing students in digital clinical experiences (DCEs). Methods A qualitative phenomenological research design, grounded in Husserlian phenomenology, was employed. Purposive sampling was utilized to select 21 participants actively involved in DCEs. In-depth interviews were conducted to collect rich, narrative data. Results The thematic analysis has yielded four themes, namely, "comfort and safety", "critical thinking and problem solving", "appraisal of knowledge", and "transition to practice." Conclusions The findings contribute to ongoing discussions about leveraging technology in nursing education, emphasizing the need for educators and policymakers to integrate digital tools that enhance the learning experiences of nursing students.

Targeted therapy or immunotherapy in BRAF-mutated metastatic melanoma: a Spanish center's decade of experience.

Background: Targeted therapies and immunotherapy are currently considered the mainstay first-line treatment for advanced BRAF-mutated melanoma. However, the impact of treatment (targeted therapy and immunotherapy) and the prognostic factors are still not clear. Material and methods: Medical records of 140 patients diagnosed with advanced melanoma between 2011 and 2021 were retrospectively reviewed to extract demographic, BRAF status, treatment, performance status, and survival data. ORR, PFS, and OS were compared between patients diagnosed with advanced melanoma and treated with first-line IT or BRAF/MEKi. The prognostic factors were assessed using Cox regression models. Results: In all patients and those treated with immunotherapy, we did not find any effect of BRAF status on ORR, PFS, or OS. In patients with BRAF-mutated melanoma, ORR was 43.8% vs. 70% (P=0.04), PFS was 19.2 vs. 11.5 months (p=0.22), and OS was 33.4 vs. 16.4 months for the immunotherapy and targeted therapy groups, respectively (P=0.04). ECOG, presence of brain metastases, and high LDH level from initiation of first-line treatment were all associated with differences in PFS and OS. Conclusion: Patients with advanced BRAF-mutated melanoma treated with first-line immunotherapy had a significantly longer PFS and OS than those treated with first-line BRAF/MEKi; however, first-line BRAF/MEKi treatment had a significantly higher ORR than first-line immunotherapy.

Perceptions of Clinical Experience and Scientific Evidence in Medical Decision Making: A Survey of a Stratified Random Sample of Swedish Health Care Professionals.

BACKGROUND: Evidence-based medicine recognizes that clinical expertise gained through experience is essential to good medical practice. However, it is not known what beliefs clinicians hold about how personal clinical experience and scientific knowledge contribute to their clinical decision making and how those beliefs vary between professions, which themselves vary along relevant characteristics, such as their evidence base. DESIGN: We investigate how years in the profession influence health care professionals' beliefs about science and their clinical experience through surveys administered to random samples of Swedish physicians, nurses, occupational therapists, dentists, and dental hygienists. The sampling frame was each profession's most recent occupational registry. RESULTS: Participants (N = 1,627, 46% response rate) viewed science as more important for decision making, more certain, and more systematic than experience. Differences among the professions were greatest for systematicity, where physicians saw the largest gap between the 2 types of knowledge across all levels of professional experience. The effect of years in the profession varied; it had little effect on assessments of importance across all professions but otherwise tended to decrease the difference between assessments of science and experience. Physicians placed the greatest emphasis on science over clinical experience among the 5 professions surveyed. CONCLUSIONS: Health care professions appear to share some attitudes toward professional knowledge, despite the variation in the age of the professions and the scientific knowledge base available to practitioners. Training and policy making about clinical decision making might improve by accounting for the ways in which knowledge is understood across the professions. HIGHLIGHTS: Study participants, representing 5 health care professions-medicine, nursing, occupational therapy, dentistry, and dental hygiene-viewed science as more important for decision making, more certain, and more systematic than their personal clinical experience.Of all the professions represented in the study, physicians saw the greatest differences between the 2 types of knowledge.The effect of years of professional experience varied but tended to be small, attenuating the differences seen between science and clinical experience.

Comparison between direct and indirect "digital image" dental visual shade matching considering the effect of clinical experience and gender.

INTRODUCTION: Shade matching is an essential procedure to obtain an esthetic prosthesis. The Direct Visual Shade Matching (DSM) method using shade guides is the most used method by dentists. However, The Indirect Visual Digital Shade Matching (ISM) method based on digital imaging is concerned to be reliable and useful in determining shade matching in dental practice. Several factors such as method, clinical experience, and gender can affect the success of shade matching. AIM OF THE STUDY: This study aimed to compare these two methods and evaluate the effect of experience and gender on the results. MATERIALS AND METHODS: Three volunteers' maxillary central incisor teeth were evaluated using (DSM) and (ISM) methods by 87 examiners (42 males, 45 females). These examiners were further divided into three groups based on their clinical experience: Undergraduate Preclinical Dental Students (UPDS) with 31 examiners, Undergraduate Clinical Dental Students (UCDS) with 34 examiners, and Postgraduate Dental Students from the Department of Prosthodontics (PDS) with 22 examiners. The spectrophotometer device results of three teeth were considered as a reference for shade matching. Statistical analyses of the data were performed using Kruskal-Wallis, Mann-Whitney U, and Chi-square tests. RESULTS: No significant difference was found between indirect and direct methods according to Perfect Matches (p > 0.05). However, according to Shade Matching Deviation Score (SMDS) values a statistically significant difference was found between the two methods where the best result was obtained with the ISM method (p < 0.05). There was a significant difference between the PDS group and the other two groups in terms of clinical experience (p < 0.05). There was no significant difference between gender groups (p > 0.05). CONCLUSION: Digital images, captured under standardized lighting conditions, may serve as a reliable alternative method for direct shade matching. The (ISM) method requires a camera, related accessories, and computer skills. However, as these tools are commonly available nowadays, the focus for practitioners should be on effectively learning and applying these tools to achieve the best results. While clinical experience plays a significant role in the shade matching process, gender does not appear to have a substantial influence. CLINICAL SIGNIFICANCE: This study found no significant differences between the (DSM) and (ISM) methods, leaving the clinical relevance of this method open to debate. However, the ISM method yielded superior responses. Despite requiring specialized tools, conditions, and training, the widespread use of cameras and computers in modern clinics makes the necessary equipment and software readily available. This method enhances clinician-technician communication, potentially improving prosthesis esthetics and patient satisfaction, especially for less experienced clinicians or those with color deficiencies. Further research is crucial to determine its clinical significance.

Does clinical experience affect the bracket bonding accuracy of guided bonding devices in vitro?

OBJECTIVES: To study whether and how the clinical experience of the operator affects the accuracy of bracket placement using guided bonding devices (GBDs) in vitro. MATERIALS AND METHODS: Five resin models were bonded virtually with brackets, and the corresponding GBDs were generated and three-dimensionally printed. Nine operators, which included three dental students, three orthodontic students, and three orthodontists, bonded the brackets on the resin models using GBDs on a dental mannequin. After being bonded with brackets, the models were scanned, and the actual and designed positions of the brackets were compared. RESULTS: There was no immediate debonding. The orthodontists spent a significantly shorter time (22.36 minutes) in bracket bonding than the dental students (24.62 minutes; P < .05). The brackets tended to deviate to the buccal side in the dental student group. Linear deviations tended to be smallest in the orthodontic student group, but no significant difference was found among operators with different clinical experience (P > .5). All linear and angular deviations in each group were under 0.5 mm and 2°, respectively. CONCLUSIONS: Clinical experience was positively related to the bonding accuracy using GBDs, especially in the buccolingual dimension. Inexperience also led to longer bonding duration. However, bonding accuracy was clinically acceptable in general.

Effect of clinical experience and training with visual feedback on standardized palpation outcomes-Potential implications for assessment of jaw muscle sensitivity.

BACKGROUND: The evaluation of muscle pain and sensitivity by manual palpation is an important part of the clinical examination in patients with myalgia. However, the effects of clinical experience and visual feedback on palpation of the masticatory muscles with or without a palpometer are not known. OBJECTIVE: To estimate the effects of clinical experience and visual feedback on the accuracy of palpation in standardized settings. METHODS: Thirty-two dentists (age 35 ± 11 years) classified as either specialists (n = 16) or generalists (n = 16) participated in this experiment. All dentists were instructed to target force levels of 500- or 1000-gf, as determined on an electronic scale using either standardized palpometers or manual palpation (MP). All dentists participated in four different tests: MP, MP with visual feedback (MPVF), palpometer (PAL) and PAL with visual feedback (PALVF). Actual force values for each type of palpation from 0 to 2, 2 to 5 and 0 to 5 s were analysed by calculating target force level. RESULTS: The relative differences during 2-5 and 0-5 s with 1000 gf were significantly lower for generalists than for specialists (p < .05). In generalists and specialists, the coefficients of variation and the relative differences during 2-5 s were significantly lower for PAL and PALVF than for MP (p < .05). CONCLUSIONS: These findings suggest that the use of a palpometer, but not clinical experience with palpation of masticatory muscles, increases the accuracy of palpation, and ≥2 s of palpation with a palpometer is optimal for masticatory muscles.

The Application of Classic Formulas in the Treatment of Malignant Tumors / 浙江中医药大学学报

[Objective]To summarize the experience in treating malignant tumors based on the syndrome differentiation of the six meridians and the usage characteristics of classic formulas in the Treatise on Febrile and Miscellaneous Diseases.[Methods]Based on the analysis of the disease classification method of"six channels differentiation of syndromes"in Treatise on Febrile Diseases and Miscellaneous Diseases and the process of malignant tumor onset,advance and prognosis is dynamized and the possibility of traditional Chinese medicine in the prevention and treatment of malignant tumors by"preventing the disease before it changes"is explored.At the same time,the common clinical strategies for the treatment of malignant tumor adverse reactions are listed,the modern application of classic formulas in the treatment of malignant tumor according to the clinical characteristics of the disease and literature research is summarized.[Results]As a positioning method in the process of disease development,the differentiation of six meridians can indicate the depth of the disease and the state of the struggle between positive and evil Qi during the development of malignant tumors,providing theoretical reference for the formation mechanism,site of onset,and prognosis of malignant tumors.Classic formulas have the characteristics of clinical universality,standardization of addition and subtraction methods,and comprehensive participation in anti-tumor treatment,reflecting the potential advantages of traditional Chinese medicine in treating malignant tumors.Classical formulas have practical value in treating cancer fever,cancer pain,radiation inflammation,nerve damage,digestive tract reaction and so on.[Conclusion]The application of classic formulas can effectively improve the quality of life of patients with malignant tumors,with the characteristics of full process,overall,and flexibility.The role of classic formulas in the treatment of malignant tumors is worth further exploration.

Analysis of CHEN Yongcan's Experience in Treating Chronic Atrophic Gastritis with Intestinal Metaplasia Based on the Patho-genesis of"Deficiency in Origin and Toxin Accumulation" / 浙江中医药大学学报

[Objective]To summarize Director CHEN Yongcan's experience in treating chronic atrophic gastritis with intestinal metaplasia the pathogenesis of"deficiency in origin and toxin accumulation".[Methods]Through following Director CHEN Yongcan's outpatient service,sorting out and analyzing typical medical cases,combined with the view of Director CHEN in clinical practice,it summed up his experience in treating chronic atrophic gastritis with intestinal metaplasia from three aspects:core pathogenesis,syndrome differentiation and treatment,prescription and medication,and a proved case was attached to support the treatment.[Results]Chronic atrophic gastritis with intestinal metaplasia is one of the key links in the occurrence and development of gastric cancer.Director CHEN Yongcan believes that the"deficiency in origin and toxin accumulation"is the core pathogenesis of chronic atrophic gastritis with intestinal metaplasia."Deficiency in origin"means deficiency in the spleen and stomach,insufficiency of vital Qi;"toxin accumulation"namely turbidity-toxicity stays stagnation,accumulated and hidden.Taking the cold-heat complex syndrome as the basic point for syndrome differentiation and treatment,it's called for keeping the balance of cold and heat.According to the proportion of deficiency and excess,he treats the disease with the syndrome.The prescription is mainly self-made prescription Shiwei Xiexin Decoction,which can detoxify and benefit vital Qi.If spleen deficiency causes kidney deficiency,kidney-nourishing herbs should be added to solve this condition.If there're Qi and blood stasis,flower herbs are preferred for use.Aiming at the difference between phlegm toxin,stasis toxin and heat toxin,three pairs of triplet herbs which include Cremastrae Pseudobulbus-Salvia chinensis-Actinidia Valvata Dunn,Nidus Vespae-Herba Artemisiae Anomalae-Rhizoma Curcumae and Taraxacum mongolicum-Scutellariae Barbatae Herba-Hedyotis Diffusa are selected for treatment.The syndrome differentiation of the case was spleen deficiency and toxin accumulation,and complex cold-heat.The treatment was invigorating the spleen and detoxifying,and adjusting cold-heat in balance,and Shiwei Xiexin Decoction was used,considering the combination of blood stasis and toxin accumulation,Nidus Vespae-Herba Artemisiae Anomalae-Rhizoma Curcumae were selected.At the follow-up visit,because of obstruction of Qi and blood and imbalance of Qi movement,and Sanhua Baicao Drink to gently promote depression.In the third visit,considering age growth,the liver and kidney were gradually declining,the long-term illness damaged primordial Qi,and the Sijun Zhenyuan Decoction was used to invigorate the spleen and tonify the kidney,consolidate the basis and cultivate primordial Qi.[Conclusion]Director CHEN's experience in differentiating and treating chronic atrophic gastritis with intestinal metaplasia from"deficiency in origin and toxin accumulation"is unique and effective,which is worthy of promotion and learning.

Study on Clinical Medicine Thought of the Zhejiang School of Traditional Chinese Medicine Doctor ZHU Danxi in Phlegm Syndrome / 浙江中医药大学学报

[Objective]To explore the clinical experience of ZHU Danxi,a doctor of Zhejiang school of traditional Chinese medicine,on the diagnosis and treatment of phlegm-related diseases.[Methods]By means of literature research and data mining,the treatment database of ZHU Danxi in phlegm syndrome was constructed,and his clinical thoughts were summarized from the aspects of pathogenic factors,pathogenesis,treatment and prescriptions.[Results]According to ZHU Danxi,the pathogenesis of phlegm syndrome was mainly related to stagnation of Qi activity,the etiology was related to external contraction of six excesses,internal injury of seven emotions,improper diet.Phlegm syndrome was divided into hot phlegm,wet phlegm,food phlegm,cold phlegm,wind phlegm,old phlegm,etc.ZHU Danxi determined the different treatment principles such as clearing heat and resolving phlegm,drying dampness and resolving phlegm,resolving phlegm to remove stagnancy,warming and resolving cold-phlegm,dispelling wind and resolving phlegm,moistening dryness and resolving phlegm and so on.Phlegm wss easy to knot with stasis,so it was commonly used to remove phlegm and remove stasis.According to the site of the phlegm syndrome,ZHU Danxi used different herbs and methods of vomiting and purging,treating both symptoms and root causes,starting from the spleen,lung and liver meridian,and basing on Erchen Decoction.ZHU Danxi used phlegm-eliminating herbs,spleen strengthening herbs,Qi-regulating herbs and heat-clearing herbs.[Conclusion]ZHU Danxi's experience in treatment of phlegm related diseases is fully effective,and the principles,methods,and prescriptions for preventing and treating phlegm syndrome can provide more ideas for clinical practice.

Analysis of LU Keda's Experience in Treating IgA Nephropathy with Yiqi Yangyin Qufeng Prescription / 浙江中医药大学学报

[Objective]To explore Professor LU Keda's clinical experience in treating IgA nephropathy with Yiqi Yangyin Qufeng prescription.[Methods]Through outpatient learning with teacher,consulting IgA nephropathy related literature,Professor LU's clinical experience in treating IgA nephropathy with Yiqi Yangyin Qufeng Prescription was summarized,and one medical case was provided to support the treatment.[Results]Professor LU points out that the early IgA nephropathy patients are deficient in spleen and kidney,and always invaded by wind easily.He applies the thought of syndrome differentiation and prescription called"state target binding"from Academician TONG Xiaolin,taking"Qi and Yin deficiency syndrome"as the state,and the physical and chemical indexes"proteinuria and hematuria"as the target,using Yiqi Yangyin Qufeng Prescription for treatment.The medical case mentioned later was identified as early-stage IgA nephropathy,belonged to Qi and Yin deficiency syndrome.The treatment was to invigorate the spleen and tonify Qi,nourish Yin and promote body fluid and dispel wind.It had great curative effect by using Yiqi Yangyin Qufeng Prescription.[Conclusion]Professor LU's experience in establishing the treatment of IgA nephropathy from the perspective of"state target syndrome differentiation"is worth learning and inheriting.

CHEN Yongcan's Experience in Treating Postoperative Complications of Anorectal Disease from the Liver and Spleen / 浙江中医药大学学报

[Objective]To summarize the clinical experience of Director CHEN Yongcan in the treatment of postoperative complications of anorectal disease from the liver and spleen.[Methods]Through learning from teachers,collecting clinical medical cases,reviewing relevant literature,analyzing the relationship between liver and spleen and anorectum,the key pathogenesis and main treatment methods of this disease were proposed,and the clinical experience of Director CHEN in treating postoperative complications of anorectal disease from the liver and spleen was expounded,and three medical cases were attached for evidence.[Results]Director CHEN believes that the postoperative complications of anorectal disease are closely related to liver and spleen disorders,and the disease is located in the anorectum,and the liver and spleen are responsible.The relationship between anorectum and liver and spleen reflects in three aspects:physiological communication,functional connection and five elements correlation,and the key pathogenesis is liver and spleen discord and Qi imbalance,and the treatment advocates starting from the liver and spleen,with the three methods of rising,clearing and nourishing,harmonizing the liver and spleen,regulating the Qi movement,and promoting the recovery of anorectal function after surgery.The cited medical cases included the treatment of postoperative constipation of mixed hemorrhoids by raising the spleen and soothing the liver,the treatment of postoperative abdominal distension of anal fistula by clearing the liver and promoting the spleen,and the treatment of postoperative diarrhea of rectal cancer by nourishing the spleen and softening the liver,all of which achieved good therapeutic effects.[Conclusion]Director CHEN has rich experience in the treatment of postoperative complications of anorectal disease from the liver and spleen,which is practical and worthy of promotion.

Analysis on Chen Yongcan's Experience in the Treatment of Chronic Atrophic Gastritis with Intestinal Metaplasia Based on the Theory of"Yang Transforming into Qi and Yin Forming Shape" / 中国中医药信息杂志

Chronic atrophic gastritis with intestinal metaplasia is a necessary stage for chronic gastritis to develop into gastric cancer.Chen Yongcan believes that the theory of"yang transforming into qi and yin forming shape"can explain the development and diagnosis of chronic atrophic gastritis with intestinal metaplasia.The deficiency of"yang transforming into qi"leads to too much"yin forming shape",which changes the physiological function of the spleen and stomach,and then develops into the pathological process of chronic atrophic gastritis with intestinal metaplasia.Based on the theory of"yang transforming into qi and yin forming shape",the pathogenesis of this disease was briefly analyzed.In clinical treatment,the state of yin and yang was first identified,and the treatment principle of tonifying yang qi to remove yin turbidity was put forward to achieve the purpose of treating both manifestation and root causes.