Medical student's note

美容与中医 面部痤疮、色斑等是损美性疾病，严重影响人的面容，尤其女性患者更加痛苦，急于寻医问药，希望得到治疗。激光美容是西医治疗皮肤疾病的常见方式，但激光具有较高能量、聚焦精准、穿透力强，易使皮肤受损。 中医认为人体是一个完整的有机体。《黄帝内经·灵枢·本脏》云：“视其外应，以知其内脏，则知所病矣”。这说明了内在脏腑的病变必然会反映在皮肤、形体、官窍上。因此，五脏六腑的机理功能正常与否，可影响皮肤。 医案1 某某，女，35岁，面部有斑5年余，双颧部明显，呈黄褐色，曾行激光治疗，暂时得效，3～5个月后复发。平素纳食不香，烧心、反酸，弯腰时胃脘部马上有胀饱感，似有石头，起身后好转， 平素情绪不佳，爱与家人生闷气及吵架 ，大便干，小便正常，形体偏瘦， 舌质暗淡，苔薄白，脉细涩 。 分析： 肝主疏泄，性喜条达而恶抑郁，若情绪刺激，肝气郁滞，则必然导致气滞血瘀，血不上荣，而气郁化火，木火刑金，又可致肺金失于清肃，出现面部黧黑斑、急躁易怒、大便秘结等症。 治法：疏肝理气和胃活血 拟方： 香附10 g，郁金10 g，炒白芍10 g，茯苓30 g，生白术10 g，浙贝母15 g，白及10 g，煅瓦楞子15 g，丹参15 g，益母草15 g，玫瑰花15 g，莪术6 g，枸杞子10 g，女贞子20 g，山药30 g，白芷6 g，白薇10 g。 服法：7剂水冲服，早晚各1剂，嘱其调节情绪 进展： 👉胃脘部症状减轻，已无明显烧心、反酸及胀饱感，但面部斑未见减轻。 上方去贝母、瓦楞子，继服14剂，对其情绪继续劝说一番 贝母：化痰止咳、清热解毒，还能开郁散结 瓦楞子：化痰、软坚、散瘀 👉面部斑明显减轻，肤色较前有光泽，胃脘部无不适，大便偏稀 生白术更换为炒白术20 g，服用14剂 白术：健脾益气，燥湿利水，止汗，安胎 炒白术使其燥湿功能增强 👉面色较前荣润光泽，斑变淡 逍遥散及益母草膏口服巩固 逍遥散：调和肝脾，疏肝解郁，养血健脾 益母草膏：活血调经 医案2 张某某，男，50岁，面部痤疮、黑斑3年，未予治疗，既往有“小三阳”、胆结石、肝功能异常病史， 平素大便干稀不调，胃胀，纳食不香，喜饮酒。 查见面色红，油腻，面部散在痤疮，有抓痕，部分凸起伴有脓头，部分凹陷伴有黑褐色色素沉着， 舌质红，舌体胖 ，苔黄微腻， 脉弦滑 。 分析： 三焦湿热，夹有瘀毒。三焦运化失常，则运化水湿功能下降，水湿

围绝经期综合征（perimenopausal syndrome，PMS） 是指处于绝经前后的女性因其卵巢功能衰退引起的雌激素水平波动或下降，从而出现月经紊乱、潮热盗汗心情烦躁、焦虑易怒等症状。 内容： 1. 中医对PMS的认识 2. PMS证型 3. 症状分析 4. 常用中药 5. 针灸治疗 6. 参考资料 Related link:  【About Girl】Menopause   【About girl】Hormonal Functions of the Female,  Hormonal control of the menstrual cycle 1. 中医对PMS的认识 与生理特点有关。 七七之年，肾气逐渐衰退，天癸渐竭，冲任二脉逐渐亏虚，月经将断而至绝经。 “肾为先天之本”，故肾阴阳失调，易波及其他脏腑； 其他脏腑病变，久则必累及于肾，故“五脏相移穷必及肾”。 肾、肝、心、脾等多个器官的功能失调，从而产生致病产物，如火旺、血瘀、气滞、痰湿，造成是气血失调，冷热失调，阴阳失调。 2. PMS证型 a. 肝肾阴虚型 表现： 失眠、易怒、发热汗出、头晕耳鸣、腰膝酸软、目干、口干、便秘、皮肤蚁走感、月经提前、舌红、苔少、脉细弦数。 其中目干、皮肤蚁走感、月经提前为其特异性症状。 治法：补益肝肾，滋阴清热 b. 心肾不交型 表现： 头晕耳鸣、腰膝酸软、心悸、健忘、怔忡、舌红、苔少、脉弦数。 其中心悸、健忘、怔忡为其特异性症状。 治法：滋阴降火，交通心肾 c. 肝郁气滞型 表现： 胸闷、胁胀、胸痛、精神抑郁、紧张、腹痛、面色潮红、舌瘀点、脉弦。 其中胁胀、胸闷、精神抑郁、紧张为特异性症状。 治法：疏肝理气。 方药：柴胡疏肝散加味。 组成：柴胡15g，白芍20g，枳壳l0g，川芎l0g，香附15g，甘草10g，陈皮l0g，郁金15g。 加减： 乳房胀痛为主加路路通15g，王不留行15g 乳房胀痛有结节者加橘核15g，夏枯草15g，穿山甲15g 若肝郁化火致头晕头痛者，减香附、陈皮，加菊花15g、黄芩15g、钩藤15g、代赭石30g 若肢体肿胀者，可加泽兰15g，泽泻15g，槟榔15g 若狂躁不安者加磁石30g，琥珀25g，石菖蒲15g d. 肾阴虚型 表现：发热汗出、心烦失眠、口干、皮肤蚁走感、月经提前。 治法：补肾益精，滋阴潜阳 方药：左归丸 组成：熟地25g，山药

阿片类药物（Opioids） 是治疗中重度疼痛的首选药物。 其不良反应主要包括： 便秘 恶心呕吐 瘙痒 头晕 尿潴留 嗜睡 谵妄 认知障碍 呼吸抑制 Related link:  【Pharmacology】OPIOIDS 内容： 1. 癌性疼痛 2. 便秘 3. 阿片类成瘾慢性稽延症状 4. 参考文献 1. 癌性疼痛 是晚期恶性肿瘤最常见症状之一 被列为“第五生命体征” 生命四大体征：呼吸、体温、脉搏、血压 癌痛治疗的药物： 非甾体类抗炎药物 (Non-Steroidal Anti-Inflammatory Drug) 阿片类药物 (Opioids) 中医 癌性疼痛属“痛证”范畴 病因：正气亏虚、邪毒内侵 病机：“毒、瘀”壅塞经络 治疗：行气活血、化瘀解毒功效的中药组方外敷联合西药治疗 好处： 增强止痛效果 缩短止痛起效时间 延长镇痛时间从而减少爆发痛次数 提高患者的生活质量 一定的抗肿瘤作用 中药方： “双黄散结散” 全方具有清热解毒、散结止痛的作用。 君： a. 大黄 (Rhubarb) 苦寒泻热：荡涤胸腹之邪热 b. 黄柏 (Phellodendron amurense Rupr) 苦寒泻热：清下焦热 & 大黄：清热解毒散结 臣： a. 苦参 (Sophora flavescens) b. 蒲公英 (Dandelion Herb) 加强清热解毒之功 c. 三棱 (rhizoma sparganii) d. 莪术 (Curcuma) 破血逐瘀 佐使： a. 乳香 (frankincense) 行气舒筋 b. 没药 (Myrrh) 行气化瘀 & 乳香：活血定痛 c. 冰片 (Borneol) 通窍散火、消肿止痛 **现代研究亦表明，大黄、黄柏、冰片、乳香、没药、三棱、莪术、蒲公英等药物均有有很好的抑制肿瘤、止痛等作用。 另外一方： 川芎、白芷、姜黄、乳香、没药、肿节风、山慈姑、蚤休、麻黄、白芥子、王不留行 11味中药精细加工成粉并与凡士林调和而成膏状 功能：扶正气、消肿痛、活血化瘀，调畅经脉，透皮达里，引诸药直达病所。 好处： 避免了异体蛋白过敏现象 因其主要成分为植物 避免药物通过肝脏时的首过效应 其中药有效成分透过皮肤屏障，直接进入人体循环，无胃肠降解和胃肠刺激作用 治疗疼痛效果明显、持续时间长 无不良反应 & 产

Opioids sometimes called narcotics, are a group of drugs that act on the central nervous system to produce morphine-like effects such as pain relief and euphoria. Content: 1. Neurotransmission of pain signal 2. Endogenous opioids & opioid receptors 3. Buprenorphine 4. Naloxone 5. Reference 1. Neurotransmission of pain signal Pain begins at the nociceptors high threshold primary sensory neurons respond to damage to the body by transmitting the painful stimulus to the second-order neurons in the dorsal horn of the spinal cord. signal is carried through spinothalamic tract thalamus somatosensory cortex where pain is perceived On a microscopic level, pain signal takes the form of a series of action potentials fire repeatedly depending on the intensity of pain To enhance movement across the synaptic cleft, transmitter chemicals are released from the presynaptic neurons, including  glutamate activate both NMDA and AMPA receptors permit influx of positively charged calcium and sodium ions

Anesthesia  A reversible condition induced by anesthetic drugs that cause reduction or complete loss of response to pain or another sensation such as consciousness and muscle movements during surgery or other invasive procedures that can be painful. Two main types of anesthesia: General anesthesia: makes the whole body lose feeling movement and consciousness drugs Local anesthesia: numbs only a specific targeted area of the body drugs   Content: 1. Anesthesia stage 2. Mechanism of action 3. General anesthetics      i. 1st group (Intravenous agents)      ii. 2nd agent (Intravenous & Inhalation agent)      iii. 3rd agent (halogenated volatile anesthetics) 4. Dexmedetomidine 5. Local anesthetics 6. Reference 1. Anesthesia stage Anesthesia performed with general anesthetics occurs in four stages: Stage 1: Induction a period during which the patient goes from state of consciousness to a state of unconsciousness Stage 2: Excitement depression of inhibitory neurons in the CNS leads to inc

 Alzheimer's disease a progressive neurodegenerative disease that leads to symptoms of dementia. pathophysiology of this disease is quite complex and not entirely understood. Content: 1. 3 hypotheses that try to explain the cause of Alzheimer’s 2. Drug 3. Future of Alzheimer’s disease treatments 4. Reference 1. 3 hypotheses that try to explain the cause of Alzheimer’s a. Cholinergic hypothesis the loss of central cholinergic neurons and ensuing deficiency of acetylcholine, a neurotransmitter involved in memory and learning. b. Amyloid hypothesis caused by accumulation of abnormally folded beta-amyloid proteins. Beta-amyloid: a metabolic waste product present in the fluid between brain cells clumps together to form amyloid plaques, which are thought to induce neuroinflammation and disrupt communication between neurons. c. Tau hypothesis abnormal aggregation of Tau proteins that leads to the formation of tangles within nerve cells in the brain. When Tau dissociates, the microtubule a

Pesticides-induced Parkinson’s Disease Excess usage of insecticides leads to contamination of water source and soil. The toxicity of the pesticides may react to the environment and result in ecological disturbance and even species extinction.  Pesticides taken in human body by drinking and food ingestion may act as the neurotoxin and carcinogens that affect humans’ health, especially the nervous system.  Content: 1. The classification of insecticide 2. Mechanism of organophosphates & carbamates 3. Syndrome 4. Comparison between organophosphates & carbamates 5. Parkinson’s disease (PD)  6. Reference 1. The classification of insecticide There are four main chemical components under the classification of insecticide: Organophosphates (OPs) Carbamates Pyrethroids Organochlorine Among all the others, OPs and carbamates are found to be the frequently used insecticides that contain compounds that may lead to Parkinson’s disease (PD).  Organophosphates  Organophosphates (OPs) also know