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Continuing Education of Licensed Pharmacists in Shandong Province in 2007
Answer questions about Chinese medicine knowledge
Subject: Examination questions of drug laws and regulations
1.A-type questions (the best multiple-choice question, a total of 20 questions, there is only one best answer among the alternative answers to each question. )
The title is 1 23455 6789 10.
Answer D C A C B B A E D C
The title is11213141516171819 20.
Answer B C A C B A A A E D
Second, type B questions (compatibility multiple-choice questions, a total of 20 questions, alternative answers in front, questions in the back. Each set of questions corresponds to the same set of alternative answers, and each question has only one correct answer. Each alternative answer may or may not be reused)
Title 2 1 22 23 24 25 26 27 28 29 30
Answer A B C A B D C A C A
Title 3 1 32 33 34 35 36 37 38 39 40
Answer B C D D A A B C C C c c
Third, X-type questions (multiple choice questions, a total of 20 questions. There are two or more correct answers in the alternative answers to each question. )
Title 4 1 42 43 44 45 46 47 48 49 50
Answer ABCD ABCD ABCD ABCD ABCD ABCD ABCD ABCD ABCD ABCD ABCD ABCD ABCD ABCD ABCD ABC
Fourth, short answer questions
1. A: Pharmacists should review the applicability of prescription drugs, including:
(1) For drugs that must undergo skin test, whether the prescription indicates the allergy test and result judgment;
(2) Consistency between prescription medication and clinical diagnosis;
(3) the correctness of dosage and usage;
(four) the rationality of the choice of dosage form and route of administration;
(five) whether there is a phenomenon of repeated administration;
(6) Whether there are potential clinical drug interactions and incompatibility;
(seven) other inappropriate drugs.
2. Answer: When using drugs, users must not have the following behaviors:
(a) the application of counterfeit drugs and inferior drugs;
(2) using drugs in violation of drug contraindications or compatibility contraindications;
(three) the use of drugs that obviously exceed the types and quantities needed to treat diseases;
(4) Failing to use drugs according to the instructions for drug use without justifiable reasons;
(five) using non-drugs as drugs to treat diseases;
(six) other acts prohibited by laws and regulations.
Verb (abbreviation for verb) Seminar topic (optional)
A: With the improvement of people's living standards, people pay more and more attention to health, and the smooth information channels give people more choices in health care and lifestyle. Relevant data show that only 30% of consumers who buy drugs in pharmacies have a correct understanding of the use of over-the-counter drugs, and most of them take drugs by experience. Many people obviously lack the understanding of drug resistance and medication time when they take drugs, blindly increase the dosage in their medication habits, and even change drugs frequently. These behaviors and understandings directly endanger the safety and effectiveness of drug use. Safe and rational drug use is to choose drugs reasonably according to the condition, the patient's physique and the overall situation of drugs, so as to truly "suit the right medicine" and at the same time use drugs accurately with appropriate methods, dosage and time. Pay attention to the contraindications, adverse reactions and interactions of this drug. And pay attention to spend as little money as possible. Only in this way can we use drugs safely, reasonably, effectively and economically.
In order to choose drugs safely and reasonably, we must first diagnose what the patient has, and then prescribe the right medicine, and we can't just use drugs casually based on the patient's self-feeling. For example, fever and headache are common symptoms of many diseases, and you can't simply take some painkillers and antipyretics. Another example is abdominal pain, which is also a common symptom of some diseases. If you use painkillers indiscriminately, it will cover up some symptoms of acute abdomen, delay the illness and cause serious consequences.
In fact, to understand the nature, characteristics, indications and adverse reactions of drugs, it is necessary to choose drugs with good curative effect and low toxicity. This is why doctors often talk about "first choice medicine" and "second line medicine".
(a) to strengthen the inspection of prescription drugs and over-the-counter drugs in pharmaceutical retail enterprises and standardize the proprietary labels, and actively promote pharmaceutical retail enterprises to meet the requirements of drug classification management.
(two) to strengthen the inspection of licensed pharmacists in the store and on the job, as well as the implementation of the prescription audit system. Combined with GSP certification, we will further improve the allocation system and prescription audit system of licensed pharmacists in stores.
(three) to strengthen the supervision and inspection of drugs that have been explicitly banned by pharmaceutical retail enterprises. Those who violate the provisions shall be dealt with according to the Drug Administration Law, the Regulations for the Implementation of the Drug Administration Law and other relevant laws and regulations.
(four) for drugs that have been clearly stipulated to be sold by prescription, it is necessary to strengthen the inspection of the implementation of prescription sales regulations by pharmaceutical retail enterprises. The illegal sales of prescription drugs by pharmaceutical retail enterprises should be corrected in time and punished according to regulations.
(5) The pharmaceutical supervisory and administrative departments at all levels should strengthen the supervision and inspection of advertisements for prescription drugs and over-the-counter drugs, especially the inspection of illegal advertisements for prescription drugs in the mass media, and expand the publicity of over-the-counter drugs in the mass media.
(6) Non-prescription drug manufacturers must replace the packaging in strict accordance with the product labels, instructions and proprietary signs approved by the state.
In addition, some people think that expensive medicine is a good medicine, but it is not. Because the price of drugs is determined by their own sources, costs, production output and manufacturers, drugs produced by joint venture pharmaceutical companies are more expensive than those produced by domestic pharmaceutical companies, and imported drugs are more expensive. Expensive is not equal to good, the key is to suit the symptoms.
Subject: Physiological test questions
1.A-type questions (the best multiple-choice question, a total of 20 questions, there is only one best answer among the alternative answers to each question. )
The title is 1 23455 6789 10.
Answer c d c c b e a d c b
The title is11213141516171819 20.
Answer d c d d d d b e d b d a
Second, type B questions (compatibility multiple-choice questions, a total of 20 questions, alternative answers in front, questions in the back. Each set of questions corresponds to the same set of alternative answers, and each question has only one correct answer. Each alternative answer may or may not be reused)
Title 2 1 22 23 24 25 26 27 28 29 30
Answer D B C D E A D D B E
Title 3 1 32 33 34 35 36 37 38 39 40
Answer a d c d b a b b b c b c
Third, X-type questions (multiple choice questions, a total of 20 questions. There are two or more correct answers in the alternative answers to each question. )
Title 4 1 42 43 44 45 46 47 48 49 50
Answer ABC ABCD BCDE de ade ABCD BCD AC BCE ABC
Fourth, short answer questions
1, a: The pressure reflex of carotid sinus and aortic arch is the arterial catheter when arterial blood pressure rises.
With the increase of ventricular wall extension, the baroreceptor of carotid sinus aortic arch is excited, and the nerve impulse is enhanced, which is introduced into the cardiovascular center of medulla oblongata through sinus nerve and aortic nerve, so that the nerve activity of cardiac vagus nerve is strengthened, and the nerve activity of cardiac sympathetic nerve and sympathetic vasoconstrictor is weakened, resulting in the weakening of myocardial contractility, slowing heart rate, reducing cardiac output and reducing peripheral vascular resistance, so the arterial blood pressure is reduced. On the contrary, when the arterial blood pressure decreases, the afferent impulse of baroreceptor decreases, which weakens the vagal nerve tension and increases the sympathetic nerve tension, so the heart rate increases, the cardiac output increases, the peripheral vascular resistance increases and the blood pressure increases. Baroreflex is a classical negative feedback regulation mechanism, and its receptors feel the changes of blood pressure in the range of 60-80mmHg, among which the rapid changes of arterial blood pressure 100mmHg are the most sensitive. Therefore, the physiological significance of this reflex is to finely adjust the rapid changes of arterial blood pressure, so as to maintain the relative stability of normal arterial blood pressure in human body.
2. A: Thyroid hormone is necessary for the normal development and maturity of the body. Thyroid hormone can stimulate the development of ossification center, ossify cartilage and promote long bone growth; It also promotes the division of neurons, the formation of axes and dendrites, and the growth of myelin sheath and glial cells by promoting the synthesis of some growth factors. Therefore, in the absence of thyroid hormone secretion, brain development and bone maturity are damaged, leading to dementia. Thyroid hormone accelerates the protein synthesis of muscle, bone, liver, kidney and other tissues, reduces urine nitrogen, showing a negative nitrogen balance, which is beneficial to the growth and development of the body in childhood. However, the excessive secretion of thyroid hormone accelerates the protein decomposition of tissues, especially the protein decomposition of skeletal muscles, which leads to muscle wasting and fatigue and stagnant growth and development in hyperthyroidism.
Verb (abbreviation for verb) seminar theme
Answer: When the excitement (action potential) of presynaptic neurons reaches the nerve endings, the presynaptic membrane depolarizes, which opens the voltage-gated Ca2+ channel of the presynaptic membrane, and extracellular Ca2+ flows into the presynaptic endings. The entry of Ca2+ into the anterior terminal promotes the fusion of synaptic vesicle and membrane and cell division, which leads to the quantum release of transmitter in synaptic vesicle. Transmitters entering the synaptic cleft diffuse to the postsynaptic membrane and act on the specific receptors on the postsynaptic membrane, causing the permeability of some ion channels on the postsynaptic membrane to change, making charged ions enter and leave the postsynaptic membrane, and producing a certain degree of depolarization or hyperpolarization on the postsynaptic membrane, that is, postsynaptic potential. For example, when the presynaptic membrane is excited, it releases excitatory neurotransmitters and acts on the prominent posterior membrane, which increases the permeability of the posterior membrane. Especially for Na+, the influx of Na+ produces local depolarization potential (EPSP) on the prominent posterior membrane. When EPSP reaches the threshold potential, it triggers the axon burst action potential of postsynaptic neurons, that is, the process of prominent transmission is completed. Excitative postsynaptic potential (EPSP) refers to the depolarization potential that the presynaptic membrane releases excitatory neurotransmitters to make the posterior membrane protrude.
Subject: Medical Microbiology and Immunology Examination Questions
1.A-type questions (the best multiple-choice question, a total of 20 questions, there is only one best answer among the alternative answers to each question. )
The title is 1 23455 6789 10.
Answer a d c d d d d b a c b
The title is11213141516171819 20.
Answer b b c a a a b b c
Second, type B questions (compatibility multiple-choice questions, a total of 20 questions, alternative answers in front, questions in the back. Each set of questions corresponds to the same set of alternative answers, and each question has only one correct answer. Each alternative answer may or may not be reused)
Title 2 1 22 23 24 25 26 27 28 29 30
Answer e c c c c c a d b
Title 3 1 32 33 34 35 36 37 38 39 40
Answer E F C B E C D A B B
Third, X-type questions (multiple choice questions, a total of 20 questions. There are two or more correct answers in the alternative answers to each question. )
Title 4 1 42 43 44 45 46 47 48 49 50
Answer AD CD AC BD CE BE BC ACD AE BC
Title 5 1 52 53 54 55 56 57 58 59 60
Answer ACDE ABC ACE ABCD ACE ABCE ABC Abd Ade Abd
Fourth, short answer questions
1, a: Biological antagonism: If pathogenic bacteria want to invade the host body, they must first break through the barrier of skin and mucosa, and the normal flora living in these parts can resist the invasion of pathogenic bacteria through nutritional competition and metabolites.
Promote digestion: Normal flora in intestinal tract can transform insoluble protein and sugar in intestinal tract into soluble state, and promote human digestion and absorption.
Nutritional function: Escherichia coli and Lactococcus lactis in normal flora can synthesize vitamins B, C and K.
The acidic environment caused by acid production by Bifidobacterium promotes the absorption of vitamin D, calcium and iron.
Immune function: On the one hand, normal flora can promote the development and maturity of immune organs; on the other hand, normal flora has immunogenicity, mitogenic effect and adjuvant effect, which can continuously stimulate the host immune system to produce immune response.
In addition, the normal intestinal flora is related to the anti-aging of the body; It also has a certain anti-tumor effect.
2. A: Under natural conditions, skin and mucous membranes are important portals for viruses to invade the human body. The spread of virus infection among individuals, including the spread of vector animals, is called horizontal transmission; The direct transmission of the virus from parents to offspring is called vertical transmission.
I. Horizontal communication
1. Most viruses transmitted through mucosal surfaces can invade through respiratory tract, digestive tract and urogenital tract.
When entering the body, epithelial cells on the mucosal surface are the first place for some viruses to proliferate. For example, influenza patients spread influenza virus to the surrounding people through cough droplets, immerse themselves in the respiratory tract, proliferate in ciliated columnar epithelial cells, and spread along the cells to cause respiratory diseases. Hepatitis A virus invades the body through fecal-oral route, first proliferates in intestinal epithelial cells, then reaches the liver through blood flow, and then proliferates in target cells to cause liver diseases. There are also some viruses that can be transmitted through human contact, such as corneal conjunctivitis caused by direct contact with conjunctiva and sexually transmitted diseases caused by virus infection through urogenital mucosa through sexual contact.
2. Some viruses transmitted through skin can invade the body from skin wounds through insect bites or animal bites and cause diseases. Such as Japanese encephalitis virus and rabies virus.
3. Iatrogenic transmission through injection, blood transfusion, tooth extraction and other dental treatments, surgery, organ transplantation, etc. Viruses are infected through blood, such as hepatitis B and hepatitis C virus.
Second, vertical transmission.
1. More than ten kinds of viruses, such as hepatitis B virus, human immunodeficiency virus, herpes virus, measles virus and varicella virus, can spread through the placenta.
2. In the process of delivery, women's birth canal viruses can infect newborns, such as herpes virus type 2 and HIV, which can infect newborns through birth canal and become lifelong carriers of the virus.
Virus infection can be divided into recessive infection and dominant infection, acute infection and persistent infection.
Verb (abbreviation for verb) seminar theme
A: In the process of antibody production, the reaction to td antigen has been proved to be mφ, T cells and B.
It is the result of cell interaction, so does mφ present antigen directly to T cells or B cells? Or both? According to the analysis of existing data, there may be the interaction between mφ and T, the interaction between T and B, and the interaction between mφ and B cells.
I. the interaction between macrophages and th cells
Th cells must be activated from static th to th to help B cells produce antibodies. Regarding the mechanism of th cell activation, a dual-signal hypothesis is proposed based on the existing experimental data.
Recent experiments have proved that at least two molecules on the surface of antigen presenting cells (apc) are related to the activation of th cells. One is antigen presenting molecules, which are composed of mhc molecules. It can be combined with exogenous or endogenous antigenic peptide fragments, then transported to the cell surface and presented to T cells, and the 1 activation signal is generated by tcr/ce3 stimulation. Another molecule, the so-called costimulatory molecule (CM), is composed of a group of adhesion molecules, which can not only promote the direct contact between apc and T cells, but also induce signal transmission. This group of molecules can bind to the costimulatory molecule receptor (CMR) on T cells and stimulate them to produce costimulatory signals, which are called second signals.
Cmr or helper molecules on T cells are also composed of a group of adhesion molecules. The molecular structure, function and signal transduction pathway of cmr and its ligands need to be further studied, but cd28 molecule, ctla-4 molecule and its ligand b7/bb 1 molecule are considered to be the main molecules that produce synergistic stimulation signals. Under the action of these two signals, T cells can be activated, and can synthesize and secrete il-2 and express il-2r, which will eventually lead to cell division and clonal expansion. If there is no second signal, T cells will not be activated and will not cause clonal expansion, so they are in a state of clonal inactivity. Blocking or giving the second signal can artificially adjust the enhancement or inhibition of immune response, which provides a new means for immunotherapy. For example, blocking the generation of the second signal can make T cells in an immune tolerance state, reduce the immune response of the body, help prevent the occurrence of transplant rejection, and help treat hypersensitive diseases and autoimmune diseases. If b7 gene is introduced into some tumor cells, the anti-tumor immune response of the body can be enhanced. At present, there have been many reports in this regard.
Second, the interaction between th cells and B cells.
(A) B cell response to T cell-dependent antigen
Generally speaking, when a large number of antigens enter the non-immune body and induce the primary immune response, antigen presenting cells are mostly completed by macrophages. After mφ activates th cells, the activated th cells help B cells to produce antibodies and form memory B cells. However, when the second immune response occurs, the antigen-presenting cells are mainly borne by the expanded B cell clones. Because of the high affinity of ig receptor, it can also adsorb a small amount of antigen, so it can replace the antigen presentation of macrophages.
In the past, it was thought that the interaction between B cells and th cells was caused by antigen bridging, that is, the antigen receptor of B cells could recognize the hapten part of antigen molecules, while the antigen receptor of th cells could recognize the carrier part of antigen molecules. However, recent experiments have proved that B cells, like mφ, interact with th cells through antigen presentation. That is, B cells can bind to the T-dependent antigen protein antigen of their membrane ig receptor and take up the antigen through internalization. Then, after processing, T cell determinants combine with MHC class II molecules to form mhc- peptide molecular complexes, which are transported to the surface of B cells and presented to th cells, so the interaction between B cells and th cells is also limited by MHC.
B cells and th cells can be in direct contact with antigen presentation through their adhesion molecules, and can induce each other's activation. With the help of th cells, activated B cells eventually proliferate and differentiate into plasma cells, and synthesize and secrete various immunoglobulin molecules.
B cells can stimulate T cell antigen receptor (tcr/cd3) to generate activation signal 1 through its antigen presentation, and combine with corresponding receptor molecules such as cd28, ifa- 1 on the surface of T cells through its surface b7 to stimulate to generate costimulatory signal (i.e. signal 2), thus activating th cells under the action of dual signals.
B cells should bind to antigens through their bcr, that is, surface ig receptors. Iga and igβ chains are equivalent to cd3 molecules, which can transmit the activation signal of 1. In recent years, it has been proved that the cd40 molecule expressed on the surface of B cells can bind to the corresponding ligand molecule gp39 (cd40 ligand molecule, cd40l) on the surface of T cells, which can stimulate them to produce activation signal 2, and B cells are activated by this dual signal.
Activated B cells can proliferate and differentiate into antibody-secreting plasma cells and memory B cells under the action of various cytokines secreted by activated th cells. In the second response, a series of changes can occur, such as ig class conversion and antibody affinity maturity.
(2) The response of B cells to T-cell-independent antigens
The activation mechanism of B cells to cell-independent antigen (t 1) is completely different from that of T cell-dependent antigen. For type I t 1 antigen, such as bacterial lipopolysaccharide antigen, it is a polyclonal activator of B cells at high concentration. The determinant of this kind of antigen can bind to the antigen receptor on the surface of B cell, which has the structure of mitogen and can bind to its corresponding receptor. Under the combined action of these two structures, B cells were activated by polyclonal.
However, the structural feature of t 1 antigen is that there are many repeated antigenic determinants in linear arrangement, which is not easy to degrade in vivo, such as polysaccharide antigens such as pneumococcus. These antigenic determinants have strong affinity for B cell antigen receptors, and B cells are activated due to the cross-linking of the receptors.
T 1 antigen A.I is a polyclonal activator B. Type II t 1 antigen has multiple rows of repeated antigenic determinants to cross-link the receptor.
T 1 antigen can be taken up by apc, but it can't be processed, so it can't combine with MHCⅱⅱ class II molecules. Therefore, the reaction of B cells to t 1 antigen is not involved by th cells, but only shows the characteristics of the first reaction, without a series of changes in the second reaction.
Thirdly, the interaction between macrophages and B cells.
The interaction between these two kinds of cells is still uncertain. However, because B cells need the cooperation of th in most cases, the activation of B cells at least indirectly needs mφ to have a direct effect on the activation of B cells, and its secreted il- 1 can promote the activation of B cells.
Subject: Basic Test Questions of Traditional Chinese Medicine
1.A-type questions (the best multiple-choice question, a total of 20 questions, there is only one best answer among the alternative answers to each question. )
The title is 1 23455 6789 10.
Answer b b c c c d a d d d
The title is11213141516171819 20.
Answer d b d b b b b e b e d
Second, type B questions (compatibility multiple-choice questions, a total of 20 questions, alternative answers in front, questions in the back. Each set of questions corresponds to the same set of alternative answers, and each question has only one correct answer. Each alternative answer may or may not be reused)
Title 2 1 22 23 24 25 26 27 28 29 30
Answer b c a d b c b c a
Title 3 1 32 33 34 35 36 37 38 39 40
Answer a b d c a c b d c
Third, X-type questions (multiple choice questions, a total of 20 questions. There are two or more correct answers in the alternative answers to each question. )
Title 4 1 42 43 44 45 46 47 48 49 50
A: AC ADCDE ADCD BCE ADCD ADCD ADCD DCD ADCD
Fourth, short answer questions
1, A: Differentiation of diseases and treatment refers to the determination of treatment principles according to diseases after the diagnosis of diseases is established. For relatively simple diseases, it is relatively easy to treat them according to syndrome differentiation. But most diseases are a long process, and the pathological changes in each stage are different, so it is difficult to determine a unified treatment. Therefore, the treatment policy can only be determined according to the pathological summary of each stage in the process of disease development, that is, the treatment method is determined according to dialectics rather than disease differentiation. This is the reason why TCM syndrome differentiation is much more used than disease differentiation. The same disease, due to different pathological changes in different stages of disease development, that is, different syndromes, has different treatment methods according to the principle of syndrome differentiation and treatment, which is called "different treatment for the same disease". On the contrary, sometimes in different diseases, the same or similar pathological changes will occur, that is, the same or similar syndromes will appear. According to the principle of syndrome differentiation and treatment, the same syndrome differentiation and treatment is the same. Therefore, different diseases adopt the same treatment method, which is called "treating different diseases at the same time".
In fact, the meaning of "different treatment for the same disease" and "different treatment for the same disease" is the same. Generally speaking, everyone emphasizes the importance of syndrome differentiation and treatment. Therefore, in the treatment process of traditional Chinese medicine, it is generally based on syndrome differentiation first and then syndrome differentiation, with syndrome differentiation as the main factor and syndrome differentiation as the supplement; When choosing drugs, we should treat them according to syndrome differentiation and give consideration to disease differentiation.
Clinically, under the premise of treatment or syndrome differentiation, some symptomatic treatment methods aimed at relieving patients' pain in time should be adopted in the overall treatment plan. However, it must be understood that symptomatic treatment can only alleviate the temporary pain of patients, but can not solve the fundamental problem, and sometimes it will cover up some main symptoms, which makes it difficult to treat them according to syndrome differentiation or disease differentiation. Therefore, symptomatic treatment can be used, but it should be used with caution and should not be used as the main treatment.
2. A: The occurrence and development of diseases are influenced by many factors, such as seasons, geographical environment and physical differences of patients. Therefore, in the treatment of diseases, we must consider different seasonal climate, geographical environment, individual physical differences and other factors, formulate appropriate treatment methods, and choose appropriate drugs.
1, according to time: the climate change all the year round will have a certain impact on human physiology and pathology.
Influence. Generally speaking, in spring and summer, the climate changes from warm to hot, the yang rises, and the human body is loose. At this time, even if it is cold, it is not advisable to use pungent and warm products to avoid excessive excretion and injury to body fluids. In autumn and winter, the climate changes from cold to cold, the yin and cold are getting stronger, the human body is dense, and the yang is restrained. At this time, if you feel cold, the pungent taste will not hinder you, but if it is not a heat syndrome, you should use cold products with caution to avoid damaging the yang.
2. According to local conditions: Different geographical environments have different physiological functions and pathological changes due to different climatic characteristics and people's living habits, and the therapeutic drugs are also different. For example, in the south of the Yangtze River in China, the climate is warm and humid, people have diarrhea in their stomachs, and they catch a cold due to wind and heat, and commonly use pungent and cool drugs to relieve exterior syndrome; In the northwest of China, the weather is cold and dry, and people feel wind evil and catch a cold, mostly a cold. Spicy and sweaty drugs are often used to relieve exterior syndrome. Even if it is the same disease, we should consider the characteristics of different regions when using drugs. Such as exogenous wind-cold exterior syndrome, northwest region, cold weather, you can use heavy agents such as ephedra, cassia twig and other pungent and warm products; In the south of the Yangtze River, the weather is warm, even if you use ephedra, cassia twig and other pungent and sweaty people, the dosage should be slightly lighter, or you can use Schizonepeta and Saposhnikovia divaricata instead.
3. Adapt people to their needs
(1) Age: Different ages have different physiological functions and pathological changes, so when using drugs for treatment,
Age must be considered.
(2) Gender: Men and women are different in gender, each with its own physiological and pathological characteristics and different therapeutic drugs.
(3) Physique: In terms of physique, because everyone's innate endowment and acquired nursed back to health are different, individual qualities are not only strong or weak, but also cold and hot, and there is a chronic disease, so although they suffer from the same disease, the treatment and medication should be different. For example, Wang Yang's body should be warm with caution, and the shady body should be cold with caution.
In addition, different occupations and working environments also have certain effects on the physiological functions and pathological changes of the human body, and therapeutic drugs should also be considered.
To sum up, the principle of treating according to time, place and person fully embodies the principle and flexibility of the overall concept of TCM and the treatment based on syndrome differentiation in practical application. Only by looking at the problem comprehensively and analyzing the specific situation can we achieve the purpose of syndrome differentiation and treatment.
Verb (abbreviation for verb) seminar theme
A: The principle of treating diseases is formulated under the guidance of the overall concept of traditional Chinese medicine and the spirit of syndrome differentiation and treatment, which has universal guiding significance for clinical legislation and prescription selection.
Therapeutic principle is the general principle used to guide treatment methods, and therapeutic principle is a specific method to treat diseases under the guidance of therapeutic principle, which belongs to certain therapeutic principles. For example, from the relationship between evil and positive, various diseases are nothing more than the struggle between evil and positive, ups and downs, ups and downs. Therefore, in the treatment, strengthening the body resistance and eliminating evil has become the basic principle of treatment. Under the guidance of this general principle, according to the specific situation, the methods of supplementing qi and nourishing blood, nourishing yin and strengthening yang are the specific methods of strengthening the body resistance, while the method of sweating and vomiting is the specific method of eliminating evil.
(A) to find the root cause of the disease
Understanding and treating diseases is the first principle of Chinese medicine. The occurrence of any disease is always manifested by several symptoms, but these symptoms are only the superficial phenomenon of the disease. Only by comprehensively analyzing these superficial phenomena and distinguishing the etiology, nature and location of the disease and the relationship between pathogenic factors and syndromes can we determine the corresponding treatment methods and choose the corresponding drugs for treatment.
Targeted therapy and its guiding role in drug selection
In complex and changeable diseases, the priority of specimens should be carefully distinguished to determine the priority of treatment.
Reasonable choice of drugs.
(1) Slow down and cure the root cause: under the guidance of the principle of finding the root cause, treat the diseases that are not urgent and grasp the essence of the diseases. The principle of delaying illness is generally applicable to chronic diseases, or when the condition improves, the vital qi is insufficient and the pathogenic factors are not exhausted.
(2) Cure the symptoms when it is urgent: when the target disease is urgent and may be life-threatening, or the target disease affects the treatment of the first disease in the later stage, the method of treating the symptoms first and then curing the root cause after the target disease is relieved. The principle of treating symptoms rather than root causes is generally applicable to sudden and serious diseases, or when some life-threatening symptoms appear in the process of disease development. If the treatment of sudden illness should not be delayed, and the evil of the initial illness has not gone deep, it should be treated urgently to eliminate the evil, so that the healthy qi is not harmed and the patient can recover easily. Another example is massive blood loss, which is manifested as bleeding. The cause of bleeding is fundamental, but its potential is critical. Therefore, hemostasis and treatment of symptoms are often the first task, and then the cause of bleeding is treated after the bleeding stops.
It must be pointed out that the so-called "urgency is a palliative, and delay is a permanent cure", which cannot be absolute. There is no need to cure the problem if it is urgent. For example, if the yang collapses, the way to save the inverse is to treat the symptoms. After massive hemorrhage, qi is lost with blood. It is also a radical solution to replenish qi and consolidate the foundation with Shen Du decoction. Regardless of the specimen, it is the fundamental principle to treat the emergency first. At the same time, it is not impossible to treat the symptoms if you are slow. For patients with spleen deficiency and qi stagnation, symptomatic treatment with qi-regulating drugs is more different from simple spleen strengthening.
(3) Treat both the symptoms and root causes: that is, treat both the symptoms and root causes. Treat both the symptoms and root causes, and treat both the symptoms and the diseases. For example, patients with dysentery, qi deficiency (this) is due to poor diet, and diarrhea is not only due to evil (standard). At this time, it is necessary to treat both the symptoms and root causes, and at the same time, we must use drugs to strengthen the body resistance and eliminate pathogenic factors and clear damp-heat, that is, treat both the symptoms and root causes. Another example is patients with spleen deficiency and qi stagnation. Spleen deficiency is the foundation and qi stagnation is the standard. Ginseng, Atractylodes macrocephala, Poria, Glycyrrhiza uralensis Fisch, Radix Aucklandiae, Fructus Amomi, and Pericarpium Citri Tangerinae regulate qi and relieve exterior syndrome. The principle of treating both the symptoms and root causes is widely used, such as Shensuyin, Zhi Zhu Pill and Zengye Chengqi Decoction. According to the needs of the disease, treating both the symptoms and the root causes can go hand in hand and complement each other.
To sum up, generally speaking, if the disease develops slowly, it is necessary to treat it fundamentally; If the onset is urgent, the symptoms should be treated first; If the symptoms and root causes are urgent, we should treat both the symptoms and the root causes. In short, we must treat diseases from a dynamic point of view in clinic and be good at grasping the main contradictions, so as to determine the priorities of treatment.
2. Positive treatment and negative treatment, and their guiding role in drug selection.
(1) Zheng Zhi: It is a therapeutic principle aimed at its syndrome nature, so it is also called "reverse treatment". It is suitable for diseases with the same essence and phenomenon. Zheng Zhi is the most commonly used therapeutic principle in clinic. For example, "cold is hot" means that cold lesions appear cold and are treated with warm drugs, that is, heat is used to treat cold. For exterior cold syndrome, pungent warming relieves exterior cold. "Heat is cold" means that the heat syndrome is hot now, so it should be treated with cold medicine? For example, exogenous heat syndrome uses pungent cooling to relieve exterior syndrome, while internal heat syndrome uses bitter cold to clear heat. "Those who are deficient make up for it" means seeing deficiency in deficiency syndrome, and using tonic to make up for its deficiency. For example, yang deficiency syndrome is treated by strengthening yang, while yin deficiency syndrome is treated by nourishing yin. "Purging evil spirits" refers to removing evil spirits by purging evil spirits under the condition that real evidence shows real phenomena. For example, food stagnation syndrome is treated by digestion, water stagnation syndrome is treated by drainage, blood stasis syndrome is treated by promoting blood circulation and removing blood stasis, and insect accumulation syndrome is treated by anthelmintic method.
(2) Anti-treatment: it is a treatment rule that obeys the illusion of disease. That is to say, the nature of prescription or measure accords with the illusion of disease, which is consistent with the illusion of disease, so it is also called "from treatment". It is suitable for diseases whose symptoms and essence are not completely consistent. In essence, it is a method of treatment according to the nature of the disease under the guidance of the principle of seeking the root and treating the essence, so it is still "seeking the root and treating the essence". For example, "heat due to heat" refers to the method of treating diseases and syndromes with deficiency-heat symptoms with hot drugs. "Cold due to cold" refers to the method of treating diseases and syndromes with deficiency-cold symptoms with cold medicine. "Senatong" is a method of treating diseases with occlusive symptoms with tonics. Applicable to true and false evidence blocked by lack. For example, the spleen and stomach are weak, leading to abdominal distension and fullness. The method of invigorating spleen and regulating stomach should be adopted in treatment to restore the functions of spleen and stomach ascending and descending and qi circulation.