1、中医急诊学的源流和发展 The originanddevelopmentof the emergency of Traditional Chinese Medicine,方邦江 教授Prof. FANG Bangjiang上海中医药大学附属龙华医院Longhua hospital affiliated to Shanghai university of traditional Chinese medicine,方邦江教授 简介,教授/主任医师、医学博士博士生导师急救科主任中华医学会急诊分会常务委员中华中医药学会急诊分会副主任委员世界中医药联合会急诊分会会长中国中西医结合学会急救医学专业委员会副
2、主任委员,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 Emergenc
3、y Branch of the World Federation of Chinese Medicine Deputy committee director of Emergency Branch of the Integrated Traditional Chinese and Western Medicine,中医急诊学的历史源流The historical originof the emergency of Traditional Chinese Medicine,黄帝内经奠定了中医急症理论基础的雏形Huangdi Neijing established an initial theor
4、etical foundation of the emergency science of TCM.黄帝内经中详细记载了中医急症相关病名、临床表现、病因病机、诊治要点及预后，从而奠定了中医急诊医学的理论基础。It recorded the related disease names, the clinical manifestations, etiologyandpathogenesis, diagnosis and treatment, prognosis in detail of the TCM emergency.,伤寒杂病论推动中医急症理论的发展Treatise on Febrile
5、and Miscellaneous Diseasespromoted the development of the theory of the TCM emergency.张仲景以当时伤寒热病为基础，创立了中医学辨证论治的学术思想，奠定了中医急诊学辨证救治体系。Zhang Zhongjing created the academic thoughts of treatment based on syndrome differentiation，which established a system of syndrome differentiation and treatment.,晋唐时期至明
6、清的重要贡献The significant contributions from Jin and Tang Dynasty to Ming and Qing Dynasty.晋葛洪肘后备急方总结了魏晋南北朝时期治疗内、外、妇、儿、五官科急症的经验，拓宽了急症范围，发展了给药途径，创立了肠吻合术。Ge Hong from Jin Dynasty written the Zhouhou Beiji Fang. He summarized the medical experience of treating the acute diseases of internal, surgical, gyne
7、cological, pediatric and ENT medicine. He broaden the scope of acute diseases and developed the route of administration. He also created the intestinal anastomosis.,隋代巢元方编著的诸病源候论，其中急症病证占四分之一多。Chao Yuanfang from Sui Dynasty written the book Treatise on the Causes and Manifestations of Diseases. There
8、 are more than a quarter of pages recorded the acute syndromes and diseases.,唐孙思邈在千金要方和千金翼方中明确提出“备急方”，27首专供急救，如“仓公散”“还魂散”。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.,金元四大家进一步丰富和发展了急
9、症的理论和治疗方法。The four eminent physicians in Jin and Yuan period enriched and developed the theory and treatment of the acute diseases.,温病学说的形成和发展最终奠定了中医急诊医学理论体系The formation and development of the theory of epidemic febrile disease finally established the theoretical system of TCM emergency.,中医药在急危重症中的
10、应用历史悠久,The Traditional Chinese Medicine has a long history in treating the critical and acute diseases.,几千年来，中医学形成了完整系统的理论体系。在没有现代医学介入的漫长年代中，一切急、慢性疾病皆诊治于中医药。The Traditional Chinese Medicine has formed a complete theoretical system for thousands of years. In the time without the western medicine, the
11、 acute and chronic diseases are all diagnosed and treated with TCM.,中医药在救治急危重症、保障中华民族的生命健康中起着不可磨灭的贡献，中医急症是中医学精华之所聚。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 the essence of
12、 the Traditional Chinese Medicine.,华佗创制麻沸散Doctor HUA Tuo created Mafeisan (One kind of anesthetic medicine),晋代葛洪肘后备急方口对口吹气法 Doctor GE Hong in Jin Dynasty introduced artificial respiration in the book “Zhouhou Beiji Fang”,唐代孙思邈发明葱管导尿法Doctor SUN Simiao in Tang Dynasty introduced catheterize technology
13、 by scallion stem.,扁鹊救治尸厥,扁鹊乃使弟子子阳厉针砥石，以取外三阳五会。有间，太子苏。,乃使子豹为五分之熨，以八减之齐和煮之，以更熨两胁下。太子起坐。,更适阴阳，但服汤二旬。而复故。,故天下尽以扁鹊能生死人。扁鹊曰：“越人非能生死人也，此自当生者，越人能使之起耳。”,节选自史记扁鹊仓公列传,Doctor Bian Que treated syncope,Doctor Bian Que told his student Zi Yang to sharpen the needle and to acupoint Baihui. In a moment the prince w
14、as 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 decoction for 20 days. Finally t
15、he prince regained his health. -From “The records of the historian Bian Que Cang Gong biography”,张仲景救治自缢,记载 1700多年前,徐徐抱解，不得截绳，上下安被卧之一人以脚踏其两肩，手少挽其发，常弦弦勿纵之 一人以手按揉胸上，数动之一人摩捋臂胫屈伸之若已僵，但渐渐强屈之，并按其腹如此一炊顷，气从口出，呼吸，眼开，而犹引按莫置,平卧体位开放气道连续胸外心脏按压舒展胸廓，助力呼吸腹部按压助以通气和血液回流不可中断心脏按压，直至复苏成功,Doctor ZHANG Zhongjing saved han
16、ging,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,中医药在急危重症领域中的发展,The development of
17、Traditional Chinese Medicine in Emergency.,吴咸中院士运用中医药方法治疗急腹症,天津南开医院吴咸中院士建立了“中医辩证与西医辨病相结合”的临床研究方法，确定了以“通里攻下法”为代表的“急腹症八法”的治疗法则大黄制剂在急性胰腺炎中应用。,Academician WU Xianzhong treated acute abdomen with TCM,Academician Wu in Tianjin Nankai Hospital established the “Chinese and Western medicine dialectical combi
18、nation 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.,王今达教授运用中医药方法治疗脓毒血症,天津急救医学研究所王今达教授（我国危重病医学的创始人）创立血必净注射液临床用于脓毒血症的治疗广泛用于脓毒症、多器官功能障碍综合征、急性呼吸窘迫综合征、
19、慢性肺源性心脏病心功能不全、重症急性胰腺炎等多种危急重症,Prof. Wang Jinda treated sepsis with TCM,Professor 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 widely used in sepsis, MODS, acute respi
20、ratory distress syndrome, chronic pulmonary heart disease heart failure, severe acute severe pancreatitis and other critical diseases.,毒热证,血虚证,血瘀证,Sepsis恶化,活血化瘀法,扶正固本法,清热解毒法,瘀毒互结,祖国医学针对脓毒血症内因治疗的 “三证三法”,Toxic heat,血必净在脓毒血症中的作用环节,Sepsis, Diffuse intravascular coagulation, DIC, Septic shock,朱培庭教授运用中医药方
21、法治疗急性胆道感染、胆石病,在总结顾伯华、徐长生教授的经验基础上，灵活应用“理气解郁、清热解毒、通里攻下” 基本治法。感染较重者，特别注意采用清热解毒与通里攻下并进，扶正与驱邪相结合的原则。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 heavy-infected patients, using the pri
22、nciples combined with clearing away heat, toxic material and purgative, strengthening body resistance and eliminating evil.,朱培庭教授运用中医药方法治疗急性胆道感染、胆石病,清热解毒可弥补单用抗生素的不足，还具有减毒的作用；通里攻下，可改善呼吸功能，减少毒素吸收，增加胆汁流量和松弛括约肌。临床使用后可明显降低手术率。 Detoxification way can not only compensates for the disadvantage of antibiotic
23、s, 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 significantly reduced .,唐汉钧教授运用中医药方法治疗毒蛇咬伤,中西医
24、结合治疗毒蛇咬伤是优势与特色之一。季得胜蛇药是具有代表性临床治疗毒蛇咬伤药物。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.,唐汉钧教授运用中医药方法治疗毒蛇咬伤,目前我院每年救治大约100例蛇伤病人，除一例因送院时间晚、救治无效死亡外，其他千余例病人全部被
25、抢救成功，已经成为上海市和华东地区著名的治疗毒蛇咬伤专科。Currently 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 specialized hospital in Shanghai and EasternChina.,图为包机从烟台
26、送到我院成功救治的蔡淳治先生，中央电视台等多家媒体滚动宣传。 The picture shows Mr. Cai Chunzhi who charter flights from Yantai to our hospital and successfully be treated. CCTV and other media roll propaganda.,龙华医院急诊科开展特色技术、疗法研究Emergency department of Longhua Hospital carries out special medical technology and treatment.,针刺、灌肠综合
27、治疗AECOPD显示出有效改善呼吸肌疲劳、减轻胃肠道胀气和瘀血，促进呼吸衰竭的纠正。The comprehensive treatment of acupuncture and enema for AECOPD effectively improve respiratory muscle fatigue, reduce gastrointestinal and stasis flatulence. The therapy can help to treat respiratory failure.,成功救治鱼胆中毒并多脏器功能衰竭患者,Successful treatment of patient of fish bile poisoning and multiple organ failure.,心肺复苏后综合征、严重脓毒症患者Patient of postcardiopulmonary resuscitation and severe sepsis.,谢 谢！Thanks for your time!,
