難道所有人都不能吃冰嗎?統計數據與個人經驗的探討

每次門診都會被問到這樣的問題,乾脆在這篇文章來說清楚好了。

我們在門診的歷程中,常會遇到反覆感冒的小孩及某些呼吸道疾患,我們在問診的過程中,常會發現,在疾病發生前,常有過食冰品甜食的現象而導致感冒發作或哮喘的舊疾復發。

因此絕大多數的中醫師,甚至好心的長輩,都會提醒呼吸道比較常生病的孩子少吃冰品和甜食。

但我們接著要探討,要把"不要吃冰"這個概念推廣到所有人,是否會依然一概普適呢?

我覺得那就未必有這個必要了。因為個體差異實在太大了啊!

對於身體強健,無任何呼吸道疾患,女性沒有婦科的問題,吃完冰沒有不舒服的情況,也沒有長期大量食用而導致不適。偶爾為之而已,我們似乎也找不到理由讓人家完全別吃啊。

有些朋友會說,為什麼該不該吃冰的這種大是大非的問題,卻沒有臨床醫學統計數據來研究呢?

就來稍微說一下我所了解科研計畫的大致過程,需要做臨床調研,私人診所一般是做不了的(你也沒那個精力),必須要醫院內部或是向政府有補助的單位,提出科研計畫(在大陸叫做標書)來申請經費與許可,再用經費和人力按照想要調研的項目。選病人入組,完成臨床調研。

或許上一段聽起來有點複雜,但說成白話,科研可不是你想做就做的,是需要經費與人力及醫院許可的。

能不能吃冰這種事,你寫個標書往上報,我想,應該經費批不下來的吧。

即使做為研究生,你做這個題目,除非指導教授真的願意挺你,要不然開題的時候,想順利過,不和其他稍微高大上點的內容綁在一塊,似乎也薄弱了一點。

我想,這大概是"該不該吃冰"這個問題,一直停留在生活與臨床經驗,比較少科學數據來佐証的原因。

就好比吃西瓜吃太多會拉肚子,這是常有的生活經驗,每個人的體質差異,相差極大,但似乎也沒有科研去研究,到底平均吃多少西瓜會拉肚子。這會是同樣的道理。

看到這裡,那讀者能不能吃冰呢?

既然是個人與臨床經驗,那我們就試著回歸生活和臨床的實證。

如果發現疾病的復發與吃冰有明顯的因果關係,不但在發作期間建議暫時忌口,即使平常不發作期間,能避免也盡量避免。

舉個例子,某些哮喘或是容易氣管炎的孩子,如果吃完冰品後哮喘發作的頻率明顯增加。那我便不建議再吃冰。

抑或是,某些容易有痛經,月經來的時候小腹會涼的女性朋友,吃冰後會加重的,我也建議在治好前,最好忌口,以免病情反覆甚至加重。

同樣道理,某些吃完冰會胃脹不舒服,甚至拉肚子的,我也建議暫時不要吃冰,等病治好再說。

本文濃縮成一句話:如果你吃完冰會不舒服,甚至原有的病加重,那就該考慮面對問題,在治好前好好忌口,而不該以沒有科學數據為藉口,因循苟且,得過且過。

張貼在 兒科, 呼吸系統, 婦科問題, 消化系統 | 標記 , , , , , | 發表留言

吃完藥才會好,那有點久,我希望走出門前就能好。

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要先掌握本質,中醫不只是「經驗醫學」We must first grasp the essence, Chinese medicine is not just “empirical medicine"

今天輔導我家小五的小兒子做數學題目時,出現了以下的題目:

袋中放有同樣大小的白球29個,黑球21個.魔術師每次從袋中隨意摸出兩個球放外面,如果摸出的兩個球同色,就另外再拿一個黑球放入袋中,如果摸出的兩個球異色,就把其中那個白球放回袋中,這樣操作了48次,袋中還剩下幾個球?各是什麼顏色的?

第一次看到時,腦袋浮現的「是什麼鬼啊?這不是國中才會學到的機率嗎?怎麼用來考小五的孩子呢?真是殘害民族幼苗並為難我們家長啊!」

無奈之下,只好上網百度一下答案,看完恍然大悟,人家考的不是把把的機率啊,而是到底有沒有掌握變化的本質。

每次拿出兩顆,都會塞回一顆,當兩球異色時,白球會被塞回去,導致白球數會不變。

當兩球同色 白球一定會被拿出來,所以白球會以偶數的形式遞減。

48次會被拿走48顆球,共有50顆球,最後會剩下2顆,而白球原本為奇數,被偶數形式遞減,最後只能剩下1顆,所以 一定是1顆黑球和1顆白球。

看,很簡單吧。人家原來考的是目前的本質和變化的本質。

其實看病的時候不也是如此?疾病千百萬種,遇到的時候,也是得掌握當下的本質到底是什麼?

中醫不只是經驗醫學

前幾天看有中醫師在自己的書上寫,中醫是「經驗醫學」,乍聽之下,沒毛病,除了明師指點外,經驗在中醫領域的確重要。

但人家「經驗醫學」是個有專門意義名詞,是指「只有經驗沒有理論」,中醫豈是沒有理論體系?

中醫大學花了五年到七年光陰朝夕培養的,不正是這些中醫理論,讓初學者能透過這些理論快速掌握中醫臨床遭遇到問題的本質?

古代的醫家,以陰陽為總綱,再加上表裏、寒熱、虛實,成為了八綱,構成了後世所認知的八綱辨證體系,用來掌握疾病變化過程中的八個本質的問題,掌握了本質,便可以輕易的以簡馭繁。針對目前本質上的問題來解決。

中醫迷人之處,便是在於能夠找到本質後,便能像庖丁解牛般,逐次解開各種糾纏,治病如此,養生也如此。

We must first grasp the essence, Chinese medicine is not just “empirical medicine"

When tutoring my youngest son in the fifth grade of mathematics, the following questions appeared:

There are 29 white balls and 21 black balls of the same size in the bag. Every time the magician takes out two balls from the bag and puts them out, if the two balls are of the same color, he puts another black ball into the bag. If the two balls are of different colors, put the other one. Put the white ball back into the bag. After doing this 48 times, how many balls are left in the bag? What color are they?

When I saw it for the first time, “What the hell is it? Isn’t this a chance question to be learned only in junior high schools? How can it be used for children in the fifth grade? It really hurts my kid  and embarrass us!"

In desperation, I had to go online to check the answer on Baidu. After reading it, I suddenly realized that what people tested was not the probability of the test, but whether they grasped the nature of the change.

Each time two balls are taken out, one will be stuffed back. When the two balls are of different colors, the white balls will be stuffed back, causing the number of white balls to remain unchanged.

When two balls are of the same color, the white ball will definitely be taken out, so the white ball will decrease in an even number.

48 balls will be taken away in 48 times, a total of 50 balls, there will be 2 in the end, and the white balls were originally odd numbers, but the even numbers are reduced, and only 1 ball is left, so it must be 1 black ball and 1 White balls.

Look, it’s simple. People originally considered the current nature and the changed nature.

In fact, this is not the case when seeing a doctor? There are millions of diseases, and when you encounter them, you have to grasp the essence of the current situation.

Chinese medicine is not just empirical medicine

A few days ago, I saw a Chinese medicine doctor wrote in his book that Chinese medicine is “empirical medicine." At first glance, there is nothing wrong with it. Except for the guidance of the master, experience is indeed important in the field of Chinese medicine.

But “empirical medicine" is a term with special meaning. It means “experience but no theory." Does Chinese medicine have no theoretical system?

It took five to seven years for the University of Chinese Medicine to cultivate. Isn’t it just these theories of Chinese medicine that allow beginners to quickly grasp the essence of the problems encountered in clinical Chinese medicine through these theories?

Ancient chinese physicians used yin and yang as the general outline, together with the exterior and interior, cold and heat, as well as the deficiency and actuality, to form the Eight Principal , which constituted the Eight Principal syndrome differentiation system recognized by later generations, used to grasp the eight essential problems in the process of disease change. In essence, you can easily control the complex with simplicity. To solve the current essential problems.

The fascinating thing about Chinese medicine is that after being able to find the essence, it can solve various entanglements one by one like Pao Ding solves a cow. This is the case for curing diseases and health preservation.

張貼在 醫學 | 標記 , , | 發表留言

幫一家醫院的院長治好了鼻炎和板機指,送了我這兩瓶酒。聽說是25年的女兒紅

未提供相片說明。
張貼在 小廢文 | 標記 | 發表留言

又協助一個抽動症小朋友結束戰鬥,這次只花了兩週

這孩子不但有抽動的症狀,而且在學校每週上體育課都一定和其他小孩起衝突。

還有一個更特殊的症狀:老是愛扮成小貓小狗給同學騎在身上當寵物。小孩媽媽為了這讓人頭痛的問題,操碎了心。但找了很多醫生治療,包含中西醫、甚至心理醫生,做了不少檢查,查不出具體原因,嘗試很多治療,但都沒有什麼改善。光這附近的診所,就換了五個醫生。

這孩子的父親偶然到我門診看到我有治療抽動症,想說碰碰運氣,試試台灣醫生。結果喝上中藥一週後,不但抽動好轉,也不和同學吵架了。兩週後,抽動已基本消失,也不再扮寵物讓人騎了。

只剩一個症狀:愛玩不愛寫作業,我告訴孩子的媽媽,我小時候也不愛寫作業,小孩都這樣,沒有關係啦~

今天是第三週,我在準備讓他停藥前合影留念一下,紀念協助與陪伴的這兩週時光。希望他恢復後,能夠快快樂樂,從此和和氣氣的和身邊的人相處。恢復正常後,從此人生有更多的選擇了。時間在過很快,下次再見面,搞不好就比我還要高了。

Assisted another kid with Tourette syndrome to end the fight, this time it only took two weeks
This child not only has symptoms of tics, but also has to clash with other children in physical education every week at school.

There is also a more special symptom: I always pretend to be cats and puppies for classmates to ride on as pets. The mother of the child broke her heart for this headache. However, I found many doctors for treatment, including Chinese and Western medicine, and even psychologists. I did a lot of examinations. I couldn’t find out the specific reasons. I tried many treatments, but nothing improved. There were five doctors in the clinic nearby.

This child’s father came to my clinic by chance and saw that I was treating tics, and wanted to try his luck and try a Taiwanese doctor. As a result, after taking Chinese medicine for a week, not only did her twitching get better, she also stopped quarreling with classmates. After two weeks, the twitching has basically disappeared, and I no longer pretend to be pets for people to ride.

There is only one symptom left: I love to play or not to do homework. I told my child’s mother that I didn’t like to do homework when I was a child. It’s okay for children to do this.

Today is the third week, I took a group photo before letting him stop the medication to commemorate the two weeks of assistance and company. I hope that after he recovers, he can be happy and get along with the people around him happily ever after. After returning to normal, there are more choices in life. Time is passing fast, and I will meet again next time, maybe it will be higher than me.

圖像裡可能有1 人、特寫
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給88歲老伯伯的聖誕禮物–減輕了他褲襠裏巨大的負擔 讓他終於能坐著過聖誕節(有圖慎入)

這週在廣安的門診,週一出現了特別的客人,是個徬徨無助的88歲Y老伯。他找不到適當的醫生能解決他的問題,情急之下,便找了來自台灣的我。

剛進門的時候,我摸了摸脈,問他是不是大便不太好,他告訴我的確是,由於最近辣椒吃太多,導致大便排不出來,好像有點痔瘡。我便讓他把褲子脫下來我看看。

當他脫下褲子時,我嚇一跳,一個頗巨大的痔瘡出現在我眼前,我進一步追問了一下,原來Y老伯原本沒有高血壓,是由於大便排不出來,很難受,晚上也睡不著,導致高壓升到快160。

於是我按照表現出來的症狀,依照傷寒六經辨證,給他開了些通便消痣的藥。

過了兩天,Y老伯又跑來我門診掛號,說要讓我再看看,他露出痔瘡時,我發現雖然只吃兩天藥(一帖半),痔瘡的大小竟然縮小了近一半。

我問問老人家的感覺,他說雖然排便還沒完全順暢,但明顯覺得好多了,摸脈時脈管的緊張度也明顯放鬆不少。

我稍微幫他針灸了一下頭上和腰部的穴位,並囑咐他要繼續堅持服藥,希望下次見面能小更多。

能讓88歲的老人家舒服的坐下來,大概是我能帶給他最好的聖誕禮物吧。

A Christmas gift for the 88-year-old uncle-relieved the huge burden in his crotch, so that he can finally sit down and spend Christmas (with pictures carefully)

In the outpatient clinic in Guang’an this week, a special guest appeared on Monday, a helpless 88-year-old man Y.

When I first entered the door, I felt the pulse and asked him if he had a bad bowel movement. He told me that “It was because I had eaten too much chili recently, which caused bowel movements to be unable to pass out, which seemed to have hemorrhoids." I asked him to take off his pants and let me see. When he took off his pants, I was shocked. A huge hemorrhoid appeared in front of my eyes. I asked him further. It turned out that Old Man Y did not have high blood pressure in the past. “I can’t get my stools out, I feel uncomfortable, and I can’t sleep at night"he said, causing the high pressure to rise to nearly 160.

So I prescribed some laxative medicine for removing moles according to the symptoms and the six symptoms of typhoid fever.

Two days later, Mr. Y came to my clinic again and asked me to see him again. When he showed his hemorrhoids, I found that although he took medicine for only two days (one pack and a half), the size of the hemorrhoids had shrunk by nearly half. I asked the elderly how he felt. He said that he obviously felt better, and the tension of the vessel was obviously relaxed when he felt the pulse. Although the bowel movement was not completely smooth, I helped him acupuncture the acupuncture points on his head and waist a little, and asked him continue to take the medicine ,I hope that the next meeting will be smaller.

It is probably the best Christmas gift I can bring to an 88-year-old man to sit down comfortably.

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一歲小雲的中醫體驗 原本困難的爬行好多了

一歲小雲的中醫體驗 原本困難的爬行好多了

小孩爬行是一件很自然的事,但對於產程過程中腦損傷,而肌肉強直的孩子來說,卻是一段艱難的訓練。

這是上上周遇到的一個帶來看咳嗽的小女孩,在問診時得知,她是由於產程過長,造成腦部缺氧,而導致肌肉強直。

目前正在兒童醫院做運動訓練。除了咳嗽外,媽媽還為了她下肢肌肉強直,爬行不便,苦惱不已。

我開了湯藥讓她回去吃,在治咳的同時,加入了疏通經絡,改善肌肉彈性的配方。

感謝家長對我的信任與配合,經過一周多的調理,這周來咳嗽已經好多了,意外的竟然連肌肉的強直都明顯減輕,爬行順暢多了。

中藥的效果有時真是讓人驚艷啊~

第一次看到我時,可能因為白衣恐懼症,狂哭。

這次終於沒有哭,願意和我牽手拍照了 😃

希望小雲能夠早日恢復正常,像正常孩子一樣健康成長。

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該怎麼跟你的中醫師溝通?(我的建議)

1.請把與病情相關的資料,整理後發給醫師。 而不是像擠牙膏一樣,有所保留,一次只給一點。

2.如果正住院接受西醫治療,又想同時接受中醫治療,請親自和西醫主管醫師協調。而不是要中醫師幫你去說服西醫主管醫師。

3.初次就診,必須親自到場。

4.如果需要針灸治療,醫師會當場親自執行。不建議遠程教學,由經驗不足的來操作。

5.病情危重,建議就近線下看診比較好。

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如何预约峻生医师的线上看诊呢?

对于已经有初诊纪录的朋友,常因为

1.   人在外地  

2.   工作繁忙

3.   就诊不便(小孩已經發熱)

因此特别开设在线看诊,方便老朋友们看诊调方,并且提供药物代煎及寄送服务。尽我们所能给您看诊服药的便利。

以下内容便是简介在线看诊如何预约

目前在线看诊的时间,暂时安排在二四下午2:30~4:00  及周六下午3:00~4:00

操作步骤如下:

1.   进入我们的在线看诊预约网页:  https://aa168.365bookings.cn/v2/

2.   点击预约按钮

3.选择您想在线看诊的时间段,并在上面点击

4.输入您的数据:姓名、邮箱、联系手机,并记得最后点击预约​

5.如果要预约两个号以上 当屏幕出现这些时,点加号。

6.预约被确认后,您的邮箱会收到确认信,那表示预约已经被完成了。

使用过程中有任何问题,欢迎随时跟我们反映。

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後疫情時代的世界趨勢對醫師有什麼影響

新冠疫情持續延燒,美國感染人數突破67萬人,社區感染已然從最嚴重的紐約,已經蔓延到中部各城。紐約州州長終於將下令公共場所必須戴口罩。在這樣的疫情進行式中,我們看見了大量的新冠患者,擠爆了美國的醫院,屍袋和停屍間都不夠用。新冠病毒對醫療資源的擠兌,使其他疾病的患者就醫權益受到了很大的影響。即使在疫情已經緩和的地方,也不少民眾不敢到醫院就診。一方面深怕受到傳染,也不想多花好幾倍的時間和風險而只為了些還能忍受的病。雖然疫苗已經在研發,有些專家也不斷提醒民眾需要多加注意,唯恐新冠變得像流感一樣,不慎又再受到疫情的波及。
在這樣的時代趨勢下,對於醫師的診務有何影響?最近台灣雖然疫情尚在可控之下,餐飲、旅遊、觀光早已哀鴻遍野。但也有些醫療院所如耳鼻喉科診所,反應門診量降到原來的一半。也不少牙醫診所,出現門診量下降的情況。就算是中醫診所,也有傳出門診量下滑的情況。原因無他,群眾避免出門的結果,當然導致門診量下滑。就在大家都受到影響時,原本有規劃線上看診機制的某些自費門診,卻逆勢開始問診人數增加。由此現象可以窺見,後疫情時代,隨著民眾生活開始因為疫情開始線上化,,加上5G和電子貨幣及物聯網的推波助瀾下,就醫方式的改變或許會越來越明顯。但問題是醫師對於這股可能出現的潮流,做好準備了嗎?當看診形式可能往線上分流,醫師需要準備些什麼呢?可能要面對下列三個問題1.是否完成診務的數字化?患者從預約到看診到取藥,流程是否已經能夠數字化?還是需要醫師在診所裡發號施令才能完成呢?
2.是否有線上簡介與諮詢?某些初診的患者,對醫師不一定理解,是否有網上的文章或視頻能對醫師進行了解呢?
3.是否有線上的衛教與客服?很多疾病事後的調養很重要,是否有這方面的數字內容如文章、視頻供患者瀏覽呢?
即將開展線上業務的醫師,恐怕難免得面對這些問題,我們期待透過這次疫情的警鐘,能讓未來部分的就診模式發生改變。有利患者、也有利醫師。

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