脊柱疾患临床诊断的辩证思维

脊柱外科是骨科学的一个亚专科,也是外科学领域中发展最为迅速的一个分支学科.脊柱外科疾患的正确诊断有赖于诊断过程中的正确辩证思维.在临床诊断思维中,从疾病擎角度和症状学角度,需要正确处理几个辩证关系,同时要避免临床思维常见误区,才能提高诊断正确性.     

脊柱疾患临床诊断的辩证思维

脊柱外科是骨科学的一个亚专科,也是外科学领域中发展最为迅速的一个分支学科。脊柱外科疾患的正确诊断有赖于诊断过程中的正确辩证思维。在临床诊断思维中,从疾病学角度和症状学角度,需要正确处理几个辨证关系,同时要避免临床思维常见误区,才能提高诊断正确性。     

辩证思维与基层医院RMS的诊断

辩证思维与基层医院ＲＭＳ的诊断甘肃省清水县卫生职业技术学校（７４１４００）李首阳在边远山区由于受到交通不便、信息不灵、缺医少药以及人们思想和经济相对落后等主客观条件的限制，病人很难到大医院去就诊，因此，基层医务人员特别是乡村医生便历史性地承担了这一诊...     

不对称临床现象的诊断思维

不对称临床现象指患者病史、症状、体征、实验室检查以及影像学检查之间不一致性,通常是不典型临床表现的形式.由于专业知识及临床思维的局限,不对称临床现象如未引起足够重视,易造成漏诊、误诊.本文介绍不对称临床现象的几种类型,重点讨论辩证思维中需要考虑的疾病类型及基本诊断思维过程,以提高对临床疾病的诊断能力.     

医学影像诊断中的辩证思维

辩证思维是最普遍适用、最重要的科学思维方法之一,医学影像诊断的各个方面均适用及应用着辩证思维。运用辩证思维能帮助分析疾病繁杂的外在表现,从而深刻认识疾病的本质,使影像诊断的结论更为准确和合理。     

临床决策需要辩证思维

对于一名临床医师来说,临床决策是一项十分重要的基本功.所谓临床决策,主要是指对疾病的正确诊断和及时有效地决定治疗方案并付诸实施.笔者从事口腔颌面外科临床工作50余年,深感临床决策的重要性,在笔者大半生的工作中,绝大多数情况下临床决策都是正确的.然而,医师是人不是神,一位医师在一生中总不能没有一点临床决策上的错误,或者说是"失误";但应力求少犯,特别要防止重大的失误.临床决策失误往往与医师的思维方法关系密切.现仅就临床决策的一些经验体会略加讨论.     

临床决策需要辩证思维

对于一名临床医师来说,临床决策是一项十分重要的基本功。所谓临床决策,主要是指对疾病的正确诊断和及时有效地决定治疗方案并付诸实施。笔者从事口腔颌面外科临床工作50余年,深感临床决策的重要性,在笔者大半生的工作中,绝大多数情况下临床决策都是正确的。然而,医师是人不是神,一位医师在一生中总不能没有一点临床决策上的错误,或者说是“失误”;但应力求少犯,特别要防止重大的失误。临床决策失误往往与医师的思维方法关系密切。现仅就临床决策的一些经验体会略加讨论。     

辩证否定观与临床诊断

辩证否定观与临床诊断贵州省黔东南自治州图书馆（５５６０００）张群英南京中医学院研究生（２１００３８）龙明照疾病的临床表现错综复杂,同一种疾病在不同的病人有不同的临床表现,甚至在同病人的不同阶段有不同的表现。在诊断过程中,坚持辩证否定观,就是一个由肯定...     

现象的本质

物、现象是主体运用自己的先验感知模式整理纯粹本体的结果。它具有现实确定性、质量性、合理性、时间性、空间性、生灭性、特殊性、有用、有利等属性。拥有这些属性的现象是人类知识的对象。现象是相对的,因此它的这些属性也都是相对的。同时,存在不仅仅有生生不息的纯粹本体,而且它的必然伴随物即现象也是存在的真谛。现象与纯粹本体一起共同构成存在的事实本体。纯粹本体、现象的分与合即一三三一圆融构成了存在的综合本体。纯粹本体论、事实本体论和综合本体论构成了中国古代形而上学史上三个不同的发展阶段。     

Appearance and reality

There is tension between the appealing idea that visual experience puts us in touch with objective reality and the doctrine of perceptual relativity, the claim that experience varies with such factors as distance, lighting, and angle of view. In this paper I present arguments for relativity, and then go on to propose that in view of relativity, we should believe that the properties presented to us in perception are relational and viewpoint‐dependent. I conclude by sketching a theory of how we nonetheless manage to achieve contact with objective properties. According to the theory, such contact is best explained in terms of perceptual representations acting in concert with cognitive and motoric representations, not in terms of perceptual representations alone.     

准确、完整的诊断与临床决策

正确的诊断是正确的临床决策的基础,正确的诊断依赖于详细的病史、准确全面的体格检查、合理的辅助检查资料的分析及正确的临床诊断思维方法。如果其中任何一项被忽视,临床医生可能会做出错误的诊断和错误的治疗,给病人造成不必要的损害。为了避免上述情况的发生,临床医生必须在掌握全面的临床资料的基础上,加以科学的综合分析,这样才能得出正确的诊断,给病人以正确的治疗。     

准确、完整的诊断与临床决策

正确的诊断是正确的临床决策的基础,正确的诊断依赖于详细的病史、准确全面的体格检查、合理的辅助检查资料的分析及正确的临床诊断思维方法.如果其中任何一项被忽视,临床医生可能会做出错误的诊断和错误的治疗,给病人造成不必要的损害.为了避免上述情况的发生,临床医生必须在掌握全面的临床资料的基础上,加以科学的综合分析,这样才能得出正确的诊断,给病人以正确的治疗.     

Essence in abundance

Fine (1994 “Essence and Modality”, Philosophical Perspectives, 8: 1–16) is widely thought to have refuted the simple modal account of essence, which takes the essential properties of a thing to be those it cannot exist without exemplifying. Yet, a number of philosophers have suggested resuscitating the simple modal account by appealing to distinctions akin to the distinction Lewis (1983. “New Work For a Theory of Universals”, Australasian Journal of Philosophy, 61: 343–377; 1986. On the Plurality of Worlds. Oxford: Blackwell) draws between sparse and abundant properties, treating only those in the former class as candidates for essentiality. I argue that ‘sparse modalism’ succumbs to counterexamples similar to those originally posed by Fine, and fails to capture paradigmatic instances of essence involving abundant properties and relations.     

Artifact and Essence

An essential property is a property that an object possesses in every possible world in which that object exists. An individual essence is a property (or set of properties) that an object possesses in every world in which that object exists, and that no other object possesses in any possible world. Call the claim that some artifacts possess an individual essence ‘artifactual essentialism’. I will argue that artifactual essentialism is true. In doing so, I will be responding to two recent arguments by Penelope Mackie against artifactual essentialism (Mackie (2006), esp. ch. 3.). In “Individual Essence Properties”, I will rehearse the qualifications that any property must meet if it is to constitute an individual essence, and in “Artifacts and the Recycling Problem” and “Artifacts and the Tolerance Problem”, I will rehearse Mackie’s arguments against artifactual essentialism. In “Artifacts and Weak Unshareability?” and “Artifacts and Strong Unshareability?”, I will show why both of these arguments fail. In “Mona Lisa’s Essence”, I will defend the interesting claim that some artifacts possess an individual essence. In the final section I will entertain some objections to my proposal.     

模态与本质

模态(modality)是指可能性、必然性等哲学范畴。根据关涉对象的不同,它可以分为从言模态与从物模态两类:若模态性质指的是命题或语句为真的可能性与必然性,则它是从言模态;若模态性质指的是事物具有某种性质或关系的可能性与必然性,则它是从物模态。     

Understanding and Essence

Modal epistemology has been dominated by a focus on establishing an account either of how we have modal knowledge or how we have justified beliefs about modality. One component of this focus has been that necessity and possibility are basic access points for modal reasoning. For example, knowing that P is necessary plays a role in deducing that P is essential, and knowing that both P and ¬P are possible plays a role in knowing that P is accidental. Chalmers (2002) and Williamson (2007) provide two good examples of contrasting views in modal epistemology that focus on providing an account of modal knowledge where necessity and possibility are basic access points for modal knowledge, and Yablo (1993) provides a good account of how we have justified beliefs about modality. In contrast to this tradition I argue for and outline a modal epistemology based on objectual understanding and essence, rather than knowledge or justification and necessity and possibility. The account employs a non-modal conception of essence and takes objectual understanding of essence, rather than knowledge of essence to be basic in modal reasoning. I begin by articulating Kvanvig’s (2003) account of objectual understanding, on which objectual understanding of Φ is not equivalent to propositional knowledge of Φ. I then argue that an epistemology of essence that uses property variation-in-imagination is better construed as a model that delivers objectual understanding of essence rather than knowledge of essence. I argue that this is so, since the latter and not the former runs into a version of the Meno paradox. I show how this account can be applied to two issues in modal epistemology: the Benacerraf problem for modality, and the architecture of modal knowledge.