关于证候定义的三点商榷

对证候定义研究中存在的问题进行剖析,提出三点商榷意见.首先,"证"是病理学概念,不是诊断学概念.其次,"证"发生在病人身上,并非由诊断"概括"出来.第三,应当把内在的病理改变与外在疾病征象区别开来.     

‘Her Majesty the Baby’: narcissistic states in babies and young children

This article considers narcissistic states in babies and young children with some reference to the myth of Narcissus in Ovid’s Metamorphosis. The object-seeking character of babies from the beginning of life is elaborated in connection with selected research from mother–baby interaction. This forms the backdrop to a discussion of withdrawal into illusions of self-sufficiency and denial of dependence in adverse circumstances. Two clinical cases are discussed in some depth. One boy whose superiority, self-reliance and pseudo maturity is prompted by anxieties around separation as he approaches starting school is considered within the parameters of ordinary transient narcissism. The lengthy psychotherapy of another child, who developed entrenched narcissistic defences as a response to traumatic, abusive and neglectful experiences in early life, and who needed considerable help, is described in greater detail. Some links are made with difficulties associated with the emergence from narcissistic functioning and encountering the pain of separation and loss.     

Comorbidity in allergic asthma and allergic rhinitis: functional somatic syndromes

Based on the concept of central sensitisation, the present study tested the hypothesis of comorbidity in allergic asthma and allergic rhinitis with diagnoses of functional somatic syndromes (FSSs), including fibromyalgia, irritable bowel syndrome and migraine. Data were used from the population-based Västerbotten Environmental Health Study (n = 3406). The participants consisted of 164 individuals with allergic asthma and 298 individuals with allergic rhinitis as well as 2876 individuals without allergic or non-allergic asthma, allergic rhinitis or atopic dermatitis. Diagnoses were based on self-reports of having been diagnosed by a physician. Odds ratios (ORs) were calculated from binary logistic regression analysis, both crude and adjusted for age and education. The adjusted ORs (1.87–4.00) for all FSSs differed significantly from unity for both allergic asthma and rhinitis. The results provide support for the hypothesis of comorbidity in allergic asthma and rhinitis with FSSs. Since central sensitisation is likely to underlie FSSs, the present findings raises the question as to whether central sensitisation may also be involved in allergic asthma and rhinitis.     

Existential function of babies: Babies as a buffer of death-related anxiety

The present study examined babies as death anxiety buffers with Chinese participants in three experiments. In Experiment 1, death-related thoughts increased college-aged participants' interest in human babies. In Experiment 2, images of newborn animals reduced the number of death-related thoughts recorded by college-aged participants. In Experiment 3, female factory workers who read news articles describing deaths of babies had pessimistic estimations of their own life expectancies. An explanation of these results is provided within a terror management theory framework, with a primary focus on how babies reinforce cultural worldviews and enhance self-esteem via the notion of symbolic immortality. Thus, the anxiety-buffering function of baby is subsumed under cultural worldviews validation and self-esteem enhancement.     

EMPATHY AND THE EXTENDED MIND

I draw upon the conceptual resources of the extended mind thesis (EM) to analyze empathy and interpersonal understanding. Against the dominant mentalistic paradigm, I argue that empathy is fundamentally an extended bodily activity and that much of our social understanding happens outside of the head. First, I look at how the two dominant models of interpersonal understanding, theory theory and simulation theory, portray the cognitive link between folk psychology and empathy. Next, I challenge their internalist orthodoxy and offer an alternative "extended" characterization of empathy. In support of this characterization, I analyze some narratives of individuals with Moebius syndrome, a kind of expressive deficit resulting from bilateral facial paralysis. I conclude by discussing how a Zen Buddhist ethics of responsiveness is helpful for articulating the practical significance of an extended, body-based account of empathy.     

论中医的辨证论治与肿瘤的分子靶向治疗

辨证论治是中医认识和治疗疾病的基本原则,“同病异治”和“异病同治”是辨证论治的精神实质。恶性肿瘤的分子靶向治疗在很多方面都贯彻了“辨证论治”观念,将所辨的证候落实到受体、基因和各种调控系统上。尽管两者理论基础完全不同,但都强调以患者为中心的综合治疗和个体化治疗理念,对建立正确的临床思维非常重要。     

Working memory impairment in people with Williams syndrome: Effects of delay, task and stimuli

Williams syndrome (WS) is a neurodevelopmental disorder associated with impaired visuospatial representations subserved by the dorsal stream and relatively strong object recognition abilities subserved by the ventral stream. There is conflicting evidence on whether this uneven pattern in WS extends to working memory (WM). The present studies provide a new perspective, testing WM for a single stimulus using a delayed recognition paradigm in individuals with WS and typically developing children matched for mental age (MA matches). In three experiments, participants judged whether a second stimulus ‘matched’ an initial sample, either in location or identity. We first examined memory for faces, houses and locations using a 5 s delay (Experiment 1) and a 2 s delay (Experiment 2). We then tested memory for human faces, houses, cat faces, and shoes with a 2 s delay using a new set of stimuli that were better controlled for expression, hairline and orientation (Experiment 3). With the 5 s delay (Experiment 1), the WS group was impaired overall compared to MA matches. While participants with WS tended to perform more poorly than MA matches with the 2 s delay, they also exhibited an uneven profile compared to MA matches. Face recognition was relatively preserved in WS with friendly faces (Experiment 2) but not when the faces had a neutral expression and were less natural looking (Experiment 3). Experiment 3 indicated that memory for object identity was relatively stronger than memory for location in WS. These findings reveal an overall WM impairment in WS that can be overcome under some conditions. Abnormalities in the parietal lobe/dorsal stream in WS may damage not only the representation of spatial location but may also impact WM for visual stimuli more generally.     

The use of observation in the psychoanalytic treatment of a 12-year-old boy with Asperger's syndrome

The author describes some aspects of a once-weekly psychoanalytic psychotherapy of a 12-year-old boy diagnosed with Asperger's syndrome. The patient's emotional and cognitive development had been impaired since early life, possibly due to an internal deficit and to the likelihood of inadequate environmental holding. He was unaware of having difficulties but was underachieving academically, was socially isolated and often visibly unhappy in his life. The patient's denial, splitting, and projection of emotion and insight presented the therapist with the difficult task of how to reach him. In order to communicate with him emotionally, the therapist created a modified technique which reflected the patient's development from part-object to whole-object relationships. This development became apparent in the sessions and was interpreted in the transference relationship. An account of the patient's early years was pieced together from a detailed commentary of what was being observed and intuited by the therapist during the sessions, as well as by an understanding of the countertransference. By the end of two years' treatment, the patient's sensitivity and creativity, which had been buried beneath a self-sufficient, autistic-like encapsulation, finally began to emerge in his communications with his therapist.     

'Actual neurosis' and psychosomatic medicine: THE VICISSITUDES OFAN ENIGMATIC CONCEPT

Out of the concept of neurasthenia, the main non-psychotic diagnosis of nineteenth-century psychiatry besides hysteria, and on the basis of psychophysiological problems of his own, self-diagnosed as neurasthenia, Freud developed the notion of 'actual neurosis', a 'contentless psychic state' manifested by various somatic symptoms and a depressive mood, which he attributed to a chemical factor associated with aberrant sexual practices and in particular masturbation. Rejected by post-Freudian analysts as such along with the diagnosis of neurasthenia, the concept of 'actual neurosis' has survived under various theoretical schemes that seek to explain psychosomatic illness and somatisation, in general, with its concomitant poverty of affects and dearth of fantasy life. In more recent years, the concept of 'actual neurosis' has resurfaced under the label of chronic fatigue syndrome, a medical entity thought to be an immunological deficiency, while in psychoanalysis Freud's idea of a contentless mental state has been replaced by that of unconscious fantasy and symbolisation at a pre-genital or pre-verbal level.