Well connected in the recipe

 Traditional remedies
1, soaring poisoning licorice 1 Solution
two mung bean 2 two, water decoction. Solvable soaring poisoning.

2, remove eggplant slices white freckles method
rub the affected area will disappear a few days since.

3, set only method
brown nose bleeding a rope, tied in the section of the index finger, left tied to the left nasal bleeding, nasal bleeding tied to the right hand, immediately after ending tied.

4, pharyngitis without medication administration to take appropriate method
tea wrapped with gauze and put it into boiling water bubbles out of the cup than tea drinking slightly thick tea), plus amount of honey and stir well. Use this tea every half hour and rinse throat and swallow the effective date, the 2nd recovery.

5, rule 3 diarrhea without medication
two of vinegar, to boil, a drink, and drink that is, except three.

6, dysmenorrhea simple treatment of women in the premenstrual
1,2 days, the Chinese medicine three fingers at the Guanyuan, and then the (Note: during pregnancy)

7, clear the bad breath of fresh reed rhizome method
8 money, crystal sugar Zhuzhi service, three times a day dose, to clear the bad breath.

8, skin is pale and delicate flesh boils water in winter common law
face, take a sponge bath, the skin becomes pale and delicate.

9, to prevent motion sickness, cut a slice of fresh ginger slices
law, in the car attached to the navel on the Pro, and with the injury or medical tape fixed wet paste Well, lost upon arrival. This approach works well gone through many trials

10, teeth whitening method with a fine cloth dipped in baking soda to clean brush teeth, make teeth become whiter.

11, stiff neck treatment
simple lemon water with a towel soaked dry, wrap the injured area, repeated several times Jiyu.

12, through dry stool Lotus
5 grams of tomato juice, drunk as a tea twice with open blisters, about 4 hours to discharge stool. Such as constipation particularly serious and stubborn and can be used raw Sichuan army 12 grams, 10 grams of hemp seed, Yuli Ren 10 grams, decoction in two suits, 4 hours defecation.

13, Fishbone card method
throat grab from a duck, bring leg of the duck, duck head down so that, from duck mouth salivary flow solution (viscosity of water), will drop choking duck, the fish bone from the of the clean.

14, a hundred insects ear if since the law
insects crawl into the ear, ear drops with cat urine, the worm immediately out. (Garlic rub cat nose, cat from the urine.)

15, no sweat clever method
orange alum, borneol and one each in money, bubble white wine or two, a day after the entry of new shoes to wear dry shoes on indoors, and never a sweat.

16, yellow water sores, eczema effects of prednisone therapy
4, flapping and sensitivity 4, a total of four research griseofulvin into a fine, and then four chloramphenicol-pin fully dissolved, and mix thoroughly with when applied to affected area once or twice a day, two days of recovery.

17, Astragalus treatment of prolapse miraculous method
4 two, wind 1 money, Shuijianbi. Children by half, regardless of eight or ten years Jieyou wonders.

18, clear the acne (pimple worse) effects method
loquat leaf 12 g, Morus alba L., Scutellaria, Gardenia raw, red peony, Dan skin, Forsythia of 9 grams, 3 grams of raw licorice, each serving a day, Shuijianbi. 10-15 agents that is, except with clothes.

19, the treatment of insomnia good side
floating wheat (wheat Amoy floating in the water when the top of the flat thin wheat) 60 grams, 30 grams of licorice, large 15 dates, fry 1 cup water 4 bowls, sooner or later once the service, excellent results.

20, set to play only if uh method
treatment by other methods can not only beat uh, just a little gourd nose inhaling pepper, it will even make some spray tears, playing uh basis.

21, aphthous unilateral
habitat of infant 10 grams, 5 grams of bamboo leaves, Forsythia 10 grams, 1 gram of even half of Sichuan, Ophiopogon japonicus 10 grams, Chine 15 grams, 5 grams of grass shoots, Shuijianbi a 3-day 4-day recovery.

22, the eradication of a centipede Chaojiao Corn Law
research side, the first scrape the corn crust, cast Emulsion, fixed with adhesive tape, the three days from the addition.

23, mouth crooked eye oblique simple therapy will be able to call out the cicada
3, tied with a cord, hanging in the sunlight Shaisi, dried, then placed the tile on the baked yellow, research into Ximo, with a dose of rice wine, cover the body with the quilt after the service so that sweating sleep, twice the dynamic recovery.

24, the new law to eliminate the hairy
technology to eliminate the hairy youth (Hu and other face, especially hairy girls), because of the annoyance hairy, Shanghai pharmaceutical factory produced a ninth-date And can be eradicated. 5 per bottle sold separately angle, angle of 8 points ex-factory price 3. In addition to those who would like to be hairy to the drugstore to buy, use and dosage, see

25, Qiaozhi rice ringworm rub method
affected area with a bitter almonds, three times a day, several times since the addition.

26, mad dog bites therapy
spot Cui 7, centipede an inquiry into fine, blunt wine.

27, children with Enterobius simple therapy
hazelnut 7, to the skin, a night filled anus, even 7 days can be.

28, summer clever method to avoid mosquito bites
anise 10, Jianshui rub the affected area, running from the mosquitoes do not bite.

29, to enhance children's memory method
Polygalaceae, 10 grams Shuijianbi each puzzle, can enhance memory.

30, more than half a catty
rapid extraction method of a carp, built-in Hong Fan 2 money, there is wind, no date on the place, 7 days fish from the frost, take a little mercury was added, (Serve from the bone Dan), a forest with a fish cream, hand teeth from the off.

31, mole removal (freckles) Act
lime, alkali side in half, alcohol reconcile into a paste, wipe away from the mole.

32, slow convulsion law governing child swallows nest
a duck protein amount, were broken up drunk, fixed or deposited on the deposited navel pit of the stomach .

33, Solving Method
malaria medicine kaempferol, rosin the total research money for the end of 3, before the onset of spreading fixed with adhesive tape on the navel, a basis.

34, treatment of burn method
sesame oil, the amount of egg with sesame oil and egg to reconcile and wrap the affected area.

35, treatment of burns do not blister method
who face amount of alkali, temperature and coated with a water soaked by the skin. Foaming who, with the white wine for the confused Chen lime affected area.

36, treatment of trachoma method
two blue fish gall, little borneol, borneol into the fish will be within the gall, stir well eye, that is, more.

37, pertussis law governing child of two gall
chicken, orange peel at the end of 5 for 7 day of addition.

38, more special effects rule the night sleep method
Angelica, habitat, safflower, Achyranthes the 3 money, peach 4, money, money, Citrus aurantium 2 , Campanulaceae a money and a half, half the money Chuanxiong 1, Shuijianbi, two pairs of Jiyu.

39, treating the whole body pain (back pain, arm pain, back pain) Act
Gentiana 1 money, 2 money Chuanxiong, peach 3 money, safflower 3 money 2 money myrrh, angelica 3 money, WULINGZHI 2 money (speculation), Cyperus rotundus 1 money, Achyranthes 3 money, the money to Long 2 (peeled), Shuijianbi.

40, scorpion sting therapy
tobacco smoke oil nozzle house, with a small Daogua a little, wipe the affected area that is good.

41, cleared a two-beriberi method
alcohol, formaldehyde and a half two, shake the bottle, wipe that is, except four.

42, treatment of hearing loss by 2 points method
Gan, licorice 2 points, the research into a fine flour, drugs and stopped their ears with a cotton bag (left Gan-by-ear, right ear licorice), daily before going to bed stuffed, remove the morning, to the more continuous.

43, governing law
Intestinal effects of a bed-wetting, built-in traditional Chinese medicine powder 2 Alisma money, cook food, day one, that ate 7 days good.

44, rule Shao Baitou effective therapy
with the same amount of fleece-flower root, black date, black beans, black sesame seeds were pounding drunk, and dense for the pills, 10 grams per pill, Japan 3 times, once a pill, and even clothes 3-6 months, the effect is significant.

45, treatment of women drug magic of vaginal leukorrhea therapy
Spleen: Codonopsis 12 grams, 10 grams Atractylodes, Poria 15 grams, 10 grams of the herb, yam 15 grams, 10 grams of dried tangerine peel, astragalus 18 grams, 15 grams of white peony root, plantago m 3 grams, 15 grams of Eucommia, dodder seed 12 grams, 10 grams of leaves, Cyperus rotundus 12 grams, limonene solid 12 grams, 24 grams cuttlefish bone, water, decoction. Heat leukorrhea: gentian 6 g, Poria 15 grams, 30 grams of Plantago, bacteria Chen 15 grams, 10 grams of TPG, Dan 10 grams, 15 grams of the second flower, forsythia 12 grams, gardenia 10 grams, 15 grams of Achyranthes decoction.

46, treatment of women infertility Zuchuan Liang Fang
cumin 1 Chinese money (speculation), Ginger 5 (fried), Yuan Hu 2 money, money 3, myrrh, angelica 4, money, money Chuanxiong 3, Guangui 3 money, TPG 2 money, money Puhuang 3 (Health), WULINGZHI 3 money (speculation), Shuijianbi. 3-5 to pay even serving, can protect conceived without incident.

47, practical magic formula
Paishi governance Lygodium + Money Grass and small stones bought Lygodium money grass, every day of the 20 grams, Jianshui drunk as a tea. Two weeks later, it really is excreted from the urine of the size of a grain like wheat stone.

48, children Queru (milk) effects method
two with fresh suet 1, 1 bowl of fried rice cooked without salt, to milk immediately after eating.

49, anti-freezing method
effects of ginger 2 two two-alcohol 4, the ginger slices soaked in wine, 1 day, scrub the affected area with alcohol. Early for frostbite.

50, calculation of pregnant women of normal pregnancy is 280 days from the time of the last menstrual date, plus 9 or minus 3 months, 7 days plus obtained is that due date. If the last menstrual period to January 5, plus 9 to 10 months, plus 7 to 12 days, estimated date is October 12.

Give you a free

 Give you a free
- written August 30, 2010
days and bright last night after a long time to
good
screen flashes will eventually be staring
thoughts I do not know to what
confusion are too selfish, maybe we
too self-protection of the
Maybe we are too proud
the same as the story is I finally pass
me, everything goes blank the
even if we do not have to learn to let go of willing
my stubborn willfulness you have nothing to do
you want freedom I finally paid you back
2010 年 8 月 31 Tuesday
the last day of August, is the last day of sprint TOP2000
early today will be particularly simple, a bad mood yesterday, called Xuan independence will be a birthday into. It had been raining that morning, wear your coat or cold feeling cold. This is the first time in eight years to Chengdu in August feel the chill of winter. Longing, said: woman fell faster than the open book. I think the weather in Chengdu, Sichuan Opera face with the face also win a fight.
early in the morning I called my mother gave (her mother feel very surprised, never in the morning to the mother on the phone), but I only know Mom's voice have the power to support me.
Xuan Chen organization makes me a bit by surprise, as the big brother Yuan Hu said: Perhaps it is an accident, perhaps a coincidence, in this day. Arrangements for each employee up memories of host in August, the most moving in August, the most memorable things we share, is intended to create a touching and warm.
Indeed, thought August would be very easy in the past, a happy thought in August to the past, thought August was a new starting point. However, yesterday I remember so well, today is 31. August 11, then still in ear Xuan Rao, has over the past 20 days. Fast, but every day, feeling very confused, very long, very helpless, very suffering ... ...
Some colleagues memorable in Tanabata Festival, Tanabata Festival with her lover (or husband, or wife, or boyfriend, or girlfriend) with a romantic ferry However, as Miss Li Shen, Tanabata Festival in the small pantry with her husband sitting on the future of small family planning; Again Mui, the Tanabata Festival received a bouquet of flowers this year's first memorable ... ... a colleague at the Tanabata festival, such as Qiuhua, love travel, facing the sky, the one with the Acacia. Whether alone, Acacia,
colleagues remember the parents rushed over to see two years from Hebei no daughter; a colleague memorable carrying 30 kilos in August, the son of sixties with parents to see the World Expo; a colleague memorable set in in August, his first car operator; a colleague memorable set at the wedding in August, a diamond ring; colleagues remember her daughter's birthday in August ; a colleague Nanwang little daughter in one day in August, suddenly stood up, walked a dozen paces; a colleague Nan Wang with friends at the wedding, the parents of all mean that a ... ... a family member, a family, because of that Parental love, filial piety to their parents that this child is the love between married couples, give us tolerance, motivation, support, makes us feel cozy and warm, moving, and this is happiness.
are grateful for the guidance of the leadership, who recommended counseling, care and help of my colleagues; a memorable at 1:00 give me a call asking for leave I am not allowed to leave; a memorable day in August at the time I let her attendance; a memorable policy to determine the risk of nephritis was found that clients were refused insurance; a memorable QUICKSTAR training on the company's rapid promotion yourself; a memorable at the Ying The evening will share the total; a memorable to customers in person to pick their own customers to see referrals; a memorable on their own a little bit of wealth to insist that customer acceptance is scheduled to vote; a memorable manager at ZHOU Lin Japan did not want to buy their own insurance policies linked to zero ... ...
And when all my colleagues are calling me up in unison to share my most memorable thing when my eyes moist, not a surprise, but as the Yuan Hu said front of them may be with their son or daughter or brother and sister as large as the naive and ignorant, the same young and vulnerable, as have their own unhappy, not happy, as have their own emotions; as friends, but it is in wine on the table a glass cup to drink, when a sentence is not happy nagging; and as a In fact, everyone has their own memorable and moving moment, there are uncomfortable moments and tears, we can communicate with each other to talk, you can vent, but still have to continue to live looked up, smiled and continued to live, we went a step and growth, and there broke. As Yang Division said: any thing more to be optimistic, more calmly.
August, a month should be the most memorable, whether it is work and life. August from Yunnan Province, actually, should be back from Hong Kong in July, the team a little bit decadent, morale a little bit depressed. Integration team from the beginning in March, has been slow to do the work, is a painful process. May through the August, 11 August (and perhaps coincidentally, perhaps accidentally) finally Maybe a lot of people will But I think that has been dragging its way, so that people can not develop to the development of better to come second Any implementation of the system are arduous process, the U.S. legal system goes through many generations of tempered and suffering, but they now are all beneficiaries. It may be a minority of most people, the future is certainly most people to change a few people who, by that time, I is successful.
August, the life With their parents and close friends back home called and said the National Day together, to ensure that will definitely come back. Costa said the result was so in the acridine acridine can learn language the phone can call me
August, especially from 11 -30 May, just 20 days, but it felt like a flash; just 20 days, but several years experience ;
August, after a two festival, Tanabata Festival and the Ghost Festival, all my mind ... ...
forget the reason why is because we have every intention of one day;
forget the reason why is because people care about or be concerned about someone being moved or touched by someone in the manufacturing
forget the reason why is because drops in the experiences and feelings
You say you want freedom, I give you so-called free
I said, I bound you, but shook his head denied
you do not willful, and I mature enough
said that time will tell
do not know the time to prove that my attachment, or you reject ... ...
give you a free
so lonely with me to go.

How to choose a kindergarten for children

  Now a wide range of kindergartens , there are public , and private, have full-time , there are boarding , there are large, there are small, there are far , there is close, in addition to a variety of unique nursery , such as dancing characteristics, Features piano , opera features , etc., cost varies naturally , does expensive than the average kindergarten unique nursery is good? This is also the question many parents confused . Conditions of children in kindergarten after the hardware is good, better access to many things , of course , but there should be some standards can be used for reference by parents : 1. is suitable for children, such as boarding kindergartens far from home , because in about three years old , the child is key to the development of secure attachment , during this period , if mother and meet every day, or full-time as appropriate ; but What kind of sub- child emotional development if the child was not bad in itself , but also interacting with others , but also desire to take care of themselves , at boarding school can also try ; 2. is suitable for parents , if far from home , fees and more expensive , parents will be very hard, can also cause economic strain, after all , this is only during the nursery , primary school after the kids go to the university, is a big expenditure on education A ; 3. and teachers with the very important. Children to nursery schools , the principal or the parents of the most important. Family education is still essential. Even without a high standard for their children does not matter kindergarten , kindergarten enrollment once the can , already have a certain condition, teachers, equipment can meet the minimum requirements. Dedication to go as long as parents raise children with the greatest spirit of cooperation and a nursery efforts can achieve the purpose of healthy growth of children .

Win playing mahjong skills ( Collector's Edition , every bet will win )

 Win mahjong skills (Collector's Edition, every bet will win)
win mahjong skills (Collector's Edition, every bet will win) (last)
1.147,258 rules: under 1 million homes lost, 3,4,7 million basic eating, 2,5 million may eat;
2. license more than half of ten days, the family began to wind down son, do not touch (touch, except to listen to Zhang);
3. Board has never Hu, best not to move cards, want to make cooked Zhang, license to eat a big possibility of moving there;
4. under 3,8 million homes lost, it may hand 3,5,6,8 million, 4,7 million to be careful to play;
5. under 8,9 million homes lost, it is possible there are 4,7 million hands, hit 4,7 million to be careful;
6. opening laps, in addition to inlay sheets, side sheets, the two sheets is best not to eat, first on the other sheets, and wait to get home and then this card, he'll call down;
7. the hands of 1 million one, if this card type 2, lost 3 million people, if mixed (wild) Do not eat (other than eating to listen to Zhang);
8. outside sub-except east wind all met outside, can not play, there may be bars open, at least call to see two circles;
9. knocked out a 70000, 80000 see two, 90,000 people are basically touch;
10. Xiandiu swing Photo cards start, then lost the wind son, but the hands of the child not more than two wind;
11. he has no mixed (wild card) to listen to Chang, such as 2,5 million, 2,5 million lost on the home, if you eat a listen 2,5,8, there is no need to eat;
12. Do not hang a single hanging have not seen the pieces, the best two are knocked hanging outside, see one of Zhang and wind child;
13. opening laps, it was lost east wind the hands of something, we must first throw the west wind, may have been due to take the westerly right, others throw you out the lap will be round, you also could get wind right.
guess what tactics ① Zhiyizhibi card
guess there are two brand content:
(a) of the attack: they want the sheets, the family has not? Ken refused to fight? Zhang has been heard, the people will not play? It hit?
(b) defensive time: people want what brand? People listen to what card?
the offensive is to get yourself on the sheets as soon as possible, as soon as possible and out, so people in and out, although the attack also Expertise meaning.
the defensive accurate guess when you seek to narrow the range of g card, and give yourself a way out, although the defensive attack is also included.
There are two cases guess card:
(a) Preliminary: what about the next family road signs. This card to play out, probably someone to touch, eat, or to and.
(b) of the ironclad: This is a card to play out, some people in and out, and must be a one and out.
former general, according to statistics, observations and get an answer; the latter is determined, by no means alone is estimated that the available answers.
card is based on guess what?
guess card always make judgments based on these phenomena. Without the prior list and analysis of these phenomena may be to point out: The following were cited, although the phenomenon appears to be isolated, but this phenomena is actually coherent with each other.
Here is the phenomenon of licenses, according to guess:
(a) of the river card
is four cards of the play. For example: white board met two, if there is a white board in your hand resolved, no one wanted, and no one will call you. This example seems childish, but you may have to be inferred from this example. Such as the eight-cylinder has see three, nine tube see one, and your hands are seven or eight six-cylinder, nine sub-barrel ride, certainly very easy to eat, or in and out (if the sheets have been listening to it). For one example, the river rarely five, sixty thousand, then four, seventy people is easy to eat, or in and out of the card.
do not think that this phenomenon is evident that many persons into the Council ignored this phenomenon is the wrong cast, such as that eight-cylinder (with eight three-cylinder, see example) is the familiar eight-cylinder beat Zhang, This superbly in noticing the opportunities I lost; or see that ten thousand have been three or four (to five, sixty thousand little example), forty is also to play. This is the initial guess the concept of licensing; and mature most accurate guess the brand built on top of the initial concept.
(b) of the other home to play cards in the order
which we in the ? Which must be reasonable.
example: the house first hit the second barrel, after playing four-cylinder. He may take the child removed; may be arrested and brought into play when the second tube with a five-cylinder, while playing four-cylinder into the six-cylinder when caught (because a pair of four-cylinder), or still leave three, six cylinder take the child; may When the second tube is arrested and brought into play a six cylinder, and because when arrested and brought into a four-cylinder barrel seven.
If the first hit on the home four cylinder, two cylinder after the fight. He may take the child removed; may be used to have a pair of cylinders, so the first hit four-cylinder, do not take the loss, but when you want to play the second barrel to touch a cylinder, or to make a cylinder a pair of mahjong.
can be of any card, any card will provide an information, because no one will play cards for no reason.
Some people may say: I was always playing cards for no reason. No, you sometimes so casually playing cards, because many hands of cards free sheets, and this is a kind of information, but also a reason.
do the following further explanation.
first hit the second barrel, after playing four-cylinder is the rule: first hit four-cylinder, the latter playing the second tube is abnormal. Because the second tube nearer unitary, nine. Any abnormal play, and often an obvious truth.
If the first hit on the home four cylinder, two cylinder after the fight, while the river has not seen a tube, a tube in his hand a pair, they are more sure. If the phenomenon longer to other circumstantial evidence that it has a tube on the house a pair of hands or a bucket can be accurately confirmed.
According to guess the card phenomenon has links to each other, this is an example. Of course, this is the simplest.
(c) of the cards pose
hand is a big if, or excessive tension emerged in a particular state of mind carefully, like a license number to the number thirteen, each can be considered to play a card; before listening to a Photo deliberately played heavier the license to the table hard for a shot; is eat into a card, suddenly was hit on the house to go to half of the cards out again retracted; a tap but not touch ... ....
These movements are virtually tell you: what have a few cards in his hand, and are generally wrong. Mahjong skills unskilled people, almost every kind of cards that have this; and experts were sometimes inevitable, you can always learn to know his hand a few cards, then from the circumstantial evidence to prove it can be know what further cards in his hand to play, eat, going to the.
(d) of the mouth of the amazing words,
shown that most people touch a card to go, or taken by it; license change from time to time will make people say many words inadvertently, and from these words can be found in some of the clues. Speech and gestures are sometimes intentionally manufactured, but as long as he could remember the simplicity of the words and actions, and post-licensing and out of the cards out of his share to be in control, he will know his temper - is the revelation of the truth or Die for sample.
mahjong need for applied psychology. If we can see through the licensing of large ones, plus psychological speculation, guessing that it is straightforward brand of kung fu.
(e) the last few cards
card in hand when a four time (or time is late, when the hands of seven cards left), after he was arrested and brought into one, for the one to, you can guess all of his hands card. However, this speculation should be ready to play cards in the order of his past, and his playing card on the home to verify that before they get the right answer. Otherwise may not be accurate.
played in a variety of cards, after all, the remaining cards can be clear, others may meet there to listen to copies of the restrictions, at such times, you can find a kind of to
five cited above, the phenomenon can be used as the basis for licensing guess, but the most fundamental thing is the large ones in the master card.
(1) early hit, fat, white, and when there are attempts to make peace.
(2) in the played two, three, four, five, six, seven, eight, after playing unitary, nine, non-demolition take that to Yan Zhang.
(3) demolition of two take the children and not have to do the same color of the suspects, that is, a lot of large unitary pair.
(4) first hit one, after playing two tight against the three and six.
(5) first hit nine, eight after the fight, tight against four, seven.
(6) to open big unitary right, there are easy to take.
(7) want to eat do not eat, there must be more than the same card.
(8) a tap does not touch, do not prevent the collision a large unitary.
(9) mahjong head, not three, four, six, seven.
(10) embedded in the second, eight are on the easy to take children.
(11) licenses will be finished, semi card and need proof.
(12) unitary, nine rare, there must be pairs.
(13) Threatened (referring to a big finish or to grasp the time) and fought Zhang, must have big hands.
(14) cards regardless of color, ill-intentioned.
cited above, but is most easily understood if they can add to these examples mastered, will be able to touch the card means a guess.
example: in the center of Zhang played, suddenly and from there to play a unitary nine (from the original card to play out, and grip to hit, were great, playing cards and other non noted that this point is not), that
If you have five, eight cable take the child, the family played a nine cable, of course, hope he can play an eight-rope to you, but he was arrested and brought into the second when, out of a five-for-cable come, you will not have to wait for his eight claims, and because he was not removed edge seven eight ropes embedded cable or take the child. If you see the phenomenon from another, for example, claims the river but not eight, but seven, and nine claims have been all see three, finds that he can claim a pair of eight or a bucket; or he is arrested and brought into a six- Faso, for nine out of a claim for.
Another example is the first hit one second after the fight, of course, to watch his three, six take the child; but perhaps he is simply to take the demolition of a side of three children, you tight against three, six had it not in vain you! Therefore, in the application of such large ones, they have to look ahead and behind, can there be a more reliable answer.
Now, we must further consider a more difficult to determine the factors, as a guess under license.
Mahjongg skills to his level? If there was any particular brand gas?
called The Art of War: Mahjong fork should apply this principle. According to our experience, the mahjong skills into the middle and lower levels. This is based on three levels to distinguish the following phenomena:
(a) of the catch into the six-cylinder will not change the barrel for example nine, seven, eight, nine for a smooth tube, grab a six-cylinder is still playing into the six-cylinder - Mahjong skills of such people can only manage existing the cards, but the idea for a play can not be generated. Of course, instead of listening to the three cross-listening, raw and cooked like Zhang unclear problems are also included. This is the lower.
(b) six-cylinder will be arrested and brought into play the same nine cylinder precedent, can play nine-for-barrel, that has to see the nine unitary tube big, comparatively easy to give people cheap. He has to understand the other sheets of raw and cooked, in the process of fully licensed, you can take Buzhi Yu loss. This is the intermediate.
(c) arrested and brought into play for nine cylinder and six-cylinder with precedent, to this fight, shows a higher level, because he caught nine into a cylinder, with knowledge is born nine tube sheets, the risk of six-cylinder is poured, has been able to lift the unitary, cooked in the center of nine dead Zhang limit, which is obviously the more skills into one. He not only were able to see through raw copies, but also whenever necessary, and resourceful, has reached the point where superb. This is higher.
also been used to distinguish between another phenomenon, namely:
lower - I do not know to listen to one, four, seven and listen to four, seven, such as two, three, three, four or five, arrested and brought into a six, and hit six three-hit wonder.
Intermediate - listen to one, four, seven.
higher - would rather not listen to one, four, seven, and listen to embedded VII.
cases of the foregoing reasons and the same. Under the care of his family were also not comprehensive care, intermediate have been able to show consideration for myself and not yet attained a pinnacle, while those higher Zhang blood, know ourselves, to attack to defend, flexible application.
license in guessing factors, this estimate is the most fundamental; for each incoming if you are not correct estimate of the standard will always doubt your guess is wrong, thought he was beyond the playing cards unexpected. In fact thoughtful enough to you.
example: an eight, ninety-two thousand, when arrested and brought into a sixty thousand, in the middle and lower-level skills will play ninety thousand, while the higher level skills may not be the case, almost out of this science, the art of card it is a guess a superior.
House brand strategy stage
in the mahjong, the house brand is very important. Touch, eat, touch, bars are into sheets, care card is out of sheets, so the level of skills of mahjong, the outcome of sports, licensing systems in half of the homes, and even more than half. Mahjong master play
homes is the importance of brand:
First, the safety of licensed homes in the order can be disrupted Mopai;
second round card to determine the use of various tactics;
third round card to promote the upgrading of others into the hearing;
Fourth, care card to destroy other people's strategic plan;
fifth round license to others the license can contain the situation;
Sixth, care card to put gun sake of others, food;
seventh round card to confuse others, to make their own food and;
particularly trendy playing mahjong, your homes Pai smart, do not point guns, even 88 people and scores of Da Sixi, Big Three, and you only lost by 8 points. So as long as willing to fine, no points or less points gun shot, and then get a few cards to high-fan, probably will be able assurance of success.
1. The initial license to go round single
general license for the initial round one to forty-five Tour. Hands with 13 cards, each have varying degrees of wind from a few long single Wrigley, What in the nine sheets of plaster boards and sheets. Pai homes at this stage the order is generally: the wind Wrigley, What in the nine sheets of plaster boards and cards.
Pai early war, the general care of the leaflet is the first wind, Wrigley. Typing skills are card: first hit the wind, the arrow after the fight. The order of the typhoon is: first hit off the wind, the wind and the door after the wind circle, the last hit, hair, white, wind can also put the door hit the back of Wrigley.
hands with license if the wind had eighty-nine Wrigley much, and there are three pairs, we should stay, while Ben does not rely on the whole,
2. What brand to go with nine left
line sheets, such as free sheets no wind arrows, or have the wind kick down arrow case free sheets, million children, cops, and cheese of the sheets (2 to 8-color points) easily caught into by Zhang, inconvenience to the first play (but the design Licensing Board, to consider the end to end, grasping the opportunity by Chang Chang less than the double, so at the table, immediately following the wind, the arrow after each play more are what, nine free sheets.
Generally from plates, the cards are not the wind arrow, no Mody nine, shot to see the side of the sheets or sheets, that this Board or design Shisanbukao better, and the remaining three rows sheets, it should be more Beware. What nine copies for free play, is not no has, often the following situations:
(l) of the design
(2) in the hand, the existing licensing associate, take the child, or pairs are formed in both sheets, then the design when the Board, will shun considered Why, nine cards, can be destroyed; if the Board take the child and the pair in the more ready to rely on to eat, touch, grasp to group vice, consider leaving one or Why not meet for a single nine-catch Chang Dang bid, and hope to become larger. Therefore, such a situation what, nine choices, we must develop as the Board may be a;
(3) If there has been Vice-Pai l, 2,3 or 7,8,9 De straight deputy, then, resort to what, nine free sheets should be with the design of the Flowers Overall priorities should be considered;
(4) The Licensing Board composed of late, take the child in the original side sheets 8,9, based on the catch into the same card 6, which should hit 9 left 6, 6,8 embedded into the ride. Small head, too, as in the original side sheets take the sub-l, 2 based on the catch into the same card 4, should also play 'so-called
(5) 凡属 design Shisanbukao Licensing Board, in addition to the wind outside the left arrow, for the million children, cops, and cheese, be sure to retain what, nine best, in the middle do not rely on card and can be extended to 4,5 or 6, Zhang Jin, deputy degree of widening, which will help the sheets into and, admittedly, when the Mody nine free sheets, not only can not be destroyed, shall be considered superior in the card and the. The sheets, once the sheets in pairs, that is good in the superior Board Mahjong head. Like this in the sheets, free and useful, of course, is not easily line Zhang homes out.
3. Mid-round view of brand three
fierce fighting in the disk stage, the stage of tension, a house are related to take a victory or defeat, it must be a card for each round to grasp the real security clearance, as far as possible under the care home is not the license to to eat, so do not touch at home opportunities, but can not let other home and the possibility of success.
Mahjong actual combat, license plate potential just go to the stage, each on the hand from the ever-changing touch to play one or two patrol plates, sheets previously cooked at this time may have become the raw sheets, and before that Security card, is now likely to become dangerous hands, this time out if the homes are not to be under the house eat something, is to be the rest of the family into and really every other tour, such as health Zhang, An old new risk variable.
Mahjong homes combined card and poker table under the sign face changes to develop measures and strategies and tactics, so that fancy house, silent under the house, stare of the home.
fancy home. That is played on the home should look to understand what kind of color cards, eat something, anything from touching suit. Because he eats, the touch of the card, that is, the color needs his hands; play cards, but also you can eat something, hitting from the suit. In this way, you can determine what you should keep the suit, only to eat quickly, the opportunity to touch the cards. If you are in the hands of color, but also on the family would like to retain, no homes out, naturally there is no way you touch the card to the rapid combination of eating their cards front of the.
silent under the house. In contrast with the fancy house, under the house was going to play the card by your hand to determine their own fate in hand. If you would out of the card, mostly under the house was going to eat something, then of course he would quickly eat into a pair of flashed cards spread out, and called the hearing. Therefore, playing cards, try not to eat on their own homes under the house out of cards, it becomes very important for thought.
stare of the home. Only a fancy house, silent under the house, they must stare on the home, so what color the three families of cards, what is the brand may even need to point are you expected, know ourselves, can only win every battle. For myself, what to do suit of cards, into what kind of and to their advantage, must be considered carefully, so as to quick success.
4. Anti-gun point of care Zhong Pan card
Zhong Pan all close combat stage, the duel will be played in the stage of confrontation, not the slightest negligence. Zhong Pan into the stage, the following two conditions:
first two or four in one, still maintained a license to listen to, food and spy machine. But the development of brand potential flattening had forced to play cards, entertainment war. Each other are defense oriented, and finally to a small loss of points and the ending.
second is to continue to contain each of four, played safety card. In fact, one of them or both, had to give up license to listen, to take a small loss of points in the operational plan.
against any licensed master altar, the situation is not uncommon, together with the first hands of the tables and entertainment, down food and very different. Envisaged, the table has one or two low hands, meant to make war situation developed to the stage Zhong Pan, it seems impossible.
the following situations to talk about some signs deal:
① shooting dangerous hands
here that the risk of card, refers to his family after his release, and the absolute into dangerous hands. When the Board entered the late stages of middle game, for any house brand, is filled with numerous dangers.
Indeed, some cards in a number of occasions, is not dangerous hands, but feel they do not think the safety card, which is being affected due to blasting of KB concepts.
so in the interim, every card on the next family homes can not be safe for the card, then how to handle these dangerous hands, need to be further explored. In addition to absolute security other than licensing (such as the East hit the plate, Youmo into the fourth), the total number of other players a bit dangerous. Now to focus on licensing the risk of shooting, observation of the point changes.
First: blasting dangerous hands is the other side has to be heard card after Zhang, in the event, you can become and. If a card is now in hand, the risk is not directly criticize the card, but this card is the other big hit and led him to complete the fan listening
Zhang state, then this card should be considered dangerous hands shooting.
Second: If the disk can be spotted each other in the post-war situation of barbarian units, then where Taiwan has nothing to do with the type of fan card, can be largely regarded as a security card.
Third: shooting from the various homes can sometimes be dangerous phase Pai way to speculate, cut homes and few varieties of cards, dangerous, especially in raw cards, shooting more dangerous.
Fourth: his hand in a dark bucket, and the same line card, is the danger of blasting license. For example, in a dark bucket hand 3 3 and 6 a, when the desktop has not been such a license to listen to Zhang's bid may have been a 3,6 bar, and he and Zhang license bid have half the number of hold in your hands, so you can stop him winning a great extent.
② high risk licensed premises method
know blasting license, no one would play out. However, in case of high suspicion of dangerous hands, depends on the courage and homes dealer license in the end the outcome of the council hold expectations of what kind of set the. Since the late stage of the disk Zhong Pan phases, such as your hand is not likely to pose much Pai, while the other hand quite a harbinger of repeated patterns, the best and the heart does not die, do not fight dangerous hands security card face even removed in order to spend the last one or two visits to Mopai difficulties, until the yellow card.
③ shooting licensing approach
first: into combinations of face. Zhong Pan Board to the period since the shooting Pai can not play, can not alone single remain in the hand, the prejudice to himself and licensing. This is best prepared to criticize the dangerous hands to hand card and noodles, this is the safest and most advantageous tactics. Because this way, this danger signs about shooting to contact cards are also marked with the insurance factor, are not easily rounded out the risk greatly reduced.
second: victory lap exit immediately. Mahjong the competition, to make decisions to withdraw from the winning circle approach is very wise. Especially the multi-gate card license to listen to posture, knowing touch into dangerous hands, but for fear of disrupting the shape cards situation, but insisted the homes, luxury get away. Realize that such tactics will see victory or defeat legislation, must not cross the boundary of the Fifth shooting and opened, said.
Third: There is no security card confusion. Pose in all kinds of cards, often feel that there was no security in the hand a card to play a sense of distress. Admittedly, this is caused by man, can be divided into two types: one, hand in the exposed group of friends too, hungry to see eat eat, it was touch touch, neither calculation, without taking into account the strategic The result reduced hand, reduces the leeway to adjust surface is also slimmer. Only a few cards in hand, that there is no safe card to play the situation, so give yourself a great deal of confusion, and even the danger of shooting. Second, although it does not eat does not touch the front of the clear conditions, but hand 13 cards still feel there is no safe card to play, which is actually fear.
according to conventional warfare, there is no security card hand to say is unrealistic. Have a license to listen to three opponents, each family is usually two to listen to, that the three together it is called to listen to the six to be Pai. This is clear in front of the 13 hand for hand, there are at least more than half of the cards are safe cards. Even fewer people hand, Zhang and others not necessarily known to be a license to listen to exactly right. The question is whether homes are willing to listen and then step back and know how to calculate homes licensing phase. So, play a card is not safe, accountable to the technical level of validation.
win mahjong skills (Collector's Edition, every bet will win) (the)
example mahjong license management analysis
① hope the cards did not listen to Zhang Zi:
Example 1: Chinese, white, hair, east, south, l, 2,6,9 cylinder, 6,8 bar, 8,9 million.
Obviously, this shop Pai, there are five single plates and three old card (Why nine), Why can not form a nine cards back nine cards. This card can be quite a bad hand. Although there are 3 groups which may constitute a face card and poor but that is the opportunity take the edge l, 2, and 8,9 million with the embedded tube ride 6,8 bar. According to Pai spectrum of the so-called is bound to be mentally prepared and not ready.
licenses so homes should be determined depending on the sea Licensing, not easily thrown off the wind, the three unlicensed also need to consider carefully, otherwise it will increase the fan and the other family. Do not play until after the home, then go after the cooked sheets no later than the first round out of the course, the old man card.
potential in such a bad case of Pai, in addition to chasing cooked cards, it should be mindful of the hands of a company, estimated and license flat, you can try for the card, and promoting its early into the morning and, less loss of fan points.
Example 2: in hair, East, North, 2,5,9,9 bar, 4,5,9 cylinder, 2,4 million.
these hands, although the potential is better than the previous example, the wind was a little arrow, pair, take the child plus embedded ride, leaflets in the card five card and two there, contact worth more, but from listening to Zhang is still far worse. If forced expect and licensing, will lose big mistake.
Example 3: fat hair, west, white, 1,5,9 cylinder, 1,2,4,8 bar, 4,5 million.
within four plates, only the elements of the green made a pair. Although the compound 1,2,4-face section, but only three to be a card is definitely not conducive to the situation. 4,5 million barrel with the card to the card shop 5 glimmer of hope, but only the lack of mahjong head.
into a mold will depend on if the first card, then be changed at least 5 to 6 times more than the trip so far, probably less than to Zhang, the long lost. Therefore the same strategy with Example 2, as usual, a play, many are beneficial to the.
② close to the license to listen to the
Example 4: in the, white, 1,4,5,8-cylinder, 3,6 bar, 1,2,7,9 million.
this case a red line elements in the pairs, combined with cheese 4,5, 1,2 million and 7,9 million embedded side take the ride, face plates together for the 4 elements. If the 3 and 6 in the card and deep into any one little note in the form of a face, then again, that there
5 element of which has the license to listen to qualifications.
licensing spectrum in these words: Therefore, when using this routine led to call to listen to, you must be prepared, do not count on it. Straighten out your hand to be the occasion special is not
know others have early
Example 5: East, South, West, 1,2,3,6 cylinder, 2,3 bar, 1,7,9 million.
have been here 4 ready-made elements, namely a set of house style pair, a pair of 123 cylinders, 2,3 and 7,9 million in sub-section embedded ride ride, of course, if deep into a tube with the sheets 6 phase contact card, you can reproduce the life of the sign face.
For these elements, once the food hit the formation of peer group face a license to be reasonable license carefully weighed. Although the leaflets of the east and south wind is a two-passenger air card, this can be discarded. However, for this case practical point of view, sometimes leaving an air card (naturally the
Example 6: vain, South, 1,2 bar, 3,4 million 1,222,6,8 tube.
At first glance, the deck clean and tidy, with a pair of white board, 1,2 edges ride, ride embedded 2,4 million, 6,8 tube embedded in the ride, and face a total of 1,222 composite barrel element 5 . However, this potential crisis of great cards, both sides take, take and composite face insert, can be signboards Full is the tip of 3 and 7 cards, these tips for a master card, the very last dance out, simple rely on peer group composed of eating opportunities are very few opportunities for the remaining half can only rely on themselves deep into the. 3 If touch the hand of every one if available, at least, to be 12 Tour Mopai Caixing.
Example 7: East, West, 1,2,3,77 million, 2,5,8 articles, 3,7,9 cylinder
deck rather than on routine benefit. Although many single cards, but easy to succeed on the sheets, it is their firm belief in the old Mahjong. Although the two plates, and the wind card for the customer, even if the play is also not be affected much. Here, 70,000 pairs to the head, a pair of 1.23 million, 7,9 tube is embedded in the ride, although only three elements, but on the sheets fast. One million children into any license with the cheese, can be composed of composite face, not into the swing sheets. On the note, first of all sheets should be destroyed in 5 (which is many people do not want to), from a tactical point of view, out of five homes after 2 and 8 there are two, in addition to deep into the 5 out of luck in the articles, no matter what Zhang Jin, and can be composed of a pair of elements, which are in good hands are very understand.
So, if the play along, then, the fastest is only 5 hands (touch the 5 license) can be called listening.
③ and grasp with the cards into position:
Example 8: East, 2,7,8 cylinder, 3,5,7,8 bar, 1,3,4,6 million.
deck itself has a 5 group elements, in addition to single brand for 2 cylinders, but may face in the compound as 1,6 million leaflets Pai treatment.
First of all, care card is undoubtedly the 2 barrel. Appears on the card in case of embedded or embedded 50 000 20 000 when the insert can be removed take 3,5 bar. Conversely, if there embedded 4, first hit 60,000. Because 60,000 is greater than the risk in the old Zhang license 10000, home not get started until the next lay down, put gun can be avoided. Once the name is called and the time to listen, call 10000, or cause errors.
Example 9: Southern, hair hair, 3,5,6,8 cylinder, 5,6 bar, 11,3,4 million.
It is also five elements complete card. In addition to leaflets southerly card, the composite face of the 3,8 tube can also be treated as a single house card.
Jin Zhang southerly If any one of or a cheese, the care card should be carefully. Of course, the first of the cheese brand will soon hit the south wind, if then into the cheese should be considered more appropriate to lay down 40,000, so as to preserve 1,1,3 million complex face.
However, the habit of those cards from the general point of view, many people prefer to split the cheese, and said nothing of the original hit 40,000. This indirect approach of the play, is still worst. It is obvious that this pair of green cards issued out of the easy touch, and never will stay on hand for the use, then the only the head is only 10,000. As long as the cheese into the sheets, the dissolution of 3,4 million homes take the child is more reasonable. Indeed, take the child for the purposes of Article 5,6, as a purely central Zhang, once the demolition of homes out, and can easily be next to the house eating, so better give up better.
Example 10: Western, 5,6 tube, 2,3,666 article, 2,3,4,6,7 million.
This is an excellent face card. Both hands or two or three hands with Pai's face after the card, as long as the food license, or on the sheets, the two take the child should not be left to seek the head. From the actual fighting of view, should not hesitate to lay down a pung 6, both to retain the head, but also constitutes a peace. Paul and no doubt this system is the best policy. Conversely, if the child could not bear to six engraved, is likely to miss this opportunity, this is where the decision win spectrum licenses.
Example 11: South, West, 88, 3,4 tube, 1,2,3,4,5 million.
In this case there are 3 groups pair to these elements, 6 groups together, so a group of redundant elements, in this case, it is bound to tear down a group of homes. Indeed, two pairs of Winds easier to hit out, so when someone shot one of them when the plates do not have to rush to touch, but for the demolition of the house style of play as an object in order to check under the house.
for 8, the best is to feed sheets 7, 8 shot, the formation of sub-brand plane ride, so shop for a license constitutes a better peace. If the table right there at the south wind circle, but it is sitting on the third, then two should be touching the wind out of the whole child, and demolition of homes 3,4 tube. Take the child would help if all eat the two cards, to be demolished homes 8 pairs, the two double-wind as the wind sub-sub for listening and a double hit.
I wish you will win every bet!

Beiyisanyuan Experts on amyotrophic lateral sclerosis (getting freezing) of control

 Interview topics: 2008 Shen Yang, director
Fan Dongsheng president, Zhang Jun and Shen Yang, director of interviews between the director of guest experts to talk with netizens Good afternoon! Welcome to the Sohu interview between healthy.
gradually freeze people specifically what kind of disease
Moderator: interviews begin, first Professor Zhang Jun brief introduction to getting cold What kind of specific people disease, its incidence and trends of how, many users is the first time I heard of the disease.
Zhang Jun: This disease has been a hundred years of history, neurological diseases in general are crazy in the form of disease, is reasons not clear at present, a total of about sports, including the motor neurons and lower motor neuron damage have occurred. Popular speaking, all about sports, our breathing, our movements, our activities, all with the movement between cells, will be affected. the disease up to now one hundred years of history, in general, this disease is very dangerous disease, mainly caused by rapid increase in motor system malleable malignant process. about this disease, relatively speaking In a relatively rare neurological disease, the patient is the most common cause of onset found in the lock when the patient or when picking up things from the ground that muscle atrophy, along with the progress of the disease, found the legs difficult to walk, eat, and difficult , and finally the gradual emergence of breathing difficulties. The disease is gradually developing process, probably only three to five years survival is 50% of patients will die three years, five years 90% of patients will die, is a very bad disease.
Moderator: our country have the disease, there is no statistical figures?
Zhang Jun: our country has not a detailed epidemiological information on the country, suggesting that groups in the fifty thousand new cases in China between the seventy.
early symptoms of gradually freezing
Moderator: Now the disease have emphasized early detection and early treatment, Director Zhang will explain what the early symptoms of the disease, early detection of disease is not very difficult?
Zhang Jun: Indeed it is, the early onset of the disease is a part of the small muscles of patients with atrophy, the early onset of many diseases are the same clinical manifestations. The age of disease onset 40 to 60 years old, this age is the stage of a high incidence of cervical disease. Many patients with cervical disease can occur early unilateral limb muscle atrophy and weakness, so many patients mistakenly believe that cervical spondylosis, the wrong surgery The first diagnosis of the patient, it is important point directly to delay the patient's condition related to the treatment with him.
Moderator: This disease has not susceptible?
Zhang Jun: It is not clear epidemiological data, epidemiological data from the international point of view, some groups relative to the general population the incidence is slightly higher, such as steel mill workers, a number of marathon runners are relatively higher incidence of , there are some countries a high incidence of a number of football players, not to say that with the general population, these groups were significantly increased, the may be speculated that with the environment, sports injuries related to a certain extent.
Moderator: This violations of human disease is the movement of the system, and ultimately with the sports-related features are lost?
Zhang Jun: all functions associated with the movement are lost.
the purpose of checking serum protein electrophoresis to exclude any disease?
User: Will Fan Yuanzhang, if the suspected motor neuron disease, the purpose of checking serum protein electrophoresis to exclude any disease? my family members of patients in Inner Mongolia, in January 2008 to three homes please Fanyuan Zhang doctor, he suspected that exercise neuron disease, to check the serum protein electrophoresis, we have not figure out, I ask: check what is the meaning of serum protein electrophoresis to exclude or to check what disease? Thank you.
Fan Dongsheng: check serum protein electrophoresis, to exclude a MGUS disease, usually with a monoclonal virus immunization-related disease, usually of bone marrow and blood system are related by serum protein electrophoresis to see if there is a normal serum protein concentration, so we as a screening, with some clinical manifestations. If checked is negative, to rule out the MGUS patients, if you examine the problems, that is positive to be treated.
Fan Dongsheng, Professor
the diagnosis of motor neuron disease: early diagnosis is very important.
Moderator: The diagnosis of motor neuron disease need to exclude a number of factors, make the correct diagnosis is very difficult.
Fan Dongsheng: patients, a late no difficulty. simply to get clinical data can be seen, of motor neuron disease check difficulty is in the early atypical time, there are some performance can be shown, if not experience, it may be difficult to judge in this regard disease. of motor neuron disease early diagnosis is very important to the late diagnosed is meaningless. emphasis on early diagnosis, to the authority of the hospital authority of doctors to find a clear diagnosis, if misdiagnosed, may delay the timing, if a diagnosis of the disease that otherwise would waste a lot of time, it will cost a lot. If not the disease to petrified. Hirayama disease and motor neuron disease manifestations are different. diagnosis of early diagnosis and screening is very important.
treatment, including what
Moderator: go to the hospital for some authorities diagnosis. For the unfortunate people who put this disease, treatment consists of what?
Zhang Jun: We know this disease has a hundred years of history, the first few years are no way these diseases, whether domestic or doctor International doctor. In recent decades, many breakthroughs in the treatment, the first is drugs, the only universally recognized world power, such as too, can delay the development of the disease. Other treatments, including early non-invasive treatment of respiratory computer, but also a gastrostomy. now emphasizes the treatment of multiple factors, since not clear what causes this disease, as long as with the disease-related factors, are targeted for treatment. the international community are doing the screening of a large-scale look at whether the drugs RIS find effective drug. RIS treatment is comprehensive treatment, including medication, therapy and nephrostomy computer treatment, and symptomatic treatment of patients, integrated together. Therefore, patients must have confidence in this regard, for patients, not without any treatment approaches, there are ways to gradually improve the patient's symptoms and delay the development of the disease.
Fan Dongsheng: In fact, the treatment of this disease, that is to be summarized in three aspects, the first treatment is the most basic nutrition, that is, the gastrostomy problems, the present study shows that the development of the disease condition and the nutritional status of the patients very closely, and if poor nutrition, can lead to the rapid development of the disease, the nutritional status of patients and their families to adjust our efforts to do things Because the patient has some features may affect the throat, the patient into the food difficult for patients to have difficulty eating can choose gastrostomy. ostomy feeding difficulties can be improved to enhance nutrition. So the most important nutrient is the most basic treatment. building the first want to make foundation, nutrition is the foundation, if nutrition is not doing a good job, what expensive drugs, is a great waste.
second is drug therapy, drug therapy, there is a disease. Rilutek is the only treatment of this disease drugs, and other drugs are still exploring them.
Third, if there is ventilatory disorder patients, available evidence shows that the breathing machine early on to help slow the disease has meaning, you can play the same and drugs role, the question is when to use breathing machine, the patient to the hospital diagnosis and follow-up, do not forget to check once every three months, lung function, respiratory function to determine whether the patient look downward, if dropped, down to a certain extent , the largest decline in more than 70% ventilation, we recommend the early use of the patient, if the 50% reduction, it must be used, it is 100%, 90% can not temporarily. on the clinical follow-up indicators of this indicator is very important.
stress again three aspects, the most basic nutrition support, and the second is drug therapy, such as too is the power of the center, along with other drugs. the third time in the appropriate use of ventilator treatment.
what aspects of nutritional support, including
Moderator: I just talked about nutrition support, nutritional support, including specially to buy some special food, or some of their daily intake of protein can.
Fan Dongsheng: mainly high-calorie nutrition, such as the United States to do Experimental animal studies have shown that patients with motor neuron model, two groups of animals, other treatment is the same, the only difference between a normal diet with a group of high-calorie feeding, feeding time found that high-calorie animals fed a diet, time of onset and the onset of symptoms were significantly higher than normal feed to late onset of symptoms to light, indicating that nutritional status of the transition of the disease has a very important role in the development, now not only in animal experiments, the patient The study also showed that out of an article published in the United States show a relatively high cholesterol, high blood lipid levels compared the prognosis of patients find that their situation is better. lipids in the elderly is higher than the positive side, but the movement neuron disease, high blood lipids have a protective role. Although this is not very precise results, but the current situation, basic research with animal experiments and the situation in general view now is to enhance the nutritional support in this regard, especially when the patient developed throat problems, be sure to pay attention to early conduct gastrostomy surgery, can eliminate the disease caused by malnutrition aggravating factors.
Zhang Jun: high-calorie diet does not have to require patients to buy health products . patients need high-calorie diet is due to two aspects, on the one hand the disease itself is a high metabolic state, requires high-energy metabolism. Another patient was due to problems with swallowing, can not guarantee enough heat, enough energy, enough nutrition into the body. gastrostomy primary purpose for the patient to establish a channel to ensure that nutrition stuff into the body, absorbed into the body, patients have to buy unnecessary so-called high nutrient, high metabolism thing. gastrostomy at the finish After mainly adds the amount of protein in fat can guarantee the most basic needs of patients.
Professor Zhang Jun
fistula into the food on the preparation of the principle of
users: About fistula into the preparation of food, because just do ostomy, we do not know how to prepare the food into. There are some things that sounds simple, but the specific operation is not easy, such as how food is thin consistency? no medical knowledge and experience is very difficult to grasp from the outset, improper food preparation afraid the tube is blocked. if it is available, then, can be in Sunday's patients at the test range and counseling? explain what food can play in, what kind of mill broke. Thank you. In addition, patients in three hospital colostomy done, whether it can also set up a program for nurses or doctors to do some demonstration and operation of gastric fistula use and food preparation. This may also discuss and Gastroenterology. sorry to mention a lot of requirements, I know you are all busy. Thank you very much.
Zhang Jun: the proportion of foreign to do fistula is very high, with the United States had talked to experts in this field has reached nearly 50% of patients do before. abroad more convenient that they have a ready-made nutrient solution selling, with their own families do not have bags, there are daily, with weekly use, finished, ready-made nutrient solution to the families of the patients reached the herd the. According to China's current situation, the high cost of foreign costs may be reimbursed, and the country is not reimbursed. We need to finish their home after ostomy, to deploy their so-called diet. principle is: they do not block control things can look inside to play, this thing hit enter, do not block the fistula can be. generally need to mill, including the foam fish, juice, fruit juice can fight. just do the fistula early, not well adapted to the gastrointestinal need a few times, while the temperature of the food fight fistula as possible consistent with the temperature, not too cold, easy to diarrhea, overheating caused the patient harm. With increased gradually, gastrointestinal gradually adapt. Now the question is, preparing the next Beiyisanyuan Editorial Board missionary in this area will increase, so that nurses on the topic how to fistula care, if the fistula in the diet, do subject teachers. < br> Fan Dongsheng: The patient's problems are more specific. just started not too familiar with the case number can be a little thin. The tube if the care is good, for once a year, if the tube is blocked, just finished two months for one, increased costs and increase the suffering of patients. slowly, there will be some experience. comes to nutrition, there are not any, and if their economic circumstances permit, you can buy intestinal nutrient solution to the hospital, but the relative prices will be expensive, if your configuration, then broke through the mill, we have a patient, poultry meat have broken, its dilution, can. worry about plugging in every time a gastrostomy feeding principle, each time to ensure that water washing, washed away to solve this problem, do not rinse with water, a little bit longer, dry and completely blocked the tube. In principle, rare bit of good.
gastrostomy fistula infection how to do
Moderator: There is this problem in two patients, because it is not in Beijing, relatively far away from Beijing. they feel to do gastrostomy here in Beijing, what happens in case of infection or other problems to handle them too much trouble. like this happens, it will not happen very often?
Fan Dongsheng: gastrostomy less chance of infection, because it is minimally invasive surgery, the stomach itself is not absolutely sterile, Because the food into the stomach, we see virtually no infections of patients, from the yellow Beiyisanyuan Gastroenterology, Professor Wang, this has been very much to do, has done a very skilled, in general, 15 minutes to 20 minutes done, finished, because to stay in hospital to do the body to adjust. this not particularly worried. If the patient is far away from Beijing, Shanghai there less do I know, probably some of the equipment such as tube reasons, do not do in some places, some patients heavier, went to Beijing to do, not good physical condition, not suitable. gastrostomy can not be done locally, you can do to a surgical operation, so the effect is the same , but not invasive, it is necessary to do into the operating room, surgery can also address nutrition problems, it is able to do surgery general surgery. If the patient activities are easy to do gastrostomy is completely minimally invasive , damage is relatively small, relatively cheap.
Zhang Jun: motor neuron disease to do with an ordinary patient gastrostomy very different, often do gastrostomy patients are injured, the first of these patients prone to asphyxia, respiratory function is often not a good second, if the doctor is not very specialized, relatively speaking gastrostomy do have some risks. Beiyisanyuan very much similar to the patients, mainly China as fistula, and through our endoscopy to do more under the ostomy, colostomy done so Gastroenterology on this type of ALS patients experience relatively more certain. as far as possible want to live near or around Beijing Beiyisanyuan to our side to do the best, If the difficulty, do as Fanyuan Zhang said surgery is a very good solution.
insomnia, pain mm gradually freeze the psychological adjustment
Moderator: This disease is very painful. Patients suffering from this disease, will also be a great psychological pressure, many users mentioned. The patient's mood is irritable, as well as the patient is difficult to fall asleep, this year there will be no New Year slept, sleeping on the couch all the above, how this treatment as ?

Professor Shen Yang Shen Yang: I have two professors, in the course of treatment, in addition to treatment for the disease itself, there is another check against therapy for the symptoms. check against the purpose of treatment to reduce the survival of patients suffering this time, of course, impossible to reduce, pay attention to this problem is to make the best possible conditions to alleviate the suffering of patients and improve his quality of life. patients with motor neuron disease the development of muscle atrophy may be accompanied by very powerful, there joint dislocation, muscle spasms occur, or excessive secretion of saliva. had the disease after a relatively high degree of malignant disease, the patients themselves and their families psychologically a blow, this is the case, the patient may have depression, mood, whether it is breathing, such as breathing machines have been used to the night may be oxygen, can cause insomnia, its easy to get up early, because the status of the middle of hypoxia, then a Pain, pain is severe, it may cause can not sleep, or pain in the future will wake up sleeping. some patients to stop drooling at night, swallowing function is poor, unlike the normal function of a self-protection, which will affect sleep. saliva after too easily obstruct breathing.
the patient presented to sleep well, in the end have to analyze what causes, if it is too much saliva, but there will be restlessness, bad mood, emotion depression, irritability, this situation can be added to the tricyclic anti-coke drugs, this drug has a side effect, can cause dry mouth, constipation, etc. situation. If the patient disease to a certain extent, at the breathing machine, then if have sleep problems, the first judge is not a breathing problem, such as during the day, such patients must regularly check the blood to ventilation, and if found that he has this problem, it should be a ventilator, can reduce oxygen at night situation. and then the data of a current through the foreign including our own findings, if possible, conditions, sleep apnea do to patients early in the monitoring, polysomnography, the role of the examinations can be done at night determined the concentration of blood vessels, we Some affected patients ventilator during the day without any symptoms, ventilatory function in the early investigation is good, but do polysomnography, can be found down stage, and some even reached 65%, and now there is economic conditions to promote Figure patients can sleep early to do monitoring, but also help early detection of respiratory problems, to provide an early use of respiratory support and tips.
Moderator: In general, is to make concrete analysis of the reasons for poor sleep.
Zhang Jun: Indeed it is, the patient bad mood, irritable, there may be two reasons, one reason is that ALS patients to the cortex, the patient developed cerebral cortex damage, there will be psychiatric symptoms, including mood changes. In addition we ALS is a very bad disease, we conducted a survey among patients and family members of patients in which anxiety is high. sleep well because of anxiety caused? or depression caused? or breathing disorder caused by the breathing machine anomaly caused by oxygen? specific situation should be approached. We are now before the disease management model and is very different, both domestic and international, before we concern is the physical condition of patients, to treat diseases where there is where the tumor was obtained, We remove the tumor has now become a psychological, physiological, and even social psychology, physiological model. this is very important thing to pay attention to the patient, now that ALS can not be completely cured, it is necessary to work in many areas, such as drug treatment, ventilator therapy, the treatment of early gastric fistula, there is very important that we promote the overall care of patients or the overall care, which is composed of multi-professional tier model, this model may be for many patients, including patients symptomatic such as headaches, sleep well must be addressed, including swallowing problems, emotional problems and even his life. abroad to do it very small, the patient is sick, but he was still at work, in the case of the disease , how to adapt to the current work is still work training, including how the physical rehabilitation after paralysis, even when the patient got the disease abroad, Christians think that is not what I do a lot of bad things, God punish me. Then the priest to enlighten . or even the patient has died, one year after the death, family members should be concerned about the situation in foreign countries, not simply your sick I simply give you some medicine, but the mental and physical aspects of attention and treatment.
Whatever the cause of sleep disorder, caused by the exclusion of some causes of sleep disorders, the many patients want to eat some of the drugs to promote sleep and promoting sleep drugs are tranquilizers, such as stability, Shu fixed, Gallo determined The drugs inhibit the effect of breathing, can cause damage of thinking. ALS patients in the use of sleeping pills, when a great danger. If by check, do not exclude the involvement of the role of mechanical ventilation, we use the second generation in the class drugs or can, if there is respiratory drugs, non-plate two post-drug, non-North, to BAK farmers, but large, they would have side effects. Atypical Antipsychotic drugs Aodan United States Lin, specifically designed to anxiety, such as Mu Dan Ping, both of the side effects of medicines the patient is likely to cause sleep too much, in clinical practice, use of these drugs to improve the patient does not sleep problems, relatively speaking, to be safer than sedatives.
should How to care?
User: What is holistic nursing? at home, what can families do? Where can I find a good, experienced nanny? your hospital nurse can provide on-site service? example to the house to guide the suction like?
Zhang Jun: foreign model is multi-disciplinary team, including the responsibility of nurses, dieticians, nurse therapists, spiritual comfort, social workers, medical consultants and even some volunteers, is a multi-disciplinary team. how to develop nursing? vast majority of patients at home, and all patients will feel very comfortable, we know that the hospital environment, including life will be greatly affected, in the home will be very good. multi-disciplinary team on a regular basis to give the patient and his family meeting to discuss the patient and the biggest problem, the biggest problem is, what family needs, what the patient needs to discuss with the families and patients, after finalizing a treatment program, according to this treatment at home for multi-directional multi-disciplinary aspects of care and treatment. domestic point of view also can not do this now because of all this foreign stuff is foreign to the burden of health insurance is, currently only in the hospital to carry out domestic multi-disciplinary team for treatment, the patient at home to carry out, is still very difficult, there are practical problems.
Fan Dongsheng: We are now actively push ahead on this matter, the case of domestic and foreign differential, foreign Zhang Jun the situation described is very satisfactory, but at this stage we can not, can not we do not, and now we have a team is actively advancing this matter, including hospitals and related links, in the hope that the relatively fixed, more specialized health care team, we also contacted a number of hospitals, is negotiating process. as site service, medical cost, many large hospitals, can not spare to do these things. now can do some early patients, with the family of late and I hope the early intervention of patients with advanced earlier decision to do the next step, from the professional knowledge to provide some guidance, once the patient breathing on it, to find temporary hospital ventilator, very difficult, and the family to make decisions is also very confused, do or not do it, do after the opportunity to spend a lot of money on the breath, if not, the patient will have problems seeing. These things were discussed and the guidance in advance, this is our things to do at this stage, can be stratified in future management of patients who asked not to be as early, on how patients with advanced guidance. our overall efforts to push ahead now in the care, but in stages, and all of a sudden do so a little difficult to go abroad, the majority of patients and their families hope and consensus, and actively promote this thing.
Zhang Jun: We also want to make the patient live with dignity, while his family home care from the very heavy work of liberation.
at home can use the Machine?
Moderator: Several talked about the breathing machine for the case of patients, such as breathing machine in the family can do?
Fan Dongsheng: Speaking of breathing machines, But listen, wonder, there are two concepts, the early patients using noninvasive ventilator, sometimes called the doctor will simply BiPAP, 20,000 to 30,000 dollars to buy back home, wearing a face mask, nasal mask used in the home . This is the early use of the patient, the effect of delaying the development of the disease. There are significant patient to the late symptoms of shortness of breath, without ventilation support, oxygen patients will be serious and even choked to death, is the so-called invasive tracheotomy in the hospital with a large ventilator, the patient should be hospitalized, living in the ICU ward, non-invasive and invasive a two-stage, non-invasive early, invasive in the end use. Non-invasive ventilation is not up to use, non-invasive how to use the breathing machine, what time to use, this is the regular pulmonary function testing is very important, if lung function is 100% can not, if dropped, to 50% must use, if we do not, the condition will develop significant influence. to 60%, 70% with early use, in general, non-invasive ventilation is not the answer the patient's difficulties, but the treatment of disease and disease prevention play a further increase in the role. has created the solution to the latter part of the patient breathing symptoms, use this to go to the hospital.
Zhang Jun: We advocate the early use of noninvasive ventilation is a treatment, not to say that bad breath, with breathing machines to maintain it. and this breathing machine should use at home, after a hospital doctor and ventilator factory trained, who mastered the non-invasive mechanical ventilation, the so-called non-invasive patient by face mask and nasal mask for ventilation in the treatment, especially early, not 24 hours wear, bed, watching TV , rest time, when the fixed wear, evening wear, when to sleep, ambulation usually do not need to wear, it is very convenient.
on drug treatment
Moderator: experts mentioned drugs Rilutek Treatment of Amyotrophic Lateral Sclerosis are the most commonly used drugs, a lot of outsiders to this drug that can not buy anywhere else, and no access to health care.
Zhang Jun: Rilutek ALS patients, drugs are epoch-making significance, changed from no to a drug treatment drug treatment as the significance of this milestone. If the patient if economic conditions permit, as early use, from all clinical data, only in the early stage of drug Rilutek most significant effect is the most obvious. now Rilutek are all drugs sold in several big cities of Beijing, Shanghai and Guangzhou are all sold, Beijing Beiyisanyuan, Union Hospital, Xuanwu Hospital, Shanghai, Wah Yan Hospital, Zhongshan hospital or some.
friends: My mother had amyotrophic lateral sclerosis, I have seen on some Web sites that East peacekeeping force (L-carnitine) is a force as the only alternative medicine too, and I would like to ask can eat this medicine? What role have you?
Fan Dongsheng: In 2006, Japan has an animal experimental study, found that L-carnitine on the animal model of prolonged survival time. any valid and effective drug treatment to see animals experiment effectively invalid, then use the clinic, a look is not safe, two small-scale experiments in the effective or not effective, if effective access to three large-scale look is not really effective. the drug in animals has good results, the Japanese research results, the article also published in the journal better. Since the animal effective to see a clinical safety unsafe, L-carnitine is commonly used in clinical medicine, the treatment of other disease is the medicine this substance in the body can produce its own material, there is no problem in terms of security. security can be used. to see if he did not work effectively, efficiently animal experiments to clinical not effective if the patient is not clinically use of force, such as economic conditions too, such as too much power over four thousand dollars a month, a considerable portion of patients can not afford the medicine, he will have the treatment, no treatment, the patient may also have no hope. levocarnitine the drug from the animal experimental point of view there are good results, said earlier that security is better, so those who do not like too much hard drugs in patients with no economic conditions, you can use the drug L-carnitine. but in fact not a substitute for, since not replace the role of the ultimate clinical efficacy has not been confirmed. just because it is safe, so we recommend that in the absence of conditions, you can use one with a look, but not recommended as a standard. If the patient conditions, such as force too, do not propose to use the L-carnitine. Because Rilutek is the result of thousands of patients proved to be effective, and L-carnitine was confirmed without extensive, but effective in animal experiments. It can not serve as an alternative This is not a concept.
User: Can lithium carbonate in ALS patients and its application prospect? When will the trial of the drug?
Fan Dongsheng: This is the antipsychotic, is effective in the clinical use of drugs , he himself is anti-psychotic drug, a clinical but also safe. in Italy showed a certain secondary clinical efficacy, now entering Phase III clinical, multi-center Phase II clinical studies to confirm the effect of how to our nation. is promoting this thing, the use of any drug use can not think of it to use, must have the approval by the SFDA, we are doing this, other users have mentioned, why did you say delayed treatment, because there are many areas not that we can grasp, you must get the national documents of approval to do this thing, next Monday there on the further progress of this matter. In this respect the patient's own unauthorized use is not recommended, there are many drugs that are effective, as the most typical Last year, the year before last, there is an international drug is minocycline tetracycline drug effective in animal experiments, after a clinical, Phase II clinical use is valid, then some ranging Phase II clinical valid and effective, Phase III clinical is proven to use, if the patient their own use, there may be harmful results. We must Phase III clinical trial results through the standard use until after publication. If we start to do the drug test, will be recruiting patients, will strict indications and contraindications as well as observation indicators, to ensure patient safety, do not own the unauthorized use of the patient.
Moderator: recruiting the patient's condition, will come out through a number of ways to publish?
Fan Dongsheng : Yes, if started, there will be ways to recruit.
friends: We all know that this disease is very painful, very painful father feel alive, has been trying to persuade him, and now more and more serious diseases, will have several experts some experience, how to motivate the patient, how to convince some of his father's firm.
Zhang Jun: ALS is a very personal indeed, the disease progressed very quickly, then got the disease, regardless of the patients themselves and their families have to endure psychological and economic pressure is very large, the incidence population is 40 years old to 60 years of age is high, and it is young and healthy, family, contributing to society ages, this problem occurs, we say that ALS is not the worst case , said dementia, although can live for many years, but do not have good quality of life. motor neuron characteristics of patients with the greatest feeling there is no problem, thinking no problem. the one hand, the progress of our medical and scientific research in progress, we strive to treat the disease, alleviate its symptoms, reduce the suffering of the patients, on the other hand the survival of the patient for a long time, we recommend that patients can read a book called II

Shaping the perspective of IBM's life sciences market in China

 Zhuanzhai Note: The following quote from IBM's announcement of a White Paper on China's pharmaceutical market, we can understand from the perspective of the IT companies to look at the Chinese pharmaceutical market, I believe there will be inspired.
Life science market in China has become even the engine of global development. even in this financial turmoil, because of strong consumer demand, China's pharmaceutical and medical device market is still maintained double-digit growth every year. China should focus on the concerns of long-term life sciences market development potential. China life sciences market is undergoing a revolutionary change, the most compelling next three years, governments at all levels will be invested in the new health reform 850 billion yuan (about 125 billion U.S. dollars), the healthcare enterprises that is undoubtedly a golden opportunity. Meanwhile, the Chinese government will also aim to create a more transparent and regulated health care market environment. This white paper the main market structure will change and the impact of related enterprises discussed:
1. to improve health insurance coverage to a wider audience can enjoy affordable health care services: pharmaceuticals and medical equipment to stimulate growth in consumption.
2. to provide a more efficient health services: urban primary care system and the establishment of rural health care system to promote a new generation of consumer groups, triggering changes in channel structure, and thus on the ability of business operations with new requirements.
3. to establish and implement national essential drug list drugs online public bidding in order to strengthen drug sales and use regulation.
the Chinese government is committed to promoting the pharmaceutical industry innovation, promote China's pharmaceutical enterprises to enhance competitiveness, thus forming a new pattern of life science market. We believe that this is R & D resources and innovative ways to promote the integration of medicine. When R & D (R & D) market is full of energy, will attract more investment; and increased investment will lead to further promote the sound development of pharmaceutical R & D market. China in recent years pharmaceutical manufacturing practices (GMP) and drug quality management specification (GSP) of the revised standards to improve the quality of medicines, but also on pharmaceutical manufacturing and distribution companies set higher requirements. With the further integration of the pharmaceutical industry, a group of weak competitiveness of enterprises will be eliminated, the pharmaceutical industry The access threshold will become higher. In short, we hope that China's life sciences industry will become increasingly mature and more competitive in the international market.
this white paper to the China life sciences companies to the rapid development of and full of success in the market change to provide practical insight into the views. We recommend that companies should follow the following three key operational capabilities to enhance:
b innovation: the development of domestic technology industries and government support for the opportunity to strengthen R & D capacity . through cooperation with external institutions to enhance research and development capabilities, by developing internal talent and manage projects to enhance internal management capabilities.
b production quality: high-quality products is not only the pharmaceutical companies marketing differentiation in the embodiment, it is which pharmaceutical companies first condition of existence. companies must improve productivity, reduce operating costs to achieve supply chain operational excellence.
b sales, marketing and distribution: business channels and by strengthening logistics management, so that more consumers can easily buy high-quality drugs. Therefore, strategies to expand sales channels and strengthen sales force management is the key to future business run-off market. Pharmaceutical manufacturers and pharmaceutical distribution enterprises to be more closely together to enhance overall operational efficiency. the definition of life sciences market

defined our extensive coverage of the life sciences market throughout the health of ecosystems and life sciences ecosystem, the main enterprise (organization), as shown in Figure 1. these companies in the medical field engaged in pharmaceuticals, medical devices and diagnostic tests and other content related to business activities, through innovation (R & D), manufacturing, marketing and distribution of the whole process, and ultimately commitment to patients and provide consumers with better health services. < br> When the slowdown in other industries, China's life sciences market is undoubtedly a bright spot in the global economy. Chinese medicine market because of its huge development potential and attracted much attention. Chinese brand prescription and non prescription drugs (OTC) 1997 years market size of only 37 million, while 2010 is expected to reach 220-250 billion U.S. dollars. estimated 2009 pharmaceutical market in China will reach an annual growth rate of 25%, higher than in other emerging markets growth rate of 15% and much higher in developed market growth rate of about 5% .3 is the world's attention even more is expected in 2020 to 220 billion U.S. dollars in China is expected the market to become world's second largest after the U.S. pharmaceutical market .4
China The current health care reform and the Government to establish more innovative and competitive industry initiatives, will promote China's booming life sciences market. When corporate exposure in a more orderly, more regulated market environment, to better meet patient needs demand responsibility, and gradually become a global market leader.
health care reform on China's Life Sciences Industry in China is
health system reform its huge investment In 2009 an unprecedented 1 month, the State Council announced the next two years will be 850 billion yuan investment in the health sector (about 125 billion U.S. dollars), and provide residents with high-quality, affordable health services .5 expects the investment will in the life sciences market, pharmaceutical, medical equipment manufacturing and pharmaceutical distribution and other enterprises have a significant impact.
more people can enjoy affordable health services means that the increase in health care spending, resulting in the demand for drugs and medical equipment rose
health reform One of the main objectives is to solve China's population and of coverage due to lack of medical problems. in recent years in the medical security system in China has made significant progress, by 2010 Medicare will cover all kinds of more than 90% of urban and rural residents, countries through the implementation of the basic medical insurance, basic medical insurance for urban residents and the new rural cooperative medical care (referred to as the new rural cooperative), a wide range of urban and rural residents to improve health insurance coverage. 6
new broader health insurance cover not only the crowd, and that the government increased subsidies for individual insurance. For example, the government medical insurance for urban residents per person per year subsidy from the standard 80 yuan to 120 yuan, the new rural cooperative subsidy from the standard 40 yuan per person per year increased to 120. Government subsidies increase the number of each individual concerned may not, but taking into account the total number of health insurance coverage is very large, this initiative will profoundly affect the total consumption expenditure on health. Analysts predict that by 2011 to increase coverage for health care reform pharmaceutical market brought about expansion will reach 1650-3330 million .7 There is no doubt that the next two years, health insurance coverage will promote the improvement of pharmaceutical sales.
more efficient health service system will change the life of existing scientific institutions channel, product and customer portfolio
reverse city doctors, hospital beds, medical facilities, etc.), the inequality. 8 China's current urban medical service system of medical resources from the hospital too focused on high-end will be referred to a hospital for further treatment.
This marks the existing health service system, patients are mainly concentrated in large urban hospitals would be a dramatic change in status. The new model, the main function of the high-end hospitals is the treatment incurable diseases, serious illness serious illness, teaching and research, large-scale clinical trials and medical research. can be expected, the high-end hospital resource utilization will gradually decline, such as out-patient share from the current 80% to 50%. midrange Hospitals will also be divided, some hospitals with better conditions will be transformed into the top three hospitals, in part poor efficiency, small-scale hospitals, may be converted into community health centers or other services.
With the establishment of urban primary care health system, the number of community health services will grow rapidly. Community health services provided at a lower price treatment of common diseases, preventive health and disease control services, to provide economic and convenient health services. From 2007 to 2010, China will in all level and above the county level cities and in the establishment of 40,000 urban community health services. The goal is 3-10 per million inhabitants, or by district offices and the establishment of a number of health centers community health service stations .9
rapid emergence of health services will be at the basis of medical institutions and medical market enterprises (such as manufacturers of generic drugs, basic medical equipment manufacturers and pharmaceutical distribution business) have a profound impact. Community health services institutions were established, and will produce a large number in a certain period of recruitment and training of qualified medical personnel needs; medical device manufacturers will usher in a new market demand, expected funding for community health for 30% of institution-building will be used to purchase basic medical equipment . Meanwhile, the commonly used drugs, especially generics sales will go up.
three-tier health service system in rural development, life sciences sector will face new customers and channels
will establish a new rural health services in three system so that minor illnesses within the village of rural residents, serious illness not counties. county hospital will become a regional treatment center, the main provider of basic health services and specialist disease clinics, while rural health facilities will also provide training and operational staff and technical guidance . Since the 3 years beginning in 2009, the central key support around 2000 county hospital building, so that each county at least one county-level hospitals to standardize the level of .10
basic community health agencies and similar organizations in the development of rural health for pharmaceutical companies, medical device manufacturers and medical distribution companies to bring new channels and markets. community and the rise of the two major markets in rural areas, will have sales of drugs, types and significant impact on the current channel structure.
strengthen drug sale and use of regulatory, operational requirements of life science institutions change
content as part of new health care reform, medical reform led to widespread popular attention and discussion, especially in drug procurement, drug distribution and so on. Although the drug sales and use implementation details have not yet released, but the new health reform program can determine that the drug sales and use will enhance the transparency, to reduce the total cost of medical services (see Figure 3) .11
to control medical costs is a key initiative to establish national Drugs List, based on types and brands of drugs into three categories, each set different types of pharmaceutical reimbursement. A majority of medicines covered by basic drugs, from state subsidies received full reimbursement of the insurance sector, B medicines for a certain reimbursement ratio, C medicines to be paid at their own expense. local governments have increased in the B class directory and remove the flexibility of 5% of drugs. National Drug List will be given the highest guiding price of each drug, and the final price tenders by local governments through decision.
health reform under the new policy, all community health agencies all use the essential drugs list in the variety of other medical and health institutions such as tertiary hospitals should give priority to use the directory prescription drugs .12 In addition, there are some on the use of essential drugs List of proposals to lower drug costs, such as retail pharmacies to buy drugs in the base directory will be included in the scope of reimbursement. The overall objective is to full competition by encouraging the market to further reduce drug prices.
Another important reform is the provincial government for the establishment of centralized procurement of drugs for profit platform, state-owned non-profit medical institutions must all participate in centralized drug purchasing. implementing web-based centralized procurement and online auction to raise medical drug procurement process more transparent. the provincial government to establish a scientific evaluation of drug procurement methods gradually increase the weights of different elements, such as drug quality, price, service and reputation, and other elements of pharmaceutical manufacturers. Meanwhile, to encourage standardization of medical prescription drugs in order to improve health care quality and regulate the behavior of prescribing part of .13
local governments such as Guangdong have tried to make some reforms. This requires pharmaceutical companies and distribution companies to enhance the quality and cost control. pharmaceutical distribution market will be affected, the next 80% of the essential drugs will be directly delivered to the community or rural health facilities medical institutions, which will encourage the use of large regional and national circulation circulation commercial business, giving rise to the integration of pharmaceutical distribution market. 14
China's health reforms will change the existing channels and customer segments
Chinese medical and health Life sciences companies will bring reform to market changes and opportunities. pharmaceutical companies, especially manufacturers of generic drugs, medical equipment manufacturers, vaccine manufacturers will benefit from increased public expenditure on basic health services and health insurance coverage expansion initiatives have been interests. National Essential Drugs List in 50% of Chinese patent medicines, the Chinese manufacturers are also expected to benefit from it.
bring health care reform and pharmaceutical channel structure changes in the consumer market segments. estimated that about 20% of the drugs transferred from the hospital market to the third terminal market, the third terminal market is outside of the hospital pharmacies and retail pharmacies sell drugs directly to consumers terminals, such as community health agencies, clinics, health care centers. 15
us noted that health care reform will promote the formation of three major market segments, companies in every market segment for marketing, sales and distribution activities, will need to build the operational capabilities of differentiation (see Figure 4).
basic State Drugs List, drug procurement and other measures to increase the public bidding of drug sales and use of supervision, but also pharmaceutical companies and distribution companies put forward higher requirements. companies need to enhance the pharmaceutical, medical equipment sales and distribution of the transparency of the process and control at the same time, product pricing, market entry, medical claims, etc., need to be strengthened with the government, social insurance institutions relationship management.
create a more competitive and innovative life science market in China
life science industry's competitiveness and innovation is growing. The Chinese government is taking important measures to encourage innovation, improve industry standards, and continuously improve the industrial environment. This is consistent with the national support for domestic companies to extend high-end value chain, engaged in high value-added innovation activities, thereby enhancing local enterprises in China and the global competitiveness of the overall objective.
efforts to promote innovation and to in the global life sciences industry shows great potential for development, the Chinese government to establish bio-pharmaceutical industry as the pillar industry of China in 2020 .16 biomedical industry will account for gross domestic product (GDP) of 4%. bio-industry development, First Five-Year Plan Chinese enterprises encouraged to develop new drugs in 2010 .19 The specific objectives of:
b build 10-20 new drug incubator 8-10
b form drug development alliance
b cultivate a number of chemical drugs , Chinese medicine and biological medicine big business
b 2008-2010 budget for the 6.6 billion annual investment (about $ 96,000,000)
b completed clinical study of 30 new drugs, for 1-2 innovations with intellectual property rights drugs can be completed or substantially completed in developed countries clinical trials
b 20-30 items and strive to break through the key new drug research and development of technologies, including chemical medicine, Chinese medicine and biotechnology drug development and quality control of new drugs that the special will
implemented in two tranches, the first establishment of a special group of enterprises the main incubator of innovative drug research center .2008, Beijing Pharmaceutical Group, North China Pharmaceutical, Shijiazhuang Pharmaceutical Group, Zhejiang Medical Group, Tianjin Tasly Group, Jiangsu Hengrui Medicine and other six companies short-listed the first national technology research, innovative drug research and development, new drug research and development of technology platform and other projects.
created a major new drug is one of the special importance of the domestic R & D R & D focus on key areas. For example, specific for the 10 categories (species ) seriously endangers the health of the people of the major disease drug research, standardization of traditional Chinese medicine to strengthen the field of biological agents in the lead. to establish state-level enterprise research center, will help to focus funds and resources to high-potential Chinese enterprises. aware of multinational corporations expensive drug development model is not suitable for China, Chinese companies try to to attract talent, and leading academic institutions and biotechnology companies to form strategic alliances, and many other challenges, but also is becoming a popular innovative multinational territory.
recognized life sciences industry has to attract high value-added manufacturing and the promotion of local employment development potential, local governments have to build a large pharmaceutical industrial park. For example, Tianjin aims to biopharmaceutical R & D base, limited production. At present, around the emergence of highly competitive industrial park, the country is said about 14 Medical Park, the United States only 16. However, there is a lot of multinational companies has completed investments in R & D base, and mainly concentrated in Beijing and Shanghai.
in promoting innovation in local government also play a key role. Figure 5 shows, across different policy to concentrate resources to promote biomedical innovation.
enhance and strengthen the GxP standards, pharmaceutical companies and distribution companies to improve the competitive threshold
China is implementing management practices and revise various types of drugs standards that affect the development of drugs to the sales process from all aspects. in research and development, China adopted the International Drug Clinical Practice (GCP) and medical laboratory practice (GLP), mainly used in contract R & D outsourcing (CRO) and other R & D R & D institutions and multinational agencies. China's current Good Manufacturing Practices (GMP) and drug management quality management practices (GSP) with different standards in Europe and America, but the Chinese government has set standards revised and improved to meet the national security and quality requirements. as the Chinese government to improve standards of GMP and GSP, pharmaceutical companies and distribution companies the threshold will be increased competition, which will likely trigger a new round of industry shuffling.
GMP standards to improve the pharmaceutical the operational efficiency of enterprises, higher current requirements of GMP standards in the execution of
when, in fact, expanded the scope of review and improve a request for review in 2004 did not shut down the 1800 GMP standard pharmaceutical enterprises, these enterprises are due to lack of funds and human resources and shut down production. This incident has greatly enhanced the quality awareness of pharmaceutical companies, and to promote the adjustment of industrial structure.
government implemented in 2010 the latest GMP standards to improve the Chinese pharmaceutical companies the level of product quality and competitiveness. The focus of the revised GMP by GMP review and improve the quality control of pharmaceutical companies and software management requirements to ensure that companies comply with the management of drug registration and recall regulations. The main changes include :
b pharmaceutical companies apply for GMP certification, to assess their compliance with medication supervision, registration and recall of the Ordinance
b pharmaceutical companies to perform an annual quality inspection and is responsible for the recall of substandard products
b improve drug quality assurance, design validation and change control requirements such as filing a new concept. The current requirements of GMP standards for pharmaceutical companies only on the main production steps and processes for archiving key areas, while the new standards may be required to record and archive products before distribution to the pharmaceutical distribution companies in the entire production process 21
revised GMP standards will encourage enterprises to improve the new drug safety requirements of pharmaceutical companies improve the effectiveness of manufacturing systems. To meet the new standard product recall traceability , pharmaceutical companies and medical distribution companies need to work closely in ensuring the visibility of the process of drug distribution.
Duiyu drug export of Chinese pharmaceutical enterprises, to follow the national and international quality standards is essential to invest. domestic pharmaceutical companies to upgrade from the production of pharmaceutical raw materials to finished products exported to seek more value-added drug development, the prerequisite is to improve the standards and compliance to meet international standards. At present, less than 20 pharmaceutical companies in China by the EU's European cGMP standards Zhejiang China Sea only get the finished product, a pharmaceutical drug exports to the U.S. certification. Huahai successful 2007, the domestic production of finished drug exports to the U.S. FDA certification, is a milestone in the history of the pharmaceutical industry.
a generic enterprises to successfully export to the United States finished drug case
Ltd. Zhejiang Huahai start in 1989, is a leading pharmaceutical companies, the main raw material medicine, the company exports to over 30 countries and regions. In 2007, an anti-HIV drugs Huahai received U.S. FDA approval, became the first production by the U.S. FDA approved anti-HIV drugs business. HUAHAI FDA-approved and put the whole application process is painful and enormous: from the beginning of the planning, preparation documents to the FDA field investigations, the whole application process took 5 years to spend more than 1 billion yuan. but the benefits are huge. of course, have to wait until China Sea in May 2012 to patent expiration in the U.S. pharmaceutical exports to the United States. When certification from the FDA to Hua Hailiang after the green light, which not only make the Chinese sea approval from other countries easier access to medicines, but also improves the China Sea and other international pharmaceutical giants capacity. 2008 Merck China Sea by the United States medicine in China, designated as OEM (OEM) of the pharmaceutical companies .22
pharmaceutical quality management specification revision (GSP) standards, will accelerate the maturity of pharmaceutical distribution industry in China released a new version of GSP
comments draft, which will pharmaceutical companies and medical distribution companies, higher demands. excerpt may change the terms of the:
b more stringent regulatory measures: the illegal drug business enterprises to strengthen the punishment, such as suspension, revocation GSP certificate and business license drugs.
b stressed that traceability: new coverage for drugs purchased computer information systems, storage, marketing and other business aspects of all of the requirements of the quality control process in order to achieve the management of the flow of drugs and so on, and procurement of medicines to make strict rules to control the source.
b strengthen the management of pharmaceutical distribution companies: the in warehousing of 15,000 square meters area of not less than .23
new GSP, once implemented, will promote the pharmaceutical distribution industry, the acceleration of change. In the past few years, the Chinese pharmaceutical distribution industry has experienced a regional expansion to drive industry consolidation. current China circulation market of the top three market share close to 20%, although with the United States and Japan accounted for 95% of the top three, respectively, compared to 65% of the market share gap between the obvious, but it will be a key turning point in the industry. new changes in GSP requiring companies to have better infrastructure, more efficient operational processes and systems to ensure compliance with government regulations. This may require the implementation of product traceability system and pharmaceutical electronic resume (e-pedigree) and other solutions in the process of production and circulation effective management of medicines. the threshold will increase competition in the industry, some small businesses can not meet the standards could face closure or consolidation.
In short, we expect more innovative enterprises with domestic and competitiveness, China will become more prosperous life science industry shown in Figure 6. multinationals also benefit from their R & D in China and outsourcing manufacturing to find more opportunities for cooperation.
prescription should change: recommendations for life sciences companies to
In the rapidly changing market environment to be successful, life sciences companies need to build and strengthen the three core operational capability: innovation, product quality and sales, marketing and distribution.
innovation: enterprises should strengthen the research capacity to seize this golden opportunity for development
enterprises will continue to strengthen in the short term R & D activities. In addition to the above-mentioned innovative activities of domestic enterprises, multinational pharmaceutical companies grow in accordance with market conditions may still continue to increase R & D (R & D) investment. Enterprise The innovation will be more complex, particularly the exploratory stage in the product.
when China gradually developed into a major global pharmaceutical industry, innovation centers, companies will generally face two major challenges. First, the establishment and strengthening of internal capacity, which can be through talent recruitment, retention and management of projects to be realized, the competition for talent in the pharmaceutical industry, the two centers will focus on the Beijing-Shanghai is particularly intense. The second is to expand through collaboration with external R & D capacity, which is carried out within the current industry model innovation and effective general trend, but also the capacity required for the global R & D institutions. IBM to a recent survey showed that two thirds of the CEO believe that the life sciences staff skills will lead to major changes in the next three years the major companies will face different .24 Challenge Summary Figure 7.
domestic companies choose different strategies can be used to develop its innovative model
generic drugs from domestic pharmaceutical companies to change drug innovation need to gradually establish echelon personnel, expertise and access to capital. We the development of its innovative model of domestic enterprises have made different strategic choices.
b hybrid model: low-cost advantage of China to provide outsourcing services for third parties to obtain the funds required for research activities. Hisun ceremony on the adoption of the United States the company produced its own research and development of tuberculosis drugs to raise funds.
b form a strategic alliance: strategic alliances with multinational corporations, academic institutions to establish licensing partnerships to develop profitable product mix, and eventually enter the international market. North China Pharmaceutical new drug development company, Yunnan Institute of Microbiology and the German Institute for Natural Products HKI strategic alliance for cancer drug research.
b into the branded generics market: Simcere to take strategy, the successful introduction of only two edaravone injection, one of the generic product than the deposit (Bicun).
b to expand export markets: the breakdown of generic drug products into export markets, such as the China Sea in addition to the U.S. FDA approved the export of anti-HIV drugs, in early 2008 and successfully exported products to the European preparations.
b Find China has a unique advantage of new market: Focus on domestic and international markets Biosimiliars unregulated commercial development. Such products contain interference factors, growth factors erythropoietin, human insulin, erythropoietin and other growth factors, the production of such drugs Dragon Pharmaceutical company, Toho Pharmaceutical, etc..
multinational enterprises should make full use of China's growing research and development capabilities, increased global sales channels and accelerate time to market
the past few years, many multinational companies have invested heavily in China to establish R & D center. taking into account the importance of the Chinese market and China's potential for innovation, multinational corporations should take the initiative to explore the innovation base in China increased R & D pipeline, clinical trials take full advantage of China's leading CRO capabilities and improve speed to market, accelerate product development.
multinational partners to implement effective strategies bio: 25
b based on the advantages: multinational research and development in China team should actively seek partners in China, including leading research institutions, biotechnology companies, and establish the ideal partner to seek win-win good reputation
b: to understand the unique demands of R & D institutions in China, such as academic research scientists to provide a more influential position
b appropriate alliance management: when partners began to work with global teams, to promote interaction with partners to reduce unnecessary conflicts, a leading multinational has entered
areas of strength in China, hoping to mine from the traditional Chinese medicine infectious diseases, biological agents in the drug, and using the Chinese hepatitis, cancer and other major diseases, population-based participation in global research and development.
manufacturing quality: companies must transform their manufacturing capacity in order to achieve more efficient, lower operating costs and better compliance when the GMP standard production
improve manufacturing quality and compliance to pharmaceutical companies is no longer a differentiation advantage, and become a prerequisite. If properly managed, high-quality harmony manufacturing not only will not increase the regulatory cost of doing business, on the contrary, higher productivity and lower operating costs will bring more business value.
leading pharmaceutical companies should have the following prerequisites in order to improve compliance and improve product quality:
b familiar with compliance requirements, wanting to enter the international market, it is particularly important: If Chinese enterprises want to enter the U.S. market, you need to be familiar with federal law CFR21 requirements and provisions of 210 (the current drug production, processing, packaging or preservation of production management practices) and operate. For example, they will need to consider how to meet the requirements of electronic batch records
b establish an effective quality management processes and systems: through the establishment of systems (including processes, facilities, etc. ) is particularly important to improve the quality, rather than focus only on a single product
b considered to complete the delivery of high quality organizations and personnel readiness
b using the appropriate, integrated IT systems to support document management, change control and real-time risk management, integrated IT system can also improve management efficiency, control and improve product quality and traceability
b cooperate with the FDA: FDA sought and established offices in China, the cooperation between
from a strategic, tactical and technical aspects of the structured approach of examining:
b strategy: risk assessment, identify failures, production risks and the underlying causes of income. This can help companies sort, to develop and identify best course of action to reduce risk program.
b tactics: the use of science, systems and technology to ensure product and process quality, and product product quality, efficacy and safety.
sales, marketing and distribution: to improve the channels and logistics management can help companies improve operational breadth, accuracy, economy, timely response and security
how to provide more reliable , higher quality and safer drugs are life sciences companies are facing challenges. in addition to the extension of an effective channel strategy and sales force management, pharmaceutical companies and medical distribution companies need to work closely with the effective management of channels and logistics.
the complexity of the Chinese market in sales and marketing at the right time to do, the correct information and data is passed to the right people is challenging. For example, enterprises in the new situation to be successful, needs and national, local Government to establish a solid relationship. marketing major hospitals in addition to the traditional objects of professional doctors, pharmaceutical companies gave the health care reform has brought primary health care work in the new target customers. The community health care and rural health facilities and clinics for the working characteristics of is very different.
enterprises are facing a major challenge is how to cost advantage in the two communities and rural areas to expand into new markets, the main consideration is shown in Figure 8.
to meet the market demand for these dynamic , Life Science Enterprise ...