中醫(yī)診斷學第一章

中醫(yī)診斷學第一章第一頁，共45頁。conceptionToknowtheonset,development,treatment,presentsymptomsandotherinformationofdiseasebyquestioningpatientoraccompanyingpeopleInternalclassicTreatiseoncoldattackThousandworthyprescriptionsforemergence第二頁，共45頁。purposeToknowthehobby,customofpatientOnsetdevelopmentofdiseaseJudgethecauseandnatureofdiseaseDatafromalldiagnosticmethodsshouldbetakenintocomprehensiveconsiderationinordertoavoidmistakeindiagnosis第三頁，共45頁。MethodofinterrogationSuitableenvironmentAskthepatientdirectlyQuestioningmethodinemergencyThedoctorshouldbeseriousandpatient,andbegoodatthinkingandarousingpatients第四頁，共45頁。Contentofinterrogation1.Generaldata:name,sexoccupation,birthplace,nationality,address,marriagestate,24-solartermsofdiseaseonset,visitdata,admissiondataExamples:hepaticechinococcosis(包蟲病)(pastoralarea),rheumatism(風濕病),postpartumdisease(產后病)2.Lifestyleandprocess(Diet,mentalactivity,regulardailylife)第五頁，共45頁。3.Familyhistoryandanamnesis4.ChiefcomplaintThesymptomsthepatientfeelsthemostobviousandpainfullyandthemaincauseforvisitingadoctor.symptoms+period第六頁，共45頁。5.Historyofdisease

1)Thecauseofdiseaseonset—circumstance,time,symptoms,suddenornot,causeorpredisposingcause,developmentandtreatment

2)Presentsymptoms明代醫(yī)學家張景岳《十問歌》：一問寒熱二問汗，三問頭身四問便，五問飲食六問胸，七聾八渴俱當辨，九問舊病十問因，再兼服藥參機變，婦女尤必問經期，遲速閉崩皆可見，再添片語告兒科，天花麻疹全占驗。第七頁，共45頁。ColdandfeverAversiontocoldIntoleranceofcoldA.Chillandfevera.morechillthanfeverb.morefeverthanchillc.feverwithaversiontocold第八頁，共45頁。B.thechillandfeversepratelya.feverwithoutchillsthenicfever,tidalfever,oleranceofcoldwithoutfeverC.Alternatechillandfevera.shaoyangsyndromeb.malaria第九頁，共45頁。sweatingTheactionofyangputsonyinmakesthesweating.Nosweatingwind-coldintheexterioryininsufficiencySweatingNormalsweatingAbnormalsweating第十頁，共45頁。AbnormalityofsweatingcharacterA.spontaneoussweatingB.NightsweatingC.profusesweatingheatorcoldD.yellowsweatingdamp-heatE.fightingsweatingF.dyingsweating第十一頁，共45頁。AbnormalityonsweatinglocationA.hemihidrosis(半身汗)B.headsweatingC.ChestsweatingD.sweatinginthepalmandsoleE.genitalsweating第十二頁，共45頁。PainMechanismofpain:StagnationorstasisInnutritionofbodyClassificationofpainA.CharacterofpainB.LocationofPainTodistinguish:heat

coldexcessdeficiencypain第十三頁，共45頁。CharacterofpainExcess:suddenonset,severeand,incessantaggravatedbypressingCauses:exogenousevils,qistagnation,bloodstasis,

phlegmretention,parasitosisorfoodretentionDeficiency:occursgradually,dull,paroxysmal,relievedbypressing第十四頁，共45頁。A.Distendingpain-----qistagnationB.Stabbingpain---bloodstasisC.Colicpain(絞痛)---solidevilsobstructionD.Retractionpain(掣痛)—malnutritionoftendonsE.Scorchingpain(灼痛)—fireevilsF.Coldpain---yangdeficiency,coldattackG.Hollowpain—deficiencyofessenceorbloodH.Dullpain(鈍痛)—deficiencyofpain第十五頁，共45頁。LocationofpainA.Headache

excessdeficiencyOcciputradiatingtonape---taiyangmeridianforehead----yangmingmeridianbilateralsides---shaoyangmeridianvertex----jueyinmeridian第十六頁，共45頁。appendixDizzinessorvertigo:NophlegmnovertigoNodeficiencynovertigoExcess----phlegm–dampnessDeficiency--qiandblood,Ascendanthyperactivityofliveryang,kidneyessence第十七頁，共45頁。B.Generalaching(pantalgia)wind-cold,wind-dampnesspestilentialtoxin

InsufficiencyanddisharmonyofqiandbloodC.Chestpain

lung—phlegm-dampness,heat,abscess,yindeficiency

heart—qideficiencyandbloodstasis,qistagnation第十八頁，共45頁。D.Hypochondriacpainblazingofliverfireshaoyangsyndromebloodstasisfromsprainorfallingdowndamp-heatsuspendingfluidretention第十九頁，共45頁。E.stomachachestomachcoldorheatliverqistagnationbloodstasisspleenyangdeficiencyspleenyindeficiency

第二十頁，共45頁。F.abdominalpaincoldheatexcessdeficiencyyangmingfusyndromedeficientcoldofspleenbloodstasisinlowerjiaocoldattacklivermeridianparasitosisintestinalabcess

第二十一頁，共45頁。G.lumbagokidneyyinoryangdeficiencybloodstasiscoldattackH.Painoflimbs(joints)wind,heat,cold,dampness

第二十二頁，共45頁。4.Dietandtasteinmouth

(飲食與口味)A.Thirstanddrinking(口渴與引水)B.Appetiteandfoodintake(食欲與進食)C.Abnormaltasteinmouth(異?？谖?第二十三頁，共45頁。A.Thirstanddrinking

a.Nothirst(口不渴)b.Thirstwithprofusedrinkingandurine(伴多汗)consumptivethirstdiseaselungstomachheat,kidneyyindeficiencyc.Thirstbutlittledrinking(少飲)yindeficiency\damp-heat\fluid-retentionbloodstasis第二十四頁，共45頁。B.Appetiteandfoodintake

食欲與進食Todistinguishtheyinoryangconstitutionofbodya.Poorappetite(食欲差)spleendeficiency/dampness/qistagnation/foodinjury/pregnancyb.overeatingbutstillfeelinghungry(多食易饑)stomachfire/strongstomachandweakspleenc.Hungerwithoutappetite(饑不欲食)stomachyindeficiency第二十五頁，共45頁。d.foodaddiction(偏嗜)parasitosis/pregnancy/Symptomsrelievedafterfoodtaking---deficiencySymptomsaggravatedafterfoodtaking-excess(食后痛減,食后加重)Fooddrunk(食醉)---spleendeficiencyToknowthedevelopingtendencyofdisease第二十六頁，共45頁。C.TasteinthemouthMorbidtasteinthemouth(口味異常)Tastelessness(口淡)–deficiencyofspleenandstomachSweettaste(口甜)-damp-heatinmiddlejiaoSourtaste(口酸)—heataccumulationinliverandstomachBittertaste(口苦)—gallbladderheatsyndromeSaltytaste(口咸)—kidneydisease第二十七頁，共45頁。5.Defecationandurination

二便Defecationisrelatedtolargeintestine/lung/spleen/liver/kidneyUrinationisrelatedtobladder/kidney/lung/liverToknowthenatureofdiseaseandthefuntionofviscera第二十八頁，共45頁。A.defecation(大便)a.stoolform(便形):drystoolanddarkcolor---heatinlargeintestineextremelydrystool—bloodorbodyfluiddeficiency

loosebowel---deficientcoldinspleen

hardstoolfirst&loosethen-dampness/deficiencyalternatedryandloose---stagnationofliverqi

undigestedfoodinstool---kidneyyangdeficiency

foodretention/damp-heatinlargeintestine第二十九頁，共45頁。b.Frequencyofdefecation(大便次數)

constipation(便秘):excessiveheat/coldaccumulation/yinorqiblooddeficiency

diarrhea(腹瀉):spleendeficiency/decliningoflifegate/fire/foodretention/damp-heat第三十頁，共45頁。c.colorofstool(便色):

darkyellow–stagnatedheatinintestineblack---farbloodred----nearbloodredandwhite---dampnessinlargeintestine

grayishwhite---jaundanceofdampheat第三十一頁，共45頁。d.feelingofdefecation(便感)

hotandburningsensation---dampheat

unsmoothdefecation---liverqistagnationtenesmus(里急后重)—dampheat

fecalincontinence(大便失禁)---deficiencyofspleenandkidney第三十二頁，共45頁。Urination(小便)Relatedtobodyfluid/lung/spleen/kidney4-6timesaday1500-2000mladayReflecttheconditionofbodyfluid/viscera第三十三頁，共45頁。Urination(小便)a.amountofurine(尿量)

Excessiveurine(多尿):kidneyyangdeficiency

consumptivethirst(消渴)kidneyyindeficiency

Scantyurine(少尿):heat/sweating/vomiting/Diarrhea/deficiency

b.frequencyofurinationFrequenturination(尿頻)kidneyyangdeficiencydampheatinlowerjiaodysuriaandanuria(癃閉):excessanddeficiency第三十四頁，共45頁。c.colorofurine(尿色)normal---lightyellowandtranparent

yellow---heat,dampheat(jaundice黃疸)

clear---deficiencycold

red---collateralimpairmentFeelingofurinationurethralpain(尿痛)enuresis(遺尿)dripping(淋瀝不盡)incontinence(失禁)第三十五頁，共45頁。6.sleepNormal---hidingofyangandflourishofyin(陽潛陰盛則寐)a.Insomnia(失眠)1.Disharmonybetweentheheartandkidney(心腎不交)2.Deficiencyofheartandspleen(心脾兩虛)3.Gallbladderstagnationandphlegmdisturbing(膽郁痰擾)4.Foodretention(食積)第三十六頁，共45頁。b.Sleepiness(嗜睡)1.damp-phlegmencumberinginspleen(痰濕困脾)2.spleenqideficiency(脾氣虛)食醉3.deficiencyofheartandkidney4.heatinpericardium(熱入心包)第三十七頁，共45頁。7.WomendiseaseA.menstruation(月經)5-724-30B.vaginaldischarge(白帶)C.pregnancy(懷孕)D.symptomsafterdelivery(產后癥狀)第三十八頁，共45頁。A.menstruation(月經)

a.Irregularmenstruation(月經不調)prece