广中医中医诊断.pptx

Visceral syndrome differentiationTang rongcuan:If a doctor doesnt know viscera,he could not distinguish the cause of disease and set up the principle of prescription.ConceptBased on:theory of zang fu visceraA dialectic辩证method Analyze and synthesize clinical data(four methods)Define location,the nature,pathological mechanism,wax and wane of genuine qi and evils(邪正盛衰)content1.zang syndrome differentiation2.fu syndrome plicated syndrome differentiationWhat we should pay attention to?The nature and change of the viscus(viscera)The relationship between viscus and other organs and tissuesThe relationship between viscus and other zang fu visceraSyndrome differentiation of heartThink over the following aspectsLocates in the chestDominates the bloodMind stays in heartMonarch fire belongs to the heartMatches joy in emotionsTongue as its out orifice,face and sweat Palpitation(心悸)Vexation(心烦)Cardiac pain(心痛)Insomnia and dreamy(失眠多梦)Poor memory(健忘)Delirium coma(谵妄、神昏)Intermittent pulse（间歇脉）Red tongue tip crimsin tongue(舌尖红)Yellow urine with urodynia（排尿痛）Heart qi deficiency Syndrome of heart dysfunctionCongenital defect,aging,chronic disease,over think.Palpitation chest distress胸闷shortness of breathSweatinglistlessness（倦怠）and deteriorated by exertionpale complexionweak pulseKeys of clinical manifestationsPalpitationQi deficiency Heart yang deficiencyHeart yang on decline,the severe deficiency of heart qi.Impairment by cold evil,over sweating and purgationHQD manifestation plus cardiac pain,intolerance to cold(畏寒）,cold limbs，lusterless complexion，Faint pulseLoss of heart yangSeparation of yin and yang due to sudden depletion of heart yang.Critical or emergency diseaseBlue lips,cold sweating,serious cold limbs,severe palpitation,feeble breath,stupor or coma.Heart blood deficiencyLack of blood in the heart and the heart being lack of nourishmentCongenital defect,over mental activities,blood loss and chronic diseasePale or sallow complexion,pale lips and tongue,lusterless nails,insomnia,poor memory,profuse dreams,thready pulse Heart yin deficiencyMalnourished heart due to heart yin deficiencyOver thinking,warm disease,insufficiency of production of yin.Palpitation,insomnia,excessive dream,tidal fever,fidget,hot sensation in the five centers,night sweating,hectic cheek潮红红,dry throat,red tongue with little coating,thready and rapid pulseBlood stasis in heartBlockage due to blood stasis in the heartAged patient or chronic disease,deficiency of yang,phlegm retention,cold evils,and qi stagnation.Palpitation,chest distress,stabbing cardiac pain radiating to arm,even to hand,aggravated by physical exertion.dark purplr tongue or ecchymosis瘀斑Blood stasis in heartPhlegm:choking pain/corpulent and heavy body/white greasy coating/deep and slippery pulseCold evil:severe and attacking suddenly pain/intolerance to cold,pale tongue with white coating/deep slow taut pulseQi stagnation:distending pain related to emotional changes/hypochondriac distention/pink tongue/taut pulseFire blazing in heartExcessive fire in heartEmotional stress,six climatic evils,over fatigue,over taking pungent food or rich foodFlushed face,dry throat,preference of drinking water,ulcer in mouth,vexation and hot sensation in chest,insomnia,turbid urine,red tongue,yellow coating,rapid pulse.bleedingHeart disturbed by phlegm fireMind disturbed by phlegm fireEmotional stress,six climatic evils,over fatigue,over taking pungent food or rich food Flushed face,fever,mania狂躁,restlessness坐立不,delirium slurred speech谵语,expectoration of yellow thick sputum,incoherent speech语无伦次,changeable emotions,vexation心烦and hot sensation in chest,insomnia,turbid urine尿浊,red tongue,yellow coating,rapid pulse.Syndrome differentiation of lung and large intestine disease1Syndrome differentiation of lung disease2 Syndrome differentiation of large intestine diseaseConcept:Pulmonary qi asthenia syndrome refers to asthenia syndrome due to insufficiency of pulmonary qi and hypofunction of the lung in governing qi and weakness of weiqi to protect the superficies.1.1 pulmonary qi astheniaClinical manifestations:the feeble cough and dyspnea呼吸困难shortness of breath,thin and clear sputum,feeble voice of speaking and indolence of speaking are usually the main symptoms.The patient is susceptible to the cold.The tongue is pale and pulse is weak.Key points for syndrome differentiation:Feeble coughExpectoration with thin and clear sputumFunctional decline due to qi asthenia1.2 lung yin asthenia syndromeConcept:This syndrome refers to syndrome of asthenic internal heat due to insufficiency of lung yin and failure of depuration.It is often caused by consumption of lung yin due to dry heat impairing the lung or consumptive disease damaging the lung.Clinical manifestations dry cough with scanty sputum or scanty and sticky sputum difficult to expectorate sputum mixed with blood hoarseness声嘶 dry mouth and throat emaciation消瘦 feverish sensation over five centers(五心烦热)afternoon tidal fever flushed cheeks and night sweating reddish tongue with scanty fluid as well as thin and fast pulse.Key points for syndrome differentiation:Dry cough Scanty and sticky sputumInternal heat with yin asthenia1.3 syndrome of wind cold encumbering lungConcept:Refers to the syndrome of failure of pulmonary qi to disperse due to wind cold attacking the lung.This syndrome is often caused by failure of pulmonary qi to disperse due to exogenous wind cold.Clinical manifestations:CoughThin expectorationStuffy nose with clear snivel and throat itchingAccompanied by aversion to cold恶寒,畏寒and feverBody pain without sweatingWhitish thin tongue fur as well as floating and tense pulseKey points for syndrome differentiation:CoughThin and clear sputumAversion to cold FeverPain of head and body as well as no sweating 1.4 wind heat invading lung syndrome Concept:wind heat invading lung syndrome refers to the syndrome of the lung failing to disperse resulting from wind heat attacking the lung.This syndrome pertains to weifen syndrome in syndrome differentiation of wei,qi,ying and blood.It is often caused by invasion of wind heat into the lung.Clinical manifestations:Cough Yellowish thick sputumStuffy nose with turbid snivelFeverSlight aversion to wind and coldSlight thirstSore-throatReddish tongue tipThin and yellowish tongue furFloating and fast pulseKey points for syndrome differentiation:CoughYellowish thick sputumSlight aversion to wind and cold FeverSlight thirst Reddish tongue tip 1.5 Syndrome of dryness attacking lungConcept:Refers to the syndrome of consumption of fluid in the lung system due to invasion of pathogenic dryness into the lung.This syndrome is divided into febrile dryness syndrome and cool dryness syndrome according to its heat or cold nature.Clinical manifestations:Dry cough with scanty sputum,Sticky sputum difficult to expectorateChest pain,Sputum mingled with bloodEpistaxis鼻衄,Hematemesis呕血;吐血;咯血Dryness of mouth,lips,nose and throatDry feces with scanty urine Thin and dry tongue with scanty salivaFloating and fast or tense pulseKey points for syndrome differentiation:Dry coughScanty and sticky sputum difficult to expectorateDryness of mouth,lips,nose and throat with scanty saliva1.6 syndrome of accumulation of pathogenic heat in lungConcept:syndrome of accumulation of pathogenic heat in lung refers to the syndrome due to loss of depuration of the lung resulting from exuberant pathogenic heat in the lung.Clinical manifestations:Fever,cough,asthmatic breath,even flapping nose with hot breath,red swelling and pain of throat,chest pain,yellowish sticky sputum,or rusty sputum铁锈色痰,or foul sputum mingled with blood,thirst,scanty urine,constipation便秘,red tongue with yellow fur and fast pulse.咳嗽伴痰中有血丝或大量咳血者,若血色为鲜红以肺结核、支气管扩张和肺癌为多见;血色为铁锈色,痰液粘滞且有脓性.感染;如痰液恶臭色红,多是肺癌晚期。Key points for syndrome differentiation:FeverCoughAsthmatic breathChest painYellowish sticky sputum1.7 syndrome of phlegmatic dampness retention in lungConcept:means to the syndrome due to failure of the lung to disperse and descend resulting from retention of phlegmatic dampness in the lung.It is often caused by retention of phlegm coagulating from fluid in the lung due to asthenia of splenic qi.Clinical manifestations:Cough with profuse whitish sputum大量白色痰easy to expectorate or with clear,thin and frothy sputum泡沫痰pale tongue with whitish greasy fur and slippery pulse.usually seen in chronic bronchitis,bronchial asthma,chronic obstructive pulmonary emphysema,chronic pulmonogenic heart disease and lung cancer.Key points for syndrome differentiation:Cough Asthmatic breathProfuse whitish sputum which is either sticky and slippery or thin and clear.2 syndrome differentiation of large intestine disease Large intestine disease mainly reflects the dysfunction of the large intesting proper and the pathological changes in its functions in transportation and transformation.The clinical symptoms of large intestinal disorder are usually constipation便秘,diarrhea腹泻and purulent and bloody dysentery痢疾.2.1 syndrome of large intestinal damp-heatConcept:Refers to the symptoms of diarrhea and dysentery due to invasion of damp heat into the intestinal tract and failure of the intestine to transport.It is often caused by damp-heat pathological in summer and autumn.Clinical manifestations:Abdominal pain,yellowish and foul fulminant突然diarrhea,scorching灼热sensation over the anus肛门,or purulent and bloody dysentery,tenesmus里急后重,scanty and yellow urine(小便短赤),reddish tongue,yellow and greasy tongue fur as well as slippery and rapid pulse.Key points for syndrome differentiation:Abdominal pain Fulminant(暴发的)diarrheaPurulent bloody dysentery as well as manifestations of damp-heat2.2 syndrome of large intestinal fluid consumption Concept:Refers to the symptoms of retention of dry feces and difficulty in defecation due to consumption of large intestinal fluid and inhibited transportation.Clinical manifestations:Dry feces and difficulty in defecation,defecation once in several days,dry mouth and throat,or dizziness and halitosis,reddish tongue with scanty fluid,yellow and dry tongue fur,as well as thin and unsmooth pulse.Key points for syndrome differentiation:Retention of dry fecesDifficulty in defecation Manifestations of loss of fluid ConclusionSyndrome differentiation of Heart and Lung diseaseThe common symptomsThe different symptoms Syndrome differentiation of small intestine andlarge intestine diseaseThe common symptomsThe different symptoms QuestionsWhat about the syndrome differentiation of Lung disease?How many kinds of there are in differentiation of heart disease?How about the difference of the different syndrome of lung diseases?How to differentiate the different kinds of large intestine?MRSA耐甲氧西林金黄色葡萄球菌感染人体血管,破坏肌肉,甚至死亡世界三大最难解决感染性疾病第一位主要通过手部接触传染,或者与已感染者共用同一物品时发生传染勤洗手尽早隔离尽量控制抗生素的使用,患者滥用抗生素会使病菌逐渐产生抵抗性,进而影响治疗效果万古霉素WHOTCM 标准出台