中医英语病例讨论.ppt

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1、中医病例讨论胃脘痛胃脘痛（中焦阳虚）（中焦阳虚）一.辩证导引wToday we will discuss the TCM case of a 36-year-old man。w今天我们要讨论的是3岁男性中医病例.二.病史陈述wFirst of all,I would like to present the case.首先，我为大家介绍此病例二.病史陈述wToday we will discuss the case of a 36-year-old man with recurrent epigastric pain for five months.今天我们要讨论的是一位近五个月以来上腹疼痛的3

2、6岁男性病例。二.病史陈述wFive months ago,the patient felt epigastric pain.At that time,the amylase levels was 349 U per liter.The white-cell count and the results of tests of liver function were normal.the pain continued,and the amylase levels did not return to normal.w五个月前五个月前,病人感到上腹疼痛病人感到上腹疼痛.淀粉酶水平是淀粉酶水平是349

3、单位每升单位每升.白细胞数目和肝功能正常白细胞数目和肝功能正常.疼痛继续疼痛继续.淀粉酶水平一直不正常淀粉酶水平一直不正常.二.病史陈述wTwelve weeks ago,he was administration of prednisone(20 mg twice daily).The patients pain resolved.The patient had lost 5.5 kg in weight during recent weeks.w12周前周前,病人使用了强的松病人使用了强的松20毫克毫克,每天两次每天两次.最最近几周病人体重下降近几周病人体重下降5.5公斤公斤.二.病史陈述

4、wSixteen weeks before admission，an endoscopic examination showed diffuse attenuation of the common bile duct and focal narrowing at the origin of the left hepatic ductw入院前入院前16周周,内窥镜显示胆管变薄内窥镜显示胆管变薄,左侧胆管变狭左侧胆管变狭窄窄.二.病史陈述wbut the intrahepatic duct s were not optimally distended.The same day an upper g

5、astrointestinal endoscopic examination showed abnormalities in the entire pancreas，w但是肝内胆管无扩张但是肝内胆管无扩张.同一天的胃肠内窥镜显示同一天的胃肠内窥镜显示胰腺的畸形胰腺的畸形.二.病史陈述wHe had a tendency toward constipation and urinary frequency.He had had no recent episodes of nausea,vomiting,or diarrhea.His paternal grandmother had died of

6、“stomach cancer,”but there was no family history of pancreatitis.w最近他有便秘和尿频现象最近他有便秘和尿频现象.没有头晕恶心没有头晕恶心,呕吐呕吐,腹泻的现象腹泻的现象.他的曾祖母死于胃癌他的曾祖母死于胃癌,没有胰腺炎家没有胰腺炎家族史族史.二.病史陈述wPhysical examination(体格检查):wT 36.7 ,HR83bpm,BP 115/75 mmHg;Normal development,normal nourishment,unpalpation of superficial lymph node,norm

7、al breath sound of the lung,HR 83bpm,regular.Slightly palpational pain in epigastric abdomen,no palpational pain in other region,without any reflect pain.No edema in the low extremities.w w发育正常，营养良好，浅表淋巴结未及，双肺呼吸音发育正常，营养良好，浅表淋巴结未及，双肺呼吸音正常，心率正常，心率83 bpm83 bpm，律齐。中上腹轻压痛，律齐。中上腹轻压痛，无反跳痛，无反跳痛，其余部位无压痛，双下肢无

8、水肿。其余部位无压痛，双下肢无水肿。二.病史陈述wInspection，Auscultation and Olfaction,pulse-feeling and palpation:wsallow complexion，fatigue looking,lassitude,reluctance to speak,emaciation,wcold limb aversion to cold,eyeball without icterus.painful express.w望、闻、切：面色萎黄望、闻、切：面色萎黄,神疲乏力，少气懒言，神疲乏力，少气懒言，形寒肢冷，恶寒，无黄睛，苦痛楚楚。形寒肢冷，恶

9、寒，无黄睛，苦痛楚楚。二.病史陈述w wInquiry:poor appetide,constipation and urinary Inquiry:poor appetide,constipation and urinary frequary,good sleep,no nausea,vomiting,diarrheafrequary,good sleep,no nausea,vomiting,diarrhea.w w问诊：胃纳不馨，大便闭塞，小便清长，夜寐尚安。无问诊：胃纳不馨，大便闭塞，小便清长，夜寐尚安。无问诊：胃纳不馨，大便闭塞，小便清长，夜寐尚安。无问诊：胃纳不馨，大便闭塞，小便清

10、长，夜寐尚安。无恶心、呕吐、腹泻等症。恶心、呕吐、腹泻等症。恶心、呕吐、腹泻等症。恶心、呕吐、腹泻等症。w wPicture of the tongue:whitish enlarged tang with slight Picture of the tongue:whitish enlarged tang with slight yellow fur in center.yellow fur in center.w w舌象：淡白胖大舌，中有薄黄苔舌象：淡白胖大舌，中有薄黄苔舌象：淡白胖大舌，中有薄黄苔舌象：淡白胖大舌，中有薄黄苔w wPulse-taking:Thin,weakPulse-t

11、aking:Thin,weak w w脉象：细脉象：细脉象：细脉象：细 弱弱弱弱三.病证要点wepigestric painw胃脘痛胃脘痛四.中医辨证wEpigastric pain is a chronic persist ache in the upper abdomen.It can be caused by Qi asthemia,pathogenic cold invasion and blood stasis，etc.w胃脘痛是中上腹的慢性持续性疼痛，可以因为胃脘痛是中上腹的慢性持续性疼痛，可以因为气虚、外寒入侵或是血瘀等引起。气虚、外寒入侵或是血瘀等引起。四.中医辨证wIt is

12、 not likely the dianosis of heart-ache.Because it usually companied with a series of cardiac sympotoms like irregular heart rate,short breath,palpitation,cardialgia.So heart disease is an unlikely disease in this case.w鉴别诊断：真心痛：可有一系列心脏的症状伴鉴别诊断：真心痛：可有一系列心脏的症状伴随随,如：心律失常、如：心律失常、短气、心悸、心痛等。本短气、心悸、心痛等。本病程

13、中无任何上述伴随症状出现，基本可以排病程中无任何上述伴随症状出现，基本可以排除心脏病。除心脏病。五.病机分析wIt is because of insufficiency gastroplenic Yang.Asthenic Yang cause endogenous cold(said Nei Jing),coldness leads to ache.And the tongue and the pulse also suggest the diagnosis.w本证主要因中焦阳气不足引起。本证主要因中焦阳气不足引起。内经内经云云“阳阳虚则寒虚则寒”，寒主痛，故中焦阳气不足而见胃脘痛。，寒主

14、痛，故中焦阳气不足而见胃脘痛。舌脉亦见阳气虚损症状。舌脉亦见阳气虚损症状。六.中医诊断wDiagnosis of TCM:epigestric pain(insufficiency of gastrolenic Qi)w入院中医诊断：胃脘痛（中焦阳虚）入院中医诊断：胃脘痛（中焦阳虚）七.治疗原则wPrinciple:invigorating Yang，worming the stomach to liminate cold w治则：温阳健脾，温中散寒治则：温阳健脾，温中散寒八.方剂选择wPrescription:Pegulating the Middle Decoction&Rour Noble Drug Decoction w方剂：理中汤（伤寒论）合四君子汤圣方剂：理中汤（伤寒论）合四君子汤圣济总录济总录