中医英语病例讨论

.,中医病例讨论,胃脘痛（中焦阳虚）,.,一.辩证导引,TodaywewilldiscusstheTCMcaseofa36-year-oldman。今天我们要讨论的是3岁男性中医病例.,.,二.病史陈述,Firstofall,Iwouldliketopresentthecase.首先，我为大家介绍此病例,.,二.病史陈述,Todaywewilldiscussthecaseofa36-year-oldmanwithrecurrentepigastricpainforfivemonths.今天我们要讨论的是一位近五个月以来上腹疼痛的36岁男性病例。,.,二.病史陈述,Fivemonthsago,thepatientfeltepigastricpain.Atthattime,theamylaselevelswas349Uperliter.Thewhite-cellcountandtheresultsoftestsofliverfunctionwerenormal.thepaincontinued,andtheamylaselevelsdidnotreturntonormal.五个月前,病人感到上腹疼痛.淀粉酶水平是349单位每升.白细胞数目和肝功能正常.疼痛继续.淀粉酶水平一直不正常.,.,二.病史陈述,Twelveweeksago,hewasadministrationofprednisone(20mgtwicedaily).Thepatientspainresolved.Thepatienthadlost5.5kginweightduringrecentweeks.12周前,病人使用了强的松20毫克,每天两次.最近几周病人体重下降5.5公斤.,.,二.病史陈述,Sixteenweeksbeforeadmission，anendoscopicexaminationshoweddiffuseattenuationofthecommonbileductandfocalnarrowingattheoriginofthelefthepaticduct入院前16周,内窥镜显示胆管变薄,左侧胆管变狭窄.,.,二.病史陈述,buttheintrahepaticductswerenotoptimallydistended.Thesamedayanuppergastrointestinalendoscopicexaminationshowedabnormalitiesintheentirepancreas，但是肝内胆管无扩张.同一天的胃肠内窥镜显示胰腺的畸形.,.,二.病史陈述,Hehadatendencytowardconstipationandurinaryfrequency.Hehadhadnorecentepisodesofnausea,vomiting,ordiarrhea.Hispaternalgrandmotherhaddiedof“stomachcancer,”buttherewasnofamilyhistoryofpancreatitis.最近他有便秘和尿频现象.没有头晕恶心,呕吐,腹泻的现象.他的曾祖母死于胃癌,没有胰腺炎家族史.,.,二.病史陈述,Physicalexamination(体格检查):T36.7,HR83bpm,BP115/75mmHg;Normaldevelopment,normalnourishment,unpalpationofsuperficiallymphnode,normalbreathsoundofthelung,HR83bpm,regular.Slightlypalpationalpaininepigastricabdomen,nopalpationalpaininotherregion,withoutanyreflectpain.Noedemainthelowextremities.发育正常，营养良好，浅表淋巴结未及，双肺呼吸音正常，心率83bpm，律齐。中上腹轻压痛，无反跳痛，其余部位无压痛，双下肢无水肿。,.,二.病史陈述,Inspection，AuscultationandOlfaction,pulse-feelingandpalpation:sallowcomplexion，fatiguelooking,lassitude,reluctancetospeak,emaciation,coldlimbaversiontocold,eyeballwithouticterus.painfulexpress.望、闻、切：面色萎黄,神疲乏力，少气懒言，形寒肢冷，恶寒，无黄睛，苦痛楚楚。,.,二.病史陈述,Inquiry:poorappetide,constipationandurinaryfrequary,goodsleep,nonausea,vomiting,diarrhea.问诊：胃纳不馨，大便闭塞，小便清长，夜寐尚安。无恶心、呕吐、腹泻等症。Pictureofthetongue:whitishenlargedtangwithslightyellowfurincenter.舌象：淡白胖大舌，中有薄黄苔Pulse-taking:Thin,weak脉象：细弱,.,三.病证要点,epigestricpain胃脘痛,.,四.中医辨证,Epigastricpainisachronicpersistacheintheupperabdomen.ItcanbecausedbyQiasthemia,pathogeniccoldinvasionandbloodstasis，etc.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。,.,四.中医辨证,Itisnotlikelythedianosisofheart-ache.Becauseitusuallycompaniedwithaseriesofcardiacsympotomslikeirregularheartrate,shortbreath,palpitation,cardialgia.Soheartdiseaseisanunlikelydiseaseinthiscase.鉴别诊断：真心痛：可有一系列心脏的症状伴随,如：心律失常、短气、心悸、心痛等。本病程中无任何上述伴随症状出现，基本可以排除心脏病。,.,五.病机分析,ItisbecauseofinsufficiencygastroplenicYang.AsthenicYangcauseendogenouscold(saidNeiJing),coldnessleadstoache.Andthetongueandthepulsealsosuggestthediagnosis.本证主要因中焦阳气不足引起。内经云“阳虚则寒”，寒主痛，故中焦阳气不足而见胃脘痛。舌脉亦见阳气虚损症状。,.,六.中医诊断,DiagnosisofTCM:epigestricpain(insufficiencyofgastrolenicQi)入院中医诊断：胃脘痛（中焦阳虚）,.,七.治疗原则,Principle