中医病例讨论培训课件

一.辩证导引TodaywewilldiscusstheTCMcaseofa36-year-oldman。今天我们要讨论的是3６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-oldmanwith

recurrentepigastricpainforfivemonths

.

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.病史陈述二.病史陈述Twelveweeksago,hewasadministrationofprednisone(20mgtwicedaily).Thepatient’spainresolved.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(insufficiency