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1、中医内科护理主讲：高健1Goals of Studying掌握各个病证的病情分析及护理。掌握相关专业词汇。熟悉各个病证的定义。了解各个病证的健康指导。能够灵活运用理论知识对个案进行有针对性 的护理。http:/ 2感冒Common cold3Common coldDefinitionDefinitionCommon cold 是感受触冒外邪所导致的 常见外感疾病，临床表现以鼻塞，流涕， 喷嚏，头痛，恶寒、发热、全身不适等为 特征。四季均可发病，尤以冬春季节为多 。 4感冒一名，北宋仁斋直指方即有记载 。而内经已指出感冒主要是外感风邪所 致。元丹溪心法伤风明确指出病位属肺 ，根据辨证，分列辛温、
2、辛凉两大治法。此 后医家又对虚人感冒有进一步的认识，提出 扶正达邪的治疗要求。Common cold5Cause of Disease andCause of Disease and Pathomechanism Pathomechanismv六淫( six exogenous pathogenic factors )v时行病毒( seasonal virus ) v人体正气( health qi )不足 其病机关键在于邪实正虚(excess of evil and asthenia of health qi ) 。 Common cold6Analyses of pathological c
3、onditionsAnalyses of pathological conditionsv风寒感冒(common cold due to wind-cold) v风热感冒(common cold due to wind-heat) v暑湿感冒(common cold due to summer-dampness)v体虚感冒 气虚感冒(common cold due to asthenia of qi)阴虚感冒 (common cold due to asthenia of yin)Common cold7Analyses of pathological conditionsAnalyses o
4、f pathological conditionsv Common cold due to wind-cold恶寒重，发热轻，无汗头痛，肢体痰楚， 鼻塞声重，时流清涕，咽痒咳嗽，痰稀薄色 白，口不渴或喜热饮，苔薄白而润，脉浮或 浮紧。 Common cold8Analyses of pathological Analyses of pathological conditionsconditionsv Common cold due to wind-heat身热较著，微恶风，汗泄不畅，头胀痛 ，鼻塞，流黄浊涕，口渴欲饮，咽喉红肿 疼痛，咳嗽，痰黄粘稠，苔薄黄，脉浮数 。 Common cold9
5、Analyses of pathological Analyses of pathological conditionsconditionsv Common cold due to summer- dampness身热，微恶风，汗少，肢体酸重或疼 痛，头昏重胀痛，咳嗽痰粘，鼻流浊涕， 心烦口渴，或口中粘腻，渴不多饮，胸闷 ，泛恶，小便短赤，舌苔薄黄而腻，脉濡 数。 Common cold10Analyses of pathological Analyses of pathological conditionsconditionsv Common cold due to asthenia of
6、qi经常感冒，反复不愈，恶寒重，发热 ，咳嗽，咳痰无力，气短，倦怠，舌淡苔 白，脉浮无力。 v Common cold due to asthenia of yin头痛身热，微恶风寒，少汗，头昏， 心烦，口干，于咳少痰，舌红少苔，脉细 数。 Common cold11Problems of patientsProblems of patients Nursing goalsNursing goalsCommon cold12Nursing interventionsNursing interventionsv Common cold due to wind-cold Principle of
7、nursing ：辛温解表Entirety nursing：Life care：Diet care：Drugs care：Acupuncture ：Tui na：Common cold13Nursing interventionsNursing interventionsv Common cold due to wind-heat Principle of nursing ：辛凉解表Entirety nursing ：Life care：Diet care：Drugs care：Acupuncture ： Tui na：Common cold14Nursing interventionsNur
8、sing interventionsv Common cold due to summer-dampness Principle of nursing ：驱湿解表Entirety nursing ：Life care：Diet care：Drugs care：Acupuncture ：Tui na：Common cold15Nursing interventionsNursing interventionsv Common cold due to asthenia of qi Principle of nursing ：益气解表Entirety nursing ：Life care：Diet
9、care：Drugs care：Acupuncture ：Tui na：Common cold16Nursing interventionsNursing interventionsv Common cold due to asthenia of yin Principle of nursing ：滋阴解表Entirety nursing ：Life care：Diet care：Drugs care：Acupuncture ：Tui na：Common cold17Nursing evaluationNursing evaluationIntroduction on healthIntrod
10、uction on healthv气候突变时要注意保暖，坐卧须防外邪。v保持室内空气流通，或选用食醋熏蒸法、消 毒香熏法等做空气消毒。v时行感冒流行期间，可用板蓝根冲剂预防给 药。v积极参加体育锻炼，以增强体质。 Common cold1819Cough咳嗽20Teaching objectives 熟悉咳嗽的病因病机 了解其诊断与鉴别诊断 熟悉外感咳嗽及内伤咳嗽的护治原则 掌握常见七种类型咳嗽的辨证施护 了解预防与调养。21What is cough ?22DefinitionCough 是指肺气上逆做声，咯吐痰涎 而言，为肺系疾病的主要证候之一。分 别言之，有声无痰为咳，有痰无声为嗽 ，一
11、般多痰、声并见，故以咳嗽并称。 23Evolution History 内经对咳嗽已有论述，素问咳论 明确指出“五脏六腑皆令人咳，非独 肺也。” 明代张景岳将咳嗽归纳为外感、内伤两 大类，为咳嗽的辨证奠定了基础。24What is its cause ?25Cause of Disease & Pathomechanism咳嗽的病因有外感与内伤两大类，外 感咳嗽为六淫外邪人侵肺系；内伤咳嗽为 脏腑功能失调，内邪干肺。病机关键在于 肺失宣肃，肺气上逆而作咳。v外感咳嗽( exogenous cough )v内伤咳嗽( cough due to internal injury ) 26Analys
12、es of pathological conditionsv exogenous coughv cough due to internal injury风寒袭肺 风热犯肺 风燥伤肺 痰湿犯肺 痰热郁肺 肝火犯肺肺阴亏耗 27vExogenous cough风寒袭肺( wind-cold attacking lung )咳嗽声重，气急，咽痒，咳痰稀 薄色白，常伴有鼻塞、流清涕、头痛 、肢体酸楚、恶寒发热、无汗等表证 ，苔薄白，脉浮或浮紧。 Analyses of pathological conditions28vExogenous cough风热犯肺( wind-heat attacking
13、lung )咳嗽频剧，气粗，或咳声嘶哑， 喉痒咽痛，咳痰不爽，痰粘稠或色黄 ，咳时汗出，常伴有鼻流黄涕、口渴 、身热等表证，舌苔薄黄，脉浮数。 Analyses of pathological conditions29vExogenous cough风燥伤肺( wind-dryness attacking lung )干咳频作，连声作呛，咽喉干痛 ，唇鼻干燥，无痰，或痰少而粘连成 丝，不易咳出，痰中带血丝，口干， 初起可伴有鼻塞、头痛、微寒身热等 表证，苔薄白或薄黄，质红，干而少 津，脉浮数。 Analyses of pathological conditions30vCough due to
14、 internal injury 痰湿犯肺 ( phlegm-dampness obstructing lung )咳嗽反复发作，咳声重浊，痰多， 因痰而咳，痰出咳平，痰粘腻或稠厚成 块，色白或黄灰色，胸闷，脘痞，呕恶 ，食少，体倦，大便时溏，苔白腻，脉 濡滑。 Analyses of pathological conditions31vCough due to internal injury痰热郁肺 ( stagnation of phlegm-dampness in lung )咳嗽气息粗促，或喉间有痰声，痰 多质粘或稠黄，咯吐不爽，或吐血痰， 胸胁胀满，咳时引痛，面赤，或有身热 ，口干欲
15、饮，舌红，苔薄黄腻，脉滑数 。 Analyses of pathological conditions32vCough due to internal injury肝火犯肺( liver-fire attacking lung )上气咳逆阵作，咳时面赤，咽 干，常感痰滞咽喉，咯之难出，量 少质粘，胸胁胀痛，咳时引痛，口 干苦，可随情绪波动而增减，舌苔 薄黄少津，脉弦数。 Analyses of pathological conditions33vCough due to internal injury肺阴亏耗( lack of lung-yin )干咳，咳声短促，痰少粘白，或痰中 夹血，或声音
16、逐渐嘶哑，口干咽燥，或午 后潮热颧红，手足心热，盗汗，神疲，舌 质红，少苔，脉细数。 Analyses of pathological conditions34诊断 Diagnosis鉴别诊断 Differential diagnosis&35诊断 Diagnosis 咳逆有声，或伴咽痒咯痰。 外感咳嗽，起病急，可伴有寒热等表证 ；内伤咳嗽，每因外感反复发作，病程 较长，咳而伴喘。 急性期，血白细胞总数和中性粒细胞增 高。 听诊可闻及两肺野呼吸音增粗，或伴散 在干湿性罗音。 肺部线摄片检查，正常或肺纹理增粗 。36Problems of patients Nursing goals37vExogenous cough wind-cold attacking lungPrinciple of nursing ：疏风散寒，宣 肺
