中医学教学课件：08 八纲辨证

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1、第七章 辨证Chapter 7 differentiation of syndromeSyndromeSyndrome is the pathological summarization of a is the pathological summarization of a disease in a certain stage. disease in a certain stage. It includes the location, cause, nature, and It includes the location, cause, nature, and relationship bet

2、ween healthy relationship between healthy qiqi and pathogenic and pathogenic factors. factors. It reflects the essence of pathological changes in It reflects the essence of pathological changes in the process of the disease at some stage, so it is the process of the disease at some stage, so it is m

3、ore comprehensive, more profound and more more comprehensive, more profound and more correctly reveal the nature of the diseasecorrectly reveal the nature of the disease than the than the manifestations.manifestations.证证（证候）（证候）: : 是机体在疾病发展过程中的某一阶段是机体在疾病发展过程中的某一阶段的病理概括。的病理概括。 它包括病变的部位、原因、性质及邪它包括病变的部

4、位、原因、性质及邪正关系，反映出疾病发展过程中某一阶正关系，反映出疾病发展过程中某一阶段的病理变化的本质，因此它比症状更段的病理变化的本质，因此它比症状更全面、更深刻、更正确地揭示了疾病的全面、更深刻、更正确地揭示了疾病的本质。本质。 The difference between Manifestation and Syndrome Manifestations reflect the outward sign of disease, Syndrome reflects the nature of the disease症和证的区别：症和证的区别：症状是疾病的外在表现，证是疾病的症状是疾病的外

5、在表现，证是疾病的本质反映。本质反映。Differentiation of syndrome ：means to analyzing and judging the data obtained from the four diagnostic methods so as to differentiation the nature of the disease and make clear the naming of the syndrome.辨辨证证：在在中中医医学学理理论论指指导导下下，通通过过四四诊诊检检查查所所得得的的临临床床资资料料，对对疾疾病病所所表表现现的的具具有有内内在在联联系系

6、的的各各种种症症状状进进行行分分析析、综合，从而确定病人属于何证的过程。综合，从而确定病人属于何证的过程。 辨证方法辨证方法八纲辨证八纲辨证用于确定疾病性质用于确定疾病性质 Syndrome differentiation with eight principles is used to determine the nature of disease病因辨证病因辨证可以区分致病原因可以区分致病原因 Etiology differentiation of syndrome is used to distinguish the cause of disease脏腑、经络辨证脏腑、经络辨证能够落实病

7、变部位能够落实病变部位 Syndrome differentiation of viscera and meridians are helpful for the location of disease气血津液辨证气血津液辨证则是分析人体生理功能与水则是分析人体生理功能与水液、营养物质等的异常变化液、营养物质等的异常变化 Syndrome differentiation of qi, blood and body fluid means to analysis of abnormal changes in human physiological function and liquid wate

8、r, nutrients, etc.n n六经辨证六经辨证、卫气营血辨证卫气营血辨证及及三焦辨证三焦辨证，则，则用于诊断外感热病用于诊断外感热病 nSyndrome differentiation of six-meridians and defensive qi, qi, nutrient qi and blood, and triple energizer are mainly used to differentiate syndromes in exogenous heat diseases第一节第一节 八纲辨证八纲辨证Syndrome differentiation with eigh

9、t principles A A comprehensive comprehensive analysis analysis to to group group the the disease disease into eight categories of syndrome :into eight categories of syndrome :yinyin and and yangyang, , internalinternal and and externalexternal aspects, aspects, cold cold and and heatheat as as well

10、well as as astheniaasthenia and and stheniasthenia, , based based on on the the information information obtained obtained by by four four diagnostic diagnostic methods methods and and according according to to the the depth depth of of disease disease location, location, the the nature nature and an

11、d exuberance exuberance of of the the pathogenic factors, the strength of the healthy pathogenic factors, the strength of the healthy qiqi . .Syndrome differentiation with eight principlesSyndrome differentiation with eight principles 八纲辨证：八纲辨证： 通通过过四四诊诊，掌掌握握辨辨证证的的资资料料之之后后，根根据据病病位位的的深深浅浅，病病邪邪的的性性质质及

12、及盛盛衰衰，人人体体正正气气的的强强弱弱等等，加加以以综综合合分分析析，归归纳纳为为阴阴、阳、表、里、寒、热、虚、实阳、表、里、寒、热、虚、实八类证候。八类证候。八八纲纲：阴阴、阳阳、表表、里里、寒寒、热热、虚虚、实实八个纲领八个纲领“表里表里表里表里”是是是是辨别辨别辨别辨别病证的内外深浅位置病证的内外深浅位置病证的内外深浅位置病证的内外深浅位置的纲领。的纲领。的纲领。的纲领。 E Extxternalernal or or internalinternal are two principles used to are two principles used to differentiate

13、 the location of diseases.differentiate the location of diseases.“寒热寒热寒热寒热”是辨别病是辨别病是辨别病是辨别病证证证证性质的纲领性质的纲领性质的纲领性质的纲领 Cold and heat are two principles used to Cold and heat are two principles used to differentiate the nature of diseases.differentiate the nature of diseases.“虚实虚实虚实虚实”是辨别是辨别是辨别是辨别病病病病证证

14、证证邪正盛衰的纲领：邪正盛衰的纲领：邪正盛衰的纲领：邪正盛衰的纲领： Asthenia and Asthenia and stheniasthenia are two principles to are two principles to differentiate the conditions of healthy differentiate the conditions of healthy qiqi and and pathogenic factors.pathogenic factors.八纲之间的相互联系：八纲之间的相互联系：InterlinkagesInterlinkages be

15、tween the eight principles between the eight principles “ “阴阳阴阳阴阳阴阳” ”两纲可概括其他六纲：两纲可概括其他六纲：两纲可概括其他六纲：两纲可概括其他六纲：表、热、实证属表、热、实证属表、热、实证属表、热、实证属“ “阳阳阳阳” ”，里、虚、寒证属里、虚、寒证属里、虚、寒证属里、虚、寒证属“ “阴阴阴阴” ”，所以所以所以所以“ “阴阳阴阳阴阳阴阳” ”又是八纲中的总纲。又是八纲中的总纲。又是八纲中的总纲。又是八纲中的总纲。 Yin Yin and and yang yang can can be be used used to

16、to general general other other six six principles: principles: external, external, heat heat and and stheniasthenia are are of of yang; yang; while while internal, internal, cold cold and and asthenia asthenia are are of of yin. yin. So So yin yin and and yang yang are are the the general general pr

17、inciples principles in in all all the the eight eight principles.principles. 一、表里一、表里Exernal and internal表里是相对的概念表里是相对的概念ExernalExernal and internal are two relative concepts and internal are two relative concepts 即病证的内外深浅位置都是相对而言的即病证的内外深浅位置都是相对而言的即病证的内外深浅位置都是相对而言的即病证的内外深浅位置都是相对而言的。 The depth and in

18、side or outside of the disease The depth and inside or outside of the disease location are relative location are relative. . . .表里病位的简单划分：表里病位的简单划分： Simple division of external and internal location of Simple division of external and internal location of diseasesdiseases外外外外( ( ( (皮毛、肌腠、经络皮毛、肌腠、经络皮毛

19、、肌腠、经络皮毛、肌腠、经络) ) ) )有病有病有病有病-表，病较轻浅表，病较轻浅表，病较轻浅表，病较轻浅 Disease in external (skin, hair, muscular interstices, Disease in external (skin, hair, muscular interstices, meridians and collaterals)-external, disease is meridians and collaterals)-external, disease is relatively light and shallow relatively

20、 light and shallow 内内内内( ( ( (脏腑、血脉、骨髓脏腑、血脉、骨髓脏腑、血脉、骨髓脏腑、血脉、骨髓) ) ) )有病有病有病有病-里，病较深重里，病较深重里，病较深重里，病较深重 Disease in Disease in internal(viscerainternal(viscera, blood, bone marrow) , blood, bone marrow) internal, disease is relatively deeper and seriousinternal, disease is relatively deeper and seriou

21、s 表里辨证可测病势表里辨证可测病势： External and internal differentiation of Syndrome External and internal differentiation of Syndrome enables doctors to understand the development of enables doctors to understand the development of pathological changes.pathological changes. 病邪由表入病邪由表入里里-病势进而加病势进而加重重； 病邪由里出病邪由里出表表

22、-病势退而减病势退而减轻轻。 In exogenous disease, pathogenic factors transmit In exogenous disease, pathogenic factors transmit In exogenous disease, pathogenic factors transmit In exogenous disease, pathogenic factors transmit from the exterior into the interior- disease from the exterior into the interior- dis

23、ease from the exterior into the interior- disease from the exterior into the interior- disease developed and aggravateddeveloped and aggravateddeveloped and aggravateddeveloped and aggravated Pathogenic factors transmit from the interior into Pathogenic factors transmit from the interior into Pathog

24、enic factors transmit from the interior into Pathogenic factors transmit from the interior into the exterior-disease retreated and alleviatedthe exterior-disease retreated and alleviatedthe exterior-disease retreated and alleviatedthe exterior-disease retreated and alleviated（一）表证（一）表证external syndr

25、ome表表证证：是是指指六六淫淫、疫疫疠疠等等外外邪邪经经皮皮毛毛、口口鼻鼻侵侵入入，正正气气开开始始抗抗邪邪阶阶段段所所表表现现的的轻轻浅浅证候。证候。External syndrome refers refers to to the the symptoms symptoms appearing appearing at at the the primary primary stage stage of of exogenous exogenous diseases diseases caused caused by by invasion invasion of of six six p

26、athogenic pathogenic factors factors into into the the body body through through skin, skin, mouth mouth and and nose.nose.特特点点：起起病病多多急急，病病程程较较短短，病病情情较较轻轻，病性一般属实病性一般属实 。CharacteristicsCharacteristics: : sudden sudden sudden sudden onset, onset, onset, onset, short short short short duration, duratio

27、n, duration, duration, lighter condition, is generally lighter condition, is generally lighter condition, is generally lighter condition, is generally stheniastheniastheniasthenia syndrome. syndrome. syndrome. syndrome.主主症症: : 发发热热恶恶寒寒或或恶恶风风、舌舌苔苔薄薄白白、脉脉浮浮为为主，兼见头身痛、鼻塞、咳嗽等症状。主，兼见头身痛、鼻塞、咳嗽等症状。 Main sym

28、ptoms: fever, aversion to cold or wind, thin and white fur and floating pulse, accompanied by head and body pain, stuffy nose and cough.（二）里证（二）里证Internal syndrome里里证证的的概概念念：是是泛泛指指病病位位在在内内，脏脏腑腑、气气血、骨髓等受病所反映的证候。血、骨髓等受病所反映的证候。Internal Internal syndrome syndrome refers refers to to the the symptoms sym

29、ptoms in in disorders disorders with with deep deep location, location, such such as as viscera, viscera, qi and blood, and bone marrow.形成里证的途径：形成里证的途径： Conditions Conditions contributed contributed to to the the formation formation of of internal syndromeinternal syndrome表证不解，病邪传里，形成里证：表证不解，病邪传里，形成

30、里证： further further development development of of exogenous exogenous disease disease due due to to interior interior transmission transmission of of pathogenic pathogenic factor from the exterior.factor from the exterior.外邪外邪“直中直中”脏腑，成为里证；脏腑，成为里证； Invasion Invasion of of the the viscera viscera by

31、by the the pathogenic pathogenic factors.factors.情情志志内内伤伤、饮饮食食劳劳倦倦等等，或或脏脏腑腑气气血血失失调调，气血津精等受病所表现的种种证候。气血津精等受病所表现的种种证候。 Dysfunctions of the viscera and imbalance Dysfunctions of the viscera and imbalance between between qiqi and blood due to impairment and blood due to impairment of the viscera caused

32、by emotional upsets, of the viscera caused by emotional upsets, improper diet and improper daily lifeimproper diet and improper daily life特特点点：无无恶恶寒寒发发热热并并见见，并并以以脏脏腑腑症症状状为为主主要要表表现现，其其起起病病可可急急可可缓缓，一一般般病病情情较较重、病程较长。重、病程较长。CharacteristicsCharacteristics: : No No occurrence occurrence of of fever fever

33、and and aversion aversion to to coldcold, , , , viscera viscera viscera viscera dysfunction dysfunction dysfunction dysfunction as as as as the the the the basic basic basic basic clinical clinical clinical clinical manifestation, manifestation, manifestation, manifestation, sudden sudden sudden sud

34、den or or or or slow slow slow slow onset, onset, onset, onset, generally generally generally generally with with with with serious serious serious serious condition condition condition condition and and and and long long long long duration.duration.duration.duration.（三）表证和里证的关系（三）表证和里证的关系Relationsh

35、ip between External and internal syndrome表里同病：表里同病：表证和里证同时在一个病人身上出表证和里证同时在一个病人身上出表证和里证同时在一个病人身上出表证和里证同时在一个病人身上出现，称为表里同病。现，称为表里同病。现，称为表里同病。现，称为表里同病。 Simultaneous Simultaneous external and internal disorderexternal and internal disorder: External and internal syndrome appeared on the External and inte

36、rnal syndrome appeared on the same patient simultaneouslysame patient simultaneously表里转化：表里转化：表证和里证还可以相互转化，即所表证和里证还可以相互转化，即所表证和里证还可以相互转化，即所表证和里证还可以相互转化，即所谓谓谓谓“ “由表入里由表入里由表入里由表入里” ”和和和和“ “由里出表由里出表由里出表由里出表” ”。 Transformation between External and internal Transformation between External and internal sy

37、ndrome:syndrome: pathogenic factors transmit from the pathogenic factors transmit from the exterior into the interior, or from the interiorexterior into the interior, or from the interior into the into the exteriorexterior表证和里证的鉴别要点表证和里证的鉴别要点: :发热恶寒同时并见的属表证；但发热不恶寒或但寒发热恶寒同时并见的属表证；但发热不恶寒或但寒发热恶寒同时并见的属表

38、证；但发热不恶寒或但寒发热恶寒同时并见的属表证；但发热不恶寒或但寒不热的属里证。表证舌苔少变化，里证舌苔多有变不热的属里证。表证舌苔少变化，里证舌苔多有变不热的属里证。表证舌苔少变化，里证舌苔多有变不热的属里证。表证舌苔少变化，里证舌苔多有变化，脉浮主表证，脉沉主里证。化，脉浮主表证，脉沉主里证。化，脉浮主表证，脉沉主里证。化，脉浮主表证，脉沉主里证。 Differential points forDifferential points for External and internal External and internal syndrome: syndrome: In exogenou

39、s disease, it belongs to In exogenous disease, it belongs to external syndrome if fever and aversion to cold external syndrome if fever and aversion to cold appear simultaneously, whereas, it belongs to appear simultaneously, whereas, it belongs to internal syndrome if they appear separately; extern

40、al internal syndrome if they appear separately; external syndrome comes with less changeable fur, internal syndrome comes with less changeable fur, internal syndrome comes with changeable fur; external syndrome comes with changeable fur; external syndrome comes with floating pulse, internal syndrome

41、 comes with floating pulse, internal syndrome comes with deep pulse.syndrome comes with deep pulse.表里证鉴别要点表里证鉴别要点Differential points forDifferential points for External External and internal syndromeand internal syndrome 病程病程病程病程 寒热特点寒热特点寒热特点寒热特点 常见症状常见症状常见症状常见症状 舌象舌象舌象舌象 脉象脉象脉象脉象 表证表证表证表证 较短较短较短较短

42、恶寒发热恶寒发热恶寒发热恶寒发热 头身痛等头身痛等头身痛等头身痛等 不明显不明显不明显不明显 脉浮脉浮脉浮脉浮 里证里证里证里证 较长较长较长较长 但寒不热但寒不热但寒不热但寒不热 内脏症状内脏症状内脏症状内脏症状 多有变化多有变化多有变化多有变化 脉沉脉沉脉沉脉沉 但热不寒但热不寒但热不寒但热不寒Differential points for External and internal syndrome duratidurationon featuresfeaturescommon common symptomsymptomfurfurpulsepulseexternal external

43、syndromesyndromeshortshortfever and aversion to fever and aversion to coldcoldhead and body head and body painpainnot not obviousobviousfloatingfloatinginternal internal syndromesyndromelonglongfever without aversion fever without aversion to coldto coldor aversion to cold or aversion to cold withou

44、t feverwithout feverviscera viscera dysfunctiondysfunctionchangeabchangeable ledeepdeep 张张某某，男男，5050岁岁。时时值值冬冬日日，一一周周前前，晚晚间间外外出出沐沐浴浴，出出浴浴室室后后即即感感风风寒寒透透骨骨，恶恶寒寒怕怕冷冷，当当夜夜即即发发热热，鼻鼻塞塞声声重重，周周身身酸酸楚楚。次次日日就就诊诊，可可见见舌舌苔苔薄薄白白，脉脉浮浮紧紧稍稍数数。病病人人不不以以为为意意，仅仅服服西西药药止止痛痛消消炎炎，虽虽汗汗出出而而热热未未退退。第第三三日日发发生生高高热热，汗汗出出，口口干干，已已二二日日

45、不不大大便便，胸胸闷闷，不不欲欲食食，查查舌苔黄厚舌苔黄厚、舌质红，脉洪数有力舌质红，脉洪数有力。练习病案练习病案讨论讨论提示提示：按病程,依据辨证要点进行表里辨证。本病例可分为两个阶段：本病例可分为两个阶段：第第一一阶阶段段：疾疾病病初初起起，因因于于外外感感寒寒邪邪，突突见见恶恶寒寒、发发热热、身身痛痛、苔苔薄薄白白、脉脉浮浮等等证证，其其他他症症状状不不明明显显。根根据据表表证证的的辨辨证证要要点点，此属表证。此属表证。第第二二阶阶段段：服服西西药药后后，虽虽汗汗而而邪邪未未解解，入入里里化化热热，见见但但热热不不寒寒、胸胸闷闷不不食食、大大便便秘秘结结等等内内脏脏症症状状，舌舌红红苔苔

46、黄黄而而厚厚，舌舌象象变变化化明明显显，脉不浮脉不浮而洪数有力，当属里证。而洪数有力，当属里证。病案分析示范病案分析示范二二、虚实、虚实asthenia and asthenia and stheniastheniaAsthenia and Asthenia and stheniasthenia are two principles to are two principles to differentiate the conditions of healthy differentiate the conditions of healthy qiqi and pathogenic factors

47、and pathogenic factors：Asthenia refers to insufficiency of healthy Asthenia refers to insufficiency of healthy qiqi, while , while stheniasthenia refers to exuberance of refers to exuberance of pathogenic pathogenic fatorsfators. . 虚实是辨别邪正盛衰的纲领：虚实是辨别邪正盛衰的纲领：实指邪气盛实，虚指正气不足实指邪气盛实，虚指正气不足。即即所所谓谓“邪邪气气盛盛则则

48、实实，精精气气夺夺则则虚虚。” ( (素问素问通评虚实论通评虚实论) )。证证候候之之虚虚实实是是依依据据双双方方的的盛盛衰衰而而定定的的，即即正正盛盛邪邪实实为为实实证证，正正虚虚邪邪衰衰为为虚虚证证，正正虚虚邪实为邪实为虚实夹杂证虚实夹杂证。Asthenia syndromeConcept: Concept: Concept: Concept: symptoms symptoms symptoms symptoms marked marked marked marked by by by by asthenia asthenia asthenia asthenia of of of of

49、healthy healthy healthy healthy qiqiqiqi and and and and non-predomination non-predomination non-predomination non-predomination of of of of pathogenic pathogenic pathogenic pathogenic factors.factors.factors.factors.featurefeaturefeaturefeature： asthenia asthenia asthenia asthenia of of of of healt

50、hy healthy healthy healthy qiqiqiqi and and and and non-non-non-non-predomination predomination predomination predomination of of of of pathogenic pathogenic pathogenic pathogenic factors, factors, factors, factors, characterized characterized characterized characterized by by by by deficiency, defi

51、ciency, deficiency, deficiency, recession, recession, recession, recession, slack(deficiencyslack(deficiencyslack(deficiencyslack(deficiency of of of of healthy healthy healthy healthy qiqiqiqi, , , , functional functional functional functional decline, decline, decline, decline, clinical manifestat

52、ion of slack) clinical manifestation of slack) clinical manifestation of slack) clinical manifestation of slack) Corresponding Corresponding Corresponding Corresponding to to to to different different different different degree degree degree degree of of of of asthenia, asthenia, asthenia, asthenia,

53、 clinical clinical clinical clinical manifestations manifestations manifestations manifestations appear appear appear appear as as as as deficiency, deficiency, deficiency, deficiency, scarcity, scarcity, scarcity, scarcity, weakness, weakness, weakness, weakness, decline, decline, decline, decline,

54、 depletion, depletion, depletion, depletion, collapse, collapse, collapse, collapse, but no obvious boundaries between them.but no obvious boundaries between them.but no obvious boundaries between them.but no obvious boundaries between them.虚虚 证证概概念念：虚虚证证是是对对人人体体正正气气虚虚弱弱、不不足足为为主主所产生的各种虚弱证候的概括。所产生的各种

55、虚弱证候的概括。特特点点：正正虚虚而而邪邪不不显显，以以不不足足、衰衰退退、松松弛弛等等为为特特点点（指指正正气气不不足足、功功能能衰衰退退、临临床床表表现现松松弛弛）。虚虚损损程程度度有有所所不不同同，临临床床有有不不足足、亏亏虚虚、虚虚弱弱、虚虚衰衰、亡亡、脱脱之之别别，但其间并没有明显的界线。但其间并没有明显的界线。Asthenia syndromepathogenesis analysispathogenesis analysispathogenesis analysispathogenesis analysis：Congenital Congenital Congenital Con

56、genital deficiency deficiency deficiency deficiency or or or or postnatal postnatal postnatal postnatal disorder disorder disorder disorder or or or or consumption consumption consumption consumption of of of of diseasediseasediseasedisease（ improper improper improper improper diet, diet, diet, diet

57、, impairment impairment impairment impairment of of of of visceral visceral visceral visceral qiqiqiqi and and and and blood, blood, blood, blood, overstrain, overstrain, overstrain, overstrain, excessive excessive excessive excessive coitus, coitus, coitus, coitus, prolonged prolonged prolonged pro

58、longed disease disease disease disease and and and and mistreatment; mistreatment; mistreatment; mistreatment; sweat, sweat, sweat, sweat, vomit, vomit, vomit, vomit, and and and and blood blood blood blood loss, loss, loss, loss, etc.) etc.) etc.) etc.) Syndrome Syndrome Syndrome Syndrome caused ca

59、used caused caused by by by by deficiency deficiency deficiency deficiency of of of of Yang Yang Yang Yang qiqiqiqi, , , , Yin Yin Yin Yin fluid, fluid, fluid, fluid, essence, essence, essence, essence, mostly mostly mostly mostly involving involving involving involving parts parts parts parts such

60、such such such as as as as Viscera, Viscera, Viscera, Viscera, bone bone bone bone marrow, marrow, marrow, marrow, mostly mostly mostly mostly onononon infirm infirm infirm infirm patients patients patients patients with with with with prolonged prolonged prolonged prolonged chronic chronic chronic

61、chronic disease disease disease disease and and and and excessive consumptionexcessive consumptionexcessive consumptionexcessive consumption虚 证病因病机：病因病机：先先天天禀禀赋赋不不足足，后后天天失失调调或或病病耗耗（饮饮食食失失调调、生生化化不不足足；思思虑虑劳劳倦倦太太过过；房房室室不不节节；久久病病失失治治、误误治治；汗汗、吐吐、下下、失失血血、失失精精等等）阳阳气气、阴阴液液以以及及精精、血血、津津液液、营营、卫卫等等亏亏虚虚不不足足所所致致证

62、证候候，多多涉涉及及脏脏腑腑、骨髓等部位。骨髓等部位。临床多为久病、势缓、耗损过多及体弱者。临床多为久病、势缓、耗损过多及体弱者。clinical manifestations ： The clinical manifestations of asthenia syndrome The clinical manifestations of asthenia syndrome The clinical manifestations of asthenia syndrome The clinical manifestations of asthenia syndrome vary with dif

63、ferent types.vary with different types.vary with different types.vary with different types. The common symptoms: The common symptoms: The common symptoms: The common symptoms: pale or sallow pale or sallow pale or sallow pale or sallow complexioncomplexioncomplexioncomplexion, , , , listlessnesslist

64、lessnesslistlessnesslistlessness, , , , fatiguefatiguefatiguefatigue, shortness of , shortness of , shortness of , shortness of breath, palpitation, aversion to cold and cold breath, palpitation, aversion to cold and cold breath, palpitation, aversion to cold and cold breath, palpitation, aversion t

65、o cold and cold limbs, limbs, limbs, limbs, spontaneous sweatingspontaneous sweatingspontaneous sweatingspontaneous sweating, loose stool, urinary , loose stool, urinary , loose stool, urinary , loose stool, urinary incontinence, incontinence, incontinence, incontinence, fat pale tongue, fat pale to

66、ngue, fat pale tongue, fat pale tongue, weak deep slow weak deep slow weak deep slow weak deep slow pulsepulsepulsepulse. Or . Or . Or . Or feverish sensation over the five centersfeverish sensation over the five centersfeverish sensation over the five centersfeverish sensation over the five centers

67、, , , , emaciation, flushed cheeksemaciation, flushed cheeksemaciation, flushed cheeksemaciation, flushed cheeks, dry mouth and throat, , dry mouth and throat, , dry mouth and throat, , dry mouth and throat, night sweatingnight sweatingnight sweatingnight sweating, tidal fever, , tidal fever, , tida

68、l fever, , tidal fever, reddish tongue with reddish tongue with reddish tongue with reddish tongue with little fur, little fur, little fur, little fur, weak fast thin pulseweak fast thin pulseweak fast thin pulseweak fast thin pulse. . . .临床表现：临床表现： 各种虚证的表现极不一致很难全面概括。各种虚证的表现极不一致很难全面概括。常常见见的的有有；面面色色淡

69、淡白白或或萎萎黄黄 ，精精神神萎萎靡靡，神神疲疲乏乏力力，心心悸悸气气短短，形形寒寒肢肢冷冷，自自汗汗，大大便便滑滑脱脱，小小便便失失禁禁，舌舌淡淡胖胖，脉脉虚虚沉沉迟迟，或或为为五五心心烦烦热热，消消瘦瘦颧颧红红，口口咽咽干干燥燥，盗盗汗汗潮潮热热，舌舌红红少少苔苔，脉脉虚细数虚细数。StheniaSthenia syndrome syndromeconcept: concept: StheniaSthenia syndromesyndrome is is the the generalization generalization of of Various Various clinical

70、 clinical syndrome syndrome caused caused by by invasion invasion of of pathogenic pathogenic factors factors or or due due to to dysfunction dysfunction of of yin, yin, yang, yang, qiqi, , blood, blood, marked marked by by yang, yang, heat, heat, stagnation, stagnation, obstructionobstruction, , or

71、 or produced produced by by accumulation accumulation of of pathological productpathological product. .Features: predominant pathogenic factors and non-Features: predominant pathogenic factors and non-asthenicasthenic healthy healthy qiqi, conflicting of the two leads to , conflicting of the two lea

72、ds to accumulation of pathological products.accumulation of pathological products.实证实证概概念念: 实实证证是是对对人人体体感感受受外外邪邪或或疾疾病病过过程程中中阴阴阳阳气气血血失失调调而而以以阳阳、热热、滞滞、闭闭等等为为主主，或或体体内内病病理理产产物物蓄蓄积积所所形形成成的的各各种种临临床床证证候的病理概括。候的病理概括。特特点点：邪邪盛盛而而正正气气不不虚虚，正正邪邪剧剧争争，以以有有余余、强强烈烈、停停聚聚为为特特点点（邪邪气气有有余余，表表现现强烈，病理产物停聚）。强烈，病理产物停聚）。Sthen

73、iaSthenia syndrome syndromePathogenesis analysisPathogenesis analysis：n nInvasion of exogenous pathogenic factorsInvasion of exogenous pathogenic factors into the into the body and confliction with healthy body and confliction with healthy qiqi 寒热显著，寒热显著，寒热显著，寒热显著，疼痛剧烈，呕吐咳喘明显，二便不通，脉实等。疼痛剧烈，呕吐咳喘明显，二便

74、不通，脉实等。疼痛剧烈，呕吐咳喘明显，二便不通，脉实等。疼痛剧烈，呕吐咳喘明显，二便不通，脉实等。（病势亢奋，急迫。）（病势亢奋，急迫。）（病势亢奋，急迫。）（病势亢奋，急迫。）n nDysfunction of the viscera, leading to the Dysfunction of the viscera, leading to the accumulation of pathological productsaccumulation of pathological products痰、饮、痰、饮、痰、饮、痰、饮、水、湿、瘀血、宿食等。水、湿、瘀血、宿食等。水、湿、瘀血、宿食等

75、。水、湿、瘀血、宿食等。n nMostly Mostly onon strong strong patients patients with with emergingdiseases emergingdiseases or or sudden severe diseases.sudden severe diseases.实实 证证病因病机：病因病机：六淫六淫( (疫疬、虫毒疫疬、虫毒) )等邪气侵袭，正气抗邪等邪气侵袭，正气抗邪寒热显著，疼痛剧烈，呕吐咳喘明显，二寒热显著，疼痛剧烈，呕吐咳喘明显，二便不通，脉实等。（病势亢奋，急迫。）便不通，脉实等。（病势亢奋，急迫。）脏腑功能失调，气化障碍

76、，气机阻滞脏腑功能失调，气化障碍，气机阻滞痰、痰、饮、水、湿、瘀血、宿食等有形病理产物壅饮、水、湿、瘀血、宿食等有形病理产物壅聚停积于体内。聚停积于体内。临床多为新病、暴病、剧烈、体壮者。临床多为新病、暴病、剧烈、体壮者。Clinical manifestations: The clinical manifestations vary with different The clinical manifestations vary with different types of types of stheniasthenia syndrome due to the difference of s

77、yndrome due to the difference of pathogenic factors and the invading and pathogenic factors and the invading and accumulating regions.accumulating regions. The common symptoms The common symptoms include fever, include fever, unpalpableunpalpable pain of abdomen, chest pain of abdomen, chest oppress

78、ion, restlessness, even coma with delirium, oppression, restlessness, even coma with delirium, hoarse breathhoarse breath, exuberance of phlegm and drool, , exuberance of phlegm and drool, retention of dry fecesretention of dry feces, or dysentery or , or dysentery or tenesmustenesmus, , inhibited u

79、rination, or painful inhibited urination, or painful stringuriastringuria, , tough tough tonguetongue, , thick or greasy fur thick or greasy fur and and sthenicsthenic pulse pulse. .临床表现：临床表现： 由由于于致致病病邪邪气气的的性性质质及及所所在在部部位位的的不不同同，实实证证的的表表现现亦亦极极不不一一致致，而而常常见见的的主主要要有有：发发热热，腹腹胀胀痛痛拒拒按按，胸胸闷闷烦烦躁躁，甚甚至至神神昏昏谵谵语

80、语，呼呼吸吸气气粗粗，痰痰涎涎壅壅盛盛，大大便便秘秘结结，或或下下利利、里里急急后后重重，小小便便不不利利，或或淋淋沥沥涩涩痛，痛，舌质苍老舌质苍老，舌苔，舌苔厚腻厚腻，脉实脉实有力。有力。Differential points for asthenia and sthenia syndrome CourseCoursehabitushabitus vitalityvitalitysoundsoundurineandurineandstoolstooltonguetonguepulsepulseStheniaSthenia syndromesyndromeemergingemergingdis

81、easesdiseasesstrongstrong hectichectichoarsehoarsebreathbreathdryfeces,dryfeces,scantyandscantyandbrownishbrownishurineurineToughtongueToughtongueandthickfurandthickfurstronstrong gAstheniaAstheniasyndromesyndromeprolongedprolongedchronicchronicdiseasediseaseweakweakaccidiaccidie eFaintFaintlowlowvo

82、icevoiceloosestool,loosestool,clearurineclearurinetendertendertongue,thintongue,thinorlittlefurorlittlefurweakweak虚证和实证的鉴别 病程病程病程病程 体质体质体质体质 精神精神精神精神 声息声息声息声息 二便二便二便二便 舌象舌象舌象舌象 脉象脉象脉象脉象实证实证实证实证 新病新病新病新病 强壮强壮强壮强壮 兴奋兴奋兴奋兴奋 气高息促气高息促气高息促气高息促 大便秘结大便秘结大便秘结大便秘结 质老苔厚质老苔厚质老苔厚质老苔厚 有力有力有力有力 小便短赤小便短赤小便短赤小便短赤虚证虚

83、证虚证虚证 久病久病久病久病 虚弱虚弱虚弱虚弱 倦怠倦怠倦怠倦怠 声低息微声低息微声低息微声低息微 大便稀溏大便稀溏大便稀溏大便稀溏 质嫩苔少质嫩苔少质嫩苔少质嫩苔少 无力无力无力无力 小便清长小便清长小便清长小便清长练习病案练习病案 杨杨某某，女女，1818岁岁。昨昨日日午午饭饭后后突突然然恶恶心心不不适适，旋旋即即呕呕吐吐，胃胃脘脘疼疼痛痛胀胀满满颇颇剧剧，嗳嗳气气，稍稍进进饮饮食食则则疼疼痛痛更更甚甚，大大便便微微溏溏，小小便便黄黄，身身倦倦，夜夜寐寐不不安安，月月经经正正常常，舌舌苔苔厚厚腻腻，脉脉沉沉弦弦。（选选自自施施今今墨墨临临床床经经验验）病案讨论病案讨论提示提示：根据虚实证鉴

84、别要点进行辨证分析。病案分析示范病案分析示范 患患者者突突然然起起病病，以以饮饮食食积积滞滞胃胃脘脘，胃胃气气失失和和，胃胃气气上上逆逆为为主主要要病病机机变变化化；见见疼疼痛痛胀胀满满剧剧烈烈，进进食食更更甚甚，苔苔厚厚腻腻，脉脉沉沉弦弦等等邪邪气气有有余余，反反映映强强烈烈，饮饮食食停聚停聚等临床特征，等临床特征，故为实证。故为实证。三三、 寒热寒热syndrome differentiation of cold and syndrome differentiation of cold and heatheat寒热是辨别病寒热是辨别病证证性质的纲领性质的纲领 Cold and heat a

85、re two principles used to Cold and heat are two principles used to differentiate the nature of diseases.differentiate the nature of diseases.寒证：寒证：是感受寒邪，或阳虚阴盛，表现为机体机是感受寒邪，或阳虚阴盛，表现为机体机是感受寒邪，或阳虚阴盛，表现为机体机是感受寒邪，或阳虚阴盛，表现为机体机能活动抑制或衰减的证候。能活动抑制或衰减的证候。能活动抑制或衰减的证候。能活动抑制或衰减的证候。 Cold syndrome Cold syndrome refe

86、rs to symptoms caused by refers to symptoms caused by refers to symptoms caused by refers to symptoms caused by yang asthenia or yin predomination due to yang asthenia or yin predomination due to yang asthenia or yin predomination due to yang asthenia or yin predomination due to invasion of cold pat

87、hogenic factors or various invasion of cold pathogenic factors or various invasion of cold pathogenic factors or various invasion of cold pathogenic factors or various other factors.other factors.other factors.other factors.热证：热证：热证：热证：是感受热邪，或阴虚阳盛，人体的机能活是感受热邪，或阴虚阳盛，人体的机能活是感受热邪，或阴虚阳盛，人体的机能活是感受热邪，或阴虚阳

88、盛，人体的机能活动亢进所表现的证候。动亢进所表现的证候。动亢进所表现的证候。动亢进所表现的证候。 Heat syndrome Heat syndrome Heat syndrome Heat syndrome refers to symptoms due to attack refers to symptoms due to attack refers to symptoms due to attack refers to symptoms due to attack by yang heat or various other factors or yin by yang heat or va

89、rious other factors or yin by yang heat or various other factors or yin by yang heat or various other factors or yin asthenia.asthenia.asthenia.asthenia.寒寒证证: :乃乃感感受受阴阴寒寒邪邪气气或或阳阳衰衰阴阴盛盛所所致致，有有虚实表里的不同虚实表里的不同。Symptoms Symptoms Symptoms Symptoms caused caused caused caused by by by by yang yang yang yan

90、g asthenia asthenia asthenia asthenia or or or or yin yin yin yin predomination predomination predomination predomination due due due due to to to to invasion invasion invasion invasion of of of of cold cold cold cold pathogenic pathogenic pathogenic pathogenic factors, factors, factors, factors, in

91、cluding including including including external external external external cold cold cold cold syndrome, syndrome, syndrome, syndrome, internal internal internal internal cold cold cold cold syndrome, syndrome, syndrome, syndrome, asthenicasthenicasthenicasthenic cold cold cold cold syndrome syndrome

92、 syndrome syndrome and and and and sthenicsthenicsthenicsthenic cold syndrome. cold syndrome. cold syndrome. cold syndrome.（一）寒（一）寒 证证Cold syndromeCold syndrome实实寒寒证证：见见于于感感受受阴阴寒寒邪邪气气( (如如淋淋雨雨, ,衣衣单单, ,露露宿等受寒或过服饮食生冷寒宿等受寒或过服饮食生冷寒 凉凉), ),病急体壮者。病急体壮者。 SthenicSthenic cold cold syndrome syndrome appears

93、appears appears appears on on on on strong strong strong strong person person person person with with with with sudden sudden sudden sudden onset onset onset onset caused caused caused caused by by by by invasion invasion invasion invasion of of of of cold cold cold cold pathogenic pathogenic pathog

94、enic pathogenic factors(Suchfactors(Suchfactors(Suchfactors(Such as as as as rain, rain, rain, rain, thin thin thin thin clothes, clothes, clothes, clothes, bivouac, excessive cold diet)bivouac, excessive cold diet)bivouac, excessive cold diet)bivouac, excessive cold diet)虚虚寒寒证证：见见于于内内伤伤久久病病, ,阳阳气气耗

95、耗伤伤而而阴阴寒寒偏偏盛者。盛者。 AsthenicAsthenic cold cold syndrome syndrome appears appears appears appears on on on on patients patients patients patients with with with with deficiency deficiency deficiency deficiency of of of of yang yang yang yang qiqiqiqi and and and and exuberance exuberance exuberance exu

96、berance of of of of yin yin yin yin cold caused by chronic disease.cold caused by chronic disease.cold caused by chronic disease.cold caused by chronic disease.表寒证：寒邪侵袭肌表所致表寒证：寒邪侵袭肌表所致. .属于实寒。属于实寒。External External cold cold syndrome syndrome refers refers refers refers to to to to the the the the s

97、ymptoms symptoms symptoms symptoms of of of of exogenous exogenous exogenous exogenous disease disease disease disease at at at at the the the the primary primary primary primary stage stage stage stage caused caused caused caused by by by by pathogenic pathogenic pathogenic pathogenic wind wind win

98、d wind and and and and cold cold cold cold attacking the surface of he body.attacking the surface of he body.attacking the surface of he body.attacking the surface of he body. 里里寒寒证证：寒寒邪邪客客于于脏脏腑腑者者属属于于实实寒寒, ,阳阳气气亏亏虚所致者属虚寒。虚所致者属虚寒。Internal Internal cold cold syndrome: syndrome: symptoms symptoms symp

99、toms symptoms caused caused caused caused by by by by invasion invasion invasion invasion of of of of pathogenic pathogenic pathogenic pathogenic yin yin yin yin cold cold cold cold to to to to viscera viscera viscera viscera is is is is sthenicsthenicsthenicsthenic cold cold cold cold syndrome; syn

100、drome; syndrome; syndrome; symptoms symptoms symptoms symptoms caused caused caused caused by by by by deficiency of yang deficiency of yang deficiency of yang deficiency of yang qiqiqiqi is is is is asthenicasthenicasthenicasthenic cold syndrome cold syndrome cold syndrome cold syndromeAttackAttack

101、 byby pathogenicpathogenic coldcoldandand stagnationstagnation ofof yangqiyangqi orinsufficiencyoforinsufficiencyofyangqiyangqitowarmthebodytowarmthebodyaversionaversion toto coldcold oror aversionaversion toto coldcold withwithpreferencepreferenceforforwarmth,warmth,coldcoldlimbs,limbs,palepalecomp

102、lextioncomplextion, , lightlight coloredcolored tongue,tongue, slowslow oror tensetensepulsepulseNon-consumptionNon-consumption ofof bodybody fluidfluid accountaccount forfor moistmoistmouthmouth withoutwithout thirst;thirst; failurefailure ofof asthenicasthenic yangyang totowarmwarm andand transfor

103、mtransform fluidfluid leadsleads toto clearclearsputum,sputum,snivel,snivel, salivasaliva andand urine;urine; looseloose stool,stool, whitishwhitishslipperyandmoistfurslipperyandmoistfurClinical manifestations and pathogenesis Clinical manifestations and pathogenesis analysisanalysiscold cold cold c

104、old syndrome syndrome syndrome syndrome （ yang yang yang yang asthenia asthenia asthenia asthenia or yin or yin or yin or yin predominpredominpredominpredomination ation ation ation ）寒遏阳气，或阳虚阴盛，温煦失职寒遏阳气，或阳虚阴盛，温煦失职 恶恶寒寒或或畏畏寒寒，冷冷痛痛喜喜暖暖，肢肢冷冷，面面 白，舌淡，脉紧或迟。白，舌淡，脉紧或迟。寒寒水水不不化化（ 寒寒不不消消水水 ），津津液液未未伤伤口口淡淡不不渴渴，

105、痰痰、涎涎、涕涕等等清清稀稀，小小便便清清长长，大大便便稀稀溏溏 （排排出出物物澄澄澈澈清冷），苔白而润。清冷），苔白而润。临床表现及病因病机分析：临床表现及病因病机分析：寒证寒证寒证寒证（感寒或（感寒或（感寒或（感寒或 阳虚）阳虚）阳虚）阳虚）热证乃感受阳热邪气或阴虚阳亢所致热证乃感受阳热邪气或阴虚阳亢所致, ,亦有亦有虚实表里的不同：虚实表里的不同： heat syndrome refers to symptoms due to heat syndrome refers to symptoms due to attack by yang heat or various other fact

106、ors attack by yang heat or various other factors of yin asthenia and yang of yin asthenia and yang stheniasthenia. It may be . It may be further divided into external, internal, further divided into external, internal, asthenicasthenic and and sthenicsthenic heat syndrome. heat syndrome. （二）热（二）热 证证

107、heat heat syndromesyndrome实热证实热证：见于感受火热阳邪或过服辛辣温：见于感受火热阳邪或过服辛辣温热热, ,病急体壮者。病急体壮者。SthenicSthenic heat syndrome: heat syndrome: appears on strong appears on strong appears on strong appears on strong patient with sudden onset caused by invasion of patient with sudden onset caused by invasion of patient

108、with sudden onset caused by invasion of patient with sudden onset caused by invasion of pathogenic yang heat or excessive intake of hot pathogenic yang heat or excessive intake of hot pathogenic yang heat or excessive intake of hot pathogenic yang heat or excessive intake of hot spicyspicyspicyspicy

109、虚热证虚热证：见于内伤久病：见于内伤久病, ,阴液亏损而阳热阴液亏损而阳热偏盛者。偏盛者。Asthenia heat syndromeAsthenia heat syndromeAsthenia heat syndromeAsthenia heat syndrome: appears on patient : appears on patient : appears on patient : appears on patient with consumption of body fluid and with consumption of body fluid and with consumpt

110、ion of body fluid and with consumption of body fluid and exuberance of yang heat caused by prolonged exuberance of yang heat caused by prolonged exuberance of yang heat caused by prolonged exuberance of yang heat caused by prolonged internal impairment.internal impairment.internal impairment.interna

111、l impairment.表热证表热证：风热邪气侵袭体表所致：风热邪气侵袭体表所致, ,属实热。属实热。External heat syndromeExternal heat syndrome: : symptoms of symptoms of symptoms of symptoms of exogenous febrile disease at the primary stage exogenous febrile disease at the primary stage exogenous febrile disease at the primary stage exogenous f

112、ebrile disease at the primary stage caused by wind and heat attacking the surface caused by wind and heat attacking the surface caused by wind and heat attacking the surface caused by wind and heat attacking the surface of the body, belongs to of the body, belongs to of the body, belongs to of the b

113、ody, belongs to sthenicsthenicsthenicsthenic heat heat heat heat syndromesyndromesyndromesyndrome里热证里热证：热邪内犯脏腑者属实热：热邪内犯脏腑者属实热, ,阴液亏阴液亏虚所致者属虚热。虚所致者属虚热。Internal heat syndromeInternal heat syndrome: : sthenicsthenicsthenicsthenic heat caused heat caused heat caused heat caused by pathogenic yang heat a

114、ttacking viscera ; by pathogenic yang heat attacking viscera ; by pathogenic yang heat attacking viscera ; by pathogenic yang heat attacking viscera ; asthenia heat caused by consumption of body asthenia heat caused by consumption of body asthenia heat caused by consumption of body asthenia heat cau

115、sed by consumption of body fluid.fluid.fluid.fluid.Predomination Predomination Predomination Predomination of of of of yang yang yang yang heat heat heat heat fever fever and and aversion aversion aversion aversion to to to to heat heat heat heat with with with with preference preference preference

116、preference for for for for cold, cold, cold, cold, flushed flushed flushed flushed complextioncomplextioncomplextioncomplextion, , , , restlessness restlessness restlessness restlessness and and and and reddish reddish reddish reddish tongue tongue tongue tongue with with with with yellow yellow yel

117、low yellow fur, fur, fur, fur, fast fast fast fast pulsepulsepulsepulseconsumption consumption consumption consumption of of of of body body body body fluid fluid fluid fluid by by by by exuberant exuberant exuberant exuberant heat heat heat heat or or or or deficiency deficiency deficiency deficien

118、cy of of of of yin yin yin yin fluid fluid fluid fluid thirst, thirst, thirst, thirst, yellowish yellowish yellowish yellowish thick thick thick thick sputum sputum sputum sputum and and and and snivel, snivel, snivel, snivel, scanty scanty scanty scanty and and and and brownish brownish brownish br

119、ownish urine, urine, urine, urine, dry dry dry dry feces, feces, feces, feces, dry dry dry dry tongue with scanty fluid,tongue with scanty fluid,tongue with scanty fluid,tongue with scanty fluid,Clinical manifestations and pathogenesis Clinical manifestations and pathogenesis analysisanalysisheat he

120、at heat heat syndrome syndrome syndrome syndrome （ predominpredominpredominpredomination of ation of ation of ation of yang heat yang heat yang heat yang heat or yin or yin or yin or yin asthenia asthenia asthenia asthenia ）阳阳热热偏偏盛盛, ,功功能能亢亢奋奋发发热热，恶恶热热，喜喜冷冷，面面赤赤，烦烦躁躁不不宁宁，舌舌红、苔黄，脉数。红、苔黄，脉数。热热盛盛伤伤津津或或

121、阴阴虚虚津津少少口口渴渴欲欲饮饮，痰痰、涕涕黄黄稠稠，小小便便短短赤赤，大大便便干干结结（排排出出物物稠稠浊浊色色黄黄），舌舌干干燥燥少津等。少津等。临床表现及病因病机分析临床表现及病因病机分析热证热证（感热或（感热或阴虚）阴虚）Differential points for cold and heat syndrome ColdorheatColdorheatpreferencepreference thirstthirstlimlimb bcomcomplexiplexiononurineandurineandstoolstooltonguetonguepulsepulsecoldcold

122、syndromesyndromeaversion to coldaversion to coldWith With preference for preference for warmthwarmthNot Not thirstthirstcoldcoldpalepaleloosestool,loosestool,clearurineclearurineLightcoloredtongueLightcoloredtonguewithwhitishslipperywithwhitishslipperyandmoistfurandmoistfurslowsloworortensetenseHeat

123、Heatsyndromesyndromeaversion to heataversion to heatWith With preference for preference for coldcoldthirstthirstheatheatflushflushededscantyandscantyandbrownishbrownishurine,dryurine,dryfecesfecesReddishtonguewithReddishtonguewithdryandyellowfurdryandyellowfurfastfast 寒热喜恶寒热喜恶寒热喜恶寒热喜恶 口渴口渴口渴口渴 肢体肢体肢

124、体肢体 面色面色面色面色 二便二便二便二便 舌象舌象舌象舌象 脉象脉象脉象脉象 寒证寒证寒证寒证 怕冷喜热怕冷喜热怕冷喜热怕冷喜热 不渴不渴不渴不渴 冷冷冷冷 白白白白 大便稀溏大便稀溏大便稀溏大便稀溏 舌淡舌淡舌淡舌淡 迟紧迟紧迟紧迟紧 小便清长小便清长小便清长小便清长 苔白润苔白润苔白润苔白润 热证热证热证热证 怕热喜冷怕热喜冷怕热喜冷怕热喜冷 口渴口渴口渴口渴 热热热热 赤赤赤赤 大便干结大便干结大便干结大便干结 舌红舌红舌红舌红 数数数数 小便短赤小便短赤小便短赤小便短赤 苔黄干苔黄干苔黄干苔黄干 寒热证鉴别要点寒热证鉴别要点练习病案练习病案 患者素体虚弱，面色晄白，畏寒特甚，手足常凉

125、，稍活动便气短汗出，近因事外出，深夜始归，次日晨起便感头痛、鼻塞、怕冷更甚，体温38oC，舌质淡，苔薄白，脉微细。病案讨论病案讨论提示：提示：分阶段，依据辨证要点作寒热辨证及表里辨证。病案分析示范病案分析示范 第第一一阶阶段段：患患者者体体虚虚日日久久，常常有有畏畏寒寒怕怕冷冷、手手足足冰冰冷冷、面面色色晃晃白白以以及及气气短短自自汗汗等等症症，当当属属阳气不足阳气不足、温煦失职温煦失职之里虚寒证。之里虚寒证。 第第二二阶阶段段：由由于于阳阳气气本本虚虚，不不耐耐深深夜夜阴阴寒寒，遂遂见见怕怕冷冷、发发热热（体体温温3838o oC C）、头头痛痛、鼻鼻塞塞、苔苔薄薄白白等等表表症症。阳阳气气

126、虚虚而而鼓鼓动动乏乏力力，故故脉脉不不浮而反见浮而反见微细。微细。Four : syndrome differentiation of yin and yangYin and yang are the leading principles in the eight principles. All diseases can be divided into two categories as yin and yang四、阴阳四、阴阳阴阳是八纲辩证的总纲阴阳是八纲辩证的总纲： 在诊断上，可根据临床证候所表现的病理性在诊断上，可根据临床证候所表现的病理性质，将一切疾病分为阴阳两个主要方面。质，将一切疾

127、病分为阴阳两个主要方面。素问素问 阴阳应象大论阴阳应象大论说说“善诊者，察色善诊者，察色按脉，先别阴阳。按脉，先别阴阳。” Yin syndrome: syndromes that correspond to the nature of “yin” are called yin syndromes. Internal syndrome, cold syndrome and asthenia syndrome are of yin category.Clinical manifestations: cold limbs, fatigue, dull complexion, shortness o

128、f breath, low voice, bland taste in mouth without thirst, loose stool, clear and profuse urine, pale and tender tongue, sunken and weak pulse.阴证阴证：凡符合凡符合“阴阴”的一般属性的证候，的一般属性的证候，称为阴证。如里证，虚证和寒证属于阴证。称为阴证。如里证，虚证和寒证属于阴证。阴证一般表现：阴证一般表现：形寒肢冷，倦怠无力，面形寒肢冷，倦怠无力，面色苍白暗淡气短懒言，口淡不渴大便色苍白暗淡气短懒言，口淡不渴大便溏泄，小便清长，舌淡胖嫩，苔白润，脉溏

129、泄，小便清长，舌淡胖嫩，苔白润，脉沉弱。沉弱。Yang syndrome: the syndromes that correspond to the nature of “yang” are called yang syndromes. External syndrome, heat syndrome and sthenia syndrome are of yang category.Clinical manifestations: fever, flushed complexion, restlessness, dry mouth with thirst and desire for col

130、d drink, scanty brownish urine, retention of dry feces, deep reddish tongue with yellow and dry fur, powerful and full pulse.阳证阳证：凡符合：凡符合“阳阳”的一般属性的证候，的一般属性的证候，称为阳证。如表证，实证和热证属于阳证。称为阳证。如表证，实证和热证属于阳证。阳证一般表现：阳证一般表现：不同的疾病所表现的阳热不同的疾病所表现的阳热证候是有区别的。常见的有：发热，面赤，证候是有区别的。常见的有：发热，面赤，烦躁，口干渴，喜冷饮，小便短赤，大便烦躁，口干渴，喜冷饮，

131、小便短赤，大便燥结、舌红苔黄干，脉洪数。燥结、舌红苔黄干，脉洪数。n n阴阳辨证又包含有具体的辨证内容，其主阴阳辨证又包含有具体的辨证内容，其主要者有要者有阳虚证阳虚证、阴虚证阴虚证、阴盛证阴盛证、阳盛证阳盛证，以及以及亡阳证亡阳证、亡阴证亡阴证等。等。n n所谓阴盛证实际是指实寒证。所谓阴盛证实际是指实寒证。n n所谓阳盛证实际是指实热证。所谓阳盛证实际是指实热证。n n阳虚证阳虚证即虚寒证。即虚寒证。n n阴虚证阴虚证即虚热证。即虚热证。 n n1.阴阳偏盛阴阳偏盛 阳偏盛：阳胜则热阳偏盛：阳胜则热实热证实热证 阴偏盛：阴胜则寒阴偏盛：阴胜则寒实寒证实寒证n n2.阴阳偏衰阴阳偏衰 阳偏衰

132、：阳虚则寒阳偏衰：阳虚则寒虚寒证虚寒证 阴偏衰：阴虚则热阴偏衰：阴虚则热虚热证虚热证Yang asthenia syndromen n阳虚证阳虚证：阳气亏虚，阳失温煦、推动、蒸：阳气亏虚，阳失温煦、推动、蒸腾、气化作用，表现为腾、气化作用，表现为虚寒证虚寒证。n n临床表现：经常畏冷，四肢不温，口淡不临床表现：经常畏冷，四肢不温，口淡不渴，或渴喜热饮，可有自汗，小便清长，渴，或渴喜热饮，可有自汗，小便清长，大便溏薄，面色淡白，舌淡胖，苔白滑，大便溏薄，面色淡白，舌淡胖，苔白滑，脉沉迟脉沉迟(或为细数或为细数)无力，并可兼有神疲、乏无力，并可兼有神疲、乏力、气短等气虚的证候。阳虚证多见于病力、气

133、短等气虚的证候。阳虚证多见于病久体弱者，病势一般较缓。久体弱者，病势一般较缓。 Yin asthenia syndromen n阴虚证阴虚证：机体阴液亏少，阴不制阳，及失：机体阴液亏少，阴不制阳，及失去其濡养滋润的作用，所表现的去其濡养滋润的作用，所表现的虚热证虚热证。n n临床表现：以形体消瘦，口燥咽干，潮热临床表现：以形体消瘦，口燥咽干，潮热颧红，五心烦热，盗汗，小便短黄，大便颧红，五心烦热，盗汗，小便短黄，大便干结，舌红少津少苔，脉细数等为证候特干结，舌红少津少苔，脉细数等为证候特征，并具有病程长、病势缓等虚证的特点。征，并具有病程长、病势缓等虚证的特点。 Yin depletion s

134、yndromeYin depletion syndrome: refers to the critical : refers to the critical conditions of severe exhaustion of yin fluid. conditions of severe exhaustion of yin fluid. Clinical manifestations including pyretic and Clinical manifestations including pyretic and sticky sweating, warm limbs, thirst w

135、ith preference sticky sweating, warm limbs, thirst with preference for cold drinks, flushed complexion, reddish and for cold drinks, flushed complexion, reddish and dry tongue as well as thin and fast pulse.dry tongue as well as thin and fast pulse.Yang depletion syndromeYang depletion syndrome: ref

136、ers to the critical : refers to the critical syndromes due to declination of syndromes due to declination of yangqiyangqi. . Clinical manifestations including profuse cold Clinical manifestations including profuse cold sweating, pale complexion, cold skin, cold limbs, sweating, pale complexion, cold

137、 skin, cold limbs, bland taste in the mouth without thirst, weak breath, bland taste in the mouth without thirst, weak breath, pale and moist tongue as well as indistinct pale and moist tongue as well as indistinct pulespules. .亡阴亡阴 亡阴是指体液大量消耗，阴液严重亏竭产亡阴是指体液大量消耗，阴液严重亏竭产亡阴是指体液大量消耗，阴液严重亏竭产亡阴是指体液大量消耗，阴液

138、严重亏竭产生的一种病况。汗多，汁粘而热，肌肤热，手足生的一种病况。汗多，汁粘而热，肌肤热，手足生的一种病况。汗多，汁粘而热，肌肤热，手足生的一种病况。汗多，汁粘而热，肌肤热，手足温，口大渴喜冷饮，呼吸气粗，面色潮红温，口大渴喜冷饮，呼吸气粗，面色潮红温，口大渴喜冷饮，呼吸气粗，面色潮红温，口大渴喜冷饮，呼吸气粗，面色潮红, , , ,舌红而舌红而舌红而舌红而干，脉细数。干，脉细数。干，脉细数。干，脉细数。亡阳亡阳 亡阳是体内阳气极度衰竭、阳气将脱的一亡阳是体内阳气极度衰竭、阳气将脱的一亡阳是体内阳气极度衰竭、阳气将脱的一亡阳是体内阳气极度衰竭、阳气将脱的一种病况。大汗淋漓，汗出冷而稀，肤冷，手

139、足凉，种病况。大汗淋漓，汗出冷而稀，肤冷，手足凉，种病况。大汗淋漓，汗出冷而稀，肤冷，手足凉，种病况。大汗淋漓，汗出冷而稀，肤冷，手足凉，口不渴，呼吸气微，面色苍白，舌淡润，脉微欲口不渴，呼吸气微，面色苍白，舌淡润，脉微欲口不渴，呼吸气微，面色苍白，舌淡润，脉微欲口不渴，呼吸气微，面色苍白，舌淡润，脉微欲绝。绝。绝。绝。亡阴与亡阳的现代认识亡阴与亡阳的现代认识 亡阴与亡阳见于危重病。亡阴与亡阳见于危重病。亡阴亡阴多见于高热多见于高热汗多，或呕吐过度，脱水、失血等体液代汗多，或呕吐过度，脱水、失血等体液代谢紊乱时。谢紊乱时。亡阳亡阳则多见于则多见于休克休克等急性血液等急性血液循环障碍时。有人认为

140、亡阴、亡阳的出现，循环障碍时。有人认为亡阴、亡阳的出现，与机体的体质及当时的反应状态有密切关与机体的体质及当时的反应状态有密切关系。亡阴与亡阳到最后都转为系。亡阴与亡阳到最后都转为有效循环血有效循环血量减少量减少、缺氧、代谢障碍及酸中毒，以致、缺氧、代谢障碍及酸中毒，以致危及生命。危及生命。Differential points forDifferential points for Yin depletion syndrome and and Yang depletion syndrome sweatsweatlimbslimbstonguetonguepulsepulseothersothe

141、rsYin depletion Yin depletion syndromesyndromePyretic,Pyretic,saltyandsaltyandstickystickywarmwarm ReddishReddishanddryanddryThin,Thin,fastandfastandweakweakFever,Fever,restlessness,thirstrestlessness,thirstwithpreferencewithpreferenceforcolddrinksforcolddrinksYang Yang depletion depletion syndromes

142、yndromeCold,Cold,blandandblandandwaterywaterycoldcoldPaleandPaleandmoistmoistindistincindistinct tcold,cold,dispiritedness,dispiritedness,blandtasteblandtastepreferenceforhotpreferenceforhotdrinksdrinks亡阴亡阳鉴别表亡阴亡阳鉴别表亡阴亡阴亡阴亡阴亡阳亡阳亡阳亡阳汗汗汗汗汗热，味咸，粘稠汗热，味咸，粘稠汗热，味咸，粘稠汗热，味咸，粘稠汗冷，味淡，微粘汗冷，味淡，微粘汗冷，味淡，微粘汗冷，味淡，微粘

143、四肢四肢四肢四肢温和温和温和温和厥冷厥冷厥冷厥冷舌象舌象舌象舌象红干红干红干红干白润白润白润白润脉象脉象脉象脉象细数无力细数无力细数无力细数无力微细欲绝微细欲绝微细欲绝微细欲绝其它其它其它其它身热，烦躁不安，身热，烦躁不安，身热，烦躁不安，身热，烦躁不安，口渴，喜冷饮口渴，喜冷饮口渴，喜冷饮口渴，喜冷饮身冷，蜷卧神疲，身冷，蜷卧神疲，身冷，蜷卧神疲，身冷，蜷卧神疲，口淡，喜热饮口淡，喜热饮口淡，喜热饮口淡，喜热饮小结 n n本章主要掌握掌握八纲辨证的概念、方法本章主要掌握掌握八纲辨证的概念、方法和内容和内容 。思考题n n何谓八纲？八纲辨证的总纲是什么？何谓八纲？八纲辨证的总纲是什么？n n表证与里证如何鉴别？表证与里证如何鉴别？n n虚证与实证如何鉴别？虚证与实证如何鉴别？n n寒证与热证如何鉴别？寒证与热证如何鉴别？