中妇症瘕课件.ppt

1、 when is your birthday can you play the guitar what time do you go to school主主 讲讲 人人:侯丽辉侯丽辉 教授教授 when is your birthday can you play the guitar what time do you go to school when is your birthday can you play the guitar what time do you go to school when is your birthday can you play the guitar what

2、time do you go to school when is your birthday can you play the guitar what time do you go to school when is your birthday can you play the guitar what time do you go to school when is your birthday can you play the guitar what time do you go to school1.1.该病的中西医临床诊断？该病的中西医临床诊断？2.2.该病的病因病机？该病的病因病机？3.

3、3.如何进行诊断？如何进行诊断？4.4.临床的对策及转归？临床的对策及转归？5.5.中医治疗的优势与特色？中医治疗的优势与特色？when is your birthday can you play the guitar what time do you go to school 黑龙江中医药大学中医妇科黑龙江中医药大学中医妇科 侯丽辉教授侯丽辉教授 when is your birthday can you play the guitar what time do you go to school （一）定义：（一）定义：妇人下腹有结块，或胀、或满、或痛妇人下腹有结块，或胀、或满、或痛 者，称

4、为癥瘕。者，称为癥瘕。一、概一、概 述述 when is your birthday can you play the guitar what time do you go to school（二）关于病名（二）关于病名 1、该病首见于、该病首见于素问素问骨空论骨空论：“任脉为病，男任脉为病，男 子内结七疝，女子带下瘕聚。子内结七疝，女子带下瘕聚。”when is your birthday can you play the guitar what time do you go to school 2 2、灵枢灵枢水胀水胀：肠覃何如？肠覃何如？寒气客于肠外，与卫气相搏，寒气客于肠外，与卫气相搏

5、，气不气不得荣，因有所系，得荣，因有所系，癖而内著，恶气乃起，瘜肉乃癖而内著，恶气乃起，瘜肉乃生生。其始生也，。其始生也，大如鸡卵，大如鸡卵，稍以益大，至其成也，稍以益大，至其成也，如怀子之状，如怀子之状，久者离岁，久者离岁，按之则坚，推之则移，按之则坚，推之则移，月事以时下，月事以时下，此其候也。此其候也。石瘕何如？石瘕何如？石瘕生于胞中，寒气客于子门，石瘕生于胞中，寒气客于子门，子门子门闭塞，闭塞，气不得通，恶血当泻不泻气不得通，恶血当泻不泻，日以益大，状日以益大，状如怀子，月事不以时下。如怀子，月事不以时下。皆生于女子，可导而下。皆生于女子，可导而下。when is your birth

6、day can you play the guitar what time do you go to school（三）癥与瘕的区别（三）癥与瘕的区别 癥癥坚硬成块，固定不移，推揉不散，坚硬成块，固定不移，推揉不散，痛有定处，病属血分。痛有定处，病属血分。瘕瘕痞满无形，时聚时散，推揉转动，痞满无形，时聚时散，推揉转动，痛无定处，病属气分。痛无定处，病属气分。when is your birthday can you play the guitar what time do you go to school when is your birthday can you play the guita

7、r what time do you go to school素体虚弱素体虚弱经期产后经期产后胞脉空虚胞脉空虚七情所伤七情所伤外邪侵袭外邪侵袭 气机阻滞气机阻滞 瘀血内停瘀血内停 痰血搏结痰血搏结 毒热与血结毒热与血结胞脉胞脉冲任冲任胞宫胞宫二二 、病、病 因因 病病 机机 when is your birthday can you play the guitar what time do you go to school 病病 位位 子宫子宫 胞脉胞脉 多靶位多靶位 冲任冲任 when is your birthday can you play the guitar what time do

8、 you go to school 病病 性性 初起多实初起多实 久则虚实夹杂久则虚实夹杂 when is your birthday can you play the guitar what time do you go to school（一）诊（一）诊 断断 病史：病史：1 1、经期产后感受外邪、经期产后感受外邪 2 2、长期情志不舒、长期情志不舒 3 3、月经不调、带下病史、月经不调、带下病史 when is your birthday can you play the guitar what time do you go to school 主证主证 小腹有包块，或胀、或满、或痛。小

9、腹有包块，或胀、或满、或痛。检查检查 1.1.妇科检查：生殖脏器可触及包块。妇科检查：生殖脏器可触及包块。2.2.实验室检查：宫颈活组织检；阴道细胞学检实验室检查：宫颈活组织检；阴道细胞学检 查；查；诊断性刮宫；红细胞沉降率；甲胎蛋白诊断性刮宫；红细胞沉降率；甲胎蛋白 测定；病理检查，碱性磷酸酶测定。测定；病理检查，碱性磷酸酶测定。3.3.其他检查：其他检查：B B超、内窥镜、腹部超、内窥镜、腹部X X线平片等检线平片等检 查。查。when is your birthday can you play the guitar what time do you go to school（二）鉴别诊断

10、（二）鉴别诊断与妊娠鉴别：与妊娠鉴别：1 1、停经史、停经史 ；2 2、早孕反应，子宫增大与停经月份相、早孕反应，子宫增大与停经月份相 符，质软，囊性感；符，质软，囊性感；3 3、妇科检查、妊娠试验、妇科检查、妊娠试验、B B超检查。超检查。when is your birthday can you play the guitar what time do you go to school 妇人宿有妇人宿有癥病，经断未及三月，癥病，经断未及三月，而得漏而得漏下不止下不止，胎动在脐上者，为，胎动在脐上者，为癥痼害癥痼害。妊。妊娠六月动者，前三月经水利时胎也。下娠六月动者，前三月经水利时胎也。下血

11、者，后断三月也。所以血不止者，其血者，后断三月也。所以血不止者，其癥不去故也，当下其癥，桂枝茯苓丸主癥不去故也，当下其癥，桂枝茯苓丸主之。之。when is your birthday can you play the guitar what time do you go to school 与癃闭鉴别：与癃闭鉴别：1 1、尿液在膀胱内积聚，不能溺出；、尿液在膀胱内积聚，不能溺出；2 2、导尿后诸症消失；、导尿后诸症消失；3 3、超声检查。、超声检查。when is your birthday can you play the guitar what time do you go to sch

12、ool （一）辩证思路（一）辩证思路 1.1.抓住主诉：抓住主诉：以象为素、以素为候、以候为证以象为素、以素为候、以候为证 “有诸内必形于诸外有诸内必形于诸外”2.2.提取证候要素：提取证候要素：气、瘀、痰、毒气、瘀、痰、毒 when is your birthday can you play the guitar what time do you go to school3.应证组合应证组合气滞气滞 包块特征包块特征 推之可移，时聚时散，疼推之可移，时聚时散，疼 痛，痛无定处。痛，痛无定处。全身特征全身特征 小腹胀满，胸闷不舒，精神小腹胀满，胸闷不舒，精神 抑郁，舌红，苔薄，脉沉抑郁，舌红，

13、苔薄，脉沉 弦。弦。when is your birthday can you play the guitar what time do you go to school 血瘀血瘀 包块特征包块特征 固定不移，疼痛拒按。固定不移，疼痛拒按。全身特征全身特征 肌肤少泽，口干不欲饮，月经不肌肤少泽，口干不欲饮，月经不 调，或量多，或淋漓不断，面色调，或量多，或淋漓不断，面色 晦暗，舌紫暗，苔厚而干，脉沉晦暗，舌紫暗，苔厚而干，脉沉 涩。涩。when is your birthday can you play the guitar what time do you go to school 痰湿痰湿

14、 包块特征包块特征 按之不坚，有时作痛。按之不坚，有时作痛。全身特征全身特征 带下量多，脘腹痞闷，时欲呕带下量多，脘腹痞闷，时欲呕 恶等。恶等。when is your birthday can you play the guitar what time do you go to school 毒热毒热 包块特征包块特征 包块边界不清，形不正，灼包块边界不清，形不正，灼 痛，拒按，痛及腰骶。痛，拒按，痛及腰骶。全身特征全身特征 带下量多或脓性或无色带下，带下量多或脓性或无色带下，月经改变等，烦躁易怒，发热月经改变等，烦躁易怒，发热 口渴，舌红，苔黄，脉滑数。口渴，舌红，苔黄，脉滑数。when

15、is your birthday can you play the guitar what time do you go to school4.厘定靶位（病位）厘定靶位（病位）子宫子宫 胞脉胞脉 冲任冲任 根据伴随症状，结合妇科检查，腹部检查，根据伴随症状，结合妇科检查，腹部检查，B B超，宫腔镜，超，宫腔镜，CTCT，核磁，进一步明确病位。，核磁，进一步明确病位。when is your birthday can you play the guitar what time do you go to school5.确定病性确定病性辨善恶辨善恶 诸病源候论诸病源候论癥瘕死候癥瘕死候：“劳积引岁

16、月，劳积引岁月，人即柴瘦，腹转大，遂即死。诊其脉弦而伏，人即柴瘦，腹转大，遂即死。诊其脉弦而伏，其其癥不转动者必死。癥不转动者必死。”when is your birthday can you play the guitar what time do you go to school 善证善证-发展缓慢，按之可动，边界规发展缓慢，按之可动，边界规 整，精神如常，面色光泽。整，精神如常，面色光泽。恶证恶证-发展迅速，按之坚硬，边界不发展迅速，按之坚硬，边界不 清，或崩或漏，或无色带下，清，或崩或漏，或无色带下，形瘦而黯。形瘦而黯。when is your birthday can you pla

17、y the guitar what time do you go to school 6 6、方证对应：方证对应：气滞型：气滞型：治疗法则：疏肝解郁，行气散结治疗法则：疏肝解郁，行气散结 方方 药：香棱丸药：香棱丸济生方济生方 when is your birthday can you play the guitar what time do you go to school 方方 解：解：木香、丁香、小茴香木香、丁香、小茴香温经理气温经理气 川楝、枳壳川楝、枳壳除下焦之郁结，行气止痛除下焦之郁结，行气止痛 三棱、莪术三棱、莪术行气破血、消癥散结行气破血、消癥散结 青皮青皮疏肝解郁，消积行滞疏

18、肝解郁，消积行滞 朱砂朱砂护心宁神护心宁神 when is your birthday can you play the guitar what time do you go to school 血瘀型：血瘀型：治疗法则：活血破瘀，散结消癥治疗法则：活血破瘀，散结消癥 方方 药：桂枝茯苓丸药：桂枝茯苓丸金匮要略金匮要略 若兼血瘀甚者，兼肌肤甲错，两目黯黑，用若兼血瘀甚者，兼肌肤甲错，两目黯黑，用 大黄蛰虫丸大黄蛰虫丸金匮要略金匮要略。when is your birthday can you play the guitar what time do you go to school 方方 解：

19、解：桂枝桂枝温通血脉温通血脉 芍药芍药行血中之滞以开郁结行血中之滞以开郁结 茯苓茯苓淡渗以利行血，与桂枝同用能入阴通淡渗以利行血，与桂枝同用能入阴通 阳阳 丹皮、桃仁丹皮、桃仁破瘀散结消癥破瘀散结消癥 when is your birthday can you play the guitar what time do you go to school 痰湿型：痰湿型：治疗法则：除湿化痰，散结消癥治疗法则：除湿化痰，散结消癥 方方 药：散聚汤药：散聚汤妇科秘诀大全妇科秘诀大全 若兼血滞者，用三棱煎若兼血滞者，用三棱煎妇人大全良方妇人大全良方 when is your birthday can y

20、ou play the guitar what time do you go to school 方方 解：解：杏仁杏仁 陈皮陈皮 行上、中、下三焦之气滞而化痰结行上、中、下三焦之气滞而化痰结 槟榔槟榔 半夏、茯苓半夏、茯苓除湿化痰，降逆止呕除湿化痰，降逆止呕 桂心、当归桂心、当归温经活血而消癥温经活血而消癥 甘草甘草调和诸药调和诸药 when is your birthday can you play the guitar what time do you go to school 毒热型：毒热型：治疗法则：解毒除湿，颇瘀消癥治疗法则：解毒除湿，颇瘀消癥 方方 药：银花蕺菜饮药：银花蕺菜饮中

21、医妇科治疗学中医妇科治疗学加赤加赤 芍、丹皮、丹参、三棱、莪术、皂角芍、丹皮、丹参、三棱、莪术、皂角 刺。刺。when is your birthday can you play the guitar what time do you go to school 方方 解：解：金银花、金银花、土茯苓土茯苓 清热解毒，利湿排脓清热解毒，利湿排脓 蕺蕺 菜、菜、炒荆芥炒荆芥 赤芍、丹皮、丹参赤芍、丹皮、丹参清热凉血，活血化瘀清热凉血，活血化瘀 三棱、莪术、皂角三棱、莪术、皂角行气破瘀，消癥散结行气破瘀，消癥散结 when is your birthday can you play the guitar what time do you go to school五、中医药治疗的特色和优势是什么？五、中医药治疗的特色和优势是什么？