概念 全身望诊,又称整体望诊,是医生在诊察病人时首先对病（3天）课件.ppt

1、概念 全身望诊，又称整体望诊，是医生在诊察病人时首先对病人的精神、色泽、形体、姿态等整体表现进行扼要的观察，以期对病情的寒热虚实和轻重缓急等获得一个总体的印象。要求 1、对病人的整体情况有第一直觉印象，达到“一会即觉”的目的。2、在全身望诊的同时做到神形合参。第一节 全身望诊 概念 神的含义有二：一是“神气”，是指脏腑功能活动的外在表现要求；二是“神志”，是指人的思维、意识和情志活动。望神是通过观察人体生命活动的整体表现来判断病情的方法。（一）望神的原理灵枢本神指出：“生之来者谓之精，两精相搏谓之神。”灵枢平人绝谷：“神者水谷之精气也。”神产生于先天之精，又必须依赖后天水谷精气的充养。可见神的

2、产生与人体精气和脏腑功能的关系十分密切，所以观察神的旺衰可以了解精气的盛衰、推断病情的轻重、判断病变的预后。正如素问移精变气论所说：“得神者昌，失神者亡。”（二）神的具体表现神是人体生命活动的总的体现，具体表现在人体的目光、色泽、神情、体态诸方面，而诊察眼神的变化是望神的重点。一、望神 1、两目含义：人两眼的神情。原理：首先，眼神是心神的外在表现。灵枢大惑论“目者，心使也”；其次，视觉可反映脏腑精气的盛衰。灵枢大惑论“五脏六腑之精气皆上注于目而为之精”。生理：两目神光充沛，精彩内含，运动灵活，视物清晰者，有神，是脏腑精气充足的表现；病理：两目浮光外露，目无精彩，运动不灵，视物模糊者，无神，是脏

3、腑精气虚衰现。2、色泽 含义：人的周身皮肤（以面部为主）的色泽。原理：皮肤的色泽荣润或枯槁是脏腑精气盛衰的重要表现。医门法律说：“色者，神之旗也，神旺则色旺，神衰则色衰，神藏则色藏，神露则色露。”生理：色泽荣润，有神；病理：色泽枯槁，无神；3、神情含义：人的精神意识和面部表情。原理：心主神志，其华在面，心为五脏六腑之大主，故神情是心 神和脏腑精气盛衰的外现。生理：神志清晰，思维有序，表情自然，反应灵敏，心神正常。病理：神识昏蒙，思维混乱，表情淡漠，反应迟钝，心神已衰。4、体态含义：人的形体动态。原理：人的形体动态使机体功能强弱的外征。素问上古天真论说：“形神合一”，生理：形体丰满，动作自如，有

4、神。病理：形体瘦削，动作艰难，无神。望神除上述重点外，还要结合语言、呼吸、舌象、脉象等表现进行综合判断。按神的盛衰和病情的轻重一般可分为得神、失神、少神、假神及神乱五种。1、得神（又称有神）含义：得神是精充气足神旺的表现。临床特征：两目灵活，明亮有神，面色荣润，含蓄不露，神志清晰，表情自然，肌肉不削,反应灵敏。临床意义：提示精气充盛，体健神旺，为健康表现，或虽病精气未衰，病轻易治，良好。形象：面色浮红而清、明润而散；鼻旁有红色瘀点，目眥微黄，目光炯炯 主病：新病；阳证；热证；轻病 病例：风热皮疹。外感风热，客于肌肤。（过敏性皮炎）（三）神的分类及判断 含义：少神是正气不足的表现。临床特征：两目

5、晦暗，目光乏神，面色少华，暗淡不容，精神不振，思维迟钝，肌肉松弛，动作迟缓。临床意义：精气不足，机能减退，多见于虚证患者或疾病恢复期病人。关键词：虚证，少神形象：目无神采，精神萎靡，面色苍白，下颏青黑，沉浊色微 主病：久病气虚阳虚；气血双亏；思伤心脾 病例：阳虚胃脘痛。脾阳不振，肝木乘脾（十二指肠溃疡）2、少神（又称神气不足）关键词：虚证少神形象：目光呆滞，眼睑下垂，面色淡黄，沉微而散，头发作穗 主病：脾气虚弱；气血双亏 病例：睑废。脾气虚弱（重症肌无力）关键词：少神形象：目精生光，稍有灵活，面有血色 主病：病例：经治疗好转后的神色 含义：失神是精亏神衰或邪盛神乱的重病表现。临床特征：（1）精

6、亏神衰而失神者两目晦暗，目无光彩，面色无华，晦暗暴露，精神萎靡，意识模糊，反应迟钝，手撒尿遗，骨枯肉脱，形体羸瘦。（2）邪盛神乱而失神者神昏谵语，寻衣摸床，撮空理线，或卒倒神昏，两手固握，牙关紧闭。临床意义：（1）精亏神衰而失神者的临床特征提示精气大伤，机能减退，多见于久病重病患者，预后不良。（2）邪盛神乱而失神者的临床特征提示邪气亢盛，热陷心包，扰乱神明，或肝风夹痰蒙蔽清窍，阻闭经络，多见于急性危重病人。3、失神（又称无神）关键词：无神（昏迷）形象：目陷睛迷，双睑下垂露睛；面色黧黑，沉浊而甚；口开不闭，呼之不应；表情呆板，项强痉挛 主病：精气衰竭；神志昏迷；预后不良 病例：风痰发痉。精气衰竭

7、，肝风挟痰，迷于心窍 关键词：无神（昏迷）形象：两目呆滞，目陷睛迷，口开不闭，表情呆板，面容消瘦，色虽不华，尚较明润。主病：阴阳俱衰，病重失神。仍属善色 病例：虚痨发痉。肝肾不足，阴阳俱衰。（高度营养不良原因待查；震颤麻痹；泌尿系感染；股骨颈骨折）关键词：无神（重病）形象：肌肉萎缩，肋骨突出，呈舟状腹，乳房干瘪，皮肤枯萎 主病：精气衰竭；津液耗伤，阴阳俱衰 病例：关键词：重病失神形象：两眼发直，目无神采；面容瘦削，萎黄晦暗，夭然不泽，口唇眼窝发黑。主病：脾肾俱衰；气血双亏；阴精耗伤；阳气不振病例：虚损。脾肾俱衰，气血耗竭。（风湿性心脏病，脑栓塞）关键词：目暗睛迷无神形象：目不欲睁，暗淡无光，神

8、志不清，面色苍白，消瘦口开。主病：阴阳具衰，气血双亏 病例：脑血栓形成，风中脏腑 含义：久病、重病之人本已极度衰竭，突然出现某些神气暂时“好转”的虚假表现。临床特征：久病、重病之人原本目光晦暗，突然目似有光，但浮光外露；原本面色晦暗，突然面似有华，但泛红如妆；原本精神萎靡，突然神识似清，想见亲人，言语不休，但烦躁不安；原本毫无食欲，久不能食，突然欲进饮食，且食量大增等。关键词：病危假神形象：面色苍白沉浊，忽然微有红润；周身大肉已脱，腹大青筋气喘，突然目光有神，言语响亮。鼻出血血迹未干 主病：“回光返照，残灯复明”阴不敛阳，虚阳浮越；预后不良 病例：臌胀。癥积日久，精气衰竭，虚阳浮越。（肝硬变并

9、发肝癌）4、假神 临床意义：精气衰竭已极，阴不敛阳，虚阳外越，阴阳即将离绝所致，是临终的预兆。含义：神志错乱失常。临床特征：焦虑恐惧，狂躁不安，淡漠痴呆，卒然昏倒。临床意义：神乱是指神志错乱，多反复发作，缓解时常无“神乱”表现，神乱表现可作为诊病的依据。5、神乱关键词：脏躁形象：泪眼模糊，哭泣面容，面色苍白，微黄而沉，虽较明润，仪表不整，抬上病床，数问不答。主病：肝气郁结，肺气不足；心气虚，神不足。病例：脏躁。心肺气虚，金不制木（癔病）关键词：癫狂形象：自言自语，喜笑怒骂，有如讲演，比比划划，口若悬河，滔滔不绝。不分时间场合，完全丧失理智。形象：癫狂失神；痰火扰心病例：狂证。气郁化火，痰火扰心

10、。（精神分裂证，狂躁型）关键词：癫狂形象：自言自语，喜笑怒骂，有如讲演，比比划划，口若悬河，滔滔不绝。不分时间场合，完全丧失理智。主病：癫狂失神；痰火扰心。病例：狂证。气郁化火，痰火扰心。（精神分裂证，狂躁型）关键词：神志异常，痴呆形象：两眼发直，内眥距宽，眼裂开大，呈倒八字型。面色粉白（因反射强光而有失真），头发作穗 主病：神志痴呆，智能不全；气血不足，心神失养病例：痴呆。肾气不足，心血亏虚（先天智能发育不全，愚鲁型）得神 少神 失神 假神目光 两目灵活 两目晦暗 两目晦暗 目似有光 明亮有神 目光乏神 目无光彩 但浮光外露面色 面色荣润 面色少华 面色无华 面似有华 含蓄不露 暗淡不容 晦

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