中医临床病证 - 上海中医药大学精品课程网

advertisement
Wheezing Syndrome
哮 病
杨明山
上海中医药大学教务处
Contents
① Terminology
病名
② Etiology
病因
③ Mechanism
病机
④ Manifestation
症候
⑤ TCM Diagnosis
四诊
⑥ Differentiation
辨证
⑦ Therapy
治则
⑧ TCM Formulae
方药
⑨ Others
其他
Terminology
病名
2000年前
内
经
1180年
1224年
针灸资生经
1481年
1515年
丹溪
心法
医学
正传
医
说
01.《内经∙素问∙阴阳别论篇》提到“喘鸣” 。
古文:阴争于内阳扰于外,魄汗未藏,四逆而
起,起则熏肺,使人喘鸣。
If yin dominates interiorly and yang intrudes
exteriorly exteriorly, the soul sweating fails
to be stored and the disorders develops all
over the body, starting with lung damaged
which will lead to wheezing with stridor.
主
02. 南宋嘉定(1220)王执中《针灸资生经》最
早提出“哮喘”之名。
古文:因与人治哮喘,只缪(刺)肺腧,
不缪他穴。
Acupoint Feishu more than others is
needled to treat asthma.
03. 南宋张杲《医说∙卷四》提到“齁喘”。
古文:因食盐虾过多,遂得齁喘之疾。
Taking too much salty fish will lead to
asthma due to fish (Houchuan).
04.元朱丹溪首创“哮喘”病名,《丹溪心法》
设独立篇名《哮喘十四》;另设《喘十
五》;自此喘与哮分别叙述。
It’s the first time to give name “asthma” to this
disorder used as the title of one chapter and
then to discuss wheezing syndrome and
dyspnea syndrome separately.
06. 明朝秦景明在《症因脉治•卷二哮病论》
提出“哮病”之病名。
• 古文:哮病内伤痰饮,
外感风寒,合而成。
• 英文:Wheezing
syndrome is caused by
both interior phlegmretention and exterior
wind-cold.
05.明虞抟《医学正传∙哮喘》区别哮与喘。
古文:哮以声响言,喘以气息言。
We diagnose asthma especially from it’s
sound, and diagnose gasping from it’s
breath.
Terminology
• 喘:
panting
• 喘鸣:stridor
• 喘证:gasping syndrome
• 哮证:wheezing syndrome
• 哮喘:asthma
Etiology
病因
01《内经∙素问∙阴阳别论篇》认识到内外因素
影响脏功能(尤其是肺)是哮病的主要病机。
• 古文:阴争于内阳扰于外,魄汗未藏,四逆
而起,起则熏肺,使人喘鸣。
• If yin dominates interiorly and yang intrudes
exteriorly, the soul sweating fails to be stored
and the disorders develops all over the body,
starting with lung damaged and leading to
stridor and wheezing.
02《内经·素问·太阴阳明论》
提出外(风)邪致哮说。
• 古文:犯贼风虚邪者,
…阳受之则入六腑…
入六腑则身热,不时卧,上为喘呼。
• It proposed the theory that exogenous evil
can cause the illness, “When the body is
infected by occult evil wind, … yang six FUorgans are affected if yang is involved, …
then the patient has a fever and fails to sleep
flat, leading to whooping upward.
03《黄帝内经·灵枢·邪气藏府病形》提出外
感“寒邪”之认识。
• 古文:两寒相感,中外皆伤,故气逆而上。
• When two kinds of cold meet, both
interior and exterior of the body
are impaired, resulting in
qi ascending reversely.
04 元朱丹溪《丹溪心法·喘十五》述及情志、饮食、
体弱等多种病因。
• 古文:六淫七情之所感伤,饱食动作,脏气不和,
呼吸之息,不得宣畅而为喘急。亦有脾肾俱虚,
体弱之人,皆能发喘。
• Damaged by six climatic exopathogens and seven
emotions as well as action after full stomach, the
visceral qi will be disharmonized resulting in
obstructive respiration and rapid gasping.
Anybody whose spleen and kidney are
deficient can develop gasping syndrome.
04: Damaged
by six climatic exopathogens
and seven emotions as well as action
after full stomach, the visceral qi will
be disharmonized resulting in
obstructive respiration and rapid
gasping. Anybody whose spleen and
kidney are deficient can develop
gasping syndrome.
05明秦景明《症因脉治∙喘》指出体虚之病因。
• 古文:气虚喘逆之因,或本元素虚,或大
病后,大劳后,失于调养,元气大伤。
• The cause of wheezing conversely with qi
deficiency is due to failure of recovery
leading to damaging primordial qi after
severe disease or exhaustion.
病因总结
wind
motion
morbid
cold
diet
overstrain
2000年前
中国古代医学对于哮喘的
病因记载已经相当完整
2000年前
《内经·素问·太阴阳明论》提出风邪致哮说:
犯贼风虚邪者, 阳受之则入六腑, 入六腑则
身热,不时卧,上为喘呼。
1938年
西方撰此词
古希腊医学认为此病与风相关。
相似何其乃尔
Mechanism
病机
01《黄帝内经·灵枢·本藏第四十七》最早提
到肺与本病的特殊关系
• 古文:肺高则上气肩息咳。
• If the lung is in superior
position, the patient will
gasp and cough with raised
shoulder.
02《黄帝内经•素问•至真要大论篇第七十四》
提出水饮之内因可上犯于肺引发本病。
• 古文:饮发于中,咳喘有声。
• When the fluid retention occurs inside the
body, it will cause cough and wheezing with
stridor.
03隋巢元方550-630在《诸病源候论卷十四·咳
嗽病诸候》最早指出痰饮与本病的关系。
• 古文:其胸膈痰饮多者,嗽则气动于痰,
上搏喉咽之间,痰气相击,随嗽动息,呼
呷有声,谓之呷嗽。
• If there is too much phlegm above the
diaphragm in the chest, the qi vibrates upward
with the phlegm in the throat when the phlegm
and qi struggle mutually worsening with the
coughing and wheezing, accompanied by the
sound, which is called as Xiasou (stridor).
If there is too much phlegm above the
diaphragm in the chest, the qi vibrates
upward with the phlegm in the throat when
the phlegm and qi struggle mutually
worsening with the coughing and wheezing,
accompanied by the sound, which is called as
xia sou (stridor).
04 东汉张仲景在《金匮要略∙痰饮咳嗽病脉证
治第十二》中,将哮证归为“伏饮”证。
• 古文:膈上病痰,满喘咳吐,发则寒热,
背痛腰疼,目泣自出,其人振振身膶剧,
必有伏饮。
• With diseased phlegm above diaphragm, the
patient will have heavy panting with cough
and vomiting, and then develop fever, lower
backache, spontaneous tearing and body
shivering during attack, which is rooted in
concealed fluid retention inside body.
哮病的三饮
水饮-痰饮-伏饮
水电解质
失衡
免疫反应
05 明戴思恭1324-1405《秘传证治要诀及类方
•哮喘》明确提出本病的“宿根”之说。
• 古文:喘气之病,哮吼如水鸡之声,牵引
胸背,气不得息,坐卧不安。此为嗽而气
喘,或宿有此根,遇寒暄则发,一时暴感。
• The disease of gasping syndrome is whooping with
frog-like sound and raising the chest and
shoulders leading to dyspnea and failing to sit and
sleep. It is characterized by cough accompanied by
gasping or fundamental illness which will recur in
case of cold paroxysmally.
06 清李用粹《正治汇补∙哮病》全面阐明哮病病机。
• 古文:哮即痰喘之久而常发者,因内有壅塞之气,
外有非时之感,膈有胶固之痰,三者相合闭拒气
道,搏击有声,发为哮病。
• It summed up the three links of asthma: “Asthma
is long-term wheezing with phlegm having
frequent recurrence because there is interior qi
obstruction, induction of exogenous factors and
tenacious phlegm above the diaphragm, three of
which meet together to obstruct airway, fighting
mutually with stridor, called as asthma.
太复杂
失去中医特色
Mechanism
Trilogy
Fluid retention
Phlegm r.

Concealed r.
induced factors
Root
Manifestation
症候
01巢元芳《诸病源候论•卷之十四•气病诸侯》
最早描述“水鸡之鸣”,犹如西医之喉鸣。
• 古文:肺病令人上气,兼胸膈痰满,气行
壅滞, 喘息不调, 致咽喉有声, 如水鸡之鸣也。
• Lung disease makes qi
ascend with chest full of
phlegm and qi stagnation,
causing abnormal breathing
and noisy sound in the throat
like the sound of frog.
02《黄帝内经•素问•逆调论
篇第三十四》已经记载
本病的端坐呼吸。
• 古文:不得卧而息有音。
• The patient can’t sleep
flat and wheezing with
stridor.
03《黄帝内经•灵枢•五阅五使第三十七》已经
提到呼吸衰竭时出现的鼻翼扇动。
• 古文:肺病者,喘息鼻张。
• A person with the pulmonary disease will
wheeze with nasal flaring.
04明李中梓1588-1655在《医宗必读•卷九》
(1637成)记载呼气性呼吸困难之表现。
• 古文:哮者与喘相类,但不似喘开口出气
之多,而有呀呷之音。
• Asthma and
wheezing are similar,
but asthma does not
breathe as much as
wheezing,and have
it’s sound like “yaxia”
古代中医早已完整记
载哮喘的临床表现
TCM Diagnosis
四诊
• (一)望诊
01唐朝王焘670-755在《外台秘要卷九•久咳坐卧不
得方》(752年撰成)准确描述哮证大作症候。
• 古文:久患气嗽,发时奔喘,坐卧不得,并喉里
呀声,气欲绝。
• It records the paroxysmal manifestations of severe
wheezing and dyspnea syndrome: “The patient
with long-term coughing and wheezing has heavy
wheezing, fails to sit and sleep with stridor in the
throat and even and is going to be suffocated due
to dyspnea.
02 明王肯堂1549-1613《证治准绳∙喘》描述
哮证发作症候,与西医呼衰表现一致。
• 古文:喘者,促促气急,
喝喝息数,张口抬肩,摇身撷肚。
• The patient with asthma is out of breath,
wheezing rapidly with stridor, opening
mouth and shrugging shoulder, as well as
shaking body and abdomen going forward.
03清汪宏在《望诊遵经•卷二诊唇气色条目》
(撰于1875年)述及哮喘之望诊。
• 古文:唇色黑瘀,目睛凸露,呼吸上逆者,
哮喘也。
• If the patient has black stasis, bulging eyes
and upward breathing, asthma would be
diagnosed.
03清汪宏在《望诊遵经•卷二诊唇气色条目》
(撰于1875年)述及哮喘之望诊。
• 古文:唇色黑瘀,目睛凸露,呼吸上逆者,
哮喘也。
• If the patient has bluish color to the lips,
bulging eyes and upward breathing,
asthma would be diagnosed.
风寒犯肺
• 症状:主证加咳痰稀白,表寒证,口不渴。
• 舌象:舌淡苔薄白而滑
痰热遏肺
• 症状:主证加咳嗽痰黄稠,咽干,口
渴喜冷饮,尿赤,便结或发热。
• 舌脉:舌红苔黄腻
(二)问诊
03 清何梦瑶在《医碥·喘哮》指出哮与饮食的
关系。
• 古文:得之食味酸咸太过,幼时多食盐醋,
往往成此疾,俗谓之盐哮。
• Wheezing syndrome is caused by too much
acid and salt in the diet during childhood, it
is referred to salty wheezing syndrome.
(二)问诊
04 南宋张杲撰在《医说·卷四》(1224刊)记载
“鱼腥哮 fish-asthma”。
• 古文:因食盐虾过多,遂得齁喘之疾。
• Taking too much salty fish will lead to
asthma due to fish (Houchuan).
• (二)问诊
05南宋许叔微1079-1154在《普济本事方
•卷一》(撰于1132年)中已经认识到
本证具有遗传性。
• 古文:此病有苦而至终身者,亦有母子相
传者。
• The patient can suffer from this all his life
which can also be inherited from mother to
son.
• (三)闻诊
06明朝虞抟1438-1517在《医学正传•卷之二•
哮喘》(撰于1515年)提出“哮”与“喘”
之别
• 古文:夫喘促喉中如水鸡声者,谓之哮;
气促而连属不能以息者,谓之喘。
• It is called asthma for the patient is
wheezing with frog-like sound in the throat
and it is called gasping syndrome for the
patient is panting with accelerated and
panting respiration.
• (四)切诊
07《黄帝内经•素问•通评虚实篇第二十八》中
首次提到用脉象判断哮病的预后
• 古文:乳子中风热,喘鸣肩息者,脉实大
也。缓则生,急着死。
• The Infantile patient suffering from
wheezing syndrome with stridor and raised
shoulder has a large and excess pulse. He
will live on with relaxed pulse but die with
swift pulse.
Manifestations
喉鸣
一般
呼吸衰竭
gasping
fever
orthopnea
wheezing
cough
raised shoulder
whooping
panting
Nasal flare
Xiasou Expiratory d.
Shivering
bruise lip
tearing
齁喘
stridor
dyspnea
bulging eyes
(四)切诊
08 唐王焘《外台秘要∙上气喉中水鸡鸣方》记
载脉诊诊断本病。
• 古文:脉浮咳逆,咽喉中水鸡鸣,喘息不
通,呼吸欲死。
• The patient has floating pulse, bad cough
and upwelling qi with frog-like sounds in
the throat, gasping because of obstruction of
airways and even feeling to die.
TCM Differentiation
辨证
01 明虞抟1438-1517《医学正传∙哮喘》(1515
年成)提出“哮”与“喘”之别
• 古文:大抵哮以声响名,喘以气息言。
• We diagnose asthma espcially from it’s
sound, and diagnose wheesing from it’s
breath.
02 元朝朱丹溪1281-1358《丹溪心法·卷二·哮
喘十五》提出虚实辨证。
• 古文:实喘气实肺盛,虚喘由肾虚。
• The excessive wheezing syndrome due to
excessive lung qi and deficienct wheezing
syndrome due to kidney deficiency.
肺盛
肾虚
03 明张景岳《景岳全书·杂证》归纳虚实两证。
• 古文:实喘者有邪,邪气实也;
虚喘者无邪,元气虚也。
• Excessive gasping syndrome has evil qi in
which evil qi is excessive and deficient
gasping syndrome has no evil in which vital
qi is deficient.
05 清林佩琴《类证治裁卷之二∙哮症论治》提
出哮喘有冷哮、热哮两大证候。
• 古文:遇风寒而发者为冷哮为实,伤暑热
而哮者为热哮为虚,其盐哮、酒哮、糖哮,
皆虚哮也……。
• Cold asthma is the excessive one caused by
cold wind while the hot asthma is the
efficient caused by summer heat and asthma
induced by salt, wine and sugar are all
deficient one.
06明王肯堂在《证治准绳·第二册·诸气
门· ·哮》(撰于1608年)中对寒哮作进一步辨
证。
• 古文:哮喘遇冷则发者有二证∶其一属中外
皆寒,……。其二属寒包热,……。
• 译文:Wheezing syndrome induced by cold
has two subtypes: One belongs to cold
wheezing syndrome with both interior and
exterior cold, the other belongs to the one
with exterior cold wrapping heat.
哮病虚实辨证 - 明清佳
实证
虚证
实喘气实肺盛
实喘者有邪
新病多实
遇风寒而发者
虚喘由肾虚
虚喘者无邪
久病多虚
暑热而哮者
冷哮
热哮
Treatment Principal
治则
01元朝朱丹溪(1281-1358)在《丹溪心法∙卷
二∙哮喘十五》提出治疗“已发”与“未发”
之别。
• 古文:凡久喘之症,未发宜扶正气为主,
已发用攻邪为主。
• For the patient with long-term disease, vital
qi has to be strengthened for pre-paroxysms
while evil qi has to be eliminated for
paroxysm.
02 明张景岳《景岳全书∙杂证谟∙卷之十九明集•喘促》
仔细分析哮证的治疗方法。
• 古文:扶正气者,须辩阴阳,阴虚者补其阴,阳
虚者补其阳。攻邪气者,须分微甚,或散其风,
或温其寒,或清其痰火。
• The yin-yang differentiation has to be made in the
case of strengthening vital Qi, for which yin has to
be replenished for the yin-deficient while yang has
to be replenished for the yang-deficient. The
careful differentiation has to be made in the case
of eliminating evil, in which the wind has to be
dispelled, the cold be warmed or the fire be
cleared.
The yin-yang differentiation has to be made in
the case of strengthening vital Qi, for which
yin has to be replenished for the yin-deficient
while yang has to be replenished for the yangdeficient. The careful differentiation has to be
made in the case of eliminating evil, in which
the wind has to be dispelled, the cold be
warmed or the fire be cleared.
03 元朱丹溪(1281-1358)《丹溪心法·哮喘十四》
之治法为后世所宗。
• 古文:哮喘必用薄滋味,专主于痰,宜大
吐。
• The plain food must be recommended to the
patient with asthma, for whom the emetic
agents is used to resolve the phlegm
specifically.
04 清林佩琴《类证治裁卷二∙哮症论治》(撰
于1773年)提出外感内伤两种治法。
• 古文:喘由外感者治肺,内伤者治肾。
• Gasping syndrome caused by exogenous
factor should be treated with focusing on
lung, while by internal damage, on kidney.
Principle of Treatment
① 凡久喘之症, 未发宜扶正气为主, 已发用攻
邪为主。
② 扶正气者, 须辩阴阳, 阴虚者补其阴, 阳虚
者补其阳。攻邪气者, 须分微甚, 或散其风,
或温其寒, 或清其痰火。
③ 喘由外感者治肺, 内伤者治肾。
④ 大凡治哮病, 宜忌燥药: 亦不宜纯用凉药。
Principle of Treatment
① (背诵) For the patient with long-term
disease, vital qi has to be
strengthened for pre-paroxysms
while evil qi has to be eliminated for
paroxysm.
②
扶正气者, 须辩阴阳, 阴虚者补其阴, 阳虚者补其阳。攻邪气者, 须分微甚, 或散其风, 或温其寒,
或清其痰火。
③
喘由外感者治肺, 内伤者治肾。
④
大凡治哮病, 宜忌燥药: 亦不宜纯用凉药。
TCM Formulae
方药
(一)发作期:治寒哮
01 张仲景《金匮要略·肺痿肺痈咳嗽上气病脉
证并治第七》(撰于3世纪初)记载的射干麻
黄汤为治疗哮病(寒哮大作)的祖方。
• 古文:咳而上气,喉中水鸡声,射干麻黄
汤主之。
• If the patient has cough with upwelling qi
and stridor a frog-like sound in throat,
Shegan Mahuang decoction should be used
as main formula.
(一)发作期:治寒哮
02东汉张仲景在《伤寒论·卷第三·辨太阳病脉
证并治中第六》 提出以小青龙汤治喘。
• 古文:伤寒,心下有水气,咳而微喘,发热
不渴。……小青龙汤主之。
• If there is pathogenic water fluid below
heart, cough and little gasping and fever
without thirsty due to damaged cold, Minor
Blue Dragon Decoction is used.
(一)发作期:治寒哮
03东汉张仲景在《伤寒论》中记载治喘之方。
• 古文:喘家作,桂枝加厚朴杏子佳。
• When the patient has an attack of wheezing
with this previous history, it is better to give
him Guizhi plus Houpu and Xingzi.
(二)发作期:治热哮
01明龚廷贤在《寿世保元·卷三·哮吼》用千金
定喘汤治热哮。
• 古文:千金定喘汤 治哮吼如神。
• Qianjin Dingchuan decoction is effective in
the treatment of wheezing with stirdor.
(二)发作期:治热哮
02清林佩琴在《类证治裁卷二∙哮症论治》(撰
于1773)中提出治热哮之方。
• 古文:热哮当暑月火盛痰喘者,桑白皮汤,
或白虎汤加芩、枳、瓜蒌霜。
• When wheezing syndrome attacks in
summer with exuberant fire and phlegmgasping, Sangbaipi Decoction or Baihu
Decoction plus Powder of Baical Skullcap,
Orange Fruit, and Snakegourd Fruit is used.
(二)发作期:治热哮
03 清吴瑭《温病条辨∙寒湿》麻杏石甘汤治疗
热饮。
• 古文:喘咳患促,吐稀涎,脉洪效,右大
于左,喉哑,是为热饮,麻杏石甘汤主之
• If the patient has cough and wheezing with
thin saliva and hoarse voice , whose pulse is
rapidly surging with the right bigger than
the left, the disease is due to heat fluid
which should be treated with Mahuang
Xingren Gancao .
(三)缓解期
01张仲景在《金匮要略∙肺痿肺痈咳嗽上气病
脉证并治第七》(撰于3世纪初)记载麦门
冬汤。
• 古文:大逆上气,咽喉不利,止逆下气,
麦门冬汤主之。
• When qi is ascending reversely and the
throat is constricted, Maimendong
decoction is used to control reverse qi.
(四)喘脱
01 唐王焘670-755在《外台秘要》(撰于752年)
用人参之治喘脱。
• 古文:“疗咳上气,喘息便欲绝,以人参
末之,日五次。
• To treat cough and upward qi so as to
resolve wheezing and gasping, ginseng
powder could be used five times a day.
方药小结
寒哮大发祖方
寒哮微喘
喘作
热哮
热饮
缓解期
射干麻黄汤
小青龙汤
桂枝加厚朴杏子
千金定喘汤
麻杏石甘汤
麦门冬汤
Minor Blue Dragon Decoction
Acupuncture &
Moxibustion
针灸
(一)实证:宜针。
01南宋王执中《针灸资生经》(撰于1180-1195)
• 古文:凡有哮喘者,为按肺俞,无不酸痛,
皆为缪刺肺俞,令灸而愈。
• Any patient with wheezing syndrome feels
ache when pressing acupoint of feishu,
which is contray puncture on Feishu and
could be cured with moxibustion on it.
(Canon of Promoting Health with
Acupuncture and Moxibustion).
(一)实证:宜针。
02 明杨继洲1522-1619《针灸大成》(1601)
• 古文:哮吼嗽喘:俞府、天突、膻中、
肺俞、三里、中脘 (主要)
• Wheezing Syndrome with croup: Shufu,
Tiantu, Danzhong, Feishu, Sanli and
Zhongwan are used.
(二)虚证:宜灸
01 明朝高武《针灸聚英》(刊于1529年)
• 古文:喘,灸中府、云门、天府、华盖、
肺俞。
• Moxibustion is applied in acupoints of
zhongfu, yunmen, tianfu, huagai and feishu
are selected to treat gasping syndrome.
总 结
了解
掌握
Diagnostic Terms
• 喘证:gasping syndrome
• 哮证:wheezing syndrome
• 哮喘:asthma
Mechanism
Trilogy
Fluid retention
Phlegm r.

Concealed r.
induced factors
Root
掌握
Manifestations
喉鸣
一般
呼吸衰竭
gasping
fever
orthopnea
wheezing
cough
raised shoulder
whooping
panting
Nasal flare
Xiasou Expiratory d.
Shivering
stridor
bruise lip
tearing
dyspnea
bulging eyes
方药小结
寒哮大发祖方
射干麻黄汤
寒哮微喘
Minor Blue
Dragon Decoction
喘作
热哮
热饮
缓解期
桂枝加厚朴杏子
千金定喘汤
麻杏石甘汤
麦门冬汤
病案分析
杨某,男,20岁,工人。常发作性喉间
哮鸣气急6年,入夏即发。最近哮喘又
作,喘息抬肩,喉中痰鸣如锯,不能
平卧,痰黄粘稠,咳吐不利,口渴喜
冷饮,胸闷、心悸,疲乏无力,舌红,
两侧糜烂,舌苔薄白,脉象细数。
• Case Brief
• Mr. Yang, 20-year-old, worker, has paroxysmal
wheezing with stridor and shortness of breath for
6 years, which recur in summer. Recently the
patient has recurrence of asthma again, having
wheezing with raised shoulder, phlegm rattling in
the throat, failure to lie flat and difficulty in
coughing with yellow sticky sputum. Other
symptoms can be also found: fondness of cold
drinks when thirsty, stuffy chest, palpitations,
asthenia, red tongue with erosions on both sides,
thin white fur and thready-rapid pulse.
诊治程序示范
第一步:明确诊断。
根据“常发作喉间哮鸣气喘, 不能平卧”,
诊断哮病证无疑。
第二步:鉴别缓解期与发作期哮病
根据“喘息抬肩, 喉中痰鸣如锯, 不能平卧,
胸闷,心悸等症”,当属哮喘发作期。
第三步:鉴别寒哮与热哮。
根据“入夏即发,痰黄粘稠,咳吐不利,口渴
喜冷饮,舌红,两侧糜烂,舌苔薄白,脉象细
数等症”,有热象表现,故属热哮。
第四步:确立治疗。
辨证属热哮,痰热郁肺,治疗应清热化痰,降
气平喘。方可定喘汤加减。
• Step1: Diagnosis
• It can be undoubtedly diagnosed as asthma
according to “paroxysmal wheezing with
stridor, shortness of breath and failure to
lie flat”.
• Step 2: Differentiate remission stage and
stage of attack
• It can be diagnosed as wheezing syndrome
in the stage of attack based on the
manifestation: wheezing with raised
shoulder, phlegm rattling in the throat in
throat, failure to lie flat, stuffy chest and
palpitations.
• Step 3: Syndrome differentiations for coldtype or heat-type of wheezing syndrome
• It can be diagnosed as heat-type of
wheezing syndrome according to the
manifestation: recurrence in summer,
difficulty in coughing yellow sticky sputum,
fondness of cold drinks, red tongue with
erosions on both sides, thin white fur and
thready-rapid pulse, all of which are
regarded as heat syndrome.
• Step 4:
Treatment principles & Prescriptions
• Syndrome: heat-type of wheezing
syndrome due to phlegm-heat
accumulating in lung
• Therapeutic principles: to clear heat and
resolve phlegm, lowering reverse qi to
relieve wheezing
• Prescription: Modified Dingchuan
Decoction
THANK YOU
Download
Related flashcards

Security

27 cards

Surgery

42 cards

Orthopedics

21 cards

History of medicine

34 cards

Security

37 cards

Create Flashcards