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1、内科中医诊疗方案目录咳嗽（急性支气管炎）中医诊疗方案 2中风病（脑梗塞）急性期中医诊疗方案6胃痛（慢性胃炎）中医诊疗方案 12附：咳嗽（急性支气管炎）、中风病（脑梗塞）急性期、胃痛（慢性胃炎）的优化及总结17精品w o r d 可编辑资料-第 1 页，共 25 页-咳嗽（急性支气管炎）中医诊疗方案一、适用对象中医诊断：第一诊断为咳嗽（TCD编码：BNF010）西医诊断：第一诊断为急性支气管炎（ICD-10 编码：）二、诊断（一）疾病诊断1中医诊断标准：参照中医内科学（田德禄主编，人民卫生出版社，2002 年）、中华人民共和国中医药行业标准中医病证诊断疗效标准（ZY/）。（1）有上呼吸道感染史。
2、（2）咳嗽为主，或伴有咯痰，或咽干、咽痒，（3）胸部查体双肺呼吸音粗，有时可闻及湿性或干性啰音。X线有肺纹理增多、增粗。2西医诊断标准：参照咳嗽的诊断与治疗指南（中华医学会，2009 年）。属于急性咳嗽的患者（1）病史：由呼吸道感染引起，或冷空气、粉尘及刺激性气体诱发的一类咳嗽。（2）主要症状：多表现为咳嗽，或咳白色黏液痰或黄浓痰。（3）主要体征：查体双肺呼吸音粗，有时可闻及湿性或干性啰音。（4）辅助检查：胸部X线检查有肺纹理增多、增粗。精品w o r d 可编辑资料-第 2 页，共 25 页-文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6
3、X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 Z
4、I5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6
5、X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 Z
6、I5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6
7、X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 Z
8、I5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6
9、X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8（二）证候诊断 1.风寒袭肺证：咳嗽声重，咯稀白痰，常伴鼻塞流清涕，头痛，肢体酸楚，恶寒发热，无汗等表证，舌苔薄白，脉浮或浮紧。2风热犯肺证：咳嗽气粗，喉燥咽痛，痰粘或黄，常伴鼻流黄涕，头痛，恶风身热等表证，舌苔薄黄，脉浮数或浮滑。3风燥伤肺证：咳嗽，少痰，口干，咽干，鼻燥，鼻痒，大便干，夜间咳甚，舌淡红、少津，脉细数。三、治疗方案（一）辨证选择口服中药汤剂和中成药1.风寒袭肺证治法：疏风散寒，宣肺止咳。推荐方药：三拗汤合止嗽散。麻黄、荆芥、百部、杏仁、紫
10、菀、甘草、陈皮、桔梗、白前。中成药：藿香正气口服液、玉屏风颗粒等。2风热犯肺证治法：疏风清热，宣肺止咳。推荐方药：桑菊饮。桑叶、菊花、杏仁、桔梗、连翘、薄荷、苇根、甘草。中成药：金贝痰咳清颗粒等。3风燥伤肺证治法：疏风清肺，润燥止咳。推荐方药：桑杏汤。桑叶、杏仁、沙参、象贝、豆豉、栀子、梨皮。精品w o r d 可编辑资料-第 3 页，共 25 页-文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码
11、:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6
12、K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码
13、:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6
14、K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码
15、:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6
16、K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8中成药：
17、养阴清肺丸等。（二）针灸、穴位埋线、穴位注射、药线点灸根据病情可选择大椎、肺俞、定喘、风门、天突、合谷、尺泽、足三里等穴。（三）药物贴敷根据病情可辨证选择药物贴敷治疗。（四）刮痧、拔罐疗法凡士林涂搽后背暴露部位，用刮痧板反复刮、擦背部膀胱经、督脉，以微现红瘀为度，可配合风门、大椎、肺俞等穴闪罐，达到疏通经络、驱散风邪的作用。每日12 次。（五）其他疗法咽痒、咽部不适、咳嗽痰多等症状时，可配合雾化吸入治疗。（六）健康教育1生活、饮食指导。2心理辅导。四、难点分析1、有些咳嗽治疗效果不佳，与生活调护不利有关，必须详细交代患者谨记忌食辛辣、肥甘，远烟酒及房事等，有助于人体正气的恢复，是非药物疗法中重
18、要的一环。2、燥咳者，多于夜间及晨起时发作，此多为营卫二气不和，肺气不利所致，现代医学解释为过敏，一般止咳药和抗生素无效，较为棘手，可用脱敏煎（防风、乌梅、五味子、徐长卿、玄参等）加减，或非那根片等抗过敏治疗，能提高疗效。精品w o r d 可编辑资料-第 4 页，共 25 页-文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8
19、文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1
20、Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8
21、文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1
22、Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8
23、文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1
24、Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8五、疗效评价（一）评价标准以咳嗽症状计分为疗效评价标准。1、痊愈：咳嗽症状完全消
25、失（治疗后降至0 分）。2、显效：咳嗽症状明显减轻（治疗后较治疗前减少69 分）。3、有效：咳嗽症状减轻（治疗后较治疗前减少25 分）。4、无效：咳嗽症状无改善或加重。（二）评价方法咳嗽症状计分：由患者每天根据自己前24 小时的咳嗽症状，对照计分表进行判断及记录：总分值=日间计分+夜间计分。计分日间咳嗽症状夜间咳嗽症状0无咳嗽无咳嗽112 次短暂咳嗽仅在清晨或将要入睡时咳嗽22 次以上短暂咳嗽因咳嗽导致惊醒1次或早醒3频繁咳嗽，但不影响日常活动因咳嗽导致夜间频繁惊醒4频繁咳嗽，影响日常活动夜间大部分时间咳嗽5严重咳嗽，不能进行日常活动严重咳嗽不能入睡精品w o r d 可编辑资料-第 5 页，
26、共 25 页-文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C
27、1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J
28、6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C
29、1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J
30、6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C
31、1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J
32、6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8中风病（脑梗塞）急性期诊疗方案一、适用对象中医诊断：第一诊断为中风（TCD编码：DNG080）西医诊断：第一诊断为脑梗塞急性期（ICD-10 编码：）二、诊断（一）疾病诊断1中医诊断标准：参照国家中医药管理局脑病急症科研协作组起草制订的中风病中医诊断疗效评定标准（试行，1995 年）。主要症状：偏瘫、神识昏蒙，言语謇涩或不语，偏身感觉异常，口舌
33、歪斜。次要症状：头痛，眩晕，瞳神变化，饮水发呛，目偏不瞬，共济失调。急性起病，发病前多有诱因，常有先兆症状。发病年龄多在40 岁以上。具备 2 个主症以上，或1 个主症、2 个次症，结合起病、诱因、先兆症状、年龄即可确诊；不具备上述条件，结合影像学检查结果亦可确诊。2西医诊断标准：参照2010 年中华医学会神经病学分会脑血管病学组制定的中国急性缺血性脑卒中诊治指南2010。（1）急性起病（2）局灶性神经功能缺损，少数为全面神经功能缺损（3）症状和体征持续数小时以上精品w o r d 可编辑资料-第 6 页，共 25 页-文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I
34、6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1
35、HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I
36、6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1
37、HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I
38、6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1
39、HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I
40、6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8（4）脑 CT或 MRI排除脑出血和其它病变（5）脑 CT或 MRI有责任梗死病灶。（二）疾病分期1急性期：发病2 周以内。2恢复期：发病2 周至 6 个月。3后遗症期：发病6 个月以后。（三）病类诊断1中经络：中风病无意识障碍者。2中脏腑：中风病有意识障碍者。（四）证候诊断1中经络（1）风火上扰证：眩晕头痛，面红耳赤，口苦咽干，心烦易怒，尿赤便干，舌质红绛，舌苔黄腻而干，脉弦数。（2）风痰阻络证：头晕目眩，痰多而黏，舌质暗淡，舌
41、苔薄白或白腻，脉弦滑。（3）阴虚风动证：眩晕耳鸣，手足心热，咽干口燥，舌质红而体瘦，少苔或无苔，脉弦细数。（4）气虚血瘀证：面色晄白，气短乏力，口角流涎，自汗出，心悸便溏，手足肿胀，舌质暗淡，舌苔白腻，有齿痕，脉沉细。2.中脏腑（1）痰热内闭证（阳闭）：意识障碍、半身不遂，口舌歪斜，言语謇涩或不语，鼻鼾痰鸣，或肢体拘急，或躁扰不宁，或身热，或口臭，或抽搐，或呕血，舌质红、舌苔黄腻，脉弦滑数。精品w o r d 可编辑资料-第 7 页，共 25 页-文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6
42、S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1
43、A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6
44、S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1
45、A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6
46、S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1
47、A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6
48、S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8（2）元气败脱证：昏愦不知，目合口开，四肢松懈瘫软，肢冷汗多，二便自遗，舌卷缩，舌质紫暗，苔白腻，脉微欲绝。三、治疗方案（一）辨证选择口服中药汤剂、中成药中风病（脑梗死）急性期治疗重在祛邪，佐以扶正，以醒神开窍、化痰通腑、平肝息风、化痰通络为主要治法。1中经络（1）风火上扰证治法：清热平肝，潜阳息风。推荐方药：天麻钩藤饮。天麻、钩藤后下、石决明先煎、牛膝、黄芩、山栀、杜仲、桑寄生、益母草、茯神、夜交藤。中成药：天麻杜仲胶囊等。（2）风痰阻络证治法：息风化痰通络。推荐方药：半夏白术天麻汤。半夏、天麻、茯苓
49、、橘红、白术、甘草。中成药:华佗再造丸等。（3）阴虚风动证治法：滋阴息风。推荐方药：镇肝熄风汤。牛膝、代赭石、生龙骨先煎、生牡蛎先煎、先煎、龟板先煎、白芍、玄参、天冬9g、川楝子、茵陈、麦芽、甘草。中成药：镇脑宁胶囊、知柏地黄丸等。（4）气虚血瘀证精品w o r d 可编辑资料-第 8 页，共 25 页-文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z
50、1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX2M6X1C1A1 HE1Q2K6K2Z1 ZI5J6S1I6C8文档编码:CX