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1、中医内科护理中医内科护理中医内科护理中医内科护理主讲：高健1Goals of Studying掌握各个病证的病情分析及护理。掌握相关专业词汇。熟悉各个病证的定义。了解各个病证的健康指导。能够灵活运用理论知识对个案进行有针对性的护理。http:/ cold3Common coldDefinition Common cold 是感受触冒外邪所导致的常见外感疾病，临床表现以鼻塞，流涕，喷嚏，头痛，恶寒、发热、全身不适等为特征。四季均可发病，尤以冬春季节为多。4感冒一名，北宋仁斋直指方即有记载。而内经已指出感冒主要是外感风邪所致。元丹溪心法伤风明确指出病位属肺，根据辨证，分列辛温、辛凉两大治法。此后医
2、家又对虚人感冒有进一步的认识，提出扶正达邪的治疗要求。Common cold5Cause of Disease and Pathomechanismv六淫(six exogenous pathogenic factors)v时行病毒(seasonal virus)v人体正气(health qi)不足其病机关键在于邪实正虚(excess of evil and asthenia of health qi)。Common cold6Analyses of pathological conditionsv风寒感冒(common cold due to wind-cold)v风热感冒(common c
3、old due to wind-heat)v暑湿感冒(common cold due to summer-dampness)v体虚感冒 气虚感冒(common cold due to asthenia of qi)阴虚感冒(common cold due to asthenia of yin)Common cold7Analyses of pathological conditionsv Common cold due to wind-cold 恶寒重，发热轻，无汗头痛，肢体痰楚，鼻塞声重，时流清涕，咽痒咳嗽，痰稀薄色白，口不渴或喜热饮，苔薄白而润，脉浮或浮紧。Common cold8Anal
4、yses of pathological conditionsv Common cold due to wind-heat 身热较著，微恶风，汗泄不畅，头胀痛，鼻塞，流黄浊涕，口渴欲饮，咽喉红肿疼痛，咳嗽，痰黄粘稠，苔薄黄，脉浮数。Common cold9Analyses of pathological conditionsv Common cold due to summer-dampness 身热，微恶风，汗少，肢体酸重或疼痛，头昏重胀痛，咳嗽痰粘，鼻流浊涕，心烦口渴，或口中粘腻，渴不多饮，胸闷，泛恶，小便短赤，舌苔薄黄而腻，脉濡数。Common cold10Analyses of pat
5、hological conditionsv Common cold due to asthenia of qi 经常感冒，反复不愈，恶寒重，发热，咳嗽，咳痰无力，气短，倦怠，舌淡苔白，脉浮无力。v Common cold due to asthenia of yin 头痛身热，微恶风寒，少汗，头昏，心烦，口干，于咳少痰，舌红少苔，脉细数。Common cold11Problems of patientsNursing goalsCommon cold12Nursing interventionsv Common cold due to wind-coldPrinciple of nursing
6、：辛温解表Entirety nursing：Life care：Diet care：Drugs care：Acupuncture：Tui na：Common cold13Nursing interventionsv Common cold due to wind-heatPrinciple of nursing：辛凉解表Entirety nursing：Life care：Diet care：Drugs care：Acupuncture：Tui na：Common cold14Nursing interventionsv Common cold due to summer-dampnessPr
7、inciple of nursing：驱湿解表Entirety nursing：Life care：Diet care：Drugs care：Acupuncture：Tui na：Common cold15Nursing interventionsv Common cold due to asthenia of qiPrinciple of nursing：益气解表Entirety nursing：Life care：Diet care：Drugs care：Acupuncture：Tui na：Common cold16Nursing interventionsv Common cold d
8、ue to asthenia of yinPrinciple of nursing：滋阴解表Entirety nursing：Life care：Diet care：Drugs care：Acupuncture：Tui na：Common cold17Nursing evaluationIntroduction on healthv气候突变时要注意保暖，坐卧须防外邪。v保持室内空气流通，或选用食醋熏蒸法、消毒香熏法等做空气消毒。v时行感冒流行期间，可用板蓝根冲剂预防给药。v积极参加体育锻炼，以增强体质。Common cold1819Cough咳嗽20Teaching objectives熟悉咳
9、嗽的病因病机了解其诊断与鉴别诊断熟悉外感咳嗽及内伤咳嗽的护治原则掌握常见七种类型咳嗽的辨证施护了解预防与调养。21What is cough?22Definition Cough 是指肺气上逆做声，咯吐痰涎而言，为肺系疾病的主要证候之一。分别言之，有声无痰为咳，有痰无声为嗽，一般多痰、声并见，故以咳嗽并称。23Evolution History内经对咳嗽已有论述，素问咳论明确指出“五脏六腑皆令人咳，非独肺也。”明代张景岳将咳嗽归纳为外感、内伤两大类，为咳嗽的辨证奠定了基础。24What is its cause?25Cause of Disease&Pathomechanism 咳嗽的病因有外
10、感与内伤两大类，外感咳嗽为六淫外邪人侵肺系；内伤咳嗽为脏腑功能失调，内邪干肺。病机关键在于肺失宣肃，肺气上逆而作咳。v外感咳嗽(exogenous cough)v内伤咳嗽(cough due to internal injury)26Analyses of pathological conditions v exogenous coughv cough due to internal injury风寒袭肺 风热犯肺 风燥伤肺 痰湿犯肺 痰热郁肺 肝火犯肺肺阴亏耗 27vExogenous cough风寒袭肺(wind-cold attacking lung)咳嗽声重，气急，咽痒，咳痰稀薄色白，
11、常伴有鼻塞、流清涕、头痛、肢体酸楚、恶寒发热、无汗等表证，苔薄白，脉浮或浮紧。Analyses of pathological conditions28vExogenous cough风热犯肺(wind-heat attacking lung)咳嗽频剧，气粗，或咳声嘶哑，喉痒咽痛，咳痰不爽，痰粘稠或色黄，咳时汗出，常伴有鼻流黄涕、口渴、身热等表证，舌苔薄黄，脉浮数。Analyses of pathological conditions29vExogenous cough风燥伤肺(wind-dryness attacking lung)干咳频作，连声作呛，咽喉干痛，唇鼻干燥，无痰，或痰少而粘连成
12、丝，不易咳出，痰中带血丝，口干，初起可伴有鼻塞、头痛、微寒身热等表证，苔薄白或薄黄，质红，干而少津，脉浮数。Analyses of pathological conditions30vCough due to internal injury痰湿犯肺(phlegm-dampness obstructing lung)咳嗽反复发作，咳声重浊，痰多，因痰而咳，痰出咳平，痰粘腻或稠厚成块，色白或黄灰色，胸闷，脘痞，呕恶，食少，体倦，大便时溏，苔白腻，脉濡滑。Analyses of pathological conditions31vCough due to internal injury痰热郁肺(st
13、agnation of phlegm-dampness in lung)咳嗽气息粗促，或喉间有痰声，痰多质粘或稠黄，咯吐不爽，或吐血痰，胸胁胀满，咳时引痛，面赤，或有身热，口干欲饮，舌红，苔薄黄腻，脉滑数。Analyses of pathological conditions32vCough due to internal injury肝火犯肺(liver-fire attacking lung)上气咳逆阵作，咳时面赤，咽干，常感痰滞咽喉，咯之难出，量少质粘，胸胁胀痛，咳时引痛，口干苦，可随情绪波动而增减，舌苔薄黄少津，脉弦数。Analyses of pathological conditio
14、ns33vCough due to internal injury肺阴亏耗(lack of lung-yin)干咳，咳声短促，痰少粘白，或痰中夹血，或声音逐渐嘶哑，口干咽燥，或午后潮热颧红，手足心热，盗汗，神疲，舌质红，少苔，脉细数。Analyses of pathological conditions34诊断 Diagnosis鉴别诊断 Differential diagnosis&35诊断 Diagnosis咳逆有声，或伴咽痒咯痰。外感咳嗽，起病急，可伴有寒热等表证；内伤咳嗽，每因外感反复发作，病程较长，咳而伴喘。急性期，血白细胞总数和中性粒细胞增高。听诊可闻及两肺野呼吸音增粗，或伴散在干
15、湿性罗音。肺部线摄片检查，正常或肺纹理增粗。36Problems of patientsNursing goals37vExogenous coughwind-cold attacking lungPrinciple of nursing：疏风散寒，宣肺止咳Entirety nursing：Life care：Diet care：Drugs care：Acupuncture：Tui na：Nursing interventions38vExogenous coughwind-heat attacking lungPrinciple of nursing：疏风清热，宣肺化痰Entirety nu
16、rsing：Life care：Diet care：Drugs care：Acupuncture：Tui na：Nursing interventions39vExogenous coughwind-dryness attacking lungPrinciple of nursing：疏风清肺，润燥止咳Entirety nursing：Life care：Diet care：Drugs care：Acupuncture：Tui na：Nursing interventions40vCough due to internal injuryphlegm-dampness obstructing l
17、ungPrinciple of nursing：健脾燥湿，化痰止咳Entirety nursing：Life care：Diet care：Drugs care：Acupuncture：Tui na：Nursing interventions41vCough due to internal injurystagnation of phlegm-dampness in lungPrinciple of nursing：清热化痰肃肺Entirety nursing：Life care：Diet care：Drugs care：Acupuncture：Tui na：Nursing intervent
18、ions42vCough due to internal injuryLiver-fire attacking lungPrinciple of nursing：清肺平肝，顺气降火Entirety nursing：Life care：Diet care：Drugs care：Acupuncture：Tui na：Nursing interventions43vCough due to internal injuryLack of lung-yinPrinciple of nursing：滋阴润肺，止咳化痰Entirety nursing：Life care：Diet care：Drugs ca
19、re：Acupuncture：Tui na：Nursing interventions44Nursing evaluationIntroduction on healthv 防寒保暖，避免外邪侵袭。若已有感冒迹象者，可服用姜糖水或解表药以驱邪外出。v 锻炼身体，增强体质，配合气功或呼吸操v 戒烟，忌食辛辣油腻之品。45哮证Wheezing syndrome46Wheezing syndromedefinition Wheezing syndrome 是一种发作性的痰鸣气喘疾患。发作时喉中哮鸣有声，呼吸气促困难，甚则喘息不能平卧。47 哮证发作期的基本病理变化为“伏痰（latent phlegm
20、)”遇感饮触，痰随气升，气因痰阻，相互搏结，壅塞气道，肺气宣降失常，引动停积之痰，而致痰鸣如吼，气息喘促。Cause of Disease&Pathomechanism48Analyses of pathological conditionsv寒哮(cold wheezing)：呼吸急促，喉中哮鸣有声，胸膈满闷如塞，咳不甚，痰少咯吐不爽，面色晦滞，口不渴；或渴喜热饮，天冷或受寒易发，形寒肢冷，舌苔白滑，脉弦紧或浮紧。v热哮(hot wheezing)：气喘息涌，喉中痰鸣如吼，胸高胁胀，呛咳阵作，咳痰色黄或白，粘浊稠厚，排吐不利，烦闷不安，汗出，面赤，口苦，口渴喜饮，舌红，苔黄腻，脉弦滑或滑数。
21、Wheezing syndrome49Problems of patientsNursing goalsWheezing syndrome50Nursing interventionsvCold wheezing Principle of nursing：温肺散寒，化痰平喘 Entirety nursingLife care：Diet care：Drugs care：Acupuncture：Other methods:Wheezing syndrome51Nursing interventionsvHot wheezing Principle of nursing：清热宣肺，化痰平喘 Enti
22、rety nursing:Life care：Diet care：Drugs care：Acupuncture：Other methods：Wheezing syndrome52Nursing evaluationIntroduction on healthv可视身体情况进行跑步、太极拳、冷水浴等锻炼。v避免接触刺激性的气体、灰尘、花粉等，忌吸烟。v饮食宜清淡，忌食肥甘、腥膻、辛辣、生冷等。Wheezing syndrome53喘证Asthma syndrome/dyspnea syndrome54了解喘证的概念，范围熟悉喘证的病因病机掌握实喘与虚喘的鉴别诊断和各证型的辨证施护熟悉喘脱的护治措
23、施了解预防与调养。Teaching objectives55Definition Asthma syndrome 是以呼吸困难，甚至张口抬肩，鼻翼煽动，不能平卧为特征。严重者可持续不解，发生喘脱。56Evolution History内经认为喘证以肺为主病之脏，并且描述了喘证的临床特点。金匮要略肺痿肺痈咳嗽上气病中，“上气”即指喘息不能平卧的症候。明张景岳把喘证归纳为虚实两类，指出喘证的辨证纲领。清叶天士进一步指出喘证“在肺为实，在肾为虚”，为喘证的病机重点。57Cause of Disease&Pathomechanism 总之，喘证病因有外感与内伤，病性有虚实不同，病位主要在肺肾两脏，实喘
24、(sthenia dyspnea/excess dyspnea)在肺，为外邪、痰浊、肝郁气逆等，邪壅肺气，宣降不利；虚喘(asthenia-asthma/deficiency-asthma)责之于肺肾两脏，因精气不足，气阴亏耗而致肺肾出纳失常，重点在肾，且以气虚为主。58Analyses of pathological conditionsvExcess dyspnea vAsthenia asthma风寒袭肺表寒里热痰浊阻肺肺气郁痹 肺虚肾虚59vExcess dyspneaWind-cold attacking lung 喘咳气急，胸部胀闷，痰多稀薄色白，兼有头痛，恶寒，或伴发热，口不渴，
25、无汗，苔薄白而滑，脉浮紧。Analyses of pathological conditions60vExcess dyspnea表寒里热(exterior cold and interior heat)喘逆上气，胸胀或痛，鼻煽，咳而不爽，咳痰稠粘，伴有形寒，身热，烦闷，身痛，有汗或无汗，口渴，舌质红，苔薄白或黄，脉浮数或滑。Analyses of pathological conditions61vExcess dyspnea痰浊阻肺(turbid phlegm obstructing lung)喘而胸满窒闷，甚则胸盈仰息，咳嗽痰多粘腻色白，咯吐不利，兼有呕恶，纳呆，口粘不渴，苔白厚腻，脉滑
26、。Analyses of pathological conditions62vExcess dyspnea肺气郁痹(obstruction of pulmonary qi)每遇情志刺激而诱发，发时突然呼吸短促，但喉中痰声不著，气憋，胸闷胸痛，咽中如窒，失眠，心悸，苔薄，脉弦。Analyses of pathological conditions63vAsthenia-asthma肺虚(lung-asthenia)喘促短气，气怯声低，喉有鼾声，咳声低弱，痰吐稀薄，自汗恶风，或咳呛痰少，质粘，烦热口干，咽喉不利，舌质淡红或舌红苔剥，脉软弱或细数。Analyses of pathological c
27、onditions64vAsthenia-asthma肾虚(kidney-asthenia)喘促日久，动则喘甚，呼多吸少，气不得续，形瘦神惫，汗出肢冷，面青唇紫，舌苔淡白，脉微细或沉弱。或喘咳，面红烦躁，足冷，汗出如油，舌红少津，脉细数。Analyses of pathological conditions65诊断 Diagnosis鉴别诊断 Differential diagnosis&66诊断 Diagnosis以气短喘促，呼吸困难，甚至张口抬肩，鼻翼煽动，不能平卧，口唇发绀为特征多有慢性咳嗽，哮病，肺痿，心悸等病史，每遇外感及劳累而诱发。呈桶状胸，叩诊胸部呈过清音，心浊音界缩小或消失，肝
28、浊音界下移，肺呼吸音减低。67诊断 Diagnosis可闻及干、湿性罗音或哮鸣音。或肝肿大，下肢浮肿，颈静脉怒张。合并感染者，白细胞总数及中性粒细胞可增高。必要时查血钾、钠，二氧化碳结合力及X线胸部摄片，心电图，心、肺功能测定，血气分析等。68Problems of patientsNursing goals69vExcess dyspneaWind-cold attacking lung Principle of nursing：宣肺散寒平喘 Entirety nursing:Life care：Diet care：Drugs care：Acupuncture：Other methods：N
29、ursing interventions70vExcess dyspneaExterior cold and interior heat Principle of nursing：宣肺泄热 Entirety nursing:Life care：Diet care：Drugs care：Acupuncture：Other methods：Nursing interventions71vExcess dyspneaTurbid phlegm obstructing lung Principle of nursing：化痰降气 Entirety nursing:Life care：Diet care
30、：Drugs care：Acupuncture：Other methods：Nursing interventions72vExcess dyspneaObstruction of pulmonary qi Principle of nursing：开郁降气平喘 Entirety nursing:Life care：Diet care：Drugs care：Acupuncture：Other methods：Nursing interventions73vAsthenia-asthmaLung-asthenia Principle of nursing：补肺益气养阴 Entirety nurs
31、ing:Life care：Diet care：Drugs care：Acupuncture：Other methods：Nursing interventions74vAsthenia-asthmaKidney-asthenia Principle of nursing：补肾纳气 Entirety nursing:Life care：Diet care：Drugs care：Acupuncture：Other methods：Nursing interventions75Nursing evaluationIntroduction on health1.慎风寒，节饮食，薄滋味，积极参加体育锻炼以增强体质。2.积极治疗感冒，咳嗽等肺系病证，防止演变成本证3.戒烟，避免各种有害的气体及烟尘刺激。4.注意情志调畅，保持良好的心情；要节制房事。7677