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5.1.1 Chills and fever(Aversion to cold with fever)课程教案、知识点、字幕

同学们好

下面我们开始对问诊 问现在症的部分

进行讲解

现在症

总共有十个内容

我们首先来学习 第一个部分 就是问寒热

问寒热是指的

问病人有无怕冷的感觉 或发热的症状

寒 是指怕冷的感觉

它主要有三种感觉

第一种怕冷 叫恶寒

恶寒 是指病人自觉怕冷

多加衣被 或者是近火取暖

仍觉得寒冷不能够缓解的

第二种怕冷 称为畏寒

是指病人身寒怕冷

但是加衣服 盖被子或者是近火取暖

而寒冷能够缓解的

第三种怕冷 称为恶风

恶风是指的病人主要怕风吹

被风吹就会觉得冷

避免风吹 就不会觉得冷

热 是指的发热

就是俗称发烧的症状

它主要有两种表现

第一种发热 是体温绝对的升高

人体正常体温在三十六到三十七摄氏度

超过三十七度

甚至达三十八三十九四十度则为发热

第二种发热 就是病人自觉全身

或者是局部发热

但体温是正常的

寒热的产生 它取决于两种机理

首先

寒热取决于病邪性质 比如

感受寒邪致病 通常主要以恶寒为主

而感受热邪 通常发烧的症状会比较明显

其次 寒热取决于阴阳的盛衰

我们曾经讲过

阳盛则热 阴盛则寒

阳虚则寒 阴虚则热的病变机理

阳盛和阴盛 表现出来的是实热 实寒证

而阳虚和阴虚 表现出来的是虚热和虚寒证

所以通过询问病人的怕冷和发热的情况

可以辨别病邪的性质和阴阳的盛衰

问寒热

首先要询问病人有无

怕冷和发热的症状

如果有怕冷和发热的症状

必须询问怕冷和发热是不是同时出现

还应该注意询问寒热的新久

轻重的程度 持续时间的长短

寒热出现有没有时间 或者是部位特点

寒热与体温的关系

寒热的消长 或缓解的条件

以及全身的兼症等等

临床上 常见的寒热症状有

恶寒发热 但寒不热

但热不寒 或者是寒热往来四种类型

寒热的第一种类型是 恶寒发热

恶寒发热 是指的病人恶寒和发热同时出现的症状

这是表证的特征性的症状

表证 就是外邪侵犯肌表引起的病证

这里的外邪主要是指以风邪为主的外邪

风邪为百病之长

风可以夹着其他的外邪

比如寒邪和热邪 侵犯人体

如果风夹寒邪 称为风寒之邪

风夹热邪 称为风热之邪

不夹寒不夹热 仅仅只有风邪

我们就称为外感风邪

不论是风寒之邪 风热之邪 还是单纯的风邪

只要侵犯人体肌表 卫阳被遏

体表的肌腠皮毛失去温煦

而出现体表恶寒的症状

外邪侵犯人体体表

卫阳郁闭 失于宣发

就会在体内郁而发热

所以 只要有外感邪气

不论是风寒 风热还是风邪 都会出现

恶寒和发热同时出现的症状

恶寒发热同时出现 见于表证

如何区别表证是由风寒引起

还是由风热引起

抑或是伤风引起的呢

比如

风寒之邪 就是以寒邪为主的外邪

寒为阴邪易伤阳气 寒性凝滞和收引

当寒邪侵犯人体肌表 遏制阳气

使体表阳气受损

肌表失去温煦

所以体表怕冷的症状比较重

而体内阳气由于郁闭而发热

但是

由于寒邪郁闭的阳气

使体内发热的症状不太重

所以 当恶寒和发热同时出现的时候

体表的恶寒怕冷的症状比较明显

而体内发热的症状不是很明显的时候

也就是我们称为 恶寒重而发热轻

就可以判断为外感风寒引起的表证

下面我们再看看风热之邪

风热之邪就是以热邪为主的外邪

热为阳邪 易耗气伤津

当热邪侵犯人体肌表

体表阳气就会被遏制

从而表现出怕冷

但是

由于热邪侵犯了体表 使毛孔肌腠都打开了

卫阳虽被遏制

但是能够从打开的毛孔发泄

所以体表怕冷的症状是比较轻

而体内的阳气同样也会郁闭而发热

由于热邪是阳热之邪

所以热邪能使体内的发热症状比较明显

所以

当恶寒和发热同时出现

体内发热的症状比较明显

而体表的恶寒怕冷的症状不是很明显

这就是 发热重而恶寒轻

就可以判断为外感风热之邪引起的表证

下面我们再看看 风邪

风为阳邪其性开泄

开泄是指的风邪能使皮肤毛孔打开

当风邪侵犯人体的肌表

体表阳气仍然会被遏制而出现体表怕冷

但是由于风性开泄 使腠理疏松

所以 体表怕冷的症状会比较轻

仅仅只是恶风

风一吹就觉得冷

体内的阳气同样也会郁闭

但是由于毛孔打开了

所以体内的阳气郁闭也不是很重

因此 体内的发烧的症状也是比较轻

所以

当恶寒和发热同时出现

体表的怕冷症状比较轻

体内发热症状也比较轻

这就是所谓的 发热轻而恶风

这就可以判断为外感风邪引起的表证

恶寒和发热同时出现主要见于表证

其中 恶寒重而发热轻 为外感风寒之邪引起的

我们称为风寒表证

发热重而恶寒轻 是外感风热之邪引起的

我们称为风热表证

发热轻而恶风 是外感风邪引起的

我们称为伤风表证

寒热的轻重不仅与感邪的性质有关

也与感邪的轻重和邪正盛衰有关

感邪轻的 通常寒热都比较轻

感邪重的 通常寒热都比较重

恶寒发热都很重 说明邪正俱盛

恶寒发热都比较轻

说明邪气比较轻 正气也虚衰了

而如果恶寒重而发热轻 说明邪气比较盛

正气又衰竭了

外感病初期的表证阶段

有的病人虽只有恶寒的感觉

并不觉得发热 但实际上体温多有升高

随着病情的发展 病人很快就会出现

发热的感觉

所以无论何种外邪侵犯

比如说 寒邪 热邪或者风邪

无论病人自己有没有感觉到有发热

但是 恶寒为必有的症状

因此古人说 有一份恶寒就有一份表证

我们可以这么理解

当我们开始觉得怕冷的时候

我们就已经进入了表证的阶段

因为表证又多见于感冒病证

也就是说

当我们开始觉得怕冷

就可以说我们已经进入到感冒的阶段了

另外我们还要指出

恶寒发热是表证的特征性的症状

但是某些里热证也可以表现出

恶寒和发热并见

比如 肠痈 疮疡 瘟疫

以及邪毒内陷等等

常表现为自觉恶寒严重 甚至寒战

而又有发热 体温升高的症状

这就是正气和邪气剧烈斗争的反映

Diagnostics in Chinese Medicine课程列表:

Week 1 Introduction

-Introductory remark

--Introductory remark

--QQ groups、WeChat public account

-Introduction

--Introduction

--【Discussion 1】Why do you want to take this course?

-Unit test for Introduction

Week 1 Basic Theory of Chinese Medicine 1:Yin-Yang and Five Elements Theory

-1.1 Yin-yang theory

--1.1 Yin-yang theory

-1.2 The theory of five elements

--1.2.1 The theory of five elements

--1.2.2 Application of the theory of five elements

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 1

Week 2 Basic Theory of Chinese Medicine 2:Zang-Fu Theory

-2.0 Outline

--2.0 Outline

--【Discussion 2】How to understand the holistic view centered on the Zang Fu theory?

-2.1 Liver

--2.1 Liver

--【Discussion 3】Why is repose more important than vigorous exercise in recuperation for patients with

-2.2 Heart

--2.2 Heart

-2.3 Spleen

--2.3 Spleen

-2.4 Lung

--2.4 Lung

-2.5 Kidney

--2.5 Kidney

-2.6 Six fu organs

--2.6 Six fu organs

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 2

Week 3 Basic Theory of Chinese Medicine 3:Qi,Blood and Body Fluid Theory

-3.1 Qi

--3.1 Qi

-3.2 Blood

--3.2 Blood

-3.3 Body fluid

--3.3 Body fluid

-3.4 The relationship of qi, blood and body fluid

--3.4 The relationship of qi, blood and body fluid

--【Discussion 4】A discussion about the theory of qi, blood and body fluid

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 3

Week 4 Basic Theory of Chinese Medicine 4: The theory of etiologic factor

-4.0 Outline

--4.0 Outline

-4.1 Six exogenous factors

--4.1.1 Six exogenous factors

--4.1.2 Nature and pathogenicity of wind and cold

--4.1.3 Nature and pathogenicity of summer heat and damp

--4.1.4 Nature and pathogenicity of dryness and fire

-4.2 Etiology of visceral impairment

--4.2 Etiology of visceral impairment

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 4

Week 5 Diagnosis methods: Inquiry (1)

-5.0 Outline of inquiry

--5.0.1 Outline of inquiry(1)

--5.0.2 Outline of inquiry(2)

--【Discussion 5】If you were a patient, how would you describe your condition to your doctor first?

-5.1 Inquiry of Chills and fever

--5.1.1 Chills and fever(Aversion to cold with fever)

--5.1.2 Chills and fever(Chills without fever)

--5.1.3 Chills and fever(Fever without chills)

--5.1.4 Chills and fever(Alternative chills and fever)

--【Discussion 6】How to understand "if you have clinical manifestations of cold, that is exterior syndr

-5.2 Inquiry of perspiration

--5.2 Inquiry of perspiration

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 5

Week 6 Diagnosis methods: Inquiry (2)

-5.3 Inquiring of pain

--5.3 Inquiring of pain

--【Discussion 7】How to understand "stagnation leading to pain and innourish leading to pain"?

-5.4 Inquiring of head, body, thorax and abdomen

--5.4 Inquiring of head, body, thorax and abdomen

-5.5 Inquiring of ears and eyes

--5.5 Inquiring of ears and eyes

-5.6 Inquiring of sleep

--5.6 Inquiring of sleep

-5.7 Inquiring of food and drink, appetite and taste

--5.7 Inquiring of food and drink, appetite and taste

-5.8 Inquiring of defecation and urination

--5.8.1 Inquiring of defecation

--5.8.2 Inquiring of urination

-5.9 Inquiring of infantile and women's disease

--5.9 Inquiring of infantile and women's disease

-Unit test for week 6

Week 7 Diagnosis methods: Observation (1)

-6.0 Outline of Observation

--6.0 Outline of Observation

--【Discussion 8】Please use the whole body inspection (including the expression, complexion and figure)

-6.1.1 Observation of vitality

--6.1.1 Observation of vitality

-6.1.2 Observation of the color

--6.1.2.1 The content, principles of inspection of the color

--6.1.2.2 Indication of diseases by five colors

--【Discussion 9】How do you understand the normal complexion of a normal people?

-6.1.3 Observation of the appearance

--6.1.3 Observation of the appearance

-6.1.4 Observation of figure and posture

--6.1.4 Observation of figure and posture

-Unit test for week 7

Week 8 Diagnosis methods: Observation (2)

-6.2.1 Observation of head and face

--6.2.1 Observation of head and face

-6.2.2 Observation of five sensory organs

--6.2.2.1Observation of five sensory organs(observation of eyes,ears,nose)

--6.2.2.2Observation of five sensory organs(observation of lips,teeth and gums,throat)

-6.2.3 Observation of body

--6.2.3 Observation of body

-6.2.4 Observation of limbs

--6.2.4 Observation of limbs

-6.2.5 Observation of two lower orifices

--6.2.5 Observation of two lower orifices

-6.2.6 Observation of skin

--6.2.6 Observation of skin

-6.3 Observation of excreta

--6.3 Observation of excreta

-6.4 Observation of infantile fingerprints

--6.4 Observation of infantile fingerprints

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 8

Week 9 Diagnosis methods: Inspection of tongue

-7.1 Outline of tongue inspection

--7.1.1 The morphology and structure of the tongue

--7.1.2 The principle of tongue examination

--7.1.3 The method and precaution of tongue examination

--7.1.4 The content of tongue examination, normal tongue

-7.2 Inspection of tongue structure

--7.2.1 Observe the color of tongue

--7.2.2 Observe the shape of tongue

--7.2.3 Observe the states of tongue

--7.2.4 Observation of sublingual vein

-7.3 Observation of tongue coating

--7.3.1 Observation of coating texture

--7.3.2 Observe the color of coating

-7.4 Clinical significance of tongue diagnosis

--7.4 Clinical significance of tongue diagnosis

--【Discussion 10】Why to observe the tongue can be used to diagnose disease?

-Unit test for week 9

Week 10 Diagnosis methods::Pulse examination

-8.1 The principle of pulse examination

--8.1 The principle of pulse examination

-8.2 The regions and methods of pulse examination

--8.2 The regions and methods of pulse examination

-8.3 The elements of pulse examination and the normal pulse

--8.3 The elements of pulse examination and the normal pulse

-8.4 Characteristics and significance of pulse

--8.4.1 Superficial pulse, deep pulse, slow pulse, rapid pulse

--8.4.2 Surging pulse, thin pulse, long pulse, short pulse

--8.4.3 Feeble pulse, forceful pulse, slippery pulse, uneven

--8.4.4 Taut pulse, tense pulse,soggy pulse, moderate pulse

--8.4.5 Knotted, slow-regular-intermittent, irregularly abrupt

-8.5 Similar pulse, concurrent pulse, pulse indicating deterioration of visceral qi۞

--8.5 Similar pulse, concurrent pulse, pulse indicating deterioration of visceral qi۞

--【Discussion 11】Why is complex pulse more common than single-factor pulse?

-8.6 Women’s pulse, children’s pulse

--8.6 Women’s pulse, children’s pulse

-8.7 The clinical significance of pulse diagnosis

--8.7 The clinical significance of pulse diagnosis

-Unit test for week 10

Week 11 Diagnosis methods:Listening and smelling examination

-9.1 Listening

--9.1 Listening

-9.2.1 Abnormal sound

--9.2.1 Abnormal sound

-9.2.2 Abnormal language

--9.2.2 Abnormal language

-9.2.3 Respiratory abnormality

--9.2.3 Respiratory abnormality

-9.2.4 Cough

--9.2.4 Cough

--【Discussion 12】How to observe the patient's cough sound and sputum changes to determine whether the

-9.2.5 Abnormal sounds of the stomach and intestines

--9.2.5 Abnormal sounds of the stomach and intestines

-9.3 Smelling

--9.3 Smelling

--【Discussion 13】How to diagnose by smelling?

-Unit test for week 11

Week 12 Diagnosis methods:Palpation

-10.1 The method, meaning and precautions of palpation

--10.1 The method, meaning and precautions of palpation

-10.2 Contents of palpation

--10.2.1 Palpating chest and hypochondrium

--10.2.2 Palpating stomach and abdomen

--10.2.3 Palpating skin

--10.2.4 Palpating hands and feet, palpating acupoints

--【Discussion 14】How to determine whether external or internal injuries?

-Unit test for week 12

Conclusion

-Conclusion

--Conclusion

Final Exam

-Final Exam

--Final Exam

5.1.1 Chills and fever(Aversion to cold with fever)笔记与讨论

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