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5.8.2 Inquiring of urination课程教案、知识点、字幕

同学们好

下面我们来继续学习问二便的问小便的内容

问小便 首先 我们要了解小便的形成

和排泄的过程

小便的形成和排泄 主要与人体的津液有关

饮食入胃

这里主要是指饮食物中的水分入胃

通过胃的受纳腐熟

传向小肠

通过小肠的分清别浊 再传向大肠

通过大肠的燥化和传导

一部分变成大便

还有一部分会转变成为小便

其中胃的受纳腐熟

小肠的分清别浊

和大肠的燥化

都与脾的运化升清功能有关

脾升清 不仅把饮食水谷精微中间的

津液部分提取出来

通过肺宣发和肃降到全身

同时小肠的别浊

和大肠的燥化

使水分气化到膀胱变成小便

另外

肾阳的温煦和推动功能

也可以气化全身大部分的水分

变成小便 贮存在膀胱

再由膀胱气化成为尿液 排出体外

所以小便的形成过程和排泄过程

与大小肠 膀胱

与肺 脾 肾

以及三焦

都是有密切关系的

所以我们问小便

可以诊察体内津液的盈亏

以及有关脏器的气化功能

问小便的内容

主要问尿次 尿量和排尿的感觉

首先我们看看正常的小便

健康成年人 白天排尿三到五次

夜间排尿零到一次

一昼夜的总尿量是1000到2000毫升

颜色是淡黄色

排出通畅 有便即解

这里需要说明几点

第一个就是

尿量和尿次受温度 比如气温 体温

以及饮水 出汗和年龄因素的影响

比如

天气热的时候 出汗多

排尿次数就会减少

天气冷的时候 排尿次数就会增多

喝水多 排尿次数就会增多

出汗多 排尿次数就会减少

第二个就是

小便是判断肾精充足与否的一个很重要的标志

尤其是夜尿的次数

在判断肾气是否充足最重要的

通常来讲 成年人肾精充足

夜尿次数应该为零次

也就是

不会有夜尿

而老年人

比如49岁以上的女性

和56岁以上的男性

由于肾精的生理性的衰退

所以

有一次的夜尿也是属于正常的

如果成年人经常有一次夜尿

或者老年人经常有一次以上的夜尿

都是属于肾精不足的标志

那么还要强调一下夜尿

夜尿 是指的夜晚睡着了之后到第二天早上起床的时候

这个中间的夜尿次数 才称为夜尿

但是如果一个人晚上没有睡觉

或者在熬夜 可能上很多次厕所

都不能够称为夜尿

小便异常 主要是从三个方面来看

尿量的异常 尿次异常和排尿感觉异常

我们先来看看尿量的异常

尿量的异常有两种

量多和量少

尿量和尿次都明显超过正常 称为量多

通常白天清长而量多

夜晚夜尿也比较多

这是由于

肾阳虚 不能气化津液

水液直趋膀胱所导致的

另外 有一种

多饮 多食 多尿 伴有消瘦

这是消渴病的典型的特征

量少 是指的尿量和尿次都明显于少于正常

可以见于以下两种

尿量少 伴有口渴咽干

通常见于热病损伤了津液

或腹泻以及汗吐下损伤的津液

引起了小便化源不足 会引起尿少

另外

尿少伴有浮肿的病人

多见于水肿病

比如 心阳衰竭的水肿

以及脾肺肾功能失常 气化不利

引起的水液内停 导致的水肿

都可以表现出尿少 伴有浮肿

尿次的异常

可以见于以下三种

频数 次数减少以及癃闭

频数 就是尿量次数增多

根据小便的感觉 分成两种

第一种就是 短赤而急迫

是指不仅尿的次数多 还伴尿急尿痛的症状

通常可用尿频 尿急 尿痛来概括

中医称为淋证

这是由于下焦湿热 膀胱气化不利所导致的

另外一种是没有尿痛的感觉

主要表现为白天尿量次数很多 色清

夜尿尤其明显增多

这是属于下焦肾阳虚寒

膀胱失约所导致的病变

尿次减少的原因 与尿量减少是一样的

就是尿次减少 尿量也同样减少

伴有口渴咽干

与热病伤津 腹泻或汗吐下伤津有关

另外

尿量以及尿次减少 伴有浮肿

这与心阳衰竭的水肿

或者脾肺肾功能失常 气化不利

引起的水肿病有关

癃闭有两种表现

小便不畅 点滴而出为隆

小便不畅 点滴不出为闭

这个病情比较复杂 有实有虚

实证通常与湿热下注

瘀血 结石阻塞有关

虚证与肾阳虚 肾阴不足有关系

癃闭 一部分相当于西医里面的尿毒症

正常的排尿感觉

是有便即解 没有疼痛的感觉

排尿感觉异常 有四种表现

即尿道涩痛 余溺不尽 小便失禁和遗尿

尿道涩痛 多见于淋证

与湿热下注 热灼津液

结石或者瘀血阻塞

肝郁气滞 阴虚火旺 中气下陷等等

虚和实病变有关系

余溺不尽(即尿不干净)见于虚证

与久病体虚 肾阳亏虚

或肾气不固 湿热留注有关

小便失禁 通常与先天的肾虚

后天的脾虚 膀胱虚寒有关

肾气不足 下元不固 膀胱失约

以及脾虚气陷及膀胱虚寒 不能够固摄尿液

或尿路损伤 湿热 瘀血阻滞 尿路失约

以及热病神昏 心失主宰

都会引起小便失禁

遗尿 通常是虚弱的表现

与先天禀赋不足 肾气亏虚

以及后天脾虚气陷

膀胱虚寒有密切的关系

以上是我们学习的问小便的尿次 尿量和排尿感觉的异常

本节课就上到这里

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

5.8.2 Inquiring of urination笔记与讨论

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