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6.3 Observation of excreta课程教案、知识点、字幕

同学们好

下面我们学习中医望诊之望排出物

望排出物是指观察病人的分泌物 排泄物

和某些排出体外的病理产物的

形 色 质 量的变化

来诊察病情的方法

这里的分泌物通常是指

泪 涕 唾 涎等等液体

排泄物是指大小便

而病理产物是指痰液或呕吐物

所以我们的望排出物主要

望痰 涕 涎 唾 呕吐物以及大小便等

望排出物变化

总的规律是

如果排出物色白 清稀伴有腥臭味或者不臭

或者臭味不浓的

通常是属于虚证和寒证

而如果排出物色黄 稠浊

味道非常臭秽者 多为实证和热证

下面我们学习的排出物的病变意义

都是符合这个规律的

我们首先来学习望痰涕

痰 是由肺和气道排出的病理性粘液

中医认为

脾为生痰之源 肺为贮痰之器

所以望痰可以判断脏腑

尤其是脾肺的病变 以及病邪的性质

望痰主要望痰的色 质和量的内容

通常来讲

痰白量多而清稀是属于寒痰

痰白滑量多 很滑 很容易咳出来是属于湿痰

痰黄 或痰白 或痰是绿色

但只要质地是稠浊有块

通常都属于热痰

痰少而黏难以咯出 这是属于燥痰

痰中带血 颜色鲜红者 是属于咯血

通常属于肺阴虚火旺的虚火

或肝火犯肺的实火灼伤肺络所导致的咯血

如果咯吐脓血痰 气味腥臭

通常属于肺痈

是属于热毒蕴肺 肉腐成脓所导致的病变

第二是望涕

中医认为 涕为肺液

所以望涕可以了解诊查肺的病变

鼻塞流清涕 通常为外感风寒所致

鼻塞流脓涕 又称为浊涕

是属于外感风热所导致

如果阵发性清涕量多伴喷嚏频作频作

中医称为鼻鼽

是属于风寒束肺所导致的病证

久流浊涕质稠而且量多味

腥臭者属于鼻渊

通常为湿热郁阻所导致的病证

下面我们来学习望涎唾

涎 是从口腔流出的清稀粘液

中医认为涎为脾液

所以望涎可以诊察脾胃的病变

如果口流清涎而量多

为脾胃虚寒 气不化津的表现

口中时时吐黏涎

是脾胃湿热所导致

小儿口角流涎又称为滞颐

通常是脾虚不能固摄津液

或者胃热(虫积)所导致的

睡中流涎 就是睡觉的时候流口水

通常是胃中有热 宿食内停

或痰热内蕴所导致的

第二是望唾

唾是从口腔吐出的稠滞的泡沫状粘液

中医认为 唾为肾液 关乎于胃

所以诊察唾可以了解胃和肾的病变

一般来讲

时时地吐唾沫 这是属于胃中虚冷

肾阳不足 水邪上泛所表现出来的病证

而唾液非常多

则是属于胃中宿食或湿邪留滞所表现出来的病证

下面我们来学习望呕吐物

呕吐物是胃气上逆

由口吐突出的胃内容物

通常外感和内伤都能够引起呕吐

望呕吐物通常可以了解胃气上逆的原因

和病性的寒热虚实

我们主要通过望呕吐物的

色 质和量的变化

来判断胃气上逆的原因和病性变化

一般来讲

呕吐物清稀 无酸臭味 属于寒呕

通常是胃寒所导致的病证

呕吐物秽浊 有酸臭味 属于热呕

通常是胃热所导致的病证

如果呕吐物中有不消化食物

同时伴有酸腐臭味

这是属于暴饮暴食 饮食积滞

所导致的伤食的病证

如果呕吐黄绿苦水

通常是属于肝郁横逆犯胃

或肝胆湿热的病证

呕吐清水痰涎 胃有振水声

是痰饮停于胃的一种病证

呕血 挟有食物残渣

如果血色鲜红

通常是属于肝火或者是胃热所导致的

如果呕血 血色紫黯有块

是属于胃腑血瘀所导致的病证

第四个内容望二便 即大小便

大小便虽然是人体的排泄物

但是大小便包含了人体很多健康信息

因此 不能因为是排泄物一冲了之

而应该仔细的观察

首先是望大便

望大便主要是诊察脾 胃 肠和肝肾的病变

以及了解病性的寒热虚实

望大便 主要望大便的形 色 质 量

一般来讲

大便清稀如水样 通常是寒湿泄泻

外感或内伤都可以导致

大便黄褐如糜而臭 通常是湿热泄泻

外感或内伤也都可以导致

大便清稀 完谷不化或如鸭溏这是脾肾阳虚的病证

大便粘冻 挟有脓血便

这是痢疾的特征性的病证

通常是属于湿热蕴结大肠的表现

大便燥结 干如羊屎 排出困难这是便秘

通常是属于肠道津亏 或热盛伤津

胃火亢盛 阴血亏损所导致的病证

大便出血称为便血

便血分为远血和近血

通常来讲

近血 血色鲜红

通常见于痔疮或者是肛裂

而远血

通常是大便出血的血色暗红或紫黑

这是胃有瘀血的征象

第二望小便

望小便可以诊察肾 膀胱 肺 脾 三焦的病变

并且了解津液的盈亏和病性的寒热虚实

望小便 主要望小便的色 质和量

一般来讲

小便清长 属虚寒

小便短少 属实热

小便尿中带血

不痛者为尿血 痛者为血淋

通常是热伤血络 脾肾不固

或湿热蕴结所导致

尿中沙石 一般来说会伴有疼痛

所以又称为石淋

是由湿热蕴结所致

如果小便混浊

不痛者为尿浊 痛者为膏淋

通常是由脾肾亏虚或湿热下注所致

由于大小便涉及到隐私

所以望大小便 通常由病人本人去完成

然后将信息告诉给医生

因此对于每一个学习者而言

自己的大小便一定要由自己去仔细观察

从而了解自身的健康和疾病的状况

以上是望排出物的内容

本节课就讲到这里

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

6.3 Observation of excreta笔记与讨论

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