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9.2.3 Respiratory abnormality课程教案、知识点、字幕

同学们好

下面我们学习闻呼吸的异常

闻呼吸

是诊察病人的呼吸的快慢

是否均匀通畅

以及气息的强弱粗细

呼吸音的清浊 有没有罗音等等情况

闻呼吸声的意义 有以下规律

一般来说

有病而呼吸正常 是形病气未病

有病而呼吸异常 是形气俱病

当呼吸气粗 疾出疾入者

多属于实证和热证 多见于外感病

当呼吸气微 徐出徐入者

多属于寒证和虚证 多见于内伤病

异常的呼吸音 我们主要从四个方面来学习

第一种异常呼吸音 就是喘

喘 是指呼吸困难

短促急迫 甚则鼻翼煽动

张口抬肩 不能平卧

喘的主要症状就是呼吸困难

短促急迫 鼻翼扇动 张口抬肩 不能平卧

都是在描述呼吸困难的具体表现

喘的病变部位

主要与肺和心有关

涉及到 脾和肾

喘 重点要区别实喘和虚喘

实喘 通常发病急骤

喘息气粗

急欲呼出余气

临床以呼多吸少为特征

请同学们

听一听下面这个病人的呼吸困难的声音

(喘息气粗 呼多吸少)

这是一个实喘病人

主要表现为呼吸声粗 呼多吸少

这种实喘

多由于风寒袭肺 痰热壅肺 痰饮停肺

从而导致肺失宣肃所导致的病变

虚喘 通常病势缓慢

喘而气微而声低

惟恐气难相续 动则喘甚

临表以呼少吸多为特征

下面请同学们来听一听

这个病人的呼吸困难的声音

(气微而声低 吸多呼少)

这是一个虚喘的病人

主要表现为呼吸气微 吸多呼少

这种虚喘

多由肺气虚

肾虚不能够摄纳肺气的

肺肾两虚的病证有关

另外 实喘和虚喘

也与心的病变有关

实喘 可由水气凌心所导致

虚喘 多与心阳气虚有关

下面我们来学习第二种异常呼吸音 哮

哮 是指呼吸急促似喘

喉间有哮鸣音的一种症状

哮的主要特征就是在

呼吸困难过程中伴有哮鸣音

下面请同学们听一听这个哮的声音变化

请同学们注意到

在病人每次呼吸末尾时

会伴随一个像吹口哨的声音

这就叫哮鸣音

(呼吸困难 伴有哮鸣音)

这个病人以呼吸困难

加上哮鸣音为主要表现 这就是哮

哮和喘有什么区别

喘主要是以气息急迫 呼吸困难为主

而哮是以喉间哮鸣音为临床特征

哮的发病 通常会伴随着呼吸困难

所以 哮必兼喘

而喘是以呼吸困难为主

不必兼有哮鸣音

所以 喘不必兼哮

由于哮在发作时 常伴有喘同时出现

所以常并称为哮喘

哮的病变机理是什么呢

哮是一个过敏性疾病

中医认为哮是由于宿痰内伏

复感外邪诱发

或因为久居寒湿之地

或过食酸咸生冷所诱发而导致的病证

其中

宿痰内伏 是指病人的过敏性体质 这是内因

外邪 寒湿以及酸咸生冷的食物的诱发

就是外因 也称诱因

相当于过敏原

哮在发作的时候

也是内外因同时致病

因此 要针对内外因同时治疗

当哮在缓解期 没有发作的时候 中医强调

仍然需要针对宿痰内伏的体质进行调理

由于脾为生痰之源

因此哮在缓解期时要重点健脾化痰

调理治疗

如果宿痰得化 内因不存在了

哮也不会再发作了

下面我们来学习第三种异常呼吸音 短气

短气 是指自觉呼吸短促不相连续

气短不足以息的轻度呼吸困难

短气的表现似喘而不抬肩

气急而没有痰声

即只有自觉呼吸短促

他觉征象不明显

短气有虚实之分

虚证的短气

常兼有形瘦神疲 声低息微

多因体质虚弱 或元气损伤所致

实证的短气 常兼有呼吸声粗

或胸腹胀满等等

多因为痰饮 胃肠积滞

或气滞 或瘀阻所致

最后一种异常呼吸音就是 少气

少气是指呼吸微弱短促而声低

气少不足以息 言语无力的一种症状

少气只见于虚证

多因久病体虚 或肺肾气虚所导致的一种病证

以上是四种病态呼吸音的临床意义

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

9.2.3 Respiratory abnormality笔记与讨论

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