中风历节病篇.ppt

中风历节病篇中风历节病篇中风——是以口眼喎斜、语言不利、半身不遂，甚或突然昏倒，不省人事为主要表现的疾病，多因正气亏虚，偶受外邪诱发致病历节——是以疼痛遍历关节，痛势剧烈，日久可致骨节变形为主要临床表现的疾病除正气亏虚为发病条件外，尚与感受风邪有较密切关系一、中风成因与辨证脉证与鉴别 [原文] 寸口脉浮而紧，紧则为寒，浮则为虚；寒虚相搏，邪在皮肤；浮者血虚，络脉空虚；贼邪不泻，或左或右；邪气反缓，正气引邪，喎僻不遂邪在于络，肌肤不仁；邪在于经，即重不胜；邪入于腑，即不识人；邪入于脏，舌即难言，口吐涎2）  [提要] 本条论述中风的病因、病机和脉证病因：正气不足，又外感风寒 病机：病邪痹阻经络 症状：邪气痹阻络脉则见肌肤不仁；邪气痹阻经脉则见肢体沉重，半身不遂；邪气内陷于腑则见昏迷不省人事；邪气内陷于脏，又增语言不利，口吐涎水等症  [原文] 夫风之为病，当半身不遂，或但臂不遂者，此为痹脉微而数，中风使然1） [提要] 本条论述中风病的脉证及中风与痹症的鉴别病因：气血不足，外感风邪 脉证：半身不遂，脉微而数 中风与痹证的鉴别：中风为半身不遂，痹证为但臂不遂（某一侧肢臂不遂）二、历节病因、病机证治  [原文] 寸口脉沉而弱，沉即主骨，弱即主筋，沉即为肾，弱即为肝。

汗出入水中，如水伤心，历节黄汗出，故曰历节4）[提要] 本条论述的历节病机病机：肝肾不足，寒湿内侵，痹阻关节 [原文] 少阴脉浮而弱，弱则血不足，浮则为风，风血相搏，即疼痛如掣 6）[提要] 本条论述历节的病机病机：阴血不足，外感风邪，痹阻关节[原文] 盛人脉涩小，短气，自汗出，历节痛，不可屈伸，此皆饮酒汗出当风所致7）[提要] 本条论述历节的病机病机：阳虚湿盛，外感风邪，痹阻关节 [原文] 诸肢节疼痛，身体魁羸，脚肿如脱，头眩短气，温温欲吐，桂枝芍药知母汤主之8）[提要] 本条论述风湿历节的证治病机：风湿痹阻关节，日久化热伤阴 症状：遍历关节疼痛、足部肿大、身体消瘦、头眩、短气、恶心呕吐 治则：祛风除湿，滋阴清热 方剂：桂枝芍药知母汤（桂枝、芍药、甘草、麻黄、生姜、白术、知母、防风、附子）  [原文] 病历节不可屈伸，疼痛，乌头汤主之10）[提要] 本条论述寒湿历节的证治病机：寒湿痹阻关节，经脉气血不畅 症状：关节剧烈疼痛，不能屈伸 治则：温经祛寒，除湿止痛 方剂：乌头汤（麻黄、芍药、黄芪、甘草、川乌） 桂枝芍药知母汤证与乌头汤证鉴别中风历节病小结复习思考题⒈何谓中风？其病因病机及主症是什么？ ⒉中风在络在经、入腑入脏有何不同表现？四者有何内在联系？ 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