GoalsofStudying掌握各個病證的病情分析及護理。掌握相關(guān)專業(yè)詞匯。熟悉各個病證的定義。了解各個病證的健康指導(dǎo)。能夠靈活運用理論知識對個案進行有針對性的護理。1/24/20251感冒Commoncold1/24/20252CommoncoldDefinition

Commoncold

是感受觸冒外邪所導(dǎo)致的常見外感疾病，臨床表現(xiàn)以鼻塞，流涕，噴嚏，頭痛，惡寒、發(fā)熱、全身不適等為特征。四季均可發(fā)病，尤以冬春季節(jié)為多。

1/24/20253

感冒一名，北宋《仁齋直指方》即有記載。而《內(nèi)經(jīng)》已指出感冒主要是外感風(fēng)邪所致。元《丹溪心法·傷風(fēng)》明確指出病位屬肺，根據(jù)辨證，分列辛溫、辛涼兩大治法。此后醫(yī)家又對虛人感冒有進一步的認識，提出扶正達邪的治療要求。Commoncold1/24/20254CauseofDiseaseandPathomechanism六淫(sixexogenouspathogenicfactors)時行病毒(seasonalvirus)人體正氣(healthqi

)不足其病機關(guān)鍵在于邪實正虛(excessofevilandastheniaofhealthqi

)。

Commoncold1/24/20255Analysesofpathologicalconditions風(fēng)寒感冒(commoncoldduetowind-cold)風(fēng)熱感冒(commoncoldduetowind-heat)暑濕感冒(commoncoldduetosummer-dampness)體虛感冒氣虛感冒

(commoncoldduetoastheniaofqi)陰虛感冒(commoncoldduetoastheniaofyin)Commoncold1/24/20256AnalysesofpathologicalconditionsCommoncoldduetowind-cold

惡寒重，發(fā)熱輕，無汗頭痛，肢體痰楚，鼻塞聲重，時流清涕，咽癢咳嗽，痰稀薄色白，口不渴或喜熱飲，苔薄白而潤，脈浮或浮緊。Commoncold1/24/20257AnalysesofpathologicalconditionsCommoncoldduetowind-heat

身熱較著，微惡風(fēng)，汗泄不暢，頭脹痛，鼻塞，流黃濁涕，口渴欲飲，咽喉紅腫疼痛，咳嗽，痰黃粘稠，苔薄黃，脈浮數(shù)。Commoncold1/24/20258AnalysesofpathologicalconditionsCommoncoldduetosummer-dampness

身熱，微惡風(fēng)，汗少，肢體酸重或疼痛，頭昏重脹痛，咳嗽痰粘，鼻流濁涕，心煩口渴，或口中粘膩，渴不多飲，胸悶，泛惡，小便短赤，舌苔薄黃而膩，脈濡數(shù)。Commoncold1/24/20259AnalysesofpathologicalconditionsCommoncoldduetoastheniaofqi

經(jīng)常感冒，反復(fù)不愈，惡寒重，發(fā)熱，咳嗽，咳痰無力，氣短，倦怠，舌淡苔白，脈浮無力。

Commoncoldduetoastheniaofyin

頭痛身熱，微惡風(fēng)寒，少汗，頭昏，心煩，口干，于咳少痰，舌紅少苔，脈細數(shù)。Commoncold1/24/202510ProblemsofpatientsNursinggoalsCommoncold1/24/202511Nursinginterventions

Commoncoldduetowind-coldPrincipleofnursing：辛溫解表Entiretynursing：

Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：Commoncold1/24/202512NursinginterventionsCommoncoldduetowind-heatPrincipleofnursing：辛涼解表Entiretynursing：

Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：Commoncold1/24/202513Nursinginterventions

Commoncoldduetosummer-dampnessPrincipleofnursing：驅(qū)濕解表Entiretynursing：

Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：Commoncold1/24/202514Nursinginterventions

CommoncoldduetoastheniaofqiPrincipleofnursing：益氣解表Entiretynursing：

Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：Commoncold1/24/202515Nursinginterventions

CommoncoldduetoastheniaofyinPrincipleofnursing：滋陰解表Entiretynursing：

Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：Commoncold1/24/202516NursingevaluationIntroductiononhealth氣候突變時要注意保暖，坐臥須防外邪。保持室內(nèi)空氣流通，或選用食醋熏蒸法、消毒香熏法等做空氣消毒。時行感冒流行期間，可用板藍根沖劑預(yù)防給藥。積極參加體育鍛煉，以增強體質(zhì)。

Commoncold1/24/2025171/24/202518Cough咳嗽1/24/202519Teachingobjectives熟悉咳嗽的病因病機了解其診斷與鑒別診斷熟悉外感咳嗽及內(nèi)傷咳嗽的護治原則掌握常見七種類型咳嗽的辨證施護了解預(yù)防與調(diào)養(yǎng)。

1/24/202520Whatiscough1/24/202521Definition

Cough是指肺氣上逆做聲，咯吐痰涎而言，為肺系疾病的主要證候之一。分別言之，有聲無痰為咳，有痰無聲為嗽，一般多痰、聲并見，故以咳嗽并稱。

1/24/202522EvolutionHistory《內(nèi)經(jīng)》對咳嗽已有論述，《素問·咳論》明確指出“五臟六腑皆令人咳，非獨肺也?！泵鞔鷱埦霸缹⒖人詺w納為外感、內(nèi)傷兩大類，為咳嗽的辨證奠定了基礎(chǔ)。

1/24/202523Whatisitscause1/24/202524CauseofDisease&Pathomechanism

咳嗽的病因有外感與內(nèi)傷兩大類，外感咳嗽為六淫外邪人侵肺系；內(nèi)傷咳嗽為臟腑功能失調(diào)，內(nèi)邪干肺。病機關(guān)鍵在于肺失宣肅，肺氣上逆而作咳。外感咳嗽(exogenouscough)內(nèi)傷咳嗽(coughduetointernalinjury)1/24/202525Analysesofpathologicalconditions

exogenouscough

coughduetointernalinjury風(fēng)寒襲肺

風(fēng)熱犯肺

風(fēng)燥傷肺

痰濕犯肺

痰熱郁肺

肝火犯肺肺陰虧耗

1/24/202526Exogenouscough風(fēng)寒襲肺(wind-coldattackinglung)

咳嗽聲重，氣急，咽癢，咳痰稀薄色白，常伴有鼻塞、流清涕、頭痛、肢體酸楚、惡寒發(fā)熱、無汗等表證，苔薄白，脈浮或浮緊。Analysesofpathologicalconditions1/24/202527Exogenouscough風(fēng)熱犯肺(wind-heatattackinglung)

咳嗽頻劇，氣粗，或咳聲嘶啞，喉癢咽痛，咳痰不爽，痰粘稠或色黃，咳時汗出，常伴有鼻流黃涕、口渴、身熱等表證，舌苔薄黃，脈浮數(shù)。Analysesofpathologicalconditions1/24/202528Exogenouscough風(fēng)燥傷肺(wind-drynessattackinglung)

干咳頻作，連聲作嗆，咽喉干痛，唇鼻干燥，無痰，或痰少而粘連成絲，不易咳出，痰中帶血絲，口干，初起可伴有鼻塞、頭痛、微寒身熱等表證，苔薄白或薄黃，質(zhì)紅，干而少津，脈浮數(shù)。Analysesofpathologicalconditions1/24/202529Coughduetointernalinjury痰濕犯肺(phlegm-dampnessobstructinglung

)

咳嗽反復(fù)發(fā)作，咳聲重濁，痰多，因痰而咳，痰出咳平，痰粘膩或稠厚成塊，色白或黃灰色，胸悶，脘痞，嘔惡，食少，體倦，大便時溏，苔白膩，脈濡滑。Analysesofpathologicalconditions1/24/202530Coughduetointernalinjury痰熱郁肺(stagnationofphlegm-dampnessinlung)

咳嗽氣息粗促，或喉間有痰聲，痰多質(zhì)粘或稠黃，咯吐不爽，或吐血痰，胸脅脹滿，咳時引痛，面赤，或有身熱，口干欲飲，舌紅，苔薄黃膩，脈滑數(shù)。Analysesofpathologicalconditions1/24/202531Coughduetointernalinjury肝火犯肺(liver-fireattackinglung)

上氣咳逆陣作，咳時面赤，咽干，常感痰滯咽喉，咯之難出，量少質(zhì)粘，胸脅脹痛，咳時引痛，口干苦，可隨情緒波動而增減，舌苔薄黃少津，脈弦數(shù)。

Analysesofpathologicalconditions1/24/202532Coughduetointernalinjury肺陰虧耗(lackoflung-yin)

干咳，咳聲短促，痰少粘白，或痰中夾血，或聲音逐漸嘶啞，口干咽燥，或午后潮熱顴紅，手足心熱，盜汗，神疲，舌質(zhì)紅，少苔，脈細數(shù)。Analysesofpathologicalconditions1/24/202533診斷Diagnosis鑒別診斷

Differentialdiagnosis

&1/24/202534診斷Diagnosis咳逆有聲，或伴咽癢咯痰。外感咳嗽，起病急，可伴有寒熱等表證；內(nèi)傷咳嗽，每因外感反復(fù)發(fā)作，病程較長，咳而伴喘。急性期，血白細胞總數(shù)和中性粒細胞增高。聽診可聞及兩肺野呼吸音增粗，或伴散在干濕性羅音。肺部Ｘ線攝片檢查，正常或肺紋理增粗。1/24/202535ProblemsofpatientsNursinggoals1/24/202536Exogenouscoughwind-coldattackinglung

Principleofnursing：疏風(fēng)散寒，宣肺止咳

Entiretynursing：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：：Nursinginterventions1/24/202537Exogenouscoughwind-heatattackinglung

Principleofnursing：疏風(fēng)清熱，宣肺化痰

Entiretynursing：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：Nursinginterventions1/24/202538Exogenouscoughwind-drynessattackinglung

Principleofnursing：疏風(fēng)清肺，潤燥止咳

Entiretynursing：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：Nursinginterventions1/24/202539Coughduetointernalinjuryphlegm-dampnessobstructinglung

Principleofnursing：健脾燥濕，化痰止咳

Entiretynursing：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：Nursinginterventions1/24/202540Coughduetointernalinjurystagnationofphlegm-dampnessinlung

Principleofnursing：清熱化痰肅肺

Entiretynursing：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：Nursinginterventions1/24/202541CoughduetointernalinjuryLiver-fireattackinglung

Principleofnursing：清肺平肝，順氣降火

Entiretynursing：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：Nursinginterventions1/24/202542CoughduetointernalinjuryLackoflung-yin

Principleofnursing：滋陰潤肺，止咳化痰

Entiretynursing：Lifecare：Dietcare：Drugscare：Acupuncture：Tuina：Nursinginterventions1/24/202543NursingevaluationIntroductiononhealth

防寒保暖，避免外邪侵襲。若已有感冒跡象者，可服用姜糖水或解表藥以驅(qū)邪外出。鍛煉身體，增強體質(zhì)，配合氣功或呼吸操戒煙，忌食辛辣油膩之品。1/24/202544哮證Wheezingsyndrome1/24/202545Wheezingsyndromedefinition

Wheezingsyndrome

是一種發(fā)作性的痰鳴氣喘疾患。發(fā)作時喉中哮鳴有聲，呼吸氣促困難，甚則喘息不能平臥。

1/24/202546哮證發(fā)作期的基本病理變化為“伏痰（latentphlegm)”遇感飲觸，痰隨氣升，氣因痰阻，相互搏結(jié)，壅塞氣道，肺氣宣降失常，引動停積之痰，而致痰鳴如吼，氣息喘促。

CauseofDisease&Pathomechanism1/24/202547Analysesofpathologicalconditions寒哮(coldwheezing)：呼吸急促，喉中哮鳴有聲，胸膈滿悶如塞，咳不甚，痰少咯吐不爽，面色晦滯，口不渴；或渴喜熱飲，天冷或受寒易發(fā)，形寒肢冷，舌苔白滑，脈弦緊或浮緊。熱哮(hotwheezing)：氣喘息涌，喉中痰鳴如吼，胸高脅脹，嗆咳陣作，咳痰色黃或白，粘濁稠厚，排吐不利，煩悶不安，汗出，面赤，口苦，口渴喜飲，舌紅，苔黃膩，脈弦滑或滑數(shù)。

Wheezingsyndrome1/24/202548ProblemsofpatientsNursinggoalsWheezingsyndrome1/24/202549NursinginterventionsColdwheezing

Principleofnursing

：溫肺散寒，化痰平喘

EntiretynursingLifecare：Dietcare：Drugscare：Acupuncture：Othermethods:Wheezingsyndrome1/24/202550NursinginterventionsHotwheezing

Principleofnursing

：清熱宣肺，化痰平喘

Entiretynursing:Lifecare：Dietcare：Drugscare：Acupuncture：Othermethods：Wheezingsyndrome1/24/202551NursingevaluationIntroductiononhealth可視身體情況進行跑步、太極拳、冷水浴等鍛煉。避免接觸刺激性的氣體、灰塵、花粉等，忌吸煙。飲食宜清淡，忌食肥甘、腥膻、辛辣、生冷等。

Wheezingsyndrome1/24/202552喘證Asthmasyndrome/dyspneasyndrome1/24/202553了解喘證的概念，范圍熟悉喘證的病因病機掌握實喘與虛喘的鑒別診斷和各證型的辨證施護熟悉喘脫的護治措施了解預(yù)防與調(diào)養(yǎng)。Teachingobjectives1/24/202554DefinitionAsthmasyndrome

是以呼吸困難，甚至張口抬肩，鼻翼煽動，不能平臥為特征。嚴(yán)重者可持續(xù)不解，發(fā)生喘脫。

1/24/202555EvolutionHistory《內(nèi)經(jīng)》認為喘證以肺為主病之臟，并且描述了喘證的臨床特點?！督饏T要略·肺痿肺癰咳嗽上氣病》中，“上氣”即指喘息不能平臥的癥候。明張景岳把喘證歸納為虛實兩類，指出喘證的辨證綱領(lǐng)。清·葉天士進一步指出喘證“在肺為實，在腎為虛”，為喘證的病機重點。1/24/202556CauseofDisease&Pathomechanism總之，喘證病因有外感與內(nèi)傷，病性有虛實不同，病位主要在肺腎兩臟，實喘(stheniadyspnea/excessdyspnea)在肺，為外邪、痰濁、肝郁氣逆等，邪壅肺氣，宣降不利；虛喘(asthenia-asthma/deficiency-asthma)責(zé)之于肺腎兩臟，因精氣不足，氣陰虧耗而致肺腎出納失常，重點在腎，且以氣虛為主。

1/24/202557AnalysesofpathologicalconditionsExcessdyspneaAstheniaasthma風(fēng)寒襲肺表寒里熱痰濁阻肺肺氣郁痹

肺虛

腎虛1/24/202558ExcessdyspneaWind-coldattackinglung

喘咳氣急，胸部脹悶，痰多稀薄色白，兼有頭痛，惡寒，或伴發(fā)熱，口不渴，無汗，苔薄白而滑，脈浮緊。Analysesofpathologicalconditions1/24/202559Excessdyspnea表寒里熱(exteriorcoldandinteriorheat)

喘逆上氣，胸脹或痛，鼻煽，咳而不爽，咳痰稠粘，伴有形寒，身熱，煩悶，身痛，有汗或無汗，口渴，舌質(zhì)紅，苔薄白或黃，脈浮數(shù)或滑。Analysesofpathologicalconditions1/24/202560Excessdyspnea痰濁阻肺(turbidphlegmobstructinglung)

喘而胸滿窒悶，甚則胸盈仰息，咳嗽痰多粘膩色白，咯吐不利，兼有嘔惡，納呆，口粘不渴，苔白厚膩，脈滑。

Analysesofpathologicalconditions1/24/202561Excessdyspnea肺氣郁痹(obstructionofpulmonaryqi

)

每遇情志刺激而誘發(fā)，發(fā)時突然呼吸短促，但喉中痰聲不著，氣憋，胸悶胸痛，咽中如窒，失眠，心悸，苔薄，脈弦。Analysesofpathologicalconditions1/24/202562Asthenia-asthma肺虛(lung-asthenia)

喘促短氣，氣怯聲低，喉有鼾聲，咳聲低弱，痰吐稀薄，自汗惡風(fēng)，或咳嗆痰少，質(zhì)粘，煩熱口干，咽喉不利，舌質(zhì)淡紅或舌紅苔剝，脈軟弱或細數(shù)。

Analysesofpathologicalconditions1/24/202563Asthenia-asthma腎虛(kidney-asthenia)

喘促日久，動則喘甚，呼多吸少，氣不得續(xù)，形瘦神憊，汗出肢冷，面青唇紫，舌苔淡白，脈微細或沉弱。或喘咳，面紅煩躁，足冷，汗出如油，舌紅少津，脈細數(shù)。Analysesofpathologicalconditions1/24/202564診斷Diagnosis鑒別診斷

Differentialdiagnosis

&1/24/202565診斷Diagnosis以氣短喘促，呼吸困難，甚至張口抬肩，鼻翼煽動，不能平臥，口唇發(fā)紺為特征多有慢性咳嗽，哮病，肺痿，心悸等病史，每遇外感及勞累而誘發(fā)。呈桶狀胸，叩診胸部呈過清音，心濁音界縮小或消失，肝濁音界下移，肺呼吸音減低。1/24/202566診斷Diagnosis可聞及干、濕性羅音或哮鳴音?；蚋文[大，下肢浮腫，頸靜脈怒張。合并感染者，白細胞總數(shù)及中性粒細胞可增高。必要時查血鉀、鈉，二氧化碳結(jié)合力及X線胸部攝片，心電圖，心、肺功能測定，血氣分析等。1/24/202567ProblemsofpatientsNursinggoals1/24/202568ExcessdyspneaWind-coldattackinglung

Principleofnursing：宣肺散寒平喘

Entiretynursing:Lifecare：Dietcare：Drugscare：Acupuncture：Othermethods：Nursinginterventions1/24/202569ExcessdyspneaExterior