中医基础理论之病因篇.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,第六章 病因,Cause of Disease,学习要点,中医对病因的认识方法及分类,六淫的概念及致病特点,七情的概念及七情内伤,痰饮、瘀血、结石的概念、形成及致病特点,KEY WORDS,Cause of disease,病因,Etiology,病因学说,Six excesses,六淫,Pestilential qi,疠气,Seven emotions,七情,Interal-injury pathogenic factors,七情内伤,Phlegm-fluid retention,痰饮,Stagnant blood,瘀血,Abdominal mass,徵积,Calculus,结石,Medicine pathogens,药邪,Iatrogenic factors,医过,Fetal weakness,胎弱,Fetal toxin,胎毒,Concept:,The cause of disease,refers to the factors that damage the relative epuilibrium and result in disease and are also called pathogenic factors.,Methods,of CM probing into pathogenic factors,Asking directly,Referring the cause by syndrome differentiation,Introduction,中医病因,1.,六淫,2.,七情,3.,疠气,4.,饮食,5.,劳逸,6.,痰饮,7.,瘀血,8.,结石,9.,外伤,10.,寄生虫,11.,药邪,12.,先天因素,13.,医过等,西医病因,1.,生物病原：,如细菌、病毒、真菌等。,2.,物理因素：,如噪音、高温、气压、放射线等。,3.,化学因素：,如化学药品、污染、毒物等。,4.,营养因素：,如偏食、营养不良等。,5.,精神因素：,如情绪、心理等。,6.,遗传因素：,如遗传病等。,第一节,六淫,Six Excesses,Concept of Six Excesses,The six excesses are a collective term used for six kinds of exogenous pathogens of,wind,cold,summer-heat,dampness,dryness and fire.,Under normal conditions,they are called“,six climatic factors,”,Common pathogenic characteristics of six excesses,1.exogenousness,2.seasonality,3.regionality,bination,5.transformability,一、风,自然界中具有风之轻扬开泄、善动不居特性的外邪，称为风邪。,性质,致病特点,主要病症,轻扬开泄,（浮越）,病位在上,病位在表,头痛、鼻塞、咽痒。,恶风、发热、汗出。,善行数变,病位游走不定,行痹之四肢关节疼痛，游走不定。,症状变化多端,风疹块之皮疹时隐时现，此起彼伏。,主动,动摇不定,眩晕、抽搐、拘挛、角弓反张，两目上吊。,为百病之长,致病先导,风寒、风热、风湿、风寒湿等兼夹证。,Wind pathogen,All exogenous pathogenic factors,characteristic of,lightness,rising,and opening-dispersing and migrating are called wind pathogen.,natures,Pathogenic characteristics,Clinical nanifestations,Light and opening-dispersing,Being apt to attack yang portion of body and discharging the pore,Headache,stuffy nasal,itching throat.,Aversion to wind,fever and sweating.,Being mobile and changeable,Characterized by migratory location,sudden onset and constantly changing,Migratory arthralgia(migratory pain in the jounts of the four limbs),Rubella,characteristic of constantly changing,Being mobile,Characterized by sway,Vergo,convulsion,spasm,opisthotonus,upward squint,Being primary pathogen,The precursor of various diseases,Tends to cause disease in mixture with other pathogenic factors such as cold,heat,dampness and dryness,etc,二、寒,自然界中具有寒冷、凝结特性的外邪，称为寒邪。,性质,致病特点,主要病症,寒为阴邪,寒证，伤阳气,伤寒：恶寒、无汗,中寒：脘腹冷痛、呕吐腹泻伴有形寒肢冷。,凝 滞,气血运行迟滞甚至凝结不通产生疼痛,局部冷痛，遇热缓解，遇冷加重,收引,腠理汗孔收缩,恶寒、无汗、发热,筋脉牵引拘急,四肢拘急，屈伸不利,Cold pathogen,All exogenous pathogenic factors characteristic of cold,coagulation and contraction are called cold pathogen.,Natures,Pathogenic characteristics,Clinical manifestation,A yin pathogen,Tending to attack yang qi and being manifested as cold syndrome,Cold-attack,：,aversion to cold,absent sweating,Cold-stroke,：,cold pain in the stomach and abdomen,vomiting and diarrhea,。,Coagulation and stagnation,Leading to stagnant of qi and blood,Local cold pains in the body,alleviated with warmth,aggravated by cold,contraction,Blockage of pores,Aversion to cold,absent sweating,and fever,Contraction of tendons and vessels,Spasm of the limbs,性质,致病特点,主要病症,重浊,周身困重,头身困重，四肢发沉，关节重着疼痛,分泌物排泄物秽浊不清,小便混浊、大便溏泄、下痢粘液脓血、面垢眵多。,粘滞,症状的粘滞性,大便粘滞不爽，小便涩而不畅，苔腻。,病程的缠绵性,湿痹、湿温、湿疹的病程长、反复发作。,为阴邪,阻遏气机损伤阳气,阻遏脾胃气机见脘腹胀满，食欲不振；脾阳不振见腹泻、水肿。,趋下,伤及人体下部，症状多见于下部,淋浊、带下、泄泻、痢疾、下肢水肿、下肢溃疡。,三、湿,自然界中具有水湿之重浊、粘滞、趋下特性的外邪，称为湿邪。,natures,Pathogenic characteristics,Clinical manifestations,Heavy and turbid,General heaviness,Heavy sensation in the head and body,aching and painful limbs,Turbid excretion and secretion,Turbid urination,diarrhea with purulent and bloody dysentery,dirty complexion,excessive eye secretions,Sticky and stagnant,Symptoms characteristic of stickiness and stagnancy with a lingering pathological course,Sticky stools with difficulty in emptying bowels,difficulty in urination,greasy fur with a long duration and recurrent episodes.,A yin pathogen,Obstructing qi movement and damaging yang qi,Oppression in chest,epigastric and abdominal distension,poor appetite,diarrhea,scanty urine,diarrhea,edema,descending,Usually attacking the lower part of the body,Turbid stranguria,leukorrhagia,diarrhea,dysentery,edema in the lower limbs and cankerous legs,Dampness pathogen,All exogenous pathogenic factors characteristic of heavy turbidity,stickiness and downwardness are called dampness pathogen.,四、燥,自然界中具有干燥、收敛清肃特性的外邪，称为燥邪。,温燥,凉燥,时间,初秋,深秋,气候,有夏热之余气，燥与热结合,有近冬之寒气，燥与寒结合,证候,燥而偏热（温燥证）,燥而偏寒（凉燥证）,性质,致病特点,主要病症,干涩,易伤津液，出现各种干燥症状,口干唇燥，鼻咽干燥皲裂，小便短少，大便干结。,易伤肺阴,干咳少痰，或痰粘难咯，痰中带血。,Dryness pathogen,All exogenous pathogenic factors characteristic of dryness and asringency are called dryness pathogen.,Warmth-dryness,Cool-dryness,season,Early autumn,Later autumn,climate,Dryness is complicated by heat of summer,Dryness is complicated by cold of winter,syndrome,Warmth-dryness syndrome,Cool-dryness syndrome,natures,Pathogenic characteristics,Clinical manifestations,Being dry and puckery,Being apt to impair fluids,Dry mouth,nose and throat,or even claps,scanty urine and dry stools,Being apt to injury lung-yin,Dry cough,scanty or sticky phlegm,bloody sputum,性质,致病特点,主要病症,炎热,灼燔,为阳邪，实热证,高热，面红，心烦，口渴，尿赤，脉洪。,炎上，症状多见于上部,发热，头昏，头痛，面红，目赤，咽喉红肿疼痛，口舌糜烂。,易伤津耗气,口渴喜饮，咽干唇焦，舌质红绛，体倦乏力少气。,易生风,高热，四肢抽搐，牙关紧闭，两目上视，角弓反张（热极生风）。,易动血,热迫血妄行，如吐血、咯血、衄血、尿血、皮肤发斑。,易扰心神,高热，狂躁，神昏，谵语，失眠。,易致肿疡,痈肿，疮疡，局部红肿热痛，化脓。,五、热（火）邪,自然界中具有火之炎热特性的外邪，称为火邪。（少火及壮火的概念）,natures,Pathogenic characteristics,Clinical manifestations,Flaming,Upward,And,scorching,Is a yang pathogen and leads to heat syndrome,High fever,reddish complexion,dysphoria,thirsty,red urine,surging and rapid pulse,Attacking the upper part of the body,Dizziness,headache,reddish complexion,conjunctival congestion,swelling and pain of throat,erosion of mucous membrane in oral cavity.,Consuming fluids and exhausting qi,Thirst with desire for cool drink,dry throat and lips,brownish tongue,tired and debility.,Causing convulsion and bleeding,High fever and coma,spasm of limbs,locked jaw,upward squint,opisthotonus,Heamatemesis,non-traumatic hemorrhage,bloody urine,echymosis.,Disturbing heart-mind,Dysphoria,coma,delirious speacking.Insomnia,Producing sores,ulcers and abscesses,Abscess,red,swollen,burning,painful sensation in the local areas with the formation of pus.,Fire(heat)pathogen,All exogenous pathogenic factors characteristic of torridity and flaming up are called fire(heat)pathogen.,六、暑邪,暑为夏季的火热之邪。大凡夏至以后，立秋以前，自然界中的火热外邪，称为暑邪。暑邪致病具有明显的季节性。,性质,致病特点,主要病症,炎热,为阳邪，实热证,高热，烦渴，面红，目赤，脉洪大。,升散,上犯头目,伤暑：头昏、目眩。,上扰心神,中暑：突然昏倒，不省人事。,腠理开泄,多汗,伤津耗气,口渴多饮，舌红少津，气短乏力。,多夹湿,暑湿夹杂证,身热不扬，烦渴，身重倦怠，胸闷，呕恶，苔黄腻。,Summer-heat pathogen,During the time from summer solstice to autumn begins,the exogenous pathogenic factors characteristic of scorching-hot,ascending and dispersive,mixed with dampness are called pathogenic summer-heat.Summer-heat pathogen is characterixed by an apparent seasonality.,natures,Pathogenic characteristics,Clinical manifestations,Characteristic being scorching-hot,A yang pathogen and leads to excess-heat syndrome,High fever,dipsesis,reddish complexion,conjunctival congestion,surging and large pulse,Characteristic being ascending and dispersive,Attacking the head and eye,Summer-heat attack:dizziness,dizzy vision,Disturbing heart-spirit,Summer-heat stoke:sudden coma and unconsciousness,Opening and dispersing the striae of the skin,sweating,Impairing fluids and exhausting qi,Thirst with preference for drink,red tongue and scanty fluids,short breath and lack of strength,Likely to be mixed with being dampness,Summer-heat causing disease in mixture with dampness,Hiding fever,dipsesis,lassitude of limbs,oppression in chest,nausea and vomiting,yellowish and greasy tongue fur.,第二节,七情,Seven Emotions,Concept of seven emotions,The seven emotions refer to seven emotional activities including joy,anger,worry,anxiety,sadness,fear and fright.,Normally,the seven emotions dont cause diseases and only when the emotional stimulations are too abrupt,violent,and prolonged and beyond ones adaptability or when there is diminished adaptability due to imbalanced yin-yang,qi and blood of viscera,can they turn into pathogenic factors,thus causing diseases.,情志异常的病因,外因主要是指社会因素、个人处境及自然环境对机体的影响。七情病变的内因是个体素质。,个体素质主要决定于先天禀赋，后天营养、性格陶冶、文化修养、个人经历等多方面的因素。当突发性的强烈刺激或长期持久的精神负担超过了机体对情志调节的灵敏阈时，就产生了七情病变，灵敏阈的高低标志着个体体质的差异性。,Pathogenic characteristics of internal injury due to seven emotions,1.Seven emotions arising from the heart,2.Impairing the viscera,以心、肝、脾三脏为多见,3.Affecting the visceral qi movement,rage leading to qi ascending,excessive joy leading to qi loose,excessive sorrow leading to qi consumption,fear leading to qi sinking,fright leading to qi turbulence,pensiveness leading to qi knotting,怒则气上、喜则气缓、悲则气消、恐则气下、惊则气乱、思则气结,4.Tending to cause emotional diseases,5.Affecting the sequelae of diseases,第三节,疠气、劳逸、饮食、外伤、寄生虫,pestilential qi,work and rest,diet,trauma,parasite,疠气的概念,pestilential qi is an exogenous pathogenic factor which is strongly infective.It is variously called epidemic toxin,epidemic qi,special pathogenic factor,pestilential qi or poisonous qi etc.syndromes produced by pestilential qi are called pestilences,which include many highly contagious diseases in modern medicine.,疠气是一类具有强烈传染性的外邪。又称“疫气”、“疫毒”、“戾气”、“乖戾之气”等。疠气引起的疾病称为“疫病”、“瘟病”、“瘟疫病”。实际上包括了现代许多传染病和烈性传染病。,Pathogenic characteristics,1.Strong infectivity and epidemic,2.Acute onset and severe condition,3.Diseases vary with pestilential qi but symptoms are similar,Factors affecting the formation and epidemic of pestilential qi,1.Abnormal climates,2.Environmental and food pollution,3.Lack of strict preventative measures,4.Social conditions,劳逸失当,Imbalance between,work and rest,过劳,overstrain,饮食失宜,Irregularity of diet,饥饱失常,improper diet,过逸,Indulgence in easy life,房劳过度,sexual overstrain,劳神过度,mental overstrain,劳力过度,overexertion,饮食偏嗜,diet predilection,饮食不洁,unhygienic diet,外 伤,traumatic injuries,枪弹、金刃伤、跌打损伤、持重努伤,烧烫伤、冻伤（全身、局部）,化学伤、溺水、雷击伤、虫兽伤,寄生虫,parasites,蛔虫、钩虫、蛲虫、绦虫、,疟原虫、血吸虫等。,中医称寄生虫病为“虫积”。,第四节,痰饮,Phlegm-fluid retention,痰饮的基本概念,痰饮是机体水液代谢障碍所形成的病理变化及其病理性产物。稠浊者为痰，清稀者为饮。痰饮作为一种新的致病因素作用于机体，导致新的病变，则为继发病因。,Phlegm-fluid retention is the pathological product resulting from the metabolic disorders of body fluids.It can be divided into phlegm and fluid retention with the former being sticky and turbid and the latter being thin and clear.As a new pathogenic factor,when stagnated in the body,it can lead to various pathological changes and different new syndromes.,痰饮,有形之痰,substantial phlegm,无形之痰,insubstantial phlegm,痰饮的形成,外感六淫,饮食失宜,七情内伤,劳逸太过,肺,失宣降,脾,不健运,肾,气化失司,肝,失疏泄,三焦,水道不利,膀胱,气化不利,伤及内脏,津液代谢障碍,水液停滞,痰饮,痰饮是由外感六淫、或饮食失常、或七情内伤、或劳逸太过等原因，导致肺、脾、肾、三焦等脏腑对水液的气化功能失常，津液代谢障碍，以致水液停滞而生成。,痰饮致病的病位,痰,饮,随气机的升降流行，内而脏腑，外达筋骨皮肉，无处不到，病位广泛。,部 位,主要病症,饮停于肺,胸闷、咳喘不能平卧、其形如肿、吐清稀痰液,（支饮）,饮在肠胃,脘腹胀痛、肠鸣漉漉有声、呕吐清水痰涎,（痰饮）,饮在胸胁,胸胁胀满、咳嗽引胁作痛,（悬饮）,饮溢肌肤,水肿、身重无汗、尿少,（溢饮）,饮停腹中,腹胀大如鼓、尿少、腹壁青筋显露,（腹水）,痰饮的致病特点,致病特点,主要病症,阻滞气机，阻碍气血,痰阻于肺,胸闷、咳嗽、喘促,湿困中焦,脘腹胀满，恶心呕吐,痰阻经络,肢体麻木，屈伸不利,痰聚于局部,痰核、瘰疠、阴疽流注,致病广泛，变化多端,百病多由痰作祟，怪病多痰,病势缠绵，病程较长,咳喘、眩晕、瘰疠、胸痹、癫痫、流注、中风、痰核、阴疽,易扰乱神明,出现神志失常的病证：精神不振，失眠易怒；喜笑不休，甚则发狂。,多见滑腻舌苔,Pathogenic characteristics of phlegm-fluid retention,Pathogenic characteristics,Clinical manifestation,Stagnating the flow of qi and blood,Phlegm in lung,Oppression in chest,cough,dyspnea with rapid and short breath,In mid-jiao,Abdominal distention,nausea and vomiting,In meridians,Numbness of limbs,difficult,flexing and stretching,In apart areas,superficial nodule,abdominal mass,dorsal furuncle,Widely pathogenic and changeful,Singular diseases usually result from phlegm-fluid retention,prolonged disease are usually caused by phlegm,Lingering pathological condition and prolonged duration,Cough and asthma,dizzy,abdominal mass,thoracic obstruction,epilepsy,stroke,superficial nodule,dorsal furuncle,Tending to block spirit,Dispirited,dementia and tantrum,constant laughter,even leading to crazy,Often manifested creasy fur,第五节,瘀血,stagnant blood,瘀血的概念,是指体内血液停滞。包括离经之血停积于体内的病理性产物，以及血液运行不畅而阻滞于脏腑经络之中的病理变化。血液停滞于体内又能导致新的病变，而成为继发病因。,Stagnant blood is a pathological product resulting from disturbance and stagnation of blood circulation,including abnormal flow of blood,or stagnated blood in meridians or viscera due to disturbed blood flow.Once it is formed,stagnant blood will become a new pathogenic factor.,外邪,情志,饮食,劳逸,外伤,外伤,络伤血溢,气虚,气不摄血,血热,迫血妄行,损伤机体,血离脉道，停积体内,气血功能失调导致瘀血形成主要有以下四种：,1.,气虚血瘀,2.,气滞血瘀,3.,血寒致瘀,4.,血热成瘀,气虚,血行无力,气滞,血行受阻,血寒,寒凝血滞,血热,煎熬粘滞,血行不畅阻滞脏腑经络,瘀血,瘀血的形成,Tending to stagnate qi movement,Affecting blood circulation,Affecting the generation of new blood,Causing various syndromes with fixed location,Pathogenic characteristics of stagnant blood,瘀血致病的共同特点,特 点,1.,疼痛,性质多为刺痛，亦可发为绞痛；部位固定不移，疼痛拒按。,2.,肿块,固定不移，在体表局部青紫肿胀（外伤性）；在体内多为 积（质硬、压痛）。,3.,出血,血色紫暗，夹有血块。,4.,望诊,面部、口唇、爪甲青紫；舌质紫暗或有瘀点瘀斑；皮下紫斑；面色 黑、肌肤甲错。,5.,脉诊,涩、迟、弦、结、代脉。,Clinical features of diseases caused by stagnant blood,Clinical features,1.pain,Stabbing and fixed pain,aggravated by pressure,2.swelling,Fixed,bruise,abdominal mass,3.bleeding,Purplish in color with clots,4.observation,Dark complexion,purplish lips and nails,dark purplish tongue with ecchymoses and petechiae,scaly skin,5.pulse,Choppy,slow,string,knotted,intermittent pulse,第六节,结石,Calculus,结石的概念,凡体内湿热浊邪，蕴结不散，或久经煎熬，形成砂石样的病理产物，称为结石。,Calculus refers to a mineral-like pathological product that results from accumulation of dampness-heat.,结石的形成,1.,饮食不节,食物，水,肝胆气郁，胆汁蕴结,胆结石,长期腹用钙、镁、铋等药物,胃结石,长期服用碱性药物，某些磺胺类药物,肾及膀胱结石,气机不利，湿热内生,结石,2.,情志内伤,3.,药物服用不当,4.,外感六淫，过度安逸,结石致病的特点,特 点,1.usually affects the six fu,临床上虽有肾结石，但更多见到胆结石、胃结石、膀胱结石。,2.prolonged clinical course with mild or severe conditions,结石多由湿热气血淤阻，日久煎熬而成；症状由结石的大小和停留的部位不同而不同。,3.tending to stagnate qi movement and damage the vessels,影响气血、水谷、水液等运行与排泄；可损伤脉络而引起出血。,4.even griping pain occurred,一般可见到局部的胀痛、酸痛；若结石导致通道梗塞不通，可发生绞痛、冷汗淋漓、恶心呕吐。,第七节,药邪、医过、先天因素,Medicine pathogen,iatrogenic factors,congenital facors,药 邪,用药过量,炮制不当,配伍不当,用法不当,1.,多表现为中毒症状,2.,发病急，病势易趋,危重状态,3.,加重病情，变生它疾,语言不妥,文字不规范,误治,操作不当,医 过,先天因素,指人未出生前因父母体质或胎儿发育过程中形成的病因。实际上包括了现代医学中某些先天性或遗传性的致病因素。,