临床见习记录2
436
00:14:52,666 --> 00:14:54,333
15分钟以后我再来听好
437
00:14:54,333 --> 00:14:55,700
下面一点也没有了
438
00:14:55,700 --> 00:14:58,333
完全消失了或者明显的减轻了下
439
00:14:58,333 --> 00:15:00,133
这一个对于整个哮喘
440
00:15:00,133 --> 00:15:01,733
那也是很有帮助的啊
441
00:15:02,000 --> 00:15:02,766
但是总的来说
442
00:15:02,766 --> 00:15:05,500
从我们询问的这个小孩的病史特点
443
00:15:05,733 --> 00:15:07,500
然后发作时的情况
444
00:15:07,500 --> 00:15:08,666
肺部的体征
445
00:15:08,700 --> 00:15:09,933
以及其他的一些
446
00:15:09,933 --> 00:15:11,900
以前做过的辅助检查呢
447
00:15:11,900 --> 00:15:14,266
中医诊断哮喘应该是没有问题
448
00:15:14,866 --> 00:15:16,800
那我就看了这个病例的书写
449
00:15:16,800 --> 00:15:17,266
我不知道
450
00:15:17,266 --> 00:15:19,366
你们大家同学也没有注意到啊
451
00:15:19,400 --> 00:15:21,266
从他写的这个病例来说
452
00:15:21,266 --> 00:15:23,100
这个主数咳喘一天
453
00:15:23,566 --> 00:15:25,866
他诊断他也是诊断的一个哮喘
454
00:15:26,166 --> 00:15:27,166
就从这一个主数
455
00:15:27,166 --> 00:15:28,966
我们说能不能诊断他哮喘
456
00:15:29,066 --> 00:15:31,200
能不能引出哮喘的这一个诊断
457
00:15:32,000 --> 00:15:32,800
不能
458
00:15:34,166 --> 00:15:34,766
哮喘
459
00:15:34,766 --> 00:15:36,533
哮喘是要反复发
460
00:15:36,533 --> 00:15:37,266
这个弹
461
00:15:37,266 --> 00:15:37,933
性
462
00:15:37,933 --> 00:15:39,333
而他只有一天
463
00:15:39,333 --> 00:15:41,933
就就不能算得上是哮喘
464
00:15:41,933 --> 00:15:43,133
只能说是喘
465
00:15:43,366 --> 00:15:44,533
或者说是哮喘
466
00:15:45,933 --> 00:15:48,666
所以像这个病例书写就不规范啊
467
00:15:48,666 --> 00:15:50,466
你经常经常看到有这种
468
00:15:50,466 --> 00:15:52,200
我说我来一看你这个主数
469
00:15:52,200 --> 00:15:53,600
我就知道你这个诊断
470
00:15:53,600 --> 00:15:55,700
和你的这一个符不符合
471
00:15:55,766 --> 00:15:57,366
那比如说这个哮喘的小孩
472
00:15:57,366 --> 00:16:00,900
我们可以写到反复客串多长时间
473
00:16:01,366 --> 00:16:03,266
这个小孩你说有两年的病史
474
00:16:03,266 --> 00:16:04,700
那我就反复客传2年
475
00:16:05,000 --> 00:16:06,366
这一次我是复发
476
00:16:06,400 --> 00:16:07,900
我正好复发一天
477
00:16:07,966 --> 00:16:09,533
有的人复发了三四天
478
00:16:09,533 --> 00:16:11,666
今天特别重收到病房里来
479
00:16:11,666 --> 00:16:14,400
你也可以这样反复客传2年
480
00:16:14,600 --> 00:16:15,733
复发5天
481
00:16:16,066 --> 00:16:16,900
加重一贴
482
00:16:17,000 --> 00:16:19,566
那如果加重以后他又出现发烧的情况
483
00:16:19,566 --> 00:16:21,666
那我可以加重半发热一贴
484
00:16:21,666 --> 00:16:24,200
注意哎你一看到这样的一个手术
485
00:16:24,200 --> 00:16:26,500
你可能就难考虑到这个小孩的怎么办
486
00:16:26,533 --> 00:16:27,600
是个哮喘啊
487
00:16:27,700 --> 00:16:30,000
当然他在这一个呃
488
00:16:30,733 --> 00:16:33,600
过敏史和这一个既王史里面呢
489
00:16:33,600 --> 00:16:34,600
他也有提到
490
00:16:34,600 --> 00:16:35,200
他还专门
491
00:16:35,200 --> 00:16:37,333
提到了这个小孩科察了多少次
492
00:16:37,366 --> 00:16:39,333
包括对什么东西有没有过敏史
493
00:16:39,333 --> 00:16:39,933
过敏
494
00:16:39,933 --> 00:16:40,600
等等等等
495
00:16:40,600 --> 00:16:43,100
这一些呢都是能够帮助我们过敏的
496
00:16:43,866 --> 00:16:46,100
其他的我们说这个诊断没有问题了
497
00:16:46,100 --> 00:16:48,133
那就涉及到一个辩证的问题
498
00:16:48,266 --> 00:16:49,866
辩证呢刚才因为你们
499
00:16:49,866 --> 00:16:51,866
我听到你们在问诊的过程当中
500
00:16:51,866 --> 00:16:53,166
不止问了一个定时
501
00:16:53,166 --> 00:16:55,466
也问了懈怠咳嗽和喘的情况
502
00:16:55,566 --> 00:16:58,733
那还有其他的一些能够帮助你辨证的
503
00:16:58,800 --> 00:17:00,133
我们讲讲啊
504
00:17:00,133 --> 00:17:02,566
这个哮喘发作的时候分了几个阵型啊
505
00:17:02,566 --> 00:17:05,266
那你看这个小孩你还需要补充一些
506
00:17:05,300 --> 00:17:06,133
问他什么
507
00:17:06,133 --> 00:17:06,933
来帮助你
508
00:17:07,266 --> 00:17:08,766
变小奶奶在这里啊
509
00:17:08,900 --> 00:17:09,900
吃饭怎么样
510
00:17:10,133 --> 00:17:12,500
吃饭反正就是一般化
511
00:17:13,500 --> 00:17:14,300
嗯
512
00:17:14,300 --> 00:17:16,766
就是肉嗯那个肉给他吃一点
513
00:17:16,766 --> 00:17:18,133
就是鱼下午不敢
514
00:17:18,400 --> 00:17:19,300
吃鱼下不敢吃
515
00:17:19,300 --> 00:17:20,366
鸡蛋很少
516
00:17:20,800 --> 00:17:22,900
就是现在才当一部分很
517
00:17:23,300 --> 00:17:23,733
正常
518
00:17:23,733 --> 00:17:24,666
一次到两次
519
00:17:24,666 --> 00:17:25,400
嗯
520
00:17:25,400 --> 00:17:27,866
平时他们是缺干还是缺稀的
521
00:17:27,966 --> 00:17:28,966
有的时候干
522
00:17:29,133 --> 00:17:30,066
有时候干
523
00:17:30,066 --> 00:17:31,566
有的时候干的时候多一些
524
00:17:31,666 --> 00:17:32,466
哎
525
00:17:32,766 --> 00:17:35,533
啊他平时还那个容易有口气啊
526
00:17:35,533 --> 00:17:38,066
或者说那个口水喜欢喝水啊
527
00:17:38,166 --> 00:17:40,200
喝水冻喝水冻喝水冻
528
00:17:41,500 --> 00:17:41,666
来
529
00:17:41,666 --> 00:17:42,566
躺下来躺下来
530
00:17:42,566 --> 00:17:43,400
我再看一看
531
00:17:44,133 --> 00:17:44,733
坐下来
532
00:17:44,733 --> 00:17:46,100
坐下来坐下来
533
00:17:46,866 --> 00:17:48,066
不要喝水啊
534
00:17:48,066 --> 00:17:48,700
这小孩啦
535
00:17:48,700 --> 00:17:49,466
我们说查题
536
00:17:49,466 --> 00:17:51,400
为什么刚才我就亲了他一下
537
00:17:51,400 --> 00:17:52,300
其他我都没看
538
00:17:52,300 --> 00:17:53,366
然后让你们来听
539
00:17:53,366 --> 00:17:55,900
来来来这小小他还算比较配合一点
540
00:17:55,966 --> 00:17:57,300
再小一点的小孩
541
00:17:57,500 --> 00:17:59,366
我们说如果你先一看喉咙
542
00:17:59,366 --> 00:18:01,500
一叫他弄舌头他马上开始哭
543
00:18:01,533 --> 00:18:03,900
一哭起来你可能听的时候就听不清楚
544
00:18:04,000 --> 00:18:06,466
所以我们一般都先做哎
545
00:18:06,466 --> 00:18:08,166
对小孩影响小的检查啊
546
00:18:08,166 --> 00:18:09,900
这个为了给大家看这个听的
547
00:18:09,900 --> 00:18:10,766
所以我们就先听
548
00:18:10,766 --> 00:18:11,900
听了以后给大家听
549
00:18:12,200 --> 00:18:14,133
那现在我们再来看小孩子呢
550
00:18:14,133 --> 00:18:16,766
一般来说我们都必须要看一看喉咙啊
551
00:18:16,800 --> 00:18:18,566
看看喉咙的情况来
552
00:18:20,966 --> 00:18:22,566
刚才没注意他就喝水了
553
00:18:22,566 --> 00:18:24,600
还有最好你想要看他的水
554
00:18:25,400 --> 00:18:26,900
冷水不能吃啊
555
00:18:26,900 --> 00:18:27,933
不能喝冷水
556
00:18:28,000 --> 00:18:30,666
那个要看他的那个舌相啊什么的时候
557
00:18:30,666 --> 00:18:33,266
一般最好你不要喝水喝饮料
558
00:18:33,466 --> 00:18:34,333
不要吃东西
559
00:18:34,333 --> 00:18:36,166
吃过以后你马上这个就会影响
560
00:18:36,166 --> 00:18:37,266
特别是中药也是
561
00:18:37,266 --> 00:18:39,600
我们查房之前啊就喝一杯中药下去
562
00:18:39,666 --> 00:18:40,933
你看不出来这个
563
00:18:41,366 --> 00:18:43,366
坐下来我看一看舌头好不好
564
00:18:43,666 --> 00:18:43,900
好
565
00:18:43,900 --> 00:18:44,900
给阿姨看一下
566
00:18:45,566 --> 00:18:48,700
有一些小孩那个哮喘反复的发作以后
567
00:18:48,700 --> 00:18:51,500
还长期的缺氧和可能表现为一个
568
00:18:51,666 --> 00:18:52,266
肿状中
569
00:18:52,266 --> 00:18:55,500
还有发作的时候三腰针比较明显发黑
570
00:18:55,933 --> 00:18:58,133
不是看你坐下来还没看完呢来
571
00:18:58,500 --> 00:18:59,766
因为我们表现真棒
572
00:18:59,766 --> 00:19:01,266
坐下来还能把舌头伸出来
573
00:19:01,266 --> 00:19:02,200
给我们看看呢
574
00:19:03,266 --> 00:19:04,133
不错不错啊
575
00:19:04,133 --> 00:19:05,300
看看这个舌质
576
00:19:06,066 --> 00:19:06,933
舌质红
577
00:19:06,933 --> 00:19:09,866
但是舌苔倒是没有明显的舌苔啊
578
00:19:11,000 --> 00:19:11,800
白开
579
00:19:12,300 --> 00:19:13,200
舌尖也比较红
580
00:19:13,500 --> 00:19:14,733
舌尖比较红一些
581
00:19:14,800 --> 00:19:16,333
整个舌质是红的
582
00:19:16,400 --> 00:19:18,333
尤其舌尖的红比较明显
583
00:19:18,333 --> 00:19:19,266
而且他有时候
584
00:19:19,566 --> 00:19:21,933
哮喘一发病也不是蛮消灭什么
585
00:19:21,933 --> 00:19:23,300
也是痛啊也是痛啊
586
00:19:23,300 --> 00:19:24,266
哎呀
587
00:19:24,900 --> 00:19:26,200
看看喉咙啊来
588
00:19:26,766 --> 00:19:27,866
那个也不错
589
00:19:27,866 --> 00:19:29,166
平时汗也比较多
590
00:19:30,000 --> 00:19:31,900
哎呦表现真棒啊
591
00:19:33,666 --> 00:19:34,466
啊
592
00:19:34,700 --> 00:19:35,400
擦一下
593
00:19:35,400 --> 00:19:36,300
嗯好
594
00:19:36,300 --> 00:19:38,600
喉咙稍微有点充血啊还好
595
00:19:43,400 --> 00:19:46,700
嗯那这个小孩我们就是问了他的病史
596
00:19:46,866 --> 00:19:49,900
也听了他的体征啊该问的我们都问了
597
00:19:49,900 --> 00:19:52,200
那究竟他病症属于什么呢
598
00:19:52,566 --> 00:19:54,333
每个人心里都在思考哈
599
00:19:54,333 --> 00:19:55,166
123456
600
00:19:55,166 --> 00:19:57,500
你最后要落实到这个小孩的一个诊断
601
00:19:57,500 --> 00:19:58,200
一个辩证
602
00:19:58,200 --> 00:20:00,933
然后才说我们的治疗方案怎么来治疗
603
00:20:01,266 --> 00:20:01,800
对这个呢
604
00:20:01,800 --> 00:20:03,400
我们一会到这个私教室里去
605
00:20:03,400 --> 00:20:04,200
我们一起来谈
606
00:20:04,500 --> 00:20:05,300
这个小孩
607
00:20:05,300 --> 00:20:07,066
究竟他辩证是属于什么
608
00:20:07,200 --> 00:20:08,100
应该怎样治疗
609
00:20:08,100 --> 00:20:10,266
他目前的治疗方式是合理啊
610
00:20:11,666 --> 00:20:13,266
行啊那我们到私教室去吧
611
00:20:13,533 --> 00:20:15,500
我们看一看这个贴纸啊
612
00:20:17,100 --> 00:20:17,600
看一下
613
00:20:17,600 --> 00:20:19,766
最好呢是到那个独贴金上面
614
00:20:20,266 --> 00:20:21,900
纹理还是比较多一些的
615
00:20:21,900 --> 00:20:24,366
但是那个典型的多一块一块的
616
00:20:25,466 --> 00:20:27,400
致命啊炎症的阴影
617
00:20:27,533 --> 00:20:30,100
就是一般的这个哮喘的小孩啊
618
00:20:30,100 --> 00:20:32,700
贴纸上就没有什么特异性的改变
619
00:20:33,300 --> 00:20:35,866
当然也有一些哮喘多病的肺炎的小孩
620
00:20:35,866 --> 00:20:37,700
你可能看出来他会是一个
621
00:20:38,900 --> 00:20:40,466
所以这个要注意界别化
622
00:20:40,500 --> 00:20:41,300
注意下啊
623
00:20:41,866 --> 00:20:44,366
刚才呢因为我们看了两个小孩
624
00:20:44,366 --> 00:20:46,766
一个非常的典型刚刚才发作
625
00:20:46,800 --> 00:20:49,300
一个呢是已经发作有十几天了
626
00:20:49,333 --> 00:20:51,666
在我们这边住院也住了十几天啊
627
00:20:51,666 --> 00:20:52,566
这两个小孩
628
00:20:52,733 --> 00:20:55,266
看了以后大家可能印象非常的深刻
629
00:20:55,566 --> 00:20:57,266
我们一个一个的来讨论吧
630
00:20:57,733 --> 00:20:59,766
先说说那个三床的这一个小孩
631
00:20:59,766 --> 00:21:01,533
刚才在病房里已经问了大家
632
00:21:01,533 --> 00:21:03,000
诊断没有问题啊
633
00:21:03,166 --> 00:21:05,533
诊断中医诊断哮喘没有问题
634
00:21:05,533 --> 00:21:07,200
我们来说说他的辨证
635
00:21:08,100 --> 00:21:09,500
啊你们也问了他的情况
636
00:21:09,500 --> 00:21:10,966
他应该辨个什么证呢
637
00:21:12,700 --> 00:21:13,500
从
638
00:21:13,700 --> 00:21:15,733
一个小孩慢慢看
639
00:21:15,800 --> 00:21:17,300
从看看舌头
640
00:21:17,333 --> 00:21:19,866
嗯小孩热性还是比较明显
641
00:21:20,133 --> 00:21:21,066
舌头比较红
642
00:21:21,166 --> 00:21:22,566
搭配稍微偏干一点
643
00:21:28,400 --> 00:21:29,800
弹弹性看不出来
644
00:21:29,866 --> 00:21:31,066
弹因为小孩弹
645
00:21:31,400 --> 00:21:32,333
吐不出来吗
646
00:21:32,533 --> 00:21:34,200
然后你也看不出来家长说他
647
00:21:35,366 --> 00:21:37,066
那个饮水量比较大
648
00:21:37,333 --> 00:21:38,600
嗯热性比较多
649
00:21:38,733 --> 00:21:41,266
热性明显喝水比较多
650
00:21:41,266 --> 00:21:44,500
嗯一个可以可以诊断为一个热效
651
00:21:45,166 --> 00:21:45,500
热性
652
00:21:45,500 --> 00:21:47,366
夏草热性嗯
653
00:21:48,533 --> 00:21:50,500
那我们讲这个热性哮喘了
654
00:21:50,500 --> 00:21:52,166
当然你讲到咳嗽喘
655
00:21:52,566 --> 00:21:56,133
这个啊症状这个是属于发作期
656
00:21:56,166 --> 00:21:57,533
首先我们说出辨证
657
00:21:57,533 --> 00:21:59,466
还要是规范一点的讲
658
00:21:59,466 --> 00:22:00,766
你说你要先辨什么
659
00:22:00,766 --> 00:22:02,066
发作期还是缓解
660
00:22:02,066 --> 00:22:02,866
期
661
00:22:02,966 --> 00:22:05,800
往往住到病房里来的他肯定是发作期
662
00:22:05,800 --> 00:22:07,600
他缓解期不回来住院啊
663
00:22:07,700 --> 00:22:09,733
而且确实是症状也很明显
664
00:22:09,733 --> 00:22:11,933
发作的这个症状还是发作期
665
00:22:12,266 --> 00:22:13,133
发作期呢
666
00:22:13,133 --> 00:22:15,700
我们课堂上给大家讲的分了4个症状
667
00:22:16,366 --> 00:22:19,000
其实重点让大家别是别什么呢
668
00:22:19,933 --> 00:22:21,100
寒热虚实
669
00:22:21,600 --> 00:22:24,400
寒热虚实实际上变寒热虚实
670
00:22:24,566 --> 00:22:25,933
所以擅长的这个小孩
671
00:22:25,933 --> 00:22:28,300
首先我们说虚实来说
672
00:22:28,300 --> 00:22:29,100
它是什么
673
00:22:29,766 --> 00:22:31,900
啊以湿症为主啊
674
00:22:31,900 --> 00:22:33,666
那从这个寒热来说呢
675
00:22:33,966 --> 00:22:35,666
刚才大家都认为它是有热
676
00:22:35,666 --> 00:22:37,766
我们在病房里问的情况啊
677
00:22:37,766 --> 00:22:40,333
那个家长就是讲这个小孩就是怕热
678
00:22:40,666 --> 00:22:42,000
摸起来全身也是烫的
679
00:22:42,000 --> 00:22:43,533
我们看到舌子也很红
680
00:22:43,533 --> 00:22:46,000
你们还专门讲出舌尖特别的红啊
681
00:22:46,066 --> 00:22:49,266
但是舌苔呢不算太厚腻啊有一点舌苔
682
00:22:49,366 --> 00:22:52,266
它的颜色也不是明显的偏黄或者是
683
00:22:52,933 --> 00:22:54,300
铁白或者什么的
684
00:22:54,333 --> 00:22:56,600
所以有的时候小孩的这一种寒热啊
685
00:22:56,600 --> 00:22:58,933
我们还不能单纯看舌苔来变
686
00:22:58,966 --> 00:23:01,200
你要看他的本质还是得看舌质
687
00:23:01,200 --> 00:23:03,366
嗯包括还有一个大便的问题
688
00:23:03,366 --> 00:23:04,600
家长也讲到了
689
00:23:04,600 --> 00:23:06,966
他平时的大便是偏干的对不对
690
00:23:07,466 --> 00:23:09,666
所以有时候我们要问他这个大便啊
691
00:23:09,700 --> 00:23:11,333
还有有时候干有时候湿
692
00:23:11,466 --> 00:23:12,866
或者有的时候进来以后
693
00:23:12,866 --> 00:23:14,533
有的用药以后他也会干
694
00:23:14,533 --> 00:23:16,200
于你对这个寒热的判断
695
00:23:16,200 --> 00:23:17,933
那你要问他平时大便
696
00:23:18,466 --> 00:23:19,800
他是以偏干的位置
697
00:23:19,800 --> 00:23:22,400
还小孩口渴水也喜欢喝的多啊
698
00:23:22,500 --> 00:23:23,933
从这些现象来看
699
00:23:23,966 --> 00:23:25,766
其实他就是属于热性哮喘
700
00:23:26,066 --> 00:23:28,500
那热性哮喘其实我们书上还讲到
701
00:23:28,500 --> 00:23:31,133
在治疗的时候还要去辨一个表
702
00:23:31,133 --> 00:23:32,200
证明不明显
703
00:23:32,200 --> 00:23:34,200
嗯所以对这个小孩来说
704
00:23:34,200 --> 00:23:36,000
你们觉得他表证明不明显
705
00:23:37,066 --> 00:23:37,700
不明显不明显
706
00:23:37,700 --> 00:23:38,733
不明显对吧
707
00:23:38,733 --> 00:23:40,333
虽然他的病程比较短但
708
00:23:40,333 --> 00:23:41,666
他表症不明显啊
709
00:23:41,666 --> 00:23:43,500
没有明显的打喷嚏流鼻涕
710
00:23:43,500 --> 00:23:45,900
甚至于发热捂寒等等
711
00:23:45,900 --> 00:23:46,700
这一个
712
00:23:46,933 --> 00:23:49,866
我们讲有一分雾寒就有一分表症
713
00:23:49,866 --> 00:23:51,200
哎他没有
714
00:23:51,300 --> 00:23:53,133
那所以说我们就是热性哮喘
715
00:23:53,133 --> 00:23:54,133
那治疗呢
716
00:23:55,000 --> 00:23:56,700
辩证没问题大家都同意
717
00:23:56,933 --> 00:23:59,100
发作期啊是个热性哮喘
718
00:24:00,566 --> 00:24:01,600
用什么方式
719
00:24:01,966 --> 00:24:02,533
正常
720
00:24:02,533 --> 00:24:04,000
用正常的方式
721
00:24:04,400 --> 00:24:06,466
嗯我觉得也可以
722
00:24:06,566 --> 00:24:08,100
麻性时间加减
723
00:24:08,266 --> 00:24:10,200
嗯麻性时间瘫加减
724
00:24:11,733 --> 00:24:12,700
嗯
725
00:24:13,333 --> 00:24:13,800
嗯可以
726
00:24:13,800 --> 00:24:15,566
但是我觉得蚂蚁是干烫的话
727
00:24:15,566 --> 00:24:18,366
就是要考虑到小孩有没有热向重点
728
00:24:18,366 --> 00:24:20,300
如果小孩热向重点的话
729
00:24:20,500 --> 00:24:22,466
可以考虑把石膏量加大一点
730
00:24:22,733 --> 00:24:24,600
嗯但这个小孩现在没有热
731
00:24:24,600 --> 00:24:26,700
对石膏量可以稍微小一点
732
00:24:27,733 --> 00:24:28,166
嗯嗯
733
00:24:28,166 --> 00:24:29,200
因为发热啊
734
00:24:29,200 --> 00:24:30,133
热是比较高的
735
00:24:30,133 --> 00:24:32,133
有时候还有大便特别干的
736
00:24:32,133 --> 00:24:33,966
那湿膏我们是可以重用
737
00:24:33,966 --> 00:24:36,533
它泄肺热的力量还是比较强的
738
00:24:37,533 --> 00:24:38,533
嗯那那你说说吧
739
00:24:38,533 --> 00:24:40,166
你说说如果叫你开方子
740
00:24:40,166 --> 00:24:42,133
你可能会开一些什么样的药
741
00:24:42,500 --> 00:24:46,000
嗯首先那个小孩现在喘还是有的
742
00:24:46,066 --> 00:24:47,366
嗯喘的话这个
743
00:24:48,333 --> 00:24:50,933
蚂蝗要蚂蝗剖开
744
00:24:50,966 --> 00:24:52,300
嗯然后有杏仁
745
00:24:52,366 --> 00:24:53,566
嗯嗯
746
00:24:53,733 --> 00:24:55,200
如果他现在传
747
00:24:55,200 --> 00:24:56,900
你写下来吧你就先开个方
748
00:24:56,900 --> 00:24:59,066
嗯我们平常在病房里就这样
749
00:24:59,166 --> 00:25:01,500
开了以后就叫同学先开方子
750
00:25:01,533 --> 00:25:03,400
开了以后拿过来给我们看看
751
00:25:03,466 --> 00:25:05,966
改一改哎他觉得好不好
752
00:25:09,933 --> 00:25:11,700
啊那这个病人没有问题啊
753
00:25:11,700 --> 00:25:13,133
我们再来说说这一个
754
00:25:13,133 --> 00:25:14,700
43层的这一个病人
755
00:25:14,966 --> 00:25:15,800
这个小孩
756
00:25:16,500 --> 00:25:17,300
来
757
00:25:17,333 --> 00:25:19,533
大家说说这个变症变什么
758
00:25:19,566 --> 00:25:20,666
诊断也没问题
759
00:25:20,666 --> 00:25:22,800
这两个小孩诊断哮喘都没有问题
760
00:25:25,466 --> 00:25:26,933
是三种小孩子
761
00:25:27,133 --> 00:25:29,966
他的病程稍微有一些偏长
762
00:25:30,066 --> 00:25:33,600
嗯然后他的舌质红嗯然后胎少胎
763
00:25:33,666 --> 00:25:38,200
嗯然后大便倒也还好有点阴虚的表现
764
00:25:38,300 --> 00:25:39,566
嗯嗯嗯
765
00:25:40,866 --> 00:25:42,400
他就比较灵活了啊
766
00:25:42,400 --> 00:25:44,600
不是说那个书上讲四个阵型
767
00:25:44,600 --> 00:25:46,366
那个临床上的小孩生病
768
00:25:46,366 --> 00:25:47,966
他不是按照书来生的
769
00:25:48,166 --> 00:25:48,933
那他就不生
770
00:25:48,933 --> 00:25:50,100
今天我们看这个小孩
771
00:25:50,100 --> 00:25:52,133
真的典型的就是有阴虚的表现
772
00:25:52,566 --> 00:25:55,266
舌质红舌苔是少没什么胎对吧
773
00:25:55,466 --> 00:25:56,500
啊嘴唇也红
774
00:25:56,533 --> 00:25:58,300
然后另外就是你考虑孕期
775
00:25:58,300 --> 00:25:59,700
当时还应该再补充问
776
00:25:59,866 --> 00:26:01,766
有没有这个晚上容易出汗啊
777
00:26:01,966 --> 00:26:03,800
盗汗的这种情况啊
778
00:26:03,933 --> 00:26:05,566
小孩的手心脚心啊
779
00:26:05,666 --> 00:26:07,600
摸起来是不是热啊等等
780
00:26:07,900 --> 00:26:09,500
当然他的已经是到了后期
781
00:26:09,500 --> 00:26:11,933
我们可以说他这个就是一个虚实交杂
782
00:26:12,200 --> 00:26:13,566
虚实交杂的情况
783
00:26:13,600 --> 00:26:15,733
本身发作期也讲到了一个
784
00:26:15,766 --> 00:26:17,466
除了变寒热变虚实
785
00:26:17,933 --> 00:26:19,566
讲到了有一个寒热交杂
786
00:26:19,766 --> 00:26:21,066
有个虚死交杂青蛙
787
00:26:21,066 --> 00:26:22,933
其实这小孩就是个虚死交杂
788
00:26:23,066 --> 00:26:25,600
但是我们书上讲到的那个虚死交杂呢
789
00:26:25,733 --> 00:26:28,133
讲答的是偏肾阳虚对吧
790
00:26:28,133 --> 00:26:29,000
讲答的是
791
00:26:29,466 --> 00:26:30,933
哎那个确实阴虚
792
00:26:30,933 --> 00:26:32,900
还是那个手脚凉
793
00:26:33,000 --> 00:26:34,133
四肢比较凉
794
00:26:34,266 --> 00:26:35,066
怕冷
795
00:26:35,166 --> 00:26:38,066
还有那个小便清肠等等动作气喘
796
00:26:38,166 --> 00:26:39,600
这实际上讲到的是个阳虚
797
00:26:39,600 --> 00:26:41,166
但这个小孩就是个阴虚
798
00:26:41,166 --> 00:26:43,266
可以啊没问题那你就是爱阴虚
799
00:26:43,366 --> 00:26:44,900
当然你在治疗上呢
800
00:26:45,500 --> 00:26:48,000
平卡的药他现在还有喘啊有咳嗽
801
00:26:48,000 --> 00:26:49,000
我还是用
802
00:26:49,100 --> 00:26:50,600
但是我还要偏重于
803
00:26:51,000 --> 00:26:52,933
适当的加一些养阴的
804
00:26:53,000 --> 00:26:54,566
养阴也不要太滋利
805
00:26:54,666 --> 00:26:56,800
那比如说让你来你就送个代表方
806
00:26:56,800 --> 00:26:58,866
如果你来学方你会学什么
807
00:26:59,366 --> 00:27:01,733
嗯沙参麦冬汤
808
00:27:02,333 --> 00:27:03,866
就是在平常的基础上呢
809
00:27:03,866 --> 00:27:05,800
再加上三参麦冬汤的加减
810
00:27:06,000 --> 00:27:08,133
嗯加花生麦冬汤啊
811
00:27:08,733 --> 00:27:10,566
沙参麦冬汤也可以
812
00:27:10,766 --> 00:27:12,100
也可以啊
813
00:27:12,100 --> 00:27:13,466
那用麦味地黄丸
814
00:27:13,666 --> 00:27:15,400
因为像沙参麦冬汤呢
815
00:27:15,733 --> 00:27:17,400
在什么时候用的比较多
816
00:27:18,333 --> 00:27:20,166
在一些热病的后期
817
00:27:20,166 --> 00:27:22,400
伤了肺胃之阴的时候是吧
818
00:27:22,400 --> 00:27:23,600
我们用的多一些
819
00:27:23,600 --> 00:27:24,400
你比如肺炎
820
00:27:24,400 --> 00:27:26,800
后期讲到的那个阴虚肺热
821
00:27:26,800 --> 00:27:28,333
你用的是沙生脉动弹
822
00:27:28,533 --> 00:27:30,166
还有一些传染病的后期
823
00:27:30,200 --> 00:27:32,800
麻疹青红热水痘等等啊
824
00:27:33,333 --> 00:27:35,300
那你的后期包括这个川崎病
825
00:27:35,800 --> 00:27:37,533
到后面你用沙生脉动糖
826
00:27:37,733 --> 00:27:40,266
像这种呃哮喘的小孩啊
827
00:27:40,266 --> 00:27:41,500
前面也没有发烧也没
828
00:27:41,500 --> 00:27:43,500
就是这一个喘的时间久了
829
00:27:43,500 --> 00:27:46,000
当然他用脉位地方啊也是可以的啊
830
00:27:46,066 --> 00:27:46,933
这个根据情况
831
00:27:46,933 --> 00:27:48,966
比如现在你熟地你就不太好用
832
00:27:48,966 --> 00:27:49,733
太致力了
833
00:27:49,733 --> 00:27:51,333
那可能我就用生地啊
834
00:27:51,333 --> 00:27:53,266
你说你这个沙生脉动不用脉动
835
00:27:53,266 --> 00:27:55,200
沙生我可以用一些的对不对啊
836
00:27:55,533 --> 00:27:57,200
甚至于像太子参这一类的
837
00:27:57,200 --> 00:27:58,300
益气养阴的药
838
00:27:58,300 --> 00:27:59,266
我完全可以用
839
00:27:59,266 --> 00:28:01,400
那其他平常的药我还是可以用啊
840
00:28:01,400 --> 00:28:03,300
产的明显的麻烦我还能用啊
841
00:28:03,766 --> 00:28:05,933
但是有一些其他的可能伤阴的
842
00:28:05,933 --> 00:28:06,866
这些药物呢
843
00:28:06,866 --> 00:28:09,566
你就要注意一些太温燥的一些药物
844
00:28:09,766 --> 00:28:10,766
嗯可能就不要用
845
00:28:10,766 --> 00:28:12,000
比如说你像陈皮啊
846
00:28:12,000 --> 00:28:13,566
半夏这些你就不太适合用
847
00:28:13,566 --> 00:28:14,366
对不对啊
848
00:28:14,500 --> 00:28:16,333
不是说你都用一些去化痰的
849
00:28:16,333 --> 00:28:18,266
陈皮和半夏它就偏温二成三
850
00:28:18,266 --> 00:28:19,266
它是化痰的
