上焦病證
溫(wen)(wen)(wen)邪(xie)上受,首(shou)先犯肺(fei),外感(gan)溫(wen)(wen)(wen)熱(re)病(bing)的初期常表現為(wei)肺(fei)衛癥狀,屬手太陰肺(fei)經。具傳變有(you)二,順(shun)傳則(ze)發(fa)展為(wei)中(zhong)焦(jiao)病(bing)證(zheng)(zheng)(zheng),逆傳則(ze)出(chu)現心(xin)包(bao)證(zheng)(zheng)(zheng)。上焦(jiao)病(bing)證(zheng)(zheng)(zheng)主(zhu)要是指(zhi)溫(wen)(wen)(wen)邪(xie)侵犯肺(fei)經及逆傳心(xin)包(bao)的證(zheng)(zheng)(zheng)候,也包(bao)括頭面、胸脅等的病(bing)證(zheng)(zheng)(zheng)。
主要臨床表現:發熱(re),微惡風(feng)寒,無汗(han)或少汗(han),口微渴,咳嗽,咽紅(hong)(hong)(hong)腫痛(tong),苔薄白,舌(she)邊尖紅(hong)(hong)(hong),脈浮(fu)數;或神昏譫語,或昏憒不語,舌(she)蹇,肢厥,舌(she)紅(hong)(hong)(hong)或降(jiang)。
病機分析:溫熱之邪(xie)(xie)侵(qin)襲肺衛(wei),衛(wei)氣被遏,奮起抗邪(xie)(xie),則(ze)發熱;微(wei)惡風(feng)寒(han),肺合皮毛(mao)主表,肺氣失(shi)宣,開合失(shi)司(si),則(ze)無汗或少汗;溫熱之邪(xie)(xie)傷津則(ze)口微(wei)渴;
溫(wen)熱(re)(re)(re)之(zhi)邪犯肺(fei),肺(fei)失宣(xuan)肅則(ze)(ze)咳嗽;咽為肺(fei)之(zhi)門戶,溫(wen)熱(re)(re)(re)之(zhi)邪侵襲則(ze)(ze)咽紅腫痛;溫(wen)熱(re)(re)(re)之(zhi)邪侵襲體表,故苔白,舌(she)邊尖紅,脈浮數(shu)。溫(wen)熱(re)(re)(re)之(zhi)邪道傳心(xin)(xin)包,心(xin)(xin)神(shen)被(bei)擾(rao),則(ze)(ze)神(shen)昏譫語(yu),或(huo)昏憒不(bu)語(yu);心(xin)(xin)開竅于舌(she),心(xin)(xin)神(shen)被(bei)擾(rao)則(ze)(ze)舌(she)蹇;熱(re)(re)(re)盛(sheng)于內,陽氣郁遏,不(bu)達四肢則(ze)(ze)肢厥;熱(re)(re)(re)盛(sheng)波及(ji)營(ying)分,則(ze)(ze)舌(she)紅或(huo)降。
相(xiang)似(si)證(zheng)(zheng)候(hou)的辨(bian)別(bie)(bie):本(ben)證(zheng)(zheng)的肺衛癥(zheng)狀與(yu)衛分證(zheng)(zheng)基(ji)本(ben)相(xiang)同(tong)(tong),當與(yu)表寒證(zheng)(zheng)、太(tai)陽病等辨(bian)別(bie)(bie)。表寒證(zheng)(zheng)、太(tai)陽病以(yi)感受(shou)風寒之(zhi)邪(xie)為主,臨床以(yi)惡寒嚴重.頭痛(tong)身痛(tong)明顯等為特征(zheng),一般無口渴、咽紅腫痛(tong)、舌邊央紅等熱(re)象。本(ben)證(zheng)(zheng)為感受(shou)溫熱(re)之(zhi)邪(xie)為主,臨床以(yi)熱(re)邪(xie)致(zhi)病表現為特征(zheng)。本(ben)證(zheng)(zheng)的心神癥(zheng)狀與(yu)心包證(zheng)(zheng)相(xiang)同(tong)(tong),當區別(bie)(bie)熱(re)鬧與(yu)疾蒙(meng)的不同(tong)(tong)。
辨(bian)證注(zhu)意點:抓住病位特征,出現肺(fei)衛、心包等癥狀為辨(bian)證依據。
上(shang)焦病(bing)證(zheng)(zheng)還包括其他證(zheng)(zheng)候,如熱(re)擾胸膈證(zheng)(zheng)可(ke)出(chu)現(xian)(xian)身(shen)熱(re),心胸煩(fan)熱(re),煩(fan)躁(zao)不安等(deng)癥狀;熱(re)邪壅肺證(zheng)(zheng)可(ke)出(chu)現(xian)(xian)身(shen)熱(re),汗(han)出(chu),煩(fan)渴(ke),咳喘等(deng)表現(xian)(xian);熱(re)毒上(shang)壅證(zheng)(zheng)可(ke)出(chu)現(xian)(xian)頭(tou)面(mian)?腫(zhong),耳前后腫(zhong)等(deng),多見于大頭(tou)瘟、瘁腮、爛喉痧、纏喉風(feng)等(deng)病(bing)證(zheng)(zheng)。
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