中醫(yī)基礎(chǔ)理論之病因篇

第六章病因

CauseofDisease學(xué)習(xí)要點(diǎn)中醫(yī)對(duì)病因的認(rèn)識(shí)方法及分類六淫的概念及致病特點(diǎn)七情的概念及七情內(nèi)傷痰飲、瘀血、結(jié)石的概念、形成及致病特點(diǎn)KEYWORDSCauseofdisease病因Etiology病因?qū)W說Sixexcesses六淫Pestilentialqi癘氣Sevenemotions七情Interal-injurypathogenicfactors七情內(nèi)傷Phlegm-fluidretention痰飲Stagnantblood瘀血Abdominalmass徵積Calculus結(jié)石Medicinepathogens藥邪Iatrogenicfactors醫(yī)過Fetalweakness胎弱Fetaltoxin胎毒Concept:Thecauseofdisease,referstothefactorsthatdamagetherelativeepuilibriumandresultindiseaseandarealsocalledpathogenicfactors.

Methods

ofCMprobingintopathogenicfactors

AskingdirectlyReferringthecausebysyndromedifferentiationIntroduction中醫(yī)病因1.六淫2.七情3.癘氣4.飲食5.勞逸6.痰飲7.瘀血8.結(jié)石9.外傷10.寄生蟲11.藥邪12.先天因素13.醫(yī)過等西醫(yī)病因1.生物病原：如細(xì)菌、病毒、真菌等。2.物理因素：如噪音、高溫、氣壓、放射線等。3.化學(xué)因素：如化學(xué)藥品、污染、毒物等。4.營養(yǎng)因素：如偏食、營養(yǎng)不良等。

5.精神因素：如情緒、心理等。6.遺傳因素：如遺傳病等。第一節(jié)六淫

SixExcessesConceptofSixExcessesThesixexcessesareacollectivetermusedforsixkindsofexogenouspathogensofwind,cold,summer-heat,dampness,drynessandfire.Undernormalconditions,theyarecalled“sixclimaticfactors”Commonpathogeniccharacteristicsofsixexcesses1.exogenousness2.seasonality3.regionality4.combination5.transformability一、風(fēng)自然界中具有風(fēng)之輕揚(yáng)開泄、善動(dòng)不居特性的外邪，稱為風(fēng)邪。性質(zhì)致病特點(diǎn)主要病癥輕揚(yáng)開泄（浮越）病位在上病位在表頭痛、鼻塞、咽癢。惡風(fēng)、發(fā)熱、汗出。善行數(shù)變病位游走不定行痹之四肢關(guān)節(jié)疼痛，游走不定。癥狀變化多端風(fēng)疹塊之皮疹時(shí)隱時(shí)現(xiàn)，此起彼伏。主動(dòng)動(dòng)搖不定眩暈、抽搐、拘攣、角弓反張，兩目上吊。為百病之長致病先導(dǎo)風(fēng)寒、風(fēng)熱、風(fēng)濕、風(fēng)寒濕等兼夾證。WindpathogenAllexogenouspathogenicfactorscharacteristicoflightness,rising,andopening-dispersingandmigratingarecalledwindpathogen.naturesPathogeniccharacteristicsClinicalnanifestationsLightandopening-dispersingBeingapttoattackyangportionofbodyanddischargingtheporeHeadache,stuffynasal,itchingthroat.Aversiontowind,feverandsweating.BeingmobileandchangeableCharacterizedbymigratorylocation,suddenonsetandconstantlychangingMigratoryarthralgia(migratorypaininthejountsofthefourlimbs)Rubella,characteristicofconstantlychangingBeingmobileCharacterizedbyswayVergo,convulsion,spasm,opisthotonus,upwardsquintBeingprimarypathogenTheprecursorofvariousdiseasesTendstocausediseaseinmixturewithotherpathogenicfactorssuchascold,heat,dampnessanddryness,etc二、寒自然界中具有寒冷、凝結(jié)特性的外邪，稱為寒邪。性質(zhì)致病特點(diǎn)主要病癥寒為陰邪寒證，傷陽氣傷寒：惡寒、無汗中寒：脘腹冷痛、嘔吐腹瀉伴有形寒肢冷。凝滯氣血運(yùn)行遲滯甚至凝結(jié)不通產(chǎn)生疼痛局部冷痛，遇熱緩解，遇冷加重收引腠理汗孔收縮惡寒、無汗、發(fā)熱筋脈牽引拘急四肢拘急，屈伸不利ColdpathogenAllexogenouspathogenicfactorscharacteristicofcold,coagulationandcontractionarecalledcoldpathogen.NaturesPathogeniccharacteristicsClinicalmanifestationAyinpathogenTendingtoattackyangqiandbeingmanifestedascoldsyndromeCold-attack：aversiontocold,absentsweatingCold-stroke：coldpaininthestomachandabdomen,vomitinganddiarrhea。CoagulationandstagnationLeadingtostagnantofqiandbloodLocalcoldpainsinthebody,alleviatedwithwarmth,aggravatedbycoldcontractionBlockageofporesAversiontocold,absentsweatingandfeverContractionoftendonsandvesselsSpasmofthelimbs性質(zhì)致病特點(diǎn)主要病癥重濁周身困重頭身困重，四肢發(fā)沉，關(guān)節(jié)重著疼痛分泌物排泄物穢濁不清小便混濁、大便溏泄、下痢粘液膿血、面垢眵多。粘滯癥狀的粘滯性大便粘滯不爽，小便澀而不暢，苔膩。病程的纏綿性濕痹、濕溫、濕疹的病程長、反復(fù)發(fā)作。為陰邪阻遏氣機(jī)損傷陽氣阻遏脾胃氣機(jī)見脘腹脹滿，食欲不振；脾陽不振見腹瀉、水腫。趨下傷及人體下部，癥狀多見于下部淋濁、帶下、泄瀉、痢疾、下肢水腫、下肢潰瘍。三、濕自然界中具有水濕之重濁、粘滯、趨下特性的外邪，稱為濕邪。naturesPathogeniccharacteristicsClinicalmanifestationsHeavyandturbidGeneralheavinessHeavysensationintheheadandbody,achingandpainfullimbsTurbidexcretionandsecretionTurbidurination,diarrheawithpurulentandbloodydysentery,dirtycomplexion,excessiveeyesecretionsStickyandstagnantSymptomscharacteristicofstickinessandstagnancywithalingeringpathologicalcourseStickystoolswithdifficultyinemptyingbowels,difficultyinurination,greasyfurwithalongdurationandrecurrentepisodes.AyinpathogenObstructingqimovementanddamagingyangqiOppressioninchest,epigastricandabdominaldistension,poorappetite,diarrhea,scantyurine,diarrhea,edemadescendingUsuallyattackingthelowerpartofthebodyTurbidstranguria,leukorrhagia,diarrhea,dysentery,edemainthelowerlimbsandcankerouslegsDampnesspathogenAllexogenouspathogenicfactorscharacteristicofheavyturbidity,stickinessanddownwardnessarecalleddampnesspathogen.四、燥自然界中具有干燥、收斂清肅特性的外邪，稱為燥邪。溫燥涼燥時(shí)間初秋深秋氣候有夏熱之余氣，燥與熱結(jié)合有近冬之寒氣，燥與寒結(jié)合證候燥而偏熱（溫燥證）燥而偏寒（涼燥證）性質(zhì)致病特點(diǎn)主要病癥干澀易傷津液，出現(xiàn)各種干燥癥狀口干唇燥，鼻咽干燥皸裂，小便短少，大便干結(jié)。易傷肺陰干咳少痰，或痰粘難咯，痰中帶血。DrynesspathogenAllexogenouspathogenicfactorscharacteristicofdrynessandasringencyarecalleddrynesspathogen.Warmth-drynessCool-drynessseasonEarlyautumnLaterautumnclimateDrynessiscomplicatedbyheatofsummerDrynessiscomplicatedbycoldofwintersyndromeWarmth-drynesssyndromeCool-drynesssyndromenaturesPathogeniccharacteristicsClinicalmanifestationsBeingdryandpuckeryBeingapttoimpairfluidsDrymouth,noseandthroat,orevenclaps,scantyurineanddrystoolsBeingapttoinjurylung-yinDrycough,scantyorstickyphlegm,bloodysputum性質(zhì)致病特點(diǎn)主要病癥炎熱灼燔為陽邪，實(shí)熱證高熱，面紅，心煩，口渴，尿赤，脈洪。炎上，癥狀多見于上部發(fā)熱，頭昏，頭痛，面紅，目赤，咽喉紅腫疼痛，口舌糜爛。易傷津耗氣口渴喜飲，咽干唇焦，舌質(zhì)紅絳，體倦乏力少氣。易生風(fēng)高熱，四肢抽搐，牙關(guān)緊閉，兩目上視，角弓反張（熱極生風(fēng)）。易動(dòng)血熱迫血妄行，如吐血、咯血、衄血、尿血、皮膚發(fā)斑。易擾心神高熱，狂躁，神昏，譫語，失眠。易致腫瘍癰腫，瘡瘍，局部紅腫熱痛，化膿。五、熱（火）邪自然界中具有火之炎熱特性的外邪，稱為火邪。（少火及壯火的概念）naturesPathogeniccharacteristicsClinicalmanifestationsFlamingUpwardAndscorchingIsayangpathogenandleadstoheatsyndromeHighfever,reddishcomplexion,dysphoria,thirsty,redurine,surgingandrapidpulseAttackingtheupperpartofthebodyDizziness,headache,reddishcomplexion,conjunctivalcongestion,swellingandpainofthroat,erosionofmucousmembraneinoralcavity.ConsumingfluidsandexhaustingqiThirstwithdesireforcooldrink,drythroatandlips,brownishtongue,tiredanddebility.CausingconvulsionandbleedingHighfeverandcoma,spasmoflimbs,lockedjaw,upwardsquint,opisthotonusHeamatemesis,non-traumatichemorrhage,bloodyurine,echymosis.Disturbingheart-mindDysphoria,coma,deliriousspeacking.InsomniaProducingsores,ulcersandabscessesAbscess,red,swollen,burning,painfulsensationinthelocalareaswiththeformationofpus.Fire(heat)pathogenAllexogenouspathogenicfactorscharacteristicoftorridityandflaminguparecalledfire(heat)pathogen.六、暑邪暑為夏季的火熱之邪。大凡夏至以后，立秋以前，自然界中的火熱外邪，稱為暑邪。暑邪致病具有明顯的季節(jié)性。性質(zhì)致病特點(diǎn)主要病癥炎熱為陽邪，實(shí)熱證高熱，煩渴，面紅，目赤，脈洪大。升散上犯頭目傷暑：頭昏、目眩。上擾心神中暑：突然昏倒，不省人事。腠理開泄多汗傷津耗氣口渴多飲，舌紅少津，氣短乏力。多夾濕暑濕夾雜證身熱不揚(yáng)，煩渴，身重倦怠，胸悶，嘔惡，苔黃膩。Summer-heatpathogenDuringthetimefromsummersolsticetoautumnbegins,theexogenouspathogenicfactorscharacteristicofscorching-hot,ascendinganddispersive,mixedwithdampnessarecalledpathogenicsummer-heat.Summer-heatpathogenischaracterixedbyanapparentseasonality.naturesPathogeniccharacteristicsClinicalmanifestationsCharacteristicbeingscorching-hotAyangpathogenandleadstoexcess-heatsyndromeHighfever,dipsesis,reddishcomplexion,conjunctivalcongestion,surgingandlargepulseCharacteristicbeingascendinganddispersiveAttackingtheheadandeyeSummer-heatattack:dizziness,dizzyvisionDisturbingheart-spiritSummer-heatstoke:suddencomaandunconsciousnessOpeninganddispersingthestriaeoftheskinsweatingImpairingfluidsandexhaustingqiThirstwithpreferencefordrink,redtongueandscantyfluids,shortbreathandlackofstrengthLikelytobemixedwithbeingdampnessSummer-heatcausingdiseaseinmixturewithdampnessHidingfever,dipsesis,lassitudeoflimbs,oppressioninchest,nauseaandvomiting,yellowishandgreasytonguefur.第二節(jié)七情

SevenEmotionsConceptofsevenemotionsThesevenemotionsrefertosevenemotionalactivitiesincludingjoy,anger,worry,anxiety,sadness,fearandfright.Normally,thesevenemotionsdon’tcausediseasesandonlywhentheemotionalstimulationsaretooabrupt,violent,andprolongedandbeyondone’sadaptabilityorwhenthereisdiminishedadaptabilityduetoimbalancedyin-yang,qiandbloodofviscera,cantheyturnintopathogenicfactors,thuscausingdiseases.情志異常的病因

外因主要是指社會(huì)因素、個(gè)人處境及自然環(huán)境對(duì)機(jī)體的影響。七情病變的內(nèi)因是個(gè)體素質(zhì)。個(gè)體素質(zhì)主要決定于先天稟賦，后天營養(yǎng)、性格陶冶、文化修養(yǎng)、個(gè)人經(jīng)歷等多方面的因素。。當(dāng)突發(fā)性的強(qiáng)烈刺激或長期持久的精神負(fù)擔(dān)超過了機(jī)體對(duì)情志調(diào)節(jié)的靈敏閾時(shí)，就產(chǎn)生了七情病變，靈敏閾的高低標(biāo)志著個(gè)體體質(zhì)的差異性。Pathogeniccharacteristicsofinternalinjuryduetosevenemotions1.Sevenemotionsarisingfromtheheart2.Impairingtheviscera

以心、肝、脾三臟為多見3.Affectingthevisceralqimovementrageleadingtoqiascending,excessivejoyleadingtoqiloose,excessivesorrowleadingtoqiconsumption,fearleadingtoqisinking,frightleadingtoqiturbulence,pensivenessleadingtoqiknotting怒則氣上、喜則氣緩、悲則氣消、恐則氣下、驚則氣亂、思則氣結(jié)

4.Tendingtocauseemotionaldiseases5.Affectingthesequelaeofdiseases第三節(jié)癘氣、勞逸、飲食、外傷、寄生蟲

pestilentialqi,workandrest,diet,trauma,parasite癘氣的概念pestilentialqiisanexogenouspathogenicfactorwhichisstronglyinfective.Itisvariouslycalledepidemictoxin,epidemicqi,specialpathogenicfactor,pestilentialqiorpoisonousqietc.syndromesproducedbypestilentialqiarecalledpestilences,whichincludemanyhighlycontagiousdiseasesinmodernmedicine.癘氣是一類具有強(qiáng)烈傳染性的外邪。又稱“疫氣”、“疫毒”、“戾氣”、“乖戾之氣”等。癘氣引起的疾病稱為“疫病”、“瘟病”、“瘟疫病”。實(shí)際上包括了現(xiàn)代許多傳染病和烈性傳染病。Pathogeniccharacteristics1.Stronginfectivityandepidemic2.Acuteonsetandseverecondition3.DiseasesvarywithpestilentialqibutsymptomsaresimilarFactorsaffectingtheformationandepidemicofpestilentialqi1.Abnormalclimates2.Environmentalandfoodpollution3.Lackofstrictpreventativemeasures4.Socialconditions勞逸失當(dāng)Imbalancebetweenworkandrest過勞overstrain飲食失宜Irregularityofdiet饑飽失常improperdiet過逸Indulgenceineasylife房勞過度sexualoverstrain勞神過度mentaloverstrain勞力過度overexertion飲食偏嗜dietpredilection飲食不潔unhygienicdiet外傷traumaticinjuries槍彈、金刃傷、跌打損傷、持重努傷燒燙傷、凍傷（全身、局部）化學(xué)傷、溺水、雷擊傷、蟲獸傷寄生蟲parasites蛔蟲、鉤蟲、蟯蟲、絳蟲、瘧原蟲、血吸蟲等。中醫(yī)稱寄生蟲病為“蟲積”。

第四節(jié)痰飲Phlegm-fluidretention痰飲的基本概念

痰飲是機(jī)體水液代謝障礙所形成的病理變化及其病理性產(chǎn)物。稠濁者為痰，清稀者為飲。痰飲作為一種新的致病因素作用于機(jī)體，導(dǎo)致新的病變，則為繼發(fā)病因。Phlegm-fluidretentionisthepathologicalproductresultingfromthemetabolicdisordersofbodyfluids.Itcanbedividedintophlegmandfluidretentionwiththeformerbeingstickyandturbidandthelatterbeingthinandclear.Asanewpathogenicfactor,whenstagnatedinthebody,itcanleadtovariouspathologicalchangesanddifferentnewsyndromes.痰飲有形之痰substantialphlegm無形之痰insubstantialphlegm痰飲的形成外感六淫飲食失宜七情內(nèi)傷勞逸太過肺失宣降脾不健運(yùn)腎氣化失司肝失疏泄三焦水道不利膀胱氣化不利傷及內(nèi)臟津液代謝障礙水液停滯

痰飲痰飲是由外感六淫、或飲食失常、或七情內(nèi)傷、或勞逸太過等原因，導(dǎo)致肺、脾、腎、三焦等臟腑對(duì)水液的氣化功能失常，津液代謝障礙，以致水液停滯而生成。痰飲致病的病位痰飲隨氣機(jī)的升降流行，內(nèi)而臟腑，外達(dá)筋骨皮肉，無處不到，病位廣泛。部位主要病癥飲停于肺胸悶、咳喘不能平臥、其形如腫、吐清稀痰液（支飲）飲在腸胃脘腹脹痛、腸鳴漉漉有聲、嘔吐清水痰涎（痰飲）飲在胸脅胸脅脹滿、咳嗽引脅作痛（懸飲）飲溢肌膚水腫、身重?zé)o汗、尿少（溢飲）飲停腹中腹脹大如鼓、尿少、腹壁青筋顯露（腹水）痰飲的致病特點(diǎn)致病特點(diǎn)主要病癥阻滯氣機(jī)，阻礙氣血痰阻于肺胸悶、咳嗽、喘促濕困中焦脘腹脹滿，惡心嘔吐痰阻經(jīng)絡(luò)肢體麻木，屈伸不利痰聚于局部痰核、瘰癘、陰疽流注致病廣泛，變化多端百病多由痰作祟，怪病多痰病勢纏綿，病程較長咳喘、眩暈、瘰癘、胸痹、癲癇、流注、中風(fēng)、痰核、陰疽易擾亂神明出現(xiàn)神志失常的病證：精神不振，失眠易怒；喜笑不休，甚則發(fā)狂。多見滑膩舌苔Pathogeniccharacteristicsofphlegm-fluidretentionPathogeniccharacteristicsClinicalmanifestationStagnatingtheflowofqiandbloodPhlegminlungOppressioninchest,cough,dyspneawithrapidandshortbreathInmid-jiaoAbdominaldistention,nauseaandvomitingInmeridiansNumbnessoflimbs,difficultflexingandstretchingInapartareassuperficialnodule,abdominalmass,dorsalfuruncleWidelypathogenicandchangefulSingulardiseasesusuallyresultfromphlegm-fluidretention,prolongeddiseaseareusuallycausedbyphlegmLingeringpathologicalconditionandprolongeddurationCoughandasthma,dizzy,abdominalmass,thoracicobstruction,epilepsy,stroke,superficialnodule,dorsalfuruncleTendingtoblockspiritDispirited,dementiaandtantrum,constantlaughter,evenleadingtocrazyOftenmanifestedcreasyfur

第五節(jié)瘀血stagnantblood瘀血的概念

是指體內(nèi)血液停滯。包括離經(jīng)之血停積于體內(nèi)的病理性產(chǎn)物，以及血液運(yùn)行不暢而阻滯于臟腑經(jīng)絡(luò)之中的病理變化。血液停滯于體內(nèi)又能導(dǎo)致新的病變，而成為繼發(fā)病因。Stagnantbloodisapathologicalproductresultingfromdisturbanceandstagnationofbloodcirculation,includingabnormalflowofblood,orstagnatedbloodinmeridiansorvisceraduetodisturbedbloodflow.Onceitisformed,stagnantbloodwillbecomeanewpathogenicfactor.外邪情志飲食勞逸外傷外傷—絡(luò)傷血溢氣虛—?dú)獠粩z血血熱—迫血妄行損傷機(jī)體血離脈道，停積體內(nèi)氣血功能失調(diào)導(dǎo)致瘀血形成主要有以下四種：1.氣虛血瘀2.氣滯血瘀3.血寒致瘀4.血熱成瘀氣虛—血行無力氣滯—血行受阻血寒—寒凝血滯血熱—煎熬粘滯血行不暢阻滯臟腑經(jīng)絡(luò)瘀血瘀血的形成TendingtostagnateqimovementAffectingbloodcirculationAffectingthegenerationofnewbloodCausingvarioussyndromeswithfixedlocationPathogeniccharacteri