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1、概 说 outline,1. 病因学说的概念 ：concept,研究各种致病因素的概念、形成、性质、致病特点及所致病证临床表现的理论 theoretical research on the concept, production, nature, and characteristic of causing disease as well as its clinical manifestation,2. 病因的概念：concept of causative factors,凡能导致疾病发生的原因，又称致病因素 all factors which can bring about the occur
2、rence of diseases,如：六淫、疠气、七情、饮食、劳逸、外伤、虫兽等 six exogenous evils, pestilence, seven emotions, food intake, over work and over-rest, traumatic injury, and injuries caused by insects and animals 痰饮、瘀血、结石 phlegm retention, blood stagnation, and calculus,1,病因医疗专业资料,11/18/2022,概 说 outline1. 病因学说的概念 ：c,中医临床探
3、求病因的方法methods to seek causative factors in TCM直接询问发病原因 direct inquiring about the factors 辨证求因(审证求因)：以疾病的临床表现为依据，通过对疾病症状和体征的综合分析来推求致病因素。Differentiation according to different syndromes and symptoms,2,病因医疗专业资料,11/18/2022,中医临床探求病因的方法methods to seek cau,第一节 外感病因 exogenous factors,六淫，即风、寒、暑、湿、燥、火(热)六种外感
4、病邪的统称。又称为“六邪”。淫，有太过和浸淫之意wind, cold, summer-heat, damp(phlegm), dryness, fire(heat), 淫means over or infiltration,一、六淫 concept and common characters,正常情况下称为“六气” six seasonal qi in normal condition,万物生长化收藏 cycle of everything in nature as spring wind, summer heat,人类赖以生存的必要条件 basic condition for human l
5、ife,异常情况下称为“六淫” six exogenous factors in abnormal conditions,超过人体的适应能力 surpass adaptation of humans vital qi,正气不支，抵抗力下降 weak of vital qi failing in protection,3,病因医疗专业资料,11/18/2022,第一节 外感病因 exogenous factor,The changes of weathers are relative:1. 与该地区常年同期气候变化相比，或太过，或不及，或非其时而有其气，或气候变化过于剧烈急骤，此时六气则变为六淫
6、而侵人发病 too much, not enough, abnormal seasonal climate, severe changes of climate in different regions2. 气候变化作为致病条件，与人体正气的强弱及调节适应能力相对而言，若气候剧变，正气充盛者则可自我调节而不病，正气虚弱之人则可发病；气候正常，个体正气不足，仍可发病，这时对于病人而言，六气即成为致病邪气，所致病证也属六淫致病范畴comparison between vital qi and seasonal change. Vital energy seasonal changes,4,病因医疗
7、专业资料,11/18/2022,The changes of weathers are re,六淫的共同特点 common characters of 6 factors,1.exougenous：,avenue,外感病exogenous disease,2.seasonal：春springwind，summersummer-heat，长夏late summer湿damp，秋autumn燥dryness，冬winter寒cold,气候变化相对性夏季见寒，冬季见热 cold in summer, heat in winter due to the relativity of climate,Wi
8、nd, cold, dampyinskin,Wind, heat, dryyangnose or mouth,5 pieces in all:,5,病因医疗专业资料,11/18/2022,六淫的共同特点 common characters of 6,binig：风寒感冒，风热感冒，暑湿感冒，湿热泄泻，风寒湿痹common cold due to wind cold, wind heat, summer-heat and damp, diarrhea due to damp heat, Bi syndrome due to wind, cold and damp,5. transformatio
9、n： 六淫致病在一定的条件下，其证候的病理性质可发生转化under certain conditions, the pathology of 6 exogenous factors can be transformed into another one 风寒表证里热证 superficial cold syndromeinternal heat syndrome,3.regional：西北north west燥dryness，东北north east寒cold，江南south湿热damp heat，久居潮湿 liviing in damp region湿dampness，高温作业working
10、 in high temperature燥热fire 、火热heat living in different area will produce different types of diseases according to local conditions,6,病因医疗专业资料,11/18/2022,binig：风寒感冒，风热感冒，暑湿感冒，湿热泄泻,(1)轻扬开泄 ascending and opening(2)善行数变 tends to mobile and change(3)动摇不定 characterized as movement(4)多兼他邪 wind is the leadi
11、ng cause of all other factors,（一）风邪 wind factors,春季主气，四季长在 main qi in spring, exist in four seasons,风袭肌表外风病证 external wind syndrome,1. 风邪的性质 nature of wind factor,7,病因医疗专业资料,11/18/2022,(1)轻扬开泄 ascending and opening（,(1)易于侵袭阳位 attacking yang position,Yang positionhead and faceheadache, facial paralys
12、is（头、面）、skinsweating, aversion to wind,(2)病位游走不定 tends to mobile and change,Tend to move migration, unstable, movingreuhmatic diseases,changesfast onset and easy to change荨麻疹，外感病 urticarial, exogenous diseases,2. 风邪的致病特点 characters of wind factor,8,病因医疗专业资料,11/18/2022,(1)易于侵袭阳位 attacking yang posi,(
13、3)肢体异常运动 tends to movement,movement动摇不定面肌抽动、眩晕、震颤 tremor of muscles, dizziness, convulsion,(4)外邪致病的先导 wind is the leading cause of all diseases,引邪而入风寒、风热、风湿、风燥 tourist guidewind cold, wind heat, wind damp, wind dry,风病最多四季机会多，表里内外皆可及 more wind diseases in different seasons and different places,9,病因医疗
14、专业资料,11/18/2022,(3)肢体异常运动 tends to movementmov,（二）寒邪 cold factor,冬季主气，它季可见 main qi in winter, appear in four seasons,寒邪袭人外寒证 external cold syndrome due to cold in the superficial,寒邪直中，伤及脏腑阳气中寒 internal cold syndrome due to cold attacking inside,(1) 寒冷 yin evil tends to impair yang qi,(2) 凝滞 cold ten
15、ds to coagulate,(3) 收引 cold tends to contract,1. 寒邪的性质 nature of cold,10,病因医疗专业资料,11/18/2022,（二）寒邪 cold factor冬季主气，它季可见 m,(1) 易伤阳气，表现寒象 yin evil tends to impair yang qi,阴邪阴气盛 predominance of yin imparing yang,伤阳阳本制阴祛寒，寒盛阳被其伤 basically, yang is balanced with yin, if too much yin attacks, yang will be
16、 impaired by yin cold,Cold imparing yang,Restricting defensive yangexcess cold syndromeaversion to cold、fever、no sweating、stuff nose,Imparing internal yangdeficient coldabdominal cold pain、vomiting、diarrhea, cold feeling in 4 limbs, and lie with knees drawn up,2. 寒邪的致病特点 characters of cold factor,11
17、,病因医疗专业资料,11/18/2022,(1) 易伤阳气，表现寒象 yin evil tends,(2) 阻滞气血，多见疼痛 blocking qi and blood,寒伤阳气、失于温煦、气血凝涩、不通则痛 yang fails to warm, stagnationsevere pain,凝coagulate气血津液凝结blocking qi, blood, body fluid,滞stagnation经脉运行阻滞blocking the smooth of meridian,Characters of pain,1. 多为局部冷痛 local cold pain,2. 得温则减，遇寒加
18、剧 relieved by warming, aggravated by more cold,3. 寒客肌表经络头身肢体关节疼痛 pain around surface of the body,4. 痹证关节冷痛寒痹、痛痹 bi syndromecold Bi, and pain Bi,5. 寒邪直中胃肠脘腹剧痛 severe abdominal pain due to cold attacking st. and intestine,6. 寒客肝脉少腹或阴部冷痛 cold pain in lower abdomen and pudenda,12,病因医疗专业资料,11/18/2022,(2)
19、 阻滞气血，多见疼痛 blocking qi and,(3) 腠理、经脉、筋脉收缩拘急 cold tends to contract,收缩牵引 contraction,气机收敛 astringency of qi movement,腠理、经络、筋脉收缩而挛急 contraction and spasm of skin, meridians, and muscles,manifestation,寒邪袭表skin closeddefensive yang is restrictedsuperficial cold syndromeaversion to cold, fever, no sweati
20、ng,寒客血脉cold in vessels头身痛，脉紧cold retentionspasm of vessels, headache, tense pulse,寒客经络关节经脉收缩拘急挛急作痛 cold in meridians and jointsspasm of meridians, pain along meridians,contraction,13,病因医疗专业资料,11/18/2022,(3) 腠理、经脉、筋脉收缩拘急 cold tends t,（三）暑邪 summer heart factor,(1)暑性炎热 yang evil is extreme hot (2)暑性升散
21、tends to ascend and disperse (3)暑多挟湿 summer-heat is often complicated by dampness,夏至立秋之间、具有炎热升散兼湿特性的外邪 characteristic in late summer, with hot flaming up and damp together,先夏至日者为病温，后夏至日者为病暑 febrile disease before summer solstice, summer-heat after summer solstice,1.暑邪的性质 nature of summer heat,14,病因医
22、疗专业资料,11/18/2022,（三）暑邪 summer heart factor(1)暑性,(1) 表现阳热之象 yang evil is extreme hot,阳邪火热所化属阳changed from fire and heat pertains to yang,阳热症状heat excess symptomshigh fever, red face, full pulse , profuse sweating and severe thirsty,(2) 上犯头目，扰及心神 tends to ascend and disturb mind,侵犯头目胸闷、头昏、目眩influencin
23、g upperchest, head and eyeschest oppression, dizziness, vertigo,扰神心烦闷乱而不宁 stirring heart mind makes irritability,2. Characters of summer heat,Heat is easy to attack heart mind,15,病因医疗专业资料,11/18/2022,(1) 表现阳热之象 yang evil is extr,(4) 暑多挟湿 summer-heat is often complicated by dampness,挟湿热蒸湿动，水气弥漫 heat s
24、teams damp leading to vapor diffusion,身热不扬、四肢困倦、胸闷、呕恶、便溏 recessive fever, lassitude of four limbs, chest oppression, nausea and vomiting, loose stool,重证突然昏倒、不省人事气津两伤、清窍失养 severe conditionsudden fall down with unconsciousness due to the impairment of qi and body fluid failing to nourish the clear ori
25、fice,伤津liquidthirsty and desire to drink yellow and scanty urine,伤气qishort of breath and lassitude,More sweating consumes both body fluid and qi,（3）易于伤津耗气 tends to consume qi and body fluid,散腠理开泄而多汗 make interstitial space open and loose, with the consequence of over sweating,16,病因医疗专业资料,11/18/2022,
26、(4) 暑多挟湿 summer-heat is ofte,（四）湿邪 damp factor,夏秋之交长夏具有重浊、黏滞、趋下特性的外邪characteristic in heavy-turbid, sticky-stagnant, tends to move downward,长夏主气，它季可见 main qi in late-summer, appear in four seasons,1.湿邪的性质 nature of damp factor,(1) 湿性重浊 dampness is heavy and turbid,(2) 湿性黏滞 dampness is sticky and sta
27、gnant,(3) 湿性趋下tends to move downward to attack pudenda,2. Characters of damp factor,17,病因医疗专业资料,11/18/2022,（四）湿邪 damp factor夏秋之交长夏具有重浊,(1) 易于损伤阳气，tends to impair yang qi,阴邪与水同类 heavy and turbid constitution, same as water,伤阳阴邪与阳气抗争 yin evil fighting with yang qi,气机脾运水液，喜燥恶湿湿困脾土 damp embarrasses sple
28、en qi,Block qi movement,Up-jiao气机不畅胸膈满闷 fullness in chest and diaphragm,Middle-jiao脾胃升降失司abdominal fullness, poor appetite,Lower-jiao肾与膀胱气机不利fullness in lower abdomen，dysuria,脾阳不振imparing spleen yangdiarrhea, edema, little urine,（2）易于阻遏气机 tends to block qi movement,(3) 易于侵袭阴位 tends to move downward
29、to attack pudenda,趋下重着有质之邪，水类趋下，下部属阴 heavy tends downward,水肿、湿疹下部多见 edema and eczema often appear lower part,湿邪下注turbid urine、diarrhea、dysentery、leukorrhea,18,病因医疗专业资料,11/18/2022,(1) 易于损伤阳气，tends to impair yan,（4）病程缠绵难愈 lingering period of diseases,sticky,湿阻气机气不行则湿不化 damp blocking qi moving,起病缓，病程长，
30、反复发作 long course of disease, repeated,湿温、湿疹、湿痹 damp-heat, eczema, damp Bi syndrome,（5）多见头身肢体困重 heavy and sour feeling in head and limbs,重沉重、重着湿为病沉重感 heavy and sinking sensation,头身困重，四肢酸楚沉重 heavy and sour feeling in head and limbs,清阳不升因于湿，首如裹wrapping feeling on head due to damp,阻滞经络关节，阳气不布肌肤不仁，关节疼痛重着
31、 blocking meridians numbness on skin , heavy and pain around joints,heavy,19,病因医疗专业资料,11/18/2022,（4）病程缠绵难愈 lingering period of,dirty,秽浊在上面垢、眵多 upperdirty face and eye gum,湿滞大肠便溏、下利脓血 in L.I. loose stool, dysentery,湿浊下注小便浑浊、白带多 lowerdirty urine, leukorrhea,湿淫肌肤湿疹 eczema,sticky,痢疾排泄不爽dysentery not smo
32、oth excretion,淋证小便滞涩不畅 stranguria difficulty in urination,脾湿口黏、口甘、舌苔厚腻in spleensticky mouth, sweet taste in mouth, thick greasy coating of tongue,（6）排泄物和分泌物discharge and excretiondirty and turbid,20,病因医疗专业资料,11/18/2022,dirty秽浊在上面垢、眵多 upperdirty fa,（五）燥邪 dry factor,具有干燥、收敛特性的外邪characteristic in dryne
33、ss, and astringency,秋季主气，气候干燥，失于水分 main qi in autumn, the climate is dry,燥邪伤人口鼻而入首犯肺卫外燥证 external dry syndrome is caused by defensive qi attacked by dry factor,初秋燥合夏末之余热温燥 early autumnwarm dryness,深秋燥合初冬之早寒凉燥 late autumncool dryness,1.燥邪的性质干燥和涩滞 dryness and astringency,21,病因医疗专业资料,11/18/2022,（五）燥邪 d
34、ry factor具有干燥、收敛特性的外邪ch,2. 燥邪的致病特点 characters of dry factor,(1) 易于耗伤津液tends to impair body fluid,燥胜则干exotic, consuming body fluid口鼻干燥、咽干、口渴、皮肤干涩、毛发不荣、小便短少、大便干结dry skin, dry mouth, dry throat, dry eyes, thirsty, scanty urine and constipation,(2) 易于伤肺 dryness tends to impair lung,伤肺肺为娇脏，喜润恶燥lungs is d
35、elicate organ, tends to moisten but not dryness,燥入口鼻灼伤肺津影响宣降 dryness injures body fluid of lung through nose and mouth influencing opening and descending,干咳少痰、痰黏难咯、痰中带血 dry cough without sputum, or sticky sputum, blood sputum,肺与大肠相表里肺津耗伤，大肠失润便干 constipation due to lung and L.I. are interior and exte
36、rior related organs,22,病因医疗专业资料,11/18/2022,2. 燥邪的致病特点 characters of dry f,（六）热（火）邪 heat (fire) factor,(1) 燔灼 scorching and burning(2) 炎上 fire tends to stir upward(3) 急迫 acute onset,具有炎热升腾特性的外邪characteristic in hot and flaming up,旺于夏季，四季均见 main qi in summer, and appear in 4 seasons,1.火热之邪的性质 nature o
37、f heat factor,热属外感heat from outside风热wind heat，火自内生fire from inside心火 heart fire or liver fire,23,病因医疗专业资料,11/18/2022,（六）热（火）邪 heat (fire) factor(1),热与火之比较 comparison between the heat and fire,24,病因医疗专业资料,11/18/2022,similarity阳盛、六淫邪气、致病相同,(1) 表现阳热之象 hot evil tends to ascending,阳盛则热高热、恶热、烦渴、汗出、脉洪数 ex
38、cessive heat syndromehigh fever, aversion to heat, severe thirsty, profuse sweating,(2) 易于伤津耗气 tends to impair body fluid and consume qi,迫津外泄heat steaming body fluid out of skin津亏气耗 consume both body fluid and qi,煎熬津液heat burning body fluid inside the body热盛伤阴 predominance of heat consumes yin in th
39、e end,轻证light case口渴喜冷饮、咽干口燥、小便短赤，便秘 thirsty, dry mouth and throat, scanty urine and constipation,中证less severe case体倦乏力、少气懒言气虚 fatigue, short of breathqi deficiency,2. 热（火）邪的致病特点 characters of heat,阳邪燔灼升腾 yang factorscorching, burning, and flaming up,Consuming body fluid and qi,重证severe case全身津气脱失气
40、脱证 qi collapse syndrome,25,病因医疗专业资料,11/18/2022,(1) 表现阳热之象 hot evil tends to,（3）主要侵犯人体上部 tends to attack upper part,阳邪燔灼升腾 yang factor scorching, burning, and flaming up,趋上侵害上部目赤肿痛、咽喉肿痛、口舌生疮、牙龈肿痛 upper parts injuredred eyes, sore throat, tongue and mouth ulcer, swollen gum,(4) 易致生风动血 tends to produce
41、 wind and disturb blood,生风producing wind火热燔灼肝经，耗伤津液tendon is injured due to heat热极生风 liver wind,高热、神昏、四肢抽搐、两目上视、角弓反张 high fever, unconsciousness, convulsion, staring eyes, opisthotonus,动血disturb blood迫血妄行heat makes blood irregular movementcompel blood to flow out of vessels,吐血、衄血、便血、尿血、发斑、月经过多 hemat
42、emesis, nose bleeding, blood stool, blood urine, mense bleeding,26,病因医疗专业资料,11/18/2022,（3）主要侵犯人体上部 tends to attack up,(5) 易扰心神 fire tends to stir heart mind,扰心神火热与心火相同易入营血影响心神 influence heart mind,轻证light case心神不宁、心烦、失眠 disphoria, irritability, insomnia,重证severe case扰乱心神，狂躁不安、神昏、谵语 mania, delirium,
43、unconscious,(5) 易致阳性疮痈 tends to cause carbuncle and furuncle,疮痈火入血分，腐蚀血肉痈肿疮疡 putrefy blood and muscles,局部红肿热痛 local red, swelling, heat and pain,27,病因医疗专业资料,11/18/2022,(5) 易扰心神 fire tends to stir,二、 疫气 pestilence,疫气的基本概念 concept疠气具有强烈致病性和传染性的外感病邪 pestilential evils are the most serious exogenous cau
44、sative and contagious pathogenic factors,别名瘟疫，疫毒，异气，疫气，戾气，毒气，乖戾之气 nick nameplague, pestilential poison, strange agents, poisonous agents, perverse agents,著作吴又可瘟疫论“天地间别有一种异气所感” Treatise on Pestilence by Wu You-ke initiated that there is a strange agent causing disease between heaven and earth,途径空气、口鼻
45、、食物、虫兽、皮肤 avenuesair, mouth and nose, food, worm and animal, skin,疾病痄腮、猩红热、疫毒痢、白喉、天花、肠伤寒、霍乱、鼠疫、疫黄、流行性出血热、爱滋病 mumps, scarlet fever, infectious dysentery, diphtheria, smallpox, typhoid, cholera, plague, infectious hepatitis, epidemic hemorrhagic fever, Aids, Sars,28,病因医疗专业资料,11/18/2022,二、 疫气 pestilenc
46、e疫气的基本概念 co,（一）疫气的性质和致病特点 characters1. 传染性强，易于流行strong infection and easiness to spread 通过空气和食物传播 spread through air and food 流行区域无问大小，皆相染易 people will be easily infected no matter the ages or health in the local epidemic area 2. 特异性强，症状相似 one pestilence will cause one disease with similar symptoms
47、and signs疠气对脏腑器官具有特异性和选择性各自的临床特点和传变规律痄腮（耳下腮部肿胀）pestilence has the particularity and selection to organs and tissues with the clinical characters and transmission rules respectively such as mumps and dysentery etc. 3. 发病急骤，病情危笃 acute onset with severe condition急骤热毒之邪，挟毒雾、瘴气，比六淫急骤而凶猛 heat evil with po
48、isonous fog and miasma, more acute and fierce than six exogenous evils 发热、扰神、动血、生风、剧烈吐泄 fever, disturb mind, disturb blood, produce wind, severe vomiting and diarrhea,29,病因医疗专业资料,11/18/2022,（一）疫气的性质和致病特点 characters29病因医疗,（二）疫气发生和疫病流行的原因 factors to influence the occurrence of pestilence,1. 气候反常：自然气候的
49、反常变化，如久旱、酷热，洪涝、湿雾瘴气、地震等 abnormal change of climatedrought, extremely hot weather, flooding, damp, and fog miasma, earthquake 2. 环境污染和饮食不洁：环境卫生不良，如水源、空气污染、食物污染等 polluted environment(air, food) water contamination 3. 预防隔离工作不严格：若预防隔离工作不力，也往往会使疫病发生或流行 delayed prevention and isolation will lead the onset
50、 or spread of pestilence4. 社会因素：若战乱不停，社会动荡，工作环境恶劣，生活极度贫困，则疫病不断发生和流行 certain social factors such as unceasing war, social turbulence, bad working condition, extremely poverty will also lead the onset or spread of pestilence,30,病因医疗专业资料,11/18/2022,（二）疫气发生和疫病流行的原因 factors to in,第二节 内伤病因 internal impair
