第二百五十五章节 伟大的名词(2 / 2)

重振中医 蜀都小侯爷 1147 字 2022-04-25

这恰恰是钟医缺少给白兴腾的。所以,钟医给白兴腾找了一个很好的老师——戴高。

钟医对白兴腾的话也是点到为止。

“下面,我来给你说说冠心病的中医诊断。中医其实对冠心病早期、无创、敏感的诊断方法,尚未形成常规。但是,中医对冠心病诊断,是可以通过经络形诸于外,形成四诊之征,从而不断探索中医诊断冠心病的规律。望诊包含察舌,观耳垂皱褶征、脉诊等内容,以寻求中医对冠心病的诊断规律,并通过对诊察的分析,提出中医诊断冠心病的具体条件。同时也认为舌象及观耳褶是冠心病中医辨证施治较为可靠的客观指征,而对脉象的准确诊察更加考验功夫。”钟医对白兴腾说道。

“那么望诊中舌苔怎么看?”白兴腾迅速抓到了关键。

这都是精华啊。在重视传承的中医世界里面,一般的人真的接触不到这么详细的数据和经验。

“看病人的舌质和舌苔。如果我们对一百例例冠心病患者进行观察,发现舌质红赤、紫暗或兼瘀斑者占百分之59,淡紫而胖者占百分之41,故冠心病以紫舌者多见,

老年人冠心病紫黯舌与红绛舌有一定比例,说明有阴虚与瘀血证之存在,而舌苔变化老人则以白腻苔最多,此与气阴虚衰关系密切。血气分析亦证明紫舌者确实存在血氧含量明显下降,其Pco2,血氧饱和度明显低于淡红舌组,而肺泡动脉氧分压差高于淡红舌组。

舌质的变化对急性心肌梗塞病情的进退同样有重要的诊察意义。我们对100例急性心肌梗塞的观察表明,在发病早期舌质颜色偏暗或紫色占百分之93.0,有瘀斑点的百分之33,而再梗塞患者舌质有瘀斑点的可高达百分之50.0。合并心室壁瘤的则更高,为百分之62.5。

我们这么一观察分析,就会发现急性心肌梗塞并发心力衰竭和心源性休克患者舌质的变化一般发病初期以黯舌为主,分别占92%、94.4%。随病情好转,黯舌有不同程度的减轻,四周后部分恢复正常,分别下降到63.7%、56.3%。同时舌质的变化也可反映瘀血程度之轻重,如一例男性患者发生阿-斯综合征,呼吸心跳停止达二十余分钟,经抢救复苏成活,其舌质始终成紫黯。观察急性心肌梗塞患者的舌苔,也可以发现病情的变化是循着一定的规律的:苔由腻而转为薄白苔为顺象,多提示病情较轻浅。若苔由白而灰,由灰变黑或呈黄褐腻、或厚腻久久不退者多为危象,示邪深病重,若舌苔骤退、骤无、不由渐而退,呈舌光或花剥苔者,示胃气将绝,病多危候。初期即呈黄厚腻,黄褐腻,腻垢苔者,示病情复杂往往有合并症,以伴心力衰竭及心源性休克为多。

结果表明,中医的舌是心之外候这一理论特点,为判断冠心病之顺逆及预测患者之生死提供了重要依据。近年来关于冠心病与舌质的一些研究均提示舌象的改变有可能作为机体循环功能,特别是微循环状态一个较敏感的指标,实践证明舌象的变化已显示出临床对冠心病诊断、治疗及预后的参考价值。

然后。我们再观察舌下筋脉。

依据前人“如见舌下筋脉粗胀,作青紫,甚则带紫黑色,大多数为瘀血之证”之说,对30例急性心肌梗塞患者舌下筋脉进行了观察,(正常人舌下筋脉中央为舌系带,其两旁为平直伸展于粘膜下的小静脉大约为系带的2~3倍)按其反映瘀血的轻重程度,大致分为如下四级。

第一级:舌下两侧瘀筋增粗,作青紫色;第二级:除具有第一级改变外,尚于增粗瘀筋的周围有紫纹分布或瘀筋迂曲;第三级:除具有第二级改变外尚于增粗瘀筋的周围有散在突起呈点状扩张的血管球。严重时可集聚呈葡萄样串珠状;第四级:舌色紫暗,舌边尖有瘀斑,并可以兼有第1~3级中部分瘀血见征。本组30例中,有25例具有舌下瘀筋增粗及舌质青紫瘀斑等。

且上述所见到的增粗的瘀筋、紫纹、扩张的血管球状突起及舌色青紫等,均可随着应用活血化瘀方药后,在疼痛缓解、病情好转时而有所减轻或完全消退,但对其舌上的瘀点瘀斑则较难以全部消退。有鉴于此,黄氏等认为舌下瘀筋及其状态可以作为急性心肌梗塞时早期气滞血瘀之见证,并可供临床辨证用药时较为可靠的客观指标之一,且其部位又在薄膜之内,明晰可辨,检查方便。

不用病人先说症状,仅凭着这一手,你就能看到百分之五十。”

钟医说得很慢,像是要把自己最宝贵的东西交出去一般。

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