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,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,0.0,中 医 内 科 学,呕 吐,0.0,1,概念,胃失和降，气逆于上，迫使胃中之物从口中吐出的一种病证,有物有声谓之吐，无物有声谓之呕,神经性呕吐、急性胃炎、,胃痉挛、胆囊炎、胰腺炎,肠梗阻、尿毒症、颅高压、心衰,0.0,2,历史沿革,秦汉时期,素问,举痛论,“寒气客于肠胃，厥逆上出，,故痛而呕也”,素问,至真要大论,“诸呕吐酸，皆属于热”,“少阳之胜，热客于胃，呕酸善饥”,“燥湿所胜，民病喜呕，呕有苦”,0.0,3,历史沿革,秦汉时期,金匮要略,大半夏汤，小半夏汤，生姜半夏汤，半夏泻心汤，小柴胡汤，吴茱萸汤,呕吐哕下利病脉证治,“夫呕家有痈脓，不可治呕，脓尽自愈”,0.0,4,历史沿革,隋唐时期,诸病源侯论,呕吐候,“呕吐之病者，由脾胃有邪，谷气不治所为也，胃受邪，气逆则呕”,备急千金要方,呕吐哕逆,“凡呕者，多食生姜，此是呕家圣药”,0.0,5,历史沿革,金元时期,朱丹溪,刘元素,0.0,6,历史沿革,明清时期,寿世保元,呕吐,“有外感寒邪者，有内伤饮食者，有气逆者，三者皆从藿香正气散加减治之，有胃热者，清胃保中汤，有胃寒者，附子理中汤；有呕哕痰涎者，加减二陈汤；有水寒停胃者，茯苓半夏汤；有久病胃虚者，比和饮。医者宜审而治之也”,0.0,7,病因病机,外感六淫,内伤饮食,情志不调,禀赋不足,胃失和降胃气上逆,0.0,8,病因,外邪犯胃,胃失和降,外感六淫,秽浊之气,寒邪,0.0,9,病因,饮食不节,暴饮暴食,多食生冷辛辣,肥甘不洁,食滞不化胃气不降,0.0,10,病因,情志失调,肝气犯胃,恼怒伤肝,肝失疏泄,食停难化,忧思伤脾,脾失健运,食随气逆,脾胃素虚,气恼逆食,0.0,11,病因,病后体虚,脾胃虚弱,耗伤中气,胃虚不受水谷脾虚不化精微,食滞胃中,病后虚弱,0.0,12,病机,胃失和降，胃气上逆,实证,外邪、食滞、痰饮,肝郁,胃气痞满，升降失调,虚证,脾胃气阴亏虚,运化失常不能和降,0.0,13,病机,胃,肝,脾,肾,0.0,14,诊断,初起呕吐量多，吐出物多有酸腐气味，久病呕吐，时作时止，吐出物不多，酸臭气味不甚,新病邪实，呕吐频频，常伴有恶寒、发热、脉实有力。久病正虚，呕吐无力，常伴精神萎靡，倦怠，面色萎黄，脉弱无力等症。,常有饮食不节，过食生冷，恼怒气郁，久病不愈病史,0.0,15,病证鉴别,呕吐与反胃,病机相同，反胃是脾胃虚寒，胃中无火，食物,难以腐熟，朝食暮吐，暮食朝吐。呕吐有虚实,呕吐与噎膈,0.0,16,病证鉴别,酸腐量多气味难闻,饮食停滞食积内腐,呕吐苦水黄水,胆热犯胃胃失和降,呕吐酸水绿水,肝热犯胃胃气上逆,呕吐物鉴别,呕吐痰浊涎沫,痰饮中阻气逆犯胃,呕吐清水量少,胃气亏虚运化失职,0.0,17,辨证论治,辨证要点,辨,病,虚实,景岳全书,呕吐,“呕吐一证，最当详辨虚实”,0.0,18,辨证论治,治疗原则,和胃降逆,解表、消食、化痰、解郁,健运脾胃、益气养阴,0.0,19,证治分类,实证,1,.,外邪犯胃证,症状,：发热恶寒，头身疼痛，胸脘满闷,证机概要,：外邪犯胃，中焦,气滞，浊气上逆,治法,：疏邪解表，化浊和中,代表方,：藿香正气散加,减,0.0,20,证治分类,实证,2,.,食滞内停证,症状,：呕吐酸腐，脘腹胀满，嗳气厌食,证机概要,：食积内停，气机受阻，浊气上逆,治法,：消食化滞，和胃降逆,代表方,：保和丸加,减,0.0,21,证治分类,实证,3.,痰饮内阻证,症状,：呕吐清水痰涎，头眩心悸，舌白腻，脉滑,证机概要,：痰饮内停，中阳不振，胃气上逆,治法,：温中化饮，和胃降逆,代表方,：小半夏汤合苓桂术甘汤加减,0.0,22,证治分类,实证,4.,肝气犯胃证,症状,：呕吐，嗳气，胸胁胀痛,证机概要,：肝气不疏，横逆犯胃，胃失和降,治法,：疏肝理气，和胃降逆,代表方,：四七汤加减,0.0,23,证治分类,虚证,1.,脾胃气虚证,症状,：食欲不振，食入难化，脉虚,证机概要,：脾胃气虚，运化无力，胃虚气逆,治法,：健脾益气，和胃降逆,代表方,：香砂六君子汤加,减,0.0,24,证治分类,虚证,2.,脾胃阳虚证,症状,：食多即吐，恶寒喜温，肢冷便溏,证机概要,：脾胃虚寒，运化失职,治法,：温中健脾，和胃降逆,代表方,：理中汤加,减,0.0,25,证治分类,虚证,3.,胃阴不足证,症状,：干呕，饥而不欲食，口燥咽干,证机概要,：胃阴不足，胃失濡润,治法,：滋养胃阴，降逆止呕,代表方,：麦门冬汤加,减,0.0,26,预防调护,起居有常，生活有节，避风寒暑湿秽浊之气,避免精神刺激,饮食调理,少量频服,0.0,27,小结,胃失和降，气逆于上的病证,辨证关键在虚实,治疗：和胃降逆为原则,0.0,28,临证备要,半夏（生半夏）、生姜止呕主药,大黄甘草汤,食入即吐,针灸治疗,呕吐日久应补液,辨明发病原因，不可见吐止吐（中毒、尿毒症）,0.0,29,
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