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</div>  <div id="hrqgomv" class="news_con"> <div id="kcbosjd" class="jxbox clearfix"> <p>相信很多<a href="http://thedailypurge.net/xiangcunquanke/" target="_blank" title="鄉(xiāng)村全科助理醫(yī)師" class="hotLink">鄉(xiāng)村全科助理醫(yī)師</a>考生都想知道問(wèn)診：?jiǎn)柡疅幔t(yī)學(xué)教育網(wǎng)編輯為您搜集整理了“問(wèn)診：?jiǎn)柡疅?rdquo;信息，供您參考。 </p> <p>問(wèn)寒熱是詢問(wèn)患者有無(wú)冷與熱的感覺(jué)。寒，即怕冷的感覺(jué)；熱，即發(fā)熱?；颊唧w溫高于正常，或者體溫正常，但全身或局部有熱的感覺(jué)，都稱為發(fā)熱。寒熱的產(chǎn)生，主要取決于病邪的性質(zhì)和機(jī)體的陰陽(yáng)盛衰兩個(gè)方面。因此，通過(guò)問(wèn)患者寒熱感覺(jué)可以辨別病變的寒熱性質(zhì)和陰陽(yáng)盛衰等情況。 </p> <p>寒與熱是臨床常見(jiàn)癥狀，問(wèn)診時(shí)應(yīng)注意詢問(wèn)患者有無(wú)寒與熱的感覺(jué)，二者是單獨(dú)存在還是同時(shí)并見(jiàn)，還要注意詢問(wèn)寒熱癥狀的輕重程度、出現(xiàn)的時(shí)間、持續(xù)時(shí)間的長(zhǎng)短、臨床表現(xiàn)特點(diǎn)及其兼癥等。臨床常見(jiàn)的寒熱癥狀有以下4種情況： </p> <p>1.但寒不熱 </p> <p>在通常的情況下，患者只有怕冷的感覺(jué)而無(wú)發(fā)熱者，即為但寒不熱?？梢?jiàn)于外感病初起尚未發(fā)熱之時(shí)，或者寒邪直中臟腑經(jīng)絡(luò)，以及內(nèi)傷虛證等。根據(jù)患者怕冷感覺(jué)的不同特點(diǎn)，臨床又分別稱為惡風(fēng)、惡寒、寒戰(zhàn)、畏寒等。 </p> <p>惡風(fēng)：是患者遇風(fēng)則有怕風(fēng)戰(zhàn)抖的感覺(jué)，避風(fēng)則緩。多為外感風(fēng)邪所致。風(fēng)邪在表，衛(wèi)分受損，則失其溫分肉司開(kāi)闔的作用，故遇風(fēng)有冷感而避之可緩。此外，惡風(fēng)還可見(jiàn)于素體肺衛(wèi)氣虛肌表不固者。 </p> <p>惡寒：是患者時(shí)時(shí)覺(jué)冷，雖加衣覆被近火取暖仍不能解其寒。多為外感病初起，衛(wèi)氣不能外達(dá)，肌表失其溫煦而惡寒。此時(shí)雖加及衣火，仍不能使肌體的陽(yáng)氣宣達(dá)于表，故得溫而寒冷感無(wú)明顯緩解?？梢?jiàn)于多種外感病的初期階段，病性多屬于實(shí)。 </p> <p>寒戰(zhàn)：患者惡寒的同時(shí)伴有戰(zhàn)栗者，稱為寒戰(zhàn)，是惡寒之甚。其病機(jī)、病性與惡寒同。 </p> <p>應(yīng)注意，外感病中惡風(fēng)、惡寒、寒戰(zhàn)癥狀獨(dú)立存在的時(shí)間很短，很快就會(huì)出現(xiàn)發(fā)熱癥狀，成為惡寒發(fā)熱或寒熱往來(lái)。亦有少數(shù)病例存在時(shí)間較長(zhǎng)，一般亦必然會(huì)出現(xiàn)發(fā)熱。這些對(duì)于掌握疾病的進(jìn)程有一定幫助。 </p> <p>畏寒：是患者自覺(jué)怕冷，但加衣被近火取暖可以緩解，稱為畏寒，多為里寒證。機(jī)體內(nèi)傷久病，陽(yáng)氣虛于內(nèi)。或寒邪過(guò)盛，直中于里損傷陽(yáng)氣，溫煦肌表無(wú)力而出現(xiàn)怕冷的感覺(jué)。 </p> <p>此時(shí)若加衣近火，防止陽(yáng)氣的耗散，或以熱助陽(yáng)，使陽(yáng)氣暫時(shí)恢復(fù)，肌表得溫，畏寒即可緩解。 </p> <p>2.但熱不寒 </p> <p>患者但覺(jué)發(fā)熱而無(wú)怕冷的感覺(jué)者，稱為但熱不寒?？梢?jiàn)于里熱證，由于熱勢(shì)輕重、時(shí)間長(zhǎng)短及其變化規(guī)律的不同，臨床上有壯熱、潮熱、微熱之分。 </p> <p>壯熱：即患者身發(fā)高熱（體溫超過(guò)39度），持續(xù)不退，屬里實(shí)熱證。為風(fēng)寒之邪入里化熱或溫?zé)嶂皟?nèi)傳于里，邪盛正實(shí)，交爭(zhēng)劇烈，里熱熾盛，蒸達(dá)于外所致。 </p> <p>潮熱：即患者定時(shí)發(fā)熱或定時(shí)熱甚，有一定規(guī)律，如潮汐之有定時(shí)。外感與內(nèi)傷疾病中皆可見(jiàn)有潮熱。由于潮熱的熱勢(shì)高低、持續(xù)時(shí)間不同，臨床上又有以下三種情況： </p> <p>陽(yáng)明潮熱：此種潮熱多見(jiàn)于《傷寒論》中的陽(yáng)明腑實(shí)證，故稱陽(yáng)明潮熱。其特點(diǎn)是熱勢(shì)較高，熱退不凈，多在日晡時(shí)熱勢(shì)加劇，因此又稱日晡潮熱。是由邪熱蘊(yùn)結(jié)胃腸，燥屎內(nèi)結(jié)而致，病在陽(yáng)明胃與大腸。 </p> <p>濕溫潮熱：此種潮熱多見(jiàn)于“溫病”中的濕溫病，故稱濕溫潮熱。其特點(diǎn)是患者雖自覺(jué)熱甚，但初按肌膚多不甚熱，捫之稍久才覺(jué)灼手。臨床上又稱之為“身熱不揚(yáng)”，多在午后 </p> <p>熱勢(shì)加劇，退后熱不凈。是濕熱病特有的一種熱型，亦屬潮熱的范疇。 </p> <p>陰虛潮熱：此種潮熱多見(jiàn)于陰虛證候之中。其特點(diǎn)是午后或夜間發(fā)熱加重，熱勢(shì)較低，往往僅能自我感覺(jué)，體溫并不高，多見(jiàn)胸中煩熱，手足心發(fā)熱，故又稱“五心煩熱”。嚴(yán)重者有熱自骨髓向外透發(fā)的感覺(jué)，則稱為“骨蒸潮熱”。是由各種原因致陰液虧少，虛陽(yáng)偏亢而生內(nèi)熱。 </p> <p>微熱：即患者發(fā)熱時(shí)間較長(zhǎng)，熱勢(shì)較輕微，體溫一般不超過(guò) 38度，又稱長(zhǎng)期低熱。可見(jiàn)于溫病后期，內(nèi)傷氣虛、陰虛、小兒夏季熱等病證中。溫病后期，余邪未清，余熱留戀，患者出現(xiàn)微熱持續(xù)不退。 </p> <p>由氣虛而引起的長(zhǎng)期微熱，又稱為氣虛發(fā)熱。其特點(diǎn)是長(zhǎng)期發(fā)熱不止，熱勢(shì)較低，勞累后發(fā)熱明顯增重。其主要病機(jī)是因脾氣虛，中氣不足，無(wú)力升發(fā)敷布陽(yáng)氣，陽(yáng)氣不能宣泄而郁于肌表，故發(fā)熱。勞則氣耗，中氣益虛，陽(yáng)氣更不得敷布，故郁熱加重。 </p> <p>小兒夏季熱：小兒在氣候炎熱時(shí)發(fā)熱不已，至秋涼時(shí)不治自愈，亦屬微熱。是小兒氣陰不足（體溫調(diào)節(jié)機(jī)能尚不完善），不能適應(yīng)夏令炎熱氣候所致。 </p> <p>以上“問(wèn)診：?jiǎn)柡疅?rdquo;由醫(yī)學(xué)教育網(wǎng)小編整理，希望對(duì)您有所幫助。</p> <div style="DISPLAY: none" class="editor"><a class="jc-an fl" target="_blank" href="http://thedailypurge.net/jiucuo/">糾錯(cuò)</a><span id="jkvqfzu" class="fl"> 責(zé)任編輯：biu~</span></div> </div> </div>  <div style="margin-bottom:10px;"> <p align="center"> <img src="http://thedailypurge.net/upload/resources/image/2023/04/14/709082.jpg" alt="醫(yī)師資格考試公眾號(hào)" border="0"> </p> </div>    <div id="emtndtn" class="share new-share clearfix"> <div id="goveusb" class="info-share-new fl"> <div id="iyevoud" class="snltxt fl">分享到：</div> <div id="zihrgih" class="fl" id="share-2020" data-sites="wechat, qzone, weibo, qq"></div> 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