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class="layout clearfix crumbs_wrap two msf"> <div id="tybdfho" class="crumbs fl">您的位置：<a href='/'>醫(yī)學教育網(wǎng)</a> > <a href='/zhongxiyineikezhuzhiyishi/'>中西醫(yī)內(nèi)科主治</a> > <a href='/zhongxiyineikezhuzhiyishi/fudaopeixun/'>輔導精華</a></div> </div> <div id="afhemhj" class="layout clearfix msf new-wrap"> <div id="stcxczg" class="new_left fl"> <div id="kpppqvx" class="news_mian"> <div id="mwcxdag" class="tit"> <h1>【來看干貨】中醫(yī)診斷學?？贾畣柡疅?/h1> <div id="eovtywb" class="mark clearfix"> <div id="dpswxsw" class="fl"> <span id="qtyvbch" class="time">2022-01-14 18:11</span> <a href="http://thedailypurge.net" title="醫(yī)學教育網(wǎng)" class="a1">醫(yī)學教育網(wǎng)</a> </div> <a href="javascript:void(0)" onclick="window.external.AddFavorite(location.href,document.title);" target="_self" class="collection ico fr"></a>  <div id="hkkrsuy" class="fen fr">|</div> <div id="bjliopu" class="font_size fr ico"><a href="javascript:void(0);" target="_self" class="big lan ico">大</a><a href="javascript:void(0);" target="_self" class="small ico">小</a></div> </div> </div> </div>  <div style="width: 800px;text-align: left;margin: 0 auto;margin-bottom: 20px;"> <div style="width:800px; height:90px;"> <a href="http://thedailypurge.net/webhtml/project/zhongxiyineikezhuzhiyishi.htm"target="_blank"> <img title="" src="http://thedailypurge.net/upload/resources/image/2024/05/30/806806.png" width="800" height="90" style="border:0px;"></a> </div> </div>  <div id="hgpoosp" class="news_con"> <div id="nvaeace" class="jxbox clearfix">  <p><span style="font-family: inherit;">在這個疫情籠罩的時代，一提到發(fā)熱，大家不免心中悸動一下。那么我們今天就具體來說一下發(fā)熱這個癥狀。發(fā)熱可以見于多種疾病，對于我們中醫(yī)來說，不同的發(fā)熱類型代表著不同的臨床意義，和不同的發(fā)病機制，下面我們具體來說一下中醫(yī)診斷學涉及到的關(guān)于發(fā)熱的</span><span style="font-family: inherit;">知識點。</span></p><p><span style="font-family: inherit;">寒熱癥狀的常見類型、臨床表現(xiàn)及意義：</span></p><p><strong><span style="font-family: inherit;">1.</span><span style="font-family: inherit;">惡寒發(fā)熱的臨床表現(xiàn)及意義：</span></strong></p><p><span style="font-family: inherit;">根據(jù)惡寒發(fā)熱的輕重不同和有關(guān)兼癥，又可分為以下三種類型：</span></p><p><span style="font-family: inherit;">（</span><span style="font-family: inherit;">1</span><span style="font-family: inherit;">）惡寒重發(fā)熱輕——風寒表證。</span></p><p><span style="font-family: inherit;">（</span><span style="font-family: inherit;">2</span><span style="font-family: inherit;">）發(fā)熱輕而惡風——傷風表證。</span></p><p><span style="font-family: inherit;">（</span><span style="font-family: inherit;">3</span><span style="font-family: inherit;">）發(fā)熱重惡寒輕——風熱表證。</span></p><p><strong><span style="font-family: inherit;">2.</span><span style="font-family: inherit;">但寒不熱的臨床表現(xiàn)及意義：</span></strong></p><p><span style="font-family: inherit;">但寒不熱是指病人只感寒冷而不發(fā)熱的癥狀。臨床常有新病惡寒、久病畏寒之分。</span></p><p><span style="font-family: inherit;">（</span><span style="font-family: inherit;">1</span><span style="font-family: inherit;">）新病惡寒——病人突然感覺怕冷，且體溫不高的癥狀。常伴有四肢不溫，或脘腹、肢體冷痛，或嘔吐泄瀉，或咳喘痰鳴，脈沉緊等癥。主要見于里實寒證。</span></p><p><span style="font-family: inherit;">（</span><span style="font-family: inherit;">2</span><span style="font-family: inherit;">）久病畏寒</span><span style="font-family: inherit;">——病人經(jīng)常怕冷，四肢涼，得溫可緩的癥狀。常兼有面色?白，舌淡胖嫩，脈弱等癥。主要見于里虛寒證。</span></p><p><strong><span style="font-family: inherit;">3.</span><span style="font-family: inherit;">但熱不寒的臨床表現(xiàn)及意義：</span></strong></p><p><span style="font-family: inherit;">但熱不寒是指病人只發(fā)熱而無怕冷感覺的癥狀，是里熱證的寒熱特征。臨床表現(xiàn)可有壯熱、潮熱、微熱之別。</span></p><p><span style="font-family: inherit;">（</span><span style="font-family: inherit;">1</span><span style="font-family: inherit;">）壯熱：即病人身發(fā)高熱，持續(xù)不退（體溫超過</span><span style="font-family: inherit;">39</span><span style="font-family: inherit;">℃以上），屬里實熱證?？梢姖M面通紅、口渴飲冷、大汗出、脈洪大等癥，是風寒之邪入里化熱，或風熱內(nèi)傳，正盛邪實，邪正劇爭，里熱亢盛，蒸達于外的表現(xiàn)。多見于傷寒陽明經(jīng)證和溫病氣分階段。</span></p><p><span style="font-family: inherit;">（</span><span style="font-family: inherit;">2</span><span style="font-family: inherit;">）潮熱：即病人定時發(fā)熱或定時熱甚，有一定的規(guī)律，如潮汐之有定時。</span></p><p><span style="font-family: inherit;">①日晡潮熱：其特點是熱勢較高，日晡熱甚，兼見腹脹、便秘等，屬陽明腑實證。因熱結(jié)于陽明胃與大腸，日晡（申時，即下午</span><span style="font-family: inherit;">3</span><span style="font-family: inherit;">～</span><span style="font-family: inherit;">5</span><span style="font-family: inherit;">時）為陽明經(jīng)氣當旺之時，陽明氣盛而又加之有實熱，故日晡熱甚。</span></p><p><span style="font-family: inherit;">②骨蒸潮熱：午后或夜間潮熱，其特點是午后和夜間有低熱。有熱自骨內(nèi)向外透發(fā)的感覺者，稱為骨蒸發(fā)熱，多屬陰虛火旺所致。由于陰液虧虛，不能制陽，機體陽氣偏亢，午后衛(wèi)陽漸入于里，夜間衛(wèi)陽行于里，使體內(nèi)偏亢的陽氣更加亢盛而生內(nèi)熱。</span></p><p><span style="font-family: inherit;">③濕溫潮熱：午后發(fā)熱明顯，其特點是身熱不揚，肌膚初捫之不覺很熱，捫之稍久即覺灼手，此屬濕溫，為濕郁熱蒸之象。</span></p><p><span style="font-family: inherit;">④瘀血潮熱：午后和夜間有低熱，可兼見肌膚甲錯，舌有瘀點瘀斑者，屬瘀血積久，郁而化熱。</span></p><p><span style="font-family: inherit;">（</span><span style="font-family: inherit;">3</span><span style="font-family: inherit;">）微熱：指發(fā)熱不高，體溫一般在</span><span style="font-family: inherit;">37</span><span style="font-family: inherit;">℃～</span><span style="font-family: inherit;">38</span><span style="font-family: inherit;">℃之間，或僅自覺發(fā)熱的癥狀。常見于某些內(nèi)傷病和溫熱病的后期。按病機有氣虛發(fā)熱、血虛發(fā)熱、陰虛發(fā)熱、氣郁發(fā)熱和氣陰兩虛導致的小兒夏季發(fā)熱。</span></p><p><span style="font-family: inherit;">①氣虛發(fā)熱：長期微熱，煩勞則甚，兼見有少氣自汗、倦怠乏力等癥。</span></p><p><span style="font-family: inherit;">②血虛發(fā)熱：時有低熱，兼面白、頭暈、舌淡脈細等癥。</span></p><p><span style="font-family: inherit;">③陰虛發(fā)熱：長期低熱，兼顴紅、五心煩熱等癥。</span></p><p><span style="font-family: inherit;">④氣郁發(fā)熱：每因情志不舒而時有微熱，兼胸悶、急躁易怒等癥。</span></p><p><span style="font-family: inherit;">⑤小兒夏季熱：小兒在夏季氣候炎熱時長期發(fā)熱不已，兼見煩躁、口渴、無汗、多尿等癥，至秋涼時不治自愈，是由于小兒氣陰不足，不能適應(yīng)夏令炎熱氣候所致。</span></p><p><strong><span style="font-family: inherit;">4.</span><span style="font-family: inherit;">寒熱往來的臨床表現(xiàn)及意義：</span></strong></p><p><span style="font-family: inherit;">寒熱往來是指病人自覺惡寒與發(fā)熱交替發(fā)作的癥狀，是正邪相爭，互為進退的病理反應(yīng)，為半表半里證寒熱的特征。在臨床上有以下兩種類型：</span></p><p><span style="font-family: inherit;">（</span><span style="font-family: inherit;">1</span><span style="font-family: inherit;">）寒熱往來無定時：病人自覺時冷時熱，一日多次發(fā)作而無時間規(guī)律的癥狀，多見于少陽病。</span></p><p><span style="font-family: inherit;">（</span><span style="font-family: inherit;">2</span><span style="font-family: inherit;">）寒熱往來有定時：病人惡寒戰(zhàn)栗與髙熱交替發(fā)作，發(fā)有定時，每日發(fā)作一次，或二三日發(fā)作一次的癥狀，常見于瘧疾。</span></p><p><span style="font-family: inherit;">發(fā)熱是機體的應(yīng)激反應(yīng)，是我們判斷疾病情況的一個重要的癥狀，患者出現(xiàn)發(fā)熱癥狀大家一定不要慌，根據(jù)體溫的高低和發(fā)熱時的伴隨癥狀，進行相關(guān)檢查確定發(fā)熱原因后有針對性的進行治療。</span></p><p><span style="font-family: inherit;">疫情當下，各位臨床醫(yī)生辛苦了！</span></p><p style="white-space: normal; text-align: center;">〖醫(yī)學教育網(wǎng)版權(quán)所有，轉(zhuǎn)載務(wù)必注明出處，違者將追究法律責任〗</p><p style="white-space: normal;">為了幫助各位中西醫(yī)內(nèi)科主治考生復(fù)習備考，醫(yī)學教育網(wǎng)為大家提供2022年中西醫(yī)內(nèi)科主治醫(yī)師考試輔導課程，專業(yè)師資授課，科學制定復(fù)習計劃，更有專業(yè)老師答疑！<a href="http://thedailypurge.net/webhtml/project/zhongxiyineikezhuzhiyishi.htm" target="_blank" textvalue=" 點擊了解更多>>"> 點擊了解更多>></a></p><p 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