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一、中医内科疾病
肺系疾病
1.感冒(以恶寒发热同时并见、鼻塞流涕为主症,舌苔薄,脉浮)
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2.咳嗽(以咳嗽为主症)
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3.哮病(以喉中哮鸣有声、呼吸困难为主症。有反复发作病史,发作前有先兆)
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4.喘证(以气喘为主症)
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5.肺痨(包含咳嗽,咯血,潮热,盗汗四大主症)
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注意:题目中病因病机分析时,“患者因感受痨虫,致……”
6.肺胀(以胸部膨满、喘咳为主症)
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总结:
(1)肺系四个痰热证(苔黄腻,脉滑数)
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(2)两个表有寒、里有热的证候
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心系疾病
7.心悸(以心悸为主症)
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注意:1.心悸的病机总体概括:气血阴阳亏虚,心失所养;或邪扰心神,心神不宁。病因病机分析时可据此总结。
2.鉴别诊断多考心悸与奔豚的鉴别,本病内部分类的鉴别出题概率小。
8.胸痹(以胸闷心痛为主症)
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9.不寐(以不寐为主症)
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10.痫病(以突然昏倒,不省人事,四肢抽搐,两目上视,醒后如常为主症)
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总结:
(1)特殊证
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(2)心系三个阴虚证
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(3)心系三个痰热证
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(4)部分方剂药物组成(一)
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注意:有自己的记忆方法即可,或方歌,或趣味记法。
脾系疾病
11.胃痛(以胃脘部疼痛为主症)
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注意:所有痛证,如胃痛、腹痛、胁痛、痛经等,回答病因病机分析的题目时,都可以落脚在“不通则痛,或不荣则痛”上。
12.呕吐(以呕吐为主症)
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13.腹痛(以腹部疼痛为主症)
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注意:同样有寒象,都会出现形寒肢冷等临床表现,可根据“拒按还是喜按”来区分实寒和虚寒。
14.泄泻(以泄泻为主症)
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15.痢疾(以腹痛,里急后重,泻下赤白脓血为主症)
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16.便秘(以大便秘结为主症)
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总结:
(1)特殊证(饮邪)
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(2)脾系四个与肝经相关证候
肝经:情志相关。循行部位:颠顶,两目,乳房,胸胁,少腹,会阴。
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(3)脾系几个食积证
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(4)部分方剂药物组成(二)
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肝系疾病
17.胁痛(以胁肋部疼痛为主症)
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18.黄疸(以目黄,身黄,小便黄为主症)
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注意:①胆腑郁热证,“口干苦”不能作为辨证依据,其他证型都有这个症状。“右胁胀痛、寒热往来”才是题眼。②黄疸消退后三个证型出题概率比较小。
19.鼓胀(以腹大胀满为主症)
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脑系疾病
20.头痛(以头痛为主症)
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注意:区分风湿头痛和痰浊头痛,前者为“头痛如裹”,后者为“头痛昏蒙”。
21.眩晕(以眩晕为主症)
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22.中风(以突然昏仆,不省人事,半身不遂,口舌㖞斜,言语不利为主症;轻者可无昏仆而仅见半身不遂及口舌㖞斜等症状)
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鉴别诊断:
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中风辨证思路:
①根据发病时间,先判断是中风急性期还是恢复期和后遗症期。
②急性期:根据意识是否清楚,判别是中经络还是中脏腑。
③中经络者,风痰瘀阻证有瘀血征象,可见舌质紫暗,或有瘀斑;风阳上扰证可见脉弦;阴虚风动证可见耳鸣腰酸、手指动等肝肾阴虚症状。
④中脏腑者,先分清闭证和脱证。牙关紧闭,口噤不开,两手握固,大小便闭则为闭证;目合口张,手撒肢冷,汗多,大小便自遗则为脱证。
⑤闭证中分阳闭和阴闭。一派热象见苔黄腻为阳闭证,即痰火内闭;没有热象见苔白腻为阴闭证,即痰浊内闭。
⑥中风恢复期和后遗症期,以舌强语謇或失语为主症,为风痰瘀阻证;以肢体偏枯不用为主症,是气虚络瘀证;以患肢僵硬拘挛变形,肌肉萎缩为主症,是肝肾亏虚证。
23.颤证(助理不考)(以头部、肢体颤动为主症)
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总结:
(1)脑系四个天麻钩藤饮证
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(2)部分方剂药物组成(三)
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肾系疾病
24.水肿(以头面眼睑、四肢或全身浮肿为主症)
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注意:区分水湿浸渍证和脾阳虚衰证,后者为阴水,主症有“按之凹陷不易恢复”。
25.淋证(以小便频数短涩,淋沥涩痛,小腹拘急引痛为主症)
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气血津液病
26.郁证(以忧郁不畅,情绪不宁,胸胁胀满疼痛为主症)
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注意:痰气郁结证即梅核气,心神失养证即脏躁。但作答时,辨病为郁证,辨证为痰气郁结证或心神失养证。可以在证型后面括号里写上梅核气或脏躁,也可以不写。
鉴别诊断:
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27.血证
鼻衄(以鼻道出血为主症)
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齿衄(以齿龈或齿缝出血为主症)
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咳血(以咳血,或痰中带血为主症)
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吐血(以吐血为主症)
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便血(以大便色鲜红、暗红或紫暗,甚至黑如柏油样为主症)
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尿血(以尿血或小便混有血液、夹有血丝为主症,排尿时无疼痛)
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紫斑(以皮肤出现青紫色斑点或斑块为主症)
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28.消渴(以多饮、多食、多尿、乏力、消瘦为主症)
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注意:以“口渴多饮”为主症,是上消;以“多食易饥”为主症,是中消的表现,其中“能食与便溏并见”是气阴两虚的特征性表现;以“多尿,小便频数”为主症,是下消。
29.瘿病(助理不考)(以颈前喉结两旁结块肿大为主症)
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30.内伤发热(以发热为主症——多为潮热或低热)
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31.癌病(助理不考)
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总结:
(1)特殊证
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(2)部分方剂药物组成(四)
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肢体经络病
32.痹证(以关节、肌肉疼痛,屈伸不利,甚至关节肿大变形为主症)
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33.痿证(以肢体痿软无力为主症)
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34.腰痛(以腰部疼痛为主症)
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总结:
(1)中医内科瘀血证候小结
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(2)部分方剂药物组成(五)
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