1、第三節(jié) 七情T(mén)he Seven Emotions 1、 七情的基本概念一、The basic concept of seven emotions七情是指喜、怒、憂、思、悲、恐、驚等七種情志活動(dòng)，是人體對(duì)外界事物的情感反應(yīng)。七情一般不會(huì)使人致病。只有強(qiáng)烈、持久或突然的情志刺激，超過(guò)人體本身的正常生理活動(dòng)范圍，使人體氣機(jī)紊亂，臟腑陰陽(yáng)氣血失調(diào)，才會(huì)導(dǎo)致疾病的發(fā)生。七情直接影響有關(guān)臟腑而發(fā)病，故又稱(chēng)“內(nèi)傷七情”。Seven emotions refer to joy, anger, worry, thinking, sorrow, fear and fright. They are emotiona

2、l reflection of the body to objective things. They generally do not cause diseases. Sudden, intense or prolonged emotional stimulation beyond the regulatory range of physiological activities of the body can cause disturbances of qi dynamic, disorders of yin-yang and qi-blood of the viscera, thus giv

3、ing rise to the onset of disease. As they directly affect the viscera and trigger disease, seven passions is also called “endogenous seven affects”.二、七情的致病特點(diǎn)二、Pathogenic character of the seven emotions（一） 直接傷及臟腑：（一）Direct injury to the viscera:人體的情志活動(dòng)與臟腑有密切關(guān)系，所以情志刺激最易傷及臟腑。七情損傷臟腑，主要有三種情況，一是特異性損傷，即根據(jù)五

4、臟和五志的聯(lián)系，如喜傷心、怒傷肝、思傷脾；悲憂傷肺；恐傷腎。二是心藏神，肝主疏泄、條暢情志，脾藏意，情志所傷，數(shù)情交織，多傷及心肝脾。三是情志所傷，多傷及潛病之臟腑。Since emotional activities are closely related to the viscera, emotional stimulation can hurt viscera in the easiest way. Seven emotions hurt viscera mainly in three conditions. First, special injury identified by the

5、 relations between five Zang-viscera and five emotions, for instance, over joy hurts the heart, rage hurts the liver, over thinking hurts the spleen, grief hurts the lungs and great fear hurts the kidneys. Second, the heart houses the spirit. The liver is in charge of free flow of qi and in control

6、of emotions. The spleen houses wishes. If emotions mingle and are damaged by emotional pathogens, most may hurt the liver and spleen. Third, injuries caused by emotional pathogens, most are potential disease of the viscera. (二)影響臟腑氣機(jī)(二)Influence on qi dynamic of the viscera七情致病主要是導(dǎo)致臟腑氣機(jī)紊亂，陰陽(yáng)失調(diào)。Disea

7、ses triggered by seven emotions are disturbances of qi dynamic of the viscera, dysfunctions of yin and yang. 1.怒則氣上 氣上，氣機(jī)上逆之意。暴怒傷肝，使肝氣疏泄太過(guò)而上逆為病。肝氣上逆，可見(jiàn)頭暈頭痛、面赤耳鳴，甚者嘔血或昏厥。肝氣橫逆，犯脾可見(jiàn)腹脹、飧泄。犯胃可出現(xiàn)呃逆、嘔吐等。1. Rage causes qi to go upward. Going upward means that qi dynamic goes reversed. Rage hurts liver, caus

8、ing diseases due to over-adverse flow of qi. Dizziness, headache, flushed complexion and ears ring may be seen as symptoms with reversed upward flow of the liver-qi. Severe ones even spit blood or feel faint. Invasion of the hyperactive liver-qi can cause distended abdomen and night diarrhea in ones

9、 spleen, hiccups and vomiting in ones stomach. 2.喜則氣緩 氣緩，心氣弛緩之意。暴喜傷心，使心氣渙散，神不守舍，出現(xiàn)乏力、懈怠、注意力不集中，乃至心悸、失神，甚至狂亂等。2. Over joy causes qi to relax. Relaxed qi means slow flow of qi in the heart. Over joy hurts heart, causing disorder of heart-energy. Patients may be short of strength, slack off, distractio

10、n and even heart palpitation and in mania, etc.3.悲則氣消 悲哀太過(guò)，耗傷肺氣，使氣弱消減，意志消沉。可見(jiàn)氣短胸悶、精神萎靡不振和懶惰等。3. Grief causes qi to be consumed. Great sorrow will cause the consumption of lung qi and depression. Patients may be seen as shortness of breath and oppression in the chest, feel dejected and apathetic and

11、laziness, etc.4.思則氣結(jié) 思慮太過(guò)，氣結(jié)于中，見(jiàn)胃納呆滯、脘腹痞塞、腹脹便溏，甚至肌肉消瘦等。思慮太過(guò)，既可傷脾，也會(huì)傷心，使心血虛弱，神失所養(yǎng)，而致心悸、怔忡、失眠、健忘、多夢(mèng)等，臨床稱(chēng)為“心脾兩傷”。4. Over-thinking causes qi to depress. Over-thinking makes qi gather together. Common symptoms are torpid stomach intake, mass in abdomen, abdominal distention and loose stool, even muscle s

12、ymptosis. Over-thinking hurts both spleen and heart, resulting in heart blood and essence deficiency. Hence, common symptoms are palpitation, fearful throbbing, insomnia, amnesia and dreaminess, etc. In the clinical theory, it can be called “heart-spleen deficiency”5.恐則氣下 恐懼傷腎，可見(jiàn)心神不安、夜不能寐、二便失禁、精遺骨痿等

13、癥。 5. Fear causes qi to go downward. Fear hurts kidney. Common symptoms are disquieted heart spirit, inability to sleep at night, fecal and urinary incontinence, spermatorrhea and bone wilting, etc.6. 驚則氣亂 大驚則心氣紊亂，氣血失調(diào)，出現(xiàn)心悸、失眠、心煩、氣短，甚則精神錯(cuò)亂等癥狀。 6. Fright causes disruption of qi. Great fright can caus

14、e disorder of heart Qi, dysfunction of Qi and blood. Common symptoms are palpitation, insomnia, vexation and shortness of breath, even entanglement, etc.此外，喜、怒、憂、思、恐等情志活動(dòng)失調(diào)，能夠引起臟腑氣機(jī)紊亂，郁而化火，出現(xiàn)煩躁、易怒、失眠、面赤、口苦，以及吐血、衄血等屬于火的表現(xiàn)，稱(chēng)之為“五志化火”。In addition, dysfunctions of emotional activities including joy, ange

15、r, worry, thinking and fear can cause disorder of qi dynamic of the viscera and fire formation of the depression. Fire formation can be demonstrated as agitation, irascibility, insomnia, flushed face, bitterness in the mouth, blood ejection, and apostaxis, which can be called “fire formation due to

16、excess among the five minds”.（3） 影響病情變化 (三) Influence on changes of conditions情志異常，可以引起疾病，而且對(duì)整個(gè)病情的發(fā)展、變化都可以產(chǎn)生影響。不良情緒或異常的情感波動(dòng)能夠加重病情，或使其惡化。但良好的情感活動(dòng)有助于治療和保持健康。Abnormal emotions can cause diseases and influence on changes and development of conditions. Unhealthy or abnormal emotions can exacerbate or det

17、eriorate conditions, healthy emotional activities, however, can be advantageous to treatment and keep fit. 第四節(jié) 病理產(chǎn)物性病因Pathogens from Pathological Products在疾病發(fā)生和發(fā)展過(guò)程中，痰飲、瘀血等是疾病過(guò)程中所形成的病理產(chǎn)物。它們滯留體內(nèi)又可成為新的致病因素，引起各種新的病理變化，又稱(chēng)繼發(fā)性致病因素，或病理性致病因素。In the process of onset and development of diseases, phlegm, stagn

18、ant fluid, and stagnant blood are the pathological outcome in the course of disease due to pathogenic factors. 一、 痰飲Phlegm and Stagnant Fluid痰飲是機(jī)體水液代謝障礙所形成的病理產(chǎn)物。稠粘為痰，清稀為飲。兩者同源而異流，常并稱(chēng)為痰飲。（一）痰飲的形成痰飲多由外感六淫，或飲食及七情所傷等，使肺、脾、腎及三焦等臟腑氣化功能失常，水液不能正常輸布，聚而為痰為飲。如肺失宣降，津液不布，水道不利；脾失健運(yùn)，水濕不化；腎不蒸騰氣化；三焦不利等，均可聚濕而生痰飲。（二）痰

19、飲的致病特點(diǎn) 1.阻礙氣血運(yùn)行：痰飲隨氣流行，機(jī)體內(nèi)外無(wú)所不至。若痰飲流注經(jīng)絡(luò)，會(huì)出現(xiàn)肢體麻木、屈伸不利，甚至半身不遂等。若結(jié)聚于局部，則形成腫塊（瘰癘、痰核、陰疽、流注等）。痰飲停肺，可出現(xiàn)胸悶、咳嗽、喘促等。痰飲停于胃，則出現(xiàn)惡心嘔吐等。2.影響水液代謝：痰飲本為水液代謝失常的病理產(chǎn)物，但形成之后，又可以反過(guò)來(lái)作用于機(jī)體，進(jìn)一步影響肌體的水液輸布，使水液代謝障礙更為嚴(yán)重。3.易于蒙蔽清竅：痰濁上擾，蒙蔽清陽(yáng)，會(huì)出現(xiàn)頭昏目眩、精神不振、痰迷心竅。痰火擾心、心神被蒙，可引起胸悶心悸、神昏譫妄，或引起癲狂癰等疾病。 4.致病廣泛，變幻多端：痰飲致病，無(wú)處不到，其臨床表現(xiàn)也十分復(fù)雜。痰飲停留在不同

20、的部位可表現(xiàn)出不同的癥狀，變化多端。故有“百病皆由痰作祟”、“怪病多痰”之說(shuō)。二、 瘀血Stagnant Blood 瘀血指因體內(nèi)血液停滯或血行不暢，阻滯于臟腑經(jīng)絡(luò)的血液。瘀血是血液運(yùn)行失常的病理產(chǎn)物，又是具有致病性的“惡血”、“死血”。 （一）瘀血的形成 1.離經(jīng)之血。出血之后，未能及時(shí)消散或排出體外而為瘀。如跌打損傷、負(fù)重過(guò)度等各種內(nèi)外傷造成的出血；氣不攝血或血熱妄行等所致的血行脈外。2.各種影響血液運(yùn)行的因素，使血液循行不暢，凝聚停留而為瘀血。常見(jiàn)因素有：氣虛、氣滯、血寒、血熱、情志內(nèi)傷和生活失宜等。 （二）瘀血的致病特點(diǎn) 瘀血形成之后，不僅失去正常血液的濡養(yǎng)作用，而且反過(guò)來(lái)可以導(dǎo)致新的

21、病變發(fā)生。概括起來(lái)可分為以下幾點(diǎn)： 1.疼痛：一般多刺痛，固定不移，且多夜間為重的特點(diǎn)。 2.腫塊：體表腫塊見(jiàn)色青紫或青黃，體內(nèi)為癥積，固定不移。 3.出血：血色紫暗或夾有瘀塊。 4.紫紺：面部、口唇、爪甲青紫。 5.舌質(zhì)紫暗或有瘀點(diǎn)、瘀斑。是瘀血最常見(jiàn)的也是最敏感的指征。 6.脈細(xì)澀沉弦或結(jié)代。除掌握上述瘀血特征外，在臨床上可從以下幾點(diǎn)判斷是否有瘀血存在： 1.有外傷、出血、月經(jīng)胎產(chǎn)史者； 2.瘀血征象雖不太明顯，但屢治無(wú)效，或無(wú)瘀血證之前久治不愈者。中醫(yī)有“久病入絡(luò)”之說(shuō) 3.此外，面色黧黑、肌膚甲錯(cuò)、善忘、狂躁等怪病也多按瘀論治。第五節(jié) 飲食失宜Improper Diet 飲食水谷是化生

22、氣血，以維持人體生長(zhǎng)、發(fā)育，完成各種生理功能，保證生命生存和健康的基本條件。所謂“民以食為天”。但“病從口入”也是不爭(zhēng)的事實(shí)。飲食失宜不僅損傷脾胃，引起消化機(jī)能障礙；還能積滯生熱、助濕生痰等等，成為疾病發(fā)生的一個(gè)重要因素。一、 飲食不節(jié)Immoderate Diet 按固定時(shí)間，有規(guī)律地進(jìn)食，可以保證脾胃消化吸收功能有節(jié)奏地進(jìn)行活動(dòng)，使水谷精微化生有序，有條不紊地輸布全身。1.過(guò)饑：攝食不足，如饑不得食或脾胃虛弱，食不得入，致使氣血衰少，臟腑功能減退；正氣虛弱，抵抗力降低又易使外邪入侵。 2.過(guò)飽：飲食過(guò)量，如暴飲暴食，或脾胃虛弱而強(qiáng)食，可導(dǎo)致飲食阻滯，出現(xiàn)脘腹脹滿、噯腐泛酸、厭食、吐瀉等食傷

23、脾胃之病。所謂“飲食自倍，腸胃乃傷”。小兒脾胃較弱及文化原因，食積尤為多見(jiàn)。 3.饑飽失常：自古就有一日三餐。所謂“早飯宜好，午飯宜飽，晚飯宜少”。若飲食無(wú)時(shí)，饑一頓，飽一頓最易損傷胃腸，變生他病。二、飲食偏嗜Particular Diet 特別嗜好某些食物，可導(dǎo)致陰陽(yáng)失調(diào)，或某些營(yíng)養(yǎng)缺乏而發(fā)生疾病。1種類(lèi)偏嗜：人的膳食結(jié)構(gòu)應(yīng)該以谷類(lèi)為主，肉類(lèi)為副，蔬菜為充，水果為助，才能獲得充足的營(yíng)養(yǎng)，以滿足生命活動(dòng)的需要。若專(zhuān)嗜某類(lèi)或厭惡不食某類(lèi)食物，會(huì)造成肌體營(yíng)養(yǎng)不全從而導(dǎo)致一些疾病的發(fā)生。如腳氣病、癭瘤、佝僂癥、夜盲等。2寒熱偏嗜：過(guò)食生冷寒涼，可損傷脾胃陽(yáng)氣，寒濕內(nèi)生，發(fā)生腹痛泄瀉等癥。偏食辛溫燥熱

24、，可使胃腸積熱，出現(xiàn)口渴、便秘，或釀成痔瘡。 3五味偏嗜：五味與五臟，各有其親和性，如酸入肝，苦入心，甘入脾，辛入肺，咸入腎。長(zhǎng)期嗜好某味食物，就會(huì)使該臟腑機(jī)能偏盛偏衰，久之甚至可以損傷他臟而發(fā)生疾病。只有“謹(jǐn)和五味”才能健康長(zhǎng)壽。三、飲食不潔Insanitary Diet進(jìn)食不潔，會(huì)引起多種胃腸道疾病，出現(xiàn)腹痛、吐瀉、痢疾等；或引起寄生蟲(chóng)病，如蛔蟲(chóng)、蟯蟲(chóng)、寸白蟲(chóng)等；若進(jìn)食腐敗變質(zhì)有毒食物，可致食物中毒，常出現(xiàn)腹痛、吐瀉，重者可出現(xiàn)昏迷或死亡。隨著時(shí)代的發(fā)展，相對(duì)感染病、寄生蟲(chóng)病發(fā)病率大大降低，但食品安全也是當(dāng)代中國(guó)人最關(guān)心的問(wèn)題之一。第六節(jié) 勞逸失度Maladjustment of Work

25、 and Leisure正常的勞動(dòng)和必要的休息，是保證人體健康的必要條件。但勞逸失度。Appropriate work and suitable rest are the essential prerequisites for a healthy body. 一、 過(guò)勞一、 Over-work1勞力過(guò)度：勞力過(guò)度主要指超過(guò)體力負(fù)擔(dān)和不適當(dāng)?shù)幕顒?dòng)。勞力過(guò)度可出現(xiàn)少氣無(wú)力、四肢困倦、精神疲憊、形體消瘦等，即所謂“勞則氣耗”。中醫(yī)有久視傷血、久臥傷氣、久坐傷肉、久立傷骨、久行傷筋之說(shuō)。1. Physical over-strain: physical over-strain2勞神過(guò)度：勞神過(guò)度指思慮

26、勞神過(guò)度。勞神過(guò)度可耗傷心血，損傷脾氣，出現(xiàn)心悸、健忘、失眠、多夢(mèng)及納呆、腹脹、便溏等癥。2. Mental over-strain: Mental over-strain3房勞過(guò)度：房勞是指房事過(guò)度。房勞過(guò)度會(huì)耗傷腎精，可致腰膝酸軟、眩暈耳鳴、精神萎靡，或男子遺精滑泄、性功能減退，甚或陽(yáng)痿。3.Sexual over-strain: Sexual over-strain（二） 過(guò)逸 (二) Over-ease過(guò)逸是使人體氣血運(yùn)行不暢，脾胃呆滯，或體虛發(fā)胖等。過(guò)度安逸，陽(yáng)氣不振，神倦，乏力，筋骨柔脆甚或繼發(fā)他病。第七節(jié) 其他病因Other pathogens一、 外傷Traumatic Injuries（一）外傷的概念外傷指因受撲擊、跌仆、利器等外力所致，以及蟲(chóng)獸咬傷、燒燙傷、凍傷等而致形體組織的損傷。外傷一般有明顯的外傷史。（二）外傷的致病特點(diǎn)1外力損傷:因暴力引起的創(chuàng)傷。包括槍炮、金刃、持