{"id":12851,"date":"2024-12-10T10:52:03","date_gmt":"2024-12-10T00:52:03","guid":{"rendered":"https:\/\/tcmdrma.com\/?p=12851"},"modified":"2024-12-10T10:54:24","modified_gmt":"2024-12-10T00:54:24","slug":"%e7%bb%8f%e6%96%b9%e6%b2%bb%e7%96%97%e5%a4%96%e6%84%9f%e5%90%8e%e9%98%b4%e8%99%9a%e5%92%b3%e5%97%bd%e4%b8%80%e4%be%8b","status":"publish","type":"post","link":"https:\/\/tcmdrma.com\/zh-hans\/%e7%bb%8f%e6%96%b9%e6%b2%bb%e7%96%97%e5%a4%96%e6%84%9f%e5%90%8e%e9%98%b4%e8%99%9a%e5%92%b3%e5%97%bd%e4%b8%80%e4%be%8b\/","title":{"rendered":"\u7ecf\u65b9\u6cbb\u7597\u5916\u611f\u540e\u9634\u865a\u54b3\u55fd\u4e00\u4f8b"},"content":{"rendered":"

患者，女性，亚裔，58岁，主诉为久咳不愈一月余。患者先找中医看，被诊断为风寒咳嗽，服用一剂后咳嗽加重，未再服，转而找西医治疗，予激素（prednisolone）及抗生素治疗。患者反馈服用西药后咳嗽迅速好了8成，但近期吃了一点鸡肉后，咳嗽又转剧，伴痰及干燥、咽痒，夜尿5-6次。 舌红苔少，脉浮弦数紧细滑。病机为风热伤津、肾阴虚及痰饮。服药两周后（患者可能误解了医嘱，7天的药用了14天）自感咳嗽已经明显改善，还有一些痰，夜尿好转到1-2次，继服一周巩固。<\/p>\n

 <\/p>\n

下面分析一下这个医案。<\/p>\n

    \n
  1. 为什么不是风寒咳嗽？ 虽然脉象有浮紧的成分，但是脉中还兼有数。虽然患者自身没有出现明显的感冒症状（体虚），但脉象为风热兼寒。这是前医的一个诊断错误，故而纯用温药导致咳嗽加重。<\/li>\n
  2. 为什么西医的激素和抗生素治疗初期有效但出现反复？本质上就是不对症，用药没有办法祛除体内的风热痰饮，其治疗效果是通过激素的强压制作用达成的，药效过了，病机未变，原来的病就又显现了出来。患者听从我的建议未再继续服用激素类药物。如果采取一直压制到病证不再显现的方法，很可能会为多年后的肺系疾病埋下伏笔。<\/li>\n
  3. 这个患者本身很瘦，日常饮食又过于清淡，本身就是阴虚体质，外感风热则进一步伤阴，故而咽燥口渴，此时的治疗必须补阴才能止咳，也防止进一步伤及肾阴，动摇身体之本。<\/li>\n<\/ol>\n

     <\/p>\n

    医案编号：105   @安发中医馆，墨尔本<\/p>\n","protected":false},"excerpt":{"rendered":"

    患者，女性，亚裔，5 […]<\/p>\n","protected":false},"author":1,"featured_media":12852,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_uag_custom_page_level_css":"","footnotes":""},"categories":[76],"tags":[91],"class_list":["post-12851","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-76","tag-91"],"acf":[],"uagb_featured_image_src":{"full":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-scaled.jpg",2560,1706,false],"thumbnail":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-150x150.jpg",150,150,true],"medium":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-300x200.jpg",300,200,true],"medium_large":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-768x512.jpg",768,512,true],"large":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-1024x683.jpg",1024,683,true],"1536x1536":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-1536x1024.jpg",1536,1024,true],"2048x2048":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-2048x1365.jpg",2048,1365,true],"blog-large":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-669x272.jpg",669,272,true],"blog-medium":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-320x202.jpg",320,202,true],"recent-posts":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-700x441.jpg",700,441,true],"recent-works-thumbnail":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-66x66.jpg",66,66,true],"fusion-200":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-200x133.jpg",200,133,true],"fusion-400":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-400x267.jpg",400,267,true],"fusion-600":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-600x400.jpg",600,400,true],"fusion-800":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-800x533.jpg",800,533,true],"fusion-1200":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-1200x800.jpg",1200,800,true],"portfolio-full":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-940x400.jpg",940,400,true],"portfolio-one":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-540x272.jpg",540,272,true],"portfolio-two":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-460x295.jpg",460,295,true],"portfolio-three":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-300x214.jpg",300,214,true],"portfolio-five":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-177x142.jpg",177,142,true],"woocommerce_thumbnail":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-500x333.jpg",500,333,true],"woocommerce_single":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-700x467.jpg",700,467,true],"woocommerce_gallery_thumbnail":["https:\/\/tcmdrma.com\/wp-content\/uploads\/2024\/12\/pexels-photo-5790716-5790716-100x100.jpg",100,100,true]},"uagb_author_info":{"display_name":"Max Ma","author_link":"https:\/\/tcmdrma.com\/zh-hans\/author\/tcmdrma-com\/"},"uagb_comment_info":0,"uagb_excerpt":"患者，女性，亚…","_links":{"self":[{"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/posts\/12851","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/comments?post=12851"}],"version-history":[{"count":3,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/posts\/12851\/revisions"}],"predecessor-version":[{"id":12856,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/posts\/12851\/revisions\/12856"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/media\/12852"}],"wp:attachment":[{"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/media?parent=12851"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/categories?post=12851"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tcmdrma.com\/zh-hans\/wp-json\/wp\/v2\/tags?post=12851"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}