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慢性阻塞性肺疾病、支气管哮喘、支气管扩张等呼吸系统常见病的规范诊断与治疗 肺癌的规范诊断与综合治疗；肺癌的规范诊断与综合治疗","上海市东方医院","呼吸内科","主治医师",9,"鼻窒","","https://cdn.yishi-tong.com/console/3/CNinVA9TiB64e_GMxCaJAdPQNX5g_jhB.png",2,"WEBVTT\n\n00:01.742 --> 00:02.292\n大家好，\n\n00:02.542 --> 00:05.392\n今天给大家做一个临床讲座。\n\n00:05.791 --> 00:07.842\n临床讲座的内容是鼻子。\n\n00:09.718 --> 00:11.368\n首先介绍一个医案，\n\n00:11.817 --> 00:14.517\n这个患者是一个30岁的男性，\n\n00:14.817 --> 00:16.868\n他的主诉是鼻塞不通，\n\n00:17.118 --> 00:18.618\n张口呼吸数年。\n\n00:19.368 --> 00:20.167\n患者呢，\n\n00:20.167 --> 00:21.818\n自幼鼻塞多涕，\n\n00:22.318 --> 00:23.318\n初为单侧，\n\n00:23.318 --> 00:24.468\n两鼻交替，\n\n00:24.468 --> 00:25.667\n时轻时重。\n\n00:26.218 --> 00:29.443\n对于麻黄碱鼻炎净之类的药物呢，\n\n00:29.443 --> 00:30.868\n初期是有效的，\n\n00:31.218 --> 00:32.217\n滴之即通，\n\n00:32.467 --> 00:34.717\n后发展为用之无效。\n\n00:35.068 --> 00:37.368\n鼻塞照旧持续不减，\n\n00:37.868 --> 00:38.693\n鼻内呢，\n\n00:38.693 --> 00:39.917\n堵塞闷胀。\n\n00:40.029 --> 00:42.330\n鼻音增重患者呢，\n\n00:42.330 --> 00:43.529\n需要张口呼吸，\n\n00:43.880 --> 00:47.279\n导致嗅觉迟钝、头昏耳鸣，\n\n00:47.380 --> 00:48.580\n记忆力下降。\n\n00:49.987 --> 00:50.487\n鼻涕呢，\n\n00:50.487 --> 00:51.437\n白而粘稠，\n\n00:51.638 --> 00:52.687\n难以擤出。\n\n00:53.287 --> 00:54.638\n曾于5年前呢，\n\n00:54.638 --> 00:56.787\n做过下鼻甲的部分切除术，\n\n00:57.388 --> 00:58.612\n术后不久呢，\n\n00:58.612 --> 00:59.987\n症状又出现了，\n\n01:00.237 --> 01:02.338\n严重影响了工作和生活。\n\n01:03.388 --> 01:04.263\n检查呢，\n\n01:04.263 --> 01:05.737\n全身症状不明显。\n\n01:07.278 --> 01:09.228\n鼻内筋膜暗红肿胀，\n\n01:09.579 --> 01:10.653\n鼻甲肿实，\n\n01:10.653 --> 01:11.278\n色暗，\n\n01:11.378 --> 01:12.478\n呈桑葚状，\n\n01:12.929 --> 01:14.028\n表面坚实，\n\n01:14.028 --> 01:14.778\n无弹性，\n\n01:14.778 --> 01:15.929\n收缩欠佳。\n\n01:16.429 --> 01:18.228\n鼻道狭窄拥挤，\n\n01:18.628 --> 01:20.579\n鼻道内分泌物排出不畅，\n\n01:20.579 --> 01:21.728\n流于体内，\n\n01:21.929 --> 01:22.753\n有时呢，\n\n01:22.753 --> 01:24.778\n从咽部吸出后吐出。\n\n01:25.278 --> 01:26.079\n舌质红，\n\n01:26.079 --> 01:26.778\n有瘀点。\n\n01:27.399 --> 01:27.999\n脉弦细。\n\n01:30.613 --> 01:32.963\n那这个患者的诊断是什么呢？\n\n01:33.113 --> 01:34.888\n病因病机如何呢？\n\n01:34.888 --> 01:35.914\n怎么治疗呢？\n\n01:38.194 --> 01:39.994\n这个患者鼻塞不通，\n\n01:40.094 --> 01:41.143\n初为单侧，\n\n01:41.143 --> 01:42.244\n两鼻交替，\n\n01:42.393 --> 01:43.494\n时轻时重，\n\n01:43.744 --> 01:44.518\n后鼻塞，\n\n01:44.518 --> 01:45.793\n持续检查，\n\n01:45.793 --> 01:47.444\n鼻内筋膜暗红肿胀，\n\n01:47.543 --> 01:48.569\n鼻甲肿实，\n\n01:48.569 --> 01:49.043\n色暗，\n\n01:49.043 --> 01:50.043\n呈伤肾状，\n\n01:50.293 --> 01:51.969\n表面坚实无弹性，\n\n01:51.969 --> 01:52.893\n收缩欠佳。\n\n01:53.244 --> 01:54.444\n所以它的主症呢，\n\n01:54.444 --> 01:56.043\n是鼻塞体症呢，\n\n01:56.043 --> 01:56.994\n是鼻甲肿大。\n\n01:58.070 --> 01:59.496\n该病的诊断呢，\n\n01:59.496 --> 02:00.320\n就是鼻子。\n\n02:04.325 --> 02:04.725\n嗯，\n\n02:05.075 --> 02:07.401\n介绍一下今天讲座呢，\n\n02:07.401 --> 02:08.725\n一共是八个内容。\n\n02:08.975 --> 02:09.526\n首先，\n\n02:09.526 --> 02:11.276\n介绍一下鼻子的概念。\n\n02:12.757 --> 02:13.158\n嗯，\n\n02:13.457 --> 02:14.182\n治呢，\n\n02:14.182 --> 02:17.358\n就是中文指出治塞也。\n\n02:17.608 --> 02:18.757\n素问玄机，\n\n02:19.108 --> 02:23.908\n原病是六气为兵热类鼻治条是曰鼻窒，\n\n02:24.007 --> 02:25.257\n窒塞也。\n\n02:25.757 --> 02:26.432\n所以呢，\n\n02:26.432 --> 02:28.908\n窒乃堵塞不通之意，\n\n02:29.158 --> 02:29.957\n鼻窒呢，\n\n02:29.957 --> 02:31.108\n就是鼻腔堵塞，\n\n02:31.207 --> 02:33.007\n气息出入不通之意。\n\n02:33.774 --> 02:34.548\n鼻涕呢，\n\n02:34.548 --> 02:37.574\n它是以主要症状而命名的疾病的名称。\n\n02:39.824 --> 02:40.223\n嗯。\n\n02:41.779 --> 02:42.429\n一句呢，\n\n02:42.679 --> 02:45.779\n在素问五常正大论中指出，\n\n02:46.380 --> 02:49.229\n少阳司天火气下临，\n\n02:49.729 --> 02:52.229\n肺气上从大暑以行。\n\n02:54.841 --> 02:55.442\n和T。\n\n02:57.294 --> 02:59.319\n求扭鼻治灵枢。\n\n02:59.319 --> 03:00.343\n本辰指出，\n\n03:00.694 --> 03:03.393\n肺气虚则鼻塞不利少气。\n\n03:04.789 --> 03:06.289\n内经中的鼻涕呢，\n\n03:06.289 --> 03:07.690\n指的是鼻塞的症状，\n\n03:08.089 --> 03:09.914\n和今天的鼻涕的含义呢，\n\n03:09.914 --> 03:10.940\n是有区别的。\n\n03:12.335 --> 03:13.386\n内经认为，\n\n03:13.436 --> 03:16.085\n鼻塞主要与肺的功能失调有关，\n\n03:16.186 --> 03:17.436\n有虚有实。\n\n03:18.582 --> 03:20.082\n东汉张仲景呢，\n\n03:20.182 --> 03:25.332\n在金匮要略尽湿喝病脉症第二中指出，\n\n03:25.632 --> 03:26.781\n头中寒湿，\n\n03:26.882 --> 03:28.656\n故鼻塞内药，\n\n03:28.656 --> 03:29.582\n鼻中则愈。\n\n03:30.598 --> 03:30.848\n嗯，\n\n03:30.848 --> 03:32.522\n指出了头中寒湿呢，\n\n03:32.522 --> 03:33.397\n可导致鼻塞，\n\n03:33.498 --> 03:38.998\n而且开外治法治疗鼻塞的先河晋隋唐时期。\n\n03:39.919 --> 03:40.343\n鼻涕呢，\n\n03:40.343 --> 03:46.419\n多称为鼻问鼻塞、鼻塞气息不通、鼻窒塞不通等。\n\n03:47.518 --> 03:48.544\n那个时候呢，\n\n03:48.544 --> 03:52.018\n多以鼻窒塞或鼻塞气体不通称之。\n\n03:52.419 --> 03:54.919\n虽没有直接使用鼻支这个病名，\n\n03:55.369 --> 03:56.069\n但是呢，\n\n03:56.069 --> 03:59.069\n和目前来说的鼻子的特征是类似的，\n\n03:59.218 --> 04:00.869\n多用塞鼻法治疗。\n\n04:01.567 --> 04:03.167\n提出了综合性的疗法，\n\n04:03.617 --> 04:05.167\n在内外治的同时呢，\n\n04:05.167 --> 04:06.617\n选用针灸按摩，\n\n04:06.817 --> 04:09.317\n改善鼻塞不闻香臭的症状。\n\n04:11.324 --> 04:14.250\n金元时期素问玄机，\n\n04:14.250 --> 04:16.024\n元病是从火立论。\n\n04:16.799 --> 04:20.500\n素问玄机元病是指出但见侧卧，\n\n04:20.649 --> 04:22.049\n则上窍通利，\n\n04:22.049 --> 04:23.100\n而下窍闭塞。\n\n04:24.415 --> 04:25.815\n金元时期呢，\n\n04:26.015 --> 04:28.214\n指出鼻子的临床特点，\n\n04:28.915 --> 04:30.765\n侧卧则上窍通利，\n\n04:30.765 --> 04:31.815\n下窍闭塞。\n\n04:32.214 --> 04:35.815\n这就反映了当时对鼻子认识的学术水平。\n\n04:39.665 --> 04:40.466\n鼻涕呢，\n\n04:40.466 --> 04:42.115\n在历代文献当中呢，\n\n04:42.115 --> 04:44.966\n被称为鼻瓮瓮鼻，\n\n04:45.115 --> 04:48.265\n鼻窒鼻塞鼻塞气息不通，\n\n04:48.566 --> 04:50.015\n鼻塞不闻香臭，\n\n04:50.265 --> 04:52.165\n鼻窒塞鼻聋等名。\n\n04:55.437 --> 04:58.912\n在历史文献的病因病机总结，\n\n04:58.912 --> 05:00.613\n第一个原因呢，\n\n05:00.613 --> 05:01.888\n是肺经受寒，\n\n05:02.088 --> 05:03.588\n滞留鼻窍学说。\n\n05:04.488 --> 05:06.338\n因为肺开窍于鼻，\n\n05:06.787 --> 05:07.912\n肺气宣发，\n\n05:07.912 --> 05:09.187\n则鼻气通利，\n\n05:09.437 --> 05:10.963\n若风寒袭肺，\n\n05:10.963 --> 05:12.088\n肺湿宣发，\n\n05:12.238 --> 05:14.588\n寒邪循经上乘于鼻，\n\n05:15.138 --> 05:16.187\n壅滞不去，\n\n05:16.588 --> 05:17.763\n则鼻失通利，\n\n05:17.763 --> 05:19.537\n而成滞塞A之患。\n\n05:20.394 --> 05:21.544\n故风寒袭肺，\n\n05:21.544 --> 05:22.593\n滞留鼻窍，\n\n05:22.843 --> 05:23.894\n久温不去，\n\n05:24.144 --> 05:26.694\n亦是造成鼻子的主要原因之一。\n\n05:28.539 --> 05:32.389\n诸病源候论卷二十九鼻病诸侯指出，\n\n05:32.739 --> 05:34.139\n若肺脏调和，\n\n05:34.239 --> 05:36.139\n则鼻气通利而之香臭，\n\n05:36.688 --> 05:39.438\n若风冷伤于脏腑，\n\n05:39.639 --> 05:42.188\n则邪气沉于大太阴之经，\n\n05:42.489 --> 05:44.438\n其气蕴积于鼻者，\n\n05:44.838 --> 05:46.289\n则津液壅塞，\n\n05:46.688 --> 05:48.139\n鼻气不宣调，\n\n05:48.588 --> 05:51.139\n故不知香臭而为鼻问也。\n\n05:52.289 --> 05:53.739\n肺所通于鼻，\n\n05:53.838 --> 05:55.588\n其脏为冷风所伤，\n\n05:55.838 --> 05:58.039\n故鼻气不宣利。\n\n05:58.653 --> 05:59.553\n拥塞成梦。\n\n06:01.282 --> 06:02.356\n第二个学说呢，\n\n06:02.356 --> 06:03.981\n是肺经淤热学说。\n\n06:05.032 --> 06:06.506\n肺经淤热学说呢，\n\n06:06.506 --> 06:08.832\n起源并盛行于明清时期，\n\n06:09.381 --> 06:13.782\n打破了隋唐宋时期肺经收寒学说的流行观点。\n\n06:14.332 --> 06:20.256\n对鼻子发病学说进一步发展与完善一点之论，\n\n06:20.256 --> 06:27.731\n首次提出了鼻子的局部病理改变在于吸液浸盈肉里胀满翘窄无缝。\n\n06:29.424 --> 06:30.199\n这个论述呢，\n\n06:30.199 --> 06:35.424\n类似于现代有关慢性鼻炎的主要病理变化在于鼻粘膜肥厚，\n\n06:35.424 --> 06:36.924\n鼻甲肥大的论点。\n\n06:37.574 --> 06:39.598\n名医杂著卷之三，\n\n06:39.598 --> 06:42.523\n鼻塞指出鼻塞而不闻香臭，\n\n06:42.873 --> 06:44.873\n或遇寒多塞，\n\n06:45.023 --> 06:46.873\n或略感风寒变塞，\n\n06:47.123 --> 06:48.373\n不时举发者。\n\n06:49.858 --> 06:51.507\n世俗皆为肺寒，\n\n06:51.808 --> 06:54.757\n而用表解通利辛温之药不效。\n\n06:55.007 --> 06:57.507\n殊不知此是肺经有火，\n\n06:57.708 --> 06:58.858\n邪火愈盛，\n\n06:59.308 --> 07:01.308\n则喜得热而勿见寒，\n\n07:01.608 --> 07:02.958\n故遇寒便塞，\n\n07:03.407 --> 07:04.708\n偶感便发也。\n\n07:06.587 --> 07:07.337\n一扁指出，\n\n07:07.536 --> 07:09.136\n鼻塞亦有脑冷，\n\n07:09.136 --> 07:11.386\n而气化液下凝于鼻，\n\n07:11.636 --> 07:14.937\n亦有气热蒸涕壅塞故矣。\n\n07:15.236 --> 07:17.937\n乃极力去其涕而人不通者，\n\n07:17.986 --> 07:21.136\n则窍之外皆涕液之所尽凝，\n\n07:21.437 --> 07:22.437\n肉里胀满，\n\n07:22.687 --> 07:24.187\n窍窄无缝故也。\n\n07:26.342 --> 07:28.641\n第三个学说是阳明预热学说。\n\n07:30.442 --> 07:33.243\n素问玄机元病是六气为病，\n\n07:33.292 --> 07:34.743\n热泪鼻至指出。\n\n07:39.160 --> 07:39.859\n博主称。\n\n07:41.398 --> 07:42.447\n分肿胀，\n\n07:42.648 --> 07:45.023\n故热克阳明而鼻中，\n\n07:45.023 --> 07:46.648\n则致塞也，\n\n07:47.097 --> 07:47.972\n或畏寒，\n\n07:47.972 --> 07:48.747\n主闭藏，\n\n07:49.048 --> 07:50.997\n妄以鼻之为寒物也。\n\n07:51.197 --> 07:54.222\n盖阳气盛于上而侧卧，\n\n07:54.222 --> 07:56.398\n上窍通利而下窍闭塞者，\n\n07:56.697 --> 07:57.898\n谓阳明之脉。\n\n07:57.898 --> 07:58.798\n左右相交，\n\n07:58.947 --> 08:00.697\n而左脉注于右窍，\n\n08:00.898 --> 08:02.298\n右脉注于左窍，\n\n08:02.648 --> 08:05.648\n故风热郁结并偏于左侧，\n\n08:05.947 --> 08:07.597\n右窍反塞之也。\n\n08:08.347 --> 08:10.222\n这说明阳明郁热，\n\n08:10.222 --> 08:11.597\n导致鼻子的发生。\n\n08:11.902 --> 08:15.252\n而且描述了交替性鼻塞的临床特征，\n\n08:15.601 --> 08:17.302\n并以经络学说为主，\n\n08:17.451 --> 08:20.101\n阐述了交替性鼻塞的病理机制。\n\n08:20.802 --> 08:24.002\n第四个学说是肺虚胃弱学说，\n\n08:24.701 --> 08:25.951\n因肺主鼻，\n\n08:26.101 --> 08:27.451\n肺气通于鼻，\n\n08:27.752 --> 08:29.902\n鼻受肺气之温煦方。\n\n08:30.860 --> 08:31.911\n能通利思嗅。\n\n08:32.161 --> 08:33.661\n如果肺气虚弱，\n\n08:33.710 --> 08:34.760\n卫外不固，\n\n08:35.161 --> 08:36.411\n寒邪滞鼻，\n\n08:36.460 --> 08:38.260\n则可致鼻失宣通，\n\n08:38.411 --> 08:40.611\n而是塞成梦矣。\n\n08:41.499 --> 08:44.698\n本学说最早记载于灵枢本神篇，\n\n08:45.598 --> 08:47.473\n肺气虚则鼻塞不利，\n\n08:47.473 --> 08:49.698\n少气赤水悬出，\n\n08:49.698 --> 08:50.999\n捐塞鼻门，\n\n08:51.749 --> 08:53.799\n指出因胃气失守，\n\n08:53.898 --> 08:55.448\n寒邪客于头面，\n\n08:55.549 --> 08:57.674\n鼻亦受之不能为用，\n\n08:57.674 --> 08:59.698\n也是不闻香臭矣。\n\n09:01.794 --> 09:04.794\n第五个学说是脾胃虚损学说。\n\n09:05.393 --> 09:08.044\n素问玉机真脏论曰，\n\n09:08.393 --> 09:09.393\n脾为孤脏，\n\n09:09.794 --> 09:12.544\n其不及则令人九窍不通，\n\n09:12.794 --> 09:13.643\n不及者，\n\n09:13.744 --> 09:15.494\n即虚损不足也。\n\n09:15.794 --> 09:16.693\n九窍者，\n\n09:16.693 --> 09:17.843\n包括鼻在内。\n\n09:18.771 --> 09:19.872\n金元时期，\n\n09:20.122 --> 09:22.997\n李东垣据内经之论，\n\n09:22.997 --> 09:26.622\n明确指出了脾胃虚则九窍不通的论断，\n\n09:26.971 --> 09:31.122\n进一步将其发展为脾胃虚损的鼻子发病学说。\n\n09:31.885 --> 09:34.185\n脾胃虚损可致鼻塞失嗅，\n\n09:34.685 --> 09:36.385\n医学入门卷四鼻，\n\n09:36.635 --> 09:40.135\n进一步认识到鼻塞日久亦可内伤脾胃，\n\n09:41.036 --> 09:42.361\n鼻塞久不愈者，\n\n09:42.361 --> 09:43.585\n必内伤脾胃，\n\n09:43.736 --> 09:45.185\n清气不能上升，\n\n09:45.185 --> 09:46.435\n肺外感也。\n\n09:47.185 --> 09:49.835\n脾胃虚损和鼻子互为致病。\n\n09:50.515 --> 09:54.414\n这种脾虚和鼻子互相损伤的观点，\n\n09:54.414 --> 09:57.614\n也是古代鼻子发病学说中的又一特点。\n\n10:00.065 --> 10:00.440\n嗯，\n\n10:00.440 --> 10:01.940\n鼻子这个疾病啊，\n\n10:01.940 --> 10:04.815\n是以经常性鼻塞为主要特征的疾病。\n\n10:05.366 --> 10:07.640\n西医学的慢性鼻炎等疾病呢，\n\n10:07.640 --> 10:10.416\n可以参考本病进行辨证的治疗。\n\n10:13.070 --> 10:14.669\n鼻子的临床诊断，\n\n10:14.770 --> 10:16.719\n它有必备的临床特征，\n\n10:16.869 --> 10:18.919\n就是经常性的鼻塞。\n\n10:20.369 --> 10:22.419\n鼻子的病程一般较长，\n\n10:22.719 --> 10:24.219\n多在3个月以上，\n\n10:24.219 --> 10:25.919\n经常反复出现鼻塞。\n\n10:27.187 --> 10:28.437\n间歇性鼻塞，\n\n10:28.437 --> 10:29.737\n交替性鼻塞，\n\n10:29.987 --> 10:33.038\n有时候鼻塞有时候通畅，\n\n10:33.338 --> 10:34.388\n有时候左侧，\n\n10:34.388 --> 10:35.437\n有时候右侧。\n\n10:36.703 --> 10:38.129\n鼻子严重者呢，\n\n10:38.129 --> 10:39.854\n表现为持续性的鼻塞，\n\n10:40.304 --> 10:41.254\n病程长。\n\n10:42.304 --> 10:42.703\n患者呢，\n\n10:42.703 --> 10:44.854\n多有长期使用滴鼻药的病史，\n\n10:45.754 --> 10:47.028\n所用的滴鼻药呢，\n\n10:47.028 --> 10:49.254\n有强烈收缩血管的作用。\n\n10:49.504 --> 10:50.653\n长时间使用，\n\n10:50.653 --> 10:54.054\n使鼻粘膜对药物失去了敏感性。\n\n10:56.552 --> 10:56.927\n嗯，\n\n10:56.927 --> 10:59.901\n鼻涕的伴随症状可以少量的流涕，\n\n11:00.351 --> 11:01.276\n或者清晰，\n\n11:01.276 --> 11:02.101\n或者粘稠。\n\n11:02.452 --> 11:03.002\n有时，\n\n11:03.002 --> 11:05.052\n鼻涕可以向后流向咽部。\n\n11:06.635 --> 11:08.234\n对于鼻塞为主的检查，\n\n11:08.335 --> 11:10.085\n鼻腔检查是必须的，\n\n11:10.135 --> 11:12.159\n包括前鼻镜的检查，\n\n11:12.159 --> 11:13.284\n鼻内镜的检查，\n\n11:13.835 --> 11:16.559\n探针试验和血管收缩剂的试验呢，\n\n11:16.559 --> 11:17.585\n有参考价值。\n\n11:17.984 --> 11:20.484\n鼻部CT检查也有重要的作用。\n\n11:21.822 --> 11:22.047\n嗯，\n\n11:22.047 --> 11:23.223\n鼻腔检查发现，\n\n11:23.223 --> 11:26.572\n鼻痣患者早期鼻粘膜色红或暗红，\n\n11:26.773 --> 11:28.023\n下鼻甲肿胀，\n\n11:28.023 --> 11:29.023\n表面光滑，\n\n11:29.273 --> 11:30.247\n触之柔软，\n\n11:30.247 --> 11:32.497\n弹性好久病者呢，\n\n11:32.497 --> 11:34.023\n发现下鼻甲肥大，\n\n11:34.023 --> 11:35.922\n呈桑葚状或结节状，\n\n11:36.023 --> 11:36.747\n触之呢，\n\n11:36.747 --> 11:37.547\n有硬实感，\n\n11:37.547 --> 11:38.622\n弹性比较差。\n\n11:41.309 --> 11:42.559\n慢性单纯性鼻炎，\n\n11:42.559 --> 11:44.010\n它的鼻塞是间歇性。\n\n11:44.010 --> 11:44.710\n交替性。\n\n11:45.109 --> 11:47.335\n慢性鼻厚肥厚性鼻炎呢，\n\n11:47.335 --> 11:48.809\n它的鼻塞是持续性。\n\n11:49.586 --> 11:52.062\n慢性单纯性鼻炎的患者，\n\n11:52.062 --> 11:53.111\n鼻粘膜肿胀，\n\n11:53.111 --> 11:54.437\n表面光滑湿润，\n\n11:54.437 --> 11:55.286\n呈暗红色。\n\n11:55.637 --> 11:57.786\n慢性肥厚性鼻炎的患者呢，\n\n11:57.986 --> 11:59.637\n粘膜鼻腔骨肥大，\n\n11:59.637 --> 12:01.086\n鼻粘膜表面不平，\n\n12:01.536 --> 12:03.086\n结节状桑葚状，\n\n12:03.336 --> 12:04.187\n色苍白，\n\n12:04.187 --> 12:05.437\n淡红或紫红。\n\n12:05.986 --> 12:08.062\n慢性单纯性鼻炎的患者呢，\n\n12:08.062 --> 12:10.736\n触针探针触诊呢，\n\n12:10.736 --> 12:12.086\n柔软富有弹性。\n\n12:12.086 --> 12:13.262\n探针离开后呢，\n\n12:13.262 --> 12:14.286\n可以立即恢复。\n\n12:14.536 --> 12:16.586\n而慢性肥厚性鼻炎的患者，\n\n12:16.887 --> 12:19.687\n探针触诊硬实感触之不限。\n\n12:19.835 --> 12:21.635\n凹陷或虽然凹陷，\n\n12:21.635 --> 12:23.835\n但不不容易立刻恢复。\n\n12:24.979 --> 12:25.278\n嗯，\n\n12:25.278 --> 12:29.828\n慢性单纯性鼻炎的患者对麻黄素反应使粘膜很快收缩，\n\n12:30.129 --> 12:35.129\n而慢性肥厚性鼻炎的患者对麻黄素使粘膜不收缩或者收缩很少。\n\n12:36.627 --> 12:37.427\nCT检查呢，\n\n12:37.427 --> 12:41.052\n用于观察鼻子的患者鼻腔结构有没有异常。\n\n12:43.848 --> 12:44.098\n嗯，\n\n12:44.247 --> 12:47.997\n鼻子和伤风鼻塞要有鉴别。\n\n12:48.447 --> 12:51.122\n鼻子的发病的病机呢，\n\n12:51.122 --> 12:52.148\n是正气虚弱，\n\n12:52.148 --> 12:53.047\n淤邪不清。\n\n12:53.598 --> 12:54.898\n伤风鼻塞呢，\n\n12:54.898 --> 12:56.047\n发病的病机呢，\n\n12:56.047 --> 12:58.797\n是外感鼻涕呢，\n\n12:58.898 --> 13:00.848\n间歇性交替性的鼻塞。\n\n13:01.098 --> 13:02.848\n而伤风引起的鼻塞呢，\n\n13:02.848 --> 13:04.822\n是鼻痒鼻塞流涕，\n\n13:04.822 --> 13:05.398\n喷嚏，\n\n13:05.648 --> 13:06.797\n畏寒发热，\n\n13:06.997 --> 13:08.047\n头身疼痛。\n\n13:08.747 --> 13:10.398\n鼻区的体检呢，\n\n13:10.398 --> 13:11.598\n是鼻腔粘膜炎。\n\n13:12.161 --> 13:13.661\n暗红下鼻甲肥大，\n\n13:14.111 --> 13:16.585\n而伤风引起的鼻塞呢，\n\n13:16.585 --> 13:18.310\n是鼻粘膜充血肿胀，\n\n13:18.510 --> 13:22.036\n清涕逐渐转为黄稠鼻涕呢，\n\n13:22.036 --> 13:24.161\n病程持续数月以上，\n\n13:24.161 --> 13:25.060\n反复发作，\n\n13:25.310 --> 13:26.760\n而伤风鼻塞呢，\n\n13:26.760 --> 13:28.060\n病程一周左右。\n\n13:31.781 --> 13:33.831\n鼻子和鼻咽也要进行鉴别，\n\n13:33.981 --> 13:36.281\n鼻子的发病部位是在鼻腔，\n\n13:36.481 --> 13:38.081\n而鼻炎的发病部位呢，\n\n13:38.081 --> 13:38.882\n是在鼻窦。\n\n13:39.781 --> 13:40.981\n鼻涕的病史呢，\n\n13:40.981 --> 13:42.932\n是伤风鼻塞反复发作，\n\n13:43.281 --> 13:44.007\n鼻炎呢，\n\n13:44.007 --> 13:45.831\n是伤风鼻塞或者鼻窒。\n\n13:47.075 --> 13:50.125\n鼻涕的主要症状是间歇性、交替性的鼻塞。\n\n13:50.375 --> 13:53.424\n鼻炎的主要症状是鼻塞和鼻流脓涕，\n\n13:53.674 --> 13:54.674\n量多不止。\n\n13:56.429 --> 13:56.780\n嗯，\n\n13:56.780 --> 13:58.330\n鼻子的病程呢，\n\n13:58.330 --> 13:59.530\n持续数月以上，\n\n13:59.780 --> 14:00.780\n反复发作。\n\n14:01.030 --> 14:02.030\n而鼻渊呢，\n\n14:02.030 --> 14:03.729\n病程可长可短。\n\n14:06.370 --> 14:08.570\n鼻子和鼻息肉也要进行鉴别，\n\n14:09.320 --> 14:12.870\n鼻子间歇性交替性的鼻塞，\n\n14:12.870 --> 14:17.645\n而鼻息息肉是渐进性持续性的鼻塞体征呢，\n\n14:17.645 --> 14:19.870\n鼻支的患者鼻腔粘膜暗红，\n\n14:19.870 --> 14:21.120\n下鼻甲肿大，\n\n14:21.471 --> 14:22.895\n而鼻息肉的患者呢，\n\n14:22.895 --> 14:25.171\n鼻腔灰白色半透明的新生物。\n\n14:30.794 --> 14:31.744\n鼻涕的患者，\n\n14:32.145 --> 14:33.145\n鼻病日久，\n\n14:33.145 --> 14:35.645\n鼻塞持续不减，\n\n14:36.044 --> 14:37.770\n它是邪毒滞留，\n\n14:37.770 --> 14:39.145\n气血不畅的表现。\n\n14:39.395 --> 14:40.195\n鼻甲呢，\n\n14:40.195 --> 14:41.244\n是暗红肿胀，\n\n14:41.344 --> 14:42.994\n这是气血不畅所致。\n\n14:43.344 --> 14:45.294\n患者的舌质红瘀点，\n\n14:45.695 --> 14:46.570\n脉弦细，\n\n14:46.570 --> 14:49.344\n是气滞血瘀之象。\n\n14:49.344 --> 14:53.145\n刚才介绍那个病案的病因病机呢，\n\n14:53.145 --> 14:57.195\n一个是气滞血瘀患者反复伤风鼻塞，\n\n14:57.594 --> 14:58.695\n素体虚弱，\n\n14:58.994 --> 15:00.469\n致使淤邪不清，\n\n15:00.469 --> 15:00.994\n滞留。\n\n15:01.057 --> 15:01.456\n鼻翘。\n\n15:04.286 --> 15:05.486\n它还有一个病机呢，\n\n15:05.486 --> 15:06.687\n是邪滞鼻窍。\n\n15:07.086 --> 15:08.236\n鼻子的发病呢，\n\n15:08.236 --> 15:10.986\n往往由于患者的脏腑虚弱，\n\n15:11.387 --> 15:12.887\n鼻塞反复发作。\n\n15:12.887 --> 15:13.687\n于是呢，\n\n15:13.687 --> 15:15.762\n邪滞鼻窍临床中呢，\n\n15:15.762 --> 15:17.236\n主要有三大类原因，\n\n15:17.536 --> 15:18.887\n一个是郁热，\n\n15:19.086 --> 15:20.036\n二是气虚，\n\n15:20.137 --> 15:21.687\n第三个是血瘀。\n\n15:24.731 --> 15:28.330\n肺经温热就是患者的鼻塞反复发作，\n\n15:28.531 --> 15:30.330\n导致气郁化热。\n\n15:31.179 --> 15:32.030\n肺经郁热，\n\n15:32.130 --> 15:34.330\n邪热循经上犯鼻窍，\n\n15:34.729 --> 15:35.705\n肺热熏蒸，\n\n15:35.705 --> 15:36.554\n鼻甲肿胀，\n\n15:36.554 --> 15:37.530\n导致了鼻子。\n\n15:38.179 --> 15:39.179\n第二个原因呢，\n\n15:39.179 --> 15:41.205\n是肺脾气虚，\n\n15:41.205 --> 15:42.130\n思虑太过，\n\n15:42.130 --> 15:43.880\n饮食不节，\n\n15:44.030 --> 15:45.880\n劳倦过度，\n\n15:45.880 --> 15:47.280\n身体脾胃虚弱，\n\n15:47.630 --> 15:48.604\n久病体弱，\n\n15:48.604 --> 15:50.030\n导致肺脾气虚。\n\n15:50.729 --> 15:51.130\n嗯，\n\n15:51.630 --> 15:52.455\n这这呢，\n\n15:52.455 --> 15:54.205\n就导致患者气不清，\n\n15:54.205 --> 15:57.080\n诉滞邪滞鼻窍导致了鼻滞。\n\n15:57.630 --> 15:58.655\n第三个原因呢，\n\n15:58.655 --> 15:59.729\n是气滞血瘀，\n\n16:00.330 --> 16:00.705\n嗯，\n\n16:00.705 --> 16:01.280\n鼻塞。\n\n16:01.489 --> 16:01.838\n久滞，\n\n16:02.338 --> 16:03.338\n气行不畅，\n\n16:03.489 --> 16:04.489\n久病入络，\n\n16:04.588 --> 16:05.638\n寒凝血脉，\n\n16:05.689 --> 16:07.338\n导致了气滞血瘀，\n\n16:07.739 --> 16:08.838\n鼻甲血瘀，\n\n16:08.939 --> 16:09.989\n淤血充血，\n\n16:10.239 --> 16:11.439\n痰阻鼻窍，\n\n16:11.439 --> 16:12.539\n导致了鼻滞。\n\n16:15.622 --> 16:15.822\n嗯，\n\n16:16.572 --> 16:18.547\n这个患者的辨证治疗呢，\n\n16:18.547 --> 16:19.247\n治则呢，\n\n16:19.247 --> 16:20.723\n一个是活血化瘀，\n\n16:20.822 --> 16:22.023\n芳香通窍。\n\n16:22.822 --> 16:23.197\n嗯，\n\n16:23.197 --> 16:24.447\n针对这个患者呢，\n\n16:24.447 --> 16:27.023\n给予方药是苍耳子散加味，\n\n16:27.273 --> 16:27.973\n桃仁，\n\n16:27.973 --> 16:30.223\n红花丹皮赤芍各六克，\n\n16:30.422 --> 16:31.572\n当归12g，\n\n16:31.723 --> 16:32.922\n川芎12g，\n\n16:33.172 --> 16:34.773\n生山楂30g，\n\n16:34.872 --> 16:36.322\n黄牛膝30g，\n\n16:36.422 --> 16:38.322\n丝瓜络20g，\n\n16:38.322 --> 16:39.172\nXH九克，\n\n16:39.172 --> 16:40.223\n辛夷九克，\n\n16:40.223 --> 16:41.273\n白芷十克，\n\n16:41.523 --> 16:42.672\n薄荷六克，\n\n16:43.072 --> 16:44.148\n甘草三克，\n\n16:44.148 --> 16:45.822\n六G水煎每日。\n\n16:45.888 --> 16:49.489\n服一剂患者的鼻病日久邪毒留滞，\n\n16:50.039 --> 16:51.939\n以致气血运行受阻，\n\n16:52.189 --> 16:53.689\n久致气滞血瘀，\n\n16:53.939 --> 16:54.939\n筋膜肿胀，\n\n16:54.939 --> 16:55.838\n鼻甲暗时，\n\n16:55.838 --> 16:58.989\n鼻道壅塞而致鼻质持续不减。\n\n16:59.388 --> 17:01.213\n应用的活血化瘀法，\n\n17:01.213 --> 17:03.138\n使痰阻之血则化，\n\n17:03.489 --> 17:06.313\n壅滞之气得行气血气和，\n\n17:06.313 --> 17:07.188\n脉络通畅，\n\n17:07.188 --> 17:08.188\n鼻气通利。\n\n17:11.347 --> 17:12.146\n的确呢，\n\n17:12.146 --> 17:13.296\n是邪滞鼻窍，\n\n17:13.546 --> 17:18.046\n成因包括热淤血瘀和气血清素三方面的原因。\n\n17:18.347 --> 17:20.972\n针对这三方面同时进行治疗，\n\n17:20.972 --> 17:21.896\n有的放矢。\n\n17:24.052 --> 17:24.427\n嗯，\n\n17:24.427 --> 17:26.602\n阵型一是肺经温热。\n\n17:28.052 --> 17:29.452\n肺经温热的主症呢，\n\n17:29.452 --> 17:31.376\n是患者鼻塞时轻时重，\n\n17:31.376 --> 17:32.602\n交替性的鼻塞，\n\n17:32.802 --> 17:33.526\n鼻涕呢，\n\n17:33.526 --> 17:33.952\n色黄，\n\n17:33.952 --> 17:34.501\n量少，\n\n17:34.952 --> 17:36.151\n下比较红肿，\n\n17:36.151 --> 17:37.952\n表面光滑柔软有弹性，\n\n17:38.151 --> 17:40.702\n常有口干咳嗽痰黄的表现。\n\n17:41.251 --> 17:41.977\n体检呢，\n\n17:41.977 --> 17:43.052\n发现舌尖红，\n\n17:43.302 --> 17:44.202\n苔薄黄，\n\n17:44.251 --> 17:44.901\n脉数。\n\n17:46.562 --> 17:46.987\n定性呢，\n\n17:46.987 --> 17:47.761\n是个热邪，\n\n17:47.812 --> 17:48.562\n定位呢，\n\n17:48.562 --> 17:50.062\n是肺热定病呢，\n\n17:50.062 --> 17:52.462\n是鼻治治法呢，\n\n17:52.462 --> 17:53.761\n是清热散邪，\n\n17:53.911 --> 17:55.011\n宣肺通窍。\n\n17:55.712 --> 17:56.062\n嗯，\n\n17:56.062 --> 17:57.349\n方剂是黄芩汤，\n\n17:57.349 --> 17:59.062\n加减组成呢，\n\n17:59.062 --> 18:03.261\n是黄芩、栀子、桑白皮、麦冬、赤芍、桔梗。\n\n18:04.006 --> 18:05.807\n薄荷、甘草、荆芥穗。\n\n18:08.907 --> 18:11.608\n黄芩、栀子、桑白皮、麦冬可以清肺热，\n\n18:11.858 --> 18:14.508\n桔梗、薄荷、荆芥穗呢，\n\n18:14.508 --> 18:15.708\n可以清宣肺气，\n\n18:15.758 --> 18:16.708\n通利鼻窍。\n\n18:17.057 --> 18:19.358\n黄芩、赤芍清热化瘀滞。\n\n18:19.807 --> 18:21.233\n如果患者鼻塞重，\n\n18:21.233 --> 18:27.858\n可酌情增加一些白芷、辛夷花地龙等芳香通窍宣肺通络的药物。\n\n18:29.312 --> 18:30.463\n症型二呢，\n\n18:30.463 --> 18:32.312\n是肺脾气虚。\n\n18:33.162 --> 18:33.562\n嗯，\n\n18:33.562 --> 18:35.687\n这些患者的症状呢，\n\n18:35.687 --> 18:37.463\n主要是鼻塞时轻时重，\n\n18:37.463 --> 18:38.412\n呈交替性，\n\n18:38.713 --> 18:39.387\n鼻涕呢，\n\n18:39.387 --> 18:39.963\n白而黏，\n\n18:40.162 --> 18:41.488\n遇寒冷的时候呢，\n\n18:41.488 --> 18:42.312\n症状加重。\n\n18:42.412 --> 18:44.137\n鼻粘膜及鼻甲呢，\n\n18:44.137 --> 18:45.012\n淡红肿胀。\n\n18:45.363 --> 18:46.037\n患者呢，\n\n18:46.037 --> 18:46.838\n倦怠乏力，\n\n18:46.838 --> 18:47.912\n少气懒言，\n\n18:48.512 --> 18:49.588\n恶风自汗，\n\n18:49.588 --> 18:50.613\n咳嗽痰稀，\n\n18:51.363 --> 18:52.488\n纳差便溏，\n\n18:52.488 --> 18:53.963\n头重头昏。\n\n18:54.887 --> 18:55.287\n体检呢，\n\n18:55.287 --> 18:56.037\n是舌质淡，\n\n18:56.037 --> 18:56.537\n苔白，\n\n18:56.537 --> 18:57.287\n脉缓弱。\n\n18:58.696 --> 19:00.370\n这些患者的定性呢，\n\n19:00.370 --> 19:01.071\n是气虚，\n\n19:01.071 --> 19:02.234\n定位是肺脾。\n\n19:02.234 --> 19:03.645\n气虚定病呢，\n\n19:03.645 --> 19:04.395\n是鼻质。\n\n19:06.027 --> 19:06.677\n治法呢，\n\n19:06.677 --> 19:08.128\n是补益肺脾，\n\n19:08.378 --> 19:09.578\n散泻通窍。\n\n19:09.978 --> 19:10.753\n方剂呢，\n\n19:10.753 --> 19:12.302\n是温肺止流丹，\n\n19:12.302 --> 19:13.927\n加减组成呢，\n\n19:13.927 --> 19:20.578\n是细辛、荆芥、人参、甘草、诃子、桔梗、鱼脑石。\n\n19:22.025 --> 19:23.125\n细辛荆芥呢，\n\n19:23.125 --> 19:24.275\n可以疏散风寒。\n\n19:24.474 --> 19:26.175\n人参甘草诃子呢，\n\n19:26.175 --> 19:27.224\n是补肺敛气。\n\n19:27.474 --> 19:29.625\n桔梗与脑石散呢，\n\n19:29.775 --> 19:31.125\n可以散结除气。\n\n19:32.057 --> 19:34.358\n如果患者是脾气虚为主呢，\n\n19:34.358 --> 19:36.157\n可用补中益气汤加减。\n\n19:37.279 --> 19:37.979\n阵型三呢，\n\n19:37.979 --> 19:39.379\n是气滞血瘀，\n\n19:39.828 --> 19:42.529\n这些患者的鼻塞持续不减。\n\n19:43.807 --> 19:44.506\n嗅觉减退，\n\n19:44.607 --> 19:45.432\n鼻甲呢，\n\n19:45.432 --> 19:46.256\n肥大质硬，\n\n19:46.256 --> 19:48.207\n表面伤肾状凹凸不平。\n\n19:48.557 --> 19:49.457\n患者呢，\n\n19:49.457 --> 19:50.707\n头胀头痛，\n\n19:51.207 --> 19:52.207\n耳壁重听。\n\n19:53.060 --> 19:53.660\n体检发现，\n\n19:53.660 --> 19:55.185\n舌质暗红或有瘀点，\n\n19:55.185 --> 19:55.760\n脉涩。\n\n19:56.209 --> 19:56.984\n定性呢，\n\n19:56.984 --> 19:58.685\n是气滞血瘀病，\n\n19:58.685 --> 19:59.760\n病是鼻滞。\n\n20:00.109 --> 20:00.834\n治法呢，\n\n20:00.834 --> 20:03.209\n是行气活血化瘀通窍。\n\n20:03.560 --> 20:04.359\n方剂呢，\n\n20:04.359 --> 20:13.660\n是通窍活血汤加减它的组成是赤芍、川芎、桃仁、红花、生姜、大枣、老葱、麝香、黄酒。\n\n20:14.260 --> 20:15.810\n桃仁、红花、赤芍呢，\n\n20:15.810 --> 20:16.959\n可以活血化瘀。\n\n20:17.060 --> 20:17.885\n川芎呢，\n\n20:17.885 --> 20:19.060\n可以行气活血。\n\n20:19.209 --> 20:19.984\n黄酒呢，\n\n20:19.984 --> 20:21.310\n是通经活络。\n\n20:21.709 --> 20:23.010\n老葱生姜呢。\n\n20:23.301 --> 20:24.451\n温散通窍，\n\n20:24.951 --> 20:25.725\n麝香呢，\n\n20:25.725 --> 20:26.576\n芳香走窜，\n\n20:26.576 --> 20:27.551\n通窍开闭。\n\n20:27.850 --> 20:28.625\n红枣呢，\n\n20:28.625 --> 20:29.600\n是健脾和中。\n\n20:30.100 --> 20:31.951\n如果患者鼻塞明显，\n\n20:31.951 --> 20:33.000\n嗅觉迟钝，\n\n20:33.201 --> 20:36.551\n可加辛夷花、白芷、石菖蒲、丝瓜络。\n\n20:36.901 --> 20:38.401\n如果患者头胀痛，\n\n20:38.401 --> 20:39.151\n耳病重，\n\n20:39.151 --> 20:41.201\n听加柴胡。\n\n20:42.493 --> 20:44.692\n蔓荆子菊花与亲密头目。\n\n20:46.536 --> 20:47.885\n推荐治疗方药呢，\n\n20:47.885 --> 20:49.436\n是消肿扩皮汤。\n\n20:52.842 --> 20:55.266\n慢性鼻炎多由急性转来酿，\n\n20:55.266 --> 20:56.041\n经日久，\n\n20:56.041 --> 20:57.467\n或为积热生痰，\n\n20:57.467 --> 20:59.442\n或为气滞血滞，\n\n20:59.641 --> 21:00.991\n或致气虚。\n\n21:00.991 --> 21:01.692\n清素。\n\n21:07.147 --> 21:08.647\n消肿扩鼻汤呢，\n\n21:08.998 --> 21:13.098\n它的主要是芙蓉叶、丝瓜叶清肺消肿扩鼻。\n\n21:13.297 --> 21:14.022\n辅药呢，\n\n21:14.022 --> 21:15.772\n是浙贝母马勃协助，\n\n21:15.772 --> 21:17.297\n主要发挥更好的作用。\n\n21:17.498 --> 21:18.272\n佐药呢，\n\n21:18.272 --> 21:19.647\n是注入通红花，\n\n21:19.748 --> 21:22.498\n是通气活血消肿散结。\n\n21:22.647 --> 21:23.422\n使药呢，\n\n21:23.422 --> 21:25.197\n是石菖蒲苍耳子，\n\n21:25.197 --> 21:26.598\n通窍畅鼻。\n\n21:29.421 --> 21:30.571\n对于鼻子的患者，\n\n21:31.071 --> 21:34.770\n可以用滴鼻芳香通窍的中药滴鼻剂滴鼻，\n\n21:35.071 --> 21:38.620\n还可以中药煎煮液如苍耳子散啊，\n\n21:38.770 --> 21:42.370\n柴胡当归丹参注射液等雾化经鼻息肉。\n\n21:42.821 --> 21:44.620\n鼻甲肥大的患者呢，\n\n21:44.620 --> 21:49.821\n可以酌情使用当归黄芪复方丹参注射液进行下鼻甲的注射。\n\n21:51.796 --> 21:53.245\n鼻子的患者呢，\n\n21:53.595 --> 21:56.095\n养成良好的饮食起居习惯，\n\n21:56.395 --> 21:57.546\n戒烟戒酒，\n\n21:57.546 --> 21:58.495\n增强体质，\n\n21:58.595 --> 22:01.895\n可以积极预防鼻子的这个疾病。\n\n22:02.536 --> 22:07.386\n鼻支的患者应该避免长期局部使用血管收缩剂滴鼻药物。\n\n22:09.646 --> 22:10.597\n鼻子的患者呢，\n\n22:10.597 --> 22:12.296\n如果在早期治疗得当，\n\n22:12.296 --> 22:13.597\n可以获得痊愈，\n\n22:13.847 --> 22:15.322\n如果长期不治疗，\n\n22:15.322 --> 22:17.046\n则缠绵难愈，\n\n22:17.197 --> 22:20.197\n还可以引发耳胀、喉痹等疾病。\n\n22:25.155 --> 22:27.755\n今天给大家介绍了鼻子这个疾病，\n\n22:27.755 --> 22:29.155\n谢谢大家的聆听。\n\n","v0247cg10004d6pmlc2ljht7u31tgop0",1350,1,796,"2026-01-26 10:55:17"," 高清MP4视频下载 - d801ecc8798a8fc47e445ad6b4c426ac.mp4  "," MP4视频下载, 高清视频资源, 免费视频文件, d801ecc8798a8fc47e445ad6b4c426ac.mp4, 视频分享  "," 提供d801ecc8798a8fc47e445ad6b4c426ac.mp4高清MP4视频文件的免费下载，适合各类用途，确保高质量和流畅播放体验。","2026-04-25 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