)病 毒 性 心 肌 炎.ppt

13-yr-old female C/O: Vomiting （呕吐） HPC: Sudden onset of vomiting 6 hours ago, vomit food only. Associated features: exhausted; pallor complexion; limbs cold and sweating.（疲倦乏力，面色苍白，肢冷汗多） O/E: CVS: BP: 105/70mmhg, HR:123/min, no murmurs; GIT: soft, no mess, no palpable liver and spleen; （腹软，肝脾不大） RS, CNS: normal. Investigation: blood sodium and potassium slightly fall （低钠，低钾血症） Diagnosis: Gastritis, moderate dehydration. （急性胃炎，中度脱水） Treatment: Rehydration.（补液治疗） Result: deteriorated and died.; 病 毒 性 心 肌 炎 (viral myocarditis, VMC);目的与要求（objective and requirement）:;概 述（summarization）;概 述（summarization）;中医病因病机（aetiology and pathogenesis);病因和发病机制（pathogenic and pathogenesis）;When there is marked cellular injury, there is cell death. This microscopic appearance of myocardium is a mess because so many cells have died that the tissue is not recognizable. Many nuclei have become pyknotic (shrunken and dark) and have then undergone karorrhexis (fragmentation) and karyolysis (dissolution). The cytoplasm and cell borders are not recognizable. ;临床表现（clinical symptom）：;实验室检查 (investigation)：;实验室检查(laboratory examination)：;实验室检查 (investigation)：;实验室检查 (investigation)：;实验室检查 (investigation)：;诊 断（diagnosis）;诊 断（diagnosis）;诊 断（diagnosis）;诊 断（diagnosis）;诊 断（diagnosis）;鉴别诊断differential diagnosis;辨证论治 selection of treatment base on the differential diagnosis ;三、分证论治 （一）风热邪毒，内侵心脉（wind－heat evil toxic invade heart meridian） 证侯特点:风热证＋邪毒侵心+舌红，苔薄黄，脉浮数或结代。 治法：疏风清热，护心复脉。 方药：银翘散加减。 （二）湿热邪毒，内侵心脉（dampness－heat evil toxic invade heart meridian ） 证侯特点：湿热证＋邪毒侵心+舌红，苔黄腻，脉濡数或结代。 治法：清热利湿，解毒透邪。 方药：葛根芩连汤加减。; （三）心阳虚脱（collapse of heart－Yang） 证侯特点：心阳虚或心阳暴脱+苔白，脉细弱而数，或脉微欲绝。 治法：温阳益气，强心复脉，救逆固脱。 方药：参附龙牡救逆汤加减。 （四） 气阴两虚（deficiency of both qi and Ying） 证侯特点：心气虚+心阴虚+舌光红，脉细数或结代。 治法：益气养阴。 方药：生脉散合复脉汤加减。; （五）气虚血滞（deficiency of qi and stagnation of blood） 证侯特点：心血瘀阻+心气虚