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第67章 诊脉的进阶(2 / 2)

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文老摸了摸下巴,继续问道:“小腹隐痛,是在月经前后,还是月经期间?”

赵琳答道:“通常是在月经前后,特别是晚上,感觉特别明显。”

文老观察了赵琳的舌苔,舌质稍暗,苔白腻,提示脾胃虚弱,血液运行不畅。结合林婉儿的脉象判断,这个病例确实是肝气郁结,脾虚导致月经不调。

药方:

逍遥散(疏肝解郁,调和脾胃)

柴胡、白芍(疏肝解郁,调经)

当归、白术(补气血,健脾)

文老叮嘱林婉儿:“治疗月经不调时,关键是疏肝解郁,调和脾胃。你要注意辨证施治,不是单纯的活血化瘀。”

病人:李爷爷,75岁,慢性咳嗽已持续三月,咳痰较多,痰黄,且咳嗽时伴有胸闷、气短,稍微活动就疲倦。

林婉儿走到李爷爷床前,仔细观察他的面色和舌苔,发现李爷爷的面色略显苍白,气色差,舌苔薄黄,舌体胖大,呈现湿润的状态。

脉诊:

她握住李爷爷的脉,感受到脉象较为沉缓,脉搏不规则,略带虚软。特别是在肺脉部,略显无力,反映出肺气虚弱。

“这个脉象属于沉缓脉,虚弱脉,结合咳痰多、胸闷、气短的症状,很明显是肺气虚弱,痰湿阻肺。”林婉儿心中做了判断。

她在笔记本上写下了脉诊与症状:沉缓脉,肺气虚,痰湿阻肺,随后转向文老求证。

文老手搭在老人家的手上,很仔细的诊断之后,看向婉儿。这时的他也是带着期待的,毕竟老人家的身体通常会夹杂着更多的其他病症,不容易把握准确。他也很期待看到婉儿的答案。

文老通过观察李爷爷的舌苔和询问症状,最终确认了林婉儿的脉诊。

“李爷爷,您这几个月的咳嗽是不是早晨最严重?”

李爷爷点头:“是的,早晨起来总是咳得厉害,痰多,吐不完。”

文老眉头一皱,继续问道:“最近有没有容易气喘或者是感觉活动后特别累?”

李爷爷叹了口气:“有的,活动一会儿就气喘,特别是爬楼梯。”

结合李爷爷的症状和舌脉,文老确认是肺气虚弱,痰湿阻肺。

药方:

补肺汤(补益肺气,化痰止咳)

人参、黄芪(补气)

陈皮、半夏(化痰止咳)

五味子(固肺)

文老总结道:“老年人的肺气虚弱,不能过度清肺化痰,补气是治疗的关键。”

这几次婉儿的表现非常的不错,但是文老也担心她因此会骄傲,他却并未提醒她,毕竟现在在自己身边,如果犯了错还能及时纠正,要让她吃点亏才行。人教人不会,事教人很快就会。

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