最新实验二 瑞文标准推理测验 一、简介瑞文标准推理测验（14课件PPT.ppt 13页

'实验二瑞文标准推理测验一、简介瑞文标准推理测验（14 我们这个测验要用心理测评工具箱标准版V3.0做，其中采用的瑞文标准推理测验是由张厚粲教授于1985年修订后的中国城市版。SPM包括60道题，分为A、B、C、D、E5组，每组12题。A、B、C、D、E这5组题目难度逐步增加，每组内部题目也由易到难排列，所用解题思路一致，而各组之间有差异。SPM施测无严格时限，一般可用40分钟左右完成，答对题目的总分转化为百分等级。 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 中医辩证属肝胆湿热蕴阻经络，不通则痛，结合西医诊治经过和化验检查结果该病人属不典型带状疱疹，治疗以清利湿热，凉血通络为法，方选龙胆泻肝汤加减常规服。服6剂后，患者疼痛明显减轻，继服6剂疼痛消失。 2.女，65岁，2004年10月27日初诊。1月前患者生气后出现右胁肋部胀满，恶心欲吐，时泛酸，心烦易怒。于当地某医院行腹部B超未见明显异常。心电图：正常范围。钡餐示：慢性浅表性胃炎。曾服多种治疗胃炎药物及柴胡疏肝散、逍遥散等疏肝理气方剂效不佳，求诊于中医。诊见：右胁肋部疼痛难忍，轻微触摸便引起剧烈疼痛，疼痛有火灼感、过电感，伴有胃脘部痞满不适，泛酸、恶心，纳差，食欲不振，眠差。大便干，1-2天一行，小便黄。舌质红，苔薄黄，脉弦。查右胁肋部皮色、皮温正常，有压痛及反跳痛。 中医辩证为肝郁脾虚，湿热蕴结。治宜清热解毒，健脾利湿。方选龙胆泻肝汤加减常规服。服2剂后右胁肋部出现疱疹但疼痛程度减轻，继服20剂，疱疹痊愈，疼痛消失。 3.男，68岁，2004年10月15日初诊。既往有高血压病史20余年，一周前受凉后出现左侧偏头痛，疼痛渐加重。诊见：左侧太阳穴及前额部灼热疼痛，无鼻塞流涕，无发热恶寒，面红耳赤，心烦易怒，纳可，眠差，二便调。舌暗红，苔黄腻，脉弦滑。查BP150/90mmHg。颅脑CT：未见明显异常。笔者以高血压外感头痛论治，予芎芷石膏汤加减常规服，服3剂后患者左侧头部出现疱疹，笔者恍然大悟，遂知误诊，改用清利肝胆湿热之剂，疱疹痊愈。 4.女，63岁，2004年11月8日初诊。平素有胆囊炎病史。一周前服食变质食物后出现腹痛腹泻，自服黄连素后腹痛腹泻好转，但右胁部疼痛加剧，行腹部B超示：慢性胆囊炎。于省级某医院消化科住院治疗10天，疼痛未缓解，遂来求诊。诊见：右胁部灼热疼痛，纳差，厌食油腻，眠差，大便稀溏，一日3次，小便黄。舌偏红，苔黄腻，脉弦。查体：右胁部皮色正常，皮温较左侧高，有压痛及反跳痛，莫菲氏征（+）。中医辩证属湿热蕴蒸肝胆，处以龙胆泻肝汤加减，服12剂疼痛消失。 5.小结：综合以上四例，患者均为老年人，年老体弱，正气亏虚，抗邪之力下降，加之素有冠心病、胆囊炎等疾病，易误认为旧病复发，且患者病前多有外感病史，毒邪稽留体内与气血搏结，阻于经络，滞于脏腑，使气机运行受阻，经络阻塞不通，“不通则痛”故临床疼痛症状较明显。有些病人可因早期仅有疼痛而误诊为心绞痛、胆绞痛等。有些患者免疫力较差或早期应用抗生素、清热解毒药物而不出现疱疹仅有疼痛，故临证应根据疼痛的特点及用药后的临床变化，注意鉴别诊断，避免误诊误治。 谢谢！'