最新工作总结模板11课件PPT.ppt 79页

'工作总结模板11 CONTENTS年度工作概述工作完成情况成果及不足明年工作计划e7d195523061f1c0deeec63e560781cfd59afb0ea006f2a87ABB68BF51EA6619813959095094C18C62A12F549504892A4AAA8C1554C6663626E05CA27F281A14E6983772AFC3FB97135759321DEA3D70CCCB10945EC5A0322096E752803368C2184698845E3CCD6DB7F651295A8E4F3FDC19EA64A2B4A4AC1434B55AAE41CF0BF61B375C23F3039959E085EE760725AA 年度工作概述e7d195523061f1c0deeec63e560781cfd59afb0ea006f2a87ABB68BF51EA6619813959095094C18C62A12F549504892A4AAA8C1554C6663626E05CA27F281A14E6983772AFC3FB97135759321DEA3D70CCCB10945EC5A0322096E752803368C2184698845E3CCD6DB7F651295A8E4F3FDC19EA64A2B4A4AC1434B55AAE41CF0BF61B375C23F3039959E085EE760725AA YOURTEXTHEREYOURTEXTHEREYOURTEXTHEREYOURTEXTHEREYOURTEXTHERE此处输入您的文本内容e7d195523061f1c0deeec63e560781cfd59afb0ea006f2a87ABB68BF51EA6619813959095094C18C62A12F549504892A4AAA8C1554C6663626E05CA27F281A14E6983772AFC3FB97135759321DEA3D70CCCB10945EC5A0322096E752803368C2184698845E3CCD6DB7F651295A8E4F3FDC19EA64A2B4A4AC1434B55AAE41CF0BF61B375C23F3039959E085EE760725AA 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此处输入您的文本内容Thisisasampletext.Insertyourdesiredtexthere.Again,thisisadummytext,enteryourowntexthere.YOURTEXTHEREThisisasampletext.Insertyourdesiredtexthere.Again,thisisadummytext,enteryourowntexthere.YOURTEXTHEREThisisasampletext.Insertyourdesiredtexthere.Again,thisisadummytext,enteryourowntexthere.YOURTEXTHEREThisisasampletext.Insertyourdesiredtexthere.Again,thisisadummytext,enteryourowntexthere.YOURTEXTHEREe7d195523061f1c0deeec63e560781cfd59afb0ea006f2a87ABB68BF51EA6619813959095094C18C62A12F549504892A4AAA8C1554C6663626E05CA27F281A14E6983772AFC3FB97135759321DEA3D70CCCB10945EC5A0322096E752803368C2184698845E3CCD6DB7F651295A8E4F3FDC19EA64A2B4A4AC1434B55AAE41CF0BF61B375C23F3039959E085EE760725AA 明年工作计划e7d195523061f1c0deeec63e560781cfd59afb0ea006f2a87ABB68BF51EA6619813959095094C18C62A12F549504892A4AAA8C1554C6663626E05CA27F281A14E6983772AFC3FB97135759321DEA3D70CCCB10945EC5A0322096E752803368C2184698845E3CCD6DB7F651295A8E4F3FDC19EA64A2B4A4AC1434B55AAE41CF0BF61B375C23F3039959E085EE760725AA 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TEXTHEREATEXTHEREBTEXTHERECTEXTHERETEXTHERE此处输入您的文本内容e7d195523061f1c0deeec63e560781cfd59afb0ea006f2a87ABB68BF51EA6619813959095094C18C62A12F549504892A4AAA8C1554C6663626E05CA27F281A14E6983772AFC3FB97135759321DEA3D70CCCB10945EC5A0322096E752803368C2184698845E3CCD6DB7F651295A8E4F3FDC19EA64A2B4A4AC1434B55AAE41CF0BF61B375C23F3039959E085EE760725AA ABCD此处输入您的文本内容Thisisasampletext.Insertyourdesiredtexthere.Again,thisisadummytext,enteryourowntexthere.YOURTEXTHEREThisisasampletext.Insertyourdesiredtexthere.Again,thisisadummytext,enteryourowntexthere.YOURTEXTHEREThisisasampletext.Insertyourdesiredtexthere.Again,thisisadummytext,enteryourowntexthere.YOURTEXTHEREThisisasampletext.Insertyourdesiredtexthere.Again,thisisadummytext,enteryourowntexthere.YOURTEXTHEREe7d195523061f1c0deeec63e560781cfd59afb0ea006f2a87ABB68BF51EA6619813959095094C18C62A12F549504892A4AAA8C1554C6663626E05CA27F281A14E6983772AFC3FB97135759321DEA3D70CCCB10945EC5A0322096E752803368C2184698845E3CCD6DB7F651295A8E4F3FDC19EA64A2B4A4AC1434B55AAE41CF0BF61B375C23F3039959E085EE760725AA Thisisasampletext.Insertyourdesiredtexthere.Again,thisisadummytext,enteryourowntexthere.YOURTEXTHEREThisisasampletext.Insertyourdesiredtexthere.Again,thisisadummytext,enteryourowntexthere.YOURTEXTHEREThisisasampletext.Insertyourdesiredtexthere.Again,thisisadummytext,enteryourowntexthere.YOURTEXTHERE此处输入您的文本内容e7d195523061f1c0deeec63e560781cfd59afb0ea006f2a87ABB68BF51EA6619813959095094C18C62A12F549504892A4AAA8C1554C6663626E05CA27F281A14E6983772AFC3FB97135759321DEA3D70CCCB10945EC5A0322096E752803368C2184698845E3CCD6DB7F651295A8E4F3FDC19EA64A2B4A4AC1434B55AAE41CF0BF61B375C23F3039959E085EE760725AA 2018演示完毕感谢聆听e7d195523061f1c0deeec63e560781cfd59afb0ea006f2a87ABB68BF51EA6619813959095094C18C62A12F549504892A4AAA8C1554C6663626E05CA27F281A14E6983772AFC3FB97135759321DEA3D70CCCB10945EC5A0322096E752803368C2184698845E3CCD6DB7F651295A8E4F3FDC19EA64A2B4A4AC1434B55AAE41CF0BF61B375C23F3039959E085EE760725AA 第三节少阳病兼变证 一变证治则[原文]［原文］若已吐、下、發汗、溫計，譫語，柴胡湯證罷，此為壞病。知犯何逆，以法治之。（267） ［讨论］1本条承（266）而来，前言太阳传少阳，未经吐下，治当和解，方用小柴胡汤；此言少阳误用汗、吐、下、温针之类而成坏病，不可再与小柴胡汤，而应要“知犯何逆，以法治之”。 2少阳误治而成变证，变化多端，非止谵语一证，故应遵循“知犯何逆，以法治之”的原则。3本条与（16）的基本精神一致。由于桂枝汤和小柴胡汤都是运用广泛的方，所以要重申其诫。 二柴胡桂枝汤证［原文］傷寒六七日，發熱微惡寒，支節煩疼，微嘔，心下支結，外證未去者，柴胡桂枝湯主之。柴胡桂枝湯方桂枝一兩半（去皮）　芍藥一兩半　黃芩一兩半　人參一兩半　甘草一兩（炙）　半夏二合半（洗）大棗六枚（擘）　生薑一兩半（切）　柴胡四兩上九味，以水七升，煮取三升，去滓，溫服一升。本雲：人參湯，作如桂枝法，加半夏、柴胡、黃芩；複如柴胡法，今用人參，作半劑。 ［讨论］1支节烦疼：烦，《周礼》郑玄注“烦犹剧也”。因疼痛而烦不得宁。2心下支结：即患者自觉心下支撑结聚。另：支，边也。指其痞结在心下两边部位，即少阳胁肋部位。 3证治证：发热、微恶寒、支节烦疼――太阳未罢微呕、心下支结――已入少阳机：邪入少阳，表证未解。治：和解少阳，兼以解表。 方：柴胡桂枝汤桂枝汤（半量）――调和营卫，解肌散邪柴胡汤（半量）――和解少阳，宣展气机 5运用(1)有消化系统表现和支节烦疼者；(2)肝郁有周身疼痛者；(3)风湿痹证兼胸胁苦满、脉弦等少阳表现者；(4)“肝气窜”：多见于妇女，患者自觉有股气在胸胁脘腹甚至四肢游走窜行，气至之处觉疼痛，多无器质性病变；(5)本方去大枣，加鳖甲、牡蛎、红花、茜草等软坚化瘀药，治疗慢性肝炎，肝脾肿大及早期肝硬化。(6)柴桂温胆定志汤治疗精神抑郁症，即本方合温胆汤、小定志汤（人参、茯苓、菖蒲、远志）。(7)治脂膜炎、不安腿综合征。 三大柴胡汤证［原文］太陽病，過經十餘日，反二三下之，後四五日，柴胡證仍在者，先與小柴胡湯；嘔不止，心下急，鬱鬱微煩者，為未解也，與大柴胡湯下之則愈。（103）大柴胡湯方柴胡半斤　黃芩三兩　芍藥三兩　半夏半升（洗）　生薑五兩（切）　枳實四枚（炙）　大棗十二枚（擘）上七味，以水一鬥二升，煮取六升，去滓，再煎（取三升），溫服一升，日三服。一方，加大黃二兩。若不加，恐不為大柴胡湯。 傷寒發熱，汗出不解，心中痞硬，嘔吐而下利者，大柴胡湯主之。（165）傷寒十三日，不解，胸脅滿而嘔，日晡所發潮熱……（104）傷寒十餘日，熱結在裏，複往來寒熱者，與大柴胡湯……（136） ［讨论］1方中应有大黄。2证治 证：呕不止，或呕吐而下利――胆热胃逆，热迫津泄心下急或心中痞硬――胃气壅滞郁郁微烦――气机郁滞尚可见发热汗出，或往来寒热，胸胁苦满，小便色黄，苔黄少津，脉弦数等。呕吐的特征：呕吐酸苦水或苦水。下利的特征：利下污浊臭秽，呈泥状或粘液状，亦有便秘者。 机：少阳兼阳明里实（胆胃热郁气逆）。治：和解少阳，通下里实。方：大柴胡汤柴、芩――和解少阳大黄、枳实――通腑泻实姜、夏――降逆止呕　　　　　配大黄――治腹中实痛（桂枝加大黄汤）芍药――益阴和营―――――配柴、枳――调和肝脾（四逆散）大枣――补中益气，调和诸药　配芩、枣――清热止利（黄芩汤） 3关于少阳腑证梅国强教授提出大柴胡汤证为少阳腑证。腑证的定义是：其病变部位在腑，其证候除通过经脉而有全身反映外，并有在腑之局部反映。 理由有三：其一，从证候分析，大柴胡汤证之急迫疼痛在心下，尤以胆囊炎患者最为明显，为胆腑热结所致，不同于阳明腑实；其二，从方药分析，方中用大黄、枳实之目的在于泄热，并非攻下燥屎；其三，从中西医结合临床实践来看，临床上用大柴胡汤治疗多种急性胆系疾病疗效显著。 4心中痞大黄黄连泻心汤――按之濡，其脉关上浮瓜蒂散――胸中痞硬，气上冲咽喉不得息旋复代赭汤――心下痞硬，噫气不除大柴胡汤――心中痞硬，呕吐而下利 四柴胡加芒硝汤［原文］傷寒十三日，不解，胸脅滿而嘔，日晡所發潮熱，已而微利，此本柴胡證，下之以不得利，今反利者，知醫以丸藥下之，此非其治也。潮熱者，實也。先宜服小柴胡湯以解外，後以柴胡加芒硝湯主之。（104） 柴胡加芒硝湯方柴胡二兩十六銖　黃芩一兩　人參一兩　甘草一兩（炙）　生薑一兩（切）　半夏二十銖（本雲五枚，洗）　大棗四枚（擘）　芒硝二兩上八味，以水四升，煮取二升，去滓，內芒硝，更煮微沸，分溫再服。不解，更作。 ［讨论］1误治前伤寒十三日不解――病情传变胸胁满而呕――病入少阳此本（大）柴胡证日晡所发潮热――邪入阳明 2误治后已而微利――误用丸药下之潮热――里实未去 3治疗先宜服小柴胡汤以解外――一则因少阳之邪未解，再则因误攻而大便微利后以柴胡加芒硝汤主之――和解兼通下 4柴胡加芒硝汤小柴胡汤――和解少阳芒硝――泻热去实，软坚通便 5与大柴胡汤比较大柴胡　　　　　　　　　　里实甚而正不虚　　　　　　去参草，加枳芍黄均治少阳兼里实　　　　　　　　　小柴胡汤柴胡加芒硝　　　　　　　　里实不甚而正已虚　　　　　但加芒硝 五柴胡桂枝干姜汤证[原文]傷寒五六日，已發汗而複下之，胸脅滿微結，小便不利，渴而不嘔，但頭汗出，往來寒熱，心煩者，此為未解也，柴胡桂枝幹姜湯主之。（147） 柴胡桂枝幹姜湯方柴胡半斤　桂枝三兩（去皮）　幹薑二兩　栝蔞根四兩　黃芩三兩　牡蠣二兩（熬）　甘草二兩（炙）上七味，以水一鬥二升，煮取六升，去滓，再煎取三升，溫服一升，日三服。初服微煩，複服，汗出便愈。 ［讨论］1成因：伤寒五六日，已发汗而复下之――汗下失当，邪入少阳，水饮内停。 2证治：证：胸胁满、往来寒热、心烦――邪入少阳小便不利、微结、渴――气郁饮停，三焦阻隔但头汗出――阳郁不宣，蒸腾于上机：邪入少阳，三焦阻隔，水饮内结。治：和解少阳，温化水饮。 方：柴胡桂枝干姜汤柴、芩――和解少阳栝蒌根、牡蛎――逐饮生津解结桂枝、干姜、炙甘草――振奋中阳，温化寒饮不呕――去姜、夏饮结――去参、枣之甘 药效：初服微烦――本证阳郁，初服正气得药力之助，与邪相争，阳郁求伸；复服汗出则愈――复服，气机宣通，阳郁得伸，汗出邪去则愈。 3本方“复服汗出则愈”当与（230）服小柴胡汤后“上焦得通，津液得下，胃气因和，身濈然汗出而解”、以及五苓散要求“多饮暖水汗出愈”联系起来理解，可见汗出是祛邪的途径，也是人体气机宣畅的标志。 4运用肝胆湿热气郁胁痛胀满，脾阳不足腹胀便溏，津液不足口渴等并见者。少阳兼太阴脾虚寒证，既有口苦口渴，心烦胁痛等肝胆湿热之证；又有便溏腹胀纳差等脾胃虚寒之象。有些慢性肝炎、迁延性肝炎，右胁放射性疼痛上至肩胛，下至腰部，或见右肩与手指麻木，下午腹胀，脉弦而缓，可用本方。糖尿病口渴欲饮，又见少阳主证者，也可用本方。 六柴胡加龙骨牡蛎汤［原文］傷寒八九日，下之，胸滿煩驚，小便不利，譫語，一身盡重，不可轉側者，柴胡加龍骨牡蠣湯主之。(107) 柴胡加龍骨牡蠣湯方柴胡四兩　龍骨　黃芩　生薑（切）　鉛丹　人參　桂枝（去皮）　茯苓各一兩半　半夏二合半（洗）　大黃二兩　牡蠣　一兩半（熬）　大棗六枚（擘）上十二味，以水八升，煮取四升，內大黃切如棋子，更煮一兩沸，去滓，溫服一升。本雲：柴胡湯，今加龍骨等。 ［讨论］1证治证：胸满――少阳经气不利烦、谵语――胆火上炎，扰乱心神，轻者则烦，重则谵语惊――误下胆虚则惊，（264）谓“吐下则悸而惊”小便不利――枢机不利，三焦阻隔一身尽重，不可转侧――阳气内郁，不得宣达 机：少阳误下，致阳气内郁，胆气虚怯，心神被扰。治：和解少阳，宣通阳气，益气壮胆，泻热宁心。 方：柴胡加龙骨牡蛎汤小柴胡汤――和解少阳，扶正祛邪桂枝――宣通阳气龙骨牡蛎铅丹――和小柴胡汤合用益气壮胆，重镇安神大黄――泻热宁心茯苓――合桂枝通阳化，合小柴胡汤疏利三焦，并宁心去炙甘草――因有阳气内郁，气机不畅，故去甘缓壅滞之品 2铅丹铅丹为四氧化三铅（Pb3O4）,可坠痰，重镇安神，但因其含重金属铅，故现已少用，可用生铁落、磁石、琥珀末等替代。3运用下肝胆之惊痰，以之治癫痫、心悸等。现在主要用于治疗肝胆失调之心悸癫痫等。凡少阳兼神志症状者，都可考虑用本方。 4病机本条开头为“伤寒八九日，下之”，结合（264）“少阳中风……不可吐下，吐下则悸而惊”来理解，此时的误下应是在伤寒传至少阳以后，因为病在少阳即胆和三焦，少阳本该用小柴胡汤和解，反而误用下法，则伤及胆气使胆不主决断而惊；三焦不主决渎则小便不利；胆失疏泄，三焦不畅，气机郁滞则一身尽重，不可转侧；胆郁相火上炎，扰乱心神则烦、谵语。所以本证的病机脉络清晰，并不复杂。 七热入血室［原文］婦人中風，發熱惡寒，經水適來，得之七八日，熱除而脈返身涼，胸脅下滿如結胸狀，譫語者。此為熱入血室也。當刺期門，隨其實而取之。（143） 婦人中風七八日，續得寒熱，發作有時，經水適斷者，此為熱入血室。其血必結，故使如瘧狀，發作有時，小柴胡湯主之。（144）婦人傷寒，發熱，經水適來，晝日明瞭，暮則譫語如見鬼狀者，此為熱入血室。無犯胃氣及上二焦，必自愈。（145） ［讨论］1血室：指胞宫，即子宫。2热入血室：即邪热内陷，结于血室。其病得于经期，因血室空虚，乘虚而入。因其证如结胸状，故有人称为“血结胸”。 3证治（143）刺期门法：妇人中风，发热恶寒――表证经水适来，得之七八日――血室空虚热除而脉迟身凉――热入于里，结于血室，脉道阻滞胸胁下满如结胸状――肝主藏血，血室瘀滞，肝脉不利谵语――血热上扰刺期门，随其实而泻之――肝之幕穴，泻其邪热 （144）小柴胡汤法：妇人中风――表证七八日经水适断――血室空虚续得寒热，发作有时，如疟状――热入血室，正邪分争，病势向外当有胸胁下满，谵语等――据上条补充小柴胡汤主之――和解枢机，助正达邪，可加牛膝、桃仁、丹皮之类。 （145）血去自愈法：妇人伤寒，发热――表证经水适来――血室空虚昼日明了，暮则谵语如见鬼状――血属阴，入暮则血热上扰心神无犯胃气及上二焦――此谵语非阳明，亦亦非热入心包必自愈――经水适来，若热随经血出而去，则有自愈之机，亦可用小柴胡汤或刺期门 '