最新申请设立(变更)娱乐场所的相关人 ..61课件PPT.ppt 66页

'申请设立(变更)娱乐场所的相关人..61 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesChapter12StatisticalFundamentalsControlChartsSomeControlChartConceptsforVariablesProcessCapabilityforVariablesACloserLookatQualityOtherStatisticalTechniquesinQualityManagement2 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesStatisticalFundamentalsStatisticalThinkingAllworkoccursinasystemofinterconnectedprocessesAllprocesshavevariation(Theamount…tendstobeunderestimated)Understandingvariationandreducingvariationareimportantkeystosuccess3 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesStatisticalFundamentalsWhydostatisticssometimesfailintheworkplace?Mostpeopledon’tunderstandrandomvariationStatisticaltoolsoftenarereactiveandfocusoneffectsratherthancauses7 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesStatisticalFundamentalsTypeIandTypeIIErrorsTypeIerrorProducersriskProbabilitythatagoodproductwillberejectedTypeIIerrorConsumersriskProbabilitythatanonconformingproductwillbeavailableforsale8 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesStatisticalFundamentalsUnderstandingProcessVariationRandomvariationCenteredaroundthemeanConsistentamountofdispersion9 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesStatisticalFundamentalsUnderstandingProcessVariationNonrandomvariation“SpecialCauses”ResultsfromsomeeventDispersionandaverageoftheprocessarechangingProcessthatisnotrepeatable10 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesStatisticalFundamentalsUnderstandingProcessVariationProcessstabilityRandomVariationNotnonrandomvariationProcessCharts11 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesStatisticalFundamentalsUnderstandingProcessVariationSamplingMethodsSamplesarecheaperTakelesstimeLessintrusiveDestructivetestsmaydestroythesample12 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesStatisticalFundamentalsRandomSamplesEachpiecehasanequalchanceofbeingselectedforinspectionSystematicSamplesAccordingtotimeorsequenceRationalsubgroupsAgroupofdatathatislogicallyhomogeneousComputingvariationbetweensubgroups13 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesStatisticalFundamentalsPlanningforInspectionWhattypeofplanningwillbeusedWhowillperformtheinspectionWhatcriticalattributestobeinspectedare14 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesControlChartsVariablesandattributescontrolchartsYoumustunderstandthisgenericprocessforimplementingprocesschartsYoumustknowhowtointerpretprocesscharts15 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesControlChartsVariablesandattributescontrolchartsYouneedtoknowwhendifferentprocesschartsareusedYouneedtoknowhowtocomputerlimitsforthedifferenttypeofprocesschart16 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesControlChartsAgeneralizedprocedurefordevelopingprocesschartsIdentifycriticaloperationsintheprocessIdentifycriticalproductcharacteristicsDeterminewhetherthecriticalproductcharacteristicisavariableoranattribute17 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesControlChartsAgeneralizedprocedurefordevelopingprocesschartsSelecttheappropriateprocesscontrolchartEstablishthecontrollimitsandusethecharttocontinuallymonitorandimproveUpdatethelimitswhenchangeshavebeenmadetotheprocess18 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesControlChartsUnderstandingcontrolchartsAcontrolchartisanapplicationofhypothesistestingwhere:Thenullhypothesisisthattheprocessisstable19 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesSomeControlChartConceptsforVariablesChoosingthecorrectvariablescontrolchartArethedatavariable?Isithomogeneousinnatureornotconducivetosubgroupsampling?20 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesSomeControlChartConceptsforVariablesWhenaprocessisoutofcontrolsomecorrectiveactionisneeded:IdentifythequalityproblemFormthecorrectteamtoevaluateandsolvetheproblemUsestructuredbrainstormingBrainstormtoidentifypotentialsolutions21 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesSomeControlChartConceptsforVariablesWhenaprocessisoutofcontrolsomecorrectiveactionisneeded:EliminatethecauseRestarttheprocessDocumenttheproblem,rootcauseandsolutionsCommunicatetheresults22 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesProcessCapabilityforVariablesAhighlycapableprocessproduceshighvolumeswithfewornodefectsWorld-classlevelsofprocesscapabilityaremeasuredbypartspermillion(ppm)defectlevels23 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesProcessCapabilityforVariablesSixSigmaAdesignprogramwhichemphasizedengineeringpartssothattheyarehighlycapable24 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesProcessCapabilityforVariablesCapabilityStudiesTwopurposestodeterminewhetheraprocessiscapableTodeterminewhetheraprocessconsistentlyresultsinproductsthatmeetspecificationsTodeterminewhetheraisinneedofmonitoring25 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesProcessCapabilityforVariablesThedifferencebetweencapabilityandstabilityAprocessiscapableifindividualproductsconsistentlymeetspecificationAprocessisstableonlyifcommonvariationispresentintheprocess26 StrategicQualityPlanningStatistically-BasedQualityImprovementforVariablesSummaryYouneed:ToknowthegenericprocessfordevelopingchartsTobeabletointerpretchartsTobeabletochoosewhichcharttouseTheformulastoderivethechartsTounderstandthepurposesandassumptionsunderlyingthecharts27 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28©2007PearsonEducation 第八章病机29医学课件 概述病机含义：即疾病发生、发展与变化的机理。意义：是用中医理论分析疾病现象，从而得到的对疾病内在本质规律性的认识，是防治疾病的依据。30医学课件 含义：是研究疾病发生发展和变化的机理并揭示其规律的中医基础理论分支学科。形成：病机理论源于《内经》《素问·至真要大论》的“病机十九条”奠定了脏腑病机、六气病机理论基础。病机学说31医学课件 《伤寒杂病论》发展了六经病机，发挥了脏腑、经络、气血、痰饮病机。《诸病源候论》为最早的中医病因病机专著。《小儿药证直诀》奠定了儿科病机理论基础，阐明了儿科病机特点。刘完素认为“六气皆从火化”。发展32医学课件 李东垣确立“阴火”的病机概念。朱震亨倡“相火论”，提出“阳有余、阴不足”及阐发“六郁”病机。温病学派阐发了卫、气、营、血病机传变规律与三焦传变机理《医林改错》丰富了瘀血病机理论。《血证论》对血证与脏腑病机作出了突出的贡献。33医学课件 基本病机——邪正盛衰、阴阳失调、气血津液失常系统病机——经络、脏腑病机等疾病病机——六经病机、卫气营血病机、三焦病机等病证病机——感冒、哮证、痰饮等的病机症状病机——疼痛、发热、健忘等的病机近几十年新病机理论：病机层次说、痰瘀同源说、体质病机说等。主要内容34医学课件 第一节基本病机邪正盛衰阴阳失调气血失常津液代谢失常内生“五邪”35医学课件 邪正盛衰与虚实变化邪正盛衰与疾病转归36医学课件 实的病机——邪气盛则实含义：实，主要指邪气盛，是以邪气亢盛为矛盾主要方面的一种病理状态。特点：正邪斗争激烈，病理反映比较剧烈的、有余的证候。形成：外感六淫和疠气致病的初、中期，或痰、食、血、水滞留体内的内伤病。表现：体质壮实、壮热狂躁、声高气粗、腹痛拒按、二便不通、脉实有力、舌苔厚腻等。37医学课件 虚的病机——精气夺则虚含义：虚，主要指正气不足，以正气虚损为矛盾主要方面的一种病理反映。特点：抗病力低下，正邪斗争不剧烈表现出的系列虚弱、衰退和不足的证候。38医学课件 先天禀赋不足气、血、津、液、阴阳耗伤；病后亏虚气化功能减退，精气血津液生化不足；多种慢性病损耗气化功能亢奋，但消耗精微过多。邪气损害形成表现：神疲体倦、气短、面色无华、自汗、盗汗、二便失禁、五心烦热、畏寒肢冷、脉虚无力等。39医学课件 虚实错杂含义：指疾病过程中，邪盛与正虚同时并存的病理状态。形成：实性病变失治，邪久留、损正气，形成邪实正虚的虚实错杂病变。正气不足，无力驱邪外出；或本正虚，兼内生痰、食、瘀血、水湿凝滞的正虚邪实的虚实错杂病变。40医学课件 表现：虚中夹实——指病理变化以正虚为主，又兼夹实邪为患的病理状态。（如脾气不足，运化无权之湿滞中焦证）实中夹虚——指病理变化，以邪实为主，又兼有正气虚损的病理状态。（如邪热炽盛灼伤津液，致气阴两伤证）由实转虚——实邪久留而损伤正气的病理转化过程由虚转实——正气不足而致实邪积聚的病理转化过程41医学课件 虚实真假真虚假实——“至虚有盛候”含义：病机的本质为“虚”，表现为“实”的临床假象。形成：正气虚弱，脏腑气血不足，推动、激发功能减退所致。表现：纳食减少，疲乏无力，舌淡嫩。又兼腹满(时减)、腹痛(喜按)等假象。42医学课件 真实假虚——“大实有羸状”含义：病机的本质为“实”，表现为“虚”的临床假象。形成：邪气亢盛、结聚于内，阻滞经络，气血不能畅达于外。表现：如热结胃肠，便秘腹痛拒按，潮热谵语。又兼面色苍白，四肢逆冷，精神萎顿等状似虚寒的假象。43医学课件 邪正盛衰与转归正胜邪退邪去正虚邪盛正虚邪正相持正虚邪恋44医学课件 正胜邪退含义：正气奋起抗邪，正气日趋强盛，邪日衰疾病向好转和痊愈方向发展的一种病理变化。形成：患病机体正气较盛，抗邪能力较强；或邪气较弱；或治疗正确及时。转归：为疾病向好转或痊愈发展的最常见的转归。45医学课件 邪盛正虚含义：邪气亢盛，正气虚弱而抗邪无力，疾病向恶化、危重、甚至向死亡转归的一种病理变化。形成：受邪机体正气愈虚，病势急重，无力抗邪；病邪愈盛，毒力愈强，生理功能衰惫，病情趋向恶化，阴阳离决如“亡阴”、“亡阳”。或在外感病有两感、直中、内陷等。转归：邪盛正虚，正不敌邪，病势恶化，甚至死亡。46医学课件 邪正相持含义：疾病过程中，正气不甚虚弱，邪气亦不亢盛，二者相持不下，病势迁延。形成：多见于病之中期，或慢性病迁延期。转归：正气不能完全驱邪外出，病邪稽留于一定部位(邪留、邪结)，或为慢性病证。47医学课件 正虚邪恋含义：正气已虚，余邪未尽，因正气难复，致病处缠绵难愈的病理过程。为邪正相持的特殊病机。形成：多见于疾病后期，急性转为慢性；或慢病久不愈，正虚驱邪无力而致。转归：1.积极治疗和调理，正气增强，余邪散尽，病趋好转或痊愈。2.调养失当，正气难复，无力驱邪，或病邪粘滞缠绵、难以速除，使正气久而不复则转为迁延性或慢性病证，或留下后遗症。48医学课件 概念：指机体在疾病发生、发展过程中，由于致病因素的影响，致机体阴阳双方失去相对协调平衡，形成阴阳或偏胜、或偏衰、互损、格拒、转化、亡失等的病理变化。同时，阴阳失调又是脏腑、经络、营卫、气血等关系失调，以及表里出入、上下升降等运动失常的概括。表现：主要为阴阳偏胜、阴阳偏衰、阴阳互损、阴阳格拒、阴阳转化和阴阳亡失。阴阳失调49医学课件 阴阳偏胜含义：指人体阴阳双方中的某一方的病理性亢盛状态。阴胜则寒(实寒)阴胜则阳病表现转归阳胜则热(实热)阳胜则阴病“邪气盛则实”的病机和病证。50医学课件 阳偏胜含义：指机体在疾病过程中所出现的一种阳气病理性偏盛，机能亢奋，机体反应性增强，热量过剩的病理状态。特点：一般多表现为阳盛而阴未虚(或虚亏不甚)的实热病证。多因感受温热阳邪形成感阴邪从阳化热原因五志过极化火气滞、血瘀、食积郁而化热51医学课件 阳邪入侵，从阳化热机理阳热亢盛邪自内生，气郁化火热——壮热、面红、目赤表现动——脉数、心烦、躁扰阳胜则热燥——口渴、便干、苔黄转归：实热兼阴亏病证(阳胜则阴病)。虚热病证(久之由实转虚)。52医学课件 阴偏胜含义：指机体在疾病过程中所出现的一种阴气病理性偏盛，机能抑制，热量耗伤过多，病理性代谢产物积聚的病理状态。特点：一般多表现为阴寒偏盛而阳气未虚(或虚损不甚)的实寒病证。感受寒湿阴邪形成原因过食生冷，寒滞中阳，遏抑阳气53医学课件 机理：阴寒邪盛、阳不制阴；寒湿内聚、阴寒内盛。表现：寒——恶寒、喜暖、肢冷静——舌淡、脉迟、蜷卧阴胜则寒以寒为主湿——水肿、泄泻、痰液清冷转归：实寒兼阳虚(阴胜则阳病)；虚寒证(久之由实转虚)。54医学课件 阴阳偏衰含义：指机体阴或阳虚衰不足的病理状态.表现：阳虚则寒、阳虚则阴盛——虚寒证阴虚则热、阴虚则阳亢——虚热证“精气夺则虚”的病机和病证。55医学课件 阳偏衰——阳虚则寒以虚为主含义：即阳虚。指机体阳气虚损，机体衰退或衰弱，代谢缓慢，产热不足的病理状态。特点：一般多表现为机体阳气不足，阳不制阴，阴气相对偏亢的虚寒证。先天禀赋不足机体阳气虚损，以脾肾形成后天饮食失养阳虚为主，尤以肾阳虚衰原因劳倦内伤最为重要。(肾阳为诸阳久病伤阳之本)畏寒肢冷，脘腹冷痛、面色白光白，舌淡脉迟等温煦作用减退的寒象表现神疲、喜静瞋卧，小便清长，下利清谷等温养兴奋不足的虚象56医学课件 阴偏衰含义：指机体阴气不足，阴不制阳，导致阳气相对偏盛，机能虚性亢奋的病理状态。特点：一般多表现为阴气不足、阳气相对亢盛的虚热证。阳邪伤阴五脏皆可发生，以肺、形成五志过极肝、肾为主，尤以肾阴亏原因化火伤阴虚最为重要（肾阴为诸阴久病伤阴之本）表现：骨蒸潮热、盗汗、五心烦热、颧红升火、消瘦、咽干口燥舌红少津、脉细数等——阴虚则热（全身热象）火旺(多局部热象)。阳亢(上部或全身症状)。57医学课件 阴阳互损含义：指阴或阳任何一方虚损到相当程度，病变发展影响及相对的一方，形成阴阳两虚的病机。形成：由于阴阳互为根本，故阴或阳之间可以发生互损；由于肾阴阳为人体阴阳之本，均以肾中精气为基础，故无论阴虚或阳虚，多在累及肾阴或肾阳，及肾本身阴阳失调时，才易发生阴阳互损。58医学课件 表现：1.阴损及阳——阴虚到相当程度，累及阳气生化不足，继而致以阴虚为主的阴阳两虚病理状态。（如肝阳上亢，病机为阴虚不能制阳，继而损及肾阳，现畏寒肢冷、面白而灰黯、脉沉细等阴阳两虚证。）2.阳损及阴——阳虚较重，无阳则阴无以生，导致阴虚，形成阳虚为主的阴阳两虚证。（如肾阳不足，气化失司之水肿，继而发展为烦躁，抽搐等阴虚症状，形成阴阳两虚证。）59医学课件 阴阳格拒概念：即阴盛格阳，阳盛格阴。为在阴阳偏胜基础上由阴阳双方相互排斥而出现寒热真假病变的一类病机。形阴和阳中的一方偏盛至极成或阴和阳中一方极端虚弱双方盛衰悬殊，盛者壅于内，将另一方排斥格拒于外，迫使阴阳间不相维系，出现真寒假热或真热假寒之病理。60医学课件 阴盛格阳含义：又称格阳。指阴寒偏盛至极，壅闭于内，迫阳浮越于外，相互格拒的一种病理状态。特点：阴寒内盛是疾病本质。因格阳于外，现真寒假热证(严重的虚寒证)。表现：阳极虚之虚寒证——可见面色苍白，四肢逆冷，精神萎靡，畏寒倦卧，脉微细欲绝。假热证——突然面红，烦热、口渴、脉大无根等。61医学课件 阳盛格阴含义：又称格阴。指邪热极盛，深伏于里，阳气被遏、郁闭于内，不得外达四肢而格阴于外的病理状态。特点：阳盛于内，邪热炽盛为疾病的本质。由于阳气壅遏深伏于内，格阴于外，故现真热假寒证(很重的实热证)。表现外感热病，实热炽盛——壮热、面红、气粗、烦躁、舌红、脉数有力。假寒——突然四肢厥冷，脉象沉伏。62医学课件 阴阳转化在一定条件下，疾病的病理性质可发生向相反的方向转化的病理过程。由阳转阴：如急性温热病耗伤元气，则会出现阳气暴脱之危象。由阴转阳：如寒饮中阻（阴盛）日久则化热，由寒转热。63医学课件 亡阳含义：指机体阳气发生大量脱失，致全身机能严重衰竭的一种病理状态。邪气太盛，阳损太多素体阳虚，劳伤过度阳气亏损殆尽形成汗吐下甚，气随津脱↓大量失血，气随血脱属阳的功能突然严重衰竭慢性病长期大量耗阳特点：全身属阳的功能都会衰竭，而以温煦、推动、兴奋卫外功能衰竭尤为突出表现：大汗淋漓，肌肤手足逆冷，面色苍白，精神萎靡，畏寒蜷卧，脉微欲绝64医学课件 亡阴含义：机体阴气发生大量亡失，致全身机能严重衰竭的一种病理状态。邪热炽盛伤阴阴气耗竭形成邪热久留，严重伤阴↓长期慢性消耗属阴的功能突然严重衰竭特点：全身属阴的功能都会衰竭，而以宁静、滋润与内守功能衰竭最明显。表现：烦躁不安、口渴欲饮、气喘、手足虽温但大汗欲脱、脉数疾等65医学课件 亡阴与亡阳都是功能衰竭；在其发生过程中气的耗损都是关键；大汗不止，使病情愈来愈恶化。相应地在治疗中指导使用温阳或补阴药；大剂补气药；重用固摄药。66医学课件'