最新人教版高中英语必修一第一单元课件教学讲义PPT课件 148页

人教版高中英语必修一第一单元课件\nDoyouneedfriends?Why?※tohelpme/calmmedownwhenIwasupset※tosharemyworriesandsecretsinmyinnerworld※tosharemyhappinessandsorrows※tobeconcernedaboutmyfeelingsIneedfriends:\nadj.平静的，镇静的E.g.Thehighwindpassedandtheseawascalmagain.vi.平静，镇静E.g.Thesituationcalmeddownslowly.vt.使…平静，使…镇静E.g.Atlastwecalmedhimdown.calm\n\n\n\nTruefriendsleteveryonecomealong…\nTruefriendshelpyouupwhenyourdown…\nAndtruefriendsneverletyoudosomethingyou’llregretwhenyouwakeupthenextmorning!\nGoodfriendhonestfunnyfriendlyhelpfuleasy-goingcarefulbravepatientThequalitiesofagoodfriend\nMakingasurveyResultsGradeI4-7pointsYouarealwaysthinkingaboutyourself.Youshouldcaremoreaboutyourfriends.Ifyoucontinuetobeself-concernedanddon’tconsiderothers’feelings,youwon’tmakemorefriendsandkeepfriendshipforlong.\nMakingasurveyResultsGradeII8-12pointsYoutakethingssmoothly.Youseldomhurtyourfriendswithyourbenefitconsidered.Youareagoodfriend,butYou’dbettertrytostrikeabalancebetweenyourfriend'sneedsandyourownresponsibilities．\nMakingasurveyResultsGradeIII13-18pointsWow!Howfaithfulandgenerousyouare!Congratulations!Youarealwaysreadytohelpyourfriends.Whenevertheyhaveanydifficulty,you’lltryyourbesttohelpthem.Youareanexcellentfriend.\nTEXTDearLisa,Thereisnothingwrongwithyouandthisboybeingfriendsandstudyingtogether.Andnomatterwhatotherstudentssay,itispossibleforaboyandagirltobejustgoodfriends.Endingyourfriendshipwiththisboywouldbeastupidthingtodo.Notonlywouldyouloseagoodfriend,butyouwouldalsolosesomeonewhoishelpingyouwithyourstudies.\nTeenagersliketogossip,andtheyoftenseesomethingthatdoesn'texist.Perhapstheycan'tunderstandyourfriendshipwiththisboy.Butthat'snoreasontothrowitaway.Youshouldfeelsorryforthosestudentswhohaveneverenjoyedsuchafriendship.Myadviceistoignoreyourgossipingclassmates.Thatwayyouwillshowthemthatyouaremoregrownupthantheyare.Yours,WangFei\nMissWangsaysthatthereisnothing______inLisamakingfriendswithaboyandthatitis_______foraboyandagirltobejustgoodfiends.MissWangsaysthatteenagersliketo______andthatperhapstheycan’tunderstandLisa’sfriendshipwiththeboy.MissWangsaysthatLisa’sendingthefriendshipwiththeboywouldbea______thingtodo.MissWangsaysthatthereisno_______forLisatothrowawayherfriendshipwiththeboy.MissWangasksLisato______hergossipingclassmatesandshowthemthatsheismore______up.wrongpossiblegossipstupidreasonignoregrown\nReadthetextandfindouttheanswertothefollowingquestion.WhatwasupsettingLisa?Hewasmisunderstoodbyotherstohavefalleninlovewithaboy.\nGroupdiscussionDoyouagreewithMissWang?Whatdoyouthinkofthefriendshipbetweenboysandgirls?\nPeriod2Reading\nAnneBornonJune12,1929,AnneFrankwasaGerman-JewishteenagerwhowasforcedtogointohidingduringtheHolocaust（大屠杀）.\nBackgroundThisisatruestory.IttookplaceinAmsterdam,Hollandintheearly1940saftertheGermanNazishadoccupiedmostofEurope.TheNaziPartyruledGermanyfrom1933to1945.OneoftheirkeypolicieswastokillalltheJewsinEurope.IfanypersonsknowntobeJewswerefound,theywouldbesenttoconcentrationcamps(集中营),mostlyinPoland.Toavoidthisterriblefate,someJewishfamilieswentintohiding,oftenwiththehelpofnon-Jewishfriends.ThisdiarywaswrittenduringthetimewhenAnneandherfamilymovedtoescapefrombeingkilledbyNazis.\nPeriod3Languagepoints\n(1).tosufferanunpleasantexperience经历(不快的事)e.g.Iraqhasgonethroughtoomanywarsinthepasttenyears.(2).tolookatsthcarefully,especiallyinordertofindsth仔细检查e.g.IwentthroughallmypocketsbutIcouldn’tfindmywallet.1.…justcan’tunderstandwhatyouaregoingthrough?\n2.Idon’twanttosetdownaseriesoffactsinadiaryasmostpeopledo,butI…(1)setdown=writedowne.g.Isetdowneverythingthathappenedthen.(2)seriesn.连续,系列单复数同形aseriesof+n(复数）e.g.Therehasbeenaseriesofcaraccidentsatthecrossing.aseriesofgoodstamps\n6.as正如,照……的方式(1)DoasIsay.(2)David,asyouknow,isateacher.(3)AsIsaidinmylastletter,I’mtakingtheexaminJuly.\n3.I’vegrownsocrazyabouteverything…be/get/growcrazyaboutsb./sth.着迷，狂热e.g.(1)Theboyiscrazyaboutskiing.(2)Theteenagersarecrazyaboutpopularsingers.\nbecrazytodosthe.g.(1)Youarecrazytodosuchathing.(2)Youarecrazytobuyacaratsuchahighprice.=It’scrazyofyoutobuyacaratsuchahighprice.\nIstayedawakeonpurpose…inordertohaveagoodlookatthemoon.(1)stay(linkv.)+adj/ne.g.Hestayedsingleallhislife.e.g.Theystayedfriendsforyears.他们的友谊维持了多年。\n(2)purpose:目的,意图coverone’struepurpose掩盖真实意图onpurpose故意地e.g.Hebrokethewindowonpurpose.(3)inorderto=to:withthepurposeorintentionofdoingsth目的在于e.g.Shearrivedearlyinordertogetagoodseat.\n…,Ididn’tdareopenawindow.dare既可以用作情态动词，也可以用作行为动词。(1)情态动词：敢于，竟敢，多用于否定、疑问句中。e.g.Idarenotaskhimthesecondquestion.Daren'tyoureadwhatitsays?(2)行为动词：胆敢，敢于daretodosth.e.g.Hedaredtodothatandsomethingevenworse.\n…,Ihappenedtobeupstairsoneeveningwhenthewindowwasopen.happenvi.takeplace,发生(1)Whattimedidtheaccidenthappen?(2)Nooneknowwhohadfiredthegun—itallhappenedsoquickly.\n=tobeorasifbychancesb.happentodosth.(似乎)碰巧e.g.Ihappenedtoseeheronmywaytowork.Ithappens/happened+thatclausee.g.IthappenedthattheywentoutwhenIcalled.\n…,thethunderingcloudsheldmeentirelyintheirpower;itwasthefirsttimeinayearandahalfthat…(1)hold/havesbinone’spower控制住/摆布某人(2)Itis/was+序数词+time+that+主语+完成时态e.g.ItisthesecondtimethatTomhasbeentoBeijing.ItwasthefirsttimethatIhadcometomountainTai.\nPeriod4Grammar直接引语和间接引语DirectandIndirectSpeech\n(1)Johnsaid,”Ilikereadingnovels.”(2)Johnsaidthathelikedreadingnovels.直接引语:直接引述别人的话.间接引语:用自己的话转述别人的话.它构成宾语从句.\nGrammar:DirectandIndirectSpeech(1)转述他人的陈述→陈述句→SheaskedmewhatIwasdoing.1)Hesaid,“I’mgoingtoBeijing.”→HesaidthathewasgoingtoBeijing.2)Heasked,“Areyouateacher?”→Heaskedmeif/whetherIwasateacher.3)Shesaid,“Whatareyoudoing?”2.转述他人的疑问→一般疑问句3.转述他人的问题→特殊疑问句\n直接引语变成间接引语，句子结构的变化Hesaid,“IhavebeentotheGreatWall.”HesaidtousthathehadbeentotheGreatWall.Hesaid,“I'llgiveyouanexaminationnextMonday.”HetoldusthathewouldgiveusanexaminationthenextMonday.陈述句用连词that引导，that在口语中常省略。主句的谓语动词可直接用引语中的said,也可用told来代替，注意，可以说saidthat,saidtosb.that,toldsb.that，不可直接说toldthat\n陈述句解题步骤:“Idon’tlikecomputers,”Sarahsaidtoherfriends.SarahsaidtoherfriendsthatIdon’tlikecomputers.saiddidn’tsheSarahsaidtoherfriendsthatshedidn’tlikecomputers.Sarah\n一般疑问句Hesaid,“Doyouhaveanydifficultywithpronunciation?”Heasked(me)whether/ifIhadanydifficultywithmypronunciation.Hesaid,“YouareinterestedinEnglish,aren'tyou?”HeaskedwhetherIwasinterestedinEnglish.间接引语用连词whether或if引导，原主句中谓语动词said要改为asked(me/him/us等)，语序是陈述句的语序\n一般疑问句解题步骤:Isiteasytoimprovetheconditionofthesoil?(Theyaskedhim)TheyaskedhimifItiseasytoimprovetheconditionofthesoil.itiseasytoimprovetheconditionofthesoil.askediswasTheyaskedhimifitwaseasytoimprovetheconditionofthesoil.\n特殊疑问句Hesaidtome，“What'syourname?”Heaskedmewhatmynamewas.Heaskedus,“Howmanycarfactorieshavebeenbuiltinyourcountry?”Heaskedushowmanycarfactorieshadbeenbuiltinourcountry.原来的疑问词作为间接引语的连词，主句的谓语动词用ask(sb.)来表达，语序改为陈述句语序\n3.特殊疑问句解题步骤：Whendoyouharvestthewheat?(Theyaskedhim)TheyaskedhimWhenyouharvestthewheatyouharvestthewheat.heharvestedTheyaskedhimwhenheharvestedthewheat.\n选择疑问句Heasked,“DoyouspeakEnglishorFrench?”HeaskedmewhetherIspokeEnglishorFrench.用whether…or…表达，而不用if…or…，也不用either…or…\n在直接引语变为间接引语时需要注意的变化1.注意时态的变化2.注意人称变化3.注意语序的变化4.其他\n直接引语directspeech间接引语indirectspeech一般现在时一般过去时现在进行时过去进行时现在完成时过去完成时一般过去时过去完成时一般将来时过去将来时过去完成时过去完成时\nThegeographyteachertoldusthatthesunrisesintheeastandsetsinthewest.谓语动词时态变化需要注意：直接引语表述的是客观真理，变为间接引语时，时态不变Thegeographyteachersaid,“Thesunrisesintheeastandsetsinthewest.”\n直接引语间接引语指示代词时间状语地点状语方向性动词this,that,thesethosenow,then,todaythatdaythisweekthatweekyesterdaythedaybeforelastweektheweekbeforefourdaysagofourdaysbeforethedaybeforeyesterdaytwodaysbeforetomorrowthenextdaynextmonththenextmonthheretherecome,go,bringtake\n直接引语中的助动词间接引语中的助动词shallshouldshouldShould（不变）willwouldwouldWould（不变）maymightmightMight（不变）cancouldcouldCould（不变）mustMust/hadto\nExercises:1.Hesaid,“ImafraidIcan’tfinishthiswork.”2.Hesaid,“Ihaven’theardfromhimsinceMay.”3.Tomsaid“Iwillseeyounextweek.”Hesaidthathewasafraidhecouldn’tfinishthatwork.Hesaidthathehadn’theardfromhimsinceMay.Tomsaidthathewouldseemethenextweek.\n4.“Whyareyoulateagain?”Theteachersaidtome.5.“Idon’tlikeswimming,”saidSarah.6.HisfriendsaskedhimifhewouldgotoDalian.7.“HaveyoubeentoParis?”Myclassmateaskedme.TheteacheraskedmewhyIwaslateagain.Sarahsaidshedidn’tlikeswimming.Hisfriendsaskedhim,“WillyougotoDalian?”MyclassmateaskedmeifIhadbeentoParis.\nPeriod5Speaking&Writing\nAfriendinneedisafriendindeed.患难见真情。Friendsarelikewine;theolder,thebetter.友谊象美酒,越陈越醇厚.Afriendisasecondself.朋友是另一个我.Betweenfriendsalliscommon.朋友之间不分彼此.Thebestmirrorisanoldfriend.老朋友是最好的镜子.Truefriendshiplastsforever.真正的友谊地久天长。\nFriendshipcannotstandalwaysononeside.来而不往非礼也.Falsefriendsareworsethanopenenemies.明枪易躲，暗箭难防。没有缺点的朋友是永远找不到的.Friendship----onesoulintwobodies.友谊是两人一条心.Afriendwithoutfaultswillneverbefound.Withoutafriend,theworldisawilderness.没有朋友，世界成了荒野。Betterbealonethaninbadcompany.交损友不如无友。\nFriendshipislovewithunderstanding.友谊是爱加上谅解。Walkingwithafriendinthedarkisbetterthanwalkingaloneinthelight.和朋友走在黑暗中要好过一个人独自在光明中行走。Alifewithoutafriendisalifewithoutasun.人生在世无朋友，犹如生活无太阳。Afaithfulfriendishardtofind.知音难觅。Abosomfriendafarbringsdistantlandnear.海内存知己，天涯若比邻.\n3.ReadthelettertotheeditorfromXiaodong:Deareditor,I’mgladtotellyouthatIhavebeenadmittedintoNo.1HighSchool,whichIamlongingfor.I’mcrazyabouteverythinginthenewschool.However,myfathersays,“Studentsinhighschoolaretoobusytocareaboutothers.”Facingthenewclassmatesandnewteachers,Ireallydon’tknowwhattodo.Besides,I’mnotgoodatcommunicatingwithpeople.IwonderifIcangetalongwellwithmynewclassmates.I’mreallyupset.Deareditor,canyoutellmehowtomakefriends?Andwhatisfriendshipexactly?Iwouldbegratefulifyouwouldgivemesomeadvice.BestwishesXiaodong\n1)WhatproblemdoesXiaodonghave?Doyouagreewithwhathisfathersays?Discussingroupsoffour.CollectyouradvicetoXiaodongandyourattitude.UsefulexpressionsInmyopinion,youshould…Myadviceis…Ithink/believe…I’mafraidthat…Iadviseyouto…Idon’tthink…Don’tworry…Iagree/Idon’tagree.Ithinkso./Idon’tthinkso.\nWritingtaskAlettertoXiaodongStructureThetopicsentence(yourpointofview)Body(yourreasons)conclusion\nConnectingwordsIllustration(阐述）Addition（递进）Contrast（转折）Summary（总结）Ithink…Ibelieve…Isuggest…InmyopinionSecondly…Andthen…Besides…Inaddition…But…However…Ontheotherhand…Inshort…Inaword…Therefore…So…\nPeriod6WordStudy\npoint_______cheat_______reason________share________feeling__________German________series__________nature_______purpose_______power_______wordcardusefulnouns点；要点；尖端；分数欺骗；骗子理由；原因；理智份；分额；股分感觉；感受；感想；感情德国人；德语连续；系列自然；自然界目的；意图能力；力量；权力trust_________list_________teenager________advice__________questionnaire_________quiz________situation______editor_______habit________usefulnouns信任；所依靠的人；委托清单；名单；一览表（13-19岁的）少年，少女忠告；建议调查表；问卷测验；提问情形；境遇；位置编辑习惯；习性；举止\nadd_______point_______ignore________concern________loose__________cheat________wordcardusefulverbsvt.增加；添加；补充说vi.加；加起来；增添vt.&vi.指向；瞄准vt.不理睬；忽视vt.涉及；关系到vt.解；弄松vi.变松；松开vt.&vi.欺骗；骗取；欺诈；作弊share_______dare_______trust_______suffer_________communicate_________usefulverbsvt.&vi.分享；均分；分担aux.敢；胆敢vt.&vi.信任；信赖vt.&vi.遭受；经历；忍受vt.传达信息等vi.交际；沟通\naddup_______calmdown_______havegotto________beconcernabout________walkthedog__________gothrough________hideaway________setdown__________Expressionscardusefulexpressions加起来平静下来不得不；必须关心；挂念遛狗经历；经受aseriesof__________onpurpose_______inorderto_______facetoface_______accordingto_________getalongwith_________fallinlove___________joinin_________一连串的；一系列；一套故意为了…面对面地按照；根据…所说与…相处；进展usefulexpressions躲藏；隐藏放下；记下；登记相爱；爱上参加；加入\nWordstudydaredare既可以用作情态动词，也可以用作行为动词。(1)情态动词：敢于，竟敢，多用于否定、疑问句中，常与hardly,never,noone,nobody连用,后面跟动词原形。过去式为dared，否定式为darenot.(2)行为动词：胆敢，敢于daretodosth.注意：肯定句中，不定式一般加to.e.g.Hedarednotgonearthedog.在用do或does构成的否定句或疑问句中，to常常省略。e.g.Idon’tdare(to)gobacktolook.e.g.Hedaredtodothatandsomethingevenworse.\nWordstudyseriese.g.Therehasbeenaseriesofcaraccidentsatthecrossing.indoors/outdoorsadv.e.g.go/stayindoorsgothrough/suffere.g.Iraqhasgonethroughtoomanywarsinthepasttenyears.\nAnswerkeysforExercise2:Theyhidthereforalmosttwoyearsandneverdaredgoout.Wetriedtocalmhimdown,buthekeptshouting.3.Don’tlaughathim.Sometimesyouarenotabletodoaswellashe(does).4.Intheearly20thcentury,Chinawentthroughtoomanywars.Thechildrenhavebeenindoorsallday.Letthemplayoutdoorsforawhile.\nAnswerkeysforExercise2:6.Pleaseusethewordtomakeasentenceaccordingtothesituationgiven.Thisseriesofreadersisveryinteresting.Themansavedthegirlfromtheriverandhermotherwasverygrateful.Mr.Joneslivesaloneandoftenfeelslonely.10.WecommunicatewitheachotherbyInternet/throughtheInternet.\nThankyouforyourattention!\n刘尉生新密市中医院卫气营血辨证68\n概说一、卫气营血辨证的源流卫气营血理论作为温病的辨证体系是在清代确立起来的，由温热大师叶天士创立，并经以后的温病学家如吴鞠通、王孟英、章虚谷等加以充实和完善，从而最终形成的具有独特证治内容的辨治体系。69\n★温病的定义：温病是由温邪引起的以发热为主症，具有热象偏重，易化燥伤阴等特点的一类急性外感热病。相当或包括现代医学的病种：①多种急性传染病；②多种感染性疾病；③还包括某些非传染性的热性病。70\n★温邪包括：风热病邪、暑热病邪、湿热病邪、燥热病邪、暑湿病邪、疠气、温毒等。发于冬春——风热病邪温病发于夏季——暑热病邪因与四时有关，故发于长夏——湿热病邪又称为四时温病。发于秋季——燥热病邪★温病具有传染性、流行性、季节性、地域性。71\n★温病与伤寒的关系:广义伤寒隶属关系温病狭义伤寒并列关系72\n★伤寒与温病的区别：73\n㈠立论基础卫气营血理论的立论基础是《内经》、《伤寒论》等经典著作中有关“营卫气血”生理、病理方面的论述。74\n㈡实践依据叶天士汲取前人学术经验和运用传统理论，分析、解决实践中的诊治问题，不断总结、探索，提出新的思维，创建了新的学说。叶天士丰富的临床经验是创立卫气营血辨证的实践依据。75\n二、卫气营血辨证的临床意义㈠证候类型的区分1.卫分证2.气分证3.营分证4.血分证76\n㈡分析病变机理在温病过程中的卫气营血的病机变化是指人体在温邪作用下所导致的卫气营血某一部分的功能失调或实质损害，它体现了温病过程中不同证候的内在本质。卫分、气分的病机变化以功能失调为主。营分、血分的病机变化以实质损害为主。77\n㈢判定病情轻重㈣识别病情传变卫分(初期阶段)肺卫气分(中期)病位肺、胃、肠、胆、脾、膀胱等营分(严重阶段)心与心包血分(晚期阶段)心、肝、肾78\n㈤指导立法制方卫汗之---银翘散气治疗大法清气---白虎汤营透热转气---清营汤血凉血散血---犀角地黄汤79\n第二节卫分证辨证80\n一、基本内容★．生理功能：《灵枢·本脏篇》：“卫气者，所以温分肉、充皮肤，肥腠理，司开合者也”。又说：“卫者，卫外而为固也”。①卫气是人体的阳气之一，主要敷布于人的体表，以温养肌肤。②有抵御外邪的侵袭和驱邪外出的作用。③它内与肺气相通，外司毛孔，汗腺的开合。81\n★．卫分证的概念：卫分证是温邪初袭人体肌表，引起卫外功能失调而产生的一类证候类型。卫分证分为温热和湿热两大类别。82\n★．临床表现：发热，微恶风寒，头痛，无汗或少汗，咳嗽，口微渴，舌苔薄白，舌边尖红，脉浮数等。★．病因病机：邪郁卫表，肺卫失宣。★．治疗措施:疏卫透表----代表方银翘散。83\n二、常见的卫分证㈠风热在卫证发热，微恶风寒偏于卫者---银翘散咳嗽,疏风散热苔薄白，脉浮数偏于肺者---桑菊饮84\n㈡暑湿在卫证发热恶寒脘闷心烦外散表寒，内清暑湿---新加香薷饮舌苔薄腻85\n㈢湿热在卫证恶寒头重胸闷脘痞芳香透泄，宣肺祛湿---藿朴夏苓汤苔白腻86\n㈣燥热在卫证发热微恶风寒，干咳痰少，咽干辛凉甘润,清透肺卫---桑杏汤鼻燥，苔薄白欠润87\n㈤风热毒邪犯卫证恶寒发热全身酸楚疏风透表,宣肺利咽---葱豉桔梗汤头面红肿88\n㈥温热毒邪犯卫证憎寒发热，咽喉红肿疼痛，透表泄热，解毒利咽，凉营透疹肌肤丹痧隐隐-----清咽栀豉汤89\n三、卫分证的辨证思路㈠首先确立邪在卫分。（注意与风寒表证区别，并辨别病邪的性质为温邪）㈡次审卫分具体病因。（病因与季节相关，并有时毒侵袭）㈢再察卫分病位重心。90\n第二节　气分证辨证91\n一、基本内容：★．生理功能：《灵枢·决气篇》云：“上焦开发，宣五谷味，熏肤，充身，泽毛，若雾露之溉，是谓气”。①输布营养物质，维持生命活动；②抗御外邪，维持体温；③是全身各脏腑功能活动的原动力。92\n★．气分证的概念：凡温邪不在卫分，又未传入营(血)分的证候皆属气分范围。气分证的病变范围较广泛，涉及的脏腑主要有肺、胃、脾、肠、胆、膜原、胸膈等。临床上可分为温热性的气分证和湿热性的气分证两大类，临床表现较为复杂。93\n★．临床表现:气分证可分为温热性的和湿热性的两大类，气分证因病变部位及其证候类型不同而症状各异。★．病因病机:温热性的气分证邪正剧争，里热蒸迫，热炽津伤.湿热性气分证病机复杂，以内外合邪，湿热交蒸，阻滞气机，流连气分，缠绵难愈为特点。★．治疗措施：清解气热----代表方是白虎汤。94\n二、常见的气分证㈠热郁胸膈证心烦懊憹轻清宣气---栀子豉汤舌苔微黄95\n㈡阳明热盛证壮热、多汗、渴饮、辛寒清气，达热出表---白虎汤脉洪大96\n㈢热郁胆腑证身热,口苦胸胁不舒，苦寒清热，宣郁透邪---黄芩汤加豆豉玄参方脉弦97\n㈣湿热困中证发热汗出不解，脘痞呕恶，辛开苦降，燥湿泻热---王氏连朴饮心中烦闷，苔黄腻98\n㈤热盛动风证身热壮盛，动风见证凉肝熄风---羚角钩藤汤舌红苔黄99\n㈥毒盛气分证壮热烦渴头面红肿清热解毒，疏风消肿---普济消毒饮疼痛明显100\n三、气分证的辨证思路㈠掌握基本特点，首辨温热湿热:101\n气分证有温热与湿热的不同，证情相对复杂。温热性的气分证多见壮热，不恶寒，反恶热，汗多，渴喜饮冷，尿赤，舌质红，苔黄，脉数有力等.气分证湿偏盛者----身热不扬，舌苔多白腻；湿热性的气分证热重湿轻身热汗出，不为汗衰，或湿热俱盛舌苔黄腻或黄浊。102\n㈡次辨病位所在，区别具体证型:邪热壅肺、热郁胸膈、气分证涉及上,中,下三焦热郁胆腑阳明热炽湿热困脾暑湿弥漫三焦103\n㈢分清外蒸内郁，辨察痰湿兼挟★分清外蒸内郁体表壮热外蒸---里热蒸腾于外,症见面赤大汗治当辛寒泄热外达脉象洪数有力心烦内郁---热郁于里,症见口苦治当苦寒直清里热溲赤104\n★辨察痰湿兼挟胸闷咯痰气分证伴见或脘痞呕逆属兼挟痰湿之象舌苔粘腻105\n㈣注重动态观察,把握传变趋向邪正剧烈交争证候易于变幻气分证故应详辨邪热传营---斑疹隐隐、心烦不宁、舌色转深等.热盛动风---惊搐、手足震颤、两目直视等。有无邪热深陷内传的征象有无正气欲脱的征兆骤然发生的身热陡降，肢冷汗出，面色苍白，脉象细数等。106\n第三节营分证辨证107\n一、基本内容★.生理功能：《素问·痹论》：“营者水谷之精气，和调于五脏，洒陈于六腑”。①营气源于水谷之精微，运行于经脉之中，内则营养五脏六腑，外则润泽筋骨皮毛；②营气通于心，心主神明，主宰人体的一切精神活动。108\n★.营分证的概念：营分证是指热邪深入，劫灼营阴、扰乱心神而产生的一类证候类型。因为营为血之标，所以营分证为血分证的前期。109\n★.临床表现:身热夜甚，口干，反不甚渴饮，心烦不寐，时有谵语，斑疹隐隐，舌质红绛，脉细数等。★.病因病机:营热阴伤，扰神窜络。★.治疗措施:清营泄热---代表方清营汤。110\n二、常见的营分证㈠热入营分证身热夜甚，心烦躁扰，时有谵语，口干反不甚渴饮，清营泄热---清营汤舌质红绛无苔，脉细数。111\n㈡热入心包证神昏谵语或昏愦不语，身热，舌謇肢厥，清心凉营，豁痰开窍---清宫汤舌质纯绛鲜泽,脉细数。112\n㈢毒燔气营（血）证咽喉红肿糜烂，甚则气道阻塞，声哑气急，肌肤丹痧密布，红晕如斑，赤紫成片，清气凉营，解毒救阴壮热，汗多，口渴，烦躁，-----凉营清气汤舌绛干燥，遍起芒刺，状如杨梅，脉细数。113\n三、营分证的辨证思路1、辨识营分特征，重视神志变化★.舌象变化:舌质由红渐转红绛。★.神志症状:营分证各证型均有神志方面的异常变化。114\n营分证各证型均有神志异常：邪势尚不太盛，神志见症较轻神志见症相应加重出现严重神志见症邪热初入营分营分之热转盛躁扰不宁，时有谵语神昏谵语,昏聩不语心烦不宁，夜甚无寐营热炽盛内陷心包115\n2、审视证候兼挟，注意体质差异★审视证候兼挟：卫营同病营热已炽而卫分之邪未净治当泄卫透营气营两燔营热已炽而气分之邪未净治当气营两清116\n★审视证候兼挟舌苔尤为重要：邪热入营舌质红绛无苔若苔白若苔黄若苔粘腻卫分之邪未净气分之邪未净兼挟痰湿秽浊117\n★注意体质差异：1.小儿2.年老体弱者3.产妇4.素有宿疾者118\n第四节血分证辨证119\n一、基本内容：★.生理功能：《灵枢·邪客篇》云：“营气者，泌其津液，注之于脉，化以为血”。①心主血脉，藏神明，乃总统于心，运行脉中，周而复始，环流不息。②血为营气所化生，有濡润筋脉，营养五脏六腑之功用。120\n★.血分证的概念：血分证是指温邪深入血分，引起耗血动血，瘀热互结为主要病机变化的一类证候。临床上以高热和出血为其特点。121\n★.临床表现:身热，躁扰不安，或神昏谵狂，吐血，衄血，便血，尿血，斑疹密布，舌质深绛。★.病因病机：热盛耗血动血，热瘀交结。★.治疗措施：凉血散血---代表方犀角地黄汤。122\n二、常见的血分证㈠热盛动血证身体灼热，躁扰不安，甚或昏狂谵妄斑疹密布，色呈紫黑凉血散血或吐衄便血，---犀角地黄汤舌质深绛紫绛，脉细数等。123\n㈡气营（血）两燔证壮热，口渴，头痛，烦躁不安，气营(血)两清外发斑疹，甚或吐血溺血，神昏谵妄，两目昏瞀，口秽喷人，---加减玉女煎周身关节痛如被杖，苔黄燥---化斑汤或焦黑，舌质深绛或紫绛等。---清瘟败毒饮气营(血)两清----即辛寒清气合凉营（血）解毒124\n㈢热与血结证少腹坚满，按之疼痛，大便色黑，小便自利，神志如狂，或清或乱，攻下泄热，活血逐瘀口干，漱水不欲咽，脉沉实或细涩，---桃仁承气汤舌有瘀斑或紫绛，脉细涩。125\n三、血分证的辨证思路㈠辨清出血部位，明确体内脏腑126\n㈡谨析血瘀程度，慎察神志变化★辨血瘀的程度，其辨证的主要着眼点如下：1．舌象变化2．斑疹色泽3．血液颜色4．脉象的变化127\n★血分证多有神志方面的异常：1．血热较轻者多表现为躁扰不宁，甚或偶有谵语。2．热毒炽盛者可为昏狂谵妄。3．瘀热扰乱心神则可见如狂发狂的狂乱之象。4．营血热邪内陷心包，灼液为痰堵闭清窍，则可见神昏谵语或昏聩不语。128\n㈢关注正气盛衰，判明预后转归辨察的着眼点主要是审察以下脉证的动态变化：如在病程中发现患者面色苍白、神情萎靡、四肢不温和脉象微细欲绝等征象，则为正气欲脱或外脱之兆，临床应予高度重视。1.发热2.出汗3.面色4.神情5.气息6.脉象129\n卫气营血辨证小结130\n★.温病常见症状一、发热：发热是贯穿于温病始终的最主要症状之一，也是温病的必具症状。然而由于温病不同的阶段的不同，则发热的机理亦不同。热势又各具特点。131\n（1）发热恶寒——发热与恶寒并见，发热时伴有恶寒。主病——温病初起邪在肺卫。（2）寒热往来——恶寒与发热交替出现，定时或不定时发作。主病——温病中湿热秽浊郁闭膜原之象。（伤寒病中，为热郁半表半里，少阳枢机不利的表现。）（3）壮热——热势炽盛，多表现为但热，不恶寒，反恶热。主病——热入阳明，气分热盛。132\n（4）日晡潮热——发热于下午益盛，热势起伏如潮水状。主病——阳明腑实。（5）身热不扬——身热稽留而热象不显，扪久始觉灼手。主病——湿中蕴热，湿热郁蒸。133\n（6）身热夜甚——发热以夜间为甚。主病——邪热入营，营阴耗损。（7）身热肢厥——指胸腹灼热，手足厥冷。主病——多见于营、血分，也可见于气分腑实内结，邪热闭郁。134\n（8）夜热早凉——夜间发热，清晨热退身凉而无汗。主病——温病后期，邪热未尽，留伏阴分。（9）低热——热势不高而持续不退。主病——温病后期，邪少虚多，肝肾阴虚，内生虚热。135\n二、汗出异常①无汗温病初期————邪遏肌表，腠理闭塞。（兼发热恶寒，口微渴。）温病中期————热入营，营阴伤，无作汗之源。（兼灼热、烦躁、舌绛。）温病未期————液亏里虚，阳弱阴衰。（兼肢厥、肌肤甲错，脉细。）136\n表虚不固——发热，恶风，脉虚。②时有汗出湿热郁蒸——汗出热减，继而复热，脉濡数。137\n实证————阳明热炽，迫津外泄。（兼高热烦渴）③大汗亡阴——津气外泄，亡阴脱变。（兼神志恍惚，口干，舌红无津，脉数大）虚证亡阳——阳气外亡，阴不内守，气脱亡阳。（兼肢冷脉伏舌淡）138\n④、战汗：在温病过程中突见肢冷爪青，脉沉伏。全身战粟，甚或肢冷脉伏，继而全身大汗淋漓.机理：邪留气分，正不甚衰，正邪相争，正逐邪出。战汗转归：①病愈——战汗后神清而静，脉静身凉，为正胜邪却，病情向愈。②邪陷——战汗后身热不退，烦躁不安，气粗而短，脉躁急为正不胜邪，邪热内陷。③战而无汗——全身战栗而无汗出，为正气亏虚，不能托邪外达。139\n（二）口渴温邪袭表，津液未伤——一般口不渴。①卫分邪犯肺卫，微伤津液——咽干，口微渴。140\n——大渴引饮，喜冷饮。②气分热重于湿——口渴饮不多。湿重于热——口渴不欲饮或喜热饮。热盛伤津气分湿热，气机受阻，津液不布141\n③营血分——邪热入营，热蒸营阴上承——口干不甚渴饮。④温病兼挟痰饮——渴不欲饮，或渴喜热饮，但所饮不多，或饮下不舒。⑤胆火内炽，津液受伤——口苦而渴，常并见寒热如疟，心烦，脉弦数等症。142\n（四）神志异常1.烦躁不安——心中烦热，坐卧不安，但神志尚清。原因：热扰心神。143\n2．神昏谵语——神志不清，意识丧失，语无伦次。①营热扰心——舌绛无苔，心烦不安，时有谵语。②血热扰心——斑疹，吐血，便血，昏谵似狂。③热陷心包——体热肢厥，不语，舌绛，神昏。④热结肠腑——潮热，便秘，舌苔黄燥，神昏谵妄。144\n3．神志昏蒙——表现意识模糊，时明时昧，似清似昧，呼之能应，如呆如痴，时有谵语等。原因：气分湿热，酿蒸痰浊，蒙蔽心包，扰及心神。145\n4．昏聩不语——意识完全丧失，沉迷不语，属神志异常中最严重的。原因：多因热闭心包而致。5．神志如狂——表现昏谵躁扰，妄为如狂。原因：多为下焦蓄血，瘀热扰心所致。146\n（五）痉（1）热盛动风（实风）——来势急剧，抽搐频繁有力，颈项强直，牙关紧闭，甚至角弓反张，两目上视，肢厥昏谵，脉弦数或弦数有力，舌红绛。（2）阴虚动风（虚风）——手足徐徐蠕动，或口角颤动，心中憺憺大动，伴见低热，颧红，手足心热甚于手足背，形体消瘦，口干舌燥，盗汗神疲，舌红少苔，脉虚数等147\n（六）出血温病过程中发生出血，一般为邪热深入营血，迫血妄行所致。温病出血的特点：①多为突然发生的多部位的出血，即广泛出血，病情重。②或以一个部位出血为主而兼有其他部位的出血，与内科之血证表现局部出血，时出时止为主者不同。148