Transcript PPT file - 加州中醫公會CAAM.US

基礎臨床檢驗和中醫臨床運用
呂寶江醫師
呂寶江醫師

學歷





台灣國防醫學院醫學系畢業 1980
美國德州空軍航太醫學學院高級班結業 1982
台灣中國醫藥學院 西學中學分班畢業 1997
美國南灣中醫大學畢業 2002
證照

台灣醫師執照 (1980)



台灣中醫師執照 (2000)



內科專科醫師證書
胸腔病專科證書
中西醫整合醫學專科證書
加州中醫師執照 (2002)
美國聯邦中醫師執照
血液常規檢查 (CBC)



紅血球 (Red cells)
白血球 (White cells)
血小板 (Platelets)
紅血球






Hemoglobin (Hgb)
Hematocrit (Hct)
MCV
MCH
MCHC
Red cell number


用於鑑別貧血及貧血
種類
用於評估水分容量
Classification of Anemia




Sickle cell anemia
Iron deficiency anemia
Vitamin deficiency
Bone marrow and stem cell
problems



Aplastic anemia
Thalassemia
Lead toxicity
貧血



Iron deficiency
anemia (small RBC)
Pernicious anemia
(big RBC)
Aplastic anemia

血虛

血虛

髓虛
白血球

Neutrophil (中性球)
Lymphocyte (淋巴球)
Monocyte ( 單核球)
Basophil (嗜鹼性球)

Eosinophil (嗜酸性球)








Bacterial infection
Virus infection
EB virus
Allergy/ Parasite,
Cancer
Allergy /Parasite
Causes of Leukocytosis

Neutrophilia



Eosinophilia




Allergic reaction
Parasite infection
Basophilia
Monocytosis




Acute bacterial infection
Tissue necrosis
Chronic infections:
Systemic autoimmune disease
Inflammatory bowel disease
Lymphocytosis


Chronic infection
Viral infection
Causes of Leukopenia








Chemotherapy
Radiation therapy
Myelofibrosis
Aplastic anemia
HIV & AIDS
Influenza
Hodgkin’s lymphoma
Mineral deficiency: Copper & Zinc
白血球的功能


免疫機能
防制致病菌的侵入




衛外功能的部分
感染屬外因
癌症,炎症屬內因
多從傷寒, 溫病的角
度論治
血小板 (Platelet)

凝血機能之一

紫斑
血糖 (Blood sugar)



Fasting blood sugar
2 hours blood sugar
Hgb A1c
Diagnosis of Diabetes Mellitus

2006 HMO Diabetes criteria




Fasting Plasma glucose level >/= 126mg/dl
Plasma glucose >/= 200mg/dl, 2 hours
after OGTT
Symptom of hyperglycemia, and casual
plasma glucose >/= 200mg/dl
Glycate Hemoglobin (Hgb A1c) >/= 6.5%
Classification of DM

Type I


Type II


Insulin deficiency
Insulin resistance
Gestational diabetes
消渴症

上消

肺熱傷津


中消

胃熱熾盛


煩渴多飲, 口乾舌燥, 尿頻量多, 舌邊尖紅, 苔黃脈洪數
多食易飢,形體消瘦, 大便乾燥, 苔黃, 脈滑實有力
下消

腎陰虧虛


尿頻量多,混濁如膏或尿甜, 口乾舌燥,舌紅, 脈沉細數
陰陽兩虛

小便頻數, 混濁如膏, 面色鯬黒, 耳輪焦乾, 腰膝酸軟, 形寒
胃冷, 陽委不舉, 舌淡苔白, 脈沉細無力
肝功能檢查 (LIVER FUNCTION
TEST)

Total protein







Albumin (白蛋白)
Globulin (球蛋白)
AST (GOT)
ALT (GPT)
LDH
Alkaline phosphatase (鹼性磷酸酶)
Bilirubin (膽色素)


Direct
Indirect
Total PROTEIN

ALBUMIN

Regulate blood
volume


Oncotic pressure
Carrier of low water
soluble molecules

GLOBULIN

Immuoglobulin





IgG
IgA
IgE
IgM
IgD
LIVER FUNCTION TEST



AST (GOT)
ALT (GPT)
LDH (Lactate
dehydrogenase)



Heart, Liver, Muscle
Mainly in Liver
Heart, Liver, Muscle,
most organ
Alkaline phosphatase

來源


骨骼
代謝

肝臟
Bilirubin (膽色素)

Source:



Breakdown Heme
Indirect Bilirubin: Un-conjugated
bilirubin
Direct Bilirubin: Conjugated bilirubin
Bilirubin

Un-conjugated (Indirect) bilirubin



Bind with albumin
Not water soluble
Conjugated (Direct) bilirubin


Bind with glucuronic acid in liver
Water soluble
Jaundice

Pre-hepatic (Indirect bilirubin)



Hepatic



Hemolysis
Bleeding
Hepatitis
Cirrhosis of liver
Post-hepatic: (Direct bilirubin)

Obstruction of bile duct
黃疸中醫論治



“血分”濕熱乃發黃
肝膽疏泄功能失調
熱瘀在裡: 寓含邪熱結于血分之意
黃疸中醫分類

陰黃




較晦暗
接近direct bilirubin
病程較常
陽黃



較鮮明
接近indirect bilirubin
病程較短
血脂肪 (Lipid Profile)


Triglyceride
Cholesterol



LDL
HDL
VLDL
KIDNEY FUNCTION TEST



BUN (blood urea nitrogen)
Creatinine: creatinine clearance rate
Glomerular infiltration rate (GFR)
電解質 (Electrolyte)




Sodium
Potassium
Chloride
Calcium
Thyroid function test



TSH
T3 (triiodothyronine)
T4 (thyroxine)
Causes of hyperthyroidism





Grave’s disease
Toxic thyroid adenoma
Toxic Goiter
Inflammation: Hashimoto’s thyroiditis,
subacute thyroiditis
Drugs


Thyroid tablet, Amiodaron
Postpartum thyroiditis
Symptom of hyperthyroidism







Weight loss, hypoglycemia, polyuria,
polydipsia
Heat intolerance, sweating
Anxiety, irritable, hyperactivity, tremor
Palpitation, arrhythmia
Weakness, muscle aches, myopathy, peroidic
paralysis
Loss of libido
Nausea, vomiting, diarrhea
甲狀腺亢進中醫論治

從肝論治



心悸
震顫: 諸風掉眩皆屬肝
焦慮
結論




醫學浩瀚, 無任何醫學可以涵蓋整體醫學
中醫,西醫也許角度不同論點不同,但疾病
卻是千百年不變
中醫應予現代醫學接軌
中醫利用現代醫學的知識, 突破中醫舊有
的盲點, 為中醫尋求新的生命