两胁胀痛

患者女性，35岁。主诉腹泻、腹痛反复发作半年，加重3天。病程半年，诱因工作劳累、饮食不规律。腹泻、腹痛，右下腹剧痛，泻后痛减，大便溏，3～4次/天，纳差，口中黏腻，失眠多梦。舌质红，苔黄腻，脉弦滑数。急躁易怒，两胁胀痛，舌根部有片状小溃疡，小便色赤。中医诊断为泄泻，证属肝郁脾虚，郁而化热，湿热内蕴。

赵某，女，30岁。长期两胁肋胀痛，饮食不佳，大便溏薄，小便黄少，头晕耳鸣，心慌心累，夜多恶梦，午后低烧，眼周围有黑圈，腹部两侧有包块突起，形体消瘦。舌质澹红，黄腻苔，脉弦细。肝经气滞血阻，肝郁脾滞，湿热内聚，肝脏阴亏阳亢。腹部两侧包块突起，肝脾肿大，肝脏中等硬度。午后低烧，心慌心累，头晕耳鸣，口干，噩梦，眼周黑圈，面色皖白，腹内胀气，少气乏力。舌上细黄腻苔退减，舌质澹，脉弦细。两胁肋隐痛，腹中疼痛，大便溏薄，小便黄少，时欲呕吐，胸闷头胀。

患者年龄40岁，男性。主诉左胸痛一年余，近半年病情加重。胸痛伴气短，左胸痛时上身转侧不利，口干不思饮，胃脘及两胁不适，呕逆吐苦水，头重颠眩。舌澹胖苔白微腻，脉沉弦。中医辨证为饮邪上犯，胸阳痹阻，胆胃不和，升降失司。

患者31岁，男性。两胁胀痛，腰酸乏力，气郁多怒，睾丸坠胀，纳呆食少。舌质暗，苔澹黄，脉沉弦细尺弱。精液检查示精子死亡率96%，活力Ⅰ级，精子密度4600万/ml。中医诊断为肝郁气结，血瘀精脉。病因病机为肝气郁结，血瘀阻滞精脉。

女，21岁，经期鼻衄，口苦咽干，头晕目眩，两胁胀痛，腹胀，便秘，小便短少。舌质红、苔薄黄，脉弦滑。证属阳明里实，兼夹少阳郁热之逆经。

57岁，乏力、气短、纳差、肝区不适、两胁胀痛、睡眠差、大便软，病程30余年。肝郁脾虚，气虚血瘀。面色晦暗无光泽，舌淡红，苔薄白，脉平缓。蜘蛛痣，血清谷草转氨酶升高，血红蛋白降低，血小板减少。

18岁女性，主诉周期性鼻衄伴月经异常，病程三年。舌质微红，舌边有针刺样瘀点，苔薄白，脉涩而沉。证属肝气不舒，气滞血瘀。情志不舒，两胁及少腹胀痛，每于周期性发作时加剧。头昏，失眠。

36岁男性，胃脘隐痛半年，食后及夜间加重，与家人生闷气后出现，气短乏力，两肋胀痛，睡眠欠佳，纳谷不香，善太息。脉沉弦，舌边尖红，苔白微腻。中医诊断胃脘痛，证属肝郁脾虚，肝木克害脾土。

患者女性，38岁。主诉腹部膨隆，反复发作十年。病史中见嗳气、恶心、两胁作胀、大便不消化物。临床表现见两胁作胀、中脘膨隆如鼓、嗳气频频、头面四肢微浮肿、脉弦、苔腻。中医诊断为胃肠功能紊乱。病因病机为肝失条达，气郁于中，气郁则瘀阻，瘀阻则气滞。舌象见苔腻，脉象见弦。

患者主诉小溲刺痛，胸脘痞闷，两胁胀痛，遍身酸楚，口干不多饮，呃逆频频，吐蛔一条。舌质光，脉弦滑。中医诊断为肝经气火横亢，胃失通降之权。病机为肝阳犯胃，蛔不得安，热而吐蛔。望诊见舌质光，闻诊无特殊描述，问诊见症状多样，切诊脉弦滑。

女，58岁，胸骨后疼痛2月余，伴反酸，两胁胀痛，大便偏烂。吐酸，肝胃郁热，夹有痰湿。舌质暗红，苔黄腻，脉细。

张某，47岁，男性。主诉乏力、腹胀、下肢浮肿、两胁胀痛、小便黄赤。病程十余年，慢性乙型肝炎史，肝硬化失代偿期，腹水，低蛋白血症，脾功能亢进。面色晦暗，身体消瘦，腹部胀满，腹水征阳性，下肢凹陷性浮肿，肝掌阳性，蜘蛛痣阳性。气虚血滞，水湿内停。舌象未提，脉象未提。

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患者37岁，女性。主诉胃脘部疼痛，按之痛甚，发紧发胀，发作持续10分钟左右，不能平卧，伴冷汗出，活动加剧，口苦，恶心，两胁胀痛牵及少腹，纳差，大便干。舌淡红，苔薄白，脉弦细略数。中医诊断为胃脘痛，辨证为肝胃不和，冲气上逆，阴维内结。

患者40岁，女性。主诉肝肿大，子宫肿瘤术后。病程自今年2月手术起，现发现肝肿大4.8cm×5.0cm，正在接受化疗。疲惫面容，眼圈发黑。查体无其他阳性体征。面色黑斑，肝区胀痛，周身乏力，两胁胀痛，疲倦感明显减轻，面色转佳，面有光泽。

男，40岁，头晕头胀，心中懊恼，胸脘痞闷，心下满，按之痛，两胁胀痛，不思饮食，心烦，口苦咽干，大便秘结，小便黄赤。舌质红，舌苔微黄，脉弦数。证属肝郁化热，肝热犯胃，肝胃同病。

患者年龄34岁，女性。主诉胃痛发作3个月，伴两胁胀痛、周身痛、背心冷痛、口干苦、大便黑色。中医病名胃痛，证型肝气郁结，肝郁化火，火伤胃络。病因病机为肝气郁结，久郁化火，火邪伤阴，胃络受损，瘀血阻滞，湿热蕴结。舌红苔灰黑，脉沉弦。面色未提及，声音未提及，气味未提及，病史为胃痛3个月。

男，发热、呕吐，病程二三日。发热、呕吐、口苦，少阳枢机不利、胆胃逆行。巩膜及周身黄染，尿色深黄，两胁胀痛，肝郁不达、胆道不利。舌象未提，脉象未提。

患者42岁，男性。主诉胃胀2年，胃胀痛反复发作，情志刺激加重。主要症状包括胃院胀痛、反酸烧心、痞塞不舒、暖气频作、两胁胀痛、大便稀。舌红，苔薄白，脉弦。中医诊断为胃痞，证型为肝气不和。病因病机为情志所伤，肝失疏泄，影响脾胃功能。

患者45岁，女性。主诉咳嗽气紧，吐白泡沫清痰，全身软弱无力，卧床不起，2日未进饮食，大便不通，力乏喘促，面赤唇红，咳连续一二十声，神识恍惚，说话不清，两足厥逆。舌质淡，苔白腻。脉沉细，右寸脉不显。诊断为元阳有欲从上脱之势。