双下肢水肿

女性，49岁，腰痠痛反复发作6年，加重15天。腰痠痛，双下肢水肿，夜尿频多，尿色淡黄，尿中有泡沫。舌质黯红，苔黄，脉沉。中医诊断为腰痛，证属脾肾亏虚兼湿浊血瘀。尿常规示隐血(++)，尿蛋白(+++)，镜检红细胞17.6个/HP，24h尿蛋白定量2200mg/24h，尿微量白蛋白103.4μg/L，肾功能正常，肾彩超示双肾囊肿。

57岁女性，腹部胀满，胁下隐痛，双下肢及腹部水肿，精神疲惫，病程6个月。面色萎黄，腹胀如箕，双下肢水肿光亮欠温，巩膜黄染，腰酸畏寒，大便稀薄，小便色白量少，脉沉细而涩，舌质澹少津，边缘瘀点。辨证为脾肾阳虚，阳气不运，水湿泛滥，瘀血闭阻肝络。

75岁女性，双下肢水肿2年，伴活动后气喘。食少，神倦乏力，形寒肢冷，大便解出困难，常不成形。舌淡苔薄干少津，脉细弱。证属气虚血瘀水停。

68岁男性，咳喘反复8年，近2周加重，伴双下肢水肿。咳嗽、痰白或黄、呼多吸少、端坐呼吸、汗出、大便秘结、尿少色黄。舌质暗红，苔黄白腻，脉弦细数。肺胀，肺肾气虚、寒热错杂。外邪上受，肺气壅遏，清肃失常，日久损肺肾，肺气虚卫外不固，肾虚制水失职，水湿化痰饮上犯，肺气壅遏，咳喘反复。

52岁男性，主诉肝病3年，肝区疼痛加剧，食少肢软，倦怠懒言，气短汗多，颈胸蜘蛛痔，肝区叩击痛，肝大质硬，腹部移动性浊音阳性，双手肝掌，双下肢水肿。舌红，舌尖边有深红色瘀点，脉弦。诊断为气虚邪实，肝胃不和。

女性，31岁，急性粒细胞白血病伴高热，病程危重。元气大虚，气阴两伤，中焦衰微，无权运化。面色苍白无华，精神极差，卧床，面部虚浮，语言低微，双下肢水肿，高热40度，口干不欲饮，身不冷，气短乏力，心悸，恶心欲呕，腹泻频繁，脉细无力，舌质淡白、无苔、少津。热伤血络，手足心热，皮肤出血点。

女，63岁。胸闷憋气间作2年余，加重半年。胸闷憋气，心慌气短，喘憋，劳累后尤甚，口干口苦，双下肢水肿(+)，便秘，3日1行。舌红绛，舌根部苔黄腻。脉弦。脾肾两虚证。冠脉三支病变，右冠近段狭窄95%，前降支中端狭窄，第一对角支近段80%，回旋支远端90%。

患者65岁，男性，主诉活动后气促5年，再发加重伴双下肢浮肿1周。喘证，心肾阳虚，血瘀水停。面色少华，舌质澹胖，边有齿印夹瘀点，脉细涩。活动后气促，倦怠乏力，腰酸，双下肢水肿，颈静脉充盈，心界扩大，心音强弱快慢不一，心尖区杂音SM3/6，肝颈征阳性。

患者72岁，女性。主诉肝脏占位1年，情绪低落伴胁肋胀痛、纳呆腹胀2个月，加重1周。中医病名肝积，证型肝郁脾虚证，郁证。舌质淡夹瘀，苔薄白，脉弦细。面色萎黄，形体消瘦，全身皮肤、巩膜轻度黄染，双下肢轻度凹陷性水肿，腹膨隆，肝大，脾大，腹部移动性浊音阳性。情绪悲观忧郁，胸胁胀满疼痛，善叹息，倦怠乏力，口淡无味，恶心反酸，腹胀腹痛，纳眠差，大便稀，小便调。

患者55岁，女性。周身乏力2年，伴纳差，眼睑浮肿。面色萎黄，舌质澹，苔薄白，脉弦细。颜面及双下肢水肿，大便干，小便量偏少，时有头痛，夜眠差。中医诊断为虚劳，辨证为脾肾气虚。BUN27.9mmol/L，Cr1137μmol/L，CO2-CP 8.2mmol/L。

患者年龄80岁，男性。主要症状包括头晕、胸闷痛、心悸乏力、上肢麻木、进食少、睡眠差、大便溏。病程未明确提及。中医病名为心脾两虚，血脉瘀阻。病因病机为心脾两虚，气滞血瘀，血脉瘀阻。舌象为舌胖暗、苔白腻，脉象为脉细弦。体征包括双下肢轻度凹陷性水肿。

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患者年龄83岁，主诉反复咳嗽咳痰30余年，气急10年，病程较长。中医诊断为肺胀，证型为气虚血瘀，阳虚水泛。舌淡红苔薄白，脉弦。

患者年龄81岁，男性。主要症状为多个关节肿痛，累及双肩、双腕、近指、掌指及双踝关节，晨僵，手指屈伸不利，双踝肿胀明显，伴口干喜饮、口苦、寐差。中医诊断为痹证，证型为肝肾亏虚，湿热痹阻。望诊见舌质红，少苔，色黄；切诊见脉细数。

女，59岁，主诉小便淋漓不畅5~6年，双下肢水肿伴麻木，心慌、胸闷、乏力，纳不佳。慢性肾功能不全、CKD5期，病程较长。舌红苔薄白中裂纹，面色黧黑少华，脉结。中医诊断脾肾亏虚、水饮浊邪内停。辨证为脾肾亏虚，浊邪内停。望诊面色黧黑，舌红苔薄白中裂纹。闻诊未提及。问诊小便淋漓不畅、尿频尿急、水肿、心慌、胸闷、乏力、纳差。切诊脉结。

67岁男性，胸闷、气短、咳脓血半年，加重半个月。面色萎黄，双下肢凹陷性水肿，纳呆，食后腹胀痛，夜间发热，舌暗苔黄腻，脉弦细。中医诊断肺积，证属痰瘀毒蕴肺，热伤血络。舌暗，苔黄腻，脉弦细。面色萎黄，双下肢水肿，夜间发热，纳呆，腹胀痛，大便不畅。舌暗，苔黄厚腻，脉细滑。舌暗，苔白厚腻，脉细缓。

患者55岁，男性，慢性咳嗽20余年，近半月加重，咳黄色黏性痰，伴气促、低热、双下肢浮肿。中医诊断肺胀，证型为心肺脾肾虚，外感偏热，水肿型。舌质晦暗，胖有齿印，舌苔黄腻厚，脉滑数。体征见呼吸短促，口唇发绀，双下肢水肿，肺部呼吸音减弱，湿性啰音，心律失常，高血压病史，吸烟史。

82岁女性，反复咳嗽、咳痰20年，喘累8年，心悸5年，复发3天。咳嗽、咳白色泡沫痰，心悸，动则喘累，纳呆，听力下降，尿多，双下肢水肿。肺胀，脾肾阳虚，痰湿内停。面色晦暗，舌淡，苔白，脉沉弱。颈静脉怒张，桶状胸，双肺散在干鸣音，中下部湿啰音，心率104次/分，肝右肋下2cm，双下肢水肿。

女，46岁，肝硬化病史10余年，食欲不振，劳累后乏力，尿量减少，腹胀，下肢水肿，气短喘促，不能平卧，畏寒乏力，舌淡体胖边有齿痕，苔白，脉细弱。肝炎肝硬化（肝功能B级），肝性胸水（左侧）。饮证（脾阳不振、水饮凌心型）。

77岁男性，反复活动后呼吸困难6年，加重伴双下肢水肿1周。心衰病史20年，现症见呼吸困难、不能平卧、夜间阵发性呼吸困难、尿少、双下肢浮肿、肢冷。舌淡苔白，脉沉细。心音低钝，右肺底湿啰音，双下肢水肿。心脏彩超示左心室扩大，LV EF 42%。中医辨证为心肾阳虚，水饮内停。