睡眠差

患者49岁，男性。主诉胃脘痞闷不适伴发作性心慌2年。主要症状包括胃脘痞闷、腹部隐痛、腹胀、嗳气、晨起口苦、发作性心慌、饥饿感，进食后缓解。纳眠差，大便质稀，1~2日1次。舌象澹白苔，脉象弦长稍数。中医诊断痞满，辨证为湿热内蕴，困阻脾胃，气机不利。

女性，48岁，眩晕，头部沉重感，左侧面颜部突发闪电式针刺样剧痛，病程2年。三叉神经痛，风阳上扰，痰热瘀阻，苔腻微黄，舌暗红，脉弦。

金xx，男，52岁。主诉心绞痛，胸痛彻背，胸闷，心慌，血压偏高，睡眠不佳。病程较长，曾住院治疗。面色灰暗，脉右沉濡，左沉弦细，舌正常无苔。中医诊断心气不足，营气不调。病因病机为心气不足，营卫不调。舌象正常无苔，脉象右沉濡，左沉弦细。

80岁男性，反复头痛、头晕12年，伴间歇性四肢畏寒7年。头痛、头晕，心烦易怒，手足心热，盗汗明显，四肢畏寒，腰膝酸软乏力，口干苦，胃纳欠佳，大便干结，睡眠欠佳，耳鸣，舌红少苔，脉细弦。中医病名未明确提及，证型为阴虚血少肝旺。望诊见舌红少苔，切诊见脉细弦。病程长，症状复杂，阴虚与阳虚并见。

患者54岁，女性。主诉阵发头晕2年，加重1个月。舌质黯红，苔黄少津，脉细弦。中医诊断眩晕，属肝阳上亢，肝肾阴虚。病程2年，情绪焦虑诱发，伴面部潮热、心烦、口干、汗出、睡眠差、小便色黄、大便干燥。血压165/80mmHg。

李某，38岁，男性。反复胃脘疼痛6年。隐痛，有时胀痛，偶有反酸、嗳气，口干不苦，纳差，睡眠差，大便不畅，尚成形。舌淡暗，苔薄黄，脉细数。证属脾胃虚弱，湿热内蕴。

75岁男性，反复心悸、胸闷4年，伴浮肿3月。心悸、胸闷、气短乏力、肢体沉重、畏寒、纳呆、睡眠差、全身浮肿。舌质淡红，边有瘀点，苔白根部稍厚。脉结代。诊断为心悸、胸闷、气短乏力、肢体沉重、畏寒、纳呆、睡眠差、全身浮肿。病机为脾胃虚弱、痰湿内生、痰阻脉络、心失所养。

张某，女性，30岁。主诉颈项疼痛伴头痛5天，颈项持续性酸胀刺痛，疼痛向后枕部及右侧头部放射，右眼发胀，右鼻塞，疼痛剧烈时感恶心欲吐，劳累及颈部活动时加重，睡眠差。舌淡苔白，脉弦涩。中医诊断项痹病，证型气滞血瘀证。

男，48岁，发作性胸痛伴胸闷、心慌、气短近一年。心痛彻背，颈背牵强，心悸，胸闷，气短，易汗出，头痛头晕，睡眠极差，食纳差，大便干，双下肢偶有轻度浮肿，舌质正常，苔白稍腻，脉沉细。高师认为长期应用活血化瘀方药致心阳不振，营卫失调。

周某，男，65岁，右下肺肿物，抗结核治疗无效，术后诊断为肺泡细胞癌、乳头状腺癌。体虚乏力，咳嗽痰多，自汗盗汗，食欲不振，睡眠差，苔黄腻，脉沉细。气短，中气不足，周身乏力，纳差食少，恶心呕吐，大便干，舌瘀暗，苔黄，脉细数。中气不足，动甚气短，偶有咳嗽，自汗，睡眠差，舌略暗，苔薄黄，脉细。肺积，正虚邪实，气阴两虚，瘀毒内阻，痰凝气滞。面色晦暗，舌瘀暗，苔黄腻、苔黄、苔薄黄，脉沉细、脉细数、脉细。

45岁，耳鸣声如雷鸣，头晕，听力下降，干呕，纳谷不香，咽干口苦，小便色黄，大便干结，睡眠欠佳。舌红，苔黄腻，脉弦滑数。中医病名耳鸣，证属痰火上扰，耳窍闭塞。病因病机为肝气不舒，郁而化火，痰火上扰。望诊舌红苔黄腻，闻诊无特殊，问诊有耳鸣、头晕、干呕、纳差、口苦、便结、失眠，切诊脉弦滑数。

44岁，神疲体倦，两胁胀痛，腹胀，纳少，睡眠差，小便黄，苔薄黄腻，脉弦细。证属肝郁脾虚，气滞血瘀。面色晦暗，舌苔薄黄腻，脉弦细。病程较长，有肝炎史15年余，曾行肝癌根治术。

男，36岁，神疲体倦、血脂增高2月，舌质暗，舌苔稍黄腻，脉滑细，证属肝脾失调，痰浊血瘀致病，头胀且重，脘腹痞满，体重渐增，右胁隐痛，睡眠差，小便黄，大便稀溏。

患者62岁，女性。主诉胸闷气促、活动后加重，时感心慌心悸，腰痛畏寒，稍咳少痰，食欲不振，睡眠差。面色无华，舌淡，苔少，脉结代。中医辨证为脾肾两虚，瘀毒阻滞，水湿聚积。望诊见面色无华，舌淡苔少。闻诊未见明显异常。问诊见胸闷气促、心慌心悸、腰痛畏寒、咳嗽少痰、食欲不振、睡眠差。切诊见脉结代。

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患者男性，47岁。病程3年，主要症状为下肢酸胀乏力、下半身汗多、寐差梦多、动则气短、大便色黑。舌质紫，苔薄白，脉弦滑。中医诊断为饮邪蕴滞，经脉失调。病因病机为饮邪蕴滞，经脉失调。四诊信息包括舌质紫、苔薄白、脉弦滑。

72岁男性，记忆锐减34天，反应迟钝，头痛，口中苦，睡眠差，右手麻木，舌质澹红，苔薄白，脉细弦。中医病名呆病，证型肾虚髓亏证。舌质澹红，苔薄白，脉细弦。智能障碍，血管性痴呆，右枕叶低密度灶，脱髓鞘改变。

患者28岁，男性，主诉早泄半年，伴睡眠差、多梦、尿频。既往有慢性前列腺炎病史，前列腺液检查示白细胞2~4个，卵磷脂小体+~++/HP。中医诊断为早泄、慢性前列腺炎。辨证为心脾失调、肾虚精关不固证。望诊未提及，闻诊未提及，问诊示睡眠差、多梦、尿频，切诊示脉沉细。

患者女，30岁。四肢末梢针刺感，晨起发红继发凉，肢端苍白疼痛麻木，手指僵硬，右足较重，桡骨动脉未扪及，遇冷痛甚。面色无华，四肢末端青紫，冷感麻木，舌质澹紫，苔薄白而润，脉弦细。中医诊断为脾肾阳虚，气滞血瘀，寒凝络阻。病程较长，症状随季节变化，表现为寒热错杂之象。

患者年龄47岁，主诉心悸反复发作2年，病程较长。主要症状为心悸不宁，用脑后尤甚，伴心前区隐痛，睡眠差。舌质红，苔薄白，脉细弦不齐。中医诊断为心血亏虚，病机为血虚不能养心，心神失养。