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1、13-yr-oldfemaleC/O:Vomiting（呕吐）HPC:Suddenonsetofvomiting6hoursago,vomitfoodonly.Associatedfeatures:exhausted;pallorcomplexion;limbscoldandsweating.（疲倦乏力，面色苍白，肢冷汗多）O/E:CVS:BP:105/70mmhg,HR:123/min,nomurmurs;GIT:soft,nomess,nopalpableliverandspleen;（腹软，肝脾不大）RS,CNS:normal.Investigation:bloodsodiuma
2、ndpotassiumslightlyfall（低钠，低钾血症）Diagnosis:Gastritis,moderatedehydration.（急性胃炎，中度脱水）Treatment:Rehydration.（补液治疗）Result:deterioratedanddied.1病毒性心肌炎 (viralmyocarditis,VMC)PediatricAcademicGroupSally2目的与要求（objectiveandrequirement）:1、掌握中医辨证论治与西医治疗原则。Master:selectionoftreatmentbaseondifferentialofsyn
3、dromesintraditionalChinesemedicineandtherapeuticprincipleofWesternmedicine.2、熟悉病因病理。Familiar:diagnosis,pathogenicandpathology.3、了解概念，研究进展。Understand:definitionandresearchprogress.3概述（summarization）1.定义：病毒侵犯心脏所致的，以心肌的局限性或弥漫性炎性病变为主要表现的疾病。Definition:inflammationofmyocardiumcausebyviralinfection.(pe
4、ricardiumorendocardium)2.典型症状：神疲乏力，面色苍白，心悸气短，肢冷多汗。Typicalsymptom:exhausted,pallorcomplexion,palpitations,shortnessofbreath,limbscoldandexcessivesweating.3.中医属温病、怔忡、胸痹、虚劳等范畴。Seasonalfebriledisease,severepalpitation,chestbi-syndromeandconsumptivedisease.4概述（summarization）4.中医文献论述(referent)：（1）《小儿药
5、证直决·脉证治法》：“心主惊……，虚则卧而悸动不安。”（2）《张氏医通·神志门》：“夫悸之症状不齐，总不外乎心伤而火动，火郁而生涎也。若夫虚实之分，气血之辨，痰与饮，寒与热，外感六淫，内伤七情，在临证辨之。”（3）《伤寒论·辨太阳病脉证并治》：“伤寒脉结代，心动悸，炙甘草汤主之。”5中医病因病机（aetiologyandpathogenesis)风热侵心气阴受损正气袭肺卫邪毒心血瘀滞内舍痰瘀互结不足湿热困于心心阳虚衰阻脾胃水湿内停病因是风热、湿热(wind－heat,dampness－heat)之入侵；病机是邪毒内损于心，心脉痹阻(stagnationofheartmeridian)。
6、瘀血，痰浊(stagnationofblood,phlegm)是病理产物。6病因和发病机制（pathogenicandpathogenesis）一、病因(pathogenic)：肠道和呼吸道病毒。最常见CVB1~6。Morethan20kindsofvirus，includingrespiratoryvirusandintestinalvirus，themostcommoniscoxsackievirusB.二、发病(pathogenesis)病毒血循环心肌自身免疫(autoimmunity)毒素细胞补体参与(complement)细胞因子(cytokine)神经体液(nerveand
7、humor)脂质过氧化物(lipidperoxide)7病因和发病机制（pathogenicandpathogenesis）三、病理（pathologic）：炎症细胞浸润、心肌细胞变性坏死、心肌纤维化、瘢痕形成。8Whenthereismarkedcellularinjury,thereiscelldeath.Thismicroscopicappearanceofmyocardiumisamessbecausesomanycellshavedi
