5.3 语境学习法
语境（context）指某个词、句的上下文或语言使用的环境。词汇和语境相互依存，脱离了语境，词汇的意义就不明确。词汇只有在具体的语境中才能表达其准确的词义。词汇与阅读相互制约，阅读能力的高低与词汇量的大小息息相关。语境学习法是提高医学术语习得效果的有效途径。Nation（1990）认为脱离语境的学习对了解术语的用法没有意义，而在广泛的阅读中，由于理解文章的需要，学习者就会将认知重点放在词汇的意义和用法上。结合语境学习医学术语，有助于理解术语的真正含义。在理解的基础上进行的术语记忆效果会更好。在语境中学习医学术语有助于学习者快速理解医学术语在语境中的含义，从而提升文献阅读速度。下面举例分析。
例1 （S1）Arteriosclerosis is a hardening of arterial walls that causes them to become thickened and brittle.（S2）This hardening results from a build-up of a plaque-like substance composed of cholesterol，lipids，and cellular debris（atheroma）.（S3）Over time，it builds up on the inside lining of the arterial walls.（S4）Eventually，the plaque hardens（atherosclerosis），causing the vessel to lose elasticity.（S5）The lumen narrows as the plaque becomes larger.（S6）After a while，it becomes difficult for blood to pass through the blocked areas.（S7）Tissues distal to the occlusion become ischemic.（S8）In many instances，blood hemorrhages into the plaque and forms a clot（thrombus）that may dislodge.（S9）When a thrombus travels through the vascular system it is called an embolus（plural，emboli）.（S10）Emboli in venous circulation may cause death.（S11）Emboli in arterial circulation commonly lodge in a capillary bed and cause localized tissue death（infarct）.（S12）Sometimes plaque weakens the vessel wall to such an extent that it forms a bulge（aneurysm）that may rupture.（S13）Arteriosclerosis usually affects large-or medium-sized arteries，including the abdominal aorta；coronary，cerebral，and renal arteries；and major arteries of the legs（femoral arteries）.（S14）One of the major risk factors for developing arteriosclerosis is an elevated cholesterol level（hypercholesterolemia）.（S15）Other major risk factors include age，family history，smoking，hypertension，and diabetes.（S16）Treatment for arthrosclerosis varies depending on the location and symptoms.（S17）In one method，occluding material and plaque are removed from the innermost layer of the artery（endarterectomy）.（S18）In this procedure，the surgeon opens the site and removes the plaque，thereby resuming normal blood flow.（S19）Physicians commonly use endarterectomy to treat carotid artery disease，peripheral arterial disease，and diseases of the renal artery and aortic arch.（S20）In order for the heart to function effectively，it must receive an uninterrupted supply of blood.（S21）This blood is delivered to the heart muscle by way of the coronary arteries.（S22）Failure of the coronary arteries to deliver an adequate supply of blood to the myocardium is called coronary artery disease（CAD）.（S23）Its major cause is the accumulation of plaque that causes the walls of the artery to harden（arteriosclerosis）.（S24）With partial occlusion，localized areas of the heart experience oxygen deficiency（ischemia）.（S25）When the occlusion is total or almost total，the affected area of the heart muscle dies（infarction）.（S26）The clinical signs and symptoms of myocardial infarction（MI）typically include intense chest pain（angina），profuse sweating（diaphoresis），paleness，and labored breathing（dyspnea）.（S27）Arrhythmia with an abnormally rapid heart rate（tachycardia）or an abnormally slow heart rate（bradycardia）may also accompany an MI.
医学术语语境学习法分析：
注解：（S＝Sentence）
S1 Arteriosclerosis is a hardening of arterial walls that causes them to become thickened and brittle.
分析：通过上下文a hardening of arterial walls（动脉壁变硬）、become thickened and brittle（变厚且易脆），便可知道arteriosclerosis表示“动脉粥样硬化，表现为动脉壁变硬、增厚，造成血管脆弱”。
S2 This hardening results from a build-up of a plaque-like substance composed of cholesterol，lipids，and cellular debris（atheroma）.
分析：通过上下文中关键词build-up（积聚）、plaque-like substance（粥样斑），便可知道硬化的原因是粥样斑积聚。通过上下文plaque-like substance composed of cholesterol，lipids，and cellular debris（atheroma），便得知atheroma是由胆固醇、脂肪和细胞碎屑积聚增多后形成的粥样斑。
S4 Eventually，the plaque hardens（atherosclerosis），causing the vessel to lose elasticity.
分析：通过上下文the plaque hardens（斑块变硬），便可知道atherosclerosis表示“动脉粥样斑增多使血管变硬”，导致血管弹性（elasticity）下降。
S6 After a while，it becomes difficult for blood to pass through the blocked areas.S7 Tissues distal to the occlusion become ischemic.
分析：通过上下文it becomes difficult for blood to pass through the blocked areas（血液很难通过堵塞部位），所以必然导致tissues distal to the occlusion（堵塞点远端组织）become ischemic，根据常识和上下文判断，ischemic表示“因为血液很难通过堵塞部位，所以必然导致堵塞点远端组织得不到足够的血液供应，也就是缺血”。因此，ischemic就表示“缺血”。
S8 In many instances，blood hemorrhages into the plaque and forms a clot（thrombus）that may dislodge.
分析：通过上下文blood hemorrhages into the plaque（斑块出血）and forms a clot（形成血凝块），便可知道thrombus表示“因为斑块出血后形成的血凝块，也就是血栓”。
S9 When a thrombus travels through the vascular system it is called an embolus（plural，emboli）.
分析：通过上下文thrombus travels through the vascular system（血栓物在血管内游走）便可知道embolus表示“血管中游走的血栓”，也就是“栓子”。
S11 Emboli in arterial circulation commonly lodge in a capillary bed and cause localized tissue death（infarct）.
分析：通过上下文Emboli in arterial circulation commonly lodge in a capillary bed（栓子常常停留在毛细血管床）便可知道栓子容易造成毛细血管完全堵塞，因为毛细血管内径太窄，而毛细血管堵塞容易造成局部组织坏死，所以infarct的含义就是death of localized tissue death（局部组织坏死，或称梗死）。
S12 Sometimes plaque weakens the vessel wall to such an extent that it forms a bulge（aneurysm）that may rupture.
分析：通过上下文plaque weakens the vessel wall（斑块会削弱血管壁）to such an extent that it forms a bulge（凸出）that may rupture（破裂），便可知道aneurysm的含义就是因为斑块使血管壁薄弱、膨出从而造成破裂的风险，这就是所谓的“动脉瘤”。
S13 Arteriosclerosis usually affects large-or medium-sized arteries，including the abdominal aorta；coronary，cerebral，and renal arteries；and major arteries of the legs（femoral arteries）.
分析：由上下文语境，femoral arteries指的是the major arteries of the legs（腿部大动脉），而只要具备基本解剖知识便知道腿部大动脉就是股动脉，因此，femoral arteries指的就是“股动脉”。
S14 One of the major risk factors for developing arteriosclerosis is an elevated cholesterol level（hypercholesterolemia）.
分析：通过上下文elevated cholesterol level（高胆固醇水平）以及hypercholesterolemia术语中的后缀-emia（condition of blood）便可知道hypercholesterolemia表示“高胆固醇血症”。
S17 In one method，occluding material and plaque are removed from the innermost layer of the artery（endarterectomy）.
分析：通过上下文得知endarterectomy指的是occluding material and plaque are removed from the innermost layer of the artery（切除动脉内层堵塞物及斑块），也就是“动脉内膜切除术”。
S22 Failure of the coronary arteries to deliver an adequate supply of blood to the myocardium is called coronary artery disease（CAD）.
分析：通过上下文中关键词coronary arteries（冠状动脉）、to deliver an adequate supply of blood to（供血给某个部位），通过医学常识，我们可以判断冠状动脉供血的部位是心肌，因此，术语myocardium的含义是“心肌”。
S24 With partial occlusion，localized areas of the heart experience oxygen deficiency（ischemia）.
分析：通过上下文oxygen deficiency（局部缺氧，而缺氧由缺血引起，因为氧气是以与血红蛋白结合的形式（氧合血红蛋白）被运送到组织细胞为细胞活动所需，缺氧的前提是缺血）便可以判断ischemia的含义是“局部缺血”。
S25 When the occlusion is total or almost total，the affected area of the heart muscle dies（infarction）.
分析：通过上下文the heart muscle dies便可知道infarction的含义是“梗死”。
S26 The clinical signs and symptoms of myocardial infarction（MI）typically include intense chest pain（angina），profuse sweating（diaphoresis），paleness，and labored breathing（dyspnea）.
分析：通过上下文intense chest pain便可知道angina的含义是“剧烈胸痛（心绞痛）”；从上下文profuse sweating便得知diaphoresis的含义是“大量出汗”；由labored breathing便知道dyspnea的含义是“呼吸困难”。
S27 Arrhythmia with an abnormally rapid heart rate（tachycardia）or an abnormally slow heart rate（bradycardia）may also accompany an MI（myocardial infarction）.
分析：通过上下文abnormally rapid heart rate便得知tachycardia的含义是“心率异常加快（心动过速）”；通过上下文an abnormally slow heart rate便得知bradycardia的含义是“心率异常缓慢（心动过缓）”；通过上下文arrhythmia包含tachycardia（心动过速）和bradycardia（心动过缓）的情况，加上该术语的前缀a-（表示“不，无，非”），因此，可以判断该术语表示“心率不正常或心率失常”。
例2 （S1）The heart and circulatory system make up your cardiovascular system.（S2）Your heart works as a pump that pushes blood to the organs，tissues，and cells of your body.（S3）Blood delivers oxygen and nutrients to every cell and removes the carbon dioxide and waste products made by those cells.（S4）Blood is carried from your heart to the rest of your body through a complex network of arteries，arterioles，and capillaries.（S5）Blood is returned to your heart through venules and veins.（S6）If all the vessels of this network were laid end to end，they would extend for about 60，000 miles（more than 96，500 kilometers），which is far enough to circle the planet Earth more than twice.（S7）The one-way system carries blood to all parts of your body.（S8）This process of blood flow within your body is called circulation.（S9）Arteries carry oxygen-rich blood away from your heart，and veins carry oxygen-poor blood back to your heart.（S10）In pulmonary circulation，though，the roles are switched.（S11）It is the pulmonary artery that brings oxygen-poor blood into your lungs and the pulmonary vein that brings oxygen-rich blood back to your heart.
医学术语语境学习法分析：
S1 The heart and circulatory system make up your cardiovascular system.
分析：通过上下文The heart and circulatory system（心脏与循环系统）make up your cardiovascular system便可知道cardiovascular system指的是“心脏与循环系统”，也就是“心血管系统”。
S3 Blood delivers oxygen and nutrients to every cell and removes the carbon dioxide and waste products made by those cells.(https://www.daowen.com)
分析：通过上下文Blood delivers oxygen and nutrients to every cell（血液递送氧气和营养物给细胞），and removes（清除……）the carbon dioxide and waste products made by those cells（细胞产生的carbon dioxide和废物），根据常识便可判断carbon dioxide表示“二氧化碳”，因为细胞代谢会产生废物，还会产生二氧化碳。
S4 Blood is carried from your heart to the rest of your body through a complex network of arteries，arterioles，and capillaries.Blood is returned to your heart through venules and veins.
分析：通过上下文Blood is carried from your heart to the rest of your body through a complex network（血液从心脏通过一个复杂的网络输送到身体的其他部位）便得知arteries，arterioles，and capillaries表示“血管”，而通过常识便知道将血液从心脏运输出去的血管由大到小，我们判断arteries表示大血管“动脉”，然后是arterioles（小动脉），再是capillaries（毛细血管）；通过上下文Blood is returned to your heart through venules and veins（血液通过血管回流到心脏），根据常识我们知道血液是通过静脉回流到心脏，因此判断venules and veins表示“静脉”，而按血流路径，先是小静脉，再是静脉，最后通过腔静脉回到右心房，所以便得知venules表示“小静脉”，veins表示“静脉”。
S8 This process of blood flow within your body is called circulation.S9 Arteries carry oxygen-rich blood away from your heart，and veins carry oxygen-poor blood back to your heart.In pulmonary circulation，though，the roles are switched.
分析：通过上下文This process of blood flow within your body is called circulation便可判断circulation表示（血液在体内流动的过程）。通过上下文Arteries carry oxygen-rich blood away from your heart（动脉将……丰富的血液从心脏输送出去），and veins carry oxygen-poor blood back to your heart（静脉将……贫乏的血液输送回心脏），根据常识，便知道oxygen-rich blood的含义是“含氧丰富的血液”，而oxygen-poor blood的含义是“缺氧的血液”。通过上下文In pulmonary circulation，though，the roles are switched（在肺循环中，角色发生互换）便得知肺动脉血实际上为“缺氧的血液”，而肺静脉血实际上为“含氧丰富的血液”。
例3 （S1）Asthma produces spasms in the bronchial passages（bronchospasms）that may be sudden and violent（paroxysmal）and lead to dyspnea.（S2）Asthma is commonly caused by exposure to allergens or irritants.（S3）Other causes include stress，cold，and exercise.（S4）During recovery，coughing episodes produce large amounts of mucus（productive cough）.（S5）Over time，the epithelium of the bronchial passages thickens，and breathing becomes more difficult.（S6）Treatment includes agents that loosen and break down mucus（mucolytics）and medications that expand the bronchi（bronchodilators）by relaxing their smooth muscles.（S7）If usual measures do not reverse the bronchospasms，the condition is referred to as status asthmaticus.
医学术语语境学习法分析：
S1 Asthma produces spasms in the bronchial passages（bronchospasms）that may be sudden and violent（paroxysmal）and lead to dyspnea.
分析：通过上下文spasms in the bronchial passages（支气管痉挛）便知道bronchospasms的含义是“支气管痉挛”；通过上下文sudden and violent便得知paroxysmal表示“发生突然且剧烈”，也就是“阵发性的、突发性的”。
S2 Asthma is commonly caused by exposure to allergens or irritants.S3 Other causes include stress，cold，and exercise.
分析：通过上下文exposure to allergens or irritants中的or便可知道allergens与irritants意思相同或相近，因此，可以判断allergens是一种irritants“刺激物（过敏原）”。
S4 During recovery，coughing episodes produce large amounts of mucus（productive cough）.
分析：通过上下文coughing episodes produce large amounts of mucus（咳嗽发作时会产生大量黏液）便可得知productive cough表示“有痰咳嗽”。
S6 Treatment includes agents that loosen and break down mucus（mucolytics）and medications that expand the bronchi（bronchodilators）by relaxing their smooth muscles.
分析：通过上下文得知agents that loosen and break down mucus（稀释分解黏液的药物）便可得知mucolytics表示“化痰药物”。由上下文medications that expand the bronchi（扩张支气管的药物）便可知道bronchodilators表示“支扩剂”。
S7 If usual measures do not reverse the bronchospasms，the condition is referred to as status asthmaticus.
分析：通过上下文usual measures do not reverse the bronchospasms（用通常使用的方法并不能逆转支气管痉挛这种状况）便可得知status asthmaticus指的是“支气管痉挛持续存在的状态”。
例4 （S1）Any abnormal fluid in the pleural cavity，the space between the visceral and parietal pleura，is called pleural effusion.（S2）Normally，the pleural cavity contains only a small amount of lubricating fluid.（S3）However，some disorders may cause excessive fluid to collect in the pleural cavity.（S4）Two initial techniques used to diagnose pleural effusion are auscultation and percussion.（S5）Auscultation is the listening of sounds made by organs of the body using a stethoscope.（S6）Percussion is the gentle tapping on the chest with the fingers and listening to the resultant sounds to determine the position，size，or consistency of the underlying structures.（S7）Chest x-ray（CXR）or magnetic resonance imaging（MRI）confirms the diagnosis.（S8）Effusions are classified as transudates and exudates.（S9）A transudate is a noninflammatory fluid that resembles serum but w ith slightly less protein.（S10）It results from an imbalance in venous arterial pressure or decrease of protein in blood.（S11）Both of these conditions allow serum to leak from the vascular system and collect in the pleural space.（S12）Common causes include left ventricular heart failure and liver disorders.（S13）An exudate is usually high in protein and often contains blood and immune cells.（S14）Common causes include tumors，infections，and inflammation.（S15）Various types of pleural effusions include serum（hydrothorax），pus（empyema or pyothorax），and blood（hemothorax）.（S16）Although not considered as pleural effusion，air can enter the pleural space（pneumothorax），resulting in a partial or complete collapse of a lung.
（S17）Treatment consists of correcting the underlying cause of the effusion.（S18）Often a surgical puncture of the chest using a hollow-bore needle（thoracocentesis，thoracentesis）is undertaken to remove excess fluid for diagnostic or therapeutic purposes.（S19）Sometimes chest tubes are inserted to drain fluid or remove air in pneumothorax.
医学术语语境学习法分析：
S4 Two initial techniques used to diagnose pleural effusion are auscultation and percussion.S5 Auscultation is the listening of sounds made by organs of the body using a stethoscope.S6 Percussion is the gentle tapping the chest with the fingers and listening to the resultant sounds to determine the position，size，or consistency of the underlying structures.
分析：通过上下文得知auscultation and percussion指的是胸腔积液的两种主要检查手段（Two initial techniques used to diagnose pleural effusion）；通过上下文auscultation is the listening of sounds made by organs of the body using a stethoscope，得知auscultation这种检查手段是通过用听诊器听身体器官发出的声音，因此判断ausculation表示“听诊”；通过上下文percussion is the gentle tapping the chest with the fingers and listening to the resultant sounds to determine the position，size，or consistency of the underlying structures（用手指轻轻叩击胸部，并用听诊器听声音，以确定解剖结构的部位、大小或一致性）得知percussion的含义是“触诊”。
S8 Effusions are classified as transudates and exudates.
分析：通过上下文判断transudates与exudates都属于effusions（渗漏物），通过transudates术语中的前缀trans-（穿过，跨过）可以判断这种渗液是跨膜渗出，而通过exudates术语的前缀ex-（出去）可以判断该术语表示“液体渗出”。
S15 Various types of pleural effusions include serum（hydrothorax），pus（empyema or pyothorax），and blood（hemothorax）.S16 Although not considered as pleural effusion，air can enter the pleural space（pneumothorax），resulting in a partial or complete collapse of a lung.
分析：通过上下文Various types of pleural effusions（几种不同的胸腔积液）include serum（hydrothorax），pus（empyema or pyothorax），and blood（hemothorax）判断hydrothorax，empyema or pyothorax以及hemothorax指的是“几种不同的胸腔积液”。根据积聚物质的种类，有不同的命名，从上下文serum（血清）可以判断hydrothorax是因为血清积聚造成，因此该术语的含义就是“水胸”，从pus（脓）判断empyema or pyothorax的含义是“脓胸”，而从上下文blood（血）判断hemothorax的含义是“血胸”。
S18 Often a surgical puncture of the chest using a hollow-bore needle（thoracocentesis or thoracentesis）is undertaken to remove excess fluid for diagnostic or therapeutic purposes.
分析：通过上下文a surgical puncture of the chest using a hollow-bore needle（用空针穿刺胸部以抽出液体用于诊断或治疗）判断thoracocentesis或thoracentesis的含义是“胸腔穿刺术”。
例5 （S1）Pneumonia is any inflammatory disease of the lungs that may be caused by bacteria，viruses，or fungi.（S2）Chemicals or other agents can cause the lungs to become inflamed.（S3）A type of pneumonia associated with influenza is sometimes fatal.（S4）Other potentially fatal pneumonia may result from food or liquid inhalation（aspiration pneumonia）.（S5）Some types of pneumonia affect only a lobe of the lung（lobar pneumonia），but some others are more diffuse（bronchopneumonia）.（S6）Chest pain，mucopurulent sputum，and spitting of blood（hemoptysis）are common signs and symptoms of the disease.（S7）If the air in the lungs is replaced by fluid and inflammatory debris，the lung tissue loses its spongy texture and becomes swollen and engorged（consolidation）.（S8）Consolidation is associated primarily with bacterial pneumonia，not viral pneumonia.（S9）Pneumocystis carinii pneumonia（PCP）is a type of pneumonia closely associated with AIDS.（S10）Recent evidence suggests that it is caused by a fungus that resides in or on most people（normal flora）but causes no harm as long as the individual remains healthy.（S11）When the immune system begins to fail，this organism becomes infectious（opportunistic）.（S12）Diagnosis relies on examination of biopsied lung tissue or bronchial washings（lavage）.
医学术语语境学习法分析：
S1 Pneumonia is any inflammatory disease of the lungs that may be caused by bacteria，viruses，or fungi.
分析：通过上下文any inflammatory disease of the lungs（肺部的炎性疾病）判断pneumonia的含义是“肺炎”。
S4 Other potentially fatal pneumonia may result from food or liquid inhalation（aspiration pneumonia）.S5 Some types of pneumonia affect only a lobe of the lung（lobar pneumonia），but some others are more diffuse（bronchopneumonia）.
分析：通过上下文other potentially fatal pneumonia may result from food or liquid inhalation（因吸入液体引起的致命性肺炎）便可以判断aspiration pneumonia的含义是“吸入性肺炎”；从上下文pneumonia affect only a lobe of the lung判断lobar pneumonia指的是“累及整叶肺的肺炎（大叶性肺炎）”；从上下文some are more diffuse（弥散的）判断bronchopneumonia指的是“病灶弥散型肺炎”，而bronchopneumonia术语词素bronch／o表示“支气管”，所以我们得知这个术语表示“支气管肺炎”。
S6 Chest pain，mucopurulent sputum，and spitting of blood（hemoptysis）are common signs and symptoms of the disease.
分析：通过上下文spitting of blood（痰中带血）可以判断hemoptysis的含义是“咯血”。
S7 If the air in the lungs is replaced by fluid and inflammatory debris，the lung tissue loses its spongy texture and become swollen and engorged（consolidation）.
分析：通过上下文the lung tissue loses its spongy texture and become swollen and engorged（肺组织失去了海绵状结构，变得肿胀和充盈）可以判断consolidation的含义是“肺部实变”。
S11 When the immune system begins to fail，this organism becomes infectious（opportunistic）.
分析：通过上下文When the immune system begins to fail，this organism becomes infectious（opportunistic）（当免疫系统功能开始衰退时，这种微生物（病原体）就会具有传染性，便可以判断opportunistic的含义是“机会性感染”，也就是一些致病力较弱的病原体，在人体免疫功能正常时不能致病，但当人体免疫功能降低时，它们乘虚而入，侵入人体内，导致各种疾病。
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