脈診

Pulse-taking脈診

Pulse-taking脈診是醫(yī)者用手指觸按患者一定部位的脈搏，以體察脈象、了解病情的一種診病方法。機(jī)理—略脈象的形成與諸臟腑、氣血的功能密切相關(guān)。心臟與血脈緊密相連；心氣心陽推動血液通過脈管而布運全身，內(nèi)人五臟六腑，外至四肢百骸，運行不息，并導(dǎo)致脈搏的跳動。另外，心對于血液的生成具有一定的作用。肺主氣，“肺朝百脈”，肺氣的敷布是心對血液推動作用的輔助。脾胃為“氣血生化之源”；脾又主統(tǒng)血，血液在脈管內(nèi)流行不致逸出脈外，有賴脾氣的統(tǒng)攝。肝主疏泄，對于全身氣機(jī)的調(diào)暢起著重要的作用，并促進(jìn)血液營運不休；肝又主藏血，能調(diào)節(jié)血流量。腎藏精，腎中精、氣、陰、陽是人體各臟腑陰、陽的根本；且精可以化生血，腎精充足，則血有所充。Pulse-takingmeansthatthedoctoruseshisorherhandtopresscertainpartofthepatient'spulsetoexaminetheconditionsofthepulseanddiagnosedisease.Thepulseconditionsarecloselyrelatedtothevisceraandqiandblood.Theheartisconnectedwiththevessels:theheartqipropelsbloodtocirculateinthevesselsallthroughthebody,thatis,fromvisceratoallthelimbsandjointsofthebody.Suchanincessantcirculationleadstothepulsationofthevessels.Besides,theheartexertscertaineffectontheproductionofblood.Thelunggovernsqiand"connectswithallvessels".Thedistributionofpulmonaryqihelpstheheartpropelblood.Thespleenandthestomachare"thesourceofqiandblood";thespleendirectbloodtocirculateinthevessels.Thelivergovernsconveyanceandcoursing,regulatingtheactivityofqithroughthebodyandpromotingbloodcirculation;theliveralsostoresbloodandregulatestheflowofblood.Thekidneystoresessence;thekidneyessence,qi,yinandyangconstitutethesourceofyinandyangintheotherviscera.Sinceessencecantransformintoblood,theexuberanceofkidneyessenceensuressufficiencyofbloodinthebody.脈診

Pulse-taking機(jī)理--脈為血之府，是氣血運行的通道。氣血的盛衰和運行狀況，脈管的緊張度、彈性、粗細(xì)等，直接對脈象產(chǎn)生影響。因此，人體各臟腑功能活動及氣、血、津液的盛衰和運行狀況，都可以直接或間接地對脈象產(chǎn)生影響。當(dāng)致病因素作用于人體，引起臟腑、氣、血、津液的功能失常，脈象亦隨之發(fā)生改變。故通過診脈可以診察疾病。Thevesselsaretheorganstoholdbloodandthepathwaysforqiandbloodtocirculate.Theconditionsandcirculationofqiandbloodaswellasthetensity,elasticityandthicknessofthevesselsdirectlyinfluencethestatesofpulse.Besides,thefunctionalactivitiesofallvisceraaswellastheconditionsandcirculationofqi,bloodandbodyfluidinthemallcandirectlyorindirectlyaffectthestatesofpulse.Whenpathogenicfactorsinvadethebodyandcausedysfunctionoftheviscera,qi,bloodandbodyfluid,theconditionsofpulsewillchangeaccordingly.Therefore,examinationofpulsecanhelpdiagnosisofdiseases.診脈的部位

Regionsfortakingpulse現(xiàn)在通行的是診寸口。寸口又稱“氣口’’或“脈口”，即手腕后橈動脈搏動處。寸口位于手太陰肺經(jīng)的脈動應(yīng)手之處，是肺經(jīng)氣血流通之處，同時，全身臟腑氣血循行都要流經(jīng)肺而大會于寸口；手太陰肺經(jīng)起于中焦，與足太陰脾經(jīng)相通，而脾胃為氣血生化之源，后天之本，故寸口可以反映胃氣的強(qiáng)弱。另外，肺經(jīng)為十二經(jīng)之始終，十二經(jīng)氣血循環(huán)流注起于肺紹又終止于肺經(jīng)，復(fù)會于寸口所以，全身臟腑、氣血、經(jīng)絡(luò)日盛衰，功能的強(qiáng)弱，都可以反映于寸口。Cunkouistheusualregionselectedtotakepulse.Cunkou,alsoknownas“qikou”(openingofqi)or“maikou”(openingofpulse),referstopulsation搏動

ofradialarteryonthewrist.Cunkouislocatedonthepulsationofthelungmeridianwhereqiandbloodinthelungmeridianflowsby.Besides,qiandbloodfromallvisceracirculatesthroughthelungandconvergesovercunkou.Thelungmeridianstartsfromthemiddleenergizerandconvergeswiththespleenmeridian.Sincethespleenandthestomacharethesourcesofqiandbloodandfunctionaspostnatalbaseoflife,cunkoucanreflecttheconditionsofthegastricqi.Ontheotherhand,thelungmeridianisthemeridianfromwherealltheothermeridiansbeginandendtheircirculation,becausethecirculationofqiandbloodinallthetwelvemeridiansstartsfromandendsatthelungmeridian,finallyconvergingovercunkou.Thatiswhycunkoucanreflecttheconditionsofallviscera,qi,bloodandmeridiansinthebody.診脈的部位

Regionsfortakingpulse寸口診法將寸口脈分為寸、關(guān)、尺三部。以掌后高骨(橈骨莖突)稍內(nèi)下方的部位為“關(guān)”，關(guān)前(腕端)為“寸”，關(guān)后(肘端)為“尺”(見圖3)。左右兩手各有寸、關(guān)、尺三部，共六部脈。Pulseovercunkouisdividedintothreeparts:cun,guanandchi.Thepartslightlybelowthestyloidprocessofradiusisguanpulse,thepartanteriortheguanpulseisthecunpulse,andthepartposteriortheguanpulseisthechipulse(seeFig.3).Bothhandshavethreedivisionsofpulse,i.e.cunpulse,guanpulseandchipulse.Soaltogethertherearesixdivisionsofpulse.診脈的部位

Regionsfortakingpulse診脈的部位

Regionsfortakingpulse關(guān)于寸口脈三部分候臟腑，目前臨床所用多根據(jù)《內(nèi)經(jīng)》“上竟上”、“下竟下”的原則，即上(寸脈)以候上(身軀上部)，下(尺脈)以候下(身軀下部)，具體內(nèi)容如下：左寸候：心與膻中；右寸候：肺與胸中。左關(guān)候：肝與膽；右關(guān)候：脾與胃。左尺候：腎與小腹；右尺候：腎與小腹。ClinicallythecorrespondenceofcunkoupulseandthevisceraisdecidedaccordingtothedescriptioninNeijing(CanonofMedicine),thatistheupperpulse(cunpulse)correspondstotheupperpartofthebodyandthelowerpulse(chipulse)correspondstothelowerpartofthebody:Theleftcunpulseandthecorrespondingviscera:theheartandtanzhong(thepartbetweenthebreasts).Therightcunpulseandthecorrespondingviscera:thelungandthethorax.Theleftguanpulseandthecorrespondingviscera:theliverandthegallbladder.Therightguanpulseandthecorrespondingviscera:thespleenandthestomach.Thechipulseandthecorrespondingviscera:thekidneyandthelowerabdomen.Therightchipulseandthecorrespondingviscera:thekidneyandthelowerabdomen.診脈的部位

Regionsfortakingpulse這種寸口脈三部分候臟腑的理論具有一定的臨床參考價值，但臨床運用時切不可機(jī)械刻板，必須四診合參，綜合分析，才能得出比較正確的診斷。Suchatheoryabouttherelationshipbetweenthecunkoupulseandthecorrespondingvisceraissignificantinclinicaldiagnosis.However,theapplicationshouldbeflexibleandbasedonthesyntheticanalysisofthedataobtainedfromthefourdiagnosticmethods.切脈的方法Themethodsfortakingpulse切脈的方法，主要應(yīng)掌握以下幾點。(1)時間：清晨，脈象尚未受飲食、活動等因素的影響，是診脈的理想時間。但是，臨床上一般很難做到。只是要求患者在診脈前休息片刻，使之心靜氣寧，也可以診得較準(zhǔn)確的脈象。每次診脈時間至少在1分鐘以上，以準(zhǔn)確體察脈象。Thefollowingpointsshouldbeborneinmindintakingpulse.Time:Earlymorningistheidealtimefortakingpulsebecausetheconditionsofthepulsearenotaffectedbyfoodandotheractivities.However,thisrequirementisdifficulttofillinclinicalpractice.Toensureaccuratepulsetaking,thepatientshouldrestforawhiletotranquilizetheheartandbreathbeforethetakingofpulse.Thepulseshouldbetakenatleastforoneminuteeachtimeinordertocorrectlyexaminetheconditionsofthepulse.切脈的方法Themethodsfortakingpulse(2)平息：診脈時醫(yī)者要調(diào)勻自己的呼吸，靜心凝神，體察脈象，并以自己的一呼一吸的時間來計算患者的脈率。正常人平靜狀態(tài)下呼吸每分鐘16～18次，每次呼吸脈動4次，間或5次，即一息四五至，約60～90次／分鐘。(3)姿勢：患者正坐或仰臥，前臂自然平展，與心臟同一水平。直腕、仰掌，手指放松，使寸口部充分伸展，氣血流暢。Normalandcalmbreath:Normalandcalmbreathmeansthatthedoctorkeepshisorherownbreathquiettoexaminethepulseofthepatientandcalculatethebeatofthepulseaccordingtohisorherowncycleofexhalationandinhalation.Healthypeoplebreathe16-18timesoneminuteundernormalconditions.Andthepulsebeats4-5timesinacycleofexhalationandinhalation,

about60-90beatsperminute.Posture:

Thepatientsitserectorliesinsupinationandtheforearmsstretchesoutnaturallytotheleveloftheheart.Thewristisputstraight,thepalmturnsoverandthefingersarerelaxedtoextendthecunkouregionandenableqiandbloodtoflowfreely.切脈的方法Themethodsfortakingpulse(4)布指：醫(yī)者三指平齊，手指略呈弓形，以指目按脈脊。中指定關(guān)，食指在關(guān)前(遠(yuǎn)心端)定寸，無名指在關(guān)后(近心端)定尺，布指的疏密需與患者手臂長短相適應(yīng)。小兒可采用“一指定關(guān)法”而不細(xì)分三部。Arrangementoffingers:

Thethreefingersofthedoctorareputatthesamelevelandslightlyarchedtopressthepulsewiththebellyofthefingers--指腹.Themiddlefingerpressesontheguanpulse,theindexfingerpressesontheregionanteriortheguanpulse(distaltotheheartregion),theringfingeronthechipulseposteriortotheguanpulse(proximaltotheheartregion).Thearrangementofthefingersismadeaccordingtotheconditionsofthepatient'sarm.Indiagnosingdiseasesinchildren,"onefingerisusedtopressjusttheguanpulse".Itisunnecessarytodividethepulseintothreepartsinthiscase.切脈的方法Themethodsfortakingpulse(5)總按與單按：總按是三指同時切脈，從總體上辨別寸、關(guān)、尺三部和左右兩手的脈象。單按是用一個手指診察一部脈象，分別了解寸、關(guān)、尺各部的脈象。臨床上可根據(jù)需要，總按與單按結(jié)合運用。Generalpressureandsinglepressure:

Generalpressuremeanstopressthepulsewiththreefingerstodistinguishtheconditionsofcun,guanandchipulsesonbothhands.Singlepressuremeanstoexaminethepulseononehandwithjustonefingertodifferentiatethestatesofcun,guanandchipulses.Clinicallythesetwomethodsareusedaccordingtothepathologicalconditionsinquestion.切脈的方法Themethodsfortakingpulse(6)舉按尋：這是診脈時運用指力的輕重和挪移，以探求脈象的手法。用輕指力診脈為“舉”，又稱“浮取”或“輕取”；用重指力診脈為“按”，又稱“沉取”或“重按”；用力適中，不輕不重，或左右推尋挪移，以尋找脈象應(yīng)指最明顯的部位，為“尋”。診脈時必須注意體會舉、按、尋不同指力下的脈象變化。Lifting,pressingandsearching:Lifting,pressingandsearchingrefertoflexiblepressureofpulseinordertodistinguishtheconditionsofpulse.Lightpressuremeans"lifting";heavypressuremeans"pressing";andmobilemoderatepressuremeans"searching"whichisusedtolookforthemostobviousregionofthepulse.Intheprocedureofdiagnosis,doctorsshouldpayattentiontotheuseofthesethreemethodstodistinguishthevariationsofpulse.切脈的方法Themethodsfortakingpulse(7)體察脈象：脈象是指脈動應(yīng)指的形象。體察脈象就是分別從脈位(脈搏顯現(xiàn)部位的浮沉和長短)、至數(shù)(脈搏頻率的快慢和節(jié)律)、形態(tài)(脈搏的幅度、充盈度、緊張度、流利度)、氣勢(脈搏應(yīng)指的強(qiáng)弱)等方面辨別脈動應(yīng)指的指感特征。Examiningtheconditionsofpulse:Theconditionsofthepulsereferstothesensationofpulsefeltbythefingers.Theexaminationofpulseconditionsmeanstodistinguishthefeaturesofpulseaccordingtothepositionofpulse,therhythmofpulse,theshapeofpulseandthestrengthofpulse.常脈Normalpulse常脈是指人體在健康狀況下的脈象，又稱為平脈。Normalpulsereferstothepulseconditionsofthehealthypeople.常脈的形象不浮不沉，中取即得，不快不慢，一息四五至(60～90次／分鐘)，從容和緩，應(yīng)指有力，不大不小，節(jié)律均勻無歇止，并隨生理活動和外在環(huán)境的變化而有一定的變化。TheshapeofthenormalpulseThenormalpulseisneitherfloatingnorsunken,neitherfastnorslow,sensiblewithmoderatepressure,usuallybeating4-5timesinacycleofbreath(about60-90beatsperminute),gentleinsensation,powerfulinrebounding,moderateinsize,regularinbeatingandvaryingwithphysicalactivitiesandenvironmentalchanges.常脈的特點Thecharacteristicsofthenormalpulse常脈具有胃、神、根三個特點。有胃，即脈有胃氣。是指脈位居中，不浮不沉；脈律調(diào)勻，不快不慢；脈力充盈，不大不??；脈勢和緩，從容流利。其中最主要的是和緩、從容、流利。有神，是指脈象應(yīng)指柔和有力，節(jié)律整齊。有根，是指脈象尺部沉取有力，應(yīng)指不絕。總之，胃、神、根是從不同側(cè)面強(qiáng)調(diào)正常脈象的特點，三者相互補(bǔ)充而不能截然分開。若三者兼?zhèn)?，則反映機(jī)體臟臟功能強(qiáng)健，氣血充盈。Thenormalpulseismarkedbygastricqi,spiritandroot.Gastricqimeansthatthepulseislocatedatthemiddle,neitherfloatingnorsunken,regularinbeating,moderateinsize,gentleinsensation.Spiritmeansthatthepulseissoft,powerfulandrhythmic.Rootmeansthatthechipulseispowerfulandconstantlybeatingunderheavypressure.Gastricqi,spiritandrootarethreebasicfeaturesofthenormalpulsewhichcomplementeachotherandcannotbeseparated.Simultaneousappearanceofthethreereflectsstrongfunctionsofthevisceraandsufficiencyofqiandblood.影響常脈的主要因素

Mainfactorstoaffectthenormalpulse在人體內(nèi)外環(huán)境各種因素的影響下，常脈可以出現(xiàn)一定范圍內(nèi)的變化。(1)年齡、性別、形體等因素：如兒童脈多小數(shù)，青年脈多平滑，老人脈多弦硬；男子脈多緩而有力，女子脈多濡細(xì)而略數(shù)，妊婦脈多滑數(shù)；肥胖者脈沉細(xì)或濡細(xì)，消瘦者脈較浮大，身材高大者脈位較長，身材矮小者脈位較短。(2)生活起居、精神狀態(tài)等因素：如運動、飽餐、酒后脈多滑數(shù)有力，饑餓時脈多軟弱；怒時脈弦，驚時脈動無序。Thenormalpulsemayvarywithphysiologicalandpsychologicalfactorsinthehumanbodyandtheenvironmentalfactorsoutside.Age,sexandbuildingofthebody:Thepulseisusuallysmallandfastinchildren,smoothandslipperyinyoungpeople,tautandhardinoldpeople,moderateandpowerfulinmen,softandthininwomen,slipperyandfastingravida-孕婦,sunkenandthinorsoftandthininobesepeople,floatingandlargeinleanpeople,longintallpeopleandshortinsmallpeople.Dailylifeandpsychologicalfactors:Thepulseappearsslippery,fastandpowerfulaftermovement,eatinganddrinkingofwine,weakwithhunger,tautinangerandirregularinfright.影響常脈的主要因素

Mainfactorstoaffectthenormalpulse(3)四季氣候、晝夜、地理環(huán)境等因素：如春季脈微弦，夏季脈微鉤(洪)，秋季脈微毛(浮)，冬季脈微石(沉)；晝?nèi)彰}偏浮而有力，夜間脈偏沉而細(xì)緩；北方人脈多沉實，南方人脈多軟弱。此外，由于橈動脈解剖位置的變異，寸口不見脈象搏動，而由尺部斜向手背，稱為斜飛脈；若脈象搏動出現(xiàn)于寸口的背側(cè)，則稱為反關(guān)脈。上述各種因素都可能導(dǎo)致脈象出現(xiàn)相應(yīng)的變化，但只要有胃、有神、有根，均屬常脈范圍，臨床應(yīng)與病脈相鑒別。Seasonal,alternationofdayandnightandgeographicalfactors:

Thepulseappearsslightlytautinspring,slightlyfullinsummer,slightlyfloatinginautumnandslightlysunkeninwinter;slightlyfloatingandpowerfulinthedaytimeandslightlysunken,thinandslowinnight;sunkenandenergeticamongthepeopleinthenorthandsoftamongthepeopleinthesouth.Besides,thechangesoftheanatomicpositionoftheradialarterymayshiftthepulsenormallyatthecunkouregiontothedorsumofthehandfromthechiregion,knownasobliqueflyingpulse.Thepulse,shiftedtothebackofthecunkouregion,iscalledectopicradialpulse.Allthefactorsabovementionedmayaffecttheconditionsofthepulse.However,ifthepulsestillkeepsgastricqi,spiritandroot,itisstillthenormalpulse.異位的

病脈

Morbidpulse在疾病過程中出現(xiàn)的異常脈象，即為病脈。在病脈中，有些脈象主要表現(xiàn)為脈位的變化，或表現(xiàn)出至數(shù)的不同，或表現(xiàn)為形態(tài)各異，或是脈的氣勢強(qiáng)弱不同；有些脈象則在位、數(shù)、形、勢等方面同時具有多個方面的變化。Thepulseinamorbidconditioniscalledmorbidpulse,inwhichthemanifestationsofpulseconditionsareeitherthechangesofthepositionofthepulse,orthedifferenceinrhythm,orvariationinmorphology,orchangesinstrength.Sometimesmorbidpulsemayshowdifferenceinvariousaspects,suchastheposition,rhythmandstrengthofthepulse.Thefollowingisaspecificdiscussion:浮脈Floatingpulse脈象特征：輕取即得，按之稍弱而不空。浮脈以脈動顯現(xiàn)部位淺表為特點。臨床意義：多主表證，浮而有力為表實，浮而無力為表虛。亦可見于久病精血虧虛，虛陽外越的里虛證。Features:Sensibleunderlightpressure,weakandconstantbeatingunderheavypressure.Floatingpulseismarkedbysuperficialbeating.Clinicalsignificance.FloatingpulseIndicatesexternalsyndrome,floatingandpowerfulpulsesignifyingexternalstheniasyndromewhilefloatingandweakpulsemanifestingexternalastheniasyndrome.Floatingpulsecanalsobeseenininternalastheniasyndromeduetoconsumptionofessenceandbloodinchronicdiseaseandexternalfloatingofasthenicyang.散脈 脈象特征：浮散無根，至數(shù)不清，按之消失。散脈以脈位浮取應(yīng)指，稍按則無，脈勢軟弱，脈律不齊，至數(shù)模糊不清為特點。臨床意義：主元氣耗散，臟腑精氣將絕，虛陽外越。ScatteredpulseFeatures:Rootless,arrhythmicanddisappearingunderpressure.Clinicalsignificance:Indicatingdepletionofprimordialqi,visceralessenceatthevergetoexhaustandexternalfloatingofasthenicyang.芤脈脈象特征：浮大中空，如按蔥管。芤脈以脈位浮，脈形大而勢軟，按之空豁為特點。臨床意義：主失血，傷陰。HollowpulseFeatures:Floating,largeandhollowliketheleafofscallion.Clinicalsignificance:Indicatinglossofbloodandimpairmentofyin.沉脈脈象特征：輕取不應(yīng)，重按始得。沉脈以脈動顯現(xiàn)部位較深沉為特點。臨床意義：主里證。沉而有力為里實，沉而無力為里虛。SunkenpulseFeatures:Sensibleonlyunderheavypressure.Clinicalsignificance:Indicatinginternalsyndrome.Sunkenandpowerfulpulsesignifiesstheniainternalsyndrome,whilesunkenandweakpulseshowsasthenicinternalsyndrome.遲脈脈象特征：脈來遲慢，一息脈動不足四至(<60次／分鐘)。臨床意義：主寒證。遲而有力為實寒，遲而無力為虛寒。亦可見于邪熱結(jié)聚的里實熱證。運動員或青壯年鍛煉有素者出現(xiàn)遲脈屬生理現(xiàn)象，應(yīng)予以鑒別。SlowpulseFeatures:Nomorethan4beatsinacycleofbreath(<60/min).Clinicalsignificance:Indicatingcoldsyndrome.Slowandpowerfulpulsesignifiesstheniacoldsyndrome,whileslowandweakpulseshowsastheniccoldsyndrome.Suchapulseconditionisalsoseenininternalstheniaheatsyndromeduetointernalaccumulationofpathogenicheat.Athleteswithslowpulseareinanormalcondition.緩脈脈象特征：脈來和緩有力，一息四至；或脈來緩怠，一息四至(60～70次／分鐘)。臨床意義：主濕病，脾胃虛弱。ModeratepulseFeatures:Thepulseismoderateandpowerful,beating4timesinacycleofbreath;ormoderateandsluggish,beating4timesinacycleofbreath(60-70/min).Clinicalsignificance:Indicatingdampdiseaseandweaknessofthestomachandspleen.數(shù)脈脈象特征：脈來快數(shù)，一息五六至(75～90次／分鐘)。臨床意義：主熱證。有力為實熱，無力為虛熱。亦可見于虛陽外越證。FastpulseFeatures:Thepulsebeatsover5-6timesinacycleofbreath(75-90/min).Clinicalsignificance:Indicatingheatsyndrome.Fastandpowerfulpulsesignifiesstheniaheatsyndrome,whilefastandweakpulseshowsasthenicheatsyndrome.Suchapulseconditionisalsoseeninthesyndromeduetoexternalfloatingofasthenicyang.疾脈脈象特征：脈來急疾，一息七至以上(≥140次／分鐘)。臨床意義：主亢陽無制，真陰垂絕，元氣將脫。SwiftpulseFeatures.Thepulsebeatsover7timesinacycleofbreath(≥140/min).Clinicalsignificance:Indicatinglossofcontrolofhyperactiveyang,declinationofkidneyyinandneardepletionofprimordialqi.虛脈脈象特征：三部脈舉之無力，按之空豁，是無力脈的總稱。虛脈以寸、關(guān)、尺三部，浮、中、沉三候均應(yīng)指勢弱，鼓動無力為特點。臨床意義：主虛證。多見于氣血兩虛，尤以氣虛為主。WeakpulseFeatures.Weakpulseismarkedbyweakbeatingofthepulseatallthecun,guanandchiregions.Clinicalsignificance:Indicatingastheniasyndrome,usuallyseeninastheniaofbothqiandblood,especiallyinqiasthenia.實脈脈象特征：三部脈舉按皆充實有力，是有力脈的總稱。實脈以寸、關(guān)、尺三部，浮、中、沉三候均應(yīng)指勢強(qiáng)，鼓動有力為特點。臨床意義：主實證。PowerfulpulseFeatures:Powerfulpulseismarkedbypowerful