脉诊双语课件

脉诊

Pulse-taking脉诊

Pulse-taking脉诊是医者用手指触按患者一定部位的脉搏，以体察脉象、了解病情的一种诊病方法。机理—略脉象的形成与诸脏腑、气血的功能密切相关。心脏与血脉紧密相连；心气心阳推动血液通过脉管而布运全身，内人五脏六腑，外至四肢百骸，运行不息，并导致脉搏的跳动。另外，心对于血液的生成具有一定的作用。肺主气，“肺朝百脉”，肺气的敷布是心对血液推动作用的辅助。脾胃为“气血生化之源”；脾又主统血，血液在脉管内流行不致逸出脉外，有赖脾气的统摄。肝主疏泄，对于全身气机的调畅起着重要的作用，并促进血液营运不休；肝又主藏血，能调节血流量。肾藏精，肾中精、气、阴、阳是人体各脏腑阴、阳的根本；且精可以化生血，肾精充足，则血有所充。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.脉诊

Pulse-taking机理--脉为血之府，是气血运行的通道。气血的盛衰和运行状况，脉管的紧张度、弹性、粗细等，直接对脉象产生影响。因此，人体各脏腑功能活动及气、血、津液的盛衰和运行状况，都可以直接或间接地对脉象产生影响。当致病因素作用于人体，引起脏腑、气、血、津液的功能失常，脉象亦随之发生改变。故通过诊脉可以诊察疾病。Thevesselsaretheorganstoholdbloodandthepathwaysforqiandbloodtocirculate.Theconditionsandcirculationofqiandbloodaswellasthetensity,elasticityandthicknessofthevesselsdirectlyinfluencethestatesofpulse.Besides,thefunctionalactivitiesofallvisceraaswellastheconditionsandcirculationofqi,bloodandbodyfluidinthemallcandirectlyorindirectlyaffectthestatesofpulse.Whenpathogenicfactorsinvadethebodyandcausedysfunctionoftheviscera,qi,bloodandbodyfluid,theconditionsofpulsewillchangeaccordingly.Therefore,examinationofpulsecanhelpdiagnosisofdiseases.诊脉的部位

Regionsfortakingpulse现在通行的是诊寸口。寸口又称“气口’’或“脉口”，即手腕后桡动脉搏动处。寸口位于手太阴肺经的脉动应手之处，是肺经气血流通之处，同时，全身脏腑气血循行都要流经肺而大会于寸口；手太阴肺经起于中焦，与足太阴脾经相通，而脾胃为气血生化之源，后天之本，故寸口可以反映胃气的强弱。另外，肺经为十二经之始终，十二经气血循环流注起于肺绍又终止于肺经，复会于寸口所以，全身脏腑、气血、经络日盛衰，功能的强弱，都可以反映于寸口。Cunkouistheusualregionselectedtotakepulse.Cunkou,alsoknownas“qikou”(openingofqi)or“maikou”(openingofpulse),referstopulsation搏动

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

Regionsfortakingpulse寸口诊法将寸口脉分为寸、关、尺三部。以掌后高骨(桡骨茎突)稍内下方的部位为“关”，关前(腕端)为“寸”，关后(肘端)为“尺”(见图3)。左右两手各有寸、关、尺三部，共六部脉。Pulseovercunkouisdividedintothreeparts:cun,guanandchi.Thepartslightlybelowthestyloidprocessofradiusisguanpulse,thepartanteriortheguanpulseisthecunpulse,andthepartposteriortheguanpulseisthechipulse(seeFig.3).Bothhandshavethreedivisionsofpulse,i.e.cunpulse,guanpulseandchipulse.Soaltogethertherearesixdivisionsofpulse.诊脉的部位

Regionsfortakingpulse诊脉的部位

Regionsfortakingpulse关于寸口脉三部分候脏腑，目前临床所用多根据《内经》“上竟上”、“下竟下”的原则，即上(寸脉)以候上(身躯上部)，下(尺脉)以候下(身躯下部)，具体内容如下：左寸候：心与膻中；右寸候：肺与胸中。左关候：肝与胆；右关候：脾与胃。左尺候：肾与小腹；右尺候：肾与小腹。ClinicallythecorrespondenceofcunkoupulseandthevisceraisdecidedaccordingtothedescriptioninNeijing(CanonofMedicine),thatistheupperpulse(cunpulse)correspondstotheupperpartofthebodyandthelowerpulse(chipulse)correspondstothelowerpartofthebody:Theleftcunpulseandthecorrespondingviscera:theheartandtanzhong(thepartbetweenthebreasts).Therightcunpulseandthecorrespondingviscera:thelungandthethorax.Theleftguanpulseandthecorrespondingviscera:theliverandthegallbladder.Therightguanpulseandthecorrespondingviscera:thespleenandthestomach.Thechipulseandthecorrespondingviscera:thekidneyandthelowerabdomen.Therightchipulseandthecorrespondingviscera:thekidneyandthelowerabdomen.诊脉的部位

Regionsfortakingpulse这种寸口脉三部分候脏腑的理论具有一定的临床参考价值，但临床运用时切不可机械刻板，必须四诊合参，综合分析，才能得出比较正确的诊断。Suchatheoryabouttherelationshipbetweenthecunkoupulseandthecorrespondingvisceraissignificantinclinicaldiagnosis.However,theapplicationshouldbeflexibleandbasedonthesyntheticanalysisofthedataobtainedfromthefourdiagnosticmethods.切脉的方法Themethodsfortakingpulse切脉的方法，主要应掌握以下几点。(1)时间：清晨，脉象尚未受饮食、活动等因素的影响，是诊脉的理想时间。但是，临床上一般很难做到。只是要求患者在诊脉前休息片刻，使之心静气宁，也可以诊得较准确的脉象。每次诊脉时间至少在1分钟以上，以准确体察脉象。Thefollowingpointsshouldbeborneinmindintakingpulse.Time:Earlymorningistheidealtimefortakingpulsebecausetheconditionsofthepulsearenotaffectedbyfoodandotheractivities.However,thisrequirementisdifficulttofillinclinicalpractice.Toensureaccuratepulsetaking,thepatientshouldrestforawhiletotranquilizetheheartandbreathbeforethetakingofpulse.Thepulseshouldbetakenatleastforoneminuteeachtimeinordertocorrectlyexaminetheconditionsofthepulse.切脉的方法Themethodsfortakingpulse(2)平息：诊脉时医者要调匀自己的呼吸，静心凝神，体察脉象，并以自己的一呼一吸的时间来计算患者的脉率。正常人平静状态下呼吸每分钟16～18次，每次呼吸脉动4次，间或5次，即一息四五至，约60～90次／分钟。(3)姿势：患者正坐或仰卧，前臂自然平展，与心脏同一水平。直腕、仰掌，手指放松，使寸口部充分伸展，气血流畅。Normalandcalmbreath:Normalandcalmbreathmeansthatthedoctorkeepshisorherownbreathquiettoexaminethepulseofthepatientandcalculatethebeatofthepulseaccordingtohisorherowncycleofexhalationandinhalation.Healthypeoplebreathe16-18timesoneminuteundernormalconditions.Andthepulsebeats4-5timesinacycleofexhalationandinhalation,

about60-90beatsperminute.Posture:

Thepatientsitserectorliesinsupinationandtheforearmsstretchesoutnaturallytotheleveloftheheart.Thewristisputstraight,thepalmturnsoverandthefingersarerelaxedtoextendthecunkouregionandenableqiandbloodtoflowfreely.切脉的方法Themethodsfortakingpulse(4)布指：医者三指平齐，手指略呈弓形，以指目按脉脊。中指定关，食指在关前(远心端)定寸，无名指在关后(近心端)定尺，布指的疏密需与患者手臂长短相适应。小儿可采用“一指定关法”而不细分三部。Arrangementoffingers:

Thethreefingersofthedoctorareputatthesamelevelandslightlyarchedtopressthepulsewiththebellyofthefingers--指腹.Themiddlefingerpressesontheguanpulse,theindexfingerpressesontheregionanteriortheguanpulse(distaltotheheartregion),theringfingeronthechipulseposteriortotheguanpulse(proximaltotheheartregion).Thearrangementofthefingersismadeaccordingtotheconditionsofthepatient'sarm.Indiagnosingdiseasesinchildren,"onefingerisusedtopressjusttheguanpulse".Itisunnecessarytodividethepulseintothreepartsinthiscase.切脉的方法Themethodsfortakingpulse(5)总按与单按：总按是三指同时切脉，从总体上辨别寸、关、尺三部和左右两手的脉象。单按是用一个手指诊察一部脉象，分别了解寸、关、尺各部的脉象。临床上可根据需要，总按与单按结合运用。Generalpressureandsinglepressure:

Generalpressuremeanstopressthepulsewiththreefingerstodistinguishtheconditionsofcun,guanandchipulsesonbothhands.Singlepressuremeanstoexaminethepulseononehandwithjustonefingertodifferentiatethestatesofcun,guanandchipulses.Clinicallythesetwomethodsareusedaccordingtothepathologicalconditionsinquestion.切脉的方法Themethodsfortakingpulse(6)举按寻：这是诊脉时运用指力的轻重和挪移，以探求脉象的手法。用轻指力诊脉为“举”，又称“浮取”或“轻取”；用重指力诊脉为“按”，又称“沉取”或“重按”；用力适中，不轻不重，或左右推寻挪移，以寻找脉象应指最明显的部位，为“寻”。诊脉时必须注意体会举、按、寻不同指力下的脉象变化。Lifting,pressingandsearching:Lifting,pressingandsearchingrefertoflexiblepressureofpulseinordertodistinguishtheconditionsofpulse.Lightpressuremeans"lifting";heavypressuremeans"pressing";andmobilemoderatepressuremeans"searching"whichisusedtolookforthemostobviousregionofthepulse.Intheprocedureofdiagnosis,doctorsshouldpayattentiontotheuseofthesethreemethodstodistinguishthevariationsofpulse.切脉的方法Themethodsfortakingpulse(7)体察脉象：脉象是指脉动应指的形象。体察脉象就是分别从脉位(脉搏显现部位的浮沉和长短)、至数(脉搏频率的快慢和节律)、形态(脉搏的幅度、充盈度、紧张度、流利度)、气势(脉搏应指的强弱)等方面辨别脉动应指的指感特征。Examiningtheconditionsofpulse:Theconditionsofthepulsereferstothesensationofpulsefeltbythefingers.Theexaminationofpulseconditionsmeanstodistinguishthefeaturesofpulseaccordingtothepositionofpulse,therhythmofpulse,theshapeofpulseandthestrengthofpulse.常脉Normalpulse常脉是指人体在健康状况下的脉象，又称为平脉。Normalpulsereferstothepulseconditionsofthehealthypeople.常脉的形象不浮不沉，中取即得，不快不慢，一息四五至(60～90次／分钟)，从容和缓，应指有力，不大不小，节律均匀无歇止，并随生理活动和外在环境的变化而有一定的变化。TheshapeofthenormalpulseThenormalpulseisneitherfloatingnorsunken,neitherfastnorslow,sensiblewithmoderatepressure,usuallybeating4-5timesinacycleofbreath(about60-90beatsperminute),gentleinsensation,powerfulinrebounding,moderateinsize,regularinbeatingandvaryingwithphysicalactivitiesandenvironmentalchanges.常脉的特点Thecharacteristicsofthenormalpulse常脉具有胃、神、根三个特点。有胃，即脉有胃气。是指脉位居中，不浮不沉；脉律调匀，不快不慢；脉力充盈，不大不小；脉势和缓，从容流利。其中最主要的是和缓、从容、流利。有神，是指脉象应指柔和有力，节律整齐。有根，是指脉象尺部沉取有力，应指不绝。总之，胃、神、根是从不同侧面强调正常脉象的特点，三者相互补充而不能截然分开。若三者兼备，则反映机体脏脏功能强健，气血充盈。Thenormalpulseismarkedbygastricqi,spiritandroot.Gastricqimeansthatthepulseislocatedatthemiddle,neitherfloatingnorsunken,regularinbeating,moderateinsize,gentleinsensation.Spiritmeansthatthepulseissoft,powerfulandrhythmic.Rootmeansthatthechipulseispowerfulandconstantlybeatingunderheavypressure.Gastricqi,spiritandrootarethreebasicfeaturesofthenormalpulsewhichcomplementeachotherandcannotbeseparated.Simultaneousappearanceofthethreereflectsstrongfunctionsofthevisceraandsufficiencyofqiandblood.影响常脉的主要因素

Mainfactorstoaffectthenormalpulse在人体内外环境各种因素的影响下，常脉可以出现一定范围内的变化。(1)年龄、性别、形体等因素：如儿童脉多小数，青年脉多平滑，老人脉多弦硬；男子脉多缓而有力，女子脉多濡细而略数，妊妇脉多滑数；肥胖者脉沉细或濡细，消瘦者脉较浮大，身材高大者脉位较长，身材矮小者脉位较短。(2)生活起居、精神状态等因素：如运动、饱餐、酒后脉多滑数有力，饥饿时脉多软弱；怒时脉弦，惊时脉动无序。Thenormalpulsemayvarywithphysiologicalandpsychologicalfactorsinthehumanbodyandtheenvironmentalfactorsoutside.Age,sexandbuildingofthebody:Thepulseisusuallysmallandfastinchildren,smoothandslipperyinyoungpeople,tautandhardinoldpeople,moderateandpowerfulinmen,softandthininwomen,slipperyandfastingravida-孕妇,sunkenandthinorsoftandthininobesepeople,floatingandlargeinleanpeople,longintallpeopleandshortinsmallpeople.Dailylifeandpsychologicalfactors:Thepulseappearsslippery,fastandpowerfulaftermovement,eatinganddrinkingofwine,weakwithhunger,tautinangerandirregularinfright.影响常脉的主要因素

Mainfactorstoaffectthenormalpulse(3)四季气候、昼夜、地理环境等因素：如春季脉微弦，夏季脉微钩(洪)，秋季脉微毛(浮)，冬季脉微石(沉)；昼日脉偏浮而有力，夜间脉偏沉而细缓；北方人脉多沉实，南方人脉多软弱。此外，由于桡动脉解剖位置的变异，寸口不见脉象搏动，而由尺部斜向手背，称为斜飞脉；若脉象搏动出现于寸口的背侧，则称为反关脉。上述各种因素都可能导致脉象出现相应的变化，但只要有胃、有神、有根，均属常脉范围，临床应与病脉相鉴别。Seasonal,alternationofdayandnightandgeographicalfactors:

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

病脉

Morbidpulse在疾病过程中出现的异常脉象，即为病脉。在病脉中，有些脉象主要表现为脉位的变化，或表现出至数的不同，或表现为形态各异，或是脉的气势强弱不同；有些脉象则在位、数、形、势等方面同时具有多个方面的变化。Thepulseinamorbidconditioniscalledmorbidpulse,inwhichthemanifestationsofpulseconditionsareeitherthechangesofthepositionofthepulse,orthedifferenceinrhythm,orvariationinmorphology,orchangesinstrength.Sometimesmorbidpulsemayshowdifferenceinvariousaspects,suchastheposition,rhythmandstrengthofthepulse.Thefollowingisaspecificdiscussion:浮脉Floatingpulse脉象特征：轻取即得，按之稍弱而不空。浮脉以脉动显现部位浅表为特点。临床意义：多主表证，浮而有力为表实，浮而无力为表虚。亦可见于久病精血亏虚，虚阳外越的里虚证。Features:Sensibleunderlightpressure,weakandconstantbeatingunderheavypressure.Floatingpulseismarkedbysuperficialbeating.Clinicalsignificance.FloatingpulseIndicatesexternalsyndrome,floatingandpowerfulpulsesignifyingexternalstheniasyndromewhilefloatingandweakpulsemanifestingexternalastheniasyndrome.Floatingpulsecanalsobeseenininternalastheniasyndromeduetoconsumptionofessenceandbloodinchronicdiseaseandexternalfloatingofasthenicyang.散脉 脉象特征：浮散无根，至数不清，按之消失。散脉以脉位浮取应指，稍按则无，脉势软弱，脉律不齐，至数模糊不清为特点。临床意义：主元气耗散，脏腑精气将绝，虚阳外越。ScatteredpulseFeatures:Rootless,arrhythmicanddisappearingunderpressure.Clinicalsignificance:Indicatingdepletionofprimordialqi,visceralessenceatthevergetoexhaustandexternalfloatingofasthenicyang.芤脉脉象特征：浮大中空，如按葱管。芤脉以脉位浮，脉形大而势软，按之空豁为特点。临床意义：主失血，伤阴。HollowpulseFeatures:Floating,largeandhollowliketheleafofscallion.Clinicalsignificance:Indicatinglossofbloodandimpairmentofyin.沉脉脉象特征：轻取不应，重按始得。沉脉以脉动显现部位较深沉为特点。临床意义：主里证。沉而有力为里实，沉而无力为里虚。SunkenpulseFeatures:Sensibleonlyunderheavypressure.Clinicalsignificance:Indicatinginternalsyndrome.Sunkenandpowerfulpulsesignifiesstheniainternalsyndrome,whilesunkenandweakpulseshowsasthenicinternalsyndrome.迟脉脉象特征：脉来迟慢，一息脉动不足四至(<60次／分钟)。临床意义：主寒证。迟而有力为实寒，迟而无力为虚寒。亦可见于邪热结聚的里实热证。运动员或青壮年锻炼有素者出现迟脉属生理现象，应予以鉴别。SlowpulseFeatures:Nomorethan4beatsinacycleofbreath(<60/min).Clinicalsignificance:Indicatingcoldsyndrome.Slowandpowerfulpulsesignifiesstheniacoldsyndrome,whileslowandweakpulseshowsastheniccoldsyndrome.Suchapulseconditionisalsoseenininternalstheniaheatsyndromeduetointernalaccumulationofpathogenicheat.Athleteswithslowpulseareinanormalcondition.缓脉脉象特征：脉来和缓有力，一息四至；或脉来缓怠，一息四至(60～70次／分钟)。临床意义：主湿病，脾胃虚弱。ModeratepulseFeatures:Thepulseismoderateandpowerful,beating4timesinacycleofbreath;ormoderateandsluggish,beating4timesinacycleofbreath(60-70/min).Clinicalsignificance:Indicatingdampdiseaseandweaknessofthestomachandspleen.数脉脉象特征：脉来快数，一息五六至(75～90次／分钟)。临床意义：主热证。有力为实热，无力为虚热。亦可见于虚阳外越证。FastpulseFeatures:Thepulsebeatsover5-6timesinacycleofbreath(75-90/min).Clinicalsignificance:Indicatingheatsyndrome.Fastandpowerfulpulsesignifiesstheniaheatsyndrome,whilefastandweakpulseshowsasthenicheatsyndrome.Suchapulseconditionisalsoseeninthesyndromeduetoexternalfloatingofasthenicyang.疾脉脉象特征：脉来急疾，一息七至以上(≥140次／分钟)。临床意义：主亢阳无制，真阴垂绝，元气将脱。SwiftpulseFeatures.Thepulsebeatsover7timesinacycleofbreath(≥140/min).Clinicalsignificance:Indicatinglossofcontrolofhyperactiveyang,declinationofkidneyyinandneardepletionofprimordialqi.虚脉脉象特征：三部脉举之无力，按之空豁，是无力脉的总称。虚脉以寸、关、尺三部，浮、中、沉三候均应指势弱，鼓动无力为特点。临床意义：主虚证。多见于气血两虚，尤以气虚为主。WeakpulseFeatures.Weakpulseismarkedbyweakbeatingofthepulseatallthecun,guanandchiregions.Clinicalsignificance:Indicatingastheniasyndrome,usuallyseeninastheniaofbothqiandblood,especiallyinqiasthenia.实脉脉象特征：三部脉举按皆充实有力，是有力脉的总称。实脉以寸、关、尺三部，浮、中、沉三候均应指势强，鼓动有力为特点。临床意义：主实证。PowerfulpulseFeatures:Powerfulpulseismarkedbypowerful