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8.4.1 Superficial pulse, deep pulse, slow pulse, rapid pulse课程教案、知识点、字幕

同学们好

下面我们正式学习常见脉象及其临床意义

疾病反映于脉象的变化 叫病理脉象

简称为 病脉

一般来说

除了正常生理变化范围以内

以及个体生理特异变化之外的脉象

均属于病脉

脉象的数量 历代医家著作有所差别

《内经》记载有二十一种脉象

《伤寒杂病论》中记载有二十六种脉象

《脉经》总结为二十四种

《景岳全书》只分为十六种

《濒湖脉学》则为二十七种

《诊家正眼》为二十八种脉象

近代临床提及的脉象 通常为二十八种脉象

本课程只讲述

二十八种脉象中常见的十九种脉象

我们按照脉象的位 数 形 势四个要素的

八个方面来学习

首先我来学习按脉位分类的一对脉象

浮脉和沉脉

首先 我们来学习浮脉

浮脉的脉象特征 是指

轻取即得 重按稍减而不空

举之有余 按之不足

浮脉 可理解为 浅脉

浮脉的脉象特征是脉管的搏动在皮下较浅表的部位

即位于皮下浅层

因此轻取即得 重按稍减而不空

又称为举之有余 按之不足

这里的 举 就是轻按

按 就是重按

一般来说

浮脉多见于表证 这是机体抗邪向外的一种表现

当外感风寒之邪

风热之邪 和风邪 侵袭肌表

卫阳抗邪外出

人体气血趋向于肌表

所以脉气鼓动血脉向外 故见浮脉

邪盛而正气不虚 脉浮而有力

虚人外感 或邪盛正虚时

脉多浮而无力

外感风寒 则寒主收引

血管拘急 故脉多浮紧

因此 浮紧脉见于风寒表证

外感风热

热则血流加速 故脉多浮数

因此 浮数脉多见于风热表证

虚人外感风邪

风鼓动血脉向外而浮

正气不足 则脉缓

所以虚人外感风邪 脉多浮缓

因此浮缓脉见于伤风表证

浮脉在病变上多见于表证

但是浮脉也可以见于某些正常人 比如

瘦人肌肤瘦薄 可见于浮脉

秋季平脉 也可以见于浮脉

下面我们来学习按脉位分类的另外一个脉象 沉脉

沉脉的脉象特征 是轻取不应 重按始得

举之不足 按之有余

沉脉显现的部位较正常脉深

所以又称为 深脉

沉脉的脉象特征是脉管搏动的部位

在皮肉之下 靠近筋骨之处

因此用轻指力触按通常不能够察觉

用中等指力按触搏动也不明显

只有用重力按压到筋骨时

才能够感觉到脉搏明显的跳动

这是因为沉脉的脉气沉

脉搏显现的部位深沉所导致的

沉脉 多见于里证

沉而有力 为里实证

多为邪实内郁 阻碍阳气

不能鼓动脉气所导致的

可见于气滞 血瘀 食积 痰饮等病证

沉而无力 为里虚证

这是由于气血不足 或阳气亏乏

无力升举鼓动所导致的

可见于各种脏腑的虚证

比如 气虚 血虚 阴虚 阳虚都可以见到沉脉

不过沉脉也可以见于正常人 比如

肥胖的人 脂肪较厚 脉管深沉

故脉多沉

冬季气血收敛 脉象也偏沉

若两手皆沉细 而无临床症状

为六阴脉 可视为平脉

从上面可以看出

浮脉和沉脉 这一对脉位相反的脉象

主要是分辨病位的浅深 其中

浮脉主表 沉脉主里

浮脉和沉脉是一对

辨别病位的纲领性的脉象

因此概括为 浮沉分表里

下面我们来学习 按照脉率分类的一对脉象

迟脉和数脉

首先 我们来学习迟脉

迟脉的脉象特征是 脉来迟缓 一息不足四至

相当于每分钟脉搏在四十五到六十次以下

迟脉的脉象特征

就是脉管搏动的频率小于正常脉率

迟脉 多见于寒证

迟而有力 为实寒证

通常由于寒邪侵袭

困阻阳气 不能鼓动脉搏所致

迟而无力 为虚寒证

通常是由于阳气亏损

无力鼓动脉搏所致

此外

迟脉也可以见于某些正常人 比如

运动员和经常锻炼的人 心脏的功能强大

可见脉迟而和缓有力

正常人入睡以后 脉来迟缓 都属于平脉

下面我们来学习

按照脉率分类的另外一个脉象 数脉

数脉与迟脉相反

数脉的脉象特征是 脉来急促 一息五到六至

相当于每分钟脉搏在九十到一百二十次左右

数脉的脉象特点 就是脉率较正常为快

数脉多见于热证

数而有力 为实热证

它是由于邪热亢盛 正气不衰

邪热鼓动血脉运行加速所导致的

数而无力 为虚热证

它是由于阴虚不足 虚热内生

也可以鼓动血脉运行加速所导致的

数脉除了主热证之外

它也可以见到某些正常人

数脉 正常主要见于小儿

比如

三岁以下小儿脉搏 一息七至以上

又称为疾脉

三到五岁小儿脉搏 一息六到七至

五到十岁小儿脉搏 一息五到六至

接近于正常人

从上面可以看出 迟脉和数脉

这一对脉率相反地脉象

主要是分辨 病性的寒热

其中 迟脉主寒证

数脉主热证

迟脉和数脉 这是一对

辨别病性的纲领性的脉象

因此可概括为 迟数辨寒热

以上是我们学习的浮 沉 迟 数

四个脉象的脉象特征和临床意义

本节课就上到这里

Diagnostics in Chinese Medicine课程列表:

Week 1 Introduction

-Introductory remark

--Introductory remark

--QQ groups、WeChat public account

-Introduction

--Introduction

--【Discussion 1】Why do you want to take this course?

-Unit test for Introduction

Week 1 Basic Theory of Chinese Medicine 1:Yin-Yang and Five Elements Theory

-1.1 Yin-yang theory

--1.1 Yin-yang theory

-1.2 The theory of five elements

--1.2.1 The theory of five elements

--1.2.2 Application of the theory of five elements

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 1

Week 2 Basic Theory of Chinese Medicine 2:Zang-Fu Theory

-2.0 Outline

--2.0 Outline

--【Discussion 2】How to understand the holistic view centered on the Zang Fu theory?

-2.1 Liver

--2.1 Liver

--【Discussion 3】Why is repose more important than vigorous exercise in recuperation for patients with

-2.2 Heart

--2.2 Heart

-2.3 Spleen

--2.3 Spleen

-2.4 Lung

--2.4 Lung

-2.5 Kidney

--2.5 Kidney

-2.6 Six fu organs

--2.6 Six fu organs

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 2

Week 3 Basic Theory of Chinese Medicine 3:Qi,Blood and Body Fluid Theory

-3.1 Qi

--3.1 Qi

-3.2 Blood

--3.2 Blood

-3.3 Body fluid

--3.3 Body fluid

-3.4 The relationship of qi, blood and body fluid

--3.4 The relationship of qi, blood and body fluid

--【Discussion 4】A discussion about the theory of qi, blood and body fluid

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 3

Week 4 Basic Theory of Chinese Medicine 4: The theory of etiologic factor

-4.0 Outline

--4.0 Outline

-4.1 Six exogenous factors

--4.1.1 Six exogenous factors

--4.1.2 Nature and pathogenicity of wind and cold

--4.1.3 Nature and pathogenicity of summer heat and damp

--4.1.4 Nature and pathogenicity of dryness and fire

-4.2 Etiology of visceral impairment

--4.2 Etiology of visceral impairment

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 4

Week 5 Diagnosis methods: Inquiry (1)

-5.0 Outline of inquiry

--5.0.1 Outline of inquiry(1)

--5.0.2 Outline of inquiry(2)

--【Discussion 5】If you were a patient, how would you describe your condition to your doctor first?

-5.1 Inquiry of Chills and fever

--5.1.1 Chills and fever(Aversion to cold with fever)

--5.1.2 Chills and fever(Chills without fever)

--5.1.3 Chills and fever(Fever without chills)

--5.1.4 Chills and fever(Alternative chills and fever)

--【Discussion 6】How to understand "if you have clinical manifestations of cold, that is exterior syndr

-5.2 Inquiry of perspiration

--5.2 Inquiry of perspiration

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 5

Week 6 Diagnosis methods: Inquiry (2)

-5.3 Inquiring of pain

--5.3 Inquiring of pain

--【Discussion 7】How to understand "stagnation leading to pain and innourish leading to pain"?

-5.4 Inquiring of head, body, thorax and abdomen

--5.4 Inquiring of head, body, thorax and abdomen

-5.5 Inquiring of ears and eyes

--5.5 Inquiring of ears and eyes

-5.6 Inquiring of sleep

--5.6 Inquiring of sleep

-5.7 Inquiring of food and drink, appetite and taste

--5.7 Inquiring of food and drink, appetite and taste

-5.8 Inquiring of defecation and urination

--5.8.1 Inquiring of defecation

--5.8.2 Inquiring of urination

-5.9 Inquiring of infantile and women's disease

--5.9 Inquiring of infantile and women's disease

-Unit test for week 6

Week 7 Diagnosis methods: Observation (1)

-6.0 Outline of Observation

--6.0 Outline of Observation

--【Discussion 8】Please use the whole body inspection (including the expression, complexion and figure)

-6.1.1 Observation of vitality

--6.1.1 Observation of vitality

-6.1.2 Observation of the color

--6.1.2.1 The content, principles of inspection of the color

--6.1.2.2 Indication of diseases by five colors

--【Discussion 9】How do you understand the normal complexion of a normal people?

-6.1.3 Observation of the appearance

--6.1.3 Observation of the appearance

-6.1.4 Observation of figure and posture

--6.1.4 Observation of figure and posture

-Unit test for week 7

Week 8 Diagnosis methods: Observation (2)

-6.2.1 Observation of head and face

--6.2.1 Observation of head and face

-6.2.2 Observation of five sensory organs

--6.2.2.1Observation of five sensory organs(observation of eyes,ears,nose)

--6.2.2.2Observation of five sensory organs(observation of lips,teeth and gums,throat)

-6.2.3 Observation of body

--6.2.3 Observation of body

-6.2.4 Observation of limbs

--6.2.4 Observation of limbs

-6.2.5 Observation of two lower orifices

--6.2.5 Observation of two lower orifices

-6.2.6 Observation of skin

--6.2.6 Observation of skin

-6.3 Observation of excreta

--6.3 Observation of excreta

-6.4 Observation of infantile fingerprints

--6.4 Observation of infantile fingerprints

-Frequently Asked Questions

--Frequently Asked Questions

-Unit test for week 8

Week 9 Diagnosis methods: Inspection of tongue

-7.1 Outline of tongue inspection

--7.1.1 The morphology and structure of the tongue

--7.1.2 The principle of tongue examination

--7.1.3 The method and precaution of tongue examination

--7.1.4 The content of tongue examination, normal tongue

-7.2 Inspection of tongue structure

--7.2.1 Observe the color of tongue

--7.2.2 Observe the shape of tongue

--7.2.3 Observe the states of tongue

--7.2.4 Observation of sublingual vein

-7.3 Observation of tongue coating

--7.3.1 Observation of coating texture

--7.3.2 Observe the color of coating

-7.4 Clinical significance of tongue diagnosis

--7.4 Clinical significance of tongue diagnosis

--【Discussion 10】Why to observe the tongue can be used to diagnose disease?

-Unit test for week 9

Week 10 Diagnosis methods::Pulse examination

-8.1 The principle of pulse examination

--8.1 The principle of pulse examination

-8.2 The regions and methods of pulse examination

--8.2 The regions and methods of pulse examination

-8.3 The elements of pulse examination and the normal pulse

--8.3 The elements of pulse examination and the normal pulse

-8.4 Characteristics and significance of pulse

--8.4.1 Superficial pulse, deep pulse, slow pulse, rapid pulse

--8.4.2 Surging pulse, thin pulse, long pulse, short pulse

--8.4.3 Feeble pulse, forceful pulse, slippery pulse, uneven

--8.4.4 Taut pulse, tense pulse,soggy pulse, moderate pulse

--8.4.5 Knotted, slow-regular-intermittent, irregularly abrupt

-8.5 Similar pulse, concurrent pulse, pulse indicating deterioration of visceral qi۞

--8.5 Similar pulse, concurrent pulse, pulse indicating deterioration of visceral qi۞

--【Discussion 11】Why is complex pulse more common than single-factor pulse?

-8.6 Women’s pulse, children’s pulse

--8.6 Women’s pulse, children’s pulse

-8.7 The clinical significance of pulse diagnosis

--8.7 The clinical significance of pulse diagnosis

-Unit test for week 10

Week 11 Diagnosis methods:Listening and smelling examination

-9.1 Listening

--9.1 Listening

-9.2.1 Abnormal sound

--9.2.1 Abnormal sound

-9.2.2 Abnormal language

--9.2.2 Abnormal language

-9.2.3 Respiratory abnormality

--9.2.3 Respiratory abnormality

-9.2.4 Cough

--9.2.4 Cough

--【Discussion 12】How to observe the patient's cough sound and sputum changes to determine whether the

-9.2.5 Abnormal sounds of the stomach and intestines

--9.2.5 Abnormal sounds of the stomach and intestines

-9.3 Smelling

--9.3 Smelling

--【Discussion 13】How to diagnose by smelling?

-Unit test for week 11

Week 12 Diagnosis methods:Palpation

-10.1 The method, meaning and precautions of palpation

--10.1 The method, meaning and precautions of palpation

-10.2 Contents of palpation

--10.2.1 Palpating chest and hypochondrium

--10.2.2 Palpating stomach and abdomen

--10.2.3 Palpating skin

--10.2.4 Palpating hands and feet, palpating acupoints

--【Discussion 14】How to determine whether external or internal injuries?

-Unit test for week 12

Conclusion

-Conclusion

--Conclusion

Final Exam

-Final Exam

--Final Exam

8.4.1 Superficial pulse, deep pulse, slow pulse, rapid pulse笔记与讨论

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