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8.5 Similar pulse, concurrent pulse, pulse indicating deterioration of visceral qi۞课程教案、知识点、字幕

同学们好

我们学习了二十八种脉中常见的十九种脉象的

脉象特征和临床意义

由于脉象繁多 很多脉象彼此非常相似

不容易掌握和记忆

所以我们将二十八种脉进行归类和分纲

可以起到提纲挈领 执简驭繁的效果

下面我们来学习

脉象的类比 相兼脉和真脏脉

首先是相类脉的比较

临床的病脉都是在邪正斗争中形成的

辨证以 表里 寒热 虚实 为纲

所以脉象也以浮 沉 迟 数 虚 实六纲相应

因此我们按照浮 沉 迟 数 虚 实六纲脉

将二十八脉进行分类

其中

凡是具有脉位表浅 轻取即得特征的脉象

都归于浮脉类

比如 浮脉 散脉 芤脉 革脉

凡是具有脉位深沉 重按始得特征的脉象

都归于沉脉类

比如 沉脉 伏脉和牢脉

凡是具有脉率均快于正常脉象

一息五至以上的特征的脉象

都归于数脉类

比如 数脉 疾脉 动脉和促脉

凡是具有脉率较慢

一息不足四至的特征的脉象

都归于迟脉类

比如 迟脉 缓脉 结脉和代脉

凡是具有脉形细小

脉势软弱 应指无力的特征的脉象

都归于虚脉类

比如 虚脉 濡脉 细脉

弱脉 微脉 涩脉和短脉

凡是具有脉势充实 应指有力的特征的脉象

都归于实脉类

比如 实脉 滑脉 洪脉 大脉

弦脉 紧脉和长脉等等

通过以上的分类方法 将二十八种脉分为

浮 沉 迟 数 虚 实 六大类

临床常见的病脉的脉象和主病归类表

由于时间有限

每一个脉象的脉象特征和主病意义

我就不再重复讲述了

请同学们参考课后文本

再认真学习

下面 我们来学习一下相兼脉 以及相兼脉的主病

什么是相兼脉呢

相兼脉 又称复合脉

它是指两种或者两种以上

单因素的脉同时出现

复合构成的脉象

什么是单因素脉象

单因素脉象就是

只反映位 数 形 势四个要素中某一个要素的脉象

这就是单因素脉象

比如浮脉 沉脉

迟脉 数脉 长脉 短脉

大脉和细脉等等

这些都是属于单因素的脉象

而复合脉 比如

浮紧脉 浮数脉 浮缓脉 沉细脉 沉细数脉等等

这些由两种或者两种以上的单因素脉象

同时出现的脉象

称之为复合脉

另外 还有一些脉象

它本身就是几个单因素的脉象复合而成的

比如 濡脉

它就是由浮 细 软三种因素合成的

涩脉

它是细脉 迟脉

以及脉势不均 脉力不匀的脉象复合形成的

另外 还有几种脉象 我们没有学的

比如 弱脉

它是由沉 细 软三种因素合成

动脉

它是由滑 数 短三种因素合成的

牢脉 它是由

沉 实 大 弦 长 五种因素合成

相兼脉为什么会出现呢

这是因为

临床每一种疾病都会包含有

正邪盛衰的变化 病因的变化

病位的变化和病性变化

因此 临床所见的脉象

就会从脉势 脉形 脉位和脉数上表现出来

因此 诊脉时也必须从各个方面进行综合考虑

因此 临床上所见的脉象 基本上都是

脉势 脉形 脉位和脉数

兼有的相兼脉

相兼脉有什么样构成原则呢

它的原则就是

只要不是性质相反的脉象

都可以构成相兼脉

比如

浮脉类的浮 散 芤 革脉

以及沉脉类的沉 伏 牢脉

性质相反

因此它们不可能同时出现在同一个病人

数脉类的数 疾 动 促脉 以及

迟脉类的迟 缓 结 代脉

性质也相反

因此它们不可能同时出现在同一个病人

虚脉类

比如 虚 濡 细 涩 短脉等等

以及实脉类的

实 滑 洪 大 弦 紧 长脉等等

它们也是性质相反

因此它们也不可能同时出现在同一个病人

只要不是性质相反的脉就可以构成相兼脉

相兼脉构成以后 它的主要疾病规律又是什么呢

相兼脉的主病 等于该相兼的

各单一脉象主病的有机结合

用四个比较常见的脉象来举例 比如

浮脉的相兼脉

浮主表 数主热

因此浮数脉 主外感风热之邪引起的表热证

又称为风热表证

浮主表 紧主寒 所以

浮紧脉 主外感风寒之邪导致的表寒证

又称为风寒表证

浮主表 缓主虚

所以浮缓脉主外感风邪之表虚证

又称为伤风表证

再比如 沉脉的相兼脉

沉主里 迟主寒 所以沉迟脉主里寒证

沉主里 弦主肝病

所以沉弦脉主肝郁气滞 或水饮内停

沉主里 细主虚

所以沉细脉主里虚证

由于细脉主要与血虚不能充盈有关

所以沉细脉主血虚证

沉主里 细主虚 数又主热

所以沉细数主里虚热证

也就是阴虚内热证

沉主里 涩主血瘀 所以沉涩脉 主血瘀证

尤常见于阳虚而寒凝血瘀证

再比如 弦脉的相兼脉

弦为肝脉 紧脉主寒主痛

所以弦紧脉 常与寒滞肝脉的病变有关

弦为肝脉 数主热

所以弦数脉 主肝郁化火

或肝胆湿热 肝阳上亢证

弦为肝脉 细主虚

所以弦细脉 主肝血亏虚

或者是肝郁脾虚证

弦为肝脉 细主虚 数主热

所以弦细数脉 主肝肾阴虚火旺

弦脉主肝病 疼痛和(痰饮)

而滑脉主痰饮 食积和实热证

数主热

所以

弦滑数

它可以见于肝火夹痰 肝胆湿热

或肝阳上扰、痰火内郁等等病证

再比如 数脉的相兼脉

数主热 滑主痰饮 食积和实热

所以滑数脉主痰热 湿热 或食积化热

数主热 洪主实热证

所以洪数脉 主实热证

多见于外感热病

数主热 细主虚

所以细数脉 主虚热证(阴虚火旺证)

以上就是相兼脉 及相兼脉的主病规律

最后 我们来简单学习一下真脏脉

真脏脉 是在疾病危重期出现的无胃 无神 无根的脉象

真脏脉 通常是病邪深重 元气衰竭

胃气衰败 病情危重的一个征象

因此 真脏脉又称为

败脉 绝脉 死脉和十怪脉

真脏脉主要分为无胃脉 无神脉和无根脉

无胃脉 是脉象以无冲和之意 应指坚搏为特征

主要有偃刀脉 转豆脉 弹石脉

无根脉 是以虚大无根或微弱不应指为特征

如釜沸脉 鱼翔脉和虾游脉

无神脉 是以脉率无序 脉形散乱为特征

比如雀啄脉 屋漏脉 解索脉和麻促脉等

真脏脉 虽见于病情危重的病人

但是随着医疗技术的不断提高

通过不断研究和临床实践

对真脏脉有新的认识

其中有一部分是由于心脏器质性病变所造成的

但不一定是无可救药的死证

应该仔细观察 尽力救治

以上是我们学习的相类脉 相兼脉和

真脏脉的内容

本节课就讲到这里

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

8.5 Similar pulse, concurrent pulse, pulse indicating deterioration of visceral qi۞笔记与讨论

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