仲景脉诊方法辨识概要

仲景脉法贯穿《伤寒杂病论》整套诊治体系,是正确应用经方的客观凭据,本文先简述脉诊源流;然后介绍仲景脉法的基本要点和操作要领,即仲景常用脉法和寸口分部与人体的对应关系及仲景平脉特点,以期知常达变;再论述仲景以阴阳脉法为辨证总纲,察独和脉症(证)并举的脉诊要点。并以浮脉为例,阐述仲景脉法在病脉证治体系中的具体操作要领,即通过脉诊与已知证素,推测病因,确立病位,判断病性,阐述病机,确立病证,指导治则、处方用药,判断疗效、预后、传变。     

仲景脉法浅析

脉诊是中医诊断学中精华之一，在临床中有着重要的诊断意义。《内经》曰：“微妙在脉，不可不察。”一般而言，脉与证应当合参，各种疾病常有其主要脉象，如仲景《伤寒杂病论》中，太阳伤寒病的脉浮紧、少阴病的脉微细、百合病的脉微数、疟疾脉弦等。仲景脉法，有其独到之处，仲景往往用几种复杂的脉象结合起来以阐释病机，有时以脉象代替证候，有时还依据脉象来指导治疗，根据脉象推断病情、判断预后、制定禁忌等。现将仲景脉法浅析如下；1．以脉象阐释病机《金医·腹满寒庙宿食病》曰；“腹痛，脉弦而紧，弦则卫气不行，即恶寒，紧则不欲…     

仲景脉法特点浅论

仲景《伤寒论》、《金匮要略》虽非脉学专著,但其所论脉法却极精详。脉证合参是其诊病的基本特点,更具特色的是原书所载脉法往往独以脉象阐述病机,确定病位,作诊断及鉴别诊断,建立治则方药,判断预后等等。本文试就仲景脉法特点作一浅论。1　重视脉证合参仲景重视脉证合参,在其二书中大多是脉证并举,辨治结合。如《伤寒论》第1条:“太阳之为病,脉浮,头项强痛而恶寒。”条文中脉证俱备,且将脉象冠以诸证之首,明确提出了太阳病的主要脉证,并列为太阳病的提纲。又如在《金匮·痉湿日曷篇》:“太阳病关节疼痛而烦,脉沉而细者,此名湿痹。”条文同…     

《金匮要略》病证脉象分析

对<金匮要略>中痉病、疟病、胸痹病、水气病和黄疸病的脉法进行了归纳整理,分析提炼出其纲脉、可见脉、变脉和死脉,并结合后世医家杂病脉诊运用的有关论述进行分析,使仲景杂病脉候病机思想具体化,以有利于临床辨证方法的充实,对临床诊治疾病具有指导意义.     

《伤寒论》弦脉探要

《伤寒论》是中医的经典著作之一,其中《伤寒论》中的脉学也是独具特色,仲景在开篇的辨脉法中就提到“问曰：脉有阴阳者何谓也。答曰：凡脉大、浮、数、动、滑,此名阳也;凡脉沉、涩、迟、弦、微,此名阴也,凡阴病见阳脉者生,阳病见阴脉者死。”这就充分证明了脉法在《伤寒论》中的重要性。万事万物都分阴阳,脉也如此。其中,仲景把弦脉定义为阴脉。但通读全文,仔细分析弦脉的脉形、脉位和主病,我认为更应该把弦脉定义为阴中之阳脉。     

《伤寒论》脉法研究现状分析

《黄帝内经》有"能和色脉,可以万全""微妙在脉,不得不察",说明脉诊在古典中医诊断中的重要地位。成书于东汉时期的《伤寒论》对于脉诊尤为重视,形成了独特的脉法体系,也是学术界一直以来的研究重点。本文系统梳理分析近三十年有关《伤寒论》脉法研究的文献,并对其分类研究发现目前学术界主要对仲景脉法的源流考证争议比较大,对脉法的内涵,尤其是阴阳的定义以及平脉、变脉的诠释说法不一,对《伤寒论》中单脉和兼脉的解读也存在不同观点。此外,对脉与病机之间的关系也有不同的解读,甚至还有结合现代技术对仲景脉法进行分析研究,期望更好地还原仲景脉法的科学内涵。本文结合中医经典理论,详细分析《伤寒论》脉法研究现状,从而论证仲景脉法真实内涵,以求更好地指导张仲景脉法体系的研究和临床运用。     

仲景脉法自成体系,平脉辨证,服务临床

仲景脉法是仲景学说的重要内容之一。张仲景在总结继承总结《内经》《难经》脉法的基础上,创立了仲景脉法,自成体系,切合实用,为后世脉学的发展奠定了坚实的基础。仲景脉法对我们理解张仲景的学术思想,学好《伤寒论》提高临床疗效有着重要的指导意义。因此,我们应重视《伤寒论》中的仲景脉学思想,学习继承仲景脉法,传承经典,实践创新,融合各家脉学思想,领会其中的深意,为现代临床服务。     

论张仲景妇科学术思想

仲景治疗妇科疾病,分为妊娠、产后、杂病,计三十六病。在《金匮要略》分三篇论述,分别是妇人妊娠病脉证治、妇人产后病脉证治、妇人杂病脉证并治。重视气血阴阳,调护胃气,责于肝、脾、肾,"保护胃气"仲景一个重要的学术思想。《金匾要略》妇人病三篇方证之中,内寓暖肝、清肝、养肝、抑肝、疏肝诸法。仲景非常重视安胎养胎,论述安胎养胎七法。仲景将瘀血的病因归结为:外伤、寒凝、热煎、气滞、气虚等,同时强调了瘀血是疾病发展过程中形成的病理产物,又是某些疾病的致病因素。月经病属于妇科杂病,妇科杂病病因多因虚、积冷、结气三个方面,辨证以寒、热、虚、实为主。仲景对妇女情志疾病的论治具有重要的指导意义。在治疗方面,仲景根据不同病情,不同病症,采用多种治法和剂型。     

《和家氏伤寒论》仲景脉法述要

通过对《和家氏伤寒论》有关"脉"的条文检索、分类、整理、归纳,结合《脉经》及后世宋本《伤寒论》中"辨脉法""平脉法"的相关论述,对仲景脉法的实用性、科学性、可操作性以及可传承性进行研究、探析和述评。系统整理仲景脉法及后世对脉法发挥之间的差异,用辩证唯物观和历史发展观的科学思维方法认识仲景脉学,为防止中医脉学发展走向神秘化和简单化两个极端、异端,提供客观、充实、强有力的仲景学说实践经验和理论支撑。     

仲景对脉学的继承与发展

仲景对脉学真正的贡献不只是在于书中所保留的各种详细脉诊法则与实例,而是承上启下地将中医脉学推向了一个新的高度。首先,仲景肯定了《难经》独取寸口诊法简便准确的特点,虽然尚有三部诊脉法,但是在书中主要以寸口脉诊法为主,这为后世"独取寸口"的脉诊诊法奠定了主基调。其次,仲景之后的王叔和对于仲景的《伤寒论》进行了比较系统而全面的整理,王叔和在整理过程中必然对于《伤寒论》特色—脉学有相当深入的研究,而叔和的《脉经》也引用了很多《伤寒论·平脉法》和《伤寒论·辨脉法》的内容,仲景脉法对叔和脉法的影响亦是足见一斑。     

料度脏腑，独见若神——谈仲景脉法的学习与经方的应用（二）

1 六经病的脉证应用要略 1．1太阳病本病提纲为“太阳之为病,脉浮,头项强痛而恶寒”（1条）。提示太阳病主脉象浮,为阳证,主症为头项强痛而恶寒。 《脉经》云：“尺寸俱浮者,太阳受病也,当一二日发。以其脉上连风府,故头项痛,腰脊强。．”临证所见,太阳病独脉为寸部脉浮,尤以左寸浮明显。     

大柴胡汤合方治疗支气管哮喘验案分析

大柴胡汤出自《伤寒论》及《金匮要略》,由柴胡、黄芩、半夏、枳实、芍药、大黄、生姜、大枣等药物组成,主治少阳阳明合病。临床研究证实,大柴胡汤具有抗炎、抗过敏瞳’及治疗抑郁症、抑制胃食管反流的作用。     

杨洪涛运用健脾和中降浊法治疗腹膜透析消化系统并发症经验

腹膜透析(peritoneal dialysis,PD)主要用于治疗.肾衰竭,其利用人体自身腹膜作为透析膜,通过PD管向腹腔灌注透析液,保留一段时间,利用弥散、对流、渗透及超滤原理清除体内代谢废物和过多的水分,纠正水、电解质和酸碱平衡紊乱;同时通过透析液补充机体某些所需物质,如电解质、碱基和葡萄糖等.     

黄建平辨治胆石症、胆囊炎经验

黄建平教授系上海中医药大学附属曙光医院普外科主任医师,上海市中西医结合外科学会委员,主要从事中西医结合肝胆疾病的临床与研究工作,擅长治疗各类肝胆胰疾病。笔者有幸师从黄建平教授,获益匪浅，兹将老师辨治胆石症、胆囊炎的经验整理如下。     

DT-13, a saponin of dwarf lilyturf tuber,exhibits anti-cancer activity by down-regulating C-C chemokine receptor type 5 and vascular endothelial growth factor in MDA-MB-435 cells简

AIM： To investigate the anticancer activity of DT-13 under normoxia and determine the underlying mechanisms of action. METHODS： MDA-MB-435 cell proliferation, migration, and adhesion were performed to assess the anticancer activity of DT-13, a saponin from Ophiopogonjaponicus, in vitro. In addition, the effects of DT-13 on tumor growth and metastasis in vivo were evaluated by orthotopic implantation of MDA-MB-435 cells into nude mice; mRNA levels of vascular endothelial growth factor （VEGF）, C-C chemokine receptor type 5 （CCR5） and hypoxia-inducible factor 1a （HIF-1a） were evaluated by real-time quantitative PCR; and CCR5 protein levels were detected by Western blot assay. RESULTS： At 0.01 to 1 umol·L -1, DT-13 inhibited MDA-MB-435 cell proliferation, migration, and adhesion significantly in vitro. DT-13 reduced VEGF and CCR5 mRNAs, and decreased CCR5 protein expression by down-regulating HIF-1 a. In addition, DT-13 inhibited MDA-MB-435 cell lung metastasis, and restricted tumor growth slightly in vivo. CONCLUSION： DT-13 inhibited MDA-MB-435 cell proliferation, adhesion, and migration in vitro, and lung metastasis in vivo by reducing VEGF, CCR5, and HIF-la expression.     

Effects of feeding tyrosine and phenylalanine on the accumulation of phenylethanoid glycosides to Cistanche deserticola cell suspension culture

AIM： To investigate the effects of feeding phenylalanine （Phe） and tyrosine （Tyr） on the accumulation of total phenolic compounds and four phenylethanoid glycosides （PeGs） to a cell suspension culture of the parasitic plant Cistanche deserticola.METHOD： A cell suspension culture of C. deserticola was established and precursors of different concentrations were fed. In each group, the cell was sampled at the 24^th day after inoculation. The content of total phenolic compounds and four PeGs compounds were determined using the Folin-Ciocalteu method and an HPLC method, respectively.RESULTS： In the Phe fed cells, the maximum PeGs yield was achieved when Phe was fed at 1.5 mmol·L^-1 and the yield reached 1.13 times the control cell concentration. In the Tyr fed cells, the maximum yield of PeGs was 1.60 times of control when 0.75 mmol·L^-1 Tyr was fed to the cells. Furthermore, it was found that the salidroside yield was 4.01 times of control group when 5 mmol·L^-1 Tyr was fed.CONCLUSION： Tyr is a better precursor for PeGs accumulation compared with Phe, and the rate limiting enzymes might be involved in the Tyr branch.     

辨方证的临床体会

辨方证是中医临床最重要的诊疗手段,现结合本人的临床体会将辨方证的方法分析如下。     

Combinatorial effects of conception and governor vessel electroacu- puncture and human umbilical cord blood-derived mesenchymal stem cells on pathomorphologic lesion and cellular apoptosis in rats with cerebral ischemia/reperfusion

OBJECTIVE： To investigate the combinatorial ef- fects of conception and governor vessel electroacu- puncture （EA） and human umbilical cord blood-de- rived mesenchymal stem cells （HUCB-MSCs） on pathomorphologic lesion and cellular apoptosis in rats with cerebral ischemia/reperfusion. METHODS： With the HUCB-MSCs isolated, cultured and identified and the models of cerebral isch- emia-reperfusion established, the HUCB-MSCs of passage three were intracranially transplanted andthe EA at conception and governor vessels was ap- plied. The pathomorphologic lesion by hematoxy- lin-eosin staining and the cellular apoptosis by ter- minal deoxynucleotidyl transferase-mediated nick-end labeling method around the ischemic fo- cus were observed. RESULTS： The cultured adherent HUCB-MSCs ex- hibited a spindle shape and expressed MSC-specif- ic markers, with the cell purity and proliferation rate significantly increasing after the primary pas- sage. HE staining showed that there were no patho- logical changes observed in the sham surgery group. However, in the PBS transplantation group, degeneration and necrosis of a great number of nerve cells were seen. In both the HUCB-MSCs transplantation group and the HUCB-MSCs trans- plantation ＋ EA group, reparative changes of the pathomorphism of the tissue were found. Both combination treatment and simple MSCs treat- ment were able to improve the pathomorphorlogic lesion following cerebral ischemia and reduce the abnormal TUNEL-positive numbers, with former better than latter. CONCLUSION： HUCB-MSCs improve pathological lesions and inhibit the cellular apoptosis around the cerebral ischemic area. EA at conception and governor vessels also improve pathological lesion and inhibit the cellular apoptosis in rats treated with HUCB-MSCs transplantation, which effects were superior to that of simple HUCB-MSCs trans- plantation.     

沈敏鹤从三焦辨治肿瘤临床经验

沈敏鹤主任医师系国家级名老中医吴良村教授的学术继承人,从事中西医结合肿瘤内科临床工作二十余载,擅长中西医结合治疗各种常见恶性肿瘤,尤其对从三焦辨治肿瘤见解独到。笔者有幸随师侍诊,获益匪浅,现将沈师从三焦辨治肿瘤的临床经验总结介绍如下。