脉诊实验三步教学法初探

为加强脉诊教学,创建了脉诊实验三步教学法。其第一步是传授方法,辨识平脉;第二步是利用模型,辨识病脉;第三步是测定脉象,反复实践。通过教学实践,发现脉诊实验三步教学法能充分调动学生学习的积极性,有效地将理论与实践相结合,将中医脉诊"心中易了,指下难明"的只可意会、不可言传的师承教学转变为有据可依的形象直观的规模教学,使学生能尽快全面、正确掌握诊脉方法、诊脉技巧和常见脉象的特点。     

浅谈脉诊实验在中医诊断学教学中的应用与体会

中医诊断学是中医诊察疾病的基本理论、基本知识和基本技能的一门学科。显而易见，实践性很强。脉诊是中医学的瑰宝，脉诊一直都是中医学对各种疾病最有效、最基本的检查手段之一。因此，中医诊断学教学必须进行脉诊实验教学，主要就是要重视诊脉技能的培养，加强实践环节。脉诊实验教学实践证明，在见习基地相对不足的情况下，通过脉诊实验课教学，使抽象玄奥的脉象通过学生相互练习诊脉和具体可触的模拟脉象装置，为学生理解脉诊理论、掌握脉象提供了新的教学方法和手段。学生不仅能亲自动手，而且还可以反复练习，加深对常见脉象指感特征的体会。此外，进行脉诊实验可以培养学生的科研意识和科研思维，提高学生参与科研的兴趣与能力，对提高学生中医诊断能力，特别是脉诊水平是一次有益的探索与尝试。为此在本校中医、中西医结合等专业的中医诊断学实验教学中，开展了脉诊实验课程，为学生理解脉诊理论，掌握诊脉技能提供了新的有效途径。现将实验应用和体会加以认真总结分析，使之更好地发挥其功能。     

SSE联合纠错教学法在中医脉诊模拟教学中的应用

诊脉是一门极为精巧的技术,有明确的操作要领和操作规程。但实际应用中,学生更多关注于脉象形态特征和主病的描述,常常忽视操作要领和操作规范,使得诊脉徒有其表,更谈不上体会和把握脉象特征,而且缺乏训练和有效的反馈调节手段,这些成为阻碍中医诊断技术传承和发展的瓶颈。为此,笔者开设了中医诊断模拟训练课程,并在脉诊训练课中,使用SSE联合纠错教学法,旨在培养学生的综合素质,提高学生实践技能,做到理解到位,操作得心应手。     

关于脉象在疑难病诊治中作用的一些认识

临床治疗疑难病证的难以取效,原因较多,但与忽视脉象在诊疗中的作用是有一定关系的.望闻问切四诊当中,切诊脉象,目下越来越不被中医界重视,推究其原因,可能与"脉理精微……,在心易了,指下难明",难以掌握,以及西医各种检查发展迅速,以为足以为凭等因素有关.近十余年来,笔者既防止把诊脉神化,以为无所不能,又防止把诊脉形式化作为摆设,以为一无所能,对于脉象在疑难病诊治中的作用有一些粗浅认识,试述如下.     

唐蜀华论脉象七要素

唐蜀华教授提出诊脉时应注重脉象的七要素,即脉位、脉率、脉律、脉形、脉体、脉力与脉势,并力争从这七个方面做到脉诊的规范化、客观化、量化.现代中医可从脉诊中直接提取相对单一而易于把握的七大特征要素信息,用若干脉象要素术语对特定脉象进行多维扫描,描绘出看得见摸得着的立体脉象,以更细致地理解和掌握脉诊.     

诊脉切忌想象推测

诊脉是中医认识疾病、分析疾病、判断疾病,进而辨清病变证机属性的重要诊断方法之一,诊脉必须从病人的脉象形态及特征中而诊断.可有的描述脉象形态不是从具体病症中诊察出来的,而是从理论思维想象中推测出来的,其结果则会导致中医诊脉理论变为玄学而不能指导临床运用,于此试举两例,以明是非.     

脉诊辨析

脉诊是医生运用手指切按患者体表动脉,探查脉象,用以了解病情、辨识病证的一种诊病方法.中医学对于脉诊,尤其是寸口诊脉极为重视,并使之成为临床的常规诊法.学习脉诊只有熟悉脉学的基本知识,掌握切脉的基本技能,反复实践,仔细体会,才能逐步识别各种脉象,并运用于临床.     

脉诊客观化研究新思路

通过对中医脉诊客观化研究的发展历程和现状进行分析,发现现在诊脉机理研究和应用开发上遇到一些瓶颈性的问题难以突破。首次提出通过采集妊娠脉象,利用数字信号处理技术,找出并提取妊娠脉象中跟婴儿性别相关的特征信息,能建立定量采集、分析人体脉搏波的一般方法,将可能为临床诊脉提供既量化又敏感的指标。分析脉搏波中产生此特征信息的成因,对检验、完善脉搏系统力学模型具有指导意义;以妊娠脉象和婴儿性别为研究突破口对脉诊客观化研究具有重大意义。     

《伤寒杂病论》对脉学的学术贡献

《伤寒杂病论》对脉学极其重视,促进了后世脉学的发展：在诊脉中重视采用“寸口诊脉法”诊断疾病;诊脉方法多样化,针对不同疾病,采用不同诊脉方法;仲景脉学应用“阴阳学说”思想,认为脉诊以阴阳为纲;凭借脉象来判断疾病的病因、病位、病性、邪正盛衰、预后,并确立相应的治法,体现“脉证合参”的诊脉辨证思想;注重因人辨脉,人的体质胖瘦与脉象有一定关系;注重因时辨脉的思想,认为脉象受四时之气的影响。     

精神情志影响脉象诊断的临证举隅

<内经·脉要精微论>提出了医者进行诊脉时的基本要求,即"持脉有道,虚静为保".在临证诊脉过程中,只有参与双方均保持身心安静状态,才利于准确诊查脉象,诊断疾病.临床实践中,有些患者外表平和,医者难以发现其内心较为强烈的情志活动,也就不会意识到即刻的脉象并不能代表其真实的生理病理状态.如果不主动认识这些因素,将临时加入的精神情志因素与生理病理的基本脉象因素加以甄别,就可能对脉象做出误判,不利于诊疗活动的进一步开展.现结合三则脉案介绍如下.     

平、滑、弦脉的脉图分类参数范围研究

目的以单部脉脉图为依据,建立平、滑、弦三种脉象的特征参数及正常医学指标参考范围。方法分析447例非疾病人群的脉图,其中平脉脉图171例,弦脉脉图118例,滑脉脉图158例。对脉图幅值、时值等特征参数进行分析,探讨平、滑、弦脉特征参数指标与分布范围。结果平脉、弦脉、滑脉两两比较,h_1/t_1、h_3/h_1及h_4/h_1比值差异有统计学意义(P0.01)。平脉与滑脉比较,w/t比值差异无统计学意义(P0.05);弦脉与滑脉、平脉与弦脉比较,w/t比值差异有统计学意义(P0.01)。通过测量脉图特征参数的指标范围,建立了三种脉象特征参数的正常医学指标参考范围。结论基于以h_3/h_1、h_4/h_1、w/t和脉形为核心的指标参数,可以建立平脉、弦脉、滑脉脉图的判别标准。     

伏脉、牢脉、沉脉辨析

伏脉、牢脉、沉脉、三者皆属于六纲脉之沉脉类,本文从脉象特征、临床意义两方面分析三者阴阳属性、主病特点和脉位特征,精确判断伏脉、牢脉、沉脉三者脉位,仔细辨别三者异同,为临床诊疗提供先机.     

对疼痛脉象脉图的认识

紧脉和弦脉是疼痛的常见脉象,通过对近年有关弦脉及紧脉研究论文的查阅整理,了解其研究现状,为疼痛脉象的进一步研究提供思路和方法。     

Acupuncture effects on the pulse spectrum of radial pressure pulse in dyspepsia

This study is to investigate the influences of acupuncture for dyspepsia on the Radial Pressure Pulse (RPP) between the Chun, Guan and Chy positions of the right/left wrist. Two series of experiments were designed; for the first series, 30 patients with dyspepsia (Group P) and 30 normal subjects (Group N) were seated to undergo the measurements of pulse pressure waveforms from radial artery by sphygmograph. The parameters of RPP included the spectral energy of 0-10 Hz (SE(0-10 Hz)), 10-50 Hz (SE(10-50 Hz)) and 13-50 Hz (SE(13-50 Hz)). For the second series, acupuncture was administered at the right and left Tsu San Li (St-36) points for the same 30 dyspepsia patients, and then their pulse pressure waveforms were re-examined. The results showed that the SE(0-10 Hz) at Right Guan (RB) (p < 0.05), the SE(10-50 Hz) at RB (p < 0.01), and the SE(13-50 Hz) at RB (p < 0.01) and Left Guan (LB) (p < 0.05) of Group P were significantly greater than that of Group N. After the acupuncture, there were significant decreases in the SE(0-10 Hz) only at RB (p < 0.01), in the SE(10-50 Hz) at RB (p < 0.01), Right Chy (RC) (p < 0.05) and LB (p < 0.05), and in the SE(13-50 Hz) RB (p < 0.01), RC (p < 0.05) and LB (p < 0.01). We concluded that the pulse-frequency spectrum at RB was a more effective characteristic for dyspepsia patients, and the acupuncture had an effect on SE(10-50 Hz) and SE(13-50 Hz) more obviously than that on SE(0-10 Hz).     

弦脉与紧脉辨析

弦脉与紧脉在脉象上均具有脉气紧张的特点,临床切脉易将两者混淆.从弦脉与紧脉的脉象构成要素、脉图特征及脉象形成机制等方面研究其异同之处,掌握辨析要点,对临床鉴别弦脉与紧脉具有重要意义.     

浅议"迟脉主寒,数脉主热"

迟脉是脉率不及之脉象,《诊家枢要》曰:"迟,不及也,以至数言之,呼吸之间,脉仅三至,减于平脉一至也。"《脉诀汇辨》曰:"迟脉属阴,象为不及,往来     

紧脉的再认识

综合历代有关紧脉的医籍记载及最近研究成果,探讨紧脉的命名、脉形、主病、形成机理等问题。     

浮脉略谈

传统医学博大精深,脉诊更是神中之妙。"切脉而知之谓之巧""切脉而知之者,诊其寸口,视其虚实,以知其病,病在何脏腑也。"脉象中蕴含的信息恒河沙数,内知脏腑,外识肌表,兼以辨识气、血、津液等的盛衰,特别是在望、闻、问诊无法准确萃取的真寒假热、真热假寒、真虚假实、真实假虚的病证中,脉诊更能发挥其独一无二的作用。在诸多脉象中"浮脉"位居其首,历代论述脉诊的医籍均以浮脉为篇首进行论述,可见其处尊居显。浮脉为阳,表病居,但不限于表。其主病为截然相反之两证,一为实证、一为虚证,不可局限。在临床中浮脉较常见,无论外感,内伤,表证,里证,虚证,实证,都可涉及。     

Relationship between Renying pulse augmentation index and Cunkou pulse condition in different blood pressure groups

Objective

To explore the relationship between Renying pulse (carotid) augmentation index (AI) and Cunkou pulse condition in different blood pressure groups, and the clinical significance of Renying and Cunkou pulse parameters to reflect vascular function.

Methods

Eighty-six patients with essential hypertension (EH) and 52 individuals with normal blood pressure (control group) between September 2010 and January 2012 were included in this study. Renying pulse AI was examined by a new diagnostic tool (ALOKA ProSound Alpha 10) — wave intensity (WI) that is calculated as the product of the derivatives of the simultaneously recorded blood pressure changes (dP/dt) and blood-flow-velocity changes (dU/dt), while Cunkou pulse condition was detected by DDMX-100 Pulse Apparatus in both EH and control groups. A multifactorial correlation analysis was performed for data analysis.

Results

After adjusting for potential confounding variables, in the EH group, AI was positively correlated with t₅, w_2/t (r_t5=0.225, P<0.05; r_w2/t=0.230, P< 0.05) and negatively correlated with h₅, h₅/h₁ and w₂ (r_h5= − 0.393, P<0.01; r_h5/h1= − 0.444, P<0.01; r_w2= − 0.389, P<0.01). In the control group, AI was positively correlated with t₃, t₄, t₅ and w₁ (r_t3=0.595, P<0.01; r_t4= 0.292, P<0.05; r_t5=0.318, P<0.05; r_w1=0.541, P<0.01) and negatively correlated with h₁, h₂, h₃, Ad and A (r_h1= − 0.368, P<0.05; r_h2= − 0.330, P<0.05; r_h3= − 0.327, P< 0.05; r_Ad= − 0.322, P<0.05; r_A= − 0.410, P<0.01). In the total sample group (EH plus control group, n= 138), AI was positively correlated with t, t₅, w₁ and w_2/t (r_t=0.257, P<0.01; r_t5=0.266, P<0.01; r_w1=0.184, P< 0.05; r_w2/t=0.210, P<0.05) and negatively correlated with h₅, h₅/h₁, w₂ and Ad (r_h5= − 0.230, P<0.01; r_h5/h1= − 0.218, P<0.05; r_w2= − 0.267, P<0.01; r_Ad= - 0.246, P<0.01). Multiple linear regression analysis was carried out to model the relationship (F=7.887, P< 0.001).

Conclusion

Renying pulse AI can effectively predict arterial stiffness in synchrony with the manifestations of Cunkou pulse in elderly patients with hypertension. Cunkou pulse apparatus is a valuable tool for evaluating AI in clinical practice. The close correlations reported above reflect the holistic concept of Traditional Chinese Medicine.     

The arterial pulse analyzer as a potential replacement for manual pulse palpation in Oriental medicine

Application of the arterial pulse analyzer now makes it possible to automatically diagnose such geriatric disorders as arteriosclerosis by using simple electrocardiograms and radial, carotid and posterior tibial artery pressure pulse wave charts. If the arterial pulse analyzer is adopted for use in Oriental medical clinics, there will no longer be a need for manual pulse palpation. In brief, applying the arterial pulse analyzer to the 8 key pulses of Oriental medicine yields the following results: 1) 'Slow' or 'rapid' pulses can be defined by the S-S interval (almost identical to the R-R interval of the ECG). 2) 'Slippery' or 'hesitant' pulses can be defined by the S-P time and the Dh/Ch% (P time & Incisura) ratio. 3) 'Floating' or 'submerged' pulses can be defined by the Ph/Ch% (pressure pulse wave to height) ratio. 4) 'Scattered' or 'moderate' pulses can be defined by the S-C- time (E time). Thus, by employing the arterial pulse analyzer, subjectivity problems inherent in the manual pulse palpation used by Oriental medicine for over 1500 years can be analyzed objectively.