伏脉

伏脉是单因素的脉象。 伏脉属沉脉类，但程度上与沉脉有明显的差异，伏脉脉位极深，需要重按，方可得见。     

浮脉、沉脉的脉象特征及临床意义发展源流

通过对《黄帝内经》以降相关文献的梳理,概述浮脉、沉脉的脉象特征与临床意义的发展轨迹,以正本清源,为脉象的规范化研究及指导临床实际提供一定依据。结果表明,现今所认识的浮脉、沉脉,无论从诊脉方法还是内涵,与古代尤其是《黄帝内经》《难经》《伤寒杂病论》中所记载的"浮""沉"脉不完全相同:1)古人认为浮脉、沉脉可以是生理脉象;2)古人用浮、沉表述疾病状态下脉位浅、深的动态变化;3)古人用静态的浮脉、沉脉反映人体的生理、病理特征。中医对浮脉、沉脉脉象特征及临床意义的认识是在发展中逐步完善的。     

牢脉详解

古代各医家和现代医家对牢脉的认识不尽相同,笔者参考古代文献和个人体会认为牢脉极沉而坚实,举寻不可得,左右推寻动而不移是其诊断的关键.牢脉是实邪深入在里,里实表虚,虚实并见,寒气外束,寒热错杂之象,主内积、气结、血瘀等症.     

沉脉

沉脉为具有独立意义之单因素脉象,不含有其他因素。主要是脉位较沉,沉取时脉搏动感较中取、轻取时明显。沉脉只以部位言,其位置深在,近于筋骨,位于“肌肉之下”,且有深深下沉之势,与浮、中构成不同深浅位置之脉位。     

二十八脉速记歌

一、浮脉类:浮濡乳革散浮脉为阳轻轻按,主表需分热与寒。浮小细软是谓濡,若非诸虚湿为主。浮大中空如葱管,伤阴失血礼脉显。中空外坚是谓革,浮而搏指亡精血。元气虚损散脉提,浮散无根至难齐。二、沉脉类:沉伏弱牢沉属阴脉按需重,病有虚实皆里证。推筋着骨伏脉得,病主阳衰痛闭厥。沉而柔细弱脉定,气血不足虚弱证。牢主阴寒积痞病,实大弦长沉取见。三、迟脉类:迟缓结涩代一息三至脉曰迟,主寒当辫虚和实。缓脉米怠缓整四至,若非脾虚定是湿。结脉缓慢止无定,血淤气滞阴寒盛。涩脉艰涩缓不畅,气滞血淤精血伤。代脉中止数有定,脏衰元亏风与痛。四…     

沉脉的特征、形成机制及主病研究

从脉象特征、影响因素、形成机制、浮沉比较、所主病证5个方面对沉脉进行了阐述。其特征是脉位较低,轻取不应,重按乃得;影响因素包括体型、季节、性别;沉脉的形成与疾病的表里、气血的强弱、气机郁滞的程度、邪气的性质及多少有密切关系;借助浮沉脉象的比较,可判断正气的强弱,邪气的多少以及病位和病势;沉脉主里此为常规,多见于阴寒内盛、水饮、阳气虚衰、气机郁滞、血虚、阴虚内热等情况;沉脉也有主表之时,多见于表证初期和太少两感。     

《素问》中“浮”脉与“沉”脉含义简析

高等中医药院校统编教材《中医诊断学》中浮脉与沉脉是一对反映脉位深浅的相反脉;《素问》中"浮"与"沉"则用来描述正常和疾病状态下脉位的动态变化。通过对《素问》中"浮"脉与"沉"脉相关记载的分析,探讨其与现今国家高等中医药院校统编教材认识的异同,以期为目前的脉诊教学提供参考,为丰富和发展脉学提供一定依据。     

弱脉

弱脉是具有复合因素的脉象。 弱脉由沉、细、无力、软的特征要素构成。     

脉象记忆一得

一、按脉位记此类脉的共同特点是脉位异常,包括浮、濡、散、沉、伏、牢、弱7种。重取稍减而不空者为浮脉;浮而细软者为濡脉;浮散无力,漫无根蒂,重按消失者为散脉。轻取不应,重按始得,举之不足,按之有余者为沉脉;若脉更深于沉者为伏脉;沉而实大弦长者为牢脉;沉而细软者为弱脉。二、按脉率记此类脉的共同特点是脉率异常,包括数、疾、迟3种,一息5—6至者为数脉;脉来急疾,一息7至者为疾脉。一息     

仲景脉学研究及临床应用（三）——沉脉的临床应用

沉脉是较为常见的脉象,最主要的脉象特点是脉位深沉。体型、季节、性别对沉脉均有一定的影响。其形成机理与气血不足、阴邪郁遏、气机郁滞等有关。沉脉在主病方面,既主里证,又见于表证。     

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。     

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.     

妊娠滑脉和病理滑脉的脉图和血液流变学对比研究

目的:观察妊娠滑脉和病理滑脉脉图参数和血液流变学指标间的关系。方法:采用最适取法提取左关部脉图有关参数:升支最大斜率(MSAB)、降支最大斜率(MSBC)、降中波波幅(HFF’)、降中峡高/主波高(HE/HB)、主波宽(TW);同时检测血液流变学相关指标:全血比黏度之低切比黏度(ηb低切)、高切比黏度(ηb高切)、血浆比黏度(ηp)、红细胞聚集指数(Lb)、红细胞压积(Hct)。结果:两滑脉组MSAB、MSBC和HFF’较正常对照组增大,HE/HB和TW较正常对照组减小(P<0.001);与妊娠滑脉组比较,病理滑脉组MSAB、MS-BC和HFF’减低,而HE/HB和TW增大(P<0.01)。两滑脉组ηb低切、ηb高切、ηp、Lb和Hct较正常对照组均减低(P<0.001);与妊娠滑脉组比较,病理滑脉组ηb低切、ηb高切和ηp增高(P<0.01)。结论:妊娠滑脉组血液黏滞性较病理滑脉组低。     

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。     

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     

脉诊操作学习中的常见问题及应用脉象因素教学的体会

脉诊历来是中医诊断教学中的难点,应用脉象因素教学法,按照八因素总结了常见脉象的特征进行分类学习.教学中特别重视指力的练习和对平脉的体会.通过教学实践,发现应用脉象因素教学法能使学生迅速掌握脉象特征,熟练诊脉实际操作,并能充分调动学生学习的积极性,在促使学生全面、正确地掌握诊脉方法、诊脉技巧和常见脉象的特点方面,取得了良好的教学效果.     

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.     

Relationship between Renying pulse augmentation index and Cunk- ou 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 pres- sure groups, and the clinical significance of Reny- ing and Cunkou pulse parameters to reflect vascu- lar function. METHODS： Eighty-six patients with essential hyper- tension （EH） and 52 individuals with normal blood pressure （control group） between and January 2012 were included September 2010 this study. Reny- ing pulse AI was examined by a new diagnostic tool （ALOKA ProSound Alpha 10） --wave intensity （Wl） that is calculated as the product of the deriva- tives of the simultaneously recorded blood pres- sure changes （dP/dt） and blood-flow-velocity changes （dU/dt）, while Cunkou pulse condition was detected by DDMX-100 Pulse Apparatus inboth EH and control groups. A multifactorial corre- lation analysis was performed for data analysis. RESULTS： After adjusting for potential confound- ing variables, in the EH group, AI was positively cor- related with ts, w2/t （rts=0.225, P〈0.05; rw2/t=0.230, P〈 0.05） and negatively correlated with hs, hs/hl and w2 （rhs=- 0.393,P〈0.01 ;rhs/l=- 0.444, P〈0.01 ;rw2=- 0.389, P〈0.01）. In the control group, AI was positively cor- related with t3, t4, ts and w, （rt3=0.595, P〈0.01; r,4= 0.292, P〈0.05; rt5=0.318, P〈0.05; rw1=0.541, P〈0.01） and negatively correlated with h1, h2, h3, Ad and A （rh1= - 0.368, P〈0.05; rh2= - 0.330, P〈0.05; rh3= - 0.327, P〈 0.05; rAd=- 0.322, P〈0.05; rA=- 0.410, P〈0.01）. In the total sample group （EH plus control group, n= 138）, AI was positively correlated with t, ts, w1 and w, （rt=0.257, P〈0.01; rt5=0.266, P〈0.01; rw1=0.184, P〈 0.05; rw/t=0.210, P〈0.05） and negatively correlated with hs, hs/hl, w2 and Ad （rhs= - 0.230, P〈0.01; rh5/h1= - 0.218, P〈0.05; rw2= - 0.267, P〈0.01; rAd= - 0.246, P〈0.01）. Multiple linear regression analysis was car- ried out to model the relationship （F=7.887, P〈 0.001）.CONCLU     

齐派医学与脉学流派

中医脉法主要有古遍诊脉法、独取寸口脉法和太素脉法,并相应形成不同的脉学流派。以秦越人、淳于意为核心的齐派医家倡立、西晋王叔和发展并完善的"独取寸口"诊脉法,对中医脉学产生了巨大影响,成为中医学的主要脉学流派。