广中医-中医诊断-切诊2.ppt

1、Oblique flying pulse （斜飞脉） Ectopic radial pulse （反关脉） All the factors above mentioned may affect the conditions of the pulse. However , if the pulse still keeps gastric qi, spirit and root, it is still the normal pulse.,Morbid pulse The pulse in a morbid condition is called morbid pulse, in which th

2、e manifestations of pulse conditions are either the changes of the position of the pulse, or the difference in rhythm, or variation in morphology形态, or changes in strength.,1 floating pulse Features: sensible under light pressure, weak and constant beating under heavy pressure. Floating pulse is mar

3、ked by superficial beating. Clinical significance: Indicates external syndrome or internal asthenia syndrome. a. floating and powerful external sthenia syndrome b. Floating and weak external asthenia syndrome,示意图,浮 脉,脉图,如 水 漂 木,浮 中 沉,2 sunken (deep) pulse,Features: sensible only under heavy pressure

4、. “weak by touching and strong by pressing.” Clinical significance: Indicates internal syndrome. a. sunken and powerful internal sthenia syndrome b. sunken and weak internal asthenia syndrome,沉 脉,示意图,脉图,如 水 沉 石,浮 中 沉,3 Slow pulse Features: the pulse pulsates no more than 4 beats in a cycle of breath

5、 (60/min). Clinical significance: Indicates cold syndrome. a. slow and powerful sthenia cold syndrome b. sunken and weak asthenia cold syndrome,示意图,迟 脉,脉图,浮 中 沉,一息,Such a pulse condition is also seen in internal sthenia heat syndrome due to internal accumulation of pathogenic heat. Athletes or young

6、 ( the strong) are in a normal condition. Not only cold syndrome, but also heat syndrome.,4 Moderate pulse Features: the pulse pulsates 4 beats in a cycle of breath (60-70/min). Clinical significance: Indicates damp disease and weakness of the stomach and spleen. If the pulse is vigorous with equal

7、intervals, and the pulses in three portions are the same, the is a normal pulse.,示意图,缓 脉,脉图,一息,如 微 风 拂 柳,浮 中 沉,5 Fast pulse Features: the pulse pulsates over 5-6 beats in a cycle of breath (90/min). Clinical significance: Indicates heat syndrome. a. heat and powerful sthenia heat syndrome b. heat an

8、d weak asthenia heat syndrome Maybe seen in the syndrome due to external floating of asthenic yang(虚阳外越）.,示意图,数 脉,脉图,一息,浮 中 沉,6 Weak pulse Features: the pulse is marked by weak beating of the pulse at all the cun, guan and chi regions. Clinical significance: Indicates asthenia syndrome. usually seen

9、 in asthenia of both qi and blood, especially in qi asthenia.,7 Powerful pulse Features: the pulse is marked by powerful sensation of the pulse beating at all the cun, guan and chi regions under superficial, moderate and heavy pressure. Clinical significance: Indicates sthenia syndrome. usually havi

10、ng the main symptoms like: fever, abscess (脓肿), indigestion, constipation 便秘, mania躁狂 and fidget烦躁不安.,8 Slippery pulse Features: the pulse is beating freely and smoothly like the movement of beads of an abacus. Clinical significance: Indicates retention of phlegm and fluid, dyspepsia消化不良and sthenia

11、heat. Such a pulse is also seen among yung and strong people and gravida孕妇.,示意图,脉图,如 盘 走 珠,浮 中 沉,9 Astringent pulse Features: the pulse is beating in an inhibited way like scraping a piece of bamboo. In different strength and rhythm of the pulse is the key points. Clinical significance: Indicates di

12、fferent syndrome. a. astringent and powerful qi stagnation and blood stasis b. astringent and weak lack of essence and insufficiency of blood,示意图,脉图,如 轻 刀 刮 竹,浮 中 沉,10 Full pulse Features: the pulse is marked by wide size and full content, beating like roaring waves and sensibility under light press

13、ure and surges as well as sudden flowing and ebbing. Clinical significance: Indicates exuberant internal heat. usually having the main symptoms like: extremely thirst, macular斑点 and papular eruption 丘疹, headache, mania躁狂 and fidget烦躁不安. the pulse is mostly seen in the fulminant stage of warm disease

14、s.,示意图,脉图,如 波 涛 汹 涌,浮 中 沉,11 Thin pulse Features: the pulse is as thin as a thread, weak and quite sensible under pressure. Clinical significance: Indicates asthenia syndrome. usually seen in asthenia of both qi and blood, various overstrain虚劳 and diseases due to pathogenic dampness.,示意图,脉图,细 如 丝 线,

15、浮 中 沉,12 Taut pulse 弦脉 Features: the pulse appears straight, energetic and hard like the feeling of pressing the string of a vilolin. Clinical significance: Indicates disorders of the liver and gallbladder胆囊, pain syndrome and retention of phlegm and fluid.,示意图,脉图,如 按 琴 弦,浮 中 沉,14 Rapid and intermit

16、tent pulse (running pulse) Features: the pulse beats fast with occasional and irregular inter-mittence间歇. Clinical significance: Indicates different syndrome. a. fast, intermittent and powerful hyperactivity of yang heat, qi stagnation, blood stasis and retention of phlegm and food b. fast, intermit

17、tent and weak weakness of visceral qi and insufficiency of blood.,15 Slow and intermittent pulse Features: the pulse beats slow with occasional and irregular intermittence Clinical significance: Indicates different syndrome. a. slow, intermittent and powerful: predominance of yin and qi stagnation阴盛

18、气结, retention of phlegm and blood stasis b. slow, intermittent and weak: insufficiency of qi and blood.,16 Regular and intermittent pulse Features: the pulse beats slow and weak with regular intermittence. Clinical significance: Indicates declination of visceral qi and asthenia of primordial qi. It

19、is a dangerous portent前兆. It is also seen in emotional change, trauma, apoplexy and pain disease, the condition need not be worried, because the pause is due to the evil obstruction.,Combined pulse The pulse conditions mentioned above do not exist in a single form in the clinical practice. Usually t

20、wo or more pulse conditions appear at the same time. Such a pulse condition called combined pulse. The conditions of pulse may appear at the same time, unless they are contrary in nature, so as to comprehensively reflect the pathological changes in the body.,And the diseases indicated by the combine

21、d pulse is the synthesis of the diseases indicated by the pulse conditions appearing simultaneously in a case. On the whole, all related factors should be taken into consideration in differentiating pulse for making correct clinical diagnosis.,The significance of pulse examination a to recognize the

22、 exterior and interior of disease; b to judge the deficiency and excess; c to ascertain nature of disease; d to identify causes of disease; e to inspect the disease mechanism; f to predict the prognosis.,The relation between pulse and symptoms In most of the clinical conditions, a doctor could not m

23、ake diagnosis only by the pulse, but also the comprehensive data. The relation between pulse and symptoms may be one or two of the following two kinds. a the identical or non-identical relation b choosing one from the non-identical pulse and symptoms,脉紧张度分类:紧脉 弦脉 革脉 牢脉 缓脉 濡脉,常见病脉分类,脉位分类：浮脉 散脉 芤脉 沉脉 伏脉,脉率分类：迟脉 数脉 疾脉,脉宽度分类: 洪脉 细脉 弱脉 微脉,脉力度分类：虚脉 实脉,脉长度分类:长脉 短脉 动脉,脉流利度分类:滑脉 涩脉,脉均匀度分类:促脉 结脉 代脉,Palpation means to use fingers or