PDLP Chapter 1422 Pulse Diagnosis
Chapter 1422 Pulse Diagnosis
The four diagnostic methods of traditional Chinese medicine have a long history. The four diagnostic methods of traditional Chinese medicine appeared in the Spring and Autumn Period and the Warring States Period. Bian Que, a folk doctor in the Spring and Autumn and Warring States Period, clearly proposed the four diagnostic methods of traditional Chinese medicine!
According to "Historical Records? Biography of Bian Que": Once Bian Que went to Jin to practice medicine, he met Zhao Jianzi who was seriously ill and had been in a coma for 5 days and was unconscious.His relatives and staff were very worried and asked Bian Que to treat Zhao Jianzi's illness.
Bian Que felt that Zhao Jianzi's heart was still beating slightly through pulse-taking, and through interrogation, he learned that the political struggle in Jin State was very fierce at that time, so he concluded that Zhao Jianzi was in a coma for a while due to excessive use of his brain in the political struggle, and he did not die.
After careful treatment by Bian Que, Zhao Jianzi recovered from his illness within 3 days.This shows that Bian Que is very proficient in the four diagnosis methods.
The four diagnostic methods of traditional Chinese medicine also have a profound scientific basis.The ancient Chinese medical classic "Nei Jing" said: "Man and the heaven and the earth are connected, and they correspond to the sun and the moon."
That is to say, people and the external environment are unified, and the external environment has an impact on the activities of human body functions.The external environment includes the natural environment and the social environment. Man is the product of the evolution of nature, and a certain natural environment is a necessary condition for human survival. Man and the natural environment have a material relationship｜万｜｜吧｜ .[n][s] [b].m identity.The influence of the natural environment on human body functions involves many aspects, such as seasonal climate changes, differences in regional environments, etc., and even 24-hour changes in a day also have a certain effect on the activities of human body functions.
"Internal Classics" pointed out: "Thus, those with yang qi dominate the outside in one day. The yang qi is born in the middle of the day, and the yang qi grows in the middle of the day. In the west, the yang qi is exhausted, and the qi door is closed." That is to say.The activity of Yang Qi in the human body presents regular diurnal fluctuations, and this change trend is very consistent with the daily fluctuation curve of human body temperature revealed by modern physiological research.
Modern chronobiology research shows that almost all functional activities of the human body have rhythmic changes like day and night.Scientific facts have proved that the understanding of ancient Chinese medicine is very correct.
As for the violent social environment, it has a greater impact on people's physical and mental functions.The Zhao Jianzi mentioned above, who became unconscious due to excessive use of his brain in political struggles, is an obvious example.
Therefore, ancient Chinese medical scientists attached great importance to consultation.Through interrogation, understanding the external environment of the patient's illness will help to find the root of the disease and the nature of the disease.Thus diagnosed.
Ancient Chinese medicine also believes that human beings are an organic whole.Various viscera, organs and tissues are interrelated and affect each other physiologically and pathologically. "If there are all inside, there must be all outside", that is to say.There is a definite corresponding relationship between the external appearance of the body and the internal situation.
This determines that doctors can diagnose through inspection, auscultation, and palpation.Observing the external pathological manifestations of the patient, guessing the pathological changes of the internal organs, and then making a diagnosis.
The "Four Diagnosis Methods" summed up by Bian Que, a Chinese folk doctor in the Warring States Period more than 2000 years ago, fully conforms to the theories of holistic method, systematic method, and dialectical method in modern science, which cannot but be admired.
The Four Diagnosis Method is the traditional method of Chinese medicine to diagnose diseases, and acupuncture is an important means of Chinese medicine to treat diseases.In the medical forest of the world, acupuncture and moxibustion can be regarded as the oldest strange tree.It is said to be the oldest because it originated in human childhood.
The "Peking Man" who lived about 50 years ago was able to manufacture pointed stone tools and bone tools.Knowing how to use fire is not only important for human beings to seek food and clothing.And it is of great significance to human beings to overcome diseases.Because of the use of pointed stone tools, bone tools and fire, primitive medical tools were provided for humans.
For thousands of years, the study of pulse in our country has been advancing amidst the contention of a hundred schools of thought.
Among the four diagnosis methods of traditional Chinese medicine, it is the most practical. All Chinese medicine must master the pulse in the four diagnosis methods, that is, pulse diagnosis.A real Chinese medicine doctor can only be qualified to treat people if he has mastered the method of pulse diagnosis.
Diagnose the pulse by touching the pulse in different parts of the human body to observe the changes in the pulse condition.
Clinically, it is mainly to master the time of pulse diagnosis, the patient's body position, the doctor's fingering and finger strength, and the time of each pulse pressing, which should not be less than 50 pulses on each side. Only then can the pulse diagnosis be performed correctly.
Pulse diagnosis has a long history in my country, and it is a summary of the long-term medical practice experience of ancient Chinese medical scientists.
Bian Que, a famous doctor in the Spring and Autumn Period and Warring States Period recorded in "Historical Records", is famous for his methods of looking, hearing, asking, and feeling, especially pulse diagnosis. Sima Qian, the author of "Historical Records", even said: "To this day, Bian Que is the one who speaks pulse in the world." He fully attributed the invention of pulse diagnosis in ancient my country to Bian Que, which is not accurate.
According to historical records, the origin of pulse diagnosis in our country is very ancient. For example, the legendary ancient doctors Do Loan Ji and Guiyu District have discussed pulse diagnosis.By the Spring and Autumn Period and the Warring States Period, pulse diagnosis had reached a considerable level.There have been many detailed discussions on pulse diagnosis in the important medical works "Huangdi Neijing" and the later "Nanjing" that began to appear at that time.
In 1973, the silk scripts of medical literature unearthed from Han Tomb No. 2000 Mawangdui, Changsha, Hunan Province - "Pulse Method" and "Yin-Yang Vessel Syndrome" are also valuable materials for diagnosis of diseases by pulse diagnosis.All these show that as early as more than [-] years ago, pulse science has become an important part of ancient Chinese medicine.
In the Han Dynasty, pulse diagnosis became more common. Another famous doctor Chunyuyi (also known as Canggong, about 205 BC-?) recorded in "Historical Records" had followed his teacher Gongcheng Yangqing to learn the art of pulse for three years, and accepted the teaching of Gongcheng Yangqing. The "Bian Que Pulse Book" given to him.
It can be seen from the "diagnosis records" (medical records) of Chunyu Yi's medical treatment recorded in "Historical Records" that he had to check the pulse first when he saw a doctor at that time.
In "Treatise on Febrile Diseases and Miscellaneous Diseases" written by Zhang Zhongjing, a famous doctor in the Eastern Han Dynasty, it can be seen that pulse diagnosis has been widely used in clinical practice, and has been further developed and improved.
In the Jin Dynasty, the famous doctor Wang Shuhe synthesized the knowledge and experience of previous dynasties on pulse science and wrote the book "Mai Jing", which became the earliest existing monograph on pulse science in my country.
The book divides pulses into 24 types, explains each type of pulse, and describes various methods of pulse detection and pulse symptoms of various miscellaneous diseases, further combining pulse diagnosis and symptoms.Make pulse science a more practical knowledge.
Since then, the number of writings on pulsology in ancient my country has continued to increase.
Many famous doctors are proficient in pulse science, for example.Li Shizhen of the Ming Dynasty also conducted in-depth research on pulsology, and wrote books such as "Binhu pulsology" (AD 1564).
According to incomplete statistics, there were more than 100 writings on pulse studies before the Qing Dynasty.Although there are repetitions among them, they still reflect the development of ancient pulse studies in my country to varying degrees.
Diagnosing the pulse is also called cutting the pulse, pressing the pulse, and holding the pulse.The formation of the pulse condition is closely related to the qi and blood of the viscera. If the qi and blood of the viscera are diseased, the operation of the blood vessels will be affected, and the pulse condition will change.
The change of the pulse condition is related to the disease location, nature and ups and downs of the disease.If the disease location is shallow on the surface, the pulse will be floating, and if the disease location is deep inside, the pulse will be deep; if the disease is cold, the pulse will be slow, if the disease is hot, the pulse will be frequent; if the pathogenic energy is strong, the pulse will be firm.Deficiency of righteousness leads to deficiency of pulse.
Pulse diagnosis can be used clinically to infer the progress and prognosis of a disease.If the pulse is slow for a long time, it is a sign that the stomach qi is gradually recovering and the disease is healing; if the pulse is flooded for a long time, it is mostly a critical period of evil prosperity and positive decline.
Exogenous fever.The heat is fading.If the pulse condition is moderate, it means that it is about to recover; if the pulse is rapid and irritated, it means that the disease is progressing.
There are three methods of pulse diagnosis: one-time diagnosis method.There are three parts of the head, hands and feet for cutting the pulse (see three parts and nine waiting points).
2 three-part pulse diagnosis method.That is to observe the three veins of Renying, Cunkou and Fuyang.Among them, Cunkou is used to wait for the twelve meridians, Renying and Fuyang are used to divide stomach qi, and some people add Foot Shaoyin (Taixi Point) to wait for the kidney.
3-inch mouth diagnosis method.That is, examine the location of the radial artery behind the wrist.The general diagnosis method and the three-part pulse diagnosis method are seldom used. Renying, Fuyang and Taixi are only diagnosed in critical diseases and when there is no pulse in both hands, so as to determine the survival of stomach and kidney qi.
certainly.When performing pulse diagnosis, there are still some points to pay attention to.
1. Time: The best time to check the pulse is early in the morning. "Su Wen? Pulse Essentials Essence Theory" pointed out: "The diagnosis method is often based on Pingdan, Yin Qi has not moved, Yang Qi has not dissipated, diet has not been taken, meridians are not full, meridians are well-balanced, and Qi and blood are not disordered, so it can be diagnosed as wrong. pulse."
Because the patient is not affected by various factors such as diet and activities in the early morning, the internal and external environment is relatively quiet, and the qi and blood meridians are in a state of less interference, so it is easy to identify the disease pulse.
But it does not mean that pulse diagnosis cannot be made at other times. Wang Ji thinks: "If you are sick, you can make a diagnosis at any time, and you don't have to be restricted by ordinary days." Generally speaking, a quiet internal and external environment is required for pulse diagnosis. .
Before diagnosing the pulse, let the patient rest for a while to calm the qi and blood, and keep quiet in the consulting room to avoid the influence of the external environment and the patient's emotional fluctuations, and help the doctor understand the pulse.Under special circumstances, patients should be diagnosed anytime and anywhere, and they don't have to stick to these conditions.
2. Position: Ask the patient to take a sitting or lying position, with arms flat and close to the same level as the heart, wrists straight, palms up, and a pillow on the back of the wrist joints to facilitate pulse detection.Incorrect posture will affect the movement of local Qi and blood and affect the pulse condition.
3. Fingering: The doctor and the patient sit sideways, press the patient's right hand with the left hand, and press the patient's left hand with the right hand.
When diagnosing the pulse of the lower finger, first use the middle finger to press the Guanmai on the inner side of the high bone behind the palm, then use the index finger to press the Cunmai in front of the Guan, and the ring finger to press the Chimai behind the Guanmai. Touch the pulse body with the pulp of the finger, and the feeling with the pulp of the finger is more sensitive.
The density of the finger cloth should be adapted to the patient's body length. For a tall person with long arms, the finger cloth should be sparse, and for a short body with short arms, the finger cloth should be dense.
After the position is determined, press the pulse with three fingers with a flat cloth at the same time, which is called total pressing.
In order to focus on a certain pulse condition, one finger can also be used to press one of the pulse conditions. For example, when diagnosing the Cun pulse, slightly lift the middle finger and ring finger; when diagnosing the Guan pulse, slightly lift the index finger and ring finger; And the middle finger, clinically, the general press and the single press are often used together.
Diagnosing children's pulse can use "one-finger (thumb) determination method", instead of subdividing into three parts, because children's mouth is short, it is not allowed to specify three inches, and they are easy to cry and do not cooperate.
4. Lifting and searching: This is a way to explore the pulse condition by using the weight and movement of the finger force when diagnosing the pulse.
Hua Boren's "Diagnostics" said: "There are three ways to hold the pulse: lifting, pressing, and searching. To follow with light hands is to lift, to take with heavy hands is to press, to be neither light nor heavy, to seek with perversion is to find."
Hold the pulse for the first time, wait for it with light hands, when the pulse is seen between the skin, it is also the yang, the internal organs, and the response of the heart and lungs.It is obtained by heavy hands, and the pulse lies under the flesh, which is yin, viscera, and also the response of liver and kidney.
Neither light nor heavy, choose the middle one, the pulse should be between the flesh and blood, and the yin and yang are compatible.The response of Chong harmony is also the time of spleen and stomach.If you can't see it when you are floating in the middle of the sinking, you can only ask for it.If it is hidden or visible, then the veins of yin and yang are concealed, and all three parts are the same. "
Pressing lightly on the skin is called lifting, also called floating or lightly picking; pressing with heavy finger force between the muscles and bones is called pressing, also called sinking or heavy picking; the fingering force is neither light nor heavy, it can be light or light Heavy.Seeking it with humiliation is called seeking.
Therefore, when diagnosing the pulse, one must pay attention to the pulse condition changes between lifting, pressing and searching.In addition, when the three meridians are unique, the finger positions must be gradually moved.Search inside and outside.The meaning of the seeker is to seek, not to pick from the middle.
5. Resting: Breathing in and out is called one breath. When diagnosing the pulse, the doctor's breathing should be natural and even.take a breath time
To count the patient's pulse.For example, the late count of the pulse is measured by interest rate.In addition, it also reminds doctors to be open-minded and calm when diagnosing the pulse, concentrate their thoughts, and fully understand the pulse condition. "Suwen?
6. Fifty movements: every pulse diagnosis.It must be full of fifty moves.That is to say, every time the pulse is pressed, the pulse on each side should not be less than fifty times.Its significance is: on the one hand, it is used to understand whether there are knots, generation, and pulse-promoting pulses in the fifty beats of the pulse.
But if necessary, it can be postponed to the second and third 3th movement. The purpose is always to distinguish the pulse condition, so it is advisable to wait for the pulse for 5 to [-] minutes each time; Act sloppily.
Pulse diagnosis requires doctors to have relevant knowledge of anatomy and physiology.In this regard, there are many valuable records in ancient my country.
First, about the relationship between the heart, blood and blood vessels.Arteries are closely related to blood and heart.
"Internal Classics" clearly stated: "Blood is stored, and the Qi of the pulse is also" ("Pingren Qi Theory)); "The five internal organs are governed, and the heart dominates the pulse ("Xuan Ming Wu Qi"); all blood and blood vessels are controlled by the heart; The blood vessel is the place where the blood flows; the heart and the pulse are compatible; when the heart qi is stopped, the pulse will not flow, and if the pulse is blocked, the blood will not flow; when the pulse is cleared, the blood energy will flow.
It clearly points out that the pulse is the blood vessel, originating from the heart, and the pulse is the concrete performance of the heart function.It is particularly commendable that the concept of blood circulation has been described in the "Nei Jing".
For example, diet passes through the digestive system, absorbs nutrients and spreads to the liver, from the liver to the heart, from the heart to the lungs, and from the lungs to the heart, and then transmits essence and energy to the viscera and fur ("Meridians": "Food Qi enters the stomach, disperses essence in the liver,... the turbid qi returns to the heart, perverts the camphor in the veins, the meridian qi flows through, the meridian qi returns to the lungs, the lungs go to the hundred meridians, the essence is infused into the fur, the hair veins contain essence, and the qi flows through the government." ); and it is said that the blood circulation of the vessels flows continuously, intersecting from top to bottom, like a ring without end, and so on.
Although this kind of understanding is preliminary and even has some imaginative elements, it reflects the ancient physicians' understanding of circulatory physiology and provides a basis for the development of ancient pulse diagnosis.
Second, the understanding of blood velocity.
Ancient Chinese physicians have noticed the problem of blood flow velocity. "Nanjing" says: When a person exhales, the blood in the vessel flows three inches; when he inhales, it also flows three inches;
"When a person breathes out, the pulse moves three inches, when he breathes in, the pulse moves three inches, and when he breathes in, the pulse moves six inches." Although this kind of understanding is very imprecise, it is very meaningful, because the blood velocity is an important indicator of the state of blood circulation. As an indicator, modern doctors do clinical examinations for patients with cardiovascular system, and they also regard measuring the time of large and small circulation as a routine.
Third, knowledge about the relationship between respiration and pulse rate.
The "Nei Jing" says: When a person exhales, the pulse beats twice, when he inhales, the pulse beats twice again, when he exhales and inhales, the pulse beats four times. ("Plain People's Meteorological Theory": "When a person exhales, the pulse moves again, and when he inhales, the pulse also moves again.") In this way, counting continuously, based on eighteen breaths per minute, the pulse will jump 1 times in one minute.Not only the relationship between pulse and respiration is clearly pointed out here, but also the ratio between respiration and pulse frequency is one to four, which is consistent with what modern physiology observes.
In addition, the "Neijing" also records that the change in the ratio between the pulse and the number of breaths is an abnormal phenomenon: it points out that a person's pulse only beats once when he exhales, and pulses only once when he inhales, and that he pulses three times when he exhales, and pulses when he inhales. The pulse beats three times, all of which are sick. ("When a person exhales and pulses once, and when he inhales, he has less qi; when a person exhales and pulses three times, and when he inhales three times, he becomes irritable. When the chi is hot, the disease is febrile. If the chi is not hot, the pulse is slippery and the pulse is gouty. The pulse is astringent and numb. ")
We know that the relationship between pulse and respiration mirrors the relationship between heart and lung function.It is not difficult to observe clinically that the arrhythmia of the heartbeat and the change of the character of the pulse are caused by the hypoxia of the pulmonary circulation and arterial blood.
Fourth, the understanding of the location of the pulse.There was a process of detection and change in ancient my country for the location of the pulse.
There have been "full-body diagnosis", "three-part diagnosis" and "inch-mouth diagnosis" successively.At first, it was mainly a "whole body diagnosis", which was to feel the arteries that can be touched from head to toe, including the head, neck, and buccal arteries, the radial arteries of the upper limbs, and the posterior, dorsum of the foot, popliteal, and femoral arteries of the lower limbs.The arteries in these parts are all on the body surface, or attached to the bone and subcutaneous.
The pulse pulse described in the "Nei Jing" is mainly "diagnosing the whole body". "Whole body diagnosis" is also called "three parts and nine waiting" diagnosis. The "three-part diagnosis" is to examine the Renying (yingdeen artery) of the head, the Cunkou of the wrist (radial artery) and the falling Yang of the foot (dorsalis pedis artery).
Cunkou diagnosis is to cut and feel the radial artery protruding from the back of both palms (radial styloid process), which is the so-called "Cunkou alone". .
This method has been described in the "Nei Jing", and later "Nan Jing" and "Mai Jing" and other books mainly describe the Cun Mouth Diagnosis, and it has been used until today.
"Whole body diagnosis" was not commonly used, or even used.In fact, this approach still has practical significance even today.We know that the pressure wave generated by the blood when the heart contracts is called a pulse wave, and the pulse wave is transmitted to the whole body through the arterial tube.
The shape of the pulse wave changes with the condition of the circulatory system, which reflects the condition of the heart and the elasticity of the arterial tube.Therefore, observing the shape of the pulse throughout the body can provide a more comprehensive diagnosis of signs.
For example, "pulseless syndrome" is mainly caused by lesions of the aortic arch and other related arteries. Due to hemorrhage in the limbs, some arterial pulses in the upper and lower limbs can be weakened or disappeared.
Carrying out "whole body diagnosis" on such a patient can help to understand the pathological condition of his blood vessels.Another example is that for patients with heart disease and thromboangiitis obliterans, it is also meaningful to use "whole body diagnosis".
Fifth, the understanding of factors related to pulse cutting, "Neijing" says that pulse diagnosis should always be in the early morning, when the person's yin qi is not moving, and yang qi is not disturbed, so that abnormal pulses can be detected.
He also said that the pulse should change according to the climate of the four seasons; he also pointed out that the pulse diagnosis should pay attention to the courage and timidity of the person's character, the texture of the flesh and skin, the "fatness and thinness of the shape", and the mental factors of the person. It is believed that fear, anxiety, movement and stillness will cause the pulse Variety.
In future pulse books, the discussion on this aspect will be more comprehensive, such as the height of men and women, etc. are all included.
Modern physiology has proved that the activity of the human heart (heart rate, cardiac output, etc.) is easily affected by various factors.In terms of cardiac blood output, in a very still state, such as when you wake up early in the morning and have not yet gotten up, your cardiac blood output is quite constant.Another example is the normal heart rate of a person. Not only is there a difference between men and women, but also the age is different. Even the same person in the same day often varies due to changes in body posture, activity, and mental changes.
It can be seen that the ancients observed the factors related to pulse cutting very carefully, because at this time, it is very related to distinguish between normal pulse and diseased pulse.
ps: ?? Note: Thank you Jin Guiguan for molesting and Xie Zhixiu for your support, thank you!