Contents 1 Pinyin 2 English Reference 3 Overview 4 English Translation 5 Definition 6 Pulse Diagnosis 6.1 1 The location of taking the pulse 6.2 2 The method of taking the pulse 6.3 3 The status of the Cunkou pulse and the internal organs 6.4 4 Things to pay attention to when taking the pulse 6.5 5 Normal pulse 6.6 6 Abnormal pulse and clinical significance 6.7 7 Phase and pulse and main disease 7 Palpation 7.1 1 Skin palpation 7.2 2 Limb palpation 7.3 3 Chest palpation 7.4 4 Abdominal palpation 7.5 5 Pressing Shu points 8 Application 9 Reference Attached information: 1 Diagnosis in ancient books 1 Pinyin
qiē zhěn 2 English reference
pulsefeeling and palpation [Xiangya Medical Professional Dictionary]
pulsetaking and palpitation [Xiangya Medical Professional Dictionary]
palpation and pulse taking [Traditional Chinese Medicine Terminology Approval Committee. Traditional Chinese Medicine Terminology (2004)] 3 Overview
Palpation and pulse taking is one of the four diagnostics [1 ]. Including pulse diagnosis and massage[2]. It refers to the method in which the doctor uses the touch of fingers or palms to touch, touch, press and press the patient's pulse and whole body to understand the condition and diagnose the disease [3][2]. The examination content includes changes in pulse, lumps in the chest and abdomen, swelling of the skin, depressions and nodules under the skin, warmth and coolness of the hands and feet, painful areas, etc.[2] The obtained materials are combined with the other three diagnoses to make a judgment [2]. In particular, taking pulses and examining sensitive parts are indispensable diagnostic methods in clinical acupuncture [2].
4 English translation
palpation
Explanation: one of the four diagnostic examinations, including touching and pressing the body surface with the hand or fingers 5 Definition< /p>
Cut-out diagnosis is one of the four diagnoses [1], including pulse diagnosis and massage diagnosis [2]. It means that the doctor uses the touch of fingers or palms to touch, touch, press and press the patient's pulse and whole body. , in order to understand the condition and diagnose the disease [3][2]. 6 Pulse diagnosis
Pulse diagnosis is to use fingers to press and cut the patient's arteries to understand the internal changes in the condition. It is also called pulse taking or pulse diagnosis.
The pulse is the blood house and runs through the whole body. The Qi and blood of the five internal organs and six organs must flow around the whole body through the blood vessels. When the body is affected by internal and external factors, it will inevitably affect the circulation of Qi and blood, and then the pulse will When changes occur, doctors can detect the internal organs and qi by understanding the depth of the pulse position, the speed, strength (power or weakness) of the pulse, the rhythm (qi or not), the shape (size) of the pulse, and the smoothness of the blood flow. The rise and fall of blood, the rise and fall of evil and good, as well as the appearance and interior of diseases, deficiency and excess, cold and heat. For example, when the disease is on the muscle surface, floating pulses appear; when the disease is in the organs, sinking pulses appear; when the disease is caused by yin syndrome, Yang Qi is insufficient, blood flow is slow, and the pulse is delayed; when the disease is caused by yang syndrome, the blood flow accelerates, showing several pulses, etc. Pulse diagnosis is an important basis for dialectics of traditional Chinese medicine. The predecessors have accumulated rich experience in long-term practice, and it is a unique diagnostic method of traditional Chinese medicine. However, in clinical diagnosis, there are also special cases where the pulse syndrome does not match. For example, the yang syndrome reflects the yin pulse, and the yin syndrome reflects the yang pulse. Therefore, using pulse diagnosis as the only diagnostic method is very one-sided. It is necessary to emphasize the four diagnostic methods in order to understand A complete picture of the disease to make a correct diagnosis. 6.1 1 The site for taking the pulse
Generally, the Cunkou pulse is taken, which is the superficial part of the radial artery behind the wrist. 6.2 2 Method of taking the pulse
When taking the pulse, ask the patient to sit or lie down, stretch out the arm and place it at the same level as the heart, with the palm facing upward and the forearm flat to allow smooth blood flow.
Cut into the human vein and position it with three fingers. First, use the middle finger to press the radial artery at the high bone (radial styloid process) to determine the measurement. Continue to use the index finger to determine the measurement in front of the measurement (distal end), and then Use the ring finger to hold the ruler behind the guan (proximal to the heart) and press the three fingers diagonally at the same level in an arch shape, and touch the pulse body with the fingertips. The density of the three fingers should be appropriately adjusted according to the patient's height. If the patient is taller, the doctor's three fingers can be arranged looser. If the patient is shorter, the three fingers can be arranged more tightly. At the same time, the three fingers must be arranged neatly, otherwise it will affect the patient's health. Accuracy of pulse shape.
In children, the cun opening is too narrow to accommodate three fingers. One finger (thumb) can be used to determine the opening without subdividing the three parts. For children under three years old, fingerprint reading can be used instead of taking pulse.
Use three kinds of finger force when cutting the pulse. First, use light force, and it will float on the skin, which is called lifting; The muscles and bones are extracted and called pressing.
According to clinical needs, the patient can be touched repeatedly in the order of lifting, searching, pressing or in the opposite order, or can be felt by pressing directly with one finger in parts.
There are three parts of Cun, Guan and Chi, and each part has three periods of floating, middle and sinking, which are called the Three Parts and Nine Periods. 6.3 3 Cunkou pulse divides the conditions of the internal organs
Different parts of the Cunkou pulse reflect different parts and the functions of different internal organs. The Cunguan ruler is used to classify the corresponding internal organs. This is the experience of the predecessors. It has certain reference significance when diagnosing a disease, but it still needs to be considered comprehensively during clinical diagnosis. 6.4 4 Things to pay attention to when checking the pulse
① The doctor must pay full attention, touch carefully, and experience it repeatedly to avoid subjective assumptions and carelessness, and the time should not be too short (the time of each pulse diagnosis should not be less than 50 seconds).
② Pay attention to the influence of internal and external factors on pulse condition: for example, the pulse of children is softer and more numerous than that of adults, that of women is thinner and less frequent than that of men, and that of obese people is thinner and heavier. The pulse is louder in summer and deeper and smaller in winter. Pulse surge after strenuous exercise, pulse after drinking, mental illness and certain drugs can also cause temporary changes in pulse condition.
③ In some people, due to the difference in the anatomical position of the radial artery, the pulse is not found at the mouth of the cun but at the wrist side of the thumb, which is called the anti-Guan pulse. From the ulnar part to the back of the hand, it is called the Oblique Flying pulse. 6.5 5 Normal pulse condition
The pulse condition of healthy people is called normal pulse condition. Generally neither float nor sink. Neither big nor small, neither strong nor weak, neither fast nor slow, even and gentle, with regular rhythm, it is also called flat pulse or slow pulse. Ping pulse until the number is clear, four to five times in one breath (that is, one exhalation and one inhalation); equivalent to 72 to 80 times, the rhythm, strength and strength are consistent. It is normal for the pulse condition to undergo physiological or temporary changes due to the influence of internal and external factors. For example, the younger the age, the faster the pulse beats. Infants have rapid pulses, 120 to 140 times per minute. Five- and six-year-old children often have six breaths per minute, 90 to 110 times per minute. Young adults have strong bodies and strong pulses. The elderly are frail and have a weak pulse. The pulse of adult women is thinner and slightly faster than that of adult men. Thin people have more floating pulses, fat people have heavy pulses, heavy physical work, strenuous exercise, long distance walking, drinking and eating, being emotional, and how fast the pulse is. The pulse is strong and weak when hungry. 6.6 6 Abnormal pulse conditions and clinical significance
There are 28 types of diseased pulses recorded in Chinese medicine monographs on pulseology. However, according to the pulse position, pulse rate, pulse force, pulse shape, and smoothness of the pulse Pulse conditions classified by degree and rhythm are often mixed, and some diseased pulses are composed of two or more single pulses. Now the 14 common clinical pulse conditions and their clinical significance are described as follows:
(1) Floating pulse
The pulse appears at a shallow location. Just take it lightly and you will feel the effect slightly less when you press it harder. This pulse is mostly external syndrome, indicating that the disease is superficial. Floating and tight means superficial cold, floating and numbered means superficial heat, floating and strong means superficial deficiency, and floating but weak means superficial deficiency. Commonly seen in the early stages of colds, colds and various infectious diseases. However, there are also cases where the body is weak due to long-term illness or the yin is deficient and the yang has no support, and the floating yang crosses outwards, resulting in a floating and weak weak pulse.
(2) Shen pulse (with Fu pulse)
The pulse appears deep. It won't be visible when you pick it up lightly, but it will be revealed when you press it hard. This pulse governs internal syndrome. If it is heavy and strong, it is internal deficiency. If it is heavy and weak, it is internal deficiency. If it is deep and slow, it is internal cold. If it is sinking several times, it is internal heat. If it is heavy and astringent, it is qi stagnation and blood stasis. It is common in edema, abdominal pain, chronic illness and multiple diseases. A debilitating disease.
The Fu pulse: It is deeper than the Shen pulse. It can only be found by pressing and pushing the muscles and bones. It is syndrome of internal obstruction of evil energy or severe pain or syncope.
(3) Late pulse
The pulse frequency is low, less than four pulses per breath (less than 60 pulses per minute), mainly cold syndrome, late and weak pulse is cold accumulation (yang deficiency and yin Excessive), late and weak are symptoms of deficiency and cold, which are common in diseases such as weak heart qi.
(4) Pulse counting (with diseased pulse)
The number of pulses is high, six or more in one breath (more than 90 pulses per minute). Mainly heat syndrome, the floating number is superficial heat, the sinking number is internal heat, the flood number is excess heat, the thin number is deficiency heat, the string number mostly indicates excessive liver fire, which is common in febrile venereal disease or hyperthyroidism, and weakness in counting can also be seen in Qi deficiency syndrome.
Disease pulse: Seven or eight pulses per breath (about 120 times per minute), mostly due to severe symptoms of extremely strong Yang Qi, exhaustion of Yin Qi, or loss of vitality.
(5) Slippery pulse
The pulse is fluent and smooth, like a rolling ball, which is mostly caused by excessive evil and stagnation of phlegm and food. This pulse can sometimes be seen in normal people with abundant qi and blood. This pulse is more common in women during pregnancy. Diseased pulses are more common in phlegm, food stagnation, blood stasis, excess heat, such as various inflammations, indigestion, amenorrhea, and malignant tumors. wait.
(6) Pulsed pulse
Pulsed and stagnant pulse, like scraping bamboo with a knife, is mostly due to deficiency of essence, low blood, qi stagnation, and blood stasis. It is common in anemia and blood loss. , postpartum and blood stasis and other diseases.
(7) Xian pulse
The pulse is straight and long, like pressing a bowstring, strong and elastic, and the veins are hard. Mainly used for qi stagnation, liver and gallbladder disease syndrome and pain syndrome. Commonly seen in exogenous Shaoyang syndrome, liver disease, biliary disease, hypertension, arteriosclerosis and various pain diseases.
(8) Tight pulse
When the pulse is tight and urgent, it should be strong, like a rope twisting, the pulse tension is high, and the pulse beats powerfully. It mainly refers to cold syndrome, pain syndrome and local food syndrome. Seen in exogenous wind-cold, severe pain, etc.
(9) Slow pulse
Four breaths in one breath, neither fast nor slow, neither strong nor weak. The pulse is gentle and slow. The hardness and tension of the pulse are moderate. This is a normal pulse with stomach qi. Seen in healthy people. The pulse of the disease is seen in the dampness syndrome where the qi mechanism is trapped by dampness, or when it recovers after illness.
(10) Hong pulse (with large pulse)
The pulse shape is huge, the pulse comes like rough waves, rises and falls, the pulse shape is wide, and the fluctuations are large. Mainly heat syndrome, excessive yang heat. Common in patients with high fever.
Big pulse: The pulse shape is large and does not have the tendency of rising and falling. It is mostly a sign of the progression of the disease. The so-called big pulse indicates the progression of the disease (big and powerful), and it also indicates positive deficiency (big and weak).
(11) Veins (small pulses)
The pulse shape is as thin as a line, the pulse shape is narrow, and the fluctuation is small. Mainly deficiency syndrome (qi deficiency and lack of blood). Commonly seen in patients with various fatigue, chronic diseases.
Small pulses are also small pulses, and the main disease is the same as fine pulses.
(12) Pulse-stimulating
The pulse comes rapidly, sometimes stops, and stops indefinitely, that is, the pulse is fast with irregular intervals. It is caused by yang excess and heat, or qi, blood, phlegm and food stagnation. It is seen in qi, blood, phlegm and food stasis, swelling and pain, and various excess heat syndromes. A thin, rapid and weak pulse is often a sign of collapse.
(13) Pulse knot
The pulse is slow and stops for an indefinite period, that is, the pulse is slow and has irregular intervals, which is due to accumulation of yin and cold or qi and blood stasis. Stagnation is seen in qi stagnation and blood stasis, phlegm accumulation and food accumulation, syndrome accumulation, hernia pain, etc. Absence of knots and weakness is a sign of Qi and blood deficiency, which is seen in arrhythmia caused by fatigue, long-term illness, and various types of heart disease.
(14) Dai Pulse
The pulse comes and stops, stops for a certain number, cannot return on its own, and resumes for a long time, that is, there are regular intervals. The pulse stops for a certain number of times. Once, the rest time is longer, which is a sign of the decline of viscera and qi, which can be seen in arrhythmias such as bigeminy and triplen rhythm. 6.7 7 The concurrent pulse and the main disease
The causes of disease are multifaceted, and the manifestations and changes of the disease are complicated. Therefore, the common clinical pulse conditions often reflect the multiple aspects of the disease. .
Xiangjian pulse, also known as compound pulse, is a comprehensive manifestation of two or more single pulse conditions. As long as two or more single pulses are not completely opposite, they may appear at the same time to form a concurrent pulse, such as floating tight, floating, sinking, sinking and thin, etc. Their clinical significance is generally that the single pulses that make up the combined pulse A combination of diseases dominated by pulses, such as floating and tight pulses for superficial cold syndrome; floating and rapid pulses for superficial heat syndromes; deep and slow pulses for internal cold syndromes; deep and thin pulses for internal deficiency and heat syndromes, etc.
Pulse tracing
Use a sphygmograph to trace the pulse wave curve, which can be divided into wave spokes, main waves, ascending limbs, descending limbs, notches and double waves. Due to the different performance of tracing instruments and different standards of measurement parameters, the results are not uniform. However, according to the current tracings of floating pulse, sinking pulse, late pulse, several pulse, Hong pulse, stringy pulse, Hua pulse, astringent pulse, thin pulse, Different pulse conditions such as large pulse and tight pulse have different characteristics, which are basically the same as those obtained by cutting the pulse. For example, a floating pulse can be traced as an obvious curve without applying pressure, but when external pressure is applied (equivalent to pressing the pulse again), the pulse wave will decrease instead; the opposite is true for the sinking pulse, which cannot be traced without external pressure. For the waveform, considerable external pressure must be applied to draw the waveform curve; the flood pulse curve has a particularly high amplitude, with the main wave rising steeply and falling quickly, which is equivalent to the rising and falling of the pulse when cutting the pulse; the string pulse curve after the main wave rises, It continues for a short period of time and then starts to decrease, so the peak of the main wave is flat; it is equivalent to pressing a bowstring when cutting the pulse; the counting pulse and the delayed pulse are changes in the pulse rate, and the tracing results are completely consistent with the pulse cutting; the curve of the sliding pulse rises and falls equally Rapid and obvious dicrotic waves, appearing to come and go as fluently as beads; the amplitude of the thin pulse is low, and the rising and falling slopes are small; the rising and falling of the waveform of the astringent pulse are slower than that of the thin pulse, and small notches can be seen on the pulse peak and descending branch. , feeling unfluent when taking pulse.
The principle of pulse generation
Some data have also been accumulated in this area of ??research. Changes in pulse conditions have extensive pathological and physiological basis, and their changes are closely related to cardiovascular function and neurohumoral regulation system.
Pulse condition is composed of pulse rate, rhythm, intensity, position and shape, etc., and is related to cardiac output, heart valve function, blood pressure, quality and quantity of blood in blood vessels, and peripheral blood vessels. functional status, etc.
The formation of floating pulse may be related to reduced (or normal) cardiac output, peripheral vasoconstriction, increased vascular elastic resistance, and a decrease in voltage visible on the electrocardiogram.
Sinus bradycardia can be seen on the electrocardiogram as a delayed pulse, which can be caused by increased vagus nerve excitability, atrioventricular block, atrioventricular nodal rhythm, etc.
Sinus tachycardia can be seen on the electrocardiogram due to infection and other factors, which can cause sinus tachycardia due to a drop in blood pressure, or due to increased myocardial excitability and weakened myocardial strength, leading to heart failure. Compensatory increase in stroke.
Deficient pulse is mostly caused by reduced cardiac output, reduced vascular elastic resistance, and lowered blood pressure.
The formation of a solid pulse is related to increased cardiac output and vascular elastic resistance, and its pulse pressure is normal.
The cardiac output of Huamai is normal or slightly higher, the elastic resistance of blood vessels is normal or reduced, the blood becomes thinner, and the blood flow increases, so the blood flow is smooth and shows a wave-like process on the blood vessels.
Astringent pulse may be related to factors such as vagus nerve excitement, slowed heart rate, reduced cardiac output, and peripheral vasoconstriction.
Hongmai may be related to increased cardiac output, peripheral blood vessel dilation, high systolic blood pressure, low diastolic blood pressure, high pulse pressure, and increased blood flow velocity.
Thin pulses may be related to factors such as decreased cardiac function, reduced cardiac output, peripheral vasoconstriction, increased vascular elastic resistance, and low pulse pressure.
Moistening of the pulse may be related to reduced cardiac output and low vascular elastic resistance.
The formation of stringy pulse may be related to factors such as poor elasticity of the arterial wall or arteriosclerosis, contraction of vascular smooth muscle, thickening of the blood vessel wall, smaller diameter of blood vessels during relaxation, increased vascular resistance, high arterial tension, and increased blood pressure. Relatedly, the occurrence of stringy pulse in pain and liver disease may be the result of the influence of changes in neurohumoral fluids on vascular function, and its formation factors are relatively complex.
Tight pulse may be related to factors such as increased cardiac output, peripheral vasoconstriction, and increased arterial tone.
The rapid pulse may be atrial fibrillation, or there may be tachycardia with premature contractions.
The knot pulse appears as various premature contractions, escape beats, asystole and atrial fibrillation on the electrocardiogram.
Pulse generation is seen in bigeminy and trilogy caused by premature contractions or second-degree atrioventricular block.
The pulses that are stimulated, knotted and replaced are irregular pulses, mainly caused by the disease of the heart itself. Certain drugs such as digitalis poisoning can also cause knotted pulses and replaced pulses. 7 Palpation
Palpation is when doctors touch and press the patient’s skin, limbs, chest and abdomen and other diseased parts to distinguish whether they are warm, cool, moist, dry, soft, hard, swollen, mass and The patient's reaction to pressing, such as pain, joy of pressing, cabinet pressing, etc., can be used to infer the location and nature of the disease. 7.1 1 Skin palpation
Identify warmth, coolness, moistness, swelling, etc.
The warmth and coolness of the skin can generally reflect the level of body temperature. However, it should be noted that when the heat evil is internally closed, the chest and abdomen will be burning but the limbs and forehead will not be very hot, or even the skin is not warm. The moistening of the skin can reflect the level of body temperature. If there is sweat, no juice, and body fluids are depleted, if the skin is moist, most of the body fluids are not injured. If the skin is dry and shriveled, it means the body fluids are dehydrated, Qi and Yin are seriously injured, and the skin is very dry due to long-term illness and is stinging when touched. It is caused by the skin nail defect and internal blood stasis caused by insufficient Yin and blood. If the skin is sunken and pitted when pressed, it is edema and bloated skin that does not rise immediately. If it rises easily when pressed, it is emphysema and puffiness. 7.2 2 Palpation of the limbs
Low temperature of the limbs is a manifestation of yang deficiency. Cold limbs are a sign of Yang deficiency or internal heat evil. If the body is hot but the fingertips are cold, it may be Yang deficiency or internal heat deficiency. Heat in the hands, feet and heart is a sign of yin deficiency and fever. In addition, palpation of the limbs should also pay attention to check for paralysis or ankylosis of the limbs. 7.3 3 Chest palpation
Diagnosing the deficiency can determine the severity of the disease. The beating in the virtual space (i.e. the apical pulse) is located between the fourth and fifth ribs under the left breast of the chest. It contains the heart and is the root of all the meridians. Whenever you press the right hand, if it moves without being tight, neither slow nor urgent, it means that Zong Qi has accumulated in the chest, which is a sign that there is no disease. If the movement is subtle but not obvious, it is due to internal deficiency of Zong Qi. If the person moves and responds to the clothes, it is a sign that the Zong Qi is leaking out. If the movement is only temporary and recovers soon, it is more common after panic or drunkenness. Under normal circumstances, fat people have weaker beats and thin people have stronger beats, which does not mean they are pathological.
Press the heart, that is, whether the part below the sternum is soft or hard and tender. If the heart is hard and painful, it is chest knot, which is true; if it is soft but not painful, it is mostly due to chest pain. Puff syndrome, belongs to deficiency. 7.4 4 Abdominal palpation
Identify the location of the disease, the nature of abdominal pain and mass accumulation.
The lesions belong to the stomach in the epigastrium (middle and upper abdomen), to the liver and gallbladder under the two flanks (left and right flanks), to the stomach or large and small intestines around the umbilicus, and to the liver, bladder or kidneys in the lower abdomen.
If the pain is relieved after pressing (please press), it is mostly virtual pain. If the pain is aggravated after pressing (refuse to press), it is mostly real pain or hot pain.
If there is a lump in the abdomen, if it is pressed softly and can even be dispersed, it is called a lump or a gathering. Most of them belong to qi stagnation and the location is fixed. If it is pressed hard and cannot disappear, it is called a lump. Most of them are lumps. It is caused by the accumulation of real evils such as blood stasis, phlegm, and water. 7.5 5 Press Shu points
Organ lesions can react at corresponding body surface acupoints. By palpating Shu points on the meridian, nodules, cord-like objects, pain points or allergic reaction points can be found. As an auxiliary diagnosis for certain diseases. For example, patients with hepatitis have tenderness at Qimen and Ganshu points; patients with gallbladder disease have tenderness at Danshu point; patients with gastric and duodenal ulcers have tenderness at Zusanli point; patients with acute appendicitis have tenderness at the appendix point (zu Three miles below the inch) there is obvious tenderness and so on.
8 Applications