《黄帝内经》四时平脉与同名病脉的鉴别体会

Identification of normal pulse of four seasons and abnormal pulse of same name in Huangdi Neijing

简要介绍四时平脉的特点及表现,提出其应与同名病脉严格鉴别区分,防止漏诊和失治误治。结合经典文献提出三个鉴别点:其一,四时平脉和同名病脉在脉形脉气方面有差异,四时平脉为有胃气之和缓从容脉象,突出"缓"和"平"特征,而同名病脉则为燥急偏胜之脉象,全失缓平之意;其二,病脉伴随色诊亦为病色,即客色常加临而主色不显,而四时平脉则主色占优势客色偶现;其三,结合问诊四诊合参方可全面了解病情。因此,临证必须察色、按脉、听声、写形合而为一方为周全,鉴别才具说服力和临床意义。

This paper briefly introduces the characteristics and manifestations of normal pulse of four seasons,and puts forward that it should be distinguished from the abnormal pulse of same name,so as to prevent misdiagnosis and mistreatment. Combined with classical literatures,three identification points are put forward. Firstly,there are differences on the shape and qi of pulse between the two. The normal pulse of four seasons shows the moderate and clam pulse manifestations of stomach qi,and emphasizes the moderate and normal characteristics. While the abnormal pulse of same name shows the dry and irritated manifestations without any moderate and normal characteristics. Secondly,the abnormal pulse combined with color inspection also can be considered as sick complexion,that is the visiting complexion is often presented and the governing complexion is not obvious. While in the normal pulse of four seasons,the governing complexion is dominant and the visiting complexion is occasionally presented. Thirdly,combined with inquiry,comprehensive analysis of data gained by four diagnostic methods can fully understand the condition of disease. Therefore,clinical practice must take color,pulse,sound and shape in combination,and the identification is of persuasion and clinical significance.