试论“上鱼际脉”在眼科诊治中的指导作用

Discussion on guiding function of“superior thenar pulse”in ophthalmology diagnosis and treatment

现代中医眼科学注重“望”诊和“问”诊,常常忽略“切”诊。寸口脉搏,是机体在寸口部的全息反映。寸部脉统括上焦,即胸以上及头部的疾病,而头面五官疾病在脉诊中属于《黄帝内经》“上竟上”的范畴。“上鱼际脉”,即“溢脉”,名称首见于当代已故名老中医刘绍武的“三部六病”理论,该脉过寸口直到腕横纹,遂上鱼际,轻可切之跳动,重可望见搏动。但在诸多脉学专著或专论中,缺乏对脉位中常见的“上鱼际脉”的脉象描述和临床指征的详细论解。笔者在临床工作中总结出“上鱼际脉”最常见的3种病机:肝胆火旺,气血逆冲;中气不足,升降失权,清阳不升,浊阴不降;阴阳失合,浮阳上越。因此,笔者以医案的形式探讨“上鱼际脉”在眼科疾病诊治中的指导意义。

Modern ophthalmology of Traditional Chinese Medicine pays attention to the observation and inquiry diagnosis,and often ignores the pulse diagnosis.A person's pulse on the wrist is the holographic reaction of the body.The cun pulse on the wrist covers diseases of upper energizer,or in other words,organs above the chest including the head.The diseases of the head,face and five sense organs belong to the category of the uppermost part(of pulse)in the book of Huangdineijing(Yellow Emperor’s Canon of Medicine).Superior thenar pulse,or overflow pulse,is first seen in the theory of three positions and six diseases proposed by Liu Shaowu,a famous contemporary late Chinese Medicine doctor.Such pulse shows that the pulse passes over the cunkou(wrist pulse)area to the wrist striation,and then goes to the thenar position,where the pulse can be touched lightly or be seen even.However,there is no detailed explanation pulse position of the superior thenar pulse description and clinical indications of the common in most pulse monographs.In clinical work,the author summed up the three most common pathogenesis of superior thenar pulse:excessive fire in the liver and gallbladder,and backward flush of qi and blood;deficiency of middle qi,upward and downward movement of qi out of control,and the lucid yang does not rise,the turbid yin does not fall;the yin and yang in disharmony,and the floating yang floating upward.Therefore,the author discussed the guiding significance of superior thenar pulse in the diagnosis and treatment of ophthalmic diseases by the form of medical records.