探究国医大师临床医案中心系疾病脉象分布规律

The pulse distribution of cardiac diseases in clinical medical records of TCM masters

目的:探究国医大师临床医案中心系疾病的脉象分布规律。方法:用Excel表格将搜集到的国医大师医案予以记录,记录要点为病证(或病名)、病因病机、初诊脉象及复诊脉象。记录完毕后,首先对脉象总体分布规律进行探讨,观察临床中脉象的分布规律,然后对心系疾病脉象分布规律进行分析。结论:中医难,难在识证。而识证的关键在于脉诊,脉诊可以定性、定位、定量、定势。脉诊乃四诊方法之一,在疾病的诊断中起着决定性的作用,是诊断疾病和判断疾病转归、预后的重要依据,历来为医家所重视。我们在漫长的学习、实践过程中逐渐形成了以脉诊为中心的辨证论治方法。通过对16位国医大师1707例医案的分析,发现临床上因疾病复杂多变,患者的脉象多为复合脉或相兼脉,其中单一脉仅68例;在传统的28种脉中,细脉、弦脉、沉脉、数脉、滑脉及其相兼脉最为常见,其次为弱脉、浮脉、结脉、代脉、濡脉、缓脉等,从此结果来看,现代慢性消耗性疾病增多,虚证略多于实证。从119例心系疾病的医案中总结出细脉、沉脉、弦脉出现频次最多,其中细脉出现57次,沉脉出现41次,弦脉出现39次,其他脉象如弱脉、涩脉等交替出现,但总体频次不多,这在一定程度上反映了心系疾病的病机多为心阳气虚、心脉淤滞。

Objective:To explore the pulse distribution of cardiac diseases based on the clinical medical records of TCM masters.Methods:The clinical records of TCM masters were collected and input into an Excel spreadsheet.The main points of the records included disease syndrome(or disease name),etiology and pathogenesis,pulse condition at the first visit,and pulse condition at the second visit.After recording,the overall distribution pattern of the pulse condition was firstly explored to observe the distribution pattern of the pulse condition in the clinic,and then the distribution pattern of the pulse condition of cardiac diseases was analyzed.Conclusion:The difficulty of TCM lies in the identification of syndromes.The key of syndrome identification is pulse diagnosis,which can be qualitative,positioning,quantitative,and stereotype.The pulse diagnosis is one of the four diagnostic methods,which plays a decisive role in the diagnosis of diseases.It is an important basis for diagnosing disease,and judging disease regression and prognosis,has been valued by medical practitioners.We have gradually developed the syndrome differentiation and treatment method centered on pulse diagnosis in the long process of study and practice.Through the analysis of 1707 medical cases of 16 TCM masters,it is found that clinically due to the complexity and variability of cardiac diseases,the pulse manifestations are mostly compound pulses or concurrent pulses,of which only 68 cases were single pulse.In the traditional 28 kinds of pulse manifestations,the thin pulse,string pulse,sinking pulse,number pulse,slippery pulse and their concurrent pulses were the most common,followed by weak pulse,floating pulse,knotted pulse,substitute pulse,soft pulse,slow pulse,etc.It can be seen from this results that the modern chronic consumptive diseases are increasing,and the deficiencies syndrome is slightly more than the excess syndrome.From 119 cases of cardiac diseases,it was concluded that the frequencies of fine pulse,sinking pulse and string pulse were the most,with 57 times of fine pulse,41 times of sinking pulse,and 39 times of string pulse.The other pulse manifestations such as weak pulse and astringent pulse were obtained alternately,but the overall frequency was not much,which reflected to a certain extent that the pathogenesis of cardiac diseases was mostly Yangqi(气)deficiency of the heart and heart pulse stagnation.