脉诊学习(初学)

脉诊学习(初学) 脉象NO 至数 力量 形态 主要临床意义 备注 名称 轻取即得，如水表证 1 浮脉 漂木 久病、失血见此脉 里证 一息不足四 轻取不应手，2 沉脉 寒证，阳虚 至 重按始得 一息六至以3 迟脉 热证 上 虚证，气血不足，4 虚脉 很弱 举按均无力 以气虚为主 三部脉举按均5 实脉 很强 实证，热结 有力 如盘滚珠，流利妊娠，痰饮，实热，6 滑脉 较强 圆滑 食积 如刀刮竹，涩滞精亏血少，气滞血可见于贫血，失7 涩脉 弱 不畅瘀血，失瘀等 挺直而长，如按肝胆病，气郁，诸8 弦脉 较强 可见于动脉硬化 弓弦 痛 气血不足，湿邪致9 濡脉 较弱 浮小而软 病 绷急有力，如绳弦而有力，也可见10 紧脉 强 寒证，剧痛，宿食 索绞转 于动脉硬化 一息四至或湿证，病后元气恢11 缓脉 中等 脉来和缓 多为正常脉 略少于四至 复 脉形宽大，来盛慢性病见此为逆12 洪脉 强 热盛 去衰 证 13 细脉 较弱 脉形细小如线 气血不足的虚证 仅指脉形大不说14 大脉 脉形宽大 在慢性病说明病进 明脉搏力量 appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 脉形微小，重按气血虚衰，阴阳两15 微脉 很弱 多为阳衰急证 模糊 虚 浮而无力，重按阳气外脱，元气离16 散脉 很弱 脏腑之气将绝 无根 散 重按浮大中空，状如17 芤脉 亡血，失精 多见于大出血 无力 葱管 浮而搏指，中空18 革脉 较强 亡血，失精 即芤、弦脉并见 外坚 阴寒内盛,症瘕，疝即沉弦、实三脉并19 牢脉 较强 沉而实大弦长 气 见 一息七至以阳极阴竭，元气将20 疾脉 脉来急疾 上 脱 一息六至以脉形短滑，跳动即滑、短、数三脉21 动脉 强 妊娠，痛症，惊证 上 如豆状 并见 重按推筋着骨病邪内闭，厥证，22 伏脉 比沉脉更沉 始得 痛极，阳衰 一息六至以阳盛热实或气血痰心律失常偶可见23 促脉 不规则的间歇 上 食停滞 于正常人 一息四至以阳盛寒积，气血瘀心律失常偶可见24 结脉 不规律的间歇 下 滞 于正常人 心律失常的二联25 代脉 有规律的间歇 脏气衰败 律、三联律 脉形长，超过寸26 长脉 阳气有余，热证 和尺部 脉形短，不及寸有力主气郁，无力27 短脉 和尺部 主虚损 NO 脉名 主病 appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 表寒、风寒、1 浮紧 风痹 2 浮缓 表证有汗者 3 浮数 表热或风热 风痰或表证4 浮滑 夹痰湿 5 沉迟 里寒 6 沉紧 里寒、痛证 7 沉滑 痰饮、食积 肝郁气滞、8 沉弦 痛证 脾肾阳虚，9 沉缓 水湿停留 血瘀，尤常 10 沉涩 见于阳虚而 寒凝血瘀者 里虚、气血11 沉细 虚 12 沉数 里热 沉细阴虚，或血13 数虚有热 14 洪数 气分热盛 肝热、肝火15 弦数 或肝胆湿热 肝热挟痰，16 弦滑 停食 肝火挟痰，弦滑或风阳上17 数 扰，痰火内 appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 蕴 18 弦迟 寒滞肝脉 寒痛、寒滞19 弦紧 肝脉 肝肾阴虚或 20 弦细 血虚肝郁， 或肝郁脾虚 痰热，痰火21 滑数 或内热食积 三根手指辨健康 ——中医脉诊的奥秘 ?寸口位于手太阴肺经原穴所在之处，为脉之大会，而“肺朝百脉”，五脏六腑十二经气血的运行都始于肺而止于肺，因此，寸口脉能够反映五脏六腑十二经气血的病变。 ?另一方面，手太阴肺经起于中焦，与脾同属太阴，与脾气相通，而脾为后天之本、气血生化之源，所以脏腑气血的盛衰都可以反映于寸口。 “小姑娘，你的脉轻轻摸的话，感觉不明显，需要用点力才能摸到，这叫做沉脉，《脉经》里解释是‘举之不足，按之有余’，主里证。搏动力度偏弱，是阳气虚的脉象。”北京中医药大学中医教授王天芳一边将手指搭在我的手腕上切脉，一边解说。听到她的解释，我不禁暗暗吃惊，心想，最近的节食活动恐怕是有点过头了。 脉诊初感受 千百年来中医诊病就像一场考试，求诊的人在医生面前把手一伸，医生摸摸左手脉，摸摸右手脉，看看舌苔，反复询问病人症状、感觉，然后大夫就会将患者的病证清清楚楚地讲出来，如果患者信服，这场考试就算通过了。医生是如何通过摸脉来判断病证的呢, 王天芳指导我将自己左手的食指、中指、无名指并拢放在右手手腕后寸口的位置，感觉脉搏的活动。 首先感觉到脉搏的位置，有的轻轻一摸就能摸到，有的却需要用力才能摸到，这就分出了浮脉和沉脉。 第二点是脉搏的力度，搏动有力为实脉，无力的则为虚脉。 appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 第三点是脉搏的频率，健康人在一呼一吸之间脉搏应搏动4次，不足4次为迟脉，超过5次不足7次为数脉。 第四点是脉搏的紧张度，如果按下去，感觉像按在琴弦上，强而硬，为弦脉。如果感觉松弛和缓则为缓脉。 第五点是脉搏的均匀度，节律是否均匀，力度、大小是否一致，节律不均匀的就有促脉、结脉、代脉，力度、大小不均匀的有微脉、散脉等。 第六点是脉搏的流利度，也就是脉搏来势的流畅程度，脉来圆滑流利为滑脉，往来艰涩为涩脉。 第七点是脉搏的长度，也就是手指能够感觉到的脉动的轴向范围的长短，分为长脉和短脉。 第八点是脉搏的宽度，即手指能够感觉到的脉动的径向范围大小，分为大脉和细脉。 即使在王天芳手把手的指导下，我这个门外汉也只能感受到这八点中的一部分，更不要说分辨临床中各种复杂的脉象，可见中医脉诊的学习难度之大。 在感受过脉搏的各种应指形象后，王天芳告诉我，几千年来，中医大夫通过临床实践，不断，不断验证，不断修正，最终建立了脉诊的理论体系，将可以感受的外在脉象与内在病证建立联系，结合望、闻、问等其他方法，共同诊断病情。 切脉为何选手腕 人体头部、四肢、躯干都有动脉分布，可供切脉的地方很多，为什么中医大夫无一例外地选择了手腕部位呢, “脉诊又称切脉，是医生用手指的指目，也就是指尖与指腹交界处椭圆形的一小块区域，切按患者的脉搏，根据脉动应指的形象来了解病情、辨别病证的诊察方法”，王天芳介绍道，“诊脉的部位并不是一开始就确定在寸口，它有一个发展变化的过程。” 最初医生选用遍诊法，将头、手、足三部分的有关动脉全部诊察，张仲景提出三部诊法，诊人迎、寸口、趺阳三脉，经过《难经》、《脉经》的总结，最终寸口诊法被后世医家普遍采用。 究其原因，王天芳说，寸口位于手太阴肺经原穴所在之处，为脉之大会，而“肺朝百脉”，五脏六腑十二经气血的运行都始于肺而止于肺，因此，寸口脉能够反映五脏六腑十二经气血的病变。 另一方面，手太阴肺经起于中焦，与脾同属太阴，与脾气相通，而脾为后天之本、气血生化之源，所以脏腑气血的盛衰都可以反映于寸口。 appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 结 语 脉诊作为中医“四诊”之一，从脉象出发了解病情，经过长期的医学实践已经积累了丰富的经验，具有毋庸置疑的科学性。但不能盲目夸大其作用，悬丝诊脉、摸脉断命运之说不可信。在临床诊断中，四诊合一、病证合参、整体审察才能准确地判断病情，辨证施治。 脉诊是以手指按切病人动脉以了解病情的内在变化也称切脉或诊脉。 脉为血府，贯通周身，五脏六腑的气血都要通过血脉周流全身，当机体受到内外因素刺激时，必然影响到气血的周流，随之脉搏发生变化，医者可以通过了解脉位的深浅，搏动的快慢、强弱(有力无力)、节律(齐否)、脉的形态(大小)及血流的流利度等不同表现而测知脏腑、气血的盛衰和邪正消长的情况以及疾病的表里、虚实、寒热。如病变在肌表时呈现浮脉;病变在脏腑时，呈现沉脉;阴证病候时阳气不足，血行缓慢，呈现迟脉;阳证病候时血流加速，呈现数脉等。脉诊是中医辩证的一个重要依据，前人在长期的实践中积累了丰富的经验，是中医独特的诊法。但在临诊中也有脉证不符的特殊情况，如阳证反见阴脉，阴证反见阳脉，因此把脉诊作为唯一的诊断方法是非常片面的，必须强调四诊合参，才能了解疾病全貌，作出正确的诊断。 1.切脉的部位:一般取寸口脉，即桡动脉腕后浅表部分。 2.切脉的方法;切脉时让病人取坐位或仰卧位，伸出手臂置于心脏近于同一水平，手掌向上，前臂放平，以使血流通顺。 切***脉，以三指定位，先用中指按在高骨(桡骨茎突)部位的桡动脉定关，继续以食指在关前(远心端)定寸，然后用无名指在关后(近心端)定尺三指应呈弓形斜按在同一水平，以指腹按触脉体。三指的疏密应以病人的高矮适当调整，如患者身体较高，医生三指排列可松一些，而病人身体较矮，则三指排列可紧一些，同时要三指排列整齐，否则影响脉形的准确性。 小儿寸口部位狭小，不能容纳三指，可用一指(拇指)定关法，而不细分三部。三岁以下的小儿，可用望指纹代替切脉。 切脉时运用三种指力，开始轻度用力，在皮肤为浮取，名为举;然后中等度用力，在肌肉为中取，名为寻;再重度用力，在筋骨为沉取，名为按。根据临床需要，可用举、寻、按或相反的顺序反复触按，也可分部以一指直按的方法体会。 寸、关、尺三部，每部有浮、中、沉三候，称为三部九候。 appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 3.寸口脉分候脏腑情况:寸口脉的不同部位，反映不同部位，反映不同脏腑的功能情况，以寸关尺分候相应的脏腑，这是前人的经验，在诊病时有一定的参考意义，但在临诊时仍需全盘考虑。 4.切脉应注意的事项: ?医者须全神贯注，仔细按触，反复细心体验，防止主观臆测粗枝大叶，时间也不能过于短促(每次诊脉时间不应少于50秒)。 ?注意内外因素对脉象的影响:如小儿脉较***脉软而数，妇女数较男子脉细弱而略数，胖人脉较瘦人脉沉。夏天脉较洪大，冬天脉较沉小。剧烈运动后脉洪数，酒后脉数，精神刺激和某些药物也可引起脉象的暂时变化。 ?有些人因桡动脉解剖位置的差异，脉不见于寸口部而于拇指腕侧处，称为反关脉，从尺部斜向手背，称为斜飞脉。 5.正常脉象:健康人的脉象称为正常脉象。一般是不浮不沉。不大不小，不强不弱，不快不慢，均匀和缓，节律整齐，又称为平脉或缓脉。平脉至数清楚，一息(即一呼一吸)之间四至五次;相当于72,80次，节律、强弱一致。脉象受体内外因素的影响而发生生理的或暂时的变化，也属正常。如年龄越小，脉跳越快，婴儿脉急数，每分钟120,140次，五、 110次，青壮年体强，脉多有力，年老人体弱，脉来较六岁儿童常为一息六至，每分钟90, 弱，成年人女性较成年男性脉细弱而略快，瘦人脉较浮，胖人脉多沉，重体力劳动，剧烈运动长途步行，饮酒饱餐，情绪激动，脉多快而有力，饥饿时则脉较弱。 6.异常脉象与临床意义:在祖国医学有关脉学的专著中所记载的病脉有28种，然而根据脉位、脉率、脉力、脉形、脉流的流利度及节律等划分的脉象往往是混合构成，有些病脉是两个以上单一脉复合组成的脉。 田原:很多学生觉得脉象学很难，您的中医全部是自学的，在脉诊这方面给他们一些忠告, 李 可:脉象这个东西啊，主要是要做到能看出来病势、走向，你掌握浮、沉、迟、数四个脉就可以了。比如说，数，你要掌握他的一呼一吸要超过多少下，超过八、九十下就属于数了。数在脉经上讲，属热，但是我发现呀，数脉它不但主寒，而且是主大寒，非常危险的寒，正所谓热极必反。就是当你这个脉搏跳到一百次以上，甚至两百次，这个时候啊，你这个阳气已经没有了，完全外散了。可它是数脉，对于这种数脉你绝对不能用凉药。 所以学中医的人你要活看，你要结合不同机体的病人，在我身上如果是数脉，可能就是„„appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 唉呀，我身上哪一个地方有火，清泻一下就过了，但是有些病人他表现出一种反相，一种假相。你比如说肺结核，肺结核的病人，他那个基础脉搏数啊，就在一百次以上，他能有什么热,他那个元气都散光了，你要再给他去治热，那他就死路一条了，然后他得感谢你给他治病。(笑)很多东西并不像本上写的那么简单、明了，一眼就能看透。 再说迟脉，迟脉主寒，但是有些热极的病，上下关格不通，他那个脉也很迟，那你就要给他通腹，要用大承气去让他泻肚子，一般的迟脉是要扶阳，但是特殊的迟脉就不能一样治了„„所以要把这些情况都搞清楚，你心中就有数了。 现在把脉一般都是个样儿，看上去是看脉呢，其实脑袋不知道想啥呢。然后他问你，你怎么回事，你说了半天，他把那个脉早忘记了是啥脉了。所以判断脉的时候啊，要读那个彭子益脉法，很有特殊启发作用。他那个方法特殊，病人坐在对面，两个手平放，这六部脉，心、肝、肾、肺、脾、命门，哪一路脉独特，就是那个地方有病。 田原:同时按，然后进行比较, 李 可:哎，你不比较怎么知道强弱、快慢,所以看病的时候你还要结合望诊。比如面色晦暗，但是他脉非常快，那就是阳气快完了，绝对不是热症。 田原:是寒症, 李 可:对。所以你看那个脉案上写着脉数，数不但主虚、主寒，而且主亡阳，但是脉诀上没给你那么写吧,你要这么讲那别人都得说这家伙是胡说八道，实际上就是这么回事。 还有浮，浮主表，但是当人阳气外散的时候，这个浮啊，绝对不是表症，如果你按表症给他治，用麻黄汤、桂枝汤，他就完了，赶快用四逆汤吧。 这只是四种脉里面的三种，就有这么多变局啊，正局当然好看了，那个变局呀，十有九都是变局，正局表现的很少。尤其是一些现代病，西医治到不能治的才找中医，他那个脉象就是恰恰相反，你看他热症，他肯定是个寒症。真正对脉很通的，现在周围已经没有。最好的脉法还是《难经》脉法。 过去河北有一个梁秀清，他看脉，旁边放张纸，在那儿画图，最后画到肺这个地方了，他说你这个肺的左边有这么大块的东西，你去透视一下。出来一看，他左边有个肿瘤;还有一个将军去找他看病，其实也不是看病，本来是计划砸他那个牌子，说这个人太神了，肯定是一个江湖术士啊。这个将军进去以后，这个梁秀清一般不许病人讲话，他就看脉，看了半天以后啊，他说你这个背部太阳经第几个穴位那个部位啊，有一个异常的东西，不是你本来应该有的，这个将军就惊呆了，说我那是个弹片，正好在那个肺和心的中间。 田原:太神奇了，就是通过脉象看出来的, 李 可:就是啊。但是这个人治病不怎么样，他断病非常强，他就好像有透视眼似的，断病非常准确。 appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 人体的脉象啊，一天二十四小时有一个循行的路线，循行到哪一个部位不通的时候，他那个脉象就会出现很突然的变化，他就能抓住那个东西，就给你断定了，告诉你，你哪个地方有病。 这个方法失传了，没有人能知道。 田原:脉象二十四小时还有一个运动的规律, 李 可:对，肯定的。 田原:如果是这样的话，现在中医大夫，把脉就把个半分钟、一分钟，能看出来什么, 李 可:(笑)啥也看不出来，江湖骗子。所以说中医的四诊是一个综合性的判断，单纯靠哪一个也不行。脉象只是其中的一个方法。 现在也有看脉象和心脏是不是同步啊，心脏跳几下，脉就跳几下，那和中医的脉风马牛不相及(笑)。根本不是一回事儿。这还算是中西结合里的一个成果呢。 田原:李老，咱们从开始聊天到现在，你可吸了不少烟„„ 李 可:挺好啊，除了感冒，一般是不咳嗽。 田原:中医说吸烟耗阴，抽烟的人嘴唇一般都是干红的，有虚热的表现。 李 可:胡说八道。那是假辨症，看到表相，看不到本质。我告诉你啊，现在教科书上的结论基本上是错的，特别是阴阳的辨证，其它的就不用讲了。 先父在1930年讲诊脉时说;诊脉不是只诊出一个脉，从一个脉就定病。诊脉必须诊出脉的病位，脉的虚实、寒热、表里、气血，再辨明病证是有余还是不足，先治何病，后调何疾，这全在脉中诊出。譬如表有病不论风寒风热，脉的部位一定在浮位。温病的卫分证也在表，所以脉也在浮位。如浮紧风寒、脉缓风虚、浮迟中风、浮数风热等。 appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 单凭一个浮脉不能断定是什么病，必须再诊出八纲脉来断其表里、寒热、虚实与气血，如浮滑是风痰、浮弦是风邪挟郁、浮数是风热等。但是要想诊断一个完整的疾病，还必须再诊出第三个脉来，如浮滑数是风痰热，浮紧弦是风寒而体痛。这样还不够，要想看清病人的疾病，进一步弄清病人的体质与疾病的转机，就要再找出第四个脉来，如浮滑数而按之弦细，这就清楚多了，弦则肝郁，细为血虚，脉象告诉你，这人是素来血虚肝郁，目前是风火痰热，你在开方治风火痰热时，要照顾到血虚肝郁方面。也就是说，在治风火痰热时不可以过凉，也不可以过于祛风(因为病人体质是血虚肝郁，不能多散风，多清热而忘了病人是血虚之体了。先父经常说:看脉必须看出五个脉才能诊断清楚，不是一个什么脉就诊什么病、就用什么药。 二 诊脉是不是都必须诊出五个脉才算诊断清楚,不然。就是诊出五个脉来，也只能是比较清楚，一定还要望舌、观色、看形体、问病情及治疗经过，才能初步诊出病机，决定治疗，再通过试验治疗，才能进一步决定出确诊与否，不然不是科学的，也不可能将病治好。我们在临床实际工作中，诊脉达到理想的要求是比较难的，但我们可以结合望、闻、问诊进行分析，不断积累经验。“诊脉完全依赖医生指端感觉的灵敏度，要掌握切脉的技术，必须在有经验的老师指导下，经常作切脉的锻炼，以保准字。”这是先父生前常常讲述的话，要达到指下清楚，判断准确确实要下一定工夫。 诊脉必须五十动以上，才能诊出有病之脉，张仲景曾说过;“动数发息，不满五十，短期未知决诊，九候曾无仿佛”。说明了诊脉需有五十动的时间，才能辨出几种脉形，辨出主脉兼脉，在诊清病情的基础上才能立法、处方，这是我们临床医生必须遵守的。 三 先父根指他的经验认为:测脉定位当以浮、中、按、沉四部来分，以更好地定表、里，定功能与实质。以浮部定表分，中以走偏里，按是属里，沉则为深层极里。也可以说浮脉主表、沉脉主里，中与按皆为半表半里。温病的卫、气、营、血四个阶段，可以用浮中按沉来划分。总之，浮、中主功能方面疾病，而接与沉主实质性的疾病。又如新病与久病，气病与血病，外感与内伤等，都能用浮中按沉四部辨别清楚。下面淡淡浮中与按沉的取脉方法。 1(浮部的取脉法 医生用指轻轻地接在病人挠骨动脉皮肤上，浮位表示病位在表分，如伤寒病人初起病在太阳，温病则为病在卫分，或为在肺与皮毛。当然，浮只表示病在表位，要想全面了解病因、病机，还要看兼脉的情况，如浮滑主风痰，浮数主风热等。若想进一步测虚实、寒热、表里、气血，或停痰、停饮、郁热、血瘀等，就必须检查其它兼脉，不然就难以详细确诊病位与病机。 2(中部的取脉法 是从浮位加小力，诊于皮肤之下即是中部。如浮位用三菽之力(菽:豆也)，中部即是六菽之力，表示病在气分，或定为病在肌肉，或在胃。伤寒病是标志邪从表入里，主胃主阳明;温病则明显属气分;在一般杂病中，即称它为在肺胃之间。总之，凡脉来明显 在“浮”与“中”位者，多主功能性疾病，属阳、属气分。若再加力而入“按”、“沉”部位，这说明邪已入营、入卫了。 appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 3(按部的取脉法 医生切脉，从浮、中再加重力量(九菽之力)，按在肌肉部分、反映邪在里之病，如《伤寒论》的太阴证，温病的营分证，杂病则主肝、主筋膜之间的病变。凡脉在按部出现则说明病已入里，主营分、主阴。 4(沉部的取脉法 从按部加重用十二菽之力向下切脉，已接至筋骨，表示病已深入，主下焦、主肾、主命门。如《伤寒论》病在少阴、厥阴。少阴病以沉细为代表脉，而厥阴病以沉弦为代表脉。在温病则表示邪入血分。在杂病中说明病延日久，邪已深入，当细致审证治疗。如病人脉象见于按沉，主实质性疾病，也说明了疾病的实质性问题。 四 自己这些年来体会，尤其是近开年来自己的看法:诊脉不能简单、机械，必须分清浮、中、按、沉四部，上面的浮中两部反映功能方面的疾患;下面的按、沉两部才反映疾病实质的病变。正象舌苔与舌质的关系一样。凡属舌苔变化多端，归根结底是E反映功能方面的问题;舌质的变化虽少，但万变不离其宗，都说明本质的情况。所谓功能方面的病变，是指在表位、浅层、卫分、气分阶段，如气郁不舒、木土不和、肝郁气滞、停疾、停饮、胃肠消化欠佳等所导致的疾病。用疏调解郁即可改善这些功能性疾病。所谓本质性病变(是指本质阳虚、命门火衰或阴虚阳亢等，或病在营分、血分以及陈痰久郁阻于络脉、癥瘕积聚、肿瘤等一类疾病。另外，久病邪深入于肝肾，下元久虚，慢性消耗性疾病，需要用滋补、培元等方法者，皆可以认为是本质性疾病。 临床诊脉所见，浮中与按沉所得脉象往往有迥然不同者，一般来说浮中见其标象，按沉得其本质，若诊脉能辨别浮中与按沉之异，则病之表里、寒热、虚实，纵其错综复杂，亦必无遁矣。古之名医多重视沉取至骨以察其真，如朱丹溪《濇脉论》云:“涩之见固多虚寒，亦有病热为病者，医于指下有不足之气象，便以为虚，或以为寒，孟浪与药，无非热外，轻病必重，重病为死者多矣，何者,人之所籍以为生者，血与气也，或因忧郁，或因厚味，或因无汗，或因补剂。气腾血沸，清化为法，老痰宿饮，胶固杂揉，脉道阻塞;不能自行，亦见涩状，若查取至骨，来似有力，且数，以意参之于证，验之形气，但有热证。当作痼热可也。”涩缘血少或亡精，因多虚寒，然按之至骨且有力且数，以此而知其断非虚寒可比，此乃老痰瘀血，阻塞脉道使然，郁久化热。深伏于里，故日痼热，言其深且久也。若不沉取至骨，何以辨此痼热之证哉,此前贤诊脉之精髓所在也。 绍琴幼承庭训，及长，历随数名医临诊，每叹诸师诊脉之精湛，迄今潜心研讨五十年，悟得诊脉必分浮、中、按、沉四部，浮中为标，按沉主本，若二部之脉不同，则必参舌、色、证，以辨其真假、主次、缓急，以定其何者宜先治，何者当后医，何者须兼顾，何者可独行。脉象一明，治则随之，有如成竹在胸，定可稳操胜券矣 近代名医张锡纯著《医学衷中参西录》，影响深远。重温该书，体会张氏对脉诊亦多有发微appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 创新，感悟颇深。 辨外感与内伤 脉象浮，为外感 张氏在寒解汤验案中载:一少年，孟夏长途劳役，得温病医治半月不效。张氏诊视，见其两目清白，竟无所见;两手循衣摸床，乱动不休，谵语不省人事，其大便仍每日一两次。诊其脉“浮数，右手之浮尤甚，两尺按之即无。”张氏分析:虽然病势垂危之极，但脉浮表明病仍在太阳，且“右寸浮尤甚”，为将汗之势;其之所以将汗而不汗者，乃人身之有汗，如天地之有雨，应天地阴阳和而后才能有雨，人身亦阴阳和而后才汗。此证因为“尺脉甚弱”，阳升而阴不能应，故而无汗则表证不解。对此，张氏运用大润之剂，峻补真阴(熟地黄、玄参、阿胶、枸杞之类，约重六七两，煎汤一大碗，徐徐温饮下，一日连进两剂)，济阴以应阳，即日大汗而愈。此案表明:病人右脉寸浮，虽表证仍在，但内伤正虚已现，故“右寸之浮大甚”，但两尺按之即无，表明两手尺脉均弱甚。未提左脉，表明左寸无浮象。虽有外感太阳表邪未除，但正气虚象毕露。表证汗解，观“非必发汗之药始发汗也”，张氏大补真阴，以阴阳和达表从汗解之妙。 左脉大于右脉，从外感论治 张氏记录一验案:周宝和，二十余岁，得温病，医者用药清解之，旬日其热不退。张氏诊其脉“左大于右一倍，”且“按之有力”。张氏分析认为:如果寒温之邪传入阳明，其“脉皆右大于左”，因为右脉阳明属脾胃也，因而认为“阳明之脉在右也”;因此，张氏认为“此证独左大于右，乃温病之变证”也;故从外感论治，方用小剂白虎汤(生石膏用五钱)，重加生杭芍两半，煎汤两茶杯顿饮之，须臾小便一次甚多，病若失。 右脉大于左脉，从内伤论治 张氏验案:陈某，年四十余，自正月中旬，觉心中发热懒食，延至暮春，其热益甚，常腹疼，时或泄泻，舌苔微黄，其“脉右部弦硬异常，按之甚实”。张氏认为:其“脉象不为洪实而弦硬之象者”，因胃土受侮。亦从肝木之化也;此乃外感伏邪，因春萌动，传入胃腑，久而化热，而肝木复乘时令之旺以侮克胃土所致也。因此，治用滋阴泄热之法，药用生杭芍、山药、滑石、玄参各一两，甘草、连翘各三钱，煎服一剂，热与腹痛皆愈强半，且“脉象已近和平”，又将芍药、滑石、玄参各减半，又服一剂而痊愈。 辨肝之虚实 脉弦而有力，主肝胆火盛 张氏有一验案为:一人年过四旬，胁下掀疼，大便七八日未行，医者投以大承气汤，大便未通而胁下之疼转甚(张氏注，通而未下者，此乃为实热也)，张氏诊其脉“弦而有力”，知其为肝气胆火恣盛也，投以金铃泄肝汤(川楝子、乳香、没药，三枝、莪术、甘草)加柴胡、龙胆草，服后须臾大便下，胁疼顿愈。 左关主肝 张氏验案:一妇人，年二十余，因与其夫反目，怒吞鸦片，已经救愈，忽发喘逆，迫促异常，须臾又呼吸停顿，气息全无，约十余呼吸之顷，手足乱动，似有畜积之势，而喘复如故，若是循环不已，势近垂危，延医数人此不知为何病。后张氏为其诊脉，其脉“左关弦硬”，“右寸无力”。静思良久，恍然悟到:“此必怒激肝胆之火，扶下焦冲气上冲胃气”，欲治此证，非一药而兼能升陷降逆不为功，随用桂枝尖四钱，煎汤饮下，须臾气息调和如常。或问:桂枝辛散温通之品，为何有降逆之功?张氏谓:桂枝其花开于中秋，是桂之性原得金气而旺，且味辛属金，故善抑肝木之盛使不横恣，而桂枝之枝形如鹿角，直上无曲，故又善理肝木之郁使之条达也;且其味甘，故又善和脾胃，能使脾气之陷者升，胃气之逆者下降。一疏肝之郁，二平喘之逆，三调气之升降。 左关微弱为肝虚 张氏验案:周某，年三十许。当大怒之后，渐觉腿疼，日甚一日，两月之后，卧床不能转侧。医者因其得之恼怒之余，皆有舒肝理气之药，病转加剧。张氏诊其脉，发现“左部微弱异常”(左关脉)，且病人自言凡疼痛之处皆热。张氏恍悟出:怒则伤肝，伤肝者，乃伤肝经之气血;气血伤则脉弱随之，故其左部脉象如是也。其腿疼者，肝主疏泄，中藏相火，肝虚不能疏泄，相火即不能逍遥流行于周身，以致郁于经络之间，与气血appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 凝滞而作热作疼，所以热剧之处疼亦剧也。对此张氏重用山萸肉一两，加知母、当归、丹参、乳香、没药，连服10剂，热消疼止，步履如常。其门生万泽东，治一壮年子，因屡经恼怒之余，腹中常作疼。他医用通气、活血、消食、祛寒之药，皆不效。万泽东诊其“脉左关微弱”，知其系怒久伤肝，肝虚不能疏泄也。随用山萸肉二两，佐以当归、丹参、柏子仁，连服数剂，腹痛遂愈。张氏辨治一少年，其肝脏素有伤损，“左关脉独微弱”，一日忽胁下作疼，张氏单用柏子仁一两，煎汤服之立愈。张氏认为“柏子仁禀金水之气，水能滋木，如统师旅者之厚其饷也;金能镇木，如统师旅者之严其律也，滋之镇之，则肝木得其养兼得其平，将军之官安其职矣。张氏还曾治一女郎，因怒气伤肝经，医者多用理肝之品，至其虚弱，坐时左半身常觉下坠，卧时不能左侧，诊其脉，“左关微弱异常”，知其肝虚，遂重用生黄芪八钱以升补肝气，又佐以当归、山萸肉各数钱，一剂知，数剂痊愈。 张氏所创镇肝熄风汤治中风证，首辨为“脉弦长有力”，或“上盛下虚”;若“尺脉重按虚者”，加入熟地黄、山萸肉。镇肝熄风汤因其名可知治肝之理，而“脉弦长有力”主肝火上盛，“尺脉重按虚者”为下焦有虚。张氏治刘铁珊将军，其脑中常觉发热，时或眩晕，心中烦躁不宁，“脉象弦长有力，左右皆然”，诊为脑充血证，投以镇肝熄风汤，加地黄一两，连服数剂，脑中不觉热，后减地黄用量，服药旬日，脉象和平。又治一新妇，过门旬余，忽然头痛。他医不效，张氏诊其“脉弦硬而长，左部尤甚”，知其肝胆之火上冲过甚也。遂用镇肝熄风汤。加龙胆草，服两剂头不痛，而“脉象依然有力”，又去龙胆草加地黄，服药数剂，“脉象如常”。从镇肝熄风汤可看出，张氏认为肝脉为弦在左为主，而尺脉弱者则为肝阴之不足，故方中有平肝、镇肝的赭石、龙牡，又有滋阴补肝的龟板、芍药、玄参、天冬，还有疏肝之麦芽、茵陈，可谓是顺从肝之特性，充分体现张氏对肝脉认识与研究至深之理。 白虎汤证脉象辨 白虎汤证脉当洪滑 白虎汤方三见于《伤寒论》。一在太阳篇，其脉浮滑;二在阳明篇，治三阳合病自汗出者;三在厥阴，其脉滑而厥。张氏认为，白虎汤证之脉象当如洪滑无疑，如果其脉为洪滑者，知其为阳明腑实证，投以大剂白虎汤原方，其病必立愈。在石膏解及寒解汤验案中，张氏变通应用白虎汤，其效如神。视其脉象均为洪、滑、数而有力之脉证，张氏辨析白虎汤证在《伤寒论》太阳篇，其“脉浮滑”，知病在表，于是加薄荷，或加连翘、蝉衣(即为寒解汤)，服后须臾即可由汗解而愈。 白虎汤证脉证不一时，方用白虎加人参汤 张氏认为，病人若有白虎汤证，但其脉象非“浮滑”而数或弦硬，或洪滑而重按无力者，或虽有力而数逾六至，或年过五旬，或在劳心劳力之余，或其人身形素羸，即便非在汗吐下后，渴而心烦者，当用白虎汤时皆宜加人参。张氏临证多年，治寒温实热用白虎加人参汤，恒多于用白虎汤;凡遇“脉过六至者”，恒用生淮山药一两代方中梗米;若遇阳明实热，又兼下痢者，方中用白芍一两代知母;若妇人产后患寒温实热者，亦以山药代梗米，玄参代知母。临床效验病案不计其数 连建伟，教授，国家级名中医，博士生导师。18岁即开始行医，师从诸多名医。1978年考入北京中医药大学，攻读硕士研究生，师从王绵之、岳美中等多位名师，精研《伤寒论》、《金匮要略》以及历代方书，著述颇丰。临床以内科杂病和妇科病为主。治病强调脉症合参，知常达变。本文主要记载了连建伟教授妇人脉诊的临床经验体会。他认为妇人脉诊亦遵循脉诊的一般原则，但因妇人有经、带、胎、产等特有的生理变化和疾病，脉象也会随之发生变化。本文从月经脉、带下脉、妊娠脉、临产脉、产后脉、男女胎识别法等方面对其进行了深appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 入探讨，冀能发现妇人脉诊的一般规律，以飨同道。 妇人脉诊亦遵循脉诊的一般原则，但因妇人有经、带、胎、产等特有的生理变化和疾病，脉象也会随之发生变化。《千金翼方》日:“凡妇人脉，常欲濡弱于丈夫。男左大为顺，女右大为顺。”丹溪亦云:“男子病，右脉充于左者，有胃气也，病虽重可治，女子病，左脉充于右者，有胃气也，病虽重可治。”《四诊抉微》载:“按诊者，诊男先诊左，诊女先诊右。非男女经脉有别也，从其阴阳，以察其盛衰也。”吾师亦认为，一般妇人脉较男子略濡弱，而且右脉大于左脉，诊脉时顺序以先右后左为宜。 1、月经脉 女子左关尺脉，忽洪大于右手，见心烦乳胀，口不苦，身不热，腹不胀，是月经将至的表现;经血来潮，脉象转缓。 月经先期、经血过多，脉来洪大或滑数，此为冲任有热，可用四物汤加黄芩、石膏等以清冲任之热;经水先期、经血少，脉来细数，多为肾中火旺而阴水亏也，可拟知柏地黄丸加减;月经先期，量多色淡，神疲，懒言，脉细弱，此为脾虚不固，可用圣愈汤加减;月经后期，经血过少，脉来沉细而弱，为阳虚内寒而致，可用大营煎加减;月经先后无定期，脉弦，此为肝气郁结也，可用柴胡疏肝散或逍遥散加减。 痛经一证，临床所见，虚少而实多，实证多为气滞、血瘀所致，虚证多为气血虚弱所致。行经时少腹胀痛，脉弦者，此为肝气郁结也，可用柴胡疏肝散或逍遥散加减治之。而血瘀一证，又有属寒属热之不同。大凡寒凝血脉者，经行多后期，少腹冷痛，经水中有紫黯色瘀块，脉来沉迟或涩，可用王清任少腹逐瘀汤调治;瘀热痛经，常见经行前期，少腹疼痛拒按，经水中有紫红色瘀块，脉来实大而数，吾师以自制之二丹桃红四物汤(桃红四物汤加丹皮、丹参)治之。 妇人闭经有虚实之分，脉来细涩，或细弱，或尺脉微，多为冲任虚亏、精血不足的虚闭证，可用归脾汤或十全大补汤加减;脉来弦涩，多为邪气阻滞之实闭证，可用桃红四物汤或下瘀血汤等加减治疗。 血崩不止，脉多见芤，可用独参汤以救之;漏下不止，量多色淡，脉来细弱，可用归脾汤或圣愈汤之属治之;漏下不止，五心烦热，脉来细数，可用知柏地黄丸加减治疗。 2、带下脉 带下病一证，吾师多遵傅青主。带下色白，清稀如涕，脉缓或濡弱，多为脾虚肝郁，带脉失约，湿浊下注所致，可拟完带汤加减;若带下色黄，宛如浓茶，脉来滑数，多为湿热下注，损伤冲任所致，可以易黄汤治之;带下色青，稠粘不断，其气腥臭，脉来弦滑而数，多为肝郁湿热所致，可用加减逍遥散治之;带下色红，似血非血，烦躁易怒，脉左关弦数，右关稍缓，此为肝郁化火，横克脾土，湿热下注，与血俱下，可与清肝止淋汤治疗;带下色黑，气腥，伴有腹中疼痛，小便赤涩，烦热，喜冷饮，脉来洪大，此为胃火太旺，与命门、膀胱、三焦之火合而煎熬所致，可用利火汤治之。 3、妊娠脉 已婚妇人平素月经正常，婚后停经二三月，脉来滑数冲和，左寸动甚，伴有嗜酸或者呕吐等表现，为受孕怀胎之候。 《素问?平人气象论》“手少阴脉动甚者，妊子也。”仲景云:“妇人脉滑数而经断者为有孕。”《脉经》亦云:“三部脉浮沉正等，按之无绝者，有妊也。” 妊娠脉须与闭经脉相鉴别:妊娠脉必滑数冲和，而闭经虚证多为精血不足而脉细弱，可予十全大补汤治之;实证或因痰湿阻滞、冲任不利所致，其脉虽滑，但多兼弦，可用温胆汤或导痰汤加减治疗;或因瘀血阻滞，其脉多涩，可用桃红四物汤或温经汤或少腹逐瘀汤治之。 4、临产脉 appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening 《诸病源候论》日:“孕妇诊其尺脉。转急如切绳转珠者，即产也。”《脉经》:“妇人怀妊离经，其脉浮，设腹痛引腰脊，为今欲生也，但离经者，不病也。”《医存》云:“妇人两中指顶节之两旁，非正产时则无脉，不可临盆。若此处脉跳，腹连腰痛，一阵紧一阵，二目乱出金花，乃正产时也。”吾师深以为是。 5、产后脉 妇人产后气血亏虚，故脉象多为虚缓平和。四诊抉微》云:“新产之脉，沉细缓为吉，实大弦牢，其凶可明。”脉细弱伴乳汁不足，为气血虚弱之候，可用八珍汤或十全大补汤治之;脉弦而见乳汁量少，多属肝气郁结，可用柴胡疏肝散或逍遥散治疗;脉弦紧伴腹痛，恶露不下，多为寒凝气滞，可予生化汤尝之。 6、男女胎识别法 如何识别孕男孕女，古代医籍有诸多记载。《脉经》云:“妇人，妊娠四月，欲知男女法:左疾为男，右疾为女，俱疾为生二子。”又“左手沉实为男，右手浮大为女。左右手俱沉实，为生二男，左右手俱浮大，为生二女。”又云:“尺脉左偏大为男，右偏大为女。”《四诊抉微》记载:“妊娠，其脉三部俱滑大而疾，在左则男，在右则女。”吾师以为，一般而言，左脉滑数甚则为男，右脉滑数甚则为女，但临证时切勿将诊断结果告诉求诊者 appearance of the weld appearance quality technical requirements of the project must not have a molten metal stream does not melt the base metal to weld, weld seam and heat-affected zone surface must not have cracks, pores, defects such as crater and ash, surface smoothing, weld and base metal should be evenly smooth transition. Width 2-3 mm from the edge of weld Groove. Surface reinforcement should be less than or equal to 1 + 0.2 times the slope edge width, and should not be greater than 4 mm. Depth of undercut should be less than or equal to 0.5 mm, total length of the welds on both sides undercut not exceed 10% of the weld length, and long continuous should not be greater than 100 mm. Wrong side should be less than or at 0.2T, and should not be greater than 2 mm (wall thickness mm t) incomplete or not allow 7.5 7.5.1 installation quality process standards of the electrical enclosure Cabinet surface is clean, neat, no significant phenomenon of convex, close to nature, close the door. 7.5.2 Cabinet Cabinet face paints no paint, returned to rusted, consistent color. 7.5.3 uniform indirect gap from top to bottom, slot width <1.5mm 7.5.4 adjacent Cabinet surface roughness is 0. 7.5.5 the cabinets firmly fixed, crafts beautiful. 7.5.6 Cabinet surface gauge, switch cabinet mark clear, neat, firm paste. 7.5.7 Terminal row of neat, is reliable, the appearance is clean and not damaged. 7.5.8 cables neat and clean, solid binding, binding process in appearance. 7.5.9 the first cable production firm, crafts beautiful, clear signage does not fade. 7.5.10 fireproof plugging tight, no cracks and pores. 7.6 7.6.1 of the standard electrical wiring quality technology cable a, the multi-core wire bunch arrangement should be parallel to each other, horizontal wire harness or wire should be perpendicular to the longitudinal multi-core wire bunch. The distance between the wire harness and wire harness symmetry, and as close as possible. B-core wiring harness into round, multi-core wire bunch used g wire binding, fastening