1 脉象理论基础
1.1 脉象的信息学基础
1.1.1 脉象是“形与神俱”的多重信息源
“夫脉者,血之府也”(《素问·脉要精微论》)从中指出,所有脏腑组织需要血供,其信息反应于血流;“心藏脉,脉舍神”(《灵枢·本神》)则表明心理活动通过大脑皮层,皮层下影响心脏、血管功能活动。
1.1.2 脉象特征是生物学信息,某些具体的特征具有生理、病理和心理学的多重意义
1.2 基于认知心理学的脉象信息研究
脉象包括古代摹绘写意、现代认知心理学和系统科学,后者就形成辨证脉学体系。传统脉象理论具有四方面局限性:首先是整体观、笼统摹写、表象记载的方式传承;再者是特定脉象的组成因素不确定;其次是对诊脉者的心理认知过程缺乏研究;最后受诊者主观因素的影响较重。相比较而言系统辨证脉学特点就会明显:从认知心理学理论出发,强调人的手指各种感觉功能;强化人体的注意功能和“反应时间”缩短等;运用系统学原理,将脉象分化成各级不同层次,最终至25对脉象要素;用现代物理学术语和计量单位进行描述和量化脉象要素;强调脉象要素之间的联系对疾病各级层次的表征作用;概括了古、今脉象研究成果,并进行创新。
2 手指感觉及单一感觉通道运用
2.1 触压觉:
触觉是皮肤表面受到微弱的机械刺激,兴奋了皮肤浅层的触觉感受器引起的感觉。压觉是较强的机械刺激使皮肤深部组织变形但未达到疼痛时所产生的感觉。用于感受血管壁张力和血管内压力、脉搏搏动应指。可用纤毛或绷紧的细线或钝头器物轻触手指皮肤。
2.2 振动觉:
一个振动着的物体接触皮肤时产生的感觉叫振动觉。脉诊中运用手指的振动觉可以感知脉搏的起伏程度、脉搏搏动的谐振波等。可用震动的手机、音叉等进行感觉训练。
2.3 运动觉:
也叫动觉,由位于肌肉、肌腱和关节内的终末器官所调制的一种感觉,反映自己身体各部分运动和位置状态。脉诊中运用手指的运动觉可感知桡动脉脉搏的轴向、周向扩张和血液流动的状态等。用流动的、压力不稳的、充满液体的橡皮管进行感觉训练。
2.4 实体觉:
实体觉是非视觉条件下以手摸或举起物体来感觉或感知物体性质(如形状、重量)的能力。脉诊运用手指的实体觉感知脉象的整体、局部乃至微观的形状和性质特征,如囊状、砂石状、橡皮状。可感触各种性质不同的物体进行训练。
2.5 温度觉:
由冷觉与热觉两种感受不同温度范围的感受器感受外界环境中的温度变化所引起的感觉。运用温度觉可以感知脉象的整体和某一局部的温度特点。可用具有温度梯度的物体进行训练。
2.6 位置觉:
判断身体在空间中的位置以及身体各部分的相对位置,或诱发姿势反射的本体感受性感觉。
2.7 定位觉:
人体通过反射活动判断出刺激作用于机体某部位的能力。将手指与桡动脉固定,运用手指的位置觉和定位觉可感知脉象在寸口部显现出的空间位置和脉象特征所处的层面、时段等,如浮、中、沉。
2.8 两点辨别觉:
是区别一个或两个刺激的能力,皮肤的不同部位具有不同的触觉感受性。主要感受脉象中的多个特征所出现的时段。可用逐渐缩小距离的尖状物进行训练。
2.9 图形觉:
机体感觉并辨别几何线条和几何符号等反映事物各类特征和变化规律的能力。运用手指的图形觉可以感知随着脉搏搏动管壁外是否存在着皱起或塌陷、脉象特征的空间形态等,可用不同空间形态的物体进行训练。
2.10 精细感觉:
能辨别物体形状和性质,以及两点之间距离的感觉等。用于脉诊过程中感受血液的流利度等,感觉各种运动物体的滑利程度。
2.11 复合感觉:
对感觉刺激的综合、分析、统一与判断的能力,因此又称为皮层感觉,包括定位觉、两点辨别觉、实体觉、重量觉、图形觉,用于脉象性质的多重信息评定。
2.12 重量识别觉:
机体具有能够辨别地心引力作用下物体所具有向下的力大小的能力。
2.13 质地识别觉:
分别将棉、毛、丝、橡皮等不同质地的物质放入手中,分辨其质地的能力。运用手指的质地识别觉可以感知血液及某些脉象特征的质地特性,如软、硬。可用气囊、液态、韧性、尖锐等物体进行训练。
2.14 速度觉:
是对物体运动的快慢程度进行分辨的感觉。运用手指的速度觉感知脉搏搏动在桡动脉管壁上的传导速度和血管中血液流动速度及变化,可用不同运动速度的物质或液体进行训练。
齐向华
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