Choose the appropriate letters A-H.Which TWO factors ar

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案例分析题

The examination of the pulse is a subtle skill in Traditional Chinese Medicine (TCM); however it provides a comprehensive diagnosis of the condition of practically the entire human body, from the more obvious heart rate to the condition of each internal organ. It is estimated that a pulse reading traditionally accounts for up to 30% of a TCM diagnosis, which is quite surprising to many Westerners. Although many Westerners may have heard of other diagnostic methods like inspecting (general physical observations of the patient), listening (breathing, coughing, voice quality) and inquiring (current symptoms and past medical history), pulse reading as a tool to determine physical condition is not common knowledge. It is therefore worth taking a closer look at how illnesses are identified using this ancient medical skill which dates back more than 2000 years.

The reason such a small area on the wrist can give a traditional Chinese medical practitioner such a thorough indication of a person's well-being is the fact that each wrist is divided into 9 regions along the radial artery. There are 3 positions on the wrist which are used for analysis: the front, middle and rear positions, and analysed at 3 different levels: superficial, middle and deep.

On the left wrist, the front position focuses on the condition of the heart and small intestine, the middle position concentrates on the functions of the liver and gall bladder, and the rear position indicates the status of the kidney and bladder. The lungs and large intestine are the centre of attention in the front position on the right wrist, with the middle position focusing on the spleen and stomach and the rear position taking note of the 'Gate of Vitality Fire'. This is the body's motivating force and provider of heat for all bodily functions.

In regards to the various levels, the superficial level reflects the state of Qi (energy) as well as the health of the Yang organs (small/large intestine, gal1 bladder, stomach and bladder), the middle level shows the state of blood flow, and the deep level is an indication of the state of the Yin organs (the heart, liver, lungs, spleen, and kidneys).

Supposing that the pulse in the left middle position was soft and smooth, neither superficial nor deep, it would suggest that the liver and gall bladder are in a good state of health. However if the patient's pulse feels harder or tighter than normal and is more superficial and pounding, it may result in his/her suffering from a headache or migraine as the excessive liver fire rises up through the gall bladder channel to the head.

Diagnosing patients through pulse examination is actually much more complicated, due to the fact that practitioners need to be able to identify 26 different pulse categories. Some of these categories are more significant for practitioners in the modern day setting than others. For example, today Chinese doctors hopefully would rarely come across a scattered pulse which is irregular and hardly perceptible, a sign that a patient is critically ill and nearing death. Other pulse categories which suggest extreme illness include the intermittent, swift, hollow, faint, surging and hidden pulse. More commonly observed pulse categories include the rapid pulse, which increases in frequency (more than 90 beats per minute) and may be indicative of a fever, or the tense pulse, which feels like a stretched cord, and may suggest that the patient has a cold or is suffering from pain. Many pulses only have subtle differences or are the combination of several pulses; thus, pulse examination is often seen as being more than just a skill but an actual art form.

This kind of medical diagnosis can be affected by a number of factors, so before any examination, it is important that patients are in a relaxed physical and mental state so they can get the most accurate reading. The morning is often the best time to take such a reading, as a busy day in the office or vigorous exercise before seeing the doctor can influence the quality of the pulse. Secondly, both the patient's and the doctor's arm, hand, wrist and fingers must be relaxed and in the correct position. Thirdly, the right amount of pressure must be applied by the doctor for the right duration of time in order to be effective. Even seasonal influences need to be taken into account. In the spring, the pulse tends to be slightly taut; in summer, it is slightly fuller and surging. The autumn pulse is somewhat floating, fine and soft while the winter pulse is rather sinking and slippery or hard. Patients' characteristics are also of importance. Children, for instance, have quick pulses, athletes have slower than usual ones, and obese people have deeper ones. Women have stronger right pulses than their left, as opposed to men where the opposite is true. Finally drug use, either pharmaceuticals or narcotics, can have an influence on a patient's pulse.

The basic form of a patient's pulse will be able to tell a doctor whether the function being observed is at the body's surface or interior, whether it is hot or cold in nature, and whether an excess or deficiency in that particular function exists. It ought to be remembered that pulse examination does not replace other types of medical diagnosis, which also play an integral role in the overall prognosis of the patient.

Choose the appropriate letters A-H.
Which TWO factors are NOT mentioned as possibly influencing the accuracy of a pulse reading?
A.Physical examination
B.Time of day
C.Work
D.Position of upper limbs
E.Amount of force used
F.Climate
G.Illegal substances
H.Chemists

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