四诊—诊察疾病的方法THE FOUR DIAGNOSTIC METHODS

THE FOUR DIAGNOSTIC METHODS THE METHODS TO OBSERVE AND DIAGNOSE DISEASES 四诊四诊 诊察疾病的方法诊察疾病的方法 The four diagnostic methods namelv inspection auscultation and olfaction inquiry and pulse taking and palpation refer to the four basic procedures used in diagnosing a disease They are the presuppositions of correct differentiation and effective treatment in TCM 四诊即望 闻 问 切 指 的是用于诊断疾病的四个基本步骤 它们是中医正确辨证和有效治疗的前提 When a disease occurs there must be its abnormal outward manifestations from which the pathological changes may be inferred as is stated in Danxi s Experience on Medicine DanxiXin Fa To want knowing the internal conditions of the body the external manifestations of the body should be observed to diagnose the external parts of the body may also know the internal conditions That is because the internal conditions of the body are always reflected on the exterior of the body The four diagnostic methods examine and learn about the pathological conditions from different angle and aspect and find out the etiology and pathogenesis thereby providing the basis for TDS The four methods are related to and supplement one another They cannot be separated from one another each having its specific function that cannot be substituted for the others In clinical practice only when the four techniques are organically combined can a disease be understood all sidedly Thus a correct diagnosis can be made 疾病发生时必有相关的病理改变引起的异常外在表现 正如 丹溪心法 所指出的 欲知其内者 当以观乎外 诊于外者 斯以知其内 盖有诸内者形诸外 四诊可以 从不同角度检查和了解病理状态 找出病因和病机 从而为辨证论治提供基础 四诊相互联系 相互补充 不能相互分离 每一部分都有其特殊的功能 不可代替 在临床实践中 只有将四 诊有机联系 才能全面了解疾病 因此 才能做出正确的诊断 1 Inspection 1 望 Inspection is the first diagnostic procedure by which the physician may observe the patient s vitality complexion physical build head neck five sense organs skin tongue external genitalia and anus on purpose so as to understand the condition of a disease TCM holds that the human body is an organic whole The exterior of the body is closely related to the internal organs Take observation the vitality and complexion for examples the vitality refers to the general external manifestations of life activity of the human body including spirit consciousness and thinking And it is the outward sign of the conditions of qi and blood yin and yang or the zang fu organs The vitality is manifested in manifold aspects such as eyesight complexion facial expressions physical build behavior and so on among which the expression of the eyes is the most important This is because all the vital essence from the five zang and six fu organs converges into the eyes From the observation of vitality the physician may infer the abundance or inadequacy of the vital essence analyze mildness or the severeness of the disease and predict the prognosis of disease It is quite evident that the observation of vitality is of an important significance in diagnosing a disease The manifestations of vitality are as follows being of vitality pseudo vitality and loss of vitality 望诊是诊断的首要程序 通过望诊 医生可以有目的的观察病人的神 色 体质 头 颈 五官 皮肤 舌头 前后二阴 以了解 疾病的状况 中医认为人体是一个有机整体 体表和内脏是紧密联系的 以观察神色为例 神 指的是人体生命活动的外在表现 包括精神和意识 它是气血 阴阳 脏腑状态的外在征象 神体现于多方面 如眼 面色 表情 体质 行为等 这之中 眼神是最重要的 这是由于 五 脏之精上注于目 通过对神的观察 医生可以了解正气的充足与否 分析疾病的严重程度和预 测疾病的预后 很明显察神是诊断疾病的一个重要指征 神有如下表现 得神 假神和失神 The observation of complexion is a diagnostic method for inspecting the colour and lustre of the face TCM divides the facial colours into blue yellow red pale and black also known as the five colours whose changes may indicates the nature and the location of a disease Generally speaking red complexion indicates heat syndromes white complexion indicates cold and deficiency syndrome yellow complexion deficiency and dampness syndromes blue complexion suggests pain and cold syndrome blood stasis and convulsion and black complexion hints deficiency of the kidney blood stasis and fluid retention Inspection also includes observation of the physical build By the observation of sturdiness weakness obesity or emaciation as well as the posture of the movement and stillness different kinds of diseases may he found out And in particular the observation of the tongue is a unique procedure in TCM diagnosis It is used to observe the changes of the tongue proper and the tongue coating so as to determine the abundance or decline of vital qi tell the location of a disease distinguish the nature of pathogenic factors and infer the degree of seriousness of a disease 察色是观察 面部的颜色和光泽的一种诊断方法 中医将面色分为青 黄 红 白 黑 也称为 五色 面色 的改变可以提示疾病的性质和部位 总的来说 色红提示热证 色白提示寒证和虚证 黄色提 示虚证和湿证 青色提示痛证 寒证 血瘀和痉证 黑色提示肾虚 血瘀和水液停滞 望还包 括对体质的观察 观察体质的强弱 肥瘦和动静姿势可以发现不同的疾病 望舌是中医独特的 诊断步骤 通常用观察舌质和舌苔的改变来确定正气的盛衰和疾病的部位 区分病邪的性质 推断疾病的严重程度 2 Auscultation and Olfaction 2 闻 Another diagnostic method is auscultation and olfaction Auscultation means listening to the patient s voice speaking respiration coughing and moaning By auscultation the doctor can not only learn about the changes of the phonatory organ but also infer the pathological changes of the internal organs While olfaction means smelling the patient s odor of the secretion and excretion By and large stench odor usually indicates heat syndromes of excess stinking 烂醉 odor suggests cold syndromes of deficiency and foul and sour odor implies retention of food 另外一种诊断方法是听和嗅 听意味着听病人的声音 言语 呼吸 咳嗽和呻吟 通过 听 医生不仅可以了解发音器官的变化 还可以推断内脏器官的病理改变 嗅指的湿闻病人分 泌物和排泄物的气味 扩展来说 臭气通常提示实热证 恶臭提示虚寒证 腐味和酸味暗示食 滞 3 Inquiry 3 问 This is a diagnostic method in which the patient or his companion are inquired to collect the information concerning a disease The content of inquiry includes the chief complaints present case history past history life history family history as well as age sex native place occupation address and so forth inquiry though covering a wide range of topics should be conducted step by step in a planned way with questions focused on the chief complaint and the history of present disease Therefore when asking a patient the physician should focus his attention on the chief complaint to understand both the main reasons for the disease and clearest the most suffered symptoms of the patient Besides the physician should understand the occurrence progress diagnosis and treatment of a disease through asking Here is an outline of inquiring about the present illness 这是一种向病人及其同伴询问 和收集有关疾病信息的一种诊断方法 问的的内容包括主诉 过去史 生活史 家庭史 以及 年龄 性别 出生地 职业 家庭住址等 虽然问的主题范围很广 但必须围绕主诉和现病史 有计划的一步步进行 因此 医生在询问病人时应注意病人的主诉以了解疾病的主要原因和病 人最难受的症状 除此之外 医生还应通过询问了解疾病的发生 过程 诊断和治疗 以下是 现病史的询问列表 A Asking about Chills and Fever A 问寒热 a aversion to cold and heat a 恶寒发热 It means that the patient feels cold with a high temperature 它提示病人高热时恶 寒的感觉 b Alternate spell of chills and fever b 寒热交替 They are the manifestations of half exterior and half interior seen in shaoyang disease or malaria 它是半表半里证的表现 见于少阳病和 疟疾 c Chills without fever c 寒战无热 It implies that the patient only has an aversion to cold but no heat sensation or fever which is a sign of the deficiency and cold syndrome 它提示了病人只有 恶寒没有热感或发热 这是虚寒证的征象 d Fever without chills d 发热无战 This suggests that the patient with fever has a aversion to heat but not to cold which pertains to interior heat syndrome 这提示了病人发热恶热而不恶寒 属于里热证 B Asking about Perspiration B 问汗 This is a procedure for the physician to differentiate the conditions of interior and exterior heat and cold deficiency and excess of a disease Asking about perspiration includes the presence of sweating the location of sweating the time of sweating and the amount of sweating 这是医生区分疾病表里 寒热 虚实的一个步骤 问汗包括出汗的部位 时 间和数量 C Asking about Diet and Appetite C 问饮食 Asking diet and appetite may know the conditions of the spleen and stomach It includes thirst and drinking appetite and amount of food taste 问饮食可以了 解脾胃的状况 包括 渴 饮 胃口和饭量 D Asking about Defecation and Urination D 问二便 This is also a procedure in which the physician may learn whether the digestion and absorption as well as fluid metabolism are normal or not and also learn about frequency time amount quality color odor of defecation and urination and accompanied syndromes 这也是医生了解消化吸收和水液代谢是否正常的一个程序 可以了解粪 便和尿液的次数 时间 数量 质地 颜色 气味和伴随症状 E Questioning about Pain E 问痛 a Asking about nature of the pain helps tell the cause and pathogenesis a 问疼痛的性质可以帮助了解病因和病机 b Asking about locality of the pain helps understand pathological changes of internal organs and meridians b 问疼痛的部位可以帮助 了解脏腑经络的病理改变 F Questioning ahout Sleep F 问睡眠 It refers to inquiring about insomnia dreaminess and lethargy to know excess and deficiency of yin and yang 指的是询问失眠 多梦和昏睡以了解阴阳的虚实 Besides chest and abdomen ears and eyes women s diseases pediatric diseases may be asked 除此之外 还可以询问胸腹 眼耳 妇科和儿科疾病 4 Pulse taking and Palpation 4 切 It is the fourth diagnostic methnd including pulse taking and on the other palpation of different parts of the body The former is a diagnostic procedure by which the physician may feel the patient s radial arteries with the finger tips to judge pulse condition thus learning and inferring the condition of illness The latter is also a procedure by which the physician may touch feel push and press certain parts of the body to detect local abnormal changes thereby determining the location and nature of the disease 这是第四种诊断方法 包括切脉和按压身体的其它部位 前者是 通过医生的指尖感觉患者桡侧腕部动脉以判断脉的状况的一个诊断步骤 从而了解和推断疾病 的状况 后者也是医生通过触摸 感觉 推和按身体的一定部位 检查局部异常改变的一个步 骤 因此 可以确定疾病的部位和性质 The location for feeling the pulse at present time is the patient s cunkou also named qikou or maikou Cunkou refers to obvious pulsative place of the radial artery on both sides of the wrist and is divided into three regions cun guan and chi inch bar and cubit which on the left hand reflect respectively the conditions of the heart liver and kidney and on the right hand the conditions of the lung the spleen the stomach and the kidney TCM holds that each of the six regions for pulse feeling corresponds to one of the internal organs and reveals the pathologic changes of the relevant organ For this reason cunkou pulse taking is commonly accepted by practitioners through the ages and still used today The pulse is differentiated in terms of depth superficial or deep speed rapid or slow strength forceful or weak shape thick or thready soft or hard and rhythm Different pulse condition indicate different syndromes For example superficial pulse fu mai which is easily felt with gentle touch indicates exterior syndromes and is present at the early stage of exogenous diseases while deep pulse chen mai which is felt only by heavy pressure indicates interior syndromes and so on 现今按脉的部位是病人的 寸口 也叫 气口 或 脉口 寸口指的是双侧腕部桡动脉明显 搏动的位置 可以分为三个区域 寸 关 尺 左手单独反应的是心 肝 肾的状况 右手反 应的是肺 脾胃和肾的状况 中医认为切脉的每一个部位都与内脏之一相对应 可以揭示相关 器官的病理变化 因此 寸口取脉历时沿用至今 受到临床医师的普遍承认 脉应区分其的沉 浮 快慢 强弱 形状和节律 不同的脉象提示不同的证候 例如 浮脉轻按则得 提示表证 和表证早期得表现 而沉脉重按则得 提示里证 等