中医诊断学第一章

1、Interrogation,Qu hongda,conception,To know the onset ,development,treatment,present symptoms and other information of disease by questioning patient or accompanying people Internal classic Treatise on cold attack Thousand worthy prescriptions for emergence,purpose,To know the hobby , custom of patie

2、nt Onset development of disease Judge the cause and nature of disease Data from all diagnostic methods should be taken into comprehensive consideration in order to avoid mistake in diagnosis,Method of interrogation,Suitable environment Ask the patient directly Questioning method in emergency The doc

3、tor should be serious and patient, and be good at thinking and arousing patients,Content of interrogation,1.General data: name ,sex occupation,birth place,nationality, address, marriage state,24-solar terms of disease onset, visit data ,admission data Examples:hepatic echinococcosis(包虫病)(pastoral ar

4、ea), rheumatism(风湿病),postpartum disease(产后病) 2.Life style and process(Diet, mental activity,regular daily life),3. Family history and anamnesis 4.Chief complaint The symptoms the patient feels the most obvious and painfully and the main cause for visiting a doctor. symptoms + period,5.History of dis

5、ease 1)The cause of disease onsetcircumstance,time,symptoms,sudden or not,cause or predisposing cause , development and treatment 2)Present symptoms 明代医学家张景岳十问歌： 一问寒热二问汗，三问头身四问便， 五问饮食六问胸，七聋八渴俱当辨， 九问旧病十问因，再兼服药参机变， 妇女尤必问经期，迟速闭崩皆可见， 再添片语告儿科，天花麻疹全占验。,Cold and fever Aversion to cold Intolerance of cold A

6、. Chill and fever a.more chill than fever b.more fever than chill c.fever with aversion to cold,B.the chill and fever seprately a.fever without chill sthenic fever,tidal fever,low grade fever olerance of cold without fever C.Alternate chill and fever a.shaoyang syndrome b.malaria,sweating,The a

7、ction of yang puts on yin makes the sweating. No sweating wind-cold in the exterior yin insufficiency Sweating Normal sweating Abnormal sweating,Abnormality of sweating character,A.spontaneous sweating B.Night sweating C.profuse sweating heat or cold D.yellow sweating damp-heat E.fighting sweating F

8、.dying sweating,Abnormality on sweating location,A.hemihidrosis(半身汗) B.head sweating C.Chest sweating D.sweating in the palm and sole E.genital sweating,Pain,Mechanism of pain: Stagnation or stasis Innutrition of body Classification of pain A. Character of pain B. Location of Pain To distinguish: he

9、at cold excess deficiency,pain,Character of pain,Excess: sudden onset, severe and, incessant aggravated by pressing Causes: exogenous evils, qi stagnation,blood stasis, phlegm retention ,parasitosis or food retention Deficiency: occurs gradually , dull, paroxysmal, relieved by pressing,A. Distending

10、 pain-qi stagnation B. Stabbing pain-blood stasis C. Colic pain(绞痛)-solid evils obstruction D. Retraction pain(掣痛)malnutrition of tendons E. Scorching pain(灼痛)fire evils F. Cold pain-yang deficiency , cold attack G. Hollow paindeficiency of essence or blood H. Dull pain(钝痛)deficiency of pain,Locatio

11、n of pain,A. Headache excess deficiency Occiput radiating to nape -taiyang meridian forehead- yangming meridian bilateral sides -shaoyang meridian vertex - jueyin meridian,appendix,Dizziness or vertigo: No phlegm no vertigo No deficiency no vertigo Excess-phlegm dampness Deficiency - qi and blood, A

12、scendant hyperactivity of liver yang , kidney essence,B. General aching(pantalgia) wind-cold, wind-dampness pestilential toxin Insufficiency and disharmony of qi and blood C. Chest pain lungphlegm-dampness, heat, abscess, yin deficiency heartqi deficiency and blood stasis, qi stagnation,D. Hypochond

13、riac pain blazing of liver fire shaoyang syndrome blood stasis from sprain or falling down damp-heat suspending fluid retention,E. stomachache stomach cold or heat liver qi stagnation blood stasis spleen yang deficiency spleen yin deficiency,F. abdominal pain cold heat excess deficiency yangming fu

14、syndrome deficient cold of spleen blood stasis in lower jiao cold attack liver meridian parasitosis intestinal abcess,G. lumbago kidney yin or yang deficiency blood stasis cold attack H. Pain of limbs(joints) wind, heat ,cold ,dampness,4.Diet and taste in mouth(饮食与 口味),A. Thirst and drinking(口渴与引水)

15、B. Appetite and food intake(食欲与进食) C. Abnormal taste in mouth(异常口味),A. Thirst and drinking,a. No thirst(口不渴) b. Thirst with profuse drinking and urine(伴多汗) consumptive thirst disease lung stomach heat, kidney yin deficiency c. Thirst but little drinking(少饮) yin deficiencydamp-heatfluid-retention blo

16、od stasis,B.Appetite and food intake食欲与进食,To distinguish the yin or yang constitution of body a. Poor appetite(食欲差) spleen deficiency/dampness/qi stagnation/food injury/pregnancy b.over eating but still feeling hungry(多食易饥) stomach fire/strong stomach and weak spleen c.Hunger without appetite (饥不欲食)

17、 stomach yin deficiency,d.food addiction(偏嗜) parasitosis/pregnancy/ Symptoms relieved after food taking-deficiency Symptoms aggravated after food taking-excess (食后痛减,食后加重) Food drunk(食醉)-spleen deficiency To know the developing tendency of disease,C.Taste in the mouth,Morbid taste in the mouth(口味异常)

18、 Tastelessness(口淡) deficiency of spleen and stomach Sweet taste(口甜)-damp-heat in middle jiao Sour taste(口酸)heat accumulation in liver and stomach Bitter taste(口苦)gallbladder heat syndrome Salty taste(口咸)kidney disease,5.Defecation and urination二便,Defecation is related to large intestine/lung /spleen

19、/liver/kidney Urination is related to bladder/kidney/lung/liver To know the nature of disease and the funtion of viscera,A. defecation(大便),a.stool form(便形): dry stool and dark color-heat in large intestine extremely dry stoolblood or body fluid deficiency loose bowel-deficient cold in spleen hard st

20、ool first &loose then-dampness / deficiency alternate dry and loose-stagnation of liver qi undigested food in stool-kidney yang deficiency food retention/ damp-heat in large intestine,b.Frequency of defecation(大便次数) constipation(便秘): excessive heat /cold accumulation/ yin or qi blood deficiency diar

21、rhea(腹泻): spleen deficiency/declining of life gate / fire/food retention/damp-heat,c.color of stool(便色): dark yellow stagnated heat in intestine black- far blood red -near blood red and white-dampness in large intestine grayish white-jaundance of damp heat,d. feeling of defecation(便感) hot and burnin

22、g sensation-damp heat unsmooth defecation-liver qi stagnation tenesmus(里急后重)dampheat fecal incontinence(大便失禁)-deficiency of spleen and kidney,Urination(小便),Related to body fluid/lung/spleen/kidney 4-6 times a day 1500-2000 ml a day Reflect the condition of body fluid/viscera,Urination(小便),a.amount o

23、f urine( 尿量) Excessive urine(多尿): kidney yang deficiency consumptive thirst(消渴) kidney yin deficiency Scanty urine(少尿):heat /sweating/vomiting /Diarrhea / deficiency b. frequency of urination Frequent urination(尿频) kidney yang deficiency damp heat in lower jiao dysuria and anuria(癃闭): excess and def

24、iciency,c. color of urine(尿色) normal-light yellow and tranparent yellow-heat, dampheat(jaundice 黄疸) clear-deficiency cold red-collateral impairment Feeling of urination urethral pain(尿痛) enuresis(遗尿) dripping (淋沥不尽) incontinence(失禁),6.sleep,Normal -hiding of yang and flourish of yin (阳潜阴盛则寐) a. Inso

25、mnia(失眠) 1. Disharmony between the heart and kidney (心肾不交) 2. Deficiency of heart and spleen(心脾两虚) 3. Gallbladder stagnation and phlegm disturbing ( 胆郁痰扰) 4. Food retention(食积),b. Sleepiness(嗜睡) 1. damp-phlegm encumbering in spleen (痰湿困脾) 2.spleen qi deficiency (脾气虚)食醉 3.deficiency of heart and kidney 4. heat in pericardium(热入心包),7 . Women disease,A. menstruation( 月经) 5-7 12-2007.03.12 24-30 B.vaginal discharge(白带) C. pregnancy(怀孕) D.symptoms after delivery(产后症状),A. menstruation( 月经),a.Irregular menstruation(月经不调) preceded menstruation delayed menstruat