大便之利不利,关乎里之虚实也。闭者为实,若内外并无热证,则为阴结便闭也。通者为虚,若内外并
无寒证,则为阳实热利也。小便之红与白,主乎里之寒热也。红者为热,若平素浅红淡黄,则为阴虚也。
白者为寒,若平素白浑如米泔,则为湿热所化也。
一问寒热二问汗,
问其寒热多寡,以审阴阳,以辨真假。问其汗之有无,以辨风寒,以别虚实。
三问头身四问便,
问其头痛为邪甚,不痛为正虚。暴眩为风火与痰,渐眩为土虚气陷。问其身之部位,以审经络。亦以一
身重痛为邪甚,软弱为正虚。问其小便红白、多少,大便秘溏,清谷、清水以辨寒热虚实。
五问饮食六问胸,
问饮食以察其胃气之强弱。问胸者,该胃口而言也。浊气上干,则胸满痛为结,胸不痛而胀连心下
为痞气。
七聋八渴俱当辨,
问聋者,伤寒以辨其在少阳与厥阴,杂病以聋为重,不聋为轻也。问渴者,以寒热虚实俱有渴,大抵以
口中和,索水不欲饮者为寒;口中热,引饮不休者为热;大渴谵语,不大便者为实;时欲饮水,饮亦不多,二
便通利者为虚。
九问旧病十问因,
问旧病以知其有素病与否,问其致病之因,以为用药之准。
再将服药参机变。
表里寒热补泻之中,自有神机变化之妙。
妇人尤必问经期,迟速闭崩皆可见。
妇人以经为主,问其有无迟速,以探病情,兼察有孕与否。
再添短语告儿科,天花麻疹全占验。
小儿欲作痘疹,与外感同,宜辨其手中指、足胫、耳后筋色为据。
大便通畅与否,关系到体内(里)的虚证或实证。大便闭塞不通属于实证;如果内外都没有热象,则属于阴结导致的大便闭结。大便通畅泄利属于虚证;如果内外都没有寒象,则属于阳实热导致的泄利。小便颜色红或白,主要反映体内(里)的寒证或热证。小便发红属于热证;如果平时小便颜色浅红淡黄,则属于阴虚。小便发白属于寒证;如果平时小便浑浊如米泔水,则属于湿热转化所致。
第一问寒热,第二问汗出情况,
询问患者寒热的程度和多少,以审查阴阳盛衰,辨别病证的真假。询问是否有汗出,以辨别是风寒还是风热,区分虚证与实证。
第三问头身症状,第四问二便情况,
询问头痛是因为邪气盛,不痛则是正气虚弱。突然眩晕是由于风火与痰饮,逐渐眩晕则是脾土虚弱、中气下陷。询问身体疼痛的具体部位,以审查病变所在的经络。同样,全身沉重疼痛表示邪气盛,肢体软弱无力表示正气虚弱。询问小便的红白颜色、多少,以及大便秘结或溏泄、完谷不化、清水样便等,以辨别寒热虚实。
第五问饮食情况,第六问胸脘部感觉,
询问饮食情况以观察胃气的强弱。询问胸脘部不适,包括胃口区域。浊气上逆干扰,导致胸部满痛且为结聚之证;胸部不痛但胀满并牵连心下部位,则为痞气证。
第七问耳聋,第八问口渴,都应当仔细辨别,
询问耳聋,伤寒病中用以辨别病位在少阳经还是厥阴经,杂病中以耳聋为重证,不聋为轻证。询问口渴,因为寒热虚实都可能出现口渴,大致而言:口中感觉平和,想要喝水但不想喝的是寒证;口中感觉发热,饮水不止的是热证;极度口渴伴胡言乱语、大便秘结的是实证;时常想喝水,但喝得不多,大小便通畅的是虚证。
第九问既往病史,第十问致病原因,
询问旧病以了解患者是否有素来存在的疾病,询问致病的原因,作为用药的依据。
再结合服药后的反应参悟机变。
在表里、寒热、补泻的治疗原则中,自有神妙变化的机理。
对于妇女,尤其必须询问月经情况,经期推迟、提前、闭经或崩漏都能反映出病情。
妇女以月经为主,询问其有无及快慢,以探知病情,同时检查是否怀孕。
再加几句短语告知儿科医生,天花和麻疹的诊断全部包含在内。
小儿即将发作痘疹时,与外感病相似,应当以手中指、足胫部、耳后筋络的颜色作为诊断依据。
The patency or impaction of bowel movements relates to the deficiency or excess in the interior (Li). Impaction indicates an Excess pattern; if there are no heat signs internally or externally, it is Yin-Jie constipation (constipation due to Yin-cold accumulation). Frequent loose stools indicate a Deficiency pattern; if there are no cold signs internally or externally, it is Yang-Shi hot diarrhea (diarrhea due to internal heat and excess). The redness or whiteness of urine primarily reflects cold or heat in the interior. Red urine indicates Heat; if the urine is normally pale red and light yellow, it indicates Yin Deficiency. White urine indicates Cold; if the urine is turbid like rice washings, it is transformed by Damp-Heat.
First, inquire about Chills and Fever; second, about Sweating.
Inquire about the degree and frequency of chills and fever to examine Yin and Yang, and to distinguish between true and false patterns. Inquire about the presence or absence of sweating to differentiate between Wind-Cold and other pathogens, and to distinguish between Deficiency and Excess.
Third, inquire about Head and Body sensations; fourth, about Bowel and Urine movements.
Inquire about headache: it indicates severe pathogenic factors; absence of pain indicates righteous Qi deficiency. Sudden dizziness is caused by Wind-Fire and Phlegm; gradual dizziness is caused by Earth (Spleen) deficiency and Qi sinking. Inquire about the specific locations of body pain to examine the Meridians. Similarly, heavy and painful body indicates severe pathogens; weakness indicates righteous Qi deficiency. Inquire about the color (red/white) and volume of urine, and whether stool is constipated or loose, undigested food, or clear water, to differentiate Cold, Heat, Deficiency, and Excess.
Fifth, inquire about Diet; sixth, about the Chest.
Inquire about diet to observe the strength of Stomach Qi. Inquiry about the chest includes the epigastric region. When turbid Qi rises to interfere, fullness and pain in the chest indicate a Knotting (Jie) pattern; distension without pain extending to the heart area below indicates Pi-Qi (Stagnation) pattern.
Seventh, Deafness; Eighth, Thirst, both must be differentiated.
Inquiry about deafness: in Shanghan (Cold Damage), it distinguishes between Shaoyang and Jueyin meridians; in miscellaneous diseases, deafness is considered severe, while absence is mild. Inquiry about thirst: since thirst can occur in Cold, Heat, Deficiency, and Excess patterns generally, the rule is: normal mouth sensation with desire for water but refusal to drink indicates Cold; hot sensation in the mouth with incessant drinking indicates Heat; extreme thirst with delirium and constipation indicates Excess; occasional desire to drink, small amounts consumed, with free urination and defecation indicates Deficiency.
Ninth, Past Illnesses; Tenth, Etiology.
Inquire about past illnesses to know if there is a pre-existing condition; inquire about the cause of disease to serve as a guide for medication.
Furthermore, consider changes based on response to medication.
Within the principles of Exterior/Interior, Cold/Heat, Tonification/Drainage, there are miraculous variations of divine mechanism.
For women, menstruation must especially be inquired about; delays, accelerations, amenorrhea, and flooding all reveal the condition.
Women's health centers on menstruation; inquiring about its presence and timing helps probe the condition and check for pregnancy.
Add a few words for pediatrics: Smallpox and Measles diagnosis relies entirely on these inquiries.
When children are about to develop variola (smallpox) or rubeola (measles), similar to exterior syndromes, one should use the color of the tendons in the middle finger, lower legs, and behind the ears as evidence.