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。(景岳八问。)
凡诊病必先问是何人,或男或女,或老或幼,或婢外家僮仆,问而不答,必是耳聋,须询其左右,平
素何如,否则病久,或汗下所致。诊妇人,必先问月信何如,寡妇气血凝涩,
两尺多滑,不可误以为胎,室女亦有之。
世道不古,以问为末,抱病不惟不言,虽再三询叩,终亦不告,反诋医拙,甚至有隐疾困医者,医固
为所困矣,身不亦为医所困乎。虽然为医者,亦须贵乎有学,大率诊视已
毕,不可便指病名,发言率易,须从所得脉象说起,广引经说,以为证据。渐渐说归病证,务要精当确实,
不可支离狂妄,说证已毕,然后徐徐问其所苦,或论说未尽,患者已一一详告,却以彼所说,校吾所诊,
或同或异,而折衷之。如此,则彼我之间,交相符契,必收全功。(汪石山。)
按医者当问之事甚多,必须诊得脉真,然后从脉上理路问去,方得就绪,若海概问之,庸有当乎,无
怪令人相轻也。《内经》曰∶明知逆顺,正行无问。又曰∶谨熟阴阳,无与众谋。是又有以问为戒者,盖
病家所答,往往根据违影响,未可尽信也。若不能明知与谨熟也,而徒以不问为高,虽告之
而反厌弃焉,忽视人命,其罪又当何如耶。
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。(景岳八问。)
询问病情时,首先要问是否有怕冷或发热的感觉,其次问出汗情况,再问头部和身体有无不适,接着问大小便是否正常,然后问饮食习惯,最后问胸部是否有胀闷疼痛等感觉。此外,耳聋和口渴的症状也应当仔细辨别。(这是张景岳提出的“八问”法。)
凡是诊断疾病,必须先询问患者是何种身份的人,是男是女,是老是幼,或者是婢女、外家亲戚、僮仆等。如果询问而不回答,必定是耳聋,需要向旁边的家属或仆人打听,了解其平素的情况,否则可能是因病日久,或者是因为误用发汗、攻下法所致。诊治妇女时,必须先询问月经情况如何。寡妇由于气血凝滞不畅,两尺脉(尺部脉象)多呈现滑象,不可误认为是怀孕;未婚少女也有可能出现这种情况。
世风不古,人们把问诊当作次要的事,生病的人不仅不说,即使再三询问叩击,最终也不告知,反而指责医生医术拙劣,甚至有隐藏隐疾困扰医生的,医生固然被困扰了,病人不也被医生所困扰吗?虽然如此,作为医生,也必须重视学问。大致在诊视结束后,不能立刻指出病名,说话轻率随意,必须从所得的脉象说起,广泛引用经典理论作为证据。逐渐引导到具体的病证上,务必精确恰当确实,不可支离破碎狂妄自大。说完证候之后,然后慢慢询问患者的痛苦所在,或者论述未尽之处,患者已经一一详细告知,再用患者所说的来核对我的诊断,或者相同或者不同,从而折衷判断。这样,医患之间就能相互契合,一定能取得完全的效果。(汪石山的话。)
按:医生应当询问的事情很多,必须诊得脉象真实无误,然后顺着脉理的逻辑去询问,才能安排妥当。如果像海(作者自指)那样一概而论地询问,难道合适吗?难怪会被人轻视。《黄帝内经》说:“明知逆顺,正行无问。”又说:“谨熟阴阳,无与众谋。”这又有以不问为戒的情况,大概因为病患的回答,往往与实际情况相差甚远,不可完全相信。如果不能做到明察逆顺和熟练阴阳,却徒然以不问为高明,即使告知了反而厌恶抛弃,忽视人命,这种罪过又该怎样呢?
First inquire about chills and fever, second about sweating, third about the head and body, fourth about urination and defecation, fifth about diet, sixth about the chest. Deafness and thirst in the seventh and eighth aspects must all be distinguished. (The Eight Questions of Jingyue.)
When diagnosing illness, one must first ask what kind of person the patient is: male or female, old or young, or whether they are a maid, a relative from the wife's family, or a servant. If they do not answer when asked, it is likely due to deafness; one must inquire with those around them regarding their usual condition. Otherwise, it may be due to long-standing illness or caused by improper use of diaphoresis (sweating method) or purgation (drastic evacuation method). When examining women, one must first ask about their menstrual flow. Widows often have stagnant and sluggish Qi and Blood, resulting in slippery pulses at both Chi positions (the distal pulse positions on both wrists); this should not be mistaken for pregnancy. Unmarried girls may also exhibit this condition.
The customs of the world are not as they were in ancient times; inquiry is treated as secondary. Those who are ill not only do not speak, but even after repeated questioning, they ultimately refuse to disclose information, instead blaming the physician for poor skills. Some even conceal sensitive ailments that trouble the physician; thus, the physician is indeed troubled, and is the patient not also troubled by the physician? Nevertheless, physicians must value learning. Generally, after completing the examination, one should not immediately state the disease name nor speak lightly and rashly. One must begin with the obtained pulse presentation, extensively citing classic theories as evidence. Gradually guide the discussion back to the specific syndrome, ensuring precision and accuracy, avoiding fragmented and arrogant statements. After discussing the syndrome, slowly ask about the patient's suffering. If the explanation is incomplete, the patient may provide detailed accounts. Then, compare what the patient says with one's own diagnosis; whether similar or different, arrive at a balanced conclusion. In this way, mutual understanding between doctor and patient will be achieved, and full therapeutic success will be attained. (Words of Wang Shishan.)
Note: There are many things a physician ought to inquire about. One must first obtain an accurate pulse diagnosis, then proceed with inquiries based on the logical path of the pulse findings to ensure orderliness. If one were to inquire indiscriminately as I (Hai) might, would it be appropriate? No wonder one is looked down upon by others. The *Neijing* (Inner Canon) states: "If you clearly understand reversal and normalcy, you can act correctly without needing to ask." It also states: "Be diligent in mastering Yin and Yang, and do not consult with the masses." This implies there are cases where inquiry is cautioned against, largely because patients' answers often deviate significantly from reality and cannot be fully trusted. If one fails to clearly understand reversal/normalcy and diligently master Yin/Yang, yet arrogantly considers not asking as superior, and even rejects advice while disregarding human life, what would be the magnitude of such sin?