典藏书目

The methods for diagnosing diseases do not exceed the four examinations: Inspection (Wang), Auscultation and Olfaction (Wen), Inquiry (Wen), and Palpation (Qie), which are known as the "Four Examinations" (Si Zhen). These four characters are known to everyone, but if one truly masters their methods, there is no disease that cannot be cured.

However, the reason why many physicians make errors is that they can speak of them verbally, but cannot grasp them in their minds, nor can their hands respond accordingly. The subtleties within are difficult to fully explain, but for beginners learning diagnosis, if they can grasp the general principles, pay attention during clinical practice, and eventually become proficient through long-term experience, they will naturally achieve the ability to cure diseases with a touch.

The first is Inspection (Wang). Inspection refers to observing the complexion. The five facial orifices correspond to the Five Zang Organs: the eyes are the orifice of the Liver, the nose is the orifice of the Lung, the ears are the orifice of the Kidney, the mouth is the orifice of the Spleen, the Heart opens into the tongue, and additionally, the Heart寄 (resides) its orifice in the ears. If a disease is in a specific orifice, one can know which Zang Organ is affected. Furthermore, the five colors correspond to the Five Zang Organs: White belongs to the Lung, Red to the Heart, Black to the Kidney, Green/Blue to the Liver, and Yellow to the Spleen. The appearance of colors on the face allows one to infer the state of the Zang Organs. The entire face generally relates to the Yangming Channel; the left cheekbone corresponds to the Liver, and the right cheekbone to the Lung. If inappropriate colors appear, one can deduce which Zang Organ is being overcome by another according to the Five Elements. All these variations cannot be exhaustively described, but by applying the generation and overcoming cycles of the Five Elements (Wu Xing), one will naturally gain understanding. In ancient times, Bian Que saw the Duke of Qi and knew from one glance that his disease was in the skin and muscles (Cou Li); five days later, he knew it was in the blood vessels; five days after that, in the stomach and intestines; and five days after that, in the marrow. The significance of Inspection is indeed great! Although modern people dare not hope to become divine physicians like those of old, the qi and color manifesting on the face can certainly be observed and understood. Observing the tongue is particularly crucial. Since diseases reside in the Zang and Fu organs, unless a physician is a Lu Yi or Bian Que, how can they see inside? Among visible parts, besides urine and feces, the tongue is key. The tongue offers much to speculate upon. The thirty-six tongue presentations in *Shanghan Shejian* (Tongue Diagnosis in Cold Damage) must be mastered. *Zhangshi Yitong* expands this to one hundred and twenty tongue presentations, mostly distinguishing based on cracks in the coating, claiming precision, but in reality, this is often contrived and only confuses people. I believe the way to examine the tongue is to first check for the presence or absence of coating. A red tongue without coating indicates extreme Yin deficiency. Coating on the sides but none in the center, resembling a red groove, also indicates Yin deficiency. A thin trace of coating is normal for healthy individuals. Thick coating indicates stagnation in the Stomach; white indicates cold, yellow indicates heat, stiff/coated indicates stagnation not yet resolved, and rotten/fatty coating indicates stagnation gradually resolving. Coating like rice flour indicates severe stagnation; in the category of epidemic pathogens, even if white and dry, purgatives may be used. However, one must observe whether the coating is tight or loose; tight indicates excess, loose indicates deficiency, and tonification may reduce it. Scorched coating color is caused by heat. Full black coating represents extreme fire resembling water, requiring purgation. But one must examine if it is dry or moist; dry with prickles confirms severe heat; if black and moist, with no thirst or irritability, it indicates Fire failing to return to its source (Yin Deficiency leading to Floating Yang), requiring immediate use of Guizhi Tang (Cinnamon Twig Decoction) and Fuzi (Aconite Root) to restore Yang; slight use of cold herbs would be fatal. Thus, the focus of tongue inspection lies in the coating. The tongue is the sprout of the Heart, the Spleen channel connects to the root of the tongue, the Kidney channel flanks the root of the tongue, and the Liver channel winds around the root of the tongue. Redness at the root indicates Yin deficiency with internal heat; redness at the tip indicates Heart Fire; swelling, redness, or painful ulceration at the root indicates accumulated Heat in the Heart and Spleen; stiffness indicates Phlegm-Heat; curling indicates impending extinction of Liver Qi; inability to speak indicates failure of Kidney Qi. Most such conditions originate from the Zang organs, relying entirely on detailed inspection, making tongue observation truly essential.

The second is Auscultation and Olfaction (Wen). Diagnosing via hearing is less common, but still requires discrimination. External contraction diseases often present with loud, vigorous voices, while internal injury diseases present with weak, timid voices. Listen to breathing to judge if it is regular; listen to nasal respiration to judge if it is unobstructed. Disease odor in the bed curtains indicates deep pathogenic factors; absence indicates shallow pathogenic factors. Disordered speech suggests latent pathogens; clear speech suggests mere internal injury. Continuous groaning suggests unbearable pain; lethargy and reluctance to speak suggest exhaustion of both form and spirit. These are aspects of Auscultation that cannot be ignored.

The third is Inquiry (Wen), which must be especially meticulous. Ask about chills and fever; ask about sweating; ask about headache and body ache; ask about constipation; ask about stool consistency (dry, loose, or watery) and whether it is hot or foul-smelling upon expulsion; ask about urination frequency and volume; ask about urine color (white, yellow, or red) and whether it is hot, foul-smelling, clear, or turbid; ask about sleep quality at night; ask if drinking brings relief or causes vomiting when hungry; ask about chest and epigastric stuffiness; ask about abdominal pain. Pain with refusal to press indicates Excess; mild cases require digestion-promoting methods, severe cases require purgation. Pain relieved by pressure indicates Deficiency; warm unblocking or strong warming tonification is appropriate. Ask about dryness and thirst in the mouth; desire to drink; preference for hot or cold drinks. Thirst due to pathogenic heat必然 (necessarily) involves desire to drink. Thirst due to Yin deficiency with internal heat involves desire but unwillingness to swallow. Ask about sweating; does sweating reduce fever? Pathogens resolving via sweating leads to fever reduction after sweating; if not fully reduced, a second sweating may clear it. Fever due to Yin deficiency does not resolve with sweating; repeated sweating worsens the fever. These cannot be known without inquiry. Further necessary inquiries include asking about past chronic diseases, history of Liver Qi stagnation, or history of Blood disorders. Dispersing herbs are acrid-warm; excessive use may trigger Liver Qi issues. Digestion-promoting herbs are often aromatic-dry; excessive use may trigger hematemesis or hematochezia. If external pathogens remain while internal injuries increase, how should the physician act? Given the complexity of conditions, any chronic history must be clearly ascertained, and medication must account for it, providing early control. Knowing through inquiry is called skillful, is this not true?

The fourth is Palpation (Qie), the most important of the Four Examinations. Learners must carefully study the twenty-seven pulse types, memorize *Binhu Maijue* (Pulse Rhymes by Li Shizhen), and test themselves against various experts' discussions on symptoms and pulses. During clinical practice, maintain a calm mind and steady breath. First, place the middle finger on the Guan (Bar) pulse. The high bone behind the palm is the Guan position. Place fingers anterior and posterior to it, forming the Three Positions (San Bu): the anterior finger presses the Cun (Inch) position before Guan, and the posterior finger presses the Chi (Cubit) position after Guan. Perform superficial (Fu), moderate (Zhong), and deep (Chen) palpation for each position, totaling Nine Probes (Jiu Hou). Do not rigidly search for disease pulses using the twenty-seven types; rather, let the patient's natural pulse reveal itself. Generally, Fu, Chen, Chi, and Shu pulses are easy to understand; Hong, Wei, Xian, and Hua pulses are also comprehensible. Other pulse images are difficult for beginners, but with long-term proficiency and integration, understanding will come naturally. Although Master Zhang Zhongjing said, "The mind understands clearly, but the fingers find it hard to clarify," this precisely calls for careful comprehension. Otherwise, how can one diagnose without knowing pulses? Regarding which pulse governs which disease, some appear alone, some jointly, some three or four together. For example, Shanghan (Cold Damage) pulses are typically Fu and joint Jin (Tight); Shangfeng (Wind Strike) pulses are Fu and joint Huan (Lax); Wind-Cold transforming to Heat pulses are Fu and joint Shu (Rapid); Heat generating Phlegm pulses are Shu and joint Hua (Slippery). Liver disease pulses are typically Xian (Wiry); with Heat, they join Shu; invading the Stomach and generating Phlegm, they are Xian-Shu-Hua. All diseases can be inferred thus. Unique Da (Large), Xiao (Small), Shu (Rapid), or Xian (Wiry) pulses help locate the disease. Six Yang pulses indicate prior Yin deficiency; Six Yin pulses indicate prior Yang insufficiency. Medication requires further deliberation. Although diseases vary infinitely, they ultimately concern the Five Zang and Six Fu organs. If the Three Positions and Nine Probes are accurate, treatment according to the channels will naturally follow. My discussion covers only the basics, but learners entering here, with diligent study and verification, need not worry about not mastering the medical Dao.