典藏书目

The *Classic of Medicine* (*Huangdi Neijing*) states: "Close the doors and windows, focus on the patient, inquire repeatedly about their condition, to follow their will." This is intended to allow the patient to remain quiet and undisturbed, so that one may calmly inquire about their history and gently accommodate their qi dynamics. By avoiding annoyance, one can fully understand the root causes and sequence of events, ensuring that treatment begins without error. However, in recent times, physicians have prided themselves on knowing pulse diagnosis, while patients wish to test their skills; thus, they remain silent and merely extend their hands for examination. Physicians are forced to guess. If a guess happens to be correct, it is believed to be miraculous; if incorrect, it is despised as foolish. This leads to mutual distrust and ultimate failure, which is truly lamentable. Therefore, Zhang Zhongjing said: "Observe the physicians of today: in examining illnesses and asking about diseases, they rely on fluent speech. In a brief moment, they prescribe decoctions. They palpate the cun position but not the chi position; they grasp the hand but not the foot. They do not compare the Renying (carotid) and Fuyang (dorsalis pedis) pulses with the three positions. The pulse beats rapidly, yet fewer than fifty beats occur per respiration. They make diagnostic decisions before prognostic signs have arrived; there is no impression from the nine palpation positions. They fail to inspect the Mingtang (nose), Que (glabella), and Ting (forehead). This is like looking at the sky through a tube." Inspection, Auscultation-Olfaction, Inquiry, and Palpation are like the four limbs of a person. If one limb is disabled, the person is incomplete; if one diagnostic method is missing, the physician is incomplete. However, the reason inspection comes first, followed by auscultation-olfaction, then inquiry, and finally palpation, is that the emphasis lies heavily beyond just palpation.

Wang Haizang stated: Patients sit with hands folded and silent, allowing only pulse taking to test if the doctor knows the truth. Heat manifests as a rapid pulse, cold as a slow pulse, excess as forceful, and deficiency as weak; these can be known via the pulse. But how can the cause of illness or specific injuries be known solely by the pulse? Many patients do not understand this principle and often conceal their ailments, waiting for the doctor to speak first. They do not realize that diseases may present with similar symptoms and identical pulses, yet have vastly different etiologies. Without prior clarification, suddenly palpating the Qikou (radial artery) pulse, how can accuracy be achieved? Furthermore, consider cases where status changes from noble to base, or poor to rich; sudden joy turning to sorrow, or initial joy leading to suffering; or regarding thoughts, likes, dislikes, desires, doubts, and fears. One must know what caused the initial injury, what was contracted, where it originated, and its location. Also, the daily progression of the disease and whether post-onset medications were appropriate or contraindicated must be detailed. Only then will pulse diagnosis be free of doubt. Nowadays, people are often biased in their views; contradicting them offends their feelings, while agreeing with them worsens their condition, leaving one helpless. Yet, if one asks sincerely and clearly explains that doing so leads to improvement while doing otherwise leads to deterioration, who would prefer death rather than submit their heart and comply? The manifestations of illness are countless. For instance, if a patient has intense thirst at the onset but a neutral mouth feel after a long time, treating all cases with standard methods without inquiry would surely harm them. If a patient previously had Pi Yue (Spleen Constriction, a condition involving constipation due to spleen dysfunction) but suddenly experiences frequent bowel movements upon falling ill, treating based on days elapsed without inquiry would surely harm them. If a patient had entrenched chronic diseases before and acquires new ailments now, adhering rigidly to established formulas without inquiry would surely harm them. In difficult and complex cases, if one probes deeply but fails to ascertain the truth, trivial chatter might reveal the real picture; acting rashly without careful inquiry would surely harm them. The *Chapter on Disease Forms* (*Bing Xing Pian*) states: "Inquiring about the illness and knowing its location is called being a skilled artisan (Gong)." Those today who claim to be artisans ask irrelevant questions and indulge in flattery; patients happily comply. When conditions worsen and doctors change, the same occurs. Many wander between medical treatments, ultimately unrecoverable. Therefore, those concerned with saving the world must guide patients gently to preserve benevolent arts. One cannot casually detach oneself from responsibility. I often see households of officials using heavy curtains when examining women in inner chambers, wrapping their hands in silk so that the doctor's three fingers cannot fully press the pulse. Doctors then examine carelessly. This fails to utilize the subtleties of inspection, auscultation-olfaction, and inquiry, and even loses precision in palpation. They treat doctors as if they were thieves. Can the words of Su Dongpo and Wang Haizang be understood by every household? I only hope patients prioritize their health, abandon old habits, and allow doctors to exert their full capabilities. May doctors conduct themselves according to the Dao, avoid vulgar conventions, and ensure patients honestly disclose their histories. Thus, no illness will hide, and doctors and patients will achieve mutual benefit.