“望而知之谓之神,闻而知之谓之圣,问而知之谓之工,切而知之谓之巧。”西医讲求四诊合参、辨证论治,四诊便是望闻问切。
说到西医的四诊,就不得不说起西医问诊《十问歌》即“一问寒热二问汗,三问头身四问便,五问饮食六胸腹,七聋八渴俱当辨,九问宿病十问因,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。”
tahenhaodizongjielexiyiwenzhendefangfa,tixingdafuyaojingyoujinchengzhouquandesizhenhecan,zonghexingdetingzhichanfazhenduan,zuichulaijiandingbingzheng。
gonggongjinxiuxiyiwenzhen《shiwenge》,kelinghuiyixiexiyiwenzhenchangshi,yehuiduijiuzhiqidaozhidianganhua。 一问寒热二问汗 问寒热 寒热是区分患者病邪性子和机体阴阳隆替的首要按照。 “wenhanre”zhikouwenhuanzheshibushiganshoupalenghuofashao。“han”kefenwei:
yufengjueleng,weizhiefeng;zifapaleng,duojiayibeihuojinhuoqunuanhehebunengjianhuan,weizhiehan;ruojiayibeihuojinhuoqunuanhehenengjianhuan,chengweiweihan。“re”baohantiwenjiangdi,huotiwenyibanerzifamanshen、bufenfashao。 xiyiyouanzhaohanrezhijiandeganxitingzhifenlei,yicixiangjinqufenjibing,huanzheyekeanzhaoyixiabiaoxiankankanbenshenshuyunayizhongbingzheng:
ehanfashao,zhiehanyufashaotongshichengxian;zhiganshoulengerbufashao,chengweidanhanbure;zhiganshoufashaoerbupaleng,zeweidanrebuhan;hanrelaiwang,zhiehanyufashaoguadaichengxian。 问汗 汗能反映人体阴阳和表里两方面变更,“问汗”首要诊察患者是不是出汗及部位、时候、几多等。 表证辨汗:
表证无汗多为外感风寒;表证有汗为表虚或表热证。 里证辨汗:
汗出不已,动则减轻者为自汗,这类人多为阳气虚损;睡时汗出,醒则汗止者为冷汗,多属阴虚内热;身大热而大汗出,多为里热炽盛;先恶寒颤栗,继而满身大汗者为战汗,多见于急性热病;汗身世热、焦躁不安、脉来短促,为邪盛正衰之危候。 部分辨汗:
头部出汗能够是因为阳热或干冷;额部出汗,脉微欲绝,为元阳团圆,虚阳浮越之危象;半身汗出者,无汗部位多为病侧,可因痰湿或风湿停滞,或营卫和睦,或中风偏枯;伯仲心多汗,多因脾胃干冷,或阴经郁热而至。 三问头身四问便 问头身 头痛有真假之分。头部胀痛、刺痛、牢固痛等多失实证;头部空痛、隐痛多属虚症。头晕亦分真假,实证大多由怒火、痰湿、瘀血而至,虚证多由气血亏虚或肾虚精亏而至。在呈现头痛、头晕病症时,总会有其余陪同病症,咱们能够经由进程陪同病症区分寒热真假。周身、四肢为十二经络循行的地方,气血之所荣,以是周身、四肢很是也反映了疾病的寒热真假。若自发身材困重乏力,伴见舌苔腻等湿滞之象,这大多是因为水湿泛溢而至;若身重疲惫,多为肢体筋络失于濡养而至。 问便 “二便为一身之流派”。大便的分泌与脾胃受纳运化、肾阳和煦、肝的疏泄、肺气肃降都有紧密亲密干系。小便的排挤,与肾的气化、脾的运化、肺的肃降和三焦通调有关。以是,“二便为一身之流派,不管外伤外感,皆当察此,以辨寒热真假。” linchuangwenerbian,shouyaokouwenerbiancishu、bianliang、xingzhuang、secai、qixihepaibianshihou、paibianshideganshouheyoubupeitongbingzheng,zheixiefangmiandebiangengtixinghuanzhedehanrezhenjiayanbian,ruguofaminghenshibixuyinfazhengshi。ruojianxiaobiansehuangchierqueshaozhe,duoshurezheng;niaosebaierqingfulao,duoshuhanzheng。bianmianhanrezhenjiakefenwei:
shirezhe,duofuzhangmanmen,tongerjuan,taihuangzaolie;shihanzhe,duofutongjuan,taibaishenleng,weihanxiegejueyangqi,fuqibutong。xiexieyiyouhanrezhenjiazhibie:
ganlengxiexie,kejianbaoxuanxiexie,dabianchouhui,futongchangming,lijihouzhong,gangmenchire;hanshixiexie,kejianxieruxishui,sedanhuangerweixingchou;shizhixiexie,kejiantuxiejiaozuo,tuwusuanchou,xiexiachouhui;pixuxiexie,kejianwangubuhua,bianxitangbo,tuoyanrijiu;zhurifuxiaoqianfutongxiexie,xiehouzean,duoweishenyangxuxiexie,youcheng“wugengxie”;gangmenqizhui,shenzetuogang,duoweizhongqixiaxian。 五问饮食六胸腹 问饮食 脾胃是人体最首要的器官之一,是气血生化之源。人体发展发育、保持性命的统统养分物资都要靠脾胃供应。一旦脾胃功效变态,人体安康、推陈出新、气血轮回等城市遭到严峻影响。 chideshao、xiaohuabuliangzhe,huoweipiweiqixu,huoweiwaishangshizhi,huoweishixiekunpi;pingchangqingyiyanshi、weibuzhangtong、aiqi、fansuanderen,duoweixiaohuabuliang;aihaochireshihuochiwanfanhouchangganshoubaozhangzhe,duoshipiweixuhan;yanshiqingdan、xiezhangoue,kejianyugandanganleng、hengnifanwei;xiaogushanjizhe,duoweiweihuochisheng,banyouduoyinduoniaozhe,kejianyuxiaokebing;jibuyushizhe,changweiweiyinquefaerzhi;shirujitu,qishijiaomeng,duoshuweizhongshihuoshangni;chaoshimutu,mushichaotu,duoyinpiweixuhan;tunyanhuise、xionggegengzuzhe,duoweiyegezheng。 问胸腹 胸即膻中,上连心肺,下通脏腑。与胸腹部相干的疾病良多,“问胸腹”首要区分脏腑病证,包含胸闷、心悸、胁胀、腹胀等。 xiongmenduoyuxinfeidengzangqiqijibuchang,huohanrezhenjiayouguan;xinjiduoshiyinweixinhuoxinshenfabaobingbianerzhi;xiezhangduoshiyinweigandanjiqijingmaifabaobingbian;fuzhangduoweiqijibuchang。 七聋八渴俱当辨 问听力 西医常会问患者:
“日常平凡有不耳鸣、听力降落等题目?” xiyiwenjijilu:
“ersuishaoyangzhijing,ershiweishenzangzhiguan,youweizongmaizhisuoju,wenzhifeiweikebianzhenjia,yiqiekezhisisheng。”ruohuanzheyoutinglishaoweixiaotui,huotingjuechidundengbingzheng,chengweizhongting;tinglijiaozhexiaotui,naizhitingjuewanzhengsunshi,chengweierlong;zifaerneiyouxiangsheng,chengweierming。erming、erlongzhe,youdeshiyinweishenxuyinfa,yeyounenggoushinuhuohuoganjingganlengerzhi,shenxuzheduobanyouyaoxisuanruan、yeniaopinqieqingzhang。 问口渴 患者救治时,西医常会问:
“日常平凡喝水环境怎样样?是不是常常感受口干口渴?” koukeshouyaoshiyinweitineijinyequefa,huojinyeshubuchengxianfangaierzhi。xiyiyiwei,“wenkeyubuke,nenggouchalizhengzhihanre,erzhenjiazhibianyicongyijian。”xiyiwenzhenshi,huizhuzhonghuanzheyoubukouke、yinshuijiduo、lengreaihaojiqiyubingzheng。 kouke,kejianyujinyeyishang、shuishineiting;henshikeyouaihaochilengyin,weireshengshangjin;keweijiyin,huoshuirujitu,kejianyutanyinshuishineitinghuoganlengneikun;koukedanyongshuishukouyoubuxiangyanxia,qiebanyouduoyinduoniaoderen,duodelexiaokebing。 九问宿病十问因 问宿病 “之前有近似环境吗?有家属史吗?有过敏的药物吗?”问宿病是取得患者疾病信息的首要体例,能够发明疾病的诱因、病发病程及家属史等。 dafuwensubing,yeshiweilekankanhuanzhebencijibingbingzhengshibushiyuzhiqiandejibinghuojiashushixianggan。ruguohuanzherichangpingfanshencaiqiangjian,debingduoshishizheng;ruoshencaishuairuozhedebing,duoshuxuzheng;richangpingfanyangxu、weihanpalengderendebing,duoweihanzheng;yinxuzhedebing,duoweirezheng。 问因 “问因”即大夫经由进程问诊,找到能够引发疾病的缘由,以便辨证施治、迷信用药。 zongdelaijiang,bingyinshuhan,duoweihanzheng,yizhiduoyongwenreleiyaowu;bingyinshure,duoweirezheng,yizhiduoyonghanliangleiyaowu。lingwai,fuyaojinchengzhong,ruohuanzheshencaichengxianbuliangfanying,yingshishiyudafuxiangtong,diaojiyongyao。 chuguanliwenzhenneirongwai,funvyingjiawenyuejing、daixia、huaitaihechanyudenghuanjing,yeyinglinghuixiaoerdanshengqianhoudehuanjing、fangbeijiezhonghuanjingheshibushihuanguomazhen、shuidoudengzhanbaobingjizhanbaobingdazhangshi。 xiyiwenzhenneirongfeichangfengshuo,benwenzhiluoliehukouzhonghanjiandeyiyu。ruguohukouzhongjiandaojiaoweipangzadehuanjing,rengshichangyidashiquzhengguibingyuanjiuzhi。