The basic principles of TCM diagnosis
1. Overall inspection
(1) When collecting medical information, it is necessary to consider the whole situation and not only see the local pain.
(2) To conduct a comprehensive analysis and judgment of the disease, we should not only take care of one point and not the rest, and not only pay attention to the current, local and obvious pathological changes, but ignore the particularity of time, place, person and disease.
(3) Consider the causes and consequences of the disease, as well as the evolution and development trend of the disease.
2. 四诊合参
Pay equal attention to the four diagnoses, use all methods, and comprehensively collect disease data.
3. Combination of symptoms
The combination of illness and disease is the combination of "differentiation" and "dialectic". Disease is a generalization of the characteristics and laws of the whole process of the disease, and the conclusion of the location and nature of the disease in the current stage of the disease. Because of the difference in the focus of "disease" and "syndrome" on the nature of the disease, Chinese medicine emphasizes the combination of "disease discrimination" and "syndrome differentiation", so as to facilitate a comprehensive understanding of the nature of the disease.
Written in 1875 by Wang Hong of the Qing Dynasty, the author collected information from the Neijing, the Difficult Scripture, the Treatise on Typhoid Fever and Miscellaneous Diseases, and other works to summarize and organize this book. The content is rich, and the commentary is in accordance with the scriptures. The first volume describes the importance of visiting patients and the basic principles of their mastery and application, and clarifies the relationship between complexion and illness according to the theory of "what is inside must be outside", combined with factors such as body parts, four seasons, five directions, and temperament. The following volume lists the outline of the observation and diagnosis of various parts of the body surface, and discusses the special significance of the changes in sweat, blood, stool, drowning, phlegm, menstruation, etc. in the differentiation and treatment of certain diseases.
The Real Chinese Medicine "Ten Methods of Looking"
Xiao Wang asked again: "Teacher Xie, I am actually very interested in the 'Ten Methods of Looking', but I don't know much about the details of it. Can you explain to me in detail the principles and applications of these ten methods? ”
Teacher Xie nodded, smiled gently, closed the ancient book in his hand, and began to explain: "The 'Ten Methods of Looking' are divided into five groups: floating, sinking, clear, turbid, micro, even, scattered, ze, and xiao, which are used to judge the surface, inside, yin, yang, void, real, new, long, light, and heavy of the disease. This is one of the important methods of our TCM diagnosis, which helps us to observe the patient's complexion so as to judge the nature of the disease and the changes in the condition. ”
He began to explain the principles and applications of each method one by one.
Ups and downs are divided into the inside and outside
"The first is the ups and downs. The floating finger color is exposed, and the main disease is on the surface; Shen refers to a dull complexion, and the main illness is inside. This means that if the patient's complexion is light and noticeably red, then the problem may be on the surface. And if the complexion is dull, the disease may be hidden deep in the body. ”
Xiao Wang took notes seriously, nodding his head and acknowledging to continue.
Clear turbidity, don't yin and yang
"Next is to clear the turbidity and say goodbye to yin and yang. Qing refers to the clear color and the main disease is yang; Turbidity refers to the dark color, and the main disease is yin. That is to say, if the complexion is bright, the disease may be of a yang nature, and conversely, if the complexion is dull, it may be of a yin nature. ”
Xiao Wang's eyes flashed with excitement, and he continued to record.
There is a difference between the real and the small
And then there's the subtlety. Micro refers to the light color, the main disease is empty; It even refers to the dark color, and the main disease is real. This tells us that if the complexion is light, the patient may be debilitating, while the dark color may indicate a substantial problem. ”
Xiao Wang's note-taking speed is getting faster and faster, and he can't wait to learn more.
Scatter and measure for a long time
"The next step is to scatter and measure the proximity. Scattered refers to the color evacuation, the main new disease or long-term illness will be solved; It refers to the stagnation of color, and the gradual accumulation of long-term illness or new illness of the Lord. This is an indication of the progression of the disease, and we can understand the trend of the disease from the change in complexion. ”
Xiao Wang's brows furrowed slightly, as if he had some doubts about this method. He modestly asked, "Mr. Xie, what does this concept of loose and loose and 抟 mean?" ”
Teacher Xie smiled and explained, "Loose is a face that looks loose and cheerful, as if the disease is gradually dissipating. On the contrary, the complexion looks more restrained and cloudy, as if the disease is gradually accumulating. This is an important marker for us to observe changes in our condition. ”
Xiao Wang suddenly realized and continued to record.
Ze Yao decided life and death
"In the end, Ze Yao decided life and death. Ze refers to a radiant complexion with a good prognosis; It refers to a dull and withered complexion with a poor prognosis. This rule is related to the severity and prognosis of the disease, if the complexion is good, the condition may be better, and if the complexion looks poor, the prognosis may not be good. ”
Precautions for looking at color
Teacher Xie said, "Xiao Wang, we also have to pay attention to the precautions for looking. First of all, we need to understand the importance of color and pulse, and the combination of symptoms. Generally speaking, the patient's complexion corresponds to the pulse and symptoms. For example, when the patient's complexion is red, it is usually accompanied by symptoms such as high fever, sweating, thirst, red tongue, thick and dry moss, and the number of pulses. ”
Xiao Wang carefully wrote down, "The color, pulse, and symptoms correspond, and the condition is relatively simple." What if the color does not correspond to the pulse and the symptoms? ”
Teacher Xie nodded, "That's a very good question. When the condition is complicated, there may be a situation where the complexion does not correspond to the pulse and symptoms. At this time, we must make a comprehensive judgment in combination with other diagnostic methods to avoid misdiagnosis. For example, some patients may have red cheeks like makeup, but the whole body is manifested by symptoms of yang deficiency and coldness, such as chills, cold limbs, listlessness, clear and long urine, and loose stools. This situation is called the Dai Yang certificate of true cold and false heat, not the real heat certificate. ”
Xiao Wang asked suspiciously, "Teacher, why is there such a situation of real cold and false heat?" ”
"This is because the patient's internal cold symptoms mask the external heat. Although the complexion is ruddy, it is actually caused by the lack of yang energy in the body and the floating of the void yang. We should pay attention to these details when diagnosing to avoid misjudgment. ”
Xiao Wang nodded thoughtfully, "I see, I'll pay attention to this." ”
Teacher Xie continued, "In addition, we also need to pay attention to the influence of non-disease factors when we look at color. Man is an organic whole and is closely related to the natural world. Factors such as genetics, ethnicity, season, time of day, environment, alcohol consumption, and mood all have an impact on complexion. ”
Xiao Wang listened attentively, "Teacher, can you talk about these factors specifically?" ”
Teacher Xie smiled and nodded, "Of course you can." For example, genetics and race, people of different races will have natural differences in complexion; Seasons and seasons of the day can also affect complexion, for example, people may be paler in winter and rudder in summer. environment and drinking, people who have been in a polluted environment for a long time or who drink regularly may have abnormal complexions; Mood changes can also affect complexion, such as redness when angry and pale when fearful. ”
Xiao Wang nodded while recording, "These factors are indeed important, so how should we distinguish them when diagnosing them?" ”
Teacher Xie sighed, "This requires us to observe more and accumulate experience. When looking at the patient, we should combine the patient's medical history, pulse, symptoms, and other diagnostic methods to make a comprehensive analysis and judgment. Only in this way can the patient's condition be accurately diagnosed. ”