中医诊疗

问诊 (Interrogation)
明·张景岳《十问歌》 “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，九问旧病十问因， 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。 一、问寒热 恶寒 壮热 畏寒 潮热 五心烦热
1、恶寒发热 恶寒发热同时出现， 外感表证。 恶寒发热同时出现，为外感表证。 恶寒重发热轻，为外感风寒 恶寒重发热轻，为外感风寒 恶寒轻发热重，为外感风热 恶寒轻发热重，为外感风热 2、但寒不热 多为里寒 里寒证 久病畏寒多为阳气虚。 多为里寒证。久病畏寒多为阳气虚。 3、但热不寒 多属里热证 多属里热 里热证 4、寒热往来 恶寒发热交替发作， 恶寒发热交替发作，可见于少阳病和疟疾
4) Alternative attacks of chills and fever: fever: Chills alternate with fever, which is the reflection of the struggle between the vital qi and the pathogenic factor when pathogens are retained in the site between half exterior and half interior. It is found in malaria or shaoyang disease.
II. Sweating of interior syndrome: syndrome: ① Spontaneous perspiration: the patient perspiration: sweats in day time and sweats more when he is moving about. At the same time, he feels intolerance of coldness, weary, shortness of breath and unwilling to speak. This syndrome pertains to insufficiency of qi or yang. yang. ② Night sweat: the patient sweats when he falls sweat: asleep but his sweating stops when he wakes up. Due to deficiency of yin, night sweat is usually yin, accompanied with hectic fever, flushing cheek and dysphoria with feverish sensation in the chest, soles and palms.
3. Pains
The nature of pain: Severe pain with a short course pertains to excess syndrome; dull pain which has lingered for a long time is due to deficiency syndrome; pain that can be alleviated by pressing pertains to deficiency syndrome; pain aggravated by pressing, to excess syndrome; distending and unfixed pain is due to stagnation of qi; stabbing and fixed pain indicates blood stasis; pain with a feeling of coldness pertains to cold syndrome; pain with a feverish sensation, to heat syndrome.
闻诊
(Auscultation and Olfaction) 一、听声音 原则：响亮、高亢的声音 原则：响亮、高亢的声音 ——多为实证、 ——多为实证、热证 多为实证 低微、无力的声音 低微、无力的声音 ——多为虚证、 ——多为虚证、寒证 多为虚证 二、嗅气味 原则：气味臭秽 气味重者属热 臭秽、 原则：气味臭秽、气味重者属热证 气味轻 腥气者属 者属虚 气味轻，有腥气者属虚，属寒
三、问疼痛 1、疼痛的部位 2、疼痛的性质： 疼痛的性质： 新病剧痛属实 久痛时缓属虚 新病剧痛属实；久痛时缓属虚； 拒按属实 喜按（隐痛） 拒按属实；喜按（隐痛）属虚； 胀痛，痛处走窜者， 气滞； 胀痛，痛处走窜者，为气滞； 刺痛，痛处固定者为血瘀 重痛为湿邪 血瘀； 湿邪盛 刺痛，痛处固定者为血瘀；重痛为湿邪盛 冷痛属寒 灼痛属热 冷痛属寒；灼痛属热。 四、问饮食口味 1、食欲与食量 食少纳呆者，为脾胃虚弱；伴胸脘痞闷、 食少纳呆者，为脾胃虚弱；伴胸脘痞闷、苔腻
Interrogation 1 Cold and Heat * Aversion to cold : the patient can not endure cold and his aversion can not be relieved by warmth. This is often found in exterior-syndrome. exterior* Intolerance of cold : the patient can not stand cold, but this can be relieved by warmth. * Fever: What TCM means by “fever” is that the Fever: patient’s temperature is really higher than normal, or that he feels feverish but his temperature is normal normal.
2 Abnormal perspiration Anhidrosis: Anhidrosis: Anhidrosis of exterior syndrome accompanied with severe aversion to cold, fever comparatively less severe, floating and tight pulse pertains to exterior syndrome due to pathogenic cold. Hidrosis: Hidrosis: I. Sweating of exterior syndrome : if accompanied with higher fever, slight aversion to coldness, sore throat, floating and rapid pulse , it is regarded as exterior heat syndrome, caused by exopathic heat. syndrome,
二、问汗 1、辨有汗、无汗 辨有汗、 表证无汗，多为表寒证 表实证） 表寒证( 表证无汗，多为表寒证(表实证）； 表证有汗， 表热证或表虚证 证或表虚 表证有汗，为表热证或表虚证 大汗，伴壮热口渴为里实热 里实热证 大汗，伴壮热口渴为里实热证； 伴脉微肢冷、神疲为阳虚气脱 伴脉微肢冷、神疲为阳虚气脱 2、辨汗出时间 汗出不已，动则加重者， 汗出不已，动则加重者， 为自汗，多为气虚 阳虚； 气虚、 为自汗，多为气虚、阳虚； 睡时汗出， 睡时汗出，醒则汗止者 阴虚。 为盗汗，多属阴虚 为盗汗，多属阴虚。
中医的诊疗过程与其说是技术操作，毋宁说 是艺术创作。中医诊疗的过程观察周全，灵 活善变。看似随心所欲，实则终不逾距，为 医理所涵，有法可循。 与西医之看重形态变化，看重化验指标数据 相对， 中医学临床重视功能的失调，重视病 人的主观感受。如前所述之“脏躁证”,“梅核气” 闻、问、切三诊也无一不体现出此特点。
为湿困脾胃；厌油，胁胀呕恶，为肝胆湿热； 湿困脾胃；厌油，胁胀呕恶， 肝胆湿热； 胃火炽盛或消渴病 消谷善饥者，多为胃火炽盛或消渴病； 消谷善饥者，多为胃火炽盛或消渴病； 饥不欲食者为胃阴不足 饥不欲食者为胃阴不足 2、口渴与饮水 热盛伤津； 渴喜冷饮为热盛伤津 渴喜冷饮为热盛伤津； 喜热饮为寒湿内停 口淡不渴多为寒 寒湿内停； 喜热饮为寒湿内停；口淡不渴多为寒证； 多饮多尿者，为消渴病。 多饮多尿者，为消渴病。 3、口味 胃火或 口苦为胃火 肝胆湿热； 口苦为胃火或肝胆湿热； 口淡为脾虚湿停 脾虚湿停； 口淡为脾虚湿停； 脾胃湿热； 口甜多为脾胃湿热 口咸多为肾虚 口甜多为脾胃湿热；口咸多为肾虚
4. Abnormal diet The amount of diet is directly connected with the functions of the spleen and the stomach. 1) No thirst: it shows that the patient’s body fluid hasn’t been consumed. It is often seen in cold syndrome, damp syndrome. 2) Thirst and polydipsia: the patient always feels thirsty and drinks plenty of water, which is a sign that the patient’s body fluid has been consumed. Extreme thirst with plenty of urine, polyphagia and emaciation is seen in xiao ke (including diabetes and others) 3)Poor appetite: If this occurs with fatigue , emaciation, abdominal distention and loose stool, pale tongue and weak pulse, it is due to insufficiency of qi in the spleen and stomach