Diagnosis and Techniques of Traditional Chinese Medicine
Novice, hesitant to ask. Zhou Lao once said that when traditional Chinese medicine is first introduced, people often ask questions, for fear of inadequate questions, missing important clues, and even wrong diagnosis and treatment.
This is due to the fledgling first time, “I have a heart diagnosis for my pulse diagnosis, but it is difficult to understand under my fingertips”. Looking at it, I have no experience accumulation in the second diagnosis.”Only reliable and detailed consultations, or even all aspects, can be used to understand the condition. This is a last resort. It is a common problem of novice Chinese medicine practitioners.
Judging from the currently used textbook “Traditional Chinese Medicine Diagnostics” in the planning of higher education institutions in the new century, the consultation is also listed as the first chapter of the book, and it is the first of the four consultations. It seems that the rise of the consultation has gradually becomeConsensus in the current TCM community.
As everyone knows, the same disease, the patient’s physique and tolerance are different, the patient’s feelings are different, and the description of the same symptom will inevitably be different; in addition, the patient’s occupation, education level and language expression ability are different, and the same illness expressionIt’s not the same; not to mention whether the clinical data provided by the patient is completely reliable and whether the “water” is eliminated.
Therefore, in the TCM diagnosis method, whether to ask the question as the first of the four consultations, it is necessary to explore incrementally.
According to Zhou Lao’s personal experience, through the continuous accumulation of clinical evidence experience, when the kung fu reaches a certain level, you can gradually discover the situation of observation, which is one of the important skills in the diagnosis of traditional Chinese medicine.
It is one of the important signs that the traditional Chinese medicine practice of maturity and maturity is becoming more and more mature.
Zhou Lao once said that the severity of the patient’s illness, the coldness and heat of the disease, and the fact that the patient’s surface is above and below the surface, experienced Chinese medicine practitioners often look at it in the past.
The patient’s words may not be true, but the patient’s look is often difficult to falsify.
Therefore, Director Zhou Lao: “The ancients were‘ the gods who knew what they knew, ‘and it ‘s really meaningful to put the doctor in the first four consultations.
“Modern science also confirms that 90% of the information obtained by humans is obtained visually, so it is inevitable that the clinic will collect patient identification information.
Aiming at the sages, looking at the color of Qihou, Zhong Jing broke Zhongxuan’s forty and frowned, which made people wonder at the magic of the traditional Chinese medicine.
“Nei Jing” has “a person with a face like a lacquered wood, the heart dies first”, which is a terminal illness; “Four Clinics Clinic” once said: “Ten fingers are like a pestle, the lungs are sick”;”Fire”, “fat people have more strokes, thin people have more coughs”, etc., all are known at a glance. The question is whether the doctor can pay attention to it everywhere.Improvement?
This is true of Chinese medicine as well as Western medicine.
For example, patients with uremia have pale faces, heart failure, cyanosis in the lips of patients with hypoxia, mauve in the mitral valve suture of rheumatic heart disease, spider moles in liver cirrhosis, palm of the liver, dark face, and hyperthyroidism, myxedema, typhoid fever, systemicPatients with lupus erythematosus and others have special symptoms, which is also known at a glance.
“God knows God”, through the information exchange between the deep-hearted doctor and the patient, in addition to language, but also requires spiritual communication, so the first priority is to see God in the clinic.
Although the diagnosis is full body, partial, tongue, fecal matter, fingerprints, etc., whether you can see at a glance, the key is that the doctor must have sharp eyes and “know the god with God” and be good at capturing patients.Eyes, straight through physiology, capture the first impression.
Especially for patients with human diseases, functional diseases and sub-health status.
The expression “to understand the gods” is seen in Shi Shoutang of the Qing Dynasty, “Yiyuan · Wang Shen must check the spirit theory”, which reads: “The god who knows what he knows is called the god, and he will be able to use my god.God of the other.
The spirit of the lady lives in both eyes, and it is experienced by all the bodies, especially the one who observes the whole body . The spirit of people is revealed most intentionally or unintentionally.Together, the doctor and the sick are in a fascination, feeling suspicious and elusive.
This is based on the magic of God.
“Indicating that when the doctor sees the doctor, the moment the patient is not in contact (intentionally or unintentionally), when the patient is not paying attention (intentionally or unintentionally), he is calm and gazing at the eye, and looks directly at the patient’s eyes for a very short time, and through the window of the soul,Penetrate deep into the patient’s heart, so as to spy on and grasp the information of changes in the patient’s internal condition.
Therefore, the doctors are required to use God’s specificity, observe the Qiuhao clearly, and be good at using the God of oneself to inspect the God of others, to meet, communicate, and communicate with the patient’s consciousness with their own consciousness, so as to obtain the presence and weakness of the patient’s god,Deep sorrow, sorrow, innocence, and the true state of internal organs’ functional activities.
Because man is the spirit of all things, full of thoughts and feelings, when the patient finds that the doctor is looking at himself, he often shows restraint, improves cover, and affects the true condition of his god.
And if doctors are too intentional and make continuous observations, they are often prone to subjective ideas, which affects the observations and make it difficult for them to make correct judgments.
Therefore, the best time to look at God is when the doctor first comes into contact with the patient, when the patient has not yet noticed, is not restrained, and has no cover up, the energy displayed at this time is the most reliable activity in the heart.
Zhou Lao expert, this ability to “know in a while” and “go to the gods” is one of the important skills of TCM visits, which requires continuous training in clinical and daily practice to obtain them.
From the “Historical Records of Bian Tsang Cang Biography” Bian Tseng can “see a person in the same place, thus seeing the disease, seeing the five internal organs, especially in the name of the diagnosis of the pulse”, if we canWith insights into the continuous implantation of training, the uniform has developed to a level where it can “see the crux of the five internal organs”, and then it’s back to life. “Cheng Limin is in water and fire.” It is entirely possible to search for things without any effort.
The main point of the diagnosis method is “Yu Yang · Yin Yang Ying Xiang Da Lun”, which is called “Yin Yueyang”: “Good diagnosis, check the color and follow the pulse, don’t start with Yin and Yang.
“Jing Yue Quan Shu Chuan Zhong Lu” also said: “Every diagnosis and treatment of the disease must be examined first, Yin and Yang, is the program of medical ethics.
Yin and Yang are infallible, is there a poor cure?
Although the medical path is complicated, the one who can cover it in a single word is just yin and yang.
“Although the contents of the four clinics of Chinese medicine are numerous, only monology and tongue monographs are available, but to sum up, there is only the word” yin and yang “.
Therefore, the key to mastering the contents of the four consultations is to grasp the yin and yang, and to be good at the opposite of the patient’s disease performance, to grasp the yin and yang, the surface, the cold and the heat, the virtual reality, the specimen, etc. in the opposition, so as to provide the first-hand information for the traditional Chinese medicine syndrome differentiation.
The occurrence of any disease is actually a manifestation of the yin-yang disorder of the human body.”The patient’s disease is cold, hot, and the condition is debilitating and true. The patient’s position is on the surface, in the inside, or in the viscera, and the sickness; is the patient’s acute or chronic illness; is the critically ill patient internal or external?Waiting, it is completely different from the doctor’s visit alone. If you judge Xiaoliang, you only need to pay attention to it at a glance.
Hearing, asking, and cutting three clinics are the same.
Judging from the diagnosis, those who speak well are hot; on the contrary, those who are lazy are cold; those who are strong are true, those who are weak are false.
In terms of consultation, those who like to drink hot drink are cold stomach, those who like to drink cold drink have stomach heat; those who like to press the abdominal pain are deficient, and those who refuse to press are true.
The main surface of the floating pulse is the natural pulse of the Shenmai; the number of pulses is mainly hot, and the late pulse is naturally cold; the pulse is strong to be true, and weakness is naturally empty.
As a medical practitioner, you should be good at continuously improving your clinical observation ability from this kind of antagonism between yin and yang, and between different positive and negative comparisons. Seeing the micro knowledge and knowing the end of the fall, this is one of the important contents of practicing the basic skills of the four diagnosis of Chinese medicine.
For thousands of years, Chinese medicine has accumulated a wealth of experience in this area.
For example, from the perspective of inspections only, “Lingshu · Five Colors” states: “The five colors see each department, and check its ups and downs, to understand the depth; to check its ze, to see the success or failure; to check its dispersal, to know the distanceLook up and down to know the disease. ”
In the Qing Dynasty, Wang Hong combined with his clinical experience, in the “Diagnosis and Observation of the Scriptures” to further play the role of the surface to look up and down to identify the disease, observe the turbid and distinguish the yin and yang of the disease, the observation is very different from the true and the false.Depending on the length of the disease, and the prognosis of the prognosis of Beize, we all grasp the change of the condition from the opposition between yin and yang.
“Lingshu · Five Colors” also said: “Those who go from the outside to the inside will get sick from the outside, and those who go from the inside to the outside will get sick from the inside.
“It can be seen that the ancients were not only good at grasping the essentials of the four consultations from the opposition between yin and yang, but also paid particular attention to grasping the progress and retreat of the disease from the transformation of yin and yang, which deserves our high clinical attention.
Questions are focused, and traditional Chinese medicine consultations are supervised systematically, comprehensively and carefully. In fact, Zhou Lao thinks that it is not necessary to be as comprehensive as the “ten questions”.
Because each disease has its own etiology and pathogenesis evolution rules, so it has its own characteristics in clinical manifestations. These key points should be grasped, key questions asked, and every sentence can be asked on ideas.Conducive to the continuous improvement of the level of TCM diagnosis and treatment.
(1) Focusing on syndrome differentiation is a substitute for TCM treatment. Therefore, there are key questions to ask, and you should first ask around the syndrome.
If you think the patient has a fever syndrome, do you need to ask thirst?
Yellow urine or not?
Does the stool dry?
For further confirmation.
At the same time, it is necessary to further ask which dirty fiery fever is. For example, patients who are upset and irritable are mostly prone to liver fire, and those who have difficulty sleeping at night are mostly worried about heart fire, and those who are easy to survive and eat more often have a burning stomach.
(2) The main symptoms are closely related to the main symptoms of the patient at the time of consultation, and are also the main contradictions that we must first resolve at the time of clinical examination. Therefore, there is a key point. When the main symptoms are closely related, we cannot “off topic” or “off topic”.
Such as exogenous patients with high fever, we must ask if the cold is not cold, whether there is sweating, the time and characteristics of fever.
If the chills and fever appear at the same time, it indicates that the evil heat is on the surface; it indicates that the hot and hot is on the surface;The air is hot and hot; the body heat is high in the afternoon, and the delay is difficult to resolve. Those who are not hot are mostly hot, humid and steaming; the fever is diminished at night and night, which indicates that the evil heat is deep.
In addition, the accompanying symptoms of fever should be further examined, such as heat but no sweat, wind and cold attack, or both internal and external fever; although sweating, but sweating is not smooth, and the heat decreases with sweat,It belongs to damp heat prevention table; sweat sweats, and the heat does not decrease with sweat, it is rizhe; sweat comes out with trembling, for evil heat to dispel or righteousness; most thirsty drinkers belong to the heat in the heat;Those who are thirsty, dry, and dry, suggest heat and dysentery; those who do not want to drink are mostly damp, hot, and stagnation; abdominal fullness, pain, constipation, or scaling, suggesting dryness and internal knots; bleeding with consciousness or body surface,The blood is hot for the camp; seeing night sweats, redness, and hot hands, feet, and heart, indicating that the heat is really overcast.
If it is based on the main symptoms, it is necessary to ask the key points to distinguish different fevers, so as to provide a basis for dialectical medication.
(3) According to the development and pathogenesis of the pathogenesis, it is thought that the disease may have combined symptoms, and then there will be further in-depth investigations. If you can master the initiative, preemptive action. This is what Chow has figured out in many years of clinical practice.One of the important questioning techniques.
If you encounter a liver stagnation patient who is full of two threats, chest tightness, abdominal distension, and hi-breathing, you should think that the qi is more than fire, and qi stagnation can be turned into fire at any time. You should further ask whether the patient has both upset and irritability, dry mouth,Fiery manifestations such as constipation, yellowness, constipation, etc. It should be further thought that liver fire can easily induce liver wind. The liver wind can rise to the top and appear dizzy. You can also walk around the limbs, numbness, restraint, etc., so we have to further understand the patient.Is there a need for boss and limb symptoms?
At least, it should also be noted that patients with liver and fire may not only suffer from spleen and spleen, but also suffer from poor appetite and full stomach; they may also cause kidney yin injury, liver yang and wind, dizziness, or even stroke.
If so, ask a guide, the hole is slightly faint, you can distinguish the clues, then you have your own foresight.
Zhengyu Jiayan said: “People who have a single finger with a single finger will have a stroke within three years.” It can be seen that clinical evidence is good at asking questions and even predicting the occurrence of disease.
The pulse can not be light, nor can Xuan Zhou Lao believe that the diagnosis of the pulse can neither be deified, mysterious, or like some people think it is a radial artery.
Western medicine believes that patients with hyperthyroidism, fever, and severe anemia may have water flushing pulses, and strange pulses may appear during pericardial effusion or pericarditis, that is, the pulse is significantly weakened or disappeared during inhalation.
It shows that western medicine not only has the content of diagnosis, but also can be used to diagnose diseases.
The content of traditional Chinese medicine diagnosis is quite rich. After several years of development, it has become a relatively independent discipline. It can still effectively guide clinical practice to this day, and it should attract our great attention.
Clinically, all patients with strong pulse strings are usually phlegm and fire, which are more common in patients with hypertension and hyperlipidemia.
Patients must have arrhythmia at any time, and the so-called “Treatment on Febrile Diseases” said “heartbeat, pulse.”
Zangmai appears in fever patients. Western medicine is called relative slow pulse. It is one of the basis for diagnosing typhoid fever. Traditional Chinese medicine believes that dampness and heat are a problem and it is difficult to heal.
Since the pulse is dominated by the autonomic nerve and does not transfer with the will of the person, it is a true reflection of the objective situation in the human body and can directly serve the TCM dialectical medicine.
Zhou Lao had had a pulse diagnosis, and it was concluded that two menstrual periods had just passed 4?
The patient was pregnant for 5 days.One of them was amenorrhea, and menstruation only came once. It was confirmed by diagnosis alone that she was happy, and she finally gave birth to a boy.
This is what “Women’s Hands Shao Yin pulsate, which leads to the Son” as stated in “Su Wen · Ping Ren Meteorology”.
Zhou Lao realized that this kind of pregnancy slippery pulse is obvious. It is more common in women with strong constitutions, and the weak constitution is generally not obvious.
Gu Moumou, an academician of Southeast University, is very dirty, the diseased entity is deficient, and he has been in bed for a long time. It is not reasonable to have a strong pulse.
Zhou Lao believes that the patient’s prognosis is not good. Therefore, the patient will die soon, and in less than three months he will die.
The master died prematurely and was very sentimental, but it is also reasonable for TCM to break the disease based on the pulse.
The ancients not only highly recognized the diagnosis of the pulse, but also particularly sophisticated.
The first article of Treatise on Febrile Diseases: “The sun is sick, its pulses are floating, its head is very painful and it is cold.
“It is about the pulse first, then the disease, and the pulse comes first.
The transition throughout the entire chapter of “Golden Missing Essentials” is to “identify and cure certain disease symptoms and signs.” In “Qin Jin Yao Fang”, when identifying the internal organ diseases, the first part is placed with “pulse theory first”, which is not bad.The understanding of the ancient sages on the diagnosis of the pulse.
As far as floating veins are concerned, evil offenders are on the surface, and blood and blood rise to drive away evils, so the pulses float accordingly.
Therefore, there is a saying that “floating veins are positive for the disease of the Yang Table”, and “some points of the floating veins have a table of evidence”.
For example, if the patient has a headache and chills, it looks very similar to the evidence, but if the pulse does not float, it is difficult to say that it is a sun syndrome, let alone a simple sweating method.
On the contrary, if the patient has floating veins, it means that the body is full of blood and blood, so it ‘s exactly what the disease is, and do n’t care how long the disease is. First, you should consider the disease may be unexplained or other diseases caused by unexplained evil.
Treatment should be guided by the situation and drive out evil spirits.
For this reason, Zhou Lao mainly used the sweat method to treat nephritis and edema, acute diarrhea, jaundice hepatitis, bronchial discomfort, allergic rhinitis, rheumatoid arthritis, and acute measles.This experience has been written as a “flexible application of the Khan method”.
Of course, there are also times when the floating veins are not the main watch, but that is another problem.
For example, those with large pulses and emptiness, or those with insufficient feet, are often seen in Daiyang’s patients who suffer from false heat and false heat, which is naturally different from what we call “water drifting wood”.
The floating pulse is like this, the main pulse of Shen pulse, the main pulse is hot, the late pulse is cold, the pulse is strong and true, the weakness is weak, and so on.
Exogenous heavy tongue, heavy pulse examination of various diseases, tongue detection and pulse diagnosis are the most distinctive contents in the four diagnosis of traditional Chinese medicine. At the same time, they often interact with each other to determine the appearance of the disease, cold, heat, deficiency, reality, progress, retreat, good and bad,The prognosis is waiting, but Zhou Lao has realized from many years of clinical practice that in the case of exogenous acute diseases, the tongue test should be recognized especially; in the case of injuries and miscellaneous diseases, he should be aware of the diagnosis.
Exogenous sensation and epidemic qi, although the pulse also responds, but the changes in tongue quality and tongue coating are relatively early, more obvious, so it is a guideline for clinical significance.
In this regard, the warm pathologist has accumulated a wealth of experience for us.
With regard to the quality of the tongue, if the warmth is offended by the watch, only the tip of the tongue is red; if the hot evil enters the table and enters the air, the tongue is red; if the air enters the camp, the tongue is swollen; if the camp enters the blood,The tongue is deep.
If the tongue coating changes from white to yellow, from yellow to gray, and from gray to black, it means that the heat is light, the heat is heavy, and the heat pole is different.
In addition, you should pay attention to the tongue detection by warming the disease, one is to examine the cold temperature of the Qi, and the other is to check whether it is moist, so as to detect the glory and dryness of the fluid.
There are also those who suffer from yin injury and insufficient stomach yin, and their tongues are white and dry; those with insufficient kidney yin, their tongues are red and dry.
If the external sensation begins, the saliva on the tongue surface is thick and the tongue is cracked, and the tongue is red, and the genus is hot and new, it should be opened first and then the heat should be cleared.
Tongue coating can determine the treatment of current diseases, and tongue coating of miscellaneous diseases can sometimes only serve as a reference in the process of dialectical treatment.
Some kind of thirsty patients seeing greasy moss does not hinder the use of nourishing yin and moistening medicine, but when using it, pay attention to being light and avoid being too greasy, or add a little fragrant incense in the cleaning agent, Pelan, Bai Kou, Cangzhu, Chenpi, etc. to condition.
If you see a lot of greasy moss and apply Pinellia ternata in large quantities, Magnolia officinalis, grass fruit, grass cardamom and other bitter temperature and humidity will be inappropriate, and even worsen the disease.
The same is true of patients who are overworked and sick.
For internal injuries and miscellaneous diseases, especially those suffering from chronic illnesses and debilitating age, the significance of tongue and vein diagnosis and pulse diagnosis.
At the same time floating, middle, and Shen three waiting, Shen waiting is more important, and can better reflect the real situation inside the human body.
For example, a person who has been chronically ill has blushing, upset, thirsty and happy drinking, sweating, but his pulse is weak and weak.
Neither can it be used simply for treating yin deficiency, nor can it be used as an agent of bitter cold and purging fire, and the product of Ganwen Yiqi should be reused, so that qi and yin gradually recover, and gradually be cured.
If you don’t check the pulse, but see the yin deficiency and fire flourishing, you will use the nourishing yin and purging fire agent lightly.
Not only have no power, but have had it, but careless!