四診—診察疾病的方法THEFOURDIAGNOSTICMETHODS

1、THE FOUR DIAGNOSTIC METHODS-THE METHODS TO OBSERVE AND DIAGNOSE DISEASES 四診 診察疾病的方法The four diagnostic methods, namelv inspection, auscultation and olfaction, inquiry, and pulse-taking and palpation, refer to the four basic proceduresused in diagnosing a disease, They are the presuppositions of corr

2、ect differentiation and effective treatment in TCM. 四診即 望、聞、問、切， 指 的是用于診斷疾病的四個(gè)基本步驟，它們是中醫(yī)正確辨證和有效治療的前提。When a disease occurs, there must be its abnormal outward manifestations from which the pathological changes may be inferred, as is stated in Danxis Experience on Medicin(e DanxiXin Fa) , To want kno

3、wing the internal conditions of the body, the external manifestations of the body should be observed ; to diagnose the external parts of the body may also know the internal conditions. That is becausethe internal conditions of the body are always reflected on the exterior of the body.The four diagno

4、stic methods examine and learn about the pathological conditions from different angle and aspect and find out the etiology and pathogenesis, thereby providing the basis for TDS. The four methods are related to and supplement one another. They cannot be separated from one another, each having its spe

5、cific function that cannot be substituted for the others. In clinical practice, only when the four techniques are organically combined can a disease beunderstood all-sidedly. Thus, a correct diagnosis can be made疾病發(fā)生時(shí)必有相關(guān)的病理改變引起的異常外在表現(xiàn)，正如丹溪心法所指出的： “欲知其內(nèi)者，當(dāng)以觀乎外，診于外者，斯以知其內(nèi)，蓋有諸內(nèi)者形諸外。 ”四診可以從不同角度 檢查和了解病理

6、狀態(tài)，找出病因和病機(jī)，從而為辨證論治提供基礎(chǔ)。四診相互聯(lián)系、相互補(bǔ)充， 不能相互分離，每一部分都有其特殊的功能，不可代替。在臨床實(shí)踐中，只有將四診有機(jī)聯(lián)系， 才能全面了解疾病。因此，才能做出正確的診斷。1. Inspection 1.望 Inspection is the first diagnostic procedure by which the physician may observe the patients vitality, complexion, physical build, head, neck, five senseorgans, skin, tongue, extern

7、al genitalia and anus on purpose so as to understand the condition of a disease. TCM holds that the human body is an organic whole. The exterior of the body is closely related to the internal organs. Take observation the vitality and complexion for examples, the vitality refers to the general extern

8、al manifestations of life activity of the human body, including spirit, consciousness and thinking. And it is the outward sign of the conditions of qi and blood, yin and yang, or the zang-fu organs. The vitality is manifested in manifold aspects, such as eyesight, complexion, facial expressions, phy

9、sical build, behavior and so on, amongwhich the expression of the eyes is the most important. This is becauseall the vital essencefrom the five zang and six fu organs convergesinto the eyes. From the observation of vitality the physician may infer the abundance or inadequacy of the vital essence, an

10、alyzemildness or the severeness of the disease and predict the prognosis of disease. It is quitveideent that the observation of vitality is of an important significance in diagnosing a disease.The manifestations of vitality are as follows; being of vitality, pseudo-vitality, and loss of vitality. 望診

11、是診斷的首要程序， 通過望診， 醫(yī)生可以有目的的觀察病人的神、色、體質(zhì)、頭、頸、五官、皮膚、舌頭、前后二陰，以了解疾 病的狀況。中醫(yī)認(rèn)為人體是一個(gè)有機(jī)整體，體表和內(nèi)臟是緊密聯(lián)系的。以觀察神色為例，神指的 是人體生命活動(dòng)的外在表現(xiàn)，包括精神和意識(shí)。它是氣血、陰陽(yáng)、臟腑狀態(tài)的外在征象。神體現(xiàn) 于多方面，如眼、面色、表情、體質(zhì)、行為等，這之中，眼神是最重要的。這是由于 “五臟之精上 注于目 ”。通過對(duì)神的觀察， 醫(yī)生可以了解正氣的充足與否， 分析疾病的嚴(yán)重程度和預(yù)測(cè)疾病的預(yù) 后。很明顯察神是診斷疾病的一個(gè)重要指征。神有如下表現(xiàn)：得神、假神和失神。The observation of complexi

12、on is a diagnostic method for inspecting the colour and lustre of the face. TCM divides the facial colours into blue, yellow, red, pale and black, also known as the five colours, whose changesmay indicates the nature and thelocation of a disease. Generally speaking, red complexion indicates heat syn

13、dromes; white complexion indicates cold and deficiency syndrome; yellow complexion deficiency and dampness syndromes; blue complexion suggests pain and cold syndrome,blood stasis and convulsion; and black complexion hints deficiency of the kidney, blood stasis and fluid retention. Inspection also in

14、cludes observation of the physical build. By the observation of sturdiness, weakness, obesity or emaciation as well as the posture of the movement and stillness, different kinds of diseasesmay he found out. And, in particular, the observation of the tongue is a unique procedure in TCM diagnosis. It

15、is used to observe the changes of the tongue proper and the tongue coating so as to determine the abundanceor decline of vital qi, tell the location of a disease, dist in guish the n ature of pathoge nic factors and infer the degree of serious ness of a disea察色是觀察 面部的顏色和光澤的一種診斷方法。中醫(yī)將面色分為青、黃、紅、白、黑，也稱

16、為 “五色 ”，面色 的改變可以提示疾病的性質(zhì)和部位?？偟膩?lái)說，色紅提示熱證；色白提示寒證和虛證；黃色提示 虛證和濕證；青色提示痛證、寒證、血瘀和痙證；黑色提示腎虛、血瘀和水液停滯。望還包括對(duì) 體質(zhì)的觀察。觀察體質(zhì)的強(qiáng)弱、肥瘦和動(dòng)靜姿勢(shì)可以發(fā)現(xiàn)不同的疾病。望舌是中醫(yī)獨(dú)特的診斷步 驟。通常用觀察舌質(zhì)和舌苔的改變來(lái)確定正氣的盛衰和疾病的部位，區(qū)分病邪的性質(zhì)，推斷疾病 的嚴(yán)重程度。2. Auscultation and Olfaction 2.聞 Another diagnostic method is auscultation and olfaction. Auscultation means l

17、istening to the patients voice, speaking, respiration, coughing and moaning. By auscultation, the doctor can not only learn about the changes of the phonatory organ, butalso infer the pathological changes of the internal organs. While olfaction meanssmelling the patients odor of the secretion and ex

18、cretion.By and large, stench odor usually indicates heat syndromes ofexcess; stinking (爛醉) odor suggests cold syndromes of deficiency; and foul and sour odor implies retention of food. 另外一種診斷方法是聽和嗅。聽意味著聽病人的聲音、言語(yǔ)、呼吸、咳嗽和呻吟。通過聽，醫(yī)生 不僅可以了解發(fā)音器官的變化，還可以推斷內(nèi)臟器官的病理改變。嗅指的濕聞病人分泌物和排泄 物的氣味。擴(kuò)展來(lái)說，臭氣通常提示實(shí)熱證；惡臭提示虛寒證；腐

19、味和酸味暗示食滯。3. Inquiry 3.問 This is a diagnostic method in which the patient or his companion are inquired to collect the information concerning a disease. The content of inquiry includes the chief complaints, present case history past history, life history, family history, as well as age, sex, native p

20、lace, occupation, address and so forth inquiry, though covering a wide range of topics, should be conducted step by step in a planned way, with questions focused on the chief complaint and the history of present disease. Therefore, when asking a patient. the physician should focus his attention on t

21、he chief complaint to understand both the main reasons for the disease and clearest, the most suffered symptoms of the patient. Besides, the physician should understand the occurrence, progress, diagnosis and treatment of a disease through ask ing. Here is an outli ne of inq uiri ng about the prese

22、nt ill ness這是一種向病人及其同伴詢問 和收集有關(guān)疾病信息的一種診斷方法。問的的內(nèi)容包括主訴、過去史、生活史、家庭史，以及年 齡、性別、出生地、職業(yè)、家庭住址等。雖然問的主題范圍很廣，但必須圍繞主訴和現(xiàn)病史有計(jì) 劃的一步步進(jìn)行。因此，醫(yī)生在詢問病人時(shí)應(yīng)注意病人的主訴以了解疾病的主要原因和病人最難 受的癥狀。除此之外，醫(yī)生還應(yīng)通過詢問了解疾病的發(fā)生、過程、診斷和治療。以下是現(xiàn)病史的詢問列表：A. Asking about Chills and Fever A.問寒熱(a). aversion to cold and heat (a)惡寒發(fā)熱 It means that the pati

23、ent feels cold with a high temperature.提示病人高熱時(shí)惡寒的感覺。(b) . Alternate spell of chills and feve( (b)寒熱交替 They are the manifestations of half exterior and half in terior see n in shaoya ng disease or malari它 是半表半里證的表現(xiàn)，見于少陽(yáng)病和瘧疾。(c) . Chills without fever (c)寒戰(zhàn)無(wú)熱 It implies that the patient only has an av

24、ersion to cold but no heat sen sati on or fever, which is a sig n of the deficie ncy and cold syn drom 它提示了病人只有惡寒 沒有熱感或發(fā)熱，這是虛寒證的征象。(d) Fever without chills (d)發(fā)熱無(wú)戰(zhàn) This suggests that the patient with fever has a aversion to heat but not to cold, which pertains to interior heat syndrome. 這提示了病人發(fā)熱惡熱而不

25、惡寒， 屬于里熱證。B. Asking about Perspiration B.問汗 This is a procedure for the physician to differentiate the conditions of interior and exterior, heat and cold, deficiency and excess of a disease. Asking about perspiration includes the presenceof sweating, the location of sweating, the time of sweating an

26、d the amou nt of sweat ing這是醫(yī)生區(qū)分疾病表里、寒熱、虛實(shí)的一個(gè)步驟。問汗包括出汗的部位、時(shí)間 和數(shù)量。C. Asking about Diet and Appetite C.問飲食 Asking diet and appetite may know the conditions of the splee n and stomach. It in cludes: thirst and drinking appetite and amount of food tast 問飲食可以了 解脾胃的狀況，包括：渴、飲、胃口和飯量。D. Asking about Defecati

27、on and Urination D.問二便 This is also a procedure in which thephysician may learn whether the digestion and absorption as well as fluid metabolism are normal or not, and also learn about frequency, time, amount, quality, color, odor of defecation and urination and accompa nied syn dromes這也是醫(yī)生了解消化吸收和水液

28、代謝是否正常的一個(gè)程序，可以了解糞便和尿液的次數(shù)、時(shí)間、數(shù)量、質(zhì)地、顏色、氣味和伴隨癥狀。E. Questioning about Pain E.問痛(a) Asking about nature of the pain helps tell the cause andpathogenesis(a)問疼痛的性質(zhì)可以幫助了解病因和病機(jī)(b) Asking about locality of the pain helpsun dersta nd pathological cha nges of in ternal organs and meridia n(;b) 問疼痛的部位可以幫助了解臟 腑經(jīng)絡(luò)

29、的病理改變。F. Questi oning ahout Sleep F可 睡眠 It refers to inq uiri ng about insomnia, dream in ess and lethargy to know excess and deficie ncy of yin and ya ng指的是詢問失眠、多夢(mèng)和昏睡以了解陰陽(yáng)的虛實(shí)。Besides, chest and abdome n, ears and eyes, wome ns diseasepediatric diseases may be askedfe 此之外，還可以詢問胸腹、眼耳、婦科和兒科疾病。4. Pulse

30、-taking and Palpation 4切. It is the fourth diagnostic methnd, including pulse-taking and, on the other, palpation of different parts of the body. The former is a diagnostic procedureby which the physician may feel the patients radial arteries with the finger-tips to judge pulse condition, thus learn

31、ing and inferring the condition of illness. The latter is also a procedure by which the physician may touch, feel, push and press certain parts of the body to detectlocal abnormal changes, thereby determining the location and n ature of the disease這是第四種診斷方法，包括切脈和按壓身體的其它部位。前者是 通過醫(yī)生的指尖感覺患者橈側(cè)腕部動(dòng)脈以判斷脈的狀

32、況的一個(gè)診斷步驟，從而了解和推斷疾病的 狀況。后者也是醫(yī)生通過觸摸、感覺、推和按身體的一定部位，檢查局部異常改變的一個(gè)步驟， 因此，可以確定疾病的部位和性質(zhì)。The location for feeling the pulse at present time is the patients cunkou, also namedqikou, or maikou. Cunkou refers to obvious pulsative place of the radial artery on both sides of the wrist, and is divided into three re

33、gions: cun, guan and chi ( inch, bar and cubit) , which, on the left hand, reflect respectively the conditions of the heart, liver and kidney and, on the right hand, the conditions of the lung, the spleen, the stomach andthe kidney. TCM holds that each of the six regions for pulse-feeling correspond

34、sto one of the internal organs and revealsthe pathologic changes of the relevant organ. For this reason, cunkou pulse-taking is commonly accepted by practitioners through the agesand still used today. The pulse is differentiated in terms of depth (superficial or deep) , speed ( rapid or slow) , stre

35、ngth ( forceful or weak) , shape ( thick or thready, soft or hard) and rhythm. Different pulse condition indicate different syndromes. For example, superficial pulse ( fu mai) , which is easily feltwith gentle touch, indicates exterior syndromes andis present at the early stage of exogenous diseases

36、; while deep puls(e chen mai), which is felt only by heavy pressure, indicates interior syndromes, and so on現(xiàn)今按脈的部位是病人的寸口”也叫 氣口”或 脈口”寸口指的是雙側(cè)腕部橈動(dòng)脈明顯搏動(dòng)的位置，可以分為三個(gè)區(qū)域：寸、關(guān)、尺，左手單獨(dú)反應(yīng)的是心、肝、腎的狀況，右手反應(yīng)的是 肺、脾胃和腎的狀況。中醫(yī)認(rèn)為切脈的每一個(gè)部位都與內(nèi)臟之一相對(duì)應(yīng)，可以揭示相關(guān)器官的病 理變化。因此，寸口取脈歷時(shí)沿用至今，受到 臨床醫(yī)師 的普遍承認(rèn)。脈應(yīng)區(qū)分其的沉浮、快慢、 強(qiáng)弱、形狀和節(jié)律。不同的脈象提示不同的證候。例如，浮脈輕按則得，提示表證和表證早期得 表現(xiàn)；而沉脈重按則得，提示里證，等。Palpati o