经曰∶“闭户塞牖,系之病者,数问其情,以从其意。”盖欲病患静而无扰,然后从容询其情,委
曲顺其气。使不厌烦,悉其本末之因,而治始无误也。乃近世医者,自附于知脉,而病家亦欲
试其本领,遂绝口不言,惟伸手就诊。医者强为揣摩,揣摩偶合,则信为神奇;揣摩不合,则薄
为愚昧。致两者相失,而讫无成功,良足叹也。故仲景曰∶“观今之医,省疾问病,务在口给。相
对斯须,便处汤药。按寸不及尺,握手不及足。人迎跗阳,三部不参。动数发息,不满五十。短期
未至决诊,九候曾无仿佛。明堂阙庭,尽不见察。所谓管窥而已。”望闻问切,犹人有四肢也。
一肢废不成其为人,一诊缺不成其为医。然必先望、次闻、次问而后切者,所重有甚于切也。
王海藏云∶病患拱默,惟令切脉,试其知否。夫热则脉数,寒则脉迟,实则有力,虚则无力,可以
脉知也。若得病之由及所伤之物。岂能以脉知乎?其如病家不知此理者众,往往秘其所患,
以俟医之先言。岂知病固有证似脉同,而所患大相剌谬。若不先言明白,猝持气口,其何能
中?又如其人或先贵后贱,或先贫后富,暴乐暴苦,始乐始苦,及所思、所喜、所恶、所欲、所疑、所
惧之云何,其始病所伤、所感、所起、所在之云何,以至病体日逐转移之情形,病后所服药饵
之违合,必详言之,则切脉自无疑惑。今人多偏执己见,逆之则拂其意,顺之则加其病,莫如
之何。然苟设诚致问,明告以如此则善,如彼则败,谁甘死亡而不降心以从耶!夫受病情形,
百端难尽。如初病口大渴,久病口中和,若不问而概以常法治之,宁不伤人乎?如未病素脾
约,才病忽便利,若不问而计日以施治,宁不伤人乎?如未病先有锢疾,已病重添新患,如不
问而概守成法治之,宁不伤人乎?如疑难证着意根究,遽不得情,他事闲言,反呈真面,若不
细问而仓卒妄投宁不伤人乎?《病形篇》谓∶“问其病,知其处,命曰工。”今之称为工者,问非
所问,谀佞其间,病者欣然乐从;及病增更医,亦复如是。 徨医药,终于不救者多矣。故留心
济世者,须委曲开导,以全仁术。未可任意而飘然事外也。予每见缙绅之家,凡诊内室,皆重
帷密幄,以帛缠手,使医者三指不能尽按,而医亦潦草诊视,此又不能行望、闻、问之神妙,并
切而且失之度,其视医不啻如盗贼然。东坡、海藏之言,岂能家喻而户说哉!惟愿病家以病
为重,不循故习,使医者得尽其长,医者以道自处,不蹈陋规,使病家诚告以故。庶病无遁形,
而医者之与病者有相成之功矣。
The *Classic of Medicine* (*Huangdi Neijing*) states: "Close the doors and windows, focus on the patient, inquire repeatedly about their condition, to follow their will." This is intended to allow the patient to remain quiet and undisturbed, so that one may calmly inquire about their history and gently accommodate their qi dynamics. By avoiding annoyance, one can fully understand the root causes and sequence of events, ensuring that treatment begins without error. However, in recent times, physicians have prided themselves on knowing pulse diagnosis, while patients wish to test their skills; thus, they remain silent and merely extend their hands for examination. Physicians are forced to guess. If a guess happens to be correct, it is believed to be miraculous; if incorrect, it is despised as foolish. This leads to mutual distrust and ultimate failure, which is truly lamentable. Therefore, Zhang Zhongjing said: "Observe the physicians of today: in examining illnesses and asking about diseases, they rely on fluent speech. In a brief moment, they prescribe decoctions. They palpate the cun position but not the chi position; they grasp the hand but not the foot. They do not compare the Renying (carotid) and Fuyang (dorsalis pedis) pulses with the three positions. The pulse beats rapidly, yet fewer than fifty beats occur per respiration. They make diagnostic decisions before prognostic signs have arrived; there is no impression from the nine palpation positions. They fail to inspect the Mingtang (nose), Que (glabella), and Ting (forehead). This is like looking at the sky through a tube." Inspection, Auscultation-Olfaction, Inquiry, and Palpation are like the four limbs of a person. If one limb is disabled, the person is incomplete; if one diagnostic method is missing, the physician is incomplete. However, the reason inspection comes first, followed by auscultation-olfaction, then inquiry, and finally palpation, is that the emphasis lies heavily beyond just palpation.
Wang Haizang stated: Patients sit with hands folded and silent, allowing only pulse taking to test if the doctor knows the truth. Heat manifests as a rapid pulse, cold as a slow pulse, excess as forceful, and deficiency as weak; these can be known via the pulse. But how can the cause of illness or specific injuries be known solely by the pulse? Many patients do not understand this principle and often conceal their ailments, waiting for the doctor to speak first. They do not realize that diseases may present with similar symptoms and identical pulses, yet have vastly different etiologies. Without prior clarification, suddenly palpating the Qikou (radial artery) pulse, how can accuracy be achieved? Furthermore, consider cases where status changes from noble to base, or poor to rich; sudden joy turning to sorrow, or initial joy leading to suffering; or regarding thoughts, likes, dislikes, desires, doubts, and fears. One must know what caused the initial injury, what was contracted, where it originated, and its location. Also, the daily progression of the disease and whether post-onset medications were appropriate or contraindicated must be detailed. Only then will pulse diagnosis be free of doubt. Nowadays, people are often biased in their views; contradicting them offends their feelings, while agreeing with them worsens their condition, leaving one helpless. Yet, if one asks sincerely and clearly explains that doing so leads to improvement while doing otherwise leads to deterioration, who would prefer death rather than submit their heart and comply? The manifestations of illness are countless. For instance, if a patient has intense thirst at the onset but a neutral mouth feel after a long time, treating all cases with standard methods without inquiry would surely harm them. If a patient previously had Pi Yue (Spleen Constriction, a condition involving constipation due to spleen dysfunction) but suddenly experiences frequent bowel movements upon falling ill, treating based on days elapsed without inquiry would surely harm them. If a patient had entrenched chronic diseases before and acquires new ailments now, adhering rigidly to established formulas without inquiry would surely harm them. In difficult and complex cases, if one probes deeply but fails to ascertain the truth, trivial chatter might reveal the real picture; acting rashly without careful inquiry would surely harm them. The *Chapter on Disease Forms* (*Bing Xing Pian*) states: "Inquiring about the illness and knowing its location is called being a skilled artisan (Gong)." Those today who claim to be artisans ask irrelevant questions and indulge in flattery; patients happily comply. When conditions worsen and doctors change, the same occurs. Many wander between medical treatments, ultimately unrecoverable. Therefore, those concerned with saving the world must guide patients gently to preserve benevolent arts. One cannot casually detach oneself from responsibility. I often see households of officials using heavy curtains when examining women in inner chambers, wrapping their hands in silk so that the doctor's three fingers cannot fully press the pulse. Doctors then examine carelessly. This fails to utilize the subtleties of inspection, auscultation-olfaction, and inquiry, and even loses precision in palpation. They treat doctors as if they were thieves. Can the words of Su Dongpo and Wang Haizang be understood by every household? I only hope patients prioritize their health, abandon old habits, and allow doctors to exert their full capabilities. May doctors conduct themselves according to the Dao, avoid vulgar conventions, and ensure patients honestly disclose their histories. Thus, no illness will hide, and doctors and patients will achieve mutual benefit.