凡诊病。必先问是何人。或男。或女。或老。或幼。或外家婢童仆。问而不答。必耳聋。
须询其左右。平素何如。否则病久或汗下致聋。问而懒答或点头。皆中虚昏愦。不知人。非
暴厥。即久病也。如妇人多中气。诊妇人。必当问月信如何。寡妇血气凝滞。两尺多滑。不
可误断为胎。室女亦有之。又问其病于何日。(日少为新病实症居多。日多为久病。虚症居
多。)曾食何物。(食冰而病。药用冰煎若伤肉食用草果山楂之类。详伤食本条。)曾有怒劳
房欲等事。(怒则伤肝。劳则内伤元气。房劳则伤肾。)及问初起何症。(如初起头疼发热恶
寒。属外感。如初起心腹疼痛及泻痢等症。属内伤。)后变何病。(如痢变泻变疟为轻。疟泻
变痢为重。先喘后胀病在肺先胀后喘病在脾。先渴后呕为停水之类。)今口渴思饮否。(口不
渴。内无热也。口渴欲饮为热。老人口干不须饮。主津液少苦。漱水不欲咽。主蓄血。主阴
极发躁。)喜热喜冷否。(喜热内寒。喜冷内热。)口中何味。(苦热咸寒。虚淡甘。脾热成疳。
伤食口酸。)思食否。(伤食不思食。杂症思食。为有胃气则生。若绝食为无胃气则死。)五
味中喜食何味。(喜甘脾弱。喜酸肝虚之类。)胸中宽否。(不宽。伤食痰积气滞之症。)及腹
中有无痛处否。(无痛。病不在内主虚。有痛处。主食积痰血之类。有痛处。手按则减者为
虚。)大小便如常否。(小便秘。黄赤为热。清白为寒。浊如米泔为湿热下陷。大便秘为实。
久泻久痢为虚。下黄赤为热。下清白为寒。)足冷暖否。(足暖阳症。足冷阴症。乍冷乍温便
结属阳。大便如常属虚。)及平日劳逸喜怒忧思。及素食何物。(劳则气散。逸则气滞。喜伤
心。怒伤肝。忧伤肺。思虑伤脾。恐伤肾素食浓味则生痰。醇酒则发热。)种种问法。实为
活人之快捷方式。
凡诊治疾病,必须先询问患者是何人。是男性还是女性?是老人还是儿童?或者是外家的婢女、童仆等。如果询问后不回答,必定是耳聋。
需要向患者的左右侍从询问其平素的情况。否则,因病日久或经过发汗、攻下治疗导致耳聋。如果询问后懒得回答或只是点头,都是中气虚弱、神志昏乱、不知人事的表现。这不是突然发生的厥证,就是久病所致。
如妇女多患中气病(指气机郁滞之病),诊察妇人时,必须询问月经情况如何。寡妇血气凝滞,两尺脉多呈滑象,不可误断为怀孕。未婚女子也有这种情况。
又询问患病于何日。(发病时间短的,多为新病实证居多;发病时间长的,多为久病虚证居多。)
曾吃过什么食物。(因吃冰而病的,用药宜用冰煎;若因损伤肉食而病的,用草果、山楂之类。详见伤食本条。)
曾有发怒、劳累、房事过度等事情吗?(发怒则伤肝,劳累则内伤元气,房劳则伤肾。)
以及初起时有什么症状?(如初起时头痛、发热、恶寒,属于外感;如初起时心腹疼痛及泻痢等症状,属于内伤。)
后来变成了什么病?(如痢疾变为泄泻、变为疟疾为轻症;疟疾、泄泻变为痢疾为重症。先喘后胀,病在肺;先胀后喘,病在脾。先渴后呕,为停水之类。)
现在口渴想喝水吗?(口不渴,说明体内无热。口渴欲饮为有热。老年人口干但不需饮水,主津液不足之苦。漱口不想咽下,主蓄血,主阴盛格阳导致的烦躁。)
喜欢热的还是冷的?(喜欢热的,说明体内寒;喜欢冷的,说明体内热。)
口中有什么味道?(苦为热,咸为寒,淡为虚,甘为脾热成疳。伤食则口酸。)
想吃东西吗?(伤食则不思食。杂症思食,为有胃气则生。若绝食,为无胃气则死。)
五味中喜欢吃哪种味道?(喜甘味,脾弱;喜酸味,肝虚之类。)
胸中宽畅吗?(不宽畅,为伤食、痰积、气滞之症。)
以及腹中有无痛处吗?(无痛,病不在内,主虚。有痛处,主食积、痰、血之类。有痛处,手按则减轻的为虚。)
大小便正常吗?(小便不通畅,色黄赤为热,清白为寒。浑浊如米泔水为湿热下陷。大便秘结为实。久泻久痢为虚。大便下黄赤为热,下清白为寒。)
脚冷还是暖?(脚暖为阳证,脚冷为阴证。乍冷乍温且大便干结属阳,大便正常属虚。)
以及平日劳逸、喜怒忧思等情况,以及平时素食吃什么?(劳累则气散,安逸则气滞。喜伤心,怒伤肝,忧伤肺,思虑伤脾,恐伤肾。素食浓味则生痰,醇酒则发热。)
种种问法,实在是救人的快捷方式。
In the diagnosis of any disease, one must first inquire about the patient's identity: whether male or female, elderly or young, or a servant, child, or attendant from an external household. If there is no response to inquiries, it indicates deafness.
One must consult those around the patient regarding their usual state. Otherwise, deafness may result from prolonged illness or from treatments involving sweating (Han, 汗) and purging (Xia, 下). If the patient responds lazily or merely nods, it signifies deficiency of Zhong Qi (Middle Qi, 中气), mental confusion, and loss of consciousness. This is neither a sudden Jue syndrome (Jue Zheng, 厥证) nor a chronic condition.
For women, who often suffer from Qi stagnation disorders (Zhong Qi Bing, 中气病), one must ask about their menstrual cycle. Widows, whose blood and Qi are stagnant, often present with slippery pulses at both Chi positions (Liang Chi, 两尺); this should not be mistaken for pregnancy. Unmarried women may also exhibit this.
Furthermore, inquire when the illness began. (A short duration suggests a new disease, predominantly Excess syndromes; a long duration suggests a chronic disease, predominantly Deficiency syndromes.)
Ask what food was consumed. (Illness caused by eating ice requires medicine decocted with ice; illness caused by damaging meat digestion requires herbs such as Caoguo (Tsaoko Fructus, 草果) and Shanzha (Crataegi Fructus, 山楂). See the section on Food Stagnation.)
Ask if there were instances of anger, overexertion, or sexual excess. (Anger injures the Liver; overexertion damages Yuan Qi (Original Qi, 元气); sexual excess injures the Kidney.)
Ask about the initial symptoms. (Initial headache, fever, and aversion to cold indicate External Contraction; initial epigastric/abdominal pain, diarrhea, and dysentery indicate Internal Injury.)
Ask how the disease has evolved. (Dysentery changing into diarrhea or malaria is mild; malaria or diarrhea changing into dysentery is severe. Wheezing preceding distension indicates Lung pathology; distension preceding wheezing indicates Spleen pathology. Thirst preceding vomiting indicates retained fluids.)
Is the patient currently thirsty and desiring to drink? (No thirst indicates absence of Heat within. Thirst with desire to drink indicates Heat. In the elderly, dry mouth without desire to drink indicates insufficiency of Body Fluids. Rinsing the mouth but not swallowing indicates Blood Stasis or Yin extreme causing false agitation.)
Does the patient prefer heat or cold? (Preference for heat indicates internal Cold; preference for cold indicates internal Heat.)
What is the taste in the mouth? (Bitter indicates Heat; salty indicates Cold; bland indicates Deficiency; sweet indicates Spleen Heat leading to Gan disease (Gan Zheng, 疳证). Sour taste indicates Food Stagnation.)
Is there an appetite? (Loss of appetite indicates Food Stagnation. Desire to eat in miscellaneous diseases indicates the presence of Stomach Qi, which means survival. Absence of appetite indicates loss of Stomach Qi, which means death.)
Which of the five flavors does the patient prefer? (Preference for sweet indicates weak Spleen; preference for sour indicates deficient Liver.)
Is the chest comfortable/broad? (Discomfort indicates Food Stagnation, Phlegm accumulation, or Qi stagnation.)
Are there painful areas in the abdomen? (Absence of pain suggests the disease is not internal and points to Deficiency. Presence of pain suggests Food Stagnation, Phlegm, or Blood stasis. If pressing on the painful area relieves the pain, it indicates Deficiency.)
Are urination and defecation normal? (Urinary difficulty with yellow/red urine indicates Heat; clear/white urine indicates Cold. Turbid urine like rice water indicates Damp-Heat sinking downward. Constipation indicates Excess. Chronic diarrhea and dysentery indicate Deficiency. Passing yellow/red stool indicates Heat; passing clear/white stool indicates Cold.)
Are the feet warm or cold? (Warm feet indicate Yang syndrome; cold feet indicate Yin syndrome. Alternating cold and warmth with constipation indicates Yang; normal bowel movements indicate Deficiency.)
Also inquire about daily work/rest balance, emotions (joy, anger, worry, thought), and dietary habits. (Overwork scatters Qi; idleness causes Qi stagnation. Joy injures the Heart; anger injures the Liver; sorrow injures the Lung; excessive thinking injures the Spleen; fear injures the Kidney. Rich foods generate Phlegm; strong wine generates Heat.)
These various questioning methods are indeed the quickest way to save lives.