经曰必审问其所始病。与今之所方病。然后各切循其脉。又曰必问尝贵后贱。虽不中邪
。病
从内生。名曰脱营。尝富后贫。名曰失精。五气留连。病有所作医。工诊之不在脏腑。不变
形躯。诊之而疑。不知病名。身体日减。气虚无精。病深无气。漉漉然时警病深者以其外耗
于卫。内夺于营。良工所失。不知病情。
又曰诊有三常。必问贵贱。封君败伤及欲侯王。
又曰入国问俗。入家问讳上堂问礼。临病患问所。便慎之至也。又云凡诊病者必问饮食起
居。暴乐暴苦。始乐后苦。皆伤真气。又云诊病不问其始忧患饮食之失节。起居之过度。或
伤于毒。不先言此。卒诊寸口。何病能中。
凡百病问其昼则增剧。夜则安静。是阳气有余。乃气病而血不病也。夜则增剧。昼则安
静。是阴病有余。乃血病而气不病也。
问其昼则发热。夜则安静。是阳气自旺于阳分也。昼则安静。夜则发热烦躁。是阳气下
陷入
阴中也。名曰热入血室。昼则发热烦躁。夜亦发热烦躁。是重阳无阴也。当亟泻其阳。峻补
其阴。
问其昼则恶寒。夜则安静。是阴血自旺于阴分也。夜则安静。昼则恶寒。是阴气上溢于
阳分也。夜则恶寒。昼亦恶寒。是重阴无阳也。当亟泻其阴。峻补其阳。
昼则恶寒。夜则烦躁。饮食不入。病名阴阳交变。阴阳交变者死矣。闭户塞牖。击之病
者。数问其情。以从其意。得神者昌。失神者亡。
甲乙经云所问病者问所思何也。所惧何也。所欲何也。所疑何也。问之要察阴阳之虚实
。辨脏腑之寒热。疾病所生。不离阴阳脏腑寒热虚实。辨之分明。治无误矣。
难经云问病欲得寒。欲见人者病在腑也。病欲得温。不欲见人者病在脏也。
东垣内外伤辨问其发热恶寒。寒热间作。蒸蒸燥热。发于肌肉之间者内伤也。发热恶寒
。寒
热并作。怫怫发热皮毛之上者外感也。问其口不知味。饮食不下。手足不和。两胁俱热者内
伤证也。问其饮食知味。腹中和。二便如常。筋骨疼痛。不能动摇。非扶不起。外感证也。
问其恶风居露地。大漫风起。却不知恶。惟恶窗隙些小贼风。是内伤证也。问其鼻流清涕。
头痛自汗。间而有之。鼻中气短少气不足以息。怯不欲言。乃内伤证也。问其小便频数而不
渴。初以劳役得之。食少小便黄赤。大便尝难。或涩或结。或虚。坐常有些少如痢非痢。或
泻黄糜。或溏泄。或结而不通。皆内伤证也。问其心下痞。或胸中闭塞。如刀割之痛。二者
亦互作而不并出。有时胃脘当心而痛。上支两胁痛。四肢不收。无力以动。而懒倦嗜卧。皆
内伤证也。问其脐下相火之气。直上冲胸而不可遏。其气无息。甚则高喘。皆内伤证也。问
其头痛。常常有之而不间者外伤也。问其痛积不移者血痛。走痛不常者气病也。问其痛处按
之而已者虚病。按之而痛愈甚者实病。问其走注则为风。拘挛则为寒。烦渴则为暑。重涩则
为湿。或好于善淫。或触于惊恐。或伤于饮食。或深居简出而受暑。皆为受病之因。所以
贵于问也。
女科产后先问坐草难易。恶露多少。饮食迟早。生子存亡。有形伤血伤之不同。补气补血之
各异。饮食不节宜调中。生子不存宜开郁。问其所欲。以知其病。如欲热者知为寒。欲冷者
知为热。如好静恶动者知其为虚。烦躁不宁者知其为实。恶食知伤食。恶风知伤风。好食甘
为脾虚。好食辛为肺病。好食酸为肝病。好食咸为肾弱。嗜食苦为心病。此皆顺应而易治。
若乃心病爱咸。肺伤欲苦。脾弱喜酸。肝病好辣。肾衰嗜甘。此为逆候。病轻必危。危者必
死。治得其法。服药预防可回生。
昔有人病喉痛。诸医不效。一医问其平日好食斑鸠。乃知鸠食半夏苗而贻毒。治以生姜
愈。
唐汝正治小儿风热。通身俱愈。惟头顶不痊。问其因乳母好热酒。知其贻毒本方。倍用葛根
黄连而愈。
《黄帝内经》说：必须详细询问疾病最初发生的情况，以及现在正在发生的病症。然后分别切按循摸患者的脉象。又说：必须询问患者过去是否地位尊贵而后变得卑贱。即使没有受到外邪侵袭，疾病也会从体内产生，这种病叫做“脱营”。曾经富有后来贫穷，这种病叫做“失精”。五脏之气滞留连滞不去，疾病由此发作。医生诊治时，如果不在脏腑层面寻找原因，身体外形也没有明显变化，诊察时感到疑惑，不知道是什么病名。但患者身体日渐消瘦，气虚无精，病情深重导致元气衰竭，表现为漉漉有声（形容气息微弱或体内有水饮等异常声音），时时惊恐。病情深重的原因在于外部耗损了卫气，内部掠夺了营气。高明的医生之所以失误，是因为不了解病情的本质。
又说：诊察有三种常情，必须询问患者的贵贱身份。例如封君败伤及想要成为侯王的人（指因地位变动产生的心理因素致病）。
又说：进入一个国家要询问当地风俗，进入一个家庭要询问避讳之事，登上厅堂要询问礼仪规范，面对病患要询问其适宜便利之处。这是极其谨慎的态度。又说：凡是诊察疾病，必须询问饮食起居情况。突然的大喜、大悲，或者先乐后苦，都会损伤真气。又说：诊察疾病如果不询问起初的忧患、饮食的不节制、起居的过度劳累，或者是否有中毒情况，不先了解这些，就仓促地诊察寸口脉，怎么能准确判断是什么病呢？
大凡各种疾病，如果白天加重，夜间安静，这是阳气有余，属于气分有病而血分无病。如果夜间加重，白天安静，这是阴病有余，属于血分有病而气分无病。
询问如果白天发热，夜间安静，这是阳气在阳分自然旺盛。如果白天安静，夜间发热烦躁，这是阳气下陷陷入阴分中，这种病名叫“热入血室”（热邪侵入血室）。如果白天发热烦躁，夜间也发热烦躁，这是重阳无阴（阳盛极而无阴制约）。应当紧急泻其阳热，峻补其阴液。
询问如果白天怕冷，夜间安静，这是阴血在阴分自然旺盛。如果夜间安静，白天怕冷，这是阴气上溢于阳分。如果夜间怕冷，白天也怕冷，这是重阴无阳（阴盛极而无阳制约）。应当紧急泻其阴寒，峻补其阳气。
如果白天怕冷，夜间烦躁，饮食无法入口，这种病名叫“阴阳交变”，阴阳交变的病证是死证。此时应关闭门窗，敲击房门以惊动患者，多次询问其内心情感，顺从其意愿。得神者昌，失神者亡。
《甲乙经》说：询问患病者，要问他们思念什么，恐惧什么，想要什么，怀疑什么。问诊的关键在于考察阴阳的虚实，辨别脏腑的寒热。疾病的产生，离不开阴阳、脏腑、寒热、虚实的变化。辨别得清楚，治疗就不会有误。
《难经》说：询问病人，如果想要寒冷、想见人的，病在腑。如果想要温暖、不想见人的，病在脏。
李东垣在《内外伤辨惑论》中论述：询问发热恶寒，寒热交替发作，蒸蒸燥热发于肌肉之间的，是内伤病。发热恶寒，寒热同时发作，怫怫发热在皮毛表面的，是外感病。询问口不知味，饮食不下，手足不和，两胁都热的，是内伤证。询问饮食知味，腹部平和，二便正常，筋骨疼痛，不能动摇，不扶起就不能站立的，是外感证。询问怕风，居住在露天之地，大风刮过却不知道怕，只怕窗户缝隙里进来的小贼风，这是内伤证。询问流清涕，头痛自汗，间或有之，鼻中气短，少气不足以息，怯懦不想说话，这是内伤证。询问小便频数但不口渴，起初是因为劳役所得，食少，小便黄赤，大便常常困难，或者涩滞或者结聚，或者虚软，坐着时常有些许像痢疾但不是痢疾的症状，或者泻下黄色糜烂物，或者溏泄，或者结聚不通，这些都是内伤证。询问心下痞满，或者胸中闭塞，像刀割一样的疼痛，这两种症状也交替出现而不一起发作。有时胃脘当心而痛，向上支撑两胁疼痛，四肢不收，无力活动，懒倦嗜卧，都是内伤证。询问脐下相火之气，直冲胸部而不可遏制，气息急促，甚至气喘吁吁，都是内伤证。询问头痛，经常有且不间断的是外伤（此处指外感）引起的。询问疼痛固定不移的是血痛，游走不定的则是气病。询问疼痛部位按压后缓解的是虚病，按压后疼痛加剧的是实病。询问疼痛走窜则为风邪，拘挛则为寒邪，烦渴则为暑邪，沉重涩滞则为湿邪。或者喜好房事，或者遭受惊恐，或者饮食受伤，或者深居简出却受暑邪，这些都是致病的原因。所以问诊非常宝贵。
妇科产后，首先要询问分娩难易，恶露多少，饮食早晚，胎儿存活与否。有形之伤，伤血与伤气的不同，补气补血的方法也各异。饮食不节应当调理中焦，胎儿未存活应当疏解郁结。询问病人的欲望，以此推知病情。如想要热食的，可知为寒证；想要冷食的，可知为热证。如喜欢安静厌恶活动的，可知为虚证；烦躁不安的，可知为实证。厌恶食物可知为伤食，厌恶风可知为伤风。喜好甘味为脾虚，喜好辛味为肺病，喜好酸味为肝病，喜好咸味为肾弱，嗜食苦味为心病。这些都是顺应病机而易治的情况。如果是心病却爱吃咸，肺病却想吃苦，脾弱却喜酸，肝病却好辣，肾衰却嗜甘，这称为逆候。病轻则必危，危者必死。如果治疗方法得当，服药预防可以起死回生。
从前有人患喉痛，众医治疗无效。一位医生询问他平日喜好吃什么，得知他喜欢吃斑鸠，于是知道是因为斑鸠吃了半夏苗而带有毒素，用生姜治疗而痊愈。
唐汝正治疗小儿风热，通身症状都好了，只有头顶没有痊愈。询问其原因，发现是因为乳母喜好喝热酒，知道是乳汁传递了毒气，于是加倍使用葛根、黄连而治愈。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: One must carefully inquire about the initial onset of the disease and its current manifestation. Then, palpate and trace the pulse in various positions. It also states: One must ask if the patient has experienced a change from high status to low status. Even without external pathogenic factors, diseases can arise internally; this is called "Tuo Ying" (Depletion of Ying/Nutritive Qi). If one was once wealthy but became poor, this condition is called "Shi Jing" (Loss of Jing/Essence). The five visceral qi may linger and stagnate, causing diseases to manifest. When physicians diagnose, if they do not examine the Zang-Fu organs, and the physical form remains unchanged, diagnosis becomes doubtful, and the disease name remains unknown. The body wastes away daily, Qi becomes deficient and Jing is depleted. In deep-seated diseases, Qi is exhausted, manifested by rattling sounds (indicating fluid retention or weak respiration) and frequent fright. The severity of the disease stems from external depletion of Wei Qi (Defensive Qi) and internal exhaustion of Ying Qi (Nutritive Qi). Skilled physicians err because they fail to understand the nature of the pathology.
It further states: There are three common aspects to consider during diagnosis; one must inquire about the patient's social status. For instance, those who have lost their noble rank or aspire to become feudal lords may suffer from psychosomatic illnesses.
It also states: When entering a country, inquire about local customs; when entering a home, ask about taboos; upon entering the hall, ask about etiquette; and when facing a patient, ask about their preferences and conveniences. This demonstrates utmost caution. Furthermore, when diagnosing any illness, one must inquire about diet and daily routine. Sudden extreme joy or sorrow, or a shift from happiness to suffering, all damage True Qi. Additionally, if diagnosis does not first inquire about initial worries, dietary irregularities, excessive living habits, or potential poisoning, and instead hastily palpates the Cun Kou (Radial Artery at the wrist), how can one accurately determine the disease?
Generally, for various diseases, if symptoms worsen during the day and remain quiet at night, it indicates excess Yang, meaning there is a Qi disorder but no Blood disorder. If symptoms worsen at night and remain quiet during the day, it indicates excess Yin, meaning there is a Blood disorder but no Qi disorder.
If one asks and finds fever during the day but quietness at night, it indicates Yang Qi naturally flourishing in the Yang aspect. If quiet during the day but feverish and irritable at night, it indicates Yang Qi sinking into the Yin aspect, a condition named "Re Ru Xue Shi" (Heat Entering the Blood Chamber). If feverish and irritable both day and night, it indicates Extreme Yang with no Yin (Yang Excess without Yin constraint). One should urgently drain the Yang heat and vigorously tonify the Yin.
If one asks and finds aversion to cold during the day but quietness at night, it indicates Yin Blood naturally flourishing in the Yin aspect. If quiet at night but aversion to cold during the day, it indicates Yin Qi overflowing into the Yang aspect. If aversion to cold occurs both day and night, it indicates Extreme Yin with no Yang (Yin Excess without Yang constraint). One should urgently drain the Yin cold and vigorously tonify the Yang.
If there is aversion to cold during the day, irritability at night, and inability to eat, the disease is named "Yin Yang Jiao Bian" (Yin-Yang Interaction/Conflict), which is a fatal prognosis. In such cases, close doors and windows, strike them to startle the patient, and repeatedly inquire about their emotional state, accommodating their will. Those who retain Shen (Spirit) prosper; those who lose Shen perish.
The *Jia Yi Jing* (Classical Text of Jia Yi) states: When asking about the illness, inquire what they think about, fear, desire, and doubt. The key to inquiry lies in examining the deficiency and excess of Yin and Yang, and distinguishing the cold and heat of the Zang-Fu organs. Disease generation revolves around Yin-Yang, Zang-Fu, Cold-Heat, and Deficiency-Excess. Clear distinction leads to error-free treatment.
The *Nan Jing* (Classic of Difficult Issues) states: If a patient desires cold and wishes to see people, the disease is in the Fu organs. If a patient desires warmth and does not wish to see people, the disease is in the Zang organs.
Li Dongyuan, in his *Differentiation of Internal Injury and External Contraction*, discusses: Regarding fever and aversion to cold, if chills and fever alternate, with steaming heat arising from within the muscles, it is an internal injury. If fever and aversion to cold occur simultaneously, with surface heat on the skin and hair, it is an external contraction. Regarding taste and digestion, if one cannot taste food, cannot swallow, has disharmonious limbs, and heat in both hypochondria, it is an internal injury syndrome. If one retains taste, has a harmonious abdomen, normal excretion, but suffers from bone and joint pain, immobility, and requires support to stand, it is an external contraction syndrome. Regarding wind sensitivity, if one lives outdoors in strong winds without feeling afraid, but only fears drafts from window cracks, it is an internal injury syndrome. Regarding nasal discharge and breathing, if there is clear runny nose, headache, spontaneous sweating, shortness of breath, reluctance to speak, it is an internal injury syndrome. Regarding urination and defecation, if there is frequent urination without thirst, initially caused by overwork, with poor appetite, yellow-red urine, difficult stool (constipation or hardness), or loose stools resembling dysentery but not being so, or yellow mushy diarrhea, or alternating constipation and diarrhea, these are all internal injury syndromes. Regarding chest and abdominal discomfort, if there is epigastric fullness or chest oppression with knife-like pain, occurring alternately rather than simultaneously, sometimes with heartburn pain radiating to the hypochondria, limb flaccidity, weakness, lethargy, and drowsiness, these are internal injury syndromes. Regarding the Qi of Minister Fire below the navel rushing up to the chest uncontrollably, causing rapid breathing and severe panting, these are internal injury syndromes. Regarding headache, constant and unceasing pain suggests external contraction. Fixed pain indicates Blood stasis; wandering pain indicates Qi disorder. Pain relieved by pressure indicates deficiency; pain aggravated by pressure indicates excess. Wandering pain indicates Wind; spasms indicate Cold; irritability and thirst indicate Summerheat; heaviness and stiffness indicate Dampness. Other causes include excessive sexual activity, fright, dietary injury, or Summerheat contracted while staying indoors. These are the reasons why inquiry is precious.
In gynecology regarding postpartum care, one must first ask about the ease or difficulty of labor, the amount of lochia, timing of diet, and survival of the infant. Different types of tangible injuries affect Blood differently, requiring distinct methods for tonifying Qi and Blood. Irregular diet requires regulating the Middle Jiao; loss of fetus requires resolving depression. Inquiring about desires helps identify the disease: craving hot foods indicates Cold; craving cold foods indicates Heat; preferring stillness and disliking movement indicates Deficiency; irritability and restlessness indicate Excess. Aversion to food indicates Food Stagnation; aversion to wind indicates Wind Invasion. Craving sweet flavors indicates Spleen Deficiency; craving pungent flavors indicates Lung disease; craving sour flavors indicates Liver disease; craving salty flavors indicates Kidney weakness; craving bitter flavors indicates Heart disease. These are favorable patterns and easy to treat. However, if Heart disease craves salt, Lung disease craves bitterness, Spleen weakness prefers sour, Liver disease likes spicy, and Kidney decline craves sweet, these are adverse signs. Mild illness becomes critical; critical illness leads to death. With correct treatment and preventive medication, life can be saved.
Once, a patient suffered from sore throat, and many physicians failed to cure him. One physician asked about his usual diet and learned he liked eating turtledoves. He deduced that the doves had eaten Banxia (Pinellia Tuber) seedlings, leading to toxicity. The patient was cured using Shengjiang (Fresh Ginger).
Tang Ruzheng treated a child with Wind-Heat. The whole body recovered except for the vertex of the head. Upon inquiry, he learned the wet nurse frequently drank hot wine. He identified this as the source of toxicity transmitted through milk and prescribed doubled doses of Gegen (Puerariae Radix) and Huanglian (Coptidis Rhizoma), resulting in a cure.