凡诊伤寒时病。须先观病患两目。次看口舌。以后用两手按其胸脘至小腹。有无痛
处。再问其口渴与不渴。大小便通与不通。服过何药。或久或新。察其病之端的。然后
切脉辨症。以症证脉。必要问得其由。切得其象。以问证切。以切证问。查明其病源。
审定其现象。预料其变症。心中了了。毫无疑似。始可断其吉凶生死。庶得用药无差。
问心无愧。慎毋相对斯须。便处方药。此种诊法。最关紧要。此余数十年临症之心法也
。试举其要以析言之。
【荣斋按】本章以全身检查的方法，来观察疾病；然尚有“察耳鼻”一法，亦属重
要，兹从戈存橘伤寒补天石录入。戈氏说∶“伤寒耳聋，属少阳，宜和解。久病耳聋、
属气虚，元气恢复，耳自聪也。伤寒耳聋为常例，但舌卷、唇青、囊缩、耳聋者，为难
治。耳黑枯燥为肾败，盖肾开窍于耳也。少阳之脉络耳中，凡耳聋、耳痛、耳肿、皆属
少阳风热。如病患鼻色青者，主腹中痛；若冷者死。微黑者，有水气。黄者小便难。白
者属气虚。赤者属肺热。鲜明者有留饮。鼻孔干燥，必衄血。鼻燥如烟煤者，属阳毒。
鼻孔冷滑而黑，属阴毒。鼻塞浊涕属风热。鼻流清涕属肺寒。鼻孔癖涩属肺热。其中，“黄者
小便难”“白者属气虚”“鼻燥如烟煤者为阳毒”这几句，对病理机转说得不够明白，
特作如下解释∶根据文献记载“鼻燥色黄为积热溺涩”，是小便难由于积热所致；“鼻
色白主吐泻伤脾”，是虚由吐泻所致；“鼻如烟筒主热伤肺脏及惊中危症”，则知所谓
“阳毒”者，就是热伤肺脏。
凡诊治伤寒时病，必须先观察患者的双眼，其次查看口舌，然后用双手按压从胸脘到小腹的部位，检查是否有疼痛之处。再询问患者是否口渴，大小便是否通畅，以及服用过什么药物，病程是久是新，以此查明疾病的根本原因。然后切脉辨证，将症状、证候与脉象相互印证，必须问清病因，摸准脉象特征。通过问诊来验证脉诊，通过脉诊来验证问诊，查明确切的病源，审定疾病的表现，预判可能出现的变症。心中清楚明白，毫无疑惑，才可以判断吉凶生死，从而用药无误，问心无愧。千万不要相对片刻就开处方药，这种诊法最为关键，这是我数十年临证的心得。试列举其要点进行分析说明。
【荣斋按】本章采用全身检查的方法来观察疾病；然而还有“察耳鼻”这一方法，也属重要，现从戈存橘《伤寒补天石》中录入。戈氏说：“伤寒导致的耳聋，属于少阳经病，适宜和解法治疗。久病耳聋，属于气虚，元气恢复后，耳朵自然聪敏。伤寒耳聋是常见情况，但如果出现舌卷、唇青、囊缩、耳聋的情况，则难以治疗。耳廓黑而枯燥，表明肾气败坏，因为肾开窍于耳。少阳经脉络入耳中，凡是耳聋、耳痛、耳肿，都属于少阳风热。如果患者鼻色发青，主腹中痛；若鼻色冷者死。微黑者，体内有水气。黄色者小便困难。白色者属于气虚。赤色者属于肺热。鲜明者有留饮。鼻孔干燥，必然流鼻血。鼻燥如烟煤状者，属于阳毒。鼻孔冷滑而黑，属于阴毒。鼻塞流浊涕属于风热。鼻流清涕属于肺寒。鼻孔干涩属于肺热。其中，‘黄者小便难’‘白者属气虚’‘鼻燥如烟煤者为阳毒’这几句，对病理机转说得不够明白，特作如下解释：根据文献记载‘鼻燥色黄为积热溺涩’，是小便难由于积热所致；‘鼻色白主吐泻伤脾’，是虚由吐泻所致；‘鼻如烟筒主热伤肺脏及惊中危症’，则知所谓‘阳毒’者，就是热伤肺脏。”
When diagnosing and treating Shanghan (Cold Damage) or seasonal diseases, one must first observe the patient's eyes, then examine the mouth and tongue. Subsequently, use both hands to palpate from the chest and epigastrium down to the lower abdomen to check for tenderness. Next, inquire about thirst or lack thereof, the patency of urination and defecation, what medications have been taken previously, and whether the disease is acute or chronic. This allows for ascertaining the precise nature of the illness. Only then should pulse diagnosis be performed to differentiate syndromes. Symptoms, syndromes, and pulses must be cross-verified; it is essential to ascertain the etiology through inquiry and identify the pulse characteristics through palpation. Use inquiry to verify pulse findings, and use pulse findings to verify inquiry results. Once the disease source is clarified, the manifestations are determined, and potential complications are anticipated, with a clear mind free of doubt, one can then judge the prognosis (life or death). This ensures accurate prescription and a clear conscience. One must not hastily prescribe medication after merely facing the patient for a moment. This diagnostic approach is of utmost importance and represents my clinical insights accumulated over decades. I will now outline the key points for analysis.
[Rongzhai's Note] This chapter employs whole-body examination methods to observe diseases; however, the method of "observing the ears and nose" is also important. It is hereby recorded from Ge Cunju's *Shanghan Butianshi* (Supplementary Stone for Saving Lives in Cold Damage). Mr. Ge stated: "Deafness caused by Shanghan belongs to Shaoyang (Lesser Yang), and is suitable for Harmonizing treatment. Deafness resulting from chronic illness belongs to Qi Deficiency; once Yuanqi (Original Qi) recovers, hearing will naturally improve. Deafness in Shanghan is a common occurrence, but if accompanied by curled tongue, cyanotic lips, retracted scrotum, and deafness, it is difficult to treat. Black and dry ears indicate Kidney failure, as the Kidney opens into the ears. The Shaoyang meridians enter the ears; therefore, deafness, ear pain, and ear swelling all belong to Shaoyang Wind-Heat. If the patient's nasal color is green, it indicates abdominal pain; if cold, it signifies death. Slightly black indicates Water-Qi retention. Yellow indicates difficulty in urination. White indicates Qi Deficiency. Red indicates Lung Heat. Bright/lustrous indicates retained fluids. Dry nostrils inevitably lead to epistaxis (nosebleed). Nostrils dry like soot indicate Yang Toxin. Cold, slippery, and black nostrils indicate Yin Toxin. Nasal congestion with turbid discharge indicates Wind-Heat. Clear nasal discharge indicates Lung Cold. Dry and rough nostrils indicate Lung Heat. Among these, 'Yellow indicates difficulty in urination,' 'White indicates Qi Deficiency,' and 'Nostrils dry like soot indicate Yang Toxin' do not sufficiently explain the pathological mechanisms. Therefore, the following explanations are provided: According to literature records, 'dry yellow nose indicates accumulated heat and scanty urine,' meaning difficulty in urination is caused by accumulated heat; 'white nasal color indicates vomiting and diarrhea damaging the Spleen,' meaning deficiency is caused by vomiting and diarrhea; 'nose resembling a chimney indicates heat damaging the Lung organ and critical conditions involving fright,' thus knowing that the so-called 'Yang Toxin' refers to heat damaging the Lung organ."