(凡四则)
式云某处有某人某年月日。填医案一宗。
望形色∶
\r图一\ph1.bmp\r
\r图二\ph2.bmp\r
闻声音∶
\r图三\ph3.bmp\r
问情状∶
何处苦楚? 何因而致?
何日为始? 昼夜孰甚?
寒热孰多? 喜恶何物?
曾服何药? 曾经何地?
切脉理∶
左部
寸 浮本位 中取 沉候
关 浮取 中候 沉本位
尺 浮候 中取 沉本位
右部
寸 浮本位 中候 沉取
关 浮取 中本位 沉候
尺 浮应上焦 中应右关 沉应肝肾
论病原∶
某人素禀孰盛? 其病今在何类?
标本孰居? 毕竟何如?(按∶此句是论吉凶顺逆易治难治。)
服药宜如何将息? 病疾沉 痼今在何际?
治方术∶
主治用何法? 先后用何方?
六法者,望、闻、问、切、论、治也。凡治一病,用此式一纸为案。首填某地某时,审
风土与时令也;次以明聪望之、闻之,不惜详问之,察其外也;然后切脉、论断、处方,得
其真也。各各填注,庶几病者持循待续,不为临敌易将之失,而医之心思既竭,百发百中矣
。
予既立兼施式,有刑名家过而言曰∶望、闻即两造具备,察言观色之时,问而笔之供词
也,切则考鞫亲切,而论治为招判发落矣。其言虽谑,足以解惑云。
或曰∶六法兼施,得无琐琐乎?予应之曰∶医药,人之司命,为谋弗忠,非仁术矣。病
有不治之条,医有 股之念,诚如是而不救焉,彼虽命尔,吾犹以为未精吾技而误于人
人也。若夫轻疾小恙,虽不填案可也,畏其琐而并弃之,非予志矣。
(共有四条内容)
格式要求写明:某处有某人,于某年某月某日。填写一份医案。
望诊观察神色形态:
[图一]
[图二]
闻诊听取声音:
[图三]
问诊询问病情状况:
哪里感到痛苦?是什么原因导致的?
从哪一天开始发作?白天和夜晚哪个时段更严重?
怕冷和发热哪个更多?喜欢或厌恶什么事物?
曾经服用过什么药物?曾经去过什么地方?
切诊脉理分析:
左手脉象
寸部 浮取为本位,中取,沉取
关部 浮取,中取,沉取为本位
尺部 浮取,中取,沉取为本位
右手脉象
寸部 浮取为本位,中取,沉取
关部 浮取,中取为本位,沉取
尺部 浮取应上焦,中取应右关,沉取应肝肾
论述病因病机:
此人平素体质哪方面偏盛?现在的疾病属于哪一类?
标和本哪个居主导?究竟情况如何?(按语:这句话是讨论吉凶、顺逆以及易治难治的情况。)
服药期间适宜如何进行调养护理?疾病深重顽固,现在处于什么阶段?
制定治疗方案:
主治采用什么方法?先后使用什么方剂?
所谓“六法”,是指望、闻、问、切、论、治这六种方法。凡是治疗一种疾病,用这一张表格作为医案。首先填写某地某时,以审察当地风土气候和时令节气;其次通过明察秋毫的望诊和闻诊,不吝惜详细询问,以观察患者的外在表现;然后进行切脉、论述判断、开具处方,从而获得疾病的真相。各项分别填写注释,这样患者可以持此记录以便后续参照,避免临阵换将的错误,而医生的心思也得以穷尽,做到百发百中。
我既然制定了兼施六法的格式,有一位精通刑法的官员经过并评论说:“望诊和闻诊就像诉讼中双方都到场,是观察言辞和神态的时候;问诊并记录下来就是获取供词;切诊就像深入审讯以查明实情;而论治则是像法官招供判决并执行刑罚。”他的话虽然带有戏谑成分,但足以让人解开疑惑。
有人问:“六法兼用,难道不显得琐碎吗?”我回答说:“医药关乎人的生死命运,如果谋划不忠诚尽责,就不是仁爱的医术了。疾病中有无法治愈的情况,医生也有懈怠的念头,如果真的这样而不施救,即使病人把性命托付给你,我仍然认为这是技术不精湛而误害他人。至于轻微的疾病和小毛病,虽然可以不填写医案,但如果因为害怕繁琐而一并抛弃这种做法,就不是我的本意了。”
(There are four items in total.)
The format requires stating: A certain person in a certain place, on a certain year, month, and day. Fill out one medical case record.
Observation of complexion and form (Wang):
[Image 1]
[Image 2]
Listening to sounds and odors (Wen):
[Image 3]
Inquiry into symptoms and conditions (Wen):
Where is the discomfort? What caused it?
When did it start? Which is worse, day or night?
Is chills or fever more predominant? What does the patient like or dislike?
What medicines have been taken before? Where has the patient traveled or lived?
Pulse diagnosis principles (Qie):
Left hand pulse
Cun (Inch) position: Floating is the standard position; Middle; Deep
Guan (Bar) position: Floating; Middle; Deep is the standard position
Chi (Cubit) position: Floating; Middle; Deep is the standard position
Right hand pulse
Cun (Inch) position: Floating is the standard position; Middle; Deep
Guan (Bar) position: Floating; Middle is the standard position; Deep
Chi (Cubit) position: Floating corresponds to the Upper Jiao (Upper Burner); Middle corresponds to the Right Guan; Deep corresponds to the Liver and Kidney
Discussion of etiology and pathogenesis (Lun):
Which aspect of the person's innate constitution is strong? In which category does the current disease fall?
Which is primary (Ben) and which is secondary (Biao)? What is the ultimate situation? (Note: This sentence discusses auspiciousness/inauspiciousness, favorable/unfavorable progression, and ease/difficulty of treatment.)
How should medication be administered and what lifestyle adjustments (Jiangxi) are appropriate? The disease is deep-seated and chronic; what is its current stage?
Formulation of treatment methods (Zhi):
What method is used for the main treatment? What formulas are used sequentially?
The "Six Methods" refer to Observation (Wang), Listening/Smelling (Wen), Inquiry (Wen), Pulse-taking (Qie), Discussion/Diagnosis (Lun), and Treatment (Zhi). Whenever treating a disease, use this single sheet as a case record. First, fill in the location and time to examine the local climate and seasonal regulations; second, observe and listen with keen insight, asking in detail without sparing effort, to inspect external manifestations; then, take the pulse, discuss and diagnose, and prescribe medicine to grasp the truth. Each item should be filled in and annotated, so that the patient can hold this record for continuity, avoiding the mistake of changing generals during battle, and allowing the physician's mind to be fully exerted, achieving success in every attempt.
After I established the combined Six Methods format, a legal expert passed by and commented: "Observation and listening are like when both parties in a lawsuit are present, observing speech and demeanor; inquiry and recording constitute obtaining confessions; pulse-taking is like thorough interrogation to ascertain facts; and discussion and treatment are like issuing a verdict and execution." Although his words were somewhat jesting, they are sufficient to clarify doubts.
Someone asked: "Using all six methods together, is it not too trivial?" I replied: "Medicine and pharmacy determine human life and death. If one does not plan with loyalty and diligence, it is not a benevolent art. There are cases where diseases cannot be cured, and there may be thoughts of laziness among physicians. If one truly adopts such an attitude and fails to rescue, even if the patient entrusts their life to you, I still consider this to be imprecise skills that harm others. As for minor illnesses and slight ailments, although filling out a case record might be omitted, abandoning this practice entirely out of fear of triviality is not my intention."