Make diagnosis from skin color.

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医理真传

Yi Li Zhen Chuan

原著       ·  郑钦安

Author; Zhen Qin-An (Qing dynasty, China)

 

望色

Make diagnosis from skin color.

望色无他术,专在神气求。

When make diagnosis from the skin color, no other way but pay attention to the tint of the color.

实症多红艳,虚症白青浮。

In true Fire, the color is usually bright red, and in Xu Fire, the color is with white-blue tint and the color appears floating.

部位须分定,(额心、颏肾、鼻脾、左腮肝、右腮肺)生克仔细筹。

The location of the color bears meaning too. Color in the forehead suggests disease in the Heart; in the chin, suggests disease in the Kidney; nose, the Spleen; left cheek, the Liver, and right cheek, the Lung.

吉凶都可料,阳浮记心头(久病之人,未受外感,忽面现红光,若无病者,乃元阳外越,旦夕死亡之征)。

The color can also predict the death. If a person, who has been in disease for a long time, and who did not have common cold recently, shows red color in the face as there is no any disease, it suggests the Yuan Yang is escaping, the person will die pretty soon.

闻声

Diagnosis by person’s voice and sound.

细听呼与吸(呼出心肺,吸入肝肾),痰喘有无声。

When make diagnosis from the sound of the body, listen to the exhalation and the inhalation. Exhalation is governed by the heart and the lung, and the inhalation is governed by the liver and kidney. Also pay attention to the sound when the patient has asthma and phlegm.

呃逆分新久,微(微言也)厉(声大也)判盈缩。

Also pay attention to the hiccups. Weak or strong hiccups suggests the regression or progression of a disease.

抑郁多长气,腹痛定呻吟。

People with depression must have long sign. People with stomach pain will have groan.

谵语虚实异,留神仔细评(阳明实症谵语,乃热甚神昏,热极者,狂叫喜笑不休。少阴虚寒症,言语错乱若谵语,其实非谵语也,乃气虚阳脱,神无所主也)。

When a person has delirious speech, pay attention to its meaning. If it is due to a Shi condition, or a Xu condition. In Yangming stage of a disease, the person has fever, loss of consciousness, behaves as madness, has continuous mad laugh, and the delirious speech. In Shaoyin weak and cold condition, the person can also have delirious speech, and it is not real delirious speech, but the escaping of the Yuan Yang, since the “Shen” loses control to the consciousness. [1]

【阐释】《难经》谓:"呼出心肺主之,吸入肝肾主之,呼吸之中,脾胃主之。"故闻呼吸声息,可为察知五脏之助,自当细心听取。至于痰喘之有声无声,呃逆之新久轻重,声音之大小,气息之长短,以及呻吟谵语等,均属闻诊中的主要项目,故须仔细留神。石寿棠《医原·闻声须察阴阳论》以燥湿为纲,分辨各种声音,而知其病之所在,颇为精审。其说谓:"五音不外阴阳,阴阳不外燥湿。……燥邪干涩,声多属仄,或干哕,或咳声不扬,或咳则牵痛,或干咳连声,或太息气短;化火则多言,甚则谵狂,其声似破似哑,听之有干涩不利之象。湿邪重浊,声必低平,壅塞不宣,古谓如从瓮中作声者然。或默默懒言,或昏昏倦怠,或多嗽多痰,或痰在喉中漉漉有声,或水停心下汨汨有声,或多噫气;化火则上蒸心肺,神智模糊,呢喃自语,或昏沉迷睡,一派皆重浊不清之象,流露于呼吸之间。"又谓:"实喘责在肺,虚喘责在肾。实喘者,胸满声粗,气长而有馀;虚喘者,呼长吸短,息促而不足。实喘者,出气不爽;虚喘者,入气有音。实喘,有水邪射肺,有痰饮遏肺,有客邪干肺,上焦气壅,治宜疏利;虚喘为肾不纳气,孤阳无根,治宜固摄。虚实分途,阴阳异治,然则闻声之道,顾不重哉!"可供辨证参考。

(This paragraph belongs to explanation by other author, not belongs to the original part of the book).

问症

Diagnosis by inquiring.

探病须细问,疼痛何由生。 寒热分新久,痞满判重轻。 喜饮冷和热,二便黄与清。 妇女胎产异,经信最为凭。

During inquiring, ask the reason(s) for a pain; how long time the cold or fever has been; how severe the fullness feeling is in stomach; like or dislike warm or cold drinks; the color of the stool and urine; normal or abnormal of the period and pregnancy of a woman, etc.

切脉

Diagnosis by pulse feeling.

脉分上、中、下,浮、沉、迟、数,有力与无力,虚、实自然明,大、小兼长、短,阴阳盛衰情,二十八脉象,堪为学者绳(脉之一途,千变万化,总在这阴阳两字上求之,其要不出浮、沉、迟、数,有力与无力耳。李士材之二十八脉,虽说繁冗,然逐步以言病,亦大费苦心,初学原不可少,此特明其要)。

When feels pulse, pay attention to the position of the pulse (upper, middle, or lower position); the depth of the pulse (floating, or deep); speed of the pulse (slow or fast); intense of the pulse (strong or weak), so to know the weak or strong of the pulse. You also need to pay attention to its large, or small, long or shot of the pulse. The summery of 28 different pulse feeling should be studied carefully. (The pulse is complex and largely variable. But it anyway falls into the Yin and Yang. The major pulse is floating, deep, frequent or less frequent. The 28 pulse of the doctor Li Shicai, though complexd, but it is associated to specific disease condition. A beginner needs to spend time to study it.)

【阐释】脉学自《内经》、《难经》以后,历代医家多有论述,明李士材二十八脉最为流行,至清周学海著脉学四书,精详条畅,可谓集脉学之大成。其说谓:"总以浮、沉、迟、数、虚、实、长、短,八者为之提纲,得其纲则中有主宰,乃可应于无穷。故芤、革,浮也;牢、伏,沉也;代、迟也;促、数也;濡、弱、细、微,虚也;洪(促、牢、滑、动),实也;弦、缓,长也;动、结、滑、涩、紧、散,短也"。并说这些都是脉的位、数、形、势,而其根源则在于阴阳、血气、寒热、虚实的病机。察脉即所以察病机,必须察脉准而后辨病始真。郑氏切脉诗大体与周氏相近,而极简明扼要,便于应用。并谓二十八脉虽繁冗,但初学原不可少,亦属切当之论。较郑氏稍后的蜀中名医家唐宗海,除著《中西汇通五种》外,还著有《医学一见能》一书,以示初学。其中对二十八脉的脉象与病机,有扼要的叙说,特转录以资参考。

(This paragraph belongs to explanation by other author, not belongs to the original part of the book).

 

浮脉,轻按即见,主表实,亦主里气内虚。

沉脉,重按乃见,主里实,亦主里气内虚。

迟脉,一息三至,主虚寒,亦主在脏之病。

数脉,一息六至,主实热,亦主真寒假热。

虚脉,三部无力,主诸虚,亦主素禀不足。

实脉,三部有力,主诸实,亦主素禀有馀。

大脉,应指洪阔,主病进,亦主正气内虚。

缓脉,应指柔和,主病退,亦主胃气有馀。

长脉,过于三指,主气盛,亦主阳盛阴虚。

短脉,不满三指,主气损,亦主中有窒塞。

滑脉,往来流利,主血走,亦主痰饮为病。

涩脉,往来艰滞,主血虚,亦主瘀血凝积。

洪脉,涌沸有力,主实热,亦主内虚不足。

紧脉,劲疾无定,主寒实,亦主身体疼痛。

细脉,窄小不粗,主冷气,亦主血脉不足。

微脉,模糊不显,主阳虚,亦主元气败绝。

芤脉,浮大中空,主亡血,亦主遗精小产。

弦脉,端直中劲,主木旺,亦主痰饮内痛。

革脉,浮极有力,主阴亡,亦主阳不入阴。

牢脉,沉极有力,主寒实,亦主内有积聚。

濡脉,浮细无力,主气虚,亦主外受湿气。

弱脉,沉细无力,主血虚,亦主胃气不盛。

动脉,摇曳在关,主惊气,亦主阴阳相搏。

伏脉,沉潜着骨,主邪闭,亦主阴寒在内。

促脉,数中时止,主郁热,亦主邪气内陷。

结脉,迟中时止,主寒结,亦主气血渐衰。

代脉,止有定候,主气绝,亦主经隧有阻。

散脉,去来缭乱,主气散,亦主产妇之凶。

浮沉分表里,迟数定寒热,虚实分盛衰,大缓辨进退。长有馀而短不足,滑流利而涩艰难,寒、热、紧、洪俱属实,细、微、血气总为虚。芤中空而血亡故道,弦中劲而木乘脾经。革则阳气外越,牢则阴邪内固。濡气虚,弱血虚,虚各有别;动气搏,伏气闭,气总乖和。结阴促阳,辨迟与数;代亡散绝,有去无来。

(This paragraph belongs to explanation by other author, not belongs to the original part of the book).

脉法多端,此为总索。



[1] “Shen” here means something in between the consciousness and the spirit. It is the function of the Heart. The Shen make the person have consciousness. The Shen control the person what to say, what to eat, to drink, where to move the arm or legs, etc. It is hard to find a proper word in English to describe it.