(1) Asking about cold and heat
Cold and heat is one of the common symptoms of diseases, and it is an important basis to distinguish the nature of diseases from the ups and downs of yin and yang. Asking about cold and heat means asking whether the patient is afraid of cold or heat.
1. aversion to cold, fever and aversion to cold refer to the patient's fear of cold. Aversion to cold and fever occur at the same time, which is more common in the stage of exogenous diseases. The ancients said that "aversion to cold leads to symptoms." Therefore, aversion to cold and fever is an important basis for the diagnosis of exterior syndrome.
(1) aversion to cold and slight fever: The patient obviously feels aversion to cold with slight fever, which is the characteristic of exogenous wind-cold.
(2) Fever is more serious than aversion to cold: the patient's fever is heavier and aversion to cold is lighter, which is the characteristic of exogenous wind-heat and the exterior syndrome of wind-heat.
(3) Fever is mild, and the wind is evil: the patient feels slight heat, and when he meets the wind, he feels cold, so he can take shelter from the wind, which is caused by exogenous wind evil and is a cold syndrome.
2. But cold is not hot, but cold is not hot, which means that patients only have the feeling of being afraid of cold and have no feeling of fever, and most of them are true cold or deficiency cold syndrome. There are two kinds of patients who are afraid of cold: cold and cold. "Afraid of cold" means that patients are afraid of cold, but it can be alleviated by adding clothes and being warmed by quilt or near the fire. "aversion to cold" refers to the patient's fear of cold, which can not be alleviated even if he is dressed or warmed by fire. Yang Qi's deficiency can't warm the body, and there may be deficiency-cold syndrome of being afraid of cold but not hot; Feeling the cold pathogen is heavier, the yang is suppressed, and the fur loses temperature, which can lead to the syndrome of excess cold that only hates cold but does not feel heat.
3. But hot but not cold but hot but not cold means that the patient only feels hot, does not feel cold, or hates heat. Mostly internal heat syndrome.
(1) excess heat: refers to the patient's persistent high fever, and he hates heat instead of cold. It is more common that wind-cold turns into heat, or wind-heat dissipates internally, and symptoms such as sweating and polydipsia often appear. The inside is full of evil, the inside is full of heat, and there is steam outside, so the heat potential is weak and strong.
(2) Hot flashes: fever occurs in a specified period, and fever or fever is even worse in a certain period of time.
① Hot flashes due to yin deficiency: whenever fever occurs in the afternoon or at night, it belongs to "internal heat due to yin deficiency", which is characterized by five upset nerves and even has the feeling that heat permeates from the depths to the outside, so it is also called "bone steaming hot flashes". Often accompanied by night sweats, zygomatic redness, dry mouth and throat, red tongue and insufficient body fluid.
② Wet temperature and hot flashes: It is very hot in the afternoon, but the body is not hot. Its disease is mostly in the spleen and stomach, which is difficult to penetrate because of dampness, so the body is not hot, not hot at first, but hot for a long time.
(3) Yangming hot flashes: it means that it is often very hot during the day (3-5 pm). Most of them are caused by hot and dry stomach. Often accompanied by abdominal pain, refusal to press, dry stool and so on.
(3) Low fever: refers to low fever or only conscious fever. It is more common in people who have been ill for a long time because of qi deficiency and fever, often accompanied by pale face, lack of food and fatigue, shortness of breath and laziness.
4. Cold and heat exchange Cold and heat exchange refers to the alternation of aversion to cold and fever, which is a manifestation of the struggle between good and evil in the human body, and is more common in Shaoyang disease or malaria. There is no time sequence of cold and heat in shaoyang disease, but there is time sequence of cold and heat in malaria.
(2) Sweating
Sweat is heart fluid, which is formed by steaming Yang Qi into body fluids. When you ask about sweating, you should first pay attention to whether you are sweating, and then learn about other situations of sweating.
1. At the initial stage when the human body feels exogenous pathogenic factors, exterior syndromes such as aversion to cold and fever often appear. Exterior syndrome of anhidrosis is mostly exogenous cold pathogen, such as typhoid exterior syndrome; The exterior syndrome is sweating, which mostly belongs to exogenous wind evil, such as solar apoplexy or exogenous wind-heat syndrome.
2. When people are quiet due to activities or other factors, spontaneous sweating is called spontaneous sweating. Mostly caused by qi deficiency and external insecurity, often accompanied by mental fatigue, fatigue, shortness of breath, chills and so on.
3. Night sweats refer to sweating when you fall asleep, but when you wake up, it will stop sweating, mostly caused by yin deficiency and hyperactivity of yang and evaporation of yin and body fluid, often accompanied by five upset, insomnia, red cheekbones, dry mouth and dry throat.
4. Sweating profusely and discharging a lot of body fluids. Sweating and steaming, with high fever, polydipsia and cold drinks, and heavy pulse, mostly due to excess heat syndrome of yang heat; Sweating like rain, accompanied by shortness of breath and fatigue, cold limbs and slightly heartbroken pulse, is the danger of yang failure and loss of vitality.
5. War sweat is more common in fever. First, I trembled all over, and after several struggles, I sweated. This is a manifestation of the struggle between evil and righteousness.
If the fever goes down and the body cools down after the war, it is a manifestation of getting rid of evil spirits and turning right. If you feel excited after sweating, your pulse will accelerate, which is an important manifestation of evil overcoming health decline.
6. Local sweating (1) Head sweating: Head sweating refers to sweating only on the head or the top of the head, also known as "sweating only on the head". Most of them are caused by pathogenic heat in the upper jiao or damp-heat stagnation and steaming in the middle jiao. After a serious illness, the forehead sweats, mostly because of deficiency syndrome. Headache due to a serious illness is due to yang deficiency ascending yue, yin deficiency failing to converge yang, and yin and body fluid escaping with qi.
(2) Semi-sweating: Semi-sweating refers to sweating on the left or right side of the body, or sweating on the upper or lower body. All of them are caused by wind phlegm or rheumatic pathogens blocking human meridians, or disharmony between ying and Wei, or disharmony between qi and blood, which makes the operation of qi and blood unfavorable.
(3) Hyperhidrosis of hand, foot and heart: Patients with hyperhidrosis of hand, foot and heart are mostly related to the spleen and stomach. Spleen and stomach diseases, abnormal transport and transformation, body fluid reaching its side limbs, sweaty hands and feet.
(3) Asking about pain
Pain is a patient's conscious symptom and one of the common clinical symptoms. It can occur in many parts of the human body.
The causes of pain are different from deficiency and excess, cold and heat. Clinically, patients who complain of pain should first find the painful part, and then judge the deficiency of cold and heat according to the nature of pain. Under normal circumstances, the pain is mostly qi stagnation; Sting and pain parts are motionless, mostly blood stasis; Severe pain, refusal to press, mostly empirical; Persistent pain and happy pressing are mostly deficiency syndrome; The pain site is uncertain, and it is migratory, mostly rheumatism.
Traditional Chinese medicine believes that the main mechanism of pain is stagnation of qi and blood. The pain theory in Huangdi Neijing says: "The emperor said: I would like to hear the pain of the five internal organs. What is the reason? " Qi Bo said to him: "Meridian is not only popular, but also endless. When the cold enters the meridians, it will be delayed, but you can't cry. When the guest is outside the pulse, there is little blood, and when the guest is in the pulse, he will die, so the pain of death is also. "
1. Headache at the pain site (1): Headache can be caused by many reasons, whether it is exogenous six evils or internal seven emotions, whether it is pathogenic qi deficiency or positive qi deficiency. By understanding the nature, location and syndrome of headache, we can make a correct analysis and judgment.
Judging from the location of the headache: there is eyebrow muscle pain on the forehead, which belongs to the headache of Yangming meridian; Pain near the temple is a headache of shaoyang meridian; Pain in the back of the head is a headache of the sun meridian; Top pain is headache in Jueyin meridian.
Judging from the nature of headache: those with severe headache, endless pain, acute onset and short course of disease are mostly exogenous headaches, which are empirical; Pain is intermittent, accompanied by dizziness, mostly internal injuries and headaches; Headache is persistent, and overwork is very serious, which belongs to qi deficiency headache; Patients with brain empty pain and soreness of waist and knees belong to kidney deficiency headache; Headache, like foreskin, is a rheumatic headache.
(2) Chest pain: The chest is where the heart and lungs are located, and the pathological changes of the heart and lungs can cause discomfort and pain in the chest. Such as chest pain, purulent cough with blood, more common in lung carbuncle; Chest pain and shortness of breath, accompanied by fever, coughing up rust-colored sputum, mostly lung heat; Chest pain, hot flashes, night sweats, blood in sputum, mostly tuberculosis; Chest pain runs through the back, and back pain runs through the chest, which is mostly caused by deficiency of heart-yang and phlegm-blood stasis. A dull pain in the chest, pain like a needle knife, and even a gray face, is "true heartache"; Chest pain is full, mostly phlegm; Chest tightness and pain, belching and pain are reduced, which are mostly caused by qi stagnation.
(3) hypochondriac pain: hypochondriac pain can be caused by diseases such as stagnation of liver qi, stagnation of liver fire, damp-heat in liver and gallbladder, blood stasis and qi stagnation.
(4) epigastric pain: "epigastric pain", also known as "epigastric pain", refers to the upper abdomen. Stomach pain is mostly deficiency syndrome, mostly empirical. The cold pain in the epigastric cavity is more severe, and the heat pain is reduced, which belongs to the cold evil invading the stomach; Heartburn pain, hunger, halitosis and constipation belong to stomach fire; Stomach pain and belching belong to liver-qi invading the stomach, and qi stagnation is uncomfortable; The epigastric cavity is stinging and the pain is limited, which belongs to blood stasis in the stomach fu-organs; Those who have dull pain in the epigastric cavity, like warm pressure and spit clear water belong to deficiency of stomach yang.
(5) Abdominal pain: Abdominal pain above navel belongs to the spleen and stomach; Below the umbilicus to above the pubic hairline is called the lower abdomen, which belongs to the kidney, bladder, large intestine and uterus; On both sides of the lower abdomen, there is a lower abdomen, where the liver meridian of Foot Jueyin passes. Abdominal pain, warm pressure, loose stool, spleen and stomach deficiency and cold; Abdominal distension and abdominal pain, unfavorable urination, incontinence; Less abdominal cold pain, traction of genitals, cold coagulation of liver pulse; Pain around the navel, there is a lump, and most of them can move by pressing. Severe abdominal pain, refusal to press, mostly empirical; Abdominal pain is slow, and most of them like to press deficiency syndrome.
(6) Low back pain: the waist is the house of the kidney, and those with persistent pain and weakness belong to kidney deficiency and low back pain; The cold pain in the waist is heavier, and it is aggravated in rainy days, which belongs to cold and wet low back pain; Low back pain, such as stabbing, is determined by pain, mostly caused by falling servants and blood stasis blocking the waist.
(7) Limb pain: Limb pain is caused by the invasion of pathogenic wind, cold and dampness, which blocks the circulation of qi and blood. It is also due to the damage of spleen and stomach, Shui Gu's vital energy is not transported, and his limbs are dystrophy, which belongs to deficiency syndrome; Pain only appears in the heel and even the back, mostly caused by kidney deficiency.
2. The nature of pain (1) Swelling pain: the combination of swelling pain is called "distending pain", and its pathogenesis changes are mostly qi stagnation, such as stomach pain caused by moderate focal qi stagnation and chest pain caused by liver depression and qi stagnation. Headache is more common in the syndrome of hyperactivity of liver yang or hyperactivity of liver fire.
(2) Severe pain: the combination of pain and heaviness is called "severe pain", and its pathogenesis changes are mostly caused by dampness blocking qi and blood, such as severe headache caused by dampness blocking qi and blood, severe pain in limbs, and severe pain from falling back.
(3) Stinging: The person who stings is called "stabbing pain", and its pathogenesis changes are mostly blood stasis, such as stabbing pain in chest, hypochondrium, lower abdomen and upper abdomen.
(4) Colic: Pain such as colic is called "colic". Its pathogenesis changes are mostly caused by pathogenic factors blocking qi, such as true heartache caused by blood stasis, small abdominal pain caused by stranguria, abdominal pain caused by ascaris lumbricoides and so on.
(5) Burning pain: The combination of pain and burning pain is called "burning pain", and its pathogenesis changes are mostly caused by obstruction of collaterals by fire pathogen or excessive fire due to yin deficiency, such as hypochondriac pain caused by obstruction of collaterals by fire pathogen and epigastric pain caused by insufficient stomach yin.
(6) Cold pain: The pain with cold sensation is called "cold pain", and its pathogenesis changes are mostly cold pathogen blocking collaterals or yang deficiency and tepid, and the common ones are cold pain in head, waist and abdomen.
(7) Hidden pain: the pain is not intense and lingering, and its pathogenesis changes are mostly qi and blood deficiency, endogenous yin cold, qi stagnation and blood stasis. , such as head, abdomen, waist and other virtual pain.
(8) Traction pain: traction or traction is called "traction pain", and its pathogenesis changes are mostly tendon dystrophy or tendon block.
The main muscle of the liver, and pain is mostly related to liver disease.
(9) Deficiency pain: the pain with emptiness belongs to "deficiency pain", and its pathogenesis changes are mostly deficiency of qi and blood, such as head and abdomen pain.
(4) Ask about sleep.
Sleep is an important part of human physiological activities. Traditional Chinese medicine believes that Wei Qi moves in the Yang meridian during the day, moves in the Yin meridian at night, wakes up in the Yang and sleeps in the Yin. Sleep disorders are mainly manifested in two aspects: insomnia and lethargy.
Insomnia: it is difficult for patients to fall asleep, wake up easily after sleep, or stay up all night, which is a pathological manifestation of yin deficiency or yang deficiency, yang failing to enter yin, uneasy mind and uneasy mind; Insomnia and irritability at night, accompanied by abdominal distension and thick and greasy tongue coating, are caused by stomach disharmony, turbid qi attacking and disturbing the mind.
Sleepiness: lethargy is easy to drowse, accompanied by dizziness and fatigue, which belongs to phlegm-dampness and spleen deficiency; After a meal, the spirit is tired and sleepy, and it is easy to fall asleep. At the same time, the body is weak and the temper is weak.
(5) ask about the taste of food.
Diet is the basic condition for human survival, and the generation of qi and blood in human body is related to diet, and the taste of diet often changes when diseases occur.
1. Appetite and appetite refer to the requirement and desire to eat. Food intake refers to the actual amount of food consumed.
(1) Loss of appetite: including anorexia, anorexia and anorexia. If you don't want to eat, you don't want to eat, or if you eat tasteless and eat less, it is also called loss of appetite; Eating less means eating less, which is often caused by loss of appetite; Naidai means no hunger, no food requirements, even bad food. Loss of appetite for new diseases is generally a protective reflection of healthy qi against evil spirits; Loss of appetite after a long illness, accompanied by mental fatigue, sallow complexion, pale tongue and weak pulse, are mostly manifestations of spleen and stomach weakness; Eating too little, feeling sleepy in the head and body, abdominal distension, and thick and greasy tongue coating are mostly caused by damp stagnation of the spleen or diet and poor transport and transformation of the spleen and stomach.
(2) Anorexia: Anorexia refers to aversion to food or the bad smell of food. There are anorexia, belching, acid rot, abdominal distension and so on. , belonging to food accumulation; There are greasy foods that belong to spleen and stomach dampness, chest tightness and nausea, and loose stool's discomfort; Damp-heat in liver and gallbladder, burning pain in hypochondriac ribs, low body heat and greasy and sticky smell.
(3) Eliminating hunger means overeating. Soon after eating, you will feel hungry and eat too much. Most of them belong to stomach fire, such as hunger, thin body and dry mouth. Eating too much is easy to get hungry, and the stool is loose, mostly because the stomach is strong and the spleen is weak.
(4) Hunger: It means that although the patient is hungry, he doesn't want to eat or doesn't eat much. Most of them are caused by deficiency of stomach yin and internal disturbance of deficiency fire.
(5) Food preference: I like to eat raw rice, mud and other foreign bodies. Common in children, mostly parasitic diseases. Women who prefer certain foods during pregnancy generally don't get sick.
2. Taste refers to the abnormal taste or smell in the mouth. Most delicious mouths are spleen and stomach qi deficiency or cold syndrome; Bitter mouth is more common in the liver and gallbladder, and the gallbladder is rebellious; Sweet mouth is mostly caused by exogenous damp-heat accumulated in spleen and stomach, or spleen deficiency; Stomach acid is more common in liver qi invading the stomach, disharmony between liver and stomach, or food stagnation and rancidity; Mouth astringency is more common in body fluid injury caused by dryness and heat, or excessive yang heat in zang-fu organs and rising of qi and fire; Salty mouth is mostly related to kidney deficiency and cold water; Stickiness in the mouth is more common in wet and turbid diet and accumulation of phlegm.
(6) Ask if you are thirsty.
1. mouth thirst reflects the rise and fall of body fluid and its distribution in the body. If the mouth is not thirsty and you don't want to drink, the body fluid will not hurt, which is more common in cold syndrome and wet syndrome.
2. Thirst for drinking is the manifestation of body fluid injury, which is more common in dryness syndrome and heat syndrome. Such as thirst, fever, slight aversion to cold, sore throat, etc. , more common in exogenous fever; Very thirsty for cold drinks, red face and sweating, rapid pulse, etc. , more common in Yangming meridian syndrome; Thirst for hot drinks, not much water, mostly due to phlegm or yang deficiency, water and body fluid can not bear; Thirst, less drinking, low body temperature, heavy head and tiredness, nausea, yellow and greasy tongue coating, which are more common in damp-heat resistance and body fluid gasification disorder; Drinking when thirsty, vomiting immediately after drinking, stopping drinking in the stomach is not conducive to gasification, which is called "water reverse" syndrome; When pathogenic heat enters the camp, it can also be seen that thirst and drinking water are not much.
I am thirsty, but I don't want to drink water. Although thirsty, I don't want to drink water, mostly because of dampness.
(7) Ask two questions.
The discharge of urine and feces is a normal physiological phenomenon of human body, such as abnormal changes in character, color, smell, time, amount of urine and feces, defecation times, defecation feeling and so on. It is a pathological phenomenon.
1. Stool (1) Constipation: The stool is dry and hard, difficult to be discharged, the interval between defecation is long, and the frequency of defecation is reduced, which is called "constipation". If you see hot flashes on a fever day, most of them belong to the hot colon; Constipation in the elderly is mostly caused by insufficient body fluid or deficiency of both qi and liquid.
(2) Diarrhea: The stool is thin, soft and shapeless, even watery, and the stool frequency increases and the interval is shortened, which is called "diarrhea".
The change of stool shape is mostly due to the loss of spleen defense, turbid small intestine and wet water, which tends to large intestine; The stool is dry first and then swollen, mostly due to spleen and stomach weakness; When the stool is dry, it is mostly due to liver depression and spleen deficiency, and the liver and spleen are not harmonious; It is often diarrhea in the fifth watch, and the Lishui Valley does not change, which is called diarrhea in the fifth watch, mostly due to spleen and kidney yang deficiency; Celiac disease is mostly damp-heat in large intestine; Li Xia is sour and smelly, and most of it is indigestion.
Abnormal defecation sensation includes: anal burning during defecation, mostly heat forcing rectum; The stool can't help slipping, and the anus has a feeling of falling or even rectocele, which is more common in spleen deficiency subsidence; When defecating, it is urgent first and then heavy, which is more common in dysentery; Fecal discomfort is mostly the manifestation of liver failure to relieve diarrhea.
2. Abnormal urine volume (1): excessive urine volume, mostly caused by deficiency-cold syndrome or diabetes; Short and red urine can be seen in body fluid injury caused by excessive heat, or hyperhidrosis, vomiting and diarrhea, or abnormal lung, spleen and kidney function, unfavorable gasification, etc. Urine obstruction, dripping is "retention", urine obstruction, dripping is "retention", generally called "retention", mostly due to damp-heat betting or blood stasis stone obstruction, or kidney yang deficiency, or kidney yin loss and body fluid exhaustion.
(2) Abnormal micturition: refers to the increase of micturition frequency and the desire to micturite. For example, frequent micturition, short micturition, red micturition and urgent micturition caused by new diseases are mostly damp-heat in lower energizer; Frequent urination, clear and colorful urine volume, excessive deficiency and cold in the lower jiao, unstable kidney qi and bladder failure; Frequent micturition is mostly due to yin deficiency and internal heat; The decrease of urinary frequency can be seen in the loss of body fluid, insufficient chemical source, or unfavorable gasification, and the water stops wet.
(3) Abnormal urine sensation: urethral pain during urination, accompanied by urgency, difficulty and burning sensation. , mostly due to wet and hot betting caused by gonorrhea; After urinating, I feel empty and painful, and most of them fail because of insufficient kidney qi; The residual water after urine is endless, which is mostly caused by insufficient kidney qi; Involuntary urination, or uncontrollable dripping of urine, is mostly "urinary incontinence" with unstable kidney qi; If accompanied by coma, it is mostly critical syndrome.
(eight) ask the warp belt
Women have physiological characteristics of menstruation, leucorrhea, pregnancy and childbirth. Therefore, in addition to the above, women should also be asked about menstruation and childbirth.
1. Ask about menstruation. Female patients must ask about menstruation, including menarche age, menstrual cycle, menstrual days, menstrual blood color and presence of blood clots.
(1) Question about menstruation: The menstrual cycle is generally around 28 days. If the menstrual period is more than eight or nine days earlier, it is menarche, which is mostly caused by pathogenic heat forcing blood to rush, or qi deficiency can not suck blood, and blood circulation is out of control; If the menstrual period is more than eight or nine days later, it is the late menstrual period, mostly due to cold coagulation and qi stagnation, poor blood circulation, or blood deficiency and less pulse; If the menstrual period is disordered, or irregular before and after, it is mostly due to stagnation of liver qi, deficiency of both spleen and kidney, or blood stasis, and abnormal operation of qi and blood.
(2) Menstruation: excessive menstrual flow, mostly due to blood heat, or damage to chong and ren, or qi deficiency can not suck blood; Too little menstruation, mostly due to blood deficiency and biochemical deficiency, or cold coagulation, phlegm resistance, etc., so that blood circulation is not smooth; No pregnancy after menstruation for more than three months is "amenorrhea", which means qi deficiency and blood deficiency, or blood stasis, or blood cold stagnation. Menopause is not morbid because there is no obvious discomfort due to the change of living environment.
(3) Color: Normal menstruation is red in color, with neither thin nor thick texture and no blood clots. If the blood color is reddish and thin, it is mostly blood deficiency and loss of integrity, which belongs to deficiency syndrome; The blood color is deep red and thick, which belongs to blood heat, which is empirical; Blood is purple-black, with lumps, mostly caused by cold coagulation and blood stasis.
(4) Menstrual abdominal pain: pain in the waist and abdomen during menstruation, even unbearable severe pain, occurs with the menstrual cycle and is called "dysmenorrhea".
Abdominal distension and pain before or during menstruation are mostly caused by qi stagnation and blood stasis; Cold pain in the lower abdomen, slow when warm, mostly cold coagulation; After menstruation, there is dull pain in the lower abdomen or backache, mostly due to lack of qi and blood and pulse dystrophy.
2. Leucorrhea refers to a small amount of milky white and tasteless secretions in women's vagina, which has the function of moistening the vagina. If leucorrhea is excessive, dripping continuously, with color, qualitative change or foul smell, it belongs to pathological leucorrhea. Such as leucorrhea, colorful leucorrhea, thin as tears, mostly due to spleen and kidney yang deficiency, cold and dampness betting; Yellow, sticky and smelly, mostly hot and humid bets; Leucorrhea is red and white, mostly due to liver meridian heat depression, or hot and humid betting.