Chinese medicine attaches great importance to visiting doctors, and Neijing says, "Knowing by looking is the God", and knowing by looking is the work in the four diagnoses. Inspection is a method for doctors to visually examine the abnormal changes of the patient's spirit, color, shape, posture, tongue picture, secretion, excrement and body parts, and then diagnose diseases.
Chinese medicine inspection mainly includes two aspects: look and shape.
1. Look
Look refers to the patient's spirit and color. Looking at the face includes the overall observation of the patient's mental state, facial color, body movements and postures.
(1) Looking at God
In traditional Chinese medicine, the concept of "God" is relatively broad. In a broad sense, it refers to the vitality of the human body, so the significance of looking at God is very important.
To look at God as a whole, we should carefully observe the patient's manners, movements, language, expression and eyes.
1. Looking at the eyes is the window of the soul. The Theory of Lingshu Dazzling says: "The essence of the five internal organs is focused on the eyes and refined." It is also said that "the eyes are driven by the heart", so the functional state of the two eyes can reflect the rise and fall of human viscera and essence, and to some extent reflect the state of human life phenomenon as a whole. The eyes are black and white, shiny, flexible, and clear-cut as a spirit, which is a manifestation of sufficient essence of viscera; Dull eyes, lack of luster, unclear vision, inflexible movement, or floating light exposure are manifestations of deficiency or deficiency of viscera essence.
staring at the eyes, which is called "wearing eyes", is mostly due to the exhaustion of vital qi, and the essence is not superior to the eyes, which is a manifestation of critical illness.
2. Looking at the expression refers to people's facial expressions, which are the external manifestations of the mind and one of the external manifestations of people's mental consciousness and thinking activities. Looking comfortable, relaxed and happy is a manifestation of healthy qi; Dull expression, slow response and dull expression are manifestations of mental damage. In a word, people's clear mind, orderly thinking, normal mood and proper behavior are the normal manifestations of God's functional state; When the mind is disturbed or deprived of nourishment, people may be confused, confused, emotionally extreme, or acting strangely.
3. God who has gained and lost
(1) God: also known as "God". The clinical manifestations are lucid mind, flexible eyes, bright eyes, steady breathing, clear language, radiant face, free movement and quick response. It shows that the human body is full of vital qi, full of essential qi, and the body functions normally and healthily. If it is sick, it is also a light syndrome that vital qi is not injured and essential qi is not decayed.
(2) Insufficiency of spirit: the clinical manifestations are listlessness, lack of vision, pale complexion, flabby muscles, fatigue, lack of breath, laziness in speaking and slowness in moving. It shows that the vital qi is insufficient, the essence is damaged and the body function is weak. Can be seen in the recovery period of mild illness or disease or weak constitution.
(3) Absence: also known as "absence of god". The clinical manifestations are listlessness, dull complexion, dull eyes, slight or shortness of breath, language disorder, thin body, difficult movements, slow response, and even confusion. It shows that vital qi is seriously injured, essence and qi are deficient, and the body function is seriously declining. It is more common in patients with long illness and serious illness.
false gods: refers to all kinds of false clinical manifestations in which critically ill patients are temporarily "better". The clinical manifestation is that people who have been ill for a long time or are seriously ill have been absent, but suddenly they are awake, their spirits are getting better, their speech is increasing, their appetite is increasing, they want to see their relatives, their faces are dull, and their cheeks are red as makeup. The overall situation of his body is not consistent with his sudden changes, indicating that the patient's viscera and vital energy are extremely exhausted, the vital qi will be removed, the yin will not converge on the yang, the deficiency of the yang will exceed, and the yin and yang will soon be separated. Clinically, it is more common in critically ill patients, which is often the manifestation of the patient's dying.
insanity: the clinical manifestations of insanity are anxiety and fear, or mania, or indifference and dementia, sudden fainting, etc., most of which are recurrent attacks, and the manifestations of insanity in remission are not obvious.
(2) looking at the color
looking at the color is to observe the color of the patient's skin surface, mainly to observe the color of the face in clinic. This diagnostic method is also called "five-color diagnosis". Traditional Chinese medicine believes that the five zang-organs are dominant colors, with green dominating the liver, red dominating the heart, yellow dominating the spleen, white dominating the lung and black dominating the kidney; The five internal organs dominate the prosperous season respectively in a year, such as liver governing spring, heart governing summer, spleen governing long summer, lung governing autumn and kidney governing winter. In the four seasons of the year, the five colors of the five zang-organs are presented according to their prosperous times, not as sick colors.
1. The normal color of the human body should be subtle and shiny, and it can't be completely exposed. Huangdi Neijing said: "Red desire is like white wrapped in Zhu ... white desire is like goose feather ... green desire is like pale jade ... yellow desire is like Luo wrapped in realgar ... black desire is like heavy paint color", indicating that five colors should be implied, such as red color should be white inside and red, yellow color should be white inside and yellow. Due to the differences in skin color and individual characteristics, such as slightly white or slightly black, it also belongs to the normal range. As the Golden Mirror of Medical Zong said: "The color of the five internal organs, as seen by people of the five elements, remains unchanged for a hundred years, so it is the main color." Because man and nature are a whole, the skin color of man will change slightly with the change of natural seasons and temperature, such as the complexion becomes slightly green in spring, slightly red in summer, slightly white in autumn, slightly black in winter, etc., but this is not obvious and needs careful observation to be identified.
2. Sick color Because of illness, people often change their color. Generally speaking, cyan dominates pain, white dominates cold, and yellow and red dominates heat. If the color is completely exposed, it is a manifestation of long illness and serious illness.
white: deficiency syndrome, cold syndrome, blood loss and qi loss. The patient's face is pale, which is caused by qi deficiency and less blood or yang failure and cold excess, so that qi and blood can not be honored on the face. Those with pale complexion and pale lips mostly belong to blood deficiency syndrome or blood loss syndrome; Those with white complexion are mostly yang-deficiency syndrome, and those with both deficiency and buoyancy are mostly yang-deficiency and watery; Pale face, mostly due to the sudden loss of yang spirit or yin cold.
yellow: spleen deficiency syndrome and dampness syndrome. The patient's complexion is yellow, which is caused by the loss of nutrition due to spleen deficiency, or the accumulation of damp evil and the loss of spleen health.
people with sallow complexion mostly belong to spleen-stomach qi deficiency syndrome; Those with yellow face and vain floating mostly belong to spleen deficiency and dampness accumulation syndrome; Those who are all yellow in appearance, the bright yellow belongs to the yang yellow of jaundice, and the dark yellow belongs to the yin yellow of jaundice.
red color: the main heat syndrome can also be seen as Dai Yang syndrome. The patient's face is red, which is caused by the expansion of facial veins caused by yang heat, the filling of qi and blood or the floating of deficiency yang. Those with flushed face mostly belong to excess heat syndrome with excessive pathogenic heat; In the afternoon, those with flushed cheeks mostly belong to the syndrome of yin deficiency and hyperactivity of yang and hyperactivity of fire due to deficiency. A person who is pale after a long illness and serious illness, but sometimes his face is as red as makeup, belongs to Dai Yang's syndrome that yin fails to converge yang and deficiency yang floats.
cyan: it governs cold syndrome, pain, qi stagnation, blood stasis and convulsion. The patient's face is blue, which is caused by cold coagulation and stagnation of qi, or internal resistance of blood stasis, or facial vein stasis caused by tendon spasm. Those with pale or black faces are mostly cold and painful dramas; Those with blue complexion and lips mostly belong to the syndrome of heart-qi and heart-yang deficiency; Those with pale complexion, blue lips and weak pulse in limbs mostly belong to the true heartache syndrome of sudden loss of heart yang; Those with yellowish complexion can be seen in the syndrome of liver depression and spleen deficiency; Children with blue eyebrows, nose column and lips are mostly of the syndrome of convulsion caused by excessive pathogenic heat.
Black refers to kidney deficiency, cold syndrome, water drinking syndrome and blood stasis syndrome. Deficiency of kidney-yang, excess of Shui Han, loss of warm blood and poor blood circulation. < P > Those with dark complexion mostly belong to the syndrome of kidney-yang deficiency due to yang deficiency, fire failure, Shui Han failure and warmth; Those with dark complexion and scorched dryness mostly belong to kidney-yin deficiency syndrome with yin deficiency and excessive fire and malnutrition; Those with black eyes around the orbit mostly belong to water-drinking syndrome of kidney deficiency or leukorrhagia syndrome of cold and dampness; Those with dark complexion and wrong nail are mostly blood stasis syndrome with a long course of disease.
(3) Looking at the luster
The skin color and complexion are radiant and shiny, which are the manifestations of the essence of the zang-fu organs; The complexion and skin are withered, dark and dull, which indicates that the viscera and qi of the human body are insufficient, and the stomach qi cannot be glorious. Generally speaking, new diseases, mild diseases and yang syndromes are bright and moist, which are "good colors"; Long-term illness, serious illness, and gloomy Yin syndrome are "evil colors". Just as "Su Wen's pulse should be subtle" said: "The husband is smart and colorful, and he is also full of qi. He wants to be as white as Zhu, but he doesn't want to be like a shackle; White desires are like goose feathers, but not like salt; Green desire is like the color of pale jade, but not like blue; Yellow wants to be wrapped in realgar, but not like loess; Black desire is like heavy paint, and I don't want to be like the ground. "
ii. gazing form
gazing form mainly includes gazing form and gazing posture.
(1) looking body
1. Five bodies and five bodies refer to tendons, veins, meat, skin and bones. Traditional Chinese medicine believes that these are the parts where the five zang-organs are exposed, and the changes in these parts can be used to judge the rise and fall of qi and blood in the zang-fu organs.
Fat and thin: A normal body should be moderately fat and thin, and being too fat or too thin is a disease state. Those who are obese, dull in complexion and depressed in spirit belong to "qi deficiency due to excess of form", mostly due to deficiency of yang; Thin body, sallow complexion, narrow chest and dry skin are more common in yin and blood deficiency; The big meat has disappeared, and the gas is weak and timid, which is more common in the failure of essence.
Fascia: strong tendons, fatigue tolerance, and flexible joint movements reflect the fullness of liver blood; On the contrary, muscle weakness, fatigue, and unfavorable joint flexion and extension are the manifestations of liver blood deficiency's weakness in blood.
fur: the fur is moist and shiny, and the muscle abscess closely reflects the lung qi sufficiency; Dry and gaunt fur and loose muscles are manifestations of lung qi deficiency.
bones and hair: the bones are strong and strong, and the tall and straight figure reflects that the essence of the kidney is sufficient, and the essence can fill the marrow, and the marrow can nourish the bones; For example, the bones are fragile, or the bones are soft and weak, or the body deformity is a manifestation of insufficient kidney essence and loss of bone support. Traditional Chinese medicine believes that the kidney is "blooming", and the rise and fall of kidney qi can be reflected from the prosperity and decline of hair. The dry hair and easy folding are kidney essence loss; Hair thinning, easy to fall off, or dry hair, mostly due to insufficient blood and essence; Sudden flaky alopecia, mostly due to blood deficiency and wind; Young people's hair is sparse and easy to fall, and dizziness, forgetfulness, and soreness of the waist and knees are mostly kidney deficiency; The scalp is itchy, dandruff and fatty, mostly due to blood heat and dryness; Children's hair is sparse, yellow and soft, growth is slow, or even undeveloped for a long time, mostly due to congenital deficiency and kidney essence loss; Children's hair knots are like spikes, and they are yellow and dull, which is more common in malnutrition syndrome. "Teeth are beyond bones", and the dryness and loss of teeth are also manifestations of kidney qi deficiency and kidney essence dystrophy.
2. Hope physique is the individual quality of physical structure and function formed in the process of human growth and development, which can reflect the difference of yin and yang, the rise and fall of qi and blood and the difference of endowment to a certain extent, and is helpful for the diagnosis of diseases.
The figure tends to be short and fat, with broad shoulders and thick chest, round head and thick neck, and he likes heat and hates cold, and has a lot of stool. It is characterized by weak yang and strong yin, and it is easy to change from yin to cold after illness.
The figure tends to be slender, with narrow shoulders and flat chest, long head and thin neck, and likes cold and heat, and the stool is dry. It is characterized by yin deficiency and yang excess, and it is easy to change from yang to heat after illness.
The body shape is between the above two, which is characterized by the balance of Yin and Yang and the balance of Qi and blood, and is the physique type of most people.
(2) gaze posture
gaze posture is to observe the performance characteristics of patients in behavior and movements, such as the likes and dislikes of patients' sitting posture and lying posture, and the dynamic and static state of patients is closely related to the rise and fall of yin and yang of the body.
In the state of illness, if the patient is lying down, his body is light and turns freely, and his face is often outward, his symptoms are mostly yang, heat and excess; The patient's weight is difficult to turn sideways, his face is often inward, and his spirit is sluggish. Most of his symptoms are yin, cold and deficiency. When patients lie down, they stretch their feet on their backs and often take off their clothes and quilts, which mostly belong to heat syndrome; When patients lie down, they curl up into a ball and like to add clothes and quilts, which are mostly cold syndrome; The patient is not allowed to lie down when sitting, but wheezes when lying down, which is mostly caused by water vapor; Patients sit with their heads up, and most of them are filled with phlegm and saliva in their lungs; Patients who sit and bow, are short of breath and lazy to talk, mostly due to lung deficiency or kidney failure to accept qi; The patient is not allowed to lie down when sitting, but wheezes when lying down, which is mostly caused by water vapor.
when a disease occurs, patients often have some abnormal actions. The patient's lips, eyelids, fingers and toes vibrate, which is more common in the early stage of exogenous febrile diseases or internal injuries, such as deficiency of qi and blood and dystrophy of tendons and veins; Neck rigidity, eyes looking up, limbs twitching, angular arch stretching back, which are common in liver wind moving due to extreme heat; Sudden fall, unconsciousness, skewed mouth, hemiplegia, is a stroke syndrome; The pawn fell unconscious, spat at the mouth, twitched limbs, and woke up as usual, which was epilepsy; Weak limbs, ineffective movements, mostly flaccidity syndrome; Following clothes and touching the bed, hands are empty, mostly critical syndromes.
3. Looking at the head and face
(1) The head
is a smart house, and the brain is a sea of marrow. The marrow is transformed from essence and the kidney is rich in essence. Therefore, the change of head shape can reflect the essence of the five internal organs, especially the kidney. Abnormal head shape, or abnormal head shape, is more common in infants and young children who are in the developmental stage. There are two fontanels at the top of children's head, the front fontanel is rhombic and closed about 12 ~ 18 months after birth, and the back fontanel is triangular and closed about 2 ~ 4 months after birth. < P > Children's skulls are evenly enlarged, cranial sutures are cracked, their faces are small, and their intelligence is low. Most of them are congenital deficiency and kidney essence deficiency. Children's heads are narrow, the top of the head is round, the cranial suture is closed early, and their intelligence is low, mostly due to insufficient kidney essence and skull dysplasia; Children's forehead protrudes left and right, the top of the head is flat, and it is square skull-shaped, mostly due to kidney essence deficiency or spleen and stomach weakness; The fontanel process is mostly empirical, either due to the attack of fire and toxin caused by epidemic febrile disease or the stagnation of intracranial water and fluid; The fontanel depression is mostly a reflection of pathological changes of deficiency syndrome, such as vomiting and diarrhea, deficiency of qi and blood, or brain marrow deficiency due to congenital deficiency of essence and qi. The late closure of fontanel is mostly rickets due to deficiency of kidney-qi and dysplasia.
(2) The cheeks on one or both sides of the face
are swollen with the earlobe as the center, and the edges are unclear, which makes them feel flexible or tender, and they are often mumps; The mouth and eyes are skewed without hemiplegia, the affected facial muscles relax, the forehead lines disappear, the eyes can't be closed, and the nasolabial groove becomes shallow, mostly due to wind evil in the collateral; If the mouth and eyes are skewed, accompanied by hemiplegia, it belongs to the stroke syndrome of hyperactivity of liver yang and obstruction of collaterals by wind and phlegm; The patient's facial expression is frightened, which is more common in children with convulsion and tetanus. The patient's expression is wry, which is more common in neonatal umbilical wind and tetanus hemifacial spasm.
(3) five senses
1. Eye
(1) Eye shape
① Eye cell edema: The eye cell looks like a silkworm, which is the manifestation of Feng Shui syndrome and is caused by excessive water wetness.
② eye socket depression: it is more common in patients with fluid injury or deficiency of qi and blood, such as patients with severe vomiting and diarrhea, patients with chronic illness or serious deficiency of qi and blood, etc.
③ exophthalmos: those with exophthalmos and full breath belong to pulmonary distension; Exophthalmos with slight swelling in front of the neck, impatience and irritability, is gall disease.
④ redness and swelling of eye cells: mostly due to wind-heat in liver meridian, and red canthus mostly due to damp-heat in liver and spleen.
(2) eye color ① redness and swelling of eyes: redness of white eyes is lung fire or exogenous wind-heat, redness and pain of two canthus is heart fire, and redness and swelling of whole eyes is wind-fire attack of liver meridian.
② yellow white eyes: yellow white eyes are mostly jaundice, which is caused by damp-heat or cold-dampness, abnormal liver and gallbladder drainage and bile overflow.
③ the canthus is pale: this is mostly the manifestation that the blood is too little to be proud of the purpose.
④ The color of eye cells is dark: it is mostly caused by deficiency of kidney essence or Shui Han.
(3) eye dynamics ① binocular direct vision: the patient's eyes are fixed forward, and he is unconscious, which is mostly a dangerous syndrome that the viscera and essence will be exhausted.
(2) wearing eyes and turning back: the patient can't turn with his eyes looking up, and has a strong twitch and an upturned horn arch, which is a unique syndrome of the sun meridian.
③ Sleeping eyes with eyes exposed: it is more common in children with spleen deficiency who have vomiting and diarrhea, or slow spleen wind.
④ blepharoptosis: Most of the patients with blepharoptosis are congenital deficiency and deficiency of spleen and kidney; Single eyelid drooping is mostly caused by spleen-qi deficiency or trauma.
2. ear (1) color change ① the helix is pale and white, mostly due to deficiency of qi and blood.
② The helix is red and swollen, mostly due to damp-heat in the liver and gallbladder or heat-toxin attack.
③ The helix is black and blue, which can be seen in patients with yin cold or severe pain.
④ The helix is dry and blackened, which mostly belongs to the severe syndrome of kidney essence deficiency.
⑤ Redness at the back of the ears and coldness at the roots of the ears are mostly signs of measles.
(2) Changes in the ear: The purulent water in the ear is purulent ear, mostly.