Four consultation visits

Doctors use their own vision to observe the whole body and local conditions, so as to obtain information related to diseases, which can be used as the basis for analyzing visceral diseases. Including spirit, color, shape, tongue and catharsis. Including the external manifestations of mental consciousness activities and human life activities, we can observe the patient's mental state, whether the consciousness is awake, whether the response is sensitive, whether the movements are coordinated and so on. Through mental state, facial expression, language breath, etc. So as to judge the rise and fall of human qi, blood, yin and yang and the severity of the disease.

1. The patient's mind is undisturbed, his eyes are flexible, his eyes are bright, his language is clear, and his voice is loud, which shows that vital qi is not damaged, his viscera function is not damaged, his condition is mild, his prognosis is good, and he mostly belongs to excess syndrome, heat syndrome and yang syndrome.

2. The patient is listless, his eyes are dim, his reaction is slow, his language is weak, and his voice is low, indicating that vital qi has been injured and his condition is serious, mostly caused by deficiency syndrome, cold syndrome and yin syndrome. It is seen in serious diseases and chronic diseases.

3. Coma, delirium, restless hands and feet, although manifested as yang syndrome, heat syndrome and excess syndrome, but vital qi has been injured, pathogenic factors are excessive, the disease is deep, and the prognosis is poor. Observe the color of the patient's skin, which is the external glory of the viscera and qi and blood. The change of color can reflect the different syndromes of different zang-fu organs and the different nature of diseases; The change of luster, that is, the glory or decline of skin color, can reflect the rise and fall of viscera essence. "the twelve meridians has 365 collaterals, and its qi is injected into the face". The face is full of qi and blood, the skin is thin and tender, and the color change is obvious, so the complexion mainly refers to the color of the face. Through the change of facial color, it is helpful to understand the rise and fall of qi and blood and the development and change of diseases.

1. Normal people are yellowish, ruddy and shiny.

2. Redness of face: heat syndrome. Blood vessels in congested skin are red. Blood heat, full pulse, and heat syndrome is redder. If the face is flushed, it is mostly real heat; If the cheeks flush, it is mostly due to yin deficiency and excessive fire and insufficient heat.

3. White complexion: deficiency-cold syndrome or blood loss. Blood deficiency, pale complexion. Cold leads to coagulation, cold leads to coagulation of channels and collaterals, and deficiency of blood and qi leads to pulse deficiency. If the face is pale and vain, there will be more qi deficiency; Pale and haggard face is mostly blood deficiency.

4. Yellow complexion: mostly due to spleen deficiency, water is not wet, or skin qi and blood are insufficient. If the face is Huang Liang and yellow, it is mostly damp and hot; The face is dark yellow, mostly cold and wet; Pale, withered, dull and sallow, mostly due to spleen and stomach weakness and insufficient blood supply; The complexion is yellow and fat, which is mostly caused by deficiency of qi and blood and internal dampness.

5. Black complexion: mostly cold syndrome; Deficiency syndrome is often chronic illness, serious illness and yang deficiency. Yang deficiency is cold, water is not wet, and qi and blood stagnate, so it is more common in kidney deficiency and blood stasis syndrome.

6. Pale face: mostly cold syndrome, pain syndrome and liver disease. It is caused by qi and blood obstruction and vein obstruction. Appearance corresponds to the five internal organs. Generally speaking, the five internal organs are strong and the appearance is strong. The five internal organs are weak.

1. Strong physique, full muscles and moist skin indicate strong physique and full righteousness; Thin body, thin muscles and dull skin indicate weakness and lack of healthy qi.

2. Obesity, shortness of breath and fatigue, mostly due to spleen deficiency and excessive phlegm.

3. The body is thin, mostly due to yin deficiency and fire.

4. Difficulties in flexion and extension of hands and feet or swelling are mostly caused by wind, cold and dampness.

5. convulsions, spasms, mostly liver wind.

6. Knee weakness, poor mobility, mostly flaccidity.

7. One hand and foot failed to move, mostly because of stroke and hemiplegia.

tongue diagnosis

Tongue diagnosis is an important method to diagnose diseases in traditional Chinese medicine. Tongue is connected with five internal organs through meridians, so the deficiency and deficiency of viscera, qi and blood, body fluid and the changes of diseases can be objectively reflected in the tongue picture. Through tongue diagnosis, we can understand the deficiency and excess of zang-fu organs and the nature, severity and changes of diseases. Among them, the change of tongue quality mainly reflects the deficiency of viscera and the rise and fall of qi and blood; The change of tongue coating is mainly used to judge the depth and severity of exogenous pathogens and the rise and fall of stomach qi.

Traditional Chinese medicine divides the tongue into tip of tongue, middle of tongue, root of tongue and side of tongue. It is considered that the tip of the tongue belongs to the heart and lung, the middle tongue belongs to the spleen and stomach, the root of the tongue belongs to the kidney, and both sides of the tongue belong to the liver and gallbladder (see Figure 3- 1). According to different parts of the tongue, reflecting different visceral diseases has certain reference value in clinic, but it can't be seen mechanically and needs to be considered comprehensively in combination with other symptoms and signs.

1. Tongue quality:

Refers to the tongue body, mainly observing its color, shape and state.

Normal tongue is reddish in color, fine and moist, fat, thin, old and tender, and flexible in activities, indicating sufficient qi and blood. Can be seen in healthy people, but also can be seen with initial exogenous diseases or mild internal injuries.

(1) Tongue color

① Pale tongue: the color of the tongue is lighter than normal, and blood deficiency is more common in the syndrome of deficiency and cold of the main body, like yang deficiency and deficiency of qi and blood. Pale color and fat tenderness belong to deficiency cold; Fat and tender with tooth marks on the side is qi deficiency and yang deficiency.

② Red tongue: The tongue color is darker than normal and bright red, mainly due to internal heat syndrome. Redness of the tip of the tongue is inflammation of the heart; Red tongue indicates that the liver and gallbladder are hot; Red dryness refers to body fluid injury caused by heat or excessive fire due to yin deficiency.

③ Crimson tongue: the tongue is deep red in color, which belongs to heat syndrome, mostly due to pathogenic heat entering the camp, blood deficiency or yin deficiency, and excessive fire. The deeper the crimson tongue, the heavier the heat toxicity.

4 ecchymosis tongue: there are blue-purple ecchymosis or spots on the tongue, mostly with blood stasis accumulation inside.

⑤ Sudden tongue: The whole tongue is bluish, which is either extremely hot or cold-heat syndrome. The tongue is deep purple and dry, extremely hot, and fever is evil blood; The tongue is yellowish purple or bluish purple and smooth, which is yin-cold syndrome.

(2) Tongue shape: Observe the old, tender, fat, prickly and cracked tongue.

① Old and tender: "old" refers to rough tongue, tight and convergent shape and color, mostly due to excess heat syndrome; "Tenderness" refers to the delicate tongue quality and delicate color, which is mostly caused by deficiency syndrome or deficiency-cold syndrome.

2 Fat and thin: "Fat" refers to the swelling of the tongue, which is mostly related to water and dampness. The tongue is light and fat, and there are teeth marks on the edge of the tongue, which mostly belong to spleen deficiency or kidney yang deficiency and water-dampness retention; The tongue is red and swollen, which is mostly caused by damp-heat accumulation or excessive heat toxicity. "Thin" refers to the thin tongue, which belongs to deficiency syndrome. People with pale tongue and thin tongue shape are mostly deficient in qi and blood; Red tongue and thin tongue are mostly caused by yin deficiency and internal heat.

③ Puncture: Tongue papilla hyperplasia and hypertrophy, protruding like a thorn, mostly caused by excessive heat. The heavier the heat evil is, the bigger the thorns are. Clinically, the tip of the tongue and the edge of the tongue are often stinging, and the sting of the tip of the tongue is mostly caused by excess heat in the liver and gallbladder.

④ Cracks: There are various longitudinal or transverse cracks or wrinkles on the tongue, mostly caused by mucosal atrophy. A few normal people can see a cleft tongue. The tongue is crimson and cracked, mostly due to heat syndrome; Most people with light and cracked tongue belong to deficiency of both qi and yin.

(3) Tongue image: Observe whether the tongue body is trembling, skewed, flabby and firm.

① Tremor: The tongue vibrates involuntarily, which is mostly caused by deficiency of both qi and blood or internal movement of liver wind.

② Oblique: The tongue inclines to one side, which is mostly a stroke hemiplegia or a precursor of stroke.

③ Weakness: the tongue is weak in stretching and rolling, which is mostly caused by deficiency of both qi and blood and dystrophy of tendons and veins.

④ Toughness: the tongue body is not soft, which is not conducive to flexion and extension, or even unable to rotate. Most of them are caused by high fever and excessive pathogenic heat, or are signs of stroke.

2. Tongue coating:

Tongue coating is caused by the anger of the stomach. Zhang Xugu said: "Tongue coating shows qi in the stomach, and stomach qi occurs in the heart and spleen. Therefore, people who are not sick often have a thin layer, which is the gas in their stomachs, just like the grass on the ground. If the land is barren, the soil will be lifeless. " Wu Kun 'an said: "The tongue is covered with moss, and the ground is covered with moss. The moss of the earth is born on moisture; Tongue coating is caused by stomach steaming and spleen dampness, so it is called coating. " Modern doctors believe that the formation of tongue coating is mainly the differentiation of filiform papillae. The ends of filamentous papillae differentiate into keratinized trees, and the gaps between the branches of keratinized trees are often filled with exfoliated keratinized epithelium, saliva, bacteria, food residues and oozing white blood cells, forming a normal tongue coating. The normal tongue coating is thin and white, the white coating is tender but not thick, with moderate dryness and wetness, and it is not slippery or dry. Observe the color, thickness and moisture of tongue coating.

(1) Moss color: white, yellow, gray and black.

① White fur is the most common in clinic, and other colors of fur can be considered to be formed on the basis of white fur. White fur generally belongs to the lung, with exterior syndrome and cold syndrome, but there are exterior syndrome and heat syndrome in clinic. Thin as white, moist as cold; Thin and white dryness is wind and heat; Cold-dampness syndrome can be seen as white and thick greasy fur.

② The yellow coating is light yellow, light yellow, dark yellow and brown. Generally speaking, the darker the yellow hair, the heavier the heat evil. Pale yellow and slightly hot; Pale yellow heat is heavier; Deep yellow and heavy heat; Brown is a hot knot; Yellow dryness is heat-induced body fluid; Yellow, greasy and damp.

③ Gray-black coating is mainly used for heat syndrome, and also has cold-dampness or deficiency-cold syndrome. The tongue coating is dark and dry, and body fluid is injured by heat; Dark and moist tongue coating is mostly caused by yang deficiency and cold excess. Gray-black moss is more common in the stage of severe illness.

(2) Thickness: thin coating, thick coating, less coating and no coating.

Thin fur is mostly the first disease, with pathogenic factors in the exterior and mild illness; Thick fur indicates that pathogenic factors are abundant and have internal transmission; Or gastrointestinal stagnation; Or phlegm. The thicker the moss, the stronger the pathogenicity and the more serious the disease. However, the formation of tongue coating reflects the presence or absence of stomach qi. Although the tongue coating is thick, it shows that there is another side of stomach qi, while less coating often indicates that the body is unhealthy, and no coating indicates that the stomach qi is insufficient and there is no chance to grow hair. Irregular tongue coating is peeling off on the tongue surface, and the peeling place is smooth and without coating, which is called flower peeling off, mostly due to deficiency of both stomach qi and yin. If there is greasy fur, it means that phlegm-dampness has not turned into dampness and healthy qi has been damaged.

(3) moistening dryness: reflecting body fluid. Normal tongue coating is not dry or wet, and no coating is dry, indicating that body fluid is consumed. Exogenous diseases are mostly dry and hot, while internal injuries are mostly yin deficiency and body fluid deficiency. The tongue coating is wet, indicating that the body fluid is not injured, but the coating surface is too wet, making the tongue stick out and drip, which is called slippery coating, indicating that there is moisture retention in the body.

Greasy coating: The coating is dense and delicate, such as a layer of turbid and smooth mucus covering the tongue surface, which is not easy to erase, and is mostly filled with phlegm and dampness.

Rotten moss: loose moss, such as bean curd residue, accumulates on the tongue surface and is easy to wipe off. Most of them are due to excessive steaming of turbid substances in the stomach, which is a manifestation of retaining the stomach and removing rot.

(5) Observe children's fingerprints

Fingerprint refers to the visible vein floating on the radial side of the index finger (that is, the superficial vein on the palm of the index finger), which is the pulmonary vein branch of Taiyin hand. Therefore, reading children's fingerprints and diagnosing mouth pulse have similar clinical significance, which is suitable for children under three years old. Looking at fingerprints is mainly to observe the changes in color and shape.

(1) Three levels: Children's fingerprints are divided into three levels: wind level, gas level and life level. The first segment of the index finger is Feng Guan, the second segment is Qi Guan and the third segment is Life Guan. (See Figure 3-2).

(2) Method of reading fingerprints: The doctor pushes the child's index finger with his left hand and his thumb with his right hand several times to make the fingerprints obvious and easy to observe.

(3) Look at the three customs to distinguish the severity of the disease: fingerprints are only found in Fengguan, indicating that shallow diseases are easy to treat; Excessive qi makes the disease worse and deeper; If the wind reaches the life gate, that is, the fingerprint extends to the fingertips, then the so-called "nail piercing" is a deep-seated disease.

(4) Look at the color and shape of fingerprints: Normal fingerprints are yellow and red, which are looming in the wind.

Color change: bright red stripes are mostly exogenous wind-cold exterior syndrome; Purplish red is heat syndrome; Green dominates shock, wind and pain; Pale color is deficiency syndrome.

Morphological changes: the grain color is deep and thick, indicating that the evil is strong and the disease is serious, the fingerprint is extremely thin, the color is light, and most of them are positive deficiency; Stripe floating is a disease in the table; Wen Shen is ill in hospital.

It is generally believed that the change of fingerprint fullness is mainly related to venous pressure. Children with heart failure, pneumonia and other diseases. Most of them extend to the Ming gate, which is caused by the increase of venous pressure. The higher the venous pressure, the greater the fingerprint filling degree, that is, the more it extends to the fingertips. The color of fingerprints can reflect the degree of hypoxia in the body to some extent. The more severe the hypoxia, the more hemoglobin in the blood decreases and the more blue fingerprints there are. Therefore, in children with pneumonia and heart failure, blue-purple or purple fingerprints often appear, while in children with anemia, the color of fingerprints becomes lighter due to the decrease of red blood cells and hemoglobin.

(6) Expectant secretions include expectoration, vomiting, runny nose, tears, sweating, pus discharge, defecation and menstrual blood. Observe the change of the shape and color quality of the discharge, and provide the necessary reference for dialectical analysis. Most of the content is often observed and described by patients, which has become the content of consultation. Generally speaking, the light and thin ones are mostly cold syndrome, and the dark and sticky ones are mostly heat syndrome.