Clinical syndrome is an important part of TCM clinical practice, and multi-clinical syndrome is the key to improving the clinical level of TCM. Although Wang Shuhe elaborated on the study of the pulse in the "Pulse Meridian", he could not really understand the essence of the pulse science just by reading the "Pulse Meridian". Only by taking the pulse on the patient many times can we truly grasp the essence of pulse science and improve the accuracy of clinical diagnosis.
The accumulation of clinical experience is very important for the differentiation and treatment of TCM. Looking, hearing, inquiring, and cutting are the four methods of diagnosis in traditional Chinese medicine, among which observation and palpation are particularly important. Observation can determine the nature and extent of the disease by observing the patient's expression, shape, tongue coating, etc., while palpation can perceive the internal changes of the disease by touching the patient's pulse. These two methods can accurately understand the patient's condition and provide important diagnostic evidence for doctors.
During the visit, the doctor needs to pay attention to the changes in the patient's complexion, eyes, tongue coating, etc., as well as the performance of body shape and posture. By observing these details, the doctor can preliminarily determine the physical characteristics of the patient, such as cold, heat, deficiency, and reality, as well as the nature and extent of the disease. At the same time, doctors also need to pay attention to details such as the patient's clothing, hairstyle, **, etc., which can also provide important diagnostic information for doctors.
During palpation, doctors need to master the correct method of pulse cutting, including choosing the right time, adjusting their breathing, and maintaining the sensitivity of their fingers. By touching the patient's pulse, the doctor can perceive the patient's physical characteristics such as qi and blood luck, cold, heat, deficiency and reality, as well as the nature and degree of the disease. At the same time, doctors also need to pay attention to changes in the temperature of the patient's arm, the color of the fingernails, etc., which can also provide important diagnostic information for the doctor.
To sum up, multi-clinical syndrome is the key to improving the clinical level of traditional Chinese medicine. By taking the pulse on the patient many times, observing the changes in the patient's expression, shape, tongue coating, etc., and mastering the correct pulse cutting method, doctors can gradually improve their clinical level and better serve the patient.
Especially for pulse science, I would like to write a few more words here. For example, when a patient with a loose syndrome comes, often the patient's left hand is a weak string, because the left guan belongs to the liver, and the right guan should be slow and weak, and the right guan belongs to the spleen, and the pathogenesis is liver stagnation and blood deficiency and spleen weakness, so the left guan pulse string, and the string is weak, it is a false string, and the main liver is depressed and blood deficiency. The right guan pulse is slow and weak, and it is a weak spleen pulse.
And Bupleurum soothing the liver and dispersing the syndrome, it should be the left Guan pulse string and powerful. The main liver qi is that the qi cannot be declared, which is empirical, and the right guan spleen and stomach veins are relatively powerful, which is the stagnation of liver and stomach qi.
There is also a big chai hu soup certificate, the guan pulse of this person's left hand should be stringy and powerful, and the right guan stomach pulse is also really large, and it is powerful to press it. Because Da Chai Hu Tang is a sign of liver and gallbladder qi depression, it is a sign of less yang, but it also has yang and bright hot knots, so the right guan pulse is really large and the heavy press is powerful. In this case, a laxative can be used, Yida Chai Hu Tang. There are citrus aurantium shells and rhubarb in the big chaihu soup, that is, there is a Chengqi soup in the formula, which is a recipe formed by the addition and subtraction of the small chaihu soup and the small Chengqi soup, so it depends on the pulse. If there is no corresponding pulse, how can you use Da Chai Hu Tang casually?
How can I learn to learn pulse science well?
First of all, we must be very quiet, there is a special article in "Su Wen" "Pulse to Subtlety", pulse is the most subtle and subtle knowledge, "hold the pulse has a way, and the silence is the guarantee". To call for a pulse, first of all, the heart must be empty and quiet. The so-called emptiness is not to have any prejudices, to give the patient a pulse in a pure and undistracted manner, and not to chat or laugh. Therefore, Mr. He Ren, a master of traditional Chinese medicine, never speaks when he gives a pulse to a patient. Wei Changchun, a famous old Chinese medicine doctor, is deaf and relies on the pulse.
I have great admiration for Wei Lao. I remember the Spring Festival in 1974, that is, 35 years ago, when I was working as a doctor in the countryside. Because of my admiration for Wei Lao's clinical skills, I came to Hangzhou Zhejiang Provincial Hospital of Traditional Chinese Medicine to learn some skills, stand next to him, chat with him, and learn a little. But after I came, I saw that Wei Lao was very busy, and besides, he was deaf, so I couldn't communicate with him. But I think he just relied on the pulse, and when he got the pulse, he prescribed it, and the medical records were clearly written. At this time, I happened to see a table next to him, and one of his students was carving an article on the stencil paper entitled "Pulse Diagnosis Must Know Constant and Change". I had an idea, and when I returned to the countryside, I wrote a letter to Wei Lao. I said: "Dear Wei Lao, I want to come to learn Xi from you, but I came to Hangzhou to see a lot of your outpatients, and I can't interject, but I see that you have an article, your ** is engraved, can you let me learn from this article." ”
Wei Lao is indeed very good, and after a few days, he sent him this article. I got the article and couldn't be happier. In this article, because there were individual words engraved incorrectly, Wei Lao corrected the typos one by one with a red pen. The article is 15,000 words long. I studied the article well in the country. Later, I went to Beijing to study and brought it to Beijing like a baby. At the end of 1980, I went to work at Zhejiang College of Traditional Chinese Medicine and brought it to Hangzhou. A few years ago, I met Wei Musen, the son of Wei Lao, and I said, "Director Wei, your father has an article with me, as far as I know, this article has not been published publicly, and I want to sort it out and publish it." "Why?Because of the publication of the article, generally two pages are remarkable. Two pages is 3,000 words. And the article is 15,000 words long, and it can't be published in a magazine. Director Wei said, "Okay, you can sort it out." "I deleted a large part of the article quoting the content of "Lake Pulse Science", preserved the most essential part of about 10,000 words, and published it in two issues in the Journal of Zhejiang University of Traditional Chinese Medicine.
My own perception: Because the ten fingers are connected to the heart, I give the patient a pulse, and when the heart arrives, it will be realized, and when it is realized, it will be angry. In fact, it is the communication with the patient's qi and the capture of the information of his life.
The clinical certificate does require a foundation, and it is not possible to do without a foundation. In February last year, there was a cadre who had an external feeling when he became ill. At that time, he asked me to show him, and I used a mulberry chrysanthemum drink, and added a hot honeysuckle and the like. I went to see it at noon, and he didn't have time to take Chinese medicine that afternoon. In the evening, his body temperature rose very high, and he was sweating profusely, and he was taken to Zhejiang Hospital. The next day, his secretary called again, saying that he wanted to show him again. I went to Zhejiang Hospital, and according to the syndrome, he was very hot, sweating, thirsty, and had a strong pulse. These are the four major evidences. The four major certificates apply white tiger soup. We use the theory of traditional Chinese medicine to think that the four major signs are the Yangming meridian heat syndrome, and the white tiger soup: that is, gypsum, zhimu, licorice, and smallpox pollen, reed root, grass root, honeysuckle, and so on. With three pairs of medicines, the fever and sweating stopped, and I was discharged.
Therefore, traditional Chinese medicine is inseparable from syndrome differentiation, syndrome differentiation and treatment, and there is no definite law. There is a law, but there is no law, because the disease is changing, and it can be changed sooner or later, so it should be that there is no law in the law. In the morning, it is a mulberry chrysanthemum drinking certificate, and in the evening, it becomes a white tiger soup certificate.