and excretion. Normal production, distribution 功能，同时也离不开肺、脾、and excretion of body fluid are inseparable 肝、肾和三焦的功能。 from ascending, descending, exiting and

entering movement of qi and its transforming function. And also. they cannot be separated from the functions of the lung, spleen, liver, kidney and the triple energizer.

The five endogenous pathogens refer to the pathological changes caused by the dysfunction 内生五邪指的是气血津of qi, blood, body fluid and the zang-fu organs, 液和脏腑功能失调引起的病namely endogenous wind, endogenous cold, 理改变，即内风、内寒、内endogenous dryness ， endogenous fire and 燥、内火和内湿。它们不是endogenous dampness. They are not pathogenic 病理因素，而是五种综合的factors; they are five comprehensive changes of 病理改变。 pathogenesis. Special phrases

特殊短语

1.The disharmony of qi and blood may cause 1.气血不和，百病乃变化而various diseases. 生 2.Heat-transformation, fire-transformation,

2.化热、化火、化风、化燥、

wind-transformation, dryness-transformation,

化湿

dampness-transformation

3.Insufficiency of vital qi is the intrinsic 3.正气不足是发病的内在根factor of the occurrence of disease. 据 4.Pathogenic factors are the predominant factor of disease.

4.邪气是疾病发生的重要条件

THE FOUR DIAGNOSTIC METHODS-THE METHODS TO OBSERVE AND DIAGNOSE DISEASES

四诊—诊察疾病的方法

The four diagnostic methods, namelv inspection, auscultation and olfaction, 四诊即望、闻、inquiry, and pulse-taking and palpation, refer 问、切，指的是用于诊断to the four basic procedures used in diagnosing 疾病的四个基本步骤，它a disease, They are the presuppositions of 们是中医正确辨证和有效correct differentiation and effective treatment 治疗的前提。 in TCM.

When a disease occurs, there must be its abnormal outward manifestations from which the pathological changes may be inferred, as is stated in Danxi's Experience on Medicine 疾病发生时必有相关( DanxiXin Fa) , \To want knowing the internal 的病理改变引起的异常外conditions of the body, the external 在表现，正如《丹溪心法》manifestations of the body should be observed ; 所指出的：“欲知其内者，to diagnose the external parts of the body may 当以观乎外，诊于外者，also know the internal conditions. That is 斯以知其内，盖有诸内者because the internal conditions of the body are 形诸外。”四诊可以从不always reflected on the exterior of the body\同角度检查和了解病理状four diagnostic methods examine and learn about 态，找出病因和病机，从the pathological conditions from different angle 而为辨证论治提供基础。and aspect and find out the etiology and 四诊相互联系、相互补充，pathogenesis, thereby providing the basis for 不能相互分离，每一部分TDS. The four methods are related to and 都有其特殊的功能，不可supplement one another. They cannot be separated 代替。在临床实践中，只from one another, each having its specific 有将四诊有机联系，才能function that cannot be substituted for the 全面了解疾病。因此，才others. In clinical practice, only when the four 能做出正确的诊断。 techniques are organically combined can a disease be understood all-sidedly. Thus, a correct diagnosis can be made. 1. Inspection

1.望

Inspection is the first diagnostic procedure 望诊是诊断的首要程by which the physician may observe the patient's 序，通过望诊，医生可以vitality, complexion, physical build, head, 有目的的观察病人的神、neck, five sense organs, skin, tongue, external 色、体质、头、颈、五官、genitalia and anus on purpose so as to understand 皮肤、舌头、前后二阴，the condition of a disease. TCM holds that the 以了解疾病的状况。中医human body is an organic whole. The exterior of 认为人体是一个有机整the body is closely related to the internal 体，体表和内脏是紧密联organs. Take observation the vitality and 系的。以观察神色为例，complexion for examples, the vitality refers to 神指的是人体生命活动的the general external manifestations of life 外在表现，包括精神和意activity of the human body, including spirit, 识。它是气血、阴阳、脏consciousness and thinking. And it is the outward 腑状态的外在征象。神体sign of the conditions of qi and blood, yin and 现于多方面，如眼、面色、yang, or the zang-fu organs. The vitality is 表情、体质、行为等，这manifested in manifold aspects, such as 之中，眼神是最重要的。eyesight, complexion, facial expressions, 这是由于“五脏之精上注physical build, behavior and so on, among which 于目”。通过对神的观察，the expression of the eyes is the most important. 医生可以了解正气的充足This is because \与否，分析疾病的严重程

five zang and six fu organs converges into the 度和预测疾病的预后。很eyes.\明显察神是诊断疾病的一physician may infer the abundance or inadequacy 个重要指征。神有如下表of the vital essence, analyze mildness or the 现：得神、假神和失神。 severeness of the disease and predict the

prognosis of disease. It is quite evident that the observation of vitality is of an important significance in diagnosing a disease. The

manifestations of vitality are as follows; being of vitality, pseudo-vitality, and loss of vitality.

The observation of complexion is a

diagnostic method for inspecting the colour and lustre of the face. TCM divides the facial colours into blue, yellow, red, pale and black, 察色是观察面部的颜also known as the \色和光泽的一种诊断方may indicates the nature and the location of a 法。中医将面色分为青、disease. Generally speaking, red complexion 黄、红、白、黑，也称为indicates heat syndromes; white complexion “五色”，面色的改变可indicates cold and deficiency syndrome; yellow 以提示疾病的性质和部complexion deficiency and dampness syndromes; 位。总的来说，色红提示blue complexion suggests pain and cold 热证；色白提示寒证和虚syndrome,blood stasis and convulsion; and black 证；黄色提示虚证和湿证；complexion hints deficiency of the kidney, blood 青色提示痛证、寒证、血stasis and fluid retention. Inspection also 瘀和痉证；黑色提示肾虚、includes observation of the physical build. By 血瘀和水液停滞。望还包the observation of sturdiness, weakness, obesity 括对体质的观察。观察体or emaciation as well as the posture of the 质的强弱、肥瘦和动静姿movement and stillness, different kinds of 势可以发现不同的疾病。diseases may he found out. And, in particular, 望舌是中医独特的诊断步the observation of the tongue is a unique 骤。通常用观察舌质和舌procedure in TCM diagnosis. It is used to observe 苔的改变来确定正气的盛the changes of the tongue proper and the tongue 衰和疾病的部位，区分病coating so as to determine the abundance or 邪的性质，推断疾病的严decline of vital qi, tell the location of a 重程度。 disease, distinguish the nature of pathogenic factors and infer the degree of seriousness of a disease.

2. Auscultation and Olfaction

2.闻

Another diagnostic method is auscultation

另外一种诊断方法是

and olfaction. Auscultation means listening to

听和嗅。听意味着听病人

the patient's voice, speaking, respiration,

的声音、言语、呼吸、咳

coughing and moaning. By auscultation, the

嗽和呻吟。通过听，医生

doctor can not only learn about the changes of

不仅可以了解发音器官的

the phonatory organ, but also infer the

变化，还可以推断内脏器

pathological changes of the internal organs.

官的病理改变。嗅指的湿

While olfaction means smelling the patient's

闻病人分泌物和排泄物的

odor of the secretion and excretion. By and

气味。扩展来说，臭气通

large, stench odor usually indicates heat

常提示实热证；恶臭提示

syndromes of excess; stinking（烂醉） odor

虚寒证；腐味和酸味暗示

suggests cold syndromes of deficiency; and foul

食滞。

and sour odor implies retention of food. 3. Inquiry

3.问

This is a diagnostic method in which the patient or his companion are inquired to collect 这是一种向病人及其the information concerning a disease. The 同伴询问和收集有关疾病content of inquiry includes the chief 信息的一种诊断方法。问complaints, present case history past history, 的的内容包括主诉、过去life history, family history, as well as age, 史、生活史、家庭史，以sex, native place, occupation, address and so 及年龄、性别、出生地、forth inquiry, though covering a wide range of 职业、家庭住址等。虽然topics, should be conducted step by step in a 问的主题范围很广，但必planned way, with questions focused on the chief 须围绕主诉和现病史有计complaint and the history of present disease. 划的一步步进行。因此，Therefore, when asking a patient. the physician 医生在询问病人时应注意should focus his attention on the chief complaint 病人的主诉以了解疾病的to understand both the main reasons for the 主要原因和病人最难受的disease and clearest, the most suffered symptoms 症状。除此之外，医生还of the patient. Besides, the physician should 应通过询问了解疾病的发understand the occurrence, progress, diagnosis 生、过程、诊断和治疗。and treatment of a disease through asking. Here 以下是现病史的询问列is an outline of inquiring about the present 表： illness:

A. Asking about Chills and Fever (a) . aversion to cold and heat

A.问寒热 （a）恶寒发热

It means that the patient feels cold with a 它提示病人高热时恶high temperature. 寒的感觉。 (b) . Alternate spell of chills and fever

（b）寒热交替

They are the manifestations of half exterior

它是半表半里证的表

and half interior seen in shaoyang disease or

现，见于少阳病和疟疾。

malaria.