Pulse fortune telling _ What is the basis of pulse fortune telling?
It is always very difficult to accurately grasp the representative significance of symptoms in Treatise on Febrile Diseases and apply them flexibly in clinic. Even if you have rich experience, you will inevitably make mistakes, which shows the importance of pulse condition. If you have rich experience in pulse-taking, even if you don't know enough about the pathogenesis of clinical symptoms, you can accurately grasp the change of yang according to the change of pulse condition, which is enough to choose the other medicine. Why does Treatise on Febrile Diseases particularly emphasize "pulse combination syndrome" and put pulse before syndrome and treatment? It is because the pulse condition can directly reflect the change of the trend of yang, and the symptoms need to be differentiated to represent the change of yang. Pulse condition is the direct experience of the change of yang in patients, and the symptoms also have a process of analyzing the pathogenesis, so the correct diagnosis of pulse condition can greatly increase your grasp of the change of yang, thus improving the accuracy and clinical efficacy of the classics.
Therefore, pulse-taking is not something that you can just teach by hand, nor can you learn by reading a book. In the process of studying Treatise on Febrile Diseases, you must try your best to understand the function of each prescription in the operation of yang. After thoroughly understanding the various normal and abnormal operating states of Yang described in Treatise on Febrile Diseases, you will gradually form corresponding pulse conditions in your mind, and then through the verification of clinical practice, you can skillfully use pulse diagnosis to guide the application of classic prescriptions without being taught or reading special pulse books. Using pulse diagnosis in this way can deepen your understanding of classic prescriptions and Treatise on Febrile Diseases.
Everyone who goes to see a doctor with me knows that I don't ask enough at the beginning, but collect clinical manifestations purposefully, and then prescribe drugs by grasping the changing characteristics of Yang according to the pulse condition. Pulse-taking is no substitute for consultation. It is not the so-called "don't ask the patient" to know what disease he has and what symptoms he has, but to systematically grasp the changes of his yang, so as to directly guide how to prescribe drugs. Like fortune-telling for the elderly, it is not the purpose of our efforts to guess what symptoms the patient has by taking the pulse.
When seeing a doctor in clinic, many novices ask very seriously and carefully. According to ten questions about Song, one about cold and heat, two about sweat, three about head and body, four about foot ... From the beginning. Someone has asked this question and found it comprehensive. Send it to me and let me prescribe a prescription according to the results of the consultation. I really can't take it out. On the contrary, I see patients face to face, and sometimes it takes only three sentences, plus my tongue pulse, and the prescription comes out. Why is this happening?
Well, from the moment the patient enters the door, his expression, color and state will give you a preliminary impression. You may not have time to summarize this impression, but it has actually affected your prescription. This is an interview. Sometimes it's hard to describe this feeling directly. It is more of an intuition and is based on long-term clinical practice. This intuition sometimes corresponds to a prescription in your subconscious. After the patient sits down in front of you, he reaches out and feels his pulse. If the pulse in his right inch slips, bamboo leaf plaster soup will pop up in his mind. If you look at this pulse again, although it is slippery, it doesn't feel very strong, and there is a feeling of lack of confidence. Then Gui Ling Shugan Decoction will come out soon. For another example, the cunguan pulse in the left hand is slippery, while the Guan pulse in the right hand is a little heavy and thin, which will immediately give you the impression of Chaihu Guizhi Ganjiang Decoction. Then ask the patient, ask what? In addition to the chief complaint, you should also ask Taiyin to understand the problems of the spleen and stomach, because this will determine whether the prescriptions you have considered before can be used, such as asking your appetite. Ask if the stomach is swollen or not, and ask if the stool is shapeless, several times a day. If you don't poop several times a day, you don't have to look at the rest. It must be lunar disease. Let's talk about Chinese soup and Sini soup first. On this basis, if the left pulse is slippery, the right pulse is weak, and there is Taiyin disease, the general idea of Chaihu Guizhi Ganjiang Decoction has been decided. However, if this prescription is obviously too yin deficiency and cold, and the intensity of warming spleen and yang alone is still insufficient, then add Fuzi Lizhong decoction. Ginseng should be used to defecate in Lizhong decoction several times a day instead of Dangshen. This is a thinking process of my clinical prescription selection and medication. In fact, I chose, screened, determined and excluded the prescriptions and syndromes step by step through the information obtained by listening, listening and asking, and finally decided on the treatment plan.
For example, a person comes in outside, female, thin, always sighing, and then you feel the pulse. At this time, I first thought of Chaihu syndrome, and then asked her how her appetite was. She said she had a bad appetite. What do you want to treat this time? She may say that I'm here to treat urticaria, or I'm here to treat irregular menstruation, or I'm not feeling well all over these days. At this time, you usually think that she is an adenopathy patient. Then ask, did you like tonsillitis when you were a child? Did you often catch a cold or get tracheitis and rhinitis when you were a child? Do you often get nodular diseases such as thyroid nodules, hyperplasia of mammary glands and irregular menstruation with age? If these are certain, then when they come out, they must be Chaihu Guizhi Decoction, and then add and subtract according to the specific complaint. If it is for urticaria, add allergies; If it is to treat irregular menstruation, add Danggui Shaoyao powder. If you have nodules and hyperplasia of mammary glands, you can use Chaihu Guizhi Ganjiang Decoction, Green Pericarpium Citri Reticulatae Viride, Fritillaria and the like.
Therefore, seeing a doctor does not mean asking a lot, and the time for pulse diagnosis does not have to reach many minutes. The routine requirement of consultation is to press ten questions and feel fifty pulses, but to tell the truth, some prescriptions you didn't understand in your mind beforehand, that is, you didn't understand them or didn't understand them. It's like you've never seen a cat, and you can't recognize it even if you stare at it for five hours. If you've seen a cat before, or even had a cat, to be honest, you'll know it's a cat as long as you hear a meow from a distance or glance at it occasionally.
Why are we talking about this? Because when Zhang Zhongjing talks about any problem, he actually uses the exclusion method the most. This is the thinking of Zhang Zhongjing's Treatise on Febrile Diseases, but it is also our medical thinking. Combine this idea with the process of seeing a doctor, and you can understand how to go on step by step. Someone asked the patient in detail according to their own ideas, and also wrote the pulse of the tongue, asking if I could prescribe medicine accordingly. Frankly speaking, if I am a medical record analyst, of course I can write it. But if it is a real patient, I may still be at a loss. It is very likely that all your contents are just lacking information that can provide me with prescription information and further screening. Your tongue pulse may be different from my judgment standard, so I still have to see the patient myself.
For example, once our department admitted a new hospitalized patient who was dizzy and had rheumatoid arthritis in the past and was diagnosed as severe anemia. Platelets dropped to the critical value, and renal function was basically normal. Other results have not been returned. The next morning, I was going abroad on business and didn't have time to see him. At 9 o'clock in the morning, when I was still on the train, the doctor in charge of the patient's bed suddenly called and said that the patient suddenly had severe pain all over his body and asked me what was going on. I know what happened. Other test results have not come out yet. Who am I asking? In an instant, several critical situations flashed through my mind. What causes thrombocytopenia and spontaneous bleeding? Sepsis? DIC？ Cardiovascular and cerebrovascular accidents are all thought of. But it is urgent to deal with this problem at once. The bed manager can't give me any more information. I used my quick wits to ask the bed manager to call the patient and the patient to call me. After hearing the patient's voice, the stone in my heart immediately fell to the ground. Although it is not clear what it is, these key situations should not be considered before. The biggest possibility is the pain caused by primary rheumatoid arthritis. So I told the doctor in charge of the bed, don't worry, the patient is fine, and I will go back to see the patient at noon in combination with the inspection report. Actually, I didn't ask when I was on the phone with the patient. By listening to his voice, I have an intuition in my heart. You should describe this intuition as a calm and gentle voice or something, which is an afterthought, but it was actually an intuition at that time.
Another patient, a little girl with nephrotic syndrome, was about ten years old. Hormone and cyclophosphamide have no effect, severe edema, massive proteinuria and hypoproteinemia. At that time, it was mainly treated with pure Chinese medicine. Astragalus membranaceus uses100g every day. Once I went to make rounds, holding her leg and asking the patient, your dosage of Astragalus membranaceus certainly didn't reach100g, which is half of the maximum dosage. What happened? As a result, she said that she didn't know to drink two packs at a time at first, thinking that drinking one pack was enough. In fact, 100g Astragalus plus other medicines, you have to drink two packs at a time and four packs a day, which is different from before, so there are mistakes. The other doctors who made rounds together were surprised. Why did leg press know that there was not enough astragalus? This matter can be passed around or passed around very well. But it's actually very simple. This is related to the drug syndrome of Astragalus. When I press the skin on my leg, it still feels vain and soft as cotton, which is a typical medicine certificate of Astragalus. Let's see if a patient can use astragalus. If the skin is particularly white, tender and vain, there are basically indications for Astragalus. The skin feels particularly soft, and the subcutaneous tissue and muscles are also particularly soft, just like freshly cooked steamed bread. This is the syndrome of astragalus. Generally speaking, this indication can be felt by pulse-cutting.