《傷寒論》望診的相關論述和臨床應用

Related Discussion and Clinical Applications of Inspection in "Treatise on Febrile Diseases (Shang Han Lun)"

羅明宇(Ming-Yu Lo)

《北市中醫會刊》 16卷4期 (2010/12) Pp. 18-42

https://doi.org/10.6718/TJCMb.201012_16(4).0002

摘要

望診在馬王堆醫書中已經出現。《陰陽十一脈灸經》足陽明脈：“是動則病：灑灑病寒，善伸，數欠，顏黑，病腫。”就應用望診的方法。《內經》中望診應用更加全面，望色的“色”字就出現了327次。望診的主要內容是觀察人體的神色形態，醫生運用視覺從病患之臉色、眼色、精神氣色及外貌形觀看出端倪推斷疾病。而《傷寒論》開辨證論治體系的先河，重視望、聞、間、切四診合參。《傷寒論》的診斷方法是在《內經》基礎上發展起來的。《傷寒論》作為辨證論治疾病的可靠依據，該書對望神、望色、望形態、望排泄物、望舌均有許多詳盡的論述。例如原文106條“太陽病不解，熱結膀胱，其人如狂，血自下，下者愈”是對望神的描寫；259條“身自為黃，所以然者，以寒濕在裹不解故也”是對望色的描寫；86條“汗出必額上陷，脈急緊，直視不能眴”則是對病人之形態進行的描寫。另有“自利清水色純青”、“下利便膿血”、“舌上燥而渴”、“舌上白苔者”等對排泄物及舌象的細緻觀察和論述。《傷寒論》中的望診不僅用於診斷外感病，而對臨床各科疾病的診斷都有一定的價值。重色診、參脈症，注重病機，仲景色診，將脈、徵、症（證）諸象結合，目的在於辨析病機。他不僅外感病用之，內傷雜病等，也都相合互參。《傷寒論》中依據望診對疾病診斷和治療的內容極其豐富，至今仍有效地導引著臨床驗證。本文就《傷寒論》診法中的望診作以粗淺歸納探討，以期能對中醫望診的進一步完善發展有所裨益。

關鍵字

傷寒論 ； 望診 ； 望神 ； 望色 ； 望形態

並列摘要

Article 106 in ”Treatise on Febrile Diseases (Shang Han Lun)”: ”If the Taiyang stage continues, the disease may attack and invade further deeper into the urine bladder system. If this is true, the person will feel mad, and has bleeding in urine. After the urine bleeding, the clinic condition will cure.” It's about inspection of mental state. Article 259: ”With Cold-invasion Shanghan disease, the person turns yellow in color in skin and in the eyes after a sweat therapy. This is due to a Cold in the body surface and Wet in the side both has not been depleted yet.” It's about inspection of facial expression and complexion Article 86: ”If a person is easy to have nose bleeding, a sweat therapy is forbidden to use. Otherwise, the sweat therapy may cause shrink in his side of head, staring eyes, hard to close eye lids, hard to fall into sleep. His pulse is tight and fast.” It's about inspection of physical condition. The descriptions of ”if the person has diarrhea with clear and pure water in the stool....”, ”diarrhea with pus and blood”, ”feels dry in mouth and feels thirsty”, and ”has nausea and white tongue covering” are about the observation of the patient's tongue and excreta.

並列關鍵字

Treatise on Febrile Diseases Shang Han Lun ； inspection ； inspection of mental state ； inspection of facial expression and complexion ； inspection of physical condition