《中医诊断学》中关于问汗内容刍议

On the content of asking about sweat in the diagnosis oftraditional Chinese medicine

问汗是《中医诊断学》问诊中重要的部分,汗出有无及特点在临床有很重要的指导意义。汗是津液的组成部分,为人体阳气蒸化津液达于体表而成,具有调节体温、滋润皮肤、排出废物等作用。如《素问•阴阳别论》说:“阳加于阴谓之汗”汗液分泌,虽资于阴精,运用于阳气,但还须依靠人体卫气之调节,腠理玄府开合适宜,才能汗出有度,从而保持体内之阴阳平衡。结合自己的教学体会,将教材问汗部分内容做相应调整,以问汗的要点:汗出有无,在疾病过程中,尤其是对外感患者,询问汗的有无,是判断感受外邪的性质和卫气盛衰的重要依据。汗出时间我们从两个方面来看,一个是昼夜时间点,一个是疾病发展变化时间点。按昼夜时间不同,常见的汗出类型有自汗、盗汗。疾病发展阶段变化时间点,我们谈战汗;汗出量多少,是汗出量的评价,大体可以划分无汗、微汗、汗多、大量汗出不同程度;汗出部位及兼证为纲目,清醒时经常汗出不止,活动之后更甚的表现称自汗;熟睡之后汗出,醒后汗止,称盗汗。盗汗主阴虚内热证;战汗是疾病病情发展的转折点,病势深重阶段,先见恶寒战栗,而后汗出者,使初学者便于理解和掌握。

Asking about sweating is an important part in the diagnosis of traditional Chinese medicine.The characteristics of sweating have important clinical significance.Sweat is a part of body fluid,which is formed by steaming body fluid into body surface,and which has the function of regulating body temperature,moistening skin,discharging waste and so on.The other theory of Yin and Yang in Plain Conversations said:"Yang added to Yin is called sweat",sweat secretion,relies on Yin essence,uses Yang qi,but also must rely on the human body to regulate the health of qi,the knee of xuanfu opening and closeing appropriately,to sweat a degree,so as to maintain the balance of Yin and Yang in the body.Combining with the teaching experience,corresponding adjustments to the content of the teaching material to ask the key points of sweatwill be made:whether there is sweat in the process of disease,especially in patients with external sense,to ask whether there is sweat is an important basis to judge the nature of feeling external evil and the rise and fall of wei qi.Asking about sweating time,we look at it from two aspects,one is the diurnal time point,the other is the time point of disease development and change.According to different sweating time,common sweat type includes spontaneous sweat and night sweat.Based on the stages of disease change time points,we talk about war sweat;the amount of perspiration is the evaluation of the amount of perspiration,which can be roughly divided into different degrees of sweat-free,microsweat-free,much sweat and hyperhidrosis.As a compendium,spontaneous sweating often attacks during night,more sweating after activity.Night sweats refers to the sweat after sleeping,sweat-stop after the waking up.Night sweat is mainly of Yin deficiency internal heat syndrome;War sweat is the turning point of the development of the disease.The disease is in a very serious stage,and the first symptom is the cold trembling and the seond is sweat.These symptoms are discribed in order.It is clearer and easier for beginners to understand and master.