Content of Inquiry 1 General Information: Includes Name, Gender, Age, Occupation, Marital Status, Ethnicity, Place of Origin, Workplace, Current Address, etc. Clinical Significance: 1) Facilitates contact and follow-up with patients or their families. 2) Provides doctors with relevant information about diseases, offering a basis for the diagnosis and treatment of certain endemic diseases, occupational diseases, infectious diseases, gynecological diseases, male diseases, pediatric diseases, and geriatric diseases. 2Main Complaint: Refers to the most distressing symptoms, signs, and their duration as stated by the patient during the visit. Clinical Significance: The main complaint often represents the primary conflict of the disease, providing important clues for the preliminary estimation of the disease’s category, type, and severity. 3Precautions: (1) The main complaint is the most distressing symptom or sign that the patient usually describes first, but it should only be limited to one or two symptoms, not exceeding three. (2) The location, nature, degree, duration, and treatment history of the symptoms or signs described in the main complaint must be clearly inquired about, avoiding vague or ambiguous descriptions. (3) The disease name should not be listed as the main complaint. 4Present Illness History: Refers to the occurrence, development, and evolution of the disease from onset to the time of consultation, as well as the treatment process and the current symptoms exhibited by the patient. 5Onset Condition: Includes the duration of the onset, the cause or trigger of the disease, the initial symptoms and their nature, location, and any treatments that were administered at that time. 6Disease Progression: Refers to the main changes in the condition from the onset of the disease to the time of consultation. Generally, inquiries are made in chronological order. 7Treatment History: Refers to the diagnoses and treatments that have been performed prior to this consultation. 8Current Symptoms: Refers to the pain and discomfort felt by the patient at the time of consultation, as well as the overall condition related to the disease. 9Past Medical History: Also known as past illness history, refers to the patient’s health status before the illness and any other diseases previously suffered. 10Personal History:

Life Experience: Mainly inquires about the patient’s birthplace, residence, and experiences to rule out certain endemic and infectious diseases. Diet and Lifestyle: Understanding dietary preferences and lifestyle habits is significant for analyzing and judging the causes and nature of diseases. Emotional State: Understanding the patient’s personality traits, current emotional state, and its relationship with the disease can assist in diagnosis and suggest to the doctor the need for psychological therapies alongside medication for diseases caused by emotional stress. 14 Marriage and Childbearing: Inquiring whether adult male and female patients are married, their age at marriage, and their childbearing status is important for diagnosing gynecological and male diseases. 15Family History: Refers to inquiring about the health and disease status of the patient’s close family members, including parents, siblings, spouses, and children. It is necessary to inquire about the causes and times of death of direct relatives when needed, which helps in diagnosing certain hereditary and infectious diseases.

3. Inquiry about Current Symptoms includes asking about the characteristics of the main symptoms, accompanying symptoms, and other general conditions. 1Inquiry about Cold and Heat: Refers to asking whether the patient has feelings of cold or fever, whether they occur simultaneously, the duration, severity, and accompanying symptoms. This can help differentiate the nature of the pathogenic factor and the balance of Yin and Yang in the body. Chills with Fever: Refers to the patient feeling cold while also having an elevated body temperature, indicating an exterior syndrome. Severe Chills with Mild Fever: Indicates that the patient feels significant chills with slight fever, suggesting a wind-cold exterior syndrome. Severe Fever with Mild Chills:Indicates that the patient feels a significant fever while also experiencing slight chills, suggesting a wind-heat exterior syndrome. Mild Fever with Aversion to Wind: Indicates that the patient feels a slight fever and experiences chills when exposed to wind, which can be alleviated by avoiding the wind, indicating a wind-cold exterior syndrome. Only Cold, No Heat:Refers to the patient feeling only cold without any sensation of fever. New Illness with Chills: Any patient who feels cold and finds that adding clothing or getting close to a fire does not alleviate the symptoms indicates an exterior syndrome or a syndrome of both exterior and interior cold. Chronic Illness with Aversion to Cold: Patients who feel cold and need to add clothing or get close to a fire for relief indicate an interior deficiency cold syndrome. Only Heat, No Cold:Refers to the patient feeling heat and aversion to heat without any sensation of cold. Fever: Refers to the patient feeling heat in the whole body or a specific area, with either elevated or normal body temperature. High Fever: Indicates that the patient has a high fever (body temperature above 39°C) that persists without chills, suggesting an interior excess heat syndrome or Qi deficiency heat. Tidal Fever: Refers to fever that occurs at specific times; or fever that is more severe at specific times, resembling tidal patterns. This includes daytime tidal fever; and tidal fever in the afternoon and evening. Mild Fever: Refers to a slight fever, generally not exceeding 38°C, or a sensation of heat without an elevated body temperature, termed mild fever. This is often seen in Yin deficiency internal heat, Qi deficiency with stagnant Yang leading to prolonged mild fever, or emotional distress causing Qi stagnation transforming into fire, resulting in intermittent mild fever, termed stagnant heat. Alternating Chills and Fever: Refers to the alternating occurrence of chills and fever, also known as alternating chills and fever. This indicates a half-exterior, half-interior syndrome. Alternating chills and fever occur without a fixed time, accompanied by bitter mouth, dry throat, dizziness, fullness in the chest and hypochondria, loss of appetite, and wiry pulse, indicating Shaoyang disease. Chills and high fever alternating with severe headaches, thirst, and sweating indicate malaria. Severe chills with shivering are termed chills.

2. Inquiry about Sweating Understand the patient’s abnormal sweating conditions, such as whether there is sweating, the timing, amount, location, and accompanying symptoms, which can help diagnose the nature of the pathogenic factor and the balance of Yin and Yang in the body. 1) With Sweat or Without Sweat Exterior Syndrome with Sweat:Often belongs to Taiyang wind exterior deficiency syndrome or exterior heat syndrome. Exterior Syndrome without Sweat:Often belongs to cold damage exterior excess syndrome. Interior Syndrome with Sweat:Requires differentiation based on the timing, location, amount of sweat, and accompanying symptoms. Interior Syndrome without Sweat:Refers to patients who do not sweat when they should, often due to chronic illness or deficiency syndrome. 2) Special Sweating Conditions Spontaneous Sweating: Refers to continuous sweating, which worsens with movement, termed spontaneous sweating. Accompanied by fatigue, aversion to cold, and cold limbs, often belongs to Qi deficiency or Yang deficiency syndrome. Night Sweats: Refers to sweating during sleep, which stops upon waking, termed night sweats. Accompanied by tidal fever, red cheeks, red tongue with little moisture, and thin rapid pulse, often belongs to Yin deficiency internal heat syndrome. Qi and Yin deficiency often present with both spontaneous sweating and night sweats. Profuse Sweating: Refers to excessive sweating, leading to significant fluid loss, belonging to interior excess heat syndrome or loss of Yin or Yang. Battle Sweating: Refers to sweating that occurs after severe shivering and struggling, indicating a critical turning point in the disease. If sweating occurs and the fever subsides, pulse is calm and body cool, it indicates that the pathogenic factor has been expelled and the condition is improving; if sweating occurs but the fever does not decrease, or if the patient is agitated and pulse is rapid, it indicates that the pathogenic factor is strong and the vital energy is declining, leading to disease deterioration. 3) Localized Sweating Head Sweating: Refers to excessive sweating on the head or neck, also known as localized head sweating. Often due to excessive heat in the upper jiao or damp-heat accumulation in the middle jiao. If there is continuous cold sweat on the forehead, pale complexion, cold limbs, and weak pulse, it indicates Yang deficiency syndrome. Head sweating occurs when consuming spicy food, hot soup, or alcohol, which is a physiological phenomenon.

Half-Body Sweating: Refers to sweating on one side of the body while the other side does not, either on the left or right side, or on the upper or lower half of the body. This is seen in stroke patients, atrophy, and paralysis. Hand and Foot Sweating: Often closely related to spleen and stomach function. Mild sweating is generally a physiological phenomenon. Chest Sweating: Refers to excessive sweating in the chest area. Often seen in various heart deficiency syndromes. Sweating that sticks to clothing and is yellow like Huangbai juice is termed yellow sweat, often due to the interaction of wind, dampness, and heat.

3. Inquiry about Pain

Inquire about the location, nature, degree, timing, and preferences regarding pain, which can help differentiate the disease’s deficiency or excess, cold or heat. Pathogenesis: Pain due to excess, where pathogenic Qi obstructs, “where there is no flow, there is pain”; pain due to deficiency, where the vital Qi is insufficient, “where there is no nourishment, there is pain”. 1) Inquiry about the Location of Pain (1Headache): Refers to pain in the entire head or in the front, back, sides, or top of the head. Headaches that radiate to the neck belong to the Taiyang channel; headaches on both sides belong to the Shaoyang channel; frontal headaches that radiate to the brow ridge belong to the Yangming channel; vertex pain belongs to the Jueyin channel; headaches that radiate to the teeth belong to the Shaoyin channel, etc. (2Chest Pain): Refers to pain in the center or side of the chest. Pain in the “empty interior” area of the chest or pain radiating to the inner arm often indicates heart issues; pain in the chest area often indicates lung issues. (3) Hypochondriac Pain: Refers to pain on one or both sides of the hypochondrium. Often closely related to liver and gallbladder issues. (4) Epigastric Pain: Refers to pain in the epigastric area, which is located below the xiphoid process and is where the stomach is located, hence termed “epigastric pain”. (5) Abdominal Pain: Inquiring about abdominal pain is often closely related to palpation to determine the exact location of the pain and diagnose the affected organ. The upper abdomen (below the diaphragm and above the navel) includes the epigastric area, left upper abdomen, and right upper abdomen, which are all related to the spleen, stomach, and liver, gallbladder; the lower abdomen (below the navel and above the pubic bone) relates to the kidneys, bladder, large and small intestines, and uterus; the lower abdomen (on both sides) is where the foot Jueyin liver meridian passes. (6) Back Pain: The central back is the spine, which contains marrow, and the Du meridian runs along the spine. The two sides of the spine are where the foot Taiyang bladder meridian passes, and the shoulder blades have the hand Yangming meridian distribution. Pain in the spine that restricts movement often results from injury to the Du meridian; back pain that radiates to the neck is often due to wind-cold invading the Taiyang channel; shoulder and back pain is often caused by wind-damp obstruction and poor circulation of Qi. (7) Lumbar Pain: Refers to pain in the lumbar region, either in the center or on both sides. Clinical examination combined with palpation can help determine if there is percussion pain on both sides of the lumbar region, which is an important indicator for diagnosing kidney disease. (8) Limbs Pain: Refers to pain in the limbs, which can be in the muscles, joints, or meridians. Joint pain with limited movement is often seen in Bi syndrome. Muscle pain in the limbs is often due to spleen and stomach deficiency. If there is only pain in the heels or shins, it often indicates kidney deficiency. (9) Generalized Pain: Refers to pain felt throughout the head, body, back, and limbs. New illnesses with generalized pain often indicate excess conditions, mostly due to the invasion of wind, cold, and dampness; chronic illnesses with prolonged bed rest and generalized pain often indicate deficiency conditions. 2) Inquiry about the Nature of Pain (1) Distending Pain: Refers to pain accompanied by a feeling of distension. Indicates Qi stagnation. (2) Stabbing Pain: Refers to pain that feels like being pricked by needles. Indicates blood stasis. (3) Wandering Pain: Refers to pain that moves unpredictably or attacks intermittently. Pain in the joints that moves unpredictably is termed wandering pain, often seen in wind-damp Bi syndrome. Pain in the chest, hypochondrium, and abdomen that moves unpredictably is termed migrating pain, often due to Qi stagnation in the internal organs. (4) Fixed Pain: Refers to pain that is localized and does not move. Fixed pain in the chest, hypochondrium, and abdomen often indicates blood stasis. Fixed pain in the limbs and joints often indicates cold-damp Bi syndrome. (5) Cold Pain: Refers to pain that feels cold, worsens with cold, and improves with warmth. Indicates cold syndrome. (6) Burning Pain: Refers to pain that feels hot, worsens with heat, and improves with cold. Indicates heat syndrome. (7) Cramping Pain: Refers to severe pain that feels like being twisted by a knife. Indicates excess syndrome, often due to tangible excess obstructing Qi or cold obstructing Qi. (8) Dull Pain: Refers to pain that is not very severe but persists. Indicates deficiency syndrome. (9) Heavy Pain: Refers to pain accompanied by a feeling of heaviness. Indicates dampness syndrome or liver Yang rising with Qi and blood stagnation. (10) Sore Pain: Refers to pain accompanied by a feeling of soreness. Often due to dampness invasion. Lumbar and knee soreness often indicates kidney deficiency. (11) Pulling Pain: Refers to pain that pulls or tugs at other areas. Also known as referred pain. Often due to meridian malnourishment or obstruction, often related to heart and liver issues. (12) Empty Pain: Refers to pain accompanied by a feeling of emptiness. Often due to deficiency of Qi, blood, and essence, leading to insufficient nourishment of tissues and organs. Empty pain in the head often indicates kidney deficiency; empty pain in the lower abdomen often indicates blood deficiency. Inquiring about pain should also consider the urgency of onset, duration of the illness, timing, and degree of pain for differentiation. Generally, new pain is more severe, persistent, and painful to the touch, indicating excess syndrome; chronic pain is milder, intermittent, and relieved by pressure, indicating deficiency syndrome.

4. Inquiry about Discomfort in the Head, Body, Chest, and Abdomen Refers to a feeling of fullness and discomfort in the abdomen, as if something is pressing against it. 1) Dizziness: Refers to the patient feeling a sensation of spinning in the head; mild cases stop when the eyes are closed, while severe cases feel as if oneself or objects are spinning, leading to instability and inability to open the eyes, and in severe cases, fainting. 2) Chest Tightness: Refers to a feeling of fullness and tightness in the chest, also known as chest oppression. Often related to heart and lung diseases. 3) Palpitations: Refers to the patient frequently feeling anxious, with an irregular heartbeat, and even involuntary symptoms. Often reflects issues with the heart or spirit. Palpitations caused by fright or easily startled are termed “fright palpitations”. Severe palpitations that extend from the heart to the abdomen are termed “palpitations of fright”. Both fright palpitations and palpitations of fright fall under the category of palpitations. 4) Hypochondriac Distension: Refers to a feeling of fullness and discomfort on one or both sides of the hypochondrium. Often seen in liver and gallbladder diseases. 5) Epigastric Distension: Refers to the patient feeling fullness and discomfort in the epigastric area, also known as epigastric distension. Often indicates spleen and stomach diseases. 6) Abdominal Distension: Refers to the patient often experiencing issues related to the spleen, stomach, intestines, and liver and gallbladder. If the abdomen is distended like a drum, with a pale complexion and prominent veins on the abdominal wall, it is termed ascites. 7) Heaviness of the Body: Refers to a feeling of heaviness and discomfort in the body. Often related to phlegm, dampness, and water retention. Commonly seen in diseases of the lungs, spleen, and kidneys. 8) Numbness: Refers to a decrease or loss of sensation in the skin, also known as numbness. Often due to Qi and blood deficiency, internal wind, or damp phlegm and blood stasis obstructing the meridians. 5. Inquiry about Ears and Eyes 1) Inquiry about Ears (1) Tinnitus: Refers to the patient perceiving a ringing sound in the ears, like the sound of cicadas or waves, which interferes with hearing. Sudden onset of loud tinnitus, or a sound like waves that does not diminish when pressed, often indicates excess syndrome. Often due to excessive liver and gallbladder fire disturbing the clear orifices. Gradual onset of tinnitus with a faint sound, like cicadas, that diminishes or temporarily stops when pressed, often indicates deficiency syndrome. Commonly due to liver and kidney Yin deficiency, liver Yang rising, or kidney deficiency with essence deficiency. (2) Hearing Loss: Refers to varying degrees of hearing impairment or even complete loss of hearing. Sudden hearing loss often indicates excess syndrome. Gradual hearing loss often indicates deficiency syndrome. Age-related hearing loss is often due to essence and Qi deficiency, which is a physiological phenomenon. Heavy Hearing: Refers to decreased hearing ability, unclear sounds, and repeated sounds. Gradual onset of heavy hearing often indicates deficiency syndrome, commonly due to kidney essence deficiency leading to loss of nourishment in the ear orifices. Often seen in elderly patients. Sudden onset of heavy hearing often indicates excess syndrome, commonly due to phlegm turbidity obstructing or wind evil invading the ear orifices. 2) Inquiry about Eyes Itching Eyes: Refers to itching sensations in the eyelids, inner corners, or eyeballs, which may be mild and relieved by rubbing, or severe and intolerable. Often indicates excess syndrome. If both eyes itch as if insects are crawling, with light sensitivity, tearing, and a burning sensation, it indicates wind-fire disturbing the liver channel. If both eyes itch mildly and gradually, it often indicates blood deficiency, leading to insufficient nourishment of the eyes. Eye Pain: Refers to pain in one or both eyes. Often indicates excess syndrome. Severe eye pain, accompanied by redness and swelling, bitter mouth, and irritability, indicates liver fire rising; red and swollen eyes with light sensitivity and excessive tearing indicate wind-heat attacking. Mildly red and mildly painful eyes that are intermittently painful and dry often indicate Yin deficiency with excessive fire. Dizziness: Refers to a sensation of spinning or swaying, as if on a boat or vehicle, or a feeling of flying insects in front of the eyes. Blurred Vision: Refers to unclear vision or difficulty seeing clearly. Night Blindness: Refers to normal vision during the day but difficulty seeing at dusk, similar to the blindness of a sparrow. Double Vision: Refers to seeing one object as two, also known as diplopia. The above three conditions are all related to visual impairment, with similar causes and mechanisms, often due to liver and kidney deficiency, leading to insufficient essence and blood, resulting in inadequate nourishment of the eyes. Commonly seen in chronic illnesses or elderly, weak individuals. 6. Inquiry about Sleep Insomnia: Also known as unrestful sleep. Refers to the patient frequently having difficulty falling asleep, waking easily, or not sleeping deeply, often accompanied by vivid dreams. This is a pathological manifestation of excessive Yang and deficient Yin, where Yang does not enter Yin, and the spirit is not at rest. Mechanism: (1) Deficiency of Ying and blood leads to insufficient nourishment of the spirit, or excessive internal fire disturbs the spirit. (2) Pathogenic factors interfere, such as phlegm-heat disturbing the spirit or food stagnation causing internal blockage. Common Patterns: Heart and Spleen Deficiency: Difficulty falling asleep, accompanied by palpitations, forgetfulness, poor appetite, loose stools, fatigue, pale tongue, and weak pulse; Heart and Kidney Disharmony: Difficulty falling asleep, accompanied by irritability, vivid dreams, sore lower back and knees, tidal fever, night sweats, red tongue, and thin rapid pulse; Gallbladder Qi Stagnation with Phlegm Disturbance: Insomnia with frequent awakenings, vivid dreams, accompanied by dizziness, chest tightness, fearfulness, irritability, bitter mouth, and nausea, red tongue with yellow greasy coating, wiry or slippery pulse; Food Stagnation in the Stomach: Epigastric distension and pain, restless sleep, accompanied by epigastric fullness, belching, acid reflux, and thick greasy tongue coating.Excessive Sleepiness: Refers to the patient feeling very sleepy at any time of day or night, often falling asleep involuntarily, also known as hypersomnia. Mechanism:Excessive phlegm and dampness, with Yang deficiency and Yin excess. Common Patterns: Heart and Kidney Yang Deficiency: Extreme fatigue, desire to sleep but unable to, feeling as if asleep but not truly asleep. Phlegm Dampness Obstructing the Spleen: Drowsiness and excessive sleepiness, accompanied by dizziness, chest tightness, and heaviness in the limbs. Spleen and Stomach Qi Deficiency: Sleepiness after meals, accompanied by fatigue, poor appetite, and sluggishness. After a major illness, extreme fatigue and sleepiness indicate a lack of recovery of the vital energy. Heat Entering the Pericardium: High fever and drowsiness during febrile diseases; or phlegm and blood stasis obstructing the spirit, leading to drowsiness with snoring and phlegm sounds, which do not fall under the category of excessive sleepiness but rather indicate a state of coma.

7. Inquiry about Diet and Taste, Thirst and Drinking 1) No Thirst: Refers to the patient feeling no thirst and not wanting to drink, indicating that body fluids are not damaged, often seen in cold or damp syndromes, or in diseases without obvious dryness or heat changes. 2) Thirst with Excessive Drinking: Refers to the patient feeling significant thirst and drinking a lot, indicating damage to body fluids, often seen in dry or heat syndromes. Mild Thirst: Accompanied by fever, slight aversion to wind and cold, and sore throat indicates the early stage of an externally contracted warm disease. Severe Thirst with Preference for Cold Drinks: Accompanied by a flushed face, sweating, and a rapid pulse indicates severe internal heat, with significant damage to body fluids, often seen in Yangming channel syndrome. Thirst with Excessive Drinking, frequent urination, excessive hunger, and gradual weight loss indicate diabetes. 3) Thirst without Excessive Drinking: Refers to the patient feeling dry or thirsty but not drinking much or not wanting to drink. This indicates damage to Yin or obstruction of fluid distribution, seen in Yin deficiency, damp-heat, phlegm, or blood stasis syndromes. Preference for Hot Drinks, with little drinking, indicates phlegm and dampness obstructing the body, or Yang Qi deficiency leading to insufficient upward movement of fluids. Thirst without Excessive Drinking, accompanied by no significant fever, heaviness in the body, epigastric fullness, and yellow greasy tongue coating indicates damp-heat syndrome; or warm disease with Yin damage, due to pathogenic heat steaming the Yin. Thirst followed by Vomiting, or Vomiting Immediately After Drinking often indicates “water counterflow” due to fluid stagnation in the stomach. Vomiting Before Thirst indicates damage to body fluids, a sign of self-rescue through drinking. Dry mouth, desiring to rinse but not swallow, accompanied by purple spots on the tongue indicates internal blood stasis.Appetite and Food Intake (1) Decreased Appetite: Refers to a lack of desire to eat, or food tasting bland, with reduced food intake, also known as loss of appetite. Reduced Intake: Refers to decreased food intake, often due to lack of appetite. Indifferent Appetite: Refers to no feeling of hunger, with the ability to eat or not eat, or even aversion to food. Food Aversion: Refers to a dislike of food or aversion to food smells, termed food aversion or dislike of food. New illnesses with decreased appetite often indicate a protective response of the vital energy against pathogenic factors. Chronic illnesses with decreased appetite, accompanied by fatigue, pale complexion, and weak pulse, often indicate spleen and stomach deficiency. Reduced intake with indifference, accompanied by heaviness in the body, epigastric fullness, and thick greasy tongue coating, often indicates dampness obstructing the spleen. Food aversion with belching of sour and rotten smells, and abdominal fullness often indicates food stagnation in the stomach. Food aversion to greasy foods, accompanied by chest tightness and nausea, and abdominal fullness often indicates spleen and stomach damp-heat. Early pregnancy may cause food aversion, which is generally a physiological phenomenon. However, severe cases may lead to inability to eat, termed “morning sickness”. 2) Excessive Appetite: Refers to an overly strong appetite, feeling hungry shortly after eating, with increased food intake, also known as excessive eating and easy hunger. This is often due to excessive stomach fire, leading to over-digestion. Excessive appetite with weight loss often indicates diabetes. Excessive eating with loose stools often indicates a strong stomach with weak spleen. 3) Hunger without Desire to Eat: Refers to the patient feeling hungry but not wanting to eat or eating little. This often indicates insufficient stomach Yin, with internal fire disturbing the body. 4) Food Cravings: Refers to the patient having cravings for certain foods or unusual substances. Cravings for raw rice, dirt, or other unusual substances are often seen in children, often due to parasitic accumulation. Women during pregnancy may crave sour or spicy foods, which is a common early pregnancy response and generally not pathological. Craving fatty and sweet foods can lead to phlegm and dampness; craving raw and cold foods can harm the spleen and stomach; excessive consumption of spicy foods can lead to dryness and heat. Inquiring about changes in appetite and food intake during the course of the disease can help understand the severity and prognosis of the disease. Recovery of appetite and gradual increase in food intake indicate a gradual recovery of stomach Qi and improvement of the disease; gradual decrease in appetite and food intake indicates weakened spleen and stomach function, suggesting worsening of the condition; in patients with chronic or severe illness, the appetite is generally poor, and they may even be unable to eat. If there is a sudden desire to eat or binge eating, termed “removal from the center”, it indicates that the Qi of the spleen and stomach is about to fail, indicating a critical condition.Flavor: Refers to abnormal tastes or smells in the mouth. Bland and Tasteless: Refers to a lack of taste in the mouth, with reduced taste sensation on the tongue. This often indicates spleen and stomach Qi deficiency or cold syndrome. Sweet Taste: Refers to a sweet sensation in the mouth. Sweet and sticky with a thick tongue coating indicates damp-heat accumulating in the spleen; sweet but with a thin and clean tongue coating indicates spleen deficiency. Bitter Taste: Refers to a bitter sensation in the mouth. This is often seen in heart fire, stomach heat, liver and gallbladder fire, or bile Qi rising. Sour Taste: Refers to a sour sensation in the mouth or a sour smell. This often indicates food stagnation in the stomach or liver Qi invading the stomach. Salty Taste: Refers to a salty sensation in the mouth. This is often related to kidney deficiency and cold water rising. Astringent Taste: Refers to a sensation of astringency in the mouth, similar to eating raw persimmons. This often occurs simultaneously with dryness of the tongue. This indicates dryness-heat damaging body fluids or excessive Yang heat in the organs, leading to Qi and fire rising. Sticky Taste: Refers to a sticky sensation in the mouth, often accompanied by a thick tongue coating, indicating dampness or phlegm stagnation. If sticky and sweet, it often indicates spleen and stomach damp-heat; if sticky and bitter, it often indicates liver and gallbladder damp-heat. Numbness of the Mouth and Tongue with reduced sensation often indicates liver Yang transforming into wind or excessive use of certain medications. Oral pain often indicates stomach fire rising or Yin deficiency with excessive fire.

8. Inquiry about Bowel Movements 1) Inquiry about Defecation Healthy individuals generally have a bowel movement once a day or every other day, with formed stools that are not dry, with moderate moisture, and smooth passage, often yellow in color, without pus, blood, mucus, or undigested food. (1) Abnormal Frequency: Constipation: Refers to difficulty in passing stools, with reduced frequency, or prolonged time to defecate, often termed difficult defecation. This can be due to heat obstructing the intestines, insufficient body fluids, or blood deficiency leading to dryness, or Qi deficiency leading to weak peristalsis, or Yang deficiency leading to cold obstructing the intestines. This is also known as cold constipation. Diarrhea: Refers to increased frequency of bowel movements, with loose, watery stools. This often results from dietary indiscretion, external pathogenic factors, or insufficient Yang Qi, or emotional disturbances leading to spleen dysfunction, causing water and dampness to descend, leading to abnormal bowel movements. Loose stools with reduced appetite, abdominal distension, and pain in the upper abdomen often indicate spleen and stomach Qi deficiency; vomiting of sour and rotten material, abdominal fullness, foul-smelling stools, and relief after defecation often indicate food stagnation; yellow, watery stools with abdominal pain and burning sensation in the anus often indicate damp-heat in the large intestine; abdominal pain before dawn with diarrhea indicates “five morning diarrhea”, often due to declining fire in the Mingmen and cold in the spleen. (2) Abnormal Stool Quality: Undigested Food: Refers to stools containing a significant amount of undigested food. This is often seen in spleen and stomach deficiency or kidney Yang deficiency leading to diarrhea. Loose and Hard Stools: Refers to stools that alternate between hard and loose. This is often due to liver Qi stagnation and spleen deficiency. If stools are hard followed by loose, it often indicates spleen and stomach weakness. Pus and Blood in Stools: Refers to stools containing pus and blood, often seen in dysentery. Blood in Stools: If blood appears before stools, it indicates distant bleeding; if blood appears after stools, it indicates recent bleeding. (3) Abnormal Sensation During Defecation: Burning Sensation in the Anus: Refers to a burning sensation during defecation, often seen in heat diarrhea or damp-heat dysentery. Urgency and Heaviness: Refers to abdominal pain and a constant urge to defecate, with a feeling of heaviness in the anus, often due to internal damp-heat obstructing the intestines. This is one of the main symptoms of dysentery. Incomplete Defecation: Refers to a feeling of incomplete defecation, with a sensation of obstruction. Abdominal pain, yellow, sticky stools, and incomplete defecation often indicate damp-heat in the large intestine; abdominal pain and diarrhea with a feeling of obstruction, accompanied by abdominal distension and gas, often indicate liver Qi stagnation affecting the spleen; incomplete defecation with undigested food, sour and foul-smelling stools, and relief after defecation often indicate food stagnation.

Incontinence: Refers to an inability to control bowel movements, leading to involuntary passage of stools, even to the point of not realizing it, also known as incontinence. This often results from spleen and kidney deficiency, leading to loss of control of the anus. Feeling of Heaviness in the Anus: Refers to a feeling of heaviness in the anus, which may worsen with exertion or after defecation, often indicating spleen Qi deficiency leading to sinking of the middle Qi. 2) Inquiry about Urination Healthy adults generally urinate 3-5 times during the day and 0-1 time at night, with a total daily urine volume of about 1000-1800 milliliters. The frequency and volume of urination are influenced by factors such as fluid intake, temperature, sweating, and age. (1) Abnormal Urine Volume: Increased Urine Volume: Refers to a significant increase in urination frequency and volume. Clear, frequent urination with a preference for warmth often indicates a deficiency-cold syndrome. If accompanied by thirst, excessive drinking, and weight loss, it indicates diabetes. Decreased Urine Volume: Refers to a significant decrease in urination frequency and volume. Dark urine with low volume often indicates excess heat syndrome. Low urine volume with edema indicates water retention. (2) Abnormal Urination Frequency: Frequent Urination: Refers to an increased frequency of urination, with a constant urge to urinate. New cases of frequent urination with urgency and dark urine often indicate damp-heat in the lower jiao; frequent urination with clear, abundant urine, especially at night, often indicates kidney Yang deficiency, leading to weak bladder control. Urinary Retention: Refers to difficulty in urination, with dribbling or complete inability to urinate, often due to kidney Yang deficiency leading to weak Qi transformation, or damp-heat obstructing the bladder. (3) Abnormal Sensation During Urination: Painful Urination: Refers to difficulty in urination accompanied by pain, often due to damp-heat obstructing the bladder, seen in Lin syndrome. Post-Urination Dribbling: Refers to residual urine dripping after urination, often due to weak kidney Qi leading to loss of control. Urinary Incontinence: Refers to an inability to control urination, leading to involuntary passage of urine, often due to weak kidney Qi or deficiency-cold in the lower jiao. Bedwetting: Refers to involuntary urination during sleep, commonly known as bedwetting. This often indicates kidney Qi deficiency leading to loss of control of the bladder. If accompanied by confusion and involuntary urination, it indicates a critical condition.

9. Inquiry about Women 1) Inquiry about Menstruation Menstruation refers to the regular, periodic uterine bleeding. Generally occurs once a month, with a predictable cycle, also known as menstrual flow, menstrual water, or menstrual message. Healthy women generally begin menstruating around the age of fourteen, known as menarche. Menstruation typically ceases around the age of forty-nine, known as menopause. Inquiring about menstruation should focus on understanding the menstrual cycle, duration of menstruation (menstrual period), volume, color, quality, and any accompanying symptoms such as amenorrhea or menstrual pain. If necessary, inquire about the date of the last menstrual period and the age of menarche or menopause. The normal menstrual cycle is about 28 days, with a menstrual period of 3-5 days. The amount of blood discharged during menstruation is generally 50-100ml, with a bright red color. The menstrual flow should not be too thin or too thick, and should not contain clots. Early Menstruation: Refers to a menstrual cycle that occurs more than eight or nine days earlier than usual, occurring consecutively more than twice, also known as early menstruation. Often due to Qi deficiency or blood heat. Late Menstruation: Refers to a menstrual cycle that occurs more than eight or nine days later than usual, occurring consecutively more than twice, also known as delayed menstruation. Often due to blood deficiency, cold in the uterus, Qi stagnation, or blood stasis. Irregular Menstruation: Refers to menstruation that occurs either earlier or later, with a discrepancy of more than eight or nine days, occurring consecutively more than three times, also known as irregular menstruation. Often due to liver Qi stagnation, spleen and kidney deficiency, or blood stasis leading to abnormal accumulation of blood. Heavy Menstruation: Refers to a significant increase in menstrual volume compared to previous cycles, with a generally normal cycle. Often due to blood heat, Qi deficiency, or blood stasis. Menorrhagia: Refers to heavy bleeding from the vagina outside of the menstrual period, or continuous bleeding that does not stop, termed menorrhagia. Generally, if the bleeding is sudden and heavy, it is termed menorrhagia; if the bleeding is slow and light, it is termed metrorrhagia. Both are collectively referred to as menorrhagia. Often due to blood heat, Qi deficiency, or blood stasis. Light Menstruation: Refers to a menstrual cycle that is generally normal but with significantly reduced volume, or even spotting. Often due to blood deficiency or essence deficiency; or due to cold obstruction, blood stasis, or phlegm-damp obstruction. Amenorrhea: Refers to women who have not menstruated by the age of 18, or who have previously menstruated but have not had a period for more than three months without pregnancy. This can be due to Qi deficiency and blood loss, leading to emptying of the blood sea, indicating a deficiency syndrome; or due to Qi stagnation and blood stasis, or cold obstruction and phlegm blockage, leading to obstruction of the meridians, indicating an excess syndrome. Abnormal color and quality of menstruation: If the menstrual blood is light red and thin, it indicates blood deficiency; if the blood is dark red and thick, it indicates internal heat; if the blood is purple and dark with clots, accompanied by cold pain in the lower abdomen, it indicates cold obstruction and blood stasis. Dysmenorrhea: Refers to periodic abdominal pain occurring during menstruation or just before or after menstruation, often accompanied by pain radiating to the lower back, and can be severe and intolerable, also known as menstrual pain. 2) Inquiry about Vaginal Discharge Vaginal discharge refers to a small amount of colorless, odorless secretion from the vagina, which serves to lubricate the vagina. Excessive discharge, continuous dripping, or changes in color, quality, or odor are all pathological discharges. Inquiring about vaginal discharge should focus on the quantity, color, quality, odor, and accompanying symptoms. (1) White Discharge: Refers to a white, abundant, thin discharge without odor. Often indicates dampness and cold descending. (2) Yellow Discharge: Refers to a yellow, abundant, thick discharge with an unpleasant odor. Often indicates damp-heat descending. (3) Red and White Discharge: Refers to blood mixed with white discharge, indicating liver channel heat or damp-heat descending. (4) If there is abnormal colored discharge after menopause, with an unpleasant odor, it should raise suspicion of cancer. 10. Inquiry about Children Physiological Characteristics of Children: Delicate organs, vigorous life force, rapid development. Pathological Characteristics: Rapid onset of disease, frequent changes, prone to deficiency and excess. 1) Inquiry about Conditions Before and After Birth Newborns (from birth to 1 month) often have diseases related to congenital factors or delivery conditions, so it is important to inquire about the mother’s nutritional health during pregnancy, any diseases, medications taken, and whether there were complications during delivery, such as difficult or premature birth, to understand the child’s congenital condition. Infants and Young Children (from 1 month to 3 years) develop rapidly, so it is important to inquire about feeding methods and the timing of milestones such as sitting, crawling, standing, walking, teething, and language development to understand the child’s nutritional status and growth development. 2) Vaccination and history of infectious diseases. 3) Factors that may cause illness in children: susceptibility to external pathogens; prone to dietary issues; easily frightened.How to Differentiate Tidal FeverDaytime Tidal Fever: Characterized by high fever, especially worse during the afternoon (3-5 PM). Indicates Yangming bowel excess syndrome, also known as Yangming tidal fever. Damp-Warm Tidal Fever: Characterized by significant afternoon fever, with body heat not rising (initially feeling warm to the touch but feeling hot after prolonged contact), indicating damp-warm disease. Yin Deficiency Tidal Fever: Characterized by low-grade fever in the afternoon or at night, with five palms feeling hot, and bone steaming tidal fever, indicating Yin deficiency internal heat. Warm disease heat entering the Ying level, burning the Ying Yin, leading to body heat worsening at night, but with a lower overall fever. How to Differentiate Profuse Sweating Profuse sweating accompanied by fever, flushed face, thirst, red urine, constipation, red tongue with yellow coating, and rapid pulse indicates interior excess heat syndrome. If a critically ill patient experiences continuous profuse sweating, it may lead to loss of Yin or Yang, termed absolute sweating or loss of sweating. If a critically ill patient has profuse sweating that is oily, hot, and sticky, with high fever and thirst, and a rapid pulse, it indicates loss of Yin. If a critically ill patient has profuse sweating that is thin and cool, with cold limbs and weak pulse, it indicates loss of Yang. How to Differentiate Dizziness Dizziness with Distension, accompanied by irritability, flushed face, tinnitus, bitter mouth, dry throat, red tongue, and rapid pulse often indicates excessive liver and gallbladder fire; Dizziness with Distension and Pain, accompanied by tinnitus and heat, sore lower back and knees, red tongue with little coating, and thin pulse, often worsened by anger, indicates Yin deficiency of the liver and kidney with excessive Yang; White Dizziness, accompanied by fatigue, palpitations, and insomnia, pale tongue, and thin pulse, often worsened by fatigue, indicates deficiency of the heart and spleen with insufficient Qi and blood; Heavy Dizziness, feeling as if wrapped in something, with chest tightness and nausea, white greasy tongue coating, often indicates phlegm-damp obstruction, preventing the clear Yang from rising; Dizziness with Cloudiness, accompanied by memory loss and sore lower back, often indicates deficiency of kidney essence, leading to insufficient nourishment of the brain; if dizziness occurs after trauma with stabbing pain, it often indicates blood stasis obstructing the meridians.

Methods and Precautions for Inquiry. 1Main Content of Inquiry 1) General Information: Name, Gender, Age, Marital Status, Occupation, Workplace, Address, etc. 2) Main Complaint: The most distressing symptom or sign the patient feels during the visit and its duration. 3) Present Illness History: Onset situation, evolution process, treatment history, current symptoms. 4) Past Medical History: The patient’s health status before the illness and any other diseases previously suffered. 5) Personal History: Life experience, diet and lifestyle, emotional state, marriage and childbearing. 6) Family History: The health and disease status of the patient’s close family members, including parents, siblings, spouses, and children, as well as the causes and times of death of direct relatives when necessary. 2Clinical Manifestations and Clinical Significance of Current Symptoms Common Symptoms: Cold and heat, sweating, pain, etc. Routine Content: Diet, sleep, bowel movements, etc. Special Content: Inquiry about women, inquiry about children, etc.

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