“Wang, Wen, Wen, Qie” (Observation, Listening, Inquiry, and Palpation) is a significant characteristic of Traditional Chinese Medicine (TCM), among which inquiry is the most fundamental and important part.
The basic inquiry skills generally include sleep inquiry, dietary preferences inquiry, inquiry about cold and heat, inquiry about sweating, inquiry about pain, and inquiry about urination and defecation. Below is a detailed compilation for your study and reference.
01 Sleep Inquiry
Insomnia:
1. Symptoms such as irritability, vivid dreams, tidal fever, night sweats, and soreness in the lower back and knees, along with five hearts heat, indicate a severe deficiency of Kidney Yin (Shen Yin), where the inability of Kidney Yin to nourish Heart Fire leads to insomnia due to the disharmony between Heart and Kidney. (Most common)
2. Waking easily after falling asleep, palpitations, shortness of breath, poor appetite, fatigue, weak pulse, and pale tongue indicate insomnia due to Heart and Spleen Qi Deficiency (Xin Pi Liang Xu).
3. Symptoms like abdominal fullness, belching, and discomfort due to food stagnation leading to insomnia are termed as “Stomach Unsettled” (Wei Bu Ning Wo An) in TCM, with the root cause being Liver Qi Stagnation (Gan Yu) and Spleen Deficiency (Pi Xu), resulting in poor transformation and transportation.
4. Easily startled awake, night sweats, dizziness, chest tightness, fearfulness, irritability, and nausea indicate Liver and Gallbladder Qi Stagnation (Gan Dan Yu Zao). This is due to issues with the Liver and Gallbladder, accompanied by nausea, irritability, dizziness, and chest tightness, leading to insomnia caused by Liver and Gallbladder Heat (Gan Dan Xu Re).
5. An unsuitable sleeping environment is also a significant cause of insomnia, such as cold, damp heat, and noise.
6. Cold, fever, and cough can also lead to insomnia, requiring differential diagnosis and intervention.
Hypersomnia:
Excessive sleepiness, often falling asleep involuntarily. In elderly or weak individuals, this is often due to Heart and Kidney Yang Deficiency (Xin Shen Yang Xu); in overweight individuals, it is often accompanied by abdominal distension and phlegm, resulting from Spleen Qi Deficiency (Pi Xu) and excessive dampness.
02 Dietary Preferences Inquiry
This includes understanding the amount of water intake, preference for cold or hot foods, appetite and food quantity, and any abnormal taste sensations.
Excessive thirst: Excessive thirst and drinking are often due to damage to body fluids, commonly seen in heat syndromes or dryness syndromes, or excessive sweating, vomiting, or diarrhea. If there is a preference for cold drinks, it indicates internal heat damaging fluids. Frequent urination and weight loss may indicate diabetes.
No thirst and little drinking: No thirst and lack of desire to drink water are often associated with cold syndromes. If there is thirst with a preference for drinking but vomiting after drinking, it is often due to water dampness stagnating in the stomach. Little thirst with a preference for hot drinks often indicates dampness or deficiency cold, while a preference for cold drinks indicates damp-heat syndrome.
Lack of appetite and aversion to food: Lack of desire to eat or finding food tasteless, leading to decreased appetite, is termed lack of appetite. In acute cases, it is often due to food injury or external heat. In chronic cases, it indicates Spleen and Stomach Deficiency (Pi Wei Xu). If there is aversion to food, it is often due to food stagnation or Liver and Spleen Damp-Heat (Gan Pi Shi Re).
Excessive eating and picky eating: Excessive eating leading to frequent hunger is often due to excessive stomach fire, where stomach heat consumes food. In chronic illness, if a person who cannot eat suddenly overeats, it indicates impending exhaustion of Spleen and Stomach Qi. Picky eating of raw rice, dirt, or foreign objects indicates parasitic accumulation.
Taste sensations: Bitter taste indicates heat in the Liver and Gallbladder, sour taste indicates stagnation in the stomach and intestines, foul breath indicates excessive stomach fire, bland taste indicates dampness in the stomach or deficiency syndrome, sweet taste indicates damp-heat in the Spleen, salty taste indicates Kidney deficiency.
03 Inquiry about Cold and Heat
The occurrence of cold and heat is mainly determined by the nature of the pathogenic factor and the balance of Yin and Yang in the body, reflecting the interaction between the body’s righteousness and evil.
Cold without heat: The patient feels cold without fever, indicating a deficiency of Yang Qi and a cold deficiency syndrome.
Heat without cold: The patient has fever without feeling cold or even fears heat, indicating internal heat syndrome. If high fever is accompanied by thirst and a preference for cold drinks, sweating, and constipation, it indicates excess heat syndrome. If there is low-grade fever in the afternoon, accompanied by heat in the palms and soles, night sweats, and redness in the cheeks, it indicates internal deficiency heat syndrome.
Intermittent cold and heat: Cold and heat appear alternately. If the cold and heat alternate at regular intervals, it indicates malaria. If they alternate irregularly, accompanied by pain in the flanks and bitter taste, it indicates liver and gallbladder disease.
04 Inquiry about Sweating
Sweating is related to the fluctuation of Yang Qi and the balance of body fluids.
No sweating: In cases of external pathogenic cold, fever, fear of cold, and headache without sweating, it indicates a solid exterior syndrome.
Sweating: In cases of external wind invasion, fever, fear of wind, and sweating, it indicates a deficiency exterior syndrome.
Spontaneous sweating: Sweating with slight activity during the day, often accompanied by fatigue, shortness of breath, and fear of cold, indicates Yang Qi deficiency, often due to internal injury.
Night sweating: Refers to sweating after falling asleep at night, accompanied by fever, flushed cheeks, irritability, insomnia with vivid dreams, and dry mouth, indicating internal heat due to Yin deficiency, often due to internal injury.
05 Inquiry about Pain
Inquire about the location, nature, and intensity of pain to observe the condition.
Cold pain: Often indicates Yang deficiency and excessive cold;
Burning pain: Often indicates Yin deficiency and heat;
Heavy pain and aching pain: Often due to dampness obstructing, heavy head pain may indicate Yang excess and Qi and blood stagnation;
Stabbing pain and fixed pain: Indicates blood stasis, which may also be due to cold obstruction;
Distending pain and wandering pain: Often indicates Qi pain, Qi stagnation, head and eye distension pain often belongs to Yang excess, heat, and phlegm turbidity, while wandering joint pain often indicates wind excess.
Cramping pain: Commonly seen in cold obstruction, Qi blockage, and stasis;
Dull pain and hidden pain: Often belong to deficiency syndromes, such as insufficient Qi and blood or Yin essence;
Severe pain: Often indicates meridian obstruction.
06 Inquiry about Urination and Defecation
Understand the characteristics, color, odor, timing, quantity, and frequency of urination and defecation, as well as the sensations during these processes.
Abnormal bowel movements: Difficulty in defecation, not defecating for many days, is termed constipation. Excessive heat damaging fluids leads to heat constipation, while internal cold accumulation leads to cold constipation, Qi stagnation leads to Qi constipation, and Qi deficiency leads to deficiency constipation. Unformed stools or watery stools with increased frequency indicate diarrhea. Loose stools that are unformed are termed damp diarrhea, often due to Spleen’s failure to transport. Abdominal pain with diarrhea at dawn indicates “Five Morning Diarrhea”, often due to Kidney Yang deficiency. Abdominal pain with diarrhea that reduces after defecation indicates food injury diarrhea.
Abnormal stool quality: A burning sensation or feeling of heaviness in the anus during defecation indicates Spleen Qi sinking. Incomplete sensation during defecation indicates Liver Qi stagnation. Diarrhea with undigested food indicates food injury. If the stool is yellow and sticky, it often indicates damp-heat accumulation in the large intestine.
In addition to the above inquiry questions, it is also important to understand the patient’s past medical history, personal history, menstrual history, reproductive history (for females), and family history, and to consider these comprehensively.
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