Inquiry Content 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: 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 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 should 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 Conditions: Includes the duration of onset, causes or triggers, 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 to the time of consultation, generally inquiring in chronological order. 7Diagnosis and Treatment 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 current illness and any other diseases previously suffered. 10Personal History:
Life Experience: Mainly inquiring 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 the disease. 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 illness 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.
Three, 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 feels cold or feverish, whether they occur simultaneously, the timing of their appearance, duration, severity, and accompanying symptoms, etc. Can distinguish the nature of the pathogenic factor and the body’s yin-yang balance. Chills and Fever: Refers to the patient feeling chills while also having an elevated body temperature, indicating an exterior syndrome. Severe Chills with Mild Fever: Indicates the patient feels significant chills with slight fever, indicating a wind-cold exterior syndrome. Severe Fever with Mild Chills:Indicates the patient feels more severe fever with slight chills, indicating a wind-heat exterior syndrome. Mild Fever with Aversion to Wind: Indicates the patient feels slight fever and aversion to wind, which can be alleviated by avoiding wind, indicating a wind-cold exterior syndrome. But Cold without 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. But Heat without Cold: Refers to the patient feeling heat but not cold. Indicates an interior heat syndrome. Fever: Refers to the patient feeling feverish all over or in a specific area, with either elevated or normal body temperature. High Fever: Indicates the patient has a high fever (body temperature above 39°C) that persists without relief, with no aversion to cold but aversion to heat, indicating an interior excess-heat syndrome or qi deficiency fever. Tidal Fever: Refers to fever that occurs at specific times; or fever that is more severe at specific times, like tidal waves. Divided into daytime tidal fever; afternoon and nighttime tidal fever, etc. Mild Fever: Refers to slight fever, with a lower intensity of heat, generally not exceeding 38°C, or only feeling feverish while having a normal body temperature, referred to as mild fever. Commonly seen in yin deficiency with internal heat, qi deficiency with stagnant clear yang leading to prolonged mild fever, or even high fever that does not subside; emotional distress leading to qi stagnation transforming into fire, resulting in intermittent mild fever, referred to as stagnant heat. Alternating Cold and Heat: Refers to alternating chills and fever, also known as alternating cold and heat. 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 a shaoyang disease. Chills and high fever alternating with fixed times, occurring once daily or every two to three days, accompanied by severe headache, thirst, and sweating, indicating malaria. Chills: Severe chills accompanied by body shivering are referred to as chills.
2. Inquiry about Sweating Understand the patient’s abnormal sweating conditions, such as whether there is sweating, the timing of sweating, the amount, location, and accompanying symptoms, which can help diagnose the nature of the pathogenic factor and the body’s yin-yang balance. 1) With Sweat or Without Sweat Exterior Syndrome with Sweat:Often belongs to a taiyang wind-exterior deficiency syndrome or exterior heat syndrome. Exterior Syndrome without Sweat: Often belongs to a cold damage exterior excess syndrome. Interior Syndrome with Sweat: Needs to be distinguished based on the timing, location, amount of sweat, and accompanying symptoms. Interior Syndrome without Sweat: Refers to patients with interior syndrome who do not sweat when they should, often belonging to chronic illness or deficiency syndrome. 2) Special Sweating Conditions Spontaneous Sweating: Constant sweating that does not stop, worsening with movement, referred to as 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 after sleep, stopping upon waking, known as night sweats. Accompanied by tidal fever, flushed cheeks, red tongue with little moisture, and thin rapid pulse, often belongs to yin deficiency with 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. Belongs to interior excess heat syndrome or loss of yin or yang. Battle Sweat: Refers to the patient experiencing severe shivering and trembling, with a painful expression, followed by sweating. This is a manifestation of intense struggle between pathogenic and righteous qi, marking a turning point in the disease. If sweating occurs and heat subsides, pulse is calm and body cool, it indicates the departure of the pathogenic factor and recovery of the disease; if sweating occurs but body heat does not decrease, or if there is agitation and rapid pulse, it indicates the pathogenic factor is strong and the righteous qi is weak, leading to disease deterioration. 3) Localized Sweating Head Sweating: Refers to excessive sweating only on the head or neck, also known as localized head sweating. Often caused by 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 loss of yang 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. Seen in stroke patients, atrophy, and paraplegia. 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 called yellow sweat, often due to the interaction of wind, dampness, and heat.
3. Inquiry about Pain Inquire about the location, nature, degree, duration, and preferences regarding pain, which can help distinguish the disease’s deficiency or excess, cold or heat. Pathogenesis: Pain due to excess, where pathogenic qi obstructs, “no flow leads to pain”; pain due to deficiency, where righteous qi is insufficient, “no nourishment leads to pain”. 1) Inquiry about the Location of Pain (1Headache: Refers to pain in the entire head or in the front, back, sides, and top of the head. Headaches that radiate to the neck belong to the taiyang channel; pain on both sides of the head belongs to the shaoyang channel; pain in the forehead and brow bone belongs to the yangming channel; pain at the top of the head 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 “virtual 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 disorders. (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 called “epigastric pain.” (5)Abdominal Pain: Inquiry about abdominal pain is often closely related to palpation to determine the exact location of the pain and diagnose the affected organ. Upper abdomen (below the diaphragm, 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; lower abdomen (below the navel to above the pubic bone): related to the kidneys, bladder, large and small intestines, and uterus; 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 governing vessel runs along the spine. The two sides of the spine are where the foot taiyang bladder channel passes. Pain in the spine that prevents bending or stretching is often due to injury to the governing vessel; back pain radiating to the neck is often due to wind-cold pathogenic factors affecting 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 spine or on both sides of the lumbar area. Clinically, it is important to inquire whether there is percussion pain on both sides of the lumbar area, which is a significant indicator for diagnosing kidney disease. (8)Limbs Pain: Refers to pain in the limbs, whether 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 heel or shin pain, 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 belong to excess syndromes, mostly due to the invasion of wind, cold, and dampness; chronic illnesses with bed rest and generalized pain often belong to deficiency syndromes. 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 wanders. Pain in the joints that moves unpredictably is called wandering pain, often seen in wind-damp bi syndrome. Pain in the chest, hypochondrium, and abdomen that moves unpredictably is called wandering pain, often due to stagnation of qi in the internal organs. (4)Fixed Pain: Refers to pain that is fixed 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, worsening with cold and alleviating with warmth. Indicates a cold syndrome. (6)Burning Pain: Refers to pain that feels hot, worsening with heat and alleviating with cold. Indicates a heat syndrome. (7)Cramping Pain: Refers to severe pain that feels like being cut. Indicates an excess syndrome, often due to a tangible excess obstructing the qi mechanism or cold obstructing the qi mechanism. (8)Dull Pain: Refers to pain that is not very severe but persists. Indicates a deficiency syndrome. (9)Heavy Pain: Refers to pain accompanied by a feeling of heaviness. Indicates dampness. Or due to liver yang rising, qi and blood stagnation. (10)Soreness: Refers to pain accompanied by a feeling of soreness. Often caused by dampness. Lumbar and knee soreness often indicates kidney deficiency. (11)Pulling Pain: Refers to pain that pulls and tugs at other areas. Also known as referred pain. Often due to meridian nourishment loss or obstruction, often related to heart and liver disorders. (12)Empty Pain: Refers to pain accompanied by a feeling of emptiness. Often due to deficiency of qi, blood, and essence, leading to loss of nourishment in tissues and organs. Empty pain in the head often indicates kidney deficiency; empty pain in the lower abdomen often indicates blood deficiency. Inquiry about pain should also consider the urgency of onset, duration of the illness, timing, and degree of pain for differentiation. Generally, new illnesses with severe pain, persistent pain, and pain that resists pressure often belong to excess syndromes; chronic illnesses with mild pain, intermittent pain, and pain that is relieved by pressure often belong to deficiency syndromes.
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 spinning sensation in the head; in mild cases, closing the eyes alleviates it; in severe cases, the patient feels themselves or objects spinning, unsteady on their feet, unable to open their eyes, and may even faint. 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 disorders. 3) Palpitations: Refers to the patient frequently feeling anxious, with an irregular heartbeat, and even involuntary symptoms. Often reflects issues with the heart spirit or heart disease. Palpitations caused by fright or easily startled are referred to as “fright palpitations.” Severe palpitations that extend from the heart to the abdomen are referred to as “panic.” Both fright palpitations and panic 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 disorders. 5) Epigastric Distension: Refers to the patient feeling fullness and discomfort in the epigastric area, also known as epigastric distension. Often belongs to spleen and stomach disorders. 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 referred to as abdominal distension. 7) Heaviness of the Body: Refers to a feeling of heaviness and soreness in the body. Often related to phlegm, dampness, and water retention. Commonly seen in lung, spleen, and kidney disorders. 8) Numbness: Refers to a reduction or loss of sensation in the skin, also known as numbness. Often due to deficiency of qi and blood, or internal wind, or obstruction from damp phlegm and blood stasis.
5. Inquiry about Ears and Eyes 1) Inquiry about Ears (1) Tinnitus: Refers to the patient perceiving ringing in the ears, like the sound of cicadas or waves, which interferes with hearing. Sudden onset of loud tinnitus, like thunder or waves, that does not diminish when pressing on the ears often belongs to excess syndromes. 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 pressing on the ears often belongs to deficiency syndromes. Commonly due to liver and kidney yin deficiency, liver yang rising, or kidney deficiency with essence depletion. (2) Hearing Loss: Refers to varying degrees of hearing impairment or even loss of hearing. Sudden hearing loss often belongs to excess syndromes. Gradual hearing loss often belongs to deficiency syndromes. Age-related hearing loss is often due to essence and qi deficiency, which is a physiological phenomenon. Heavy hearing: Refers to reduced hearing, unclear sounds, and repeated sounds. Gradual onset of heavy hearing often indicates deficiency syndromes, commonly due to deficiency of kidney essence and qi, leading to loss of nourishment in the ear orifices. Often seen in elderly patients with physical decline. Sudden onset of heavy hearing often belongs to excess syndromes, commonly due to phlegm turbidity obstructing or wind evil attacking the ear orifices. 2) Inquiry about Eyes Itching Eyes: Refers to itching sensations in the eyelids, inner corners, or eyeballs; mild cases can be alleviated by rubbing, while severe cases are intolerably itchy. Often belongs to excess syndromes. 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 are slightly itchy and the condition is mild, it often indicates blood deficiency, leading to insufficient nourishment of the eyes. Eye Pain: Refers to pain in one or both eyes. Often more common in excess syndromes. Severe eye pain, accompanied by a red face, red eyes, bitter mouth, and irritability, indicates liver fire rising; red, swollen, painful eyes with light sensitivity and excessive tearing indicate wind-heat attacking. Slightly red and slightly painful eyes, with intermittent pain and dryness, often due to yin deficiency with excessive fire. Dizziness: Refers to a spinning sensation when viewing objects, as if on a boat or feeling like there are flies moving in front of the eyes, also known as visual disturbances. Dim Vision: Refers to unclear or blurred vision. Night Blindness: Refers to normal vision during the day but unclear vision at dusk, like a sparrow’s blindness. 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 non-sleep. Refers to the patient frequently having difficulty falling asleep, or waking easily and unable to fall back asleep, or not sleeping deeply and waking easily, or even being unable to sleep through the night, 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 nourishing blood leads to the heart spirit being un-nourished, or obstructed by excessive fire, disturbing the heart spirit. (2) Pathogenic factors interfere, such as phlegm-heat disturbing the heart spirit or food stagnation obstructing the interior. Common Patterns: Heart and Spleen Deficiency: Waking easily after sleep, accompanied by palpitations, forgetfulness, reduced appetite, loose stools, fatigue, pale tongue, and weak pulse; Heart and Kidney Disharmony: Difficulty falling asleep, accompanied by irritability, vivid dreams, soreness in the lower back and knees, tidal fever, night sweats, red tongue with little moisture, and thin rapid pulse; Liver 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, and wiry or slippery pulse; Food Stagnation in the Stomach: Epigastric distension and pain, restless at night, accompanied by epigastric fullness, belching, acid reflux, and thick greasy tongue coating. Excessive Sleepiness: Refers to the patient feeling very sleepy regardless of day or night, often falling asleep involuntarily, also known as hypersomnia. Mechanism:Excessive phlegm and dampness, with yang deficiency and excessive yin. Common Patterns: Heart and Kidney Yang Deficiency: Extreme fatigue, wanting to sleep but not being able to, feeling as if they are in a dream. Phlegm-Damp 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 and reduced appetite. After a major illness, extreme fatigue and sleepiness indicate a lack of recovery of righteous qi. Heat Entering the Pericardium: High fever and drowsiness in febrile diseases; or phlegm and blood stasis obstructing the heart spirit, leading to drowsiness with snoring and phlegm sounds, which do not fall under the category of hypersomnia but rather indicate a state of coma.
7. Inquiry about Diet and Taste Thirst and Drinking 1) No Thirst or Desire to Drink: Refers to the patient not feeling thirsty or desiring to drink, indicating that body fluids are not damaged, often seen in cold syndromes or damp syndromes, or in diseases without obvious dryness or heat changes. 2) Thirst with Excessive Drinking: Refers to the patient feeling significantly thirsty and drinking a lot. Indicates 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 external warm disease. Severe Thirst with Preference for Cold Drinks, accompanied by flushed face, sweating, and rapid pulse, often belongs to excessive internal heat, leading to significant damage to body fluids, often seen in yangming channel disorders. Thirst with Excessive Drinking, large urine output, and easy hunger, leading to gradual weight loss indicates diabetes. 3) Thirst without Excessive Drinking: Refers to the patient feeling dry or thirsty but not drinking much or not wanting to drink. Indicates damage to yin or obstruction of fluid distribution. Seen in yin deficiency, damp-heat, phlegm, and blood stasis syndromes. Preference for Hot Drinks, with little drinking, indicates phlegm and dampness obstructing the interior, or weakness of yang qi, leading to water not being able to ascend. Thirst but Not Drinking Much, accompanied by no significant fever, heaviness in the body, epigastric fullness, and yellow greasy tongue coating indicates damp-heat syndrome. Or in warm diseases with yin damage, due to pathogenic heat steaming the yin and ascending. Vomiting after Drinking or Vomiting Immediately after Drinking often indicates “water counterflow” due to fluid stagnation in the stomach. Vomiting before Thirst or Wanting to Drink Water indicates damage to body fluids, a sign of self-rescue through drinking. Dry mouth but only wanting to rinse with water and not swallow, accompanied by purple spots on the tongue indicates internal blood stasis.Appetite and Food Intake (1)Decreased Appetite: Refers to not wanting to eat or finding food tasteless, with reduced food intake, also known as loss of appetite. Reduced Intake: Refers to decreased food intake, often due to loss of appetite. Indifferent Appetite: Refers to having no hunger, being able to eat or not eat, or even having an aversion to food. Food Aversion: Refers to a dislike of food or aversion to the smell of food. New illnesses with decreased appetite are a protective response of righteous qi 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 heaviness in the body, epigastric fullness, and thick greasy tongue coating indicates dampness obstructing the spleen. Food aversion with acid regurgitation and abdominal fullness often indicates food stagnation in the stomach. Aversion to greasy foods, accompanied by chest tightness and nausea, and abdominal fullness often indicates damp-heat in the spleen and stomach. Aversion to greasy and rich foods, accompanied by hypochondriac distension and burning pain, with no significant fever, often indicates damp-heat in the liver and gallbladder. Early pregnancy may cause food aversion, which is generally a physiological phenomenon. However, if severe, it may lead to inability to eat, indicating pregnancy sickness. 2) Excessive Hunger: Refers to excessive appetite, feeling hungry shortly after eating, and consuming large amounts of food, also known as excessive eating and easy hunger. This is often due to excessive stomach fire and over-digestion. Excessive hunger with weight loss often indicates diabetes. Excessive eating and easy hunger, accompanied by 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 very little. Often due to insufficient stomach yin and internal disturbance of deficiency fire. 4) Food Cravings: Refers to the patient having cravings for certain foods or unusual substances. Craving for raw rice, dirt, or other unusual substances is often seen in children and often indicates parasitic accumulation. Women during pregnancy may crave sour and spicy foods, which is a common early pregnancy response and generally not pathological. Craving for rich and fatty foods can lead to phlegm and dampness; craving for 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 recovery of stomach qi and improvement of the disease; gradual decrease in appetite and food intake indicates weakening of spleen and stomach function, suggesting worsening of the condition; in chronic or severe illness, patients often have little or tasteless food, or even cannot eat. If there is a sudden desire to eat or binge eating, it is referred to as “removal of the center,” indicating that the qi of the spleen and stomach is about to collapse, which is a sign of critical illness.Taste: Refers to abnormal taste sensations or odors in the mouth. Flat and Tasteless Mouth: Refers to a lack of taste in the mouth, with reduced taste sensation on the tongue. Indicates spleen and stomach qi deficiency or cold syndrome. Sweet Taste: Refers to a sweet sensation in the mouth. Sweet and sticky sensation in the mouth with yellow greasy tongue coating indicates damp-heat in the spleen; sweet taste with a thin and clean tongue coating indicates spleen deficiency. Bitter Taste: Refers to a bitter sensation in the mouth. Often seen in heart fire, stomach heat, liver and gallbladder fire, and gallbladder qi rising. Sour Taste: Refers to a sour sensation in the mouth or a sour odor. Often indicates food stagnation in the stomach or liver qi invading the stomach. Salty Taste: Refers to a salty sensation in the mouth. Often related to kidney deficiency and cold water rising. Astringent Taste: Refers to a sensation of astringency in the mouth, like eating raw persimmons. Often occurs simultaneously with dry tongue. Indicates dryness-heat damaging body fluids or excessive yang heat in the organs. Sticky Taste: Refers to a sticky sensation in the mouth, often accompanied by thick greasy tongue coating, indicating damp stagnation or phlegm accumulation. If sticky and sweet, often indicates damp-heat in the spleen; if sticky and bitter, often indicates damp-heat in the liver and gallbladder. Numbness of the Mouth and Tongue with reduced sensation often indicates liver yang transforming into wind or excessive medication. Oral pain often indicates stomach fire rising or yin deficiency with excessive fire.
8. Inquiry about Bowel Movements 1) Inquiry about Bowel Movements: 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, usually yellow in color, without pus, blood, mucus, or undigested food. (1) Abnormal Bowel Frequency: Constipation: Refers to hard, difficult-to-pass stools, with reduced frequency or prolonged time for bowel movements, often referred to as difficult bowel movements. Caused by heat binding the intestines, insufficient body fluids, or deficiency of yin and blood leading to dryness, or qi deficiency leading to weak propulsion, or yang deficiency leading to cold binding, causing stagnation in the intestines. Also known as cold constipation. Diarrhea: Refers to increased frequency of bowel movements, with loose, watery stools. Often caused by internal injury from diet, invasion of external pathogens, insufficient yang qi, or emotional disturbances, leading to the spleen’s inability to transport and transform, causing water and dampness to descend, resulting in abnormal bowel movements. Loose stools with reduced appetite, abdominal distension, and hidden pain often indicate spleen and stomach qi deficiency; vomiting and sour regurgitation, epigastric fullness, foul-smelling stools, and relief after defecation often indicate food stagnation; yellow, watery stools with abdominal pain and burning sensation at the anus often indicate damp-heat in the large intestine; abdominal pain occurring before dawn, with relief after defecation, cold limbs, and soreness in the lower back and knees, referred to as “five dawn diarrhea,” often indicates decline of the fire at the life gate and cold in the spleen leading to dysfunction. (2) Abnormal Stool Quality: Undigested Food in Stools: Refers to stools containing a significant amount of undigested food. Often seen in spleen and stomach deficiency or kidney yang deficiency leading to diarrhea. Loose and Hard Stools: Refers to stools that are sometimes hard and sometimes loose. Often due to liver stagnation and spleen deficiency, leading to disharmony between the liver and spleen. If stools are hard first and then loose, 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 the stool, it indicates distant blood; if blood appears after the stool, it indicates recent blood. (3) Abnormal Sensation during Defecation: Burning Sensation in the Anus: Refers to a burning sensation in the anus during defecation. Often seen in heat diarrhea or damp-heat dysentery. Urgency and Heaviness in the Anus: Refers to abdominal pain and urgency to defecate, with a feeling of heaviness in the anus, often due to internal damp-heat obstruction and stagnation of qi in the intestines, being one of the main symptoms of dysentery. Incomplete Defecation: Refers to a feeling of incomplete defecation, with a sensation of obstruction and difficulty in finishing. Abdominal pain, yellow, sticky stools, and incomplete defecation often indicate damp-heat in the large intestine; abdominal pain and diarrhea with incomplete defecation, accompanied by abdominal distension and gas, often indicate liver qi stagnation affecting the spleen; diarrhea with incomplete defecation, containing undigested food, sour and foul-smelling, with relief after defecation, often indicates food stagnation. Incontinence: Refers to the inability to control bowel movements, leading to involuntary passage of stool, even to the point of not realizing it, also known as incontinence. Often due to deficiency of spleen and kidney, 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 deficiency with sinking 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 output of about 1000-1800 milliliters. Urination frequency and volume are influenced by factors such as fluid intake, temperature, sweating, and age. (1) Abnormal Urine Volume: Increased Urine Volume: Refers to significantly increased frequency and volume of urination. Clear, copious urine, 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 significantly reduced frequency and volume of urination. Dark urine with low volume often indicates an excess-heat syndrome. Low urine output with edema indicates a water retention condition. (2) Abnormal Urination Frequency: Frequent Urination: Refers to 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, copious urine, especially at night, often indicates kidney yang deficiency, leading to loss of control of the bladder. Urinary Retention: Refers to difficulty urinating, with dribbling or complete inability to urinate, known as urinary retention. Often due to kidney yang deficiency, leading to weak qi transformation, or due to damp-heat obstruction, or blood stasis or stones causing blockage, often indicating an excess syndrome. (3) Abnormal Sensation during Urination: Painful Urination: Refers to difficulty urinating with pain, or accompanied by urgency, burning sensation, etc., often due to damp-heat obstruction. Post-Urination Dribbling: Refers to dribbling after urination, also known as post-urination dribbling. Often due to weak kidney qi, leading to loss of control. Urinary Incontinence: Refers to the inability to control urination, leading to involuntary passage of urine, often due to weak kidney qi or deficiency-cold in the lower jiao, leading to loss of control. Bedwetting: Refers to involuntary urination during sleep, commonly known as bedwetting. Often due to insufficient kidney qi, 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 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 cycle, duration (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 generally lasting 3-5 days. The amount of blood discharged during menstruation is generally 50-100ml, with the color being bright red. The quality of the menstrual blood is neither too thin nor too thick, and it does 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 premature 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: Menstruation that occurs either early or late, with a discrepancy of more than eight or nine days, occurring consecutively more than three times, is referred to as irregular menstruation, also known as irregular menstrual cycles. Often due to liver qi stagnation, spleen and kidney deficiency, or blood stasis leading to abnormal accumulation of blood. Excessive Menstrual Flow: 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 excessive bleeding from the vagina outside of the menstrual period, or continuous bleeding that does not stop, known as menorrhagia. Generally, if the bleeding is sudden and heavy, it is referred to as menorrhagia; if the bleeding is slow and light, it is referred to as spotting. Both are collectively referred to as menorrhagia. Often due to blood heat, qi deficiency, or blood stasis. Scanty Menstruation: Refers to a generally normal menstrual cycle with significantly reduced menstrual volume, or even spotting. Often due to blood deficiency or essence depletion; or due to cold stagnation, blood stasis, or dampness obstructing the flow. Amenorrhea: Refers to women who have not menstruated by the age of 18, or who have previously menstruated but have not done so for more than three months without pregnancy, known as amenorrhea. Often due to qi deficiency and blood loss, leading to empty blood sea; or due to qi stagnation and blood stasis, or cold stagnation and phlegm obstruction, leading to blockage of the meridians. Abnormal color and quality of menstrual blood: If the 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 stagnation and blood stasis. Dysmenorrhea: Refers to periodic abdominal pain occurring during menstruation or just before or after menstruation, which can be severe and intolerable, also known as menstrual pain. 2) Inquiry about Leucorrhea Leucorrhea refers to a small amount of colorless, odorless secretion from the vagina, which serves to lubricate the vagina. Excessive leucorrhea, continuous discharge, or changes in color, quality, or odor are all pathological. Inquiring about leucorrhea should focus on the quantity, color, quality, odor, and accompanying symptoms. (1) White Leucorrhea: Refers to white, copious, thin leucorrhea that is continuous and odorless. Often indicates dampness descending. (2) Yellow Leucorrhea: Refers to yellow, copious, thick, foul-smelling leucorrhea. Often indicates damp-heat descending. (3) Red and White Leucorrhea: Refers to blood mixed with leucorrhea, with both red and white present, often indicating liver channel heat stagnation or damp-heat descending. (4) If there is abnormal colored discharge after menopause, with foul odor, it should raise suspicion of cancer.
10. Inquiry about Children Physiological Characteristics of Children: Organs are delicate, vitality is vigorous, and development is rapid. Pathological Characteristics: Diseases occur quickly, with many changes, easily deficient or excessive. 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 Toddlers (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 history, history of infectious diseases 3) Factors that easily cause illness in children: susceptibility to external pathogens; easily harmed by food; easily frightened. How to Identify Tidal Fever: Characterized by high fever, especially during the afternoon (3-5 PM). Indicates yangming organ 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 hearts feeling hot, bone steaming tidal fever, indicating yin deficiency with internal heat. Warm diseases with heat entering the nutrient level, burning the nutrient yin, show body heat worsening at night, but the fever is not very high. Two 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, referred to as absolute sweating or loss of sweating. For critically ill patients, sweating that is oily, hot, and sticky, accompanied by high fever and thirst, with a rapid pulse, indicates loss of yin. If a critically ill patient experiences profuse sweating that is thin and cool, with cold limbs and weak pulse, it indicates loss of yang. Three, 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, soreness in the lower back and knees, red tongue with little coating, and thin pulse, often indicates liver and kidney yin deficiency with excessive liver yang; Dizziness with Pale Face, fatigue, palpitations, and insomnia, with pale tongue and thin pulse, often indicates heart and spleen deficiency with insufficient qi and blood; Dizziness with Heaviness, feeling as if wrapped in something, with chest tightness and nausea, and white greasy tongue coating, often indicates phlegm-damp obstruction, preventing clear yang from rising; Dizziness with Heavy Head, accompanied by memory decline, soreness in the lower back, and nocturnal emissions, often indicates kidney essence deficiency, leading to loss of nourishment in the brain; if dizziness occurs after trauma with stabbing pain, it often indicates blood stasis obstruction, leading to blocked 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 symptoms or signs and their duration as stated by the patient during the visit. 3) Present Illness History: Onset conditions, evolution process, treatment history, current symptoms. 4) Past Medical History: The patient’s health status before the current 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 illness 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. 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.