Inquiry
Concept: It is a method for doctors to understand the health status and diagnose the condition by purposefully questioning the patient or their companions.
Section One: Significance and Methods of Inquiry
1. Significance of Inquiry:① The information obtained about the condition is relatively comprehensive (symptoms, related data) ② It is conducive to timely diagnosis of diseases (early) ③ It helps communication between doctors and patients (emotional, psychological)
2. Methods and Considerations of Inquiry
(1) Methods of Inquiry:① Focus on key points and ask comprehensively (chief complaint) ② Ask while differentiating, combining inquiry and differentiation
(2) Considerations in Inquiry:① The consultation room should be quiet and suitable (avoid interference) ② Attitude should be kind and serious ③ Language should be simple and easy to understand (calm response)
④ Avoid leading suggestions (appropriate guidance) ⑤ Distinguish between primary and secondary urgency (rescue first) ⑥ Complete medical records
Section Two: Content of Inquiry
1. General Information (facilitates connection; aids diagnosis)
Name, gender, age, marital status, ethnicity, occupation, place of origin or birthplace, workplace, current address, etc.
2. Chief Complaint (focus on key points, ask comprehensively) — concise summary
The chief complaint is the most painful symptom, sign, and its duration as stated by the patient during the visit. It consists of the location, nature, degree, and duration of the symptoms.
Preliminary estimation of the category and scope of the disease, severity, and urgency, etc.
3. Present Illness History
The present illness history is the occurrence, development, and treatment process of the disease from onset to the current visit. (Ask in order)
Includes: onset situation (time, urgency, cause, inducement, symptoms, and handling)
Course of the disease (any changes, when changes occurred, and regularity)
Treatment process (where examinations were done, diagnoses, treatments, effects)
Current symptoms
4. Past Medical History
The past medical history refers to the patient’s usual health status and previous illnesses.
Includes: usual health status (constitution, deficiency, excess, cold, heat)
Previous illnesses (old diseases, history of infectious diseases, allergy history, surgical history)
5. Personal Life History
Content:① Life experiences (birth, residence, places lived) ② Diet and daily activities ③ Mental and emotional state ④ Marital and reproductive status
6. Family History
The family history involves inquiring about the health and illness of direct relatives (parents, siblings, children) and relatives closely related to the patient (spouse), as well as the causes of death of direct relatives.
Section Three: Inquiry on Current Symptoms
Concept: Inquiry on current symptoms involves asking the patient about the pain and discomfort they feel during the visit, as well as the overall condition related to the illness.
Note: Focus on subjective symptoms; the main contradiction of the disease; it is the main basis for diagnosing and differentiating.
“Ten Questions Song” (Ming Dynasty, compiled by Zhang Jiebin / modified by Chen Xiuyuan in Qing Dynasty)
First ask about cold and heat, second ask about sweating, third ask about head and body, fourth ask about bowel movements. Fifth ask about diet, sixth ask about the chest, seventh ask about deafness, eighth ask about thirst, all must be differentiated.
Ninth ask about old diseases, tenth ask about causes, and also consider medication changes. Women must especially ask about menstrual periods, delays, speed, and irregularities can all be seen.
Also add a few words to inform pediatrics, smallpox, and measles are all included.
1. Ask about Cold and Heat — Inquire whether there is a fear of cold or feeling of heat
Cold: feeling of cold, divided into aversion to wind, aversion to cold, and fear of cold.
Aversion to Wind refers to the patient feeling cold when encountering wind, which can be alleviated by avoiding it;
Aversion to Cold refers to the patient feeling cold, and even adding clothes or getting close to fire does not relieve it;
Fear of Cold refers to the patient feeling cold, but adding clothes or getting close to fire can relieve it.
Heat: fever, including elevated body temperature, normal temperature, and subjective feeling of heat.
Mechanism: the cold and heat nature of the pathogenic factor; the yin and yang balance of the body.
How to Ask? — Is there a fear of cold or heat? Do cold and heat appear simultaneously, when do they appear, their severity, characteristics, and duration? Any related symptoms?
(1) Aversion to Cold and Fever — Aversion to cold and fever appearing together, often seen in external pathogenic surface conditions “for every bit of aversion to cold, there is a corresponding surface condition”
Mechanism: the defensive yang is obstructed and cannot reach the muscle surface, leading to aversion to cold; the conflict between the pathogenic factor and the righteous qi leads to fever.
Based on the severity of aversion to cold and fever, it can be divided into:
Exterior Cold Syndrome — Aversion to cold is severe, fever is mild
Exterior Heat Syndrome — Fever is severe, aversion to cold is mild
Exterior Deficiency Syndrome (wind injury) — Fever, aversion to wind, sweating
(2) Only Cold, No Heat — Only fear of cold without fever, with differentiation between deficiency and excess (interior cold syndrome)
Excess Cold: Cold pathogenic factor directly invades, damaging the body’s yang qi (new disease)
Deficiency Cold: The body is usually yang deficient, unable to warm the muscle surface (chronic disease)
(3) Only Heat, No Cold — Only fever without fear of cold, seen in interior heat syndrome, classified into three types based on the characteristics of fever:
1、High Fever: Persistent high fever, often seen in interior heat excess syndrome, a manifestation of yang excess heat, accompanied by flushed face, excessive sweating, and thirst..
Characteristics: high fever(≥39℃) that does not subside, no aversion to cold but aversion to heat.
Related symptoms: profuse sweating, extreme thirst, pulse is surging and large.
Significance: interior excess heat syndrome.
Conditions: warm disease qi level syndrome, cold damage yangming channel syndrome.
2、Intermittent Fever: Fever that comes and goes like a tide, occurring at regular intervals or increasing in intensity at certain times..
|
Name |
Characteristics |
Significance |
Related Symptoms |
|
Yangming Intermittent Fever |
Severe heat in the afternoon (3-5 PM) |
Yangming organ syndrome |
Thirst for cold drinks, abdominal distension, constipation |
|
Yin Deficiency Intermittent Fever |
Low fever in the afternoon or at night, characterized by five hearts feeling hot or bone steaming heat |
Deficiency heat syndrome |
Flushed cheeks, night sweats, red tongue with little coating |
|
Wet Warm Intermittent Fever |
Severe heat in the afternoon, body heat not rising |
Wet warm disease |
Heavy body, fullness in the stomach, red tongue with greasy coating |
3、Mild Fever: Long-term fever with low intensity or subjective feeling of heat while body temperature is normal, seen in yin deficiency syndrome, qi deficiency syndrome, or summer heat disease..
Characteristics: low fever (≤38℃) that does not subside, or only subjective feeling of heat. Fever lasts for a long time.
Significance: seen in the late stage of warm disease, internal injury. Qi deficiency, yin deficiency, qi stagnation. (children’s summer heat (qi and yin deficiency)).
(4) Alternating Cold and Heat — Aversion to cold and fever alternating, the pathogenic factor and righteous qi are in a half-surface, half-interior state.
Shaoyang disease: alternating cold and heat without a fixed time — external pathogenic disease reaches the half-surface, half-interior stage.
Malaria: alternating cold and heat, with a fixed time of occurrence — the pathogenic factor is hidden in the membrane, occurring at fixed times.
2. Ask about Sweating — Yang qi vaporizes body fluids through sweat pores to the surface. “Yang added to yin is called sweat.”
Pathological mechanism: related to the nature of the pathogenic factor, the rise and fall of yang qi, the surplus and deficiency of body fluids, and the opening and closing of pores..
Key Points of Inquiry: Is there sweating; the time, location, amount of sweating, and related symptoms..
Significance: To assess the surplus and deficiency of body fluids, the rise and fall of yin and yang, the severity of the condition, and prognosis.
(1) Sweating or No Sweating (excessive sweating when it should not occur, or no sweating when it should)
1. No Sweating
(1) Surface syndrome without sweating — wind-cold surface syndrome
(2) Interior syndrome without sweating — new disease, excess syndrome (internal cold excess); chronic disease, deficiency syndrome (yang qi, body fluids insufficient)
2. With Sweating
(1) Surface syndrome with sweating — wind-heat surface syndrome, wind-cold surface syndrome
(2) Interior syndrome with sweating — new disease, excess syndrome (interior heat excess); chronic disease, deficiency syndrome (yang deficiency, yin deficiency)
(2) Special Sweating
1. Spontaneous Sweating: Frequent sweating while awake, especially after activity — qi deficiency, yang deficiency
2. Night Sweats: Sweating during sleep, stopping upon waking — yin deficiency
3. Profuse Sweating: Severe sweating that does not stop in critical illness — loss of yin, loss of yang
4. Cold Sweating: Chills and shivering, followed by sweating — turning point of the disease (progression or regression)
5. Yellow Sweating: Sweat that stains clothes, yellow like the juice of Phellodendron — wind, damp, and heat pathogenic factors steaming together
(3) Localized Sweating
1、Head Sweating — Excess heat in the upper jiao, damp-heat in the middle jiao, qi deficiency
2、Hand and Foot Sweating — Internal heat due to yin deficiency, dryness-heat in the yangming, damp-heat in the spleen and stomach
3、Chest Sweating — Heart and spleen deficiency, heart and kidney not communicating
4、Perineal Sweating — Damp-heat in the lower jiao
5、Half-body Sweating — Stroke, atrophy, paralysis (no sweating on the affected side) (wind-phlegm, phlegm-stasis, wind-damp obstructing the channels)
3. Ask about Pain
Pathogenesis and Inference:
Excess — Pathogenic qi is abundant, obstructing qi and blood, meridians “no flow means pain”; in new diseases, pain is severe, persistent, and painful upon pressure.
Deficiency — Insufficient yin, yang, qi, and blood, organs and meridians lack nourishment “no nourishment means pain”; in chronic diseases, pain is mild, intermittent, and relieved by pressure.
Key Points of Inquiry: Nature, location, degree, time, preferences, and related symptoms..
(1) Ask about the Nature of Pain
Distension Pain — Pain with a feeling of distension, often due to qi stagnation. Manifestations: location is not fixed, occurs in the chest, ribs, abdomen; influenced by emotional fluctuations, relieved by belching or passing gas. However, headache with distension is often due to liver fire or liver yang rising.
Stabbing Pain — Pain like being pierced by a needle, often caused by blood stasis. Manifestations: location is relatively fixed, especially severe at night.
Wandering Pain — Pain that moves unpredictably, or migratory pain..Chest, ribs, and abdomen often due to qi stagnation.
Wandering Pain — Pain that moves unpredictably — often in the joints of the limbs due to wind bi..
Fixed Pain — Often in the abdomen due to blood stasis; in the limbs often due to cold-damp bi pain..
Cold Pain — Pain with a cold sensation and preference for warmth, often due to cold pathogenic factors injuring yang..
Burning Pain — Pain with a burning sensation and preference for coolness, often due to fire pathogenic factors invading the meridians..
Heavy Pain — Pain accompanied by a feeling of heaviness, often due to dampness obstructing qi and blood..
Cramping Pain — Severe pain like being twisted by a knife; often due to tangible excess obstructing qi mechanism..
Dull Pain — Pain that is not severe but continuous, often due to insufficient essence and blood, yang qi deficiency leading to lack of nourishment..
Empty Pain — Due to deficiency of qi, blood, and essence..
Pulling Pain — Lack of nourishment in the meridians, often related to the liver..
Soreness — Pain with a sore and soft feeling, can be due to invasion of dampness or kidney deficiency.
(2) Ask about the Location of Pain
Significance: To assess the related organs, meridians of the disease. Combine with the nature of pain and related symptoms.
1、Headache
The location of headache relates to the meridians: (by location) headache with neck pain — Taiyang meridian; headache on both sides — Shaoyang meridian; frontal pain — Yangming meridian; vertex pain — Jueyin meridian.
Excess: external invasion, phlegm and stasis obstructing internally.
Deficiency: deficiency of qi and blood, kidney essence depletion.
2、Chest Pain (heart, lung)
Pain in the left chest area, feeling of tightness, intermittent pain radiating to the shoulder and arm — obstruction of heart vessels by phlegm and stasis — chest obstruction.
Severe chest pain, cyanosis of the face, extremities turning blue to the joints — true heart pain.
Chest pain, flushed cheeks, night sweats, afternoon tidal fever, cough with blood-streaked phlegm — lung yin deficiency, deficiency fire injuring lung collaterals — pulmonary tuberculosis.
Chest pain, shortness of breath, flushed face, high fever — heat pathogenic factor obstructing the lung.
Chest pain, high fever, cough with purulent, foul-smelling phlegm — lung abscess.
Chest distension and pain, wandering pain, sighing and irritability — qi stagnation.
3、Flank Pain: Often related to liver and gallbladder diseases. Liver qi stagnation, damp-heat in the liver and gallbladder, liver fire excess, liver yin deficiency, and food stagnation in the chest and flank.
4、Abdominal Pain: “Abdomen” is the location of the stomach, with both deficiency and excess conditions.
Relieved by eating — deficiency; worsened by eating — excess.
Cold pain, relieved by warmth — cold; burning pain, prefers coolness and dislikes heat — heat.
5、Back Pain: Governing vessel, foot taiyang meridian.
6、Lumbar Pain (“the lumbar region is the residence of the kidneys”)
Excess syndrome — cold-damp, blood stasis obstructing the meridians; deficiency syndrome — kidney deficiency and substantive kidney disease.
Lumbar pain that is continuous, sore, and weak: kidney deficiency.
Lumbar pain with cold sensation, worsened in cold and rainy weather: cold-damp bi.
Lumbar cramping pain, hematuria: stones.
Lumbar pain, frequent urination, urgency, painful urination, hematuria: damp-heat (lin).
7、Limbs Pain:
Pain in the joints of the limbs often belongs to bi syndrome, caused by invasion of wind, cold, and dampness; isolated heel pain, especially radiating to the waist and back, or soreness in the shins and knees, often due to kidney deficiency.
8、Whole Body Pain: New disease: excess (external invasion of wind, cold, damp); chronic disease: deficiency (qi and blood deficiency).
4. Ask about Discomfort in the Head, Body, Chest, and Abdomen
(1) Dizziness: A feeling of dizziness, objects spinning, unsteady standing.
Liver fire rising — dizziness accompanied by irritability, bitter mouth, dry mouth, red tongue with yellow coating, wiry and rapid pulse.
Liver yang rising — dizziness accompanied by head heaviness, tinnitus, soreness in the waist and knees, facial heat, red tongue with little coating, thin and rapid pulse.
Qi and blood deficiency — dizziness with pale face, fatigue, worsens with exertion, pale tongue, thin pulse.
Phlegm-damp obstruction — dizziness with a heavy feeling, chest tightness, nausea, white greasy tongue coating, wiry and slippery pulse.
Blood stasis obstructing the meridians — often seen after trauma, with obstructed pulse.
(2) Chest Tightness: A feeling of fullness and tightness in the chest. Related to the heart and lungs.
Chest tightness, accompanied by palpitations and shortness of breath — insufficient heart qi, heart yang not uplifting.
Chest tightness, accompanied by cough and phlegm — phlegm-damp obstructing the lungs.
Chest tightness, high fever, flaring nostrils — heat pathogenic factor or phlegm-heat obstructing the lungs.
Chest tightness, shortness of breath, cold limbs — cold pathogenic factor invading the lungs.
Chest tightness, shortness of breath, insufficient qi to breathe — lung qi deficiency or lung-kidney qi deficiency.
(3) Palpitations: A feeling of irregular heartbeat. Divided into fright palpitations and anxiety palpitations. — Heart-related symptoms.
Fright palpitations: Occur due to fright, or palpitations easily startled. Often intermittent, milder symptoms;
Anxiety palpitations: Severe palpitations, from the heart to the chest, down to the abdomen, feeling restless. Longer duration, more severe symptoms.
(4) Flank Distension: Distension and discomfort in the flank; related to liver and gallbladder diseases.
(5) Abdominal Distension: Stomach fullness and distension; related to spleen and stomach diseases.
(6) Abdominal Bloating
Likes pressure — deficiency: spleen deficiency unable to transform; dislikes pressure — excess: qi obstruction.
Post-meal bloating — spleen deficiency unable to transport.
Bloating, cold pain, vomiting clear fluid — cold-damp invading the stomach or spleen yang deficiency.
Bloating, body heat, flushed face, constipation, hard abdomen, dislikes pressure — yangming organ excess.
Bloating, loss of appetite, sour belching, or abdominal pain with pressure, constipation — food accumulation.
Bloating, sighing, worsened by emotional distress — liver qi stagnation.
Bloating, hiccups, vomiting, abdominal sounds of water — phlegm-damp.
In children, large abdomen, yellow face, thin body, lack of appetite, with a knot like a tassel — accumulation disorder.
(7) Heaviness of the Body: Related to spleen and lung, edema, damp obstruction, etc.
(8) Itching of the Body: A feeling of skin itching and discomfort — wind.
(9) Numbness: Decreased or lost sensation — qi and blood deficiency, phlegm-stasis obstructing the meridians.
(10) Spasms: Muscle spasms in the hands and feet, difficulty in flexing and extending — qi and blood deficiency, cold pathogenic factors causing stagnation.
(11) Fatigue: Lethargy, fatigue, and weakness — qi deficiency, dampness.
5. Ask about Ears and Eyes
Explanation: The kidneys open to the ears, and the hand and foot shaoyang meridians distribute in the ears; the liver opens to the eyes, and the essence and qi of the five organs and six bowels all flow to the eyes.
Significance: Inquiring about the ears and eyes helps to understand whether there are local diseases and the condition of related organs such as the liver, gallbladder, and kidneys.
(1) Ask about the Ears
1、Tinnitus: A subjective ringing sound in the ears, significantly affecting hearing.
Excess: Sudden tinnitus, loud like thunder, worsens upon pressure — liver and gallbladder fire excess, liver yang rising, phlegm-stasis obstruction, etc.
Deficiency: Gradual tinnitus, soft like cicadas, relieved by pressure — kidney essence deficiency, spleen qi sinking, liver yin and blood deficiency.
2、Hearing Loss: “Loss of essence leads to hearing loss.”
Excess syndrome — Sudden deafness; excess pathogenic factors obstructing the ears, blocking the clear orifices.
Deficiency syndrome — Gradual deafness; aging leads to essence and qi deficiency, brain not being nourished.
3、Difficulty Hearing: Age-related decline in kidney essence and qi.
(2) Ask about the Eyes
1、Eye Pain: Redness and swelling with significant pain — liver fire rising, acute conjunctivitis, etc.; mild pain with dryness — yin deficiency with excess fire.
2、Blurred Vision: A feeling of dizziness, objects spinning, or seeing spots — liver fire, liver yang, phlegm-damp; qi deficiency, liver and kidney insufficiency (dizziness syndrome).
3、Vision Impairment — unclear vision (decreased vision); night blindness — inability to see at dusk; diplopia — seeing double. (All are deficiency syndromes).
6. Ask about Sleep — Related to the circulation of defensive qi, the rise and fall of yin and yang, the surplus and deficiency of qi and blood, and the functions of the heart and kidneys.
Key Points of Inquiry: Difficulty falling asleep, duration of sleep, ease of waking, dreaming, and related symptoms.
1、Insomnia (Difficulty Sleeping): Difficulty falling asleep, waking easily, or not sleeping soundly, even staying awake all night, often accompanied by many dreams.
Pathogenesis: Imbalance of yin and yang, yin deficiency with yang excess, yang not entering yin, spirit not being settled, heart spirit not at peace.
Deficiency: Deficiency of nourishing blood or yin deficiency with excess fire, heart spirit not nourished, qi deficiency of heart and gallbladder, heart spirit not at peace..
Excess: Internal pathogenic factors, disturbing the heart spirit. Such as fire pathogenic factors, phlegm-heat, qi stagnation, food accumulation in the stomach, etc.
2、Hypersomnia (Excessive Sleepiness): Regardless of day or night, feeling fatigued, with a strong desire to sleep, often falling asleep involuntarily.
Pathogenesis: Imbalance of yin and yang, yang deficiency with yin excess.
Fatigue and excessive sleepiness, accompanied by dizziness, chest tightness, heaviness in limbs — phlegm-damp obstructing the spleen.
Sleepiness after meals, accompanied by abdominal distension, shortness of breath, and lethargy — spleen qi deficiency.
Sleepiness with fatigue, accompanied by cold limbs and weak pulse — heart and kidney yang deficiency.
Note: Hypersomnia is different from stupor.
7、Ask about Diet and Taste
Key Points of Inquiry: Is there thirst, how much water is consumed, preference for cold or hot, appetite, amount of food, likes and dislikes of food, and any abnormal taste or smell in the mouth.
(1) Thirst and Drinking:: To understand the surplus and deficiency of body fluids and the distribution of diseases related to cold, heat, deficiency, and excess.
1、No Thirst: No obvious thirst, little drinking. (Body fluids not harmed) — cold, damp; no obvious dry-heat disease.
2、Thirst with Desire to Drink: Obvious thirst, large amount of drinking. (Body fluids harmed) — dryness, heat.
Great thirst with preference for cold drinks, accompanied by high fever, sweating, and surging pulse — interior heat excess.
Thirst with excessive drinking, accompanied by increased appetite, frequent urination, and weight loss — diabetes (yin deficiency, internal dryness).
3、Thirst but Not Much Drinking: Dry mouth and thirst, but no desire to drink, or little drinking. (Mild harm to body fluids; or not harmed, but qi transformation and distribution are obstructed).
Dry mouth with mild thirst, aversion to cold and fever, sore throat, floating and rapid pulse — wind-heat surface syndrome.
Thirst but not much drinking, body heat worse at night, red tongue — warm disease at the nutrient level.
Dry mouth with no desire to drink, five hearts feeling hot, flushed cheeks, night sweats, red tongue with little coating — deficiency heat.
Thirst but not much drinking, body heat not rising, heaviness in the body, yellow greasy tongue coating — damp-heat.
Thirst, preference for hot drinks, little drinking, or vomiting immediately after drinking — phlegm-damp or yang deficiency.
Dry mouth, desiring to rinse but not swallow, with purple and dark spots on the tongue — blood stasis.
(2) Appetite and Food Intake: To understand the strength of digestive function and the prognosis of diseases.
1、Decreased Appetite: Pathogenic qi obstructing the middle jiao or spleen losing its ability to transport and receive — spleen deficiency; poor appetite — dampness obstructing the spleen.
2、Aversions to Food: Food accumulation — “injury from food leads to aversion to food”; aversion to greasy food — damp-heat; pregnant women — stomach losing harmony and descent.
3、Increased Appetite: Increased appetite, eating a lot, easily feeling hungry. Excessive appetite, eating a lot, easily feeling hungry. Stomach heat excess, diabetes, strong stomach, weak spleen.
4、Hungry but Not Wanting to Eat: Feeling hungry but not wanting to eat, or eating little. Stomach yin deficiency, internal fire disturbance.
5、Stomach Noises: Stomach feeling empty, seeming hungry but not really, seeming painful but not really, heat and irritation. Liver qi not smooth, prolonged stagnation transforming into heat, liver fire counteracting the stomach.
6、Food Cravings: Craving for certain foods or foreign substances, such as raw rice, dirt, etc. — children with parasitic accumulation.
7、Sudden Increase in Appetite: Critical patients who previously had no appetite suddenly crave food or increase their intake.
(3) Ask about Taste
1、Flat Taste: Spleen and stomach qi deficiency, cold syndrome.
2、Bitter Taste: Heat syndrome.
3、Sweet Taste: Damp-heat accumulating in the spleen and stomach..
4、Sour Taste: Indigestion, liver qi invading the stomach.
5、Dry Taste: Dryness and heat injuring body fluids.
6、Salty Taste: Kidney deficiency and cold water invading.
7、Sticky Taste: Dampness and turbidity, phlegm-damp, food accumulation.
8. Ask about Urination and Defecation — To understand digestion, water metabolism, related organ functions, and the cold, heat, deficiency, and excess of diseases.
Key Points of Inquiry: Frequency, odor, color, consistency, volume of stools, time of defecation, sensations during defecation, and accompanying symptoms.
(1) Ask about Bowel Movements
1、Abnormal Bowel Movements: Divided into constipation and diarrhea.
(1) Constipation: Long time to defecate, reduced frequency, dry stools, difficulty in defecation.
Excess syndrome — heat accumulation, cold obstruction.Heat constipation: heat injures body fluids; cold constipation: cold obstructs.
Deficiency syndrome — insufficient yin, blood, body fluids, qi, and yang. Qi constipation: qi deficiency unable to promote; deficiency constipation: blood deficiency leading to lack of lubrication.
(2) Diarrhea: Increased frequency of bowel movements, loose stools, even watery stools.
|
Manifestations |
|
|
Spleen Deficiency |
Diarrhea, accompanied by poor appetite, abdominal distension, hidden pain relieved by pressure, fatigue and weight loss. |
|
Spleen and Kidney Yang Deficiency (Early Morning Diarrhea) |
Abdominal pain before dawn, relieved after defecation, accompanied by soreness in the waist and knees, cold limbs. |
|
Cold Dampness |
Clear, thin diarrhea without odor, abdominal pain relieved by warmth, pale tongue with white greasy coating. |
|
Damp Heat |
Diarrhea with yellow, foul-smelling stools, burning sensation in the anus, red tongue with yellow greasy coating. |
|
Food Stagnation |
Diarrhea with foul odor, vomiting sour and rotten food, undigested food in the stool. |
|
Liver Qi Stagnation Invading the Spleen |
Abdominal pain leading to diarrhea, pain relieved after defecation, changes with emotions. |
2、Abnormal Stool Color:
Stool yellow-brown and foul — damp-heat. Stool gray-white like clay — jaundice.
Stool with sticky pus and blood — dysentery.
3、Abnormal Stool Quality: (dry, loose)
Undigested food — stool with a lot of undigested food — spleen and kidney yang deficiency, unable to digest and absorb.
Loose and irregular stools — alternating between dry and loose, not smooth — liver qi stagnation and spleen deficiency, liver and spleen not in harmony.
Pus and blood in stool — stool with pus and blood — dysentery, damp-heat obstructing the intestines, damaging the vessels.
Blood in stool: Dark blood — blood appears after stool, dark red or purple-black, even black like tar — spleen deficiency unable to hold, stasis obstructing the stomach collaterals.
Bright red blood — blood appears before or after stool, attached to the surface of the stool, bright red — damp-heat in the large intestine, wind-dryness injuring the blood vessels.
4、Abnormal Sensation During Defecation:
Burning sensation in the anus — damp-heat in the large intestine.
Urgent need to defecate — abdominal pain and urgency, frequent desire to defecate, heavy feeling in the anus, unsatisfactory defecation — dysentery — damp-heat in the large intestine.
Unsatisfactory defecation — feeling of obstruction, difficulty in completing — qi stagnation in the large intestine.
① Abdominal pain with urgency, unsatisfactory defecation, irritability — liver qi invading the spleen.
② Unsatisfactory defecation, abdominal pain with diarrhea, yellow foul-smelling stools, burning sensation in the anus — damp-heat in the large intestine.
③ Unsatisfactory defecation, abdominal distension and diarrhea, with undigested food, sour and foul smell — food injury.
Slippery diarrhea — inability to control bowel movements, slipping out — spleen and kidney yang deficiency.
Heavy feeling in the anus — spleen qi sinking or damp-heat in the large intestine.
① Heavy feeling in the anus, even prolapse, dizziness, fatigue, pale complexion — spleen qi sinking.
② Heavy feeling in the anus, abdominal pain with urgency, frequent desire to defecate, yellow foul-smelling stools — damp-heat in the large intestine.
(2) Ask about Urination
1、Abnormal Urine Volume:
(1) Increased Urine Volume: Deficiency and excess syndrome — qi not transforming body fluids; diabetes — kidney deficiency.
(2) Decreased Urine Volume: Interior heat syndrome — heat damaging body fluids; edema — dysfunction of lung, spleen, and kidney.
2、Abnormal Urination Frequency:
(1) Frequent Urination: Damp-heat in the lower jiao: frequent urination, short, red, and urgent; kidney qi deficiency: large volume, clear, especially at night.
(2) Urinary Retention: Dribbling urination is retention; no urination is closure.
Deficiency syndrome: yang deficiency, qi transformation weak or qi deficiency, opening and closing dysfunction.
Excess syndrome: damp-heat, blood stasis, stones obstructing.
3、Abnormal Urine Color and Quality:
(1) Clear, frequent urination — clear color, large volume — cold syndrome.
(2) Short, yellow urination — yellow color, small volume — heat syndrome.
(3) Blood in urine — heat, spleen not controlling blood, kidney deficiency not securing.
(4) Cloudy urine — like grease or rice wash.
Cloudy urine like grease, or painful urination, yellow greasy tongue coating — greasy lin.
Cloudy urine like rice wash, heavy feeling in the lower abdomen, fatigue, worsens with exertion — qi sinking.
(5) Stones in urine — stone lin.
4、Abnormal Sensation During Urination:
(1) Painful urination: damp-heat accumulation, bladder qi transformation not smooth.
(2) Dribbling after urination: Kidney qi deficiency, bladder dysfunction.
(3) Incontinence: Kidney qi deficiency, lower jiao cold.
(4) Enuresis: Kidney qi deficiency, bladder qi transformation dysfunction.
9. Ask about Menstruation and Vaginal Discharge
Key Points of Inquiry: Menstrual cycle, duration of menstruation, amount, color, quality, any amenorrhea, or menstrual pain. Vaginal discharge amount, color, quality, odor, etc., to assess related organ functions and the cold, heat, deficiency, and excess of diseases.
(1) Ask about Menstruation
1、Menstrual Cycle Abnormalities:
|
Meaning |
Significance |
|
|
Early Menstruation |
Menstruation occurring more than 7 days early, for more than 2 consecutive cycles. |
Heat (blood heat, liver qi stagnation transforming into heat, deficiency heat), qi deficiency. |
|
Late Menstruation |
Menstruation occurring more than 7 days late, for more than 2 consecutive cycles. |
Blood deficiency (nourishing blood, kidney essence, yang qi); blood stasis (qi stagnation, cold obstruction, phlegm obstruction). |
|
Irregular Menstruation |
Menstruation occurring either early or late by more than 7 days, for more than 2 consecutive cycles. |
Liver qi stagnation, spleen and kidney deficiency. |
2、Abnormal Menstrual Volume:
|
Meaning |
Significance |
|
|
Excessive Menstruation |
Menstrual volume significantly increased compared to normal, with a generally normal cycle. |
Blood heat, qi deficiency, blood stasis. |
|
Menorrhagia |
Vaginal bleeding outside of the menstrual period. Rapid onset, large volume, bleeding is called menorrhagia; slow onset, small volume, continuous bleeding is called spotting. |
Blood heat, qi deficiency, blood stasis. |
|
Scanty Menstruation |
Menstrual volume significantly decreased compared to normal, with a generally normal cycle. |
Essence, qi, blood deficiency; cold obstruction, blood stasis, phlegm obstruction. |
3、Abnormal Menstrual Color and Quality:
Light red color, thin quality — qi and blood deficiency.
Dark red color, thick quality — blood heat.
Purple dark color with blood clots — blood stasis.
4. Menstrual Pain: Occurs cyclically in the lower abdomen before or after menstruation, or pain radiating to the lower back, often severe and unbearable.
Pain in the lower abdomen before or during menstruation — qi stagnation or blood stasis.
Pain in the lower abdomen after menstruation, dull pain or empty pain — deficiency of qi and blood.
Cold pain in the lower abdomen during menstruation, relieved by warmth — cold obstruction or yang deficiency.
(2) Ask about Vaginal Discharge
|
Meaning |
Significance |
|
|
White Discharge |
White color, thin quality, large volume, no odor. White color, thick quality, resembling curd or tofu residue. |
Spleen and kidney yang deficiency; cold dampness descending; damp turbidity descending. |
|
Yellow Discharge |
Yellow color, thick, foul-smelling. |
Damp-heat descending. |
|
Red and White Discharge |
White discharge mixed with blood, alternating red and white. |
Liver channel heat stagnation. |
10. Ask about Children
Physiologically: delicate organs, vigorous vitality, rapid development.
Pathologically: rapid onset, significant changes, easily deficient or excess.
Conditions before and after birth.
Vaccination history, history of infectious diseases.
Causes of disease: external invasion, diet, fright.