Traditional Chinese Medicine – Inquiry
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Inquiry
Editor Discussion
Inquiry refers to the method used in Traditional Chinese Medicine (TCM) to diagnose diseases by conversing with patients and their informants to gather information about the onset, development, current symptoms, and treatment history of the disease. It is one of the four diagnostic methods.
The content of inquiry can be traced back to texts such as the “Su Wen: Zheng Si Shi Lun”. The “Nan Jing” lists the four diagnostic methods: observation, listening, inquiry, and palpation. In the Ming Dynasty, Zhang Jingyue’s “Jingyue Quanshu: Shi Wen Pian” comprehensively summarized the content, sequence, and significance of inquiry. In the Qing Dynasty, Lin Zhihan’s “Si Zhen Jue Wei” dedicated a chapter to inquiry.
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Chinese Name
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Inquiry
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Reference Books
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Su Wen: Zheng Si Shi Lun, Nan Jing
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Representative Figures
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Lin Zhihan from the Qing Dynasty
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Main Inquiry Items
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Current Medical History
Table of Contents
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1 Introduction
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▪ First Inquiry: Cold and Heat
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▪ Second Inquiry: Sweating
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▪ Third Inquiry: Head, Body, Chest, and Abdomen
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2 Main Text
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▪ Methods
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▪ Basic Content
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▪ Inquiry about Cold and Heat
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▪ Inquiry about Sweating
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▪ Inquiry about Head and Body
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▪ Inquiry about Stomach and Abdomen
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▪ Inquiry about Diet
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▪ Inquiry about Sleep
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▪ Inquiry about Urination and Defecation
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▪ Inquiry about Women
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▪ Inquiry about Children
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▪ Development Trends
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3 Western Medicine Content
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▪ General Items
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▪ Main Complaint
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▪ Current Medical History
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▪ Past Medical History
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▪ System Review
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▪ Personal History
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▪ Marital History
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▪ Menstrual and Reproductive History
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▪ Family History
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▪ Medication History
Introduction
Editor
Inquiry involves asking patients and their families to understand the current symptoms and medical history, providing a basis for pattern differentiation.
Zhang Jingyue, a physician from the Ming Dynasty, believed that inquiry is “the key to diagnosis and treatment, the primary task in clinical practice.” Most of the symptoms obtained from the four diagnostic methods are derived from inquiry, indicating the truth of this statement. The scope of inquiry is extensive, and the ten inquiries listed in the “Jingyue Quanshu” can be discussed with additions and omissions.
First inquiry: Cold and Heat; second inquiry: Sweating; third inquiry: Pain; fourth inquiry: Defecation; fifth inquiry: Nausea and Dizziness; sixth inquiry: Palpitations; seventh inquiry: Bitter and Thirst; eighth inquiry: Old Illness; ninth inquiry: Causes; the disease mechanism is fully derived from the symptoms. For women, it is essential to inquire about the menstrual cycle, whether it is early or late, and to ask comprehensively. Additionally, brief notes should be made for pediatrics, as external pathogens and food accumulation are common.
The main inquiry items include: general information (name, age, etc.), main complaint (the primary reason or symptom for the patient’s visit), current medical history (the onset time, triggers, location, duration, etc. of current symptoms), past medical history, system review, menstrual history, reproductive history, family history, etc. Some simple or intuitive diseases can be preliminarily diagnosed through inquiry. Inquiry can also initially differentiate some diseases, such as ectopic pregnancy and appendicitis, both of which can cause acute lower abdominal pain; in this case, the doctor can preliminarily differentiate by inquiring about the patient’s menstrual history.
Inquiry is a diagnostic term. It is one of the four diagnostic methods. Through inquiry, one can understand the patient’s medical history, family history, causes of onset, disease progression, treatment process, main suffering, subjective symptoms, dietary preferences, etc., combined with observation, palpation, and listening, to make a comprehensive analysis and judgment. The “Su Wen: San Bu Jiu Hou Lun” states: “One must carefully inquire about the initial disease and the current disease, and then check the pulse accordingly.” The “Su Wen: Shu Wu Guo Lun” states: “Anyone wishing to diagnose a disease must inquire about diet and living conditions.” Later generations of physicians summarized the main content of inquiry into “ten inquiries” and compiled a song for easy memorization. Refer to the ten inquiry items.
Ten Inquiry Song: First inquiry: Cold and Heat; second inquiry: Sweating; third inquiry: Head and Body; fourth inquiry: Defecation; fifth inquiry: Diet; sixth inquiry: Chest and Abdomen; seventh inquiry: Deafness; eighth inquiry: Thirst; ninth inquiry: Old Illness; tenth inquiry: Causes; additionally, medication should be considered for changes. For women, it is essential to inquire about the menstrual cycle; both early and late cessation can be observed. Additional notes should be made for pediatrics, as smallpox and measles are common.
First Inquiry: Cold and Heat
1. Chills and Fever: When a disease first arises, chills and fever appear simultaneously, often indicating an exterior syndrome. There are three types:
⑴ Exterior Cold Syndrome: Chills are severe, and fever is mild. This is caused by an exterior cold pathogen, often accompanied by no sweating, headache, body aches, and a floating tight pulse.
⑵ Exterior Heat Syndrome: Chills are mild, and fever is severe. This is caused by an exterior heat pathogen, often accompanied by dry mouth and slight thirst, or sweating, with a floating rapid pulse.
⑶ Taiyang Wind Syndrome: Mild fever, aversion to wind, and spontaneous sweating. This is caused by an exterior wind pathogen.
2. Alternating Cold and Heat: Chills and fever alternate, indicating a half-exterior, half-interior condition.
3. Only Cold, No Heat: The patient fears cold but does not have a fever, referred to as only cold, no heat.
4. Only Heat, No Cold: Fever without aversion to cold but aversion to heat, mostly indicating an interior heat syndrome. There are several types:
⑴ High Fever: Persistent high fever without aversion to cold, but aversion to heat.
⑵ Tidal Fever: Fever occurs like a tide at specific times, commonly seen in three types:
1) Yin Deficiency Tidal Fever: Often occurs in the afternoon or at night, characterized by five hearts feeling hot, often accompanied by red cheeks and night sweats, red tongue with little coating, and thin rapid pulse, indicating internal heat due to yin deficiency.
2) Yangming Tidal Fever: Often occurs in the afternoon (3-5 PM), with high fever, also known as diurnal tidal fever, mostly caused by dryness and heat in the stomach and intestines, often accompanied by abdominal fullness, hard pain, and constipation, with a yellow dry tongue coating.
3) Damp-Heat Tidal Fever: Characterized by severe afternoon heat, with body heat not rising. Often caused by dampness obstructing heat, making it difficult for heat to reach the surface, often accompanied by heaviness in the head and body, chest tightness, nausea, loose stools, and greasy tongue coating.
4) Low Fever: Refers to mild fever (body temperature mostly between 37-38 degrees Celsius), but lasting for a long time, often seen in yin deficiency tidal fever or qi deficiency fever.
Second Inquiry: Sweating
1. Differentiating Sweating in Exterior Syndromes 2. Differentiating Sweating in Interior Syndromes 3. Localized Sweating
Third Inquiry: Head, Body, Chest, and Abdomen
Pain in the forehead extending to the brow ridge is Yangming headache; pain on both sides of the head is Shaoyang headache; pain in the occiput extending to the neck is Taiyang headache; pain in the head and neck is Jueyin pain; heaviness in the head is Taiyin headache; severe headache is Shaoyin headache.
Main Text
Editor
Traditional Chinese Medicine uses a conversational method to inquire about the occurrence, development, symptoms, and treatment history of diseases to diagnose them. It is one of the four diagnostic methods. Its content can be traced back to texts such as the “Su Wen: Zheng Si Shi Lun”. The “Nan Jing” lists the four diagnostic methods: observation, listening, inquiry, and palpation. In the Ming Dynasty, Zhang Jingyue’s “Jingyue Quanshu: Shi Wen Pian” comprehensively summarized the content, sequence, and significance of inquiry. In the Qing Dynasty, Lin Zhihan’s “Si Zhen Jue Wei” dedicated a chapter to inquiry.
Inquiry is primarily used when the signs of disease are lacking or not obvious, to discover diagnostic information or clues for further examination; at the same time, it comprehensively understands other situations related to the disease, including the patient’s daily life, work environment, dietary preferences, marital status, etc. If other diagnostic methods reveal abnormal signs, inquiry can also be purposefully used to understand the dynamic changes of the disease, expanding diagnostic information for comprehensive analysis. This provides reliable evidence for doctors to correctly analyze the condition, infer the location, nature, and balance of the disease, and conduct reasonable treatment.
Methods
Inquiry should first focus on the patient’s main symptoms, then conduct purposeful and step-by-step questioning around the main symptoms, highlighting key points while also obtaining a comprehensive understanding. At the same time, a serious and responsible attitude is required; inquiries should be detailed, and the doctor should express sympathy towards the patient, speaking kindly, understandably, and patiently to gain the patient’s trust and obtain detailed and reliable disease information. During inquiry, avoid using leading or suggestive questions to prevent the information obtained from being inconsistent with reality. For critically ill patients, inquiries should be concise to facilitate timely rescue, and one should not delay treatment for the sake of completeness. Additionally, psychological comfort can be strengthened to help the patient build confidence.
Basic Content
During inquiry, in addition to listening to the patient’s main complaint, the following items can be inquired: general information (name, gender, age, occupation, marital status, ethnicity, place of origin, address, date of visit), disease occurrence and development, current symptoms, personal medical history, family medical history, etc. For women, it is also necessary to inquire about menstrual history and reproductive history. Among these, symptoms are the main content of inquiry and an important basis for pattern differentiation. The inquiry about symptoms mainly includes inquiries about cold and heat, sweating, head and body, chest and abdomen, stomach and abdomen, diet, sleep, emotions, urination and defecation, as well as specific inquiries for women and children.
Inquiry about Cold and Heat
This refers to inquiring whether the patient has any sensations of cold or heat. The sensation of cold and heat can provide a basis for determining the interior and exterior conditions of the disease. Clinically, if the patient only feels cold without feeling hot, it is referred to as only cold, which mostly belongs to cold syndrome; if there is fever without feeling cold, it is referred to as only heat, which mostly belongs to heat syndrome; if both fever and aversion to cold occur, or if one first feels cold and then fever, it is referred to as aversion to cold and fever, which mostly belongs to exterior syndrome; if chills and fever alternate, it is referred to as alternating cold and heat, which mostly belongs to half-exterior, half-interior syndrome. Severe chills with mild fever mostly belong to wind-cold exterior syndrome; mild chills with severe fever mostly belong to wind-heat exterior syndrome. If chills and fever occur at specific times, it is often malaria. Fever occurring every afternoon from 3-5 PM is referred to as Yangming fever, mostly caused by dryness and heat in the stomach, leading to constipation; low-grade fever in the afternoon or at night, with weight loss, is referred to as bone steaming tidal fever, mostly due to yin deficiency. Long-term low-grade fever, accompanied by reduced appetite, fatigue, and lack of desire to talk or move, indicates qi deficiency fever.
Inquiry about Sweating
Sweating is a component of body fluids, and normal sweating has the functions of harmonizing the defensive and nutritive qi and moisturizing the skin. Generally, both exterior and interior injuries can cause abnormal sweating. Inquiring about the patient’s sweating can help differentiate the interior and exterior conditions of cold and heat. When inquiring, focus on: ① Whether there is sweating or not. If the patient feels cold, fever, headache, and body aches without sweating, it indicates that the wind-cold pathogen is obstructing the muscle surface; if sweating occurs, it indicates that the wind-cold pathogen has penetrated the muscle surface. ② Inquire about the sweating situation. If there is frequent sweating that worsens with slight activity, it indicates spontaneous sweating, mostly belonging to qi deficiency or yang deficiency; if sweating occurs during sleep and stops upon waking, it indicates night sweats, mostly belonging to yin deficiency internal heat or qi and yin deficiency; if the patient first experiences shivering and then sweats, it indicates battle sweat, which is often a sign of a turning point in the disease. If sweating leads to a decrease in fever and the body feels cool, it indicates a positive change; if sweating does not reduce the fever and the patient feels restless, it indicates a dangerous condition. In severe cases, if the patient sweats profusely, it is referred to as absolute sweating, also known as脱汗. ③ Inquire about the location of sweating. Sweating in the chest area often indicates heart qi deficiency or insufficient heart blood; sweating on the head often indicates damp-heat steaming; sweating on the palms and soles often indicates spleen and stomach weakness or damp-heat obstructing the spleen and stomach; sweating in the upper body often indicates yang qi deficiency; sweating in the lower body often indicates yin deficiency internal heat or deficiency of both yin and yang; sweating on one side of the body can be seen in stroke with hemiplegia (the side without sweating is the paralyzed limb).
Inquiry about Head and Body
Pain is a common clinical symptom. Inquiring about the location, time of occurrence, and accompanying symptoms of pain can help differentiate between yin and yang, exterior and interior, cold and heat, and deficiency and excess syndromes. ① Inquire about the location of headache. If the pain is in the back of the head and extends to the neck, it is governed by the Taiyang meridian; if the pain is in the forehead and extends to the brow ridge, it is governed by the Yangming meridian; if the pain is in the temples or on both sides of the head, it is governed by the Shaoyang meridian; if the pain is in the head and neck, it is governed by the Jueyin meridian; if the head feels heavy, it is governed by the Taiyin meridian; if the headache is severe and feels like a piercing pain, it is governed by the Shaoyin meridian.
Main Text
Editor
Traditional Chinese Medicine uses a conversational method to inquire about the occurrence, development, symptoms, and treatment history of diseases to diagnose them. It is one of the four diagnostic methods. Its content can be traced back to texts such as the “Su Wen: Zheng Si Shi Lun”. The “Nan Jing” lists the four diagnostic methods: observation, listening, inquiry, and palpation. In the Ming Dynasty, Zhang Jingyue’s “Jingyue Quanshu: Shi Wen Pian” comprehensively summarized the content, sequence, and significance of inquiry. In the Qing Dynasty, Lin Zhihan’s “Si Zhen Jue Wei” dedicated a chapter to inquiry.
Inquiry is primarily used when the signs of disease are lacking or not obvious, to discover diagnostic information or clues for further examination; at the same time, it comprehensively understands other situations related to the disease, including the patient’s daily life, work environment, dietary preferences, marital status, etc. If other diagnostic methods reveal abnormal signs, inquiry can also be purposefully used to understand the dynamic changes of the disease, expanding diagnostic information for comprehensive analysis. This provides reliable evidence for doctors to correctly analyze the condition, infer the location, nature, and balance of the disease, and conduct reasonable treatment.
Methods
Inquiry should first focus on the patient’s main symptoms, then conduct purposeful and step-by-step questioning around the main symptoms, highlighting key points while also obtaining a comprehensive understanding. At the same time, a serious and responsible attitude is required; inquiries should be detailed, and the doctor should express sympathy towards the patient, speaking kindly, understandably, and patiently to gain the patient’s trust and obtain detailed and reliable disease information. During inquiry, avoid using leading or suggestive questions to prevent the information obtained from being inconsistent with reality. For critically ill patients, inquiries should be concise to facilitate timely rescue, and one should not delay treatment for the sake of completeness. Additionally, psychological comfort can be strengthened to help the patient build confidence.
Basic Content
During inquiry, in addition to listening to the patient’s main complaint, the following items can be inquired: general information (name, gender, age, occupation, marital status, ethnicity, place of origin, address, date of visit), disease occurrence and development, current symptoms, personal medical history, family medical history, etc. For women, it is also necessary to inquire about menstrual history and reproductive history. Among these, symptoms are the main content of inquiry and an important basis for pattern differentiation. The inquiry about symptoms mainly includes inquiries about cold and heat, sweating, head and body, chest and abdomen, stomach and abdomen, diet, sleep, emotions, urination and defecation, as well as specific inquiries for women and children.
Inquiry about Cold and Heat
This refers to inquiring whether the patient has any sensations of cold or heat. The sensation of cold and heat can provide a basis for determining the interior and exterior conditions of the disease. Clinically, if the patient only feels cold without feeling hot, it is referred to as only cold, which mostly belongs to cold syndrome; if there is fever without feeling cold, it is referred to as only heat, which mostly belongs to heat syndrome; if both fever and aversion to cold occur, or if one first feels cold and then fever, it is referred to as aversion to cold and fever, which mostly belongs to exterior syndrome; if chills and fever alternate, it is referred to as alternating cold and heat, which mostly belongs to half-exterior, half-interior syndrome. Severe chills with mild fever mostly belong to wind-cold exterior syndrome; mild chills with severe fever mostly belong to wind-heat exterior syndrome. If chills and fever occur at specific times, it is often malaria. Fever occurring every afternoon from 3-5 PM is referred to as Yangming fever, mostly caused by dryness and heat in the stomach, leading to constipation; low-grade fever in the afternoon or at night, with weight loss, is referred to as bone steaming tidal fever, mostly due to yin deficiency. Long-term low-grade fever, accompanied by reduced appetite, fatigue, and lack of desire to talk or move, indicates qi deficiency fever.
Inquiry about Sweating
Sweating is a component of body fluids, and normal sweating has the functions of harmonizing the defensive and nutritive qi and moisturizing the skin. Generally, both exterior and interior injuries can cause abnormal sweating. Inquiring about the patient’s sweating can help differentiate the interior and exterior conditions of cold and heat. When inquiring, focus on: ① Whether there is sweating or not. If the patient feels cold, fever, headache, and body aches without sweating, it indicates that the wind-cold pathogen is obstructing the muscle surface; if sweating occurs, it indicates that the wind-cold pathogen has penetrated the muscle surface. ② Inquire about the sweating situation. If there is frequent sweating that worsens with slight activity, it indicates spontaneous sweating, mostly belonging to qi deficiency or yang deficiency; if sweating occurs during sleep and stops upon waking, it indicates night sweats, mostly belonging to yin deficiency internal heat or qi and yin deficiency; if the patient first experiences shivering and then sweats, it indicates battle sweat, which is often a sign of a turning point in the disease. If sweating leads to a decrease in fever and the body feels cool, it indicates a positive change; if sweating does not reduce the fever and the patient feels restless, it indicates a dangerous condition. In severe cases, if the patient sweats profusely, it is referred to as absolute sweating, also known as脱汗. ③ Inquire about the location of sweating. Sweating in the chest area often indicates heart qi deficiency or insufficient heart blood; sweating on the head often indicates damp-heat steaming; sweating on the palms and soles often indicates spleen and stomach weakness or damp-heat obstructing the spleen and stomach; sweating in the upper body often indicates yang qi deficiency; sweating in the lower body often indicates yin deficiency internal heat or deficiency of both yin and yang; sweating on one side of the body can be seen in stroke with hemiplegia (the side without sweating is the paralyzed limb).
Inquiry about Head and Body
Pain is a common clinical symptom. Inquiring about the location, time of occurrence, and accompanying symptoms of pain can help differentiate between yin and yang, exterior and interior, cold and heat, and deficiency and excess syndromes. ① Inquire about the location of headache. If the pain is in the back of the head and extends to the neck, it is governed by the Taiyang meridian; if the pain is in the forehead and extends to the brow ridge, it is governed by the Yangming meridian; if the pain is in the temples or on both sides of the head, it is governed by the Shaoyang meridian; if the pain is in the head and neck, it is governed by the Jueyin meridian; if the head feels heavy, it is governed by the Taiyin meridian; if the headache is severe and feels like a piercing pain, it is governed by the Shaoyin meridian.
In summary, inquiry is a crucial aspect of TCM diagnosis, allowing practitioners to gather essential information about the patient’s condition and tailor treatment accordingly.