“Wang Wen Wen Qie” (Observation, Listening, Inquiry, and Pulse Diagnosis) is a significant characteristic of Traditional Chinese Medicine (TCM) in treating diseases, among which inquiry is the most fundamental and important part of medical diagnosis. In fact, there are some fixed routines for inquiry; these questions can be asked by anyone, and through these questions, one can understand some conditions of the patient, facilitating targeted medication. So, what exactly should be asked during an inquiry?
1. Inquire about Bowel and Urination
Understand the characteristics, color, odor, timing, quantity, and frequency of bowel movements and urination, as well as the sensations during these processes.
Abnormal Bowel Movements: Difficulty in bowel movements, not having a bowel movement for several days, is termed constipation. Heat excess injures body fluids leading to heat constipation, while cold accumulation leads to cold constipation. Qi stagnation results in qi constipation, and deficiency of qi leads to deficiency constipation. Unformed or watery stools with increased frequency indicate diarrhea. Loose stools that are unformed are termed damp diarrhea, often due to spleen dysfunction. Abdominal pain with diarrhea at dawn is termed “Wu Geng Xie” (Five Dawn Diarrhea), often due to Kidney Yang Deficiency. Abdominal pain with diarrhea that reduces after defecation is termed food injury diarrhea.
Abnormal Stool Quality: A burning sensation or feeling of heaviness in the anus during bowel movements indicates spleen deficiency with qi sinking. Unsatisfactory bowel movements suggest liver qi stagnation. Diarrhea with undigested food and reduced pain after defecation is often due to food injury. If the stool is yellow and sticky, it often indicates damp-heat accumulation in the large intestine. Abdominal pain with urgency and frequent desire to defecate is often due to damp-heat obstruction and intestinal qi stagnation, which are symptoms of Dysentery. Incontinence of stool is often due to kidney yang deficiency.
Abnormal Urination Volume: Increased urination volume indicates deficiency-cold. Decreased urination volume is due to heat excess, excessive sweating injuring body fluids, or vomiting and diarrhea damaging body fluids.
Abnormal Urination Frequency: Increased urination frequency with short, red, urgent urination is often due to damp-heat. Chronic illness with clear, frequent urination at night indicates kidney yang deficiency. Difficulty urinating with dribbling is generally due to damp-heat or blood stasis, while blockage from stones indicates a real condition; if due to insufficient kidney yang, it indicates a deficiency condition.
Abnormal Urination Sensation: Painful urination, urgency, and burning sensations are often due to damp-heat descending to the bladder, commonly seen in gonorrhea. Incontinence during sleep indicates kidney qi instability. Coma with incontinence indicates a critical condition.
2. Inquire about Cold and Heat
The occurrence of cold and heat is mainly determined by the nature of the pathogenic factor and the balance of yin and yang in the body, reflecting the interaction between the body’s righteousness and evil.
Cold without Heat: The patient feels cold but does not have a fever, indicating a deficiency-cold condition due to insufficient yang qi.
Heat without Cold: The patient has a fever but does not feel cold or is afraid of heat, indicating internal heat syndrome. If high fever is accompanied by thirst for cold drinks, sweating, and constipation, it indicates a real heat condition. If there is low fever in the afternoon, with hot palms and soles, night sweats, and flushed cheeks, it indicates internal deficiency heat syndrome.
Chills and Fever: The patient feels cold and has a rising body temperature, indicating the initial stage of an external pathogen.
Alternating Cold and Heat: Cold and heat appear alternately. Regular alternating cold and heat indicates malaria. Irregular alternating cold and heat, accompanied by pain in the flanks and bitter mouth, indicates liver and gallbladder disease.
3. Inquire about Sweating
The occurrence of sweating is related to the balance of yang qi and the loss or gain of body fluids.
No Sweating: In cases of external pathogen cold, fever, chills, and headache without sweating indicate a real condition.
Sweating: In cases of external wind pathogen, fever, and fear of wind with sweating indicate a deficiency condition.
Spontaneous Sweating: Sweating with slight activity during the day, often accompanied by fatigue, shortness of breath, and fear of cold, indicates yang qi deficiency, often due to internal injury.
Night Sweats: Sweating during sleep at night, accompanied by fever, flushed cheeks, irritability, insomnia, and dry mouth, indicates internal heat due to yin deficiency, often due to internal injury.
4. Inquire about Sleep
Insomnia: Difficulty falling asleep or waking easily during sleep, difficulty returning to sleep, or sleeplessness throughout the night, often indicates insufficient yin blood and heart not being nourished. Commonly accompanied by palpitations, vivid dreams, tinnitus, and tidal fever. If phlegm-heat or food accumulation causes insomnia, it is often accompanied by flushed face, shortness of breath, thirst, and discomfort in the stomach.
Excessive Sleepiness: Intense sleepiness, often falling asleep involuntarily. In older individuals with physical weakness, it often indicates heart and kidney yang deficiency; in overweight individuals, it is often accompanied by abdominal distension and phlegm, indicating spleen deficiency with excessive dampness, preventing clear yang from rising.
5. Inquire about Pain
Ask about the location, nature, and intensity of pain to observe the condition.
Headache: Sudden headache, continuous pain, accompanied by chills and fever, often indicates an external pathogenic real condition. Intermittent headaches with a feeling of pressure, worsening after fatigue, or accompanied by dizziness, often indicate an internal injury deficiency condition.
Chest Pain: Chest pain due to lung heat is often unilateral, accompanied by fever, cough, and thick yellow phlegm; chest obstruction syndrome presents as a feeling of heaviness in the heart area, or stabbing pain, recurring, accompanied by palpitations and shortness of breath.
Liver and Gallbladder Pain: Presents as discomfort and distension in the flanks.
Stomach Pain: Presents as distension and pain in the stomach area, accompanied by belching and sour regurgitation.
6. Inquire about Dietary Preferences
This includes understanding the amount of water intake, preference for hot or cold foods, appetite and food quantity, and any abnormal taste sensations.
Thirst and Excessive Drinking: Excessive thirst and drinking often indicate injury to body fluids, commonly seen in heat or dryness syndromes, or excessive sweating, vomiting, or diarrhea. If thirst is accompanied by a preference for cold drinks, it indicates internal heat injuring body fluids. Increased urination and weight loss indicate diabetes.
No Thirst and Low Drinking: No thirst and lack of desire to drink often indicate a cold syndrome. If there is thirst but vomiting after drinking, it often indicates water dampness stagnating in the stomach. If there is thirst but low drinking preference, and a preference for hot drinks, it often indicates damp or deficiency-cold syndrome; a preference for cold drinks indicates damp-heat syndrome.
No Desire to Eat and Anorexia: Lack of desire to eat or food tasting bland, low appetite indicates no desire to eat. In new illnesses, it often indicates food injury or external pathogen heat. In chronic illnesses, lack of desire to eat indicates spleen and stomach weakness. If there is aversion to food, it is often due to food stagnation or liver-spleen damp-heat.
Excessive Eating and Selective Eating: Excessive eating and easy hunger often indicate excessive stomach fire; if a person who has been ill suddenly eats excessively, it often indicates impending failure of spleen and stomach qi. Selective eating of raw rice, dirt, or foreign objects indicates parasitic accumulation.
Taste Preferences: Bitter taste indicates liver and gallbladder heat; sour taste indicates gastrointestinal stagnation; foul breath indicates excessive stomach fire; bland taste indicates stomach dampness or deficiency; sweet taste indicates spleen damp-heat; salty taste indicates kidney deficiency.
In addition to the above inquiry questions, pharmacy staff should also understand the patient’s past medical history, personal history, menstrual history, reproductive history (for females), and family history, and consider them comprehensively.
1. Past Medical History
(1) The patient’s previous health status.
(2) Past diseases (including various infectious diseases), especially those closely related to the current illness. For example, patients with coronary atherosclerotic heart disease should be asked about past hypertension, diabetes, etc. When documenting, care should be taken not to confuse with current medical history.
(3) History of trauma, surgery, accidents, and vaccination.
(4) Allergy history (to medications, foods, and environmental factors).
(5) Major infectious diseases and endemic diseases in the living or residing area should also be recorded in the past history.
(6) The recording order is generally arranged chronologically by year and month.
2. Personal History
Personal experiences related to health and disease, including:
(1) Social experiences including birthplace, residence area and duration (especially epidemic areas and areas with endemic diseases), education level, economic life, and hobbies.
(2) Occupational and working conditions including job type, labor environment, exposure to industrial toxins, and duration.
(3) Habits and preferences including daily routines and hygiene habits, dietary regularity and quality, smoking and alcohol preferences and intake.
(4) Sexual history including any unclean sexual intercourse, history of gonorrhea, condyloma acuminatum, or chancroid.
3. Menstrual History
The menstrual status of female patients. Mainly documenting age of menarche, menstrual cycle, duration of menstruation, amount and color of menstrual blood, menstrual symptoms, presence of dysmenorrhea, leukorrhea, date of last menstruation, date of amenorrhea, age of menopause, etc.
4. Reproductive History
The reproductive status of the patient. Including number and age of pregnancies and births, number of induced or spontaneous abortions, presence of premature births, stillbirths, surgical births, puerperal fever, and family planning status, etc. Male patients should document any reproductive system diseases.
5. Family History
Refers to the health status of relevant family members of the patient, including:
(1) Age and health status of parents (including grandparents).
(2) Age and health status of spouse.
(3) Age and health status of siblings.
(4) Age and health status of children.
(5) Any family members with similar diseases or hereditary diseases, such as albinism, hemophilia, congenital spherocytosis, diabetes, familial hypothyroidism, mental illness, etc. For deceased direct relatives, inquire about the cause of death and age.
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