• Chills and fever
• Perspiration
• Appetite, thirst and taste
• Defecation and urination
• Pain
• Sleep
• Sex and reproductive system
• Obtaining a history in children

As in the West Medicine, TCM physicians will start a consultation by inquiring about the patient’s immediate complaint, its onset and duration and relevant medical history. He will proceed to systematically inquiring about chills and fever, perspiration, appetite and taste, defecation and urination, pain and sleep. Women are likely to be asked about their menses and obstetric history. The first consultation may be lengthy and you may be asked for details concerning present symptoms and even seemingly irrelevant questions! The answers give clues to the physician about the possible causes for your complaint and how best to treat it. Sometimes, a simple seemingly harmless symptom may be significant clinical clue to discern what the problem is by TCM physicians.

A song created by Zhang Jiebin (1563-1640) in the Ming Dynasty, called the “Ten Questions Song,” was used as an outline for guiding TCM physicians about what questions to ask their patients. It was later supplemented by other scholars.

Ten Questions Song

First ask hot and cold, second ask sweat,
Third ask head and body, fourth ask stools and urine,
Fifth ask food and drink, sixth ask chest,
Seventh ask hearing, eighth ask thirst,
Ninth ask old disease, tenth ask cause.
In taking medicinals, what changes appear.
Women especially, ask the time of menses, slow, fast, block or flood.
For children, add experience with measles and chicken pox.

**Practical Diagnosis in Traditional Chinese Medicine, Deng Tietao, 1999 p.64.

Below are common questions asked by TCM physicians during a consultation.

Chills and fever

Inquiring about a person’s reaction to cold and heat can help to distinguish between exogenous or endogenous causes of illness, and also to know whether it is a exterior or exterior problem, and even belongs to yin or yang.

• Chills and fever indicate invasion of the body by exogenous pathogenic factors. If chills are predominant, it indicates an invasion by wind-cold but if fever predominates, wind-heat is to be blamed.
• Chills without fever reflects endogenous cold caused by weakness of yang qi . This may also result from exogenous pathogenic cold affecting certain zang or fu organs.
• One may also experience fever without chills. Persistent high fever indicates excessive internal heat that can be resulted from invasion of exogenous heat evils, or the exogenous pathogens have entered from the exterior to the interior body. Low grade fever occurring at a definite time of day is called tidal fever, resulting from endogenous heat caused by yin deficiency.

Perspiration

Sweat is created by yang qi steaming and transforming yin fluids, which becomes evident when emerging from sweat pores on the body surface. Physician will ask whether the patient sweats or not. If yes, the following questions about when, where and how much the patient sweats are asked. By inquiring about patterns of perspiration, one can differentiate if the pathogenic force or healthy energy is strong or weak, and whether the sweat pores are opened or blocked. One can also know about the states of qi (vital energy) and blood inside the body.

• For cold and flu, sweating indicates the superficial portion of the body has been invaded by exogenous pathogenic factors, while the absence of perspiration means the condition is attacked by a combination of wind and cold evils.
• Frequent sweating upon slight exertion is referred to as spontaneous sweating, that usually occurs when yang-qi is insufficiency, and infirmity of protective qi.
• Night sweating occurs during sleep but ceases when the person awakes, which suggests a deficient yin.

Appetite, thirst and taste

Food and drink are necessities for maintaining functioning and vitality of body, which are sourced from the spleen and stomach to create nutrient essence. Inquiry about thirst, appetite and mouth taste reveal the functional states of these organs.

• Thirst combined with a desire for drinks is common in internal heat disharmony, body fluid depletion or kidney yin deficiency; while absence of thirst, or thirst without desire for drinks indicates cold or dampness accumulation.
• Preferences for cold food and beverages signifies a heat disharmony; while preference for hot food and beverages imply a cold disharmony.
• Poor appetite and the sensation of tasteless food and fullness in the abdomen indicate weakness of the spleen and stomach.
• Foul belching, acid regurgitation and nausea indicate retention of food.
• A sticky, sweet taste in the mouth reflects damp-heat; while a bitter taste suggests a hyperactive liver and gall-bladder.

Defecation and urination

The spleen and stomach govern the reception of water and food, and perform digestion and transformation functions to turn them into nutrient essence used by the body. The kidneys, large intestine, triple burner and urinary bladder are all involved in the urination and defecation processes and interact with the spleen and stomach. Hence, by inquiring about stools and urine, physicians can find out about the functioning of all these organs.

• Constipation with dry stool usually indicates heat in the intestines. However, if this occurs in the elderly, women after childbirth, or individuals with chronic illness, it usually indicates deficiency of qi and insufficient body fluids.
• If stools are passed with pus after painful straining, it indicates damp-heat in the intestines.
• Loose stool with undigested food reflects weakness of the spleen and stomach.
• Constant diarrhea before daybreak suggests yang deficiency of the spleen and kidneys.
• Deep yellow urine indicates heat type, while clear and profuse urine indicates cold type.
• Urgency, painful, scanty urination and in deep yellow color suggest accumulation of damp-heat in the bladder; while frequency with clear urine, incontinence, dribbling urine afterward are possibly due to insecurity of kidney qi.
• Dysfunction of the lungs, kidneys or spleen can lead to fluid retention in the body, and will produce little urine or no urine at all.

Pain

Pain is one of the most common complaints of patients. Apart from a thorough understanding of the history and accompanying symptoms and signs, TCM focuses on the nature and locations of pain. The nature of the pain helps to identify its etiology (cause) and pathology, while locality of the pain helps to determine which organs and meridians may be affected. For example the location of headache can indicate problems with different meridians.

Leg Shao Yang Gall Bladder Meridian	Leg Tai Yang Bladder Meridian
Leg Jue Yin Liver Meridian	Leg Yang Ming Stomach Meridian

1.Nature of pain from a TCM perspective

Pain that is aggravated by pressure, acute onset, persistent and severe usually belongs to a excess (shi) type. That means the pain is mainly associated with obstruction of meridians, or stagnation of qi (vital energy) and blood caused by various pathogenic factors.

Pain which is developed slowly, alleviated by pressure, mild and intermittent is usually caused by malnutrition of the tendons and collaterals due to insufficient qi (vital energy) and blood, and essence. If the pain is relieved by warmth, the pain belongs to a cold type; if the pain is relieved by cold, then it belongs to a heat type. Most migrating pain is due to invasion of collaterals by wind; fixed pain may be due to the obstruction of collaterals.

Below summarized the types, characteristics and clinical significance of pain from a TCM perspective:

2. Locations of pain from a TCM perspective

Obstruction in the above meridians can cause hypochondriac (rib sides) pain.

• Headache: The head is the pivot of blood and qi circulation, meeting place for the yang meridians and the brain is the sea of marrow. If there is pathogen invasions, stagnation of qi and blood, or blockage in the meridians, headache will ensue. TCM physician will identify the affected meridians according to the specific headache regions (see above). They can also differentiate between different types of headache according to the nature of the headache and its concomitant symptoms.
• Chest pain (1): The heart and lungs reside in the chest, chest pain usually indicates the associated problems.
• Hypochondriac pain (2, rib side pain): The hypochondriac region is traveled by the liver and gall-bladder meridians. Obstruction or malnutrition of these meridians may produce hypochondriac pain.
• Epigastric pain (3): This refers to the upper abdomen where the stomach is situated. Epigastric pain may result from invasion of the stomach by pathogenic cold, retention of food in the stomach, or invasion of the stomach by the liver qi.
• Abdominal pain: The abdomen is divided into the upper abdomen, lower abdomen and sides of the lower abdomen. The upper abdomen (4) refers to the area above the umbilicus and pertains to the spleen. The area below the umbilicus is the lower abdomen (5) and pertains to the kidneys, bladder, large and small intestines and uterus. Both sides of the lower abdomen (6) are traveled by the liver meridian.  So according to the locality of the pain, the diseased organs and meridians can be identified.
• Lumbar pain: The kidneys resides in the lumbar region, pain in it may result from obstruction of the meridians in the local area; besides, deficiency of the kidneys is also the cause.
• Pain in the limbs: Pain in the four limbs may be related to the joints or muscles, which may due to invasion of the exogenous pathogens, or bi syndrome.

Sleep

• Insomnia refers to difficulty in falling sleep, inability to sleep soundly, waking easily and lying awake. Insomnia accompanied by dizziness and palpitation indicates insufficiency of blood that fails to nourish the spirit. Insomnia accompanied by restlessness and nightmares indicates heart fire blazing.
• Drowsiness is known as lethargy, if accompanied by low spirited, fatigue, dizziness, general heaviness, loose bowels and poor appetite, it may due to  phlegm-dampness disturbing spleen; if accompanied by general weakness, slow mental response, aversion to coldness, and reluctant to move, then it may due to yang deficiency of heart and kidneys.

Sex and reproductive system

Physicians usually ask women about their menstrual cycles, vaginal discharges, pregnancy and childbirth history. These are the basis of female physiology and closely related to disease development on them. Men may also be asked about any problems they may be experiencing such as ejaculation problems or problems they encounter when having sex.

Obtaining a history in children

From a TCM viewpoint, a child’s body is purely yang. Children have a tender and delicate yin-yang balance because their bodies are not yet fully developed. Their organs are fragile and delicate, therefore, they are easily attacked by exogenous evils and thus often cause diseases like flu and cold. Digestive problems are common too, because children themselves are not able to control their diet. Since they are under rapid growth and development, their disease courses tend to change rapidly, allowing them to either heal or aggravated quickly. Special attention is paid by physicians to these characteristics of development when examining a child.

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