The Four Examinations, Part 5 (Inquiry/Asking Diagnosis)

The "10 Questions"

Inquiry/Asking

Demographics: name, age, sex, profession, life circumstances, birth place, where they live…

Past Medical History: Birth history (did mom have trouble conceiving, did she have any health problems during or prior to pregnancy, early, late, induced, breech, forceps, stuck in birth canal, cord wrapped around neck, jaundiced, blue, other complications…)

Childhood illnesses, learning disabilities

Traumas: sudden death of loved one, abuse (sexual, physical, emotional, verbal), major accidents, broken bones……………

Vaccinations

Medication history: antibiotics

Smoking/Recreational Drugs/Coffee

Exercise history: child athlete?………….

Family Medical History:diabetes, hepatitis, high blood pressure………….

Chief Complaint: why did they come in, when did it start (acute, chronic, what induced it), where is it located, progression, what makes it better or worse…..

10 Questions: 1. temperature: hot/cold; fever/chills
w/ chronic heat, can be from too much yang or too little yin
acute pathogenic invasion: wind-cold, wind-heat
yang pathogens: w-h, dryness, summerheat
yin pathogens: cold, damp
simultaneous fever and chills:
a. wind cold: more chills than heat (subjective), strong aversion to cold (wei qi can’t get to surface and warm you up; blankets don’t help), body aches; tongue normal b/c acute; pulse floating tight. This is the tai yang level of disease –most superficial
b. wind heat: more fever than chills, slight aversion to cold, sore throat, rashes, tongue normal or thin yellow coat, pulse slightly rapid and floating.
Alternating fever and chills: bitter taste in mouth, hypochondriac pain (malaria at its worst). The pathogen has penetrated into shao yang level.
Fever and no chills: internal heat
Chills and no fever: internal cold

Temperature can also tell us about vacuity/repletion
Vacuity:
Cold: maybe spontaneous sweating, body/limbs cold, clothes help, fear of cold
Heat: no aversion ot cold, heat in 5 centers, chronic

Repletion:
Cold: strong aversion to cold, bland taste in mouth, no thirst, diarrhea, clothes don’t help
Heat: acute, strong fever, 5 bigs

2. sweating
lungs disperses wei qi; fluid of heart; spleen and kidney w/ fluid metabolism; yin or qi defic? Excess yang or heat
a. where is person sweating?
a. Only on hands: nervous condition or lung qi defic
b. Only on extremities: spleen qi defic
c. Only on head and back of neck: ST heat or dampheat
d. Only on chest, palms and soles: yin defic
e. On head only: defic
f. All over body plus constip: repletion heat
b. What time of day?
a. Spontaneous sweat during day: qi is not holding/regulating pores/qi defic
b. Sweats in evening or during sleep: yin defic
c. Quality of sweat
a. Oily: yang defic. Looks like pearls
b. Profuse cold sweat after chronic illness: yang defic
c. Yellow: damp heat
d. W/ external pathogen: wind cold or wind damp: if doesn’t resolve: wei qi defic
d. Smell of sweat
e. Quantity of sweat


3. pain/head (dizziness)
head is most yang aspect of the body. All yang channels meet there. Sense organs on head

a. headaches:
i. acute: exterior attack, usually wind cold
ii. gradual onset: interior condition
iii. severe: excess/repletion
iv. annoying dull: defic/vacuity
v. daytime headache:
i. yang defic (annoying/dull)
ii. qi defic
vi. night headache: annoying: yin defic/ blood defic
Location: locations of meridians are important.
i. back of neck into eye: Tai yang channels
ii. frontal HA: yang ming
iii. side of head: shao yang
iv. vertex: liver
v. whole head band around: dampness
vi. pain inside head: damp; phlegm
What makes it better or worse.
i. worse w/ cold: cold pathogen. Better w/ heat
ii. averse to heat: heat pathogen
iii. better w/ pressure: vacuity
iv. aggravated by pressure: excess
v. fixed location/stabbing: blood stasis
vi. pain moves location and intensity: qi stag
vii. heavy: damp
viii. worse w/ activity: defic. Better w/ rest
ix. worse w/ rest: repletion. Better w/ activity

b. dizziness: due to wind, fire, defic of qi, or phlegm
i. swaying, losing balance: vertigo: internal wind
ii. head and ear clogged: phlegm

i.and ii. Are both excess conditions w/ fire components bringing up phlegm

iii. worse w/ fatigue, change of position: qi defic


4. hearing and vision
kidneys open to ears; liver to eyes. Gb and SJ have special affinity w/ ear

Ears:

Pain:
i. acute and repletion patterns: dealing more w/ channels involved and EPI and occasionally w/ externally/internally related channel (liver)
ii. chronic and gradual onset: vacuity. Dealing more w/ Kidneys
iii. better w/ pressure: defic
iv. worse w/ pressure: excess

Quality of Sound
v. tinnitus:
a. low pitch: KI defic
b. high pitch/whistle: repletion/Liver
vi. deafness:
a. sudden onset: repletion
b. gradual: vacuity

Vision:
Liver opens to eyes. Many meridians feed eyes (ht, st, gb, ub, sj)
Repletion:
Pain, swelling, itching, redness (wind-heat (acute) or internal liver fire)
Sharp stabbing pain like needles: toxic heat, fire poison in heart channel
Sand in eyes: spleen damp
Deficiency:
Blurred vision, floaters, flowery, photophobia, chronic dryness: liver blood defic
Pressure in eyes: kidney yin defic

5. stool and urine
Stool:
no pain w/ bloating: LV qi stag (harmonize ST and SP)
amount and color; well formed w/ no undigested food; easily eliminated
better w/ bowel movement: replete
energy of bowel movement tires you: defic
constipation: due to excess, defic, defic qi, blood, yin, yang, liver qi stag
acute: full heat in ST or intestines (yang ming). Tongue red w/ thick yellow coat
constip: from dryness in intestines
goat stools: small hard droppings (heat in intestines drying or LV qi stag)
abd cold to touch: cold or yang defic
abd hot: heat
alternating constip: LV qi stag invading SP and ST

diarrhea: could be same etiology as above; could be SP qi not transforming
foul smelling: heat
lack of smell: cold
cock’s crow: first thing in morning: KI and SP yang defic
blood in stool: damp heat in intestines
black stools: more serious: blood stasis (high in GI tract)
pus/mucus in stool: dampness
flatulence: LV qi stag
w/ odor: damp heat
no odor: cold in ST
borborygmus: gurgling: SP qi defic
Urine:
Ask about color, amount, pain, inhibition, etc.
Color:
pale/clear: cold in bladder or kidney
Dark yellow/brown: heat
Cloudy/turbid: damp
Amount:
scanty: heat (dried out fluids), KI yin defic (scanty but frequent), KI qi defic
copious: KI qi defic not consolidating (KI should mist up to Lungs and control bladder)
dribbling: KI qi defic
Pain:
Pain before urination, relief after: qi stag in lower jiao
Painful urination: heat in bladder
Retention of urine: damp-heat in bladder
Inhibited urine: can also be LV qi stag

6. appetite and thirst (taste)
Appetite: tells about SP and ST
Aggravated by eating: replete
Alleviated by eating: vacuity
Better w/ bowel movement: replete
Lack of appetite: SP qi defic
Excess appetite: ST heat
Appetite (hunger) w/o desire to eat: ST heat turning to yin defic heat. (May have red tongue w/ no coat)

Taste:
Desire for hot temp: cold
Desire for cold temp: heat
5 Element correspondences
craving or aversion for 5 element tastes
little stimulates: too much dampens/weakens
odd taste in mouth: look to 5 element correspondence; (ie bitter taste = LV/GB disharmony)
No taste: SP
7. sleep
shen is stored in HT and blood peacefully stored in LV. Sleep depends on state of blood and yin in body. If enough blood and yin, you sleep peacefully
Insomnia:
Can’t fall asleep, but once asleep, stays asleep: HT blood defic
Wakes easily: KI yin defic, HT yin defic
Combo of first two: HT and KI not communicating: usually more severe sx
Excess HT fire
Excess LV fire
ST heat due to food stagnation
Lethargy/Somnolence:
Sleepy after eating: SP qi defic
Fatigue (extreme) and cold: yang defic
Fatigue and heavy limbs: damp
Lethargy w/ signs of stupor and heat: external invasion of PC
Wakes up and doesn’t feel rested: GB qi defic
Grinding teeth:
Parasites
Emotional

8. chest and abdomen: pain/pressure, etc.
tightness in chest: lungs, heart, muscular
pain in sides/ribs/hypochondria: LV qi, GB qi stag (binding, constricted, can’t take deep breath, gas, bloating)
pain in lower abd/navel: intestinal cramping (SP), menstrual (LV/KI)
pain in epigastrium/solar plexus: ST region, food stag, or ST qi defic (differentiate by how pressure makes it feel)
pain in inguinal region/testicles: liver channel

9. gynecological: thorough history, first onset, timing, quantity and quality of blood, PMS, pain before, during or after periods, pregnancy and contraceptive, and sexual history, discharges, etc.
Chong and Ren: Need good LV blood and storage to fill Chong. Need enough KI yin and essence to make blood and SP to hold blood
If periods to frequent or comes early: heat: Liver gets hot; or SP qi not holding or LV qi not storing
Excess: thick, fire engine red
Defic: thin, watery
Period too late (more than 35 days): pregnant?:
Cold: congealed blood
Qi blood stagnation
Not enough blood: blood defic
Little blood: obstruction (qi, blood, cold) or defic
Lots of blood: qi defic (not holding) if pale, thin, or heat (more bright red and thick)
Leukorrhea:
White discharge: no odor: cold (yeast infection?)
Yellow discharge: smell: heat (yeast infection?)

10. lifestyle: rest/sleep/stress/emotions/tendencies
previous illnesses
old illnesses may show root of present disease
prior successes, failure
habits contributing to illness
demographics and emotional life and exercise, working conditions, etc.