Diagnosis by Inquiry

Pattern identification through 8 principles, Zang Fu, pathogenic factors, and meridians

Chills and fever (feeling of heat)

- aversion to cold (Wind/Cold or Wind/Heat)

- fever and chills (Wind/Cold, Taiyang stage), more fever than chills (Wind/Heat, Wei Qi level)

- fever without aversion to cold (internal Heat, Yangming stage)

- alternating chills and fever (exterior invasion of Wind/Cold or Wind/Heat at Shaoyang stage)

- relief of coldness (clothing/covering relieves cold sensation– internal yang deficient cold, no relief)

– Wind/Cold) - low grade fever worse in afternoon or at night with sweats (Yin deficiency)

- constant low grade fever (Damp/Heat)

Sweating

- sweat with exterior symptoms (Wind/Heat, or Wind/Cold with deficiency) region

- only on head (Stomach Heat, or Damp/Heat)

- on forehead, oily (Yang collapse)

- only on arms and legs (Spleen Stomach deficiency)

- only on hands (Lung deficiency, or nerves)

- whole body (Lung deficiency)

- 5 centers (Yin deficiency) time

- daytime (Yang deficiency) - night (Yin deficiency) condition

- profuse cold sweats (Yang collapse)

- oily sweat on forehead like pearls not following Yang collapse (danger of imminent death) quality

- oily (severe Yang deficiency)

- yellow (Damp/Heat)

Pain

excess obstruction of Qi flow in the meridians, more severe, constant

- exterior pathogenic invasions

- internal Cold or Heat

- Qi stagnation (distension/throbbing more than pain, no fixed location)

- Blood stagnation

- Phlegm stagnation

- food retention

- Blood Stasis (stabbing, fixed location)

deficiency dull intermittent - Qi and/or Blood deficiency

- Yin deficiency consuming body fluids

Deficiency character: dull, lingering pressure: relieves food: relieves temperature: heat helps bowel movement: pain after posture: prefer lying down onset: slow gradual vomiting: pain after rest/movement: better with rest

Excess character: sharp intense pressure: aggravates food: aggravates temperature: cold helps bowel movement: relieved after posture: prefer sitting onset: sudden vomiting: relieved after rest/movement: better with movement

Cold character: cramping temperature: heat helps bowel movement: pain after vomiting: pain after rest/movement: better with movement

Heat character: burning temperature: cold helps bowel movement: relieved after vomiting: relived after rest/movement: worse with movement

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Head and body

headache

onset - recent, short duration (Wind/Cold) - gradual onset, come in attacks (interior)

time of day

- day time (Qi or Yang deficiency) - evening (Blood or Yin deficiency) location

- nape of neck: taiyang (Wind/Cold, or Kidney deficiency)

- forehead: yangming (Stomach Heat, or Blood deficiency) - temples/temporal region: Shaoyang (Liver Gallbladder Fire)

- vertex: jueyin (Liver blood deficiency)

- whole head (Wind/Cold)

pain characteristics

- heavy (Damp or Phlegm)

- inside the head/brain (Kidney deficiency)

- pounding, distending, throbbing (Liver Yang rising)

- boring, like a small nail point (Blood Stasis) condition

- with exterior symptoms (Wind/Cold, or Wind/Heat)

- aggravated by cold (Cold) - aggravated by heat (Heat) - aggravated by fatigue, better with rest (Qi deficiency)

Pain in whole body

- sudden onset with chills and fever (Wind/Cold)

- pain everywhere with tiredness (Qi blood deficiency)

- after childbirth - dull pain (Blood deficiency) - severe (Blood Stasis)

- pain in arms only when walking (Liver Qi stagnation)

- pain in all muscles and hot sensation of the flesh (Stomach heat)

- pain with heavy feelings (Damp obstructing muscles)

Pain in joints - wondering from joint to joint (Wind) - severe fixed (Cold) - fixed with swelling and numbness (Damp)

Backache - continuous dull (Kidney deficiency) - acute severe with stiffness (Blood Stasis) - severe, aggravated by cold and damp weather (Cold/Damp invasion of the meridians) - boring pain, tough to turn waist (Blood Stasis) - extending up to the shoulders (exterior attack)

Numbness - arms and legs only, or hands and feet only (Blood deficiency) - fingers, elbow and arm on one side only, especially the first three fingers (Wind and Phlegm, possible Wind stroke)

Dizziness Mostly diagnosed through identification of other symptoms - usually root cause is Blood deficiency - giddiness when everything seems to sway, lose balance (internal Wind) - mild, with heaviness and cloudiness in head (Phlegm) - aggravated when fatigued (Qi deficiency)

Thorax and abdomen

- chest pain (Heart Blood Stasis due to Yang deficiency)

- chest pain with cough and copious yellow sputum (Lung Heat)

- hypochondriac distension (Liver Qi stagnation, if severe – Liver Blood Stasis)

- epigastric pain (food retention, Stomach Heat)

- dull epigastric pain (deficient Cold of Stomach)

- epigastric fullness (Spleen deficiency or Damp)

- low abdominal pain (internal Cold, Liver Qi stagnation, Liver Blood stagnation, Damp/Heat, intestinal or uterine Blood Stasis)

- hypogastric pain (Damp/Heat in Bladder, or Liver Fire moving down to the Bladder)

Diet, Appetite, and Taste

- discomfort relieved by eating (deficiency), aggravated by eating (excess)

- no appetite (Spleen deficiency) - always hungry (Stomach Heat)

- fullness and bloating after meals (food retention)

- prefer hot temperature foods (Cold) - prefer cold temperature foods (Heat) taste

- bitter taste (Liver or Heart Heat)

- sweet taste (Spleen deficiency, or Damp/Heat)

- sour taste (food retention, or Liver Stomach disharmony)

- salty taste (Kidney Yin deficiency)

- lack of taste (Spleen deficiency)

- pungent taste (Lung Heat) vomit

- sour vomit (Stomach insult Liver)

- bitter vomit (Liver Gallbladder Heat)

- clear watery (Stomach Cold with fluid retention)

- soon after eating (Heat)

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Stool

Constipation

- pain after movement (deficiency) - pain relieved after movement (excess) - acute with thirst, dry yellow tongue coat (Stomach and intestine Heat) - old people or after childbirth (Blood deficiency) - small bitty rabbit stools (Blood deficiency, Liver Qi stagnation, or Heat) - difficult to move but not dry (Liver Qi stagnation) - with abdominal pain (deficient Yang Cold) - dry stools without thirst (Kidney and/or Stomach Yin deficiency) - alternating constipation and diarrhea (Wood overact on Earth)

Diarrhea - painful (Liver, or Heat) - foul smell (Heat), no smell (Cold) - chronic (Spleen and/or Kidney Yang deficiency) - 5am (Kidney Yang deficiency) - abdominal pain (Cold in intestines) - with mucous (Damp), mucous and blood (Damp/Heat) - undigested food (Spleen deficiency) - burning sensation (Heat) - bowel incontinence (Spleen Qi sinking) - black tarry stools (blood stasis), if blood comes first (Damp/Heat in intestines) - if blood comes first, is dirty, and anus feels heavy and painful (Heat in Blood) - if stool comes first then blood that is thin and watery (Spleen can’t keep blood in vessels) - borborygmi with loose stool (Spleen deficiency) - borborygmi without loose stool (Liver Qi stagnation) - flatulence (Liver Qi stagnation) - flatulence with smell (Damp/Heat in Spleen , or Stomach Heat), no smell (Spleen Yang deficient Cold)

Urine function - enuresis or incontinence (Kidney deficiency) - retention of urine (Damp/Deat in Bladder) - difficulty (Damp/Heat in Bladder, or Kidney deficiency) - frequent copious (Kidney deficiency) - frequent scanty (Qi deficiency)pain - before urination (Low Jiao Qi stagnation) - during urination (Bladder Heat) - after urination (Qi deficiency) colour - pale (Bladder or Kidney Cold) - dark (Heat, or external pathogen has entered deeply) - turbid or cloudy (Damp in Bladder) - copious clear pale during exterior attack (pathogen has not entered deeply) amount - copious (Kidney Yang deficiency) - scanty (Kidney Yin deficiency)

Sleep

insomnia - can’t get to sleep, but sleep well after falling to sleep (Heart Blood deficiency) - light sleep, waking frequently (Kidney Yin deficiency) - dream disturbed (Liver or Heart Fire) - restless sleep with lots of dreams (food retention) - wake very early in morning, can’t get back to sleep (Gallbladder deficiency) lethargy - sleepy after eating (Spleen deficiency) - heaviness (Damp), if with dizziness (Phlegm) - very fatigued with cold feelings (Kidney Yang deficiency) - tired stupor with external heat (Heat invaded the Pericardium) - tired stupor with rattling in throat, slippery pulse, sticky tongue coat (Phlegm misting the mind)

Ears

tinnitus onset - sudden (Liver Fire, or Liver Wind) - gradual (Kidney deficiency) pressure - aggravated by pressing the ears (excess) - relieved by pressing the ears (deficiency) tone - loud high pitched like whistle, constant (Liver Yang, Liver Fire, or Liver Wind) - low pitched, intermittent (Kidney deficiency)

deafness - sudden onset (Liver Fire, or Liver Wind) - gradual onset (deficiency) - chronic (Kidney deficiency, Heart blood deficiency, deficiency of Qi of the upper Jiao, Yang Qi deficiency)

Eyes pain

- needle like pain with redness and headache (Toxic Fire in the Heart meridian) - pain swelling and redness, (Wind/Heat, or Liver Fire) - blurred vision and/or floaters (Liver Blood deficiency) - photophobia (Liver Blood deficiency) - eye pressure (Kidney Yin deficiency)dryness - dryness (Liver and/or Kidney Yin deficiency)

Thirst and Drink

- desire to drink large amounts of cold water (excess Heat of any organ) - desire to drink warm water (Cold) - no thirst (Spleen or Stomach Cold) - thirst but no desire to drink (Damp/Heat) - thirst with desire to sip slowly (Stomach or Kidney Yin deficiency)

Women

menstruation cycle - early (Heat in Blood or Qi deficiency) - late (Blood deficiency, Blood stagnation, Cold) - irregular (Liver Qi stagnation, Liver Blood stagnation, Spleen deficiency) quantity - heavy flow/loss (Heat in Blood or Qi deficiency) - scanty (Blood deficiency, Blood stagnation, Cold) colour - dark or bright red (Heat in the Blood) - pale red (Blood deficiency) - purple or blackish (Blood Stasis, Cold) - fresh red (Yin deficiency Heat) quality - thicker blood with clots ( Blood Stasis or Cold) - watery (Blood or Yin deficiency) - turbid (Heat in Blood or Cold stagnation) pain - before period (Qi or Blood stagnation) - during period (Heat in Blood or Cold stagnation) - after periods (Blood deficiency)

leukorrhea colour - white (Cold from Spleen or Kidney Damp, Cold/Damp, Liver Qi stagnation) - yellow (Damp/Heat in low Jiao) - greenish (Damp/Heat in Liver meridian) - red and white (Damp/Heat) - yellow with pus and blood after menopause (Toxic Damp/Heat in Uterus) consistency - watery (Cold/Damp) - thick (Damp/Heat) odour - fishy (Damp/Cold) - putrid (Damp/Heat)

pregnancy

infertility - Blood or Kidney Essence deficiency, Damp/Heat in low Jiao, Blood Stasis in Uterus, Liver Qi stagnation, Spleen Kidney Yang deficiency vomiting - Stomach and Chong mai deficiency

miscarriage - before 3 months (Blood or Essence deficiency) - after 3 months (Liver Blood Stasis or Spleen Qi sinking) childbirth - sweating and fever after delivery (Qi and Blood exhaustion) -

post partum depression (Blood deficiency leads to Heart Blood deficiency)