Self-conscious symptoms mainly depend on asking, which helps to find other symptoms. The general content and chief complaint of the inquiry are roughly the same as those of western medicine. First, grasp the chief complaint, that is, one or several main symptoms and time that patients feel most painful when they see a doctor, and inquire about the present medical history in depth around the symptoms of the chief complaint, which is different from the basic theory of traditional Chinese medicine and the requirements of syndrome differentiation. Including name, gender, age, marriage, occupation, native place, address, etc.
Knowing the general situation, we can get information related to the disease. Different age, sex, occupation and place of origin may have different conditions for birth and burial, and may also have different diseases, such as measles, chickenpox and whooping cough, which are more common in children. More common evidence of diseases among young people; Deficiency syndrome is more common in the elderly. In addition to general diseases, women also have specific diseases such as menstruation, vaginal discharge, fetus and childbirth. There are schistosomiasis in the coastal areas of rivers and lakes south of the Yangtze River; Hookworm disease is more common in sericulture areas. Silicosis, lead poisoning and mercury poisoning are related to occupational diseases. The occurrence, development, change and treatment of diseases from onset to treatment.
1. Ask about the illness.
The cause, process and symptoms of the disease, the location and nature of the symptoms, sudden or slow onset, and the inducement of the disease.
Understand the characteristics and changing rules of the course of disease and main symptoms, such as continuous or intermittent, aggravating or relieving, whether the nature has changed, whether it has been treated during the course of disease, what medicine it has taken and how it reacts.
Understanding the pathogenesis is of great significance for mastering the law of occurrence, development and change of diseases and guiding dialectical treatment.
Step 2 ask about current symptoms
(1) Ask about cold and fever: aversion to cold and fever is often the main manifestation of some diseases. Pay attention to the relationship between aversion to cold and fever and its severity, time and attack characteristics.
① aversion to cold and fever occur at the same time, mostly superficial or semi-superficial.
Severe aversion to cold, mild fever, mostly exterior cold syndrome; Severe fever, mild aversion to cold, mostly superficial heat syndrome; Aversion to cold and fever appear alternately, which is called the combination of cold and heat, and most of them are half exterior and half interior syndrome.
② Fever is not aversion to cold, but mostly internal heat syndrome.
High fever, thirst, red urine and constipation are internal heat syndromes; Long-term hot flashes, fever caused by five poisons and weakness of bone steaming are mostly due to yin deficiency and internal heat syndrome.
③ Fear of cold without fever, fear of cold, chills in hands and feet, and low body temperature are the syndromes of yang deficiency and internal cold.
(2) Ask about sweating: Pay attention to sweating, non-sweating, sweating time, sweating position, sweating amount and characteristics.
① Exogenous fever, aversion to cold and sweating are exterior syndromes; Fever, aversion to cold and anhidrosis are exterior syndromes. Those who have a high fever and sweat but are not afraid of the cold are all internal heat.
② Sweating often during the day, especially after activities. Feeling cold and short of breath after sweating is called spontaneous sweating, mostly due to qi deficiency and yang deficiency. Sweating after falling asleep and stopping sweating after waking up are called night sweats, which mostly belong to yin deficiency.
(3) Sweating is confined to the head, which can be seen in damp-heat syndrome in which heat cannot be leaked out, and it is depressed in the body; Half-body sweating is mostly due to poor blood circulation.
④ Sweating all over the body, sweating profusely, and seeing cold limbs belong to the "Yang Death Syndrome" of heartbroken Yang.
(3) Asking about diet
Pay attention to ask whether you are thirsty, how much water you drink, appetite and appetite, like cold and hot, and whether there is any abnormal taste and smell in your mouth.
(1) Thirst and drinking water:
Drink more when you are thirsty, like cold drinks, it's really hot; Mouth is not thirsty, does not like to drink, or likes to drink hot, mostly belonging to deficiency-cold syndrome; Thirst does not like to drink, mostly damp and hot; Dry mouth and throat, but not much water, mostly caused by yin deficiency and internal heat.
② Appetite and eating:
Loss of appetite, chronic diseases are mostly spleen and stomach weakness, and new diseases are mostly caused by food injury, food stagnation, or exogenous dampness. Overappetite, eating too much and being hungry is a stomach fire; Hunger without food is mostly due to insufficient stomach yin.
It can be eaten during illness, indicating that stomach qi is not hurt and the prognosis is good; The gradual increase in food intake during illness is due to the gradual recovery of stomach qi. Although the condition is serious, there is a turn for the better.
③ Abnormal taste and smell in the mouth:
Bitter mouth is more common in heat syndrome, especially in liver and gallbladder depression syndrome; Oral acid rot mostly belongs to gastrointestinal stagnation; Delicious mouth is spleen deficiency and dampness; Salty mouth is mostly kidney deficiency; The foul smell in the mouth is mostly caused by excessive stomach fire.
(4) Ask about defecation.
① Defecation: Ask about the frequency, time, fecal characteristics and accompanying symptoms of defecation.
Constipation: Fecal matter is reduced, defecation is difficult, and feces are few and hard. Constipation and abdominal distension and pain are mostly caused by excess syndrome and heat syndrome; Long-term illness, constipation in the elderly or pregnant women, and difficulty in defecation are mostly caused by insufficient body fluid or deficiency of both qi and blood.
Diarrhea: frequent defecation, soft and shapeless feces. Most of them are spleen and stomach deficiency and cold. Diarrhea at dawn, mostly due to spleen and kidney yang deficiency; Diarrhea is like water, gambling water is wet; Secretion, such as spraying, burning anus, is damp-heat diarrhea; Purulent blood in stool, which is acute and then heavy, is dysentery, mostly damp-heat in large intestine; The stool is black because there is congestion in it; Blood in the stool is bright red, and the anus is swollen and painful, which is blood heat; The color of stool is dark red, and the complexion is yellow and weak, because the spleen does not control blood.
② Urination: Ask about the color, quantity, frequency and accompanying symptoms of urine.
Short and red urine: less urine, yellow heat, mostly heat syndrome; Urine is short but not hot, which can be seen in sweating, vomiting, diarrhea or other reasons.
Clear urine; Excessive urine and clear color belong to deficiency-cold syndrome, which can also be seen in diabetes.
Frequent urination or enuresis; Most of them belong to qi deficiency or kidney qi instability.
Urodynia or frequent micturition and urgency: mostly damp-heat bladder, or stranguria with hematuria and gravel.
Dysuria: dribbling is stranguria, urine is blocked by cold, and anuria is stranguria, sudden strangulation, dribbling, urine odor, abdominal distension, pain or fever, which belongs to excess syndrome; Urine volume gradually decreases, even no urine, accompanied by backache and chills in limbs. Pale complexion, belonging to deficiency syndrome.
(5) Ask about pain and discomfort:
① Location: Pain or discomfort in different parts such as head, body, chest, hypochondrium, abdomen, abdomen, waist and joints. It reflects the pathological changes of different organs.
Headache, especially the head and occipital part, even the nape part, is a disease of the sun meridian; Frontal pain and eyebrow rib are diseases of Yangming Meridian, temporal headache and migraine caused by shaoyang Meridian, and top pain is the leading angle, which is diseases of Jueyin Meridian.
Body pain, body pain, fever and aversion to cold are mostly exogenous diseases, and body pain after a long illness is mostly due to lack of qi and blood.
Chest pain, accompanied by fever and cough, expectoration is mostly lung heat; Chest pain recurred after a long illness, mostly due to chest yang deficiency, accompanied by qi and blood phlegm and blood stasis.
Hypochondriac pain is a syndrome of shaoyang or stagnation of liver qi.
Pain in the upper abdomen (upper abdominal cavity) is mostly caused by spleen and stomach diseases or food stagnation.
Abdominal pain is mostly intestinal diseases, insect accumulation, or constipation.
Abdominal pain is less, mostly due to stagnation of liver pulse, or hernia, intestinal carbuncle and gynecological diseases.
Low back pain is mostly kidney deficiency.
Arthralgia is mostly caused by pathogenic qi and yin in meridians.
② Nature and degree:
Wandering pain is mostly caused by pathogenic factors blocking meridians. Heavy, acid-tired, swollen, mostly wet syndrome, cold pain, chills, painful drama, mostly cold syndrome; Heat pain, fear of heat, redness and swelling are mostly heat syndrome; Pain is substantial and lasting, mostly empirical; Hidden pain, persistent pain, and when the pain stops, it is mostly deficiency syndrome; The fleeting pain and distending pain, which are heavy and light, are mostly qi stagnation; Sting, tingling and pain are local and persistent, mostly caused by blood stasis.
Generally speaking, sudden pain is more real, and long-term pain is more virtual.
Pain refused to press as evidence; Happy press is a kind of deficiency syndrome.
Warm-loving is cold syndrome; Being fond of coldness is a heat syndrome.
Abdominal distension and pain aggravation after eating are empirical; Pain relief after meals is a deficiency syndrome.
④ Pay attention to the relationship with other symptoms, such as nausea, vomiting, belching, lack of courtesy, defecation, menstruation and pain.
(6) Ask about eyes and ears: Ask about changes in hearing and vision.
Sudden deafness is mostly due to liver and gallbladder fire; Long-term deafness is mostly due to kidney deficiency.
Tinnitus with dizziness and backache is kidney deficiency; Tinnitus, bitter taste, hypochondriac pain, is liver and gallbladder fire.
Blurred vision, night blindness and liver deficiency; Red eyes and swelling and pain are liver fire.
(7) Ask about sleep: Ask about the amount, depth and accompanying symptoms of sleep.
It is difficult to fall asleep, easy to wake up after sleep, dreamy, etc. , mostly due to heart yin deficiency, failure to hide heart yang, or heart failure; Restlessness at night, upset and easy to wake up, sore tongue coating, redness on the tip of the tongue as excessive heart fire, and screaming in dreams are mostly caused by gallbladder qi deficiency or stomach heat.
Sleepiness is very strong, and often falling asleep involuntarily is called salivation, which is mostly caused by qi deficiency and yang deficiency, or wet spleen and yang deficiency. The salivation of seriously ill patients is mostly crisis; The lethargy of patients with fever is mostly caused by heat entering the pericardium.
(8) Asking about the delivery of the fetus during the menstrual period: asking about the age of menarche, menopause and menstrual period. The quantity, quality, color and days of menstruation are all accompanied by menstrual symptoms. Married women ask about the date of birth and last menstruation of the fetus.
Delayed menstruation; Dark menstrual blood, blood clots, dysmenorrhea, mostly blood stasis or cold syndrome; Less menstrual flow, pale color, mostly blood deficiency; Menstruation is heavy and pale, which is mostly caused by qi deficiency.
Irregular menstruation: often accompanied by dysmenorrhea or premenstrual breast pain, belonging to liver depression and qi stagnation.
Menstruation does not come: first, pregnancy or amenorrhea. Amenorrhea may include blood dryness, blood stasis, blood consumption and stagnation of liver qi. If menstruation stops suddenly, ask if you have a cold or are too depressed.
Leucorrhea: Ask about the quantity, color and smell of leucorrhea. A large amount of leucorrhea, clear and thin, white in color, less smelly or fishy is mostly deficiency cold; Leucorrhea is heavy, sticky, yellow and smelly, mostly damp and hot.
(9) The medical history of children depends on asking family members and accompanying personnel. In addition to the general content, you should also ask about the growth and development before and after birth, the health status of parents, brothers and sisters, the history of vaccination, the history of infectious diseases, etc. Including past history, personal history and family history:
Understand the patient's past health status, what diseases he has suffered and what kind of treatment he has received. Known as hyperactivity of liver yang, it can lead to stroke. Known as gastropathy, epilepsy, asthma, dysentery and so on. , are easy to relapse.
Personal and living habits, eating habits, female fertility and so on will have a certain impact on the disease. For patients with infectious and hereditary diseases, asking about the patient's family history is helpful for diagnosis.
Attachment: Ten Questions about Song Dynasty
Ask about cold and heat, sweat, head and body, and ask about it.
Five questions about diet and six questions about chest, seven deafness and eight thirst should be distinguished,
Ask nine questions and ten questions about the cause of the old disease, and then take medicine to participate in the machine change.
In particular, women must ask about their menstrual period, and late closure and collapse can be seen.
By the way, tell pediatrics that smallpox and measles should be tested.