Asking the right questions – Part 1 of a Traditional Chinese Medicine (TCM) Assessment

by Robert Tan / Saturday, 08 April 2017 / Published in TCM

By Robert Tan, R. Ac, R. TCMP

A Traditional Chinese Medicine (TCM) or acupuncture assessment consists of four methods: Asking questions, observation, sensation (including smelling, hearing, and palpation), and taking the radial pulse. The data obtained from each of the four methods are combined to form a diagnosis for the treatment plan.

What kind of questions will be asked during the assessment?

For instance, if you are visiting for pain or discomfort in the body, I need to know:

Location of the pain/discomfort – This allows me to determine the appropriate meridian channel.
Quality of the pain/discomfort – Does it move around? Does it only occur during specific times of the day or during specific movements? Is it a stabbing or dull pain? In the case of skin conditions, what does it look like, and is it aggravated by any known factors such as food, animals, lack of rest, etc? Is there any tenderness?

Sometimes just by answering the above questions, it is enough for me to formulate a diagnosis a treatment plan. However, people who visit acupuncturists or TCM practitioners often have more complicated issues, and in order to determine the cause of an issue, I often need to ask the following:

Questions about your primary complaint – These can vary based on what the complaint is.
Questions about appetite and diet – Excessive, not enough, or normal? This usually helps pinpoint issues with the digestive system (stomach, spleen, large and small intestines). Your diet can also reveal the causes of your health issues. For instance, if your diet consists of foods that are processed (baked, roasted, fried, stir-fried, and barbequed), you may be prone to constipation, excessive thirst, blood in the stool, or pain during urination. If you frequently eat ice cream, drink ice water, and eat cold and raw foods you may be prone to diarrhea, headaches, or menstrual pain.
Questions about medical history, emotional trauma, prescription intake – What ailments have you had in the past? Have you suffered any emotional trauma? What prescriptions are you currently taking? All of these can help determine the cause of your symptoms, for example, too much worrying or sadness can cause damage to the heart and lung systems, which may result in insomnia, irregular menstruation, etc. Some birth control medication are known to have side effects such as digestive issues, gallstones, nausea, water retention etc. Sometimes the side effects of medication become worse than the issues that you are taking the medication for, and may not become apparent until months or years after you start taking them.
Questions about bowel movements and urination – How often, what colour, and what quality? Depending on the answer, this can indicate issues with the digestive system, heart, lung, liver/gallbladder, or kidney and bladder systems, since all of these systems play a role in regulating bowel movements.
Level of thirst – Excessive thirst, or very little water intake during the day? This can indicate excessive heat or coldness in the digestive system and in the lungs, as well as the presence of phlegm or blood stagnation.
Quality of sleep – Any difficulties falling asleep or staying asleep? Issues with the heart, lung, liver, and gallbladder systems often cause symptoms having to do with sleep. For example, patients with gallstones or sludge can find it difficult to sleep between 11pm-1am.
Abnormal feelings of warmness or coldness or sweating – Do you have hot flashes, chills, or a mixture of both? Any abnormal sweating? These can indicate issues with the digestive system, with the exterior of the body (skin and muscles), and with heart, lung, and sanjiao systems.

The answers to these questions provide me with a basic understanding of the condition, whether it is exterior versus interior, hot versus cold, excess versus defiency, or yin versus yang. However, in some instances more information is required to confirm the diagnosis, and I will proceed onto observation, sensation, and taking of the pulse.