Many people new to acupuncture may
ask, “Why does my acupuncturist ask so many questions?”
An initial visit to an acupuncturist
usually involves filling out an extensive health history form and having an
in-depth discussion with your practitioner. An acupuncturist will ask a number
of questions about your health and lifestyle, many of which may seem unrelated
to your main reason for seeking acupuncture. The questions, however, are linked
together and your answers provide valuable input into the diagnostic process.
Along with tongue and pulsediagnosis,
asking what are known as the “10 questions” allows your practitioner
to create a unique treatment plan for you as an individual. This taking into
account a wide variety of signs and symptoms is the key to the success of
acupuncture and your practitioners ability to treat conditions where other
methods may have failed.
Traditionally the framework for asking diagnosis is the 10
questions:
- Hot,
Cold and Fever, Chills
- Sweat
- Head
& Face
- Pain
- Urine,
Stool
- Thirst,
Appetite, Taste
- Sleep
- Thorax,
Abdomen
- Gynecological
- History
- Discuss
Acupuncture Theory
Questions About
Temperature
Hot, Cold and Fever, Chills
Questions about temperature are
common ways of finding both the level of a particular disease as well as
whether it is an internal or external problem. External Wind-Cold, for example,
is essentially the common cold but before a fever or other heat signs such as
yellow mucus have begun. This is an important distinction as the treatments for
wind-cold and wind-heat are quite different.
- Acute condition with chills
predominating = External
Wind-Cold
- Acute condition with fever
predominating = External
Wind-Heat
- Alternates between feeling hot
and cold = Shao Yang Stage of Disease
- Low grade fever in the
afternoon or evening = Yin
Deficiency
- Fever that worsens in the
afternoon = Yang Ming Stage of Disease
- Chronic low grade fever = Damp
Heat Condition
- Patient feels hot w/o fever =
Internal Heat
- Patient feels cold w/o signs of
external pathogens = Internal Cold
Questions about sweating can provide
valuable information regarding deficiencies that may exist in the body. Night
sweats, for example, are an important indicator of Yin deficiency – a TCM
diagnosis which may involve such conditions as insomnia and anxiety.
- Spontaneous daytime sweating
w/little or no exertion = Qi or Yang
Deficency
- Nightsweats = Yin
Deficiency
- Exterior conditions w/sweating
= Deficiency
- Exterior conditions w/o
sweating = Excess
- Oily beady sweat on forehead
= Collapse
of Yang
- Sweating of the whole body
= Lung
Qi Deficiency
- Sweating on palms, soles and
chest (“heat in the 5 palms”) = Yin
Deficiency
Questions About The Head and Face
Questions surrounding the head and
face help to assimilate a broad range of information. There are many types of
and treatments for headache, for example, and questioning the patient is an
important component in coming to an appropriate TCM diagnosis.
- Headache:
- Chronic = Internal Disharmony
- Severe = Excess Condition
- Dull Pain = Deficient Condition
- Distending a/or Throbbing Pain
= LV
- Boring Pain = Blood Stagnation
- Worse with wind a/or cold =
Cold Condition
- Worse with fatigue = Qi
Deficiency
- Feels heavy “like a damp
towel wrapped around” = Damp Condition
- Frontal Headache = Yang Ming
Meridians
- Temporal Headache = Shao Yang
Meridians
- Vertex Headache = LV
- Posterior a/or Occipital = Tai
Yang Meridians
- Worse during the day = Qi a/or
Yang Deficiency
- Worse during the evening =
Blood a/or Yin Deficiency
- Dizziness:
- With Loss of Balance = Internal
Wind
- With heavy/muzzy feeling in the
head = Phlegm Obstruction
- Worse with fatigue = Qi
Deficiency
- Sudden onset = Excess Condition
- Gradual onset = Deficient
Condition
- Eyes:
- Eye pain, swelling a/or redness
= LV Fire or Wind Heat
- Blurred vision a/or
“floaters” = LV
Blood Deficiency
- Dry eyes = Deficiency of KD Yin
or LV
- Yellow sclera = Jaundice
- Abnormal eye movements = LV
Wind
- Ears:
- Sudden onset tinnitus = Excess
Condition, LV Heat/Wind
- Chronic tinnitus = KD
Deficiency
- Sudden onset deafness = Excess
Condition
- Gradual onset deafness = KD
Deficiency
Questions About Pain Related Issues
Finding the nature and causal
factors involved in pain conditions is an important part of an effective
treatment. While treatment of the local area is important, without an
understanding of the conditions underlying the pain, the long-term effects may
be limited.
- Pain that is better with the
application of heat = Cold Condition
- Pain that is improved with
pressure on the area = Deficient Condition
- Pain that is aggravated with
pressure on the area = Excess Condition
- Pain that is aggravated with
damp weather = Damp Condition
- Pain associated with bloating,
fullness a/or distention = Qi Stagnation
- Pain that is sharp a/or
stabbing = Blood Stagnation
- Pain that moves from location
to location = Qi Stagnation a/or Wind
- Dull pain that is worse with
fatigue = Qi Deficiency
- Backpain:
- Chronic dull pain = KD
Deficiency
- Acute = LV
Questions About
Elimination
Urine & Stools
Questions about stools and urination
are usually the ones considered most unrelated by patients. As an example, it
is often difficult to understand how the quality of ones stools can be related
to their knee pain. Asking questions about the elimination system provides
important indications about the functioning of the Kidneys and the digestive
system. Weak kidneys, for example, are often related to lower back and knee
pain in Chinese medicine and a poorly functioning digestive system can lead to
internal dampness which can also settle in the joints and cause pain.
- Urine:
- Incontinence = KD Deficiency
- Retention of Urine = KD
Deficiency or Damp Heat
- Incomplete urination = Qi a/or
Yang Deficiency, may also be Dampness
- Pain with urination = Damp Heat
or Heat in the UB
- Pale colored urine = Cold
Condition
- Dark colored urine = Heat
- Copious amounts of urine = KD
Yang Deficiency
- Scanty urination = KD Yin
Deficiency or Damp Heat
- Stools:
- Constipation with heat signs
(yellow tongue coat, etc.) = Heat in the ST or Intestines
- Constipation in elderly
patients = Blood Deficiency
- Small stools = LV Qi Stagnation
or Heat in the ST or Intestines
- Infrequent but not dry bowel
movements = LV Qi Stagnation
- Alternating Diarrhea and
Constipation = LV invading the SP
- Chronic diarrhea = Chronic Qi
a/or Yang Deficiency usually of the SP or KD or Acute Damp or Cold
- Urgent diarrhea with heat signs
= Damp Heat or Heat
- Diarrhea after eating a meal =
SP Qi Deficiency
- Early morning diarrhea (cock’s
crow) = KD Yang Deficiency
- Discomfort improves after a
bowel movement = Excess Condition
Questions About
Digestion
Thirst, Appetite & Tastes
Questions about appetite and tastes
are helpful in understanding the quality of the digestive system as well as
whether a person has an underlying cold/deficiency syndrome or a heat/excess
one. The relationship of tastes to certain conditions are drawn from the five
element theory.
- Thirst:
- Lack of thirst a/or desire for
warm liquids = Cold Condition
- Strong thirst esp. for cold
liquids = Heat Condition
- Dry mouth w/desire to sip
liquids = Yin Deficiency
- Thirst w/o desire to drink =
Dampness
- Appetite:
- Lack of appetite = SP Qi
Deficiency
- Insatiable appetite = ST Heat
- Fullness, bloating a/or
distention after eating = Food Stagnation
- Preference for warm/hot foods =
Cold Condition
- Preference for cold/cool foods
= Heat Condition
- Tastes (Based on 5 Elements):
- Bitter taste = Full Heat in
LV/GB
- Sweet taste = SP Qi Deficiency
a/or Dampness
- Sour taste = Retention of Food
a/or LV invading ST
- Salty taste = KD Yin Deficiency
- Pungent taste = Heat in the LU
- Metallic taste = Intestinal
Issues
- Lack of taste = SP Deficiency
Questions About Sleep
Quality and Habits
Sleep is an important part of a
persons overall health. The inability to get a good nights rest usually
involves TCM diagnoses which would indicate other issues as well. Heart
Blood Deficiency, for example, may involve other
symptoms which effect the person during the day such as poor concentration and
anxiety.
- Difficulty falling asleep but
sleeps well = HT Blood Deficiency
- Wakes often = HT a/or KD Yin
Deficiency
- Nightmares a/or violent dreams
= LV a/or HT Fire
- Restless sleeping after eating
late = Retention of Food
Questions About the
Thorax and Abdomen Area
Pain may arise in the thorax and
abdominal areas in physical conditions involving the heart, lungs, digestive
system and liver. From a TCM perspective, however, pain may also arise in these
areas due to psycho-emotional issues. A western medical diagnosis is usually
helpful in these conditions, however, pain in these areas does not always
involve an underlying physical problem. Pain in the hypochondriac region, for
example, may be related to a physical liver problem or – from a TCM perspective
– is indicative of some LV Qi
Stagnation issues. LV Qi Stagnation may
present with hypochondriac pain and symptoms of depression but does not
indicate any physical problems with the Liver.
- Pain in the chest area = HT
Blood Stagnation
- Pain in the chest w/cough = LU
- Costal Pain = LV/GB
- Hypchondriac Pain = LV Qi
Stagnation
- Epigastric Pain = Retention of
Food or ST Heat
- Lower abdominal Pain = Blood
Stagnation, LV Qi Stagnation, Interior Cold or Damp Heat in the Intestines
Questions Regarding
Gynecological Issues
The status of a women’s menstrual
cycle is an important indicator of her overall health. Whether you are
diagnosing a gynecological condition such as irregular menstruation or a
non-gynecological related condition, the information from the questions below
is extremely valuable in forming an appropriate diagnosis.
- Early Periods = SP Deficiency
or Heat in the Blood
- Late Periods = Blood Stagnation
or Deficiency or Cold Condition
- Irregular Periods = LV Qi
Stagnation
- Heavy Periods = Heat in the
Blood or Qi Deficiency
- Scanty Periods = Blood
Stagnation or Deficiency or Cold Condition
- Bright or Dark Red Blood = Heat
in the Blood
- Pale Blood = Blood Stagnation
or Cold Condition
- Blood Clots = Blood Stagnation
or Cold Condition
- Leukorrhea:
- White = Cold Condition
- Yellow = Heat Condition
- Green or Red/White = Damp Heat
Medical History
Questions
Lifestyle and Habits
A complete view of a persons medical
history, diet, lifestyle and habits is an important part of the overall
diagnostic procedure. There are many questions that can be asked and the value
of their answers depends on the conditions you are trying to treat. Most
practitioners have a lengthy section of their intake form which covers this
information in detail.
- Medical History:
- All major illnesses and
procedures one has had
- Family/Genetic illnesses
- Prescription and Recreation
Drug Use may cause issues with the LV a/or Kidney meridians and others may
require changes in treatments (i.e. blood thinners, may bruise easily,
insulin, be careful not to drop blood sugar too low, etc.)
- Emotional states should be
considered via the 5 Elements
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