E-Book Excerpt: How to Assess Patients with Traditional Chinese Medicine

Many practitioners spend most of their time with assessment and each person has their preferred approach. Some will start with the chief complaint and others may assess from head to toe. Either way, for all but the simplest or most acute issues, TCM practitioners typically ask a wide range of questions, even ones that may seem unrelated. For example, a patient may have insomnia, but the practitioner may ask about digestion, or vice versa.

• What is the intensity of the symptom? 
• How does the patient describe the sensation of this symptom? 
• Is there a time of day it tends to occur or not occur? 
• Is there a season when this symptom tends to occur or not occur?
• Is it affected by stress, food, sleep, mood, weather, or temperature?
• What does the patient find helps alleviate the symptom?
• What does the patient find aggravates the symptom?
• Is the symptom continuous or intermittent?
• When did the issue first occur and what was going on in the patient’s life at that time?
• What aspects of living have been affected by the symptom?
• How does the patient feel emotionally when this symptom arises?
• Do any family members also experience this symptom?
• Do people living or working in the same environment complain of this symptom?

General questions, seemingly unrelated to the chief complaints are also valuable, and questions may include:

• How is the patient’s energy level?
• Is their energy higher or lower than usual?
• If they say they are tired, does it feel like physical fatigue or mental fatigue?
• How is the patient’s sleep?
• What is the patient’s pattern to go to sleep, to stay asleep, and to wake up?
• Does the patient dream a lot, and if so, do they remember their dreams or how they felt?
• Does the patient feel rested when they wake up?
• When does the patient feel most energized and most sleepy?
• How is the patient feeling emotionally? 
• How is the patient’s digestion?
• Does the patient have any foods they avoid?
• Does the patient have any cravings for particular foods or flavors? 
• How is the patient’s appetite?
• What is the patient’s dietary routine for food and timing to eat?
• How are the patient’s bowel movements: frequency, consistency of stool, feeling of completion, any symptoms of discomfort?
• What is the patient’s urination like: frequency, color, any symptoms of discomfort? 
• How does the patient feel for body temperature: tendency to warm or cold, warm or cold hands or feet? 
• Does the patient sweat normally? 
• Does the patient have any issues with seeing, hearing, tasting, feeling (touch)?
• Does the patient experience shortness of breath or breathing issues?
• Does the patient have allergies or sensitivities?
• Does the patient have any skin issues: rashes, dry, oily, sensitive?
• Does the patient bruise easily?
• Does the patient have any heart issues or palpitations?
• How does the patient feel mentally: concentration, focus, decision-making, memory, planning, organizing, ability to perform common or familiar tasks?
• Does the patient have any pain?
• Has the patient undergone any surgeries or major medical procedures?
• What is the patient’s medical history?
• What is the patient’s family medical history?
• Does the patient have any blood test, urine test, imaging, or other reports to offer?
• What medications and supplements is the patient taking?
• What routines does the patient have for self-care: therapeutic treatments, breathing exercises, meditation, exercise?

My approach if a patient comes in with one or two chief complaints is to ask them about those issues and let them tell their story in their words. For me, the process of asking allows me time to use other aspects of assessment, listening and seeing. I listen to the wording they use, where they focus their attention, the volume and tone of their voice, their posture and body language as they talk, and perhaps what information they seem to leave out.

For example, many chronic pain patients feel unheard and defensive about their suffering. They may sit with their arms crossed in a selfprotective posture and behave apologetically, leaving out key pieces of information like other therapies they’ve tried or medications they are on. Or they may act out angrily, talking loudly and quickly as they cover all the details of the injuries and list off all the tests, procedures, and treatments that have failed to bring them relief. With this, I can see how I can best respond to meet them where they are and gather the information I need. I can also start to formulate a TCM diagnosis using the five elements, eight guiding principles, and five vital substances.

In the example of the chronic pain patient who acts apologetic, I may start to guess that they are Earth element dominant and ask questions about their sensation of pain, energy level, potential digestive issues, feeling hot or cold, emotional health, and whether they have any selfcare practices. If their pain is dull and heavy, they feel fatigued and foggy-headed, they have bloating and poor digestion, they are often worried, and they are caregivers to everyone but themselves, I can start to see a pattern:

• Earth element
• Possible Yang deficiency, internal, cold, deficiency 
• Qi deficiency and stagnation (pain always causes stagnation) and Dampness

In the example of the chronic pain patient who acts angrily defensive, I might test to see if a Wood element dominant pattern is present. I could ask about their type of pain sensations, where they feel tension in their body, how do they feel for body temperature, how is their sleep, and question any hormonal imbalances. If their pain is aching and tight, they clench their teeth, have tight neck and shoulders, have cold hands and feet, suffer from insomnia, and suffer from PMS with irritability and fatigue, I would see the following patterns:

• Wood element
• Possible Yang excess, internal, cold, excess and deficiency
• Qi stagnation, Blood deficiency

This is only the start of a complete TCM diagnosis, but helps narrow the scope of possibilities, allowing for more specific questions.

Less often, but most appropriately, patients come in for assessment or treatment without any specific health complaints or issues. They are seeking optimal wellness and disease prevention. This is the ideal for TCM. While this is not practical in today’s modern practice, it may be something to strive toward. For these wellness-care patients, I recommend they come in for treatment, usually acupuncture, as often as once a month if they have highly active and stressful lives, once every change of seasons for seasonal tune-ups, or a couple of times a year for checkup and small tweaks to potential health imbalances.

For most new patients, I do not do any treatment at the first appointment because I want to spend more time in assessment, so I can be clear about my TCM diagnosis, plan out my best treatment approach, and offer the patient dietary, lifestyle, and supplement recommendations. I email the recommendations to the patient in a detailed written treatment plan.

If a patient comes in with a specific pain, injury, or acute symptom like a current headache, cold, or nausea, I complete a shorter intake assessment and do a treatment in session one, noting to the patient that the first treatment will still be shorter than subsequent ones because of the need for more dialogue at intake.

Editor’s Note: This is an excerpt from the e-book, An Introductory Guide to Traditional Chinese Medicine. To access the full text, click here.