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To treat disease before it arises. For those whose Zang-Fu organs are not yet exhausted, Qi and Blood are not yet chaotic, and Spirit is not yet scattered, complete recovery is possible; for those where the disease has already formed, half recovery is possible; for those where the pathological trend has passed (indicating deficiency of healthy Qi with lingering pathogenic factors or predominance of deficiency), the condition is critical.

First, observe the patient's Shen (Spirit) and complexion: whether lustrous or withered, fat or thin, and their sleep and waking states.
People who are fat and white-skinned often have Phlegm-Dampness; people who are dark and thin often have Fire-Heat. If one is fat but dark-skinned, or thin but white-skinned, refer to the symptoms at hand; judge from the body shape or from the complexion, do not be dogmatic.

Lustrous indicates life, withered indicates death; fatness suggests Excess, thinness suggests Deficiency—this is a tradition passed down through ancient and modern times. A humble, curled posture indicates pain in the waist and interior; knitting brows indicates headache and dizziness. Inability to raise hands indicates shoulder and back pain; difficulty walking indicates leg pain. Hands crossed over the chest indicate chest pain; pressing the middle indicates abdominal pain. Insomnia upon rising is often due to Phlegm-Heat; excessive sleepiness is caused by Deficiency-Cold. Facing the wall and curling up mostly indicates Cold; lying on the back stretching out indicates Heat torment. Yellowing of the whole body, face, and eyes indicates Spleen Damp-Heat; blue lips and black face indicate Cold as mentioned before.

The five tones correspond to the Five Zang organs: Metal tone is crisp, Earth tone is turbid, Wood tone is long, Water tone is clear, and Fire tone is dry. If the voice is clear, Lung Qi is smooth. If the voice sounds like it comes from a room, it indicates internal Dampness.
Speaking faintly, taking all day to say a few words, indicates Loss of Qi (severe depletion of Yuan Qi). Starting light then becoming heavy, loud and forceful, indicates External Contraction. Starting heavy then becoming light, deep and weak, indicates Internal Injury.

Second, listen to the clarity or turbidity of the voice to distinguish true speech from delirious speech. Turbid voice indicates Phlegm obstruction; clear voice indicates Cold as its source. Sincere speech is not Excess-Heat; delirious shouting indicates Deep and Firm Heat. Calling out to spirits, climbing walls, with Phlegm stagnation in the chest and diaphragm, is classified as Dian (Manic Disorder). If the cause persists for a long time and the voice suddenly disappears, life ends.

Ask if there is head or body pain; if chills and fever are unceasing, it clarifies External Contraction. Hot palms and loss of taste indicate Internal Injury from diet and fatigue. Five-palm heat combined with cough indicates Yin Deficiency with Fire stirring. Besides these three, miscellaneous diseases appear: such as Malaria or Dysentery, which have specific names. Question from head to toe carefully; listen attentively to the varying symptoms.
Is there headache? Uninterrupted pain is External Contraction; intermittent pain is Internal Injury.
Are eyes red and swollen? Or sudden swelling/redness, or chronic pain.
Is there tinnitus or deafness? On the left or right. For chronic deafness, do not use purely tonifying and astringent formulas; must combine with opening and Qi-moving herbs.
Is there nasal discharge? Or no discharge but dryness, or nasal congestion, or chronic runny nose, or nasal polyps, or rhinophyma.
Can you taste food? If you can taste without eating, it is External Wind-Cold; if you cannot taste even when eating, it is Internal Injury from diet.
Are you thirsty? Thirst for cold water indicates Heat; thirst for hot water indicates Deficiency; great thirst in summer indicates Summerheat.
Is there tongue coating? White, yellow, black, or red with cracks.
Do teeth hurt? Upper jaw, lower jaw, or gum recession/bleeding.
Is the neck stiff? Sudden stiffness is Wind-Cold; chronic stiffness is Phlegm-Fire.
Does the throat hurt? Sudden pain is mostly Phlegm-Heat; habitual pain is mostly Lower Jiao Deficiency.
Are palms hot? Back of hand heat is External Contraction; palm heat is Internal Injury; both are Internal Injury plus External Contraction.
Are fingertips cold? Cold indicates Cold invasion; not cold indicates Wind injury; chronically cold indicates Constitution Deficiency.
Is there paralysis of limbs? Left limb/arm inability to lift or pain indicates Blood Deficiency with Fire; right limb/arm inability to lift or pain indicates Qi Deficiency with Phlegm.
Do shoulders/back hurt? Sudden pain is External Contraction; chronic pain is Deficiency with Stagnation.
Do waist/spine hurt? Sudden pain is also External Contraction; chronic pain is Kidney Deficiency with Stasis.
Does the sacrum hurt? Sudden pain is Shaoyang channel pathogen; chronic pain is Shaoyang channel Fire.
Is the chest/diaphragm full? After purgation, it is Jie Xiong (Chest Binding); before purgation, it is pathogen entering Shaoyang channel, not Jie Xiong. Habitual chest fullness indicates Stagnation, Phlegm-Fire, and Lower Deficiency.
Do flanks hurt? Left, right, both, or a single empty pain.
Is abdomen bloated? Large abdomen or small abdomen.
Is there abdominal pain? Large abdomen, umbilicus, or small abdomen; pain stopping upon pressure or continuing despite pressure.
Are there abdominal masses? Above, below, left, right, or center of umbilicus. Do not rashly use sweating, vomiting, or purging methods that move Qi and cause stagnation; should combine resolving and Qi-moving agents.
Is there heart pain? Sudden pain is Cold; chronic pain is Fire or Deficiency.
Is there mental restlessness? Only irritability is Za Cao (Gluttony sensation); wanting to vomit but unable is Za Cao. Frequent fright is Zheng Chong (Palpitations).
Is there vomiting? Wet vomiting, dry vomiting, vomiting immediately after eating, or vomiting after a long time.
Is there diarrhea? Loose stool, watery stool, morning diarrhea, post-prandial diarrhea, or evening diarrhea; how many times per day.
Is there constipation? Constipation with thirst/bloating is Heat; constipation without thirst/bloating is Deficiency.
Is urination clear and free? Clear/free indicates pathogen in Exterior; red/astringent indicates pathogen in Interior; frequent/urgent indicates Lower Deficiency with Fire; dangerous for chronic patients and elderly.
Is there strangury/retention? With thirst is Heat; without thirst is Deficiency.
Is there penile erection? Erection indicates Fire; flaccidity indicates No Fire.
Do you have hernia? If yes, combine liver-soothing herbs; do not rashly use ascending or Qi-moving agents.
Do you have hematochezia? Hemorrhoids? If present, avoid excessive drying herbs to prevent damaging Yin and Zang organs.
Do you have sores/scabies? Sweating is contraindicated; combine clearing Heat, nourishing Blood, and dispelling Wind.
Do you have nocturnal emission or leukorrhea? Emission indicates Essence Deficiency; avoid rash sweating or purging.
Is there sexual activity? Men engaging in sex suffer sudden Qi/Blood deficiency; even with external pathogens, avoid harsh formulas. Tonify first, then attack, is acceptable.
Are knees sore/weak? Sudden soreness is Hong Kong Foot (Gout/Jamming), or weak Stomach. Chronic is Kidney Deficiency.
Are feet swollen/painful? Swollen and painful is mostly Wind-Damp; non-swollen, with withered/thin calves and pain is Blood Deficiency or Damp-Heat pouring downward.
Are soles hot? Heat indicates Lower Deficiency with Fire stirring. Heel pain is also Kidney Deficiency with Heat. Cold toes/soles indicate Cold.
Is there chills/fever? Intermittent? No interval is External Contraction; interval is Internal Injury. Chills noon/fever night is Yin Deficiency with Fire stirring.
Preference for cold food? Cold preference indicates Middle Heat; hot preference indicates Middle Cold.
Digestion ability? Eating but not digesting is Spleen Cold/Stomach Heat.
Amount of food? Able to eat is easy to treat; unable to eat is difficult. Except for Shang Han where anorexia is harmless.
History of alcohol/fried foods? Alcohol drinkers often have Phlegm-Heat; fried foods affect Upper Jiao or Large Intestine causing Damp-Heat.
Is there sweating? External with sweat is Wind Injury; without sweat is Cold Injury. Miscellaneous spontaneous sweating is Yang Deficiency.
Is there night sweats? Sweating during sleep: External is Half-Exterior/Half-Interior pathogen; Internal is Yin Deficiency with Fire.
Is there generalized joint pain? External is pathogen in Exterior; Internal is Qi/Blood dysfunction; heavy pain indicates Dampness.
Worse at night? Light day/heavy night is Blood disease; light night/heavy day is Qi disease.
Age? Young adults tolerate illness better; elderly with mixed diseases struggle with Yuan Qi. Women with few births have strong Qi/Blood; many births + old age requires tonification, not attack.
Duration? Days, weeks, or years.
Environment favorable? Favorable environment leads to harmonious emotions and easy Qi/Blood regulation; unfavorable leads to Qi/Blood depression; add Qi-opening/stagnation-resolving herbs to medication.
Mistaken medication? Mistakes cause Qi/Blood chaos and meridian confusion. Acute cases need immediate adjustment; chronic cases wait 1-2 days before medicating.
Menstruation regular? Referencing previous points: before period is Blood Heat; after is Blood Deficiency. External contraction during menstruation disperses after; do not rashly medicate to avoid violating Blood Sea.
Amenorrhea? With tidal fever, cough/diarrhea, bleeding, or leukorrhea? Able to eat? If able, Blood regulates and symptoms resolve; reduced intake/emaciation is critical.
Have Ju (Masses)? Abdominal pain, tidal fever, and a solid mass indicate Ju.
Pregnancy movement? Solid movable mass in abdomen without pain/tidal fever indicates pregnancy. Empty large distension without solid mass indicates Qi disease, with occasional vaginal bleeding.
Postpartum chills/fever? Pain? Sweat? Cough/wheeze? Chills/fever mostly External; pain mostly Blood Stasis or Food Retention. Single tidal sweating indicates severe Qi/Blood Deficiency. Cough/wheeze indicates Blood Stasis entering Lungs, difficult to treat.

When initial diagnosis is undetermined, careful examination is essential. Patients must not hide illness; doctors must ask comprehensively. No single pulse reading reveals the entire condition. Beginners should copy a questioning sheet and use it frequently. Once diagnosed as External, Internal, or Miscellaneous, follow ancient methods; do not indiscriminately apply dispersing formulas.