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Entering a country, one asks about its customs; how much more so when treating illness? Only when the root and branch causes are clear in mind can one administer medication with few failures.

Medicine is a benevolent art. A benevolent person is deeply affectionate, viewing patients as oneself, asking about their suffering, leaving no aspect unaddressed. The *Ling Shu: Shi Chuan Chapter* states: "When entering a country, ask about its customs; when entering a home, ask about its taboos; when ascending the hall, ask about its etiquette; when facing a patient, ask about their preferences." If the physician has a thorough understanding of the disease's origin and progression, whether employing attack or tonification methods, how could one fail to hit the mark!

In diagnosing any illness, first inquire about the patient's identity, whether male or female.
Males and females differ in Yin and Yang; pulse and complexion have distinctions of favorable and unfavorable patterns. Therefore, one must distinguish gender and observe corresponding characteristics.
Whether old or young.
For the elderly, seek pathology in the Fu organs (Hollow organs); for the young, seek it in the Jing meridians (Channels); for the vigorous/adult, seek it in the Zang organs (Solid organs).
Whether servants or daughters married out.
Those of lower social status cannot freely control their movements and activities.
Widows and nuns.
Having encountered misfortune, their emotional state is often depressed and stagnant.
Body shape: fat or thin.
Fat people tend to have Dampness (Pathogenic moisture), while thin people tend to have Fire (Pathogenic heat), etc. This usually belongs to Inspection (Observation). However, families of wealth and nobility often live behind heavy curtains, so detailed inquiry is necessary. If not covered by silk garments, seeing the patient's hands allows the physician to roughly ascertain their physique.

Next, inquire on which day the illness began.
Newly acquired illnesses may be treated with attacking methods; long-standing illnesses may be treated with tonifying methods.
Diet and Stomach Qi (Vital Energy of the Stomach).
Liver diseases favor Sour taste; Heart diseases favor Bitter taste; Spleen diseases favor Sweet taste; Lung diseases favor Pungent taste; Kidney diseases favor Salty taste. Internal Heat favors cold; Internal Cold favors warm. Ability to digest food indicates prosperity; inability to digest food indicates peril.
Presence or absence of dreams.
Excess Yin leads to dreams of large water and fear; Excess Yang leads to dreams of burning fire; Excess of both Yin and Yang leads to dreams of killing and destruction. Upper excess leads to dreams of flying; Lower excess leads to dreams of falling. Fullness leads to dreams of giving; Hunger leads to dreams of taking. Liver Qi excess leads to dreams of anger; Lung Qi excess leads to dreams of crying. Many short parasites lead to dreams of gathering crowds; many long parasites lead to dreams of self-harm.

Inquire about desires and cravings to understand the disease.
Natural properties vary, each having specific cravings. Sounds, colors, smells, and tastes have their respective affinities.
Craving a specific flavor may indicate pathology related to a specific age or organ system. One must distinguish between favorable (Shun) and unfavorable (Ni) patterns to judge auspiciousness or inauspiciousness.
Clear Yang transforms into Qi, originating from Heaven; thus, Heaven nourishes humans with five odors: Musky odor enters the Liver, Scorched odor enters the Heart, Fragrant odor enters the Spleen, Fishy odor enters the Lungs, and Putrid odor enters the Kidneys. Turbid Yin forms flavors, originating from Earth; thus, Earth nourishes humans with five flavors: Sour enters the Liver first, Bitter enters the Heart first, Sweet enters the Spleen first, Pungent enters the Lungs first, and Salty enters the Kidneys first. When Zang organs are deficient, they necessarily seek relief through flavors; for example, Liver deficiency craves sour. This is called "following the trend" (Shun Ying) and is easy to treat. If Heart disease accepts Salty, Lung disease craves Bitter, Spleen weakness prefers Sour, Liver disease likes Pungent, and Kidney disease craves Sweet, this is called an "unfavorable sign" (Ni Hou); mild cases will become critical, and critical cases will result in death.
Heart preferring heat indicates Cold; Heart preferring cold indicates Heat. Preferring stillness and disliking movement indicates Deficiency; Restlessness and agitation indicate Excess. Food stagnation dislikes food; Wind injury dislikes wind; Cold injury dislikes cold.
These obvious signs require detailed inquiry. Although restlessness can also belong to Deficiency, it must be accompanied by a pulse lacking spirit (Shen), and other symptoms must be considered.
Whether they indulge in alcohol.
Those who indulge in alcohol not only have internal Damp-Heat but also risk engaging in sexual activity while intoxicated.
Whether they practice long-term vegetarianism/abstinence.
While clarity and emptiness are paths to longevity, excessive asceticism can cause disease. Or, those abstaining may develop a craving for specific foods like gluten or cooked chestnuts, which are hard to digest, requiring careful examination.

One must distinguish the "Three Constants" regarding life circumstances throughout the illness.
The *Su Wen: Shu Wu Guo Lun* states: "Diagnosis involves three constants." Referring to constant status (noble/common), constant wealth (rich/poor), and constant emotion (happy/sorrowful).
Loss of noble rank, and desire for titles.
Loss of noble rank involves regret over the past; desiring titles involves delusion about the future. Both are causes of disease.
Once noble, now humble: although not struck by external pathogens, disease arises internally, named "Tuo Ying" (Depletion of Nutritive Qi).
Those once noble now humble feel humiliated, their Shen Spirit unable to extend. Though not affected by external pathogens, disease arises internally. Ying (Nutritive Qi) is Yin Qi, circulating within the vessels, governed by the Heart. If Heart will is stifled, blood fails to generate, vessels deplete daily, hence "Tuo Ying."
Once wealthy, now poor: named "Shi Jing" (Loss of Essence); Five Qi lingers, pathogenic factors combine.
Those once wealthy now poor face increasing anxiety and reduced sustenance, causing the essence of the Five Zang organs to deteriorate daily, termed "Shi Jing." Loss of essence leads to Qi decline; Qi decline leads to stagnation, causing pathogenic accumulation.
Great loss from former wealth severs sinews and cuts off pulses; though the body may walk again, fluids cease to grow.
"Great loss" refers to extreme labor and suffering. Thus sinews seem severed, pulses cut off, due to consumption. Although the body may resume walking, fluids (Jin Ye) cease to regenerate. Fluids refer to bodily juices; "Xi" means growth.

Thus, old injuries and blockages, lingering and thinning, return to Yang, forming pus accumulations and alternating cold and heat.
"Gu" refers to the old. Old injuries with blockages cause Blood and Qi to linger without dispersing, becoming stagnant and maturing, returning to the Yang aspect, leading to pus and blood accumulation, causing alternating chills and fever.
Sudden joy followed by sudden sorrow, or initial joy turning to sorrow, all damage Essence-Qi. When Essence-Qi is exhausted, the form also rapidly deteriorates.
Joy leads to Xi (Delight), which relaxes Qi. Sorrow leads to Bei (Grief), which dissipates Qi. Thus, abnormal joy and sorrow damage Essence-Qi, potentially exhausting it and destroying the physical form.
Violent anger damages Yin; violent joy damages Yang.
Anger injures the Liver, which stores Blood, thus damaging Yin. Joy injures the Heart, which houses the Shen Spirit, thus damaging Yang.
Jue Qi (Rebellious Qi) moves upward, filling the vessels and separating from the form.
Jue Qi is rebellious Qi. Excessive anger or joy damaging Essence-Qi can cause Qi rebellion moving upward. Qi rebelling in vessels fills them; Essence escaping internally separates from the form.

Physical comfort but mental distress: disease arises in vessels, treated with moxibustion and acupuncture.
Physically comfortable means no bodily labor; mentally distressed means excessive mental worry. The Heart governs vessels; deep thinking and worry cause vessel pathology. Vessel pathology requires treating collateral knots, hence appropriate moxibustion and acupuncture.
Physical comfort and mental ease: disease arises in flesh, treated with needles and stones.
Physically comfortable means leisure; mentally easy means idleness. Eating constantly without exercise damages the Spleen. The Spleen governs muscles, hence disease arises in flesh. Flesh disease may involve Wei Qi stagnation or pus/blood accumulation, requiring needle and stone therapy.
Physical distress and mental ease: disease arises in sinews, treated with hot compresses and Daoyin (guiding and pulling exercises).
Physically distressed means heavy labor; mentally at ease means no worries. Labor injures sinews, hence disease arises in sinews. "Wen" refers to herbal hot compresses; "Yin" refers to Daoyin.
Physical distress and mental distress: disease arises in the throat/pharynx, regulated with sweet medicines.
Physical and mental distress implies much worry and thought. Worry injures the Lungs; thought injures the Spleen. Injury to Spleen and Lung Qi causes deficiency and stagnation. The Spleen and Lung meridians ascend to the pharynx, hence disease arises there. For instance, excessive grief causes throat tightness and difficulty swallowing; excessive thought causes upper Jiao obstruction and a sensation of a lump in the throat.
The *Ling Shu: Xie Qi Zang Fu Bing Xing* mentions "regulate with sweet medicine." The *Zhong Shi Chapter* says: "Use sweet medicine, do not drink potent doses." The statement in *Su Wen: Xue Qi Xing Zhi* "treat with sweet medicine" is considered erroneous.
Frequent fright and terror: meridians blocked, disease manifests as numbness (Bu Ren), treated with massage and medicinal wine.
Physical labor combined with frequent fright causes unhappiness, meridian blockage, and numbness (insensitivity to cold, heat, pain, itch). Treatment involves massage and drinking medicinal wine to promote smooth circulation of Blood and Qi.

How are daily routines?
Daily routines encompass environmental dryness/dampness of living quarters, and movement/stillness of sitting/lying. For example, Lung disease favors bending; Spleen disease favors singing; Kidney disease favors chanting; Liver disease favors shouting; Heart disease favors rambling speech. These should be examined one by one.

Inquire about previous injuries.
Whether improper diet, irregular labor/sexual activity, or inappropriate tonification/attacking by incompetent physicians.

How are urination and defecation?
Heat causes yellow/red urine and hard constipation; Cold causes clear/white urine and diarrhea with undigested food.

What medications were previously taken?
If cold medicines failed or hot medicines were ineffective, examine the syndrome and pulse to consider changing the treatment plan.

Is there distension or oppression?
Chest and abdominal distension may be due to Qi stagnation, Blood stasis, Food retention, Cold coagulation, or Deficiency. All must be correlated with the pulse.

Changes in temperament, detail them clearly.
Patients often exhibit changes in normal joy and anger.