8. The four examinations

The first read happens before anyone sits down: how the person rises from the chair, the colour and lustre of the face, whether the eyes are bright. Classical texts rank Shén above everything else because it tracks reserve — a patient with a frightening symptom list and intact Shén is in better shape than a quiet one whose eyes have gone flat.

Complexion is read for colour and for lustre separately. Pale and dull is different from pale and moist. Sallow suggests Spleen, greenish suggests Liver or pain, dark under the eyes suggests Kidney or Blood stasis.

The classical ten questions still structure a good intake: cold and heat, sweating, head and body, stool and urine, food and taste, chest and abdomen, hearing, thirst, previous illness, and cause of onset. In a modern clinic, add sleep with timing, menstrual detail, medication and supplement list, and the pattern of the working week.

• ·Cold and heat — subjective feeling, aversion, and the time of day it moves.
• ·Sweating — spontaneous (Qì/Yáng) versus night sweats (Yīn).
• ·Pain — quality, whether pressure helps, whether it moves, and what time it peaks.
• ·Digestion — appetite, bloating timing, stool form, and whether food or rest helps.
• ·Sleep — trouble falling asleep versus waking at a fixed hour.

Signs conflict often, and the classical rule is to weigh the objective over the reported when they diverge: tongue and pulse over subjective description, and pulse over tongue in acute conditions, tongue over pulse in chronic ones. That is a heuristic, not a law, and the honest move is to name the contradiction in your notes and re-check it next visit.

A common example: a patient describes burning heat, but the tongue is pale and swollen and the pulse deep and weak. That is usually Yáng deficiency with floating Yáng, not Heat, and treating it as Heat will make it worse.