Year, month, day:
Body weight, fat or thin (qualitative):
Height, tall or short (qualitative):1
Skin colour and gloss:
Pitch and strength of voice:
Temperament, sad or happy:
Date of onset of illness:
First medicine taken:
Next medicine taken:
Effectiveness, slight or none:
Is illness more serious during day or night?:
Are cold or hot sensations preponderant?:
Cravings for and adversions to food and drink:
Is elimination difficult or easy?:
Of the nine readings on the three pulse sections, which is abnormal?:
Of the twenty-four pulse types, which appears alone?:
Which pulse types appear in combination?:
The symptoms may indicate a disorder of internal or external origin, or both, or neither; according to the classics, what disorder is to be diagnosed?:
Where are the root and ramifications, and the prior and posterior manifesta- tions, of the disorder located?:2
Of [the various therapeutic approaches]—sweating, disgorging, bringing down, mediating, cooling, warming, replenishing, draining—which is to be used?:
If the seven formula types (qi fang) are appropriate, which is to be used?:
If the ten prescription types (shi qi) are appropriate, which is to be used?:
Of the five qi, which is to be used?:
Of the five sapors, which is to be used?:3
Record the infusion to be prescribed, and how its composition is to be adjusted to the indications:
When is its efficacy to be determined?:
Each [answer] is to be recorded clearly and in detail, without the least omission. This will give rise to universal trust [on the parts of patients. This form] has long been a model for the medical profession. There is no need to be discursive [when filling it in].4
This is neither the only, nor the first, standard form for diagnosis. Despite the title, it includes planning and evaluating a program me of therapy.
See the discussion of a related topic, forms for case records, in
Cullen, C. 2001, ‘From Case Records to Case Histories: The Modernisation of a Chinese Medical Genre, 1912–49’, in E. Hsu (ed.), Innovation in Chinese Medicine, Needham Research Institute Studies, 3, Cambridge: Cambridge University Press, 324–36.
1 Both of these are qualitative notations. Even in the early twentieth century, traditional physicians did not weigh or measure the height of patients.
2 ‘Root and ramifications’ refers to fundamental and secondary aspects of the disorder, which in a given case may be defined by the relation between the invading qi and that of the body, by temporal or causal order of symptoms, or by location. See Traditional Medicine in Contemporary China, Cambridge: MIT Press, 1977, pp. 414–16.
3 The seven formula types represent various ways of combining drugs in a formula; the ten prescription types, ten physiological functions of drugs which determine which will be combined. The five qi and five sapors are other classical ways of specifying drug action, correlated with yin and yang (immature and mature yin and yang and a neutral balance of the two) in the former case and the Five Phases in the latter.
4 The text goes on (42b–43b) to explain each item and concept.