From the Guidelines
Yes, a History of Present Illness (HPI) is required in a Traditional Chinese Medicine (TCM) visit. During a TCM consultation, practitioners need to understand the patient's current symptoms, their onset, duration, severity, and progression to formulate an accurate diagnosis and treatment plan. This information gathering process, similar to the Western medical HPI, is part of the "Four Examinations" methodology in TCM: looking (observation), listening/smelling, asking (inquiry), and touching (palpation) 1. The questioning component specifically explores the patient's symptoms in detail, including pain characteristics, aggravating and alleviating factors, and relationship to environmental factors like temperature or seasons.
Some key points to consider when taking an HPI in a TCM visit include:
- Understanding the patient's principal cognitive and behavioral symptoms and their impact on daily function, interpersonal relationships, and comportment 1
- Obtaining a thorough health history, including information on cardiovascular disease, cerebrovascular disease, and other medical conditions 1
- Inquiring about the patient's lifestyle habits, medications, and comorbidities 1
- Using the information gathered to identify patterns of disharmony according to TCM principles of yin-yang balance, five elements theory, and qi circulation
Without a thorough HPI, the practitioner would lack essential information needed to determine which acupuncture points to use, which herbs to prescribe, or what lifestyle modifications to recommend, potentially compromising the effectiveness of treatment. The most recent and highest quality study, published in 2023, emphasizes the importance of medical history in evaluating patients with non-neurogenic male lower urinary tract symptoms 1. Similarly, a 2021 study on the diagnosis and management of migraine highlights the need for a comprehensive medical history, including information on headache episodes, pain characteristics, and accompanying symptoms 1.
Overall, the evidence suggests that a thorough HPI is essential in TCM visits to ensure accurate diagnosis and effective treatment. A comprehensive HPI is crucial for identifying patterns of disharmony and developing an effective treatment plan.
From the Research
History of Present Illness (HPI) in Traditional Chinese Medicine (TCM) Visits
- The provided studies do not directly address whether a History of Present Illness (HPI) is required in a Traditional Chinese Medicine (TCM) visit 2, 3, 4, 5, 6.
- However, the importance of taking a thorough patient history is emphasized in various medical contexts, including Western medicine, as it is fundamental for accurate diagnosis and effective management of health conditions 5, 6.
- In Western medicine, a significant proportion of diagnoses are made based on history taking, often alongside physical assessments and laboratory investigations 5.
- The process of taking a patient history is a structured but flexible process of gathering relevant information from patients to inform diagnosis and treatment, and important communication skills for healthcare professionals include active listening, empathetic communication, and cultural sensitivity 5.
- While there is no direct evidence on the requirement of HPI in TCM visits, the general principles of taking a patient history may still be applicable, as they are essential for building a physician-patient relationship, transforming the database into an etiologic narrative, and using the narrative to coprocess the experience of illness with the patient 4.