Do Not Ignore This: Early Warning Signs & Medical Red Flags

A calm guide to symptoms that deserve prompt or urgent medical attention

This book provides general health education and does not replace individual diagnosis or emergency medical care.

CHAPTER 1

Chest Pain or Pressure: When Not to Wait

Chest discomfort has many causes, but possible heart-attack symptoms need emergency assessment. Learn the warning pattern and why TCM should wait.

Key points

Possible heart-attack symptoms may feel like pressure or heaviness rather than sharp pain.

Sweating, nausea, breathlessness, faintness or discomfort spreading to the arm, jaw, back or shoulder increase concern.

People with diabetes and older adults may have less typical symptoms.

Why this deserves attention

Not every chest pain comes from the heart. Muscles, reflux, anxiety, lungs and other conditions can also cause discomfort. The problem is that a dangerous heart problem cannot be safely excluded from a website description. Pressure, tightness, heaviness or pain in the chest — especially when new, severe, brought on by exertion, or accompanied by other symptoms — should be taken seriously.

What makes it more important

Risk factors such as smoking, diabetes, high blood pressure, high cholesterol, kidney disease and a strong family history make heart disease more likely, but an emergency should not be dismissed simply because someone is young or has no known risk factors. Women can also experience heart attacks with less dramatic or less “classic” symptoms.

What to do next

If symptoms are mild but recurrent, arrange medical review rather than repeatedly assuming reflux or muscle strain. A clinician may need to consider an ECG, blood tests or other investigations based on the story and risk profile. Keep track of what you were doing when the symptom started, how long it lasted and what came with it.

Where TCM may fit

Do not use acupuncture, Tuina, herbs or acupressure to test whether serious chest pain “goes away”. Complementary care may be discussed only after urgent causes have been appropriately excluded and the person is medically stable.

When not to wait

New severe chest pressure, chest discomfort with breathlessness, sweating, fainting or other possible heart-attack symptoms should be treated as an emergency. In Singapore, call 995 for an ambulance rather than driving yourself if a heart attack is suspected.

CHAPTER 2

Stroke and TIA: Think F.A.S.T. and Do Not Wait

Sudden face weakness, arm weakness or speech difficulty can be stroke. In Singapore, call 995 immediately even if symptoms improve.

Key points

F.A.S.T.: Face drooping, Arm weakness, Speech difficulty, Time to call 995.

Any one sudden FAST sign can be enough to suspect stroke.

Sudden vision loss, severe imbalance or an unusual severe headache can also be important neurological symptoms.

Why this deserves attention

A stroke happens when blood flow to part of the brain is interrupted or when bleeding occurs in the brain. Treatment is time-sensitive. A transient ischaemic attack (TIA) can produce similar symptoms that improve after minutes or hours, but improvement does not make it safe to ignore; it can be a warning that a larger stroke may follow.

What makes it more important

High blood pressure, diabetes, smoking, high cholesterol, atrial fibrillation and previous TIA/stroke increase risk, but stroke can happen without a person knowing they have these conditions. This is one reason preventive screening matters before symptoms appear.

What to do next

Do not wait to see whether symptoms settle, sleep it off or arrange a routine clinic appointment. Record the time the person was last known to be well because treatment decisions may depend on timing. Use an ambulance rather than driving yourself.

Where TCM may fit

Acupuncture, Tuina and herbs are not first-line responses to a possible acute stroke or TIA. TCM rehabilitation may be discussed later only after hospital assessment and when the person is medically stable.

When not to wait

If a sudden FAST symptom or other possible stroke sign appears, call 995 immediately in Singapore. Even if the symptom disappears, urgent medical assessment is still required.

CHAPTER 3

Sudden Weakness or Numbness: When It Is a Neurological Emergency

Numbness can come from posture or a trapped nerve, but sudden one-sided weakness or numbness can be stroke. Learn the difference in urgency.

Key points

Sudden one-sided weakness or numbness should be treated as possible stroke.

New speech, vision, balance or facial changes increase urgency.

Persistent or progressive numbness also deserves medical review even when it is not an emergency.

Why this deserves attention

A hand that goes numb after sleeping awkwardly is very different from suddenly losing strength or sensation on one side of the body. Location, speed of onset and associated symptoms are critical. Nerve compression often follows a recognisable distribution and may relate to posture or movement; stroke and other brain problems can appear abruptly and affect the face, arm and/or leg.

What makes it more important

Diabetes, vitamin deficiencies, thyroid disease, spinal problems and peripheral nerve conditions can cause chronic numbness. Hand numbness at night may suggest carpal tunnel syndrome; leg numbness with back pain may relate to nerve-root irritation. These patterns need different assessment from sudden neurological loss.

What to do next

For ongoing symptoms, note the exact area, whether there is weakness, what movements trigger it and whether you have neck/back pain. A clinician may need neurological examination, blood tests or imaging depending on the pattern.

Where TCM may fit

TCM or manual therapy may be considered for some musculoskeletal or nerve-compression problems after appropriate assessment. Do not massage or needle a new sudden neurological deficit while waiting to see whether it improves.

When not to wait

Call 995 for sudden one-sided weakness/numbness, facial droop, speech difficulty, severe new imbalance or other possible stroke symptoms.

CHAPTER 4

Yellow Eyes, Dark Urine or Pale Stools: Liver and Bile Warning Signs

Jaundice and major urine/stool colour changes can reflect liver or bile problems. Learn when they need prompt medical assessment.

Key points

Yellow eyes are more significant than simply “looking tired”.

Dark urine with pale stools can point to impaired bile flow.

Fever and right-upper abdominal pain with jaundice can be urgent.

Why this deserves attention

Yellowing of the eyes or skin is called jaundice and occurs when bilirubin builds up. Dark urine, pale stools, itching, abdominal pain or fever can accompany liver, gallbladder or bile-duct problems. Food colour and dehydration can change urine or stool appearance, but true jaundice should not be self-diagnosed or watched for weeks.

What makes it more important

Possible causes range from viral hepatitis and gallstones to medication effects and other liver/bile diseases. Travel, alcohol, recent new medicines, supplements, herbal products and previous liver disease all matter to the assessment.

What to do next

Arrange prompt medical review for true jaundice or persistent major colour changes. Blood tests and imaging may be needed. Do not repeatedly use “cooling” or detox products while waiting for jaundice to resolve.

Where TCM may fit

TCM terminology such as “damp-heat” is not a substitute for identifying hepatitis, obstruction or drug-related liver injury. Stop and disclose non-essential supplements/herbs if a clinician advises this, and bring packaging for review.

When not to wait

Jaundice with high fever, severe abdominal pain, confusion, collapse, vomiting blood or black stools requires urgent medical care.

CHAPTER 5

Unexplained Weight Loss: When Losing Weight Is Not Good News

Unplanned weight loss can come from many causes, including thyroid, diabetes, digestive disease, depression or cancer. Persistence deserves assessment.

Key points

Track actual weight rather than relying on clothes alone.

Appetite loss, swallowing difficulty, persistent diarrhoea, bleeding or fever add useful clues.

Older adults are especially vulnerable to muscle loss and malnutrition.

Why this deserves attention

Weight naturally fluctuates, but losing a noticeable amount without trying deserves attention, especially when appetite, energy or function also changes. Possible causes range from stress and dental problems to overactive thyroid, diabetes, gastrointestinal disease, chronic infection, depression and cancer. The symptom is non-specific, which is exactly why guessing is unhelpful.

What makes it more important

If weight loss is intentional, make sure the plan preserves protein, muscle and overall nutrition. If it is unintentional, bring a timeline of weight changes, appetite, bowel symptoms, medicines and any new pain or lumps to a doctor.

What to do next

A medical assessment may include examination and targeted blood tests or imaging depending on the symptoms. There is no single “cancer blood test” that explains every unexplained weight change.

Where TCM may fit

TCM should not be used to label persistent unintentional weight loss simply as “spleen qi deficiency” or poor digestion. Nutrition support or symptom care may be discussed after serious causes are being appropriately investigated.

When not to wait

Seek prompt care if weight loss comes with dehydration, inability to swallow, significant bleeding, severe weakness, persistent vomiting, jaundice or rapidly worsening illness.

CHAPTER 6

A New Lump or Swelling: When to Stop Watching and Get It Checked

Most lumps are benign, but new persistent or changing lumps deserve medical assessment. Learn what details to notice without repeatedly pressing them.

Key points

A lump that persists, enlarges or feels fixed deserves review.

Fever, night sweats, weight loss or multiple enlarging lymph nodes add concern.

Do not squeeze or aggressively massage an unexplained lump.

Why this deserves attention

Lumps can come from lymph nodes, cysts, lipomas, infections, glands, hernias and many other causes. Most are not cancer. The safest approach is not to panic and not to ignore: note where the lump is, how long it has been present, whether it is changing and whether there are other symptoms.

What makes it more important

A lump after a recent infection may settle as the illness resolves, while an inflamed painful lump can reflect infection. Location also matters: breast, testicle, neck, abdomen and groin lumps each have different possible causes and assessment pathways.

What to do next

If a lump persists or changes, arrange examination rather than repeatedly photographing it for months. A clinician may use ultrasound or other tests depending on the location. Bringing a simple timeline is more useful than trying to diagnose texture yourself.

Where TCM may fit

TCM massage, gua sha, cupping or topical products should not be applied over an unexplained persistent lump until it has been appropriately assessed.

When not to wait

Seek prompt care for a rapidly enlarging lump, severe pain with fever, airway/swallowing difficulty, a testicular lump, breast changes or a lump associated with major weight loss.

CHAPTER 7

Bleeding After Menopause: Why It Should Always Be Checked

Bleeding after menopause is not automatically cancer, but it should be medically assessed rather than treated as a return of “periods”.

Key points

Any bleeding after menopause should be reported to a doctor.

Do not wait for repeated episodes before seeking review.

Hormone therapy and blood-thinning medicines are relevant but do not automatically explain away bleeding.

Why this deserves attention

After menopause, vaginal bleeding is no longer expected as a normal menstrual event. Causes include thinning of vaginal or uterine tissues, polyps, medication effects and other gynaecological conditions; cancer is one important cause that doctors need to exclude. Even a small amount of spotting deserves attention.

What makes it more important

A doctor may perform examination, ultrasound or other tests depending on the situation. The goal is to find a benign explanation when possible while not missing serious disease.

What to do next

Keep note of how much bleeding occurred, whether there is pain, discharge, weight loss or use of hormones. If taking blood thinners, do not stop them without medical advice.

Where TCM may fit

TCM should not be used to “regulate” postmenopausal bleeding as if it were an irregular menstrual cycle. Any complementary care should follow appropriate gynaecological assessment.

When not to wait

Heavy bleeding, fainting, severe pelvic/abdominal pain, weakness or bleeding with major systemic illness requires urgent medical care.

CHAPTER 8

A Testicular Lump or Swelling: Do Not Be Embarrassed to Get It Checked

Most scrotal lumps are not cancer, but a new testicular lump deserves prompt assessment. Sudden severe pain can be an emergency.

Key points

A painless testicular lump is not something to ignore.

Sudden severe testicular pain can be torsion and is time-sensitive.

Fever, urinary symptoms or discharge may point toward infection but still require assessment.

Why this deserves attention

A lump or swelling in the scrotum can come from cysts, fluid collections, enlarged veins, infection, hernia or a testicular tumour. The person cannot reliably distinguish these by touch alone. A new lump within the testicle deserves medical assessment even if it is painless.

What makes it more important

Note whether the change is in the testicle itself or around it, whether it appeared suddenly and whether there was injury. Ultrasound is often useful for distinguishing different causes.

What to do next

Do not repeatedly squeeze a lump to see whether it changes. Arrange medical review promptly; embarrassment should not create months of delay.

Where TCM may fit

TCM massage, topical medicines or strong heat should not be applied to a new unexplained testicular lump before diagnosis.

When not to wait

Sudden severe testicular pain, especially with nausea/vomiting or a high-riding testicle, requires emergency assessment because torsion can threaten the testicle.

References & Further Reading

Singapore Ministry of Health — Screening Test Review Committee 2026

HealthHub / Healthier SG Screening

HealthHub public education on stroke, chronic kidney disease and screening