Inquiry Diagnosis (Wen Zhen): The Art of Asking in TCM

What is Inquiry Diagnosis?

Inquiry Diagnosis (问诊, Wèn Zhěn) is the third of the Four Diagnostic Methods in TCM and arguably the most information-rich. Through systematic questioning, the practitioner gathers the patient’s subjective experience of their symptoms, medical history, lifestyle, and emotional state — information that no pulse reading or tongue observation can reveal alone.

The legendary Qing Dynasty physician Zhang Jingyue (张景岳) developed the famous Ten Questions (十问歌), a comprehensive questioning framework that remains the gold standard in TCM clinical practice today.

Key principle: “To ask is to understand.” A skilled TCM practitioner can often identify the pattern before ever touching the pulse — simply by asking the right questions in the right order.

Zhang Jingyue’s Ten Questions

The classic “Ten Questions Song” covers every major area of health:

1. Cold and Fever (寒热)

Key questions:

• Do you feel cold or hot?
• Do you have chills? Fever? Or alternating chills and fever?
• Is the fever persistent or does it come and go?
• Do you feel hot on the surface but cold inside?

Response	TCM Pattern
Chills without fever	Cold pattern / Yang deficiency
Fever without chills	Heat pattern
Alternating chills and fever	Shaoyang pattern (half-exterior, half-interior)
Fever that’s worse in the afternoon	Yin deficiency Heat
Feeling cold with warm skin	True Heat, False Cold
Feeling hot with cold skin	True Cold, False Heat

2. Sweat (汗)

Key questions:

• Do you sweat easily?
• When do you sweat — daytime or night?
• Do you sweat with or without exertion?
• Where on the body do you sweat?

Response	TCM Pattern
No sweating with chills/fever	Exterior Excess (pores locked)
Sweating with chills/fever	Exterior Deficiency (pores loose)
Spontaneous daytime sweating	Qi deficiency (Wei Qi weak)
Night sweats	Yin deficiency
Sweating only on head	Damp-Heat or Yangming Heat
Cold sweat with pale face	Yang collapse (emergency)

3. Head and Body (头身)

Key questions:

• Do you have headaches? Where exactly?
• Do you feel heaviness in the body?
• Any lower back pain or knee weakness?

Headache Location	Related Meridian
Forehead	Yangming (Stomach/Large Intestine)
Sides (temples)	Shaoyang (Gallbladder/Triple Burner)
Back of head	Taiyang (Bladder/Small Intestine)
Top of head	Jueyin (Liver)
Inside the head (deep)	Kidney deficiency

4. Urine and Stool (二便)

Key questions:

• How often do you urinate? What color?
• Is urination frequent at night?
• Are your stools formed or loose?
• Any constipation or diarrhea?

Urine Sign	Pattern
Dark, scanty, yellow	Heat
Pale, copious, clear	Cold / Yang deficiency
Frequent at night	Kidney Yang deficiency
Burning urination	Damp-Heat in Bladder

Stool Sign	Pattern
Dry, hard, difficult	Heat or Fluid deficiency
Loose, watery, with undigested food	Spleen Yang deficiency
Sticky, foul-smelling, difficult to wipe clean	Damp-Heat
Alternating loose and dry	Liver Qi stagnation with Spleen deficiency

5. Food and Drink (饮食)

Key questions:

• How is your appetite?
• Do you prefer hot or cold drinks?
• Do you feel thirsty? What type of drink satisfies it?

Response	Pattern
Poor appetite	Spleen Qi deficiency
Hungry but can’t eat much	Stomach Yin deficiency
Strong thirst, preference for cold drinks	Heat pattern
No thirst, preference for hot drinks	Cold pattern
Thirst but no desire to drink	Dampness
Bitter taste in mouth	Heat (Liver or Heart)
Sweet or sticky taste	Spleen Damp-Heat

6. Chest and Abdomen (胸腹)

Key questions:

• Any fullness or pain in the chest?
• Do you feel bloated after eating?
• Is the pain improved or worsened by pressure?

Response	Pattern
Pain worse with pressure	Excess pattern (food stagnation, Blood stasis)
Pain better with pressure	Deficiency pattern
Chest fullness, sighing	Liver Qi stagnation
Epigastric fullness after eating	Food stagnation or Spleen deficiency
Lower abdominal pain with menstrual clots	Blood stasis

7. Hearing and Vision (耳目)

Key questions:

• Any ringing in the ears (tinnitus)?
• Is your hearing affected?
• Any blurred vision or floaters?

Response	Pattern
Sudden tinnitus, loud	Excess (Liver Fire)
Gradual tinnitus, low-pitched	Deficiency (Kidney)
Blurred vision with floaters	Liver Blood deficiency
Red, bloodshot eyes	Liver Heat or Fire

8. Thirst (渴)

Already covered under Food and Drink, but specifically:

• Thirst with desire to drink large amounts: Excess Heat
• Thirst with desire to sip small amounts: Yin deficiency or Dampness
• No thirst: Cold pattern or Dampness

9. Past Medical History (旧病)

Key questions:

• What illnesses have you had before?
• Any chronic conditions?
• Have you had surgery?
• What medications are you taking?

Past conditions shape the current pattern. For example, a patient with chronic pneumonia may have lingering Lung Yin deficiency that affects current treatment.

10. Cause and Onset (因)

Key questions:

• When did the symptoms start?
• What was happening in your life at that time?
• Any emotional stress, dietary change, or weather exposure before onset?

Trigger	Likely Pattern
After exposure to cold wind	Wind-Cold invasion
After emotional upset	Liver Qi stagnation
After overeating rich food	Food stagnation
After excessive worry	Spleen Qi deficiency
Gradual onset, worse with fatigue	Deficiency pattern
Sudden onset, severe symptoms	Excess pattern

Beyond the Ten Questions: Modern Additions

Contemporary TCM practitioners also ask about:

Topic	Why It Matters
Sleep quality	Insomnia patterns reveal Heart/Liver/Kidney imbalances
Menstrual history	Cycle, color, clots, pain reveal Blood and organ status
Emotional state	Each emotion relates to a specific organ (anger→Liver, worry→Spleen)
Energy level	Fatigue patterns distinguish Qi from Yang deficiency
Medications	Drug effects can mask or mimic TCM patterns
Lifestyle	Exercise, diet, work habits inform treatment strategy

The Art of Questioning

Effective inquiry diagnosis requires skill beyond simply reading a checklist:

• Start open-ended: “What brings you in today?” lets the patient tell their story
• Follow the thread: Pursue unexpected answers with deeper questions
• Watch for patterns: Connect answers across categories (e.g., night sweats + lower back pain = Kidney Yin deficiency)
• Compare and contrast: “Is the pain better or worse after eating?” distinguishes Excess from Deficiency
• Note what’s NOT said: Absence of expected symptoms is also diagnostic

Key Takeaways

• Inquiry Diagnosis is the most information-rich of the Four Diagnostic Methods
• Zhang Jingyue’s Ten Questions provide a systematic framework covering all major health areas
• Questions about cold/fever, sweat, pain, digestion, and elimination reveal the pattern’s nature and location
• A symptom’s characteristics (better/worse with pressure, time of day, triggers) are as important as the symptom itself
• The art lies in connecting answers across categories to build a complete diagnostic picture

Disclaimer: This article is for educational purposes only. Professional TCM diagnosis combines inquiry with inspection, auscultation-olfaction, and palpation.

Related Articles

• Four Diagnostic Methods
• Eight Principles
• Pulse Diagnosis
• Tongue Diagnosis