The Ten Questions of TCM Inquiry Diagnosis (十问歌): A 300-Year-Old Checklist That Still Works

Why a Poem Matters in Medicine

In 1624, a physician named Zhang Jingyue (张景岳) published a book called Jing Yue Quan Shu (《景岳全书》, “Complete Works of Jingyue”). In it, he included a short verse — just ten lines — designed to help doctors remember what to ask during a patient interview [^1]. Over a century later, the physician Chen Xiu-yuan (陈修园) expanded it in his Yi Xue Xin Wu (《医学心悟》, 1732) [^2].

The result is the Ten Questions Song (十问歌) — probably the most memorized piece of diagnostic verse in the history of Chinese medicine. Medical students across China learn it in their first year and some can recite it decades into their career.

Here is the expanded version:

一问寒热二问汗，三问头身四问便， 五问饮食六胸腹，七聋八渴俱当辨， 九问旧病十问因，再兼服药参机变， 妇女尤必问经期，迟速闭崩皆可见。

Roughly translated:

1. Ask about chills and fever
2. Ask about sweating
3. Ask about the head and body
4. Ask about urination and defecation
5. Ask about food and drink
6. Ask about the chest and abdomen
7. Ask about hearing
8. Ask about thirst
9. Ask about past illnesses
10. Ask about the cause
11. Also consider medications taken
12. For women, always ask about menstruation

What makes this remarkable is how clinically relevant it remains. These are not esoteric questions — they are the same questions a good doctor of any tradition would ask, organized in a sequence that builds a complete picture.

Walking Through Each Question

Question 1: Chills and Fever (寒热)

This is always first because it immediately narrows the diagnostic possibilities.

| Pattern | What the patient reports | TCM interpretation | |---------|------------------------|-------------------| | Chills with no fever | Feeling cold, no elevated temperature | Cold pattern, possibly Yang deficiency | | Fever with no chills | Feeling hot, possibly with thirst | Heat pattern | | Chills and fever together | Alternating, or simultaneous | External pathogen (wind-cold or wind-heat) | | Fever worse in afternoon | Low-grade fever peaking in late afternoon | Yin deficiency heat (虚热) | | Feeling cold but hot to touch | Subjective cold, objective warmth | True cold, false heat — a complex pattern |

The Shanghan Lun (《伤寒论》) builds its entire diagnostic system on the analysis of chills and fever patterns, making this question the gateway to understanding whether a condition is internal or external, hot or cold [^3].

Question 2: Sweat (汗)

This question catches many patients off guard — why does the doctor care about sweating?

Because sweat patterns reveal the body’s internal temperature regulation and the strength of defensive Qi (卫气):

• No sweat during fever: External cold constraining the surface — the pathogen is locked in
• Spontaneous daytime sweating: Qi deficiency — the defensive Qi cannot hold the pores closed
• Night sweats: Yin deficiency — the body’s cooling system runs at the wrong time
• Sweat only on hands and feet: Often Heart or Spleen imbalance
• Profuse sweating with cold limbs: Yang collapse — a medical emergency

Question 3: Head and Body (头身)

This covers headaches, body aches, and the general physical feeling.

• Headache location matters: Vertex = Liver; temples = Shaoyang; back of head = Taiyang; forehead = Yangming/Stomach. The Shanghan Lun uses headache location to identify which meridian is affected [^3].
• Body aches everywhere: External wind-damp
• Lower back pain specifically: Kidney involvement
• Heaviness in the limbs: Dampness

Question 4: Urination and Defecation (便)

These are not glamorous topics, but in TCM they are diagnostic gold.

• Dark yellow, scanty urine: Heat
• Clear, copious urine: Cold
• Frequent urination at night: Kidney Yang deficiency
• Constipation with dry stool: Heat or Yin deficiency
• Loose stools, worse after cold food: Spleen Yang deficiency
• Diarrhea with urgency, burning: Damp-heat in the intestines

The Huangdi Neijing calls the examination of excreta one of the essential diagnostic methods, ranking it alongside pulse and tongue diagnosis [^4].

Question 5: Food and Drink (饮食)

This reveals Spleen-Stomach function — the center of all Qi and blood production:

• Poor appetite, easy fullness: Spleen Qi deficiency
• Hungry but cannot eat much: Stomach Yin deficiency
• Cravings for specific tastes: Sweet = Spleen weakness; salty = Kidney; sour = Liver; bitter = Heart heat; spicy = Lung cold
• Aversion to greasy food: Liver-Gallbladder disharmony or damp-heat
• Thirst with desire for cold drinks: Heat
• Thirst but no desire to drink: Dampness (the body wants water but cannot process it)

Question 6: Chest and Abdomen (胸腹)

Pain, fullness, or discomfort in these areas directly reflects internal organ status:

• Chest tightness with sighing: Liver Qi stagnation
• Epigastric fullness after eating: Food stagnation or Spleen deficiency
• Lower abdominal pain, fixed location: Blood stasis
• Abdominal pain that improves with pressure: Deficiency (needs support)
• Abdominal pain that worsens with pressure: Excess (has a blockage)

This distinction — pain better with pressure vs. worse with pressure — is one of the most clinically useful findings in TCM abdominal diagnosis and dates back to the Shanghan Lun [^3].

Question 7: Hearing (聋)

Hearing loss and tinnitus may seem like minor complaints, but in TCM they carry significant diagnostic weight:

• Sudden hearing loss: Wind-heat or liver fire (acute pattern)
• Gradual hearing loss with tinnitus: Kidney deficiency (chronic pattern)
• Tinnitus like cicadas (high-pitched): Kidney Yin deficiency
• Tinnitus like ocean waves (low-pitched, rushing): Liver Yang rising

Question 8: Thirst (渴)

Related to but distinct from the food question:

• No thirst: Cold pattern, or dampness (body has water but cannot use it)
• Thirst for large amounts of cold water: Severe heat (e.g., Bai Hu Tang pattern)
• Thirst but only sips: Damp-heat or Yin deficiency with dampness
• Dry mouth at night: Yin deficiency

Question 9: Past Illnesses (旧病)

Understanding what came before helps distinguish new acute conditions from chronic patterns. A patient with recurrent colds has a different underlying picture from one having their first cold. This is just good clinical medicine — every doctor asks this.

Question 10: Cause (因)

What triggered the current illness? Common causes in TCM:

• Exposure to wind/cold → External contraction
• Emotional upset → Liver Qi stagnation
• Overeating or eating unclean food → Food stagnation or dampness
• Overwork → Qi or Kidney deficiency
• Physical trauma → Blood stasis

Questions 11–12: Medications and Menstruation

The expanded version adds two critical follow-ups:

• What medications have you taken? — Both TCM and Western drugs affect the clinical picture. A patient on antihypertensives may show Kidney deficiency signs that are partially masked. Someone who has been taking the wrong TCM formula may have new iatrogenic patterns.
• Women: menstrual history — Cycle length, flow volume, color, clots, pain. In TCM gynecology, the menstrual pattern is one of the most important diagnostic tools available.

Why This Checklist Survived 300 Years

The ten questions work because they are systematic without being rigid. A skilled practitioner does not mechanically go through all ten — they use them as a framework, spending more time on the questions most relevant to the patient’s presentation and briefly checking the others.

In modern Chinese medical schools, students are taught to memorize the song and then practice it in clinical rotations until it becomes second nature. A 2019 survey of TCM university teaching methods published in China Higher Medical Education found that 94% of TCM diagnostic courses still use the Ten Questions Song as their primary teaching tool for inquiry diagnosis [^5].

There is something to be said for a system that has been refined over three centuries of clinical practice. It is not perfect — it does not directly address mental health, sleep quality, or modern lifestyle factors. But as a starting framework, it is remarkably efficient.

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References:

[^1]: Zhang Jingyue. Jing Yue Quan Shu (《景岳全书》). 1624. Volume 1, “Chuan Zhong Lu” (传忠录). People’s Medical Publishing House, annotated edition. [^2]: Chen Xiu-yuan. Yi Xue Xin Wu (《医学心悟》). 1732. Volume 1, “Ten Questions Song” section. [^3]: Zhang Zhongjing. Shanghan Lun (《伤寒论》). c. 220 CE. Multiple clauses reference chills/fever and headache location. [^4]: Huangdi Neijing Suwen (《黄帝内经·素问》). Chapter 17, “Mai Yao Jing Wei Lun” (脉要精微论). [^5]: Liu XM, et al. “Teaching methods for TCM diagnostic inquiry: A nationwide survey.” China Higher Medical Education (《中国高等医学教育》). 2019;(3):78–80.

Disclaimer: This article is for educational purposes only. Consult a qualified TCM practitioner for proper diagnostic evaluation.

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