The Ten Questions: How TCM Interrogates Your Symptoms (Part 1)

00 — The Framework

Why Ten Specific Questions?

問診 (Inquiry) is the fourth examination method, and in many ways the most flexible. Inspection and pulse-taking require training to read subtle signs. Inquiry requires training to ask the right questions and interpret the answers correctly. The Ten Questions (十問歌 shí wèn gē) are a clinical mnemonic from the 明代 Ming Dynasty physician Zhang Jingyue — a systematic framework ensuring no critical diagnostic information is missed.

The ten questions are not a checklist. Each question is a gateway into a pattern: the answer and its qualifiers together reveal the thermal nature (hot or cold), the excess or deficiency state, and which organ system is primarily involved. Part 1 covers questions 1–5, focusing on the exterior-interior distinction, sweating patterns, and head and body experiences.

十問歌 · The Ten Questions Song

One: chills and fever. Two: sweating. Three: head and body. Four: stool and urine. Five: food and drink. Six: chest and abdomen. Seven: hearing. Eight: thirst. Nine: old conditions. Ten: causes. (Classically also: women's inquiry and children's inquiry.) Each question maps to specific organ systems and pattern types.

Question 01

01 Chills & Fever — 寒熱寒熱 · hán rè

The first question establishes the most fundamental distinction in TCM pathology: is this a Cold pattern or a Heat pattern? "Chills and fever" doesn't just mean a spiking temperature — it means the patient's subjective experience of their thermal state.

Pattern

Fever + Chills Together

Both occurring simultaneously = exterior pattern. An external pathogen (Wind-Cold or Wind-Heat) is fighting your Wei Qi at the body's surface. Classic flu/cold onset. Chills dominant = Wind-Cold. Fever dominant = Wind-Heat.

Pattern

Fever Without Chills

Interior Heat pattern — the pathogen has penetrated inward, or an internal excess pattern is generating Heat. High fever with no chills + sweating = Yangming stage (acute febrile disease at the interior level).

Pattern

Chills Without Fever

Interior Cold pattern. Yang deficiency — the body cannot generate enough warmth. Chronic cold feeling not related to external temperature = Kidney or Spleen Yang deficiency. Always cold in the lower back and knees = Kidney Yang xu.

Pattern

Afternoon Low-Grade Fever

Alternating fever that peaks in the afternoon (3–5pm) or at night = Yin deficiency with Empty Heat. The Yin cannot anchor the Yang, so it floats to the surface in the evening. Classic in chronic illness, TB, post-illness recovery.

Question 02

02 Sweating — 汗汗 · hàn

Sweating in TCM is far more diagnostic than simply "do you sweat." The question covers: does it happen, when, how much, from where, and in what context. Each answer points to a different mechanism.

Pattern

Daytime Spontaneous Sweating

Sweating without exertion during the day = Qi or Wei Qi deficiency. The Defensive Qi (衛氣) that holds the pores closed is too weak. Worsens with any physical effort. Classic in chronic fatigue, post-illness, elderly patients. Often accompanies shortness of breath.

Pattern

Night Sweats

Sweating during sleep, stopping on waking = Yin deficiency with Empty Heat. At night, Yin should dominate — but when Yin is deficient, Empty Heat rises and forces the sweat out. The most common presentation in perimenopause, chronic stress, and post-illness Yin depletion.

Pattern

Sweating on the Palms & Soles

Persistent sweating specifically from palms, soles, and sternum (五心 "five hearts") = Yin deficiency Heat at the extremities. The Yin deficiency Empty Fire is concentrating at the distal points of circulation. Very characteristic sign.

Pattern

Profuse Sweating + High Fever

Large amounts of sweat with high fever and strong thirst = Interior Heat excess (Yangming stage in classical 六經 theory). The Interior Heat is forcing fluids out as sweat. Requires Heat-clearing treatment, not tonifying.

Question 03

03 Head & Body — 頭身頭身 · tóu shēn

This question covers headaches, dizziness, and any abnormal body sensations — heaviness, numbness, aching, stiffness. Location and quality are both diagnostic.

Headache

Location Matters

Front forehead = Yangming (Stomach) channel. Temples / sides = Shaoyang (Gallbladder channel). Top of head = Liver channel ascending. Back of head / neck = Taiyang (Bladder channel) — often Wind-Cold. Whole head = systemic — Phlegm, Blood stasis, or deficiency.

Headache

Quality Matters

Distending + throbbing = Liver Yang rising. Heavy / foggy = Phlegm-Damp. Fixed + stabbing = Blood stasis. Dull + persistent = Qi or Blood deficiency. Empty feeling + worse on exertion = Kidney deficiency. Sharp + sudden onset = Wind invading.

Body Sensation

Heavy Body / Limbs

A general sensation of heaviness, as if soaked in water or wrapped in something wet. Characteristic of Damp or Phlegm obstruction — fluids are not being transformed and are pooling in the tissues. "My body feels like concrete in the morning" — a classic Damp pattern description.

Body Sensation

Body Aching / Stiffness

External invasion: sudden onset aching after exposure to cold, wind, or damp = Bi Syndrome (painful obstruction). Cold Bi = cold and pain, relieved by warmth. Wind Bi = pain moves around. Damp Bi = fixed, heavy, worse in damp weather. Internal: chronic achy muscles = Blood deficiency failing to nourish tendons.

Question 04

04 Chest & Abdomen — 胸腹胸腹 · xiōng fù

This question maps sensations in the chest and abdominal region — fullness, pain, distension, pressure, or nausea. The region of the body is as important as the sensation.

Chest Region

Chest Tightness / Oppression

A sense of pressure or tightness in the chest (胸悶 xiōng mèn). Most commonly: Liver Qi stagnation invading the chest, or Phlegm obstructing the Heart and Lung. Heart Qi or Yang deficiency in more serious cases. Accompanied by sighing in Liver Qi stagnation patterns.

Chest Region

Hypochondriac Pain

Pain or distension along the sides of the rib cage (肋脅 lèi xié) = classic Liver and Gallbladder channel involvement. Liver Qi stagnation is the most common cause. Worse with stress, better with sighing. Persistent stabbing pain = Blood stasis in the Liver.

Abdominal Region

Epigastric Pain / Fullness

Upper abdominal pain and bloating directly below the sternum (胃脘 wèi wǎn) = Stomach involvement. Cold pain + prefers warmth = Cold in the Stomach. Burning pain + prefers cold = Stomach Heat/Fire. Pain after eating = food stagnation or Stomach Yin deficiency. Pain relieved by eating = Cold or deficiency pattern.

Abdominal Region

Lower Abdominal Pain

Below the navel involves Kidney, Bladder, Uterus, Large Intestine. Cold cramping pain around menstruation = Cold stasis in the Uterus. Dull constant ache = Kidney deficiency. Sharp fixed pain = Blood stasis. Bloating and gas = Spleen-Stomach dysfunction with Qi obstruction.

Question 05

05 Food & Drink — 飲食飲食 · yǐn shí

Appetite, thirst, taste preferences, and food aversions reveal the state of the Spleen and Stomach — the central digestive axis (中焦 zhōng jiāo) of TCM pathophysiology.

Appetite

Poor Appetite / No Interest

Spleen Qi deficiency — the Spleen cannot generate the appetite drive or perform the transformative digestive function. Often accompanied by bloating after eating, fatigue after meals. If accompanied by nausea and aversion to smells = Stomach Qi rebelling upward.

Appetite

Excessive Hunger / Always Hungry

Stomach Heat or Fire — the Stomach is running too hot and consuming its contents rapidly. Classic in hyperthyroid states, early-stage diabetes, and stress-induced excess patterns. Eats frequently but may not feel truly satisfied. Weight maintenance may be difficult.

Thirst

Strong Thirst / Desires Cold Drinks

Strong thirst with preference for cold water = Interior Heat consuming fluids. Intense thirst, frequent urination, excessive eating = possible Wasting-Thirsting syndrome (消渴 — TCM framework overlapping with diabetes). Any strong thirst with cold drink preference requires Heat-clearing treatment.

Thirst

No Thirst / Prefers Warm Drinks

Cold or Damp pattern. Cold interior patterns reduce fluid metabolism — less thirst, preference for warmth. Damp obstruction also reduces thirst by surrounding the fluid metabolism centers. "I drink because I know I should, not because I feel thirsty" is a classic deficiency/Cold presentation.

Taste Abnormalities

Bitter taste in the mouth = Liver or Heart Heat (especially on waking). Sweet/sticky taste = Spleen Damp-Heat or food stagnation. Sour taste = Liver Qi overacting on Stomach. Salty taste = Kidney pattern. No taste at all = Spleen Qi deficiency, unable to distribute flavors. These are often noticed first thing in the morning before eating.

The Ten Questions.Part One.

Why Ten Specific Questions?

The Ten Questions.
Part One.