Questions Six Through Ten
The first five questions (see Part 1) establish the thermal nature, the depth of the pathology, and the state of digestion. Questions 6–10 complete the picture: the quality of sleep, the state of the eliminations (stool and urine), the specific character of pain, and, for female patients, the detailed inquiry into menstruation and reproductive function that is central to TCM gynecology.
The classical Ten Questions also include a children's inquiry (小兒問診) for pediatric cases, asking about birth history, vaccinations, feeding, and childhood illness patterns. This article focuses on the adult questions.
TCM views sleep as the descent of Yang Qi into the interior — the body drawing inward during the night as Yin dominates. Disruptions to sleep reflect disruptions in this Yang-Yin cycling, in the specific organs responsible for anchoring the mind (神 Shen), or in excess pathologies that produce restlessness.
The eliminations (二便 — "two excretions") are among the most direct diagnostic data in TCM. They represent the end product of digestion and fluid metabolism — how the body has processed what came in. The Spleen, Stomach, Large Intestine, Small Intestine, Kidney, and Bladder are all reflected here.
In TCM, the character of pain is more diagnostic than its intensity. "It hurts" tells us almost nothing. The qualities below each carry a specific pattern diagnosis. The pain inquiry covers location, quality, onset, timing, what makes it better, and what makes it worse.
"通則不痛，痛則不通" — Where there is free flow, there is no pain. Where there is no free flow, there is pain. All pain in TCM reflects obstruction — of Qi, Blood, or both — at some level.
In female patients, the menstrual inquiry is not optional — it is central. TCM gynecology (婦科) treats the menstrual cycle as the most visible expression of the Liver, Kidney, and Chong-Ren (沖任) vessel system. The menstrual history often reveals the core pattern before any other question.
The vaginal discharge is also inquired: white, thin, and copious = Spleen Qi deficiency (cannot transform Damp). Yellow, thick, or foul-smelling = Damp-Heat in the Lower Jiao. These map directly to the Dai Vessel (帶脈) governing leukorrhea and the patterns that affect it.
The final question encompasses medical history, the original cause of the illness, and the circumstances of onset. TCM uses this to understand the etiological chain — how the current presentation developed from its origin.
How the Ten Questions Build a Pattern
No single question is diagnostic in isolation. The pattern emerges from convergence: a patient who has afternoon fever (Q1), night sweats (Q2), vivid dreams of fire (Q6), dark urine (Q7), and early/short menstrual cycles with bright red blood (Q9) is producing a clear constellation of signs pointing to Yin deficiency with Empty Heat. Each question confirms and deepens the picture.
A patient with chills and no fever (Q1), spontaneous daytime sweating (Q2), poor appetite and no thirst with preference for warm drinks (Q5), chronic loose morning stool (Q7), and dull constant lower back ache (Q8) is describing Spleen-Kidney Yang deficiency — equally clearly, from a completely different set of answers.
Together, the Ten Questions survey every major organ system and pathological mechanism. By the end of the interview, a skilled practitioner has already formed a working diagnosis — the tongue and pulse examination that follows will confirm or modify it, not discover it from scratch. 問診 is not preamble. It is diagnosis.