The Ten Questions (十问歌): TCM's Time-Tested Guide to Taking a Case History

A Checklist That Survived Four Centuries

Inquiry (问诊, wèn zhēn) is one of the four examinations (四诊) of TCM — inspection, listening/smelling, inquiry, and palpation — and for internal, chronic complaints it is often the examination that matters most. A skilled practitioner can draw an enormous amount from a conversation, provided the right questions get asked.

To make sure none were forgotten, the Ming-dynasty physician Zhang Jingyue (张景岳, 1563–1640) condensed the whole interview into a memorable verse. Later, the Qing physician Chen Xiuyuan (陈修园) revised it. The result is the Ten Questions Song (十问歌), still recited by students today as a skeleton for any case history.

The Verse

Zhang Jingyue’s original, with Chen Xiuyuan’s additions widely included in the modern form:

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， 再添片语告儿科，天花麻疹全当验。

Walking Through Each Line

1. Cold and Heat (寒热)

“One, ask about cold and heat.” Is there chills, fever, or alternating chills-and-fever? A new fever with strong chills points to an exterior wind-cold pattern; high fever with little chill suggests heat has entered; alternating chills and fever is the signature of a Shaoyang stage. Cold and heat are the fastest route to the cold-heat axis of the eight principles.

2. Sweating (汗)

“Two, ask about sweat.” Spontaneous daytime sweating with fatigue suggests Qi deficiency; night sweats with heat in the palms and soles point to Yin deficiency. An exterior invasion with no sweat leans toward wind-cold; one with sweat toward wind-heat or a weakened defensive Qi.

3. Head and Body (头身)

“Three, ask about head and body.” Headaches, dizziness, and body aches are located and characterized: a heavy, wrapped sensation suggests dampness; wandering joint pain suggests wind; soreness and weakness of the lower back and knees points toward Kidney deficiency.

4. Urine and Stool (便)

“Four, ask about the bowels.” Constipation can mean heat or dryness — or, paradoxically, cold and deficiency that lacks the strength to move. Loose stools and poor digestion usually implicate Spleen deficiency or dampness. Urine that is scant and dark yellow signals heat; clear and copious urine signals cold.

5. Food and Drink (饮食)

“Five, ask about food and drink.” Appetite, taste in the mouth, thirst, and preferred temperature of drinks all matter. A bitter taste points to heat (often Liver/gallbladder); a sweet, sticky taste to dampness; no thirst or thirst for warm drinks to cold; thirst for cold drinks to heat. Loss of appetite and bloating after eating implicates the Spleen.

6. Chest and Abdomen (胸腹)

“Six, ask about chest and abdomen.” Pain, fullness, or distension here is mapped to the organs it overlies. Distension that moves with mood suggests Liver Qi stagnation; fixed, stabbing pain suggests blood stasis; pain relieved by pressure and warmth suggests deficiency-cold; pain worsened by pressure suggests excess.

7 and 8. Hearing and Thirst (聋/渴)

“Seven, deafness; eight, thirst — both must be distinguished.” Ringing in the ears (tinnitus) that comes on slowly with low sound is often Kidney deficiency; a sudden, loud ringing is often Liver fire. (Hearing also folds into the listening/smelling examination — the strength of the voice, sighing, belching.) Thirst, as above, distinguishes heat from cold and fluid status.

9 and 10. Old Illness and Cause (旧病/因)

“Nine, ask about old illness; ten, ask about the cause.” A chronic condition layered on a recent one, family history, emotional shock, overwork, dietary indiscretion, or an external exposure — the onset story often reveals whether the root is deficiency, stagnation, or a lingering pathogen. And “re兼服药参机变” — always ask what has already been taken, because a prior formula or drug can change the current picture entirely.

The Additions: Women and Children

Chen Xiuyuan’s lines extend the framework where it mattered most. For women (妇女尤必问经期): ask about the menstrual cycle — early or late, heavy or scant, painful, or stopped (闭) or flooding (崩). The menstrual history is so diagnostic in women’s patterns that omitting it is a serious blind spot. For children: ask about pediatric febrile rashes and epidemic diseases, since a child’s chief complaint is often a fever that an adult cannot describe for them.

Why a Verse, and Why It Endures

A mnemonic exists because the cost of a forgotten question is high. Forget to ask about sweating, and you may misread a wind pattern; forget the menstrual cycle, and a woman’s pattern stays half-invisible. The song is not a rigid script — experienced practitioners adapt and expand it — but it guarantees that the essential axes of cold/heat, deficiency/excess, interior/exterior, and the affected organ are touched on every time.

It also embodies a quietly radical idea: that the most sophisticated diagnostic instruments TCM possesses are a thoughtful clinician and a thorough conversation.

Key Takeaways

• The Ten Questions (十问歌) is the classic TCM inquiry checklist, originating with Zhang Jingyue and refined by Chen Xiuyuan.
• It moves through cold/heat, sweat, head/body, urine/stool, food/drink, chest/abdomen, hearing, thirst, past illness, and cause.
• Later verses add menstrual history for women and fever/rash history for children.
• Each answer maps onto the eight principles and the organ systems — together they sketch the zheng (pattern).
• It remains a practical skeleton that ensures no key question is forgotten, even as modern practitioners adapt it.

Related Articles

• TCM Inquiry Diagnosis
• Eight Principles Differentiation
• TCM Cold and Heat Patterns
• Tongue Diagnosis