The Ten Questions in TCM Diagnosis

Methods of Analysis in Traditional Chinese Medicine

Jan 11, 2010 Terrie Schultz
Asking questions is an integral part of diagnosis in traditional Chinese medicine. Learn what types of
questions to expect when visiting an acupuncturist or herbalist.



A visit to a traditional Chinese medicine (TCM) acupuncturist, herbalist or alternative medicine
practitioner usually begins by answering a long list of questions. Some of the questions may seem
irrelevant to patients who come in for treatment of a specific ailment. While patients may wonder why
the practitioner needs to know all of this information when it appears to have nothing to do with their
complaint, every piece of information is important in differential diagnosis.
Traditional Chinese Medicine is Holistic

Traditional Chinese medicine takes a holistic approach to healing. Rather than diagnosing and treating
named diseases as in Western medicine, TCM looks at the person as a whole to determine patterns of
disharmony. Information about all aspects of the patient's condition will allow the practitioner to
discover the underlying root of the problem and recommend an appropriate treatment strategy to
achieve optimal health. This may include acupuncture, Chinese herbal remedies, lifestyle changes, or a
combination of strategies.
The Ten Questions

The Ten Questions have been an integral part of TCM diagnosis for centuries. The first recorded list of
ten questions was compiled by Zhang Jie-bing in 1624 during the Ming dynasty. The exact phrasing and
number of questions has varied over the years, but the following are general questions that a patient
may expect to be asked on a visit to a TCM practitioner, and examples of what type of information he or
she is looking for.
Cold and Heat, Chills and Fever- whether the patient always feels cold, has cold hands and feet, cannot
tolerate cold, or whether he or she generally feels too warm. In an acute illness, the severity of chills and
fever, and whether the fever fluctuates with time of day.
Perspiration- night sweats or spontaneous perspiration without physical activity, a high fever with no
perspiration, or sweating of palms and soles of the feet.
Pains in Head and Body- the location of pain, such as lower back, knees, chest, front, sides or back of the
head; if there is an uncomfortable feeling of fullness in the chest or abdomen; the type of pain (sharp
and piercing or dull and aching); and whether the pain is relieved or worsened by application of cold,
heat or pressure. Dizziness would also fall under this category.
Urination and Bowel Movements- frequency of urination and bowel movements (times per day),
constipation, diarrhea, frequent copious clear urination, scanty dark urination, incontinence, or needing
to get up one or more times during the night to urinate.
Diet and Appetite- lack of appetite, constant insatiable hunger, bloating after eating, desire for hot or
cold foods, craving certain tastes such as sweet, sour, salty or spicy, habitual intake of sugar, caffeine or
alcohol. This category also includes experiencing a particular taste in the mouth such as metallic or
bitter.
Thirst- excessive thirst, lack of thirst, thirst with no desire to drink, or constant desire for cold drinks.
Mental or Emotional State- TCM recognizes that the emotional and physical are interrelated, and
emotional states such as grief, anger, worry or fear can affect the patient's physical well-being.
Conversely, physical disharmonies can bring about emotional responses.
Hearing- tinnitus (ringing or other sounds in the ears), sudden or gradual hearing loss
Sleep- excessive desire to sleep, difficulty falling asleep, or waking in the middle of the night and being
unable to fall back asleep. Nightmares or dream-disturbed sleep are also included in this category.
Gynecological Issues- women would be asked whether the menses are early or late, irregular, if the flow
is light or heavy, if the color is light or dark, and if they experience pain or cramps during menstruation.

In addition to asking these or similar questions, the TCM practitioner will want to know about the
patient's medical history and previous diseases or ailments, and will employ observation of the patient's
overall demeanor, speaking voice, energy level, coloration, eyes, and other physical characteristics, as
well as pulse and tongue diagnosis, in order to make an accurate diagnosis and choose the most
effective treatment.

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