Introduction
Learning the TCM diagnostic method through the “Ten Questions Song” can help the public understand some TCM diagnostic knowledge and provide guidance for seeking medical treatment.
“To know by observation is called divine, to know by hearing is called sage, to know by inquiry is called skilled, to know by palpation is called clever.” TCM emphasizes the integration of the four examinations (望闻问切) and pattern differentiation for treatment. The four examinations include observation, listening, inquiry, and palpation.When discussing TCM’s four examinations, one must mention the “Ten Questions Song”:“First ask about cold and heat, second ask about sweating, third ask about head and body, fourth ask about bowel movements, fifth ask about diet, sixth ask about the chest and abdomen, seventh ask about deafness, eighth ask about thirst, ninth ask about past illnesses, and tenth ask about causes. Women must especially inquire about menstrual periods, whether they are delayed, rapid, or have abnormal bleeding. Additionally, brief inquiries for pediatrics include smallpox and measles, which should be fully examined.”This song summarizes the essentials of TCM inquiry, reminding doctors to conduct comprehensive analysis and diagnosis through the integration of the four examinations, ultimately determining the patient’s condition. Learning the “Ten Questions Song” can help the public understand some TCM diagnostic knowledge and provide guidance for seeking medical treatment.First ask about cold and heat, second ask about sweatingAsking about cold and heat is an important basis for distinguishing the nature of the patient’s illness and the balance of yin and yang in the body.“Asking about cold and heat” refers to inquiring whether the patient feels cold or hot. “Cold” can be divided into: feeling cold when encountering wind, known as aversion to wind; feeling cold and needing more clothing or warmth from fire without relief, known as aversion to cold; if adding clothing or warmth provides relief, it is called fear of cold. “Heat” includes elevated body temperature or normal temperature with a subjective feeling of heat in the whole body or locally.TCM also classifies conditions based on the relationship between cold and heat to finely differentiate diseases. Patients can refer to the following manifestations to see which symptoms they belong to: aversion to cold and fever indicates both symptoms appear simultaneously; feeling cold without fever is termed cold without heat; feeling hot without aversion to cold is termed heat without cold; alternating cold and heat indicates the symptoms alternate.Asking about sweating: Sweat can reflect changes in the body’s yin and yang as well as the exterior and interior. “Asking about sweating” mainly examines whether the patient sweats, the location, timing, and amount.Exterior syndrome and sweating: No sweating in exterior syndrome is often due to external wind-cold; sweating in exterior syndrome indicates either exterior deficiency or exterior heat syndrome.Interior syndrome and sweating: Continuous sweating that worsens with movement indicates spontaneous sweating, often due to yang deficiency; sweating during sleep that stops upon waking indicates night sweats, commonly associated with yin deficiency and internal heat; profuse sweating with high body temperature often indicates intense internal heat; initial aversion to cold followed by profuse sweating indicates battle sweat, commonly seen in acute febrile diseases; sweating with body heat, restlessness, and rapid pulse indicates a critical condition of excess evil and deficiency of righteousness.Local sweating: Sweating on the head may be due to yang heat or damp-heat; sweating on the forehead with a weak pulse indicates a critical sign of dispersed original yang; sweating on one side of the body often indicates the affected side, possibly due to phlegm-damp or wind-damp obstruction, or disharmony of nutritive and defensive qi, or stroke; excessive sweating on the palms and soles is often due to piwei shire (spleen and stomach damp-heat) or heat in the yin channels.Third ask about head and body, fourth ask about bowel movementsAsking about the head and body: Headaches can be classified as deficiency or excess. Headaches that are distending, stabbing, or fixed are mostly excess; headaches that are hollow or dull are mostly deficiency. Dizziness can also be classified as deficiency or excess, with excess often caused by liver fire, phlegm-damp, or blood stasis, while deficiency is often due to qi and blood deficiency or shenxu jingkui (kidney deficiency). When experiencing headaches or dizziness, there are often accompanying symptoms that can help differentiate between cold, heat, deficiency, and excess. Abnormalities in the body and limbs reflect the cold, heat, deficiency, and excess of diseases. If one feels heavy and fatigued, accompanied by a greasy tongue coating, it is often due to excessive dampness; if feeling heavy and fatigued, it is often due to the limbs and channels lacking nourishment.Asking about bowel movements: “The two excretions are the gateways of the body.” The excretion of stool is closely related to the spleen and stomach’s reception and transformation, kidney yang’s warming, liver’s regulation, and the descending of spleen qi. The excretion of urine is related to the kidney’s qi transformation, spleen’s transportation, lung’s descending, and the regulation of the san jiao (triple burner). Therefore, “the two excretions are the gateways of the body; whether due to internal injury or external invasion, this must be observed to differentiate cold, heat, deficiency, and excess.”Clinically, when inquiring about the two excretions, the main focus is on the frequency, volume, characteristics, color, odor, timing, sensations during excretion, and any accompanying symptoms. Changes in these aspects can indicate the evolution of the patient’s cold, heat, deficiency, and excess. If abnormalities are found, they must be taken seriously. For example, if urine is yellow and scant, it often indicates a heat syndrome; if urine is clear and abundant, it often indicates a cold syndrome. Constipation can be classified by cold, heat, deficiency, and excess: excess heat often presents with abdominal distension, pain upon palpation, and a yellow, dry tongue coating; excess cold often presents with abdominal pain upon palpation, a white tongue coating, and cold body, indicating cold evil obstructing yang qi and preventing bowel movement. Diarrhea also has distinctions of cold, heat, deficiency, and excess: damp-heat diarrhea can present as explosive diarrhea with foul-smelling stools, abdominal pain, and borborygmi, with urgency and a burning sensation in the anus; cold-damp diarrhea can present as watery stools, light yellow color, and a fishy odor; food stagnation diarrhea can present as alternating vomiting and diarrhea with sour-smelling vomit and foul stools; spleen deficiency diarrhea can present as undigested food, thin stools, and prolonged duration; abdominal pain and diarrhea before dawn, with relief after defecation, often indicates kidney yang deficiency diarrhea, also known as “five dawn diarrhea”; a feeling of heaviness in the anus, and in severe cases, prolapse, often indicates sinking of middle qi.Fifth ask about diet, sixth ask about the chest and abdomenAsking about diet: The spleen and stomach are among the most important organs in the human body, serving as the source of qi and blood. All nutrients necessary for growth, development, and sustaining life depend on the spleen and stomach. Once the function of the spleen and stomach is abnormal, the health, metabolism, and circulation of qi and blood will be severely affected.Those who eat little or have poor digestion may have spleen and stomach qi deficiency, internal injury from food stagnation, or dampness obstructing the spleen; those who often have aversion to food, abdominal distension, belching, or acid reflux may have digestive issues; those who prefer hot food or feel full and bloated after meals may have spleen and stomach deficiency-cold; those who dislike greasy food, experience rib distension and nausea, may have liver-gallbladder damp-heat or rebellious stomach qi; those who feel hungry after eating may have excessive stomach fire, often accompanied by polydipsia and polyuria, indicating diabetes; those who do not want to eat when hungry are often due to insufficient stomach yin; those who vomit immediately after eating, especially forcefully, often have excess fire in the stomach; those who vomit in the morning and evening often have spleen and stomach deficiency-cold; those who have difficulty swallowing or feel a blockage in the chest often have esophageal obstruction syndrome.Asking about the chest and abdomen: The chest (膻中) connects to the heart and lungs above and communicates with the internal organs below. Many diseases are related to the chest and abdomen, and “asking about the chest and abdomen” mainly differentiates organ diseases, including chest tightness, palpitations, rib distension, and abdominal distension.Chest tightness is often related to the obstruction of qi in the heart and lungs or is associated with cold, heat, deficiency, or excess; palpitations are often due to changes in the heart or spirit; rib distension is often due to changes in the liver, gallbladder, and their meridians; abdominal distension is often due to qi obstruction.Seventh ask about deafness, eighth ask about thirstAsking about hearing: TCM often asks patients, “Do you usually experience tinnitus or hearing loss?”TCM classics state: “The ear, though a lesser yang channel, is actually an organ of the kidneys and is where the ancestral vessels converge. Inquiring about it can not only differentiate deficiency and excess but also understand life and death.” If a patient has slight hearing loss or dull hearing, it is termed heavy hearing; if hearing loss is significant or complete, it is termed deafness; if the patient perceives sounds in the ear, it is termed tinnitus. Tinnitus and deafness can be caused by kidney deficiency, liver fire, or damp-heat in the liver channel. Kidney deficiency is often accompanied by soreness in the lower back and knees, and frequent clear urination at night.Asking about thirst: When patients visit, TCM often asks, “How is your water intake? Do you often feel dry and thirsty?”Thirst is mainly due to insufficient body fluids or obstruction in the distribution of body fluids. TCM believes, “Asking about thirst and not thirst can help observe the cold and heat of the interior, and the differentiation of deficiency and excess can also be seen from this.” During TCM inquiry, attention is paid to whether the patient feels thirsty, how much they drink, their preference for hot or cold drinks, and any other symptoms.Thirst can be seen in cases of damaged body fluids or internal stagnation of dampness; extreme thirst with a preference for cold drinks indicates excessive heat damaging body fluids; thirst without much drinking, or vomiting after drinking, can indicate internal stagnation of phlegm-damp or internal damp-heat; thirst with a preference for rinsing the mouth but not swallowing, and accompanied by polydipsia and polyuria, often indicates diabetes.Ninth ask about past illnesses, tenth ask about causesAsking about past illnesses: “Have you had similar situations before? Is there a family history? Are there any known allergies to medications?” Inquiring about past illnesses is an important way to obtain information about the patient’s disease, which can reveal the causes, course of the disease, and family history.Doctors ask about past illnesses to see if the current symptoms are related to previous diseases or family history. If the patient is usually strong, the illness is often an excess syndrome; if the patient is weak, the illness is often a deficiency syndrome; if the patient is usually yang deficient and fears cold, the illness is often a cold syndrome; if the patient is yin deficient, the illness is often a heat syndrome.Asking about causes: “Asking about causes” means that the doctor finds possible reasons for the disease through inquiry, in order to apply pattern differentiation and scientific medication.In general, if the cause of the disease is cold, it is often a cold syndrome, and treatment often uses warming herbs; if the cause is heat, it is often a heat syndrome, and treatment often uses cooling herbs. Additionally, during medication, if the patient experiences adverse reactions, they should communicate with the doctor promptly to adjust the medication.In addition to the routine inquiry content, women should also inquire about menstruation, discharge, pregnancy, and childbirth, as well as understand the situation of children before and after birth, vaccination status, and any history of infectious diseases such as measles or chickenpox.
TCM inquiry content is very rich; this article only lists a common aspect of daily life. If more complex situations arise, it is still recommended to seek treatment at a regular hospital.
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