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Zhang Jingyue’s “Ten Questions Song”
Ancient physicians placed great importance on the patient’s main complaints. The most famous is Zhang Jingyue from the Ming Dynasty, who wrote the “Ten Questions” in the “Complete Works of Jingyue”:
“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, seventh ask about deafness, eighth ask about thirst, all must be distinguished; ninth observe pulse and color to discern yin and yang, tenth from the breath and taste to see the spirit. Although these matters are not difficult, one must be wise and avoid causing resentment.”
This is referred to as the “Ten Questions Song”. The first eight questions pertain to inquiry, while the ninth and tenth involve pulse diagnosis, observation, and listening diagnosis.
Modern interpretations of the “Ten Questions Song” have expanded it, changing the eighth question to “Ninth ask about past illnesses, tenth ask about causes, and additionally inquire about medication changes; for women, it is essential to ask about menstrual cycles, whether delayed, rapid, or irregular, and also brief notes for pediatrics, as variances in measles and smallpox are also significant.” This has made it much more comprehensive.
However, the first eight questions by Jingyue are quite cumbersome and impractical. In fact, it is rare for a doctor to ask a patient endlessly from cold and heat to thirst. This method is necessary for external heat illnesses, but for general miscellaneous diseases, it is unnecessary and may even cause patients to feel resentful, leading them to mock the doctor as someone who only “asks about illness and prescribes medicine.”
What should be asked in a consultation?
I believe that inquiries should focus on common aspects of daily life that people can genuinely feel. These are the essential elements of life: “eating, drinking, defecating, urinating, and sleeping.”
Eating refers to food intake; drinking refers to water consumption; defecating refers to bowel movements; urinating refers to urination; sleeping refers to sleep. Although the terms may seem crude, they reflect the overall living conditions of ordinary people and patients, and since they are common language, they are easier for the public to understand.
On the surface, these inquiries are simple and clear, but their implications are rich and profound. Starting from these questions can help discern the majority of syndromes, including their internal and external conditions, cold and heat, deficiency and excess. To avoid overshadowing the main topic, this book will only briefly discuss these points, with more detailed content to be elaborated in other texts.
First Question: “Eating”
Can you eat when hungry? Are there any discomforts after eating? When feeling empty during hunger, if one urgently wants to eat, it often indicates a deficiency syndrome. If there is a sensation of heaviness in the stomach, it often indicates a sinking of the middle qi; if accompanied by palpitations and shortness of breath, it often indicates deficiency of heart and spleen blood.
If one feels empty when hungry and desires to eat but experiences fullness and bloating after eating, it indicates a deficiency of the spleen with qi stagnation, a mixed syndrome of deficiency and excess.
If one feels empty when hungry, eats little and feels comfortable, but feels bloated or even painful after eating, especially if there is tenderness above the navel, it does not indicate a deficiency syndrome but is caused by blood stasis.
Those with liver qi stagnation may know hunger and can eat, but feel bloated and uncomfortable after eating; those with liver qi depression may not feel hungry and have no desire to eat, as in the saying “it is hard to swallow food when it reaches the mouth.”
If food feels stuck in the middle jiao and difficult to descend after eating, it indicates dampness and qi obstruction of the spleen. There are also those who, despite feeling hungry, do not want to eat; if they feel restless and have a dry mouth and tongue, it indicates insufficient stomach yin; if they feel weak in the lower back and legs, it indicates kidney yin deficiency.
Those who feel comfortable when warmed are indicative of a cold syndrome; those who feel comfortable when cooled are indicative of a heat syndrome; if one desires to eat cold food but feels uncomfortable after eating, it indicates a mixed syndrome of cold and heat.
Generally, exterior syndromes do not affect eating, but if one feels a sensation of qi rising in the area below the sternum, it may be accompanied by vomiting, which hinders eating, and should be carefully distinguished.
If one feels weak all over when hungry and the condition worsens, it often indicates a deficiency syndrome. If one knows they are hungry but can endure for several hours and function normally, it often indicates an excess syndrome.
Second Question: “Drinking”
Are you thirsty? When are you most thirsty, and do you feel discomfort after drinking? Distinguishing between a preference for cold or hot drinks can help differentiate between heat and cold syndromes, which is well known and will not be elaborated here.
It is worth noting that if one feels dry mouth and desires to drink at night or in the morning, it often indicates yin deficiency.
If drinking does not quench thirst and one urinates immediately after drinking, it often indicates dysfunction of the triple burner qi transformation, with different implications for bladder qi dysfunction and kidney yang deficiency.
If there is a gurgling sound in the stomach after drinking, and especially if there are palpitations under the heart, it indicates water retention in the middle jiao. If one feels dry in the throat and desires to drink but only sips and then stops, and later drinks again, it often indicates yin deficiency; if one only wants to rinse their mouth without swallowing, it indicates blood stasis.
Third Question: “Defecating”
When do you have bowel movements, what is the nature of the stool, and are there any discomforts before, during, or after defecation? General differentiation of diarrhea, dysentery, constipation, etc., is covered in internal medicine texts and will not be discussed here.
It should be noted that having a bowel movement only once every few days, but with normal stool consistency and no discomfort, should not be considered constipation.
To differentiate between cold and heat, deficiency and excess, if the stool is clear and watery with no heat in the anus, it indicates cold; if the stool is yellow and sticky with a burning sensation in the anus, it indicates heat.
If one feels comfortable in the abdomen and all over after defecation, regardless of the stool’s nature, it indicates an excess syndrome; if one feels more fatigued and weak all over after defecation, even experiencing palpitations, it indicates a deficiency syndrome.
Moreover, if liver qi stagnation occurs without spleen deficiency, one may experience loose stools with abdominal pain before defecation, and the pain may lessen but not disappear after defecation, with a sensation of incomplete bowel movement; if the spleen is already deficient, one may also have loose stools with abdominal pain before defecation, but the pain may disappear after defecation, and the bowel movement may feel smooth and complete.
This is because the former has the strength to resist, while the latter lacks the strength to do so.
Fourth Question: “Urinating”
What is the frequency, volume, and nature of urination, and are there any discomforts before or after urination? Normal urination is characterized by a normal volume, light yellow color, and no discomfort before or after urination.
If the volume decreases and the urine turns dark yellow, in the case of an external illness, it indicates a transition from exterior to interior; in miscellaneous diseases, it indicates pre-existing internal heat. Such patients may also experience a burning sensation in the urethra during urination.
Difficulty urinating or incomplete urination is often seen in those with liver qi stagnation.
Frequent urination at night with a large volume often indicates kidney deficiency.
If one urinates immediately after drinking and feels thirsty after urination, it often indicates dysfunction of the triple burner qi transformation. This condition often occurs during the day and should not be considered solely as “diabetes insipidus”; once the yang is activated to transform water, the condition can resolve itself.
There are also those who frequently urinate due to tension, as seen in the previously mentioned Ganmai Dazao Decoction syndrome.
Fifth Question: “Sleeping”
Is it easy to fall asleep? Do you wake up easily after sleeping? Is it easy to fall back asleep after waking? Do you wake up early? Do you have many dreams while sleeping? Are they chaotic or frightening dreams?
Insomnia patients are very common in daily outpatient clinics, so inquiring about sleep conditions is very necessary. After treatment, if insomnia is alleviated, other symptoms often improve as well.
In miscellaneous diseases, those who eat and sleep normally tend to respond well to treatment, while the opposite is often more challenging.
“Yang enters yin to sleep”; those who find it difficult to fall asleep often do so due to obstruction or disturbance from pathogens, whether it be clearing heat, transforming phlegm, digesting food, relieving depression, or dispelling stasis, appropriate treatment can yield results.
If one wakes easily after falling asleep, intermittently sleeps, and finds it difficult to fall back asleep, it may indicate both excess and deficiency; the excess is as mentioned above, while the deficiency may be due to yin deficiency with excess fire, heart and spleen blood deficiency, or liver blood insufficiency, leading to sleeplessness throughout the night, with yin deficiency and excess fire being the most common.
Waking up early is often seen in cases of heart and spleen blood deficiency or liver blood insufficiency.
Unrestful sleep, with intermittent waking, accompanied by dizziness and leg weakness, often indicates liver yang rising, disturbing the liver spirit; if accompanied by sadness and poor appetite, it indicates liver qi stagnation and lack of nourishment to the liver spirit.
Frequent chaotic dreams often indicate phlegm obstruction, and if accompanied by irritability, it indicates phlegm heat.
Waking from nightmares often indicates deficiency of heart and gallbladder qi.
In general, if normal sleep can significantly alleviate symptoms, it often indicates a deficiency syndrome; if symptoms do not improve despite normal sleep, or if one feels more heavy and lethargic upon waking, it may be due to damp obstruction, qi stagnation, or blood stasis, all indicating an excess syndrome.
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