"The Ten Questions" Clinical Questioning in TCM Acupuncture Theory

Many people new to acupuncture may ask, "Why does my acupuncturist ask so many questions?"

An initial visit to an acupuncturist usually involves filling out an extensive health history form and having an in-depth discussion with your practitioner. An acupuncturist will ask a number of questions about your health and lifestyle, many of which may seem unrelated to your main reason for seeking acupuncture. The questions, however, are linked together and your answers provide valuable input into the diagnostic process. Along with tongue and pulse diagnosis, asking what are known as the "10 questions" allows your practitioner to create a unique treatment plan for you as an individual. This taking into account a wide variety of signs and symptoms is the key to the success of acupuncture and your practitioners ability to treat conditions where other methods may have failed.

Traditionally the framework for asking diagnosis is the 10 questions:


Questions About Temperature
Hot, Cold and Fever, Chills

Questions about temperature are common ways of finding both the level of a particular disease as well as whether it is an internal or external problem. External Wind-Cold, for example, is essentially the common cold but before a fever or other heat signs such as yellow mucus have begun. This is an important distinction as the treatments for wind-cold and wind-heat are quite different.

  • Acute condition with chills predominating = External Wind-Cold
  • Acute condition with fever predominating = External Wind-Heat
  • Alternates between feeling hot and cold = Shao Yang Stage of Disease
  • Low grade fever in the afternoon or evening = Yin Deficiency
  • Fever that worsens in the afternoon = Yang Ming Stage of Disease
  • Chronic low grade fever = Damp Heat Condition
  • Patient feels hot w/o fever = Internal Heat
  • Patient feels cold w/o signs of external pathogens = Internal Cold

Questions About Sweating

Questions about sweating can provide valuable information regarding deficiencies that may exist in the body. Night sweats, for example, are an important indicator of Yin deficiency - a TCM diagnosis which may involve such conditions as insomnia and anxiety.

Questions About The Head and Face

Questions surrounding the head and face help to assimilate a broad range of information. There are many types of and treatments for headache, for example, and questioning the patient is an important component in coming to an appropriate TCM diagnosis.

  • Headache:
  • Chronic = Internal Disharmony
  • Severe = Excess Condition
  • Dull Pain = Deficient Condition
  • Distending a/or Throbbing Pain = LV
  • Boring Pain = Blood Stagnation
  • Worse with wind a/or cold = Cold Condition
  • Worse with fatigue = Qi Deficiency
  • Feels heavy "like a damp towel wrapped around" = Damp Condition
  • Frontal Headache = Yang Ming Meridians
  • Temporal Headache = Shao Yang Meridians
  • Vertex Headache = LV
  • Posterior a/or Occipital = Tai Yang Meridians
  • Worse during the day = Qi a/or Yang Deficiency
  • Worse during the evening = Blood a/or Yin Deficiency
  • Dizziness:
  • With Loss of Balance = Internal Wind
  • With heavy/muzzy feeling in the head = Phlegm Obstruction
  • Worse with fatigue = Qi Deficiency
  • Sudden onset = Excess Condition
  • Gradual onset = Deficient Condition
  • Eyes:
  • Eye pain, swelling a/or redness = LV Fire or Wind Heat
  • Blurred vision a/or "floaters" = LV Blood Deficiency
  • Dry eyes = Deficiency of KD Yin or LV
  • Yellow sclera = Jaundice
  • Abnormal eye movements = LV Wind
  • Ears:
  • Sudden onset tinnitus = Excess Condition, LV Heat/Wind
  • Chronic tinnitus = KD Deficiency
  • Sudden onset deafness = Excess Condition
  • Gradual onset deafness = KD Deficiency

Questions About Pain Related Issues

Finding the nature and causal factors involved in pain conditions is an important part of an effective treatment. While treatment of the local area is important, without an understanding of the conditions underlying the pain, the long-term effects may be limited.

  • Pain that is better with the application of heat = Cold Condition
  • Pain that is improved with pressure on the area = Deficient Condition
  • Pain that is aggravated with pressure on the area = Excess Condition
  • Pain that is aggravated with damp weather = Damp Condition
  • Pain associated with bloating, fullness a/or distention = Qi Stagnation
  • Pain that is sharp a/or stabbing = Blood Stagnation
  • Pain that moves from location to location = Qi Stagnation a/or Wind
  • Dull pain that is worse with fatigue = Qi Deficiency
  • Backpain:
  • Chronic dull pain = KD Deficiency
  • Acute = LV

Questions About Elimination
Urine & Stools

Questions about stools and urination are usually the ones considered most unrelated by patients. As an example, it is often difficult to understand how the quality of ones stools can be related to their knee pain. Asking questions about the elimination system provides important indications about the functioning of the Kidneys and the digestive system. Weak kidneys, for example, are often related to lower back and knee pain in Chinese medicine and a poorly functioning digestive system can lead to internal dampness which can also settle in the joints and cause pain.

  • Urine:
  • Incontinence = KD Deficiency
  • Retention of Urine = KD Deficiency or Damp Heat
  • Incomplete urination = Qi a/or Yang Deficiency, may also be Dampness
  • Pain with urination = Damp Heat or Heat in the UB
  • Pale colored urine = Cold Condition
  • Dark colored urine = Heat
  • Copious amounts of urine = KD Yang Deficiency
  • Scanty urination = KD Yin Deficiency or Damp Heat
  • Stools:
  • Constipation with heat signs (yellow tongue coat, etc.) = Heat in the ST or Intestines
  • Constipation in elderly patients = Blood Deficiency
  • Small stools = LV Qi Stagnation or Heat in the ST or Intestines
  • Infrequent but not dry bowel movements = LV Qi Stagnation
  • Alternating Diarrhea and Constipation = LV invading the SP
  • Chronic diarrhea = Chronic Qi a/or Yang Deficiency usually of the SP or KD or Acute Damp or Cold
  • Urgent diarrhea with heat signs = Damp Heat or Heat
  • Diarrhea after eating a meal = SP Qi Deficiency
  • Early morning diarrhea (cock's crow) = KD Yang Deficiency
  • Discomfort improves after a bowel movement = Excess Condition

Questions About Digestion
Thirst, Appetite & Tastes

Questions about appetite and tastes are helpful in understanding the quality of the digestive system as well as whether a person has an underlying cold/deficiency syndrome or a heat/excess one. The relationship of tastes to certain conditions are drawn from the five element theory.

  • Thirst:
  • Lack of thirst a/or desire for warm liquids = Cold Condition
  • Strong thirst esp. for cold liquids = Heat Condition
  • Dry mouth w/desire to sip liquids = Yin Deficiency
  • Thirst w/o desire to drink = Dampness
  • Appetite:
  • Lack of appetite = SP Qi Deficiency
  • Insatiable appetite = ST Heat
  • Fullness, bloating a/or distention after eating = Food Stagnation
  • Preference for warm/hot foods = Cold Condition
  • Preference for cold/cool foods = Heat Condition
  • Tastes (Based on 5 Elements):
  • Bitter taste = Full Heat in LV/GB
  • Sweet taste = SP Qi Deficiency a/or Dampness
  • Sour taste = Retention of Food a/or LV invading ST
  • Salty taste = KD Yin Deficiency
  • Pungent taste = Heat in the LU
  • Metallic taste = Intestinal Issues
  • Lack of taste = SP Deficiency

Questions About Sleep
Quality and Habits

Sleep is an important part of a persons overall health. The inability to get a good nights rest usually involves TCM diagnoses which would indicate other issues as well. Heart Blood Deficiency, for example, may involve other symptoms which effect the person during the day such as poor concentration and anxiety.

  • Difficulty falling asleep but sleeps well = HT Blood Deficiency
  • Wakes often = HT a/or KD Yin Deficiency
  • Nightmares a/or violent dreams = LV a/or HT Fire
  • Restless sleeping after eating late = Retention of Food

Questions About the Thorax and Abdomen Area

Pain may arise in the thorax and abdominal areas in physical conditions involving the heart, lungs, digestive system and liver. From a TCM perspective, however, pain may also arise in these areas due to psycho-emotional issues. A western medical diagnosis is usually helpful in these conditions, however, pain in these areas does not always involve an underlying physical problem. Pain in the hypochondriac region, for example, may be related to a physical liver problem or - from a TCM perspective - is indicative of some LV Qi Stagnation issues. LV Qi Stagnation may present with hypochondriac pain and symptoms of depression but does not indicate any physical problems with the Liver.

  • Pain in the chest area = HT Blood Stagnation
  • Pain in the chest w/cough = LU
  • Costal Pain = LV/GB
  • Hypchondriac Pain = LV Qi Stagnation
  • Epigastric Pain = Retention of Food or ST Heat
  • Lower abdominal Pain = Blood Stagnation, LV Qi Stagnation, Interior Cold or Damp Heat in the Intestines

Questions Regarding Gynecological Issues

The status of a women's menstrual cycle is an important indicator of her overall health. Whether you are diagnosing a gynecological condition such as irregular menstruation or a non-gynecological related condition, the information from the questions below is extremely valuable in forming an appropriate diagnosis.

  • Early Periods = SP Deficiency or Heat in the Blood
  • Late Periods = Blood Stagnation or Deficiency or Cold Condition
  • Irregular Periods = LV Qi Stagnation
  • Heavy Periods = Heat in the Blood or Qi Deficiency
  • Scanty Periods = Blood Stagnation or Deficiency or Cold Condition
  • Bright or Dark Red Blood = Heat in the Blood
  • Pale Blood = Blood Stagnation or Cold Condition
  • Blood Clots = Blood Stagnation or Cold Condition
  • Leukorrhea:
  • White = Cold Condition
  • Yellow = Heat Condition
  • Green or Red/White = Damp Heat

Medical History Questions
Lifestyle and Habits

A complete view of a persons medical history, diet, lifestyle and habits is an important part of the overall diagnostic procedure. There are many questions that can be asked and the value of their answers depends on the conditions you are trying to treat. Most practitioners have a lengthy section of their intake form which covers this information in detail.

  • Medical History:
  • All major illnesses and procedures one has had
  • Family/Genetic illnesses
  • Prescription and Recreation Drug Use may cause issues with the LV a/or Kidney meridians and others may require changes in treatments (i.e. blood thinners, may bruise easily, insulin, be careful not to drop blood sugar too low, etc.)
  • Emotional states should be considered via the 5 Elements

Sources and More Information

The information on our site is drawn from our own lecture notes and clinical experience.

For a complete list of valuable resources, see our (TCM) Chinese Acupuncture Resources section. The most recommended texts are below: