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Chinese Herb Questionaire

Herbs are like food. Body gets used to it and become "lazy" toward its effects. For example, a lactaid intolerance body type normally gets diarrhea if he/she eats too much ice cream, pizza, or daily products. However, they can build their tolerance up by taking these dairy products one bit at a time like drinking milk half cup every day for a week. The body can get used to it and won't get loose stools so easily as before. Same thing happens to herbs. No formula stays forever effective with the same composition after a while. Body starts to get used to it and the formula needs to get updated often.

Please answer the following questions for an updated herbal formula:

Main Concern : What is the main issue of your concern? When did it first start? Did any therapy you tried work for you? Why and why not?

Herbal Formula : Do you have any herbal powder left? Did the formula work for you this last time? If yes, How and in what ways it helped? If not, in what way not?

Head : Was your head cloudy/foggy? Or any difficulty in focus or remember? any head ache(HA)? Where was the HA? (frontal, top, side, or occiput?) how often? How is your sinus issues? Any congestions or runny sinus? any mucous (clear, yellow, or white)? fluid or phlegm? cough? sore throat? post nasal drip? (worse than before or about the same? Or mild, moderate, or severe?)

Respiratory : Is your chest tight? feeling any pressure? Is your issue more of a head issue or more of a chest issue? Any palpitation? Sweat (day or night, how bad? do you have to change clothes, and where in body like in hands, feet, upper torso, or head?)

Digestion : Do you have a good appetite? gassy, or bloaty? (mild, moderate, or severe?) acid reflux? (can taste the acids?) Heart burns? (nausea?) How often? (once or more? times a week/month)

Bowel Movement : Do you go every day? easy to go? shape? soft, hard, loose, or watery? complete when done?

Urination : How is It? Frequent urination? Urgency? Dribbling? How many times in the morning? how many times in the pm? evening? night urination (how many times)? incontinence? is it hard to go? when going, is it dribbling or stop & go?
[For males only: any enlargement in prostate gland? do you know your PSA number?]

GYN (for females only): Date of Last Menstrual Period (first day)? Regular or irregular? How many days of your cycle? how many days did the last period go? Color? (red, dark red, pink, light brown, or else?) clots? (dime, stringy, quarter- sized?) crampy? (before, during, or after period? How severe it gets? How long it last?

Emotions : Hyper (irriated, frustrated, anxious, mad, or angry) or Hypo (sad, melancholy, depressed)? If combo of hypo or hyper, how much % of your time did each occupy your time in last two weeks? For the emotion you mentioned, was it mild, moderate, or severe?

Body Temperature : neutral, warm (prefer to drink icy water? sweating? sweating at night? hot flashes?), or cold(1st person to put on sweaters in an air conditioned room, drinking warm or hot water)?

Muscle/Skeletal pain : where does it hurt? and how often? pain scale (1 to 10, 1 is no pain, 10 is you cannot even move or let get touched)? is it better after rest? or after you have moved a bit later?

Energy : how much on a scale of 1-10? (1 is no energy and 10 is you can run around dancing without any problem.)

Sleep - falling asleep ok? staying asleep ok? When you wake up are you refreshed?

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