Reservation

Problem that you want to heal most
Your past illness
Medications that you currently take

Please check the symptoms below which most describe you.

Head HeadacheFeel heavy in the headFeel head coveredDizzinessHot FlushScurfy HeadOrthostatic Hypotension (Dizziness from standing up too fast)

Eyes, Ears, Nose Tired eyesLow VisionRinging in the earsPlugged earsSneezingRunning noseStuffiness

Throat, MouthExcessive thirstDry mouthSore throatFeeling as if something is stuck in throatSwollen throatDifficulty in swallowingBitter inside the mouthCoughExcessive salivaPhlegmBruxismNausea

Neck, Shoulders, BackStiff NeckStiff ShouldersStiff on the backRound Shoulder

Chest Chest painTightness in chestHeart palpitationShortness of breath

Stomach HeartburnStomachacheDiscomfort in Solar PlexusBurpNauseaVomitting

Intestine StomachacheAbdominal bloatingFartsHeartburnRumbling noise in intestineColdness in intenstineDiarrheaChronic constipationBack and forth between diarrhea and constipationLoss of appetite

Hands, LegsPainLegs feeling heavyFlush on hands and feetColdness in hands and feetSwelling

Others PaleEasily fatiquedFeeling heavyWeak (tired)Easily catch a coldHave a weak stomachSweat a lotNight sweatSweat lessChilbliansAllergyGet car sick easilyTicklishItchingDry skinRashChapIrritationLow-spiritedLapse of memoryDecline of sexual desireSevere pain during periodIrregular period

Sleep Difficulty in falling asleepLight sleepBroken sleepDifficulty in waking upDream a lot

Defecation time(s) in day(s), HardNormalSoftPastyDiarrhea

Appetite GoodNormalPoor

Allery WheatRiceSesameBeansMilkDairy ProductOthers

Smoking SmokeDo not smoke
( If smoke, how many a day )