Internal Medcine Consultation – Chinese Medicine Ten Questions

There are ten questions to ask you to help us to do diagnosis without western test. They are:

Do you feel hungry at:__Breakfast?___Lunch?__Dinner?  Can you taste food? _                  Do you consume small, moderate, or large amounts of food at mealtimes?___________
Do you crave for any kind taste foods?  ___________________________________
Do use sea salt in your cooking?_____Do not use refined sugars?____Eat like a king for   breakfast,  a prince for lunch, and a pauper for dinner.
Additional comment concerning your appetite:__________________________

Are you able to sleep through the entire night without waking up?____________              If not what time do you wake up?________ What did you do?_______________
Do you feel recharged after wake up?_________________________________
Additional comment concerning your sleep pattern:__________________________

Do you urinate approximately 5 to 7 times per day?________
What is the color of your urine?___ Is your urine clear or cloudy?____________
Do you take vitamins?__________________________________________
Do you have a small, moderate, or large amount of urine?__                                                       Is there adequate force when urinating?_____                                                                               Additional comments or concerns about your urine:

Do you have a bowel movement at least once a day in the morning?                                            Is the texture of your stools firm and long?_____What is the color of your stools?_____
Do you have the feeling of having adequately emptied your bowels?____                                Additional comments or concerns about your bowel:_________________________

AM Yang:
(MALES) Do you have an erection upon waking first thing in the morning?                             (FEMALES) Are your nipples erect upon waking first thing in the morning? __________

Four Limbs:
Does your forehead feel cool and comfortable compared to the temperature of your hands?
Does the back of your hands and tops of your feet feel cooler than the palms and soles?
Do you have to keep your feet covered at night?

Do you have any type of abnormal thirst?_______ Can you feel thirst? ___________
Note that it is normal to have some thirst after sweating from exertion. The amount of thirst that you have should be in proportion to your activity level and the environment.
Do you prefer warm, room temp, cool, or cold water?__                                                               Drinking hot teas is good for your body. The fluids in fruits do more to rehydrate your body than drinking anything else.

Do you have any type of abnormal sweating?___If yes, what is it?______Night Sweat?_
Can you sweat?___________Is there any abnormal color for your sweats? _________

Your energy level? ___________ What time your energy dropped?_______________

Female Only:
When was your first menstruation? __________Last menstruation?______________
How many days is your menstruation period?________ How many days bleeding?____
The color and amount of your menstruation?_______________________________
Is there any clots and/or discomfort before or during your menstruation?____________

Other Comments: List any other symptoms, concerns, and questions here.

The above questions are majority from and credited to Dr. Ni, Hai-Sha (A great Traditional Chinese Medicine physician in modern Chinese Medicine. He corrected many mistakes in modern Chinese Medicine practices).


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