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Self-Assessment Health Profile
This profile can be used as an educational device as well as a diagnostic tool. It will aid you in becoming acquainted with the language of Chinese medicine. Check the symptoms you have experienced during the last six months. Check those that have been most troublesome.
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Patterns of Depletion
Deficient Qi
weak, lethargic, weary
apathy
dull thinking or feeling
excessive need for sleep
susceptible to colds, flus, allergies
prolonged recovery following illness
pasty, pale complexion
shortness of breath
aversion to talking
perspires easily with exertion
easily chills
Slack Qi
perspires easily while at rest
atony or prolapse of stomach, intestines, anus
constant diarrhea or lack of bowel control
hemorrhoids, varicose veins
dizzy or weak after meal or bowel movement
well-being followed by sudden exhaustion
Deficient Moisture
parched, thirsty
extreme dryness of skin or mucous membranes
scant secretions and urination
uncomfortable feeling of heat in the body
low afternoon fever with sweating
constipation
hot flashes
night sweats
unstable blood sugar, emotional lability
persistent dry cough
Slack Moisture
excess secretions: eyes, nose, mouth, skin, vagina
seminal incontinence, premature ejaculation
frequent urination or incontinence
dizzy or weak after sex
Deficient Blood
restless fatigue
emotional sensitivity
insomnia and anxious sleep
dryness without thirst
blurred or weak vision
thinning of hair
dry or hard stool
dry skin, eyes, hair, nails
anemia
muscle cramps
lack of semen
scanty or infrequent menstruation
insufficent lactation
pale, sallow complexion
poor skin healing
palpitations
night sweats
Slack Blood
easy bruising or bleeding
chronic ulcers: mouth, throat, stomach, intestines, vagina
excessive bleeding during menses, pregnancy, postpartum or menopause
bleeding hemorrhoids and blood in stool, urine, or sputum
Diminished Essence
profound weakness
atrophy of muscles and organs
sagging or wrinkling of skin
diminished sexual arousal and pleasure
infertility or early menopause
repeated miscarriages
loosening or loss of teeth
early thinning or graying of head and pubic hair
decline of memory, vision or hearing
progressive loss of weight or emaciation
compromised immunity
Disturbed Shen
restlessness and agitation
hypersensitivity to pain or insult
sudden rage, grief or panic
constant anxiety, ,worry or confusion
easily startled or frightened
erratic sleep, insomnia or disturbing dreams
dull, glazed or bizarre look to eyes and face
delerium
Patterns of Congestion
Stagnant Qi
stuffy head
mild nausea or reflux
distension or fullness in chest or abdomen
gas pains, cramps, tension in stomach or intestines
hiccups, belching or flatulence
constipation or irregular bowel movements
dull or intermittent pains
Obstructed Qi
acute discomfort, fullness, pressure in head, chest, limbs or abdomen
abdominal bloating but unable to release gas
wheezing and chest pain
difficulty swallowing, as if something stuck
stitch or acute pain in abdomen, ribs, or flanks
fullness or dull pain under ribs or sternum
Stagnant Moisture
soft or loose stool
puffy eyes, face, hands or ankles
frequent, scanty or difficult urination
lethargic in humid weather
soft swellings, nodules, cysts, enlarged lymph nodes
premenstrual edema and swelling of breasts
tender muscles or joints
dry but thirsty
Stagnant Blood
easy bruising
cold hands and feet
irregular or painful menses
mottling, numbing and chilling of limbs
sharp pains: head, eyes, joints, limbs, breasts, organs
mid-cycle or premenstrual pain or tender breasts
painful hemorrhoids, cysts or lumps
Obstructed Blood
angina
severe or constant headache
traumatic bruises, swellings and sprains
stabbing or throbbing aches or pains
pain aggravated at night or from inactivity
severe cramping, numbness or paralysis
dark red or purple complexion
purple lesions on the skin, tongue, mouth or lips
severe menstrual cramps with dark blood or clots
hard or immobile lumps, masses or organs
Adverse Conditions
Heat
fever
pain, soreness, swelling or dryness with a sensation of heat or burning
sores or infections with green or yellow pus
yellow, green, or foul smelling discharge from ears, nose, throat, anus, vagina or urethra
extreme thirst with a craving for cold foods or drink
red eyes, ears, nose, lips, face, skin
feeling of heat: limbs, abdomen, chest, head, gentials
aggravation from alcohol, fried, or spicy foods, and heat environment
Cold
lack of thirst
listless and weak
cold feeling in limbs, head, chest, abdomen or genitals
pale face with cold, clammy hands and feet
loose stool after eating raw or cold foods and liquids
profuse urination or edema in cold climate or after ingesting cold liquids, eating raw or cold foods
craving for warm, cooked foods and hot drinks
pain in head, chest, limbs, joints aggravated by cold
pale, purplish skin, nail beds, lips, or tongue
Damp Heat
dryness or thirst without desire or ability to drink
feeling of heat in stomach or chest with a nauseating taste in the mouth
sticky yellow or green discharge from nose, throat, bronchi, urethra, or vagina
hot flashes with profuse perspiration
fever or heat not relieved by perspiring or drinking
loose or sticky stool streaked with mucus or pus
burning, red, oozing sores, boils, pimples, blisters or rashes
worse from heat and/or humidity, and sweet, spicy or oily foods
pale, purplish skin, nail beds, lips, or tongue
External Wind
itching or prickling sensations of skin, ears, eyes, nose; sneezing, headache
unpredictable or migrating pains
dizziness or headache with cold, flu, or allergy
muscle soreness or shivering in winds or drafts
numbness or pain of face or scalp
neck stiffness or spasm
worse from drafts, changing temperatures, pressure
Internal Wind
trembling hands, feet, head
disequilibrium, incoordination
contracture or quivering of tongue
spasms, twitches, cramps of nerves, muscles, viscera
vertigo, motion sickness, hypertension
headache with vertigo, numbness, spasms, parasthesia (strange sensations)
seizures, sequellae of stroke or T.I.A.
worse from wind, changing barometric pressure, or changing from lying to upright posture
Phlegm
dizziness or fullness in head from mucus congestion
nausea with phlegm in chest or throat
thick, sticky secretions from ears, eyes, nose, throat, mouth, anus, vagina or urethra
firm, mobile lumps, cysts, enlarged lymph nodes
worse in humid environment or from eating sticky, greasy, oily foods, milk products, eggs, sugar
sticky or greasy stool
Organ Network Disturbances
Liver Network
dry eyes
blurred or unclear vision
easy chilling arms, hands, legs, feet
coarse, brittle nails or hair
touchiness from heat, wind, noise, bright light
numbness, tingling of limbs when asleep or inactive
muscle cramps of pelvis, sides, hips, calves, feet
tension in shoulders, neck, sacrum, hips, legs
stitching under diaphragm, between ribs, groin, pelvis
high pitched or loud ringing in the ears (tinnitus)
dizzy, queasy, flushed, headache from hunger, anger
hypersensitive genital organs
nervous, irritable, short tempered
Heart Network
anxiety, dread
restless and excitable
mood swings (laughs easily, cries easily)
insomnia when nervous, worried or excited
restless sleep and vivid dreams or nightmares
cravings for cool drinks, juicy or hot, spicy foods
sores of mouth and tongue
easily overheats and perspires
easy blushing of face, chest, neck, and ears
burning, sensitivity or irritation of mouth, tongue, urethra, vagina or anus
frequent urination or bowel movements from nervousness
palpitations when nervous, upset or fatigued
easily confused or disoriented
Spleen Network
tender muscles
slow digestion or indigestion
variable appetite
frequent abdominal gas or bloating
loose stool from raw or cold foods and liquids
lingering hunger after meals
hard to gain, lose or regulate weight
difficulty focusing, distractable
overwhelmed by details, upset by changes
lethargy and inertia
prolapse of stomach, intestines, uterus, vagina, bladder
lack of muscle tone or strength
water retention, puffiness, heaviness of head, limbs
easy bruising, prolonged or heavy menstruation
easily worried, obsessed
Lung Network
weakness of chest
respiratory allergies
runny nose or stuffy sinuses
frequent, lingering colds, coughs, throat clearing, laryngitis
morning attacks of coughing or sneezing
constant phlegm in chest or throat
shortness of breath, chest pain, wheezing from fatigue or exertion
dryness and tightness of mucous membranes or skin
urge to urinate after laughing, coughing, or sneezing
skin rashes, eczema, hives
sensitive to wind, cold and dryness
stiffness of joints and muscles
easily disappointed or offended
Kidney Network
puffiness around eyes
diminished libido
lack of sexual secretions
loss or thinning of pubic hair
early cessation of menses, irregular cycle
disorder of urination
rigidity of spine and joints
difficulty conceiving or carrying to term
weak or sore low back, hips, knees, ankles or feet
lack of stamina and endurance
diminished motivation and apathy
forgetfulness and mental dullness
puffiness or swelling of feet and ankles
weak vision, dull hearing
low humming or buzzing in ears (tinnitus)
sore throat from fatigue or in the morning
easily defeated and disgruntled
Conflicts Between Organ Networks
Liver - Spleen Disharmony
cold hands and feet with feeling of fullness in throat, chest, or abdomen
indigestion with nausea, bloating, flatulence, belching
erratic elimination, constipation or diarrhea
spasm, pain of esophagus, stomach, intestines, uterus
thirst for alternately cold and hot liquids
sensitivity or aversion to strong odors or flavors
erratic cravings for fatty, sour, or sweet foods
erratic appetite, difficulty knowing what to eat
tenderness, tension and heaviness in muscles, especially head, neck, jaw, elbows or knees
headache with heaviness or pressure behind eyes, nausea, diarrhea
sensitivity to light, noise, heat and humidity
variable blood sugar
eating disorders
irritable bowel
food sensitivity or intolerance
vacillates between assertiveness and ambivalence, irritability and lethargy
Spleen - Kidney Disharmony
slow digestion, sluggish intestines
weak gums and loose teeth
dryness and thirst with water retention
sore, swollen joints and muscles
heaviness, weakness and soreness of head, neck, back, sacrum and limbs
loose or dry, small stool with bloating
frequent, scanty or difficult urination
easily chilled in back, belly, legs or arms
craves salty or sweet foods, causing constipation, dryness and water retention
edema
rheumatism
cystitis, urethritis, vaginitis, leucorrhea
prostatic hypertrophy or prostatitis
distractible, insecure, volatile or apathetic, inert
Kidney - Heart Disharmony
insomnia or restless sleep alternating with heavy slumber and difficulty awakening
nervousness or mood swings alternating with fatigue and lumbar weakness
easily overheated or chilled
hot chest, head, ears, face and hands, with cold belly, buttocks, feet
easily enthused but difficult to sustain effort or excitement
melancholy and restless after prolonged mental or physical exertion
sexually excitable but difficult to sustain arousal or achieve release
anxiety, despair, phobias
nausea, diarrhea, urinary frequency associated with anxiety or fright
craves salty, spicy food and stimulants
chronic endometritis/cervicitis/urethritis
Heart - Lung Disharmony
sensitivity to changes in temperature and humidity
easily overheated but can’t sweat
dry cough with heat in throat or chest
flushes when coughing, laughing, or sneezing
heat triggers sneezing, itchy throat or rashes
dry skin with cracking, redness and itching, especially from cold and dryness
light sleeper and wakes easily
itching, inflammation of vagina or urethra without discharge
alternately euphoric and melancholic, hysterical or depressed
easily hurt or offended
craves spicy, hot foods and stimulants
hives, eczema, rashes, worse in daytime
Lung - Liver Disharmony
tense, stiff neck, shoulders, chest, or loins
irregular bowel movements
sensitivity or aversion to strong odors or flavors
loss of ability to smell
irregular, tense or shallow breathing wheezing or sighing
sensitive, easily irritated skin or mucous membranes of upper respiratory or genito-urinary tracts
sensitivity or aversion to heat, dryness, wind, drafts or sudden changes in weather
feels awkward expressing feelings or reactions
craving for fatty, sour and spicy foods
hives, itching, worse at night
sensitive to rage or rejection
seasonal sinusitis or hayfever
bursitis, lumbago or sciatica that comes and goes
neck spasms, and occipital or lateral headaches
depressed, sad, quiet, angry
Please list your additional health concerns:
This Health Profile is excerpted from
Between Heaven and Earth: A Guide to Chinese Medicine
(Beinfield & Korngold, Ballantine, 1991). This book is a good resource to help you understand more about Chinese medicine, available through local bookstores.
Archetype Self-Assessment Profile
WOOD ARCHETYPE: The Pioneer
feel confident, act assertively
ambitious & enjoy competition
enjoy being first, best, unique
can be pushy or provocative
openly discuss abilities and achievements
comfort with challenges, conflict, pressure
right, even if others disagree or disapprove
pleasure in public recognition
comfortable directing or leading others
follow my own hunches, take initiative
comfortable with bold, decisive action
tend to argue with opinions, especially of me
FIRE ARCHETYPE: The Wizard
enjoy the pleasure of my senses
seek excitement & stimulation
intuitive about what others think or feel
seek physical contact, emotional intimacy
easily share innermost feelings & desires
tend to live in the here-and-now
see the humorous side of life
get involved easily, moved emotionally
optimistic & hopeful no matter what
identify with another’s joy & pain
unabashed affection, enthusiasm & excitement
enjoy being attractive & magnetic
EARTH ARCHETYPE: The Peacemaker
agreeable and accommodating
nurturing, putting other’s needs first
seek socializing with friends and family
seek being relied upon for reassurance & help
the hub of my social and family networks
mediate disputes so that all are satisfied
involved in other peoples’ lives
create comfortable environment for others
loyal & accessible
diplomatic and tactful—a consensus builder
happy to rely on skills & intelligence of others
like getting close & being needed
comfortable & open, even with strangers
METAL ARCHETYPE: The Alchemist
prefer a neat & orderly lifestyle
enjoy convivial but undemanding social life
committed to moral principles & conduct
enjoy logical, systematic problem-solving
meticulous, tasteful, discriminating
self-contained
temperate & moderate
enjoy solving puzzles and mysteries
appreciate well defined goals and guidelines
accept authority of those with more competence
virtue & principle before pleasure & fulfillment
likes things to run calmly & smoothly
WATER ARCHETYPE: The Philosopher
cautious, sensible, self-sufficient
enjoy solitude, cherish privacy
curious & imaginative
content being anonymous
keep feelings, thoughts, opinions to myself
don't mind being unusual or eccentric
excited by intellectual pursuits
careful about what I reveal to others
stubborn defender of the truth as I see it
patient & persevering in spite of defeats
objective & fair, regardless of others
content figuring things out for myself
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