Constitution Evaluation Questionnaire

Constitution Analysis Questionnaire
Please choose your gender
Group I- Your Look
1. Do you like being quiet but not talking?
2. Does your face look gloomy or prone to speckles?
3. Are you prone to dark circles around the eyes?
4. Are your lips dim or darkish?
5. Are your lips redder than the average?
6. Are your skin or lips dry?
7. Are your cheeks flushing or reddish?
8. Are there any fine red lines on your cheeks?
9. Is your abdomen plump and soft?
10. Do you have an oily face?
11. Is your upper eyelid slightly swelling?
12. Do you feel oily on your face or nose?
13. Are you prone to acne or boils?
14. Do you get purple bruises under the skin?
15. Is your skin prone to red marks when scratched?
Group II- Your Feeling
1. Are you energetic?
2. Are you easy to get tired?
3. Are you easily nervous or anxious?
4. Are you sentimental?
5. Are you easily scared or frightened?
6. Is your voice low and weak?
7. Do you feel gloomy and depressed?
8. Do you feel bitterness or odor in your mouth?
9. Do you feel dry eyes?
10. Do you feel dry and want to drink water?
11. Do you feel chest stuffiness or fullness in the abdomen?
12. Does your body feel heavy?
13. Do you feel hot in the hands and feet?
14. Do you feel hot in the face?
15. Do you sigh for no reason?
16. Are you forgetful?
17. Are you easy to catch a cold?
18. Do you feel sticky in the mouth?
19. Do you feel much phlegm in your throat?
20. Is your tongue coating thick and greasy?
21. Does your stool feel sticky or unfinished after the bowel movement?
22. Do you feel cold in the stomach, back, waist, or knees?
23. Do you feel any pain in the body?
24. Do you feel any swelling pain in the side ribs or breast?
25. Do you feel like any foreign body in the throat, that neither be coughed up nor swallowed?
26. Do you fear cold and have to wear more than others? *
Group III- Your Discomfort
1. Are you less tolerant to cold than average, like the chill in winter, low AC in summer?
2. Can you adapt well to weather changes?
3. Are you prone to shortness of breath or difficulty in catching breath?
4. Are you easily nervous or flustered?
5. Are you prone to insomnia?
6. Are you prone to dizziness, especially when standing up?
7. Are you prone to profuse sweating whenever you start exercising?
8. Are your hands and feet cold?
9. Do you feel uncomfortable or afraid of consuming cold foods?
10. Are you prone to diarrhea after catching a cold or consuming cold food?
11. Do you sneeze when not catching a cold?
12. Do you have a stuffy and runny nose when not catching a cold?
13. Do you cough during seasonal and temperature changes or because of peculiar smells?
14. Do you have allergies, e.g., medicine, food, smell, pollen, and during the season or climate change?
15. Are you prone to constipation or dry feces?
16. Do you feel hot in the urinary tract while urinating, and is your urine deep in color?
17. Is your skin prone to hives, wheal, or urticaria?
18. Have you ever experienced skin purpura (purple blood stasis and bruises) due to allergies?
Please select your age group