症状体质问卷表 | Symptom & Constitution Questionnaire

外感 / external pathogen

饮食 / diet

情志 / emotions

劳倦 / fatigue/overexertion

其它 / other

头痛 / headache

头晕 / dizziness

眼睛胀痛 / eye pain/swelling

咽喉肿痛 / sore throat

咳嗽 / cough

便秘 / constipation

小便黄 / dark urine

出汗 / sweating

泄泻 / diarrhea

尿频 / frequent urination

白带多 / excessive vaginal discharge

食欲 / appetite changes

腹胀 / abdominal bloating

血压高 / high blood pressure

血糖高 / high blood sugar

血脂高 / high blood lipids

尿酸高 / high uric acid

生长发育迟缓，生殖力下降，记忆力减退，精力不济，须发早白，易衰老 | Delayed growth and development, reduced fertility, memory decline, low energy, premature graying, accelerated aging

免疫力低下，疲劳，精神不振，头昏，易感冒，自汗 | Weak immunity, fatigue, low spirits, lightheadedness, frequent colds, spontaneous sweating

贫血，失眠，眩晕，心慌，易紧张，易焦虑，疼痛、瘙痒 | Anemia, insomnia, vertigo, palpitations, prone to nervousness/anxiety, pain, itching

干燥(口干、眼干、鼻干、大便干)，五心烦热(心烦，手足心热)，舌红少苔或无苔，脉细数，易“上火” | Dryness (mouth, eyes, nose, stool), “five-center heat” (restlessness, warm palms/soles), red tongue with little/no coating, thin rapid pulse, prone to “internal heat”

畏寒，手足怕冷及全身(关节冷、胃冷、小腹冷、头背冷、腰冷)，腰膝酸软，不易“上火” | Cold intolerance, cold hands/feet and whole body (cold joints, stomach, lower abdomen, head/back, lower back), sore/weak lower back and knees, not prone to “internal heat”

受寒或阴雨天气变化等诱发或加重，受凉感冒，恶寒，怕风无汗，鼻塞流清涕，关节酸痛 | Triggered/worsened by cold or damp/rainy weather; catching cold, aversion to cold, aversion to wind without sweating, nasal congestion with clear discharge, joint aches

急性炎症，痈脓，局部红肿热痛，痤疮，皮痒，分泌物(脓、涕、眵、痰、汗、白带等)粘稠或色黄，舌红苔黄，口干口渴，口舌生疮，小便色深，大便干结，易“上火” | Acute inflammation, abscess/pus, localized redness/swelling/heat/pain, acne, itchy skin; thick or yellow discharge (pus, nasal mucus, eye discharge, phlegm, sweat, vaginal discharge), red tongue with yellow coating, dry mouth and thirst, mouth ulcers, dark urine, dry hard stool, prone to “internal heat”

肥胖，舌苔厚或腻，痰多，皮肤出油，水肿，积液 | Obesity, thick/greasy tongue coating, excess phlegm, oily skin, edema, fluid accumulation

胸闷，胸胀，乳房胀，胃胀，腹胀，生气，紧张，焦虑，胀痛 | Chest tightness/fullness, breast distension, stomach/abdominal bloating, irritability, tension, anxiety, distending pain

经色黯黑有血块，心脑血管病，结节，肿瘤，静脉曲张，痒痛部位固定，刺痛，唇舌紫暗，舌下络脉粗色深暗 | Dark menstrual blood with clots, cardio-cerebrovascular disease, nodules, tumors, varicose veins, fixed sites of itching/pain, stabbing pain, dark purplish lips/tongue, thick dark sublingual veins

头面多油，鼻头色红，身体困重，肚大腰圆，易打饱嗝，长期腹泻，易患四高，易患结石，舌红苔腻 | Oily face/scalp, red nose tip, heavy/sluggish body, large belly and thick waist, frequent belching, chronic diarrhea, prone to the “four highs” (BP/sugar/lipid/uric acid), prone to stones, red tongue with greasy coating

鼻根青，面色黄，舌质红，舌苔白，形体消瘦，夜间盗汗，大便干结，扁桃体肿大，淋巴结肿大 | Bluish bridge of the nose, sallow complexion, red tongue body, white tongue coating, emaciation, night sweats, dry hard stool, enlarged tonsils, swollen lymph nodes