Health Profile
Check all of the symptoms you have experienced during the last six months, or characteristics which describe you. Additionally, circle those
symptoms that have been most troublesome.
 Numbness /tingling of hands and feet (night)
 Dry mouth or throat
 Frequent throat clearing or laryngitis
 Irritable: “things get on my nerves”
 Hot flashes
 Morning attacks of coughing or sneezing with
 Touchiness from heat, wind, noise
 Restlessness and fatigue
clear phlegm or mucus discharge
 Muscle cramps: lower abdomen, hips, calves,
 Frequent urination and bowel movements
 Shortness of breath, chest pain, or sneezing in
feet
from nervousness
chest from fatigue or exertion
 Pain from tension in shoulders/neck, or in
 Palpitations when nervous, upset or exhausted  Dryness of mucous membranes
hips
 Makes friends easily
 Dry skin
 Stitching pains under diaphragm, in ribs,
 Slow digestion or indigestion
 Itchiness or rashes of skin
groin or pelvic region
 Frequent abdominal gas or bloating
 Easily disappointed or offended
 Easy chilling of arms, hands, legs feet
 Loose stool from raw or cold foods, cold
 Sensitive to wind, cold and dryness
 Coarse, brittle nails or hair
liquids
 Daily routine is important
 Dry eyes, weak or blurred vision
 Excess or deficient appetite
 Spiritual
 Difficult elimination, dry or hard stool, tense
 Lingering hunger after meals
 Holds onto things you don’t need
colon
 Hard to gain, lose or regulate weight
 Difficulty conceiving or carrying to term
 Whistling or loud ringing in the ears (tinnitus)  Easily worried
 Diminished libido
 Weak, dizzy, flushed when hungry, tense or
 Difficulty focusing, jumps from one thing to
 Lack of sexual secretions
angry
another
 Loss or thinning of hair / pubic hair
 Nausea or queasiness from hunger or fatigue
 Overwhelmed by details
 Amenorrhea (no menstruation)
 Genital organ hypersensitivity
 Upset by changes
 Excess or scanty urination
 Difficulty making decisions
 Lethargy and inertia
 Frequent or difficult urination
 Inflexible
 Prolapse of stomach, intestines, uterus, vagina  Pain in low back, sacrum or hips
 Timid
or bladder or Hemorrhoids
 Weakness or soreness of hips, knees, ankles
 Easily startled
 Lack of muscle tone or strength, especially of
or feet
 Anxiety
abdomen, back or neck
 Lack of stamina, runs out of steam quickly
 Mood swings (laughs easily, cries easily)
 Water retention and puffiness
 Needs to sleep a lot
 Insomnia when nervous, worried or overtired
 Heaviness of head and limbs
 Diminished motivation
 Excitement, anxiety and fatigue cause light,
 Tender muscles
 Forgetfulness and dull-minded
restless sleep and vivid dreams or nightmares
 Frequent but scanty urination
 Puffiness or swelling of feet and ankles
 Craving for cool drinks and juicy foods
 Easy or frequent bruising
 Puffiness around eyes
 Slight exertion or excitement causes heat,
 Strong desire to tend to others or be tended to
 Dull hearing/low humming in ears (tinnitus)
perspiration
 Rejects being nurtured / tended to
 Sore throat from fatigue
 Easily overheats and over chills
 Issues around food (bulimia, anorexia)
 Easily defeated and disgruntled
 Easy blushing of face and ears
 Fearful / Fearless
 Burning, sensitivity or irritation of mouth,
 Frequent colds or coughs / allergies
 Tends to push when exhausted
tongue, urethra, vagina or anus
 Frequent runny nose or stuffy sinuses
 Difficulty being still/ relaxing