Questionnaire Step 1 of 4 25% Name* First Last Email* Answer the following questions according to your experience and feelings of the last 12 MonthsAre you easy to feel anxious and tension?*NeverSeldomSometimesOftenAlwaysHAre you sentimental and easy to feel sad?*NeverSeldomSometimesOftenAlwaysHAre you easy to get scared or be startled?*NeverSeldomSometimesOftenAlwaysHAre you easily to sigh even for no reasons?*NeverSeldomSometimesOftenAlwaysHCan you adapt to the change of nature and society?*NeverSeldomSometimesOftenAlwaysAWhen you speak do you carry a low voice without strength?*NeverSeldomSometimesOftenAlwaysA,BDo you like to keep quiet and sometimes feel lazy to talk?*NeverSeldomSometimesOftenAlwaysBAre you easy to forget things?*NeverSeldomSometimesOftenAlwaysA,GAre you easy to feel dizzy overall or especially when standing up?*NeverSeldomSometimesOftenAlwaysBDo you feel unhappy and emotionally down?*NeverSeldomSometimesOftenAlwaysA,HAre you easy to feel panic or have your heart racing?*NeverSeldomSometimesOftenAlwaysBDo you feel a body ache for no reasons?*NeverSeldomSometimesOftenAlwaysGDo you have insomnia?*NeverSeldomSometimesOftenAlwaysA Do you feel energetic?NeverSeldomSometimesOftenAlwaysAAre you easy to feel tired?*NeverSeldomSometimesOftenAlwaysA,BAre you easy to feel out of breath?*NeverSeldomSometimesOftenAlwaysBDo you feel full and heavy to breathe?*NeverSeldomSometimesOftenAlwaysEDo you feel pain in your ribs and chest?*NeverSeldomSometimesOftenAlwaysHDo you feel heavy and not relaxed in your body?*NeverSeldomSometimesOftenAlwaysEDo you sweat a lot even for low intensity/sports activity*NeverSeldomSometimesOftenAlwaysBIs your waist loose and have a fair amount of fat?*NeverSeldomSometimesOftenAlwaysEAre you easy to have constipation or is your stool dry?*NeverSeldomSometimesOftenAlwaysDWill you have diarrhea when you eat/drink cold items?*NeverSeldomSometimesOftenAlwaysCWhen you go to toilet, do you feel you can not empty your bowels completely or is your stool sticky?*NeverSeldomSometimesOftenAlwaysFWhen you pee do you have hot feeling in your urethra and your urine is thick?*NeverSeldomSometimesOftenAlwaysFDoes your vaginal discharge carry some yellow color? (for females)NeverSeldomSometimesOftenAlwaysFIs your scrotum area wet? (for male)NeverSeldomSometimesOftenAlwaysFAre you easy to be allergic (such as to food, medicine, odors, pollen or seasonal change)?*NeverSeldomSometimesOftenAlwaysIDo you catch a cold easier than average people?*NeverSeldomSometimesOftenAlwaysB,C Do you have less tolerance of cold than average people?*NeverSeldomSometimesOftenAlwaysA,CAre your hands and feet cold?*NeverSeldomSometimesOftenAlwaysCDo you feel cold in the area of your stomach, back or waist?*NeverSeldomSometimesOftenAlwaysCOn average do you feel cold and need to wear more clothes than average people?*NeverSeldomSometimesOftenAlwaysCDo you feel unwell when you eat/drink cold items or do you dislike cold foods/drinks?*NeverSeldomSometimesOftenAlwaysCDo you feel hot in your palm and at the bottom of your feet?*NeverSeldomSometimesOftenAlwaysDDo you feel hot in your face and body?*NeverSeldomSometimesOftenAlwaysDDo you feel bitter in your mouth or do you have bad breath?*NeverSeldomSometimesOftenAlwaysFDo you feel dry in your throat and always want to drink?*NeverSeldomSometimesOftenAlwaysDDo you feel sticky in your mouth?*NeverSeldomSometimesOftenAlwaysEDo you have lots of phlegm, especially do you feel phlegm stuck in your throat?*NeverSeldomSometimesOftenAlwaysEDo you have a thick layer on your tongue?*NeverSeldomSometimesOftenAlwaysEDo you feel having something in your throat that you can neither swallow nor spit out?*NeverSeldomSometimesOftenAlwaysHDo you sneeze even when you do not have cold?*NeverSeldomSometimesOftenAlwaysIDo you have running nose or your nose is blocked even when you do not have cold?*NeverSeldomSometimesOftenAlwaysIDo you cough due to the change of seasons, temperature or a strange odor?*NeverSeldomSometimesOftenAlwaysIIs your nose canal oily?*NeverSeldomSometimesOftenAlwaysF Do you have rosy cheeks for a few hours?*NeverSeldomSometimesOftenAlwaysDAre your lips more red than average people?*NeverSeldomSometimesOftenAlwaysDDo you have blue on the skin (bleeding under the skin) when you do not even realize that it exists?*NeverSeldomSometimesOftenAlwaysDDo you have small red capillaries on your cheeks?*NeverSeldomSometimesOftenAlwaysGDo you have dark/tired eyes?*NeverSeldomSometimesOftenAlwaysGDo you have weak face color and often have face impurities?*NeverSeldomSometimesOftenAlwaysGIs the color of your mouth and lips dark?*NeverSeldomSometimesOftenAlwaysGAre you oily in your forehead?*NeverSeldomSometimesOftenAlwaysEIs your upper eyelash swollen (as if it contains some water)?*NeverSeldomSometimesOftenAlwaysEAre you easy to grow pickles/acne?*NeverSeldomSometimesOftenAlwaysFAre you easy to have rashes that show up suddenly and disappear again quickly?*NeverSeldomSometimesOftenAlwaysIWill your skin have red or purple dots due to allergy?NeverSeldomSometimesOftenAlwaysIDoes your skin become red easily when you scratch it?NeverSeldomSometimesOftenAlwaysIDo you feel dry in your eyes?*NeverSeldomSometimesOftenAlwaysDDo you feel dry in your skin or your lips?*NeverSeldomSometimesOftenAlwaysDDo you sneeze even you don’t have a cold or flu?*NeverSeldomSometimesOftenAlwaysIDoes your nose clogged, or do you have a running nose even when you don’t have a cold or flu?*NeverSeldomSometimesOftenAlwaysIIs your skin prone to hives (wind masses, rubella lump, wind bumps)?*NeverSeldomSometimesOftenAlwaysIHave you had purpura (purple petechiae, ecchymosis) on your skin due to allergies?*NeverSeldomSometimesOftenAlwaysI
