Development and Preliminary Validation of the Questionnaire (the First Edition) Based on TCM for Detecting Health Status in China

Table 6

Do you have the symptoms of the following? How often?
		1	2	3	4	5
1	Nasal obstruction	□	□	□	□	□
2	Running nose	□	□	□	□	□
3	Throat itching	□	□	□	□	□
4	Cough	□	□	□	□	□
5	Expectoration	□	□	□	□	□
6	Chest distress	□	□	□	□	□
7	Palpitation	□	□	□	□	□
8	Vexation	□	□	□	□	□
9	Dryness of mouth	□	□	□	□	□
10	Polydipsia	□	□	□	□	□
11	Acid regurgitation	□	□	□	□	□
12	Belching	□	□	□	□	□
13	Nausea	□	□	□	□	□
14	Vomit	□	□	□	□	□
15	Abdominal distension	□	□	□	□	□
16	Diarrhea	□	□	□	□	□
17	Soreness of the waist	□	□	□	□	□
18	Lassitude in the knees	□	□	□	□	□
19	Frequency of micturition	□	□	□	□	□
20	Urgency of urination	□	□	□	□	□
21	Dysuria	□	□	□	□	□
22	Polyuria	□	□	□	□	□
23	Edema	□	□	□	□	□
24	Fatigue	□	□	□	□	□
25	Shortness of breath	□	□	□	□	□
26	Simultaneous sweat and night sweat	□	□	□	□	□
27	Overdrinking	□	□	□	□	□
28	Dizziness	□	□	□	□	□
29	Memory deterioration	□	□	□	□	□
30	Insomnia, dream disturbed sleep	□	□	□	□	□
31	Hypoacusis	□	□	□	□	□
32	Tinnitus	□	□	□	□	□
33	Pain	□	□	□	□	□
34	Symptoms of bleeding	□	□	□	□	□
35	Pruritus	□	□	□	□	□
Physical examination: Is there something wrong with the part of body as following?
		YES	NO	Comments
36	Complexion	□	□
37	Skin color and luster	□	□
38	Skin diseases	□	□
39	Skin swelling	□	□
40	Five sense organs: eyes, ears, nose, and lips	□	□
41	Teeth and gums	□	□
42	Mouth (bad breath)	□	□
43	Hoarse voice or aphonia	□	□
44	Throat	□	□
45	Neck	□	□
46	Chest and abdomen	□	□
47	Waist and back	□	□
48	Arms and legs	□	□
49	Renal percussive pain	□	□