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