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| Yin Deficiency Questionnaire () | Qi Deficiency Questionnaire () | Food Stagnation Questionnaire () | Blood Stasis Questionnaire () | Phlegm Pattern Questionnaire () | Seven Emotions Impairment Questionnaire () |
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| I urinate frequently | I usually feel tired or languid | I feel pain in the pit of my stomach | I recently sprained my ankle or waist | I feel unclear in the head | I am often angry |
| My urine is dark yellow | I feel heavy or weak in the limbs | I have a feeling of fullness in the stomach after eating | I recently was hurt in a fall or traffic accident | I have a headache | I have alternating chills and fever |
| I feel residual urine | I have trouble standing or walking for a long time | I often have an upset stomach | I was operated on ( ) times | I feel dizzy | I feel dizzy |
| I cannot contain my urine | I have a heavy feeling in my anus | I feel stomach pain immediately after eating | I have dull pain that lasts for a long time | I have ringing in the ears | I feel heavy in the chest |
| I wake to urinate in the night | My memory has gone from bad to worse | I often belch | I have joint pain | I feel my heart palpitates | I have tightening in the chest |
| My stool is hard | I often catch common colds | I have water brash | I have lower abdominal pain | I am startled by faint noise | I have chest pain |
| My hair falls out | My colds last for a long time | I feel sick to my stomach | I have flank pain | I feel heavy in the chest | I often sigh |
| I have a rough skin | My voice easily becomes hoarse after talking | I have a bowel movement immediately after eating | I have pain that disturbs my sleep in the night | I have a cough | I taste bitter tastes |
| I have an itch in the night | I often have a weak voice | I am very fond of eating | I often have a bruise | I have sputum in my throat | I feel my heart palpitates |
| I have a dry mouth | I sweat spontaneously | I feel heavy in the body | My lips or tongue is dark blue | I feel a foreign body present in the throat, neither swallowed nor ejected | I am sleepless |
| My heel is dry and cracked | I often have a fever | I feel languid after eating | My face is dark blue | I feel short of breath | I am forgetful |
| I do not gain weight despite eating fully | I often experience nosebleeds | I swell in the face or limbs | I have dark circles under the eyes | I feel fatigued | I am startled by faint noise |
| I have a fever in the night | I overwork myself | I gained weight recently | My stool is black | I feel heavy or weak in the limbs | I feel down and uninterested in everything |
| I have a fever in the afternoon | My work hours are irregular | I often urinate | I feel a lump in my abdomen | I have a poor appetite | I feel like lying because of fatigue |
| I have a flush in the afternoon | I am under stress because of my work | My stool is mucousy | | I feel sick to the stomach | I have indigestion despite a normal appetite |
| My soles are hot in the night | I feel pain after working | I have pain in the joints | | I have indigestion | I feel uneasy |
| I feel hot deep in the body, for example, in the bone | I feel short of breath after working | I have a water-change-related diarrhea or abdominal pain | | I have a feeling of fullness in the stomach with just a little food | I sweat during sleep |
| I prefer cold beverages to warm beverages | My mealtimes are irregular | I have a food-related allergy | | My stomach or intestine rumbles | I have many things worrying me |
| I am susceptible to heat and cold | I feel weak after skipping meals | I have abdominal fullness or diarrhea after drinking | | My stool is mucousy | I have trouble with my family |
| I sweat during sleep | I feel drowsy or languid after meals | (for women) I have vaginal discharge | | I have a lump somewhere on my body | I have vaginal bleeding during sex |
| My ear rings | I have indigestion | | | My face is yellowish | My menstrual bleeding volume is irregular |
| I have a cough in the afternoon | I have a poor appetite | | | I have dark circles under the eyes | My menstrual period is irregular |
| I have a cough in the night | | | | I feel itchy | |
| My cough lasts for a long time | | | | I have pain in the joints | |
| I feel tired or languid | | | | I have flank pain | |
| I feel tired in the morning | | | | I gained or lost weight recently | |
| I feel low back pain | | | | | |
| I feel dull pain in my ankle or knee | | | | | |
| I feel heavy or weak in my lower limbs | | | | | |
| I feel dull pain in my heel | | | | | |
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