Part I: Gastrointestinal

Section A: Gastric Function

  1. Indigestion, food repeats on you after you eat
  2. Excessive burping, belching and/or bloating following meals
  3. Stomach spasms and cramping during or after eating
  4. A sensation that food just sits in your stomach creating uncomfortable fullness, pressure and bloating during or after a meal.
  5. Bad taste in your mouth
  6. Small amounts of food fill you up immediately
  7. Skip meals or eat erratically because you have no appetite


Section B: GI Inflammation

  1. Strong emotions, or the thought or smell of food aggravates your stomach or make it hurt
  2. Feel hungry an hour or two after eating a good-sized meal
  3. Stomach pain, burning and/or aching over a period of 1-4 hours after eating
  4. Stomach pain, burning and/or aching relieved by eating food; drinking carbonated beverages, cream or milk; or taking antacids
  5. Burning sensation in the lower part of your chest, especially when lying down or bending forward
  6. Digestive problems that subside with rest and relaxation
  7. Eating spicy and fatty (fried) foods, chocolate, coffee, alcohol, citrus or hot peppers causes your stomach to burn or ache
  8. Feel a sense of nausea when you eat
  9. Difficulty or pain when swallowing food or beverage


Section C: Small Intestine & Pancreas

  1. Whenmassaging under your rib cage on your left side, there is pain, tenderness or soreness
  2. Indigestion, fullness or tension in your abdomen is delayed, occurring 2-4 hours after eating a meal
  3. Lower abdominal discomfort is relieved with the passage of gas or with a bowel movement
  4. Specific foods/beverages aggravate indigestion
  5. The consistency or form of your stool changes (e.g., from narrow to loose) within the course of a day
  6. Stool odor is embarrassing
  7. Undigested food in your stool
  8. Three or more large bowel movements daily
  9. Diarrhea (frequent loose, watery stool)
  10. Bowel movements shortly after eating (within 1 hour)


Section D: Colon

  1. Discomfort, pain or cramps in your colon (lower abdominal area)
  2. Emotional stress and/or eating raw fruits and vegetables cause abdominal bloating, pain, cramps or gas
  3. Generally constipated (or straining during bowel movements)
  4. Stool is small, hard and dry
  5. Pass mucus in your stool
  6. Alternate between constipation and diarrhea
  7. Rectal pain, itching or cramping
  8. No urge to have a bowel movement
  9. An almost continual need to have a bowel movement


Part II: Liver/Gal Bladder - Hepatobiliary Function

  1. When massaging under your rib cage on your right side, there is pain, tenderness or soreness
  2. Abdominal pain worsens with deep breathing
  3. Pain at night that may move to your back or right shoulder
  4. Bitter fluid repeats after eating
  5. Feel abdominal discomfort or nausea when eating rich, fatty or fried foods
  6. Throbbing temples and/or dull pain in forehead associated with overeating
  7. Unexplained itchy skin that's worse at night
  8. Stool color alternates from clay colored to normal brown
  9. General feeling of poor health
  10. Aching muscles not due to exercise
  11. Retain fluid and feel swollen around the abdominal area
  12. Reddened skin, especially palms
  13. Very strong body odor
  14. Are you embarrassed by your breath?
  15. Bruise easily
  16. Yellowish cast to eyes


PART III: Endocrine

Section A: Thyroid

  1. Feel cold or chilled--hands, feet or all over-- for no apparent reason
  2. Your upper eyelids look swollen
  3. Muscles are weak, cramp and/or tremble
  4. Are you forgetful?
  5. Do you feel like your heart beats slowly?
  6. Reaction time seems slowed down
  7. In general, are you disinterested in sex because your desire is low?
  8. Feel sluggish
  9. Constipation
  10. Dryness, discoloration of skin and/or hair
  11. Have you noticed recently that your voice is deepening?
  12. Thick, brittle nails
  13. Weight gain for no apparent reason
  14. Outer third of your eyebrow is thinning or disappearing
  15. Swelling of the neck


Section B: Adrenal

  1. Lingering mild fatigue after exertion or stress
  2. Do you find that you get tired and exhaust easily?
  3. Craving for salty foods
  4. Sensitive to minor changes in weather and surroundings
  5. Dizzy when rising or standing up from a kneeling position
  6. Dark bluish or black circles under your eyes
  7. Have bouts of nausea with or without vomiting
  8. Catch colds or infections easily
  9. Wounds heal slowly
  10. Your body or parts of your body feel tender, sore, sensitive to the touch, hot and/or painful
  11. Feel puffy and swollen all over your body
  12. Skin is gradually tanning without exposure to the sun or the ingestion of high levels of carotene-rich foods or supplements


PART IV: Glucose Regulation

Section A: Dysglycemia-L

When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms?

  1. A sense of weakness
  2. A sudden sense of anxiety when you get hungry
  3. Tingling sensation in your hands
  4. A sensation of your heart beating too quickly or forcefully
  5. Shaky, jittery, trembling hands
  6. Sudden profuse sweating and/or your skin feels clammy
  7. Nightmares possibly associated with going to be on an empty stomach
  8. Wake up at night feeling restless
  9. Agitation, easily upset, nervous
  10. Poor memory, forgetful
  11. Confused or disoriented
  12. Dizzy, faint
  13. Cold or numb
  14. Mild headaches or head pounding
  15. Blurred vision or double vision
  16. Feel clumsy and uncoordinated


Section B: Dysglycemia-E

  1. Frequent urination during the day and night
  2. Unusual thirst -- feeling like you can't drink enough water
  3. Unusual hunger -- eating all the time
  4. Vision blurs
  5. Feel itchy all over
  6. Tingling or numbness in your feet
  7. Sense of drowsiness, lethargy during the day not associated with missing meals or not sleeping
  8. Eating starchy foods, even if they are healthy and unprocessed (like rice, corn, beans, whole wheat or oats), causes you to gain weight or prevents you from losing weight
  9. Sores heal slowly
  10. Loss of hair on your legs


PART V: Cardiovascular

Section A: Heart

  1. Feel jittery
  2. First effort of the day causes pain, pressure, tightness or heaviness around the chest
  3. Exhaustion with minor exertion
  4. Heavy sweating (no exertion, no hot flashes)
  5. Difficulty catching breath, especially during exercise
  6. Heart pounding, sensation of heart beating too quickly, too slowly or irregularly
  7. Swelling in feet, ankles and/or legs comes and goes for no apparent reason


Section B: Circulation

  1. Muscle pain at rest
  2. Cramp-like pains in your ankles, calves or legs
  3. Numbness, tingling and prickling sensation in hands and feet
  4. Cold feet and/or toes appear blue
  5. Brief moments of hearing loss
  6. Nausea comes and goes quickly (unrelated to eating)
  7. Feel worse standing: legs get heavy and fatigued
  8. Fingers and toes get numb in cold weather even when protected



Section A: Depression

  1. Family, friends, work, hobbies or activities you hold dear are no longer of interest
  2. Do you cry?
  3. Does life look entirely hopeless?
  4. Would you describe yourself as feeling miserable and sad, unhappy or blue?
  5. Do you find it hard to make the best of difficult situations?
  6. Sleep problems -- too much or too little?
  7. Changes in your appetite and weight
  8. Lately you've noticed an inability to think clearly or concentrate
  9. Difficulty making decisions and/or clarifying and achieving your goals


Section B: Anxiety

  1. Does worrying get you down?
  2. Does every little thing get on your nerves and wear you out?
  3. Would you consider yourself a nervous person?
  4. Do you feel easily agitated?
  5. Do you shake and tremble?
  6. Are you keyed up and jittery?
  7. Do you tremble or feel weak when someone shouts at you?
  8. Do you become scared at sudden movements or noises at night?
  9. Do you find yourself sighing a lot?
  10. Are you awakened out of your sleep by frightening dreams?
  11. Do frightening thoughts keep coming back in your mind?
  12. Do you become suddenly scared for no reason?
  13. Do you break out in a cold sweat?
  14. "Butterflies in your stomach," nausea and/or diarrhea


Section C: Anger

  1. Do you feel pent up and ready to explode?
  2. Are you prone to noisy and emotional outbursts?
  3. Do you do things on impulse?
  4. Are you easily upset or irritated?
  5. Do you go to pieces if you don't control yourself?
  6. Do little annoyances get on your nerves and make you angry?
  7. Does it make you angry to have anyone tell you what to do?
  8. Do you flare up in anger if you can't have what you want right away?


PART VII: Immune System - Eyes, Ears, Nose, Throat & Lungs

  1. Eyes water or tear
  2. Mucus discharge from the eyes
  3. Ears ache, itch, feel congested or sore
  4. Discharge from the ears
  5. Is your nose continually congested?
  6. Are you prone to loud snoring?
  7. Does your nose run?
  8. Nosebleeds
  9. Hoarse voice
  10. Do you have to clear your throat?
  11. Do you feel a choking lump in your throat?
  12. Do you suffer from severe colds?
  13. Do frequent colds keep you miserable all winter?
  14. Flu symptoms last longer than 5 days?
  15. Do infections settle in your lungs?
  16. Chest discomfort or pain
  17. Do you experience sudden breathing difficulties?
  18. Do you struggle with shortness of breath?
  19. Difficulty exhaling (breathing out)
  20. Breathlessness followed by coughing during exertion, no matter how slight
  21. Inability to breath comfortably while lying down
  22. Do you cough up lots of phlegm?
  23. Can you hear noisy rattling sounds when breathing in and out?
  24. Are you troubled with coughing?
  25. Do you wheeze?
  26. Do you have severe soaking sweats at night?
  27. Do your lips and/or nails have a bluish hue?
  28. Are you sleepy during the day?
  29. Do you have difficulty concentrating?
  30. Eyes, ears, nose, throat and lung symptoms seem associated with specific foods like dairy or wheat products
  31. Eyes, ears, nose, throat and lung symptoms are associated with seasonal changes


PART VIII: Urological - Kidney & Bladder

  1. Involuntary loss of urine when you cough, lift something or strain during an activity
  2. Mild lower back ache or pain
  3. Abdominal achiness or pain
  4. Pain or burning when urinating
  5. Rarely feel the urge to urinate
  6. Feel the need to urinate less than every two hours during the day or night
  7. Strong smelling urine
  8. Back or leg pains are associated with dripping after urination
  9. Sore or painful genitals
  10. Urine is a rose color
  11. Sudden urge to void causes involuntary loss of urine
  12. Generalized sense of water retention throughout your body


PART IX: Musculoskeletal

Section A: Bone Integrity

  1. Bones throughout your entire body ache, feel tender or sore
  2. Localized bone pain
  3. Hands, feet or throat get tight, spasm or feel numb
  4. Difficulty sitting straight
  5. Upper back pain
  6. Lower back pain
  7. Pain when sitting down or walking
  8. Find yourself limping or favoring one leg
  9. Shins hurt during or after exercise


Section B: Connective Tissue

  1. Are you stiff in the morning when you wake up?
  2. Difficulty bending down and picking up clothing or anything form the floor?
  3. Joint swelling, pain or stiffness involving one or more areas (fingers, hands, wrists, elbows, shoulders,  toes, arches, feet, ankles, knees or ankles)
  4. Joints hurt when moving or when carrying weight
  5. A routine exercise program, like daily walking, causes your knees to swell or hurt
  6. Difficulty opening jars that were previously easy to open
  7. Discomfort, numbness, prickling or tingling sensation, or pain in neck, shoulder or arm
  8. Intermittent pain or ache on one side of head spreading to cheek, temple, lower jaw, ear, neck and shoulder
  9. Difficulty chewing good or opening mouth
  10. Difficulty standing up from a sitting position
  11. Shooting, aching, tingling pain down the back of leg
  12. Is it difficult to reach up and get a 5-pound object like a bag of flout from just above your head?
  13. Injure, strain or sprain easily


Section C: Muscle & Nerves

  1. Muscles stiff, sore, tense and/or achy
  2. Burning, throbbing, shooting or stabbing muscle pain
  3. Muscle cramps or spasms (involuntary or after exertion/exercise)
  4. Is muscle pain or stiffness greater in the morning than other times of the day?
  5. Specific points on body feel sore when pressed
  6. Feel unrefreshed upon awakening
  7. Headaches
  8. Pain at the sides of your head or in your face especially when awakening
  9. Your jaw clicks or pops
  10. Muscle twitch or tremor -- eyelids, thumb, calf muscle
  11. Irresistible urge to move legs
  12. Legs move during sleep
  13. Unpleasant crawling sensation inside calves when lying down
  14. Hand and wrist numbness or pain (e.g. , interferes with writing or with buttoning or unbuttoning your clothes)
  15. Feeling of "pins and needles? In your thumb and first three fingers
  16. Pain in forearm and sometimes in shoulder


PART X: CNS & Brain

Section A: Central Nervous Sytem

  1. Head feels heavy
  2. Dizziness
  3. Difficulty bending over, standing up from sitting, rolling over in bed and/or turning your head from side to side
  4. Your hands tremble, ever so slightly, for no apparent reason
  5. You feel like you're wearing heavy weights on your feet when walking
  6. Bump into things, trip, stumble and feel clumsy
  7. Difficulty breathing
  8. Difficulty swallowing
  9. People tell you to speak up because they have trouble hearing you
  10. Speaking and forming words does not feel automatic
  11. Need 10-12 hours of sleep to feel rested
  12. Lack of strength (your grip is weak, holding your head or picking your arms up takes effort)
  13. Hands get tired when you write and your handwriting is less legible and smaller than it used to be
  14. Muscles in arms and legs seem softer and smaller
  15. Is your eyesight, sense of smell and taste or ability to hear not as sharp as it used to be?
  16. Do you find yourself moving slower than you used to?


Section B: Cognition

  1. Difficulty absorbing new information
  2. Tend to forget things
  3. Trouble thinking or concentrating
  4. Easily distracted
  5. Do you have a tendency to become frustrated quickly?
  6. Inability to sit still for any length of time, even at mealtime
  7. Finishing tasks is easier said than done
  8. Do you have more trouble solving problems or managing your time than usual?
  9. Low tolerance for stress and otherwise ordinary problems



  1. Sensation of not emptying your bladder completely
  2. Need to urinate less than 2 hours after you have finished urinating
  3. Find yourself needing to stop and start again several times while urinating
  4. Find it difficult to postpone urination
  5. Have a weak urinary stream
  6. Need to push or strain to begin urinating
  7. Dripping after urination
  8. Urge to urinate several times at night