Part I: Gastrointestinal

Section A: Gastric Function

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

Section B: GI Inflammation

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

Section C: Small Intestine & Pancreas

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

Section D: Colon

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

Part II: Liver/Gal Bladder - Hepatobiliary Function

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

PART III: Endocrine

Section A: Thyroid

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

Section B: Adrenal

Lingering mild fatigue after exertion or stress
Do you find that you get tired and exhaust easily?
Craving for salty foods
Sensitive to minor changes in weather and surroundings
Dizzy when rising or standing up from a kneeling position
Dark bluish or black circles under your eyes
Have bouts of nausea with or without vomiting
Catch colds or infections easily
Wounds heal slowly
Your body or parts of your body feel tender, sore, sensitive to the touch, hot and/or painful
Feel puffy and swollen all over your body
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?

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

Section B: Dysglycemia-E

Frequent urination during the day and night
Unusual thirst -- feeling like you can't drink enough water
Unusual hunger -- eating all the time
Vision blurs
Feel itchy all over
Tingling or numbness in your feet
Sense of drowsiness, lethargy during the day not associated with missing meals or not sleeping
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
Sores heal slowly
Loss of hair on your legs

PART V: Cardiovascular

Section A: Heart

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

Section B: Circulation

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

PART VI: Mood

Section A: Depression

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

Section B: Anxiety

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

Section C: Anger

Do you feel pent up and ready to explode?
Are you prone to noisy and emotional outbursts?
Do you do things on impulse?
Are you easily upset or irritated?
Do you go to pieces if you don't control yourself?
Do little annoyances get on your nerves and make you angry?
Does it make you angry to have anyone tell you what to do?
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

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

PART VIII: Urological - Kidney & Bladder

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

PART IX: Musculoskeletal

Section A: Bone Integrity

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

Section B: Connective Tissue

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

Section C: Muscle & Nerves

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

PART X: CNS & Brain

Section A: Central Nervous Sytem

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

Section B: Cognition

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

PART XI -- MEN ONLY

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