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CHIEF COMPLAINT (CC)
1.
What is your chief complaint (CC)? Tell as much about it as you can: the
sensations, the kind of pain, the location, how your energy has been affected
(for example, has the complaint made you restless, weak, nervous, anxious,
irritable, hypersensitive, affected your thirst and appetite, your body
temperature, and so on).
2. When did this problem begin? What happened in your life around that time?
What do you think caused it?
3. What aggravates the CC? (for example, certain types of food or weather,
movement, light, noise, heat/cold, or anything else that you can think of;
please be specific) and what makes the CC better (for example hot or cold,
massage, eating, lying still, music, company...)?
4. At what time of the day or night is the CC the worst? Specify an hour if you
can.
5. What symptoms can you identify that accompany the CC (whether directly
related or not; for example, headache with nausea; or menstrual cramps with
diarrhea; a cold with irritability and anger?
GENERAL QUESTIONS
6.
Environment: With regard to the seasons, weather, outdoor temperature, indoor
temperature, drafts, air quality, air-conditioning, ocean air, mountain air,
humidity, the sun/rain/thunderstorms/clouds/fog, etc.: what environmental
factors give you comfort and relief, and which ones cause discomfort and
distress? Try to give examples.
7. What position is most uncomfortable for you?
8. a) Do you tend to be chilly or warm? Are there parts of your body that are
colder or warmer than the rest of you? Is there a special time of day or night
when they are colder or warmer? b) Do you perspire a great deal? If so, when?
And where on the body? (feet, head, hair, chest, armpits, etc) Does it leave a
stain of a particular color? Is there a particular odor?
9. Describe what your tongue looks like.
MENTAL/EMOTIONAL
10.
What do you worry about? How do you deal with worries?
11. How do you keep your house/your desk/your room/your study/your bathroom?
12. How easily do you cry? In what situations?
13. When you are upset, what do you do to help yourself feel better?
14. What makes you angry? What do you do when you're angry?
15. Do you have an emotion that predominates; such as anger, depression,
irritability, anxiety, jealousy, joy...or possibly two emotions that tend to
alternate predictably?
16. What fears do you have?
17. What have been the most difficult circumstances in your life? How did you
cope?
18. What are the greatest joys you have had in your life?
19. What was your childhood like?
20. What bothers you most in other people? How, if at all, do you express it?
21. What causes the most problems in your relationships?
22. Do you have any recurring dreams? What are they about?
23. What would you need to feel happy?
24. What do you do for work? Ideally, what would you like to do?
25. If you were made President for a day, what would you change?
26. When people have criticized you, what were they complaining about?
Similarly, when people have praised you, what did you receive praise for?
27. What would you like to change most about yourself?
FOOD
28.
How do you feel before, during and after meals? How do you feel if you go
without a meal?
29. What would you most like to eat (if you did not have to consider calories,
fat, anything you've read about the right way to eat)?
30. What foods do you dislike and refuse to eat? What foods do you react badly
to, and in what way?
31. How much do you drink in a day? Include sodas, juice, coffee, tea, milk, and
alcoholic beverages as well as water. How thirsty do you tend to get? What
temperature would you like your drinks to be?
SLEEP
32.
How is your sleep? Do you have any recurrent dreams?
33. Do you do anything during sleep? (speak, laugh, shriek, toss about, grind
your teeth, drool, snore, walk, talk, etc.)
34. Do you have trouble falling asleep? What keeps you awake? Do you wake always
at a certain time? What causes you to wake up? What position do you sleep in?
WOMEN
35.
Number of pregnancies, number of children, number of miscarriages, number of
abortions
36. At what age did your menses begin? If you have gone through menopause, at
what age?
37. How frequently do they (or did they) come?
38. What about their duration, abundance, color, time of day when flow is
greatest; any odor or clots?
39. How do you (did you) feel before, during and after menses?
HEALTH HISTORY
40.
What medications are you taking at present?
41. How frequently do you get colds and flues?
42. Have you had any childhood illnesses twice, or in a very severe form, or
after puberty?
43. Have you had any vaccinations since the standard childhood ones? Have you
ever had an
adverse or unusual reaction to a vaccination?
44. Have you had any surgery? What and when?
45. Have you had at any time (mention year): warts, cysts, Polyps, or tumors?
Where were they located? How were they treated?
46. Do you tend to have any discharges (nasal, vaginal, etc.)? What is the
color, consistency?
SENSITIVITY
47.
a) Do you tend to need a smaller dose of medications than most other people?
b) Do you need less anesthesia than others, or have a hard time coming out of
it?
c) Do you tend to react to vitamins and herbs and/or need hypoallergenic
vitamins?
d) Are you sensitive to paint fumes, exhaust, dry cleaning fluid, fragrances
etc.?
48. Family history: Mention diseases, causes and ages of deaths of father,
mother, sisters, brothers and grandparents on both sides.
49. Construct a time line: Mention from birth on to the present day, all
IMPORTANT events (emotional and physical traumas, heartbreaks, divorces,
work-related events, diseases or traumas your mother had while being pregnant
with you, family stress, death in the family or of friends, disappointment,
etc.) Mention the symptoms experienced at those moments or which you can date to
those traumas.
50. When you stand in line at the bank or supermarket, how do you feel?
51. When your family member was last sick, what did you do?
52. How is your sexual energy?
53. How do you react to consolation?
54. What part of your life do you have the most difficulty coping with.
55. What are your hobbies?
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