Self Evaluation Health Form

July 10, 2018

If you have any below issue, I may help you with Chinese Medicine (acupuncture and herbs).  


Head: Foggy, ache, poor memory

Eye: Dry, red, blurry

Ear: Tinnitus, hearing loss

Nose: Congestion, allergy, wheezing

Mouth: Dry, thirsty, bitter taste, ulcer or canker sore, sticky, bad breath

Body: Itchy skin, numbing on certain part



Liver: dizziness, vertigo, red eye, blurry vision, tinnitus, irritable, anger, depression, timidity, insomnia, excessive dream, bitter taste in mouth, rib pain, numbness, shaking, spasm, high blood pressure, timidity, indecisive


Heart: palpitation, irregular heart beat, heavy in the chest, chest pain, shortness of breath, insomnia, timidity, canker sore


Spleen: poor appetite, indigestion, bloated stomach, acid regurgitation, hipcup, belching, diarrhea, constipation, shortness of breath, weak arm and leg, dizzy, heavy feeling, overweight, insomnia, excessive dream, phlegm, dry mouth and thirsty, bruise easily, overthinking, worrying


Lung: shortness of breath, heavy chest, spontaneous sweat, phlegm, sentimental, allergy to pollen, asthma, dry mouth, dry skin, thirsty, grief


Kidney: sore knee and lower back, arthritis, dry mouth and thirsty, nocturnal emission, night sweat, infertility, impotence, low sex drive, hair thinning or loss (with dry or oily scalp), edema, cold hands and feet, hot hands and feet, poor memory, difficulty focusing, fear, blurry vision, loose teeth, shortness of breath, fear


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