First questionnaire | |||||
We would like to know more about any problems you have experienced recently. Please answer all of the questions by marking the answer that most closely applies to you. Question 1–6: 0: disagree strongly, 1: disagree, 2: agree, 3: agree strongly | |||||
Condition | 0 | 1 | 2 | 3 | |
1. My face is pale or yellowish | |||||
2. I have a feeling of fullness in my stomach after eating | |||||
3. I have indigestion | |||||
4. My stool is loose | |||||
5. I usually feel tired or languid | |||||
6. I have a poor appetite and eat just a little food | |||||
7. I have a thin body (According to BMI): 0:≥22, 1:≥20,<22, 2:≥18.5, <20.0, 3:≤18.5) *BMI=weight (kg)/(height (cm)×height (cm)) | |||||
- Scores≥11 → Do not need to complete second questionnaire. - Scores<10 → Complete second questionnaire. | |||||
Second questionnaire | |||||
Question 1-5: Please answer all of the questions by marking the answer that most closely describes your symptoms over the last 2 weeks. | |||||
Question 1. Aversion to cold or heat | 1 □ | 2 □ | 3 □ | 4 □ | 5 □ |
I have had considerable aversion to cold | I have had slight aversion to cold | Normal | I have had slight aversion to heat | I have had considerable aversion to heat | |
Question 2. Preference for warm or cold water | 1 □ | 2 □fidentiality of their persona | 3 □ | 4 □ | 5 □ |
I have had considerable preference for warm water | I have had slight preference for warm water a little | Normal | I have had slight preference for cold water | I have had considerable preference for cold water | |
Question 3. Colour of face | 1 □ | 2 □ | 3 □ | 4 □ | 5 □ |
My face has been very pale | My face has been a little pale | Normal | My face has been flushed a little | My face has been flushed very much | |
Question 4. Shape and consistency of stool | 1 □ | 2 □ | 3 □ | 4 □ | 5 □ |
Liquid consistency with no solid pieces | Soft blobs with clear-cut edges | Smooth, soft, and sausage-like | Lumpy sausage shaped or sausage-like with cracks in the surface | Separate hard lumps | |
Question 5. Colour of urine | 1 □ | 2 □ | 3 □ | 4 □ | 5 □ |
Completely transparent with no yellow colour | Almost transparent with little yellow colour | Light yellow | Yellow | Dark yellow or light orange colour | |
Question 6–7: Clinician’s assessment questions | |||||
Question 6. Clinician checks the score after enquiring about the colour and viscosity of rhinorrhoea | 1 □ | 2 □ | 3 □ | 4 □ | 5 □ |
Totally watery and transparent | Slightly watery and transparent | Slightly sticky and transparent | Slightly sticky and yellowish | Totally sticky and yellowish | |
Question 7. Clinician checks the score after observing the nasal membrane colour of the patient using nasal endoscopy and referring to the pictures. | 1 □ | 2 □ | 3 □ | 4 □ | 5 □ |
Severe pale | Mild pale | Normal | Mild hyperaemia | Severe hyperaemia |
Pattern identificaiton:
Lung–cold: first questionnaire scores<10, second questionnaire score ≥21.
Spleen qi deficiency: first questionnaire scores ≥11.
Lung-heat: first questionnaire scores<10, second questionnaire score ≥7,<20.