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Learn Your Imbalances According to Chinese Medicine!

Important Directions! Please Read

-You CAN skip questions that are unrelated to you.

-You will be able to view your scores immediately after completion through a link provided

-There are three separate sections to complete. A link for Part 2 will be provided at the end of Part 1 and so on.

Most people are able to discern what problems they have and are able to report them. Often times people will think, "Why should I mention the ringing in my ears when I really am worried about my back pain?" In Chinese medicine, the ringing in the ears helps to determine where the back pain is, or is not, originating from. Your results will be better with accurate information inputs.

Disclaimer

The results of this questionnaire do not constitute a diagnosis. The questionnaire is designed for you to better understand "patterns" of imbalance that you have according to Traditional Chinese Medicine.

This form does not address acute health conditions such as a viral or bacterial infection. Not intended for children or nursing or pregnant women.
Thank you!

Part 1-Earth Element Indications

Scores indicate level of Spleen Qi Deficiency as follows:
4-16 Moderate
18-32 Significant
34+ Severe

Apply the Earth Element Aroma Acu-stick® to Appropriate Points to Activate Acu-points and Initiate Healing! Buy sticks, find related points, and learn how Aroma Acu-therapy™ works here:

agelessherbs.com/earth-element-acupressure-stick/

I have been diagnosed as pre-diabetic and/or insulin resistance

2 points

yes

Clear selection

I have diabetes and am able to control it with diet and good lifestyle choices

2 points

yes

Clear selection

I am diabetic and depend on medication or insulin to balance my blood sugar levels

2 points

yes

Clear selection

I have hypoglycemia

2 points

yes

Clear selection

I crave sweets often

2 points

yes

Clear selection

I feel nauseated often

2 points

yes

Clear selection

I do not have a good appetite often

2 points

yes

Clear selection

My tongue is scalloped along the edges

2 points

yes

Clear selection

I vomit often

2 points

yes

Clear selection

I am obese

2 points

yes

Clear selection

I feel bloated after meals

2 points

yes

Clear selection

I have dull, achy lower abdominal pain

2 points

yes

Clear selection

My lower abdominal pain feels better when I apply heat or pressure

2 points

yes

Clear selection

I cannot digest fatty foods or fried foods well

2 points

yes

Clear selection

My body feels heavy

2 points

yes

Clear selection

My arms and legs feel heavy

2 points

yes

Clear selection

I have trouble getting out of bed in the morning, even after a full night's sleep

2 points

yes

Clear selection

I rethink things in my mind over and over

2 points

yes

Clear selection

I have weak, flabby muscles

2 points

yes

Clear selection

I bruise easily

2 points

yes

Clear selection

My muscles feel tender to the touch

2 points

yes

Clear selection

I have a prolapse of one or more organ: uterus, bladder, vaginal, etc

2 points

yes

Clear selection

I have a lot of spider veins

2 points

yes

Clear selection

I have varicose veins

2 points

yes

Clear selection

I sometimes have bleeding from hemorrhoids

2 points

yes

Clear selection

I do not feel emotionally grounded to the Earth

2 points

yes

Clear selection

I lack empathy for others

2 points

yes

Clear selection

I feel like no one cares about me

2 points

yes

Clear selection

I give too much of myself in the care of others

2 points

yes

Clear selection

I perspire easily, even without exercise

2 points

yes

Clear selection

My bowel movements are often loose often

2 points

yes

Clear selection

My bowel movements are shaped like balls often

2 points

yes

Clear selection

I have alternating constipation and diarrhea or IBS

2 points

yes

Clear selection

My bowel movements are sticky and hard to express often

2 points

yes

Clear selection

My ears fill with damp fluid often

2 points

yes

Clear selection

Submit

Clear form

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