Five Element Theory Questionnaire

According to traditional Chinese philosophy, we are surrounded by five constantly moving and changing energy fields: earth, wood, fire, metal and water. Oriental Medicine uses this time-tested, diagnostic model to analyze how the various parts of a person's body and mind interact to affect health. Check the symptoms/illnesses you have recently experienced in the last 6 months. Often, people will have a predominance of symptoms in one of the elemental categories. This is an indication of an imbalance and should be addressed.

WATER	WOOD	FIRE	EARTH	METAL
Swollen Ankles	Anemia	Angina Pains	Clammy Hands	Bronchitis
Burning with Urination	Bitter Taste in Mouth	Anxiety	Lack of Appetite	Cough
Frequent Urination	Difficulty Digesting Oily or Fatty Foods	Frequent Crying	Low Blood Sugar	Chest Congestion
Frequent Urination at Night	Difficulty Making Plans or Decisions	Heat Intolerance	Belching or Burping	Shortness of Breath
Urine Retention	Easily Angered or Agitated	Nervousness	Sweet Cravings	Decreased Sense of Smell
Painful Urination	Eye Problems (tearing, itching, blurred vision)	Nightmares	Loose Stools or Undigested Food	Feeling of Claustrophobia
Kidney Stones	Gall Stones	Poor Memory	Afternoon Slump	Fever
Cold Intolerance	Hemorrhoids	Irregular Heart Rate	Nausea	Frequent Sore Throats
Decreased Sex Drive	Hepatitis	Pressure in Chest	Drowsiness	Asthma
Hair Loss	High Cholesterol	Easily Excitable	Tendency to be "Obsessive"	Nasal Problems
Knee Problems	Impatience	Mental Confusion	Fatigue after a Meal	Recent Use of Antibiotics
Night Sweats	Depression	Insomnia	Food Sensitivity	Frequent Colds
Fearful	Light-colored Stools		Easily Bruised	Chills
Ringing in Ears	Pain Under Ribs		Indigestion	Constipation
Burning Hands or Feet	Soft/Brittle Nails		Vomiting	Blood in Stool
Blood in Urine	Spasm or Twitching Muscles		Tendency to Worry	Inhalation of Toxic Chemicals
Low Blood Pressure	Stiff Neck/ Shoulders		Bloating	Swollen Lymph Glands
Salt Craving	Tightness in Ribs			Allergies
Stress	Varicose Veins			Infections
Sleeplessness	Anger			Chronic Illness
Dizziness	High Blood Pressure			Sweating without Exercise
Dark Circules Under Eyes	Fever Blisters			Intolerant to Weather Changes
Low Back Pain
Hearing Impairment
Afternoon Fever