TCM Questionnaire Health Assessment
Please answer the following questions by checking which of the statements most relate to you right now, or in the past regarding your health. Please do not over analyzing as you answer them and answer them as truthfully as possible.
Email address
HEAT
Fire
Earth
Metal
Water
Wood
Total number of checks in this section
Your answer
Which element has the most checks?
COLD
Fire
Earth
Metal
Water
Wood
Total number of checks in this section
Your answer
Which element has the most checks?
STAGNATION
Fire
Earth
Metal
Water
Wood
Total number of checks in this section
Your answer
Which element has the most checks?
During which season have you completed the questionnaire?
Additional
Interpreting the Questionnaire
When you have completed the assessment notice which states hot, cold or stagnate you have most checked. When you discover you have the most checked in heat, this would indicate there is too much heat in the internal organs and systems. There is likely inflammation and some kind of chronic discomfort that you feel intermittently. When there is heat, it is better to consume foods that are more cooling, and less cooked and relaxing in nature. Cinnamon and Pepper for example would be too stimulating and warming.

Where if you have found that you have the most checked in Cold, I would recommend you do eat more cooked foods- and include more warming and stimulating foods, in the category of earth and root vegetables with aromatic herbs and spices like cinnamon and ginger. This will warm things up and improve an under-functioning system, whether it be in your digestion or your sex life.

When you find there are the most checked in Stagnation there is likely a toxicity overload. There may be an overgrowth of bacteria, like in Candida Albicans, or a fungal infection, a parasite or a lingering virus. When these hosts settle into the system signs of stagnation, and chronic health concerns have surely surfaced.

Please utilize this assessment as a stepping stone to better understand your present health. This is by no means a diagnosis, but an information gathering questionnaire and a tool to help you, and or your health care practitioner to guide you on your path to health and wholeness. OM. Please contact Dharani Healing Arts for more information or to book an appointment to follow up with this guidance.

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