sarithabijeesh on 2012-03-29
Patient ID: Sex: Age:
Please answer the following questions in a descriptive manner after careful analysis
and recollection of previous experiences and happenings.
1. Describe your main suffering?
2. What other physical sufferings do you have in your body?
3. What mental sufferings / feelings do you have associated with your physical
4. What exactly do you feel when you are at your worst?
5. When did it all start? Can you connect it to any past event or disease?
6. Which time of the day you are worst?
7. What are the things which aggravate your suffering and which are those which
ameliorate the same?
8. Do your think your sufferings have relation to any external stimuli (like, change of
place) or any internal biological changes in the body, like, menses (in females)?
9. When do you feel better, during hot weather or cold weather, humid or dry weather?
10. Describe your general mental set up? Are you Moody, Arrogant, Mild, Agreeable
Changeable, Nervous, Suspicious, Easily offended, Quiet, Arguing, Irritating, Lazy etc.
- How do you feel before or during a thunderstorm?
- Do you like being consoled during your tough times?
- Are you sensitive to external stimuli like smell, noise, light etc?
- Do you have any typical habit or gesture like nail biting, causeless
weeping, talking to one self etc?
- How do you feel about your friends, family, your children and especially your
husband / wife?
11. What are your fears and do you dream of any situation repeatedly?
12. What do you crave for in food items and what are your aversions?
13. How is your thirst: Less, Normal or Excessive?
14. How if your hunger: Less, Normal or Excessive?
15. Is there any kind of food which your body cant stand?
16. Is your sweat normal or less or more? Where does it sweat more: Head, Trunk or
17. How is your bowel movement and stool type?
18. How well do you sleep? Do you have a particular posture of sleeping?
19. Do you think you are able to satisfy your sexual desires in general?
20. How do you think you are different from others, if at all?
21. What medications have been taken earlier by you to treat the diseases and do you
have any particular symptom surfacing after the medication?
22. What major diseases are running in your family?
23. Describe, how do you look like? Describe your overall appearance
24. (ONLY FOR FEMALES)
Please answer the following questions:
(Please give details of your past menstruation if you have attained menopause.)
- Are the periods early, regular or late in general? How long do they last?
- Do you suffer from any kind of physical or mental discomfort before, during or after
- Is the flow scanty, normal or excessive?
- Is the blood thick bright red or pale watery?
- Do you notice any clots in the flow?
shouse_nsk last decade
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