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Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Acid foods upset
Get chilled often
“Lump” in throat
Dry mouth-eyes-nose
Pulse speeds after meal
Keyed up - fail to calm
Cut heals slowly
Gag easily
Unable to relax; startles easily
Extremities cold, clammy
Strong light irritates
Urine amount reduced
Heart pounds after retiring
Nervous stomach
Appetite reduced
Cold sweats often
Fever easily raised
Neuralgia-like pains
Staring, blinks little
Sour stomach often

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Joint stiffness on arising
Muscle-leg-toe cramps at night
“Butterfly” stomach, cramps
Eyes or nose water
Eyes blink often
Eyelids swollen, puffy
Indigestion soon after meals
Always seems hungry; feels “lightheaded” often
Digestion rapid
Vomiting frequent
Hoarseness frequent
Breathing irregular
Pulse slow; feels “irregular”
Gagging reflex slow
Difficulty swallowing
Constipation, diarrhea alternating
“Slow starter”
Get “chilled” infrequently
Perspire easily
Circulation poor, sensitive to cold
Subject to colds, asthma, bronchitis

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Eat when nervous
Excessive appetite
Hungry between meals
Irritable before meals
Get “shaky” before meals
Fatigue, eating relieves
“Lightheaded” if meals delayed
Heart palpitates if meals missed or delayed
Afternoon headaches
Overeating sweets upsets
Awaken after few hours sleep - hard to go back to sleep
Crave candy or coffee in afternoons
Moods of depression - “blues” or melancholy
Abnormal craving for sweets or snacks

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Hands and feet go to sleep easily, numbness
Sigh frequently, “air hunger”
Aware of “breathing heavily”
High altitude discomfort
Opens windows in closed rooms
Susceptible to colds and fevers
Afternoon “yawner”
Get “drowsy” often
Swollen ankles, worse at night
Muscle cramps, worse during exercise: get “charley horses”
Shortness of breath on exertion
Dull pain in chest or radiating into left arm, worse on exertion
Bruise easily, “black and blue” spots
Tendency to anemia
“Nose bleeds” frequent
Noises in head, or “ringing in ears”
Tension under the breastbone, or feeling of “tightness”, worse on exertion

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Dizziness
Dry skin
Burning feet
Blurred vision
Itching skin and feet
Excessive falling hair
Frequent skin rashes
Bitter, metallic taste in mouth in mornings
Bowel movements painful or difficult
Worrier, feels insecure
Feeling queasy; headache over eyes
Greasy foods upset
Stools light colored
Skin peels on foot soles
Pain between shoulder blades
Use laxatives
Stools alternate from soft to watery
History of gallbladder attacks or gallstones
Sneezing attacks
Dreaming, nightmare type bad dreams
Bad breath (halitosis)
Milk products cause distress
Sensitive to hot weather
Burning or itching anus
Crave sweets

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Loss of taste for meat
Lower bowel gas several hours after eating
Burning stomach sensations, eating relieves
Coated tongue
Pass large amounts of foul-smelling gas
Indigestion 1/2-1 hour after eating; may be up to 3-4 hours
Mucous colitis or irritable bowel
Gas shortly after eating
Stomach “bloating” after eating

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Insomnia
Nervousness
Can’t gain weight
Intolerance to heat
Highly emotional
Flush easily
Night sweats
Thin, moist skin
Inward trembling
Heart palpitates
Increased appetite without weight gain
Pulse fast at rest
Eyelids and face twitch
Irritable and restless
Can’t work under pressure

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Increase in weight
Decrease in appetite
Fatigue easily
Ringing in ears
Sleepy during day
Sensitive to cold
Dry or scaly skin
Constipation
Mental sluggishness
Hair coarse, falls out
Headaches upon arising, wear off during day
Slow pulse, below 65
Frequency of urination
Impaired hearing
Reduced initiative

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Failing memory
Low blood pressure
Increased sex drive
Headaches, “splitting or rending” type
Decreased sugar tolerance

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Abnormal thirst
Bloating of abdomen
Weight gain around hips or waist
Sex drive reduced or lacking
Tendency to ulcers, colitis
Increased sugar tolerance
Women: menstrual disorders
Young girls: lack of menstrual function

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Dizziness
Headaches
Hot flashes
Increased blood pressure
Hair growth on face or body (female)
Sugar in urine (not diabetes)
Masculine tendencies (female)

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Weakness, dizziness
Chronic fatigue
Low blood pressure
Nails weak, ridged
Tendency to hives
Arthritic tendencies
Perspiration increased
Bowel disorders
Poor circulation
Swollen ankles
Crave salt
Brown spots or bronzing of skin
Allergies - tendency to asthma

Rows	1 (Mild)	2 (Moderate)	3 (Severe)
Muscle weakness
Lack of stamina
Drowsiness after eating
Muscular soreness
Rapid heartbeat
Hyper-irritable
Feeling of a band around your head
Melancholia (feeling of sadness)
Swelling of ankles
Diminished urination
Tendency to consume sweets or carbohydrates
Muscle spasms
Blurred vision
Loss of muscular control
Numbness
Night sweats
Rapid digestion
Sensitivity to noise
Redness of palms of hands and bottom of feet
Visible veins on chest and abdomen
Hemorrhoids
Apprehension (feeling that something bad will happen)
Nervousness causing loss of appetite
Nervousness with indigestion
Gastritis
Forgetfulness
Thinning hair