Academic Medical Center, Inc.

Have your health evaluated by a doctor professionally trained in Traditional Chinese Medicine for a minimal fee of $40.

Please fill in and submit the evaluation form below. After you have paid the minimal fee of $40, a licensed Traditional Chinese Medicine doctor will evaluate your health and recommend the herbal remedies that best suit you and your condition. You may purchase these herbal remedies from us or from other sources. Please be patient; the evaluation may take from 1-5 days.

According to the HIPAA laws, no one may reveal or solicit patient's medical information in public. We will keep patient's information confidential.

First name:

Last name:

Gender:
Male
Female

Date of Birth (mm/dd/yyyy):

Marriage Status:
Single
Married
Divorced
Widowed

Occupation:

Weight:

Height:

Address: City:

State or Province:

Zip Code or Postal Code:

Country:

Email:

Telephone: Fax:

What is your main concern for this consultation? Any information will be helpful to the doctor in the evaluation.

Have you seen a physician or Traditional Chinese Medicine doctor for this condition? What is the diagnosis?

Have you taken any prescribed medicine or herbal remedies for this condition? If so, please provide the name, dosage, and the effects, if any.

Do you have any of the following?

Diabetes:
Yes, Blood Sugar Level:
No
Not sure

High Cholesterol:

Yes, Cholesterol Level:
No
Not sure

High Blood Pressure:

Yes, Blood Pressure Level:
No
Not sure

Risk of Stroke:

Yes, Date of Last Stroke:
No
Not sure

Heart Disease:

Yes. Please specify:
No
Not sure

Kidney Disease:

Yes. Please specify:
No
Not sure

Liver Disease:

Yes. Please specify:
No
Not sure

Do you have any other major medical conditions? If so, provide them in the box below.

Do you have any of the following conditions? Choose all that apply:

Pain:
Distending Pain
Bursting Pain
Heaviness Pain
Stabbing Pain
Dull Pain
Angina (colic)
Tic Pain
Burning Pain
Cold Pain
Emptiness Pain
Throbbing Pain
Rebounding Pain
Bearing-down Pain
Coagulating Pain
Dragging Pain
Referred Pain
Radiating Pain
Wandering Pain
Slight Pain
Soreness Pain
Numbness Pain
Stiffness Pain
Spasm Pain
Localized Pain
Tenderness
Pressing Pain
Desire for pressure while in pain
Detesting of pressure while in pain
Desire for cold compress
Desire for fomentation

Chills and Fever? (Choose all that apply:
Aversion to cold with fever
Aversion to cold as cold water sprinkling over body
Furling Fever
Heavy aversion to cold with light fever
Heavy fever with light aversion to cold
Fever with aversion to wind
Alternating onset in chills and fever
Alternating in shiver and ardert fever
Relief of fever after sweating and continued relapse
Prolonged unrecovery
Fever without chill
High fever
Low fever
Prolonged low fever
Morning Fever
Afternoon Fever
Afternoon hectic fever
Night high fever
Feverish sensation to the head
Feverish sensation of the five centers
Feverish sensation over palm or sole
Hot feeling on the dorsum of the hands or feet
Recessive fever
Hectic fever due to Yin-deficiency (bone-heat syndrome)
Prolonged Fever
Autopsychic fever under normal temperature
Chill without fever
Acrohypothermia
Cold hands or feet
Deadly cold hands or feet
Chilly sensation of back
Cold sensation of back (as if ice is covering back)

Perspiration (Sweat)?
Intolerance to cold without sweating
Aversion to wind with sweating
Perspiration following chills
Profuse perspiration
Sweating as steaming
Continuous sweating
Spontaneous perspiration
Night sweat
Clammy sweat
Warm perspiration
Sweating on the forehead
Greasy sweating
Yellowish perspiration
Cold limbs after sweating
Sweating but without relief of fever
Morbid perspiration over the head
Morbid perspiration over the chest
Perspiration around the external genitals
Perspiration over the hands or feet
Sweating during activities
Sweating over left side of body
Sweating over right side of body
Sweating over lower half of body
Sweating over left uper limb
Sweating over right upper limb
Sweating over left lower limb
Sweating over right lower limb

Conditions of the Head and Body?:
General headache
Bilateral headache
Migranous headache
Helmet headache
Frontal headache
Occipital headache
Occipital headache referring to neck and back
Parietal headache
Stiffness and pain of the neck and head
Heaviness of head
Dizziness
Vertigo
Intense headache and splitting flaccidity of neck
Feeling of distention in the head
Feverish sensation over the head
Involuntary head shaking or twitching
Seborrheic dermatitis
Sounding inside the head
Fracture of the skull or cranial bone
Feeling of numbness on the scalp

Face and Eye:
Itching of the face
Numbness of the face
Feverish sensation over cheeks or behind ear
Dryness and uneasy feeling of the eye
Photophobia
Itching of the eye
Eyeball pain
Dimness of vision
Hypopsia
Diplopia (double vision)
Photism
Night blindness
Supra-orbital pain
Infra-orbital pain
Maxillary pain
Mandibular pain

Lips, Tongue, and Teeth:
Itching of lips
Numbness of lips
Loss of sensation of lips
Swollen lips
Trembling lips
Exfoliative inflammation of lips
Lockjaw
Chapped lips
Dry lips
Cyanosis of lips
Itching of the tongue
Numbness of the tongue
Swollen tongue
Pain in tongue
Toothache
Cold feeling of the tooth
Feebleness of the tooth
Bleeding gums
Gingivitis

Ear, Nose, and Throat:
Ringing in the ear
A nosie in the ear as chipring, roaring, ringing
Hard of hearing
Deafness
Poor auditory acuity
Sudden loss of auditory acuity
Gradual loss of auditory acuity
Earache
Itching in ear
Heavy discharge from ear
Heavy earwax
Foreign body in ear
Bleeding of ear
Stuffy nose
Itching nose
Itching over tip of nose
Pain of nose
Dry nasal cavity
Ozena
Thick and yellowish nasal discharge
Thin and whitish nasal discharge
Epsitaxis
Impairment of smell
Anosmia
Continued sneezing
Occasional sneezing
Sore throat
Dry throat
Itching throat
Congested throat
Swelling and pain in t hroat
Wheezing sounds
Obstruction of throat by sputum
Ulceration of the pharynx

Trunk and Limbs:
Ache or pain over the entire body
Pain of shoulder and back
Vague ache of the back and shoulder
Lassitude ache of the shoulder and arm
Pain on the scapular area
Debility of neck
Stiffness of nape
Stiffness of nape and back
Arthrodynia of the extremities
General weakness
Lassitude of limbs
Heaviness of limbs
General fatigue
Numbness of limbs
Cold clammy limbs
Spasms of limbs
Cramps of limbs
Edema of limbs
Flaccid paralysis of limbs
Redness, swelling, heat, and pain of the joints
Dyskinesia of the limbs
Localized arthralgia
Migratory arthralgia
Pain that is aggravated by cold and relived by heat
Pain that is aggravated by heat and relieved by cold
Paralysis of limbs
Weakness, limited movement, or muscular atrophy of limbs
Ankylosis
Arthrocele
Deformity of joints
Pain related to weather

Chest and Hypochondria:
Chest pain
Feeling of oppression in chest
Feeeling of fullness and dull pain in chest and upper abdomen
Chest and back pain
Feeling of fullness and oppression in the chest and hypochondria
Hypochondriac pain
Distending pain in the hypochondrium
Fullness and rigidity of the hypochondrium
Upset chest and hypochondria (vexation)
Palpitation
Severe palpitation
Violent palpitation with irritability
Palpitation with a feeling of pulling
Restlessness
Tachycardia
Heart attack
Heart diseases
Cardiac failure

Conditions of Gastric Cavity:
Stomachache
Anorexia (loss of appetite)
Frequent vomiting
Distended stomach
Upset stomach
Feeling of obstruction in upper abdomen
Epigastric distendign pain
Feeling of fullness and dull pain in the upper abdomen
Epigastric throb
Epigastric pain
Nausea
Fullness and oppression of upper abdomen
Feeling of emptiness, burning, and uneasiness in upper abdomen
Acid regurgitation
Eructation with foul odor
Eructation
Hiccup
Vomiting
Billious vomiting
Hematemesis
Regurgitation of milk
Pain while eating
Pain in anti cibum before meal
Pain when hungry
Pain in post cibum
Desire for cold drinks
Desire for hot drinks

Abdomen:
Fullness of abdomen, flatulence
Abdominal pain
Borborygmus
Mass in the abdomen

Lower back:
Lumbago
Pain of the back and loin
Pain along the spinal column
Lumbosacral pain
Cool feeling on lower back
Weak feeling in loin
Limp feeling in loin
Pain of the waist and lower extremities
Pain on the left lower back or right lower back that radiates downward

Sleep:
Difficulty falling asleep
Sleeplessness
Waking up early
Easily woken up
Sleep drunkenness
Dreaminess
Night terrors
Nightmares
Sleep-talking
Sleep-walking
Restlessness (Fidgeting)at night, peace during the day
Sleepiness in the daytime
Sleepiness
Drowsiness
Falling asleep quickly, but woken up easily
Half asleep daze

Mental State
Amnesia (forgetfulness)
Oversensitive (Oversuspicious)
Sentimental
Depression
Uncommunicative and melancholy
Dysphoria
Irritability
Paraphronia
Paraphobia
Hypersomnia
Sudden onsets of suffocating sensation
Paraphasia
Muteness
Mania
Demonstration with shouting or yelling
Tearing off clothes and running about
Smashing things and hitting people

Appetite and Taste:
Thirst and desire for drinking but vomiting immediately after drinking
Dryness of the mouth but only desire for gargling without swallowing
Hunger without desire to eat
Polyorexia
No desire for eating
Loss of apetite(anorexia)
Abdominal distension after meal
Bulemia
Normal appetite
Detesting greasy or sweet foods
Craving for unusual foods (sour food, pungent food, raw rice, soil)
Bitter taste in mouth
Foul breath
Flat taste in mouth
Sweet taste in mouth
Salty taste in mouth
Sour taste in mouth
Spoiled taste in mouth
Excessive secretion of saliva
Numbness of the mouth and lips
Normal sense of the mouth
Recent weight loss
Recent weight gain

Vomiting and Hiccups:
Nausea
Hiccups
Occassional onset of hiccups
Frequent onset of hiccups
Acute onset of hiccups
Chronic onset of hiccups
Eructation
Vomiting after meals
Evening vomiting with vomitus containing food eaten from morning
Morning vomiting with vomitus containing food eaten the previous night
Vomiting of food
Vomiting of fluids
Vomiting of bitter (bilious) fluid
Vomiting of phlegm
Regurgitation of milk
Hematemesis
Vomit with blood
Copremesis
Sour regurgitation

Urination and Defacation:
Constipation
Coprastasis
Dry stool
Dyschesia
Dry stool followed by loose stool
Loose stool and malaise of anus
Stool burning anus
Constipation with occassional watery discharge
Impotency in defecation (Severe rectal tenesmus)
Diarrhea after abdominal pain
Sudden onset of watery diarrhea
Watery diarrhea with ingested food in stool
Fluid stools containing undigested food
Diarrhea with purulent and bloody discharge
Tenesmus
Watery diarrhea
Diarrhea before dawn
Defecation ocne each day
Defecation several times each day
Defecation once every two or several days
Loose and unformed stool
Diarrhea with water in stool
Diarrhea with yellow rottenness
Diarrhea with sour rotten foul filthy discharge
Tarry stool
Discharged of feces followed by blood
Discharge of blood followed by feces
Burning sensation in anus during defecation
Tenesmus sensation in anus or prolapse of anus
Encopresis
Clear urine
Oliguria with reddish urine
Turbid urine
Yellowish or reddish urine
Deep colored urine
Cloudy white urine
Urination with burning sensation
Ardor urinae
Difficulty and pain in micturition
Irritable bladder
Emergency of micturition
Dripping discharge of urine
Difficulty in micturition
Retention of urine
Oliguria
Incontinence of urine
Bed wetting
Involuntary discharge of urine when sleeping at night
Polyuria with watery urine
Polyuria
Polyuria at night
Small urinary stream
Blood in urine

Anterior and Posterior Orifice:
Vilvitis
Cold feeling of external genitals
Swelling of female pudendum
Prolapse of uterus
Ulceration of external genitals
Pruritus of female pudendum
Vaginal bleeding
Abnormally prolonged erection of the penis
Inguinal hernia dropping to the scrotum
Flaccid constriction of the penis
Tinea inguinalis
Impotence
Seminal emission (weat dreams, emission)
Nocturnal emission
Premature ejaculation
Prolonged erection of penis with spontaneous emission
Shrinkage of scrotum
Wetness of scrotum
Pruritus of scrotum
Painful and swollen testes
Orchialgia
Testicular atrophy
Pain of the lower abdomen referring to the testes
Pain of the anus
Anal fissure
Perianal abscess
Anal fistula
Prolapse of rectum

Women Only

Menstruation and Leukorrhea:
Polymenorrhea (Preceded menstrual period)
Delayed or infrequent menstrual period
Irregular mensturation
Menostaxis (Prolonged menstrual period)
Short menstrual period
Profuse menstruation
Scanty menstruation
Oligomenorrhea
Light colored menses
Bright red menses
Deep red menses
Purple red colored menses
Lump menses
Difficult menstruation
Abdominal pain before, during, or after menstruation
Lumbosacral pain before, during, or after menstration
Mania before, during, or after menstruation
Delirium before, during, or after menstruation
Fever before, during, or after menstruation
Vomiting before, during, or after menstration
Edema before, during, or after menstruation
Hematemesis before, during, or after menstruation
Retrograde menstruation
Hemafecia before, during, or after menstruation
Bodily pain before, during, or after menstruation
Diarrhea before, during, or after menstration
Epistaxis and hematemesis before, during, or after mensturation
Amenorrhea (suppressed menstruation)
Amenorrhea accompanied with edema
Latent menstruation
Thin leukorrhagia
Thick leukorrhagia
Whitish abnormal vaginal discharge
Greenish abnormal vaginal discharge
Reddish abnormal vaginal discharge
Leukorrhagia with reddish and whitish discharge
Leukorrhea with yellowish discharge
Foul smelling leukorrhea
Leukorrhea

If you have any other conditions that were not stated above, please list them below:

Have you paid the $40 fee for this consultation?
Yes.
No.
Waived fee.


☛Home ☛About Us ☛Contact Us ☛Driving Direction ☛Consultation ☛Practice ☛Product Herbal Medicine ☛Research ☛Academic Publishing-General ☛Academic Publishing-Professional ☛Academic Publishing-Chronomedicine ☛Academic Publishing-Holographic Biomedicine ☛Education ☛International Medical Academic Exchanges ☛Trading of Health Devices ☛Services ☛Sales Promotions ☛Testimonials ☛Videos ☛USA Transfer Factor Sale	Traditional Chinese Medicine Consultation Have your health evaluated by a doctor professionally trained in Traditional Chinese Medicine for a minimal fee of $40. Please fill in and submit the evaluation form below. After you have paid the minimal fee of $40, a licensed Traditional Chinese Medicine doctor will evaluate your health and recommend the herbal remedies that best suit you and your condition. You may purchase these herbal remedies from us or from other sources. Please be patient; the evaluation may take from 1-5 days. According to the HIPAA laws, no one may reveal or solicit patient's medical information in public. We will keep patient's information confidential. First name: Last name: Gender: Male Female Date of Birth (mm/dd/yyyy): Marriage Status: Single Married Divorced Widowed Occupation: Weight: Height: Address: City: State or Province: Zip Code or Postal Code: Country: Email: Telephone: Fax: What is your main concern for this consultation? Any information will be helpful to the doctor in the evaluation. Have you seen a physician or Traditional Chinese Medicine doctor for this condition? What is the diagnosis? Have you taken any prescribed medicine or herbal remedies for this condition? If so, please provide the name, dosage, and the effects, if any. Do you have any of the following? Diabetes: Yes, Blood Sugar Level: No Not sure High Cholesterol: Yes, Cholesterol Level: No Not sure High Blood Pressure: Yes, Blood Pressure Level: No Not sure Risk of Stroke: Yes, Date of Last Stroke: No Not sure Heart Disease: Yes. Please specify: No Not sure Kidney Disease: Yes. Please specify: No Not sure Liver Disease: Yes. Please specify: No Not sure Do you have any other major medical conditions? If so, provide them in the box below. Do you have any of the following conditions? Choose all that apply: Pain: Distending Pain Bursting Pain Heaviness Pain Stabbing Pain Dull Pain Angina (colic) Tic Pain Burning Pain Cold Pain Emptiness Pain Throbbing Pain Rebounding Pain Bearing-down Pain Coagulating Pain Dragging Pain Referred Pain Radiating Pain Wandering Pain Slight Pain Soreness Pain Numbness Pain Stiffness Pain Spasm Pain Localized Pain Tenderness Pressing Pain Desire for pressure while in pain Detesting of pressure while in pain Desire for cold compress Desire for fomentation Chills and Fever? (Choose all that apply: Aversion to cold with fever Aversion to cold as cold water sprinkling over body Furling Fever Heavy aversion to cold with light fever Heavy fever with light aversion to cold Fever with aversion to wind Alternating onset in chills and fever Alternating in shiver and ardert fever Relief of fever after sweating and continued relapse Prolonged unrecovery Fever without chill High fever Low fever Prolonged low fever Morning Fever Afternoon Fever Afternoon hectic fever Night high fever Feverish sensation to the head Feverish sensation of the five centers Feverish sensation over palm or sole Hot feeling on the dorsum of the hands or feet Recessive fever Hectic fever due to Yin-deficiency (bone-heat syndrome) Prolonged Fever Autopsychic fever under normal temperature Chill without fever Acrohypothermia Cold hands or feet Deadly cold hands or feet Chilly sensation of back Cold sensation of back (as if ice is covering back) Perspiration (Sweat)? Intolerance to cold without sweating Aversion to wind with sweating Perspiration following chills Profuse perspiration Sweating as steaming Continuous sweating Spontaneous perspiration Night sweat Clammy sweat Warm perspiration Sweating on the forehead Greasy sweating Yellowish perspiration Cold limbs after sweating Sweating but without relief of fever Morbid perspiration over the head Morbid perspiration over the chest Perspiration around the external genitals Perspiration over the hands or feet Sweating during activities Sweating over left side of body Sweating over right side of body Sweating over lower half of body Sweating over left uper limb Sweating over right upper limb Sweating over left lower limb Sweating over right lower limb Conditions of the Head and Body?: General headache Bilateral headache Migranous headache Helmet headache Frontal headache Occipital headache Occipital headache referring to neck and back Parietal headache Stiffness and pain of the neck and head Heaviness of head Dizziness Vertigo Intense headache and splitting flaccidity of neck Feeling of distention in the head Feverish sensation over the head Involuntary head shaking or twitching Seborrheic dermatitis Sounding inside the head Fracture of the skull or cranial bone Feeling of numbness on the scalp Face and Eye: Itching of the face Numbness of the face Feverish sensation over cheeks or behind ear Dryness and uneasy feeling of the eye Photophobia Itching of the eye Eyeball pain Dimness of vision Hypopsia Diplopia (double vision) Photism Night blindness Supra-orbital pain Infra-orbital pain Maxillary pain Mandibular pain Lips, Tongue, and Teeth: Itching of lips Numbness of lips Loss of sensation of lips Swollen lips Trembling lips Exfoliative inflammation of lips Lockjaw Chapped lips Dry lips Cyanosis of lips Itching of the tongue Numbness of the tongue Swollen tongue Pain in tongue Toothache Cold feeling of the tooth Feebleness of the tooth Bleeding gums Gingivitis Ear, Nose, and Throat: Ringing in the ear A nosie in the ear as chipring, roaring, ringing Hard of hearing Deafness Poor auditory acuity Sudden loss of auditory acuity Gradual loss of auditory acuity Earache Itching in ear Heavy discharge from ear Heavy earwax Foreign body in ear Bleeding of ear Stuffy nose Itching nose Itching over tip of nose Pain of nose Dry nasal cavity Ozena Thick and yellowish nasal discharge Thin and whitish nasal discharge Epsitaxis Impairment of smell Anosmia Continued sneezing Occasional sneezing Sore throat Dry throat Itching throat Congested throat Swelling and pain in t hroat Wheezing sounds Obstruction of throat by sputum Ulceration of the pharynx Trunk and Limbs: Ache or pain over the entire body Pain of shoulder and back Vague ache of the back and shoulder Lassitude ache of the shoulder and arm Pain on the scapular area Debility of neck Stiffness of nape Stiffness of nape and back Arthrodynia of the extremities General weakness Lassitude of limbs Heaviness of limbs General fatigue Numbness of limbs Cold clammy limbs Spasms of limbs Cramps of limbs Edema of limbs Flaccid paralysis of limbs Redness, swelling, heat, and pain of the joints Dyskinesia of the limbs Localized arthralgia Migratory arthralgia Pain that is aggravated by cold and relived by heat Pain that is aggravated by heat and relieved by cold Paralysis of limbs Weakness, limited movement, or muscular atrophy of limbs Ankylosis Arthrocele Deformity of joints Pain related to weather Chest and Hypochondria: Chest pain Feeling of oppression in chest Feeeling of fullness and dull pain in chest and upper abdomen Chest and back pain Feeling of fullness and oppression in the chest and hypochondria Hypochondriac pain Distending pain in the hypochondrium Fullness and rigidity of the hypochondrium Upset chest and hypochondria (vexation) Palpitation Severe palpitation Violent palpitation with irritability Palpitation with a feeling of pulling Restlessness Tachycardia Heart attack Heart diseases Cardiac failure Conditions of Gastric Cavity: Stomachache Anorexia (loss of appetite) Frequent vomiting Distended stomach Upset stomach Feeling of obstruction in upper abdomen Epigastric distendign pain Feeling of fullness and dull pain in the upper abdomen Epigastric throb Epigastric pain Nausea Fullness and oppression of upper abdomen Feeling of emptiness, burning, and uneasiness in upper abdomen Acid regurgitation Eructation with foul odor Eructation Hiccup Vomiting Billious vomiting Hematemesis Regurgitation of milk Pain while eating Pain in anti cibum before meal Pain when hungry Pain in post cibum Desire for cold drinks Desire for hot drinks Abdomen: Fullness of abdomen, flatulence Abdominal pain Borborygmus Mass in the abdomen Lower back: Lumbago Pain of the back and loin Pain along the spinal column Lumbosacral pain Cool feeling on lower back Weak feeling in loin Limp feeling in loin Pain of the waist and lower extremities Pain on the left lower back or right lower back that radiates downward Sleep: Difficulty falling asleep Sleeplessness Waking up early Easily woken up Sleep drunkenness Dreaminess Night terrors Nightmares Sleep-talking Sleep-walking Restlessness (Fidgeting)at night, peace during the day Sleepiness in the daytime Sleepiness Drowsiness Falling asleep quickly, but woken up easily Half asleep daze Mental State Amnesia (forgetfulness) Oversensitive (Oversuspicious) Sentimental Depression Uncommunicative and melancholy Dysphoria Irritability Paraphronia Paraphobia Hypersomnia Sudden onsets of suffocating sensation Paraphasia Muteness Mania Demonstration with shouting or yelling Tearing off clothes and running about Smashing things and hitting people Appetite and Taste: Thirst and desire for drinking but vomiting immediately after drinking Dryness of the mouth but only desire for gargling without swallowing Hunger without desire to eat Polyorexia No desire for eating Loss of apetite(anorexia) Abdominal distension after meal Bulemia Normal appetite Detesting greasy or sweet foods Craving for unusual foods (sour food, pungent food, raw rice, soil) Bitter taste in mouth Foul breath Flat taste in mouth Sweet taste in mouth Salty taste in mouth Sour taste in mouth Spoiled taste in mouth Excessive secretion of saliva Numbness of the mouth and lips Normal sense of the mouth Recent weight loss Recent weight gain Vomiting and Hiccups: Nausea Hiccups Occassional onset of hiccups Frequent onset of hiccups Acute onset of hiccups Chronic onset of hiccups Eructation Vomiting after meals Evening vomiting with vomitus containing food eaten from morning Morning vomiting with vomitus containing food eaten the previous night Vomiting of food Vomiting of fluids Vomiting of bitter (bilious) fluid Vomiting of phlegm Regurgitation of milk Hematemesis Vomit with blood Copremesis Sour regurgitation Urination and Defacation: Constipation Coprastasis Dry stool Dyschesia Dry stool followed by loose stool Loose stool and malaise of anus Stool burning anus Constipation with occassional watery discharge Impotency in defecation (Severe rectal tenesmus) Diarrhea after abdominal pain Sudden onset of watery diarrhea Watery diarrhea with ingested food in stool Fluid stools containing undigested food Diarrhea with purulent and bloody discharge Tenesmus Watery diarrhea Diarrhea before dawn Defecation ocne each day Defecation several times each day Defecation once every two or several days Loose and unformed stool Diarrhea with water in stool Diarrhea with yellow rottenness Diarrhea with sour rotten foul filthy discharge Tarry stool Discharged of feces followed by blood Discharge of blood followed by feces Burning sensation in anus during defecation Tenesmus sensation in anus or prolapse of anus Encopresis Clear urine Oliguria with reddish urine Turbid urine Yellowish or reddish urine Deep colored urine Cloudy white urine Urination with burning sensation Ardor urinae Difficulty and pain in micturition Irritable bladder Emergency of micturition Dripping discharge of urine Difficulty in micturition Retention of urine Oliguria Incontinence of urine Bed wetting Involuntary discharge of urine when sleeping at night Polyuria with watery urine Polyuria Polyuria at night Small urinary stream Blood in urine Anterior and Posterior Orifice: Vilvitis Cold feeling of external genitals Swelling of female pudendum Prolapse of uterus Ulceration of external genitals Pruritus of female pudendum Vaginal bleeding Abnormally prolonged erection of the penis Inguinal hernia dropping to the scrotum Flaccid constriction of the penis Tinea inguinalis Impotence Seminal emission (weat dreams, emission) Nocturnal emission Premature ejaculation Prolonged erection of penis with spontaneous emission Shrinkage of scrotum Wetness of scrotum Pruritus of scrotum Painful and swollen testes Orchialgia Testicular atrophy Pain of the lower abdomen referring to the testes Pain of the anus Anal fissure Perianal abscess Anal fistula Prolapse of rectum Women Only Menstruation and Leukorrhea: Polymenorrhea (Preceded menstrual period) Delayed or infrequent menstrual period Irregular mensturation Menostaxis (Prolonged menstrual period) Short menstrual period Profuse menstruation Scanty menstruation Oligomenorrhea Light colored menses Bright red menses Deep red menses Purple red colored menses Lump menses Difficult menstruation Abdominal pain before, during, or after menstruation Lumbosacral pain before, during, or after menstration Mania before, during, or after menstruation Delirium before, during, or after menstruation Fever before, during, or after menstruation Vomiting before, during, or after menstration Edema before, during, or after menstruation Hematemesis before, during, or after menstruation Retrograde menstruation Hemafecia before, during, or after menstruation Bodily pain before, during, or after menstruation Diarrhea before, during, or after menstration Epistaxis and hematemesis before, during, or after mensturation Amenorrhea (suppressed menstruation) Amenorrhea accompanied with edema Latent menstruation Thin leukorrhagia Thick leukorrhagia Whitish abnormal vaginal discharge Greenish abnormal vaginal discharge Reddish abnormal vaginal discharge Leukorrhagia with reddish and whitish discharge Leukorrhea with yellowish discharge Foul smelling leukorrhea Leukorrhea If you have any other conditions that were not stated above, please list them below: Have you paid the $40 fee for this consultation? Yes. No. Waived fee.
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Traditional Chinese Medicine Consultation