Assessment First and Last Name(Required) Date(Required) Cold PatternsThe following are descriptions of a few common patterns that cause health, weight and emotional imbalances. Place a check mark beside symptoms you have experienced frequently in the last 9-12 months. Feeling cold Craving warmth Prefer hot foods and drinks Pale complexion Quiet, withdrawn, shy, introverted Depression Urine is pale or clear Stools generally loose Slow metabolism, hypothyroid Difficulty losing weight Frequent fatigue; apathy Muscles are soft/fleshy; not toned Physical Stiffness and inflexibility Poor circulation Arthritic pain General weakness; malaise Weak adrenals Anemia Weak digestion; gas and/or bloating Kidney or bladder problems Depressed mental function Heat Patterns Feeling too warm most of the time Uncomfortable in hot weather Craves cold drinks Prefers cooler temperatures Red face, ruddy complexion Loud voice Irritable outbursts of temper Voracious appetite Cravings for fatty, greasy foods Cravings for cold foods High blood pressure Headaches Sleep issues Memory loss Mental illness Eczema or psoriasis Hyperthyroid Red acnes, rashes Fever blisters, canker sores Urine is deep yellow or dark Nosebleeds Bleeding gums Restless sleep with disturbing dreams Mania Gum disease Bowel movements less than once daily Irregular or racing heartbeat Heart disease Stroke High cholesterol Confused speech; stuttering Gastric ulcers Excessive or no laughter Damp Patterns Overweight; difficulty losing weight Aversion to humid and wet weather Retain fluid especially in legs, ankles Feelings of heaviness, especially lower body Mental fuzziness; brain fog Menstrual problems Yeast problems; candidiasis Puffy face; creases beneath eyes Prone to respiratory infections Irritable Bowel Syndrome Colitis Sinus infections Hay fever Post nasal drip, runny nose, frequent colds Fatigue, sluggishness, chronic tiredness Abdominal bloating; feelings of fullness Hemorrhoids Bloating, indigestion Fixed joint pain Urinary tract problems Cloudy urine Varicose veins Rarely hungry Tendency to form lumps, masses Anal itching Prefers warm food and hot, spicy food Easily short of breath Dislike exercise Chapped, cracked, or pale lips Edema Parasites Prolapses Fungal problems; athletes foot Difficulty drinking a lot of water Craves dry food Tendency to oily skin and hair Dry Patterns Dry cough and/or throat Dry skin Dry mouth and/or tongue Dry eyes Dry hair Flaky scalp; dandruff Brittle nails Dry stools; constipation Bowel movement less than once daily Tendency to diabetes Tendency to hypoglycemia Frequently crave sweets Prefer warm or room temperature beverages Easily irritated and frustrated Restless and anxious Poor memory Infertility Flushed red cheeks, especially in afternoon or after exercise Excessive sorrow Possessive Avoid risks Wind Patterns Rashes that move to different parts of the body Itchy skin Tremors Twitching Dizziness Vertigo Aversion to cold weather or wind Frequent colds with shivering, sneezing Coughing, runny nose Prone to flu Paralysis in any part of the body Itchy sensation in throat Nervous and easily irritated Stroke Bells Palsy Parkinson's Disease Seizures or convulsions High cholesterol Clogged arteries High blood pressure Uncoordinated, clumsy Erratic, impulsive behavior Volatile Dryness Symptoms that change location in the body
