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8.FOREHEAD
& TEMPLES
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9.
PALATE
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10.
NECK.
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11.
CHEEKS
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12.
CHIN
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13.SHOULDERS
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14.
ABDOMEN
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15.
CHEST
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16.
JOINTS OF THE UPPER LIMB
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17.
JOINTS OF THE LOWER LIMB
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18.
VOICE
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19. TEETH
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20.
URINE
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21. SWEAT
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22. FAECES
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23. BODY
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24.
BONES (especially collar bones, chin & heels)
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General
Attributes
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42. Mental tranquility Yes No
(Do you have peace
of mind?) |
43. Delicate
behavior Yes No
( Easily upset and
feel hurt over situations) |
44. Lack of endurance Good endurance Medium endurance
(Endurance is the
ability to bear suffering & pain) |
45. Dream
during sleepYes No |
46. Pleasing nature Yes No
( Able to make
friends easily) |
47. Patience
Yes No |
48. Command Yes No
( Ability to command
others) |
49. Lack of
greed Yes No |
50. Simplicity Yes No
( Is a simple way of
living satisfying to you?) |
51. Very
enthusiastic Yes No |
52. Active Yes No
( Mentally very
active ) |
53.Good
memory Yes No |
54. Devotion Yes No
(Do you have
dedication / attachment to your work, friends etc.,?) |
55. Always
acknowledge & have gratitude for help received Yes No |
56. Skill
Human Relation Skill Technical
& Managerial Skill
Conceptual skill |
57.
Courageous in combating Yes No |
58. Absence of sorrow Yes No |
59.Attracted by opposite sex Yes No |
60. Virtuous acts Yes No
(Do you act with
moral excellence, goodness & high righteousness?) |
61. Self
confidence in all enterprises Yes No |
62.Happiness Yes No |
63. Children
with similar qualities Yes No |
64. Wealth Yes No |
65. Pleasing look Yes No |
66. The taste you like most
Sweet Sour Salty Bitter Pungent
Astringent |
67.
Spend money quickly Spend
money on luxuries Save
money |
68.
Difficulty in making decisions Quick in making decisions, strong minded
Slow in making decisions & actions. |
69.Social dignity and respect Yes No |
70.
Quick, inconsistent erratic speech & talkative Moderate, convincing speech,
argumentative
Slow definite speech, not very talkative. |
71.
Fearful, anxious & nervous Angry & irritable in emotions
Sentimental, calm, attached with emotions |
72.
Light, disturbed sleep
Moderate sleep, may wake up & fall asleep
Heavy sleep ,difficulty in waking up |
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Physical power You should state your body strength in general
Are there some conditions in which you feel weak or strong?
Which kind of weather bothers you the most?
Which part of the day or night do you feel the strongest?
How many hours do you work daily?
Do you exercise regularly?
What kind of exercises do you do and how often?
At what time of the day do you exercise and in what surroundings?
How do you feel after exercise?
Any other information you wish to share?
Mental nature and the
nervous system
Are you always in tension,
anxiety or stress and what causes this? Is it related to some diet, activity or climatic
condition?
How is your sleep? Is it sound
sleep / disturbed?
How many hours do you usually
sleep? Please mention the timings of going to bed and waking up.
Do you think your disease has
some relation to your being nervous, stressful, fearful, anxious etc? Do you find any
change in the symptoms under such conditions?
Whether the following
matches with you or not ?
Appetite, Diet &
Habits
.
Are you a voracious eater? Does the food
get digested easily?
Do you have problems like heaviness, feeling weak and
lethargy immediately after eating?
Do you have any pain in the
abdomen, specially after eating or on empty stomach? If yes, specify the area of pain.
Do you have wind or gas?
Do you over-eat?
What kind of foods bother you ? What kind of trouble do you have when you take
these foods?
Do you often have acidity , burping with or without burning sensation in the
stomach and chest?
Any other information, that you would like to share?
It would be helpfull if you could describe your diet. You can use the
following guidelines, if you are not able to explain the diet.
Kinds of food usually taken:
Breakfast
Lunch
Dinner
Are you a
vegetarian? If not, how often do you eat meat, seafood or other kinds of non-vegetarian
foods.
Do you take snacks / foods in between your main meals? If yes, what and how often?
Quantity of tea, coffee, alcohol, or any other kind of drinks taken in a day?
How often do you eat fast foods, fried foods, frozen foods and foods that have been
in the microwave?
How much water do you usually drink in a day and when(before / after meal etc)?
Quantity of milk products and sweets and their types (eg:cheese,chocolate
etc.,)
Addiction to any unhealthy habits?
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