Pain Assessment Severity: Location: 1 2 3 4 5 6 7 8 9 10 Pain Assessment Location: Onset: Pain Assessment Location: Better: Makes Better: Worse: Onset: Associated Symptoms: Makes Better: Makes Worse: Makes Worse: Quality: Associated Symptoms: constant intermittent Associated Symptoms: sharp dull Quality: Quality: pressure burning constant intermittent constant intermittent Severity: dull sharp dull 1 2 3 4 5 6 7 8 9 10 pressure burning pressure burning Severity: 1 2 3 4 5 6 7 8 9 10 Treatments I’ve Physical therapy Chiropractic Injections ____________ 4. Please check any statements that apply to you. JUE YIN / SHAO YANG Fire I can be characterized as irritable, anxious, nervous and emotionally unstable at times. I tend to harbor grudges and have explosive anger. I tend to get tension headaches or stress-related headaches. MH Master of I have insomnia. the Heart I prefer dark chocolate. I tend to find problems in any situation. (KM) I experience premature ejaculation. I tend to repeat certain activities to relieve anxiety. I tend to obsess about things, including sex. I can be characterized as clear thinking and decisive. I get agitated and this results in insomnia. I tend to grind my teeth and have tight jaws. TH I tend to have great self-confidence. Triple I have muscular aches and cramps. Heater I tend to be well muscled, well and need to stretch. I generally speak rapidly. (KT) I experience hot flashes. I have ringing in my ears. I tend to tap my fingers and fidget. Wood GB I can be characterized as indecisive, well and/or having dark circles under my eyes.
Pain Assessment Location: Onset: Makes Better: Makes Worse: Associated Symptoms: Quality: constant intermittent sharp dull pressure burning Severity: 1 2 3 4 5 6 7 8 9 10 Pain Assessment Location: Onset: Makes Better: Makes Worse: Associated Symptoms: Quality: constant intermittent dull pressure burning Severity: 1 2 3 4 5 6 7 8 9 10 Pain Assessment Location: Better: Worse: Associated Symptoms: Quality: constant intermittent sharp dull pressure burning Severity: 1 2 3 4 5 6 7 8 9 10 Treatments I’ve Physical therapy Chiropractic Injections ____________ 4. Please check any statements that apply to you. JUE YIN / SHAO YANG Fire MH Master of the Heart (KM) I can be characterized as irritable, anxious, nervous and emotionally unstable at times. I tend to harbor grudges and have explosive anger. I tend to get tension headaches or stress-related headaches. I have insomnia. I prefer dark chocolate. I tend to find problems in any situation. I experience premature ejaculation. I tend to repeat certain activities to relieve anxiety. I tend to obsess about things, including sex. TH Triple Heater (KT) I can be characterized as clear thinking and decisive. I get agitated and this results in insomnia. I tend to grind my teeth and have tight jaws. I tend to have great self-confidence. I have muscular aches and cramps. I tend to be well muscled, well and need to stretch. I generally speak rapidly. I experience hot flashes. I have ringing in my ears. I tend to tap my fingers and fidget. Wood GB I can be characterized as indecisive, well and/or having dark circles under my eyes.
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