Set F Questions

Page 6 of 9

Answer the following questions based on your past 12 months experience:

Answer the following questions: No Seldom Sometimes Often Always
1. Do you have oily skin on your face and nose area?
2. Do you have pimples / breakout easily?
3. Do you feel bitterness or a
strange taste in your mouth?
4. Do you have sticky stools or
always feel you don't have a complete defecate?
5. Do you feel your urethra has
a hot sensation when you urine?
Or your urine is dark in color?
6. [For Men] Does your private part area feel damp?
[For Women] Does your discharge yellow or brown in color?