1. Chills and fever: Does patient feel cold or hot? Any preference for warm/cold drinks or environment?  

2. Perspiration: Does patient sweat easily? At night? Localized or general?  

3. Head and body: Any headaches, dizziness, body aches, or stiffness?  

4. Stool and urine: Bowel movements (frequency, consistency, color)? Urination (color, burning, frequency ,any other details)?  

5. Appetite and thirst: Is appetite normal? Thirst? Craving hot or cold drinks?  

6. Chest and abdomen: Quadrant tenderness, any distension, pain, or discomfort anywhere?  

7. Sleep: Quality, difficulty falling asleep, waking up, dreaming?  

8. Ears and eyes: Tinnitus, hearing changes, vision blurring, dry eyes?  

9. Past medical history: any other chronic conditions? Medications?  

10. Menstrual / gynaecological history: Age of menopause/ menarche? Length of period, length of cycle If post menopausal bleeding when did bleeding start again? Amount, colour, clots? Any discharge? History of miscarriage or still birth. 

PLEASE NOTE THAT IT IS ALSO IMPORTANT THAT YOU DISCLOSE TO US WHEN RECEIVING HERBAL TREATMENT WHAT MEDICATION YOU ARE TAKING AND ALSO IF YOU ARE TAKING ANY NON PRESCRIBED DRUGS (LEGAL OR OTHERWISE)