7TCM Online TCM Consultation

Please fill out the online TCM consultation form below, then send your tongue coating photo to the email address [email protected]. We will arrange for a professional TCM practitioner to reply to your consultation via email within 24 hours.
You can also download the online TCM consultation form, fill it out and send it to us via email.

For details about online TCM consultation fees, please refer to: 7TCM TCM Consultation Pricing

User Information

Name
Gender
Age
Country
Address
Email
Phone
Other Contact
Height
Weight
Body Temp
Heart Rate
Blood Pressure

Chief Complaint

Cold, Heat & Sweating
3.1 Sensation of Cold and Heat
Do you generally feel cold or hot?
Feel cold
Feel hot
Both obvious
No obvious deviation
Location of feeling cold:
Whole body
Hands and feet
Back
Abdomen
Knees
Other
Degree of feeling cold:
Dress more than others
Dress less than others
Need additional heating
Wear long sleeves even in summer
Location of feeling hot:
Whole body
Palms and soles
Chest
Head
Other
Type of feverish sensation:
None
Afternoon tidal fever
Heat in palms, soles, chest
Paroxysmal flushing heat
Sensitive to air conditioning/fan?
No discomfort
Uncomfortable with air flow
Must have air flow
Fear of wind
Hands and feet in winter:
Warm
Cold
History of frostbite
Hands and feet in summer:
Normal
Palms and soles feverish
Sweaty palms
3.2 Sweating
Overall amount of sweating:
Normal
Excessive
Scant
Almost no sweating
Under what conditions do you sweat easily?
Profuse sweating with slight movement
Sweating while eating
Night sweats
Daytime sweating without reason
Sweating when nervous
Location of sweating:
Whole body
Head and face
Palms and soles
Back
Chest
Underarms
Nature of sweat:
Thin and watery
Sticky
Yellowish
Foul odor
Feeling after sweating:
Comfortable
Fear of wind and cold
Fatigue
No special feeling
Head, Face & Spirit
4.1 Head
Do you have headaches?
No
Yes
Location of headache:
Forehead
Back of head
Temples (both sides)
Top of head
Whole head
One side
Nature of headache:
Distending pain
Stabbing pain
Empty pain
Heavy pain
Dull pain
Throbbing pain
Timing of headache:
Morning
Afternoon
Evening
Irregular
After exertion
After emotional波动
Do you have dizziness?
No
Yes
Nature of dizziness:
Spinning sensation
Light-headedness
Darkening before eyes
Feeling of fogginess
Timing of dizziness:
When getting up or lying down
When standing up after sitting
Persistent
4.3 Thirst & Drinking
Are you thirsty?
Not thirsty
Thirsty, want to drink
Thirsty but don't want to drink
Dry mouth but not thirsty
Preferred temperature for drinks:
Ice water
Cold water
Warm water
Hot water
No preference
Amount of water intake?
Normal
More than normal
Less than normal
Feeling after drinking water?
Quenches thirst
Still thirsty
Bloating
Increased urination
4.4 Ears & Hearing
Is your hearing normal?
Normal
Slightly decreased
Obviously decreased
Deafness
Do you have tinnitus?
No
Yes
Sound of tinnitus:
Cicada chirping
Buzzing
Machine sound
Pulsing sound
Pattern of tinnitus?
Continuous
Intermittent
Worsens after exertion
Do you have a feeling of fullness in the ear?
No
Yes
4.5 Spirit & Mentation
Mental state:
Energetic
Easily fatigued
Sleepy
Irritable
Low mood
Anxious
Loss of interest
Poor concentration
Forgetful
Characteristics of fatigue:
Morning energetic, afternoon tired
Fatigued all day
Worsens after activity
Not relieved by rest
Other conditions:
Palpitations
Chest tightness, shortness of breath
Heartburn/irritability
Timid, easily startled
Frequent sighing
Appetite & Taste
Appetite:
Normal
Increased appetite
Poor appetite
Bloats after eating a little
Hungry but no desire to eat
Food quantity:
Normal
More than normal
Less than normal
Post-meal reaction:
No discomfort
Bloating
Belching
Acid reflux
Nausea
Immediate drowsiness
Food regurgitation
Food preferences:
Prefer hot drinks
Prefer cold drinks
Prefer sweet
Prefer spicy
Prefer salty
Prefer sour
Prefer greasy
No obvious preference
Do you crave specific foods?
No
Meat
Sweets
Fried foods
Raw/cold foods
Spicy foods
Drinking habits:
Drink a lot
Drink little
Normal
Don't drink unless thirsty
What do you prefer to drink?
Warm/hot water
Cold water
Ice water
Tea
Soft drinks/beverages
Are you thirsty?
No
Thirsty, want to drink
Thirsty but don't want to drink
Dry mouth but not thirsty
Do you have a bitter taste in mouth?
No
Morning
After meals
All day
Do you have bad breath?
No
Yes
Do you have acid reflux or heartburn?
No
Occasionally
Frequently
Chest, Abdomen, Back & Limbs
8.1 Chest
Do you have chest tightness?
No
Occasionally
Frequently
Do you have chest pain?
No
Yes
Location of chest pain:
Precordial area
Retrosternal area
Both sides
Do you have palpitations?
No
Yes
Triggers for palpitations:
Fatigue
Emotions
Empty stomach
No trigger
Do you have hypochondriac distending pain?
No
Yes
Location of hypochondriac pain:
Left side
Right side
Both sides
Related to emotions?
Yes
No
8.2 Abdomen
Do you have abdominal bloating?
No
After meals
All day
Relieved by passing gas
Do you have abdominal pain?
No
Yes
Location of abdominal pain:
Epigastric
Periumbilical
Lower abdomen
Whole abdomen
Nature of abdominal pain:
Dull pain
Distending pain
Stabbing pain
Cold pain
Does pressure relieve or worsen pain?
Relieved by pressure
Worsened by pressure
No difference
Do you prefer warmth or coolness on abdomen?
Prefer warmth
Prefer coolness
Do you have any abdominal mass?
No
Yes
8.3 Back & Limbs
Do you have low back soreness/pain?
No
Yes
Nature of low back pain:
Soreness
Pain
Cold sensation
Heaviness
Characteristics of low back pain:
Worsens after exertion
Relieved by rest
Worsens at night
Relieved by activity
Do you have upper back pain?
No
Yes
Location of back pain:
Upper back
Lower back
Sensation in limbs:
Normal
Numbness
Heaviness
Soreness
Weakness
Joint condition:
Normal
Pain
Swelling
Limited range of motion
Do you have edema?
No
Yes
Location of edema:
Eyelids
Hands
Ankles
Lower legs
Timing of edema:
Morning
Afternoon
All day
Bowel & Bladder
7.1 Bowel Movements (Stool)
Frequency:
Once daily
2-3 times daily
Once every 2 days
Once every 3+ days
>3 times daily
Typical time:
Morning
After meals
Irregular
Form:
Formed
Dry/hard
Loose/soft
Hard then loose
Watery
Sticks to toilet
Color:
Brownish-yellow
Black
Bloody
Green
Clay-colored
Sensation:
Smooth
Straining
Incomplete evacuation
Rectal tenesmus
Do you have abdominal pain followed by diarrhea?
No
Yes
Do you take laxatives?
No
Yes
7.2 Urination
Color:
Light yellow
Dark yellow
Clear like water
Red
Cloudy
Frequency:
Normal during day
Frequent during day
Nighttime times/night
Sensation:
Smooth stream
Burning sensation
Painful urination
Incomplete emptying
Foamy urine
Do you have incontinence?
No
Yes (with cough/sneeze/jump)
Nighttime bedwetting
Sleep
Average bedtime:
:
How long does it take to fall asleep?
<20 min
20-40 min
40-60 min
>60 min
Manifestations of difficulty falling asleep:
Racing thoughts, can't stop
Physical restlessness
No obvious cause
Number of nighttime awakenings:
0 times
1-2 times
3-4 times
>4 times
Can you fall back asleep after waking?
Easily
With difficulty
Cannot fall back asleep
Do you dream a lot?
No
Yes, occasionally
Yes, frequently
Many nightmares
Do you snore?
No
Mild
Severe
Sleep apnea (waking up gasping)
Morning feeling:
Well-rested
Still fatigued
Head feels heavy/foggy
Dry mouth, bitter taste
Swollen eyelids
Daytime sleepiness:
None
Mild
Moderate
Severe (involuntary dozing)
Average sleep duration:
Approximately hours/day
Do you take naps?
Never
Occasionally
Frequently minutes
Do you take sleep aids?
No
Western medicine
Chinese medicine/supplements
Female Specific
Age of first period:
Menstrual cycle:
Regular (___ days)
Short cycle (early)
Long cycle (late)
Completely irregular
Duration of period:
Menstrual flow amount:
Normal
Heavy
Light
Prolonged spotting
Menstrual blood color:
Bright red
Dark red
Pale red
Dark brown/black
Menstrual blood consistency:
Normal
Thin, watery
Thick, sticky
Many clots
Dysmenorrhea (painful periods):
None
Yes (before period)
Yes (during period)
Yes (after period)
Mild
Moderate
Severe
Premenstrual syndrome (PMS):
None
Breast tenderness
Mood swings
Headache
Bloating/edema
Acne
Date of last period:
Amount of vaginal discharge (leukorrhea):
Normal
Excessive
Scant
Color of discharge:
White
Yellow
Yellow-green
Blood-tinged
Consistency of discharge:
Thin, watery
Thick, sticky
Cottage cheese-like
Frothy
Odor of discharge:
None
Fishy
Foul
Are you pregnant or breastfeeding?
No
Pregnant (___ weeks)
Breastfeeding (___ months postpartum)
Are you perimenopausal?
No
Yes
Gynecological history:
Lifestyle Habits
13.1 Smoking & Alcohol
Smoking:
Never
Occasionally
Regularly (, )
Alcohol:
Never
Occasionally ()
Regularly ()
13.2 Exercise
Frequency:
Almost never
1-2 times/week
3-5 times/week
Daily
Type:
Walking
Running
Swimming
Yoga
Gym/Fitness
Ball sports
Tai Chi
Ba Duan Jin
Other
Duration per session:
Intensity:
Light
Moderate
Vigorous
Tongue Diagnosis (Please take photos)
📌 Photo Guide: Take photos in natural light, no filters or beauty mode. Open mouth and extend tongue to show entire surface. Best taken in the morning on an empty stomach, before brushing teeth.
Tongue color:
Pale red
Pale white
Red
Deep red
Purple-dark
Blue-purple
Tongue coating thickness:
Thin
Thick
Tongue coating color:
White
White and greasy
Yellow
Yellow and greasy
Gray-black
No coating
Tongue coating moisture:
Moist
Dry
Slippery
Greasy
Curd-like
Peeled coating
Tongue body shape:
Normal
Swollen/Enlarged
Thin and small
Tooth-marked
Cracked
Prickled (strawberry tongue)
Deviated
Trembling
Sublingual veins:
Not obvious
Visible
Dilated/tortuous/blue-purple
Other description:
Tongue surface and sublingual vein photos
Please take photos of the tongue surface and sublingual veins and send them to our email address
Other Supplementary Information
Please describe any symptoms,situations, or questions not covered: