Headshaking Diagnosis

TCM
Diagnosis Questionnaire

Observe your horse carefully & check the boxes that are relevant. This will enable us to establish the
type/types of syndrome that are affecting him & suggest a relevant course of TCM Herbal supplementation.

Horses Name Age Mare Gelding Owner E-Mail address Please describe your horses problem Behaviour Aggressive Puts ears back Bites Scrapes Barges Cribs/windsucks Weaves Squeaks Stares into the distance Coughs Snorts Jealous Coltish Greedy Clingy Anxious Spooky Panic attacks Irrational fear Noise sensitive Depressed Lethargic Yawns Sighs Licks things Energy bursts Shows irritation when girthed/rugged Seasons No seasons Long seasons Irregular seasons PMS symptoms Sweating Oversweats Anhydrosis (lack of sweating) Temperature Prefers warmth needs lots of rugs Needs few rugs-gets too hot Seeks out shade Loves to sunbathe Physical signs Head seems hot Rubs head Dislikes head being touched Pale lower eye membrane Pink lower eye membrane Red lower eyemem Mixed colour lower eyemembrane Red eye corner Brown eye corner Pale eye corner Red sclera White sclera Yellow sclera Blue ring round iris Dry skin Itchy skin Sensitive skin Dry mane/tail Rubs mane/tail Sweet-itch Very pale urine Cloudy/thick urine Golden yellow urine Dark yellow urine Yellow/brown Brown urine Copious amount Scanty urination Frequent urination Loose droppings Loose in morning Loose when upset Dry droppings Changes from day to day History of colic Kicks stomach whilst eating suffers with gas Has suffered tendon problems Clicky joints/tendons Joint stiffness/pain with heat Joint stiffness/pain w/o heat Tightness/pain in neck Tightness /pain in back Unexplained lameness/back pain Coughs/snorts when upset Cough with white sputum Cough with yellow sputum Dry cough Fat/bulgy tongue Pale tongue Thin tongue Pink along edges of tongue Blue/purple hue to tongue Small raised spots on tongue Yellow coating on tongue Red tongue Pale gums Yellow gums Ulcerated gums Hyper salivates Lack of saliva Too much weight Not enough weight Photosensitive Pollen sensitive Please list the drugs/vaccines your horse has had in the last 2 years

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