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 (Mares)

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


back to home page