Table 2 Original version of the blood stasis questionnaire
Question | None | Mild | Moderate | Severe | Very severe |
|---|---|---|---|---|---|
1. Having dizziness | ① | ② | ③ | ④ | ⑤ |
2. Having central-type palsy | ① | ② | ③ | ④ | ⑤ |
3. Sublingual varicosities | ① | ② | ③ | ④ | ⑤ |
4. Dark purple of palate mucosa | ① | ② | ③ | ④ | ⑤ |
5. Blackish red gingiva | ① | ② | ③ | ④ | ⑤ |
6. Blackish red lips | ① | ② | ③ | ④ | ⑤ |
7. Blackish red tongue | ① | ② | ③ | ④ | ⑤ |
8. Ecchymosis of tongue | ① | ② | ③ | ④ | ⑤ |
9. Dark colouration of periocular region | ① | ② | ③ | ④ | ⑤ |
10. A dark colouration of the face | ① | ② | ③ | ④ | ⑤ |
11. Having chest pain without angina pectoris | ① | ② | ③ | ④ | ⑤ |
12. Side pain | ① | ② | ③ | ④ | ⑤ |
13. Tenderness and resistance of hypochondrium | ① | ② | ③ | ④ | ⑤ |
14. Tenderness and resistance of navel region | ① | ② | ③ | ④ | ⑤ |
15. Lower abdominal pain | ① | ② | ③ | ④ | ⑤ |
16. Tenderness and resistance of ileocecum | ① | ② | ③ | ④ | ⑤ |
17. Tenderness and resistance of sigmoid colon | ① | ② | ③ | ④ | ⑤ |
18. Haemorrhoid | ① | ② | ③ | ④ | ⑤ |
19. Dark stool | ① | ② | ③ | ④ | ⑤ |
20. Having pain due to sprain of ankle, wrist, and spine | ① | ② | ③ | ④ | ⑤ |
21. Having symptoms (pain, bruise) due to contusion or traffic accident | ① | ② | ③ | ④ | ⑤ |
22. Chronic pain in joint/palsies and numbness | ① | ② | ③ | ④ | ⑤ |
23. Stabbing pain | ① | ② | ③ | ④ | ⑤ |
24. Pain at night | ① | ② | ③ | ④ | ⑤ |
25. Ecchymosis of skin | ① | ② | ③ | ④ | ⑤ |
26. Scaly and rough skin | ① | ② | ③ | ④ | ⑤ |
27. Telangiectasia or angioectasia | ① | ② | ③ | ④ | ⑤ |
28. Palmar erythema | ① | ② | ③ | ④ | ⑤ |
29. Bruised easily | ① | ② | ③ | ④ | ⑤ |
30. Angina pectoris | ① No | ② Yes | |||
31. Rough pulse | ① No | ② Yes | |||