Body Constitution Quiz for Men

Javascript is disabled

Javascript is disabled on your browser. Please enable it in order to use this form.

Form successfully restored

The form has been restored from your last edit. If wish to start over, please click the 'RESET' button

Before we begin, what’s your email and age?
Discomfort or pain in your body
Face Complexion
Skin
Eye
Limbs, Muscles and Joints
Heart and Chest
Stomach and Intestines
Mental Condition
Tongue - (Hand mirror ready)
Mouth and Throat
Sleep
Sweating
Urination
Stools
Health intolerance
Reproductive issues
Result
Complete your Kampo care

Before we begin, what’s your email and age?

Email Address

First Name

Last Name

How old are you?*

Age

Why we ask: We’ll use this in order to start saving your answers and personalize your experience. Your answers help us determine the herbal ingredients, diet, and lifestyle recommendations that are right for your unique needs. This is important because, depending on your stage of life, you may require different lifestyle choices.

Discomfort or pain in your body

Please select all that apply*

Head

Eye

Ear, Nose, Throat

Neck

Shoulder

Arm

Elbow

Wrist, Hand, Fingers

Chest

Epigastrium, Stomach

Abdomen

Genitalia

Upper Back

Lower Back

Buttock

Thigh

Knee

Leg, Calf

Foot, Ankle, Toes

Any specific health concerns you'd like to share? The more you share, the better we can help.*

Yes

Write here

Face Complexion

Please select all that apply*

Pale

Dull

Dark or purplish

Yellowish

Red cheeks

Lustrous healthy skin

Skin

2/16*

Dry

Rough

Age spots or Hyper-pigmentation

Oily

Eczema

Acne

Rashes

Edema (puffy face)

Do not have any skin problems

Not applicable

Eye

3/16*

Red eye

Eye fatigue

Dry eye

Worsening eyesight

Blurred vision

Dark circles under eyes

Watery eye

Floaters

Do not have any eye problems

Not applicable

Limbs, Muscles and Joints

4/16*

Cold limbs

Cold fingers and toes

Numbness or tingling

Severe or stabbing pain in muscles or/and joints

Joints pain with redness or/and swelling

Sweaty hands

Weak limbs

Edema

Do not have any problems

Not applicable

Heart and Chest

5/16*

Feeling oppression in the chest

Stabbing pain in the chest

Palpitations

Do not have any Heart or Chest problems

Not applicable

Stomach and Intestines

6/16*

Poor appetite

Abdominal heaviness or distension

Abdominal pain

Excessive belching or flatulence

Epigastic pain

Nausea or Vomiting

Not applicable

Mental Condition

7/16*

Depression

Anxiety

Sadness

Moodiness

Irritability, short temper, easily angered

Poor memory

Restlessness

Forgetfulness

Feeling heaviness of the head

Lack of motivation

Calm and stable mind, good concentration

Tongue - (Hand mirror ready)

8/17*

B = Base (color + condition), C = Coating (color + condition)

B: Pink, Slightly moist, C: Thin-white

B: Pale, Teeth-marks, C: Thin-white

B: Pale, Swollen, C: Thick-white

B: Pale, C: Little/no coat

B: Red, Cracks, C: Little/no coat

B: Red tip, C: Thin-white

B: Purple, Black spots

B: Red, C: Yellow-greasy

Mouth and Throat

9/16*

Weak voice

Frequent sighing

Sticky yellow phlegm

Sticky white phlegm

Coughing up with profuse phlegm

Desire cold drinks but small amount

Desire warm drinks

Dry throat or/and no thirst

Not applicable

Sleep

10/16*

Difficulty in falling asleep

Waking up frequently during night

Excessive dreaming

Sleep well & wake up full of energy

Sweating

11/16*

Excessive sweating

Sweat easily

Sticky yellow sweats

Night sweats while sleeping

Not applicable

Urination

12/16*

Pain after urination

Pain before urination

Pain during urination

Frequent urination

Scanty and dark urine

Normal (Between 6 - 7 per day, no pain and normal color)

Stools

13/16*

Loose stools

Chronic diarrhea

Chronic constipation

Alternating constipation and diarrhea

Small, dry, bitty stools like goat’s stools

Dark blood in stool

Black or very dark stools

Normal (Bowel movement 3 times a day to every other day)

Health intolerance

14/16*

catch a cold easily

feel hot or heavy easily

feel heat on the face

have constant low-grade temperature

have low-grade fever worse in the afternoon

robust health (very strong or healthy)

Reproductive issues

15/16*

Lack of sexual desire

Excessive sexual activity

Premature ejaculation

Infertility

Impotence

heaviness of the scrotum

Not applicable

Result

Your current Body Constitution is...

Qi Deficiency

Qi Stagnation

Blood Deficiency

Blood Stasis

Damp-Heat

Damp-Phlegm

Yin Deficiency

Yang Deficiency

Healthy Constitution

click "NEXT" to complete the last page.

Complete your Kampo care

Step 1 : Interested in trying Kampo?*

Kampo Therapy ➤ Book Online Consultation

Not this time — let us know when you're ready!

Step 2 : Submission*

By submitting, I agree to receive my Kampo quiz results by email. If I choose to place an order, I consent to my responses being used to prepare a personalized Kampo product.

Your form has been submitted.

Thank you, %NAME%, for taking your quiz.

We've emailed you a copy of your quiz results. Feel free to contact us with any questions.

If you wish to place an order and haven’t done so yet, please select your Kampo option from the list below:

Kampo Therapy ➤ Book Online Consultation

Server Side Error

We faced problems while connecting to the server or receiving data from the server. Please wait for a few seconds and try again.

If the problem persists, then check your internet connectivity. If all other sites open fine, then please contact the administrator of this website with the following information.

TextStatus: undefined
HTTP Error: undefined

Processing your request

Error

Some error has occured.