Foundation for Integrated Medicine Questionnaire
Mediators Questionnaire
Antecedents Questionnaire
Triggers Questionnaire
Effects Questionnaire
Reducing Questionnaire
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1. UNMASKING YOUR MEDIATORS, THE AGENTS OF ILLNESS

    SECTION 1. Do you need an oil change?

        I experience:

Soft, fraying or brittle nails
Dry, scaly or flaky skin
Chicken skin (tiny bumps on my arms)

Dandruff

Pain or stiffness of my joints
Dry, lackluster or unruly hair
Excessive thirst
Menstrual cramps
Premenstrual breast pain
      TOTAL

            If your total score is 5 or more, you may be lacking essential fatty acids.

 

SECTION 2. What's your MQ (Magnesium Quotient)?

        I experience:

Leg or foot cramps
Sensitivity to loud noises
Muscle twitches, spasms, tension
Palpitations
Trouble falling asleep
Restless legs
Sighing
Irritability
Migraine headaches
     TOTAL

            If your total score is 4 or more, you may be lacking in magnesium.
             See pages 150-156 of POWER HEALING.

 

SECTION 3. Do you suffer from a toxic overload?

I look older than my age
I feel more tired than I should
My whole body aches
I have trouble concentrating
My body retains excess fluid
I seem to be less healthy every year
Smells and odors make me sick
I get every cold or flu that comes by
I take pain relievers or antacids
People think I drink too much
I feel ashamed of my drinking
I need a drink of alcohol to feel well
I smoke cigarettes
I use street drugs

I take prescription medication for a chronic health condition

I don't like vegetables
     TOTAL

            If your total score is 6 or more, you may need help
            detoxifying your body.

 

ECTION 4. Is your nutri-type out of balance?

I actually feel worse on a "healthy" diet
I feel dizzy for no apparent reason
My energy swings from high to low
My moods swing up and down
A single cup of coffee makes me anxious
Eating a steak puts me to sleep
Eating a steak make me feel strong
I thrive on "juicing"
I must eat frequently during the day
     TOTAL

            If your score is 6 or more, you may be suffering from
            the Watson Effect. See Appendix F of POWER HEALING.

 

SECTION 5. How's your rhythm?

I wake up in the morning without an alarm clock

I feel well-rested after a night's sleep

I spend time each day in quiet reflection, prayer or relaxation

I spend most of the day on my feet

I walk briskly for 30 minutes or more

I engage in sports activities

I go to bed and wake up at about the same time each day

On weekends, I get up at about the same time as on weekdays

I get fresh air and sunshine
I eat leisurely, enjoying my meals
I engage in strenuous work
     TOTAL

            If your total score is less than 12, you have an imbalance
            in your daily rhythm.

 

SECTION 6. How's your health self-image?

    I believe I can do well in the following activities:

Following a prescribed diet for six months
Following an exercise routine
Taking a daily relaxation break
Spending more time with loved ones
Overcoming a bad habit
Distracting myself from problems
Seeking information about problems
Solving problems
Taking prescribed medication

Asserting my needs with my spouse or partner

Asserting my needs with my children
Asserting my needs with my parents
Asserting my needs with my co-workers
Asserting my needs with my boss
Asserting my needs with my doctor
     TOTAL

            If your total score is less than 20, you may need help in creating
            a positive self-image that boosts your feelings of self-efficacy.

 

SECTION 7. How's your social nourishment?

There are people I can turn to or confide in

I get along well with my spouse or partner

I get along well with my parents

I get along well with my children
I get along well with my siblings
I get along well with my co-workers
I get along well with my close friends
I attend church or temple

I am active in a social, cultural or service organization

I'm satisfied with my family life
I'm satisfied with my friendships
I'm satisfied with my social life
I'm satisfied with my work
I'm satisfied with my doctor
     TOTAL

             If your total score is less than 16, you may need more
            support from friends or family.

 

SECTION 8. How's your hormone balance?

I crave salt
I feel weak or dizzy when standing up
I feel worse after exercise than before
I feel bad when the temperature is hot
I feel bad when the temperature is cold
My blood pressure is low
I'm hungry all the time
Coping with stress is unbearably difficult
My sleep is interrupted by hot flashes
I feel so tired I can't get out of bed
     TOTAL

            If your total score is 7 or more, you may be troubled by
            autonomic instability or a hormonal imbalance.

 

 

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