Sleep Well Now Questionnaire

Chinese Herbal Formulas for Insomnia

Please check the symptoms you may have in each of the following:
1. An Mien Pian: 5. Gui Pi Wan: Insomnia Insomnia Excessive dreaming Anxiety Agitation, anxiety Personality Disorders Depression Phobias Panic attacks Neurosis Poor memory Nightmares   Restlessness 2. An Shui Wan: Rapid heartbeat Insomnia Heart Palpitations Dream disturbed sleep Congestive heart disease Nightmares Fatigue Irritability Pale Complexion Mental Restlessness Poor memory Agitation Chronic bleeding syndrome Heart palpitations Functional uterine bleeding Poor memory Anemia     3. Bu Nao Wan: 6. Suan Zao Ren Tang: Insomnia Insomnia Poor concentration Excessive dreams Poor memory Nightmares Headache Heart palpitations Dizziness Mental restlessness Heart palpitations Night sweats Anxiety Dry mouth Neurosis Dizziness Panic attacks   Phobias   A.D.D.   Alzheimer's disease       4. Emperor's Teapills:   Insomnia   Heart Palpitations   Restlessness   Irribability   Fatigue   Hypertension   Hyperthyroidism   Constipation   Heart disease   Menopausal syndrome   Night sweats   Poor memory
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