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The Body Cleansing and Rejuvenating Clinic
The Clinic and its Treatments
Treatments at the Clinic are intended for Clients
experiencing a very wide range of Physical or
Stress related problems and want help and
support in recovering from or alleviating them.
Usually this involves more than one of the
following Therapies - Colonic Hydrotherapy,
Professional Nutritional Advice, Herbs and
Supplements, Bio‑resonance and Deep Tissue
Massage - all designed to achieve a worthwhile
improvement in health.
I try to ensure that clients feel they are the only
person who matters when I am treating them and
they are always given all the time needed.
However I do ask clients not to arrive late,
because if they do the whole day from then
onwards is sure to run late. So please try to arrive
a little early; there is always traffic congestion at
some unexpected places and trains do run late. If
you assume that everything will be smooth on
your journey you will be sure to be late arriving.
One of my objectives is to teach clients who
have been to me for a full investigation and in-
depth consultation to look after their health
themselves. I encourage such established clients
to telephone me if they have a problem - no fee
is charged for this.
I have a substantial range of bio-resonance (Vega
and Avatar) equipment that I use for general
Diagnostic Testing and for specific testing for
matters such as allergies, food, chemical and
heavy metal intolerances, mineral and vitamin
deficiencies and mercury toxicity and also for the
treatment of a very wide range of health
problems. If you wish to give up smoking or any
other addiction, Bio-resonance therapy has been
shown to be very effective. All the testing is non-
intrusive.
Experience is that the time required for
consultation, testing, treatment and advice
involving bio-resonance equipment (referred to
in the previous paragraph) varies considerably
from client to client so my fees are based on
time. A typical fee for Allergy Testing is £120.
For appointments on a Saturday or at 5.00pm or
later on a weekday all fees are increased by 10%.
Continued on the next page
BCRC Page 1
Tel: 020 8679 6119 Fax: 020 8679 6292
Email: [email protected]
www.colon-clinic.co.uk
15 Westwell Road
Streatham
London
SW16 5RU
UK
Page Index General information about the Clinic and its treatments, preparing
yourself for your first appointment, public transport, car parking and fees
Colonic Hydrotherapy
Matrix Regeneration Therapy and VEGASOM equipment for treating a
very wide range of problems
Wholistic Questionnaire - I will send you a copy for completion before
you come for the first time
This page & page 2
Pages 3 to 6
Pages 7 to 10
Pages 11 to14
If you come to the Clinic for the first time for
consultation, treatment or to buy supplements you
will be tested on diagnostic equipment. No new
Client will be supplied with supplements without a
consultation (for which a fee will be charged). So
as to ensure the reliability of the results please:
(1) for 48 hours preceding the appointment, do
not take any strong medication (sleeping
pills, tranquillisers, psychopharmaceutical
products, antibiotics, cortisone preparations
etc). Medication which cannot be interrupted
should, naturally, be continued but please let
me know before the test;
(2) on the day of the appointment please do not
drink any coffee, tea or alcohol;
(3) on the day of the appointment do not smoke,
do not take a cold bath or cold shower, do not
use any body sprays, any creams, oils or
ointments;
Please wear loose, comfortable clothing.
I advise all new clients to:
(a) eat meals regularly in the days before they
come to the Clinic for their first treatment;
(b) drink at least 2 litres (8 full glasses) of water
every day before coming in for the first
time;
(c) make sure that they do NOT arrive at the
Clinic hungry or immediately after a heavy
meal.
Credit Cards are welcomed.
The Clinic is close to Streatham Common & within a short walk of:
(a) Streatham Common NR station (Victoria 15 mins, Clapham Junction 10 mins, Balham on the Northern Line 4 mins, East & West Croydon 10 mins ) and: (b Streatham NR station (London Bridge, Blackfriars, Farringdon, Kings Cross & West Hampstead via Thameslink). There are frequent buses from Brixton tube station on the Victoria Line, Croydon and from both the West and the East.
Free on-street car parking is always available.
Professional Fees
Colonic Hydrotherapy
Weekday before 5.00pm £70.00
Weekday 5.00pm or later &
all day Saturdays £77.00
Bacterial Implants (optional) £7.50
Seven Day Cleanses £590.00
Any supplements clients may elect to have
are extra.
Please do NOT arrive at the Clinic
hungry.
Massage Weekdays before 5.00pm from £35.00
Weekday 5.00pm or later &
all day Saturdays from £38.50
Diagnostic Testing, Bio -resonance Treatments, In–depth Consultations and Nutritional Advice
Fees are based on the time involved which will vary from Client to Client. Typically a daytime weekday consultation fee is £87.00 & Vega treatment from £45.00. Time based fees are increased by 10% for weekday appointments at 5.00pm or later & for all Saturday appointments
BCRC Page 2
The Body Cleansing
and
Rejuvenating Clinic
Health
Improvement
with the help of
COLONIC
HYDROTHERAPY
THE COLON
The colon, or large intestine, is an important
part of the digestive system; some 5 feet in
length and 2.5 inches in diameter, situated at
the end of the alimentary canal, it completes
the digestive process and handles our food
waste and much other body waste. It is
normally populated by billions of friendly
bacteria which assist in detoxifying waste,
synthesise certain vitamins and help us guard
against infection. These same bacteria make
up some 70% of the dry weight of our faecal
waste. The colon structure is of smooth
muscle and it is broadly divided into 3
segments; the caecum and ascending colon
into which food waste enters in a fluid state
through the ileo-caecal valve, the transverse
colon where water, minerals and vitamins are
re-absorbed and the descending colon where
mucus is secreted to coat the faeces prior to
defecation through the rectum and anus.
In health, bowel transit time from eating to
defecation is 24 hours or less and bowel
movement is at least once daily. In disease,
poor digestion, yeast overgrowth, spastic
colon, irritable bowel syndrome, chronic
constipation and diarrhoea are usually
accompanied by auto-intoxication, literally,
"self-poisoning' - the re-absorption of soluble
wastes into the bloodstream - which places a
heavy burden upon the other eliminative
organs of the body, the kidneys, the skin and
the lungs.
Chronic constipation can lead to further direct
complications: diverticulitis, haemorrhoids,
fissures, atonicity, spasticity, prolapsis, colitis
and even bowel cancer as well as chronic
toxic conditions in the rest of the body, like
the skin (e.g. acne and eczema), the
cardiovascular system, the nervous system
and the liver.
Correct function of the colon is a necessity
for health, for truly 'disease can begin in the
colon'. It has been said that colon
malfunction can lead to 80% of all diseased
states.
BCRC Page 3
At the BCRC, Colonic
Hydrotherapy is often
combined with
Professional Nutritional
Advice. It frequently forms
part of an integrated
programme involving
Diagnostic Testing and
Treatment with a range of
Bio-resonance Equipment,
often Nutritional
Supplements and a variety
of Massages including
Deep Tissue all designed to
achieve a
worthwhile improvement
in health.
A Healthy Colon
Why Colonic
Hydrotherapy?
Poor elimination can lead to many chronic
conditions; it is these very conditions that
colonic hydrotherapy can help: Constipation
- Diarrhoea Mucus colitis - Colitis - Spastic
Colon Diverticulitis - Liver sluggishness -
Halitosis - Headaches - Flatulence -
Haemorrhoids - Skin problems (acne, eczema
and psoriasis) - Abdominal bloating -
Asthma - Allergies - Fatigue - many
'Psychological' states such as depression,
lethargy, schizophrenia, etc. It is also of
benefit prior to and following barium enemas
and during therapeutic fasting Some complex
conditions such as Crohn's disease, Myalgic
encephalomyelitis (M.E.) and intestinal
Candida are also helped by the resultant
detoxifying effect of colonic hydrotherapy.
What is involved?
Filtered water at a carefully regulated
temperature is introduced under gentle
gravitational pressure through the rectum
into the colon. With special massage
techniques, the water begins to soften and
cleanse the colon of faecal matter and old
deposits which are piped away with the
waste water. The therapist works
progressively around the structure of the
colon allowing water alternately to flow in
and release. Before having Colonic
Hydrotherapy for the first time at this Clinic,
the Client takes a Diagnostic Test to check
that Colonic treatment is appropriate for
them.. Taking this test adds 20 minutes to the
normal appointment time. for Colonic
treatment. If the results of the test suggest
that an In-depth Consultation is advisable
this can be arranged for a subsequent
appointment.
What is Colonic
Hydrotherapy?
Colonic hydrotherapy is an internal bath that
helps cleanse the colon of poisons, gas,
accumulated faecal matter and mucus
deposits. Such techniques were first
recorded in 1500 BC and have been used in
traditional and naturopathic medicine since
that time. Using sterilised equipment,
filtered water is gently introduced into the
rectum which progressively softens and
expels faecal matter and compacted deposits.
Colonic Hydrotherapy is much more
effective than an enema, since the whole
colon is treated and water is not purposely
retained. It is best used as a complementary
technique to other therapies. By improving
elimination, response to dietary,
homoeopathic, herbal, manipulative and
other therapies is markedly improved.
Is any preparation required?
All new clients are advised to:
(1) eat meals regularly in the days before they come to the Clinic for their first treatment;
(2) drink at least 2 litres (8 full glasses) of water every day before coming in for the first time;
(3) make sure that they do NOT arrive at the Clinic hungry or immediately after a heavy meal.
BCRC Page 4
Is it safe?
Yes. Equipment is disposable or sterilised
using hospital approved sterilisation solutions
which kill all prevalent bacteria, viruses and
fungi in minutes. Countless thousands of
colonics have been given safely; the water
pressure is very low, so there is no danger of
bowel perforation and the water used is pre-
filtered.
Unlike regular use of laxatives, colonic
hydrotherapy is not habit-forming, and in fact
improves colon muscle tone.
The Association of Colon Hydrotherapists
maintains high standards of qualification for
its registered therapists
And the results ....
Most people quickly experience improved
mental clarity after colonic hydrotherapy. With
their toxic load diminished and elimination
improved, a greater feeling of well-being and
lightness is felt.
There is obvious relief from bloating and
constipation, toxic headaches, painful
haemorrhoids and skin problems. In the
longer term, bowel disease risk is also
diminished and nutrients are better absorbed
leading to improved all-round health.
Who can benefit from
Colonics?
Essentially anyone with a condition
aggravated or caused totally or in part by
autotoxicity, and where the resulting improved
elimination aids healing. Most diets include
mucus-forming foods like dairy eggs, sugar,
flour, and tofu and even those people on
relatively good diets and who have regular
bowel movements have old hardened
accumulations of mucoid deposits which
hinder proper elimination and need periodic
cleansing.
How many treatments?
Human bodies vary greatly and it suggested
that a new Client books for their first
treatment only. During the first appointment
the Client will be given advice. At the end of
the first appointment the new Client may then
decide what further treatment, if any, they
want. However, deposits built up over a
lifetime cannot be shifted with one or two
irrigations only. It is a good idea to have a
treatment every 3 to 6 months to maintain
inner cleanliness and good elimination but
again this will vary from Client to Client.
Implants of friendly bacteria are normally
advisable after treatment. The modesty of the
Client is maintained throughout the treatment.
The Association and Register of Colon
Hydrotherapists (formerly the Colonic
International Association) was founded in
1987 by Dr. M. Siewert, an experienced
Medical practitioner and Chiropractor, now
specialising in enterotoxicity and
detoxification. The Association aims to
maintain a high standard of practise and
training in colonic hydrotherapy and to care
for the patient.
For information about Bacterial
Implants please see next page.
BCRC Page 5
BACTERIAL IMPLANTS are advised after Colonic
Hydrotherapy treatment
Each Bacterial Implant contains B. bifidum, B. longum, L. acidophilus &
L. casei. Following Colonic Hydrotherapy the bowel is denuded of its
complement of essential bacteria which needs to be replaced rapidly so as to
reduce the possibility of opportunistic infestation by Candida albicans &
other unfriendly bacteria. Implants provide active live bacteria that normally
reside in the healthy colon. The bacteria are essential if the normal bowel
function is to be maintained & opportunistic bacteria & yeast organisms are
to be controlled.
L. acidophilus and B. bifidum are both resident organisms found in the
human intestinal tract & modern day diets, stress & antibiotic therapy can all
have an impact on these sensitive organisms.
L. acidophilus may lessen the proliferation of yeast organisms such as
Candida albicans in the intestinal tract. It also helps to reduce unfriendly
bacteria by producing natural antibiotic substances 'on site' on the intestinal
wall.
Bifidobacterium helps to reduce opportunistic bacteria & the absorption of
protonated amines. In addition it helps with lipid metabolism & in the
reduction of available cholesterol in the diet.
L. casei & B. longum are transitory organisms that exert a positive influence
on intestinal pH.
SUPPLEMENTS
Supplements will not be supplied to anyone who is not a Client of the Clinic and has undergone a Consultation for which a fee has been charged.
BCRC Page 6
Vega Check test report
VEGA Equipment The Clinic has a complete range of VEGA equipment, developed and manufactured by VEGA Grieshaber KG in Germany some of which is used for testing and to help with diagnosis and some used for therapeutic purposes. The next 3 pages deal specifically with just two of the pieces of the therapeutic equipment - the Matrix Regeneration Therapy (MRT) equipment and the VEGASOM. MRT is an excellent preparation for subsequent follow up therapy for almost all chronic diseases examples of which are: Rheumatic diseases Chronic inflammation (wounds) Bronchial Asthma Allergies Skin diseases Lymphostasis (blockage of normal lymph flow) Degenerative diseases (spinal column & joints) MRT helps the essential detoxification process when the body is unable to do this unassisted.
Although normally MRT is recommended initially at weekly intervals for 6 to 8 weeks it is not unusual for people experience an improvement after even only one treatment.
VEGASOM treatment has proved successful, often in conjunction with other treatment in treating: Depression Stress Anxiety A wide range of physical problems such as bronchial asthma, acne, eczema, stuttering. Chronic diseases are on the increase, all too often exhibiting new and relatively unknown symptoms. There are an enormous number of new chemical compounds which, to a large degree, wind up in being incorporated into our bodies. Today, everyone is thus polluted to a greater or lesser extent with these substances, whether or not they experience symptoms of illness. Practitioners are seeing an increase in psychic problems and VEGASOM treatment is particularly useful in the treatment of diseases with a psychosomatic component.
BCRC Page 7
MRT on its Trolley
THE VEGASOM
Matrix Regeneration Therapy has 3 components working in parallel The Petechial Vacuum Extraction Massage creates a partial vacuum in the tissue (normally of the back). Used up blood laden with toxins is drawn to the surface where it is removed via the lymphatic system. In the case of previously damaged tissue, this can actually cause hematomas (bleeding on the surface). Initially the intense red streaks on the skin may be visible for days. After a number of treatments - and as tissue continues to regenerate (it gets noticeably firmer) - these streaks fade after a few minutes and the pain sensitivity also abates more and more. The MRT’s effectiveness is not based just on mechanical tissue cleansing but, in a special way, on two other energetic components. The suctioned-up toxins and waste by-products can be regarded as electro-magnetic information with a pathological vibrational pattern. Using Systems Information Therapy, a further development of bio-resonance therapy, the organisation’s underlying disturbance fields can be neutralized, taking a considerable load off the immune system. A visible consequence of this is that disease conditioned muscular tension eases up during the course of treatment. Although the therapy is primarily performed on the back, all internal organs are accessed via neural reflex zones thus achieving a very deep effect. The third component is low intensity Direct Current Treatment that re-polarizes diseased tissue in order to stimulate regeneration whereby existing charge deficits are compensated out.
MRT All three components work together towards synergistically reinforcing each others’ effects. The effects achieved by using MRT far transcend those described above. Each treatment strongly stimulated the immune system to greater defensive readiness. Also hematopoiesis (the formation of blood cells) and the lymphatic system are intensely stimulated. Chronis mal-position of the spinal column due to muscular tension, as well as blockages that impede the flow of energy in the body can be relieved - and the stress overload on the brain’s central hormonal regulatory system vanishes. Thus a single operation performs a comprehensive whole-body-orientated treatment
BCRC Page 8
Petechial Vacuum Extraction
Massage
The MRT uses a suction
electrode to generate a partial
vacuum in tissue. Worn-out and
toxin laden blood is drawn to
the surface. Consequently the
suction electrode is an ideal
input electrode for recording
pathological frequency patterns
to be used in System
Information Therapy.
The matrix is the organism’s
basal system comprising about
80% of the total cell mass. It is
the supply and waste-disposal
system of the organ cells as well
as the home of the body’s
defences. Because of its central
importance for health, it is,
when fighting disease, the main
attack point of any effective
therapy.
Direct Current Treatment
A crucial part of the therapeutic
effect of MRT involves the
matrix’s charge state and
hormonal situation. A weak
electric current is introduced into
the tissue behind a roller
electrode which shunts off excess
charge from diseased tissue. The
repolarized tissue becomes
alkaline again - a precondition
for normal metabolic function.
System Information Therapy
T h e n e u t r a l i z a t i o n o f
pathological energy fields is the
domain of System Information
Therapy, a further development
of bio-resonance therapy. Via
the suction electrode toxin
information is detected and
transmitted to the control unit
for processing when these
pathological frequency patterns
are transformed into therapeutic
signals and routed back to the
patient.
Self healing powers can thus be
activated by means of
resonance effects and the
healing process initiated.
BCRC Page 9
VEGASOM VEGASOM Therapy works by ”re-normalising” brain wave patterns that have gone “askew”. A study at the University of Freiburg showed that induction therapy with the aid of the VEGASOM is not stressful to patients and to the extent that the patient is receptive to the treatment it stimulates the brain. Experiments have shown that if the Client rejects being treated with the induction specific frequencies then no benefit is achieved. Hence an appreciable proportion of Clients will not benefit from the therapy—nor will they be harmed by it. In such cases alternative or additional therapies will be used to achieve results. Experiments at the International Institute for Psychosomatic Medicine in Prague on 81 patients showed that the VEGASOM can be used for a broad range of modern “diseases of civilisation” which have a psychic aspect. The therapy helped in cases when conventional treatment had not been of use. Many of the patients noticed a therapeutic effect after the very first treatment. The problems faced by the 81 patients are shown in the graph below.
The VEGASOM induces brain wave frequencies with the aid of micro-currents in order to treat psychosomatic disorders. With the aid of standard programs the practitioner can call up particular therapy programs which are associated with specific problems. The results of the treatment of the 81 patients are shown in the pie charts below. Overall 83% of the patients benefited (and, of course 17% did not) and 53% ended treatment cured. Results were particularly good for those suffering from depression or stress where those cured were 72% and 68% respectively
Depression No success 14%
Improvement 14% No complaint 72%
No success 13%
Improvement 19%
Stress
No complaint 68%
Overall healing success with VEGASOM
No improvement 17%
Improvement 30% No complaints 53%
Healing 83%
Patient complaint
epilepsie
tic-neurosis
stuttering
dysmenorrhea
bronch. asthma
migraine
enuresis noct.
acne
eczema
stress
depression
Patient
numbers
BCRC Page 10
The Body Cleansing and Rejuvenating Clinic Please complete this and return to:
Tel: 020-8679-6119 BCRC
E-mail [email protected] 9H 15 Westwell Road
fax 020-8679-6292 LONDON
http://www.colon-clinic.co.uk SW16 5RU
UK
WHOLISTIC QUESTIONNAIRE If you already have an appointment please state date ……………………& time ……… Please use separate sheets of paper if you find insufficient room on this questionnaire. Add any further
information you think it would be helpful for me to know. Completion of this questionnaire in no way
commits you to coming on the programme but if you do arrange an appointment you must undertake to give at
least a full 48 normal weekday hours (i.e. excluding Saturdays, Sundays and Bank Holidays) notice of a
cancellation to avoid being invoiced for the full fee. Please sign & date on page 4
NAME ...................................................................... ………………………………………………
Email ……………………………………………………………………………………………….
HOME ADDRESS .................................................................................................................................
..........................................................................................................................................................
TELEPHONE HOME .................................WORK ................................MOBILE ………………..
OCCUPATION ............................................................... . DATE OF BIRTH .......................
HEIGHT ......................... WEIGHT ........................... MARITAL STATUS ...................
ARE YOU UNDER A DOCTOR'S CARE? ......... IF YES, PLEASE GIVE DETAILS .................
..........................................................................................................................................................
DOCTOR'S NAME .............................................................. TELEPHONE ............................
DO YOU HAVE ANY SERIOUS HEART, LIVER OR KIDNEY COMPLAINTS? .......................
IF YES, PLEASE GIVE DETAILS .................................................................................................
ANY OTHER MAJOR PHYSICAL COMPLAINTS? .....................................................................
..........................................................................................................................................................
PLEASE LIST ANY SURGERY YOU HAVE HAD ......................................................................
..........................................................................................................................................................
DO YOU HAVE ANY TUMOURS OR GROWTHS? ...... IF SO, PLEASE GIVE DETAILS
..........................................................................................................................................................
BCRC Page 11 Partners: Jean Clarke LCSP(Phys), DHD, MACH, RT & Brian T Collins FICE, FRTPI, FCILT, FCMI, MIStructE
ARE YOU DIABETIC? .............. ARE YOU PREGNANT? .................
PLEASE LIST ALL MEDICATION & SUPPLEMENTS YOU NOW TAKE REGULARLY
(including over the counter medication)
...............................................................................
..........................................................................................................................................................
PLEASE LIST ALL KNOWN ALLERGIES ...................................................................................
..........................................................................................................................................................
HAVE YOU HAD COLONIC HYDROTHERAPY? ......... IF YES, WHEN LAST? .....…....
HAVE YOU CONSULTED A NUTRITIONIST RECENTLY? .............. IF YES. WHY? .........
..........................................................................................................................................................
HOW MANY BOWEL MOVEMENTS PER DAY DO YOU USUALLY HAVE? ........
DO YOU NORMALLY HAVE TO STRAIN TO HAVE A BOWEL MOVEMENT? .....................
DO YOU USE A STOOL SOFTENER OR LAXATIVE? ........ HERBAL LAXATIVE? ........
SUPPOSITORY? ........
DO YOU HAVE HAEMORRHOIDS OR OTHER RECTAL PROBLEMS? ...........
HAVE YOU EVER HAD RECTAL BLEEDING? ......... IF YES, WHEN? ...................
HAVE YOU EVER HAD BLEEDING FROM ANY OTHER BODILY ORIFICES? .........
IF YES, PLEASE GIVE DETAILS .................................................................................................
HAVE YOU EVER HAD A BARIUM ENEMA? ............ IF YES, WHEN? .....................
TO GIVE ME AN IDEA OF YOUR GENETIC HEALTH PROFILE PLEASE LIST ANY
HEALTH PROBLEMS THAT HAVE AFFECTED YOUR:
MATERNAL GRANDMOTHER .....................................................................................................
MATERNAL GRANDFATHER ......................................................................................................
PATERNAL GRANDMOTHER ......................................................................................................
PATERNAL GRANDFATHER ........................................................................................................
MOTHER .........................................................................................................................................
FATHER ..........................................................................................................................................
SISTERS ..........................................................................................................................................
BROTHERS .....................................................................................................................................
BCRC Page 12
HOW MANY CHILDREN DID YOUR PARENTS HAVE? ...... WHAT WAS YOUR
BIRTH POSITION IN THE FAMILY? ...........................................................................................
WERE YOU BREAST FED AS A BABY? .....................................................................................
IF YOU ARE FEMALE, DO YOU HAVE ANY CHILDREN? ......... IF YES, HOW MANY? ......
HOW FAR APART WERE THEY BORN? ...............................................................
PLEASE LIST THE FOODS AND DRINKS YOU WOULD HAVE ON A NORMAL DAY.
BEGIN WITH FIRST THING YOU HAVE IN THE MORNING THROUGH TO THE LAST
THING AT NIGHT. IT IS IMPORTANT THAT YOU LIST ALL FOODS AND DRINK IN
EACH MEAL AND BETWEEN MEALS. WHEN YOU DESCRIBE YOUR DRINKS PLEASE
STATE EXACTLY WHAT THEY ARE AND WHAT YOU ADD TO THEM, IF ANYTHING.
..........................................................................................................................................................
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What do you hope to achieve by having treatment at the Clinic?
..........................................................................................................................................................
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BCRC Page 13
PLEASE TICK [] ANY PRESENT CONDITIONS
CROSS [×] ANY PAST CONDITIONS YOU NO LONGER HAVE
LEAVE BLANK CONDITIONS YOU HAVE NOT EXPERIENCED
Blurred vision
Hoarseness frequent
Burning feet
Falling hair excessive
Breathing irregular
Itching feet and/or skin
Eat when nervous
Bitter metallic taste in mouth
in morning
Dry eyes, mouth & nose
Eyelids swollen & puffy
Eyes or nose watery
Difficulty in remembering
Sneezing attacks
Moods of depression
Worried, feel insecure
Irritable before meals
Faintness when meals
delayed
Coated tongue
Cannot get thoughts out of
head
Frequent nose bleeds
Nightmare type dreams
Noises in head or ears
Keyed up
Susceptible to colds
Afternoon headaches
Get drowsy often
Cannot get to sleep
Bad breath (halitosis)
Crave candy or coffee
Fever easily raised
Sigh frequently, 'air hunger'
Perspire easily
Pressure in pit of stomach
Extremities cold & clammy
Heart pounds after retiring
Hands & feet go to sleep
easily, numbness
Greasy food upsets
Pain between shoulder
blades
History of gall bladder
problems
Overeating of sweets upsets
History of gallstones
Acid food upsets
Indigestion ½ to 1 hour after
meals or up to 3-4 hours later
Wake up after a few hours
sleep & hard to get back to
sleep
Difficulty swallowing
Milk products distress
Dull pain in chest & left arm
Stomach bloating after meals
Sour stomach frequently
Circulation poor
Tension under rib cage
Pulse speeds up after meals
Digestion difficult
'Butterfly' stomach, cramps
Indigestion soon after meals
Aware of 'breathing heavily'
Biliousness
Heart palpitates if meals
missed or delayed
Constipation / diarrhoea
alternate
Mucus colitis
Nervous' stomach
Susceptible to colds, asthma,
bronchitis
Stools light in colour
Sensitive to hot weather
Lose taste for meals
Excessive appetite
Get 'shaky' if hungry
Vomiting frequently
Pulse slow, irregular
Gag easily
Shortness of breath
Gas shortly after eating
Appetite reduced
Neuralgia like pain
Bowel movements painful and
difficult
Loss of leg energy
Muscle/leg/toe cramps at night
Swollen ankles
Lower bowel gas a few hours
after eating
Skin peels on feet
Stools alternate soft / watery
Urine amount reduced
Muscle cramps worse during
exercise, get 'Charley horses'
Frequent urination
Stool has foul odour
Burning or itching anus
Dizziness
Dry skin
Skin rashes frequent
Hungry between meals
Fatigue relieved by eating
Joint stiffness after getting up
Do you need to open windows
in a closed room
Strong light irritates
Cold sweats often
Bruise easily, 'black & blue'
spots
Burning stomach sensations
...................................................
Signed
Date ……………………..…..
NOTE To supplement the information
given by your completed
Questionnaire normally you will
be tested on diagnostic equipment.
So as to ensure the reliability of
the results please: (1) for 48
hours preceding the
appointment, do not take any
strong medication (sleeping pills,
tranquillisers,
psychopharmaceutical products,
antibiotics, cortisone
preparations etc.). Medication
which cannot be interrupted should
naturally be continued but please
let me know before the test;
(2) on the day of the
appointment please do not drink
any coffee, tea or alcohol;
(3) on the day of the
appointment do not smoke, do
not take a cold bath or cold
shower, do not use any body
sprays, any creams, oils or
ointments;
(4) please wear loose,
comfortable clothing
BCRC Page 14