SECTION B: MAJOR SYMPTOMS

For each symptom which is present, enter the appropriate 
figure in the Point Score Column:

If a symptom is occasional or mild ....................score 3 points.
If a symptom is frequent and/or moderately severe .....score 6 points.
If a symptom is severe and/or disabling ...............score 9 points.

Add total score for this section and record it in the 
box at the end of this section.
								 Point 
								 Score
								 Column

1. Fatigue or lethargy__________________________________________ ______

2. Feeling of being "drained"___________________________________ ______

3. Poor memory__________________________________________________ ______

4. Feeling "spacey" or "unreal"_________________________________ ______

5. Inability to make decisions__________________________________ ______

6. Numbness, burning or tingling________________________________ ______

7. Insomnia_____________________________________________________ ______

8. Muscle aches_________________________________________________ ______

9. Muscle weakness or paralysis_________________________________ ______

10. Paint and/or swelling in joints_____________________________ ______

11. Abdominal pain______________________________________________ ______

12. Constipation________________________________________________ ______

13. Diarrhea____________________________________________________ ______

14. Bloating, belching or intestinal gas________________________ ______

15. Troublesome vaginal burning, itching or discharge___________ ______

16. Prostatitis_________________________________________________ ______

17. Impotence___________________________________________________ ______

18. Loss of sexual desire or feeling____________________________ ______

19. Endometriosis or infertility_________________________________ ______

20. Cramps and/or other menstrual irregularities_________________ ______

21. Premenstrual tension_________________________________________ ______

22. Attacks of anxiety or crying_________________________________ ______

23. Cold hands or feet and/or chilliness_________________________ ______

24. Shaking or irritable when hungry_____________________________ ______
      
    Total Score, Section B ....................................._________
							     Point Score Total