CMCS121. Session 4. Interview Workshop/ Abdominal Pain. Chinese Medicine Department.

Size: px
Start display at page:

Download "CMCS121. Session 4. Interview Workshop/ Abdominal Pain. Chinese Medicine Department."

Transcription

1 CMCS121 Session 4 Interview Workshop/ Abdominal Pain Chinese Medicine Department

2 Abdominal Pain o Maciocia, p , o Pain, p , o Digestive symptoms p 262, o Asking about the abdomen, p , o Palpating the abdomen, p , o Children's, p 412, 864-5, 867 o Maclean and Lyttleton, Vol 2, Spleen and Stomach, p Endeavour College of Natural Health 2

3 Our Abdomen Digestive System anatomy Endeavour College of Natural Health 3

4 Abdominal Pain o Today s class will focus on some common TCM patterns of Abdominal Pain, to build the skills necessary in the interview,when asking about this condition in Student Clinic. o This topic will be revisited and covered comprehensively in later CMAC classes o This is a large topic and so the focus will be on developing palpatory and interrogatory skills for the preclinical student Endeavour College of Natural Health 4

5 Observation of the Abdomen o You will be hearing many of these terms as you progress through the course. Lets review. Palpate these areas if you want to. The abdomen is considered to reflect the status of the Sp/St(post natal qi) while the lower abdomen is ruled by the Ki( pre natal qi) o What is the xiphoid process and where is it? o What is the epigastrium and where is it? o What is the hypochondrium and where is it? o What is the umbilicus and where is it? o What is the central lower abdomen and where is it? o What is the lateral lower abdomen and where is it? o What is meant by RLQ? RUQ, LLQ, LUQ? Endeavour College of Natural Health 5

6 Palpating the Abdominal Regions o Hypochondrium: Tender when palpated = Lv Qi Yu, Lv Xue Yu or Damp-heat in the Lv/GB o Feels better with palpation: Lv Xue xu o Epigastrium: Feels hard in area just below xiphoid process = Qi or xue yu of heart o Feels hard = St Full condition( Qi Yu, Xue yu, damp, food retention) o Feels distended( drum like) = Qi Yu o Patient feels like epigastrium is full but feels soft to practitioner = Sp xu and St shi( heat) mixed picture. o Better with touch/pressure: = Xu o Umbilicus: Hard and painful = Chong Mai Qi or xue yu o Lat lower abd: Hard and painful = damp of intestines, Chong mai,xue yu o Cent lower abd: Damp in Si or Bl or, if painful, = Qi or xue yu in Si or Bl Endeavour College of Natural Health 6

7 Lets look for these signs on a patient s abdomen o Distention: (Bloated feeling,subjectively, or like a drum on palpation, objectively) o Oedema: fluid retention, pitting or other o Thin abdomen o Large or sagging abdomen o Abdominal masses: Fixed,boring pain(xue yu) or moveable, comes and goes (qi xu) o Lumps in the hypochondrium or epigastrium? Endeavour College of Natural Health 7

8 Describe your pain for me. cutting Sore Our patients may say bloating. In TCM this is distending pain Nervy, full, empty, heavy, comes and goes, stuffy uncomfortable feeling Throbbing boring Moves around Fixed Temperature: Cold or hot pain Burning Stabbing Endeavour College of Natural Health 8

9 Pain is often the Main Complaint.. o Location: The word stomach can mean the area that we consider the abdomen. Where is the pain?. Can you point to where the pain is please? (mark on your intake form) = Which channels and organs are involved o Nature: Describe the pain for me o Timing: Do you feel the pain all the time? When do you feel the pain? o Aggravating or Ameliorating factors: What makes it feel worse? What makes it feel better? o Does it feel better or worse with pressure? o Does it feel better or worse with heat/cold? Endeavour College of Natural Health 9

10 What might these pain words o Boring pain o Burning pain indicate in TCM? o Distending pain ( sometimes might be described as a throbbing/dragging pain) o It is worse when you push on it or touch it o It is better when you push on it or touch it o It feels better when I put a heating pad on it o It feels better when I ice it o It feels better/worse when I eat o It feels better/ worse when I drink cold/hot liquids o It feels better/worse when I have a bowel movement Endeavour College of Natural Health 10

11 There are many Abdominal Pain patterns. Let us just talk about some common ones extensively covered in later CMAC subject

12 Below the Xiphoid Process St heat sx: burning pain, thirst, sour regurg, nausea, excess hunger, foul breath, feel hot. Red tongue yellow coat, full rapid pulse Pain below the xiphoid Stomach Heat Endeavour College of Natural Health 12

13 Stomach Food Retention Feeling of fullness, pain and distention below the xiphoid that feels better after vomiting + Nausea, vomit sour fluids, foul breath, belching, diarrh or constip, thick tongue coat, full slippery pulse = Food retention of the Stomach Endeavour College of Natural Health 13

14 Phlegm in the Stomach Pain Sx: Pain below the xiphoid, feeling of oppression in chest/epigast + Phlegm symptoms: phlegm in the throat, nausea, swollen tongue with sticky coat, slippery pulse = Phlegm in the Stomach Endeavour College of Natural Health 14

15 Epigastric Pain Pain sx: dull epig pain better with eating or pressure + Sp and St Sp qi xu sx: low appetite, bloating after eating, tired, loose stools, pale, pale tongue, empty pulse = St and Sp Qi xu Endeavour College of Natural Health 15

16 Liver invading the Stomach St sx: Epigast and hypochond pain and distention, sour regurg, hiccup, belching, nausea, vomiting + Lv Qi Yu Sx: Irritability, sighing normal tongue colour, red sides, wiry on Left, weak on R(St) = Lv invading St Endeavour College of Natural Health 16

17 Cold in the Stomach St sx: severe acute spastic epigast pain, better with warm drinks, worse with cold drinks, nausea and vomiting after cold drinks + Cold Sx: better with warm drinks, feel cold, cold limbs, thick white tongue coat, deep, tight, slow pulse = Cold in the Stomach Endeavour College of Natural Health 17

18 Stomach Fire St sx: bleeding gums, mouth ulcers, vomit after eating, foul breath, nausea, feel hot + Fire Sx: Burning epigast pain, intense thirst w/ desire to drink cold liquid, mentally restless, dry mouth. Red tongue with thick dry dk yellow coat, Deep, full rapid pulse = Stomach Fire Endeavour College of Natural Health 18

19 Damp-Heat in the Stomach Damp-Heat sx: feel heavy,stuffed nose or thick nasal discharge, thirst w/no desire to drink, nausea, feel hot, red tongue with sticky yellow coat,slippery rapid pulse + Stomach pain sx: Epigast pain and feeling of fullness = Damp- Heat in the Stomach Endeavour College of Natural Health 19

20 Hypochondrial Pain Hypochondrial Pain: no fixed location, worse with emotion Lv Qi Yu Sx: irrit, moodiness, PMS sx, lump in the throat. Wiry pulse Lv Qi Yu Endeavour College of Natural Health 20

21 Lower Abdominal Pain Umbilical pain: (SI) not relieved by BM Damp heat sx: diarr, mucous/blood in stool, burning anus, scanty dark urine, smelly stools, sweat, feel hot, thirst w/no desire to drink, heavy feeling, red tongue with sticky yellow coat, slippery rapid pulse Damp-heat in the Intestines Endeavour College of Natural Health 21

22 Case Study Exercise: Clinical Rounds and Observation:

23 Cheat Sheet for Case Study Exercise o What do each of the 4 Diagnostic methods add to your interview and to your diagnosis? o Are there any questions that you feel should have been asked and why? o What is your 8 principle analysis of this case? o Which organ or organs are involved? Why? o Is it acute or chronic? o What does the pulse and tongue add to the symptom picture? o What do the signs and symptoms that you noted from observation add to the formulation of your diagnosis? Endeavour College of Natural Health 23

24 Readings for Next Week o Dizziness o Maciocia, p 295-6, o Maclean and Lyttleton, Vol 1, Lung, Liver, Kidney, Heart, p Endeavour College of Natural Health 24

25 References o Maciocia, G 2004, Diagnosis in Chinese Medicine, Churchill Livingstone, Edinburgh o Maclean,W & Lyttleton J 1998 Clinical Handbook of Internal Medicine: Vol 2, University of Western Sydney, Sydney Endeavour College of Natural Health 25

CMPR121. Session 13. Small Intestine

CMPR121. Session 13. Small Intestine CMPR121 Session 13 Small Intestine Chinese Medicine Department www.endeavour.edu.au Small Intestine o Separates the pure from the impure o Receives & transports food o Separates fluids o Is responsible

More information

Patient Intake Form for Acupuncture Treatment at Infinite Healing

Patient Intake Form for Acupuncture Treatment at Infinite Healing Section A: Your Information Patient Intake Form for Acupuncture Treatment at Infinite Healing Last Name: First Name: Middle Initial: Mailing Address: _ City: Postal Code: E-mail: Birth date: M D YR Age:

More information

PHLEGM. Signs of Phlegm The essential signs of Phlegm are a Swollen tongue body with a sticky tongue coating and a Slippery or Wiry pulse.

PHLEGM. Signs of Phlegm The essential signs of Phlegm are a Swollen tongue body with a sticky tongue coating and a Slippery or Wiry pulse. PHLEGM The concept of Phlegm is very wide-ranging and important in Chinese Medicine. Phlegm is extremely frequent in clinical practice and is at the same time a pathological condition and an aetiological

More information

Upper Jiao problem Pallor of face Qi/Yang/Blood Xu or Cold Can be excess, or Blood Deficiency

Upper Jiao problem Pallor of face Qi/Yang/Blood Xu or Cold Can be excess, or Blood Deficiency Course: Diagnostics II Date: Dec 8, 2007 Combination Symptoms Combination Syndrome Symptom Caused by Qi Deficiency of Heart and Lung Palpitation Indicative of heart problem Cough with difficult inhalation,

More information

Traditional Chinese Medicine Diagnostic 10 Questions Please answer each question.

Traditional Chinese Medicine Diagnostic 10 Questions Please answer each question. 1 Traditional Chinese Medicine Diagnostic 10 Questions Please answer each question. 1. Thinking about your internal thermostat and where you feel your body temperature is most of the day, do you think

More information

Course: Diagnostics II Date: Class #: 2

Course: Diagnostics II Date: Class #: 2 Course: Diagnostics II Date: 10-03-07 Class #: 2 Eight principles cont d Know: what is true/what is false (true cold/false heat for example) Know yin deficiency symptoms Know exterior/interior dx. Note:

More information

CMAC311. Session 12. Miscellaneous disorders. Abdominal mass and Myoma (Ji Ju and Zhang Jia) PCOS Endometriosis Chinese Medicine Department

CMAC311. Session 12. Miscellaneous disorders. Abdominal mass and Myoma (Ji Ju and Zhang Jia) PCOS Endometriosis Chinese Medicine Department CMAC311 Session 12 Miscellaneous disorders Abdominal mass and Myoma (Ji Ju and Zhang Jia) PCOS Endometriosis Chinese Medicine Department www.endeavour.edu.au Session Contents o Discuss the TCM aetiology

More information

Traditional Chinese Medicine (TCM) Assessment Instructions

Traditional Chinese Medicine (TCM) Assessment Instructions Traditional Chinese Medicine (TCM) Assessment Instructions This assessment form is designed to determine your current health condition according to Traditional Chinese Medicine (TCM). Each patient must

More information

!!!! Traditional & Contemporary Acupuncture! 19 Golden Ave, Toronto ON! ! Gregory Cockerill, R.

!!!! Traditional & Contemporary Acupuncture! 19 Golden Ave, Toronto ON! ! Gregory Cockerill, R. Traditional & Contemporary Acupuncture 19 Golden Ave, Toronto ON info@livehandacupuncture.com 416-899-3364 Gregory Cockerill, R.Ac First Name: Last Name: Birthdate: Gender: Female Male Address: Email:

More information

POST GRADUATE DIPLOMA IN ACUPUNCTURE (PGDACP) Term-End Examination December, 2010 PGDACP-01 : BASIC THEORIES OF ACUPUNCTURE/TCM DIAGNOSIS

POST GRADUATE DIPLOMA IN ACUPUNCTURE (PGDACP) Term-End Examination December, 2010 PGDACP-01 : BASIC THEORIES OF ACUPUNCTURE/TCM DIAGNOSIS No. of Printed Pages : 11 PGDACP - 01 l POST GRADUATE DIPLOMA IN ACUPUNCTURE (PGDACP) 00061 Term-End Examination December, 2010 PGDACP-01 : BASIC THEORIES OF ACUPUNCTURE/TCM DIAGNOSIS Time : 2 Hours Maximum

More information

Symptom Review (page 1) Name Date

Symptom Review (page 1) Name Date v2.4, 2/13 JonathanTreasure.com Botanical Medicine & Cancer Herb Drug Interactions Herbalism 3.0 Symptom Review (page 1) Name Date INSTRUCTIONS Please read each section below carefully and, after each

More information

ACUPUNCTURE FOR HEALTH WENDY STALKER R.Ac. Dip.Ac. B.Sc. Name: Date of Birth: Date:

ACUPUNCTURE FOR HEALTH WENDY STALKER R.Ac. Dip.Ac. B.Sc. Name: Date of Birth: Date: Name: Date of Birth: Date: Address: Postal Code: Occupation: Telephone: Day: Cell Phone: E-mail address: Emergency Contact: Evening: Telephone: Male Female Where did you hear about Acupuncture for Health?

More information

Emotional Relationships Social Life Sexually Recreation

Emotional Relationships Social Life Sexually Recreation Name Date Address City State Zip Married Single Partner Divorced Widowed Date of Birth SS# Email Work Phone Home Phone Cell Phone Occupation Referred by Emergency Contact Family Physician Contact May we

More information

Have you had all childhood diseases i.e.? chickenpox. Y N. Have you ever suffered from an infectious illness? i.e. glandular fever.

Have you had all childhood diseases i.e.? chickenpox. Y N. Have you ever suffered from an infectious illness? i.e. glandular fever. Acupuncture case history card Name: Date: Address: Ph No: (H) (W) (M) E-mail: Fax: D.O.B Sex: M F Marital Status: Occupation: Dr: Suburb: Referred by: Health fund Medical history For the following questions,

More information

Tongue Evaluation. Body Color. Including colors at different locations. Indications. Body temperature regulation.

Tongue Evaluation. Body Color. Including colors at different locations. Indications. Body temperature regulation. Tongue Evaluation Christopher Rodgers, Student Body. Refers to the overall appearance including muscles, arteries, and veins. Associations. Conditions of the cardiovascular, nervous, reproductive, urinary

More information

Session 9. Abdominal pain (Fu tong, 腹痛 ) Nausea / vomiting. Chinese Medicine Department. SP, ST & Intestinal Pathologies

Session 9. Abdominal pain (Fu tong, 腹痛 ) Nausea / vomiting. Chinese Medicine Department. SP, ST & Intestinal Pathologies Session 9 SP, ST & Intestinal Pathologies Abdominal pain (Fu tong, 腹痛 ) Abdominal Distension (Fu Zhang, 腹胀 ) Nausea / vomiting (E Xin/Ou Tu, 恶心 / 呕吐 ) Chinese Medicine Department www.endeavour.edu.au o

More information

Course: Diagnostics I Date: August 14, 2007 Class #: 7. Drinking (pt of Q5)

Course: Diagnostics I Date: August 14, 2007 Class #: 7. Drinking (pt of Q5) Course: Diagnostics I Date: August 14, 2007 Class #: 7 For quiz review the 10 trad questions, 16 questions. And more. 10 Traditional q s (cont d) Thirsty? Ask this first. Most important question. Drinking

More information

Natalie Kilheeney L.Ac., Dipl. OM Licensed Acupuncturist & Herbalist

Natalie Kilheeney L.Ac., Dipl. OM Licensed Acupuncturist & Herbalist *All information is important to your intake and valuable to your personal treatment plan. Please answer as thorough as possible. Patient Information: Name: Date: / / (First Middle Last) Address: City:

More information

DIFFERENTIAL QUESTIONS

DIFFERENTIAL QUESTIONS 4 IMBALANCES AND 5 ORGANS A New System for Diagnosis and Treatment DIFFERENTIAL QUESTIONS Jeremy Ross www.jeremyross.com DIFFERENTIAL QUESTIONS A New System for Diagnosis 90 Organ syndromes In Chinese

More information

4-1 Dyspnea (Chuan, 喘 )

4-1 Dyspnea (Chuan, 喘 ) 4-1 Dyspnea (Chuan, 喘 ) Concept Breathing with difficulty (open wide mouth, raise shoulders) Etiology and pathogenesis Climatic factors Phlegm fluid Emotion Chronic diseases Exertion Over sex Diagnosis

More information

TONICS TO TONIFY OR TO EXPEL: THAT IS THE QUESTION

TONICS TO TONIFY OR TO EXPEL: THAT IS THE QUESTION TONICS "The three months of Autumn are the time of harvest. The energy of Heaven begins to blow swiftly and the energy of Earth begins to change colour. One should go to bed early and rise early: maintain

More information

ACUPUNCTURE SPECIFIC INTAKE FORM

ACUPUNCTURE SPECIFIC INTAKE FORM ACUPUNCTURE SPECIFIC INTAKE FORM A naturopathic approach to medicine is holistic and seeks to understand all factors that may be affecting your health. Please answer the following questions to the best

More information

四 Differentiation on Liver and G.B.

四 Differentiation on Liver and G.B. 四 Differentiation on Liver and G.B. The main physiological function of the liver is in charge of promotion of free flow of whole body s Qi and storing the blood. The common pathogenic changes of liver

More information

Differentiation in lung and L.I.

Differentiation in lung and L.I. Differentiation in lung and L.I. The main physiological function of the lung is in charge of breathing, supplements heart for blood circulation, and regulates the water metabolism. It s common manifestation

More information

QI STAGNATION AETIOLOGY. The aetiological factors of Qi stagnation are essentially only two, i.e. emotional or dietary.

QI STAGNATION AETIOLOGY. The aetiological factors of Qi stagnation are essentially only two, i.e. emotional or dietary. QI STAGNATION This newsletter will discuss the aetiology, pathology, patterns and treatment of Qi stagnation. Qi stagnation is one of the most common pathological situations encountered in practice and

More information

URINARY DISORDERS: Lin Syndromes. Linda Boggie Eric Hartmann

URINARY DISORDERS: Lin Syndromes. Linda Boggie Eric Hartmann URINARY DISORDERS: Lin Syndromes Linda Boggie Eric Hartmann Lin Syndromes Painful Urination Syndromes Painful Frequent Short Urgent Dribbling A disruption in urine flow Often associated with or are an

More information

TCM & CONSTIPATION. Provided by AcuPro Academy - Copyright AcuPro Academy 2014 All Rights Reserved

TCM & CONSTIPATION. Provided by AcuPro Academy - Copyright AcuPro Academy 2014 All Rights Reserved TCM & CONSTIPATION Provided by AcuPro Academy - 1 INTRODUCTION TO CONSTIPATION Causes Diet Illnesses Drugs Lack of exercise Emotions 2 TCM PATTERNS FOR CONSTIPATION TCM patterns Symptoms Tx Principles

More information

Dang Gui Si Ni Tang Tangkuei Decoction for Frigid Extremities

Dang Gui Si Ni Tang Tangkuei Decoction for Frigid Extremities Dang Gui Si Ni Tang Tangkuei Decoction for Frigid Extremities D F E G ctions: Warms the channels, disperses cold, nourishes the xue, and unblocks the xue vessels. hief Deputy (a) Dang Gui (b) Gui Zhi (c)

More information

DIAGNOSIS YES NO. KIDNEY YIN DEFICIENTY (Ki Yi- -) Do you have lower back weakness, soreness, or pain, or knee problems?

DIAGNOSIS YES NO. KIDNEY YIN DEFICIENTY (Ki Yi- -) Do you have lower back weakness, soreness, or pain, or knee problems? Answer yes or no to each of the following questions. Don t worry about what the symptoms mean; just note whether you experience them. If you have more than one--fourth to one--third yes re- sponses in

More information

CMAC311. Session 4. Chinese Medicine Department MENSTRUATION DISORDERS. Pre-menstrual Syndrome (PMS) Dysmenorrhea (painful periods)

CMAC311. Session 4. Chinese Medicine Department MENSTRUATION DISORDERS. Pre-menstrual Syndrome (PMS) Dysmenorrhea (painful periods) CMAC311 Session 4 MENSTRUATION DISORDERS Pre-menstrual Syndrome (PMS) Dysmenorrhea (painful periods) Chinese Medicine Department www.endeavour.edu.au Session Contents o Explain the aetiology factors &

More information

Personal Information

Personal Information Personal Information 1. Date: / / mm dd yy 2. Name: 3. Gender: M F 4. Date of Birth: / / mm dd yy 5. Marital Status: Single Married Divorce Widow 6. Do you have insurance? Y N 7. Patient's address: Address:

More information

complexion, fatigue, profuse clear and frequent urination, chronic loose stools, edema in the lower

complexion, fatigue, profuse clear and frequent urination, chronic loose stools, edema in the lower Course: Acupuncture Treatment of Disease 2 Doc: Case Studies Week 1 Infertility and Impotence (really from week 12 last term) Li, Female Age 25 She suffered from infertility for 4 years. She had profuse,

More information

28-DAY CLEANSE GUT C.A.R.E. by Dr. Vincent Pedre. Pre-Program Medical Symptoms Questionnaire

28-DAY CLEANSE GUT C.A.R.E. by Dr. Vincent Pedre. Pre-Program Medical Symptoms Questionnaire 28-DAY CLEANSE HAPPY GUT GUT C.A.R.E. by Dr. Vincent Pedre Pre-Program Medical Symptoms Questionnaire NAME ADDRESS EMAIL PHONE RATE EACH OF THE FOLLOWING SYMPTOMS BASED UPON HOW YOU HAVE FELT OVER THE

More information

Syndrome Differentiation. REVIEW Dr Igor Mićunović Ph.D

Syndrome Differentiation. REVIEW Dr Igor Mićunović Ph.D Syndrome Differentiation REVIEW Dr Igor Mićunović Ph.D Outline Syndrome differentiation in TCM is a method to analyses and recognize the syndrome of disease. In other words, it is also a process in which

More information

New Patient Medical History Intake Form

New Patient Medical History Intake Form New Patient Medical History Intake Form Name: Todays Date: / / Date of Birth: / / Age: Gender: M / F Marital Status: S M D W Address: City: State: Zip Code Primary Ph.# (cell, hm, wk) Email Address 2nd

More information

Patient Health History

Patient Health History Patient Health History Name: Date: Address: City, State, Zip code Phones: Home Work: Cell: Email address: Date of Birth: Age: Occupation: Emergency contact: Referred by: Current Medications: Are you/might

More information

FAMILIES OF REMEDIES

FAMILIES OF REMEDIES FAMILIES OF REMEDIES This newsletter will present the main "families" of remedies grouped according to condition treated in a tabular form for quick reference. The "families" of remedies considered will

More information

Term-End Examination December, 2009

Term-End Examination December, 2009 PGDACP - 01 POST GRADUATE DIPLOMA IN ACUPUNCTURE (PGDACP) 00931 Term-End Examination December, 2009 PGDACP-01 : BASIC THEORIES OF ACUPUNCTURE/TCM DIAGNOSIS Time : 2 Hours Maximum Marks : 70 Note : There

More information

The Big Picture. The Good & The Bad 9/13/2012

The Big Picture. The Good & The Bad 9/13/2012 ChiroCredit.com Presents: AcuPractice Seminars 211: Spleen / Stomach Spleen AKA: Pi Wife of the Stomach The Minister Of Agriculture The Official In Charge of T & T Stomach AKA: Wei Husband of the Spleen

More information

Symptom Questionnaire

Symptom Questionnaire Symptom Questionnaire The following questionnaire is a general assessment of your health developed by Dr Royal Lee D.D.S. Each grouping represents a particular area of your body that may be causing you

More information

Course: Formulas 1 Date: December 2, 2009 Class #: 10. Function in Formula. Disperse stagnation

Course: Formulas 1 Date: December 2, 2009 Class #: 10. Function in Formula. Disperse stagnation Course: Formulas 1 Date: December 2, 2009 Class #: 10 Xi Jiao Di Huang Tang : o Clear Heat toxins o o Disperse stagnation : o Heat in the blood Xi jiao Sheng di Shao yao Mu dan pi Clear Heart heat Nourish

More information

Dexamethasone is used to treat cancer. This drug can be given in the vein (IV), by mouth, or as an eye drop.

Dexamethasone is used to treat cancer. This drug can be given in the vein (IV), by mouth, or as an eye drop. Dexamethasone Other Names: Decadron About This Drug Dexamethasone is used to treat cancer. This drug can be given in the vein (IV), by mouth, or as an eye drop. Possible Side Effects (More Common) Increased

More information

Patient Information. Vibrant Health Acupuncture & Wellness Center, LLC 260 Gateway Drive, Suite 7B Bel Air, Maryland

Patient Information. Vibrant Health Acupuncture & Wellness Center, LLC 260 Gateway Drive, Suite 7B Bel Air, Maryland Patient Information Vibrant Health Acupuncture & Wellness Center, LLC 260 Gateway Drive, Suite 7B Bel Air, Maryland 21014 410-913-8322 Patient Name: Date of Birth: Age: Male: Female: Single: Married: Separated:

More information

Course: Diagnostics II Date: 9/26/07 Class #: 1

Course: Diagnostics II Date: 9/26/07 Class #: 1 Course: Diagnostics II Date: 9/26/07 Class #: 1 Theories of disease and symptom analysis to acquire differentiation. There are several tools and systems you can use to analyze symptoms and get form a differentiation

More information

Course: Acupuncture Treatment of Disease 2 Date: February 26, 2009 Doc: Case Studies for Quiz 2

Course: Acupuncture Treatment of Disease 2 Date: February 26, 2009 Doc: Case Studies for Quiz 2 Course: Acupuncture Treatment of Disease 2 Date: February 26, 2009 Doc: Case Studies for Quiz 2 This quiz covers: Class 4: Epilepsy Class 5: Headaches and Migraines Class 6: Shingles (Herpes zoster) and

More information

Term-End Examination June, 2010

Term-End Examination June, 2010 00643 No. of Printed Pages : 12 PGDACP - 01 POST GRADUATE DIPLOMA IN ACUPUNCTURE (PGDACP) Term-End Examination June, 2010 PGDACP-01 : BASIC THEORIES OF ACUPUNCTURE/TCM DIAGNOSIS Time : 2 Hours Maximum

More information

Associations of Yin & Yang Yin Disorders

Associations of Yin & Yang Yin Disorders Review ChiroCredit.com Presents: AcuPractice 202 Yin & Yang II, The 8 Principles Yin vs. Yang Substance vs. Function Cooling vs. Warming Activity vs. Rest Protection vs. Recovery Transformation vs. Maintenance

More information

Oriental Medicine Questionnaire

Oriental Medicine Questionnaire Oriental Medicine Questionnaire Date: Name: DOB Sex: M F SS# Address: City State Zip Cell Phone: Home Phone: Business Phone Occupation: Height: Weight: Who referred you to this office? 1.What brought you

More information

Introduction to Aetiology. Terminology 1. Terminology 2. Aims. Aetiology Clinical manifestations Pattern Pathology Diagnosis

Introduction to Aetiology. Terminology 1. Terminology 2. Aims. Aetiology Clinical manifestations Pattern Pathology Diagnosis Introduction to Aetiology Aims to learn about the three classic divisions of aetiology reflect on emotions and feelings Terminology Aetiology Clinical manifestations Pattern Pathology Diagnosis Terminology

More information

Patient Health History for Fertility

Patient Health History for Fertility Patient Health History for Fertility Name: Date: Address: City, State, Zip code Phones: Home Work: Cell: Email address: Date of Birth: Age: Occupation: Emergency contact: Ob/Gyn: Current Medications: What

More information

CONSULTATION & CONSENT FORMS p. 1 of 5

CONSULTATION & CONSENT FORMS p. 1 of 5 CONSULTATION & CONSENT FORMS p. 1 of 5 ******************************************************************************** List your full name, age, sex, and today's date List your complete address List your

More information

Inner Balance Acupuncture

Inner Balance Acupuncture Patient Information Inner Balance Acupuncture 274 Southland Drive, Suite 101, Lexington, KY 40503 859-595-2164 www.acupunctureky.com Name: Today s date: Age: Male Female Marital status: Date of Birth:

More information

DISEASES OF THE RESPIRATORY SYSTEM

DISEASES OF THE RESPIRATORY SYSTEM DISEASES OF THE RESPIRATORY SYSTEM Respiratory diseases are extremely common and often respond very well to treatment with acupuncture and Chinese herbs. Both acute and respiratory diseases can be helped.

More information

Combination Syndromes

Combination Syndromes Course: Diagnostics 2 Date: 11/14/07 Class #: 8 No download for this on the Student Portal at this time, but I have exactly made sure I copied down everything from the handout. The bullet points from the

More information

ALIGN ACUPUNCTURE AND HERBS LLC Rebekah V. Michaels MAOM, Diplomate OM, Lic Ac

ALIGN ACUPUNCTURE AND HERBS LLC Rebekah V. Michaels MAOM, Diplomate OM, Lic Ac ALIGN ACUPUNCTURE AND HERBS LLC Rebekah V. Michaels MAOM, Diplomate OM, Lic Ac. 617-835-2512 Patient Information and Health History Date: Name: Date of Birth: Street: City: State: Zip: Phone: (H) (W) )

More information

Patient Information & Health History

Patient Information & Health History Patient Information & Health History Name Date Date of Birth (mm/dd/yy) Age Male Female Address City Postal Code Occupation Phone (H) E-mail Phone (C) Married Single Divorced Widowed Phone (W) Spouse s

More information

PHYSIOTHERAPIST. Date of last visit MASSAGE THERAPIST. Date of last visit SPECIALISTS. Date of last visit WHAT ARE YOUR PRIMARY HEALTH CONCERNS?

PHYSIOTHERAPIST. Date of last visit MASSAGE THERAPIST. Date of last visit SPECIALISTS. Date of last visit WHAT ARE YOUR PRIMARY HEALTH CONCERNS? 2 PHYSIOTHERAPIST Date of last visit MASSAGE THERAPIST Date of last visit SPECIALISTS Date of last visit WHAT ARE YOUR PRIMARY HEALTH CONCERNS? WHAT IS THE PRIMARY REASON YOU ARE SEEKING CONSULTATION/TREATMENT?

More information

Address: Phone: Date of Birth: / / Major Complaints: 1) 3) 2) 4)

Address: Phone:   Date of Birth: / / Major Complaints: 1) 3) 2) 4) Head To Heal Family Wellness Acupuncture Intake Form Patient Name: Address: Phone: email: Date of Birth: / / Major Complaints: 1) 3) 2) 4) Details regarding Major Complaint: Where is the problem located?

More information

Center for Traditional Health Arts 5 Keller Street, Suite A, Petaluma, CA (707)

Center for Traditional Health Arts 5 Keller Street, Suite A, Petaluma, CA (707) Center for Traditional Health Arts 5 Keller Street, Suite A, Petaluma, CA 94952 (707) 763-8040 www.traditionalhealtharts.com Name Address Phone (home) Phone (work) Email Classical Chinese Medicine & Health

More information

NEW PATIENT INTAKE FORM

NEW PATIENT INTAKE FORM NEW PATIENT INTAKE FORM Acupuncture * Herbs * Nutrition Located inside of Yoga 360 91 Bankview Drive Frankfort, IL 60423 815-806-0360/www.yoga-360.com lkacupuncture.com lizkelchak@gmail.com How To Prepare

More information

Bowel Resection Surgery (Open Method)

Bowel Resection Surgery (Open Method) Bowel Resection Surgery (Open Method) What is a bowel resection? A bowel resection is surgery to remove a part of the large or small intestine. These parts are shown on this diagram. small intestine large

More information

For the Patient: Ponatinib Other names: ICLUSIG

For the Patient: Ponatinib Other names: ICLUSIG For the Patient: Other names: ICLUSIG (poe na' ti nib) is a drug that is used to treat some types of cancer. It is a tablet that you take by mouth. The tablet contains lactose. Tell your doctor if you

More information

Angela Berscheid RAc 02183; 697 Seedtree Rd, Sooke BC V9Z 1C2 (250) Patient Symptom and Evaluation Sheet

Angela Berscheid RAc 02183; 697 Seedtree Rd, Sooke BC V9Z 1C2 (250) Patient Symptom and Evaluation Sheet 1 Patient Symptom and Evaluation Sheet 1. General Energy: normal low For how long?_ 2. Fever and Chills: fever chills alternating fever and chills fever in the afternoon all day evening dislike of heat

More information

Head To Heal Acupuncture Intake

Head To Heal Acupuncture Intake Form Head To Heal Acupuncture Intake Patient Name: Date of Birth: / / Address: Phone: In case of emergency contact (name & #): Consent to treat with acupuncture (signature): Major Concerns: 1) 3) 2) 4)

More information

Nivolumab. Other Names: Opdivo. About this Drug. Possible Side Effects (More Common) Warnings and Precautions

Nivolumab. Other Names: Opdivo. About this Drug. Possible Side Effects (More Common) Warnings and Precautions Nivolumab Other Names: Opdivo About this Drug Nivolumab is used to treat cancer. It is given in the vein (IV). Possible Side Effects (More Common) Bone marrow depression. This is a decrease in the number

More information

CMAC212. Session 9. Special point categories. Focusing on: Small & Large Intestine. Chinese Medicine Department.

CMAC212. Session 9. Special point categories. Focusing on: Small & Large Intestine. Chinese Medicine Department. CMAC212 Session 9 Special point categories Focusing on: Small & Large Intestine Chinese Medicine Department www.endeavour.edu.au Session 9 Today we shall: o Discuss point prescriptions for the take home

More information

For the Patient: ULUAVPMB

For the Patient: ULUAVPMB For the Patient: ULUAVPMB Other Names: Treatment of Advanced Non-Small Cell Lung Cancer Using Pembrolizumab U = Undesignated (requires special approval) LU = LUng AV = AdVanced PMB = PeMBrolizumab ABOUT

More information

2. Approx. Date of Onset: 3. Approx. Date of Onset:

2. Approx. Date of Onset: 3. Approx. Date of Onset: Healthy Balance Lisa A. Dulac, L.Ac. Acupuncture Patient Intake Form Present Health Concerns: Please list your most important health concerns in order of their significance. 1. Approx. Date of Onset: 2.

More information

Course: Acupuncture Treatment of Disease 2 Date: March 2009 Doc: Case Studies and Discussions for Final

Course: Acupuncture Treatment of Disease 2 Date: March 2009 Doc: Case Studies and Discussions for Final Course: Acupuncture Treatment of Disease 2 Date: March 2009 Doc: Case Studies and Discussions for Final Please exactly make sure that you also study case discussions that applied to Quizzes 1 and 2. Class

More information

Qi & Blood Deficiency Signs. Qi & Blood Deficiency Signs. Weak voice and lack of desire to speak. Chinese Pathology of 10

Qi & Blood Deficiency Signs. Qi & Blood Deficiency Signs. Weak voice and lack of desire to speak. Chinese Pathology of 10 Qi & Blood Deficiency Signs Qi Deficiency Blood Deficiency Qi & Blood Deficiency Signs Qi Deficiency Pale bright complexion Shortness of breath Weakness/Exhaustion (Lassitude of spirit) Weak voice and

More information

Used for exterior conditions such as common colds, fevers, and flu s. Many of these formulas induce sweating. This category can be subdivided into

Used for exterior conditions such as common colds, fevers, and flu s. Many of these formulas induce sweating. This category can be subdivided into Section 1 Used for exterior conditions such as common colds, fevers, and flu s. Many of these formulas induce sweating. This category can be subdivided into formulas the release cold or heat. Traditionally

More information

Acupuncture Health History Page 1 of 5

Acupuncture Health History Page 1 of 5 General Contact Information Acupuncture Health History Page 1 of 5 Name: Date of Birth: Address: City: Postal Code: Contact Numbers#: Home #: Email: (By checking you give David E. Chung Permission to email

More information

205 W Giaconda Way, Suite 135 Tucson, AZ, (520) Name: Birth date: Age: Today s Date:

205 W Giaconda Way, Suite 135 Tucson, AZ, (520) Name: Birth date: Age: Today s Date: 205 W Giaconda Way, Suite 135 Tucson, AZ, 85704 (520) 219-2400 www.forever-able.com info@forever-able.com Name: Birth date: Age: Today s Date: Address: Email: Home phone: Mobile phone: May we add you to

More information

Table 1. Traditional Chinese Medicine Syndrome Differentiation Diagnostic Criteria for Apoplexy Scale

Table 1. Traditional Chinese Medicine Syndrome Differentiation Diagnostic Criteria for Apoplexy Scale Table. Traditional Chinese Medicine Syndrome Differentiation Diagnostic Criteria for Apoplexy Scale TCM Item Acute ischemic stroke related symptoms and signs Score Wind Onset Peaked 8 hours Peaked hours

More information

Essential Wellness Of Illinois, LLC Health History Questionnaire Christine A. Renz L.Ac., Dipl OM, MSTOM

Essential Wellness Of Illinois, LLC Health History Questionnaire Christine A. Renz L.Ac., Dipl OM, MSTOM Name Date Address City State Zip Home Phone Cell Fax Email Emergency Contact Emergency Number Date of Birth Age Sex Height Weight Lbs Marital Status Occupation Who referred you to this office? Name of

More information

For the Patient: Paclitaxel Other names: TAXOL

For the Patient: Paclitaxel Other names: TAXOL For the Patient: Paclitaxel Other names: TAXOL Paclitaxel (pak'' li tax' el) is a drug that is used to treat many types of cancer. It is a clear liquid that is injected into a vein. Tell your doctor if

More information

Lung and Large Intestine

Lung and Large Intestine Course: Diagnostics II Date: October 17, 2007 Class #: 4 Homework For each zang or fu: make a small chart for each for symptoms. Do a chart per organ, later do a chart with combinations. See slide 9 from

More information

For the Patient: USMAVNIV

For the Patient: USMAVNIV For the Patient: USMAVNIV Other Names: Treatment of Unresectable or Metastatic Melanoma Using Nivolumab U = Undesignated (requires special approval) SM = Skin and Melanoma AV = AdVanced NIV = NIVolumab

More information

Balanced Healing Acupuncture, LLC

Balanced Healing Acupuncture, LLC Balanced Healing Acupuncture, LLC Intake Form NAME: Last First: GENDER: Date of Birth / / Age Email Address Address City State Zip Code Preferred Phone Number Cell Home Work Preferred Method of Communication:

More information

Digestion Assessment Scorecard

Digestion Assessment Scorecard Name Digestion Assessment Age Height Weight Based upon your health profile for the past 30 days, please select the appropriate number, from '0-3' on all questions (0 as least/never/no and 3 as most/always/yes).

More information

Shiatsu Intake Form PURCHASED PRODUCT/SERVICE. Date of Birth Age Height Weight. Home Address City State ZIP

Shiatsu Intake Form PURCHASED PRODUCT/SERVICE. Date of Birth Age Height Weight. Home Address City State ZIP Shiatsu Intake Form DATE PURCHASED PRODUCT/SERVICE FIRST NAME LAST NAME Date of Birth Age Height Weight Home Address City State ZIP Home Phone Cell Phone Email Name of Emergency Contact Would you like

More information

Chinese Medicine Adult Intake Form. Name (Last, First): Home address: Phone: Emergency contact name & phone number: Relationship Status:

Chinese Medicine Adult Intake Form. Name (Last, First): Home address: Phone:   Emergency contact name & phone number: Relationship Status: Chinese Medicine Adult Intake Form Name (Last, First): Date of Birth: Occupation: Hours per week: Home address: Phone: Email: Preferred contact method (circle one): Phone / Email Emergency contact name

More information

CENTRAL CARE POLICY SYMPTOMS OF ILLNESS. Policy: Consumers will be observed for symptoms of physical problems, distress, pain, or unusual behaviors.

CENTRAL CARE POLICY SYMPTOMS OF ILLNESS. Policy: Consumers will be observed for symptoms of physical problems, distress, pain, or unusual behaviors. Page 1 of 5 CENTRAL CARE POLICY SYMPTOMS OF ILLNESS SUBJECT: SYMPTOMS OF ILLNESS ANNUAL REVIEW MONTH: June RESPONSIBLE FOR REVIEW: Director of Central Care LAST REVISION DATE: June 2009 Policy: Consumers

More information

Sorafenib (so-ra-fe-nib) is a drug that is used to treat many types of cancer. It is a tablet that you take by mouth.

Sorafenib (so-ra-fe-nib) is a drug that is used to treat many types of cancer. It is a tablet that you take by mouth. For the Patient: Other names: Sorafenib NEXAVAR Sorafenib (so-ra-fe-nib) is a drug that is used to treat many types of cancer. It is a tablet that you take by mouth. A blood test may be taken before each

More information

1.0 Presenting complaint: Onset 1.1 When it started? 1.2 How did it start? Progress 1.3 Has the problem increased /decreased so far?

1.0 Presenting complaint: Onset 1.1 When it started? 1.2 How did it start? Progress 1.3 Has the problem increased /decreased so far? Case history Sr. No. Name Sex M / F Age Marital Status B / S / M / W Occupation Date 1.0 Presenting complaint: Onset 1.1 When it started? 1.2 How did it start? Progress 1.3 Has the problem increased /decreased

More information

Class 1 - Point Indication. Review of TCM theory. Yin / Yang ( / Yin and Yang are:

Class 1 - Point Indication. Review of TCM theory. Yin / Yang ( / Yin and Yang are: Class 1 - Point Indication Review of TCM theory Yin / Yang ( / Yin and Yang are: 1. Counterbalanced They are the generalization of the relative opposite principles observed throughout all things 2. Inter-transforming

More information

Docetaxel (Taxotere )

Docetaxel (Taxotere ) Page 1 of 5 Docetaxel (Taxotere ) About This Drug Docetaxel is used to treat cancer. It is given in the vein (IV). Possible Side Effects Bone marrow depression. This is a decrease in the number of white

More information

Acupuncture in the Chiropractic Practice

Acupuncture in the Chiropractic Practice Acupuncture in the Chiropractic Practice Define and describe Shen and its role in health and the five element system Identify common conditions in which Shen plays an important role Explore acupuncture

More information

Bridges Family Wellness PC. New Patient Intake. Bridges Family Wellness Intake Form SE Lake Rd, Suite 102 Milwaukie, OR

Bridges Family Wellness PC. New Patient Intake. Bridges Family Wellness Intake Form SE Lake Rd, Suite 102 Milwaukie, OR New Patient Intake Bridges Family Wellness Intake Form Full Name: * What is your birthdate? MM/DD/YYYY * What is your gender identity? * Home address: * Cell Phone * Other Phone number(s): Emergency Contact

More information

Lucas D. Brown, L.Ac. (312)

Lucas D. Brown, L.Ac. (312) Today s date: Mr. Miss Mrs. Ms. Dr. Birth date: (mm/dd/yy) Social Security Number: First name: Last name: Age: Email: Marital status: Single Divorced Married Separated Partner Widowed Street address: Apt:

More information

SYSTEMS SURVEY FORM. Doctor

SYSTEMS SURVEY FORM. Doctor Patient Birth Date / / Approx Weight SYSTEMS SURVEY FORM Doctor INSTRUCTIONS: Fill in only the circles which apply to you. Leave blank if you don't have the problem. Fill in the circle marked 1 for MILD

More information

Women s Fertility Symptom Survey

Women s Fertility Symptom Survey 535 Encinitas Blvd., Suite 115 Encinitas, CA 92024 (760) 575-4227 www.capwellnesscenter.com Women s Fertility Symptom Survey Please answer the following questions even if you have encountered the same

More information

METABOLIC ASSESSMENT FORM

METABOLIC ASSESSMENT FORM METABOLIC ASSESSMENT FORM Name: Age: Sex: Date: PART 1 Please list the 5 major health concerns in your order of importance: 1. 2. 3. 4. 5. PART 2 Please circle the appropriate number 0-3 on all questions

More information

GENERAL INFORMATION (Please print)

GENERAL INFORMATION (Please print) APPLICATION FORM & QUESTIONNAIRE GENERAL INFORMATION (Please print) Today's date Name Age Sex (M,F) Place of birth Birth date Marital status Number of children Living situation (alone, family, friends)

More information

SYSTEMS SURVEY FORM GROUP 1

SYSTEMS SURVEY FORM GROUP 1 SYSTEMS SURVEY FORM Patient Doctor Date Birth Date / / Approx Weight Vegetarian Gluten-free INSTRUCTIONS: Number only the boxes which apply to you. Leave blank if you don't have the problem. * Write 1

More information

HOW DID YOU HEAR ABOUT US?

HOW DID YOU HEAR ABOUT US? 427 Bloomfield Ave. Ste. 306 Montclair, NJ 07042 Phone: 973-746- 2848 Fax: 973-746- 2088 HOW DID YOU HEAR ABOUT US? Eastern School of Acupuncture and Traditional Medicine Student Clinic Intake Form Intake

More information

Sunitinib. Other Names: Sutent. About This Drug. Possible Side Effects. Warnings and Precautions

Sunitinib. Other Names: Sutent. About This Drug. Possible Side Effects. Warnings and Precautions Sunitinib Other Names: Sutent About This Drug Sunitnib is used to treat cancer. It is given orally (by mouth). Possible Side Effects Headache Tiredness and weakness Soreness of the mouth and throat. You

More information

ENDOMETRIOSIS WESTERN MEDICAL PERSPECTIVE

ENDOMETRIOSIS WESTERN MEDICAL PERSPECTIVE ENDOMETRIOSIS WESTERN MEDICAL PERSPECTIVE Definition Endometriosis is a condition resulting from the presence of actively growing and functioning endometrial tissue in locations outside the uterus. The

More information

GASTRECTOMY. Date of Surgery. Please bring this booklet the day of your surgery. QHC#34

GASTRECTOMY. Date of Surgery. Please bring this booklet the day of your surgery. QHC#34 GASTRECTOMY Date of Surgery Please bring this booklet the day of your surgery. QHC#34 What is a Gastrectomy? A Gastrectomy is the surgical removal of all or part of the stomach. The stomach is the digestion

More information