四 Differentiation on Liver and G.B.

Save this PDF as:
Size: px
Start display at page:

Download "四 Differentiation on Liver and G.B."

Transcription

1 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 mainly refers to the distending or running pain in the chest, hypochondriac region, breast or lower abdomen. Headache, dizziness and vertigo, depression, or irritability or easy to get angry, numbness or trembling in hands, indigestion, or eye problem, irregular menstruation, or testis pain.

2 ( 一 )Liver Qi stagnation It refers to the liver qi fails to promote the free flow of Qi resulting in the Qi stagnation. Distending or unfixed pain in the hypochondriac, chest or lower abdomen, oppressive chest with signing, depression or anger, obstruction in the throat with the feeling of difficult to swallow and spit, or goiters, or in female distending pain in the breast, or irregular menstruation, dysmenorrhea, or amenorrhea. Or masses; pale tongue with white coating, wiry or choppy pulse. 1 Liver qi stagnation failure in promotion. 2 depression and pain 3 Distending or unfixed pain in the hypochondriac, chest or lower abdomen, oppressive chest with signing, depression or anger due to liver.

3 ( 二 )Liver fire inflaming upward It refers to the excessive liver fire inflames upward. Dizziness and distending pain, tinnitus as tide, or sudden deaf with swelling and pus in the ears, or swollen and congested eyes, irritation and anger, burning pain in the hypochondriac region, bitter in the mouth, insomnia, or nightmares, flushed face and reddish eyes, or hematemesis and epistaxis; constipation, yellow and scanty urine, red tongue and yellow coating, wiry pulse. 1 excessive liver fire inflaming 2 fire inflaming in liver meridians 3 Dizziness and distending pain, tinnitus as tide, or sudden deaf with swelling and pus in the ears, or swollen and congested eyes, irritation 4 insomnia, or nightmares, flushed face and reddish eyes

4 ( 三 )Liver blood deficiency It refers to the liver blood deficiency fails to nourish the organs and tissues. Dizziness and blurred vision, pale and atrophic complexion, pale nails, blurred eyesight, or night blindness, or numb limbs and tense tendons, trembling on extremities; or in female menstruation with scanty and light colored discharge or even amenorrhea, pale tongue with thread pulse. 1 blood deficiency fails to nourish the organs 2 pale nails, dizziness 3 pale and atrophic complexion 4 Dizziness and blurred vision, pale nails, blurred eyesight, or night blindness, numb limbs and tense tendons, extremities; or in female menstruation with scanty and light colored discharge or even amenorrhea due to liver blood deficiency.

5 ( 四 )Liver Yin deficiency It refers to the liver Yin deficiency produces the internal deficient heat. Dizziness and tinitus, dryness on eyes, burning pain in hypochondriac region, or trembling on extremities, emaciated physique, dry mouth and throat, five center heat, tidal fever and night sweating, flushed complexion, red tongue with little or no coating, thread, wiry and rapid pulse. 1 liver Yin deficiency produces the deficient heat. 2 trembling on extremities 3 emaciated physique, dry mouth and throat, five center heat, tidal fever and night sweating, flushed complexion, red tongue with little or no coating, thread, wiry and rapid pulse. 4 Dizziness and tinnitus, dryness on eyes, burning pain in hypochondriac region,

6 ( 五 )Liver Yang ascending It refers to the liver and kidney Yin deficiency fails to control liver Yang--ascending. Dizziness and tinnitus, distending pain in head, reddish face and congested eyes, irritation and anger, palpitation, insomnia, heavy head, unstable walking, lassitude in loins and legs, red tongue, wiry and forceful or wiry thread pulse. 1 Liver yang ascending due to deficiency 2 distending pain in head, lassitude in loins and legs, heavy head, and long disease course. 3 Dizziness and tinnitus, reddish face and congested eyes, irritation and anger, palpitation, insomnia due to over ascending of liver 4 lassitude in loins and legs, heavy head, unstable walking, due to defi.

7 ( 六 )Internal stirring of Liver wind 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 mainly refers to the distending or running pain in the chest, hypochondriac region, breast or lower abdomen. Headache, dizziness and vertigo, depression, or irritability or easy to get angry, numbness or trembling in hands, indigestion, or eye problem, irregular menstruation, or

8 1. Liver Yang changing to wind It refers to the over ascending of liver yang results in internal wind stirring. Serious dizziness, headache with some shakes, trembling on head and extremities, stiff neck, unstable walking, numbs in extremities, dysphasis; or sudden syncope with unconsciousness, facial paralysis, hemiplegia, sputum rumbling in the throat, red tongue and white greasy coating, wiry thred forceful or wiry slippery pulse. 1 The over ascending of liver yang 2 Dizziness and vertigo, then sudden syncope, hemiplegia. 3 trembling on head and extremities, headache 4 unconsciousness, facial paralysis, hemiplegia

9 2. Excess heat producing wind It refers to the excess heat consumes the body fluid failure in nourishing tendons. High fever, irritability, irritation as mania, convulsion or trembling extremities, stiff neck, mouth closed tightly, starring eyes, opisthotonos, deep red tongue with yellow coating, wiry and rapid pulse. 1 the excess heat consumes the body fluid failure in nourishing tendons. 2 High fever and convulsion 3 High fever, irritability, irritation as mania and deep red tongue with yellow coating, wiry and rapid pulse due to excess heat. 4 convulsion or trembling extremities, stiff neck, mouth closed tightly, starring eyes, opisthotonoes due to liver wind.

10 3.Yin deficiency producing wind It refers to the Yin deficiency fails to nourish the tendons and vessels. Trembling extremities, dizziness and vertigo, tidal fever and reddish cheek, dry mouth and throat, emaciated physique, red tongue with no coating, thread and rapid pulse. 1 Yin deficiency fails to nourish the tendons and vessels. 2 Yin deficiency and wind stirring 3 dizziness and vertigo, tidal fever and reddish cheek, dry mouth and throat, red tongue with no coating, thread and rapid pulse dueto deficient heat 4Trembling extremities due to wind stirring

11 4.Blood deficiency producing wind It refers to the blood deficiency fails to nourish the tendons and vessels. Trembling extremities, muscular twitching and cramp, numb extremities, dizziness and vertigo, pale lips and nails, pale face, pale tongue with light white coating, thread and weak pulse. 1 the blood deficiency fails to nourish the tendons and vessels. 2 blood deficiency and wind stirring 3 dizziness and vertigo, pale lips and nails, pale face, pale tongue with light white coating, thread and weak pulse due to blood deficiency. 4 Trembling extremities, muscular twitching and cramp, numb extremities due to wind stirring.

12 ( 七 ) Damp heat retention in liver and gall bladder It refers to the damp heat retention in liver meridian or with gall bladder. Distending pain and masses in the hypochondriac region, abdominal distention, anorexia, bitter mouth, nausea and vomiting, irregular stool, yellow scanty urine; or bright yellow tint of sclera and skin, or alternate attacks of chill and fever, or recessive fever,; or itching in the pubic region (vulva), yellow and fetid leukorrhea; or eczema in pubic region with burning and itching; or swelling and burning pain in the testis. Red tongue and yellow greasy coating, wiry or slippery rapid pulse. 1 damp heat retention in liver meridian or with gall bladder.

13 ( 八 )Cold stagnation in liver meridian It refers to the cold evil invades and stagnates the live meridian. Sinking and cold distending pain in lower abdomen or testis, testicular contraction and dragging pain with the preference for hot compress and aggravation with coldness; cold feeling around body and cold extremities, pale tongue with white and moistened coating, deep and tense or wiry and tense pulse. 1 cold evil invades and stagnates the live meridian. 2 Sinking and cold distending pain in lower abdomen or testis 3 cold feeling around body and cold extremities, pale tongue with white and moistened coating, deep and tense or wiry and tense pulse due to cold 4 Sinking and cold distending pain in lower abdomen or testis due to cold in liver meridian.

14 ( 九 )Gall bladder stagnation with phlegm stirring It refers to the Gall bladder Qi stagnation and phlegm heat retention inside. Timidity with easy to be worried, palpitation, insomnia and dreaminess, irritation, oppressive chest, dizziness and vertigo, bitter taste in the mouth, nausea and vomiting, yellow and greasy coating, wiry rapid or slippery rapid pulse. 1 phlegm heat retention and Qi stagnation 2 palpitation, insomnia and dizziness 3 Timidity with easy to be worried, palpitation, oppressive chest due to gall bladder problem 4 dizziness and vertigo, bitter taste in the mouth, nausea and vomiting, yellow and greasy coating, wiry rapid or slippery rapid pulse due to phlegm heat retention inside.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MERIDIAN SYMPTOMOLOGY

MERIDIAN SYMPTOMOLOGY MERIDIAN SYMPTOMOLOGY According to Fukushima Kodo and Shudo Denmai a Summation by Jake Paul Fratkin, OMD Originally published in North American Journal of Oriental Medicine, Vol. 5, No. 12, March, 1998.

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

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

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

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

American Health Acupuncture LLC Healing the Body, Mind, & Spirit 7130 N Omar Dr Tucson AZ (520)

American Health Acupuncture LLC Healing the Body, Mind, & Spirit 7130 N Omar Dr Tucson AZ (520) American Health Acupuncture LLC Healing the Body, Mind, & Spirit 7130 N Omar Dr Tucson AZ 85741 (520) 544-6603 Notes for new Patients: Your first session * Can you imagine not having to wait at a doctor's

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

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

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

The Good & The Bad 9/14/2012. Names & Meanings. ChiroCredit.com Presents: AcuPractice Seminars 213: Liver /Gall Bladder

The Good & The Bad 9/14/2012. Names & Meanings. ChiroCredit.com Presents: AcuPractice Seminars 213: Liver /Gall Bladder ChiroCredit.com Presents: AcuPractice Seminars 213: Liver /Gall Bladder Liver AKA: Gan Wife Of The Gall Bladder The General Free & Easy Wanderer (Xiao Yao) Gall Bladder AKA: Dan Husband Of The Liver The

More information

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

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

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

SECTION OF NEUROSURGERY PATIENT INFORMATION SHEET

SECTION OF NEUROSURGERY PATIENT INFORMATION SHEET SECTION OF NEUROSURGERY PATIENT INFORMATION SHEET EC#: (for office use only) Patient s Name: Today s Date: Age: Date of Birth: Height: Weight: Physician you are seeing today: Marital Status: Married Work

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

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

Introduction of Korean Acupuncture focusing on Saam Five Element Acupuncture and Facial Acupuncture

Introduction of Korean Acupuncture focusing on Saam Five Element Acupuncture and Facial Acupuncture Introduction of Korean Acupuncture focusing on Saam Five Element Acupuncture and Facial Acupuncture Sanghoon Lee MD(Korean Medicine), MPH, PhD, DiplAc, LAc.(USA) Professor of Acupuncture & Moxibustion

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

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

Amarillo Surgical Group Doctor: Date:

Amarillo Surgical Group Doctor: Date: Office Visit Information (General Surgery) Amarillo Surgical Group Doctor: Date: Patient s Information Name: Last First Middle Social Security #: Date of Birth: Age Gender: [ Male / Female ] Marital Status:

More information

Questionnaire for Lipedema Patients

Questionnaire for Lipedema Patients Questionnaire for Lipedema Patients Name Date of diagnosis Date Name of physician making diagnosis Do you also have lymphedema? What areas of the body are affected? Outside of thighs Inner thighs Knees

More information

pathya some points according to liking. One which is harmful to the paths and disliked is certainly not

pathya some points according to liking. One which is harmful to the paths and disliked is certainly not pathya some points if;a ifkks uisra ; PpksDra eul% fiz;e~a ;Ppkfiz;eiF;a p fu;ra ruu y{k;sr~aa ekrzkdkyfø;khkwfensgnks"kxq.kkurje~a izki; rùkf) n` ;Urs rs rs HkkokLrFkk rfkkaa rlekr~ LoHkkoks fufnz"vlrfkk

More information

Caspian Acupuncture -- Health History Form Anita Tayyebi EAMP, LAc. 652 SW 150 th St Burien WA 98166

Caspian Acupuncture -- Health History Form Anita Tayyebi EAMP, LAc. 652 SW 150 th St Burien WA 98166 Frist Name Last: Date Phone (H) (C) (W) E-mail Address City State Zip Age DOB Place of Birth _ Marital/Partnership Status Preferred Gender Pronoun _ Profession Family Physician Telephone # Referred By

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

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

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

Medical History Form

Medical History Form Medical History Form Full Name Title: Mr/Mrs/Ms/Miss Address Date of Birth Date Telephone: Mobile: Email: How did you hear about the Garden of health? G.P s Name and Address Are you currently seeing your

More information

City State Zip Code. Ethnic Background: Caucasian African-American Asian Hispanic Native American. Previous. Hobbies/Leisure activities:,,,

City State Zip Code. Ethnic Background: Caucasian African-American Asian Hispanic Native American. Previous. Hobbies/Leisure activities:,,, History # UPIN # (Please leave blank) Name: First M.I. Last Address: Street (Apt #) City State Zip Code Phone number: ( ) ( ) Home Business Birth Date: / / Day-Month-Year Gender: M F Marital status: (Maiden

More information

Distribution Law and Dynamic Evolution of Zheng in TCM

Distribution Law and Dynamic Evolution of Zheng in TCM SMGr up Distribution Law and Dynamic Evolution of Zheng in TCM Jie Wang 1, Jia-liang Gao 1, Hong-zheng Li 1,2, Hao-qiang He 1,2, Chao Liu 1,2, Jun Li 1, Yan-wei Xing 1, Kui-wu Yao 1 and Guang Chen 1,2

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

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

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

Patient Information. Marital Status (Single, Married, Life Partner, Divorced, Widowed) CHIEF COMPLAINT

Patient Information. Marital Status (Single, Married, Life Partner, Divorced, Widowed) CHIEF COMPLAINT Patient Information Name Date Home Address City State Zip Phone E-mail Address Cell Phone: Business Address City State Zip Phone Occupation Place of Birth Date of Birth Age Height Weight Soc. Sec. # Sex

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

Luo Vessels, Cutaneous and Muscle Regions

Luo Vessels, Cutaneous and Muscle Regions Chapter 3 Luo Vessels, Cutaneous and Muscle Regions 1 Characteristics of Luo Vessels Connect external/internal pairs Distribute qi throughout the body Harmonize circulation 2 In all, there are fifteen

More information

Emory Clinic Department of Neurological Surgery Second Opinion Questionnaire

Emory Clinic Department of Neurological Surgery Second Opinion Questionnaire Emory Clinic Department of Neurological Surgery Second Opinion Questionnaire First Name: M.I. Last Name: Date of Birth: Phone: Marital Status: Married Divorced Separated Widowed Single Work Status: Employed

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

CECILIA P MARGRET MD PhD MPH Child, Adolescent and Adult Psychiatry NE 24th ST Suite 104, Bellevue WA 98007, Phone / Fax: +1 (425)

CECILIA P MARGRET MD PhD MPH Child, Adolescent and Adult Psychiatry NE 24th ST Suite 104, Bellevue WA 98007, Phone / Fax: +1 (425) IDENTIFYING INFORMATION PATIENT INFORMATION FORM Patient's Name: DOB: Ethnicity/race: Gender: Primary language if other than English: Address: Phone: Home/ Mobile/ Work Email: Occupation: Marital Status:

More information

Medical Intake Form. Patient Name: Age : Date of Birth: Gender: Female Male Marital Status: #Children: Address: City: State: Zip:

Medical Intake Form. Patient Name: Age : Date of Birth: Gender: Female Male Marital Status: #Children: Address: City: State: Zip: Date: Patient Name: Age : Date of Birth: Gender: Female Male Marital Status: #Children: Address: City: State: Zip: Home Phone: Cell Phone: Work Phone: E-mail: Person to Contact in Case of Emergency: Relationship

More information

What do you believe is causing your most important health concern?

What do you believe is causing your most important health concern? Intake form Name Today s Date Date of Birth Address City Phone Postal Code Email Primary Health Care Provider Emergency Contact Phone Note: By providing your email address you are giving us consent to

More information

Basic Internal Medicine Disease + common TCM pattern. Template 22

Basic Internal Medicine Disease + common TCM pattern. Template 22 Basic Internal Medicine Disease + common TCM pattern + Associated signs & symptoms Internal medicine diseases Common cold TCM pattern Wind-cold Wind-heat Template 22 Associated Signs & Symptoms Summer-dampness

More information

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

CMCS121. Session 4. Interview Workshop/ Abdominal Pain. Chinese Medicine Department. CMCS121 Session 4 Interview Workshop/ Abdominal Pain Chinese Medicine Department www.endeavour.edu.au Abdominal Pain o Maciocia, p 145-147, o Pain, p 255-259, 735-745 o Digestive symptoms p 262, o Asking

More information

Sixfu organs: small intestine, gall bladder, stomach, Large intestine, urinary bladder

Sixfu organs: small intestine, gall bladder, stomach, Large intestine, urinary bladder Sixzang organs: heart, liver, spleen, lung, kidney, pericardium To manufacture and store essential substances including vital essence, qi (vital energy), blood, andbodyfluid Sixfu organs : small intestine,

More information

New Patient Specialty Intake Form Department of Surgery

New Patient Specialty Intake Form Department of Surgery This form contains questions specific to the Department of Surgery. If you are new to Baylor College of Medicine and have not been seen in any of our offices, please be sure to complete our New Patient

More information

HAMILTON ANXIETY RATING SCALE (HAM-A)

HAMILTON ANXIETY RATING SCALE (HAM-A) HAMILTON ANXIETY RATING SCALE (HAM-A) Mood Disorders Psychopharmacology Unit www.mdpu.ca 1 Patient Information Patient Date Day Mth. Year Time Hour Min Personal notes 1. Anxious mood This item covers the

More information

Johanna M. Hoeller, DC PS

Johanna M. Hoeller, DC PS ENTRANCE FORM Birth date: Height: Weight: Emergency Contact: Emergency Contact Phone: ( ) Spouse/Partner or Parent s name: Children s names: Occupation (Your): Employer: Address: City/State/Zip: Phone:

More information

Laser Vein Center Thomas Wright MD Page 1 of 4

Laser Vein Center Thomas Wright MD Page 1 of 4 Demographics Laser Vein Center Thomas Wright MD Page 1 of 4 Patient Name: Address: City, St, Zip Primary Phone: Alternate: DOB: Social Security #: Insurance Information Primary Insurance ID# Group# Subscriber

More information

Table of Contents FOR DISPLAY ONLY. chapter 1 Abdominal Distention, 1. chapter 2 Abdominal Masses, 20. chapter 3 Abdominal Pain, 61

Table of Contents FOR DISPLAY ONLY. chapter 1 Abdominal Distention, 1. chapter 2 Abdominal Masses, 20. chapter 3 Abdominal Pain, 61 FOR DISPLAY ONLY introduction xix Structure of the text xxi Acknowledgements xxiii chapter 1 Abdominal Distention, 1 1 Liver qi constraint 4 2 Food stagnation 6 3 Damp-heat 8 4 Phlegm-dampness 10 5 Heat

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

MEDICAL QUESTIONNAIRE (female)

MEDICAL QUESTIONNAIRE (female) MEDICAL QUESTIONNAIRE (female) Slievemore Clinic, Old Dublin Road, Stillorgan, Co. Dublin. Tel 01-2000501 The appointment comprises of a discussion about this questionnaire and a subsequent medical examination.

More information

CHIROPRACTIC ASSOCIATES CLINIC

CHIROPRACTIC ASSOCIATES CLINIC CHIROPRACTIC ASSOCIATES CLINIC 1127 LAKEWOOD COURT NORTH, REGINA, SK S4X 3S3 PH: (306) 924-5300 FAX: (306) 924-5252 EMAIL: cac.north@accesscomm.ca CHIROPRACTIC INITIAL HEALTH FORM PATIENT INFORMATION Last

More information

The New Mexico Refugee Symptom Checklist-121 (NMRSCL-121)

The New Mexico Refugee Symptom Checklist-121 (NMRSCL-121) The New Mexico Refugee Symptom Checklist-121 (NMRSCL-121) Michael Hollifield, MD 2007 New Mexico Refugee Symptom Checklist-121 Instructions: Using the scale beside each symptom, please indicate the degree

More information

Sound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA

Sound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA Sound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA 98136 206.200.3595 Today s date Name Legal name (if different) Phone (primary) (secondary) Address City State Zip Email

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

Treatment Strategy III

Treatment Strategy III Treatment Strategy III Treatment Strategy III...1 1 Chest Pain... 1 1.1.1 TCM...3 1.1.2 Heart blood stasis...4 1.1.3 Congestion with turbid pheglm...5 1.1.4 Stagnation of Cold in the chest... 6 1.1.5 HT

More information

Headache Follow-up Visit Form

Headache Follow-up Visit Form !1 Headache Follow-up Visit Form We will be unable to see you unless this form is completely filled out. We appreciate your thoroughness. Name DOB Age Today s Date Referring doctor: Primary doctor: Neurologist:

More information

Oriental Medical Physiology. Jueyin (Liver and Pericardium) Physiology

Oriental Medical Physiology. Jueyin (Liver and Pericardium) Physiology Oriental Medical Physiology Jueyin (Liver and Pericardium) Physiology Six Levels of Physiology In Chinese Medicine Taiyang (UB/SI) Opens outward (to outside) Shaoyang (GB/SJ) Pivot Yangming (LI/ST) Closes

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

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

Scottsdale Family Health

Scottsdale Family Health Please list pharmacy you would like us to use for your medications. Pharmacy Phone Number Fax Number Since your last visit: 1. Have you been diagnosed with any new medical conditions? Yes No If Yes (give

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

Capital Health Medical Center - Hopewell NEUROSURGICAL-ONCOLOGY Patient History

Capital Health Medical Center - Hopewell NEUROSURGICAL-ONCOLOGY Patient History Capital Health Medical Center - Hopewell NEUROSURGICAL-ONCOLOGY Patient History Please take a few minutes and complete the following questions before you see the doctors so that we may learn a bit more

More information

T- Timing- concise vs. complete and thorough, depending on need of presenter and audience. E- Elicit- ask for feedback- more information needed? Less?

T- Timing- concise vs. complete and thorough, depending on need of presenter and audience. E- Elicit- ask for feedback- more information needed? Less? Review of STAGE presentation framework (from umass.macy.edu, revised Alicia Monroe, MD from 2005 STFM) S- style organization, sequencing adequate to build a case for your diagnosis or a story T- Timing-

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

CHIROPRACTIC ASSOCIATES CLINIC

CHIROPRACTIC ASSOCIATES CLINIC CHIROPRACTIC ASSOCIATES CLINIC 1127 LAKEWOOD COURT NORTH, REGINA, SK S4X 3S3 PH: (306) 924-5300 FAX: (306) 924-5252 EMAIL: cac.north@accesscomm.ca CHIROPRACTIC INITIAL HEALTH FORM Which Chiropractor are

More information

The Limits of Harm Reduction? Neil McKeganey Centre for Substance Use Research West of Scotland Science Park Glasgow Scotland

The Limits of Harm Reduction? Neil McKeganey Centre for Substance Use Research West of Scotland Science Park Glasgow Scotland The Limits of Harm Reduction? Neil McKeganey Centre for Substance Use Research West of Scotland Science Park Glasgow Scotland Principle of Harm Reduction First Do No Harm Hippocratic Oath I will use treatment

More information

PULMONARY MEDICINE PATIENT QUESTIONNAIRE

PULMONARY MEDICINE PATIENT QUESTIONNAIRE PULMONARY MEDICINE PATIENT QUESTIONNAIRE Date Name DOB Age Referring Physician What problem brings you to see us today? Have you had any of the following? (Any left blank will be reported in your medical

More information

Patient Intake Form. Name: Date of Birth: Social Security No.: Address: City: State: Zip:

Patient Intake Form. Name: Date of Birth: Social Security No.: Address: City: State: Zip: Patient Intake Form Name: Date of Birth: Social Security No.: Address: City: State: Zip: Phone (circle 1) home / cell / work: Marital Status: Single / Married / Divorced / Widowed Work Status: Employed

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

CONSULTATION ADMITTANCE FORM

CONSULTATION ADMITTANCE FORM CONSULTATION ADMITTANCE FORM Last Name: First Name: Address: City Postal Code: Home Phone: Work Phone: Age: Birth date (dd/mm/yr): Sex: M / F Height Weight Occupation: Alberta Health Care #: PLEASE CHECK

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

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

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

EMORY SLEEP CENTER Sleep and Health Questionnaire

EMORY SLEEP CENTER Sleep and Health Questionnaire EMORY SLEEP CENTER Sleep and Health Questionnaire Demographics Today s Date: / / Name: Date of Birth: / / Address: Sex: Male Female City/State/Zip: Preferred Contact Number: Work Home Cell Occupation:

More information

Medical History Form

Medical History Form General: Medical History Form 1. Chief Complaint: What are the main health concerns you wish to address? 2. Current and Past Treatment: Have you received treatment for these problems? Yes No, if yes, which:

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

Course: Diagnostics I Date: July 31, 2007 Class #: 3

Course: Diagnostics I Date: July 31, 2007 Class #: 3 Course: Diagnostics I Date: July 31, 2007 Class #: 3 Focus for today: Observation of the eyes See the mental condition thru the eye. Today talk about the specifics Complete theory of eye observations.

More information

The Rehabilitation Institute Cancer Rehabilitation

The Rehabilitation Institute Cancer Rehabilitation DO NOT DRILL The Rehabilitation Institute Cancer Rehabilitation STAR Patient Intake Form Your Name: Date: Your date of birth: Age: Who referred you (if a healthcare provider, please provide address)? Doctors

More information

THE MANY SYMPTOMS ROOTED IN HORMONE IMBALANCES

THE MANY SYMPTOMS ROOTED IN HORMONE IMBALANCES abdominal pain acne aging process accelerated allergies, including asthma, hives, rashes, sinus congestion anemia (blood hemoglobin low) anorexia anovulatory (no ovulation) anxiety anxious depression appetite

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

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

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

New Patient Health History Questionnaire

New Patient Health History Questionnaire Name:. Dear Nov Patient: a) Please read and fill in all of the information that pertains to you. b) On pages 2 through 11, under each category, check all symptoms that you experience either acutely or

More information

Please have your health insurance card(s), a valid picture ID, and any applicable copayment ready when you check-in.

Please have your health insurance card(s), a valid picture ID, and any applicable copayment ready when you check-in. Please have your health insurance card(s), a valid picture ID, and any applicable copayment ready when you check-in. We have enclosed a questionnaire for you to complete and bring to the visit. Please

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