Tongue Evaluation. Body Color. Including colors at different locations. Indications. Body temperature regulation.
|
|
- Agatha Lyons
- 5 years ago
- Views:
Transcription
1 Tongue Evaluation Christopher Rodgers, Student Body. Refers to the overall appearance including muscles, arteries, and veins. Associations. Conditions of the cardiovascular, nervous, reproductive, urinary systems, absorption, nutrition, metabolism, and bile manufacture. Indications. Long term pathological disharmonies and constitutional weakness. Coating. Refers to the thickness, color, and consistency. Associations. Urinary bladder, large intestine, small intestine, digestion, bile secretion. Indications. Acute pathologies, excess or deficient states. Body Color. Including colors at different locations. Indications. Body temperature regulation. Shape. Thick, thin, narrow, wide, pointed, flaccid, scalloped, crooked, notched, swollen, cracked, curled up or down, and depressions. Indications. Strength of vital energies of the body and the length of pathology. Humidity. Wet or dry. Movement. Trembling, shaky, deviated, or stiff. Sublingual Veins. Color, thick or thin, distended etc. Locations. Front, center, rear, or sides. Body Systems Associations on the Tongue. Tip of the tongue. Nervous system and Cardiovascular system. Beyond the tip from left to right. Respiratory system. Middle section of the tongue. Digestion, absorption, and nutrition. Sides between middle section and far sides of the tongue. Bile secretion. Sides of the tongue. Metabolism and bile manufacture. Far back of the tongue. Urinary system and Reproductive system.
2 Tissue States and the Tongue. Cold. Body pale, dark, blue, purple, gray, black. Coat white. Heat. Red- pink, painful, pointed, elongated, red protuberances, red streak down the center (heat in the digestive tract), red on the sides (heat in the liver and gallbladder). Atrophy. Dry, thin, withered, cracked, peeled. Stagnation. Coated greasy, adhesive, yellow. Relaxation. Coating white, moist, non- adhesive. Wind. Shakes, quivers, trembles. Somatotypes. Ectomorph. Thin, small, narrow, white coat, pink (maybe blue hue), dry, cracks. Mesomorph. Thick, strong, yellow coat, red, moist, muscular. Endomorph. Full, wide, round, white coat, pink or pale, moist. Normal Tongue. The overall impression is healthy. Pale red or pink. Shape is neither too thick or thin. Not cracked or crevassed. Uniformly coated thin and white, appearing almost transparent. The sublingual vein is not seen, or not dark, or distended. TONGUE BODY. Pale Tongue Body. Cold Tissue State. Neuroendocrine deficiency. Symptoms. Chronic fatigue. Lethargy. Shortness of breath. Slow metabolism. No appetite. Frequent colds and flus with slow recovery. Low soft voice. Spontaneous sweating. Frequent urination. Palpitations. Pale and Thin Tongue Body. Cold _ Atrophy Tissue State. Deficiency of blood. Symptoms. Dizziness. Blurry vision. Numbness. Restlessness. Anxiety. Slight irritability. Insomnia. Scanty menses. Dark spots in the visual fields. Dry skin, hair, or eyes. Pale face and lips. Tiredness. Easily startled. Poor memory. Pale and Swollen Tongue Body. Cold Tissue State. Symptoms. Feelings of coldness. Copious clear urine. White, copious, or runny discharges. Red Tongue Body. Heat Tissue State. Symptoms. Red face. Red eyes. Scanty dark urine. Yellow discharges. Strong odors. Fever. Restlessness. Irritability. Deep Red Tongue Body. Heat Tissue State. Extreme heat in the organs. Symptoms. Extreme heat signs with depletion of fluids. Shortness of breath. Exhaustion. Disturbed mind. Delirium. Profuse sweating. Red Tongue Body with Red Raised Points. Heat Tissue State. Toxicity. Symptoms. Skin outbreaks. Pain. Inflammation. Ulcers. Nervousness.
3 Red in the Front of the Tongue. Heat Tissue State. Heat in the Heart and Lungs. Symptoms. High sympathetic tone. High mental activity. Hormonal imbalances. Insomnia. Nervousness. Red Tongue Body and Raised Papillae. Heat _ Wind Tissue State. Symptoms. Allergies. Shortness of breath. Sneezing. Colds and Flu. Itchy skin. Blocked nasal passages. Swollen sore throat. Sweating. Skin eruptions. Bluish Tongue Body. Cold _ Stagnation Tissue State. Severe stagnation. Symptoms. Purple lips, nails, or tongue. Dark colored menses. Dark complexion. Fixed or stabbing pains. Hard, immobile masses or lumps. Hemorrhaging clots. Swelling of the organs. Purple Tongue Body. Stagnation Tissue State. Liver and blood stagnation. Black Tongue Body. Stagnation Tissue State. Very severe blood stagnation. Red, Inflamed, and Peeled on the Sides of the Tongue. Liver pathology. Symptoms. Liver inflammation. Hepatitis. Peeled Coating with Red Tongue Body. Heat Tissue State. TCM. Yin deficient heat. Symptoms. High sympathetic tone. High metabolic rate. Burned up neurotransmitters. Stress. Chronic inflammation. Auto- immune conditions. Swollen Tongue Body. Stagnation Tissue State. Accumulation of fluids. Symptoms. Feelings of heaviness. Edema. Oozing skin eruptions. Loose stools. Chest fullness. Abdominal distention. Nausea. Sore, heavy, or stiff joints. Copious bodily secretions. Extremely Swollen Tongue Body. Stagnation Tissue State. Congealed fluids. Symptoms. Mucus. Coughs. Tumors. Cysts. Soft lumps. Nodules. Numbness. Tremors. Paralysis. Narrow Tongue Body. Heat Tissue State. Heat consuming body fluids. Symptoms. Redness along the cheeks and bones. Burning sensation in the palms of the hands, soles of feet, and in the chest. Dry throat or thirst at night. Dry stools. Dark scanty urine. Agitation. Restless floating sleep. Thin Tongue Body. Atrophy Tissue State. Deficient blood and nutrition. Scalloped Edges. Pancreas; worrying too much. Nervous tension. Pink- Red Papillae Down the Sides. Indicating lymphatic inflammation. Indent in the Tip. Hyperthyroid.
4 Whole Edge of the Entire Tongue. A combination of the nervous system and digestion. Canker Sores on Tongue. Ulcers in digestive tract. Crooked Tongue. Wind Tissue State. Hollow Rut, Sides Curled Up. Deficiency. Withered, Purple. Heart deficiency, nutritional deficiency. Stiff, Hard. Heat, contraction, pain. TONGUE COATING. White Coating. Cold fluid stagnation or excess secretion. Thick Coating. Excess conditions; heat, phlegm, dampness, etc. Yellow Coating. Heat. Light Yellow, Greasy and Slippery. Too many fats in the diet, deficient liver and gallbladder functions. Yellow, Brown. Heat in the interior, constipation. Purple, Red. Engorged or stagnant heart. Greasy Coating. Digestive system disorders. Gray Coating on Back of Tongue. Sluggish bowel, smoking and excess heat, constipation. Frothy Mucus on Edges. Respiratory issues. No Coating on Tongue. Not assimilating nutrients. Central Area Red, Raw, Coated. Ulcer.
5 Tongue Evaluation Form I I Overall Condition. Body. I Coating. I Pink- Red Pale Yellow White Red Blue Orange Gray Deep Red Purple Brown Black Geographic Black Purple- red Patchy Criss- crossed Cracked Scalloped Shape. Thin Puffy Humidity. Narrow Wide Dry Moist Pointed- tip Indented- tip Withered Furred Glossy Frothy Greasy Movement. Stiff Withdrawn Flaccid Trembles Key. NS. nervous system Ht. heart Lu. lungs St. stomach S. spleen Lv. liver Gb. gallbladder Ki. kidneys In. intestines Bl. bladder
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 informationEmotional 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 informationTraditional 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 informationUpper 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 informationCourse: 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 informationTraditional 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 informationFacial Assessment. Color. Lines in the Skin.
Facial Assessment Color. Red. Heat, inflammation, upward movement. White. Closure of capillaries, cold, shock, downward/inward movement. Blue. Lack of oxygen. Purple. Stagnation, bruises. Yellow. Liver,
More informationNatalie 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 informationDIAGNOSIS 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 informationCENTRAL 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 informationNew 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 informationACUPUNCTURE 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 informationSymptom 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!!!! 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 informationPOST 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 informationTerm-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 informationPatient 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 informationDIFFERENTIAL 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 informationPatient 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 informationCMCS121. 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 informationSymptom 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 informationCaspian 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 informationPHYSIOTHERAPIST. 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 information4-1 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 informationSyndrome 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 informationPatient 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 informationPatient 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 informationURINARY 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 informationSECTION 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 information2. 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 informationAssociations 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 information205 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 informationCourse: 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 informationHeadache 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 informationcomplexion, 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 informationBridges 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 informationTerm-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 informationSixfu 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 informationSYSTEMS 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 informationMEDICAL QUESTIONNAIRE (male)
MEDICAL QUESTIONNAIRE (male) Slievemore Clinic, Old Dublin Road, Stillorgan, Co. Dublin. Tel 01-2000501/502 Fax: 01 2780248 The appointment comprises of a discussion about this questionnaire and a subsequent
More informationSYSTEMS 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 informationSound 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 informationInner 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 informationQuestionnaire 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 informationMedical Questionnaire
MEDICIS Health Testing Center Avenue de Tervueren 236 115 Bruxelles Tel : 2/762.5.44 Medical Questionnaire Name :. Maiden name : First name :. Sex :. Address :...... Phone (private) : Office :. Date of
More informationNivolumab. 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 information28-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 informationWomen 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 informationPatient 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 informationPHLEGM. 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 informationAmerican 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 informationSYSTEMS SURVEY FORM. Doctor
Patient Birth / / Approx Weight SYSTEMS SURVEY FORM 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 symptoms (occurs
More informationPatient 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 informationDISEASES 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 informationMERIDIAN 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 informationDiscussing TECENTRIQ (atezolizumab) with your healthcare team Talking to Your Doctor
Discussing TECENTRIQ (atezolizumab) with your healthcare team Talking to Your Doctor TECENTRIQ DISCUSSION SUPPORT What is TECENTRIQ? TECENTRIQ is a prescription medicine used to treat: A type of bladder
More informationIntroduction 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 informationBodily Conditions Rooted in Hormone Imbalance
Check this list for all conditions that apply to you. The total possible score is 209. Count the number of symptoms you check. The higher your score, the more likely you need to address hormone imbalances.
More informationLucas 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 informationNEW 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 informationTCM & 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 informationMEDICAL 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 informationEmory 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 informationTHE 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 informationNew Patient History. Name: DOB: Sex: Date: If yes, give the name of the physician who did your evaluation or ordered your tests:
New Patient History Name: DOB: Sex: Date: Chief Complaint: 1. Give a brief description of the problem you are seeking treatment for today: 2. Have you been evaluated for this problem or had any tests for
More informationScott Towne Center ~ 2101 Greentree Road, Suite A-204, Pittsburgh, PA ~ [412] /
Confluence Healing Scott Towne Center ~ 2101 Greentree Road, Suite A-204, Pittsburgh, PA 15220 ~ [412] 279 1115 / www.confluencehealing.com Patient Identification / Contact Information: At times it may
More informationACTION CHIROPRACTIC & SPORT THERAPY 7744 Elbow Drive SW Calgary, AB T2V 1K2 Phone: Fax: Full Name: Address:
ACTION CHIROPRACTIC & SPORT THERAPY 7744 Elbow Drive SW Calgary, AB T2V 1K2 Phone: 403.243.8114 Fax: 403.212.0880 Full Name: Address: City: Province: Postal Code: Date of Birth (MM/DD/YYYY): Home Phone:
More informationTHE ART OF VISUAL DIAGNOSIS ACTION GUIDE. FOUR TYPES OF DIAGNOSIS All of your senses are needed to properly diagnose a patient:
THE ART OF VISUAL DIAGNOSIS ACTION GUIDE Visual diagnosis is an ancient tool used by traditional healers to help discover the strengths and weaknesses, health (or lack of health), within the body. Once
More informationNutrient Assessment Chart
Vitamin A Assessment Chart Chicken skin on backs of arms Chronic acne Dry eyes Food allergies Poor night vision Recurrent infections and colds Reduced hair growth in children Ulcers B Vitamins Afternoon
More informationHealth History Questionnaire
CLINICAL ACUPUNCTURE SERVICES Cathy D. Adelman, RN, LAc PO Box 91451 Tucson, AZ 85752-1451 (520) 822-6844 cdarnlac@hughes.net www.clinicalacupunctureservices.com Health History Questionnaire I. GENERAL
More informationNew 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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Patient General Information
Patient General Information Name: (first) (middle) (last) Date of Birth: / / (mo) (day) (year) 中 文名字 : Gender: Occupation: Address: (street, apt) Phone #: (city, state, zip code) Email: Emergency Contact:
More informationMETABOLIC 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 informationHASPI Medical Biology Lab 01a
! What Does It Test For? Very Low Low Glucose Electrolytes Ferritin Blood ph The glucose test measures the amount of sugar, or glucose, in the blood or urine. A very high or very low glucose test can indicate
More informationPATIENT INFORMATION LEAFLET CARZIN XL
SCHEDULING STATUS: S3 PROPRIETARY NAME, STRENGTH AND PHARMACEUTICAL FORM: 4 mg film coated tablets. Read all of this leaflet carefully before you start taking. Keep this leaflet. You may need to read it
More informationShiatsu 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 informationNew 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 information3. Male? 4. Hydrocortisone (or derivates)? 5. Other? Vitamins/minerals/trace elements: How are you doing? very well well average not well very bad
LAUREN CIEL SWERDLOFF MD INCORPORATED 1821 WILSHIRE BLVD. SUITE # 220 SANTA MONICA, CA 90403 (310) 829-5189 FAX: (310) 829-5942 Could you please fill in this questionnaire and bring it at the next appointment?
More informationGENERAL 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 informationMetabolic Assessment Form
Metabolic Assessment Form Approach Wellness and Aesthetics 200 Forsythe Street Fayetteville, NC 28303 Office: (910) 322-7368 Fax: (910) 483-5796 www.tawellness.net Name: Age: Sex: Date: Part 1: Please
More informationMedical 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 informationAcupuncture 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 informationALIGN 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 informationAmarillo 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 informationPULMONARY 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 informationGlucose Electrolytes Ferritin Blood ph. Possible Results White Bright pink Clear White. Bright pink; fades to light pink. Light Pink fades to clear
What Does It Test For? Very Low Low Glucose Electrolytes Ferritin Blood ph The glucose test An electrolyte Ferritin is a protein The blood ph test The liver is an White blood cells measures the test measures
More informationMetabolic Assessment Form Please list your five major health concerns in your order of importance.
Metabolic Assessment Form Please list your five major health concerns in your order of importance. 1. 2. 3. 4. 5. Please check the appropriate number on all questions below, using zero as least/never to
More informationFor the Patient: Mitoxantrone Other names:
For the Patient: Mitoxantrone Other names: Mitoxantrone (mite-oh-zan-trone) is a drug that is used to treat many types of cancer. It is a blue liquid that is injected into a vein. Tell your doctor if you
More informationTONICS 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 informationCourse: 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 informationNortheast Ohio Urogynecology Patient History Intake Form. Last Name First Name Age. Date of Birth Race Referring Physician.
Northeast Ohio Urogynecology Patient History Intake Form Last Name _First Name Age_ Date of Birth Race Referring Physician Reason for Visit: _ Allergies: Preferred Lab (circle): QUEST LABCARE PLUS LABCORP
More informationWhat 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 information1. In Oriental medicine, what two organs are related to the earth element? 2. In Oriental medicine what two organs are related to the wood element?
THIS SECTION IS ON ORIENTAL MODALITIES. SOME EXAMS HAVE SEVERAL QUESTIONS ON ORIENTAL MODALITIES HOWEVER THE MBLEx DOES NOT FOCUS ON THE SPECIFICS OF ORIENTAL MODALITIES 1. In Oriental medicine, what two
More informationPlease answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY
PATIENT QUESTIONNAIRE / ASSESSMENT Endocrinology Form Please answer all questions in blue or black ink by filling in the blank or circling. SOCIAL HISTORY Date Phone (H) (W) (C) Age Male Female Marital
More informationACUPUNCTURE 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 informationMETABOLIC ASSESSMENT FORM
PART II: Please mark the appropriate number on all questions below. 0 as the least/never to 3 as the most/always METABOLIC ASSESSMENT FORM NAME: AGE: SEX: DATE: PART I: Please list your 5 major health
More information+ Color Change - + Hearing Loss - + Apnea - + Enuresis (urine - + Tremors - + Rash -
Review of Systems: 0-1 year old Constitution neg Eyes neg GI neg Neurological neg + Activity Change - + Eye Discharge - + Reflux - + Facial Asymmetry - + Appetite Change - + Eye Redness - + Vomiting -
More informationEssential 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