Observations
Date
Patient Name
*
Patient Age
*
Patient Sex
*
Choose Patient Sex
Male
Female
Body (appearance)
Slender and tall body shape
Pointed head and chin, small hands, with curly or a small amount of hair
Large head, larger body and belly, strong legs, and a wide jaw
Square and broad shoulders, strong body type, and a triangle shaped face
Round face and body with a longer than normal torso
Cereals
Oats / Millet
Wheat / Rye
Barley / Corn
Rice
Buckwheat
Climate
Wind pressure
Heat
Humidity
Dryness
Cold
Colour
Green
Red
Yellow
White
Blue/black
Colour Location
Nail
Mouth
Lips
Skin, Body hair
Head hair Teeth
Connected Tissues
Tendons
Blood vessels
Muscles, four extremities
Skin, body Hair.
Bones, Cartilage, nails, teeth, head hair.
Affected Bodyparts
Tendon pain, full body pain, weak, head ache, upper back, chest pain
Elbow joint, Wrist, Fingers, Knee, Ankle and Toe pain
Hips & Rips
Shoulder area
Neck, spinal cord, back of thighs, foot, throat, and knee pain.
Emotion
Anger
Joy
Worry
Sadness
Fear
Expression
Shouting
Laughing
Singing
Crying
Groaning
Fluids/ Toxic
Tears
Sweat
Lymph Saliva
Mucus
Urine, Sex fluid, menses.
Function
Stores the blood
Stores the spirit; governs the blood & vessels
Governs movement & transformation
Governs qì; governs diffusion & depurative Down bearing
Governs water; stores essence
Healing Sound
Shuu
Haaa, Tw/Heeeeeeee,
Whoo
Tsss
Fuu
Maintain
Sleep
Work
Appetite
Breath
Thirst
Meat
Chicken
Goat
Beef
Horse
Pork
Odour
Rancid
Scorched
Fragrant
Rotting
Putrid
Orientation
East
South
Centre
West
North
Pain
Shooting pain
Burning pain
Dull pain
Running pain
Heavy pain
Position
Too much Walking
Too much Observation
Too much Sitting
Too much Lying
Too much Standing
Pysche
Imagination
Intelligence
Thinking
Instinct
Will Power
Season
Spring January - march
Summer April - June
Late Summer July - September
Autumn Sep - October
Winter November - December
Sense Organ
Eyes
Tongue
Lips
Nose
Ears
Taste
Sour
Bitter, Astringent
Sweet
Pungent
Salty
Vegetables
Fruits
Green vegetables
Cereals
Roots
Legumes
Yang Viscera
Gall bladder
Small Intestine / Triple Warmer
Stomach
Large Intestine
Urinary bladder
Yin Organ
Liver
Heart
Spleen
Lungs
Kidney