详细中医问诊单英文版.docVIP

1, the general situation:Gender: Age:Marital Status: Height: Weight ::Disease process and the main symptoms: (Required, the more detailed the better)Western disease:Please select from the following parts of the body condition (delet the cases dont have)Facial: red, yellow, white, black, greenEye: pupil gray; white eye pupil green, yellow; has bloodshot eyes, petechiae, a raised, black spots, blue or green skin below the eye, swollen eyelidsTongue: hypertrophy, thin, sharp or the tongue red, slippery and wet, with scalloped, dry, greasy, yellow coating, white coating, there are cracks, tendons and varicose sublingualTeeth: tooth pain, activity,Ears: tinnitus, hearing loss, itching, pain, out of the liquid from ears,eye: dry, dim, dizziness, tearing, pain, itching,color of the eyes color: color green, yellow, with or without bloodshot? Have petechiae? Have black spots? Have dryness,Mouth: bitter, dry, sour, tasteless, ulcers, sleep salivationNose: blocked, runny nose, do not distinguish smells, dry,Pharynx: dry, pain, itching, difficulty swallowingHead (pain, dizzy, swelling, numbness, wood, faint, heavy in the head, two temples, occipital, frontal, full head):Neck (stiff, pain, sour, heavy, bulging, location? When heavier? Awake? Activities work?)Chest: full, nausea, swelling, pain, bone pain, heat, coldBreast: swelling, pain, hyperplasia, lumps, sides of body: swelling, pain, heat, cold,Abdomen: swelling, full, pain, hard,Vulva: Swollen, swelling, pain, heat, cold, such as fever, bulge, contractureHeart: feel upset palpitations, panic, tight, pain, cold, hot, Heartbeat fastStomach: swelling, pain, full, Pantothenic, feel cool, hotHead: pain, dizzy, hemp, slow-witted, faint, heavyHands: cold, hot, dry, sweating, numbness, trembling,fingers pain, a pain, atrophy,Waist: tired, heavy, pain, swelling, cold, heat,Legs: pain, tired, heavy,torpidity, slow-witted, swollen, swelling, stiff, soft, cool, hot,Knee: pain, swelling, cold, hot, soft, bo