详细中医问诊单 英文版.docVIP

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详细中医问诊单英文版详细中医问诊单英文版

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, green Eye: pupil gray; white eye pupil green, yellow; has bloodshot eyes, petechiae, a raised, black spots, blue or green skin below the eye, swollen eyelids Tongue: hypertrophy, thin, sharp or the tongue red, slippery and wet, with scalloped, dry, greasy, yellow coating, white coating, there are cracks, tendons and varicose sublingual Teeth: 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 salivation Nose: blocked, runny nose, do not distinguish smells, dry, Pharynx: dry, pain, itching, difficulty swallowing Head (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, cold Breast: 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, contracture Heart: feel upset palpitations, panic, tight, pain, cold, hot, Heartbeat fast Stomach: swelling, pain, full, Pantothenic, feel cool, hot Head: pain, dizzy, hemp, slow-witted, faint, heavy Hands: 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

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