FICHA DE ANAMNESE

Nome:_____________________________________________________________________________________

Idade:_______________________ Profissão: ____________________________

Constitucional:_______________________________________________________________________________

Data: _______________________

Queixa Principal:_____________________________________________________________________________

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

AVALIAÇÃO GERAL

PREFERÊNCIAS

1. ALIMENTO QUENTE ( ) ALIMENTO FRIO ( )

2. ÁGUA NATURAL( ) ÁGUA GELADA ( )
3. FRIO ( ) CALOR ( )

Padrão Sindrômico GERAL: __________________________________________________________________

SABORES

( ) Doce ( ) Azedo ( ) Salgado ( ) Amargo ( ) Picante

Padrão de Deficiência dos Cinco elementos: ____________________________________________________

ASPECTOS GERAIS

1. SONO:_______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
2. Funções
Intestinais:____________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
3. DIGESTÃO:____________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
 4. CEFALEIA:____________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Informações Adicionais:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

PULSO

DIREITO ESQUERDO

P9 P C

IG ID

P8 E F

BP VB

P7 CS R

TA B

Descrição:
+ (forte) - (fraco)
+++ (forte-rápido) ---(fraco-lento)

LÍNGUA
Saburra:
Umidade:
Aspecto:
Coloração:
Outros:
Diagnóstico
Biotipológico:________________________________________________________________________
___________________________________________________________________________________

Objetivos de Tratamento:
Físico:

Energético:

Psíquico:

Esquema de tratamento: (Justificar cada ponto selecionado)

Vaso Maravilhoso:

Ponto de Entrada:

Pontos de Indicação: