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Name:

Session:

DOB:

Address:

Date:

Telephone:

Doctors:
Initial Complaint:

LU9
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P7
R
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HT7
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SI4
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R
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SP3
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Extra
Meridians

LI4
L
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LIV3
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L
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LU
LU5
LU9
LU9
LU7
LU6
LU1
BL13
LU5

SJ4
L
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Channel
Meridian
Sedate
Tonify
Source
Luo
Xi-Cleft
Front Mu
Back Shu
He-Sea
Hui Meeting

KID3
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L
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BL64
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L
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GB40
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L
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Foot Yin Channels


SP
LIV
KID
SP5
LIV2
KID1
SP2
LIV8
KID7
SP3
LIV3
KID3
SP4
LIV5
KID4
SP8
LIV6
KID5
LIV13
LIV14
GB25
BL20
BL18
BL23
SP9
LIV8
KID10
Tendons
Vessels
GB34
LU9
Dai Mai
Yang Wei Mai
GB41-SJ5
SJ5-GB41

ST42
L
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Hand Yin Channels


Hand Yang Channels
P
HT
SI
SJ
LI
P7
HT7
SI8
SJ10
LI2
P9
HT9
SI3
SJ3
LI11
P7
HT7
SI4
SJ4
LI4
P6
HT5
SI7
SJ5
LI6
P4
HT6
SI6
SJ7
LI7
REN17
REN14
REN12
REN5
ST25
BL14
BL15
BL21
BL22
BL25
P3
HT3
SI8
SJ10
LI11
Zang
Fu
Qi
Blood
LIV13
REN12
REN17
BL17
Chong Mai
Yin Wei Mai
Du Mai
Yang Qiao Mai
SP4-P6
P6-SP4
SI3-BL62
BL62-SI3

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Foot Yang Channels


BL
GB
ST
BL65
GB38
ST45
BL67
GB43
ST41
BL64
GB40
ST42
BL58
GB37
ST40
BL63
GB36
ST34
REN3
GB24
REN12
BL28
BL19
BL21
BL40
GB34
ST36
Bones
Marrow
BL11
GB39
Ren Mai
Yin Qiao Mai
LU7-KID6
KID6-LU7