Sample Patient Report

940 E. Carol Street • Meridian, Idaho • 83646 • USA • 208-846-8448 • www.acugraph.com

 Note:

This packet contains a sample patient report, printed

from AcuGraph 3. We’ve also included a few notes about
how to read the reports.

The following page is the “Screening Report” designed for

use at public screenings and practice-building events.
This one-page report shows the patient’s results
compared with the ideal result and discusses the
meaning of these results.

The blue text is fully customizable for your practice

information.
 Meridian Energy Screening Report
Your Measurements Ideal Measurements

PIE: Your Personal Integrated Energetics™ (PIE) score is 72. This score is a reflection of the relative energetic balance
within your acupuncture meridian energy system. The ideal score is 100. A less-than-ideal score reflects energetic
imbalances that may lead to poor function and impaired health. A very low score may indicate serious problems. Your
healthcare provider can provide you with complete information about your imbalances, potential consequences, and
recommended treatments to restore your energetic balance.

200

175

150 148
140
125
115 112 114 112 112 116
104 108 110 108 110 110 110 108
101
100 98 98
94
87 88 88 90
75
60 56 52
50

25

0
L R L R L R L R L R L R L R L R L R L R L R L R
LU PC HT SI TE LI SP LR KI BL GB ST
According to acupuncture theory, energy imbalances or blockages in the acupuncture meridians may lead to
health problems, pain and disease. Acupuncture practitioners restore proper function and optimum health by
removing these blockages and restoring balance to the acupuncture meridians. Your practitioner can provide
you specific information about your particular imbalances, their impact on your health, and appropriate
treatments.

Your follow-up consultation has been scheduled for ________________ at _______ a.m./p.m. Please bring
this report with you to your appointment.

Example Patient 2/12/08 4:23 PM Source Points

Dr. Name Here Clinic Address Clinic Name Here
Clinic Phone Number / Fax number here Clinic Address 2 Website here/email here
City, State, Zip
 Note:

The next pages contain the full patient report. Within the
AcuGraph software, you can choose which items to include in the
full patient report, making it as concise or as detailed as you
desire. For this sample, we’ve included some of the most popular
report items.

A single-page “Notes” report is also available, which is suitable

for keeping on file with patient records.

Graphs are color-coded to demonstrate excessive, deficient, split

and normal meridians, as shown in the example graph above.
“Normal” is considered the range between the red and blue
horizontal lines.
Exam Findings
Example Patient - 2/12/08 4:23 PM - Source Points
Example Patient - 2/12/08 4:23 PM - Source Points
200

175

150 148
140

125
115 116
112 114 112 112
108 110 108 110 110 110 108
101 104
100 98 98
94
87 88 88 90
75

60
56
50 52

25

0
L R L R L R L R L R L R L R L R L R L R L R L R
LU PC HT SI TE LI SP LR KI BL GB ST
High: Low: Split: Normal:

Example Patient - 2/12/08 4:23 PM - Source Points

Yin: 106 Yang: 98
200

175

150 148
140

125
115 116
112 114 112 112
104 108 110 108 110 110 110 108
101
100 98 98
94
87 88 88 90
75
60
56
50 52

25

0
L R L R L R L R L R L R L R L R L R L R L R L R
LU PC HT SP LR KI SI TE LI BL GB ST
High: Low: Split: Normal:

Example Patient 2/12/08 4:23 PM Source Points

Dr. Name Here Clinic Address Clinic Name Here
Clinic Phone Number / Fax number here Clinic Address 2 Website here/email here
City, State, Zip
 Example Patient - 2/12/08 4:23 PM - Source Points
Metal: 101 Minister Fire: 68 Emperor Fire: 100 Earth: 103 Wood: 110 Water: 128
200

175

150 148
140

125
115 116
112 114 112 112
108 110 108 110 110 108 110
101 104
100 98 98
94
87 88 90 88

75

60
56
50 52

25

0
L R L R L R L R L R L R L R L R L R L R L R L R
LU LI PC TE HT SI SP ST LR GB KI BL
High: Low: Split: Normal:

Example Patient - 2/12/08 4:23 PM - Source Points

Metal Earth Emperor Fire Water Minister Fire Wood
3AM-7AM 7AM-11AM 11AM-3PM 3PM-7PM 7PM-11PM 11PM-3AM
200

175

150 148
140

125
115 112 114 116
112 112
108 110 108 110 110 110 108
101 104
100 98 98
94
87 88 90 88
75
60
56
50 52

25

0
L R L R L R L R L R L R L R L R L R L R L R L R
LU LI ST SP HT SI BL KI PC TE GB LR
High: Low: Split: Normal:

Example Patient 2/12/08 4:23 PM Source Points

Dr. Name Here Clinic Address Clinic Name Here
Clinic Phone Number / Fax number here Clinic Address 2 Website here/email here
City, State, Zip
 Example Patient - 2/12/08 4:23 PM - Source Points

84

(=) (-)

(=) (X)

110 103

(=) (=)
(=) (=)

(=) (=)

(+) (=)

128 101

High: (+) Low: (-) Split: (X) Normal: (=)

Example Patient - 2/12/08 4:23 PM - Source Points

109 112

54 113
GB LR
(=) (=)
TE LU
(-) (=)

82 89
PC LI
(X) (=)

KI ST
113 (=) (=) 98

BL SP
(+) (=)
SI HT
144 109
(=) (=)

91 109

High: (+) Low: (-) Split: (X) Normal: (=)

Example Patient 2/12/08 4:23 PM Source Points

Dr. Name Here Clinic Address Clinic Name Here
Clinic Phone Number / Fax number here Clinic Address 2 Website here/email here
City, State, Zip
 Example Patient - 2/12/08 4:23 PM - Source Points

High: Low: Split: Normal:

Example Patient - 2/12/08 4:23 PM - Source Points

Upper/Lower Balance: L/R Imbalance

21% Lower 4% Right

67%

+
101%

Chi Energy Level: 101% Energy Stability

(normal) 67%
(Within Low
Normal Limits)
Yin/Yang Balance: 8% Yin

Example Patient 2/12/08 4:23 PM Source Points

Dr. Name Here Clinic Address Clinic Name Here
Clinic Phone Number / Fax number here Clinic Address 2 Website here/email here
City, State, Zip
Meridian Analysis Information
PC(X)
The Pericardium Meridian (circulation/sex meridian) governs circulation and hormones, and protects and
regulates the heart.
Your Pericardium Meridian is split. This means there is a significant imbalance in this meridian's energy
between the right and left sides of your body.
Energetic disturbances in the pericardium meridian may involve one or more of the following emotional
factors: the ability to feel and express positive emotions
Split chi in the pericardium meridian may indicate a potential for diseases of heart, chest, stomach, upper
extremity, hormones.
Imbalance in this meridian may be associated with subluxation at the T2, T4, T8 and/or T12 level(s).

TE(-)
The Triple Heater (triple warmer) Meridian governs respiration, digestion and elimination.
Your Triple Heater (triple warmer) Meridian energy is deficient.
Energetic disturbances in the triple heater meridian may involve one or more of the following emotional
factors: the ability to feel and express positive emotions
Deficient chi in the triple heater meridian may indicate a potential for respiration disorder, nausea, stomach
disorder, cold, fatigue, endocrine dysfunction, pain in temples, nervousness, diarrhea, enuresis, edema.
Imbalance in this meridian may be associated with subluxation at the T2, T3, L1, and/or Sacrum level(s).

BL(+)
The Bladder Meridian functions with the Kidney Meridian in water metabolism and excretion. All the
associated (Shu) points are on this meridian.
Your Urinary Bladder Meridian energy is excessive.
Energetic disturbances in the urinary bladder meridian may involve one or more of the following emotional
factors: Anxiety, Paralyzed will, Holding on to old ideas, Timidity, Inefficiency, Fear of letting go, Wishy-washy,
Irritation.
Excessive chi in the urinary bladder meridian may indicate a potential for neck and back pain and stiffness,
disorder of lower extremities, eye pain, tears, brain disease, vertigo, headache along meridian, bladder
disorder, prostate disorder.
Imbalance in this meridian may be associated with subluxation at the L5, S1 and/or S2 level(s).

Element Information
Your most dominant element is Water.
• Sense Organ: Ears
• Tissue: Bone
• Taste: Salty
• Color: Blue/Black
• Sound: Groaning
• Odor: Putrid
• Emotion: Fear
• Season: Winter
• Environment: Cold

Example Patient 2/12/08 4:23 PM Source Points

Dr. Name Here Clinic Address Clinic Name Here
Clinic Phone Number / Fax number here Clinic Address 2 Website here/email here
City, State, Zip
Your least dominant element is Fire. The Fire Element contains the Heart, Pericardium, Small Intestine and
Triple Heater meridians. These regulate circulation, digestion, elimination, emotions, and hormone function in
the body. The fire element has the following associations:
• Sense Organ: Tongue
• Tissue: Vessels
• Taste: Bitter
• Color: Red
• Sound: Laughing
• Odor: Scorched
• Emotion: Joy
• Season: Summer
• Environment: Heat

Ratio Information
Yin vs. Yang
Your Yin/Yang energy balance is relatively equal with a slight Yin tendency of 8%.

Upper vs. Lower

Your Upper/Lower energy balance is somewhat unequal with Lower dominance of 21%.

Right vs. Left

Your Left/Right energy balance is relatively equal with a slight Right tendency of 4%.

Energy Level
Your overall level of chi energy is within the normal range (101%).

Energy Stability
Your energy stability is within low normal limits (67%), likely indicating reasonably good autonomic nervous
system balance.

Custom Treatment Recommendations

Pericardium Meridian Split, Triple Heater Meridian Deficient, Bladder Meridian Excessive:
This is where you can add any custom treatment recommendations of your own, including herbs,
acupuncture, diet, nutrition, qigong, or any other therapy. AcuGraph will automatically save and intelligently
apply your custom recommendations, based on exam findings.

Example Patient 2/12/08 4:23 PM Source Points

Dr. Name Here Clinic Address Clinic Name Here
Clinic Phone Number / Fax number here Clinic Address 2 Website here/email here
City, State, Zip
Notes
This is where you can add your own notes to any examination. Add observations, treatment ideas, or even
complete S.O.A.P. Notes. You can even copy and paste from any application. Any notes you add here will be
saved with the exam for later retrieval.

Basic Treatment
TE 3: Zhongzhu (Central PC 6: Nei Guan (Inner Pass)
Islet) Location:
On the anterior forearm, 2 cun
Location: proximal to the transverse wrist
In a depression on the back of crease, between the tendons of
the hand, between the 4th and palmaris longus and flexor carpi
5th metacarpals, proximal to radialis.
the MCP joint. Attributes:
Luo point of the PC channel,
Attributes: command point for the Chong
Shu-Stream, Wood and vessel. Master point for the Yin
Tonification point of the Triple Linking vessel.
Energizer channel. Functions:
Unbinds the chest and regulates
Functions: Qi, harmonizes the stomach,
Clears heat, benefits the ears, clears heat, opens the Yin linking
clears the head and eyes, vessel. Master point for the
abdomen, used for mental
activates the channel, disorders, neurosis, motion or
alleviates pain. Used for ear morning sickness, chest pain,
problems, arm pain, distention/ fullness, fever, pain
headache, sore throat, eye along the channel.
redness, febrile diseases, and Cautions:
finger paralysis, mood swings, The median nerve lies directly
beneath this point.
depression. Special for
chronic ear infections.

Example Patient 2/12/08 4:23 PM Source Points

Dr. Name Here Clinic Address Clinic Name Here
Clinic Phone Number / Fax number here Clinic Address 2 Website here/email here
City, State, Zip
BL 65: Shu Gu (Restraining Bone)
Location:
Posterior and inferior to the lateral head of the 5th metatarsal.
Attributes:
Sedation, wood, and Shu-Stream point of the Bladder channel.
Functions:
Used for headache, low back and leg pain, soothes the sinews,
clears heat, dissipates swelling, activates the channel,
alleviates pain.

Auricular Treatment
Point Zero
Frequency:
10 Hz.
Point Information:
Produces homeostatic
equilibrium and restores
energetic balance.
PC 6
Frequency:
5 Hz.
Point Information:
This point is the auricular
analogue to the Luo
(connecting) point on the
main meridian. It is
indicated for treatment of
split (left/right
imbalanced) meridians.

O = Non-Visible Surface O = Non-Visible Surface

• = Visible Surface • = Visible Surface

Example Patient 2/12/08 4:23 PM Source Points

Dr. Name Here Clinic Address Clinic Name Here
Clinic Phone Number / Fax number here Clinic Address 2 Website here/email here
City, State, Zip
 TE 3
Frequency:
5 Hz.
Point Information:
This point is the auricular
analogue to the
tonification point on the
main meridian. It is
indicated in the case of
meridian deficiency.
O = Non-Visible Surface
• = Visible Surface
PC 6
Frequency:
5 Hz.
Point Information:
This point is the auricular
analogue to the Luo
(connecting) point on the
main meridian. It is
indicated for treatment of
split (left/right
imbalanced) meridians.
O = Non-Visible Surface
• = Visible Surface
Example Patient 2/12/08 4:23 PM
Dr. Name Here Clinic Address
Clinic Phone Number / Fax number here Clinic Address 2
City, State, Zip
Point Zero
Frequency:
10 Hz.
Point Information:
Produces homeostatic
equilibrium and restores
energetic balance.
O = Non-Visible Surface
• = Visible Surface
TE 3
Frequency:
5 Hz.
Point Information:
This point is the auricular
analogue to the
tonification point on the
main meridian. It is
indicated in the case of
meridian deficiency.
O = Non-Visible Surface
• = Visible Surface
Source Points
Clinic Name Here
Website here/email here
Associated (Back Shu)
BL 22: San Jiao Shu
(Triple Burner Shu)
Location:
1.5 cun lateral to the lower
border of the spinous process
of L1, at the highest visible
point of the paraspinal
muscles.
Attributes:
Back-Shu of the Triple
Energizer.
Functions:
Moves and regulates the
Triple Energizer, Regulates
the Spleen and Stomach ,
resolves dampness, regulates
the water passages, promotes
urination, resolves masses.
Cautions:
Deep perpendicular needling
may cause Kidney injury.
Example Patient 2/12/08 4:23 PM
Dr. Name Here Clinic Address
Clinic Phone Number / Fax number here Clinic Address 2
City, State, Zip
BL 28: Pang Guang
Shu (Bladder Shu)
Location:
1.5 cun lateral to midline
level with the second
posterior sacral foramen.
Attributes:
Back-Shu of the Bladder.
Functions:
Regulates the Bladder,
clears damp-heat from
the Lower Energizer,
dispels stagnation and
masses, benefits the
lumbar region and legs.
Source Points
Clinic Name Here
Website here/email here
Herbal Prescriptions
!
SP-002 SHI QUAN DA BU PIAN!
Strengthening Qi and Blood since 1110 A.D.!
!
* TCM Therapeutic Actions: Strengthens or Tonifies Qi and blood. Warms, supports
Yang, and strengthens Wei Qi.!
!
* TCM Indications: Qi and Blood deficiency with the symptoms of sallow
complexion, shortness of breath, palpitations, dizziness, spontaneous perspiration,
mental fatigue, lassitude of the extremities, profuse menstruation, sore feet or knees.!
!
* Modern Indications: Immune system deficiency, side effects of chemotherapy and
radiation, coughs, asthma, impotence.!
!
* Comments: This versatile classical formula combines two famous formulas - one
for blood; one for Qi. Together these herbal ingredients powerfully support both. This
formula can be used after heavy bleeding like excessive blood loss due to childbirth or
surgery. It can also be used after chemotherapy and radiation to reduce side effects, as
well as increase the T-cell count. In severe cases or in early stages, may increase dose
50% for a few weeks, then decrease as symptoms improve. Contra-indicated during
acute phase of illness (cold/flu). Use care in cases of abdominal bloating, loose stools,
or general digestive weakness. Take small doses of Bao He Wan (206-SP) or Xiang Sha
Liu Jun Wan (205-SP).!
!
* Recommended Usage: 2-3 tablets twice daily with warm water.