Create an URU Diet Program 1 2 3 4 5 6 7 Patient Name* First Last Primary DiagnosisEnergy*Choose 1 or 2 options Yang Excess Yin Excess Blood Deficiency Qi Deficiency Yang Deficiency Yin Deficiency Blood Excess Balanced Temperature*Choose up to 2 as long as they are next to each other on the list Heat Empty Heat Cold Balanced Humidity* Damp Dry Phlegm Water Retention Toxin Accumulation Blood Excess Balanced Circulation* Wind due to Qi Deficiency Wind due to Blood Deficiency Blood Stagnation Qi Stagnation Balanced Specific Meridian ImbalancesImbalances are listed according to their primary pathogen.Temperature: Heat Kidney Yin Deficeincy with Empty Heat Stomach Rebelling upwards Stomach Fire Liver Fire Liver Yang Rising Blood Heat Heart Fire Blazing Small Intestine Excess Heat Lung invasion wind-heat Large Intestine Heat Temperature: Cold Stomach Qi Deficiency with cold Stomach invasion by cold Spleen Yang Deficiency Liver Cold Stagnation Kidney Yang Deficiency Kidney Qi Deficiency Bladder Deficiency with Cold Heart Yang Deficiency Heart Qi Deficiency Small Intestine Deficient with Cold Lung invasion wind-cold Lung Qi Deficiency Large Intestine Cold Gallbladder Deficiency Cold Humidity: Water, Damp & Phlegm Bladder Damp-Heat Lung obstructed by damp-phlegm Lung obstructed by phlegm-fluids Lung invasion wind-water Spleen damp-heat Liver Damp-Heat Gallbladder Damp-heat Lung obstructed by phlegm-heat Large Intestine Damp-Heat Stomach Qi Deficiency Spleen damp-cold Bladder Damp-Cold Humidity: Dry Stomach Yin Deficiency Heart Yin Deficiency Heart Blood Deficiency Lung Yin Deficiency Lung Dryness Large Intestine Dry Kidney Jing Deficiency Kidney Yin Deficiency Liver Blood Deficiency Circulation: Qi Stagnation Stomach food accumulation Liver Qi Stagnation Small Intestine Qi Stagnation Circulation: Blood Stagnation Stomach Blood Stagnation Liver Blood Stagnation Heart Blood Stagnation Circulation: Other Spleen Qi Deficiency Spleen Qi sinking Spleen unable to control blood Does your patient have Cancer High BP/Hypertension Diabetes Liver disease Bone disease Kidney disease Nerve damage Spleen disease Heart disease Gallbladder disease/removed Thyroid disease Liver Blood Deficiency Hyperacidity Patient is on Anticoagulants/Blood Thinners Edema Select your patients latest stage of cancer:*In Remission - Minimum 18 months without cancer, otherwise treat as stage 1Stage 1 or 2 - In Stages 1 and 2, the URU program does not treat all underlying patterns, but concentrate primarily on specific deficiencies of Yin, Yang, Blood and Qi.Stage 3 or 4 - In Stages 3 and 4, the URU program does not treat all underlying patterns, but concentrate primarily on expelling pathogenic factorsHas your patient received chemotherapy in the last 3 months or will be receiving chemotherapy in the next 3 months (during the time they will be on the diet program you’re currently creating)?*YesNoHas your patient received radiation in the last 6 months or will be receiving radiation in the next 3 months (during the time they will be on the diet program you’re currently creating)?*YesNo Food allergies/intolerancesGluten Rye Semolina(Durham Wheat)* Wheat Bran* Wheat* Spelt Kamut Couscous (Durham Wheat)* Barley* Soya Sauce* Malt vinegar Malt* Rice Syrup* Barley Malt* Beer/Hops* Peanuts Peanut Peanut Oil LactoseFor other dairy products, see "Dairy/Eggs" Butter (Unsalted)* Cheese (Cow)* Cheese (Goat/Sheep)* Cream* Ghee Milk(cow)* Milk(goat/sheep)* Sour Cream* Yogurt Beans/Legumes Adzuki Bean Bean(Black) Chick Pea Edamame* Green Lentil Kidney Bean Lima Bean Mungbean Peas* Snow Pea* Soy Bean (Yellow)* Soy Bean(Black)* Tofu/Bean Curd Tofu/Bean Curd* White Bean BeveragesNote: for Barley Malt* and Beer/Hops* see Gluten section Almond Milk Black Tea Camomille Tea Chai Tea Chickory Chrysanthemum Tea Cocoa/Dark Chocolate Coconut Milk Coffee Elderflower Tea Green Tea Hibiscus Tea Jasmine Tea Lemon Balm Tea Lime Flower Tea Liquor* Peppermint Tea Raspberry Leaf Tea Roasted Chickory Rosehip Tea Sake/Rice Wine* Sasparilla Juice* Soy Milk* Spearmint Tea Star Anise Tea White Tea Wine(Red)* Wine(White)* Dairy/EggsNote: See "Lactose" section for foods: Butter (Unsalted)*, Cheese (Cow)*, Cheese (Goat/Sheep)*, Cream*, Ghee, Milk(cow)*, Milk(goat/sheep)*, Sour Cream*, Yogurt Butter (lactose free)* Cheese(lactose free)* Cream (lactose free)* Egg White (Chicken) Egg Yolk (Chicken) Milk(lactose Free)* Sour Cream(lactose free)* Yogurt (lactose free)* Fruits Apple(Green) Apple(Red) Apple(Yellow) Apricot* Avocado Banana* Blackberry Blueberry/Bilberry Canteloupe* Cherry* Crabapple Cranberry Currant(Black) Date* Elderberry Fig* Goji Berry Gooseberry Grapefruit Grapefuit Peel Grapes* Guava Kiwi Kumquat* Lemon/Lime Longanberry Lychee* Mandarine Orange* Mango* Melon* Mulberry Orange* Papaya Peach* Pear* Persimmon* Pineapple* Plum* Pomegranate* Pomelo Raisons* Raspberry Rhubarb Strawberry Tangerine* Watermelon* GrainsNote: See "Gluten" section for foods: Rye, Semolina(Durham Wheat)*, Wheat Bran*, Wheat*, Spelt, Kamut, Couscous (Durham Wheat)*. Barley* Amaranth Amasake Basmati Rice Buckwheat* Jasmine Rice Jobs Tears Kasha Millet Oatmeal Pumpernickle Quinoa Rice (Brown) Rice (White) Rice(Black) Sorghum Sweet Rice* Wheat Germ* Wild Rice Herbs/Spices Aniseed Basil Bay Leaf Caraway Seed Cardamom Carob Celery Seed Chile/Capsicum Chive Leaf Chive Seed Cilantro Cinnamon Clove Coco/Dark Chocolate Corriander Seed Cumin Dill Seed Fennel Seed Fennugreek Seed Garlic Ginger (Dry) Ginger (Fresh) Hemp Seed Horseradish Licorice Marjoram Mint Mustard(with Seeds) Nutmeg Oregano Parsley Parsley Seed Pepper(Black) Pepper(Cayenne) Pepper(White) Peppermint Rosemary Saffron Sage Salt Savory (Summer) Savory (Winter) Tamarind Thyme Turmeric Vanilla Bean Wheat Grass* Wintergreen Meats Beef Beef Liver Chicken Duck Frog Goose Ham Kidney (Beef) Kidney (Pork) Kidney (Sheep) Lamb Liver (Chicken) Liver (Pork) Liver (Sheep) Oxtail Pheasant Pigeon Pork Quail Rabbit Turkey Turtle Veal Venison Nuts/SeedsNote: for Peanuts, see "Peanuts" section. Almond Brazil Nut Cashew* Chestnut Chia Seed Coconut meat Flax Seed Hazelnut Pine Nut Pistachio Poppy Seed Pumpkin Seed Sesame Seed(Black) Sesame Seed(White) Sunflower Seed Walnut Oils/CondimentsNotes: - for Peanut Oil, see "Peanuts" section. - for Malt Vinegar and Soya Sauce see "Gluten" section Agar Cidar Vinegar Horseradish Ketchup* Kuzu Lemon rind Miso* Mustard (Prepared Yellow) Olive Oil Red Wine Vinegar Sauerkraut* Sesame Oil Sherry Vinegar Soya Oil* Sunflower Oil Vinegar(White) Walnut Oil Wasabi Worcestershire Sauce* Seafood Anchovies Carp Catfish Clam (Fresh Water) Clam (Salt Water) Cod/Hake/Whiting Crab Eel Haddock Herring Lobster Mackrel Mahi Mahi Mussels Octopus Oyster Pollock Salmon Sardine Scallop Seabass Shark Shrimp/Prawn Snapper Squid Squid Tuna Whitefish SweetenersNote: for Malt and Rice Syrup see "Gluten" section Honey* Maltose* Maple Syrup* Molasses* Sugar(Brown)* Sugar(Cane)* Vegetables Acorn Squash Alfalfa Sprout Artichoke Arugula Asparagus Bamboo Shoot Beet* Bell Pepper (Orange) Bell Pepper (Red) Bell Pepper (Yellow) Bitter Melon Bokchoy Broccoli Brussel Sprout Butternut Squash Button Mushroom Cabbage(Green) Cabbage(Napa) Cabbage(Red) Carrot* Cauliflower Celery Chives Coriander Leaf Corn* Cucumber Dandilion Leaf Eggplant Endive Fava/Broad Bean Green Beans Jicama Kale Kohlrabi Leek Lettuce Long Beans Mungbean Sprout Nori Olive(Black) Olive(Green) Onion Parsnip* Pickles Plantain* Potato* Pumpkin Radish Scallion Seaweed Shitake Mushroom Spinach Squash (Winter) String Bean Sweet Potato* Swiss Chard Sword Bean (Cooked) Tomato Turnip Water Chestnut Watercress Yam* Zucchini What Season will your patient be starting URU?*Spring Program: Mar 15 - Jun 14Summer Program: Jun 15 - Sept 14Autumn Program: Sep 15 - Dec 14Winter Program: Dec 15 - Mar 14Patient GenderMaleFemaleMale Male Female gender considerationsSelect all applicable gender considerations that effect URU menu recommendations Pregnant Breastfeeding Age of patient*0-1 year1-2.5 years2.5-6.5 years6.5-12 years12-30 years30-60 yearsOver 60 years Diet Program Ready for OrderWe will email you your completed diet program within minutes of submission.URU Diet Program Service Price: $70.00 On submissionPlease note it can take a couple minutes to submit the form. 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