12. Advanced Naturopathic Case Taking Flashcards
1
Q
What are the 5 naturopathic principles?
A
Healing power of nature Treat the cause, not the symptoms Treat the whole person Prevention is preferable to a cure Education
2
Q
What are Hering’s laws of cure?
A
From the inside out From more important organs to less The mind gets better before the body Symptoms disappear in the reverse From above to below
3
Q
How is health like a tree?
A
Imbalances begin at the roots - and include traumas and lifestyle factors throughout life stages
Symptoms are the end result - leaves on the trees
(treating the individual leaves doesn’t get to the root)
4
Q
When assessing the whole person, what should you take into account?
A
Antecedents Triggers Mediators Lifestyle factors Timeline of events
5
Q
What are antecedents?
A
Predisposing factors to a disease
6
Q
Examples of antecedents
A
Genetics Constitution Age Sex Lifestyle/environment Historical trauma
7
Q
What lifestyle/environmental factors can be antecedents?
A
Nutritional deficiency at birth
Dietary toxins - pesticides, alcohol use
Drugs - antibiotics
Other toxins - pollution, heavy metals
8
Q
How do genes play a part in the health of an individual?
A
Genetics can influence the person but…
The expression of genes can be altered by the environment they’re bathed in
Switching genes on/off to create/prevent disease
9
Q
What can congenital factors be affected by?
A
Gestational environment during pregnancy
Low/high birth weight
Infections
Environment on the epigenetics of the baby
9
Q
What is the definition of a trigger?
A
Anything that initiates an acute illness or the emergence of symptoms
10
Q
What are common triggers?
A
Physical/emotional trauma Stressful life events Medications Dietary allergens Environmental toxins Temperature changes e.g. asthma/OA in winter Microbes
11
Q
What kind of questions can you ask to ascertain triggers?
A
When did the symptoms start?
Did anything happen around the time that the symptoms started?
12
Q
How can we test for trigger factors?
A
Parasitology Dysbiosis (stool testing) Heavy metal toxicity Hair mineral analysis Kinesiology (muscle testing) Allergy elimination technique (NAET)
13
Q
What is the definition of mediators?
A
Factors that contribute to pathological changes and dysfunctional responses
14
Q
Examples of mediators
A
Chronic stress Intestinal dysbiosis Sedentary lifestyle Free radicals Electromagnetic frequencies (EMFs) Cognitive/emotional Social/cultural
15
Q
How can chronic stress be a mediator?
A
Can increase cortisol levels and decrease progesterone
This can be associated with menstrual problems and lead to the effects of excess oestrogen
16
Q
How can intestinal dysbiosis be a mediator?
A
Western diet, antibiotics etc can affect neurotransmitters
e.g. reduced melatonin and increased oxidative stress
17
Q
How can a sedentary lifestyle be a mediator?
A
Influences neuropeptides
e.g. increase in substance P = increase in pain
18
Q
How can free radicals be a mediator?
A
Continued use of: Smoking Alcohol Highly processed diet Medications Vaccines
19
Q
How can electromagnetic frequencies be mediators?
A
TVs Computers WiFi Mobile phones All can disrupt sleep (lowering melatonin)
20
Q
How can cognitive/emotional factors be mediators?
A
Personal beliefs about illness
Poor self-esteem
21
Q
How can social/cultural factors be mediators?
A
Lack of resources due to social isolation/poverty
Lack of cultural understanding
Reinforcement for staying sick (supported emotionally and financially when sick but not when well)
22
Q
Which biochemical mediators can be tested?
A
Inflammatory - CRP, ESR, serum ferritin, calprotectin
Endocrine - TSH, T4, fT4, fT3, oestrogen, progesterone, testosterone, cortisol
23
Q
What are the seven core clinical imbalances that need to be considered when deciding which systems are under stress?
A
Assimilation Structural integrity Communication Defence and repair Transport and circulation Energy - mitochondrial health Detoxification and elimination
24
What are the areas to assess under assimilation?
Digestive secretions - HCl, pancreatic, bile, IF
Digestive motility - vagus nerve, SNS, PSNS, enteric NS
Digestive hormones - ghrelin, gastrin, CCK
Absorption of nutrients - villi, BB enzymes
Microbiota balance - parasites, bacteria, yeast, SCFA (fibre), lactobacilli, bifidobacteria
25
What are the areas to assess under structural integrity?
Cell membrane health - EPA/DHA
Mucous membrane/skin integrity - vit A, E, glutamine
Bones/teeth - minerals
Joints/cartilage - Ca, Mg, P, vit D, C
26
What are the areas to assess under communication?
Hormones/endocrine system
| Neurotransmitters/nervous system
27
What are the areas to assess under defence and repair?
```
Inflammation
Infections
Microbiota imbalances
Allergies
AI
Lowered immune function
```
28
What are the areas to assess under transport and circulation?
Lymphatic structures - tonsils, spleen, thymus, nodes
Vascular structures - arteries, veins, capillaries
Mobilisation of blood lipids
29
What are the areas to assess under energy (mitochondrial health)?
Energy co-factors
Biochemical imbalances in energy pathways - aluminium, fluoride, arsenic, lead
Mitochondrial integrity
Oxidative damage
30
What are the areas to assess under detoxification and elimination?
Liver/gall bladder function
Kidney function
Bowel function
Skin
Lungs
Biochemical imbalances in the biotransformation pathways
e.g. lack of methyl donors (cysteine, choline, glutathione, methionine
31
Signs and symptoms of assimilation imbalance
```
Pallor
SOB
Dysbiosis
Gas
Bloating
Food intolerances
Heartburn
Increase/decrease in body weight
```
32
Signs and symptoms of structural integrity imbalance
```
Joint pain/injury, tendons, muscles
Skin problems
Gut membrane integrity/AI conditions
Diet low in EFAs
Low exposure to sunlight
Low bone minerals - Ca, Mg, Zn, B, P
```
33
Signs and symptoms of communication imbalance
```
Hormonal issues
Reproductive
Fatigue
Stress
Mood
Sleep
```
34
Signs and symptoms of defence and repair imbalance
```
Recurring infections
Fatigue
Poor wound healing
Skin issues
AI
Intestinal permeability
Low vit D/AO
High free radicals
```
35
Signs, symptoms and conditions of mitochondrial health imbalance
```
Weakness/fatigue
CFS/ME
Parkinson's
MS
Long Covid
Poor cognitive function
Poor memory
Intestinal permeability
```
36
Conditions suggesting a transport imbalance
CVD
Raynaud's
Peripheral neuropathy
Oedema
37
Things to consider for a detoxification and elimination imbalance
```
Medications
Poor diet/lifestyle
Poor stool quality/quantity
Light coloured stools
Smoking
Alcohol
Exposure to chemicals
Low AO in diet
Jaundice
Lethargy
```
38
For a client whose main concern is optimal health and prevention, would should you ask about?
Past/present medical history
Family history
Risk factors for potential future illness - fitness, diet, sleep, alcohol, drugs, tobacco, home/work environment, stress, relationships, goals
39
For a client with an active health problem, what should the questions focus on?
What was your health like before this problem began?
Ask about antecedents, triggers, mediators
Focus on where in the client's life those triggers are occurring
40
What constitutes the art of case taking?
Observe
Listen
Clarify
Empower
41
During case taking, what can you observe?
```
Skin - tone, condition, markings, hair distribution
Nails
Tongue
Posture
Mannerisms
```
42
During case taking, how should you listen to a client?
Without judgment
| Pay attention to repetitive words/statements/phrases
43
During case taking, what should you clarify?
What the client has just said, using their words
| Summarise to ensure you've understood correctly
44
During case taking, how can you empower the client?
Give them an understanding of why they feel like they do
45
What evaluation tools can be used during a consultation to support your decision making?
```
Tongue analysis
Nail analysis
Facial analysis
Urine/stool interpretations
Anthropometric measurements
```
46
What is the Rule of Three?
Needing three factors to support a hypothesis
| e.g. low intake Mg rich foods, muscle cramps, dilated pupils
47
When identifying a potential nutrient deficient, what should you avoid saying to the client?
You are Mg deficient
| Your Mg intake is insufficient
48
When identifying a potential nutrient deficiency, what should you say to a client?
You could benefit from taking more Mg
49
What can strong red skin indicate?
Excess heat
50
What can pale red skin or flushing indicate?
Yin deficiency
SLE
Rosacea (linked to H. pylori)
B3 deficiency
51
What can pallor indicate?
Qi deficiency
| Anaemia
52
What can yellow skin indicate?
Liver disease
| Spleen Qi deficiency
53
What can puffy skin indicate?
Yang deficiency
54
What can dry skin indicate?
Yin deficiency
| Dehydration
55
What can many lines across the forehead indicate?
Poor intestinal health
56
What can one line across the forehead indicate?
Small intestine issue
| e.g. decreased absorption
57
What can one vertical line between the eyebrows indicate?
Stomach insufficiency
| e.g. HCl, pepsin
58
What can two vertical lines between the eyebrows indicate?
Liver imbalances
| e.g. alcoholic, suppressed anger
59
What can lines above the lips indicate?
'Purse strings' on upper lip
| e.g. reproductive organ weakness, blood deficiency, smoker
60
What can brown shadows under the eyes indicate?
Liver stagnation
61
What can blue/black shadows under the eyes indicate?
Adrenal exhaustion
| Kidneys
62
What can a strong body odour indicate?
Heat
63
What can bad breath indicate?
Stomach heat
64
What can smelly urine or stools indicate?
Damp heat
65
What are the observational signs of poor thyroid function?
```
Dry skin
Thin hair
Goitre
Bradycardic pulse
Low blood pressure
```
66
What are the observational signs of anaemia?
```
Pallor
Angular stomatitis
Pale tongue/gums
Tachycardic pulse
Nails - spooning
```
67
What are tissue salts?
Homeopathic remedies based on minerals
68
What can white nails indicate?
Anaemia
Oedema
Vascular conditions
69
What can white spots on the nails indicate?
Ca def
Zn def
Silica def
70
What can an absent lunula indicate?
Anaemia
| Malabsorption
71
What can a pyramidal lunula indicate?
Excessive manicure
| Trauma
72
What can a pale blue lunula indicate?
Diabetes
Anaemia
Peripheral neuropathy
73
What can a red lunula indicate?
CV disease
| Connective tissue disorder
74
What are Terry's nails?
White nails with a pink or brown band at the end
75
What can Terry's nails be caused by?
```
Ageing
Liver cirrhosis
Chronic kidney disease
T2D
Congestive heart failure
```
76
What may brown-grey nails indicate?
```
CV disease
Diabetes
B12 def
Melanoma
Topical agents
e.g. hair dyes
```
77
What can thin, brittle nails indicate?
Osteopenia
Thyroid disorders
Severe malnutrition
78
What non-dietary factors can cause thin, brittle nails?
Hand cream
Manicures
Nail varnish
Nail varnish remover
79
What is paronychia?
Infection of the skin around the nails
80
What can cause paronychia?
Trauma
Poor nutrition e.g. low vit C
Low immunity
Poor hygiene
81
What can cause wicks/hangnails?
Too little protein
Lack of B vits
Lack of vit C
82
What can dryness around the nails indicate?
EFA status
Vit A/D def
Hypothyroidism
Chemical irritants
83
How do you assess for nail clubbing?
Place both forefinger nails together
| Should show a diamond shape
84
What can cause nail clubbing?
Pulmonary disorders
CV disease
GI causes
Hyperthyroidism
85
What is koilonychia?
Concavity in the nails
86
What can cause koilonychia?
```
Fe def
Haemochromatosis
SLE
Raynaud's
Diabetes
Protein def
```
87
What are Beau's Lines?
Furrow across the nail
88
What can cause Beau's Lines?
```
Severe infection
Myocardial infarction
Severe Zn def
Surgery
Chemo
```
89
What are Mee's Lines?
White lines across the full width of nail
90
What can cause Mee's Lines?
Heavy metal toxicity
| Chemo
91
What can horizontal ridges on nails indicate?
Sign of ageing
B vit def
RA
Peripheral vascular disease
92
What can central ridges on nails indicate?
Repetitive trauma
Fe def
B9 def
Protein def
93
What can nail pitting (dents in nails) indicate?
Psoriasis
Eczema
Alopecia
94
What can nail thickening indicate?
Fungal infection
Chronic eczema/psoriasis
Peripheral vascular disease
95
What is nail beading?
Looks like small drops of wax along nail
96
What can cause nail beading?
Diabetes
Thyroid disorders
B vit def
97
What is onycholysis?
Where nail plate splits from nail bed
98
What can cause onycholysis?
```
Hyperthyroidism
Eczema
Psoriasis
Trauma
Contact dermatitis
```
99
What can brittle, peeling or splitting nails indicate?
Vit A def
100
What can frequent hang nails or swollen tissue indicate?
Vit C def
101
What can brittle or peeling nails indicate?
Vit D def
102
What can white spots, weak or brittle nails indicate?
Ca def
| Zn def
103
What can a pale nail bed, central ridge or spooning indicate?
Fe def
104
What can weak, brittle nails indicate?
Protein def
105
What can dry, peeling nails indicate?
EFA def
106
Which tissue salt can be used for white spots on nails?
Calc phos
107
Which tissue salt can be used for fungal infections or brittle nails?
Kali sulph
108
Which tissue salt can be used for any nail malformation?
Silica
109
Which organs does the tip and front of the tongue represent?
Heart
| Lungs
110
Which organs do the sides of the tongue represent?
Liver
| Gall bladder
111
Which organs does the centre of the tongue represent?
Stomach
| Spleen
112
Which organs does the back of the tongue represent?
```
Lower abdomen
Kidneys
Bladder
Intestines
Reproductive organs
```
113
What can a pale tongue indicate?
Excess cold
Yang deficiency
Blood deficiency
e.g. iron deficiency anaemia
114
What can a red tongue indicate?
Excess heat
Inflammation
Infection
115
What deficiencies can a painful red tongue indicate?
```
Folate
B1
B2
B3
B6
```
116
What can a purple tongue indicate?
Blood stagnation
Poor circulation
Cyanosis (low O2)
117
What does prominent red spots on the tongue suggest?
Excess heat
118
What does a dry and cracked tongue suggest?
Yin deficiency
| e.g. not enough fluids, or dried out due to excess heat
119
What does a wet tongue suggest?
Excess moisture
| Excess fluids
120
What does impaired taste suggest?
Zn deficiency
121
What does a thin tongue represent?
Blood deficiency
122
What does a swollen tongue suggest?
Fluid retention
| Dampness
123
What does scalloped edges around the tongue suggest?
Weak digestion
| Pancreatic insufficiency
124
What do raised edges on the tongue suggest?
High stress
125
What does a quiver on the tongue suggest?
Mg deficiency
| Anxiety
126
What is a medial fissure on the tongue?
Shallow crack through middle (not to tip)
127
What can a medial fissure suggest?
Digestion deficiency
| Under secretion of digestive juices
128
What does a midline fissure at the tip suggest?
Heart problems
| Thyroid issues
129
What does a mapped tongue suggest?
| watermarks all over
B vit deficiency
130
In which pathology do you often see a mapped tongue?
Psoriasis
131
What can a brown coating on the tongue suggest?
Chronic excess heat
132
What can a greasy yellow coating on the tongue suggest?
Inflammation
| Infection
133
What can a greasy white coating on the tongue suggest?
Excess mucus/phlegm
134
What can no coating on the tongue suggest?
Yin deficiency
135
What can dry lips suggest?
Dehydration
Excess heat
B2, B3 or folate deficency
136
What can cracks and scaling in the corners of the mouth suggest?
Deficiencies - Fe, B vits
Infections - fungi, bacteria
Bite issues
137
What can bleeding/receding gums suggest?
Vit C deficiency
Zn deficiency
CoQ10 deficiency
138
What can untreated gingivitis suggest?
High sugar, meat, dairy
| Low Zn, CoQ10
139
What can pale gums suggest?
Fe deficiency
140
What can grey gums suggest?
Biotin deficiency
141
What can a contracted pupil suggest?
PSNS dominance
Inward tension
Cautious
142
What can dilated pupils suggest?
SNS dominance
| Possible adrenal exhaustion
143
What deficiencies do dry eyes suggest?
Vit A
| EFAs
144
What deficiencies does night blindness suggest?
Vit A
| Zn
145
What deficiency does pale conjunctiva suggest?
Fe
146
What deficiency does a blue sclera suggest?
Fe
147
What deficiency does photophobia suggest?
Vit A
Zn
B2
B3
148
What deficiency does lack of eyelashes and eyebrows suggest?
Cu
| thyroid needs support
149
What deficiency can dermatitis suggest?
B2
150
What deficiency can hyperpigmentation of the mouth, cheek and eye area suggest?
Protein
151
What deficiencies can inelastic skin suggest?
C
EFAs
Cu
152
What deficiencies can hair loss suggest?
Fe
Protein
Biotin
153
What deficiencies can brittle, dry hair suggest?
Fe
Protein
EFAs
154
What deficiency can grey hair suggest?
Zn
155
What is the optimal pH range for urine?
6.5-7.25
156
What is the optimal pH for saliva?
6.8-7.5
157
What colour should normal urine be?
Straw colour
158
What colour/smell is dehydrated urine?
Dark yellow
| Strong smelling
159
What colour of urine suggests jaundice?
Very dark yellow, orange, brown
160
What can unpleasant smelling, cloudy urine suggest?
UTI
161
What can waist to hip ratio indicate?
Risk level for heart attack, stroke, diabetes, premature death
162
What waist to hip ratio is considered low risk?
<0.80 - women
| <0.95 - men
163
What waist to hip ratio is considered medium risk?
0. 81 - 0.85 - women
| 0. 96 - 1.0 - men
164
What waist to hip ratio is considered high risk?
0. 85+ - women
| 1. 0+ - men
165
What is the ideal stool?
Neither sinks nor floats - submerged
Medium brown colour
No obvious undigested food
166
What can floating stools indicate?
Fats in diet not being properly emulsified by bile
Excessive intake of fats
Insufficient bile
167
What can sinking stools indicate?
Heavy with decaying matter
| Heavy with non-used materials
168
What can thin stools indicate?
Tension
169
What can dry stools indicate?
Poor water intake
| Slow transit time - poor fibre, hypothyroid, stress
170
What is the definition of constipation?
Passing stools less than 3 times a week
Needing to strain
Passing hard pellet-like stools
171
What is a normal number of bowel movements?
1-3 times per day
172
What can cause constipation?
```
Low fibre diet
Digestive insufficiency - reduced peristalsis, low bile, HCl, panc enzymes
Dehydration
Sedentary lifestyle
Stress
Change in routine
```
173
What can the colour of a stool be influenced by?
Presence of bilirubin
| Reflection of certain foods eaten - beetroot, dark leafys, liquorice
174
What can pale, clay coloured stools indicate?
Insufficient bile
175
What can green stools indicate (non-food)?
Release of toxic matter in bile
176
What can white mucous in stools indicate?
Disturbance of intestinal flora
Microbial infection
Immune response to gluten, lactose
Inflammation from ulceration
177
What can very dark brown stools indicate?
Slow transit time in colon
| Hypothyroidism
178
What can orange coloured stools indicate?
Insufficient bile
| Insufficient pancreatic lipase enzymes
179
What can black, tarry stools indicate?
```
Oesophageal/gastric bleed
Iron supplementation (not tarry)
```
180
What can blood in stools indicate?
Darker blood - serious pathology
| Bright red blood - haemorrhoids
