Advanced naturopathic case taking Flashcards
Name the 5 naturopathic principles
The healing power of nature
treat the cause not the symptoms
treat the whole person
prevention over cure
A naturopath is an educator - empower
Explain Hering’s Law of Cure
- From the inside out (boil clears internal toxins)
- From more important organs to less (from lungs/asthma to skin/eczema)
- Mind gets better before body (anxiety before IBS)
- Symptoms disappear in reverse order
- From above to below (progression of disease fingers, wrist, elbow… elbow, wrist, fingers)
Explain ATM
Antecedents (predisposing factors to illness). Genetic, enviornment (xeno-oestrogens exposure), low fibre
Triggers (something that started the problem) eg stressful life event, environmental toxins, meds, allergens
Mediators (what keeps the illness going/things we can fix). eg work stress (raised cortisol), poor sleep
what three steps should a practitioner undertake to assess the whole person
- Take into account the ATM
- Uncover lifestyle factors
- Plot on a timeline
What factors should be considered in antecedents
Genetics, family history of disease, constitution, age, sex, lifestyle and environment (drugs, deficiencies), Historical trauma
What does the term epigenetics mean
the study of modifying gene expression rather than the genetic code itself
What is genomic testing
analysis of genetic material to detect genetic predispositions
Name some common TRIGGERS
TRAUMA - never been well since…
Microbes - H, pylori
Meds
dietary allergens
stressful life even
environmental toxins
Temperature changes - eg asthma in winter
What are mediators
factors that contribute to pathological changes and dysfunctional responses.
Name some physiological mediators
chronic stress - hormones (eg work). can increase cortisol and reduce progesterone. Associated with menstrual problems
Intestinal dysbiosis - neurotransmitters (eg caused by diet or antibiotics) reduced melatonin and increased oxidative stress
Sedentary lifestyle - neuropeptides: increase substance P which increases pain
Name biochemical mediators
free radicals - increase risk of alzheimers and CVD due to free rads
Electromagnetic frequencies (EMF) (TV, phone, WiFi) can disrupt sleep and lower melatonin
What biochemical mediators might lab tests be helpful in discovering
inflammatory mediators: C reactive Protein, erythrocyte sedimentation rate, serum ferritin, calpropectin
Endocrine mediators: TSH, fT4 fT3, oestrogen metabolism, progesterone, testosterone, cortisol, DHEA, HbA1C
When deciding which symptoms are under stress, there are 7 core areas of clinical imbalance which need to be considered. Each impacts overall health due to influencing multiple systems and structures. Name the 7 areas
- ASSIMILATION
2.STRUCTURAL INTEGRITY - COMMUNICATION
- DEFENCE AND REPAIR
- TRANSPORT AND CIRCULATION
- ENERGY: MITOCHONDRIAL HEALTH
- DETOX AND ELIMINATION
Explain the clinical imbalance ASSIMIILATION and list key signs an symptoms
All aspects of digestion and assimilation
- digestive secretions
- Digestive motility and innervation (vagus nerve, SNS, PSNS, enteric nervous system)
- Digestive hormones
- Absorption of nutrients (villi)
- Microbiota imbalance
SIGNS
Pallor, short of breath, dysbiosis, gas bloating, food allergies, weight loss/gain, illness that impedes absorption, heartburn
Explain the clinical imbalance STRUCTURAL INTEGRITY and list key signs an symptoms
- cell membrane health (EPA/DHA balance)
- Mucous membrane and skin integrity (vit A, E, glutamine)
- none and teeth (minerals)
- joint and cartilage (Ca, Mg, Phosphorus, Vit D and C)
SIGNS
structural pain/injury, skin problems, gut membrane integrity, autoimmune conditions, low dietary EFAs , low sun, low minerals eg Ca, Mg, Zn, B P
Explain the clinical imbalance COMMUNICATION and list key signs an symptoms
Hormones and endocrine system
Neurotransmitters and nervous system
SIGNS
hormonal issues from reproductive to fatigue, stress mood and sleep
Explain the clinical imbalance DEFENCE AND REPAIR and list key signs an symptoms
- Acute and chronic inflammation
- infections - WBC, ESR, lymphocytes
- Microbiota imbalance
- allergies/autoimmune disease indicating imbalanced immune system
- lowered immune functions eg reduced secretory IgA which protects the mucous membrane
SIGNS
recurring infections, fatigue, poor wound healing, skin issues, autoimmune conditions, intestinal permeability, low vit D, high free rads
Explain the clinical imbalance TRANSPORT AND CIRCULATION and list key signs an symptoms
- Lymphatic structures (tonsils, spleen, thymus, nodes)
- Vascular structures (arteries, veins, capillaries, high waist circumference, high BP, high ferritin
- mobilisation of blood lipids (high triglycerides, High LDL, low HDL
SIGNS
CVD, raynauds and peripheral neuropathy. Oedema
Explain the clinical imbalance ENERGY: MITOCHONDRIAL HEALTH and list key signs an symptoms
- cofactors for energy production (Mg, Fe, B1,2,3,6, Zn)
- biochemical imbalances in the energy production pathways due to heavy metals, etc
- mitochondrial integrity and oxidative damage
SIGNS
anything around ATP production - weakness, fatigue, CFS, ME, Parkinsons, MS, poor cognitive function, poor memory, intestinal permeability
Explain the clinical imbalance DETOX AND ELIMINATION and list key signs an symptoms
Liver, kidney, bowel, skin and lungs, biochemical imbalances in teh biotransformation pathways (eg lack of methyl donors)
SIGNS
When clients are on meds, poor diet, lifestyle, poor stool quality, alcohol, low antiox in diet, jaundice, lethargy
Naturopathic case analysis - list 5 steps to gathering the case analysis
- GATHER all of the clients information
- HIGHLIGHT ATMs
- PLOT the information within a timeline
- IDENTIFY which systems are under stress
- DECIDE which are the core clinical imbalances for the naturopathic summary
Naturopathic evaluation tools.
What should a practitioner do when taking a case
OBSERVE – skin tone/condition/markings, nails, tongue, posture
LISTEN
CLARIFY
EMPOWER
Face evaluation
What do MANY and ONE lines across the forehead indicate
MANY: poor intestinal health
ONE: SI issue - decreased absorption etc
Face evaluation
What do lined between the eyebrows indicate
one
two
one: stomach insufficiency (eg HCl, pepsin)
two: Liver imbalances (alcoholic, suppressed anger)
Lines above the lip (purse string)
Smoking
reproductive organ weakness
blood deficiency
Brown shadows under eyes
Blue/black shadows/bags
Liver stagnation
adrenal exhaustion/kidneys
Diagnosis by smelling:
BO
No smell
bad breath
smelly urine/stools
BO: high heat
no smell: cold
bad breath: stomach heat
smelly urine/stools: damp heat
If you suspected poor thyroid function, what signs/symptoms might you look for
goitre, dry skin, hair loss, bradycardiac, low BP
If you suspected anaemia what signs might you look for
Skin and conjunctiva (pallor?), mouth - angular stomatitis/pale or red tongue, tachycardia, spooning nails
What are tissue salts and who created them
homeopathic remedies based on minerals.
Organs are made of specific mineral or ratios of minerals
Schuessler developed 12 minerals in homeopathic form, each acting on a specific tissue, stimulating them to heal.
How should tissue salts be taken by Adults/children/infants
If acute/chronic
For how long
Adults: 1-2
Children: 1/2 - 1
Infants: 1/ 4- 1/2
Crush/chew/dissolve
Acute: every 15-30 mins until symptoms disappear
Chronic: 4-6 times per day
Take as long as work and stop after symptoms disappear.
Stop after 2 weeks if no improvement.
Name the tissue salts for nails, food source and herb
White spots
fungal infection
brittle nails
nail malformations
White spots: Calc phos. the cell restorer
- oats, green leafy veg, carrots
- chamomile
Fungal nail: Kali sulph, the skin conditioner
Brittle nails - alternate with silica
- oats, linseed, barley, carrots
- Meilissa, mustard, parsley
Nail malformations: silica, the skin cleanser
- tall grains, lentils, spinach
- dandelion
What is the presentation of these nutrient deficiencies in nails.
Vitamin A def
Vit C
Vit D
Zn/Ca
Fe
Protein
EFA
VIt A: brittle, peeling, splitting
Vit C: hang nails/swollen tissue
Vit D: Brittle/peeling
Zn/Ca: white spots, weak, brittle
Fe: pale nail bed, spooning, central ridge
Protein: weak and brittle
EFA: dry, peeling, swollen skin around nails
Tongue examination - what physical factors are taken into consideration
condition
shape
colour
patterns
coating
What organs do the following areas of the tongue represent
Root/back
Centre
Sides
Tip and front
Root/back: Kidney and bladder
Centre: stomach and spleen
Sides: liver and gallbladder
Tip and front: lungs and heart
Tongue colour:
Pale
Red
Purple
Pale: Excess cold. Qi or Yang deficiency
Red: Excess heat, inflammation, infection -map indicates where. Heart = anxiety
Purple: poor circulation,cuanosis, blood stagnation, reduced Qi
Tongue condition and taste;
Prominent red papillae
Excess papillae/hairy tongue
Dry and cracked
Wet
Impaired taste
Prominent red papillae: excess heat
Excess papillae/hairy tongue: antibiotic treatment. Need pro and prebiotics
Dry and cracked: yin deficiency - not enough fluids/excess heat
Wet: excess moisture / fluids
Impaired taste: zinc deficiency
Tongue shape:
Thin
Swollen
Scalloped
Raised edges
Temor
Thin: Blood deficiency
Swollen: Qi/yang def causing fluid retention - dampness
Scalloped: weak digestion, pancreatic insuffiiency
Raised edges: high stress
Temor: nervous energy/anxiety. Mg deficiency
Cracks/FISSURES on the tongue
What area of the body does the midline of the tongue represent in ayurvedic medicine
MEDIAL FISSURE
MIDLINE FISSURE AT TH ETIP
GEOGRAPHIC TONGUE
Tip is the top/cervical region, midline is the spine, back is the lumbar region. Cracks correspond to painful areas.
Medial fissure (not to tip): vertical crack through middle - DIGESTION DEFICIENCY, lack of digestion juice secretion
MIDLINE fissure at the TIP: heart or thyroid health
Geographical - yin deficiency - B vitamin. Psoriasis sufferers.
Tongue coating:
Thin white
Brown
Greasy yellow
Greasy white
No coat
Thin white: normal
Brown: chronic excess heat
Greasy yellow: damp heat - inflammation / infection
Greasy white: damp cold (excess mucus/phlegm)
No coat: yin deficiency
😁Lip condition:
DRY
Angular stomatitis/cheilitis - what is the possible cause and what tissue salts can be used to treat it
Dry: dehydration/excess heat (can be stomach heat from spicy food/sugar/alcohol)
B2, B3, folate deficiency
Angular stomatitis: reddened, cracking scaling at corners of mouth.
Iron, B vits deficiency
Infections
Tissue salts: Calc sulph, kali sulph and/or silica
GUMS
What should healthy gums look like and what could the following symptoms indiciate deficiency of:
Bleeding
Periodontal disease
Pale mucus membranes
Greyish mucous membranes
Normal: pale red, well defined margins and shallow crevices between teeth and gums.
Bleeding: vit C, Zn CoQ10 def (Pull daily with organic coconut oil for two mins and brush teeth after)
Periodontal disease: high sugar, meat, dairy, LOW Zn, coQ10, bioflavonoids
Pale mucus membranes: Fe def
Greyish mucous membranes: biotin def
The iris is governed by the autonomic nervous system. What can the following indicate and what is the dominant neurotransmitter for each:
CONTRACTED PUPIL
DILATED PUPIL
CONTRACTED PUPIL: parasympathetic dominance. ACETYLCHOLINE is the dominant neurotransmitter
DILATED PUPIL: sympathetic nervous system dominance. ADRENALINE is the dominant neurotransmitter
What nutrient deficiencies can the following eye conditions indicate:
Dry
night blindness
pale conjunctiva
Blue sclera
Photophobia
lack of eyelashes/eyebrows
Dry: Vit A. EFAs
night blindness: Vit A, Zn
pale conjunctiva: Iron
Blue sclera: iron
Photophobia: B2, B3, beta carotene, Vit A, Zn
lack of eyelashes/eyebrows: Copper. Thyroid support needed
What nutrient deficiencies do the following symptoms indicate:
Facial dematitis
Hyperpigmentation of mouth/cheek/eyes
Inelastic skin
Hair loos
Brittle, dry lacklustre hair
Hyperkeratosis
Facial dematitis: B2
Hyperpigmentation of mouth/cheek/eyes: Portein
Inelastic skin: C, EFAs, copper
Hair loss: Fe, protein, biotin, endocrine (ie hypothyroidism)
Brittle, dry lacklustre hair: Fe, protein, EFAs
Hyperkeratosis: A, EFAs
Ph levels are important as acidic tissue environment is favourable for cancer cells. What pH should the following be:
Blood
Urine
Saliva
Blood: 7.35-7.45
Urine: 6.5-7.25
Saliva: 6.8-7.5
How test pH in saliva
Spit onto pH test strip 3x day 4-5 days in succession. Not first thing due to acidic bacterial levels.
Test 1: 1 hr after brushing teeth
Test 2: 30 mins before lunch
Test 3: 30 mins before evening meal
What can affect the colour of urine
beetroot
asparagus
blackberries
B2 supplementation
Waist to hip ratio - what can it indicate and how to measure
risk level for heart attack, stroke, diabetes, premature death!
Waist: measure between top of hip bone and bottom of last rib. Breathe in and out and relax.
Hip: largest part of buttocks
CALCULATE: WAIST DIVIDED BY HIP
What are the Waist: Hip ratio health risk numbers for men and women
Low
Moderate
High
Men:
Low: 0.95 or below
Moderate: 0.96 - 1
High: 1 +
Women:
Low: 0.8 or below
Moderate: 0.81-0.85
High: 0.85+
Bristol stool chart:
what types/numbers should clients be aiming for.
Describe the ideal stool
type 3-5
Mostly submerged,medium brown, no obvious undigested remnants (corn/seeds OK)
Bristol stool chart.
What is type 1 and 2 associated with
What is type 5 associated with
Type 1 and 2: constipation
Type 5: vegetarian/vegan diets
What do the following types of stool indicate:
Floating
Sinking
Thin
Dry
Floating: fats are not emulsified properly by bile. Excess intake of fat. Insufficient bile
Sinking: heavy with decaying matter or non-used minerals
Thin: Tension - IBS
Dry: poor fibre, low water intake, slow transit time, hypothyroid, stress
What is constipation defined as
what is the idea number of bowel movements per day
What might cause infrequency of bowel movements
passing stools less than three times per week. Straining or passing hard pellet like stools on more than a quarter of occasions.
Ideally 1-3 bowel movements per day.
Caused by low fibre, digestive insufficiency, inadequate water intake, sedentary lifestyle/stress/travel
What do the following colour of stools indicate
Very pale
Green
White mucous in stool
Very dark brown
Orange
Black tarry
Blood
very pale: insufficient bile production
green: toxic matter in bile
white mucous in stool: disturbance of microflora, immune response to gluten, lactose, inflammation from ulceration
very dark brown: low transit time in colon, hypothyroidism
Orange: insufficient bile/lipase
Black tarry: red flag - oesophageal / gastric bleed. Could be iron supplementation
Blood: red flag - the darker the blood the further it has travelled through the GIT.
TCM body clock.
Why is 7am to 3pm the best time to eat
when stomach, SI and spleen energy are strongest.
What could a loss of the lateral eyebrow indicate
hypothyroidism
Copper deficiency
what is meant by paronychia and what causes this
Infection or inflammation of the skin next to the nails. Vitamin C def.
When. may be a preferable time to test for pH
Before food.
What may very pale stools indicate
Lack of bile flow. Gall bladder
Explain how a crack/fissure in the middle of the tongue might be interpreted in both TCM and ayurvedic medicine
Weakness of the digestive tract
Describe three characteristics of the perfect stool
Neither floats nor sinks, sits just below the water
Light brown in colour
Easy to pass
No signs of undigested material
If your client regularly awakes between 1-3am, which organ might you consider supporting
Liver
Explain how the pupil might give you an insight into the status of an individual’s autonomic nervous system
If the pupil is dilated it indicates that the sympathetic nervous system is activated. If not dilated then parasympathetic
