Advanced Naturopathic Case Taking Flashcards
What could a loss of the lateral eyebrow indicate?
Thinning eyebrows may indicate
- the thyroid gland needs supporrt
- copper deficiency .
What is meant by paronychia? What causes this?
It is an infection of the tissues adjacent to a nail. Where the area around the nail looks red and tender.
It is most commonly due
- vitamin C deficiency
- EFA deficiency
Also can be caused by trauma, low immunity and poor hygiene
When may be a preferable time for testing pH?
Always before food
Preferably not first thing in the morning due to bacterial levels which will be acidic.
First test: one hour after brushing teeth
Second test: 30 minutes before lunch
Third test: 30 minutes before evening meal
Do this for 4 to 5 days in succession
What may very pale stools indicate?
Ideally we want stools to be a medium brown colour.
Very pale stools could indicate insufficient production of bile and therefore issues with the gallbladder
Explain how a crack or fissure in the middle of the tongue might be interpreted in both TCM and ayurvedic medicine
TCM: A shallow vertical cracked through the middle of the tongue (not the tip) can be a sign of deficiency of digestion. This indicates an under secretion of digestive juices.
A deep central crack indicates yin deficincy
Ayurvedic: the midline of the tongue represents the spine. Cracks or visions can correspond to painful areas of the spine.
The cervical area or bottom of the spine is closer to the tip of the tongue and the coccyx further towards the back..
Describe three characteristics of the perfect stool
- Medium brown colour.
- Easy to pass – type 3 to 5 on the Bristow chart.
- Neither floats nor sinks heavily to the bottom.
If your client regularly wakes between one and 3 am, which organ might you consider supporting?
Liver
Explain how the pupil might give you an insight into the status of an individuals autonomic nervous system
A contracted pupil: parasympathetic dominance
Inward tension, internalised, cautious, reserved (slow response). Acetylcholine is the dominant neurotransmitter. We need to support the nervous system.
Dilated pupil: sympathetic nervous system dominance
Possible adrenal exhaustion, (fast response – fight and flight). Adrenaline is the dominant neurotransmitter. Support endocrine and especially adrenal glands.
You observe a constipated client’s tongue is slightly red, with a yellow coating centrally, raised red edges and central crack .
What questions would you be most interested in asking this client?
What other symptoms may the clients be experiencing?
What might you observe on this client’s face?
A red tongue might indicate excess heat, so inflammation or infection.
Yellow coating - damp heat and again inflammation and infection or implicated. Any coating on the tongue if it’s thick indicates the need for detoxification
The fact that the yellow coating is central suggests stomach and spleen
Raised red edges - a sign of high stress
Central crack in aryuvedic medicine refers to the spine where the tip of the tongue represents the top and the back of the tongue the lumber region.
Central crack in TCM medicine refers to Yin deficiency and deficiency of digestion
You suspect a client might be iron deficient. Explain how you could use clinical evaluation tools to explore the suspicion further.
Nail - white , spooning, central ridge
Anguiarvstoamtis
Pale tongue
Pale mucous membranes in the gums
Brittle, dry and lacklustre hair
Hair loss
Blue sclera/ pale conjunctiva
Breathlessness
Which of these are blood test parameters for inflammatory mediators and which are for endocrine mediators?
- Erythrocyte sedimentation rate (ESR)
- HbA1c
- Progesterone
- rT3
- C-reactive protein (CRP)
- Serum ferritin
- TSH
- calprotectin
What does a dilated pupil versus a contracted pupil if observed in a client potentially mean?
Dilated pupil – sympathetic nervous system dominance. Adrenaline is a dominant neurotransmitter. Need to support the endocrine and especially adrenal glands.
Contracted pupil – parasympathetic dominance with more of an inward tension and a need to support the nervous system
Why is it likely that anxiety would improve before IBS symptoms according to Herrings law?
One of Herrings laws of cure is that the mind gets better before the body
Why is it likely that symptoms of asthma would improve before symptoms of eczema according to herring’s Law?
From more important organs to less. The body considers the lungs (related to asthma) liver, brain and heart as the organs we need to survive and they will take precedence over less important organs.
Why is it likely that acute infection such as tonsillitis will heal before a long-standing infection such as warts according to herrings law of cure.
Symptoms disappear in the reverse order to when they arrived. If you have an acute condition, it means it’s recent and if you have a chronic condition it means it’s been around for a long time.
What does one line between the eyebrows strongly indicate?
Stomach insufficiency
E.g. of hydrochloric acid
White spots on the nails can be indicative of insufficient levels of which three minerals?
Calcium
zinc
Silicon
What disease is random nail pitting associated with?
Psoriasis
Spoon shaped nails are most likely to be associated with which mineral deficiency?
Iron
Liver stagnation will show up as which colour shadow under the eyes
Brown
A blue Klara (the whites of the eyes) is an indication of the need for which nutrient
Iron
What are the areas of health that is covered by ‘transport and circulation’ which is one of the seven core clinical imbalances?
Lymphatic structures: tonsils, spleen, thymus,nodes
Vascular structures: arteries, veins, capillaries - poor waist circumference, high blood pressure, high ferritin
Mobilisation of blood lipids: triglycerides, high LDL, low HDL
What might brown – grey nails indicated
Melanoma
Diabetes mellitus
Topic agent such as hair dye
What are the seven core clinical imbalances
TASCEDD
Transport and circulation
Assimilation
Structural integrity
Communication
Energy: mitochondrial health
Defence and repair
Detoxification and elimination
What are three examples of physiological mediation and how are they doing their mediating?
Chronic stress –hormones
Intestinal dybiosis – neurotransmitters
Sedentary lifestyle – neuropeptides
Gas, bloating and heartburn are symptoms that fit most comfortably in which of the seven clinical core imbalances?
Assimilation
Assimilation is related to all aspects of digestion and assimilation :
- Digestive secretions such a stomach acid, pancreatic juices, bile and intrinsic factor
- Digestive motility and innervation - vagus nerve, SNS, PSNS system, and enteric nervous system
- Digestive hormones: gremlin, gastrin, CCK
- Absorption of nutrients: villi, brush border enzymes
- Microbiota balance:parasites, bacteria, yeast, short chain fatty acids, lactobacilli, bifidobacteria
Frequent occurrence of hangnail and swollen tissue around the nail can indicate the need for which nutrients? Name up to 4
Vitamin C
EFA
Vitamin A
Vitamin D
What nutrient deficiencies can be seen in what nail condition?
White
White spots
Spooning
Thin/brittle
Central ridges
Paronchia (infection around nail)
Wicks/hangdogs
White - Fe
White spots - Zn, Ca
Spooning - Fe
Thin/brittle - Vit A, Vit D, EFA, Protein
Central ridges - Fe
Paronchia (infection around nail) - Vit C, EFA
Wicks/hangdogs - Vit C, Vit A, Vit D, EFA,
How might Vit C deficiency show up in nails?
Paronychia
Wicks/hamgnails
How might iron deficiency show up in nails
White/pale
Spooning
Central ridges
How might EFA deficiency show up in nails?
Paronychia
Wicks/hangnails
Thin brittle
What pathology might be indicated by the following nail conditions:
Clubbing
Spooning
Thin / brittle
Wicks/hangnail
Clubbing- pulmonary, vascular
Spooning - Raynauds, diabetes
Thin / brittle - osteopenia, thyroid
Wicks/hangnails - hypothyroidism
What does the core clinical imbalance of structural integrity cover and which nutrients are involved
Cell membrane health - eg: EPA/DHA
Mucus membrane and skin
integrity - eg Vit A, Vit E, Glutamine
Teeth - eg minerals
Joint and Cartilage - eg  calcium, magnesium, phosphorus, vitamin D, vitamin C
What does the core clinical balance of communication encompass?
- The hormones and the endocrine system.
- Neurotransmitters in the nervous system
What does the core clinical balance of defence and repair encompass?
- Inflammation – acute and chronic
- Infections
- Microbiota imbalance
- Conditions such as allergies and autoimmune disease indicating an imbalance to poorly regulation immune system
- Lower immune function
What does the core clinical balance of energy: mitochondrial health encompass?
- Cofactor energy production – zinc, magnesium, iron, B6, B1, B2, B3, sulphur
- biochemical imbalance is in the energy production pathways eg: due to aluminium, fluoride, arsenic, lead toxicity
- Mitochondrial integrity and oxidative damage
What does the core clinical imbalance of detoxification and elimination compass?
Liver (and gallbladder function)
Kidney function
Bowel function
Skin and lungs
Biochemical imbalance due to the lack of , for example, methyl donors, cysteine, methionine, choline, and glutathione.
What symptoms might see to suspect poor thyroid function?
Skin?
Hair?
Neck?
Pulse?
Blood pressure?
Skin? Dry
Hair? Thin, loss
Neck? Goitre
Pulse? Bradycardia
Blood pressure? Low
What symptoms might you suspect for anaemia?
Skin and conjunctiva ?
Mouth?
Pulse?
Nails?
Skin and conjunctiva? Pale
Mouth? Angular stomatis, pale or red tongue
Pulse? Tachycardic
Nails? Spooning, pale
There are six evaluations of the tongue.? What are they?
- Condition.
- Red papillae indicate excess heat
- Drying cracked indicates insufficient fluid
- Wet indicates to excess moisture
- Impaired taste indicate zinc deficiency - Shape.
- thin indicates blood deficiency
- Swollen indicates fluid retention and dampness
- Scalloped indicates weak digestion - Motility
- Quiver indicates nervousness or anxiousness or magnesium deficiency - Coating.
Any thick coating on the tongue indicates needs for detox.
- brown indicates chronic excess heat
- Greasy yellow indicates damn heat with inflammation and infection
- Greasy white coating indicates damp cold
- No protein indicates the human deficiency
- Patterns
- Vertical fissure in the middle of the tongue indicate digestive deficiency whereas a fissure near the tip of the tongue vertically indicates heart or thyroid issues.
- A mapping tongue where it looks a bit like a geographical map indicates the inefficiency or B vitamin deficiency - Colour
- Pale indicates iron deficiency or cold
- Red indicates excess heat, inflammation and infection
What might dry lips indicate in clinic?
Can be associated with dehydration, excess heat (stomach heat) or a B2, B3 or folate deficiency
What might angular stomatis indicate in clinic?
- Iron or B vitamin deficiencies (anaemia)
- Fungal of bacterial infections and reduced immunity
What might gum bleeding (and receding gums) indicate?
- coQ10 deficiency
- Vitamin C deficiency
- Zinc deficiency
- high sugar/meat/dairy diet
What nutrient deficiencies can be seen in what eye conditions?
If in doubt say vitamin A as it is associated with three of the conditions below - dry eyes, night blindness and photophobia
Iron is associated with two: pale conjunctiva and blue sclera.
Zinc is associated with two: photophobia and night blindness
Dry eyes: Vit A, essential fatty acids
Night blindness: vitamin A, zinc
Pale conjunctiva: iron (anaemia)
Blue sclera: iron
Photophobia: vitamin B2, B3, beta carotene, vitamin A, zinc
How does nutrient deficiency show up in skin and name the nutrients
Dermatitis: Vit B3
Hyperpigmentation of mouth, cheek and eye areas: protein
Inelastic skin: vitamin C, essential fatty acids, copper
Hyperkeratosis: vitamin A, essential fatty acids
How does nutrient deficiency show up in hair and which nutrients are deficienct
Hair loss: iron, protein, biotin, endocrine (hypothyroidism)
Brittle, dry and lack cluster: iron, protein, essential fatty acid
Four reasons for infrequent stool/constipation
Constipation is defined as passing less than three times a week, needing to strain or passing hard pallet like stools on more than a quarter of occasions.
Normal is between one and three bowel movements today
In frequency, maybe the result of
- a low fibre diet
- digestive insufficiency meeting mechanical such as reduce peristalsis and chemicals such as low bile, HCL, pancreatic enzymes
- inadequate water intake/dehydration
- A sedentary lifestyle/stress/changing routine
