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Nut 1 Semester 2 > Naturopathic Case Taking > Flashcards

Naturopathic Case Taking Flashcards

1
Q

When taking a case:

What are five naturopathic principles that should be applied to every client?

A
  1. Healing power of nature.
    Self-healing can occur given right means.
  2. Treat cause, not symptoms.
  3. Treat whole person.
    Recognise individuality of ‘whole’ person.
  4. Prevention is preferable to cure.
  5. A naturopath is an educator / teacher.
    Empowering clients to take responsibility for their health.
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2
Q

Hering’s Laws of Cure

A
  1. From inside out; a boil clears internal toxins away from more vital organs to skin.
  2. From more important organs to less; from lungs (asthma) to skin (eczema).
  3. Mind gets better before body; anxiety starts improving before IBS does.
  4. Symptoms disappear in reverse order of when they arrived.
  5. From above to below; progression of disease eg fingers, wrists, elbows –> elbows, wrists, fingers.
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3
Q

Applying Hering’s law of cure:

What symptoms may be experienced before osteoarthritis of hip occurs?

A

Osteoarthritis of hands or spine

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4
Q
  1. Antecedents
  2. Triggers
  3. Mediators
A
  1. Predisposing factors to illness
  2. What Provoked / started problem
  3. Factors that Perpetuate / keep illness going
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5
Q

Role of naturopathic practitioner when a client asks for help with symptoms?

A

Disease is an end result: clients describes symptoms.
Our role is to find cause and encourage body to heal itself without suppressing symptoms.

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6
Q

Why would treating symptoms of a disease be unlikely to resolve it?
What is naturopathic approach?

A
  1. Underlying imbalances lead to symptoms.
  2. Treating individual symptoms doesn’t address cause. “It is not what is wrong, but why”.
  3. Naturopathic nutrition addresses foundations of health through dietary and lifestyle adjustments.
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7
Q

In Case Analysis, which five steps do you follow whilst applying naturopathic principles?

A
  1. Gather all client’s information: Case history form, health concerns (HC), presenting symptoms, medical history, medication, family history, height, weight / hip-to-waist ratio, diet diary.
  2. Highlight and note down all Antecedents, Triggers, Mediators.
  3. Plot information on a timeline.
  4. Identify which systems are under stress.
  5. Decide which are core clinical imbalances for naturopathic summary.
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8
Q

There are many things that can predispose an individual to a disease. List four ANTECEDENT categories that can commonly be considered.

A
  1. Genetics and constitution:
    a) Diseases in family
    b) Constitution and energetics of individual’s life stage.
  2. Age and sex:
    a) Older women are more susceptible to developing osteoporosis due to declining oestrogen on bone density and normal ageing changes. But compounded by other factors (i.e. lifestyle, diet).
  3. Lifestyle / environment:
    a) Nutritional deficiency eg. folate and neural tube defects [develops into CNS ie spinal cord and brain]
    b) Dietary toxins (eg pesticides, additives); alcohol or cigarette use.
    c) Drugs (eg antibiotics and subsequent impact on microflora and immune development)
    d) Operations eg tonsillectomy.
    e) Other toxins: pollution, heavy metals, EMF, radiation exposure via x-rays
  4. Historical trauma:
    a) Physical / emotional trauma e.g. accident, surgery, shocking events, abuse, labour.
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9
Q

IBD with symptoms of abdominal pain, diarrhoea, bloating, urgency, rectal bleeding (red flag). What might predisposing factors have been?

A

1.Suppression (eg anti-diarrhoeals for gut infection; steroids for IBD; antibiotics) which disrupt microflora, compromising intestinal barrier and immune system, and promoting dysbiosis).
2. Poor diet high in refined carbs, low fibre, low EFAs, vits that support mucous membrane integrity and immune balance.
3. Chronic stress - compromises gut integrity, making it more prone to inflammation and permeability.

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10
Q

Describe ‘symptom tree’

A
  1. Root cause: Imbalances begin at the tree root inc:
    a) Traumas
    b) Lifestyle factors throughout lifecycle stages (Gestation, Birth, Childhood, Teenage years, Adulthood).
    c) Underlying imbalances lead to symptoms.
  2. Leaves Symptoms = end result ie leaves of tree. Treating individual leaves doesn’t get to root.
    a) It is not what is wrong, but why.
    b) Naturopathic nutrition addresses foundations of health through dietary and lifestyle adjustments.
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11
Q

Genetics mean that each person is genetically unique. How can epigenetics can impact a person.

A

Genes can switch on or off, due to environment.
1. Genetics can influence a person but expression of genes can be altered throughout:
a) eating junk / organic food
b) smoking / detoxing)
Switching genes on or off to create or prevent disease.

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12
Q

TWO ways congenital factors can impact a person.

A
  1. Gestational environment during pregnancy.
  2. Low / high birth weight and infections.
  3. Environment on epigenetics of baby.
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13
Q

List four TRIGGER categories that can commonly be considered.

A
  1. Physical or emotional trauma - “never been well since”
  2. Microbes e.g. H. pylori, food-poisoning microbes
  3. Medications e.g. antibiotics (eczema after vaccination).
  4. Dietary allergens and / or chemicals.
  5. Stressful life events (divorce, problems at work).
  6. Environmental / domestic toxins.
  7. Temperature change eg asthma and osteoarthritis in winter.
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14
Q

When taking a case history what would you include to ensure that your case taking was as comprehensive as possible?

A

Medical history, illnesses, surgeries, vaccinations, current and past medications, pregnancies, major emotional events.
1. Ask: If there was a critical incident when their health changed.
2. Use open-ended questions: eg when did it start? What happened at time of onset before gradually funneling into more closed questions for clarification.
3. Lab testing for trigger factors: parasitology, dysbiosis (stool testing), heavy metal toxicity, hair mineral analysis (eg from a mercury filling).
4. Other forms of testing: kinesiology (muscle testing), NAET (an allergy elimination technique, www.naet.com), Bio-resonance (machine to measure and positively influence EMFs.

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15
Q

What are Mediators? List some MEDIATOR categories that can commonly be considered.

A

Factors that contribute to pathological changes and dysfunctional responses. These factors can include physiological and emotional changes, - need to establish why.

Physiological mediators:
1. Chronic stress, hormones eg due to work problems can increase cortisol + reduce progesterone (check). Menstrual problems for example
2. Intestinal dysbiosis: neurotransmitters: (eg caused by a western diet, antibiotic use etc = melatonin, oxidative stress.
3. Sedentary lifestyle: neuropeptides: substance P = pain.

Biochemical:
1. Free radicals: increased risk of Alzheimers and CVD due to free radicals produced from smoking, alcohol, a highly-processed diet, medications, vaccines etc.
2. Electromagnetic frequencies (EMFs): TVs, computers, Wi-Fi, mobile phones and electrical wiring can disrupt sleep (lowering melatonin). Melatonin is crucial for its anti-oxidant, circadian rhythm-regulating and tumour-surveillance properties

Cognitive/emotional:
1. Fear of, and level of pain.
2. Personal beliefs about illness and lack of relevant health information.
3. Poor self-esteem.
4. How might someone feel after being told that their illness would last four weeks? Four months? Forever? How might this influence client?

Social / cultural:
1. Reinforcement for staying sick (e.g. supported emotionally and financially whilst sick, but not when well).
2. Lack of resources due to social isolation or poverty
3. Lack of cultural understanding.

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16
Q

How might lab testing be helpful in assessing biochemical mediators?

A
  1. ìInflammatory mediators:
    a) CRP
    b) Erythrocyte sedimentation rate (ESR)
    c) Serum ferritin,
    d) Calprotectin.
  2. Endocrine mediators:
    a) Thyroid: TSH, T4, fT4, fT3
    b) Oestrogen metabolism, progesterone, testosterone, DHEA,
    c) Cortisol
    d) HbA1C.
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17
Q

Seven core areas of clinical imbalance?

A
  1. Assimilation ie digestion
  2. Structural integrity.
  3. Communication.
  4. Defence and repair.
  5. Transport and circulation.
  6. Energy: Mitochondrial health.
  7. Detoxification and elimination.
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18
Q

Regarding clinical imbalance. What areas would you consider when thinking about ASSIMILATION?

A

All aspects of digestion and assimilation:
1. Digestive secretions: stomach acid, pancreatic juices, bile, intrinsic factor (B12).
2. Digestive motility and innervation: vagus nerve, SNS, PSNS system, enteric nervous system.
3. Digestive hormones: Ghrelin, gastrin, CCK.
4. Absorption of nutrients: Villi, brush border enzymes.
5. Microbiota balance: Parasites, bacteria, yeast, short-chain fatty acids, lactobacilli, bifido bacteria.

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19
Q

Regarding clinical imbalance: areas for STRUCTURAL INTEGRITY?

A

Structural integrity:
1. Cell membrane health: e.g. EPA/ DHA balance.
2. Mucous membrane and skin integrity: E.g. vitamin A, vitamin E (skin), glutamine.
3. Bone and teeth: eg. minerals
4. Joint and cartilage: E.g. Ca, Mg, P, vits C and D.

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20
Q

Clinical imbalance: COMMMUNICATION?

A
  1. *Hormones and endocrine system.
  2. *Neurotransmitters and nervous system
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21
Q

Clinical imbalance: DEFENSE & REPAIR?

A
  1. Inflammation: acute and chronic.
  2. Infections: WBC‚ ESR, lymphocytes and neutrophils.
  3. Microbiota imbalances.
  4. Allergies and AI = imbalanced and poorly-regulated immune system.
  5. Lowered immune function such as reduced secretory IgA which usually protects mucous membranes.
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22
Q

Clinical imbalance. TRANSPORT & CIRCULATION?

A
  1. Lymphatic structures: tonsils, spleen, thymus, nodes.
  2. Vascular structures: arteries, veins, capillaries, waist circumference, BP, ferritin
  3. Mobilisation of blood lipids: Triglycerides, LDL, HDL
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23
Q

Clinical imbalance. ENERGY: MITOCHONDRIAL HEALTH?

A
  1. Cofactors for energy production: B1, B2, B3, B6, Fe, Mg, Zn.
  2. Biochemical imbalances in energy production pathways eg. due to aluminium, fluoride, arsenic, lead toxicity.
  3. Mitochondrial integrity and oxidative damage.
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24
Q

Clinical imbalance: DETOXIFICATION & ELIMINATION?

A
  1. Liver (and gallbladder) function.
  2. Kidney function.
  3. Bowel function.
  4. Skin and lungs.
  5. Biochemical imbalances in biotransformation pathways eg lack of methyl donors (eg methionine, glutathione, cysteine, choline).
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25
Q

Clinical imbalance: ASSIMILATION signs and symptoms

A
  1. Any possible insufficiency eg pallor, shortness of breath.
  2. Dysbiosis, gas, bloating
  3. Food allergies / intolerance
  4. Heartburn
  5. Increase or decrease in body weight, illnesses such as cystic fibrosis or any that will impede absorption.
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26
Q

Clinical imbalance: signs and symptoms of STRUCTURAL INTEGRITY?

A
  1. Any issue relating to structural pain / injury, tendons or muscles eg osteoarthritis.
  2. Skin problems e.g. acne, eczema, psoriasis.
  3. Gut membrane integrity and autoimmune conditions.
  4. Diet low in EFAs and low exposure to sunlight (vitamin D) and low bone minerals such as Ca, Mg, Zn, P.
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27
Q

Clinical imbalance: signs & symptoms COMMUNICATION?

A

Any signs and symptoms related to hormonal issues:
1. Reproductive
2. Fatigue
3. Stress
4. Mood and sleep.

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28
Q

Clinical imbalance: signs & symptoms DEFENSE & REPAIR?

A
  1. Recurring infections
  2. Fatigue
  3. Poor wound healing
  4. Skin issues
  5. AIutoimmune conditions,
  6. Intestinal permeability
  7. Low vitamin D
  8. Low antioxidants in diet. High free radicals
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29
Q

Clinical imbalance: signs & symptoms MITOCHONDRIAL HEALTH?

A

Any issues affecting ATP production
1. Weakness
2. Fatigue
3. CFS/ ME
4. Parkinson’s disease
5. MS
6. Poor cognitive function
7. Poor memory
8. Intestinal permeability.

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30
Q

Clinical imbalance: signs & symptoms TRANSPORT?

A
  1. Circulatory issues such as CVD, Raynaud’s and peripheral neuropathy.
  2. Lymphatic issues such as oedema
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31
Q

Clinical imbalance: signs & symptoms DETOXIFICATION & ELIMINATION?

A
  1. Consider when clients are on meds
  2. Poor diet and lifestyle
  3. Poor stool quality / quantity: light coloured stools
  4. Smoking
  5. Alcohol
  6. Exposure to chemicals
  7. Low antioxidants in diet
  8. Jaundice
  9. Lethargy etc.
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32
Q

54-year old male client experiences utter exhaustion. He wakes many times at night, spends most afternoons napping 3-4 hours. He rarely gets ill yet feels fluey most mornings. He gets daily headaches late afternoon, which improve after a snack.

Which 3 systems are under stress?

Which core areas need support?

A

Main systems under stress: Endocrine, immune, nervous systems.

Core areas which need support.
1. Energy: mitochondrial health (including Krebs cycle).
2. Communication: thyroid, blood sugar, neurological concerns.
3. Defence and repair: Inflammation, infection, immune dysregulation.

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33
Q

What 3 areas would you consider when thinking about a client’s emotional health?

A
  1. Mental health: cognitive function and perception. Impairment may result in dementia, sensory processing disorders etc.
  2. Emotional health: emotional regulation and sense of well-being. Influenced by coping abilities, self-esteem, perception of quality of life, having a purpose in life. 3. 3. Imbalances may lead to suppressed or problematic emotions (consider childhood experiences).
  3. Spiritual health: onnection between beliefs and harmony in one’s life, based on personal values, ethics, morals and spiritual fulfilment.
  4. Considers a person’s stress, resilience and relationships with friends, family and community.
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34
Q

When taking a case history, what are 5 steps that are covered on case taking form?

A
  1. Gather all of client’s s information: case history form, health concerns (HC), presenting symptoms, medical history, medication, family history, height, weight / hip-to-waist ratio, diet diary.
    2.Highlight and note down antecedents, triggers, mediators.
    3.Plot information within a timeline: must indicate timings of mediators and triggers. eg trigger = bereavement aged 38 (plot this).
  2. Identify systems are under stress.
  3. Decide which are core clinical imbalances for naturopathic summary.
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35
Q

For a client whose main concern is optimal health and prevention, what would you ask about?

A
  1. Past and present health history, as well as family history.
  2. Risk factors for potential future illnesses, such as: fitness, diet, sleep, alcohol, drugs, tobacco, environment at home and work, stress sources and pleasure, relationships, goals in life.
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36
Q

For a client with an active health problem, what would you ask about?

A

*What was your health like before this problem began?
*Ask about possible antecedents, triggers and mediators.
*Your questioning will then focus on where in someone’s life these triggers are occurring.

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37
Q

x4 things shld aim to achieve during case taking?

A
  1. Observe client’s skin (tone, condition, markings, hair distribution), nails, tongue, posture, mannerisms.
  2. Listen to their case / story without judgement. Pay attention to repetitive words, statements or phrases.
  3. Clarify what client has said, using same words or phrases and summarise to ensure you have understood correctly.
    Empower your client with knowledge to bring case together for them and give them an understanding of why they feel like they do.
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38
Q

Name FIVE naturopathic evaluation tools

A
  1. Tongue analysis.
  2. Facial analysis.
  3. Nail assessment.
  4. Anthropometric measurements.
  5. Urine and stool interpretations
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39
Q

If you used rule of three and evaluated that your client needed more magnesium, give an example of how you might convey that information.

A
  1. Utilise Rule of Three and evaluate that your client needs more magnesium, do not say: “you are magnesium deficient” or your magnesium intake is insufficient.
  2. Say: “My evaluation indicates that you could benefit from taking more magnesium.
  3. If believe a diagnosis is needed eg iron-deficiency anaemia, refer to GP. Remember what causes iron deficiency and effects of excess iron (i.e. feeding microbes, pro-oxidant).
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40
Q

What is ‘rule of three’?

A

Rule of Three requires three factors to support a hypothesis:
*Example: Client feels anxious and cannot sleep. Look to Rule of Three, which requires you to have three factors that support your hypothesis:
1. Low intake of magnesium-rich foods (from diet diary).
2. Client describes getting frequent muscle cramps.
3. Pupils are very dilated.
There are three things that support your low magnesium hypothesis. What else might suggest a magnesium deficiency?
Numbness and tingling, anxiety. Twitches.
*So what do you do?
1. Correct diet.
2. Take Mg citrate before bed.

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41
Q

What would following skin signs indicate?

Strong Red?
Pale red or Malar flush?
Pallor?
Yellow?
Puffy?
Dry?

A
  1. Strong Red indicates Excess heat.
  2. Pale red or Malar flush indicates Yin deficiency, SLE, rosacea (linked to H pylori), B3 excess.
  3. Pallor indicates Qi deficiency, anaemia
  4. Yellow indicates liver / biliary disease, spleen Qi deficiency (if sallow yellow / pasty).
  5. Puffy indicates Yang deficiency.
  6. Dry indicates Yin deficiency, dehydration

Malar flush = red discolouration of cheeks.

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42
Q

In facial analysis what do

Lines across forehead?

Lines between eyebrows?

Lines above lips?

A

Lines across forehead
*Many : poor intestinal health.
*One: Small intestine issues (decreased absorption, etc.).

Lines between eyebrows
*One: Stomach insufficiency (e.g. HCl, pepsin).
*Two: Liver imbalances (alcoholic, suppressed anger)

Lines above lips
*reproductive organ weakness
*blood deficiency
* smoker).

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43
Q

Brown shadows under eye area?

A

Liver stagnation

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44
Q

Blue/black shadows under eyes / bags ?

A

Adrenal exhaustion / kidneys

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45
Q

Strong smell (body odour) which is not related to inadequate hygiene?

A

Strong smell (body odour) = Heat.
-Absence of smell =Cold.
-Bad breath = Stomach heat.
-Smelly urine or stools = Damp heat.

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46
Q

Absence of smell?

A

Cold

47
Q

Bad breath?

A

Stomach heat

48
Q

Smelly urine or stools?

A

Damp heat

49
Q

Which naturopathic evaluation tools might you use if you suspected poor thyroid function?

A
  1. Skin (dry?)
  2. hair (thin / loss?)
  3. Neck (goitre?)
  4. Pulse (bradycardic?)
  5. Blood pressure (low?) etc.
50
Q

Which naturopathic evaluation tools might you use if you suspected anaemia?

A
  1. Skin and conjunctiva (pallor?)
  2. Mouth (angular stomatitis / pale or red tongue?),
  3. Pulse (tachycardic?),
  4. Nails (spooning?) etc.
51
Q

Nail function is formed of three main structures, what are they?

A
  1. nail plate: keratinised structure which continues to grow throughout life.
  2. nail bed: vascular bed responsible for nail growth and support.
  3. cuticle: epidermal layer between proximal nail fold and nail plate.
52
Q

What can nails reflect?
What is rate of nail growth in an adult?
And a child?

A
  1. Nails can reflect systemic and local medical history, as well as general lifestyle over previous four-six months.
  2. three months.
53
Q

What are tissue salts?

Who developed them?

A

Tissue salts (TS): Homeopathic remedies based on minerals.
1. Organs and parts of body are made of specific minerals or ratios of different minerals.
2. These minerals play a vital role in physical integrity and proper functioning of organism.

Schuessler, a German homeopath, developed 12 minerals in a homeopathic form and called them tissue salts. Each tissue salt acts on specific tissues, stimulating them to heal.

54
Q

What is dosage for tissue salts in an adult?
A child?
An infant?

How long should they be taken?

A

Adult: 1-2, tablets
Children: 1,
Infant: 0.25 to 0.5. Chew, dissolve, crush accordingly.
Acute: every 15-30 minutes until symptoms subside.
Chronic or maintenance dose: 4-6 times per day.

*Take as long as they work. Stop taking them when symptom disappears. Also stop after two weeks if no improvement at all.

55
Q

What do white nails indicate?

A
  1. Can be caused by anaemia, oedema, or vascular conditions.
  2. Apply gentle pressure to nail bed and release. If it takes more than two seconds for redness to reappear, it suggests anaemia.
  3. Consider following possibilities if fits with client’s history:
  4. Anaemia, renal failure.
  5. Liver cirrhosis‚ chemotherapy treatment.

*White spots linked to calcium, zinc or silica deficiency / insufficiency.
TS: Calc phos.

56
Q

What is lunula?

A

Lunula = half-moon at base of fingernail.

57
Q

If you saw following on lunula what would it indicate?

Absent lunula on thumbs
A pyramidal lunula
A pale blue lunula
A red lunula

A
  1. Absent on thumbs = anaemia or malabsorption should be investigated.
  2. Pyramidal lunula = excessive manicure or trauma.
  3. Pale blue lunula = diabetes, anaemia or peripheral neuropathy.
  4. Red lunula CVD, connective tissue disorder or possible malignancy.
58
Q

Terry’s nails?
Cause?

A

White nails, with a pink or brown band at end.

Causes:
1. Ageing.
2. Liver cirrhosis.
3. Chronic kidney disease.
4. Congestive heart failure (also produces ear lobe crease).
5. T2DM
*TS: Calc sulph. And / or Nat sulph

59
Q

What might brown-grey nails suggest?

A
  1. CVD
  2. T2DM
  3. B12 def
  4. Melanoma.
  5. Lichen planus.
  6. Topical agents eg hair dye
60
Q

Lichen planus?

A

Immune-mediated disease affecting skin and mucous membranes

61
Q

What might thin, brittle nails indicate?

A
  1. Osteopenia
  2. Thyroid disorders
  3. Severe malnutrition
  4. Common mineral deficiencies.

NB Hand cream, manicures, nail varnish / varnish remover (acetone) can also increase nail dryness and brittleness.
*TS: Silica and/or kali sulph.

62
Q

Nutritional interventions to strengthen thin, brittle nails.

A
  1. Biotin: 300 mcg x five daily
    2.Vitamin B12: chlorella, wild salmon, grass-fed organic meat, organic eggs; supporting digestive health (eg stomach acid for IF production).
  2. Vitamin A: Eggshell nails: Delicate and curved.
63
Q

What is Paronychia?
Where does word come from?
What signs would you expect to see with Paronychia?

A

Paronychia: From Greek: para =around + onyx =nail.
1. Infection of tissues adjacent to a nail with redness / tenderness.
2. May be due to trauma, poor nutrition (eg. low vit C), low immunity and poor hygiene.
*Supplement vitamin C / increase; vitamin C rich foods.
TS: Silica.

64
Q

What are Wicks (or hangnails)?
What can cause Wicks?
What might they indicate?

A

Wicks (or hangnails):
1. Too little protein, low B vitamins and low vitamin C.
2. Dryness may indicate lowered EFA status, vitamin A and D, or hypothyroidism. Can be caused by chemical irritants.
3. May indicate a need for nervous system / adrenal support.
*TS: Kali phos.

65
Q

What is nail clubbing?

How would you assess for clubbing?

What are causes of clubbing?

A
  • It is thought that clubbing can begin before effects of pathology are noticed.

To assess for clubbing: Place both forefinger nails together and look between them. A small diamond space is normal (Schamroth’s window).
Lack of diamond = clubbing (Schamroth’s sign).

Causes:
* Pulmonary and cardiovascular causes (80%).
* Gastrointestinal causes (about 5%), hyperthyroidism, idiopathic.

66
Q

What is Koilonychia?

Where does word come from?

What might causes be?

Which tissue salts would be appropriate to use in this case?

A

Koilonychia:
*Spooning (i.e. concavity) of nails.
*To assess: Place a drop of water on nail. If drop does not slide off = spooning.

Causes:
1. Iron deficiency
2. Systemic lupus erythematosus.
3. Raynaud’s disease
4. Protein deficiency, especially in sulphur-containing amino acids (cysteine or methionine).
5. T2DM
6. Haemochromatosis (iron overload).

*TS: Calc phos., ferphos., calc sulph. or natsulph

67
Q

What are Beau’s Lines?

What are possible causes of Beau’s lines?

Which tissue salts might be appropriate to use in this case?

A

Beau’s Lines:
*Interrupted growth at nail matrix produces a furrow in nail.
*Location may indicate timing of illness, whilst depth may indicate severity.

Causes:
*Severe infection.
*Myocardial infarction.
*Severe zinc deficiency.
*Surgery and chemotherapy.

*TS: Calc phos. And / or silica.

68
Q

What are Mee’s Lines?

What are possible causes of Mee’s Lines?

A
  1. White bands traversing full nail width that indicates an acute illness / trigger.
  2. Like Beau’s, line location might indicate timing.

Causes:
1. Heavy metal toxicity ie arsenic).
2. Chemotherapy.

69
Q

What do Longitudinal ridges in nails indicate?

Which pathologies can longitudinal ridges be seen in?

Which tissue salts might be appropriate to use in this case?

A

Longitudinal ridges:
1. Sign of ageing.
2. Vit deficiencies.

Found in:
1. Rheumatoid arthritis.
2. Peripheral vascular disease.
3. Lichen planus.

*TS: Nat phos.

70
Q

What do Central ridges on nails indicate?

Which tissue salts might be appropriate to use in this case?

A
  1. Repetitive trauma.
  2. Fe, folate or protein deficiency

*TS: Ferphos.

71
Q

How does nail pitting present?

What might cause nail pitting?

Which tissue salts might be appropriate to use in this case?

A

Nail pitting = inflammation of nail matrix causing superficial dents.

Causes:
1. Psoriasis (random pits).
2. Alopecia areata (rippled grid).
3. Eczema.
4. Lichen planus.

*TS: Kali sulph.

72
Q

What does nail thickening indicate?

What might cause nail thickening?

Which tissue salts might be appropriate to use in this case?

A

*Slowed nail growth = increased nail thickness.

Causes:
1. Onychomycosis (fungal infection).
2. Chronic eczema and psoriasis.
3. Peripheral vascular disease.
4. May be seen in elderly.

*TS: Kali phos

73
Q

What does nail beading indicate?

What might cause nail beading?

Which tissue salts might be appropriate to use in this case?

A

Beading may appear on one or multiple nails.

Endocrine conditions:
1. T2DM
2. Thyroid disorders.
-Addison’s
-B vitamin deficiency.

*TS: Calc sulph and / or nat sulph

74
Q

What is Onycholysis?

What might cause Onycholysis?

Which tissue salts might be appropriate to use in this case?

A

Onycholysis: A common condition where nail plate splits from nail bed.

*Can be caused by:
-Hyperthyroidism.
-Psoriasis and eczema.
-Trauma and contact dermatitis.
-Chemicals e.g. acetone.

TS: Calc fluor

75
Q

x5 signs showing vitamin and mineral deficiencies in nails.

A
  1. Brittle, splitting, peeling: Vits A and D. Also protein (weak and brittle).
  2. Hang nails: vitamin C
  3. EFA deficiency: Dry, peeling, swollen skin around nails.
  4. Zn/Ca deficiency: white spots, weak or brittle nails.
  5. Spooning: Fe deficiency
  6. Pale nail bed: Fe deficiency
  7. Central ridge: Fe deficiency
  8. Spooning: Fe deficiency
76
Q

When might you use Calc Phos?

What are some food sources?

A

Calc phos = cell restorer (white spots on nails).
Food sources: Oats, green leafy veg (spinach, cabbage), carrots, wholegrains, eggs, lentils.
Herbs: Chamomile

77
Q

When might you use Kali sulph?

What are some food sources?

A

Skin conditioner. Fungal nail infections; for brittle nails alternate with silica.

Food sources: Oats, linseed, barley, cottage cheese, chicory, lettuce, carrots.
Herbs: Melissa, mustard, parsley

78
Q

When might you use Silica?

What are some food sources?

A

Skin cleanser. Any nail malformations.

-Food sources: Tall grains (barley, oats, buckwheat, rice, etc.), celery, lentils, spinach, pomegranate, apricot.
Herbs: Dandelion

79
Q

What tongue signs might you look for?

A
  1. Condition (may indicate nutrient deficiencies).
  2. Colour
  3. Coating
  4. Patterns.
  5. Shape.

-

80
Q

In tongue diagnosis what do x4 areas relate to?

A
  1. Root / back: lower abdomen, kidneys, bladder, intestines and reproductive organs.
  2. Centre: Central abdomen‚ stomach and spleen.
  3. Sides: Liver and gall bladder.
  4. Tip and front: chest, heart and lungs.
81
Q

Tongue diagnosis for
Pale
Red
Purple?

A
  1. Pale: excess cold, Qi or Yang deficiency, blood deficiency (medically a pale tongue can indicate iron deficiency anaemia).
  2. Red: excess heat, inflammation, infection
    eg red tip of tongue (heart area) indicates disturbance of shen (spirit) and often indicates underlying anxiety.Medically, a red and painful tongue / glossitis can indicate deficiency of folate, B12, B2, B3, B6.
  3. Purple: blood stagnation, reduced Qi, poor circulation, (medically a purple tongue can indicate cyanosis (low oxygen).
82
Q

What are papillae?

A

Papillae =finger-like projections from surface of tongue. Spots.

83
Q

In tongue diagnosis what do

Prominent red papillae (spots)
Excess papillae
Dry and cracked
Wet
Impaired taste

A
  1. Prominent red papillae (spots): Excess heat.
  2. Excess papillae: Hairy tongue with a thick coating may follow antibiotic treatment. Probiotics and prebiotics required.
  3. Dry and cracked: Yin deficiency (not enough fluids or dried out due to excess heat).
  4. Wet: excess moisture and fluids.
  5. Impaired taste: zinc deficiency.
84
Q

What do following tongue shapes indicate?

Thin
Swollen
Scalloped
Raised/upturned edges

A
  1. Thin: blood deficiency.
  2. Swollen: Qi or Yang deficiency causing fluid retention; dampness.
  3. Scalloped (teeth marks on sides): weak digestion (spleen Qi deficiency), pancreatic insufficiency, in ayurveda = build up of ama (undigested food toxins).
  4. Raised / upturned edges: sign of high stress
85
Q

What does a tongue quiver or tremor indicate?

A

Spleen Qi deficiency, anxiety (Ayurvadic).
Nutritionally = Mg deficiency.

86
Q

In ayurvedic tongue analysis, what is midline of tongue known as?
What does it represent?
What does a deep central crack indicate in TCM?

A

Ayurvedic tongue analysis, midline of tongue represents spine.
Tip of tongue is top (cervical region) and back bottom (lumbar region).
Cracks or fissures can correspond to painful areas of spine.

In TCM a deep central crack indicates Yin deficiency

87
Q

Cracks (fissures) = signs of potential health issues and may indicate imbalances in area where located. Where or what do following cracks relate to?

Medial
Midline
Geographical (or mapped)

A

*Medial fissure: A shallow vertical crack through middle of tongue (not to tip) ‚= deficiency of digestion ie under-secretion of digestive juices.

*Midline fissure at tip: constitutional heart or thyroid problems.

*Geographical (or mapped) tongue: Yin deficiency; nutritionally it can indicate a B vitamin deficiency. Often seen in psoriasis sufferers.

88
Q

Tongue coating reflects state of digestive system and potential toxicity. What do following coatings suggest?

Thin white
Brown
Greasy yellow
Greasy white
No coat

A
  1. Thin white: Normal.
  2. Brown: Chronic excess heat (leading to degenerative changes).
  3. Greasy yellow: damp heat (inflammation and infection).
  4. Greasy white: Damp cold (excess mucus / phlegm).
  5. No coat: Yin deficiency.
89
Q

What do dry lips indicate?

A

Associated with dehydration, excess heat (often stomach heat, perhaps associated with excess of spicy food, sugar, alcohol), or a B2, B3 or folate deficiency.

90
Q

Why might Angular stomatitis / cheilitis occur?

What tissue salts might you use to help?

A

*Angular stomatitis / cheilitis: reddened cracking and scaling in corners of mouth. Due to:
1. Deficiencies: Iron, B vitamins.
2. Infections (fungi, bacteria), reduced immunity
3. Bite issues causing drooling.

-TS: Calc sulph, kali sulph. And / or silica.

91
Q

When observing gums what do normal gums look like?

What might following signs indicate?

Bleeding (also receding)
Periodontal disease
Pale mucous membranes
Greyish mucous membranes

A
  1. Normal / healthy: pale red surface, sharp, well-defined margins between teeth and gums, shallow crevices between gums and teeth.
  2. Bleeding (also receding gums): Zn, vitamin C or CoQ10 deficiency CoQ10.
  3. Periodontal disease (often from untreated gingivitis): High sugar / meat / dairy, low bioflavonoids, zinc and CoQ10.
  4. Pale mucous membranes: Iron deficiency.
  5. Greyish mucous membranes: biotin deficiency.
92
Q

What governs pupil size?

What do contracted pupil’s indicate?

What do dilated pupil’s indicate?

A

Iris governs pupil size and is itself controlled by ANS (autonomic nervous system). Therefore pupil can be useful to indicate autonomic activity in body.

Contracted pupil:
Parasympathetic dominance; ‚inward tension / internalised / cautious / reserved (slow responses). Acetylcholine is dominant neurotransmitter.

Dilated pupil:
Sympathetic nervous system dominance, possible adrenal exhaustion (fast responses ‚fight and flight). Adrenaline is dominant neurotransmitter.

93
Q

Nutrient deficiencies can present in eyes. What might following indicate?

Dry eyes
Night blindness
Pale conjunctiva
Blue sclera
Photophobia
Lack of eyelashes and eyebrows

A
  1. Dry eyes: Vitamin A, EFAs.
  2. Night blindness: Vitamin A, zinc.
  3. Pale conjunctiva: Iron.
  4. Blue sclera: Iron.
  5. Photophobia: Vitamin B2, B3, beta-carotene, vitamin A, zinc.
  6. Lack of eyelashes and eyebrows: Copper; thinning eyebrows may indicate that thyroid gland needs support.
94
Q

Dermatitis?
Hyperpigmentation of mouth, cheek and eye areas
Inelastic skin

A

*Dermatitis (nasolabial, eyelids, in ears): B2.
*Hyperpigmentation of mouth, cheek and eye areas: Protein.
*Inelastic skin: Vitamin C, Cu, EFAs.

95
Q

Hair can indicate deficiency/insufficiency.

Hair loss?
Brittle, dry and lacklustre hair?

A

Both:
Iron, protein

Hair loss: Iron, protein, biotin, endocrine (e.g. hypothyroidism).
Brittle, dry and lacklustre: Iron, protein, EFAs.

96
Q

Peri-follicular hyperkeratosis might indicate a deficiency or insufficiency. What would that be?

A

Vitamin A
EFAs
(think hyperkeratosis is always EFAs and/or vit A)

97
Q

Why is testing pH important?

A
  1. Insight into client’s internal environment.
  2. Acidic env favourable for cancer cells eg encourages angiogenesis
98
Q

*What are normal pH ranges for

Blood
Urine
Saliva

A

pH: 7 is neutral, < 7 is acidic,> 7 is alkaline.

  1. Blood: 7.35 -7.45.
  2. Urine: 6.5-7.25 (mine was 8).
  3. Saliva: 6.8‚-7.5 (<6 = very acidic).
99
Q

How would you suggest a client tests salivary pH?

A
  1. Spit onto a pH test strip (which are easily accessible / cheap).
  2. Colour will change and match colour to corresponding chart.
  3. Perform 4-5 days in succession.
  4. Avoid testing first thing due to bacterial levels, which will be acidic.

1st test: 1 hour after brushing teeth.
2nd test: 30 mins before lunch.
3rd test:3 0 mins before evening meal.

100
Q

What can different urine colours indicate?

A

Urea is converted to ammonia which gives urine its odour.

  1. Normal: Straw, yellow colour.
  2. Pale yellow / colourless: Drinking a lot of fluid.
  3. Dark yellow/strong smelling: Dehydrated.
  4. Very dark yellow, orange or brown: Jaundice.
  5. Blood in urine: Red flag (consult doctor).
  6. Unpleasant smelling / cloudy urine: Possible UTI.
101
Q

Which foods affect urine smell and colour?

A
  1. Beetroot - red
  2. Asparagus - green and smelly
  3. Blackberries - red / brown
  4. Vitamin B2 supplementation (riboflavin).
  5. Dark green leafy vegetables
  6. Liquorice
  7. Blueberries.

NB colour of a bowel movement is influenced heavily by presence of bilirubin (in bile).

102
Q

Why would you want to take an anthropo-metric measurement, using waist-to-hip ratio?

A

Waist-to-hip ratio can indicate risk level for:
a) heart attack
b) stroke
c) diabetes
d) premature death.

Anthropometric means to measure.

Ration is calculated by waist divided by hip measurement.

103
Q

What are Low, Moderate and High risk ratios for waist to hip measurements?

For men and
For women

A

Male W:H ratio
Low: <=0.95
Moderate: - 0.96-1.0
High:1.0+

Female W:H ratio
Low: <=0.80
Moderate: 0.81-.85
High: 0.85+

104
Q

Who developed Bristol Stool Chart and why is it a useful tool?

A
  1. Helps to differentiate what a healthy stool looks like and what other types may mean.
  2. Stools are good indicators of health.

Ideal:
1. Easy passage
2. Feeling of complete evacuation afterwards
3. Type 3-5 on Bristol Stool Chart.

105
Q

Describe ideal stool

A
  1. Ideal stool neither sinks nor floats but is mostly submerged.
  2. Medium brown colour
  3. No obvious undigested food remnants
  4. NB corn, seeds etc won’t break down and stool may be coloured from certain foods.
106
Q

What does each BSC types of stools indicate?

A
  1. Type 1 and 2 seen more in constipation.
  2. Type 3 and 4 are more common in a more protein-rich or Western-style diet.
  3. Type 5 is a softer bulkier stool associated with a more vegetarian or vegan diet.
  4. Type 6 and 7 seen more in diarrhoea.
107
Q

What do different stool types indicate?

A
  1. Floating: tend not to flush away / float on surface of water. Fats not emulsified properly by bile eg excessive intake or more commonly insufficient bile.
  2. Sinking: Heavy with decaying matter or non-used minerals.
  3. Thin stools: Tension (colon spasm as seen in IBS).
  4. Dry stools: Low water, low fibre, slow transit time, hypothyroid, stress.
108
Q

Define constipation

A

Infrequent stools:
1. Passing stools less than three times per week
2. Needing to strain or passing hard pellet-like stools on more than 25% of occasions.

109
Q

What might infrequent stools suggest?

A
  1. Low-fibre diet.
  2. Digestive insufficiency:
    a) mechanical (reduced peristalsis)
    b) chemical (low bile, low HCl, pancreatic enzymes).
  3. Inadequate water intake / dehydration.
  4. Sedentary lifestyle / stress/ a change in routine eg travelling
110
Q

Ideal naturopathic bowel movement frequency?

A

1-3
Bowel movements per day. Less than one per day would be indicative of reduced function.

111
Q

What might non-food related stool colours indicate?

A
  1. Very pale / clay colour: insufficient bile production.
  2. Green: release of toxic matter in bile.
  3. White mucous:
    a) intestinal flora distburance
    b) microbial infection
    c) immune response to gluten, lactose
    d) Inflammation from ulceration.
  4. Dark brown: Slow transit time in colon; hypothyroidism
  5. Orange: insufficient bile production or pancreatic lipase enzyme insufficiency. Stool usually frothy and poorly formed.
  6. Black tarry stools: red flag (oesophageal / gastric bleed).
  7. Blacker stools: iron supplementation, although should not be tarry.
  8. Blood in stools: Red flag. Darker blood typically sign of a more serious pathology. 9. Bright red blood around stool / on toilet paper: haemorrhoids.
112
Q

Why might TCM clock be useful?

A
  1. Qi ebbs and flows through body in a 24 hour cycle like a tide.
  2. In each two hour section, specific organ at its strongest, whilst another at its weakest. 3. Clock may give clues as to why symptoms present at certain times of day.
113
Q

TCM:
*Waking at 1am-3am
*Asthma symptoms at 3am–5am
*7am-3pm

A
  1. Waking at 1am-3am: possibly liver stress.
  2. Asthma symptoms at 3am-5am may indicate lung imbalance.
  3. 7am-3pm: Ideal times to eat when stomach, small intestine and spleen energy are strongest.

Nut 1 Semester 2 (11 decks)

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