Advanced Naturopathic Case Taking Flashcards
(164 cards)
1
Q
What are the naturopathic principles?
A
- The healing power of nature: self-healing if given the right means
- Treat the cause, not the symptom
- Treat the whole person: recognise its individuality
- Prevention is preferable to cure
- A naturopath is an educator: empowering clients to take responsibility for their health
2
Q
The Hering’s laws of cure (5)
A
- From the inside out
- From more important organs to less
- The mind gets better before the body
- Symptoms disappear in the reverse order they arrived
- From above to below
3
Q
What is the process of disease?
A
Antecedents (predisposing factors to illness)
Triggers (something that triggered the problem)
Mediators (factors that maintain/keep the illness going)
Disease = end result
4
Q
Define root cause
A
Imbalances “at the root of the tree” = traumas, lifestyle factors throughout life stages
These imbalances lead to symptoms (leaves of the tree) -> by treating those, you don’t get to the root
5
Q
What does it mean to assess the whole person?
A
- Take into account the client’s antecedents, triggers, mediators
- Uncover their personal lifestyle factors (sleep, exercise,..)
- Lifestyle/environment (dietary toxins/deficiencies, drugs,…)
- Historical trauma (physical/emotional)
6
Q
What is the impact of genes on an individual
A
Genetics can influence the person, but the expression of genes can be altered throughout (e.g. smoking vs detoxing) -> switching genes on and off creates and prevents disease
7
Q
What affects congenital factors?
A
- Gestational environment during pregnancy
- Environment and epigenetics of the baby
8
Q
What is a trigger?
A
Anything initiating an acute illness or for a symptom to emerge, e.g. trauma, microbes, dietary allergens,…
9
Q
How are triggers assessed?
A
Through a comprehensive history taking :
- Ask about what happened when their health changed
- Use open ended questions
- Lab testing for trigger factors
- Other testing (e.g. kinesiology)
10
Q
What are mediators?
A
Factors that contribute to pathological changes and dysfunctional responses -> the point is to establish what is causing them
11
Q
What type of mediators are there?
A
- Physiological mediators (e.g. intestinal dysbiosis, inflammation)
- Biochemical mediators (e.g. free radicals)
- Cognitive/emotional mediators (e.g. personal belief about illness)
- Social/cultural mediators (e.g. reinforcement for staying sick or social isolation and poverty)
12
Q
How can biochemical mediators be assessed?
A
Lab testing can define
- Inflammatory mediators (CRP, ESR, ferretin,…)
- Endocrine mediators (TSH, T4, T3, oestrogen metabolism,…)
-> knowing these and where they fit in disease process is helpful in reducing symptoms/preventing further disease processes
13
Q
What are core clinical imbalances?
A
Areas of clinical imbalance to consider when deciding which system is under stress -> these impact overall health due to influencing multiple symptoms and structures
14
Q
What are the 7 core areas of clinical imbalance?
A
- Assimilation
- Structural integrity
- Communication
- Defence and repair
- Transport and circulation
- Energy : mitochondrial health
- Detoxification and elimination
15
Q
Describe assimilation as a core clinical imbalance
A
All aspects of digestion/assimilation
- Digestive secretions
- Digestive motility and innervation
- Digestive hormones
- Absorption of nutrients
- Microbiota balance
16
Q
Describe structural integrity as a core clinical imbalance
A
Range of structures in the body
- Cell membrane health (DHA/EPA balance)
- Mucous membrane and skin integrity (vitamins, glutamine)
- Bones and teeth (minerals!)
- Joint and cartilage
17
Q
Define communication as a core clinical imbalance
A
- Hormone and the endocrine system
- Neurotransmitters and the nervous system
18
Q
Define defence and repair as a core clinical imbalance
A
Covers
- Inflammation
- Infections
- Microbiota imbalances
- Low immune function
19
Q
Define transport and circulation as a core clinical imbalance
A
- Lymphatic structures
- Vascular structures
- Mobilisation of blood lipids
20
Q
Define energy/mitochondrial health as a core clinical imbalance
A
- Cofactors of energy production : Zn,Mg,B1,B2,B3,Fe
- Biochemical imbalances in the energy production pathways (e.g. due to heavy metals)
- Mitochondrial integrity and oxidative damage
21
Q
Define detoxification and elimination as core clinical imbalance
A
- Liver and gallbladder function
- Kidney function
- Bowel function
- Skin and lungs
- Biochemical imbalances in the biotransformation pathways (e.g. methylation)
22
Q
Signs and symptoms of assimilation imbalances
A
- Any insufficiency, e.g. pallor, shortness of breath
- Dysbiosis, gas, bloating, food sensitivities, heartburn, changes in body weight, illnesses that impede absorption
23
Q
Signs and symptoms of structural integrity imbalances
A
- Issues related to structural pain/injury, tendons, muscles
- Skin problems (acne, eczema, …)
- Gut membrane integrity and autoimmune conditions
- Diet low in EFAs, low vit. D exposure, low minerals
24
Q
Signs and symptoms of communication imbalances
A
Any symptom related to hormonal issues : reproductive, fatigue, stress, mood, sleep
25
Signs and symptoms of defence and repair imbalances
Recurring infections, fatigue, poor wound healing, skin issues, autoimmune conditions, intestinal permeability, low vit. D and antioxidants in diet
26
Signs and symptoms of mitochondrial health imbalances
Issues with ATP production: weakness, fatigue, Parkinson’s, MS, poor cognitive function, memory, intestinal permeability
27
Signs and symptoms of transport imbalances
- Circulatory issues (CVD, Raynaud’s, peripheral neuropathy,…)
- Lymphatic issues (oedema,…)
28
Signs and symptoms of detoxification and elimination imbalances
- Poor quality/quantity/light coloured stools, jaundice, lethargy
- To consider with clients on meds, poor diet/lifestyle, smoke, alcohol, exposure to chemicals
29
How is the naturopathic case analysis structured?
1. Gather all client’s information (case history form : presenting symptoms, system review, personal/family medical history,…)
2. Highlight antecedents, triggers and mediators
3. Plot info within a timeline
4. Identify which systems are under stress
5. Decide what are the core clinical imbalances for the naturopathic summary
30
Naturopathic evaluation tools : asking the right questions
Distinguish between clients looking for optimal health (e.g. ask about personal and family health history) and clients with active health problems (health life before problem -> identify A,T,M -> when are triggers occurring)
31
What is the art of case taking?
1. Observe client’s skin, hair, nails, tongue, posture, mannerism
2. Listen to case without judgement, pay attention to repetitive words, statements, phrases
3. Clarify what client said using same words/phrases to make sure no misunderstandings
4. Empower your client with knowledge -> bring case together
32
What are naturopathic evaluation tools?
- Tongue analysis
- Facial analysis
- Nails assessment
- Anthropometric measurements
- Urine and stool assessment
33
What are naturopathic evaluation tools for?
Help inform a deeper understanding of the client and support the decision making process when creating the naturopathic treatment plan
34
What is the rule of three?
That 3 factors are required to support an hypothesis
35
Is nutritional therapists’ job to diagnose diseases/disease states?
No: instead of saying e.g. you are magnesium deficient, say e.g. my evaluation suggest you may benefit from more magnesium -> if you believe a diagnosis is needed, refer to GP
36
What insights can colour and texture of skin provide?
Energetic excess or potential pathologies
- Strong red = excess heat
- Pale red/malar flush = Yin deficiency, SLE, rosacea (-> H. Pylori), B3 deficiency
- Pallor = Qi deficiency, anaemia
- Yellow = liver/biliary disease, spleen Qi deficiency
- Puffy = Yang deficiency
- Dry = Yin deficiency, dehydration
37
What can lines across the forehead indicate?
- Many = poor intestinal health
- One = small intestine issues
38
What can lines between the eyebrows mean?
1 = stomach insufficiency
2 = liver imbalances
39
What can lines above lips indicate?
Reproductive weakness, blood deficiency, smoker
40
What may brown shadows under eyes indicate
Liver stagnation
41
What may blue/black shadows under eyes indicate
Adrenal exhaustion/kidneys
42
What can smells tell you about energetic excesses?
- Strong smell = heat
- Absence of smell = cold
- Bad breath = stomach heat
- Smelly urine/stools = damp heat
43
What are tissue salts?
Naturopathic remedies based on minerals
Invented by German homeopath Schuessler
44
How do tissue salts work?
Different body tissues are made of ratios of specific minerals, vital for their physical integrity and proper function
12 minerals in homeopathic form acting on a specific tissue, stimulating them to heal
45
What is the correct posology for tissue salts
Chew, dissolve or crush
Adult : 1-2
Children : 0.5-1
Infant : 1/4-1/3
Acute : every 30 min until symptoms subside
Chronic/maintenance : 4-6 times x day
Take as long as they work
46
What can nail structure tell you about?
Systemic and local medical history + lifestyle over past 4-6 months (3 x kids)
47
How are nails structured?
1. Nail plate = keratinised structure that grows throughout life
2. Nail bed = vascular bed, responsible for nail growth and support
3. Cuticle = epidermal layer between proximal nail fold and nail bed
48
What may white nails indicate?
Anaemia, oedema or vascular condition
49
How can you test if white nails are due to anaemia?
Apply gentle pressure to the nail bed and release -> if it takes more than 2 sec for red to disappear -> suggest anaemia
50
What are white spots on nails linked to?
Calcium, zinc or silica deficiency/insufficiency
51
What may no lunula on the thumbs suggest?
Anaemia or malabsorption
52
What does a pyramidal lunula suggest?
Excessive manicure or trauma
53
What may a pale blue lunula suggest?
Diabetes mellitus, anaemia or peripheral neuropathy
54
What may a red lunula suggest?
CDV disease, connective tissue disorder or possible malignancy
55
What are Terry’s nails?
White nails with pink/brown at the end
56
What may Terry’s nails suggest?
Ageing, liver cirrhosis, chronic kidney disease, congestive heart failure, T2DM
57
What may brown/grey nails suggest?
CDV disease, diabetes mellitus, B12 deficiency, melanoma, lichen planus (immune mediated disease affecting skin/mucous membranes)
58
What may thin, brittle nails indicate?
Osteopenia, thyroid disorders, severe malnutrition, common mineral deficiencies
Also increased by hand cream/manicure/nail varnish and remover
59
To what nutritional imbalances may thin brittle nails be related to?
Biotin, B12, vit. A
60
What is Paronychia?
An infection of the tissue adjacent to the nail (= red and tender)
Treat by supplementing vit. C
61
What may Paronychia be due to?
Trauma, poor nutrition, low immunity, poor hygiene
62
What are wicks (or hangnails) due to?
Too little protein, lack of Bs or C
Dryness may indicate EFA status, vitamin A and D, hypothyroidism
May indicate need for nervous system/adrenal support
Can also be caused by chemical irritants
63
What is nail clubbing?
Loss of normal angle between nail bed and fold
64
How is nail clubbing assessed?
Place both forefinger nails together and look between them -> diamond = normal / lack of diamond = clubbing
65
What causes nail clubbing
Pulmonary/CDV causes (89%)
GIT causes (5%)
Hypothyroidism, idiopathic
Clubbing can begin before the effects of pathology are noticed
66
What is Koilonychia?
Nail spooning (i.e. concavity)
67
How can you assess nail spooning?
Drop of water on nail -> if doesn’t slide off = spooning
68
What may spooning nails be caused by?
Iron deficiency, Raynaud’s disease, diabetes mellitus, SLE, protein deficiency (esp. in cysteine/methionine), haemachromatosis (iron overload)
69
What are Beau’s lines?
Furrow in the nail produced by an interrupted growth at the nail matrix -> location indicates timing of illness, depth indicates severity
70
What causes Beau’s lines?
Severe infection, myocardial infraction, severe zinc deficiency, surgery, chemotherapy
71
What are Mee’s lines?
White bands traversing the full nail width -> indicates acute illness/trigger -> line location may indicate timing
72
What do longitudinal ridges on nails suggest?
May be a sign of ageing/B deficiencies
Pathologies : RA, peripheral vascular disease, lichen planus
73
What is nail pitting?
Inflammation of the nail matrix distorts the nail plate, causing superficial dents
74
What causes nail pitting?
- Psoriasis (random pits)
- Alopecia areata (rippled grid)
- Eczema
- Lichen planus
75
What is nail thickening produced by?
By the slowed nail growth
Which may be due to :
- Onychomycosis
- Chronic eczema/psoriasis
- Peripheral vascular disease
- Old age
76
What might nail beading suggest?
Endocrine conditions : diabetes, thyroid disorders, Addison’s, B deficiencies
77
What is Onycholysis?
Common condition where the nail plat splits drom the nail bed
78
What may Onycholysis be due to?
Hyperthyroidism, psoriasis, eczema, trauma, contact dermatitis, chemicals
79
How may you spot a vit. A deficiency by looking at nails?
Brittle, peeling or splitting nails
80
How may you spot a vit. C deficiency by looking at nails?
Frequent occurrence of hang nails/swollen tissue
81
How may you spot a vit. D deficiency by looking at nails?
Brittle and peeling nails
82
How may you spot a zinc/calcium deficiency by looking at nails?
White spots, weak or brittle nails
83
How may you spot an iron deficiency by looking at nails?
Pale nail bed, central ridge, spooning
84
How may you spot protein deficiency by looking at nails?
Weak and brittle nails
85
How may you spot an EFA deficiency by looking at nails?
Dry, peeling, swollen skin around nails
86
What are homeopathic tissue salts for nails?
- Calc phos = cell restorer -> x white spots
- Kali sulph = the skin conditioner -> x fungal nail infection
- Silica = the skin cleanser -> x any malformations
87
What does tongue diagnosis take into consideration?
Condition, shape, colour, patterns, coating
88
What is the tongue map x identification of dysfunctional areas?
- Root/back = lower abdomen (kidneys, bladder, intestines, reproductive organs)
- Centre = central abdomen (stomach, spleen)
- Sides = liver and gallbladder
- Tip and front = chest (heart and lungs)
89
What may a PALE BODY of the tongue indicate?
Excess cold, Qi or yang deficiency, blood deficiency (medically = iron deficiency anaemia)
90
What may a RED BODY of the tongue indicate?
Excess heat, inflammation, infection
(Clinically, red painful tongue/glossitis = folate/B1/B2/B3/B6 deficiency)
91
What may a PURPLE BODY of the tongue indicate?
Blood stagnation, reduced Qi, poor circulation
(Medically = cyanosis = low oxygen)
92
What may prominent red papillae indicate?
Excess heat
93
What may excess papillae or “hairy tongue” indicate?
May follow antibiotic treatment (treat with pre and probiotic)
94
What may a dry, cracked tongue indicate?
Yin deficiency (not enough/not holding fluids or dried out due to excess heat)
95
What may a wet tongue suggest?
Excess moisture and fluids
96
What may impaired taste suggest?
Zinc deficiency
97
What may a thin tongue indicate?
Blood deficiency
98
What may a swollen tongue indicate?
Qi or yang deficiency causing fluid retention OR dampness
99
What may a scalloped tongue indicate
Weak digestion (spleen Qi deficiency)
Pancreatic insufficiency
Infection
100
What are raised/upturned edges of tongue a sign of?
High stress
101
What may a tremor/quivering tongue suggest?
Spleen Qi deficiency
Excess vata in Ayurveda (= nervous energy, anxiety)
Nutritionally may indicate magnesium def.
102
What does the midline of the tongue (sulcus) represents in Ayurvedic medicine?
The spine
Top = cervical region
Back = lumbar region
103
What does the tongue’s sulcus represent in TCM?
Yin deficiency
104
What are tongue cracks (fissures)?
Signs of potential health issues and may indicate imbalances in the area where they are located
105
What may a medial tongue fissure indicate?
Shallow, vertical crack through middle tongue = digestion deficiency (due to under-secretion of digestive juices)
106
What may a midline fissure on the tip of the tongue indicate?
Tendency to constitutional heart problems, may also indicate thyroid issues
107
What may a geographical tongue indicate?
Yin deficiency
Nutritionally = Bs deficiencies
Seen in psoriasis sufferers
108
What does the tongue coating reflect?
State of the digestive system and potential toxicity
Use map to identify affected organs
109
What may a thin, white coating of the tongue suggest?
Nothing! It’s normal
110
What may a brown coating of the tongue suggest?
Chronic excess heat (leading to degenerative changes)
111
What may a greasy, yellow coating of the tongue indicate?
Damp heat (inflammation and infection)
112
What may a greasy, white coating of the tongue indicate?
Damp cold (excess mucus/phlegm)
113
What may a no-coat on the tongue indicate?
Yin deficiency
114
What may dry lips be associated to?
- Dehydration
- Excess heat (often stomach)
- B2/B3/folate deficiency
115
What may angular stomatitis or chelitis be associated to?
- Iron or Bs def.
- Infection (fungi, bacteria)
- Low immunity
- Bite issues causing drooling
116
How do normal and healthy gums look?
Pale red surface, sharp and well defined margins, shallow crevices between gum and teeth
117
What may bleeding/receding gums indicate?
- Vit. C and/or zinc def.
- CoQ10 def.
118
What causes periodontal disease? (Often from untreated gingivitis)
High sugar/meat/dairy and/or low bioflavonoids/zinc/CoQ10
119
What may pale mucous membranes of the mouth suggest?
Iron deficiency
120
What may greyish mucous membranes of the mouth suggest?
Biotin deficiency
121
What may the state of the pupil suggest and why?
Pupil governed by iris -> iris governed by autonomic nervous system —> pupils can indicate autonomic activity in the body
122
What may contracted pupils indicate?
Parasympathetic dominance = inward tension / internalised / cautious / reserved
Dominant neurotransmitter = acetylcholine
123
What may dilated pupils indicate?
Sympathetic dominance, possible adrenal exhaustion = fast responses, fight or flight
Dominant neurotransmitter = adrenaline
124
What deficiency may dry eyes indicate
EFA, vit. A
125
What deficiency may night blindness indicate?
Vit. A, zinc
126
What deficiency may a pale conjunctiva indicate?
Iron
127
What deficiency may a blue sclera indicate?
Iron
128
What deficiency may photophobia indicate?
B2, B3, betacarotene, vit. A, zinc
129
What deficiency may a lack of eyelashes and eyebrows indicate?
Copper
Thinning eyebrows may indicate thyroid support is needed
130
What nutrient deficit may a facial dermatitis suggest?
B2
131
What nutritional deficiency may hyperpigmentation of the mouth/cheeck/eye area suggest
Protein
132
What nutritional deficiency may inelastic facial skin suggest?
Vit. C, EFAs, copper
133
What nutritional deficiency may hair loss suggest?
Iron, protein, biotin, endocrine (e.g. hypothyroidism)
134
What nutritional deficiency may brittle, dry and lacklustre hair suggest?
Iron, protein, EFAs
135
What nutritional deficiency might perifollicular hyperkeratosis suggest?
Vit. A, EFAs
136
Why testing pH?
Gives insight on client’s internal environment
137
What are pH healthy levels?
- Blood = 7.35-7.45
- Urine = 6.5-7.25
- Saliva = 6.8-7.5
138
How to test salivary pH
Spit test
Perform 4-5 days in succession
1st : 1h after brushing teeth
2nd : 30 min before lunch
3rd : 30 min before dinner
139
What may a pale yellow/colourless urine indicate?
Drinking lots of fluids
140
What may a dark yellow/strong smelling urine indicate?
Dehydrated
141
What may a very dark yellow/orange/brown urine indicate?
Jaundice
142
What is blood in urine?
A red flag!
143
What does an unpleasant smelling/cloudy urine suggest?
UTI
144
What is an anthropometric measurement?
The measurement of waist-to-hip ratio
It may suggest risk level for heart attack, stroke, diabetes
Calculated : waist divided by hip measurement
145
What is a low-risk W:H ratio?
Male = <0.95
Female = <0.80
146
What is a moderate risk W:H ratio?
Male = 0.96-1
Female = 0.81-0.85
147
What is a high risk W:H ratio?
Male = 1+
Female = 0.85+
148
What is the BSC?
Medical aid developed by the Bristol university -> helps differentiate what a healthy stool look like and what other types may mean
149
What does a healthy stool look like?
- Easy passage
- Feeling of complete evacuation
- Type 3-5 BSC
- Ideally doesn’t sink nor float
- Medium brown colour
- No obvious undigested food
150
What does a type 1-2 BSC indicate?
Constipation
151
What does a type 2-3 BSC indicate?
Common in protein rich western diet
152
What does a type 5 BSC indicate?
Softer, bulkier -> associated with vegetarian/vegan diets
153
What does a type 6-7 BSC indicate?
Diarrhoea
154
What may floating stools indicate?
Dietary fats are not properly emulsified by bile -> may be insufficient bile or excessive fat intake
155
What may sinking stools indicate
Heavy, with decaying matter or non-used minerals
156
What may thin stools indicate
Tension (colon spasm as seen in IBS)
157
What may dry stools indicate
Poor water intake or slow transit time due to poor fibre, hypothyroidism or stress
158
What may very pale/clay coloured stools indicate?
Insufficient bile production
159
What may green stools indicate
Release of toxic matter in bile
160
What may white mucus in stool indicate?
Disturbances of the intestinal flora, microbial infection of an immune response to gluten/lactose or inflammation from ulceration
161
What may very dark brown stools indicate
Slow transit time in colon, hypothyroidism
162
What may orange colour stools indicate
Insufficient bile production or pancreatic lipase insufficiency (stool usually frothy and poorly formed)
163
What may black tarry stools indicate
Red flag! Can indicate oesophageal or gastric bleeding
(Only black - not tarry - may be due to iron supp.)
164
What may blood in stools suggest
Red flag! Darker = more serious
