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Questions and Answers
What distinguishes acute disease from chronic disease in homeopathy?
Which aspect is NOT a crucial factor in case taking during a homeopathic consultation?
Which of the following is a characteristic symptom of Arnica montana?
When does case taking in homeopathy begin?
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Which type of disease is classified under dynamic diseases?
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Which herb is known for its endocrine modulating properties in Type II Diabetes?
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What is the primary focus when combining botanicals for treating Type II Diabetes?
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Which of the following is NOT an outcome measure for treating Type II Diabetes?
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Which botanical is considered an alterative in the management of Type II Diabetes?
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What is the recommended approach to selecting herbs for treatment based on patient conditions?
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What is the primary reason why the lumbar spine allows for greater mobility compared to the thoracic spine?
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Which of the following techniques is NOT a type of glide used in lumbar mobilization?
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What anatomical feature primarily dictates the movement of the lumbar spine?
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In which scenario should mobilization techniques be avoided?
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Which of the following is a characteristic of typical lumbar vertebrae?
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What is a common misunderstanding older patients may have regarding symptoms of primary hypothyroidism?
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How do older patients commonly perceive their treatment for hypothyroidism?
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What is a typical concern for older patients regarding ongoing management of hypothyroidism?
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What distinguishes chronic fatigue syndrome (CFS) from burnout?
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What approach is essential for helping someone from a culturally different background?
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Study Notes
Classification of Disease
- Based on the Organon, diseases are classified as physical/external, dynamic, and acute/chronic
- Dynamic diseases are further classified as acute, chronic (miasmatic and non-miasmatic), epidemic, sporadic, and individual
Case Taking
- The case taking process starts from the time a patient enters a clinic and continues until they exit
- Observation plays a critical role
- The homeopath should be an unbiased observer, observing the patient before assuming the role of a homeopath to reduce bias
- The interview must be conducted with professionalism and discretion, using active listening
- When taking a case, record verbatim what the patient says and what is observed
- It is important to record "complete symptoms" which include sensations, modalities, intensity, location (precise location or tissues involved), and etiology (if applicable)
- The complete symptom is also known as S-M-I-L-E or C-L-E-M-S
Acute & First Aid Cases
- In first aid cases, two questions are often enough: "What has happened?" and "What has changed since this happened?"
- For acute cases, limit the inquiry to the acute state only, do not investigate the chronic state
- Record the "recent" changes caused by the acute state, regardless of the underlying cause
- Obtain complete symptoms by asking S-M-I-L-E questions
Arnica Montana
- Arnica Montana is a common medicine used in first aid
- It is used to reduce shock, relieve pain, diminish swelling, and promote healing
- It is also used after surgical procedures, dental surgery, and during labor to help manage shock and stress
Arnica Montana Mental Picture
- Fears touch or the approach of anyone
- Wants to be left alone
- Feels the bed is too hard
- Experiences mental strain or shock
Arnica Montana Physical Symptoms
- Pain in back and limbs feeling as if bruised or beaten
- Sprained and dislocated sensation
- Soreness after overexertion
- Everything feels too hard when lying on it
- Symmetrical distribution of eruptions
Arnica Montana Modalities
- Worse: least touch, motion, rest, wine, damp cold
- Better: lying down, head low
Natrum Sulphuricum
- Natrum Sulphuricum is the homeopathic name for Sodium Sulfate
Natrum Sulphuricum Toxicity
- Produces symptoms similar to those caused by injuries, falls, blows, contusions, or bruising
Treatment Principles for Type II Diabetes
- Lifestyle changes are essential for managing Type II Diabetes, such as diet and exercise.
- Botanical remedies can be used to improve blood sugar and insulin regulation alongside lifestyle changes.
- Herbal treatment should consider the specific symptoms of the patient to determine the lead actions and herbs needed.
Featured Herbs
- Curcuma longa (Turmeric)
- Cinnamomum zeylanicum (Cinnamon)
- Trigonella foenum-graecum (Fenugreek)
- Galega officinalis (Goat’s rue)
- Arctium lappa (Burdock)
- Gymnema sylvestre (Gymnema)
- Berberis vulgaris (Barberry)
- Momordica charantia (Bitter melon)
- Taraxacum officinalis folia (Dandelion leaf)
- Citrus reticulate (Tangerine peel)
- Urtica dioica folia (Nettle leaf)
- Hibiscus sabdariffa (Hibiscus)
Outcome Measures for Type II Diabetes treatment
- Normalize blood sugar to non-diabetic levels.
- Eliminate glucose in the urine.
- Normalize HbA1C.
- Resolve current symptoms.
- Prevent further progression of the disease.
Relevant Botanical Actions for Diabetes Management
- Primary Actions: Endocrine modulation, Alterative, Bitter
- Secondary/Supportive Actions: Diuretic, Hepatic, Carminative, Astringent, Circulatory
Featured Herbs by Botanical Action
- Endocrine Modulator (Insulin): Cinnamon, Bitter Melon, Goat’s Rue, Gymnema, Barberry.
- Hepatic: Burdock, Barberry, Bitter Melon.
- Diuretic: Dandelion Leaf, Nettle Leaf.
- Astringent: Hibiscus, Tangerine Peel.
- Circulatory: Turmeric, Cinnamon.
- Carminative: Turmeric, Cinnamon, Fenugreek.
Sample Formula and Dosage
-
Formula:
- Barberry 20
- Goat’s Rue 20
- Bitter Melon 20
- Cinnamon 20
- Fenugreek 20
- Total: 100mL
- Dosage: Tincture: 2 tsp, three times a day between meals.
- Duration: Continue for six weeks, then monitor and record blood sugar levels.
- Expected Results: If herbs are the only therapy, expect modest improvement or stabilization over 6 months. With other therapies, significant improvement in fasting glucose and HbA1C are possible.
- Cautions: This treatment may cause a hypoglycemic event, advise the patient to have candy or sugary drink on hand during the start of treatment.
- Contraindications: Avoid during pregnancy and lactation.
- Potential Side Effects: May cause GI pain and diarrhea.
- Herb-Drug Interactions: This combination will have additive effects with other diabetic medications.
Other Effective Therapies
- Dietary changes and physical activity are crucial.
- Intermittent fasting.
- Warm, well-cooked meals rich in healthy oils and protein.
- As-needed tincture for sugar cravings: Equal parts wormwood, lobelia, and passiflora.
TCM Integration: Dampness Progressing to Phlegm
- Type II Diabetes is a condition of Dampness.
- Excessive sugar and calorie intake overwhelms the Spleen.
- Clearing Dampness and preventing further accumulation is crucial for treatment.
Selected Monographs
-
Berberis vulgaris (Barberry)
- Primary Actions: Cholagogue, antimicrobial, bitter, hepatic, anti-inflammatory, alterative, endocrine modulator (insulin)
- Constituents: Isoquinoline alkaloids (berberine, hydrastine, berbamine)
- Indications: General infections, GI infections, hepatic or gallbladder conditions, constipation, type II diabetes, PCOS.
- Cautions/Contraindications: Non-toxic but very strongly bitter. Avoid during pregnancy and lactation.
- Extra Information: Useful as an alterative during and post-infection.
-
Cinnamomum zeylanicum (Cinnamon)
- Primary Actions: Diaphoretic, astringent, antimicrobial, antispasmodic, carminative, endocrine modulator (diabetes)
- Constituents: Cinnamyl acetaldehyde and ester (only bark), phellandrene (only leaf)
- Indications: Type II diabetes, diarrhea, nausea, vomiting, URTI
- Cautions/Contraindications: Considered safe as spice used in food in doses less than 5 g. Generally CI in pregnancy and lactation.
- Extra Information: In TCM, it warms the individual, increases flow through the meridians, removes obstructions to the flow of Qi, and reinforces yang.
-
Galega officinalis (Goat’s rue)
- Primary Actions: Galactagogue, hypoglycemic, diaphoretic
- Constituents: Amines, flavonoids, saponins
- Indications: Insufficient breast milk production, blood sugar dysregulation, PCOS
- Cautions/Contraindications: Will augment effects of other hypoglycemic agents. Safety rating during pregnancy and lactation not established.
-
Momordica charantia (Bitter melon)
- Primary Actions: Endocrine modulator (insulin), bitter
- Constituents: Steroidal saponins (charantin), polypeptide-p, lectins
- Indications: Type II diabetes, possibly PCOS
- Cautions/Contraindications: Considered safe, and consumed as food in many Asian cuisines. Potential to cause hypoglycemic events. Consumption of more than 2–3 of the fruit can cause GI pain and diarrhea.
- Extra Information: In the literature, ongoing consumption of approximately one fruit per day (about 25 g) shows reasonable efficacy as an effective oral hypoglycemic agent.
Lumbar Spine Anatomy
- Greater range of motion compared to thoracic spine due to lack of ribs
- Responsible for most trunk mobility
- Bears significant loads from body weight, lifting, and powerful movements
- Motion determined by facet joints:
- L1-4: In sagittal plane
- L4-5, L5-S1: Aligned closely with frontal plane
- Greater forward and backward bending in the lower lumbar spine compared to the upper lumbar spine
- Typical lumbar vertebra is large
Lumbar Lateral Flexion
- Initiated by concentric contraction of Quadratus Lumborum on the ipsilateral side
- Controlled by eccentric activity of the contralateral Quadratus Lumborum.
- Limited by impact of articular facets on the side of bending and contralateral ligaments
Lumbar Rotation
- Initiated by concentric activity of abdominal obliques
- Assisted by concentric activity of short segmental muscles (multifidus and rotatores) on the contralateral side.
- Controlled by eccentric activity of the ipsilateral Multifidus and Rotatores and ligaments
- Balancing contraction of contralateral muscles is crucial for maintaining normal axial rotation.
Risks and Contraindications of Lumbar Spine Mobilization
- Minimal risk
- Serious injury from a manipulation (Cauda Equina syndrome) is rare
Pre-existing Conditions Contraindicated for Lumbar Spine Mobilization
- Ankylosing Spondylitis
- Inflammatory Arthrides
- Radiculopathy
- Lumbar Spinal Stenosis
- Spondylolisthesis
- Osteoporosis
- Lumbar spine fracture
- Skeletal metastases
- Cauda equina syndrome
- Scheuermans disease
- Scoliosis
- Disc Herniation (for manipulations): Mobilization can be adapted based on injury stage
Lumbar Mobilization Indications
- Nonspecific Low Back Pain: Sub-acute or chronic, no recent injury, moderate pain, inflammation, swelling, erythema, or bruising
- Lumbar Radiculopathy due to muscle hypertonicity
Goals and Benefits of Lumbar Mobilization
- Reduce pain
- Restore optimal range of motion
- Improve movement quality
- Enhance proprioceptive function
- Segment-specific, targeting the area being mobilized
- Mobilization (Grade 5) tends to have collateral effects
- Mobilizing/manipulating hand glides the superior spinous process superiorly during patient exhalation
Lateral Glide Using the Spinous Process as a Lever
- Purpose:
- Assess lumbar spine joint impairment
- Increase accessory motion into lumbar vertebral body rotation
- Facet joint distraction on the rotating side
- Increase range of motion
- Reduce pain
- Positioning:
- Patient prone
- Lumbar spine in midrange
- Clinician at patient's side, facing lumbar spine
- Stabilizing hand on the inferior spinous process
- Mobilizing hand on the superior spinous process, contralateral to the stabilizing hand
- Procedure:
- Stabilizing hand holds the inferior vertebra
- Mobilizing hand glides the superior spinous process toward the contralateral side during patient exhalation
Rotation Glide in Side Lying Position
- Purpose:
- Increase accessory motion into lumbar vertebral body rotation
- Facet joint distraction toward the rotating side
- Increase range of motion
- Reduce pain
- Positioning:
- Patient side lying on the non-treatment side
- Lumbar spine in midrange
- Clinician facing the patient's anterior trunk
- Inferior vertebra locked by flexing the patient's knees
- Superior vertebra locked by rotating the upper trunk away from the clinician
- One hand on the inferior spinous process, forearm on the pelvis
- Other hand on the superior spinous process, forearm/elbow anterior and medial to the shoulder
- Procedure:
- Hand on the inferior spinous process glides upward as the forearm rotates the pelvis forward during exhalation
- Hand on the superior spinous process glides downward as the forearm rotates the upper trunk backward
Forward Bending Glide Mobilization with Movement (L1-L4)
- Purpose:
- Reduce pain
- Increase pain-free range of motion into lumbar forward bending
- Positioning:
- Patient sitting with knees bent
- Clinician behind the patient
- Clinician's hypothenar eminence on the distal tip of the spinous process
- Elbow of the mobilizing hand braced against the clinician's pelvis
- Procedure:
- Superior glide applied to the vertebra until tissue resistance is met
- Patient bends forward at the hip as far as possible without pain, holding onto the table for support
- Clinician maintains the superior glide during the movement and returns to starting position
Backward Bending Glide Mobilization with Movement
- Purpose:
- Reduce pain
- Increase pain-free range of motion into lumbar backward bending
- Positioning:
- Patient prone
- Clinician at patient's side
- Clinician's hypothenar eminence on the distal tip of the spinous process
- Guiding hand on the anterior inferior ribs for support
- Procedure:
- Superior glide applied to the vertebra until tissue resistance is met
- Patient performs a push-up, bending backward as far as possible without pain
- Overpressure is applied momentarily at the end of the backward bending movement
- Clinician maintains the superior glide during the movement and returns to starting position
Particulars for Both Techniques
- Only indicated without reproduction of pain
- Should result in immediate increase in range of motion and/or pain reduction
- If effective, should be repeated 2-3 times
Cultural Competency and Therapeutic Relationship
- Cultural competency is crucial for effective therapy.
- A mismatch between therapist and client's cultural background can hinder progress.
- Cultural competency involves understanding different cultures, including acculturation and multiple heritage.
- Skills for working with culturally diverse clients include:
- Active listening
- Utilizing client's existing support systems
- Building trust and credibility
- Adapting strategies based on client's culture
- Addressing differences openly
- Gender also plays a role in therapy.
- It's crucial to consider gender in assessments and address any gender-related issues that arise.
- Supervision is important for therapists to understand how gender affects attitudes, family roles, and potential domestic violence.
- Self-awareness of personal gender stereotypes is essential for effective therapy.
Phenomenology of Hypothyroidism and Nonorganic Fatigue
- Older patients often lack knowledge about hypothyroidism symptoms.
- They may attribute symptoms to other factors before diagnosis and struggle to connect their symptoms to hypothyroidism.
- Patients may have misconceptions about the relationship between medication dosage and health benefits, believing increases in medication will lead to weight loss or improved well-being.
- Some patients may doubt their diagnosis and treatment.
Hypothyroidism and Ongoing Management
- Older patients may experience challenges with ongoing management due to appointments, monitoring, and medication adjustments.
- Lack of feedback can lead to anxiety or frustration.
- Lack of information sharing can be problematic.
- Patients may exhibit "passive acceptance of the status quo" while trusting their physicians despite feeling vulnerable.
Chronic Fatigue and Burnout
- Chronic fatigue syndrome (CFS) is often described in somatic terms, while burnout is conceptualized in psychological terms.
- Both conditions are characterized by a lack of energy.
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Description
This quiz covers the classification of diseases based on the Organon in homeopathy. It also explores the case taking process, emphasizing the importance of observation and recording complete symptoms. Test your knowledge on acute cases and the principles of first aid in homeopathy.
