Homeopathic case taking.
Hey there, I just wants to start with very basic of a Homeopathy that is case taking.
Here I wants to introduce few case taking formats.
HOMEOPATHIC CASE TAKING FORMAT FOR ADULTS & CHILDREN
PLEASE READ THIS FIRST BEFORE FILLING THIS FORM
You have get well. We are here to select the best possible medicine for you .In order to do that, we depend on your co-operation. HOMOEOPATHIC MEDICINE IS MAINLY SELECTED ON THE SYMPTOMS YOU GIVE US. If we are to make a successful prescription, we must know all the details of your sickness. We must also understand all the features that belong to you as an individual. This includes your reactions to various factors, your past and family history and your mental make up.
This information enables us to selection the remedy that removes your sickness. The medicine also makes you well as a whole person.
In order to find out all about you, we shall be asking you many questions. Each one of these questions has a definite meaning and significance for us. There is not a single questions that is useless. Even something that your may think is not connected with your trouble, may be the most important factor in deciding the correct homoeopathic medicine. That is why you must be free and frank and give us the fullest possible information on each point. Please read each question carefully, think and if necessary, consult someone close to you and then answer completely. Do not keep anything back. Remember, whatever you tell us will remain absolutely confidential.
THIS QUESTIONNAIRE FORM HAS 8 PARTS :
In the list below, circle around names of ALL major illnesses so far suffered and on the next page give its relevant details.
Any extra remarks of information :
Mention any drugs , tonics , stimulants etc. That have been used by you at any time in life.
FAMILY INFORMATION
* How many
brother –sister are you? (including those who died , if any).
Provide information about them in the table below. Indicate your position by writing ‘SELF’.
*About your birth
Did your mother have any problem during pregnancy ?
Did She take drugs during pregnancy ?What were they?
Was there any difficulty about your birth ? Give details.
*At what age did you start.
Tick mark
(X) if any animal bites such as :
Mention if any other :
Did you take anti-rabies or anti –venom or any other treatment ?
*Vaccination & Inoculations :
Indicate number of times you were vaccinated for the following :
Was there any reaction or particular trouble after any of above vaccinations of inocculations ?
Give details:
(if married) How is the health of your husband /wife :
*Number of children living and dead . If dead , state causes :
Mention ages of children and their condition of health.
Any
abortions , miscarriages or still birth ?
Main complaints and other associated troubles: (and detailed history
of the present illness, The onset and course with dates).
ORIGIN OF CAUSE : Can you trace the origin illness to any particular circumstance accident , illness, incident or mental upset ? (e.g. Shock , worry , errors in diet ,overexertion , exposure to cold , heat etc.)?
How is your appetite?
When are you hungry?
What happens if you have to remain hungry for long?
How fast do you eat?
How much thirst do you have?
Any particular time are you specially thirsty ?
Do you feel any change in your taste and feeling in your mouth?
Please Put one tick (X) if you Like / Dislike the food or if the food disagrees. Put two tick mark(X X) if you strongly Like / Dislike the food or if the food strongly disagrees.
STOOL
Do you have any problem regarding your stools?
When and how many times a day do you pass stools ?
When is it urgent?
Do you have any problem about bowel movements?
Do you have to strain for stool? Even if soft?
Do you have belching or passing gas? Describe its character.
How do you feel after passing gas up or down?
URINATION & URINE
Any problem about urine ?
Any strong smell ? Like what?
Do you have any trouble before , during and after passing urine?
Any difficulty about the flow ? Slow to start , interrupted , feeble dribbling etc.?
Any involuntary urination? When ?
SWEAT/PERSPIRATION-FEVER-CHILL
How much do you sweat ?
Where and on what part do you sweat most?
Do you perspire on the palms or soles?
Is the sweat warm , cold , clammy, sticky, musty, greasy, stiffens the linen etc.?
What is the smell like ?e.g. foul , pungent, sour , urinous.
What colour does it stain the clothing ?
Is the stain easy to wash off or difficult ?
Any symptoms after sweating ?
When do you get fever or chill ?
What brings it on ?
Do you experience any sense of heat or cold in
Any part of your body at any particular time?
CHEST-HEART – COLD – COUGH
Do you catch cold often ?if so, how?
Describe the symptoms ,nature of discharge etc.
Is there any trouble with your CHEST or HEART ?
Is there any trouble with your voice or speech?
Is there any difficulty in breathing ?
Do you have cough ?
Is it more at any particular time?
SEXUAL SPHERE (GENERAL)
Any excessive indulgence in sex in past and present ? Any effect on your health ?
How do you feel after sexual intercourse?
Any particular feeling or symptoms appear before , during and after sexual intercourse?
Do you suffer from any sexual disturbance ?
(Homosexual inclination etc.?)
Any habit like (masturbation etc.) in past as well as present? How often?
Did you suffer from any Venereal disease ?
Syphilis ? Gonorrhoea ?
Do you have increased desire or decreased desire for sex?
What is the method you use for family planning?
FOR MEN
Any difficulty in erection ?
Wanted erection ? unwanted erection ?
Weak erection ? Failing erection ? Describe.?
Any other trouble in sex ? Describe in details
FOR WOMEN
Menses : How are the periods ;regular or irregular?
At what age did it start?
Was there any trouble then?
Mention number of days of flow.
Menstrual flow : Is there any change now in quantity , colour , smell or consistency?
Are the stains difficult to wash ?
Have you noticed any variation in quality and quantity of flow during menses?
How and when?
Do you suffer in any way before , during or after menses ?If so, describe:
What symptoms did you suffer during menopause ?
Do you feel the internal parts coming down?
Is there any white discharge?
If so , mention the nature , colour , consistency and smell of discharge.
When and under what circumstances is it more or less .
Has the discharge any relation to menses?
What is the effect of this discharge on your general feeling ? or any of your symptoms ?
Any itching , excoriation etc. due to discharge?
Do you pass any gas from vagina ?
Any trouble with breasts?
ANY
COMPLAINTS ABOUT :
VERTIGO- Do you have giddiness – vertigo?
FAINTNESS: Do you ever feel faint?
HEAD: Do you get headaches?
EYES & Vision:
EARS & sense of hearing :
NOSE & sense of smell:
FACE & Facial expression:
MOUTH & sense of taste:
About LIPS, MOUTH, TONGUE etc. :
TEETH, GUMS e.g. carious teeth m bleeding gums.
Swollen gums:
LIPS:cracked , peeling of skin etc.
THROAT (including tonsils) :
Any difficulty in swallowing?
Do you have any trouble in your BACK , LIMBS OR JOINTS? Describe in details:
If you have any pains , do they shift?
In what direction do they extend ?
Is there any complaint of skin : such as itching , eruptions , ulcers , warts, corns, peeling etc.? (Describe its name )
Any change in colour of the skin or spots on any part of the body ?
Is there any complaint or abnormality of the NAILS or skin around ?
Is there any complaint with the HAIR such as falling , graying, dandruff, dryness, oily, poor excessive or unusual growth ?
Do wounds heal slowly ?
Form keloid? Do wounds tend to form pus?
Have you a tendency to bleed?
Are your troubles one sided ? Which one?
Or more on one side?
Do they proceed from one to the other side ?
Or do they alternate or shift?
Is there any trembling ? When?
Is there any sense of weakness ? Where?
When is it more or less?
Is it in any particular part of the body?
For instance take the factor "sun". Suppose by going in the sun you get a headache, then write "Headache " opposite to "sun".
Take another example . if in hot weather you feel uneasy, then write "Uneasy" opposite to "Hot Weather " in the column.
In this way write the effect of each factor on you. Especially write the effect each factor has on your main complaints . For instance if your main complaint is asthma and this is worse when lying on the back then opposite to "lying on the back "write "asthma becomes worse"
Sometimes one factor may make you feel worse in some respect, and better in some other respect, For instance cold air may cause headache but headache but make you feel better in general. If this is so, please mention this difference clearly.
This section is most important. Do not go through it hurriedly . Think carefully about the effect of each factor before you write.
In order to understand you we will be asking certain questions . Answer them freely, carefully , and completely. This information will help us much in giving you the correct remedy . Also such a remedy will help improve your mental make up.
Answer freely. Answer frankly. Answer completely.
Are you
anxious ? About which matters?
Are you fearful of anything such as
Animals people being alone, darkness,
death, diseases, robbers, sudden noises ,
thunder, of the future , of something
unknown , high places, etc.?
Are you doubtful or suspicious ? Of what?
What are you jealous about?
Of whom ? From what symptoms do you suffer when jealous?
In which matters are you impatient?
Hurried?
How long do you remember hurts caused to you by others?
How much revengeful are you?
What are you proud of? Does your pride get easily hurt?
Depressed , Brooding , etc.?
Do you ever become suicidal? When ?
If so in what manner do you contemplate to end your life ?
Even then , are you afraid of dying ?
When are you cheerful?
Are you sexual-minded?
Any unwanted thoughts any time ?
What are they?
Have you any imaginary sensations or fears?
Do you hear voices , or that you are called ,or anything else in this line keeps on occurring in your mind unduly?
How is your memory ?
For what is it poor? e.g. names, places , faces, what you have read, etc.
Do you weep easily?
What makes you weep?
How do you feel after weeping ?
How do you feel if someone offers sympathy and consolation?
Are you easily irritated?
What makes you angry?
What bodily symptoms do you develop
When angry? e.g. trembling ,sweating etc.
Do you like company ?or like to remain alone?
How seriously are you affected by disorder and uncleanliness in your surrounding ?
What are the greatest griefs that you have gone through in your life?
What are the greatest joys that you have had in life?
What activities you deeply like?
Are there any matters which you deeply dislike?
In your opinion, which aspects of your mind
and moods are not agreeable to you . Inspite of
your awareness and maturity , are you
unable to change these these aspects?
Give a clear cut picture of your situation in life and your relationship
With each of your family members, friends and associates in work .
How does the future look to you?
Are you worried or unhappy over any and personal, domestic, economical , social or any other condition?
If so describe in detail:
S L E E P
Describe your posture in sleep.
On the back , side, abdomen etc.
Are you able to sleep in any position ?
In which position you can’t sleep?
During sleep do you:
Snore? Grind teeth?
Dribble saliva? Sweat ?
Keep eyes or mouth open?
Walk? Talk? Moan? Weep ?
Become restless? Wake up with a jerk?
Describe if anything else is unusual about your sleep: (sleepy, sleeplessness,etc. . if so when)
How much do you cover?
Do you have to uncover any parts?
2) Please write in
detail, if the mother suffered from any physical or emotional stress during
pregnancy .Also describe the dreams the mother got during pregnancy.
3) Please describe any other aspects you feel are striking about the child .
4) Describe one incident from the child’s life when he/she very upset.
We require the following details about your symptoms.
LOCATION : Please give the exact location of sensation , pain or eruption. Also describe where the pain or sensation spreads. Please use the figure on page 23 to indicate location.
SENSATION : Express the type of sensation or the pain that you get in your own words however simple or funny it may seem. You may have a sensation that a mouse is crawling or the heart was grasped by an iron hand or you may have a pain which is cutting, burning jerking , pressing . Express the sensation or pain as it feels to you.
WHAT MAKES YOU WORSE OR BETTER : Many factors are likely to influence your trouble . Some factors may cause the trouble to increase and some factors may relieve the trouble . A detailed list of the factors is given on pages 14 to 16 . Please refer to when describing each of your troubles and indicate which factors make the complaint better or worse.
DISCHARGES : You may have a discharge from ulcers , fistula, eruptions , the skin , lungs, eyes , nose , ears , mouth , private parts, etc. Please describe your discharge under the following aspects .
Please
mark in the below figure, the locations of your trouble and write the exact
sensation or type of pain you experience at those spots. For example if you
have throbbing pain on the right side of you head please mark as shown
IN THE
FOLLOWING PAGES PLEASE DESCRIBE EACH OF YOUR COMPLAINTS IN DETAILS IN THE
MANNER DESCRIBED ON PAGE 22.
Hey there, I just wants to start with very basic of a Homeopathy that is case taking.
Here I wants to introduce few case taking formats.
HOMEOPATHIC CASE TAKING FORMAT FOR ADULTS & CHILDREN
CASE - RECORD
PLEASE READ THIS FIRST BEFORE FILLING THIS FORM
You have get well. We are here to select the best possible medicine for you .In order to do that, we depend on your co-operation. HOMOEOPATHIC MEDICINE IS MAINLY SELECTED ON THE SYMPTOMS YOU GIVE US. If we are to make a successful prescription, we must know all the details of your sickness. We must also understand all the features that belong to you as an individual. This includes your reactions to various factors, your past and family history and your mental make up.
This information enables us to selection the remedy that removes your sickness. The medicine also makes you well as a whole person.
In order to find out all about you, we shall be asking you many questions. Each one of these questions has a definite meaning and significance for us. There is not a single questions that is useless. Even something that your may think is not connected with your trouble, may be the most important factor in deciding the correct homoeopathic medicine. That is why you must be free and frank and give us the fullest possible information on each point. Please read each question carefully, think and if necessary, consult someone close to you and then answer completely. Do not keep anything back. Remember, whatever you tell us will remain absolutely confidential.
THIS QUESTIONNAIRE FORM HAS 8 PARTS :
1. About your past
illnesses and family illnesses. Please take time to answer this part with the
help of your family members before coming to us.
2. History of your
present illness.
3. About all the parts
of your body.
4. Deals with the
factors that affect your health.. Please think carefully about each of the
factors mentioned and write what specific effects they have on you.
5. About your mental
state and your emotional nature . Please write in this part about your
situation in life and about all the things that are bothering you. Be totally
frank and open.
6. About your sleep
and dreams .
7. For children or you
as a child .
8. In this part you
are given instructions on how to report each of your complaints. Read the
instructions first . Then make a list of your complaints and describe each of
them according to the instructions.
C
O N F I D E N T I A L
Date
:
Name:
|
(Begin
with surname)
|
Address
:
|
| Telephone
: Residence : |
Office
: |
| Age : |
Sex:
Male / Female |
| Vegetarian
/ Non Veg. / Egg Veg. |
Single
/ Married / Divorced / Widowed |
| Occupation
(Nature of work): |
Education: |
Referred
to us by:
|
PREVIOUS DISEASES & DRUGS USED
Every disease, poisoning, drug or accident leaves its mark and remains as a
weak point in the system, much more than we imagine . Homoeopathic treatment
takes into account all these details of the past and thus removes all the weak
points. Thus your body is strengthened. That is why it is necessary for us to
know about all the ailments you have suffered from in the past and the treatments
you have taken. In the list below, circle around names of ALL major illnesses so far suffered and on the next page give its relevant details.
| Typhoid Cholera Food Poisoning Diarrhoea Dysentery |
Measles German measles Chicken-pox Small-pox Mumps Whooping cough |
Malaria Jaundice Any Liver Spleen or Gall Bladder Disease |
Miscarriage
. Abortion Currettings Sickness during Pregnancy etc. Prolapse of uterus |
| Malnutrition Rickets Rheumatism Backache |
Any
venereal Disease like Syphilis Gonorrhoea etc. |
Any heart
trouble , Blood pressure , Giddiness |
Nephritis
(Kidney or urine trouble)
Diabetes etc. Prostate trouble |
| Any
operation such as Tonsils , Abdomen , Appendix , Hernia , Piles, Uterus ,
Renal Stone , Gall Stones, Phimosis , Hydrocele , Cataract etc. Mode of
anaesthesia : general –local |
Diphtheria,
Septic Tonsils , Adenoids Recurrent infections – Sinusitis Bronchitis
–Eosinophilia Cold 0-Fever-Chill . Pneumonia Asthma –Pleurisy—T.B. |
Any
serious shock , grief , disappointments, fright , mental upset , depression
or nervous break down |
|
| Chronic
Headaches, Numbness , Cramps, Fits , Convulsions Polio, Paralysis etc.
Meningitis –Any Lumbar puncture done. |
Any major
accident or injury to body or head. Any occasion of unconsciousness Any major bleeding from any part of the body. |
Skin
diseases like Pimples , Boils, Carbuncles, Ringworms, Fungus, Scabies ,
Eczema. Ulcers on any part of the body. |
|
| Diseases
suffered from |
Approximate
Age |
Duration |
Whether
you completely recovered |
Medicines
& treatment taken |
Any other
particulars |
Any extra remarks of information :
Mention any drugs , tonics , stimulants etc. That have been used by you at any time in life.
FAMILY INFORMATION
| List of major diseases Anaemia Cancer Diabetes Insanity Rheumatism T. B. /Pleurisy Leprosy Epilepsy/fits Bleeding tendency Urticaria Eczema Asthma Paralysis Hypertension Heart trouble Kidney disease Liver disease etc. |
Relationship |
Alive
/dead |
Age |
Diseases |
Cause
of death |
|
| Paternal
Grand
Father |
||||||
| Paternal
Grand Mother |
||||||
| Maternal
Grand Father |
||||||
| Maternal
Grand Mother |
||||||
| Father |
||||||
| Mother |
||||||
| Diseases
Suffered |
||||||
| Paternal
Uncles |
||||||
| Paternal
Aunts |
||||||
| Maternal
Uncles |
||||||
| Maternal
Aunts |
||||||
| Cousin
Brother & Sister on Father’s
side |
||||||
| Cousin
Brother & Sister on Mother’s
side |
||||||
Did
any of your relatives have trouble similar to yours
|
||||||
Provide information about them in the table below. Indicate your position by writing ‘SELF’.
| SR.NO |
Brother
/Sister |
Alive /Dead |
Age |
Diseases
suffered |
| 1. |
||||
| 2. |
||||
| 3. |
||||
| 4. |
||||
| 5. |
||||
| 6. |
||||
| 7. |
||||
| 8. |
PERSONAL HISTORY
*About your birth
Did your mother have any problem during pregnancy ?
Did She take drugs during pregnancy ?What were they?
Was there any difficulty about your birth ? Give details.
*At what age did you start.
| Teething |
Urine
Control Bed wetting etc. |
||
| Sitting |
|||
| Standing |
Eating
indigestibles Like chalk , lime ,earth. Slate-pen |
||
| Walking |
|||
| Speaking |
Any
other problem about Your growth & development |
||
| Dog |
Rat |
Snake |
Scorpion |
Mention if any other :
Did you take anti-rabies or anti –venom or any other treatment ?
*Vaccination & Inoculations :
Indicate number of times you were vaccinated for the following :
| Small
pox |
Polio |
Cholera |
Measles |
|||||
Triple
|
B.C.G.
|
Typhoid
|
Tetanus
|
Was there any reaction or particular trouble after any of above vaccinations of inocculations ?
Give details:
(if married) How is the health of your husband /wife :
*Number of children living and dead . If dead , state causes :
Mention ages of children and their condition of health.
| Child’s
name |
Male/Female |
Age |
Diseases
Suffered |
| Your
Habits |
How
much |
| Smoking |
|
| Snuff |
|
| Chewing
Tobacco |
|
| Alcohol |
|
| Tea |
|
| Sleeping
Pills |
|
| Laxatives
/Purgatives |
|
| Any other |
ORIGIN OF CAUSE : Can you trace the origin illness to any particular circumstance accident , illness, incident or mental upset ? (e.g. Shock , worry , errors in diet ,overexertion , exposure to cold , heat etc.)?
APPETITE AND THIRST
How is your appetite?
When are you hungry?
What happens if you have to remain hungry for long?
How fast do you eat?
How much thirst do you have?
Any particular time are you specially thirsty ?
Do you feel any change in your taste and feeling in your mouth?
Please Put one tick (X) if you Like / Dislike the food or if the food disagrees. Put two tick mark(X X) if you strongly Like / Dislike the food or if the food strongly disagrees.
| Like |
Dislike |
Disagrees |
Like |
Dislike |
Disagrees |
|||
| Bitter |
Eggs |
|||||||
| Salt
extra |
Spicy
food |
|||||||
| Sweet |
Meat |
|||||||
| Sour |
Fish |
|||||||
| Bread |
Cabbages |
|||||||
| Butter |
Onions |
|||||||
| Fats |
Warm
food/drink |
|||||||
| Milk |
Cold
food/drink |
|||||||
| Coffee |
Fruits |
|||||||
| Mud/chalk |
Anything
else |
Do you have any problem regarding your stools?
When and how many times a day do you pass stools ?
When is it urgent?
Do you have any problem about bowel movements?
Do you have to strain for stool? Even if soft?
Do you have belching or passing gas? Describe its character.
How do you feel after passing gas up or down?
URINATION & URINE
Any problem about urine ?
Any strong smell ? Like what?
Do you have any trouble before , during and after passing urine?
Any difficulty about the flow ? Slow to start , interrupted , feeble dribbling etc.?
Any involuntary urination? When ?
SWEAT/PERSPIRATION-FEVER-CHILL
How much do you sweat ?
Where and on what part do you sweat most?
Do you perspire on the palms or soles?
Is the sweat warm , cold , clammy, sticky, musty, greasy, stiffens the linen etc.?
What is the smell like ?e.g. foul , pungent, sour , urinous.
What colour does it stain the clothing ?
Is the stain easy to wash off or difficult ?
Any symptoms after sweating ?
When do you get fever or chill ?
What brings it on ?
Do you experience any sense of heat or cold in
Any part of your body at any particular time?
CHEST-HEART – COLD – COUGH
Do you catch cold often ?if so, how?
Describe the symptoms ,nature of discharge etc.
Is there any trouble with your CHEST or HEART ?
Is there any trouble with your voice or speech?
Is there any difficulty in breathing ?
Do you have cough ?
Is it more at any particular time?
SEXUAL SPHERE (GENERAL)
Any excessive indulgence in sex in past and present ? Any effect on your health ?
How do you feel after sexual intercourse?
Any particular feeling or symptoms appear before , during and after sexual intercourse?
Do you suffer from any sexual disturbance ?
(Homosexual inclination etc.?)
Any habit like (masturbation etc.) in past as well as present? How often?
Did you suffer from any Venereal disease ?
Syphilis ? Gonorrhoea ?
Do you have increased desire or decreased desire for sex?
What is the method you use for family planning?
FOR MEN
Any difficulty in erection ?
Wanted erection ? unwanted erection ?
Weak erection ? Failing erection ? Describe.?
Any other trouble in sex ? Describe in details
FOR WOMEN
Menses : How are the periods ;regular or irregular?
At what age did it start?
Was there any trouble then?
Mention number of days of flow.
Menstrual flow : Is there any change now in quantity , colour , smell or consistency?
Are the stains difficult to wash ?
Have you noticed any variation in quality and quantity of flow during menses?
How and when?
Do you suffer in any way before , during or after menses ?If so, describe:
What symptoms did you suffer during menopause ?
Do you feel the internal parts coming down?
Is there any white discharge?
If so , mention the nature , colour , consistency and smell of discharge.
When and under what circumstances is it more or less .
Has the discharge any relation to menses?
What is the effect of this discharge on your general feeling ? or any of your symptoms ?
Any itching , excoriation etc. due to discharge?
Do you pass any gas from vagina ?
Any trouble with breasts?
VERTIGO- Do you have giddiness – vertigo?
FAINTNESS: Do you ever feel faint?
HEAD: Do you get headaches?
EYES & Vision:
EARS & sense of hearing :
NOSE & sense of smell:
FACE & Facial expression:
MOUTH & sense of taste:
About LIPS, MOUTH, TONGUE etc. :
TEETH, GUMS e.g. carious teeth m bleeding gums.
Swollen gums:
LIPS:cracked , peeling of skin etc.
THROAT (including tonsils) :
Any difficulty in swallowing?
Do you have any trouble in your BACK , LIMBS OR JOINTS? Describe in details:
If you have any pains , do they shift?
In what direction do they extend ?
Is there any complaint of skin : such as itching , eruptions , ulcers , warts, corns, peeling etc.? (Describe its name )
Any change in colour of the skin or spots on any part of the body ?
Is there any complaint or abnormality of the NAILS or skin around ?
Is there any complaint with the HAIR such as falling , graying, dandruff, dryness, oily, poor excessive or unusual growth ?
Do wounds heal slowly ?
Form keloid? Do wounds tend to form pus?
Have you a tendency to bleed?
Are your troubles one sided ? Which one?
Or more on one side?
Do they proceed from one to the other side ?
Or do they alternate or shift?
Is there any trembling ? When?
Is there any sense of weakness ? Where?
When is it more or less?
Is it in any particular part of the body?
FACTORS THAT AFFECT YOU
Below are a list of things that you are exposed to. Each of these factors may
affect you in a particular way . Please write in what way you are affected by
each of the following . Do you feel worse or better in any way from each of the
factors. In what way do they affect you.
For instance take the factor "sun". Suppose by going in the sun you get a headache, then write "Headache " opposite to "sun".
Take another example . if in hot weather you feel uneasy, then write "Uneasy" opposite to "Hot Weather " in the column.
In this way write the effect of each factor on you. Especially write the effect each factor has on your main complaints . For instance if your main complaint is asthma and this is worse when lying on the back then opposite to "lying on the back "write "asthma becomes worse"
Sometimes one factor may make you feel worse in some respect, and better in some other respect, For instance cold air may cause headache but headache but make you feel better in general. If this is so, please mention this difference clearly.
This section is most important. Do not go through it hurriedly . Think carefully about the effect of each factor before you write.
| Effect |
Effect |
|||
| Hot
weather |
Walking |
|||
| Cold
weather |
Running |
|||
| Rainy
weather |
Climbing
stairs |
|||
| Cloudy
weather |
Going
downstairs |
|||
| Change
of season |
Riding
in bus, car etc. |
|||
| Thunder
–storm |
Lying |
|||
| Covering |
Lying on
back |
|||
| Warm
bath |
Lying on
left side |
|||
| Sun |
Lying on
right side |
|||
| Cold
bathing |
Lying on
abdomen |
|||
| Lying
with head low |
Drinking |
|||
| Sitting |
After
sexual intercourse |
|||
| Sitting
erect |
Dust |
|||
| Standing |
Smoke |
|||
| Looking
up |
Touch |
|||
| Looking
down |
Pressure |
|||
| Looking
from high places |
Massage |
|||
| Looking
at moving object |
Tight
clothes |
|||
| Noise |
Before
sleep |
|||
| Sudden
noise |
During
sleep |
|||
| Music |
After
sleep |
|||
| Light |
After
afternoon nap |
|||
| Strong
smells |
Loss of
sleep |
|||
| When
constipated |
Before
stools |
|||
| Before
urine |
During
stools |
|||
| During
urine |
After
stools |
|||
| After
urine |
Coughing |
|||
| Before
menses |
Sneezing |
|||
| During
menses |
Laughing |
|||
| After
menses |
Talking |
|||
| After
Sweating |
||||
| When
Fasting |
Writing |
|||
| After
eating |
Stooping |
|||
| Before
important engagement |
Passing
gas |
|||
| Before
exams |
After
hair cut |
|||
| When
angry |
Combing
hair |
|||
| When
worried |
Brushing
teeth |
|||
| When sad |
Moonlight |
|||
| After
weeping |
Opening
the mouth |
|||
| Consolation
/sympathy |
Smoking |
|||
| In a
crowd |
Hanging
the limbs |
|||
| In a
closed room |
Hanging
the arms |
|||
| When
thinking of illness |
Near sea |
|||
| Full |
Shaving |
|||
| Morning |
Stretching |
|||
| Afternoon |
Swallowing |
|||
| Evening |
Listening
to others talk |
|||
| Night |
Vomiting |
|||
| Bathing |
Yawning |
|||
| Draft
air |
Moving
the eyes |
|||
| Biting
or chewing |
Opening
the eyes |
|||
| Blowing
nose |
Closing
the eyes |
|||
| When
alone |
Getting
feet wet |
|||
| In
company |
Over eating |
|||
| Physical
exertion |
Working
in water |
|||
| Belching |
Fanning |
MIND
It is now universally acknowledged that your mind has tremendous influence on
your body . For giving proper treatment it is necessary for us to understand
your emotional and intellectual nature . We can thus treat you as a whole. In order to understand you we will be asking certain questions . Answer them freely, carefully , and completely. This information will help us much in giving you the correct remedy . Also such a remedy will help improve your mental make up.
Answer freely. Answer frankly. Answer completely.
Are you fearful of anything such as
Animals people being alone, darkness,
death, diseases, robbers, sudden noises ,
thunder, of the future , of something
unknown , high places, etc.?
Are you doubtful or suspicious ? Of what?
What are you jealous about?
Of whom ? From what symptoms do you suffer when jealous?
In which matters are you impatient?
Hurried?
How long do you remember hurts caused to you by others?
How much revengeful are you?
What are you proud of? Does your pride get easily hurt?
Depressed , Brooding , etc.?
Do you ever become suicidal? When ?
If so in what manner do you contemplate to end your life ?
Even then , are you afraid of dying ?
When are you cheerful?
Are you sexual-minded?
Any unwanted thoughts any time ?
What are they?
Have you any imaginary sensations or fears?
Do you hear voices , or that you are called ,or anything else in this line keeps on occurring in your mind unduly?
How is your memory ?
For what is it poor? e.g. names, places , faces, what you have read, etc.
Do you weep easily?
What makes you weep?
How do you feel after weeping ?
How do you feel if someone offers sympathy and consolation?
Are you easily irritated?
What makes you angry?
What bodily symptoms do you develop
When angry? e.g. trembling ,sweating etc.
Do you like company ?or like to remain alone?
How seriously are you affected by disorder and uncleanliness in your surrounding ?
What are the greatest griefs that you have gone through in your life?
What are the greatest joys that you have had in life?
What activities you deeply like?
Are there any matters which you deeply dislike?
In your opinion, which aspects of your mind
and moods are not agreeable to you . Inspite of
your awareness and maturity , are you
unable to change these these aspects?
Give a clear cut picture of your situation in life and your relationship
With each of your family members, friends and associates in work .
How does the future look to you?
Are you worried or unhappy over any and personal, domestic, economical , social or any other condition?
If so describe in detail:
S L E E P
Describe your posture in sleep.
On the back , side, abdomen etc.
Are you able to sleep in any position ?
In which position you can’t sleep?
During sleep do you:
Snore? Grind teeth?
Dribble saliva? Sweat ?
Keep eyes or mouth open?
Walk? Talk? Moan? Weep ?
Become restless? Wake up with a jerk?
Describe if anything else is unusual about your sleep: (sleepy, sleeplessness,etc. . if so when)
How much do you cover?
Do you have to uncover any parts?
Circle types of dream that you have
| Animal Cats-dogs Horse Wild animals Snakes |
Robbers Thieves Anxious Fearful Ghosts |
Travelling Riding Flying Swimming drowning |
Houses Fruits Trees Water Snow |
Death,
Whose? Dead bodies Dead person Parts of Body Suicide |
| Being
Hungry Being Thirsty Drinking Eating |
Fire Lightning Storm Rain |
Accidents Falling Shooting Wars |
Talking Singing Dancing Pleasant |
Business Money Day’s work Forgotten work |
| Vomiting Passing stool Urinating Blood – bleeding Excrements / soiling |
Romantic Sexual pleasure Rape nakedness |
Pain Illness Sickness Mutilations |
Praying Religious Church God |
Failure
/exams Unsuccessful efforts for what Missing train Being unprepared |
| Grief Weeping Vexation Quarrels Jealousy Insults |
Police Imprisonment Crime Murder Killing Poison |
Misfortunes Insecurity Danger Being pursued By whom? -for what ? |
If any
other, specify In the space below: |
|
| Of people Children Parties Feasts Marriage |
Of
events Remote Recent Future Prophetic |
Physical
Exertion Mental Exertion Fatigue Coloured Multi-Coloured |
||
FOR CHILDREN or YOU AS A
CHILD
(IN CASE OF ADULTS )
1) Please tick mark
once (X) if the child or you as child had any of the following qualities: Tick
mark twice (XX) if they are more intense :
| Tick
Here |
Tick
here |
||
| Obstinacy |
Unusual
fears |
||
| Temper
tantrums |
Shyness |
||
| Disobedience |
Unusual
attachments (to whom) |
||
| Aggression |
Habits
like :- |
||
| Hyperactivity |
Biting
nails |
||
| Destructiveness |
Thumb
–sucking |
||
| Courage |
Picking
and playing with |
||
| Possessiveness |
(a)
mother’s body parts |
||
| Competition-winning
spirit |
(b)shawls
, handkerchieves |
||
| Sibling
jealousy |
(c)
anything else |
||
| Any
special skills |
Religious |
||
| Unusual
desires (for what ) |
Dullness
of memory |
||
| Boasting |
Slowness
(in what) |
||
| Stealing |
Laziness
/Indolence |
||
| Telling
lies |
Sensitive/Emotional |
3) Please describe any other aspects you feel are striking about the child .
4) Describe one incident from the child’s life when he/she very upset.
HOW TO DESCRIBE YOUR COMPLAINTS
In homoeopathy, prescription is based on precise details of various symptoms
from which you suffer. To tell or write to a homoeopathic physician "I
have a headache ", " an eruption ", " a cough", would
not be enough. If you inform him "I have headache with sharp shooting
pains in the left side of the head and temple ", these pains always come
on when the slightest cold air strikes the head , the pains wailing about , or
when the head becomes cool ". then only you have given all the information
required for making a good homoeopathic prescription. The success of the
prescription depends, largely on how detailed is your description of the
symptoms We require the following details about your symptoms.
LOCATION : Please give the exact location of sensation , pain or eruption. Also describe where the pain or sensation spreads. Please use the figure on page 23 to indicate location.
SENSATION : Express the type of sensation or the pain that you get in your own words however simple or funny it may seem. You may have a sensation that a mouse is crawling or the heart was grasped by an iron hand or you may have a pain which is cutting, burning jerking , pressing . Express the sensation or pain as it feels to you.
WHAT MAKES YOU WORSE OR BETTER : Many factors are likely to influence your trouble . Some factors may cause the trouble to increase and some factors may relieve the trouble . A detailed list of the factors is given on pages 14 to 16 . Please refer to when describing each of your troubles and indicate which factors make the complaint better or worse.
DISCHARGES : You may have a discharge from ulcers , fistula, eruptions , the skin , lungs, eyes , nose , ears , mouth , private parts, etc. Please describe your discharge under the following aspects .
·
The
quantity and the time or condition under which the quantity varies i.e. when is
it better or worse , increases or decreases ?
·
The
consistency : Is it thin or thick , stringy or clotted ?
·
Is
it like jelly, white of an egg, like water , sticky forming a scab etc. ?
·
The
odour , what does it remind you of ?
·
Does
it make the parts sore, and in what way?
| COMPLAINT
NO. |
WHERE
IS THE TROUBLE |
WHAT
EXACTLY DO YOU FEEL OR HAVE THERE |
WHAT
ARE THE FACTORS THAT MAKE THIS TROUBLE BETTER OR WORSE |
So by this. Anyone can get idea how the homeopathic case taking is.
