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Homeopathy and Health Forum



A very good Questionnaire (Set of Questions)

From kadwa on 2009-07-16
62 replies 9934 views
Rishimba has designed a very good Questionnaire (Set of Questions) for case taking. He designed this long back. i have been using these questions whenever i think that full case taking is needed.

These questions are designed to get the following information from the patient
1. Mental State of the patient
2. Physical Ailments
3. The likely cause for above problems
4. The modalities like whether the patient feels well or worse in hot weather, cold weather etc., he is relieved by / worsenened by hot applications, cold applications etc.

i also thank Rishimba for designing such wonderful tool for case taking. i can also understand the hard work that he has done for desiging these questions.

Patients can use this questionnaire for submitting their cases. The effectiveness of remedy selection is directly proportional to the details provided by the patient while replying these questions.

Patient ID: Sex: Age:

Please answer the following questions in a descriptive manner after careful analysis and recollection of previous experiences and happenings.

1. Describe your main suffering?
i have the sivere feet burning during night time and moderate feet burning in the day time. I also get the needle pricking pain in all my body


2. What other physical sufferings do you have in your body?
I am a diabetic patient for 15 years and depend on insulin i take injection of insulin 60 units in the morning and 60 units in the evening I had the opeartion of cataract 6 months before



3. What mental sufferings / feelings do you have associated with your physical sufferings?
am stable minded but unbearable pain in feet burning does nt allow me to sleep properly in the night


4. What exactly do you feel when you are at your worst?
unbearable pain feel like to take some medicine to get rid of the pain


5. When did it all start? Can you connect it to any past event or disease?
it started 6 months ago intially i use to feel the needle prick pain but gradually it started continous burning pain I felt the same before 2 years but during that time i was a heavy alcholic so i did nt mind the pain due the alchohol but from feb 2011 to till today 12 th sep 2011 i have totally stopped the alchohol but i do smoke lot 20 cigarette per day and drink coffee 3 to 4 times or tea


6. Which time of the day you are worst?
during night times its worst pain hence i loose sleep and apply the cold water on the feet to get some relief

7. What are the things which aggravate your suffering and which are those which ameliorate the same?
aggravate --- feet burning and needle pricking pain during night
ameliorate ---- when i apply the cold water on the feet i feel bit comfortable


8. Do your think your sufferings have relation to any external stimuli (like, change of place) or any internal biological changes in the body, like, menses (in females)?
no not applicable


9. When do you feel better, during hot weather or cold weather, humid or dry weather?
the feet burning paining i started to feeling in the summer i did nt undergo in cold humid and dry weather

10. Describe your general mental set up? Are you Moody, Arrogant, Mild, Agreeable Changeable, Nervous, Suspicious, Easily offended, Quiet, Arguing, Irritating, Lazy etc.

- How do you feel before or during a thunderstorm?
nothing to explain as i feel normal

- Do you like being consoled during your tough times?
yes may be but not necessary
- Are you sensitive to external stimuli like smell, noise, light etc?
no i am normal
- Do you have any typical habit or gesture like nail biting, causeless
weeping, talking to one self etc?
no

- How do you feel about your friends, family, your children and especially your husband / wife?
i feel they are good and normal

11. What are your fears and do you dream of any situation repeatedly?
now my fear is about my future as i am jobless for more than 3 years


12. What do you crave for in food items and what are your aversions?
i like all tasty food but due to diabetic i keep restriction in the food but some times when i feel like to take the restricted food i take coz i do insulin injection

13. How is your thirst: Less, Normal or Excessive?
i get excessive thirst specially at night since i take the restricted food like vegetable salad etc to maintain the sugar lever in normal i get excessive thirst and frequent urination at night this is i had when i was 35 yrs old when the detect diabetic on me i feel the same type now i am 54 now due to thirst frequent urination and feet burning i loose the night sleep

14. How if your hunger: Less, Normal or Excessive?
normal
15. Is there any kind of food which your body can’t stand?
all food are acceptable
16. Is your sweat normal or less or more? Where does it sweat more: Head, Trunk or Limbs?
when my sugar level goes down due to insulin injection i get profuse sweat in head trunk and lims other wise i get sweat in head and trunk in the summer time

17. How is your bowel movement and stool type?
normal
18. How well do you sleep? Do you have a particular posture of sleeping?

yes i sleep left or right side posture but not as striaght keep the face&body up posistion
19. Do you think you are able to satisfy your sexual desires in general?
yes it was 3 yeras befor but now due to diabetic i hav a dysfunction disorder once in 10 days for sex intercouse also i am 54 now but when i feel like to do masturbation i do that and take out sperms at any time there is no problems for that but actual intercourse i hav the problems

20. How do you think you are different from others, if at all?
i feel different from others coz i maintain my work time in a proper way am not lazy etc


21. What medications have been taken earlier by you to treat the diseases and do you have any particular symptom surfacing after the medication?
i take insulin for the last 10 years flexi pen novomix 30 insulin 60 units each in the morning and evening glucopage 500 mg twice daily plus twice daily the garlic capsule 1000 mg omega 3 , 6 , 9 500 mg each multi vitamin , ginseng capsule 500 mg fish oil capsule ( vit A& D) anti oxident alpha lipoic acid vit B3 B6 and B12
iron folic acid 1 mg

22. What major diseases are running in your family?
diabetic my elder brother also got the diabetic at the age of 35 like me now he is 78

23. Describe, how do you look like? Describe your overall appearance
am tall 179 cm weight 80 kg pleasant fcae with normal color

24. (ONLY FOR FEMALES)

If you are not having normal menstrual cycles, please answer the following questions:

- Are the periods early, regular or late in general? How long do they last?
- Do you suffer from any kind of physical or mental discomfort before, during or after the periods?
- Is the flow scanty, normal or excessive?
- Is the blood thick brig