NOTES ON CLINICAL FORMS CONSTITUTIONAL INTAKE FORM To be filled out by the patient or client The questions are divided into organ systems. For visual ease, the check lines preceding each question are either to the FAR left (signifying excess) or the IMMEDIATE left (signifying deficiency). Many of the questions are meant to reflect the person's view of self, and results are purely subjective. Questions of degree, such as "frequent need for laxatives" (Lower GI), "frequent minor illnesses" (Liver) and "seems to have low blood sugar" (Liver) can be open to riotous debate, both with them and you, as well as between their own dichotomies. Pursue as far as seemly, and WITHOUT JUDGMENT...this stuff lay in the realm of psych and counseling, but we are all subject to sundry views of our OWN actions on different days. The General Section questions are mainly springboards to further verbal input. PROBLEM PATIENT 1: Some folks will refuse to respond to any question that does not have an obvious bearing on their primary complaint. The woman with long, painful cycles ALWAYS has a constellation of other symptoms, but may only check the boxes that deal with "that problem". She will have fallen into the common position of separating Self from Affliction. If you are willing to pursue the interview further, you may learn the rest of the story...or not. A lot of folks with this rigidity are not going to be very good candidates for a constitutional approach. If you wish to continue anyway, rely more heavily on other observations. The General Questions are often helpful in opening up less dangerous subjects. PROBLEM PATIENT 2: Some folks check EVERYTHING, as if in confusion or having a self-inflicted role as a befuddled victim...you know the type. That often leaves the load on YOUR shoulders to somehow read their biotype without their conscious involvement. They will sometimes worry about the "right" answer, trying to put forth the facet of their nature that you will approve of, and more often than not will have such a vacillating sense of self that they are even harder to help than the first type. They are often unsure whether they are being helped at all. Then again, some people HAVE that many multi-system problems. It's, once again, up to you. Just don't get too involved in their scenarios. PROBLEM PATIENT 3: This is the person who has taken so many prescriptions and had so many operations that their real constitutional nature is deeply buried or totally obliterated. Those who have gone through the gamut of auto-immune or arthritis treatment (including orthopod surgery) or those who have FOUR different types of asthma inhalers in their pockets and glove compartments, and are taking mucolytics, anti-inflammatories, etc. can be decades removed from any sane non-iatrogenic homeostatic state as to be hopeless to evaluate. At the very least, the fluid energetic approach will bring some relief. Medications will have erased their native stress mechanisms and produced organ system energetics completely induced by the drugs, with their genetic nature deeply hidden. If you are a Medical Doctor who has found any value in my approaches, stop right now! A person so clouded by well-intentioned but routine meds can give you a sense of deep frustration. Twenty years of knee-jerk HMO medications for chronic disease will profoundly alter or erase such a person's native strengths or weaknesses. EVALUATIONS AND RECOMMENDATIONS Your office record for initial and subsequent evaluations and treatment. Bare-boned as it is, it gives you a chance to wed several levels of evaluation. The questions on the intake form are more than adequate most of the time, but you may find things out from conversation, body language or instinct that may over-ride THEIR answers. Further, if the patient's diet aggravates a moderate stress or organ system imbalance, it may add further weight to your evaluation. A person who seems to have native upper and lower GI deficiency and is ALSO taking anticholinergics, antacids or is dutifully fasting has therapies that will further aggravate their constitution. I usually end up using symbols like those in the herb charts...circling the "+" or "-" of a system or stress that is strong and needs direct action. I use plain and uncircled pluses or minuses for less important imbalances. There are areas to list any dietary recommendations you make, as well as other advice you may give that seems to have a constitutional bearing, as well as spaces to record the herbs, media, dosology and frequency. The FORMULA EVALUATIONS WORKSHEET is just that....a place to list potential herbs OR to screen formulas they are already taking. You will be surprised how many commercial herb formulas make no sense at all energetically, being simply random herbs that are only assembled together for Name Recognition and marketing value. Although herbs present few of the direct iatrogenic and constitutionally-confusing potentials of meds, a dedicated self-treatment person can STILL shunt themselves into strange patterns. Particularly since their formulas deal to some degree with conditions they are trying to treat. A person with recent hepatitis or with reoccurring bronchial problems may often take OTC herb formulas for the liver or lungs, and, because, in fact the constituents ARE those traditionally aimed at those organs, aggravate an inflammatory state by using herbs that stimulate and excite, or depress functions further that are already deficient. Don't overlook the value in showing them your scribblings in the worksheet or the multisystemic effects I have outlined in the charts. It's big, complicated, and Ever So Authoritative in visage that the patient may simply be awed into submission. Besides, it is all reasonably accurate...trust me...I'm an herbalist. FINAL NOTE: The section at the bottom of the Evaluations and Recommendations sheet marked "Self-Monitoring Parameters" is very important to use if you are dealing with a patient with a long-standing, stable, but consistent chronic disease. An ideal patient has to be your ally and partner in this process. THEY will know their physical weaknesses, THEY may have a very accurate and sophisticated system of self-monitoring their disease. The quickest way to enable them to intellectually give up to their body (a frequent enemy) and its native ability to heal or stabilize is to find ways that THEY can monitor their symptoms, and perceive changes brought about by treatment. How early in the day can they place both palms on their knees? (if arthritic), how many times a night do they have to urinate (if they have interstitial cystitis), how many units of conjugated insulin do they need at night to prevent waking up before dawn with the shakes...etc. IF the constitutional treatment helps, they will know it first, tell you second, want more treatment third, and start to trust their body fourth.