1. Physical generals.
Till now when we are working with the particulars, patient is now well aware of the environment of your clinic thus he is comfortable to answer you more details.
This is the stage where one can start with the personal history. This includes;
The way to the heart goes from stomach. Thus we can start with the appetite, time of meals, likings, cravings and aversions in meals.
One can ask craving and aversions in categories like sweets; spicy; oily n fatty food; sour/ lemonades; salt quantity; veg/ non veg; indigestible food stuffs etc.
Inferences we can get:
Taste – acute senses or altered taste can be Pqrs or a syphilitic symptom.
Appetite and meal habits – want of / voracious eater.
Cravings and aversions; these can help one in individualize a person, along with strong desire or aversion as a symptom to confirm the similimum.
One can start here from heartburn, regurgitation, hiccough, eructation, flatulence to constipation, diarrhea, dysentery, type of stool. Also one can ask the history of hemorrhoids bleeding or non bleeding. (Bleeding piles, epitasis, ecchymosis, menses profuse, bleeding gums can suggest hemorrhagic tendency.)
Generally people are not aware of the water intake. In winter they will say low and in summer will say thirsty. So try to ask the quantity in glasses or bottles of mineral water. Dryness of throat yet no need to drink water suggest a highly thirst less person. Bleeding gums can be confirmed here. (Bleeding piles, epitasis, ecchymosis, menses profuse, bleeding gums can suggest hemorrhagic tendency.) Preference for cold, chilled or luke warm water. Time interval between drinks.
Different urinary complaints like frequent micturation; nocturnal frequency; enuresis; infections in urine; pustular cast; red cells or hematuria (Bleeding piles, epitasis, ecchymosis, menses profuse, bleeding gums can suggest hemorrhagic tendency.) oozing of semen; drop by drop urination; stream bifid or other; etc can be asked for. Special conditions like calculi; cyst and tumor are also the part of it. Local complaints like itching and eruption on the genitals with there specific characteristics can make the part of it.
Do you perspire? We can start it from this question to which body parts; how much; specific time; odor; staining; acridity etc.
This is one of very important issue during case taking. This not easy to confirm whether a person is Hot or Chilly. But a strong Hot or Chilly person can lead you clearly to the thermal confirmation. There are few questions like –
How’s your tolerance for cold or hot, why?
Do you prefer covering your face while sleeping, why?
Do you prefer warm or cold water for bathing, why?
Who is the first person to wear sweater or shawl at your home? These can help one to get the specific thermals of a patient.
But most syphilitic cases have altered thermals. So unless its confirmed, don’t take it as an evaluator symptom.
History here starts from menarche; its age to attend; progress since then; regularity; flow; color; clots or membranes; how long it goes. Associated complaints can be taken as leucorrhea; odor; acridness/ blandness; dysmenorrhea; diarrhea; nausea vomiting etc. Any emotional relation of menses; fears; dreams during menses are also of much importance.
For Males : Difficulty in erection; Wanted erection; unwanted erection; Weak erection; Failing erection; any other trouble during coitus; any perversion or unusual sex; Gay; Masturbation; are the points to find.
For females : Difficulty in Coitus; Want of Desire; Dryness of vagina; Spasms; Guilty; Any other trouble during coitus; any perversion or unusual sex; lesbianism; Masturbation; are the points to find.
Sleep and dreams;
Sleep is one of the favorite issues to many. But some may have problems related with it. Thus asking what time do you sleep and arise at what time, will give you the time of sleep. Housewives have sleeping habit of noon and may compliant of night watching. Students are always in lack of sleep how much they sleep. So what patient is saying is not important unless it is verified and logical. Also try to get the position, habits like grinding teethes, somnambulism, talking, kicking, screaming, crying etc.
Dreams are the involuntary signals of brains. Some says its future and some says its unfulfilled desires. But to us this of miasmatic importance, these dreams defines the mind miasm. Thus any dream remembered by patient is important.
Different habits like tobacco, alcohol, cigarette, coffee, stimulants and drugs etc are to be taken. These help us for diet and regimen and removing the hurdles of cure.
Sensitivity of senses:
All 5 sense of human are to be asked. Any sense which got acute or diminished in action or perverted can lead to a specific PQRS symptom. Patient affected may say aggravations from least noise, photophobia, anosmia, metallic taste etc.
Also we can consider some more sensitivities which might be related with the change of weather, place, air, water, sun or moon effects etc.