Monthly Archives: मई 2006

होम्योपैथी-एक परिचय

                 होम्योपैथी का बचपन ओर उसकी तरुणता दोनो के ही रास्ते बहुत ही पथरीले रहे है। हैनिमैन जो कि स्वंय एलोपैथिक चिकित्सक थे, एक दिन एकमेटिरियामेडिकाका अनुवाद करते समय उन्होनें देखा कि स्वस्थ शरीर में यदि सिनकोना की छाल का सेवन किया जाये,तो कम्पन ओर ज्वर पैदा हो जाता है, ओर      सिनकोना    ही     कम्पन ओर ज्वर की प्रधान दवा है।  यही हैनिमैन की नवीन चिकित्सा का मूल सूत्र हुआ। इसके बाद ,इसी सूत्र के अनुसार ,उन्होने कितने भेषज-द्र्व्य् का सेवन किया ओर उनसे जो-जो लक्षण दिखाई देते,उनकी उन्होनें परीक्षा की। साथ ही किसी रोग मे वे ही सब लक्षण दिखाई देते,तो उसी भॆषज-द्र्व्य् को  देकर वे रोगी को रोग मुक्त करने लगे।       होम्योपैथी के मूल में एक प्राकर्तिक सिद्दात निहित है। लैटिन में इसे similia smilibus curentur ( रुचि का उपचार रुचि से ही हो) कहा जाता है। तत्पयर यह है कि किसी भी रोग का निदान करने के लिये किसी ऐसी ओषधि की खोज की जानी चाहिये,जो स्वस्थ मनुषों पर उसी रोग के लक्षण उत्पन्न करने में समर्थ हो।  उदाहरणार्थ जब कोई स्वस्थ मनुष्य cannabis indica  (भाग) का सेवन करता है,तो वह मति-भ्रम का शिकार हो जाता है। वह हंसता है तो हंसता ही रहता है,पास की वस्तु बहुत दूर रखी दिखाई देती है,बात करता है,तो लगातार बक-बक करने लगता है,पेशाब बूदं-बूदं टपकता है ओर साथ में जलन भी होती है। होम्योपैथिक सिद्दातं के अनुसार यदि किसी रोग में ये लक्षण हों ,तो इसका निदान होम्योपैथिक ओषिधि-cannabis indica से सम्भव है,जो भांग से तैयार की जाती है।   

      इस प्रकार हम इस निष्कर्ष पर पहुचे-

1) होम्योपैथी मूल भूत  प्राकर्तिक सिद्दातों पर आधारित है।

 2) ओषिधियां रोग उत्पन्न कर सकती है।

3) किसी ओषधि के पूरे प्रभाव को जानने के लिये उसका परीक्षण स्वस्थ मनुषों पर किया जाता है।

4) किसी भी रोग का इलाज करने के लिये उस ओषिधि का चयन होता है,जिसमें वह लक्षण हों,जो रोग में हो।   

                   किसी स्वस्थ मनुष में,ओषधि देने के पशचात जो भी मानसिक ओर शारीरक लक्षण उत्पन्न होते हैं,उनकी चर्चा materia medica  में की जाती है।( materia medica  यानी लक्षणों का शब्द कोश)

         मैनें शुरु मे लिखा कि होम्योपैथी कि राह बहुत ही पथरीली रही है, कारण जर्मनी में  हैनिमैन को उनके समकक्ष चिकित्सकों ने टिकने ना दिया,ओर आज भी सरकारी उपेक्षा का शिकार होम्योपैथी ही रही है,चाहे इन्टर्नेट पर लैन्सट की रिपोर्ट जो होम्योपैथी को अमान्य ओर बकवास चिकित्सा पद्दति करार देती है,इसके बावजूद  भी होम्योपैथी अपनी जगह बनाये हुये है।

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हिन्दी ब्लागर्स

हिन्दी लिखने के लिये मुझे कितनी माथा पच्ची करनी पडी यह तो मेरा दिल ही जानता हैइन्टर्नेट पर साफ़्टवेअर की खोज करनी शुरू की तो जा पहुँचे जीतू भाई के ब्लाग पर्। उनका मेल ढूँढा और तड से लगा दी मदद के लिये एक गुहार ,हाँ उसके पहले शुएब को भी पकडा। लेकिन सही माने मे मदद मिली जीतू जी से। वैसे आगे भी उनकी मगज मै खाता ही रहूगा।

 शुरू मे  माधयम का साफ़टवेएर भी लोड किया था लेकिन उससे बात बनी नही, रमन कौल की हिन्दी पटटी मुझे रास न आयी, बात आकर हिन्दी राइटर पर रूकी ,यह साफ़्टवेएर अब मेरे हाथो मे पूरी तरह से सेट है। कभी कभी कई शब्दों को लिखने मे दिक्कत आती है लेकिन फ़िर देवन्द्र पारख  जी ने मुझे हमेशा की तरह संकटमोचन की तरह दिखे।

  वैसे जब मै हिन्दी चिटठाकारों के बढते हुये समूह को देखता हूं तो एक अजीब सी खुशी का एहसास होता है। अभी कुछ दिन पहले तक शुएब और जीतू ही मेरे पसदीदा  ब्लागर्स मे थे। अक्षरग्राम मे आने के बाद  कई हिन्दी ब्लागरस के लिन्कस मुझे मिलने लगे। पकज बेगानी/सजय बेगानी के ब्लागस पढ कर तो वाकई मे मजा आ गया। रवि कामदार की ‘ टेक्नोलोजी का तत्वाधान ‘  और पंकज की पाठशाला एक नये तरीके का ब्लाग दिखा। शुएब के कई महत्वपूर्ण लिन्कस जो ग्राफ़िक्स और एनीमेशन से  थे ,मेरे बहुत काम आये। वैसे मै भी निधि की तरह कई दिनो तक पकज बेगानी/सजय बेगानी वाले मामले को समझ नही पा रहा था। वह एक है या दो ,बाद मे अक्षरग्राम मे एक परिचर्चा के दौरान यह बात खुली। चाहे वह प्रतीक का ब्लाग हो या रवि रतलामी का ,समाज मे हो रहे समस्यो को उन्होने बखूबी उठाया है। ब्लागर्स की कडी मे जगदीश भाटिया,अनुनाद,खालीपीली, नीरज दीवान ,शेखचिल्ली का ब्लाग भी अपनी एक अनूठी छाप छोडता दिखा।

अमित जी का ”धर्म या ढ़ोंग?  पढते समय मुझे सरिता के रिप्रिटं सेटो की याद आ गयी । धर्म और अंधविशवास पर सरिता का रूख बिल्कुल स्पष्ट है।

                                 edited 0n 12/8/06

 

VITILIGO & HOMEOPATHY

1.What is vitiligo/leucoderma?

Vitiligo is a pigmentation disorder in which special skin cells (melanocytes) that produce the pigment melanin in the skin as well as the tissues (mucous membranes) that line the inside of the mouth, nose, and genital and rectal areas, and the retina of the eyes are destroyed. As a result, white patches of skin appear on different parts of the body. The hair that grows in areas affected by vitiligo may also turn white.

2.Symptoms of vitiligo?

The typical appearance of Vitiligo is a milky white de-pigmented spot or spots. It may vary from a single white spot to multiple spots. The shape too is a variable. In some cases generalized de-pigmentation observed all over the body. It has a tendency to start as a single spot and gradually grow in size and number. It may present with a single or several spots on limbs or abdomen or back and then spreading to other parts of the body. Some cases showing affection of the muco-cutaneous junctions such as finger-tips, corners of the mouth, private parts, around eyes. The spread of the disorder is usually slow and progressive. Symmetrical appearance on both the sides of the body (say, on the legs, hands, etc.) is common. In rare cases one finds vitiligo spreading all over the body.

Associated Skin Disorders:

At times, you may find Vitiligo associated with one or more of the following conditions:
° Alopecia Areata (Loss of hair)
° Premature graying of the hair
° Lichen Planus
° Lichen sclerosus
° Psoriasis
° Halo Naevus
° Ichthyosis

Associated Systemic Disorders:

There are several systemic diseases (affecting the entire body system), which are at times associated with Vitiligo:
° Thyroid Disorders (Hypo and Hyperthyroidism)
° SLE (Systemic Lupus Erythematosus)
° Pernicious Anemia
° Addison’s Disease
° Collagen Diseases
° Grave’s Disease
° Diabetes Mellitus

It may be noted that the sufferers of Vitiligo need not be unduly scared of the above disease conditions, as they should not be regarded as the complications of Vitiligo in every case.

3.Causes of vitiligo?

The cause of vitiligo is not fully known, but there are several theories. One theory of some substance is that people with vitiligo develop antibodies that, instead of protecting them, turn upon them and destroy their own melanocytes, the special cells that produce the pigment melanin that colors their skin.

Another theory is that the melanocytes somehow attack and destroy themselves. Finally, some people with vitiligo have reported that a single event such as a severe sunburn or an episode of emotional distress seem to have triggered their vitiligo. Events of this nature, however, have not been scientifically proven to cause vitiligo and may simply be coincidences.

Who is affected by vitiligo?

About 1 to 2% of people in the world, or 40 to 50 million people, have vitiligo. In the United States alone, 2 to 5 million people have the disorder.

Ninety-five percent of people who have vitiligo develop it before their 40th birthday. The disorder affects all races and both sexes equally.

3.Is vitiligo inherited?

Yes, in some cases it is. Vitiligo may be hereditary and run in families. Children whose parents have the disorder are more likely to develop vitiligo. However, most children will not get vitiligo even if a parent has it, and most people with vitiligo do not have a family history of the disorder.

There are a sizable number of inherited disorders associated with vitiligo. To illustrate, they include: albinism of the ocular type, autoimmune polyendocrinopathy syndrome, congenital deafness with vitiligo and achalasia, dyschromatosis symmetrica hereditaria, ermine phenotype, familial histiocyctic reticulosis, kabuki syndrome, Letterer-Siwe disease, progressive hemifacial atrophy, progressive vitiligo with mental retardation and urethral duplication, Schmidt syndrome, and the syndrome of spastic paraparesis, vitiligo, premature graying and characteristic facies.

The abundance of genetic diseases associated with vitiligo clearly reflects the fact that there are a number of genes which normally govern the development and wellbeing of the melanocyte.

4.Do the depigmented patches spread?

There is no way to predict if vitiligo will spread. For some people, the depigmented patches do not spread. However, the disorder is usually progressive, and over time the white patches often spread to other areas of the body.

For some people, vitiligo spreads slowly, over many years. For others, the diffusion occurs rapidly. Some people have reported additional depigmentation following periods of physical or emotional stress.

5.How vitiligo diagnosed?

Important factors in a patient’s medical history include: vitiligo in the family; a rash, sunburn, or other skin trauma at the site of vitiligo 2 to 3 months before depigmentation started; stress or physical illness; and premature graying of the hair (before age 35). In addition, it is important to know whether the patient or anyone in the patient’s family has had any autoimmune diseases and whether the patient is very sensitive to the sun.

The doctor then examines the patient to rule out other medical problems. The doctor may take a small sample (biopsy) of the affected skin and may also take a blood sample to check the blood-cell count and thyroid function. For some patients, the doctor may recommend an eye examination to check for uveitis (inflammation of the front portion of the eye). A special blood test to look for the presence of antinuclear antibodies (a type of autoantibody) may also be done. These evaluations can help to determine if the patient has an additional autoimmune disease.

6.Treatment of vitiligo & homeopathic approach:

As a rule, homoeopathy never looks at Vitiligo as a local disease. Vitiligo has been considered as a local expression of a system disturbance. As per the classical homoeopathy, we believe in constitutional prescribing. This calls for individual case study in every case of Vitiligo. There is no single specific remedy for all the cases of Vitiligo. The exact treatment is determined only on in-depth evaluation of individual case.

Constitutional approach:

What we understand by the Constitutional Approach in homeopathy is nothing but analysis and evaluation of various factors affecting the human constitution to determine the disease diagnosis and the exact treatment in turn. Every case of Vitiligo calls for study of the patient’s constitution which includes various aspects of his physical aspects as well as the in-depth study of the mental sphere, such as emotions, psychosocial background, behavior and personality pattern, etc.

The homeopathic remedy selected in every case after such a detail study is called the constitutional medicine, which when administered in the correct dose brings about harmony at the constitutional level, stimulating the normal pigmentation and hence induces normal skin coloration. It will be of interest to note that the homeopathy medicines are essentially oral and not in the form of creams, lotions or any local application on the skin.

Diet & Regimen:

There are a few instructions for patients regarding their diet in vitiligo especially with mention of what they should avoid during the treatment of vitiligo. Following are some of our observations based on our clinical experience of treating a large number of patients (clinical observations):

Foods that are excessively sour should be avoided. The ascorbic acid in sour foods tends to reduce melanin pigmentation. So the patients should restrict their intake of citrus foods.
Non vegetarian foods are also to be avoided as they act as a foreign body to pigment cells.
Flavoured drinks are to be avoided.
Artificial colours used in various food preparations should also be avoided.

There may not be enough scientific evidence to prove how these foods worsen vitiligo but our clinical experience has shown that many patients report worsening of their vitiligo from these items and hence they are better avoided.

Usually small amounts of milk, for example in tea or coffee, do not cause any problems. Dairy products such as butter, cheese and yoghurt are also well tolerated. If milk is excluded, it should be replaced with low lactose milk or with Soya milk. This should be discussed with a dietician to ensure that the nutritional balance is maintained.

Ginkgo Extract Effective Treatment for Vitiligo:

Healthnotes Newswire (August 21, 2003)—Supplementation with a standardized extract of ginkgo (Ginkgo biloba) may help slow the progression of skin depigmentation and actually increase pigmentation in adults suffering from vitiligo, according to a study in Clinical and Experimental Dematology (2003;28:285–7). This is encouraging news for the millions of adults that have to deal with this often difficult to treat condition.
Other nutrients that may be useful in treating vitiligo include picrorhiza (Picrorhiza kurroa), a traditional Indian herb, may also stimulate repigmentation of skin in people with vitiligo.

Related posts:
1-Leucoderma and Homeopathy ( सफ़ेद दाग और होम्योपैथी)
2-सफ़ेद दाग और होम्योपैथी- आशा की एक किरण -भाग-१ (Leucoderma & homeopathy- an ultimate hope -Part-1)

Case taking outline

The patient's story

Let the patient talk until they run out of things to say.

Modalities 

Apply the following to each of the symptoms gathered so far in the following order:

  • Causes
  • Prodrome, onset, pace, sequence, duration
  • Character, location, laterality, extension and radiation of pain or sensations
  • Concomitants and alternations

Aggravation or amelioration

  • Time (hour, day, night, before or after midnight); periodicity; season; moon phases
  • Temperature and weather: Chilly or warm blooded usually, chilly or warm blooded in present illness; wet dry cold, or hot weather; weather changes; storm or thunderstorm (before, during or after); hot sun, wind, fog, snow, open air, warm room, changes from one to other, stuffy or crowded places; drafts, warmth of bed, heat of stove, uncovering
  • Bathing (hot, cold or sea), local applications (hot, cold, wet or dry)
  • Rest or motion (slow or rapid, ascending or descending, turning in bed, exertion, walking, on first motion, after moving a while, while moving, after moving), car and sea-sickness
  • Position: Standing, sitting, (knees crossed, rising from sitting), stooping (rising from stooping), lying (on painful side, back, right or left side, abdomen, head high or low, rising from lying), leaning head backward, forward, sidewise, closing or opening eyes, any unusual position such as knee-chest
  • External stimuli: Touch, hard or light, pressure, rubbing, constriction (clothing, etc.), jar, riding, stepping, light, noise, music, conversation, odors
  • Eating: In general (before, during, after, hot or cold food or drink), swallowing (solids, liquids, empty), acids, fats, salt, salty food, starches, sugar and sweets, green vegetables, milk, eggs, meat, fish, oysters, onions, beer, liquor, wine, coffee, tea, tobacco, drugs
  • Thirst, quantity, frequency, hot, cool or iced, sours, bitters, etc.
  • Sleep: In general (before, during, on falling asleep , in first sleep, after, on
  • Menses (before, during, after, or suppressed)
  • Sweat: Hot or cold, foot-sweat, partial or suppressed.
  • Other discharges: Bleeding, coryza, diarrhea, vomitus, urine, emissions, leucorrhoea, etc.; suppression of same
  • Coition, continence, masturbation, etc.
  • Emotions: Anger, grief, mortification, fear, shock, consolation, apprehension of crowds, anticipation, suppression of same

Strange, rare and peculiar symptoms

Pull these symptoms out when possible.

The patient as a whole

Physical generals

  • The constitutional type of the patient (endrinologico-homeopathic correspondences, lack or excess of vital heat, lack of reaction, sensitiveness, etc.)
  • Ailments from emotions (see also mental generals); suppressions (emotions; discharges such as menses, sweat, leucorrhoea, catarrh, diarrhea, etc.; eruptions; diseases such as malaria, rheumatic fever, exanthemas, syphilis, gonorrhea, etc.; of pathology such as hemorrhoids, fistulae, ulcers, tonsils, tumors, other surgical conditions, etc.); form exposure to cold, wet, hot sun, etc.; from mechanical conditions such as overeating, injury, etc.
  • Menses, date of establishment, regularity (early or late), duration, color, consistency, odor, amount, clots, membrane, pain (modalities of), concomitants, aggravation or amelioration before, during, or after, both physically and mentally, menopause (symptoms of)
  • Other discharges (see above) cause, color, consistency, odor, acrid or bland, symptoms from suppression of, symptoms alternating with, hot or cold, partial discharges as of sweat, laterality, better or worse from discharges (before, during, or after)
  • Sleep, better or worse from, position in, aggravation after, difficulty in getting to sleep, waking frequently or early, at what hour, somnambulism, talking in sleep, dreams (see Mentals), restless during
  • Restlessness, prostration, weakness, trembling, chill, fever, etc.
  • Aggravations and ameliorations applying to patient as a whole as above.
  • Objective symptoms such as redness of orifices, superfluous hair, applying to patient as a whole
  • Pathology which applies to patient as a whole, such as tendency to tumors, wens, cysts, polyps, warts, moles, individual and family tendency to certain diseases or weaknesses of specific organs or tissues (also related to a. above and to physical examination), frequency of catching cold

Mental generals

These are studied last for convenience.

  • Will: Loves, hates, and emotions (suicidal, loathing of life; lasciviousness, revulsion to sex, sexual perversions; fears; greed, eating, money, emotionality, smoking, drinking, drugs; dreams; homicidal tendencies, desire or aversion to company, family, friends; jealousy, suspicion, obstinacy, contrariness, depression, loquacity, weeping, laughing, impatience, conscientiousness)
  • Understanding: Delusions, delirium, hallucinations, mental confusion, loss of time sense
  • Intellect: Memory concentration, mistakes in writing and speaking

Quick review

of condition of every systems and organ, beginning with head and following order of Kent's Repertory

Past history

of patient in seven-year periods

Family history

Physical examination and laboratory tests

Case Taking Questionnaire

It is not a bad procedure to say to the patient at this time: “ I have listened to you until now without interrupting you, now we will change the role, and please don’t be astonished if I seemingly stop you while answering, to ask you the next question, because this will mean that the answer I was waiting for is obtained. Do not believe that by so doing, I underestimate your answer , but this only signifies that a longer explanation will bring neither useful nor new details in the case.”

1. General Symptoms

  1. At what time in the 24 hours do you feel worst?
  2. In which season do you feel less well?
  3. How do you stand the cold, hot, dry, and wet weather?
  4. How does fog affect you?
  5. What do you feel when exposed to the sun?
  6. How does change of weather affect you?
  7. What about snow?
  8. What kind of climate is objectionable to you, and where would you choose to spend your vacation?
  9. How do you feel before, during and after a storm?
  10. What are you reactions to north wind, south wind, to the wind in general?
  11. What about draughts of air and changes of temperature?
  12. What about warmth in general, warmth of the bed, of the room, of the stove?
  13. How do you react to extremes of temperature?
  14. What difference do you make in your clothing in winter?
  15. What about taking colds in winter and in other seasons?
  16. How do you keep your window at night?
  17. What position do you like best — sitting, standing, lying?
  18. How do you feel standing a while, or kneeling in church?

You remark that this question of the standing position comes again. You will find this way of repeating it is intentional here and there in the questionnaire. It is a very useful and necessary procedure for verification.

  1. What sports do you engage in?
  2. What about riding in cars or sailing?
  3. How do you feel before, during, and after meals?
  4. What about your appetite, how do you feel if you go without a meal?

It will be often answered to you: “I can easily go without a meal but I never can stand a big dinner or banquet.” A question that you did not ask, but which demonstrates that the question was well formulate as it made the patient talk and left him his own choice.

  1. What quantity and what do you drink? What about thirst?
  2. What are the foods that make you sick, and why?

If the patient does not answer after a while, just ask looking closely at him: sweets, salty things, sour, greasy food, eggs, meat, pork, bread, butter, vegetables, cabbages, onions, fruits?

  1. What about wine, beer, coffee, tea, milk, vinegar?
  2. How much do you smoke in a day, and how do you feel after smoking?
  3. What are the drugs to which you are very sensitive or which make you sick?
  4. What are the vaccinations you have had, and the results from them?
  5. What about cold or warm baths, sea baths?
  6. How do you feel at the seaside, or on high mountains?
  7. How do collars, belts, and tight clothing affect you?
  8. How long are your wounds in healing, how long in bleeding?
  9. In what circumstances have you felt like fainting?

2. Mental symptoms

During all these questions, the physician must by kind words, put his patient at ease, but must watch him very closely, without the patient’s noticing it.

  1. What are the greatest griefs that you have gone through in your life?

Quite often the patient will lower the head and look quite moved, and a kind word of the doctor will be needed. It is why, as soon as the extra-version of self-expression has been made, this following question will make the patient look at you again in an astonished way, and sometimes with a happy smile.

  1. What are the greatest joys you have had in life?

These two questions are very important and, when asked at the right moment, will pave the way for the coming questions.

  1. At what time in the 24 hours do you feel blue, depressed, sad, pessimistic?
  2. How do you stand worries?
  3. On what occasions do you weep?

If the patient cannot answer, we will just ask — not losing for one second his expression — music, at reproaches, at which time of the day? Certain people can refrain from weeping, some others cannot.

  1. What effect does consolation have on you?

If the answer is “It depends by whom,” you may say: “Just by people you like,” because very often people say they do not like to be comforted because they think of members of their family they hate.

  1. On what occasions do you feel despair?
  2. In what circumstances have you ever felt jealous?
  3. When and on what occasions do you feel frightened or anxious?

If the patient does not answer, ask: “Some people are afraid of the night, of darkness, to be alone, of robbers, of certain animals, of death, of certain diseases, of ghosts, to lose their reason, of noises at night, of poverty, of storm, of water.” According to the way of answering, you will at once see the real fears, and be able to discriminate those which are not to be taken into consideration.

  1. How do you feel in a room full of people, at church, at a lecture?
  2. Do you go red or white when you are angry, and how do you feel afterwards?
  3. How do you stand waiting?

If he does not answer, just question him about impatience.

  1. How rapidly do you walk, eat, talk, write?
  2. What have been the complaints or effects following chagrin, grief, disappointed love, vexation, mortification, indignation, bad news, fright?
  3. In time of depression, how do you look at death?

Certain patients have presentiments of death, thoughts of death, ever desire to die; other have tendencies or desires of suicide, some would be courageous enough to do it, others are afraid, in spite of desiring it.

  1. Tell me about over-consciousness and over-scrupulousness, about trifles; some people do not care about too many details and too much order.
  2. What about your character before, during and after your period?

3. Food cravings and aversions

Of course, all these questions have been already asked in the beginning of the questionnaire, but by asking them again, you are able, by doing some cross-questioning, to determine if they have been answered well the first time or not.

  1. What is the kind of food for which you have a marked craving or aversion, or what are those that make you sick or you cannot eat?

Here, also, it is very important to watch very carefully the expression of the atient, because it is very easy to read on the face by observing the corners of the mouth coming down if the patient is disgusted, or on the contrary coming up with big shining eyes if the craving or a strong alimentary attraction is felt. Then, one can add, for example:—

  1. What about pastry and sweets?
  2. What about sour or spiced food?
  3. What about rich or greasy food?
  4. How much salt to you need for your taste?
  5. What about thirst and what do you drink? Coffee wine, beer, etc.

4. Sleep

  1. In which position do you sleep, and since when that position? Where do you put your arms, and how do you like to have your head?
  2. What are you doing during sleep?

If the patient doesn’t answer, you add: “Some people speak, laugh, shriek, weep, are restless, are afraid, grind their teeth, have their mouth or their eyes open.”

  1. At what time do you wake up, or when are you sleepy? What makes you restless or sleepy?
  2. What about dreams?

5. For Ladies, Menses

  1. At what age did they begin?
  2. How frequently do they come?
  3. What about their duration, abundance, color, odor, what about clots, etc.
  4. At what time in the 24 hours do they flow most?
  5. How do you feel before, during, and after menses?