EOSINOPHILIA AND HOMOEOPATHY
Dr. S. Sabarirajan., M.D. (Hom).
The term Eosinophilia refers to conditions in which abnormally high amounts of Eosinophils are found in either the blood (more than 600 cells per microliter (μ L))or in body tissues. Several causes are known, with the most common being some form of allergic reaction Eosinophil is a type of white blood cell. Eosinophils are produced in the bone marrow and are normally found in the bloodstream and the gut lining. They contain proteins that help the body to fight infection from parasitic organisms, such as worms. But in certain diseases these proteins can damage the body. Diagnosis is by complete blood count (CBC).
Aetiology
- The exact causative mechanisms of Eosinophilia remain largely unclear
- Very common Causes of Eosinophilia are Asthma, Hay fever, Drug allergies, Allergic skin diseases like Eczema, Sarcoptes scabiei, Scabies
- Common Causes of Eosinophilia are Connective tissue disease, Food allergy, Psoriasis, Systemic lupus erythematosus, Allergic rhinitis
Clinical Features
Sympioms includes
- Skin allergy,
- Cough
- Frequent cold attack
- Throat irritation
- Bone pain or tenderness
- Carpal tunnel syndrome
- Joint contractures
- Muscle weakness
- Tenderness and swelling of the arms and legs (occasionally including joints)
- Thickened skin with puckered appearance
Diagnosis
- Complete blood cell (CBC) count with differential to quantitate the percentage eosinophils and absolute number of eosinophils (AEC).However, in some cases, a more accurate absolute eosinophil count may be needed.
- Medical history is taken, with emphasis on travel, allergies and drug use.
- Patients with allergic symptoms should have a nasal smear for eosinophilia and Gram stain. Patients with asthma symptoms should have sputum examination for eosinophilia.
Prevention
- Avoid exposure to known allergens.
- Do not eat raw or undercooked snails, fish, frogs, slugs, freshwater prawns or other animals that may be contaminated with parasitic worms.
- Thoroughly wash all produce to ensure that they are not contaminated with parasitic worms.
TROPICAL EOSINOPHILIA
Syn: Weingarten syndrome, pulmonary eosinophiliosis.
This condition which is common in tropics is characterized by an absolute eosinophil count of 2000/cmm or more in peripheral blood and associated with respiratory symptoms. Current evidence suggests that eosinophilia is an allergic reaction to helminthic parasites particularly filarial worms.
It is a syndrome characterized by cough dyspnea a raised white cell count with persistent and absolute eosinophilia with systemic manifestations like fever loss of weight and lassitude. Chert X-ray shows ground glass appearance.
Homoeopathic Management for Eosinophilia
- Homeopathic medicines stimulate the immune power to act against the disease. So homeopathic medicines acts well in cases of Eosinophilia. Homoeo medicine controls the Eosinophils level in body and helps to reduce the symptoms with out producing any side effect
- Homoeopathy is highly effective in the treatment of allergies and fully capable of stimulating the organism to heal to the point of complete relief from all allergy symptoms.
- There is a special mention about allergic diseases in Homoeopathic literatures under the heading IDIOSYNCRASY. Dr Samuel Hahnemann, founder of Homoeopathic system of medicine defined idiosyncrasy 200 years ago in his famous book Organon of Medicine as “Idiosyncrasies by which are meant peculiar corporeal constitutions which although otherwise healthy, posses a disposition to be brought into a more or less morbid state by certain things which seem to produce no impression and no change in many other individuals”.
- Manifestations of allergic reactions and idiosyncracies are same. Both are hypersensitive reaction. An idiosyncratic individual is oversensitive to one or few things which doesn’t require treatment as the person in healthy, but allergic disorders are due to morbid susceptibility.
- Successful Homoeopathic prescribing demands a detailed case taking to find out the evolution of disease, relation with life situation, also to find out characteristic symptoms. According to Hahnemann it is the constitution of an individual that becomes sick first. The objective of treatment should be the improvement of the constitution, so that sensitivity, which has gone bad, is corrected or brought within normal range. It has been proved, verified and confirmed that if a proper indicated constitutional treatment is given to the child for sometime, it improves the constitution. In due course, the attacks become lesser in frequency and severity.
- By constitutional approach we can prevent the recurrence of the complaint by modifying the altered susceptibility.
Miasmatic remedy can help to remove any miasmatic block obtained from the familial background, past history of patient and also the presentation.
- Acute prescriptions are required during acute flare-ups.
Thus the concept of totality of symptoms and principle of individualization together enables the homoeopathic physician to perceive the disease in its whole content to make a suitable prescription
- Lachesis is a sure cure for tropical eosinophilia.
- Remedies like Aconite napellus, allium cepa, Anti.tart, Arsenicum album, Bryonia alba, Calc.Carb, Drosera, Phosphorus, Hepar sulph, Veratrum viride, Kali carb, Mercurius sol, Kali bich, Natrum sulph, Sulphur Sambucus nigra, Ipecac, Balsamum peruvianum, Asclepias tuberose, Naphthalinum, Sinapis nigra are very much useful in treating eosinophilia.
References
1. Harrison's Principles of Internal Medicine
2. Wikipedia.com/eosinophilia
3. Quick Bedside Prescriber – J.N.SHINGHAL.
4. http://homeoall.com/eosinophilia-homeopathy-treatment/
5. http://www.homeopathyzone.com/blog/article/the-homeopathic-treatment-of-allergies
6. http://doctorprasanna.com/articles/naso-respiratory-allergies-and-homoeopathy/
7. Principles of Prescribing, Dr. K.N.Mathur.
8. LILIENTHAL S., Homoeopathic Therapeutics
9. DEWEY W. A., Practical Homeopathic Therapeutics
Dr. S. SABARIRAJAN., M.D. (Hom) (Gen.med) (Gold medalist)
Reader, Dept. of Practice of Medicine
Vinayaka Mission’s Homoeopathic Medical College & Hospital,
Salem, Tamilnadu.
Tuesday, 27 December 2011
Monday, 12 December 2011
HOMOEOPATHIC IMMUNIZATIONS - ALTERNATIVE TO VACCINATIONS
HOMOEOPATHIC IMMUNIZATIONS
- ALTERNATIVE TO VACCINATIONS
Dr. S. Sabarirajan., M.D. (Hom).
Dr. S. R. Ameerkhan Babu., M.D. (Hom).
Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. The preferred prophylactic method against infectious disease in modern medicine is vaccination but nowadays due to their adverse side effects it become highly controversial and makes the new generation to turn out to Homoeopathy for prevention of many diseases.
Homoeopathic Immunization Schedule
At birth – Sulphur 200 1 Globule in a spoon of water to prevent psoric manifestation
Second day after Birth – give Hypericum 200 - 1 Globule in a spoon of water to protect against Tetanus
At Birth to 2 weeks – give Tuberculinum 1M - 1 Globule in a spoon of water to protect against tuberculosis.
At Birth, 6,10,14 weeks, 15-18 months, 5 years – give Thuja 1M - 1 Globule in a spoon of water to protect against Polio
At Birth, 6 weeks, 6-9 months, 10 years – Give Carduus Marianus-1M - 1 Globule in a spoon of water to protect against Hepatitis B
At 6,10,14 weeks, 15-18 months, 5 years - Give Thuja CM - 1 Globule in a spoon of water to protect against diphtheria,whooping cough, tetanus in morning
At 6,10,14 weeks, 15-18 months, 5 years - Give Ledum Palustre CM - 1 Globule in a spoon of water to protect against diphtheria,whooping cough, tetanus in evening
At 9 months - Give Pulsatilla CM - 1 Globule in a spoon of water to protect against Measles
At 15-18 months - Give Pulsatilla CM - 1 Globule in a spoon of water to protect against Measles, mumps, rubella or German measles
At 10-16 years - Give Ledum Palustre CM - 1 Globule in a spoon of water to protect against tetanus
Vaccine Schedule Medicine Dose
Against tuberculosis Birth – 2 weeks Tuberculinum 1M 1 drop in a spoon of water.
Against Polio Birth, 6,10,14 weeks,15-18 months, 5 years Thuja 1M 1 drop in a spoon of water.
Against Hepatitis B Birth, 6 weeks, 6-9 months, 10 years CARDUUS MARIANUS-1M 1 drop in a spoon of water.
Against diphtheria,whooping cough, tetanus 6,10,14 weeks, 15-18 months, 5 years Thuja CM 1 drop in a spoon of water in the morning.
LEDUM PALUSTRE CM 1 drop in a spoon of water in the evening.
Measles 9 months plus PULSATILLA CM 1 drop in a spoon of water.
Against measles, mumps, rubella or German measles 15-18 months PULSATILLA CM 1 drop in a spoon of water.
Against diphtheria and tetanus 5 years Thuja CM 1 drop in a spoon of water in the morning.
LEDUM PALUSTRE CM 1 drop in a spoon of water in the evening.
Against tetanus 10-16 years LEDUM PALUSTRE CM 1 drop in a spoon of water in the evening.
Homoeopathic Immunization
Homeopathic immunizations have been used successfully for over 200 years. Our master Dr. Samuel Hahnemann, used homeopathic immunization routinely in his practice. In 1799, he used the homeopathic remedy Belladonna successfully to prevent Scarlet Fever. Following Hahnemann’s example, another eleven medical doctors prescribed Belladonna during the same epidemic. They reported that of 1,646 children exposed to scarlet fever after being given Belladonna, only 123 (7.4%) developed symptoms of infection. In contrast, the infection rate in those who did not receive the prophylactic was as high as 90%. In 1838 the Prussian Government ordered the use of Belladonna during all scarlet fever epidemics after a report from their chief of physicians, Hufeland, showed it to be an effective prophylactic.
In 1831 Samuel Hahnemann prevented and treated cholera during the 1831 Asiatic cholera epidemic with the remedies Camphor, Cuprum metallicum and Veratrum album. In 1849 Dr Clemens von Boenninghausen treated and prevented untold numbers of cholera infections during the 1849 European epidemic with the above remedies recommended by Hahnemann. While a death rate of 54-90% occurred with conventional treatment, Boenninghausen’s patients had a mortality rate of only 5-16%. In the 1800s Clemens von Boenninghausen used Thuja for both the treatment and prevention of smallpox during an epidemic. In 1902 Dr. Eaton reported that during a smallpox epidemic in Iowa, 2806 patients were treated prophylactically with homeopathic Variolinum. Of the 547 patients definitely exposed, only 14 developed the disease. The protection rate on these numbers was 97%.
In 1850 during an epidemic of poliomyelitis, Dr Taylor Smith of Johannesburg, South Africa protected 82 people with homoeopathic Lathyrus sativus. Of the 82 so immunised, 12 came into direct contact with disease. None were infected. Dr Grimmer of Chicago prophylactically treated 5,000 young children with Lathyrus sativus. None developed polio.
In 1957 a severe poliomyelitis epidemic occurred in Buenos Aires. The majority of homoeopathic doctors prescribed Lathyrus sativus as a preventative. Drug stores distributed thousands of doses to the public. None of those who used the prophylactic registered a case of contagion (Eizayaga). In 1975 during another poliomyelitis epidemic in Buenos Aires, 40,000 were given the homeopathic prophylactic Lathyrus sativus. None developed poliomyelitis (Eizayaga).
In 1996 Dengueinum 30 was administered to at least 39,200 people in the Delhi area during an epidemic of Dengue haemorrhagic fever. Follow-up of 23,520 people 10 days later showed only 5 people (0.125%) had developed mild symptoms, with the rest showing no signs or symptoms of the disease (CCRH). (During epidemics of dengue, attack rates among susceptible are often 40-50 %, but may reach 80-90 %, World Health Organization.)
In 1999 the Department of Indian Medicine and Homoeopathy started distribution of homoeopathic immunizations for Japanese Encephalitis in a systematic way throughout the Andhra Pradesh with BCT (Belladonna, Calcarea Carb and Tuberculinum). JE mortality rates had touched a high of 638 deaths from 2038 cases in 1986, but fell to four from 33 cases in 2001, following the implementation of the homeopathic immunization program. Even the World Health Organization and the Medical and Health Department acknowledge that homeopathic immunizations have been a vital factor in the sharp decline of Japanese Encephalitis cases in Andhra Pradesh.
Homoeopathic Prophylaxis
Prophylaxis against Diphtheria - Apis mellifica 30, Diphthirinum 30
Prophylaxis against epilepsy - Kali bromium, Gloninine
Prophylaxis against Influenza – Arsenicum album.
Prophylaxis against Jaundice – Cincona off
Prophylaxis against measles – Aconite nap, Pulsatilla nig., Arsenicum album or Morbillinum.
Prophylaxis against Cholera - Camphor, Cuprum metallicum, Veratrum album
Prophylaxis against Mumps – Trifole-rep, Parotidinum.
Prophylaxis against Tetenus – Ledum pal or thuja or Arnica or Tetanotoxin.
Prophylaxis against Whooping cough – Drosera, Vaccininum, Pertussin.
Prophylaxis against Plague – Buboninum 12 – 13 potency, Ignatia amara., Naja triputans.
Prophylaxis against Chicken pox – Antimonium Tart and Rhus tox
Prophylaxis against Meningitis – Cicuta virosa
Prophylaxis against poliomyelitis - Lathyrus sativus 1M or Carbolic acidum or Plumbum or Physostigma
Prophylaxis against Dengue fever – Eupatorium perf
Prophylaxis against Common cold – Nux vomica
Prophylaxis against Snake poison - Golondrina
Prophylaxis against Typhoid – Baptisia
References
1. Birch, Kate. Vaccine Free Prevention and Treatment of Infectious Contagious Disease with Homeopathy: A Manual for Practitioners and Consumers.Trafford Publishing, 2007
2. Central Council of Research in Homoeopathy. CCRH News 1996-1997.
Currim, A.M. Ed. 1996. The Collected Works of Arthur Grimmer, M.D. Norwalk and Greifenberg, Hahnemann International Institute for Homeopathic Documentation.
3. Dudgeon R. E. 1853. Lectures on the Theory and Practice of Homeopathy, p.541,2. Republished by B. Jain Publishers, 2002, New Dehli.
Eaton, Dr. C. W., Variolinum. (a paper read before the American Institute of Homeopathy), 1907.
4. Eisfelder, HW, “Poliomyelitis Immunization: A Final Report.” Journal of the American Institute of Homeopathy. V. 54, Nov-Dec 1961, pp. 166-167.
Eizayaga, Dr. F. X., Treatise on Homeopathic Medicine. (E. Marecel, Buenos Aires, pp. 282-286).
5. Golden, Dr. Isaac, Vaccination & Homeoprophylaxis? A Review of Risks and Alternatives. 6th ed., Isaac Golden Publications, 2007.
6. Hahnemann, Dr. Samuel. “Cause and Prevention of the Asiatic Cholera.”Archiv. f. hom. Helik., vol. xi, 1831.
7. Hahnemann, Dr. Samuel, “Cure and Prevention of Scarlet Fever.” Lesser Writings. Jain, 1801, p. 369-384.
8. Hufeland. “Prophylactic Power of Belladonna in Scarlet Fever,” Hufeland’s Journal, 1828.
9. Staff Reporter. “Japanese Encephalitis on the Decline in State,” The Hindu, April 1, 2003.
10. Taylor-Smith, A. “Poliomyelitis and prophylaxis.” Br Homeopath J, 1950 Apr;40(2):65-77.
11.Von Boenninghausen, C. Baron. “Vide Concerning the Curative Effects of Thuja in Smallpox.” Lesser Writings, Jain, 1908.
12.http://www.homoeopathynow.com/homoeo-articles/69-homoeopathic-immunization
13. Quick Bedside Prescriber – J.N.SHINGHAL.
14. Pocket manual of Homoeopathic Materia Medica & Repertory by William Boericke.
15. Principles of Prescribing, Dr. K.N.Mathur.
Dr. S. Sabarirajan., M.D. (Hom) (Gen.med) (Gold medalist)
Dr. S. R. Ameerkhan Babu., M.D. (Hom) (Gen.med)
Reader, Dept. of Practice of Medicine
Vinayaka Mission’s Homoeopathic Medical College & Hospital,
Salem, Tamilnadu.
- ALTERNATIVE TO VACCINATIONS
Dr. S. Sabarirajan., M.D. (Hom).
Dr. S. R. Ameerkhan Babu., M.D. (Hom).
Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. The preferred prophylactic method against infectious disease in modern medicine is vaccination but nowadays due to their adverse side effects it become highly controversial and makes the new generation to turn out to Homoeopathy for prevention of many diseases.
Homoeopathic Immunization Schedule
At birth – Sulphur 200 1 Globule in a spoon of water to prevent psoric manifestation
Second day after Birth – give Hypericum 200 - 1 Globule in a spoon of water to protect against Tetanus
At Birth to 2 weeks – give Tuberculinum 1M - 1 Globule in a spoon of water to protect against tuberculosis.
At Birth, 6,10,14 weeks, 15-18 months, 5 years – give Thuja 1M - 1 Globule in a spoon of water to protect against Polio
At Birth, 6 weeks, 6-9 months, 10 years – Give Carduus Marianus-1M - 1 Globule in a spoon of water to protect against Hepatitis B
At 6,10,14 weeks, 15-18 months, 5 years - Give Thuja CM - 1 Globule in a spoon of water to protect against diphtheria,whooping cough, tetanus in morning
At 6,10,14 weeks, 15-18 months, 5 years - Give Ledum Palustre CM - 1 Globule in a spoon of water to protect against diphtheria,whooping cough, tetanus in evening
At 9 months - Give Pulsatilla CM - 1 Globule in a spoon of water to protect against Measles
At 15-18 months - Give Pulsatilla CM - 1 Globule in a spoon of water to protect against Measles, mumps, rubella or German measles
At 10-16 years - Give Ledum Palustre CM - 1 Globule in a spoon of water to protect against tetanus
Vaccine Schedule Medicine Dose
Against tuberculosis Birth – 2 weeks Tuberculinum 1M 1 drop in a spoon of water.
Against Polio Birth, 6,10,14 weeks,15-18 months, 5 years Thuja 1M 1 drop in a spoon of water.
Against Hepatitis B Birth, 6 weeks, 6-9 months, 10 years CARDUUS MARIANUS-1M 1 drop in a spoon of water.
Against diphtheria,whooping cough, tetanus 6,10,14 weeks, 15-18 months, 5 years Thuja CM 1 drop in a spoon of water in the morning.
LEDUM PALUSTRE CM 1 drop in a spoon of water in the evening.
Measles 9 months plus PULSATILLA CM 1 drop in a spoon of water.
Against measles, mumps, rubella or German measles 15-18 months PULSATILLA CM 1 drop in a spoon of water.
Against diphtheria and tetanus 5 years Thuja CM 1 drop in a spoon of water in the morning.
LEDUM PALUSTRE CM 1 drop in a spoon of water in the evening.
Against tetanus 10-16 years LEDUM PALUSTRE CM 1 drop in a spoon of water in the evening.
Homoeopathic Immunization
Homeopathic immunizations have been used successfully for over 200 years. Our master Dr. Samuel Hahnemann, used homeopathic immunization routinely in his practice. In 1799, he used the homeopathic remedy Belladonna successfully to prevent Scarlet Fever. Following Hahnemann’s example, another eleven medical doctors prescribed Belladonna during the same epidemic. They reported that of 1,646 children exposed to scarlet fever after being given Belladonna, only 123 (7.4%) developed symptoms of infection. In contrast, the infection rate in those who did not receive the prophylactic was as high as 90%. In 1838 the Prussian Government ordered the use of Belladonna during all scarlet fever epidemics after a report from their chief of physicians, Hufeland, showed it to be an effective prophylactic.
In 1831 Samuel Hahnemann prevented and treated cholera during the 1831 Asiatic cholera epidemic with the remedies Camphor, Cuprum metallicum and Veratrum album. In 1849 Dr Clemens von Boenninghausen treated and prevented untold numbers of cholera infections during the 1849 European epidemic with the above remedies recommended by Hahnemann. While a death rate of 54-90% occurred with conventional treatment, Boenninghausen’s patients had a mortality rate of only 5-16%. In the 1800s Clemens von Boenninghausen used Thuja for both the treatment and prevention of smallpox during an epidemic. In 1902 Dr. Eaton reported that during a smallpox epidemic in Iowa, 2806 patients were treated prophylactically with homeopathic Variolinum. Of the 547 patients definitely exposed, only 14 developed the disease. The protection rate on these numbers was 97%.
In 1850 during an epidemic of poliomyelitis, Dr Taylor Smith of Johannesburg, South Africa protected 82 people with homoeopathic Lathyrus sativus. Of the 82 so immunised, 12 came into direct contact with disease. None were infected. Dr Grimmer of Chicago prophylactically treated 5,000 young children with Lathyrus sativus. None developed polio.
In 1957 a severe poliomyelitis epidemic occurred in Buenos Aires. The majority of homoeopathic doctors prescribed Lathyrus sativus as a preventative. Drug stores distributed thousands of doses to the public. None of those who used the prophylactic registered a case of contagion (Eizayaga). In 1975 during another poliomyelitis epidemic in Buenos Aires, 40,000 were given the homeopathic prophylactic Lathyrus sativus. None developed poliomyelitis (Eizayaga).
In 1996 Dengueinum 30 was administered to at least 39,200 people in the Delhi area during an epidemic of Dengue haemorrhagic fever. Follow-up of 23,520 people 10 days later showed only 5 people (0.125%) had developed mild symptoms, with the rest showing no signs or symptoms of the disease (CCRH). (During epidemics of dengue, attack rates among susceptible are often 40-50 %, but may reach 80-90 %, World Health Organization.)
In 1999 the Department of Indian Medicine and Homoeopathy started distribution of homoeopathic immunizations for Japanese Encephalitis in a systematic way throughout the Andhra Pradesh with BCT (Belladonna, Calcarea Carb and Tuberculinum). JE mortality rates had touched a high of 638 deaths from 2038 cases in 1986, but fell to four from 33 cases in 2001, following the implementation of the homeopathic immunization program. Even the World Health Organization and the Medical and Health Department acknowledge that homeopathic immunizations have been a vital factor in the sharp decline of Japanese Encephalitis cases in Andhra Pradesh.
Homoeopathic Prophylaxis
Prophylaxis against Diphtheria - Apis mellifica 30, Diphthirinum 30
Prophylaxis against epilepsy - Kali bromium, Gloninine
Prophylaxis against Influenza – Arsenicum album.
Prophylaxis against Jaundice – Cincona off
Prophylaxis against measles – Aconite nap, Pulsatilla nig., Arsenicum album or Morbillinum.
Prophylaxis against Cholera - Camphor, Cuprum metallicum, Veratrum album
Prophylaxis against Mumps – Trifole-rep, Parotidinum.
Prophylaxis against Tetenus – Ledum pal or thuja or Arnica or Tetanotoxin.
Prophylaxis against Whooping cough – Drosera, Vaccininum, Pertussin.
Prophylaxis against Plague – Buboninum 12 – 13 potency, Ignatia amara., Naja triputans.
Prophylaxis against Chicken pox – Antimonium Tart and Rhus tox
Prophylaxis against Meningitis – Cicuta virosa
Prophylaxis against poliomyelitis - Lathyrus sativus 1M or Carbolic acidum or Plumbum or Physostigma
Prophylaxis against Dengue fever – Eupatorium perf
Prophylaxis against Common cold – Nux vomica
Prophylaxis against Snake poison - Golondrina
Prophylaxis against Typhoid – Baptisia
References
1. Birch, Kate. Vaccine Free Prevention and Treatment of Infectious Contagious Disease with Homeopathy: A Manual for Practitioners and Consumers.Trafford Publishing, 2007
2. Central Council of Research in Homoeopathy. CCRH News 1996-1997.
Currim, A.M. Ed. 1996. The Collected Works of Arthur Grimmer, M.D. Norwalk and Greifenberg, Hahnemann International Institute for Homeopathic Documentation.
3. Dudgeon R. E. 1853. Lectures on the Theory and Practice of Homeopathy, p.541,2. Republished by B. Jain Publishers, 2002, New Dehli.
Eaton, Dr. C. W., Variolinum. (a paper read before the American Institute of Homeopathy), 1907.
4. Eisfelder, HW, “Poliomyelitis Immunization: A Final Report.” Journal of the American Institute of Homeopathy. V. 54, Nov-Dec 1961, pp. 166-167.
Eizayaga, Dr. F. X., Treatise on Homeopathic Medicine. (E. Marecel, Buenos Aires, pp. 282-286).
5. Golden, Dr. Isaac, Vaccination & Homeoprophylaxis? A Review of Risks and Alternatives. 6th ed., Isaac Golden Publications, 2007.
6. Hahnemann, Dr. Samuel. “Cause and Prevention of the Asiatic Cholera.”Archiv. f. hom. Helik., vol. xi, 1831.
7. Hahnemann, Dr. Samuel, “Cure and Prevention of Scarlet Fever.” Lesser Writings. Jain, 1801, p. 369-384.
8. Hufeland. “Prophylactic Power of Belladonna in Scarlet Fever,” Hufeland’s Journal, 1828.
9. Staff Reporter. “Japanese Encephalitis on the Decline in State,” The Hindu, April 1, 2003.
10. Taylor-Smith, A. “Poliomyelitis and prophylaxis.” Br Homeopath J, 1950 Apr;40(2):65-77.
11.Von Boenninghausen, C. Baron. “Vide Concerning the Curative Effects of Thuja in Smallpox.” Lesser Writings, Jain, 1908.
12.http://www.homoeopathynow.com/homoeo-articles/69-homoeopathic-immunization
13. Quick Bedside Prescriber – J.N.SHINGHAL.
14. Pocket manual of Homoeopathic Materia Medica & Repertory by William Boericke.
15. Principles of Prescribing, Dr. K.N.Mathur.
Dr. S. Sabarirajan., M.D. (Hom) (Gen.med) (Gold medalist)
Dr. S. R. Ameerkhan Babu., M.D. (Hom) (Gen.med)
Reader, Dept. of Practice of Medicine
Vinayaka Mission’s Homoeopathic Medical College & Hospital,
Salem, Tamilnadu.
Saturday, 24 September 2011
Menopause
Combined therapy along with Homoeopathic treatment helps in combating Menopause
- Dr. S. Sabarirajan & Dr.S.R. Ameerkhan babu.
Introduction
Menopause is a universal and irreversible part of the overall aging process involving a woman's reproductive system, after which she no longer menstruates. Awareness about these changes is less in our country compared to developed nations. Patients seeking treatment for menopause is less, but we find such patients visiting for their menopause related symptoms like irregular bleeding, fatigue, night sweats, etc. Though we have many rubrics in the repertory for menopause and its symptoms, many a times we fail to provide desirable results. Many physicians find in such cases along with the indicated drug, other managing measures like food modifications, exercise, home remedies and herbs, supplements, micronutrients and vitamins are helpful. This article discusses about such combined therapies along with definition, symptoms, pathophysiology, investigations, rubrics and drugs for menopause.
Definition
The word "menopause" literally means the "end of monthly cycles" from the Greek word pausis (cessation) and the root men- (month), because the word "menopause" was created to describe this change in human females, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruation or menses. Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining. Menopause typically (but not always) occurs in women in midlife, during their late 40s or early 50s, and signals the end of the fertile phase of a woman's life. It is not uncommon however to see a women menstruate well beyond the age of 50.
Perimenopause refers to the time before menopause when vasomotor symptoms and irregular menses often commence. Perimenopause can start 5-10 years or more before menopause.
Menopause is characterized by a continuation of vasomotor symptoms and by urogenital symptoms such as vaginal dryness and dyspareunia.
The cause of menopause is “burning out” of the ovaries. Throughout a woman’s reproductive life, about 400 of the primordial follicles grow into mature follicles and ovulate, and hundreds of thousands of ova degenerate. At about age 45 years, only a few primordial follicles remain to be stimulated by FSH and LH, and, the production of estrogens by the ovaries decreases as the number of primordial follicles approaches zero. When estrogen production falls below a critical value, the estrogens can no longer inhibit the production of the gonadotropins FSH and LH. Instead, the gonadotropins FSH and LH (mainly FSH) are produced after menopause in large and continuous quantities, but as the remaining primordial follicles become atretic, the production of estrogens by the ovaries falls virtually to zero.
SIGNS AND SYMPTOMS
The menopausal transition can cause
Vascular instability
• Hot flashes or hot flushes, including night sweats and, in a few people, cold flashes
• Possible but contentious increased risk of atherosclerosis
• Migraine
• Rapid heartbeat
Urogenital atrophy
• Thinning of the membranes of the vulva, the vagina, the cervix, and also the outer urinary tract, along with considerable shrinking and loss in elasticity of all of the outer and inner genital areas.
• Itching
• Dryness
• Bleeding
• Watery discharge
• Urinary frequency
• Urinary incontinence
• Urinary urgency
• Increased susceptibility to inflammation and infection, for example vaginal candidiasis, and urinary tract infections
Skeletal
• Back pain
• Joint pain, Muscle pain
• Osteopenia and the risk of osteoporosis gradually developing over time
Skin, soft tissue
• Breast atrophy
• breast tenderness +/- swelling
• Decreased elasticity of the skin
• Formication (itching, tingling, burning, pins and needles, or sensation of ants crawling on or under the skin)
• Skin thinning and becoming drier
Psychological
• Depression and/or anxiety
• Fatigue
• Irritability
• Memory loss, and problems with concentration
• Mood disturbance
• Sleep disturbances, poor quality sleep, light sleep, insomnia
Sexual
• Dyspareunia or painful intercourse
• Decreased libido
• Problems reaching orgasm
• Vaginal dryness and vaginal atrophy
PATHOPHYSIOLOGY
During climacteric, ovarian activity declines. Initially, the ovulation fails, no corpus luteum is formed and no progesterone is secreted by the ovary. Thus the menstrual cycles tend to become anovulatory and irregular (Metropathia haemorraghica).Later oestrogenic activity also diminishes and atrophic endometrium ensues, leading to menopause. As a result of cessation of ovarian activity, and fall in estrogen level, there is a rebound increase in secretion of FSH by the anterior pituitary gland. FSH level may rise as much as 50 fold, thus making menopausal urine a commercial source of Gonadotrophin(HMG). With further advancing years, gonadotrophin activity of the anterior pitiuitary also ceases and a fall in the level of FSH is eventually noticed .
CHANGES IN THE GENITAL TRACT
These changes are of atrophic type and affect the external genitalia as well as the internal organs. They take time to occur – over a number of years. Not only the main pelvic structures reduced in size but, more importantly, the fascial framework and the intra pelvic ligaments supporting the bladder and the genitalia are weakened;this may lead to complications.
Vulva: This shows the flattening of the labia majora, the minor labia becoming more evident. Sexual hair become grey and sparse. The clitoris shrinks.
Uterus: The uterus becomes small with a relatively large cervix- return to infantile proportions.
Tubes and ovaries: These show great shrinkage, the tubes becoming thin, while the ovaries are reduced to small white wrinkled bodies 2-3 cm in length. In addition to the shrinkage of the vaginal introitus, the vagina diminishes in length and its secretions are limited, leading to sexual problems. Changes in the vaginal epithelium increase these problems.
PRINCIPAL CHANGES IN THE SERUM HORMONE LEVELS
Once menopause is well established , the plasma estrogen level may remain low at 10 to 20 pg/ml. Oestrone level varies between 30 and 70 Pg/ml. the ovary also secretes a small amount of testosterone which may be responsible for mild hirsutism noticed after the menopause. The gonadotrophin hormone (FSH) appears in high concentration at menopause, because it is not inhibited by the prevailing low levels of estrogen.
Mensturation may gradually decrease, suddenly cease or become irregular. Oestrogen levels fall over the 5 years preceding ovarian failure which occurs usually between 45 and 50 years of age, with an average around 50 years. The fall in oestrodiol has a positive feedback on the pitiuitary, increasing production of FSH and LH.
The ovaries eventually produce androstenidione, which is also produced by the adrenals, and is converted in peripheral fat into weak oestrogen oestrone
INVESTIGATIONS
Assessment and evaluation prior to initiating treatment:
The following plan is recommended, it helps in finding the actual pathology and progress of symptoms, which helps in finding the constitutional or antimiasmatic remedies and further way of treatment.
1. Detailed family and personal history, physical examination - height , weight and BP.
2. Examination of breast.
3. Pelvic examination.
4. Evaluation of menopausal symptoms and need for medication.
5. Evaluation of the individual risks versus benefits from treatment.
6. Routine screening tests like blood routine, urine routine, Fasting and post prandial blood sugars.
7. Lipid profile and cardiovascular risk assessment. (Plasma lipids have been known to be altered by the with in month variations in the female hormonal system. The early menopausal subjects shows a significant increase in the total cholesterol level and slightly higher in late menopausal subjects.)
8. Transvaginal sonography and assessment of endometrial thickness.
9. Routine mammography.
10. Endometrial histology – in cases of post menopausal bleeding or family history of uterine cancer. Or past history of late menopause, infertility, and PCOD.
HORMONE REPLACEMENT AND ALLIED THERAPY
The basic objective of oestrogen replacement therapy is to increase the circulating levels of oestrogen to physiological levels of 45- 200 pg / ml to alleviate the climacteric symptoms resulting from oestrogen deficiency. Semi- synthetic hormones are used for hormone replacement therapy (HRT) because they are more physiologic in their actions. HRT can be administered in the form of oral medications, dermal patches or gels for local application, depending on the patients needs.
There are many contraindications to HRT as follows:
Conventional therapy majorly depends on the Hormone replacement therapy (HRT). But many studies suggest that HRT has got many unwanted side effects. For example, the results of a major study, called women’s health initiative (established by the Government of United States of America), had explored many health risks. In fact this important study was stopped early because the health risks outweighed the health benefits. Women taking the hormones greatly increased their risk for breast cancer, heart attacks, strokes and blood clots. However all hormone replacement therapies probably do carry some health risks, including high blood pressure, blood clots, and increased risks of breast and uterine cancers.
1. Presence of active endometrial cancer and hormone dependent tumours.
2. Active breast cancer and oestrogen progesterone receptor positive cancers.
3. Presence of or suspicion of pregnancy.
4. Undiagnosed vaginal bleeding.
5. Severe liver disease or abnormal liver function tests.
6. Acute vascular thrombosis.
7. History of thrombo embolism.
8. Estrogen dependent vascular thrombosis.
Other relative symptoms are - Strong family history of breast cancer, History of migraine and severe headaches. Thrombo phlebitis, uterine fibroids, Endometriosis, Gall bladder disease, Glucose intolerance.
HOLISTIC APPROACH TO MENOPAUSE
A holistic approach considering the lifestyle, personal habits, food habits, inclusion of nutrients and herbal diet, etc. along with homoeopathic treatment helps in overcoming menopausal symptoms. Information on each such intervention has been given under respective titles.
I. Life style changes and personal habits:
1. Exercises- Brisk walking fro 40 – 60 minutes atleast 5 times/week.
2. Physical workouts-Weight bearing exercises for limbs and back strengthening.
3. Yoga and meditation- Breathing exercises (Pranayama) beneficial in reducing stress.
4. Simple diet- Containing liberal amounts of vegetables and fruits (fibres and vitamins) lower contents of saturated fats and restricted sugar content.
5. Fluid intake- Consume fluids liberally to maintain tissue hydration.
6. Control or abstain- Smoking , alcohol intake, unrestricted consumption of tea / coffee.
II. Herbs and plant products:
Plants are a source of phyto oestrogens which have mild oestrogenic and some anti estrogenic effects. Soya has been the most extensively investigated plant. Phytooestrogens are a source of aglycones and isoflavones, coumestones and lignans.common Indian foods rich in phytooestrogens- isoflavons are found in Bengal grams, cereals fruits like apples and berries,and red clover. Lignans in whole grain, pulses, legumes and beans, sunflower seeds and saponins in herbs like turmeric fenugreek or methi ginger and also in root vegetables yam and grains.
An intake of 50 mg of isoflavones per day has been beneficial in reducing hot flushes, preventing osteoporosis, reducing ldl cholesterol. Also there is an evidence that soya exerts a protective action against breast cancer. The hot flushes can be managed with Wearing cool clothing, Drinking cold water or juice at the onset of flush, shower with tepid water.
III. Micronutrients and antioxidants:
These are essential to the body and required in very small amounts. These include vitamins minerals, essential amino acids, essential fatty acids. Many of these are antoxidants also. Antoxidants protects against the tissue damage. Menopausal women are vulnerable because of the loss of the protective effects of oestrogens and the age related effects.
IV. Calcium and vitamin D3:
In ageing women, the need for calcium supplementation increases to about 1000- 1500 mg / day Provided the calcium should be properly absorbed and utilized. Thus it slows down the process of age related osteoporosis.
This has been justified by Ried et al in 1993 in their research with supplementation of calcium carbonate and lactate- gluconate to post menopausal women in doses of 1 gm / 24 hours for 5 years and demonstrated significantly slowed axial and appendicular bone loss.
Chapuy et al in 1992 has demonstrated both suppression of bone loss and reduction of fracture.
IV. Calcitonin:
Many clinical studies have produced evidence to suggest that calcitonin is able to prevent bone loss in the spine in post menopausal women. Calcitonin injection has been known to cause side effects like nausea and vomiting , flushing and intertrigo, intranasal administration remains another alternative.
V. Biphosphonates:
These are stable active analogues of pyrophosphate, which act by inhibiting bone resorption. These compounds are worth considering in women in whom oestrogens are contraindicated, or for those averse to Hormone Replacement Therapy.
Aroma therapy, Herbalism, Accupressure, Accupuncture, Nutrition and supplements can be suggested as the supportive line of treatments for menopausal complaints.
HOMOEOPATHIC APPROACH
The advantage of homoeopathy is that it considers the patient as whole. Since the symptoms of menopause are not limited to one system or location, a drug selected on the totality is of more helpful than the “single complaint specific drugs”. Our repertory has covered the menopausal symptoms directory or indirectly. Below is a reportorial analysis on the common symptoms of menopause. Therapeutics of menopause follows the analysis.
THERAPEUTICS
Many authors have discussed about the drugs that are commonly indicated during the time of menopause or the climaxis, as referred to in many of the writings. The commonly indicated remedies for General Menopausal symptoms are Amyl Nitrosum, Belladona, Bellis perennis, Cactus grandiflorus, Calcarea carbonicum., Caulophyllum, Cimicifuga racemosa, Castoreum, Conium ,Crotalus Horridus, Erigeron, Gelsemium, Glonine, Graphitis., Kali-carbonicum, Kreosotum, LACHESIS, Manganum, Mag.phos , Murex., Nux-vomica, Nux moschata, Oophorinum, Psorinum, Pulsatilla , Sabina, Sangunaria, Sepia, Sulphur, Sulphuric acid, Thlasi bursa , Tuberculinum, Ustiligo, Vibrunum opulus and Zincum Valerianum.
Aliments from menopause
Lachesis. (It’s a Well Specific Remedy for Menopause)
Ailments during menopause
For hot flashes and night sweats: Amyl nitrosum, Belladonna, Ferrum metallicum, Lachesis, Pulsatilla, Pilocarpus microphyllus, Sepia and Valeriana.
For sleeplessness (insomnia): Aconitum napellus, Arsenicum album, Belladonna, Chamomilla, Coffea crude, Lycopodium clavatum ,Passiflora incarnata, Sulphur and Viburnum opulus.
For constipation: Hydrastis, Iris versicolor. Magnesia muriatica, Magnesia phosphorica and Sepia
For incontinence of urine: Pulsatilla and Zincum metallicum.
For vaginal dryness: Aconitum napellus, Apis mellifica, Belladonna, Bryonia, Ferrum phosphoricum Hydrophobinum, Lycopodium, Natrum muriaticum and Spiranthes.
For depression, fear, nervous or irritability: Aconitum napellus, Amyl nitrosum, Arum Metallicum, Borax, Chamomilla, Ignatia amara, Lachesis, Nux vomica, Passiflora incarnata, Sepia, Stramonium and Viburnum opulus.
For bone related problems like Osteophorosis: Bellis perennis and Calcarea carbonica
For menorrhagia: Lachesis, Sepia, Argentum mettalicum and Cimicifuga racemosa
For painful and enlarged breast: Sangunaria
For painful breast: Cimicifuga racemosa
For burning, palm, sole and vertex: Sulphur, Sangunaria and Lachesis
For excessive perspiration: Sepia
For earache: Gelsimium
For rheumatic pain: Caulophyllum
For headache: Glonine, Sangunaria, Sepia and Cimicifuga racemosa
- Dr. S. Sabarirajan & Dr.S.R. Ameerkhan babu.
Introduction
Menopause is a universal and irreversible part of the overall aging process involving a woman's reproductive system, after which she no longer menstruates. Awareness about these changes is less in our country compared to developed nations. Patients seeking treatment for menopause is less, but we find such patients visiting for their menopause related symptoms like irregular bleeding, fatigue, night sweats, etc. Though we have many rubrics in the repertory for menopause and its symptoms, many a times we fail to provide desirable results. Many physicians find in such cases along with the indicated drug, other managing measures like food modifications, exercise, home remedies and herbs, supplements, micronutrients and vitamins are helpful. This article discusses about such combined therapies along with definition, symptoms, pathophysiology, investigations, rubrics and drugs for menopause.
Definition
The word "menopause" literally means the "end of monthly cycles" from the Greek word pausis (cessation) and the root men- (month), because the word "menopause" was created to describe this change in human females, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruation or menses. Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining. Menopause typically (but not always) occurs in women in midlife, during their late 40s or early 50s, and signals the end of the fertile phase of a woman's life. It is not uncommon however to see a women menstruate well beyond the age of 50.
Perimenopause refers to the time before menopause when vasomotor symptoms and irregular menses often commence. Perimenopause can start 5-10 years or more before menopause.
Menopause is characterized by a continuation of vasomotor symptoms and by urogenital symptoms such as vaginal dryness and dyspareunia.
The cause of menopause is “burning out” of the ovaries. Throughout a woman’s reproductive life, about 400 of the primordial follicles grow into mature follicles and ovulate, and hundreds of thousands of ova degenerate. At about age 45 years, only a few primordial follicles remain to be stimulated by FSH and LH, and, the production of estrogens by the ovaries decreases as the number of primordial follicles approaches zero. When estrogen production falls below a critical value, the estrogens can no longer inhibit the production of the gonadotropins FSH and LH. Instead, the gonadotropins FSH and LH (mainly FSH) are produced after menopause in large and continuous quantities, but as the remaining primordial follicles become atretic, the production of estrogens by the ovaries falls virtually to zero.
SIGNS AND SYMPTOMS
The menopausal transition can cause
Vascular instability
• Hot flashes or hot flushes, including night sweats and, in a few people, cold flashes
• Possible but contentious increased risk of atherosclerosis
• Migraine
• Rapid heartbeat
Urogenital atrophy
• Thinning of the membranes of the vulva, the vagina, the cervix, and also the outer urinary tract, along with considerable shrinking and loss in elasticity of all of the outer and inner genital areas.
• Itching
• Dryness
• Bleeding
• Watery discharge
• Urinary frequency
• Urinary incontinence
• Urinary urgency
• Increased susceptibility to inflammation and infection, for example vaginal candidiasis, and urinary tract infections
Skeletal
• Back pain
• Joint pain, Muscle pain
• Osteopenia and the risk of osteoporosis gradually developing over time
Skin, soft tissue
• Breast atrophy
• breast tenderness +/- swelling
• Decreased elasticity of the skin
• Formication (itching, tingling, burning, pins and needles, or sensation of ants crawling on or under the skin)
• Skin thinning and becoming drier
Psychological
• Depression and/or anxiety
• Fatigue
• Irritability
• Memory loss, and problems with concentration
• Mood disturbance
• Sleep disturbances, poor quality sleep, light sleep, insomnia
Sexual
• Dyspareunia or painful intercourse
• Decreased libido
• Problems reaching orgasm
• Vaginal dryness and vaginal atrophy
PATHOPHYSIOLOGY
During climacteric, ovarian activity declines. Initially, the ovulation fails, no corpus luteum is formed and no progesterone is secreted by the ovary. Thus the menstrual cycles tend to become anovulatory and irregular (Metropathia haemorraghica).Later oestrogenic activity also diminishes and atrophic endometrium ensues, leading to menopause. As a result of cessation of ovarian activity, and fall in estrogen level, there is a rebound increase in secretion of FSH by the anterior pituitary gland. FSH level may rise as much as 50 fold, thus making menopausal urine a commercial source of Gonadotrophin(HMG). With further advancing years, gonadotrophin activity of the anterior pitiuitary also ceases and a fall in the level of FSH is eventually noticed .
CHANGES IN THE GENITAL TRACT
These changes are of atrophic type and affect the external genitalia as well as the internal organs. They take time to occur – over a number of years. Not only the main pelvic structures reduced in size but, more importantly, the fascial framework and the intra pelvic ligaments supporting the bladder and the genitalia are weakened;this may lead to complications.
Vulva: This shows the flattening of the labia majora, the minor labia becoming more evident. Sexual hair become grey and sparse. The clitoris shrinks.
Uterus: The uterus becomes small with a relatively large cervix- return to infantile proportions.
Tubes and ovaries: These show great shrinkage, the tubes becoming thin, while the ovaries are reduced to small white wrinkled bodies 2-3 cm in length. In addition to the shrinkage of the vaginal introitus, the vagina diminishes in length and its secretions are limited, leading to sexual problems. Changes in the vaginal epithelium increase these problems.
PRINCIPAL CHANGES IN THE SERUM HORMONE LEVELS
Once menopause is well established , the plasma estrogen level may remain low at 10 to 20 pg/ml. Oestrone level varies between 30 and 70 Pg/ml. the ovary also secretes a small amount of testosterone which may be responsible for mild hirsutism noticed after the menopause. The gonadotrophin hormone (FSH) appears in high concentration at menopause, because it is not inhibited by the prevailing low levels of estrogen.
Mensturation may gradually decrease, suddenly cease or become irregular. Oestrogen levels fall over the 5 years preceding ovarian failure which occurs usually between 45 and 50 years of age, with an average around 50 years. The fall in oestrodiol has a positive feedback on the pitiuitary, increasing production of FSH and LH.
The ovaries eventually produce androstenidione, which is also produced by the adrenals, and is converted in peripheral fat into weak oestrogen oestrone
INVESTIGATIONS
Assessment and evaluation prior to initiating treatment:
The following plan is recommended, it helps in finding the actual pathology and progress of symptoms, which helps in finding the constitutional or antimiasmatic remedies and further way of treatment.
1. Detailed family and personal history, physical examination - height , weight and BP.
2. Examination of breast.
3. Pelvic examination.
4. Evaluation of menopausal symptoms and need for medication.
5. Evaluation of the individual risks versus benefits from treatment.
6. Routine screening tests like blood routine, urine routine, Fasting and post prandial blood sugars.
7. Lipid profile and cardiovascular risk assessment. (Plasma lipids have been known to be altered by the with in month variations in the female hormonal system. The early menopausal subjects shows a significant increase in the total cholesterol level and slightly higher in late menopausal subjects.)
8. Transvaginal sonography and assessment of endometrial thickness.
9. Routine mammography.
10. Endometrial histology – in cases of post menopausal bleeding or family history of uterine cancer. Or past history of late menopause, infertility, and PCOD.
HORMONE REPLACEMENT AND ALLIED THERAPY
The basic objective of oestrogen replacement therapy is to increase the circulating levels of oestrogen to physiological levels of 45- 200 pg / ml to alleviate the climacteric symptoms resulting from oestrogen deficiency. Semi- synthetic hormones are used for hormone replacement therapy (HRT) because they are more physiologic in their actions. HRT can be administered in the form of oral medications, dermal patches or gels for local application, depending on the patients needs.
There are many contraindications to HRT as follows:
Conventional therapy majorly depends on the Hormone replacement therapy (HRT). But many studies suggest that HRT has got many unwanted side effects. For example, the results of a major study, called women’s health initiative (established by the Government of United States of America), had explored many health risks. In fact this important study was stopped early because the health risks outweighed the health benefits. Women taking the hormones greatly increased their risk for breast cancer, heart attacks, strokes and blood clots. However all hormone replacement therapies probably do carry some health risks, including high blood pressure, blood clots, and increased risks of breast and uterine cancers.
1. Presence of active endometrial cancer and hormone dependent tumours.
2. Active breast cancer and oestrogen progesterone receptor positive cancers.
3. Presence of or suspicion of pregnancy.
4. Undiagnosed vaginal bleeding.
5. Severe liver disease or abnormal liver function tests.
6. Acute vascular thrombosis.
7. History of thrombo embolism.
8. Estrogen dependent vascular thrombosis.
Other relative symptoms are - Strong family history of breast cancer, History of migraine and severe headaches. Thrombo phlebitis, uterine fibroids, Endometriosis, Gall bladder disease, Glucose intolerance.
HOLISTIC APPROACH TO MENOPAUSE
A holistic approach considering the lifestyle, personal habits, food habits, inclusion of nutrients and herbal diet, etc. along with homoeopathic treatment helps in overcoming menopausal symptoms. Information on each such intervention has been given under respective titles.
I. Life style changes and personal habits:
1. Exercises- Brisk walking fro 40 – 60 minutes atleast 5 times/week.
2. Physical workouts-Weight bearing exercises for limbs and back strengthening.
3. Yoga and meditation- Breathing exercises (Pranayama) beneficial in reducing stress.
4. Simple diet- Containing liberal amounts of vegetables and fruits (fibres and vitamins) lower contents of saturated fats and restricted sugar content.
5. Fluid intake- Consume fluids liberally to maintain tissue hydration.
6. Control or abstain- Smoking , alcohol intake, unrestricted consumption of tea / coffee.
II. Herbs and plant products:
Plants are a source of phyto oestrogens which have mild oestrogenic and some anti estrogenic effects. Soya has been the most extensively investigated plant. Phytooestrogens are a source of aglycones and isoflavones, coumestones and lignans.common Indian foods rich in phytooestrogens- isoflavons are found in Bengal grams, cereals fruits like apples and berries,and red clover. Lignans in whole grain, pulses, legumes and beans, sunflower seeds and saponins in herbs like turmeric fenugreek or methi ginger and also in root vegetables yam and grains.
An intake of 50 mg of isoflavones per day has been beneficial in reducing hot flushes, preventing osteoporosis, reducing ldl cholesterol. Also there is an evidence that soya exerts a protective action against breast cancer. The hot flushes can be managed with Wearing cool clothing, Drinking cold water or juice at the onset of flush, shower with tepid water.
III. Micronutrients and antioxidants:
These are essential to the body and required in very small amounts. These include vitamins minerals, essential amino acids, essential fatty acids. Many of these are antoxidants also. Antoxidants protects against the tissue damage. Menopausal women are vulnerable because of the loss of the protective effects of oestrogens and the age related effects.
IV. Calcium and vitamin D3:
In ageing women, the need for calcium supplementation increases to about 1000- 1500 mg / day Provided the calcium should be properly absorbed and utilized. Thus it slows down the process of age related osteoporosis.
This has been justified by Ried et al in 1993 in their research with supplementation of calcium carbonate and lactate- gluconate to post menopausal women in doses of 1 gm / 24 hours for 5 years and demonstrated significantly slowed axial and appendicular bone loss.
Chapuy et al in 1992 has demonstrated both suppression of bone loss and reduction of fracture.
IV. Calcitonin:
Many clinical studies have produced evidence to suggest that calcitonin is able to prevent bone loss in the spine in post menopausal women. Calcitonin injection has been known to cause side effects like nausea and vomiting , flushing and intertrigo, intranasal administration remains another alternative.
V. Biphosphonates:
These are stable active analogues of pyrophosphate, which act by inhibiting bone resorption. These compounds are worth considering in women in whom oestrogens are contraindicated, or for those averse to Hormone Replacement Therapy.
Aroma therapy, Herbalism, Accupressure, Accupuncture, Nutrition and supplements can be suggested as the supportive line of treatments for menopausal complaints.
HOMOEOPATHIC APPROACH
The advantage of homoeopathy is that it considers the patient as whole. Since the symptoms of menopause are not limited to one system or location, a drug selected on the totality is of more helpful than the “single complaint specific drugs”. Our repertory has covered the menopausal symptoms directory or indirectly. Below is a reportorial analysis on the common symptoms of menopause. Therapeutics of menopause follows the analysis.
THERAPEUTICS
Many authors have discussed about the drugs that are commonly indicated during the time of menopause or the climaxis, as referred to in many of the writings. The commonly indicated remedies for General Menopausal symptoms are Amyl Nitrosum, Belladona, Bellis perennis, Cactus grandiflorus, Calcarea carbonicum., Caulophyllum, Cimicifuga racemosa, Castoreum, Conium ,Crotalus Horridus, Erigeron, Gelsemium, Glonine, Graphitis., Kali-carbonicum, Kreosotum, LACHESIS, Manganum, Mag.phos , Murex., Nux-vomica, Nux moschata, Oophorinum, Psorinum, Pulsatilla , Sabina, Sangunaria, Sepia, Sulphur, Sulphuric acid, Thlasi bursa , Tuberculinum, Ustiligo, Vibrunum opulus and Zincum Valerianum.
Aliments from menopause
Lachesis. (It’s a Well Specific Remedy for Menopause)
Ailments during menopause
For hot flashes and night sweats: Amyl nitrosum, Belladonna, Ferrum metallicum, Lachesis, Pulsatilla, Pilocarpus microphyllus, Sepia and Valeriana.
For sleeplessness (insomnia): Aconitum napellus, Arsenicum album, Belladonna, Chamomilla, Coffea crude, Lycopodium clavatum ,Passiflora incarnata, Sulphur and Viburnum opulus.
For constipation: Hydrastis, Iris versicolor. Magnesia muriatica, Magnesia phosphorica and Sepia
For incontinence of urine: Pulsatilla and Zincum metallicum.
For vaginal dryness: Aconitum napellus, Apis mellifica, Belladonna, Bryonia, Ferrum phosphoricum Hydrophobinum, Lycopodium, Natrum muriaticum and Spiranthes.
For depression, fear, nervous or irritability: Aconitum napellus, Amyl nitrosum, Arum Metallicum, Borax, Chamomilla, Ignatia amara, Lachesis, Nux vomica, Passiflora incarnata, Sepia, Stramonium and Viburnum opulus.
For bone related problems like Osteophorosis: Bellis perennis and Calcarea carbonica
For menorrhagia: Lachesis, Sepia, Argentum mettalicum and Cimicifuga racemosa
For painful and enlarged breast: Sangunaria
For painful breast: Cimicifuga racemosa
For burning, palm, sole and vertex: Sulphur, Sangunaria and Lachesis
For excessive perspiration: Sepia
For earache: Gelsimium
For rheumatic pain: Caulophyllum
For headache: Glonine, Sangunaria, Sepia and Cimicifuga racemosa
Wednesday, 27 July 2011
COPD
OBSTRUCTIVE AIR WAY DISORDERS
DEFINITION
In this Condition there is chronic obstruction to the alveolar in flow of air either due to chronic Bronchitis and / or emphysema and / or Bronchial Asthma.
Chronic Bronchitis may be complicated with emphysema but there may be predominance of any of them. Bronchial asthma also causes generalized airway obstruction and is dealt with separately. There may be considerable over lapping of these three diseases.
CHRONIC BRONCHITIS
DEFINITION
Ch. Bronchitis may be defined as a disease characterized by cough and sputum for at least 3 consecutive months in a year for more than 2 successive Years.
AETIOLOGY
Smoking
Atmospheric Pollution
Infection
Occupation (Coal miners)
Familial and genetic abnormalities associated with alpha1 , antitrypsin deficiency -may also be present.
Pathology
Develops airway wall inflammation
Hypertrophy of mucus secreting Glands and increases in the number of Goblet cells in bronchi and bronchioles with consequent
Decrease in ciliated cells,
Obstruction of air flow.
Pathology for Cyanosis
Due to uneven distribution of the inspired air
There may be diminished diffusing capacity
Airway obstruction gives rise to ventilation perfusion in equality.
Resulting in increased paco2 and decreased pao2 with severe ventilatory failure there is falling pH together with compensatory decrease in plasma bicarbonate and respiratory acidosis.
Cyanosis
Clinical Features
Gradual onset
Cough with expectoration: It is usually starts as attacks of “winter cough” and “Smoker’s cough”. Gradually increasing in severity and duration, the expectoration is mucoid (or) mucopurulent depending on the presence of infection.
Some time there may be haemoptysis.
Shortness of breath due to airway obstruction.
SIGNS
Respiratory rate is hurried
Central cyanosis may be present.
Chest may show no signs on examinations (or) there may be prolonged expiration with transient rhonchi present.
INVESTIGATION
Blood Count: May show leucocytosis in presence of acute infection.
Polycythaemia may develop in long standing cases.
X Ray Chest
Does not show any characteristics change.
Bronchography
May show irregularities of Bronchial lumen,
Pulmonary function test: May chow some impairment due to development of emphysema, simple measurement of ventilatory capacity and arterial Paco2 may help to determine the severity of airway obstruction.
Complication
- Emphysema
- Bronchiolar Spasm
- Bronchiectasis
- Rt heart failure (ch. Cor pulmonale).
EMPHYSEMA
Def:
It is a condition of generalized over distension of the lung alveoli with Rupture of interalveolar septae, over aeration of the alveoli, loss of alveolar elasticity, impairment of pulmonary function and increased lung volume due to various causes.
Aetiology:
- Chronic Bronchitis and chronic Bronchial asthma are common predisposing causes.
- In association with fibrotic pulmonary disease such as silicosis.
C/F:
- Breathlessness (exertional dyspnoea)
- Cough with expectoration are due to associated chronic bronchitis, they usually develop before the onset of breathlessness.
- Wheezing sound present.
Sign:
- Pink buffer cyanosis is present
- Clubbing of finger present
- Respiration rate hurried.
Examination:
Inspection : Barrel shaped chest
Palpation : Vocal fermitus is diminished
Percussion : Hyper Resonant note present
Auscultation : Rhonchi present
- X Ray Chest:
- Marked radio translucent lung fields with the fine vascular striations particularly at the periphery.
- Low and flat diaphragm.
Lung Function Tests:
Blood gas analysis shows Pao2 less than 50 torr and Paco2 more than 50 torr indicative of Respiratory failure.
Complication:
- Rt heart failure
- Spontaneous pneumothorax
BRONCHIAL ASTHMA
Def:
Asthma is defined as a chronic inflammatory disorder of the airways, characterized by Reversible airflow obstruction causing cough, wheeze, chest tightness and shortness of Breath.
Types:
- Early onset asthma (or) atopic
- Late onset asthma (or) Non-atopic
1. Early Onset Asthma:
- Commonly encountered in child hood.
- Family History of this disorder present.
- These individuals are usually atopic.
- Allergic skin tests positive
- IgE level raised
- H/o Allergy present
2. Late Onset Asthma:
- It occurs in any age.
- No family history disorders.
- Non-atopic individuals
- Extrinsic allergens play no part.
- Skin Hyper sensitivity test negative
- IgE level normal.
Aetiology:
- Infections
- Cigarette Smoking
- Temperature and Humidity
- Psychological factors
- Exercise
- Allergy
Triggers of the Asthmatic Response:
- Cold Air, Tobacco, Smoking, Dust, Acid Fumes, Resp. Viral infection and emotional stress.
- In children and young adults exposure to cold air and excretion.
- Previous exposure to antigents stimulate the formation of IgE antibody in the brochi, further on exposing in the allergens.
C/F:
- Episodic Asthma
- Chronic Asthma
- Severe Acute Asthma
1. Episodic:
- Paroxysms of wheeze and breathlessness may occur at any time and can be of sudden onset.
- Episodic asthma may be triggered by Allergens, exercise and Viral infections.
- The attacks may be mild (or) severe lasting for few hours, days (or) weeks.
- Atopic individuals with episodic asthma are worse in summer, when they are heavily exposed to allergens.
2. Chronic Asthma:
- Symptoms of chest tightness, wheeze and Breathlessness on exertion together with spontaneous cough and wheeze during night.
- Cough with mucoid sputum with recurrent episodes of Resp. infection is common.
- Chronic asthma pt. Are worse in winter due to increased exposure to viral infection.
3. Severe Acute Asthma (or) “Status Asthmaticus”
This term has replaced status asthmaticus which in life threatening at time of asthma.
- The patient often has an unproductive cough.
- Respiratory symptoms such as chest tightness and breadthlessness are accompanied by tachycardia, Pulsus Paradoxis, Sweating, and Central Cyanosis.
- The Pt adopts an upright position fixing the shoulder muscle to assist the accessory muscles of respiration.
Signs:
- During an attack when the chest is held in full inspiration, the percussion note is hyper resonance.
- Broncho vesicular Breath sound present.
- Added sounds – Rhonchi, High pitched polyphonic inspiratory and expiratory Rhonchi.
- In severe asthma airflow may be insufficiency of produce a Rhonchi and chest remains silent – it is a “Ominous Sign”.
INVESTIGATION
X ray chest
In an acute attack the lungs appears hyper inflated.
In between the episodes the chest x ray is normal.
Pigeon shaped deformity can be demonstrated on a lateral view x ray.
In severe acute asthma pneumothorax may be seen.
X ray may show mediastinal (or) subcutaneous emphysema.
Pulmonary Function Test:
- Measurement of force expiratory volume in one second, vital capacity and peak expiratory volume with given indication to the degree of airflow obstruction.
Arterial Blood Gas Analysis:
Measurement of partial pressure of PO2 and PCO2 is required in the management sever acute asthma.
Skin hypersensitivity test: It is depends upon the individuals.
Complications:
- Status asthmaticus
- Secondary infection – Bronchitis, Tuberculosis.
- Emphysema of lung
- Rt. Heart failure
- Bronchiectasis.
Homoeopathic Management (Murphy repertory)
Bronchitis. Chronic
Ant.tart hep
Am.carb hydr
ant .s ipecac
ars.alb kali bic
ars.iod kaliod
bac lyco
bar.m nit.ac
calc puls
canth seneg
carb. v stann
cop sulph
Emphysema
Am.carb calc.s
Ant.ars camph
Ant.Tart carb.veg
Hepar chlor
Lachesis dig
Loblia ip
Sil lyc
Ars merc
aur.m Nat.m
bell phos
brom stry
calc.p
From, smoking
am.c
calad
Bronchial asthma
Ambr lobil
Arg. Nit Nat.s
Ars puls
Ars.iod samb
Baltta sil
Carci spong
Cupr stram
Ip sulph
Kali ars visc
Kali carb Grindilia
Kali Nit
DEFINITION
In this Condition there is chronic obstruction to the alveolar in flow of air either due to chronic Bronchitis and / or emphysema and / or Bronchial Asthma.
Chronic Bronchitis may be complicated with emphysema but there may be predominance of any of them. Bronchial asthma also causes generalized airway obstruction and is dealt with separately. There may be considerable over lapping of these three diseases.
CHRONIC BRONCHITIS
DEFINITION
Ch. Bronchitis may be defined as a disease characterized by cough and sputum for at least 3 consecutive months in a year for more than 2 successive Years.
AETIOLOGY
Smoking
Atmospheric Pollution
Infection
Occupation (Coal miners)
Familial and genetic abnormalities associated with alpha1 , antitrypsin deficiency -may also be present.
Pathology
Develops airway wall inflammation
Hypertrophy of mucus secreting Glands and increases in the number of Goblet cells in bronchi and bronchioles with consequent
Decrease in ciliated cells,
Obstruction of air flow.
Pathology for Cyanosis
Due to uneven distribution of the inspired air
There may be diminished diffusing capacity
Airway obstruction gives rise to ventilation perfusion in equality.
Resulting in increased paco2 and decreased pao2 with severe ventilatory failure there is falling pH together with compensatory decrease in plasma bicarbonate and respiratory acidosis.
Cyanosis
Clinical Features
Gradual onset
Cough with expectoration: It is usually starts as attacks of “winter cough” and “Smoker’s cough”. Gradually increasing in severity and duration, the expectoration is mucoid (or) mucopurulent depending on the presence of infection.
Some time there may be haemoptysis.
Shortness of breath due to airway obstruction.
SIGNS
Respiratory rate is hurried
Central cyanosis may be present.
Chest may show no signs on examinations (or) there may be prolonged expiration with transient rhonchi present.
INVESTIGATION
Blood Count: May show leucocytosis in presence of acute infection.
Polycythaemia may develop in long standing cases.
X Ray Chest
Does not show any characteristics change.
Bronchography
May show irregularities of Bronchial lumen,
Pulmonary function test: May chow some impairment due to development of emphysema, simple measurement of ventilatory capacity and arterial Paco2 may help to determine the severity of airway obstruction.
Complication
- Emphysema
- Bronchiolar Spasm
- Bronchiectasis
- Rt heart failure (ch. Cor pulmonale).
EMPHYSEMA
Def:
It is a condition of generalized over distension of the lung alveoli with Rupture of interalveolar septae, over aeration of the alveoli, loss of alveolar elasticity, impairment of pulmonary function and increased lung volume due to various causes.
Aetiology:
- Chronic Bronchitis and chronic Bronchial asthma are common predisposing causes.
- In association with fibrotic pulmonary disease such as silicosis.
C/F:
- Breathlessness (exertional dyspnoea)
- Cough with expectoration are due to associated chronic bronchitis, they usually develop before the onset of breathlessness.
- Wheezing sound present.
Sign:
- Pink buffer cyanosis is present
- Clubbing of finger present
- Respiration rate hurried.
Examination:
Inspection : Barrel shaped chest
Palpation : Vocal fermitus is diminished
Percussion : Hyper Resonant note present
Auscultation : Rhonchi present
- X Ray Chest:
- Marked radio translucent lung fields with the fine vascular striations particularly at the periphery.
- Low and flat diaphragm.
Lung Function Tests:
Blood gas analysis shows Pao2 less than 50 torr and Paco2 more than 50 torr indicative of Respiratory failure.
Complication:
- Rt heart failure
- Spontaneous pneumothorax
BRONCHIAL ASTHMA
Def:
Asthma is defined as a chronic inflammatory disorder of the airways, characterized by Reversible airflow obstruction causing cough, wheeze, chest tightness and shortness of Breath.
Types:
- Early onset asthma (or) atopic
- Late onset asthma (or) Non-atopic
1. Early Onset Asthma:
- Commonly encountered in child hood.
- Family History of this disorder present.
- These individuals are usually atopic.
- Allergic skin tests positive
- IgE level raised
- H/o Allergy present
2. Late Onset Asthma:
- It occurs in any age.
- No family history disorders.
- Non-atopic individuals
- Extrinsic allergens play no part.
- Skin Hyper sensitivity test negative
- IgE level normal.
Aetiology:
- Infections
- Cigarette Smoking
- Temperature and Humidity
- Psychological factors
- Exercise
- Allergy
Triggers of the Asthmatic Response:
- Cold Air, Tobacco, Smoking, Dust, Acid Fumes, Resp. Viral infection and emotional stress.
- In children and young adults exposure to cold air and excretion.
- Previous exposure to antigents stimulate the formation of IgE antibody in the brochi, further on exposing in the allergens.
C/F:
- Episodic Asthma
- Chronic Asthma
- Severe Acute Asthma
1. Episodic:
- Paroxysms of wheeze and breathlessness may occur at any time and can be of sudden onset.
- Episodic asthma may be triggered by Allergens, exercise and Viral infections.
- The attacks may be mild (or) severe lasting for few hours, days (or) weeks.
- Atopic individuals with episodic asthma are worse in summer, when they are heavily exposed to allergens.
2. Chronic Asthma:
- Symptoms of chest tightness, wheeze and Breathlessness on exertion together with spontaneous cough and wheeze during night.
- Cough with mucoid sputum with recurrent episodes of Resp. infection is common.
- Chronic asthma pt. Are worse in winter due to increased exposure to viral infection.
3. Severe Acute Asthma (or) “Status Asthmaticus”
This term has replaced status asthmaticus which in life threatening at time of asthma.
- The patient often has an unproductive cough.
- Respiratory symptoms such as chest tightness and breadthlessness are accompanied by tachycardia, Pulsus Paradoxis, Sweating, and Central Cyanosis.
- The Pt adopts an upright position fixing the shoulder muscle to assist the accessory muscles of respiration.
Signs:
- During an attack when the chest is held in full inspiration, the percussion note is hyper resonance.
- Broncho vesicular Breath sound present.
- Added sounds – Rhonchi, High pitched polyphonic inspiratory and expiratory Rhonchi.
- In severe asthma airflow may be insufficiency of produce a Rhonchi and chest remains silent – it is a “Ominous Sign”.
INVESTIGATION
X ray chest
In an acute attack the lungs appears hyper inflated.
In between the episodes the chest x ray is normal.
Pigeon shaped deformity can be demonstrated on a lateral view x ray.
In severe acute asthma pneumothorax may be seen.
X ray may show mediastinal (or) subcutaneous emphysema.
Pulmonary Function Test:
- Measurement of force expiratory volume in one second, vital capacity and peak expiratory volume with given indication to the degree of airflow obstruction.
Arterial Blood Gas Analysis:
Measurement of partial pressure of PO2 and PCO2 is required in the management sever acute asthma.
Skin hypersensitivity test: It is depends upon the individuals.
Complications:
- Status asthmaticus
- Secondary infection – Bronchitis, Tuberculosis.
- Emphysema of lung
- Rt. Heart failure
- Bronchiectasis.
Homoeopathic Management (Murphy repertory)
Bronchitis. Chronic
Ant.tart hep
Am.carb hydr
ant .s ipecac
ars.alb kali bic
ars.iod kaliod
bac lyco
bar.m nit.ac
calc puls
canth seneg
carb. v stann
cop sulph
Emphysema
Am.carb calc.s
Ant.ars camph
Ant.Tart carb.veg
Hepar chlor
Lachesis dig
Loblia ip
Sil lyc
Ars merc
aur.m Nat.m
bell phos
brom stry
calc.p
From, smoking
am.c
calad
Bronchial asthma
Ambr lobil
Arg. Nit Nat.s
Ars puls
Ars.iod samb
Baltta sil
Carci spong
Cupr stram
Ip sulph
Kali ars visc
Kali carb Grindilia
Kali Nit
Thursday, 16 June 2011
Nails- Importance in diagnosis
Nails- Importance in diagnosis
Our nails are a sign of our health. The colour shape, contour of our nails can tell us if our body is in a healthy state.
Nail disorders
Changes in nail are generally not diagnostic of a specific systemic or skin disease .all of the nail changes of systemic disorders may be seen without systemic disease.
Examination of nails helps us sometimes to diagnose a case clinically. Simultaneously we should not forget the value of study of nail changes in Homoeopathic practice
Different nail abnormalities Associated conditions
Platynychia (flat nails) Iron deficiency anemia
Koilonychia (spoon shaped nails) Iron deficiency anemia
Leuconychia (white nails) congenital or acquired
Hypoalbuminemea,
Nephrotic Syndrome
Chronic liver disease
Protein loosing enteropathy.
Onycholysis (Separation of nail from bed) Lichen planus, thyrotoxicosis Psoriasis.
Missing nail Nail patella syndrome.
Half & Half nail Proximal half- white and distal half
pink or red seen in chronic renal failure
Beau’s line
(Transverse ridges over the nails) Indicates stoppage of nail Growth temporarily. Affects all nails and appear after few week of illness. As the nail growth ridges also move to the distal part.
Mee’s line single or multiple which transverse bands on the nail- inorganic arsenic poisoning
Muehrcke’s line Narrow, white transverse bands occurring in pairs - associated with hypoalbuminaemia, they may disappear when serum albumin level is normalized
Longitudinal ridges Seen in lichen plannus and rheumatoid arthritis.
Nail bed infarct Vasculitis syndromes
Pitted Nails Psoriasis, Alopecia, eczema, ring worm infestation.
Blue Seen in cyanosis, antimalarial drugs, haematoma
Blue green In pseudomonas infection in chronic paronychia
Brown longitudinal streaks In fungal infections, staining from cigarettes
Red streaks
(Splinter hemorrhages) Infective endocarditis, trauma.
Yellow In psoriasis, fungal infections, trauma, jaundice,
* Clubbing Bulbous enlargements of distal segments of fingers and toes.
Causes;
a) Cardiovascular:
Acquired --- infective endocarditis.
Congenital---cyanotic congenital heart disease.
b) Respiratory;
-Brochiectasis
- Lung abscess.
-Bronchogenic carcinoma.
-Tuberculosis with secondary infection.
-Empyema
-Interstitial lung disease
c) Gastrointestinal;
-ulcerative colitis,
-Crohns’disease.
-Malabsorbtion syndrome.
d) Hepatic
-cirrhosis of liver.
e) Endocrine;
-Myxedema.
- Acromegaly.
-Thyroid acropachy,
f) Congenital & idiopathic clubbing.
Homoeopathic drugs according to the Nail colour, changes.
Discoloration, Nails _ Ant. c, Ars, Graph, Nit.ac, Thuja.
Black - Ars, Graph, Lept, Nat-m.
Blood, settles under Nails _ Apis.
Blueness _ Arg.n, Ars, Aur, camph, Carb.v, Chel,Chin, chin.s, Cupr, Dig, Dros, Ferr, Graph, Mez,
Nat.m, Nit.a, Nux.v, Ox.ac, Pet, Sil, Sulph,Thuja, Verat.
Dark _ Morp, Ox.ac,
Gray _ Mer.c, Sil,
Purple _ Apis, Ars, Op, samb, sec, stram,
Red _ Ars, Crot.c, Lith,
-Then black - Ars.
White - Cup, Nit.ac.
-Spots - Alum, Ars, Nit.ac, Sep, Sil, sulph,
Yellow - Ambr, Bry, Carbo.v, Con, Lyco, mer Nit.ac, Nux.v. Op, Sep, Sil, Sipg, Sulp,
Cracked Nails - Ant.c, Ars, Nat.m, Sil,
Curved finger Nails - Nit.ac.
Distorted, Nails - Alum, Fl.ac, Graph, Merc, Sep, Sil, Thuja.
In growing, Nails - Caust, Graph, Mag-aust, Nat.M, Nit.ac, Ph.ac, sil, Sulph, Teucr, Thuja,
Splinters, Nails - Alum, Ars, Nit.ac, Ph.ac, Sep, Sil, Sulph, Tub.
Spotted, Nails - Alum, Ars, Nit.ac, Ph.ac, Sep, Sil, Sulph, Tub.
Ulcers, fingernails - Bov, Hep, Merc, Nat.M, Sil, sulph, thuja,
Panaritium nails - All.c, Am.c,Am.m, Anac, Anthr, Apis, Benz.ac, Bufo, Calc, Caust, Cist, Dios, Fl.ac, Hep, Hyper, iod, iris, lach, lyc, Merc, nat.c, Nat.m, Nat.s, Nit.ac, Phyt, Rhus.tox, Sang, Sep, sil, Sulph, Tarent.c,
NOTE: Close observation and minute study about the nails is important for clinical diagnosis and also to select a remedy while treating homeopathically
Saturday, 2 April 2011
IMPOTENCE
Sex is important for the normal physical and mental development of an individual. Thus sexual disorders of any type will have some deleterious effects.
IMPOTENCY
This is a male sexual disorder, whereby a male cannot maintain an erection of penis during copulation.
Impotence is a very delicate yet complex topic for a practitioner. Although a lot of passions are involved around the sexual life of a human being, this topic is poorly understood and requires thorough education of the patient. An attempt has been made here to resolve the mysteries regarding impotence.
Above the age of 65 years about 25% males develop impotence. Most of the cases have a psychogenic cause.
NORMAL CHANGES WITH AGE
Although sexual activity normally continues throughout man’s life time, the response varies with age. He takes longer to climax and his erections may come and go. He needs more recycling time before he can get another erection.
The 20’s: A young man needs little stimulation and can get an erection in a few minutes. He usually climaxes quickly but he can regain his erection in minutes.
The 40’s: With age there is more need of direct stimulation and fantasy. An erection takes several minutes, climax is slower and erection can be regained only after an hour or so.
The 60’s: An older man needs even more direct stimulation and fantasy. He takes longer to get an erection, can maintain it longer. But may take a day (or) more to regain it.
PHYSIOLOGY OF A PENILE ERECTION
The penis consists of corpus cavernosum; two spongy paired cylinders contained in a thick envelope, the tunica albuginea, and corpus spongiosum and glans with very thin tunica, in both the structures, with in the tunica are numerous sinusoids among the interwoven trabeculae of the smooth muscles and supporting connective tissue that harbour the terminal cavernous nerves and arterioles, the paired internal pudendal artery is the main source of blood supply to the penis while venous drainage is through multiple small veins to dorsal vein and then internal pudendal vein.
The nerve supply of the penis plays an important role in erection. The penis is innervated by 2 sets of nerves; autonomic nervous system (sympathetic and parasympathetic) and somatic nerves (sensory and motor). From the neurons in the spinal cord and peripheral ganglia the sympathetic and parasym-pathetic nerves merge to form the cavernous nerves and these nerves are responsible for neurovascular events during erection and detumescence. The somatic nerves are responsible for sensation of penis and contraction of the bulbocavernous and ischiocavernous muscles.
The parasympathetic supply comes from 2,3 and 4 sacral spinal cord segments which is responsible for tumescence (erection) while sympathetic supply comes from thoracic 11 to lumbar 2 spinal segment, which is responsible for detumencence (ejaculation). The sensory pathways go via dorsal nerves of penis to internal pudendal nerve to dorsal roots of 2nd to 4th nerves of spinal cord and spino thalamic tract to the thalamus and sensory cortex of brain. Onuf’s nucleus is the centre of somatomotor penile innervation. These nerves travel in the sacral nerves to the pudendal nerves to innervate bulbocavernosus and ischioca-vernosus muscles.
The contraction of the ischiocavernosus muscle causes rigid erection phase while rhythmic contractions of the bulbocavernous muscles expels the semen down the narrowed urethral lumen and results in external ejaculation from the meatus.
The spinal erection centres are located at intermedilateral column of the sacral cord and sends processes in to the areas of laminate 5 and 7 and the dorsal commissure. In the brain medial preoptic area (MPOA) is the important integration centre for sexual drive and penile erection.
According to nature of stimulus there are 3 types of erections.
1. Reflexogenic Erection
This erection is provided by tactile stimulus to the genitalia and is mediated through lower spinal centres.
2. Psychogenic Erection
This erection originates from audiovisual impulses and fantasies and signals are mediated through brain to spinal centres.
3. Nocturnal Erection
This type of erection occurs during REM sleep through unknown mechanism.
PATHOPHYSIOLOGY OF IMPOTENCE
1. Psychogenic Importance
Psychogenic stimuli (Visual impulses, fantasies) themselves are very strong inducers of erection and also can enhance the erection induced by Genital Stimulus. On the other hand, anxiety (or) depression, religious inhibitions, sexual phobias or deviation, obsessive compulsive personality or a traumatic past experience can send strong messages from brain to inhibit or to terminate erection. This inhibition is through a direct inhibition from brain to the spinal centres or through increased level of peripheral catecholamine that renders cavernous smooth muscles less sensitive to neuro-transmitters.
2. Neurogenic Impotence
Lesions affecting brain like cerebrovascular accidents, park-inson or Alzheimer’s disease, tumors, injury etc, act through direct central hypothalamic suppression or over inhibition of spinal centres.
A dysfunction at spinal level e.g. spinabifida, disc herniation, syringomyelia, tumor and multiple sclerosis may affect either efferent or afferent nerve pathways.
Neuropathy such as seen in alcoholism, vitamin deficiency or diabetes may affect cavernous nerve terminals leading to impotency. Injury to cavernous nerve or pudendal nerve from pelvic injury or surgery may disrupt the neural pathway causing impotence.
3. Arteriogenic Impotence
Diseases of terminal aorta or the hypogastric, pudendal, or penile arteries can results in erectile failure; trauma or congenital anomaly can cause arterial insufficiency. But generalized atherosclerotic process due to hypercholesterolemia, cigarette smoking, diabetes, radiation, hypertension and perineal trauma are more common cause of arteriolar impotence.
4. Venous Impotence
Abnormal venous channel following a shunting operation for priapism. Tunical abnormality as in pyronie’s disease or functional impairment of the cavernous erectile tissue can cause venous impotence.
5. Hormonal Impotence
Diabetes mellitus in an important cause for impotence but acts not mainly through hormonal changes but through vascular, neurologic and psychologic causes.
Androgens are essential for male sexual maturity but testosterone is not absolutely essential for erection. Therefore androgen replacement therapy is absolutely indicated in cases of hypogonadism only.
Hypothalamic pituitary Gonadal axis dysfunction can result in hypogonadism, Hypogonadotrophic hypogonadism can be due to malignancy, injury or aging while hypergonadotrophic Hypogondism can be due to diseases of testes like malignancy, surgery, injury or mumps.
Hyperprolactinemia caused by pituitary adenoma, chronic renal failure, or medication can result in lowered testosterone levels leading to impotence. Hyperthyroidism and hypothyroidism can also affect sexual function.
6. Erectile tissue dysfunction
Pyronie’s disease, trauma, diabetes, tumor infiltration, scleroderma, and priapism all these lead to gross microscopic changes as well as macroscopic changes in erectile tissues of penis.
7. Impotence from aging, systemic disease and other causes.
Hypothalamic pituitary dysfunction leading to testosterone deficiency is responsible for impotence of old age, the other factors like psychogenic, vascular, neurogenic etc. also add to the problem.
Chronic renal disease needing dialysis also leads to impotence in around 50% patients. Myocardial infarction, angina, heart failure, and Emphysema patients develop impotence. One of the reasons being, they fear aggravation of the disease following intercourse. Others diseases like liver cirrhosis, sclerdoderma, chronic debility and cachexia also can cause impotence.
CAUSES OF IMPOTENCY
The normal sexual function can be divided into five events each of which is under diverse regulation, libido, erection, ejaculation, orgasm and detumescence. Hence anything hampering the normal sexual functions will give rise to impotency as stated below;
1. Loss of desire
In a small percentage of organic cases, pituitary or testicular disease gives rise to androgen deficiency which in turn causes a decreased libido; hypogonadism also gives rise to such states.
2. Failure of erection
Which may arise from the following conditions.
a. Endocrine causes
Pituitary tumors which give rise to hyperprolactinemia.
b. Neurologic causes
Lesions of anterior temporal lobe, spinal cord disorders; loss of sensory input in diabetics; neuropathies; tabes dorsalis and damage to parasympathetic nerves following surgical procedure, such as total prostatectomy, retro sigmoid operations and aortic bypass surgery if autonomic nerve supply to penis is damaged.
c. Vascular causes
Leriche syndrome
d. Penile diseases
Peyronie’s disease, priapism and penile trauma.
e. Drug induced
Prolonged use of antihistamines, antihypertensive etc., which are potentially correctable, causes of impotency.
3. Premature ejaculation
Always related to anxiety states or emotional disorder and unreasonable expectations about performance, it may rarely have an organic cause.
4. Absence of Emission
It may be due to the following conditions.
a. Retrograde ejaculation
Following surgery on the bladder neck or may develop spontaneously in diabetics.
b. Sympathetic Denervation
May occur following sympathectomy.
c. Androgen deficiency
Results in a decrease in secretions of the prostrate and seminal vesicles and diminution of the volume of ejaculate.
d. Drugs
Such as phenoxy benzamine.
e. Absence of orgasm
It is always almost due to psychological disorder if the libido and erectile functions are normal.
f. Failure of detumensence
It is due to priapism but can be associated with sickle cell anemia, chronic granulocytic leukemia or spinal cord injury.
EVALUATION OF IMPOTENCY
The central issue of Evaluating impotency is to separate those instances due to psychological factors from those due to organic causes. A good case-taking usually makes the separation possible.
The commonest cause is an anxiety or depressed state. Psychological factors like disinterest in sexual partner, marital discord etc reduce the sexual impulse.
However, if organic cause is deduced, its aetiology should be well known.
INVESTIGATION AND EXAMINATION
a. Laboratory investigation
Laboratory evaluation is probably of minimal value. Measurement of serum testosterone in the absence of evidence of feminization or hypogonadism is seldom helpful. If there is an indication from either history (or) physical examination of vascular aetiology, a doppler procedure or arteriography may be indicated.
b. Physical examination
Thorough genital examination to identify abnormalities of the penis; testicular size and abnormal masses. Evidence of feminization such as gynaecomastia and abnormal body hair distribution should be sought. All pulses should be palpated, including the penile pulse, to exclude the presence of deep cavernous arterial occlusion.
c. Systemic examination
Neurological examination is necessary for detecting peripheral neuropathy and also to assess the perianal sensation, anal sphincter tone and bulbo cavernous reflex.
DIAGNOSIS OF IMPOTENCE
Apart from history and clinical examination, Duplex and color Doppler sonography can give a complete status of the erectile function of penis; X-rays, caverno-sonography and selective pundendal arteriography have become obsolete.
PLAN OF TREATMENT
It can be broadly classified as follows;
1. Ancillary or extra medial line of treatment.
2. Surgical line of treatment.
3. Treatment with homoeopathic medicines like constitutional, inter-current medicines, mother tinctures, organopathic and rare medicines.
1. Ancillary or extra remedial line of treatment
a. Giving reassurance to the patients of anxiety states and corrective measures to depressive patients may restore sexual potency.
b. Sexual counseling, education and psychotherapy are also beneficial in alleviating psychogenic factors.
2. Surgical line of treatment
a. In case of hyperprolactinemia where prolactin secreting pituitary tumor is present; surgical removal usually results in return of potency.
b. Surgical therapy is also useful in treatment of decreased potency related to aortic obstruction.
c. Implantation of penile prosthetic by a small, blunt silastic rod (or) alternatively by an inflatable prosthetic device, can be advised. In refractory cases which are not improving with the allopathic mode of treatment or patients who are skeptical about the homoeopathic mode of treatment. However it should be remembered that these procedures are extremely costly and have a high risk of complications.
THERAPEUTICS OF IMPOTENCE
In homoeopathic prescribing, even after Repertorization, the final court of decision is the Materia Medica. Therefore I would like to suggest a few important remedies for impotency with their indications.
Abroma
Absence of sexual desire, exhausted after coitus, swelling and hanging of testicles impotency.
Adrenalin
Sexual desire increased with out erections.
Agnuscastus
Impotency after frequent attacks of gonorrhea. No erection, parts cold, relaxed desire gone.
Ant. Crud
Impotency, atrophy of penis and testicles.
Arg. Nit
Impotence, erections fail when attempt is made. Sexual desire wanting.
Avena. Sat
Impotency after too much of indulgence in sex.
Baryta .Carb
Diminished desire, premature impotency.
Baryta. Iod
Impotency, erections wanting.
Baryta. Sulph
No desire, wanting erections.
Caladium
No erection even after caress. Impotence, relaxation of parts even when excited, parts cold. No emission or orgasm after embrace.
Cal.iod
Erections wanting, sexual passions without erections.
Capsicum
Coldness of penis and scrotum with impotency, atrophied testicles.
Cal. sil
Sexual passion increased sexual desire strong without erections, swollen testicles.
Carbo. Sulph
Desire lost, parts atrophied.
Coca
Diabetes mellitus with impotency.
Chloral
Sudden impotency.
Conium
Desire increased, power decreased, sexual nervousness with feeble erections. Effects of suppressed sexual appetite.
Flour acid
Sexual passion increased with erections only at night.
Graph
Sexual debility with increased desire.
Hydrastis
Indifference to coitus, impotence.
Hyoscyamus
Impotence with lasciviousness.
Iodum
Loss of sexual power with atrophied testes.
Kali.br
Debility with impotency, effects of sexual excesses. Excitement during partial slumber.
Kali. Carb
Deficient sexual instincts.
Kali. Phos
Sexual power decreased.
Lecithin
Male power lost or enfeebled.
Lycopodium
No erectile power, impotence, premature impotence. Emissions premature. Old men with strong desire but with imperfect erections, falls asleep during an embrace.
Moschus
Impotence associated with diabetes mellitus, violent desire.
Nat. M
Impotence with retarded erections, impotence from spinal irritation.
Nat. P
Desire without erections.
Nuphar. L
Complete absence of sexual desire, parts relaxed and penis retracted.
Nux. V
Impotency with involuntary emissions during stool, when urinating, bad effect of excess of all kinds.
Onosomod
Constant sexual excitement, psychical impotency, loss of sexual desire, speedy emission. Deficient erections.
Phos. ac
Sexual powers deficient, testicles tender, swollen, parts relaxed during embrace.
Sabal. Serr
Loss of sexual power with wasting of testicles, sexual neurotics. Organs feel cold.
Selenium
Loss of sexual power with lascivious fancies penis relaxed on attempting coitus.
Staphysagria
Organs relaxed and powerless.
Sulphur
Organs relaxed and powerless, ejaculation before intromission.
Uran. N
Impotency with nocturnal emissions, organs cold, relaxed and sweaty.
X-Ray
Sexual desire lost. Testes relaxed, Feeling of impotence.
Yohimbinum
Neurastshenic impotency.
IMPOTENCY
This is a male sexual disorder, whereby a male cannot maintain an erection of penis during copulation.
Impotence is a very delicate yet complex topic for a practitioner. Although a lot of passions are involved around the sexual life of a human being, this topic is poorly understood and requires thorough education of the patient. An attempt has been made here to resolve the mysteries regarding impotence.
Above the age of 65 years about 25% males develop impotence. Most of the cases have a psychogenic cause.
NORMAL CHANGES WITH AGE
Although sexual activity normally continues throughout man’s life time, the response varies with age. He takes longer to climax and his erections may come and go. He needs more recycling time before he can get another erection.
The 20’s: A young man needs little stimulation and can get an erection in a few minutes. He usually climaxes quickly but he can regain his erection in minutes.
The 40’s: With age there is more need of direct stimulation and fantasy. An erection takes several minutes, climax is slower and erection can be regained only after an hour or so.
The 60’s: An older man needs even more direct stimulation and fantasy. He takes longer to get an erection, can maintain it longer. But may take a day (or) more to regain it.
PHYSIOLOGY OF A PENILE ERECTION
The penis consists of corpus cavernosum; two spongy paired cylinders contained in a thick envelope, the tunica albuginea, and corpus spongiosum and glans with very thin tunica, in both the structures, with in the tunica are numerous sinusoids among the interwoven trabeculae of the smooth muscles and supporting connective tissue that harbour the terminal cavernous nerves and arterioles, the paired internal pudendal artery is the main source of blood supply to the penis while venous drainage is through multiple small veins to dorsal vein and then internal pudendal vein.
The nerve supply of the penis plays an important role in erection. The penis is innervated by 2 sets of nerves; autonomic nervous system (sympathetic and parasympathetic) and somatic nerves (sensory and motor). From the neurons in the spinal cord and peripheral ganglia the sympathetic and parasym-pathetic nerves merge to form the cavernous nerves and these nerves are responsible for neurovascular events during erection and detumescence. The somatic nerves are responsible for sensation of penis and contraction of the bulbocavernous and ischiocavernous muscles.
The parasympathetic supply comes from 2,3 and 4 sacral spinal cord segments which is responsible for tumescence (erection) while sympathetic supply comes from thoracic 11 to lumbar 2 spinal segment, which is responsible for detumencence (ejaculation). The sensory pathways go via dorsal nerves of penis to internal pudendal nerve to dorsal roots of 2nd to 4th nerves of spinal cord and spino thalamic tract to the thalamus and sensory cortex of brain. Onuf’s nucleus is the centre of somatomotor penile innervation. These nerves travel in the sacral nerves to the pudendal nerves to innervate bulbocavernosus and ischioca-vernosus muscles.
The contraction of the ischiocavernosus muscle causes rigid erection phase while rhythmic contractions of the bulbocavernous muscles expels the semen down the narrowed urethral lumen and results in external ejaculation from the meatus.
The spinal erection centres are located at intermedilateral column of the sacral cord and sends processes in to the areas of laminate 5 and 7 and the dorsal commissure. In the brain medial preoptic area (MPOA) is the important integration centre for sexual drive and penile erection.
According to nature of stimulus there are 3 types of erections.
1. Reflexogenic Erection
This erection is provided by tactile stimulus to the genitalia and is mediated through lower spinal centres.
2. Psychogenic Erection
This erection originates from audiovisual impulses and fantasies and signals are mediated through brain to spinal centres.
3. Nocturnal Erection
This type of erection occurs during REM sleep through unknown mechanism.
PATHOPHYSIOLOGY OF IMPOTENCE
1. Psychogenic Importance
Psychogenic stimuli (Visual impulses, fantasies) themselves are very strong inducers of erection and also can enhance the erection induced by Genital Stimulus. On the other hand, anxiety (or) depression, religious inhibitions, sexual phobias or deviation, obsessive compulsive personality or a traumatic past experience can send strong messages from brain to inhibit or to terminate erection. This inhibition is through a direct inhibition from brain to the spinal centres or through increased level of peripheral catecholamine that renders cavernous smooth muscles less sensitive to neuro-transmitters.
2. Neurogenic Impotence
Lesions affecting brain like cerebrovascular accidents, park-inson or Alzheimer’s disease, tumors, injury etc, act through direct central hypothalamic suppression or over inhibition of spinal centres.
A dysfunction at spinal level e.g. spinabifida, disc herniation, syringomyelia, tumor and multiple sclerosis may affect either efferent or afferent nerve pathways.
Neuropathy such as seen in alcoholism, vitamin deficiency or diabetes may affect cavernous nerve terminals leading to impotency. Injury to cavernous nerve or pudendal nerve from pelvic injury or surgery may disrupt the neural pathway causing impotence.
3. Arteriogenic Impotence
Diseases of terminal aorta or the hypogastric, pudendal, or penile arteries can results in erectile failure; trauma or congenital anomaly can cause arterial insufficiency. But generalized atherosclerotic process due to hypercholesterolemia, cigarette smoking, diabetes, radiation, hypertension and perineal trauma are more common cause of arteriolar impotence.
4. Venous Impotence
Abnormal venous channel following a shunting operation for priapism. Tunical abnormality as in pyronie’s disease or functional impairment of the cavernous erectile tissue can cause venous impotence.
5. Hormonal Impotence
Diabetes mellitus in an important cause for impotence but acts not mainly through hormonal changes but through vascular, neurologic and psychologic causes.
Androgens are essential for male sexual maturity but testosterone is not absolutely essential for erection. Therefore androgen replacement therapy is absolutely indicated in cases of hypogonadism only.
Hypothalamic pituitary Gonadal axis dysfunction can result in hypogonadism, Hypogonadotrophic hypogonadism can be due to malignancy, injury or aging while hypergonadotrophic Hypogondism can be due to diseases of testes like malignancy, surgery, injury or mumps.
Hyperprolactinemia caused by pituitary adenoma, chronic renal failure, or medication can result in lowered testosterone levels leading to impotence. Hyperthyroidism and hypothyroidism can also affect sexual function.
6. Erectile tissue dysfunction
Pyronie’s disease, trauma, diabetes, tumor infiltration, scleroderma, and priapism all these lead to gross microscopic changes as well as macroscopic changes in erectile tissues of penis.
7. Impotence from aging, systemic disease and other causes.
Hypothalamic pituitary dysfunction leading to testosterone deficiency is responsible for impotence of old age, the other factors like psychogenic, vascular, neurogenic etc. also add to the problem.
Chronic renal disease needing dialysis also leads to impotence in around 50% patients. Myocardial infarction, angina, heart failure, and Emphysema patients develop impotence. One of the reasons being, they fear aggravation of the disease following intercourse. Others diseases like liver cirrhosis, sclerdoderma, chronic debility and cachexia also can cause impotence.
CAUSES OF IMPOTENCY
The normal sexual function can be divided into five events each of which is under diverse regulation, libido, erection, ejaculation, orgasm and detumescence. Hence anything hampering the normal sexual functions will give rise to impotency as stated below;
1. Loss of desire
In a small percentage of organic cases, pituitary or testicular disease gives rise to androgen deficiency which in turn causes a decreased libido; hypogonadism also gives rise to such states.
2. Failure of erection
Which may arise from the following conditions.
a. Endocrine causes
Pituitary tumors which give rise to hyperprolactinemia.
b. Neurologic causes
Lesions of anterior temporal lobe, spinal cord disorders; loss of sensory input in diabetics; neuropathies; tabes dorsalis and damage to parasympathetic nerves following surgical procedure, such as total prostatectomy, retro sigmoid operations and aortic bypass surgery if autonomic nerve supply to penis is damaged.
c. Vascular causes
Leriche syndrome
d. Penile diseases
Peyronie’s disease, priapism and penile trauma.
e. Drug induced
Prolonged use of antihistamines, antihypertensive etc., which are potentially correctable, causes of impotency.
3. Premature ejaculation
Always related to anxiety states or emotional disorder and unreasonable expectations about performance, it may rarely have an organic cause.
4. Absence of Emission
It may be due to the following conditions.
a. Retrograde ejaculation
Following surgery on the bladder neck or may develop spontaneously in diabetics.
b. Sympathetic Denervation
May occur following sympathectomy.
c. Androgen deficiency
Results in a decrease in secretions of the prostrate and seminal vesicles and diminution of the volume of ejaculate.
d. Drugs
Such as phenoxy benzamine.
e. Absence of orgasm
It is always almost due to psychological disorder if the libido and erectile functions are normal.
f. Failure of detumensence
It is due to priapism but can be associated with sickle cell anemia, chronic granulocytic leukemia or spinal cord injury.
EVALUATION OF IMPOTENCY
The central issue of Evaluating impotency is to separate those instances due to psychological factors from those due to organic causes. A good case-taking usually makes the separation possible.
The commonest cause is an anxiety or depressed state. Psychological factors like disinterest in sexual partner, marital discord etc reduce the sexual impulse.
However, if organic cause is deduced, its aetiology should be well known.
INVESTIGATION AND EXAMINATION
a. Laboratory investigation
Laboratory evaluation is probably of minimal value. Measurement of serum testosterone in the absence of evidence of feminization or hypogonadism is seldom helpful. If there is an indication from either history (or) physical examination of vascular aetiology, a doppler procedure or arteriography may be indicated.
b. Physical examination
Thorough genital examination to identify abnormalities of the penis; testicular size and abnormal masses. Evidence of feminization such as gynaecomastia and abnormal body hair distribution should be sought. All pulses should be palpated, including the penile pulse, to exclude the presence of deep cavernous arterial occlusion.
c. Systemic examination
Neurological examination is necessary for detecting peripheral neuropathy and also to assess the perianal sensation, anal sphincter tone and bulbo cavernous reflex.
DIAGNOSIS OF IMPOTENCE
Apart from history and clinical examination, Duplex and color Doppler sonography can give a complete status of the erectile function of penis; X-rays, caverno-sonography and selective pundendal arteriography have become obsolete.
PLAN OF TREATMENT
It can be broadly classified as follows;
1. Ancillary or extra medial line of treatment.
2. Surgical line of treatment.
3. Treatment with homoeopathic medicines like constitutional, inter-current medicines, mother tinctures, organopathic and rare medicines.
1. Ancillary or extra remedial line of treatment
a. Giving reassurance to the patients of anxiety states and corrective measures to depressive patients may restore sexual potency.
b. Sexual counseling, education and psychotherapy are also beneficial in alleviating psychogenic factors.
2. Surgical line of treatment
a. In case of hyperprolactinemia where prolactin secreting pituitary tumor is present; surgical removal usually results in return of potency.
b. Surgical therapy is also useful in treatment of decreased potency related to aortic obstruction.
c. Implantation of penile prosthetic by a small, blunt silastic rod (or) alternatively by an inflatable prosthetic device, can be advised. In refractory cases which are not improving with the allopathic mode of treatment or patients who are skeptical about the homoeopathic mode of treatment. However it should be remembered that these procedures are extremely costly and have a high risk of complications.
THERAPEUTICS OF IMPOTENCE
In homoeopathic prescribing, even after Repertorization, the final court of decision is the Materia Medica. Therefore I would like to suggest a few important remedies for impotency with their indications.
Abroma
Absence of sexual desire, exhausted after coitus, swelling and hanging of testicles impotency.
Adrenalin
Sexual desire increased with out erections.
Agnuscastus
Impotency after frequent attacks of gonorrhea. No erection, parts cold, relaxed desire gone.
Ant. Crud
Impotency, atrophy of penis and testicles.
Arg. Nit
Impotence, erections fail when attempt is made. Sexual desire wanting.
Avena. Sat
Impotency after too much of indulgence in sex.
Baryta .Carb
Diminished desire, premature impotency.
Baryta. Iod
Impotency, erections wanting.
Baryta. Sulph
No desire, wanting erections.
Caladium
No erection even after caress. Impotence, relaxation of parts even when excited, parts cold. No emission or orgasm after embrace.
Cal.iod
Erections wanting, sexual passions without erections.
Capsicum
Coldness of penis and scrotum with impotency, atrophied testicles.
Cal. sil
Sexual passion increased sexual desire strong without erections, swollen testicles.
Carbo. Sulph
Desire lost, parts atrophied.
Coca
Diabetes mellitus with impotency.
Chloral
Sudden impotency.
Conium
Desire increased, power decreased, sexual nervousness with feeble erections. Effects of suppressed sexual appetite.
Flour acid
Sexual passion increased with erections only at night.
Graph
Sexual debility with increased desire.
Hydrastis
Indifference to coitus, impotence.
Hyoscyamus
Impotence with lasciviousness.
Iodum
Loss of sexual power with atrophied testes.
Kali.br
Debility with impotency, effects of sexual excesses. Excitement during partial slumber.
Kali. Carb
Deficient sexual instincts.
Kali. Phos
Sexual power decreased.
Lecithin
Male power lost or enfeebled.
Lycopodium
No erectile power, impotence, premature impotence. Emissions premature. Old men with strong desire but with imperfect erections, falls asleep during an embrace.
Moschus
Impotence associated with diabetes mellitus, violent desire.
Nat. M
Impotence with retarded erections, impotence from spinal irritation.
Nat. P
Desire without erections.
Nuphar. L
Complete absence of sexual desire, parts relaxed and penis retracted.
Nux. V
Impotency with involuntary emissions during stool, when urinating, bad effect of excess of all kinds.
Onosomod
Constant sexual excitement, psychical impotency, loss of sexual desire, speedy emission. Deficient erections.
Phos. ac
Sexual powers deficient, testicles tender, swollen, parts relaxed during embrace.
Sabal. Serr
Loss of sexual power with wasting of testicles, sexual neurotics. Organs feel cold.
Selenium
Loss of sexual power with lascivious fancies penis relaxed on attempting coitus.
Staphysagria
Organs relaxed and powerless.
Sulphur
Organs relaxed and powerless, ejaculation before intromission.
Uran. N
Impotency with nocturnal emissions, organs cold, relaxed and sweaty.
X-Ray
Sexual desire lost. Testes relaxed, Feeling of impotence.
Yohimbinum
Neurastshenic impotency.
Subscribe to:
Posts (Atom)