CHRONIC BRONCHITIS

Chronic inflammation of respiratory tubes (bronchi) with mucus secretion is termed as chronic bronchitis.  Productive cough which persists for at least three months per year in two consecutive years is indicative of chronic bronchitis.  It is classed as a chronic obstructive pulmonary disease (COPD), others being emphysema.

Causes – Smoke and dust are the most common causes of chronic bronchitis.  Smoke may be of tobacco or ovens using woods, cow dung etc. or of some factory smoke polluting air.  Dusts inhaled by mine workers and stone cutters also causes chronic bronchitis.  Allergies cause symptoms similar to chronic bronchitis or asthma.

Signs and symptoms – Common symptoms of chronic bronchitis are cough with phlegm, shortness of breath and wheeze (noisy respiration).  The mucus is often yellow or green or of other color according to type of infection.  Sometimes pain chest and fever occur.  Weakness and malaise often present.

In person suffering from chronic bronchitis acute attacks are not uncommon.  During as acute episode cough and thick mucus accumulation obstructs the passage to causes severe breathing difficulty.  Sometimes chill, fever and malaise are associated with it.   

Diagnosis- Symptoms are indicative.  Noisy breathing (wheezing), prolonged expiration and decreased respiratory sounds on auscultation help to diagnose.

Chest X-ray shows hyperinflation of bronchial tubes.  Collapse and consolidation of lung indicates pneumonia.   In expectoration neutrophils and streptococcus are seen.  Infection is not a cause of chronic bronchitis but it increases neutrophil infiltration at the site which causes increased mucus secretion.  Total white cell count in blood increases with increased C-reactive protein.  Presence of goblet cells in bronchioles is confirmatory of chronic bronchitis.

In case of unresolved diagnosis High resolution Computerized Tomography (HRCT) is done.

Treatment- Conventionally chronic bronchitis is treated with antibiotics and bronchodilators.  Only in 5-10% cases infection could be related as cause of chronic bronchitis. Nicotin in any form especially smoking should be restricted as it paralyses cilia in respiratory tubes which push foreign particles up and clear the bronchi.  The paralysis results in accumulation of mucus.  A self limiting viral infection usually resolves in a few weeks. Oxygen therapy is required if acute attack in not controlled with medicines.

Homoeopathic medicines – The homoeopathic medicines listed below covers symptoms of chronic bronchitis but in homoeopathic prescribing it the man in disease which is important so none of these medicines should be prescribed for chronic bronchitis rather patient should be individualized on the basis of generals, modalities, concomitants etc..

Chronic inflammation of Bronchial tubes – Alumina, Ammonium-carb., Ammonium- caust., Ammonium-iod., Ammonium-mur., Ammoniacum, Antim-ars., Antim-iod., Antim-sulph-aurum., Antim-tart., Arsenicum alb., Arsenic-iod., Bacillinum, Balsamum-peruvianum, Balsamum-tolutanum, Baryta-carb., Baryta-mur, Calcarea carb., Calcarea-iod., Calcarea-sil., Cantharis, Carbo-animalis, Carbo-veg., Ceanothus, Chelidonium, China, Cocus cact., Conium, Copaiva, Cortisonum, Cubeba, Digitalis, Diphtherotoxinum, Drosera, Dulcamara, Eriodyctyon californicum., Eucalyptus, Eupatorium-cannabinum, Grindelia,  Heper sulph., Hydrastis, Hyoscymus, Ichthyolum, Ilex-aquifolium, Iodum, Ipecacuana, Kali-bichromat., Kali-carb., Kali-hypophos., Kali-iod., Kali-sulph., Kreosotum, Lachesis, Lycopodium, Marrubuum-vulg., Medorrhinum, Mercurius sol. ,Morgan bacillus, Muco-toxinum, Myosotis-arvensis, Myosotis-symphytifolia, Myrtus-cheken, Natrum-mur., Natrum-sul., Nitric-ac., Nux-vom., Pertusinum, Phosphorus, Pix liquida, Pneumococcinum, Pulsatilla, Rumex.,  Sabal ser., Sanguinaria, Secale cor., Senega, Sepia, Silicea, Silphium lacinatum, Spongia, Squilla, Stannum met., Stramonium, Strychninum purum, Sulphur, Taxus baccata, Terebinth., Tuberculinum bov., Tuberculinum-denys, Tub-residuum Koch Veratrum alb.

Case - G B      65 yrs.   Female   married   housewife    hindu    vegetarian

Diagnosis – chronic bronchitis.

The patient was suffering from cough for last 10 months.  Cough used to occur every winter but this time it continued beyond the winter. The cough was barking, whistling and sometime rattling aggravated at night, waking patient often. Her trouble also aggravated from fan, air draft, on lying, talking and laughing. Better by sitting up in bed, sometimes relieved after drinking. There were 2-3 coughs in every paroxysm and often excited with feeling mucus in trachea. Expectoration was white. There was a history of patient staying in hospital to nurse her ailing sister but there was no acute cough, cold or fever. 

Appetite was normal increased after exertion but patient was taking meals once a day mostly in afternoon. Thirst less. She had habit of taking coffee twice a day. She was used to wakes for urination at night for 2-3 times. Falls asleep easily and she generally sleeps on right side. Blood pressure was 130/86 mm of Hg. Tongue was thickly coated white.

Hemoglobin 13.2 gm/dl, TLC 10,520, ESR 70. Sputum was not given. X – ray chest showed prominent bronchial marking.

16/10/11 Rx Lachesis         30  twice a day for 3 days.

19/10/11 No change.

               Rx 1. Heper sulph 200 two doses at 10 minutes interval.

                    2. Causticum    200 two doses at 10 minutes interval to take after 1 week if not relieved 

                    3. Rubrum        30   twice a day for 15 days.

05/11/11 Cough relieved 75% after the dose of Heper sulph. So Causticum was not required. Hoarseness of voice and white expectoration not relieved.                        

                   Rx 1. Spongia        30  two doses at 10 minutes interval weekly.

                        2. Rubrum         30  twice a day for 30 days.

05/12/11 No expectoration. Voice became normal. Cough sometimes at night and from cold air.

                   Rx 1. Heper sulph  200   two doses at 10 minutes interval.

                        2. S. L.              200   two doses at 10 minutes interval weekly.

                        3. Rubrum         30     twice a day for 30 days.

Patient reported to be trouble free after the last dose of Heper sulph on 09/01/12.

Dr. M. K. Tyagi

D.H.M.S., Dip. N.I.H.

Research Officer, Sewa Mandir.

Mobile" 09829157926
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in

ANAL FISSURE

Anal fissure is an elongated ulcer that is a tear or break in the skin of the lower anal canal. Anal fissure is usually notice by blood stained stool or pain during or after defecation. Pain is severe in acute fissure but with chronic fissure intensity of pain is less. Anal fissure is usually occurs in posterior mid line of anus, due to unsupported nature and poor perfusion of anal wall and pelvic floor. In male 90% fissure occur in posterior midline while in female 40% fissures occur in anterior midline particularly in those who have borne children.

 Causes – An anal fissure is caused due to over stretching of anal mucosa due to poor toilet habit in children or constipation or hard stool. Fissure may be superficial or deep enough down to the underlying sphincter muscle. A superficial or a shallow anal fissure may be difficult to see as it is very thin cut and generally heal within a week or two. When anal fissures become deep, they extend to lower end of internal anal sphincter, their margins become hard (indurated) and they do not heal and become chronic. Spasm of internal sphincter muscles contributes to non-healing of chronic fissure. Chronic anal fissure may have a specific cause as infection, Crohn’s disease (multi-systemic inflammatory disease affecting any part of alimentary canal – from mouth to anus) or syphilis. Biopsy can confirm such cause. These fissure are often less painful than the appearance of the lesion.

Symptoms – Anal fissure commonly occurs in persons of age between 15 to 40 years, more in women in meridian of life. It is rare in aged because of muscular atony (relaxation) but not rare in children. Sharp agonizing pain beginning during defecation and lasting for an hour or more is characteristic of fissure. The pain subsides till the next action of bowel but it is severe enough so that the patients become constipated rather than going through the agony of pain. There are periods of remission for days or weeks.

Prevention – Avoiding strain and careful anal hygiene after defecation is the theme of preventing anal fissure. To avoid strain constipation must be prevented by eating enough food and food rich in dietary fibers, drinking sufficient water and avoiding foods causing constipation as foods containing caffeine. Diarrhea can also cause anal strain and should be treated promptly. If toilet paper is used for cleaning it should be soft.

In an infant and child also sufficient fluid intake should be ensured. Frequent change of diaper prevents anal fissure in infants.

In a suspected or preexisting fissure lubricating ointment should be used but hemorrhoid ointment should not be used as they constrict blood vessels and delay healing.

Treatment – Conventional system suggests that beside fiber rich diet and mild laxatives to avoid constipation, a fissure should initially be treated topically and then surgically if required. Locally nitroglycerin or calcium channel blockers or botulinum toxin (botox) is used to relax anal sphincter muscles. While systemic absorption of nitroglycerin (even through the finger used to apply the medicine)causes headache, the botox injection proved to be less and lesser effective after some time and patient need to find some other cure or surgery is performed. Surgery is done to reduce spasm of internal sphincter by anal dilatation or sphincterotomy (incising lateral wall of internal sphincter). The  side effect of surgery, both dilatation and incision, is mainly incontinence of stool which is for sometime immediately after operation and in about 36% cases it persists indefinitely where even solid fecal matter may pass with uncontrolled release of gases. Recurrences are not uncommon.

Homeopathic treatment causes permanent relief from the fissure. One of the following or other homoeopathic medicines can be prescribed as per indications.

RECTUM - FISSURE

Acon-lycoctonum, Aesculus hip., Agnus cast., Allium-cepa, Aloe socotrina, Alumina, Anacardium orien., Antim-crud., Apis mel., Argentum-met., Argentum-nit., Arsenic. alb., Arum-triph., Berberis vul., Bryonia, Calcarea carb., Calcarea-flor., Calcarea-phos., Capsicum, Carbo-animalis, Carbo-veg., Carcinocin., Causticum, Chamomilla, Cimex,  Colchicum, Collinsonia, Cundurango, Curare, Flouric-acid, Graphites, Gratiola, Hamamelis, Hydrastis, Ignatia, Iris versicolor, Kali-brom., Kali-carb.,  Kali-iod., Lacticum-ac., Lachesis, Ledum pal., Medorrhinum, Mercurius sol., Mercurius-dulc., Mercurius-iod.-rubrum, Mezerium, Morganum-gaertner, Morgan-pure, Morphinum, Muriatic-ac., Natrum-mur., Nitric-ac., Nux-vom., Paeonia, Petroleum,  Phosphorus, Phytolacca, Piper-nigrum, Platina, Plumbum met., Plutonium-nit., Podophylum, Ptelea trifol., Ratahnia, Rhus-tox., Sanginaria-nit., Sanicula, Sedum acre, Sepia, Silicea, Spongia, Strontium-carb., Sulphuric-ac., Sulphur, Syphilinum, Thuja occ., Triticum-vulg., Viburnum op.

CASES -

Case – 1. Mr. D B      31 yrs.    male   married     hindu    vegetarian

Diagnosis – Fissure in ano.

The patient has severe burning, cutting and stitching pains for last two weeks. There is a constant sense of plug or a wedge in anus. Aggravated during stool, at night with restlessness cannot lie in any position,. He was better after stool and bleeding from the fissure. There was bleeding after stool. Passes stool of normal consistency.

He was sleepless due to pain in fissure. No relief after Aloe soc. and pothos.

Thirst was increased, three glasses at a time 8 – 10 times a day. He desired salty food and averse pulses, vegetables.

 The patient had appointment for operation on 5^th January and had to get admitted on the 4^th. After taking above mentioned homoeopathic medicines he believed that surgery was the last solution to this pain he came again for homoeopathic medicine as pursued by his family members but on the condition that he should get relief by next day afternoon otherwise he will go for surgery.

03/01/11 Rx Sepia     30 four doses four hourly and report on next day.

04/01/11 Pain was reduced about 20%, there was no bleeding. So patient decided to continue the trial.

                  Rx Sepia     30 dose thrice a day and report after 3 days.

05/01/11 Pain was disappeared since forenoon, patient asked whether to continue with the rest of medicine. Advised to continue treatment but the patient did not as he remained well thereafter.

Case -2. Generally people do not correlate their sickness with life situation, physical strain and mental traumas. The patient in this case suffered for years took many medicines without relief but got prompt relief when he divulged his traumatic experience and physician correlated it to his suffering to mental stress and trauma.

Mr. N.  K.      30 yrs.   male   married    vegetarian      businessman

Diagnosis – Anal fissure, Hemorrhoids (Piles).

The patient presented on 01/10/09 with problem of recurrent anal fissure and piles for last three years. He had burning in fissure during stool, pile swollen and protruded during stool. Stool first hard then soft.

With the above symptoms he was treated with various medicines as Sulphur, Nux vom., Aloe s., Acid Nitricum, Aesculus h., Lycopodium, Hydrastis, Blumia od., Collinsonia, Carica papya Q, Staphysagria,  Thuja oc. etc by myself and other physicians. The patient was repeatedly queried and every time he insisted all is well with him except the above two pathology. Thus we lost one year.

When he visited on 22/11/10, he was asked to describe the happenings from the time he was perfectly well and when and how the trouble started and first occurred. He told that his mother was sick for six months previous to the onset of his trouble. He was emotionally disturbed, stressed and worried due to precarious state of mother who was diagnosed to have Acute Myeloid Leucaemia (AML). He did not get financial help and support from relatives. Mother expired after six months of struggle. Based on his narration he was prescribed –

22/11/10  Rx  1. Ignatia         1M    two doses at 10 minutes interval.

                       2. Graphite      30     two pills thrice a day for 15 days.

                       3. Rubrum       30     two pills once a day for 15 days.

 23/04/11 The patient reported after five months. He was relieved of all symptoms three days after he started the last prescribed medicines. There is recurrence from last few days after his mother died on 09 April. Now  there were swollen piles with mild pain. Bowels were normal. 

                    Rx  1. Ignatia         1M    two doses at 10 minutes interval.

                          2. Graphite       30     two pills thrice a day for 15 days.

                          3. Rubrum        30     two pills once a day for 15 days.

 18/05/11 No pain, No swelling.

                    Rx  1. Nihilum      1M    two doses at 10 minutes interval.

                          2. Graphite     30      two pills thrice a day for 15 days.

                          3. Rubrum     200     two pills once a day for 15 days.

Dr. M. K. Tyagi

D.H.M.S., Dip. N.I.H.

Research Officer, Sewa Mandir.

Mobile" 09829157926
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in

ASTHMA

Asthma means panting. It is a chronic inflammatory disease of the air ways characterized by variable and recurring symptoms, reversible airflow obstruction, and broncho-spasm. Wheezing, tightness in chest, shortness of breath and cough are common symptoms of asthma. Asthma is classified according to the frequency of symptoms, forced expiratory volume in 1 second (FEV1 more than 80% mild, 60-80% moderate and less than 60% severe asthma) and peak expiratory flow rate. Asthma is also classified as atopic (extrinsic) or non-atopic (intrinsic). 

Sign and symptoms - Recurrent episodes of wheezing, shortness of breath, chest tightness and coughing characterize asthma. These symptoms are often worse at night and in the early morning, from cold air and physical exertion. These symptoms usually occur due to some triggering factors. Symptoms may come as an acute attack or may persist continuously.

Rhino-sinusitis, sudden loss of breath during sleep (sleep apnea), some psychological conditions and gastro-esophageal reflux disease (GERD) may be associated with asthma.

Causes – Asthma is affected by many factors. Allergic asthma is basically associated with sensitivity to allergens. In a child tobacco smoking by mother during pregnancy and after delivery causes risk to asthma. Pollution in air is responsible for occurrence and exacerbations. Western style of housing causes more exposure to indoor allergens as dust mites, cockroaches, animal dander and molds which are thought to be primary cause of asthma. Studies show that exposure to cat and dog allergens during the first year of life reduce risk to allergic sensitization and developing asthma. Volatile organic compounds, formaldehyde, phthalates in PVC trigger asthma.

Viral respiratory infection is one of the leading trigger factors.

Mental stress modulates the immune system to increase the inflammatory response of air tubes to allergens.

One theory termed as hygiene hypothesis is that there is a link between asthma and degree of affluence. Modern society and modern hygienic practices prevent childhood infections of wide variety of bacteria and viruses. Lack of exposure to wide variety of the environmental factor in child hood increases sensitivity of susceptible individuals who develop asthma in later life. Children living in less hygienic environment have been found to have lower incidences of asthma and allergic diseases. This is counter to the logic that viruses are often causative to exacerbation of asthma. Some other studies show that upper respiratory infections are protective against asthma while lower respiratory infections tend to increase risk of asthma.

Antibiotics used in early life modify gut flora and immune system, affecting negatively to beneficial bacteria and other immune system modulators during development and cause increased allergy and asthma.

Caesarean section deliveries increase risk of asthma which is attributed to the lack of healthy bacterial colonization in the new born which results from passage through the birth canal.

One genetic study concluded that more than 100 genes were found to be associated with asthma.

Eczema, atopic diseases and hay fever are related with asthma. Obesity and factors related to obesity increase risk of non-eosinophilic asthma. Deposits of fat in body leads to pro-inflammatory state beside the adipose tissue depress respiratory function.

Asthma has been also associated with Churg-Strauss syndrome (medium and small vessels inflammation – autoimmune vasculitis), may begin as asthma. The person suffers from generalized urticaria, oro-pharyngeal and gastro intestinal symptoms, rhino-conjunctivitis and asthma.

Different individuals respond differently to different factors causing asthma. An acute attack may precipitate involving several triggering factors. Sometimes asthma remains stable for several months.

Diagnosis – Diagnosis of asthma is made on the basis of symptom pattern, spirometry and its response to therapy. There is no diagnostic physiological, histological or immunological test for asthma. Recurrent episodes of wheezing, breathlessness, chest tightness and cough worse at night or in early morning signify asthma. Its reversibility excludes it from the group of chronic obstructive pulmonary disease which includes chronic bronchitis, emphysema (where alveoli are affected) and bronchiectasis. Untreated asthma can lead to a state of irreversibility. 

Deepened throat pit (due to use of accessory respiratory muscles), over inflated chest, paradoxical pulse that is a pulse weaker during inhalation and stronger during exhalation, in severe cases blueness of skin and nails due to lack of oxygen are some of the diagnostic signs.

Status asthmaticus is a state where asthma does not responds to standard treatment of bronchodilators and steroids. The nonselective betablockers cause fatal status asthmaticus.

A sports person (cycling, running long distances, mountain biking and also diving and weightlifting) may have exercise induced asthma. Exposure to certain raw material and products can cause occupational asthma in sensitive workers.

Differential diagnosis – There are many condition need to be ruled out. It is important to assess the level of obstruction in the respiratory tract.

In children and infant allergic rhinitis and sinusitis, foreign body in trachea or bronchus, dysfuntioning vocal cord, tracheal stenosis, laryngotracheomalacia or some growth should be ruled out. Also some infection, broncho-pulmonary dysplasia, heart disease, aspiration or effect of some medication should be ruled out.

In adult chronic bronchitis or emphysema, pulmonary embolism, congestive heart failure, eosinophilia, some obstructive growth and medicinal effect should be ruled out.

In elderly person breathlessness, cough and fatigue are the symptom which some time are attributed to other disease and asthma may go undiagnosed. It is important that a chronic obstructive pulmonary disease can exist with asthma or may appear as a result of chronic asthma.

Prevention – Asthma being multi-factorial disease is difficult to prevent except avoiding of the known allergen or triggering factor and conditions.

 Management and treatment – Conventional system of medicine accepts that there is no cure for asthma but symptoms can be improved. Homoeopathy has recorded many cures of asthma because homoeopathy treats the man in disease and not disease in man.

Asthma is a problem of hypersensitivity or reaction out of proportion. It is said to be multi-miasmatic condition but generally one miasm is prominent at a time. Any abnormal tendency of body and mind (the constitution) cannot be cured without treating the miasmatic state. Without treating on homoeopathic principles even a homoeopathic medicine may fail to relieve or cure. Relief should be accounted only when patient’s stamina and working capacity improves otherwise symptoms may recur repeatedly.

It is important to identify triggering or exciting and maintaining cause and the patient should be advised accordingly. Life style modification is required to avoid allergens, smoke (tobacco and other), pollution, dust (mites), pets and certain medicines as non selective beta blockers and foods containing suphite. In some urgency patient may take allopathic medicine but even inhaled glucocorticoids have side effect, as can cause cataract. Indoor management and oxygen to alleviate hypoxia may be required.

Alternative therapies as breathing exercises, air ionizer, acupressure and acupuncture, osteopathy, chiropractic, physiotherapy could be tried.

Master A.        10 yrs.    male      hindu        student          vegetarian

Diagnosis – Allergic Asthma.

The patient was suffering from respiratory difficulty since last 6 years used to get worst attacks during rainy weather. Every time he was treated with bronchodilators and omnacortil.  For last six months he was regular on broncho-dilators. He had difficulty breathing worse at night, on lying on back, during sleep wakes often, in morning and evening.

He has sneezing in morning on rising, in rainy and cold weather and obstruction in nose with sensation of lump in it. Breathe with open mouth. He feels pain in chest after running.

White spots on face.

He craves green pepper, fat and deep fried things, kheer, sweets, milk and has aversion to vegetables and roti. Perspire on forehead, upper lip, neck and chest. He is hot patient. He sleeps on back which is restless. Dreams that he was caught by dinosaurs, he and his mom fought with it and killed it. He has violent anger, stops eating. He has many friends. When asked what was his problem the child narrated that he feels similar to the trouble his mother had. When asked to explain the trouble he demonstrated how his mother was breathing during an attack of asthma.

Has history of face eruption removed by some local application December 2010. Mother has hypertension and difficult respiration. Paternal grandfather was having chronic bronchitis.

 He had dry skin and earthy complexion. Height – 4’ 7”. Weight – 39 kg.

06/ 02/11 Rx 1. Plumbum met.    30     two doses at 10 minutes interval

                      2. S. L.                    30     two pills thrice a day for one month.

28/03/11- Patient’s respiration no more noisy during sleep. No snoring. Feels respiration difficult as medicine was finished. Sneezing aggravates morning, from dust.

                   Rx 1. Plumbum met.    30     two doses at 10 minutes interval

                         2. S. L.                    30     two pills thrice a day for one month.

24/04/11 Better.

                   Rx 1. Plumbum met.   30     two doses at 10 minutes interval

                         2. S. L.                   30     two pills thrice a day for one month.

21/07/11 Patient remained trouble free after finishing the medicines but feeling recurrence since five days. He aggravates from exertion. Cough dry off and on. Weight 40 kg. Chest was clear though the patient was complaining that he has same difficulty as mother used to have. The patient was a pampered child. Having a single child the parents were paying excessive attention and care to him. Patient’s demanding and attention seeking nature, and what she needs to do was explained to mother. 

                    Rx 1. Plumbum met.    30     two doses at 10 minutes interval

                          2. S. L.                    30      two pills thrice a day for one month.

Patient got no attack for last one year after the last medicine.

Dr. M. K. Tyagi

D.H.M.S., Dip. N.I.H.

Research Officer, Sewa Mandir.

Mobile" 09829157926
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in

EMPTY NEST SYNDROME

Empty nest syndrome often goes unrecognized. Moving out of a young adult from their parents' house is seen as a normal and healthy event, but there is a general feeling of grief and loneliness in parents or guardians especially when their children leave home to live on their own for the first time or permanently. This depression in parents arises out of loss of purpose and one or both the parents fail to adjust the new situation.

Cause – Every parent would feel emptiness of home (the nest) but some are more susceptible. Mother being primary care giver may be affected more but father can also be unprepared to face the emotional changes. Some factors may contribute to the effects are feeling the change as stress and not enjoyable, lack of confidence in own child that he/she would be able to do in the new situation independently, not having other employment as in case of a non-serving or retired person. Persons being full time parent and find their identity in being parent, menopause or death of spouse or having an unsatisfactory and unstable married life.

Symptoms – There could be variety of feelings as some may feel there remained no purpose in life (loss of purpose) because they no more require to work for child and their role was over, some may feel that they are no more required by their child (rejection), there could be worry and anxiety about how child would stay in the new conditions. Some parent feel guilt for not giving enough time and attention to their children when they were at home. Not always but many a time some parent develop physical symptoms of undefined sicknesses.

How to Cope with – Adjusting to the new life situation becomes a challenge to parents. They need to redefine relationships with children, spouse and society. A new relationship is to be established with children this may need patience and time.  Keeping contact with the children through phone, mail or net can ease the situation. These days communication is much easier and frequent as compared to old days when a letter used to take long time to reach both ways.  Some new engagements are required to fill the free time as reviving hobbies and interests which were forgotten during discharging the responsibilities, developing social relation and joining groups and the most important is reconnecting with spouse. They should develop a new understanding and should spend a quality time with each other. Grief should be shared with spouse, friends, relatives or some professional.

People and society should understand the change in person’s life as the joint families are disappearing and contrary to popular belief parents are not always happy as their children leave home.

Treatment – Empty Nest Syndrome in some case cause some troublesome symptoms which need treatment. Counseling is required to make the patient and spouse understand the reality. Though there is no specific homoeopathic medicine but homoeopathy offers a solution in terms that constitutional medicines help patient to reconcile with the situation. 

Case – The lady in this case had anticipation of living alone since her daughters got engaged and during preparation of marriage of first daughter she started feeling insecure, anxious, alone and sad. This feeling is expressed in certain symptom which were promptly disappeared after homoeopathic medicine and counseling.

Bottom of Form

Mrs. D. S.        55 yrs.      female      married      hindu            Vegetarian

Diagnosis – Functional disorders after Anticipation and empty  nest.

ECG – Tracing within normal limits. X-ray cervical and lumber spines show no bony pathology.

She off and on gets sudden palpitations with weak feeling for last three years. It first occurred during preparation of marriage of first daughter. Now, after second daughter left for in-laws place it has become more frequent and occurs at any time but never during sleep. She must lie down when she feels enervated. Pain in left shoulder, pectoral and left scapular region extended to neck. The pain was aggravated during day time, after brooding or getting tensed on some matter. She had numbness with formication in right hand. She was snoring since last few months. Her speech was hesitant and uncertain. She has lost confidence in her routine work and feels sad and alone after marriages of daughters, first was married 3 years back and the second was married four months back. Husband was a retired bank employee had his own circle and rough and tough but had no sympathy with her feeling. 

She got menopause at the age of 46 years. History of head pain aggravated from sunlight and exertion of eyes better after taking spectacles. No specific craving of any food but rich food caused burning abdomen.

Her mother had hypertension and palpitation problem, father had diabetes, hypertension and ischemic heart disease (got bye pass done). Sisters and brothers had migraine and high blood pressure. Maternal uncle had cancer of lungs or intestine.

The patient was lean, fair complexioned and smooth skin. Pulse was regular and thin. Her Blood pressure was 100/70 mm hg.

09/02/11 Rx 1. Pulsatilla            1M         two doses at 10 minutes interval

                       2. Nihilinum         30          two pills thrice a day for 7 days.

16/02/11 Old symptom of pain in right thumb and posterior thigh and knees reappeared on third day. Knees pain were relieved but drawing pain in right posterior thigh aggravated on squatting. No palpitation occurred though it was not a regular phenomenon.

                   Rx 1. Rubrum           1M         two doses at 10 minutes interval

                        2. Nihilinum            30          two pills thrice a day for 7 days.

22/2/11 She had increased pulse and palpitation on 18^th while dinning, relieved after lying down. It occurred once only though used to occur 2-3 times in one episode. Left hand fingers and thumb cramps after long time and for longer duration. Knees pain off and on. Her nape pain was less. Blood pressure was 110/80 mm hg.

                    Rx 1. Rubrum         1M         two doses  at 10 minutes interval

                        2. Nihilinum         30          two pills thrice a day for 10 days.

 04/03/11 Lower limb pains relieved. Shoulder stiffness decreased. No palpitation. Blood pressure –  110/70 mm hg.

                    Rx 1. Rubrum         1M         two doses  at 10 minutes interval weekly,

                        2. Nihilinum         30          two pills thrice a day for 30 days.

07/04/11 Left posterior thigh pulsating and bursting pain extending down to tendon Achillis. Aggravated in bed at night, walks to get relief, better by pressure. No other trouble.

                  

                        Rx 1. Natrum arsenicum  30  two doses at 10 minutes interval,

                              2. S. L.                      30  two pills thrice a day for 7 days.

13/04/11 Lower limb pain relieved. She felt lumbo-sacral weakness on walking with aching in thighs.

                        Rx 1. Nihilinum              30  two doses at 10 minutes interval,

                              2. S. L.                    30  two pills thrice a day for 21 days.

04/05/11 Felt weariness in left lower limb, sometimes aching left hip on walking.

                        Rx 1. Natrum arsenicum 30  two doses at 10 minutes interval,

                             2. P. L.          30  two doses at 10 minutes interval 8^th day,

                             3. S. L.          30  two pills thrice a day for 14 days.

19/05/11 Sleep restless due to drawing in calves twice in last two weeks. No other trouble. Blood pressure 110/70 mmhg.

                        Rx 1. Nihilinum   30  two doses at 10 minutes interval,

                             2. P. L.          30  two doses at 10 minutes interval 8^th day,

                             3. S. L.          30  two pills thrice a day for 14 days.

04/06/11 Trouble free except sometime aching in soles or heels.

                         Rx 1. Nihilinum   30  two doses at 10 minutes interval,

                              2. P. L.          30  two doses at 10 minutes interval 8^th day,

                              3. S. L.          30  two pills thrice a day for 14 days.

Thereafter the patient was well and stopped taking medicines.

Dr. M. K. Tyagi

D.H.M.S., Dip. N.I.H.

Research Officer, Sewa Mandir.

Mobile" 09829157926
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in

Oral Thrush

Oral thrush is infection with fungus Candida albicans in oral mucous lining. It appears as creamy white lesions, usually on tongue or inner cheeks. It can be painful and may bleed slightly. It can affect roof of mouth, gums, tonsils or pharynx that is back of throat.

Signs and symptoms – The signs and symptoms of thrush may develop suddenly with loss of taste and persist for a long time. Lesions look creamy white or cottage cheese like mostly appear on tongue, inner cheeks and sometimes on the roof of mouth, gums, tonsils and pharynx. Pain and slight bleeding may occur. Corners of mouth may be red and cracked. The thrush may spread into esophagus (food pipe) causing difficulty in swallowing. It can also spread into trachea (wind pipe) and lungs.

An infant fed on breast may become fussy and irritable if he gets thrush in mouth. Infection passes between the infant’s mouth and mother’s breast. Skin of areola (darker, circular area around nipple) becomes shiny or flaky and nipples become red and itchy and sensitive. There occur stabbing pains deep within the breast during or between feedings.

Causes - Oral thrush and other Candida infections occur due to weak immune system due to some disease as AIDS, cancer, diabetes mellitus, vaginal yeast infection, anemia or immuno-suppressive drugs - oral or inhaled corticosteroids, chemo and radio-therapy or antibiotics disturbing the natural bacterial flora in the body, some habits as smoking, tobacco chewing or wearing denture and dry mouth.

Complication - Oral thrush infection may recur in a healthy person even after being treated but can be more serious for people with the conditions mentioned in causes. Then the thrush is likely to spread to other parts of body, mouth or esophagus, digestive tract, to the intestines making nutrition difficult, also to lungs and liver.

Diagnosis – Oral thrush can be diagnosed simply by looking at the lesions, but diagnosis can be confirmed by microscopic examination of a sample. Diagnosis may be confirmed by throat swab culture for esophageal thrush and endoscopic examination of esophagus, stomach and the upper part of small intestine (duodenum).

Treatments - The treatment is aimed to stop the rapid spread of the fungus and cure it.

Homoeopathic Medicines – As indicated early that the compensated immunity is the cause of infection, homoeopathy does not treat the problem locally, as every local manifestation of disease has a support from patient’s constitution that is physical and mental makeup, which is representative of function of immune system. Therefore, homoeopathic medicine would vary accordingly from patient to patient. Here are names of a few homoeopathic medicines indicated for oral thrush -

Mouth - Thrush

Aethusa, Anantherum mur., Antimony-tart., Argentum-nit., Arsenicum alb., Asafetida,  Baptisia, Borax, Bryonia,  Butyric-ac., Candida parapsilosis, Carbolic-ac., Carbo-veg., Caulophyllum, Causticum, Chlorpromozinum, Hepar sulph., Hydrastis, Kali-brom., Kali-chloratum, Kali-iod., Kali-mur., Mercurius solubilis, Mercurius-corrosivus, Muriaticum-ac., Natrum-carb., Natrum-mur., Natrum-phos., Nitric-ac., Nux-vom., Phosphorus, Psorinum, Sarsaparilla, Sempervivum tectorum., Sepia, Staphysagria, Sulphuric-ac., Sulphur, Thuj occ.

Precaution - In case of infants and nursing mother infection passes back and forth so both mother and infant should be treated simultaneously. Breast should be cleaned thoroughly every time before and after feeding.

If a pacifier or a bottle for feeding is used, a solution of equal parts water and vinegar is used to wash nipples and pacifiers daily and dried in air to prevent fungus growth.

If a breast pump is used for certain reason, rinse the detachable parts that come in contact with milk in a vinegar and water solution.

A breast-feeding mother who has developed fungal infection should use un-synthetic disposable pads to prevent the fungus from spreading to clothes. Non-disposable pads and bras should be washed in hot water with bleach.

Adults or children who have oral thrush but are otherwise healthy should take unsweetened yogurt or acidophilus capsules or liquid which help to restore the normal bacterial flora in the body.

Persons with weakened immune systems as with HIV infection or using immunosuppressant treatment for some reason need special attention. Some allopathic antifungal medications may cause liver damage therefore liver function is needed to be monitored during treatment.

Good oral hygiene – Good oral hygiene has an important role in preventing growth and spread of candida in body.  One should brush and floss, at least twice a day better after every eating. Infected person should replace toothbrush frequently until infection clears up. Don't share toothbrushes. Avoid mouthwash or sprays — they can alter the normal flora in mouth.  

Dissolve 1/2 teaspoon of salt in 1 glass of warm water. Swish it and then spit it out, but don't swallow.

Prevention – To prevent development of Candida infection sugar and yeast containing food should be limited and mouth should be thoroughly washed after every eating.

Patient taking corticosteroid inhalers should rinse their mouth with water or brush teeth after taking inhaler as cortisones decrease the local immunity.

While taking antibiotics use fresh yogurt which contain Lactobacillus acidophilus or bifidobacteium to maintain intestinal flora.

Any vaginal yeast infection developed during pregnancy should be treated promptly.

Denture wearing persons and diabetics need a special mouth care. They should brush and floss teeth after every eating. Denture should be cleaned every night.

CASE

Mr. A G          28 years   male  CA      married        Hindu                vegetarian

Diagnosis – Oral Thrush (Candidasis).

For last more than 6 years the patient was suffering from sores on mucus membrane of mouth including tongue, the inner surface of cheeks and lips. Vesicular eruption burst to form raw ulcers covered with white material difficult to scrap and leave bleeding surface which is painfully sensitive to touch, eating or drinking anything. Mouth feels dry though moist on examination. Saliva dribbles during sleep. Has history of the similar suffering at the age of 12 years after Typhoid.

Lower limbs itching with red eruptions occur after bathing, during winters since 3 years. He also has decayed, brittle teeth, bilateral renal calculi and head pain from journey.

Appetite increased during oral infection. Thirst normal. He desires Chinese food. His perspiration is offensive and he is a chilly person. Always bath with warm water as cold bath causes chill. He sleeps on abdomen and gets dreams of office work. Anxiety about work, mutters after anger, fears high places. He feels better when alone.  He was lean, fair with smooth skin.

H e has a family history of oral infections, hypertension, renal calculi and diabetes.

14/11/09 Rx 1. Pulsatilla       200   two doses at 10 minutes.

                    2. Rubrum         30    two pills twice a day for 7 days.

23/11/09 No relief so took allopathic medicines which relieved him.

               Rx 1. Pulsatilla        200  two doses at 10 minutes stat.

                    2. Tuberculinum 200  two doses at 10 minutes on 8th day.

                    3. Rubrum          30    two pills twice a day for 15 days.

23/12/09 He was trouble free but got deep bluish ulcer on lower lip since 3 days. He feels itching all over after bathing. Cough from irritation in throat.

                 Rx 1. Phosphorus 30  two doses at 10 minutes stat.

                      2. P. L.          1M  two doses at 10 minutes on 8th day.

                      3. Rubrum      30   two pills twice a day for 15 days.

26/12/09 He has painless ulcer in side of lower lip.

                 Rx  Phosphorus    30   thrice a day for 3 days.

12/01/10 He was relieved but an ulcer has appeared under upper lip. Itching after bath recurred after medicines were over.

                  Rx 1. Phosphorus 200  two doses at 10 minutes stat.

                       2. P. L.           1M  two doses at 10 minutes on 8th day.

                       3. Rubrum        30   two pills twice a day for 30 days.

03/03/10 No itching. No oral ulcer or thrush. Mouth on examination was found clear. 

Phosphorus 200 was repeated on 03/03/10 and 22/05/10. A recurrence was reported on 19/06/10 so Phosphorus 1M one dose followed by rubrum was prescribed. Phosphorus 1M was repeated on 31/07/10, 16/09/, 16/10/10, and 10/11/10.

16/11/10 Thereafter no ulceration or thrush occurred but there was stomatitis from the next day of Phosphorus 1M, with indented tongue margins and white coated tongue with profuse salivation.

                    Rx  Merc.  Sol.        30   thrice a day for 4 days.

27/11/10 Patient reported relief after very first dose of Merc. sol.

                   Rx 1.  Merc. Sol.     200   two doses at 10 minutes interval.

                        2. Nihilum             30   two pills twice a day for 14 days.

Merc. sol. 200 was repeated on 13/12/2010 and Merc. sol. 1M one dose on 18/01/11 thereafter no recurrence occurred. Patient was advised to report if require.

Dr. M. K. Tyagi

D.H.M.S., Dip. N.I.H.

Research Officer, Sewa Mandir.

Mobile" 09829157926
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in

DYSMENORRHEA

Dysmenorrhea is a condition of pain during menstruation which interferes with daily activities or defined simply as menstrual pain or at least menstrual pain that is excessive. Contractions and relaxation of uterus is a normal phenomenon but these contractions are generally of higher strength, duration and frequency than in the rest of the menstrual cycle.

Dysmenorrhea due to some underlying disease or structural change inside or outside of uterus is termed as secondary dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis, a condition in which cells from the lining of the uterus, endometrium appear and flourish outside the uterus, most commonly on the peritoneum which lines the abdominal cavity. These endometrial cells are influenced by hormonal changes in similar way as the cells inside the uterus respond. Symptoms often worsen at the time of menses.

Other causes are leiomyoma, a benign smooth muscle growth which is rarely premalignant and most commonly occur in the uterus, small intestine and esophagus, ademomyosis, ovarian cysts and pelvic congestions. A copper IUCD (intra uterine contraceptive devise) can also cause dysmenorrhea. Primary dysmenorrhea is diagnosed when none of these are detected.

The main symptom of dysmenorrhea is pain concentrated in the lower abdomen, in the umbilical region or above the pubic region of the abdomen. The pain may felt in the right or left abdomen and may radiate to the thighs and lower back. A patient may feel different kinds of pain as throbbing, shooting, burning, nauseating, cramp like, dull or sharp pains. The pain may precede menstruation by several days for example may start at or just after ovulation which occurs around 14^th day of a regular cycle or may accompany menstruation and it usually subsides as menstruation tapers off. There may excessively blood loss with dysmenorrheal, known as menorrhagia. 

Menstrual pains may occur with nausea and vomiting, diarrhea or constipation, headache, vertigo, hypersensitivity to sound, light, smell and touch, disorientation, fainting and fatigue. Use of certain types of birth control pills can prevent the symptoms of dysmenorrhea because ovulation is prevented by birth control pills.

The diagnosis of dysmenorrhea is usually based on a medical history of menstrual pain that interferes with daily activities. Underlying cause should be investigated. Beside certain laboratory tests pap’s test and gynecologic ultrasonography are necessary. Sometime, leproscopy (Opening and looking into abdomen) may be required to diagnose the problem.

Treatment                                                                                                                                                                  Non steroidal anti-inflammatory drugs and hormonal contraceptives offer no permanent relief with their side effects. In secondary dysmenorrhea cause needs to be treated. Homeopathic treatment solves both primary and secondary dysmenorrhea. Decision of prescription of homoeopathic medicine is based on specific symptoms therefore patient need to observe type of pain and time and circumstances in which pains are aggravated.  Following are some medicines and example of modalities that is symptom variation –                                                                                                     

PAIN - Uterus - menses- before - agg.
– Alumina., Apis mel., Arund., Belladona.,  Bry., Bufo .,CALC., CALC-P., CAUL.,
Caust., Cham., Coloc., KALI-C.,  Lach., Lyc., Mag-p., Mosch., Nat-m., Nux-v.,
 Phos., PULS., Sec., SEP., Sil., Ustilago., Vibernum op., Zincum met.
– Burning – Bufo, Carb-an., Conium, Curare, Natrum-mur.
– Cramping – Cactus., CALC-P., Caust., CHAM., Mag-p., Thymol., Viber. op.
– Cutting pain – Caust., Mag-c., Murx., Natrum-carb.
– drawing pain – Juglans-reg., Thymol.
– pinching pain – Alum., Bry.
– pressing pain –jug-r.
– sore – bov.
– stitching pain – borx.
-  tearing pain – nat – m.

– during – agg .

Acon., Agar., agn., alum., Am-c., apis.,_, Arist-cl., ars-met., bamb-a., BELL., CACT., CALC., Calc-p., calc-s., caul., Cham., Cimic., Cocc., cupr., ferr., Gels., Ham., Ign., Kali-c., kali-s., Kreos., Lac-c., Lach., led., Lil-t., Lyc., Mag-m., merc., NUX-V., op., phyt., Plat., PULS., sars., sep., Stann., Sulph., symph., syph., Tarent., tritic-vg., Tub., Ust., xan., xanth.

Other methods – Transdermal nitroglycerin has been said to be effective in dysmenorrhea. Behavioral interventions are base on assumption that the physiological processes underlying dysmenorrhea are affected by environmental and psychological factors. Acupressure, spinal manipulation, topical heat and transcutaneous electric nerve stimulation, thiamine, vitamin E, acupuncture, fish oil, magnet or vitamin B 12 is used for treating dysmenorrheal.

Case - Miss A.       22 yrs.      female        student             hindu                   vegetarian

Diagnosis – Dysmenorrhea

The patient had regular menses for six days but with lower abdomen pain extending to back, aggravated 2 days before and menses, since menarche at age 14 yrs. The pain was relieved by lying on back. She has numbness in her hands on grasping anything which was relieved by motion. Her pain abdomen and head pain was aggravated on fasting. Pain in calves and ankles occurred in morning on rising. She has pain in the lumber region of her back. She got itching in inner corners of eyes.

She has desires sweets and lemon and strong aversion to milk. She perspires on forehead, in palms and soles. She prefers cold things and dislikes warmth. Has fair complexion.

26/09/11 Rx 1. Natrum mur.      30      two doses to take at 10 minutes interval.                                                            

                    2. Phytum               30      two pills thrice a day for one month,

                    3. L. S.                  200      two pills once a day.

08/11/11 No numbness in hands but knees pain and itching in eyelids was still there. Menses were almost painless this time. Hairs were graying.

                  Rx 1. Natrum mur.      30      two doses to take at 10 minutes interval.

                       2. Phytum               30      two pills thrice a day for one month,

                       3. L. S.                  200      two pills once a day.

17/12/11 Menses were painless. Pains in knees decreased. Itching eyes decreased.

                  Rx 1. Natrum mur.      30      two doses to take at 10 minutes interval.

                       2. Phytum              30      two pills thrice a day for one month.  

                       3. L. S.                  200      two pills once a day

Thereafter menses were painless and lumber pain and itching in eyes was relieved.

Dr. M. K. Tyagi

D.H.M.S., Dip. N.I.H.

Research Officer, Sewa Mandir.

Mobile" 09829157926
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in

HERPES ZOSTER

                                                          

Herpes zoster or zoster or shingles or zona, is a viral disease characterized by a painful skin rash with blisters often in a stripe in a limited area on one side of the body. The initial varicella zoster virus (VZV) infection causes the acute (short-lived) illness chickenpox in children and young people. After chickenpox has resolved, the virus is not eliminated from the body but become latent in the nerve cell bodies and sometimes in non-neural satellite cells of dorsal root, cranial nerve or autonomic ganglion without causing any symptom. Years or decades after a chickenpox infection (after age of 50 years), the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve. The virus may spread from one or more ganglia along nerves of an affected segment and infect the area of skin supplied by the spinal nerve (called dermatome) causing a painful rash. Although the rash usually heals within three to five weeks, some sufferers experience residual nerve pain for months or years, a condition called post-herpetic neuralgia. Exactly how the virus remains latent in the body, and subsequently re-activates is not understood.

Signs and symptoms

The earliest symptoms of herpes zoster, which include headache, fever and malaise, are commonly followed by burning pain, itching, hyperesthesia (oversensitivity) or paresthesia ("pins and needles" sensation, tingling, pricking or numbness). The pain may be mild to extreme in the affected dermatome, sometimes aching, throbbing and quick stabbing, agonizing pain occurs. The pain radiates along the path of a single spinal nerve (a dermatomal distribution). In children, herpes zoster is often painless.

The initial phase of 2 days to 3 weeks is followed by the appearance of the skin rash. The pain and rash mostly occurs on the body but can appear on the face, eyes or other parts of the body. At first the rash may simulate to hives but herpes zoster skin changes are limited to a dermatome normally resulting in a stripe or belt-like pattern that too, to one side of the body and it never crosses the midline. Zoster sine herpete is a condition “zoster without herpes" where a patient who has all of the symptoms of herpes zoster except the characteristic rash.

Later the rash is tuned into painful, small blisters filled with serous exudates, with the fever and general malaise. The vesicles become cloudy or darkened as fill with blood. They crust over within seven to ten days; which fall off and the skin heals, but sometimes, after severe blistering, scarring and discolored skin remain.

Depending on the dermatome involved some additional symptoms may occur. Herpes zoster ophthamicus   involves the orbit of the eye, due to the virus reactivating in the ophthalmic division of trigeminal nerve. The symptoms may include conjunctivitis, keratitis, uveitis and optic nerve palsies that can sometimes cause chronic ocular inflammation, loss of vision, and debilitating pain. Herpes zoster oticus, or Ramsay Hunt syndrome type II ( It has variable presentation which may include Bell’s palsy, deafness, vertigo and pain) involves the ear. Here the virus spreads from the facial nerve to the vestibulo-cochlear nerve. Symptoms include hearing loss and vertigo (rotational dizziness).

 Most people have history of episode of chickenpox in child hood. Repeated attacks of herpes zoster are rare and rarely a patient suffers more than three recurrences. Although it can occur at any age, but most commonly occurs after the age of 50 years. In contrast to herpes simplex virus the latency of VZV is poorly understood. The virus has not been recovered from human nerve cells by cell culture and the location and structure of the viral DNA is not known. Virus-specific proteins continue to be made by the infected cells during the latent period, so true latency, as opposed to a chronic low level infection, has not been proven. Although VZV has been detected in autopsies of nervous tissue, there is no method to find dormant virus in the ganglia in living people.

Uncompromised immune system suppresses reactivation of the virus and prevents herpes zoster. Why this suppression sometimes fails is not known, but aging, immunosuppressive therapy, psychological stress, or other factors impair immune system.

A person has no immunity to Varicella zoster virus may get chickenpox but not shingles immediately.  Until the herpes rash has developed crusts, a person is extremely contagious. A person is not infectious before blisters appear, or during post herpetic neuralgia (pain after the rash is gone).

Diagnosis:

Diagnosis is mostly made by a visual examination of the rash, since the rash in a dermatomal pattern. In absence of rash (early or late in the disease, or in the case of zoster sine herpete, a condition in which pain occurs without appearance of rash), herpes zoster can be difficult to diagnose.

Prevention:

A live vaccine for VZV exists. Adults also receive an immune boost from contact with children infected with varicell (chicken pox), a boosting method that prevents about a quarter of herpes zoster cases among unvaccinated adults,

In a controlled study it was found that intake of fresh fruit is associated with a reduced risk of developing shingles. People who consumed less than one serving of fruit a day had three times more risk than those who consumed more than three serving. For those aged 60 or more, vitamins and vegetable intake had a similar association.

Treatment

The aims of treatment are to limit the severity and duration of the episode and pain and reduce complications of post herpetic neuralgia. Post-herpetic neuralgia is very rare in people less than 50 years age and it wears off in time; even in people over 70 in 85% people the pain wore off one year after their shingles outbreak.

Homoeopathic medicines

Homoeopathic medicine is always prescribed on individualizing indications; the case given here is a good example. Iris versicolor was selected for the specific location of herpes that was right side of abdomen with acidity and constipation. Some of the homoeopathic medicines commonly indicated for herpes zoster/zona are –

Iris versicolor, Mercurius solubilis, Mezerium, Ranunculus bulbosus., Rhus toxicodendron, Arsenicum album, Carbolicum acidum., Clematis, Graphites, Heper sulphuricum, Kali bichromicum., Kali chlororicum., Lachesis, Natrum muriaticum, Nitricum acidum., Petroleum, Prunus spinosa., Sarsaparilla, Sepia, Silicea, Sulphur, Thuja, Variolinum.

Zona with neuralgic pain – Ars. alb., Dolichos, Kalmia, Mezerium, Ran.b., Stillingia sylvatica, Zincum metalicum.  

With stomach complaints – Iris. ver.

Cold application ameliorates – Apis melifica.

Warm application ameliorates – Ars. alb.

Prognosis

The rash and pain generally subside within three to five weeks, but about twenty percent patients develop post-herpetic neuralgia which is a very painful condition and often difficult to manage. Sometime there occurs zoster sine herpete due to reactivation of the virus. Sometimes complications affect several levels of the nervous system and cause many cranial neuropathies, polyneuritis, myelitis or aseptic meningitis. Other complications that may occur in some cases include partial facial paralysis  (usually temporary), ear damage or encephalitis. Chickenpox during pregnancy, may lead to infection of the fetus and complications in the newborn but chronic infection or herpes are not associated with fetal infection. Though the mechanism is not clear but after a herpes zoster infection an increased risk of developing cancer has been observed.                                                                                                                                                                                                                                                                                                                                                                      Other complications – Secondary bacterial infection, motor involvement – including weakness especially in "motor herpes zoster". Eye involvement – trigeminal nerve involvement (as seen in herpes ophthalmicus) should be treated early and aggressively as it may lead to blindness. Involvement of tip of the nose in the zoster rash is a strong predictor of herpes ophthalmicus.

Case – Mr. Ajit Bhatnagar     52 yrs.     Male    married      bank manager     hindu       nonvegetarian

Diagnosis – Herpes zoster.                                                                                                                                      

 The patient was suffering from painful herpes eruption on right side of abdomen for last three weeks which were persisting in spite of various treatments and medication. He was also having indigestion, burning, sour eructation and rumbling in abdomen with constipation.

 03/12/09 Rx 1. Iris vers.        30    twice a day for 5 days.  

                        2. P. L.               200   two doses at 10 minutes interval.                                                                                   

08/12/09 Pains were relieved after second dose of Iris. Eruptions started drying. Bowel clear and regular. Rumbling and eructation were relieved.    

                  Rx 1. Rubrum         30    twice a day for 5 days.

                       2. P. L.               200   two doses at 10 minutes interval.

14/12/09 No pain or burning. No more eruption except marks. The patient was continued on the last prescription for next 10 days. It was full recovery without after pains of herpes in last 20 months.

Dr. M. K. Tyagi

D.H.M.S., Dip. N.I.H.
Research Officer 

Sewa Mandir

Mobile" 09829157926

Email: manju_mkt2003@yahoo.co.in