Warts and Its Homoeopathic Approach

WARTS

Introduction:

A wart is a skin growth caused by some types of the virus called the human papillomavirus (HPV). There are more than 100 known types of HPV. HPV infects the top layer of skin, usually entering the body in an area of broken skin. The virus causes the top layer of skin to grow rapidly, forming a wart. Most warts go away on their own within months or years.

Classifications:

A range of types of wart have been identified, varying in shape and site affected, as well as the type of human papillomavirus involved. These include:

• Common wart (Verruca vulgaris), a raised wart with roughened surface, most common on hands, but can grow anywhere on the body;

• Flat wart (Verruca plana), a small, smooth flattened wart, flesh-coloured, which can occur in large numbers; most common on the face, neck, hands, wrists and knees;

• Filiform or digitate wart, a thread- or finger-like wart, most common on the face, especially near the eyelids and lips;

• Genital wart (venereal wart, Condyloma acuminatum, Verruca acuminata), a wart that occurs on the genitalia.

    

                 

 

• Mosaic wart, a group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet;

                                     

 

• Periungual wart, a cauliflower-like cluster of warts that occurs around the nails.

                                           

• Plantar wart (verruca, Verruca plantaris), a hard sometimes painful lump, often with multiple black specks in the center; usually only found on pressure points on the soles of the feet

Causes:

Warts are caused by the human papilloma virus (HPV). There are about 130 known types of human papilloma viruses. HPV infects the squamous epithelium, usually of the skin or genitals, but each HPV type is typically only able to infect a few specific areas on the body. Many HPV types can produce a benign growth, often called a "wart" or "papilloma", in the area they infect.

Various types of this virus thrive in warm, damp environments such as showers, locker room floors, and swimming pool areas.

You are most likely to develop a wart where you have broken skin, such as a cut, hangnail, closely bitten nail, or scrape. Plantar warts are common to swimmers whose feet are not only damp and softened but are also scratched and broken by rough pool surfaces. Common warts are often seen among those who handle meat, chicken, and fish.

.           Genital warts are spread through direct skin-to-skin contact during oral, genital, or anal sex with an infected partner. Warts are the most easily recognized symptom of genital HPV infection, and types 6 and 11 are responsible for 90% of genital warts cases. Although 90% of those who contract HPV will not develop genital warts, those infected can still transmit the virus. Some types of HPV can cause cervical cancer and anal cancers, but these are not the same types of HPV that cause genital warts. However, it is possible to be infected with different varieties of HPV, such as a low-risk HPV that causes warts and a high-risk HPV that may cause cancer, either concurrently or at different times. HPV is so common that more than half of all sexually active people will get it at some point in their lives.

How are warts spread?

Warts are easily spread by direct contact with a human papillomavirus. You can reinfect yourself by touching the wart and then another part of your body. You can infect others by sharing towels, razors, or other personal items. After exposure to a human papillomavirus, it can take many months of slow growth beneath the skin before you notice a wart.

It is unlikely that you will develop a wart every time you are exposed to a human papillomavirus. Some people are more likely to develop warts than others.

Pathophysiology:

Common warts have a characteristic appearance under the microscope. They have thickening of the stratum corneum (hyperkeratosis), thickening of the stratum spinosum (acanthosis), thickening of the stratum granulosum, rete ridge elongation, and large blood vessels at the dermoepidermal junction.

 

 

   

            

        

Clinical Features:

Warts occur in a variety of shapes and sizes. A wart may appear as a bump with a rough surface, or it may be flat and smooth. Tiny blood vessels (capillaries) grow into the core of the wart to supply it with blood. In both common and plantar warts, these capillaries may appear as dark dots (seeds) in the wart's center.

Following are descriptions of the main types of warts:

• Common warts usually appear singly or in groups on the hands, although they may grow on any part of the body. They usually are rough, gray-brown, dome-shaped growths.
• Plantar warts can develop on any part of the foot. Sometimes dark specks are visible beneath the surface of the wart. When pressure from standing or walking pushes a plantar wart beneath the skin's surface, a layer of thick, tough skin similar to a callus develops over it. As the callus and wart get larger, walking can become painful, much like walking with a pebble in your shoe. Multiple plantar warts can form in a large, flat cluster known as a "mosaic wart."
• Flat warts are usually found on the face, arms, or legs. They are small (usually smaller than the eraser on the end of a pencil), and there are usually several in one area. They have flat tops and can be pink, light brown, or light yellow. Flat warts are often spread by shaving.
• Filiform warts, a kind of flat wart, can grow around the mouth, nose, and beard area. The surface of this type of wart has many flesh-colored, finger-shaped projections.
• Periungual warts are found under and around the toenails and fingernails. They appear as rough, irregular bumps. They can affect nail growth.
• Genital warts can be extremely small and difficult to detect. For more information, see the topic Genital Warts.

Common and flat warts usually do not cause pain. But they can be bothersome and can spread easily if they are in areas that are constantly irritated by rubbing or shaving. Visible warts can be embarrassing for some people. Plantar warts often cause pain, especially if they are located over bony areas of the foot.

Other skin conditions may look like warts. These include:

• Seborrheic keratoses, which are noncancerous growths of the skin. They vary in color from light tan to black and in size from very small to the size of a coin. The growths may look waxy, pasted on, or stuck on.
• Skin tags (acrochordon), which are small, soft pieces of skin that stick out on a thin stem. They most often appear on the neck, armpits, upper trunk, and body folds. They commonly appear after middle age.
• Corns, which are areas of thick, hardened, dead skin.
• Skin cancer. Skin cancer may appear as a growth or mole, a change in sssa growth or mole, a sore that does not heal, or irritation of the skin.

Warts cover the lines and creases in the skin-this is one way to tell a wart from other skin conditions.

Management:

There are many treatments and procedures associated with wart removal. One review of 52 clinical trials of various cutaneous wart treatments concluded that topical treatments containing salicylic acid were the best supported, with an average cure rate of 75%, compared with 48% for the placebo in six placebo-controlled trials including a total of 376 participants. The reviewers also concluded that there was little evidence of a significant benefit of cryotherapy over salicylic acid.
One complicating factor in the treatment of warts is that the wart may regrow after it has been removed.

Two viral warts on a middle finger, being treated with a mixture of acids (like salicylic acid) to remove them. A white precipitate forms on the area where the product was applied.

• Imiquimod, a topical cream that helps the body's immune system fight the wart virus by encouraging interferon production. Approved by the U.S. Food and Drug Administration (FDA) for genital warts. The drug is very expensive.
• Cantharidin, a chemical found naturally in many members of the beetle family Meloidae which causes dermal blistering. Either used by itself or compounded with podophyllin. Not FDA approved, but available through Canada or select US compounding pharmacies.
• Bleomycin, not US FDA approved. One or two injections used. It can cause necrosis of digits and Raynaud syndrome.
• Dinitrochlorobenzene (DNCB), like salicylic acid, this is applied directly to the wart. Studies showed this method was effective with a cure rate of 80%. But DNCB must be used much more cautiously than salicylic acid; the chemical is known to cause genetic mutations, so it must be administered by a physician. This drug induces an allergic immune response resulting in inflammation that wards off the wart-causing virus.
• Fluorouracil, which inhibits DNA synthesis, is being used as an experimental treatment. It is applied directly to the wart (especially plantar warts) and covered (for example: with tape). This treatment is combined with the use of a pumice stone, but tends to work very slowly.
• Salicylic acid can be prescribed by a dermatologist in a higher concentration than that found in over-the-counter products. There are several over-the-counter options, commonly involving salicylic acid, readily available at pharmacies and supermarkets. There are typically two types of products: adhesive pads treated with salicylic acid or a bottle of concentrated salicylic acid solution. Removing a wart with salicylic acid can be done by cleaning the area, applying the acid, and removing the dead skin with a pumice stone or emery board. It may take up to a year to remove a wart.. Application of natural salicyclic acid sources such as podophyllum resin paint may also be effective. [podophyllum resin I.P.'66 (20% w/v), benzoin I.P. (10% w/v), aloes I.P. (2% w/v), isopropyl alcohol I.P. to make (100% v/v)]

Another product available over-the-counter that can aid in wart removal is silver nitrate in the form of a caustic pencil, which is also available at drug stores. In a placebo-controlled study of 70 patients, silver nitrate given over nine days resulted in clearance of all warts in 43% and improvement in warts in 26% one month after treatment compared to 11% and 14%, respectively, in the placebo group. The instructions must be followed to minimize staining of skin and clothing. Occasionally pigmented scars may develop.
Cryosurgery or cryotherapy devices using a dimethyl ether – propane mixture are inexpensive. A disadvantage is that the sponge applicator is too large for small warts, and the temperature achieved is not nearly as low as with liquid nitrogen. Complications include blistering of normal skin if excess freezing is not controlled.
Several randomized, controlled trials have found that zinc sulfate, consumed orally, often reduces or eliminates warts. The zinc sulfate dosage used in medical trials for treatment of warts was between 5 and 10 mg/kg/day. For elemental zinc, a lower dosage of 2.5 mg/kg/day may be appropriate as large amounts of zinc may cause a copper deficiency. Other trials have found that topical zinc sulfate solution or zinc oxide are also effective.

Procedures

Liquid nitrogen spray tank

• Keratolysis, of dead surface skin cells usually using salicylic acid, blistering agents, immune system modifiers ("immunomodulators"), or formaldehyde, often with mechanical paring of the wart with a pumice stone, blade etc.
• Electrodesiccation.
• Cryosurgery, which involves freezing the wart (generally with liquid nitrogen), creating a blister between the wart and epidermal layer, after which the wart and the surrounding dead skin fall off by themselves. An average of 3 to 4 treatments are required for warts on thin skin. Warts on calloused skin like plantar warts might take dozens or more treatments.
• Surgical curettage of the wart;
• Laser treatment – often with a pulse dye laser or carbon dioxide (CO₂) laser. Pulse dye lasers (wavelength 582 nm) work by selective absorption by blood cells (specifically haemoglobin). CO₂ lasers work by selective absorption by water molecules. Pulse dye lasers are less destructive and more likely to heal without scarring. CO₂ laser works by vaporizing and destroying tissue and skin. Laser treatments can be painful, expensive (though covered by many insurances), and can cause little scarring when used appropriately. CO₂ lasers will require local anaesthetic. Pulse dye laser treatment does not need conscious sedation nor local anesthetic. It takes 2 to 4 treatments but can be many more for extreme cases. Typically, 10–14 days are required between treatments. Preventative measures are important.
• Infrared coagulator – an intense source of infrared light in a small beam like a laser. This works essentially on the same principle as laser treatment. It is less expensive. Like the laser, it can cause blistering pain and scarring.
• Duct tape occlusion therapy involves placing a piece of duct tape over the wart. The evidence as to whether or not it is effective is poor. Thus it is not recommended as routine treatment.

Homoeopathic Management:

            Homoeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. The symptoms listed against each medicine may not be directly related to this disease because in Homoeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy.

The following homeopathic medicines are often found indicated in cases of warts: Antim-c, Bufo, Calc-c, Caust, Cinnab, Dulc, Ferr. pic, Lyco, Mag-s, Nat-c, Nat-m, Nit-ac, Ruta, Sil, Staph, Sul, Sul-ac, Thuja.

ANTIM. CRUD:

It is the leading remedy for warts, and has great practical use in homoeopathy. The warts are situated especially on hands; they are hard, horny, soft or smooth, which characteristic stinging pain. Warts are surrounded by circle of ulcers. Warts tend to develop which are pron to pressure and friction, especially suited to individuals who have tendency to grow fat. Warts develop in individuals who have suppression of eruption or ulcers.

Horny excrescences. smooth warts, often soft. Ulcers breaking out around a wart. Tendency to grow fat. Worse warm weather - heat of sun. children can't bear to be touched or looked at. Feels as if he had eaten too much. Heartburn with good appetite. Characteristic - while coated tongue.

For children and young people inclined to grow fat; for the extremes of life. Old  people with morning diarrhea, suddenly become constipated, or alternate diarrhea   and constipation; pulse hard and rapid. Sensitive to the cold < after taking cold.

BELLADONA:

It plays a very useful role whenever warts are inflamed with burning pain. They are hot & tender to touch with characteristic throbbing pain.

Adapted to bilious, lymphatic, plethoric constitutions; persons who are lively and entertaining when well, but violent and often delirious when sick.

CALC. CARB.:

Warts are present on face, neck & upper extremities, male genitalia, canthi, fingers. They are black & fleshy, hard & horny, sometimes inflamed & painful; the warts tend to suppurate. Giving an odour of stale cheese. The skin is icy cold to touch with cold & profuse perspiration. Development of warts in patient having history of suppression of eruption & perspiration. Development of warts in individual with scrofoulous diathesis with faulty development of bones. It has a typical physically constitution, i.e. fat, flabby, fair, perspiring, cold & damp.

Warts : round, soft at base, almost the colour of skin; upper surface hard, rough, whitish, horny. Wart appears, itches, bleeds & disappears. Warts : inflamed; stinging; suppurating; form ulcers. Warts thickly studding mouths of sheep. Calc. suits phlegmatic people; large head & features; pale skin & chalky look. Better dry weather, from being touched. Worse milk: from suppressed perspiration.

Leucophlegmatic, blond hair, light complexion, blue eyes, fair skin; tendency to obesity in youth. Psoric constitutions; pale, weak, timid, easily tired when walking.  Disposed to grow fat, corpulent, unwieldy.

CAUSTICUM:

Warts are present on nose, eyebrows, face, lips, near the nail, tips of fingers, upper limbs. They are large, horny, broad, fat & hard, moist and pedenculated. They tend to bleed easily. They are also prone to easy suppuration. Warts are present in individual after suppressed eruptions.

Large, jagged, often pedunculated warts exuding moisture and bleeding easily. Small, non-pedunculated warts all over the body internal & external, and on eyelids. In caust., injuries which had healed become sore again. Years ago there was an epidermic of warts on calves at a little farm - cured by causticum. Caust. is worse cold, dry weather, in clear, fine weather. Better damp & wet weather.

Adapted to persons with dark hair and  rigid fibre; weakly, psoric, with excessively  yellow, sallow complexion; subject to affections of respiratory  and  urinary  tracts.

DULCAMARA:

Warts are present on face, hands, fingers, close to nail; the warts are smooth, hard; they usually comes in crops; they always tend to aggravate when skin is washed with cold water.

In black type we find : warts, fleshy or large, smooth on dorsum of hands and on face. Dulc. is one of our very great skin medicines. Typical dulc. is worse from exposure to damp cold weather or air - a cellar or dairy. A few years ago, dulc. cured for a patient a big wart on right lower lids, not easy to see over. Big warts on face can be very trying, yet, with 'the remedy', they just drop off. Dulc. in one's mind, stands especially for warts & for umbilicalpain or eruptions.

Aggravation of sufferings, chiefly in the evening or at night, an during repose, better  by movement. Pains with coldness of the body.

NAT-MUR.:

The warts especially situated on palms, hands & knuckles. There is a cutting pain in wart, the look of the skin is oily, dry, harsh, unhealthy or yellow. Tendency to develop warts in individual after cautery with silver nitrate.

For the anaemic and cachectic, whether from lots of vital fluids- profuse menses,  seminal losses- or mental affections. Great emaciation; losing flesh while living well. Throat and neck of children emaciate rapidly during summer complaint. Great liability to take cold. Irritability: child cross when spoken to; crying from slightest   cause; gets into a passion about trifles, especially when consoled with. Awkward ,  hasty, drops things from nervous weakness. Marked disposition to weep; sad weeping  mood, without cause, but consolation from others <. her troubles.

NIT. ACID:

The warts appear on female genitals, anus, cervical region inside nose, external throat, sternum, eyelids, canthi. They usually develop after abuse of mercury. The following are the characteristics : moist, cauliflower like, hard, rhagadic, large, indented, inflamed, pricking pain < night. They emit foetid discharge, they bleed on touch.

Warts : sticking & pricking : on upper lip. Smart & bleed on washing; painful to touch. Soft with thin epidermis and moist: large, jagged, often pedunculated, exuding moisture & bleeding readily : condylomata, etc. splinter - sensations anywhere. Worse : touch, jar, cold at night.

SILICEA:

The warts are situated on throat, upper limb, back and forearm. They are large, fleshy & suppurating. They are painful to touch. Development of warts in individual with scrofulous diathesis. The patient is keenly sensitive to noise, pain and cold.

Adapted to the nervous, irritable, sanguine temperament; persons of a psoric  diathesis. Persons of light complexion; fine dry skin; pale face; weakly, with lax muscles. Constitutions which suffer from deficient nutrition, not because food is lacking in  quality or quantity, but from imperfect assimilation; oversensitive, physically and mentally.

SULPHUR:

Warts are situated on face, near eyelids, on upper lip. Warts covered with thin epidermis. The appearance of the skin is dry, rough, wringled and scaly. Warts alternate with other complaints. Suppression of warts leads to asthma.

Callous warts; especially around the fingers. Itching eruptions, or itching skin; 'feels so good to scratch.' Fantastic illusions : everything seems beautiful : as an old rag or stick. Redness about anus- red eyelids. Perspiration of single parts : of back part of body. Flushes of heat. Heaviness, abdomen; as if it needs to be bandaged or supported. Sulphur sometimes feels small, sometimes largs.

Adapted to persons of a scrofulous diathesis, subject to venous congestion; especially of portal system. Persons of nervous temperament, quick motioned, quick tempered,  plethoric, skin excessively sensitive to atmospheric changes. For lean, stoop-shouldered persons who walk and sit stooping like old men. Standing is the worst position for sulphur patients; they cannot stand; every standing position is uncomfortable. Dirty, filthy people, prone to skin affections. Aversion to being washed; always <. after a bath. Too lazy to rouse himself; too unhappy to live.

THUJA:

Warts are situated on back, cervical region, upper limb, face, nose, eyebrows, eyes, eyelids, external throat. They are broad, conical, flat pedunculated, indented, fan shaped in appearance. They are reddish in colour, bleed easily. The warts have a tendency to split from their edge or from the surface.

Warts on any part of body, with little necks called fig warts; tubular warts; i.e. long warts of the same size all the way out. Wart-like excrescences on back of hand, on chin and other places. Warts and condylomata, large, seedy & pedunculated; sometimes oozing & bleeding readily. Effects of vaccaination. Dreams of the dead : of falling.

Adapted to hydrogenoid constitution of  Grauvogl. Acts well in lymphatic temperament, in very fleshy persons, dark complexion, black hair unhealthy skin.  Ailments from bad effects of vaccination; from suppressed or maltreated gonorrhoea. Fixed ideas: as if a strange person were at his side; as if soul and body were separated;  as if a living animal were in abdomen; of being under the influence of a superior power.

Prognosis of Homoeopathy treatment varies from case to case - some warts disappear readily with medication whereas others require long-term treatment and are slow to disappear. The important thing about Homeopathic treatment is that besides healing them, it prevents the warts from spreading to other parts of the body. Proper constitutional treatment removes the tendency for wart formation from the roots thereby giving lasting results.

Overall, the treatment of warts with Homoeopathy gives good results in most cases and the best part are that the treatment is safe and without any side-effects. Homoeopathy is strongly suggested for all cases of warts.

HOMOEOPATHIC MANAGEMENT OF NASAL POLYP - Dr. BNR Vijayalakshmi BHMS

This medical system uses infinitesimal doses of natural substances to stimulate a person's immune system and body's natural defenses. Homeopathy not only offers relief from temporary disorders but, can provide long term healing of a person due to its individual and "wholistic" approach. This often leads to a complete recovery from the dis-ease, as well as, providing an improved understanding of the patient's situation. This type of healing makes it easier and possible to avoid recurrence or relapses in the future and homeopathy stimulates the body's natural defense system by    re-establishing normal immune system and cell functioning.

We study by knowing the totality of symptoms and  individualization. Miasmatic analysis is integral part of Homoeopathic evaluation of every individual case of chronic disease. Its synthesis provides insight into the pace and prognosis for the individual under consideration.

"The true natural chronic diseases are those that arise from a chronic miasm, which when left to themselves, and unchecked by the employment of those remedies that are specific for them, always go on increasing and growing worse, notwithstanding the best mental and corporeal regimen, and torment the patient to the end of his life with ever aggravated sufferings. These are the most numerous and greatest scourges of the human race; for the most robust constitution, the best regulated mode of living and the most vigorous energy of the vital force are insufficient for their eradication."                     

                                             ………...Organon Aphorism §: 78.

Miasm represents the past, the present and the future — the past in terms of the layers of suppression and their removal, the present by the removal of these layers, which leads to a clear assessment of the totality of symptoms, and the future where the patient becomes stronger as a whole and is more able to resist morbific influences. Anti-miasmatic medicines help to clear up the suppressions (in relation to the past); clear up the presenting symptoms from their root or origin (in relation to the present); and clear up the susceptibility to get infection and thereby strengthening the constitution (in relation to the prophylactic aspect or future).

To be more confident in prescribing by including the surface miasm of the case in the consideration of the totality, as miasm, the dyscrasia of the person, constitutes a major part of that totality. Miasm and the symptoms are nothing but the two sides of the coin, and one cannot be considered whilst ignoring the other. In fact, the totality of symptoms cannot be said to be total until and unless the selected remedy covers the miasm.

Even in this modern world of heroic suppressions, a proper constitutional, anti-miasmatic treatment is capable of achieving the good results; There are main sections in knowing the EFFICACY OF ANTI-MIASMATIC REMEDIES OF NASAL POLYP & ITS MIASMATIC EVOLUTION as detailed below:

Part    I    _   Philosophy and Utility of Miasm: Here I have taken the opportunity to discuss the philosophical background of Miasm, and to share my views regarding suppression and the need for miasmatic prescriptions in the modern world.

Part II      _    Miasmatic Diagnostic Classifications: schematic classification of the four miasms, including my tips for rapid miasmatic diagnosis.

Part III     _    Miasmatic Weightage of Medicines: A comprehensive guide to the weight, value or gradation of the medicines and listings of the leading anti-miasmatics.

Part IV     _   Homoeopathic therapeutics

Part V      _   Miasmatic evolution

Part VI     _   Superiority of Homoeopathic Medicines in a Case of Nasal

   Polyp.

    

           PART - I

NATURE OF CHRONIC DISEASE

The theory of miasms originates in Hahnemann's book “The Chronic Diseases” which was published in “1828”. He declared that the theory was the result of 12 years of the most painstaking work on difficult cases of a chronic character combined with his own historical research into the diseases of man. The three miasms given in that work are held to be responsible for all disease of a chronic nature and to form the foundation or basis for all disease in general.

The word miasm means a cloud or fog in the being.

The theory suggests that if 100% of all disease is miasmatic, Then 85% is due to the primary and atavist miasm [Atavist - An organism that has the characteristics of a more primitive type of that organism], Hahnemann called Psora. The remaining 15% of all disease he held to be either syphilitic or sycotic, being derived from suppressed Syphilis or suppressed Gonorrhoea.

 “Psora is that most ancient, most universal, most destructive, and yet most misapprehended chronic miasmatic disease which for many thousands of years has disfigured and tortured mankind... and become the mother of all the thousands of incredibly various chronic diseases” [Chronic Diseases, p9]

Kent, in his Lectures, then greatly enlarged upon the theory, proposing that Psora was the foundation of all other illness, without which mankind would be pure and healthy both in mind and body, as in the Garden of Eden. He thus regarded Psora as being equated with the 'Fall of Man' and with original sinfulness. He portrayed Psora in this highly moralistic light as also being the foundation of the sexual miasms that came later.

'Psora is the beginning of all physical sickness... is the underlying cause and is the primitive or primary disorder of the human race.' [ibid, p.126]

I think it is abundantly clear from these quotes that Kent took a very puritanical and moral line about the origins of disease within the human race and he apparently felt that Psora was equivalent to Original Sin or the Fall of Man.

Hahnemann specify the importance of etiological factors which can alter health like some gross errors in diet, some violent exertion of the mind or body, repeated fright, great grief, sorrow and continuous vexation etc. During the course of chronic disease some joyous occurrence or a pleasant journey, a favorable season, or a dry uniform temperature etc., can induce a symptom free interval during which the patient considers himself healthy. But this favorable pause is of no longer duration. Frequent repetition of the well-selected remedy even in appropriate doses during the recurrence of the symptoms is found to be less effective.     

The result of the Homoeopathic treatment in chronic disease is

“At their beginning were promising, the continuation less favorable and the out come hopeless”.

All chronic diseases of mankind, even those left to themselves, not aggravated by a perverted treatment, such a constancy and perseverance, that as soon as they have developed and have not been thoroughly healed by the medical art, they ever more increase with the years, and during the whole of man’s life; and they can not be diminished by the strength belonging even to the most robust constitution. i.e., They never pass away of themselves, but increase and are aggravated even till death.  

Even after the administration of most similimum Hahnemann observed a continuous relapse or recurrence of the symptoms occurred at variable intervals and thereby no complete cure. This made him think about the obstacles for complete cure and this led him to the discovery of the nature of the chronic diseases.  

After a long lasting investigation and observation in most of the chronic diseases, the master had trace a history of “itch eruption” and many of the chronic sufferers had the disease since then. Many a time this itch was suppressed by faulty practice. Finally he could find out effective means against the original malady, which he named as    “Psora”.  

Hahnemann’s continued observations of several years taught him that not only most of the many cutaneous eruptions but also almost all adventitious formation- from the common wart to the sarcomatous tumor, from the malformation of the finger nails up to the swelling of the bone and the curvature of the spine are caused by Psora.

“It is the most ancient, most universal, most destructive and most misapprehended chronic miasmatic disease” which for many thousands of years has disfigured and tortured mankind and which during the last centuries has become the mother of all thousands of incredibly various chronic diseases by which the whole civilized human race on the inhabited globe is being more and more afflicted. It is the most hydra- headed of all the chronic miasmatic diseases.  

External eruption of itch cannot only be drawn away by the faulty practices of physician and quacks but also it withdraws from the skin to affect the internal organ. But the syphilis and sycosis have greater advantages over the itch disease in that the chancre or fig warts can never leave the external part until the external repressive remedy destroys them or removed through the simultaneous internal cure of whole disease. The venereal diseases cannot therefore breakout so long as these external manifestations persist.  

Oldest documents of history also show that psora was prevalent in several varieties and this was pointed out by Moses 3400 years ago. In Leviticus chapter 13 and 21 mentions about psora where the malignant itch is designated by the word “ garab ” which the Alexandrian translators translated with “ psora agria ”,

 the vulgate with “ scabies jugis ”.  

In ancient times psora was mostly confined to its dreadful cutaneous symptoms. Only during the last few century mankind was flooded with a numberless infirmities like nervous troubles, spasm, painful ailments, ulcers (cancer), adventitious formation, dyscrasias, paralyses, consumptions and crippling of soul, mind and body etc. Hahnemann thought that the basic cause for this multitude of chronic disease was due to drinking of warm coffee and Chinese tea, which so largely increases the irritability of muscle fiber as well as excessive excitability of nerves. This undue prominence given to coffee drinking was due to the fact that Hahnemann had not then discovered the cause of chronic disease as psora.  

Psora forms 7/8 of all chronic maladies while the remaining 1/8 springs from syphilis and sycosis or from a complication of two of these three miasmatic chronic disease or from a complication of all three of them. “Psora is among all the diseases the one, which is most misapprehended, and therefore, has been medically treated” .

After many years of such treatment their suffering continually worsened and at last freed from their hand by death, the end of all earthly maladies.  

Many experience of Dr. Hahnemann in chronic diseases were frequently confirmed by observations of others, All miasmatic maladies, which show peculiar local ailments on the skin, are always present as internal maladies in the system before they show their local symptoms externally up on the skin. Here the outer local symptoms may either be driven from the skin or may disappear of itself but the internal disease if uncured neither wholly nor in part ever leaves the system; on the contrary, it continually increases with the years, unless healed by art.

“Three different important moments in the origin of chronic maladies are
1.Time of infection
2.Period of time during which the whole organism is being penetrated by the disease infused, until it has developed within and
3.Breaking out of the external ailment”.

The whole interior man must first have become thoroughly sick before its external manifestation appears on the skin or other part of the body. In impure coition, the specific contagion arises in the spot, which is touched or rubbed, most probably at the very moment of act (immediately after the moment of contagion). The spot remains healthy according to appearance, only the internal organism is called into activity by the infection, so as to incorporate the venereal miasma. When the development of the venereal disease has been completed, the diseased internal organism tries to mitigate the internal evil and to sooth it, by producing a local symptoms which first shows itself as a vesicle and later breakout in to a painful ulcer called the chancre. If the entire disease thus arising is extinguished through the internally given specific remedy, then the chancre is also healed and the man recovers. But if the chancre is destroyed through local application before the internal disease is healed (and this is still a daily practice with physicians of the old schools) the miasmatic chronic venereal disease remain in the organism as syphilis and it is aggravated, if not then cured internally, from year to year until the end of man’s life, even the most robust constitution being unable to annihilate it within itself.

Psora is much more infectious than the other two chronic miasmata (the venereal chancre disease and fig wart disease).

To effect the infection with the latter certain amount of friction is required in the tenderest part of the body as in genital organs or the miasma should touch a wounded spot.

But the miasma of the itch needs only to touch the general skin. The disposition of being affected with the psoric miasm is found with almost everyone and almost all circumstances, which is not the case with the other two miasmata.  

No other chronic miasma infects more generally, more surely, more easily and more absolutely than the miasma of itch. Psoric miasma can infect through gloves (which had been tried on by an itch patient), towel (contaminated), baby may be infected while passing through the organs of the mother or the baby receives this unlucky infection through the hand of midwife. Here, Hahnemann mentioned there are thousands of possible ways in which things polluted with this invisible miasma may touch a man in the course of his life, so that man who never been infected with the psora are the exception. He also mentioned that the chances of infection are more in crowded hospitals, factories, and prisons or in orphan houses or in the filthy huts etc. 

Usually it takes one to two weeks, from the moment of infection, for the development of itch miasm. No eruption or itching will be seen on the skin during the first few days. Thereafter when the infection invades the whole organism the local symptoms break forth, the itch vesicles. After this period with a slight or severe chill in the evening and a general heat followed by perspiration in the following night the itch vesicles come out.  

When this chronic miasmatic disease affects the whole organism, the diseased vital force endeavors to alleviate and to soothe the internal malady through the establishment of suitable local symptoms on the skin, the itch vesicles. So long as this eruption remains in its normal form, the internal psora with its secondary manifestations cannot rise, but must remain in latent form (latent psora). These troublesome eruptions act as frontrunner of the internal disease and keep the patient free from secondary ailments. Only in this stage the disease can easily be cured by internal administration of well-selected Homoeopathic medicines.  

As a result of suppression of primary manifestation of psora by local application or by non- Homoeopathic internal medicines it is driven inwards and remains in a dormant state, which is dangerous. It is called latent psora.

The consideration of miasms is of paramount importance in effective homoeopathic prescribing particularly in this world of multi-suppressions where perceiving a clear picture of disease is becoming increasingly difficult.

                                                PART II

BASIC CRITERIA OF FOUR GREAT MIASMS

KEY WORD		MIASM	CRITERIAS
IRRITATION		PSORA	LACK, SCANTY & ABSENCE
Either physical or mental			e.g. atrophy, anaemia, ataxia, anorexia etc.
Physical	Mental
Physical irritation is characterised by itching	Mental irritation leads to mental turmoil characterised by		Therefore any diseased condition characterised by deficiency, scantiness or absence, and all ‘hypo’ conditions reflect psora
e.g. itching all over the body	e.g. anxiety alertness apprehension (especially of impending misfortune), which manifests as fear. Psora has the most fears of all the miasms.		So deficient immunity resulting in increased susceptibility to catch infections i.e. ‘hyper sensitivity’ is a psoric criterion.

KEY WORD		MIASM	CRITERIAS
INCOORDINATION		SYCOSIS	HYPER
Either physical or mental
Physical	Mental		All hyper and excesses are sycotic.
Incoordination in development	Incoordination in the sensorium or comprehension		e.g. hypertrophy, hyperplasia, hypersexuality, excess working (workaholics).
Proliferation or excess	e.g. absentmindedness
e.g. tumours, fibroids, warts and any growths.	Whilst concentrating on studies the mind is abstracted and wanders off elsewhere.

KEY WORD		MIASM	CRITERIAS
DESCTRUCTION & DEGENERATION		SYPHILIS	‘DYSES’ AND IRREGULAR MANIFESTATIONS
Either physical or mental
Physical	Mental		All hypers and excesses are sycotic.
Characterised by structural destruction and degeneration	Characterised by destruction and perversion		e.g. dystrophy, dysplasia, dysphagia
Ulceration (where there is cellular destruction and degeneration) Pus formation (characterised by degenerated cellular debris) Necrosis (characterised by structural degeneration)	Love for one’s own life is destroyed (suicidal tendencies). Perverted sex and sexual cravings.		Irregular manifestations such as irregular peristaltic movement resulting in dysenteric spasm and stool, or high systolic and low diastolic blood pressure in one individual. Such manifestations reflect irregularity in the circulatory mechanism.

KEY WORD		MIASM	CRITERIAS
DISSATISFACTION		TUBERCULAR	ALTERNATING, PERIODIC, ONE-SIDED AND VAGUE MANIFESTATIONS
Either physical or mental
Physical	Mental
Person craves sugar but this makes them sick and they become dissatisfied. Perverted sexual cravings or profuse masturbation make the person exhausted (this is from the syphilitic component of the miasm), or the person enjoys sex but exhaustion does not permit so they remain     unsatisfied.	Changeable mentality (e.g. wants new clothes, changes occupation, studies, jobs partners etc. very frequently and is never satisfied). Vagabond mentality (e.g. likes to travel often, cannot stay in one place).		Alternation — e.g. constipation alternates with diarrhoea. Periodicity — e.g. headache comes on every seventh day. One sided diseases — e.g. insomnia, anorexia, migraine, fatigue etc. Other conditions which present with ill-defined symptoms or too few symptoms. All allergic manifestations such as food and dust allergies. All haemorrhages. All recurrent problems.

PART- III

LIST OF LEADING ANTI-MIASMATIC REMEDIES

Leading Anti-Psoric Medicines:

         

ALOES, Alumina, Ambra, Ammon.carb, Anac, Ant.c, Apis.mel, Arg.nit, Ars.alb,

Ars.i, Avena.sat, Baryta carb, Bell, Bry, Bufo.r, Calc.ars, CALC.CARB, Caps, Carb.veg, Caust, Cist.c, Coc.c, Conium. mac, Cup. met, Digit, Dulcamara, Ferr.m., Graph, HEPAR SULPH, Hypericum, Ignatia, Kali.p, Kali.carb, Lac.c, Lach, Led, LYCO, Mag.c, mag.m, Mang.act, Meli, Mer.cor, Mer.sol, Mur.ac, Nat.m, Nuphar.luteum, Nux mosc, Nux vom, Nycanthus, Opium, Pariffinum, Petrol, Phos, Platina, Plumb.m, PSOR,  Pyro, Rheum, Rhus.t, Robi, Sabal.ser, Saras, Sec.cor, Selen, Silica, Stan. met, SULPH, Sulp.ac, Sumbul, Syphilinum, Syzygium, Taraxacum, Tarentula, Tart.acid, Teuc.m.v, Ther, Verat.alb, Verbascum, Vinca.min, Viola.tri, ZINC MET.

Leading Anti-Sycotic Medicines:

Abrot, Act.r, Agar, Agn.c, Arg.met, Alum, Amm.benz, Amm.phos, Anac, Ant.c, Anti.t, Apoc.can, ARAN, Arg.nit, Ars.alb, Aster, Aur.mur.nat, Bacil, Bary.c, Benzoic acid, Berb.v, Bry, Calc.c, Calc.iod, Can.s, Carb.s, Carb.veg, Caul, CAUST, Cham, CONIUM, Dulc, Graph, Hell, Hep.s, Hyos, Kali.s, Kalm, Lach, Lapis. alb, Led. pal, Lil.tig, Lith.c, Lyco, Lycopus.v, Mag.p, Mang.act, MEDO, Meph, Mer.cor, Merc.d, Merc.i.f, Merc.i.r, Merc.sulph, Murex, Mygale, Myrica, NAT. SULPH,  Nat. mur, Nat. nit, NIT.AC, Nit.sp.d, Oci.can, Ooph, Orig, Pall, Pareira.brava, Pass.f, Petros, Phos, Pitu, Plat, Plumb.m, PULS, PYRO, RAD.BROM, Raph, Rhod, Rhus.t, Rhus.a, Ruta, Sabal ser, Sabina, Sang.n, Sanicula, Sars,  Sec.c, Selen, SEPIA, Sol.lyc, STAPHY, Sticta, Tell, Tereb, Teuc.m.v, Ther, Thios, Thlas.b.p, THUJA, Thymol, THYRO, Tub.bov, Uran.nit, URTICA.UR, Ust, Uva.u, Vacc, VARIOLUM, Verat.alb, Ver.vir, Vib.op, Viola.t, Vis.alb, X-RAY, Zin.m.

                                                                                                                                                                                                                                                                                                                                                                                                                                                      

Leading Anti-syphilitic Medicines:

Anthr, Arg.nit, Ars.alb, Ars.i, Art.v, Aur.mur.nat, Asaf, Aur.i, AURUM MET, Aur.brom, Bad, Bap, Calc.ars, Calc.fl, Calc.i, Calc.s, Calend, Cann.s, Canth, Carbo.v, Carbo.an, CARC, CINAB, Clem, Con, Cor.r, FLUOR.AC, Hep.s, Hydr, HYDROPH, Iod, Kali.ars, KALI.BICH, KALI.BICH, Kali.c, KALI.IOD, Kali.mur, Kali.s, Kalm, KREOS, Lach, Led, Lyco, Mang.act, Merc.i.f, merc.bin.iod, Merc.brom, Mer.cor, Merc.cyan, Merc.dulcis, Merc.i.f, Merc.i.r, Merc.proto.iod, MER.SOL, MEZ, Morphine, Muritic.ac, Myrist, NITRIC.AC, Ornith, Osmium, Paeonia, Petroleum, Phos, Phos.ac, Phys, PHYTO, Pyro, Ratan, Rhus.ven, Sabad, Sars, Sil, Solan, STELLARIA, Stillingia, Sulph, Sulp.ac, SYPH, Syzyg, TAREN.C, Thalasp.p, Trifolium, Trom, Tuber.

       

Leading Anti- Tubercular Medicines:

Acal.ind, Acet.ac, Agar.m, Ail.g, All.c, Amm.c, Amm.c, Anti.t, Arg.n, Arn.m, ARS.I, BACIL, Bapt, Bary.c, Bell, Brom, Bufo, Cact.g, CALC.C, CALC.I, Calc.phos, Calc.s, Carb.v, Carc, China.ars, CHINA, Cist, Con.m, Crot.h, Dros, Dulc, Elaps, Ferr.ar, Ferr.p, Galium, Ham, Hep.s, HYDRAS, Hydrophinum, Ign, IOD, Ipec, Kali.c, Kali.chl, Kali.iod,Kali.nit, Kali.p, Kali.s, Lac.d, Lach, Lyco, Merc.cyan, Merc.d, Merc.i.f, Merc.s, MILL, Mur.ac, Naja.t, Nat.nit, Nit.ac, Ol.j, Oxal.ac, PHOS.AC, PHOS, Plb.m, Psor, Sabina, Sang.c, Santonin, Sec.c, Senecio, Senega, Sepia, SILICA, Solidago.v, Spig, Spong, Stan.m, Stont.carb, Sulph, Sulph.ac, Tarax, TEREB, Ther, THLAPSI.B.P, Thyr, TRILL.P, TUBER.B, Urt.u, Vinc.m. 

Leading Tri-Miasmatic Medicines:

 Arg.n, Calc.c, Carc, Caust, Hydroph, Hep.s, Lyco, Merc.sol, Nit.ac, Phos, Sulph, Tuber.

Hahnemann lists the following as Psoric remedies in the Chronic Diseases:

Psoric remedies:

Hahnemann also pointed out the origins of his theory and the remedies that he decided had the power to eradicate the symptoms of a particular miasm.

Agar, alumina, ammon carb, ammon mur, anacardium, antimon crud, arsenicum alb, aurum, aurum mur, bar carb, borax, calc carb, carbo an, carbo veg, caust, clem, colocynth, conium, cuprum, dig, dulc, euphorbium, graph, guaj, hepar, iodum, kali carb, lyc, mag carb, mag mur, manganum, mez, mur ac, nat carb, nat mur, nitric acid, nitrium, petroleum, phos, phos ac, platina, sars, sepia, silica, stannum, sulph, sulp.ac, zincum.

The lists of miasmic remedies that Kent gives on page 1406 of his Repertory are as follows:

Syphilitic remedies:

Arg-m., Ars-i., ars-s-f., ars., asaf., Aur-m-n., Aur-m., Aur., bad., benz-ac., calc-i., calc-s., carb-an., carb-v., cinnb., clem., con., cor-r., crot-h., fl-ac., guai., hep., iod., kali-ar., kali-bi., kali-chl., Kali-i., Kali-s., lach., led., Merc-c., Merc-i-f., Merc-i-r., Merc., mez., Nit-ac., petr., ph-ac., phos., Phyt., sars., Sil., staph., Still., sul-i., sulph., Syph., thuj.

Sycotic remedies:

Agar., alum., alumn., anac., ant-c., ant-t., apis., aran., Arg-m., Arg-n., aster., aur-m., aur., bar-c., bry., calc., carb-an., carb-s., carb-v., caust., cham., cinnb., con., dulc., euphr., ferr., fl-ac., graph., hep., iod., kali-c., Kali-s., lach., lyc., mang., Med., merc., mez., Nat-s., Nit-ac., petr., phyt., puls., sabin., sars., sec., sel., Sep., sil., Staph., sulph., Thuj.

[These are exactly the same as the lists given on p86 of Speight's work on the miasms.]

To discover the true psoric remedies we must add together the remedies listed in the Repertory for a range of 'psoric' conditions. This means checking carefully all the symptoms and repertorising for all of them, gradually building up a master list of remedies that fit Psoric conditions. This exercise was highly recommended by Kent as a sure way of fixing in the mind the remedies of a particular miasm. It is also an excellent introduction to the miasms generally and is good for revision purposes. With computer programs like Radar and Cara this task become a lot easier than it was in Kent's or Hahnemann's day.

Since the 1950's it has been claimed that Tuberculosis have developed into new miasm in the own right, most probably as offshoots of what Hahnemann termed the 'Hydra headed Psoric miasm' (The Chronic Diseases, p14).

                                       PART - IV

HOMOEOPATHIC THERAPEUTICS:

calcarea carbonicum:

Calcarea patients are Fat, Flabbly, Flabby, Perspiring, Cold, Damp & Sour.

Leucopleghmatic temperament;

Hydrogenoid constitution;

Blond hair, Light complexion, Blue eyes, Fair skin, Tendency to obese in youth,

Persons who take cold easily, with increased mucus secretions;

Children, who grow fat, are large bellied, with large head, pale skin, and chalky look;

Nasal polyp; swelling at root of the nose;

Stoppage of nose with fetid yellowish discharge;

Offensive odor in nose;

Coryza, takes cold at every change of weather;

Catarrhal symptoms with hunger;

Coryza alternates with colic.

Teucrium marum varum:

                

A remedy of first importance in chronic nasal catarrah with atrophy; large, offensive crusts & clinkers.

Ozaena,

Anosmia, loss of sense of smell;

Discharges of large irregular clinkers, foul breathe.

Crawling in nostrils, with lachrymation & sneezing.

Coryza with stoppage of nostrils.

Catarrhal condition of both anterior & posterior nostrils;

Mucus polypus;

Sanguinaria :

                  

                   It affects chiefly the mucosa of Respiratory tract;

                   It is the Right sided remedy;

                   Nasal polypi; Laryngeal polypi;

                   Hay fever;

                   Ozaena; with profuse, offensive, yellowish discharges;

                   Chronic rhinitis; membrane dry & congested;

                   Coryza, followed by diarrhoea, sudden stoppage of catarrah

                   causes diarrhoea;

                   Associated with vasomotor disturbances;

Allium cepa:

Acute catarrhal inflammation of mucous membrane with increased secretions;

Coryza profuse, watery & acrid nasal discharge, with bland lachrymation.

Acrid watery discharge dropping from tip of the nose;discharge burns & corrodesthe upper lip;

Nasal polypus;

Spring coryza after damp northeasterly wind;

Hay fever in august every; violent sneezing on rising from bed; from handling peeches;

Eyes: burning, biting, smarting as from smoke, must rub them; watery & suffused, excessive bland lachrymation;

Catarrhal dull headache; < in the evening; > in open air; < on returning to warm room;

Apis mellifica:

Acts on cellular tissues causing odema of skin & mucous membrane;

Bad effects of acute exanthema imperfectly delevoped or suppressed, measles, scarlatina, urticaria;

Nose red , swollen, inflamed with sharp pains;

Affects right side;

Extreme sensitiveness to touch;

Pains: burning, stining, sore, suddenly migrating from one part to another;

Aggration: heat in any form, touch, pressure, late in afternoon, after sleeping, in closed room ;

Amelioration: open air, uncovering, cold bathing;

Calcarea sulphurica:

Cold in head with thick, yellowish, purulent secretion, frequently tinged with blood;

One sided affections;

Yellowish discharge from posterior nares;

Edges of nostrils sore;

Mucous discharges are yellow, thick, & lumpy;

Kali nitricum:

                  

                   Polypus, swollen feeling, < right nostril;

                   Nose pointed red & itching;

                   Sneezing;

                   < towards morning & in afternoon;

                   > drinking sips of water;

 Lemna minor:

                   A catarrhal remedy; acts especially on the nostrils;

                   Acts especially on the nostrils.

                   Nasal polpi; Swollen turbinates; Atrophic rhinitis;

                   Asthma from nasal obstruction;

                   Putrid smell; loss of smel;

                   Crusts & mucopurulent discharges very abundant;

                   Post nasal dribbing;

                   Pain like a string from nostrils to ear;

Reduces nasal obstruction, when it is an odmatous condition;

<damp rainy weather, especially heavy rains;

 Mercurius iodatus rubber:

                    Coryza & dull hearing;

                   Right side of nose hot;

                   Hawks mucus from the posterior nares;

                   Turbinates swollen;

 Phosphorous:

                    Polypi-bleeds easily;

                    It irritates , inflames & degenaretes mucus membranes;

Aggravation: touch, physical or mental exertion, twilight, warm food or drink; Change of weather; lying on left / painful side, during thunder storm, ascending stairs;

Amelioration: in dark, lying on right side, cold food, open air, washing with cold water, sleep;

 Psorinum:

                  

                   Dry coryza with stoppage of nose;

                   Chronic catarrah with post nasal dribbing;

                   Secretions filthy smelling;

Extreme senstiveness to cold, wants to be covered with fur even in summer;

Aggravation: coffee, changes of weather, in hot sunshine, dread of least cold air / draught;

Amelioration: Heat , warm clothing;

 Silicea:

                   Nose obstructed & loss of smell;

                   Dry hard crusts from bleeding when loosened;

                   Bad effects of  vaccination;

                   Suppurative process;

Aggravation: new moon, morning, from washing, uncovering;

 Sulphur:

                    Nose stuffed indoors;

                    Imaginary foul smells;

                    Chronic dry catarrah, dry scabs really bleeds;

                    Polyps & Adenoids;  offensive discharges;

Aggravation: warmth in bed, washing, bathing, in morning, 11 a.m.,night, from alcoholic stimulants, periodically;

Amelioration: dry, warm weather, lying on right side, drawing up affected limbs.

 Thuja:

                   Chronic catarrah; thick, green mucus; blood & pus;

                   On blowing nose – pain in teeth;

Hydrogenoid constitutions, whose blood is morbidly hygroscopic, worse humid atmospheres;

                   Left sided remedy; chilly patient;

Aggravation: at night, heat of bed, 3 a.m & 3 p.m ,after break fast; fat, coffee, vaccination;

Arsenicum album:

Use for throbbing and burning pains in the sinuses. Pain aggravated by light, noise, movement, after midnight, and may be triggered by anxiety, exertion, and excitability. Teeth may feel sore and painful. Nausea and vomiting along with sinusitis is a sign to use this medicine. Often patients have a big thirst, but drink frequent sips, rather than gulps. Those who feel relief by lying quietly in a dark room with the head raised on pillows exposed to cool air should use this medicine.

Belladonna

This remedy can be helpful for those whose head feels full, as if it could burst. There is throbbing pain that is worse by jarring, touch, bending forward, lying flat, or motion of the eyes and is relieved by gradually applied pressure, sitting up, or bending the head backwards. The pain usually resides in the forehead or around the eyes. The eyes are also sensitive to light and the face is flushed. They feel dizzy, which becomes worse when bending over. Also for those whose sinus pain appear rapidly then disappears temporarily, only to repeat the process of coming and going.

Kali bichromicum:

A person who needs this remedy has a thick, stringy nasal discharge. There maybe extreme pain at the root of the nose that is better by applying pressure in the area. The bones and scalp feel sore. Dizziness and nausea when rising from sitting and the severe pain may lead to dimmed vision. The preference is to lie down in a dark room, feel better with warmth, warm drinks, or overeating. These pains are often worse with cold, light, noise, walking, bending and in the morning (especially on waking) or at night.

                   Snuffles of children; especially fat, chubby babies;

Pressure & pain at the root of nose;

Fetid smell;

Discharges thick, ropy, greenish-yellow, tough elastic plugs from nose.

Loss of smell;

Post nasal dribbing;

Violent sneezing;

> from heat, < morning, hot weather, undressing;

Mercurius:

This remedy benefits those who feel as though their head was in a vise. The pains are worse in open air, from sleeping, and after eating and drinking. Pain is also aggravated by extremes of hot and cold. The scalp and the nose become very sensitive to the touch. The teeth feel sore and painful, and excessive salivation is possible. Nasal discharge is usually green but too thick to flow. It is usually offensive smelling and acrid.

Pulsatilla:

Use this remedy when nasal discharge is thick and yellow or green. Headache is worse when lying down and in a warm room, better in cool air and often begins after being over heated. Bedning, sitting, standing from lying down and eating, can aggravate the headache, which is often frontal and accompanied with digestive problems. Slow walking in open air or wrapping the head tightly in a bandage can bring relief.

Spigella:

This remedy is best for those who develop sinusitis with a sharp pain that is worse on the left side. This often occurs after exposure to cold or cold, wet, damp weather. Pain from warmth or when bending can occur and the feeling of relief when cold applications or cold water is applied.

                                               

                                                Part - v

                                   MIASMATIC EVOLUTION

Description :

EVOLUTION = A process in which something passes by degrees to a different stage

Disease pictures can be complicated for several reasons. These pictures are expanded upon within this chapter as an important starting point in understanding the value of miasms and miasmatic prescribing in modern homoeopathic practice based on miasmatic evolution.

a) Contaminated Picture: the disease is contaminated or masked. The disease picture is contaminated by various forms of suppression, which can be recognized in either of two ways:
through a lack of expression of symptoms or manifestations
due to emotional, physical or iatrogenic suppressions.

b) Conjoint Picture:
the original malady exists
upon which symptoms of various drugs are superimposed.

c) Scarcity of Symptoms:
conditions in which it is difficult to ascertain
a totality of symptoms,
i.e. one-sided diseases such as insomnia, migraine, fatigue syndromes etc.

Hahnemann makes us aware in §173 of The Organon.

These are diseases with too few symptoms, such as insomnia, anorexia and cases of hyperactive, restless children. They also include the so-called modern illnesses such as Chronic Fatigue Syndrome, where there are only one or two symptoms showing on the surface of the case. In a case of insomnia, for example, where loss of sleep is due to anxiety and nothing more, we are unable to make a totality.                                              

We cannot prescribe successfully on the basis of one or two symptoms and it is due to suppression that only one or two symptoms are visible. It follows therefore, that the manifestations and expressions of the patient must have been suppressed.

Types of suppression:

We know that in the modern world, the causes of suppression are many. They do however fall into the three main categories as follows. Examples are given under each category although it should be noted that these examples are by no means exhaustive.

a) Physical Suppressions

e.g. suppression of perspiration by antiperspirants.

b) Emotional Suppressions

E.g. broken relationships; disappointments in love; pecuniary embarrassments.

c) Iatrogenic Suppressions

Suppressions by non-homoeopathic remedies e.g. antibiotics, steroids etc.

Suppressions by homoeopathic medicines e.g. daily repetition of doses over a prolonged period, polypharmacy, quick alternation of remedies, the use of combinations.

Widespread vaccination.

Suppressions caused by the use of serums (anti-sera preparations)
such as the contraceptive pill and H.R.T.

So we can clearly see that manifestations of one-sided diseases are either contaminated, conjoined with artificial disease symptoms, or hindered and suppressed.

Clinical experience of the classical prescribers and my own ancestral wisdom has shown that the best way to open up these cases is from the miasmatic viewpoint. That is to say, we perceive the surface miasm and treat it accordingly. The surface miasm itself being diagnosed by considering the symptoms showing on the surface of the case as presenting complaints.

Uncovering the layers:                                                                                                                                                                            

It is apparent therefore, that it is necessary to understand the soil, the very dyscrasias of the person, and the miasm, which represents the stigma, groove or pollution in the system. This stigma/groove/pollution, call it what you will, can only be corrected through constitutional, anti-miasmatic treatment, and through such treatment, the complete annihilation of symptoms and perfect restoration of health will ensue.

In order to make a miasmatic assessment, we need to uncover the layers of predisposing weaknesses, which can be attributed to the different layers of suppressions. These reflect the miasmatic weakness of the individual.

I like to compare these different layers of miasmatic dyscrasias with the lotus flower. The outermost layer or petal reflects the surface miasm, that is, the presenting manifestation of the person. On the basis of the totality of symptoms, together with the miasmatic totality, the constitutional anti-miasmatic remedy is then selected for that presenting totality. This not only removes the surface symptoms but also the corresponding miasmatic dyscrasia, which was being manifested on the surface at that time.

Once the outer layer of the flower is removed the second layer is revealed. This second layer in turn becomes the surface miasm, reflecting a different group of symptoms. Dr. Kent guides us here, stating that there now has to be a change in the plan of treatment. This means that if the previous outermost layer was sycosis (and accordingly an anti-sycotic remedy was given which annihilated all the symptoms of that layer), the next miasmatic layer, which rises to the surface, has also to be addressed by its own presenting symptoms. The totality of the case needs to be reassessed and the next prescription selected on the basis of the totality of symptoms including the miasmatic symptomatology.

The skill of a homoeopathic physician is to recognize the differing layers present as they reveal themselves through the surfacing of symptoms. The remedy they select should not only cover the symptomatic totality as manifested through the surfacing of symptoms in the outermost layer but also the miasmatic totality. In such a way ‘layer upon layer of predisposing weakness’ can be peeled off, taking with them the layers of suppressions and corresponding miasma, and the miasmatic dyscrasias can be nipped in the bud.

Classical Miasmatic Prescribing:

[MTEK is a useful memory aid to arriving at a correct prescription.]

M=Miasmatic Totality; T=Totality of Symptoms; E=Essence (should include gestures, postures, behaviours etc); K=Keynotes (which should encompass PQRS symptoms, refer §153 and §209 of Hahnemann’s Organon)

When the above criteria are considered and the steps below followed, a correct prescription can be made.

Step I	Make the miasmatic diagnosis of the case i.e. ascertain the surface miasm.
Step II	Assess the Totality of Symptoms + Essence + Keynotes and PQRS of the case and formulate the indicated remedy.
Step III	Ensure that the indicated remedy covers the dominant miasm, as diagnosed in Step I (refer Miasmatic Weightage of Medicines, the last section of this book).
Step IV	Administer the remedy, which encompasses miasm as well as the Totality of Symptoms.

          By such a prescription, which covers the miasmatic dyscrasia of the person, the chances of recurrence are eradicated and the axiom of ‘rapid, gentle and permanent recovery’ (Hahnemann’s Organon §3) is encompassed. In cases of one-sided disease with a scarcity of symptoms, the action of the anti-miasmatic remedy is centrifugal, and by bringing the suppressed symptoms to the surface allows a proper totality to be framed.

A thorough dissection and incorporation of miasm in each case will help a homoeopathic prescriber in the following ways:

       i.            A deep acting anti-miasmatic medicine by virtue of its centrifugal action will open up such cases (brings to the surface the suppressed symptoms) where the totality of symptoms cannot be framed due to a scarcity of symptoms (i.e. one-sided cases), and those cases with conjoint or contaminated pictures due to various physical, emotional or iatrogenic suppressions.
 

     ii.            Also of importance is the value of selecting an anti-miasmatic medicine, which covers the psychic essence, nature and character of the individual in absence of any recognisable totality. For example, a patient presents with insomnia with no distinguishing modalities or other characters to complete the symptom. By ascertaining that person’s psychic essence or character (for instance, suspicious, jealous and exploiting in nature, representing sycosis) we can prescribe an anti-miasmatic medicine to cover the insomnia and open up the case. Thus, the anti-miasmatic medicine covers the essence of the person is capable of surfacing the suppressed symptoms and then we can easily frame the totality.
 

  iii.            To evaluate the necessity of a change in the plan of treatment or a change of remedy; when few symptoms have disappeared after the first remedy has been administered, yet the miasmatic totality shows the preponderance of the same miasm on the surface as that which was originally covered by the initial remedy. It indicates that the prescriber can stay with that initial remedy, as can be seen from the following example: a patient came with the presenting symptom of facial wart, for which Causticum was prescribed. As this medicine covers the miasm (here in this case, sycosis) as well as the symptom, the wart has fallen off; and the next suppressed layer, perhaps a profuse yellowish leucorrhoea (which was previously suppressed by cauterisation) comes to the surface. This symptom too is a sycotic manifestation, and if also covered by Causticum, then that remedy will totally eradicate the problem. So knowledge of miasm guides us to stay with the remedy and to allow its full and complete action.

  iv.            To evaluate the homoeopathic prognosis of the case, as removal of layers of suppression are manifested as clarity of symptoms and also reflected by a quantum jump in the sense of well being. Deep acting anti-miasmatic medicines by virtue of their centrifugal action will remove the layers of suppression which can be evidenced as follows:

a) A quantum jump in the sense of well being.
b) Improved energy.
c) Increased appetite.
d) Better quality of sleep.
e) Harmony and tranquillity of temperament.

a.     Stability (in obese people) or weight gain in under weight subjects.

b.     Clarity of the existing or presenting symptoms or even lighter symptoms.

c.      Suppressed symptoms (even of years ago) reappear on the surface and are permanently eradicated. This reappearance can be in a very transient form, which may not even be visible to the naked eye.

Miasmatic evolution of nasal polyp:

          The evolutionary stages of miasms has been catageriosed basedon the history of the patient viz; Family history; Past history; Personal history; Generals & particulars of the presenting complaints of the patient.

          The totality of present history of complaints indicates Dominant miasm; the history of suppressions, family history, past history, indicates Basic miasm. This differs from each & every case depending upon the case history of the patient.

          In general, the groups of symptoms occurring during the pathogenesis of nasal polyp are classified under each miasmatic group to help in the diagnosis of Dominant miasm of the patient.

SYMPTOMS OF PSORIC MIASM:

·        Clinicals                    :  Rhinitis

·        Characteristics                    :

                                      Various olfactory disturbances of functional origin;

                                         Sensationof dryness of nose;

                                      Discharges are thin, watery, & may be acrid.

                                      Stoppage of nostrils causes mouth breathing

·         Modalities                :

                                      < Morning, from cold & during sleep;

                                      > From warmth, & by natural discharges;

·        Smell                         :

                                      Hypo sensitivity / Hyper sensitivity to smell;

                                      Can’t tolerate any odours, whether good / bad;

Hypersensitivity may cause fainting, sleep disturbances like nausea, vomiting, & headaches.

·        Septum                     :

Painful boils in the nose or pimples on the septum, but there are no malignant manifestations.

Redness of the mucus membrane of the nasal orifice & a sooty, dirty appearance of the septum.

In rhinitis, septum is hot, dry, & burning.

SYMPTOMS OF SYCOTIC MIASM:

·        Clinicals                    :

                                       Sinusitis;

                                       D.N.S (Deviated Nasal septum);

                                       Swollen adenoids.

·        Characteristics          :

In sycosis, there are polyps, growths, moles, papilloma & verrucas in the nostrils. There may also be oedematous swelling of the nasal turbinate.

Bland discharges with a fish brine smell.

Difficulty in breathing through the nose can be caused by various growth & edema.

Moist snuffles with a purulent, scanty discharge, with the odor of fish brine odor & no formation of crusts.

There may be mottled appearance of the mucus.

Children born for sycotic parents complicated with gout, take cold easily at the slightest exposure & frequently suffer from acute, copious(+++) watery Coryza, which is often excoriating.

·        Modalities                 :

                                      < :  Damp & changes in weather.

> :  Abnormal discharges from various mucus membranes, such as Coryza.

·        Smell                         :

Sycotic incoordination results in the sense of smell being increased profoundly or diminished.

·        Septum                      :

Burning of nasal septum can lead to obstruction of the nose.

Thickening of the membranes or enlargement of the turbinate bones due to obstruction may cause stoppages.

SYMPTOMS OF SYPHILITIC MIASM:

·        Clinicals                    :

                                      Degenerative and ulcerative disease of the nose.

·        Characteristics          :

The nose may be flat / depressed from ulcesration / destruction of nasal septum and ulcers may occur inside the nostrils.

Clinckers (thick crusts which are black, brown, / black), can be offensive & often have to be removed. Manifest with offensive breath. 

·        Modalities                 :

                                      < : Night, warmth of bed.

                                      > : Abnormal discharges.

·        Smell                         :

Sense of smell may be diminished, lost, or perverted.

·        Septum                     :

Recurrent boils in the nostrils may result in insomnia.

Destruction of nasal septum.

SYMPTOMS OF TUBERCULAR MIASM:

·        Clinicals                    :

                                      Epistaxis.

·        Characteristics          :

There is a tendency to the recurrent catching of colds.

Epistaxis, which is bright red, may occur from any trivial cause such as over-heating, over-exercise or during fever. Relief comes by cold application but nose bleeds are difficult to stop & recur periodically.

Flushing of the face, eyes, & nose.

Snuffles are periodic & associated with haemorrhage.

A thick yellowish discharge with an odor of old cheese / sulphur, > by cold application is constantly dropping down the throat (post nasal drip).

Nasal polyp when characterized by profuse haemorrhage.

·        Modalities                 :

                                      < : Closed room.

                                      > : Open air, by epistaxis.

·        Smell                         :

Sense of smell has changeableness, &alternation of both nostrils. The patient will smell through one nose when the other is blocked.

·        Septum                     :

Tubercular nostrils are narrow & have small openings leading to nasal blockages & thereby mouth breathing.

                                     

          PART - V

SUPERIORITY OF HOMOEOPATHIC MEDICINE

Each & every system of medicines whichever in practice has their own limitations & as well as success, it changes according to the type of disease & the nature of the disease; For example most of the acute diseases in the emergency conditions Allopathic medicine acts as a life saving medicine; But most of the Chronic diseases responds well to Other Alternative Systems of medicines especially Homoeopathy, Siddha, Ayurveda, Unani etc., & Some Surgical conditions by appropriate surgical methods, each one has its own method for the purpose of cure/ relief of the patient. Regarding the topic selected NASAL POLYP, an Extra mucosal Growth from the nasal mucosa, either from Allergic cause / Recurrent Upper Respiratory Tract Infection; This condition is most commonly known Surgical Condition but recurrences are very frequent even after the surgery or any other treatment. But when treated with homoeopathic method of treatment the recurrences are reduced & even eradicated fully from the root causes.

The differences in the treatment can be explained on the basis of following points & this comparison is explained between Allopathic, Surgery, & homoeopathy systems as based on;

1.    Approach to the patient,

2.    Motive of the treatment,

3.    Scope of the treatment,

4.     Limitations of the treatment,

ALLOPATHIC TREATMENT:

Approaching the case on nosological viewpoint & treating symptomatically without removing the causative factor.

          Relieving the patients’ symptoms temporarily.

Recurrences are more in case of nasal polyp & medicines have only palliative action.

Suppressions of symptoms occur & it leads to other adverse action over internal organs of the body.

According to allopathic mode of treatment, long-term treatment is required to reduce polyp size and prevent their regrowth.

Bad effects of the drugs given during the treatment especially incase of nasal polyp, corticosteroid drugs used medically which has many constitutional bad effects occurred after taking these medicines for long period which are explained below;

 What are corticosteroids?

The corticosteroid drugs used medically are, in fact, similar to those occurring naturally in the body and produced by the adrenal glands. These natural hormones are essential to the body in fighting stress, injury and disease.

Corticosteroids (sometimes called "cortisone") are effective anti-inflammatory drugs often used to help control inflammation.

How are corticosteroids administered?

These drugs may be given by mouth (tablets), by injection or by the inhaled route using an inhaler or dry powder device.

How do corticosteroids work?

One of the important actions of corticosteroid drugs is to reduce inflammation.

 

What are the side effects?

Side effects of corticosteroids are uncommon unless you take them for a prolonged period or in very high doses.  As with any other drugs, unexpected individual reactions can occur.

Inhaled corticosteroids (e.g. Aldecin^TM, Becotide^TM, Becloforte^TM, Pulmicort^TM and Flixotide^TM) are preferred to corticosteroids taken by mouth (e.g. prednisolone, dexamethasone) because the dose required is much less and is delivered directly to the lungs. In addition, there are few side effects associated with inhaled steroid use. The commonest of these are hoarseness of the voice and a sore throat. The sore throat may be due to the development of a fungal infection (thrush) or due to the propellant in the puffers. Mouth washing and gargling after each dose and the use of a spacer device, such as a Volumatic^TM or Nebuhaler^TM will help avoid these problems. Other side effects are extremely rare.

Oral corticosteroids have a bad reputation in the community largely because of the side effects that they sometimes produce. These usually occur only when corticosteroids are taken orally over a long period of time. The most common of these include weight gain, increased susceptibility to infection, slow healing, easy bruising, fluid retention, growth retardation in children, hairiness, diabetes and thinning of the bones (osteoporosis) particularly in women during and following the menopause. Sometimes emotional upset such as depression can be troublesome. Corticosteroids may also cause indigestion and occasionally bleeding from the stomach. You should notify your doctor if you have ever suffered from peptic ulcers, indigestion or heart burn in the past.

            The most commonly encountered side effects are:

·         Sodium retention

·         Increased appetite

·         Increased fat deposits

·         Increased acid in your stomach

·         Increased sweating, especially at night

·         Increased hair growth

·         Acne on the face, back, and chest

·         Bone and muscle problems

·         Growth problems in children

·         Eye problems

·         Increased sugar in the blood

·         Increased sensitivity to the sun

·         Delayed wound healing

·         Decreased ability to fight infection

·         Thrush (Candida) growth in the mouth

Hahnemann’s view:

·         The antipathic / enantiopathic / palliative method treats a single symptom of the disease with a remedy of opposite action, “Contraria Contraris”§: 57.

·         This antipathic treatment is not defective merely because it is directly against a single symptom of the disease only, but because in persisting ailments, after it produces a short apparent amelioration, real aggravation ensues §: 58.

·         Increasing the dose at every repetition of a palliative never cures a chronic affection, but does still more harm §: 60

Dr. BNR Vijayalakshmi BHMS