Nervousness sleeplessness heart troubles palpitations of old tea drinkers, can’t lie down
Dyspepsia of old tea drinkers
Paralysis of tea tasters affecting lower Limbs with loss of sensation
Impulse to suicide or to kill children, commit homicide
Impulsive
Throw things away
Makes versus (ANT CRUD, AGAR, CANN IND, STRAM)
Pleasure on waking from a dream of Murder
Dreams of Murder in which he takes joy, horrible dreams cause no horror.
Sick headache radiating from one spot cold damp feeling at the back of head
Sinking all sensation in stomach (SEP, OLEANDER, HYDRAS)
Craves acids (SULPH, VERAT, SABINA, ANT CRUD)
Sudden flatulence borborygmi with hernia
Tender ovaries
Neuralgic pains
sciatica and Supra orbital Neuralgia
(Think of this remedy in people who are addicted to tea, have taken tea for long time. It causes dyspepsia, palpitations. The person is impulsive. Patient gets dreams of murdering someone in which he takes pleasure. Talk by making verses.
The person is quarrelsome, impulsive and throws things away.)
Vocal cord polyp are benign lesions with a variety of causes such as voice overuse (teachers, coaches, recurrent shouting, salesperson etc), acute episode of excessive shouting, gastroesophageal reflux, allergies, smoking (and inhaling other such irritants and chemicals), thyroid problems.
CASE
PRESENTATION- A teacher came with irritation on throat and chronic hoarseness of voice. She had to constantly hawk and clear and would not be able to even speak at the end of the day. She had been to an ENT specialist and who found a vocal cord nodule on laryngoscopy. She was advised complete rest to voice and a vocal cord surgery to remove the nodule. She did not want to undergo surgery due to feared complication of paralysis of cords. She had no comorbidity and other complaint.
TREATMENT- She was started on PICRIC ACID 200 once in 5 days, 6 such doses for a month as she could not stop the work (i.e. constant talking, as she was a teacher). A follow up after a month revealed much improvement in her hoarseness but remnants remaining. The dosage was reduced to once in 10 days, so she took another 3 doses the following month.
OUTCOME- Starting of the 3rd month she underwent laryngoscopy at her own accord as she felt completely normal and came with the result. It showed complete resolution of the polyp. The medicine was stopped. A 2 year follow up did not show any relapse of the complaint.
BASIS of PRESCRIPTION- PICRIC ACID was chosen on basis of overuse of the vocal cords, and the exhaustion that she felt after speaking much.
D/D of MEDICINES- other medicines that came close to the case were STANN MET, ARGENTUM MET and ARUM TRYPHYLLUM.
Traditionally patients are asked to maintain speech hygiene and the underlying cause is identified and treated. When conservative treatment does not help a surgical removal is advised as was in the case above.
The presented case clearly showed complete removal of her subjective complaints symptomatically with objective laryngoscopic evidence of resolution, highlighting the efficacy of individualised homeopathic prescriptions in treatment.
Oppresses the breath, can’t inhale sufficiently, dyspnoea from anger
Bad effects of alcohol
Delirium tremens
Day blindness
Hiccough in alcoholics
Epileptic attacks in
Eruptions
Vesicular, on hands, feet and body
Pustulous exanthema
Pain
Like a shock through body
Whole body feels beaten and pains as if ulcerated
Sore spots on body
Pains with shuddering
Agg < morning, evening
Agg < change of temperature (getting cold when heated or getting heated when cold), motion, stretch
Crawling
Sp about nose, chin
Very sensitive to open air
Chilliness in chest on walking in open air
Pleurisy pneumonia from sudden change of weather
Degeneration of spinal cord, symptoms agg change of weather
Tingling in fingers
Shooting neuralgic pains in chest, paroxysmal
Intercoastal rheumatism, < wet stormy weather
Shingles/ herpes neuralgia (MEZEREUM)
Pleurisy
Muscular pains, sp shoulder blade
After doing fine work (ACTEA RACEMOSA)
After playing piano
Corns very sensitive to touch
Dreams of drowning/ or swimming
(Think of a person who suffers from bad effects of alcohol. He is quarrelsome and has body aches as if body is beaten like ARNICA. Every change of temperature affects him badly. He gets pneumonia, headaches, neuralgias etc. You might think of SPIGELIA but keep RAN BUL in mind. He also has vesicular eruptions which might lead you to think of RHUS TOX. When you are thinking of RHUS TOX and SPIGELIA think of RANUNCULUS BULBOSUS as it covers both remedies.)
This article is an attempt to correlate symptomatic corelation of AMYL NITROSUM with pathophysiology of NEUROENDOCRINE TUMORS and is yet to be seen by author in practice.
NEUROENDOCRINE TUMORS
Def:  originating from chromaffin cells in the adrenal medulla in case of pheochromocytomas while GIT is the main site for carcinoid tumors.
Release of hormones in response to nervous stimuli.
Eg are- Pheochromocytoma, Carcinoid tumor, Islet cell tumor and some lung cancer like Small Cell CA, Merkel cell carcinoma etc.
PHEOCHROMOCYTOMAS
Hormones involved
Overproduction of catecholamines (group of hormones and neurotransmitters maintaining homeostasis and regulating the body’s response to stress eg dopamine, norepinephrine, and epinephrine).
Characteristic-
Sporadic or familial
Benign or malignant
Often associated with familial syndromes such as neurofibromatosis type 1, multiple endocrine neoplasia type 2, and von Hippel-Lindau disease.
Triggers for catecholamine release
Mechanical factors such as abdominal palpation, sexual intercourse, coughing, sneezing, defecation,
Pain,
Extreme emotions, and
Exposure to cold
Clinical Features
Release of hormone from tumor can be- paroxysmal, continuous, or mixed.
Norepinephrine is typically released continuously, leading to persistent hypertension, while epinephrine is released in a paroxysmal manner.
Episodes of hypertension associated with symptoms such as headaches, tachycardia, and sweating.
Presence of hypertension that is resistant to multiple antihypertensive therapies should raise suspicion for pheochromocytoma
Most commonly overlooked causes of secondary hypertension
Abdominal pain
Constipation
Chest pain
Dizziness
Elevated blood sugar
Facial flushing (redness)
Increased respiratory rate
Nausea
Nervousness, anxiety, and irritability, sense of doom
Typically spells characterized by headaches, palpitations, and diaphoresis in association with severe hypertension.
CARCINOID
Hormones involed and location- neuroendocrine tumors, most commonly arising from the GIT characterized by the secretion of serotonin, leading to symptoms, eg, flushing, diarrhoea, bronchospasm, and systemic complications
Characteristic
Sporadic or familial
Small or bulky
Trigger
Spontaneous
Triggered by certain factors, eg, eating, alcohol consumption.
Liver palpation, or anesthesia.
Exercise, stress, or emotional stress
Certain foods (eg, cheese) may trigger an attack.
Clinical Features
Flushing- Sudden episodes of salmon-pink characterize it to dark-red discoloration of the upper body, particularly the face, neck, and upper trunk, associated with an unpleasant warm feeling, itching, rash, sweating, palpitation tachycardia, swelling around the eyes, and increased lachrymation.
Episodes lasting anywhere from 30 seconds to 30 minutes
Periodic abdominal pain
Valvular heart lesions
Cough dyspnoea or asthma like symptoms from bronchoconstriction
Watery, frothy Diarrhoea and malabsorption or bulky stools, gastrointestinal (GI) bleed or fat in stool
Abdominal cramps
Lengthening duration of attack from initially few minutes to later few hours to even constant flushing in some cases.
DIFFERENTIAL DIAGNOSIS, D/D of Pheochromocytomas and Carcinoid tumor
Facial flushing is a grand concomitant of this remedy and accompanies almost all the symptoms.
Congestion as generality
Acute or chronic
Rush and Congestion of blood to head and face
Flushing and then hot sweat, all over the body or in parts
Localized flushings
Other parts may be icy cold
Least emotions cause flushing of face (FERRUM, COCA) (From the slightest emotion flushing of the face- Hering Guiding Symptoms)
Throbbing and pulsations
Craves fresh air, opens the window in the coldest of the weather (SULPH, LACHESIS, ARGENTUM NITRICUM)
Can’t bear anything around neck, loosens collar
Constant stretching and yawning (KALI CARB)
Convulsions
Immediately after delivery
Paroxysms run close to each other
Grasping at imaginary things during convulsions
Chorea, all muscles are in motion
Angina
With facial flushings
With pain in rt shoulder and arm
Sensation of band around chest
Choking in throat, pain extending into chest
Fluttering and tumultuous action of heart at slightest excitement
Headache
Dreamy confounding with headache
Flushing of face with headache
Migraine with pallor (ARS)
Aggravations
emotions
slight causes
climacteric
heat and closed room
DIFFERENTIAL MATERIA MEDICA
GLONINE
BELLADONNA
LACHESIS
ACONITE
COMPARISON of manifestation
A close comparison of the symptoms the Neuroendocrine tumors sp pheochromocytoma and carcinoid tumors show that AMYL NITROSUM very closely covers the main symptoms of both the conditions sp flushings diarrhoea headache and also triggers such as agg from emotional causes etc.
This is comparison of the most prominent features, further detailed study reveals the parallels between the manifestation in the disease and the medicine AMYL NITROSUM.
Few prominent comparisons are given below:
Intense surging of blood to the face and head, heat and redness; feels as if the blood would start through the skin, with lachrymation. Intense redness of surface with great subjective feeling of heat in face and head. Left side of face and 1. ear get intensely red, coming suddenly and disappearing suddenly during the intervals of the attacks of headache; most after mental symptoms- Hering Guiding Symptoms.
Face, and even the back of the hands, deeply reddened- Hering Guiding Symptoms
Flushing- Sudden episodes of salmon-pink characterize it to dark-red discoloration of the upper body, particularly the face, neck, and upper trunk, associated with an unpleasant warm feeling, itching, rash, sweating, palpitation tachycardia, swelling around the eyes, and increased lachrymation.
Feature
Pheochromocytoma/Carcinoid
Amyl Nitrosum
Flushing
Episodic, emotional triggers
Sudden, emotion-induced
Tachycardia
Paroxysmal, stress-related
Palpitations, tumultuous heart
Sweating
Common in spells
Hot sweat following flushing
Emotional aggravation
Prominent trigger
Marked aggravation
RUBRIC SUGGESTION
COMPLETE DYNAMIS
Face
Redness
Asthmatic complaints with- ACO, CAPS, THUJA
Diarrhoea with- FERR PHOS, JABORANDI
Hypertension in- STRONTIUM CARB
Pulsation about heart with- AMYL NITROSUM,
KENT REPERTORY
Face
Discolouration
Red
Many remedies are given under this rubric
BELL, GLONINE and ACONITE are other medicines which come very close to AMYL NITROSUM in repertorial analysis of symptoms of NET’s.
The final selection of the remedy is just not a pathological similimum but covers the whole history of the patient (anamnesis) with its PQRS, concomitants aggravations and particulars. The angle of prescription depends on many factors.
REFERENCES
Kent Repertory
Boericke Materia Medica and Repertory
The Encyclopedia of Pure Materia Medica- T. F. Allen
NB: This similarity is found only while studying the medicine from a pathological point of view. The confirmation can only be done by applying this knowledge in such a clinical condition, in a patient.
A similar pathogenetic condition may also be present in another drug, the differentiation between such drugs in similar pathologic condition is what makes homoeopathy an individualistic medicine.
This kind of approach is especially helpful when:
The patient is not able to give refined symptoms and sensations
One is not able to find any characteristic symptom or
The attendants are not able to give one,
There is time constraint or
The physician has not seen the patient but has received a diagnosis from attendants.
Pathology is advanced enough to wipe out the PQRS of the case.
The patient has taken conventional treatment masking or modifying the individualistic feature. (Refer to Organon of Medicine for treatment of such cases)
The results in such prescriptions would nonetheless depend on the accuracy of diagnosis and its pathological similarity to chosen medicine.
(This post is for the practitioners of Homoeopathy and not for patients for diagnosis and treatment of the said entity.)
(Similar to collapse remedies VERAT, ARS, CARBO VEG in last stages. So weak that cannot even hold neck when lifted or made to sit down, the head falls back. They are very sensitive individuals, sensitive to others misdeeds, to external stimuli, odors noise etc. They feel nauseated even at the smell of the food. They have joint pains which are very sensitive that mere touch excites pain, least stubbing causes excruciating pain. They have tingling and weakness almost bordering to paralysis. Complaints come after studying hard at night.)
(A detailed d/d of medicines is given in NM Choudhry for nausea of pregnancy. It is as follows:
Nausea of pregnancy
In COLCH. the nausea is felt in the head and is worse while riding a carriage or sailing.
IPEC. is very much like Colch. The nausea is incessant and there is not a moment’s relief.
In KALI CARB we have nausea without vomiting, coming on only during a walk. She feels like lying down anywhere and prefers even dying to such nausea. Great sleepiness while eating is also a marked symptom of Kali carb.
In KREOSOTE the patient vomits sweetish water before breakfast. She retains her breakfast and dinner, but vomits out her supper.
LOBELIA- nausea and vomiting in Lobelia with profuse running of water from the mouth. She is invariably worse after sleeping, and is relieved by taking a little food; after vomiting she breaks out into profuse sweat.
NUX VOM. has ineffectual desire for vomiting. She feels she would be better if she could only vomit.
PULSAT. can be very easily distinguished from other remedies by the excessive bad taste in the mouth in the morning.
TABACUM should not be forgotten where we notice deathly faintness and pallor of the face relieved by going out into the open air.
VERATRUM is to be distinguished by the presence of cold sweat on forehead while vomiting and a great desire for fruits, juicy things, and for acid and salty food.)
Post scarlatinal dropsy (APIS, HELL, LACH) (post streptococcal glomerulonephritis)
Albumin in urine < damp cellars
Pain alternate between naval and bladder
Lungs
Burning
Everywhere, mouth, gums, throat, stomach, GIT, rectum, anus
Meninges
Uterus
Air passages, chest,
Kidney, bladder, urethra (CANTH, BEREB)
Tip of tongue
Epigastrium
Back
Cystitis, cutting in bladder tenesmus
Haemorrhage
Haematuria, cloudy bloody urine, painless
Purpura haemorrhagic, fresh ecchymosis (SULPH AC)
Bowels from, with ulceration and epithelial degeneration (as in ulcerative colitis, typhoid ulcers etc), passive oozing from bowels
Glazed glossy skin, with prominent papillae (ARG NIT, BELL, KALI BI, NUX MOS), peeled off in patches
Excessive distension of abdomen (COLCH)
Worms
Sp lumbricid
With foul breath (SPIG)
Itching of anus
Choking (CINA, SPIG)
Diarrhoea
Fetid, exhausting, watery greenish
Congestion and inflammation of viscera
With haemorrhage
With malignant tendency
Unconsciousness followed by inability to concentrate mind
Capillary bronchitis
Convulsions
Sp on pressing on bladder
Damp weather <<
Neuralgia, as if hot water running in tubes
Sudden gripping and aching
Sore muscles
Urination excited by pain
Pain in bowels cause frequent urination
Pain in knees
Advancing purpuric spots
Band like headache
Enterocolitis with ulceration and haemorrhage from bowels
Typhoid
With tympanitis
Haemorrhage
Prostration
Biliary colic
(Note- Terebinth is an oil prepared from distillation of resinous product from some species of Pines, highly flammable in nature its toxicity closely resembles the symptoms derived in potencies with much finer shades, as happens in provings.)
Link to the medical conditions that are covered by Terebinth