Internal Medicine/Knowledge of Disease

Thunderclap headache

It is a symptom with specification and not a diagnosis.

The causes of TCH are:

• Primary TCH- defined as a high-intensity headache of abrupt onset, mimicking that of a ruptured cerebral aneurysm, in the absence of any intracranial pathology.
• Secondary causes
  • Intracerebral bleed sp subarachnoid haemorrhage SAH from aneurysmal bleed
  • Hypertensive crisis
  • Intracranial tumor complications
  • Dissection of cervical artery
  • Sinus venous thrombosis
  • Posterior reversible encephalopathy syndrome
  • Reversible cerebral vasoconstriction syndrome (RCVS)- Some recreational drugs, nasal decongestants, excessive strenuous activity, sexual activity, Valsalva manoeuvre can precipitate severe abrupt headaches.

Criterion of labelling a headache as TCH are:

• Severe head pain with abrupt onset (Sudden, Extremely severe, generally defined as the worst headache ever experienced)
• Pain reaching maximum intensity in less than one minute,
• Pain lasting at least 5 minutes, and
• Headache not better accounted for by another ichd-3 diagnosis
• Multiple (2-10) excruciating, short-lived thunderclap headaches over a few days to weeks are highly suggestive of RCVS.

Points to remember

• Both primary and secondary TCH can be precipitated by sexual activity or by exercise.
• Focal neurological signs or altered consciousness should prompt physician to look for secondary causes of the headache.
• The pain could be localized, ipsilateral or holocephalic.

Materia medica of TABACUM

Allen’s key notes

• Sudden pain on right side, of head as if struck by a hammer or a club. Dim-sighted: see as though a veil; strabismus, depending upon brain troubles.
• Sensation of excessive wretchedness
• Vomiting: violent, with cold sweat; soon as he begins to move
• Terrible, faint, sinking feeling at pit of stomach

Hering Guiding Symptoms

• When Walking, indoors or outdoors, suddenly, as if struck by a hammer or club on r. side of head, throws him to left

Beoricke Materia Medica

• Vertigo on opening eyes; sick headache, with deathly nausea; periodical. Tight feeling as from a band. Sudden pain, as if struck by a hammer

Clarke Dictionary of Practical Materia Medica

• While passing urine, suddenly attacked with pains in head, so severe he screamed for assistance; immediately followed by vomiting.-Congestion of blood in head, with internal heat, and throbbing in temples.-Neuralgic headache, sensation as of sudden blows struck by a hammer.-Periodical sick-headache from fatigue or excitement.-Tightness in head as though a band stretched round it, disturbance of vision, tinnitus, and vertigo

BBCR

• Pain head as if struck with a hammer.

Differential Diagnosis of other remedies

headache pain appearing suddenly disappearing suddenly

KENT REP

Head

Plug were thrust suddenly in by increasingly severe blows- SUL AC

Sudden pains: AGAR, ARG NIT, ASTER, BELL, CAMPH, CROC, FERR, MEZ, MORPH, PHYS, SABIN, TABAC, VALER

And go, suddenly: BELL, MERC COR

COMPLETE DYNAMIS

CAUST, VISCUM, VERAT, BELL, COLOC etc are some of the common remedies in various types of sudden severe headaches.

(BELL, GLONINE, VERAT etc are closely running remedies in such conditions, each has its own keynote like BELL has throbbing, GLONINE and VERAT are more congestive.)

TABACUM and TCH

A study of the above two aspects TCH and tabacum when brought together, suggests that Tabacum can be one of the most clinically relevant remedy in thunderclap headaches given:

• It produces a sudden, very severe, abrupt headache as if struck by hammer
• With severe nausea and may be vomiting,

All these features are very suggestive that TABACUM can be a very good remedy for thunderclap headaches. However, clinicians are always encouraged to rule out other remedies before prescribing, when possible.

Reference

• Boericke Materia Medica
• Hering’s Guiding Symptoms
• Allen’s Key Notes
• Clark Dictionary of Practical Materia Medica
• Boger Boenninghausen’s Characteristic Materia Medica and Repertory (BBCR)
• Kent Repertory
• Complete Dynamis Repertory
• https://www.ncbi.nlm.nih.gov/books/NBK560629/
• https://www.medscape.com/viewarticle/913483_2

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.)

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

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
  • Pale skin tone, Pallor
  • Rapid heart rate and heart palpitations
  • Severe headaches
  • Sweating, Diaphoresis
  • Visual disturbances
  • Weight loss
  • Tremor
  • Weakness
  • Epigastric pain
  • Flank pain
  • Weight loss
  • axillae and intertriginous areas.. café au lait spots
  • 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

• Anxiety disorder
• Hypoglycaemia
• Panic attack
• Angina
• Thyrotoxicosis

AMYL NITROSUM

(https://drshivangihomoeopathy.com/?s=amyl)

• 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
• Hering Guiding Symptoms
• Allen’s Keynotes
• Complete Dynamis
• Harrison’s Principles of Internal Medicine
• https://emedicine.medscape.com
• https://www.ncbi.nlm.nih.gov/books/NBK448096/
• https://www.ncbi.nlm.nih.gov/books/NBK589700/
• https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/rare-endocrine-tumor/carcinoid-tumor#:~:text=Other%20Rare%20Tumors-,Neuroendocrine%20Tumor%20(NET),as%20pain%20in%20the%20abdomen.

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.)

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

COLD INDUCED URTICARIA

Cause

• Urticaria after exposure to cold temperature, water, weather, cooling after overheated, swimming in cold water, exposure to cold during surgery.
  • It is a chronic inducible form of urticaria that can be precipitated and tested by Cold stimulation test
• Mechanism- this type of urticaria is IgE mediated, the pathophysiology is thought to involve the cold-induced formation of auto allergens and IgE to these auto allergens, which provoke a release of proinflammatory mediators from skin mast cells.

Symptoms

• Appear within minutes of exposure
• Swelling redness – angioedema
• Itching and wheal formation
• In rare cases if airway affected leading to swelling and choking which is emergency condition
• Many other GIT/ cardiovascular effects etc
• Localized reflex cold urticaria: Confined to specific areas. It has been reported to occur after exposure to cold at the sites of previous ragweed injections for allergies or ladybug bites.

Underlying types

• Hereditary or acquired
• Primary/ Idiopathic
  • Autoallergy, autoimmunity, neurogenic pathways and aberrant temperature sensing as underlying mechanism
• Secondary

Various underlying conditions have been recognized to which cold urticaria may be associated. A physician when presented with this type of urticaria should suspect the following conditions as underlying disease rather than simply labelling it as cold urticaria.

• Infectious diseases
  • Chickenpox (varicella)
  • Syphilis
  • Viral hepatitis
  • Infectious mononucleosis (glandular fever) and other respiratory viral infections
  • Other viral and bacterial infections
  • Cancers
    • Lymphoproliferative diseases, Chronic lymphocytic leukaemia, Blood cancers, Lymphosarcoma
  • Insect stings
  • Iatrogenic
    • Intake of certain drugs or foods
  • Immune
    • Cryoglobulinemia
    • Immunisations.

D/D

urticaria on exposure to cold or cold exposure related diseases

• Familial cold autoinflammatory syndrome (FCAS) or familial cold urticaria
• PLAID: PLC-gamma-2-associated antibody deficiency and immune dysregulation– Symptoms include hives triggered by evaporative cooling (like exposure to cold air or wind) rather than direct contact with cold objects or water. 
• Cold-dependent dermatographism
• Cryoglobunemia
• Paroxysmal cold haemoglobinuria

Materia Medica

Rhus tox and Dulcamara are the two classical remedies listed for this type of urticaria. The new repertories list many more medicines other than these two. In author’s practice this urticaria is not as uncommon as is purported by medical literature. Even long standing cases respond quickly and are easily amenable to homeopathic treatment with complete resolution. None of the cases were found to have underlying condition, despite detailed case evaluation. Nevertheless, it is always recommended to keep looking for the starting point of condition (Most probable cause/ exciting cause/ ailment from ) as sometimes patient forget the precipitating event as it happened long back in the past, making the condition chronic in its temporal dimension.

Case of urticaria treated with RHUS TOX

RHUS TOX

Pulford keynotes

• Urticaria after becoming wet.

DULCAMARA

Allen’s Key notes

• Skin is delicate, sensitive to cold, liable to eruptions, especially urticaria; every time patient takes cold or is long exposed to cold

The Encyclopedia of Pure Materia Medica

• Stinging, prickings in different parts of the skin of the neck, on walking in the (open) after drinking cold water.

Repertories

Kent repertory

• Skin, urticaria
  • Cold bath after- CALC PHOS
    • From taking- DULC

Complete repertory

• Eruptions urticaria, nettle rash
  • Air cold agg- ARS, CAUST, DULC, KALI BROM, NAT SULPH, NIT AC, RHUS TOX, RUMEX, SEP, SULPH
  • Becoming cold- ARS CALC, CAL PHOS, CHLORALUM, DULCAMARA, RHUS TOX, RUMEX, SEP, SULPH, THUJA
  • Cold agg- APIS, ARS, BELL, CALC, PHOS, CAUST, DULC, KALI BROM, NAT SULPH, NIT AC, RHUS TOX, RUMEX, SEP, SULPH
  • Wet getting after- CHLORALUM, RHUS TOX

Reference

• https://rarediseases.org/rare-diseases/urticaria-cold/
• www.sciencedirect.com
• https://pubmed.ncbi.nlm.nih.gov
• Complete Dynamis
• Kent Repertory
• Boericke Materia Medica and Repertory
• The Encyclopedia of Pure Materia Medica- T. F. Allen
• Allen’s Keynotes
• Pulford Keynotes

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.)

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

PTSD

Post traumatic stress disorder is a constellation of condition that arises in response to exposure to traumatic event or series of traumatic events such as

• Exposure to actual or threatened death,
• Serious injury, or sexual violence
• Or chronic, constant, threatening exposure to violence causing constant concern for safety and life.
• Natura disaster/ war
• Abuse (sexual, emotional, physical)

The trauma can be either

• Directly experiencing by the person,
• Witnessing a person experiencing trauma,
• Or learning that the traumatic event occurred to a close family member or friend.

Following the trauma the processing of traumatic event is affected in the brain and the trauma maintains its intensity in the memory as it first happened, modifying cognition, mood, causing somatic experiences, and behaviour changes, leading to chronic impairments and an increased risk of comorbid psychiatric illnesses and susceptibility to suicide. 

Presentation includes but is not limited to:

• Intrusive memories or nightmares
• Avoidance behaviours
• Negative changes in mood and cognition,
• Heightened arousal.
• Dissociative symptoms 
• Recurrent, involuntary, and intrusive thoughts associated with the traumatic event.
• Flashbacks, in which the individual may feel or act that the traumatic event is happening again.
• Marked physiological reactivity such as increased heart rate and blood pressure on exposure to traumatic reminders

SPONGIA

The following symptomatology indicates that SPONGIA can be one of the leading remedies for the above-mentioned presentation of PTSD. Each of the following symptoms can be corelated with the phenomenon of PTSD.

From various sources:

• Anxiety with feeling as if will die or suffocate
• Anxiety in sleep, wakes up sudden anxious and sudden, with sense of suffocation, violent loud cough, great alarm agitation, anxiety and difficult respiration
• Inclination to weep during sleep

Clarke (A Dictionary of Practical Materia Medica)

• Rouses up in sleep as if in a great fright.
• She is very timid, and is esp. pursued and incessantly tormented by a frightful scene of some mournful event of the past
• < When thinking of her symptoms.
• Sad, anxious, frightful dreams
• Excessive moral and physical dejection.
• Attacks of heat with anxiety; heat and redness of face and perspiration.

The Encyclopaedia of Pure Materia Medica

• Anxiety, as if a misfortune would befall him, which he seemed to foresee, she is very fearful, and tormented by a frightful image of a past sad event. She was very easily frightened, and started at every trifle; it always seemed that fear shoot into her feet, and afterwards they seemed to remain heavy,

This kind of presentation can also cover following disorders

D/D

• Generalized anxiety disorder
• Panic attacks
• Sleep disorders or parasomnias

(Many medicines esp. ones which cover AILMENTS FROM FRIGHT/ FEAR will be useful in PTSD and related conditions. Each drug behaves differently when faced with a situation. The final remedy selection depends on this reaction and presentation of patient, its PQRS and analysis by the physician.)

Some Rubrics from Complete Dynamis Repertory, that can be used in PTSD

• Fright Fear, agg, ailments from
  • Accident from site of an
  • Mental and emotional consequences
  • Prolonged

etc

Reference

• https://www.ncbi.nlm.nih.gov
• https://www.psychiatry.org/
• https://www.who.int/
• The Encyclopaedia of Pure Materia Medica by T F Allen
• A Dictionary of Practical Materia Medica by Clarke
• Boericke Materia Medica
• The Guiding Symptoms of Our Materia Medica by Hering
• Complete Dynamis Repertory

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.

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 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.)

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

Presentation

• Gelastic seizure or laughing seizures are spells of unmotivated laughter. The patient has short interval episodes of involuntary laughter.
• These unprovoked, out of context episodes are perceived as bizarre by people around.
• There is no social context or external trigger for the laughter and happen with no related emotion such as joy or sadness.
• The patient may or may not remember the laughter spell. There may be post ictal confusion.

Etiology

• These seizures indicate presence of Hypothalamic Hamartomas most of the times.
• Some cases have been reported in literature with temporal lobe or frontal lobe as foci of pathology such as tumors, post infectious foci or malformations giving rise to gelastic seizure.
• These are non-cancerous, nonprogressive lesion lesions in hypothalamus and are essentially abnormal tissue development in foetus

Associated features

• Hypothalamic hamartomas may also be associated with developmental delays, aggression, precocious puberty etc.
• Many behavioural and psychiatric symptoms are relatively common such as oppositional defiant disorder, attention-deficit/hyperactivity disorder, conduct disorder, and mood disorder in patients with hypothalamic hamartomas.

D/D

A wider variety of conditions can produce involuntary laughter pseudobulbar effect, which can happen after injuries to brain, in multiple sclerosis or even dementia.

In our Materia Medica this will be addressed by changeability or even laughter alternating with sadness etc.

Agaricus muscaris

A remedy which closely resembles gelastic seizure in its pathogenesy. Below are the different symptoms from various sources mentioned to point towards the similarity between the disease and the drug.

Hering

• Gaping: followed each time by involuntary laughter; makes him giddy; and sneezing, with pain in maxillary joint; with stretching, most of arms; and shaking chill.
• During violent shaking chill, after undressing in evening, a peculiar inclination to laugh.
• Morose, self-willed, stubborn, slow in learning to walk; and talk; on trying to walk; stumbled singularly often.

The Encyclopaedia of Pure Materia Medica

• Several convulsions followed each other in quick succession, first in posterior part of the chest, then in the epigastrium, afterwards in the hypogastrium, especially on the right side, attended with a sensation as if the whole body was shaken through; in the evening when standing.
• Epilepsy. In patients with epilepsy the fits came on at short intervals.
• He yawned frequently and each yawn was followed by involuntary laughter. An impulse to laugh came over in bed, owing to an indiscernibly mixed sensation of happiness and misery.

Boericke

• Laughing involuntary from pressure of spine.
• Yawning followed by involuntary laughter.

D/D- In complete repertory many other medicines are given, such as- AGAR, BORAX, AURUM, CANN IN, IGNATIA, NAT MUR, PHOS, SEPIA, TARENTULA

In summary Gelastic seizures require careful evaluation for underlying neurological conditions like hypothalamic hamartomas. From a homeopathic standpoint, Agaricus Muscarius stands out as a close remedy due to its unique symptoms of involuntary laughter, convulsions, developmental and behavioural, and emotional disturbances aligning well with the clinical picture of gelastic seizure.

References

• The Guiding Symptoms of Our Materia Medica by Hering
• Boerick’s Materia Medica
• The Encyclopedia of Pure Materia Medica by T F Allen
• Complete Repertory
• www.medscape.com
• www.sciencedirect.com
• https://www.ncbi.nlm.nih.gov/books/NBK560663/

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.

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 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.)

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

MULTIPLE SCLEROSIS

An autoimmune, inflammatory, demyelinating condition affecting CNS, which runs a variety of course from progressive to intermittent to fulminating, it is a debilitating condition which greatly affects the work and quality of life of a person in the long run.

This disease shows predilection for sex, affecting more females than males under 50 yrs of age

Clinical features

• Extreme fatigue and other constitutional symptoms that interfere with patients’ life making it difficult for them to do any physical or mental work
• Sensory disturbances such as paraesthesia, impaired proprioception etc. leading to gait disturbances
• Neuralgic pains such as trigeminal neuralgia
• Neuropathic pain of demyelination characterized by burning or shooting
• Motor symptoms such as paresis and weakness of limbs
• Vertigo, diplopia etc. when brain stem lesions are present
• Ataxia when cerebellum affected
• Emotional changes such as delusions, euphoria etc.
• Uhthoff’s phenomenon- worsening of weakness or vision with heat (this can happen after exertion, exposure to sun, hot bath or even fevers)
• Recurrent facial palsy
• Lhermitte sign- tingling in spine on neck flexion

KALMIA LATIFOLIA

The following symptoms are suggestive of multiple sclerosis in kalmia

• Affection of – nerves of spine, Eyes and Face (R).
• Weariness in all muscles; shuns all exertion, can hardly go upstairs. Weary and giddy, with diarrhoea. Weakness the only general symptom with neuralgia.
• Weakness and paralytic condition of limbs.
• Aching, bruised, stiff feeling. Tingling, numbness, trembling or paralytic weakness. Changing pains; shoot outward along nerves; or dull tearing, crushing, moving downward, then suddenly, to heart or alternating with cardiac symptoms, or between upper and lower limbs. Neuralgia
• Pains shift rapidly
• Neuralgia; pains shoot downwards, with numbness.
• Fulgurating pains of locomotor ataxia
• Paralytic sensations; pains and aching in limbs accompany nearly every group of symptoms.
• Pains affect a large part of a limb, or several joints, and pass through quickly. Weakness, numbness, pricking, and sense of coldness in limbs.
• Pain down back, as if it would break; in localized regions of spine; through shoulders. Lumbar pains, of nervous origin.
• Vertigo; worse stooping.
• Confusion of brain
• Vision impaired. Stiff, drawing sensation when moving eyes
• Prosopalgia (rt); pains, rending; agonising; stupefying or threatening delirium; with alkaline taste in mouth. Neuralgia involving upper teeth, but not from caries. Rt sided neuralgia after exposure to cold, going down r. arm; attended or succeeded by numbness in the parts; pains shooting downward, irregular; < by worry or mental exertion, > by food.
• Pain in eyes, which makes it painful to turn them.
  Sensation of stiffness in muscles around eyes, and of eyelids.
  Asthenopia; stiff, drawing sensation in muscles upon moving eyes
• Aggravation
  • Heat
  • With the sun.

It is amply evident from the above symptomatology that KALMIA covers the symptomatology of multiple sclerosis. think of this condition in kalmia when MS develops on a background of rheumatic complaints. As kalmia is not mentioned anywhere in multiple sclerosis, this exercise was to bring point the home that many remedies are still underused and less understood and their powers are not completely unearthed.

There are many more remedies in homeopathic literature that cover symptomatology of Multiple sclerosis.

We will add and discuss those medicines with time and try to differentiate between them to make a homeopathic prescription.

(It might be noted that some of the symptoms also point towards other conditions like myasthenia gravis. This is actually the strength of homoeopathy. Many conditions can be recognized and treated even before a formal diagnosis is reached. It will depend on the analytical prowess of the physician backed by right remedy.)

Reference

Davidson’s Principles and Practice of Medicine

Harrison’s Internal Medicine

Boericke Materia Medica

Clarke Dictionary of Practical Materia Medica

The Guiding Symptoms of Our Materia Medica by Hering

Boger Synoptic Key

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.

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 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.)

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

Homeopathic provings are empirical way of knowing the symptomatology/ manifest phenomenon of a given drug. Even today many of the symptoms remain unexplained. Homeopathic Materia Medica is a treasure trove of unknown conditions and symptom syndromes yet unrecognized and identified. As the knowledge and time progressed, symptoms that were earlier thought to be absurd, could be explained by advancing knowledge The following is an attempt to explain hitherto unexplained symptoms, bringing together the understanding of the Materia Medica in the light of modern medicine.

• SHORT DESCRIPTION OF CONDITION

SOMATOPARAPHRENIA– A delusional belief in a person that the paralysed limb on one side of the body (contralateral to the lesion in brain; sp of right sided lesions in brain) does not belong to them. (More extensive lesion may cause ASOMATOGNOSIA in hemiplegia). It is believed that the brain lesion causes disruption in the sensory-motor cohesion of the information that leads to a congruent body representation. This may lead to unilateral neglect of affected side.

ASOMATOGNOSIA– complete loss of awareness of limb not just a delusion as in somatoparaphrenia.

(d/d Hemi-spatial neglect)

• HOMOEOPATHIC REMEDIES from Repertories

Kent repertory

Delusion

Arms do not belong to her- AGARICUS

Knerr repertory

Delusion

one half of the body cut off- STRAMOMIUM

Complete repertory

Delusion

left half does not belong to her- COLCHICUM, SILICEA

• MATERIA MEDICA

Clarke Materia Medica

SILICEA– Sensation as if she were divided into halves and that the left side does not belong to her.

AGARICUS– Feels as if her limbs did not belong to her

STRAMONIUM- sensation as if limbs were cut off from the body)

• (D/D of medicines that could be used in somatoparaphrenia

BAPTISIA in Allen’s keynotes- Cannot go to sleep because she cannot get herself together; head or body feels scattered about the bed; tosses about to get the pieces together; thought she was three persons, could not keep them covered (PETROLEUM).

PETROLEUM– delusion that another person lies alongside of him in same bed (Allen’s key notes)

Delusion body parts scattered about bed, tosses to bring pieces together- BAPT, CAJUP, DAPH, PETRO, PHOS, PYROG, STRAM)

As can be seen above, medicines like SIL, AGAR and COLCH show clearcut coverage of these pathologies. It’s true that such syndromes baffle even neurologist, most of whom in the early phase of development of neuroscience disregarded such presentations as either useless or related them to deep psychological conflicts. It is only in recent times that some keen observers in neurosciences have started explaining and studying such phenomenon in patients. We as homeopaths have always given such symptoms their due importance, but may rarely come across such patients, but when we do, we should be ready to take the bull by its horns.

• REFERENCES

https://pubmed.ncbi.nlm.nih.gov

https://jnnp.bmj.com/content/81/3/276

Clarke Dictionary of Practical Materia Medica

Knerr Repertory

Complete Dynamis repertory

Kent Repertory

Allen’s key notes

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.

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 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.)

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

The felt passage of time, a discernment of external clock in relation to inner is an estimation made by the brain to keep the consciousness rooted in environment. This time lapse judgement can be altered in some neurological conditions, with intense practice, meditation or even during heightened emotional states.

The following short discussion tries to connect neurological perspective to homeopathic symptomatology and unravel the mysteries of mind and time.

Time passes quickly- an underestimation of time

Time passes quickly- an underestimation of time happens when more time seems to have elapsed whence the person thinks only some time has passed, i.e., durations are judged as shorter than actual.

In conditions like Parkinson’s Disease patients generally show this duration underestimations. To them their movements seem to take the normal time while in actuality there has been a slowing of speed of motion i.e bradykinesia.

Medicines like COCCULUS INDICUS and THERIDION manifest this symptom during proving. These medicines also show affection for brain tissue in general and have many symptoms related to nervous system in their symptomatology.

Time passes slowly- an overestimation of time

On the other side of the coin, overestimation of time i.e too much time seems to have passed when only little time has passed.

Under normal conditions this happens during:

• Happening in extreme threatening situations, like accidents, people have been said to observe things in slow motion. They report having gone through their whole life like a movie vividly in matter of seconds or even less. This apparent perception may increase chances of survival in emergency situation by extreme focus of brains attention.
• Similar happens when you are very bored and are acutely aware of every passing second.
• Deep meditative state and the flow state of an athlete who has Intense concentration achieved continued, repetitive and gruelling training making his movements fluid and reflexive may be other examples where the time slows down.

Abnormal conditions are:

ADHD– This happens in children and adolescents with ADHD who tend to overestimate (i.e., durations are judged as longer than controls) the time lapse. In these conditions more sensory information is absorbed with passage of time. This too much information gathering, cognitive engagement and processing seems to stretch the time.

Medicines like AMBRA GRISEA, ARGENTUM NITRICUM, NUX MOSCHATA, CANNABIS SATIVA, CANNABIS INDICA, ANHALONIUM have states where the time seems to be too long and does not pass. These medicines should be thought of when considering the pathological development of sense of expansion of time.

The other pathologies such as schizophrenia and Alzheimer’s also alter the time keeping function of the brain in a different manner where the functions such as mental time travel and time rooting in reality are affected.

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.

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 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.)

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

This reactive arthritis is an

• Immune mediated syndrome
• Characterised by a triad of arthritis urethritis and conjunctivitis
• Post an infection (a couple of days to weeks prior to presentation) usually the gastrointestinal infection (caused by Salmonella, Shigella, Campylobacter, Yersinia or Chlamydia etc) or genitourinary (Chlamydia Trachomatis, Neisseria Gonorrhoea, Mycoplasma Hominis, and Ureaplasma Urealyticum etc)
• Where the response to infection causes an aberrant autoimmune response by triggering autoantibodies to self-antigens following molecular mimicry.

A majority of these patients may be HLA b-27 positive; however, it is not used to diagnose the cases.

There may be a positive F/H/O ankylosing spondylitis or psoriasis.

Found very commonly in HIV patients, the patient presenting with new onset disease should be screened for HIV. Such patients may also have psoriasiform lesions on body.

Predominantly affects males.

Arthritis is characterised by asymmetrical involvement of weight bearing joints with night agg and morning stiffness. Chronic course may present as monoarthritis, heel pains or Achillies tendinitis.

Eye symptoms involve conjunctivitis or iritis with injection of ciliary vessels around cornea. Uveitis involves acute pain, photophobia, visual impairment, scleral injection, and hypopyon

Urethritis is characterised by dysuria, or a mucoid thread discharge just before urination. Occasionally haematuria may be there, prostatitis.

Skin may be involved with- mucosal ulcers, keratoderma blennorrhagica, circinate balanitis and erythema nodosum. There may plaque like lesions with hyperkeratosis, associated with severe nail dystrophy and subungual hyperkeratosis, nail pits.

Cardiac- carditis, aortic, conduction and valvular abnormalities

Geographic tongue

Sacroiliitis.

There may be systemic disturbances like fever, weight loss etc.

After understanding the diagnostic sphere let us now understand the closeness of this symptom constellation with SARSAPARILLA.

• Rheumatism after gonorrhoea

(Compare medicines for

Other medicines for above rubric include MEDORRHINUM, PULSATILLA, THUJA, CLEMATIS etc.

Rheumatism after diarrhoea– CIMICIFUGA, DULCAMARA, IODUM, KALI BICHROMICUM.

The above highlighted rubrics become the backbone of remedy selection in reactive arthritis.

These medicines may not cover the complete constellation but may be indicated remedies depending on presentation.)

(Since causation and past history is very important in this disease diagnosis other medicines to also consider are MEDORRHINUM, SEPIA and MERC SOL which come very close to SARSAPARILLA.)

• Urine- Severe pain before and while passing urine, pain in kidneys. Urine dribbles or passed in thin stream
• Crust sediment and shreddy urine
• Eruptions in groins and on genitals with offensive smell
• Eczema, crusta lactae or boils.
• Rhagades on fingers
• Itching pimply eruptions on body.
• Violent burning and agglutination of eyes in morning on awakening. Dimness of vision as if a gauze spread over eyes. Burning and stinging in eye with sensation of sand.

A prominent involvement of joints, genitourinary and skin along with eye symptoms makes this remedy a pathological simile of reactive arthritis.

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.

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.

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.)

References:

Boericke materia medica

Clark dictionary of materia medica

Phatak repertory

French diagnostic index

Harrison’s principles of internal medicine

Davidson’s Principles and practice of Medicine

Aude Sapere

Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/

• A neurological condition where pain, itching, burning, numbness and other sensations are felt in limb which has been amputated. This happens when brain does not receive inputs from the amputated part and tries to readjust by remapping. Sometimes neuromas can grow in the process enhancing the sensations. So it seems that the brain perceives a part falsely and also sensations from it, when actually the part is absent, hence the name phantom limb.

• The following resource can be searched for further details on the subject.

https://www.ncbi.nlm.nih.gov/books/NBK448188

• Homoeopathically speaking medicines like allium cepa and ammonium muriaticum etc fall into medicines that can cover this pathology.

ALLIUM CEPA

Traumatic chronic neuritis; Allium cepa has neuralgia of stump after amputation; burning and stinging pains (allen’s key notes)

AMMONIUM MUR

Neuralgic pain in amputated limb

Other medicines include- SYMPHYTUM, PHOSPHORIC ACID The above medicines though cover the pathology should be given only after complete case consideration.