PRESENTACION DE RESULTADOS
3.1 ANALISIS E INTERPRETACIÓN.-
The miasms are destructive in every way, of both mind and body and they tear at the very spirit of man. It is disorganizing disease that fills the state and we cannot meet these conditions intelligently until we recognize the ancient origin of disease and undertake its extermination on the basis of miasm.
The environmental factors, may be the causative modalities or maintaining cause which modifies disease response in its progression from psora to syphilis. A critical analysis of these response and final resultant expressed at different levels of organization and areas leads to the four categories of constitution with distinct predisposition to the
64
development of characteristic disease response. This division, first attempted by Hahnemann was modified in the light of clinical experience and re interpreted in the light of present day understanding of ramification and expression, internal as well as external of disease. The Hanemanian totality is an evolutionary one spreading itself in space through the four miasmatic expressions.29
A number of progressive as well as increasing abnormalities in the biochemic balance of the system are produced by the onward slaught of disease, leaving the system progressively vulnerable to further damage. By a study of the physiological function along with correlates from biochemistry, these various mechanisms are understood and their implications in terms of cellular susceptibility and sensitivity is essential for understanding of the totality of functions of the entire system.29
Concepts of general and special pathology when carefully correlated with the clinical evolution and expression of the disease gives clinically useful standard of time which can be correlated with the operations of environmental factors. It is possible to correlate and interpret all these observations in relation to Hahnemmanian theory of miasms and dyscrasia which can be generalized as time expression. It allows to evolve a continuous specific spectrum – Constitution (Normality) - Diathesis - Prodrome - Psora Sycosis - Tubercular - Syphilis.29
An alert observation is required in a fast moving clinical situation and to interpret the totality furnishing the requisite guidance correctly in terms of miasmatic interpretation. Constitutional homoeopathic prescribing will demand the use of a diverse type from various lab investigations, clinicopathological as well as radiological.29
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From the natural pathological evolution of hyperlipidemia, it is evident that though initially the only symptom is raised serum lipid profile, with time, it leads to an end stage of vascular complications causing widespread destruction of several systems of the body including vital organs.
An increased parasympathetic tone leads to an overall decrease in the activity of the endocrines which is reflected in an increase in the anabolic process and decrease in the catabolism, a reduction in the overall turnover, retention, accumulation of cholesterol, aberration in lipid metabolism leading to deposits of cholesterol and lipoprotein in the wall of blood vessels causing narrowing of the vessels.29
Properly applied constitutional treatment in the process of cure should not terminate at the disappearance of presenting symptoms but extend further towards the idealistic point of positive health by the removal of entire abnormal susceptibility so that all tendency to recurrence is eliminated.
Constitution results from the interaction between genetic factors and the environmental factors to give its peculiar reactivities to the environmental circumstances which tend to drive ahead the individual in a characteristic manner unfolding a tendency to favour expression favouring one miasm over the rest.29
Hahnemann directs that the similarity be established at the level of disease (§ 6 ) taking into account the qualitative characteristics along with causation, inclusive of hereditary and predispositions utilizing signs and symptoms as the only discernible evidence of the totality of expression of the disorder within the phenomena of the disease.34
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Miasmatic study of a disease can be assessed by taking into account in a meticulous manner, the full details of the troubles experienced by the patient inclusive of various treatments administered, its suppressive effects which must have lead to the consequence of a protracted state of ill health, continued to attract noxious environmental influences to produce a complex diseased state.29,35
Observations leads us to the concept of the fundamental miasm indicated by family history of disease as well as the personal past history as the hereditary, genetic predisposition is reinforced by the past illness. The dominant miasm is deduced from the prominent expressions of disease at the time of observation.29,36
The clinical investigation should clearly incorporate the time dimension in all its aspects and the expression (subjective or objective) demarcated fully with location, sensation, modalities and concomitant and origin, duration and progress with reference to the levels of intelligence, emotional and physical, as well as areas ( tissue, organ or system) along with environment factors (work, family and social circle). Only then the miasmatic expressions and the dynamic background of the patient can be appreciated. 29 Thereby the miasmatic basis of the hyperlipidemia, which do not express any clinical symptom of the disease other than a rise in the serum lipid levels, unless complicated is studied through ,Family and Past history, Causation, Mental generals, Physical generals, Pathological stage of disease and Symptomatology of the disease
67 Table 2: Miasmatic evaluation criteria 24,26, 29,31,38,39
Psora / Sensitising Sycotic / Constructive / Inco ordination
Tubercular / Reactive Syphilitic / destructive Mental
Generals
Anxiety. Fear. Restless.
Nervous. Irritable.
Timid. Perversion.
Tendency to commit evil.
No deep mental concentration / sacred thoughts. Hyporeasoning.
Impractical thoughts.
Hypoconfidence.
Philosopher. Builds castles in air. Indolent.
Aversion to work ,bath, keep things clean. Untidy.
Lack of discipline. Time passés too fast/ too slow Repugnance to & fatigue on mental & physical exertion.
Wants to lie down.
Sensitive to odour.
Suspicious. Jealousy.
Tendency to harm / exploit others. Hyperworkoholics.
Hypergreedy. Cross.
Irritable. No spiritual outlook, not influenced by moral doctrine or religion.
Insanity. Inclined to commit crime. Mischevous, Bent upon misdeeds. Born
criminal. Revengeful, devoid of all sense of rhiteousness.
Thinks of their own ailment.
Suppress ailments / symptoms. Brooding over things. Self condemnation.
Fixed ideas. Lack of self confidence. Suicidal
tendency with proper cause.
Dissatisfaction. Lack of tolerance. Changeable.
Anger. Irritable.
Quarrelsome.
Crave & perversions for things that will harm them.
Indifferent. Unconcerned about his sufferings.
Hopeful of recovery. Willing to take risks & undertake ventures.
Destructive. Cannot explain his symptoms.
Lack of self confidence.
Keeps dippression to monosyllables. Desire to be in solitude. Disgust of life. Desire to escape.
Lack of self confidence.
Suicidal tendency without proper cause.
Intelligence Alert. Quick. Active.
Unable to control or disappearance of thoughts.
Slow. Sluggish.
Incoordination of thoughts and perception.
Very bright, intelligent &
sharp, or slow & dull totally.
Lack of concentration
Slow to react. Careless mistakes. Arithmetical calculation difficult.
68 Memory Weakness of memory. But
studious.
Absentmindedness. Slow thought and speech. General loss of memory. Cannot find words.
Inability or slow in
comprehension. Highly keen.
Impaired memory. Total forgetfulness.
Behaviour Decietful behavior. Cruel- Mental torture.
Quarellsome. Mean minded
& concealing.
Some cruelty due to dissatisfaction.
Violent, cold blooded murderers.
Fear Fear of strangers, death, disease, future.
Fear of making mistakes Fearless. Fear of dogs, dark Fear of people. Panicky terror
Social relation Aversion to people &
company. Dreads to be alone
Extroverts Morose. Sullen. Does not like advices. Likes company
Introvert. Escapes from self & others. Aversion to company.
Attitude Internally extremely selfish.
Hide & seek nature.
Tendency to dishonesty, wickedness.
Selfish & possessive with a tendency to conceal.
Unrestrained & uncontrollable passions of life. Easily forms intense emotional bonds.
Intense sexual desire.
Constantly dwell on suicide. Merciless with no sympathy. Irresponsible, lacks sense of duty.
Perverted sexual cravings.
Sensitivity Oversensitive mentally &
physically.
Like barometer to storm or rain.
Hypersensitive. Insensitive mentally and physically.
69 Metabolism Excessive demands for all
supplies of nature but poor digestion & metabolism.
More active catabolism than anabolism. Nutritional troubles resulting from defective metabolism of resulting in increased thirst, dryness of tissues.
Inadequate utilisation in mineral metabolism. Loss of minerals
Disturbs pigment metabolism, endocrinal system. Increase in anabolic process & decrease in catabolism. A reduction in overall turnover. Retention, accumulation of cholesterol, aberration in lipid
metabolism.
Poor in bone, flesh & blood Depletion, drainage &
wasting disease. Loss of vital fluids (Diarrhoea, urine, sweat, bleeding) . Increased catabolism & decreased
Pathology Produces only functional disturbances manifested by hypersensitivity, itching, irritation, burning leading to congestion & inflammation.
Never produces any
structural damage. Spasms, paroxysmic phenomena &
neuro vegetative manifestations
Physical & mental inco ordination. Physical overgrowth, uncontrolled proliferation at the cost of other. Infiltration in the form of warts, condylomata, tumours, fibrous tissue.
Rapid response to any stimuli.
Early suppuration and delayed healing. Scars breakdown.
70 Characteristic
Nature of disease
Deficiency or lack of inhibition, all cells & organs producing an insufficiency,
assimilation. Thin, watery, acrid serous discharges.
Hypersusceptibility. Mental
& Physical irritation.
Deficiency disorders.
Reflects many subjective symptoms. Little or no objective symptoms. Hydrogenoid. Greenish or greenish yellow, jelly like, catarrhal purulent discharges with fishbrine odour.
Hypertension, Restless.
Deposition. Reflects more objective symptoms with less subjective symptom
Haemorrhages. Allergies.
Alternation & periodicity.
Changeableness. Confusing vague symptoms. Craves things which make them sick.
Depletion. Thick greenish or yellowish green discharges with smell of old cheese. Catches cold very easily Reflects many subjective symptom.
Mental, emotional,
pathological & destructive
Disorganised digestion deformities, fragility.
Putrid, offensive, pus like discharges. Little subjective symptoms.
Less desire, craving, aversion & feelings.
Pace of action Hyperactive. Dramatic development of symptoms
Extremely Slow & insidious onset & recovery
Depend on preponderance of psora / syphilitic miasms.
Moderate or Rapid
Rapid or Insidious
71 Modalities < Standing, Cold, Morning,
Movement, Between sunrise & set, Mental excitement, Worry, Grief,
<Rest, Damp, Rainy, Humid, Thunderstorm, Change of weather, Meat, Abnormal discharges, Anger, Irritability
> Slow motion, Stretching, Dry weather, Lying on stomach, Pressure, Suppressed normal discharge, When wart, fibrous growth appear.
Breaking open of old ulcers, sores, gonorrhoeal
discharges, scars.
< Thunderstorm, Milk, Night, Fruits, Oily food, Closed room, Pressure, Excitement, Physical & mental exertion, Artificial light, Anger, After sleep.
>Dry weather, Open air, Day time, External heat, Travel Outbreak of an old ulcer, diarrhoea, offensive foot or axillary sweat, nose bleeding, gonorrhoeal symptoms.
< Sunset to sunrise, Movement, Extremes of temperature, At sea side, Thunderstorm, Warmth,
History of Suppression of skin eruptions & physiological eliminations. Repeated attacks of acute infectious diseases. Stress – emotional
& Psychological.
Metabolic disorders – Hyperlipidemia, food intake. Suppression of pathological elimination &
proliferation
Tuberculosis, Whooping cough, Bronchitis, BA, Bronchopneumonia.Tendency to hay fever, common cold.
Suppression of physiological
& pathological elimination, foot sweat, skin eruption Recurrent infection
72 Constitutional
Appearance
Lean thin, Active Obese.Flabby, sluggish.
Stout, Overnourished.
Lean thin. Narrow chest Thin, wrinkled, looks old for his age.
Face Inverted pyramid
Yellow sallow, pale, earthy complexion. Eyes sunken
Dropsical. Oily skin Pale ,round, fair smooth, clear skin & waxy smooth
complexion. Sunken eyes, flushed cheeks. Thin lips.
Greasy. High cheek bones
& rough skin. Dry &
wrinkled like old person.Thick lips
Thermal Generally chilly Hot Extremely chilly Sensitive to changes either
heat or cold Perspiration Profuse, offensive, during
sleep
On forehead during sleep.
Copious.
Profuse Offensive < all complaints
Appetite Insatiable hunger Discomfort after eating Increased Decreased
Craving Sweet, Sour, Spicy, Salty.
Oily, Fried, Indigestible Unnatural substances like chalk, clay, Hot food.
Alcohol, Beer, Pungent, Well seasoned, Salty food.
Indigestible things, Potatoes, Tea, Tobacco, Meat, Salt, Greasy, fatty food. Things which make them sick. Very hot / really cold
Stimulants like alcohol, tea, coffee, very spicy.
Indigestible.Cold food
Aversion Milk, cold food Meat, milk, wine, spices Meat Meat, animal food, less
spicy food
Bowels Constipation Diarrhoea Alternating diarrhea and
constipation
Dysentry
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F/H of hyperlipidemia Strong F/H of hyperlipidemia, early CAD, stroke etc.
Etiology Unknown cause Increased intake of fat, Secondary to alcoholism, drugs, hepatic infections
Mutation in gene. Hepatic cholestasis. Enzyme
disorders Secondary to auto immune disease like SLE, endocrine disorders like DM, hypothyroidism, Cushing’s syndrome.
Mutation in gene Mutation in gene Secondary to nephritic syndrome
Pathology Defective metabolism of fat Deficiency in apoprotein or enzymes.
Defect in receptors, enzyme activity. Deposition of cholesterol & lipoprotein in the wall of blood vessels
Defect in receptors, enzymes Lack of apoprotein,
receptors, enzyme activity
No manifestations with only serum changes
Pancreatitis. Reversible with diet & life style changes
Lipemia retinalis
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HYPERLIPIDEMIA IN REPERTORY
The rubrics specifically related to hyperlipidemia seen in repertories are SYNTHESIS 9.1 40
Generals – Hyperlipidemia - all-s, aur, calc, calc-f, chel, chin, chion, chr-ac, colch, cortiso, ferr-i, hydr, lec, med, nux-v, perh-mal, tarax, thuj, thyreotr, vanad, zing
Generals – Arteriosclerosis - adren. Am-i. am-van. aml-ns. ant-ar. arg-n. Arn. ars. Ars-i.
asar. aster. Aur. aur-br. Aur-i. aur-m-n. Bar-c. bar-i. bar-m. bell-p. benz-ac. cact. cal-ren.
Calc. calc-ar. calc-f. card-m. chinin-s. chlol. con. crat. Cupr. ergot. fl-ac. form. form-ac. fuc.
Glon. hed. hyper. iod. kali-bi. Kali-i. kali-sal. kres. lach. lith-c. mag-f. mand. naja Nat-i. nit-ac. phos. Plb. Plb-i. Polyg-a. rad-br. rauw. Sec. sil. solid. spartin-s. Stront-c. Stront-i. stroph-h. sumb. sypstroph-h. Tab. thlas. thyr. Vanad. Visc. zinc-p.
- Old people in – bar-c, stroph-h
Generals – Diabetis mellitus – accompanied by arteriosclerosis – aur, chlorpr,plb, syzyg Mind – memory weakness – arteriosclerotic disease with - plb.
MURPHY’S REPERTORY 41
Blood - Blood vessels, general – atheroma- aur-m. bell. brom. Calc. Calc-f. caps. Graph.
kali-i. Lac-ac. Lach. lyc. phos. Plb. Sil. sulph.
- elderly people, in Lach.
- morbus brightii, in ph-ac.
- obese persons, in- caps.
Blood – Blood vessels, general – arteriosclerosis - adren. am-i. am-van. aml-ns. ant-ar. arg-n. Ararg-n. ars. Ars-i. Aur. aur-br. Aur-i. aur-m-arg-n. Bar-c. bar-i. bar-m. bell-p. benz-ac. cact.
cal-75
ren. Calc. calc-ar. calc-f. card-m. chinin-s. chlol. con. crat. Cupr. ergot. fl-ac. form. form-ac.
fuc. Glon. hed. hyper. iod. Kali-i. kali-sal. kres. lach. lith-c. mag-f. mang. naja Nat-i. nit-ac.
phos. Plb. Plb-i. Polyg-a. rad-br. rauw. Sec. sil. solid. Stront-c. Stront-i. stroph-h. sumb. Tab.
thlas. thyr. Vanad. Visc. zinc-p.
BOERICKE’S REPERTORY 42
Circulatory system - Arteries - Atheroma of arteries - adren. Am-i. am-van. ant-ar. arn.
ars. Ars-i. aur. Aur-i. aur-m-n. Bar-c. bar-m. cact. calc-f. chinin-s. con. crat. ergot. Glon. Kali-i. kali-sal. lach. lith-c. Nat-Kali-i. phos. plb. Plb-Kali-i. Polyg-a. sec. stront-c. Stront-Kali-i. stroph-h. sumb.
thyroiod. Vanad.
SPECIFIC THERAPEUTICS 42,43. As in any other disease, the remedy that encompasses the diseased state of the constitutional expression at all levels, body, mind and spirit, termed as constitutional remedy which necessarily coincides with the miasmatic expression of the individual is the approach to hyperlipidemia. Inspite there are certain remedies specifically related to hyperlipidemia clinically proven to bring down serum lipid levels as well as remove the pathological deposition of lipids on arterial walls.
Allium Sativum – Adapted to fleshy subjects. Patients who eat a great deal more especially meat than they drink.
Arnica – Marked effect on blood. Fatty heart and hypertrophy.
Arsenicum iodatum – Senile heart, fatty degeneration, Arteriosclerosis.
Aurum metallicum – Develops in the organism by attacking the blood. Deterioration of body fluids. Arteriosclerosis with high blood pressure.
Baryta carb – Useful in general degenerative changes, especially in coats of arteries.Acts on the muscular coats of heart and vessels. Arterial fibrosis. Blood vessels soften and degenerate.
76 Calc flour – Arteriosclerosis.
Cardus marianus – Has specific relation to vascular system. Abuse of alcoholic beverages especially beer.
Cholesterinum – Obstinate hepatic engorgements. Gallstones.
Crataegus – Arteriosclerosis. Said to have a solvent power upon crustaceous and calcareous deposits in arteries.
Glonoine – Sciatica in atheromatous subjects.
Graphites – Tendency to obesity. Aids absorption of cicatricial tissue.
Plumbum metallicum – A great drug of general sclerotic condition. Hypertension and arteriosclerosis.
Plumbum iodatum - Arteriosclerosis
Polygonum aviculare – In material doses of tincture found useful especially in arteriosclerosis
Strontia – Arteriosclerosis. High blood pressure with flushed face, pulsating arteries Strontia iodat - Arteriosclerosis
Tabacum – Produces high tension and arteriosclerosis of coronary arteries Vanadium – Arteriosclerosis. Fatty heart. Atheroma of arteries of brain and liver
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Methodology
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METHODOLOGY
Source of data
This study was conducted on the patients who reported to the outpatient department of Fr. Muller Homoeopathic Medical College and Hospital, Deralakatte, as well as from Kankanady and peripheral centres. Patients belonging to age group of 25 to 75 years were considered for the study. Both the sexes were included belonging to various socioeconomic group. A total number of 30 cases were taken randomly for the study. The cases with elevated serum Cholesterol > 200mg/ dl, Triglycerides > 150mg/dl, LDL > 130mg/ dl or HDL <40mg/ dl were selected The inclusion and exclusion criteria were followed as given later.
Methods of collection of data
The data was collected by purposive sampling technique as per the inclusion criteria and processed in a Standardized Case Record (SCR). Processing includes analysis and synthesis of the case which were done as per the guidelines and principles of Homoeopathy.
The potency selection and repetition of the dose were done according to the demand of the case, such as Acute or Chronic, Susceptibility, Vitality and Suppression (if any), Changes in structural and functional level, and the degree of correspondence to the remedies. Follow up in each case was planned for a minimum of 3 months.
During the follow up each case was evaluated according to the scoring criteria, which includes the serum lipoprotein levels before and after treatment.
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Inclusion criteria:
All cases with hyperlipidemia between the age group 25 yrs and 75yrs, from both sexes would be selected.
Subjects who have diagnosed of hyperlipidemia based on clinical history, clinical presentation, clinical examination and blood investigation.
Exclusion criteria:
Subjects below 25 years and above 75 years
Subjects with serious complications like Myocardial infarction, Stroke etc.
The method used for this study is a clinical method for the confirmation. The results obtained have been statistically analyzed and evaluated. No controls have been kept for the study. All cases were treated after detailed history taking, with the help of S.C.R., in which the complete symptomatology of patients (clinical presentation and individual symptoms) and the investigation reports were recorded.
Selection of medicine in each case was based on the data such as etiological factors, qualified mentals, physical generals, concomitants, characteristic particulars, repertorial approach and clinical indications from different authorities. Potencies ranging from 30 to 1M (centesimal scale) have been used in this study. Repetition and change of potency and remedy were done as and when needed, according to the Homoeopathic principles. In between the period of medications, all the patients were kept under placebo continuously.
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Follow ups:
Majorities of the patients were reviewed, on a fortnightly basis, to assess the subjective and objective changes. Each case was followed for a minimum of 3 – 6 months from the commencement of treatment.
The abbreviations used in the follow up were:
S – No change or same
< - Aggravation of clinical features > Amelioration of clinical features 0 – Disappearance of clinical features G – good
N – Normal
N – Normal