2. Achilles tendinitis: Gradual onset of pain. On pressing the Achilles tendon there will be severe pain. The tendon may be thickened in some people.

3. Retrocalcaneal bursitis: Pain in the backside of the heel. It may be associated with tender swelling on both sides of the insertion of the tendon. On X ray there may be calcaneal spurs in some patients.

PREDISPOSING FACTORS:
1. Injury to the tendon insertion site as well as in around the heel.
2. Repetitive overuse in athlets.
3. Prolonged Standing.
4. Improper footwear with hard soles.

WHAT TO DO?1. Wear soft footwear with heel cushions.
2. Avoid ill fitting footwear and shoes.
3. Avoid going barefoot.
4. Try to wear soft footwear even inside the house.
5. Avoid getting hurt specially to heel and backside of the heel ( tendon insertion site)
6. Physiotherapy- specially ultrasound and exercise.

HOMOEOPATHIC TREATMENT:Homoeopathic treatment for Heel pain is based on the cause and symptoms. Most of the patients respond to treatment within 45 days to 60 days.

PRESENTING COMPLIANTS:(For which you are seeking immediate attention from the doctor. Onset (How did it start- sudden/gradual), duration (since how long), and progression of the complaints with details of treatment availed)

Important informations required from the patient for planning an effective treatment:
1. Diet: Vegetarian/Non vegetarian/ Mixed.
2. Appetite/Hunger: Increased/ Normal/ Reduced.
3. Digestion: Good / Easy indigestion/ Flatulence (Gas)/ Acidity.
4. Food intake: More salty/ more spicy/ more pungent/More sweets/ Balanced (Normal).
5. Any food item which you like most:

6. Pattern of eating: Hurried eating / eating slowly.
7. Thirst : Increased/ reduced/Normal
: Preference to cold water/warm water.
: Quantity taken per day.
8. Motion: Frequency – How many times a day?
: Consistency- Hard/ Well formed (Normal)/loose
: Urgency : Present/ No urgency.
: Satisfaction: Satisfied/ not satisfied.
: First stool: After rising/ after tea or breakfast/ Irregular.
: Any discomfort or pain: Before/during/after stool
: Bleeding: Before/ during/after stool.

9. Urine : Frequency: How many times a day.
: Night – Always/ some times.
: Urgency: Present/ no urgency.
: Flow- free flow/ Interrupted/ has to wait for long before the flow starts
: Control – good / less / No control.
: Difficulty/ Pain – Present/ Absent.

10. Sleep : Duration ……….PM to ……AM.
: Character of sleep : light / deep/ disturbed.
: Quality of sleep : Refreshing / Unrefreshing.
: Sleep disturbance : Always/ Rarely.
: Sleep disturbance : beginning / later part / Cannot specify.
: Afternoon sleep : Yes/ No.
:Covering during sleep: doesn’t like any covering( blanket)/ likes to cover full/ likes to cover till neck/ wants thin blankets/wants thick blankets.
: Dreams : always / very rare.
: Dreams : remembered / unremembered.
: Dreams : Anxious/ frightful/ any other…………

11. Sexual function : Normal / Increased / decreased.
12. Menstrual function : : Cycles: regular/ irregular/ always early / always late.
: Duration of flow: ……….days.
: Flow: Normal / more / less.
: Clots: Present/ absent.
: Pain during periods : Severe / Moderate / No pain.
: Any complaints Before / during /after periods.
: White discharge : Present / with itching/ absent.

13. Perspiration / Sweating pattern : Part: all over / some parts (for e.g. palms/ head)…….
: Odor (smell): Yes / no.

14. Obstetric history : : No of pregnancies ……..
: Abortions ………
: Any complaints during and after pregnancy…………….

15. Developmental history ( for children) : Mode of birth: Normal/ caesarian / forceps/……..
: Sitting at ………months.
: Standing………..
: Talking/ speech………..
: Urine control……………..
: Breast feeding till…………months.
: Feeding problems (if any)……….
: Any significant illnesses in childhood………like measles, chickenpox, fits, behavioral problems.
: Attention and concentration in studies:……..
: Performance in school……………
: General nature….Shy/ extrovert/ restless….
: De worming done………….
: Vaccination history…………..
: Behavior- restless/mild/irritable/`stubborn or if any……

16. Physical appearance: Lean/ stocky/ obese.
17. Skin- excessively dry/ normal/……….
18. Nails: Any problem- easy breaking / growing inwards/ painful nails/ etc……………
19. Hair on head: Hair falling/ dandruff / early graying..
20. Allergic to any food items:

21. MIND / EMOTIONS: : Easy anger/ irritability
: Can suppress anger / cannot suppress anger.
: Impulsive
: Mild in nature / rarely gets angry.
: Perfectionist / wants everything to be done in a perfect manner.
: Easy depression.
: Anxiety prone.
: Hurried / slowness.
: Reserved / extrovert.
: Cosmopolitan
: Too many friends and company/ least friends.

22. Any Habits: smoking / alcohol / any other.

23. Past history and Family history ( mention any significant illness in the family)
: Father –
: Mother –
: Brothers –
: Sisters-
: Wife-
: Children-
: Self :

24. Any investigations done so far like Blood, urine, Xrays, Ultrasound scan, C T Scan, any other……….

Important Note:
1. Never ignore some peculiar symptoms thinking that it is irrevalent , a Homoeopathic doctor may need to know each and every symptom of the patients to plan a rational and logical treatment.
2. Kindly carry all the investigation files along with you for proper analysis of the case.

1. Sleep as much as you need to feel rested; do not oversleep. Many a time’s people have a habit of oversleeping on weekends and sleeping less on working days. In the long run such habit may interfere with your sleep cycle and your quality of sleep may get affected.

2. Quality of sleep is more important than the quantity of sleep. Some sleep for just 3-4 hours and remain fresh throughout the day where as others sleep 8-10 hours and yawn throught the day.

3. Exercise regularly at least 30 minutes daily, ideally 4-5 hours before your bedtime.

4. Keep a regular sleep and awakening schedule. As far as possible stick on to the fixed time for retiring and rising.

5. Do not drink caffeinated beverages later than 4 PM (tea, coffee, soft drinks etc.).

6. Do not smoke, especially in the evening.

7. Do not go to bed hungry and do not go to the bed immediately after heavy dinner.

8. Adjust the environment in the room (lights, temperature, noise etc.) The room you are sleeping should not be too warm, shouldn’t have some bright light.

9. Wear comfortable clothing when you go to bed. Sleeping with tight fitting clothing may affect your sleep.

10. Avoid watching TV, eating, and discussing emotional issues in bed.

11. A light snack may be sleep-inducing, but a heavy meal too close to bedtime interferes with sleep.

12. Milk contains the amino acid L-tryptophan, which has been shown in research to help people go to sleep.

13. Take a warm bath half an hour before going to bed.

14. Listen to light music in the evening hours or just before going to the bed. Listening to exciting music may interfere your quality of sleep.

15. Sleep with your head facing north (magnetic) and feet facing south.

16. Don’t read very interesting and thrilling books just before going to bed. Your mind may remain active for long time and you may have difficulty in initiating sleep.

17. Yoga and Pranayama may help in inducing sleep.

Homoeopathic management of Insomnia:
Many a times Insomnia is due to faulty methods adopted by the person which interferes with the sleep cycle. Few Insomniacs have some psychological and behavioral problems which need to be tackled medically. Homoeopathic medications will help in initiating and maintaining sleep in patients with anxiety neurosis, depression, obsession etc. Homoeopathic medications does not have any side/after effects and they are not habit forming.

• Uncomfortable, “itchy,” “pins and needles,” or “creepy crawly” feeling deep in the legs.
• The sensations are usually worse at rest, especially when lying in bed.
• The sensations lead to walking discomfort, sleep deprivation, and stress.

Causes: • Cause exactly not known.
• Age: generally after 40 years.
• It may be a manifestation in chronic renal failure patients.
• Also seen in patients with Rheumatoid arthritis.
• It may come during pregnancy.
• It may be one of the manifestations in Peripheral neuropathy, early Parkinson’s disease, Iron deficiency anemia, electrolyte imbalance.
• Excessive caffeine intake, withdrawal from sedatives and narcotics, alcohol withdrawal.
• Psychological factors like stress and fatigue can worsen the symptoms of Restless leg syndrome.

Homoeopathic concept of restless leg syndrome:

In Homoeopathy the restless leg syndrome can be treated with different approaches. Individual approach and disease approach are the two commonly prevailing methods in clinical practice. According to the individual approach the patient’s details are explored like physiological functions i.e. appetite, sleep, motion and urine habits, mind and emotions etc and a medicine will be selected based on the personality features. Disease approach is nothing but selection of medicine basing on disease or local part. For restless leg syndrome medicines like Rhus tox, Kali brom, Zinc met, Ars alb are highly efficacious provided the dosage and repetition of the medicines are done correctly. This can be done by any qualified Homoeopathic doctors.

Go for a lipid profile at least once in a year specially the following category of persons,

1. You are above 40 years.
2. Family history of heart diseases including High blood pressure, heart attack, stroke.
3. If you are overweight.
4. If you are in sedentary occupation.
5. If you are a Diabetic patient

When to perform the test:
One needs to fast before having a lipid profile performed. For 12 to 14 hours before the test, only water is allowed. For healthy individuals with no other risks of heart disease to be screened for cholesterol and HDL every five years. You do not need to have a full lipid profile. However, if you have other risk factors or have had high cholesterol in the past, you should be tested more regularly and you should have a full lipid profile.

Lipid Profile – Normal ValuesTest Normal Values
Serum Cholesterol American Heart Association recommendation
Normal up to 200 mgs/dl
Borderline Upto 239 mgs/dl
Elevated if > 240 mgs/dl. On repeated values.

Serum Triglycerides
< 180 mgs/dl. Normal.
Elevation of values to be considered only if repeated values are high.
HDL Cholesterol 30 – 60 mgs/dl
LDL Cholesterol 100 – 190 mgs/dl Borderline
>190 mgs/dl. Risk

Total/HDL Ratio < 4 Normal
4 – 6 Low Risk
> 6 High Risk

DIETARY GUIDELINES TO REDUCE YOUR BLOOD LIPIDS

Non vegetarian diet
allowed- Chicken, turkey, veal, rabbit. All white fish, e.g. cod, haddock, plaice. Oily fish, e.g. herring, mackerel, sardines, tuna, salmon.Egg white.
In moderation- Lean beef, bacon, ham, pork, lamb; liver, Fish fried in suitable oil. Oysters, mussels. Occasional scampi, prawns, shrimps, lobster.
avoid totally- Visible fat on meat breast of lamb, belly pork, streaky bacon, sausages, duck, goose, pork pies, meat pasties. Skin on poultry.
Fish roe, fish fried in hard fats.

Fruit and vegetables
allowed- All fresh and frozen vegetables. Peas, beans, sweetcorn. Red kidney beans, lentils, chick peas, potatoes – eat skins wherever you can. Fresh fruit, unsweetened tinned fruit, dried fruit. Walnuts, chestnuts
moderate- Avocado, pears, fruit in syrup; crystallized fruit. Almonds, hazelnuts.
avoid- Chips or roast potatoes cooked in solid fat. Oven chips. Potato crisps. coconut

Sweets
allowed- Clear pickles. Sugar-free sweeteners, e.g. saccharin tablets or liquid; aspartame sweetener.
moderate- Sweet pickles and chutney; jam, honey, syrup, peanut, butter, curd. Boiled sweets, peppermints. Sugar, glucose, fructose.
avoid - Chocolate spreads, candy bars, toffees, chocolate, coconut bars.

Dairy products
allowed- Skimmed milk. Low-fat cheeses (e.g. cottage cheese), Very-low- fat yoghurt.
moderate- Semi-skimmed milk. Low-fat yoghurt.
avoid- Full-cream milk, evaporated or condensed milk, cream, Regular fat cheeses, cream cheeses. Full-fat yoghurt.

Cereal Products
allowed- Wholemeal flour, wholemeal bread, wholegrain cereals, oatmeal, cornmeal, porridge oats, sweetcorn, wholegrain rice and pasta, crisp breads, oatcakes.
moderate- White flour, white bread, sugary breakfast cereals, oatbran, white rice and pasta, plain semi-sweet biscuits,
avoid- Fancy breads, e.g. cheese biscuits.

Beverages
allowed- Tea, coffee with skimmed milk, mineral water, sugar-free soft drinks, unsweetened fruit juice. Clear soups, home-made vegetable soup.
moderate- Sweet soft drinks, low-fat malted drinks or low-fat chocolate (occasionally). Packet soups, meat soups.
avoid- Full-fat malted drinks, drinking chocolate. Cream soups. Non-dairy coffee whitener

HOMOEOPATHIC MEDICINES:

1. Homoeopathic medications will help you to reduce your blood lipids along with the strict diet contorl.
2. Some Homoeopathic medications will also help in increasing HDL cholesterol, which is the safest and heart friendly cholesterol.
3. Homoeopathic medications available for altered lipid level are in different forms e.g. Pills, Mother tincture form and also in drops.
4. Consult qualified Homoeopathic doctor for effectively planning anti cholesterol treatment.

Pimple (acne) is an extremely common clinical condition in adolescence age group. The age of onset is that of puberty or a little after although many patients do not appear troubled until the age of 16 or 17 yrs. Men appear to be affected earlier and more severely than women.

Homoeopathic system of medicine has different approaches in the management of pimples. Homoeopathy treatment does not merely limit itself to controlling the acute manifestation of pimples, but instead, aims treatment on the person with altered hormonal levels thereby eradicating the whole problem. Homoeopathy has medicines not only for the acute painful pimples but also for reducing the excessive scar formation/ disfigurement caused due to acne. Some general guidelines has to be followed along with Homoeopathic medications which will be advised by the Homeopathic physician. In Homoeopathy the treatment of Acne (Pimple) is chiefly internal. Minimal use of external application is one of the principles of pimple management in Homoeopathy.

MYTHS ABOUT THE CAUSES OF ACNE

Myth # 1:

Acne is caused by a lazy life style of poor hygiene. In actuality diet or surface skin oils are not the causes of acne. In reality vigorous washing well only irritate the skin and aggravate your acne problems.

Myth # 2:

Diet: Choclates and greasy foods are often blamed but there is little evidence that foods have much effect on the development and cause of acne in most people. Dietary restriction resulting in marked weight loss reduces seborrhoea but can not be considered as routine treatment

Myth # 3:

Acne is just a teenage condition. The reality is acne affect every age group from teenagers to people beyond the age of 40.

Myth # 4:

Sex and masturbatum are cause of acne. Current research indicate no connection between sexual entercourse, masturbation and acne.

Myth # 5:

Squeezing and popping pimples is the ideal way to remove them pouching and popping your pimples actually can push germs under your skin which in turn can create additional redness, pain as well as infection. And popping pimples could sometimes leaded to permanent scarring.

Why pimples erupt?

There are several theories put forward by various researchers/ scientists regarding the causation of Acne. Single or multiple factor play a role in the formation of acne as discussed hereunder.

1. Circulating sex hormones:

The spurt is the levels of hormones during puberty correlates well with the onset of acne vulgaries. The physiological action of male hormones is to increase sebum secret ion and cause sebaceous gland hyperplasia. On the other hand oestrogens suppress sebaceous gland activity. Evidences suggests that acne results from hormonal imbalance, increasing in severity with an increase in the androgen : oestrogen ratio acne may also be aggravated by other hormones like corticosteroids and ACTH.

2. Alteration in the pattern of keratinization:

Electron microscopic and kinetic studies indicate that the primary change occurs in the pattern of keratinization of the pilary canal. Normally keratinous material is loosely arranged in sebaceous follicles but in acne, it becomes more dense. Increased production of keratinocytes and their increased adherence due to persistence of desmosomes leads to retention hyperkeratosis. These initial changes occur in the follicular infundibulum leading to the formation of microcomedones and there by initiating the process of acne.

3. Quantity and Quality of Sebum Secretion

Excess sebum secretion and sebaceous gland hypertrophy and hyperplasia usually occur in patients of acne. Sebum is comedogenic and causes inflammation when injected in skin, implicates sebum is the pathogenesis of the disease. Patients of acne show variation in the production of sebum. And the qualitative difference in free fatty and fraction sebum is also responsible for the causation of inflammation.

Factors that can make acne worse

1. Family / Genetic history

The tendency to develop acne runs in families. For example school age boys with acne have other members of their family with acne. A family history of acne is associated with an earlier occurance of acne and an increased number of acne and an increased number of relational acne lesions

2. Diet

a. Milk : A recent study based on a survey shows that there is a epidemiological association between acne and consumption of partially skimmed milk, instant breakfast drink, sherbet cheese. The researchers hypothesize that the association may be caused by hormones present in cow milk though there is evidence of an association between milk and acne, the exact cause is unclear.

b) Seafood: Seafood often contains relatively high levels of iodine. Iodine is known to make existing acne worse but there is probably not enough to cause an acne outbreak.

c) High carbohydrates/ high GI

It has also been suggested that there is a link between a diet high in refined sugars and other processed foods and acne. The theory is that rapidly digested carbohydrate food such as white bread and refined sugar produces an overload in metabolic glucose that is rapidly converted into the types of fat that can build up in sebaceous gland. But further research is necessary to establish whether a reduced consumption of high glycemic food can significantly alleviate acne though consumption of high glycemic food in any case be kept to a minimum for general health reason. Avoidance of junk food with its high fat and sugar content is also recommended.

d) Vit A and E

Studies have shown that newly diagnosed acne patients tend to have lower levels of vit A circulating in their blood stream than those that are acne free. In addition people with severe acne also tend to have lower blood levels of vit E.

3. Hormonal Activity: Such as menstrual cycles and puberty. During puberty and increase in male sex hormones called androgen cause the glands to get larger and make more Sebum

4. Stress: In stress there will increased output of hormones from the adrenal glands.

5. Drugs : Use of antibiotic, steroids

6. Exposure to certain chemical compounds

7. Occupation: Hydration of the ductal stratum corneum may induce acne is such occupations as catering patients dealing with on undoubtedly develop an acneiform oil folliculities. Particularly on their trunks and limbs

8. Cosmetics: Oil based cosmetics can worsen acne

9. Menopause association acne occurs as product of the natural anti acne ovarian hormone estradiol fails at menopause. The lack of estradiol also causes thining hair, hot flushes vaginal dryness and predisposes to osteoporosis as well as triggering acne

11. Pressure from sports, helmets or equipment, back packs, light collars or tight sport uniforms

12. Some secondary causes for acne vulgaris are secondary hyper androgenism, cushings diseases, PCOD, congenital adrenal hyperplasia.

Other conditions which mimic Pimples

1. Acne Rosacea

Rosacea, a disease of adults, is generally grouped with acne vulgaris because of similar involvement of the face, the appearance of papular or pustular lesions. It affects the flush areas of the face, manifesting with telangiectasia, erythema and papulpustular lesions, and running a chronic course.

The onset of rosacea is usually in early middle age females are commonly involved. Exacerbations occurs with excess of alcohol, heat, sun exposure vasodilators and hot food. Spontaneous remissions are known. Ocular rosacea is seen in about 50% of patients. Involvement of the eyes with blephritis, conjunctivitis, episcleritis, keratitis and iritis is also known, though its relationship with rosacea is not clear.

2. Milia

White heads may be confused with milia. The milia predominantly occur infra-orbitally, are whiter and can occur in association with acne.

3. Gram – Negative folliculitis

It is a complication of antibiotic therapy in acne vulgaris. So there will be prolonged history of antibiotic intake

4. Perioral dermatitis

In females, confusion with perioral dermatitis is possible, but in these patients the lesions itch, the skin in dry and non-inflamed lesions are lacking.

5. Warts

They present as superficial flat, skin coloured or slightly brown lesions 2-4mm in diameter, but absence of inflammation make it differs from acne.

6. Seborrheic Eczema

Patients with eczema do not have a greasy skin by a dry skin with erythematous scaly papules, particularly in the nasolabial fold and forehead. Similar lesions may be present in axilla, groin, upper trunk and scalp. There may be history or family history of asthma or hay fever.

SKIN CARE IN PEOPLE WITH PIMPLES:

1. Clean skin gently

Gently wash the face with a mild cleanser, once in the morning and once in the evening, as well as after heavy exercise. Wash the face from under the jaw to the hairline and be sure to thoroughly rinse your skin. Using strong soaps or rough scrub is not helpful and can actually make the problem worse.

If you have oily, hair, shampoo the hair regularly

2. Avoid frequent handling of the skin

Avoid rubbing and touching skin lesions. Squeezing, pinching or picking blemishes can lead to the development of scars or dark blotches.

3. Share carefully

Men who shave and who have acne should test both electric and safety razors to see which is more comfortable. When using a safety razor, make sure the blade is sharp and soften your beard thoroughly with soap and water before applying shaving cream. Shave gently and only when necessary to reduce the rise of nicking blemishes.

4. Avoid sunburn or suntan

Many of the medicines used to treat acne can make you more prone to sunburn. A sunburn that redness, the skin or suntan that darkness the skin may make blemishes less visible and make the skin feel drier. However these benefits are only temporary, and there are known risks of excessive sun exposure, such as more rapid skin aging and a risk of developing skin cancer.

5. Choose Cosmetics Carefully

All cosmetics, such as foundation, blush, eye shawdows, moisturizers, and hair – care products should be oil free and avoid cosmetic programes that advocate applying multiple layers of cream based cleanses and coverceps

6. Diet

The general diet has no effect on the amount or composition of the sebum, on the keratinization in the follicles, or on the inflammatory conversion of comedones follicles, or on the inflammatory conversion of comedones to papulopustules. It is therefore not necessary to forbet favoured foods such as chocolates, spices, nuts or meat. On the other hand, one should take account of individual observations of the patients.

7. Psychological advice

Acne patients often suffer severely from the fascial symptoms, withdrawal, feelings of anxiety and depressive moods are common reactive responses. Optimistic medical advice and psychotherapy is important to the patients guidance.

8. Avoid heavy smoking

9. Avoid exposure to oils and harsh chemicals such as petroleum

10. Exercise as a natural acne treatment

Exercise is also part of a natural acne healing process. One of the main cause of acne is attributed to stress. Exercise helps to relax the muscles and excess fat, it can also relieve stress

11. Vitamin Supplements

Vit A and B6 are essential for skin care. Zinc and Chromium are also important. Such minerals are found mostly in vegetables and fruits

12. Wash your hair often, if your hair is oily. Try to keep your hair off to your face

13. Avoid touching your face

14. Wear soft, cotton clothing or mole skin under sports equipment

Homoeopathy is effective in acute as well in chronic diseases. But many a times people have a wrong notion that Homoeopathy is effective only in chronic cases and in acute illnesses one need to go for Allopathy. It is totally a wrong concept. Many of the acute illnesses are easily managed with Homoeopathic medications like acute respiratory infection, fever, throat infection, severe headache, dysmenorrhea, severe joint pains, ear ache, loose stools etc. Meantime Homoeopathy is useful in recurrent, refractory chronic diseases as well.

What are these steroids and where it is used?

In our body there is a pair of endocrine gland called adrenal gland situated on the upper pole of both the kidneys. These glands produces steroid hormones of three types namely mineralocorticoids, glucocorticoids and androgens. These Hormones are very essential for maintenance of life. One cannot survive without these hormones. Excessive production of these hormones and deficient production produces various clinical disorders/Syndromes.

Among these synthetic glucocoriticoids are used for therapeutic purpose because of its anti-inflammatory, mild immunosuppressant action. These are prescribed by practioners of Allopathic system of medicine in case of acute conditions/ emergencies. These steroid preparations should not be taken for long time, and if taken should be under strict medical conditions. When these steroids are given for a long time it produces softening of the bone (osteoporosis), abnormal fat deposition over the trunk( Buffalo hump), abnormal hair growth ( Hirsutism), Diabetes, Weight gain etc.

Who can use steroids?

Only an allopathic doctor can give steroid with caution. In the market various steroid preparations are available. It is available in the form of tablets, nasal drops, inhalers, injections etc. Many a time’s steroids will save the patient in life threatening emergencies. But it should be taken strictly as per the medical advice. Qualified allopathic doctors give steroids in several clinical conditions like acute asthma, skin infections and eczemas, acute joint diseases, connective tissue disorders etc. Non allopathic doctors( Homoeopathic, Ayurvedic, Unani) are not permitted to prescribe steroids in any form.

Where is the origin of the information- Homoeopaths use steroids?

1.Many so called ‘educated people’ are ignorant about Homoeopathic system of medicine. According to them only steroid is an all time panacea for every kind of acute illnesses. So whenever they come across their relatives and friends who are on Homoeopathic treatment, they warn their relatives about steroid content in these medicines.

2. When the beneficiaries of Homoeopathy share their experience with Non Homoeopathic doctors a general warning they receive is – “careful, it may have steroids”. It may be due to ignorance about Homoeopathic system of medicine or decided aversion to alternative system of medicines.

3. This is how such irresponsible statements get disseminated and deprived many deserving patients to come for Homoeopathic treatments. This is a ‘weapon’ used by many to stop the patients going for Homoeopathic treatment. Not only steroid, some persons will go to the extent of saying that Homoeopathic medicines contain crude metals and chemicals. That’s how such false allegations are propagated in the public.

WHAT ARE THE LAB TESTS TO DETECT PRESENCE OF STEROID?

There are several Laboratory tests available to estimate the presence of steroids in a given compound. Some are old yet popular test, i.e. colorimetric tests and some are confirmatory tests like Thin layer chromatography method and UV absorption method.

BEWARE ABOUT THE FALSE POSITIVE REACTION:

One of the old methods of detecting the presence of steroid is COLORIMETRIC METHOD using tetrazolim blue salts. If the given compound contain steroid, during this test a highly coloured compound is produced which is known as FARMAZAN. This test gives false positive result if the given compound contain reducing sugar like lactose. As we all know most of the Homoeopathic medicines contain lactose( goat’s milk powder) and hence there will be a false positive reaction. Most of the potentised Homoeopathic medicines contain some percentage of dispensing alcohol and responsible for the false positive reaction. Hence this method is not advisable to confirm the presence of steroids.

CONFIRMATORY TESTS:

Other methods used to test steroids are Liberman Buchard test, thin layer chromatography method and UV absorption method.

Almost all steroids show UV absorption between 235 and 240 nm in dehydrated alcohol or methanol in a clear solution. A complete spectrum of this solution is taken between 400 NM and 200 NM on a suitable spectrophotometer, if any steroid is present, it will show maximum at 240 NM. This is the right method of testing to confirm the presence of steroids and no Homoeopathic medicines will show positive reaction.

If anyone is interested to find out any steroid content in Homoeopathic medicines they are requested to go for these above mentioned tests than colorimetric test. Many a times people are misguided because of this misleading result in colorimetric test.

There is a big list of allergic respiratory diseases. Among these most important are
1. ALLERGIC RHINITIS – affecting the upper respiratory airway like nose, throat.
2. ALLERGIC ASTHMA – affecting the lower respiratory tract.

ALLERGIC RHINITIS

Two factors required for manifestation of allergic rhinitis are sensitivity to an allergen and its presence in the environment. Allergic rhinitis may be of 2 types.

a) Seasonal allergic rhinitis
It follows a well defined course of cyclical exacerbation. Approximately 20% of cases are strictly seasonal. The antigens concerned in the seasonal form of disorder are tree pollens in spring and grass pollens in summer, weeds and moulds. Symptoms of seasonal allergies cease with the appearance of frost.

b) Perennial allergic rhinitis
40% of cases are perennial which cause year-round symptoms. It is caused by antigens derived from house dust, fungal spores or animal dander.

Clinical manifestations:
Nasal itching brings on grimacing twitching and picking of the nose, which may result in epistaxis. Children with allergic rhinitis often perform the allergic salute an upward rubbing of the nose with an open palm or extended fingers. This maneuver gives rise to the nasal crease, a horizontal skin fold over the bridge of nose.
Typical complaints include intermittent nasal congetion, itching, sneezing, clear rhinorrhoea and conjunctional irritation. The patient may lose their sense of smell and taste. Some experience headaches, wheezing, and coughing. Nasal congestion is often more severe at night causing mouth breathing and snoring, interfering with sleep and inducing irritability.
Physical examination:
• Allergic gape – continuous open mouth breathing
• Allergic shiners – dark circles under the eyes.
• Transverse nasal crease.
• Conjunctival edema, itching, hyperemia.
• Nasal examination –edematous, boggy and bluish mucous membranes with little or no erythema; swollen turbinates.
• Thick, purulent nasal secretions indicate presence of infection.

Laboratory findings:
Nasal smear shows large number of eosinophils
• Elevated IgE,
• Specific IgE antibodies
• Positive allergy skin tests.
• Peripheral eosinophilia

Complications:
• Chronic sinusitis
• Asthma
• Eustachian tube obstruction and middle ear effusion
• Nasal polyps
• Orthodontic problems due to prolonged mouth breathing.

General Management
• Education to patient which includes reassurance.
• Identifying the allergen and avoidance of the same.
• Steam inhalation to reduce nasal block
• Diet rich in vitamin C
• Reduce bananas and straw berries in diet since they release histamines in body.

BRONCHIAL ASTHMA:
Bronchial asthma is a disease characterized by an increased responsiveness of the trachea and bronchi to various stimuli. It manifests by widespread narrowing of the airways causing paroxysmal dyspnoea, wheezing or cough.
Asthma is the commonest chronic illness during childhood. In India prevalence of asthma in school going children has been reported between 4-20% in different geographic regions.

Two types of asthma are identified
Extrinsic Intrinsic
• Atopic asthma
• Hereditary predisposition
• Personal history of allergic rhinitis/atopic dermatitis
• Starts early in life
• Serum IgE level elevated
• Symptoms may be seasonal/perennial • Idiopathic/cryptogenic
• No hereditary predisposition.
• No history of allergies

• Starts late in life.
• Serum IgE levels are normal.
• Symptoms are perennial.

Risk factors associated with development of asthma include, family history of asthma and atopic diseases, bronchiolitis during infancy, sensitization to allergies during childhood and passive smoking. Exclusive breast feeding during first 6 months of life protects against development of asthma.

Clinical Features: The signs and symptoms of asthma include, cough, which sounds tight and is non productive early in the course of an attack; wheezing, tachypnea and dyspnoea with prolonged expiration and use of accessory muscles of respiration,cyanosis, hyperinflation of the chest, tachycardia, pulses paradoxus which may be present to varying degrees depending on the stage and severity of the attack. Cough may or may not be associated with wheezing.

Shortness of breath may be so severe that the child has difficulty walking or even talking. Patient may assume a hunched over, tripod-like the sitting position. Abdominal pain is common. Vomiting also may be associated. The child may sweat profusely and a low grade fever may develop during severe airway obstruction. Between exacerbations the child may be entirely free of symptoms and have no evidence of pulmonary disease on physical examination.

A barrel chest deformity is a sign of chronic unremitting airway obstruction of severe asthma. Harrison sulci, an anterolateral depression of the thorax at the insertion of the diaphragm, may be present in children with recurrent severe retractions. Clubbing of fingers is rarely observed.

Status asthmaticus:
It is the most intractable form of the asthmatic paraoxysms where the wheezing continues unabated for hours or days. There is distressing cough, tachycardia, sweating and increasing apprehension. The attacks may abruptly terminate with copious expectoration or may lead to complications or death from severe exhaustion.
It is important to remember that allergic rhinitis, eczema or urticaria may be followed by asthma; to this combination of skin and respiratory allergy the term athma eczema prurigo syndrome is sometime applied.
Exhaustion, confusion, reduced conscious level.

Laboratory findings:
1. Blood – Eosinophilia
- Total WBC count will be elevated if associated infection is present.
- Haematocrit elevated when dehydration is present or attacks are prolonged.
- Arterial blood gas analysis: Acidosis and Co2 tension may increase. Serum IgE is elevated in children with allergic asthma.
2. Sputum: Eoesinophils will be seen. Sputum will be tenacious, rubbery and whitish and eosin methylene blue stain usually discloses numerous eosinophils and the granules from disputed cells.
3. Skin tests may be positive: But it cannot be performed in acutely ill children, patients with diffuse skin disease or those who are receiving antihistamines.
4. Radiology: Increased bronchovascular and hilar markings, hyperinflation of chest. Patchy areas of atelectasis, prominent pulmonary arteries, areas of infiltration and bronchopneumonia esp in long standing cases.
5. Pulmonary Function tests: To assess degree of airway obstruction and disturbances in the gas exchange, in assessing the response to therapeutic agent and in evaluating the long term course of the disease. These tests reveals a decrease in the one second forced expiratory volume (FEV-1), decreased vital capacity (VC) and increased functional residual capacity (FRC).

Complications:
• emphysema
• generalized seizures
• bronchiectasis
• pneumothorax
• atelectasis
• collapse and corpulmonale
• tuberculosis –due to use of steroids.

TROPICAL EOSINOPHILIA
Syn: Weingarten syndrome, pulmonary eosinophiliosis.
This condition which is common in tropics is characterized by an absolute eosinophil count of 2000/cmm or more in peripheral blood and associated with respiratory symptoms. Current evidence suggests that eosinophilia is an allergic reaction to helminthic parasites particularly filarial worms.
It is a syndrome characterized by cough dyspnea a raised white cell count with persistent and absolute eosinophilia with systemic manifestations like fever loss of weight and lassitude. Chert X-ray shows ground glass appearance.

3. ALLERGIC BRONCHITIS
Inflammation of bronchi and bronchioles due to exposure to specific allergens
Aetiology:
1) Allergy
2) Infection –viral, bacterial
Clinical features:
• Dry brassy, irritating unproductive harsh cough.
• Dyspnea and wheeze.
• Scanty difficult expectoration with retrosternal pain due to tracheitis.
• Low grade fever.

HOMOEOPATHIC CONCEPT
There is a special mention about allergic diseases in Homoeopathic literatures under the heading IDIOSYNCRASY. Dr Samuel Hahnemann, founder of Homoeopathic system of medicine defined idiosyncrasy 200 years ago in his famous book Organon of Medicine as “Idiosyncrasies by which are meant peculiar corporeal constitutions which although otherwise healthy, posses a disposition to be brought into a more or less morbid state by certain things which seem to produce no impression and no change in many other individuals”.
Manifestations of allergic reactions and idiosyncracies are same. Both are hypersensitive reaction. An idiosyncratic individual is oversensitive to one or few things which doesn’t require treatment as the person in healthy, but allergic disorders are due to morbid susceptibility.
Successful Homoeopathic prescribing demands a detailed case taking to find out the evolution of disease, relation with life situation, also to find out characteristic symptoms. According to Hahnemann it is the constitution of an individual that becomes sick first. The objective of treatment should be the improvement of the constitution, so that sensitivity, which has gone bad, is corrected or brought within normal range. It has been proved, verified and confirmed that if a proper indicated constitutional treatment is given to the child for sometime, it improves the constitution. In due course, the attacks become lesser in frequency and severity. By constitutional approach we can prevent the recurrence of the complaint by modifying the altered susceptibility.
Miasmatic remedy can help to remove any miasmatic block obtained from the familial background, past history of patient and also the presentation.
Acute prescriptions are required during acute flare-ups.
Thus the concept of totality of symptoms and principle of individualization together enables the homoeopathic physician to perceive the disease in its whole content to make a suitable prescription.

Miasmatic classification of Allergic diseases :
A psoric recurrent cold would be a hypersensitive reaction to different factors like dust, some particular food items or even tension. It is marked by sneezing, running nose and malaise with or without temperature. It recovers without complication. Cough will be dry spasmodic with scanty expectoration which is better by rest and hot application.

The sycotic type of recurrent cold can lead to chest congestions and may lead in course of time to asthma. There can be loss of smell, snuffles in children, dry rattling cough which is more on slight exposure to cold. The recovery is slow.

Tubercular type of recurrent cold will lead to recurrent infections where tonsil and lymphnodes are involved. There can be post nasal dripping, thick catarrhal discharge, haemorrhages, deep cough with purulent greenish yellow expectoration. The complaints are aggravated by night (sunset to sunrise), over heating and better by nose bleeds and cold application. There will be associated prostration. Here recurrence will be frequent and recovery will be incomplete.

In syphilitic stage it may cause ulcerations of nasal septum or glands and other parts. Recovery will be difficult.

Some of the important Homoeopathic remedies used in various Nasorespiratory allergies are as follows:

1. ALLIUM CEPA:
• Important remedy for allergic rhinitis.
• Coryza, profuse watery and acrid nasal discharge with profuse bland lachrymation.
• Spring coryza; discharge burns and corrodes nose
• Hay fever: in August every year.

ANTIMONIUM TARTARICUM: •
A remedy for allergic rhinitis and bronchial asthma.
• Rattling of mucus with little expectoration
• Burning sensation in chest ascending to throat
• Cough excited by eating.
• Oedema and impending paralysis of lungs
• Child wants to be carried.

ARSENICUM ALBUM:•
A remedy for allergic rhinitis, allergic bronchitis and bronchial asthma
• Asthmatic breathing, must sit or bend forward < after midnight.
• Unable to lie down for fear of suffocation
• Thin, watery excoriating discharge.
• Sneezing without relief.
• Cough with scanty, frothy expectoration

CALCAREA CARB
• Remedy for allergic rhinitis and bronchitis
• Coryza, takes cold at every change of weather.
• Catarrhal symptoms with hunger.
• Coryza alternates with colc.
• Stoppage of nose with fetid yellow discharge

CHAMOMILLA •
Remedy for allergic rhinitis and asthmatic bronchitis
• Coryza with inability to sleep.
• Irritable dry tickling cough.
• Suffocative tightness of chest with bitter expectoration in day time.
• Rattling of mucus in child’s chest.
• Child irritable fretful, quiet only when carried, capricious

DROSERA •
Good for allergic bronchitis and asthma.
• Spasmodic, dry cough, the paraoxysms follow each other very rapidly.
• Yellow expectoration.
• Harassing and titillating cough in children
• Cough commences as soon as the head touches the pillow.
• Asthma when talking with contraction of throat at every word uttered.
• “minute gun” cough during day, whooping at right.
< warmth, drinking, singing, lying down, after midnight.

HEPAR SULPH •
Good remedy for hay fever and bronchitis
• Sneezes every time he goes into cold dry wind.
• Discharge smell like old cheese.
• Cough when any part of body is uncovered
• Asthma: short deep breathing, must bend head back and sit up.
• Sensation of a splinter, fish bone or plug in throat.

IPECAC •
Good remedy for bronchial asthma and bronchitis
• Cough dry spasmodic constricted.
• Cough incessant and violent with every breath.
• Child becomes stiff and blue in the face.
• Violent dyspnoea with wheezing and anxiety about the stomach.
• Child looses breath with gagging and vomiting of mucus, bleeding from nose or mouth.
• Tongue clean.

KALI BICH •
Remedy for rhinitis, Bronchitis etc.
• Violent sneezing, coryza with obstruction of nose.
• Snuffles in children, esp fat chubby babies.
• Discharge-thick ropy, greenish, yellow

NATRUM SULPH •
Good remedy for humid asthma in children.
• Asthma with every change to wet weather
< damp weather.
• Must hold chest when coughing
• Rattling in chest at 4 and 5a.m.
• Cough with thick ropy, greenish expectoration.
• Delayed resolution in pneumonia, pain through lower left chest.
• Nasal catarrh, with thick yellow discharge and salty mucus.

NUX VOMICA
• Remedy for allergic rhinitis, bronchitis and asthma.
• Coryza fluent in day time, stuffed up at night and outdoors.
• Asthma with fullness in stomach morning or after eating.
• Cough with sensation as if something were torn loose in chest.
• Tight dry hacking cough at times with bloody expectoration.

PHOSPHORUS •
Remedy for chronic catarrh, allergic bronchitis.
• Chronic catarrh with small haemorrhages
• Cough < cold air, talking, from going from warm room into cold air
• Hard dry tight racking cough

PULSATILLA
• Remedy for rhinitis and bronchitis
• Coryza, yellow mucus, abundant in morning stoppage in evening.
• Stoppage of left nostril.
• Dry cough < evening, night
• Urine emitted with cough
• Expectoration bland, thick, bitter, greenish

SAMBUCUS •
Remedy for allergic bronchitis, asthma
• Dry coryza of infants; nose dry and completely obstructed.
• Paroxysmal, suffocative cough, coming on about midnight.
• Child wakes up suffocated, face livid blue
• Child inspires but cannot expire sleeps into attack.
• Cough deep, dry precedes the fever paroxysm.

CAUTION:
1. It is wise to take Homoeopathic Medicines for allergic respiratory disorders after consulting a qualified Homoeopathic physician.
2. The above mentioned few medicines should be taken in appropriate dosage only after medical consultation.

Introduction:

It is not uncommon to find some patients regularly coming for consultation with vague/exaggerated, non specific multiple complaints. Most of these patients will have a thick file of investigation reports starting from simple blood tests till the latest invasive investigations like angiogram, colonoscopy, gastroscopy etc. Paradoxically none of these reports will reveal any abnormality or very minimal abnormality which is not proportionate to the patient’s clinical presentation. They keep on changing the doctors and system of medicine and rarely they are convinced with one doctor. They stick on to one doctor in the beginning, the moment doctor says there is no problem with them, they change the doctor. A busy practitioner may find such patients as problematic or wasting the precious consultation hours of other patients and to avoid them he may refer such patients another physician or specialist. Sometimes medical professionals exploit such patients by unnecessarily doing some surgeries or some procedures just for monitory purpose. These victims are called patients of somatoform disorders.

Somatoform patients:
If a patient presents with one or more physical complaints for which an adequate physical explanation cannot be found or complaints of the patient may seem greatly exaggerated in comparison with the minor physical or lab abnormalities that are identified then he/she is likely to be a patient of Somatoform disorder. In other words it is a tendency to experience and communicate psychologic distress through physical symptoms. Patients often have low self esteem; are self conscious, vulnerable to stress, anxious, hostile, depressed and are likely to be females. They resist any psychological explanation for their symptoms and usually refuse to see a psychiatrist or psychologist.
Doctor shopping is frequent in these patients. Iatrogenic complications can result from inappropriate prescription of narcotics or unnecessary surgeries.

Physician who suggests the symptoms are ” in the patients head” will be met with anger and rejection. The wise physician will not attempt to take away the patients symptoms but will instead translate the somatic symptoms in to what the patient needs.
Infact these patients often suffer from an inability to describe their feelings in words, a phenomenon known as ‘Alexithymia’.

Types of Somatoform disorders:

1. Somatization disorder.

2. Somatoform pain disorder.
3. Hypochondiasis.
4. Body dysmorphic syndrome.

1. SOMATIZATION DISORDER:
Chronic syndrome of multiple somatic symptoms that cannot be explained medically and is associated with psychological distress and medical help seeking.
The characteristic features of this condition is patient presents with the multiple physical complaints- which are vague, imprecise, inconsistent, disorganized, dramatic, emotional and describe these symptoms in very exaggerated manner and vivid and colorful language.

Commonest presentation:
1. Pain – in leg, back, joint, head etc
2. Gastrointestinal symptoms – pain abdomen, nausea, bloating, diarrhoea.
3. Cardiopulmonary symptoms- shortness of breath, dizziness, chest pain, palpitation.
4. Neurological symptoms – loss of voice, deafness, double vision, blindness, muscle weakness, dysphagia, amnesia.
5. Sexual symptoms- indifference, dysparaunia, impotence, painful periods etc.

So if the abovementioned multisystemic symptoms are present from a long time in a young (below 30) female, and if there has no attributable physical illness , but the symptoms have caused significant distress in the patients life style it is likely to be a somatization disorder. Most of these patients have attention seeking behavior with unstable home atmosphere and a positive family history of similar complaints.

Diagnosis:
Most of the time when a patient presents with a thick investigation file in his hand revealing no abnormality in any investigation report is likely to be patient of somatization disorder. In addition when the patient reveals multiple aches and pains, and other symptoms of long standing it supports the diagnosis. According to the textbook of psychiatry to call any patient having somatization disorder there should be,
-3-4 pain symptoms in different locations.
-2 neurological symptoms.
-One sexual symptoms.

On examination patient is anxious or depressed, dependent and self-centered personality, hungry for admiration and precise and manipulative.

2. SOMATOFORM PAIN DISORDER :
When the patient presents with severe and prolonged pain for which there is no medical explanation. It is commonly seen in women of age group 30-40 years with severe low backache, headache, atypical facial pain, and chronic pelvic pain. Severe continuous pain of 6 months duration with adequate medial explanation and pain is inconsistent with anatomical distribution.
Psychodynamic theory suggests that pain has unconscious meaning which originate in infantile and childhood experiences. Pain can function as a method of obtaining love, a punishment for wrongdoing. But patients deny any emotional factors and feel that life is blissful except for the pain.

Diagnosis:
Preoccupation with pains for at least 6 months and on examination no organic pathology or if there is some abnormality, symptoms are out of proportion to it and generally incapacitated by their problem.

3. HYPOCHONDRIASIS:
Fear of having or the belief that he or she has a serious disease. These patients have excessive concern about a disease. The fear or conviction of a disease is disabling and persists despite appropriate reassurance.
Pyshodynamic theroy :
Defence against the guilt, sense of innate badness, low self-esteem, excessive self-concern and past history of disappointment-rejection-loss, insolvable problems.
Unrealistic interpretation of physical symptoms and sensations leading to preoccupation with the fear or belief that one has serious disease. Eventhough no medical disease accounts for the physical signs and sensations. For e.g. a patient with chest pain thinks that he has some cardiac problems despite normal ECG , rational explanation and reassurance.

Age group : 4-5th decade; more common in men than women. Symptoms involving multiple organ systems and many anatomical locations. Generally fear of having gastrointestinal and cardiac disease.

4. BODY DYSMORPHIC SYNDROME:
Strong, nondelusional belief that a body part is misshapen or defective in some way. Such patients are normal or they may have some defect in their appearance in face, nose, hair or genitals. But patients think that they have a distorted, dirty appearance. Their anxiety is multiplied in social situations. They may seek the help of dermatologists or reconstructive surgeons for their deformity.
They remain anxious throughout or may avoid social gathering/public contact and may remain at home always.
For e.g. a small wart on nose- feels as if their nose appears very disfigured.
Negligible nasal deviation- feels as if distorted nose.
Some scar mark on face- feels as if their face is not presentable one. So when ever they speak to someone they become anxious or try to cover their so called distorted part.

MANAGEMENT:
General guidelines:
1. Establish a good rapport with the patient.
2. Once a stable doctor-patient relationship is established introduce the patient to the mind body concept.
3. Discuss the interaction between emotions and physical symptoms and explain physical symptoms using this concept.
4. Validate the symptom as “real”, don’t try to take it away from the patient.
5. Minimize medications especially those prone to cause physical dependence or abuse.
6. Medicate patients on a fixed schedule not as needed. This will reduce the patients need to have symptoms in order to receive the medications.
7. Maximize nonmedication modalities such as exercise, physical therapy, diet, yoga.
8. Schedule regular appointments for fixed periods of time, eventhough the patient is doing well. This helps to reduce the number of crisis visit.
9. Discourage “DOCTOR SHOPPING”. One doctor should be incharge of the patients overall care and management.
10. Minimize lab testing. Only do testing if symptoms are supported by objective evidence. Avoid performing any test for subjective complaints only.
11. All explanations should incorporate Mind-Body concept.

HOMOEOPATHIC APPROACH IN SOMATOFORM DISORDERS:
Dr Samuel Hahnemann in his Organon of Medicine 6th edition mentions some special guidelines for such patients. While giving the instructions for case taking he gives caution about 2 sets of difficult patients. One set of patients whom he called as Hypochondriacs and other set of patients as Indolent patients. So Hahnemann’s Hypochondriac patients are today’s somatoform patients.
In aphorism 96 of Organon of Medicine he says “so called Hypochondriacs and other persons of great sensitiveness and impatient of suffering, portray their symptoms in too vivid colours and in order to induce the physicians to give them relief, describe their ailments in exaggerated expressions.
In foot note to aphorism 96 he continues to write on such patients and emphasizes on following points.
1. He differentiates such patients from patients who feign to be ill or fabricating patients and from insane patients.
2. People who feign to be ill are doing it intentionally whereas hypochondriac will never feign, they just exaggerate their suffering to get maximum attention from the physician.
3. Physician must reassure without giving any medicine or give something quite unmedicinal.
4. To treat the portrait of their suffering the treating physician must deduct something from their exaggeration, at all events ascribe the strong character of their expression when taking of their ailments.

So Hahnemann’s instructions are very clear. We have to have a rational humanistic approach in such patients. The treatment planned should be aimed at treating the basic anxiety about health. Most of the somatoform patients have some significant life events. Like childhood trauma, unsolved mental conflicts should be explored to plan a more effective treatment.

Repertorial reference of Somatoform patients:
There are some rubrics in synthesis repertory that can be well-utilized in managing somatoform patients.
1. Mind, Hypochondriasis- Important drugs- Aur, Con, Ign, Mag M, Nit acid, Nat c, Nat Mur, Nux vom, Puls.
2. Mind, health, own- Important drugs- Arg met, Aur, Kali ars, Nat c, Nat mur, Nit acid, Nux vom, Phos acid, Phos, Puls, Sep.
3. Mind, Anxiety, Hypochondriacal- Imp remedies- Ars, Arg nit, Ars, Calc, Caust, Con, Ign, Iod, Kali ars, Kali carb, Lach, Nat mur, Nit acid, Nux vom, Phos acid, Phos, Puls, Sep.
4. Mind, anxiety, Hypochondriacal, read medical books; mania to : Calc, nux vom, Puls, staphy, sulph.
5. Mind, delusion- disease: every disease he has: Aur mur, Stram.
6. Mind, delusion, disease: incurable disease; he has an: Arg nit, Ign, Lach, Lil tig, Nit acid, Phos, Plumb, Podo, Stan.
7. Mind, Sensitive, complaints, to the most trifling: Nux vom.
8. Mind , Lamenting, Sickness : Acon, Ambr, Apis, bufo, Calad, Calc, Can ind, Canth, Carb veg, Caust, Con, Digit, Fl acid, Graph, Hyoscy, Ign, Lach, Lil tig, Lyc, Merc, Nat carb, Nat mur, Nit acid, Nux vom, Phos acid, Phos, Pic acid, Plat, Puls, Sep, Sil, Staph, Stram, Tarent, Ver.
9. Mind, Exaggerating : Agar, Calc, Plat, Stram.
10. Mind, Exaggerating, symptoms; her : Asaf, Cham, Plb.

Considering the above rubrics and its appropriate remedies a new rubric- Somatization can be added in the repertory in the chapter MIND. All the above mentioned rubrics can appear as subrubric under the main rubric, Somatization. At present we don’t have a common rubric which will fit in to the criteria of somatoform disorder. This rubric should be useful,
1. For a patient who has multiple unexplained nonspecific physical complaints?
2. Who keeps on changing the doctors, never satisfied in one?

Rubric: Somatization.
It should contain following medicines in different gradings.
3 marks : Calc, Ign, Nat mur, Nit acid, Nux vom, Phos.

2 marks :Amb gris, Ars, Arg nit,Apis, Asaf, Aur met, Carb veg, Caust, Cham, Con,Hyos,Lach, Lilium tig, Kali ars, Kali carb Phos acid, Pic acid, Plat, Puls, Sep, Sil, Staph, Ver.

1 mark :
Acon, Agar, Bufo, Can Ind, Dig, Flouric acid, Graph, Lyco, Merc, Nat carb, Plumb, Stan, Stram, Tarent.

Conclusion:

Somatoform disorder patients are on rise. Today’s modern living and competitive world has created many Hypochondriacs who are unable to explain their emotions through words and instead expresses through multiple physical complains. We have to minimize their doctor shopping. Homoeopathic approach is very friendly to somatoform patients. Our very approach of dealing with the patient (as laid by our master- Dr Hahnemann) like detailed case taking, careful listening, free from prejudice, establishing mind- body concept will definitely a great boon for such patients.

The disease has reappeared after 40 long years. In 2005-06 again there was an outbreak in 151 districts in 8 states like Andaman and nicobar island, AP, Delhi, Maharashtra, Gujarat, Karnataka, MP, Tamil Nadu and Kerala. More than 1.25 million cases have been reported in the country with majority of cases from Karnataka and Maharashtra. The latest outbreak was in coastal Karnataka in the month of April- May 2008 affecting a large number of people. Affected people are still having residual joint pains, non specific enthesopathy and musculoskeletal ache and pains.

AGENT:

Chikungunya virus is a member of the genus aphavirus in the family Togaviridae.

MODE OF TRANSMISSION:

Only by infected mosquito bite-female Aedes egypti. Air borne spread not yet confirmed.

VECTOR:

Aedes Egypti Mosquito

Female AEDES EGYPTI mosquito is responsible for the spread, can also be transmitted by culex and mansonia mosquitoes. Aedes mosquitoes are smaller than other mosquitoes and they breed only in artificially stagnated fresh water, i.e. water tanks, water stored flower pots, buckets filled with water, etc. Aedes mosquitoes are easily distinguished by white stripes on a black body. Because of the striped or banded character of their legs, they are sometimes referred to as ‘tiger mosquitoes’.

Characteristics of Aedes mosquitoes-

1. IT BITES ONLY IN THE DAY TIME.
2. Aedes bites at a time many persons and then rests. (Female anopheles bites at a time only one person and then rests). Hence the spread of Chikungunya is faster than Malaria.
3. Aedes breeds only in artificial accumulations of water in and around human dwellings such as water found in discarded tins, broken bottles, fire buckets, coconut shells, earthern pots, tree holes,clean, fresh water. The other mosquitoes like Culex breeds in dirty water collections, stagnant drains, septic tank and Mansonia mosquitoes breeds on breeds on ponds and lakes containing certain aquatic plants.

Incubation period: 4-7 days.

CLINICAL FEATURES:

Symptoms - Usually symptoms differ from place to place / patient to patient depending upon the age and stamina of the sufferer.

Severity – more in old age, undernourished people, people with existing joint diseases.

First day:
Sudden onset with fever, chills, cephalalgia, anorexia, lumbago and severe arthralgia.

Second – third day:
Fever continues, joint pain affecting hand joints (MCP), foot, toes, painful to touch. Unable to move. In 60-80 % of patients have a morbilliform rash occasionally with purpura on the trunk and limbs.

Third – fifth day:
Fever subsides. Skin lesion may recur. Joint pain increases especially small joints of hands and feet. Early morning stiffness, swelling and redness of the joints may be noted. The intensity of the joint pain varies from person to person. Patients with preexisting joint diseases may have severe manifestations compared to the people with normal joints.

After one week:
Some recover. But the recovery will not be like common viral fever. The joint pain will especially ankle pain, swelling, sensitive feet etc.

Other features: (not in all patients)
Adenopathy, bleeding form the nose, redness of the eyes, headache, vomiting or diarrhea, subungual hemorrhage, mouth ulcers.

General condition improves within one week in majority of the patients.

Clinical classification of cases:

1. Acute case- less than 7 days.
2. Sub acute case- 7-14 days.
3. Chronic case- More than 14 days.

Dermatological Manifestation in Chikungunya

• Freckle like pigmentation over face.
• Vesicobullous lesions in children.
• Nasal blotchy erythema.
• Loss of appetite, coated tongue,
• Skin rash- maculopapular, most intense on trunk and limbs and may desquamate.
• Hyperpigmentation in central part of face. Some times pigmentation of Nose.
• Pruritus.
• Erythematous rashes of body and limbs.
• Scrotal ulcers.

Musculoskeletal Manifestation
Patients are divided into 3 grades according to the functional efficiency
Grade I: active, mobile and independent.
Grade II: Not active, mobile.
Grade III: Bed ridden and dependent for ADLs.

1. Arthropathy/ Enthesopathy/ Tendinitis: Ankle and foot, Knee, spine, Wrist, shoulder, Phalanges, Tendoachillis, Hamstrings, Evertors of foot, Extensor pollicis brevis and Abductor Pollicis Longus and Rotator cuff.

2.Functional and ambulation limitations : Bathing, Grooming, Dressing are the most common activities of Daily living affected.
Washing clothes and grinding the most common instrumental activities of daily living affected.

3. Migratory polyarthralgia.

Neuro Psychiatric problems:

1. Persistent Somatoform Pain disorder- Never neglect symptoms, therapeutic dialogue (communication- verbal and nonverbal, listening and touch. Address fear, emotional conflicts and psychological problems. Encourage gradual reentry in to routine work.
2. Adjustment disorder: subjective distress and emotional disturbance interfering with social functioning, arising in a period of adaptation to a serious physical illness.
3. Depression: mostly in women, sadness of mood, lack of intrest, easy fatiguability, insomnia, loss of appetite, hopelessness and worthlessness, lasting for more than two weeks .
4. Insomnia: Common symptom in acute phase, lasts for 2 days to one week. Management of pain and reassurance alone needed in most of the cases.

LABORATORY INVESTIGATIONS.

1. BLOOD: Few patients develop Leucopenia. In some there will be thrombocytopenia. But thrombocytopenia is not severe as in Dengue.
2. SEROLOGICAL TESTS: Detection of antibodies to chikungunya virus in the blood. IgM ( ELISA)
3. Antigen detection with molecular technique like Polymerase chain reaction. ( PCR)

Differential diagnosis with differentiating features:

1. Other Viral fever- no residual joint pains and short convalescence.
2. Malaria – Blood test for MP( flourescent/smear), intermittent fever.
3. Dengue fever- Low total count, palatelet count, altered BT,CT, PTT( in Hemorrhagic complications.
4. Leptospirosis- altered liver function tests, rise in serum creatinine ( in complicated), Urine- RBC’S.
5. Urinary tract infection – Urine micro will reveal more number of pus cells.

PREVENTION OF CHIKUNGUNYA:
Prevention of mosquito breeding:

• Controlling the breeding sites of mosquito by avoiding water stagnation in and around houses.
• Keep covered, water stored in buckets and tanks
• Water from flower pots should be changed at least once a week
• Fogging and killing them (for adult mosquito) especially in daytime since they are active during daytime.
• Using bleaching powder and other pesticides / chemicals in stored water (to clear larva and pupa).
• All containers storing water should be covered with a tight lid
• Water stored in barrels, drums etc should be replaced by fresh stock (at least) once a week
• Discarded container-like objects like tyres, coconut shells, bottles, etc should be disposed off or destroyed.
• Water fountains should be kept dry once a week
• Rain water collected on terraces/roofs should be cleared (at least) once a week
• Mosquitoes can be controlled by using net, mesh, coils, liquids, sprays, creams, etc.

Prevention of Chikungunya through Homoeopathy:
The concept of Preventive strategy in Homeopathy is as old as the Homeopathic system of medicine itself. Many of the Homoeopathic literatures like Organon of medicine, Lesser writings, M L Tyler’s drug pictures will give us a definite and clear strategic plan of epidemic disease preventive and curative management. Hahenmann’s guidelines regarding the selection of genus epidemicus should be followed strictly.
Homoeopathic medicines are useful in prevention and also in reducing the severity of the illness and have some disease modifying action if taken well in advance. Homoeopathic preventive medicines are given for 5-7 days and need to repeat these medicines after 3 weeks. Constitutional medicine will give protection for a longer period.

HOMOEOPATHIC MANAGEMENT OF CHIKUNGUNYA AND POST CHIKUNGUNYA ARTHRALGIA:

ACUTE PHASE: Less than 7 days.
Apis, Arnica, Bell,Benzoid acid, Bry, Cham, Colchicum, Eupat, Formica, Gaultheria, Hymosa, ledum, Guiacum, , Rhus tox.

SUBACUTE PHASE: 7-14 days
Actea spicata, Caulophyllum, Phytolocca, Rhododendron, Rhus tox

CHRONIC PHASE- after 2 weeks.
Bry, Calc, Calc flour, Ledum, Kalmia, Medo, Puls, Ruta

Post chikungunya enthesopathy: Pain in soles, feet, Heel tendons, tennis elbow etc..: Arnica, Formica, Kali bich, Phyto, Rhodo.

Therapeutics for post chikungunya arthralgia with few joints affection:

1. Pain in the hands- Caulophyllum, Colchicum, Rhux tox.
2. Pain in the fingers – Caulophyllum, Rhodo,
3. Pain in the finger joints- Ant crud, Caulo, Caust.
4. Pain in the ankle- Ledum pal, Guaiacum, Oleum j, Verat vir,
5. Pain in the foot- Rhus tox, Hepar, Ledum, Ruta.
6. Pain in the joints of feet- Bry, Calc, Guaicum, Staphy
7. Pain in the sole- Caust.
8. Pain in the heel – Ammon Mur, Aranea diadema, Calc, Puls, Rhodo.
9. Pain in the toes- Benz acid, Caulo, Phyto, Rhodo, Rhus tox
10. Swelling of multiple joints- Act spicata, Bell, Bry, Colch, Hep, Ledum, Sulph.
11. Swelling of the wrist joint- Act spicata, Apis, Lact acid, Rhus tox.
12. Swelling of the hand- Apis, colch,
13. Swelling of the fingers- Act spic, Apis, Bry, Kali bich, Phyto, Rhus tox
14. Swelling of the finger joints- Bry, Calc, Caulo, Cham, Lactic acid, Lyco, Nit acid, Phyto, Rhus tox.
15. Swelling of the ankle- Apis, Chel, Kalm, Med
16. Swelling of foot- Apis, Ars, Bry, caust, Led, Lyco, Med, Puls, Silicea.

Dermatological manifestations:
Ars alb, Apis, Bovista, Puls, Natrum mur, Rhus tox, Sulph.

Neuropsychiatric manifestations:
Somatoform pain disorder: Chamomilla, Moschus, Lac caninum, Ignatia, Natrum Mur.