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Hospital, Lucknow
DISSERTATION
ON
STUDY OF
AND ITS
HOMOEOPATHIC MANAGEMENT
GUIDE
PRESENTED BY
2
ACKNOWLEDGEMENT
Last but not the least I express thanks to all those persons who are directly
or indirectly related to completion of the Dissertation.
3
CERTIFICATE BY PRINCIPAL
Principal
NATIONAL HOMOEOPATHIC
CERTIFICATE BY GUIDE
I hereby certify that Gyanendra Kumar Rai has prepared his dissertation on
the topic allotted to him; Study of Chronic Obstructive Pulmonary
Disease and its Homoeopathic Management under my guidance
and his work is up to my satisfaction.
Dr. D. S. Tomar
Lecturer
NATIONAL HOMOEOPATHIC
INDEX
1. INTRODUCTION
3. REVIEW OF LITERATURE
A. REVIEW OF GENERAL
MEDICAL LITERATURE
B. REVIEW OF HOMOEOPATHIC
MEDICAL LITERATURE
TREATMENT
6. ANNEXURE
A. CASE FORMATION
B. GRAPHS
C. SYNOPSIS OF CASES
7. BIBLIOGRAPHY.
7
To see the role of deep acting and short acting medicines in treatment.
REVIEW OF LITERATURE
Anatomy of Lungs
The lungs flank the heart and great vessels in the chest cavity.
Air enters and leaves the lungs via a conduit of cartilaginous passageways
the bronchi and bronchioles. In this image, lung tissue has been dissected
away to reveal the bronchioles.
The lungs are the essential organs of respiration; they are two in number,
placed one on either side within the thorax, and separated from each other
by the heart and other contents of the mediastinum. The substance of the
lung is of a light, porous, spongy texture; it floats in water, and crepitates
when handled, owing to the presence of air in the alveoli; it is also highly
elastic; hence the retracted state of these organs when they are removed
from the closed cavity of the thorax. The surface is smooth, shining, and
marked out into numerous polyhedral areas, indicating the lobules of the
organ: each of these areas is crossed by numerous lighter lines.
At birth the lungs are pinkish white in color; in adult life the color is a dark
slaty gray, mottled in patches; and as age advances, this mottling assumes a
black color. The coloring matter consists of granules of a carbonaceous
substance deposited in the areolar tissue near the surface of the organ. It
increases in quantity as age advances, and is more abundant in males than
in females. As a rule, the posterior border of the lung is darker than the
anterior.
The right lung usually weighs about 625 gm., the left 567 gm., but much
10
variation is met with according to the amount of blood or serous fluid they
may contain. The lungs are heavier in the male than in the female, their
proportion to the body being, in the former, as 1 to 37, in the latter as 1 to
43.
The apex (apex pulmonis) is rounded, and extends into the root of the
neck, reaching from 2.5 to 4 cm. above the level of the sternal end of the
first rib. A sulcus produced by the subclavian artery as it curves in front of
the pleura runs upward and lateralward immediately below the apex.
The base (basis pulmonis) is broad, concave, and rests upon the convex
surface of the diaphragm, which separates the right lung from the right lobe
of the liver, and the left lung from the left lobe of the liver, the stomach, and
the spleen. Since the diaphragm extends higher on the right than on the left
side, the concavity on the base of the right lung is deeper than that on the
left. Laterally and behind, the base is bounded by a thin, sharp margin
which projects for some distance into the phrenicocostal sinus of the
pleura, between the lower ribs and the costal attachment of the diaphragm.
The base of the lung descends during inspiration and ascends during
expiration.
11
Pulmonary vessels, seen in dorsal view of the heart and lungs. The lungs have been
pulled away from the median line, and a part of the right lung has been cut away to
display the air-ducts and bloodvessels.
and right innominate vein; behind this, and nearer the apex, is a furrow for
the innominate artery. Behind the hilus and the attachment of the
pulmonary ligament is a vertical groove for the esophagus; this groove
becomes less distinct below, owing to the inclination of the lower part of the
esophagus to the left of the middle line. In front and to the right of the
lower part of the esophageal groove is a deep concavity for the
extrapericardiac portion of the thoracic part of the inferior vena cava. On
the left lung immediately above the hilus, is a well-marked curved furrow
produced by the aortic arch, and running upward from this toward the apex
is a groove accommodating the left subclavian artery; a slight impression in
front of the latter and close to the margin of the lung lodges the left
innominate vein. Behind the hilus and pulmonary ligament is a vertical
furrow produced by the descending aorta, and in front of this, near the base
of the lung, the lower part of the esophagus causes a shallow impression.
Borders. The inferior border (margo inferior) is thin and sharp where it
separates the base from the costal surface and extends into the
phrenicocostal sinus; medially where it divides the base from the
mediastinal surface it is blunt and rounded.
13
The anterior border (margo anterior) is thin and sharp, and overlaps the
front of the pericardium. The anterior border of the right lung is almost
vertical, and projects into the costomediastinal sinus; that of the left
presents, below, an angular notch, the cardiac notch, in which the
pericardium is exposed. Opposite this notch the anterior margin of the left
lung is situated some little distance lateral to the line of reflection of the
corresponding part of the pleura.
Fissures and Lobes of the Lungs.the left lung is divided into two lobes, an
upper and a lower, by an interlobular fissure, which extends from the costal
to the mediastinal surface of the lung both above and below the hilus. As
seen on the surface, this fissure begins on the mediastinal surface of the
lung at the upper and posterior part of the hilus, and runs backward and
upward to the posterior border, which it crosses at a point about 6 cm.
14
below the apex. It then extends downward and forward over the costal
surface, and reaches the lower border a little behind its anterior extremity,
and its further course can be followed upward and backward across the
mediastinal surface as far as the lower part of the hilus. The superior lobe
lies above and in front of this fissure, and includes the apex, the anterior
border, and a considerable part of the costal surface and the greater part of
the mediastinal surface of the lung. The inferior lobe, the larger of the two,
is situated below and behind the fissure, and comprises almost the whole of
the base, a large portion of the costal surface, and the greater part of the
posterior border.
The right lung is divided into three lobes, superior, middle, and
inferior, by two interlobular fissures. One of these separates the inferior
from the middle and superior lobes, and corresponds closely with the
fissure in the left lung. Its direction is, however, more vertical, and it cuts
the lower border about 7.5 cm. behind its anterior extremity. The other
fissure separates the superior from the middle lobe. It begins in the
previous fissure near the posterior border of the lung, and, running
horizontally forward, cuts the anterior border on a level with the sternal
end of the fourth costal cartilage; on the mediastinal surface it may be
traced backward to the hilus. The middle lobe, the smallest lobe of the right
lung, is wedge-shaped, and includes the lower part of the anterior border
and the anterior part of the base of the lung.
15
The right lung, although shorter by 2.5 cm. than the left, in consequence of
the diaphragm rising higher on the right side to accommodate the liver, is
broader, owing to the inclination of the heart to the left side; its total
capacity is greater and it weighs more than the left lung.
The Root of the Lung (radix pulmonis).A little above the middle of
the mediastinal surface of each lung, and nearer its posterior than its
anterior border, is its root, by which the lung is connected to the heart and
the trachea. The root is formed by the bronchus, the pulmonary artery, the
pulmonary veins, the bronchial arteries and veins, the pulmonary plexuses
of nerves, lymphatic vessels, bronchial lymph glands, and areolar tissue, all
of which are enclosed by a reflection of the pleura. The root of the right lung
lies behind the superior vena cava and part of the right atrium, and below
the azygos vein. That of the left lung passes beneath the aortic arch and in
front of the descending aorta; the phrenic nerve, the pericardiacophrenic
artery and vein, and the anterior pulmonary plexus, lie in front of each, and
the vagus and posterior pulmonary plexus behind each; below each is the
pulmonary ligament.
The chief structures composing the root of each lung are arranged in a
similar manner from before backward on both sides, viz., the upper of the
two pulmonary veins in front; the pulmonary artery in the middle; and the
bronchus, together with the bronchial vessels, behind. From above
16
Divisions of the Bronchi.Just as the lungs differ from each other in the
number of their lobes, so the bronchi differ in their mode of subdivision.
The right bronchus gives off, about 2.5 cm. from the bifurcation of the
trachea, a branch for the superior lobe. This branch arises above the level of
the pulmonary artery, and is therefore named the eparterial bronchus. All
the other divisions of the main stem come off below the pulmonary artery,
and consequently are termed hyparterial bronchi. The first of these is
distributed to the middle lobe, and the main tube then passes downward
and backward into the inferior lobe, giving off in its course a series of large
ventral and small dorsal branches. The ventral and dorsal branches arise
alternately, and are usually eight in numberfour of each kind. The branch
to the middle lobe is regarded as the first of the ventral series.
The left bronchus passes below the level of the pulmonary artery before it
17
divides, and hence all its branches are hyparterial; it may therefore be
looked upon as equivalent to that portion of the right bronchus which lies
on the distal side of its eparterial branch. The first branch of the left
bronchus arises about 5 cm. from the bifurcation of the trachea, and is
distributed to the superior lobe. The main stem then enters the inferior
lobe, where it divides into ventral and dorsal branches similar to those in
the right lung. The branch to the superior lobe of the left lung is regarded as
the first of the ventral series.
The serous coat is the pulmonary pleura it is thin, transparent, and invests
the entire organ as far as the root.
consists of an alveolar duct, the air spaces connected with it and their
bloodvessels, lymphatics and nerves.
Part of a secondary lobule from the depth of a human lung, showing parts
19
The bronchial arteries supply blood for the nutrition of the lung; they are
derived from the thoracic aorta or from the upper aortic intercostal arteries,
and, accompanying the bronchial tubes, are distributed to the bronchial
glands and upon the walls of the larger bronchial tubes and pulmonary
vessels. Those supplying the bronchial tubes form a capillary plexus in the
muscular coat, from which branches are given off to form a second plexus
in the mucous coat; this plexus communicates with small venous trunks
that empty into the pulmonary veins. Others are distributed in the
interlobular areolar tissue, and end partly in the deep, partly in the
superficial, bronchial veins. Lastly, some ramify upon the surface of the
lung, beneath the pleura, where they form a capillary network.
The bronchial vein is formed at the root of the lung, receiving superficial
and deep veins corresponding to branches of the bronchial artery. It does
not, however, receive all the blood supplied by the artery, as some of it
passes into the pulmonary veins. It ends on the right side in the azygos
vein, and on the left side in the highest intercostal or in the accessory
22
hemiazygos vein.
The lung is the organ for gas exchange; it transfers oxygen from the air into
the blood and carbon dioxide (a waste product of the body) from the blood
into the air. To accomplish gas exchange the lung has two components;
airways and alveoli. The airways are branching, tubular passages that allow
air to move in and out of the lungs. The wider segments of the airways are
the trachea and the two bronchi (going to either the right or left lung). The
smaller segments are called bronchioles. At the ends of the bronchioles are
the alveoli, thin-walled sacs. (The airways and alveoli can be conceptualized
as bunches of grapes with the airways analogous to the stems and the
alveoli analogous to the grapes.) Small blood vessels (capillaries) run in the
walls of the alveoli, and it is across the thin walls of the alveoli where gas
exchange between air and blood takes place.
23
The walls of the bronchioles are weak and have a tendency to collapse,
especially while exhaling. Normally, the bronchioles are kept open by the
elasticity of the lung. Elasticity of the lung is supplied by elastic fibers which
surround the airways and line the walls of the alveoli. When lung tissue is
destroyed, as it is in patients with COPD who have emphysema, there is loss
of elasticity and the bronchioles can collapse and obstruct the flow of air.
24
Respiratory Process
Respiratory values
Functional residual capacity (FRC) is the volume of air in the lungs at the
end of a normal expiration. The point at which this occurs (and hence the
FRC value) is determined by a balance between the inward elastic forces of
the lung and the outward forces of the respiratory cage (mostly due to
muscle tone). FRC falls with lying supine, obesity, pregnancy and
anaesthesia, though not with age. The FRC is of particularly importance to
anaesthetists because:
In the absence of respiratory effort, the lung will come to lie at the point of
26
the FRC. To move from this position and generate respiratory movement,
two aspects need to be considered which oppose lung expansion and airflow
and therefore need to be overcome by respiratory muscle activity. These are
the airway resistance and the compliance of the lung and chest wall.
Work of breathing
Diffusion
The alveoli provide an enormous surface area for gas exchange with
pulmonary blood (between 50-100m2) with a thin membrane across which
gases must diffuse. The solubility of oxygen is such that its diffusion across
the normal alveolar-capillary membrane is an efficient and rapid process.
Under resting conditions pulmonary capillary blood is in contact with the
alveolus for about 0.75 second in total and is fully equilibrated with alveolar
oxygen after only about a third of the way along this course. If lung disease
is present which impairs diffusion there is therefore still usually sufficient
time for full equilibration of oxygen when at rest. During exercise, however,
the pulmonary blood flow is quicker, shortening the time available for gas
exchange, and so those with lung disease are unable to oxygenate the
pulmonary blood fully and thus have a limited ability to exercise.
For perfusion, the distribution throughout the lung is largely due to the
effects of gravity. Therefore in the upright position this means that the
perfusion pressure at the base of the lung is equal to the mean pulmonary
artery pressure (15mmHg or 20cmH2O) plus the hydrostatic pressure
between the main pulmonary artery and lung base (approximately
15cmH2O). At the apices the hydrostatic pressure difference is subtracted
from the pulmonary artery pressure with the result that the perfusion
pressure is very low, and may at times even fall below the pressure in the
alveoli leading to vessel compression and intermittent cessation of blood
flow.
29
V/Q mismatch occurs very commonly during anaesthesia because the FRC
falls leading to a change in the position of the lung on the compliance curve.
The apices, therefore, move to the most favourable part of the curve whilst
the bases are located on a less favourable part at the bottom of the curve.
Oxygen Transport
Oxygen carriage
The initial flat part of the curve occurs because the binding of the first
oxygen molecule causes a small structural change to Hb facilitating the
binding of subsequent oxygen molecules. The shape of the curve means that
a fall in PO2 from the normal arterial value will have little effect on the Hb
saturation (and therefore oxygen content) until the steep part of the curve
is reached, normally around 8kPa (60mmHg). Once the PO2 has reached
this level, however, a further decrease in PO2 will result in a dramatic fall in
the Hb saturation.
Causes of hypoxia
Hypoxia indicates the situation where tissues are unable to undergo normal
oxidative processes because of a failure in the supply or utilisation of
oxygen. The causes of hypoxia can be grouped in to 4 categories:
Hypoxic hypoxia
Anemic hypoxia
The oxygen content of arterial blood is almost all bound to Hb. In the
presence of severe anaemia, the oxygen content will therefore fall in
proportion to the reduction in Hb concentration, even though the PO2 is
normal. The normal compensatory mechanism to restore oxygen delivery is
an increase in cardiac output, but when this can no longer be sustained
tissue hypoxia results. Conditions in which Hb is rendered ineffective in
binding oxygen, such as carbon monoxide poisoning, produce a reduction
in oxygen carriage similar to anaemia.
from the blood, but as tissue perfusion worsens this becomes insufficient
and tissue hypoxia develops.
Histotoxic hypoxia
Pathophysiology
Chronic Bronchitis
Emphysema
The exchange of carbon dioxide and oxygen between air and the blood in
the capillaries takes place across the thin walls of the alveoli. Destruction of
the alveolar walls decreases the number of capillaries available for gas
exchange. This adds to the decrease in the ability to exchange gases.
Usually, energy is only required for inhalation to inflate the lungs. The
stretch of the lungs and distension of the chest cavity springs back to rest
during exhalation, a passive process that does not require energy. However,
in emphysema, inefficient breathing occurs because extra effort and energy
has to be expended to empty the lungs of air due to the collapse of the
airways. This essentially doubles the work of breathing, since now energy is
required for both inhalation and exhalation. In addition, because of the
reduced capacity to exchange gases with each breath (due to the collapse of
37
Smoking is responsible for 90% of COPD in the United States. Although not
all cigarette smokers will develop COPD, it is estimated that 15% will.
Smokers with COPD have higher death rates than nonsmokers with COPD.
They also have more frequent respiratory symptoms (coughing, shortness
of breath, etc.) and more deterioration in lung function than non-smokers.
Cigarette smoking damages the lungs in many ways. For example, the
irritating effect of cigarette smoke attracts cells to the lungs that promote
38
Air pollution can cause problems for persons with lung disease, but it is
unclear whether outdoor air pollution contributes to the development of
COPD. However, in the non-industrialized world, the most common cause
of COPD is indoor air pollution. This is usually due to indoor stoves used
for cooking.
Individuals with one normal and one defective AAT gene have AAT levels
that are lower than normal but higher than individuals with two defective
genes. These individuals MAY have an increased risk of developing COPD if
they do not smoke cigarettes; however, their risk of COPD probably is
40
higher than normal if they smoke. Though their Alpha-1 antitrypsin blood
levels may be in the normal range, the function of this enzyme is impaired
to relative to normals.
Symptoms of COPD
Typically, after smoking 20 or more cigarettes a day for more than twenty
years, patients with COPD develop a chronic cough, shortness of breath
(dyspnea) and frequent respiratory infections.
DIAGNOSIS OF COPD
Unfortunately, only about one third of the patients can abstain from
smoking long term. Reasons for difficulty in quitting include nicotine
addiction, stress in the workplace and at home, depression, peer pressure,
and advertising from cigarette companies.
To help those patients with symptoms of withdrawal during the early weeks
of smoking cessation, nicotine chewing gum (Nicorette Gum) and nicotine
skin patches (Transderm Nicotine) are available in the United States. Both
the gum and skin patches can deliver enough nicotine into the blood to
reduce but not totally eliminate withdrawal symptoms. Nicotine
replacement methods in conjunction with intense patient education and
behavioral modification programs have improved the rates at which
individuals quit smoking. Nicotine skin patches are easy to use. They
generally are used for four to six weeks, sometimes with a tapering period
of several additional weeks. The addiction potential of nicotine skin patches
is low.
smoking and reducing the withdrawal symptoms that lead smokers to light
up again and again. This medicine is taken over a 12 week course and can
work in ways that bupropion does not.
Bronchodilators
improve heart failure. Newer technology allows for very light weight tanks
that supply many hours of oxygen therapy. These devices increase the
mobility and hence the quality of life in these COPD patients.
Oxygen requirements can vary in patients with COPD. Some require oxygen
continuously while others only need oxygen with exercise or sleep. These
needs are determined by measurements of oxygen levels either with an
arterial blood gas (ABG) measurement or by oximetry. It is important to
note that not all patients perceive their oxygen requirements correctly.
Thus, some patients with COPD can have severely reduced levels of oxygen
and be unaware of it. These patients may resist using oxygen; however,
many scientific studies have demonstrated that using oxygen appropriately
prolongs the lives of these patients.
Lung volume reduction surgery (LVRS) has received much fanfare in the
lay press. LVRS is a surgical procedure used to treat some patients with
COPD. The premise behind this surgery is that the over-inflated, poorly-
functioning upper parts of the lung compress and impair function of the
better-functioning lung elsewhere. Thus, if the over-inflated portions of
lung are removed surgically, the compressed lung may expand and function
better. In addition, the diaphragm and the chest cavity achieve more
optimal positioning following the surgery, and this improves breathing
further. The best criteria for choosing patients for LVRS are still uncertain.
A national study was completed in 2003. Patients primarily with
emphysema at the top of their lungs, whose exercise tolerance was low even
after pulmonary rehabilitation, seemed to do the best with this procedure.
On average, lung function and exercise capacity among surviving surgical
patients improved significantly following LVRS, but after two years
returned to about the same levels as before the procedure. Patients with
forced expiratory volume in FEVI of less than 20% of predicted and either
diffuse disease on the CAT scan or lower than 20% diffusing capacity or
elevated carbon dioxide levels had higher mortality. The role of LVRS is at
53
As opposed to bronchial asthma, which has been well researched in the last
20 years, COPD has not been fully investigated. There is significant
evidence that COPD is an inflammatory process just as is bronchial asthma,
however, it seems that there are different patterns of lung inflammation in
these patients. The mechanisms of baseline inflammation in COPD and
inflammation during exacerbation of the disease need to be investigated
and better understood. There is minimal or no information on the
molecular mechanisms of inflammation in stable COPD patients. This latter
issue becomes important particularly in the area of treatments. Currently,
there are numerous clinical trials looking to intervene at the various
inflammatory pathways.
invasive procedures than LVRS are being developed to reduce this air
trapping. Investigational devices are being studied that are valve-like and
are placed directly in the airways by bronchoscope. The effectiveness of
these devices is unknown.
General Outlook
Outlook for Patients with Chronic Bronchitis. Chronic bronchitis does not
cause as much lung damage as emphysema, although the airways become
blocked from mucous plugs and narrowing due to inflammation. This poor
ventilation causes reduced levels of oxygen and high carbon dioxide levels.
Nearly half of those with COLD report that daily activities are limited. They
57
Over time, both varieties of COLD cause low oxygen levels ( hypoxia) and
high levels of carbon dioxide ( hypercapnia). In order to boost oxygen
delivery, the body compensates in a number of ways:
More red blood cells are produced to increase the blood's oxygen-
carrying capacity.
Vessels in the lung constrict to force blood and oxygen through the
circulatory system.
Eventually these activities can lead to very serious and even life-threatening
conditions:
risk for acute respiratory failure, which can cause heart rhythm
abnormalities or other life threatening conditions if not treated
immediately.
Low oxygen levels can also impair mental functioning and short-term
memory.
Infections
Any disease that affects the lungs is dangerous for COLD patients.
Pneumonia can cause acute attacks of chronic bronchitis, which in turn
may precipitate acute respiratory failure, which is life threatening for COLD
patients. Viral or bacterial infections in the lungs, seasonal changes, certain
medications, and exposure to irritants in the air may also trigger serious
lung events.
59
HOMOEOPATHIC APPROACH
The heart of the prescription is the analysis of the case which involves,
other that is to say during the process of cure if symptoms which were
according to similimum medicine have been removed, the left over will
form different layer and will at times required different medicine. All these
layers need to be eradicated to come to the cure.
COPD is not a single layer disease; it has large number of layers of pre
disposition with miasmatic block.
1. Hydrogenoid
2. Oxygenoid
3. Carbonitrogenoid
syphilis.
MIASMATIC APPROACH
The word miasm has originated from Greek word which literally means
obnoxious agent but Dr. Hahnemann has used this in much more precise
form and is used in sense of chronic syndrome. His repeated failures of
complete cure in chronic diseases led him to bring forth miasmatic
63
approach.
ACONITE NAP
ANT TART
ARS -ALB
ARS IOD
Slight hacking cough with dry and stopped up nostrils. Pneumonia that
fails to clear up. Cough dry, with little difficult expectoration. Hay fever also
present.
AMBRA GRISEA
BAR CARB
CARB VEG
CHAMOMILLA
CONIUM
coughing.
IPECAC
KALI CARB
Cutting pain in chest; worse lying on right side. Hoarseness and loss of
voice. Dry hard cough about 3 am with stitching pains and dryness of pharynx.
Whole chest is very sensitive. Expectoration scanty and tenacious, but
increasing in morning and after eating; aggravated right lower chest and lying
on painful side.
69
KALI SULPH
SAMBUCUS
SENEGA
ARS ALB
The patient is leaning thin and debilitated with waxy look of the skin.
Very fastidious wants everything neat, clean and in order. Chilly patient. He
has great fear of death. Thinks he is incurable. Mentally restless but physically
too weak to move about. Burning pain relieved by heat except in head. Great
prostration. Complaints return periodically. Desires for acids, coffee, alcohol,
cold drinks. Thirst for small quantities of water at small intervals in acute
states but in chronic state there is no thirst. Asthma comes on or aggravated by
suppressed eruptions, cold things and cold food. All symptoms are aggravated
by midday and midnight and ameliorated by heat.
CALC CARB
IODUM
KALI CARB
72
LYCOPODIUM
The patients are intellectually keen but physically weak. Upper part of
the body is emaciated, lower part semi dropsical. Complaints start on right side
and go to left. Sourness of the discharges. Intolerance of cold drinks; craves
everything warm. Desire for sweet things, warm food and drink. Aversion to
tobacco, bread, coffee. Canine hunger, but few mouthfuls fill up to the throat.
Acidity, wind and bloating of abdomen especially the lower abdomen. Half
open condition of the eyes during sleep. Right foot hot and left cold. All
symptoms < from 4 8 pm, right side, from heat, warm air. > From warm food
and drink (only stomach and throat symptoms); from uncovering the head and
73
MEDORRHINUM
NATRUM SULPH
PHOSPHORUS
SILICEA
Highly chilly patient. Wraps himself with warm clothing even in hot
summer weather. Bad effects of vaccination. Every little injury suppurates.
Want of grit either moral or physical. Very sensitive to all impressions.
Obstinate constipation, when partly expelled recedes back. Constipation before
during and after menses. Desire for cold drinks, cold food, ice cream. Seats of
hands, toes feet axillae very offensive. All symptoms < in new moon and full
moon, cold, during menses, from washing and uncovering. > By warmth,
wrapping up head and in summer.
SULPHUR
THUJA
Fig warts, condylomata and wart like excrescences upon the mucous
membrane and cutaneous surface of the body. It is a left sided drug. Bad effects
of vaccination. Sweat only on the covered parts or all over body excepting the
head especially at night. Vertigo when closing the eyes. Desire for salt, cold
food and drinks. Rheumatism, prostatitis, impotency linked with suppressed
gonorrhoea. All symptoms < at night, at 3 pm and 3 am, from cold,damp air,
cold water, after taking breakfast, fat , coffee, tea, tobacco, touch. > in open air,
warmth, by movement, pressure, rubbing.
PREVENTIVE CARE
77
Don't smoke
If you already smoke, quit before there has been permanent damage
to your lungs
Diet
Exercise
Exercise helps some people with COPD. By strengthening your legs and
arms and improving endurance, you may reduce breathlessness somewhat.
Walking, for example, is a good exercise to build endurance. Talk to your
doctor and/or respiratory therapist about how to build up slowly and safely.
Attending a comprehensive pulmonary rehabilitation is the best way to
learn exercise and safe breathing techniques (see below).
Breathing
Bromelain
Magnesium
N-acetylecysteine (NAC)
A review of scientific studies found that NAC may help dissolve mucus
and improve symptoms associated with chronic bronchitis and
emphysema. Smokers may also benefit from NAC supplementation. Studies
on large groups of people have found that NAC appears to have cancer
prevention properties in people who are at risk for lung cancer (like chronic
smokers who are also at risk for COPD).
research is needed.
Vitamin C
Other
Other supplements that have gained popularity for COPD, but need
further study before comment can be made regarding their value include:
Coenzyme Q10
L-carnitine
82
MASTER CHART
SYNOPSIS OF CASES
1. Mr. Anurag Rai 36/m/h suffers from dyspnoea so much that breath
cant be held long enough to drink, though thirsty, since last night. He
is also complaining of oppression of chest. On the basis of local
symptoms kali nit. 30 were prescribed.
3. Mrs. Jaya Verma 40/f/h suffers from asthma for last 15 years. During
the attack there is difficult shortness of breathing. She has incessant
and violent cough which increases with every breath. Symptoms are
attended with constant nausea. On the basis of local symptom Ipecac
30 was prescribed.
7. Mr. Sumit Singh 55/m/h suffers from dyspnoea for last 2 days. The
attacks come after midnight specially at 2 am. During the attack he
becomes excessively restless and anxious, canto the writ petition.
Even lie down for the fear of suffocation. Attacks are ameliorated by
bending forward. He is thirsty during the attack but can drink only a
small quantity of water. On the therapeutic basis Arsenic album 30
was prescribed.
91
8. Mr. Navneet 12/m/h suffers from asthma for last 2 years. The
symptoms aggravated on change of whether especially in damp
weather. There is great rattling in chest. After each attack he suffers
from diarrhea. The attacks generally come on about 4 am with
greenish and copious expectoration. He has burning thirst for cold
waters. Symptoms are ameiliorated in dry weather. On the
constitutional basis Natrum Sulp 1m was prescribed.
9. Mrs. Archana 26/f/h has asthma for the last 10 years. The attacks are
attended with great burning in chest. Dyspnoea occurs in the middle
of night which is relieved by sitting up. She is a hot patient and the
symptoms sggravate in summers. She has strong desire for sweets
and is very thirsty. She has excessive offensive perspiration. On the
constitutional basis Sulphur 1m was prescribed.
10. Mr. Alok Shukla 40/m/h suffers from dyspnoea and oppression of
chest. Asthmatic attacks are relieved by lying on stomach and are
aggravated while thinking of his complaints and from sunrise to
sunset. He has inordinate craving for liquor, salt, sweet and acid.
There is great burning in hands and feet. During the attacks there is a
collapsed state and he wants to be fanned all the time. On the
constitutional basis Medorrhinum 1m was prescribed.
92
AUXILIARY TREATMENT
Herbs
Garlic (Allium sativum) may help fight infection and has antioxidant
properties (see earlier discussion under Diet in section entitled Lifestyle as
well as the section on Nutrition and Dietary Supplements).
Acupuncture
Mind/Body Medicine
Yoga and tai chi are practices that use deep breathing techniques and
meditation; these practices may be helpful if you have COPD. Talk to your
doctor about safety for you.
Music therapy can help relieve anxiety associated with COPD and,
possibly, shortness of breath.
two times per day) may help reduce anxiety and shortness of breath
associatedwithCOPD
97
CASE FORMATION
PATIENT NAME
AGE/SEX..
OCCUPATION.
RELIGION.
MARITAL STATUS..
ADDRESS
.
98
DIAGNOSIS
CLINICAL HISTORY
CHIEF COMPLAINTS
PAST ILLNESS
PERSONAL HISTORY
FAMILY HISTORY
FATHER
99
MOTHER
BROTHER
SISTER
W\H
OTHERS
SOCIAL STATUS
DITETIC HABITS
PHYSICAL EXAMINATION
GENERAL EXAMINATION
APPEARANCE BUILD
100
PULSE TEETH/GUMS
B.P. TONSIL
RESPIRATION EAR
TEMPERATURE SKIN
LOCAL EXAMINATION
SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM
C.V.S.
C.N.S.
101
GENERAL SYMPTOMS
APP- (D/A)
THIRST- SLEEP
STOOL URINE
MENSTRUATION
WILL
LOVE
HATE
102
FEAR
ANGER
TEMPER.
UNDERSTANDING
INTELLECT
THOUGHT
ILLUSION
HALLUCINATION
DELUSIONS
MEMORY
103
INVESTIGATION
ROUTINE INVESTIGATION
SPECIAL INVESTIGATION
CONSULTATION OF REPERTORY
FINAL PRESCRIPTION
104
PROGRESS REPORT
GRAPH
BIBLIOGRAPHY
3. Robbins pathology
6. Guytons physiology