Lungengruppe Anhang

In pleuritis with exudation, Apis is one of the best remedies to bring about absorption of the fluid. Apis and Sulphur will cure the majority of these cases.

[W. Köster]

Eine »Ehrenrunde« hatten die Teilchen gedreht, als das Herz das Blut aus seiner rechten Hälfte durch die Lunge hindurch in seine andere Hälfte flutete. Es ist schon erstaunlich, dass die Lunge eine ganze Herzhälfte für sich beansprucht. Alle anderen Organe sollen sich mit der zweiten, wenn auch etwas kräftigeren Hälfte des Herzens begnügen. Wie begründet die Lunge ihren besonderen Anspruch?

Zunächst sieht es fast so aus, als sei die Lunge ein Teil des Herzens, so eng ist sie beiden Herzkammern zwischengeschaltet. Sie ist aber weit größer. Sie füllt fast den gesamten Raum, den ihr das Herz im Brustkorb übrig lässt, ob dieser nun einatmend geweitet ist oder nicht. Die Lunge geht konform mit den Bewegungen des Brustkorbes. Sie reagiert auf sie, indem sie ihnen passiv folgt. Dadurch atmet sie. Ohne Brustkorb kann sie nicht atmen. Sie zieht sich zusammen, schnurrt regelrecht zusammen.

Keine Bewegung geht mehr von ihr aus. Im lebendigen Brustkorb jedoch macht sie pausenlos mit. In ihrem passiven Reagieren, also dem auf einen anderen Zurückwirken, wirkt sie fast so unermüdlich wie das Herz.

In diesem bewegten Tun ist auch sie rhythmisch. Sie saugt Luft ein und bläst sie wieder aus, saugt sie wieder ein und bläst sie erneut aus. Wie das Herz besteht sie aus zwei Teilen. Doch sind die Lungenflügel viel strikter geteilt als die Herzhälften. Sie sind getrennte Organe, nur verbunden über die Luftröhre, in die beide über ihre Bronchien Luft abgeben und aufnehmen. Von einer äußerlichen Einheit wie beim Herzen kann hier also keineswegs die Rede sein. Die Lungenflügel scheinen vielmehr wie zwei Teile einer Styroporpackung die Kraftmaschine Herz rechts und links einzubetten. Dieser Vergleich passt auch insofern gut, als die Lunge aus zahllosen kleinen luftgefüllten Bläschen besteht, wie eine Bienenwabe, doch ganz elastisch. Zwischen beiden dünnhäutigen Bienenwabeneinheiten arbeitet kräftig das pulsierende Herz wie eine fleißige Biene.

Es pumpt durch beide Lungenflügel das gesamte Blut aus seiner rechten Herzkammer.

Während die Lungenflügel der Bewegung der Rippen folgen, füllen sie sich einatmend mit Luft. Aus dieser Luft dringt Sauerstoff in das durch viele Häutchen der Lunge fließende Blut. Im Gegenzug wandert Kohlendioxid aus dem Blut in die Luft der Lungen. Es wird beim Ausatmen von diesen wieder in die Umgebung hinausgeblasen.

In diesem Rhythmus ist auch die Lunge ein typisches Organ des Fließens.

Nichts bleibt ihr, alles durchfließt sie. Sie gibt bereitwillig ab und nimmt auf, ohne dass sie wie der Dünndarm oder die Leber etwas aktiv trennen oder wie der Magen etwas verdauen würde.

Die Lunge reagiert passiv dennoch ist der Druck, mit dem das Herz der Lunge das Blut zuführt, an ihrem Ende so gesunken, dass die linke Herzkammer erneut einen hohen Druck aufbauen muss. Er muss zur Durchflutung des restlichen Körpers ausreichen. Die Aktivität der r. Herzkammer wird also von den beiden Lungenflügeln aufgebraucht, und das ist ein ganz schöner Batzen Energie.

Wozu mag das Herz bei der Lunge diesen Aufwand treiben? Was bedeutet die Lunge?

Unsere bisherige Medizin ist ihr jedenfalls in mancherlei Hinsicht nicht gewachsen. Leidet ein Kranker nicht nur an einer banalen Bronchitis, die mit Ruhe und Schonung in

der Regel auch ab heilen dürfte, sondern kehrt die Bronchitis immer wieder, schleicht sich gar am Ende ein Dauerzustand ein oder entwickelt der Kranke schließlich Asthma, so müssen diese Krankheiten ebenso als unheilbar gelten wie der Lungenkrebs.

Wer die Problematik aus der täglichen Praxis kennt, die immer wiederkehrenden Asthmaanfälle oder die zunehmend chronischen Bronchitiden, die auch schon bei Kindern nicht heilbar sein können, der will wissen, was die Lunge bedeuten mag. Lassen sich nicht bei der Lunge genauso wie bei den anderen Organen sinnvolle, überzeugende Ideen finden, die uns weiterhelfen?

Die Lunge reagiert passiv Sie verbraucht durch den hohen passiven Widerstand, den sie dem Blut des Herzens entgegensetzt, viel Energie.

Das findet sich auch in der Seele wieder. Der Asthmakranke setzt seiner eigenen Krankheit oft einen druckvollen passiven Widerstand entgegen. Er ruft seinen Arzt bei einem Anfall erst fünf Minuten vor zwölf zu Hilfe, auch wenn er die Gefahren eines späten Eingreifens kennt und schon erfahren hat. Diesen Widerstand, den er durch passives Hinnehmen, durch Ignorieren, seinem Krankheitszustand entgegensetzt, scheint er im Alltag typischerweise durch eine widerstandslose Aktivität auszugleichen. Da geht er eher mit dem Kopf durch die Wand. Wir treffen hier auf die Krankenschwester, die sich ohne eigenen inneren Widerstand hemmungslos aufopfert für ihre Kranken.

Sie legt Nachtdienste und noch einmal Nachtdienste ein. Der Angestellte renoviert nach getaner Arbeit bis in die Nacht bedingungslos sein Eigenheim.

Er spürt seine Erschöpfung nicht. Er nimmt sie nicht wahr, weil er allen zeigen will, wie perfekt er das kann. Fragt man ihn, warum er so über alle Maßen aktiv ist, scheint er überrascht.

[Farokh Master]

Acute Pulmonary Congestion

Pulmonary congestion is the collection of excessive secretion in the lungs where a person is unable to expectorate and clinically he is breathless, loose rattling cough, high reparatory rate. Occasionally he can also become cyanotic. You may also find this type of problem with the patients having asthmatic bronchitis, bronchial asthma, broncho pneumonia or pneumonitis.

I had some good success with treating the above conditions and I will be discussing few rare remedies with the same.

My first remedy is Tub-a. This medicine is prepared a liver from a bird having tuberculosis that has been potentized. The chief indication to identify Tub-a. are the following:

excessive panting respiration or rattling but no expectoration. DD.: Lob. Ant-t. Dig. Ip. Seneg.

There can be extremely exhausting cough. Person coughs constantly till he gets completely exhausted (Ars. Caust. Stann-met.).

When you examine the chest you will see severe degree of rales or ronchi and this type picture is in: Tub-m. Morgan pure.

In Tub-a. I usually look for a past history or family history of tuberculosis or at least there has to be a history of primary complex in childhood.

How do I identify the person in my clinic of Tub-a? They are extremely restless, which I repeatedly confirmed. They usually have problems with the ear either recurrent otitis media or catarrh of the eustachian tube. The nose is usually obstructed; they may have a polyp inside the nose.

There will be perspiration of the palms and they desire fruits. May or may not require fan due to acute pulmonary congestion but the characteristic condition is the rattling respiration without much expectoration.

Now I would be discussing with you another remedy with the similar conditions:

Lob.: This remedy I have used in my practice so often and finally I was able to confirm some symptoms like excessive asthmatic breathing. The type of asthmatic breathing

is always characterised by some stomach disorder or some type of stomach complaints as in Nux-v. Bry. Ip. Carb-v. Most of the time this congestion comes after taking a

cold like after taking a attack of viral or allergic rhinitis or after exposed to cold air or after entering in the warm room after cold air. These are causative factors.

The more the person eats anything warm the more breathless he becomes.

Along with breathless you will find two things which are very characteristic, the breathlessness < in cold air or entering in the air conditioning room or just below the fan

and breathlessness + cough. More the breathless more the cough like Cupr-met. Dros. Phos. Ant-t.

If the person walks the breathlessness is much better but at the same time exertion makes the breathlessness worse.

So it is very unique to remember that any kind of exertion will aggravate and at the same time if the person walks very rapidly or in normal speed he feels much better.

This is exactly like Dros. what you see in your practice.

Sometimes the person can gasp or person can hyperventilate, if he lies down the breathlessness is worse but if he walks he feels much better in his breathlessness.

The type of cough that you usually see is accompanied by eructations or some gastric complaints.

So you have to keep on looking for this concomitant. Also the cough is purely the gastric in origin like Nux-v. or Ip. Here also you may find that the cough comes in people who have strong tubercular diathesis or tubercular miasm. This brings Lobelia close to Ars-i. Cor-r. Dros. Kali-c. Nit-ac.

Now how do you identify a person of Lobelia in general? Lobelia people have following mental attributes like they are fastidious and they have got a strong fear of any respiratory disease. They feel one day they are going to die because of the respiratory disease this makes it close to another remedy Lac-c. which has got a same fear.

They are, they are little serious, you do not know see them very extroverted, they may have a gastric or bilious headache which keeps on coming repeatedly.

Or may come across in Lob. that the hearing has been affected due to chronic otitis media or after suppressed eczema. The paranasal sinuses are tender to touch, there can

be a bitter taste in the mouth, there will be a sensation of lump in the throat and the eructation are acrid, burning and sour with lot of heartburn.

There can be a severe nausea with perspiration. Nausea usually comes in the evening or night + excessive perspiration. Occasionally you may have vomiting while coughing.

In the chest you may see the picture of pneumonia or bronchial asthma or bronchitis. The person is extremely chilly, sensitive to cold air, cold bathing.

They love sweets and the warm food aggravates the person. Another remedy which I have found extremely useful in my practice is Senega.

Senega is a remedy which is prepared from a dry root of polygala senega. I have been very fortunate to use this remedy in cases of pneumonia in bronchitis.

The characteristic is the person is loaded by generalized rales of the chest. Usually I have seen Senega working very well when the stage of Bryonia is over in chest congestion. The Senega person looks little flushed, it is not very bright red flushed like Bell. or Ferr-met. They have very hot sweaty skin, the face will look little bloated but most important is the complaint of severe oppression of the chest, very often they say as if there is lot of weight on my chest which is sitting on the chest and I just cannot breath because of the weight or a heavy sensation on my chest. The impression that the patient will give you that they are tired, exhausted and prostrated and beneath the prostration there is a very strong anxiety.

Senega cough is fully troublesome. It is practically constant, violent and the concomitant is that there is a strong sensitivity of the chest so when you percuss the chest of the Senega patient or when you touch the chest of the Senega patient or if you put your stethoscope on the chest of the Senega patient you will see a lot of hyperesthesia and

this hyperesthesia is more on side of the lung that is affected.

Everytime when they cough they become quite hot, face becomes red, head covers with hot sweats. In general the person feels too hot and they want lot of fresh air and

the moment the fresh air comes in contact with their body they start coughing more. I have also seen in Senega that with the cough there is an element of hoarseness.

There is usually right sided affection of the lungs. The characteristic modality in the respiratory problems is lying; with most respiratory problems they cannot lie down. The moment they lie down they feel lot of discomfort like Apis, Lach. Merc. and Tabacum.

The cough < in open air, it is loose, hacking and irritating type of cough, lying on any side < the cough. Entering a warm room also aggravates the cough so they open the window to have a fresh air but when the fresh air comes in the cough becomes much worse.

The expectoration can be extremely difficult but whenever the person brings out the expectoration it is sticky and ropy but mostly the expectoration comes out to a certain extent and then slips back in the respiratory system like Kali-s. Con. Caust.

[Farokh Master]

Random thoughts on pleural effusion and homoeopathy

Pleural effusion is the accumulation of the fluid in the pleural space as a result of excessive transudation or exudation from the pleural surfaces.

Pleural cavities normally contain less than 20 ml of fluid. Some of the common causes of the pleural effusion that I have successfully treated with homoeopathy is left ventricular failure, cirrhosis

of liver, tuberculosis and malignancy.

Another type of effusion that I have successfully treated with homoeopathy is the effusion due to empyemaand septicemia. The common symptoms that the patients usually presents

to us is breathlessness; it is directly proportional to the amount of collection of the fluid in the pleural cavity. You may also have dry cough, loss of weight, mild pain and symptoms of toxemia like

malaise, fever and low appetite. You require at least 500 ml of fluid to produce physical signs.

The characteristic clinical finding in the case of a pleural effusion will be definitely diminished mobility of the chest on the side that is affected or buldging of intercostal spaces on the side that is affected, and you will also see absolute dull note on the percussion and on auscultation you will hear diminished or absent breath sounds and crackles may be heard at the base of the opposite lung due to congestion.

Regarding homoeopathy I would like to begin with a very important remedy that I have used in my practice it is known as Eriodictyon californicum.

Dr. G.M. Pease, of San Francisco was the authority who introduced this remedy in homoeopathy. I remember a case of 60 yrs old female who came to me with excessive breathlessness + cough and profuse expectoration, whenever she expectorated the breathlessness was much better. She had a cough < on talking; the expectoration was thick, white with mucus. She had a past history of Tb.

she had a low appetite, very weak pulse, physically she was absolutely fragile and was constantly moaning during the sleep. she was on bronchodilators, and was given full course of antibiotics but it did not suit her, it rather produced diarrhea whenever she took antibiotics or it produced indigestion.

The main indications of prescription were breathlessness > expectoration, thick mucus as expectoration, cough < talking, severe loss of weight, past history of tuberculosis, Erio-c. was prescribed in 200 potency, I asked the patient to continue this medicine for 7 days and see me after a period of 7 days. The x-ray chest of the lady showed a massive effusion on the right side, I asked the lady to continue this medicine for 20 more days and at the end of 3 weeks we saw a complete resolution of the fluid under

the action of Erio-c.

Subsequently I have used this remedy in various other conditions in the respiratory system. The most common symptom is the constant irritation in the larynx where a person may get tickling, itching in the larynx (exposed to cold air) and then in Farrington’s “Lesser writings” he gives a beautiful case of catarrhal asthma with severe oppression of breathing, the person feels > expectoration.

Farrington also mentioned about the usefulness of this remedy in Tb. I have never used this remedy much in the field of tuberculosis.

Farrington also mentioned about the usefulness of this remedy for the occipital headaches and complaints around the occiput where a person feels pressure and the pressure

is such that it presses the occipital area and it tries to go outwards, it is very intense, dull and a very heavy feeling in the region of the occiput.

Yellowish greenish discharge from the nose is the one symptom which I have confirmed repeatedly in my practice and the nausea on taking the least food, with prolapsed of the anus in old people.

Another case a 65 yrs old man suffering from cancer of the bronchus, who presented to us with excessive shortness of breath, coughing, weakness, diarrhea. He was lean,

thin, emaciated, and weak. He was working as a labourer for many years and he worked quite hard in his life, he lived most of his life in a very bad phase of poverty yet

he got his children educated to the best of his ability.

He was extremely chilly person, nothing much was available from the history but what I saw was the swelling around his face, he was gasping for the breath, as soon as he

lies down the breathlessness becomes worse, he will start coughing and he will bring out frothy and profuse expectoration. The effusion was more l. but there was also mild effusion on r. side. What I saw in this case was two important modalities - < lying down and profuse expectoration.

The remedy I prescribed to this person was Ant-ars. 12C, this remedy was given in a plussing method every 4 hourly, and I asked the person to see me after 4 day.

After 4 days patient felt much better in his breathlessness so I allowed the patient to take every 6 hourly for next 10 days, subsequently I increased the potency to 30 and

200 and continued the same medicine for 2 months later when I repeated the X-ray of the patient I saw there was a more than 80% reduction in the fluid after Ant-ars.

This remedy has been used extensively in cases of pneumonia, pleurisy, pleural effusion, bronchial asthma, emphysema, COPD.

Time and again I have verified the modalities and the symptoms of the remedy.

The first important clinching diagnosis regarding this remedy is excessive dyspnoea irrespective of the modality just think of Ant-ars.

If this dyspnoea is due to acardiac cause, this is another indication of Ant-ars.

The third indication of Ant-ars. which I have learned after reading Hale’s materia medica is cardiac dyspnoea with cough. Whenever you see cardiac dyspnoea, or dyspnoea that arises from heart disease, associated with severe cough, and reading the same author what I learned was the great weakness of the heart (ejection-fraction of the heart is reduced, Ant-ars. is extremely useful.

It is usually a left sided remedy mentioned by Dr. Haarer who was one of the pioneers in introducing this remedy in homoeopathy.

Also I have used this remedy even for the right sided pleural effusion with very successful results. Another indication where I have used this remedy is in pediatric cases where there is lot of congestion in the lungs like Kali-s. or Tub-a. Sulph. and Merc-s. two remedies that frequently follow Ant-ars.

Even though materia medica mentions that it is useful remedy for the upper lobe of left lung but I have seen in my practice that it acts almost on any part of the left lung

or the right lung. Breathlessness while eating, cannot complete the food, cannot complete the meal is one of the symptoms which has been highlighted by Herring and

Allen both in their materia medica but in my practice I have found < lying down and breathlessness as the important symptom of the Ant-a.

[Navin Pawaskar]

Lysis = allmähliches Abklingen eines Krankheitsgeschehens versus Crisis

Authors - Drs. M Vamsi Krishna Reddy, B Manasa and Navin Pawaskar discuss the management of pneumonia including assessment of stage of development, miasm, characteristic symptoms, patient susceptibility and more.

Reprinted with permission from the Indian Journal of Applied Homoeopathy where it first appeared. https://www.jimshomeocollege.com/ijah-publications/

Introduction: “We are always hearing that we homoeopaths are symptom hunters. We do nothing of that kind”. Successful homoeopathic prescribing depends on how much one pays attention to clinical work. The only successful homoeopathic prescribers are most observant clinicians”- Dr. Douglas Borland.

Pneumonia was regarded by William Osler in the 19th century as “the captain of the men of death”. In spite of antibiotics in developing countries, and among the very old,

he very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus

been called “the old man’s friend”.

Definition: By definition pneumonia is inflammation of the distal lung parenchyma involving terminal airways, alveolar spaces, and interstitial lung tissue. Pneumonia causes accumulation of inflammatory cells and secretions in the alveolar spaces of lung, caused by an infection. Pneumonia is frequently encountered in community practice as well

as in hospital based practice.

Epidemiology: Pneumonia affects approximately 450 million people globally (7% of the population) and results in about 4 million deaths per year. Incidence of community-acquired pneumonia is 5-11 per 1000 adults. Of these, 1-3 per 1000 will require hospitalization, and mortality in those hospitalized is up to 14%.

Age & comorbidity:

Pneumonia caused by Chlamydia Trachomatis & RSV is seen in infants less than 6 months of age.

Haemophilus Influenza pneumonias are seen in 6 months - 5 yrs of age

Morbus Pneumoniae is seen in young adults, and those caused by M. Catarrhali seen in elderly with chronic lung disease.

Pneumonia caused by Staphylococci is seen in any age, and usually is hospital acquired in debilitated patients. Staphylococci is the commonest organism responsible for dissemination through the haematogenous route and causes rapid progress of Pneumonia.

Conventional treatment: The first thing to decide is suitability of treating a particular patient at home, at a hospital or in an intensive care unit, depending on the various risk factors for pneumonia. In conventional treatment identification of the organism and the determination of its antibiotic sensitivity are the keystones to appropriate therapy. Conventional treatment for pneumonia depends on the causative agent and the condition of the patient. For bacterial pneumonia, the physician will likely prescribe antibiotics unlike viral pneumonia which typically calls for treatment with plenty of fluids and rest, to prevent the pneumonia from progressing. Severe pneumonia treatment is with intravenous medications such as antibiotics, and with supplemental oxygen and placement on a mechanical ventilator to maintain lung function.

Classification of Pneumonia: It is important to understand various ways in which pneumonia is classified. Understanding of each component contributes towards complete diagnosis of pneumonia in a given patient. For example,community acquired lobar pneumonia caused to due streptococcus or Right lower lobe pneumonia caused due to aspiration. Each of these factors tells us about the characteristic of the pneumonia which helps in treatment and prognostication.

Anatomical:

Lobar: Parenchyma involved confined to lobe.

Bronchopneumonia: Parenchyma + Bronchi involved.

Interstitial: Confined to Interstitial Space.

Aetiological:

Bacteria. Viral.

Protozoal. Rickettsia.

Multiple organisms (Aspirated pneumonia) Non-microorganism.

Post-operative & hypostatic pneumonia. Allergic pneumonia.

Nature of host reaction:

Suppurative. Fibrinous.

Source of organism:

Community Acquired Streptococcus Pneumonias. Mycoplasma Pneumonias. Haemophilus Influenza. Influenza virus. RSV.

Hospital Acquired Staphylococcus Aureus. Enteric aerobic Gram negative bacilli.

HIV - Infection Associated. Pneumocystis Carini. M. Tuberculosis.

Aspirated Pneumonia. Multi Organism

Non-Micro-organism c hemical Lupoid. Drugs. Oil. Anticancer radiation.

In-order to understand pneumonia and its manifestations from a homeopathic perspective, it is important to understand the anatomy (structural architecture) physiology (functions of lung tissues and ventilation as a process) and manifestations of altered anatomy and physiology in terms of signs and symptoms (form of illness in an individual).

Understanding the Structure of the Lung

The respiratory bronchioles, alveolar ducts, alveolar sacs, and the alveoli constitute the respiratory zone. The respiratory bronchioles, usually up to 3 in order, give rise to up

to 9 generations of alveolar ducts. The walls of the respiratory bronchioles contain a little smooth muscle that is also present around the opening of the alveolar ducts.

The alveoli are the actual gas exchange areas and are present as small outpouchings on the respiratory bronchioles and the alveolar ducts and aggregate to form alveolar sacs

at the terminal ends of the alveolar ducts.

Function of Lung & its tissues

Ventilation: The respiratory drive is generated from the medullary centres and transmitted to the diaphragm and the intercostal muscles, the former being responsible for almost 80% of the ventilation. The descent of the diaphragm and expansion of the chest wall create a negative pleural pressure that lowers the alveolar pressure below the atmospheric, thus creating a pressure gradient for air to flow into the lungs. Expiration is a passive process. The upper zones receive more ventilation and the lower zones receive more perfusion. Airway resistance is the combination of mechanical factors that cause impediment to the flow of air from nose to the alveoli and back. Due to a tremendous increase in total cross-sectional area, as the bronchial tree divides distally, the resistance is greatest in the larger airways and diminishes distally. Compliance is the property of the lungs to expand in response to an applied change in pressure. Compliance is highest around the resting end expiratory position and reduces at very high and very low lung volumes. Low compliance indicates a stiff lung.

Gas Exchange: At rest, an adult person utilises 250 ml of oxygen per minute and exhales about 200 mL of carbon dioxide. The diffusion into the blood depends on the pressure gradient across the alveolo-capillary membrane and the surface available for gas exchange, as well as the chemical combination rate with haemoglobin, and inversely varies with the length of the passage and the thickness of the membrane. This ability of the lungs to transfer oxygen is called the diffusion capacity.

Gas Transport: Oxygen is transported in blood largely bound to the haemolytische portion of haemoglobin and to a much smaller extent dissolved in the blood, 0.0031 ml per mm PaO2. The oxygen content of arterial blood (CaO2) is the sum of the bound and dissolved oxygen. Each gram of haemoglobin can carry 1.34 ml O2 when fully saturated.

The actual delivery of oxygen to tissues is also dependent on the local blood flow that in turn depends on the cardiac output and the local regulation of blood flow in the particular tissue.

Pathology & Pathogenesis: Alveolar Macrophages process & present microbial antigens to the lymphocytes which secrete cytokines like TNF, IL -1. Cytokines modulate the immune process in T & B lymphocytes and facilitate the generation of an inflammatory responses and Cytokines recruit immunologic factors from plasma & further activate alveolar macrophage. Inflammatory exudate is responsible for local signs of pulmonary consolidation and systemic manifestation of pneumonia like fever, chill, myalgia’s & malaise.

Clinico-Pathological Correlations: The key element in clinic pathological correlation is the understanding of time dimension vis-à-vis evolution of illness. Clinico-pathological correlation helps understand the, pace & stage of disease, extent of infection, immunity of host and hence the susceptibility of the individual from homoeopathic perspective. Borland’s homoeopathic strategies for management of pneumonia are based on clinic pathological understanding of the patients. Different homoeopathic remedies get indicated based on individualistic features in succeeding stages of pneumonia e.g Aconite->Bryonia->Chelidonium-> Phosphorus->Kali Carb->Antimum tart etc.

STAGE OF CONGESTION: Lasts for about 24 hrs and is characterized by vascular engorgement, Intra-alveolar fluid with Neutrophil, presence of numerous bacteria

and grossly involved lobe will be heavy, boggy, red & sub-crepitant and clinically crepts are heard.

STAGE OF RED HEPATIZATION: Increased Neutrophils & fibrin fill the alveolar spaces and massive exudation obscures pulmonary architecture. Extravasations of

red cells causes the coloration seen on gross examination and White cells contain engulfed bacteria. There will be fibrinous or fibro-suppurative pleuritis. On Gross

examination lobe appears - red, firm, & airless with a liver-like consistency, hence term HEPATIZATION. Clinicall, dullness, bronchial breath sound is noted.

STAGE OF GRAY HEPATIZATION: Continuous accumulation of fibrin & progressive disintegration of inflammatory white cells & red cells. Fibrino-suppurative

exudate give gross appearance of GRAYISH-BROWN, DRY surface. When bacterial infection extends in to the pleural cavity, the intra-pleural Fibrino-suppurative

reaction is produced called EMPYEMA.

STAGE OF RESOLUTION: Consolidated exudate within the alveolar spaces undergoes progressive enzyme digestion to produce granular, semifluid debris that is either:

reabsorbed, ingested by macrophages, or coughed up.

In the above favourable condition, lung parenchyma is restored to its normal state. Pleura reaction also similarly resolves, but more often it undergoes organization, leaving fibrinous thickening or permanent adhesions. Clinically, crepts are noted.

ATYPICAL PNEUMONIA: An acute febrile respiratory disease characterized by patchy inflammatory changes in the lung, largely confined to alveolar septa & pulmonary interstitium. The term ‘ATYPICAL’ means lack of alveolar exudate. Caused by M. Pneumoniae and common viruses are Influenza virus type A & B, RSV, Adenovirus. Clinical presentation starts as A URTI - Common cold. Gradually extension in LRTI

Pathologyofatypicalpneumonia: Patchy or whole lobes bilaterally or unilaterally lungs are involved and there is no obvious consolidation .Pleura is smooth, & Pleuritic or Pleural effusion are infrequent. In many patient there are intra-alveolar proteinaceous material, a cellular exudate, & a pink hyaline membranes lining the alveolar walls, similar to those seen in a hyaline membrane disease of infants. These change reflect similarly to that seen diffusely in the adult respiratory distress syndrome.

Risk Factors:

Factors affecting resistance in general;

Chronic Disease, Immunologic Deficiency, being treated with immunosuppressive agents, Leukopenia, Unusually virulent infection.

Factors affecting clearing mechanisms:

Ultimately leading to aspiration of Gastric Content e.g Loss or Suppression of Cough Reflex, Coma, Anaesthesia, Neuromuscular Disorders.Chest Pain.

Injury to muco-ciliary apparatus:

Impairment of Ciliary function, destruction of ciliated epithelium, SCigarmoking, inhalation of hot or corrosive gases, genetic Disturbances like Immotile Cilia Syndrome.

Interference with the Phagocytic / Bactericidal action of alveolar Macrophage:Alcohol, Tobacco Smoke, .Anoxi

Pulmonary Congestion &Oedema.

Congestive cardiac Failure

Accumulation of Secretion:

Cystic Fibrosis, Bronchial Obstruction.

Clinical manifestations: The diagnosis of pneumonia is to be considered in any patient who has newly acquired respiratory symptoms (cough, sputum production, +/o. dyspnoea), especially if accompanied by fever and auscultatory findings of abnormal breath sounds and crackles.

The major symptoms of community acquired acute bacterial pneumonia are abrupt onset of high fever, shaking chills, and cough producing mucopurulent sputum; occasional patients may have haemoptysis. When pleuritis is present it is accompanied by pleuritic pain and pleural friction rub. The whole lobe is radiopaque in lobar pneumonia,

whereas there are focal opacities in bronchopneumonia.

Symptoms Fever, rigors, malaise, anorexia, dyspnoea, cough, purulent sputum (classically ‘rusty’ with pneumococcus), haemoptysis, and pleuritic chest pain.

Signs High grade temperature, cyanosis, herpes labialis (pneumococcus), confusion, tachypnoea, tachycardia, hypotension, signs of consolidation (diminished expansion,

dull percussion note, increased tactile vocal fremitus/vocal resonance, bronchial breathing), and a pleural rub.

Types (Anatomical)

Bronchopneumonia Lobar Pneumonia

Anatomy

When the process is restricted to alveoli contiguous to BronchiPatchy Consolidation of the lung tissue Extension of preexisting bronchitis or bronchiolitis

Involvement of large portion of a lobe or of an entire lobe

Age

Common age infancy Uncommon in infancy & in late life

Organisms

Common agents: Staphylococci, Streptococci, Pneumococci Common Agents: pneumococci, Streptococcus pneumoniae

Pathology

Consolidated area of acute suppurative inflammation Patchy Consolidation of lung through one lobe more often multi lobar & frequent bilateral & Base because of tendency

of secretions to gravitate in to lower lobes Wide spread fibrino-suppurative consolidation of large area even entire lobe 4 stages of inflammatory response

1. Congestion 2. Red Hepatization 3. Grey Hepatization 4. Resolution

Investigations:

Chest X Ray PA View.

Oxygen saturation and arterial blood gases if SaO2 <92% or severe pneumonia.

CBC, U&E, LFT, CRP, atypical serology.

Urine pneumococcal (and legionella) antigen.

Viral throat swabs if appropriate.

Blood cultures if pyrexial.

Pleural fluid may be aspirated for culture.

Bronchoscopy and broncho-alveolar lavage if the patient is immunocompromised or on ICU.

Diagnosis:

CXR:

i) Presence & Location of pulmonary infiltrate.

ii) Assess extent of the pulmonary infection.

iii) Detect pleural involvement, pulmonary cavitations or hilar lymphadenopathy.

iv) Gauge response to Rx.

Sputum examination.

CBC & ESR.

Complication of Pneumonia:

1. Lung abscesses

Spread to the pleural cavities empyema.

Spread to the pericardial cavity suppurative pericarditis.

Development of bacteraemia with metastasis abscess formation in other organs.

Pleural effusion, respiratory failure, septicaemia, myocarditis, cholestasis jaundice, acute kidney injury.

START HERE HOMOEOPATHIC MANAGEMENT

“Don’t get: panicky, give too low a potency, repeat too often, paralyze your patient’s heart with digitalis or ease his pains with morphine or try to replace simillimum with

a tank of oxygen -they won’t work”- Dr A & D T Pulford quotes in his book Homoeopathic Leaders in Pneumonia, highlighting the power of simillimum in management

of pneumonia.

Management of Pneumonia depends upon individualization based on; assessment of clinical stage of disease, symptomatology, level of Susceptibility & Miasm of an individual patient. In a nut shell, selecting a simillimum after constructing the totality of symptoms, based on symptoms of a disease and symptoms of an individual as whole.

[Borland]

Stages of pneumonia and classifies probable indicated remedies according to phases and stage of disease.

Group I incipient pneumonia: Acon. Bell. Ferr-p.

Group II frank pneumonia, Bry. Chel. Phos.

Group III (Bronchopneumonia): Nat-s Puls. Lob. Seneg.

Group III complicated pneumonia (mixed infection, aspiration), Lach. Rhus-t. Merc. Hep. Pyrog.

Group IV late pneumonia. Each of these groupings is based on the stage of disease and state of susceptibility. Carb-v. Ant-t. Kali-c. Lyc. Ars. Sulph.

Assessment of susceptibility depends upon state of pathology, clinical pace of development of disease, characteristic symptoms of patient and the underlying Miasm.

Thus, symptoms related to Structure, Function & Form point us to select a suitable drug for the patient. Understanding of susceptibility andmiasm guides in the therapeutic approach; an acute or a deep acting chronic remedy, way of repetition of dose and level of potency.

“The whole of your success in homoeopathic prescribing in pneumonia depends on your power of recognizing which symptoms are common to every case of infection by a specific organism and which are dependent on the individual reaction of the patient who is infected.”

Five pneumonia experiences are presented as sample cases to demonstrate the homoeopathic approach and the different strategies used in management of pneumonias.

CASE 1

Mr TR 16yrs/Male. Occupation: Student

Presenting complaint :Cold with nose block & sneezing from 3 days. Presented with history of exposure to cold draft of air in evening 3 days ago. From the 4^th day

developed sudden high-grade fever with chilliness and cough < drinking cold water. C/o associated with increased thirst for large quantity of cold water.

Physical examination: T-104F. P-140/Min. RR-48/Min. RS- Air Entry decreased in Left Lower Lobe, crept - Left Lower Lobe.

X-ray : inhomogeneous opacity left lower zone.

Diagnosis :Acute Community acquired Pneumonia

Case analysis :Structural changes in this case are in early acute stage of congestion in lung tissue before the exudative stage. Functional changes are ↑ Temp 104 F, PR 140/min, ↑ cough reflex, no altered gaseous exchange, RR 48/min, RS AE ↓.

Form of presentation: symptoms are rapid in onset with A/F getting cold when heated, increased thirst for large quantity of water, cough < drinking cold water which indicates good number of characteristics.

Rapid onset with robust symptomatology in first stage of pneumonic congestion & inflammation indicate minimal deviation from original state indicating good susceptibility with dominant Miasm being Psora. Overall the prognosis of the case is a good one and we should expect swift resolution with a few doses of indicated medicine.

Totality of symptoms:

A/F exposure to cold draft of air.

Increased thirst for large quantity of cold water. Cough < drinking cold water.

Sudden onset

High grade fever with chilliness.

Related remedies:

Remedies indicated in first stage of inflammation should be differentiated in this case.

Bell can be differentiated from Aconite by its extreme sensitiveness to external impressions like sound, light, least touch, movement. Cold stage is more predominant in Aconite unlike heat stage in Bell.

Ferr-p.: another drug to be differentiated from Aconite by less marked anxiety & fear. Aconite has bright flushing face appearance whereas Ferr-p. localized flush or

pallor # flushing face. Aconite < evening, Ferr-p.< early morning.

Final Prescription: Aconite

Remedy response: With ACONITE 1000 C repeated every 4^th hourly, fever came down next day morning, and cough was better 50% in 2 days.

Aconite was stopped on 3^rd day and dose of Calc. 200 as constitutional remedy on 4^th day ameliorated the patient completely and hastened the convalescence.

Discussion: Patient had come in first stage of congestion of lungs, sudden onset with good characteristics which indicated robust susceptibility with psoric Miasm in background which allowed Aconite the indicated remedy to abort the episode midway, thus preventing the disease to go into consolidation phase of red and grey hepatization.

Borland’s advice on managing pneumonia by creating crisis instead of lysis (= allmähliches Abklingen eines Krankheitsgeschehens versus Crisis).

By the administration of higher potencies, - you will find that you abort the disease. It does not run its normal course; the duration of the illness is very much shortened and you have an anticipated crisis.

CASE 2

Mrs. AR. 25 yrs / F Occupation: Housewife. Patient was brought with support of relatives to the hospital.

Presenting Complaint :Complaints started from 12 days after drinking cold water. First 4 days had watery nasal coryza that gradually became thick yellowish with occasional cough. On 5^th day patient got wet & within 2 hrs developed high grade fever with chilliness, weakness &headache. Headache was aggravated looking down, during fever & standing from sitting position. Patient had become irritable and wanted to be left alone.

On 7^th day Illness increased with scanty expectoration, chest pain < coughing, deep breathing. Vertigo with fever. Thirst increased for every 10 min. Bitter taste with appetite decreased. On 10^th day developed loose watery stools 2 - 3x daily, yellowish offensive in small quantity.

Physical examination: GC Unsatisfactory, dehydrated look, had to be carried.

Temp 104 F, P/R 124/MIN, R/R 48/min, Tongue dry thick white coated,

Respiratory System: Bronchial breathing in Right Upper Zone.

Investigation :Hb: 11.2. WBC: 11,800 N: 78 L: 20 E: 1 M: 1 ESR: 98. SGPT: 40, MP -veWidal: O: 60, H: 1:60 CUE : Alb: ++++, RBC: Occ, PC: 18-20/hpf,

PC casts: 6-7/hpf.

X-Ray Chest: Rt. Upper Lobar Pneumonia with Loculated effusion.

Diagnosis :Acute community acquired bacterial lobar Broncho Pneumonia.

Case analysis: Structural changes include inflammation of mucosa, serosa & Rt. lung upper lobe parenchyma. Stage of congestion lands into stage of red hepatization with fibrino suppurative exudation.

Functional changes seen as Nasal & Mucociliary Clearance, Cough reflex, Compliance of Lung - Hyperventilation, altered gaseous exchange, RR 48/m.

Form of presentation of symptoms are slow and gradual, watery coryza becoming thick with occasional cough. High grade fever with chilliness, - cough with scanty sputum & chest pain indicates moderate to ↑ susceptibility & dominant Miasma Sycotic.

Totality of symptoms:

A/F Exposure to heat, Suppression.

Concomitants thirst for large quantity often, Irritability & Headache.

Slow gradual onset with early pleural involvement.

Dryness of all mucous membranes.

Dry hard cough with sharp stitches in the chest Chest Pain < motion, hot weather, > pressure, rest.

Related remedies :Remedies in second stage of Inflammation like Bry., Chel., Sang. need to be considered for differentiation here.

Chel.: appearance is slightly yellowish tinge unlike bluish dusky in Bry. Both have irritability but Chelidonium is snappish unlike Bryonia who wants be left alone undisturbed.

Bry.: pains > lying on painful parts Chel. > sitting up or leaning forward.

Chel.: desires warm food & drinks unlike Bryonia has < from warmth in general.

Sang.: differentiated by circumscribed redness of cheeks of face, unlike Bry. has dusky hue. Sang. < cold weather, lying down, Bry. > cold in general, lying on painful side.

Seneg.: full of chest symptoms (pleurisy)

Final Choice: Bry.

Remedy response: BRY. 200 4^th hourly gradually improved patient of dehydration and fever in 2 days and of chest pain in 4 days.

Discussion: As compared to the first case this case had slow gradual onset.Symptoms evolved slowly yet the characteristics were present indicating moderate deviation from state of health. Thus the susceptibility was in moderate zone. The dominant Sycotic Miasm in the case was indicated through its slow onset, stage of consolidation -

Red Hepatization, Scanty yellow discharge, stitching pains.

Thus, a case which has already reached stage of Hepatization, with moderate susceptibility and dominant Miasma Sycotic, should be allowed to resolve through lysis and run the course from Hepatization to resolution. One should not attempt to abort the course as in earlier case which was in first stage of inflammation with Psoric back ground.

Borland’s advice for Repetition of doses

“When you are using low potencies, you have to keep up your drug administration right throughout the course of the disease”.

“When you are using the higher potencies, it is advisable to continue the administration of the selected drug until the temperature has reached normal and has remained normal for at least 6 hours”.

“In the average case where you are using a low potency (30 and below) it is quite sufficient to give the drug about once in four hours”.

Case 3

MRS SA 28 Yrs/F Occupation : Teacher

Presenting complaint :Patient had a frightful experience 24 hours before from which she recovered but developed cough and high grade fever with chills from 2.30 h.

Cough with blood-streaked sputum. Associated with chattering teeth during chills, extremity pain, and pain in Right dorsal back < inspiration, night in general. Appetite

low & taste insipid. Thirst for large quantity cold water. Heat sensation in mouth & eyes. Weakness. Hoarseness < talking.

Physical examination: T: 103 F. P-120/min. Throat - congestion. Dry Tongue. Respiratory System: Dull note on Percussion, reduced air entry in Rt Lower zone, occasional crepitations or rales Right. Side.

Investigations :Hb: 13 gms WBC - 19400 L- 19 N - 77 E - 03 M - 01 Plat- 32 000

Chest X Ray: Small patch of consolidation Rt. basal & Para cardiac region

Diagnosis : Broncho pneumonia.

Case analysis. In this case structural changes in lungs shows congestion with early hepatisation. Functional changes show rapid onset of respiratory distress with high grade fever & chills, weakness with app decreased, cough with bloody sputum. Form of presentation, complaints are a/f fright, rapid onset with progress, fever < night with extremity pain, Heat sensation with burning eyes & mouth, Hoarseness < talking.

A good number of characteristics with cause and effect relationship is indicative of moderate deviation from state of health indicating moderate susceptibility. Rapid onset

of symptoms, bloody sputum, and exhaustion early in the course of illness are indicative of lurking Tubercular Miasm in background.

Totality of symptoms: Insidious onset ending in severe or rapid disease.

A/F

Thirst for large quantity cold water Fever with weakness, Burning pains < night.

Thirsty with dry tongue

Bloody Discharge

Small patch of consolidation Right. Lung basal region.

Related remedies: Remedies like Merc., Phos. & Kali-c. need to be differentiated.

Merc. can be differentiated from

Phos.: discharges offensive, in this case the sputum is bloody.

Merc sol has increased thirst for cold water with moist tongue while phosphorus increased thirst for ice cold water with dry tongue.

Kali-c. has early pleural involvement with stitching pains. Kali is thirstless, < during early hours of the morning, > sitting erect and has profuse perspiration.

Phos. Has causation of fright, has rapid pace of disease, characteristic burning pains, thirst for cold water profound weakness since the beginning of illness,

bloody sputum most important the tubercular Miasmais in the background.

Final Selection: Phosphorus.

Remedy response: After starting Phos. 200 with cautious repetition, maximum up to three times day gradual improvement was seen. By 3^rd day there was no rise

of temperature. Appetite & sleep improved in 5 days and cough subsided in 10 days. Patient received constitutional medicine to complete the recovery process.

Discussion: Patient was brought to op in 2^nd stage of Red Hepatization pathology. Sudden onset & progression of symptoms, with good characteristics indicated good susceptibility of patient with predominant Tubercular Miasma. Hence patient was treated with a remedy which has tubercular base with cautious repetition.

In this case physician followed 3 points by Dr. Pulford in his book Homoeopathic Leaders in Pneumonia - “Don’t get panicky, Don’t give too low a potency, Don’t repeat

too often.”

CASE 4

Mast. A. 11 months. / M. known case of VHD with MR & Delayed Milestones.

Presenting complaint: Child was brought with cold & coryza with mucoid nasal discharge & Mild Fever since 4 days. Associated with decreased thirst & Mucous Stools

2-3 times. Based on which Pulsatilla 200 was prescribed but without relief.

From 5^th day Cough increased with high grade fever. Rattling in chest, with difficult to expectorate sputum, 1-2 sticky vomiting with drowsiness & weakness.

Cough: < Lying down, > Carrying on shoulder. Associated with Decreased appetite & thirst with white coated tongue.

Physical examination T: 102.4F RR: 50/min. P: 140/ min. RS: AE  in Right Lower Lobe, Crepts Right Lower Lobe +

Investigation: Chest X Ray: Right Lower Lobe homogenous opacity- Consolidation

Diagnosis: Aspiration pneumonia

Case analysis: This case presented with structural changes as overstimulation of pneumogastric nerve, causing increased mucous secretions. Congestion in lungs with exudative inflammation. Functional changes with hypersecretion of mucous, capillary congestion, spasm of respiratory muscles with altered gas exchange ↑ Respiratory Rate 50/ min.

Form of presentation of symptoms is rapid travel from Upper Respiratory Tract to Lower Respiratory Tract. Rattling cough, can’t be raised, >Expectoration, Vomiting. Lacks reaction, weakness. Tongue white coated. This indicates ↓ significant deviation from original state of health, indicating susceptibility is debilitated. Lack of ability to react, exhaustion, better by expectoration with Mental Retardation, &VSD , syphilitic Miasm was lurking in background.

Totality of symptoms:

Drowsiness & exhaustion

↓ Thirst with coated tongue

Cough with rattling chest

Cough with difficult Sticky expectoration. Cough ending in Vomiting < lying down.

Related remedies: Remedies like Carb-v., Ant-t. and Ip. need differentiation.

Carb-v. comes close due to exhaustion and lack of reaction, but differentiated due to its more bluish hue, coldness of skin and marked thirst, unlike Ant-t. is pale & thirstless.

Ip.: has rattling cough with nausea and vomiting with clean tongue. Ip. discharges are blood stained and + severe bronchospasm. Alertness of Ip. is preserved, child screams, howls cries, unlike drowsiness in Ant-t.. Ip.: blood streaked sputum unlike scanty mucoid sputum in Ant tart. Ipecac < lying down unlike > lying down on r: side in Ant-t:.

Remedy response: Ant-t. 200 4^th hourly was prescribed. Fever went down first, drowsiness improved next day followed by appetite and thirst. Cough improved and respiratory distress improved over 5 days. On 9^th day CXR showing total Resolution.

Discussion: This case relies on Dr. Borland’s writings on healing by lysis where a case is managed cautiously, only controlling the symptoms and preventing the complications. The debilitated susceptibility is supported till it tides over the crisis safely. The aim here is to preserve life and not to abort the disease aggressively.

Presenting complaint

Child had come with watery nasal coryza and cough from 4 days with low ↓Appetite & dullness. From 5^th day developed high grade fever with chilliness < evening.

Had 1 episode of vomiting associated with irritability, desires to be & teeth grinding.

Past history 2 episode of Lower Respiratory Tract Infection, 2 episodes of Acute Gastroenteritis.

Physical examination T- 1010 F, P/R - 110/min, R.R. - 23/min Respiratory System - Bilateral Crepts + CVS- S1S2 normal P/A- Soft

Investigation Hb 9.4%, WBC 12,400 N 74, E 2, M 2, L 22 Chest X ray left Lower Lobe Homogenous opacity consolidation+

Diagnosis Pneumonia (Late stage)

Mental generals Active and playful child. Dominating - While playing expects that others should obey his rules, keeps finding mistakes with others. Irritable - on slightest provocation. Egoistic - Does not readily mix with people and judges their suitability before befriending them. Does not like to be scolded and becomes angry. Sharp memory - Good memory of events, names etc.

Physical general Craving - Egg , Garlic , Chana. Hot patient.

Case analysis

In this chronic case structures affected are lungs with Left Lower Lobe consolidation & GIT. Functional changes are ↑ Mucous secretion→coryza, GE; ↑ Cough reflex; ↑ Temparature & PR. Form of presentation of symptoms are as Gradual pace onset, Evening ↑ Temp., Weakness & desire to be carried, Availability certain characteristic mental generals. This all indicates moderate deviation from state of health & ↑robust susceptibility

Totality of symptoms

S.NO Chronic Totality Acute Totality

1 Dominating/Egoistic Irritability heat during

2 Irritable Carried desire to

3 Sharp memory Thirst increased for sips freq.

4 Desire Egg, Garlic, Chana Fever < evening

5 Hot

Related remedies

Sulph.:

Left sided affinity

Irritable, full of anxiety & fear.

Fever with more violent Heat.

Thirst for stimulants.

< 11h.

Irritability

Aversion to business due to laziness.

Sleep- wakes up happily singing in morning.

Lyc.:

Sided affinity.

Fever with icy coldness as if lying on ice.

Thirst for Warm drinks.

< 4 - 8 h.

Irritability & aversion to undertake new things

lack of confidence.

Sleep - sadness on waking up.

< warm weather, 4 - 8 h. Chest pain > sitting up.

Kali-c.:

< cold weather , 3 h.

Chest pain > sitting with leaning forward.

Final Selection: Lycopodium

Of the three remedies Lycopodium covered the acute & chronic totality of the patient. Hence it was the choice of remedy over Sulphur and Kali-c.

Remedy response

1^st Day Temp - 1010F, Cough ++ Lycopodium 10m single dose

2^nd Day Fever > but relapse cough > but relapse Lycopodium 10m single dose

3^rd Day onwards No complaints, X ray chest with complete resolution of lung parenchyma Placebo

Discussion

Patient had two episodes of lower respiratory tract infections before this episode. Hence a drug which suits both acute & chronic symptom was best selected.

There were characteristic generals in totality including mental generals in both acute and chronic totality, indicating highly robust susceptibility hence high potency

in single dose was used. Lycopodium was used in high potency with the hope of cutting down or aborting the course of disease. Since the susceptibility was robust

and correspondence of remedy complete, the physician took the risk of aggressive strategy through creating a crisis as suggested by Borland.

Debate of Strategies Lysis versus Crisis.

Answer to the debate lies in assessment of susceptibility and Miasm.

If the indicators of susceptibility are robust; like characteristics are robust, pathology is just setting in, early stage of disease, general condition is good, no compromise in vitality and essentially psoric response from patient and if the correspondence of indicated remedy is complete, it is safe to aggressively barge in by creating crisis and cut

short or abort the course of illness.

If the indicators of susceptibility are weak; Not much characteristics, well established inflammation or its complication, general debility, vitality compromised, underlying

Co-morbidity essentially, tubercular or syphilitic miasm expressions, it is better to follow slow yet safe method of using low potency. Support the susceptibility to withstand the disease force and allow it to tide over. Choose steady lysis of disease. Patient is comforted by relief in symptoms and prevention of complication while disease runs its

full course.

Conclusion

Homoeopathy has the potential and the capability to counter and diffuse infections based on the principle of individualisation. Homoeopathic approach in pneumonia

is not different.

Totality of symptoms; i.e. the pathognomonic common symptoms of the disease caused due to infection and Characteristic symptoms exhibited by the individual as a

reaction to the infection are our guiding post to establish diagnosis and select homoeopathic remedies, respectively.

Diagnostic knowledge and skills are critical for suspecting, identifying and confirming the diagnosis of pneumonia. Clinico- pathological correlations are essential for understanding inflammatory stages of pneumonia and hence the group of remedies based on stage & type of pneumonia as suggested by Borland.

Groups suggested by Borland in 1939 based on the tissue affinity, still hold true and are seen by contemporary physicians in practice.

In homoeopathic prescribing for pneumonia, the endeavour is to find a drug that will cover not only the actual pathological picture but also reaction of the individual

patient to the infection. Individual reactions are exhibited through peculiar symptoms like; Causations, Generals, Concomitants, Modalities, and Sensations.

Case taking should focus on evolutionary picture of the disease on day to day basis. Patiently, each symptom and sign should be elicited and recorded on time line to understand onset duration and progress.

The trio of pace of disease, stage of pathology and evolution of characteristic symptoms are the basis of susceptibility assessment. Identifying pace and stage of the disease

in pneumonic inflammation goes a long way in providing assessment of susceptibility of the patient.

Miasm plays a significant role in deciding how a pneumonia is going to progress and how an individual will react in the course of the illness. Identifying phases of pneumonia from Psora to Syphilis helps in formulating strategy.

Strategy of management of pneumonia e.g Crisis or Lysis, use of acute or constitutional remedy, choice of potency and repetition is based on understanding of susceptibility and miasm of a given case.

Homoeopathic management of pneumonia is an art formulated on scientific principles of Homoeopathy which can be learnt and perfected by practice alone.

Vorwort/Suchen. Zeichen/Abkürzungen. Impressum.