Tuberkulose
Anhang
x!y
[Dr. Ardeshir T. Jagose]
The word miasm has originated from the Greek
word "Miasma" which means a stain, pollution, defilement of an
abnoxious atmosphere or infective material. Hahnemann, during his life time
discovered that a "noxious agent" was responsible for the persistence
of the disease condition which he named as miasm. It was during the evolution
of the discovery of chronic disease, he came to the conclusion that the disease
condition cannot arise, persist or even grow worse if the miasm is not present.
Hence, he named three basic miasms, i.e. Psora, Sycosis and Syphilitic miasm.
Futhermore, Dr. Tomas Paschero definition of miasm was: "A miasm is not an
infection or an intoxication, but a vibratory alteration of man’s vital energy,
determining the biological behaviour and general constitution of the
individual“.
If we look into the evolution of the history of
miasm.
Dr. Hahnemann perceived the miasm on the
physical plane based on the clinical observations.
Dr. J. T. Kent: extended and gave a
philosophical touch by who raised the miasmatic theory to the state of mind
which required deep seated perceiving.
Dr. Robert and Dr. Speight: made an analytical
study of symptomatology of diseases and correlated the miasms with symptoms.
Dr. C. M. Boger: generalised the symptoms and
converted them to pathological generals eg keloid, gangrene, desquamations,
etc. He also stressed form, function and structure of any disease condition. He
was of the opinion that disease evolves dynamically from Psora to Sycotic to
Tubercular to Syphilitic phase. He was the first person to correlate pathology
to miasms.
Dr. J. H. Allen: introduced the tubercular
miasm. In his book "The Chronic Miasms" he described psora,
pseudopsora and sycosis. He stated that the miasms psora and syphilis gave rise
to tubercular miasm and called it pseudopsora. He added that when sycosis is
added to tuberculosis, it gives rise to a malignant hue.
In other words, miasm is a concept whereas
pathology is a fact operating on the concept. Pathology is reflection of miasm
and is evidence to the presence of miasm.
Let us now understand how the knowledge of
Tubercular miasm (or any other miasm) is useful in clinical practice:
1) It helps us in identifying the state of
pathology.
2) It helps us to make a fair judgment of the
state of susceptibility.
3) It helps us to prognosticate the case in
advance.
4) It helps us to judge the further evolution
in the state of pathology.
5) It helps us to plan the second prescription.
6) It helps us to recognize suppression.
7) It helps us to find the similimum.
8) It helps us to differentiate between two
seemingly similar remedies.
9) It helps us to choose the inter current
remedy.
10) It helps us to select the potency.
11) It helps us to for a better understanding
about repetition of drug.
12) It helps us to identify the predisposition
and disposition of the case.
Now we focus attention on the tubercular miasm.
We discuss the predisposition, disposition, diathesis, generalities, modalities
and pathology.
PREDISPOSITION:
The predisposition is obtained by the
homoeopath from the family and past history of the patient who may have one or
more of the following diseases / states suggestive of tubercular miasm viz.
tuberculosis of lungs, pleura, meningitis, bones, joints, glands, blood
vessels, collagen tissue, teeth, GI tract and genitor-urinary system, etc; one
child sterility (secondary sterility), diabetes mellitus, suppuration and
recurrent abscess, sinuses, fistula, haemorrhagic diathesis, tendencies and
caries, white spots on nails or any relapsing reoccurring state.
DISPOSITION:
The word disposition means "a
tendency" or "inclination to". It may be also coined as
"type", "typology", "temperatment" or
"constitution" of an individual.
It may be defined as "an aggregation or
collection of attributes, trials, qualities of an individual on the
intellectual, mental & physical plane which is hereditary and also partly
acquired through the patients life".
Disposition may be studied under various
headings:
a) Emotions:
Heightened, unstable emotions - easily
offended, weeps easily, changeable moods, and sensitive to inputs of noise,
touch, jar, movement etc.
Anxiety, fear, fright, apprehension
(anticipatory + agitational type) grief, craves sympathy and gives it, desire
to be magnetised, very hopeful - optimistic, sentimental, suppressed anger,
friendly nature but unpredictable.
All desires of sex, love are heightened giving
rise to sexual perversions and very strong attachment to objects and persons,
but the performance is poor resulting in impotency and disappointment in love.
Poor will, motivation and drive are also seen.
b) Intellect:
Acute perception - ESP, and at the extreme end
also present is clairvoyance, clairaudience, where all responses are sharp,
quick but erratic, not long lasting but with changeability, alterations and oscillations.
Strong / heightened imagination - artistic and
intellectual precocity (cognition)
Strong / heightened perception - acute /
altered with illusion, hallucination and delusion
c) Dreams:
Amorous, frightful,
violent, prophetic, distressing, gloomy and dreams of shame. Cries out in
dreams.
d) Physical factors:
Hypersensitivity is marked to all sensory
inputs like touch, light, noise, odour. Also hypersensitive to weather,
temperature changes, lightening, thunderstorm, moonlight.
Immune levels are low, hence prone to
environmental influences causing diseases.
All discharges are profuse, white or
sero-sanguinous in nature with a musty, mouldy odour. Increased appetite, but
yet looks emaciated and marasmic. Craving for indigestible things and pica
during pregnancy with
marked aversion to meat.
BUILD / CONSTITUTION:
The person is tall, thin, lean (body growth is
disproportionate to height), fair in colour and the venules can be seen under
the skin, with blue sclera, blond hair and long eye lashes. They are emaciated,
stooped shouldered with narrow chest and depressed sternum, winged scapula,
curved spine with drawn clavicles and a drum belly, yet attractive with blond
or red hair, long delicate fingers and fine silky hair especially down the
spine with white spots
or ridges on nails and posterior cervical
glands are enlarged, small and shotty.
DIATHESIS:
Comptom J. Burnett: first person to describe
this state. He called it "comsumptiveness" and he wrote a book called
"New cures for consumption by it’s own virus".
The word "Diathesis" can be explained
as a borderline state between disposition and expression or it can be defined
as a borderline state between normal susceptibility and expression of the
disease.
Hence two types of diathesis can be described:
a) TUBERCULAR DIATHESIS OF TUBERCULINISM: the
French called it "elat tuberculinique". This diathesis is found in
offsprings of those who had suffered from tuberculosis. It may also be observed
in some individuals
who do not respond to
anti-tubercular treatment.
b) SCROPHULOUS DIATHESIS: it is similar to
tubercular lymphadenitis i.e. there is induration leading to sinuse or fistula
formation with subsequent healing by scar formation.
GENERALITIES:
1) A strong predisposition to Koch’s, pleural
effusion, Pott’s disease, tubercular glands, tubercular meningitis etc.
2) Increased activity at all levels mental and
physical followed by debility at all levels.
3) Erraticity, periodicity, hyperdynamicity,
changeability, fears and alteration of emotions, desires and dispotion in time
and space is well marked.
4) In the third phase of disease progression,
all the responses are fast.
5) Superficial disturbances of circulation are
seen - bluish pallor, purple condition of extremities with chilblains and
hypotension.
6) Increased catabolism and decreased anabolism
with poor assimilation is seen.
7) Emaciation rapid and pronounced ; loss of
muscle mass despite eating well. Takes cold easily without knowing how and
where.
8) Pains are variable, generally throbbing in
affected parts or sore, bruised, aching which are relieved by warmth and
movement .
9) Sexual precaucity is marked with
lasiviousness, nymphomania etc.
10) Recovery takes along time due to weak
system - has not been well since.
11) Where there is a lack of reaction in a
given case, when too many medicines have been given or a deep acting medicine
acts only for a few weeks.
MODALITIES:
AILMENTS FROM: Suppressed foot or axillary
sweat, suppressed eruptions (ringworms), dentition troubles, anticipation, loss
of vital fluid and exposure to damp weather.
<: Exposure to cold, sitting in a draft,
becoming fatigued, mental excitement or exertion, overeating, overwork, early
morning on awakening, from a warm room, from evening till midnight, rest,
standing, before and during a thunder storm, weather changes, night, warm damp
weather, rainy weather, after sleep, before breakfast, uncovering, scratchine,
studing, bathing, seaside, 19 – 5 h., riding in a carriage, 10 - 11 h., high
altitude, during menses, cow’s milk, potatoes, meat and sunset.
>: Open air, fresh air, motion, walking,
heat, heat of fire, eating, noose bleed, rest, quiet place, sleep, natural
discharges i.e. diarrhoea, sweat, nose bleed etc, though chilly longs for fresh
air and open windows.
Pains > hot applications and in the daytime.
Eruptions > bathing.
PATHOLOGY:
Caseation is present with giant cells in the
center surrounded by macrophages (often endothelial cell) which is further
surrounded by few collagen strands and lymphocytes.
ON CLINICAL GROUNDS the pathological findings
suggestive of tubercular miasm are as follows:
1) CBC: Leucocytosis with lymphocytes and
mononuclear cells.
2) BLOOD SUGAR: Increased levels of fasting
+/o. post prandial blood sugar levels.
3) URINE ROUTINE: Increased specific gravity
(1.016 to 1.023) or fixed at 1.010. Presence of urates, sugar, acetone blood
and casts.
4) STOOL EXAMINATION: Tarry stools with fresh
or occult blood with presence of E. histolytica, Giardia Lambia and other helminthic
infestations.
5) SPUTUM EXAMINATION: May show presence of
A.F.B.
6) MANTOUX TEST: Induration, redness and
erythema seen after 48 to 72 hours - 7 to 10 mm or more induration is
definitely positive.
7) X-RAY CHEST FINDINGS: May show caseous
hepatization of lungs/miliary mottling, tenting of diaphragm. Heart shadow
narrow, slender, tubular, with calcified aortic knuckle.
Pulmonary artery relatively wider than the
aorta.
RELATIONSHIP TO THE HOMOEOPATHIC MATERIA -
MEDICA:
A) Compatable Drugs: Bell, Bry, Calc. Calc-p. Chin. Hydr. Kali-s. Psor,
Puls, Sep. Sulph.
B) DRUGS THAT FOLLOW WELL: Calc-p. Calc.
Calc-sil. Bar-c. Sil.
C) ANTIDOTAL DRUGS: Phos, Puls and Sepia. If
the drug tuberculinum produces a fearful aggravation: Calc. or Calc-p. in low
potency may check the effect (Homoeopathic Recorder November 1928.)
Thus, after having perceived the essentials of
the tubecular miasm, we can summarise the following points:
1) Onset: incidious.
2) Pace: fast
3) Speed: rapid
4) Intensity: heightened
5) Pattern: erratic
6) Frequency: irregular
7) Sensitivity: increased
8) Reactivity: increased with an erratic and
unpredective response
9) Process: chronic
10) Immunity: low
11) Susceptibility: moderate to high
12) Depth: deep due to pathological changes
13) Pathology: chronic inflammations,
exudations, suppuration, sinus / fistula formation, discharges acrid thick
yellowish green in colour with a musty / mouldy odour.
Thus, in clinical practice the first step is to
understand the miasm, to identify the dominant miasm and the fundamental miasm
as evident from the presenting complaint, family and past history,
respectively.
While treating a case in which the fundamental
miasm is tubercular in origin, further management requires proper understanding
of the tubercular miasmatic activity during the treatment which alters morbid
susceptibility
and brings out cure. Very rarely it can occur
with a few doses of homoeopathic medication, but it requires total eradication
of the miasmatic activity. Thus, after the first prescription one has to
observe the frequency and
duration of the chief complaint, including the
pathology which will gradually decline. The miasmatic activity will come under
control only when the patient’s complaint travels from sycotic/ psoric plane
while getting cured.
In the follow up period the complaints will
remain low in intensity, will be less frequent and there will be a change in
the type of discharges like that of sycotic / psoric miasm. Therefore adequate
follow up of the case is
essential to observe all these changes.
Vorwort/Suchen Zeichen/Abkürzungen Impressum