Tuberkulose Anhang
[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