RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, …



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE-II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|1. |NAME OF THE CANDIDATE AND ADDRESS |Dr ANITHA.P, |

| |(IN BLOCK LETTERS) |FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, |

| | |UNIVERSITY ROAD, |

| | |DERALAKATTE, |

| | |MANGALORE-575018 |

| | |KARANATAKA. |

| |PERMANENT ADDRESS |D/O P.GOPALAKRISHNAN, |

| | |POOVATHODY(H), |

| | |KONDOTTY(P0),MALAPPURAM(DIST), |

| | |KERALA (ST), 673638(PIN). |

|2. |NAME OF THE INSTITUTION |FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, |

| | |DERALAKATTE, MANGALORE. |

|3. |COURSE OF THE STUDY & SUBJECT |M D (HOM) |

| | |ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY |

|4. |DATE OF ADMISSION TO THE COURSE |25.05.2010 |

|5. |TITLE OF THE TOPIC |

| | |

| |“A CLINICAL STUDY ON THE MIASMATIC EVALUATION OF ACID PEPTIC DISEASE AND ITS HOMOEOPATHIC MANAGEMENT’’ |

| 6. |BRIEF RESUME OF INTENDED WORK |

| |6.1 NEED FOR THE STUDY |

| |Acid peptic disease is one of the commonest disorders encountered in clinical practice. It has now become highly |

| |prevalent due to various stresses encountered in the modern life. Stress is seen in various aspects of life, in |

| |interpersonal relationship, area of work, financial matters etc. Also the tight and busy schedule of this world have lead|

| |to a disordered life style like irregular meals, smoking, fast food dependencies etc., all of which can cause the |

| |disease. |

| |Acid peptic diseases accounts nearly of about 10% of the medical cost for digestive diseases. Modern medicine has relied |

| |on the use of antacids, proton pump inhibitor, and H2 receptor blockers as the main stay of medical therapy and |

| |operations that reduce acid secretion as a major surgical approach in peptic ulcers. |

| |All the different modes of treatment have only helped in palliating the diseases. Homoeopathic treatment is superior to |

| |other modes of treatment since it treats the cause and not the effects. Hahnemann concluded that there must be an unknown|

| |obstacle to lasting recovery, an obstacle deep in the patients system. He observed that when one disappears, it is |

| |sometimes replaced by another. But upon closer analysis we see that these different conditions are like weeds which |

| |spring from the root. A remedy addressing a particular weed may leave the root untouched. Until the root is taken out, it|

| |will continue to produce weeds in different parts of the patients body, he identified these such roots as miasms.1 |

| |This study is an attempt to understand evaluation of different miasms in Acid Peptic Disease. It is one of the commonest |

| |diseases found in clinical practice. The reason may be the tight and busy schedule of modern life. This made me to think |

| |of a study based on this. |

| | |

| |6.2 REVIEW OF LITERATURE |

| |Acid peptic disease by definition is a disorder of gastric and duodenal mucosal barrier due to hyper or hypo secretion of|

| |acid and pepsin into the gastric juice which result in destruction of mucosal and muscular layers of stomach and |

| |duodenum. This disease provides an enriched psychosomatic relationship. Emotional factors either precipitate or modify |

| |this disease. The progress of disease is directly proportional to the stress under which the patient lives. Diet habits |

| |including irregularity in food habits and rich foods, smoking and alcohol also provides a major role in the causation of |

| |the disease in addition to psychological factors. |

| |CLINICAL FORMS OF ACID PEPTIC DISEASE |

| | |

| |Acid peptic diseases include a number of conditions whose pathophysiology is said to be result of damage from acid as |

| |well as peptic activity in gastric juices or secretions. The conditions under acid peptic diseases are: |

| | |

| |1. Gastro esophageal reflux disease |

| |2. Gastritis |

| |3. Peptic ulcer disease |

| |4. Zollinger - Ellison syndrome |

| |GASTRO ESOPHAGEAL REFLUX DISEASE (GERD) |

| |Definitions |

| |It is defined as chronic symptomatic or mucosal damage produced by abnormal reflux of gastric contents into oesophagus. |

| |Transient lower oesophageal sphincter relaxation is an important factor in GERD. |

| |The following factors all contribute to the development of GERD: |

| |Abnormalities of lower esophageal sphincter, Hiatus hernia, Delayed esophageal clearance, Gastric contents, Delayed |

| |gastric emptying, |

| |Increased intra abdominal pressure, Dietary and environmental factors |

| |Symptoms: |

| |Heartburn(pyrosis),Regurgitation,Dysphagia,Odynophagia,Waterbrash,Chestpain |

| |Pulmonary symptoms may be the only manifestation of GER and include chronic cough, hoarseness of voice, wheezing, |

| |haemoptysis, asthma, and recurrent aspiration pneumonia.2.Burning produced by bending, stooping or lying down. Eructation|

| |and dyspepsia are other symptoms.3 |

| |Investigations: |

| |- Barium swallow and meal examination, Endoscopy, Oesophageal manometry, |

| |24 hour pH monitoring is the gold standard for diagnosis of GERD.4 |

| |Complications of GERD |

| |1. Stricture 2. Esophageal shortening 3. Anaemia 4. Oesophagitis |

| |5. Gastric volvulus 6. Predisposition to malignancy |

| |Management : Lifestyle advice, including weight loss, avoidance of dietary items which the patient finds worsen symptoms,|

| |elevation of the bed head in those who experience nocturnal symptoms, avoidance of late meals and giving up smoking, are |

| |recommended but rarely heeded.5 |

| |GASTRITIS |

| |Classification: |

| |Acute gastritis: a) Acute H. Pylori infection .b) other acute infectious gastritis: bacterial, viral, mycobacterial, |

| |phlegmonous, parasitic, fungal, and syphilitic. |

| | |

| |Chronic gastritis:6 |

| |Type A: Autoimmune body predominant. |

| |Type B: H. Pylori related, antral predominant. |

| |Indeterminant. |

| |Uncommon forms of gastritis: Lymphocytic, Eosinophilic, Isolated granulomatous, Stress gastritis, Hypertrophic |

| |gastritis.6 |

| |Another classification: |

| |1. Acute Erosive and hemorrhagic gastritis (Gastropathy) |

| |2. Chronic Non erosive, non specific (histological) gastritis |

| |3. Chronic Specific type gastritis |

| |Aetiology |

| |Helicobacter pylori,2. NSAID’s and glucocorticoids,3. Irregular eating habits combined with addictions like smoking, |

| |alcoholism and stress(emotional) |

| |Investigations |

| |Upper gastro intestinal endoscopy |

| |Stool test: The test checks for the presence of blood in the stool, a sign of bleeding. It is also used to detect the |

| |presence of H.pylori in the digestive tract. |

| |PEPTIC ULCER DISEASE |

| |An ulcer that develop in the area of GI tract exposed to acid gastric juice are called peptic ulcers.7 |

| |No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance |

| |between digestive fluids in the stomach and duodenum. |

| |Classification: 1.Gastric ulcer2.Duodinal ulcer |

| |Aetiology:1. Helicobacter pylori infection |

| |2. NSAID’s and glucocorticoids |

| |3. Smoking |

| |4. Blood group O people are more prone |

| |5. Stress |

| |Symptoms: A gnawing or burning pain in the middle or upper stomach between meals or at night, Bloating, Heartburn, |

| |Nausea & vomiting |

| |In severe cases, symptoms can include: |

| |Dark or black stool (due to bleeding) and Vomiting blood (can have a “coffee-grounds” appearance |

| |Investigations: |

| |1. Examination of blood: Hb will be low due to chronic blood loss. |

| |2. Examination of stool: Occult blood detectable in all cases of active ulcer. |

| |3. Gastric function tests. |

| |4.Endoscopy has facilitated diagnosis of peptic ulcer disease8 |

| |Imaging: Barium upper GI serves in an acceptable alternative, but accuracy is limited in distinguishing the benign from |

| |malignant. . |

| |Complications: include hemorrhages, perforation and gastric outlet obstruction |

| |Management: Rest as far as practicable. Anxiety & elements of stress and strain should be avoided. Diets should be |

| |regulated and must be taken in time. Alcohol and smoking to be prohibited .8 |

| |ZOLLINGER – ELLISON SYNDROME (GASTRINOMA) |

| |ZES can be defined as severe peptic ulcer diathesis secondary to gastric acid hyper secretion due to unregulated gastrin |

| |release from a non β cell endocrine tumor (gastrinoma). |

| |Clinical Manifestation |

| |Gastric acid hyper secretion is responsible for the signs and symptoms. |

| |Peptic ulcer is the most common clinical manifestation. |

| |Gastrinoma |

| |Esophageal symptoms- mild esophagitis to frank ulceration with stricture and Barrett’s mucosa. |

| |Diarrhoea |

| |Investigation: Serum gastrin level highly elevated |

| |:Tumor localization by endoscopic ultra sound |

| |Management: Approximately 30% of small and single tumors can be localized and resected. Some patients present with |

| |metastatic disease and surgery is inappropriate. Overall 5 year survival is 60 to 75%.5 |

| |PSYCHOSOMATIC ASPECTS OF APD |

| |Physical symptoms are the manifestation of underlying psychological distress disease. As a general outline people prove |

| |to develop CVS and GI problems (APD) were found to lead a competitive achievement oriented life style and were marked by |

| |hurry, impatience nervousness and frustration. Responses to stressful events have three components: an emotional |

| |response, physical response and psychological response.9 |

| |Stress is an unavoidable effect of living and is an especially complex phenomenon in modern technological society. Stress|

| |in psychology and biology any strain or interference that disturbs the functioning of an organism. The human being |

| |responds to physical and psychological stress with a combination of psychic and physiological defenses. If the stress is |

| |too powerful or the defenses inadequate a psychosomatic or other mental disorder may result. |

| |Emotional changes in human beings were accompanied by physiological changes and when emotional changes were frequent, |

| |pathological physical changes would follow. Among psycho somatic disorders APD is very common. 10 |

| |Gastro intestinal symptoms are often an expression of stressful life. Poor appetite, abdominal pain, indigestion etc. are|

| |results of anxiety. GI disorders rank high in medical illnesses associated with stressful life events.2 |

| | |

| |HOMOEOPATHIC APPROACH |

| | |

| |Sickness is not a local affair but involves the whole man – his psychological as well as his physical make-up. A man is |

| |not sick because he has this or that local disease. The local disease is there because the man is sick. He is sick |

| |because his cells and tissues are not healthy and because, in consequence, there is a state of disorder and lack of |

| |efficiency in vital function. |

| |The sick state of the tissues, ultimately manifested in a local or organic lesion, is often widespread, thus making the |

| |whole man sick. It may indeed have been present for a long time, though perhaps undetected. |

| |Sickness is a highly individual matter. What counts in every case is not only the nature of the causal factor but also, |

| |and perhaps even more poignantly, the personal, particular and pertinent reactions of the cells and tissue fluids of the |

| |individual. Moreover, individuals differ significantly in their reactive capacities. |

| |Grave, prolonged, or chronic disease is the result of a failure on the part of the body’s defenses to withstand hostile |

| |forces. There is failure to resist infection, to neutralize and eliminate toxins, to repair damage and to restore the |

| |normal balance and rhythm of physiological function. |

| |One factor in the prolongation of chronic disease is thus a state of widespread toxicosis, often a residual intoxication |

| |from a previous infection, possibly antenatal. In as much as disease is a deviation from the normal, a disturbance of |

| |the balance and rhythm of metabolic processes essential to health, it is the living body itself that must undertake the |

| |task of reversing the disease process, repairing the damage and restoring normal function.11 |

| |This being so, it should be the aim of the physician to stimulate, strengthen and enhance the natural curative powers of |

| |the body. The homeopath must know his patient spiritually, emotionally, mentally, physically and socially.12 |

| |MIASMATIC APPROACH |

| |Hahneman's theory of miasms and the origin of the chronic disease is the most fundamental and original approach to the |

| |understanding of the phenomenon of the disease from the evolutionary point of view.13 |

| |The primary disturbances of disease are exhibited at the level of mind. Disease response is an alteration of the |

| |relationship between input and output. The different environment to which the organism is susceptible is: 1) Physical |

| |2) Emotional 3) Biological 4) socio-cultural. 14 |

| |Man must be studied as he is, as he was, everything of human race in general in order to understand disease. Thinking, |

| |willing and doing are the three things in life from which proceed chronic miasms.15 |

| |Psoric Manifestation of Acid peptic disease |

| |Unnatural hunger, hunger an hour before or an hour after eating regularly. |

| |Hunger during sleep or at night hour. |

| |Full stomach with hunger, with weak gone feeling in the abdomen with great prostration, perspiration after eating. |

| |Dull feeling with distension of abdomen after eating, with flatulence. |

| |Fainting when hungry. |

| |Constrictive feeling around the abdomen. Audible rumbling in the bowels. |

| |Disagrees to too many food items. |

| |Pain > gentle pressure. |

| |Constipation or inactivity of the bowels. |

| |Diarrhea from over eating. |

| |Sycotic manifestation |

| |Abdominal colic > doubling up |

| |> motion, hard pressure. |

| |Abdomen pains even from slightest or simplest food. |

| |Colic is prominent in painful diarrhea. Loud eructation |

| |Changeable stool with mucous. |

| |Tubercular manifestation |

| |Extreme hunger |

| |Constant hunger and eating beyond their capacity to digest. |

| |Worse from constipation and inactivity. |

| |Saucer shaped abdomen. Highly sensitive to cold. |

| |Diarrhea with great exhaustion with a feeling as if whole vitality is leaving after each evacuation |

| |Sudden urgency ................
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