Rajiv Gandhi University of Health Sciences s148
BHARATESH HOMOEOPATHIC MEDICAL COLLEGE, HOSPITALS AND POST-GRADUATE RESEARCH CENTRE, BELGAUM
Recognized by:
CENTRAL COUNCIL OF HOMOEOPATHY, NEW DELHI.
Affiliated To:
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE
M.D (Homoeopathy)
SYNOPSIS
THE STUDY OF MIASMATIC APPROACH IN NASAL POLYPS
by
Dr. SHAGUFTA.BANU
Dr.RAMDAS AMBUGA
M.D.(Hom)
Professor & Guide
Bharatesh Homoeopathic Medical College
& Hospitals. Belagum
From
Dr Shagufta
To:
Dr Ramdas Ambuga, MD (HOM)
Professor and Guide
DEPARTMENT OF ORGANON OF MEDICINE AND PHYLOSOPHY
BHARTESH HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL
BELGAUM
Sub: Application to accept my synopsis for dissertation
Respected sir
I Dr Shagufta would like to forward my application foe the approval of my synopsis under your guidance for the following, “THE STUDY OF MIASMATIC APPROACH IN NASAL POLYPS”
Hope you will approve the same
Date:
Place: Belgaum
Yours Sincerely
Dr Shagufta
DEPARTMENT OF ORGANON OF MEDICINE AND
PHYLOSOPHY
BHARTESH HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, BELGAUM
From
Dr Ramdas Ambuga, MD (HOM)
Professor and Guide
DEPARTMENT OF ORGANON OF MEDICINE AND PHYLOSOPHY
BHARTESH HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL
BELGAUM
To:
Dr Shagufta
Dear Doctor:
I have accepted your topic “THE STUDY OF MIASMATIC
APPROACH IN NASAL POLYPS” for the dissertation.
Your synopsis will be forwarded to RGUHS.
Date:
Place: Belgaum
Dr Ramdas Ambuga, MD (HOM)
Professor and Guide
DEPARTMENT OF ORGANON OF MEDICINE AND
PHYLOSOPHY
BHARTESH HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL. BELGAUM
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
ANNEXURE – II
APPLICATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Dr. SHAGUFTA BANUPOST GRADUATE STUDENT
BHARTESH HOMOEOPATHIC
MEDICAL COLLEGE &HOSPITAL,
BELGAUM.
PERMANENT ADDRESS:
C/O MD MANZOOR HUSSAIN
SOCIAL WELFARE OFFICER ,
BEHIND KALYAN MANTAP.
KUSTAGI.
DIST – KOPPAL
2 / NAME OF THE INSTITUTION / BHARTESH HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL BELGAUM .
3 / COURSE OF THE STUDY & SUBJECT / M. D. (HOM)ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY.
4 / DATE OF ADMISSION TO THE COURSE / 06-07-2010
5 / TITLE OF THE TOPIC / “ THE STUDY OF MIASMATIC APPROACH IN NASAL POLYP”
6 / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Nasal polyps are one of the mass lesions of nasal cavity. Approximately 2% of the population have tissue swellings inside the nose and sinuses can cause many of the symptoms associated with rhinosinusitis. They block nasal airways and create breathing difficulties. They inhibit proper drainage of sinus cavities creating stagnant secretions that stay in sinuses, become infected and leads to sinusitis. They present with nasal obstruction, decreased sense of smell, recurrent sinus infections and profuse nasal discharge.
Respiratory allergies are thought to be the cause of nasal polyps. These with allergy were 6 times more likely to suffer from nasal polyps. 57% of allergic children suffer from nasal polyps.Another study reported a connection with house dust mite and house dust allergies particularly in patients under 40. Other possible causes are chronic viral or bacterial infection such as staphylococcus of the sinuses,aspirin etc. According to allopathic mode of treatment; long term treatment is required to reduce polyp size and prevent their regrowth. They have to be surgically removed. It cause complications such as anosmia, damage to orbital contents, meningitis etc.
Simple polypectomy is the treatment of choice which involves removal of polyps by an avulsion or cutting snare or forceps. Endoscopic removal or Caldwell-Luc operation if recurrent.
Homoeopathic medicine not only helps in treating the nasal polyps by avoiding surgery but also prevent the recurrence. Modern school treats the disease but Homoeopathy treats the patient.Diagnosis of the disease is the aim of the modern school but diseases individualization and diagnosis of person is aim of the Homoeopaths. We study by knowing the totality of symptoms and individualization. Miasmatic analysis is integral part of Homoeopathic evaluation of every individual case of chronic diseases. Its synthesis provides insight into the pace and prognosis for the individual underconsideration. Early identification of latent miasmatic traits and evaluation of predominant miasm in individual enables us to initiate suitable preventive and curative measure.
NULL HYPOTHESIS: The study of Miasmatic approach in Nasal polyps may not be effective..
6.2 / REVIEW OF LITERATURE:
DEFINATION:
A Nasal polyp is a prolapsed pedunculated part of the oedematous mucosa of the nose or paranasal sinuses.It is not a neoplasm.
TYPES OF POLYPS :
ANTROCHOANAL:
It arises from maxillary antrum and grows backwards in the nose towards towards choana (posteriornares) and reaches the nasopharynx. In advanced cases ,it may reach upto the oropharynx.It has got three parts ;
(a) Antral;which is a thin stalk.
(b) Choanal:which is round and globular.
(c) Which is flat from side to side.
ETHMOIDAL:
They are multiple ,bilateral and arise from numerous ethmoidal sinuses .They tend to protrude forwards.
AETIOLOGY:
1. AGE: Antrochoanal polyps usually occur in children and young adults. Ethmoidal polyps occur at any age.
2. SEX: Both the sex are equally affected.
3. PREDISPOSING FACTORS:
· Allergy may cause the polyps.Ethmoidal polyps are usually allergic in origin.
· Vasomotor:The polyp result from the imbalance between sympathetic and parasympathetic nervous system in th e nose .
· Infection;may produce polyps which are single or multiple.
· Mixed:Acombination of the factors mentioned earlier may be responsible for the polyps.
· Bernouilli’s phenomenon:When air passes through a narrow area in the nose a negative pressure is created in the vicinity the paranasal sinuses leading to increased formation of the tissue fluids.This may encourage polyp formation.
· Polysaccharide changes in the ground substance may be responsible.1
HISTOPATHOLOGY:
Nasal polypi consist of swollen mucus membrane,the spaces of which are distended by fluid.The polypus is covered by a thin epithelial layer which may be pavement or ciliated columnar in type.In polypi which have prolapsed towards the nostril the epithelium may become squamous.The substance of the polypus is infiltrated by plasma cells and lymphocytes ,and most characteristic of all, large number of eosinophils. The blood supply is scanty.2
SYMPTOMS:
· Ethmoidal polyps are multiple and can occur at any age but are mostly seen
in adults.
· Nasal stuffiness leading to total nasal obstruction may be the presenting symptom.
· Partial or the total loss of smell .
· Headache due to associated sinusitis.
· Sneezing and watery nasal discharge due to associated allergy.
· Mass protruding from the nostril.
· Unilateral obstruction is the presenting symptom of Antrochoanal polyp.obstruction may become bilateral when the polyps grows into the nasopharynx and starts obstructing the opposite choana.
· Voice may become thick dull due to hyponasality.
· Nasal discharge is mostly mucoid in Antrochoanal polyp.
· Snoring and mouth breathing may occur .
.DIAGNOSIS:
Diagnosis can be easily made from clinical examination .CT scan of paranasal sinuses is essential to exclude the bony erosion and expansion suggestive of neoplasm.3
MIASMATIC APPROACH:
In 1828, Hahnemann introduced the concept of miasms; underlying causes for many known diseases. A miasm is often defined by homeopaths as an imputed "peculiar morbid derangement of the vital force". Hahnemann associated each miasm with specific diseases, with each miasm seen as the root cause of several diseases. According to Hahmemann it is essential to understand the miasmatic background of the patient which in turn helps us in understanding the reason behind the way the patient reacts in health and in a diseased condition.It also gives a clue in predicting the course of disease in the indiduals ,thereby using it for our advantage in therapeutic application.4
HAHNEMANN mentions in $ 80 $ 81 “Psora :it is the mother of all true chronic diseases except the syphilitic and sycotic .psora is the most monstrous internal chronic miasm ‘the only real fundamental cause and producer of all the other numerous,forms of disease.” 5
HAHNEMANN also mentions “Long continued obstruction of one or both nostrils,with disaggreeble sensation of dryness in the nose, predisposition to catching cold and many other,sometimes long continuing ailments arising there from ,are some of the characteristics manifestations of psoric miasm.6
DR.HARIMOHAN CHOUDARY mentions that, over growth ,infiltration and deposits, papillomata, nasal stoppage from thickening of membranes and enlargement of turbinated bones.Affection of the soft tissue are some of the manifestation of the sycotic miasm.7
According to S.K.BANERJEA syphilitic patients presents with ulceration of the nasal septum, dimunation of the sense of smell and flat and depressed nose.
PSORA NASAL SYMPTOMS:
· In psora there are various olfactory disturbance of functional originSensation of dryness in the nose.
· Psoric cold begins with sneezing, redness and heat. Nose becomes sensitive after it has been blow for sometime.Discharges are thin and watery and can be acrid also.
· Stoppage of the nostril causes mouth breathing.
· MODALITIES: Psoric nasal symptoms are aggravated in the morning from cold and during sleep. Ameliorated from warmth and by natural discharges.
SYCOSIS NASAL SYMPTOMS:
· In sycosis there are polyps,growths,moles,pailloma and veruccas in the nostrils. There may also be oedematous swelling of the nasal turbinate.
· Bland discharges with a fish brine smell are characteristic of sycosis.
· Difficulty in breathing through the nose can be caused by various growth or oedema.Sycotic nasal discharge are acrid and corrode the skin.
· MODALITIES: Sycotic nasal complaints are aggravated by damp and from change in weather. Amelioration is from abnormal discharges through various mucus membranes,such as coryza.
SYPHILIS NASAL SYMPTOMS:
· Degenerative and ulcerative conditions of the nose.
· In syphilis ,the nose may be flat or depressed from ulceration or destruction of the nasal septum and ulcers may occur inside the nostril..
· Clinkers (thick crusts )which ,can be offensive and often have to be removed.
· MODALITIES: In syphilis ,nasal symptoms are aggravated at night and from the warmth of the bed. Ameliorated by abnormal discharges.
TUBERCULAR MIASM NASAL SYMPTOMS:
· In tubercular nose there is Epistaxis,Nasal polyps which are tri- miasmatic. There is a tendency to the recurrent catching of cold ..
· Flushing in the face,eyes and nose is tubercular.
· Nasal polyps (tri-miasmatic) are termed as tuberculuar which are characterized by profuse haemorrhage.
· MODALITIES: In tubercular miasm,nasal condition are aggravated in a closed room and amelioration in open air. Amelioration by epistaxis is also characteristics of the tubercular miasm.8
In Kents Repertory he mentions under the Rubric : polypus remedies covered are alum,apis,arum-m,aur,bell,calc,calc-I,calp,carbs,con,ferm,graph,hecta,hep,hydra,kali-bi,kali- n,lyc,merc,merc-i-r,nit-ac,,phos,puls,psor,sang,sep,sil,staph,sulph,teucr,thuj.9
In Boericke Repertory he mentions under the Rubric :growth remedies covered are cadm,calc,cald,iod,calc,caust,con,formica,kalibich,kalin,lemnam,merc,nit ac,phos, psor,sang,sangn,staph,teucr,thuja,wyeth10
In Boger Repertory he mentions under the Rubric: polypi;hypertrophies remedies covered are Aur,aur-m,bell,calc-c,cad-s,con,graph,kali-bi,kali-n,merc,merc-aur,nit-ac,pul,sang,sep,sil,staph,sul,thuja. 11
6.3 OBJECTIVES OF STUDY
1)To study the clinical presentation of NASAL POLYPS.
2)To assess miasmatic evalution of Nasal polyps.
3)To signify the miasmatic approach in management of Nasal polyps.
7 / MATERIALS AND METHODS
7.1 SOURCE OF DATA
The subjects for the study will be taken from OPD’s / village camps of BHARTESH HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, BELGAUM.
7.2 METHOD OF COLLECTION OF DATA (Including sampling procedures, if any)
Study Design – Prospective study of randomized clinical trial
Sample size – Minimum 30 in number
Participant subjects –All Adult patients of both sex
irrespective of socioeconomic background.
Selection criteria – On basis of inclusion and exclusion criteria
Sampling method – Simple randomized prospective procedure will be adopted
with subjects willing to take treatment at above specified clinic.
All patients registered between the period of 30th October 2010 to 30 June 2012 will be selected. The cases registered during the same period t will be taken up for study.
Case will be followed according to the signs & symtoms until treated in the due course of study.
FOLLOWING IS THE INCLUSION CRITERIA FIXED FOR THE STUDY
1. All diagnosed cases of Nasal polyp.
2. All Adult Patients of both sex irrespective of socio economic status are taken up for the study.
FOLLOWING IS THE EXCLUSION CRITERIA FIXED FOR THE STUDY
1. Patients with the gross pathological changes.
2. Patients with systemic disorders will be excluded .
RESULT CRITERIA:
· Recovered
· Improved
· Not improved
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTION: TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.
· Routine blood investigations.
· Special investigations may be carried out as and when if it is necessary.
7.4 HAS ETHICAL CLEARANCE HAS BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3
Yes, the ethical clearance has been obtained from institution.
8. / LIST OF REFERENCES
1. Bargava KB. A Short Text Book of ENT Diseases. 7th Edition. Mumbai: Usha publications.; 2005.204,205pp.
2. Hall S and Colman BH .Disease of Nose Throat and Ear. 13th Edition. London:pulished by Churchill Livingstone.;1987.44,47pp.
3. Dhingra PL. Diseases Of The Ear Nose Throat.3rd Edition.New Delhi: Elsevier.; 2004.210,211,212,213pp.
4. www.Similia.com had accesed on19/10/10.
5. Hahnemann S. Organon of Medicine .Sixth Edition,translated by William Boericke M.D.,New Delhi: Indian Books and Periodicals Syndicate.;2005.158,159pp.
6. Hahnemann S.The Chonic Diseases by.Reprint Edition. New Delhi: B Jain Publishers (P) Ltd.;2006.93,109pp.
7. Choudary H.Indication of Miasms .Reprint Edition.New Delhi:B Jain publishers (P) Ltd.;1998.57,61,62,76,87pp.
8. Banerjea SK .Miasmatic Diagnosis Practical Tips With Clinical Comparisions. Reprint Edition.NewDelhi:B Jain Publishers (P)Ltd.;2007.36,37,38pp.
9. Kent JT. Repertory of the Homoeopathic Materia Medica.6th Edition. New Delhi: B Jain Publishers (P) Ltd.; 2007.349pp.
10. Boericke W.Pocket Manual of Homoeopathic Materia Medica and Repertory.Reprint Edition.New Delhi:Indian books and Periodical Publishers.;2004. 598,737,967,1008pp.
11. Boger CM.Boenninghausen’s Characteristics Materia Medica and repertory.Reprint Edition.New Delhi:B Jain publishers (P)
Ltd.;2005.736,737pp.
9. / SIGNATURE OF CANDIDATE
10. / REMARKS OF THE GUIDE
11. / NAME AND DESIGNATION OF
11.1 GUIDE / DR. RAMDAS .AMBUGA, M.D.(HOM)
PROF. & GUIDE
DEPT. OF ORGANON OF MEDICINE
AND PHILOSOPHY,
BHARTESH HOMOEOPATHIC
MEDICAL COLLEGE, HOSPITAL .
BELGAUM – 590010.
11.2 SIGNATURE
11.3 CO-GUIDE (if any)
11.4 SIGNATURE
11.5 HEAD OF THE
DEPARTMENT / DR.RAVEENDRA.NADHAN.M.D.(HOM)
PROF. & H.O.D
DEPT. OF ORGANON OF MEDICINE
AND PHILOSOPHY,
BHARTESH HOMOEOPATHIC
MEDICAL COLLEGE, HOSPITAL.
BELGAUM – 590010.
11.6 SIGNATURE
12. / 12.1 REMARKS OF THE
CHAIRMAN/PRINCIPAL
12.2 SIGNATURE