Scientific Homeopathy

FUNDAMENTAL RESEARCH In-vitro activity of Thuja occidentalis Linn. against human pathogenic aspergilli Dr. Girish Gupta* Dr. A. K. Srivastava** ABSTRACT In-vitro antifungal potential of homoeopathic drug Thuja occidentalis Q, 30, 200, 1M, 10M, 50M against Aspergillus flavus causing cutaneous aspergillosis and Aspergillus niger causing otomycosis in Human are evaluated by following food poisoning method. Thuja Q, 30, 200 are found highly potent against Aspergillus flavus and 50M against Aspergillus niger. Percent growth inhibition, sporulation and exudation are taken as parameters for assessment. Results are reported for the first time and are discussed in relation to homoeopathic concept quot;Higher dilution and high energyquot;. Keywords: Antifungal drugs, Thuja occidentalis, Aspergillus flavus, Aspergillus niger, Aspergil- losis INTRODUCTION mentagrophytes is reported11. The present paper explores in-vitro antifungal potential of homoeo- Aspergilli are wide spread in the environment and pathic drug Thuja occidentalis Q, 30, 200, 1M, 10M are common inhabitants of soil. It is readily recog- and 50M against human pathogenic aspergilli. nized that very large number of people, both adults and children are potentially exposed to such indoor MATERIALS AND METHODS and outdoor contaminants1,2,3. Several studies have FUNGAL ISOLATES provided evidence for the association of cancer in human with inhalation of aflatoxin contaminated A) Aspergillus niger: A clinical isolate of patient dust4,5,6. It is now recognized that there are basi- complaining of chronic ear discharge for several cally three categories of disease involving Aspergilli years. Patients registered himself in GCCHR for the viz. Allergic aspergillosis, colonizing aspergillosis management of disease. MIC of ketoconazole for and invasive aspergillosis7,8,9. Treatment of aspergil- Aspergillus niger was standardized as 0.75 mg/ml losis with an antifungal drug such as amphotericin by following the method of Jacob et al.12 - 13. B is the first step of management but in neutropenic B) Aspergillus flavus: Isolated from skin of the patients it is unsuccessful. Side effects and treat- patient at GCCHR showing hyperpigmentation with ment duration may not be overlooked and is sug- severe itching. MIC of ketoconazole for Aspergillus gestive of finding a nontoxic safe remedy9,10. niger was standardized as 0.50 mg/ml by following Thuja occidentalis, a tall tree belongs to the family the same method as above12 - 13. Cupressaceae. Thuja is considered as antisycotic homoeopathic drug used mainly for wart - like ex- MEDICINES crescences upon mucus and cutaneous surface, vegetative condylomata and spongy tumors. Thuja Thuja occidentalis in various potencies like Q, 30, is known to contain oil of thuja, a thujol, flavone gly- 200, 1M, 10M and 50M was purchased from coside thujin and an acid called thujin. Antifungal manufacturer. Quantity of drug was standardised action of Thuja occidentalis against Candida albi- as 0.5 ml. cans, Trichophyton rubrum, and Trichophyton CONTROLS * B. Sc., G.H.M.S. (Gold Medalist), Chief Consultant Three controls were taken, one of sterile water, Physician ** M. Sc., Ph.D., Medical Mycologist, second of vehicle i.e. rectified spirit and third con- GAURANG CLINIC AND CENTRE FOR HOMOEO- trol of Ketoconazole as positive control. Quantity of PATHIC RESEARCH, B-1/41, Sector A, Near Rajshree drug was taken as per their MIC calculated. Talkies, Kapoorthala, Aliganj, Lucknow-226 024 (UP), INDIA This paper has already been published in Vol. 27, No. 1, January 2002 issue of 'The Homoeopathic Heritage' on pg. 5 - 12. The same is being reprinted here with the prior permission of the authors. 1

EXPERIMENTAL PROTOCOL RESULTS Antimycotic activity of homoeopathic drug Thuja Antifungal efficacy of homoeopathic drug Thuja occidentalis Q, 30, 200, 1M, 10M, 50M prepared in occidentalis Q, 30, 200, 1M, 50M have been rectified sprit was tested by poison food technique12 presented in Tables - 1 and 2 against Aspergillus - 13 against test fungi Aspergillus niger and Aspergil- flavus and Aspergillus niger. Thuja 30, 200 are found lus flavus. 0.5 ml of each drug was mixed with 10 to inhibit the linear diametric growth of Aspergillus ml of Sabouraud's dextrose agar just before solidi- flavus equally on 9th day of post inoculation. Thuja fication in 50 mm diameter petridishes. SDA plates 1M showed no effect, the growth of Aspergillus with 0.5 ml sterile water, 0.5 ml rectified spirit and flavus was almost equal to control I (SW) and more 0.5 ml containing 5 mg ketoconozole (200mg tablet than control II (RS) (Table - 1). Other potencies dissolved in 20 ml water) for Aspergillus niger and showed less sporulation in comparison to controls 0.75 ml for Aspergillus flavus were kept as controls. but Thuja 30 and 200 showed no sporulation (Plate All the plates including controls were inoculated - I; figs : 5 - 6). Percent growth inhibition of centrally with 1.5 mm diameter of disc of test fungi Aspergillus flavus on 9th day of post inoculation are aseptically from 8 to 10 days old SDA plates cul- presented in figs. 10 and 11. Fig. 10 is based on ture. All the experimental petridishes were used in control I (SW) and fig. 11 is based on control II (RS). triplicates and incubated at 37°C. The linear dia- It is evident from the figs. 10 - 11 that Thuja 30 and metrical growth of colonies were measured (in cm.) Thuja 200 showed maximum inhibition i.e. 77.77% on 3rd, 6th and 9th days of post inoculation. The in each as compared to control I and 64.28% in results were presented on an average of three plates each as compared to control II. Percent growth on 9th days of post inoculation. Percent growth in- inhibition of positive control i.e. ketoconazole was hibition was calculated as per formula. 93.33 and 89.28 as compared to control I and control II respectively. Thuja 30 and Thuja 200 was less by 15.56 percent in each as compared to ketoconazole based on control I and 25 percent in each as compared ketoconazole based on control II. dc = Colony diameter of control Thuja 50 M was very effective against Aspergillus dt = Colony diameter of treated plate niger. Colony diameter observed was 2.2 mm al- 2

lar diseases, tissue barrier breaks, accidental in- most equal to Ketoconazole (2.1 mm) on 9th day of fections, renal or cardiac transplant and frequent post inoculation (Table - 2). However no significant use antibiotics, cortisone and cytotoxins. Treatment effect on sporulation was noted (Plate II; Figs: 12 - available for the Aspergillosis is not very safe in 20). Thuja 200 showed effect on sporulation but lin- terms of drug toxicity18 - 19. Thus in the present ear diametric growth of colony was insignificant. investigation homoeopathic drug Thuja occidentalis Percent inhibition growth was presented in figs. 21 is evaluated in vitro for its antifungal potential. - 22. Fig 21 is based on sterile water (Control I) and Thuja 30 and 200 was found promising against fig 22 is based on rectified sprit (Control II). As it is Aspergillus flavus whereas Thuja 50M was found evident from figs. 21 - 22, Thuja 50M showed maxi- effective against Aspergillus niger. Mode of action mum percent growth inhibition 52.17 of Aspergillus as to how homoeopathic drug works is not evalu- niger as compared to control I (SW) and 38.89 as ated in this study. How some potency of homoeo- compared to control II (RS). Thuja 50 M is equally pathic drugs enhanced the growth of fungus is the effective as the allopathic drug quot;Ketoconazolequot;. subject of further study. It is well established from Observations taken on 3rd and 5th day of post in- the present investigation that Thuja 30 and 200 is oculation are shown just to observe linear growth very effective against Aspergillus flavus causing pattern of test fungi thus not discussed in details cutaneous aspergillosis in human and Thuja 50M however mentioned in table 1 and table 2. is effective against Aspergillus niger known to cause otomycosis. Due to limitation of experimental ani- DISCUSSION mal facilities in our Laboratory, in - vivo experiments Infection due to species of Aspergillus have become could not be done but are suggested for further in- common and often prove fatal on systemic dissemi- vestigation. host 14,15,16,17 . nation in compromised Compromisation of the patient results from Tuber- The most controversial aspect of homoeopathic di- culosis, Cancer, Bronchiectasis, Lymphoma, Dia- lution is that succussion and trituration actually in- betes, Sarcoidosis, Silicosis and Collagen vascu- 4

crease the power of remedy. Clinical efficacy of high 7. Rippon J. W., 1988, Medical Mycology. The dilution is well established in homoeopathic science. pathogenic fungi and the pathogenic actinomycetes, But in the present investigation it is proved that there W.B. Saunders Company, Philadelphia. pp. 797 is no increase in the activity of higher dilution. Thuja 30 and 200 is effective against Aspergillus flavus 8. Emmon's E. W., 1977, Medical Mycology, however higher dilution 1M, 10M and 50M is not Lea & Febiger, Philadelphia. effective which contradicts theory of high dilution and high energy. The present investigation consti- 9. Srivastava O. P., Srivastava A. K., Shukla tute the first report for proving in vitro action of ho- P. K., 1988, Advances in Medical Mycology Vol. 2, moeopathic drug Thuja occidentalis Q, 30, 200, 1M, Evoker Research Perfecting Company, Lucknow. 10M, 50M against human pathogenic fungi viz. As- pp. 182 pergillus flavus and Aspergillus niger. The findings also disqualify the concept of higher energy and 10. Gupta G., Srivastava A. K., Gupta N., 1997, high dilution in the system of fungi - a eukarolic or- Mycoses: An update over clinical cure with Homoeo- ganism. Similar results were also observed by Singh pathic drugs. Asian Homoeopathic Journal 7(4) : and Gupta et al.20,21,22 and proved antiviral efficacy 67-96 of homoeopathic drugs against plant and animal viruses. Sharma 1998 suggested vital force is 11. Akhtar Husain et al. 1992, Directory of India certainly a form of Sharmon-composed quot;basic sub- Medicinal plants, Central Institute of Medicinal and stancequot; which mediates the molecular mechanisms aromatic plants, India pp 546. underlying vital functions of health and disease and also potentization of medicines through 12. Wahab S., Srivastava. O. P., Singh N. B., dynamization processes as human cells23. Vital Gupta S. K., 1978, Comparative in vitro and in vivo force concept requires updation in the term of en- evaluation of toliciclate, tonaftate, miconazole, ergy quanta, their measuring parameters and con- clotrimazole and undecylenic acid against Tricho- stitutional suitability of potency to the patients and phyton mentagrophytes. Indian J. Exp. Biol., 16, their disease. 1200 - 1202. REFERENCES 13. Wahab, S., Tandon, R. N., Jacob, Z., Sagar, P. & Srivastava, O. P., 1981, In vitro activity of 1. Srivastava A. K., 1991, Air pollution phytochemical alantolactone from Inula racemosa (Biopollutants in air), Ashish Publishing House, New Hook f. against some pathogenic and opportunistic Delhi, pp. 302. fungi. J. Indian Bot. Soc., 60, 278 -281. 2. Srivastava A. K., 1992, Mould Allergy - an 14. Srivastava A. K., Garg K. L., Neelima Garg, overview, Advances in Medical Mycology edited by 1992, Health risk associated with fungal agents from Mukherji et al., Aditya Books, New Delhi, pp. 63 - sludge, Advances in Medical Mycology edited by 80. Mukherji et. al., Aditya Books, New Delhi, pp. 145 - 156. 3. Nair M. V., Gupta S., Srivastava A. K.(eds), 1996, Environmental biopollutants and human 15. Wadhwani K., Srivastava A. K., 1984, Fungi health, Anmol Publication Pvt. Ltd., New Delhi, pp. from Otitis media of agricultural field workers, 199. Mycopathologia 88 : 155 -159. 4. Dvorackova I, 1976, Aflatoxin inhalation and 16. Wadhwani K., Srivastava A. K., 1985, Some alveolar cell carcinoma. Br. Med J III : 691 cases of Onchomycosis from North India in different working environment Mycopathologia 92 : 149 5. Olsen J. H., Dragsted L., Autrup H., 1998, - 266. Cancer risk and occupational exposure to aflatoxins in Denmark. Br. J Cancer 58: 392 - 396. 17. Das Gupta S. N., Shome S. K., 1959, Stud- ies in Medical Mycology I - On the occurrence of 6. Hayes R. B., Van Nieuwenhuze J. P., mycotic diseases in Lucknow. Mycopath. & Mycol Raatgever J. W., Ten Kate F. J. W. 1984, Aflatoxin Appl., 10: 177-186. exposures in the industrial setting : an epidemio- logical study of morality. Food Chem Toxicol 22: 39 18. Varma R. S., 1997, Antifungal agents from - 43. natural products, National seminar on quot;Emerging 6

trends in the management of fungal (Mycotic) in- 21. Singh B. P., Gupta G., Srivastava K. M., fectionsquot;, Nov. 14 - 16, 1997, at Industrial Toxicol- 1980, quot;Homoeopathic Drugs as inhibitors of To- ogy Research Centre, Lucknow, organized by Na- bacco Mosaic Virusquot;, (1980), Indian Journal of Ho- tional Academy of Chemistry and Biology (India), moeopathy IV(7) : 301 - 303. abstract no. 11. 22. Khurana Paul S. M., Gupta G., 1981, quot;Ho- 19. Srivastava A. K., Singh K. P., Ray P. K., 1997, moeopathy: Promises & Prospects for plant pro- Protein A induced protection against experimental tectionquot;, Advancing Homoeopathy 1: 107 - 116. Candidiasis in mice Mycopathologia 138: 21-28. 23. Sharma R. R., 1998, The vital force: An up- 20. Singh L. M., Gupta G., 1985, quot;Antiviral effi- date proceedings of 8th National homoeopathic cacy of Homoeopathic drugs against animal vi- conference 3rd and 4th April 1998, Eds. - Arora et. rusesquot;, The British Homoeopathic Journal, 74(3): al., organized by Research Society of homoeopa- 168 - 174. thy, Lucknow. 7

DRUG PROVING DRUG PROVING A Systematic Review of Homeopathic Pathogenetic Trials from 1945 To 1995 Flávio Dantas! , Peter Fisher, D.P.Rastogi, Dick Koster, Maria Eugenia Pulido Alvarez, José Eizayaga, Frank Wieland, Harald Walach, Hélio Teixeira, Jean Pierre Jansen, Luc Louis Maurice Weckx, Matheus Marim, Philippe Belon BACKGROUND However a critical analysis of Hahnemann’s method to conduct HPTs raised many flaws and systematic errors2, given our current knowledge, Homoeopathic pathogenetic trials (HPTs) are the basic method of homoeopathy. They are which could not be anticipated by Hahnemann at designed to investigate body and mind effects of that time, leading to an over-estimation of medicine potentially toxic or pathogenic substances, diluted effects. Some of them are described below: and serially agitated according to homoeopathic Absence of control group pharmacopoeias, in non-patient volunteers in good Use of well-known friends and lecture and relatively stable health conditions. They are audiences as volunteers (“believers”) clinical trials designed to assess the effects of highly Volunteers informed that they were using diluted medicines in healthy volunteers, the results a medicine to observe effects upon them are applied in practice on the basis of ‘Similia Recording of all complaints, symptoms similibus curentur’. and changes observed during the action of the medicine even if the person has The methodology of HPTs was first proposed noticed similar symptoms in himself a by Hahnemann. The controlled investigation of the considerable time before pathogenetic power of medicines was one yardstick Absence of masking in volunteers or in in Hahnemann’s writings. Hahnemann recognized early in the Organon1 the main methodological supervisors of the trial problems of HPTs, namely truthfulness of Close supervision and daily (or 2-3 days) volunteers, to use medicines with different powers interview with subjects + daily recording and to deal with individual differences. In attempting in a pocket notebook to minimize the effects of suggestion on volunteers Sudden prohibition of coffee, tea, spices Hahnemann recommended that “in the investigation and alcoholic drinks (or medicinal drugs) of these drug-symptoms all suggestion must be as Vague definition of healthy volunteers rigidly avoided as in the examination of the ==> Inclusion of non-healthy volunteers symptoms of disease”. To obtain symptoms as No random assignment of subjects accurately as possible, every subject had a pocket- size notebook to write down the sensations and changes immediately after they occurred. The Taken together these flaws are sufficient to cause volunteers were required to repeat the description serious doubts on the scientific acceptability of the of the changes without referring to this notebook specific pathogenetic symptoms reported in during the personal interview: if the accounts varied Hahnemann’s writings. This was partially confirmed he advised the director of the trial to confront the in a preliminary systematic review of HPTs published subject with both versions and invite him to choose in the UK from 1945-1995, including 45 studies, and confirm the statement which is nearest to the which showed a great deal of variability in terms of truth. Prevention of guess-work, imagination and the medicines tested, methodology, volunteers, recording of findings only after close questioning sample size and outcome. This was reflected in great were continuously stressed in different editions of variability in the numbers, incidence and types of the Organon. For him only reliable symptoms effects reported. There was also a clear association should be included in the homoeopathic materia between the methodological quality of the trial and medica. !Universidade Federal de Uberlândia / Universidade Federal de São Paulo (Brazil). Former Visiting Research Fellow, The Royal London Homoeopathic Hospital (UK) * Originally published in the transactions of the conference quot;Improving the Success of Homeopathy 5: A Global Perspectivequot;, London 26-27 january 2006. 8

the numbers of effects reported: better trials produced distinguishable from verum, placebo potentised, a lower incidence of pathogenetic effects (or none) comparative group, crossover, washout period compared to trials of poorer quality. Overall the (post-treatment observation), management of analysis of reports revealed methodological adverse effects, rules for stopping medicine, shortcomings which could seriously compromise the rationale and source of the medicine. The validity, reliability and clinical applicability of the assessment of each trial was recorded in terms of: results3. use of symptom diary, type of diary, initial interview (case-taking/ collection of previous symptoms), To what extent have HPT incorporated new follow-up interview, use of laboratory investigations, methods developed in scientific medicine in the five use of psychological tests, withdrawal/dropout of decades from 1945 to 1995? Can we rely on the volunteers, reason for withdrawal, withdrawal due conclusions drawn from HPT done during this to severe adverse effects, presence of adverse period? A systematic review of published studies effects, pre-defined categories for assessment of was therefore designed to assess the methods and the attributes of a symptom. outcomes of HPTs published in six languages (English, German, Spanish, French, Portuguese For the presentation of results we extracted and Dutch) in the five decades from 1945 to 1995 information on the frequency of symptoms in the and to help design and conduct future HPT to get sample, description of complete symptoms, more valid and reliable information. analytical presentation, chronology of symptoms, character of symptoms, location of symptoms, METHODS duration of symptoms, onset of symptoms, intensity of symptoms, modalities of symptoms, presence A criterion-based systematic review of HPTs of concomitant symptoms, inclusion of prior was done in trials published in six languages from symptoms that improved during the trial, detailed 1945 to 1995. The literature was exhaustively report of individual volunteers, use of symptom searched and only published reports of HPTs were tables and charts. included. Information was extracted by two independent reviewers, with experience in The interpretation of the results by the conducting HPT or clinical research, using a authors was reviewed in terms of : pre-defined specially developed form with 87 items. Information criteria to include medicine effects, use of on: medicines, volunteers, ethics, blinding, descriptive statistics (measures of central tendency randomisation, use of placebo, adverse effects, or dispersion of data), use of statistical tests and assessments, presentation of data and number of presence and number of significant findings claimed findings were recorded. claimed. For each medicine the name , dilution(s), Finally, each reviewer was invited to make method of dilution, presentation, dose, frequency a subjective judgement: ‘after reading and analysing per day, repetition of doses, total duration of the all the points above, and based exclusively on the trial, number of active treatment periods and published report’: duration per volunteer (in days), source of the drug, - Do you think the symptoms stated as mode of preparation and preparation responsibility belonging to the medicine can be trusted ? was recorded. Regarding the study population we - Would you apply the information given in it extracted the initial and final number, ethnic origin, into your clinical practice to prescribe this sex, age, occupation, number of control volunteers, medicine to a patient? For both questions percentage of sensitive volunteers, inclusion the options were certainly, almost certainly, criteria, exclusion criteria, assessment of health probably, possibly, with serious reservations, status prior to admission, training of volunteers, definitely not, can’t answer or none claimed personality traits, physical characteristics, informed - From a methodological point of view, you consent, method of recruitment. judge this report of proving as: completely reliable, very reliable, reliable, unreliable, The study method was assessed in terms completely unreliable of: approval of protocol by Ethical Committee, - Compared to the other reports you read, you direction/coordination, randomization, sequence think this is: below average, average, above generation of subjects in the trial, allocation average, much above average, excellent. concealment, masking (blindness) of volunteers A final, open question asked about the main and of supervisor, use of placebo, pre-trial methodological criticisms of the reviewer to each observation period with or without placebo, placebo study. 9

The methodological quality of published class I is the worst and class IV is the best quality HPTs was assessed by a specially designed index, HPT. Cutoff points of score for the different classes using mainly traditional indicators of quality in were 4,5,6 for Class I, 7,8,9,10 for Class II, 11,12,13 clinical trials, complemented by a personal for Class III and 14,15,16 for Class IV. The judgement of reviewers for each study. Scores Methodological Quality Index for homeopathic were organized in 4 methodological classes, where pathogenetic trials is shown below: SCORE Variable 1 2 3 4 Randomization Not Only stated, Incomplete, description Complete, description stated no details of sequence generation of sequence or allocation concealment generation and allocation concealment Blinding Not Single blind Double-blind without Double-blind with stated checking checking after finishing the study Inclusion and Not One partially One clearly stated or Clearly stated Exclusion stated stated both partially stated Criteria Criteria for Not At least one 2 to 4 defined More than 4 defined Selection of stated stated defined controls) were double analysed by two reviewers. Pathogenetic effects were defined as all Most reports did not mention ethical approval. Use clinical events and laboratory findings noted by of placebo control was variable, overall in 56% of volunteers during a HPT and recorded in the final trials volunteers took placebo, placebo symptoms report. In other words they are the findings claimed were often not used as comparators, some at the end of the trial by authors to be used by investigators progressively abandoned the use of practitioners seeing patients with similar pictures. placebo. The quality of reports was in general poor, We counted as one pathogenetic effect a piece of and much important information was not available. information which could be included in an homoeopathic repertory as an independent A growing number of HPTs was published subheading. For instance “boring headache along the decades, particularly in the last decade ameliorated by pressure” was counted as one (800% more than in 1945). Table 1 shows included claim. publications by language in the period from 1945 to 1995: PRELIMINARY RESULTS AND DISCUSSION 156 HPTs reporting the effects of 143 medicines in a total of 2815 volunteers (769 Time Language Total English German Dutch French Spanishl Portuguese 1945 - 1955 9 0 0 1 1 0 11 1956 - 1965 11 1 0 0 0 0 12 1966 - 1975 16 3 0 0 0 0 19 1976 - 1985 16 9 1 2 0 0 28 1986 - 1995 32 20 16 8 6 4 86 Total 84 33 17 11 7 4 156 Table 1. Number of included HPT per decade and language 10

There was a statistical difference among languages HPTs were done mainly in Índia (36 studies) of publication of HPTs only when Dutch was and United Kingdom (30), followed by German (17), compared to English and German languages. Nederlands (17), Austria (16), France (13), United Figure 1 shows the mean methodological score by States (12), Mexico (9), Brazil (2), New Zealand language: (2), Norway (1) and Argentina (1). 10 95% CI Methodological Score 8 6 4 2 English French Spanish Portuguese German Dutch Figura 1: Mean of methodological scores by language of publication Most HPTs were done in homoeopathic volunteers tend to produce more pathogenetic teaching or research centres under the supervision effects than male. Ethnicity data were in general of medical doctors. Volunteers were mainly ignored in the reports. recruited in homeopathic medical schools (India) or post-graduated courses for doctors. Trial duration Before-After studies were the most used (mean 34 days) was very variable. Studies included designs, with or without parallel groups using from 1 to 103 volunteers (median 15). A single placebo. There is a recent trend to use randomized volunteer was used in 7 HPTs and in other 3 only placebo controlled trials, 14 of them used a two volunteers were included. 57% of the reports crossover design. There was a large variation in did not state age of volunteers and in 34% there is methods and results, and in general the quality of a lack of information on gender. Age range was 5 the studies was very low. Almost all publications to 76 years. Male volunteers accounted for 1169 reported one or more pathogenetic effect. There and female volunteers were 857. In 28 studies there was a strong tendency for more symptoms to be were more female included than male, and this trend reported from HPTs of poor quality than from better was increased in the last decade. Female studies. 11

65 publications tested medicines in single dilutions Plants were the most common source for and 91 in different dilutions used by the same or tested medicines (75), followed by animal (29), different volunteers. In total 323 dilutions were used, mineral (18), chemicals (14) and pharmaceutical mostly centesimal (192) followed by decimal (129) drugs (11). Two publications studied energy and fifty millesimal (2). 30c was the most frequently sources and one study used a coded and unknown used dilution in our sample (66 trials) followed by substance. Figure 2 shows the rationale for selection 6c (33) and 6x (32). More than 50% of the tested of the substances to be tested in HPTs: medicines were not studied before the study took place. Medicinal properties 54 Human toxicity 31 Other 13 Rationale Confirming HPT 9 Animal toxicity 6 Doctrine of Signatures 3 Adverse effects of drugs 1 Not stated 46 0 10 20 30 40 50 60 Number of publications (%) Figura 2. Rationale for conducting HPTs There was a large variation in methods and The identification and causal attribution of results. Most studies were of poor quality and changes in healthy volunteers is very complex, it showed flawed designs, mainly absence of proper may be influenced by a large number of factors. It randomization, blinding, placebo control and criteria is strongly dependent on individual awareness and for analysis of outcomes. There was a significant past experiences. In the absence of adequate trend for more symptoms to be reported from HPTs control, clinical studies can yield results favouring of poor quality than from better studies. There are investigators' assumptions if the study is not properly some major outstanding methodological problems controlled, context is also important 4,5,6. The including lack of appropriate controls for proper importance of conditioning was demonstrated in evaluation of idiosyncratic effects and criteria to medical students in an experiment where students attribute symptoms to treatment. were conditioned to expect sedative or stimulant effects but received only placebo in blue or pink Several factors may account for the great capsules. Volunteers' behaviour pattern has also variability in the results. Among others the settings been shown to influence the reporting of subjective in which they were done, the lack of description of symptoms after placebo 7. Most of the HPTs inclusion and exclusion criteria for volunteers, reviewed here were done in the context of differences in study design and use of placebo, style homoeopathic courses with students learning of supervision, blinding, randomization (or homoeopathy. 7.2 body and mental changes were suggestion), criteria for selection of pathogenetic reported by healthy Brazilian medical students effects and assumptions concerning attribution of responding to a survey on symptoms they symptoms to the medicine tested. experienced in the last week8. In this situation two factors could bias the outcome towards increased 12

reporting of symptoms: the students, believers in decades several attempts to develop new the system and the production, in the past, of valid approaches to test homeopathic medicines in symptoms from HPTs; and the coordinator healthy volunteers were done, either for testing new substances10 or to confirm results11,12. It is urgent expecting the students to give him useful information after testing the substance. to improve the quality of reporting and it is imperative to have a consensus on minimal requirements for The consistency of the effects across trials reporting HPT. The central question of whether is another matter. Many investigators seemed to homoeopathic medicines in high dilutions can have taken for granted that every substance must provoke effects in healthy volunteers has not yet elicit symptoms and for this reason felt it been definitively answered. We need a pure unnecessary to use placebo as a control or failed homeopathic materia medica, with valid and reliable to include symptoms experienced by volunteers information from HPT, to get better results in our taking placebo. On the other hand the use of clinical practice and research. placebo exclusively for comparative statistical purpose excludes from consideration rare, Acknowledgements idiosyncratic effects. Attempts by Martini in the 1930's to evaluate the occurrence of pathogenetic CNPq (Conselho Nacional de Desenvolvimento effects due to highly diluted substances in HPTs Científico e Tecnológico do Brasil); Royal London were, on the whole negative, a critical reappraisal Homoeopathic Hospital; Cecília Lomônaco de Paula of his results shows that no definite conclusion can and Gleice Margarete de Souza Conceição for be drawn9. statistical advise; Mary Gooch for help in literature search; David Riley for early cooperation in Further methodological improvements for informing HPTs done in USA. designing rigorous HPT are required. In the last REFERENCES 1. Hahnemann S. The Organon of Medicine. Los Angeles; J.P. Tarcher, 1982. 2. Dantas F. How can we get more reliable information from homoeopathic pathogenetic trials? A critique of provings. Br. Hom. J. 1996; 85: 230-236. 3. Dantas F, Fisher P. A systematic review of homoeopathic pathogenetic trials ('provings') published in the United Kingdom from 1945 to 1995. In: Ernst E, Hahn EG. Homoeopathy: a critical appraisal. London: Butterworth-Heinemann; 1998. p. 69-97. 4. Green DM. Pre-existing conditions, placebo reactions and quot;side effectsquot;. Ann Int Med 1964; 60:255-265. 5. Reidenberg MM, Lowenthal DT. Adverse nondrug reactions. New Eng J Med 1968; 279:678- 9. 6. Meyer FP, Troger U, Rohl FW.Adverse nondrug reactions: an update. Clin Pharmacol Ther. 1996;60(3):347-52. 7. Drici M, Raybaud F, De Lunardo C, Iacono P, Gustovic P. Influence of the behaviour pattern on the nocebo response of healthy volunteers. Br J clin Pharmacol 1995; 39: 204 206. 8. Dantas F. Incidência de efeitos patogenéticos não-farmacológicos e triviais numa amostra de estudantes de medicina. Revista de Homeopatia 2004; 69:5-10. 9. Walach H. Research in Homoeopathy in Germany during the Thirties: Inquiry by the Reichsgesundheitsamt 1936-1939 , the remedy proving by Martini. Berlin J Research Hom 1991; 1:325-338. 10. Fisher P, Dantas F. Homeopathic pathogenetic trials of Acidum malicum and Acidum ascorbicum. Br Hom J 2001; 90(3): 118-125. 11. McCarney R, Fisher P, Spink F, Flint G, van Haselen R. Can homeopaths detect homeopathic medicines by dowsing? A randomized, double-blind, placebo-controlled trial. J R Soc Med. 2002;95(4):189-91. 12. Signorini A, Lubrano A, Manuele G, Fagone G, Vittorini C, Boso F, Vianello P, Rebuffi A, Frongia T, Rocco V, Pichler C. Classical and new proving methodology: provings of Plumbum metallicum and Piper methysticum and comparison with a classical proving of Plumbum metallicum. Homeopathy. 2005;94(3):164-74. 13

CLINICAL RESEARCH Evaluation of Homoeopathic Therapy in Osteoarthritis- A Study conducted by CCRH Abstract The prevalence of Osteoarthritis (OA) increases with advancing age, that is 50 years or above. The change in the chemical characteristics of the ground substance of the joint, heredity, overuse of joints, obesity, hyper mobility, orthopaedic deformities, endocrine diseases are important in the causation of this disease. This study was undertaken to see the effect of homoeopathic medicines and their reliable indications, their most useful potencies, frequency of administration and the same was conducted at Clinical Research Unit, Patiala and Central Research Institute, Kottayam. At Clinical Research Unit, Patiala, 93 cases were studied under Drug Related Programme and 360 cases were studied under Disease Related Programme. At Central Research Institute, Kottayam, 273 cases were studed under Disease Related Programme were studied. The patients of inflammatory, metabolic, suppurative and systemic arthritis were excluded from this study. 78 patients were found markedly improved joint pains, with agg. during motion and on beginning to move. Materials and Method Introduction A total of 726 cases were enrolled in the Osteoarthritis (OA, osteoarthrosis) is by far study. Out of these, 93 cases were studied under the most common form of arthritis. It shows a strong Drug related programme of Clinical Research in association with ageing and is a major cause of Patiala (2001-2003) and under the Disease related pain and disability in the elderly. Pathologically, it project – 360 cases at Clinical Research Unit, may be defined as a condition of synovial joints Patiala (1993 to 2003) and 273 cases at Central characterized by: Research Institute, Kottayam (2000 to 2003). The • Focal loss of articular hyaline cartilage etiological factors are : • Simultaneous proliferation of new bone with remodeling of joint contour Miasmatic profile of : Psora (33 cases), 273 cases Sycosis (68 cases), Inflammation is not a prominent feature. OA, Mixed miasm(123 cases), however, is not a disease or a single condition. It Pseudo psora (49 cases). is best viewed as the dynamic repair process of Precipitating factors : Over use of joints (263 synovial joints that may be triggered by a variety of in 545 cases cases), insults, some but not all of which result in Cold climate(155 cases), symptomatic ‘joint failure’. Radiographic and Dampness (127 cases). autopsy studies show that OA preferentially targets only certain small and large joints. There is a steady Parameters Assessment of intensity of the dis- rise in overall prevalence from age 30 such that by ease 65, 80% of people have some radiographic evidence of OA, though only 25-30% have Mild : Asymptomatic cases but only associated symptoms. The knee and hip are the radiological abnormalities principal large joints affected and the principal sites of significant disability. Knee OA is more prevalent Moderate : Cases with severe pain, stiffness, with or without than hip OA, but taken together they affect 10-25% swelling with or without of those aged over 65 years. Homoeopathic cracking in joints, with or medicines have been reported to be effective in without lock knee, with or OA. CCRH started the work with an objective to without Heberden's nodes, with see the effect of Homoeopathic therapy in OA and or without deformities but no to determine the reliable indications, potencies or pain at night. frequency of administration of the medicines found Severe : Cases with night pains useful in relieving OA. 14

Selection of research cases: Worse : Aggravation of signs and symptoms even after the General : treatment with well selected remedies. • All cases of joint disease which seem to be Result degenerative nature and excluding known cases of inflammatory, metabolic, Suppurative Improvement indices and systemic arthritis, . Total Male Female • In relation to age, sex, occupation and physical Improved constitution, the patient are registered initially - Mild 12 02 10 - Moderate 105 20 85 before the inclusion. - Marked 78 10 68 Not improved 02 00 02 Symptoms related to particular system: Not reported 37 02 35 Dropped out 19 02 17 • Joint pain Under observation 20 03 17 • Localized or generalized with or without Subjective symptoms swelling • < During rest Before After • < After bodily exertion treatment treatment • < On beginning to move Pain Joints 273 32 • Relieved by continuous motion Pain joints < motion 404 282 • Morning stiffness Pain < beginning to move 207 117 Pain < night 114 21 • Crepitus/cracking in joints Pain < day time 47 24 • Locked knee Pain < after movements 91 20 • Limitation of movement Pain < rest 447 282 • Morning stiffness 669 353 Heberden's nodes Cracking in joints 190 20 • Deformities like genu varus, halux valgus etc. Lock knee 146 10 Bilateral paraesthesia 55 07 Assessment of improvement of cases Symptoms of cord 108 36 compression Cure : Complete disappearance of the subjective & objective with no recurrence for the next five Objective symptoms years. Before After Mild : Reduction in pain and other treatment treatment symptoms with recurrence after least exertion. Swelling of joints 211 31 Limitation of motion 228 77 Marked : Complete disappearance of Deformities 05 05 subjective and objective Heberden's nodes 02 02 symptoms (excluding radiologi- Flexion contractures 01 00 cal findings) with no recur- Weakness of lower limbs 83 13 rence during the period under report. Pathological / radiological findings Moderate : Disappearance of the symptoms like morning Before After stiffness, cracking, lock knee, treatment treatment limitations of motion etc. but only the mitigation of pains. Osteophytes deposition 138 112 Reduction of joint space 131 131 Not improved : No improvement even after Sclerosis of subchondral 04 04 considerable period of bones treatment with similar remedy. Subchondral cyst 02 02 15

Drugs found effective restlessness, amelioration by warm application. pains are worse in fine weather but relieved in rainy (Before treatment/After treatment) season. Joint pains with tearing and drawing, deformities at the joint, joint affection with weakness Ars. Alb. 30,200,1M 05 04 of limbs and tendency to fall, numbness of limbs at Calc. carb. 30,200,1M 29 25 night, pains are aggravated at night with Lyco. 30,200,1M 76 67 restlessness and amel. by warm application. Medorh.30,200,1M 10 8 cracking of joints especially knee. Nat. mur. 30,200,1M,10M 12 9 Puls. 30,200,1M,10M 17 12 Graphites Rhus tox. 30,200,1M,10M 63 55 Pain especially in women of climacteric age. Sulphur 30,200,1M,10M 13 7 Pain is more at night. < cold air, cold bath, winter. > warm application, chilly patient, desiring warmth. Aversion to sweets and fish. Scanty menses of Reliable indications of the drugs found useful short duration. Habitual constipation. Lycopodium Arsenicum album Drawing and tearing pain in knee joints. Pain Nocturnal burning pain relieved by warm of knee joints worse at night and rest. Pain of knee application, warm bath. Pain agg. damp cold joint better with warm application. Swelling on the season with tingling and numbness of the limbs, rt, knee joint with numbness. Carbonitrogenoid pain agg. by cold air, fanning and uncovering. constitution, desires warm food and drinks, sweets, desires cold climate, excessive flatulence esp. Bryonia evening hours and after flatulent food. Eating a little Mild swelling in the knee joints. Stiffness in causes fullness in abdomen, pain and stiffness of the knee joints. Pain in knee joints< by motion > by joints < at night, first motion, winter, amel. continued rest. < night, change of climate from cold to warm, motion, cold applications, Rt. sided affections, amelioration by absolute rest. Backache agg. while rheumatism of right shoulder < raising the limb. turning in the bed. Joints pain amel. by lying on back, pressure or wrapping up. Pain in joints, Medorrhinum swelling, sitting, pain, agg. night, motion, change Warm patient, burning sensation all over, of climate from cold to warm, amel. by absolute desires cold food and drinks. General relief in rainy rest. Backache agg. while turning in the bed, pain season, gen. aggravation in warm and winter joints amel. by lying on back, pressure or wrapping season, pain agg. first motion, winter, summer, up, adapted to robust fibre and dark constitution. daytime, amel. contd. motion, rainy season. Calcarea carb. Natrum mur. Found effective in fat, flabby, and flatulent Constitutional remedy with caving for salt and constitution, liable to affections of weight bearing salty thing, warm patient, always desires cold, pains joints. Pain knee joints agg, squatting, rising from in spinal joints which are more during sitting, squatting., cold climate, standing in cold basement. standing and lying on sides. Pain is better by lying Amel. by warm application, cracking in joints on on back on something hard. Pain in knee joints motion, chilly patient, desires warm food, cold with cracking sensation. drinks, egg, fish, aversion to milk,. Sharp sticking pains in the knee joints. Pain worse in change of Rhus tox. weather and physical exertion. Pain in knee joint Chilly patient, desires warmth in general, warm better in warm dry climate, worse in cold weather. food and drinks, desires milk, rheumatism of left, Tendency to obesity. Burning in soles of feet. shoulder joint, left sided affections mainly, pain stiffness and swelling of joints, large and small; Calcarea phos. aggravation at night, morning, beginning to move, Chilly patient, knee joint affected from left to first motion, after physical exertion, rest, winter right, desires salt, meat and fish, cold food and season, damp season, constantly standing on drinks, , cracking in joints on motion, and on rising damp floor, bathing, cloudy weather, over exertion from seat, stiffness and pain in joints, with coldness of joints, after excessive sweating, turning in the and numbness of limbs. Pain is worse during bed, amelioration continued motion, day time, ascending. warmth, warm bath, warm application, warm season, rubbing, tight bandage, covering of the Causticum part, restless at night, constantly changes position Pain and stiffness in the knee joints. Pain in bed, pain in back especially, lumbar region is better by hard pressure and heat. Paralytic feeling amel. by lying on back. in lower limbs. Numbness of limbs at night with 16

Sulphur obesity, hper mobility, orthopaedic deformities, Rheumatism of left shoulder joint, burning type endocrine disease like Diabetes mellitus, of pain, < night, raising the affected limb, drawing hypothyroidism, hyperparathyroidism etc. are and tearing pains at night, pain agg. due to the heat important in the causation of this disease. It is of the bed, pain lumbar region, agg. standing and usually primary but may develop secondary to any rising from stooping, has to stoop a while after joint disease or joint injuries. rising, warm patient. Desires cold food and drinks, open air, and warm bath, winter season, amel. dry In our study it was observed that no age warm weather, burning Sensation of palms and was an exempted from this disease because the soles, at night, amel. by cold application, desires age of the patients ranged from 15 years to 88 sweets, aversian to milk. years (refer table 2.3.1. and 2.3.2.). However, it is further observed that in more than 225 cases Pulsatilla included in the study, age ranged from 40 to 60 Warm patient, desires open air, cold food, cold years of age. This means that this is a disease of drinks, cold climate, gen amel. in cold, sensitive advancing age. Among the 273 cases studied, 255 to pain which rapidly shift from one joint to another, belong to primary OA in which heredity, obesity, easily weeping, consolation amel., pain agg. at overuse of joints, hypermobility, etc. were found night, amel. open air, agg. rest, first motion, amel. responsible for the onset and/or continuation of the continued motion, pain agg. from letting the affected disease process. limb down, pain of drawing or tearing type, with chilliness especially at night, patient is usually Conclusion thirstless, with late or protracted menstruation. Response to treatment on the basis of Discussion recurrence of symptoms and signs during and after treatment and symptomatic improvement were also Osteo arthritis, the most common joint disease studied. It has been observed that in 88 cases no of the aged is symptomatic three times more often recurrence of signs & symptoms was noticed and in women than men, and is resulting from majority of the cases in which symptoms recurred degeneration of the articular cartilage and fibro only in less intensity and in short duration. The X- cartilage in inter vertebral discs. The prevalence ray examination shows that in a few cases even of this disease sharply increases with advancing the marginal osteophytes deposition decreased. age, with mean age of onset is 50 years but the No increase in osteophytes deposition found during other factors notably, heredity, over use of joints, the treatment but in other cases no change noticed change in the chemical characteristics of the ground was even after repeated x-ray examinations. substance of the joint, pre existing joint disease, 17

CLINICAL VERIFICATION Lac Caninum (Clinically verified Symptoms) Introduction : The secretion of the mammary glands of a lactating female dog collected at least 15 days after parturition5. The symptoms which are given in literature(1,2,3,4,5), were clinically verified by CCRH. Dog's Milk5 (Bitch's Milk)3 Name in Contemporary use : French Lait de chienne5 Synonyms : Preparation of : Solution1/100 in distilled water (Class-B), freshly made5. Homoeopathic Medicine and Class. Source of drug : Hahnemann Publishing Company Pvt. Ltd., Kolkata Period of study : April 1984- March 2003 Potencies used : 6, 30, 200, 1M Number of cases studied : 4347 Clinical Verification conducted at:- 1. Regional Research Institute (H), New Delhi 2. Homoeopathic Research Institute, Lucknow (U.P.) 3. Homoeopathic Research Institute. Jaipur (Rajasthan) 4. Clinical Verification Unit, Ghaziabad (U.P.) 5. Clinical Verification Unit, Patna (Bihar) 6. Clinical Verification Unit, Vrindavan (U.P.) 7. Clinical Research Unit, Jammu (J&K) Clinically verified Symptoms observed during the study: Location Symptom No. of patients No. of patients prescribed relieved Anxiety N Mind 2 2 Anxiety with palpitation in crowded 1 1 placeN Forgetfulness; in writing, makes 31 23 mistakesN Nervousness3 9 7 Note: i) The symptoms super scribed with a particular number(1,2,3,4) are found in the literature, as well as clinically verified by CCRH. ii) Symptoms superscribed with (N) are those reported and relieved by patients but not mentioned in the literature. iii) The figure 1,2,3 & 4 stand for the source literature referred. 18

Location Symptom No. of patients No. of patients prescribed relieved Anger easilyN 2 2 GiddinessN 3 3 - <morning N 1 1 Irritable3 4 4 Vertigo with darkness before eyes N 188 88 Thinks her disease is incurable1 13 11 Head Headache <noise, talking, 38 31 - > keeping quiet3 Severe headache with nausea 152 99 & vomiting1 Headache - occipital, forehead, temples 157 83 - with numbness <lying N - with flatulence >by pressure & cold 8 7 application3 Headache on alternate sides <morningN 31 26 - >by pressureN 1 1 - <evening, summer, looking 2 2 downwards N - left sided headache with palpitation 1 1 <standingN - bursting headache, current like 80 31 sensationN Dandruff with itching on scalp N 6 6 Falling of hair N 1 1 Alternate blockage of nostrils3 Nose 165 115 - with coryza1 23 21 - heaviness of headN 4 4 Fluent coryza - from both nostrils, 84 71 catarrh3 Coryza (with watery nasal discharge & 6 5 sneezing)N, alternate obstructions of nostrils1,3 <wakingN Coryza with thick white discharge 13 13 <evening & warmthN Tendency to catch coldN 17 17 Eyes Pain in eyes <reading, with sensation of film 35 28 over them required to be wiped off before seeing3 Noises in ears3 Ear 34 28 Cracking of jaw while eating1,3 Mouth 45 39 Gums swollen, bleeding, teeth loose, 53 45 sensitive to cold water3 Profuse salivationN 2 2 Pain in throat due to tonsillitis1 Throat 13 8 Tonsillitis on alternate sides- changes 13 12 sides rapidly1 - <sour thingsN 2 1 with cough <before menses with 1 1 - Hoarseness of voiceN 3 3 19

Location Symptom No. of patients No. of patients prescribed relieved heaviness of headN -<swallowing saliva 3 1 1 Tonsils inflamed, sore, red, shiningN 35 30 Acidity <after eatingN Stomach 7 7 Anorexia2 52 52 Thirstlessness2 7 7 Desire saltN 2 2 Flatulence <eating afterN Abdomen 61 41 Pain in abdomen & heaviness with 7 7 flatulenceN Pain in lower abdomen <during menses3 5 2 Constipation2,3 Rectum 286 189 - with scanty stoolN 30 26 - with flatulence3 26 22 - with unsatisfactory stoolsN 26 15 - with dry & hard stoolN 10 5 Pain in urethra while passing urine2 Urinary system 37 17 Leucorrhoea2,3 Female genitalia 175 129 - <walking2,3 130 67 - profuse discharge2 2 2 - whitish discharge2 31 31 - thick yellow dischargeN 42 42 - thin, watery and profuse2 30 11 - with backache2 6 5 - <during day, standing & walking3 65 56 Menses profuse, bright red blood1,2 1 1 Menses scanty painful3 12 8 Cough 1,3 Respiratory system 43 29 - with tickling in throat2,3 21 12 - with scanty expectoration & headacheN 6 6 - with hoarsness of voiceN 2 2 Cough with expectoration <nightN 16 9 Cough from tickling in larynx <talking & 60 51 lying down3 Dyspnoea3 , ascending & exertion N 18 12 Violent palpitation of heart 3 Chest 81 46 Palpitation with suffocative feeling 3 3 <exertion3 Chest pain in intercostals regions- pain 19 10 changeable N -<leaning, exertion >restN 2 2 Perspiration in axillae very fetid3 61 52 Mastitis1- painful with swellingN 134 108 - pain < from going up or down stairs3 61 52 - <before menses, motionN 45 45 - with pain & tendernessN 11 10 Painful glands around nipple with 9 9 hardness & formation of nodesN 20

Location Symptom No. of patients No. of patients prescribed relieved Back Backache-spine sensitive to touch 266 255 & pressureN Pain in back3 394 223 - on alternate sidesN 44 43 - <at nightN 22 16 - <from coldN 11 7 - >from pressureN 2 2 - <from movementN 89 48 Pain at nape of neck4 328 190 - with stiffnessN 88 45 - <on movementN 62 35 - with numbnessN 31 25 Pain in back-lumbar regionN 462 278 - <from coldN 2 2 -<on movement, walkingN 297 189 - <Sitting for long duration >by restN 112 43 - <night, rising from seatN 18 8 Pain in left lumbar region, radiate to nape 10 10 of neck, aching with restlessness N Pain in sacrum <stooping, >by leaning 55 48 back3 Shifting pain in joints3 Extremities 150 102 - <from coldN 2 1 - <from walking3 2 2 Alternating pain in jointsN 85 73 Pain in small joints with shifting 6 6 -<morning, coldN Alternating pain in handsN 5 4 - with numbnessN 4 4 Rheumatic pain in joints <movement, 380 363 (from cold)N, & on alternate sides2 Pain in joints <on movement2,3,4 382 219 - <from cold3 6 4 - with numbness4 43 38 - with stiffness1,2,3,4 291 186 - with swellingN 3 3 - <night, lying downN 19 9 - with weakness, laziness & giddinessN 3 3 - <summerN 1 1 Pain in shoulder joints3 335 199 - <on raising the handsN 26 18 - <on moving the handsN 5 4 - <from cold3 1 1 - on alternate sides3 1 1 - >by hard pressureN 1 1 - <at night3 6 4 - with difficulty to take hand backN 1 1 - in right shoulder3 24 13 Pain in legs, calvesN 286 222 - <on movement2,3 185 158 - with numbness2,3 144 82 - on alternate sides2,3 2 2 - <at nightN 22 22 21

Location Symptom No. of patients No. of patients prescribed relieved - with weaknessN 3 3 - with tingling in extermitiesN 1 1 - >by massageN 8 6 - with stiffness & numbness2,3 60 60 - pain extend to heelN 103 103 Pain in knee joints <on movement3,4 661 401 - on alternating sides3 9 9 - with numbness3,4 3 2 - with pain in calf musclesN 3 3 - with swelling in knee joints N 25 20 - with crackling sound on movementN 4 2 - walking3 & exertionN 11 3 Sciatica with pain <movementN 606 519 - with numbness in legs1 559 477 - right sided1 574 493 - <walking & exertionN 9 9 - <movement >by restN 33 9 - <standingN 2 2 - left sided3 6 4 Numbness of (hands and)N legs1,3 192 84 Burning in palms and handsN 286 198 Pain in extremities with numbnessN 505 408 -<morningN 83 37 Numbness of fingersN 44 32 Heel pain <walking whileN 68 68 Pain in hands <on abduction, movementN 4 4 Pain in hands with tingling sensationN 4 4 ChilblainsN 1 1 Swelling in ankle joints with painN 20 20 Cramping pain in calf muscles 41 37 <at nightN Pain soles <from coldN 2 2 Oedema over legs <walking2 & on standingN 3 2 Pain in lower limbs with numbness & stiffness 65 29 <night3 >pressureN Pain in wrist joints3 with swelling <walkingN 10 8 Pain in right wrist joint with swellingN 3 2 Aching pain in limbs & back <evening & 104 80 movement3 Wrist lame & painful3 65 55 Pain in right hip, (back)N & legs <walking3 35 31 Pain in fingers with swellingN 2 2 Ring worm like eruptions with itchingN Skin 1 1 Small macular eruptions with itching <nightN 1 1 Sleeplessness2 Sleep 5 5 Dreams of snakes1 2 2 Profuse perspiration over whole bodyN Perspiration 3 3 Fever Intense fever with perspiration <walking 9 9 in morning3 22

Location Symptom No. of patients No. of patients prescribed relieved General weakness with prostration1 Generalities 70 39 Generalised swellingN 2 2 Feverish feeling with tirednessN 3 2 BodyacheN 68 68 When walking patients feels that she is 3 3 walking on air1 Observation: The medicinal picture, given below is based on clinical verification studies and contain symptoms found relieved in more than 30 patients each. Drug picture: • Vertigo with darkness before eyes N • Headache <noise, talking, > keeping quiet3 • Severe headache with nausea & vomiting1 • Headache - occipital, forehead, temples, with numbness <lying N • Bursting headache, current like sensationN • Alternate blockage of nostrils3, • Fluent coryza - from both nostrils- catarrh3 • Cracking of jaw while eating1,3 • Gums swollen, bleeding, teeth loose, sensitive to cold water3 • Tonsils inflamed, sore, red, shiningN • Anorexia2 • Flatulence <eating afterN • Constipation2,3 • Pain in urethra while passing urine2 • Leucorrhoea2,3, whitish2 /thick yellow dischargeN<walking2,3,during day, standing3 • Mastitis- painful with swelling1, < from going up or down stairs3, before menses & motionN • Cough from tickling in larynx <talking & lying down3 • Violent palpitation of heart 3 • Perspiration in axillae very fetid3 • Mastitis1- painful with swellingN, pain < from going up or down stairs3 <before menses, motionN • Backache-spine sensitive to touch & pressureN • Pain in back, alternate sides3, <from movementN • Pain at nape of neck4, with stiffness4 & numbness, <on movement4 • Pain in back-lumbar region, <on movement, walking3, sitting for long duration >by rest3 • Pain in sacrum region <stooping, >by leaning back, spine sensitive to touch & pressureN • Shifting pain in joints3 • alternating pain ion jointsN • Rheumatic pain in joints <movement, (from cold)N, & on alternate sides2 • Pain in joints <on movement2,3,4, with numbness4 ,with stiffness1,2,3,4 • Pain in shoulder joints3 • Pain in legs2,3 : calvesN, <on movement, with numbness & stiffness & numbness2,3, pain extend to heelN • Pain in knee joints <on movement3,4 • Sciatica, right sided , with numbness in legs1 , Pain<movementN • Numbness of (hands and)N legs1,3 • Burning in palms1,4 and handsN • Pain in extremities with numbness, <morningN • Numbness of fingersN • Heel pain <walking whileN • Cramping pain in calf muscles <at nightN • Aching in limbs & back <evening & movement3 • Wrist lame & painful3 23

• Pain in right hip, (back)N & legs <walking3 • General weakness with prostration1 • BodyacheN Clinical conditions: Headache, Coryza, Tonsillitis, Anorexia, Mastitis, Leucorrhoea, Bronchitis, Cervical spondylosis, Lumbago, Rheumatic pain, Sciatica. Prescribing Symptoms: • Headache, on alternate sides <morning,noise, talking, > keeping quiet • Fluent coryza - from both nostrils- catarrh • Pain in eyes <reading, sensation of film over them required to be wiped off before seeing • Noise in ears • Cracking of jaw while eating • Gums swollen, bleeding, teeth loose, sensitive to cold water • Tonsils inflamed, sore, red, shining • Anorexia • Flatulence <eating after • Pain in urethra while passing urine • Leucorrhoea- whitish/thick yellow discharge <during day, standing & walking • Mastitis- painful with swellin, < from going up or down stairs, before menses & motionN • Cough from tickling in larynx <talking & lying down • Perspiration in axillae very fetid • Pain in sacrum <stooping, >by leaning back, spine sensitive to touch & pressure. • Shifting pain in joints with numbness • Rheumatic pain in joints <movement, from cold, & on alternate sides • Sciatica, right sided, with numbness in legs <movement • Pain in extremities with numbness • Cramps in calf muscles <at night • Pain in right hip, back & legs <walking Reference: Boericke William. Pocket Manual of Homoeopathic, Materia Media & Repertory, 1. B. Jain publishing company, New Delhi, (2003):pp 385 Hering C., The Guiding Symptoms of our Materia Medica, Vol.VI, B. Jain publishing 2. company, New Delhi:pp 516. Clarke J.H., Dictionary of Practical Materia Medica, Vol. II, Jain publishing company, 3. New Delhi: pp189 CCRH Quarterly Bulletin, Vol. 9 (1&2), (1987):pp 4 4. Homoeopathic Pharmacopoeia of United State , Revision service, Dec-1991:pp 5413. 5. 24

DRUG RESEARCH Pharmacognostic & Physico-Chemical Evaluation Of Psidium Guajava L. P. Subramanian*, P. Padma Rao** and M. Prabhakar*** Abstract Psidium guajava L. belonging to the family Myrtaceae is known as Guava. It is a common fruit tree, cultivated and naturalized throughout India. The leaves are used as an application in wounds, ulcers and as an astringent to bowels in Unani. Besides, it is also used as digestive, febrifuge and antispasmodic, in cerebral affections, nephritis, rheumatism, epilepsy and chorea. Leaves contain catechol and pyrogallol tannins besides oil and vitamins. Due to growing urge for introduction of well known indigenous drugs into Homoeopathy, the leaves of P. guajava are also being adopted. In the present, pharmacognostic studies of leaf comprising macro- and microscopic characters, organoleptic and powder microscopic features, besides physico-chemical constants viz. moisture content, ash and extractive values for raw drugs and parameters such as weight per ml., total solids, alcohol content and chromatographic profiles of TLC, HPTLC, along with UV absorbance for mother tincture are detailed. In view of this leaves of P. guajava is one of the Introduction drug also being tried. Review of literature reveals Psidium guajava L. belonging to the family that there is no reported work on pharmacognostic Myrtaceae is commonly known as guava in Eng- and physico-chemical aspects of the leaves of P. lish, amrud in Hindi, koyya in Tamil and tella jama guajava. Hence a detailed study on these aspects in Telugu. Guava is also referred to as the apple of is presented. the tropics. It is a native of tropical America and cultivated and naturalized throughout India1. It is Material and Methods an arborescent shrub or a small tree, upto 8 m high. Leaves of Psidium guajava L. was collected The guava leaves are used as an application in wounds, ulcers, and as an astringent for bowels from Botanic garden, Department of Botany, (Unani). The young leaves are used as a tonic in Osmania University, Hyderabad. Fresh leaves were the diseases of the digestive functions. The fixed in Carnoy's fixative. Subsequently epidermal decoction of leaves has been used in Cholera and peels of leaf and petiole were prepared following the method of Leelavathi and Ramayya6. Micro- also as a febrifuge and antispasmodic. Infusion of leaves is used in Cerebral affections, Nephritis and tome sections of 10-15 µm thick of leaf and petiole were prepared following the traditional techniques3. Cachexia. The pounded leaves are locally applied in Rheumatism and their extract in Epilepsy and Sections were stained with crystal violet and basic Chorea. Though traditionally the medicinal use of fuchsin. Powder studies were made following Youngken9 and Johansen3. leaves of P. guajava finds mention only in Unani system, their folklore utilities have been elaborate5. Leaves are reported to contain catechol and pyro- The air dried leaves were powdered to ob- gallol tannins. A new flavonol glycoside quercetin tain coarse powder 10/44 (sieve size). It was sub- 4' glucuronide was reported4. Oil of leaves is aro- jected to determination of moisture content (L.O.D.), matic and also used as a flavouring agent. Besides, Ash values and extractive values. The above pa- they also contain carotene, vitamins B1, B2 and B6 rameters were determined in accordance with the and vitamin C. Antibacterial activity is reported by procedures given in Homoeopathic Pharmacopoeia Rabe and Van Staden8. of India2. The mother tincture was prepared by per- colation technique2. Alcohol content for the prepa- Presently, there is a growing urge to intro- ration of mother tincture was fixed as per maximum duce indigenous drugs into Homoeopathic system. extractive value (M.E.V.). * Research Officer (Chemistry), ** Assistant Research Officer( Pharmacognosy), *** Ex-Project Officer, Drug Standardization Unit (H), O.U.B. 32, Road No. 4, Habsiguda, Hyderabad-500 007. 25

The alcoholic extract (mother tincture) was liptic oblong, entire glabrous above, pubescent be- subjected for a) Physico-chemical constants, b) neath, pellucid punctuate; lateral nerves 10-20 pairs, Chromatography (TLC/HPTLC), c) U.V. absorb- prominent beneath, strongly curved near the edge ance. and joined by intro marginal veins, petioles 2.5-7.5 mm long. All chemicals and solvents used were of analytical grade. Silica gel G (E Merck) was used for Microscopy: Adaxally epidermal cells polygonal thin layer chromatography (T.L.C.). U.V. spectra isodiametric or anisodiametric with sides slightly was recorded using spectrophotometer, Shimadzu thick, straight to curved; surface striated; contents make (courtesy CFTRI, Hyderabad) scanty or dense in few. Epidermal cells 5,45,000 per sq. cm. Stomata are absent on adaxial side. Physico-chemical Constants Trichomes 1) Unicellular conical hair, longer, dis- tributed all over surface. 2) Unicellular flagellate Physico-Chemical parameters viz., orga- conical hair, long, flagellate conical, all over, more noleptic characters, weight per ml. total solids, al- on vens. cohol content and pH value, were determined as per the guidelines laid down in the Homoeopathic Abaxially cells similar as on adaxial, sides Pharmacopoeia of India2. thin with curved or wavy anticlinal walls; contents scanty but with tannins in few; interspersed by se- Chromatography (T.L.C.) cretory cavities. Epidermal cells 10,20,000 per sq. cm. Stomata mostly paracytic, few anisocytic and For TLC 25 ml. alcoholic extract was evapo- anomocytic; paracytic subsidiaries longer, distinct. rated on water bath to remove alcohol. The remain- Stomatal pore large, contents dense; Stomatal fre- ing aqueous part was extracted with 25 ml. chloro- quency: 2,90,000 per sq. cm. Stomatal Index: form (three times). All the three fractions were com- 22.13; Stomatal size; 19-24 um (21) long and 12- bined and concentrated to 2ml. 15 µm was applied 16 um (15) wide. Trichomes are similar to those on activated silica gel G coated TLC plate. It was described on adaxial side. developed using chloroform and benzene with few drops of acetic acid (1:1v/v) on mobile phase and Transection (TS): 10% FeCl3 solution was sprayed for visualization. In T.S. midvein is grooved on adaxial side UV Absorbance and prominently ribbed towards abaxial. Second- ary and tertiary veins ribbed abaxially. Midvein kid- For UV absorbance, the mother tincture was ney-shaped, laterally upto 1.5 mm and vertically diluted with 99 parts 70% alcohol, scanned in the 1mm thick; Lamina isobilateral, 151-173 um thick. range of 200-300 nm. The peaks of maximum ab- Covered by conical and flagellate hair. Secretory sorption are given in Table 6. cavities conspicuously present on abaxial. HPTLC Studies Epidermis is 1-layered, adaxially large, barrel shaped or tabular to polygonal, covered by a Precoated high performance TLC plates thick cuticle and often dispersed with conical hairs. (silica gel 60 F 254 as stationary phase) were used. Abaxially cells smaller, interrupted by stomata, For sample application, CAMAG Linomat IV sam- which are sunken. Mesophyll is characterized ple applicator was employed. The speed of appli- adaxially with a hypoderm, consisting of 3-4 lay- cation was maintained at 4mm/sec. The solvent ered tabular to barrel shaped cells often containing system used for development was chloroform, ace- tannins, sphaeraphides and resins and interrupted tic acid, methanol and water (6.2 : 2.1 : 2.0 : 0.8 v/ by secretary cavities. Palisade is abaxial, 4-5 lay- v). Methanolic sulphuric acid and anisaldehyde ered, cells cylindrical, 11-27 µm (19) long and 5.5- H2SO4 were used for derivatisation. The Rf values 8 µm (7) wide; filled with chloroplasts, tannins and of the various components before and after sphaeraphides and interrupted by secretory cavi- derivatisation are provided in Table 5. ties. OBSERVATIONS Ground tissue at midvein of collenchyma, parenchyma and sclerenchyma tissues. Pharmacognostic Studies Collenchyma: abaxially 1-layered and as a group of cells on adaxial side, 5-19 µm (13) in diameter; Macroscopy : Leaves 10-15 cm long, oblong or el- angular or lamellar, contents dense. Parenchyma: 26

8-10 layered on abaxial and 6-8 layered on adaxial; adaxially and 18-22 celled on the abaxial; polyonal interspersed with secretory canals, sphaeraphidal to spherical, 11-63 um (32) in diameter; contents and tanniniferous cells; 13-68 um (11) in diameter, slightly dense, in few with tannins and walls lignified, contents scanty to slightly dense with sphaeraphides, often interspersed with secretory tannins and crystals of calcium oxalate in few. cavities. Sclerenchyma is 8-12 layered, enclosing the vascular bundle; cells polygonal, walls lignified, Vascular tissue of mid vein consists of a cen- thick, 8-19 µm (13) in diameter, contents slightly tral wedge or sigma shaped bundle, 918-950 µm dense, with tannins in few. Fibers in longituadinal laterally long and 183-205 µm thick; endarch, section long, non-libiriform and septate. bicollateral, closed, pericyclic with two small adaxial bundles. Xylem elements in radial rows, sec- Vascular tissue consists of a single large ondary walls helical, scalariform and reticulate. sigma shaped bundle at the center; endarch, Phloem on either sides with phloem parenchyma, bicollateral, conjoint and pericyclic; 2065-2151 µm sieve cells and fibers. long and 481-537 µm thick vertically. Xylary cells arranged in radial rows, few clustered, polygonal to Petiole spherical, 5.5-22 µm in diameter; walls thick, lignified, associated with xylem parenchyma; sec- Epidermal cells polygonal iso- to ondary walls mostly helical, few scalariform; phloem anisodiametric, sides thin, straight to curved, sur- scanty, on either sides of xylem and enclosed by face finely striated; contents slightly dense, in some sclerenchymatous pericycle. with tannins and crystals of calcium oxalate; interspersed with secretary cavities; Stomata absent. Powder Studies Surface covered with few conical and flagellate hairs. Microscopy: Trichomes conical and flagellate conical, either whole or fragments many. Pieces either Transection whole or fragmented sphaeraphides. Fragments of epidermis with wavy sides with stomata. Pieces In T.S. 3-4 mm in diameter, elongated later- of leaf dark and greenish with tannins. Pieces of ally with an adaxial groove; covered by conical or sclerenchymatous fibers with xylary tissue. Pieces flagellate hairs. of leaves with secretory cavities. Epidermis is unilayered, polygonal to barrel Organoleptic Characters shaped; walls slightly thick, contents tanniniferous. Collenchyma is 1-layered on the abaxial and 1-2 Colour : Light dull green layered on the adaxial, cells polygonal to spherical, Touch : Smooth or finely coarse angular or lamellar; in few with tannins and Odour : No characteristic chloroplasts. Parenchyma is 12-16 layered Taste : No characteristic PHYSICO-CHEMICAL STUDIES TABLE - 1 Standardisation of Raw Drug S.No. Parameters Quantitative values 1. Moisure content (L.O.D. at 105 C) 12.7% W/W 2. Ash value (total) 11.827% W/W 3. Acid insoluble ash 1.59% W/W 4. Water soluble ash 3.135% W/W 5. Water soluble extractive 15.0% W/W 6. Alcohol soluble extractive 23.5% W/W 27

TABLE - 2 Determination of M.E.V. using different strengths of alcohol Sl.No. Strength(s) of alcohol (% V/V) Extractive value Remarks 1. 30% 23.79% 70% alcohol 2. 40% 27.25% Used for preparation 3. 50% 20.15% of Q on the basis of 4. 60% 19.50% No. of spots and 5. 70% 11.80% stability. 6. 75% 22.45% 7. 80% 16.50% 8. 90% 12.00% 9. Absolute 23.50% TABLE - 3 Formulation and preparation of mother tincture Coarse powder of leaves of P. guajava : 100g Purified water : 300 ml. Strong alcohol : 735 ml. To make one thousand ml. of the mother tinctures TABLE - 4 Standardisation of mother tincture S.No. Parameters Observations 1. Organoleptic characters (a) Appearance Clear, non-viscous (b) Colour Tab brown (c) Odour Fruity and aromatic 2. Sediments Absent 3. Weight per ml 0.887 g. 4. Total Solids 2.34% 5. pH at room temperature 4-4.5 6. Alcohol content 68% TABLE - 5 Chromatographic result of : Psidium guajava Mother tincture (Q) Extract : Chloroform extract of Q Adsorbent : Silica gel G Layer thickness of plate : 0.4 mm in wet conditions Solvent system Detecting agent No. of spots Rf values Colour of spots Chloroform : 10% 13 0.5 Benzene, a FeCl3 0.9 few sol. Drops Sol. 0.24 of CH3COOH 0.28 (1:1 V/V) 0.39 0.45 Pink 0.51 0.59 Grey 0.69 0.73 Green 0.82 Green 0.87 Pink 0.92 28

TABLE - 6 UV Absorbance of alcoholic extract of leaves of P. guajava Mother tincture No. of peaks UV absorbance Psidium guajava Q 5 259.5 nm 254.3 nm 239.4 nm 221.5 nm 212.5 nm Petiole Discussion In surface epidermal cells are polygonal with Psidium guajava is also known as the apple straight to curved sides. Epidermal cells often pos- of the tropics and grows under a wide variety of sess tannins and prismatic crystals of calcium climatic conditions. Guava is one of the richest oxalate. The epidermal surface also is dispersed natural sources of vitamin C besides pectin and with some conical and flagellate hairs. other nutrients. Leaves are reported to contain catechol and pyrogallol types of tannins1. The leaves In transaction 3-4 mm in diameter, laterally are popularly used in tanning leathers. elongated with an adaxial groove. Epidermis is 1- layered and hypodermal collenchyma is 1-2 layered. a) Pharmacognostic features : Ground parenchyma is predominant, interspersed with cells containing tannins and sphaeraphides. 8- The leaves are light green, finely pubescent 12 layered sclerenchyma encloses the central vas- and chartaceous. Epidermal cells in surface show cular bundle. striations on adaxial side. Stomata occur only on lower surface. Paracytic type being dominant be- Vascular tissue is made of a single large sides anisocytic and anomocytic. Unicellular coni- sigma shaped bundle which is bicollateral and cal and uniseriate flagellate conical hairs occur on pericyclic. Phloem is scanty and present on either either surfaces. Stomatal index is 22.13. sides of xylem. Transectionally midvein is kidney shaped b) Physico-chemical being prominently ribbed towards abaxial and grooved adaxially. Lamina wing is 151-173 µm in Alcohol extract and mother tincture have thickneww. Secretary cavities appear conspicu- shown positive tests for tannins. The data pertain- ously on the abaxial surface. An adaxial hypoderm ing to physico-chemical studies of raw drugs is pre- of 3-4 layers is conspicuous and confirms earlier observations of Metcalfe and Chalk7. Palisade is 4 sented in table 1. Formulation of mother tincture is given in table 2 & 3. Physico-chemical constants layered and is confined to abaxial side. Secretory of mother tincture are summarized in Table 4. TLC cavities interrupt the mesophyll. Cells of mesophyll study on Chloroform extract of the mother tincture often contain tannins and sphaeraphides besides reveals 3 prominent spots on spraying with 10% chloroplasts. Ferric chloride solution and heating at 110 C (Table 5). It is evident from the raw drug studies that the Ground parenchyma at midvein is inter- value of acid insoluble ash falls within the accept- spersed with secretory cavities besides able range. sphaeraphidal and tanniniferous idioblasts. A sclerenchymatous cap of 8-10 celled thick encloses HPTLC profile shows absorbance in the short the midvein bundle. and long wave length of UV light before derivitisation while after derivitisation i.e. subsequent to spray- Central vascular bundle is sigma shaped, ing with methanolic sulfuric acid and anisaldehyde 918-950 µm laterally long and 183-205 µm verti- sulfuric acid separately, reveals eight bands with cally thick; endarch, and bicollateral. Secondary Rf values 0.15, 0.19, 0.28, 0.51, 0.57, 0.66, 0.79 walls of xylary elements possess helical and and 0.94 correspondingly in both. scalariform thickenings. 29

The diluted mother tincture (1 ml Q diluted 3. Johnson, D.A. 1940, Plant Microtechnique, with 99 ml of alcohol) reveals large number of peaks Mc Graw Hill Book Col., New York. in the UV region. It is clear that 70% alcohol used for preparation of mother tincture is the best alco- 4. Kaudil, F.E. et al., 1997. Flavonoids from hol in accordance with Homoeopathy philosophy. Psidium guajava, Asian Journal of Chemis- However, five major peaks amongst them are re- try, 9(4), 871-872. ported. 5. Kirtikar, K.R. AND b.d. Basu, 1980, Indian Acknowledgements Medicinal Plants, Vol. 2, Bishen Singh Mahendra Pal Singh, Dehradun. The authors thank Prof. C. Nayak, Director, Central Council for Research in Homoeopathy, New 6. Leelavathi, A. and N. Ramayya, 1975, Rapid, Delhi for encouragement and facilities. Thanks are isolation of leaf epidermis by double treat- also due to Anchrom HPTLC applications Labora- ment method, Geobios, Vol. 2, 117-119. tory, Mumbai, for HPTLC profile and scientist incharge, CFTRI, RC, Hyderabad, for UV studies. 7. Metcalf, C.R. and L. Chalk, 1950, Anatomy of the Dicotyledeons, Vol. 1, Oxford Univer- sity Press, London. References 8. Rabe, T. and J. Van Staden, 1997, Antibac- 1. Anonymous, 1969, Wealth of India, Raw terial activity of South African plants used for material, Vol. 8, Publication and Information medicinal purposes, J. Ethnopharmacology, Directorate, CSIR, New Delhi. 56(1), 81-87. 2. Anonymous, 1971, Homoeopathic Pharma- 9. Youngken, H.W., 1951, Pharmaceutical copoeia of India, Vol 1, Ministry of Health and Botany, Rep. Ed. International Book Distribu- Family Welfare, Govt. of India, New Delhi. tors, Dehradun. 30

GENERAL ARTICLE Role of Homoeopathy in Migraine in Adolescence Dr. S. Gopinadhan* Abstract There are two types of migraine: 1.Common migraine The aim of this paper is to show that the treatment on the basis of similia similibus curentur is the best psychosomatic approach for migraine in ado- Unilateral throbbing headache lasting a few lescence. 25 cases of adolescent patients suffer- hours with nausea and vomiting but there is no pre- ing from classical migraine were treated as out pa- ceding neurological symptoms. tients during the period 1997-2002. Homoeopathic 2. Classical migraine also known as neurologic medicines were selected on totality of symptoms. A total of 21 cases were relieved out of 25 cases. migraine; has hemicranial or generalized throbbing Of these 11 cases had no recurrence, 7 had headache with nausea and vomiting and lasts for moderate improvement and 3 had mild one to two days but is preceded by prominent improvement. 3 cases showed no improvement neurological symptoms, known as aura. whereas one patient reported with aggravation of symptoms. Diagnosis in both the varieties is made mainly from history3. The most common aura is visual Introduction disturbances such as dazzling zig zag lines, scintillating scotoma, homonymous hemianopia, Headache is a headache for both physician field defects and rarely total blindness. The aura and the patient. This is the commonest but the lasts for 15-30 minutes and usually is merged with most difficult clinical problem encountered by the hemicranial or generalized headache. There are physician. Most often headache is a many aggravating or precipitating factors but the symptomatic expression of some minor ailments, most common factors are anxiety, emotional stress, mental tension or fatigue, but occasionally it is of menstruation (pre menstrual tension), relaxation of stress, alcohol, overwork and change of weather4. sinister significance, indicative of serious intracranial disease and i.e. why when a person is As this is one of the important types of headache, having regular headache, he may be much alarmed psychological factors play a major role in its precipitation and maintenance5. due to anxiety and fear. Among different types of headaches, such as referred headache, neuralgic headache, headache due to meningeal irritation, According to modern medicine the treatment vascular headaches, traction headache and of migraine falls into three groups such as (i) avoid- psychogenic headache, vascular headache is ance of aggravating or precipitating factors (ii) con- often very severe. The commonest form of trol of acute attacks and (iii) prophylaxis. To avoid vascular headache is MIGRAINE 1. The word these precipitating factors, physician used to give Migraine came from another word 'Megrime' full explanation to the patient about the nature and meaning Hemi cranial. Migraine is characterized phenomena of migraine. But this is not always ef- by epidsodic throbbing, hemi cranial headache be- fective because the persons affected with migraine ginning in childhood, adolescent or early adult life have peculiar personality. They have excessive self which tends to decrease in intensity and frequency demands, they are over ambitious, perfectionist, as age advances. Although migraine may begin meticulous and scruplous. Failure to attain at any age the usual onset is adolescene or young perfection and ambition leads to mental stress and adult life2. Women are slightly more affected and strain. Therefore, all known precipitating factors es- out number men by about 4:1 and in many cases a pecially the anxiety and emotional stress cannot positive family history is elicitable. be avoided by the patient. Another important *Assistant Research Officer(Homoeo.), Central Research Institute(Homoeo.), Kottayam 31

precipitating factor, say, pre menstrual tension, also The method of study was purely clinical in is very difficult to avoid by mere explanation or nature. These 25 cases of migraine were included counseling. Since these patients are over ambi- for the study on the basis of the following criteria: tious they are liable to more physical strain which is 1. Only adolescent migraine cases were one of the important aggravating factors and it is selected very difficult for such persons to refrain from over 2. Only classical migraine was included work. Therefore, instead of asking them to avoid 3. Both males and females were included anxiety, overwork or mental stress, their personal 4. Patients with other systemic diseases were attitudes are to be changed and this is possible only excluded through the homoeopathic treatment because 5. Patients with emotional and psychological the personality of a person is a manifestation of the stress as precipitating factors for underlying chronic miasm. headache only were included 6. Before inclusion all related investigations This short scientific paper is based on stud- were done to exclude other causes of ies conducted in O.P.D. at CRI(H) Kottayam on 25 headache. adolescent patients suffering from classical migraine with homoeopathic medicine in the period 1997- In each case a detailed case history was 2002. All these cases were treated only with taken with special stress given to aggravating and homoeopathic medicines, i.e. without any psycho- precipitating factors, personal history and mental logical advice. Since psychological factors play a disposition of the patient and in all cases a mias- major role in the causation or precipitation of mi- matic analysis was also done in order to find out graine a complete psychosomatic approach with which miasm was predominant and later on it helped similimum is necessary. As mentioned in the Or- for the selection of remedies for follow-up studies. ganon of Medicine by Dr. Samuel Hahnemann, ‘after All these patients were given medicines after strict the control of acute attacks these patients should individualization, in minimum dose, along with be treated with deep acting anti miasmatic remedies placebo. They were advised to repeat the dose on in order to prevent further attacks’. the occurrence of the next episode only. They were also advised to avoid coffee, tea, coco and other Materials and Methods drugs used externally or internally during the whole course of the treatment. Each and every case was The materials for the study consisted of 25 followed up for two years and final assessment was cases of classical migraine in adolescence treated done after that. In many cases after the relief of the during the period between 1997-2000 as out acute attacks with short acting remedies, deep act- patients. These 25 patients included 9 males and ing anti-miasmatic remedies were found necessary 16 females (refer Table-I) between the age of 13 to prevent further episodes of headache. But in years - 18 years (refer Table-II). All of them had certain cases drugs found effective to control the aura before the onset of headache and the majority acute attacks were also found effective for the pre- had visual disturbances like dazzling, zig zag lines, vention of the episodes. dimness of vision, lachrimation, pain in eyes and photophobia (refer Table-III). The duration of the To test the significance of the result ob- complaints ranged from 8 months to 5 years but in tained the data collected from the study especially majority it was between 2 & 5 years (refer Table- the frequency of paroxysms before and after the IV). These patients had different aggravating and treatment was statistically analysed with the help precipitating factors (refer Table-V), but all of them of Paired T test. The null hypothesis H0 in this study had one or other types of emotional stress as pre- is that the treatment is not effective and the alter- cipitating factors. But in many cases more than nate hypothesis H1 is that the treatment is effec- one precipitating factors were present. Similarly tive. For the statistical analysis, disease intensity majority of the patients studied had positive family scores were given on the basis of frequency of epi- history of migraine (refer Table-VI). A detailed study sodes before and after treatment (refer Table-XVI). on the episodes of migraine reveals that the majority suffered from moderate to severe headache, the Observation duration of the episodes ranged from less than 5 hours to 15 hours and frequency of attack ranged All the results obtained were given in tabu- from more than once a month to once in three lar form from Table I-XVI. The results obtained were months. But in majority, the frequency of episodes confined to those 25 cases only. It showed that 11 was once in a month (refer Table-VIII-X). out of 25 cases had marked improvement with no recurrence after one or two initial attacks, 07 cases 32

had moderate improvement in which the duration, frequency and the intensity of the headache Table - II decreased considerably and 03 cases with mild improvement in which only the duration of episodes Age Min. 13 years Max. 18 years came down, 03 cases treated had no improvement and in 01 case symptoms aggravated during the Age Group T M F treatment. The Table-XIV on the basis of prescrip- 12 - 14 years 5 2 3 tion shows that the mostly used basis for prescription was physical generals, modalities and key 14 - 16 years 10 3 7 notes, but it was found that all the basis for pre- 16 - 18 years 6 2 4 scription was equally important. The Table on the 18 - 20 years 4 2 2 Drug Therapy showed that there was no specific drug for migraine. This showed the individuality of the patient irrespective of the same type of disease Table - III symptoms and the personality. However, the frequently indicated and effective drugs in controlling Aura* the acute episodes were Nat.mur., Nux.vom., T M F Pulsatilla, Ign. and Lycopodium. Other drugs which were prescribed on their individual features also Without Aura 0 0 0 proved best in controlling the acute attacks. But With Aura: constitutional drugs like Calc.carb., Nat.mur., Lyco., Dazzling siz zag line 6 3 3 Puls., Sulphur and Syphilinum were found useful in Dimness of vision 13 4 9 preventing the recurrence of the episodes. Lachrimation 15 5 10 The assessment of improvement was on Pain in eyes 12 4 8 the basis of duration of episodes, their frequency Photophobia 12 4 8 and intensity. There were 20 cases with duration Tingling on face 2 0 2 of acute episode ranging from less than 5 hours to 15 hours before the treatment and five patients had duration more than 15 hours. But after the treat- * Some cases have more than one aura ment the results showed that only 10 cases had less than five hours duration and three cases had 5 Table - IV to 15 hours duration and in one case it was found that the episode had duration of more than 25 hours Duration of complaints and in one case it was found that the episode had a duration of more than 25 hours. Before treatment Group T M F 5 cases had frequency more than once a month, Upto 2 years 4 1 3 14 cases had frequency once a month, 3 cases had once in 2 months and the rest had once in 3 2 - 3 years 9 3 6 months. But after the treatment only one patient 3 - 4 years 5 3 2 had the frequency greater than once a month and 4 - 5 years 5 1 4 in seven cases no recurrence was noticed. 5 - 6 years 2 1 1 Similarly 21 out of 25 cases had moderate to severe intensity of episodes before the treatment but after the treatment only 7 cases had moderate to severe Table - V intensity, 7 with mild episodes but 11 had no Precipitating factors T M F recurrence of headache. Alcohol 1 1 0 Anxiety 6 3 3 Table - I Reading 7 2 5 Emotional stress 25 9 16 Total No. of cases Noise 19 6 13 Light 21 7 4 Total Male Female Pre menstrual tension 4 0 4 25 9 16 Physical stress 5 2 3 33

Table - IX Table - VI Hereditary factors Duration of paroxysms T M F Hereditary factors 18 5 13 Duration T M F Table - VII Less than 5 hours 4 1 3 5 hours to 10 hours 10 4 6 Miasmatic factors T M F 10 hours to 15 hours 6 2 4 15 hours to 20 hours 2 1 1 Psora 11 4 7 20 hours to 25 hours 2 0 2 Syphilis 2 1 1 Sycosis 0 0 0 25 hours and above 1 1 0 Pseudopsora 7 2 5 Mixed 5 2 3 Table - X Paroxysms: Frequency of paroxysms T M F Table - VIII Once in a month 5 2 4 Intensity of paroxysms Once in a month 14 6 8 T M F Once in 2 months 3 1 2 Mild 4 1 3 Once in 3 months 3 1 2 Moderate 13 5 8 Once in 6 months 0 0 0 Severe 8 3 5 Once in year 0 0 0 DRUG THERAPY Table - XI For acute episodes No of Patients Drug Potency Prescribed Found effective in T M F T M F Arg. nit. 200 1 0 1 0 0 0 Belladonna 30 2 1 1 2 1 1 Ignatia 1M 3 1 2 3 1 2 Lycopodium 30, 200 2 2 0 1 1 0 Melilotus 30 1 0 1 1 0 1 2 Natrum mur. 30, 200 4 2 2 3 1 Nux vomica 30, 200 4 2 2 4 2 2 Pulsatilla nig. 200 4 0 4 3 0 3 Sanguinaria can. 200 1 1 0 1 1 0 Silicea 200 1 0 1 1 0 1 Sulphur 30 1 0 1 1 0 1 Tabacum 30 1 0 1 1 0 1 Table - XII Drug found effective to avoid relapses Drug Potency T M F Calc. carb. 200, 1M 3 1 2 Nat.mur. 200, 1M, 10M 3 1 2 Lycopodium 200, 1M 2 2 0 Puls. 1M 2 0 2 Sulph. 200, 1M, 10M 3 2 1 Syphilinum 1M 1 0 1 34

RESPONSE TO TREATMENT Table - XIII Improvement indices* T M F • Cured 0 0 0 • Improved • Marked 11 5 6 • Moderate 7 0 7 • Mild 3 2 1 • Not improved 3 1 2 • Aggravated 1 1 0 ______________________________________________________________________________ *Cured - complete disappearance of the subjective and objective symptoms with no recurrence for the next five years. Marked improvement - complete disappearance of the subject and objective symptoms and no recurrence for one year. Moderate improvement - complete disappearance of the subjective and objective symptoms with recurrence of occasional episodes or aura Mild improvement - Slight amelioration of the subjective or objective symptoms _______________________________________________________________________________ Table - XIV Duration of episodes Before treatment After treatment T M F T M F Less than 5 hours 4 1 3 10 2 8 5 hours - 10 hours 10 4 6 1 0 1 10 hours - 15 hours 6 2 4 2 1 1 15 hours - 20 hours 2 1 1 0 0 0 25 hours and above 1 1 0 1 1 0 Table - XV Frequency of episodes Frequency Before treatment After treatment T M F T M F More than once in a month 5 1 4 1 1 0 Once/month 14 6 8 3 2 1 Once/2 months 3 1 2 2 0 2 Once/3 months 3 1 2 4 0 4 Once/6 months 0 0 0 4 1 3 Once/Year 0 0 0 0 0 0 Table - XVI Intensity of episodes Intensity Before treatment After treatment T M F T M F Mild 4 1 3 9 1 8 Moderate 13 5 8 3 2 1 Severe 8 3 5 2 1 1 35

Discussion Conclusions 1. The most common age group which is The study of 25 cases of adolescent migraine prone to migraine of psychosomatic origin shows that all are having one or the other type of is adolescence because this age group is psychological stress and anxiety which play the role vulnerable to great emotional, psychological of exciting and maintaining cause for the headache. and physical stress as they are passing In this study group females are more affected than through a new phase of life which is different males which is in conforming with what is said in from infancy and childhood. text books. The miasmatic study shows that the 2. The predominant miasms found out in this majority of the group falls under Psora and study which are responsible for migraine Pseudopsora while the rest belongs to mixed group. are psora and pseudopsora. This may be the reason that in majority of the patients multi miasmatic remedies are found useful to 3. There is no specific remedy for adolescent control acute episodes and to prevent further at- migraine but drugs selected on strict tacks. individualization only are found useful. 4. In adolescent migraine the true psychoso- The drug therapy part shows that many drugs matic approach is the homoeopathic way of are found useful to control the acute paroxysms treatment because the drugs prescribed on and to prevent the recurrence (13 drugs in 25 the basis of the totality of the symptoms cases). This reveals that there is no specific rem- were able to give relief in 21 out of 25 edies for migraine but only specifics for individual cases. patients. Acknowledgement The table on improvement indices shows that 21 out of 25 cases improved in various degrees I acknowledge the constant help and encour- out of which 11 cases had no recurrence of head- agement received from the Director, CCRH with- ache for the next two years and 7 had moderate out which such research work could not be done. I improvement in which there was considerable re- also acknowledge with thanks those who helped duction in the duration, frequency and intensity of me in this study and the preparation of this attacks. Three cases studied shows no response scientific paper. after the treatment, but in one patient the headache References aggravated after the treatment. More than 80% improvement obtained in this study is a great achievement and this shows the efficacy of Ho- Churchil's Pocket Book of Medicine p-28. 1. moeopathic medicine given on the basis of indi- Lance J.W., Mechanism and Management 2. vidualization. This is more evident when we go of Headache Edition IV, Butterworth, through the tables on response to treatment related Stoneham M.A. 1982. to the duration, frequency and intensity of head- C. Houston, L. Joiner, R. Trounce, A Short 3. ache (refer XV-XVII). After a month the 14 cases, Text Book of Medicine, ELBS 7th Edition which had relapse of migraine, 9 cases had head- P-370. ache in mild intensity only with occasional aura while the rest had moderate to severe headache but 4. Harold I. Kaplan; Benjamin J. Sadock, the duration and frequency were reduced except Comprehensive Text Book of Psychiatry Vol. I Vth Edition p-232. in 1 case. 36

WEB INFORMATION Avian Influenza (Bird Flu) & Homoeopathy: Search On Internet O.P.Verma* quot;Given the high level of global traffic, the pandemic virus may spread rapidly, leaving little or no time to prepare.quot; - World Health Organization is HPAI. However, an absolute diagnosis is Avian influenza (AI) is a disease of viral dependent upon the isolation and identification of etiology that ranges from a mild or even the causative virus. Commercially available type A asymptomatic infection to an acute, fatal disease influenza antigen-capture enzyme linked of chickens, turkeys, guinea fowls, and other avian immunosorbent assay kits designed for use in species, especially migratory waterfowl. human influenza have recently shown promise as a possible rapid diagnostic test for poultry. Most avian species appear to be susceptible to at least some of the AI viruses. A particular isolate may produce severe disease in This article is intended for busy turkeys but not in chickens or any other avian scientists engaged in research work in the field species. Therefore, it would be impossible to of Avian Flu to help them reap the benefits of generalize on the host range for HPAI, for it will the Internet without surfing too much for likely vary with the isolate. This assumption is locating the resources. supported by reports of farm outbreaks where only a single avian species of several species present • http://www.pandemicflu.gov/ on the farm became infected. Swine appear to be important in the epidemiology of infection of turkeys One stop access to U.S. Government avian with swine influenza virus when they are in close and pandemic flu information. Managed by the proximity. Other mammals do not appear to be Department of Health and Human Services. The involved in the epidemiology of HPAI. The infection risk from avian influenza is generally low to most of humans with an H5 avian influenza virus in Hong people, because the viruses do not usually infect Kong in 1997 has resulted in a reconsideration of humans. However, confirmed cases of human the role of the avian species in the epidemiology of infection from several subtypes of avian influenza human influenza. infection, including H5N1, have been reported since 1997. Most cases of avian influenza infection in Highly pathogenic avian influenza viruses humans have resulted from contact with infected have periodically occurred in recent years in poultry (e.g., domesticated chicken, ducks, and Australia (H7), England (H7), South Africa (H5), turkeys) or surfaces contaminated with secretion/ Scotland (H5), Ireland (H5), Mexico (H5), Pakistan excretions from infected birds. (H7), and the United States (H5). Because laboratory facilities are not readily available in some parts of the world to differentiate Newcastle disease • http://www.cdc.gov/flu/avian/ and HPAI, the actual incidence of HPAI in the world's poultry flocks is difficult to define. It can occur in The Centres for Disease Control and any country, regardless of disease control Prevention stated how are avian, pandemic, and measures, probably because of its prevalence in seasonal flu different? wild migratory waterfowl, sea birds and shore birds. Avian flu is caused by avian influenza viruses, which occur naturally among birds. Highly pathogenic avian influenza is Pandemic flu is flu that causes a global outbreak, suspected with any flock where sudden deaths or pandemic, of serious illness that spreads easily follow severe depression, inappetence, and a drastic from person to person. Currently there is no decline in egg production. The presence of facial pandemic flu. edema, swollen and cyanotic combs and wattles, Seasonal flu is a contagious respiratory illness and petechial hemorrhages on internal membrane caused by influenza viruses. surfaces increases the likelihood that the disease * Librarian, Central Council for Research in Homoeopathy, New Delhi 37

• www.who.int/csr/disease/ an optimistic outlook. They point out that the avian_influenza/en/ pathogen has not appeared to evolve such that human-to-human contact is contagious, yet it WHO is coordinating the global response remains that people working with fowl, swimming in to human cases of H5N1 avian influenza and infected rivers, playing in an area where carcasses monitoring the corresponding threat of an influenza were buried, or breathing air near a poultry pandemic. Information on this page tracks the processing plant, can lead to infection. evolving situation and provides access to both • technical guidelines and information useful for the www.homeoweb.com/ general public. bird_flu_more.htm • www.homeopathy.boiron.com/en/htm/ There has been much discussion about the service/actualites.htm merits or otherwise of Avian Flu anti-viral medicines in the media but no discussion of the effectiveness The first WORLD MEDICAL of homeopathy in the treatment of influenza. History CONFERENCE on the theme 'Homeopathy and shows us that homeopathy was used by Avian Influenza' took place in Paris on Saturday 19 homeopathic physicians in USA to treat patients November 2005. Homeopathy is routinely used and during 1918-1919 influenza epidemic. From prescribed for the prevention and as treatment for information recorded by these doctors, homeopathic quot;ordinaryquot; influenza with an effectiveness that has treatment was highly successful. In most cases one been recorded in several scientific publications*. or two homeopathic medicines were needed. These This explains why homeopathic physicians and are known as the quot;Genus epidemicusquot; in an pharmacists are being increasingly consulted about epidemic and become known through the careful avian influenza: what can homeopathy do? On a observation of a number of influenza cases. It is preventive or curative level? difficult to speculate exactly what homeopathic remedies will work best in the possible Avian flu • www.homeoweb.com/clinic/ epidemic. However there are a number of known bird_flu.htm 'flu remedies that may be useful eg Gelsemium, Bryonia, Arnica, Eupatorium perfoliatum, Arsenicum Homeopathy offers a much effective etc . In the 1918 epidemic Gelsemium and Bryonia treatment against viral infections in general. Also it were most commonly indicated according to the offers complete cure in almost all infectious illness following extracts if there is not much destruction of tissues that is in • cases other than advanced pathological changes. www.acaciaanimalcare.com/ It is of greater importance that as homeopathy can influenza.htm start effective treatment based on symptomatology one can start the damage control much earlier Many viruses and bacteria travel between before actual diagnosis of bird flu. The only problem species. Usually they do not cause overt disease being many a cases of possible bird flue (or any in humans , people for example catch Fowlpox other grave or answerless illness) will be completely without even knowing they have had it, as it may cured without there is a chance for proper diagnosis not replicate in the cells. and recording the credit to the account of homeopathy. But no good homeopath needs credit • but relief to suffering human www.goldbamboo.com/topic-t7926.html • www.usenature.com/ Influenza, or flu, is a respiratory infection caused article_bird_flu.htm by a variety of flu viruses. The most familiar aspect of the flu is the way it can quot;knock you off your feetquot; Its not difficult to find someone these days who is as it sweeps through entire communities. Studies concerned about the possibility of an influenza suggest that the prescription medicines approved pandemic throughout the world. Equally common for human flu viruses would work in preventing bird are the theories that abound from a plethora of flu infection in humans. However, flu viruses can 'experts' and medical/scientific institutions about its become resistant to these drugs, so these likelihood, the form it might take and the possible medications may not always work. The risk from levels of devestation that it might reap throughout bird flu is generally low to most people because the the animal and human populations. viruses occur mainly among birds and do not usually infect humans. However, during an outbreak of bird • http://www.wisegeek.com/what-is-bird- flu among poultry (domesticated chicken, ducks, flu.htm turkeys), there is a possible risk to people who have contact with infected birds or surfaces that have Most health experts researching and been contaminated with excretions from infected fighting the incidence of human bird flu do not have birds. 38

• www.bird-flu-facts.info/date/2005/11 trials do not show that it can prevent flu. Taking it once you have flu probably shortens the illness, but What type of vaccines has been developed more research is needed. for bird flu - This website publishes bird flu • information and resources. The H5N1 strain of bird www.shrtn.info/users/surveillance- flu has killed at least 62 people in Asia so far. It is a avian-flu flu carried by birds that can be contracted by humans. There are growing fears that a pandemic This Day Online - Federal Government and could start soon as a result of this bird flu. There is the 36 state governments at the weekend called on currently no vaccine for the bird flu, but if an international agencies and other development pandemic occurs with a hybrid form, researchers partners to come to its aid in tackling the avian will be quick to engineer one. influenza which has spread to 10 states of the country so far. • www.appleseek.com/6885.php • www.netplo.com/pworldsflu.html AS BIRD flu, or Avian Influenza, raged through Asia, countries such as Vietnam, China, This is a planet wave resource area in the Thailand, Indonesia, Cambodia, Laos, Japan, Korea field of study of Avian Flu. Access to the latest news and Taiwan are stepping up on massive culling of regarding outbreaks of disease. Page also provides their poultry as they are seized by a realisation that access to disease outbreak news archives, (by year, the animal virus could eventually threaten human disease or country). A RSS feed for notification of lives. updates is also available from this page. www.information-homeopath.com/Bird-flu.html • According to CDCP (the US Centre for Disease www.avianflutests.com/list/2/avian-flu- Control and Prevention), symptoms of bird flu in homeopathic-remedy.html humans have ranged from typical flu-like symptoms (fever, cough, sore throat and muscle aches) to eye Welcome to the information page about infections, pneumonia, severe respiratory diseases avian flu homeopathic remedy. (such as acute respiratory distress), and other They have compiled a list of avian flu homeopathic severe and life-threatening complications. (The remedy websites at: avian flu homeopathic remedy symptoms of bird flu may depend on which virus Site Map. This list of avian flu homeopathic remedy caused the infection.) This sounds like bad news. websites will be updated regularly. However!... • Bird flu is hard to catch Judging from reports so far, http://www.911-bird-flu.com/ catching bird flu is quite difficult. You have to live with the chickens, literally in the same room as them, This is a specialized news site for Bird Flu. One and be handling them or in physical contact with minute the US government is stockpiling Tamiflu, them for quite some time. This explains why few the main drug used to treat flu symptoms in Asian people have caught it so far. hospitals; the next, researchers say that H5N1 virus is already mutating and building resistance to the • www.cochrane.org/reviews/en/ drug. So, what's a fairly-conscious, always- ab001957.html prepared, not-ready-to-die-of-blasted-flu health nut supposed to do? Get some antivirals in your natural Homoeopathic Oscillococcinum does not remedies cabinet. Olive leaf extract is a good one. prevent influenza, but probably shortens the length So is LarreaX, made from a plant in the Southwest of the illness .Influenza (the flu) is a highly infectious desert. Others rely on colloidal silver. disease caused by viruses. Other than treatments • for complications (such as pneumonia), www.birdfluweb.com conventional medical treatment is bed rest. Homeopathy is a system based on quot;curing like with We have put this web site together for likequot;, often using highly diluted substances. anyone interested in bird flu symptom so we invite Oscillococcinum is a homoeopathic preparation you to take a tour. We hope you find what you are manufactured from wild duck heart and liver looking for. But if you don't please do not hesitate (common sources of influenza). It is claimed that to email us at the address shown at the bottom of Oscillococcinum (or similar homeopathic medicines) this web site. It is your feedback that helps us to can be taken regularly over the winter months to make sure that this site eventually becomes one of prevent flu, or as a treatment. The review found that the best bird flu symptom resources on the web. 39

MEDI NEWS 1. Carbon Monoxide Helps Shut Down the 2. Passive Smoking Almost Doubles Risk Of Intestinal Inflammation that Causes Ulcerative Degenerative Eye Disease Colitis Doctors have long known that smokers Passive smoking doubles the risk of the rarely suffer from a common form of inflammatory degenerative eye disease, macular degeneration, bowel disease (IBD) called ulcerative colitis, but they shows research in the British Journal of didn't know why. A new study in the December 19 Ophthalmology. issue of The Journal of Experimental Medicine might help explain this apparent resistance. Scott Plevy The macula lies at the centre of retina at and his colleagues at the University of Pittsburgh the back of the eye. It's crucial for fine central vision, now show that carbon monoxide (CO), a component which is essential for tasks, such as reading and of cigarette smoke, helps shut down the intestinal driving. inflammation that causes ulcerative colitis. The risk of macular degeneration increases CO is best known as a toxic air pollutant, at the age of 60. It is a leading cause of partial but small amounts of this gas are also produced in sightedness and blindness in many European the human body as a normal by-product of countries and the USA. metabolism, suggesting that the effects of CO must not be all bad. High dose CO gas is lethal, because The researchers base their findings on 435 it robs the body of life-sustaining oxygen. It is this people with end stage macular degeneration and asphyxiant property of CO that has earned it a bad 280 partners who lived with them. reputation. But recent scientific studies have shown that CO -- at least at low concentrations -- has a They found that the more a person smoked, redeeming quality: it acts as an anti-inflammatory the greater were their chances of developing age agent. related macular degeneration. It is this quality, according to Plevy and Regularly smoking a pack or more a day colleagues, that allowed CO to ease the symptoms for 40 years almost tripled the risk of age related of IBD in mice. The group traced the action of inhaled macular degeneration compared with non-smokers. CO to a protein that is produced by immune cells called interleukin (IL)-12. IL-12 is normally produced The risks were also increased for partners during infection and helps activate the immune cells who were non-smokers, and had lived with a smoker that fight off the invading pathogens. But chronic for five years or more. Their risk nearly doubled. production of IL-12 in the gut also drives the inflammation that causes ulcerative colitis. Inhaled (Source: Medical News Today, Category: Smoking News, CO inhibited the production of IL-12, short-circuiting dated 20 Dec. 2005) the disease-causing inflammation. 3. Fish Oil Prevents Potentially Deadly Heart Rate Variability The researchers are now trying to unravel the specific cellular components that are required A two-gram fish oil supplement given daily for CO to inhibit IL-12. In the meantime, Plevy thinks to elderly persons prevented a decline in heart rate that inhaled CO might provide some relief for variability caused by tiny, dangerous airborne patients with ulcerative colitis. But non-smokers with pollutant particles. Heart rate variability, a measure IBD shouldn't necessarily break out the Marlboros, of the autonomic nervous system's regulation of the as cigarette smoking is a risk factor not only for heart, is an independent risk factor for cardiac heart disease and cancer but also for Crohn's arrhythmias, heart attack or sudden death. disease, another form of IBD. These findings appeared in the second (Source: Medical News Today, Category: Irritable-Bowel Syndrome News, dated 20 Dec. 2005) issue of the December 2005 American Journal of 40

Respiratory and Critical Care Medicine, published who have abortions are more susceptible to by the American Thoracic Society. generalized anxiety disorder and depression and are more likely to receive psychiatric treatment. Fernando Holguin, M.D., of the Centers for Sleep disorders are often linked to a mood disorder Disease Control and Prevention in Atlanta, Georgia, and posttraumatic stress disorder. and eight associates provided fish oil supplements (Source: Medical News Today, Category: Abortion News, to 26 residents of a nursing home in Mexico City. A dated 04 Jan 2006) control group of 24 residents was given soy oil supplements. The participants' average age ranged from 81 to 83 years old. 5. Smoking While Pregnant Causes Finger, Toe Deformities quot;In this randomized controlled trial, fish oil supplementation prevented the reduction in heart Women have yet another reason to stop rate variability associated with the same-day smoking while pregnant. In the largest study of its exposure to indoor particulate matter,quot; said Dr. kind, plastic surgeons found smoking during Holguin. quot;In contrast, soy oil, was associated with a pregnancy significantly elevates the risk of having marginal protection on heart rate variability.quot; a child with excess, webbed or missing fingers and toes, according to the January issue of Plastic and quot;Fish oil as a source of omega-3 Reconstructive Surgery®, the journal of the polyunsaturated fatty acids could be considered as American Society of Plastic Surgeons (ASPS). In a potential form of preventive measure to reduce fact. Smoking just half a pack per day increases the risk of arrhythmia and sudden death in elderly the risk of having a child born with a toe or finger subjects exposed to ambient air pollution,quot; said Dr. defect by 29 percent. Holguin. Researchers examined the records of more In the study, the residents were exposed than 6.8 million live births in the United States during to tiny indoor air pollutant particles that had a 2001 and 2002, finding 5,171 children born with a dimension of 2.5 micrograms or less. All participants digital anomaly where the mother smoked during spent 92 percent of their time indoors. pregnancy but did not suffer from other medical complications, such as heart disease, diabetes or The supplement study was conducted over high blood pressure. six months. None of the patients suffered from cardiac arrhythmias, had a pacemaker or were The more a woman smoked, the higher the being treated with oral anticoagulants. risk became. Women who smoked 11 to 20 cigarettes a day raised the risk 38 percent, and (Source: Medical News Today, Category: Seniors/Aging women who smoked 21 or more cigarettes per day News, dated 20 Dec. 2005) raised the risk 78 percent. 4. Women Are More Likely To Be Treated For Webbed fingers or toes occur one in every Sleep Problems After An Induced Abortion 2,000 to 2,500 live births and excess fingers or toes occur one in every 600 live births. Results of a study show that women are more likely to be treated for sleep disorders or Nevertheless, the majority of these defects disturbances following an induced abortion occur without any family history and most causes compared to a birth. The observed risk was highest are unknown which has lead researchers to in the first 180 days after pregnancy outcome but investigate environmental causes, such as smoking, was not significant after the third year. for these anomalies. The authors examined the records of quot;Smoking is so addictive that pregnant 15,345 women who had an induced abortion and women often can't stop the habit, no matter what 41,479 women who gave birth. Women with a the consequences. Our hope is this study will show history of treatment for sleep disorders before expectant mothers another danger of lighting up.quot; pregnancy were excluded. (Source: Medical News Today, Category: Smoking News, dated : 07 Jan 2006) Compared to women who carry unintended pregnancies to term, research shows that women 41

6. Treatment Of Gum Disease May Reduce The of gum disease that was so severe that all their teeth Risk Of Cardiovascular Disease had to be extracted. The blood tests were for blood- clot risk factors and signs of inflammation. The Journal of Dental Research has just published the results of a study showing that The average level of factors fell when the treatment of gum disease may reduce the risk of gum infection was eradicated, suggesting that the cardiovascular disease. risk of heart attacks and clots in the future had reduced. This also indicates that inflammation in Researchers from Australia (Sydney Dental the mouth has a measurable effect in the Hospital and Royal North Shore Hospital) and bloodstream, and therefore the rest of the body. Norway (University of Oslo) collaborated in the PERICAR clinical trial, providing strong evidence The researchers are currently studying the linking periodontal (gum) disease to an increased relationship between gum and heart disease in risk of developing blood clots, which could lead to people with less severe periodontal disease who the onset of heart attack and stroke. do not need to have all their teeth extracted. In recent years, many studies throughout Dental disease impacts on people's general the world have linked periodontal disease to health and well-being. Periodontal disease is increased cardiovascular risk, although the reasons common, preventable, and treatable. This study for this link have not been fully explained, nor has it suggests that improving periodontal health could been proven that the link is a direct causal one. significantly reduce the risk of cardiovascular One explanation is that inflammation and infection disease. have also been related to increased atherosclerosis and cardiovascular risk. Periodontal disease is the The Journal of Dental Research is the most common chronic infection in humans, and flagship publication of the International and symptoms include bleeding, swollen or receding American Associations for Dental Research gums, and bad breath. In severe cases, the teeth (www.dentalresearch.org) and is the top dental become loose and may eventually fall out. journal in the world. (Source: Medical News Today, Category: Dentistry Individual participants who were involved in the trial had blood tests before and after treatment News, dated 05 Jan 2006) 42

INSTRUCTIONS TO AUTHORS The Council invites papers for publication in in the text of the articles should not be inserted in its Quarterly Bulletin. These should be original and the abstract (of about 250 words). It should be writ- not published elsewhere. All contributors are sub- ten for the readership of both clinicians and investi- ject to peer review by independent experts and the gators and should state the hypothesis or central Editor's decision concernin question of the study or investigation, the study subjects or experimental animals, observational and g publication is final. A detailed outline is required analytical methods , the findings, and a final state- before we will agree to commission such articles. ment of the principal conclusions. All materials submitted for publication must include a covering letter, personally signed by all authors . 4. Keywords: Manuscript should be sent to The Director, A set of suitable (three to six) keywords may Central Council for Research in Homoeopathy, be provided. The terms should be based on signifi- JLN Anusandhan Bhawan, 61-65, Institutional cance of the text. Area, Janakpuri, New Delhi-110058. e-mail: ccrh@del3.vsnl.net.in 5. Introduction : Requirements for submission of Manuscripts: Introduction should be brief and state precisely the scope of the paper. Review of the litera- (a) Manuscripts should be submitted with the ture should be restricted to reasons for undertaking undertaking that they are not under the present study and provide only the most essen- consideration elsewhere and have not tial background. been reported earlier partly/totally. Submission of a manuscript indicates tacit 6. Material and Methods : acknowledgment that all authors have made significant contributions to the study The material (Patients , experimental animals and have read and approved the contents. etc.) used for making observations must be described along with all other relevant information. The (b) Acceptance of manuscripts for publication methods used in the study should be described , is based on 1. Originality of contribution; 2. giving sufficient information to permit the work to Proper analysis of scientific data; 3. Clarity be repeated. If a generally accepted technique has of presentation; 4. Ethically acceptable been used, only reference to that is enough. If, how- design of the study. All accepted ever, such a technique has been modified by the manuscripts are subject to manuscript workers, the manner in which this has been done editing. should be clearly stated. The drugs and chemicals used should be precisely identified, including ge- neric name(s), dosage(s), and route(s) of the ad- 1. General ; ministration. If statistical analysis of the data has been done , the methods used for analysis should Manuscripts must be typewritten, double- be specified. spaced with wide margin on A-4 size good quality bond paper. Each of these segments of the manu- 7. Results: scripts should begin on a new page: Title; abstract; introduction; material and methods; discussion; ac- Only such data as are essential for under- knowledgment references; legends; figures and ta- standing the discussion and main conclusions bles. emerging from the study should be included. The data should be arranged in unified and coherent 2. Title: sequence so that the report develops clearly and logically. Data presented in tables and figures should Title of the article should be short, continu- not be repeated in the text. Only important obser- ous (broken or hyphenated titles are not accepted) vations need to be emphasized or summarized. and yet sufficiently descriptive and informative so as to be useful in indexing and information retrieval. 8. Discussion: 3. Abstract: This should be limited to significance of results obtained and what can and what cannot be Abstract should be brief and indicate the concluded and why. It should not be a repetition of scope and significant results of the paper. It should the findings already given in the Results. only highlight the principal findings and conclusions so that abstracting services without modification can use it. Conclusions and recommendations not found 43

9. Acknowledgment: address a specified therapeutic and/or management issue or point of doctrine. Discussion should be Acknowledgment should be brief and made critical and reflective rather than doctrinaire. Case for specific scientific and technical assistance only analysis (symptom selection, prescribing strategy, and not for providing routine departmental facilities etc.) should be transparent and well justified. Case and encouragement or for help in the preparation histories should discuss the materia medica in- of the manuscripts. volved and the rationale of any differential diagnosis. Cases analysis and materia medica should be 10. References : illustrated with tables and figures where appropriate. Case histories should include adequate follow References should be numbered consecu- up to demonstrate sustained improvement. Docu- tively in the order in which they are first mentioned mentation and independent evidence greatly in the text. References should be typed on sepa- strengthen case reports, and as much such evi- rate page. Examples of correct form of references dence as possible should be presented. This in- are given here : cludes results of pathology and other investigations, images (including photographs), physical examina- Journal tion, ability to work and fulfill social roles, school performance, assessments by other health profes- Kumar S Mohan A. Recent concepts in the sionals and agencies. pathogenesis of bronchial asthma. Indian Jr. Chest Dis Allied Sc. 39(2) 1997:27-45. 14. Submission of disk: Book If possible please supply articles on disk. Articles supplied on disk must meet the following Behera D. Textbook of Pulmonary Medi- criteria: cine. New Delhi, Jaypee Brothers Medical Pub- lishers (P) Ltd. 1995. 1 The manuscript on disk must be identical to the hard copy. Chapter in Book 2 A double-spaced hard copy accompanies Weinstein L, Swartz MN. Pathogenic prop- the disk and matches the disk version erties of invading microorganisms. In: Sodeman WA exactly. If the disk version differs from the editor. Pathologic Physiology: mechanism of dis- hard copy, the hard copy will be used. ease. Philadelphia: Sounders;1947p.457-72. 3. The disk contains text only, excluding 11. Figures and Tables; tables, figures or graphic files. 4. Disks are 3.5 inches (90 mm) Figures: 5. The paper saved is in its original Glossy print photographs(in triplicate) are application (e.g. word perfect or Microsoft required(usually10cmX8cm); good black and white Word), also as RTF (Rich Text Format) if contrast is essential for good reproduction. All illus- available or ASCII (plain) text. trations must be numbered and cited in the text. Legends should be provided for each illustration, 6. The disk is clearly labeled with the journal listed on a separate page. title, authors names, paper title, file names and the application used. Tables; 7. Tables are provided as hard copy as well Each table should be typed double spaced as on disk. Figures/art work provided as on a separate sheet. They should have underlined hard copy as well as on disk. title followed by a legend, if any. Explanatory mat- 8. There is no automatic pagination. ter should be in a footnote, not in the title. Manuscript pages should be numbered by hand other hard copy version. 12. Abbreviations; 9. The files are not compressed. Only standard abbreviations are to be used. The title of article should not contain abbreviations. 10. There are double-line spaces between The full term for which the abbreviation stands paragraphs; first lines are not intended. should be given after its first use in the text. 11. Double-line spaces are not used between 13. Clinical case histories: items in the list or references. Cases should be well presented and concise 12. Journal style is followed for references, (maximum of 1500 words per case). Cases should capitalization, etc. 44

PSIDIUM GUAJAVA 1. Leaf epidermis, Abaxial surface x 485 2. Leaf epidermis, Abaxial surface x 418 3. Leaf midvein in Transection x 69 4. Leaf lamina in transection x 45 5. Petiole in transection x 56 6. Leaf surface showing secretory cavities x 104

TLC PFORILE OF PSIDIUM GUAJAVA Psidium guajava mother tincture (Chloroform extract) Fig. 1 70% Alcoholic extract of Psidium. Fig. 2 Fig. 3 Refined figure of Chloroform extract. S.S. Chloroform : Benzaene, few drops of Acetic acid. (1:1 v/v). Detecting agent : 10% Ferric chloride solution.

HPTLC CHROMATOGRAMS OF MOTHER TINCTURE OF PSIDIUM GUAJAVA Fig. 1 Images of chromatograms at 254 nm. before deravitization. Fig. 2 Images of chromatograms at 366 nm. before deravitization. Fig. 3 Images of chromatograms at 366 nm. after Spraying with Methanolic H2SO4. Fig. 4 Visible images of chromatograms after deravitization with Methanolic H2SO4. Fig. 5 Images of chromatograms at 366 nm. after Spraying with anisaldehyde H2SO4. Fig. 6 Visible images of chromatograms after deravitization with anisaldehyde H2SO4. Mobile phase - Chloroform : Acetic acid : Methanol : Water (6.3 : 2.1 : 2 : 0.8) Stationary phase - TLC plates Sililca get 60F 254 E. Merck. Sample concentration - T1 - 5 UL, T2 - 10 UL, T3 - 15 UL, T4 - 20 UL, T5 - 25 UL,

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Scientific Homeopathy

by Prabhat Tandon on Sep 07, 2007

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