BP should be monitored & measured correctly, where in 2’days world incidence of obesity is higher and rising further, an obese person may show higher BP with a normal size of cuff (12X23cm), in such cases better to try with a wider size of BP cuff. Cardiac output: - It is the volume of blood pumped by the left ventricle in one minute. Normally 5 to 6 liters of blood is pumped out in healthy adult. It is depends on blood volume, which is greatly depends on body sodium. Peripheral resistance: The total peripheral resistance is determined by lumen size of the arterioles, thickness of the arteriolar wall and the effects of the neural and hormonal influences that either constrict or dialate these vessels Auto regulation:-It is a process by which increased blood flow to resistant vessel induces vasoconstriction, an adaptive mechanism that protects against hyper perfusion of tissues.
Kidney influences both peripheral resistance and sodium homeostasis and the rennin-angiotensin system appears to central to these influences. Renin formed from the juxtra glomerular cells of the kidney converts plasma angiotensinogen to angiotensinI, and it is again converted into angiotensin II by ACE. Angiotenin II alters blood pressure by increasing both peripheral resistance and blood volume. Kidney produces a variety of vasodepressor that counterbalance the vasopressor effects of angiotensin.they include prostaglandins and kinins. When blood volume is reduced, the GFR falls, this in turn leads to increased reabsorbtion of sodium by proximal tubules in an attempt to conserve sodium and expand blood volume.
The following are the predisposing factors: heredity, cortical drive [get-on-at-any-cost types] emotional reaction to prolonged anxiety, hyper-reactive pressure responses which derange the baroceptor reflexes with repetitive stimulation, overweight from excessive calorie intake, excessive sodium intake or retention, smoking of tobacco which raises the Free fatty acid level, lack of exercise, soft water and low residue diet, with common accompaniments--baldness, early arcus senilis, xanthelasmata. ABCDE mnemonic Apnea (OSA) Aldosteronism (hyperaldosteronism) Bruits (renal artery stenosis/FMD) Bad Kidneys (intrinsic kidney dz) Coarctation Cushing’s Syndrome Drugs (stimulants, OCPs, NSAIDS) Diet (high Na/low K, Mg, Ca) Erythropoietin: elevated EPO in COPD or renal failure or exogenous use for anemia Endocrine: Thyroid/Parathyroid, pregnacy, pheochromocytoma, acromegaly
Ix CBC: Look for elevated Hb RFT: Look for K, elevated Bun/Cr, elevated Ca. Calc GFR U/A: Look for protein/blood Look for microscopic albumin Look for abnormal lipids ECG: Look for LVH, CAD, arrhythmia
Environmental factors: Physical (sun, lunar energy, radiation, etc.), chemical (drugs, metals, occupational hazards, etc.), biological (bacteria, fungi, vaccinations, etc.), socio-cultural, emotional, and spiritual. 2. The fundamental maintaining cause: The miasms – Psoric, Sycotic, Tubercular and Syphilitic. Based on the immune system or the Psycho-Neuro-Immuno-Endocrine (PNIE) axis , the individual has the potential to survive adverse conditions and reach an adaptive balance which allows survival. This struggle is expressed in external physical signs and symptoms as well as mental symptoms. A distinct homogeneous yet characteristic totality is expressed through presenting Symptoms and Concomitants (functional and structural) with an individualized response to various environmental factors known as Modalities. This is expressed at all levels: Body, Mind and Spirit. This homogeneous expression for adaptive balance or homeostasis is what we define as the Constitution of an individual. Miasms are considered as latent and intrinsic predisposing causes for chronic diseases. These get activated in presence of extrinsic exciting and maintaining causes. The susceptible subject may harbor disease and yet remains asymptomatic or have one-sided presentation for a long time. Therefore the proper elucidation of such miasmatic traits, along with identification of environmental exciting and maintaining causes are integral aspect of miasmatic cleavage and patient individualisation. Experience indicates that many difficult emotions are associated with midlife crises, which settle in deep structures of the body such as the blood vessels and heart,
Miasmatic expression is not merely a reflection of disease caused by an infective organism. If that were the case, then every organism would produce its own “miasm”, shifting the individual into a multitude of miasmatic expressions combined with each other! This would be a simplistic understanding of what Hahnemann termed “miasmatic expression”. The disease expression clearly falls into one of the major groups above at a particular point in time, based on the symptomatic expression which exhibits itself at the level of the intellect, the emotions, and the body simultaneously. An individual could exhibit different miasmatic expressions at different points of time. The miasmatic expression predominant at any point in time in a particular individual is in parallel with the specific infecting organism (bacteria, virus, fungi, parasite), which play a role in terms of type of clinical symptoms. But it is the underlying (fundamental) miasm that determines which organisms one is susceptible to. Miasms are the constitutional or diathesis states which determine the mode of existence of the individual. It can be seen as a predisposition towards various chronic diseases. With this understanding of the miasms, we can easily see that it corresponds to the "Constitutional or Hereditary influences" in the genesis of Essential Hypertension. Dr. M.L. Tyler says that the so called acute miasms in the past history of a patient can contribute to the maintenance of the chronic illness in the patient. Unless such acute miasmatic blocks are dealt with in the course of the treatment, either with an appropriate nosode or a drug with the indications of the past history of illness in the patient, the patient does not progress on the lines of centre to the circumference in the axiomatic parlance of Hering s Law of cure. There is no harm if the classical Hahnemannian physician brings all the acute miasms under one umbrella called psora. T he evolution of disease is ultimately the progression of disease in the opposite direction of Hering’s law of cure ! The homeopathic physician is concerned with understanding the characteristic individuality of this expression in order to find the simillimum, i.e., the single remedy which is matched to the presenting picture of disease symptoms in the patient. A distinct The remedy that encompasses the diseased state of this constitutional expression at all levels, body, mind, and spirit, is what is termed “ constitutional remedy “. It necessarily coincides with the miasmatic expression of the individual. Diathesis is an exaggerated expression of the adaptive balance of the still-healthy constitutiona precarious balance of health, with morbid tendencies which predispose the individual towards disease. All this must, however, be understood as according to Hering’s observations on the evolution of disease, which he says develops: 1. From the periphery to the center. 2. From the superficial to the deeper areas. 3. From the less vital to more vital organs. 4. From the characteristic to the common. 5. From subjective to objective symptoms.
The pseudo psoric or tubercular miasm may reflect many of the subjective symptoms, the mental and emotional reactions of the predominant parent, psora as well as the pathological changes of the syphilis. Heart troubles are accompanied by fainting, temporary loss of vision, ringing in ears, pallor, great weakness worse sitting up and better by lying down usually, can not climb mountains as disturbed circulation affects the brain.
A very pertinent question which has very often confronted the conscientious and imaginative physician is, whether the incidence of abnormal blood pressure [hypertension] can be prevented? With the rich and valuable experience of the homoeopathic physicians in the world, this question can be answered affirmatively hypertension can be prevented with a diet regimen, with occasional homoeopathic medication and with a proper outlook on life. Regarding the preventive treatment in drug therapy had good results with the occasional doses of constitutionally selected polychrest remedies like Lycopodium,Sulphur, Pulsatilla, Aurum, etc., from 200 to 10M potency at an interval of one to three months. The selection of the remedy for the preventive treatment may depend on the predisposing factors. In the asymptomatic preventive group one can safely utilize the Hahnemannian principles of one-sided disease approach as laid down in the Organon. Similarly, the incidence of smallpox or vaccinations in the past history of a patient requires Thuja or Variolinum according to Burnett.5 Tyler emphasizes Thuja whenever there is an incidence of smallpox in the past history of a patient s illness.
Hypertension - Homeopathy - Miasm
Hypertension with Miasmatic view in
(Homeopathy in cases of Hypertension
Miasms in management of Hypertension)
Dr. Manshi Mankiwala
(M.Sc. Public Health, M.D. Homeopath)
• About > 25% of world population today is hypertensive.
•Only 70% are aware they have hypertension (HTN).
•Of those aware of their HTN, only 50% are being treated.
•HTN is a one of the major risk factor for Coronary
Artery Diseases, Congestive Heart Failure, stroke, and
•Cardiovascular risk increases twofold for each
20mm/Hg rise in systolic pressure or each 10mm/Hg
rise in diastolic pressure.
Risk factors includes all age groups, obesity, sedentary
life style, family history, smocking, alcohol, high Na+
intake, low Ka+ & Mg++ intake and overuse of NSAIDs.
A broad understanding of the miasmatic influences in
Essential Hypertension is possible from the examination of
the aetiological factors, pathology and clinical presentations
Features of Psoric Predominance
Labile hypertension or hypertension caused by emotional disturbances
like anger, anxiety, worry, grief etc.
Complaining of dizziness, dyspnoea, palpitations etc. which are better by
lying down and keeping quiet and worse after eating.
The heart affection including hypertension from fear, disappointment,
loss of close one or over joy.
Heart pulsations shake the body and are accompanied with great anxiety
The mental symptoms alternate with heart troubles.
Features of Psoric Predominance
Neuralgic and stitching pains in the chest, > rest, and band like
sensation around the heart.
Sensations like rush of blood to the chest, weakness, goneness or
fullness about the chest are common.
Oppression and anxiety are worse morning and pain worse motion,
laughing and coughing.
Full bounding pulse with discomfort in the chest.
Violent hammering and beating about the head due to reflexes, such
as gastric disturbances, flatulence and uterine irritation.
Sudden onset of headache, short lasting and self limiting and violent
Recurrent headache on slight excitation.
Marked fear and apprehension
Features of Tubercular / Pseudo - Psoric Predominance
Pulse - small thread like and quick.
Wide fluctuation in blood pressure to very high levels of systolic and
Along with hypertension, haemorrhagic manifestation like epistaxis,
retinal haemorrhage, cerebral haemorrhage are present.
Vertigo and palpitation are greater than that seen with psoric
predominance and are accompanied by rush of blood to heart and
Pain in chest is worse on sitting, better by lying and is so severe that
it is associated with dimness of vision, ringing in the ears and great
The patient wants to keep still and is much aggravated by higher
altitude, climbing stairs or ascending.
Features of Sycotic predominance
In hypertension, the sycotic element may be responsible for marked
ventricular hypertrophy. Hypertension that results from damage to the
vascular bed of the kidneys and salt and water retention.
The combination of psora with sycosis may also cause marked changes
in the structure of the heart, as well as dropsical conditions.
Heart valves roughened ; Myocardium flabby, soft and lacking contractile
Hardening of elastic lamina and intimal proliferation.
Atheroma developed in large arteries results in narrowing of lumen and
Increased peripheral resistance resulting from thickness of walls of the
The sycotic patients are fleshy and puffy, their obesity contributing to
complaint of dyspnoea.
Features of Sycotic predominance
The dyspnoea is seldom painful, as opposed to the psoric or
tubercular miasm, there may be soreness and tenderness and pains
radiating from heart to scapula or from shoulder to heart.
The pains are ameliorated by motion, walking, riding or gentle
The heart complaints may be accompanied by or there may be a
past history of suppressed rheumatic symptoms.
Pulse-soft, slow and easily compressible.
Frequently face becomes blue, cyanotic or apt to be venous
congestion or rather stagnation.
Sycosis produces marked anasarca and dropsical conditions.
Post-menopausal hormonal disturbances in females causing
Hyperlipidaemia , Obesity
Desire for salt
Features of Syphilitic predominanceThe syphilitic influence in hypertension leads to widespread
destructive changes in the vital organs like heart, kidney, retina and
Fibrinoid necrosis of the vascular wall
Left ventricular hypertrophy
Many of the life threatening complication of hypertension, like
cerebral and myocardial infarction, malignant hypertension etc.
Very little mental disturbance in heart troubles even at critical periods
of the disease.
In long standing cases, left ventricular failure, which express as
exertional dyspnoea, orthopnoea and paroxysmal nocturnal
dyspnoea, suggest syphilitic miasm.
Desire for Strong stimulating things like alcohol.
Associated Diabetes Mellitus, ageing or premature old age
identifiable by degenerative changes
The essential one for homoeopathic treatment, to understand
both the reversible and irreversible Hahnemannian drug
In some patients when the offending and implicated
allopathic drug is stopped, the blood pressure rises for
sometime and in many patients it is controlled after the
constitutional homoeopathic treatment.
A hypertensive patient is the sum total of psoric-syphilitic,
psoric-sycotic or all the three classical miasms (as described
by the Master ).
-Great distress in heart and chest.
-Dreadful oppression of the precordial region.
-Inward pressing in the region of the heart.
-Palpitation with great anxiety and difficulty of breathing. Anguish
-Sensation of something rushing into head, with confusion and flying
heat in face.
-Sudden attacks of pain in heart, with dyspnoea.
ANXIOUS; restless; with fears : Fear of death.
-Sudden acute conditions from chill, shock, fright.
-All ailments and fears worse at night.
-"Sits up straight and can hardly breathe. Aconite has such a violent
cardiac irritation, pulse fluttering, weak, full and bounding; sits up in
bed, grasps the throat, wants everything thrown off; before midnight
a hot skin, great thirst, great fear - everything is associated
-Sudden attacks of pain in the heart with dyspnoea... breaks into a
profuse sweat ... awful anxiety". - Kent.
-"The lancinating, darting pains, palpitation, orthopnoea, have
rendered Apis invaluable in cardiac inflammations and dropsy".
-Sudden oedema, dyspnoea, and sudden lancinating or STINGING
pains, restlessness and anxiety.
-Think of Apis for burning and stinging pains - anywhere.
-Apis is generally thirstless.
-Is worse after sleep : from warm room, and heat : better cold air,
cold room, cold applications. (Reverse of Ars.).
-"Skin alternately dry and hot, or perspiring".
-Pain in region of heart, as if it were squeezed together (Cact., Lil.
tigr.), or had shock or blow.
-Heart first rapid, then extremely slow.
-Stitches in cardiac region : stitches left to right.
-Pulse feeble - hurried - irregular.
-Horror of instant death with cardiac distress in the night.
-One of our greatest remedies for tired heart : dilated after strain or
-Tired out from physical or mental strain.
-Feels bruised, beaten, sore : bruises easily.
-Restless because bed feels too hard.
-Does not wish to be touched : fears approach.
-Useful in advanced and desperate heart cases.
-Palpitation, with anguish; cannot lie on back : worse going up stairs;
walking. Heartbeats irritable.
-Palpitation and tremulous weakness after stool.
-Angina pectoris; sudden tightness above the heart; agonizing
precordial pain; pains extend into neck and occiput; (Kalm. to left
arm and hand); breathing difficult; fainting spells. Least motion
makes him lose his breath; sits bent forward, or with head thrown
-Worse at night, especially 1 to 5 a.m.
-Rheumatism affecting heart, with great prostration, cold, sticky
sweat; great anxiety and oppression; burning about the heart.
-Pulse small, rapid, feeble : intermittent.
-Valvular disease, with dyspnoea, anasarca.
-Hydropericardium with great irritability, anguish and restlessness.
The cardinal symptoms of Ars. are generally present : extreme
restlessness, driving out of bed, or from bed to bed.
-Thirst for small quantities, often. Aggravation from cold : relief from
heat. (Reverse of Apis. But Ars. rapidly curative in a desperate case
of hydropericardium, where these were absent.
-Frequent attacks of anguish about the heart, and tremulous
-Violent palpitation of the heart.
-Rheumatism that has gone to heart (Kalm.).
-Acute rheumatism with desperate heart conditions; extreme
dyspnoea; impossible to lie down.
-A queer symptom - heart seems to shake, as if loose, when walking.
-The Aurum mental state is profound despondency and melancholy.
-Disgust of life. Tendency to suicide.
-Absolute loss of enjoyment in everything.
-Pains wander from joint to joint and finally settle in the heart.
-Is also very valuable in heart troubles.
-Hering (Guiding Symptoms) says, "Angina pectoris (next to Arnica
-Heaviness, aching, sensation of rigidity in heart. Cardiac anguish.
-Sticking in heart.
-Palpitation of the heart : heart squeezed.
-Sensation of constriction in the heart, as if an iron band prevented
its normal movement.
-Several violent, irregular beats of the heart, with sensation of
pressure and heaviness.
-Small, irregular heart-beats, with necessity for deep inspiration.
-Congestion in chest.
-Painful constriction lower chest; "a cord tightly bound round false
ribs, obstructing breathing".
-Great constriction (sternum) "compressed by iron pincers".
-"It is the nature of Cactus to constrict.
-Tightness and constriction about head - chest - diaphragm - heart -
uterus : - clutching pain.
-Chest as if filled with hot gushes of blood.
-Fear and distress. Violent suffering.
-Screaming with the pain.
-Strong pulsations felt in strange places - stomach - bowels - even
-Sensation as though heart stood still, with great anxiety : must hold
breath, dare not move.
-Pulse very slow: thready, slow, intermittent.
-Sensation as if heart would stop beating if she moved. (Gels. must
move or it will stop.).
-Respiration difficult : sighing : stops when she drops off to sleep.
-Digitalis affects heart and liver : jaundice - white stools, with very
slow pulse. (Kalm.).
-Diarrhoea and nausea with heart disease.
-Stitching pains - chest - heart, extort cries.
-Stitches about heart and through to scapula.
-Heart's action, intermittent, irregular, tumultuous, weak. Mitral
-Leans forward resting on arms to take weight off chest (rev. Spig.).
-Stitching pains (like Bry.), but also independently of motion and
respiration (unlike Bry.).
-Worse hours are 2-4 a.m.
-Has profuse sweat. Puffiness about the eyes.
-Complementary to Carbo veg.
Kali carb. following a few doses of Carbo veg., bring back to life a
dying child, an old mitral case, with pericarditis with effusion, and
pneumonia with plural effusion
-Violent palpitations of the heart with faint feelings : with oppressed
-Wandering rheumatic pains in region of heart, extend down left arm.
-Heart disease, after frequent attacks of rheumatism, or alternating
-Hypertrophy and valvular insufficiency, or thickening after
rheumatism; paroxysms of anguish about heart, with dyspnoea and
-Remarkable slowness of pulse (Dig.). Pulse very feeble : or, heart's
action very tumultuous, rapid and visible (Spig.).
-"When rheumatism has been treated externally and cardiac
symptoms ensue". - Kent.
-Cramp-like pain in precordial region, causing palpitation with
-"Heart feels too large for containing cavity".
-Bluish lips. Cyanosis. (Spongia.).
-Intolerance of touch or pressure on throat - larynx - stomach
-As if something swollen in pit of throat would suffocate him.
-Worse after sleep. (Spongia).
-"Lachesis is one of our most useful remedies in heart troubles,
acute or chronic; the peculiar suffocation, cough, and aggravation
from constriction being the guiding symptoms". - Nash.
-Dull oppressive pain in heart; sharp quick pain, with fluttering.
-Roused from sleep by pain as if heart were violently grasped, the
grasp gradually relaxed, interrupting heartbeat and breathing.
-Sensation as if heart was grasped or squeezed in a vice (Cactus);
as if all blood had gone to heart : must bend double; (reverse of
-Heart alternately grasped and released.
-Heart feels over-loaded with blood.
-Violent palpitation with throbbing of carotids.
-Depression of spirits. Weeps.
-Characteristics : Hurried feeling, as of imperative duties and inability
to perform them.
-Pressure on rectum and bladder. Terrible urging to stool, to urinate,
all the time.
-Bearing down with heavy weight, as if whole contents of pelvis
would issue through vagina, but for upward pressure of hand.
-A great heart medicine, only proved in low potencies, so we lack the
-Heart weak. Post-diphtheritic heart.
-"For a heart damaged by Acute rheumatism".
-Palpitation, violent, on slightest motion.
-Violent, lying on left side.
-Precordial anguish from emotion.
-Heaviness, chest, as if a weight lying on it.
-Constriction : pressing sensation about heart.
-Burning pain between scapulae. (Lyc.).
Tall, fine : fear alone, dark, thunder. Thirst for cold drinks.
-Rheumatic irritation of heart, where pains shift rapidly about the
-Heart symptoms reflex from indigestion.
-Heaviness, pressure, fullness (heart). Violent palpitation with
anguish : sight obscured.
-Patient nervous, weepy, intolerant of heat : craves air and fuss.
-Violent palpitation of the heart and beating of all the arteries, in bed.
Stitches in heart.
-Violent palpitations of heart, as if it would force its way through
chest wall : relieved by walking a long distance, and walking very
-The Sepia patient is indifferent : hates.
-Tendency to ptosis and dragging down, especially in pelvic organs.
- (Lil. tigr.).
-Profuse perspirations, especially axillae.
-VIOLENT beating of heart that frequently he could hear the
pulsation, or that the beasts could be seen through the clothes.
-Palpitation aggravated by sitting down and bending forward (rev. of
-Heart seemed to be in tremulous motion.
-Worse for deep inspiration, or holding breath.
-"Heart sounds may be audible several inches away". - Nash.
-Must lie on right side, or with head very high.
-Spigelia's pains are stitching. Sharp neuralgic pains (chest, head,
heart, eyes, etc.).
-Worse for slightest motion.
-Constricting pain (cardiac) with anxiety.
-Attacks of oppression and cardiac pain agg. lying with head low.
-Palpitation : violent, with pain, gasping respiration : suddenly
awakened after midnight with suffocation, great alarm, anxiety.
-Awoke often in a fright, felt suffocating (Lach.). Lips blue (Lach.).
-Angina pectoris : contracting pain in chest, heat, suffocation,
faintness, anxious sweat.
-Anxious palpitation. Violent palpitation.
-Rush of blood to heart. "Too much blood in heart". (Cact.).
-Heart feels enlarged.
-Great orgasm of blood, with burning hands.
-Stitches heart and chest; worse deep breathing.
-Sulphur is hungry - untidy - argumentative.
-Worse heat : intolerant of clothing : fond of fat.
-Heart felt very hot : beat fast : with bursting sensation : or feeling of a cavity
where heart ought to be.
-Sharp pain at apex, worse motion.
-Great pain, heart, extending to left arm and throat.
-Intense pain, heart, radiates to all parts of left chest : worse least
worse - sunrise to sunset.
Everything seems unreal like a dream.
-Time moves so slowly : things done an hour ago, as if done a week ago. -
-Anguish : introspection : always anticipating evil happenings.
-Cannot concentrate : forgets what she is reading; cannot spell simple
words. (bac., tub).
-Heart cases where there is a family, or past history of tubercular
-Palpitation : heaviness : pressure over heart.
-Irritable : irritable on waking : nothing pleases : nothing satisfies.
-"Wants to travel : cosmopolitan condition of mind". Suffocates in a warm