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 "Higher dilution and high energy". Keywords: Antifungal drugs, Thuja occidentalis, Aspergillus flavus, Aspergillus niger, Aspergillosis INTRODUCTION
mentagrophytes is reported11. The present paper explores in-vitro antifungal potential of homoeopathic drug Thuja occidentalis Q, 30, 200, 1M, 10M and 50M against human pathogenic aspergilli.
Aspergilli are wide spread in the environment and are common inhabitants of soil. It is readily recognized that very large number of people, both adults and children are potentially exposed to such indoor and outdoor contaminants1,2,3. Several studies have provided evidence for the association of cancer in human with inhalation of aflatoxin contaminated dust4,5,6. It is now recognized that there are basically three categories of disease involving Aspergilli viz. Allergic aspergillosis, colonizing aspergillosis and invasive aspergillosis7,8,9. Treatment of aspergillosis with an antifungal drug such as amphotericin B is the first step of management but in neutropenic patients it is unsuccessful. Side effects and treatment duration may not be overlooked and is suggestive of finding a nontoxic safe remedy9,10. Thuja occidentalis, a tall tree belongs to the family Cupressaceae. Thuja is considered as antisycotic homoeopathic drug used mainly for wart - like excrescences upon mucus and cutaneous surface, vegetative condylomata and spongy tumors. Thuja is known to contain oil of thuja, a thujol, flavone glycoside thujin and an acid called thujin. Antifungal action of Thuja occidentalis against Candida albicans, Trichophyton rubrum, and Trichophyton
MATERIALS AND METHODS FUNGAL ISOLATES A) Aspergillus niger: A clinical isolate of patient complaining of chronic ear discharge for several years. Patients registered himself in GCCHR for the management of disease. MIC of ketoconazole for Aspergillus niger was standardized as 0.75 mg/ml by following the method of Jacob et al.12 - 13. B) Aspergillus flavus: Isolated from skin of the patient at GCCHR showing hyperpigmentation with severe itching. MIC of ketoconazole for Aspergillus niger was standardized as 0.50 mg/ml by following the same method as above12 - 13. MEDICINES Thuja occidentalis in various potencies like Q, 30, 200, 1M, 10M and 50M was purchased from manufacturer. Quantity of drug was standardised as 0.5 ml. CONTROLS
* B. Sc., G.H.M.S. (Gold Medalist), Chief Consultant Physician ** M. Sc., Ph.D., Medical Mycologist, GAURANG CLINIC AND CENTRE FOR HOMOEOPATHIC RESEARCH, B-1/41, Sector A, Near Rajshree Talkies, Kapoorthala, Aliganj, Lucknow-226 024 (UP), INDIA
Three controls were taken, one of sterile water, second of vehicle i.e. rectified spirit and third control of Ketoconazole as positive control. Quantity of drug was taken as per their MIC calculated.
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 occidentalis Q, 30, 200, 1M, 10M, 50M prepared in rectified sprit was tested by poison food technique12 - 13 against test fungi Aspergillus niger and Aspergillus flavus. 0.5 ml of each drug was mixed with 10 ml of Sabouraud's dextrose agar just before solidification in 50 mm diameter petridishes. SDA plates with 0.5 ml sterile water, 0.5 ml rectified spirit and 0.5 ml containing 5 mg ketoconozole (200mg tablet dissolved in 20 ml water) for Aspergillus niger and 0.75 ml for Aspergillus flavus were kept as controls. All the plates including controls were inoculated centrally with 1.5 mm diameter of disc of test fungi aseptically from 8 to 10 days old SDA plates culture. All the experimental petridishes were used in triplicates and incubated at 37°C. The linear diametrical growth of colonies were measured (in cm.) on 3rd, 6th and 9th days of post inoculation. The results were presented on an average of three plates on 9th days of post inoculation. Percent growth inhibition was calculated as per formula.
Antifungal efficacy of homoeopathic drug Thuja occidentalis Q, 30, 200, 1M, 50M have been presented in Tables - 1 and 2 against Aspergillus flavus and Aspergillus niger. Thuja 30, 200 are found to inhibit the linear diametric growth of Aspergillus flavus equally on 9th day of post inoculation. Thuja 1M showed no effect, the growth of Aspergillus flavus was almost equal to control I (SW) and more than control II (RS) (Table - 1). Other potencies showed less sporulation in comparison to controls but Thuja 30 and 200 showed no sporulation (Plate - I; figs : 5 - 6). Percent growth inhibition of Aspergillus flavus on 9th day of post inoculation are presented in figs. 10 and 11. Fig. 10 is based on control I (SW) and fig. 11 is based on control II (RS). It is evident from the figs. 10 - 11 that Thuja 30 and Thuja 200 showed maximum inhibition i.e. 77.77% in each as compared to control I and 64.28% in each as compared to control II. Percent growth inhibition of positive control i.e. ketoconazole was 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 dt = Colony diameter of treated plate
Thuja 50 M was very effective against Aspergillus niger. Colony diameter observed was 2.2 mm al-
2
3
lar diseases, tissue barrier breaks, accidental infections, renal or cardiac transplant and frequent use antibiotics, cortisone and cytotoxins. Treatment available for the Aspergillosis is not very safe in terms of drug toxicity18 - 19. Thus in the present investigation homoeopathic drug Thuja occidentalis is evaluated in vitro for its antifungal potential. Thuja 30 and 200 was found promising against Aspergillus flavus whereas Thuja 50M was found effective against Aspergillus niger. Mode of action as to how homoeopathic drug works is not evaluated in this study. How some potency of homoeopathic drugs enhanced the growth of fungus is the subject of further study. It is well established from the present investigation that Thuja 30 and 200 is very effective against Aspergillus flavus causing cutaneous aspergillosis in human and Thuja 50M is effective against Aspergillus niger known to cause otomycosis. Due to limitation of experimental animal facilities in our Laboratory, in - vivo experiments could not be done but are suggested for further investigation.
most equal to Ketoconazole (2.1 mm) on 9th day of post inoculation (Table - 2). However no significant effect on sporulation was noted (Plate II; Figs: 12 20). Thuja 200 showed effect on sporulation but linear diametric growth of colony was insignificant. Percent inhibition growth was presented in figs. 21 - 22. Fig 21 is based on sterile water (Control I) and fig 22 is based on rectified sprit (Control II). As it is evident from figs. 21 - 22, Thuja 50M showed maximum percent growth inhibition 52.17 of Aspergillus niger as compared to control I (SW) and 38.89 as compared to control II (RS). Thuja 50 M is equally effective as the allopathic drug "Ketoconazole". Observations taken on 3rd and 5th day of post inoculation are shown just to observe linear growth pattern of test fungi thus not discussed in details however mentioned in table 1 and table 2. DISCUSSION Infection due to species of Aspergillus have become common and often prove fatal on systemic dissemination in compromised host 14,15,16,17 . Compromisation of the patient results from Tuberculosis, Cancer, Bronchiectasis, Lymphoma, Diabetes, Sarcoidosis, Silicosis and Collagen vascu-
The most controversial aspect of homoeopathic dilution is that succussion and trituration actually in4
5
crease the power of remedy. Clinical efficacy of high dilution is well established in homoeopathic science. But in the present investigation it is proved that there is no increase in the activity of higher dilution. Thuja 30 and 200 is effective against Aspergillus flavus however higher dilution 1M, 10M and 50M is not effective which contradicts theory of high dilution and high energy. The present investigation constitute the first report for proving in vitro action of homoeopathic drug Thuja occidentalis Q, 30, 200, 1M, 10M, 50M against human pathogenic fungi viz. Aspergillus flavus and Aspergillus niger. The findings also disqualify the concept of higher energy and high dilution in the system of fungi - a eukarolic organism. Similar results were also observed by Singh and Gupta et al.20,21,22 and proved antiviral efficacy of homoeopathic drugs against plant and animal viruses. Sharma 1998 suggested vital force is certainly a form of Sharmon-composed "basic substance" which mediates the molecular mechanisms underlying vital functions of health and disease and also potentization of medicines through dynamization processes as human cells23. Vital force concept requires updation in the term of energy quanta, their measuring parameters and constitutional suitability of potency to the patients and their disease.
7. Rippon J. W., 1988, Medical Mycology. The pathogenic fungi and the pathogenic actinomycetes, W.B. Saunders Company, Philadelphia. pp. 797
REFERENCES
13. Wahab, S., Tandon, R. N., Jacob, Z., Sagar, P. & Srivastava, O. P., 1981, In vitro activity of phytochemical alantolactone from Inula racemosa Hook f. against some pathogenic and opportunistic fungi. J. Indian Bot. Soc., 60, 278 -281.
8. Emmon's E. W., 1977, Medical Mycology, Lea & Febiger, Philadelphia. 9. Srivastava O. P., Srivastava A. K., Shukla P. K., 1988, Advances in Medical Mycology Vol. 2, Evoker Research Perfecting Company, Lucknow. pp. 182 10. Gupta G., Srivastava A. K., Gupta N., 1997, Mycoses: An update over clinical cure with Homoeopathic drugs. Asian Homoeopathic Journal 7(4) : 67-96 11. Akhtar Husain et al. 1992, Directory of India Medicinal plants, Central Institute of Medicinal and aromatic plants, India pp 546. 12. Wahab S., Srivastava. O. P., Singh N. B., Gupta S. K., 1978, Comparative in vitro and in vivo evaluation of toliciclate, tonaftate, miconazole, clotrimazole and undecylenic acid against Trichophyton mentagrophytes. Indian J. Exp. Biol., 16, 1200 - 1202.
1. Srivastava A. K., 1991, Air pollution (Biopollutants in air), Ashish Publishing House, New Delhi, pp. 302. 2. Srivastava A. K., 1992, Mould Allergy - an overview, Advances in Medical Mycology edited by Mukherji et al., Aditya Books, New Delhi, pp. 63 80.
14. Srivastava A. K., Garg K. L., Neelima Garg, 1992, Health risk associated with fungal agents from sludge, Advances in Medical Mycology edited by 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 health, Anmol Publication Pvt. Ltd., New Delhi, pp. 199.
15. Wadhwani K., Srivastava A. K., 1984, Fungi from Otitis media of agricultural field workers, Mycopathologia 88 : 155 -159.
4. Dvorackova I, 1976, Aflatoxin inhalation and alveolar cell carcinoma. Br. Med J III : 691
16. Wadhwani K., Srivastava A. K., 1985, Some cases of Onchomycosis from North India in different working environment Mycopathologia 92 : 149 - 266.
5. Olsen J. H., Dragsted L., Autrup H., 1998, Cancer risk and occupational exposure to aflatoxins in Denmark. Br. J Cancer 58: 392 - 396.
17. Das Gupta S. N., Shome S. K., 1959, Studies in Medical Mycology I - On the occurrence of mycotic diseases in Lucknow. Mycopath. & Mycol Appl., 10: 177-186.
6. Hayes R. B., Van Nieuwenhuze J. P., Raatgever J. W., Ten Kate F. J. W. 1984, Aflatoxin exposures in the industrial setting : an epidemiological study of morality. Food Chem Toxicol 22: 39 - 43.
18. Varma R. S., 1997, Antifungal agents from natural products, National seminar on "Emerging
6
trends in the management of fungal (Mycotic) infections", Nov. 14 - 16, 1997, at Industrial Toxicology Research Centre, Lucknow, organized by National Academy of Chemistry and Biology (India), abstract no. 11.
21. Singh B. P., Gupta G., Srivastava K. M., 1980, "Homoeopathic Drugs as inhibitors of Tobacco Mosaic Virus", (1980), Indian Journal of Homoeopathy IV(7) : 301 - 303. 22. Khurana Paul S. M., Gupta G., 1981, "Homoeopathy: Promises & Prospects for plant protection", Advancing Homoeopathy 1: 107 - 116.
19. Srivastava A. K., Singh K. P., Ray P. K., 1997, Protein A induced protection against experimental Candidiasis in mice Mycopathologia 138: 21-28.
23. Sharma R. R., 1998, The vital force: An update proceedings of 8th National homoeopathic conference 3rd and 4th April 1998, Eds. - Arora et. al., organized by Research Society of homoeopathy, Lucknow.
20. Singh L. M., Gupta G., 1985, "Antiviral efficacy of Homoeopathic drugs against animal viruses", The British Homoeopathic Journal, 74(3): 168 - 174.
7
DRUGPROVING PROVING DRUG 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, which could not be anticipated by Hahnemann at that time, leading to an over-estimation of medicine effects. Some of them are described below: Absence of control group Use of well-known friends and lecture audiences as volunteers (“believers”) Volunteers informed that they were using a medicine to observe effects upon them Recording of all complaints, symptoms and changes observed during the action of the medicine even if the person has noticed similar symptoms in himself a considerable time before Absence of masking in volunteers or in supervisors of the trial Close supervision and daily (or 2-3 days) interview with subjects + daily recording in a pocket notebook Sudden prohibition of coffee, tea, spices and alcoholic drinks (or medicinal drugs) Vague definition of healthy volunteers ==> Inclusion of non-healthy volunteers No random assignment of subjects
Homoeopathic pathogenetic trials (HPTs) are the basic method of homoeopathy. They are designed to investigate body and mind effects of potentially toxic or pathogenic substances, diluted and serially agitated according to homoeopathic pharmacopoeias, in non-patient volunteers in good and relatively stable health conditions. They are clinical trials designed to assess the effects of highly diluted medicines in healthy volunteers, the results are applied in practice on the basis of ‘Similia similibus curentur’. The methodology of HPTs was first proposed by Hahnemann. The controlled investigation of the pathogenetic power of medicines was one yardstick in Hahnemann’s writings. Hahnemann recognized early in the Organon1 the main methodological problems of HPTs, namely truthfulness of volunteers, to use medicines with different powers and to deal with individual differences. In attempting to minimize the effects of suggestion on volunteers Hahnemann recommended that “in the investigation of these drug-symptoms all suggestion must be as rigidly avoided as in the examination of the symptoms of disease”. To obtain symptoms as accurately as possible, every subject had a pocketsize notebook to write down the sensations and changes immediately after they occurred. The volunteers were required to repeat the description of the changes without referring to this notebook during the personal interview: if the accounts varied he advised the director of the trial to confront the subject with both versions and invite him to choose and confirm the statement which is nearest to the truth. Prevention of guess-work, imagination and recording of findings only after close questioning were continuously stressed in different editions of the Organon. For him only reliable symptoms should be included in the homoeopathic materia medica.
Taken together these flaws are sufficient to cause serious doubts on the scientific acceptability of the specific pathogenetic symptoms reported in Hahnemann’s writings. This was partially confirmed in a preliminary systematic review of HPTs published in the UK from 1945-1995, including 45 studies, which showed a great deal of variability in terms of the medicines tested, methodology, volunteers, sample size and outcome. This was reflected in great variability in the numbers, incidence and types of effects reported. There was also a clear association between the methodological quality of the trial and
!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 "Improving the Success of Homeopathy 5: A Global Perspective", London 26-27 january 2006.
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the numbers of effects reported: better trials produced a lower incidence of pathogenetic effects (or none) compared to trials of poorer quality. Overall the analysis of reports revealed methodological shortcomings which could seriously compromise the validity, reliability and clinical applicability of the results3.
distinguishable from verum, placebo potentised, comparative group, crossover, washout period (post-treatment observation), management of adverse effects, rules for stopping medicine, rationale and source of the medicine. The assessment of each trial was recorded in terms of: use of symptom diary, type of diary, initial interview (case-taking/ collection of previous symptoms), follow-up interview, use of laboratory investigations, use of psychological tests, withdrawal/dropout of volunteers, reason for withdrawal, withdrawal due to severe adverse effects, presence of adverse effects, pre-defined categories for assessment of the attributes of a symptom.
To what extent have HPT incorporated new methods developed in scientific medicine in the five decades from 1945 to 1995? Can we rely on the conclusions drawn from HPT done during this period? A systematic review of published studies was therefore designed to assess the methods and outcomes of HPTs published in six languages (English, German, Spanish, French, Portuguese and Dutch) in the five decades from 1945 to 1995 and to help design and conduct future HPT to get more valid and reliable information.
For the presentation of results we extracted information on the frequency of symptoms in the sample, description of complete symptoms, analytical presentation, chronology of symptoms, character of symptoms, location of symptoms, duration of symptoms, onset of symptoms, intensity of symptoms, modalities of symptoms, presence of concomitant symptoms, inclusion of prior symptoms that improved during the trial, detailed report of individual volunteers, use of symptom tables and charts.
METHODS A criterion-based systematic review of HPTs was done in trials published in six languages from 1945 to 1995. The literature was exhaustively searched and only published reports of HPTs were included. Information was extracted by two independent reviewers, with experience in conducting HPT or clinical research, using a specially developed form with 87 items. Information on: medicines, volunteers, ethics, blinding, randomisation, use of placebo, adverse effects, assessments, presentation of data and number of claimed findings were recorded.
The interpretation of the results by the authors was reviewed in terms of : pre-defined criteria to include medicine effects, use of descriptive statistics (measures of central tendency or dispersion of data), use of statistical tests and presence and number of significant findings claimed.
For each medicine the name , dilution(s), method of dilution, presentation, dose, frequency per day, repetition of doses, total duration of the trial, number of active treatment periods and duration per volunteer (in days), source of the drug, mode of preparation and preparation responsibility was recorded. Regarding the study population we extracted the initial and final number, ethnic origin, sex, age, occupation, number of control volunteers, percentage of sensitive volunteers, inclusion criteria, exclusion criteria, assessment of health status prior to admission, training of volunteers, personality traits, physical characteristics, informed consent, method of recruitment.
Finally, each reviewer was invited to make a subjective judgement: ‘after reading and analysing all the points above, and based exclusively on the published report’: - Do you think the symptoms stated as belonging to the medicine can be trusted ? - Would you apply the information given in it into your clinical practice to prescribe this medicine to a patient? For both questions the options were certainly, almost certainly, probably, possibly, with serious reservations, definitely not, can’t answer or none claimed - From a methodological point of view, you judge this report of proving as: completely reliable, very reliable, reliable, unreliable, completely unreliable - Compared to the other reports you read, you think this is: below average, average, above average, much above average, excellent. A final, open question asked about the main methodological criticisms of the reviewer to each study.
The study method was assessed in terms of: approval of protocol by Ethical Committee, direction/coordination, randomization, sequence generation of subjects in the trial, allocation concealment, masking (blindness) of volunteers and of supervisor, use of placebo, pre-trial observation period with or without placebo, placebo 9
The methodological quality of published HPTs was assessed by a specially designed index, using mainly traditional indicators of quality in clinical trials, complemented by a personal judgement of reviewers for each study. Scores were organized in 4 methodological classes, where
class I is the worst and class IV is the best quality HPT. Cutoff points of score for the different classes were 4,5,6 for Class I, 7,8,9,10 for Class II, 11,12,13 for Class III and 14,15,16 for Class IV. The Methodological Quality Index for homeopathic pathogenetic trials is shown below:
SCORE Variable
1
2
3
4
Randomization
Not stated
Only stated, no details
Incomplete, description of sequence generation or allocation concealment
Blinding
Not stated
Single blind
Double-blind without checking
Inclusion and Exclusion Criteria
Not stated
One partially stated
One clearly stated or both partially stated
Criteria for Selection of
Not stated
At least one stated
2 to 4 defined defined
Complete, description of sequence generation and allocation concealment Double-blind with checking after finishing the study Clearly stated
More than 4 defined
controls) were double analysed by two reviewers. Most reports did not mention ethical approval. Use of placebo control was variable, overall in 56% of trials volunteers took placebo, placebo symptoms were often not used as comparators, some investigators progressively abandoned the use of placebo. The quality of reports was in general poor, and much important information was not available.
Pathogenetic effects were defined as all clinical events and laboratory findings noted by volunteers during a HPT and recorded in the final report. In other words they are the findings claimed at the end of the trial by authors to be used by practitioners seeing patients with similar pictures. We counted as one pathogenetic effect a piece of information which could be included in an homoeopathic repertory as an independent subheading. For instance “boring headache ameliorated by pressure” was counted as one claim.
A growing number of HPTs was published along the decades, particularly in the last decade (800% more than in 1945). Table 1 shows included 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 Dutch
Total
English
German
French
1945 - 1955 1956 - 1965 1966 - 1975 1976 - 1985 1986 - 1995
9 11 16 16 32
0 1 3 9 20
0 0 0 1 16
1 0 0 2 8
1 0 0 0 6
0 0 0 0 4
11 12 19 28 86
Total
84
33
17
11
7
4
156
Table 1. Number of included HPT per decade and language
10
Spanishl
Portuguese
There was a statistical difference among languages of publication of HPTs only when Dutch was compared to English and German languages. Figure 1 shows the mean methodological score by language:
HPTs were done mainly in Índia (36 studies) and United Kingdom (30), followed by German (17), Nederlands (17), Austria (16), France (13), United States (12), Mexico (9), Brazil (2), New Zealand (2), Norway (1) and Argentina (1).
95% CI Methodological Score
10
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 teaching or research centres under the supervision of medical doctors. Volunteers were mainly recruited in homeopathic medical schools (India) or post-graduated courses for doctors. Trial duration (mean 34 days) was very variable. Studies included from 1 to 103 volunteers (median 15). A single volunteer was used in 7 HPTs and in other 3 only two volunteers were included. 57% of the reports did not state age of volunteers and in 34% there is a lack of information on gender. Age range was 5 to 76 years. Male volunteers accounted for 1169 and female volunteers were 857. In 28 studies there were more female included than male, and this trend was increased in the last decade. Female
volunteers tend to produce more pathogenetic effects than male. Ethnicity data were in general ignored in the reports. Before-After studies were the most used designs, with or without parallel groups using placebo. There is a recent trend to use randomized placebo controlled trials, 14 of them used a crossover design. There was a large variation in methods and results, and in general the quality of the studies was very low. Almost all publications reported one or more pathogenetic effect. There was a strong tendency for more symptoms to be reported from HPTs of poor quality than from better studies.
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65 publications tested medicines in single dilutions and 91 in different dilutions used by the same or different volunteers. In total 323 dilutions were used, mostly centesimal (192) followed by decimal (129) and fifty millesimal (2). 30c was the most frequently used dilution in our sample (66 trials) followed by 6c (33) and 6x (32). More than 50% of the tested medicines were not studied before the study took place.
Plants were the most common source for tested medicines (75), followed by animal (29), mineral (18), chemicals (14) and pharmaceutical drugs (11). Two publications studied energy sources and one study used a coded and unknown substance. Figure 2 shows the rationale for selection of the substances to be tested in HPTs:
Medicinal properties
54
Human toxicity
31
Rationale
Other
13
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 results. Most studies were of poor quality and showed flawed designs, mainly absence of proper randomization, blinding, placebo control and criteria for analysis of outcomes. There was a significant trend for more symptoms to be reported from HPTs of poor quality than from better studies. There are some major outstanding methodological problems including lack of appropriate controls for proper evaluation of idiosyncratic effects and criteria to attribute symptoms to treatment.
The identification and causal attribution of changes in healthy volunteers is very complex, it may be influenced by a large number of factors. It is strongly dependent on individual awareness and past experiences. In the absence of adequate control, clinical studies can yield results favouring investigators' assumptions if the study is not properly controlled, context is also important 4,5,6. The importance of conditioning was demonstrated in medical students in an experiment where students were conditioned to expect sedative or stimulant effects but received only placebo in blue or pink capsules. Volunteers' behaviour pattern has also been shown to influence the reporting of subjective symptoms after placebo 7. Most of the HPTs reviewed here were done in the context of homoeopathic courses with students learning homoeopathy. 7.2 body and mental changes were reported by healthy Brazilian medical students responding to a survey on symptoms they experienced in the last week8. In this situation two factors could bias the outcome towards increased
Several factors may account for the great variability in the results. Among others the settings in which they were done, the lack of description of inclusion and exclusion criteria for volunteers, differences in study design and use of placebo, style of supervision, blinding, randomization (or suggestion), criteria for selection of pathogenetic effects and assumptions concerning attribution of symptoms to the medicine tested.
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decades several attempts to develop new approaches to test homeopathic medicines in healthy volunteers were done, either for testing new substances10 or to confirm results11,12. It is urgent to improve the quality of reporting and it is imperative to have a consensus on minimal requirements for reporting HPT. The central question of whether homoeopathic medicines in high dilutions can provoke effects in healthy volunteers has not yet been definitively answered. We need a pure homeopathic materia medica, with valid and reliable information from HPT, to get better results in our clinical practice and research.
reporting of symptoms: the students, believers in the system and the production, in the past, of valid symptoms from HPTs; and the coordinator expecting the students to give him useful information after testing the substance. The consistency of the effects across trials is another matter. Many investigators seemed to have taken for granted that every substance must elicit symptoms and for this reason felt it unnecessary to use placebo as a control or failed to include symptoms experienced by volunteers taking placebo. On the other hand the use of placebo exclusively for comparative statistical purpose excludes from consideration rare, idiosyncratic effects. Attempts by Martini in the 1930's to evaluate the occurrence of pathogenetic effects due to highly diluted substances in HPTs were, on the whole negative, a critical reappraisal of his results shows that no definite conclusion can be drawn9.
Acknowledgements CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico do Brasil); Royal London Homoeopathic Hospital; Cecília Lomônaco de Paula and Gleice Margarete de Souza Conceição for statistical advise; Mary Gooch for help in literature search; David Riley for early cooperation in informing HPTs done in USA.
Further methodological improvements for designing rigorous HPT are required. In the last
REFERENCES 1. 2.
Hahnemann S. The Organon of Medicine. Los Angeles; J.P. Tarcher, 1982. 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 "side effects". Ann Int Med 1964; 60:255-265. 5. Reidenberg MM, Lowenthal DT. Adverse nondrug reactions. New Eng J Med 1968; 279:6789. 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.
Introduction
Materials and Method
Osteoarthritis (OA, osteoarthrosis) is by far the most common form of arthritis. It shows a strong association with ageing and is a major cause of pain and disability in the elderly. Pathologically, it may be defined as a condition of synovial joints characterized by: • Focal loss of articular hyaline cartilage • Simultaneous proliferation of new bone with remodeling of joint contour
A total of 726 cases were enrolled in the study. Out of these, 93 cases were studied under Drug related programme of Clinical Research in Patiala (2001-2003) and under the Disease related project – 360 cases at Clinical Research Unit, Patiala (1993 to 2003) and 273 cases at Central Research Institute, Kottayam (2000 to 2003). The etiological factors are :
Inflammation is not a prominent feature. OA, however, is not a disease or a single condition. It is best viewed as the dynamic repair process of synovial joints that may be triggered by a variety of insults, some but not all of which result in symptomatic ‘joint failure’. Radiographic and autopsy studies show that OA preferentially targets only certain small and large joints. There is a steady rise in overall prevalence from age 30 such that by 65, 80% of people have some radiographic evidence of OA, though only 25-30% have associated symptoms. The knee and hip are the principal large joints affected and the principal sites of significant disability. Knee OA is more prevalent than hip OA, but taken together they affect 10-25% of those aged over 65 years. Homoeopathic medicines have been reported to be effective in OA. CCRH started the work with an objective to see the effect of Homoeopathic therapy in OA and to determine the reliable indications, potencies or frequency of administration of the medicines found useful in relieving OA.
Miasmatic profile of : 273 cases
Psora (33 cases), Sycosis (68 cases), Mixed miasm(123 cases), Pseudo psora (49 cases).
Precipitating factors : in 545 cases
Over use of joints (263 cases), Cold climate(155 cases), Dampness (127 cases).
Parameters Assessment of intensity of the disease
14
Mild
:
Asymptomatic cases but only radiological abnormalities
Moderate
:
Cases with severe pain, stiffness, with or without swelling with or without cracking in joints, with or without lock knee, with or without Heberden's nodes, with or without deformities but no pain at night.
Severe
:
Cases with night pains
Worse
Selection of research cases:
:
General :
•
•
All cases of joint disease which seem to be degenerative nature and excluding known cases of inflammatory, metabolic, Suppurative and systemic arthritis, .
Result Improvement indices
In relation to age, sex, occupation and physical constitution, the patient are registered initially before the inclusion.
Improved - Mild - Moderate - Marked Not improved Not reported Dropped out Under observation
Symptoms related to particular system:
•
• • • • • •
Joint pain • Localized or generalized with or without swelling • < During rest • < After bodily exertion • < On beginning to move • Relieved by continuous motion Morning stiffness Crepitus/cracking in joints Locked knee Limitation of movement Heberden's nodes Deformities like genu varus, halux valgus etc.
Mild
:
:
Complete disappearance of subjective and objective symptoms (excluding radiological findings) with no recurrence during the period under report.
Moderate
:
Disappearance of the symptoms like morning stiffness, cracking, lock knee, limitations of motion etc. but only the mitigation of pains.
Not improved
:
Female
12 105 78 02 37 19 20
02 20 10 00 02 02 03
10 85 68 02 35 17 17
Pain Joints Pain joints < motion Pain < beginning to move Pain < night Pain < day time Pain < after movements Pain < rest Morning stiffness Cracking in joints Lock knee Bilateral paraesthesia Symptoms of cord compression
273 404 207 114 47 91 447 669 190 146 55 108
32 282 117 21 24 20 282 353 20 10 07 36
Objective symptoms
Before After treatment treatment
Reduction in pain and other symptoms with recurrence after least exertion.
:
Male
Before After treatment treatment
Complete disappearance of the subjective & objective with no recurrence for the next five years.
Marked
Total
Subjective symptoms
Assessment of improvement of cases Cure
Aggravation of signs and symptoms even after the treatment with well selected remedies.
Swelling of joints Limitation of motion Deformities Heberden's nodes Flexion contractures Weakness of lower limbs
211 228 05 02 01 83
31 77 05 02 00 13
Pathological / radiological findings
Before After treatment treatment Osteophytes deposition Reduction of joint space Sclerosis of subchondral bones Subchondral cyst
No improvement even after considerable period of treatment with similar remedy. 15
138 131 04
112 131 04
02
02
restlessness, amelioration by warm application. pains are worse in fine weather but relieved in rainy season. Joint pains with tearing and drawing, deformities at the joint, joint affection with weakness of limbs and tendency to fall, numbness of limbs at night, pains are aggravated at night with restlessness and amel. by warm application. cracking of joints especially knee.
Drugs found effective (Before treatment/After treatment) Ars. Alb. 30,200,1M Calc. carb. 30,200,1M Lyco. 30,200,1M Medorh.30,200,1M Nat. mur. 30,200,1M,10M Puls. 30,200,1M,10M Rhus tox. 30,200,1M,10M Sulphur 30,200,1M,10M
05 29 76 10 12 17 63 13
04 25 67 8 9 12 55 7
Graphites Pain especially in women of climacteric age. Pain is more at night. < cold air, cold bath, winter. > warm application, chilly patient, desiring warmth. Aversion to sweets and fish. Scanty menses of short duration. Habitual constipation.
Reliable indications of the drugs found useful
Lycopodium Drawing and tearing pain in knee joints. Pain of knee joints worse at night and rest. Pain of knee joint better with warm application. Swelling on the rt, knee joint with numbness. Carbonitrogenoid constitution, desires warm food and drinks, sweets, desires cold climate, excessive flatulence esp. evening hours and after flatulent food. Eating a little causes fullness in abdomen, pain and stiffness of joints < at night, first motion, winter, amel. continued motion, cold applications, Rt. sided affections, rheumatism of right shoulder < raising the limb.
Arsenicum album Nocturnal burning pain relieved by warm application, warm bath. Pain agg. damp cold season with tingling and numbness of the limbs, pain agg. by cold air, fanning and uncovering. Bryonia Mild swelling in the knee joints. Stiffness in the knee joints. Pain in knee joints< by motion > by rest. < night, change of climate from cold to warm, amelioration by absolute rest. Backache agg. while turning in the bed. Joints pain amel. by lying on back, pressure or wrapping up. Pain in joints, swelling, sitting, pain, agg. night, motion, change of climate from cold to warm, amel. by absolute rest. Backache agg. while turning in the bed, pain joints amel. by lying on back, pressure or wrapping up, adapted to robust fibre and dark constitution.
Medorrhinum Warm patient, burning sensation all over, desires cold food and drinks. General relief in rainy season, gen. aggravation in warm and winter season, pain agg. first motion, winter, summer, daytime, amel. contd. motion, rainy season.
Calcarea carb. Found effective in fat, flabby, and flatulent constitution, liable to affections of weight bearing joints. Pain knee joints agg, squatting, rising from squatting., cold climate, standing in cold basement. Amel. by warm application, cracking in joints on motion, chilly patient, desires warm food, cold drinks, egg, fish, aversion to milk,. Sharp sticking pains in the knee joints. Pain worse in change of weather and physical exertion. Pain in knee joint better in warm dry climate, worse in cold weather. Tendency to obesity. Burning in soles of feet.
Natrum mur. Constitutional remedy with caving for salt and salty thing, warm patient, always desires cold, pains in spinal joints which are more during sitting, standing and lying on sides. Pain is better by lying on back on something hard. Pain in knee joints with cracking sensation. Rhus tox. Chilly patient, desires warmth in general, warm food and drinks, desires milk, rheumatism of left, shoulder joint, left sided affections mainly, pain stiffness and swelling of joints, large and small; aggravation at night, morning, beginning to move, first motion, after physical exertion, rest, winter season, damp season, constantly standing on damp floor, bathing, cloudy weather, over exertion of joints, after excessive sweating, turning in the bed, amelioration continued motion, day time, warmth, warm bath, warm application, warm season, rubbing, tight bandage, covering of the part, restless at night, constantly changes position in bed, pain in back especially, lumbar region is amel. by lying on back.
Calcarea phos. Chilly patient, knee joint affected from left to right, desires salt, meat and fish, cold food and drinks, , cracking in joints on motion, and on rising from seat, stiffness and pain in joints, with coldness and numbness of limbs. Pain is worse during ascending. Causticum Pain and stiffness in the knee joints. Pain better by hard pressure and heat. Paralytic feeling in lower limbs. Numbness of limbs at night with
16
obesity, hper mobility, orthopaedic deformities, endocrine disease like Diabetes mellitus, hypothyroidism, hyperparathyroidism etc. are important in the causation of this disease. It is usually primary but may develop secondary to any joint disease or joint injuries.
Sulphur Rheumatism of left shoulder joint, burning type of pain, < night, raising the affected limb, drawing and tearing pains at night, pain agg. due to the heat of the bed, pain lumbar region, agg. standing and rising from stooping, has to stoop a while after rising, warm patient. Desires cold food and drinks, open air, and warm bath, winter season, amel. dry warm weather, burning Sensation of palms and soles, at night, amel. by cold application, desires sweets, aversian to milk.
In our study it was observed that no age was an exempted from this disease because the age of the patients ranged from 15 years to 88 years (refer table 2.3.1. and 2.3.2.). However, it is further observed that in more than 225 cases included in the study, age ranged from 40 to 60 years of age. This means that this is a disease of advancing age. Among the 273 cases studied, 255 belong to primary OA in which heredity, obesity, overuse of joints, hypermobility, etc. were found responsible for the onset and/or continuation of the disease process.
Pulsatilla Warm patient, desires open air, cold food, cold drinks, cold climate, gen amel. in cold, sensitive to pain which rapidly shift from one joint to another, easily weeping, consolation amel., pain agg. at night, amel. open air, agg. rest, first motion, amel. continued motion, pain agg. from letting the affected limb down, pain of drawing or tearing type, with chilliness especially at night, patient is usually thirstless, with late or protracted menstruation.
Conclusion Response to treatment on the basis of recurrence of symptoms and signs during and after treatment and symptomatic improvement were also studied. It has been observed that in 88 cases no recurrence of signs & symptoms was noticed and majority of the cases in which symptoms recurred only in less intensity and in short duration. The Xray examination shows that in a few cases even the marginal osteophytes deposition decreased. No increase in osteophytes deposition found during the treatment but in other cases no change noticed was even after repeated x-ray examinations.
Discussion Osteo arthritis, the most common joint disease of the aged is symptomatic three times more often in women than men, and is resulting from degeneration of the articular cartilage and fibro cartilage in inter vertebral discs. The prevalence of this disease sharply increases with advancing age, with mean age of onset is 50 years but the other factors notably, heredity, over use of joints, change in the chemical characteristics of the ground 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.
Name in Contemporary use
:
Dog's Milk5 (Bitch's Milk)3
Synonyms
:
French Lait de chienne5
Preparation of Homoeopathic Medicine and Class.
:
Solution1/100 in distilled water (Class-B), freshly made5.
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
Mind
Anxiety N Anxiety with palpitation in crowded placeN Forgetfulness; in writing, makes mistakesN Nervousness3
Note:
i) ii) iii)
No. of patients prescribed
No. of patients relieved
2 1
2 1
31
23
9
7
The symptoms super scribed with a particular number(1,2,3,4) are found in the literature, as well as clinically verified by CCRH. Symptoms superscribed with (N) are those reported and relieved by patients but not mentioned in the literature. The figure 1,2,3 & 4 stand for the source literature referred.
18
Location
Head
Nose
Symptom
No. of patients prescribed
Anger easilyN GiddinessN -
keeping quiet3 Severe headache with nausea & vomiting1 Headache - occipital, forehead, temples - with numbness by pressure & cold application3 Headache on alternate sides by pressureN -
No. of patients relieved
2 3 1 4 188 13 38
2 3 1 4 88 11 31
152
99
157
83
8
7
31 1 2
26 1 2
1
1
80
31
6 1
6 1
165 23 4 84
115 21 4 71
6
5
13
13
17
17
Eyes
Pain in eyes
35
28
Ear
Noises in ears3
34
28
Mouth
Cracking of jaw while eating1,3 Gums swollen, bleeding, teeth loose, sensitive to cold water3 Profuse salivationN
45 53
39 45
2
2
Pain in throat due to tonsillitis1 Tonsillitis on alternate sides- changes sides rapidly1 -
13 13
8 12
2 1 3
1 1 3
Throat
19
Location
No. of patients prescribed
No. of patients relieved
heaviness of headN -
1 35
1 30
Stomach
Acidity
7 52 7 2
7 52 7 2
Abdomen
Flatulence
61 7
41 7
5
2
Rectum
Constipation2,3 - with scanty stoolN - with flatulence3 - with unsatisfactory stoolsN - with dry & hard stoolN
286 30 26 26 10
189 26 22 15 5
Urinary system
Pain in urethra while passing urine2
37
17
Female genitalia
Leucorrhoea2,3 -
175 130 2 31 42 30 6 65 1 12
129 67 2 31 42 11 5 56 1 8
Respiratory system
Cough 1,3 - with tickling in throat2,3 - with scanty expectoration & headacheN - with hoarsness of voiceN Cough with expectoration
43 21 6 2 16 60
29 12 6 2 9 51
18
12
Violent palpitation of heart 3 Palpitation with suffocative feeling restN Perspiration in axillae very fetid3 Mastitis1- painful with swellingN - pain < from going up or down stairs3 -
81 3
46 3
19
10
2 61 134 61 45 11 9
2 52 108 52 45 10 9
Chest
Symptom
20
Location
Symptom
Back
Backache-spine sensitive to touch & pressureN Pain in back3 - on alternate sidesN - from pressureN - by restN - by leaning back3
Extremities
No. of patients prescribed
Shifting pain in joints3 - by hard pressureN -
No. of patients relieved
266
255
394 44 22 11 2 89 328 88 62 31 462 2 297 112 18 10
223 43 16 7 2 48 190 45 35 25 278 2 189 43 8 10
55
48
150 2 2 85 6
102 1 2 73 6
5 4 380
4 4 363
382 6 43 291 3 19 3 1 335 26 5 1 1 1 6 1 24 286 185 144 2 22
219 4 38 186 3 9 3 1 199 18 4 1 1 1 4 1 13 222 158 82 2 22
Location
Symptom
No. of patients prescribed
- with weaknessN - with tingling in extermitiesN - >by massageN - with stiffness & numbness2,3 - pain extend to heelN Pain in knee joints by restN - pressureN Pain in wrist joints3 with swelling
No. of patients relieved
3 1 8 60 103 661 9 3 3 25 4 11 606 559 574 9 33 2 6 192 286 505 83 44 68 4 4 1 20 41
3 1 6 60 103 401 9 2 3 20 2 3 519 477 493 9 9 2 4 84 198 408 37 32 68 4 4 1 20 37
2 3 65
2 2 29
10 3 104
8 2 80
65 35 2
55 31 2
Skin
Ring worm like eruptions with itchingN Small macular eruptions with itching
1 1
1 1
Sleep
Sleeplessness2 Dreams of snakes1
5 2
5 2
Perspiration
Profuse perspiration over whole bodyN
3
3
Fever
Intense fever with perspiration
9
9
22
Location
Symptom
Generalities
General weakness with prostration1 Generalised swellingN Feverish feeling with tirednessN BodyacheN When walking patients feels that she is walking on air1
No. of patients prescribed
No. of patients relieved
70 2 3 68 3
39 2 2 68 3
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 keeping quiet3 Severe headache with nausea & vomiting1 Headache - occipital, forehead, temples, with numbness by rest3 Pain in sacrum region by leaning back, spine sensitive to touch & pressureN Shifting pain in joints3 alternating pain ion jointsN Rheumatic pain in joints
• • •
Pain in right hip, (back)N & legs
Clinical conditions: Headache, Coryza, Tonsillitis, Anorexia, Mastitis, Leucorrhoea, Bronchitis, Cervical spondylosis, Lumbago, Rheumatic pain, Sciatica. Prescribing Symptoms:
• • • • • • • • • • • • • • • • • • • • •
Headache, on alternate sides keeping quiet Fluent coryza - from both nostrils- catarrh Pain in eyes by leaning back, spine sensitive to touch & pressure. Shifting pain in joints with numbness Rheumatic pain in joints
Reference: 1.
Boericke William. Pocket Manual of Homoeopathic, Materia Media & Repertory, B. Jain publishing company, New Delhi, (2003):pp 385
2.
Hering C., The Guiding Symptoms of our Materia Medica, Vol.VI, B. Jain publishing company, New Delhi:pp 516.
3.
Clarke J.H., Dictionary of Practical Materia Medica, Vol. II, Jain publishing company, New Delhi: pp189
4.
CCRH Quarterly Bulletin, Vol. 9 (1&2), (1987):pp 4
5.
Homoeopathic Pharmacopoeia of United State , Revision service, Dec-1991:pp 5413.
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 drug also being tried. Review of literature reveals that there is no reported work on pharmacognostic and physico-chemical aspects of the leaves of P. guajava. Hence a detailed study on these aspects is presented.
Introduction
Psidium guajava L. belonging to the family Myrtaceae is commonly known as guava in English, amrud in Hindi, koyya in Tamil and tella jama in Telugu. Guava is also referred to as the apple of the tropics. It is a native of tropical America and cultivated and naturalized throughout India1. It is an arborescent shrub or a small tree, upto 8 m high. The guava leaves are used as an application in wounds, ulcers, and as an astringent for bowels (Unani). The young leaves are used as a tonic in the diseases of the digestive functions. The decoction of leaves has been used in Cholera and also as a febrifuge and antispasmodic. Infusion of leaves is used in Cerebral affections, Nephritis and Cachexia. The pounded leaves are locally applied in Rheumatism and their extract in Epilepsy and Chorea. Though traditionally the medicinal use of leaves of P. guajava finds mention only in Unani system, their folklore utilities have been elaborate5. Leaves are reported to contain catechol and pyrogallol tannins. A new flavonol glycoside quercetin 4' glucuronide was reported4. Oil of leaves is aromatic and also used as a flavouring agent. Besides, they also contain carotene, vitamins B1, B2 and B6 and vitamin C. Antibacterial activity is reported by Rabe and Van Staden8.
Material and Methods Leaves of Psidium guajava L. was collected from Botanic garden, Department of Botany, Osmania University, Hyderabad. Fresh leaves were fixed in Carnoy's fixative. Subsequently epidermal peels of leaf and petiole were prepared following the method of Leelavathi and Ramayya6. Microtome sections of 10-15 µm thick of leaf and petiole were prepared following the traditional techniques3. Sections were stained with crystal violet and basic fuchsin. Powder studies were made following Youngken9 and Johansen3. The air dried leaves were powdered to obtain coarse powder 10/44 (sieve size). It was subjected to determination of moisture content (L.O.D.), Ash values and extractive values. The above parameters were determined in accordance with the procedures given in Homoeopathic Pharmacopoeia of India2. The mother tincture was prepared by percolation technique2. Alcohol content for the preparation of mother tincture was fixed as per maximum extractive value (M.E.V.).
Presently, there is a growing urge to introduce indigenous drugs into Homoeopathic system.
* 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
liptic oblong, entire glabrous above, pubescent beneath, pellucid punctuate; lateral nerves 10-20 pairs, prominent beneath, strongly curved near the edge and joined by intro marginal veins, petioles 2.5-7.5 mm long.
The alcoholic extract (mother tincture) was subjected for a) Physico-chemical constants, b) Chromatography (TLC/HPTLC), c) U.V. absorbance. All chemicals and solvents used were of analytical grade. Silica gel G (E Merck) was used for thin layer chromatography (T.L.C.). U.V. spectra was recorded using spectrophotometer, Shimadzu make (courtesy CFTRI, Hyderabad)
Microscopy: Adaxally epidermal cells polygonal isodiametric or anisodiametric with sides slightly thick, straight to curved; surface striated; contents scanty or dense in few. Epidermal cells 5,45,000 per sq. cm. Stomata are absent on adaxial side. Trichomes 1) Unicellular conical hair, longer, distributed all over surface. 2) Unicellular flagellate conical hair, long, flagellate conical, all over, more on vens.
Physico-chemical Constants Physico-Chemical parameters viz., organoleptic characters, weight per ml. total solids, alcohol content and pH value, were determined as per the guidelines laid down in the Homoeopathic Pharmacopoeia of India2.
Abaxially cells similar as on adaxial, sides thin with curved or wavy anticlinal walls; contents scanty but with tannins in few; interspersed by secretory cavities. Epidermal cells 10,20,000 per sq. cm. Stomata mostly paracytic, few anisocytic and anomocytic; paracytic subsidiaries longer, distinct. Stomatal pore large, contents dense; Stomatal frequency: 2,90,000 per sq. cm. Stomatal Index: 22.13; Stomatal size; 19-24 um (21) long and 1216 um (15) wide. Trichomes are similar to those described on adaxial side.
Chromatography (T.L.C.) For TLC 25 ml. alcoholic extract was evaporated on water bath to remove alcohol. The remaining aqueous part was extracted with 25 ml. chloroform (three times). All the three fractions were combined and concentrated to 2ml. 15 µm was applied on activated silica gel G coated TLC plate. It was developed using chloroform and benzene with few drops of acetic acid (1:1v/v) on mobile phase and 10% FeCl3 solution was sprayed for visualization.
Transection (TS): In T.S. midvein is grooved on adaxial side and prominently ribbed towards abaxial. Secondary and tertiary veins ribbed abaxially. Midvein kidney-shaped, laterally upto 1.5 mm and vertically 1mm thick; Lamina isobilateral, 151-173 um thick. Covered by conical and flagellate hair. Secretory cavities conspicuously present on abaxial.
UV Absorbance For UV absorbance, the mother tincture was diluted with 99 parts 70% alcohol, scanned in the range of 200-300 nm. The peaks of maximum absorption are given in Table 6. HPTLC Studies
Epidermis is 1-layered, adaxially large, barrel shaped or tabular to polygonal, covered by a thick cuticle and often dispersed with conical hairs. Abaxially cells smaller, interrupted by stomata, which are sunken. Mesophyll is characterized adaxially with a hypoderm, consisting of 3-4 layered tabular to barrel shaped cells often containing tannins, sphaeraphides and resins and interrupted by secretary cavities. Palisade is abaxial, 4-5 layered, cells cylindrical, 11-27 µm (19) long and 5.58 µm (7) wide; filled with chloroplasts, tannins and sphaeraphides and interrupted by secretory cavities.
Precoated high performance TLC plates (silica gel 60 F 254 as stationary phase) were used. For sample application, CAMAG Linomat IV sample applicator was employed. The speed of application was maintained at 4mm/sec. The solvent system used for development was chloroform, acetic acid, methanol and water (6.2 : 2.1 : 2.0 : 0.8 v/ v). Methanolic sulphuric acid and anisaldehyde H2SO4 were used for derivatisation. The Rf values of the various components before and after derivatisation are provided in Table 5. OBSERVATIONS
Ground tissue at midvein of collenchyma, parenchyma and sclerenchyma tissues. Collenchyma: abaxially 1-layered and as a group of cells on adaxial side, 5-19 µm (13) in diameter; angular or lamellar, contents dense. Parenchyma:
Pharmacognostic Studies Macroscopy : Leaves 10-15 cm long, oblong or el26
8-10 layered on abaxial and 6-8 layered on adaxial; interspersed with secretory canals, sphaeraphidal and tanniniferous cells; 13-68 um (11) in diameter, walls lignified, contents scanty to slightly dense with tannins and crystals of calcium oxalate in few.
adaxially and 18-22 celled on the abaxial; polyonal to spherical, 11-63 um (32) in diameter; contents slightly dense, in few with tannins and sphaeraphides, often interspersed with secretory cavities. Sclerenchyma is 8-12 layered, enclosing the vascular bundle; cells polygonal, walls lignified, thick, 8-19 µm (13) in diameter, contents slightly dense, with tannins in few. Fibers in longituadinal section long, non-libiriform and septate.
Vascular tissue of mid vein consists of a central wedge or sigma shaped bundle, 918-950 µm laterally long and 183-205 µm thick; endarch, bicollateral, closed, pericyclic with two small adaxial bundles. Xylem elements in radial rows, secondary walls helical, scalariform and reticulate. Phloem on either sides with phloem parenchyma, sieve cells and fibers.
Vascular tissue consists of a single large sigma shaped bundle at the center; endarch, bicollateral, conjoint and pericyclic; 2065-2151 µm long and 481-537 µm thick vertically. Xylary cells arranged in radial rows, few clustered, polygonal to spherical, 5.5-22 µm in diameter; walls thick, lignified, associated with xylem parenchyma; secondary walls mostly helical, few scalariform; phloem scanty, on either sides of xylem and enclosed by sclerenchymatous pericycle.
Petiole Epidermal cells polygonal iso- to anisodiametric, sides thin, straight to curved, surface finely striated; contents slightly dense, in some with tannins and crystals of calcium oxalate; interspersed with secretary cavities; Stomata absent. Surface covered with few conical and flagellate hairs.
Powder Studies Microscopy: Trichomes conical and flagellate conical, either whole or fragments many. Pieces either whole or fragmented sphaeraphides. Fragments of epidermis with wavy sides with stomata. Pieces of leaf dark and greenish with tannins. Pieces of sclerenchymatous fibers with xylary tissue. Pieces of leaves with secretory cavities.
Transection In T.S. 3-4 mm in diameter, elongated laterally with an adaxial groove; covered by conical or flagellate hairs. Epidermis is unilayered, polygonal to barrel shaped; walls slightly thick, contents tanniniferous. Collenchyma is 1-layered on the abaxial and 1-2 layered on the adaxial, cells polygonal to spherical, angular or lamellar; in few with tannins and chloroplasts. Parenchyma is 12-16 layered
Organoleptic Characters Colour Touch Odour Taste
: : : :
Light dull green Smooth or finely coarse No characteristic No characteristic
PHYSICO-CHEMICAL STUDIES TABLE - 1 Standardisation of Raw Drug S.No. 1. 2. 3. 4. 5. 6.
Parameters
Quantitative values
Moisure content (L.O.D. at 105 C) Ash value (total) Acid insoluble ash Water soluble ash Water soluble extractive Alcohol soluble extractive
27
12.7% W/W 11.827% W/W 1.59% W/W 3.135% W/W 15.0% W/W 23.5% W/W
TABLE - 2 Determination of M.E.V. using different strengths of alcohol Sl.No.
Strength(s) of alcohol (% V/V)
1. 2. 3. 4. 5. 6. 7. 8. 9.
Extractive value
30% 40% 50% 60% 70% 75% 80% 90% Absolute
Remarks
23.79% 27.25% 20.15% 19.50% 11.80% 22.45% 16.50% 12.00% 23.50%
70% alcohol Used for preparation of Q on the basis of No. of spots and stability.
TABLE - 3 Formulation and preparation of mother tincture Coarse powder of leaves of P. guajava Purified water Strong alcohol
: : :
100g 300 ml. 735 ml.
To make one thousand ml. of the mother tinctures TABLE - 4 Standardisation of mother tincture S.No.
Parameters
1.
Observations
Organoleptic characters (a) Appearance (b) Colour (c) Odour Sediments Weight per ml Total Solids pH at room temperature Alcohol content
2. 3. 4. 5. 6.
Clear, non-viscous Tab brown Fruity and aromatic Absent 0.887 g. 2.34% 4-4.5 68% TABLE - 5
Chromatographic result of : Psidium guajava Mother tincture (Q) Extract Adsorbent Layer thickness of plate Solvent system Chloroform : Benzene, a few sol. Drops of CH3COOH (1:1 V/V)
: : :
Detecting agent 10% FeCl3 Sol.
Chloroform extract of Q Silica gel G 0.4 mm in wet conditions No. of spots 13
28
Rf values 0.5 0.9 0.24 0.28 0.39 0.45 0.51 0.59 0.69 0.73 0.82 0.87 0.92
Colour of spots
Pink Grey Green Green Pink
TABLE - 6 UV Absorbance of alcoholic extract of leaves of P. guajava Mother tincture Psidium guajava Q
No. of peaks
UV absorbance
5
259.5 nm 254.3 nm 239.4 nm 221.5 nm 212.5 nm
Discussion
Petiole
Psidium guajava is also known as the apple of the tropics and grows under a wide variety of climatic conditions. Guava is one of the richest natural sources of vitamin C besides pectin and other nutrients. Leaves are reported to contain catechol and pyrogallol types of tannins1. The leaves are popularly used in tanning leathers.
In surface epidermal cells are polygonal with straight to curved sides. Epidermal cells often possess tannins and prismatic crystals of calcium oxalate. The epidermal surface also is dispersed with some conical and flagellate hairs. In transaction 3-4 mm in diameter, laterally elongated with an adaxial groove. Epidermis is 1layered and hypodermal collenchyma is 1-2 layered. Ground parenchyma is predominant, interspersed with cells containing tannins and sphaeraphides. 812 layered sclerenchyma encloses the central vascular bundle.
a) Pharmacognostic features : The leaves are light green, finely pubescent and chartaceous. Epidermal cells in surface show striations on adaxial side. Stomata occur only on lower surface. Paracytic type being dominant besides anisocytic and anomocytic. Unicellular conical and uniseriate flagellate conical hairs occur on either surfaces. Stomatal index is 22.13.
Vascular tissue is made of a single large sigma shaped bundle which is bicollateral and pericyclic. Phloem is scanty and present on either sides of xylem.
Transectionally midvein is kidney shaped being prominently ribbed towards abaxial and grooved adaxially. Lamina wing is 151-173 µm in thickneww. Secretary cavities appear conspicuously on the abaxial surface. An adaxial hypoderm of 3-4 layers is conspicuous and confirms earlier observations of Metcalfe and Chalk7. Palisade is 4 layered and is confined to abaxial side. Secretory cavities interrupt the mesophyll. Cells of mesophyll often contain tannins and sphaeraphides besides chloroplasts.
b) Physico-chemical Alcohol extract and mother tincture have shown positive tests for tannins. The data pertaining to physico-chemical studies of raw drugs is presented in table 1. Formulation of mother tincture is given in table 2 & 3. Physico-chemical constants of mother tincture are summarized in Table 4. TLC study on Chloroform extract of the mother tincture reveals 3 prominent spots on spraying with 10% Ferric chloride solution and heating at 110 C (Table 5). It is evident from the raw drug studies that the value of acid insoluble ash falls within the acceptable range.
Ground parenchyma at midvein is interspersed with secretory cavities besides sphaeraphidal and tanniniferous idioblasts. A sclerenchymatous cap of 8-10 celled thick encloses the midvein bundle.
HPTLC profile shows absorbance in the short and long wave length of UV light before derivitisation while after derivitisation i.e. subsequent to spraying with methanolic sulfuric acid and anisaldehyde sulfuric acid separately, reveals eight bands with Rf values 0.15, 0.19, 0.28, 0.51, 0.57, 0.66, 0.79 and 0.94 correspondingly in both.
Central vascular bundle is sigma shaped, 918-950 µm laterally long and 183-205 µm vertically thick; endarch, and bicollateral. Secondary walls of xylary elements possess helical and scalariform thickenings.
29
The diluted mother tincture (1 ml Q diluted with 99 ml of alcohol) reveals large number of peaks in the UV region. It is clear that 70% alcohol used for preparation of mother tincture is the best alcohol in accordance with Homoeopathy philosophy. However, five major peaks amongst them are reported.
3.
Johnson, D.A. 1940, Plant Microtechnique, Mc Graw Hill Book Col., New York.
4.
Kaudil, F.E. et al., 1997. Flavonoids from Psidium guajava, Asian Journal of Chemistry, 9(4), 871-872.
5.
Kirtikar, K.R. AND b.d. Basu, 1980, Indian Medicinal Plants, Vol. 2, Bishen Singh Mahendra Pal Singh, Dehradun.
6.
Leelavathi, A. and N. Ramayya, 1975, Rapid, isolation of leaf epidermis by double treatment method, Geobios, Vol. 2, 117-119.
7.
Metcalf, C.R. and L. Chalk, 1950, Anatomy of the Dicotyledeons, Vol. 1, Oxford University Press, London.
8.
Rabe, T. and J. Van Staden, 1997, Antibacterial activity of South African plants used for medicinal purposes, J. Ethnopharmacology, 56(1), 81-87.
9.
Youngken, H.W., 1951, Pharmaceutical Botany, Rep. Ed. International Book Distributors, Dehradun.
Acknowledgements The authors thank Prof. C. Nayak, Director, Central Council for Research in Homoeopathy, New Delhi for encouragement and facilities. Thanks are also due to Anchrom HPTLC applications Laboratory, Mumbai, for HPTLC profile and scientist incharge, CFTRI, RC, Hyderabad, for UV studies.
References 1.
Anonymous, 1969, Wealth of India, Raw material, Vol. 8, Publication and Information Directorate, CSIR, New Delhi.
2.
Anonymous, 1971, Homoeopathic Pharmacopoeia of India, Vol 1, Ministry of Health and Family Welfare, Govt. of India, New Delhi.
30
GENERAL ARTICLE Role of Homoeopathy in Migraine in Adolescence Dr. S. Gopinadhan*
Abstract
There are two types of 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 adolescence. 25 cases of adolescent patients suffering from classical migraine were treated as out patients during the period 1997-2002. Homoeopathic medicines were selected on totality of symptoms. A total of 21 cases were relieved out of 25 cases. Of these 11 cases had no recurrence, 7 had moderate improvement and 3 had mild improvement. 3 cases showed no improvement whereas one patient reported with aggravation of symptoms.
1.Common migraine Unilateral throbbing headache lasting a few hours with nausea and vomiting but there is no preceding neurological symptoms.
2. Classical migraine also known as neurologic migraine; has hemicranial or generalized throbbing headache with nausea and vomiting and lasts for one to two days but is preceded by prominent neurological symptoms, known as aura. Diagnosis in both the varieties is made mainly from history3. The most common aura is visual disturbances such as dazzling zig zag lines, scintillating scotoma, homonymous hemianopia, field defects and rarely total blindness. The aura lasts for 15-30 minutes and usually is merged with hemicranial or generalized headache. There are many aggravating or precipitating factors but the most common factors are anxiety, emotional stress, menstruation (pre menstrual tension), relaxation of stress, alcohol, overwork and change of weather4. As this is one of the important types of headache, psychological factors play a major role in its precipitation and maintenance5.
Introduction Headache is a headache for both physician and the patient. This is the commonest but the most difficult clinical problem encountered by the physician. Most often headache is a symptomatic expression of some minor ailments, mental tension or fatigue, but occasionally it is of sinister significance, indicative of serious intracranial disease and i.e. why when a person is having regular headache, he may be much alarmed due to anxiety and fear. Among different types of headaches, such as referred headache, neuralgic headache, headache due to meningeal irritation, vascular headaches, traction headache and psychogenic headache, vascular headache is often very severe. The commonest form of vascular headache is MIGRAINE 1. The word Migraine came from another word 'Megrime' meaning Hemi cranial. Migraine is characterized by epidsodic throbbing, hemi cranial headache beginning in childhood, adolescent or early adult life which tends to decrease in intensity and frequency as age advances. Although migraine may begin at any age the usual onset is adolescene or young adult life2. Women are slightly more affected and out number men by about 4:1 and in many cases a positive family history is elicitable.
According to modern medicine the treatment of migraine falls into three groups such as (i) avoidance of aggravating or precipitating factors (ii) control of acute attacks and (iii) prophylaxis. To avoid these precipitating factors, physician used to give full explanation to the patient about the nature and phenomena of migraine. But this is not always effective because the persons affected with migraine have peculiar personality. They have excessive self demands, they are over ambitious, perfectionist, meticulous and scruplous. Failure to attain perfection and ambition leads to mental stress and strain. Therefore, all known precipitating factors especially the anxiety and emotional stress cannot be avoided by the patient. Another important
*Assistant Research Officer(Homoeo.), Central Research Institute(Homoeo.), Kottayam
31
precipitating factor, say, pre menstrual tension, also is very difficult to avoid by mere explanation or counseling. Since these patients are over ambitious they are liable to more physical strain which is one of the important aggravating factors and it is very difficult for such persons to refrain from over work. Therefore, instead of asking them to avoid anxiety, overwork or mental stress, their personal attitudes are to be changed and this is possible only through the homoeopathic treatment because the personality of a person is a manifestation of the underlying chronic miasm.
The method of study was purely clinical in nature. These 25 cases of migraine were included for the study on the basis of the following criteria: 1. Only adolescent migraine cases were selected 2. Only classical migraine was included 3. Both males and females were included 4. Patients with other systemic diseases were excluded 5. Patients with emotional and psychological stress as precipitating factors for headache only were included 6. Before inclusion all related investigations were done to exclude other causes of headache.
This short scientific paper is based on studies conducted in O.P.D. at CRI(H) Kottayam on 25 adolescent patients suffering from classical migraine with homoeopathic medicine in the period 19972002. All these cases were treated only with homoeopathic medicines, i.e. without any psychological advice. Since psychological factors play a major role in the causation or precipitation of migraine a complete psychosomatic approach with similimum is necessary. As mentioned in the Organon of Medicine by Dr. Samuel Hahnemann, ‘after the control of acute attacks these patients should be treated with deep acting anti miasmatic remedies in order to prevent further attacks’.
In each case a detailed case history was taken with special stress given to aggravating and precipitating factors, personal history and mental disposition of the patient and in all cases a miasmatic analysis was also done in order to find out which miasm was predominant and later on it helped for the selection of remedies for follow-up studies. All these patients were given medicines after strict individualization, in minimum dose, along with placebo. They were advised to repeat the dose on the occurrence of the next episode only. They were also advised to avoid coffee, tea, coco and other drugs used externally or internally during the whole course of the treatment. Each and every case was followed up for two years and final assessment was done after that. In many cases after the relief of the acute attacks with short acting remedies, deep acting anti-miasmatic remedies were found necessary to prevent further episodes of headache. But in certain cases drugs found effective to control the acute attacks were also found effective for the prevention of the episodes.
Materials and Methods The materials for the study consisted of 25 cases of classical migraine in adolescence treated during the period between 1997-2000 as out patients. These 25 patients included 9 males and 16 females (refer Table-I) between the age of 13 years - 18 years (refer Table-II). All of them had aura before the onset of headache and the majority had visual disturbances like dazzling, zig zag lines, dimness of vision, lachrimation, pain in eyes and photophobia (refer Table-III). The duration of the complaints ranged from 8 months to 5 years but in majority it was between 2 & 5 years (refer TableIV). These patients had different aggravating and precipitating factors (refer Table-V), but all of them had one or other types of emotional stress as precipitating factors. But in many cases more than one precipitating factors were present. Similarly majority of the patients studied had positive family history of migraine (refer Table-VI). A detailed study on the episodes of migraine reveals that the majority suffered from moderate to severe headache, the duration of the episodes ranged from less than 5 hours to 15 hours and frequency of attack ranged from more than once a month to once in three months. But in majority, the frequency of episodes was once in a month (refer Table-VIII-X).
To test the significance of the result obtained the data collected from the study especially the frequency of paroxysms before and after the treatment was statistically analysed with the help of Paired T test. The null hypothesis H0 in this study is that the treatment is not effective and the alternate hypothesis H1 is that the treatment is effective. For the statistical analysis, disease intensity scores were given on the basis of frequency of episodes before and after treatment (refer Table-XVI). Observation All the results obtained were given in tabular form from Table I-XVI. The results obtained were confined to those 25 cases only. It showed that 11 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 decreased considerably and 03 cases with mild improvement in which only the duration of episodes came down, 03 cases treated had no improvement and in 01 case symptoms aggravated during the treatment. The Table-XIV on the basis of prescription shows that the mostly used basis for prescription was physical generals, modalities and key notes, but it was found that all the basis for prescription was equally important. The Table on the 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 symptoms and the personality. However, the frequently indicated and effective drugs in controlling the acute episodes were Nat.mur., Nux.vom., Pulsatilla, Ign. and Lycopodium. Other drugs which were prescribed on their individual features also proved best in controlling the acute attacks. But constitutional drugs like Calc.carb., Nat.mur., Lyco., Puls., Sulphur and Syphilinum were found useful in preventing the recurrence of the episodes.
Table - II Age
25
9
16
T
M
F
12 - 14 years 14 - 16 years 16 - 18 years 18 - 20 years
5 10 6 4
2 3 2 2
3 7 4 2
Without Aura With Aura: Dazzling siz zag line Dimness of vision
T 0
M 0
F 0
6 13
3 4
3 9
Lachrimation Pain in eyes Photophobia Tingling on face
15 12 12 2
5 4 4 0
10 8 8 2
* Some cases have more than one aura Table - IV Duration of complaints Group Upto 2 years
T 4
M 1
F 3
2 - 3 years 3 - 4 years 4 - 5 years 5 - 6 years
9 5 5 2
3 3 1 1
6 2 4 1
Precipitating factors Alcohol Anxiety Reading Emotional stress Noise
T 1 6 7 25 19
M 1 3 2 9 6
F 0 3 5 16 13
Light Pre menstrual tension Physical stress
21 4 5
7 0 2
4 4 3
Table - V
Total No. of cases Female
Age Group
Aura*
Table - I
Male
Max. 18 years
Table - III
The assessment of improvement was on the basis of duration of episodes, their frequency and intensity. There were 20 cases with duration 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 treatment the results showed that only 10 cases had less than five hours duration and three cases had 5 to 15 hours duration and in one case it was found that the episode had duration of more than 25 hours and in one case it was found that the episode had a duration of more than 25 hours. Before treatment 5 cases had frequency more than once a month, 14 cases had frequency once a month, 3 cases had once in 2 months and the rest had once in 3 months. But after the treatment only one patient had the frequency greater than once a month and in seven cases no recurrence was noticed. 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 intensity, 7 with mild episodes but 11 had no recurrence of headache.
Total
Min. 13 years
33
Table - IX
Table - VI Hereditary factors T 18
Hereditary factors
M 5
Duration of paroxysms
F 13
Duration Less than 5 hours 5 hours to 10 hours 10 hours to 15 hours 15 hours to 20 hours 20 hours to 25 hours 25 hours and above
Table - VII Miasmatic factors
T
M
F
Psora Syphilis Sycosis Pseudopsora Mixed
11 2 0 7 5
4 1 0 2 2
7 1 0 5 3
T 4 10 6 2 2 1
M 1 4 2 1 0 1
F 3 6 4 1 2 0
T 5 14 3 3 0 0
M 2 6 1 1 0 0
F 4 8 2 2 0 0
Table - X
Paroxysms:
Frequency of paroxysms Table - VIII Once in a month Once in a month Once in 2 months Once in 3 months Once in 6 months Once in year
Intensity of paroxysms Mild Moderate Severe
T 4 13 8
M 1 5 3
F 3 8 5
DRUG THERAPY Table - XI For acute episodes Drug
Potency
Arg. nit. Belladonna Ignatia Lycopodium Melilotus Natrum mur. Nux vomica Pulsatilla nig. Sanguinaria can. Silicea Sulphur Tabacum
200 30 1M 30, 200 30 30, 200 30, 200 200 200 200 30 30
No of Patients Prescribed T M F 1 0 1 2 1 1 3 1 2 2 2 0 1 0 1 4 2 2 4 2 2 4 0 4 1 1 0 1 0 1 1 0 1 1 0 1
Found effective in T M F 0 0 0 2 1 1 3 1 2 1 1 0 1 0 1 2 3 1 4 2 2 3 0 3 1 1 0 1 0 1 1 0 1 1 0 1
Table - XII Drug found effective to avoid relapses Drug Calc. carb. Nat.mur. Lycopodium Puls. Sulph. Syphilinum
Potency 200, 1M 200, 1M, 10M 200, 1M 1M 200, 1M, 10M 1M
T 3 3 2 2 3 1
34
M 1 1 2 0 2 0
F 2 2 0 2 1 1
RESPONSE TO TREATMENT Table - XIII Improvement indices* T 0
• Cured • Improved • Marked • Moderate • Mild • Not improved • Aggravated
M 0
F 0
11 5 6 7 0 7 3 2 1 3 1 2 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
Less than 5 hours 5 hours - 10 hours 10 hours - 15 hours 15 hours - 20 hours 25 hours and above
T 4 10 6 2 1
Before treatment M F 1 3 4 6 2 4 1 1 1 0
After treatment T M 10 2 1 0 2 1 0 0 1 1
F 8 1 1 0 0
Table - XV Frequency of episodes Frequency T More than once in a month Once/month Once/2 months Once/3 months Once/6 months Once/Year
5 14 3 3 0 0
Before treatment M F 1 6 1 1 0 0
4 8 2 2 0 0
T 1 3 2 4 4 0
After treatment M F 1 2 0 0 1 0
0 1 2 4 3 0
Table - XVI Intensity of episodes Intensity
Mild Moderate Severe
Before treatment T M F
After treatment T M
F
4 13 8
9 3 2
8 1 1
1 5 3
3 8 5
35
1 2 1
Discussion
Conclusions 1.
The most common age group which is prone to migraine of psychosomatic origin is adolescence because this age group is vulnerable to great emotional, psychological and physical stress as they are passing through a new phase of life which is different from infancy and childhood.
2.
The predominant miasms found out in this study which are responsible for migraine are psora and pseudopsora.
3.
There is no specific remedy for adolescent migraine but drugs selected on strict individualization only are found useful.
The drug therapy part shows that many drugs are found useful to control the acute paroxysms and to prevent the recurrence (13 drugs in 25 cases). This reveals that there is no specific remedies for migraine but only specifics for individual patients.
4.
In adolescent migraine the true psychosomatic approach is the homoeopathic way of treatment because the drugs prescribed on the basis of the totality of the symptoms were able to give relief in 21 out of 25 cases.
The table on improvement indices shows that 21 out of 25 cases improved in various degrees out of which 11 cases had no recurrence of headache for the next two years and 7 had moderate improvement in which there was considerable reduction in the duration, frequency and intensity of attacks. Three cases studied shows no response after the treatment, but in one patient the headache aggravated after the treatment. More than 80% improvement obtained in this study is a great achievement and this shows the efficacy of Homoeopathic medicine given on the basis of individualization. This is more evident when we go through the tables on response to treatment related to the duration, frequency and intensity of headache (refer XV-XVII). After a month the 14 cases, which had relapse of migraine, 9 cases had headache in mild intensity only with occasional aura while the rest had moderate to severe headache but the duration and frequency were reduced except in 1 case.
Acknowledgement
The study of 25 cases of adolescent migraine shows that all are having one or the other type of psychological stress and anxiety which play the role of exciting and maintaining cause for the headache. In this study group females are more affected than males which is in conforming with what is said in text books. The miasmatic study shows that the majority of the group falls under Psora and Pseudopsora while the rest belongs to mixed group. This may be the reason that in majority of the patients multi miasmatic remedies are found useful to control acute episodes and to prevent further attacks.
I acknowledge the constant help and encouragement received from the Director, CCRH without which such research work could not be done. I also acknowledge with thanks those who helped me in this study and the preparation of this scientific paper. References
36
1.
Churchil's Pocket Book of Medicine p-28.
2.
Lance J.W., Mechanism and Management of Headache Edition IV, Butterworth, Stoneham M.A. 1982.
3.
C. Houston, L. Joiner, R. Trounce, A Short Text Book of Medicine, ELBS 7th Edition P-370.
4.
Harold I. Kaplan; Benjamin J. Sadock, Comprehensive Text Book of Psychiatry Vol. I Vth Edition p-232.
WEB INFORMATION Avian Influenza (Bird Flu) & Homoeopathy: Search On Internet O.P.Verma*
"Given the high level of global traffic, the pandemic virus may spread rapidly, leaving little or no time to prepare." - World Health Organization
is HPAI. However, an absolute diagnosis is dependent upon the isolation and identification of the causative virus. Commercially available type A influenza antigen-capture enzyme linked immunosorbent assay kits designed for use in human influenza have recently shown promise as a possible rapid diagnostic test for poultry.
Avian influenza (AI) is a disease of viral etiology that ranges from a mild or even asymptomatic infection to an acute, fatal disease of chickens, turkeys, guinea fowls, and other avian species, especially migratory waterfowl. Most avian species appear to be susceptible to at least some of the AI viruses. A particular isolate may produce severe disease in turkeys but not in chickens or any other avian species. Therefore, it would be impossible to generalize on the host range for HPAI, for it will likely vary with the isolate. This assumption is supported by reports of farm outbreaks where only a single avian species of several species present on the farm became infected. Swine appear to be important in the epidemiology of infection of turkeys with swine influenza virus when they are in close proximity. Other mammals do not appear to be involved in the epidemiology of HPAI. The infection of humans with an H5 avian influenza virus in Hong Kong in 1997 has resulted in a reconsideration of the role of the avian species in the epidemiology of human influenza.
This article is intended for busy scientists engaged in research work in the field of Avian Flu to help them reap the benefits of the Internet without surfing too much for locating the resources.
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http://www.pandemicflu.gov/
One stop access to U.S. Government avian and pandemic flu information. Managed by the Department of Health and Human Services. The risk from avian influenza is generally low to most people, because the viruses do not usually infect humans. However, confirmed cases of human infection from several subtypes of avian influenza infection, including H5N1, have been reported since 1997. Most cases of avian influenza infection in humans have resulted from contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretion/ excretions from infected birds.
Highly pathogenic avian influenza viruses have periodically occurred in recent years in Australia (H7), England (H7), South Africa (H5), Scotland (H5), Ireland (H5), Mexico (H5), Pakistan (H7), and the United States (H5). Because laboratory facilities are not readily available in some parts of the world to differentiate Newcastle disease and HPAI, the actual incidence of HPAI in the world's poultry flocks is difficult to define. It can occur in any country, regardless of disease control measures, probably because of its prevalence in wild migratory waterfowl, sea birds and shore birds.
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http://www.cdc.gov/flu/avian/
The Centres for Disease Control and Prevention stated how are avian, pandemic, and seasonal flu different? Avian flu is caused by avian influenza viruses, which occur naturally among birds. Pandemic flu is flu that causes a global outbreak, or pandemic, of serious illness that spreads easily from person to person. Currently there is no pandemic flu. Seasonal flu is a contagious respiratory illness caused by influenza viruses.
Highly pathogenic avian influenza is suspected with any flock where sudden deaths follow severe depression, inappetence, and a drastic decline in egg production. The presence of facial edema, swollen and cyanotic combs and wattles, and petechial hemorrhages on internal membrane surfaces increases the likelihood that the disease
* Librarian, Central Council for Research in Homoeopathy, New Delhi
37
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an optimistic outlook. They point out that the pathogen has not appeared to evolve such that human-to-human contact is contagious, yet it remains that people working with fowl, swimming in infected rivers, playing in an area where carcasses were buried, or breathing air near a poultry processing plant, can lead to infection.
www.who.int/csr/disease/ avian_influenza/en/ WHO is coordinating the global response to human cases of H5N1 avian influenza and monitoring the corresponding threat of an influenza pandemic. Information on this page tracks the evolving situation and provides access to both technical guidelines and information useful for the general public.
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w w w . h o m e o w e b . c o m / bird_flu_more.htm
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There has been much discussion about the merits or otherwise of Avian Flu anti-viral medicines in the media but no discussion of the effectiveness of homeopathy in the treatment of influenza. History shows us that homeopathy was used by homeopathic physicians in USA to treat patients during 1918-1919 influenza epidemic. From information recorded by these doctors, homeopathic treatment was highly successful. In most cases one or two homeopathic medicines were needed. These are known as the "Genus epidemicus" in an epidemic and become known through the careful observation of a number of influenza cases. It is difficult to speculate exactly what homeopathic remedies will work best in the possible Avian flu epidemic. However there are a number of known 'flu remedies that may be useful eg Gelsemium, Bryonia, Arnica, Eupatorium perfoliatum, Arsenicum etc . In the 1918 epidemic Gelsemium and Bryonia were most commonly indicated according to the following extracts
www.homeopathy.boiron.com/en/htm/ service/actualites.htm The first WORLD MEDICAL CONFERENCE on the theme 'Homeopathy and Avian Influenza' took place in Paris on Saturday 19 November 2005. Homeopathy is routinely used and prescribed for the prevention and as treatment for "ordinary" influenza with an effectiveness that has been recorded in several scientific publications*. This explains why homeopathic physicians and pharmacists are being increasingly consulted about avian influenza: what can homeopathy do? On a preventive or curative level?
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www.homeoweb.com/clinic/ bird_flu.htm Homeopathy offers a much effective treatment against viral infections in general. Also it offers complete cure in almost all infectious illness if there is not much destruction of tissues that is in cases other than advanced pathological changes. It is of greater importance that as homeopathy can start effective treatment based on symptomatology one can start the damage control much earlier before actual diagnosis of bird flu. The only problem being many a cases of possible bird flue (or any other grave or answerless illness) will be completely cured without there is a chance for proper diagnosis and recording the credit to the account of homeopathy. But no good homeopath needs credit but relief to suffering human
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www.acaciaanimalcare.com/ influenza.htm Many viruses and bacteria travel between species. Usually they do not cause overt disease in humans , people for example catch Fowlpox without even knowing they have had it, as it may not replicate in the cells.
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w w w . u s e n a t u r e . c o m / article_bird_flu.htm
Influenza, or flu, is a respiratory infection caused by a variety of flu viruses. The most familiar aspect of the flu is the way it can "knock you off your feet" as it sweeps through entire communities. Studies suggest that the prescription medicines approved for human flu viruses would work in preventing bird flu infection in humans. However, flu viruses can become resistant to these drugs, so these medications may not always work. The risk from bird flu is generally low to most people because the viruses occur mainly among birds and do not usually infect humans. However, during an outbreak of bird flu among poultry (domesticated chicken, ducks, turkeys), there is a possible risk to people who have contact with infected birds or surfaces that have been contaminated with excretions from infected birds.
Its not difficult to find someone these days who is concerned about the possibility of an influenza pandemic throughout the world. Equally common are the theories that abound from a plethora of 'experts' and medical/scientific institutions about its likelihood, the form it might take and the possible levels of devestation that it might reap throughout the animal and human populations.
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www.goldbamboo.com/topic-t7926.html
http://www.wisegeek.com/what-is-bird-
flu.htm Most health experts researching and fighting the incidence of human bird flu do not have 38
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trials do not show that it can prevent flu. Taking it once you have flu probably shortens the illness, but more research is needed.
www.bird-flu-facts.info/date/2005/11
What type of vaccines has been developed for bird flu - This website publishes bird flu information and resources. The H5N1 strain of bird flu has killed at least 62 people in Asia so far. It is a flu carried by birds that can be contracted by humans. There are growing fears that a pandemic could start soon as a result of this bird flu. There is currently no vaccine for the bird flu, but if an pandemic occurs with a hybrid form, researchers will be quick to engineer one.
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www.shrtn.info/users/surveillanceavian-flu This Day Online - Federal Government and the 36 state governments at the weekend called on international agencies and other development partners to come to its aid in tackling the avian influenza which has spread to 10 states of the country so far.
www.appleseek.com/6885.php
• AS BIRD flu, or Avian Influenza, raged through Asia, countries such as Vietnam, China, Thailand, Indonesia, Cambodia, Laos, Japan, Korea and Taiwan are stepping up on massive culling of their poultry as they are seized by a realisation that the animal virus could eventually threaten human lives. www.information-homeopath.com/Bird-flu.html According to CDCP (the US Centre for Disease Control and Prevention), symptoms of bird flu in humans have ranged from typical flu-like symptoms (fever, cough, sore throat and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other severe and life-threatening complications. (The symptoms of bird flu may depend on which virus caused the infection.) This sounds like bad news. However!... Bird flu is hard to catch Judging from reports so far, catching bird flu is quite difficult. You have to live with the chickens, literally in the same room as them, and be handling them or in physical contact with them for quite some time. This explains why few people have caught it so far.
www.netplo.com/pworldsflu.html
This is a planet wave resource area in the field of study of Avian Flu. Access to the latest news regarding outbreaks of disease. Page also provides access to disease outbreak news archives, (by year, disease or country). A RSS feed for notification of updates is also available from this page.
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www.avianflutests.com/list/2/avian-fluhomeopathic-remedy.html Welcome to the information page about avian flu homeopathic remedy. They have compiled a list of avian flu homeopathic remedy websites at: avian flu homeopathic remedy Site Map. This list of avian flu homeopathic remedy websites will be updated regularly.
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http://www.911-bird-flu.com/
This is a specialized news site for Bird Flu. One minute the US government is stockpiling Tamiflu, the main drug used to treat flu symptoms in Asian hospitals; the next, researchers say that H5N1 virus is already mutating and building resistance to the drug. So, what's a fairly-conscious, alwaysprepared, not-ready-to-die-of-blasted-flu health nut supposed to do? Get some antivirals in your natural remedies cabinet. Olive leaf extract is a good one. So is LarreaX, made from a plant in the Southwest desert. Others rely on colloidal silver.
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www.cochrane.org/reviews/en/ ab001957.html Homoeopathic Oscillococcinum does not prevent influenza, but probably shortens the length of the illness .Influenza (the flu) is a highly infectious disease caused by viruses. Other than treatments for complications (such as pneumonia), conventional medical treatment is bed rest. Homeopathy is a system based on "curing like with like", often using highly diluted substances. Oscillococcinum is a homoeopathic preparation manufactured from wild duck heart and liver (common sources of influenza). It is claimed that Oscillococcinum (or similar homeopathic medicines) can be taken regularly over the winter months to prevent flu, or as a treatment. The review found that
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www.birdfluweb.com
We have put this web site together for anyone interested in bird flu symptom so we invite you to take a tour. We hope you find what you are looking for. But if you don't please do not hesitate to email us at the address shown at the bottom of this web site. It is your feedback that helps us to make sure that this site eventually becomes one of the best bird flu symptom resources on the web.
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MEDI NEWS 1. Carbon Monoxide Helps Shut Down the Intestinal Inflammation that Causes Ulcerative Colitis
2. Passive Smoking Almost Doubles Risk Of Degenerative Eye Disease
Doctors have long known that smokers rarely suffer from a common form of inflammatory bowel disease (IBD) called ulcerative colitis, but they didn't know why. A new study in the December 19 issue of The Journal of Experimental Medicine might help explain this apparent resistance. Scott Plevy and his colleagues at the University of Pittsburgh now show that carbon monoxide (CO), a component of cigarette smoke, helps shut down the intestinal inflammation that causes ulcerative colitis.
Passive smoking doubles the risk of the degenerative eye disease, macular degeneration, shows research in the British Journal of Ophthalmology. The macula lies at the centre of retina at the back of the eye. It's crucial for fine central vision, which is essential for tasks, such as reading and driving. The risk of macular degeneration increases at the age of 60. It is a leading cause of partial sightedness and blindness in many European countries and the USA.
CO is best known as a toxic air pollutant, but small amounts of this gas are also produced in the human body as a normal by-product of metabolism, suggesting that the effects of CO must not be all bad. High dose CO gas is lethal, because it robs the body of life-sustaining oxygen. It is this asphyxiant property of CO that has earned it a bad reputation. But recent scientific studies have shown that CO -- at least at low concentrations -- has a redeeming quality: it acts as an anti-inflammatory agent.
The researchers base their findings on 435 people with end stage macular degeneration and 280 partners who lived with them. They found that the more a person smoked, the greater were their chances of developing age related macular degeneration.
It is this quality, according to Plevy and colleagues, that allowed CO to ease the symptoms of IBD in mice. The group traced the action of inhaled CO to a protein that is produced by immune cells called interleukin (IL)-12. IL-12 is normally produced during infection and helps activate the immune cells that fight off the invading pathogens. But chronic production of IL-12 in the gut also drives the inflammation that causes ulcerative colitis. Inhaled CO inhibited the production of IL-12, short-circuiting the disease-causing inflammation.
Regularly smoking a pack or more a day for 40 years almost tripled the risk of age related macular degeneration compared with non-smokers. The risks were also increased for partners who were non-smokers, and had lived with a smoker for five years or more. Their risk nearly doubled. (Source: Medical News Today, Category: Smoking News, dated 20 Dec. 2005)
3. Fish Oil Prevents Potentially Deadly Heart Rate Variability
The researchers are now trying to unravel the specific cellular components that are required for CO to inhibit IL-12. In the meantime, Plevy thinks that inhaled CO might provide some relief for patients with ulcerative colitis. But non-smokers with IBD shouldn't necessarily break out the Marlboros, as cigarette smoking is a risk factor not only for heart disease and cancer but also for Crohn's disease, another form of IBD.
A two-gram fish oil supplement given daily to elderly persons prevented a decline in heart rate variability caused by tiny, dangerous airborne pollutant particles. Heart rate variability, a measure of the autonomic nervous system's regulation of the heart, is an independent risk factor for cardiac arrhythmias, heart attack or sudden death. These findings appeared in the second issue of the December 2005 American Journal of
(Source: Medical News Today, Category: Irritable-Bowel Syndrome News, dated 20 Dec. 2005)
40
Respiratory and Critical Care Medicine, published by the American Thoracic Society.
who have abortions are more susceptible to generalized anxiety disorder and depression and are more likely to receive psychiatric treatment. Sleep disorders are often linked to a mood disorder and posttraumatic stress disorder.
Fernando Holguin, M.D., of the Centers for Disease Control and Prevention in Atlanta, Georgia, and eight associates provided fish oil supplements to 26 residents of a nursing home in Mexico City. A control group of 24 residents was given soy oil supplements. The participants' average age ranged from 81 to 83 years old.
(Source: Medical News Today, Category: Abortion News, dated 04 Jan 2006)
5. Smoking While Pregnant Causes Finger, Toe Deformities
"In this randomized controlled trial, fish oil supplementation prevented the reduction in heart rate variability associated with the same-day exposure to indoor particulate matter," said Dr. Holguin. "In contrast, soy oil, was associated with a marginal protection on heart rate variability."
Women have yet another reason to stop smoking while pregnant. In the largest study of its kind, plastic surgeons found smoking during pregnancy significantly elevates the risk of having a child with excess, webbed or missing fingers and toes, according to the January issue of Plastic and Reconstructive Surgery®, the journal of the American Society of Plastic Surgeons (ASPS). In fact. Smoking just half a pack per day increases the risk of having a child born with a toe or finger defect by 29 percent.
"Fish oil as a source of omega-3 polyunsaturated fatty acids could be considered as a potential form of preventive measure to reduce the risk of arrhythmia and sudden death in elderly subjects exposed to ambient air pollution," said Dr. Holguin.
Researchers examined the records of more than 6.8 million live births in the United States during 2001 and 2002, finding 5,171 children born with a digital anomaly where the mother smoked during pregnancy but did not suffer from other medical complications, such as heart disease, diabetes or high blood pressure.
In the study, the residents were exposed to tiny indoor air pollutant particles that had a dimension of 2.5 micrograms or less. All participants spent 92 percent of their time indoors. The supplement study was conducted over six months. None of the patients suffered from cardiac arrhythmias, had a pacemaker or were being treated with oral anticoagulants.
The more a woman smoked, the higher the risk became. Women who smoked 11 to 20 cigarettes a day raised the risk 38 percent, and women who smoked 21 or more cigarettes per day raised the risk 78 percent.
(Source: Medical News Today, Category: Seniors/Aging News, dated 20 Dec. 2005)
4. Women Are More Likely To Be Treated For Sleep Problems After An Induced Abortion
Webbed fingers or toes occur one in every 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 disturbances following an induced abortion compared to a birth. The observed risk was highest in the first 180 days after pregnancy outcome but was not significant after the third year.
Nevertheless, the majority of these defects occur without any family history and most causes are unknown which has lead researchers to investigate environmental causes, such as smoking, for these anomalies.
The authors examined the records of 15,345 women who had an induced abortion and 41,479 women who gave birth. Women with a history of treatment for sleep disorders before pregnancy were excluded.
"Smoking is so addictive that pregnant women often can't stop the habit, no matter what the consequences. Our hope is this study will show expectant mothers another danger of lighting up." (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 Risk Of Cardiovascular Disease
of gum disease that was so severe that all their teeth had to be extracted. The blood tests were for bloodclot risk factors and signs of inflammation.
The Journal of Dental Research has just published the results of a study showing that treatment of gum disease may reduce the risk of cardiovascular disease.
The average level of factors fell when the gum infection was eradicated, suggesting that the risk of heart attacks and clots in the future had reduced. This also indicates that inflammation in the mouth has a measurable effect in the bloodstream, and therefore the rest of the body.
Researchers from Australia (Sydney Dental Hospital and Royal North Shore Hospital) and Norway (University of Oslo) collaborated in the PERICAR clinical trial, providing strong evidence linking periodontal (gum) disease to an increased risk of developing blood clots, which could lead to the onset of heart attack and stroke.
The researchers are currently studying the relationship between gum and heart disease in people with less severe periodontal disease who do not need to have all their teeth extracted.
In recent years, many studies throughout the world have linked periodontal disease to increased cardiovascular risk, although the reasons for this link have not been fully explained, nor has it been proven that the link is a direct causal one. One explanation is that inflammation and infection have also been related to increased atherosclerosis and cardiovascular risk. Periodontal disease is the most common chronic infection in humans, and symptoms include bleeding, swollen or receding gums, and bad breath. In severe cases, the teeth become loose and may eventually fall out.
Dental disease impacts on people's general health and well-being. Periodontal disease is common, preventable, and treatable. This study suggests that improving periodontal health could significantly reduce the risk of cardiovascular disease.
Individual participants who were involved in the trial had blood tests before and after treatment
(Source: Medical News Today, Category: Dentistry News, dated 05 Jan 2006)
The Journal of Dental Research is the flagship publication of the International and American Associations for Dental Research (www.dentalresearch.org) and is the top dental journal in the world.
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INSTRUCTIONS TO AUTHORS The Council invites papers for publication in its Quarterly Bulletin. These should be original and not published elsewhere. All contributors are subject to peer review by independent experts and the Editor's decision concernin
in the text of the articles should not be inserted in the abstract (of about 250 words). It should be written for the readership of both clinicians and investigators and should state the hypothesis or central question of the study or investigation, the study subjects or experimental animals, observational and analytical methods , the findings, and a final statement of the principal conclusions.
g publication is final. A detailed outline is required before we will agree to commission such articles. All materials submitted for publication must include a covering letter, personally signed by all authors .
4.
Keywords:
Manuscript should be sent to The Director, Central Council for Research in Homoeopathy, JLN Anusandhan Bhawan, 61-65, Institutional Area, Janakpuri, New Delhi-110058. e-mail: [email protected]
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Requirements for submission of Manuscripts:
Introduction should be brief and state precisely the scope of the paper. Review of the literature should be restricted to reasons for undertaking the present study and provide only the most essential background.
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1.
General ;
6.
7.
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Title:
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The material (Patients , experimental animals etc.) used for making observations must be described along with all other relevant information. The methods used in the study should be described , giving sufficient information to permit the work to be repeated. If a generally accepted technique has been used, only reference to that is enough. If, however, such a technique has been modified by the workers, the manner in which this has been done should be clearly stated. The drugs and chemicals used should be precisely identified, including generic name(s), dosage(s), and route(s) of the administration. If statistical analysis of the data has been done , the methods used for analysis should be specified.
Manuscripts must be typewritten, doublespaced with wide margin on A-4 size good quality bond paper. Each of these segments of the manuscripts should begin on a new page: Title; abstract; introduction; material and methods; discussion; acknowledgment references; legends; figures and tables. 2.
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8.
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This should be limited to significance of results obtained and what can and what cannot be concluded and why. It should not be a repetition of the findings already given in the Results.
Abstract should be brief and indicate the scope and significant results of the paper. It should 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 critical and reflective rather than doctrinaire. Case analysis (symptom selection, prescribing strategy, etc.) should be transparent and well justified. Case histories should discuss the materia medica involved and the rationale of any differential diagnosis. Cases analysis and materia medica should be illustrated with tables and figures where appropriate. Case histories should include adequate follow up to demonstrate sustained improvement. Documentation and independent evidence greatly strengthen case reports, and as much such evidence as possible should be presented. This includes results of pathology and other investigations, images (including photographs), physical examination, ability to work and fulfill social roles, school performance, assessments by other health professionals and agencies.
Acknowledgment should be brief and made for specific scientific and technical assistance only and not for providing routine departmental facilities and encouragement or for help in the preparation of the manuscripts. 10.
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Behera D. Textbook of Pulmonary Medicine. New Delhi, Jaypee Brothers Medical Publishers (P) Ltd. 1995.
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Chapter in Book Weinstein L, Swartz MN. Pathogenic properties of invading microorganisms. In: Sodeman WA editor. Pathologic Physiology: mechanism of disease. Philadelphia: Sounders;1947p.457-72. 11.
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PSIDIUM GUAJAVA 1. 2. 3. 4. 5. 6.
Leaf epidermis, Abaxial surface Leaf epidermis, Abaxial surface Leaf midvein in Transection Leaf lamina in transection Petiole in transection Leaf surface showing secretory cavities
x 485 x 418 x 69 x 45 x 56 x 104
TLC PFORILE OF PSIDIUM GUAJAVA Fig. 1 Fig. 2 Fig. 3 S.S.
Psidium guajava mother tincture (Chloroform extract) 70% Alcoholic extract of Psidium. Refined figure of Chloroform extract. 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 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6
Images of chromatograms at 254 nm. before deravitization. Images of chromatograms at 366 nm. before deravitization. Images of chromatograms at 366 nm. after Spraying with Methanolic H2SO4. Visible images of chromatograms after deravitization with Methanolic H2SO4. Images of chromatograms at 366 nm. after Spraying with anisaldehyde H2SO4. 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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