Sunday, June 11, 2017

Research topics for PG Scholars of homoeopathic pharmacy

I am often asked to suggest some topics for PG Scholars of homoeopathic pharmacy. Here I make an attempt to list them out.

Topics are bifurcated as follows:

A.    The ones which could be done within the institute with or without little aid from outside.
B.    The ones which need to be done outside the college, i.e. other institutions/laboratories. 

A.    Within the institute
a)    plant studies, like growth of the plant, against some induced diseases, germination, etc.
b)    standardization studies include pharmacognocy, finger print studies like TLC, UV, HPLC/HPTLC, etc.; pharmaceutical analysis like presence of phytoconstituents
c)    Crystallization
d)    Drug proving
e)    Lipoid flocculation
f)     comparison of quality standards in difrerent pharmacopoeias like HPI, GHP, HPUS, FHP, Brazillinan, etc.
g)    comparison of expiry in different countries
h)    comparison of homoeopathic regulation in different 
i)      (outside institute but without dependence on other institutes) market research on purchase of homoeopathic medicine in different regions
j)      (outside institute but without dependence on other institutes) public survey on the usage of homoeopathic medicine

B.    Outside institute
a)    in-vivo animal studies on different activities like anti-inflammatory, anti-dementia, anti-epileptic, hepatoprotective, hypoglycemic, hypocholesterolemic, etc.
b)    in-vitro studies like cyto-toxic/anti-cancer, anti-oxidant, etc.
c)    nanoparticle study
d)    gene expression study

Document "Priority areas..." lists the topics which could be taken for homoeopathic research. Sub-heading 'Drug development and drug standardization' throws some idea interesting to homoeopathic pharmacy scholars.

Another paper titled 'Homeopathic standardisation...' by MV Kardile is an interesting review paper. It also throws some light on the activities of homoeopathic dilutions.

I hope this will be of some help.

Monday, July 08, 2013

Old Age Problems and Homoeopathy

Common old age problems and homoeopathic management

Ageing is not always a happy experience for many. It comes along with certain psychological issues like insecurity, stress and anxiety, dependency, etc. and with some physical ailments. None can stop ageing; but we can take away the feeling of ageing with providing good quality of life, engaging in different activities and positive thinking. As an Irish novelist and poet C.S. Lewis once wrote “You are never too old to set another goal or to dream a new dream”. One can make this statement possible with proper diet, possible physical exercises, and better awareness about the diseases that affect the old age.

As the nature takes its course, certain basic knowledge about the signs and symptoms of such affections can enable elders to tackle them and age gracefully.  The common problems during the later stage of life include cataract, dementia, diabetes, senile gait syndrome, easy exhaustion, hypertension and other cardiac problems, knee and other joint ailments, loss of hearing, palpitation, poor immune response, reduced physical activity, vertigo, vision impairment, low immune response, and many others. Many elders manage these problems with a homoeopathic kit containing 15-20 drugs. Homoeopathy eases their routine life and offers peace and solace. The purpose of this article is to list the common signs and symptoms of elderly with their probable causes/conditions and common homoeopathic remedies.

What is ageing and active ageing?
Ageing is defined in different ways by many authors, books and dictionaries. It is the irreversible biological changes in a person over time. Though it renders human beings progressively towards death, our objective is to provide better quality of life and to minimize their sufferings, which is called “active ageing”. WHO (World Health Organisation) defines “active ageing” as the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age. It applies to both individuals and population groups. Active ageing allows people to realize their potential for physical, social, and mental well-being throughout the life course and to participate in society, while providing them with adequate protection, security and care when they need.

Why is old age vulnerable to health issues?
In a young person, the body’s defence system functions actively and effectively. After certain age, this system gradually weakens attracting the diseases. The immune response to diseases becomes low. It allows many diseases to affect easily and the deteriorated cells put more fuel on it.

Yellow line between self medication and physician’s consultation
Usually multiple conditions affect elderly people. Self medication for managing the problems should be limited to minor problems and if the symptoms are not relieved one has to consult a physician. Sometimes people keep on self medicating without knowing the disease’s progression which may be harmful.

Diet in geriatrics
Since the body’s ability to digest the food may reduce at this stage, fibre-rich food can help in digesting easily. Since the absorption is normally lower in elderly, supplements like vitamins and minerals may be taken if need arises. People affected by diabetics, hypertension and other illnesses need to take specific diet suggested for such illnesses.

Common signs and symptoms, their indications and commonly used homoeopathic drugs

Common sign/symptom
What is it indicated for
Homoeopathic management
It is a common problem affecting elderly due to ageing process of alimentary canal. It affects the intestinal motility and the ability to digest the food.
Ambra grisea (frequent, ineffectual desire, which makes anxious), Antimonium crudum (alternating with diarrhoea), Arnica (rectum loaded but faeces will not come away), Baryta carbonica (hard knotty stool), Conium (frequent burning but hard and tenesmus), Phosphorus (white hard stool)
Cloudy vision
Cataract – over 50% of human population above the age of 60 years have cataract.
Corneal opacity – opacity in the cornea affects the vision
Calcarea fluorica 3x/6x (cataract and keratitis), Calcarea iodata 3x (opacity of cornea), Phosphorus (retinal troubles with lights and hallucination of vision), Silicea (cataract in office workers, after effects of keratitis, use 30th potency for months), CMS eye drops (cataract and corneal opacities 1-2 drops to be instilled 2-3 times a day)
Research suggests delirium affects up to 56% of older people admitted to hospital. The syndrome has not been well studied in residential care, but what data is available suggests a rate at least as high as that found in acute settings. It may be due to various causes like fever/inflammation, infection, neurological disorders, pain, dehydration, urinary retention, sensory impairment, drug effects, etc.
Aconitum napellus (nocturnal furious delirium), Agaricus muscarius (characterized by singing, shouting, and muttering; rhymes and prophesies), Arsenicum album (worse after mid-night), Belladonna (with restless sleep, frightful images and due to pain), Bryonia (talks about business matters), Cannabis indica (delirium tremens), Hyoscyamus (with attempt to run away), Lachesis (stupor or muttering delirium), Lycopodium (delirium even in low forms of fever), Opium (delirium with frightful visions, of mice, scorpions), Stramonium (delirium, with desire to escape), Veratrum album (attacks of pain, with delirium driving to madness)
Due to ageing, there is a progressive decline of intellectual function, which leads to forgetfulness. Insufficient blood circulation to the brain also causes senile dementia.
Acidum phosphoricum (cannot remember what he has read, and forgets names), Alumina (has to make notes to not forget), Ambra grisea (dull and mental slowness, unable to count), Anacardium (sudden loss of memory), Baryta carbonica (loss of memory from mental weakness), Bacopa monnieri Ø/1x (recent researches suggest it helps improved mental function like better acquisition of knowledge, improved retention and delayed extinction), Conium (excessive difficulty in recollecting), Crotallus horidus (clouded perception and memory), Ginseng Ø/1x (weak memory with difficult thinking process), Ginkgo biloba Ø/1x (improves the cerebral blood flow, helps to treat and prevent problems with memory, senility and mental dullness), Lycopodium (weak memory with confused thoughts)
Giddiness/ vertigo
It indicates normal ageing process of eyes, equilibrium organ in the inner ear and sensors in the muscles and joints for the sense of position, which are important organs to maintain equilibrium.
Ambra grisea (intense vertigo in open air), Arsenicum iodatum (with tremulous feeling), Baryta carbonica (when standing in the Sun), Conium maculatum (when lying down, and when turning over in bed, when turning head sidewise, or turning eyes), Cuprum metallicum (with internal tremor, better by stool), Gelsemium (spreading from occiput with dim vision),  Ginseng Ø/1x (with gray spots before eyes, objects appear double), Phosphorus (with coldness of occiput, worse after raising)
Another reason could be insufficient blood circulation to the brain.
Ginkgo biloba Ø/1x (due to insufficient cerebral circulation)
Hearing impairment
Most commonly, it is caused by changes in the inner ear that occur as people grow older. However, genetics and history of exposure to loud noises play a lead role.
Baryta carbonica (hardness of hearing), Cicuta virosa (Difficult hearing and sudden detonations especially on swallowing), Kalium muriaticum (due to chronic, catarrhal conditions of the middle ear with snapping and noises in the ear), Petroleum (dry catarrh, with deafness and noises), Phosphorus (difficult hearing especially after typhoid)
Common reason being prostatic hypertrophy in male and menopause in female, it could also be due to other causes like inflamed bladder, nerve control weakness, conditions like Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, etc.
Acidum benzoicum (Enuresis with dribbling and offensive urine in men), Argentum nitricum (Urine passes unconsciously, day and night), Arsenicum album (involuntary urination with burning and scanty urine), Aurum muriaticum (incontinence worse at night after dropsy), Baryta carbonica (urging to urinate with burning in urethra on urinating, mainly due to prostatic enlargement), Causticum (while coughing, sneezing; with very slow expulsion; with retention especially after surgical operations; during first sleep at night; from slightest excitement; with loss of sensibility on passing urine), Cicuta virosa (enuresis may be associated with frequent urination), Conium maculatum (common in men having difficulty in voiding), Iodium (in people losing flesh with great appetite), Secale cornutum (suitable in old people with shriveled skin-thin, scrawny old women), Thuja (with sudden desire, but cannot be controlled)
Pruritus (generalised itching, dryness of skin and related problems
Like cataract, reports suggest more than half of all people aged over 60 years is affected by pruritus. More common in diabetics.
Azadiracta indica Ø/1x (strong clinical observations for skin diseases, boils, ulcers, eczema & scabies from impurities of blood), Cardiospermum Ø (externally used; its antipruritic action is proven not only in practice, but also in a number of different clinical studies), Echinacea angustifolia Ø/1x (known for symptoms of skin symptoms related to blood poisoning),  Mezerium (intolerable itching; chilliness with pruritus; worse in bed), Psorinum (itching disturbs sleep), Sulphur (suitable for psoriatic patients, itching worse scratching and washing)
Sadness and grief
Depression in the elderly is a widespread problem, but it is not a normal part of aging. It is often not recognized or treated.
Arsenicum iodatum (sadness and discontent set in after prolonged illness), Aurum metallicum (profound despondency, with increased blood pressure, with thorough disgust of life, and thoughts of suicide; talks of committing suicide), Ginkgo biloba Ø/1x (studies reveal that it helps in major depression), Ginseng Ø/1x (possess adaptogenic action i.e. it helps the body to adapt to stress), Iodium (anxiety from present situation leading to depression and suicidal thoughts), Stannum metallicum (sad and discouraged with dread of seeing people), Zincum metallicum (depression with aversion to do anything, lethargic and stupidness)
Senile heart
Cardiac weakness is increasingly common in elderly people. Ageing process in the heart leads to inability of the heart to maintain an output adequate to meet the metabolic demands of the body. Clinically, it is manifested as organ hypo-perfusion and inadequate tissue oxygen delivery.
Arnica Montana 1x/2x (cardiac dropsy with dyspnoea), Crataegus oxyacantha Ø/1x (cardiac weakness. Extreme dyspnoea and exhaustion), Convallaria majalis Ø/1x (increases the heart’s action and renders it more regular), Coffea cruda 1x (acts on violent irregular palpitations especially after sudden stress), Prunus spinosa 1x (indicated for tachycardia which is exacerbated with the slightest motion)
A common symptom in elderly, it general occurs due to ageing process in the whole body. It is important to differentiate the severity to find out if there is a major illness behind it and treat them properly.
Alumina (tendency to paretic muscular states, with lack of vital heat, or prematurely old, with debility), Ambra grisea (extreme nervous hypersensitiveness), Conium maculatum (trembling with numbness), Ginkgo biloba Ø/1x (increases the blood circulation to the periphery), Kalium carbonicum (with tearing pains), Mercurius (tremors all over the body from weakness with ebullitions; trembling from least exertion), Opium (twitching of limbs; numbness and jerks as if flexors were overacting), Phosphorus (suitable from tall slender persons), Plumbum metallicum (paralysis of single muscle with difficulty to lift anything), Zincum metallicum (lameness, weakness, trembling and twitching of various muscles)

Osteoarthritis and Homoeopathy

Managing osteoarthritis homeopathically
Winter has approached. It brings along all the joint pains aggravated. It will not be a surprise for physicians to see the chronic arthritic patients making frequent visits these days. Researchers indicate that the decrease in the barometric or atmospheric air pressure during winter is the culprit for this worsened pain. Due to this reduction in pressure, tissues around the joints swell. This ultimately increases the arthritic pain. Osteoarthritis (OA), the most frequent joint disease in India, is not an exception.

Osteoarthritis is a degenerative joint disease, which is sometimes also called degenerative arthrosis or osteoarthrosis. It is the most common form of arthritis mostly in obese and middle age. Menopausal women suffer more than others due to hormonal changes, especially the oestrogen deficiency, followed by the rapid reduction in bone mineral density. But it occurs more or less frequently in both sexes. The degenerative form due to age is present in almost everyone by the age 70. Modification in diet, reduction of weight in the overweight patients and a few tone-up exercises help considerably along with the medication. Weak vital force due to ageing leads to degeneration of cartilage and hypertrophy of bone at articular margins.  Hereditary, metabolic, genetic, chemical, and mechanical factors also play a role in its development. Other causes are injury and infection. There are some cases suspected due to hypersensitivity (allergies), fungal infections, etc., which need to be considered in management of the disease. This article gives an over on the disease and its general and homoeopathic management.

Signs and symptoms
The onset is insidious. Initially there is articular stiffness, later develops pain on motion of affected joint and palpable crepitus. Other symptoms like limitation of joint, mild joint effusion and mild signs of inflammation may also be noticed.

Tests and their findings in osteoarthritis
X-ray will show some indications of the condition. Loss of cartilage, subchondral sclerosis, sharpened articular margin, narrow joint space, presence of osteophytes are the impressions usually found in the radiological reports suggesting OA. RA factor will usually be negative and ESR and other blood tests will also be normal.
General management during winters
People with OA has to wear warm clothes always. Some additional items like thermal underclothes, turtleneck, hat, scarf and gloves will be helpful during peak winters. Exercises like walking and swimming, maintenance of optimum body weight, proper rest, required physiotherapy are recommended. Running on hard surfaces is to be avoided. Active people who are into heavy weights and contact sports can develop arthritis early due to the large forces that their joints are subjected to. Once it sets in, activities like squatting, kneeling and sitting cross-legged on the floor should be avoided. Experts suggest avoiding junk food and maintaining a healthy eating helps osteoarthritis patients. Diet rich in calcium, protein, vitamin D and vitamin C are always recommended by nutritionists. Though calcium may not prevent osteoarthritis, it allows the bone beneath the degenerated surface to resist deforming forces. Engaging in some sort of physical activity at least three to four times a week is helpful. This will keep the weight in check and also strengthen the muscles, which in turn helps slowing down the progression of the condition.

The joints should not be subjected to sudden jerks and physical overload. Incorrect exercises can even be worse. Care must be taken in subjecting the bones to stress. People with low bone density and those suffering from osteoporosis must be extra cautious as they have higher risks of a joint damage. They have to be advised to take necessary supplements. Sportspersons are usually suggested to wear proper joint guards such as knee pads and other joint protections even during the practice. People with OA history in their family must take extra care of their joints. Yoga can be of help for the people who cannot do hardcore gymnasium- based exercises.

Integrative approach
The concept of integrative approach is increasing. Integrative approach is managing the patient with multi-system therapies. Homoeopathy, Yoga and naturopathy, Ayurveda/Siddha, Acupuncture, physiotherapy can be combined along with occasional intervention of conventional system as and when the need arises.

Homoeopathic remedies often used for osteoarthritis
Osteoarthritis with excessive pain before the swelling commences; joints stiff, swollen, with pricking sensation; wrists and ankle-joints painful, inflamed, very lame and sore.
Arnica montanna
Osteoarthritis due to injury; arthritic pain with fear of being touched; Feels bed on which he lies too hard; extreme coldness of forearm. 
Apis mellifica
Arthritis with oedema of the hands and feet without thirst with sensitiveness to touch; character of pain: burning, stringing, sore and suddenly migrating from one part to another.
Shiny, swollen joints of first stage inflammation; shooting pain shifting rapidly; affected joint is with heat, redness, throbbing and burning pain; arthritic affection with subcutaneous red streak
Benzoicum acidum
Pain with cracking sound on motion; tearing and stitching pain with redness and swelling of joints, worse at night.
Berberis vulgaris
Pain with extreme tiredness of affected joints after walking a short distance; osteoarthritis with uric acid diathesis
Bryonia alba
Stitching and tearing pain worse at night; osteoarthritic symptoms worse by motion, and better by absolute rest and lying on painful side.
Calcarea carbonica
Osteoarthritis of knee due to obesity; coldness of inflamed joint; pain after exposure to wet
Dull tearing pain in the affected joint.
Cobaltum metallicum
Pain with fatigue worse in the morning.
Colchicum autumnale
Drawing, tearing and pressing pain during beginning of winter with cold air; pain shifts from right to left; patient screams when touching the affected joint
Arthritis pain from exposure to cold, damp and rainy weather or changes in hot weather; arthritic affection alternates with diarrhoea; arthritis follows acute skin eruptions.
Affection of multiple joint and intense pain shifts from one joint or another; joints hot, red and swollen, worse form least motion.
Arthritis with drawing and tearing pains; sometimes with gastric and hepatic disorder.
Arthritic pain with sore feeling of whole body; arthritic patient with past history of suppressed venereal disease; pain especially when walking; arthritis with intense restless of legs and feet.
Pain shifts rapidly like electric shock; nature of pain is shooting, lancinating and flying to other part; pain better by stretching the limbs.
Pain with tearing and drawing pain in back muscles; pain shift rapidly with restlessness and sleeplessness; type of pain: drawing, tearing and tensive.
Osteoarthritis of acute stage; drawing and tearing pain worse at rest and in wet cold, windy weather.
Rhus toxicodendron
Arthritis after over lifting; pain on first motion and better by continued motion; complaints worse in rainy weather and affected parts sore to touch; joint pain better by motion, therefore cannot keep the extremities in one position.

Functional dyspepsia & homoeopathy

Functional dyspepsia – its modern understanding and homoeopathic approach

Gastric symptoms like abdominal discomfort, stomach pain, bloating, fullness, tenderness and allied symptoms are very common in day to day practice.  These abdominal symptoms have been in existence since the beginning of human history. But the term dyspepsia covering these symptoms was first recorded in the mid 18th century and since then the term has been widely used. Dyspepsia may be acute or chronic. While acute dyspepsia is a kind of indisposition which may go on its own by diet modifications, chronic dyspepsia may recur again and again. Modern pathologists tried to found out organic cause for the recurrent type but failed to identify one in many cases and termed it as functional dyspepsia (FD). Because of the absence of a clear understanding of the mechanism/s, conventional system without having effective drug mostly depend on the dietary recommendations, lifestyle modifications and psychological intervention.  The scope and success of homoeopathy in functional dyspepsia as in other functional disorders are known both in acute episodes as well as in giving stable recovery in chronic cases. This article tries to update the readers on the possible modern understanding of the disease, its miasmatic approach and drugs to manage the condition.

How prevalent is this condition?
Recent epidemiological studies indicate that functional dyspepsia is a very common condition with a high prevalence throughout the world.1 In western counties it affects about 15% of the general population2; in some countries like Canada it is estimated that 20-45% people suffer from this problem3. There are studies from different parts of India that upto 49% of the Indian population report dyspeptic symptoms4. In daily practice general practitioners encounter these cases frequently.5

Factors influencing the condition
In studies from Asia, functional dyspepsia seem to be more common in younger age group.6 While a study from urban Mumbai, India found that dyspepsia was more prevalent in adults > 40 years7, studies from Britain, Taiwan and Denmark show a decreasing trend of functional dyspepsia with age8,9,10. In the latter survey, there was a significantly lower prevalence of uninvestigated dyspepsia in adults > 70 years (10%) compared to those < 60 years (18.4%).10 Majority of population-based studies do not show any gender difference in dyspepsia prevalence but few studies from different populations, have noted a consistent female preponderance with dyspepsia.6 Two studies from Malaysia on about 2000 patients on applying Rome II diagnostic criteria showed a prevalence of dyspepsia in different ethnicity of Malaysian, Chinese and Indian populations is 231 (14.6%), 30 (19.7%) and 28 (11.2%) respectively.11,12 While some studies have shown link between some prior infections like salmonella gastroenteritis and origin of the condition13, others have shown a relationship of non-vegetarian diet, spicy food, smoking, coffee, alcohol and non-steroidal anti-inflammatory drugs (NSAIDs) with different forms of dyspepsia.6,7

How is it diagnosed?1
As per records the term functional dyspepsia has been in use since the last 5-6 decades.14 It is considered as a very common condition with a high prevalence throughout the world. Though the cases are high, there were no definite diagnostic criteria till recently. Physicians often confused this with simple heartburn, gastro-oesophageal reflux disease, drug induced gastritis, cholelithiasis, etc. Understanding the need for definite diagnostic criteria, in 1994 the Rome Diagnostic Criteria, now widely accepted criteria for functional gastrointestinal disorders, were developed. The criteria were subsequently modified in 2000 and 2006 as Rome II & Rome III respectively. Diagnostic criteria based on the most recent 2006 Rome III criteria is given below.

Diagnostic criteria of functional dyspepsia must include one or more of: (a) bothersome postprandial fullness, (b) early satiation, (c) epigastric pain and (d) epigastric burning; and there should not be any evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms. Criteria must be fulfilled for the last 3 months, with symptom onset at least 6 months prior to diagnosis.

Functional dyspepsia has been further sub-divided in to: (i) postprandial distress syndrome and (ii) epigastric pain syndrome. In postprandial distress syndrome, the diagnostic criteria must include one or both of the (a) bothersome postprandial fullness, occurring after ordinary-sized meals, at least several times per week and (b) early satiation that prevents finishing a regular meal, at least several times per week.  In this subtype too, the criteria must be fulfilled for the last 3months, with symptom onset at least 6 onths prior to diagnosis. The supportive criteria include the presence of upper abdominal bloating or postprandial nausea or excessive belching, and coexistence of epigastric pain syndrome.

In epigastric pain syndrome, the diagnostic criteria must include all of the (a) pain or burning localized to the epigastrium of at least moderate severity, at least once per week, (b) the pain is intermittent, (c) not generalized or localized to other abdominal or chest regions, (d) not relieved by defecation or passage of flatus, and (e) not fulfilling criteria for gallbladder and sphincter of Oddi disorders. Here too the criteria must be fulfilled for the last 3 months, with symptom onset at least 6 months prior to diagnosis. The supportive criteria include (a) the pain may be of a burning quality, but without a retrosternal component, (b) the pain is commonly induced or relieved by ingestion of a meal, but may occur while fasting, and (e) postprandial distress syndrome may coexist.

Clinical features15
As per the above diagnostic criteria if one or more of the mentioned symptoms at least for three months with onset at least six months previously without any structural disease is considered as functional dyspepsia. Now let us examine each symptom with its clinical presentation. Postprandial fullness is an unpleasant sensation perceived as the prolonged persistence of food in the stomach. Early satiation is a feeling that the stomach is overfilled soon after starting to eat, out of proportion to the size of the meal being eaten and such that the meal cannot be finished. Epigastric pain refers to a subjective unpleasant sensation and epigastric burning is referred to as an unpleasant subjective sensation of heat.

The subdivision of functional dyspepsia into two groups is on the distinction of meal related and meal unrelated symptoms. Post prandial distress syndrome is meal related dyspeptic symptoms characterized by post prandial fullness and early satiety. Epigastric pain syndrome is meal unrelated dyspeptic symptoms characterized by epigastric pain and burning.

Miasmatic approach of functional dyspepsia16,17
The symptoms of functional dyspepsia are functional and as such mainly psora. Pathological abnormalities and hyper activity/growth indicative of syphilitic and sycotic miasms often mingled with functional disturbances. These cases should be separately dealt as syphilitic or psychotic miasms, when the clinical presentation is more towards them. Dyspeptic and other gastric symptoms like fullness and distension of abdomen, rumbling and gurgling sound after eating; constrictive feeling around the abdomen; nausea and vomiting aggravated by any motion; pain aggravated in the morning and ameliorated by heat application; alternate constipation and diarrhoea should remind to psoric medicines.

General manifestations of psoric miasm
Basic qualities of psoric miasm include hypersensitiveness and hyperactiveness, emotional state, anxiety and restlessness. In psoric people symptoms can normally be triggered by suppression of emotions, grief and excitement. Fatigue, malaise and uneasiness may lead to vertigo, which can be aggravated by any motion. General modalities of psora are worse in the morning, new moon, before menses and odours and better by rest. Sour, sweet and bitter tastes in the mouth are especially in the morning. Yellow coating on tongue is one of the key symptoms in hepatic cases of psora. Craving for sour acids, sweets and pickles. One has to keep these in mind while taking the case. Other general symptoms like generalised itching and skin rashes, burning following itching and scratching, which aggravates at evening and midnight; dry, rough, dirty and unhealthy skin; amenorrhoea or bland/scanty/too-short menses, joint pains worse by motion and better by warmth and joint pain with constant feeling of coldness in the extremities are also indicative of psora.

General manifestations of syphilitic miasm
In syphilis, the changes would be from functional to structural disorders. Mentally they are dull, introvertic, slow in understanding, with suicidal thoughts, anxious and depression. The intensity of pain would be very high and intolerable. Complaints aggravate during and after rest, extremes of heat and cold, and at night; better by constant motion and cold application. There is always metallic or coppery taste in the mouth. Such inclination in functional dyspepsia indicates syphilitic miasm.

General manifestations of sycotic miasm
Slow recovery is the cardinal point. Sycotic people are suspicious and jealous. They quarrelsome, deceitful, cruel, cunning and have fixed ideas. They think suicide, but not daring to commit. General aggravating factors are damp weather, change of weather, daytime and meat. Feeling of weakness after sweating and other natural eliminations like stool and urine. Complaints generally relieved by slow motion, lying on abdomen, dry weather and return of suppressed normal discharges are normally found in sycotic miasm.

Commonly prescribed polychrests for functional dyspepsia and their grade of miasmatic affinity*
Ars alb – pso+++, syp+, syc+++; Bell – pso+;  Bry – syp++; Digit – pso++, syc+; Ferr m – pso++, syc++; Iod – pso+++, syp++, syc++; Kali c – pso++, syp++, syc++, Lach – pso+++, syp+++, syc++; Lyc – pso+++, syp++, syc+++; Merc s – pso++, syp+++, syc++, Nat m – pso+++, syc++; Nux v – pso++, syc+; Phos – pso++, syp++, syc++, Plum m – pso+, syp+; Puls – pso++, syc++; Rhus t – pso++, syc+, Sep – pso+++, syp+, syc+++; Sil – pso++, syp+, syc+++; Sulph – pso+++, syp++, syc++

*Note: +++ - More affinity, ++ - Moderate affinity, + - Less affinity

Specific drugs for functional dyspepsia and their indications18,19,20,21,22
Acidum sulphuricum
It covers epigastric pain and sour eructations and useful in cases of pains either violent and contractive, or are of a dull, heavy, aching character with pyrosis and flatulence. Loss of appetite and great debility are also covered.
Argentum nitricum
It covers retarded gastric pain and diarrhoea resulting from eating sweets in persons fond of sugar.  Associated stool symptoms like watery, noisy, flatulent, green with mucus or turning green after remaining on diaper in children are also covered.  Nausea and vomiting of glairy mucous are indicated by this drug. Acidity is associated in many cases.
Arsenicum album
It is useful in functional dyspepsia aggravated from vegetable diet like melons, watery fruits, acid fruits, ice cream and ice water, etc. Nausea, vomiting, faintness, icy coldness and great exhaustion are also indicated.  It covers diarrhoea after eating or drinking.  It is indicated for weakness in such cases. It is also a remedy for periodic burning pain in the stomach at night or midnight with nausea and vomiting.  Adynamia (lack of vital power), anxiety, thirst and restlessness are characteristic of the drug. Other indications include weakness, loss of weight, paleness, nausea, vomiting soon after any intake, heartburn and regurgitation of acid matter.  Dyspepsia from vinegar or acids, ice creams, tobacco.  Associated symptoms are great thirst, drinks much, gastritis, gastroenteritis, gastric ulcers etc., but in small quantities at a time.
Distended abdomen, spasmodic or colic pain worsened by pressure, improved by bending backwards, greenish stool and shuddering during stool.
Bismuthum subnitricum
It covers pressure and burning in the region of stomach. Also indicated for digestive dysfunctions like lost and diminished appetite, much thirst, eructation after drinking water, slow digestion, with frequent bitter eructations and feeling of discomfort in the stomach, vomitting with convulsive pain.  Water is vomited as soon as it reaches the stomach.
Capsicum annum
It covers symptoms like burning in the stomach after eating, great flatulence from vegetables, flatulent colic, atonic dyspepsia and painless rumbling in the abdomen. Also used in hyperacidity with reduced appetite, vomiting, much thirst, dyspepsia, and heartburn.  Pressure, pain in the pit of stomach with nausea are also covered by this medicine.
Carbo vegetabilis
Used in symptom of functional dyspepsia, lowered vital power from loss of fluids, state of collapse in cholera, frequent involuntary stools followed by burning, irritation after eating and drinking.  Simple food distresses, belching, flatulence and abdominal discomfort are effectively taken care by this.
More suitable for children who are irritable, frightful, impatient, hyper-sensitive, wants this or that and becomes angry when refused or when offered. Distension and flatulent colic which is improved by warmth.  Suits well in neuropathic or psychopathic children. Stool hot, green, watery, corroding and very offensive like rotten egg.  One cheek red and hot, the other pale and cold. 
Chelidonium majus
It is a liver remedy, covering many of the dyspeptic symptoms. It is indicated in jaundice, enlarged liver, gall colic, distension and sluggish bowels due to hepatic disease or bilious complications.
Cinchona officinalis: It covers flatulent colic, tympanitic abdomen, vomiting, slow digestion, stool frothy, yellow and painless.
Suitable for irritable persons who easily angered; epigastric pain causing patient bend double, sometimes with nausea and vomiting, sometimes with diarrhoea, sometimes with passing great quantities of gas; pains often extend into chest and pelvis; sensation as if stones were being ground together in the abdomen
Cuprum aceticum
It covers violent spasmodic pains in stomach and abdomen, vomiting, diarrhoea, slimy brown stool and violent tenesmus.
Dioscorea villosa
It is especially for colic, flatulence and problems of tea drinkers, improves digestion, used in painful affections of abdominal and pelvic viscera.
Foeniculum vulgare
A commonly used Indian household cookery, it allays griping pain and is carminative.  It helps digestion, lowers flatulence and colic.
It has a marked action on the liver, helps digestion smooth.
It acts on persistent nausea and vomiting, cutting pain around the naval, tenesmus and liver sore. This drug is well suited for children and sensitive adults.  The action of the drug on nerves, responsible for persistent nausea and vomiting.
Iris versicolor
It is indicated for violent burning like fire of whole alimentary canal, nausea and vomiting of watery and very acidic substance; heartburn and profuse flow of saliva, acidity makes the teeth blunt.  In some cases appetite is deficient. Stress and headache are aggravated in such cases.
Lycopodium clavatum
Meteoritic tenseness, lack of digestive power, often with functional disturbance of liver. Child weeps all day.  Excessive accumulation of flatulence; abdomen is bloated, full with rolling of flatulence.  Appetite good, eats more than the average, but does not put on weight.
Mentha piperita
Flatulent colic, bilious colic, deranged digestion, accumulation of gas, respiratory catarrh, dry and spasmodic cough.
Momordica balsamina
Distension and rubbing in splenic flexure of colon.  Griping, colicky pains, starting from the back, spreading over whole abdomen are covered by this drug.
Natrum phosphoricum
It acts in the conditions of sour eructations after eating, sour vomiting, dyspepsia from fatty food, heaviness and pressure in epigastrium, flatulence, rumbling, symptoms worse after eating.
Nux Vomica
It is said to be the drug for many conditions incident to modern life.  It has a calming effect on digestive, portal and hypochondrial spheres.  Headache, vertigo, nausea, vomiting abdominal colics and symptoms due to over exertion, are covered by this medicine.
It is a recently introduced remedy for indigestion as a consequence of food intolerance with gastro enteritis and food poisoning symptoms. It helps in the elimination of toxin. Dyspeptic and related symptoms like fullness of stomach with rumbling often accompanied by colic and/or diarrhoea, anorexia, flatulent dyspepsia, eructation, nausea, sometimes vomiting and vertigo occurs after changing diet are covered.
Considered to be useful in dyspeptic symptoms resulting from irritations involving the central nervous system and brain stem.  The drug is indicated for ailments aggravated from riding in cars, carriages, ship or air, fright and vexation.  Noise is unbearable; heartburn and nausea are other accompanying symptoms.
It is an established medicine for eructations, vomiting of food or blood that is temporarily ameliorated by ice-cold drinks, but returns as the stomach becomes warm. Dyspepsia with excessive flatulence and white tongue.
It is indicated for distended abdomen, feeling of heat and emptiness, sensation of weakness or sinking, painful liver region, jaundice, portal engorgement, gastro-enteritis-like symptoms.
Robinia pseudocacia
Helpful in conditions like constant eructations of a very sour fluid, heartburn and acidity especially at night, on lying down, distention of stomach and bowels, regurgitation of acid and bile, with a feeling that everything turns to acid. Gastric headache with acid vomiting, epigastric pain and retching are also covered by this medicine.
Indicated for epigastric pain, nausea, giddiness, pallor, vomiting, seasickness, prostration of entire muscular system, vertigo, sick headache and vomiting on least motion.  Pathogenesis covers migraine, neuralgias and gastrocardiac symptoms.
Tilia europaea
It covers bloated abdomen, pain around navel, flatulence, muscular pain and urticaria.

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Source: Dr. R. Valavan, Functional dyspepsia – its modern understanding and homoeopathic approach, Homoeopathy For All, Vol. 14 No. 03 (159) March 15 2013