GANGRENE 1 MIASMATIC STUDY 2 THERAPEUTICS'

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GANGRENE 1 MIASMATIC STUDY 2 THERAPEUTICS.

• DR AJEETA. M. PRABHU

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• Is death of a portion of the body with
  putrefaction. Not just necrosis or infarction but
  also infection with saprophytic putrefying
  bacteria
• TYPES
• Dry gangrene
• Wet gangrene
• Gas gangrene

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Causes of gangrene

• A. arterial occlusion
• Atherosclerosis a specific form of
  arteriosclerosis affecting primarily the intima
  of small and medium sized arteries characterized
  by fibro fatty plaques and atheromas
• Embolism process of partial or complete
  obstruction of some part of the cardiovascular
  system by any mass carried in circulation mainly
  embolus.
• Raynauds disease not a vasculitis but a
  functional vasospastic disorder affecting chiefly
  the small arteries and arterioles of extremities
  occuring in young healthy women affectinf fingers
  and hands clinically affected digit shows pallor
  cyanosis and redness

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• Beurgers diseasea specific disease entity
  affecting the small and medium sized arteries and
  veins of the extremities characterized by acute
  and chronic occlusive inflammatory involvement.
• Consistent association with heavy cigarette
  smoking..endothelial damage ,hypercoagulabity
  and thrombosis
• Cervical rib
• Syphilitic gangrene..endarteritis obliterans
  not a disease entity but a nonspecific
  inflammatory response of arteries and arterioles
  to a variety of irritants

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• B. VENOUS OBSTRUCTION
• Deep vein thrombosis
• C. NERVOUS DISEASE
• Syringomyelia- characterized by development of
  syrinx or tubular cavity in the spinal cord and
  medulla. Loss of pain and temperature in the
  affected region
• Tabes dorsalis- progressive degeneration of roots
  of the spinal nerves and the posterior columns of
  the spinal cord by spirochaetes--
• Peripheral neuritis
• Leprosy

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• D.Traumatic gangrene
• Direct injury to main artery
• Indirect injury crushing
• E. INFECTIVE GANGRENE
• Carbuncle
• Cancrum oris- NECROTISING STOMATITIS
• Gangrene of scrotum

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• F. DIABETIC GANGRENE
• ARTERIAL OCCLUSION
• PERIPHERAL NEURITIS
• INFECTION
• Simultaneously

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• G. MECHANICAL
• Heat- burns and scalds
• Cold- frostbites
• Eschartics .corrosive, acids and alkalis
• Electricity
• X-ray

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Dry gangrene

• Conditions which produce
• Senile gangrene
• Diabetic gangrene
• Buergers disease
• Raynauds disease
• Embolism
• Frostbite
• Injury to the vessel

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Arterial vessels Arthroscleroses
Ischemia Mitochondrial cell damage low ATP
Cell damage irreversible Coagulation
necrosis Degradation by enzymes
Acidosis Denaturation of protein of cytoplasm
Cell debris Infection
gradual
Decreased arterial blood supply Dilation of
arterial vessels Exudation of leucocytes Inflammat
ion Haemolysis of the blood corpuscles
Pain, swelling, tenderness Fever Dark red
induration Brawny oedema Friable skin Line of
demarcation
DRY GANGRENE Miasm --SYPHILITIC
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WET GANGRENE

• Conditions which give rise to
• Acute inflammation
• Long standing venous thrombosis
• Bed sores

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Arterial vessels Arthroscleroses
Ischemia Mitochondrial cell damage low ATP
Cell damage irreversible Coagulation
necrosis Degradation by enzymes
Acidosis Denaturation of protein of cytoplasm
Cell debris phagocytesd by
lysosomal enzymes superaded infection
hemolysis Nitrogenous products skatol indol and
H2s
RAPID
Pain, swelling, tenderness Fever Dark red
induration Brawny oedema COLD, PULSELESS,MOIST BUL
LAE, BLEBS OFFENSIVE DISCHARGES GRAVE
CONSTITUTIONAL SYMPTOMS Line of demarcation
(RARE)
Decreased arterial blood supply Dilation of
arterial vessels Exudation of leucocytes Inflammat
ion Haemolysis of the blood corpuscles by
bacteria
WET GANGRENE miasm --SYPHILITIC
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low ATP Cell damage
irreversible Coagulation necrosis
Degradation by enzymes
Acidosis Denaturation of protein of cytoplasm
Arterial vessels Artheroscleroses
Ischemia Mitochondrial cell damage Cell debris
Infection
Pain, swelling, FEVER SUBNORMAL Dark red
induration GROSS oedema Profuse foul
discharges Discolored skin crepitus Line of
demarcation Pulse rapid BP low
gradual
Decreased arterial blood supply Dilation of
arterial vessels Exudation of leucocytes Inflammat
ion Haemolysis of the blood corpuscles
GAS GANGRENE miasm --SYPHILITIC
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• THERAPEUTICS

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• ARSENICUM ALB.
• - Ulcers, look gangrenous.
• - Black nails.
• - Raynaud syndrome (1st remedy)..
• - Itching without eruption (Alum, Mez,
  Sulph).
• - Itching, must scratch until it bleed
• lt Cold.
• - lt 0-2 a.m..
• - Burning pains gt heat.
• Intense thirst for frequent sips

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• CARBO ANIMALIS
• - Malignant ulcers.
• - Blue. Venous plethora.
• - Cicatrices become painful. Depleted vital
  energy (all Carbo's).
• - MALIGNANCIES, CANCER,
• esp. stomach, uterus, glands,
• with BURNING pain.
• - lt Small vital losses. After shaving.
• - Susceptible to colds and easy sprains.
• - Induration lymphnodes, like rocks (Brom).
• - Coldness at night in bed 1st rem.

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• CARBO VEG.
• Blueness, sense of overfulness, ecchymoses,
• venous stasis,
• hemorrhages dark, oozing.
• FAINTING, COLLAPSE CHILLY, COLD PERSPIRATION,
• cold breath, from too much food, bloating, from
  pain.
• COLD, but want to be FANNED. Desire for OXYGEN.
• Complaints after severe acute illness or
  injury. Lack of reaction.
• Affects 1st stomach, 2nd circulation, 3rd
  respiration.

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• CROTALUS HORRIDUS
• EXTREMITIES
• - Blood oozing from finger nails.
• - Varicose veins.
• FEVER
• - Septic and zymotic fevers.
• PERSPIRATION
• - Bloody.
• SKIN
• - Mottled. Bluish spots. Jaundice.
• - Purpura. Ecchymosis.
• - Erysipelas.
• - Boils, carbuncles, surrounded by purplish
  skin.
• - Gangrene.
• - Network of blood vessels.

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• THROAT
• - Tonsils ooozing blood.
• - Gangrene.
• - Inflammation, lt left side (Lach).
• - Difficult swallowing of solids (Crot-c,
  Lach)
• - Intolerant of clothing.
• STOMACH
• - Bleeding. Vomiting of blood.

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• HEMORRHAGE FROM ANY ORIFICE.
• Passive, dark unclotted
  blood.
• In very sick, weakened
  persons with fever.
• - Sepsis.
• - lt Beginning of sleep sleep in general.
• - lt Right side.
• - Sudden weakness.
• - Ailments from apoplexy Convulsions,
  paralysis, aphasia, etc.
• - Varicosities. Of nose and face with
  bluish discoloration

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• LACHESIS
• SKIN
• - DISCOLORATION BLUISH, PURPLISH. Cyanosis.
  Ecchymosis.
• Purpura.
• - Oversensitive to touch, pressure.
• - Herpes zoster lt left side.
• - Gangrene. Dissecting wounds.
• EXTREMITIES
• - Varicose veins.
• Can't bear to have fingers touched each
  other, spreads them apart
• - Varicose veins, bluish purplish.

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• PHOSPHORUS
• HEMORRHAGES.
• Ecchymosis.
• - One-sided paralysis after apoplexy.
• - Burning pains. EXTREMITIES
• - Numbness hands and fingers, lt morning on
  waking.
• SKIN
• - ECCHYMOSIS
• OVERSENSITIVE TO EXTERNAL IMPRESSIONS

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• SECALE COR
• EXTREMITIES
• - CRAMPING AND TINGLING IN LEGS ON
  EXERTION.
• Claudication. Staggering gait.
• - FORMICATION AND NUMBNESS, lt calves, gt
  rubbing.
• Violent pain in finger-tips.
• - Jerks, convulsive movements lt night, gt
  stretching limb.
• - Icy coldness and cyanosis. Raynaud.
• - VARICOSITIES, lt heat, gt cold.
• - Heat of feet with UNCOVERING.
• SKIN
• - COLD TO TOUCH BUT AVERSION BEING COVERED.
• - GANGRENE, dry, black, lt distal parts.
• - Dry, shrivelled and numb.
• - FORMICATION.
• - Mottled dusky-BLUE. Ecchymosis.
• - Varicose ulcers. Ulcers black and
  burning, gt cold.

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• - lt HEAT
• - gt COLD APPLICATION, UNCOVERING.
• - gt COOL AIR, WANTS TO BE FANNED.
• - gt Being rubbed (Phos, Plat).
• - gt Stretching out limbs (Rhus-t).
• - lt Before and during menses.
• - BURNING PAIN gt COLD APPLICATION.
• - Hemorrhage PASSIVE, VENOUS, DARK OOZING
  BLOOD
• (Ham).
• - Ailments of excessive smokers.
• - Thin, scrawny, weak people with
  shrivelled skin.
• - Paralysis. Convulsions.

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• VIPERA
• Indicated in inflammation of veins with great
  swelling bursting sensation.
• Extremities.-
• Patient is obliged to keep the extremities
• elevated.
• When they are allowed to hang down, it seems as
  if they would burst, and the pain is unbearable.
  Diad.
• Varicose veins and acute phlebitis. Veins
  swollen, sensitive bursting pain.
• Severe cramps in lower extremities.
• Polyneuritis

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• Skin.
• -Livid. Skin peels in large plates.
• Lymphangioma,
• boils, carbuncles, with bursting sensation,
  relieved by elevating
• parts.

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• VERATRUM ALBUM
• EXTREMITIES
• - COLD. BLUE. Raynaud.
• - Blue nails.
• - Jerks, twitches. Cramps.
• - Rheumatic pain lt cold, wet weather,
  warmth of bed,
• gt walking up and do
• CHILLY. Internal coldness, as if ice-water in the
  veins.
• - lt COLD.
• - WEAKNESS. COLLAPSE WITH COLDNESS, COLD
  PERSPIRATION.

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• ANTHRACINUM
• BOILS ABSCESSES
• - BURNING,
• - large,
• - purple or almost black..
• - Septic fever with burning sensation (Ars,
  Pyrog).
• - gt Open air. DD Tarent smaller boils,
  less discoloration.
• Apis, Ars burning eruptions