Toxicological Materia Medica

1
Toxicological Materia Medica

• What is toxicological MM?
• What is the co-relation of toxicology with MM?
• What are its advantages and disadvantages?
• How does it help in understanding of MM?

2
Sources of Materia Medica

•  Physiological
• Relating the chief areas of drug-effects of many
  inorganic substances, (like the Natrums, Kalis
  and Calcareas) to the role played by their
  constituents in human physiology.
• Pharmacological
• Comprehend readily some of the Locations and
  types of changes induced by a drug like Nux
  vomica or Belladonna.

3
Sources of Materia Medica

• Chemical
• Group-characteristics can often be related to the
  common cation or to a dominant Anion, e.g. a
  Halogen.
• At times, a salt can be readily understood in
  terms of its constituent elements, like Ferrum
  phosphoricum.

4
Sources of Materia Medica

• Analogy (doctrine of signature)
• Relating some of the drug-effects to the
  characteristic of the substance or source or to
  its natural habitat. Examples - Snake venoms,
  Spider venoms, Sepia etc.
• Symbolism
• Linking the concepts of universal and human
  symbolism to materia medica by Jung, Whitmont
  etc.

5
Sources of Materia Medica

• Grouping
• Drugs could be conveniently grouped together for
  their similar effects or their opposite
  characteristics. The books on Homoeopathic
  Therapeutics illustrate the similar grouping
  differential study of repertorial analysis is
  another instance of such a study. Substances from
  a similar source tend to have similar effects.
• Remedy relationship
• One of the advanced methods of study of materia
  medica.
•  

6
Sources of Materia Medica

• Toxicological
• Furnishes information about the Locations,
  Pathological changes, Scope and Sphere of
  application and coarse indications. Examples
  Mercury, Phosphorus, Gelsemium.
• Render a general idea about the sphere of action
  which is mainly on CNS, CVS, extremities and
  skin. There are also subjective symptoms and
  change in behaviour after poisoning. The
  unnatural use of and ccidental overdosing produce
  many signs and symptoms.
• Hughes was an ardent follower of toxicological
  data.

7
Toxicology

• The branch of Medical science which deals with
• Reference to their sources
• Characters and properties
• The symptoms they produce
• The lethal dose
• The nature of fetal results
• The remedial measures which should be employed to
  combat their actions or effects
• The method of their detection and estimation and
• Autopsy findings

8
Poison

• A poison is commonly defined as a substance
  which, when administered, inhaled or swallowed,
  is capable of acting deleteriously on the body.
• In Law, the real difference between a medicine
  and a poison is in the intent with which it is
  given.
• If the substance is given with the intention to
  save life, it is a medicine but if it is given
  with the intention to cause bodily harm, it is
  a poison.

9
Classification of poisons

• According to mode of action
• Corrosive
• Irritant
• Neurotic
• Cardiac
• Asphyxiants
• Miscellaneous

10
Corrosive Poison Group

• Property to corrode.
• Affinity towards water
• and tissue fluid.
• Produces actual ulceration and destruction of the
  tissue.
• Consists of strong acids and strong alkalis.

11
The Corrosive group includes

• Mineral acids Sulphuric acid (Sul-ac), Nitric
  acid (Nit-ac), Hydrochloric acid(Mur-ac).
• Organic acids Oxalic acid(Ox-ac), Carbolic acid
  or phenol (Carb-ac), Acetic acid(Acet-ac),
  Salicylic acid (sal-ac).
• Vegetable acid Hydrochloric acid(hydr-ac).
• Concentrated alkalis Caustic soda (Nat-caust),
  Caustic potash (Caust), carbonates of ammonium
  (Am-c), carbonates of sodium (nat-c), carbonates
• of potassium (kali-c).
•  

12
The Group of Irritants

•  
• While corrosives lead to destruction,
• irritants lead to severe irritation.
• Both local and remote action. Remote action may
  progress to systemic effects. Produce symptoms
  of pain in the abdomen, vomiting and purging.
• Post-mortem appearances Redness
• or ulceration of GIT.
• The group consists of inorganic, organic and
  mechanical substances.

13
Inorganic sub-group

• Non-metallic poisons Phosphorus (phos),
  Chlorine (Murates), Bromine (Bromium), Iodine
  (Iod),Boron (Bor-ac, Bor-met).
• Metallic poisons Arsenic (Ars), Antimony
  (Antimoniums), Mercury(Merc), Lead(Plb),
  Copper(Cupr),Thallium(Thal), Zinc (Zinc),
  Barium (Barytas), Radioactive Substances
  (Thorium, Uranium, Radium).

14
Organic sub-group

• Vegetable poisons
• Castor oil seeds (Ricinus communis), Croton oil
  (Crot-t), Abrus precatorius (Abr) Colocynth
  (Colo), Ergot (Ergotium), Capsicum (Caps),
  Marking nut(Anac), Aloes (Aloe).

15
Organic sub-group

• Animal poisons
• Cantharides (Canth)
• Snakes (Ophidia)
• Scorpions (Scorp)
• Spiders (Spiders)
• Poisonous Insects(Insects)

16
Mechanical sub-group

• Chopped hair
• Powdered glass
• Dried spong
• Diamond dust (Diamond)

17
Neurotic Poisons

• Act directly on nervous system, though some have
  local irritant action.
• Act after absorption even after greatly diluted
  in water. All alkaloidal poisons fall into this
  group.
• Symptoms-Headache, Drowsiness, Giddiness, Stupor,
  Convulsions, Paralysis.
•  

18
Classification of poisons according to affinity

• Spinal Action on spinal cord.
• Examples Nux-vomica (Nux-v), and its
  alkaloids, and Gelsemium (Gel).
• Peripheral Poisons acting on peripheral
  nerves. Examples Curare (Cur), Coniun (Con)
• Cardiac Acting on heart like Digitalis(Dig),
  Oleander (Olnd), Aconite(Acon), Tobacco (Tab).
• Asphyxiants Acting on lungs. Coal gas, Carbon
  monoxide, Carbon dioxide, Sewer Gas.

19
Classification of poisons according to affinity

• Cerebral action Inebriant. Deliriant,
  Somniferous.
• Somniferous poisons Opium and its alkaloids.
• Inebriant poisons Alcohol, Anesthetics,
  Sedatives and hypnotics, Chloral hydrate
  (Chlorolum hydratum), Fuels Petroleum(Petr),
  Kerosene (Kerosolenum), Naphtha (Napthalinum),
  Insecticides (organophosphorus compounds like
  Tik-20, chloro compounds like DDT and endrin,
  coal-tar.
• Deliriant poisons Dhatura (Stram), Belladonna
  (Bell), Hyoscyamus (Hyos), Cannabis(Cann-i),
  Cocaine (Cocainum-hydrochloricum)

20
Miscellaneous

• Poisons having widely different actions are put
  together in this group
• Examples
• Analgesics
• Antipyretics
• Antihistaminics
• Tranquillizers
• Reserpine
• Antidepressants
• Stimulants
• Hallucinogens such as LSD

21
Toxicology Homoeopathic MM
One of the chief sources of MM is from
toxicological source either accidental or
deliberate. The pathogenetic action of a remedy
is evident from its action at tissue level, apart
from its action on the mind.
22
Copper toxicology

• Copper in human body
• The human body contains about 0.2-0.3 gm.
• Unevenly distributed through the organism
• ( parts per million)

23
Copper toxicology

• Copper is richest in liver, esp. in fetal
  liver.
• In brain richest part is substantia nigra (black
  substance in a section of the crus cerebri),
• which has melanin containing new
  cells.
• Copper is necessary for the formation of blood.

24
Toxicological symptoms
Copper

• Serum copper-abnormally high in schizophrenia,
  manic depressive insanity and epilepsy.
• Copper workers are said to have shown special
  resistance in cholera epidemics, seldom
  succumbing to this disease.

25
Toxicological symptoms
Copper

• Regular consumption of small doses of
  copper salt over a prolonged period -
  copper equilibrium.
• Hugo Scultz describes
• Psychic symptoms arise, such as
  melancholic depression, fright, fear of death,
  weakness of memory, inability to retain thoughts.
  

26
Copper
Toxicological symptoms

• Other symptoms - dizziness, heaviness, rush of
  blood to the head affection of
  consciousness bearing factors.
• The pulse - accelerated, hard, and short
  circulation affection. Chills run through the
  entire body, the warmth organization is upset.
• The lungs - full of blood. Pressure
  tension, shortness of breath is
  experienced.

27
Copper
Toxicological symptoms

• Digestive system
• The pharynx constricted, swallowing
  difficult, nausea, gastric catarrh and
  vomiting. Constipation followed by
  diarrhoea. Stools watery, brownish. The
  liver area painful. Urinary frequency with
  small voiding. Inky urine.

28
Co-relation with Materia Medica

• Spasmodic affections, cramps, convulsions. Tonic
  and clonic spasms. Jerking.
• Blueness. Collapse. Paralysis of isolated
  muscles.
• Fearful. Fear of company, of death. Attacks of
  rage wants to bite bystanders. Mania in attacks.
  Ridiculous or foolish gestures.
• Nausea. Violent vomiting. Loss of appetite.
  Colic, violent and intermittent.

29
Toxicological symptoms of Cu

• Blue lines on the gums.
• Inability to control the metabolic
  process eczema.
• Muscular spasms and painful contractions
  effects on the
• limb system.

30
Air Pollution

• A mixture of solid particles and gases in the
  air.
• Car emissions, chemicals from factories, dust,
  pollen and mold spores. Ozone, a gas, is a major
  part of air pollution in cities. When ozone forms
  air pollution, it's also called smog.
• Known or suspected to cause cancer or other
  serious health effects, such as reproductive
  effects or birth defects, or adverse
  environmental effects.

31
Examples of toxic air pollutants

• Benzene, which is found in gasoline
  perchlorethlyene, which is emitted from some dry
  cleaning factories, methylene chloride, which is
  used as a solvent and paint stripper by a number
  of industries.
• Also dioxin, asbestos, toluene, and metals such
  as cadmium, mercury, chromium and lead compounds.
•  

32
Repertorial study

•  
• Air pollution ailments from
• Ars, Berrylium, Carbo-veg, Silicea, Sulphuric
  acid.
• Carbon gas poisoning
• Acon, Am-c, Bell, Bry, Carb-v, Lach, Opium,
  Phos.

33

• Comparison of semicarpus poison and
• anacardium remedy.

34

• Comparison of semicarpus poison and
• anacardium remedy.

35
Arsenic poisoning

•   Acute poisoning
• Nausea, burning in stomach, lt pressure.
• Then severe, continuous and persistent retching
  and vomiting,.
• Vomiting first of stomach contents, then blackish
  or greenish and finally of mucus mixed with
  altered blood in varying quantity. Diarrhoea
  accompanied by tenesmus.
• The stool is tinged with blood, watery like the
  rice water stool of cholera, and shreds of mucus
  membrane and fragments of the poison even in
  three or four hours.

36
Arsenic poisoning

• Acute poisoning
• Intense thirst-a constant feature but drinking
  water accentuates the vomiting.
• Painful cramps in the legs, urine suppressed,
  collapse with cold clammy skin, pale anxious
  face, sunken eyes, dilated pupils, rapid feeble
  pulse and sighing respiration.
• Sometimes symptoms of acerebro-spinal type with
  features of narcotic poisoning, such as vertigo,
  headache, spasms, followed by stupor and profound
  depression of circulation.

37
Arsenic poisoning

• Chronic poisoning 
• 1st stage of nutritional gastro-intestinal
  disturbances - Gradual loss of weight, with
  physical and mental fatigue, loss of appetite,
  nausea and intermittent attacks of vomiting and
  diarrhoea.
• Second stage of catarrhal changes - Common cold
  with running of the nose and sense of fullness in
  the head, mucus membranes are inflamed,
  conjunctivitis, running of the eyes, coughing,
  hoarseness of voice and bronchial catarrh.

38
Arsenic poisoning

• Third stage of skin rashes Irritation of the
  skin, with vesicular eruption.
• Fourth stage of long exposurePatchy brown
  pigmentation of skin called rain drop type
  pigmentation.
• Hyperkeratosis of palms and soles
• follow. There may be falling out of hair and
  brittleness of nails.
• Other symptoms Headache, drowsiness and
  impairment of vision and mental activity.

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40
Mercury

•  
• The taste - metallic, with constriction in
  throat, burning from mouth to stomach and pain
  radiating to abdomen.
• The mouth, tongue and fauces corroded. Mucous
  membranes - grayish white.
• Nausea with frequent vomiting of long stringy
  masses of white mucus, mixed with blood, followed
  by profuse urging, often bloody with painful
  tenesmus.
• Collapse with cold clammy skin, pale, anxious
  face, sunken eyes, dilated pupils, rapid feeble
  pulse and sighing respiration.

Acute Poisoning
41
Mercury
Acute Poisoning

• Syncope, convulsion and general insensibility
  precede death which may take place in a few
  hours.
• If death is not rapid, salivation may develop.
• The gums swollen and inflamed and breath foul.
  Loosening of teeth.
• Renal lesion- nephrotoxicity of mercury. Urine
  contains albumin and blood. The output diminishes
  or stops and death ensues from uremia.
•  

42
Post- mortem appearance
Mercury

• Tongue white and sodden
• Mouth diffuse grayish white escharotics
  appearance (eschar means hard crust over a raw
  surface)
• Oesophagus- MM corroded and corrugated
• Stomach MM corroded, inflamed in patches and
  covered with grayish deposit of mercury. Areas of
  extravasated blood beneath it.

43
Mercury
Post- mortem appearance

• Small intestine- congestion
• Caecum and large intestine intense inflammation,
  ulceration and even gangrene.
• Kidneys toxic nephritis.
• Liver and heart- fatty degeneration of heart and
  subendocardial hemorrhages also.
•  

44
Mercury
Chronic poisoning

• Excessive salivation with metallic test in mouth,
  loosing of teeth with painful inflamed gums, and
  occasionally a blue-black line on gums.
• Irritation of skin penetrating ulcers on or near
  finger nails and knuckles.
• Nephritic, renal insufficiency uremia.
• Abortion is common.
• Discoloration of the capsule of the lens of the
  eye. 

45
Action on CNS and Mind
Mercury

• Action on tremors and mental symptoms known as
  erethism.
• Tremor is known as the HATTERS SHAKE because it
  is common in workers of that industry. It affects
  the hands, arms, tongue and later the legs.
• Exaggerated by voluntary efforts such as writing,
  speaking or eating and is absent during sleep.
  The tremor can be detected early in the writing
  of the patient and then from his stammering
  speech.

46
Mercury
Action on CNS and Mind

• Erethism is a peculiar disturbance of the
  personality characterized by shyness,
  irritability, tremors, loss of memory and
  insomnia.
• Hallucinations and delusions occasionally
  supervene and may lead to mental changes or
  insanity.
•  

47
Correlation with Materia Medica
Mercurius from Herings Guiding Symptoms

• Mind
• Memory weak, forgets everything. Intellect very
  weak shows every mark of imbecility.
• Imbecility foolish, mischievous, disgusting
  actions. Delirium and mental derangement of
  drunkards. Almost uncontrollable desire to travel
  far away.
• Desire to flee, with nightly anxiety and
  apprehension. Desire to kill the person
  contradicting her.
• Continuous moaning and groaning.
• Hurried and rapid talking.

48
Correlation with Materia Medica
Mercurius from Herings Guiding Symptoms of our
MM

• Mind
• Great desire to murder or commit suicide,
  particularly during menstrual period
  despondency involuntary crying great
  indifference is fearful that she may commit some
  wrong and kill herself something urges her to
  kill her husband, of whom she is very fond, and
  she implores him to hide his razor.
• Excited, lively everything is done hastily.
  Morose and mistrustful treated his associates
  almost insultingly, looked upon every one as his
  worst enemy.

49
Correlation with Materia Medica
Mercurius from Herings Guiding Symptoms

• Mind
• Great restlessness must constantly change her
  place fear, with desire to escape, as if she had
  committed some crime. Hysteria.
• A universal uneasiness of body, so that he could
  not remain one moment in the same posture.
• Bad effects from fright, leaving one in a state
  of great anxiety, agg. at night.
• Ailments from mortification from insults from
  egotism.
•  

50
Correlation with Materia Medica
Mercurius from Herings Guiding Symptoms

• Physical  
• FacePale, anxious face, sunken eyes. Pupils
  dilated.
• Tongue- Metallic test in mouth. White, sodden.
• Throat- Burning pain throat, radiating to
  stomach.

51
Correlation with Materia Medica
Mercurius from Herings Guiding Symptoms

• Physical
• Mouth- Mucus membrane, mouth, tongue become
  corroded. Grayish, salivation increased.
  Escharotic appearance.
• StomachNausea with frequent vomiting. Vomitus
  slimy, white, mucus , bilious
• Mucus membrane corroded
• Intestines feel bruised
• Teeth looseness of teethes especially molars
  with painful inflamed gums.

52
Correlation with Materia Medica
Mercurius from Herings Guiding Symptoms

• Physical
• Skin Irritation, itching here and there.
  Ulceration in fingers, nails and knuckles.
• Kidney Nephritis, renal insufficiency may
  progress to uremia.
• Pregnancy abortion are common.
• Eyes (mercuria lentis)bluish discoloration of
  lens (seen through slit lamp).
• Metals Erethism

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55
Case 1

• Name - Mr. MAK
• Age 23 years
• Sex- Male
• C/o Fever since Last 3 days.
• H/o- Patient had history of eating fish before 3
  days. Then he developed fever, suddenly, with
  profuse sweating, without any relief. Fever used
  to lt at night. Many remedies were tried on
  symptoms indications without benefit.

56
Case 1

• Vital data
• Temperature-1020 F
• Pulse rate-120/min
• Modalities- Chilliness lt night
• Offensive odour from the mouth

57
Case 1

• Rubrics
• Fever with Chills
• Fish aggravation
• Sweating profuse with no relief
• Fever aggravation at night
• Filter
• Ars 9/4, Sep 9/4, Pul 8/4, Kali-c 6/5, Carb-v
  5/4, Thuj 4/4, Merc 9/3, Sulph 8/3
• Cham 7/3, Bell 6/3
• Treatment
• Merc sol 1M, 4 hourly

58
Co-relation of toxicity of Hg

• In the general population, the main source of
  mercury poisoning is the ingestion of mercury-
  contaminated food, usually fish.
• Acute mercury exposure can cause headaches,
  salivation, a metallic taste in the mouth,
  chills, cough, fever tremors, abdominal cramps,
  diarrhea, nausea, vomiting, chest tightness,
  difficulty breathing, fatigue and/or lung
  irritation.

59
Case 2

• Name-Master T. P. D.
• Age- 5 years.
• Epileptic attacks since a year. A known case of
  mental retardation.
• Epileptic attacks, every month. Attacks of tonic
  and clonic type, lt Morning 3, lt 5 am to 6am3.
• Concomitants- Restlessness.
• Thermal State- Ambithermal
• Desires- Salt 4, Pungent 3.
• Stools-Involuntary. Cant understand the urge of
  stool.

60
Case 2

• Mind-
• Obstinate. Cries very loudly when the things are
  not given to him. Never sits quietly, very
  restless. Destructive by nature. He throws the
  things. He tears the clothes and papers. He likes
  to make noises.
• Likes to listen to the songs and likes to dance
  when the music begins. Mischievous by nature.
  First he comes very quietly, and then he bites
  and goes away.

61
Case 2

• Mind-
• He is also very angry by nature. When angry, he
  strikes his head on wall. Shouts and screams. He
  bites others and cries loudly.
• He desires to travel by vehicle only and vehicle
  must be speedy. He cant understand the boards
  and words on the roads. He is in his absorbed
  state of mind. He cant do daily activities of
  his own.

62
Case 2

• Rubrics
• Epilepsy
• Morning aggravation
• Restlessness
• Desire for Salt
• Desire Pungent
• Temper tantrum
• Desire for travelling
• Desire for biting the cloths

63
Case 2

• Rubrics
• Convulsions, children in
• Desire salt, pungent
• Temper tantrum
• Bite, desire to
• Desire to dance
• Desire to travel fast
• Filter
• Calc-11/5, Calc-p 11/5, Sulph11/5, Tub11/5,
• Phos10/5, Carc 9/5, Nit-ac 9/5, Verata 9/5,
• Nat-m 11/4, Chin9/4, Tarent-h-5/3
•  

64
Case 2

• Final Remedy
• 19-6-06 - Tarentula-hispanica 1M a single dose
• Follow-up has been continued since then and no
  episode of convulsions has occurred. Patient has
  improved mentally too.

65
Relevant information
Case 2

• The implication of neuroligins in cognitive
  disorders such as autism and mental retardation.
• Neuroligins (NL1NL4) are postsynaptic proteins
  containing an extracellular cholinesterase
  domain.
• They participate in intercellular junctions in
  which ß-neurexins tightly bind to a second class
  of neuronal cell-surface receptors called
  neuroligins.

66
Case 2
Relevant information

• a-Latrotoxin, a potent neurotoxin from black
  widow spider venom, triggers synaptic vesicle
  exocytosis from presynaptic nerve terminals.
• Neurexin I is a major Latrotoxin receptor that
  cooperates in Latrotoxin action.
• Latrotoxin is a potent neurotoxin from black
  widow spider venom that binds to presynaptic
  receptors and causes massive neurotransmitter
  release.

67
Relevant information
Case 2

• The European wolf spider, Lycosa tarentula, said
  to have caused the historical phenomenon of
  'tarantism', is the official medicinal source of
  the homeopathic remedy Tarentula hispanica. Yet,
  scientific evidence links the spider's venomous
  effects with mild necrotic and minor systemic
  effects that contrast with the proving symptoms
  of Tarentula hispanica which show a cerebral and
  neural component.
•  

68
Toxicological MM

•  
• Spider poisoning
• The venom is secreted from glands present in
  chelicerae or fangs of spiders.
• These venoms are different in different species.
• The higher potencies of spider remedies are
  prepared not from spider poisons but from living
  spiders put in alcohol.

69
Toxicological MM

• Spider poisoning
• Symptoms recorded during the proving are
  collected after actual experimentation on
  human beings under certain controlled
  conditions.
• Remedies belonging to different species
  of spiders have a closely related
  symptom picture.

70
Toxicological MM

•  
• Spider poisoning
• Dr.Boger (1926) described 15 cases of
  Arachinidism treated at Los Angeles general
  hospital. 
• Important symptoms
• In 50 of cases, the reaction at the sight
  of inoculation- a red spot, fluid filled
  vesicle and
• swelling. Severe pain and burning sensation.
  Intense pain in extremities, lumbar region and
  severe backache.

71
Toxicological MM

• Spider poisoning
• In 70 of cases, increased arterial
  pressure.
• Cutaneous and mucosal finding-roseolous
  vesicular papule, pustular rashes on chest,
  abdomen and neck, with intense itching.
• GIT findings- acute abdominal pain with
  rigidity.
• Urinary findings- moderate albuminuria
• and hematuria.

72
Spider poisoning

• Spider poisoning
• CNS findings Frequent psycho-motor excitation,
  occasional delirium, rarely meningeal symptoms
  with contraction of extremities, paralysis
  of facial nerve and widening of pupils.
• Blood findings Moderate leukocytosis with raised
  ESR, increased neutrophil count.
• Involuntary jerking lt any exertion e.g. writing,
  speaking or eating and gtsleep.
• Sleep insomnia sleepless at night.
•  

73
Case 3

• Name Master G.M.T.
• Age -2 yrs
• Complaints- Muscular dystrophy ( Duchene
  amyotrophia)
• Muscular weakness , unsteady gait.
• Skin Atopic dermatitis since 1 ½ yrs
• Dryness. Redness of skin crust formation.
  Terrible itching. lt touching. lt fish3
• Concomitants Irritability, restlessness.

74
Case 3

• Perspiration- On scalp- Profuse
• Thermal state- Hot patient C2H3
• Stool- Dry hard like balls. Straining3
• Pyelonephritis at the age of 6 months
• Enteritis- at the age of 10 months
• Tonsillitis at the age of 1 ½ year.
• Family History-
• MGF- Dermatitis, Asthma, Heart attack.
• PGF- Rheumatism, Cancer, Down Syndrome.
• Father- Chronic rhinitis. Myocarditis.
• Cousin Epilepsy.

75
Details of the case
Case 3

• He likes to play but plays alone. He cant speak
  a simple sentence. Speech delayed. While
  playing, he speaks in his own language, esp.
  when he is in good mood. Sometimes likes dancing
  but doesnt like high volume. He is not
  quarrelsome at all.
• He is soft, calm and yielding. He is not
  obstinate and most of time, he obeys what has
  been told to him. He is happy with us (parents
  say). He likes company.
• He has fears of loud noise and thunderstorm.

76
Details of the case
Case 3

• When anybody meats him for the 1st time, he tries
  to hide himself, but then he is comfortable.
• When mother is crying he tries to console her. He
  has interest in technical things.
• He has no interest in household routine items.
  He wants everything standard.
• He is fond of car and loves to go by car. He
  loves new toys. He feels no interest in usual
  plays. He gets tired suddenly. Wants everything
  new and standard

77
Rubrics
Case 3

• YIELDING
• Fish lt
• Itching lt Warmth in general
• Appetite, increased
• Atrophy
• Thirstlessness

78
Result
Case 3

• Puls11/5
• Lyco 8/4
• Phos 7/4
• Ars 6/4
• Ign 5/4
• Staph 6/3
• China 5/5

• Sep 5/3
• Arg-n 4/3
• Kali-c4/3
• Led4/3
• Nat-m4/3
• Nux-v4/3
• Carc 3/3
• Plb-5/2

79
Case 3

• Final remedy-
• 13/8/07- 1st prescription - Plumbum-met 0/1
• 7/9/07- The skin is clear than before. Physically
  become more active.
• - Plumbum-met 0/1 daily one dose
• 8/1/08 - Active but irritable too. Skin is again
  with new set of eruptions.
• - Plumbum-met 0/2 daily one dose

80
Discussion-
Case 3

• The spinal muscular atrophies are a group of
  genetically determined disorders characterized by
  degeneration of the anterior horn cells of the
  spinal cord, that usually manifest as proximal
  muscle weakness and wasting.
• Predominantly distal involvement in patients
  without demonstrable neuropathy is, however,
  uncommon. Since the first report of distal spinal
  muscular atrophy localised to upper extremity by
  Hirayama, et al. in 1959, many patients have been
  reported in the literature mainly from Asia, with
  more than 300 from Japan.

81
Discussion-
Case 3

• Although there have been quite a few reports from
  India describing adolescent and adults with this
  condition, we herein describe what is to our
  knowledge the youngest case reported with this
  condition.
• Associated high serum lead level was an
  interesting and unique feature.

82
Case 4

• Miss. S. T. Age 21 years
• Complaints-constant urge for urination, since
  puberty. She is a known case of mental
  retardation.
• Urging every 15 to 20 minutes, both day and night
  ? cant control? bedwetting. Offensive urine.
• Concomitants restless, irritability, weakness.
• Eructations, lt after overeating
• Desire- highly seasoned4, pungent4, Hot milk4,
  ice creams4
• Past history - asthma, vaccinations - all given
• Family history- PGF and PGM- diabetes mellitus

83
Case 4

• Mind
• She likes to put every thing in her mouth.
  Throughout the day she would bite garments and
  she becomes irritable when not allowed to pick up
  garments. She doesnt obey anyones order.
  Behaves obstinately if anyone disturbs her and
  she becomes violent.
• Talks arrogantly if someone scolds her if she is
  biting the garments. Weeps easily, and lt by
  contradiction. She is domineering too.

84
Case 4

• Rubrics
• DISOBEDIENCE
• Anger
• Domineering
• Contradiction lt
• Obstinate
• Irritable
• Bites Cloths and garments
•  

85
Result
Case 4

• Lyco 15/6
• Nux-v 15/6
• Cham 13/6
• Merc 12/6
• Chin 11/6
• Phos 9/6
• Am-c 7/6

• ARN 7/6
• Anac 13/6
• Staph 12/5
• Aur 11/5
• Chin 11/5
• Plb3/3

86
Treatment
Case 4

• Plumbum met 1M single dose 14/11/07

• 21/11/07- c/o biting the clothes and garments
  reduced up to 90.
• Bed-wetting frequency reduced, not daily now.
  However, it has not stopped completely.
• Obstinacy slightly less. Listens to others. Does
  some household work.
• Follow-up still continued.

87
Case-5

• Mr.BGK. Age 53.
• A known case of HTN since 9 years.
• Cramping and throbbing pain in lower
  extremities since 9 months, more on left side.
  It evolved from left ? right.
• lt standing, raising the leg, hanging, warm
  application, day.
• gt pressure, night.

88
Case-5

• Ulcer
• Size-2/2 cm, pain-aching type, round and flat.
• Modalities-
• A/f Mosquito bite, lt cold application,
• warm application, Day time, afternoon 2pm.

89
Case-5

• Mind
• Desire to be active always.
• Investigations
• Atheromatous abdominal saorta with significant
  narrowing at bifurcation. Almost no flow seen in
  infrarenal portion of aorta. Collateral flow
  noted in lower limb arteries.
• Addictions Tobacco smoking since age of 8 years.
  

90
Case-5

• Past history
• Operated for cataract, first left and then
• right.
• Personal History -
• Appearance- Short statured.
• Perspiration - Odour
• Thermal - Ambithermal Hot.
•  

91
Case-5

• Rubrics
• Ulcer on leg
• Atherosclerosis
• Desire Pungent
• Desire Tobacco Smoking
• Tobacco Abuse
• Activity desire
• Indifference

92
Case-5

• Rubrics
• Aversion to Cabbage
• Sides Left then Right
• Ulcer pain Heat aggravation
• Aggravation Daytime in general
• Leg pain aggravation by warm
• Leg pain aggravated by pressure
• Amelioration Night in general
•  

93
Case-5

• Result
• Ars 23/13 Puls 18/10 Sep19/9 Lach 17/9
• Calc 16/9 Chin 16/9 Lyco 15/8
• Nux-v 14/8 Phos 13/8 Sul 18/7
• Nit-ac 13/7
•  

94
Repertory Rubrics for Toxicology

• Aluminium poisoning
• alum, bry , plb.
• cadm-m, cadm-s, camph, cham, ip, puls.
• Antibiotics
• ars, carb-veg, chin, lyc, nat-p, thuj.
• Arsenic poisoning
• HEP
• ars-alb ,carb-v, ferr, ip, merc, phos, verat.
• camph, chin, chin-s, dig, euph, graph, iod,
  lach, nux-m, nux-v, plb, samb, sulph, tab, thuj.
•  
•  

95
Repertory Rubrics for Toxicology

• Chemotherapy treatment
• CADM-S.
• ip.
• ars, carb-veg, chin, nux-v.
• Coal gas ailments from
• carb-s ,o p.
• acet-ac, am-c, arn, bell, bor, bov, carb-v, coff,
  ip ,lach, phos, sec.
•  

96
Repertory Rubrics for Toxicology

• Copper fumes agg
• ip , merc, puls.
• camph, lyc, nux-v, op.
• Copper vessel agg
• Hep.
• Digitalis abuse
• adon, apoc, chin, crat, dig, nit-ac.
• Iodine poisoning or abuse
• ars, conv, hep, iod ,op, phos, sec.
• ant-c, ant-t , bell, camph, chin, chin-s,
  coff, hydr, lycps, merc, spong, sulph.
•  

97
Repertory Rubrics for Toxicology

• Iron poisoning or abuse
• chin, ferr, ferr-ph, hep, puls, sulph, zinc.
• ars, calc-ph, iod, ip, merc, nat-m, thea, verat.
• Lead poisoning
• ALUM, CAUST, PLB, TUB.
• alumn , bell, colo, kali-i, nat-s, plat, sul-ac,
  sulph, ter, verat.
• alum-sil, ant-c, ars, carb-s, chin, cocc, crot-t,
  cupr, gels, hep, iod, kali-br, kreos, lyc, mang,
  merc, nux-v, op, petr, uran, zinc

98
Repertory Rubrics for Toxicology

• Chronic effect
• ALUM, CAUST, PLB.
• alumn, bella, colo, kali-i , nat-s, op, plat,
  sul-ac, sulph.
• alum-sil, ant-c, ars, carb-s, chin, cocc,
  crot-t, cupr, gels, hep, iod, kali-br, kreos,
  lyc, mang, merc, nux-v, petr, zinc.
• Paralysis from
• alumn, ars , op, plat ,plb ,sul-ac.
• alum, caust, cupr, kali-i, nux-v, pipe.
•  

99
Repertory Rubrics for Toxicology

• Mercury poisoning or abuse-
• AUR, CARB-V, HEP, KALI-I, LACH, MERC, NAT-S,
  NIT-AC, PHYTO, STAPH, SULPH
• arg-met, asaf, bell, bor, calc, chel, chin, clem,
  colch, cupr, euph, guai, hydr, iod ,kali-chl,
  led, lyc, mur-ac ,ph-ac ,puls, sars ,sil.

100
Repertory Rubrics for Toxicology

• Mercury poisoning or abuse
• acon, agn, alumn, anan, ang, arn, ars, aur,
  aur-sul, calad, calo, camph, carbo-an, caust,
  cic, cina, cocc, coff, con, dig, dulc, euph,
  ferr, fl-ac, graph, iris, Kali-bi, laur, lycps,
  merc-i-r, nux-v, op, plat, plat-m, rheum, rhod,
  rhus-g, rhus-tox, sabad, sel ,sep, spong, still,
  stram, stront-c, sul-i, valer, verat, viol-t,
  zinc
• Mushrooms poisoning from
• Absin ,ars, bella, astro, camph
• Agar, pyro.

101
Repertory Rubrics for Toxicology

• Narcotics abuse
• AVEN, BELLA, CHAM, COFF, LACH, NUX-V.
• Camph , dig, graph, iod ,ip, lyc, op, puls, sep,
  valer.
• acet-ac, agar, am-c, apom, ars, aur, bry, calc,
  cann-i, canth, carb-v, caust, chin, cic, cimic,
  colch, croc, cupr, dulc, euph, hep, ign,
  kali-per, lob, macro, mag-s, merc, mosch, mur-ac,
  nat-c, nat-m, nat-ph, nit-ac, nux-m, ox-ac, ozon,
  passi, ph-ac, phos, plat, plb, rhus-tox, seneg,
  staph, sulph, thuja, verat, zinc.

102
Repertory Rubrics for Toxicology

• Ptomain poisoning ailments from-
• ars, cupr-ar ,pyro, verat.
• absin, acet-ac, all-c, camph, carbo-an, carb-v,
  crot-h, gunp, kreos, lach, puls, urt-u.
• Purgatives abuse
• NUX-V.
• lyc.
• aloe, chin, hydr, op, sulph.

103
Repertory Rubrics for Toxicology

• Radiation sickness for side effects
• CAD-S, SOL.
• ip.
• ars, calc-f, chin, fl-ac, nux-v, phos, rad-br,
  x-ray.
• Silica poisoning silicosis
• CALC, FL-AC, SIL.
• lyc, puls.
• agar-t , ars, brom, camph, hep, ictod, ip, mag-m,
  merc, nat-c, nat-a, nit-ac, penic, ph-ac, sulph.

104
Repertory Rubrics for Toxicology

• Tea abuse
• chin, dios.
• abis-n, ferr, puls, thuj.
• Tobacco ailments from
• CALAD,NUX-V.
• ars, ip, lach, lyc, nicot, phos, plan, thuj.
• abis-n, arg-n, chin-ar, coca, con, lob, scut,
  sep, spig, staph, stroph, verat.
•