AUTOIMMUNE DISORDERS

Classification :
 Organ specific autoimmune diseases
 Non-Organ specific autoimmune dise

Organ-specific autoimmune diseases :

Disease where the autoantibodies are directed against a single organ
with clinical disease localized to the some organ.

Non-Organ specific diseases :

Multiple organs are involved in the presence of a large varity of auto
antibodies directed again of subcellular structure or molecules
Non-organ specific diseases :
1) Systemic lupus erythematosus

Organon specific disease :

1) Hashimotos thyroiditis
2) Primery myxoderna
3) Thyrotoxicosis
4) Pernicious anaemia
5) Autoimmune atrophic gastritis
6) Addisons disease
7) Premature menopause
8) Insulin dependent diabetes mellitus
9) Goodpastures syndrome
 10) Myasthenia graviss
11) Male infertility
12) Pemphigus vulgoris
13) Pemphigoid
14) Sympathatic opthalmia
15) Phacogenic uveitis
16) Multiple sclerosis
17) Autoimmune hamolytic anaemia
18) Idiopathic thrombocytopenic purpura
19) Idiopathic leucopenia
20) Primary biliary cirrhosis
21) Chronic hepatitis (HBs Ag - Negative)
22) Cryptogenic cirrhosis
)
23) ulcerative colitis
24) Sjogren's syndrome
25) Rheumatoid arthritis
26) Dermatomyasitis
27) Scleroderma
28) Mixed connective tissue disease
29) Discoid hupus erythematosus

A) Systemic Lupus Erythematosus :

An inflammatory disease which results in multisystem involvement
and is varied clinical presentation.
SLE is an autoimmune disorder of uncertain aetiology. The disease
is characterized by non-organic specific autoimmunity with the presence of a
family of autoantibodies directed against components of the cell nucleus
Epidemiology :
SLE is primarily a disease of young woman in the reproductive age
group. The peak incidence is between the age of 15-40 years. The female to
male ratio varies from 9:1

Aetiology : The actual case in not known

 Immunologycal Factors :
 Antibodies to DNA are specific
 Genetic Factors :
 70% concordience for SLE between identical twins.
 Hormonal Factors : High incidence in woman of reproductive age
suggests that female hormones modify immune response, pre-
menstrual places have been controlled by antigonatropic drug danazol.
 Infection:
C-type RNA viruses have been implicated in both animal and human
disease
 Drug induced :
Hydralazine, procainamide quinidine, phenytoin, primidone, Isonized,
chlorpromazine

Immnopatholgoy :
The pathology of SLE is characterized by features strongly suggestive
of immunology mechanism of tissue damage thus the tissue demonstrate
inflammation with predominant plasma cells and lymphocytic infiltrates.
Fibrinoid necrosis degenration of the wall of the small blood vessels and the
presence of haematoxylin bodies and immune complex depositions.
Immunologycal Abhormalities Disregulatjon of the Immune System :
SLE shows a wide varity of Immunologycol abnormalities. These
effects the various cell types of the immune system including T cells and
their subsets, B cells, natural killer cells, and cells of the macrophage
monoeyte linage important for antigen processing and presentation. The
abnormalities are qualitative as well as quantative. However it is not clear
whether these are the cause or the effect of the disease. Among these
abnormalities the one that is of importance is the imbalance in the ratio of
Th1/Th2. There is a prependrance of Th1 cells in autoimmune diseases in
general and in SLE in particular
Clinical Features :
1) Acute or subacute SLE :
Fever, Tachycardia, rash of acute cutanous lupus erythematosus
Mucosal ulcers, Arthralgia, Myalgia, Lymphadenopathy,
Hepatosplenomegaly Hamatologycal abnormalitites, pleural, effusion,
pleurisy, pericardial effusion, Heart murmurs, urinary abnormalities lupus
nephritis and neuropsychiatric feathures
2) Mild mucocutanous SLE :
Commonest clinical form dermatology a Rhematology photosensitivity, mild
erythematous facial rash, arthralgia, myalgias inflammatory polyarthritis,
excess hair loss
3) SLE involving an organ system could present mainly dematologycal
rheumatologycal, neuropsyctiatric or hematological illness or
glomerulonephritis or pleuro pericarditis
4) Skin : Butter fly rash on face dusty iliac effusion may appear in upper
eyelids. B) vasculitis rash on elbows, knees, hands, feet punctate
erythematosus rash palmer erythma, periungel erythema
5) Musculoskeletal : Arthralgia, tenosynovitis, non erosive polyarhritis
6) Cardiac : a) Pericarditis a pericardial effusion
b) Libman sacks endocarditis
7) CNS :
Neurologycal seizures, hemiparesis, meningitis psychic
feature psychosis, depession
8) Renal : Diffuse proliferative glomerulonephritis, nephritic syndrome
9) Hematologycal : Anaemia and leucopenia thrombocytopenia,
Hemolytic anaemia
10) Preagnancy : Develop deep vein thrombosis spontanous abortion,
miscarriages, stillbirth
11 ) Late stage SLE : End stage renal disease, Atherosclersos, late stage
neurological disorders, Thrombophelbitis shrinking lung syndrome and
osteonecrosis
Complications : Late stage of SLE represents much of the long term
complications of the disease. The other complications seen in the short term
can be classified as
1) Disease complications
2) Complication of treatment
Complications of treatment mainly related to
1) NSAID induced gastrointestinal manifestations
2) Complication of long term use of corticosteroids
3) Cytotoxic drug related complication.
Diagnosis –
Laboratory investigation ANA testing : ANA are demonstrated by
indirect immunnofluorenscence using rat kidney or liver as substrate
Antibodies to DNA are the more specific tests in diagnosis.
DNA - Antinuclear Antibodies
 Complement: Sever deficiency in most pt. with active disease
 ESR and c-reative protein
High ESR but CRP less than 1ugls
 Lupus band Test:
Demonstration of immunoflorescence at the dermoepidermal junction in
non lesional skin which is not exposed to light is relatively specific.
Diagnosis :
The diagnosis of SLE is mainly based upon clinical features the pattern
of involvement of different organs. If ANA is positive in significant titres
of Anti-ds DNA anti sm antibodies clinches the diagnosis.
Differential Diagnosis :
Tuberculosis , Lymphoma, drug reactions Stevens jehnson
syndrome. Rheumatoid Arthritis. Fibromyalagia, other systemic collages
vascular diseases, psychosis and ITP.
Management:
Sysptomatic relief:
NSAID are widely used for control of Fever, Myalgias, Arthralgias. Frank
arthritis. Mild serositis before resorting to corticosteriods.
Symptomatic Rx. of hypertension heart failure, nephrotic syndrome
psychosis, convulsions and other complications.
Specific Drugs :
Anti-Malarials : 4 aminoquinoline, 9 aminocridine compounds are useful
in the management of SLE.
Corticosteroids : For the control of acute disease activity in SLE. They are
available for topical intralesional, oral, intramuscular and intravenous
preparations.
Immuno suppresives :
Severe diseases including nephritis, plasma exchange. Severe
vasculities, nephritis, used in combinations with corticosteroids and
immunosuppressives. Dialysis and Renal transplantation for late stage lupus
nephropathy.

B] Auto Immune Gastritis

Auto immune gastritis with destruction of chief and parietal cells of
the body of the stomach the antrum is unaffected. The gastric results in
failure of secretion of if hydrochloric acid and pepsin, leading to achlohydria
and malabsorptions of vit B12.
There is ineffective erythropoiesis. Uncongugated hyperbilirubinamia
and increased deposition of haemosiderin in liver spleen, kidney and bone
marrow. It is associated with other autoimmune disease such as myxoedema,
hyperthyrodism, diabetes mellitus. Rheumatoid arthritis and
hypogammaglobulinaemia. 90% of pt. have partial cell antibody in serum
and 50% have antibody to if 35% have second. If antibody which inhibits its
ideal binding site. Both these types of antibody may also occur is gastric
juice.
In some pt. the degree of gastric atrophy is severe a loss of intrinsic
factor scretion leads to pernicious anaemia. The gastritis itself is usually
asymptomatic.
Clinical Features :
The onset is insidious and the pt. presents with severe anaemia. There
is pallor of skin and mucous memb. The skin shows yellow tint due to mild
jaundice. The tongue is smooth, atrophic red and raw with loss of papillae
and there is angular stomatitis. The other feature are anorexia, dyspepsia,
alternating constipation and diarrhoea, other bowel disturbances and mild
hepatospleenomegaly Purpura due to thrombocytopenia and widespread
melanin pigmentation are less frequantly observed. There may be infertility
in young females, epigastric pain nausea and bloating.

Sings :
 Severe anaemia
 Pallor of skin, skin shows yellow tint due to mild jaundice
 Tongue is smooth, athrophic red and raw with loss of papiliae
 Angular Stomatitis
 Anorexia, milkd hepatosplenomegaly
 Symptoms - Dyspepsia :
 Alternating constipation
 Diarrhoea
 Epigastric pain
 Nausea and bloating
 Causes :
 Infections e.g. Cytomegalo virus Tuber culosis
 Gastrointestinal diseases e.g. crohns disease
 Systemic disease e.g. sarcodosis, grafl-versus, host disease
 Idiopathic e.g. granulomatous gastritis
  Diagnosis :
 Demonstration of parietal cell antibody blocking and binding
antibodies to if in serum and gastric juice
 Elevated serum gastrin level
 Histamine or pentagastrin fast
 Endoscopy
 Grastric cytology demonstrates atypia of gastric epithelium distinct
from malignant cell of gastric carcinomas
Management:
 Inj of vitamin B12 for prevention of pernicious Anaemia
 Colloidal Bismath 108 mg qds for 4 weeks with Metrotinidazole 200-
400 mg.TDS
 Amoxycilin 250 mg TDS for 2 weeks
 Demonstration of perietal cell antibody, blocking and binding
antibodies
 Elavated serum gastrin level Histamine or pentagastrin. Fast
achohydria
 Barium Meal exam.
 Atrophic gastritis seen on endoscopy

C] Ulcerative Colitis :
Is a common inflammatory disease of unknown orgin characterized
clinically by recurrent attacks of bloody diarrhoea and pathalogycally by a
diffuse inflammation of the colonic mucosa.
In the early stages the rectum and sigmoid colon show uncertain and
spasm with increase in the presacral space on barium studies. The normal
sharp mucosal outline of the colonic mucosa is replaced by fine granularity
and later by shallow ulceration. The intervening mucosa between the
ulcerations is also abnormal deep ulcerations and fistulae are uncommon.
Haustral blusting, shortening of colon and lunimal narrowing occur with
progressive disease. Ulcerative colitis predisposes to malignancy

Etiology :
Age : More common between 20-40
Sex : More in Females
Cause : Unknown
Possible Factors :
Gencticic : Increased incidence in some families
Immunological :Immune medieted mechanisms implicated because in
active disease, circulating immune complexes
Psychologycal Factors : May influence the cource of disease
Atopy : Atopic illness are more common among pt. with colitis.
Smoking :
Clinical Features :
Acute Attack : Passage of frequent, Small volume loose stools with
fresh blood and mucus, cramping abdominal pains with moderate attacks
and rectal pain tenesmus with fever and tachycardia in severe attacks. Actue
colonic dialatation with perforation may occur.
Chronic ulcerative colitis :
 Low grade fever, malaise, anorexia malabsorption and weight loss
 Insidious onset with diarrhoea and simultaneous or subsequent
passage of blood and mucus. Tenderness over affected colon.
  Anaemia, Hypoproteinemia
 Related to disease activity
 Apthous Stomatitis, Erythema nodosum pyoderma gangrenosa
 Eye comp : Conjunctivitis, episcleritis uveitis, Finger clubbing
sacroileitis, Ankylosing spondylitis, seronegative polyarthritis
 Complications : Intestinal
 Severe, life threatening inflammation of the colon
 Toxic dialatation
 Perforation of the small intestine or colon
 Life threatening acute haemorrhage
 Fistula and perianal disease
 Carcinoma of the colon Extraintestinal :
 Inflammatory bowel disease can be considered as a systemic illness
dominate the clinical picture
Sings :
 Fever and tachycardia
 Colonic dilatation with perforation
 Malaise, Anorexia
 Malabsorption
 Weight loss
 Tenderness over affected colon
 Anaemia, Hypoproteinemia Symptoms :
 Passage of Frequent small volume loose stools with fresh blood and
mucus
 Cramping abdominal pains
 Rectal pain
  Diarrhoea and simultaneous or subsequent passage of blood and
mucus
 Differential Diagnosis :
 Ulcerative colitis
 Small bowel Crohn's disease
 Investigations :
 Blood test Hb%, ESR, CFP, Culture
 Bacteriology
 Endoscopy
 Colonoscopy
 Barium Studies
 Plain radiographs
 Radionuclide scans

Investigation :
Blood Test: Hb : Reduced Anaemia from bleeding
ESR : Raised
CRP : Elevation : is helpful in monitoring crohns disease activity
Bacteriology : Stool cultures :
Are performed to exclude superimposed enteric infection
Blood Culture : Are also advisable in pt. with known colitis or crohans
disease.
Endoscopy :
Sigmoidoscopy with biopsies is a simple and essential investigations
in all pt. who present with diarrhoea. Rectal sporing, perianal disease.
Ulcers suggests crohns disease.
Colonoscopy : May show active inflammation with pseudopolyps or
complicating carcinnoma. Biopsy are takes to define disease extent.
Barium Studies :
For the investigations of colitis. Ulcerative colitis the colon is
shortened and loses hauster to become tubular and pseudopolyps are seen.
Plain Radiographs : Abdominal radiographs is essential in the management
of pt. who present with severe active disease. Colitis dialataion of the colon.
Radionuclide scans shows areas of active inflammation.

Management:
- Best treatment depends upon a team approach involving
physicians surgeons, Radiologists and dielitions
- Treat acute attacks
- Prevent relapses
- Detect CA. Early stage
Enema :
- Prednisolone phosphate enema 20 mg saline, 100 ml/day
- Prednisolone metasulphabenzoate 20 mg in saline 100 ml/day
- Hydrocortisone 125 mg/day or 125 mg bet as a foam
- Maintenance of clinical remission or mild disease.
- Oral: Mesalazine 1.2-2.49mg/day in div.
Dose osalazine – 1.39mg/day
- Topical : Enema 1g in 100 ml
- Pyrexia : Metronidazole 500 mg IV
Auto Emmunse Gastritis :
Altoimmune Gastritis :
1] Arsenic Album :
Ailments From : Chill, is winter, taking ice, icre-cream, cold fruits, decayed
food or animal matter olfaction or Ingestion, poor diet continued drainage of
body fluids anaemia, abuse of alcohol, sour beer bad sausage, strong
cheese ptomaine poisoning, tobacco, Iodine, climbing mountains and sea
bathing.
Mind :
Pt. is depressed, irritable, extremely restless and axious great fear of
death when alone or when going to bed. He is fastidious wants everything in
order, neat and clean. A gold headed cane pt. weak memory due to
confusion in head, sad tearful and anxious mood full of despair and
indifference. Mentally very restless, he is physically too weak too move .
Dreams are full of sorrow and fear, fine, darkness and death. Disease symp -
Gastric derangement such as diarrhoea, vomiting etc. are due to food
poisoning from spoiled eggs, fish or meat decayed food, alcohol, ice-cream.
As food and water touches the stomech due to inflammation and irrtation of
mucous membrane to the most destructive gastritis. Vomiting with diarrhoea
followed by great prostration spasmodic colic with sensations as if the
intestines become tuisted, dark or black watery, very offensive rice watery
stool. Diarrhoea worse at night especially at mid night from 12-2 am
Constitution : The pt. is lean thin, debilited having hippocratic face, dirty
and waxy look of the skin. General Symptoms:
- Great fear of death
- Mentally restless by physically week and exhausted to move about
- Great prostration, restlessness
- Complaints return periodically
 - All discharges are acrid, scan and putrid, dark offensive with
cadevorous odour.
- Thirst for small quantity
- Symp. aggravated mid day and mid night
Modalities :
Aggravation : Periodically, mid day and mid night 12 am 1 pm, cold food
And drinks, exertion, lying as affected side.
Amelioration : Heat is general, hot drink hot application, motion

2] Bismuth :
Ailments From :
Syphilis, heat and summer complaints, abdominal operations
Mind : Solitude is unberable. He wants and desires company always.
This is particularly noticed in children who hold mothers hand for company
great anguish and restlessness. He sits walks and then lies, never remains
for long in one place.
Delireum tremens with loss of conciousoress. Mentally apathy with
insensibility.
Disease symp :
Vomiting of water in large quantity as soon as it reaches the stomach
but solid food is retained for a long time until large accumulation, takes
place in the stomach which is also vomited later on in decomposed form
which is very offensive.
There is great pain which is cramp and spasmodic in nature with
irritation. There is purging and diarrhoea, stool is watery, profuse, painless
and very offensive.
General Symp. :
 There is post operative vomiting especially of liquid particularly after
leparotomy.
 Pain in the stomach, relieved by bending backword by eructations
 Headache alternates with gastralgia worse after eating and better by
cold bathing and cold drinks
 Motion relieves most symptoms except headache Modalities :
 Aggravation : by heat summer weather
 Amelioration : By cold application, cold bathing, open air
3] Phosphorus:
Ailments From :
Mental exertion, strong emotion, strong odours, gas vapours,
thunderstorm, lightning, sexual excess, loss of vital fluid sprains, wounds,
lifting, exposure to drenching rain, tobacco.

Mind :
The main feeling of phosphorus is of being unloved and uncared for to
which the pt. reacts by being affection etc. Friendly a sympathetic in the
hope that this love and cure will be reciprocate. He must be sensitive to the
felines of others to win their affection. He is sensitive to all emotions, onset
fear and grief and has the unque symptom. Hot flushes from excitement. He
feels alone and hence, very vulnerary to enviormenstal and emotional
foetars. Fear of the thundersterm. Delusic chocked by forms, being ailments
from grief, phospherus people is that they are very sensitive to those around
then. They are tend no attract attention towards them selves either by the
appearance. It is difficult to ignore. Yet behind this sensitivity is lurking the
feeling that they are not getting cough attention. They are very emotional,
very loving, afficnionate, sympathetic caring. Pt the same time they can be
very easily excited. Very anxious fearful dairvoyant and resless, in the
intellectual sphere we find the increased activity expressed as Ideas
abuodant, clearness of mind memery active. Industrious.

Dise. Symp.:
Empty all gone sensations in stomach pt. craves cold food and drink,
icy-cold, refreshing, juicy things, ice-cream relieves the gastric pain great
burning in the stomach, constipation stool is slender, long dry, tough and
hard. Dog like stool voided with great difficulty and straining profuse watery
stool. Involuntory stool with sago like particles pain in stomach relieved by
cold water.
General Symp. :
 Burning is the keynote symptom
 Burning anywhere and everywhere
 A weak empty all gone sensation in head, chest, stomach, entire
abdomen.
 Over sensitiveness of all senses
 Restlessness, pt. moves continuously
 Perspiration smells like sulphur
Constitution :
Phosphorus is best suited for all slender persons with narrow chest,
who are good and beautiful to look at having fair thin, transparent skin,
delicate eyelashes, fine bland or brownish red hair, young people who grow
too rapidly
Modalities :
Agg : Evening and before mid night lying on left or painful side
Amel: Lying on rt. side, cold water cold food

4] Argentinum Nitricum :
Ailments from :
Apprehension and fear eating ice and ice-cream sugar and sugar
candy, Mental stress and strain, tobacco etc.

Mind :
Argentum met whose main theme as performance in sudden danger or
crisis. There is feeling as if the person will be accepted only if he can
perform at the time of crisis. There is a feeling of being neglectd and
despised if he does not perform at the time of crisis. They are trouble
shooters of the highest degree and see their role feeling much neglected or
isolated. He has tremendous sense of fault within which he is trying to cover
up and hence has several sycotic traits such as compulsion about of narrow
places, fear when anticipating an engangement. Anticipation, fear of failure.
Feer of falling, Diarrhoea from anxity.
Dise symp. : Belching accompanies most gastric alments nause retching,
vomiting of glairy much. Air rushes out with great violence both ways
without any relief flatulence dyspepcia. Flatulence painful swelling of fit
painful spot over stomach that radiates to all parts of the abdomen.
Gnawing ulcerating pain, burning and constriction. Ineffectual effort at
eructation. Great craving for sweet Gastritis of drunkards. Ulcerative pain in
left side under ribs. Ulceration of stomach.
Constitution :
Adopted to hysterical nervous persons with vivid imagination, having,
carbo, nitrogenoid or hydrogenoid constitution.
Modalities :
Agg : Worse, warmth in any form at night, from cold food sweets, after
eating, at menstrual period, from emotions.
Aml: From eructations, fresh air, cold pressure.

5] Lachesis:
Ailments From : Long lasting grief, sorrow, fright, jealous, vexation,
disappointed love etc. Bad effects of poison wounds postmartom,
suppression of quinine.

Mind :
Specific problem of Lachesis seems to be the problem of jealousy or
how to get the better of rival. She has the feeling of weakness within herself
as she compares herself to her younger and more attractive rival. She feels
that there are conspiracies again her and this makes her suspicious of people
around her. Her survival depressed on her being one up on her rival and she
does this with clever, manipulative talk. With her loquacity. She is able to
attract and retain the attention of the listener. Judgeing all the time his
interest level. And at the correct moment unnoticed by the latter. She injects
the venom that works in his after he has left her presences. Her talk can be
clairvoyant. Prophetic she has to shut off from work.
Dise. Symp :
Craving for alcohol, cysters. Any food causes distress. Pit of stomach
painful to touch hungry can not against for food. Gnawing pressures mode
better by eating, but returning in a few hrs perceptible trembling movement
in the epigastric region. Empty swallowing more painful than swallowing
solids.
Constitution :
It is ideally suited to thin and emaciated subjects during and after
climacteric age. Who have been changed both mentally and physically by
their illness, to persons having disposition to low spirit and indolence with
Blue and purple look.
Modalities :
Agg : After sleep, heat in general extremes of temp, alcohol acids, mercury,
quinine, pressure or constriction, summer, heat on sum
Amel: With appearance of discharge and cold application

Uncerative Colitis :
1] Kali Bich :
A/F : Alcohol, beer, hot weather, Autumn a spring
Mind : III humoured, low spirited and indifferent easily excited, Anxiety
arises from chest with distress in stomach. There is the very strong focus on
family life. They live for their family, they have to have the perfect little
family. One might mockighly call them typical bourgeois people with their
nice house, shiny car, children doing very nicely at university. A slimy
person is one who always wants to present his good side who continuously
wants to please others. The stringlness is a great keynotes of kali bich
sexual desire absent in plethoric people, kali bich pt. is generally chilly.

Disease Symptoms :
Peptic ulcers i.e. gastric and duodenal ulcers. Weight in the pit of
stomach with loss of appetite of great flatulence. Punched out ulcer of
stomach with pain in small spots which can be covered with tip of a finger,
shifts rapidly from one part to another, appears, disappears suddenly gastric
symptoms ultemates with rheumatism
Dysentry with jelly like mucus great tenesmus.
Constitution :
Fatty persons having light hair fine complexion and suffering from
catarrhal affections. Babies are fat. Clubby, and short necked. Disposed to
croup and croupy effections.
Modalities :
Agg. : From beer, morning, hot weather and undressing
Amel: Skin symptoms are better in clod weather by lying down.

2] Mercurius Corrosivus :
A/F : Syphilis, sun and summer weather
Mind :
Impulsiveness with expression of hurriedness restlessness and
Anxiousness and Imbecile Behaviour, Gradual decrease in the functioning of
higher centers of brain right from the childhood. Which expresses in the
form of slowness. He is slow to answer the questions slow to compressed.
Slow in resoning and because of this behaviour is childish. He does foolish
things, disgusting actions and behaves in a very foolish manner, does things
which harm others. His memory becomes weak. He becomes forgetful. All
this produces marked irresolution. He gets various impulses lack of
confidence which makes him anxious and irritable at the slightest cause. He
becomes suspecious and tired of life. He develops forsakes feeling and
wants to commit suicide.
Dise Symp. :
Great tenesmus persists before during and even after stool. Tensmus
not relieved by stool, scanty mucus mixed with stool, copious, Bleeding
slimy. Very offensive, Frequent evacuation, cutting and urging to stool.
During stool tenesmus of the rectum and may be accompanied with tensmus
of bladder too. No relief after stool tenesmus persists for some time. Great
burning in the rectum faintness, weakness and shuddering, cramps in the calf
muscles.
Constitution : Especially suited to people who are pale, tremulous, weak
and sweaty, bleeding gums glandular affections can not tolerate. Extremes
of temperatures and are very hurried restless and impulsive.
Modalities :
Agg : Afternoon, At night and during summer
Amel : By rest

3] Carbo Veg :
 Loss of vital fluid, mieryry, salt, salted meat of fish and from abuse of
quinine especially suppressed chill and fever bad effects of long ago injury
persons who have never fully recovered. From the bad effects of some
previous illness.
Mind :
Sluggishness and its expression in the form of dullness, slow thought
process and indeciveness at the mental level. Sluggishness is present both at
mental and pyscial level. They are milk, timed. Fearsome, slow in thinking,
slow to learn and suffer from night terrors have feer of ghost, will not sleep
alone or go to bed in dark they hardly react to pleasure or pain. They easily
reduced worked up over small things and have lack of self confidence. They
become coward. Fearsome and dull. The become prone to frequent mood
changes.
Disc. Symp. :
Great drain to the vitality due to profuseness of discharges, simple
food disagrees due to weak digestion with excessive accumulation of gas in
the intestine. There is frequent, involuntary cadaverous smelling stool. There
is cold sweat on the forehead with coldness of entire body.

Constitution :
Sluggishness, turbidity and swelling of the parts, everything about the
economy is sluggish, turbid distended and swollen. The head feels full and
the limbs feel dull and puffy. The veins are relaxed and paralysed. It also
produces vaso motor paralysis.
Modality :
Agg. : In the evening, open air, from cold, hot food, butter, coffee, milk,
warm damp weather and alcoholic drinks
Ame : From eructations, from fanning rapidly from a close distance and by
cold application.

4] Aloe Scortina :
A/F : Fear, fright, coffee tobacco.
Mind :
Time passes to slowly. Insecurity, of rectum. Dissatisfied and angry
about himself or complaints especially when cooslipated. Adopted to weary
people the aged and phlegmatic, old beer drinkers. Dissatisfied and angery
about himself alternating with lumbago.
Dise symp. :
Inflammatory condition of lower portion of colen and rectum.
 Bloody discharge with much jelly like mucus and less blood. Rubbing
around in the abdomen which is full of gas
 Cutting, griping pain in the lower portion of abdomen
 Constant bearing down pain in the rectum with intense itching,
burning in anus

Constitution :
Especially suited to old people woman of relaxed, phelgmatie habit
Indolent weary persons, leading sedentary life, averse to either physical and
mental labour
Modalities :
Agg. : Early in the morning, sedentary life, hot dry weather, after eating and
drinking standing or walking
Amel.: Cold water, cold weather, discharge of flatus and stool.

5] Holarrhena Anti Dystrica : Kurchi, Kutaji

(Buch. Horn.)
It is excellent remedy for dysentry acute or chronic. It is an antipyretic
and ani dysenteric also. Drysentry associated with weakness, emaciation
loss of appetite aversion to food colicky pain around the naval, more mucus
but less blood.
Common Name : Kurchi, Kutaji
Family : Appoynaceae
It is a small decidous plant with white flower and generally grows in
the tropical Himalayan region. The seeds are called jodrayana or indras seed
in Sanskrit. Though it is found two varieties white and black but mostly
white is used for medicinal purpose. As the name suggests it is highly
effective again and dysentery is specially of the chronic form. Bark, seeds
are used for preparation of the medicine.
Homoeopathic Uses :
It has been verified for dysentery with the following symptoms.

Dysentery :
Frequent loose stool with rumbling in abdomens with colicky pain in
naval before stool. Stool mixed with profuse mucus. Dysentry associated
with weakness emaciation, loss of appetite and aversion to food and also
when colicky pain tenesmus persist but mucus and blood in stool has
decreased potency 30
SLE
1] Natrum Carbonicum :
Ailments From :
heat of summer gaslight storm, over study cold drinks when overheated etc.
Mind :
Very much sad, depressed and melancholic. There is sadness and
depression of spirit. There is difficulty in comprehension, inability to
combine the ideas while writing or reading. Inability to think or to perform
any mental labour as if causes headache music is unbearable causes
tendency to suicide, melancholy and weeping, music, causes great sadness
which leads even to religious insanity. There is attack of anxiety and
restlessness. Fear of people and dreads being alose. Fear of death she
become suspecious violent, indignant, needless, imaging herself to sick and
seeing no hope in her. no win situations. She becomes sad and weeps and
in extreme cases can become indifferent and suicidal

Dise. Symp:
Dry rough, cracked skin eruptions on finger tips, knuckles and toes,
vesicular eruptions in patache and circles
 Easy dislocation and spraining of ankle soreness between toes and
fingers. Heel and tendo. Achilles affected. Dry cough with coldness of
left side of breast amorous dreams. Drowsy during day
 Induration of cervix. Pudenda sore menses late scanty leucorrhoea.
 Freckles yellow spots. Pimples swelling of upper lip pale with blue
rings around the eyes.
Constitution :
Suited to persons of leucophlegmatic constitution the pt. has aversion to
opens air and dislike of exercise, either mental or physical. Imbecility. Face
pale with blue ring around the eyes.
Modalities :
Agg : From music, in the sun, excessive summer heat, mental exertion
and thunderstrom
Amel: by moving by bearing in ears and nose

2] Rhus Tox :
Ailments From :
Spraining or straining a single part, muscle or tendon over lifting,
particularly streatching high up to reach things, lying an damp ground. From
wetting and too much summer bathing in lake or live cold air, getting wet
when heated Mind : Pt. has a constant anxiety as if something is going is
happen, fear of evil, fear of being hurt, of being murdered. He is extremely
superstitious. This constant anxiety makes him restless and doesn't allow
him to rest in any position. There is a feeling of helplessness of being
forsaken by others his friends. A feeling that something bad is going to
happen anxiety more inside the house and is ameiliorated by walking in
open air faces some kind of danger of attack from members of his own
family and feels helpless and forsaken by others. There is no clinging no
desire for company. Night approaches the anxiety grows. Fear of murder
even after midnight. She is nervous sad she is brooding.
Dise. Symp. :
Erysiples, vesicular eruptions. Vesicles are yellow from left to right
with much swelling, burning imflammation, itching and stinging, external,
genitals inflamed, erysepelatous.
 Backache between shoulderness and small of the back. Pain with
stiffness
 Rheumatism of any joints especially joints of rt. side.
 Brain feels loose when stepping or shaking the head. Sensation of
swashing in brain. Stupefying brain feels as if torn.
Constitution : The pt. is very chilly easily susceptible to cold & aggravated
by cold in general very chilly pt. Even open air is intolerable.
Modalities :
Aggravation : During sleep, cold wet rainy weather and after rain at night.
During rest, drenching when lying on back or rt. side
Ameiliration : Warm, dry weather, motion, walking, change of position,
rubbing warm application from stretching out limbs.

3] Sepia:
Ailments From :
Exposure to cold, laundry work, alcohol, tobacco, wetting before and
during menses after eating going upstairs, coitus, change of weather from
cold air, milk acids, fats and before thunderstorm.

Mind :
The main feeling of the sepia is that she is forced to undertake things
opposed to her intentions to do what she doen't want to do. She feels that
her body is disfigured and unattractive especially the opposite sex. In order
to keep him happy. So that she is accepted by him. She has to do what he
wishes not what she wishes. There is one side of her that says "Do what you
want to do, be independent occupy yourself. And indeed sepia likes to
occupy herself mentally and physically. She lies brisk movements, dancing
etc. She is too independent she will lose her support and will not be able to
keep her husband and children happy. The dependance may be emotional
or financial. She is fereed to do things she does not want to do. This is the
uncompensated, failed side.

Disc. Symp :
Yellow blotches, pale or sallow, elow about mouth. Rosacea, saddle
like brownish distribution on rose and cheeks
 Herpes circinatus in isolated spots. Itching not relieved by scratching
worse in bends of elbow and knees. Chloasma. Herpetic eruptions on
lips about mouth and nose. Ringworm like eruptions every spring.
Urticaria on going in open air better in warm room. Hyperidrosis and
Bromidiosis
 Weakness of small of back, lower extremities lame and stiff tension as
if too short, Heaviness and Bruised feeling, Restless in all limbs,
twiching and jerking night and day
 Red adhesive, sand in urine, innvoluntary urination, during first sleep
chronic cystitis slow Micturation with beering down sensation above
pubis.
Constitution: Weak persons with yellow earthycomplexion, discolouration,
desquamation shallow skin, yellowishness of the face and conjunctiva,
yellow spots on the chest a tell tale face. Recording clock moth spots
cachectic face with yellow saddle across the rose with male type of pelvis in
women.
Modalities :
Agg: Forenoons and evenings, washing laundry work, dampness, left side
after sweat, cold air, Before thunderstrom.
Amel: By exercise, pressure, warmth of bed, hot applications, Drawing
limbs up, cold bathing, after sleep

4] Terbithina:
A/F :
Heat with violent thirst, profuse cold clammy sweat, Alcohol, damp
cellars.
Mind :
Anxiety of mind and body. Strong oversion to striking colours such
as green red and black. Very sensitive to music. It relieves all symptoms
but sometime it excites violently, loss of shame, lascivious, uncontrollable
sexual desire. Pt. fellings all sorts of sickness. They not only imagine
themselves sick but they preted to be sick when they are not. When there are
no observer there is no hysteria but when attention is directed to be she
beging to twich. Violence is a strong feature of this remedy. Strikes her
attendant, nurse, tear cloths.
Disease Symp :
Acne, erythema, itching pustuler vesicular eruptions, urticaria,
purpura ecchymosis, dropsies, scarlatina chilblains with excessive itching
and pulsative pains.
 Burning pain in region of kidneys
 Drawing in rt. kidney extending to hip
 Strangury with bloody urine, scanty suppressed odour of violent,
urethritis with painful erection. Inflamed kidneys any acute disease.
Constant tenesmus
 Intense burning in uterine region

Constitution :
It acts best on persons with light blue eyes flaxe hair, light eye
brows, fair delicate skin, suited to blonde, red checked scrofulous persons.
Model :
Agg : Dampness, cold, night lying, pressure
Amel: Motion

5] Sulphur:
Ailments From :
Alcohol, suppression of skin diseases, sun heat, over exertion
Mind :
The main feeling of sulphur is that of being scorned. Suppressed, put
down criticized. The person is made to feel humilited his pride is hurt.
Embarrasmart is one of the main feelings of pt. There is therefore a constant
effect a struggle to come up again to be someone to know something, to earn
respect. He feels that he is expected to be good in his appearance his
relationships and in his business, knowledge talent and capabilities. Struggle
is for ego and honour. Desire for business, the desire to make money and to
be financially sound. There is the feeling of being poor. Delusion old rags
are as fine as silk. Indolence are very well known. They feel insulted when
do not know something and try to make up for what they do not know by
theorizing. They live each in their own world. Where they can feel good
about themselves by imaging that they possess great knowledge a lot of
wealth and good look to others. The pt. is feel that they are expected to be
good in their relationship with people and so they are caring and do a lot for
other.
 All sorts of skin eruptions, vesicular, pustular especially skin
affections, little injury suppurates freckles. Itching, burning worse
scratching and washing, pimple eruption, pustules, rhagade hang nails,
excoriation.
 Trembling of hands, Rheumatic pain in shoulder Heaviness, paretic
feeling, Rheumatic gout with itching. Tearing in arms and hands,
stiffness of knees and ankles can not walk erect.
 Drawing pain between shoulders stiffness of nape sensations as if
vertebrae glided over each other.
 Frequent Micturation especially at night enuresis especially in
scrofulus, untidy children. Burning in urethra during Micturation last
long. Mucus and pus in urine

Constitution :
Lean, stoop shouldered persons who walk and sit stooping, walk
stopping like an old man. Standing is the worst position for a sulphur pt.
They cannot remain standing. Every standing position is very uncomfortable
and unbearable
 Dirty fifthy look of the body. Prone to skin affections. Redness of
external orifices.
Modalities :
Agg.:
At rest when standing, warmth in bed washing bathing in morning 11
am. Night
Amel :
Dry, Warm weather, lying on rt. side from drawing up affected limbs.