SMT.

CHANDABEN MOHANBHAI PATEL HOMOEOPATHIC

MEDICAL COLLEGE.
NATAKKAR RAM GANESH GADKARI MARG,
IRLA, VILE PARLE (W), MUMBAI-56.

2008-2009

CERTIFICATE

This is to certify that dissertation entitled “ROLE OF PSYCOSOMATIC

MENTALS IN HOMOEOPATHIC TREATMENT OF ECZEMA” has been carried
out by Mr.Chirag R Rathod under the guidance of Dr. Jai B. Patel (M.D. Hom.) in partial
fulfillment of completion of internship for BHMS Degree.
This work has not been submitted elsewhere for another examination. This work
is recommended for awarding BHMS Degree.

DR. JAI B. PATEL DR. N. O. GOEL

(M.D. HOM) (M.D. HOM)
HOD REPERTORY DEPARTMENT PRINCIPAL
SMT. C.M.P.H.M.C. SMT. C.M.P.H.M.C.
 CONTENTS

TOPIC PAGE NO.

1. ACKNOWLEDGEMENT 1
2. AIMS AND OBJECTIVES 2
3. INTRODUCTION 3
4. HOMOEOPATHIC APPROACH 34
5. HOMOEOPATHIC THERAPEUTICS 56
6. REPERTORY 67
7. METHODOLOGY 70
8. CASES 72
9. RESULTS 143
10. SUMMARY 146
11. CONCLUSION 147
12. BIBLIOGRAPHY 148
 ACKNOWLEDGEMENT

I would like to take this opportunity to express my gratitude to Smt. C.M.P.

Homoeopathic Medical College’s Department of Repertory and Case-taking for
sanctioning me dissertation topic entitled, “ROLE OF PSYCOSOMATIC MENTALS
IN HOMOEOPATHIC TREATMENT OF ECZEMA” and for allowing me to use
various resources in the institute.

I would like to thank and express my sincere gratitude to the H.O.D. of

Department of Repertory and Case-taking and guide Dr. Jai Patel (M.D. Hom.) for his
valuable guidance and cooperation in every possible way and also for the encouragement
given for being sincere and successful human being.

I would like to thank Dr. Gausia Z. Sayed (M.D. Hom.) for her precious time,
valuable guidance & fantastic suggestions. She has guided me with the right path not
only helped me in completing my task but also helped me to expand the horizons of my
knowledge immensely.

I would like to thank Dr. Kamlesh Mehta (M.D. Hom.) for his valuable
guidance & cooperation.

I would also like to thank Dr. Rajan Damodaran for improving my knowledge and
application in the concerned topic.

**I would also like to thank Dr. N.O.Goel (M.D. Hom.), Dr. Jai Patel (M.D.
Hom.), Dr. Nimish Mehta (M.D. Hom.), Dr. Jayesh Dhingreja (B.H.M.S. Hom.) and Dr.
P. Humranwala (M.D. Hom.) for providing the cases which are documented in this thesis.

Lastly, I would like to thank my parents, colleagues, friends who were directly or
indirectly involved in my work.

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 AIMS AND OBJECTIVES OF THE STUDY

 To study in depth the given topic by analysis of several cases.

 To know the efficacy of homoeopathy in management of eczema.

 To treat patients with holistic approach and provide best possible results.

 It helps us in better understanding of dynamis concept of disease & improves our

knowledge about different repertory about given rubrics under heading skin.

 To plan the approach towards a case based on whether patient comes to us in

acute, subacute, or chronic state.

 To individualise cases with similar exciting and maintaining causes yet requiring
different chronic remedies depending on different fundamental causes.

 To understand improvement in susceptibility after acute and chronic remedies.

 To understand the role of auxillary line of treatment along with Homoeopathic

Medicine.

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 INTRODUCTION

 ANATOMY OF SKIN

 FUNCTIONS OF SKIN

 ECZEMA- DEFINITION

 HISTOPATHOLOGY

 AETIOLOGY

 CLASSIFICATION

 INVESTIGATIONS

 COMPLICATIONS

 ALLOPATHIC MANAGEMENT

 PREVENTION: DO’S AND DONT’S

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 ANATOMY OF SKIN

In zootomy and dermatology, skin is an organ of the integumentary system made

up of multiple layers of epithelial tissues that guard underlying muscles and organs.

The skin is often known as "the largest organ of the human body". This applies to
exterior surface, as it covers the body, appearing to have the largest surface area of all the
organs. Moreover, it applies to weight, as it weighs more than any single internal organ,
accounting for about 15 percent of body weight. For the average adult human, the skin
has a surface area of between 1.5-2.0 square meters; most of it is between 2-3 mm thick.
The average square inch of skin holds 650 sweat glands, 20 blood vessels, 60,000
melanocytes, and more than a thousand nerve endings of epithelial tissues that guard
underlying muscles and organs.

As the interface with the surroundings, skin plays the most important role in
protecting (the body) against pathogens. Its other main functions are insulation and
temperature regulation, sensation, and synthesis of vitamin D and vitamin B.

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 Severely damaged skin will try to heal by forming scar tissue, often giving rise to
discoloration and depigmentation of the skin.

Skin is composed of three primary layers: the epidermis, which provides

waterproofing and serves as a barrier to infection; the dermis, which serves as a location
for the appendages of skin; and the hypodermis (subcutaneous adipose layer), which is
called the basement membrane.

EPIDERMIS

Epidermis is the outermost layer of the skin. It forms the waterproof, protective
wrap over the body's surface and is made up of stratified squamous epithelium with an
underlying basal lamina.
The outermost epidermis consists of stratified squamous epithelium with an
underlying connective tissue section, or dermis, and a hypodermis, or basement
membrane. The epidermis contains no blood vessels, and cells in the deepest layers are
nourished by diffusion from blood capillaries extending to the upper layers of the dermis.
The main types of cells which make up the epidermis are keratinocytes, with melanocytes
and Langerhans cells are also present. The epidermis can be further subdivided into the
following strata (beginning with the outermost layer): corneum, lucidum (only in palms
of hands and bottoms of feet), granulosum, spinosum, basale. Cells are formed through
mitosis at the basale layer. The daughter cells move up the strata changing shape and
composition as they die due to isolation from their blood source. The cytoplasm is
released and the protein keratin is inserted. They eventually reach the corneum and
5
slough off (desquamation). This process is called keratinization and takes place within
about 30 days. This keratinized layer of skin is responsible for keeping water in the body
and keeping other harmful chemicals and pathogens out, making skin a natural barrier to
infection

Components

The epidermis contains no blood vessels, and is nourished by diffusion from the dermis.
The main types of cells which make up the epidermis are keratinocytes, melanocytes,
Langerhans cells and Merkels cells.

Layers & Sublayers

Epidermis is divided into the following 5 sublayers or strata:

 Stratum corneum
 Stratum lucidum
 Stratum granulosum
 Stratum spinosum
 Stratum germinativum (also called "stratum basale")

6
Stratum Corneum:

The stratum corneum ("the horny layer") is the outermost layer of the epidermis (the
outermost layer of the skin). It is composed mainly of dead cells that lack nuclei. As these
dead cells slough off, they are continuously replaced by new cells from the stratum
germinativum (basale). In the human forearm, for example, about 1300 cells/cm 2/hr are
shed and commonly accumulate as house dust.

Cells of the stratum corneum contain keratin, a protein that helps keep the skin hydrated
by preventing water evaporation. In addition, these cells can also absorb water, further
aiding in hydration and explaining why humans and other animals experience wrinkling
of the skin on the fingers and toes (colloquially called "pruning") when immersed in
water for prolonged periods.

The thickness of the stratum corneum varies according to the amount of protection and/or
grip required by a region of the body. For example, the hands are typically used to grasp
objects, requiring the palms to be covered with a thick stratum corneum. Similarly, the
sole of the foot is prone to injury, and so it is protected with a thick stratum corneum
layer. In general, the stratum corneum contains 15 to 20 layers of dead cells.

Stratum Lucidum:

The stratum lucidum (Latin for "clear layer") is a thin, clear layer of dead skin cells in the
epidermis, and is named for its translucent appearance under a microscope. It is found
beneath the stratum corneum of thick skin, such as that on the palms of the hands and the
soles of the feet. The keratinocytes of the stratum lucidum do not feature distinct
boundaries and are filled with eleidin, an intermediate form of keratin.

The cells of the stratum lucidum are flattened and contain an oily substance that is
thought to be the result of lysosome disintegration. It is this substance that gives the
stratum lucidum its waterproof properties and thus, it is also called the barrier layer of the
skin.

Stratum Granulosum:

In microscopic views of skin, the stratum granulosum layer of the epidermis lies between
the stratum spinosum below and the stratum lucidum above. This layer typically contains
1 to 3 rows of squamous cells with many small basophilic granules in their cytoplasm.

These keratohyalin granules are a step in the synthesis of the waterproofing protein
keratin, and contain large amounts of filaggrin.

This is the highest layer in the epidermis where living cells are found, the stratum
lucidum above appears clear due to auto-digestion of cellular organelles.

This layer also includes lamellar granules and tonofibrils

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Stratum spinoa:

In the skin, the stratum spinosum is a multi-layered arrangement of cuboidal cells that sits
beneath the stratum granulosum. Adjacent cells are joined by desmosomes giving them
the spiny appearance from which their name is derived. Their nuclei are often darkened
(a condition called pyknosis), which is an early sign of cell death. Their fate is sealed
because the nutrients and oxygen in interstitial fluid have become exhausted before the
fluid is able to reach them by diffusion.

Cells of the stratum spinosum actively synthesize intermediate filaments called

cytokeratins which are composed of keratin. These intermediate filaments are anchored to
the desmosomes joining adjacent cells to provide structural support, helping the skin
resist abrasion.

Stratum Basale:

Stratum germinativum (also stratum basale or basal cell layer) is the layer of
keratinocytes that lies at the base of the epidermis immediately above the dermis. It
consists of a single layer of tall, simple columnar epithelial cells lying on a basement
membrane. These cells undergo rapid cell division, mitosis to replenish the regular loss of
skin by shedding from the surface. About 25% of the cells are melanocytes, which
produce melanin which provides pigmentation for skin and hair.

DERMIS

The dermis is a layer of skin beneath the epidermis that consists of connective
tissue and cushions the body from stress and strain. The dermis is tightly connected to the
epidermis by a basement membrane. It also harbors many nerve endings that provide the
sense of touch and heat. It contains the hair follicles, sweat glands, sebaceous glands,
apocrine glands and blood vessels. The blood vessels in the dermis provide nourishment
and waste removal to its own cells as well as the Stratum basale of the epidermis

Structure

The dermis is structurally divided into two areas: a superficial area adjacent to the
epidermis, called the papillary region, and a deep thicker area known as the reticular
region.

Papillary region

The papillary region is composed of loose areolar connective tissue. It is named for its
fingerlike projections called papillae, that extend toward the epidermis. The papillae
provide the dermis with a "bumpy" surface that interdigitates with the epidermis,
strengthening the connection between the two layers of skin.

8
In the palms, fingers, soles, and toes, the influence of the papillae projecting into the
epidermis forms contours in the skin's surface. These are called friction ridges, because
they help the hand or foot to grasp by increasing friction. Friction ridges occur in patterns
that are genetically determined and are therefore unique to the individual, making it
possible to use fingerprints or footprints as a means of identification.

Reticular region

The reticular region lies deep in the papillary region and is usually much thicker. It is
composed of dense irregular connective tissue, and receives its name from the dense
concentration of collagenous, elastic, and reticular fibers that weave throughout it. These
protein fibers give the dermis its properties of strength, extensibility, and elasticity.

Located within the reticular region are also the hair root, sebaceous glands, sweat glands,
receptors, nails, and blood vessels. Tattoo ink is injected into the dermis. Stretch marks
from pregnancy are also located on the dermis.

SEBACEOUS GLAND

An oil gland is a sebaceous (or sebiferous) gland that secretes sebaceous matter. They are
mainly situated in the corium or true skin. True oil glands secrete matter through a duct.
Many creatures, as fish, e. g., have oil glands.

Ductless glands

Ductless glands situated internally are not true oil glands, however, fishermen will often
cleanse bottom-feeding fish such as carp by removing an internal organ (which is said to
be "the oil gland"). Ductless internal organs are called "glands," as well. Having no ducts,
they tend to store substances which give a disagreeable taste to a cooked fish. Removing

9
"the oil gland" from a carp prior to cooking removes some of the accumulated substances,
some of which may also be toxic or harmful to a person who eats fish.

THE HAIR ROOT

The root of the hair ends in an enlargement, the hair bulb, which is whiter in color and
softer in texture than the shaft, and is lodged in a follicular involution of the epidermis
called the hair follicle

At the base of the hair follicle are sensory nerve fibers that wrap around each hair bulb.
Bending the hair stimulates the nerve endings allowing a person to feel that the hair has
been moved. One of the main functions of hair is to act as a sensitive touch receptor.
Sebaceous glands are also associated with each hair follicle that produce an oily secretion
to help condition the hair and surrounding skin.

HYPODERMIS

The hypodermis is not part of the skin, and lies below the dermis. Its purpose is to
attach the skin to underlying bone and muscle as well as supplying it with blood vessels
and nerves. It consists of loose connective tissue and elastin. The main cell types are
fibroblasts, macrophages and adipocytes (the hypodermis contains 50% of body fat). Fat
serves as padding and insulation for the body.

Skin has pigmentation, or melanin, provided by melanocytes, which absorb some

of the potentially dangerous ultraviolet radiation in sunlight. It also contains DNA repair
enzymes which help to reverse UV damage, and people who lack the genes for these
enzymes suffer high rates of skin cancer.

Human skin pigmentation varies among populations in a striking manner. This

has sometimes led to the classification of people(s) on the basis of skin color.

The skin of black people has more variation in color from one part of the body to
another than does the skin of other racial groups, particularly the palms of the hands and
soles of the feet. Part of this is the result of the variations in the thickness of the skin or
different parts of the body. The thicker the skin, the more layers of cells with melanin in
them, and the darker the color. In addition, these parts of the body do not have melanin-
producing cells.

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 FUNCTIONS OF SKIN

Skin performs the following functions:

1. Protection: an anatomical barrier between the internal and external environment in

bodily defense; Langerhans cells in the skin are part of the adaptive immune
system.
2. Sensation: contains a variety of nerve endings that react to heat and cold, touch,
pressure, vibration, and tissue injury;
3. Heat regulation: the skin contains a blood supply far greater than its requirements
which allows precise control of energy loss by radiation, convection and
conduction to maintain blood flow and conserve heat. Erector pili muscles are
significant in animals.
4. Control of evaporation: the skin provides on. Dilated blood vessels increase
perfusion and heat loss while constricted vessels greatly reduce cutaneous a
relatively dry and impermeable barrier to fluid loss. Loss of this function
contributes to the massive fluid loss in burns.
5. Aesthetics and communication: others see our skin and can assess our mood,
physical state and attractiveness.
6. Storage and synthesis: acts as a storage centre for lipids and water, as well as a
means of synthesis of vitamin D and B by action of UV on certain parts of the
skin. This synthesis is linked to pigmentation, with darker skin producing more
vitamin B than D, and vice versa.
7. Excretion: The concentration of urea is 1/130th that of urine. Excretion by
sweating is at most a secondary function to temperature regulation.
8. Absorption: Oxygen, nitrogen and carbon dioxide can diffuse into the epidermis
in small amounts, some animals using their skin for their sole respiration organ. In
addition, medicine can be administered through the skin, by ointments or by
means of adhesive patch, such as the nicotine patch. The skin is an important site
of transport in many other organisms.

(Gray’s Anatomy-The anatomical basis of medicine and surgery. 38th edition ,

Churchill livingstone publications.)

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 ECZEMA - DEFINITION

Eczema is a distinctive pattern of inflammatory response of skin, induced by a

wide range of external and internal factors acting singly or in combination. The main
focus of damage is in the epidermis. The epidermal cells become separated by edema
fluid (spongiosis). Other signs of inflammation, including the accumulation of
inflammatory cells and vasodilatation are seen in the upper dermis immediately beneath
the epidermis.

The terms dermatitis and eczema are regarded by dermatologists as synonymous.

The term ‘Eczema’ is a Greek word: ‘Ec means out’ and ‘zeo means boil’. The whole
word implies ‘boil out’. The Hindustani name for eczema is ‘chambal’.

This type of response is provoked by a wide variety of stimuli including direct

injury from toxic chemicals and mechanical trauma and immunological reactions
although the cause of some eczematous disorders has not yet been discovered.

Eczema accounts for a very large proportion of all skin diseases. The
classification of the many clinical forms is difficult, because in so many cases multiple
etiological factors are implicated, and because two or more forms of eczema may be
present in the same patient, simultaneously or consecutively.

The skin of the atopic subject is exceptionally vulnerable to primary irritants

which may initiate or perpetuate atopic dermatitis, but shows no increased susceptibility
to allergic contact dermatitis. Lichen simplex is a characteristic atopic manifestation, but
also occurs in many individuals with no other sign of atopic state. Seborrhoeic dermatitis
may co exist with atopic dermatitis in infancy and especially at adolescence but neither
predisposes to the other.

Inappropriate treatment may superimpose a primary irritant dermatitis or allergic

contact dermatitis on lesions of other origin. Pyogenic infections may complicate any
eczema, as may infective dermatitis, though less commonly. These and other sequences
are more confusing in theory than in practice and a careful history and examination
usually allow a reliable assessment to be made.

(Roxburg’s common skin diseases by R. Mark- 16th edition – Reprint 1993 Publisher –
Chapman and hall medical.)

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 HISTOPATHOLOGY

The histopathological features of eczema reflect a dynamic sequence of changes

resulting from inflammation of the epidermis and the underlying dermal structures. These
vary with the intensity and stage of the eczematous process and are frequently modified
by secondary events such as trauma and infection.

Epidermal changes:

The essential feature is spongiosis, an intercellular epidermal edema that leads to

stretching and eventual rupture of the intercellular attachments with the formation of
‘primordial’ vesicles. These commonly occur in discrete foci and in the mid-epidermal
region. On the palms and soles the vesicles do not rupture easily and become large by
coalescence. There is variable infiltration of the epidermis by lymphocytes. Accelerated
epidermal activity leads to acanthosis but if spongiosis is intense, disintegration of the
suprapapillary epidermis may cause clefts to form to expose the underlying dermis.
In the sub acute stage spongiosis diminishes and increasing acanthosis is
associated with formation of a parakeratotic horny layer. This often contains layers if
dried-up serum and pyknotic nuclei of inflammatory cells. Later, the rete ridges become
elongated and broadened and hyperkeratosis replaces parakeratosis. The changes are then
those of lichenification.

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 Dermal changes:

Vascular dilatation may be the earliest change and is marked in all stages. The
papillary vessels are especially involved and in lichenification may become tortuous. The
infiltrate is predominantly lymphocytic, though polymorphs and eosinophils may occur in
very acute eczema and eosinophils in particular in eczematous drug eruptions. In the
presence of infection, polymorphs may invade the epidermis. In grossly lichenified
eczema, prurigo and exfoliative dermatitis, the infiltrate is mixed and may be so dense as
to simulate a granuloma.

Complications:

The trauma of rubbing or scratching may cause superficial erosions, hemorrhage

or sub epidermal fibrinoid changes. While some degree of lichenification is always
present during a prolonged attack of eczema, it is particularly prominent in atopic
dermatitis and has been referred to as ‘neurodermatitis reaction’. At times, extreme
hyperkeratosis and papillomatosis develop. With secondary infection, the formations of
follicular or subcorneal pustules simulate the appearance of impetigo, though typical
eczematous changes are still visible at the edges of the lesion.

Differential diagnosis:

The presence of the primordial vesicle and of parakeratosis are crucial to the
diagnosis and are always present at some stage or other in all lesions that are referred as
‘eczema’. But the dynamic nature of the changes and their modification by secondary
events may make histological diagnosis difficult. All the changes except for the
primordial vesicle may be found in burns or simple traumatic lesions of the skin.
The distinction between eczema and psoriasis can be especially difficult,
particularly on the palms and soles. The finding of Munro micro-abscesses is diagnostic.
The histological features of pityriasis rosea and of chronic superficial dermatitis
and pseudopara-psoriasis are those of eczema.

Changes in the various stages of eczema :

Acute: The histological picture is dominated by spongiosis and vesicle formation.

The intercellular edema may be diffuse but more commonly occurs in discrete foci and is
most intense in the mid-epidermal region. Loosening and disruption of the individual
Malpighian cells occur and some intracellular vacuolation may be found, with
displacement of the nucleus from the centre of the cell. Loose, shrunken epidermal cells
may resemble histiocytes. Vesiculation occurs as a result of further fluid accumulation
and detachment of cells. When this is intense, the appearances are those of reticular
degeneration. The vesicles and the edematous epidermis may be permeated by
mononuclear cells, chiefly monocytes.
On the palms and soles, the resistance of the thick stratum corneum delays the
rupture of the vesicles, which tend, in consequence, to become large and bullous by

14
coalescence. In the weeping stage, thinning or destruction of the suprapapillary epidermis
causes clefts, which may reach the underlying dermis.

Sub-acute: Spongiosis and vesiculation diminish and acanthosis increases. A

parakeratotic stratum corneum forms, which contains coagulated plasma and the pyknotic
nuclei of inflammatory cells. Later, the epidermal thickening becomes more marked and
the rete pegs more elongated and broadened. The appearances merge into those of
lichenification.

Chronic: Hyperkeratosis co-exists with areas of parakeratosis. Spongiosis and

vesiculation give rise to acanthosis. Cells no longer invade the epidermis but dermal
changes become more prominent.

Recovery: In uncomplicated eczema, where no secondary changes or fresh

attacks occur, the changes gradually regress to normal. Infection or the trauma of rubbing
or scratching obviously modifies the process.

The basis of pathological changes:

The changes in eczema have been described as a series of chain reactions which
take place in the epidermis and proceed from a primordial vesicle to the extrusion, after
more or less spongiosis and exocytosis, of a ‘parakeratotic scale’. All these, except the
primordial vesicle, can be found in burns or simple traumatic lesions of the skin.
Spongiosis and the presence of this intra-epidermal vesicle are therefore of paramount
importance in the histological diagnosis of all but the most chronic lesions.
In light and electron microscopic studies carried out on experimentally (patch
tested) produced allergic contact dermatitis; the earliest changes consist of vasodilatation
and extravasation of monocytes from the vessels, followed by spongiosis as they migrate
into the epidermis. This is in contrast to the findings in irritant dermatitis where primary
epidermal damage may progress to sub-epidermal blister formation.

(Textbook of Dermatology by Arthur Rook, D.S. Wilkinson – Volume 1, 3rd edition.

Blackwell scientific publications.)

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 AETIOLOGY

It is difficult to determine the exact cause of eczema as there are many different
types of eczema and each has its own causes. The causes of certain types of eczema
remain to be explained, though links with environmental factors and stress are being
explored.
No one really knows what causes eczema, however, we do know of certain things
that can cause eczema to "flare-up", or get worse. A flare-up occurs when the immune
system in people's skin overreacts to environmental or emotional triggers and causes
symptoms such as an itchy rash to appear.

Basically, two factors play role in causing eczema:

1) Allergic or sensitive skin
2) Exposure to allergen or irritant.

The general predisposing causes are-

1) Age: Usually occurs in infancy, at puberty, at menopause.
2) Familial: Personal or family history of allergy viz. asthma, eczema, hay fever etc.
3) Genetic: Predisposition in certain families.
4) Physical Debility: Predisposes by lowering resistance.
5) Climate extremes: Like heat, sun, dampness, severe cold etc.
6) Psychological stresses.

Precipitating, aggravating or exciting factors which causes eczema:

1) Irritant – physical, chemical or electrical.
2) Sensitizers – Plants, cosmetics, clothing, medicaments & occupational hazards.
3) External infections – streptococci, staphylococci, fungus etc.
4) Mental & emotional – conflicts, strains, stresses.
5) Internal septic focus – shedding toxins or causing bacteremia.
6) Diet & state of digestion.
7) Diathesis – allergic, xerodemic, hyperhydrotic, seborrhoeic.
8) Drugs.
9) State of local or general nutrition.
10) Climate – temperature & humidity.

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 CLASSIFICATION

Traditionally, eczematous disorders are divided into:

1) Endogenous (or constitutional) type

2) Exogenous type.

1) Endogenous type – In which the cause of the problem stems from the patient’s
inherent constitution rather than the environment.

2) Exogenous type – Which result from an external influence of same kind.

The division, in fact, is not that simple as endogenous eczema is often precipitated
or aggravated by external factors and exogenous eczema occurs more readily in patients
who have had endogenous eczema. The clinical picture of the eczematous diseases is
quite varied, depending on the nature of the provoking stimulus and the activity of the
process.

Morpho-clinical classification:

The morpho-clinical classification into acute, sub-acute and chronic phases helps
us decide about the prognosis and line of symptomatic treatment.

Acute Phase: Erythema, edema, vesiculation, oozing and crusting.

Sub-acute Phase: Erythema, hyper pigmented plaques with scaling and crusting.

Chronic Phase: Lichenification (a combination of thickening, hyperpigmentation and

prominent skin markings).

Most of the typical eczemas of moderate intensity start with acute phase morphological
features. This phase does not last long. In about a couple of weeks the lesions start to
heal. If the cause persists, and the eczema lasts over months or years, it becomes chronic.
This is the end result of all types of long standing eczemas. In between the acute and the
chronic phases, is the sub-acute phase. Acute eczema may pass through this phase before
it heals completely or becomes chronic.

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 TYPES OF ECZEMA :

TYPE SYNONYMS FREQUENCY / AGE REMARKS

GROUP

1)Atopic dermatitis - Neurodermatitis Very common, mostly Cause unknown but appears
- Besnier’s occurs in infants and to be immunologically
prurigo. the very young. mediated.
- Infantile eczema

2)Seborrhoeic - Infectious Very common, all age Probably has a microbial

dermatitis eczematoid groups. cause with overgrowth of
dermatitis normal skin flora being
responsible.

3) Discoid eczema - Nummular Uncommon, mainly in Cause unknown.

eczema middle-aged
individuals.

4) Lichen simplex - Circumscribed Quite common, Initial cause appears to be

chronicus neurodermatitis mainly in young and localized itch, causing an
middle aged adults. ‘itch-scratch cycle’.

5) Eczema - Ateatotic eczema Uncommon, restricted Low humidity and rigorous

craquelée to elderly. washing seem responsible.

6) Venous eczema - Stasis dermatitis Common in age group Multiple causes, common
- Gravitational that has gravitational variety is allergic contact
eczema syndrome. dermatitis to medicaments
used.

7) Allergic contact - Common in all adult Delayed hypersensitivity

dermatitis age groups save the response to a specific agent.
very old.
8) Primary irritant - Occupational Very common in all Both mechanical and
contact dermatitis dermatitis adult age groups save chemical trauma
‘Housewives the very elderly. responsible.
eczema’

9) Photosensitivity - Not uncommon, Both phototoxic and photo

eczema mainly in adults. allergic types occur.

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 Atopic Dermatitis of hand. Allergic contact dermatitis to nickel.

Discoid Eczema / Nummular eczema. Primary irritant dermatitis.

Gravitational Eczema/Stasis Dermatitis Seborrhoeic dermatitis

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ATOPIC DERMATITIS

Definition:
This is a very common, extremely itchy disorder of unknown cause that
characteristically but not invariably affects the face and flexures of infants , children ,
adolescents and young adults.
Persistent pruritus with secondary effects from scratching is characteristic of atopic
dermatitis.
The disorder mostly presents at three to five months of age (approximately 60%)
with 15-20% developing the disease before then and some 20-30% subsequently. A small
number of patients develop the disease in late childhood or early adult life. It affects both
the sexes equally and as far as is known, all racial and social groups. The only good thing
about atopic dermatitis is that it tends to improve and at every decade there are less
patients with the disease. It is said that some 75% of those troubled in early childhood are
free of atopic dermatitis by the age of 15years.

Clinical Features:

Signs & symptoms:

The major issue as far as this disease is concerned is itching. When the disorder is in
an ‘active phase’ the patient is constantly itchy and restless but subject to irregular
episodes of intense and quite disabling intensification of the pruritus. The itchiness is
made worse by changes in temperature, by rough clothing (such as woolens) and by
sundry other minor environmental alterations. This symptom greatly disturbs sleep.
Scratching results from the severe pruritus in all save infants under the age of two
months. In addition to scratching, patients with atopic dermatitis often rub the affected
itching parts – they frequently rub their eyes with the index finger knuckles. The
incessant scratching and rubbing results in considerable injury to the skin and the most
obvious of which is the simple linear scratch mark or excoriation. More significant than
the excoriation is the chronic thickening of the skin that results from the perpetual
scratching. This is also characterized by accentuation of the skin markings at the site
involved. The thickening and accentuation of the skin markings is known as
lichenification and is due to massive epidermal hypertrophy as well as edema and
inflammatory cell infiltrate in the upper dermis.
In many patients there is a widespread fine scaling of the skin surface described as
‘dryness’ or xeroderma , but which is not really a form of ichthyosis as sometimes
described incorrectly, but the results of the eczematous process itself. Another feature
sometimes incorrectly ascribed to ichthyosis is the presence of increased prominence of
the skin marking on the palms- the so-called hyper linear palms. Luckily these give rise
to no particular disability and the true cause is unknown. In the most severely affected
patients there is in addition a background pinkness of the skin as well as cracking and
fissuring at some sites because of the inelasticity of the abnormal stratum corneum.
The skin of the cheeks is often quite pale in contrast to the rest of the skin and this
feature, taken together with crease lines just below the eyes (known as Denny Morgan
folds) probably the result of continual rubbing, makes the facial appearance quite
characteristic.
20
 When the skin of the back of an atopic dermatitis patient is firmly stroked with a
blunt object such as a key, a white line results in some 70% of patients called ‘white
dermographism’. This is the reverse of the normal triple response and tends to disappear
when the condition improves. The cause of this paradoxical blanching is unknown but is
presumably similar to a blanching observed after intracutaneous injection of
methacholine or carbamyl choline into the skin of atopic dermatitis patients.

Sites affected:
The sites mostly affected are the flexures, particularly the antecubital and popliteal
fossa, the face and neck, the wrists and ankles, but truncal skin and indeed anywhere on
the skin surface can be involved. Because of the continual rubbing the nails tend to be
smooth and shiny and the eyelashes and eyebrows may be obviously deficient for the
same reason.

Clinical variants:
In patients with black skin there is a marked follicular component to the disorder in
which there are numerous follicular papules in affected areas. In lichenified areas in
black-skinned patients there may be irregular pigmentation with hyperpigmentation at
some sites and loss of pigment at other sites.
Some individuals lose their childhood eczema only to develop chronic palmar
eczema in later years. This is believed also to be a manifestation of atopic disease.

Associated disorders:
Patients with atopic dermatitis quite often also suffer from asthma. Approximately
30% of the atopic dermatitis patients will also have had asthma before their skin disorder
has healed. There is no particular synchronization and the worsening or remission of one
has no particular implication as far as the state of the other is concerned. Patients with
atopic dermatitis also have an increased prevalence of hay fever and once again the
activity of one seems to bear no particular relationship with the activity of the other.
Atopic dermatitis, asthma and hay fever seem to share pathogenetic mechanisms in
which aberrant immune processes play an important part. These three ‘atopic’ disorders
cluster in families and the tendency to one or the other or all is inherited in an as yet
uncharacterized way.
Other disorders that are said to occur more frequently in ‘atopic’ patients include
chronic urticaria and migraine. Alopecia areata occurs more often in atopic dermatitis
patients than normal control subjects and is more intractable when it does.
In addition to these associations, the skin of patients with atopic dermatitis is more
vulnerable to both chemical and mechanical trauma and has an unfortunate tendency to
develop irritant dermatitis.

Complications:
Patients with atopic dermatitis are frequently troubled by skin infections. The
appearance of pustules and the development of impetiginized areas represent pyococcal
infection and are the most frequent expression of this propensity. They are usually fairly
easily treated but tend to recur. Cellulitis may also develop, giving rise to fever and

21
systemic upset. Viral warts and mollusca contagion also occur more frequently and more
extensively than in normal subjects.
Patients with atopic dermatitis may also become seriously unwell if infected with the
human herpes simplex virus. Vesicles and vesicular pustules develop over large areas of
the skin surface producing severe systemic toxicity. Exudation and crusting contribute to
the discomfort but despite the dire appearance; patients usually recover spontaneously
after some 10-14 days.

SEBORRHOEIC DERMATITIS

Definition:
A common eczematous disorder that characteristically occurs in “hairy areas”, both
in the flexures and on the central parts of the trunk, and is now believed to be at least in
part due to overgrowth of the normal skin flora in the regions affected.
The condition is extremely common at all ages and in both sexes. Severe and
widespread seborrhoeic dermatitis is a particular problem for elderly men.

Clinical Features:

Signs and symptoms:

Reddened itching patches appear at the affected sites which may become either scaly
or exudative and crusted. Scaling is a common feature when the condition develops
insidiously and scaling lesions are the most frequently seen. Often mild scaling occurs
without erythema as it does, for example, on the scalp as ‘dandruff ’. When severe, the
eyebrows may be affected. Other facial areas may become involved such as the
nasolabial folds, the paranasal sites and the retro auricular folds. Scaling and erythema of
the eyelid margins (marginal blepharitis) may also occur. Another type of lesion seen in
seborrhoeic dermatitis is a form of folliculitis. This seborrhoeic folliculitis is marked by
the presence of sheets of small papules and papulopustules which if closely examined
seem to derive from the hair follicle in the region. At least in some of these patients the
usually commensal yeast-like micro-organism Pityrosporon ovale seems to have taken on
an aggressive role and to have been responsible for the inflammatory lesions seen.
The condition may also erupt suddenly and cause exudative lesions in the flexures.
This is especially prone to occur in the summer months in overweight individuals. In the
elderly, seborrhoeic dermatitis sometimes rapidly spreads, becoming generalized. This
‘erythrodermic’ picture is disabling but luckily quite uncommon.
The disorder causes considerable itchiness, as do all the eczematous disorders. It also
gives rise to soreness and much discomfort when it is exudative and affects the major
flexures.
The disorder has become notorious recently as a sign of AIDS and presumably this is
a result of the underlying immunosuppresion.
Left untreated, the condition waxes and wanes over many years. Indeed some
individuals seem curiously prone to develop lesions of seborrhoeic dermatitis and are
rarely free of one type or another over long periods.

22
Sites affected:
The facial sites include scalp, forehead, eyebrows, lash line, nasolabial folds, beard,
and the post auricular skin. Scaling patches occurring on the central chest and over the
upper back are less common now than they once were in middle-aged and elderly men.
Itchy erythematous areas occurring in the groins, especially in the overweight and
especially in middle-aged and elderly men are extremely common. When acute and
severe the condition becomes exudative and other flexural sites such as the axillae and
the umbilicus also become involved sometimes known as infectious eczematoid
dermatitis.

Differential Diagnosis:
In the groin area it is important to distinguish flexural psoriasis and ringworm
infection (tinea cruris). Ringworm rashes are usually asymmetrical and don’t reach up
right into the groin apices. There is usually a raised advancing edge to ringworm and a
tendency to clear centrally. Mycological testing is so simple and useful and the results of
misdiagnosis so embarrassing that all should become proficient at skin scraping and
recognition of fungal mycelium. Rarely, Hailey-Hailey disease (chronic benign familial
pemphigus) presents with persistent exudative lesions that may resemble seborrhoeic
dermatitis.
A rash diagnosed as seborrhoeic dermatitis in infancy is now thought by some to be a
form of atopic dermatitis, ‘Cradle cap’ occurring in the newborn is probably not related
to proper seborrhoeic dermatitis but represents a minor transient abnormality of
desquamation from the scalp.

DISCOID ECZEMA (syn. NUMMULAR ECZEMA)

Definition:
Discoid eczema is a quite common eczematous disorder of unknown cause
distinguished by the appearance of reddened scaling rounded areas on the arms and legs.
It is one of the less common eczematous conditions but is by no means rare. It is
most common in the middle aged and elderly. The condition is not as persistent as many
types of eczema and is not usually troublesome after a few months.

Clinical Features:

Signs and symptoms:

Slightly raised, pink-red scaly discs, varying in diameter from 1 to 4 cm, appear on
the arms and legs and less frequently on the trunk. The disorder is usually quite itchy but
not usually as itchy as many other eczematous disorders. It is not usually acute and
exudative, but can be. The skin on the arms and legs often shows dryness as well.

Differential Diagnosis:
The condition has to be distinguished from psoriasis, in which the margins are
more distinct, from ringworm, which usually spreads peripherally and has a raised

23
margin, and from Bowen’s disease, which is mostly restricted to the light exposed areas
and is usually one or two solitary red scaling patches.

ECZEMA CRAQUELÉE (syn. ASTEATOTIC ECZEMA) :

Definition:
Eczema craquelée is an uncommon eczematous disorder that occurs on the
extensor aspects of the limbs of elderly subjects and is characterized by a ‘crazed’ and
fissured appearance.
The disorder is restricted to the elderly and is mainly seen in the newly
hospitalized or institutionalized individual when there is low ambient relative humidity
and after unaccustomed vigorous bathing. The condition persists if untreated but rapidly
remits with the treatment.

Clinical Features:

Signs and symptoms:

The most common affected sites are the shins, but the sides of the thighs and
extensor aspects of the upper arms and forearms, as well as the back, are all sometimes
involved. Involved skin is pink, roughened and superficially fissured, giving a crazed
appearance. The areas affected are more sore than itchy. The condition has a very
characteristic appearance and it is uncommon for it to be mistaken for any other disorder.

LICHEN SIMPLEX CHRONICUS (syn. CIRCUMSCRIBED

NEURODERMATITIS):

Definition:
This is a disorder localized to one or, less frequently, two or more sites that is
intensely pruritic and is characterized by thickening and exaggeration of skin markings
on the surface.
This not uncommon condition is mainly seen in tense and anxious middle-aged
subjects of both sex and all races.

Clinical Features:

Signs and symptoms:

Some areas seem predisposed to the development of lichen simplex chronicus
(LCS) including the medial aspect of the ankle, the back of the scalp, the extensor aspects
of the forearms around the wrists, and the genitalia. The condition is extremely itchy and
patients complain bitterly about the intense local irritation that they experience.
The lesions are characteristically raised irregular red plaques with a well-defined
margin which have exaggerated skin markings (lichenification) over the scaling surface.
If the itching is persistent and intense and the resultant scratching vigorous, the affected
sites may become very thickened, raised and excoriated. The resultant lesion is known as
a prurigo nodule and unlike LSC many such nodules may occur over the skin in an
uncommon disorder known as prurigo nodularis.
24
Differential Diagnosis:
Hypertrophic lichen planus may be difficult to distinguish although this disorder
tends to be more mauve and be less regularly lichenified than LSC. Biopsy may be
needed to distinguish these disorders with certainty. Lichen simplex chronicus may also
resemble a patch of psoriasis although the distinct lichenification of LSC should
distinguish it.

CONTACT DERMATITIS:

This term is used to describe an eczematous rash developing as a result of

contacting injurious materials. These materials may injure by a direct toxic action on the
skin or may induce an immunological reaction of delayed hypersensitivity type. The
former is known as a primary irritant contact dermatitis. The latter is allergic contact
hypersensitivity. They may be difficult to distinguish clinically. Both types of contact
dermatitis are common and extremely important as they cause a great deal of loss of work
and disability.

PRIMARY IRRITANT DERMATITIS:

Definition:
Primary irritant dermatitis is an eczematous rash that results from direct contact
with toxic ‘irritating’ materials.

Clinical Features:
Scaly red and fissured areas appear on the irritated skin. The hands are the most
frequently affected. The palmar skin and the palmar surfaces of the fingers are often
affected but the areas between the fingers and elsewhere on the hands may also be
involved. The condition may become exudative and very inflamed if the substances
contacted are very toxic.
This form of contact dermatitis causes considerable soreness and irritates. The
fissures make movement very difficult and effectively disable the victims.

Differential Diagnosis:
The condition must be distinguished from allergic contact dermatitis by a
carefully taken history and patch testing. Psoriasis of the palms may resemble contact
dermatitis but is usually accompanied by signs of psoriasis elsewhere and distinguished
by having an easily discernible margin.
Ringworm usually affects one palm only and is marked by diffuse erythema and
silvery scaling. Of there is any doubt, scales should be examined for fungal mycelium
under the microscope.

25
ALLERGIC CONTACT DERMATITIS:

Definition:
Allergic contact dermatitis is an eczematous rash that develops after contact with
an agent to which delayed (cellular) hypersensitivity has developed.
Allergic contact dermatitis is not as prevalent as primary irritant dermatitis but is
nonetheless quite common. It is rare in children and less common in black skinned
individuals.

Clinical Features:
The rash develops at the sites of skin contact with the ‘allergen’ but occasionally
spreads outside these limits for unknown reasons. The vigor and speed of the reaction
vary enormously depending on the particular individual. When very acute, the reaction
develops within a few hours of contacting the responsible substance-such a speedy
response is seen, for example, in the condition of ‘poison ivy’ which is common in the
USA. Itching is noticed at first and then the area involved becomes red, swollen and
vesicular. Later the area becomes scaling & fissured.
An enormous number of substances are potentially capable of causing
‘sensitization’ so that allergic contact dermatitis develops after contact with these
materials. Nickel dermatitis is one of the commonest examples of allergic contact
dermatitis. Patients who are nickel sensitive may also react to ‘dichromate’ and other
chromate salts.
Other examples of allergy of this type include allergy to chemicals rubber, for
example, mercaptobenzthiazole (MBT) and thiouram, and to formalin. These allergies
may cause dermatitis when wearing particular clothes, as indeed may sensitivities to
dyes.
Allergies to lanolin (in sheepwool fat and used in many ointments and creams)
and to perfumes, can cause dermatitis. Dyes can also be cause of allergic contact
dermatitis. Plants such as garlic & flowers such as primulas and chrysanthemums often
sensitize as well.

VENOUS ECZEMA (syn. GRAVITATIONAL ECZEMA; STASIS

DERMATITIS):

Definition:
This is an eczematous disorder occurring predominantly on the lower legs in
individuals with chronic venous hypertension.

Clinical Features:
Itchy pink scaling areas which become exudative and fissured intermittently
develop on a background of the changes of chronic venous hypertension. The affected
areas are often around venous ulcers but the margins of the eczematous process are
poorly defined. Occasionally the process spreads to the contra lateral leg and even to the
thighs and arms.
(Roxburg’s common skin diseases by R. Mark- 16 th edition – Reprint 1993 Publisher –
Chapman and hall medical.)
26
27
 INVESTIGATIONS

Even though eczema cannot be fixed with any tests, tests can rule out other
diseases to fix the complaint as eczema. Eczema can be fixed with its close relation to
allergic problem and wheezing. Other than routine blood tests Tc, Dc, ESR, Hb, absolute
eosinophil count, blood sugar, etc., skin swab and culture may be necessary to rule out
other complaints. Allergy test (patch or prick test) are also often evaluated to note
allergens that need to be avoided.

1) Patch test :

 These are performed in suspected cases of contact allergic dermatitis. It detects a

type IV (delayed or cell mediated) hypersensitivity. It is common practice for a
battery of round 20 common antigens, which include nickel, rubber & fragrance
mix to be applied to the skin of the back under the aluminum disc for 48 hours.
 The sites are then examined for positive reaction 24 hours later & possibly again a
further 24 hours later. An eczematous reaction in absence of an irritant reaction,
suggest a type IV hypersensitivity to that particular allergen.
 A negative patch test doesn’t exclude a pathogenic role for a particular antigen
nor for the presence of a particular response to an antigen means that this antigen
is causing the clinical disease.

2) IgE & Specific IgE test:

 These are occasionally performed to support the diagnosis of atopic eczema & to
determine specific environmental allergens, eg. pet dander, horse hair, house dust,
mite, pollen & foods.

3) Prick Test:

 Indication same as for the specific IgE but is less commonly performed.
 This test is way of detecting the cutaneous type I (immediate hypersensitivity to
various antigens such as pollen, house dust, mite or dander.)
 The skin is pricked with commercially available stylets through a dilution of
appropriate antigen solution. After 10 minutes a positive response is indicated by
a weal & flare. The weal is due to a local capillary permeability & the flare is a
result of activation of the axon reflex. A positive control (histamine) & a negative
control (antigen diluents) should be performed.

4) Bacterial & viral swab for microscopy & culture:

 Useful in suspected secondary infection.

28
 Skin swab for bacteriological assessment will invariably reveal the presence of
bacteria & antibacterial treatment should be reserved for those with evidence of
clinical infection.
 In case of recurrent impetigo in a child with atopic eczema, bacterial swab should
be taken from carrier sites (nares, axillae & groin) from both the affected
individual & all household members.

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 COMPLICATIONS

 Infection with staphylococcus or Streptococcus (‘impetiginisation’); Herpes

simplex (‘eczema herpeticum’); fungi; molluscum contagiosum; human
papilloma virus (warts).
 Fissures (causing pain+++), can lead to loss of function and significant
disability.
 Chronic eczema formation – ‘prurigo nodularis’.
 ‘Lichen amyloidosis’ – amyloid deposition due to chronic rubbing and
scratching.
 Post inflammatory hyperpigmentation or hypo pigmentation.
 Scarring following excoriation and/or infection.
 Beau’s lines due to proximal nail fold eczema.
 Complications due to eczema treatments e.g. steroid induced atopy and striae,
cataract formation.
 Loss of quality of life (to individual and family).
 Significant morbidity and cost to individual and society.
 Decreased quality of life of patient & parent/family.
 Impaired learning/days off school.
 Failure to thrive/growth delay.
 Depression & other behavioral difficulties.
 Days off work.
 Financial costs of treatment.
 Occupational eczema – can mean a change of career required if very severe.
 In children there is an increased incidence of food allergy, particularly egg’s
cow’s milk, protein, fish, wheat & soya. These foods cause an immediate
urticarial eruption rather exacerbating their eczema.

30
 ALLOPATHIC MANAGEMENT

GOALS FOR THE TREATMENT OF ECZEMA:

Most treatment plans involve two main components:

1. Healing the skin (through topical or oral medications) and
2. Preventing new flare ups from occurring through moisturizing skin lotions and life-
style management.

Thus the treatment may involve both lifestyle changes and the use of medications.
Treatment is always based upon an individual’s age, overall health status, and the type
and severity of the condition.

Conservative treatment:
Keeping the skin well hydrated through the application of creams (with a low
water and high oil content) can promote healing and retain natural moisture. This is the
most important self-care treatment that one can use in eczema.
The use of anything that may dry out the skin or that remove the natural oils from
the skin should be discontinued.
Soap removes dirt but also removes natural oils from the skin; making the skin
dry, irritated and itchy. The removal of soap altogether and the use of soap-free body
washes will maintain natural skin oils and may reduce some of the need to moisturize the
skin.
Lifestyle modifications to avoid triggers for the condition are also recommended.

Anti-histaminic therapy:
If itching is severe, oral antihistamines may be prescribed. To control itching, the
sedative type antihistamine drugs (e.g. diphenhydramine, hydroxyzine, and
(cyproheptadine) appear to be most effective. The reduced scratching in turn reduces
damage & irritation to the skin.

Corticosteroid treatment:
Corticosteroid creams are sometimes prescribed to decrease the inflammatory
reaction in the skin. Corticosteroids do not cure eczema, but are highly effective in
controlling or suppressing symptoms in most cases. These may be mild-, medium-, or
high-potency corticosteroid creams, depending upon the severity of the symptoms.
In some cases, a short course of oral corticosteroids (such as prednisone) is
prescribed to control an acute outbreak of eczema, although their long-term use is
discouraged in the treatment of this non life-threatening condition because of unpleasant
and potentially harmful side effects.
Because of the risks associated with this type of drug, a steroid of an appropriate
strength should be sparingly applied only to control an episode of eczema. Once the
desired response has been achieved, it should be discontinued and replaced with
emollients as maintenance therapy. Corticosteroids are generally considered safe to use in

31
the short- to medium-term for controlling eczema, with no significant side effects
differing from treatment with non-steroidal ointment.

Immunomodulators:
The oral immunosuppressant drug cyclosporine has also been used to treat some
cases of eczema. They effectively suppress the immune system in the affected area, and
appear to yield better results in some populations.

Antibiotics:
The disruption to the skin's normal barrier protection through dry and cracked
skin allows easy entry for bacteria. Scratching by the patient both introduces infection
and spreads it from one area to another. Any skin infection further irritates the skin and a
rapid deterioration in the condition may ensue; the appropriate antibiotic should be given.

Light therapy:
Ultraviolet light therapy (phototherapy) is another treatment option for some
people with eczema.

Finally, two topical (cream) medications have been approved by the U.S. FDA for the
treatment of eczema, tacrolimus (Protopic) and pimecrolimus (Elidel). These drugs
belong to a class of immune suppressant drugs known as calcineurin inhibitors. In 2006,
the FDA issued a warning about the use of these drugs, citing studies in animals that
showed a possible association between use of these drugs and the development of certain
types of cancer. It is recommended that these drugs only be used as second-line therapy
for cases that are unresponsive to other forms of treatment, and that their use be limited to
short time periods, and the minimum time periods needed to control symptoms. Use of
these drugs should also be limited in people who have compromised immune systems.

32
 PREVENTION: DO’S & DONT’S

Taking care of the skin in a simple manner can prevent triggers and flare-ups.

DO’S:

 Control scratching. Try not to scratch the irritated area on your skin even if it
itches. Scratching can break the skin. Bacteria can enter these breaks and cause
infection.
 Keep nails short and trim.
 Maintain personal hygiene by proper washing & cleaning the skin.
 Wash and keep the parts clean. Because soaps and wetness can cause skin
irritation, wash your hands only when necessary, especially if you have eczema
on your hands. Be sure to dry your hands completely after you wash them.
 Bathe only with a mild soap. Then use a soft towel to pat your skin dry without
rubbing. Immediately after drying, apply a moisturizer to your skin. This helps
seal in the moisture.
 Use moisturizer to avoid dryness of skin especially in winter. Moisturizers help
keep your skin soft and flexible. They prevent skin cracks. A plain moisturizer is
best. Avoid moisturizers with fragrances (perfume) and a lot of extra ingredients.
A good, cheap moisturizer is plain petroleum jelly (such as Vaseline). Use
moisturizers that are more greasy than creamy, because creams usually have more
preservatives in them. Regular use of a moisturizer can help prevent the dry skin
that is common in winter.
 Dry the sweat fast.

AVOID

 Irritants or allergic substances – food / pollens / chemicals / drugs. Try to avoid

contact with things that may irritate your skin that make you break out with
eczema.
 Long time exposure of extreme temperatures / direct sunlight.
 Swimming pool water. The chemicals in swimming pool water can cause flare
ups for some people. Avoid pools if this is a problem for you.
 Excessive sweating. Too much heat and sweat can make your skin more irritated
and itchy. Try to avoid activities that make you hot and sweaty.
 Cosmetics - strong soaps, powders, perfumes
 Stimulants - coffee, alcohol, smoking & chewing tobacco.
 Preservative added tin-packed foods / drinks.
 Animal proteins i.e. meat, fish, egg, also mil in high concentration.
 High sugars, i.e. chocolate, pastry, cakes.
 Emotional or mental stress. Eczema can flare up when you are under stress. Learn
how to recognize and cope with stress. Stress reduction techniques can help.
Changing your activities to reduce daily stress can also be helpful.
 Unnecessary medication
33
  Woolen clothes. Wool and some synthetic fabrics can irritate your skin. Most
people with sensitive skin feel better in clothes made of cotton or a cotton blend.

TAKE

 A lot of water to maintain good hydration.

 Diet should be simple; salt and fluids should be cut down. Sattvik (vegetarian
food without spices and beverages like tea, coffee, alcohol) is helpful in bad
cases. In acute disseminated eczemas, it is advisable to put the patient on light
food for a few days to help the body get rid of toxic substances. In allergic
eczemas, eliminative diets may be tried.
 Fresh fruits and vegetables for healthy skin especially carrot, apple, pineapple,
papaya, cherry, ginger, beetroot and spinach. 
 Vitamins A, C and zinc supplements for healthy skin.

REASSURANCE TO THE PATIENT:

Reassuring the patient and his relatives about the disease being curable, non-
infectious and non-scarring is important. A patient with chronic eczema naturally worries
about the chronic nature of his illness, the expense of treatment and the loss of income
because of his inability to work.
Hence reassurance on all these accounts is very important in winning his
confidence, and thus his co- operation in treatment. Tactful bedside psychotherapy pays
dividends in all cases.

(Diseases of the Skin by Dr. Farokh J. Master- Reprint 1994, B. Jain Publishers.)

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 HOMOEOPATHIC APPROACH

 PSYCHOSOMATIC RELATION

 APHORISMS FROM ORGANON OF MEDICINE

 HOMOEOPATHIC MANAGEMENT

 MIASMS

 SUSCEPTIBILITY

 POSOLOGY

35
 PSYCOSOMATIC RELATION

There is no line that can be drawn between the physical and the mental/emotional
processes. They are inextricable linked and cannot be separated.
How can the body & mind be separate when ‘fear causes a white face’, ‘anger causes a
red face’ and ‘sadness causes a wet face’?
Every physical disharmony is accompanied by a change in the mental/emotional
sphere and vice-versa i.e. any mental/emotional state, especially if profound or of long
duration is capable of causing physical ill health and any physical disease is bound to
result in a change in the mental/emotional state, this is true in both acute and chronic
illness.
The situation of the skin at the interface of the organism and its environment
probably accounts for its very early recognition as an important somatic sounding board
for the emotions. As the organ system most visible to inspection, the skin serves as a
mirror of emotional states. Because of its rich endowment with sense receptors for pain,
touch and temperature sensations, the skin becomes the matrix for the body ego.

Pruritus:
Anxious and tense individuals or a normally well adjusted individual at times of
anxiety and tension may be more conscious than usual of itching sensations from a given
lesion. Guilt, anger, boredom, irritation and sexual arousal may all predispose the
individual to itching and subsequent scratching.
The emotions that most frequently lead to generalized psychogenic pruritus are
repressed anger and repressed anxiety. An almost irresistible urge to scratch one results
from the itching impulse. Whenever persons consciously or preconsciously experience
anger or anxiety, they scratch themselves, often violently. An inordinate need for
affection is a common characteristic of these patients. Frustrations of this need elicit
aggressiveness that is inhibited. The rubbing of the skin provides a substitute gratification
of the frustrated need and the scratching represents aggression turned against the self.
The touch system is related to and sub serves ego functioning. Responses of
normal adaptation appear related to optimum balance between erotic, instinctual life and
ego control, insofar as this can be reflected in the skin. Reactions of no adaptation ( all
itch and tickle) indicate excessive emotionality and deficient control. Reactions of touch
only are correlated with attempts at excessive and rigid control of affects.
Scratching evidently derives from reflexive movements that serve to clear the skin
of irritants. In humans it may be both painful and highly pleasurable and may thus serve
both self-punitive and auto-erotic purposes.

Eczema:
Of the many diseases in the eczema-dermatitis group, atopic dermatitis has long
been regarded as the one most strongly influenced by the emotional life. It is usually
accompanied by itching that often appears disproportionate in severity to the visible
lesions. This condition is found in both a childhood and an adult form, both frequently
appearing in the same individual with an intervening period of several years. The term
36
‘atopic’ signifies that it is regarded as an allergic disorder, but the specific
interrelationship of allergic and emotional factors is far from clear.
A study of events and circumstances at onset reveals a preponderance of
emotionally significant events. The literature abounds with references to the appearance
of atopic dermatitis following an emotional disturbance. In 77 of 90 patients studied by
Wittkower and Edgell, events of a disturbing nature preceded the onset of dermatitis, and
147 episodes were discerned in which onset, relapses or aggravations were clearly related
to emotionally disturbing situations. The recurring theme that seems to pervade all the
varieties of precipitating events is that of loss of love. This can be undisguised or so
heavily disguised as to be indistinguishable as such until one is well acquainted with the
history and dynamics of the individual.
Patients studied by Wittkower and Edgell felt that they had not had their fair share
of affection as children and tended to maintain in adult life an inordinate childlike
dependence on their parents, in most cases the mother. For some, a need for affection,
attention and support found its expression in a submissive, docile or even overtly helpless
attitude. In others, the same need was concealed behind self-assertive, ambitious or even
provocative behavior. For many, the lack of self-confidence impaired their social and
occupational progress. Many remained single or married partners who appeared to serve
as parent substitutes.
Wittkower and Hunt studied atopic dermatitis in children. Scrutiny of the child-
parent relationships stressed the factor of maternal rejection, a rejection that could be
either overt or disguised beneath a reaction formation of intense over protectiveness.
Abramson referred to an engulfing attitude in the parents of eczematous children wherein
the parent demands narcissistic satisfaction, regardless of any danger to the child. Thus,
simply stated, in somatically susceptible individuals rendered emotionally vulnerable by
childhood experience, events that reactivate feelings of longing for love are found to
precipitate the onset and exacerbations of atopic dermatitis.

(Comprehensive textbook of Psychiatry edited by Harold I. Kaplan (M.D.) , Alfred

M. Freedman , Benjamin J. Sadock. Publiction- Williams & Wilkins.)

37
 APHORISMS FROM ORGANON OF MEDICINE

6TH EDITION

§ 185

Among the one-sided disease an important place is occupied by the so-called local
maladies, by which term is signified those changes and ailments that appear on the
external parts of the body. Till now the idea prevalent in the schools was that these parts
were alone morbidly affected, and that the rest of the body did not participate in the
disease - a theoretical, absurd doctrine, which has led to the most disastrous medical
treatment.

§ 186

Those so-called local maladies which have been produced a short time previously,
solely by an external lesion; still appear at first sight to deserve the name of local
disease. But then the lesion must be very trivial, and in that case it would be of no great
moment. For in the case of injuries accruing to the body from without, if they be at all
severe, the whole living organism sympathizes; there occur fever, etc. The treatment of
such diseases is relegated to surgery; but this is right only in so far as the affected parts
require mechanical aid, whereby the external obstacles to the cure, which can only be
expected to take place by the agency of the vital force, may be removed by mechanical
means, e.g., by the reduction of dislocations, by needles and bandages to bring together
the lips of wounds, by mechanical pressure to still the flow of blood from open arteries,
by the extraction of foreign bodies that have penetrated into the living parts, by making
an opening into a cavity of the body in order to remove an irritating substance or to
procure the evacuation of effusions or collections of fluids, by bringing into apposition
the broken extremities of a fractured bone and retaining them in exact contact by an
appropriate bandage, etc. But when in such injuries the whole living organism requires,
as it always does, active dynamic aid to put it in a position to accomplish the work of
healing, e.g. when the violent fever resulting from extensive contusions, lacerated
muscles, tendons and blood-vessels requires to be removed by medicine given
internally, or when the external pain of scalded or burnt parts needs to be
homoeopathically subdued, then the services of the dynamic physician and his helpful
homoeopathy come into requisition.

§ 187

But those affections, alterations and ailments appearing on the external parts, that do not
arise from any external injury or that have only some slight external wound for their
immediate exciting cause, are produced in quite another manner; their source lies in
some internal malady. To consider them as mere local affections, and at the same time
to treat them only, or almost only, as it were surgically, with topical applications - as the
38
old school have done from the remotest ages - is as absurd as it is pernicious in its
results.

 § 188

These affections were considered to be merely topical, and were therefore called local
diseases, as if they were maladies exclusively limited to those parts wherein the
organism took little or no part, or affections of these particular visible parts of which the
rest of the living organism, so to speak, knew nothing.1

1 One of the many great and pernicious blunders of the old school.

§ 189

And yet very little reflection will suffice to convince us that no external malady (not
occasioned by some important injury from without) can arise, persist or even grow
worse without some internal cause, without the co-operation of the whole organism,
which must consequently be in a diseased state. It could not make its appearance at all
without the consent of the whole of the rest of the health, and without the participation
of the rest of the living whole (of the vital force that pervades all the other sensitive and
irritable parts of the organism); indeed, it is impossible to conceive its production
without the instrumentality of the whole (deranged) life; so intimately are all parts of
the organism connected together to form an indivisible whole in sensation and
functions. No eruption on the lips, no whitlow can occur without previous and
simultaneous internal ill-health.

§ 190

All true medical treatment of a disease on the external parts of the body that has
occurred from little or no injury from without must, therefore, be directed against the
whole, must effect the annihilation and cure of the general malady by means of internal
remedies, if it is wished that the treatment should be judicious, sure, efficacious and
radical.

§ 191

This is confirmed in the most unambiguous manner by experience, which shows in all
cases that every powerful internal medicine immediately after its ingestion causes
important changes in the general health of such a patient, and particularly in the affected
external parts (which the ordinary medical school regards as quite isolated), even in a
39
so-called local disease of the most external parts of the body, and the change it produces
is most salutary, being the restoration to health of the entire body, along with the
disappearance of the external affection (without the aid of any external remedy),
provided the internal remedy directed towards the whole state was suitable chosen in a
homoeopathic sense.

§ 192

This is best effected when, in the investigation of the case of disease, along with the
exact character of the local affection, all the changes, sufferings and symptoms
observable in the patient's health, and which may have been previously noticed when no
medicines had been used, are taken in conjunction to form a complete picture of the
disease before searching among the medicines, whose peculiar pathogenetic effects are
known, for a remedy corresponding to the totality of the symptoms, so that the selection
may be truly homoeopathic.

§ 193

By means of this medicine, employed only internally (and, if the disease be but of
recent origin, often by the very first dose of it), the general morbid state of the body is
removed along with the local affection, and the latter is cured at the same time as the
former, proving that the local affection depended solely on a disease of the rest of the
body, and should only be regarded as an inseparable part of the whole, as one of the
most considerable and striking symptoms of the whole disease.

§ 194

It is not useful, either in acute local diseases of recent origin or in local affections that
have already existed a long time, to rub in or apply externally to the spot an external
remedy, even though it be the specific and, when used internally, salutary by reason of
its homoeopathicity, even although it should be at the same time administered
internally; for the acute topical affections (e.g., inflammations of the individual parts,
erysipelas, etc.), which have not been caused by external injury of proportionate
violence, but by dynamic or internal causes, yield most surely to internal remedies
homoeopathically adapted to the perceptible state of the health present in the exterior
and interior, selected from the general store of proved medicines,1 and generally without
40
any other aid; but if these diseases do not yield to them completely, and if there still
remain in the affected spot and in the whole state, notwithstanding good regimen, a relic
of disease which the vital force is not competent to restore to the normal state, then the
acute disease was (as not infrequently happens) a product of psora which had hitherto
remained latent in the interior, but has now burst forth and is on the point of developing
into a palpable chronic disease.

§ 195

In order to effect a radical cure in such cases, which are by no means rare, after the
acute state has pretty well subsided, an appropriate anti psoric treatment (as is taught in
my work on Chronic Diseases) must then be directed against the symptoms that still
remain and the morbid state of health to which the patient was previously subject. In
chronic local maladies that are not obviously venereal, the anti psoric internal treatment
is, moreover, alone requisite.

§ 196

It might, indeed, seen as though the cure of such diseases would be hastened by
employing the medicinal substance which is known to be truly homoeopathic to the
totality of the symptoms, not only internally, but also externally, because the action of a
medicine applied to the seat of the local affection might effect a more rapid change in it.

§ 197

This treatment, however, is quite inadmissible, not only for the local symptoms arising
from the miasm of psora, but also and especially for those originating in the miasm of
syphilis or sycosis, for the simultaneous local application, along with the internal
employment, of the remedy in diseases whose chief symptom is a constant local
affection, has this great disadvantage, that, by such a topical application, this chief
symptom (local affection)1 will usually be annihilated sooner than the internal disease,
and we shall now be deceived by the semblance of a perfect cure; or at least it will be
difficult, and in some cases impossible, to determine, from the premature disappearance
of the local symptom, if the general disease is destroyed by the simultaneous
employment of the internal medicine.

41
1Recent itch eruption, chancre, condylomata, as I have indicated in my book of
Chronic Diseases.

§ 198

The mere topical employment of medicines, that are powerful for cure when given
internally, to the local symptoms of chronic miasmatic diseases is for the same reason
quite inadmissible; for if the local affection of the chronic disease be only removed
locally and in a one-sided manner, the internal treatment indispensable for the complete
restoration of the health remains in dubious obscurity; the chief symptom (the local
affection) is gone, and there remain only the other, less distinguishable symptoms,
which are less constant and less persistent than the local affection, and frequently not
sufficiently peculiar and too slightly characteristic to display after that, a picture of the
disease in clear and peculiar outlines.

§ 199

If the remedy perfectly homoeopathic to the disease had not yet been discovered1 at the
time when the local symptoms were destroyed by a corrosive or desiccative external
remedy or by the knife, then the case becomes much more difficult on account of the
too indefinite (uncharacteristic) and inconstant appearance of the remaining symptoms;
for what might have contributed most to determine the selection of the most suitable
remedy, and its internal employment until the disease should have been completely
annihilated, namely, the external principal symptom, has been removed from our
observation.

1 As was the case before my time with the remedies for the condylomatous disease (and
the anti psoric medicines).

§ 200

Had it still been present to guide the internal treatment, the homoeopathic remedy for
the whole disease might have been discovered, and had that been found, the persistence
of the local affection during its internal employment would have shown that the cure
was not yet completed; but were it cured on its seat, this would be a convincing proof
that the disease was completely eradicated, and the desired recovery from the entire
disease was fully accomplished - an inestimable, indispensable advantage to reach a
perfect cure.

42
 § 201

It is evident that man's vital force, when encumbered with a chronic disease which it is
unable to overcome by its own powers instinctively, adopts the plan of developing a
local malady on some external part, solely for this object, that by making and keeping in
a diseased state this part which is not indispensable to human life, it may thereby silence
the internal disease, which otherwise threatens to destroy the vital organs (and to
deprive the patient of life), and that it may thereby, so to speak, transfer the internal
disease to the vicarious local affection and, as it were, draw it thither. The presence of
the local affection thus silences, for a time, the internal disease, though without being
able either to cure it or to diminish it materially.1 The local affection, however, is never
anything else than a part of the general disease, but a part of it increased all in one
direction by the organic vital force, and transferred to a less dangerous (external) part of
the body, in order to allay the internal ailment. But (as has been said) by this local
symptom that silences the internal disease, so far from anything being gained by the
vital force towards diminishing or curing the whole malady, the internal disease, on the
contrary, continues, in spite of it, gradually to increase and Nature is constrained to
enlarge and aggravate the local symptom always more and more, in order that it may
still suffice as a substitute for the increased internal disease and may still keep it under.
Old ulcers on the legs get worse as long as the internal psora is uncured, the chancre
enlarges as long as the internal syphilis remains uncured, the fig warts increased and
grow while the sycosis is not cured whereby the latter is rendered more and more
difficult to cure, just as the general internal disease continues to increase as time goes
on.

1 The issues of the old-school do something similar; as artificial ulcers on external parts,
they silence some internal chronic diseases, but only for a short time, as long as they
cause a painful irritation to which the sick organism is not used, without being able to
cure them; but, on the other hand, they weaken and destroy the general health much
more than is done by most of the metastases effected by the instinctive vital force.

§ 202

If the old-school physician should now destroy the local symptom by the topical
application of external remedies, under the belief that he thereby cures the whole
disease, Nature makes up for its loss by rousing the internal malady and the other
symptoms that previously existed in a latent state side by side with the local affection;
that is to say, she increases the internal disease. When this occurs it is usual to say,
though incorrectly that the local affection has been driven back into the system or upon
the nerves by the external remedies.

43
 § 203

Every external treatment of such local symptoms, the object of which is to remove them
from the surface of the body, while the internal miasmatic disease is left uncured, as, for
instance, driving off the skin the psoric eruption by all sorts of ointments, burning away
the chancre by caustics and destroying the condylomata on their seat by the knife, the
ligature or the actual cautery; this pernicious external mode of treatment, hitherto so
universally practiced, has been the most prolific source of all the innumerable named or
unnamed chronic maladies under which mankind groans; it is one of the most criminal
procedures the medical world can be guilty of, and yet it has hitherto been the one
generally adopted, and taught from the professional chairs as the only one.1

1For any medicines that might at the same time be given internally served but to
aggravate the malady, as these remedies possessed no specific power of curing the
whole disease, but assailed the organism, weakened it and inflicted on it, in addition,
other chronic medicinal diseases.

EXPLANATION:

According to Hahnemann there cannot be, strictly speaking, any local disease of
the living organism. The organism is a living indivisible whole acts and reacts as a whole.
Any disturbance in the nature of a dynamic change is never confined to a specific part of
the organism in the sense that rest of the body participates in the dynamic change
produced by any means.

The maladies which are purely local are more or less of recent origin & produced
solely by an external lesion which must be too trivial to evoke response from the
organism as whole, e.g. very slight injuries, etc.

Where the extent of the injury is violent enough to evoke dynamic reactions in the
organism or where the affection is out of proportion to the external injury, the source of
trouble is an internal morbid state of the organism, then dynamic treatment with remedies
is required along with surgical help. To regard these conditions as merely local affections
or treat them surgically & exclusively by local applications is absolutely erroneous &
most detrimental to the health of the patient.

All local affections whether acute or chronic are only an inseparable part of the
whole disease. Medicine should be administered for curing the whole disease of which
local affections are but a part of external manifestations.

It is sometimes argued that in local affections (caused by dynamic causes) the

external application of the medicine which is also homoeopathic to the whole disease
along with internal administration of the same remedy might expedite cure. But this kind
of treatment is entirely objectionable on the ground that in all such diseases characterized
44
by a prominent local affection, the latter is generally removed by topical applications
more rapidly than the internal disease, often leading to a deceptive impression that a
complete cure has been affected. This premature disappearance of this local symptom
will leave us in doubt whether the total disease has been removed by the internal remedy.

For the same reason, the medicine, homoeopathically indicated for the whole
case, should not be used exclusively as a topical application to the local symptoms of
chronic miasmatic diseases. Because with the disappearance of the chief symptom (the
local affection) the residual picture of the whole disease remains in a mutilated & vague
form, thus depriving the physician to get hold of individualizing symptoms for selection
of a similimum.

The treatment and consequent removal of local affections with corrosives,

caustics, escharotics or by excision, leads us into greater difficulties for bringing about
complete cure of the patient. For in the patient concerned the totality of symptoms, this
“outwardly reflected picture of the internal essence of the disease”, becomes so distorted,
obscure and vague that it turns out to be very difficult or almost impossible in many
cases, to individualize the patient and select a similimum thereof and to bring about
radical and complete cure of the patient.

Persistence of local affections in spite of taking recourse to local measures

indicates that the source of the disease has not yet been tackled effectively. Under
circumstance if a homoeopathic remedy is still possible to be selected and during its
internal administration the persistence of the local affection indicates the incompleteness
of cure. But if the local affection were cured on its seat by the internal administration of
the remedy it is a proof positive that the entire disease has been cured.

Removal of the local symptoms of the local affection by topical administration of

unhomoeopathic external remedies leads to rousing up of the internal disease and other
symptoms that previously existed in a latent state side by side with the local affection.
This is nothing but Nature’s revenge against injudicious human healing art. Such a
disappearance of the local symptoms of the local affection is popularly, though
incorrectly called suppression of driving the whole disease back into the system or upon
the nerves. What really happens is intensification of the internal disease and canalizing
the disease force through other channels leading to derangements of other parts of the
body.

In chronic diseases neither the unaided vital force nor the chronic miasmatic
disease force can overcome each other-and the result is a chronic (life-long) suffering of
the individual. It is the inherent property of life-principle to preserve the existence of the
organism up to the last. The organism is an indivisible whole but it consists of parts-some
essential & other not so essential for the maintenance and continuance of life in it. It tries
to preserve the integrity of the vital organs of the organism by its attempt to localize the
disturbing principle by throwing it out into some part of the body which is not
indispensable to human life. The disease seems too beheld confined to that part for the

45
time being; and the life principle may thereby silence the internal disease, which
otherwise threatens to destroy the vital organs and the very existence of the patient.

The vicarious substitution of disease from the essential to non-essential part of

body keeps the internal disease into abeyance for a time, but the internal disease remains
none-the-less, uncured and not lessened essentially. In fact the local affection continuing,
always, as a part and parcel of whole disease affecting the organism, may be regarded as
a part “which has become excessively developed in our direction by the organic vital
force” as a nature’s provision to save the vital organs from damage. But nature never
becomes completely successful in this attempt as evidenced by the fact that the internal
disease goes on increasing gradually and the nature, correspondingly trying to checkmate
its progressive intensification by enlarging and aggravating the local symptoms.

Hahnemann came to the conclusion that the innumerable named or unnamed

chronic maladies, from which people suffer, owe their origin and spread to the
suppression of local manifestations of these chronic disease and consequence
intensification of the respective internal diseases and progressive affection of various
internal organs one after another. Hahnemann’s investigation of chronic diseases led him
to discover three kinds of miasmatic infection, e.g. psora, sycosis and syphilis, each
accompanied with itchy vesicular eruptions, condylomata, chancre or bubo respectively.

46
 HOMOEOPATHIC MANAGEMENT

Skin is the covering of the body. Its healthiness imparts beauty to our body. Its
prime function is to protect the body. According to hierarchy, skin is the less vital organ
of the body. When diseases show their appearance on the skin, they are less likely to take
life of the patient. But if topical means are used for treatment, then they don’t cure the
lesion but instead of it they implant this malady into deeper organ (minor to major organ).
As per Herring’s law of direction of cure : “Cure takes place from within
outwards, from above downwards and from more important organs to less important
organs & in the reverse order of their appearance. So skin is one of the organs of
elimination in either health or disease.
The science of homeopathy looks at any skin disorder as an external expression of
the internal disharmony. In other words, it is understood that due to certain internal
system disorder, the eczema is manifested as an outcome. With this appreciation, it is
emphasized that the treatment of eczema has to be essentially in order to normalize the
internal disorder instead of just suppressing the skin eruptions with any local application
of creams.

As per the above logical theory, Eczema is not a local disease but a local
expression of a systemic disease, which should be treated at the system level in a planned
manner. Hence, any use of local suppressant is strictly prohibited in homeopathy.
The homeopathic treatment is determined after evaluation of the patient's case in a
great detail. The case-study is the most vital part of the treatment, whereby various
aspects of the patient's life-style, personality, food-habits, emotional make-up, personal
and the family history are evaluated appropriately to decide on the correct medication to
treat Eczema.
Thus the entire constitution (physical and mental) of the patients is evaluated in a
systematic manner. Hence it’s not treating a disease in a man, but treating a man in
disease.
The significance of this treatment in homeopathy is to 'treat the patient as a whole'
or 'patient as a person' which is directed to heal the body-mind system from within. This
helps the body's own healing mechanism, enhances body's self-recovery capacity hence
leading to a long-term cure.

47
 MIASMS

PSORA:

Psora is Hebraic in origin, the original word being ‘Tsorat’ which means a groove, a
fault, a pollution, a stigma, often applied to leprous manifestations and to the great
plagues. Psora means ‘itch’ or ‘itch-mite’.

Hypersensitivity and hyperactivity are hallmarks of psora. Activity runs high pitch at all
levels under the continual environmental stimuli of varied sorts. The result is quickness
of response at all levels – acute, sharp, alert, intense, sudden with quick, sharp swings,
oscillations and changeableness of symptoms.

The processes of growth, development, digestion, assimilation, eliminations and sex

reproduction are rapid and heightened.

The input and the output are relatively proportionate. They throw up a lot of peculiar and
characteristic symptoms during their sickness.

Very sensitive and emotional people. Warm and affectionate.

They have a lot of strong cravings and aversions which even continue at a later stage.
They are often imaginative people, timid, very sensitive to all impressions, active
thinking, plenty of ideas and multiple desires.

Anger in psoric people is sudden, lasting for a short while till the event is over, handled
or expressed. They forgive and forget easily once the event is over.

They are fearless in the right sense, i.e. they will not be afraid of things they should not
be of. If they are afraid or anxious then it is for a valid reason.

Simple inflammatory processes resolve rapidly without suppuration and residue.

Characteristic and classical eruptions and discharges mainly on the skin are clinical
manifestations of primary psora. When these peripheral expressions of primary psora are
blocked through suppressive measures, the road is clear for progressive internalization of
trouble with increasing involvement of more vital organs. Secondary psora if not treated
in adequate manner, gradually progresses and relentlessly to final destruction through
phases of sycosis, tubercular and syphilis.

SYCOSIS:

The term sycosis is derived from a Greek word, commonly employed by Hahnemann to
designate the typical manifestation, the ‘fig wart’. His original concept was the
manifestation in a person after he is affected with a gonorrheal virus.

48
An overstimulated, hypersensitive and responsive system under continuous bombardment
of adverse environmental inputs is driven to disorientation. The controls are lost.
Inappropriate, inefficient and aberrant immune responses and progressively inefficient
metabolic adjustments designed to produce a system with increasing inertia.

Person in this phase is confused mentally and physically. He, thus, reacts in 4 different
ways:
 Reacts after a long time with a pause between action and reaction
 Reacts in a way which is harmful to himself [e.g. internalizing of the emotions or
of the disease]
 No reaction at all
 Repression of emotions

They are dull, lazy, sluggish and slow to act. They are slow to assimilate or receive any
inputs & also slow to respond, or to react to any stimuli, weakness of memory, fixed
ideas.

They are easily moved to negative emotions like anger, irritability, rage, hurt, jealousy,
suspiciousness etc.

They keep on thinking about unpleasant incidences constantly, and build up hard feelings
against all those who have hurt them or troubled them in any way. They find it difficult to
express their emotions.

They show marked anxiety, esp. about their health,

This anxious state often makes them fearful of everything around them. They develop
marked fear of being alone, of dark, of failures, of performance, of meeting people, etc.

They see frightful dreams. Even their dreams manifest their anxious state; they dream as
if something would happen, of death, of missing a train, of failing in exams, of missing
achievement, failures, etc

Metabolism is slow. Immune response is slow. Cellular response is slow. Thickening of

tissues and with recurrent infection and inflammation, there is increased parasympathetic
tone. A patient well established in this phase has all potential to drive him on through the
next phase of tubercular and even syphilis even in the absence of further stimulation.

TUBERCULAR :

An indolent system with aberrant, hypertrophic, erratic, spasmodic and target cell
responses makes a last ditch effort to survive and to return to normalcy – in the presence
of continued adverse factors in the environment.

There is forced mobilization and resulting hectic activity with poor resources ultimately
leads to exhaustion and debility at all levels.
49
The core of the Tubercular miasm is:
 Activity
 Erratic and Changeability
 Hopefulness and
 Weakness and Exhaustion
 
The Sensitivity level of people belonging to this phase is high, but their reaction to any
stimulus is sudden, erratic and unpredictable.

The Will, drive and motivation being poor, the heightened imaginations, desires and
strong attachments fall quite short of translation into practice, resulting in frustration,
disappointments, insecurity, fears & anxiety. Unfulfilled desires express themselves
indirectly through day & night dreams, fancies,etc. Empty theorizing.

Fear and anxiety are strong features of this miasm. They have numerous fears without an
appropriate cause.

They get angry and irritated at trifles easily, they become full of rage, may use bad or
abusive language, and sometimes become violent and cause harm to themselves or others.

Another important feature of this miasm is the desire and love to travel and wander
everywhere.

All tubercular manifestations may be designated as ‘heightened psora’. There is

heightened perception and clairvoyance. Excessive and intense desires and perversions.

On a strong hereditary background of tuberculosis as revealed in family history or on a

base provided by the historical past, psoric expression travels directly to the tubercular
miasm with minimal or no sycotic projection.

SYPHILIS:

This miasm is full of:

 Destruction
 Violence
 Negativism and
 Degeneration

On a strong hereditary & historical background, the syphilitic miasm is inducted earlier in
life (perhaps even at birth) with shortening of life-span due to progressively pronounced
structural alterations in vital organs.

50
The overstimulated and exhausted system under continued adverse environmental inputs
leads to a total loss of controls with resulting inadequacy of functioning at all levels –
intellectual, emotional and physical.

Syphilitic response is irrational, disproportionate, progressive and proceeds remorselessly

and relentlessly towards destruction at all levels – from the spirit through the intellect &
the feeling state to physical level.

They show disinterest/ little interest or aversion to everything. They have an extremely
low intelligence and cannot correlate many things in life.

Syphilitic people are slow to react to any emotions or sometimes do not react at all.
They are extremely cunning, vindictive and malicious. They are cruel in their behavior
and have no love or respect for anybody. They plot or plan against people and instigate
other people, too, to resort to destruction.

Feeling of dissatisfaction and suicidal instinct is a prominent feature in this miasm.

Violence and destruction at physical level are expressed in all tissues and systems in
diverse pathological formations. Degenerations and atrophy of tissues and organs
resulting in loss of function and faculties is an expression of syphilitic miasm.

MIASM AND ECZEMA:

Eczema is a multi-miasmatic condition.

Psoric phase :
Characterized by erythema, vesicle associated with pruritus, and a serous
discharge. Skin is dirty, dry & harsh. Itching without pus & at times no discharge at all.
Burning, scaly eruptions & tendency of recurring skin diseases.

Sycotic phase :
Characterized by pigmentation and lichenification. Small, reddish, flat, vesicular
eruption which doesn’t heal fast. Unnaturally thickened skin. Exfoliating eczemas.
Disturbed pigment metabolism producing hyperpigmentation and depigmentation.

Tubercular phase :
Characterized by pustular discharge secondary to infection, formation of crusts.
Recurrent & obstinate boils with profuse pus discharge & fever. In tubercular patients, if
skin disease is suppressed, respiratory system is affected asthma, tuberculosis and
tonsillitis.
51
Syphilitic phase:
Characterized by scar formation, & occasionally vesicular stage developing into
ulcerations. Discharge of fluid and pus, which is offensive & spreads. Ulcer and
putrefaction of tissues and may be devoid of pain & itching. Ulcerated skin with pus &
blood represents syphilis.

52
 SUSCEPTIBILITY

Susceptibility is an inherent capacity in all living things to react to stimuli in the

environment and represents a fundamental quality that distinguishes the living from the
non-living. Susceptibility varies in degree in different patients, and at different times in
the same patient.

NORMAL SUSCEPTIBILITY:
Here the capacity to respond works in such a manner that all the stimuli are
responded in a balanced way (neither exaggerated nor suppressed) or they are resolved &
the final balance is maintained. The reaction is in accordance to the stimuli, thus not
creating any problem to health.
Any change in the normal susceptibility will interfere with the capacity of pre-
determined response and this interference will be reflected in a chain-response which
ultimately leads to a loss of balance as evidenced by the development of disease.
As normal susceptibility is essential for the maintenance of health and disease
results from abnormal susceptibility thus all rational therapies aim at restoration of
normal susceptibility.

ABNORMAL SUSCEPTIBILITY:
The stimuli are not resolved and there are disturbances thus causing diseased
state. Abnormal susceptibility could be high, low or reaction poor.

High susceptibility:
High reactivity, high sensitivity and so symptoms come up at early stage of
disease & also superficial organs affected.
Characteristic PQRS symptoms appear earlier and are more than common
symptoms. Characteristic symptoms appear more at the mental and general level. Pace of
disease is slow, long prodromal period. Disease is at functional level without
structural/pathological changes. Usually disease restricted to superficial level. There is no
past h/o suppression. Patient has overall ability to keep a positive attitude while coping
with stress.

Low susceptibility:
Low reactivity, low sensitivity and so symptoms come up at later stage of disease
& structural changes seen.
Common symptoms appear earlier and are more than characteristic symptoms.
There will be ore physical particular and pathological symptoms than physical general &
mental symptoms. No prodrome, relatively less clear functional stage, easily structural
stage. Damage occurs faster. The disease is not halted at the superficial level but gone to
structural affections. There is h/o suppression in the past. More negative outlook in life.

53
Reaction poor:
Poor reactivity, poor immunity and so disease quickly and directly affect
vital/deeper organs.
Characteristic symptoms are absent. Sometimes common symptoms also not
present. There is directly severe manifestation of deep seated vital organs. Symptoms
present at the level of pathological generals or particulars. Rapid pace of disease aimed at
vital organs. No prodrome stage. There is minimal or very rapid functional stage. There is
h/o suppression in the past. Direct structural changes are seen. There could be
suppression at emotional level.

54
 POSOLOGY

The fundamentals of homoeopathic posology are represented in the trinity of :

 Single remedy,
 Minimum dose, and
 Minimum repetition.

HIGH POTENCY:
Indications:
1. Extremely close correspondence of a remedy to the picture as presented by the
patient.
2. Predominant mental symptoms in a case.
3. Allergy to chemicals or drugs. Such cases are known to respond well to the same
chemical or drug administered in high potency.
4. In cases of reaction poor, if a nosode is to be preferred, then a high potency,
repeated infrequently, is employed.

Contra-indications:
1. In advanced pathological changes in vital organs; high potencies can cause severe
aggravations.
2. In hypersensitive patients & even persons with skin allergies.

LOW POTENCY:
Indications:
1. Cases in which symptoms of the disease predominate, indicating gross advanced
pathological changes.
2. Organ remedies which are not properly proved and are generally employed for
particular effects in a definite sphere.

Contra-indications:
1. Hypersensitive patients who show a tendency to come down with medicinal
aggravation.
2. Cases with predominantly mental symptomatology will not respond to the lower
ranges.

MEDIUM POTENCY:
Indications:
1. Hypersensitive and idiosyncratic patients.
2. In people with skin allergies, repeat till either definite amelioration is seen or a
slight aggravation makes its appearance.

Contra-indications:
1. Advanced / gross pathology.
55
 GENERAL GUIDELINES:
 A potency which has helped a patient in the past should not be lightly changed;
otherwise, a needless aggravation may be precipitated.
 In chronic cases, when highest potencies have been tried with progressively
decreasing responses, medium potency repeated to the point of reaction works
satisfactorily.
 When an allergic patient reports with the same old symptomatology after a long
remission from a constitutional remedy in a high potency, the use of the same
potency might this time precipitate a severe aggravation. So medium potencies of
same remedy should be given & regulate further repetition accordingly.

(Principles and practice of Homoeopathy – Vol 1 by Dr. M.L. Dhawale, M.D. -

Karnataka Publishing House. 3rd Edition-3rd reprint 2004.)

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 HOMOEOPATHIC THERAPEUTICS

1. ARSENICUM ALBUM (Arsenious Acid-Arsenic Trioxide)

It is a profoundly acting remedy on every organ and tissue. It’s most important general
symptoms include prevailing debility, exhaustion, and restlessness, with nightly
aggravation. There is great exhaustion after the slightest exertion with irritability. There
are burning pains. There is unquenchable thirst. The burning pains are relieved by heat.
Patient has seaside complaints. Fear fright and worry. Green discharges. There are septic
infections and low vitality.

Mind--Great anguish and restlessness. Changes place continually. There are fears, of
death, of being left alone. There could be great fear, with cold sweat. Patient thinks it
useless to take medicine. Patient could be suicidal. Patient may have hallucinations of
smell and sight. Despair drives him from place to place. He could be miserly, malicious,
selfish, lacks courage. General sensibility increased. There could be sensitivity to
disorder and confusion.

Skin--Itching, burning, swellings; edema, eruption, papular, dry, rough, scaly; worse cold
and scratching. Malignant pustules present. Ulcers with offensive discharge present.
Anthrax, poisoned wounds present. Urticaria may be with burning and restlessness.
Psoriasis. Scirrhus. There could be icy coldness of body. Epithelioma of the skin may be
present. Gangrenous inflammations present. Scalp itches intolerably; circular patches of
bare spots; rough, dirty, sensitive, and covered with dry scales; nightly burning and
itching; dandruff. Scalp very sensitive; cannot brush hair.

Modalities--Worse, wet weather, after midnight; from cold, cold drinks, or food,
seashore, right side. Better from heat; from head elevated; warm drinks.

2. ANACARDIUM ORIENTALE (Marking Nut)

There is intermittency of symptoms. Impaired memory, depression, and irritability;

diminution of senses (smell, sight, hearing) may be present. Syphilitic patients often
suffer with these conditions. Fear of examination in students. Weakening of all senses,
sight, hearing, etc could be there. Aversion to work; lacks self-confidence; irresistible
desire to swear and curse. Sensation of a plug in various parts - eyes, rectum, bladder, etc;
also of a band is observed. This is a sure indication, often verified. Its skin symptoms are
similar to Rhus, and it has proved a valuable antidote to Poison-Oak.

Mind--Fixed ideas. Hallucinations; thinks he is possessed of two persons or wills.

Anxiety when walking, as if pursued is present. There is profound melancholy and
hypochondriasis, with tendency to use violent language. Brain-fag, impaired memory,
absent mindedness may be present. Patient is very easily offended. Malicious; seems bent
on wickedness. There is lack of confidence in self or others. Suspicious. Clairaudient,
57
hears voices far away or of the dead. Senile dementia. There could be absence of all
moral restraint.

Skin--Intense itching, eczema, with mental irritability; vesicular eruption; swelling,

urticaria; eruption like that of Poison-Oak. Lichen planus; neurotic eczema. Warts on
hands are observed. Ulcer formation on forearm is present. Itching and little boils on
scalp are seen.

Modalities--Worse, on application of hot water. Better, from eating. When lying on side,
from rubbing.

3. BOVISTA LYCOPERDON (Puff-Ball)

Has a marked effect on the skin, producing eruption like eczema, also upon the
circulation, predisposing to hemorrhages; marked languor and lassitude. It is adapted to
stammering children, old maids with palpitation; and "tettery" patients.

Mind--Enlarged sensation. Awkward in speech and action; everything falls from hands.
Sensitive, irritable, takes everything a miss. Laughs and cries alternately.

Skin--Blunt instrument leave deep impression on the skin. There is urticaria on

excitement, with rheumatic lameness, palpitation and diarrhea. There is itching on getting
warm. Eczema, moist; formation of thick crusts is seen. Pimples cover the entire body;
scurvy; herpetic eruptions. Pruritus ani. There is urticaria on waking in the morning,
worse from bathing. Pellagra. Scalp itches; worse, warmth; sensitive; must scratch until
sore. Moist eczema on back of hand is seen. Itching of feet and legs is present.

Modalities—Worse, in hot weather, getting warm, wine, coffee. Better, bending double,
hot food, eating.

4. CALCAREA SULPHURICA (Sulphate of Lime-Plaster of Paris)

Eczema and torpid glandular swellings are present. Cystic tumors present. Fibroids
present. Suppurative processes come within the range of this remedy, after pus has found
a vent. Mucous discharges are yellow, thick and lumpy. Lupus vulgaris.

Mind—Hurried. Patient despises those who do not agree with him. He grumbles that his
value is not understood by others. Sits and meditates over imaginary misfortune.

Skin--Cuts, wounds, bruises, etc, unhealthy, discharging pus; they do not heal readily.
Yellow, purulent crusts or discharge present. Purulent exudations in or upon the skin are
present. Skin affections with yellowish scabs are present. Many little matterless pimples
under the hair, bleeding when scratched. Dry eczema is seen in children. Scald-head of
children, if there be purulent discharge, or yellow, purulent crusts.
58
Modalities —worse, from drafts, touch, cold, wet and heat of room. Better, in open air,
bathing, eating, local heat, uncovering.

5. DULCAMARA (Bitter-sweet)

Hot days and cold nights towards the close of summer are especially favorable to the
action of Dulcamara, and is one of the remedies that correspond in their symptoms to the
conditions found as effects of damp weather, colds after exposure to wet, especially
diarrhea. It has a specific relation also to the skin, glands, and digestive organs, mucous
membranes secreting more profusely while the skin is inactive. One-sided spasms with
speechlessness are seen. Paralysis of single parts could be present. It is indicated for
patients living or working in damp, cold basements. Eruptions on hands, arms or face
around the menstrual period are seen.

Skin--Pruritus, always worse in cold, wet weather. Herpes zoster, pemphigus also could
be present. Swelling and indurated glands from cold. Vesicular eruptions are seen.
Sensitive bleeding ulcers present. Little boils. Red spots, urticaria, brought on by
exposure, or sour stomach. Humid eruptions on face, genitals, hands, etc seen. Warts,
large, smooth, on face and palmar surface of hands. Thick, brown-yellow crusts, bleeding
when scratched. Scald head, thick brown crusts, bleeding when scratched.

Modalities--Worse, at night; from cold in general, damp, rainy weather. Better, from
moving about, external warmth.

6. GRAPHITES (Black Lead-Plumbago)

Like all the carbons, this remedy is an anti-psoric of great power, but especially active in
patients who are rather stout, of fair complexion, with tendency to skin affections and
constipation, fat, chilly, and costive, with delayed menstrual history, take cold easily.
Children impudent, teasing, laugh at reprimands. Has a particular tendency to develop the
skin phase of internal disorders. It eradicates tendency to erysipelas. Anemia with redness
of face is seen. Tendency to obesity could be present. Swollen genitals seen. Gushing
leucorrhea could be present. It aids absorption of cicatricial tissue. Indurations of tissue,
Cancer of pylorus, duodenal ulcers may be present.

Mind--Great tendency to start. He is timid and unable to decide. Want of disposition to

work. He is fidgety while sitting at work. Music makes her weep. Patient could be
apprehensive, despondency, indecision.

Skin--Rough, hard, persistent dryness of portions of skin unaffected by eczema. Good in

early stage of keloid and fibroma. Pimples and acne, eruptions, oozing out a sticky
exudation is seen. Rawness in bends of limbs, groins, neck, behind ears is seen.
Unhealthy skin; every little injury suppurates. Ulcers discharging a glutinous fluid, thin
and sticky present. Swelling and indurations of glands present. Gouty nodosities present.
Cracks in nipples, mouth, between toes, anus. Phlegmonous erysipelas of face; burning
59
and stinging pain is present. Swelling of feet is seen. Wens. Chronic Poison Oak. Humid,
itching eruptions on hairy scalp, emitting a fetid odor are seen.

Modalities--Worse, warmth, at night, during and after menstruation. Better, in the dark,
from wrapping up.

7. HEPAR SULPHUR (Hahnemann's Calcium Sulphide)

It suits especially scrofulous and lymphatic constitutions that are inclined to have
eruptions and glandular swellings, blondes with sluggish character and weak muscles.
Unhealthy skin is present. There is great sensitiveness to all impressions. Patient is
sweating and pulling blanket around him. Infected sinus with pus forming tendency is
present. The tendency to suppuration is most marked. The lesions spread by the
formation of small papules around the side of the old lesion. Chilliness,
hypersensitiveness, splinter-like pains, craving for sour and strong things are very
characteristic symptoms present. There is feeling as if wind were blowing on some part.

Mind--Anguish in the evening and night, with thoughts of suicide. The slightest cause
irritates him. He is dejected and sad. Ferocious. Patient has hasty speech.

Skin--Abscesses; suppurating glands are very sensitive. There is presence of papules

prone to suppurate and extend. Acne in youth is seen. Suppurate with prickly pain. Easily
bleed. Angio-neurotic edema is present. Unhealthy skin; every little injury suppurates.
Chapped skin, with deep cracks on hands and feet may be present. Ulcers, with bloody
suppuration, smelling like old cheese may be present. The ulcers are very sensitive to
contact, burning, stinging, and easily bleeding. He sweats day and night without relief.
There are "Cold-sores" very sensitive. Cannot bear to be uncovered; wants to be wrapped
up warmly. Sticking or pricking in afflicted parts. There are putrid ulcers, surrounded by
little pimples. Great sensitiveness to slightest touch is present. Chronic and recurring
urticaria is present. Herpes circinatus. Constant offensive exhalation from the body is
present. Scalp is sensitive and sore. There is humid scald-head itching and burning. Cold
sweat on head is present.

Modalities--Worse, from dry cold winds; cool air; slightest draught, from Mercury,
touch; lying on painful side. Better, in damp weather, from wrapping head up, from
warmth, after eating.

8. KALIUM MURIATICUM (Chloride of Potassium-KCl)

It is of great value in catarrhal affections, in sub-acute inflammatory states, fibrinous

exudations, and glandular swellings. White or gray coating of base of tongue, and
expectoration of thick, white phlegm, seem to be special guiding symptoms.
60
Mind—patient could be discontent, discouraged and fears evil, sits in silence. Imagines
he must starve. He is irritable and angry at trifles.

Skin.--Acne, erythema, and eczema, with vesicles containing thick, white contents. Dry,
flour-like scales on the skin are seen. Bursitis is seen. Dandruff is present.

Modalities.--Worse, rich food, fats, motion. Better, rubbing, letting hair down.

9. LYCOPODIUM CLAVATUM (Club Moss)

In nearly all cases where Lycopodium is the remedy, some evidence of urinary or
digestive disturbance will be found. It corresponds to Grauvogle's carbo-nitrogenoid
constitution, the non-eliminative lithæmic. Lycopodium is adapted more especially to
ailments gradually developing, functional power weakening, with failures of the digestive
powers, where the function of the liver is seriously disturbed. Atony. Malnutrition. It is
for mild temperaments of lymphatic constitution, with catarrhal tendencies; older
persons, where the skin shows yellowish spots, earthy complexion, uric acid diathesis,
etc; also precocious, weakly children. Symptoms characteristically run from right to left,
acts especially on right side of body, and are worse from about 4 to 8 pm. Intolerant of
cold drinks; craves everything warm. Emaciation and debility present in the morning.
Lycopodium patient is thin, withered, full of gas and dry. Lacks vital heat; has poor
circulation, cold extremities. Pains come and go suddenly. Is very sensitive to noise and
odors.

Mind—Melancholy and is afraid to be alone. Little things annoy, extremely sensitive. He

is averse to undertaking new things. Patient is head strong and haughty when sick. Loss
of self-confidence is present. Patient is hurried when eating. There is constant fear of
breaking down under stress. He is very apprehensive. Weak memory, confused thoughts;
spells or writes wrong words and syllables. There is failing brain-power. He cannot bear
to see anything new. Cannot read what he writes. There is sadness in morning on
awaking.

Skin--Ulcerates. Abscesses beneath skin; worse warm applications. Hives is worse from
warmth. Violent itching; fissured eruptions, acne are present. Chronic eczema associated
with urinary, gastric and hepatic disorders; bleeds easily. Skin becomes thick and
indurated. Varicose veins, nævi, erectile tumors. Brown spots, freckles worse on left side
of face and nose. Dry, shrunken, especially palms; hair becomes prematurely gray.
Offensive secretions; viscid and offensive perspiration, especially of feet and axilla is
seen. Psoriasis. Hair fall, Eczema; moist oozing behind ears is present. Deep furrows on
forehead with premature baldness and gray hair is present.

Modalities--Worse, right side, from right to left, from above downward, 4 to 8 pm; from
heat or warm room, hot air, bed, warm applications, except throat and stomach which are
better from warm drinks. Better, by motion, after midnight, from warm food and drink,
on getting cold, from being uncovered.

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10. MEZEREUM (Spurge Olive)

Skin symptoms, affections of bones, and neuralgias are most important, especially about
teeth and face. Bruised, weary feeling in joints, with drawing and stiffness is present.
Pains of various kinds, with chilliness and sensitiveness to cold air are present. Bone
pains. There are eruptions which occur after vaccination. Burning, darting sensation in
the muscles; subsultus tendinum is present. Pains shoot upward and seem to draw patient
up out of bed. Semi-lateral complaints are present. Patient is very sensitive to cold air.

Mind--Indifference to everything and everybody; looks through a window for hours

without being conscious of objects around. Patient is apprehensive at the pit of the
stomach when expecting some very unpleasant intelligence or pain or shock. Forgetful,
religious and financial melancholy is present. Aversion to talk; it seems to him to be hard
work to utter a word. Reproaches or quarrels with others.

Skin--Eczema; intolerable itching; chilliness with pruritus; worse in bed. Ulcers itch and
burn, surrounded by vesicles and shining, fiery-red areola with burning pain. Bones,
especially long bones, inflamed and swollen; caries, exostosis; pain worse night, touch,
damp weather. Eruptions ulcerate and form thick scabs under which purulent matter
exudes. Affections of external head; scaly eruption, white scabs are present. Head
covered with thick, leathery crusts, under which pus collects.

Modalities--Worse, cold air; night, evening until midnight, warm food, touch, motion.
Better, open air.

11. NATRIUM MURIATICUM (Chloride of Sodium)

A great remedy for certain forms of intermittent fever, anemia, chlorosis, many
disturbances of the alimentary tract and skin. Great debility; most weakness felt in the
morning in bed. There is coldness of the body. Emaciation is most notable in neck. There
is great liability to take cold. There is dryness of mucous membranes. Constrictive
sensation throughout the body is felt. There is great weakness and weariness of the body.
There is oversensitivity to all sorts of influences.

Mind--Psychic causes of disease; ill effects of grief, fright, anger, etc. Patient is
depressed, particularly in chronic diseases. Consolation aggravates. Irritable; gets into a
passion about trifles. Awkward, hasty and wants to be alone to cry. Tear with laughter.

Skin—Skin is greasy, oily, especially on hairy parts. There are dry eruptions, especially
on margin of hairy scalp and bends of joints. Fever blisters. Urticaria; there is itching and
burning of skin. Crusty eruptions in bends of limbs, margin of scalp, behind ears. There
are warts on palms of hands. There is eczema; raw, red, and inflamed; worse, eating salt,

62
at seashore. There is affection of hair follicles. Alopecia. There is hives with itching after
exertion. Patient has greasy skin.

Modalities--Worse, noise, music, warm room, lying down about 10 am; at seashore,
mental exertion, consolation, heat, talking. Better, open air, cold bathing, going without
regular meals, lying on right side; pressure against back, tight clothing.

12. OLEANDER (Rose-laurel - NERIUM ODORUM)

Has a marked action on the skin, heart and nervous system, producing and curing
paralytic conditions with cramp-like contractions of upper extremities. Hemiplegia.
Difficult articulation may be seen.

Mind--Memory weak; slow perception. There is melancholy, with obstinate constipation.

Skin--Itching, scurfy pimples; herpes; sensitive and numb. Nocturnal burning is present.
Very sensitive skin; slightest friction causes soreness and chapping. Violent itching
eruption, bleeding, oozing; want of perspiration. There is pruritus especially of scalp,
which is sensitive. Eruption on scalp is seen. There are humid, fetid spots behind ears and
occiput, with red, rough, herpetic spots in front. There is corrosive itching on forehead
and edge of hair; worse, heat.

Modalities--Worse, undressing, rest, friction of clothes.

13. PETROLEUM (Crude Rock-oil)

It is suited to strumous diathesis, especially the dark type, who suffers from catarrhal
conditions of the mucous membranes, gastric acidity and cutaneous eruptions. Very
marked skin symptoms, acting on sweat and oil glands; Ailments are worse during the
winter season. There are ailments from riding in cars, carriages, or ships; lingering gastric
and lung troubles; chronic diarrhea. Long-lasting complaints follow mental states-fright,
vexation, etc.

Mind--Marked aggravation from mental emotions. Patient loses his way in streets. Thinks
he is double, or some one else lying alongside. Feels that death is near, and must hurry to
settle affairs. Irritable, easily offended, vexed at everything. Low-spirited, with dimness
of sight is seen.

Skin--Itching at night. Chilblains, moist, itch and burn may be present. Bed-sores present.
Skin is dry, constricted, very sensitive, rough and cracked, leathery. Herpes. Slightest
scratch makes skin suppurate. Intertrigo; psoriasis of hands may be seen. Thick, greenish
crusts, burning and itching; redness, raw; cracks bleed easily. Eczema. Rhagades are
worse in winter. Moist eruption on scalp is present which are worse, back and ears. Scalp
sore to touch, followed by numbness.
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Modalities--Worse, dampness, before and during a thunder-storm, from riding in cars,
passive motion; in winter, eating, from mental states. Better, warm air; lying with head
high; dry weather.

14. PSORINUM (Scabies Vesicle)

The therapeutic field of this remedy is found in so-called psoric manifestations. Psorinum
is a cold medicine; wants the head kept warm, wants warm clothing even in summer.
Extreme sensitiveness to cold is seen. There is debility, independent of any organic
disease, especially the weakness remaining after acute disease. Lack of reaction, i.e.,
phagocytes defective; when well-chosen remedies fail to act. It is suited to scrofulous
patients. Secretions have a filthy smell. Skin symptoms are very prominent. Often gives
immunity from cold-catching. There is easy perspiration when walking. Offensive
discharges.

Mind—Patient is hopeless and despair of recovery. There is melancholy, deep and

persistent; religious person. Suicidal tendency may be present.

Skin--Dirty, dingy look. Hair is dry, lusterless, and rough. Intolerable itching. There are
herpetic eruptions, especially on scalp and bends of joints with itching; worse, from
warmth of bed. Enlarged glands are present. Sebaceous glands secrete excessively; oily
skin. Indolent ulcers slow to heal. Eczema behind ears observed. Crusty eruptions all over
the body are seen. There is urticaria seen after every exertion. Pustules are present near
finger-nails. Humid eruption on scalp; hair matted. Hair becomes dry.

Modalities--Worse, coffee; Psorinum patient does not improve while using coffee.
Worse, changes of weather, in hot sunshine, from cold. Dread of least cold air or draft.
Better in heat, warm clothing, even in summer.

15. RHUS TOXICODENDRON (Poison-ivy)

The effects on the skin, rheumatic pains, mucous membrane affections, and a typhoid
type of fever, make this remedy frequently indicated. Rhus affects fibrous tissue
markedly-joints, tendons, sheaths-aponeurosis, etc, producing pains and stiffness. It is
indicated for post-operative complications. Tearing asunder pains are present. Motion
always "limbers up" the Rhus patient, and hence he feels better for a time from a change
of position. Ailments from strains, over lifting, get wet while perspiring. Good for septic
conditions. Cellulitis and infections, carbuncles may be seen in early stages. There could
be rheumatism in the cold season. Good for septicemia.

Mind—Patient is listless and sad. There are thoughts of suicide. There is extreme
restlessness, with continued change of position. There is delirium, with fear of being
poisoned. Sensorium becomes cloudy. Great apprehension at night cannot remain in bed.

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Skin--Red, swollen; itches intense. There are vesicles, herpes; urticaria; pemphigus;
erysipelas; vesicular suppurative forms. Glands are swollen. Cellulitis. There are burning
eczematous eruptions with tendency to scale formation. Scalp sensitive; worse on side
lain on. There are humid eruptions on scalp; itching greatly.

Modalities--Worse, during sleep, cold, wet rainy weather and after rain; at night, during
rest, drenching, when lying on back or right side. Better, warm, dry weather, motion;
walking, change of position, rubbing, warm applications, from stretching out limbs.

16. SILICEA TERRA (Silica - Pure Flint)

There is imperfect assimilation and consequent defective nutrition. It goes further and
produces neurasthenic states in consequence, and increased susceptibility to nervous
stimuli and exaggerated reflexes. Diseases of bones, caries and necrosis may be present.
Silica can stimulate the organism to re-absorb fibrotic conditions and scar-tissue. Organic
changes; it is deep and slow in action. Periodical states; abscesses, quinsy, headaches,
spasms, epilepsy, feeling of coldness are observed before an attack. Keloid growth may
be seen. Scrofulous, rachitic children, with large head open fontanelles and sutures,
distended abdomen, slow in walking. It is suited in ill effects of vaccination. Suppurative
processes. It is related to all fistulous burrowing. It ripens abscesses since it promotes
suppuration. Silica patient is cold, chilly, hugs the fire, wants plenty warm clothing, hates
drafts, hands and feet cold, worse in winter. There is lack of vital heat. There is
prostration of mind and body. There is great sensitiveness to taking cold. There is
intolerance of alcoholic stimulants. Ailments attended with pus formation. Epilepsy.
Want of grit, moral or physical.

Mind--Yielding, faint-hearted, anxious. Person is nervous and excitable. He is sensitive

to all impressions. Brain-fag may be felt. It is suited for obstinate, headstrong children.
Abstracted fixed ideas; thinks only of pins, fears them, searches and counts them.

Skin--Felons, abscesses, boils and old fistulous ulcers. There is delicate, pale, waxy look.
There are cracks at end of fingers. There is painless swelling of glands. Rose-colored
blotches. Scars suddenly become painful. There is offensive pustular discharge. It
promotes expulsion of foreign bodies from tissues. Every little injury suppurates. There
are long lasting suppuration and fistulous tracts. Dry finger tips. Eruptions itch only in
daytime and evening. Crippled nails are present. Indurated tumors may be present.
Abscesses of joints may be present. It is indicated for complaints coming up after impure
vaccination. Bursa. Lepra, nodes, and coppery spots are present. Keloid growths
observed.

Modalities--Worse, new moon, in morning, from washing, during menses, uncovering,

lying down, damp, lying on, left side, cold. Better, warmth, wrapping up head, summer;
in wet or humid weather.

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17. SULPHUR (Sublimated Sulphur)

This is great Hahnemannian anti-psoric. Its action is centrifugal-from within outward-

having an elective affinity for the skin, where it produces heat and burning, with itching;
made worse by heat of bed. Inertia and relaxation of fiber; hence feebleness of tone
characterizes its symptoms. Ebullitions of heat, dislike of water, dry and hard hair and
skin, red orifices, sinking feeling at stomach about 11 am, and cat-nap sleep; always
indicate Sulphur homeopathically. Standing is the worst position for sulphur patients, it is
always uncomfortable. It is indicated for dirty, filthy people, prone to skin affections.
There is aversion to being washed. It is indicated in complaints that relapse. There is
general offensive character of discharge and exhalations. Very red lips and face is
observed which flush easily. It is often great use in beginning the treatment of chronic
cases and in finishing acute ones.

Mind—He is very forgetful. He has difficult thinking. Delusions; thinks rags beautiful
things-that he is immensely wealthy. Busy all the time. Childish peevishness in grown
people is observed. They are irritable, affections vitiated; very selfish, no regard for
others. Religious melancholy is seen. There is aversion to business; loafs-too lazy to
arouse himself. Always imagines giving wrong things to people, causing their death.
Sulphur subjects are nearly always irritable, depressed, thin and weak, even with good
appetite.

Skin--Dry, scaly, unhealthy; every little injury suppurates. Freckles are seen. Itching,
burning; worse scratching and washing. There are pimply eruption, pustules, rhagades,
and hang-nails. There is excoriation, especially in folds. There is feeling of a band around
bones. There are skin affections after local medication. Pruritus, especially from warmth,
is evening, often recurs in spring-time, in damp weather. Scalp dry, falling of hair; worse,
washing. Itching; scratching causes burning.

Modalities--Worse, at rest, when standing, warmth in bed, washing, bathing, in morning,

11 am, night, from alcoholic stimulants, periodically. Better, dry, warm weather, lying on
right side, from drawing up affected limbs.

18. STAPHYSAGRIA (Stavesacre)

Nervous affections with marked irritability, diseases of the genito-urinary tract and skin,
most frequently give symptoms calling for this drug. It acts on teeth and alveolar
periosteum. There are ill effects of anger and insults. It is indicated for sexual sins and
excesses. He is a very sensitive personality. There are lacerated tissues. There Is pain and
nervousness after extraction of teeth. Sphincters lacerated or stretched.

Mind--Impetuous, violent outbursts of passion, hypochondria cal, sad. Very sensitive as

to what others say about her. Dwells on sexual matters; prefers solitude. Peevish, child
cries for many things, and refuses them when offered.
66
Skin--Eczema of head, ears, face, and body; thick scabs, dry, and itch violently;
scratching changes location of itching. There are fig-warts pedunculated. Arthritic nodes
are observed. Inflammation of phalanges is seen. Night-sweats occur. There are itching
eruptions above and behind ears.

Modalities--Worse, anger, indignation, grief, mortification, loss of fluids, onanism,

sexual excesses, tobacco; least touch on affected parts. Better after breakfast, warmth,
rest at night.

(Pocket Manual of Homoeopathic Materia Medica by William Boericke, M.D. , 9th

edition , IBP Publishers.)

67
ECZEMA REPERTORY (KENT):

ECZEMA- alum., am-c., am-m., anac., ant-c., arg-nit., ars., ars-i., astac., aur., aur-m.,
bar-m., bell., bor., brom., bry., calad., calc., calc-s., canth., carb-ac., carb-s., carb-v.,
caust., cic., clem., cop., crot-t., cycl., dulc., fl-ac., graph., hep., hydr., iris., jug-c., jug-
r., kali-ar., kali-bi., kali-c., kali-chlor., kali- sulph., lach., lap-m., led., lith., lyc., merc.,
mez., nat-m., nat-p., nat-s., nit-ac., olnd., petr., phos., phyt., psor., ran-b., rhus-t., rhus-
v., sars., sep., sil., staph., sulph., sul-i., thuj., viol-t.

Alternating with internal affections: graph

Acidity with- nat-p., vinca., zinc.

Acute- acon., anac., bell., canth., chin-s., crot-s.,mez., rhus-t., sep.

Anaemia with- calc- p

Atrophy, of infants- petr

Bleeds easily and is covered with thick crusts with fetid secretions beneath it – lyc

Blondes inclined to obesity in – graph

Thick mild secretion – calc

Of strumous persons – aethiops., ars-i., calc., calc-i.,

Calc-p., caust., cistus., crot-t., hep., mer-c., merc., rumx., sep., sil., tub

Pustular – ant-t., arg-n., calc., calc-p., carbol-ac., carb-s., caust., cic., con., crot-t., hep.,
jug., kali-bi., kali-i., merc., mez., nat-m., rhus-t., rhus-v., sil., sulph., tarent

Exudation dries of into hard lemon coloured scab- cic

Figurata- ars., calc., clem., con., dulc., graph., lyc., merc., thuja., sulph

Pimples from scabs- carb-s

Recent case in adults- viol- tri

Pigmentation in circumscribed areas following-

Berb-v

Pregnancy and nursing during , on face – sep

Raw fluid destroying hair_ nat- mur

68
Redness small blisters intense itching- anac

Right side on, moist- canth

Rubrum – acon., alum., am-m., anac., apis., bell., bov., calc., canth., carb-v., ., crot-t.,
dulc., lyc., mez., rhus-t., sulp.

Sea shore, ocean, voyage., excess of salt worse-

Nat-m

Scabs thick and honey combed- hep

Scabs thick hard from which pus exudes on pressure-

Mez

Scurfy- kreos

Scurfy discharging , corrosive fluids, which eats hair,

Worse on edged of hair – nat-m

Smarts as if scalded – ran-b

Scratching one place itching ceases but appears at another place – staph

Scrofulous- dulc, tell

Small thin white scurfs on surface- merc

Sun exposure from- mur-ac

Smarting burning when touched – canth

Solaris- acon., arum-m., bell. Camph., canth., clem., hyos., nat-c, mur-ac

Squamous in conjunctivitis scrofula-

Kali-bi

Suppressed- cap-ac., kali-sulph

Suppressed in epilepsy – kali- m

Suppressed following vaccination – ammoniac

Severe and stubborn of sweating parts of body, exposed to fumes of poison- merc- cor

Thickening of skin and hard horny scabs –ran-b

69
Urinary, gastric, hepatic disorders with- lyc.,

Ulcer large surrounded by smaller ones some haeling, some healed- phos

Umbical- sulph

Vaccination after, worse- mez

Washing agg- ars- iod

Watery vesicles- canth

White secretions- kali- m

Winter annual agg- merc

SOME SPECIFIC LOCATIONS

Around eyes- bry., sep

Meatus in- bor., graph., kreos., nit-ac., petr., psor

Beard of – ars-iod

Chin on – bor., cic. graph. rhus-t., sep.

Mouth corner of- mur-ac, nat mur

Temples about – alumina

BOERICKE REPERTORY :

ECZEMA –
Aethi-m ; Aln ; Alum ; Anac ; Ant-c ; Anthro ; Arbu ; Ars ; Ars-i ; Berb ; Berb-a ;
Bor ; Bov ; Calc ; Canth ; Caps ; Carb-ac ; Carb-v ; Cast-eq ; Caust ; Chrysar ; Cic ;
Clem ; Con ; Croto-t ; Dulc ; Euph ; Fl-ac ; Frax ; Fuli ; Graph ; Hep; Hippoz ; Hydrc ;
Jab ; Jug-c ; Kali-ar ; Kali-m ; Kreos ; Lyc ; Mang ; Merc ; Merc-c ; Merc-d ; Merc-pr-
r ; Mez ; Mur-ac ; Nat-ar ; Nat-m ; Nux-v ; Olnd ; Per ; Petr ; Plumbg ; Podo ; Prim-v
; Psor ; Rhus-t ; Rhus-v ; Sars ; Sep ; Skook ; Sul-i ; Sulph ; Thuj ; Tub ; Ust ; Vinc ;
Viol-t ; X-ray ; Xero.

70
Eczema:Acute form –
Acon ; Anac ; Bell ; Canth ; Chin-s ; Croto-t ; Mez ; Rhus-t ; Sep.

Eczema:Behind ears –
Ars ; Arund ; Bov ; Chrysar ; Graph ; Hep ; Jug-r ; Kali-m ; Lyc ; Mez ;
Olnd ; Petr ; Psor ; Rhus-t ; Sanic ; Scroph-n ; Sep ; Staph ; Tub.

Eczema:Face –
Anac ; Ant-c ; Bac ; Calc ; Carb-ac ; Cic ; Coll ; Corn ; Croto-t ; Hyper ; Kali-
ar ; Led ; Merc-pr-r ; Psor ; Rhus-t ; Sep ; Staph ; Sul-i ; Sulph ; Vinc.

Eczema:Flexures of joints –
Aeth ; Am-c ; Caust ; Graph ; Hep ; Kali-ar ; Lyc ; Mang ; Nat-m ; Psor ;
Sep ; Sulph.

Eczema:Hands (locomotor system) –

Anag ; Bar-c ; Berb ; Bov ; Calc ; Graph ; Hep ; Hyper ; Jug-c ; Kreos ;
Maland ; Petr ; Pix ; Plumbg ; Rhus-v ; Sanic ; Sel ; Sep ; Still.

Eczema:Neurasthenic persons –
Anac ; Ars ; Phos ; Stry-ar ; Stry-p ; Viol-t ; Zinc-p.

Eczema:Pudendum –
Am-c ; Ant-c ; Ars ; Canth ; Croto-t ; Hep ; Plb ; Rhus-t ; Sanic ; Sep.

Eczema:Rheumatico-gouty persons –
Alum ; Arbu ; Lac-ac ; Rhus-t ; Ur-ac ; Urea.

Eczema:Scalp –
Astac ; Berb-a ; Calc ; Cic ; Clem ; Fl-ac ; Hep ; Kali-m ; Lyc ; Mez ;
Nat-m ; Olnd ; Petr ; Psor ; Sel ; Sep ; Staph ; Sulph ; Tub ; Vinc ; Viol-o.

Eczema:Strumous persons –
Aethi-m; Ars-i ; Calc ; Calc-i ; Calc-p ; Caust ; Cist ; Croto-t ; Hep ;
Merc ; Merc-c ; Rumx ; Sep ; Sil ; Tub.

Eczema:Whole body –
Croto-t ; Rhus-t.
Eczema:Madidans –
Cic ; Con ; Dulc ; Graph ; Hep ; Kali-m ; Merc-c ; Merc-pr-r ; Mez ;
Sep ; Staph ; Tub ; Viol-t.

Eczema:Pigmentation in circumscribed areas following,with – Berb.

Eczema:Urinary, gastric, hepatic disorders,with – Lyc.

71
Eczema:Worse after vaccination – Mez.

Eczema:Worse at menstrual period, menopause – Mang.

Eczema:Worse at sea shore, ocean voyage, excess of salt – Nat-m.

72
 CASES

CHECK-LIST FOR CASE 1

1. NAME: Miss (Baby) Nishtha Menroa
2. AGE: 1½ years.
3. SEX: Male  / Female 
4. ADDRESS: 1004- Lavender Apts., Deendayal Upadhya Marg, Mulund (W),
Mumbai-80.
5. OCCUPATION: Worker 
Office 
Maid / Servant 
Housewife 
Student 
Others 
6. RELIGION: Hindu
7. MARITAL STATUS: Married 
Single 
Divorcee 
Widow 
Widower 
8. PAST HISTORY: Koch’s 
DM 
Asthma 
Hypertension 
IHD 
Any Allergies 
Others £
9. HABITS: ---
10. FAMILY HISTORY: Husband 
Wife 
Mother  Similar complaints
Father 
Brother 
Sister 
Paternal → Grandfather 
→ Grandmother 
Maternal→ Grandfather 
→ Grandmother  Similar complaints
11. DRUG HISTORY: ----
12. DISEASE HISTORY: Age of onset: 4 months back.
Complaints: Itching: 
Scratching: 
Burning: 
Redness: 
Dryness: 
Swelling: 
73
 Cracks & scales: 
Bleeding: 
Discolouration: 
Lichenification: 
Recurrence: 
Continuous: 
Irritants /Allergens: 
Temperature Affection: Hot < or >: ---
Cold < or >: ---
Climatic affection: Winter < or >: ---
Summer < or >: ---
Area of Affection:

13. EMOTIONAL FACTORS: History Of: Suppression or Over expression:

Anger / Vexation: --
Stress / Tensions: --
Depression / or Grief: --
Despair / loathing: --
Anxieties: --
Low self-esteem: --
Others: Is a very cheerful child, loves to play.

74
 CASE 1

Name: Miss (Baby) Nishtha Menroa

Address: 1004- Lavender Apts., Deendayal Upadhya Marg, Mulund (W), Mumbai-80.
Age: 1½ years.
Sex: Female.
Status: Single.
Religion: Hindu.
Occupation: Child.
Physician-in-charge: Dr. Jai Patel.
Date: 17/07/08.

Chief Complaint:
Rashes on the elbow with redness- R> L, knee joint, on the back since 4 months.
Itching ++. > scratching, > oil application.
Skin is dry & rough. First the rashes appeared on the elbow then on the knees.
Breast fed up to 3 months, then given lactogen for 1 month, then cow’s milk.
Mother  H/o stress related rashes all over her body.

Patient as a person:
Appetite: Good.
Likes: cheese3, apples
Dislikes: sour3, curd3
Thirst: Likes cold water, cold drinks, and large amounts at a time.
Stool: one per day.
Urine: No complaints.
Perspiration: Moderate,
Non-offensive, Non-staining.
Sleep: 12 hours, very restless before sleeping.
Dreams: --

Child development & growth:

Birth weight: 2.5 kg.
Walking: 1 year of age

Mind:
Playful, likes to be independent at home but when she goes out she gets scared. She
shares her toys. Doesn’t like loud noise, wants to be with people around. She is very
particular about the people she is with. She keeps demanding things when she doesn’t get
it then she becomes angry but is happy when she gets it. Enjoys playing in water doesn’t
like to play with dolls or kitchen set. More interested in doing things those elders like to
do.

Thermal Reaction:
Prefers winter season
Fan  wants fan.
75
Covering: Doesn’t like covering in winter also.
HOT patient

P/H: --

F/H: Mother  similar skin complaints.

Maternal grandmother  similar complaints

O/E – General Examination:

Pulse: 94 /min.
Temp: Afebrile.
No pallor, no icterus, no cyanosis, no lymphadenopathy.

Systemic Examination:
RS- clear, AEBE.
CVS- S1S2 heard.

Local examination:
Erythematous patches on the elbow joint, knee joint & on the back..

Diagnosis: Atopic Dermatitis/Eczema.

Hahnemannian Classification: Dynamic chronic miasmatic disease with fully

developed symptoms.

Prescriptive Totality: 1. Cheerful;

2. Fastidious;
3. Playful, play desire to;
4. Aversion: sour;
5. Desires: cold drinks, water;
6. Desires: cheese;
7. Warm room, agg;
8. Hot Patient.
9. Itching, >scratching

76
 Repertorial Totality:

Sulph Arg-n Fl-ac Puls Nat-m Plat Med Croc Bry Lyco
Cheerfulness, gaiety, 2 1 2 1 1 2 1 3 1 2
happiness: Tendency:
Fastidious: 1 1 3 2 1 1
Play: Desire to, playful: 1 1
Aversion: sour, acids: 2 1 2 1 1
Desires: cold drinks, 1 2 1 1 2 1 1 2 3 2
water:
Desires: cheese: 1 1
Warmth: agg: room: 3 2 2 3 1 1 1 3 2 3
Itching: scratching: 2 2 1 2
amel.:
11/6 8/6 9/5 9/5 7/5 6/5 6/6 9/4 8/4 8/4

Susceptibility: High.

Miasm: Psora
-Redness.
-Itching over rashes.
-Mother has history of similar rashes.

Remedy Selected: Sulphur

Potency selected: 30 (II doses. Once every 7 days).

Follow Up:
Date Complaints Remedy given.
24/07/08 Itching >50%
Redness –SQ– Sulphur 30 (1dose)
No new eruptions. SL 30 tds (4-4-4) x 15
Generals – App: decreased. days.
Thirst: good.
Stool: normal.
Urine: normal.
Sleep: good. Refreshing.

10/08/08 New boils after 4 days .Increased day by day.

Diagnosed as chicken pox. Now >. Phytum 30 (4 doses –
Generals- App: now good. once every week)
Thirst: normal. SL 30 tds (4-4-4) x 7

77
 Stool: normal. days.
Urine: normal.
Sleep: good. Refreshing.

17/08/08 No new eruptions.

Skin has become a little rough on face, flexor Phytum 30 (I dose)
aspect of elbow, popliteal fossa. SL 30 tds (4-4-4) x 7
Itching <sweating. days.
> scratching.

Generals: App: good.

Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: disturbed due to complaints.

24/08/08 Itch < with climate change.

Fussy about food. Phytum 30 (4 doses –
Dentition: good. once every week)
Sleep: good. SL 30 tds (4-4-4) x 15
Generals: App: good. days.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: Unrefreshing.

07/09/08 Itching < than last time.

Rash <. New eruptions on arms, abdomen, left Sulphur 30 bd x 2 days.
hand, neck. SL 30 tds (4-4-4) x 5
Skin has become rough. Uses Aloe Vera, oil & days.
calendula soap.
Generals- App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: disturbed due to complaints.

Discussion: Patient Miss Nishtha Menroa suffering from Atopic dermatitis since 4
months was given Sulphur 30 on the basis of totality of symptoms. In the follow ups
gradual improvement was seen.

78
 CHECK-LIST FOR CASE 2

1. NAME: Mr. Ganpat Tulsukar

2. AGE: 67 years.
3. SEX: Male  / Female 
4. ADDRESS: B-10, Shiv Shakti Society, Prabhadevi, Mumbai-23.
5. OCCUPATION: Worker 
Office 
Maid / Servant 
Housewife 
Student 
Others 
6. RELIGION: Hindu
7. MARITAL STATUS: Married 
Single 
Divorcee 
Widow 
Widower 

8. PAST HISTORY: Koch’s 

DM 
Asthma 
Hypertension 
IHD 
Any Allergies 
Others Malaria 5-6years back.
9. HABITS: Smoking since 12 years and occasional drinking.
10. FAMILY HISTORY: Husband 
Wife 
Mother   Ca Breast.
Father 
Brother 
Sister 
Paternal → Grandfather 
→ Grandmother 
Maternal→ Grandfather 
→ Grandmother 
11. DRUG HISTORY: --
12. DISEASE HISTORY: Age of onset: since 1 year.
Complaints: Itching: 
Scratching: 
Burning: 
Redness: 
Dryness: 
Swelling: 
79
 Cracks & scales:
Bleeding: 
Discolouration: 
Lichenification: 
Recurrence: 
Continuous: 
Irritants /Allergens:  chana & its products.
Temperature Affection: Hot < or >: Warm water >
Cold < or >: Cold water <
Climatic affection: Winter < or >: ---
Summer < or >: ---
Area of Affection:

13. EMOTIONAL FACTORS: History Of: Suppression or Over expression:

Anger / Vexation: - Suppressed
Stress / Tensions: - Suppressed
Depression / or Grief: - Suppressed
Despair / loathing:
Anxieties: - About his health.
Ambitions affected:
Others:

80
 CASE 2

Name: Mr. Ganpat Tulsukar

Address: B-10, Shiv Shakti Society, Prabhadevi, Mumbai-23.
Age: 67 years.
Sex: Male.
Status: Married since 40 years.
Religion: Hindu.
Occupation: Cashier in cloth shop.
Physician-in-charge: Dr. N.O.Goel.
Date: 02/3/08.

Chief Complaint:
Itching, hyper pigmentation, peeling of skin on both legs since 1 year.
There is lot of burning along with itching.
< When skin is touched
< Cold water
< Mental exertion
With peeling of skin there is oozing of watery fluid which is very offensive.
< Chana, chana powder leads to itching.
> Warm water.

Patient as a person:
Appetite: Good. Non-vegetarian diet
Likes: Chana.
Dislikes: ––
Thirst: Adequate, 1-2 liters/day, plain water.
Food/drinks agg/amel: < chana & its products  itching.
Stool: No complaints.
Urine: No complaints.
Perspiration: Moderate,
Non-offensive, Non-Staining.
Sleep: 6-7 hours, Refreshing.
Dreams: Unremembered.

Mind:
Patient stays with wife. His son stays separate & his daughter is married.
Anxious about his health
Says is very reserved. Doesn’t mix easily
Doesn’t talk to anybody about his problems, Keeps it to himself. Suppresses his thoughts
& which then gives him tensions.
Doesn’t want to work, Says I have worked throughout my life, now I want to rest.
If someone tells him that you have not done anything for me then he gets disturbed.
Says is emotional & very sensitive.

81
Some people around me ask me not to work say now rest, but I work coz I don’t work for
free, I get paid. I haven’t received any funds from my place of retirement. My son wants
to take care of my complete financial requirement, but I hesitate, Says not till I can earn
Patient wants things in the house to be kept properly, clean & is very particular about
that.

Thermal Reaction:
Can’t tolerate extremes of temperature, Prefers winter season
Fan  summer – full fan
 Winter – slow fan. But can do without it.
Covering: summer – no covering
 Winter – thin.
Bath: Lukewarm water throughout the year.
Ambithermal  Hot patient

P/H: Malaria 5-6 years back.

F/H: Mother- Ca Breast.

O/E – General Examination:

Pulse: 78/min.
Temp: Afebrile.
BP: 130/80 mm of Hg.
No pallor, no icterus, no clubbing, no cyanosis, no lymphadenopathy.

Systemic Examination:
RS- clear, AEBE.
CVS- S1S2 heard.

Local examination:
Peeling of skin on the legs-shin, little watery discharge oozing

Diagnosis: Primary irritant contact dermatitis.

Hahnemannian Classification: Dynamic chronic miasmatic disease with fully

developed symptoms.

Prescriptive Totality: 1.Anxiety about health;

2. Fastidious;
3. Reserved;
4. Mental exertion: agg;
5. Emotions: anger, vexation; silent grief, suppressed etc., with
agg;
6. Discharges, secretions: offensive;
7. Hot patient;
8. Skin: Itching: touched, when;
82
 9. Skin: Itching: burning;
10. Skin: Itching: Cold: Agg;
11. Skin: Itching: Warmth: amel.;

Repertorial Totality:

Nat-m Puls Sulph Lyco Lach Plat Arn Spong Anac Arg-n
Anxiety: Health, about: 1 2 1 2 1 1 1 1
Fastidious: 2 3 1 1 2 1
Reserved: 1 2 1 1 1 2 1 1 1 1
Mental exertion: agg: 3 2 2 3 3 1 1 1 2 3
Emotions: anger, 2 1 4 1
vexation, etc: Silent
Grief, suppressed etc.,
with agg:
Discharges, secretions: 1 3 1
offensive:
Skin: Itching: touched, 1
when:
Skin: Itching: Burning: 1 3 3 3 3 1 1 1 1
Skin: itching: Cold: Agg:
Skin: itching: Warmth: 1
amel:
11/7 13/6 9/6 13/5 11/5 6/5 5/5 5/5 6/4 6/4

Susceptibility: High.

Miasm: Sycosis.
-Anxiety about health.
-Suppressed emotions.
-Itching and burning of skin.
-Hyper pigmentation of skin.

Remedy Selected: Natrum Mur

Potency selected: 200 (1 dose).

Follow Up:
Date Complaints Remedy given.
09/03/08 Lesions have become dry.
No watery discharge oozing after scratching. Cosmos 200 (1dose)
Itching >25%. SL 30 tds x 7days.

83
 Pain in the soles > 50 %
Patient is feeling generally > 50%.
Patient is now hopeful about recovery. Previously
was doubtful about cure. Now sure about his
recovery.
Patient is on Medrol 4mg (1 HS) & Salicylix
cream.
Generals – App: good.
Thirst: good.
Stool: normal.
Urine: normal.
Sleep: good. Refreshing.

16/03/08 Lesions have become dry.

No watery discharge. Cosmos 200 (1dose)
Itching >25 %. SL 30 tds (4-4-4) x
Generals- App: good. 7days.
Thirst: normal. Adv: Medrol dosage to
Stool: normal. be reduced to half. No
Urine: normal. local application.
Sleep: good.

23/03/08 Lesions appear better-dry.

No discharge. Cosmos 200 (1dose)
Itching >scratching. SL 30 tds (4-4-4) x
Generals: App: good. 7days.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

30/03/08 Lesions dried up.

No discharge. Cosmos 200 (1dose).
Itching >> SL 30 tds (4-4-4) x
Generals: App: good. 15days.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

13/04/08 Lesions on both legs dried. Nat Mur 200 (1dose).

Itching persists. SL 30 tds (4-4-4) x 15
Mentally tensed. days.
Generals- App: good.
Thirst: normal.
Stool: normal.
84
 Urine: normal.
Sleep: disturbed due to complaints.

27/04/08 Lesions >> Cosmos 200 (1dose)

Itching >50%. SL 200 tds (4-4-4) x
Generals: App: good. 15days.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

30/08/08 Lesions –SQ– Nat Mur 1M (1dose)

Itching << SL 200 tds (4-4-4) x
Generals: App: good. 15days.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

Discussion: Patient Mr. Ganpat Tulsukar suffering from allergic dermatitis/eczema since
1 year was given Natrum Mur 200 on the basis of totality of symptoms. In the follow ups
improvement is seen. In later follow ups potency was raised to Natrum Mur 1M since
response to previous potency was no longer obtainable.

85
 CHECK-LIST FOR CASE 3

1. NAME: Mrs. Sufia Ahmad

2. AGE: 45 years.
3. SEX: Male  / Female 
4. ADDRESS: Humara Park, B-wing, Pathanwadi, Malad-(w).
5. OCCUPATION: Worker 
Office 
Maid / Servant 
Housewife 
Student 
Others 
6. RELIGION: Muslim
7. MARITAL STATUS: Married 
Single 
Divorcee 
Widow 
Widower 

8. PAST HISTORY: Koch’s 

DM 
Asthma 
Hypertension 
IHD 
Any Allergies 
Others lipoma.
9. HABITS: ---
10. FAMILY HISTORY: Husband 
Wife 
Mother Renal failure
Father 
Brother 1 Renal failure
Brother 2 MI.
Sister 
Paternal → Grandfather 
→ Grandmother 
Maternal→ Grandfather 
→ Grandmother 
11. DRUG HISTORY: --
12. DISEASE HISTORY: Age of onset: since 1-1 ½ years.
Complaints: Itching: 
Scratching: 
Burning: 
Redness: 
Dryness: 
Swelling: 
86
 Cracks & scales: 
Bleeding: 
Discolouration: 
Lichenification: 
Recurrence: 
Continuous: 
Irritants /Allergens: ---
Temperature Affection: Hot < or >: --
Cold < or >: Ice >
Climatic affection: Winter < or >: Winter <
Summer < or >: Summer >
Area of Affection:

13. EMOTIONAL FACTORS: History Of: Suppression or Over expression:

Anger / Vexation: irritability
Stress / Tensions:
Depression / or Grief: feels constant grief
Despair / loathing:
Anxieties: about disease & about family
Low self-esteem:
Others:
87
 CASE 3

Name: Mrs. Sufia Ahmad

Address: Humara park, B-wing, Pathanwadi, Malad-(w).
Age: 45 years.
Sex: Female.
Status: Married since 22 years.
Religion: Muslim.
Occupation: Housewife.
Physician-in-charge: Dr. N.O.Goel.
Date: 23/3/08.

Chief Complaint:
Blackish discolouration patches on left leg ankle region since 1-1½ years.
Itching with discharge of sticky fluid, When it itches she must scratch.
>applying cream. > Sometimes with ice.
No burning. No bleeding.
Similar patches on left & right hand since 6 months.
All complaints are < winter season.
Dryness of skin of upper & lower extremities

Associated Complaints:
Pain in lower extremities since 4 years
< walking, getting up from sitting position
> Hot fomentation.

Patient as a person:
Appetite: Good. Non-vegetarian diet
Likes: fish, spicy
Thirst: Adequate, 1-2 liters/day.
Stool: No complaints.
Urine: No complaints.
Perspiration: Moderate, More on back & axillae.
Non-offensive, Non-staining
Sleep: 6-7 hours, refreshing.
Dreams: Dreams of her mother & 2 brothers who have expired. She sees that they are
sitting and talking to each other.

Gynaec/Obs History:
FMP: 14 years, LMP: 13/3/04
Duration: 2-3 days.
Colour: red
Cycle: Regular, 30-31 days
Non-offensive, Non-staining.

88
Quantity: moderate.
Complaints before- pain in the legs
G5P3A2L3: P1 ♀ 22years FTND-Hospital Delivery.
P2 ♀ 20years FTND-Hospital Delivery
P3 ♀ 18years FTND-Hospital Delivery

Mind:
They are 6 brothers and 3 sisters, she is elder most.
Stays with husband and 3 daughters
Studied till 10th Std. didn’t like to study so left.
Anxiety about disease condition regarding the spread of disease to her daughter
At times very irritable and even sometimes used to beat her daughter before, but now
doesn’t beat.
Wants everything very clean & tidy, everything should be kept properly in its exact place.
Asks everyone to keep things in place, cries very easily & gets anxious.
Says she feels lonely after the death of her mother and 2 brothers. Thinks about them a
lot, says there is no one and I am alone here.
Cries if anyone tells her anything wrong

Thermal Reaction:
Fan  summer – slow fan
 Winter – no fan.
Covering: summer – occasional thin covering
 Winter – wants thick covering.
Bath: Hot water in winter & cold water in summer.
Ambithermal  Chilly patient

P/H: Operated for lipoma on left side.

F/H: Mother- Kidney failure died 21years back.

Brother 1- kidney failure died 20 years back.
Brother 2- heart attack died.

O/E – General Examination:

Pulse: 66/min.
Temp: Afebrile.
BP: 140/110 mm of Hg.
No pallor, no icterus, no clubbing, no cyanosis, no lymphadenopathy.

Systemic Examination:
RS- clear, AEBE.
CVS- S1S2 heard.

Local examination:
Left ankle patch blackened rough, oozing of sticky discharge.
Left hand 3rd metacarpal blackish discolouration, no discharge
89
 Right hand 2nd metacarpal blackish discolouration, no discharge.

Diagnosis: Nummular Eczema.

Hahnemannian Classification: Dynamic chronic miasmatic disease with fully
developed symptoms.

Prescriptive Totality: 1.Anxiety: family about his;

2. Irritability;
3. Weeping tendency, with anxiety;
4. Grief: constant & chronic;
5. Fastidious;
6. Dreams of dead people;
7. Winter agg;
8. Skin-blackish spots discolouration;
9. Eruptions: discharging, moist: glutinous;
10. Itching, scratching must;
11. Dry skin;
12. Chilly patient;

Repertorial Totality:

Graph Ars Phos Sulph Nat-m Caust Kali-c Calc Rhus-t Sil
Anxiety: Family, about 2 1 1 2 3
his:
Irritability: 3 3 3 3 3 3 3 3 3 3
Weeping, tearful mood: 3 1 1
tendency: anxious:
Grief: constant & 2
chronic:
Fastidious: 2 2 1 1 2 2 1
Dreams: Dead: people, of 2 3 2 2 1 2 2 1
Season: Winter: agg: 1 3 2 2 1 2 3 2 3 2
Skin: discolouration: 2 1 1
blackish spots:
Eruptions: Discharging, 3 1 2 2
moist: Glutinous:
Itching: scratch, must 1 1 1 1 1 1 1 1 1 1
Dry, skin: 2 3 3 3 2 1 3 3 2 3
19/9 19/8 14/8 14/8 12/7 11/7 14/6 13/6 13/6 11/6

Susceptibility: High

Miasm: Sycosis.
-Slow gradual progress of disease.
-Easy anxiety, esp. about family & her disease.
90
 -Gets irritated easily.
-P/H of lipoma.
-Hyper pigmentation of skin.
-Fastidious.

Remedy Selected: Graphites

Potency selected: 200 (1 dose).

Follow Up:
Date Complaints Remedy given.
02/04/08 Itching persistent.
Sticky discharge from the wound ed. Graph 200 (1dose)
Generals – App: good. SL 30 tds x 21 days.
Thirst: good.
Stool: normal.
Urine: normal.
Sleep: good.

23/04/08 No sticky discharge.

Dry wound. Graph 200 (1dose)
Generals- App: good. SL 30 tds x 30 days.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: disturbed due to complaints.

25/05/08 Itching –SQ–

Dry eruptions. Cosmos 200 (1dose)
No sticky discharge. SL 30 tds x 30 days.
Generals: App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good.

Following this patient was better & was on SL till

25/03/05.

25/07/08 Itching over the left ankle region.

No discharge. Graph 200 (1dose).
Generals- App: good. SL 200 tds x 30days.
Thirst: normal.
Stool: normal.
Urine: normal.
91
 Sleep: disturbed due to complaints.

In the following 2 follow ups Graphites 200 was

repeated each.

18/08/08 Lesion better.

Itching >> 50% Cosmos 200 (1dose)
Generals: App: good. SL 200 tds x 1 month.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

15/12/08 Itching –SQ–

Eczematous patches << Tub 1M (1dose)
No discharge. SL 200 tds x 15days.
Generals: App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing

09/01/09 Itching on & off.

No discharge. Graph 1M (1dose)
Black discolouration –SQ– SL 200 tds x 15days.
Generals: App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

02/02/09 Eczematous patch >70%

Blackish discolouration > Cosmos 200 (1dose)
Itching on & off. SL 200 tds x 15days.

Discussion: Patient Mrs. Sufia Ahmad suffering from nummular eczema since 1-1½
years was given Graphites 200 on the basis of totality of symptoms. In the follow ups
improvement was seen. Once during the course of treatment Tub 1M (1 dose) was given
followed by Graph 1M (1dose). The potency was increased since response to previous
potency was no longer obtainable.

92
 CHECK-LIST FOR CASE 4

1. NAME: Miss Chantelle Saldanha

2. AGE: 17 years.
3. SEX: Male  / Female 
4. ADDRESS: Vasant Colony, Mars, C-wing 702, Bangur Nagar, Goregaon(W)-99.
5. OCCUPATION: Worker 
Office 
Maid / Servant 
Housewife 
Student 
Others 
6. RELIGION: Roman Catholic
7. MARITAL STATUS: Married 
Single 
Divorcee 
Widow 
Widower 

8. PAST HISTORY: Koch’s 

DM 
Asthma 
Hypertension 
IHD 
Any Allergies 
Others  Herpes on back-1 yr back.
9. HABITS: ---
10. FAMILY HISTORY: Husband 
Wife 
Mother 
Father Gastritis
Brother 
Sister 
Paternal → Grandfather 
→ Grandmother 
Maternal→ Grandfather DM, MI?
→ Grandmother 
11. DRUG HISTORY: ---
12. DISEASE HISTORY: Age of onset: since 2 years
Complaints: Itching: 
Scratching: 
Burning: 
Redness: 
Dryness: 
Swelling: 
Cracks & scales: 
93
 Bleeding: 
Discolouration: 
Lichenification: 
Recurrence: 
Continuous: 
Irritants /Allergens: ---
Temperature Affection: Hot < or >: --
Cold < or >: --
Climatic affection: Winter < or >: --
Summer < or >: Summer <
Area of Affection:

13. EMOTIONAL FACTORS: History Of: Suppression or Over expression:

Anger / Vexation: easily, aggressive.
Stress / Tensions: with excitement & nervousness.
Depression / or Grief:
Despair / loathing:
Anxieties: with trembling.
Low self-esteem:
Ambitions affected:
Others: impatience & indecisive
94
 CASE 4

Name: Miss Chantelle Saldanha

Address: Vasant Colony, Mars, C-wing 702, Bangur Nagar, Goregaon(W)-99.
Age: 17 years.
Sex: Female.
Status: Single.
Religion: Roman Catholic.
Occupation: Student-12th Std.
Physician-in-charge: Dr. N.O.Goel.
Date: 16/10/07.

Chief Complaint:
Itching of skin  followed by scratching. Patches of blackish red discolouration on
flexor aspect of elbow joint, near knee joint bilaterally & on back & upper part of lips
since 2 years
Complaints remain throughout better by allopathic medicines.
Itching N Night, N summer
Burning pain N scratching
Size increased gradually. No history of discharge or vesicles or boils.
Started on right elbow flexor aspect  left elbow  right knee  left knee  above lips
Discolouration of proximal right hand all fingers. Dry skin since 6-7 month with itching
Black discolouration of left thumb since 4 years of age

Associated Complaint:
Dryness of skin in winter > Vaseline. Recurrent cold & cough-throat pain < getting
wet, < frozen food. Hair fall & thinning of hair, dandruff.

Patient as a person:
Appetite: Good. Non-vegetarian diet
Likes: Chocolates3, Chinese food2, sweets, fish.
Dislikes: Bitter gourd, green leafy vegetables and onions
Thirst: ½ liter/day, wants cold water.
Stool: No complaints.
Urine: No complaints.
Perspiration: Moderate, More on armpits.
Non-offensive, Non-staining
Sleep: 6-7 hours, feels sleepy after getting up, sleeps on the right side.
Dreams: Unremembered.

Gynaec/Obs History:
FMP: 11 years, LMP: 8/10/07.
Duration: 5 days. Quantity- moderate
Colour: Red
Cycle: Irregular till 10th Std. Now it is regular.
95
Non-offensive, Non-staining,
Clots on the 2nd day. During menses she has abdomen pains occasionally.

Mind:
Patient stays with father, mother and younger sister. Says is short tempered. Gets
angry easily, gets irritated easily and hits her sister. She shouts at others. She is impulsive
and aggressive. Impatient – wants things fast, can’t wait.
She has few close friends, dependent on friends, family. She can’t take decisions on
her own. She wants to become an airhostess. She likes drawing, sketching, dancing,
elocution.
Takes part in extra-curricular activities. She likes comedy movies.
She has great nervousness and anxiety before exams, competition. Hands tremble &
become cold. Appetite decreased.

Thermal Reaction:
Prefers winter season
Fan  wants full fan throughout the year.
Covering: summer – nil.
 Winter – thin.
Bath: Winter - lukewarm.
Summer – tap water.
HOT patient

P/H: Herpes on back-1year back.

She had chicken pox in childhood.

F/H: Maternal grandfather – DM, MI?

Paternal uncle – DM, IHD, HT.
Father - gastritis

O/E – General Examination:

Pulse: 80/min.
Temp: Afebrile.
BP: 130/80 mm of Hg.
No pallor, no icterus, no clubbing, no cyanosis, no lymphadenopathy.

Systemic Examination:
RS- clear, AEBE.
CVS- S1S2 heard.

Local examination:
Right & left elbow- blackish red discolouration with central cleaning.
Right hand fingers – dry skin, black discolouration.
Knee joint: discolouration, white scales.

Diagnosis: Atopic Dermatitis/Eczema.

96
 Hahnemannian Classification: Dynamic chronic miasmatic disease with fully
developed symptoms.

Prescriptive Totality: 1. Excitement: excitable: tendency: nervous;

2. Anxiety: trembling, with;
3. Impatience:
4. Irresolution, indecision: acts in;
5. Anger: tendency: easily;
6. Desires: chocolates;
7. Desires: highly seasoned food;
8. Desires: sweets;
9. Skin: itching: night;
10. Skin: Pain: burning: scratching, after;
11. Skin: discolouration: blackish;
12. Summer: agg;
13. Hot patient;

Repertorial Totality:

Phos Lyco Puls Sep Nit-ac Ars Nux-V Calc Nat-c Arg-n
Excitement, excitable: 1 1 1 2 1 2 2 1 1 1
tendency: nervous:
Anxiety: trembling, with: 1 1 2 1 1 3 2 2
Impatience: 2 2 3 1 2 3 2 1
Irresolution, indecision: 1 1
Acts, in:
Anger, irascibility: 2 3 1 1 1 3 1 1 1
tendency: easily:
Desires: Chocolates: 3 1 1 1 2 1
Desires: Spices, 3 1 2 1 1 2 2 1
condiments, highly
seasoned food:
Desires: sweets: 2 3 2 2 2 3 1 2 2 3
Skin: itching: night: 1 1 1 1
Skin: Pain: burning: 2 2 1 3 1 2 1 1 1
scratching, after:
Skin: discolouration: 1 1 3 2
Blackish:
Season: summer: agg: 2 2 3 1 1 2 1 3 1
18/10 17/10 15/9 15/9 10/9 18/8 15/8 12/8 12/8 11/8

97
Susceptibility: High.

Miasm: Tubercular.
-Recurrent cold & cough.
-Itching <night.
-Anticipatory anxiety and nervousness.
-Artistic nature.
Remedy Selected: Lycopodium.

Potency selected: 200 (II doses. Once every 7 days).

Follow Up:
Date Complaints Remedy given.
06/11/07 Red discolouration of skin-flexor aspect of elbow
joint >25%. Phytum 200 (4 doses –
Knee joint & upper part of lips >>50%. once every week)
Right hand-proximal phalynx >20%. SL 30 tds (4-4-4) x 1
Itching still there. Has to scratch. >scratching. month.
Burning after scratching. Bleeding twice after
scratching. No discharge.
Acne ---0---. Cold & cough ---0---.
Hair fall >20%. Dandruff is very less.
Generals – App: good.
Thirst: good.
Stool: normal.
Urine: normal.
Sleep: good. Refreshing.

18/12/07 Redness on finger tip<. Blood oozes out.

Blackish discolouration >>50%. Phytum 200 (4 doses –
White discolouration on knee >, on upper lip > but once every week)
itching still persists. SL 30 tds (4-4-4) x 1
Cold since 2-3 days. No discharges, No nose- month.
blocks.
Generals- App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good. Refreshing.

15/01/08 Redness & itching +++

<scratching  Bleeding. Lycopodium 200 (3
Knee joint & popliteal fossa – itching +++ doses -once every
Dryness +++ 15days)
Hair fall –SQ– SL 30 tds (4-4-4) x 1½
98
 Generals: App: good. month.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: disturbed due to complaints.

05/03/08 Redness + Itching3.

Pain3 (took combiflam). Calc Sulph 30 tds (4-4-
Peeling of skin of right fingers & upper part of lips 4) x 15 days.
–SQ--.
Both elbows Erythematous patches.
Boils on fingers. Pustular on right fingers.
Knee joint & popliteal fossa >
Generals: App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: Unrefreshing.

06/04/08 Patient off medicine since one week.

Upper part of lips< Cosmos 200 (2 doses –
Itching >. once every week)
Redness & pain >. SL 30 tds (4-4-4) x 15
Boils – Pustular- no new ones. days.
Peeling of skin ---0---.
Erythematous lesions on elbows>.
Generals- App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: disturbed due to complaints.

14/05/08 Itching ++ Redness < since 3-4 days.

Discharge watery. Lycopodium 1M (1dose)
Eruptions on both elbows flexor aspect < since 3 to SL 200 tds (4-4-4) x 7
4 days with pain. days.
Knee joint & popliteal fossa dryness of skin.
Generals: App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

21/05/08 Itching >>.

Redness & pain + with few cracks on skin. Cosmos 200 (2 doses –
Eruption & itching on left side of elbow > once every week)
99
 No new complaints or eruptions. SL 30 tds (4-4-4) x 15
Hair fall >. days.

Discussion: Patient Miss Chantelle Saldanha suffering from Atopic dermatitis since 2
years was given Lycopodium 200 on the basis of totality of symptoms. Once when
patient was aggravated & complained of pustular eruptions, Calc Sulph 30 repeatedly
given helped to improve the condition. Later Lycopodium 1M was given since response
to the previous potency was not satisfactory. Every time the remedy was prescribed the
reaction obtained was short-lived and followed by aggravation.

100
 CHECK-LIST FOR CASE 5

1. NAME: Mrs. Vinod Katyal

2. AGE: 51 years.
3. SEX: Male  / Female 
4. ADDRESS: Swati Society, Flat No. 410, Building no. 22B, Apna ghar, Shree Swami
Samarth Nagar, Lokhandwala Complex, Andheri (W).
5. OCCUPATION: Worker 
Office 
Maid / Servant 
Housewife 
Student 
Others  Dance teacher
6. RELIGION: Hindu
7. MARITAL STATUS: Married 
Single 
Divorcee 
Widow 
Widower 
8. PAST HISTORY: Koch’s 
DM 
Asthma 
Hypertension 
IHD 
Any Allergies 
Others 
9. HABITS: ---
10. FAMILY HISTORY: Husband 
Wife 
Mother Hypertension,CRF
Father MI.
Brother 
Sister 
Paternal → Grandfather 
→ Grandmother 
Maternal→ Grandfather 
→ Grandmother 
11. DRUG HISTORY: T. Dexamethasone, Ointment Tenovate-G.
T. Cetrizine and T. Fluconazole.
12. DISEASE HISTORY: Age of onset: since 4 months
Complaints: Itching: 
Scratching: 
Burning: 
Redness: 
Dryness: 
Swelling: 
101
 Cracks & scales: 
Bleeding: 
Discolouration: 
Lichenification: 
Recurrence: 
Continuous: 
Irritants /Allergens:--
Temperature Affection: Hot < or >: warm water >
Cold < or >: --
Climatic affection: Winter < or >: --
Summer < or >: --
Area of Affection:

13. EMOTIONAL FACTORS: History Of: Suppression or Over expression:

Anger / Vexation:
Stress / Tensions: takes tension easily.
Depression / or Grief: keeps emotions to herself.
Despair / loathing: without dance.
Anxieties:
Ambitions affected:
Others: Music ameliorates.
102
 CASE 5

Name: Mrs. Vinod Katyal

Address: Swati Society, Flat No. 410, Building no. 22B, Apna ghar, Shree Swami
Samarth Nagar, Lokhandwala Complex, Andheri (W).
Age: 51 years.
Sex: Female.
Status: Married since 33 years.
Religion: Hindu.
Occupation: Dance Teacher.
Physician-in-charge: Dr. N.O.Goel.
Date: 12/2/08.

Chief Complaint:
Patch with crack on both palms medially since 4 months. (L) > (R). Scaling is also
present.
No bleeding.
Started with itching  applied itch guard  was temporarily better but then itching
started again. Taken allopathic treatment for 3 weeks, complaints were better but now
since 3 to 4 days complaints started again.
Itching3 <night,
<Scratching,
>pressure,
>putting hand in warm water.
Feels as if cutting off the finger & throwing them away.
Swelling of fingers <morning.
Pain3 <cutting sour foodstuff,
<salt,
>pressure
Cracks are very painful.

Past Drug History: T. Dexamethasone.

Ointment Tenovate-G.
T. Cetrizine and T. Fluconazole.

Patient as a person:
Appetite: Good. Vegetarian diet
Likes: Paneer2, green peas, curd3, warm food.
Dislikes: Dal, bitter taste
Thirst: Adequate, 1-2 liters/day, wants cold water only3, 2 glasses at a time.
Stool: No complaints.
Urine: No complaints.
Perspiration: Moderate, More on forehead, armpit, back.
Non-offensive, Stains2.
Sleep: 7 hours, Non-refreshing.
Dreams: Dreams that she is sleeping & when she gets up she can’t open her eyes, feels as
103
if she’ll go blind-this dream came recently.
-Dreams of robber where she shouts but no voice comes out.
-Once dream of cat attacking her & she is trying to rescue herself (moving her hand).

Gynaec/Obs History:
FMP: 14 years, LMP:
Duration: 7days.
Colour: dark red
Cycle: Regular, 21 days.
Non-offensive, Non-staining.
Quantity- moderate.
Menopause since 3 years.
G2P1A1L1: G1 ♀ 32years FTND-Hospital Delivery.
G2 MTP done.

Mind:
Patient stays with her husband.
Says takes tension very easily, so to avoid it keeps her busy. She feels that if there was no
dance she would have gone mad.
Says is very sensitive. Loves watching T.V. mostly watches family oriented serials. She
doesn’t like fighting. Even in school all other teachers chit chat & mock at others which
she hates & will leave the staff room & go to library & read books.
She has her private dancing classes also but doesn’t want to leave school as there she gets
her salary time to time.
If she is tensed she keeps thinking about the problem & worries about it.
Likes listening to music & loves dancing mainly classical.
Says I am reserved, won’t speak more but will listen more.
She is very particular about her things & work. She wants everything in place & neat &
tidy.
Doesn’t like to stay with lots of people around- prefers to stay alone.
Says she keeps her feelings & emotions to herself, doesn’t tell anyone what she feels.

Thermal Reaction:
Can’t tolerate extremes of temperature, prefers winter season
Fan  summer – full A/C
 Winter – low speed wants fan throughout the year. Can’t do without it
Covering: summer – thin for mosquitoes
 Winter – thick
Bath: Lukewarm water throughout the year.
HOT patient

P/H: nothing significant.

F/H: Mother- Hypertension expired due to CRF.

Father - MI.

104
 O/E – General Examination:
Pulse: 74/min.
Temp: Afebrile.
BP: 124/80 mm of Hg.
No pallor, no icterus, no clubbing, no cyanosis, no lymphadenopathy.

Systemic Examination:
RS- clear, AEBE.
CVS- S1S2 heard.

Local examination:
Both palms medial side – redness, scaling, cracks, no bleeding.
Fingers are slightly swollen.

Diagnosis: Palmar Eczema.

Hahnemannian Classification: Dynamic chronic miasmatic disease with fully

developed symptoms.

Prescriptive Totality: 1. Cares, worries, full of;

2. Company aversion to, agg: Alone: amel. When;
3. Fastidious;
4. Music: amel;
5. Reserved;
6. Dreams: nightmares;
7. Itching: hand: palms;
8. Itching: scratching: agg;
9. Cracks, fissures: painful;
10. Pressure: amel;
11. Hot patient;
Repertorial Totality:

Sulph Nat-M Ars Con Sep Alum Mang Ambr Aur Graph
Cares, worries; full of; 2 1 3 1 1 1 1 2 1 1
Company: aversion to, 1 2 1 3 1
Agg: Alone: amel. when:
Fastidious: 1 2 2 1 1 1 1 2
Music: amel: 1 1 1 3
Reserved: 1 1 1 1 1 1 2 1 1 1
Dreams: Nightmare: 3 1 1 2 1 2 1 1
Itching: hand: palm 3 1 1 1 1 1 1 1 1 1
Itching: scratching: agg: 3 1 2
Cracks, fissures: painful: 1 2
Pressure: amel: 1 2 1 3 2 1 2 1 2 2
15/8 11/8 10/7 10/7 10/7 9/7 9/7 8/7 9/6 9/6

105
Susceptibility: High.

Miasm: Sycosis.
-Itching with cracks.
-Anxious dreams.
-Gets easily tensed.
-Fastidious.

Remedy Selected: Natrum Mur

Potency selected: 200 (1 dose).

Follow Up:
Date Complaints Remedy given.
22/02/08 Swelling of fingers >
Itching of palms2 Cosmos 30 (1dose)
Cracks still slightly painful. SL 30 tds (4-4-4) x 1
No new eruptions or cracks. month.
Generals – App: good.
Thirst: good.
Stool: normal.
Urine: normal.
Sleep: good. Refreshing.

22/03/08 Swelling on left hand fingers.

Palms- Itching3 Calc Sulph 30 tds
Cracks painful3 (4-4-4) x 4 days.
Furuncle- on leg- pus3.
Generals- App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: disturbed due to complaints.

29/03/08 Palms- Itching >>>

Pain >>> Natrum Mur 200 (1dose)
Swelling of fingers >> SL 30 tds (4-4-4) x 15
Furuncle on leg >>> reduction in size of patch. days.
No new eruptions.
Generals: App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

106
16/04/08 Palms- Itching & pain >>>
Leg-furuncle - >> Cosmos 200 (1dose).
Generals: App: good. SL 30 tds (4-4-4) x 2
Thirst: normal. months.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

11/06/08 Palms- Itching >

Burning of palms. Tub 1M (1dose).
Generals- App: good. SL 200 tds (4-4-4) x 1
Thirst: normal. month.
Stool: normal.
Urine: normal.
Sleep: disturbed due to complaints.

12/07/08 Palms – Itching >>

pain>> Natrum Mur 1M (1dose)
Leg- furuncle >> SL 200 tds (4-4-4) x 1
no new eruptions. month.
Generals: App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

30/08/08 Palms- Itching <

Pain ---0--- Cosmos 1M (1dose)
No new eruptions. SL 200 tds (4-4-4) x 1
Patient is generally better. month.
Generals: App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

Discussion: Patient Mrs. Vinod Katyal suffering from palmar eczema since 4 months
was given Natrum Mur 200 on the basis of totality of symptoms. In one follow up Calc
Sulph 30 tds was given for pustular furuncle on the leg. Following this Nat Mur 200 was
repeated. In the follow ups improvement was seen. One dose of Tub 1M was given. Then
Nat Mur 1M was given. Potency was increased as the result obtained by the previous
potency was not satisfactory.

107
 CHECK-LIST FOR CASE 6

1. NAME: Mrs. Vidya N. Hinduja

2. AGE: 65 years.
3. SEX: Male  / Female 
4. ADDRESS: New Sarvotum Society, Irla Bridge, Andheri (W).
5. OCCUPATION: Worker 
Office 
Maid / Servant 
Housewife 
Student 
Others 
6. RELIGION: Hindu
7. MARITAL STATUS: Married 
Single 
Divorcee 
Widow 
Widower 

8. PAST HISTORY: Koch’s 

DM 
Asthma 
Hypertension 
IHD 
Any Allergies 
Others  Malaria-5yrs ago, Bilateral cataract-10yrs ago.
9. HABITS: ---
10. FAMILY HISTORY: Husband 
Wife 
Mother 
Father  IHD-35yrs back expired.
Brother 
Sister 
Paternal → Grandfather 
→ Grandmother 
Maternal→ Grandfather 
→ Grandmother 
11. DRUG HISTORY: ---
12. DISEASE HISTORY: Age of onset: since 3-4 years.
Complaints: Itching: 
Scratching: 
Burning: 
Redness: 
Dryness: 
Swelling: 
Cracks & scales: 
108
 Bleeding: 
Discolouration:  with varicose veins.
Lichenification: 
Recurrence: 
Continuous: 
Irritants /Allergens: ---
Temperature Affection: Hot < or >: --
Cold < or >: --
Climatic affection: Winter < or >: --
Summer < or >: --
Area of Affection:

13. EMOTIONAL FACTORS: History Of: Suppression or Over expression:

Anger / Vexation: violent anger3
Stress / Tensions:
Depression / or Grief:
Despair / loathing:
Anxieties:
Low self-esteem:
Ambitions affected:
Others: impatience prefers being alone.
109
 CASE 6

Name: Mrs. Vidya N. Hinduja

Address: New Sarvotum Society, Irla Bridge, Andheri (W).
Age: 65 years.
Sex: Female.
Status: Married since 40 years.
Religion: Hindu.
Occupation: Housewife.
Physician-in-charge: Dr. Nimish Mehta.
Date: 07/06/08.

Chief Complaint:
Blackish discolouration of skin over the shin of tibia since 3-4years. It started with
some wound  transparent watery yellowish discharge  followed by hyper
pigmentation of the skin.
Discharge foul, very offensive in nature.
Itching was initially very bad now presently it is less.
No alteration of sensation, no pain, no fever.
Discolouration has now increased gradually.

Patient as a person:
Appetite: Good. Vegetarian diet
Likes: Sweets3, highly seasoned food3.
Dislikes: Spicy food2
Thirst: 4-5 glasses/day, cold water, 1glass at a time.
Stool: No complaints.
Urine: No complaints.
Perspiration: Scanty, More on face-forehead.
Non-offensive, Non-staining
Sleep: 7 hours, Refreshing.
Dreams: Dreams of robbers taking away all her money.
Dreams of falling in a ditch
Dreams of family members & of God
These dreams cause her to wake up from sleep.

Gynaec/Obs History:
Menopause since 10 years.
G3P1A2L1: G1 ♂ 35 years FTND-Hospital Delivery.
She has aborted twice as didn’t want more children.

Mind:
Patient stays with her husband, son, and daughter-in-law.
Anger3 – when repeats a thing thrice & no one listens to her then gets angry. Now
controls her anger as tells I will spoil my health, so it is better to control it. Before several
110
years, was a very angry person & used to throw things in anger. Now if she gets angry
then talks less & does some other work- sees TV, goes out for walk. Goes in satsang
where she is taught all this. Husband says has less tolerance power, still there is lot of
anger & irritability. There is spontaneous anger which goes in two minutes. Her anger is
better by consolation.
Fastidious - wants everything in order. She gets angry when things are not in order. She
will do it by herself then.
Likes to be alone-because of excessive noise, gets irritated & angry.
She likes to roam out with everyone.
No fears.
About disease- has come to take treatment as husband told her, says as it is the
discolouration is on leg which is not seen.
Wants work to be done fast-hurried nature.
Tension that daughter-in-law doesn’t have children. Says I buy chocolates & give to other
children, someone should be there at home too.
Tension when husband is unwell.
Observation- there was restlessness of the upper extremities. (Patient was shouting,
screaming & was not ready to wait.)

Thermal Reaction:
Can’t tolerate summer
Fan  full throughout the year.
Covering: summer – thin
 Winter – thick
Bath: Cold water throughout the year.
Ambithermal  Hot

P/H: Malaria-5 years back.

No H/o TB, asthma, thyroid, HT, DM.
She was operated for left eye cataract 10 years back- since then no vision in the
left eye.
Also was operated for right eye cataract.

F/H: Mother- expired 30 yrs back (old age).

Father – IHD-35 years back-expired.

O/E – General Examination:

Pulse: 68/min.
Temp: Afebrile.
BP: 138/88 mm of Hg.
No pallor, no icterus, no clubbing, no cyanosis, no lymphadenopathy.

Systemic Examination:
RS- clear, AEBE.
CVS- S1S2 heard.

111
 Local examination:
Varicosities of lower limbs seen.
There is black discolouration over the skin of right tibia.
No discharge oozing.

Diagnosis: Varicose veins with Stasis dermatitis.

Hahnemannian Classification: Dynamic chronic miasmatic disease with fully

developed symptoms.

Prescriptive Totality: 1. Impatience;

2. Anger, tendency: violent;
3. Fastidious;
4. Delusions, imaginations: Thieves, robbers, sees;
5. Desires-highly seasoned food;
6. Desires-sweets;
7. Restlessness of upper limbs;

Repertorial Totality:

Ars Nux-v Kali-c Nat-m Sep Phos Sil Sulph Puls Lyc
Impatience 2 3 2 2 3 3 3 2 2
Anger, irascibility: tendency: 2 3 2 2 2 1 1 1 1 2
violent:
Fastidious: 2 2 2 2 1 1 1 1 3
Delusions, imaginations: 1 1 2 1 1
Thieves, robbers, sees:
Desires: Spices, 2 2 1 1 3 3 2 1
condiments, piquant,
highly seasoned food:
Desires: Sweets: 3 1 2 1 2 2 1 3 2 3
Restlessness: upper limbs: 1 1 1 1 1 1 1
13/7 12/6 10/6 10/6 10/6 9/6 8/6 11/5 10/5 9/5

Susceptibility: High.

Miasm: Sycosis.
-Black discolouration.
-Offensive discharges.
-Varicosities.
-Violent anger.
-Fastidious.

Remedy Selected: Nux Vomica

112
Potency selected: 200 (1 dose).

Follow Up: On 07/06/07(on day of case taking) patient was given SL as patient was not
ready to wait.

Date Complaints Remedy given.

14/06/08 Itching >> 20-30 % Nux Vom 200 (1dose)
Feels blackish discolouration has reduced. SL 30 tds (4-4-4) x 7
Generals – App: good. days.
Thirst: good.
Stool: normal.
Urine: normal.
Sleep: says due to medicine sleep has
increased. Gets up at 10:00am for last 3 days.

21/06/08 Itching >20 %

Says discolouration has reduced++. Nux Vom 200 (1dose).
Anger & irritability >15-20% SL 30 tds (4-4-4) x 15
Generals- App: good. days.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good.

09/07/08 Itching >70%

Discolouration further reduced++. Nux Vom 200 (1dose)
Anger & irritability >25%. SL 30 tds (4-4-4) x 15
Generals: App: good. days.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.
(Patient’s husband says she has no power of
understanding. She can’t defend herself in front of
others or can’t fight.)

21/07/08 Itching –SQ–. Nux Vom 200 (4 doses-

Discolouration reduced. once every week).
Anger >50%. SL 30 tds (4-4-4) x 1
Generals: App: good. month.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.
113
23/08/08 Itching was > after last medicine. Increased
gradually after 4-5 days, now it is more. No new Nux Vom 200 HS daily.
eruptions. SL 30 bd (4-4) x 15
Discolouration reddish. days.
> Ice application locally.
Gets irritated at trifles & remains angry for long
time.
Generals- App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: normal.

17/09/08 Itching >30%. Nux Vom 200 tds

Last time reddish discolouration, now reddish (4-4-4) x 3 days.
black discolouration. SL 200 tds (4-4-4) x 14
Cough since 4-5 days since drank cold mosambi days.
juice & cold drink-Miranda. Difficult
expectoration. Craves cold drinks.
Mild fever since 5-6 days. No chills.
Irritability & anger –SQ–
Generals: App: decreased since 5-6days.
Thirst: decreased. Wants cold drinks.
Stool: normal.
Urine: normal.
Sleep: disturbed due to cough.

11/10/08 Itching >50%.

Reddish black discolouration. Nux Vom 200 tds
Irritability –SQ–. (4-4-4) x 14 days.
Cough & fever ---0---.
Generals: App: improved.
Thirst: reduced.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

11/10/08 Itching –SQ–. Nux Vom 1M HS (1

Reddish black discolouration –SQ–. dose)
(According to daughter-in-law irritability has SL 30 tds x 7 days.
increased.)
Generals: App: normal.
Thirst: normal.
Stool: normal.
Urine: normal.
114
 Sleep: good, Refreshing.

Discussion: Patient Mrs. Vidya Hinduja suffering from varicose veins with stasis
dermatitis since 3-4 years was given Nux Vomica 200 on the basis of totality of
symptoms. Patient is gradually improving. Potency was increased to Nux Vomica 1M
since response to previous potency was no longer obtainable.

115
 CHECK-LIST FOR CASE 7

1. NAME: Mr. Mohammad Habib Chaudhari.

2. AGE: 63 years
3. SEX: Male  / Female 
4. ADDRESS: 4/401, Kapadia Nagar, Kurla (W).
5. OCCUPATION: Worker 
Office 
Maid / Servant 
Housewife 
Student 
Others 
6. RELIGION: Muslim
7. MARITAL STATUS: Married 
Single 
Divorcee 
Widow 
Widower 

8. PAST HISTORY: Koch’s 

DM 
Asthma 
Hypertension  since 4-5 years.
IHD 
Any Allergies 
Others  Haematoma in brain 4-5yrs back.
9. HABITS: tobacco chewing & bettlenut since the age of 17-18 yrs.
10. FAMILY HISTORY: Husband 
Wife 
Mother  Asthma (expired)
Father 
Brother 1  Asthma
Brother 2  MI-Bypass surgery done.
Paternal → Grandfather 
→ Grandmother 
Maternal→ Grandfather 
→ Grandmother 
11. DRUG HISTORY: Allopathic ointment & T.Cetrizine.
12. DISEASE HISTORY: Age of onset: since 14-15 years.
Complaints: Itching: 
Scratching: 
Burning: 
Redness: 
Dryness: 
Swelling: 
Cracks & scales: 
116
 Bleeding: 
Discolouration: 
Lichenification: 
Recurrence: 
Continuous: 
Irritants /Allergens: --
Temperature Affection: Hot < or >: --
Cold < or >: --
Climatic affection: Winter < or >: --
Summer < or >: --
Area of Affection:

13. EMOTIONAL FACTORS: History Of: Suppression or Over expression:

Anger / Vexation: > by speaking it out.
Stress / Tensions:
Depression / or Grief: easily affected by others sufferings.
Despair / loathing:
Anxieties:
Low self-esteem:
Ambitions affected: wanted to be an officer, but financial troubles.
Others: conscientious
117
 CASE 7

Name: Mr. Mohammad Habib Chaudhari.

Address: 4/401, Kapadia Nagar, Kurla (W).
Age: 63 years.
Sex: Male.
Status: Married since 40 years.
Religion: Muslim.
Occupation: Steel business.
Physician-in-charge: Dr. N.O.Goel.
Date: 21/06/08.

Chief Complaint:
Dry, scaly skin. Patient has eruptions on both palms, both heels, both knees & on
scalp, on chest since 14-15 years.
It started first on one (?) hand, then both hands were affected, then both the feet &
lastly on scalp & the chest.
Skin eruptions dry, scaly, bad in odor, indurated.
It started with the complaints of boil on back then it cracked.
Occasionally, she has itching since 4-5 years.
Taken allopathic treatment 4-5 years back-some ointment & T.Cetrizine. She got
temporary relief.

Patient as a person:
Appetite: Good. Non-vegetarian diet
Likes: Sweets+.
Dislikes: ––
Thirst: 6-8 glasses/day prefers plain water.
Food/drinks agg/amel: —
Stool: No complaints.
Urine: No complaints.
Perspiration: Scanty, mostly on chest.
Non-offensive, Non-Staining
Sleep: 6-7 hours, Refreshing.
Dreams: Dreams of flying.
Dreams of giving exams
Habits: Tobacco chewing & bettlenut since the age of 17 to 18 years.

Mind:
Patient has studied till 10th Std. Stays in Mumbai since 1965 with his wife, 4 sons & 5
daughters. He says he is mild, likes to sit with mild people, not aggressive.
She likes company, can’t tolerate wrong things, shows them what’s right or wrong then
whoever they may be. Says he can control his anger, doesn’t easily become angry. Anger
just expressed by speaking out. She likes to fight. Anger persists in his mind until he
speaks it out. After talking it out he forgets. She is very particular about cleanliness,

118
particularly about food & surroundings. She loves to eat healthy food. He wants to
become an officer, couldn’t study more because of financial problems.
Says he is very sensitive. Gets affected easily by seeing others in trouble & tries to solve
their problems.
Observation: thinks a lot while speaking. She talks a lot.

Thermal Reaction:
Aggravated in summer season- gets irritated & restless.
Fan  summer – full fan
 Winter – slow fan. But can do without it.
Covering: summer – no covering
 Winter – thin.
Bath: Lukewarm water throughout the year.
Ambithermal  Hot patient

P/H: Haematoma in brain 4-5 years back. He had been operated for that.
She is suffering from hypertension since 4-5 years.

F/H: Mother- Asthma (expired)

Eldest brother: Asthma.
Younger brother: MI-Bypass surgery done.

O/E – General Examination:

Pulse: 74/min.
Temp: Afebrile.
BP: 130/90 mm of Hg.
No pallor, no icterus, no clubbing, no cyanosis, no lymphadenopathy.

Systemic Examination:
RS- clear, AEBE.
CVS- S1S2 heard.

Local examination:
Skin over lower limbs is dry & scaly eruptions.
Scalp has eruptions, scaling.
Skin of palms has scaling & dryness.

Diagnosis: Lichenified Eczema.

Hahnemannian Classification: Dynamic chronic miasmatic disease with fully

developed symptoms.

Prescriptive Totality: 1. Conscientious about trifles;

2. Desires Company;
3. Horrible, sad stories affect profoundly;
4. Fastidious;
119
 5. Dreams: Flying;
6. Desires: sweets;
7. Hot patient;
8. Skin: dry eruptions;

Repertorial Totality:

Lyco Sulph Puls Calc-s Nat-m Iod Bry Carb-v Plat Arg-n
Conscientious about 2 2 2 1 1 1 1
trifles:
Company: desire for: 3 1 2 1 1 1 1 3
Horrible things, sad 2 2 2 1 1 3 1 1
stories affect her
profoundly:
Fastidious: 1 3 2 1 1 1
Dreams: Flying: 1
Sweets: Desires: 3 3 2 2 1 2 2 1 3
Skin: Eruptions: dry: 2 2 3 1 2 2 2
13/6 11/6 11/5 8/5 6/5 7/4 6/4 6/4 4/4 7/3

Susceptibility: Low

Miasm: Sycosis.
-Dry, indurated eruptions.
-Offensive discharges.
-P/H Haematoma.
-K/c/o hypertension.
-Fastidious.

Remedy Selected: Lycopodium

Potency selected: 200 (1 dose).

Follow Up:
Date Complaints Remedy given.
28/06/08 Dryness of skin still persists.
Scaling of skin of legs & hands & scalp >>>. Cosmos 200 (1dose)
Generals – App: good. SL 30 tds (4-4-4) x 15
Thirst: good. days.
Stool: normal.
Urine: normal.
Sleep: good. Refreshing.

12/07/08 Patient was better in all aspects & was on SL for

to all this period.
120
13/09/08
04/04/08 Complaints are < again. Dryness & scaling of
palms come up again. On lower limbs –SQ–. Lyco 1M (1dose)
Generals: App: good. SL 30 tds (4-4-4) x 1
Thirst: normal. month.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

08/08/08 Eczema on hands & feet >.

Itching occasionally there. > scratching. Cosmos 200 (1dose).
Generals: App: good. SL 30 tds (4-4-4) x 1
Thirst: normal. month.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

20/04/09 Was better for about 6 months.

Now eruptions on the hands, feet & knee have Lyco 1M (2 doses-once
increased. Complains of itching. every week).
Generals-App: good. SL 30 tds (4-4-4) x 15
Thirst: normal. days.
Stool: normal.
Urine: normal.
Sleep: disturbed due to complaints.

08/05/09 Eruptions on hand & feet >>

Occasional itching > Medo 200 (2 doses-
Eruptions on scalp(behind ears)>> once every week)
Chest almost normal. SL 200 tds (4-4-4) x
Generals: App: good. 15days.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

29/05/09 Eruptions on hand & feet >>25%.

Itching >> Lyco 1M (1 dose)
Eruptions on knee joint & chest –SQ–. SL 200 tds (4-4-4) x
Eruptions on scalp (behind ears) >>. 15days.
Generals: App: increased.
Thirst: increased.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

121
Discussion: Patient Mr. Md. Habib Chaudhari suffering from lichenified eczema since
14-15 years was given Lycopodium 200 on the basis of totality of symptoms. Medo 200
(2 doses) were given following which Lyco 1M was given. Potency was increased since
response to previous potency was not satisfactory. Gradual improvement is seen in the
case.

122
 CHECK-LIST FOR CASE 8

1. NAME: Mrs. Salmabibi Mandal.

2. AGE: 23 years.
3. SEX: Male  / Female 
4. ADDRESS: Juhu, Indranagar, Room.No:71, Santacruz (W).
5. OCCUPATION: Worker 
Office 
Maid / Servant 
Housewife 
Student 
Others 
6. RELIGION: Bengali
7. MARITAL STATUS: Married 
Single 
Divorcee 
Widow 
Widower 

8. PAST HISTORY: Koch’s 

DM 
Asthma 
Hypertension 
IHD 
Any Allergies 
Others  some drug reaction.
9. HABITS: ---
10. FAMILY HISTORY: Husband 
Wife 
Mother 
Father 
Brother 
Sister 
Paternal → Grandfather 
→ Grandmother 
Maternal→ Grandfather 
→ Grandmother 
11. DRUG HISTORY: ---
12. DISEASE HISTORY: Age of onset: since 10 years
Complaints: Itching: 
Scratching: 
Burning: 
Redness: 
Dryness: 
Swelling: 
Cracks & scales: 
123
 Bleeding: 
Discolouration: 
Lichenification: 
Recurrence: 
Continuous: 
Irritants /Allergens: imitation jewellery

Temperature Affection: Hot < or >: --

Cold < or >: --
Climatic affection: Winter < or >: Any change in atmosphere <.
Summer < or >:
Area of Affection:

13. EMOTIONAL FACTORS: History Of: Suppression or Over expression:

Anger / Vexation:
Stress / Tensions: fear of poverty
Depression / or Grief: forsaken feeling, unloved.
Despair / loathing:
Anxieties:
Others: insecurity, suspicious, hasty, obstinate.

124
 CASE 8

Name: Mrs. Salmabibi Mandal.

Address: Juhu, Indranagar, Room.No:71, Santacruz (W).
Age: 23 years.
Sex: Female.
Status: Married since 8 years.
Religion: Bengali.
Occupation: Housewife.
Physician-in-charge: Dr. Jayesh Dhingreja.
Date: 06/03/08.

Chief Complaint:
Eruptions on hands & legs since 10 years. Eruptions increased in size, filled with
water. Itching++. There is watery discharge.
> scratching. < Detergent  burning
Burning when touched with water.
It starts from tip of finger  entire fingers  Palms. In legs there are eruptions only at
tip of toes.
After wearing imitation jewellery  skin becomes red & itching starts.
< Change of atmosphere/ environment

Associated Complaint:
Itching in left breast. No eruptions. There is redness after scratching.
Watering from eye (right) since 1 month after applying cosmetics. No itching.

Patient as a person:
Appetite: Eats at little intervals. Non-vegetarian diet
Likes: mutton, brinjal, tea, cold drinks, fried food.
Dislikes: Bitter, vegetables
Thirst: 1& half liters/day, sips at a time.
Stool: No complaints.
Urine: No complaints.
Perspiration: Moderate.
Non-offensive, Non-staining
Sleep: 7 hours, Unrefreshing. Good sleep usually but disturbed if tension about money &
family matters.
Dreams: Unremembered.

Gynaec/Obs History:
FMP: 12 years, LMP?
Duration: 4 days.
Colour: dark red
Cycle: Regular, 21 days.
Offensive, Staining: yellow.
Quantity: moderate.
125
During menses: backache <standing.
G2P1A1L1: G1 ♀ 7 years FTND-Hospital Delivery.

Mind:
When she thinks of something, keeps on thinking about it, she can’t forget it and
then can’t sleep. Can’t remember where she has kept her things.
She gets irritated if she has to wait for long for someone or has to sit idle. She gets bored.
Mother died at early age, father married again. She feels that she did not get love
in her childhood. Has good relation with her husband & behaves like a child with him.
Thinks from where I did not get love, why should I talk to them. Will talk to her father if
he himself comes but she will not go to talk to him. Has good relations with her
husband’s family but feels that few of them do not love her but behave well with her
because she earns. She wants to help her husband’s family but feels they do not have the
same attitude like hers.
She doesn’t like to go to village. Since she doesn’t like the village life, the way
they life, the way they live & talk. Says standard is not there. Thinks now, if the house
gets ready how will I settle there, keeps on thinking about it. Memory weak-says can’t
remember where she has kept things. Insecurity regarding husband- what if he leaves
her?? She is suspicious about her husband. Insecurity about money - what about the
money I have earned, will it be enough. She has feeling of being unloved by her parents.
She gets irritable, angry when things go slow. She is very hurried. She doesn’t
like when others are slow. She even eats fast.

Thermal Reaction:
Can’t tolerate summer
Fan  summer – fast.
 Winter – slow
Covering: summer – thin
 Winter – thick
Bath: warm water throughout the year.
Ambithermal  Hot

P/H: Admitted for some kind of drug reaction.

F/H: ---

O/E – General Examination:

Pulse: 72/min.
Temp: Afebrile.
BP: 100/64 mm of Hg.
No pallor, no icterus, no clubbing, no cyanosis, no lymphadenopathy.

Systemic Examination:
RS- clear, AEBE.
CVS- S1S2 heard.

126
 Local examination:
There are vesicles on fingers & feet. No redness.

Diagnosis: Allergic contact dermatitis.

Hahnemannian Classification: Dynamic chronic miasmatic disease with fully

developed symptoms

Prescriptive Totality: 1. Forsaken feeling; unloved;

2. dwells on past disagreeable occurrences;
3. Suspicious;
4. Insecurity;
5. Fear of poverty;
6. Hurried; hasty;
7. Obstinate;
8. Aversion: vegetables;
9. Desires: meat;
10. Desires: cold drinks, water;
11. Skin: itching, scratching, amel;

Repertorial Totality:

Sulph Calc Ars Phos Sep Bry Nuv-v Caust Nat-m Bell
Forsaken feeling; 1 1 2 1
beloved by his parents,
wife, friends, feels he is
not being:
Dwells on past disagreeable 2 1 1 2 1 3
occurrences;
Suspicious; 3 1 3 2 2 3 2 3 2
mistrustfulness:
Insecurity; mental: 2
Fear: poverty; 1 2 1 2 3 1
Hurried; haste: tendency; 3 1 2 1 1 2 2 1 3 2
Obstinate, headstrong; 2 3 2 1 1 1 3 1 1 3

Aversion: vegetables; 1 2 2 2 1
Desires: meat; 2 1 1 1 2 1
Desires: cold drinks, 1 2 3 3 2 3 1 2 2 2
water
Skin: itching, scratching, 2 3 1 3 2 2 1 1 1
amel;
18/10 15/9 15/8 14/8 13/8 16/7 12/7 11/7 12/6 11/6

127
Susceptibility: High

Miasm: Sycosis.
-Feeling of insecurity.
-Suspicious nature.
-Easily angered.
-Burning and itching of eruptions.

Remedy Selected: Calcarea Carb

Potency selected: 200 (1 dose).

Follow Up:

Date Complaints Remedy given.

13/03/08 Eruptions on hands & legs >.
Itching >. Cosmos 200 (1dose)
No burning in eruptions. SL 30 tds (4-4-4) x 7
Itching of breast –SQ–. days.
Generals – App: good.
Thirst: good.
Stool: normal.
Urine: normal.
Sleep: good. Refreshing.

03/04/08 Itching on fingers (nail bed) >20 %

Itching on toes –SQ–. Cosmos 200 (1dose).
Itching of breast (nipple) increased. Itching when SL 30 tds (4-4-4) x 15
excessive causes pain. No cracks, no discharge. days.
O/E - Breast left – nipple – red. No cracks or
discharge.
Generals- App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: disturbed. Has many problems &
tension as one relative diagnosed with renal calculi
& has to be operated. So worried about the
expenses & how they will get help.

17/04/08 Itching on fingers & toes –SQ–.

Itching on left nipple >. O/E – left nipple no Cosmos 200 (1 dose).
redness. No complaints. SL 30 tds (4-4-4) x
Watering of eyes < with make up. 15days.
128
 Forgetfulness –SQ–.
Generals: App: doesn’t feel like eating.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: gets sleep but wakes up in middle
& then sleepless because of financial tensions.
Dreams: in the past had a dream as if her child was
dead. Recently dreamt related to money.

Discussion: Patient Mrs. Salmabibi Mandal suffering from allergic contact dermatitis
since 10 years was given Calcarea Carb 200 on the basis of totality of symptoms.
Reaction showed initial amelioration followed by status quo.

129
 CHECK-LIST FOR CASE 9

1. NAME: Mr. Dharmesh Panchal.

2. AGE: 27 years.
3. SEX: Male  / Female 
4. ADDRESS: Flat no.3-Bwing,GangaVihar,Raheja Township,Malad(E),Mumbai-97.
5. OCCUPATION: Worker 
Office 
Maid / Servant 
Housewife 
Student 
Others 
6. RELIGION: Hindu
7. MARITAL STATUS: Married 
Single 
Divorcee 
Widow 
Widower 

8. PAST HISTORY: Koch’s 

DM 
Asthma 
Hypertension 
IHD 
Any Allergies 
Others 
9. HABITS: ---
10. FAMILY HISTORY: Husband 
Wife 
Mother  DM, IHD?
Father 
Brother 
Sister 
Paternal → Grandfather 
→ Grandmother 
Maternal→ Grandfather 
→ Grandmother 
11. DRUG HISTORY: On allopathic treatment since long.
12. DISEASE HISTORY: Age of onset: since 5-6 years.
Complaints: Itching: 
Scratching: 
Burning: 
Redness: 
Dryness: 
Swelling: 
Cracks & scales: scaling on scalp
130
 Bleeding: 
Discolouration: 
Lichenification: 
Recurrence: 
Continuous: 
Irritants /Allergens: --
Temperature Affection: Hot < or >: --
Cold < or >: --
Climatic affection: Winter < or >: --
Summer < or >: --
Area of Affection:

13. EMOTIONAL FACTORS: History Of: Suppression or Over expression:

Anger / Vexation: ailments from suppressed anger, vexation.
Stress / Tensions:
Depression / or Grief: ailments from disappointed love.
Despair / loathing:
Anxieties: guilt feelings.
Low self-esteem:
Ambitions affected:
Others: loves traveling & music.
131
 CASE 9

Name: Mr. Dharmesh Panchal.

Address: Flat no.3- Bwing, Ganga Vihar, Raheja Township, Malad (E), Mumbai-97.
Age: 27 years.
Sex: Male.
Status: Single.
Religion: Hindu.
Occupation: Service- Hardware & networking.
Physician-in-charge: Dr. Nimish Mehta.
Date: 24/05/08.

Chief Complaint:
Itching & scaly over the face & scalp since 5-6 years.
It is progressing gradually. It is unbearable.
Gradual onset but increased in intensity.
Itching & scaling which spills over the face.
Itching & redness Whitish scales.
Itching on scalp after sweating
Itching on face <<shaving.
She complains of alopecia since 5-6 years at vertex. Also complains of dandruff.
Initially hair fall was more but now it has decreased in quantity.
< Stress, < combing hair when dry.
Crack with yellow discolouration of nails – right ring finger & left little finger.

Associated Complaint:
She complains of pain in left knee since one month with sudden onset and
progressing gradually.
< Exertion, < flexion of knee, < upstairs

Present Drug History: Taking some steroidal drug for itching & scaling.
She applies some local ointment. Dipsalic lotion for scalp:
twice/week.
She uses Lobate-M for nails.

Past Drug History: T. Supradyn

T. Fiuperia 1 mg
T. Pasys 150
T. Betuesol
T. Tyrobit cream.
Flurozane and Diprovate lotion

Patient as a person:
Appetite: Good. Vegetarian diet
Likes: Panner3, Chinese food, spicy2.
Dislikes: Oily food
132
Thirst: 6-7 liters/day, large quantity of water, prefers plain water.
Food/drinks agg/amel: —
Stool: Occasional constipation, hard stool, has to strain.
Urine: No complaints.
Perspiration: Moderate, more on scalp, armpit & back3.
Offensive, yellow staining: indelible.
Sleep: 6-7 hours, Refreshing.
Dreams: Occasionally, dreams of ghosts.

Mind:
She stays with parents & 1 elder & I younger brother.
Patient says I get angry when I do something good for someone & that someone does
something wrong with me.
He says he is a peace lover. Whenever I see anyone fighting around I try to
resolve the fight. Says I am basically a non-violent person.
Says he feels like crying when he remembers about his studying. Says I feel I
should have studied well during my college days because I see young people around me
who are well qualified than me.
Says he feels depressed because he really liked a girl but was unable to restore the
relationship because of his attitude. Says I had a neglecting nature but since after that I
became very concerned regarding everything. I was depressed for almost one month &
still think about her.( happened 6-7 years back).
Patient also feels he hasn’t achieved many things in life.
I am good in making friends but my relationship doesn’t last longer due to my
schedule of work, I have no time for them.
Fear of any sharp & heavy object around like iron sheets, metal-sharp edged. I
feel that thing will hurt me.
Has guilt feeling. Says haven’t done enough for my family & I still regret about it.
She is fond of traveling, music-light music, movies, making friends.
She is very conscious about image.

Thermal Reaction:
Fan  summer – full fan
 Winter – minimal or no fan
Covering: summer – thin
 Winter – thick
Bath: Lukewarm water throughout the year.
Ambithermal  Chilly patient

P/H: ---

F/H: Mother- DM, Cardiac problem (?).

O/E – General Examination:

Pulse: 66/min.
Temp: Afebrile.
133
 BP: 120/80 mm of Hg.
No pallor, no icterus, no clubbing, no cyanosis, no lymphadenopathy.

Systemic Examination:
RS- clear, AEBE.
CVS- S1S2 heard.

Local examination:
Scalp: scales seen.
Nails- Yellow cracked nails of right ring finger & left little finger.

Diagnosis: Seborrhoeic Dermatitis.

Hahnemannian Classification: Dynamic chronic miasmatic disease with fully

developed symptoms.

Prescriptive Totality: 1. Ailments from: anger, vexation: suppressed, from;

2. Ailments from: love disappointed, unhappy;
3. Fear: pins, pointed, sharp things, of;
4. Anxiety: conscience, of;
5. Perspiration: offensive;
6. Perspiration: Staining yellow;
7. Desires: Spices, condiments, piquant, highly seasoned food;
8. Skin: itching, perspiration agg;

Repertorial Totality:

Nat-m Merc Staph Aur Sulph Ars Ign Lach Sil Lyc
Ailments from: anger, 2 3 2 2 3
vexation: suppressed,
from
Ailments from: love 3 4 3 1 4 2
disappointed, unhappy;
Fear: pins, pointed, sharp 1 1 1 4
things, of;
Anxiety: conscience, of; 2 2 1 4 3 3 2 2 2
Perspiration: offensive; 1 3 2 3 2 1 2 3 3
Perspiration: Staining 3 1 3 1
yellow;
Desires: Spices, 1 1 1 3 2 1
condiments, piquant,
highly seasoned food;
Skin: itching, 1 2
perspiration agg;
11/7 11/5 11/5 10/4 10/4 9/5 9/4 9/4 9/3 8/4

134
Susceptibility: High

Miasm: Sycosis.
-Gradual progress of disease.
-Indelible staining.
-Dreams of ghosts.
-Image conscious.

Remedy Selected: Staphysagria

Potency selected: 200 (1 dose) (advised to stop all local applications).

Follow Up:
Date Complaints Remedy given.
03/11/08 Itching on face increased since 4 days.(applied
steroid lotion twice). Staph 200 (1dose)
Itching on scalp increased. Was better initially but SL 30 tds (4-4-4) x 15
complain has increased since one week. days.
Yellowish discolouration of nails –SQ–.
Pain in left knee joint >.occasional pain.
Generals – App: good.
Thirst: good.
Stool: Hard stools, has to strain.
Urine: normal.
Sleep: disturbed due to change in
working shifts.

05/12/08 Dandruff > ;

Itching > 10%. Staph 200 (1dose)
Face scaling & itching > SL 30 tds (4-4-4) x 7
Knee joint > pain on continuous walking. days.
Yellowish discolouration of nails –SQ–.
Back stiffness >>.
Dryness of skin –SQ–.
Hair fall –SQ–.
Perspiration- previously profuse now decreased.
Generals: App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

14/12/08 Dandruff –SQ–. Itching –SQ–.

Face scaling & itching >> after local application. Tub 1M (2 doses-once
135
 Knee joint pain > but started again since 3-4 days. every week HS)
Yellowish discolouration of nails increased, Staph 1M (2 doses-once
painful. every week HS)
Back stiffness. SL 30 tds (4-4-4) x 15
Perspiration- less. days.
Generals: App: increased.
Thirst: normal.
Stool: constipation.
Urine: normal.
Sleep: ok, mentally irritated with work
tensions.

23/01/09 Scalp itching occasionally.

Skin scaling < – >. Staph 1M (2 doses) HS.
Hair fall –SQ–. SL 30 tds (4-4-4) x 1
Back stiffness on & off. month.
Headache > 30-40%.
Burning of eyes.
Generals: App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: disturbed.

27/04/09 Hair fall –SQ–.

Dandruff –SQ–.
Scalp itching >50%.
Pain in knee since 6-7 month. Cosmos 1M (2 doses-
< walking once every week).
< climbing up SL 30 tds (4-4-4) x 15
< Since a week. days.
Yellow discolouration of nail is >.
Applies Lobate M for itching & discolouration.
Generals- App: good.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: decreased.

19/06/09 Itching on face >>.

Dandruff >>. Staph 1M (2 doses-once
Pain in knees >> every week)
< On walking. SL 30 tds (4-4-4) x
Sensation of numbness in left hip since 10 days. 15days.
H/o similar pain 4 months back.
Generals: App: good.
136
 Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

10/07/09 Itching on face >50%.

Dandruff <; Hair fall with itching of scalp<. Tub 1M (1 dose)
Pain in left ankle <pressure. Staph 1M (2 doses-once
Pain with severe numbness for 2-3mins on every week)
standing, continuous pain. SL 30 tds (4-4-4) x
Pain in knees >10%. 15days.
< walking for long or standing for long.
Sensation of numbness in left hip >.
Crack & discolouration of nails –SQ–.
Mouth ulcers since 1 week on lateral border of
tongue on left side < morning.
Generals: App: increased.
Thirst: increased.
Stool: constipation since a week.
Urine: normal.
Sleep: good, Refreshing.

Discussion: Patient Mr. Dharmesh Panchal suffering from seborrhoeic dermatitis since 5-
6 years was given Staph 200 on the basis of totality of symptoms. Partial improvement
was seen. Tub 1M was prescribed which was followed by Staph 1M. Reaction has been
status quo.

137
 CHECK-LIST FOR CASE 10

1. NAME: Miss Ohawana Shetty

2. AGE: 6 years.
3. SEX: Male  / Female 
4. ADDRESS: V-24, Golden Valley, Opposite Canara Bank. Kalina.
5. OCCUPATION: Worker 
Office 
Maid / Servant 
Housewife 
Student 
Others 
6. RELIGION: Hindu
7. MARITAL STATUS: Married 
Single 
Divorcee 
Widow 
Widower 

8. PAST HISTORY: Koch’s 

DM 
Asthma  1½ year back.
Hypertension 
IHD 
Any Allergies 
Others  worms in stool-4 years back.
9. HABITS: ---
10. FAMILY HISTORY: Husband 
Wife 
Mother  Hypertension
Father  Hypertension
Brother 
Sister 
Paternal → Grandfather 
→ Grandmother 
Maternal→ Grandfather 
→ Grandmother 
11. DRUG HISTORY: ---

12. DISEASE HISTORY: Age of onset: since 2 years

Complaints: Itching: 
Scratching: 
Burning: 
Redness: 
Dryness: 
Swelling: 
138
 Cracks & scales: 
Bleeding: 
Discolouration: 
Lichenification: 
Recurrence: 
Continuous: 
Irritants /Allergens: chocolates.

Temperature Affection: Hot < or >: --

Cold < or >: --
Climatic affection: Winter < or >: change of weather <.
Summer < or >:
Area of Affection:

13. EMOTIONAL FACTORS: History Of: Suppression or Over expression:

Anger / Vexation:
Stress / Tensions:
Depression / or Grief:
Despair / loathing:
Anxieties:
Others: very cheerful, jovial, increased confidence, oversensitive, restless.
139
 CASE 10

Name: Miss Ohawana Shetty

Address: V-24, Golden Valley, Opposite Canara Bank. Kalina.
Age: 6 years.
Sex: Female.
Status: Single.
Religion: Hindu.
Occupation: Student.
Physician-in-charge: Dr. P. Humranwala.
Date: 06/09/08.

Chief Complaint:
Maculo-papular eruptions on scalp, face, chest, abdomen & upper & lower
extremities. Hyper pigmented patches.
There is itching2 over the skin.
< evening till night, midnight.
< Change of weather
< Chocolates

Patient as a person:
Appetite: Good. Non-vegetarian diet
Likes: Chicken, Ice cream2, chocolates2.
Dislikes: Pungent2, sour
Thirst: 1 liter/day.
Food/drinks agg/amel: Chocolates  itching.
Stool: Tendency to constipation, hard stool, difficult to pass.
Urine: No complaints.
Perspiration: Profuse, only on neck.
Non-offensive, Non-staining
Sleep: 6-7 hours, Refreshing.
Dreams: nothing significant.

Mind:
Intelligent-good grasping power, remembers spellings accurately.
Very particular about her things e.g. her school uniform should always be pressed, will
polish her shoes everyday.
She is very cheerful all the time. She enjoys herself. She talks with confidence.
Has great confidence in self. Easily affected – is very sensitive to things.
If mother shouts at her she never back answers instead she just starts crying and later says
sorry.
On observation- she is very restless, jovial and expressive.

140
Thermal Reaction:
Can’t tolerate summer
Fan  full throughout the year.
Covering: summer – thin
 Winter – thick
Bath: Cold water throughout the year.
Ambithermal  Hot

P/H: Worms in stool- 4 years back.   

  Asthma – 1 ½ year back.

F/H: Mother has hypertension since 2 years.

Father has hypertension since 2 years.

O/E – General Examination:

Pulse: 78/min.
Temp: Afebrile.
No pallor, no icterus, no clubbing, no cyanosis, no lymphadenopathy.

Systemic Examination:
RS- clear, AEBE.
CVS- S1S2 heard.

Local examination:
SCALP-Maculo-papular eruption, Face- Maculo-papular eruption
  Neck- Maculo-papular eruption, abdomen-hyper pigmentation

Diagnosis: Atopic Dermatitis.

Hahnemannian Classification: Dynamic chronic miasmatic disease with fully

developed symptoms.

Prescriptive Totality: 1. Cheerful/ gaity

2. Fastidious
3. Confidence-increased
4. Oversensitive
5. Ice-cream desires
6. Chocolate desires
7. Sour aversion
141
 Repertorial Totality:

Nat-m Sulph Arg-n Phos Puls Carc Lyc Calc Nux-v Sil
Cheerfulness, gaiety, 1 2 1 2 1 1 2 2 2 1
happiness: Tendency.
Fastidious 2 1 1 1 3 3 2 1
Confidence: increased 1
Sensitive, oversensitive 3 3 3 3 3 1 3 2 3 3
Desires: ice-cream. 1 1 1 3 1 1 2 2
Desires: chocolates 2 1 1 3 1 2 1 2
Aversion: sour 1 2 1 1 1
10/6 10/6 8/6 12/5 9/5 8/5 8/5 8/4 8/4 7/4

Susceptibility: High

Miasm: Tubercular.
-Jovial, cheerful.
-Increased confidence.
-Oversensitive.
-Desires: ice-creams, chocolates.
-Aversion: sour.
-P/H of worms.

Remedy Selected: Phosphorus

Potency selected: 200 (1 dose)

Follow Up:
Date Complaints Remedy given.
3/9/08 Eruptions-dried
Itching-SQ Phytum 200 (1dose)
Cough- > SL 30 tds (4-4-4) x 15
Generals – App: good. days.
Thirst: good.
Stool: Hard stools, has to strain.
Urine: normal.
Sleep: good.

142
27/9/08 Skin eruption->20%
Itching-SQ Phytum 200 (1dose)
Cough  -0- SL 30 tds (4-4-4) x 15
Generals: App: good. days.
Thirst: normal.
Stool: normal.
Urine: normal.
Sleep: good, Refreshing.

11/10/08 Skin eruptions- <<

Itching ,burning- << Phytum 200 (1 dose)
Generals: App: increased. SL 30 tds (4-4-4) x 15
Thirst: normal. days.
Stool: constipation.
Urine: normal.
Sleep: good

25/10/08 Scratching- <

Burning- < Phos 1M (1 dose)
Generals: App: good. SL 30 tds (4-4-4) x 1
Thirst: normal. month.
Stool: normal.
Urine: normal.
Sleep: disturbed.

1/11/08 Itching- >

Eruptions- > Phytum 1M (1 dose)
Generals- App: good. SL 30 tds (4-4-4) x 15
Thirst: normal. days.
Stool: normal.
Urine: normal.
Sleep: good.

15/11/08 Skin eruptions- <<

Itching- << Phos 1M (1 dose)
Generals: App: good. SL 30 tds (4-4-4) x 15
Thirst: normal. days.
Stool: normal.
Urine: normal.
Sleep: good.

Discussion: Patient Miss Ohawana Shetty suffering from Atopic dermatitis was given
Phosphorus 200 on the basis of totality of symptoms. There is improvement seen.
Potency was increased since response to the previous potency was no longer obtainable.

143
 RESULTS

Miasmatic Distribution

Psora
Tubercular 10%
20%

Psora
Sycosis
Tubercular

Sycosis
70%

144
 Diagrammatic representation of male is
to female ratio

♂- Male
30%
♂- Male

♀- Female

♀- Female
70%

RESULTS

Diagrammatic representation of
susceptibility in eczema cases

Low
10%

High

Low
High
90%

145
 Diagrammatic representation of Types of
eczema/dermatitis

10%

10% 30% Atopic dermatitis

Contact dermatitis
Nummular dermatitis
10% Stasis dermatitis
Lichenified dermatitis
Seborrhoeic dermatitis
10% Palmar Eczema

20%
10%

146
 RESULTS

Diagrammatic representation of remedy

reactions
Status Quo
20%

Overall improvement
Satisfactory
improvement Satisfactory
10% improvement
Overall Status Quo
improvement
70%

147
 SUMMARY

Case ♂-Male / Type of eczema/ Miasm Susceptibility Follow up

No. ♀- Female dermatitis

1. Female Atopic Dermatitis Psora High Overall

improvement
2. Male Primary irritant Sycosis High Overall
Contact improvement
Dermatitis
3. Female Nummular Sycosis High Overall
Eczema improvement
4. Female Atopic Dermatitis Tubercular High Satisfactory
improvement
5. Female Palmar Eczema Sycosis High Overall
improvement
6. Female Stasis Dermatitis Sycosis High Overall
improvement
7. Male Lichenified Sycosis Low Overall
Dermatitis improvement
8. Female Allergic Contact Sycosis High Status Quo
Dermatitis
9. Male Seborrhoeic Sycosis High Status Quo
Dermatitis
10. Female Atopic Dermatitis Tubercular High Overall
improvement

148
 CONCLUSION

After studying 10 cases of eczema I come to the following conclusions:

 Eczema/dermatitis should be differentiated from other local skin diseases with

similar presentation.

 Following individualization and holistic approach, treatment of the patient

suffering from eczema (and not treatment of eczema in the patient) gives best
results.

 It is seen that characteristic mental state of the patient plays a vital role in
deciding the remedy.

 In some cases which responded to the indicated remedy, the patient stopped
improving after a particular point then an anti-miasmatic remedy was prescribed
which helped in further improvement of the patient.

 From the 10 cases it is observed that atopic eczema/dermatitis is a more common

form of eczema.

 It highlighted the role of diet and regimen in order to remove the maintaining
cause and thereby facilitating rapid cure with homoeopathy.

Numerical conclusion from 10 cases is given below:

Miasmatic ratio – Psora: Sycosis: Tubercular = 1:7:2.

Male: Female = 3:7.

Susceptibility – High: Low = 9:1

Types of eczema – Atopic eczema: Contact eczema: Nummular eczema: Stasis

dermatitis: Lichenified dermatitis: Seborrhoeic dermatitis: Palmar eczema =
3:2:1:1:1:1:1.

Remedy reactions – Overall improvement: Satisfactory improvement: Status quo = 7:1:2.

149
8. BIBLIOGRAPHY.

1. Textbook of skin diseases by Dr. Uday Khopkar- 4th edition Bhalani Publisher.

2. Roxburg’s common skin diseases by R. Mark- 16th edition – Reprint 1993

Publisher –Chapman and hall medical.

3. Gray’s Anatomy-The anatomical basis of medicine and surgery. 38th edition,

Churchill livingstone publications.

4. Textbook of Dermatology by Arthur Rook, D.S. Wilkinson – Volume 1, 3rd

edition. Blackwell scientific publications.

5. Comprehensive textbook of Psychiatry edited by Harold I. Kaplan (M.D.), Alfred

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