RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE-II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE & ADDRESS

PERMANENT ADDRESS

DR.SHEREEF AHAMED.PDEPARTMENT OF ORGANON ,FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, DERALAKATTE,MANGALORE-574160KARNATAKA

PULIKKAPARAMBIL ( H )PALLIPPURAM ( PO )PALAKKAD ( DT )KERALA-679305

2. NAME OF THE INSTITUTION FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL,DERALAKATTE,MANGALORE

3. COURSE OF THE STUDY & SUBJECT

M.D.(HOM)ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY

4. DATE OF ADMISSION TO THE COURSE

06-06-2009

5. TITLE OF THE TOPIC “ EFFECTIVENESS OF CONSTITUTIONAL APPROACH IN PSYCHOSOMATIC DISORDERS ”

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6. BRIEF RESUME OF THE INTENDED WORK

6.1 Need For Study:

Homeopathy could be considered a complete medicine as it goes beyond

the simple treatment of illness or disease. In the process used to determine the

appropriate medication for a particular patient's symptoms, the whole person is

taken into consideration. This means the physical symptoms are evaluated as well

as the patient's mental and emotional well being.

The concept of disease in homoeopathy is that disease is a total affection

of mind and body, the disturbance of the whole organism. Individual organs are

not the cause of illness but disturbance at the inner level (disturbance of the life

force, the vital energy of the body) is the cause of illness. Therefore homoeopathy

does not believe in giving different medicines for different afflicted parts of body

but rather give one single constitutional remedy which will cover the disturbance

of the whole person. Homoeopathy treats the patient as a whole and not just the

disease. Medical philosophy is coming more and more to the conclusion that the

mere treatment of symptoms and organs can only help temporarily and that it is the

healing power of the body as whole that has to be enhanced. Homoeopathy

believes in holistic, totalistic and individualistic approach.7

Homoeopathy always examines patient's mental and emotional make-up

in all cases and remedies are given acting at the level of mind and body together,

thus eradicating the disease completely. Because by relieving the emotions such as

above, Homeopathic remedies bring about harmonious state of health.

The psychosomatic disorders like Migraine, Paroxysmal Rhinorrhoeas,

Bronchial Asthma, Gastric and Duodenal Ulcer, Ulcerative Colitis, Essential

Hypertension, Arterial Degeneration (including coronary artery disease) if

occurring before the senile age period, Hyperthyroidism, Chronic Arthritis, Certain

Skin Diseases such as Urticaria And Pruritus, Enuresis; Primary Dysmenorrhoea

etc are successfully treated with Homoeopathy. Perhaps no other system of

medicine has such a superb approach of tackling the mind-body disorders except

Homoeopathy.

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Why I selected this topic because In the modern world cause for many

somatic problems are the stress, tension, emotional factors (Psychological factors)

due to the modern lifestyle of the people. In homoeopathy for the treatment we

consider the psychological factor (mind) and also the physical problems (somatic).

And hense it is much easier to treat. When treated homeopathically, gives better

results compared to other systems of medicine.The constitutional approach can

give a better result in psychosomatic disorders,and I want to evaluate how much

effective the constitutional approach in psychosomatic disorders.

6.2 Review of the Literature:

Definition:

Psychosomatic means mind ('psyche') and body ('soma'). A psychosomatic

disorder is a disease which involves both mind and body. Some physical diseases

are thought to be particularly prone to be made worse by mental factors such as

stress and anxiety. Your current mental state can affect how bad a physical disease

is at any given time.1

History

In the medieval Islamic world the Muslim psychologist-physicians Ahmed

ibn Sahl al-Balkhi (d. 934) and Haly Abbas (d. 994) developed an early

understanding of illness that was due to the interaction of the mind and the body.

They realized how a patient's physiology and psychology can have an effect on

one another. They found a correlation between patients who were physically and

mentally healthy and those who were physically and mentally ill.2 Avicenna (980-

1037) recognized 'physiological psychology' in the treatment of illnesses involving

emotions, and developed a system for associating changes in the pulse rate with

inner feelings which is seen as an anticipation of the word association test later

developed by Carl Jung.3

Franz Alexander led in the beginings of the 20th century, the movement

looking for the dynamic interrelation between mind and body.4Sigmund Freud

pursued a deep interest in psychosomatic illnesses following his correspondence

with Georg Groddeck who was, at the time, researching the possibility of treating

physical disorders through psychological processes.5 Sigmund Freud famously

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studied psychosomatic illnesses, which informed his theories of the unconscious

mind and repression. Many identifiable illnesses have previously been labelled as

'hysterical' or 'psychosomatic', for example asthma, allergies, false pregnancy, and

migraines. Some illnesses are under debate, including multiple chemical

sensitivity, Gulf War syndrome, and chronic fatigue syndrome. Some people

suggest that stigmatics suffer a psychosomatic illness based on identifying with the

biblical crucified Jesus.5

Alexander was the one who first postulated a multicasual etiology for

psychosomatic disease. He was also the first to study mind-body interactions in a

systemic way.6

Etiological features 

Experimental and clinical evidence has shown that the emotional

disturbances could be responsible as predisposing, precipitating and perpetuating

factors in this illness.

Several etiological theories have been postulated.

 Neuroendocrine theories:-the autonomic nervous system influences and is

influenced by both, other parts of the nervous system and the endocrine glands.

Complex inter relation of these various structures have been postulated to explain

the translation of the conflicts arising from the problems of the every day living

into abnormal physiological functions and tissue damage. The hypothalamus being

the centre for the sympathetic and parasympathetic nervous activities is of central

importance In these feed back circuits.7

It is postulated that emotional disturbances acting through the hypothalamus affect

the sympathetic and parasympathetic nervous system, which results in alteration in

the structure of the viscera to which these systems innervate.

            The imbalance of the sympathetic and the parasympathetic nervous

activities would alter the function of the viscera.

            The end result of all these change reactions would be the revitalization of

the organs. Eventually the organ becomes more susceptible to external and internal

stimuli.7

Specific psychic stress may be defined as a specific personality or a

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specific unconscious conflict that causes a homeostatic disequilibrium contributing

to development of psychosomatic disorder.8

 Discussion

Psychosomatic illness begins with emotional stress or a damaging thought

pattern. It manifests itself through physical symptoms that are real. Stress-related

illness is very common and it can harm you as much as the symptoms that you feel

from it. Many people tend to write off stress-related illness as not being real, but it

is a serious condition that should be deal with.7

It is estimated that approximately 90% of doctor's visits are due to issues

that are influenced in part by stress. This shows that psychosomatic illness is much

more common than people realize. If you have a problem with stress and your

health, you need to search for stress relief as well as learn various stress

management techniques.7

Often times, psychosomatic disorders are caused by more than simple day-

to-day or workplace stress. This type of stress is often related to major life

changing events. For instance, the loss of parents or the loss of a spouse can cause

a unique type of stress to be placed on a person. Combine this stress with grief and

you are likely to see an onset of physical disorders associated with it.7

The natural aging process can also influence or exacerbate psychosomatic

disorders, especially those generated by depression or depression caused by stress.

This is also related to psychosomatic disorders caused by the loss of loved ones or

even retirement. In this case, the person often exhibits the onset of physical

disorders as they relate to aging.7

In order to stay healthy, it is important that you learn how to deal with your

stress and eliminate unnecessary stress from your life. There are various methods

that you can utilize to create a healthier lifestyle and to live a stress free life. The

first step in doing this is to take a stress test. This is generally a personality test

that helps you to determine how much stress you are under. From there, you can

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work to create a stress management plan.7

According to the DSM II classification it has listed 10 categories of psycho-

physiologic disorder:

Skin disorders

Musculoskeletal disorders

Respiratory disorders

Cardiovascular disorders

Genitourinary disorders

Endocrine disorders

Disorders of organ of special sense - Chronic conjunctivitis

Disorder of other types - Disturbances in the nervous system in which

emotional factors play a significant role, such as multiple sclerosis.

Sometimes a physical symptom is a metaphor for the person's psychologic

problem, as when a person with a "broken heart" experiences chest pain. Other

times, a physical symptom reflects identification with another person's pain.9

Some people also use the term psychosomatic disorder when mental factors

cause physical symptoms, but where there is no physical disease. For example, a

chest pain may be caused by stress, and no physical disease is can be found.

Physical symptoms caused by mental factors are discussed further in a another

leaflet called 'Somatization and Somatoform Disorders.9

Clinical manifestations

  The commonly recognized psychosomatic conditions are classified

according to the organ system involved are given below. It’s sometimes difficult to

separate between system nervous, cardiovascular, because, many disorders touch

more than one organ

• Nervous system: headache, twitching, neurovegetative disorders (which may

include a lot of other following disorders).

• Digestive system: peptic ulcer (with Helicobacter Pylori, hyperacidity.then stress

may induce ulcers), colopathy (constipation or diarrhea), ulcerative colitis,

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anorexia nervosa, irritable bowel syndrome.

• Cancers: In fact we cannot say that the cancer is a psychosomatic disorder; there

are genetics pathology, surroundings factors, and psychosomatic factors.

• Rheumatism and osteo-musles disorders: arthritis, lumbago, in which we can

encounter for example loss of freedom in environment that produces the same type

of limitation in the body. In a way, the body says: look at me, I can do nothing!

• Cardiovascular system: arterial hypertension, throbbing of heart, infarct. Many

processes can be seen in those cases. Hta can be the consequence of double

bounded situation, of which I spoke higher. The only action body find is to

increase tension. Before it depresses and looses its energy. Throbbing of heart

shows anxiety coming soon. For example, a month before an exam, you can feel

anxious in stomach. A day before, it may be in heart. The upper level, the

"quicker" anxiety. But besides this, throbbing may show that you deny problem

you're in front of. So you have to look at things as they are! As for infarction: first,

you have a certain type of personality who can develop coronaries disease:

Intolerance to frustration is the key point! (further details later). And also, your

infarction does not appear haphazardly, frustration is not far in the past maybe.

• Immunologic disorders: allergy: asthma.conjutivitis. Asthma is a rich

psychosomatic manifestation. Summing up: been out-of-breath, symbolically! As

for connectivitis, it's difficult to find understanding ways which would explain this

problem. Infections also, wherever they take place: for instance, tonsillitis if often

repeated, may come when you have something to say that you cannot dare to say.

• Endocrine diseases: hyperthyroidism (both auto immune and endocrine disorder),

diabetes, obesity.

•Lungs diseases: cough, dyspnea,

•Nutritive function disorders: anorexia, bulimia.

• Gynecology and Obstetric: menstrual disorders, like ammenorrhoea,

dysmenorrheal, menorrhgia, metropathica haemorraghica, pre menstrual tension.

• Sexology: "ejaculatio ante portas", impotence, anaphrodisy( loss of pleasure): sex

is a high place of somatization.

• Dermatology: uriticaria,psoriasis, hyper hidrosis, eczema,neurodermatitis.

• Child psychosomatic troubles (Chronic Abdominal Pain, Enuresis, appetite

troubles...) in which the relation child -mother is so important.7

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General management

Psychotherapy or personal counseling with a psychotherapist, is an

intentional interpersonal relationship used by trained psychotherapists to

aid a client or patient in problems of living.1

Presently psychosomatic treatment uses psycho-education, relaxation

techniques, stress management and supportive therapy, mainly cognitive-

behavioral and psychodynamic therapies. Psychotherapy seems to be

efficient in the treatment of bronchial asthma, duodenal ulcer and migraine,

and less efficient in the treatment of high blood pressure and ulcerative

colitis, the results being variable depending on the type of therapy

involved.1

Relaxation is of several types: release, profound and controlled relaxation.

Therapy begins with the Jacobson deep muscle relaxation, a technique

which can be recorded and given to the patient to listen to at home, with

the recommendation to practice the exercise daily. Release relaxation, like

deep relaxation, has the purpose of reducing muscular tension, without

reference to both muscular relaxation and contraction like in the Jacobson

relaxation technique. Release relaxation is recommended as a next step,

after the patient becomes familiar with the deep muscle relaxation.

Controlled relaxation combines relaxation and deep breathing exercises,

using a word or image to trigger the immediate feeling of muscle

relaxation. Relaxation may be counter- indicated for some patients, for

instance those with organic cerebral diseases or head injuries and cognitive

impairment, depending on their functioning level. Deep breathing exercises

improve the respiratory function and eliminate stress and tension.1

Give the patient a positive explanation including but not over emphasizing

psychological factors.10

Encourage a return to normal functioning.10

Homoeopathic treatment

Homoeopathy is a holistic therapy. The individual is considered as a

whole, and signs from the body, mind, and spirit are all regarded when a

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practitioner chooses a homeopathic remedy. Homeopathic practitioners take into

consideration a person's environment and way of life, and provide individualized

treatment for the person.7

The crucial difference between psychoanalysis and homoeopathy is that the

former deals in what is latent,and the latter in what is manifest.11

Homœopathy treats the sick individual; it is therefore a speciality. In spite

of the trend toward group practice, group thinking and even group mode of life as

seen all about us today, we have yet to be convinced that the man is not greater

than the mass and that as long as intelligent thinking people realize and prize their

individuality, the individual approach will hold an appeal to them. Therefore,

homœopathy offers a special inducement to the man who can teach people to think

and act as individuals, and to demand medical treatment as individuals.12

Homoeopathy is not limited to certain diseases but is universally applicable

to all kinds of diseases. It is time, when people must be made fully aware of the

benefits and the scope of homoeopathy in various day to day diseases.

Homoeopathy should be more and more made available to the benefit of ailing

persons, as it can positively help 90% of the diseases we have today.7

The concept of disease in homoeopathy is that disease is a total affection of

mind and body, the disturbance of the whole organism. Individual organs are not

the cause of illness but disturbance at the inner level (disturbance of the life force,

the vital energy of the body) is the cause of illness. Therefore homoeopathy does

not believe in giving different medicines for different afflicted parts of body but

rather give one single constitutional remedy which will cover the disturbance of

the whole person. Homoeopathy treats the patient as a whole and not just the

disease. Medical philosophy is coming more and more to the conclusion that the

mere treatment of symptoms and organs can only help temporarily and that it is the

healing power of the body as whole that has to be enhanced. Homoeopathy

believes in holistic, totalistic and individualistic approach.7

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7.

In Hahnemann's Organon of medicine he mentions about psychosomatic

disorders. In §210 to§230 Hahnemann mentions about mental disorders.

Psychosomatic disorder is 4th type of mental disease according to Hahnemann.13

The perfection of a cure consists, first in restoring health, and this is to be

done promptly, mildly and permanently. The cure must be quick or speedy, it must

be gentle, and it must be continuous or permanent.14

6.3 OBJECTIVE OF THE STUDY:

To assess the effectiveness of constitutional approach in the treatment of

psychosomatic disorders.

To analyze miasmatic expression in the cases.

MATERIALS AND METHODS:7.1 Source of data:

The subjects will be selected from OPD and peripheral centers of Fr.

Muller Homoeopathic Medical College, Mangalore.

7.2 Method of collection of data

A sample of minimum of 30 cases will be selected purposive sampling

method as per the inclusion criteria and will be followed for a minimum period of

4-6 months duration.

Every case will be analysed with reference from materia medica repertory and

therapeutics whenever required.

The potency selection and repetition of the doses will be done according to

the demand of the case, with consideration of potency selection criteria such as

Acute or Chronic, Susceptibility, Vitality and Suppression (if any), changes in

structural and functional level and the degree of correspondence to the remedies

selected.

Inclusion criteria:

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1. The sample on both sexes and different age group.

2. Diagnostic criteria is mainly on clinical presentation and local

Examination.

Exclusion criteria:

1. Cases except psychosomatic diseases.

2. Cases associated with systemic disorders and complications.

Research hypothesis:

Homoeopathic constitutional approach is effective in psychosomatic

disorders.

Null hypothesis:

There is no significant improvement among psychosomatic diseases

after homoeopathic constitutional treatment.

Plan for data collected will be analyzed by statistical methods at the

end.

7.3 Does the study require any investigations to be conducted on patients, or

other humans (or animals)? If so please describe briefly.

Yes, investigations like blood, urine, X-ray, Endoscopy, USG, CT scan, MRI

if it is relevant in each case.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, enclosed.

LIST OF REFERENCES:

1) http://www.psychosomaticmedicine.org.

2) NURDEEN DEURASEH and MANSOR ABU TALIB Mental health

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8.

in Islamic medical tradition, The International Medical Journal 4 (2),

pg. 76-79.

3) IBRAHIM B. SYED PhD, "Islamic Medicine: 1000 years ahead of its

times", Journal of the Islamic Medical Association pg. 2-9 .

4) ASAAD, GHAZI (1996). Psychosomatic Disorders: Theoretical and

Clinical Aspects. Brunner-Mazel. Pg 129–130.

5) ERWIN, EDWARD (2002). The Freud Encyclopedia: Theory, Therapy

and Culture. Routledge. pg. 245–246.

6) HEROLLD I KAPLAN MD,BENJAMIN J SADOCK MD

Comprehensive text book of psychiatry,6 th edition,1995.pg 826.

7) http://www.similima.com/psychosomatic disorders

8) BENJAMIN JAMES SADOCK,MD,VIRGINIA ALKOTT

SADOCK,MD,Synopsis of Psychiatry,9 th edition,2002,pg 499.

9) http://www.depression_guide.com/psychophysiology.htm

10) NICHOLAS A.BOON,NICKI R.COLLEDGE,BRIAN R.WALKER

Davidsons principles & practice of medicine 20 th edition,Elsevier

limited,pg 250.

11) LUIS DETINIS MD Mental symptoms in Homoeopathy,Elsevier

limited,1990-1994,pg 5.

12) H A ROBERT,MD Principles and art of cure by

Homoeopathy,newdelhi IBPP,pg 15.

13) SAMUEL HAHNEMANN Organon of medicine,6th edition,newdelhi

B.jain ublishers(P)Ltd p. 187-196.

14) DR J T KENT ,Lectures on Homoeopathic philosophy.,newdelhi B.jain

ublishers(P)Ltd 1999(Reprint edition) pg 27.

9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

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11. 11.1 NAME AND DESIGNATION OF GUIDE( In block letters)

DR. ROSHAN PINTO B.H.M.S, M.D (HOM).

PROFESSOR , DEPT OF ORGANON OF

MEDICINE AND HOMOEOPATHIC

PHILOSOPHY,

FATHER MULLER HOMOEOPATHIC

MEDICAL COLLEGE & HOSPITAL,

DERALAKATTE,

MANGALORE- 574 160

11.2 SIGNATURE

11.3 CO-GUIDE11.4 SIGNATURE11.5 HEAD OF THE DEPARTMENT

DR. SHIVAPRASAD.K, B.Sc, B.H.M.S, M.D

(HOM).

PROFESSOR AND HOD,DEPT OF

ORGANON OF MEDICINE AND

HOMOEOPATHIC PHILOSOPHY,

FATHER MULLER HOMOEOPATHIC

MEDICAL COLLEGE & HOSPITAL,

DERALAKATTE,

MANGALORE- 574 160

11.6 SIGNATURE

12. 12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL12.2 SIGNATURE

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