Toxicological Materia Medica

Toxicological Materia Medica

• What is toxicological MM?

• What is the co-relation of toxicology with MM?

• What are its advantages and disadvantages?

• How does it help in understanding of MM?

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Sources of Materia MedicaSources of Materia Medica

Physiological: • Relating the chief areas of drug-

effects of many inorganic substances, (like the Natrums, Kalis and Calcareas) to the role played by their constituents in human physiology.

PharmacologicalPharmacological::• Comprehend readily some of the

Locations and types of changes induced by a drug like Nux vomica or Belladonna.

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ChemicalChemical::• Group-characteristics can often

be related to the common cation or to a dominant Anion, e.g. a Halogen.

•

• At times, a salt can be readily understood in terms of its constituent elements, like Ferrum phosphoricum.


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Analogy (doctrine of signature)Analogy (doctrine of signature)::• Relating some of the drug-effects to the

characteristic of the substance or source or to its natural habitat. Examples - Snake venoms, Spider venoms, Sepia etc.

SymbolismSymbolism:• Linking the concepts of universal and human

symbolism to materia medica by Jung, Whitmont etc.


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GroupingGrouping:: • Drugs could be conveniently grouped together for

their similar effects or their opposite characteristics. The books on Homoeopathic Therapeutics illustrate the similar grouping; differential study of repertorial analysis is another instance of such a study. Substances from a similar source tend to have similar effects.

Remedy relationshipRemedy relationship::• One of the advanced methods of study of materia

medica.


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ToxicologicalToxicological::• Furnishes information about the Locations,

Pathological changes, Scope and Sphere of application and coarse indications. Examples: Mercury, Phosphorus, Gelsemium.

• Render a general idea about the sphere of action which is mainly on CNS, CVS, extremities and skin. There are also subjective symptoms and change in behaviour after poisoning. The unnatural use of and ccidental overdosing produce many signs and symptoms.

• Hughes was an ardent follower of toxicological data.


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The branch of Medical science which deals with

•Reference to their sources Characters and properties The symptoms they produce The lethal dose The nature of fetal results The remedial measures which should be employed

to combat their actions or effects The method of their detection and estimation and Autopsy findings

ToxicologyToxicology

PoisonPoison

• A poison is commonly defined as a substance which, when administered, inhaled or swallowed, is capable of acting deleteriously on the body.

• In Law, the real difference between a medicine and a poison is in the intent with which it is given.

• If the substance is given with the intention to save life, it is a medicine but if it is given with the intention to cause bodily harm, it is a poison.

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According to mode of actionAccording to mode of action:: Corrosive Irritant Neurotic Cardiac Asphyxiants Miscellaneous

Classification of poisonsClassification of poisons

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Property to corrode. Affinity towards water and tissue fluid. Produces actual ulceration and

destruction of the tissue. Consists of strong acids and

strong alkalis.

Corrosive Poison GroupCorrosive Poison Group

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• Mineral acids: Sulphuric acid (Sul-ac), Nitric acid (Nit-ac), Hydrochloric acid(Mur-ac).

Organic acids: Oxalic acid(Ox-ac), Carbolic acid or phenol (Carb-ac), Acetic acid(Acet-ac), Salicylic acid (sal-ac).

Vegetable acid: Hydrochloric acid(hydr-ac). Concentrated alkalis: Caustic soda (Nat-caust),

Caustic potash (Caust), carbonates of ammonium (Am-c), carbonates of sodium (nat-c), carbonates

of potassium (kali-c).

The Corrosive group includesThe Corrosive group includes

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The Group of Irritants

● While corrosives lead to destruction, irritants lead to severe irritation.● Both local and remote action.

Remote action may progress to systemic effects. Produce symptoms of pain in the abdomen, vomiting and purging.

● Post-mortem appearances: Redness or ulceration of GIT.● The group consists of inorganic,

organic and mechanical substances.

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Inorganic sub-groupInorganic sub-group

Non-metallic poisons: Phosphorus (phos), Chlorine (Murates), Bromine (Bromium), Iodine (Iod),Boron (Bor-ac, Bor-met).

Metallic poisons: Arsenic (Ars), Antimony (Antimoniums), Mercury(Merc), Lead(Plb), Copper(Cupr),Thallium(Thal), Zinc (Zinc), Barium (Barytas), Radioactive Substances (Thorium, Uranium, Radium).

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Organic sub-groupOrganic sub-group

Vegetable poisons:

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

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Organic sub-group

Animal poisons:

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

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Mechanical sub-group

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

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Neurotic PoisonsNeurotic Poisons

• Act directly on nervous system, though some have local irritant action.

• Act after absorption even after greatly diluted in water. All alkaloidal poisons fall into this group.

• Symptoms-Headache, Drowsiness, Giddiness, Stupor, Convulsions, Paralysis.

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Spinal: Action on spinal cord. Examples: Nux-vomica (Nux-v),

and its alkaloids, and Gelsemium (Gel).

Peripheral: Poisons acting on peripheral nerves. Examples: Curare (Cur), Coniun (Con)

•Cardiac: Acting on heart like Digitalis(Dig), Oleander (Olnd), Aconite(Acon), Tobacco (Tab).

•Asphyxiants: Acting on lungs. Coal gas, Carbon monoxide, Carbon dioxide, Sewer Gas.

Classification of poisons according to affinity

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Classification of poisons according to affinity

• Cerebral action: Inebriant. Deliriant, Somniferous.

• Somniferous poisons: Opium and its alkaloids.

• Inebriant poisons: Alcohol, Anesthetics, Sedatives and hypnotics, Chloral hydrate (Chlorolum hydratum), Fuels: Petroleum(Petr), Kerosene (Kerosolenum), Naphtha (Napthalinum), Insecticides (organophosphorus compounds like Tik-20, chloro compounds like DDT and endrin, coal-tar.

• Deliriant poisons: Dhatura (Stram), Belladonna (Bell), Hyoscyamus (Hyos), Cannabis(Cann-i), Cocaine (Cocainum-hydrochloricum)

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Miscellaneous

Poisons having widely different actions are put together in this group

Examples Analgesics Antipyretics Antihistaminics Tranquillizers Reserpine Antidepressants Stimulants Hallucinogens such as LSD

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Toxicology & Homoeopathic MM

One of the chief sources of MM is from toxicological source either accidental or deliberate.

The pathogenetic action of a remedy is evident from its action at tissue level, apart from its action on the mind.

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Copper toxicologyCopper toxicology

Copper in human body

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

Brain Pancreas Heart Nucleus

3 3 3 3

Kidneys Lungs Spleen Liver

2.98 2.5 1.78 7.522www.similima.com

Copper is richest in liver, esp. in fetal liver.

In brain richest part is substantia nigra (black substance in a section of the crus cerebri),

which has melanin containing new cells.

Copper is necessary for the formation of blood.

Copper toxicologyCopper toxicology

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Toxicological symptoms:Toxicological symptoms:

Serum copper-abnormally high in schizophrenia, manic depressive insanity and epilepsy.

Copper workers are said to have shown special resistance in cholera epidemics, seldom succumbing to this disease.

Copper

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Regular consumption of small doses of copper salt over a prolonged period -“ copper equilibrium.”

Hugo Scultz describes: Psychic symptoms arise, such

as melancholic depression, fright, fear of death, weakness of memory, inability to retain thoughts.

Toxicological symptomsToxicological symptoms::

Copper

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• Other symptoms - dizziness, heaviness, rush of blood to the head affection of consciousness – bearing factors.

• The pulse - accelerated, hard, and short circulation affection. Chills run through the entire body, the warmth organization is upset.

• The lungs - full of blood. Pressure tension, shortness of breath is experienced.

Toxicological symptomsToxicological symptomsCopper

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http://library.thinkquest.org/trio/TTQ05011/Images/dizziness.jpg

Digestive system: • The pharynx constricted,

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

Toxicological symptomsToxicological symptoms

Copper

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Co-relation with Materia MedicaCo-relation with Materia Medica

• Spasmodic affections, cramps, convulsions. Tonic and clonic spasms. Jerking.

• Blueness. Collapse. Paralysis of isolated muscles.

• Fearful. Fear of company, of death. Attacks of rage; wants to bite bystanders. Mania in attacks. Ridiculous or foolish gestures.

• Nausea. Violent vomiting. Loss of appetite. Colic, violent and intermittent.

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Toxicological symptoms of CuToxicological symptoms of Cu

• Blue lines on the gums.

• Inability to control the metabolic process= eczema.

• Muscular spasms and painful contractions = effects on the

limb system.

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Air Pollution

• A mixture of solid particles and gases in the air.

• Car emissions, chemicals from factories, dust, pollen and mold spores. Ozone, a gas, is a major part of air pollution in cities. When ozone forms air pollution, it's also called smog.

• Known or suspected to cause cancer or other serious health effects, such as reproductive effects or birth defects, or adverse environmental effects.

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• Benzene, which is found in gasoline; perchlorethlyene, which is emitted from some dry cleaning factories, methylene chloride, which is used as a solvent and paint stripper by a number of industries.

• Also dioxin, asbestos, toluene, and metals such as cadmium, mercury, chromium and lead compounds.

Examples of toxic air pollutants

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Repertorial studyRepertorial study

• Air pollution ailments from: Ars, Berrylium, Carbo-veg, Silicea,

Sulphuric acid.

• Carbon gas poisoning: Acon, Am-c, Bell, Bry, Carb-v, Lach,

Opium, Phos.

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Comparison of semicarpus poison and anacardium remedy.

Semicarpus poison Anacardium

Local split overskin, bruised, painful lesion.Marginal blistersItching. Ulceration

Skin-Intense, itching eczema with mental irritability.Vesicular eruptions.Urticaria.Lichen planus. Neurotic eczema.Ulcer formation on forearm.

GIT – Mouth, burning.Pain in throat and abdomen.Blister formation in throat.

Weak digestion, eructation, nausea.

Respiratory system Oppression of chest with internal heat.33www.similima.com

Comparison of semicarpus poison and anacardium remedy.

Semicarpus poison Anacardium

Cardiovascular system:Rapid pulse

Heart: Palpitation with weak memory.Stitches in heart region.

CNS: Loss of reflexes.Delirium, coma, death.

Brain fag. Impaired memory, neuralgia in thumb. Paralytic weakness. Knees feel paralyzed, bandaged.

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Acute poisoning:

Nausea, burning in stomach, < pressure. Then severe, continuous and persistent retching

and vomiting,. Vomiting first of stomach contents, then blackish

or greenish and finally of mucus mixed with altered blood in varying quantity. Diarrhoea accompanied by tenesmus.

The stool is tinged with blood, watery like the rice water stool of cholera, and shreds of mucus membrane and fragments of the poison even in three or four hours.

Arsenic poisoningArsenic poisoning

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Acute poisoning

Intense thirst-a constant feature but drinking water accentuates the vomiting.

Painful cramps in the legs, urine suppressed, collapse with cold clammy skin, pale anxious face, sunken eyes, dilated pupils, rapid feeble pulse and sighing respiration.

Sometimes symptoms of acerebro-spinal type with features of narcotic poisoning, such as vertigo, headache, spasms, followed by stupor and profound depression of circulation.


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Chronic poisoning:

•

1

st

stage of nutritional & gastro-intestinal

disturbances - Gradual loss of weight, with physical and mental fatigue, loss of appetite, nausea and intermittent attacks of vomiting and diarrhoea.

• Second stage of catarrhal changes - Common cold with running of the nose and sense of fullness in the head, mucus membranes are inflamed, conjunctivitis, running of the eyes, coughing, hoarseness of voice and bronchial catarrh.


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Third stage of skin rashes:Third stage of skin rashes: Irritation of the skin, with vesicular eruption.

Fourth stage of long exposure:Fourth stage of long exposure:Patchy brown pigmentation of skin called “rain drop” type pigmentation.

Hyperkeratosis of palms and soles follow. There may be falling out of

hair and brittleness of nails.Other symptoms: Headache, drowsiness

and impairment of vision and mental activity.

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Arsenic poisonArsenic poison Arsenicum albumArsenicum album

Dehydration due to diarrhoea and vomiting.

Debility, exhaustion, restlessness. Irritable weakness. Cholera. Prostration.

Irritant properties of poison burning pain – mouth. Abdomen – tenderness.

Burning everywhere. One of the trio of burning – Nash.

Throat difficulty deglutition Throat – swollen, odematous, constricted, burning. Unable to swallow.

CVS – Depression of myocardium. Abnormal T-wave.

Heart – Palpitation. Pain dyspnoea, faintness, pulse-more rapid in morning.

Ulceration Local action irritation of mucus membrane.

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MercuryMercury

The taste - metallic, with constriction in throat,

burning from mouth to stomach and pain radiating to abdomen.

The mouth, tongue and fauces – corroded. Mucous membranes - grayish white.

Nausea with frequent vomiting of long stringy masses of white mucus, mixed with blood, followed by profuse urging, often bloody with painful tenesmus.

Collapse: with cold clammy skin, pale, anxious face, sunken eyes, dilated pupils, rapid feeble pulse and sighing respiration.

Acute Poisoning

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• Syncope, convulsion and general insensibility precede death which may take place in a few hours.

• If death is not rapid, salivation may develop. • The gums swollen and inflamed and breath

foul. Loosening of teeth.• Renal lesion- nephrotoxicity of mercury. Urine

contains albumin and blood. The output diminishes or stops and death ensues from uremia.

MercuryMercury

Acute Poisoning

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Post- mortem appearancePost- mortem appearance

• Tongue – white and sodden • Mouth – diffuse grayish white escharotics

appearance (eschar means hard crust over a raw surface)

• Oesophagus- MM corroded and corrugated• Stomach – MM corroded, inflamed in patches

and covered with grayish deposit of mercury. Areas of extravasated blood beneath it.

MercuryMercury

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• Small intestine- congestion• Caecum and large intestine– intense

inflammation, ulceration and even gangrene.• Kidneys– toxic nephritis.• Liver and heart- fatty degeneration of heart and

subendocardial hemorrhages also.

Post- mortem appearancePost- mortem appearance

MercuryMercury

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Mercury Mercury

Excessive salivation with metallic test in mouth, loosing of teeth with painful inflamed gums, and occasionally a blue-black line on gums.

Irritation of skin; penetrating ulcers on or near finger nails and knuckles.

Nephritic, renal insufficiency uremia. Abortion is common. Discoloration of the capsule of the lens of the

eye.

Chronic poisoning:Chronic poisoning:

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Action on CNS and Mind: Action on CNS and Mind:

Action on tremors and mental symptoms known as erethism.

Tremor is known as the HATTER’S SHAKE because it is common in workers of that industry. It affects the hands, arms, tongue and later the legs.

Exaggerated by voluntary efforts such as writing, speaking or eating and is absent during sleep. The tremor can be detected early in the writing of the patient and then from his stammering speech.

Mercury Mercury

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• Erethism is a peculiar disturbance of the personality characterized by shyness, irritability, tremors, loss of memory and insomnia.

• Hallucinations and delusions occasionally supervene and may lead to mental changes or insanity.

Action on CNS and Mind: Action on CNS and Mind:

Mercury Mercury

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Correlation with Materia Medica Correlation with Materia Medica

Mind: Memory weak, forgets everything. Intellect very

weak; shows every mark of imbecility. Imbecility; foolish, mischievous, disgusting

actions. Delirium and mental derangement of drunkards. Almost uncontrollable desire to travel far away.

Desire to flee, with nightly anxiety and apprehension. Desire to kill the person contradicting her.

Continuous moaning and groaning. Hurried and rapid talking.

Mercurius from Hering’s Guiding Symptoms

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Mind: Great desire to murder or commit suicide,

particularly during menstrual period; despondency; involuntary crying; great indifference; is fearful that she may commit some wrong and kill herself; something urges her to kill her husband, of whom she is very fond, and she implores him to hide his razor.

Excited, lively; everything is done hastily. Morose and mistrustful; treated his associates almost insultingly, looked upon every one as his worst enemy.


Mercurius from Hering’s Guiding Symptoms of our MM

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Mind:• Great restlessness; must constantly change

her place; fear, with desire to escape, as if she had committed some crime. Hysteria.

• A universal uneasiness of body, so that he could not remain one moment in the same posture.

• Bad effects from fright, leaving one in a state of great anxiety, agg. at night.

• Ailments from mortification; from insults; from egotism.



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Physical Physical

• Face–Pale, anxious face, sunken eyes. Pupils dilated.

• Tongue- Metallic test in mouth. White, sodden.

• Throat- Burning pain throat, radiating to stomach.



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Physical Physical • Mouth- Mucus membrane, mouth, tongue

become corroded. Grayish, salivation increased. Escharotic appearance.

• Stomach–Nausea with frequent vomiting. Vomitus: slimy, white, mucus , bilious

• Mucus membrane corroded• Intestines feel bruised • Teeth –looseness of teethes especially molars

with painful inflamed gums.



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Physical Physical • Skin – Irritation, itching here and there.

Ulceration in fingers, nails and knuckles.• Kidney –Nephritis, renal insufficiency may

progress to uremia.• Pregnancy – abortion are common.• Eyes (mercuria lentis)bluish discoloration of lens

(seen through slit lamp).• Metals – Erethism



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Phosphorus poisonPhosphorus poison Phosphorus Phosphorus

Taste – Burning Mouth – Burning.One of the remedies of burning trio.

Smell – Garlicky Offensive foul smelling sinuses

Local destruction of tissue in contact.

Destructive metabolism.

Cirrhosis of liver. Jaundice. Atrophy of liver. Sub-acute hepatitis. Fatty degeneration of liver. Jaundice.

Bleeding under serous membrane.

Blood extravasation.

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Phosphorus poisonPhosphorus poison Phosphorus Phosphorus

Delirium, convulsion. Neuritism, paralytic symptoms.

Phossy jaw. Sequestration of gums.

Osteomyelitis. Bone fragility.

Local destruction of tissue in contact.

Wound bleed very easily. Heal and break out. Ulcer outside large wound.Perpura haemorrgica???

Pain- burning severe contact burning.

One of trio of burning. Burning back feet and chest.

Diarrhoea – stool bloody.Urine – blood, albumin, bile salts, sugar.

Stool – blood from rectum, bleeding haemorrhage.Urine - haematuria, turbid, brown with red sediment.

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Case 1

• Name - Mr. MAK• Age – 23 years• Sex- Male• C/o –Fever since Last 3 days.• H/o- Patient had history of eating fish before 3

days. Then he developed fever, suddenly, with profuse sweating, without any relief. Fever used to < at night. Many remedies were tried on symptoms indications without benefit.

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Vital data:

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

Case 1

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Case 1

Rubrics• Fever with Chills• Fish aggravation• Sweating profuse with no relief• Fever aggravation at nightFilter• Ars 9/4, Sep 9/4, Pul 8/4, Kali-c 6/5,

Carb-v 5/4, Thuj 4/4, Merc 9/3, Sulph 8/3 Cham 7/3, Bell 6/3TreatmentMerc –sol Merc –sol 1M, 4 hourly

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Co-relation of toxicity of Hg

• In the general population, the main source of mercury poisoning is the ingestion of mercury- contaminated food, usually fish.

• Acute mercury exposure can cause headaches, salivation, a metallic taste in the mouth, chills, cough, fever tremors, abdominal cramps, diarrhea, nausea, vomiting, chest tightness, difficulty breathing, fatigue and/or lung irritation.

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Case 2

• Name-Master T. P. D. • Age- 5 years.• Epileptic attacks since a year. A known case of

mental retardation.• Epileptic attacks, every month. Attacks of tonic

and clonic type, < Morning 3, < 5 am to 6am3.• Concomitants- Restlessness. • Thermal State- Ambithermal• Desires- Salt 4, Pungent 3.• Stools-Involuntary. Can’t understand the urge of

stool.

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Mind-• Obstinate. Cries very loudly when the things are

not given to him. Never sits quietly, very restless. Destructive by nature. He throws the things. He tears the clothes and papers. He likes to make noises.

• Likes to listen to the songs and likes to dance when the music begins. Mischievous by nature. First he comes very quietly, and then he bites and goes away.

Case 2

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Mind-• He is also very angry by nature. When

angry, he strikes his head on wall. Shouts and screams. He bites others and cries loudly.

• He desires to travel by vehicle only and vehicle must be speedy. He can’t understand the boards and words on the roads. He is in his absorbed state of mind. He can’t do daily activities of his own.

Case 2

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

Case 2

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

Case 2

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Final Remedy:

• 19-6-06 - Tarentula-hispanica 1M a single dose

• Follow-up has been continued since then and no episode of convulsions has occurred. Patient has improved mentally too.

Case 2

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Relevant information

• The implication of neuroligins in cognitive disorders such as autism and mental retardation.

•

• Neuroligins (NL1–NL4) are postsynaptic proteins containing an extracellular cholinesterase domain.

• They participate in intercellular junctions in which β-neurexins tightly bind to a second class of neuronal cell-surface receptors called neuroligins.

Case 2

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• α-Latrotoxin, a potent neurotoxin from black widow spider venom, triggers synaptic vesicle exocytosis from presynaptic nerve terminals.

• Neurexin I is a major Latrotoxin receptor that cooperates in Latrotoxin action.

• Latrotoxin is a potent neurotoxin from black widow spider venom that binds to presynaptic receptors and causes massive neurotransmitterrelease.

Case 2


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


Case 2

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Toxicological MMToxicological MM

Spider poisoning:

•The venom is secreted from glands present in chelicerae or fangs of spiders.

•These venoms are different in different species.

•The higher potencies of spider remedies are prepared not from spider poisons but from living spiders put in alcohol.

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Spider poisoning: Symptoms recorded during the

proving are collected after actual experimentation on human beings under certain controlled conditions.

Remedies belonging to different species of spiders have a closely related symptom picture.


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Spider poisoning:

• Dr.Boger (1926) described 15 cases of Arachinidism treated at Los Angeles general hospital.

Important symptoms• In 50 % of cases, the reaction at the sight of

inoculation- a red spot, fluid filled vesicle and swelling. Severe pain and burning sensation.

Intense pain in extremities, lumbar region and severe backache.


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Spider poisoning:

• In 70 % of cases, increased arterial pressure. • Cutaneous and mucosal finding-roseolous–

vesicular papule, pustular rashes on chest, abdomen and neck, with intense itching.

• GIT findings- acute abdominal pain with rigidity.

• Urinary findings- moderate albuminuria and hematuria.


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Spider poisoning

Spider poisoning:

• CNS findings: Frequent psycho-motor excitation, occasional delirium, rarely meningeal symptoms with contraction of extremities, paralysis of facial nerve and widening of pupils.

• Blood findings: Moderate leukocytosis with raised ESR, increased neutrophil count.

• Involuntary jerking < any exertion e.g. writing, speaking or eating and >sleep.

• Sleep – insomnia; sleepless at night.

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• Name – Master G.M.T.• Age -2 yrs • Complaints- Muscular dystrophy ( Duchene

amyotrophia)• Muscular weakness , unsteady gait. • Skin: Atopic dermatitis since 1 ½ yrs • Dryness. Redness of skin; crust formation.

Terrible itching. < touching. < fish3

• Concomitants –Irritability, restlessness.

Case 3

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

Case 3

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Details of the case

• He likes to play but plays alone. He can’t speak a simple sentence. Speech delayed. While playing, he speaks in his own language, esp. when he is in good mood. Sometimes likes dancing but doesn’t like high volume. He is not quarrelsome at all.

• He is soft, calm and yielding. He is not obstinate and most of time, he obeys what has been told to him. He is happy with us (parents say). He likes company.

• He has fears of loud noise and thunderstorm.

Case 3

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• When anybody meats him for the 1st time, he tries to hide himself, but then he is comfortable.

• When mother is crying he tries to console her. He has interest in technical things.

• He has no interest in household routine items. He wants everything standard.

• He is fond of car and loves to go by car. He loves new toys. He feels no interest in usual plays. He gets tired suddenly. Wants everything new and standard

Details of the case

Case 3

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

Rubrics

Case 3

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Result

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

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

Case 3

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Final remedy- • 13/8/07- 1st prescription - Plumbum-met 0/1• 7/9/07- The skin is clear than before. Physically

become more active. - Plumbum-met 0/1 daily one dose • 8/1/08 - Active but irritable too. Skin is again

with new set of eruptions. - Plumbum-met 0/2 daily one dose

Case 3

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Discussion-

• The spinal muscular atrophies are a group of genetically determined disorders characterized by degeneration of the anterior horn cells of the spinal cord, that usually manifest as proximal muscle weakness and wasting.

• Predominantly distal involvement in patients without demonstrable neuropathy is, however, uncommon. Since the first report of distal spinal muscular atrophy localised to upper extremity by Hirayama, et al. in 1959, many patients have been reported in the literature mainly from Asia, with more than 300 from Japan.

Case 3

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• Although there have been quite a few reports from India describing adolescent and adults with this condition, we herein describe what is to our knowledge the youngest case reported with this condition.

• Associated high serum lead level was an interesting and unique feature.

Discussion-

Case 3

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Case 4

• Miss. S. T. Age – 21 years• Complaints-constant urge for urination, since

puberty. She is a known case of mental retardation.

• Urging every 15 to 20 minutes, both day and night can’t control bedwetting. Offensive urine.

• Concomitants: restless, irritability, weakness.• Eructations, < after overeating • Desire- highly seasoned4, pungent4, Hot milk4,

ice creams4• Past history: - asthma, vaccinations - all given• Family history- PGF and PGM- diabetes mellitus 82www.similima.com

Mind • She likes to put every thing in her mouth.

Throughout the day she would bite garments and she becomes irritable when not allowed to pick up garments. She doesn’t obey anyone’s order. Behaves obstinately if anyone disturbs her and she becomes violent.

• Talks arrogantly if someone scolds her if she is biting the garments. Weeps easily, and < by contradiction. She is domineering too.

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

Case 4

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Result

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

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

Case 4

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Treatment

• Plumbum met 1M single dose 14/11/07

Case 4

• 21/11/07:- c/o biting the clothes and garments reduced up to 90%.

• Bed-wetting frequency reduced, not daily now. However, it has not stopped completely.

• Obstinacy slightly less. Listens to others. Does some household work.

• Follow-up still continued.

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Case-5

• Mr.BGK. Age 53. • A known case of HTN since 9 years.• Cramping and throbbing pain in lower

extremities since 9 months, more on left side. It evolved from left right.

• < standing, raising the leg, hanging, warm application, day.

• > pressure+, night.

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Ulcer – Size-2/2 cm, pain-aching type, round and flat.

Modalities:- A/f Mosquito bite, < cold application,warm application, Day time, afternoon 2pm.

Case-5

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Mind• Desire to be active always.Investigations• Atheromatous abdominal s:aorta with

significant narrowing at bifurcation. Almost no flow seen in infrarenal portion of aorta. Collateral flow noted in lower limb arteries.

• Addictions: Tobacco smoking since age of 8 years.

Case-5

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

Case-5

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

Case-5

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

Case-5

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

Case-5

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Repertory Rubrics for Toxicology Repertory Rubrics for Toxicology

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

iod, lach, nux-m, nux-v, plb, samb, sulph, tab, thuj.

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

coff, ip ,lach, phos, sec. •


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

coff, hydr, lycps, merc, spong, sulph.


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Iron poisoning or abuse• chin, ferr, ferr-ph, hep, puls, sulph, zinc.• ars, calc-ph, iod, ip, merc, nat-m, thea, verat.Lead poisoning • ALUM, CAUST, PLB, TUB.• alumn , bell, colo, kali-i, nat-s, plat, sul-ac,

sulph, ter, verat.• alum-sil, ant-c, ars, carb-s, chin, cocc, crot-t,

cupr, gels, hep, iod, kali-br, kreos, lyc, mang, merc, nux-v, op, petr, uran, zinc


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Chronic effect ALUM, CAUST, PLB. alumn, bella, colo, kali-i , nat-s, op,

plat, sul-ac, sulph. alum-sil, ant-c, ars, carb-s, chin, cocc,

crot-t, cupr, gels, hep, iod, kali-br, kreos, lyc, mang, merc, nux-v, petr, zinc.

Paralysis from alumn, ars , op, plat ,plb ,sul-ac. alum, caust, cupr, kali-i, nux-v, pipe.


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Mercury poisoning or abuse- AUR, CARB-V, HEP, KALI-I, LACH, MERC, NAT-S,

NIT-AC, PHYTO, STAPH, SULPH arg-met, asaf, bell, bor, calc, chel, chin, clem,

colch, cupr, euph, guai, hydr, iod ,kali-chl, led, lyc, mur-ac ,ph-ac ,puls, sars ,sil.


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Mercury poisoning or abuse• acon, agn, alumn, anan, ang, arn, ars, aur,

aur-sul, calad, calo, camph, carbo-an, caust, cic, cina, cocc, coff, con, dig, dulc, euph, ferr, fl-ac, graph, iris, Kali-bi, laur, lycps, merc-i-r, nux-v, op, plat, plat-m, rheum, rhod, rhus-g, rhus-tox, sabad, sel ,sep, spong, still, stram, stront-c, sul-i, valer, verat, viol-t, zinc

Mushrooms poisoning from• Absin ,ars, bella, astro, camph• Agar, pyro.


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Narcotics abuse• AVEN, BELLA, CHAM, COFF, LACH, NUX-V.• Camph , dig, graph, iod ,ip, lyc, op, puls, sep,

valer.• acet-ac, agar, am-c, apom, ars, aur, bry, calc,

cann-i, canth, carb-v, caust, chin, cic, cimic, colch, croc, cupr, dulc, euph, hep, ign, kali-per, lob, macro, mag-s, merc, mosch, mur-ac, nat-c, nat-m, nat-ph, nit-ac, nux-m, ox-ac, ozon, passi, ph-ac, phos, plat, plb, rhus-tox, seneg, staph, sulph, thuja, verat, zinc.


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Ptomain poisoning ailments from-• ars, cupr-ar ,pyro, verat.• absin, acet-ac, all-c, camph, carbo-an,

carb-v, crot-h, gunp, kreos, lach, puls, urt-u.

Purgatives abuse• NUX-V.• lyc.• aloe, chin, hydr, op, sulph.


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Radiation sickness for side effects• CAD-S, SOL.• ip.• ars, calc-f, chin, fl-ac, nux-v, phos, rad-br,

x-ray.Silica poisoning silicosis• CALC, FL-AC, SIL.• lyc, puls.• agar-t , ars, brom, camph, hep, ictod, ip,

mag-m, merc, nat-c, nat-a, nit-ac, penic, ph-ac, sulph.


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

sep, spig, staph, stroph, verat.


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Toxicological Materia Medica

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