An Exposition on Efficacy of Homoeopathyin Sarcoidosis with Miasmatic Concepts

By Dr. Rajneesh Kumar SharmaB.Sc., B.H.M.S., M.D. (Organon & Homoeopathic Philosophy), hMD (U.K.), D.I. Hom. (London), D.Lit. (U.K.) etc…

Homoeo Cure & Research Centre P. Ltd.

NH 74 - Moradabad Road, Kashipur - 244713

Uttaranchal (INDIA)

An Exposition on Efficacy of Homoeopathy in Sarcoidosis with Miasmatic Concepts

Author-

Dr. Rajneesh Kumar Sharma

Address-

Homoeo Cure & Research Centre P. Ltd.

NH 74, Moradabad Road,

Kashipur (Uttaranchal)

244713- India

Published by-

Homoeo Cure & Research Centre P. Ltd.

NH 74, Moradabad Road,

Kashipur (Uttaranchal)

244713- India

2009- 2010

© All rights reserved with author.

Price- Rs. 650/-

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Dedication

Dedicated

To our parents- who devised us!

To our family- which sustained us!

To our collegues and friends- who shored up us!

&

To Homoeopathy- which endulged us!

&

dissolved we all into it!

AcknowledgementI am unspeakably grateful to Dr. (Prof. Emeritus) V. K. Gupta, Dr. (Prof. Emeritus) V. K. Khanna and Dr. (Prof.) V. C. Acharya whose sharp intellect, scientific outlook, constant guidance, perpetual encouragement and abundant interest have always enabled me to effort hard through out the course of my research works. Without their teachings, no work in Homoeopathic Research would have been accomplished. I am extremely thankful to them for sparing their valuable time in guiding me time to time, out of their immensely busy schedules.

I salute to the devotion of my friends and colleagues who, at times, counseled me in this tenure.

In last, I thank to my family who suffered silently to support me and sacrificed their rights for the sake of accomplishment of this chore.

My hospital personnels and acquaintances also deserve to be thanked in helping me in this regard.

(Dr. Rajneesh Kumar Sharma)

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Preface‘Sarcoidosis’ refers to the life threatening granulomatous disorder of still unknown origin.

The disease occurs worldwide; no race, sex or age is immune from it. Its unpredictable multisystemic presentation can involve any organ in the body. Owing to its diverse presentation, the disease easily crosses the artificial boundaries of medical specialities, and appears in the offices and clinics of practitioners of different disciplines.

Though not common, it is often a disorder causing a deal of degenerations in all the organs of the patient.

‘Sarcoidosis’, like other disease, affects the person as a whole irrespective of the cause. The whole economy of the patient is altered producing signs of Sarcoidosis as well as a characteristic picture of sick individual including mentals and physicals specific to his personality. This disease picture, specific to that particular patient, is always different from that in another one. This difference is due to his particular identity proving him to be an ‘Individual’. The totality of symptoms depends upon the Miasms under-running the disease process in that individual.

Since the aetiology of Sarcoidosis is not known, it becomes very difficult to treat it. Only on the basis of symptomatology, the final cure is not always possible. Therefore it becomes neccessory to understand its basic disease phenomenona in terms of Homoeopathy i.e. miasms and only then its proper eradication can be done.

In this book, we have discussed the disorder in all possible angles covering the work as historical review, homoepathy overview, definition, incidence and prevalence, clinical staging, diagnosis, pathological differential diagnosis and treatment of Sarcoidosis. In later half, after the studies about homoeopathy, Sarcoidosis and Homoeopathy are correlated and explained with miasmatic analysis of signs and symptoms associated with it. In last, therapeutics and repertory of Sarcoidosis are given for its complete homoeopathic cure.

(Dr. Rajneesh Kumar Sharma)

22-02-2010

ContentsEfficacy of homoeopathy in sarcoidosis with miasmatic concepts 8Sarcoidosis – the historical review 8ORIGIN OF WORDS- ‘SARCOIDOSIS’ 8History of sarcoidosis 9The pioneers of sarcoidosis 11SARCOIDOSIS IN INDIA 16Studies related to homoeopathy 18ORIGIN OF HOMOEOPATHY 19Sarcoidosis 22Incidence and prevalence 24Clinical staging of sarcoidosis 28DIAGNOSIS OF SARCOIDOSIS 43CRITERIA OF DIAGNOSIS OF SARCOIDOSIS 43CLINICAL AND/OR RADIOLOGICAL PATTERNS OF SARCOIDOSIS 44DIAGNOSTIC TESTS FOR SARCOIDOSIS 45SERUM ANGIOTENSIN CONVERTING ENZYME 45LAB STUDIES FOR SARCOIDOSIS 46PATHOLOGICAL DIFFERENTIAL DIAGNOSIS 53THE CONDITIONS “POSSIBLE BUT MOST UNLIKELY” WITH SARCOIDOSIS 54DIFFERENTIAL DIAGNOSIS OF SARCOIDOSIS 54Treatment of sarcoidosis 56Homoeopathy- a breif study 59CONCEPTS AND PRINCIPLES 59THE LAW OF SIMILARS 59THE LAW OF SINGLE REMEDY 59THE LAW OF MINIMUM DOSE 59HOLISTIC APPROACH AND THEORY OF INDIVIDUALISATION 59CONCEPT OF VITAL FORCE 59CHRONIC DISEASES 60MIASM 61PHASES OF MIASMS 62TYPES OF MIASMS 62SIGNS AND SYMPTOMS OF MIASMS 63TOTALITY, CONSTITUTION AND THE MIASMS 65IDIOSYNCRACY 65Sarcoidosis and homoeopathy 66MIASMATIC ANALYSIS OF SIGNS AND SYMPTOMS ASSOCIATED WITH SARCOIDOSIS 66LITERATURE RELATED WITH ‘SARCOIDOSIS’ FOUND IN VARIOUS HOMOEOPATHIC BOOKS 66THERAPEUTICS 67Repertory of sarcoidosis 73Bibliography 79

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Efficacy of Homoeopathy in Sarcoidosis with Miasmatic Concepts‘Sarcoidosis’ is a ‘NOT WELL UNDERSTOOD’ complex multisytem disease. The lungs are the most commonly involved organs, but no structure of the body is known to be immune to its wrecks. It is a commonplace inflammatory disease, characterised by the formation of noncaseating granulomas. The granuloma is a battle clashed on a genetically susceptible ground between an unrecognised antigen(s) and a highly organised squad of lymphocytes and macrophages. The disease occurs worldwide; no race, sex or age is immune from it. Its unpredictable multisystemic presentation can involve any organ in the body. Owing to its diverse presentation, the disease easily crosses the artificial boundaries of medical specialities, and appears in the offices and clinics of practitioners of different disciplines.

The cause of sarcoidosis is not known till now. Early studies about the role of atmospheric influence, soil, plants, pollen, propinquity to woods and forests, exposure to pets and farm animals etc. proved to be of no reward. The disease most likely represents an inflammatory response to one or many agents (e.g., bacteria, fungi, viruses, chemicals) in a person with either an inherited or acquired predisposition.

Though not common, it is often a disorder causing a deal of mental stress and worry to the patient, often leading to permanent failure or disabilities of the organs ultimately leading to the end of vital functions.

‘Sarcoidosis’, like other disease, affects the person as a whole irrespective of the cause. The whole economy of the patient is altered producing the signa of Sarcoidosis as well as a characteristic picture of sick individual including mentals and physicals specific to his personality. This disease picture specific to that particular patient is always different from that in another one. This difference is due to his particular identity proving him to be an ‘Individual’. The totality of symptoms depends upon the Miasms under-running the disease process in that individual.

The Psora being the fundamental miasm plays maximum role in altering the physiology rendering the entire imbalance. While in combination with other miasms, it produces the worst stage of the sickness. The syphilis produces destruction of tissues. To combat it, Sycosis and Psora play their vital part. This combination in turn increases the destruction as well as new tissue formation too, producing granulomas and fibromas publishing the complete portrait of Sarcoidosis.

The illness can be self-limited or chronic, with episodic recrudescence and remissions. The course and prognosis may correlate with the mode of onset and the extent of the disease. This exposition examines the current understanding of sarcoidosis, including the epidemiology, etiology, immunopathogenesis, pathology, clinical manifestations, diagnosis, management, and prognosis especially in terms of Homoeopathy.

Since the aetiology of Sarcoidosis is not known, it becomes very difficult to treat it. Only on the basis of symptomatology, the final cure is not always possible. Therefore it becomes neccessory to understand its basic disease phenomenona in terms of Homoeopathy i.e. miasms and only then its proper eradication can be done.

Sarcoidosis – the Historical Review

Origin of Words- ‘Sarcoidosis’-

The word "sarcoidosis" comes from the Greek word "sarkodes," meaning "fleshy," and the Greek suffix "-osis," meaning "condition."

History of Sarcoidosis

3.6 Million Years Ago

Sarcoidosis claims its first victim as a female Australopithecus ancestor who falls out of tree while in the throes of a Sarcoidosis coughing fit and is promptly eaten by a saber tooth tiger waiting below. Her family troop continues to eat leaves, unfazed.

2,353 B.C.

The first ever Sarcoidosis biopsy occurs when Thog the Conqueror is speared through his mediastinal lymphadenopathy by a Bronze Age villager who didn’t feel like being conquered. No one hangs around long enough to make a diagnosis.

501 A.D.

Sarcoidosis sufferer, and professional peasant, Theodoric Dung, discovers an easy pathway to universal enlightenment, a perfect utopian society, and how to achieve peace and prosperity for the entire world. Unfortunately he feels like crap, sleeps most of the time, and never tells anyone. The Dark Ages linger on for another thousand years.

1287

King Henrik the Expectorate is thought to be the first monarch in history to show signs of Sarcoidosis , as coughing aloud, all day long, become very fashionable among the nobility of his court.

1877

Dr. Jonathan Hutchinson, a London surgeon-dermatologist, is the first to thoroughly describe a new disorder like Sarcoidosis for his colleagues, then admits he was just kidding; it’s actually all in the patient’s imagination. The doctors all laugh merrily and shortly retire to brandy and cigars.

1889

Norwegian dermatologist Dr. Cesar Boeck names the process “multiple benign sarcoid of the skin.” He also showed that patients with Sarcoidosis were a great source of steady income! Doctors everywhere rejoice.

1920

The term Sarcoidosis becomes official. It is derived from the Latin root ‘Sarc” for ‘Sarcastic’ the root ‘Oid’ meaning ‘Comment’ and ‘Osis’ for the Greek “Oh, its you again, what’s wrong now?”

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1941

There is a sharp rise in cases of Sarcoidosis, discovered as thousands of men are drafted into World War II and have their chests x-rayed in routine medical examinations for military service. Doctors determine that, in spite of the evidence, standing in line in your underwear is not a trigger for Sarcoidosis.

1958

Scientists and doctors from all over the world meet at Brompton Hospital in London for the first ever conference about Sarcoidosis. Since nobody knows anything about the disorder, they shortly retire to brandy and cigars.

1965

The synthetic corticosteroid drug Prednisone becomes available and doctors around the world begin prescribing it immediately regardless of the diagnosis. Drug companies everywhere rejoice.

1972

The first-ever holistic approach to Sarcoidosis is discovered by one Susan ‘moonchild’ Coombs of San Francisco, California, when she stuffs her bouquet of wild flowers in her doctor’s mouth and leaves his office to find an alternative to western medicine.

1977

Doctors around the world celebrate “100 Years of Knowing Nothing about Sarcoidosis” by prescribing a Limited Edition Commemorative Prednisone Pack in a collectable tin suitable for framing. Drug companies everywhere rejoice.

1996

The Internet becomes widely available to peoples everywhere allowing Sarcoidosis sufferers a way to reach out to each other and bitch about their doctors. Sensing this, doctors worldwide rename themselves Primary Care Physicians, and shortly retire to brandy and cigars.

2002

In a modern medical breakthrough, the World Consortium on Sarcoidosis Research Redundancy announces they have undeniable proof that Sarcoidosis does, in fact, go into remission. Stating: “this is clearly demonstrated by sheer number of times a patient will have flare-ups, and as anyone knows, one can not have a flare-up without having a remission in between.”

2007

A new congress takes office in America and Sarcoidosis Research is cued up to receive government funding in its traditional slot between Mouse Flatulence Research and The Taskforce on Hangnails.

The Pioneers of Sarcoidosis

1- Jonathan Hutchinson

Jonathan Hutchinson

The first case of sarcoidosis was identified at King’s College Hospital, London by a surgeon dermatologist, Sir Jonathan Hutchinson (1828–1913) more than a century ago.

The first patient with sarcoidosis described by J. Hutchinson had multiple, raised, dusty-red patches on his feet, fingers and arms

2- Robert Willan

Robert Willan (1757–1812)

The term erythema nodosum was first introduced by Robert Willan (1757–1812), the father of modern dermatology. He described the lesion as elevated, painful, red protuberances on the legs, occurring

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mostly in female servants. Much of the current terminology of skin disease can be attributed to Willan, who was also the first to use the term wheal for skin lesions that occur in nettle rash.

3- Ernst Henri Besnier

Ernst Henri Besnier (1831–1909) was the first to report lupus pernio. He described the skin lesions on his patient’s face as lupus pernio de la face-synovites fougueusses (scrofulo-tuberculoses) symetriques des

extrémities superièures. He introduced the term biopsy, in its more archaic “biopsie”.

4- Caesar Peter Moller Boeck

Caesar Peter Moller Boeck (1845–1917) described skin lesions of a patient with lymphadenopathy as lymphoma cutis multiplex/multiple benign sarcoid of the skin.

5- Jorgen Schaumann

Jorgen Schaumann (1879–1953)

Jorgen Schaumann (1879– 1953) was the first to report systemic sarcoidosis, calling it lymphogranulomatosis benigna.

6- Sven Löfgren

Sven Löfgren (1910–1978)

Sven Löfgren (1910–1978) was the first to link erythema nodosum with sarcoidosis. The association is now called Löfgren’s syndrome.

7- Louis Eliot Siltzbach

Louis Eliot Siltzbach (1906–1980)

Louis Eliot Siltzbach (1906–1980) established the specific diagnostic value of the Kveim test in 1954, which is now, appropriately called the Kveim Siltzbach test.

8- Carol Johnson Johns

Carol Johnson Johns (1923–2000)

Carol Johnson Johns (1923–2000) was the first woman to organize an International Conference on Sarcoidosis, held at the Johns Hopkins Medical School in Baltimore in 1984.

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9- Keitzo Nobechi

Keitzo Nobechi (1890–1978)

Keitzo Nobechi (1890–1978) was the first to report the uneven geographic distribution of Japanese cases of sarcoidosis.

D. Geraint James, Founder President WASOG

10- Om P Sharma

President of WASOG.

Om P Sharma

Sarcoidosis milestones

Year Event

1869 J. Hutchinson: first account of skin lesions

1888 E. Besnier: coined term lupus pernio

1892 M. Tenneson: defined histology

1897 C. Boeck: described a policeman with skin lesions

1902 R. Kienbock/K. Kreibich/O. Jungling: described bone changes

1906 Darier–Roussy syndrome: subcutaneous nodules described

1909–1910

H. Schumacher/Christian Heerfordt/F. Bering: recognized uveitis

1915 J. Schaumann: emphasized multisystemic disorder

1915 E. Kuznitsky: classified skin lesions

1915 A. Bittorf: described lung lesions

1937 W. Bruins-Slot/L-M. Pautrier/W.T. Longcope/J. Pierson/ J. Costa Waldenstrom: uveoparotid fever

1941 A. Kveim: introduced Kveim test

S. Lo¨ fgren: described Lo¨ fgren’s syndrome

1958 K. Wurm: first proposal for radiographic staging

1958 1st International Conference on Sarcoidosis: London, UK

1961 1st USA conference: Washington, DC, USA

1967–1981

H. Reynolds, G. Hunninghake, R Crystal: bronchoalveolar lavage

1976 Commemorative publication dedicated to L. Siltzbach: Mount Sinai Journal of Medicine, New York

1984 G. Rizzato: starts journal Sarcoidosis (now called Sarcoidosis, Vasculitis and Diffuse Lung Diseases)

1987 G. Rizzato: founds World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG);

D.G. James elected the first president

1987 Commemorative publication dedicated to D.G. James: Sarcoidosis

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Sarcoidosis in India

Although a short review of sarcoidosis with a case report was published as early as 1957 in the Indian Journal of Dermatology, the disease remained hidden under the menace of widespread tuberculosis for a long time. The late S. Gupta shared his experience on clinical aspects of sarcoidosis in India at various national and international conferences. In his hometown, Kolkata (previously known as Calcutta), India, on February 22, 2003, the Indian Association of Sarcoidosis and other Granulomatous Disorders (IASOG) was inaugurated. The first annual meeting of the IASOG was held on January 12, 2004 and was organized by A. Shah. The events came too late for S. Gupta, a pioneer in sarcoidosis and tuberculosis, who had passed away earlier on September 9, 2002.In a clinical study “Efficacy of Homoeopathy in Sarcoidosis with Miasmatic Concepts”, the following results were obtained-

Sex incidence-The most affected are females than males. Males- 04%, Females 07%.

Age incidence- The incidence of Sarcoidosis is maximum in age group of 31-50 years and least in prepuberty and aged group.

Marital status incidence-It was more in married patients (82%) than singles (18%).

Physical built incidence-Maximum cases were recorded from moderate built persons.

Caste incidence-The Hindu were more affected than muslims and the Sikhs.

Occupational incidence-The prevalence of Sarcoidosis was mosty in working patients (46%), House wives (27%), Students (18%) and non working ones (09%).

Socioeconomic incidence-Sarcoidosis was most prevalant in rich persons (46%) and least in average (20%).

Pathological incidence-The most frequent was Idiopathic Sarcoidosis (100%), The second one being Sarcoidosis with pulmonary manifestations (55%), then Sarcoidosis with arthritis (37%), then Sarcoidosis with other manifestations was 9%.

Menstrual incidence-It was maximum seen in the females without menses especially those with amenorrhoea or postmenopausal ones. In females with menses, it was mainly in normally menstruating ladies than those with scanty menses.

Miasmatic incidence-The Sycosis was found to be the top ranking miasm causing Sarcoidosis (37%), the next being Psora ( 36%) and then Pseudopsora (27%).

Mode of prescription- The mode of prescription in various cases was based on totality of symptoms. The way to reach the similimum remedy was either through mental to physical generals and particulars; or through the key of rare and peculier symptoms if available in some cases.

Gross Cure incidence-The Homoeopathic treatment was found to be miraculously effective in treatment of Sarcoidosis. The data revealed- Cured- 27%, Relieved- 73% and Not Cured- 00% .

Cure incidence based on Socioeconomic Status-The cure rate was highest in poor patients and the lowest in rich.

Cure incidence based on Menstrual states-Females with normal menses were 50% cured those with scanty menses were 100% cured, those with amenorrhoea were 100% relieved and postmenopausal ones were 100% relieved.

Cure incidence based on Miasms-The highiest percentage of cure was in Sycosis (50%) with 50% relief and the least in Psora (00%) with 100% relieved. Those with Pseudopsora were 33% cured with 67% relief.

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STUDIES RELATED TO HOMOEOPATHYThe word ‘Homoeopathy’ is derived from two Greek words, ‘Homois’- meaning similar and ‘pathos’- mean suffering. Homoeopathy simply means treating diseases with remedies, prescribed in minute doses, which are capable of producing symptoms similar to the disease when taken by healthy people. It is based on the natural law of healing- “Similia Similibus Curantur” which means “likes are cured by likes”. Dr. Christian Friedrich Samuel Gottfried Hahnemann (Thursday, 11:55 PM, 10th April 1755- Sunday, 05:00 AM, 02nd July 1843) gave it a scientific basis in the early 19 th century. It has been serving suffering humanity for over two centuries and has withstood the upheavals of time and has emerged as a time-tested therapy. The scientific principles propounded by Dr. Hahnemann are natural and well proven and continue to be followed with success.

Dr. Christian Friedrich Samuel Gottfried Hahnemann

Homoeopathy today is a rapidly growing system and is being practiced almost all over the world. In India it has become a household name due the safety of its pills and gentleness of its cure. A rough study indicates that about 10% of the Indian population solely depends on Homoeopathy for their health care needs.

It is more than a century and a half now that Homoeopathy is being practiced in India. It has blended so well into the roots and traditions of the country that it has been recognized as one of the National Systems of Medicine and plays an important role in providing health care to a large number of people. Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels.

Origin of HomoeopathyThe principle of Homoeopathy has been known since the time of Hippocrates from Greece, the founder of medicine, around 450 BC More than a thousand years later the Swiss alchemist Paracelsus employed the same system of healing based upon the principle that “like cures like”. But it was not until the late 18th century that Homoeopathy as it is practiced today was evolved by the great German physician, Dr. Samuel Hahnemann. He was appalled by the medical practices of that time and set about to develop a method of healing which would be safe, gentle, and effective. He believed that human beings have a capacity for healing themselves and that the symptoms of disease reflect the individuals struggle to overcome his illness.

Over two hundred years ago, the German physician Dr. Samuel Hahnemann discovered the principle that what substance could cause in the way of symptoms, it could also cure. Dr. Hahnemann was struck by the effect that certain drugs, when taken by him while quite healthy, produced symptoms that the drug was known to cure in sick. For instance, when he took Cinchona Bark, which contains quinine, he became ill with symptoms that exactly mimicked intermittent fever (now called malaria). He wondered if the reason Cinchona worked against intermittent fever was because it caused symptoms indistinguishable from intermittent fever in a healthy human as demonstrated bt Dr. William Cullen in his Materia Medica.

Hahnemann caught the essence of this action of cinchona while translating the works of Dr. Cullen in 1789 giving birth to the true and the only system of medicine based on nature’s law of cure, treating a person as awhole, not its parts or organs, therefore also called as the holistic system of treatment.

Dr. William Cullen, Pharmaceutical Bottle of Quinine used by Hahnemann and Front Page of Cullen’s Materia Medica

Master Hahnemann continued to experiment, noting that every substance he took, whether a herb, a mineral, an animal product or a chemical compound, produced definite distinct symptoms in him. He further noted that no two substances produced exactly the same set of symptoms. Each provoked its own unique pattern of symptoms. Furthermore the symptoms were not just confined to the physical plane. Every substance tested also affected the mind and the emotions apart from the body. Eventually, Dr. Hahnemann began to treat the sick on the principle ‘let likes be treated by likes’. From the outset he achieved outstanding clinical success.

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Page No. 151 of Cullen’s Materia Medica showing Cinchona Pharmacology- Adopted from The Works of Willium Cullen by John Thomson- Edinburgh

Hahnemann divided sickness into-

1- Indisposition- slight alteration in the state of health manifested by one or more trivial symptoms. Slight alteration in diet or/and regimen will dispel it.

2- Surgical diseases- the diseases with gross pathological, often irreversible changes.

3- Dynamic diseases- the diseases due to functional derangement of normal hormony of health, often reversible.

A. Acute Diseases- any disease or illness which can disturb the health of a person temporarily in a negative way. They are rapid in course, intense in pain and severity, short or moderate in duration and end in recovery or death.

a. Individual- occurring only in one individual at a time with different group of symptoms.

b. Sporadic- attacking several persons at a time in different localities with somewhat similar symptoms. viz. Viral Fever, Influenza, Dysentery, Typhoid etc.

c. Endemic- diseases prevalent in a particular locality due to some local circuminstances.

d. Epidemic- attacking a large numbr of persons of a vast area at a time with similar set of symptoms.

i. Immunizing- occur only once in the life time of an individual, profylacting against second attack. viz. Small pox, Chicken pox, Measles, Whooping Cough, Scarlet Fever, Mumps etc..

ii. Non immunizing- may occur several times in life of an individual. viz. Cholera, Plague, Yellow Fever, Diphtheria etc.

e. Pandemic- attacking a large area of the world with similar symptoms. viz. influenza.

B. Chronic diseases- the diseases appearing incidiously, running indefinitely and leaving life long conseqences or terminating in death, often based on activities of one or more miams, the fundamental causes of all the chronic diseases.

a. Artificial- iatrogenic diseases. i.e. diseases due to excessive use of drugs.

b. Inappropriately named chronic diseases- false chronic diseses, persisting due to some maintaing cause. viz. occupational diseases; bad habits, dust exposure etc.

c. True Natural or Miasmatic diseases- chronic diseases with constitutional signs and symptoms.

i. One sided diseases- having very few perceptive symptoms.

a) Internal- affection of an internal kind, viz. chronic headache or diarrhea.

b) External- affection of an external kind localized in one part only, viz. venous stasis, varicose veins etc.

ii. Diseases with full developed symptoms- these are full fledged chronic diseases.

a) Single diseases- having only one miasm at a time.

i. Psora- the functional miasm causing disturbances in physiology only.

ii. Sycosis- the mal-growth miasm, causing exfoliations, tumorization etc.

iii. Syphilis- the degenerating miasm, causing destructions.

b) Compound Diseases- diseases having combination of the more than one miasms.

i. Psora-sycosis- abnormal growths. viz. tumors, keloids etc.

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ii. Psora-syphilis- also called Pseudopsora, or Tubercular miasm, causing tubercular degenerations etc. viz. phthisis etc.

iii. Syco-syphilis- causing cystic degenerations. viz. Tubo-ovarian mass etc.

iv. Psora-syco-syphilis- also called cancerous miasm, causing worst forms of diseases like cancer.

SARCOIDOSIS

Definition of Sarcoidosis-

It is hard to provide a concise definition of a disease whose cause is yet to be discovered. Scadding and Mitchell recommended the following: "Sarcoidosis is a disease characterized by the formation in all of several affected tissues of epithelioid-cell tubercles without caseation though fibrinoid necrosis may be present at the centre of a few, proceeding either to resolution or to conversion into hyaline fibrous tissue".

Other Definitions of Sarcoidosis-

A systemic granulomatous disease of unknown cause, especially involving the lungs with resulting fibrosis, but also involving lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands; granulomas are composed of epithelioid and multinucleated giant cells with little or no necrosis. Syn: Besnier-Boeck-Schaumann disease, Besnier-Boeck-Schaumann syndrome, Boeck's disease, Boeck's sarcoid, Schaumann's syndrome.

o X Term Medical Dictionary

A systemic granulomatous disease of unknown cause, especially involving the lungs with resulting fibrosis, but also involving lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands; granulomas are composed of epithelioid and multinucleated giant cells with little or no necrosis. Syn: Besnier-Boeck-Schaumann disease, Besnier-Boeck-Schaumann syndrome, Boeck's disease, Boeck's sarcoid, sarcoid(1), Schaumann's syndrome.

o Stedman’s Electronic Medical Dictionary V. 4.0

A chronic disease of unknown cause marked by the formation of nodules in the lungs and liver and lymph glands and salivary glands.

o wordnetweb.princeton.edu/perl/webwn

Sarcoidosis (sarc = flesh, -oid = like, -osis = a process), also called sarcoid or Besnier-Boeck disease, is a multisystem disorder characterized by non-caseating granulomas (small inflammatory nodules). The cause of the disease is still unknown.

o en.wikipedia.org/wiki/Sarcoidosis

A rare inflammation of the lymph nodes and other tissues throughout the body. sella turcica - bony structure that houses the pituitary gland. suprarenal glands - another name for the adrenal glands.

o www.methodisthealth.com/tmhs/basic.do

A systemic disease involving the lungs, lymph nodes, skin, liver, spleen, eyes, phalangial bones, and parotid glands, characterized by granular nodules. Its cause is not known.

o www.cdc.gov/cfs/cfsglossary.htm

A condition that causes small, fleshy swellings in the liver, lungs, and spleen.

o ukhealthcare.uky.edu/patient/glossary/glossary-s.htm

A disease of unknown origin that causes small lumps (granulomas) due to chronic inflammation to develop in a great range of body tissues. Sarcoidosis can appear in almost any body organ, but most often starts in the lungs or lymph nodes.

o www.emedicinehealth.com/arthritis/glossary_em.htm

A chronic, progressive, systemic granulomatous reticulosis of unknown etiology, involving almost any organ or tissue, including the skin, lungs.

o courses.washington.edu/hubio567/lang/term2.html

An inflammatory disease marked by the formation of granulomas (small nodules of immune cells) in the lungs, lymph nodes, and other organs.

o www.ecancerawareness.com/cancer_glossary/s.php

A rare disease with no known cause that leads to inflammation in tissues throughout the body, including the lymph nodes, lungs, liver, skin, and eyes.

o www.american-depot.com/services/resources_gl_s.asp

Sarcoidosis is a multi system disorder characterized in affected organs by a type of inflammation called granulomas. The cause is unknown. Some people with sarcoidosis affecting their pituitary glands can develop diabetes insipidus.

o www.diabetesinsipidus.org/whatisdi_glossary.htm

A rheumatic disease that often involves a sudden onset of arthritis in the feet and ankles.

o www.arthritis.org/disease-center.php

An inflammatory disease that can affect almost any organ in the body. It causes heightened immunity which means that a person's immune system, which normally protects the body from infection and disease, overreacts, resulting in damage to the body's own tissues.

o www.stopsarcoidosis.org/sarcoidosis/glossary.htm

A disease characterized by granulomas (small growths of blood vessels, cells, and connective tissue) that can lead to problems in the skin, lungs, eyes, joints, and muscles.

o womenshealth.about.com/library/bl_autoimmune12.htm

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Some doctors use melatonin to help treat sarcoidosis (a condition where fibrous tissue develops in the lungs and other tissues). A few clinical studies suggest that melatonin may be helpful for those who do not improve from conventional steroid treatment.

o dukehealthsystem.adam.com/content.aspx

Sarcoidosis - Synonyms

Language SynonymEnglish SarcoidosisHindi

Africans SarcoïdoseChinese 结节病Czech sarkoidózaDutch sarcoïdoseGerman SarkoidoseGreek σαρκοείδωσηFrench sarcoïdoseItalian sarcoidosiJapanese サルコイドーシスKorean sarcoidosisPotugese sarcoidoseRussian саркоидозTurkish sarkoidoz

Incidence and Prevalence

Geographical Incidence

Europe- the prevalence ranges from 3-50 cases per 100,000 population, with the disease most frequently affecting persons aged 20-40 years.

Sweden- the highest reported incidence of sarcoidosis in Europe, ranging from 64 cases per 100,000 population using mass radiographic screening to 641 cases per 100,000 population using autopsy studies.

United Kingdom- the overall prevalence of sarcoidosis is approximately 20 per 100,000 population.

Denmark- One review reported that the approximate incidence of clinically recognized sarcoidosis in Danish children younger than 15 years was 0.22-0.27 per 100,000 children per year, corresponding to approximately 3 new cases each year.

New York- 39 out of every 100,000 are affected.

Spain- only 1.2 per 100,000 are infected.

Middle East, China, SE Asia, or among the Inuit or Native North Americans- Sarcoidosis is rarely reported.

Portugal, India, Saudi Arabia, or South America- In these and many more countries, the prevalence of sarcoidosis is low, possibly because of the absence of mass chest radiographic screening and also because of the presence of other more commonly recognized granulomatous diseases, especially tuberculosis, that mimic sarcoidosis.

Racial Incidence

Within a geographical area, the frequency and course of the disease vary considerably among racial groups.

In one study of sarcoidosis in London, for example, the incidence of sarcoidosis in W. Indian and Asian immigrants is 10 times higher than in the indigenous Caucasian population. Also, in the immigrant population, there is a greater need for corticosteroid treatment and a lower chance for full recovery.

In another study, researchers found that sarcoidosis in S. Africa occurs in 23 out of every 100,000 black persons, 12 of every 100,000 mixed race persons, and 4 of every 100,000 Caucasians.

In the United States, various studies have shown that sarcoidosis occurs in 10–80 of every 100,000 African Americans, compared to less than 8 of every 100,000 Caucasians.

Genetic Factorial Incidence

Prevalence in certain race Familial clustering

HLA -A1, -B8, and -DR3

HLA B22 in Italians

HLA DR-17 good prognosis in Scandinavians; protracted course with DR 15 and 16

DR5j Japanese patients have poor prognosis

Negative association- HLA B12 and -DR4

Sexual Incidence

African American women develop sarcoidosis twice as often as African American men. Caucasian women and men are equally likely to develop it. Overall, it is more frequent in females.

Age IncidenceThe highest prevalence is in 25-34 year olds.

Smokers v/s Nonsmokers Incidence

Unlike most lung diseases, sarcoidosis actually occurs more frequently in nonsmokers than smokers. It is not clear why.

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Characteristic features of sarcoidosis

Often symptomless May have associated dull, ache in chest, malaise & fever

More progressive & leads to dyspnea…cor pulmonale…death

Honeycomb appearance on chest x-ray

PFT’s restrictive pattern

Common Symptoms of Sarcoidosis

General discomfort, uneasiness, or ill feeling (malaise) Fever

Shortness of breath

Cough

Skin lesions

Skin rash

Headache

Visual changes

Neurological changes

Enlarged lymph glands (armpit lump)

Enlarged liver

Enlarged spleen, which leads to a decrease in platelets in blood and pain in upper left abdomen.

Dry mouth

Fatigue (one of the most common symptoms in children)

Weight loss (one of the most common symptoms in children)

Additional symptoms of this disease:

Tearing, decreased

Seizures

Nosebleed - symptom

Joint stiffness

Hair loss

Eye burning, itching, and discharge

Abnormal breath sounds (e.g. rales)

Nasal obstruction or frequent bouts of sinusitis.

Lung Symptoms

Shortness of breath A dry cough that doesn't bring up phlegm

Wheezing

Pain in the middle of chest that gets worse deep breath or cough (rare).

Lymph Node Symptoms

Enlarged and sometimes tender lymph nodes most often those in neck and chest but sometimes those under chin, in arm pits, or groin.

Skin Symptoms

Various types of bumps, ulcers, or, rarely, flat areas of discolored skin, that appear mostly near nose, eyes, back, arms, legs, and scalp. They usually itch but aren't painful. They usually last a long time.

Painful bumps called erythema nodosum, that usually appear on ankles and shins and can be warm, tender, red or purple-to-red in color, and slightly raised. Fever and swollen ankles and joint pain along with the bumps may appear. The bumps often are an early sign of sarcoidosis, but they occur in other diseases too. The bumps usually go away in weeks to months, even without treatment.

Disfiguring skin sores that may affect the nose, nasal passages, cheeks, ears, eyelids, and fingers. This is called lupus pernio. The sores tend to be ongoing and can return after treatment is over.

Eye Symptoms

Burning, itching, tearing, pain Red eye

Sensitivity to light

Dryness

Floaters

Blurred vision

Reduced color vision

Reduced visual clearness

Blindness (in rare cases).

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Heart Symptoms

Shortness of breath Swelling in legs

Wheezing

Coughing

Irregular heartbeat, including palpitations and skipped beats

Sudden loss of consciousness

Sudden death.

Joint and Muscle Symptoms

Joint stiffness or swellingusually in ankles, feet, and hands. Joint pain.

Myalgias.

Muscle pain, a mass in a muscle, or muscle weakness.

Painful arthritis in ankles that results from erythema nodosum, which may need treatment but usually clears up in several weeks.

Painless arthritis that can last for months or even years.

Bone Symptoms

Painless holes in bones. Painless swelling, most often in fingers.

Anemia that results from granulomas affecting bone marrow.

Liver Symptoms

Fever Fatigue

Itching

Pain in the upper right part of abdomen, under the right ribs

Enlarged liver.

Gland Symptoms

Swelling, which makes cheeks look puffy Excessive dryness in mouth and throat.

Blood, Urinary Tract, and Kidney Symptoms

Increased calcium in blood or urine, which can lead to painful kidney stones Confusion

Increased urination.

Nervous System Symptoms

Headaches. Vision problems.

Weakness or numbness of an arm or leg.

Coma (rare).

Drooping of one side of face that results from sarcoidosis affecting a facial nerve.

Paralysis of arms or legs that results from sarcoidosis affecting spinal cord.

Weakness, pain, or a "stinging needles" sensation in areas where many nerves are affected by sarcoidosis.

Pituitary Gland Symptoms (Rare)

Headaches Vision problems

Weakness or numbness of an arm or leg

Coma (rare).

Clinical Staging of Sarcoidosis

This is based on the pattern of chest radiographic findings-

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Stage 0 a normal chest radiographStage I lymphadenopathy onlyStage II lymphadenopathy and lung parenchymal diseaseStage III parenchymal lung disease only Stage IV pulmonary fibrosis

Although most cases of sarcoidosis either regress or remain stable, 10-15% progress to pulmonary fibrosis. Generally, pulmonary function worsens with an increasing stage of disease, but radiologic staging

does not correlate well with the severity of pulmonary function abnormalities. Often, the radiographic abnormalities appear worse than the degree of functional impairment actually present.

Frequency of organ involvement

The frequency of organ involvement varies considerably. The organ involvement rates may be as follows-

Organ PrevalanceLung 90%Lymph nodes 75-90%Pleura 01-05%Skin 25%Eye 25%Nasal mucosa 20%Larynx 05%Bone marrow 15-40%Spleen 50-60%Liver 60-90%Kidney RareCalcium disorder 01-02%CNS 05%Bones 05%Joints 25-50%Heart 05%Endocrine glands RareParotid gland 10%GI tract Rare

Pathophysiology

Suspected Causes of SarcoidosisInfectious

Mycobacteria

1. Tuberculous2. Nontuberculous3. Cell-wall deficient (L-forms)

Bacteria

1. Corynebacterium spp.2. Propionibacterium acnes3. Tropheryma whippleii4. Others

Fungi

1. Cryptococcus spp.2. Endemic fungi

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Viruses

1. Cytomegalovirus2. Epstein-Barr virus3. Herpes simplex virus4. Others

Noninfectious

Dusts

1. Clay2. Pine3. Pollen4. Talc5. Mixed

Metals

1. Aluminum2. Beryllium3. Zirconium

Sarcoidosis is a chronic inflammatory disease characterized by a highly focused exaggerated immune response to an unknown antigen at the target organs. The hallmarks of the disease, sarcoid granulomas, most likely are formed in response to a persistent, poorly degradable, antigenic stimulus. Sarcoidosis is associated with the expansion of IL-2-producing activated CD41 T lymphocytes. A number of factors including IL-18 have been implicated in IL-2 expression in vitro.

1- Interaction of antigens-

The first step involves the interaction of an unknown antigen or antigens with alveolar macrophages bearing increased expression of major histocompatibility complex (MHC) class II molecules. These macrophages engulf, process, and present the putative antigen or antigens to T-lymphocyte cells of type 1 (Th-1). The activated T-cells release a number of cytokines, including interleukin-2, monocyte chemotactic factor, macrophage migration inhibition factor, and leukocyte inhibitory factor.

2- Granuloma formation-

Interleukin-2 activates and expands various clones of T lymphocytes, while monocyte chemotactic factor attracts monocytes from the blood into the lungs.1–3 Macrophage migration inhibitory factor influences

the trapped monocytes that are ready to transform into epithelioid cell and modulate the formation of a granuloma.

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3- Lung injury-

The granuloma formation and associated helper (CD+4) T-lymphocyte alveolitis may lead to substantial lung injury. The lung is the site of an outpouring of lymphocytes, but the peripheral blood shows a CD+4 T-lymphopenia and depression of cutaneous delayed hypersensitivity.

Inflammatory phases in lung Sarcoidosis. Magnified view shows how illness may affect the normal lung, going from alveolitis, to granuloma formation, to fibrosis

4- Circulating immune complexes-

B-cell function increases. It is manifested by hyperglobulinemia, increased antibodies to Epstein Barr, herpes simplex and other viruses and the presence of circulating immune complexes.

Circulating immune complexes

5- Fibrosis-

The activated macrophages release a number of mediators including fibronectin, cytokines and growth factors responsible for causing fibrosis.

As a result of these various immunologic interactions, an acute and often a chronic cascade of inflammation occurs. This is characterized by changes in tissue permeability, cellular influx, and local cell roliferation, resulting in a granuloma, circulating immune complexes, B-cell hyperactivity, spontaneous in situ production of immunoglobulins, and depression of cutaneous delayed-type hypersensitivity reactions.

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Extensive lung fibrosis

Sarcoidosis in females

Sarcoidosis has been reported to be slightly more predominant in woman than in men. Chronic inflammation in sarcoidosis causes continuous oxidative stress, the patients may therefore have demonstrated accelerated telomere erosion in their peripheral blood cells. Oestrogen induced vascular endothelial growth factor (VEGF) expression, and increasing levels of VEGF, have been shown to be closely related with inflammation and oxidative stress, which is responsible for aggression of Sarcoidosis. In contrast, oestrogen could also stimulate telomerase while reducing oxidative stress. A significant shortening of telomeres in the female sarcoidosis patients versus the males is observed, thus suggesting that the later protection function of oestrogen is relatively weak in sarcoidosis.

Clinical Prsentations of Sarcoidosis-

1. General Manifestations

Fever, anorexia, weight loss, lymphadenopathy, parotid enlargement, acute arthritis, nasal stuffiness, hoarseness etc.

2. Pulmonological Manifestations

Seen in 90% of cases, dyspnea, dry cough, and chest pain. Primary involvement of the parenchyma, lymph node and airway lesions (larynx, trachea and bronchi), 20% asthma-like features. Uncommon manifestations include pleural effusion, pleural nodules, pleural thickening, pneumothorax, chylothorax, massive effusion, haemothorax, cavity formation, lymph node calcification etc.

3. Otorhinolaryngological Manifestations

Parotid enlargement, hoarseness, nasal stuffiness.

4. Dermatological Manifestations

Erythema nodosum and onycholysis

In chronic sarcoidosis 15-20% patients have main lesions including erythema nodosum (EN) with fever and arthralgias, maculopapular rash, scars, keloids, plaques, papules and subcutaneous nodules.

Lupus pernio (violaceous, chronic and disfiguring lesions of the ears, nose and cheeks), onycholysis, keloid formation in atrophic scars, nasal and conjunctival mucosal granulomas are other manifestations. EN + BHL = Lofgren’s syndrome, foreshadows a good prognosis.

5. Cardiological Manifestations

Dyspnea, cardiac failure, sudden death, heart block, arrhythmias (restrictive type), conduction abnormalities, abnormal ECG, cough, wheezing, cor pulmonale, valvular involvement, ventricular aneurysm, pericardial involvement.

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Myocardial infarction-like picture with myocardial involvement 5-10%. The risk of cardiac dysfunction or sudden death in these patients is low (those with + thallium-201 imaging), endomyocardial biopsy confirms the diagnosis, needs to exclude CAD.

Cardiac MR imaging- location (subendocardial, transmural, subepicardial, or mesocardial) & pattern (patchy or diffuse) of abnormal delayed myocardial enhancement allow differentiation between

ischemic (infarct-related) and nonischemic cardiomyopathies

6. Radiological Manifestations

Abnormal chest X-ray, bilateral hilar lymphadenopathy, interstitial fibrosis, bone cysts.

Chest PA - bilateral hilar adenopathy with "separation" of nodes from heart (broncho-pulmonary nodes in sarcoid are more peripherally placed than true hilar nodes that enlarge in lymphoma)

7. Nephrological Manifestations

It may lead to renal failure. The major pathological findings are- focal segmental glomerulosclerosis, membranous glomerulonephritis, mesangial proliferative, glomerulonephritis, immunoglobulin A nephropathy, crescentic glomerulonephritis.

The principal manifestations of renal involvement in sarcoidosis are the functional abnormalities resulting from the altered metabolism of calcium as a result of the increased synthesis of 1,25-dihydroxy-vitamin D3 by the macrophages of the granulomatous lesions. The consequent increased calcium absorption from the gastrointestinal tract results in the hypercalciuria.

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8. Mammary gland Manifestations

Breast involvement by sarcoidosis is rare. It may be found clinically as a palpable mass or an incidental finding (i.e. single or multiple nodular densities on screening mammography.

(a,b) Mediolateral oblique and (c,d) cranio-caudal views of both breasts demonstrate an asymmetric density in the upper outer quadrant of the left breast (a,c)

9. Rheumatological Manifestations

Arthritis, Bone cysts.

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Diffuse trabecular change, leading to a lattice work or lacy network configuration and multiple lucent lesions of varying sizes are found in the fingers. (The lytic change produces the cystic-like appearance)

10. Ophthalmological Manifestations

Conjunctivitis, Iritis, choroiditis, keratoconjunctivitis, glaucoma, cataract, enlarged lachrymal glands, dry eye.

Sarcoidosis can result in anterior uveitis, granuloma in eyes (red, swollen palpebral lobe of the lachrymal gland is observed on eversion of the upper eyelids)and/or enlarged lachrymal and salivary

glands (Mikulicz syndrome)

MR findings in 43-year-old woman with horizontal and vertical diplopia. A–D, Axial (A) and coronal (B) T1- weighted (450/16/1) images through the orbits show marked enlargement of the lachrymal

glands (solid arrows) and rectus muscles (asterisks) as well as the markedly enlarged insertion of the right superior rectus muscle (open arrow). Axial T2-weighted (2500/90/1) image (C) shows markedly

hypointense rectus muscles (arrowheads). Axial contrastenhanced T1-weighted (450/16/1) fatsuppressed image (D) shows intense abnormal enhancement of the lacrimalglands and extraocular

muscles

In 15-25% of cases- Anterior uveitis - the most common form of ocular sarcoidosis, photophobia and ocular discomfort. Heerfordt’s syndrome or uveoparotid fever - anterior uveitis + parotitis, fever, and facial palsy. Posterior uveitis - vitreous infiltrates, choroidal nodules, periphlebitis, retinal hemorrhage, and papilledema.

11. Neurological Manifestations

Cranial nerve palsies, papilledema, meningitis, myopathy, peripheral neuropathy, Seizures, space occupying lesions, Spinal cord involvement, Cerebellar ataxia, Psychiatric symptoms. In 5-10% of cases: unilateral facial nerve palsy. HP axis involvement can cause hyperprolactinemia and DI, Hypothalamic and Pituitary gland sarcoidosis.

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CT Head- 1.5 cm enhancing suprasellar cistern mass llifting the optic chiasm slightly in the cephalad direction

12. Endocrinological Manifestations

Diabetes insipidus, Hypercalcemia, Hyperthyroidism. Endocrinopathy occurring in sarcoidosis is relatively rare, the hypothalamus and pituitary gland being the most commonly affected regions. Of the numerous symptoms attributed to neuroendocrine sarcoidosis, polyuria and polydipsia are the most frequent.

Patients with neuroendocrine sarcoidosis commonly have hypothalamic dysfunction and, to a lesser extent, variable involvement of the infundibulum, the pituitary gland, or both. In addition to diabetes insipidus, they often exhibit hypothalamic disturbances and anterior pituitary hormone deficiency.

13. Haematological Manifestations

Anemia, Thrombocytopenia, Hypersplenism, Leucopenia.

Splenic lesions with uptake from sarcoidosis in 43-year-old woman with history of Hodgkin’s lymphoma. A–C, Images from combined PET/CT show low-density lesions (arrows, A and C) in spleen

on coronal CT image (A). Lesions show increased FDG uptake on fused PET/ CT (B) and unfused PET (C) images.

14. Orthopaedic Manifestations

Lytic lesions, permeative lesions, destructive lesions, periosteal reaction, digital clubbing, nasal bone involvement, vertebral sarcoidosis, calcaneal sarcoidosis. Acute polyarthritis may be prominent. Chronic periarticular swelling and tenderness due to osseous changes in phalanges.

Lytic lesions of vertebral bodies with associated sclerosis are usually found. There is a predilection for involvement of the thoracic vertebrae. More commonly, there is little or no disc-space involvement.

Anteroposterior view of the left knee and tibia reveals a 2.5-cm ovoid lytic lesion in the anterolateral cortex of the left tibial shaft and lucent zone in medial half of left patella. (B) A 2-cm ovoid tytic lesion

in the anterior cortex of proximal right tibial shaft.

15. Hepatological Manifestations

Portal hypertension, abnormal liver function tests. Hepatic granulomas in biopsy in 50-80% of patients with normal liver function. Hepatomegaly in < 10%. Severe liver disease and jaundice are rare manifestations. Myopathy is also seen.

16. Lymphatic System Manifestations

Most common lymph nodes involved are cervical, epitrochlear, axillary, and inguinal nodes. Glands are discrete, movable and non-tender which do not ulcerate and form draining sinuses.

In the neck, the posterior triangle nodes are affected more commonly than the nodes in the anterior triangle.

17. Urological Manifestations

Hypercalciuria.

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18. Myological Manifestations

Asymptomatic granulomatous muscle involvement, palpable muscle nodules, polymyositis, chronic myopathy, isolated sarcoid myopathy.

19. Gastrointestinal Manifestations

Sarcoidosis rarely affects the gastrointestinal system, but incidences do occur. Symptomless granulomatous involvement of the gastric mucosa or gastric ulcers (single or multiple) with “funnel-shaped” distortion of the stomach, generalized “linitis plastica syndrome,” with epigastric pain, nausea, abdominal cramps, and occasionally diarrhea. The esophagus, small intestine, pancreas and peritoneum are rare localization of sarcoidosis.

Linitis plastica syndrome

20. Sarcoidosis and Malignancy

The most frequent type of cancer associated with sarcoidosis is adenocarcinoma. The sarcoid reaction, or sarcoid-like reaction, characterized by granuloma formation may be found in the regional lymph nodes draining a carcinoma. Sarcoidosis- malignancy association is due to an immunologic abnormality in sarcoidosis which may promote the development of cancer or malignant disease may produce a local sarcoidlike reaction or initiate directly manifestations of systemic sarcoidosis.

21. Sarcoidosis and Pregnancy

Oestrogen levels increase during pregnancy, resulting in a decreased Th1-mediated immune response, which can improve active sarcoidosis. Free plasma cortisol concentrations increase in pregnancy, with plasma levels 2- to 3-fold higher than those of non-pregnant controls, suggesting greater tissue exposure to glucocorticoids during pregnancy. This may result in decreased

granulomatous inflammation with improvement in symptoms and clinical findings. During the postpartum period, when free cortisol levels return to the prior non-pregnant levels, reactivation of sarcoidosis can occur.

Diagnosis of Sarcoidosis

The basic lesion in sarcoidosis is a well-defined round or oval granuloma made up of compact radially arranged epithelioid cells with pale staining nuclei, a few multinucleate giant cells, and a scanty rim of lymphocytes. Exclusion of other causes of granulomatous inflammation requires special stains for acid-fast bacilli and fungi. The presence of necrotic lesions in the biopsy specimen requires further investigations for mycobacteria, fungi, other potential pathogens, and vasculitis.

Inclusions composed of calcium carbonate or calcium oxalate are often found in sarcoid multinucleate giant cells. The size of these inclusions is even larger than those capable of being inhaled, and they do support the diagnosis of sarcoidosis.

Criteria of Diagnosis of Sarcoidosis

For diagnosis of sarcoidosis the following criteria should be fulfilled-

1. Histological evidence of granulomatous inflammation.2. The exclusion of the known causes of granulomatous inflammation other than sarcoidosis.

3. Evidence of at least two separate organs involved with the disease.

Examinations and Tests for Sarcoidosis

CBC Chem-7 or chem-20

ACE levels

Chest x-ray to see if the lungs are involved or lymph nodes are enlarged

CT scan

Lymph node biopsy

Skin lesion biopsy

Bronchoscopy

Open lung biopsy

Liver biopsy

Kidney biopsy

EKG to see if the heart is involved

Sarcoidosis may also alter the results of the following tests-

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Quantitative immunoglobulins (nephelometry) PTH

Serum phosphorus

Nerve biopsy

Mediastinoscopy with biopsy

Lung gallium (Ga.) scan

Immunoelectrophoresis - serum

Calcium - urine

Calcium - ionized

Calcium - serum

Liver function tests

Clinical and/or radiological patterns of sarcoidosis-

The following are all clinical and/or radiological patterns of sarcoidosis-

1. Bilateral hilar adenopathy- Asymptomatic patients with bilateral hilar adenopathy and no pulmonary infiltrates.

2. Panda sign- It has been classically described as indicating Sarcoidosis.

Panda sign - lachrymal and parotid uptake on a total body 67 GA scan, combined with Lambda pattern (right azygos and bilateral hilar thoracic uptake).

3. Lofgren’s syndrome- A patient with a typical Lofgren’s syndrome (fever, erythema nodosum, arthralgias, and bilateral hilar adenopathy).

4. Heerfordt’s syndrome- A patient with Heerfordt’s syndrome (Fever, parotid gland enlargement, facial palsy, and anterior uveitis).

Bilateral inflammatory involvement of the parotid and lachrymal glands results in Gallium-67 citrate uptake called as panda sign. The presence of perihilar adenopathy adds the lambda distribution of increased uptake in the chest, which at times has been included in the description of the panda distribution.

Diagnostic Tests for Sarcoidosis

Pulmonary Function Test

Pulmonary function tests show restriction, decreased compliance, and impaired diffusing capacity.

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Pulmonary function test with a restrictive pattern

CO2 retention is uncommon, but airway obstruction is common in endobronchial disease and late states with pulmonary fibrosis or Bullae. Serial PFTs are important for guiding treatment.

Kveim-Stiltzbach test

Intradermal injection of homogonized tissue of organs involved with sarcoidosis causes delayed cutaneous reaction in 4-6 weeks within granulomas are multi-nucleated giant cells called with stellate inclusions called asteroid bodies and laminated calcifications called Schaumann’s bodies.

Serum Angiotensin Converting Enzyme

Serum ACE activity elevated in 40- 90% due to macrophage activity, but nonspecific since histoplasmosis, acute miliary TB, hepatitis, and lymphomas also have this finding (5% false +).

It lacks diagnostic specificity and poor prognostic value in identifying patients with progressive disease. Tissue ACE activity is highest in sarcoid lymph nodes rather than in pulmonary tissues.

Lab Studies for Sarcoidosis

Leukopenia frequent

Serum uric acid high, but gout is rare

Alk phos and GGT may be high if liver involved

Hypercalcemia +/- hypercalciuria due to calcitriol from

Macrophages

Depression of delayed hypersensitivity is characteristic

Hypergammaglobulinema is common in blacks

BAL/Gallium scanningCD4/CD8 ratio is elevated in sarcoidosis on bronchoalveolar lavage, but reduced in hypersensitivity pneuomonitis whole-body gallium scanning is sensitive, but not specific. Symmetric uptake in mediastinal and hilar nodes (lambda sign) and in lachrymal, parotid, and salivary glands (panda sign), which are pathognomonic for sarcoidosis.

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Thoracic Sarcoidosis- Gallium-67 scans in a patient who had a normal chest radiograph. Study shows increased uptake in the lung fields, higher than the background activity

BiopsyTissue biopsy is essential. It is almost always positive if skin, lymph nodes, conjunctiva are involved. Transbronchial biopsy is best initial procedure for securing histological evidence since granulomas can be seen regardless of chest x-ray findings. Diagnosis of pulmonary sarcoidosis relies on:

Tight, well-formed granulomas and a rim of lymphocytes and fibroblasts

Perilymphatic distribution of granulomas

Exclusion of an alternative cause

Below here is given an atlas of biopsy slides prepared from various samples taken from different organs-

Pulmonary interstitial non-caseating granulomatous inflammation. Giant cells and histiocytes form nodular aggregates without necrosis

Pulmonary Interstitial granulomas

Granulomas involving visceral pleura

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Heart- Granulomatous (giant cell) myocarditis, medium magnification

Heart- Granulomatous (giant cell) myocarditis, high magnification

Liver - Granulomas and fibrosis involving portal triad.

Bone marrow

Female breast

Skeletal muscle

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Liver – Parenchymal granuloma

Brain, cerebellum, granulomatous angiitis

Brain, granulomatous angiitis

Peritoneum, granulomatous angiitis

Urinary bladder

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Mediastinal lymph node

Skin Lesion in Sarcoidosis

Pathological Differential Diagnosis-

Lungs

Tuberculosis, atypical mycobacteriosis

Fungal: histoplasmosis, coccidioidomycosis, cryptococcosis, blastomycosis, aspergillosis

PCP (Pneumocystis Pneumonia ), mycoplasma

Pneumoconioses: beryllium, titanium, aluminum

Drug reactions

Hypersensitivity pneumonitis

Aspiration of foreign materials

Wegener’s granulomatosis

CIP (cellular interstitial pneumonitis)- all variants e.g. UIP (usual interstitial pneumonitis) and LIP (lymphoid interstitial pneumonitis) and DIP (desquamative interstitial pneumonitis).

NSG (necrotizing sarcoid granulomatosis)

Lymph Node

TB, atypical mycobacteriosis

Brucellosis

Toxoplasmosis

Granulocytic histiocytic necrotizing lymphadenitis (Kikuchi’s disease)

Cat scratch disease

Sarcoid reaction in regional Lymph nodes to carcinoma

Hodgkin’s disease

NHL (non-Hodgkin's lymphoma)

GLUS (granulomatous lesions of unknown significance)

Skin

TB, atypical mycobacteriosis

Fungal infections

Reaction to foreign bodies: beryllium, zirconium, tattooing, paraffin, etc.

Rheumatoid nodules

Liver

TB, Brucellosis

Schistosomiasis

PBC (Primary Biliary Cirrhosis)

Crohn’s disease

Hodgkin’s and NHL

GLUS (Granulomatous lesions of unknown significance)

Bone Marrow

TB, histoplasmosis, IM (Infectious Mononucleosis), CMV (Cytomegalovirus)

Hodgkin’s and NHL

Drugs

GLUS (Granulomatous lesions of unknown significance)

Other organs

TB, brucellosis

Giant cell myocarditis

The Conditions “possible but most unlikely” with sarcoidosis-

1. No evidence of extrapulmonary disease (chronic berylliosis, other possible granulomatous lung disease).

2. No thoracic lymphadenopathy on radiographic studies (hypersensitivity pneumonitis, other granulomatous lung disease).

3. The patient with the very low likelihood of having sarcoidosis (e.g., young age).

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Differential diagnosis of sarcoidosis-

The differential diagnosis depends largely on the clinical presentation of sarcoidosis. Granulomatous pulmonary infections, especially those caused by mycobacteria and fungi should be ruled out. Neoplastic diseases, such as lymphoma, in cases with hilar adenopathy should be excluded.

Hypercalcemia in sarcoidosis may mimic metabolic disorders, such as primary hyperparathyroidism. Early onset sarcoidosis is often misdiagnosed as systemic-onset juvenile rheumatoid arthritis (JRA). Rarely, severe symptomatic bone marrow involvement may mimic a number of infectious and neoplastic disorders.

Blau’s Syndrome

Blau’s syndrome is an autosomal dominant condition with variable penetration that consists of granulomatous arthritis, iritis, and skin rash, occurring prior to 12 years of age.

Erdheim–Chester Disease

It is a rare histiocytic disorder of adults characterized by an infiltrate of lipid-laden macrophages, multinucleated giant cells, and inflammatory infiltrate of lymphocytes and histiocytes in the bone marrow and a generalized sclerosis of the long bones sparing the epiphysis.

Ill defined sclerosis of distal femur extending to the epiphysis of the medial femoral condyle (arrows) and sparing the lateral condyle (arrowhead)

Bone involvement is constant but the kidney, retroperitoneal space, skin, brain and lungs are also affected.

Necrotizing Sarcoid Granulomatosis

Necrotizing sarcoid granulomatosis (NSG) has an uncertain relationship to sarcoidosis. The NSG lesion represents a sarcoid granuloma with necrosis and vasculitis. Some authors consider it a variant of sarcoidosis.

Necrotizing sarcoid granulomatosis

Granulomatous Lesions of Unknown Significance

Granulomatous lesions of unknown significance (GLUS syndrome) is described clinically as prolonged fever with epithelioid granulomas in liver, bone marrow, spleen, and lymph nodes. It has a benign course and a tendency for recurrence.

Prognosis of Sarcoidosis

In many people sarcoidosis is usually asymptomatic and the disease may resolve without treatment. 30 - 50% of cases resolve without treatment in about 3 years. About 20% of those with lung involvement develop lung damage. Death from sarcoidosis is rare. Mortality rate is less than 3%. Pulmonary fibrosis leading to cardiopulmonary resuscitation failure is most common cause of death. About 10% have serious disability such as ocular or respiratory. Pulmonary hemorrhage from asperigilloma is an acute complication.

Common Complications of Sarcoidosis Diffuse interstitial pulmonary fibrosis Pulmonary hypertension

Anterior uveitis

Glaucoma and blindness (rare)

Cardiac arrhythmias

Cranial or peripheral nerve palsies

Kidney stones

Organ failure, leading to the need for a transplant

Treatment of Sarcoidosis

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Main Goals of treatment

To improve how the organs affected by sarcoidosis work To relieve symptoms

To shrink the granulomas

The treatment depends on-

Symptoms Severity of symptoms

Involvement of vital organs (e.g., lungs, eyes, heart, or brain)

Extent of affection of the organs.

Some organs must be treated, regardless of the symptoms while others may not need to be treated. Usually, if asymptomatic, no need of treatment is there, and the patient probably recovers in time.

Management of sarcoidosis

Many people with sarcoidosis can lead normal lives, and are able to carry on with their usual social, intellectual, artistic and athletic activities. There are several important steps a person with active or inactive sarcoidosis can take to keep healthy-

If sarcoidosis is active, the patient must have frequent medical checkups so the illness can be monitored and adjustment of treatment can be done if needed.

If sarcoidosis becomes inactive and/or the patient has no symptoms, he should have a checkup at least once a year.

An ophthalmological exam each year is necessary.

Smoking should be stopped, it can make it worse.

Dust, chemicals, fumes and other substances that can harm the lungs should be avoided.

Exercise and active routine as the patient can must be continued but without strain.

Homoeopathy- A Breif Study

Concepts and PrinciplesHomoeopathy is the system of treatment invented by Dr. Christian Frederick Samuel Gottfried Hahnemann of Germany which is based on demonstrable laws and principles, viz. -

The Law of Similars- It is also called the Law of Cure. This law demonstrates that the selected remedy is able to produce a range of symptoms in a healthy person similar to that observed in the patient, thus leading to the principle of Similia Similibus Curentur i.e. let likes be treated by likes. To give a simple example the effects of peeling an onion are very similar to the symptoms of acute cold. The remedy prepared from the bitch’s milk, Lac caninum, is used to treat the Sarcoidosis in which the symptoms resemble those we get from taking it in potentized form in healthy state.

The Law of Single Remedy- This law directs to choose and administer such a single remedy, which is most similar to the symptom complex of the sick person at a time.

The Law of Minimum Dose- The similar remedy selected for a sick should be prescribed in minimum dose, so that when administered there is no toxic effects on the body. It just acts as a triggering and catalytic agent; to stimulate and strengthen the existing defense mechanism of the body. It does not need to be repeated frequently.

Holistic approach and Theory of Individualisation This is a key point and unique to Homoeopathy. Even though it may sound strange, Homoeopathy does not treat disease per se. A Homoeopath does not concentrate his therapy on, say Sarcoidosis or prolactinoma or gyanecomastia. In other words he does not limit his treatment to overflowing milk from the breasts, macroadenoma or a infertility. Rather, he treats all aspects mental, emotional and physical of the person who happens to be suffering with Sarcoidosis or prolactinoma or gyanecomastia.

Homoeopathy regards each patient as a unique individual, e.g. six persons with Sarcoidosis might get a different Homoeopathic remedy, each one aimed at the individual’s totality of symptoms rather than at his liver alone. The physicians’ interest is not only to alleviate the patients’ present symptoms but also his long-term well being.

Concept of Vital ForceThis vital force is the dynamic, imponderable, invisible universal force of life energy found in all the living and to some extent in nonliving things also. One can easily appreciate its presence in living things due to visible results. Its existence in nonliving things can only be explained by science.

Every thing consists of small units of molecules. These molecules are made of tiny atoms. Each atom is made of electrons, protons and neutrons (now presence of some more constituents has been proved viz. Positron etc.). Most of these finest particles are electrically charged and are kept together by electromagnetic field of attraction. These ultimate constituents are in the state of certain rhythmical and precise motions, and consequently, whole structure is in a state of harmonious oscillations and vibrations.

Great scientist Albert Einstein says— 63

‘MASS’ and ‘ENERGY’ are inter-convertible. The ultimate result of divisions of a substance is energy. Whenever anything is tried to divide a matter beyond atomic state, nothing is left except energy, in the form of photons. This energy is nothing but a form of life energy, equivalent to vital force.

Thus, this energy or vital force is omnipresent and is infinte. Everything uses a very little fraction of this force to exist.

Hahnemann Says-

“In the healthy condition of man, the spiritual vital force (autocracy), the dynamis that animates the material body (organism), rules with unbounded sway, and retains all the parts of the organism in admirable, harmonious, vital operation, as regards both sensations and functions, so that our indwelling, reason-gifted mind can freely employ this living, healthy instrument for the higher purposes of our existence”. (Aphorism no. 9)

According to Dr. Kent the Vital Force or the simple substance has the character of formative intelligence, is subject to changes, pervades the material substance without replacing it, creating order in the body, belonging to the realm of quantity (the realms of degrees of fineness) being adaptable and being constructive.

To sum up the idea of Vital Force as presented by Dr. Kent is given above, according to Dr. Vithoulkas it is the defence mechanism in the living body and according to the ancient Indian thought it is the sookshama shareera (the subtle body) or the consciousness.

Experience has well established the fact that the innerself of the living organism governs. When this innerself is disordered, as seen during diseases, whole being gets disordered. This disordered state is represented by various signs and symptoms, if these signs and symptoms are not interpreted properly in the beginning of the disease and not remedied by proper homoeopathic medicines, gross irreversible pathological changes take place and recovery becomes more and more tedious or impossible.

Similarly, the drugs when potentized and proved well, become live entities and capable of affecting the innerself instantly.

Chronic Diseases-Hahnemann observed that the acute diseases were cured successfully but the constitional health of the patients was not improving, rather declining. He quietly searched for the fundamental cause of the chronic diseases that was slowly destroying the health of the patients. The outcome of this research was published in 1828 in the first edition of his great work, The Chronic Diseases Their Peculiar Nature and their Homoeopathic Cure, commonly known as The Chronic Diseases.

By “Chronic Disease” Dr. Hahnemann did not mean exactly the same thing as is now generally understood by the phrase - a disease that lasts a long time and is incurable. To make his meaning clear, I can not do better than quote Dr. Hahnemann’s own definition of acute and chronic diseases, from paragraph 72 of his Organon:

“The diseases to which is liable are either rapid morbid processes of the abnormally deranged vital force , which have a tendency to finish their course more or less quickly, but always in a moderate time - these are termed acute diseases; or they are diseases of such a character that, with small, often imperceptible beginnings, dynamically derange the living organism, each in its own peculiar manner, and cause it to deviate from the healthy condition in such a way that the automatic life energy, called vital force, whose

office it is preserve the health, only opposes to them at the commencement and during their progress, imperfect, unsuitable, useless resistance, but must helplessly suffer (them to spread and) itself to be more and more abnormally deranged, until at length the organism is destroyed; these are termed chronic diseases. They are caused by infection from a chronic miasm.”

Miasm-Ancient Greek physician, Hippocrates, taught that all diseases were caused by the predisposition inherent in the innate constitution and its susceptibility to a constellation of causation rather than any one single effect. In the Greek philosophy disease is caused by an interdependent set of circumstances which disrupts the natural ebb and flow of the pneuma (vital force) within the organism.

In his Organon of Medicine, Samuel Hahnemann separated the origin of disease into two categories, the exciting and fundamental causes, and related them very closely to the susceptibility of the physical constitution.

It is necessary for a homoeopath to understand the nature of the exciting causes of acute diseases as well as the underlying fundamental cause of long lasting diseases, which is usually due to the chronic miasms. Acute diseases are self-limiting disorders which have quick onsets, rapid progressions, and a tendency to develop an immediate crisis. Many of these acute diseases are actually acute acerbations of the chronic states latent within the constitution that have been brought forth by exciting factors. The nature of chronic miasmic disease is slow and insidious in its onset and gradual in its progression. These negative transformations gradually increase until they bring on complex pathologies that eventually are the cause of premature old age and death. The chronic miasms are the effects of infections that are non self-limiting which cause considerable damage to the immune system, the vital force, and the constitution.

Hahnemann taught that the susceptibility to the exciting factors lies in the fundamental cause which is attributed to the chronic miasms. The etiology of a disease, the constitution and temperament of the individual, and the totality of the signs and symptoms are three factors that form a complete picture of an illness.

In Homoeopathy we often speak of the totality of the symptoms as the basis of selecting a remedy, but sometimes we forget to include the causative factors, the miasms, and the nature of the physical constitution of the individual. Understanding the innate constitution is fundamental to homoeopathic treatment because it holds the keys to an individual’s susceptibility as well as the inherited effects of the chronic miasms.

Hippocrates was the first physician to use the term “miasm” which has its origins in the Greek word for taint or fault. He postulated that certain infectious diseases were transmitted to humans by air and water tainted by miasms. In late 18th century it was a common belief that miasms were impure airs that were responsible for the spread of epidemic diseases among groups of people. Hahnemann realized that the air could carry infectious diseases but he did not consider the pathogenic material to be gaseous in nature. By the late 1790s Hahnemann had realized that syphilis was an infectious blood disease that could mask itself with the symptoms of many different illnesses. Early in his career he made a special preparation called Mercurius Solubilis Hahnemanni that was the standard treatment for syphilis throughout Europe. He soon found that Mercury in homoeopathic potency worked much better on syphilis than the crude poisonous form and he recorded several permanent cures.

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A Dutch naturalist named van Leeuwenhoek invented the microscope and published his observations of small living “animalcules” before in his death in 1723. This information led Hahnemann to believe that microorganisms were at the root of many infectious diseases. For this reason he supported the ideas of the animalculists but at the same time upheld the importance of susceptibility of the host constitution. Very early in his career Hahnemann suggested that certain skin eruptions, such as “crusta lactea”, were being caused by microscopic “miasmic animalcule” i.e., micro-organisms. At this time there were four major theories about diseases that spread in an infectious manner.

Miasma as a foul gaseous exhalation.

The theory of the animalcule.

The zymotic theory.

The theory of spontaneous generation.

Some scientists suggested that certain substances called “zymes” that were inert outside the body could lie dormant until the internal terrain made it possible for them to multiply and caused specific diseases. The observations of the zymotists are very similar to the activities of viral material in the human body. The term zymotic can be found in the old homoeopathic literature and is a rubric in the general section of Kent’s Repertory. Hahnemann synthesized the ideas of the animalcule and zymes and redefined the Hippocratic term “miasma” to express the constitutional derangements caused by parasitic infections. He carefully separated the self-limiting acute miasms from the syndromes of long lasting diseases and started to develop a special materia medica and repertory for the treatment of the chronic miasms. Therefore, in Hahnemannian Homoeopathy the word “miasm” means the effects of microorganisms on the vital force including the symptoms that are transmitted to the following generations. These chronic miasms are capable of producing degenerative illnesses, auto-immune diseases and lead the organismtoward immuno-deficiency disorders.

Phases of Miasms-Hahnemann noticed that each of the chronic diseases has three phases-

Primary stage

Latent stage

Secondary or tertiary state.

The effects of these miasms were then passed from one generation to the next generation by inheritance and caused predispositions to certain disease syndromes. In condition of Sarcoidosis, all the miasms frequently show their active part and according to their sequence of activity, the whole process of Sarcoidosis is settled.

Types of Miasms-The three chronic miasms that Hahnemann introduced in 1828 were called-

Psora (the itch miasm)

Sycosis (the gonorrheal miasm)

Syphilis (the chancre miasm).

From the time of Hippocrates healers conjectured about the possibility of invisible organisms causing disease but Hahnemann founded the modern concept of infection. In the preface of Charles Hempel’s translation of the Organon, Constantine Hering recorded that late in his life Hahnemann made further discoveries and developed a new aspect of the theory of Psora with the introduction of a new miasm he called Pseudo-psora. Hering wrote:

“Hahnemann distinguishes the venereal miasms as syphilis and sycosis; and also subdivides psora with pseudo- Hahnemann’s miasmic theory now contained two venereal and two non-venereal miasms that produced life-long chronic diseases. The two non-venereal miasms are Psora (the itch disease) and Pseudo-psora (the tubercle disease). The two venereal miasms are Sycosis (the fig wart diseases) and Syphilis (the chancre disease). Hahnemann noticed that some cases that appeared to be Psora did not depend exclusively on an external skin eruption for their development. He observed that this disease was infectious in nature and possessed primary, latent, and secondary symptoms as well as inherited aspects. He decided that it was caused by a miasmic agent with a distinct etiology so he separated its symptoms from Psora and made a new classification called the Pseudo-psora, the TB miasm. All of these miasms may be acquired through a primary infection or their effects can be experienced through heredity.

The Fundamental Miasms and Their Combinations

It is sometimes considered, if Hahnemann taught that all long-lasting diseases are caused by chronic miasms. This is not the total picture. In the Organon, he mentions three classifications of long lasting disease:

Those caused by continuing stress factors (disorders upheld by maintaining causes which by their nature are not necessarily true chronic disorders §73),

Those caused by drug toxicity and faulty treatment (physician caused §74.),

Those caused by infectious miasms (naturally caused §78).

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Signs and Symptoms of Miasms-Each of the chronic miasms have their own characteristic signs that are an integral part of the totality of the symptoms. For example-

Psora tends to produce irritation, inflammation, and hypersensitivity.

Sycosis tends to produce infiltrations, indurations, and over growth.

Pseudo-psora tends toward tubercles, fibrosis and suppuration.

Syphilis tends toward granulation, degeneration and ulceration.

Physical constitution- Psora tends to make the organism toxic, the skin unhealthy, and perverts the functions of the

digestive and eliminative organs.

Pseudo-psora tends to produce pipe stem bones, narrow chests, sunken cheeks and sparkling eyes.

Sycosis tends to cause heavy bones, water retention, over growth of tissue like gynaecomastia, hirsutism and slow metabolism.

Syphilis tends to cause congenital defects, asymmetrical bony structure, deformed teeth and the classic bull dog face.

Temperament- Psora is full of pseudo-scientific, philosophical, political, religious ideas. They are self expressive,

talkative, self deceptive and may think they are full of genius yet seem foolish and impractical to others.

Pseudo-psora (Tubercular miasm) is romantic, erotic, social, extroverted, cosmopolitan, erratic, optimistic, yet dissatisfied and always wants to change places, jobs, mates, etc.

Sycosis is pessimistic, a hard realist, skeptical, secretive, suspicious, jealous and has fixed ideas and hidden self disgust.

Syphilis has a mixture of madness and genius with a deep sense of irony that leads to obsession with death and destruction. They become guilty, self destructive, and end in idiocy, insanity or suicide.

Pains- Psora pains are itchy, crawling, tickling, and burning

Pseudo-psora pains are neuralgic, sharp, piercing, twisting, stitching.

Sycosis pains are sudden, intense, spasmodic, crampy and colicky.

Syphilis pains are lacking for the condition present or are deep, aching, agonizing, and esp. < at night.

Discharges- Psora has fairly scanty, irritating, itchy discharges.

Pseudo-psora has pussy, purulent, yellow, bloody, musty discharges.

Sycosis has pungent, brine-like, fishy odors with watery greenish or dirty brown discharges.

Syphilitic miasm has very offensive, foul, putrid, smelly discharges.

Skin- Psora is dry, rough, unhealthy, every little injury becomes infected and the lesions are itchy and

have scanty pus. The symptoms repeatedly found with Sarcoidosis cases.

Pseudo-psora is translucent, fine, smooth, bruises easily, and its lesions bleed easily and exude excessive pus.

Sycosis is full of warts, flecks, moles, growths, dark discolorations with over growth of hair- so called hirsutism.

Syphilitic skin has brownish red, or coppery color spots, eruptions that do not itch, and a tendency toward easy ulceration.

The final combination of all the three miasms is called cancerous miasm and produces the worst forms of illness viz. tumours like prolactinoma, micro or macroadenoma etc.

Thus we can see that in Dr. Hahnemann’s method the totality of the symptoms includes the signs and symptoms of the miasms classified by their layers and listed according to their development. The active miasm is the center on which the totality of symptoms is built so that the remedy chosen matches the underlying miasm syndromes.

Dr. Allen offered his opinion as to the use of the totality without an understanding of the chronic miasms and their layers in his classic, The Chronic Miasms.

“I think I hear many say, are not the totality of the symptoms, all there is to disease? Yes, but to me it is necessary to know something of what is behind that grouping of the totality. If you do not know this you are prescribing for a Jack-in-the-box. You cannot follow the evolution of the curative process; you cannot even prescribe intelligently the proper diet for a patient, unless you know the basic miasm. Of course the diseases that are present will help you to some extent, but you have no surety unless you know the underlying basic disturber of the disordered life”.

Totality, Constitution and the Miasms-The etiology of a disease, the constitutional temperament of the patient, and the totality of the signs and symptoms are three factors that form a complete picture of a disease. In Homoeopathy we often speak of the totality of the symptoms as the basis of selecting a remedy, but sometimes we forget to include the causative factors, miasms, and the physical constitution of the individual.

The physical signs of a person are fundamental to the treatment of chronic disorders because the constitution and temperament shows the effects of the inherited miasms.

We must get beyond relying solely on the personal or family history to uncover miasms. The miasms are present in the very symptomatology of the client. The syndromes produced by the miasms point to the fundamental cause even if it can not be traced in the case taking to a specific etiologic factor. In this way,

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to treat a seemingly simple case of Sarcoidosis, it is neccessory to collect all the signs and symptoms to constitute the totality for correct treatment.

IdiosyncracyNo two individuals are alike. They differ from each other in several ways viz. mental, physical, social, pathological or their responces to the external stimuli. The most important becomes the susceptibility of the individual which ascertains his inclination to be sick or to be extraordinarily susceptible to certain things for which other persons are not normally reactant or too responsive. In modern terminology the term idiosyncracy has been replaced with allergy and the various stimuli are termed as allergens.

This condition of being hypersensititive for certain stimuli, either external or internal, is called idiosyncracy. Idiosyncratics are more susceptible to various causes and more prone to have Sarcoidosis.

Indisposition

Often, the stimuli affecting an individual may disturb his normal health economy slightly and temporarily, which almost always autoreversible. This condition of slight deviation from health is called indisposition which usually requires no medical treatment and is spontaneously recovered.

Very frequently, we see the cases of idiopathic Sarcoidosis, which fall in this category. By slight correction in habit, habitat and dietary regimen and removal of exciting cause, the condition may be cured completely.

Sarcoidosis and Homoeopathy

Miasmatic Analysis of Signs and Symptoms associated with ‘Sarcoidosis’-Sign or Symptom Fundamental Miasm Secondary/ Associated

Miasm

General discomfort, uneasiness, or ill feeling (malaise)

Psora Psora- Syphilis

Fever PsoraShortness of breath Psora SycosisCough Psora Sycosis, SyphilisSkin lesions Psora SycosisSkin rash PsoraHeadache Psora Sycosis, SyphilisVisual changes Psora-Sycosis-SyphilisNeurological changes Sycosis-Syphilis PsoraEnlarged lymph glands (armpit lump) Psora SycosisEnlarged liver Psora SycosisEnlarged spleen Psora SycosisDry mouth PsoraFatigue (one of the most common symptoms in children)

Psora Syphilis

Weight loss (one of the most common symptoms in children)

Psora-Syphilis

Tearing, decreased Psora Sycosis, SyphilisSeizures Psora Psora- SyphilisNosebleed - symptom Psora- Syphilis

Joint stiffness Psora SycosisHair loss Psora Sycosis, SyphilisEye burning, itching, and discharge Psora Psora- SyphilisAbnormal breath sounds (e.g. rales) Psora- Syphilis Sycosis

Literature related with ‘Sarcoidosis’ found in various Homoeopathic Books

THERAPEUTICS

1- Degroote F., Physical Examination and Observation in Homoeopathy

Materia Medica

Tuberculinum bovinum kent

Clinical Observations

Enlarged and induration of glands. Sarcoidosis.

2- Indian Journal of Homoeopathic Medicine-1995- vol. 30

Homoeopathic Approach to the Problem of Cancer

Cancer- Sarcoidosis and Pneumoconiosis- Berrylium

3- International Foundation for Homoeopathy

Case Conference Procedings- 1991

The Emerging Picture of Leprominium

The Leprosy Nosode

Conclusion

Leprosy resembles many skin conditions. Leprominium should be useful in many of these conditions, including: leucoderma, nutritional discoloration of the skin, macular syphilides, tinea versicolor, lupus erythematosus, lupus vulgaris, neurofibromatosis, cutaneous sarcoidosis, leukemia cutis, Kaposi's sarcoma, subcutaneous phycomycosis, lymphoma, seborrheic dermatitis, erythema multiforme, alopecia areata, ringworm, psoriasis, lichen planus, pityriasis rosea, urticaria, scleroderma, lipoma, acne vulgaris, and molluscum contagiosum.

4- Murphy R. Homoeopathic Remedy Guide

Beryllium metallicum

Symptoms

Lungs

Appearance similar to tuberculosis or sarcoidosis.

5- Murphy R. Homoeopathic Remedy Guide

Beryllium metallicum

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Symptomatology

Clinical Diagnosis

Generalities

Sarcoidosis.

6- Murphy R. Homoeopathic Remedy Guide

Beryllium metallicum

Symptomatology

Clinical Diagnosis

Respirator System

Pulmonary sarcoidosis.

7- Murphy R. Homoeopathic Remedy Guide

Beryllium metallicum

Symptomatology

Clinical Diagnosis

Locomotor

Sarcoidosis of the bones.

8- Liga Medicorum Homoeopathica Internationalis- 1988

Leprominium

Conclusion

Leprosy resembles many skin conditions like leucoderma, nutritional discolouration of skin, macular syphilides tinea versicolor, Lupus erythematous, lupus vulgaris, neurofibromatosis, cutaneous sarcoidosis, leukaemia cutis, kaposis sarcoma, subcutaneous phycomycosis, lymphoma, seborrhoic dermatitis, erythema multiform, alopecia areata ringworm of the skin, psoriasis, lichen planus, pityriasis rosea, urticaria, scleroderma, lipoma, acne vulgaris, molluscum contagiosum, etc. It should be useful in many of these conditions.

9- Master F. J. Tubercular Miasm Tuberculins

The Secondary Symptoms of Tuberculosis

Heart

Boeck's Sarcoidosis.

10- Morrison R. Seminar Burgh Haamstede Sept 1987

Nux vomica

Case 1

Then I had another two more cases that came in, absolutely perfect cases, my first three cases. The first was Crohns disease, the second was scleroderma - which was a Kali carbonicum, and the third was sarcoidosis - which was a Pulsatilla case. Absolutely perfect clear cases: essence, totality, keynotes - everything. Then I had to wait one year before I saw another such case! So you see that homeopathy seduces us and makes us think: "Oh, how easy, how wonderful" and then we get trapped and it makes us work very hard.

11- Morrison R. Seminar Burgh Haamstede Sept 1987

Remarks, Questions

Studying Homoeopathy

Usually long before you think you are ready you should start. Because if you don't start, you cannot learn. You have to make sure to start the practice with simple cases. Don't do what I did and start with Crohns disease and sarcoidosis. But start with headache, arthritis, simple cases first.

12- Murphy R. Homoeopathic Remedy Guide

Beryllium metallicum

Clinical

Allergic conditions. Cancerous conditions. Chronic fatigue syndrome. Kidney stones. Sarcoidosis. Tubercular conditions.

13- Murphy R. Homoeopathic Remedy Guide

Beryllium metallicum

Limbs

Rheumatism. Pain in the arms as if bruised. Buttocks cold. Clubbed fingers. Blue discoloration of the hands. Sarcoidosis of the bones. Deposits around the inter-phalangeal joints.

14- Murphy R. Homoeopathic Remedy Guide

Beryllium metallicum

Lungs

Respiration painful, aggravated by movement. Cough deep, dry, painful, aggravated by bending backwards. Aggravated by smoke, improved in a very warm room. Sputum streaked with blood. Cyanosis, cough accelerating the respiratory rhythm. Spasmodic cough with pain behind the sternum. Appearance similar to tuberculosis or sarcoidosis. Tracheitis and bronchitis. Capillary bronchitis. Dilation of the bronchi. Pulmonary sarcoidosis. Pneumoconiosis. Pulmonary tuberculosis, early stage. Emphysema.

15- Scholten J. – Homoeopathy And The Elements

Carbon Sereis: Lithium to Neon

Beryllium metallicum

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Beryllium is known to cause a disease picture that is almost identical to sarcoidosis (also called Besnier-Boeck disease). Julian (1979, 1981) has described a proving of Beryllium.

16- Scholten J. – Homoeopathy and The Elements

Carbon Sereis: Lithium to Neon

Beryllium metallicum

Picture of Beryllium Metallicum

Complaints

Lung affection: sarcoidosis, cancer.

17- Scholten J. – Homoeopathy And The Elements

Ferrum Sereis: Kali ti Krypton

Manganum sulphuricum

Case by Rienk Stuut

She eats a lot. An X-ray of her lungs showed she had sarcoidosis.

18- Scholten J. – Homoeopathy And The Elements

Ferrum Sereis: Kali ti Krypton

Manganum sulphuricum

Case by Rienk Stuut

Reaction

The pains in her knee had disappeared by the next day. The dizziness also went away quite soon and the tiredness disappeared after an initial aggravation. For the first time in her life she feels completely fit and well. The sarcoidosis also disappeared. One year after she got the remedy she still feels fine and she looks radiant.

19- Schroyens F.- Synthesis (Original English Version)- 9th Ed.

Natrium arsenicosum

Chest

CHEST - SARCOIDOSIS pulmonalis

20- Van Woensel E., Radar Keynotes Version 4

Characterstics and Peculiarities

A Compiled Materia Medica

Beryllium metallicum

Respiratory Tract

Tuberculosis. Sarcoidosis.

21- Vermeulen F.- Prisma- Materia Medica

Calcarea carbonica

Signs

HYPERCALCEMIA Prolonged administration of calcium carbonate may result in hypercalcemia, producing confused behaviour, anorexia, abdominal pain and weak muscles, possibly leading to the development of kidney stones and impaired kidney function. When bred after a week on diets supplemented with high amounts of calcium, female mice produced young which were lower in weight and number. Mortality was increased. The highest level of supplemented calcium carbonate caused heart enlargement. In humans, five hundred milligrams per kilogram of body weight was fed to ulcer victims for three weeks - 145 times the normal ingested amount. Apart from hypercalcemia, some patients suffered from nausea, weakness, and dizziness. A rare syndrome occurring in very young children, named idiopathic hypercalcemia, results in osteosclerosis, renal insufficiency, and sometimes hypertension; may also be associated with supravalvular aortic stenosis, mental retardation, and elfin facies. The latter is characterised by a short, upturned nose, wide mouth, widely spaced eyes, and full cheeks. Primary causes of hypercalcemia are: [1] parathyroid hormone excess; [2] malignancy with bone metastases; [3] hyperthyroidism; [4] vitamin D intoxication; vitamin A intoxication; [5] excessive gastrointestinal calcium absorption or intake; [6] sarcoidosis; [7] myxedema, Addison's disease, postoperative Cushing's disease; [8] lithium intoxication; [9] aluminium-induced osteomalacie; [10] immobilization, e.g. in young, growing individuals, in elderly patients with osteoporosis, and in paraplegics or quadriplegics. Symptoms of mild hypercalcemia include constipation, anorexia, nausea and vomiting with abdominal pain and ileus. In more severe cases, there is emotional lability, confusion, delirium, psychosis, stupor, and coma. Neuromuscular involvement may cause prominent skeletal muscle weakness. Hypercalciuria with nephrolithiasis or urolithiasis is common. Peptic ulcers and pancreatitis may be associated with hyperparathyroidism. 7

22- Vermeulen F.

Prisma

Materia Medica

Colchicum autumnale

Signs

COLCHICINE The major alkaloid of Colchicum autumnale is colchicine. The colchicine content is highest in the seeds [up to 1,3%], followed by the corm, while the leaves and flowers have the lowest content. Pure colchicine consists of pale yellow scales or powder, darkening on exposure to light. Its biological activities include antimitotic, anti-inflammatory, and antifibrogenic actions. It also acts on liver functions: it modifies membrane fluidity, and increases membrane enzymes activities and glycogen levels. Colchicine is used to treat acute gout, familial mediterranean fever, and, less frequently, leukemia, and Behçet's syndrome. More recently, the use of colchicine has expanded to

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include such indications as primary biliary cirrhosis, alcohol-induced cirrhosis, sarcoidosis, and scleroderma. Because it inhibits collagen transport to the extracellular space, it is employed in the prevention or treatment of amyloidosis and scleroderma. Colchicine has been shown to be more toxic in the elderly, especially those with liver or kidney dysfunction. Patients are advised to consume a large amount of fluids while taking colchicine. Although research is inconsistent, colchicine is believed to prevent vitamins A and B12 absorption. It has also been associated with impaired absorption of beta-carotene, fat, lactose, potassium, and sodium. Acidifying agents inhibit the action of colchicine, while alkalinizing agents potentiate it. Highly toxic, death has resulted from single oral doses of 3 to 13 mg colchicine, although the estimated lethal dose is 20-65 mg. In laboratory animals, this alkaloid has caused both birth defects and damage to the reproductive system.

23- Vermeulen F.

Synoptic Materia Medica 2

Beryllium metallicum

Leading Symptoms

P Sarcoidosis [Besnier-Boeck-Schaumann disease].

24- Vithoulkas G. Materia Medica Viva

Arsenicum bromatum

The Essential Features

This is a remedy that should be thought of in cases of cancerous affections or affections involving the glands with swelling and induration. Hodgkin's disease, sarcoidosis, tuberculosis and infectious mononucleosis may be classed under its pathology. It will suit cases of diabetis mellitus and insipidus, accompanied by a dramatic loss of weight and excessive thirst, and cases presenting an excessive amount of sugar in the urine in diabetis mellitus. It will also suit cases of nephritis.

25- Vithoulkas G. Materia Medica Viva

Arsenicum iodatum

Generalities

Inflammation of glands, bones and serous membranes. Hodgkin's disease. Sarcoidosis. Mucus secretions increased, copious catarrhal discharges, thick and yellow resembling yellow honey, or yellow-green.

26- Yasgur J. Homoeopathic Dictionary

Dictionary

B

Boeck’s Sarcoid

(sarcoidosis, Besnier-Boeck-Schaumann syndrome) a connective tissue tumor, usually highly malignant, and of unknown origin, which involves the lungs, lymph nodes, skin,

liver, spleen, eyes, bones of the fingers and toes, and parotid glands. These tissues gradually become fibrous (harden). Named after P.M. Boeck (1845-1917), a Norwegian dermatologist. ‘Sarcoid’ means ‘resembling flesh’.

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Repertory of SarcoidosisCHEST - SARCOIDOSIS pulmonalis

ars-br. Ars-i. Beryl. lyc. Mang-s. nat-ar. parathyr. pin-s. puls. Tub-m. tub. v-a-b.

CHEST - SARCOIDOSIS, pulmonary

beryl. nat-ar.

SKIN - SARCOIDOSIS

beryl.

GENERALITIES - BESNIER-BOECK, morbus, Sarcoidosis

aq-mar. aran-ix. asar. beryl. hip-ac. hist. kres. lepr. lyc. mand. nat-ar. parathyr. pin-s. puls. thiop. tub-m. tub. v-a-b.

EYE - INFLAMMATION - Iris

acon. Apis Arg-n. ARN. Ars-i. ars-s-f. Ars. Asaf. aur-ar. aur-i. aur-s. Aur. Bell. BRY. calc-hi. calc. Cedr. Chin. chinin-m. Cinnb. Clem. Colch. Coloc. Com. con. crot-h. Crot-t. dub. Dulc. Euphr. ferr-p. gels. grin. ham. Hep. iod. Kali-bi. Kali-i. kalm. lepr. MERC-C. merc-i-f. merc-pn. Merc. mez. morg-p. Nat-m. nat-sal. Nit-ac. nux-v. petr. phyt. plb. Puls. RHUS-T. sabal sal-ac. Seneg. Sil. spig. Staph. sul-i. Sulph. Syph. tell. Ter. thuj. toxo-g. vac. zinc.

EYE - INFLAMMATION - Iris - adhesions, with

Calc. Clem. graph. Merc-c. Nit-ac. sil. spig. staph. Sulph. Ter.

FACE - DISCOLORATION - bluish

absin. acon. agar-ph. Agar. Ail. alum-p. alum-sil. am-c. aml-ns. androc. ang. ant-c. ant-t. Apis Arg-n. Ars-i. ars-s-f. ARS. ASAF. asar. asim. aur-ar. Aur. bad. BAPT. BELL. borx. both. brom. BRY. bufo Cact. cadm-met. calc-p. calc. CAMPH. CANN-I. Canth. Carb-an. CARB-V. Carbn-s. carl. Caust. Cedr. Cench. Cham. chinin-ar. chlf. Chlol. Chlor. Cic. cimic. Cina cinnb. Cocc. colch. CON. cor-r. croc. crot-h. crot-t. Cupr-act. CUPR. cypra-eg. cyt-l. DIG. Dros. Dulc. ferr. frag. gels. Glon. helo-s. Hep. hydr-ac. HYOS. ign. indg. iod. IP. jal. Kali-c. kali-cy. Kali-i. kali-m. kali-p. kali-sil. Kreos. LACH. lachn. Laur. loxo-lae. Lyc. mag-p. meph. merc-c. merc-cy. merc. mez. mill. MORPH. mosch. nat-ar. Nat-m. nat-p. nitro-o. Nux-v. oena. OP. ox-ac. petr. phenac. phos. Phyt. plb. prun. psor. Puls. rhus-t. russ. Samb. sang. sars. sec. sil. spig. Spong. Staph. Stram. Stry. succ-ac. sul-ac. Sulph. Tab. Tarent. tub. VERAT-V. VERAT. vesp. Vip. visc. zinc-p. zinc.

FACE - DISCOLORATION - cyanotic

anan. androc. ANT-T. ARS. atra-r. Aur. borx. both. Cact. carb-v. Cupr. hydr-ac. ix. lat-m. laur. lyss. merc-cy. NAT-M. ox-ac. physala-p. psor. russ. spig. vesp.

EXTERNAL THROAT - SWELLING - Cervical Glands

acon-l. acon. aesc. aeth. Agar. agath-a. aids. alum-sil. Alum. Alumn. Am-c. Am-m. ambr. ant-c. ant-t. Apis aq-mar. arg-met. arn. ars-br. Ars. ARUM-T. Asaf. asar. astac. aur. bac. bamb-a. BAR-C. bar-i. BAR-M. bar-s.

BELL. borx. bov. brom. Bry. calad. calc-chln. calc-f. calc-i. calc-p. calc-s. calc-sil. CALC. camph. canth. Carb-an. Carb-v. carbn-s. caust. Cham. Chel. Chin. chir-fl. chord-umb. Cic. cinnb. CIST. clem. cocc. coli. Con. cupr. Dig. diph. dros. Dulc. ferr-i. ferr. glon. GRAPH. hecla Hell. helodr-cal. Hep. hydrog. ign. Iod. irid-met. kali-bi. KALI-C. Kali-chl. Kali-i. kali-m. kali-sil. ketogl-ac. kiss. kola kreos. Lach. Lap-a. lap-la. led. Lith-c. luna LYC. Mag-m. mag-p. marb-w. Merc-c. merc-cy. Merc-d. Merc-i-f. Merc-i-r. MERC. mez. moni. Morb. mur-ac. nabal. Nat-c. Nat-m. Nat-s. Nit-ac. Nux-v. ozone Petr. Ph-ac. Phos. Phyt. plb. polys. pot-e. Psor. Puls. ran-s. rhus-r. RHUS-T. rhus-v. ruta sabad. sal-fr. sal-mar. sars. scarl. sel. Sep. SIL. Spig. Spong. stann. STAPH. staphycoc. stict. Still. streptoc. suis-em. sul-ac. sul-i. SULPH. syc. syph. tarent. tep. Thuj. Toxo-g. Tub. urol-h. v-a-b. ven-m. verat. vesp. viol-t. wies. zinc.

EXTERNAL THROAT - SWELLING - Cervical Glands - suppurative

CALC. Cist. Hep. Lith-c. MERC. Nit-ac. SIL. Sulph. Tub. v-a-b.

ABDOMEN - ENLARGED - Liver

aconin. aesc. agar. aloe anders. anis. ant-t. ars-i. Ars. aur-ar. aur-i. Aur-m. aur-s. aur. bar-m. boerh-d. brass-n-o. Bry. bufo caesal-b. Calc-ar. calc-sil. Calc. Carb-v. carc. card-m. Chel. CHIN. chinin-ar. Chion. Cocc. coloc. Con. Dig. eberth. eup-per. ferr-ar. ferr-i. ferr-p. Ferr. Fl-ac. glyc. graph. Hep. Hippoz. hydr. Iod. kali-br. Kali-c. kali-s. lac-e. lach. lact. lat-m. Laur. loxo-lae. loxo-recl. luf-b. LYC. mag-c. MAG-M. mang-act. Merc-d. merc-i-r. Merc. mur-ac. Nat-m. NAT-S. Nit-ac. Nux-m. NUX-V. Phos. pin-s. plb. Podo. pop-cand. ptel. sec. sel. senn. sep. sil. stel. sul-i. Sulph. symph. tab. tarax. thuj. toxo-g. Tub. urt-u. vip. zinc-p. Zinc.

ABDOMEN - ENLARGED - Spleen

aconin. agar. agn. anders. Anthraci. Aran. ars-br. Ars-i. ars-s-f. Ars. Aur-m. bell-p. brass-n-o. brom. calc-ar. calc-i. Calc. Caps. carb-v. card-m. CEAN. cedr. CHIN. chinin-ar. Chinin-s. chion. cimx. Cit-v. Cocc. Con. dros. ferr-act. ferr-ar. ferr-i. Ferr-m. ferr-p. Ferr. grin. Helia. Hippoz. hydr. Ign. IOD. kali-br. kali-m. Lach. laur. leucas-a. loxo-lae. loxo-recl. luf-b. mag-m. malar. merc-i-r. Nat-m. Nit-ac. nux-m. Nux-v. Op. Ph-ac. Phos. plb-i. plb. polyg-h. Polym. QUERC. Ran-s. rhus-t. rub-t. ruta saroth. squil. staphycoc. succ. Sul-ac. sul-i. Sulph. tab. tinas. toxo-g. tub. Urt-u. xanrhi.

ABDOMEN - SWELLING - Inguinal region - Glands, of

alum. am-c. anan. ant-c. Apis ars. Asaf. aur-m. aur-s. Aur. bac. BAD. bapt. Bar-c. Bar-m. Bell. brom. Bufo calc-ar. Calc-p. CALC. Carb-an. carb-v. carc. caust. Chel. Chin. cinnb. CLEM. cocc. Con. cop. crot-h. Cupr. DULC. elaps eupi. Ferr. gels. Graph. HEP. Hippoz. Iod. Kali-c. Kali-i. lac-c. LACH. lat-m. lyc. Lyss. med. MERC-C. Merc-i-f. Merc-i-r. MERC. nat-ar. Nat-c. nat-m. NIT-AC. nux-v. oci. ozone pall. ph-ac. phos. Phyt. pin-s. Puls. Rhus-t. sal-al. sep. Sil. sin-n. spong. stann. Staph. stram. sul-i. SULPH. sumb. Syph. tarent-c. tarent. tep. Thuj. Tub. xero. zinc.

CHEST - SWELLING

ars. bell. bry. cadm-s. calc. cann-s. Dulc. iod. kali-bi. kali-chl. kali-m. kali-n. merc. mez. nat-c. pot-e. rhus-t. ribo. sep. Sil. Sulph.

EXTREMITIES - INFLAMMATION - Bones

Asaf. Aur. Calc. FL-AC. mang. MERC. Mez. PH-AC. Rhus-t. SIL.

79

EXTREMITIES - INFLAMMATION - Fingers - Bones

Staph.

FEVER - FEVER, heat in general

abrom-a. acet-ac. ACON. aesc. aeth. agar. agn. agrosti-vg. alet. all-s. alst. alum. am-act. am-c. am-m. Ambr. anac. Ang. ant-c. ANT-T. anthraci. APIS aran. arg-met. Arist-cl. ARN. ars-h. ARS. arum-i. Arum-t. asaf. asim. astac. aur-m. aur-s. aur. Bapt. Bar-c. bar-ox-suc. basil. bell-p. BELL. ben. benz-ac. benzo. berb. bid-p. bit-ar. bol-la. both. brom. BRY. CACT. cadm-s. cain. calad. Calc. calen. calo. camph. Canch. Canth. Caps. carb-an. carb-v. Carbn-s. card-b. card-m. casc. caul. caust. cedr. cent. Cham. Chel. chim. Chin. CHININ-S. chir-fl. cic. cimic. cimx. Cina cinch. cloth. coca Cocc. Coff. Colch. colchin. coloc. colum-p. CON. convo-s. conyz-sm. cop. corn-a. corn-f. croc. crot-h. cupr. Cur. Cycl. cymbop-ci. daph. Dig. diph-t-tpt. diph. dor. dros. Dulc. eberth. echi. Elaps elat. epil. ery-m. eucal. eup-a. Eup-per. eup-pur. euph. euphr. eys. ferr-ar. FERR-P. Ferr. fic-m. Fl-ac. galv. gard-t. GELS. gent-l. Graph. guaj. guiz-sc. gymno. hedy. Hell. Hep. Hyos. hyosin. Ign. Iod. IP. iris-t. ix. kali-bi. kali-c. kali-chl. KALI-I. kali-s. Kreos. Lac-c. lacer. Lach. lachn. lat-m. Laur. Led. leptos-ih. lim. lob. loxo-lae. loxo-recl. LYC. lyss. Mag-c. mag-m. mag-s. malar. mang. markh-l. med. meny. Merc-c. Merc-cy. Merc. Merl. MEZ. micr. mik-c. mill. mom-ch. mosch. Mur-ac. muru. nat-c. NAT-M. nat-p. nat-s. nat-sal. Nit-ac. Nux-m. NUX-V. oci-g. oci-sa. ol-j. olib-sac. Op. oper. oxyt. Parathyr. parth. pert-vc. pert. petr-ra. petr. Ph-ac. phenac. PHOS. physala-p. pic-ac. pimp. pisc. plb. plect. plumbg. Podo. positr. prim-v. prin. Psor. ptel. PULS. pyre-p. pyrog. queb. ran-a. raph. rhod. RHUS-T. Rhus-v. ruta sabad. Sabin. sal-n. sal-p. salol. Samb. Sang. sapin. saroth. sarr. sars. scarl. SEC. senec-ma. seneg. Sep. ser-a-c. SIL. spig. SPONG. SQUIL. Stann. Staph. STRAM. Sul-ac. Sulph. Sumb. TARAX. Tarent. ter. teucr. thuj. toxo-g. triclis-g. trios. tritic-vg. tub-a. tub-m. urt-u. Valer. vario. Verat-v. VERAT. vern-am. Viol-t. wye. yohim. zinc.

SKIN - DISCOLORATION - bluish

acon. Aeth. ail. am-c. ang. Ant-t. Apis Arg-n. arn. Ars. aur-ar. aur. Bapt. Bell. bism. both. Brom. bry. bufo cadm-s. calc-sil. calc. Camph. Carb-an. CARB-V. Carbn-s. chin. chinin-ar. coca cocc. con. cop. CROT-C. Crot-h. Cupr. cur. DIG. elaps Ferr-p. gels. glon. Hydr-ac. kali-bi. Kali-br. kreos. lac-e. lac-h. LACH. lat-m. Laur. led. mang. Merc-c. merc-cy. merc. mur-ac. naja nat-m. Nux-m. NUX-V. OP. Ox-ac. oxyurn-sc. petr. ph-ac. phos. Phyt. plb. puls. rhus-t. ruta samb. Sec. sil. spong. Stram. sulph. syph. tarent-c. Tarent. thuj. thymol. VERAT-V. VERAT. vip.

SKIN - ERUPTIONS - bluish - dark

Ail. arg-n. Crot-h. Lach. Ran-b. sars. Sulph.

SKIN - ERUPTIONS - tubercles

agar. alum. am-c. Am-m. anac. ang. Ant-c. apis aran. Ars. aur. Bar-c. bar-m. bar-s. Bell. Bry. calc-p. calc-s. CALC. Carb-an. Carb-v. carbn-s. CAUST. Cic. cocc. Con. crot-h. Dulc. Fl-ac. Graph. hell. Hep. hydrc. kali-ar. Kali-bi. Kali-br. kali-c. Kali-i. kali-n. kali-s. LACH. LED. Lyc. mag-c. mag-m. mag-s. mang. merc-c. Merc. Mez. Mur-ac. nat-ar. Nat-c. Nat-m. Nit-ac. nux-v. Olnd. Petr. ph-ac. Phos. Rhus-t. sec. sel. sep. Sil. stann. Staph. sul-ac. Sulph. syph. tarax. Thuj. tub. valer. verat. Zinc.

SKIN - INDURATIONS, nodules, etc.

aeth. Agar. ail. alum. alumn. am-c. am-m. anac. ANT-C. Ant-t. antho. Apis arg-met. arg-n. Ars-i. ars-s-f. ars. aur. Bar-c. bell. berb. borx. bov. brom. Bry. bufo calc-sil. CALC. cann-s. canth. caps. Carb-an. carb-v. carbn-

s. Caul. caust. Chel. chin. chlol. cic. cinnb. Clem. cocc. CON. crot-h. crot-t. dig. dros. Dulc. euph. Graph. guaj. hell. Hep. hydr. ign. Iod. ip. iris Kali-bi. kali-br. Kali-c. kali-i. kali-n. kali-s. kali-sil. kreos. lach. Led. loxo-recl. LYC. mag-c. mag-m. maland. Mang. merc-i-f. merc-i-r. Merc. mez. Mur-ac. nat-c. Nat-m. nat-s. nit-ac. nux-v. olnd. op. par. petr. ph-ac. PHOS. phyt. psor. PULS. Ran-b. RHOD. RHUS-T. Ruta sabin. sars. Sec. sel. SEP. SIL. spig. spong. squil. stann. Staph. stram. sul-ac. SULPH. tarax. ther. Thuj. tritic-vg. tub. urt-u. valer. verat. verb. viol-t. zinc-s. zinc.

SKIN - LUPUS

abr. agar. alum-sil. alum. alumn. ant-c. apis arg-n. ars-i. ARS. aur-ar. aur-i. aur-m. Bar-c. bell. calc-i. calc-s. calc-sil. calc. calo. Carb-ac. Carb-v. Caust. chr-o. cic. Cist. cund. ferr-pic. form-ac. form. germ-met. graph. guar. guare. hep. Hydr. Hydrc. irid-met. kali-ar. Kali-bi. kali-c. Kali-chl. Kali-i. Kali-s. kali-sil. Kreos. lach. LYC. m-arct. merc-i-r. merc. nat-m. NIT-AC. nux-v. ol-j. Phyt. Psor. puls. ran-b. rhus-t. sabin. sep. Sil. sol spong. staph. sulph. thiosin. THUJ. titan. tub. urea x-ray

SKIN - NETWORK of blood vessels

ant-t. Ars. bell. berb. Calc. carb-an. Carb-v. Caust. clem. Crot-h. ferr-p. graph. hydr. kreos. lach. lyc. merc. nat-m. nit-ac. nux-v. ox-ac. petr. Phos. plat. puls. rhus-t. sabad. sec. Sep. sil. staph. sul-ac. sulph. thuj.

GENERALS - ABSCESSES - Glands

anthraci. ars. Aur-m-n. Aur. bad. Bar-c. bar-m. Bell. brom. calc-f. Calc-hp. calc-i. calc-p. CALC-S. CALC. canth. carb-an. carb-v. cinnb. cist. clem. coloc. crot-h. Dulc. echi. fl-ac. Form. Guaj. guare. HEP. hyos. ign. jug-r. KALI-I. kreos. Lach. lap-a. Lyc. MERC. moni. myris. Nit-ac. petr. Phos. Phyt. Pyrog. Rhus-t. Sars. sec. Sep. sil-mar. SIL. spig. squil. Stram. sul-ac. SULPH. Syph. teucr-s. toxo-g. Tub. v-a-b. zinc.

GENERALS - EMACIATION

ABROT. acal. Acet-ac. adren. Agar. alco. Alet. alf. all-s. alum-p. alum-sil. Alum. alumn. am-c. am-caust. am-m. Ambr. ambro. anac. androc. ang. ant-c. ant-t. anthraci. Apis apoc. aq-mar. Arg-met. Arg-n. arn. ARS-I. ars-met. ars-s-f. ARS. arum-i. asc-t. astra-e. astra-m. aur-ar. aur-m. Aur. bac. bapt. bar-act. BAR-C. bar-i. Bar-m. bar-s. Bell. ben-n. benz-ac. beryl. bism. borx. both. brach. brass-n-o. Brom. Bry. Bufo buni-o. Cact. calc-ar. calc-f. calc-hp. CALC-I. calc-m. calc-ox. Calc-p. Calc-sil. CALC. Camph. cann-s. Canth. Caps. Carb-an. Carb-v. carbn-o. Carbn-s. carc. carl. carneg-g. Caust. cench. cere-b. Cetr. Cham. Chel. CHIN. chinin-ar. chinin-s. Chion. chlol. Chlor. cic. cimic. cina Cist. Clem. cob-n. coca Cocc. coff. Colch. Coloc. con. cor-r. cordyc. cory. Crot-c. crot-t. cub. cund. Cupr. dig. digin. diphtox. dros. dulc. echi. echit. euphr. eupi. Ferr-ar. Ferr-i. Ferr-m. ferr-p. FERR. Fl-ac. fuc. gaert. Gamb. gels. germ-met. Glycyr-g. gran. GRAPH. Guaj. haliae-lc. hed. HELL. helo-s. helo. Helon. Hep. Hippoz. hura Hydr. hydrog. Ign. IOD. Ip. jal. jug-c. kali-ar. kali-bi. Kali-br. Kali-c. Kali-i. Kali-p. kali-s. Kali-sil. kali-t. Kreos. kres. Lac-ac. lac-c. Lac-d. Lach. lat-k. lat-m. Laur. lec. led. lil-t. Lith-c. luf-op. LYC. Lycps-v. lyss. mag-c. mag-m. mag-p. mang-act. mang. med. Merc-c. merc-k-i. Merc. mez. moly-met. morph. Mucor Mur-ac. myos-a. Myos-s. naja Nat-ar. Nat-c. NAT-HCHLS. NAT-M. Nat-n. Nat-p. Nat-s. nat-sil. Nicc. NIT-AC. nit-s-d. nuph. nux-m. NUX-V. Ol-j. Op. ox-ac. ozone parathyr. pers. Petr. Ph-ac. phel. PHOS. Phyt. pic-ac. pilo. pin-s. pip-m. Plan. plb-xyz. PLB. Podo. Psor. Puls. pyrog. raph. Rheum rhus-g. Rhus-t. rhus-v. Rumx. ruta sacch. samb. Sanic. saroth. Sars. Sec. SEL. Senec. sep. SIL. spig. spong. Stann-i. STANN. staph. still. Stram. Strept-ent. Stront-c. Sul-ac. sul-h. sul-i. sulfa. SULPH. sumb. symph. Syph. syzyg. tab. Tarent. Ter. Teucr. thal-xyz. thal. ther. thuj-l. Thuj. thyr. tritic-vg. tub-a. tub-m. tub-r. TUB. uran-met. uran-n. v-a-b. vanad. vanil. Verat-v. Verat. vesp. vip. voes. x-ray zinc-m. zinc-val. Zinc. Zinc.

81

GENERALS - INFLAMMATION - Bones; of

Acon. Ang. ars-i. ars. Asaf. aur-ar. aur-i. Aur-m. aur-s. aur. Bell. bry. calc-f. calc-sil. Calc. chin. clem. coloc. con. conch. cupr. dig. dys. euph. FL-AC. guaj. hecla hep. iod. Kali-i. kreos. Lac-ac. lach. Lyc. mag-m. mang-act. Mang. merc-c. merc-k-i. merc-sul. MERC. MEZ. nat-c. nat-sil. Nit-ac. PH-AC. Phos. Phyt. plb. Psor. PULS. rhus-t. sep. SIL. spig. STAPH. staphycoc. still. stront-c. Sulph. Symph. thuj. tub-m. tub. verat.

GENERALS - SWELLING - Glands; of

abrot. acon-l. acon. Aesc. aeth. agn. Ail. Aln. alum-sil. alum. Alumn. am-c. Am-m. ambr. ancis-p. ant-c. ant-t. Anthraci. Apis aq-mar. arg-met. arn. ARS-I. ars-s-f. Ars. Arum-t. asaf. astac. aur-ar. aur-i. Aur-m. aur-s. aur. Bad. Bapt. BAR-C. BAR-I. BAR-M. bar-s. BELL. Berb. bit-ar. borx. both-ax. both. bov. BROM. Bry. Bufo calad. calc-ar. Calc-f. calc-hp. CALC-I. calc-m. calc-p. CALC-S. Calc-sil. Calc. Calen. camph. cann-s. Canth. caps. CARB-AN. CARB-V. Carbn-s. carc. caust. cench. Cham. chim. chin. cic. cinnb. CIST. CLEM. cloth. coc-c. cocc. coloc. CON. cor-r. cory. croc. crot-c. crot-h. cupr. cycl. dig. dros. DULC. Eucal. euph. euphr. eupi. ferr-ar. ferr-i. FERR. fl-ac. fuc. GRAPH. hall ham. Hecla hed. hell. HEP. hippoz. hydrc. hyos. ign. IOD. Iris jug-r. Kali-ar. Kali-bi. kali-br. Kali-c. Kali-chl. Kali-i. kali-m. kreos. lac-c. lach. Lap-a. lat-m. led. Lith-c. LYC. mag-c. mag-m. mang. med. MERC-C. merc-d. Merc-i-f. Merc-i-r. merc-k-i. MERC. mez. mur-ac. Nat-c. nat-m. Nat-p. nat-s. NIT-AC. Nux-v. ol-j. ozone petr. Ph-ac. PHOS. Phyt. plb. psor. Puls. pyrog. ran-b. ran-s. raph. rhod. RHUS-T. Rumx. ruta sabad. sabin. samb. sars. scir. scol. scroph-n. sec. Sep. sil-mar. SIL. sol-a. sol-o. spig. SPONG. squil. Stann. staph. stict. stram. streptoc. stront-c. Sul-ac. Sul-i. SULPH. symph. Syph. tab. tarent. ter. teucr. ther. thiosin. THUJ. toxo-g. tub-a. tub-m. Tub. uran-n. urea v-a-b. Verat. viol-o. viol-t. vip. Zinc.

GENERALS - SWELLING - Glands; of - painless

ars. asaf. CALC. cocc. Con. cycl. dulc. Ign. lach. merc. Nit-ac. Ph-ac. plb. Sep. sil. staph. sulph. thuj. Tub.

GENERALS - WEAKNESS

abies-c. abies-n. abrom-a. abrot. absin. Acet-ac. Acetan. achy. acon-c. acon-f. Acon. adam. adlu. Adon. adox. adren. aesc-g. aesc. Aeth. aether agar-cpn. agar-em. agar-pa. Agar-ph. agar-pr. agar-st. agar. agath-a. agav-t. Agn. aids. ail. alco. Alet. alf. all-c. all-s. allox. aln. Aloe alst-s. alst. alum-p. alum-sil. Alum. alumn. am-br. AM-C. am-caust. am-m. Ambr. Aml-ns. ammc. amor-r. amph. amyg. ANAC. Anag. anan. ancis-p. androc. Ang. anil. Ant-ar. Ant-c. ant-m. ant-o. ANT-T. anth. anthraci. anthraco. anthraq. Antip. aphis APIS apoc-a. apoc. apom. aq-mar. aq-pet. ara-maca. aral. aran-sc. Aran. arg-cy. ARG-MET. Arg-n. arist-cl. ARN. ars-h. ars-i. Ars-met. ars-s-f. ars-s-r. ARS. arum-d. arum-i. arum-m. arum-t. asaf. asar. asc-t. asim. aspar. astac. aster. atha. atra-r. atro. aur-ar. aur-fu. aur-m-n. Aur-m. aur-s. Aur. Aven. bac. bacls-7. Bals-p. BAPT. bar-act. BAR-C. bar-i. Bar-m. bar-ox-suc. bart. bell-p. bell. ben-n. ben. Benz-ac. berb. berbin. beryl. bism-o. Bism. Bit-ar. Bol-la. bol-s. borx. Both. bov. brach. brass-n-o. BROM. bruc. brucel. brucin. Bry. bufo bung-fa. buni-o. buth-a. Cact. cadm-met. cadm-s. cain. caj. calad. calc-ar. calc-caust. calc-hp. CALC-I. calc-m. calc-p. calc-s. calc-sil. CALC. Camph. cann-i. cann-s. Canth. canthin. caps. car. CARB-AC. Carb-an. carb-v. carbn-chl. carbn-h. carbn-o. Carbn-s. carc. card-m. Carl. cartl-s. casc. cass. cassia-s. castm. castn-v. Caul. Caust. cedr. cench. cent. cere-b. cerv. Cham. chap. CHEL. chelo. Chim. CHIN. chinin-ar. Chinin-fcit. CHININ-S. chion. chir-fl. chlam-tr. chlf. chlol. chloram. chlorpr. choc. chord-umb. chr-ac. Cic. cich. cimic. cimx. Cina cinnb. cinnm. cist. cit-l. cit-v. Clem. Cloth. cob-n. cob. coc-c. COCA Cocc. coch. cod. Coff. COLCH. colchin. Coli. coll. coloc. colocin. colum-p. com. CON. conin-br. conin. conv. cop. cor-r. cordyc. corian-s. corn-a. corn. cortico. cortiso. cot. crat. croc. Crot-c. Crot-h. Crot-t. cub. culx. cupr-act. Cupr-ar. cupr-s. Cupr. cur. Cycl. cyn-d. cypr. cypra-eg. cystein-l. cyt-l. Daph. dendr-pol. der. dicha. DIG. Digin. digox. dios. dip. diph.

diphtox. dirc. dor. Dros. dubo-m. Dulc. Echi. elaps elat. ephe-si. equis-h. erig. ery-a. ery-m. eryt-j. esch. eucal. eug. eup-per. eup-pur. euph-a. euph-c. euph-hy. euph-ip. euph. euphr. eupi. fab. fago. fagu. ferr-ar. FERR-I. FERR-M. ferr-ma. Ferr-p. ferr-pic. ferr. fic-m. fic-r. fil. Fl-ac. flor-p. Form. frag. franz. Fum. fuma-ac. gad. gal-ac. galeg. galin. galla-q-r. Gamb. gard-j. gast. GELS. gent-l. gent-q. germ-met. get. gink-b. gins. glon. glyc. Glycyr-g. goss. gran. Granit-m. GRAPH. grat. guaj. guan. guar. guare. haem. haliae-lc. hall Ham. hed. hedeo. hell-o. Hell. helo-s. helo. helodr-cal. helon. HEP. hera. hip-ac. Hipp. hippoc-k. hir. hist. home. hura Hydr-ac. Hydr. Hydrc. Hydrog. hydroph. HYOS. hyosin. Hyper. iber. Ign. ind. indg. IOD. Ip. Irid-met. iris jab. jal. jasm. jatr-c. jug-c. jug-r. juni-v. KALI-AR. Kali-bi. Kali-br. KALI-C. kali-chl. kali-cy. KALI-FCY. Kali-i. kali-m. kali-n. kali-ox. KALI-P. kali-perm. kali-s. kali-sil. kali-sula. kali-t. KALM. ketogl-ac. kino kiss. kola kou. kreos. kres. lac-ac. Lac-c. Lac-d. lac-del. lac-h. Lac-leo. LACH. lachn. lact. lam. lap-la. lapa. lat-h. lat-k. lat-m. LAUR. LEC. led. lepi. lept. lev. lil-s. lil-t. lim. limest-b. lina. linu-c. lipp. lith-c. lith-chl. lob-c. lob-p. lob-s. lob. lobin. Lol. loxo-lae. loxo-recl. luf-op. LUNA Lyc. lycps-v. lyss. m-ambo. m-arct. m-aust. macro. mag-c. mag-f. mag-m. Mag-p. mag-s. magn-gr. maland. malar. manc. mand. mang-o. mang-p. mang. MED. mela. melal-alt. meli. menis. meny. meph. merc-br. MERC-C. MERC-CY. merc-d. merc-i-f. merc-i-r. merc-k-i. merc-meth. merc-ns. merc-sul. MERC. merl. methys. mez. mill. mim-p. mit. moly-met. Mom-b. Moni. morph. mosch. MUR-AC. murx. musca-d. mygal. Myric. nabal. naja napht. narcin. narz. nat-ar. Nat-c. Nat-chl. nat-f. NAT-HCHLS. nat-lac. NAT-M. nat-n. NAT-P. NAT-S. Nat-sal. nat-sil. nat-sula. nauf-helv-li. nep. nept-m. nicc-met. nicc-s. nicc. nicot. nid. nig-s. NIT-AC. nit-m-ac. nit-s-d. nitro-o. nuph. Nux-m. Nux-v. oci-sa. oena. okou. ol-an. Ol-j. Olib-sac. OLND. onos. op. opun-v. orch. orig. orni. orot-ac. osm. ost. osteo-a. Ox-ac. oxal-a. oxyg. ozone paeon. pall. palo. pana. par. parathyr. parth. paull. ped. penic. perh. pert. petr-ra. Petr. PH-AC. phal. phel. PHOS. Phys. physal-al. Phyt. PIC-AC. pilo. pimp. pin-con. pip-m. pitu-gl. pitu-p. pitu. pix plac-s. plan. Plat. plb-chr. PLB. plect. plumbg. plut-n. pneu. podo. polyg-h. polyp-p. polys. Positr. Prim-o. Propr. prun-p. psil. PSOR. ptel. puls-n. Puls. pulx. Pycnop-sa. pyrid. pyrog. pyrus querc-r. rad-br. ran-a. RAN-B. ran-s. Raph. rat. rham-f. rheum rhod. rhodi. rhus-g. RHUS-T. Rhus-v. ribo. ric. Rob. Rosm. rumx-act. Rumx. ruta Sabad. sabal sabin. sacch-a. sacch. sal-fr. salin. samb-c. samb. Sang. sanguis-s. Sanic. santin. sapin. Sarcol-ac. saroth. sarr. Sars. scarl. Scor. scroph-n. scut. SEC. SEL. senec. Seneg. senn. SEP. sieg. SIL. silphu. sin-n. sinus. sium sol-mm. sol-ni. sol-t-ae. sol-t. solid. solin. sphing. spig. spira. spirae. Spong. SQUIL. STANN. STAPH. staphycoc. Stict. still. Stram. stront-c. stroph-h. stry-p. stry. suis-pan. SUL-AC. sul-h. sul-i. sulfa. Sulfon. sulfonam. SULPH. sumb. suprar. symph. syph. syzyg. TAB. tanac. tang. tann-ac. taosc. tarax. tarent-c. TARENT. tart-ac. tax. Tell. TER. tere-ch. teucr. thal-xyz. thal. thea Ther. thiop. thres-a. Thuj. thymol. thyr. til. tox-th. toxo-g. trach. tril-p. tritic-vg. trom. tub-d. tub-r. tub-sp. TUB. tus-p. uncar-tom. upa. uran-met. uran-n. urea ust. uva v-a-b. vac. valer. vanil. ven-m. verat-v. VERAT. verb. verin. vesp. vib. vichy-g. vinc. viol-o. viol-t. vip-a-c. vip-a. vip-d. vip. visc. voes. wies. wildb. wye. x-ray xan. Zinc-ar. zinc-m. zinc-o. zinc-p. Zinc-pic. zinc-s. Zinc. zing. ziz.

83

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Index

A

Abdomen - enlarged - liver 100Abdomen - enlarged - spleen 100Abdomen - swelling - inguinal region - glands, of 100Abnormal breath sounds (e.g. Rales) 40, 90Abnormal chest x-ray, bilateral hilar lymphadenopathy,

interstitial fibrosis, bone cysts. 52Ace levels 62Acknowledgement 7Acute diseases 32African american women 38Age incidence 26Albert einstein 81Anemia, thrombocytopenia, hypersplenism, leucopenia 59Anterior uveitis 57, 77Arthritis, bone cysts 55Artificial- iatrogenic diseases 32Aspiration of foreign materials 74Asymptomatic granulomatous muscle involvement

myopathy, isolated sarcoid myopathy. 61Atoms 81Autocracy 81

B

Bacteria 45Inappropriately named chronic diseases 33Bal/gallium scanning 67B-cell function 48Beryllium metallicum 91, 92, 93, 94, 95, 97Bibliography 10, 106Bilateral hilar adenopathy 63Biopsy 67, 116Blindness 41Blood, urinary tract, and kidney symptoms 42Blurred vision 41Bone involvement 76Bone marrow 45, 70, 75Bone symptoms 42Brain, cerebellum, granulomatous angiitis 71Brain, granulomatous angiitis 72Breast involvement 55Bronchoscopy 63Brucellosis 74Burning, itching, tearing, pain 41

C

C. Boeck 20Caesar peter moller boeck 16, 48, 65, 91Caesar peter moller boeck 16

Cardiac arrhythmias 77Cardiological manifestations 52Carol johnson johns 18, 92Case by rienk stuut 95Caste incidence 27Cat scratch disease 74Characteristic features of sarcoidosis 39Characterstics and peculiarities 95Chest 53, 63, 95, 108, 109, 110Chest - sarcoidosis pulmonalis 95, 99Chest - swelling 101Chest pa - bilateral hilar adenopathy with 53Chest x-ray to see if the lungs are involved or lymph nodes

are enlarged 63Chronic diseases 32, 82Cip (cellular interstitial pneumonitis) 74Circulating immune complexes 49Clinical and/or radiological patterns 63Clinical and/or radiological patterns of sarcoidosis- 63Clinical diagnosis 92Clinical observations 91Clinical prsentations of sarcoidosis 50Clinical staging of sarcoidosis 43Co2 retention 65Coma 42, 43Common complications of sarcoidosis 77Common symptoms of sarcoidosis 39Compound diseases 33Concept of vital force 81, 116Concepts and principles 80, 116Conclusion 91, 92Confusion 42Consciousness. 81Constitution 88Contents 10Cough 39, 89, 94Coughing 41Cranial or peripheral nerve palsies 77Criteria of diagnosis of sarcoidosis 62Ct head- 1.5 cm enhancing suprasellar cistern mass llifting

the optic chiasm slightly in the cephalad direction 58Ct scan 63, 108Cure incidence 28Cure incidence based on menstrual states 28Cure incidence based on miasms 28Cure incidence based on socioeconomic status 28

D

D. Geraint james, founder president wasog 18D.g. James elected the first president 25Darier–roussy syndrome 20Defense mechanism 80Definition of sarcoidosis 34

91

Depression of delayed hypersensitivity is characteristic 66Dermatological manifestations 51Diagnosis of sarcoidosis 62Diagnostic tests for sarcoidosis 65Dictionary 34, 97, 113Differential diagnosis of sarcoidosis 75Diffuse interstitial pulmonary fibrosis 77Diffuse trabecular change 56Diphtheria 32Discharges 87Diseases with full developed symptoms 33Disfiguring skin sores 41The chronic miasms xe “miasms” . 88Dr. Christian friedrich samuel gottfried hahnemann 29Dr. Kent 81Dr. William cullen, pharmaceutical bottle of quinine used by

hahnemann and front page of cullen’s materia medica30Drug reactions 73Dry mouth 39, 90Dusts 46Dynamic 31, 81Dynamic diseases 31

E

E. Besnier coined term lupus pernio 19E. Kuznitsky classified skin lesions 21, 22Chronic miasms 85Ekg 63Electromagnetic field 81Electrons 81En + bhl = lofgren’s syndrome 51Endemic 32Endocrinological manifestations 58Energy 81Enlarged and induration of glands. Sarcoidosis. 91Enlarged liver 39, 42, 90Enlarged lymph glands (armpit lump) 39, 90Enlarged spleen 39Epidemic 32Erdheim–chester disease 76Ernst henri besnier 16, 48, 62, 91Erythema nodosum and onycholysis 51Europe 37Examinations and tests for sarcoidosis 62Extensive lung fibrosis 50Extent of affection of the organs 78Eye symptoms 41

F

Familial clustering 38Fatigue 39, 42, 90Fatigue (one of the most common symptoms in children) 39,

90Female breast 70Fever 32, 39, 40, 42, 50, 64, 89Floaters 41

Flow 82Frequency of organ involvement 45Fundamental miasm 89Fungal infections 74Fungi 45

G

G. Rizzato 25Journal sarcoidosis 18, 24Gastrointestinal manifestations 61General discomfort, uneasiness, or ill feeling (malaise) 39,

89General manifestations 50Genetic factorial incidence 38Geographical incidence 37Giant cell myocarditis 75Gland symptoms 42Glaucoma and blindness (rare) 77Glus (granulomatous lesions of unknown significance)74, 75Granulocytic histiocytic necrotizing lymphadenitis (kikuchi’s

disease) 74Granulomas involving visceral pleura 69Granulomatous lesions of unknown significance 77Greek 12, 13, 29, 36, 82, 83Gross cure incidence 28

H

H. Reynolds, g. Hunninghake, r crystal bronchoalveolar lavage 24

H. Schumacher/christian heerfordt/f. Bering recognized uveitis 20

Haematological manifestations 59Hair loss 40, 90Headaches 39, 42, 43, 89Health 29Heart 41, 45, 69, 93, 113, 114Heart- granulomatous (giant cell) myocarditis, medium

magnification 69Heart symptoms 41Hepatological manifestations 60Hippocrates 30, 82, 83, 84Histological evidence of granulomatous inflammation. 62History of sarcoidosis 12Hla -a1, -b8, and -dr3 38Hla b22 in italians 38Holistic approach 80Holistic approach and theory of individualisation 80Homoeopathic 2, 7, 28, 80, 82, 91, 92, 93, 94, 97, 106, 108,

110, 111, 114Homoeopathic approach to the problem of cancer 91Homoeopathy 2, 4, 6, 8, 11, 26, 29, 30, 80, 83, 84, 88, 89,

91, 93, 94, 95, 106, 107, 109, 110, 111, 113, 114Homoeopathy- a breif study 80Honeycomb appearance on chest x-ray 39Hypercalcemia +/- hypercalciuria due to calcitriol from 66Hypercalciuria 61

Hypergammaglobulinema 67Hypersensitivity pneumonitis 74

I

Idiosyncracy 89, 116Ill defined sclerosis of distal femur extending to the

epiphysis of the medial femoral condyle (arrows) and sparing the lateral condyle (arrowhead) 76

Immunizing 32Immunoelectrophoresis - serum 63Imponderable 81Chronic sarcoidosis 51Organon of medicine 82Incidence 37, 38, 39Incidence and prevalence 37Increased calcium in blood or urine 42Increased urination 42Indisposition 31, 89Individual 8, 11, 30, 32, 80, 83, 88Infectious 45, 112Inflammation of glands, bones and serous membranes

97Inflammatory phases in lung sarcoidosis 48Invisible 81, 84Involvement of vital organs 78Irregular heartbeat 41Itching 42

J

J. Hutchinson first account of skin lesions 19J. Schaumann 21, 22Joint and muscle symptoms 41Joint pain 41Joint stiffness 40, 41, 90Jonathan hutchinson 13, 15, 46, 91Jorgen schaumann 16, 49, 57, 60, 92Jorgen schaumann (1879– 1953) 17Jorgen schaumann (1879–1953) 17

K

K. Wurm first proposal for radiographic staging 13, 23Keitzo nobechi 18, 93Kidney biopsy 63Kidney stones 77King henrik 12Kveim-stiltzbach test 65

L

Lab studies for sarcoidosis 66Latent stage 84Law of cure 80Law of minimum dose 80

Law of similars 80Leading symptoms 97Leukopenia frequent 66Limbs 94Linitis plastica syndrome 61Literature 91Literature “literature” related with ‘sarcoidosis

“galactorrhoea” ’ found in various homoeopathic Homoeopathic books 91Liver 42, 45, 63, 70, 71, 74Liver - granulomas and fibrosis involving portal triad. 70Liver – parenchymal granuloma 71Liver biopsy 63Liver function tests 63Liver symptoms 42Locomotor 92Louis eliot siltzbach 17, 92, 106Lung affection 95Lung gallium (ga.) Scan 63Lung symptoms 40Lungs 73, 92, 94, 111Lupus pernio 51Lymph node 40, 74Lymph node biopsy 63Lymph node symptoms 40Lymphadenopathy and lung parenchymal disease 44Lymphadenopathy only 43, 44Lymphatic system manifestations 60Lytic lesions of vertebral bodies 59

M

M. Tenneson defined histology 19Macrophages 66Main goals of treatment 78Mammary gland manifestations 55Management of sarcoidosis 78Marital status incidence 27Marital status incidence 27Mass 81Materia medica 30, 91, 96Mediastinal lymph node 73Mediastinoscopy with biopsy 63Menstrual incidence 27Menstrual incidence 27Menstrual states 28Mental 11, 30, 80Metals 46Miasm 82, 89, 93, 107Miasma as a foul gaseous exhalation 83Miasmatic analysis of signs and symptoms Miasmatic incidence 27Miasms 8, 11, 28, 82, 84, 85, 88, 89, 106, 111, 113Mode of prescription 28Molecules 81Most common lymph nodes involved 60

93

Muscle pain, a mass in a muscle, or muscle weakness41

Myalgias 41Mycobacteria 45Myocardial infarction 52Myological manifestations 61

N

Nasal obstruction 40National systems of medicine 29Natrium arsenicosum 95Necrotizing sarcoid granulomatosis 76, 77Negative association- hla b12 and -dr4 38Nephrological manifestations 53Nerve biopsy 63Nervous system symptoms 42Neurological changes 39, 90Neurological manifestations 57Neutrons 81Nhl (non-hodgkin's lymphoma) 74Norwegian dermatologist dr. Cesar boeck names the

process 13Nosebleed - symptom 40, 90Nsg (necrotizing sarcoid granulomatosis) 74

O

Occupational incidence 27Om p sharma 19One sided diseases 33Open lung biopsy 63Ophthalmological manifestations 56The mode of prescription 28Organ failure 77Organism 81, 82, 84, 86Origin 12, 30Origin of homoeopathy 30Origin "origin" of words- ‘sarcoidosis’ 12Orthopaedic manifestations 59Other definitions of sarcoidosis 34Otorhinolaryngological manifestations 51

P

Page no. 151 of cullen’s materia medica showing cinchona pharmacology 31

Painful arthritis in ankles 41Painless arthritis 41Painless holes in bones 42Painless swelling, most often in fingers 42Pains 87Panda sign - lachrymal and parotid uptake on a total body

67 ga scan, combined with lambda pattern (right azygos and bilateral hilar thoracic uptake). 64

Panda sign 63Pandemic 32Paralysis of arms or legs 42

Parenchymal lung disease only 44Parotid enlargement, hoarseness, nasal stuffiness 51Pathological differential diagnosis 73Pathological incidence 27Pathophysiology 45, 111Pbc (primary biliary cirrhosis) 75Pcp (pneumocystis pneumonia ), mycoplasma 73Perilymphatic distribution of granulomas 67Peritoneum, granulomatous angiitis 72Phases of miasms miasms 84Physical built incidence 27Physical constitution 86Physical level 30Pituitary gland symptoms (rare) 43Pneumoconioses beryllium, titanium, aluminum 73Portal hypertension 60Positron 81Potentized 82Preface 8Prevalance 37, 38, 45, 77, 112Prevalence in certain race 38Primary stage 84Prisma 96Prognosis of sarcoidosis 77Protons 81Hla dr-17 good prognosis in scandinavians 38Pseudo-psora (tubercular miasm) 86Psora 11, 27, 28, 32, 33, 34, 39, 40, 41, 42, 50, 57, 64, 84,

86, 87, 89, 90, 94Psora- syphilis 40, 90Psora-sycosis 33Psora-sycosis-syphilis 34, 39, 89Psora-syphilis 40, 90Pth 63Pulmonary fibrosis 44Pulmonary function test 65Pulmonary function test with a restrictive pattern 65Pulmonary hypertension 77Pulmonary interstitial granulomas 68Pulmonary interstitial non-caseating granulomatous

inflammation 68Pulmonary sarcoidosis 92, 94Pulmonological manifestations 50

Q

Quantitative immunoglobulins (nephelometry) 63

R

R. Kienbock/k. Kreibich/o. Jungling described bone changes20

Racial incidence 38Radiological manifestations 52Red eye 41Reduced color vision 41Reduced visual clearness 41Remedy 80, 91, 92, 93, 94

Repertory of sarcoidosis 99Respiratory tract 95Rheumatism 94Rheumatoid nodules 74Rheumatological manifestations 55Robert willan 15, 16, 46, 47, 60, 62, 91

S

S. Lo¨ fgren described lo¨ fgren’s syndrome 23Sarcoid reaction in regional lymph nodes to carcinoma 74Sarcoidose 37Sarcoïdose 36, 83Sarcoidosi 36Sarcoidosis 2, 4, 8, 10, 11, 12, 13, 14, 15, 18, 19, 23, 24, 25,

26, 27, 28, 34, 35, 36, 37, 39, 43, 45, 46, 48, 50, 56, 61, 62, 63, 65, 66, 67, 73, 77, 78, 80, 84, 87, 88, 89, 91, 92, 93, 94, 95, 97, 99, 107, 109, 110, 111, 112, 113, 114

Sarcoidosis - synonyms 36Sarcoidosis – the historical review 12Sarcoidosis and malignancy 61Sarcoidosis and pregnancy 62Sarcoidosis in females 50Sarcoidosis in india 26Sarcoidosis milestones 19Sarcoidosis of the bones 92Sarkoidose 30, 36Sarkoidoz 37Sarkoidóza 36Schistosomiasis 74Secondary or tertiary state 84Seizures 40, 57, 90Sensitivity to light 41Serum ace activity 65Serum angiotensin converting enzyme 65Serum phosphorus 63Serum uric acid 66Severity of symptoms 78Sex incidence 26Sex incidence 26Sexual incidence 38Shortness of breath 39, 40, 41, 89Signs and symptoms miasms 85Similia similibus curantur 29Single diseases 33Skeletal muscle 71Skin 39, 40, 45, 63, 73, 74, 87, 89, 108, 111, 112, 114, 117Skin lesion biopsy 63Skin lesion in sarcoidosis 73Skin lesions 39, 89Skin rash 39, 89Skin symptoms 40Smokers v/s nonsmokers incidence 39Socioeconomic incidence 27Sookshama shareera 81Spiritual 30, 81

Sporadic 32Studies related to homoeopathy 29, 117Subtle body 81Sudden death 41Sudden loss of consciousness 41Surgical diseases 31Suspected causes of sarcoidosis 45Sven löfgren 17, 92Swelling in legs 41Sycosis 11, 27, 28, 33, 84, 86, 87, 89, 90Sycosis (the gonorrheal miasm) 84Sycosis-syphilis 39, 90Syco-syphilis 33Symptomatology 92Symptoms 78, 85, 89, 92, 96, 117Synonyms 36Syphilis 33, 84, 86, 87, 89, 90

T

Tb, atypical mycobacteriosis 74Tb, brucellosis 74, 75Tb, histoplasmosis, im (infectious mononucleosis), cmv

(cytomegalovirus) 75Tearing, decreased 40, 90Temperament 86The essential features 97The first case of sarcoidosis 15The first ever sarcoidosis biopsy 12The first patient with sarcoidosis 15The first-ever holistic approach to sarcoidosis 14The frequency of organ involvement 45The fundamental miasms and their combinations 85The law of minimum dose 80The law of similars 80The law of single remedy 80The leprosy nosode 91The pioneers of sarcoidosis 15The prevalence of sarcoidosis 27The secondary symptoms of tuberculosis 93The theory of spontaneous generation 83The theory of the animalcule 83The three chronic miasms that hahnemann introduced 84The zymotic theory 83Therapeutics 10, 91, 106, 107, 108, 109, 110, 111, 117Thoracic sarcoidosis 67To shrink the granulomas 78Totality 88Totality, constitution and the miasms- 88Toxoplasmosis 74Treatment of sarcoidosis 78True natural or miasmatic diseases 33Tuberculosis, atypical mycobacteriosis 73Tuberculosis. Sarcoidosis. 95Types of miasms 84

95

U

Universal force of life energy 81Urinary bladder 72Urological manifestations 61

V

Viruses 46Vision problems 42, 43Visual changes 39, 89

Vital force 81, 82, 83, 84

W

W. Bruins-slot/l-m. Pautrier/w.t. Longcope/j. Pierson/ j. Costa waldenstromUveoparotid fever 22

Weakness or numbness of an arm or leg 42, 43Weight loss 40, 90Wheezing 40, 41