TEACHING Homoeopathic approach in Thrombosis

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TEACHING Homoeopathic approach in Thrombosis
infarction

• DR R.Y NADAF
• 
  M.D (Hom)
• PRINCIPAL
• Dr. B.D Jatti Homoeopathic Medical College
  Hospital, Dharwad

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• To teach successfully,
• One must plan successfully.
• And successful planning means
• Knowing how to facilitate a positive
  learning experience for all students.

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TEACHING

• The teacher should use his / her best
  professional judgement to decide which method,
• Strategy techniques which will work best for
  particular situation.

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TEACHING

• . In recent years there has been increased
  concern among practitioners and educational
  researchers about practical side and
  effectiveness of teaching

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TEACHING

• The how of teaching is now being given as
  much significance as what and why in
  academic circles

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TEACHING Pathology

• Pathology forms a core component of any
  medical or dental undergraduate's course, yet it
  is a subject that students often struggle with
  due to the overwhelming amount of information
  there is to assimilate in the time available.

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TEACHING Pathology

• Fundamental pathologic theory and principles
  in co relation with General pathology of
  Homoeopathy need to be explained in an
  easy-to-read and engaging manner, using extensive
  learning features to make learning as quick and
  effective as possible

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TEACHING Pathology

• Dramatic curricular reforms in undergraduate
  homoeopathic medical education mean that many
  teachers now find themselves involved in courses
  that are significantly different from those which
  they encountered as medical students.
• Department-led didactic courses in pathology have
  been replaced by centrally managed, problem-based
  integrated curricula in which pathology may at
  first be difficult to identify.

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TEACHING Pathology

• Finally, consideration needs to be given
  to the necessity for those involved in
  homoeopathic medical education to be proficient
  both in homoeopathic perspective and in
  pathological basics.

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TEACHING Pathology

• The following are model slides an attempt
  to teach thrombosis Infarction to students as
  a pathological phenomenon its homoeopathic
  perspective.

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Thrombosis Infarction

• A coronary thrombosis is seen
  microscopically occluding the remaining small
  lumen of this coronary artery. Such an acute
  coronary thrombosis is often the antecedent to
  acute myocardial infarction.

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What is Thrombosis ?

• Thrombosis (Greek ???µß?s??) is the
  formation of a blood clot (thrombus) inside a
  blood vessel, obstructing the flow of blood
  through the circulatory system. When a blood
  vessel is injured, the body uses platelets and
  fibrin to form a blood clot, because the first
  step in repairing it (hemostasis) is to prevent
  loss of blood. If that mechanism causes too much
  clotting, and the clot breaks free, an embolus is
  formed

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Causes of Thrombosis

• In classical terms, thrombosis is
  caused by abnormalities in one or more of the
  following (Virchow's triad) The triad consists
  of
• 1. Alterations in normal blood flow2.
  Injuries to the vascular endothelium3.
  Alterations in the constitution of blood
• (hypercoagulability)

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Virchows Triad

• 1) Alteration in blood flow can include
  turbulence,
• stasis, mitral stenosis, and varicose veins.
  
• 2)Injuries to the vascular endothelium can be
• cause by damage to the veins arising from
  shear stress or hypertension.
• 3)Hypercoagubility can be a consequence of
  numerous possible risk factors such as
  hyperviscosity, deficiency of antithrombin III,
  nephrotic syndrome, changes after severe trauma
  or burn, disseminated cancer, late pregnancy and
  delivery, race, age, smoking, and obesity.

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Virchows Triad
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Classification

• There are two distinct forms of
  thrombosis, each of which can be presented by
  several subtypes
• 1.Venous Thrombosis - is the formation of a
  thrombus (blood clot) within a vein.
• 2. Arterial thrombosis - is the formation of a
  thrombus within an artery. In most cases,
  arterial thrombosis follows rupture of atheroma,
  and is therefore referred to as atherothrombosis

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Classification

• Venous thrombosis
• 1. Deep vein thrombosis
• 2. Portal vein thrombosis
• 3. Jugular vein thrombosis
• 4. Renal vein thrombosis
• 5. Budd Chiari Syndrome
• 6. Pagett Schrotter disease
• 7. Cerebral venous sinus thrombosis

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Classification

• 2 )Arterial Thrombosis
• 1. Stroke
• 2. Myocardial
• infarction

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Venous thrombosis

• 1.Deep vein thrombosis (DVT) is the
  formation of a blood clot within a deep
  vein.
• - It most commonly affects leg veins, such
  as the
• femoral vein.
• - Three factors are important in the
  formation of a blood clot within a deep
  veinthese are the rate of blood flow, the
  thickness of the blood and qualities of the
  vessel wall.
• - Classical signs of DVT include swelling,
  pain and redness of the affected area.

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Venous thrombosis

• 2.Portal vein thrombosis - Portal vein thrombosis
  is a form of venous thrombosis affecting the
  hepatic portal vein, which can lead to portal
  hypertension and reduction of the blood supply to
  the liver. It usually has a pathological cause
  such as pancreatitis, cirrhosis, diverticulitis
  or cholangiocarcinoma

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Venous thrombosis

• 3.Jugular Vein Thrombosis - is a condition that
  may occur due to infection, intravenous drug use
  or malignancy. Jugular Vein Thrombosis can have a
  varying list of complications, including
  systemic sepsis, pulmonary embolism, and
  papilledema. Characterized by a sharp pain at the
  site of the vein, it's difficult to diagnose,
  because it can occur at random.

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Venous thrombosis

• 4. Renal vein thrombosis - is the obstruction of
  the renal vein by a thrombus. This tends to lead
  to reduced drainage from the kidney.

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Venous thrombosis

• 5.Budd-Chiari syndrome is the blockage of the
  hepatic vein or the inferior vena cava. This form
  of thrombosis presents with abdominal pain,
  ascites and hepatomegaly. Treatment varies
  between drug therapy and surgical intervention by
  the use of shunts.

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Venous thrombosis

• 6. Paget-Schroetter disease - is the obstruction
  of an upper extremity vein (such as the axillary
  vein or subclavian vein) by a thrombus. The
  condition usually comes to light after vigorous
  exercise and usually presents in younger,
  otherwise healthy people. Men are affected more
  than women

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Venous thrombosis

• 7. Cerebral venous sinus thrombosis (CVST) - is a
  rare form of stroke which results from the
  blockage of the dural venous sinuses by a
  thrombus. Symptoms may include headache, abnormal
  vision, any of the symptoms of stroke such as
  weakness of the face and limbs on one side of the
  body and seizures. The diagnosis is usually made
  with a CT or MRI scan. The majority of persons
  affected make a full recovery.

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Arterial thrombosis - Stroke

• 1.Stroke - is the rapid decline of brain
  function due to a disturbance in the supply of
  blood to the brain. This can be due to ischemia,
  thrombus, embolus (a lodged particle) or
  hemorrhage (a bleed). In thrombotic stroke, a
  thrombus (blood clot) usually forms around
  atherosclerotic plaques. Since blockage of the
  artery is gradual, onset of symptomatic
  thrombotic strokes is slower.

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2. Arterial thrombosis - Stroke

• Thrombotic stroke can be divided into two
  categorieslarge vessel disease and small vessel
  disease. The former affects vessels such as the
  internal carotids, vertebral and the circle of
  Willis. The latter can affect smaller vessels
  such as the branches of the circle of Willis.

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2. Arterial thrombosis

• Myocardial infarction (MI) is caused by an
  infarct (death of tissue due to ischemia), often
  due to the obstruction of the coronary artery by
  a thrombus. MI can quickly become fatal if
  emergency medical treatment is not received
  promptly .

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What is infarction ?

• An infarction is the process of tissue
  death (necrosis) caused by blockage of the
  tissue's blood supply.
• The supplying artery may be blocked by an
  obstruction (e.g. an embolus, thrombus, or
  atherosclerotic plaque),
• may be mechanically compressed (e.g. tumor,
  volvulus, or hernia), ruptured by trauma (e.g.
  atherosclerosis or vasculitides), or
• vasoconstricted (e.g. cocaine vasoconstriction
  leading to myocardial infarction).

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Infarctions

• Infarctions are commonly associated with
  hypertension or atherosclerosis. In
  atherosclerotic formations a plaque develops
  under a fibrous cap. When the fibrous cap is
  degraded by metalloproteinases released from
  macrophages or by intravascular shear force from
  blood flow subendothelial thrombogenic material
  (extracellular matrix) is exposed to circulating
  platelets and thrombus formation occurs on the
  vessel wall occluding blood flow.

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Infarctions

• Occasionally, the plaque may rupture
  forming an embolus that travels with the blood
  flow downstream where the vessel narrows and
  eventually clogs the vessel lumen. Infarctions
  can also involve mechanical blockage of the blood
  supply, such as when part of the gut or testicles
  herniates or becomes involved in a volvulus.

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Classification of infarction

• Infarctions are divided into 2 types
  according to the amount of blood present
• 1.White infarctions (anemic infarcts)
• 2.Red infarctions (hemorrhagic infarcts)

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1.White infarctions (anemic infarcts)

• White infarctions (anemic infarcts)
  affect solid organs such as the heart, spleen and
  kidneys wherein the solidity of the tissue
  (biology) substantially limits the amount of
  nutrients (blood/oxygen/glucose/fuel) that can
  flow into the area of ischemic necrosis. Similar
  occlusion to blood flow and consequent necrosis
  can occur as a result of severe vasoconstriction
  as illustrated in severe Raynaud's phenomenon
  that can lead to irreversible gangrene.

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2. Red infarctions (hemorrhagic infarcts)

• Red infarctions (hemorrhagic infarcts),
  generally affect the lungs or other loose organs
  (testis, ovary, small intestines). The occlusion
  consists more of red blood cells and fibrin
  strands. Characteristics of red infarcts include
  occlusion of a vein loose tissues that allow
  blood to collect in the infarcted zone tissues
  with a dual circulatory system (lung, small
  intestines) tissues previously congested from
  sluggish venous outflow and reperfusion (injury)
  of previously ischemic tissue that is associated
  with reperfusion-related diseases such as -
  Myocardial infarction, stroke (cerebral
  infarction), shock-resuscitation, replantation
  surgery, frostbite, burns and organ
  transplantation

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Diseases commonly associated with infarctions
include

• 1. Myocardial infarction (heart attack)
• 2. Pulmonary embolism ("lung attack")
• 3.Cerebral infarction (stroke)
• 4.Peripheral artery occlusive disease (the
  most
• severe form of which is gangrene)
• 5.Antiphospholipid syndrome
• 6.Sepsis
• 7.Giant-cell arteritis (GCA)
• 8.Hernia
• 9.Volvulus
• 10.Splenic infarction

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Homoeopathic Perspective

• Therapeutic nihilism( travesty of medicine)
  originated with that group of pathologists (not
  practicing physicians) who sought to identify
  every disorder disease with definite anatomical
  changes. They led clinicians to study disease
  only in this relation. The fact is that
  anatomical changes are results of disease not
  the disease process itself.

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Homoeopathic Perspective

• Disturbed physiology always precedes
  pathology but does not always produce it.
  Therefore, symptoms present themselves, before
  during , as well as after the formation of
  pathological end products or tissue changes. The
  homoeopathic prescriber utilizes all signs
  symptoms but recognizes their relative importance

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Hahnemannian concept of disease phenomenon

• Disease is primarily a disturbance in the
  vital force which governs regulates all the
  organs parts of the body. In health this vital
  force maintains normal growth co-ordination of
  all organic functions. when, from some
  disease-producing cause, this force becomes
  disturbed, disease or disharmony of function
  results. The cause of disturbance may be
  infections, injuries, climatic conditions,
  violent emotions, dietary errors etc.

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Understanding pathology in homoeopathic parlance

• A true science of pathology must include be
  able to explain all the symptoms of disease -
  the finer, subjective individual symptoms as well
  as the general functional, organic objective
  changes that occur in a disease.
• A true science of therapeutics must be able to
  explain all the symptoms of disease the finer,

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MIASM- Fundamental cause Each and every
individual receives a number of inputs through
out his/her life every one reacts differently
to each of these inputs.
H
Input
Output
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• The reactions
• are mainly
• dependant on
• Heredity
• Genetic pattern and
• The environmental influences that one
• experiences in every stage of ones life.

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Miasmatic cleavage of thrombosis Infarction

• From the structural point of view, thrombosis is
  an expression of an actual change of structure in
  the arterial system.
• Change of structure occurs in complicated Psora,
  i.e when the psoric dyscrasia is combined with
  syphillitic, structural changes do take place,
  in this manifestation we have an expression of
  the combination of the two stigmata.

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Miasmatic cleavage of thrombosis Infarction

• Syphillitic dyscrasia befits the expression of
  infarction. Infarction is a process of tissue
  death infarctions are commonly associated with
  hypertension or atherosclerosis which contribute
  to gross structural changes.
• White infarcts are more of functional distortion
  culminating into death of tissues due to lack of
  blood supply.Hence psora to syphillis.
• Red infarcts occur in previously ischemic tissue
  that is associated with reperfusion-related
  diseases such as - Myocardial infarction, stroke
  (cerebral infarction) the tissues are under the
  deadning influence of syphillitic dyscrasia.

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Treatment Protocol

• Totalistic ,Holistic, or Constitutional treatment
  in tandem with life style changes is the basis
  of prescription in the homoeopathic management of
  Thrombosis Infarction.
• Role of homoeopathy is more in Preventive
  Cardiology Post infarction Management.
  Homoeopathic medicines can control prevent
  causes of IHD

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Therapeutics - Thrombosis

• Mainly indicated remedies are Apis, Ars, Both-l,
  Lach, Kali-m, Nat-s, and Vip. Aconitum napellus
  Arnica montana Belladonna atropa Bothrops
  lanceolatus Hamamelis virginica Lachesis
  Pulsatilla nigricans.

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Therapeutics -Cerebral Haemorrhage, Embolism
and Thrombosis -

• Opium, Belladonna, Arnica, Laurocerasus are the
  remedies undoubtedly most similar to the general
  symptoms of apoplexy

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Therapeutics Myocardial infarction

• Aconite, Cactus grandiflora,Glonine,
• Camphor, Digitalis, Arnica, Rhus tox

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