THROMBOANGIITIS OBLITERANS (BUERGERS DISEASE) AND ITS HOMOEOPATHIC PERSPECTIVES
Author: Dr. Soorya Hencifa Cleetus
PG Scholar
Department of Organon Of Medicine and Homoeopathic Philosophy
Father Muller Homoeopathic Medical College and Hospital Deralakatte
Mangalore
ABSTRACT
This work is about thromboangiitis obliterans, etiology, epidemiology, pathophysiology, its risk factors, how homoeopathy help in managing such cases and reportorial rubrics.
KEYWORDS
Thromboangiitis obliterans, non – atherosclerotic inflammatory disorder, smoking, tobacco, homoeopathic treatment, related rubrics.
ABBREVIATIONS
TAO – Thromboangiitis obliterans, HLA – Human Leukocyte Antigen, FBC – Full Blood Count, LFT – Liver Function Test, FBS – Fasting Blood Sugar, CRP – C-reactive Protein.
INTRODUCTION
It is a segmental non-atherosclerotic inflammatory disorder primarily involves the small and medium sized arteries principally the tibial and radial arteries and sometimes secondarily extending to veins and nerves of extremities.
ETIOLOGY
The specific cause is not known, but exposure to tobacco by any means either by smoking or chewing or marijuana use is known to be the initiation, maintenance and progression of TAO.
Certain polyphenols from tobacco elicit antibodies and can induce inflammation. It can also cause direct endothelial damage leading to hyper coagulability and thrombosis. As HLA-A9 and HLA-B5 haplotypes are more common among TAO patients suggests that a genetically controlled hypersensitivity to tobacco is also involved in the pathogenesis of the disease.
EPIDEMIOLOGY
The classic buergers disease patient is young male (20-40 years old) who is a heavy cigarette smoker. Most recently a high percentage of women and people over the age of 50 have been recognized to have this disease. Present worldwide more prevalent in middle east and far east than in Europe and north America.
CLINICAL FEATURES
• Cramping of calf muscles.
• Pain in arms, hands, legs, fingers or toes.
• Pale, red or blue hands or feet.
• Cold hands or feet.
• Numbness or tingling in limbs.
• Skin ulcers or wounds that doesn’t heal especially on extremities.
PATHOPHYSIOLOGY
Cigarette smoking leads to nicotine, carbon monoxide, carbon dioxide deposition. if nicotine gets deposited it leads to vasoconstriction of arteries and in carbon monoxide leads to destruction of the lining of the blood vessels which leads to the triggering of autoimmune response and in case of carbon dioxide deposition it leads to the decreased transportation of oxygen to tissues. All the three pathways leads to tissue ischemia may causes anaerobic metabolism to formation of lactic acid to intermittent claudication or directly causes cyanosis. That results in tissue necrosis.
DIAGNOSTIC CRITERIA
• Smoking history.
• Onset before the age of 50 years.
• Infra popliteal arterial occlusions.
• Either upper limb involvement or phlebitis migrans.
• Absence of atherosclerotic risk factors other than smoking.
INVESTIGATIONS TO BE ADVISED
SEROLOGICAL
• FBC, LFTs, renal function test, FBS, CRP, autoantibodies and screening for hyper coagulability.
IMAGING
• ANGIOGRAPHY – Corkscrew appearance of arteries especially wrist and ankles. Also shows occlusion or stenosis.
• DOPPLER ULTRASOUND – Reveals segmental occlusion of arteries.
• ALLENS TEST for blood flow.
GENERAL MANAGEMENT
• Advice to stop smoking.
• Gentle massage and warmth to increase circulation.
• Avoiding cold temperature that reduce peripheral circulation.
• Avoid sitting or standing in one position for long period.
• Avoid tight or restrictive clothing.
HOMOEOPATHIC MANAGEMENT
• If the patient has claudication pain and if the generals are varied due to the pain and if the complication like ulcer is increased along with increased suffering of the patient then can go for acute totality.
• Then can go with constitutional totality for the complete cure (asymptomatic) with the help of similima.
HOMOEOPATHIC THERAPEUTICS
• SECALE CORNUTUM – Cold, dry hands and feet of excessive smokers with feeling of fuzziness in fingers. Trembling staggering gait. Fingers and feet bluish, numb, violent cramps. Icy coldness of extremities, tingling of toes, dry gangrene, formication under skin.
• PLUMBUM METALLICUM – Hands and feet cold. Stinging and tearing in limbs also twitching and tingling, numbness, pain or tremor.
• ARNICA – Skin black and blue, itching burning eruption. Deathly coldness of forearm. Thrombosis.
• ARSENICUM ALBUM – Burning, restlessness and tingling of extremities.
• CACTUS – Tingling icy cold hands, pain in fingers or swollen feet.
• CROTALUS HORRIDUS – Hands feel numb, start trembling or become swollen.
• DULCAMARA – “Cold in your bones” feeling or have limb paralysis.
• LACHESIS – Toes feel broken, feet feel sweaty or have trembling or prickling of hands.
• ANTHRACINUM – Gangrene, foul secretions, hemorrhages, black, thick, tar like, rapidly decomposing.
RUBRICS RELATED TO TAO
SYNTHESIS REPERTORY
• Skin – Ulcers – Indolent. Pg.no 1880.
• Extremities – Thrombosis – Lower limbs. Pg.no 1678.
• Extremities – Gangrene – Feet. Pg.no 1479.
• Extremities – Gangrene – Hand. Pg.no 1479.
• Extremities – Coldness – Feet. Pg.no 1433.
• Extremities – Coldness – Hands. Pg.no 1433.
• Extremities – Tingling – Feet. Pg.no 1679.
• Extremities – Numbness – Feet. Pg.no 1508.
• Extremities – Numbness – Hands. Pg.no 1510.
• Extremities – Discoloration – Foot – Blueness. Pg.np 1454.
• Extremities – Discoloration – Foot – Redness. Pg.no 1454.
• Extremities – Discoloration – Foot – Pale. Pg.no 1454.
• Extremities – Discoloration – Hand – Blueness. Pg.no 1455.
• Extremities – Discoloration – Hand – Redness. Pg.no 1455.
• Extremities – Discoloration – Hand – Paleness. Pg.no 1455.
ROBIN MURPHY CLINICAL REPERTORY
• Clinical – Ulcers – Gangrene – Cold – Dry. Pg.no 480
• Clinical – Ulcers – Indolent. Pg.no 484.
• Legs – Cramps – Legs – Calves. Pg.no 1333.
• Feet – Cold. Pg.no 718.
• Feet – Numbness. Pg.no 731.
• Feet – Tingling. Pg.no 746.
• Feet – Discoloration – Blueness. Pg.no 722.
• Feet – Discoloration – Paleness. Pg.no 722.
• Hand – Coldness. Pg.no 1007.
• Hands – Tingling. Pg.no 1039.
• Hands – Numbness. Pg.no 1023.
• Hands – Discoloration – Blueness. Pg.no 1011.
• Hands – Discoloration – Redness. Pg.no 1011.
• Hands – Discoloration – Pale. Pg.no 1011.
• Hands – Pain – Moving when. Pg.no 1027.
BOGER BOENNINGHAUSEN CHARACTERISTIC REPERTORY
• Skin and exterior body – Gangrene, cold, sphacelus: Pg.no 955.
• Lower extremities – Circulation – Impeded as if. Pg.no 848
• Lower extremities – Blue skin. Pg.no 846.
• Lower extremities – Numbness. Pg.no 859.
• Lower extremities – Tingling. Pg.no 871.
• Upper extremities – Coldness. Pg.no 812.
• Upper extremities – Blueness of skin. Pg.no 810.
• Upper extremities – Numb. Pg.no 823.
• Upper extremities – Tingling and tickling, palms. Pg.no 834.
REFERENCES
1. Harsh Mohan Text book of pathology, 6th edition.
2. Rubin`s Pathology. By Emanuel Rubin, 7th edition.
3. Robbins and Cotran pathologic basic of disease. By Vinay Kumar, South Asia edition.
4. Boericke`s New Manual of Homoeopathic Materia Medica with repertory, 9th edition.
5. Augmented Clinical Synthesis repertory. By Dr. Frederik Schroyens, edition 9.1.
6. Homoeopathic Medical Repertory. By Robin Murphy, 3rd revised edition.
7. Boger Boenninghausen`s characteristics and repertory. By C M Boger.
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880529/
9. https://patient.info/doctor/buergers-disease-pro
10. https://www.hopkinsvasculitis.org/types-vasculitis/buergers-disease/
11. https://www.upmc.com/services/heart-vascular/conditions-treatments/buergers-disease
12. https://www.scribd.com/doc/53064983/PATHOPHYSIOLOGY-OF-BUERGER-disease
UNDER THE GUIDENCE OF
DR JACINTHA MONTEIRO
Professor, Department of Organon of Medicine and Homoeopathic Philosophy
Father Muller Homoeopathic Medical College,
Deralakatte, Mangalore.
