DISSERTATION

of

“To study the usefulness of Homoeopathic medicine incases

of Psoriasis”

A Dissertation to be submitted In Partial Fulfillment of the Requirement forThe

Award of the Degree of
DOCTOR OF MEDICINE IN HOMOEOPATHY
(PRACTICE OF MEDICINE)
Of
DR BHIM RAO AMBEDKAR UNIVERSITY, AGRA U.P.)
At
BAKSON HOMOEOPATHIC MEDICAL COLLEGE
&HOSPITAL
36-B KNOWLEDGE PARK-I, GREATER NOIDA (U.P.)

By

FalakNishat
Session: (2016-19)
Under the guidance & supervision of

Prof. (Dr.) Mini Arora

M.D. (Hom.)Department of Practice of Medicine

Bakson Homoeopathic Medical College & Hospital

36-B, Knowledge Park-I, Greater NOIDA (U.P.)
 CERTIFICATE
This is to certify that the dissertation entitled “Usefulness of
homoeopathic medicine in the case of psoriasis” is a bonafide work of
Falak Nishat under the guidance of Dr. Mini Arora in partial fulfillment
of regulation for the award of Degree of Doctor of Medicine in
Homeopathy [M.D. (Hom..).] in practice of medicine.
This has been carried out under my guidance and supervision. I
am satisfied with the authenticity of the experiments, observations and
interpretation embodied in this dissertation.
The work is recommended to the Dr. Bheem Rao Ambedkar
University, Agra, Uttar Pradesh for the award of the degree of Doctor of
Medicine in Homeopathy [M.D. (Hom.).] in practice of medicine.

Date: Prof. (Dr. Mini Arora)

Guide
Bakson Homeopathic Medical Collage and Hospital
Greater Noida, Uttar Pradesh

1
 CERTIFICATE
This is to certify that the dissertation entitled “Usefulness of
homoeopathic medicine in the case of psoriasis” is a bonafide work of
Falak Nishat under the guidance of Dr. Rashmi in partial fulfillment of
regulation for the award of Degree of Doctor of Medicine in
Homeopathy [M.D. (Hom.).] in practice of medicine.
This has been carried out under my guidance and supervision. I
am satisfied with the authenticity of the experiments, observations and
interpretation embodied in this dissertation.
The work is recommended to the Dr. Bheem Rao Ambedkar
University, Agra, Uttar Pradesh for the award of the degree of Doctor of
Medicine in Homeopathy [M.D. (Hom.).] in practice of medicine.

Date: Prof. (Dr. Rashmi)

HOD
Bakson Homeopathic Medical Collage and Hospital
Greater Noida, Uttar Pradesh

2
 CERTIFICATE
This is to certify that Dr. Falak Nishat (MD 2016-2019) Batch has
properly completed his dissertation topic entitled “usefulness of
homoeopathic medicines in the case of Psoriasis”. under sincere
guidance of. guide, Dr. Mini Arora, .Prof. of Bakson Homoeopathic
Medical College & Hospital, Greater Noida. I wish him all the best &
success in life.

(Dr. C.P. Sharma)

Principal
Bakson Homoeopathic Medical
College & Hospital, Greater
Noida, UP

3
 DEDICATION

It is indeed an over whelming joyous feeling to dedicate this work to the

lotus feet of master Dr. Samuel Hahnemann, the father of homeopathy,
undoubtedly the greatest genius the world has ever seen…

To all the homeopathic stalwarts of past and present who have shown us
the way to practice this art of healing successfully and judiciously, that is
to serve the suffering humanity.

( Dr. Falak Nishat )

M.D ( Practice of Medicine )
Enrollment No. A - 161350
Batch 2016 – 2019

4
 DECLERATION

This is to certify that the dissertation entitled “Usefulness of

Homoeopathic medicine in the case of Psoriasis” is a bonafide work of
Falak Nishat under the guidance of Dr. Mini Arora in partial fulfillment
of regulation for the award of Degree of Doctor of Medicine in
Homeopathy [M.D. (Hom.)] in practice of medicine.

This work conforms to the standards of Dr. B. R. Ambedkar University

Agra. It has not been submitted partially or fully for the award of any
other degree or diploma.

I have great pleasure in forwarding to Dr. B. R. Ambedkar University

Agra.
Date:

Dr. Falak Nishat

5
 ACKNOWLEDGEMENT

I consider this as my privilege to thank the almighty god for helping me

to achieve this humble task through the following persons who have
been of immense help and source of encouragement in my endeavor...

I would like to express my special thanks to my parents and my dear and

near ones for their constant support and encouragement during the
course of my post graduate studies.

It is my privilege to express sincere gratitude to Chairman Managing

Director Dr. S. P. S. Bakshi, for providing me an opportunity and
educate facilities to carry out this work to my satisfaction in this reputed
institution.

I thank all PGS, my friends, interns, members of staff of Bakson

Homoeopathic Medical Collage and Hospital, and the non- teaching staff
of outpatient department who has provided me the case material required
for the study.

Last but not the least, my sincere thanks to all the patients on whom the
study was conducted and for taking pains to complete this work in time.

Dr. Falak Nishat

6
 CONTENTS
SR. No Page No.
1. Certificates
i. By The Guide…… ………………………1
ii. By The HOD….… ………………………2
iii. By The Principle………………………3
2. Dedication………………………………… …4
3. Declaration…………… ……………………..5
4. Acknowledgement…… ……………………..6
5. Table of contents… ………………………….7-8
6. List of tables……… …………………………9
7. List of figure……… …… …………………..10
8. Introduction ……… …………………………11-13
9. Aims & Objectives… ……………………….14
10. Review of literature… …………………15-33
11. Miasmatic and Constitutional
Background……………………………….….34-35
12. Homoeopathic Remedies
suggested in our Literature…………...…...36-44
13. Auxiliary of Management…………...….45
14. Materials and methods…………...……46-48

7
15. Observations and Results…………...…..49-53
16. Discussion…………...………………….54-56
17. Summary and Conclusion…………..…..57-59
18. References…………...………………….60-62
19. Annexures
1. Case proforma…...………………….63-71
2. Graphs…...………………………….72-74
3. Case Detail…...……………………...75-99
4. Summary of Cases...……………..100-106
5. Master Chart…...…………………107-108
6. Photographs…...………………………109
7. Patient Consent Form…………………111
8. PASI Scale..........................................112

8
 LIST OF TABLES
Table No. Title Page No.
1. Age Incidence 49
2. Sex Incidence 50
3. Predisposing Factors 50
4. Socioeconomic Status 51
5. Acute Remedies Used 52
6. Constitutional and Intercurrent 52-53
Remedies
7. Result 53
8. Master chart 107-108

9
 LIST OF FIGURE

Figure No. Name of Figure Page No.

1. Layer of Skin 19
2. Layer of Epidermis 20
3. Layer of Stratum Germinatum 21
4. Layer of Stratum 22
Germinativum
5. Layer of Stratum Lucidum 23
6. Layer of Stratum Corneum 23
7. Layer of Dermis 24
8. Papillary Dermis 25
9. Reticular Dermis 25

10
 INTRODUCTION

Psoriasis is a non- infectious, chronic inflammatory diseases of the

skin, characterized by well- defined erythematous plaques with silvery
scale with a predilection for the extensor surface and scalp, and a chronic
fluctuating course.[1] Psoriasis can use significant psychosocial
problems. In an image oriented society, presence of psoriatic skin lesions
can be psychological devastating for people affected and their families.
Healthy skin defines individuality and appearance; therefore, psoriasis
may result in reduced self-esteem and may negatively affect the quality
of life [2] Psoriasis rarely kills, but it destroy the lives of millions of
people. While most cases are mild and can be fairly well controlled, even
these may flare up and worsen at any time. In its more severe forms,
psoriasis is a disabling, disfiguring, that mutilates people physically,
psychologically, and socially. [3] It is estimated that between 1 - 5 %
that is around 125 million people of the world wide population are
affected by Psoriasis and equally common in both male and females.
People of all ages and all countries the reported prevalence of Psoriasis
in countries ranges between 0.09% and 11.43%, making Psoriasis a
serious global problem. From the available studies the prevalence of
Psoriasis in India ranges from 0.44% – 2.8%. [4, 5]
The first show an onset in the teenage and early adult years; such
individuals frequently have a family history of psoriasis and there is an
increased prevalence of HLA Cw6. [1]
In a second grouping diseases onset is in the fifties or sixties a family
history less common and the HLA group Cw6 is not so prominent. [1]
psoriasis usually presents as individual lesions well demarcated and

11
range from a few millimeters to several centimeters in diameter. The
lesion are red with dry with a silvery – white scale which may be
obvious only after scraping the surface the elbows, knees and lower back
are commonly involved.[8] other sides of predilection includes; scalps,
nails flexure and palms the clinical course of psoriasis is very variable it
is prolonged, but unpredictable. psoriasis is considered a non- curable
long – term (chronic) skin conditions it has a variable course periodically
improving and worsening it may remain as discrete plaques or may
become generalized.[11] it is not unusual for psoriasis to spontaneously
clear for years and stay in remission many people note a worsening of
their symptoms in the colder winter months.[8] Relapse is rule, Guttate
psoriasis has a better prognosis a rage of treatment have been tried for
the treatment of psoriasis such as use of external tropical agents like
corticosteroids vitamin D agonists weak tar or dianthrol preparation
ultraviolet therapies and immunosuppressive agents though different
medication with various efficacies have been used for long, no definitive
treatment has been introduced yet.[13] such an easily diagnosable
disease is left at the mercy of various dermatologists who prescribed out
ward applications of ointments, poisonous washes, corticosteroids and
other modes of treatment. Doctor Hahnemann wrote with indignation in
his book on chronic diseases, two centuries ago, that it is incredible to
wart and extent modern physicians have sinned against the welfare of
humanity. They treat skin diseases through local applications, strong
washes etc. Through prompt removal of the eruption from skin, all
consequences of the skin diseases are prevented and the body remains
entirely health in there idea. Those horrible untruths have been and are
still being carried out in practice if the deceived wretches sooner or later

12
return with the malady, the physician imagine that they have before them
something entirely new and treat it again and again in a useless and
hurtful manner directing their medicines against plankton diseases until
the patient after many years of suffering is at last free from their hands
by death thus we see that the fashionable suppressing engines of today
are so wickedly effective that they fix the diseases in the system and
combine drug effects with the natural diseases thus producing a result
that cannot always be overcome . [14]
In this study I have endeavored to have a thorough knowledge of the
general course and behavior of psoriasis and more specifically psoriatic
skin lesions so that it can be treated intelligently and successfully an
attempt has been made to explore the internal homoeopathic in which we
can be successful in preventing the injustice done to mankind by other
systems of medicines no knowledge is perfect until it includes in
understanding of the origin that is the beginning and the constitution of
the individual the present study comprises of systematic approach for
evolving constitutional treatment for psoriasis it also attempts to prove
the role of homoeopathy in the prevention of recurrence by
understanding the basic principles and directing the treatment of the
individuals with psoriasis
The study includes proven cases of psoriasis presenting at Bakson
Homoeopathic Medical College and Hospital, Greater Noida, between
April 2018 and January 2019.

13
 Aims & Objectives

To ascertain the usefulness of homeopathic
medicine in treating psoriasis.

To provide harmless and long-lasting relief

to patients suffering from psoriasis.

14
 Review of Literature

Definition

Named from the Greek word psora (itch) psoriasis is a chronic non-
contagious diseases characterized by inflamed lesions covered with
silvery- white scales of dead skin [6]
Psoriasis can begin at any stage although epidemiological studies
demonstrate that it most commonly appears for the first time between the
ages of 15 to 25 years [7]

History of psoriasis

History of psoriasis starts in the dark ancient times of

humankind for the entire history of humanity millions of people from
ordinary people to celebrities from the Egyptians pharaoh’s to the
important contemporary figures stuffed from psoriasis the patient
deemed impure during their afflicted phase and is ultimately treated by
the Kohen in the times of Hippocrates (an ancient Greek
physician)leprosy and psoriasis was described under one name – leprosy
psoriasis was frequently described as a verity leprosy the Greek use the
term lepra (λƐΠρα) for scaly skin conditions they use the term psora that
means itchy skin conditions in the late 18th century English
dermatologist Robert Willan and Thomas Bateman differentiated it from

15
the other skin diseases leprosy they said is distinguished by the regular
circular form of patches while psoriasis is always irregular.

It was not until 1841 that the conditions was finally given the name
psoriasis by the Viennese dermatologist Ferdinand Von Habra the name
is derived from the Greek word psora which means to itch it was during
the 20th century that psoriasis was further differentiated into specific
types. [9,10]

ETIOLOGY

Previously, the cause of Psoriasis was postulated by several authors to be

linked to Leprosy. Many other authors believed the etiology was
unknown, but thought that many factors contributed to its appearance. It
is now believed that Psoriasis is essentially a genetic disorder that is
triggered by some form of stress.[22]

The evidence presented within the literature does not conclusively state
the etiology of Psoriasis, but the factors that appear to contribute to its
appearance are listed below:

Genetics: The familial incidence of all cases is about 30 %. 15% chance

that an off spring would develop Psoriasis if one parent was
affected.[16] . the appearance of Psoriasis is solely a Genetic disposition
that is expressed due to a form of stress. [22]

Biochemical: The increased epidermal proliferation was due to

increased levels of prostaglandins, leukotrienes and
hydroxyeicosatetraenoic acids in the epidermis.[16]

16
Immunological: "The inflammatory reaction may be part of an
immunological response to as yet unknown antigens".[16]

Dermal: the increased epidermal cell proliferation of Psoriasis was

related to increased replication and metabolism of dermal
fibroblasts[16].

Predisposing Factors
With no definite cause of psoriasis, many factors have been found that
contribute to occurrence of the disorder:

1. Trauma. Laceration or previous surgical site can cause a Psoriatic

appearance commonly called Kőbner or Koebner
phenomenon.;[16,20]
2. Inflection. Beta - haemolytic streptococcal throat inflections or
tonsillitis can trigger Guttate Psoriasis.[16;19]
3. Climate. Psoriasis is most commonly seen in northern hemisphere
areas and is linked to winter months when duration of sunlight is
shortened [19]
4. Age. The most common age is between 15-30 years. [19]
5. Drugs. Lithium, Beta antagonists and Anti-malarial or potent
local and systemic corticosteroids may worsen Psoriatic
appearance.( 16)
6. Sunlight. Rarely ultraviolet radiation from the sun of artificial
source can worsen the condition. This occurs in approximately
10% of cases [16, 18]
7. Psychological upsets / Emotional disturbances. [16,19;20];

17
 PATHOPHYSIOLOGY
Psoriasis is an immune- mediated skin diseases where the T
cell plays a pivotal role in pathogenesis of the diseases in psoriasis,
immune cells move from the dermis to the epidermis where they
stimulates skin cells (keratinocytes) to proliferates psoriasis does not
seems to be a true autoimmune diseases. Researches have identified
many of the immune cells such as dendritic cell and T cells move from
the dermis to the epidermis secreting chemical signals such as tumor
necrosis factor-α interleukin-1β and interleukin-6 which cause
inflammation and interleukin-22 which causes keratinocytes to
proliferate the pathogenesis of psoriasis is linked to activation of several
types of leukocytes that control cellular immunity and to a T- cell
dependent inflammatory process in skin that accelerate the growth of
epidermal and vascular cells in psoriasis lesions the critical steps involve
in the pathogenesis Langerhans cell activation and maturation by
antigens in the skin activation of the T cell by mature Langerhans cells
differentiation and expansion of T cell within the lymph node to the skin
and the subsequent releases of cytokinesis these cytokinesis are
responsible for epidermal and vascular Hyper proliferation and pro-
inflammatory effects.[11,12]

Structure and function of The Skin

Skin is divided into two parts , the superficial part , the Epidermis
, and the Dermis . The epidermis is a stratified epithelium whose cells
become flattened as they mature and rise to the surface . On the palms of
hands and soles of the feet, the epidermis is extremely thick to withstand
the wear and tear that occurs in these regions . In the other areas of the

18
body , for example , on the anterior surface of the arm and forearm , it is
thin . The dermis is composed of dense connective tissue containing
many blood vessel , lymphatic vessel , and nerve . It shows considerable
variation in thickness in different parts of the body, tending to be thinner
on the anterior than the posterior surface. It is thinner in women than
men. The dermis of the skin is connected to the underlying deep fascia
or bones by the superficial fascia, otherwise known as subcutaneous
tissue. [18]

The skin over joints always folds in the same place, the skin creases. At
these sites the skin is thinner than elsewhere and is firmly tethered to
underlying structures by strong bands of fibrous tissue.

Figure -1, layer of skin,

The skin is considered the largest organ of the body and has many
different functions. The skin functions in thermoregulation, protection,

19
metabolic functions and sensation, the skin is divided into two main
regions, the epidermis, and the dermis, each providing a distinct role in
the overall function of the skin. The dermis is attached to an underlying
hypodermis, also called subcutaneous connective tissue, which stores
adipose tissue and is recognized as the superficial fascia of gross
anatomy.[15]

Figure -2, layers of epidermis,

The epidermis is the most superficial layer of the skin and provides the
first barrier of protection from the invasion of foreign substances into the
body. The principal cell of the epidermis is called a keratinocyte. The
epidermis is subdivided into five layers or strata, the stratum
germinativum, the stratum spinosum, the stratum granulosum, the
stratum lucidum (not seen in this photomicrograph) and the stratum

20
corneum in which a keratinocyte gradually migrates to the surface and is
sloughed off in a process called desquamation.[1,15,18]

Figure 1 Layer of Stratum Germinatum,

The stratum germinatum provides the germinal cells necessary for the
regeneration of the layers of the epidermis. These germinal cells are
separated from the dermis by a thin layer of basement membrane. After a
mitotic division a newly formed cell will undergo a progressive
maturation called keratinization as it migrates to the surface.[15]

21
 Figure 2 Layer of Stratum Germinativum

The cells that divide in the stratum germinativum soon begin to

accumulate many desmosomes on their outer surface which provide the
characteristic “prickles” (seen on the close-up view) of the stratum
spinosum, which is often called the prickle-cell layer[15].

The progressive maturation of a keratinocyte is characterized by the

accumulation of keratin, called keratinization. The cells of the stratum
granulosum accumulate dense basophilic keratohyalin granules (seen on
the close-up view). These granules contain lipids, which along with the
desmosomal connections, help to form a waterproof barrier that
functions to prevent fluid loss from the body.

22
 Figure 3Layer of Stratum Lucidum,

Epidermis varies in thickness throughout the body depending mainly on

frictional forces and is thickest on the palms of the hands and soles of
the feet. The stratum lucidum is normally only well seen in thick
epidermis and represents a transition from the stratum granulosum to the
stratum corneum..[15]

Figure 4 Layer of Stratum Corneum, [15]

23
 Figure 5 Layer of Dermis, [15]

The dermis assumes the important functions of thermoregulation and

supports the vascular network to supply the avascular epidermis with
nutrients. The dermis is typically subdivided into two zones, a papillary
dermis and a reticular layer. The dermis contains mostly fibroblasts
which are responsible for secreting collagen, elastin and ground
substance that give the support and elasticity of the skin. Also present
are immune cells that are involved in defense against foreign invaders
passing through the epidermis.

24
 Figure 6 Papillary Dermis
The papillary dermis contains vascular networks that have two important
functions. The first being to support the avascular epidermis with vital
nutrients and secondly to provide a network for thermoregulation. The
vasculature is organized so that by increasing or decreasing blood flow,
heat can either be conserved or dissipated. The vasculature interdigitates
in areas called dermal papillae. The papillary dermis also contains the
free sensory nerve endings and structures called Meissner’s corpuscles in
highly sensitive areas.[15]

Figure 7 Reticular Layer

25
The reticular layer of the dermis consists of dense irregular connective
tissue, which differs from the papillary layer , which is made up of
mainly loose connective tissue (note the difference in the number of
cells). The reticular layer of the dermis is important in giving the skin it
overall strength and elasticity.[15]

The skin contains a variety of appendages, mainly hair follicles, sweat

glands , and sebaceous glands , which are all embrylogically epidermal
in origin. The appendages of the skin are the Nails , Hair follicles,
Sebaceous glands, and Sweat glands.
The nails are keratinized plates on the dorsal surface of the tips of
fingers and toes.
Hairs grow out of follicles, which are invaginations of the
epidermis into the dermis. The follicles lie obliquely to the skin surface,
and there expended extremities, called the hair bulbs, penetrate to the
deeper parts of the dermis.
Sebaceous glands pour their secretions, the sebum on to the
shafts of the hairs as they pass through the neck of the follicles. They are
situated on the slopping undersurface of the follicles and lie within the
dermis. Sebum is an oily material that helps to prevent the flexibility of
the emerging hair. It also oils the surface epidermis around the mouth of
the follicles.
Sweat glands are long, spiral, tubular glands distributed over the
surface of the body except the red margins of the lips, the nail beds, and
the glans penis and clitoris. They extend through the full thickness of the
dermis and their extremities may lie in the superficial fascia. The sweat

26
glands are therefore the most deeply penetrating structures of all the
epidermal appendages.

Functions of the Skin

Protection: The outer most layer of the skin resist the action of external
agencies. It protects the internal individual injuries and bacterial
invasion. The nails are the defensive appendages of the skin.

Regulation of body temperature: Cutaneous vasodilation and

vasoconstriction of the skin is an important mechanism which helps in
regulation of heat in the body. Sweating is also an important procedure
to regulate the body temperature.[1,4]

General sensation: The skin serves as the medium for receiving the
general sensation. Touch pain temperature, etc. are sub served by the
respective nerve endings present in the skin. The hair roots are richly
supplied with nerves. In this way hairs help in the sensory functions of
the skin.[1,4]

Excretion: Through sweat and insensible perspiration, salts and

metabolites are excreted to some extents.

Synthetic function: Vitamin D is synthesized by ultra-violet rays of the

sun. [1,4]

27
Secretion:
a. Sebum- The sebaceous glands secretes a fatty substance which is rich
in cholesterol, called sebum. It helps the skin greasy and prevents
drying.

b. Sweat- It is the active secretion of the sweat glands of the skin.

c. Milk- It is the secretion of mammary glands, which are modified

sweat gland.

Absorption: Waxy layer hinders water absorption through the skin but it
is not completely waterproof. Lipids are easily permeable through the
skin. Lipid soluble substances like vitamins are easily absorbed through
the skin.[1,4]

Water balance: Formation and evaporation of sweat is an important

factor in the regulation of water balance of the body.

Acid base equilibrium: Sweat being acid in reaction, a good amount of

acid is excreted through it.

Storage function: The dermis as well as the subcutaneous tissue can

store (a) Fats, (b) Water, (c) salts, (d) Glucose and such other
substances.[1,4]

28
 COMMON PRESENTATIONS OF
PSORIASIS

SYMPTOMS OF PSORIASIS

Psoriasis symptoms vary depending on: [32]

Psoriasis types: (plaque, Guttate, Inverse, Pustular, Erythrodermic,

and Psoriatic Arthritis)

Psoriasis Vulgaris / Stable Plaque Psoriasis:

Psoriasis Vulgaris was the most common type of Psoriasis seen.

Psoriasis Vulgaris is the most stable form of Psoriasis and most easily
managed. [16,17] It's appearance is characteristic with a well-defined,
non-inflammatory, Once a remission has occurred a temporary white,
brown or red macule may remain. [20]. The most common areas affected
are he elbows, knees and lower back, but the scalp, nails, flexure
surfaces, palms and the napkin area are other common locations[17] red
based lesion covered with a uniform silver scale. Most commonly this
type of Psoriasis persists unchanged for months and even possibly years,
but disappearances and reoccurrences are inevitable

Guttate Psoriasis:

Guttate Psoriasis is seen prominently in children and adolescents as 30%

of all presentations are under 20 years of age. Commonly Guttate
Psoriasis appears after a streptococcal pharyngitis (tonsillitis) has

29
occurred. A rash like appearance of numerous small round red macules
appear. This occurs rapidly and the individual lesion range in size from
pinpoint to 1 cm. The lesions are usually droplet shaped, red in colour,
and scaly with appearance mainly on the trunk and extremities but not
the palms or soles. This rash often clears but it may continue and form a
plaque like Psoriatic appearance. [16,17;]

Erythrodermic Psoriasis:

Erythrodermic Psoriasis is a particularly unpleasant variation of

Psoriasis. With this variant, the skin also becomes red and scaly but
almost all of the body can be affected. Due to the inflammatory nature,
the individual shivers uncontrollably in an effort to compensate for the
considerable heat loss experienced.

The effects of Dithranol, tar or the withdrawal of systemic or topical

corticosteroids can initially stimulate this variation. [16]

Pustular Psoriasis:

Pustular Psoriasis is a rare but serious variant that is the most confusing
diagnostically [17]. The onset of Pustular Psoriasis is commonly sudden
and many small sterile pustules erupt. These eruptions occur usually on
the arch of the feet and middle section of the palms and have an
erythematous base.

Zumbusch Psoriasis, is a variation of Pustular Psoriasis that affects the

entire body. This serious condition requires hospital admission as the
patient is very ill.; [20])

30
The lesions of Pustular Psoriasis begin as usually deep-seated pustules
that evolve into dusky-red macules. A brown crust may cover the area,
although eruption of the sites is most common appearance. Eventually
the lesions change, forming deep yellow coloured pustules that do not
rupture, but dry up and turn brown and scaly.

PSORIATIC ARTHRITIS

About 10% 0f patients with psoriasis develop a complication called

Psoriatic arthritis. This type of arthritis can be slow to develop and mild,
or it can develop rapidly Symptoms of psoriatic arthritis include:

Joint discomfort, swelling, stiffness, pain and swelling in the toes and
ankles,pain in the lower back ,wrist, knees.[32,33]

Psoriasis Location: (scalp, Nail, Face, Palmoplanter, Genital, Skin,

Folds, and Mucos Membranes.)

Psoriasis stage: (Early, Progressive, Stationary, and regressive)

Psoriasis symptoms by stage.

Early symptoms of Psoriasis

Psoriasis usually begins with small pink papules, which are covered with
with fine white scales these papules start merging into papules which is
usually accompanied by itching.

Progressive Stage psoriasis Symptoms

In this stage smaller plques grow into larger ones, and merge with one
another, they keep itching, during this stage many patients experience

31
the keobner phenomenon in the case of skin injury(tattoo, piercing, cuts,
nicks, etc.)P,psoriasis may effect the damaged skin the reason for
koebner phenomenon is unknown this type of skin reaction was first
discovered and described by the german docter henrich koebner in 1872.
[21]

Stationary Stage Psoriasis symptoms

This stage usually begins a few weeks after the progressive stage. The
old lesions are covered with very thick white scales, but new lesions do
not appear.
SEVERITY
Psoriasis is usually graded as[13,32]
Mild - affecting less than 5% of the body
Moderate - affecting 5-20% of the body
Severe-which extends beyond 20% widespread psoriasis-life threatening.

Several scales exist for measuring the severity of psoriasis.

The Psoriasis Area Severity Index (PASI) is the most widely used
measurement tool for Psoriasis. PASI combines the assessment of the
severity of lesions and the area affected in to a single score in the range
0(no disease) to 72(maximal disease).
Mild type of psoriasis include: plaque psoriasis (red lesions covered
with silvery-white scale), Guttate Psoriasis (numerous small, red, drop-
like spots) and Inverse psoriasis (red smooth lesions in the skin folds).
Severe types of psoriasis: include pustular, psoriasis, Erythrodermic
psoriasis and psoriatic arthritis.
Physical and mental complication
1. Folate deficiency- In severe psoriasis

32
 2. Skin Cancer- Patient with severe psoriasis are at higher than
normal risk for developing cancers.

DIAGNOSIS:

Most variations of Psoriasis can be diagnosed by the characteristics of

the lesion and it's presentation pattern[19,20] stated that biopsy is
necessary to assist in identification while [16] wrote that biopsy is
seldom necessary as the clinical picture is usually characteristic.

Throat swabbing for beta haemolytic streptococci is recommended to be

performed when Guttate psoriasis is suspected[16] while [20]
recommends ESR and Rheumatoid factor tests to be completed for
suspected Psoriatic Arthritis cases.

33
 MIASMATIC AND CONSTITUTIONAL BACKGROUND IN
THE TREATMENT
Hahnemann believed that chronic diseases remained in a latent
state in the body, returning from time to time in one form or another. and
these disease could only be cured by a remedy which covered the whole
original disease..[23]
This conclusion was reached by Hahnemann after nearly twelve years
of intensive study and research. For him there were three sources of
chronic infection Miasms as he called them Psora and the two venereal
diseases Syphilis and Gonorrhoea which he called sycosis.
He stress that where eruptions on the skin are suppressed by any
means, the disease strikes inwards producing dangerous and often fatal
complications, and illustrates his argument with many cases. We give
below three of these cases in order that you may follow the strength of
his argument.[23]
Sir John weir remark-; By miasm Hahnemann means germ disease
miasm denotes the dynamic disease producing power pollutes the human
organism and become the producer of every possible disease condition.
Stuart close in his Genus of Homeopathy miasm is according to
Hahnemann and to most of his follower is an infecting agent & a cause
of disease it has been stated before that in order to succeed in the
treatment of chronic cases it is not enough that the remedy selected is
similar in symptoms only Besides the similarity in symptoms there must
also be similarity of miasm also This is to say the remedy selected must
also be miasmatic.
Dr. H.A. ROBERTZ
Psoriasis = “marriage of all the miasm”[34]
Dr. R.P Patel

34
 More of psora
A pinch of sycosis
A lot of syphilis [35]
.Chattergy.T.P
Psora-Syphilis-Sycosis together [36]
According to Dr. H. A. Roberts (The principals and art of cure by
Homeopathy) “No greater crime can be committed against the human
economy than to aid and abet these suppurations. Suppuration is the
source of many functional disturbances.”[24]
Homoeopathy is the second most holistic and alternative medicine
according to WHO. The holistic and concept of homoeopathy means
each person is treated as a unique individual and their body , mind ,
emotion are all considered in the management and prevention of disease
, thus may make quality of life better .[5]
According to homoeopathy philosophy the totality of symptoms is the
sole means , whereby the disease can make known what remedy it
requires (apho-7) that so to say , a single remedy (apho- 272 )has to be
selected on the basis of similarity of its symptoms to the totality of
symptoms which is obtained by individualizing examination of the case
(apho- 83-104 ).[31]
In 2009 a prospective multi center cohort study was conducted by a
research team at Berlin’s charity university (Germany), the study
published in the journal of the European academy of Dermatology and
Venerology, it was based on whether Homeopathy is effective in treating
Psoriasis and the result clearly demonstrate that under individualized
(classical) Homeopathy treatment, patient with Psoriasis improved in
systems and quality of life. [25]

35
 Homeopathic Remedies for psoriasis Suggested by
various Stahlwarts
Clarke J. H The Prescriber [39]
• Chronic asthma due to sudden suppression of psoriasis, sinking
sensation, flushes of heat – Sulphur – 3C – 6HRLY
• Violent itching with exfoliation – Petroleum 3C – 8HRLY
• Locally for the ulceration in Psoriasis – Lotion of Nitric Acid.

Dr. Chatter T.P My Random Notes on Some Homoeo –

Remedies, Suggests [36]
Gunpowder- Cures obstinate psoriasis
Potency – 200 and 1M
Iris Versicolor 1M
For psoriasis of knee
With usual symptoms of elongated uvula and ropy saliva

SCHUSSLER The Twelve Tissue Remedies Of Schussler

Suggests Kali sulph & Calc flour in repeated doses.[38]

BAEHR.B The Science of Therapeutics

Suggests Sulphur, Nitric acidum, Sarsaparilla & Lycopodium
Pustulous forms – Merc iod, Nitric acid, Kali Bich[37]

36
MEDICINE MOSTLY SUGGESTED IN OUR LITERATURE

KENT- SKIN- ERUPTIONS- PSORIASIS

BOERICKE- SKIN- PSORIASIS OF
KNERR- SKIN- ERUPTIONS- PSORIASIS

Arsenic, Graphites, Nit.acid,

Ars.iod, Kali.ars, Petroleum,

Borex, Kali.brom, Psorinum,

Calc.sulph, Lycopodium, Sulphur.

Chrysarobinum, Merc.sol.,[27]

The Rubric of Psoriasis in various Repertory-

IN KENT,S REPERTORY[28]
Skin, eruption, psoriasis- ars., Ars-I, s cal, calc-,kali-ars, kali-c., kali-s,
.,puls.,rhus-t., Lyc., mez., nit-ac , Petr, phos., Phyt.,psorgraph., mez.,
BBCR REPERTORY-SKIN AND EXTERIOR BODY[29]
Desquamatoin,exfoliation,peeling,etc.,of:Aco.,AM-C.,Am-
m.,Ars.,Aur.,BELL.,calc-c.,Canth.,caus.,colo.,con.,Dul.,graph.,Kag-
c.,MEZ.,Phos.,phos-ac.,rhus-t.,staph.,sul.,
Over affected parts: Rhus-t
Of hardened pieces of:graph.,Sep.,sil.
WHITE scales:Ars., calc-c.,crot-t.,dul.,lyc.,merc.

37
HOMOEOPATHIC MEDICAL REPERTORY BY ROBIN
MURPHY[30]
SKIN PSORIASIS- ars.,ARS-I., bor.,calc., calc-s.canth.,carb-
ac.,chin.,GRAPH.,kali-ars.,kali-c.,kali-s.,LYC.,merc.,
mez.,NAT-M., nit-ac.,petr., phos.,PHYT.,psor.puls., rhus-
t.,sulph.,SEP.,STAPH.,
Syphilitic;ars.,ARS-I.,COR-R.,merc.,nit-ac.,PHYT.,sars.

PLACE OF DEEP AND SHORT ACTING

REMEDIES IN TREATMENT:
Graphitis : Obstinate dryness of the skin, and absence of perspiration.
Red spots on the skin, like flea-bites. Erysipelatous inflammations..
Eruptions oozing out a thick honey-like fluid. Tetters, and other humid
or scabby eruptions, sometimes with secretion of corrosive serum, or
with itching in the evening, and at night. Eruption of pimples and
nodules (principally under hair and on covered parts) which itch very
much. Swelling and induration of the glands. Scrofulous and syphilitic
ulcers. Burning pain in an old cicatrix. Deformity and thickness of the
nails.

Petroleum : Great sensibility of the surface of skin. Eruption of

itching and burning pustules. Pruritus of the aged. Dreadful irritation all
over body, very intense in vagina, anus and perineum, preventing sleep
Ulcers with shooting pains, often deep ulcers, with raised edges. Proud

38
flesh in ulcers. When a person complains of eruption or itching at night
(affecting scrotum particularly), the eruption being either dry or moist.
Chilblains particularly where they itch a good deal and are moist.
Exanthema corroding and spreading, very difficult to heal. Sensibility of
the skin in general.

Sepia : Skin yellow, like jaundice, chapping of the skin, or cracks may
extend deeply into the tissues, and this is worse by washing in water,
exanthema in general, particularly when it is disposed to crack. .
Excessive sensibility of the skin.

Arsenic : Desquamation of the skin of the body. Skin dry as

parchment, cold and bluish. Yellowish colour of the skin. Shootings, hot
itching, and violent burning in the skin. Reddish or bluish spots in the
skin. Petechiae. Inflamed spots, chiefly in the head, face, and neck. .
Conical pimples, whitish or reddish, with burning itching. Nettle-rash.
Eruption of painful black pustules. Eruption of itchy pimples, small and
tickling. Eruption of small red pimples, which increase and change into
gnawing ulcers, and violently burning, especially at night, or with
coverings.

Sulphur : The greatest general psoric remedy for almost every kind of
itch, sore, ulcer, etc., very colicky babies with pimples, itch, or eruption
on skin, or roughness of skin. Troubles of very long standing resulting
from suppressed eruptions. Sul. will very often bring these out and cause
their cure. Exanthema in general on any part of the body which is worse
by any heat, from getting warm at work, in bed, &c., freckles, cancerous

39
ulcers. Skin dry, rough, scaly, voluptuous itching _ "feels so good to
scratch," ecchymosis, chapping of the skin, especially when it ulcerates.

Calcarea carb : Rash like eruption in the face, about the eyes and on
the nose. Violent irritation about the chest, back, neck, and shoulders,
and in the calves of the legs; a reddish rash was partly developed all over
the back and chest. Red stripes on the tibia, consisting of nettle-rash
elevations, with severe itching and burning after rubbing (after seven
days). Fine rash on the skin and neck, with itching. Eruption on the feet,
itching, violent biting, causing scratching, bleeding when scratched, and
changing to a nettle- rash-like eruption.

Causticum : Violent itching, especially in the back, and in the calves

of the legs. Itching of the whole body at night (Itch). Injuries of the skin,
which had been healed, become sore again. Itch suppressed by mercury
or sulphur, burning itch. eruptions resembling scabies. Miliary eruptions
and nettle-rash. Itching and humid tetters. Ulcerative vesicles. Burning
ulcers, with yellowish-looking skin, Excoriation in children. Painful
corns in the feet. Warts, also with pain and inflammation.

Kali Carb : Painful sensibility of skin, as if it were ulcerated, when

pressing on it. Skin dry, with obstructed perspiration. Sensation of
burning, or burning and lancinating itching, in skin. Itching, burning,
yellow, or red spots on body , sometimes with oozing after being
scratched. . Bleeding of ulcers, . Ascites and anasarca. Swelling and
induration of glands, after contusions.

40
Lycopodium : Gnawing and itching in daytime, on getting heated, or
in evening, before lying down. Tendency of the skin to become chapped.
Painful eruptions. Nettle-rash (chronic). Large red spots on skin. full of
deep cracks and thick scabs. Bleeding ulcers, with shooting pain, which
burn while being dressed, or with nocturnal tearing and itching. Great
dryness of the skin.

Merc sol : Almost CONSTANTLY MOIST. Persistent dryness of the

skin contraindicates mercurius. Excessive odorous viscid perspiration;
worse, night. GENERAL TENDENCY TO FREE PERSPIRATION,
BUT PATIENT IS NOT RELIEVED THEREBY. Vesicular and
pustular eruptions. Ulcers, irregular in shape, edges undefined. Pimples
around the main eruption. ITCHING; worse from warmth of bed. Crusta
lactea; yellowish-brown crusts, considerable suppuration. Glands swell
every time patient takes cold. Buboes. Orchitis.

Mezerium : Sensitiveness to touch. General desquamation of skin of

body, Red rash, itching violently, worse in bed, from touch, burning and
change of place after scratching. Ulcers with thick, whitish, yellow
scabs, under which thick, yellow pus collects. Skin covered with
elevated white scabs. Itching, especially at night (when in bed), more .
Ulcers: sensitive and easily bleeding when removing the linen, which
sticks, painful at night, the pus tends to form an adherent scab, under
which a quantity of pus collects, burning and stinging with
inflammation. Vesicles around the ulcers, itching violently and burning
like fire. Suppuration after inflammation.

41
Natrun mur : Miliary eruption, with shooting pain. Itching and
pricking in skin. Rash over whole body, with stinging, sensation in skin.
Red tetter in hollow of knees. Pain and redness of an old cicatrix. Skin of
hands, especially about nails, dry cracked, hang-nails. Whitish hives on
arms and hands. Itching tubercles. Nettle-rash after violent exercise
(itching). Tetters. Furunculi. Exanthema on mouth, lips, in intermittent
fever where there are large exanthematous spots looking like large peas,
on lips (cold sores), lips look puffy. Warts, on palms of hands.
Panaritium. Varices. Corns.

Psorinum : Dirty, dingy look. Dry, lustreless, rough hair.

INTOLERABLE ITCHING. Herpetic eruptions, especially on scalp and
bends of joints with itching; worse, from warmth of bed. Enlarged
glands. Sebaceous glands secrete excessively; oily skin. Indolent ulcers,
slow to heal Eczema behind ears. Crusty eruptions all over. Urticaria
after every exertion. Pustules near finger-nails.

Rhus tox : Vesicular erysipelas where the vesicles are large.

Exanthema on face in general on face, cheeks, mouth, nose, forehead,
causing much burning itching. Pustulous chilblains. Exanthema in
general, burning, burning itching, pustulous, with swelling, blotches,
blisters which will sometimes spread up the limb, and are sometimes
circular in form, spreading with a red edge in the advance, which
gradually turns to a blister, the red border still keeping in advance (if the
edges be black, *Arsen.), itching worse after scratching. Rash itches a
great deal, in scarlet fever, small-pox, &c., Humidity of skin. Hardness
of skin with thickening. Swelling (hard) of affected parts. Erysipelatous

42
inflammations. Nettle-rash. Eruptions, generally vesicular, scabby, with
burning.

Silicia : FELONS, ABSCESSES, BOILS, OLD FISTULOUS

ULCERS. Delicate, pale, waxy. Cracks at ends of fingers. Painless
swelling of glands. Rose-colored blotches. Scars suddenly become
painful. Pus offensive. PROMOTES EXPULSION OF FOREIGN
BODIES FROM TISSUES. Every little injury suppurates. Long lasting
suppuration and fistulous tracts. Dry finger tips. Eruptions itch only in
daytime and evening. CRIPPLED NAILS. Indurated tumors. Abscesses
of joints. After impure vaccination. Bursa. Lepra, nodes, and coppery
spots. KELOID GROWTHS.

Bovista : Blunt instruments leave deep impression on the skin.

URTICARIA ON EXCITEMENT; with rheumatic lameness, palpitation
and diarrhoea. [Dulc.] Itching on getting warm. Eczema, moist;
formation of thick crusts. Pimples cover the entire body; scurvy; herpetic
eruptions. Pruritus ani. Urticaria on waking in the morning, worse from
bathing.

Calcarea sulph : Cuts, wounds, bruises, etc., unhealthy, discharging

pus;they do not heal readily. Yellow, purulent crusts or discharge.
Purulent exudation in or upon the skin. Skin affections with yellowish
scabs. Many little matter less pimples under the hair, bleeding when
scratched. Dry eczema in children.

43
Dulcamara : ADENITIS. PRURITUS, ALWAYS WORSE IN
COLD, WET WEATHER. Herpes zoster, pemphigus. Swelling and
indurated glands from cold. Vesicular eruptions. Sensitive bleeding
ulcers. Little boils. Red spots, URTICARIA, brought on by exposure, or
sour stomach. Humid eruptions on face, genitals, hands etc. WARTS,
large, smooth, on face and palmar surface of hands. Anasarca. Thick,
brown-yellow crusts, bleeding when scratched.

Heper sulph : Abscesses; suppurating glands are very sensitive. .

Easily bleed. Angio-neurotic oedema. UNHEALTHY SKIN; EVERY
LITTLE INJURY SUPPURATES. Chapped skin, with DEEP CRACKS
ON HANDS AND FEET. Ulcers, with bloody suppuration, smelling like
old cheese. ULCERS VERY SENSITIVE TO CONTACT, burning,
stinging, easily bleeding. Sweats day and night without relief. "COLD-
SORES" VERY SENSITIVE. Cannot bear to be uncovered; WANTS
TO BE WRAPPED UP WARMLY. .

44
 AUXILLARY OF MANAGEMENT

1. Avoidance of Cutaneous irritants.

2. Adequate cutaneous hydration.
3. Using of Luke warm water for bathing.
4. Limited use of soap.
5. Use of rubber gloves in eczematous hands.
6. Avoidance of mental stress.
7. Use of pure and hygienic drinking water and nutritious food .
8. Ventilated and airy surroundings with proper sun light.
9. Some people has allergy with some substances. It should be
recognized and avoided.
10. The works in which the heavy metals touches the body parts
should be changed.
11. The general health of the patient has to be improved , as eczema
often occurs in individuals with debility and ill-health.
12. The discharge should be cleaned.

45
 Material And Method :

The present study comprised 30 patients of PSORIASIS who attended

the OPD,IPDand peripheral opds of Bakson Homoeopathic Medical
College and Hospital,Greater Noida.
Inclusion criteria:
1. Patients in both sexes (male and female).
2. Cases of psoriasis with symptoms as confirmed by the ICD-10
criteria of the disease-
According to ICD criteria – Psoriasis L40
Skin marked by red patches covered with white scales. Psoriasis is
a skin disease that causes itchy or sore patches of thick, red skin
with silvery scales.
3. Patients complying with regular follow up.

Exclusion criteria
1. Cases on immunosuppressive drugs.
2. Cases having active treatment of other diseases.
Patient consent form
Patient consent form is being used here in this document to inform and
educate the patient that research has been conducted on him / her and
can be used for research / study purpose without disclosing their identity.

Blood Examination
TLC , DLC , ESR , HB% , carried out in most of the cases.

46
Blood Sugar
Blood Urea
Urine examination :
Microscopic and routine

The cases were analyzed and evaluated according to Kent’s method.

The cases were recorded keeping the holistic concept in mind. Case
taking was done according to the Case Performa.

All the cases were received once in 7 days for the first 3 months, then
once in 15 days for the remaining period of study or as per the demand
of the case and the progress were recorded.
The following parameters were fixed according to the type of response
obtained after treatment and these criteria should be fulfilled for at least
6 to 12 months.

1. Recovered: patient had shown remarkable positive response to the

treatment and completely rid of suffering for a considerable period.
Lesions cured and Patients who were very happy and did not return for
the same complaints for long time.

2. Improved: Feeling of mental and physical well being along with the
disappearance of the old symptoms and considerable reduction in the
lesions and appearance of new complaints.

47
3. Not Improved: Initial response but lot of suffering continued in spite
of administering the drug. No reduction of frequency / reduction of
complaints even after defined period of treatment.

Data Analysis: It was done by data sorting on the basis of pre-defined

parameters, statistical pie chart and computer programs using a master
chart prepared after compilation of the whole data.

48
 OBSERVATIONS & RESULTS
In this study a total of 30 cases of Psoriasis were taken up irrespective of
their sex and socioeconomic status.
1. Age:

Statistical study was conducted to find out their age incidence.

Sr. Age Group (Years) No. of Patient Percentage

No
1. 0 – 10 Years 2 6.67
2. 11 – 20 Years 7 23.33
3. 21 – 30 Years 13 43.33
4. 31 – 40 Years 8 26.67
Total 30 100.00%

As shown above, the maximum age incidence was between the age
group of 21-30 years in 13 cases (43.33%). The age group from 0-10
years showed 2 case (6.67%), 11-20 years showed 7 incidences(23.33%)
and 31-40 years there were 8 cases(26.67%). There were no cases taken
above 40 years. The youngest was 8 years of age and the oldest was 40
years of age (vide table no.1).

2. Gender:

The table given below shows the statistical study of sex incidence in
30 patients with psoriasis.

49
 As shown in the table, the maximum sex incidence were in males in
17 patients i.e. 56.66% and 43.33% i.e. 13 of the total cases were
female (vide table no.2).

Table 2. Sex Incidence

Sr. SEX No. of Patient Percentage

No
1. Male 17 56.66
2. Female 13 43.33
Total 30 100.00%

3. Predisposing factors:

A statistical study was conducted to know what percentage of patients had factors
predisposing to Psoriasis.
Table 3. Predisposing factors:

Sr. Factor No. of Patient Percentage

No
1. Physiological Long 10 30.00
Term Chronic Stress
2. Genetic Predisposition 6 20.00
3. Physical Trauma 3 10.00
4. Allergies 3 10.00
5. Local Skin Injury 2 6.66
6. Climate Change 3 10.00

50
7. Recurrent Infective 1 3.33
8. Drugs 3 10.00
Total 30 100.00%

The study showed psychology long term chronic stress in about 10 cases
(30%) it is one of the major predisposing factor, Genetic predisposing in
6 cases (20%), physical trauma and local skin injuries in 5 cases
(16.66%) allergies and recurrent infection in four cases (13.33%), drug
effect in three cases (10%) and climate change into 3 cases (10%) (vide
Table No. 3)

4. Socioeconomic Status

Table 4. for socioeconomic status

Sr. Class No. of Patient Percentage

No
1. Lower 9 30.00
2. Middle 16 53.33
3. Upper 5 16.66
Total 30 100.00%

Out of 30 patients, 9 cases were of lower socioeconomic status (30%),

16 cases were of middle socioeconomic class (53.33%) and 5 cases of
upper class family (16.66%)

51
 5. Acute Remedies used during treatments

Table 5. Acute Remedies used during treatments

Sr. Remedy No. of Patient Percentage
No
1. Bryonia 1 3.33
2. Nux vomica 1 3.33
3. Rhustox 1 3.33
4. Not given 27 90.00
Total 30 100.00%

In maximum patients i.e. 27 (around 90%) acute remedies have not been
given. Bryonia, Rhustox and Nux vomica has been given for each case
respectively (3.33% each).
6. Constitutional and Inter current Remedies Used
Sepia has covered maximum 4 cases each as constitutional remedy that
is (13%), Sulphur, Natrum mur, Murc. sol. covered 4 cases about each,
Petroleum covered 3 cases that is (10%), Staphysagria covered 2 cases
that is (6.66%), and the remedies Kali sulph, Kali. Ars., Mezerium,
Lycopodium, Graphites, Pulsatilla,Rhus Tox, and Phosphorus covered
one case i.e. (3.33%), Sulphur given as inter current Rx in one case.

Table 6. Constitutional and Intercurrent Remedies Used

Sr. Constitutional Remedies No. of Patient Percentage
No
1. Sepia 4 13.33
2. Sulphur 4 13.33

52
3. Natrum mur 4 13.33
4. Murc. sol. 2 6.66
5. Petroleum 3 10.00
6. Staphysagria 2 6.66
7. Pulsatilla 1 3.33
8. Kali sulph 1 3.33
9. Kali. Ars. 1 3.33
10. Rhus Tox 1 3.33
11. Graphites 1 3.33
12. Mezerium 1 3.33
13. Phosphorus 1 3.33
Total 30 100.00%

7. Results
Table 7. Results
Sr. Results No. of Patient Percentage
No
1. Recovered 8 26.67
2. Improving 17 56.67
3. Not Improved 5 16.67
Total 30 100.00%

In this case study of Psoriasis, about 8 cases had fully recovered i.e.
about 26.67%, around 17 cases were improving i.e. 56.67% and the
cases without improvement were 5 i.e. around 16.67% of the total cases.

53
 DISCUSSION

Psoriasis is a common dermatological problem faced by the both the

sexes throughout all ages. Healthy skin has a high cosmetic value as it
reflects the personality and confidence of a person in the modern era of
beauty peagents and marketing techniques. As the conventional system
of the medicine has limited scope, we need to study the cases properly to
give a better homeopathic approach by understanding fully this disease
condition.

In this study the majority of the patient, around 13 cases (that is 43.
33%) were between 21 to 30 years of age. The next frequent incidence
was seen between 31 to 40 years has around 8 cases (that is 26.67%).
Between 0 to 10 years 2 case was reported (that is 6.67%). The age
groups between 11 to 20 years has 7 cases (that is 23.33%). The
youngest patient was 9 years of age and the oldest was 40 years. This
confirms the statement of Hanseler. T. Christopher [7]. That onset of
Psoriasis is most common between 15 to 25 years it occurs really before
5 years. It also prove the statement that both sexes at any age may be
affected but the disease is prevalent between the ages of 10 and 30 years.

Considering the sex incidence, the study showed that out of 30 cases, 17
are males and 13 are females. This confirms statement that the incidence
of Psoriasis is equal common between both males and females [4]

In the present study undertaken, frequently found predisposing or

exciting triggering factors were taken in consideration. Out of 30 cases,

54
stress factor has influenced around 10 cases that is around 30% genetic
predisposition that is familial tendency also has been shown in 6 cases
out of 30 cases (that is 20%), followed by allergies, recurrent infections,
drug affection and also weather cases. This proves that stress and other
triggering factors like skin trauma, allergies, weather changes, various
medications to be major influencing factors in Psoriasis cases [4]

During the treatment of chronic diseases, the acute exacerbation needs to

be dealt with a great care with basis of totality being acute symptoms
only.[14] The acute remedy must be chosen according to the causal or
exicting factor and its active symptoms (Von Boenninghousen method),
not according to the chronic case history (apho. 36-40) of organon.
Frequently acute compliment of the deep acting remedy required by the
chronic disease is the suitable one. In our study only 3 patients that is
10% required treatment for acute episodes. The commonly used remedy
Bryonia, Rhustox and Nux vomica given in one case each.

In chronic cases the central disturbance of life force leads to the

initiation of disease process from within outwards indicated by the
development of constitutional symptoms being more marked. The
remedies used were CPR given in 6 cases (20%) Sulphur, Natrum mur
and Merc sol. were given in 4 cases each (13.33%) each, Petroleum was
given in 3 cases (10%), Staphysagria was given in two cases (6.66%),
Kali sulph, Kali ars, Mezereum, Lycopodium, Graphites, Thyroidinum
and Arsenic iod were indicated in one case each (3.33%).

55
In this study 8 cases (26.6&%) showed recovery with feeling of mental
and physical well-being. All the clinical signs disappeared and showed
no recurrence for next 6 months even after exposing to the triggering
factors by which they were affected previously and their investigation
report has also come to normal limits. 17 patient (56.67%) showed
positive sign of improvement and were feeling mentally and physically
better. Around 5 cases (16.67%) showed no signs of improvement. None
of the patients developed any complications during the course of
treatment. Considering the patient with no improvement, there was relief
of particular symptoms but the general condition of patient remain same.

Above study prove that homeopathic treatment is the most effective

treatment in bringing out a rapid gentle and permanent cure in such
chronic skin conditions.

Acute and sectoral remedies helped in managing the acute

exarcerbations during the cronic course of the disease and constitutional
treatment helped in permanent removal of the predisposition of the
patient to the disease.

To conclude on the efficacy of the Homeopathic medicines in preventing

recurrences, a long term study is deemed necessary.

56
 SUMMARY
In this study, 30 cases of Psoriasis belonging to all cases and
irrespective of their Sex coming for ages between 8 years to 40 years
were analyzed to examine the effect of age, mode of presentation, family
history, response to constitutional treatment etc.

The incidence was greatest in adults especially between 21 to 30 years

males were having higher incidence than the females in the study
conducted.

Psychological factors, genetic factors, allergies, weather changes,

recurrent attacks, hypertension, predisposed for the disease in majority
of the cases. Both exogenous and endogenous contributory factors
contributed in incidence of the disease.

Most of the patients reported with typical symptoms of Psoriasis.

Following diseases namely respiratory complaints, anaemia, gastric
complaints etc. were found in association with the disease.

The medicines used for the treatment were mainly constitutional and the
intercurrent remedies. The medicines used as acute remedies were given
in 30, 200 potencies and constitutional medicines in 200 potency. High
potencies were given in few cases as per the need.

Specific remedies, mother tinctures or local applications were not use

since all patients were having plenty of general and particular symptoms.
Diet, regimen and skincare was taken care of in all the patient.

57
8 cases (26.67%) showed recovery, 17 cases (56.67%) improved and 5
cases (16.67%) did not improve in spite of defined treatment. None of
the patients developed any complications during the treatment course.

As told by our great genius Dr. Hahnemann, the external manifestation

of skin cannot arise, persist or even grow worse without some internal
cause and without the Co-operation of the whole organism. And it is a
sin to treat them as a separate entity or by local applications. Following
his footstep, such diseases like psoriasis can be cured only with
constitutional treatment which not only stops the progression of
pathology but also prevents the complex diseases involving the vital
organs, which arises due to their suppression.

58
 CONCLUSION

• Age of patients has not shown any deviation from

standard observation.
• Sex ratio showed male preponderance.
• Patients belonged to all types of classes.
• C Commonly found predisposing factors are
psychological, genetic factor, allergies, drugs, skin trauma
and climate factors.
• Majority of the patients showed good response to the
constitutional treatment.
• Recurrence was prevented to great extent during the
period of study.

59
 Reference:
1. Davidson’s principles and practice of medicine 20th edition
2. Krueger, G, et al.The impact of psoriasis on quality of life : Results of
a 1998 national psoriasis foundation patient- member ship survey-
Arch.Dermatol.2001.
3. colc,William.”psoriasis”family Health..
4. http;//www.psoriasis.org,about psoriasis.
5. apps.who.int prevalence of psoriasis
6. http:// www. Aad. Org. American Academy of dermatology,
definition of psoriasis
7. Henseler, T, Christophers, E. psoriasis of early and late onset:
charaterization of two types of psoriasis velgaris. J. Am. Acad.
Dermatol. 1958. 13:450-456.
8. http:// www.medicinenet.com/psoriasis/ article.htm#what_is_psoriasis
9. shaiA, Vardy D, ZvulunovA(2002).”[psoriasis, biblical affictions and
patient’s dignity]” (in Hebrew). Harefuah 141 (5):
479-82, 496. PMID 12073533
10. Click Fs (1986)” lepra, prosa, psoriasis:, J. Am Acad. Dermatol 14(5
pt 1): 863-6,doi:10, 1016/so190-9622(86) 70101-1,PMID3519699.
11. Nestle FO Kaplan DH, Baker J(July 2009) “psoriasis”.N.Engl,
361(5): 469-509.doi:10, 1056/NEJMra0804595.
12. Lee MR, Cooper AJ. Australas J Dermatol. 2006 Aug; 47(3):151-9
Review, immunopathogenesis of psoriasis, Australas J Dermatol,
2006 Aug; 47(3);151-9
13. Br j Dermatol. 2004 sep;151 [3];594-9.prevalance of symptoms
experienced by patient with different clinical type 0f psoriasis.

60
14. J.T Kent’s Lectures on homeopathic philosophy, B Jain
publishers,2002,pg.no-174-176
15. Jason R Swanson, 2016 Anatomy and Histology of normal skin
16. Adapted from Hunter, 1995
17. Dockery and Crawford 2012 2nd edition
18. Savin and Dahl, 2013 4th edition clinical dermatology
19. Solomon’s, 1988- 2010
20. Habif, 2015
21. Koebner H. Klinische, experimentelle and therapeutische mittelugen
uber psoriasis. Berlin Klin Wochenschr 1878;21;6312
22. National Psoriasis Association 1999
23. Hahneman Chronic Disease
24. Roberts. A Herbert. The Principles and Art of Cure by Homoeopathy
25. j Eur Acad Dermatol venereal 2009 may ;23 (5);538-43Epub 2009
feb2.
26. www.similima.com/psoriasis-homoeopathy-managemet
27. Homeopathy for psoriasis-Hpathy Ezine,May,2014.
28. J.T. Kent – Le ctures of Homoeopathic Materia Medica, and
Repertory B. Jain Publishers, New Delhi.
29. Boger C.M; Boger Boeninghausen,s Characteristics and
Repertory,2nd Edition,B,jain publisher,2008.
30. Murphy Robin, HOMOEOPATHIC MEDICAL REPERTORY,2nd
Edition,B,Jain publisher,2003.
31. Samual Hahnemann,organon of medicine,5th ,6th edition,translated by
R.E.Dudgeon and William Boerick,B.Jain publishers,2009.
32. Psoriasis Symptoms & Treatment.Retrieved 2012-08-27
33. www.healblog.net/psoriasis

61
34. Roberts. A Herbert,The Principles and Art of cure by Homoeopathy,
B.Jain Publisher’s 2001 pg no-228
35. Chronic miasm in homeopathyband their cure with classification of
their rubrics/symptoms in dr.kent’s repertory from Ramanlal. Patel. B.
Jain publishers.
36. Dr. Chatterje T. P. My Random Notes on some Homeopathy
remedies,B.Jain publishers.pg no-16
37. The Science of therapeutics. according to the principal of the
homeopathy / by Bemhard Baehr, translated and enriched with numerous
additions from Kafka and other sources, by Charles J. Hempel.
38. Schussle’s Biochemic.. pocket guide with Repertory, New Delhi, B.
Jain Publishers, edition 2002.
39. Clarke JH. The Prescriber, A Dictionary of the New Therapeutics,
New Delhi, Indian Books & Publishers 2001, page no.61,135,235,266

62
 Annexures
Annexure 1
CASE PROFORMA
Bakson Homeopathic Medical Collage & Hospital, Greater Noida
Recognized by Central Council of Homeopathy, New Delhi
Affiliated to Dr. B. R. Ambedkar University, Agra, Uttar Pradesh.

Sr. No. OPD No.

Date Name of patient:
Age: Sex:
Religion: Marital status:
Occupation: Contact:
Final Diagnosis:
Chief complaints with Duration:

H/O Presents complaints:

Duration of onset:
Site of onset:
Generalised / localised
Type of Eruption:
Nature of lesion:
Changing the site/ non spreading
Manner of spread: symmetrical/ universitycal/ Bilateral/ Uniletral
Aggravated by:

63
Ameliorated by:
Site of lesion at present:
Pruritus:
Photosensitivity:
Any other skin lesion:
Scales formation:
Hypertension
Recurrent attacks when stress associated
Mucous membrane presention
Any other complaints (with duration and modalities)------------------------
Any topical application before the onset:
Systemic illness

III) Past history:

Any past history of similar complaints, asthma, urticarial, Hay fever,
Tonsillitis, hypertension or any
Other significant past history.

Any past history of the same complaint:

Disaeses suffered from:
Approximate age:
Duration:
Whether completely recovered:
Medicine & treatment taken:
Remarks:

64
Family history:
Yes No Na If yes,
relationsip
A Dermatitis/
Eczema
B Asthma
C Urticaria
D Allergic
Rhinitis/ Hay
fever
E Tonsillitis
F Diabetes
mellitus
G Hypertension
H Tuberculosis
I Rheumatism
J Cancer
K Migraine
L Peptic ulcer

Grandparent(s)/ parent(s)/ sibling(s)/ children/ uncles/ aunts/

(Blood relations)
If any other relevant family history (specify)
If death due to the same please mention

65
Personal history:
a. Diet g. Micturition
b. Appetite h. Aversion
c. Perspiration i. Sexual
d. Thirst j. Habits
e. Bowels k. Addiction
f. Desires

Menstrual history:
Menarche ………. yrs.
Duration: ………. Days
Nature of flow: Acrid Bland/ Clots/ Offensive
Colour: Bright red/ Pale/ Dark
Any other Character:
Leucorrhoea: Profuse/ Scanty/ Watery/ Stringy Acid/ Bland/
Offencive/
Any other complains before/ during after, means:

Thermal state:
Bath:
Cold/ Luke warm/ Hot/ All the seasons same type of water uses/
Changes/ According to season. Covering prefers:
Yes/No/ Thick/ Woollen/ Thin/ Blankets/ in summer covers in the
similar way as cover in winter/ cover up to neck/ even head.
Seasons prefer:

66
 Summer/ winter/ Rainy/ easily chilled by rain/ cannot tolerate
damp climate/ cannot tolerate hot climate/ Extremities of climate
easily affect. Fan or air conditioners.
Not required/ always requires/ far distance/ troublesome after
using fan or A.C. Food prefers: Cold/ Warm/ Hot/ All climates/
Atmosphere:
Warm Room/ Open air/ Breeze when at outside/ Stormy
Weather/………
.

ANALYSIS OF THERMAL STATE:

Hot/ Chilly/ ambithermal
Position prefer: Any particular position prefer while standing,
sitting, sleeping.
Any other details of personal history

General modalities
Aggravation by: Cold bathing/ Cold climate/ Warm bathing/
Sudden climate change/ Prespiration/ Sunlight/ Dust/ Open air/
Warm room/ During menses.
Amelioration by: cold bathing/ Warm bathing/….
Relation with use of cosmetics
Relation with mental stress and strain
Relation with pregnancy
Life space/ mental reaction: events from childhood to at present,
which made some impact in the patient mind mental reaction of
the patient with different life situations.

67
 Life Space Analysis and Emotional state:
Sleep:
Nature: sound/ Disturbed/ Unfreshing/
Any reasons for disturbance
Timings:
Sleep abnormalities: weeps during sleep/ Talks
Sleep position:
Any other details:
Dreams: no dreams/ Unremembered
Frequent dreams of same things or events:

Dreams Analysis:
General physical examination:
i. Appearance:
ii. Constitutional appearance:
iii. Attitude and behaviour: friendly/ hosetile/ reserved/
Cooperative
iv. Activity: active/ sluggish
v. Built and nourishment:
vi. Hair and Scalp: Baldness, Greying, lustreless/ Dryness,
Dandruff/
vii. Eyes and eye lids: congestion, pallor, jaundice, Spots,
cataract/styes, Oedema
viii. Ears and ear lobes: Discharge, wax/ cyanosis
ix. Nose and nostrils; DNS/ Congested/ polyps/ Hypertrophied/
turbinates.
x. Mouth, teeth, gums and lips: Salvation, Dry/ caries/ Songy,
Dry, Pale, cracked.

68
 xi. Tongue: Dry, Moist, Cyanosis/ Cracked/Clean/ Fissured
xii. Throat and tonsils: Congested, Hypertrophed
xiii. Face and Foreheads: Oily, Dry, Pimply, Emaciated,
Wrinkled, Male, baldness
xiv. Neck and Shoulders: Short, Long, Emaciated/ Stooped
xv. Nails and nail beds: Pink/ Pale/ Cyanosis/ Hang nails/
Spots/ ridges/ Clubbing/ Koilonycha Sub – ungula
Keratosis/
xvi. Skin: Oily, Dry, Pimply, Scaly, Fine, Delicate, Fair, Dark,
Medium, Rough, Pigmentation,
xvii. Upper limbs.
xviii. Lower limbs: Oedema
xix. Chest and abdomen:
xx. Back, Gluteal region and Perineum:
xxi. Lymph nodes:
xxii. Any other details:

VITAL SIGNS
Pulse rate: ……….………………….beats/ minutes

Respiratory rate: …………………….cycles/minutes

Temperature: ………………………..degree F
Blood pressure: ………./……………Mm/hg
Height: ………………………………Feet
Weight: ………………………………kgs

Local Examination of skin:

Patches……….. Size…….. No……..
Lichenification:

69
 Scaling:
Any other findings:

Systemic Examination:
Respiratory system:
Cardiovascular system:
Central nevous system:
Gastro intestinal system:
Other systems:

Investigation system:
Blood
Tlc:
Dlc:
Neutrophils: %
Lymphocytes: %
ESR
Absolute eosinophil count:
Analysis & Evaluation of symptoms:
Repertorial analysis:
Remedial Analysis:
General Management:
Diet:
Auxiliary measures:
Specific:

70
FOLLOW – UP:
Date Follow-up Remedy

Size of the patch

No.
Lichenification
Any other symptom
Appetite:
Thirst:
Bowels:
Urine:
Sleep:
General condition:
New symptoms:

Result Remedy
Recovered Acute
Improved Constitutional
Not improved Intercurrent

71
 Annexure-2 Graphs
No. of Patients as per Age Group

Age Group 0 - 10 Age Group 11 - 20 Age Group 21 - 30 Age Group 31 - 40

7%

27%

23%

43%

72
No. of Patients according to Gender
Male Female

43%

57%

Socio-Economic Status
Lower Middle Upper

17%

30%

53%

73
 Results
Not Improved Improved Cured

17%

56%
27%

74
 Annexure-3
Case detail of case 1
Patient’s Details
Name – Mr. ABC
Age/Sex – 32 yrs/M
Address – Manak pur
Religion – Hindu
Marital status – Married
Occupation – Private job

Presenting Complaints
1. Skin eruption in both hands, feet, back since last 9 yrs.
Character of eruption – Round, Scaly& Pealing of blood.

2. Itching+++

3. Itching more in morning and evening. more in moist weather

or ,weather change.
4. Sensation of warm, fire feeling in palm, soles and abdomen.

History of Present Complaints

He was suffering from headache then he had taken

Allopathic medication resulting eruption first appeared
on head.

75
Past History

Typhoid 3 times at the age of 9yrs, 25yrs, and 30 yrs.

No history of any accidents or animal bite.

Vaccination - On time

Allergies - None

Operations – None

Personal History

Developmental landmarks: On time

Marital status: Married.

Diet: Vegetarian.

Education: Under Graduate.

Habits/Addictions: Bidi, Hukah..

Any allergy: Not specific.

Family History
NOT SPECIFIC

Physical Generals

Urine : Clear

Perspiration : more on head, offensive.

76

Discharge : not specific

Sleeps : During day time, because he works at

night shift.

Dreams : Attending wedding taking food.

Mental Generals

Memory weak, forgetfulness.

Anger is so marked, but it is generally expressed after the

disease have started.

Conscious about trifles, Very anxious about every little things.

DISPOSITION: want to do job in army but declare unfit due to

perforation in tympanic membrane.

General Physical Examination

Physical built : Fair complexion, Lean & thin, Cylindrical
built.

Nutrition : Good

Pallor : Not present

Icterus : Not present

Odema : Not present

Cyanosis : Not present

Pigmentation : Normal

77

B.P :130/70 mmHg

Pulse : 70/min, Regular

Systemic Examination

Skin- Multiple, dry, erythematous circumscribed lesion over

the back, both hands and feet . Itching+++, scaling+, with fine
silvery white scales.

Totality of Symptoms

Skin eruption in both hands, feet, back since last 9 yrs. Character
of eruption – Round, Scaly& Pealing of blood.

Itching+++, Scaly, Pealing of blood.

Itching more in morning and evening. more in moist weather or

,weather change.

Sensation of warm, fire feeling in palm, soles and abdomen.

Memory Forgetful, Conscious about trifles.

Desire for cold drink even in winter.

Repertorial totality:
1. Ailment of reserved displeasure
2. Memory forgetful
3. Anxious about every little things.
4. Desire – cold drink even in winter.
5. Sensation: fire like feeling on the palm and soles.
6. Aggravation : change weather

78
Analysis of Symptoms
Symptom MG/PG/P Common /
Uncommon
Anxious about every MG UC
little thing.
Memory MG UC
forgetfulness
Desire for cold drink PG UC
even in winter
Burning Sensation on PG UC
Palm & Sole
Aggravation : change PG UC
weather

Evaluation of Symptoms

Symptom Intensity

Look conscious 1+

Profuse thirst 2+

Desire: sweet 2+

Perspiration more on head 2+

Memory forgetful 2+

79
Miasm – Psoric

Symptoms Psora Sycosis Syphilitic

1. Fire like sensation on palms of hands
and soles √

2. Desire for cold drink √

3. Worse on weather changes √ √ √

4. Despair with excessive itching √

5. Anxious √

Final selection of remedy

Phosphorus was chosen on the basis of following points-
• Ailment of reserved displeasure.

• Memory forgetful.

• Anxious about every little things.

• Desire cold drink even in winter.

• Fire feeling sensation in the palm and sole.

• Aggravation to change weather.

• Amelioration: Sleeping.

80
First Prescription
Rx,

Phosphorus 200
B.D for 2 days
On 2nd march 2016
FOLLOW UP - 1
Date Presenting complaints Remedy Remarks
prescribed with
potency and
dosage
08/3/2016 Feeling better SL- 30 +BD Medicine was
prescribed
considering
reportorial and
symptomatic
totality.Remarks
16/3/2016 Symptoms [psoriasis] Phosphorus 200 General
Agg.-after medicine, B.D management
He has left his job 4-5 2 dose advised.
Days due to this problem. Remarks
Mentally very depressed,
weeping appetite decrease.
Eruption appear on new site.

30/3 /2016 Eruption much better Phosphorus

On back ,hand . Flushing from 200 B.D 2 d0se
whole body. Much scalies
peeling out from eruption. Feel
anxiety. thirst profuse chilled
water.

81
04/4/2016 Small new eruption at elbow Phosphorus
joint .psoriasis much better.
Flushing better.
08/6/2016 Red patches appear, itching S/L 30 3D/ 30
present, burning after scratch, days
but feels better than before .
Pain in wrist , elbow, knee
joint.
13/7/2016 Better. Discharge.
14/9/2016 All the complaints relief ,[90 Phosphorus
%] 200
S.L 30 for 1
month

30/10 /2016 Patient reported with S.L B.D for 1

marketed improvements, there month
was marked improvement in
itching and lesions over all
have disappeared. No
appearance of any new lesions
04/11/2016 Patient reported with S.L B.D for 1
marketed improvement with month
an overall sense of well being.
The lesions have all
disappeared, there is no sence
of irritability and anger now.
His appearance also have
changed more bright and
active the patient was asked to
come back if there are
appearance of any new lesions.

82
Case detail of Case -11
Patient Detail
Patient’s Name -XYZ
Age/sex -32/M
Religion -Muslim
Occupation -Day worker
Address -Gulistanpur
Presenting Complaint
• Patient has complaint of Itching eruption at both side of for arm
Since last one year on and off. Erythematous scaling lesion with
itching ++.burning after scratching.

• Mild headache with feeling of congestion in head.

• Cold and coryza with burning in head and eyes.

History of Presenting Complaints

• The patient, a 32yr old patient had complaint of Itching eruption at
both side of for arm since last one year on and off. Erythematous
scaling lesion with itching ++. He had taken allopathic treatment
for the same but he got temporary relief but again the symptoms
reappeared after sometime.

• Occasionally symptoms of cold and cough. Patient kept on taking

medicines advised from a local chemist which only brought him
temporary relief.

After some time, the eruptions had covered a major part of forearm and
secondary changes were seen like oozing of blood with itching.

Past History

Cold and cough, no other significant history of any major illness

accounted.

Family History

Father and mother died in an accident at early age.

83
Personal History

Developmental landmarks : On time

Diet : Non Vegetarian
Habits/Addictions : None
Educational Status : Studied till 5th standard
Any allergies : Nothing Significant
Environment at home : Disturbed

Physical Generals

Appetite : Easy satiety. 2-3 meals a day

Thirst : For small quantities (decreased)
Desire : N.S
Aversion : N.S
Stool : D1-2 N0, Satisfactory, NAD
Urine : D4-5, NAD
Sleep : Adequate, murmuring during sleep
Dreams : Unremembered
Perspiration : Generalized, NAD
Thermal reaction : Hot patient

Mentals

Calm and composed.

Suppression of anger and emotions.

Doesn’t like to talk much,

Enjoys music.

Wants love and attention.

Life Space

The patient was 10 years old, when his parents died in an accident. He
and his 2 year old brother and a sister were taken care by some
neighbours. After few months they all were unwillingly taken by his
paternal uncle on demand by the court of law after appealed by the
neighbours. They were ill-treated and being the eldest he was forced by

84
his uncle to work and earn if he wanted to stay in house with siblings.
He was sent on farms, dhabas and where ever daily wages were given.

General Physical Examination

Level of consciousness : Well oriented

Built and nutrition : Thin built, Poor nutrition
Decubitus : Of Choice
Pallor : Present
Icterus : Absent
Cynosis : Absent
Pigmentation : Normal
Clubbing : Absent
Lymphadenopathy : Absent
Oedema : Absent
Tongue : Clean and moist
Temperature : 100.50F
Respiratory Rate : 14/min
Pulse : 82bpm, regular
Height & Weight : 165 cm & 70 kg
Systemic Examination
Examination of skin eruptions

Site : Lesion at both side of fore arm.

Colour : Erythematous

Eruptions/lesions : Itching with scales formation.

Hemorrhage : Peeling of blood after scratch

Provisional diagnosis
Psoriasis

CASE PROCESSING

SYMPTOMS OF CASE

Eruptions on the both side of fore arm.

Itchy eruptions is burning after scratching

Cold and coryza with burning in head and eyes.

85

Murmuring during sleep

Suppression of anger and emotions.

Doesn’t like to talk much.

Wants love and attention.

Appetite: Easy satiety.

Thirst: For small quantities, decreased.

murmuring during sleep

Analysis of symptoms
Natural /
Causa
Sr.no. Symptoms miasmati occasionalis
c
1 Eruptions on the both side of fore arm.

2 Itchy eruptions is burning after scratching ü

3 Suppression of emotions. ü
4 Doesn’t like to talk much. ü
5 Appetite: Easy satiety. ü
6 Thirst: For small quantities, decreased ü
7 Murmuring during sleep ü

Miasmatic Analysis
Sr.no Symptoms Psora Syphilis Sycosis

1 Eruptions on the both side of fore arm.

2 Itchy eruptions is burning after scratching

3 Suppression of emotions.
4 Doesn’t like to talk much.
5 Appetite: Easy satiety.
6 Thirst: For small quantities, decreased
7 Murmuring during sleep.

86
Totality of Symptoms

Murmuring during sleep

Suppression of anger and emotions.

Doesn’t like to talk much

Appetite: Easy satiety

Thirst: For small quantities, decreased

Eruptions on the both side of fore arm.

Itchy eruptions is burning after scrathing.

Repertorial Analysis
Rubrics: Kent Repertory
1. Mind, muttering, sleep, in.

2. Mind, anger, suppressed from

3. Mind, talk, indisposed to, desire to be silent, taciturn

4. Stomach, appetite, easy satiety

Repertorial result
5. Stomach, Thirstless Rhus t :17/7
Merc :15/8
6. Skin, eruptions, burning after scratching Sepia :15/8
Sulph :15/8
7. Skin, eruptions, itching++
Ars :13/8
Staph :11/7
Prescription
Rhus Tox 200 x BD x7days
FOLLOW UP - 1
Date Presenting complaints Remedy Remarks
prescribed with
potency and
dosage
02/9/2017 Feeling better SL- 30 +BD Medicine was
prescribed

87
 considering
reportorial and
symptomatic
totality.Remarks
16/9/2017 Symptoms [psoriasis] Rhus Tox 200 General
Agg. - after medicine, B.D management
due to this problem. 2 dose advised.
Mentally very depressed, Remarks
weeping appetite decrease.
Eruption appear on new site.

30/10 /2017 Eruption much better Rhus Tox 200

On forearm. Much scalies B.D 2 d0se
peeling out from eruption. Feel
anxiety.
04/1/2018 Small new eruption appear. R.T

08/2/2018 Red patches appear, itching S/L 30 3D/ 30

present, burning after scratch, days
but feels better than before.
burning better.
13/3/2018 Better. Discharge.
14/4/2018 All the complaints relief ,[80 R.T 200
%] S.L 30 for 1
month

28/5 /2018 Patient reported with S.L B.D for 1

marketed improvements, there month
was marked improvement in
itching and lesions over all
have disappeared. No
appearance of any new

88
 lesions.burning after
scratching completely relieved.
02/6/2018 Patient reported with S.L B.D for 1
marketed improvement with month
an overall sense of well being.
The lesions have all
disappeared,. His appearance
also have changed more bright
and active the patient was
asked to come back if there are
appearance of any new lesions.

89
CASE DETAIL of Case-18

• Name : Mrs. A

• Age : 29 Yrs.

• Sex : Female

• Religion : Hinduism

• Marital status : Married

• Occupation : Employee in bank

• Address : Mahipalpur, New Delhi

• Reg. No. : A -24/16

PRESENTING COMPLAINTS

Patient is suffering from itching from last two months at lower back and
knees which worse principally in evening itching violently in bed.
Sleep disturbed with burning in urination.

HISTORY OF PRESENTING COMPLAINS

Patient was apparently well six months before she developed itching
at lower back. With a well-defined, red based lesion covered with a
uniform silver scale. She took allopathic treatment for the same but it got
temporarily relief and again she is suffering from the same.

PAST HISTORY
• Mumps at the age of 19 years.

FAMILY HISTORY
• Father: Nothing significant

• Mother: Nothing significant

• Siblings: Nothing significant

PHYSICAL GENERALS

90
 • Appetite – Decreased , 2meals/day

• Thirst – Thirstless [1 -2 glass per day]

• Stool – One time/day, Satisfactory, Regular

• Urine – Burning during urination

• Sleep – Disturbed

• Desire(s) – Salty things

• Aversion(s) – fatty and rich food

• Perspiration – Normal, non-offensive, non-staining

• Thermal Reaction – Hot patient

MENSTRUAL HISTORY
• Menarche- At the age of 13years

• LMP- 11 Jan 2016

• Cycle- 28 days

• Duration- 3days

• Flow- Normal, bright red colour

OBS HISTORY

Go Po Ao

MENTALS
• Cannot bear the sufferings of others

• Weeping when alone, consolation ameliorates

• Fear of Ghost

• Desires for company

• Cannot stay with same friends for long time.

91
GENERAL PHYSICAL EXAMINATION
• Built – Ectomorphic

• Temperature – 98.80F

• Pulse – 80 per minute, full, regular

• Rate of Respiration – 14 breaths per minute

• Blood pressure – 110/80 mm of Hg

• Pallor – Absent

• Icterus – Absent

• Cyanosis – Absent

• Oedema – Absent

• Clubbing – Absent

• Lymph glands – Not enlarged

• Tongue – Dry and Clean

• Height – 5 feet 2 inches

• Weight – 53 kg

SYSTEMIC EXAMINATION
Skin - dry, erythematous circumscribed lesion at the lower back,
and knee. Itching++, scaling+, with fine silvery white scales.
• Respiratory System – NAD
• Cardio Vascular System – NAD
• Central Nervous System – NAD
PROVISIONAl DIAGNOSIS
Plaque Psoriasis
CASE PROCESSING
Analysis of symptoms
(ACCORDING TO DR. HAHNEMANN)

92
GENERAL SYMPTOMS-
• Appetite- decreased

• Burning in urine

• Sleep- disturbed

UNCOMMON SYMPTOMS-

• Cannot bear the sufferings of other

• Weeping when alone , consolation>

• Desires for company

• Fear of ghosts

• Cannot stay with same friends for long time

• Desires salty things

• Aversion to fatty and rich foods.

• Hot patient

• Nausea and vomiting < by oily foods

• Thirstless

EVALUATION OF SYMPTOMS
(According to Dr. J. T. Kent)
MENTALS
WILL & EMOTION INTELLECT & MEMORY
UNDERSTANDING
Can not bear the Fear of ghosts
sufferings of others Can not stay with same
friends for long time
Weeping when alone,
consolation >
Desire for company

PHYSICAL GENERAL
GRADE – I GRADE - II GRADE – III

93
 -------- Appetite- decreased Thermal- Hot
Thirst less Sleep- disturbed
Desires- salty things
Aversion- fatty &rich
food
Burning in urine

PARTICULARS:
• Itching at back and knee
• which worse principally in evening itching violently in bed.
• Nausea and Vomiting < eating oily food
S. no Symptoms Psorsa Syphillis Psycosis Psedu-
psora
1. Can not
bear the
P
suffering of
others
2. Desire for
company
P
3. Weeping
when alone,
P P
consolation
>
4. Fear of
ghost
P
5. Cant stay
with same
P
friends for
long time
6. Appetite –
decreased
P
7. Thirstless P
8. Desires –
Salty things
P
9. Aversions –
Fatty and
P
rich food
10. Urine –
Burning
P
11. Sleep –
Disturbed
P
12. Hot patient P

94
 13. Itching
worse in
P
evening
14. Nausea <
oily foods
P
15. Vomiting <
oily foods
P

MIASMATIC DIAGNOSIS
PSORO- SYCOTIC
TOTALITY OF SYMPTOMS
• Cannot bear the suffering of others

• Weeping when alone , consolation >

• Desire for company

• Fear of ghost

• Can not stay with same friends for long time

• Appetite-Diminished

• Thirst less

• Desires – salty things

• Aversion- fatty & rich food

• Burning in urine

• Disturbed sleep

• Hot patient

• Itching worse in evening

• Nausea& Vomiting < eating oily foods

95
REPERTORIAL TOTALITY
(According to Kent Repertory)
NON- REPORTRIAL
TOTALITY
Can not bear the sufferings of Mind – Sympathetic
others
Weeping when alone
Consolation ameliorates
Desires for company
Fear of ghosts
Can not stay with one friends Mind –capriciousness
for long time
Appetite – Decreased
Thirst – Thirstless
Desires – Salty thing
Aversions – Fatty and rich
food
Urine – Burning
Sleep – Disturbed
Hot patient
Itching worse in evening
Nausea < Oily foods
vomiting< oily foods
96
REPORTORIAL TOTALITY
Mind -Weeping, tearful mood-
alone when
Mind – Consolation- amel.
Mind – company, desire
Mind – fear – ghosts of
Stomach- Appetite –
diminished
Stomach – Thirstless
Stomach – Desires – salty food
Stomach- Aversion to –fatty&
rich food
Urine – burning (include hot)
Sleep – Disturbed
Generalities-warm-
aggravation
Skin-itching worse evening
mach – nausea, fats after
eating
Stomach- vomiting, fats after
eating
 REPERTORISATION
(According to Kent Repertory)

REPERTORIAL RESULT
• Pulsatilla 28/13

• Phosphorus 23/12

• Sulphur 23/11

• Natrum mur 20/11

WHY PULSATILLA ????

• Sympathetic ( Boericke Materia Medica)

• Fear of ghosts (Boericke Materia Medica)

• Weeping when alone, consolation >(Boericke Materia Medica)

• Desires for Company (Kent’ Repertory)

• Capriciousness (Kent’ Repertory)

• Diminished Appetite (Kent’s Repertory)

97
 • Thirstless(Kent’s Repertory)

• Aversion fatty and rich food (Kent’s Repertory)

• Sleep – disturbed (Boericke Materia Medica)

• Urine- Burning (Kent’s Repertory)

• Hot patient (Kent’s Repertory)

PRESCRIPTION

20th Jan 2016

Rx
1. Pulsatilla 200C/ 1 dose

2. Rubrum. 30/ tds for 1 week.

Management

• Drink at least 3-4 liters of water.

• Keep Skin clean and apply coconut oil and don’t scratch
violently

FOLLOW UP

28th Jan 2016

• Itching slightly reduced.

• Burning in urine same as last Nausea & vomiting slightly

reduced.

• Appetite same as last visit.

Rx
Rubrum. 30
T.D.S. for 15 days

98
FOLLOW UP

13th Feb. 2016

Itching at lower back region relieved.

Burning in urine slightly relief.
Nausea & vomiting stop.
Appetite good.

Rx
1. Rubrum. 30
T.D.S. for 1 month

FOLLOW UP

14th March 2016

• All complaints relief.

• Appetite improved.

• General conditions better.

Rx
Sac lac. 30
T.D.S. for 1 month

FOLLOW UP
15th April 2016

Red patches re appear, itching present, burning after scratch, but

feels better than before.
Rx
Pulsatilla 1M/ 1 dose
S/L 200/tds for 1 month

FOLLOW UP
16th May 2016

99
 • itching relieved.

• Urine- normal

• Appetite improved.

• General conditions of patient better.

Rx
Placebo200/ tds for 1 month
FOLLOW UP
20th June 2016
• All complaints relieved.

• Appetite good

• Sleep normal

• Skin lesions almost disappear

Rx

S/L 30/tds for 1 week

11th July 2016

• No complaints.

Patient reported with marketed improvements, there was marked

improvement in itching and lesions over all have disappeared. No
appearance of any new lesions

100
 Annexure -4
SUMMARY OF CASES
Case-1
In this Case the Patient is 32 years old Male suffering from skin eruption
on both hands feet and back. Itching more in morning and evening. More
in moist weather or weather change. Memory weak forgetfulness.
Conscious about trifles. Desire for cold drink even in winter. Fire like
feeling sensation on the palm and sole. After proper repertorization with
his mental, physical and particular symptoms the remedy, Phosphorus
200 is prescribed. At next visit burning is improved. Sac Lac is
prescribed now he feels much better.

Case-2
A 36-year old male patient presented with a three-month history of a
generalised eruption. The lesions were occasionally itchy. His past
medical history was not significant except for mild hypertension for
which he received no treatment.Physical examination showed well-
defined, erythematous plaques, covered with squames, with a
generalised distribution as well as scalp involvement.General
examination was not significant. He received the homeopathic remedy
Sulphur at M potency with weekly administration and a sulphur- based
cosmetic cream for his itching. At his follow-up visits at 1 and 2 months,
he showed marked improvement and, at 4 months, he showed almost
complete clearing. He is still-lesion free 1 year after cessation of
treatment, with the exception of a few mild erythematous lesions in his
elbow areas.

101
Case-3
In this case the patient is 29 years old. He has developed erythematous
scaling lesion on the scalp, specially hair margin with itching. All these
complain worse in summer. He likes salty food. Patient are emotionally
very sensitive .he has intense emotional and sentimental attachment for
peoples. He is very introvert desiring only to be alone. Along with that
he is suffering from headache on and off. . In this case Psoric miasm is
in the background. . After proper repertorization with her mental,
physical and particular symptoms the medicine prescribed is,Natrum
mur 200. After taking the medicine his suffering is little awhile but after
some time he feels better.

Case-4
22.11.17. Patient is suffering from dry scaly and itching eruption on
right side of thigh and abdomen mostly worse at mid day and mid night.
It is temporarily relieved from some hot application. Patient has anxiety
and restlessness about his health. This is also a case of mixed Miasm but
Psora is in the background. After proper repertorization with her mental,
physical and particular symptoms the remedy, Arsenic 1M is prescribed.
After a few days she feels much better in both mental and skin
symptoms.

Case-5
A 29-year old female patient presented with a history of skin eruptions
of 1 year duration. The nail disease comprised small, fluid-filled,
discoloured nails. These had been preceded by palmar, squamous
lesions. She had been diagnosed with psoriasis and treated with topical

102
steroids. Her past medical history included an appendicectomy at 12
years of age,. On examination, yellowish nail discolouration, She
received the homeopathic remedy Arsenicum album at 200 potency,
weekly. At 6 weeks, she had observed substantial improvement in her
general state and felt able to resume many activities, although she
showed a mild aggravation of her palmar lesions. Subsequent visits
showed amelioration of these lesions and nail growth. She returned 2
months later and her nail lesions were gone, with the exception of the
nail of her right ring finger, which, though diminished, was still not
completely healed.

Case-6
13.12.17.. Patient age 24 year patient has complaint of Itching eruption
at medial aspect of neck and knee joint which is diagnosed as psoriasis.
With this at general level there is intense craving for salty things. His
thirst is increased. The Pt. is hot. he is hopeless to everything. he has
also family history of skin disease. It is the case of Psora is in the
background. After repertorization Nat-mur 200 is prescribed. After
taking it itching improved within one week.
Case-7
03.01.18. In this case the patient age 36 years old businessman. Patient
suffering from psoriasis at palm and finger of hand with bleeding’ the
disease caused from suppression of a normal itching eruption by some
local treatment. With skin disease he has some abdominal disease. There
is gastralgia pressing and drawing pain, whenever stomach is empty;
relived by constant eating, Agg. in winter. In this case Sycosis miasm is
in the background. After proper repertorization the medicine prescribed

103
is, Petrolium-200. After taking the medicine his suffering is little awhile
but after some time he feels better.

Case-8
02.02.18..In this case the patient aged 35 yrs. has diagnosed as psoriasis
on breast and abdomen . She has fat and flabby constitution with
unhealthy skin. Her menses commenced at the age of twelve yrs. About
10 yrs ago she experienced bearing down. Her menses became too
profuse and protracted. Under routine treatment the menstrual flow at
last disappeared She has family history of asthma. Pain in stomach with
flatulence. This is the case of Sycosis miasm. The remedy after
repertorization, Graphitis 200 is prescribed to the patient. After taking
medicine she gradually improved. She now enjoy good health.

Case-9
10.02.18..In case 13 the patient is 15 year old . Patient suffering from
psoriasis at soles, knees, and Palms. The disease caused from
suppression of a normal itching eruption by some local treatment. With
skin disease she has some abdominal disease. There is extreme lack of
confidence. along with eczema there is cracks in the fingers. The Pt. is
highly chilly. There is discharge honey like sticky. Pt. is very sensitive to
change of weather. In this case Sycosis is, Petroleum200. After taking
the medicine his suffering is little awhile but after some time the
improvement starts.
Case-10
28.02.18..In case18 the patient is 28 year old female. Patient suffering
from psoriasis at forearm and back the disease caused from suppression

104
of a normal itching eruption by some local treatment the Pt. is indifferent
to everything the skin looks yellowish in colour. There is craving for
sweet . the Pt. is chilly. With skin disease shee has some abdominal
disease. There is intense craving for sweet. In this case Psoric miasm is
in the background. After proper repertorization the medicine prescribed
is, Sepia 1M. After taking the medicine her suffering is little awhile but
after some time she feels better.

Case-12
13.03.18 . Patient aged 17 yrs. who is suffering from dry scaly and
itching eruption on soles of both feet. It is diagnosed as psoriasis. She
suffers from 5 yrs. Itching is temporarily relieved from some cold
application. Along with this there is burning in palms and soles. Burning
is aggravated in night and is releaved by uncovering. This is purely
psoric case. After proper repertorization with her mental, physical and
particular symptoms the remedy, Sulphur 200 is prescribed. At next visit
burning is improved. Sac Lac is prescribed now she feels much better

Case-13
02.04.18.. In case 19 the Patient is 9 yrs old. He is suffering from oozing
and itching eruption on scalp and forehead upto hairline. there is much
discharge of sticky fluid. Hairs glued together. A layer of thick crust is
formed. Crust is yellowish in colour. It is temporarily relieved from
some hot application. The Pt. is mentally restless. There is despair of
recovery. This is also a case of Syphlis is in the background. After
proper repertorization with her mental, physical and particular symptoms

105
the remedy, Mezerium 200 is prescribed. After a few days he feels much
better in both mental and skin symptoms.

Case-14
07.04.18. In this Case the patient is 38 years old and he has a scaly and
moist itching eruption at nape of neck with headache aggravated by
washing and cold atmosphere. There is oozing of sticky fluid. The Pt. is
chilly. His symptoms are aggravated in summer. It is diagnosed as
psoriasis. After complete case taking the case is recognized as a mixed
Miasm case but at that time Psora is dominant. When it is repertorized
Petroleum is selected the remedy which cover the maximum symptom.
Petroleum 200 is prescribed. The sufferings are increased for some time
but when she came next time he feels some relief.

Case-15
16.5.18..In case 3 the patient is 25 year old a student. Patient suffering
from psoriasis at right foot the disease caused from suppression of a
normal itching eruption by some local treatment. With skin disease he
has weak digestion along with fear and anxiety. In this case Psoric
miasm in the background. After proper repertorization the medicine
prescribed is, Lyco200. After taking the medicine has no improvement

106
Case-16
A 18-year old male patient, presented with a skin eruption localised to
the scalp and ear areas, which began 4 years before. It began in the area
of the left ear, then remained stable in the 1 year preceding presentation.
It appeared on the scalp about 1 month before presentation. He had
received topical steroids with temporary relief. His past medical history
was insignificant. On examination, an erythematous, well-defined
plaque, covered with squames could be seen in the left preauricular area.
General examination yielded nothing significant. The patient initially
received the homeopathic medicine Lycopodium at C200 potency, to be
administered weekly Follow-up three weeks later showed an aggravation
of the lesions with fissuring in the area of the left lobe. His prescription
was changed to Lachesis at C200 potency, also administered weekly. He
began to show improvement at 1 and 2 weeks post treatment, by 2
months following Lachesis, the patient was already almost lesion-free in
the scalp area and much improved in the preauricular area. At 4 months
post-treatment both scalp and periauricular lesions were almost gone.

107
 Annexure-5
Master chart
Sr. No Age Sex Location Miasm Remedies Potency Duration t/t
(yrs) (M/F)
1 32 M Both hand,feet and Psora Phosphoru 200 9 months
back s
2 36 M Generalised and Psora Sulphur 1M,200 8 months
scalp
3 29 M Scalp (esp. hairs Psora Natrum 200, 10 months
margines)chest, mur 1m
arms, back & face
4 20 M thighs & abdomen Psora Arsenic 200, 10 months
1M
5 29 F Palm and fingers Psora Arsenic 200 8 months
6 24 M Neck and knee Psora Natrum 200, 10 months
joint mur 1m
7 36 M Palms and index Sycosis Petroleum 200 8 months
finger of left hand
8 35 F Breast and Sycosis Graphitis 200, 11 months
abdomen 1M
9 15 F Soles, knees and sycosis Petroleum 200 10 months
palms
10 28 F Forearms & back Psora Sepia 200, 12 months
1M
11 32 M Arms, Psora Rhus Tox 200 8 months
Forearms
12 17 F Soles of both feet Psora Sulphur 200 9 months
13 9 M Scalp and forehead Syphilis Mezerium 200 9 months
upto hairline

108
14 38 M Nape of neck Psora Petroleum 200, 10 months
1m
15 25 M Right foot Psora Lycopodiu 200 9 months
m
16 18 M Scalp and ear Psora Lachesis 200 8 months

17 23 M Knees sycosis Kali ars. 200 9 months

18 29 F Back & knee Psora Pulsatilla 200, 9 months
1M
19 23 M Forearms, axilla Psora Sulphur 200 8 months
And chest
20 37 F Forearms and chest Psora Sepia 200 7 months
21 18 F Legs both upto Sycosis Natrum 200, 10 months
knees mur 1M
22 18 M Elbows and Sycosis Kali sulp 200 9 months
forearms
23 16 F Forearms Psora Sepia 200 7 months
24 28 M Chest & abdomen Psora Staphy 200 7 months
25 29 M Feet & soles Sycosis Staphysag 200, 12 months
ry 1M
26 19 F Forearms, palms Psora Sulphur 200, 12 months
1M
27 28 M Both legs Psora Merc sol 200 10 months
28 27 F Forearms, hands Psora Natrum 200, 9 months
mur 1M
29 40 M Legs Psora Sepia 200 6 months
30 23 F Both legs Psora Merc sol 200 8 months

109
 Annexure-6

Fig No.-10 Case Study 1

Fig No.-10 Case Study 11

Fig No.-10 Case Study 16

110
 Annexure -7
Patient Consent Form
All Patients: PLEASE READ AND SIGN PRIOR TO FIRST VISIT

CONSENT FOR TREATMENT

I, ________________________________ (please print name) am

voluntarily seeking medical care and treatment from Bakson
Homeopathic Medical College & Hospital, Greater Noida, UP,
give permission to the medical and mental health staff of BHMC&
Hospital to examine me, make diagnoses, and provide treatment to me in
accordance with the information, explanations and recommendations
they provide me.

_______________________________________
Patient Signature
Date ____/____/____

111
Annexure - 8

112