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NasalObstructionDec62010


Nasal airway obstruction and Homoeopathy
Introduction:  Nasal obstruction is the commonest problem, frequently ignored during study and is an important symptom of many underlying disorders.

Brief Anatomy of Nasal Airways
Nasal valve area is considered to be the narrowest portion of the human airway. It has two components i.e. External and internal nasal valves. 

1. External Nasal Valve: External nasal valve is also known as nasal vestibule. It is bounded by the caudal edge of the lateral crus of the lower lateral cartilage, fibrofatty tissue over the ala and the membranous septum.

2. Internal Nasal Valve: Boundaries of internal nasal valve include:
· Dorsal portion of nasal septum medially
· Inner caudal edge of upper lateral cartilage laterally
· Anterior head of inferior turbinate posteriorly

The internal nasal valve area is the narrowest portion of human airway and has a cross sectional area of approximately 40 – 60 mm2. This area accounts for nearly 2/3 of the whole airway resistance. Hence collapse / stenosis of this area leads to one of the commoner causes of nasal block.

3. Nasal vestibule: The nasal vestibule is the first component of the nasal resistance mechanism.

Physiology of Nasal Airways
If the nasal airflow rate exceeds 30 liters/minute, the vestibule of nose collapses causing a reduction in the rate of nasal airflow. This collapse of ala increases the nasal resistance.

On inspiration, the increased velocity of air flowing through the nasal valve area causes a drastic decrease in the intraluminal pressure causing a vacuum effect on the upper lateral cartilages. This inward pull causes collapse of upper lateral cartilage (Bernoulli's principle). Total collapse of the internal nasal valve area during this scenario is prevented only by the resilience of the upper and lower lateral cartilages.

Collapse of external nasal valve area (alar area) is by contraction of dilator naris muscles during inspiration. During expiration the positive pressure prevailing inside the nasal cavity keeps the nasal valve area open.

Causes of Nasal Obstruction
1. Previous trauma / rhinoplasty or other surgical procedures (Causa occasionalis/ Tolle causum) - cause weakening of nasal valves.
2. Nasal septal deviation (Sycosis/ Syphilis)- increases occurrence of nasal obstruction.
3. Mucociliary clearance mechanism- in patients with deviated nasal septum is slowed (Causa diceret). Stagnant secretions inside the nasal cavity may aggravate nasal obstruction.
4. Penumatization of middle turbinate (Concha bullosa) which is an anatomical variant (Causa occasionalis)- can cause significant amount of obstruction in the middle meatal area. Massive concha may cause middle meatal nasal obstructive syndrome leading on to symptoms like headache, nasal block and anosmia. Usually, majority of these patients also have deviated nasal septum (DNS) which may aggravate nasal block.
5. Neuromuscular causes like facial palsy (Psora) and aging- may cause increased prevalence of nasal obstruction. Facial palsy may cause paralysis of dilator naris (Psora/ Syphilis) leading on to nasal obstruction. Aging can weaken the fibroareolar tissues (Syphilis) present in the lateral nasal wall leading to collapse of nasal valve area causing nasal obstruction.
6. Sinonasal inflammatory diseases (Psora/ Sycosis/ Psedopsora)- are also etiological. Allergic rhinitis ( Psora/ Pseudopsora) causes congestion and enlargement of nasal turbiantes (Sycosis) and mucosa causing nasal bock. Classically, nasal obstruction is worse on lying down.
7. Drug induced iatrogenic nasal block (Rhinitis medicamentosa) (Causa diceret) - rebound nasal congestion is very common. There is loss of ciliated columnar cells (Tolle causum) and increase in capillary permeability (Psora/ Sycosis) causing interstitial oedema (Sycosis). During early phases of rhinitis medicamentosa this oedema is reversible (Causa diceret). If it continues for a period of more than 3 months it gradually becomes irreversible leading to difficult situations to manage.
8. Hypothyroidism (Psora/ Syphilis) may lead to nasal congestion and block due to unknown reason.
9. Pregancy rhinitis (Rhinopathia gravidorum) (Causa diceret)- seen commonly during the first trimester of pregnancy can cause nasal block due to unknown mechanism. Generalized fluid retention during pregnancy (Psora) and exposure of nasal mucosa to persistently elevated levels of oestrogen (Sycosis) leads to persistent intertitial oedema (Sycosis). It has also been suggested that elevated levels of oestrogen and progesterone during pregnancy (Psora/ Sycosis) may cause rhinits by causing a shift in the level of neurotransmitters like substance P and nitirc oxide (Psora).
10. Trauma (Causa occasionalis/ Tolle causum)- may cause nasal block due to the following factors: tissue oedema causing physical blockage to airflow, secondary sinusitis, and impaired sensation to air flow due to damage sustained by nasal receptors.
11. Neoplams (Cancerous)- involving the nasal cavity can cause nasal block. Nasal block in these patients may be associated with other non specific symptoms like epistaxis (Pseudopsora) and anosmia (Psora/ Syphilis) prompting the patient to seek medical attention.

Signs and symptoms of Nasal Obstruction
Subjective feeling of nasal block could be due to the following factors:
1. Sensitivity of pressure receptors in the nose (Psora/ Pseudopsora)
2. Sensitivity of thermal receptors in the nose (Psora/ Pseudopsora)
3. Sensitivity of pain receptors in the nose (Psora/ Pseudopsora)
4. Presence of excessive secretions in the nose (Psora/ Sycosis)
Patients with fixed anatomical nasal obstruction may experience intermittent symptoms secondary to nasal cycle and other autonomic phenomenon.

Role of Totality and clinical examination for nasal block
It is very important to elicit a complete history from the patient to point towards the correct cause for nasal block. 
1. All patients should be quizzed for prolonged use of drugs, nasal drops which could cause iatrogenic nasal obstruction.
2. History of previous surgeries in the nose which includes cosmetic surgery should be asked.
3. Presence of midface deformities (congenital / due to injuries) should also carefully sought for. 4- History of mouth breathing and halitosis will invariably confirm the problem of nasal block.
4. Nasal cavities should be examined for evidence of sinusitis.
5. Any discharge from the nasal cavity indicates infection.
6. Adenoid hypertrophy should be ruled out in young children.
7. Assessment of facial nerve function should be done for its integrity. Facial nerve paralysis will hamper the splinting muscles of the ala of the nose causing collapse of the airway on inspiration.
8. Examination of the nasal cavity pertaining to airflow dynamics should be done for probable sites of nasal resistance.
9. Diagnostic nasal endoscopy is the most efficient way of completely examining the interiors of the nasal cavity.
10. Nasal endoscopy is a useful tool in assessing subtle nasal mucosal inflammatory changes like mucosal nodularity, friable mucosa and synechiae.
11. Use of radiology in assessing patients with nasal block is often helpful. CT scan is helpful in evaluating bony structural abnormalities like deviated nasal septum, choanal atresia, concha bullosa, inferior turbinate hypertrophy, F.B., rhinolith etc. MRI because of its excellent soft tissue imaging capacity is very useful in identifying lesions like meningocele, encephalocele etc.

Objective evaluation of nasal block:
The following tests would help us to objectively evaluate nasal block.
1. Hygrometry- This is one of the first methods to objectively assess nasal airway patency. This procedure is performed by asking the patient to breathe on a mirror. A comparison is made between the diameters of the fog produced by each nasal airway.
2. Hum test- the nasal airway is assessed by the change in timbre of the sound caused due to nasal block. The test is performed after decongesting one nose, blocking the decongested nose and asking the patient to hum a tune. The change in timbre caused due to block in the non decongested nose is noted.
3. Peak nasal inspiratory flow- this is determined by two factors i.e. Nasal obstruction and the maximum negative pressure generated by the lower airway. Hence changes in inspiratory effort or lower airway resistance will alter the peak nasal inspiratory air flow independent of nasal obstruction. To overcome this problem Taylor suggested assessing Blockage index. Blockage index= Peak oral flow– Peak nasal flow/ Peak oral flow.
4. Acoustic rhinometry- Sound waves generated by acoustic rhinomanometer are transmitted through the nasal cavity; these sound waves get reflected back from the nasal passages and is recorded by the microphone placed at the entrance of the nasal cavity. These sound waves are converted to digital signals and a computer recording is made which is known as the “Rhinogram”. This can be used for studying- anatomical variations of nasal cavity, post surgical changes inside the nasal cavity, effect of drugs on nasal resistance, assessing the changes in the mucovasculature.
5. Rhinomanometry- This investigation involves the functional assessment of airflow inside the nasal cavity by measurement of transnasal pressure and airflow. Resistance from each nasal cavity can be compared.
6. CT volumetry- This imaging modality is highly accurate in measuring the volume of anterior nasal cavity but its accuracy reduces while measuring the volume of posterior nasal cavities.
7. Nasometry- During speech sound is transmitted through both the oral and nasal cavities. Nasal obstruction causes a reduction in the amount of sound transmitted through the nose. By measuring the nasal components of speech the patency of the nasal airway can be assessed. This is known as nasalance.
8. Cottle's test- In this test the cheek of the patient is pulled outwards and upwards. If it affords relief from nasal block then obstruction should be considered to be due to anamalous / abnormal nasal valve area. False negative Cottle's test is possible when the presence of synechiae in the nasal valve area prevents opening up of this zone when this test is being performed. As a first step the internal nasal valve area should be examined endonasally as this area contributes the maximum to the airway resistance. This area should be examined just by lifting the tip of the nose. Introduction of nasal speculum would distort this area and hence should be avoided.
9. Odisoft rhino- This technique converts the frequency of sound generated by airflow into cross sectional area measurements.

Treatment of nasal block
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Very useful article on nasal obstruction.

Nasal cycle, the alternate obstruction of nostrils, is a natural autonomic phenomenon. I have seen many patients complaining this as a sickness!
@ Dr. Rafeeque, if any nasal obstrcution due to some anatomical abnormalities or parasympathetic overactivity there can be an alternate nasal obstrution. This is pathological.

Ref: Scott Brown, Textbook of Otorhinolaryngology.
Good reference.
Thank you Dr.Rajneesh
@ Dr Nilanjana Basu - I mean the physiological obstruction of nose as a result of Nasal cycle. We can test this natural process very easily: Compare the breathing by closing each nostrils alternately. At a particular time, we feel some difficulty to breath through one nostril, and the other side feels open. Repeat the same process after a few hours (1 to 4 hours), and we will feel the reversal of obstruction in each side. This phenomenon is due to alternate congestion and shrinkage of nasal mucosa. This is physiological. Of course, the situation becomes worse when there is pathology such as DNS, turbinate hypertorphy, polyp, foreign body, allergy, sinusitis etc.
Dr. Rafeeque, that is correct. But Whenever the symptom is panic, it is to be treated.
Dear Dr Rafeeque. Somewhere I learned that everyone naturally alternates their breathing from one nostril to the other over periodic cycles during the day. And, in the pranayama breathing techniques we also use this to stimulate the brain.

Alternate Nostril Breathing (Nadi Sodhana)
This is continued since ancient era...
Yes, It really works with homeopathy!
That is true. Dr. Rafeeque. Regards..
That's true Dr. Rafeeque.. Regards.
Dr Rajneesh Sharma.
There are following homeopathic medicines used in treatment of nasal polyps -----
AGRAPHIS NUTANS (Bluebell)
Nasal polyps obstruct the nostrils; enlarged and inflamed tonsils; throat deafness.
Tendency to catch cold and free discharge from mucus membrane on every exposure to cold wind; mucus diarrhea from cold.
Mutism of childhood, unconnected with deafness.
ALLIUM CEPA (Red Onion)
Nasal polypus; profuse, watery and acrid nasal discharge, with profuse, bland lachrymation and catarrhal dull headache; feeling of a lump at root of nose; violent sneezing on rising from bed; spring coryza and hay fever in August every year.
Acute catarrhal inflammation of mucous membranes with increased secretion; worse after exposure to damp north-east wind, in evening and in warm room; better in a cold room and in open air.
Catarrhal laryngitis and hoarseness; cough compels patient to grasp the larynx; seems as if cough would tear it.
Headache ceases during menses, returns when flow disappears; burning, biting and smarting pain in eyes as from smoke.
Strong craving for raw onions.
AMMONIUM CARBONICUM (Smelling Salt / Carbonate of Ammonia)
Nose stopped at night from long-continued coryza; chronic mouth breathing and snuffles of children; epistaxis after washing and after eating; loses breath on falling asleep, must awaken to get breath.
Hemorrhagic diathesis; stout, fleshy, delicate women leading sedentary life and readily catch cold in winter; children dislike washing.
Cholera-like symptoms at the commencement of menstruation.
Dry cough; tickling in throat as from dust, in every morning from 3-4 a.m.
Worse in cold, wet weather, from wet application, washing and during menses; better in dry weather.
AMMONIUM MURIATICUM (Sal Ammoniac / Ammonium Chloride)
Hot, acrid coryza corroding the lip; sneezing; nose sore to touch; ulcerative pain in nostrils; loss of smell; obstructed, stuffy feeling; constant and unavailing efforts to blow it out; worse in morning, better in open air.
Especially adapted to fat and sluggish patients having respiratory troubles, cough and catarrh; profuse, glairy secretion.
Tough, viscid phlegm, can not be hawked up; hoarseness and burning in larynx; dry, hacking, scraping cough; worse lying on back or right side.
Diarrhea, vomiting and discharge from the bowels during menses; stool hard, crumbling and difficult to expel; menses too early, too profuse, dark, clotted, flow more at night; painful hemorrhoids after suppressed leucorrhea.
Offensive foot-sweat.
APIS MELLIFICA (Poison of the honey bee)
Coldness of tip of nose; marked edematous swelling of the nasal mucosa; polyps.
Adapted to the strumous constitution; glands enlarged, indurated; weeping disposition, can not help crying, discouraged, despondent.
Extreme sensitiveness to touch; pain burning, stinging, sore; suddenly migrating from one part to another.
Thirstlessness; craving for milk.
Edema with bag-like puffy swelling under the eyes.
Aggravation after sleeping, closed, especially warm and heated rooms are intolerable; worse from getting wet, heat in any form, touch, pressure, right side.
Amelioration from washing or moistening the part in cold water, in open air, uncovering.
ARUNDO (Reed)
Hay fever, begins with burning and itching of palate and conjunctiva; annoying itching in the nostrils and roof of the mouth; coryza and sneezing; loss of smell.
Craving for acids.
Copious and offensive sweat of feet with burning sensation; fissures in fingers and heels.
Menses too early and profuse.
ARUM MACULATUM / TRIPHYLLUM (Turnip)
Soreness of nostrils; acrid, excoriating nasal discharge; nose obstructed, must breathe through mouth; constant picking at nose until bleeds; boring with the finger into nose.
Raw feeling at roof and palate of mouth; corners of mouth sore and cracked; tongue red, sore; pick lips until they bleed; children refuse food and drink on account of soreness of mouth and throat.
Hoarseness; raw, burning sensation; after exposure to north-west wind.
CADMIUM SULPH (Cadmic Sulphate)
Polypus with tightness at the root of nose; nostrils ulcerated; nose obstructed, causes obstructive sleep apnea, wakes up suffocating, fears to go to sleep again, protracted insomnia.
Extreme chilliness and coldness, even when near the fire.
Gastric malignancy – exhaustion and extreme prostration, violent and persistent nausea, retching, vomitus black or coffee ground; black, offensive clots of blood from bowels with colic.
CALCAREA CARBONICA/OSTREARUM (Carbonate of Lime / Oyster Shell)
Dry, nostrils sore, ulcerated; stoppage of nose, also with fetid, yellow discharge; offensive odor in nose; loss of smell; polypi, especially on left side, bleeds easily; swelling at root of nose; takes cold at every change of weather; worse in cold, wet weather; better in dry weather; complaints arising from standing on cold floor.
Leucophlegmatic, light complexion, fair skin; tendency to obesity; psoric constitutions; pale, weak, timid, easily tired when walking; cold natured, extremely chilly; delayed milestones of development and bony deformities; forgetful, apprehensive, fears loss of reason.
Head sweats profusely while sleeping, wetting pillow far around; profuse perspiration, mostly on back of head and neck, or chest and upper part of body.
Great longing for boiled eggs; craves cold drinks, indigestible things, sweets and salt; aversion to meat.
Hyperacidity; sour eructation, sour vomiting, sour stool; sour odor of the whole body.
Menstruation too early, too profuse, too long lasting; aggravation from least mental excitement.
Constipated; stool has to be removed mechanically; feels better when constipated.
CASTOREUM (The Beaver)
Large nasal polyps causing chronic mouth breathing and obstructive sleep dyspnea; restless sleep with frightful dreams and starts.
Hysteria with marked prostration; day-blindness and photophobia; debilitating sweat; constant yawning.
Rounded elevation of the size of a pea in the center of the tongue with drawing sensation from center to the hyoid bone.
Amenorrhea with painful tympanitis.
CAUSTICUM
Right sided polyps, arising after injuries to nostril; coryza with hoarseness and aphonia; rawness or soreness of nostrils; worse in morning.
Melancholic, sad, hopeless, extremely sympathetic; complaints arising after severe mental shock, long-lasting grief, sorrow, fear, anger or suppressed eruption.
Constipation – frequent, but ineffectual desire; stool passes better when standing.
Urine involuntary on coughing, sneezing or blowing the nose.
Cough with rawness and soreness of chest; difficult expectoration; relieved by swallowing cold water.
Menses delayed, late; flow only during day, ceases on lying down.
Paralysis of single parts; generally of right side; from exposure to cold wind, after typhoid or diphtheria.
Warts large, jagged, pedunculated, or small, whitish, all over the body.
Aggravation in clear, fine weather, from getting wet, drafts of air; better in damp, wet weather.
CONIUM MACULATUM (Poison Hemlock)
Swelling of the nostrils, red, hot, painful; worse left side; purulent discharge from the nose; nosebleed, frequent when sneezing; increased acuteness of smell; obstinate stoppage of the nostrils.
Especially adapted to old people, women during and after menopause, old bachelors; cancerous or scrofulous persons with enlarged glands, rigid fibers and sedentary lifestyles; suffering from bad effects of non-gratified sexual desire or suppressed menses.
Domineering, quarrelsome, can not bear contradiction; dreads being alone, yet avoids society.
Glandular indurations of stony hardness; after bruises or injuries to glands; mastitis before and during menses.
Menses feeble and suppressed; rash of small, red pimples which ceases with the flow; menses stopped by taking cold; profuse, thick, acrid, milky leucorrhea after menses.
Profuse sweat; especially when lying down.
Aggravation: lying down, celibacy, before and during menses, from taking cold, bodily or mental exertion.
Amelioration: while fasting, in the dark, motion and pressure.
FORMICA RUFA (Crushed Live Ants)
Nasal polypi with coryza; a stopped up feeling in nose.
Gout and articular rheumatism – chiefly right sided and of lower extremities; pain worse from motion and better from pressure, rubbing and after midnight; attack comes on with suddenness and restlessness.
Nettle rash – redness, itching and burning; aggravates from cold, cold washing and damp; better from warmth.
Difficult passage of small quantities of flatus in the morning; afterwards diarrhea-like urging; drawing pain around the navel before stool with shuddering chilliness.
GRAPHITES (Black Lead / Amorphous Carbon)
Sore on blowing nose; smell abnormally acute; cannot tolerate flowers; chronic dryness and scabs alternating with discharge of fetid mucus; stuffed coryza leads to headache.
Suited to climacteric women, inclined to obesity, who suffer from habitual constipation; tendency to catch cold easily; with a history of delayed menstruation and hypomenorrhea; suffering from acrid and profuse leucorrhea occurring in gushes, before and after menses.
Excessive cautiousness, indecisive; fidgety while sitting at work.
Unhealthy skin; every little injury suppurates; hard cicatrices; eruption between fingers and toes from which oozes a watery, transparent, sticky fluid.
Nails are brittle, crumbling, deformed; deep fissures in ends of fingers and between the toes.
Hot drinks disagree, especially milk; aversion to meat and sweets; increased flatulence, must loosen clothing.
Worse from warmth, at night, during and after menstruation; better in the dark, from wrapping up.
KALI BICHROMICUM (Potassium Bichromate)
Snuffles of children, especially fat, chubby babies; pressure and pain at root of nose, and sticking pain in nose; fetid smell; discharge thick, ropy, and greenish-yellow; tough, elastic plugs from nose, adheres to the parts and can be drawn into long strings; leaves a raw surface; dropping from posterior nares; loss of smell; inability to breathe through nose; violent sneezing.
Complaints occurring in hot weather; liability to take cold in open air; pains in small spots, can be covered with point of finger; shift rapidly from one part to another; appear and disappear suddenly.
Tongue mapped, red, shining; uvula swollen, edematous.
After urinating a drop seems to remain which can not be expelled.
Aggravation: beer, morning, hot weather, undressing; amelioration: from heat.
KALI NITRICUM (Saltpeter)
Sneezing, violent coryza, obstructed and swollen feeling in nose; worse right nostril; aggravation towards morning and in afternoon; loss of smell; point red and itching.
The nasal and cheek bones are painful, especially to touch; frontal headache with sinusitis.
Diarrhea from eating veal.
Menses too early, profuse, black; preceded and accompanied by violent backache.
Dry morning cough with pain chest and bloody expectoration; dyspnea so great that breath can not be held long enough to drink, though thirsty; better from drinking sips of water.
LEMNA MINOR (Duckweed)
Nasal polypi with swollen turbinates; post-nasal drip; abundant crusts and mucopurulent discharge; pain like a string from nostrils to ears; difficult breathing, worse in damp, rainy weather.
Foul smell from the nose and foul taste in the morning on waking.
Dryness of pharynx and larynx.
Disposition to noisy diarrhea.
LYCOPODIUM CLAVATUM (Club Moss / Wolf’s Claw)
Sense of smell very acute; ulcerated nostrils; crusts and elastic plugs; fluent coryza; nose stopped up; snuffles; child starts from sleep rubbing nose; fan-like motion of alae nasi.
For persons intellectually keen, but physically weak; upper part of body emaciated, lower part semi-dropsical; children weak, emaciated, with well-developed head and puny, sickly bodies.
Avarice, greedy, misery, malicious, pusillanimous; irritable, peevish and cross; can not endure opposition; seeks disputes; weeping disposition, even cries when thanked.
Sour taste, eructation and vomiting; canine hunger, head aches if he does not eat, but a few mouthfuls fill up to the throat, constant sensation of satiety; excessive bloating and flatulence, loud grumbling; fullness not relieved by belching.
Constipation: since puberty; since last confinement; when away from home; of infants; with ineffectual urging; rectum contracts and protrudes during stool, developing piles.
Impotence: penis small, cold, relaxed; premature emission; of young men, from sexual excess; old men with strong desire, but imperfect erections.
Aggravation: right side, from right to left, from above downward, 4 to 8 p.m.; from heat or warm room, hot air, bed; warm applications, except throat and stomach which are better from warm drinks.
Amelioration: By motion, after midnight, from warm food and drink, on getting cold, from being uncovered.
MERCURIUS IODATUS RUBER (Bin-iodide of Mercury)
Coryza and dull hearing; hawks mucus from posterior nares; polyps with swollen turbinates; closure of eustachian tube; aggravation after sleep, after dinner, afternoon and evening.
Fauces dark red, swollen, painful swallowing; sensation of a lump in throat; left sided tonsilitis.
Past history or family history of syphilitic affection; especially left sided.
NATRUM MURIATICUM (Common Salt / Sodium Chloride)
Violent, fluent coryza, lasting from one to three days, and then changing into stoppage of nose, making breathing difficult; discharge thin, watery mucus from nose; like raw white of egg; loss of smell and taste.
Great emaciation, anemic and cachectic, losing flesh while living well; emaciation marked in neck; slow in learning to walk; face oily, shiny, as if greased.
Cross and irritable, aggravation from consolation; awkward, drops things from hand; weeping disposition; suppressive, introvert.
Left-sided migraine of school-going girls from sun-heat.
Craving for extra salt, bitter and fish; great aversion to bread.
Tongue mapped, imprint of teeth.
Constipation: dry, hard, difficult stool.
Involuntary urination on coughing, laughing or walking; has to wait a long in presence of others.
Aggravation: noise, music, warm room, lying down, 10 a.m., at seashore, mental exertion, consolation, heat, talking.
Amelioration: open air, cold bathing, going without regular meals, tight clothing.
NITRICUM ACIDUM (Nitric Acid)
Green casts from nose every morning; coryza, with sore and bleeding nostrils; stitches, as of a splinter in nose; chronic nasal catarrh with yellow, offensive, corrosive discharge.
Acts best on persons of rigid fiber, dark complexion, black hair and eyes, nervous temperament.
Irritable, headstrong; hateful and vindictive; inveterate, ill-willed, unmoved by apologies.
Tongue clean, red and wet with central furrow; ulcers in mouth with splinter-like pain.
Longing for indigestible things, salt and fatty foods; aversion to meat.
Urine scanty, dark brown, strong-smelling.
Anal fissure; tearing, lancinating pain; lasting for hours even after soft stool.
Bleeding ulcers in corners of mouth; splinter-like pain, zigzag edges, base like raw flesh; thin, acrid, offensive discharge.
Large, jagged, pedunculated warts; bleeds on washing, moist oozing.
PHOSPHORUS
Polypi; bleeding easily; quite effective in controlling post-operative hemorrhage; chronic catarrh, with small hemorrhages; handkerchief is always bloody; epistaxis instead of menses; over-sensitiveness to smell; foul imaginary odors; fan-like motion of nostrils.
Young, tall, slender persons of sanguine temperament; fair skin, delicate eyelashes; anemic or chlorotic; hemorrhagic diathesis, small wounds bleed profusely; great weakness and prostration from loss of vital fluids.
Restless, fidgety, can not sit or stand still a moment; apathetic, full of gloomy forebodings.
Weak, empty, all-gone sensation in stomach; great craving for icy-cold food and drink, ice-cream; as soon as water becomes warm in stomach, it is vomited.
Aggravation: weather changes, before midnight; amelioration: dark, icy cold food and drinks.
SANGUINARIA (Blood Root)
Nasal polyp, mostly right sided; profuse, offensive, yellowish discharge; membranes dry and congested; sudden stopping of catarrh causes diarrhea; cough of gastric origin.
Climacteric complaints – burning sensation, like from hot water, in various parts, flushes of heat, leucorrhea, mastitis.
Circumscribed redness and burning of cheeks.
Periodic sick headache; begins in the morning, increases during day, lasts until evening; sensation as if head would burst or as if eyes would be pressed out; pain begins in occiput, spreads upward and settles over right eye; better from sleeping and perfect quiet in dark room.
Facial eruption of young women, especially during scanty menses.
Craving for pungent things; unquenchable thirst.
Rheumatism of right arm and right shoulder; worse at night.
SANGUINARIA NITRICUM
Polyps causing obstruction of nose; profuse watery mucus with burning pain; enlarged turbinates; small crusts which bleed when removed; post-nasal drip adherent to nasopharynx, dislodged with difficulty.
Dry, constricted, burning sensation in throat; right tonsil sore, swallowing difficult.
Ulceration on the sides of tongue.
Short, hacking, tickling, chronic cough; voice altered, deep, hoarse.
STICTA PULMONARIA (Lungwort)
Polyps with rhinorrhea and incessant sneezing; catarrhal headache with fullness at root of nose; dryness of nasal mucosa; constant need to blow the nose, but no discharge; post-nasal drip.
Dry, hacking cough during night and loose cough in morning; cough aggravates towards evening and when tired.
Rheumatic stiffness of neck and shoulder joints; housemaid’s knee; rheumatic pain precedes catarrhal symptoms; pain starts at night and worse from sudden change of temperature, better during daytime.
TEUCRIUM MARUM VERUM (Cat-thyme)
Polyps of children; suitable after too much medicine has been taken.
Chronic nasal catarrh; loss of sense of smell; discharge of large irregular clinkers; crawling in nostrils; lachrymation and sneezing; post-nasal drip.
Stoppage of breathing on that side of nose on which one is sleeping.
Itching of anus, constant irritation when in bed; ascarides with nightly restlessness; crawling in rectum after stool.
THUJA OCCIDENTALIS (Arbor Vitae / White Cedar / Tree of Life)
Polyps with offensive, thick, greenish discharge; loss of smell; bleeds easily; dryness and ulceration within the nostrils; painful pressure at root of nose.
Commonly indicated in wasted children of sycotic parents; lymphatic temperament, fleshy persons, dark complexion, black hair, unhealthy skin; hydrogenoid constitution.
Very slow to trust others, unusual secretiveness, reserved, deceitful; dullness and forgetfulness, gradually progressing to deep despondence and dissatisfaction; fixed ideas; sensation as if someone is walking alongside him; music causes weeping.
Overgrowths of tissue; hard tumors, ranula, uterine fibroids, ovarian cysts; cauliflower-like, large, pedunculated warts; deformed, brittle nails; skin looks dirty, brownish spots here and there.
Sweat profuse, sour smelling, fetid; only on uncovered parts or all over except head; when he sleeps, stops when he wakes.
Sensation as of urine trickling in urethra after urinating; severe cutting pain at close of urination.
Feels relieved from unusual discharges.
Obstinate constipation; stool recedes after being partly expelled; piles swollen; severe pain when sitting.
Early morning diarrhea; expelled forcibly with much flatus; worse after breakfast, onions, coffee, fat food.
Other Useful Medicines at a Glance:
Alumina, Belladonna, Calcarea Iod, Calcarea Phos, Capsicum, Carb Sulph, Cortisone, Hecla Lava, Hepar Sulph, Hydrastis Can, Mercurius, Merc Cor, Psorinum, Pulsatilla, Sepia, Silicea, Staphysagria, Sulphur etc.

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