A Miasmatic Approach to Endometriosis

A Miasmatic Approach to Endometriosis – an indepth discussion on homeopathy treatment of endometriosis.

The purpose of this paper is to point out the miasmatic nature of a condition known as endometriosis and to suggest a possible approach in the homeopathic treatment of endometriosis. It is not intended that this paper present a cured case of endometriosis.

The nature, aetiology and pathophysiology of endometriosis will be touched upon and a homeopathic interpretation based on miasmatic theory will be offered. A case that responded dramatically to miasmatic prescribing will be presented.

What is endometriosis?

Endometriosis is the growth of cells similar to those that form the inside of the uterus (endometrial cells), but in a location outside of the uterus. Endometrial cells are the same cells that are shed each month during menstruation. The cells of endometriosis attach themselves to tissue outside the uterus and are called endometriosis implants. The implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder, although less commonly than other locations in the pelvis. Rarely, endometriosis implants can occur outside the pelvis, on the liver, in old surgery scars, and even in or around the lung or brain. Endometrial implants are generally benign (not cancerous).[1]

Characteristics of Endometriosis

The following are some of the commonest characteristic symptoms of endometriosis. This list is compiled from clinical experience of patients suffering from endometriosis.

  • Aggravation of many symptoms in the patients before, during, or after menses.
  • Periodicity of 4 weeks. The cycles are frequently shortened to 3 weeks, showing a poor development of the corpus luteal phase of the menstrual cycle and a weak progesterone phase.
  • Bleeding, per vaginal discharge, brown, bloody, black, copious, watery. The color and nature will vary with the phase in the cycle. The watery discharge, gushing and slightly bloody can occur during ovulation.
  • Insidious onset, usually in the mid 30’s, a close association with infertility or after a long period of not being pregnant.
  • Worsens with time and regresses after menopause; regresses during pregnancy and lactation because endometrial tissues regress with the depletion in hormones during menopause and the loss of the cyclical rhythm during pregnancy under hormonal influence.
  • Pain may be severe depending on the staging and other factors but coming at 4 week intervals, pain may be felt in the abdomen, supra pubic area, back, down the thighs (referred pain), rectum, etc. depending on the location of the cysts. Dyschaesia, i.e. pain when passing stools especially before during and after menses and dyspareunia, i.e. pain during intercourse may be present. These symptoms may be due to the endometriotic lesions in the pouch of Douglas.
  • Associated problems include emotional upsets, usually suppressed emotions, digestive problems from dyspepsia to colitis, the mildest being irritable bowel syndrome but may be severe mucous colitis, and adhesion colic.

Consequences

  • Infertility.
  • Debilitated state of patient who may not be able to assume daily activities usually two weeks in a month, every month.
  • A constant cycle of pain, recovery, a short period of feeling relatively well then a repeat. Body ache and tiredness as well as Inability to cope are frequently associated with this condition when severe.
  • Pathological changes are blood cysts in the ovaries, fallopian tubes, adherent to intestines or within the uterus resulting in adhesions, blocked tubes, and its consequences like hydrosalpinx.
  • Occasional malignant change.
  • Emotional upsets and relationship problems

There are many theories as to why endometriosis occurs. The one that I subscribe to is that there is a genetic predisposition to endometriosis. I also believe it is not a disease of the reproductive organs, but part of a larger disease that involves the immune system.

Genetic studies have shown that endometriosis may have a genetic basis, just like diabetes and hypertension. Studies on a species of monkey that spontaneously develops endometriosis are being done to demonstrate this [2]

That the immune system is affected in endometriosis was researched in a survey where the following conclusion was arrived at :

“Hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies and asthma are all significantly more common in women with endometriosis than in women in the general USA population.”[3]

Most of the diseases mentioned here are related to a defective immune system and to auto antibodies. It is possible that all of it is related to a defective immune system, but we do not yet have full knowledge of these conditions. While it is not stated that the hypothyroidism mentioned here is autoimmune, there is autoimmune thyroiditis which is also known as Hashimoto’s Thyroiditis, which leads to hypothyroidism

What seems to be happening in endometriosis is that cells that are normally found only in the endometrium of the uterus implant in other places, where they respond to the ovarian hormones in a cyclical manner and bleed when the hormone levels drop as in the normal menstrual cycle.

Two main theories exist for the pathogenesis of endometriosis. One theory is that endometrial tissue is spread by retrograde menstruation or by vascular and/or lymphatic spread. The second theory holds that the serosal epithelium of the peritoneum undergoes metaplastic differentiation into endometrium-like tissue.[4]

Endometriosis is a chronic disease that has established itself by the time a diagnosis is made. While I have not been able to find any researcher who links endometriosis to pelvic infections, there is evidence that patients with endometriosis do have infected endometriotic cysts.

Schmidt et al found pathologic evidence of infection in 11 of 510 endometriotic cysts (2%). The patients had a mean age of 34.7 years and typically presented with fever and lower abdominal pain; about half had a history of pelvic inflammatory disease. Histologic examination revealed endometriotic cysts that contained a fibrino purulent exudate, micro-abscesses, and inflammatory cells other than neutrophils, such as plasma cells. All of the patients who had one or both fallopian tubes removed at the same operation had histologic evidence of acute and/or chronic salpingitis.[5]

A Miasmatic theory of Endometriosis

In Webster’s dictionary, the term “miasm” is followed by these meanings:

“a vaporous exhalation (as of a marshy region or of a putrescent matter) formerly believed to contain a substance causing disease (as malaria)”

“a pervasive influence or atmosphere that tends to deplete or corrupt”. Its Greek root is “miainein” which means “to defile”. “to defile” means “to make something dirty or no longer pure” “to damage something holy or sacred”.

According to Shahrdar:

“From Hahnemann’s writings, it is evident that he also uses the word “miasm” simply to describe an infectious and contagious disease with a specific cause and pattern of growth which can appear in different forms of propagation such as sporadic, endemic or epidemic. In his view, a miasm may be acute or it can be chronic with ever progressing effects on the individual. Speaking in Hahnemann’s language, it should be noted that what is now known as a miasm is actually a chronic miasm”.[6]

Hence a chronic miasm is a disease that keeps progressing even when a prescription has been made that covers the presenting symptom – for according to Hahnemann, there is a hidden process that needs to be prescribed for and an unmasking of the original symptoms before a miasmatic prescription can take place.

I have made a graphic presentation of what I understand about Hahnemann’s Chronic Disease theory. To learn more please visit the minutus.org library and study Dr Shahrdar’s writings.

The terms ponos and pathos are from the writings of Hans Selye[7] and have been adapted by Shahrdar, hence I have placed them in brackets.

Ponos is the acute symptoms as a reaction to the pathogen.

Pathos is Latin for suffering and refers to secondary symptoms as the patient’s body adjusts to a state of incomplete resolution after a pathogen.

Miasmatic remedy refers to the remedy who’s choice is based on the combined symptoms of many patients who are affected by a similar pathogen. (Shahrdar uses the term ‘genus epidemicus’.)

Dr. Shahrdar has proposed that the most important group of pathogens that can cause a chronic state are viruses. He has written Materia Virosum and Repertorium Virosum that discusses these theories in great lengths and shows how they can be applied to treat cases miasmatically. I will show how it can be applied in the case we will be discussing shortly.[8]

When a person is infected by a pathogen, there is an acute illness (ponos) which is an acute disturbance caused by the pathogen. In acute diseases the infection is resolved and the patient returns to the normal optimal state. When this does not take place, the patient develops more suffering and the illness becomes chronic (pathos). Chronic illness is an adaptive state where the health is compromised and the body develops ways to adapt to the compromise in health in order to survive. An example of this is when a splinter is in the flesh and the body deals with the splinter at first by suppuration. This is the ponos reaction and then when the splinter still remains, the body acts by depositing fibrous tissue and sending white blood cells to continue attacking the splinter and the person develops a foreign body granuloma. This secondary reaction is the pathos.

In the state of Pathos, the disease progresses similarly to what we frequently see in chronic diseases like rheumatoid arthritis, systemic lupus or diabetes. It will keep getting more complex because of the presence of the unhealed chronic miasmatic state that has been hidden under the pathos. A homeopathic remedy that can heal this person has to address the original unmasked hidden state – that is, the original illness. Hence it has to be a miasmatic remedy that is similar to the hidden state and not to the general adaptive symptoms of the patient. To put it in another way, what we see is the secondary adaptive symptoms, the secondary pathological changes and not the hidden disease process that causes these reactions. In order to cure the person, we have to prescribe a remedy similar to the active hidden process. We need to unmask the hidden miasm.

A hidden state here means that the vital force did not return to normal and remains off balance.
Obviously when something is off balance, the body has to make adjustments to deal with the lack of balance.
Example:
You hurt your foot by walking on a piece of glass and there is a cut on the sole. Now you walk bearing your weight on the other foot that is healthy. When a homeopath sees you, he sees the limp but he does not see the cut and injured sole, which remains hidden, unless you tell him about the injury and show it to him. If not, it is hidden but still active. The limp is to compensate for the injured foot and the pain that comes from walking on the injury. If this situation remains for say 10 days, then more things start to happen. Because the uninjured foot has had to bear more weight, it is now being strained and, let us say there is an underlying weakness of the hip joint on this side, and now there is a limp, and pain in the hip on the uninjured side.
What needs to be treated is still the cut on the sole because apparently there is still pain causing the whole compensatory way of walking. All of the compensation is due to the vital force acting in total, but the primary state and the whole cause is still the injured foot.
One might then say, since I added that the hip has an inherent weakness ,that there is actually another state at work here and we would be right. But, if we tried to deal with this part first, the cure would not work because, the injured foot was what started to make the hip painful and it is still active.

SUMITA’s CASE: Endometriosis with Primary Infertility

Sumita is a patient of a homeopath in India and I am in Malaysia. I agreed to help him treat Sumita as a consultant and he is the homeopath who took this history. I was consulted because of primary infertility due to endometriosis, which was discovered after she was married. She did not get pregnant in the two and a half years of marriage and had undergone both homeopathic as well as allopathic management before I was consulted. She had been diagnosed to be suffering from Endometriosis by ultrasound as well as by Laparoscopy. This is important since a diagnosis of endometriosis by clinical picture or ultrasound alone is not conclusive. Note also the ultrasounds were done intra vaginal which makes them more accurate.

This case was taken at the first interview. Unless indicated as allopathic, all the doctors mentioned refer to qualified homeopathic doctors (BHMS)

Age: 27 + Married for 2 and half years, No children.

Fair, Height 5 ft, Weight 46 kg, Medium build.

History:

Menstrual Cycle of 28 days, Last time flow for 1-2 days. Soreness in lower abdomen with both legs being painful. Occasional pain in both ovaries. Occasional Leucorrhoea (thick lumps).

Last menstrual period, 2nd June 2007.

History and Background:

1. Had a history of severe injury to the head when 7 or 8 years old.

2. Had a history of headache for last 10 – 12 years agg. by sunlight, Tension, Concentration, long journeys. Used to take painkillers (diclofenac 0.25 mg) to relieve the pain.

3. Left sided. Pain after sitting for long time in front of Computer (Last 3-4 years).

4. Homeopathic treatment commenced after marriage i.e. Feb 2005 to treat headache. Had B Coli infection during March 2005. After eight months of treatment, started having menstrual pain. Pain used to stay during the periods with fever. However headache reduced subsequently under a different homeopath.

5. Menstrual Pain did not reduce after continued homeopathic treatment till June 2006. i.e one and half years of homeopathic treatment.

The then homeopath sadly passed away in July 2006. He had given the following medicines in chronological order. Arnica 1M 2 doses;, Cannabis Sataiva 1M 2 doses (For B coli infection); Tub 1M 2 doses; Bell 2C, Syphillinum 10M – 1 dose; Rhus tox 1m 2 doses; Kali Bich 1M 2 doses; Ant Crud 1M, 3 doses; Sulph 30 1 dose; Puls 1M 2 doses; Calc Phos 1M 8 doses; Sabina 30; Colocynth 200; Bovista 200 3 doses. (Note the frequent change of remedies over one month).

6. At the end of July 2006 the menstrual pain became very severe. Pain was felt particularly in the region of left ovary. USG done in July 2006 lead to diagnosed as Chocolate cyst on left ovary sized 3.7 x 3.2 cm. Uterus anteverted.

7. A new doctor was consulted who gave Viburnum Opulus 6 to be taken twice daily. Next period menstrual pain was less but flow lasted for only one day. Patient bedridden with severe ovarian pain.

8. Another doctor was consulted. He gave Lachesis 30 3-doses, repeated 30 3-doses after 10 days and then repeated 200c 2-doses after 14 days. First and second dose was very helpful but 200c caused an adverse reaction with severe pain in both ovaries. The doctor said the medicine has been overdosed.

9. Was again referred to another doctor in August 2006. He gave Camphor 200 2-doses to neutralize Lachesis and gave Apis 200 three doses. Was better after Apis, then given Pulsatilla CM. Again pain started.

10. Ultrasound scan on September 2006 (2 months after first scan) showed that the cyst on left ovary had increased to 6 x 5.5 cm and the on the right ovary a new chocolate cyst was developed of size 3.2 cm. Uterus Bulky. Musculature, Endometrium 6 mm Thickness.

11. Allopathic doctor immediately recommended diagnostic laparoscopy in September 2006. During Laparoscopy the endometrial cyst contents from the right ovary was aspired.

Report:

Dye Test: Spillage in both side, Endometriosis and adhesions were found,

Hysteroscopy showed Uterine Cavity & Cervical canal appeared normal,

Both Ostea Visulised.

Bulky Uterus with endometriosis and adhesions.

12. Given an injection of GNRH 3.75 advised Super Ovulation.

13. Again Homeopathic treatment commenced from November 2006 under the same Doctor. Has given the following medicine in chronological order.

Bacillinium 10m 1 dose with Calc Phos 6x and Ashoka Q; Cimicifuga 1M with Bell Perenis Q and Oophorinum 30c, Calc Phos 200 cwith Bell Perenis Q with Ashoka Q, Bryonia 0/2 with Ustiliago Q.

(a mixture of remedies and repeated over a short period of time)

14. Again undergone ultrasound examination on 23-04-2007. The following were found:

Uterus is anteverted, normal in shape, size and outline. Myometrial echo pattern is homogeneous, cavity is empty. Midline echo is normal. Endometrial thickness is 0.5cm. Cervical canal is normal.

Right adnexal region shows a partly solid and partly cystic space occupying lesion, measuring

5.4 x 6.3 cm.

Left adnexal region shows a cystic mass measuring 5. x 5.8 cm.

Both the space occupying lesions (SOL) are adherent to the uterus.

IMPRESSIONS

Bilateral Ovarian Cyst (Chocolate cyst)

Features of Pelvic endometriosis.

PRESENT COMPLAINT

  • Headache (much reduced by Homeopathic treatment)
  • Occasional Vertigo, Occasional nausea during morning
  • Developed yellowish blackish nails with spoon type shape
  • Nerve stimuli (kind of nerve shock) of mainly right leg during sleep. After this leg cannot be straightened for 1 minute. Then the affected leg became sore for 1-2 days. This has happened 5-7 times in last 2 years.
  • Both breasts sore. Worst before periods and better after periods.
  • Itching eruptions in elbow joint (front side) itching agg. by sweating.
  • Piles. Constipation.
  • Mild pain in ovarian region after urination and stool. Cannot control the urge to stool. The entire stomach becomes stiff and movement and standing difficult until and unless stool passes.

Physical Generals

Warm Patient, Consolation amel., Sweating ++ under arms and face, Craving for cold food and cold water, Crave for Salty food, Craving for egg but cannot tolerate omelette. Appetite normal. Cold palms occasionally.

Mental Generals

Mild, easily weeps, Fear from shouting and quarrels, religious, good natured, family life comfortable, irritability before period, depressed (better after Puls 200)

Family History

Migraine of Mother, Diabetes of Maternal Uncle.

Past History

Vaccination, Typhoid (Detected in early stage), Injury to head, hand and collar bone.

…………………………………………………………………………………………………………………………………….

Another ultrasound was done before she started treatment with me

Report: 6 July 2007

Uterus is antiverted, normal in shape, size and outline. Myometrial echo pattern is homogeneous Cavity is empty. Midline echo is normal. Endometrial thickness is 0.4cm.

Cervical canal is normal.
A thick walled cystic SOL, measuring 2.9 x 5.2 cm another rounded thick walled cystic SOL measuring 3.4 x 4.2 cm. is seen in the Pouch of Douglas.

Both cystic SOL show low level internal echoes.

IMPRESSION

Bilateral ovarian cyst (Chocolate cyst?).

After a discussion with her husband I discovered that Sumita was very sensitive to homeopathic remedies and aggravated a lot after remedies were given repeatedly.

Since I know endometriosis has a miasmatic background, it was noted that any remedy chosen had to match not only the miasmatic background, but also aspects of her presenting symptoms, signs and modalities.

Endometriosis is a sycotic condition because of the nature of the disease, which involves the pelvic organs and sexual organs. It has cysts and fibrosis and these are also sycotic.

Here is a bit about the general nature of the main miasms

General Nature of the Miasm (from JH Allen)

A – Psoric Miasm: Itching, burning, inflammation leading to congestion – philosopher, selfish, restless, weak, fears.

B – Sycotic Miasm: Over production, growths like warts, condylomata, fibrous tissue, attacks internal organs, pelvis, and sexual organs. (These are characteristics of endometriosis)

C – Syphilitic Miasm: Destructive, disorder everywhere, ulceration, fissures, deformities, ignorance, suicidal, depressed, memory diminished.

D – Tubercular Miasm: Changing symptomology, vague, weakness, shifting in location, depletion, dissatisfaction, lack of tolerance, careless, “problem child”, cravings that are not good for them.

A quote from an article by Dr Ardavan Shahrdar on miasmatic analysis:

“1. Miasmatic analysis is the process of referring to Genus Epidemicus of infectious states to complete the image which is needed for the selection of the Simillimum.

2. This type of analysis is actually based on the Hahnemannian definition of miasmatic prescription. In some schools of homeopathy, you may see different miasmatic categories instead of what is here called Genus Epidemicus. Here, the term miasm means infectious disease, as termed by Hahnemann.

3. By ‘infectious diseases’ I am not referring to ‘infectious agents’. ‘Infectious disease’ is the dynamic state following the stress caused by” infectious agent”. The infectious “state” can persist without the presence of “‘infectious agent’.

I would like to point out that by Sycosis I mean sycosis according to what Hahnemann wrote in chronic diseases and not the sycosis that has been defined by various authors according to their own notions of sycosis.

Hahnemann refers to sycosis as the fig wart disease and we now know that it is venereal wart, which is condyloma acuminatum.

Here is another quote that may bring more clarity to the meaning of sycosis

“Now we clearly know that the figwart part of Sycosis is actually Condyloma acuminatum. HPV, the virus related to condyloma acuminatum, does not cause urethritis and gonorrhea in common terminology. The type of gonorrhea that Hahnemann linked to Sycosis is actually the urethritis caused by Herpes Simplex Virus type 2 (HSV-2) which can occur as co-infection with HPV. That’s why Hahnemann states that figwarts are not always associated with gonorrhea.”[9]

Hence the sycosis that is meant by Hahnemann, is actually an HPV infection that has been complicated by a Herpes Simplex type 2. This is merely a theory of Shahrdar that I chose to accept in analysing cases. Sumita’s case is one of many that I have successfully treated by applying the same theory. I chose Sumita’s case because the records were complete and I also had a history of her previous remedies, which I usually fail to get when patients come to see me from other homeopaths.

Shahrdar has compiled a materia virosa in which he has collected from various sources the pathology produced by various viruses. Below you can see how Sumita’s symptoms correspond to the HSV2 and the HPV viral states. I am not saying that she has these two infections, only the viral state which Hahnemann named miasm. J.H. Allen in his book Chronic Miasms and Pseudopsora ,clearly stated that the sycotic miasm affected the pelvic organs as we see in cases of endometriosis in general and in Sumita’s case in particular.

Hahnemann differentiates sycotic Gonorrhoea from what he called the common Gonorrhoea. A careful reading of his description of the initial stages of Sycosis in his book Chronic Diseases will show that he distinguishes simple Gonorrhea from the more compelex Gonorrhoea of sycosis.[10]

“The gonorrhoea dependent on the figwart-miasma, as well as the above-mentioned excrescences (i.e., the whole sycosis), are cured most surely and most thoroughly through the internal use of Thuja,* which, in this case, is Homoeopathic, in a dose of a few pellets as large as poppy seeds, moistened with the dilution potentized to the decillionth degree, and when these have exhausted their action after fifteen, twenty, thirty, forty days, alternating with just as small a dose of nitric acid, diluted to the decillionth degree, which must be allowed to act as long a time, in order to remove the gonorrhoea and the excrescences; i.e., the whole sycosis. It is not necessary to use any external application, except in the most inveterate and difficult cases, when the larger figwarts may be moistened every day with the mild, pure juice pressed from the green leaves of Thuja, mixed with an equal quantity of alcohol.” Chronic Diseases page 84

Below is a repertorization to search for viral states using repetorium virosum

This is a Repertorium Virosum analysis of Sumita’s symptoms.

Note that the rubrics chosen are:

Female Leucorrhea

Female Itching

Buttock Pain shooting

Rectum constipation

Rectum hemorrhoid

The reason for the brevity and seemingly general symptoms are because of the way the materia virosa is recorded. It is all just clinical symptoms and very brief.

The other limitation of materia virosa is that it does not record secondary symptoms. For example there is no entry on dysmenorrhea or endometriosis. The only entry on endometrium is endometritis which is an acute state and not related to endometriosis, though it would be related to fibroid uterus which is actually a culmination of chronic inflammation, which we later found Sumita also had.

The RV has many limitations

1. Few and brief symptoms

2. Most secondary symptoms are not in it, and have to be deduced.

In spite of these limitations, in the hands of a person who can translate secondary symptoms back to their primary symptoms the software is a great tool for deducing the viral state that is still active. Please note that viral state is another name for viral miasm, which can be said to be a subgroup of the original miasms of Hahnemann.

In this analysis the virus that has all the rubrics is HSV2.

HPV has only one rubric, but knowing the Human Papiloma virus’s affinity to the pelvic mucous membrane as well as it being implicated in Hahnemann’s original sycotic miasm, I am inclined to think that this is a miasm that at the moment, is not dormant but present.

Below are the materia virosa of the two viral states that I mentioned above.

Papilloma viruses/Human Papilloma Virus (HPV) Main Regions

Skin, Male organs, Female organs, Mind, Extremities, Larynx, Respiration.

Modalities: Aggravations: Night.

Mind: Sadness. Taciturnity. Loathing at life. Dullness. Anger. Irritability.

Crusty eruptions. Occipital pressing pain.

Eye: Conjunctivitis. Pressing pain.

Vision: Dim vision

Nose: Catarrh. Yellow discharge.

Mouth: Condyloma.

Throat: Mucous. Pain on swallowing.

External throat: Cervical lymphadenopathy.

Stomach: Increased appetite. Eructations.

Abdomen: Distention and rumbling. Cramping pains.

Rectum: Hemorrhoids. Burning pain after stool.

Prostate gland: Enlarged prostate.

Urethra: Burning pain during urination.

Larynx: Altered cry in children. Hoarseness.

Respiration: Distress. Stridor.

Female organs: Cervical cancer. Maculopapular eruptions. Warts.

Male organs: Maculopapular eruptions. Warts. Increased sexual desire.

Expectoration Increased.

Extremities: Warts. Painful plantar warts. Itching of lower limbs. Weakness of knee.

Back: Stiffness in cervical region.

Sleep: Sleeplessness. Falling asleep late.

Skin: Warts. Painful warts.

General: Weakness. Lack of vital heat. Burning pains. Stitching pains. Yellow discharges. Aggravation at

nights.

Antimiasmatic remedies THUJ, NIT-AC, CALC, LYC, Nat-s, Staph, Sabin, Sarsaparilla

Herpes Simplex Virus 2 (HSV-2)

Main Regions

Skin. Genital organs. Rectum. Extremities. Chest. Eye. Head. Mind. Urinary system.

Modalities: < Cold.

Mind: Irritability. Anger, Excitement, Dullness, Weakness of memory.

Vertigo

Head: Encephalitis. Meningitis aseptic. Headache pressing, stitching. Frontal headache. Occipital pressing headache. Headache aggravated by stooping. Crusty eruptions on head. Moist eruptions. Falling of hair. Heaviness.

Face: Herpetic eruptions. Heat.

Eye: Chemosis. Retinitis. Ophthalmitis. Chorioretinitis. Conjunctivitis pustular. Dendritic lesions of cornea. Keratitis. Retinal necrosis. Pain burning, pressing, stitching. Photophobia. Blepharitis.

Vision: Blindness. Blurred. Dim.

Ear: Pain stitching.

Nose: Catarrh. Coryza. Purulent discharge. Dryness inside nose. Internal sore pain. Scurfy nostrils.

Mouth: Gingivitis. Stomatitis. Ulceration. Ulceration of tongue.

About the author

Suriyakhatun Osman

Suriyakhatun Osman

MBBCh, DHMS, DRM

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