Miasmatic understanding of Hypertension

Dr  Arti Sanghi Jain

Abstract:
This article includes the clinical understanding of hypertension along with its miasmatic aspect. Susceptibility plays a key role to maintain the health but when a person hangs up in dilemma of life situations it affects the person from its roots. Mechanisms those play important roles in this scenario are explained briefly along with miasmatic expression in this article.

ABBREVIATIONS: HTN: Hypertension; B.P.: Blood Pressure; Na+: Sodium;

Introduction:
Hypertension or high blood pressure is the by-product of modern civilization and it has become a “Silent killer” due to our modern stressful life. High BP is not a disease, but a manifestation or sign of internal malady or pathological process. The elevation in blood pressure is actually a compensatory or conservative process by which an adequate circulation of blood to the tissues is maintained, in spite of obstruction or increased resistance to the flow of blood. 

Hypertension is associated with various health related complications like arterial aneurysm, strokes, heart failure, heart attacks and kidney failure or can lead to death due to failure of circulation. Aside from, medication for hypertension always comes with many hurdles, so there is a need of alternative treatment to control and manage HTN.

Hypertension is a condition where arterial blood pressure is chronically elevated. BP occurs within a continuous range, so cutoff levels are defined according to their effect on patients. The British HTN Society has defined ranges of BP which are normal and those that indicate hypertension.

Category BP	Systolic BP(mmHg)	Diastolic BP(mmHg)
Optimal	<120	<80
Normal	<130	85
High normal	130-139	85-89
Hypertension
Grade1 (mild)	140-159	90-99
Grade2 (moderate)	160-179	100-109
Grade3(severe)	>180	>110
Isolated systolic Hypertension
Grade1	140-159	<90
Grade2	>160	<90

Related on etiological basis, there are two types of hypertension. One is essential HTN while another is secondary HTN. Essential or Primary HTN (90-95%) is that for which no direct cause has been identified yet, although it is closely to some risk factors as:

1. Advancing age,
2. Type A personality (active, highly ambitious, responsible, industrious, fastidious)
3. Hereditary (if one parent has hypertension 25% chances in children to develop HTN, if both parents have hypertension 60% chances in children to develop HTN),
4. Obesity
5. Addictions like smoking, excessive alcohol consumption etc.
6. Hypercholesterolemia
7. Nervous factors like temperament, emotional stress etc.
8. Increased NA+ intake or High fat intake. 

While Secondary HTN generally develop secondary to some disease condition. Endocrine, excretory, metabolic and connective tissue disorders are main cause for such type of hypertension so we should always screen these systems for cause of secondary hypertension. Causes may be:

1. Renal disorders as Glomerulonephritis, Polycystic kidney disease, tumors etc.
2. Endocrine disorders as Pheochromocytoma, Cushing’s syndrome,
3. Primary Hyperaldosteronism
4. Toxemia of pregnancy
5. Neurogenic disorders
6. Connective tissue disorders
7. Miscellaneous causes includes use of OCP or Steroids
8. Hypothyroidism or Hyperthyroidism.

Other Types of Hypertension

Malignant HTN – When the blood pressure exceeds more than 200/140 mmHg, and considered as  emergency condition because it is related to various life threatening conditions.

Resistant HTN– If blood pressure does not reduce even after antihypertensive medication.

Pathophysiology of Hypertension:
There are various Neuro-endocrinal pathways which plays important role to maintain BP in normal range. When person fails to adapt in his environment, susceptibility alters and this results in abnormal reaction pattern. Such kind of reaction affects hippocampal lobe and further other neuro-endocrinal mechanisms. The possible mechanisms for HTN includes: Failure of kidneys to excrete sodium, Over–activity of renin–angiotension in system, Sympathetic nervous system over–activity plus hereditary/genetic influence with contribution of three environmental factors: sodium, Stress and Obesity etc. This is an ultimately result of either increased cardiac output and/or increased peripheral resistance. Cardiac output is known to increase early in the disease course, with normal total PR. At time, cardiac output lowers to normal levels, but total PR is increased.

PREVALENCE IN INDIA: The prevalence of hypertension was 59.9 and 69.9 per 1000 in male and females respectively in the urban population, and 35.5 and 35.9 per 1000 in males and females respectively in the rural population (according to 2 studies conducted in Haryana State).

Investigation: We should always rule out secondary causes to confirm essential hypertension.

1. Hemoglobin, Urinalysis and kidney function study to detect haematuria, proteinuria, casts to rule out renal cause.   
2. Fasting blood sugar level (diabetes and hyperglycemia is a feature of pheochromocytoma).
3. Lipid profile (atherosclerosis).
4. Echocardiography (cardiac disease as ECG is not sensitive for LVH).
5. Specific tests like 24 hour urine free cortisol, plasma, metanephrines and plasma aldosterone/                  rennin ratio for endocrine causes of HTN.
6. Renal USG (polycystic kidney, obstructive uropathy).

HOMOEOPATHIC APPROACH:
In Homoeopathy, health indicates harmonious functioning of life force and disease is considered as deviation from health, when the harmonious functioning of this force is obscured. Homeopathy treats the sick individual, not only his sickness as stated in Hahnemann’s writing “there is no disease, but sick people”. Thus in case of primary/essential HTN, homeopathy is concerned     with the patient having high blood pressure rather than the hypertension itself. It is the constitutional makeup (inherited or acquired) of an individual and the environmental influences (internal or external) that predispose a person to develop HTN. Thus the totality of various characteristic symptoms narrated by this patient and the peculiar signs along with understanding of Miasm leads the homeopath towards similar remedy that relieves the totality of symptoms and also the symptoms of increased blood pressure.

Miasm is a topic for plenty discussion and which usually lasts with same amount of confusion.  To understand Miasm we should understand the susceptibility of person. Abnormal or altered susceptibility either demands excessive or defective stimuli or react to stimuli in an exaggerated or a diminished way. Reaction (according to Stuart Close) it is an expression of susceptibility.

1. Excessive Reaction- 

In Nervous, Sanguine and Choleric temperament and also Intelligent, Intellectual, Zealous, Impulsive person who are quick to act and react have high susceptibility this persons having  prolonged stress, anger, tension they react to abnormally and are prone to HTN due to increased susceptibility. In an hyperactive individual having more mental and physical energy. They are temperamentally becomes hyper susceptible and become restless and look for their work .These hyper susceptibility leads to HTN in these person.

2. Deficient Reaction- After menopause in women and old persons have low susceptible and prone to HTN. More cases of HTN are found in over-weight and obese individual due to low susceptibility over indulgence in alcohol, meat, Rich fatty food when prolonged for years will leads to low susceptibility and leads to HTN. Miasm can be understood in following ways in hypertension.

Psoric Predominance- Patients with Psoric predominance are likely to have hypertension, caused by prolonged emotional disturbances like anxieties, anger, worries or grief etc., the blood pressure elevation subsides with the settlement of the above factors. The Psoric element is associated with many sensations, modalities and concomitants reflect the true picture of the suffering. It is closely linked with heart trouble and could prove fatal.

Sycotic Predominance– The element of ‘excess’ found in psychotic diseases. Hypertension is usually an expression of sycosis, here the coordination of body functions is lost and they become excess. A Sycotic person is narrow–minded and the same narrowness of blood vessels leads towards HTN. Metabolic syndrome is actually a mixture of excess in different systems, as excessive fats deposition, hypertrophy of organs, accumulation of fluid in body, obesity etc. are all sycosis and are the leading causes of HTN. Pain in the Precordial region radiates towards scapula or vice versa. The miasm is transmitted to next generation.

Syphilitic Predominance–The syphilitic influence in primary/essential HTN leads to destructive changes in vital organs like retina, brain, heart and kidneys. Most of the cases of secondary HTN and malignant HTN are syphilitic in origin. HTN due to congenital defects are also syphilitic in origin. These patients are prone to die suddenly without giving any

Pseudo-Psoric Predominance–Tubercular Miasm reflects numerous subjective symptoms, the mental or emotional reactions of Psora and pathological changes of syphilis. These patients wide range of fluctuations in BP, they often present with hypertension & are prone to hemorrhagic manifestations as retinal hemorrhages, epistaxis etc.

Management:
The homeopathic management of HTN is based on the ‘Principle of Similia’. Being a chronic disorder, it calls for constitutional anti–miasmatic treatment. It is the totality of various characteristics symptoms   that guides the homeopath towards similimum. In Organon, aphorism153, homeopathy stressed upon the importance of individuality of the patient. Hahnemann stated that it is the strange, rare, peculiar characteristic symptoms of an individual and not the common symptoms that indicate the similimum. Hahnemann also emphases is on   the mental symptoms of patients in all physical disorders. He stated that the emotional reactions and mental disposition of a patient are to be particularly noticed as they often govern the remedy.

This statement of Hahnemann is applied naturally to the cases of HTN as these are the psychological factors that are responsible for the causation of disease. When a disease with multiple miasmatic influences (like essential HTN) is treated, it is significant that the remedy selected corresponds to the prominent/ dominant Miasm. Very often, it may the dominant Psoric Miasm, afterward the prominent Sycotic or syphilitic Miasm, as manifested by the case picture itself call for appropriate change of remedy.

     Dash Diet Is Recommend In Hypertensive Patient

Eatable things	Consume food rich in magnesium: sea food , nuts, green leafy vegetables, peas, pulses etc. Certain food like- custard apple and banana are high in calcium. Take rich fiber diet.
Avoidable things	Common salt less than 3gm/day Low fat diet eg. Avoid meat, eggs, milk & its products, cheese, butter, ghee, ground nut oil and other non vegetarian food.

The treatment of patient with HTN is not less than a super mastic art. The success of treatment is based on the selection of remedy that is similar to the acute totality, followed by the intake of the constitutional (anti miasmatic) drug. A repeated and strong suggestions and advice regarding dietary plan and regimen is also essential along with the appropriate similimum, in order to get the better outcome in lowering the BP. Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicine selected after a full individualizing examination and case-analysis, which includes the predisposition, disposition, diathesis and disease with expressions in various slack. When a case is presented as acute emergency, we can also manage the case by using ‘Mother Tinctures’ as an alternative or as a reserve, this is actually termed as palliative approach of homeopathy for management of HTN. The homeopathic concept of minimum dose also works even in prescribing Mother Tinctures. The use of a few drops of mother tincture is proved effective in lowering BP within few minutes in clinical practice. Thus administration of mother tincture may be better than allowing the patient to continue dangerous and heavy doses of modern medicines. The treatment is based upon the cause and the totality of the case. Many homeopathic remedies are successfully used to control hypertension.

BIBLIOGRAPHY:

• Boon Nicholas A., College Nicki R., Walker Brian R., Hunter John A.A., 2006, Davidson’s Principles & Practice Of Medicine 22ndedition , P.C.Das Churchill Livingstone Elsevier,20th Edition,
• Harrison Manual of Practical Medicine, Jaypee Brothers Medical Publishers, 20thEdition,ss
• www.hypertension.com
• www.Britishhomoeopathic.
• Hahnemann samuel. Organon Of Medicine.6th ed. New delhi: B Jain Publishers Pvt Ltd; 1997 p.172-186.
• Allen. J.H. The chronic miasms, New Delhi: B. Jain Publishers Pvt. Ltd;p.159-64
• Boericke William. New Manual of Homeopathic Materia Medica & Repertory, 2ndrevised. New Delhi: B Jain Publishers Pvt Ltd;2001.

Dr. Arti Sanghi Jain
Associate Prof. Department of HMM
Naiminath Homoeoapathic medical college,Agra(U.P)