Understanding the rubric Vertigo and the first grade remedies of Synthesis repertory

Dr Sreeja L

ABSTRACT
The term vertigo is derived from the Latin word ‘vertere’ meaning ‘to turn’. Vertigo is defined as an abnormal perception of movement of the environment or self, and occurs because of conflicting visual, proprioceptive and vestibular information about a person position in space. Vertigo commonly arises from imbalance of vestibular input and is within the experience of most people. Very often the confusion is between the terms vertigo and dizziness. In this article an attempt is made to understand the meaning of the rubric “Vertigo” and also differentiate the 1^st grade remedies from Synthesis repertory.

KEY WORDS: Vertigo, Dizziness, Meniere’s disease, Synthesis repertory

INTRODUCTION
Vertigo refers to a sense of spinning or other motion that may be physiological, occurring during or after a sustained head rotation or pathological, due to vestibular dysfunction. Dizziness is an imprecise term that means consciousness of disordered orientation of the body in space. Dizziness includes variety of symptoms it could mean vertigo, disequilibrium, light headedness, presyncope, rocking or swaying as if on a motion sickness, nausea and vomiting. 

The term light-headedness is classically applied to pre-syncopal sensations resulting from brain hypoperfusion but it may refer to other symptoms such as disequilibrium and imbalance. The challenge to diagnosis is that the patients often have difficulty distinguishing among these various symptoms and the words they choose do not reliably indicate the underlying aetiology. 

Peripheral causes of Vertigo are peripheral vestibulopathy such as labyrinthitis, vestibular neuronitis, benign positional vertigo, post-traumatic vertigo, vestibulotoxic drug induced vertigo, Meniere’s disease or any bacterial infection. Systemic cause of vertigo are drugs, hypotension, presyncope, infection (bacterial, syphilis, viral) endocrine diseases. Central neurological causes of vertigo are brainstem ischemia and infarction, Multiple sclerosis and epilepsy. 

It can be paroxysmal or due to a fixed unilateral or bilateral vestibular deficit. Acute unilateral lesions cause vertigo due to a sudden imbalance and instability of vision when head moves(oscillopsia) due to loss of normal vestibular reflexes.

A detailed history is of utmost important in evaluation of these patients. General examination, detailed neurological examination including mental status and cranial nerve especially ocular motor examination, sensorimotor and cerebellar evaluation must be done in each patient.

The rubric ‘Vertigo’ in Synthesis repertory has 34 1^st grade remedies- 3 marks

• Aconitum napellus
• Agaricus muscarius
• Ailanthus glandulosa
• Apis mellifica
• Argentum metallicum
• Baptisia tinctoria
• Belladonna
• Bryonia alba
• Calcarea carbonica
• Calcarea sulphurica
• Cannabis indica
• Carboneum sulphuratum
• Chelidonium majus 
• Chininum sulphuricum 
• Cocculus indicus 
• Conium maculatum
• Cyclamen europaeum
• Digitalis purpurea
• Dulcamara 
• Gelsemium sempervirens
• Lycopodium clavatum 
• Natrum muriaticum 
• Nux vomica 
• Onosmodium virginianum 
• Opium 
• Petroleum 
• Phosphorus 
• Pulsatilla nigricans
• Rhus Toxicodendron 
• Sanguinaria canadensis
• Secale cornutum 
• Silicea terra
• Sulphur
• Tabacum 

ACONITUM NAPELLUS

• Vertigo worse on rising and shaking head, whereby complete darkness comes before the eyes.
• It is either hyperaemic or auditory, with vanishing of sight.
• Worse on raising up, which staggers especially to the right.
• Vertigo from fright, anger, heat of sun, from shock.
• Sensation of intoxication or dizziness in the head, loss of consciousness.

AGARICUS MUSCARIUS

• Vertigo in morning from heat of sun, sunlight, yawning.
• With palpitation which is more on walking, reeling as if drunk with tendency to fall forward.
• Worse after menses with stupefaction and burning in vertex.

AILANTHUS GLANDULOSA

• Vertigo worse lying, morning 
• Vertigo with incordination of lower limbs.
• Vertigo with vomiting. 
• Ache in frontal with dizziness and red hot face.

APIS MELLIFICA

• Vertigo with sneezing worse standing, sitting, lying, shutting eyes.
• Vertigo with nausea and headache as if she would fall, with obscuration of sight, nausea and disgust for food 
• Vertigo on closing eyes, disappearing on opening them
• Spells of vertigo in spring and after least effort

ARGENTUM METALLICUM

• Attacks of vertigo on looking at running water.
• Whirling as if drunk, he cannot think rightly
• Vertigo on entering a room after a walk 
• Worse entering warm room with intoxicated feeling 
• Felt suddenly giddy and as if mist was before eyes.

BAPTISIA TINCTORIA

• Confused, swimming feeling in head, with paralysis of eyelids and severe nausea.
• Vertigo with a weak feeling especially of lower limbs and knees, as if intoxicated which is worse on walking, with pressure at root of nose

BELLADONNA

• Vertigo with anguish falling to left side or backwards, with weariness before and after each attack.
• Sensation of being rocked, worse stooping and rising from stooping, eating and drinking.
• Worse on motion, turning over in bed, with rush of blood to head roaring in ears, dim vision.

BRYONIA 

• Vertigo on raising up or stooping with a swaying feeling in brain and heat as if drunk.
• Aural vertigo with nausea and confusion, which is felt in occiput as though all the objects are whirling.
• Worse on least motion as if sinking deep down in the bed, better cold.
• As if brain were turning around, more on turning head or on stooping. 

CALCAREA CARBONICA 

• Vertigo on ascending (especially running) and when turning head
• Worse looking upwards, scratching head, after epilepsy.
• Tendency to fall to left side or backwards. 
• Whirling with nausea and vomiting worse stooping. 
• Vertigo with trembling in the early morning until he has eaten breakfast.
• Fainting attacks with blindness and coldness.

CALCAREA SULPHURICA

• Vertigo better open air but worse walking fast.
• Dizzy in head and weakness with tendency to fall. 
• Vertigo with deathly nausea.
• Epileptic vertigo, on moving head quickly, stooping.

CANNABIS INDICA

• Chronic vertigo, as of floating off the ground.
• Worse on rising with stunning pain in back part of head.
• Sensation as if the room were falling in pieces about her, feels like falling sidewise 

CARBONEUM SULPHURATUM 

• Sudden attacks of vertigo while sitting 
• Headache and vertigo 
• Dull, muddled feeling in forehead as if contracting 
• Frequent attacks of fainting 

CHELIDONIUM MAJUS 

• Vertigo with liver disturbance with inclination to fall forward.
• Vertigo felt in vertex worse closing eyes with bilious vomiting and pain in liver. 
• Worse rising from bed or sitting as if turning in a circle.
• Vertigo with shivering over upper part of the body.

CHININUM SULPHURICUM 

• Vertigo on stooping with tinnitus and throbbing headache.
• Whirling as if head were falling backwards. 
• As if intoxicated with buzzing in the ear and giddiness. 
• Falling in street, inability to remain standing with twitching of eyelids

COCCULUS INDICUS 

• Vertigo on siting up and nausea when riding. 
• Seasickness and motion sickness with nausea and vomiting. 
• When riding in a car or train worse watching moving surroundings which is along with palpitation.
• Worse in the morning, raising head, felt in forehead.
• Vertigo from loss of sleep.
• Constant sensation as if about to faint and intoxicated.

CONIUM MACULATUM 

• Vertigo when lying down and when turning over in bed.
• When turning head sidewise or turning eyes.
• Worse shaking head, slight noise or conversation of others, especially towards the left 
• Whirling when looking around 

CYCLAMEN EUROPAEUM

• Vertigo objects running in circles or look pale 
• Worse open air better in a room and sitting 
• Vertigo on standing still when he leans against something, he feels as if brain moved in the head 
• As if he was riding in a carriage with his eyes shut

DIGITALIS PURPUREA

• Constant dizziness with ringing in ears.
• Vertigo when walking or riding, rising from sitting with very low pulse.
• Vertigo from cardiac or hepatic disorder.
• With trembling, anxiety and faintness as if faintness would occur.

DULCAMARA

• Vertigo on waking in morning.
• Giddy and dizzy
• With trembling and weakness.
• Momentary vertigo when walking with darkness before eyes.

GELSEMIUM SEMPERVIRENS

• Vertigo on rising, light headedness worse by sudden movement of the head and walking. 
• Dizziness and blurred vision.
• Vertigo spreads from occiput as if drunk with visual symptoms.
• Staggering as if intoxicated when trying to move, worse from smoking.
• Vertigo with loss of sight, chilliness, accelerated pulse. 
• Dullness of vision, double vision.
• Vertigo of child being carried.

LYCOPODIUM CLAVATUM 

• Vertigo when looking at anything turning. 
• In the morning on rising, reels back and forth.
• Gets hot during vertigo, face reddens, eyes watery and become dim.
• Whirling when stooping or in a warm room.

NATRUM MURIATICUM

• Vertigo, as if falling, worse standing near a window.
• Worse on closing eyes, better lying with head high.
• Vertigo during pregnancy. 
• From straining eyes or close study. 
• With jerking in head and tendency to fall forward or to left.
• Worse in the morning on rising, after stool. 

NUX VOMICA 

• Vertigo in morning, on empty stomach, after dinner
• Intoxicated feeling, worse morning, mental exertion, tobacco, alcohol, coffee, open air.
• Brain and other objects turning in a circle. 
• With momentary loss of consciousness. 
• Cloudiness in head, as from intoxication.
• After effects of yesterday’s debauch.
• From night watching and over exertion.
• From opium, smell of flowers, gas, etheric oils etc

ONOSMODIUM VIRGINIANUM 

• Vertigo, numbness and muscular prostration
• With headache worse lying on left side, rising the hands above the head

OPIUM 

• Vertigo after fright.
• Lightness of head in the elderly from injuries to head. 
• Stupefying when raising up, compelling him to lie down. 
• Stupefaction and dull confusion of head, like vapor in brain, as from intoxication.

PETROLEUM OLEUM 

• Vertigo on rising, stooping, felt in occiput.
• As if intoxicated or seasick.
• Vertigo like that produced by swinging motion.
• Fainting with trembling during storms. 

PHOSPHOROUS 

• Vertigo with faintness, nausea and headache.
• Floating sensation on walking. 
• Vertigo after rising, with weakness of legs. 
• Worse looking up or down, exertion of vision. 
• From smell of flowers, gas, ethereal oils, turpentine.
• Vertigo of the elderly.

PULSATILLA NIGRICANS

• Vertigo caused by indigestion.
• With nausea and gastric disturbances.
• On stooping with nausea as if intoxicated.
• With whirling and loss of sight.
• Better in open air, worse sitting up, looking up.
• Vertigo before, during menses, after suppressed menses.

RHUS TOXICODENDRON

• Vertigo with heaviness in limbs.
• When rising, as if she were going to fall forward or backward.
• Vertigo while walking with staggering as if intoxicated.
• Vertigo in the aged, whirling then headache begins.
• Nausea, vertigo and bloated abdomen after eating 

SANGUINARIA CANADENSIS

• Vertigo, worse looking up and moving head rapidly. 
• Vertigo with long continuing nausea, debility and headache with diminished vision
• Head feels dizzy, cannot turn quickly, with fear of falling 

SECALE CORNUTUM

• Vertigo with stupefaction and heaviness of head.
• Reeling, inability to stand erect. 
• Vertigo as from intoxication, on slight motion, while sitting 
• Peculiar feeling of lightness of head in occiput, as from intoxication, unsteady gait 

SILICEA TERRA

• Vertigo when closing eyes and from excessive use of eyes.
• As if drunk with nausea and sleepiness
• Vertigo from looking up, when lying on left side 
• With tendency to fall backwards 
• Better wrapping up warmly, must sit down.
• Vertigo in neurasthenia, epilepsy and meniere’s disease 

SULPHUR 

• Vertigo in forehead, worse when crossing a river, stopping with headache. 
• Especially when sitting, with vanishing of sight and nose bleed. 
• Vertigo in the morning with slight epistaxis. 
• When walking in the open air, she doesn’t not look down nor stoop in the slightest degree, she must take hold of something to avoid falling. 
• When standing with rush of blood towards the heart.
• Vertigo when she lies at night on the back. 

TABACCUM 

• Vertigo with seasickness.
• Excessive vertigo, with copious cold sweat, worse opening eyes. 
• Vertigo on opening eyes, sick headache with deathly nausea, periodical 
• Worse on rising or looking upwards. 
• Worse indoors, better open air. 
• Vertigo and fainting, loss of consciousness.
• Vertigo followed by vomiting of food and tremulous weakness.
• Meniere’s disease with feeling of seasickness

CONCLUSION
Repertory is an index to Materia medica and we should not content only with repertories because it guides to the group of remedies but the final selection has to be made from foundation sources that is Materia medica. We need to exactly interprete the symptoms of the patients and also differentiate a group of similar remedies with our knowledge and experience and arrive at a right prescription and similimum. This article will help in understanding the subjective and objective symptoms of Vertigo in different remedies which is very useful in clinical practice

REFERENCES

1. Jhanwar Venugopal. Dizziness and Vertigo. In Munjal YP(ed). API Textbook of medicine,10/e,Vol 2 2015. Jaypee Brothers Medical Publishers(P)Ltd. New Delhi
2. Longo, Fauci, Kasper, Hauser, Jameson, Lascalzo. Harrison’s Principles of Internal Medicine.18^th. USA: McGraw Hill Company
3. Davidson S. Principles and Practice of medicine,22/e, Elsevier Ltd.2014
4. Schroyens F Synthesis(Repertorium Homoeopathicum Syntheticum) 9.1 ed. New Delhi. B Jain Publishers;2008
5. Kent J. Lectures on homoeopathic materia medica. New Delhi: B Jain Publisher;2018
6. Boger CM. Boenninghausen’s characteristics Materia medica and repertory with word index. New Delhi Jain publishers;2007
7. Murphy R, Lotus Materia Medica,3/e, Uttar Pradesh, Jain Publishers, 2017
8. Hahnemann Sameul, Materia medica pura.23/e. Vol 1,2.B Jain Publishers(P)Ltd. 2019
9. Hering C. The Guiding symptoms of our materia medica.12/e,B Jain Publishers(P)Ltd.2018

Dr Sreeja L
MD Part 1
Department of Case taking and Repertory
Under the guidance of  Dr Anusuya M Akareddy
Government Homoeopathic Medical College and Hospital,Bengaluru