Introduction

A chronic pulmonary obstructive disease CPOD with Immunologically positive case had responded well to Dr.Mrs.C.Sundari Semparuthi’s treatment. She presents a detailed case history here. Dr.Sundari, a Madurai based Homoeopathic graduate practicing since ten years is a good clinician and researcher.

Definition
A long term infection caused by an acid fast bacillus “Mycobacterium Tuberculi” Exposure by breathing in or eating infected droplets and it usually affects the lungs although infection of other organ systems by other ways of getting the disease occurs. The lung tissues react to the bacterium by making protective cells that surround the disease organism forming small group of cells or bumps (Tubercles). Untreated, the tubercles enlarge and merge to form large tubercles that undergo a change into a grainy mass of tissue (caseation). Eventually the separated dead tissue ends up in the cavities of lungs.
Ig A and Ig M are analyzed together to detect reactivation cases in chronic infection Ig G antibodies give an evaluation of the activity of the disease. Ig M antibodies are an indication of the beginning of a primary infection. This Ig M test is particularly useful as a diagnostic tool for the early detection of tuberculosis infection.

Case History
A businessman from upper Middle class family, aged 47, suffering from respiratory complaints for the past ten years consulted me. He had recurrent cough and wheezing with productive cough, which was worsen in early morning. warm room and lying down. He was better after expectoration. Occasionally he had high-grade fever with chills. When he was around 25, had been attacked by

pulmonary tuberculosis and received Anti tunberculosis treatment. Had typhoid fever 2 years back and suffered with Amoebiasis on and off. He is the eldest; 3 sisters got married; Mother died when he was young. His stepmother looked after them well. Father died at the age of 60 due to Ca secondaries .One of his sisters is asthmatic. He is short tempered. Shouts when works are not done in time as he expects to be. · Perspiration generally profuse < in summer esp. in chest, forehead and axillae · Craves: sweets, ice cream and cold drinks · Appetite decreased: Aversion to meat · Motion – twice daily: urine – Normal · Hot patient; cold bathing desires; complaints < during summer < warm room His blood investigation for TB antibodies showed Negative Ig G and positive IgMIgG for TB: Patient value: 67 IU / ml (Normal up to 125) IgM for TB: Patient Value: 180 IU / ml (Normal up to 135) Refer the Plate - I Miasmatic understanding of tuberculosis Psora: Primary focus & Hilar node: Under proper treatment resolves completely Sycosis: Untreated or maltreated leading to caseation. Tubercular: Healing by Fibrosis, or Miliary tuberculosis. Syphilitic: Healing by Necrosis or destruction (cavities of lungs) Constitutional Totality Hot patient; Craves: sweets, ice cream and cold drinks < During summer < warm room Profuse Expectoration- Whitish-Greenish-Yellowish Chronic of Pulsatilla- Kali Sulph
Date		Complaints			Findings		Prescription
27.1.2002		Cough since 10 days, increased, Mild fever with chill < evening Wheeze + continuous Rattling on coughing + +			Temp – 100.8. F O/E: Nails Clubbing + Mild Rhonchi + Bilateral Basal crepts + +		< Rx: Pulsatilla 30 C once in 3 hrs
28.1.2002		Cough > wheeze > Phlegm + + Fever + < Evening: Appetite less			O/E: Rhonchi Nil, Bilateral Basal Crepts ++ Investigations advised		Rx: Pulsatilla 30 C TDS
30.1.02		Cough + Mild in the morning with greenish expectoration. Temp – Normal: Appetite decreased			O/E: Bilateral Basal Crepts + + TC: 10300Cells/cumm P: 76% L: 20% E: 04% ESR: 50mm/hr Hb: 11.50gms% Widal test for Typhoid - Negative		Rx: Pulsatilla 30 C TDS
2.2.02		Severe cough since 2 days with wheezing Slight blood in sputum: Cough frequent with drenching sweats; Cough ends in vomiting with nausea: Tongue – clear Loss of Appetite & Taste Fever since 2 days.			Temp-102oF O/E: Rhonchi + + all over Bilateral Basal Crepts + + Wt. 54 ½ kg Suspecting T.B Immuno serology tests advised		Rx Ipecac 6 C / 2 hourly
5.2.02		Cough >; wheeze still present No bloody sputum			Cough >; wheeze still present No bloody sputum Refer the plate- 1		Rx Syphilinum 200 Single
<6.2.02		Cough – increased ++ Haemoptysis – Mild; Wheeze + Appetite decreased			T-100oF O/E Bilateral Basal crepts + Rhonchi + Blood Culture Negative for Enteric & Non Enteric Group of Organisms		Rx Kali Sulph 200/1 dose SL / TDS
8.2.02		Cough > Appetite Improved Sputum transparent; No wheeze Feels better, Tiredness +			Wt – 55 Kg Temp – normalSputum for AFB –negative which confirmed no active spread		Rx Kali Sulph 200 one dose, Sac Lac -BDS
30.2.02		Cough – Mild: No fever, Sleeps well: No heeze. Appetite - good : Sweat – ormal O/E : Occasional Bilateral Basal Crepts+			Chest x ray: Bilateral Bronchiectasis Advised Ig G, Ig M		Rx Histamin 6/ once in a week, Kali Sulph 200 / once a week, Sac Lac / BDS
1.6.02		Patient has mild cough in the morning			Ig G: Pt. Value: 68.9 Iu / ml Ig M: Pt. Value: 70.6 Iu / ml Previously it was 180 Refer the Plate - II		Rx Histamin 6/ once in a week, Kali Sulph 200 / once a week, Sac Lac / BDS
Patient was explained about his illness and the limitation of the treatment Advised nutritious diet, high protein diet, advised to do breathing exercises & walking.