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A person�s general health and nutrition are reflected in the state of oral mucosa.
Examination of mouth mau give some clue to the diagnosis of many diseases. Many of
those clinical signs and symptoms are well represented in the MOUTH chapter of
synthesis. Many remedies have been added with reference to �Tongue that does not
lie� by Dr.Prakash Vakil. These additions corresponds to the clinical experience of
Dr. Prakash Vakil(Bombay) who spent a greater part of his life confirming remedies
by looking at the tongue. Only the remedies with this reference are the ones
considered by �The Vakil Module�.
Side
Time
Modality
Extension
Localization
Type of pain (description of pain)
The �sides� consists of these symptoms with any subrubrics they may have,
One side
Alternating sides
Right
Left
Time am., pm. Was replaced by the international time table �0 to 24 h as used in
computer, airports etc.
Eg.:Mouth ,heat after noon 17 h:Hyper
Burning:Nat.m.
Large aphthae:Jug.c.
Mercury after abuse of:Agar.,sars.
Painful:merc.cy.
Nursing, prevents child from:Bor.,cean.,merc.,nux v.,sulph.,sul.ac.,
Patches in:Phos-2
Scabs with(seen accompanied scabs thick)
Small, dirty yellow:Agar.,iod.,sulph.
Sore persisits:Thuja-2
Tender (see Painful)
Ulcers forming:Merc.cy.
Edges(see Sides)
Sides:Anis.,bov.
Tip, ulcer:Gink.b.,med.
CLEAN tongue,smooth
Accompanied by bitter taste:Chin.s.
Women in old:Carb.v.
Brain complaints (see Head Brain accompanied tongue clean
Cholera (see Rectum cholera accompanied tongue clean)
Constipation (see Rectum Constipation accom. Tongue clean)
Dryness of tip of tongue:Sec.
Headache(see Head pain accomp. Tongue clean)
Lepra (see Gen. lepra accom.tongue lean
Nausea (see Stomach nausea accomp. Tongue clean
Nephritis acute:Apis
Root of tongue coated(see discoloration,tongue white root accom. Clean)
Smooth(see accom. Clean)
Stomach pain in(see Stomach pain accom. Tongue clean)
Typhoid fever (see FEVER Typhoid accom. Clean)
Tip of tongue,red discoloration(see Discoloration tongue red tip accom.
Menses during:Sep.
Centre accompanied by whitish discoloration of the tongue (see Discoloration
white accom. centre clean)
Sides:Mangi.
Tip accom. By liver hardness (see abdomen hardness liver)
CRACKED, tongue
accompanied by
Aphthae:Bor.
Black tongue:Lyc.
Bleeding tongue:LAch.
Burns :Calen
Dysentery(see Rctum Dysentery)
Influenza (Gen. Influenza accom.tongue cracked)
pneumoniaChest inflammation, lungs accomp. Tongue)
deep
direction in all,accom. By ulcer in the centre:Fl.ac.
moistened, as if, it would crack if not:Pic.ac.
one deep red furrow accom. By tongue pale:raph.
Purple:Raph.
Typhoid fever after:merc.
Across:Acet.ac.,asr.,cob.,kali.p.
Ant.part
Down median line:Sin.n
Two deep cracks running length wise parallel to median line:Syph.
Lengthwise:merc.,pip.m.
Upper part:merc.
Accom. By hard tongue sides:Clem.
Nursing women:Lach.
TREMBLING
accompanied by
Brain complaints:Cimic.
Chin trembling of:Nux v.
Delivery after:Crot.h
Protruding, beginning only in the:Sep.
Long time if protruded for a:Ph.ac.
Pallor-Anaemia
Red:Acute alcoholic hepatitis
Black/ brown spots around mouth, circumoral pigmentation extending to baccal
mucosa- Peutz- Jeghers Syndrome �Multiple hamartomatous polyps in small bowel and
colon- in addison�s disease-risk for small bowel adenocarcinoma
Moistness of tongue: Some indication of the state of hydration of the body provided
the patient is not a mouth breather
Dry brown tongue � later stages of severe illness-advanced uraemia � acute
intestinal obstruction
Telangiectasia: Visible dilation of small cutaneous vessels
Haemorrhages on buccal mucosa:
Scurvy
A/c Leukemia
Thrombocytopenic purpura
Granuloma on gums: from ill filling dentures
Epulis :Any swelling arising in the gum of maxilla or mandible
Hypertrophy of gums:
In Pregnancy
In those who was treated for long periods with phenytoin
Scurvy
Pyorrhea alveolaris:Pus can be sqeezed from gum
Chronic marginal gingivitis:Gums retracted
Bleeds easily
Loss their characteristic stippling
Furring on tongue in heavy smokers
Brown fur, black hairy tongue- fungal infection
Papillae:Generalised atrophy of papillae produce smooth or bald tongue
Vit- B 12 deficiency
Iron defi. Anaemia
Celiac disease
GIT disorders
Deficiency states esp. pellagra
Strawberry tongue: Bright red papillae standing out of a thick white fur. Later the
white coat disappears leaving enlarged papillae on bright red surface. Usually in
scarlet fever
Geographical tongue:Localized irregular red area of desquamated epithelium and
filiform papillae surrounded by whitish yellow border. Pappilae change inn
cidtribution and give the appearance of a map � Congenital Heart disesases, A/c
gastric problems
In children with fever false geographical tongue
Ranula: Bluish white translucent swelling of variable size and due to blockage of
duct of a mucus gland
Sublingual dermoid cyst:Round opaque swelling lying beneath mucosa either above or
below the mylohoid. Due to sequestration of epidermal tissue. Beneath the skin
along the embryological lines of fusion of the mouth
Buccal mucosa:
Koplik spots:Bluish white spots surrounded by red areola opposite the molar teeth
Irregular areas or dots of slate, gray or blue pigmentation are seen in addison�s
disease
Ulcer on buccal mucosa- Behcet�s syndrome(associated with genital ulcers and
arthritis, Chrohn�s disease
Leucoplakia:Whitish opaque areas of thickened epithelium.Premalignant lesion
Causes are 6 Ss + candidiasis
Smoking
Syphilis
Sepsis
Sharp edges of a tooth(C/c frictional irritation)
Spirits
Spices
The patient should be counseled to give up identified irritant, then early lesion
may disappear after some months, but will return promptly if the old habits are
resumed.
Hairy tongue:Keratinized layer fails to desquamate normally from the filiform
papillae becomes greatly elongated to resemble a coating of hair. The hair may take
on various colours due to the presence of chromogenic organism to produce brown or
black hairy tongue.
Breath offensive:
Carious teeth
Infection/ ulceration of gums
Retention and decomposition of secretion in follicles of enlarged tonsils
Smell of acetone:Ketosis
Fishy/ammoniacal odour-Uraemia
Mousy odour- Hepatic failure
Putrid-suppurative condition of lung
Smell as that of apple blossom with a hint of stale feces:Bronchiectasis
Characteristic smell of paraldehyde and alcohol
Stomatitis:
Predisposing factors;
Anaemia associated with vit B12, folic acid and iron deficiency, vit.C deficiency
Factors affecting the health and efficiency of epithelium_recurrent ulceration or
chronic candida albicans
Reduced ability to deal with secondary infection- recurrent ulceration- usually in
cyclical leucopenia, agranulocytosis,aplastic anaemia, hypogammaglobulinaemia
Immune or autoimmune mechanism is believed to underlie a variety of conditions
affecting the oral mucous membrane
Eg.:Pemphigus
Behcet�s syndrome(damage to submucosal vessels-thrombosis- deep penetrating ulcers
5)Certain chemicals
Mercurial vapour inhalation- Mercury poisoning-(Redness,swelling of gums,
loosening of teeth, necrosis of bone)
Chronic lead poisoning:Blue black line at the gingival margin due to decomposition
of lead sulphide in the tissues
Virus infection: Associated with chicken pox, herpes zoster, coxsackie virus
Monilial stomatitis
Angular stomatitis(Angular cheilosis): Moist infected and crusting cracks at the
angle of mouth
Leak of saliva at the corner of the mouth and the moist skin becomes infected by
candida and staphylococci
Children
Old patient: The face sags and wrinkles to produce a moist fold
Deepening of the crease at the angle of mouth tends to occur in the edentulous
person, particularly when atrophy of the ridges under the dentures permits
overclosure
Loss of canine eminence permits the angle of mouth to sag
Denotations:
Astringent-causing contraction of tissue
Blotches- pigmented or erythematous lesion
Cancrum-gangrenous ulcerativeinflammatory lesion
Cancrum oris(Noma):Gangrenous stomatitis:in poorly nourished children
Debilitated adults
Lower socio economic groups
Precede by another disease eg. Kala azar, dysentery
Pains are arranged as separate rubrics like aching, biting, boring etc. in
alphabetical order
Accompanied by � (which is present in Synthesis) is not present in Murphy�s
repertory as separate subrubric
Tongue, Teeth separate chapters
Boils, eczema, vesicles as separated chapters. But other eruptions like pimples
under the main rubric Eruption
Burnt, pain as if(Synthesis-Mucus membrane scalded)
Lips- Affection included in the mouth chapter itself(Synthesis- Lips in Face
chapter)
7)The important rubrics related to Lips which is present in Mouth chapter are;
Abscess lips-Anthr.
Upper:Bell
Acridity upper lip:Mang
Burning lip smokers in:Bry
Chapped lips
Convulsion lips:Ambr.,caust.,crot.c.,kali.c.,ran.b.
Cracked skin corners
Drawn lips
Eczema around
Egg white dried on lips
Erysipelas, lower lip extending from:Anthr-3, apis
Everted lip:Apis
Fever blisters, lips
Peeling lips
Picking lips
Quivering lips
Salty lips
Shiny lips
Shriveled lips
Smashing of lips
Veins distended lips:Crot.h.,dig.
Speech, faltering (Speak in a hesitating or broken voice)tongue- nit.ac.,sulph
Spitting constantly(Synthesis Mind spitting)
Brushing teeth
Children especially,remedies for
Licking lips
Nursing children
Putting out the tongue
Licking with the tongue
Sucking with tongue
References:
Synthesis repertory- 8.1 version
The tongue symptoms in clinical diagnosis, Dey.M
Tastes, odors �likes, dislikes: Jain .J.K
Homoeopathy in diseases of teeth and gums- agarwal .Y.R
Tongue indications-Mahendra sing
Therapeutic guide-40 years practice: Dr.G.H.G.Jahr:
Oral diseases and Homoeopathy- tonsils gums throat.Dua.S.
Boenninghausen�s Therapeutic pocket book
Boenninghausen�s Characteristic Materia Medica and Repertory by Dr. C.M.Boger
Therapeutic pointers- some common diseases-Dr. E.A.Farrington
Homoeopathic medical repertory by Dr. Robin Murphy
Hutchinson�s clinical methods
Basic Pathology- Kumar, Cotran, Robbins
Text book of Pathology- Harsh Mohan
Principles & Practice of Medicine- Davidson
Text Book Of Medicine- K.V.Krishnadas
Concise Oxford Text Book of Medicin.
Harrison�s principles of internal medicine
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