DIAGNOSTIC APPROACH TO MATERIA MEDICA

(Dr. AMIT ARORA and Dr. UDESH KUMAR)

Our material medica is full of symptoms. Each symptom of material
medica indicates toward a clinical diagnosis. In this section we have
described some drugs consisting of neurological symptoms related to
difficulty in walking.
(1) Ataxia: The patient shows no paralysis, but reveals clumsiness on
moving the limbs especially with movements of precision. The
BAA!"E is upset and #AIT is unsteady. This condition is called
ATA$IA
(a) Vestib!ar ataxia% It is acute in onset and is accompanied
by vertigo, vomiting and disordered balance. In vestibular
ata&ia, the patient tilts toward the lesion while walking
forward and to opposite side while walking backward. The
commonest causes are 'estibular neuronitis, acute
labyrinthitis, meniere(s diseases.
(b)Cerebe!!ar ataxia: It causes unsteadiness and loss of
balance in walking which is unaffected by closure of eyes.
"erebellar signs like hypotonia, stoop shoulder on side of
lesion, )erking nystagmus, scanning speech, intentional
tremor, dysdiadochokinesia, dysmetria and staggering gait
*characterised by broad base gait like a drunkard+. The
causes are basilar artery insufficiency, alcohol into&ication,
cerebellar haemorrhage or infarction, multiple sclerosis and
Inherited *spinocerebellar ata&ia and friedreich(s ata&ia+.
(") Se#s$r% ataxia: It occurs due to lesion of proprioceptive
sensory afferent fibres weather in peripheral nerves
*peripheral neuropathy+, posterior column on spinal cord and
thalamus. In ,ensory ata&ia there is ,tamping gait *here the
patient place the feet on the ground with greater emphasis
due to loss of )oint sense and other proprioceptive impulses
from foot+. In sensory ata&ia -omberg(s test is positive
*Romberg's test is positive if the patient sways or falls
while the patient's eyes are closed). The causes are
(i) Tabes dorsalis: It is characterised by lightening
pains, ata&ia, parasthesia, urinary incontinence, ata&ia, absent
tendon )erks, charcot )oint and trophic ulcers.
(ii) Subacute combined degeneration of spinal
cord: Occur due to deficiency of 'itamin B./. It is
characterised by pins and needle sensation in hands and feet
*peripheral neuropathy+, glove and stocking distribution of
sensory impairment, ata&ia, flaccidity.
(iii) Polyneuritis in metabolic/nutritional
conditions e.g. diabetes mellitus and beri beri
*iv+ ,pinal cord compression
*v+ Thalamic lesion
*vi+ To&ic effects% Alcohol
*vii+ 0ultiple sclerosis
(&) 'i()i#* *ait: In flaccid paralysis of muscles the gait is awkward
which resembles ata&ia but here the awkward movement is due to
weakness and atrophy in muscles like in muscular dystrophy and
lower motor neuron lesion like polio.
(+) S)asti" *ait: In upper motor neuron lesions the walking is difficult
due to spastic type of paralysis. The gait is spastic gait in which
upper limb is held in fle&ion and lower limb is e&tended and while
walking patient makes the semicircular movement of affected
lower limb *hemiplegia and hereditary spastic paraplegia.
(,) -esti#a#t *ait: In parkinson(s disease the walking is difficult due
to rigidity of muscles and bradykinesia and patient walks with
stoop shoulder and takes short steps *festinant gait+.
(.) Ste))i#* *ait: 1ere patient, while walking lifts the feet higher at
knee and place it in a manner that the toes strike first than the heel.
It is common in foot drops. The condition is charcot marie2tooth
disease.
(/) 0a11!i#* *ait: In muscular dystrophy and weakness in gluteal
muscles.
(2) C$"34s *ait: Patients with classic cock gait walk on the
metatarsophalangeal joints and their heels do not touch the
ground. This gait resembles the gait in manganese poisoning
(patient walks with an etended trunk and fleed arms while
strutting on one!s toes).
Diagnostic approach of movement disorder symptoms of some of drugs of
material medica (Symptoms are followed by probable diagnosis)
1. A*ari"s Ms"aris:
3ncertainty in walking, stumbles over everything in the way
*Allen+2 "erebellar ata&ia.
,ensation as if ice touched or ice cold needles were piercing the
skin4 as from hot needles. 3ncertainty in walking, stumbles over
everything in the way *Allen+ 5 ,ubacute combined
degeneration of spinal cord.
!euralgia in locomotor ata&ia *Boericke+ 5 Tabes dorsalis
6aralytic pain in left arm. 6aralysis of lower limbs with
spasmodic condition of arms. 3ncertain gait,ensation as if
pierced by needles of ice *Boericke+ 5 0ultiple sclerosis.
&. A!(i#a
Inability to walk, e&cept with eyes open and in daytime,
tottering and falling when closing eyes *Allen+ 5 ,ensory
ata&ia.
,pinal degenerations and paralysis of lower limb *Boericke+
5 ,ubacute combined degeneration of spinal cord,
7isseminated sclerosis.
+. Ar*e#t( Nitri"(:
#reat weakness of lower e&trimities, with trembling4 can not
walk with eyes closed *Allen+ 2 ,ensory ata&ia.
,. Carb$#e( s!)5rat(:
#ait unsteady, tottering4 worse in dark *Boericke+ 2 ,ensory
ata&ia.
#ait unsteady *Boericke+ 2 "erebellata&ia
7iminished sensibility of arms, hand and feet. 6eripheral
neuritis, #ait unsteady *Boericke+ 5 6eripheral neuropathy in
diabetes mellitus, dry beri beri and subacute combined
degeneration of spinal cord.
6rogressive muscular atrophy *Boericke+ 5 0uscular
dystrophy, flaccid paralysis like polio, progressive muscular
atrophy type of motor neuron disease.
.. C$#i(:
The ascending paralysis it produces, ending in death by
failure of respiration, difficult gait *Boericke+ 5 #uillain
Barre syndrome.
/. Db$isi#( :
oss of power in limbs, staggers, feels as if he has stepped in
an empty space *Boericke+ 5 ,ensory ata&ia.
2. Ge!se(i(:
ack of muscular coordination, muscles refused to obey the
will *Allen+ 5 8laccid paralysis
6. He!$1er(a:
6aralysis agitans *Boericke+
"ock(s gait *Boericke+
,ensation as if walking on a sponge *Boericke+ 5 6eripheral
neuropathy
9hen walking, lifts feet higher than ususal and heel comes
down hard *locomotor ata&ia+ *Boericke+ 5 ,tepping gait,
also stomping gait.
7. 'at5%rs:
Affects lateral column, paralytic affections of lower limb4
spastic paralysis. -efle&es always increased. ,pastic gait
*Boericke+ 5 clearly indication upper motor neuron lesion.
After influen:a and wasting, e&haustive diseases where there
is much weakness and heaviness, slow recovery of nerve
power *Boericke+ 5 #ullian Barre syndrome.
0yelitis with marked spastic symptoms.
Affects anterior column of cord. #luteal muscles and lower
limb emaciated *paraplegia+ *Boericke+ 5 8laccid paralysis
of lower limb.
6atient sits bent forward, straightens up with difficulty,
lower limb emaciated *Boericke+ 5 7uchenne muscular
dystrophy, 6olio.
18.Ma#*a#( a"eti"(:
6araplegia progressive. ,taggering gait. ,trongly
e&aggerated refle&es *Boericke+ 5 8riedreich ata&ia with
e&aggerated )erks.
9alks stooping forward, tendemcy to fall forward
*Boericke+ 5 6aralysis agitans
6eculiar slapping gait, walks on metatrasophalangeal )oint
*boericke+ 2 "ock(s gait.
11.M%*a!e:
3nsteady gait *Boericke+ 5 ,ensory ata&ia, cerebellar ata&ia.
imbs drag while walking *Boericke+ 5 8oot drop or flaccid
paralysis of lower limb.
1&.P5$s)5$rs:
Inflames spinal cord and nerves causing paralysis *Boericke+
5 Transverse myelitis or #ullian Barre syndrome.
Ascending sensory and motor paralysis from ends of fingers
and toes *Boericke+ 2 #ullian Barre syndrome.
1+.P5%s$sti*(a:
7epresses the motor and refle& activity of cord and cause
loss of sensibility to pain, muscular weakness followed by
complete paralysis *Boericke+ 5 ,ubacute combined
degeneration of spinal cord, spinal cord compression.
1,.Pi"ri" a"i1:
"auses degeneration of spinal cord with paralysis. 6ins and
needle sensation in e&tremities *Boericke+ 2 ,ubacute
combined degeneration of spinal cord, 7isseminated
sclerosis.
Acute ascending paralysis *hemiplegia+ *Boericke+
1..P!(b(:
6rogressive muscular atrophy *Boericke+
0uscular dystrophy, flaccid paralysis like polio, progressive
muscular atrophy type of motor neuron disease.
1/.S!9$#a!(:
'ertigo of cerebral origin, cerebellar disease, ata&ic
symptoms. 0uscular incoordination, staggering gait
*Boericke+ 5 "erebellar ta&ia.
12.T5a!!i(:
0ost horrible neuralgic, spasmodic shooting pains. 6aralysis
of lower limbs. ocomotor ata&ia. 6olyneuritis *boericke+5
Tabes dorsalis.
16.T5ere1i$#: Natr( sa!i"%!i"(: C5i#i#( s!)5
0eniere(s disease *Boericke+
BIBIIO#-A61;
.. Boericke,9,/<<=, !ew 0anual of 1omoeopathic 0ateria 0edica and
repertory, >
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edition, B ?ain 6ublishers 6vt td, !ew delhi
/. Allen 1."., /<</, @eynotes and characteristicks with comparisions, -eprint
editin, A.B. publications, @olkata.
A. ,avill(ssystem of medicine, .>>B, .C
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distributors, !ew delhi
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edicition, churchil
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D. http%EEwww.neurology.orgEcontentEFDE>EBAD.full
=. http%EEwww.e&pertlaw.comElibraryEenvironmentalGlawEmanganism.html
By,
.. 7r. Amit Arora *,0O+, 7te of I,0 and 1om.#nct of 7elhi
/. 7r. 3desh @umar *,0O+, 7te of I,0 and 1om.#nct of 7elhi