A prospective study on the usefulness of homoeopathic constitutional medicines in the management of chronic sinusitis in age group of 15-60 years
Dr Bhagyasree B MD(Hom)
Medical Officer, Department of Homoeopathy, Govt. of Kerala
Email : dr.bhagyasreeprakash
Background and objectives: Chronic rhinosinusitis is a condition characterized by mucosal inflammation of nose and paranasal sinuses with sino nasal symptoms persisting for greater than 12 weeks. Growing antibiotic resistance, biofilm formations, and bacterial super antigens, presence of other viruses, fungi and co-morbid conditions like atopy, aspirin sensitivity, asthma, unclear etiology and pathogenesis may usually cause failure of conventional treatments. Main objectives of the study are to assess the usefulness of homoeopathic constitutional medicines in the management of chronic sinusitis.
Methods: Prospective study is conducted in randomly selected 30 patients attending the outpatient and inpatient departments of Government Homoeopathic Medical College, Kozhikode. Adults of age group 15-60 who satisfied the diagnostic criteria for chronic sinusitis were included. In this 1 year study, cases were reviewed in every 2-3 weeks. Outcome of study were measured by score changes in major diagnostic symptoms.
Results and discussion: Higher prevalence of chronic sinusitis in middle aged females were noted.76% cases showed improvement. Pulsatilla and Nux vomica were indicated in maximum number of cases 20% .Natrum mur was indicated in 10% cases. Silicea, Thuja, Sulphur, Calcarea, sepia and Ars alb were also found effective. Presence of some anatomical variations and association of some co-morbid conditions also were observed. Higher prevalence of deviated nasal septum in 83% and hypertrophied turbinates in 66% of patients were noted. An association of allergic rhinitis and chronic sinusitis were shown in 33% cases.
Conclusion: Homoeopathic constitutional treatment is very effective in management of chronic sinusitis.
Keywords: Chronic rhinosinusitis; Refractory rhinosinusitis; Major symptoms ; Saline irrigation ; Homoeopathy ; Pulsatilla; Nux vomica.
Chronic rhinosinusitis is considered as a group of heterogeneous disorders from a multitude of causes and characterized by mucosal inflammation of nose and paranasal sinuses with sino-nasal symptoms persisting for greater than 12 weeks. No effective medical or surgical management of chronic sinusitis is present in conventional treatment. Many studies already suggested the effectiveness of Homoeopathic constitutional treatment.
In this present 1 year study 30 patients with diagnosed chronic sinusitis who attended the outpatient and inpatient departments of Govt. Homoeopathic medical college Kozhikode was included. The usefulness of homoeopathic constitutional treatment in the management of chronic sinusitis was evaluated.
A great majority of patients were middle-aged females. 40% in age group of 25- 36 and 26% from 36-45 years. Out of 30 patients studied, 73% were females and 27% were males. So this study shown a higher prevalence of chronic sinusitis in middle aged females.
83% of patients were from the urban area with a middle class socio economic background. In this 30 patients, 43% had been suffering from complaints for last 3-4 years and 27% for last 1-2 years. A majority were presented with chronic sinusitis with recurrent acute exacerbations. Minimum of 2 acute attacks were observed in 50% in previous year.
Considering the type of sinus involved in sinusitis, 30% had maxillary and another 30% patients had frontal sinusitis. Fronto maxillary sinusitis in 20% patients and pansinusitis was observed in 13% patients. There was a higher involvement of maxillary and frontal sinuses were shown in this study.
Higher prevalence of deviated nasal septum in 83%, hypertrophied turbinates in (66%) and polyps in 16% patients were noted. An association of allergic rhinitis and chronic sinusitis was observed in 33% cases. The Migraine in 26% cases and dental caries in 16% cases were also reported.
A previous history of surgical procedure related to sinusitis was also noted. Sub mucous resection for DNS was performed in 23% and FESS, tonsillectomy and adenoidectomy were performed in 16%, 6% and 10% patients respectively.
The major presenting symptom found in this study was nasal obstruction in 63% patients.40% patients were presented with facial pain and 33% with headache. Nasal discharge and post nasal drippings were founded in 23% cases and loss of smell in 16% of patients.
In all 30 cases constitutional medicines are selected according to symptom similarity. Pulsatilla and Nux vomica were indicated in maximum number of cases 20% each. Natrum mur was found indicated in 10% cases. For management of acute attack Kali.bich was used in 33% patients of this study and Bryonia, Belladonna found effective in 23% each.
After treatment in a majority of cases the main presenting symptoms either got reduced or absent. Out of 30 patients 76% got gradual relief, aggravation founded in 10% and standstill condition was noted in 13.3%.
In this small attempt of study, it was noted that Homoeopathic constitutional treatment is very useful in managing all type of chronic rhinosinusitis. In cases like refractory rhinosinusitis resistant to standard medical therapy, associated conditions like of allergy, nasal polyps, aspirin sensitivity and history of revision surgeries or depression, Homoeopathy can offer a better relief.
- Richard M. Rosenfeld, Jay F. Piccirillo, Sujana S.Chandrasekhar, et al. Clinical Practice Guideline (Update): Adult Sinusitis Otolaryngology–Head and Neck Surgery 2015: Vol. 152:(2S) S1–S39. DOI: 10.1177/0194599815574247 http://otojournal.org
- Rosenfeld RM, Andes D, Bhattacharyya N, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg.2007; 137 (3):S1-S31
- Hastan D, Fokkens WJ, Bachert C, Newson RB, Bislimovska J, Bockelbrink A ,et al. Chronic rhinosinusitis in Europe – an underestimated disease. A GA2LEN study. Allergy. 2011 Sep; 66(9):1216-23. DOI:10.1111/j.1398- 9995.2011.02646.x
- GMS Current Topics in Otorhinolaryngology – Head and Neck Surgery. 2015;V ol.14, ISSN1865- 1011https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702060/pdf/CTO-14- 11.pdf
- Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology.2012; 50(1):1-12. DOI: 10.4193/Rhino50E2 .PMID:22469599
- Gliklich RE, Metson R.The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngol Head Neck Surg. 1995;Jul;113(1):104- 9.DOI:10.1016/S0194-59989570152-4
- Leung RM, Kern RC, Conley DB, Tan BK, Chandra RK. Osteomeatal complex obstruction is not associated with adjacent sinus disease in chronic rhinosinusitis with polyps. American journal of allergy & Rhinology.2011;25(6):401-3. DOI: 10.2500/ajra.2011.25.3672 PMID: 22185744
- Brandsted R, Sindwani R. Impact of depression on disease-specific symptoms and quality of life in patients with chronic rhinosinusitis. Am J Rhinol. 2007 ;21(1):50-4. PMID: 1728356
- Smith KA, Orlandi RR, Rudmik L. cost of adult chronic rhinosinusitis: A systematic review. Laryngoscope. 2015 Jul; 125(7):1547-56. DOI: 10.1002/lary.25180
- S.R.Sharma, K.Bhanu Murty , et al. Clinical evaluation of homoeopathic medicines in sinusitis. Indian Journal of Research in Homoeopathy.2008; 2(1).
- Witt M Claudia, Lüdtke R,Willich N Stefan.Homeopathic treatment of patients with chronic sinusitis: A prospective observational study with 8 years follow- up. BMC Ear, Nose and Throat Disorders .2009; 9: 7.DOI: 10.1186/1472-6815- 9-7
- Hahnemann S. Organon of Medicine. Fifth edition. New Delhi: B Jain; 2004.
- Muhammed maqbool,Suhail maqbool;Text book of ear, nose and throat disease- 11th edition. New delhi : Jay pee brothers ; 2007
- Katya A. Shpilberg , Simon C. Daniel , Amish H. Doshi , William Lawson and Peter M. Som. Paranasal Sinuses and Nasal Cavity:Poor Correlation With Radiologically Significant Rhinosinusitis but Importance in Surgical Planning. American Journal of Roentgenology.2015; 204:1255-1260. DOI:10.2214/AJR.14.13762. http://www.ajronline.org/doi/full/10.2214/AJR.14.13762
- Ramteke S,Nayak C,Vikram singh et al. An open clinical observational study on the usefulness of predefined homoeopathic medicines in the management of chronic sinusitis. Indian Journal of Research in Homoeopathy.2009; volume 3:34-40.
- Anne Agur M R, Arthur Dalley F, Keith Moore L. Clinically oriented anatomy.6th Edition.Philedelphia.Lippincott Williams and Wilkins.2009.
- Alexandra Mavrodi, George Paraskevas. Evolution of the paranasal sinuses
anatomy through the ages. Anat Cell Biol. 2013 Dec; 46(4): 235–238. DOI: 10.5115/acb.2013.46.4.235
- Dingra P L, Sruthi Dingra.Textbook of ear,nose and throat Head and neck surgery . 6th Edition.Elsevier.2013.
- Susan Sandring. GRA Y’S ANA TOMY . The anatomical basis of clinical practice.Elsevier.2008
- Navreet Jaura,Sanjeev Bhagat,Manwinder Singh,Baldev Singh,Manoj Mathur, Girish Dogra. A Study of Lateral Nasal Wall: Anatomical Variants,Radiological And Endoscopic Appearance And Role in Symptomatology inChronic Rhinosinusitis. Journal of dental and medical sciences. February 2017; 16 (2): PP 38-43. DOI: 10.9790/0853-1602053843.
- Pinterestcom. 1. Pinterest. [Online]. A vailablefrom:https://www.pinterest.com/ explore/paranasal-sinuses/ [Accessed 28 April 2017
- Pinterestcom. 1. Pinterest. [Online]. A vailablefrom:ttps://anatomytopics.wo rdpress.com/2008/12/06/the-anatomy-of-the-nasal-cavity-and-paranasal- sinuses-the-skeletal-and-smooth-muscle-tissues-the-development-of-the- pharyngeal-gut/ [Accessed 28 April 2017]
- Pinterestcom. 1. Pinterest. [Online]. Available from: http://beckerent.com/nose-sinus-allergy/sinus-faqs/ [Accessed 28 April 2017].
- Pinterestcom. 1. Pinterest. [Online]. A vailablefrom:https://www.nycfacemd .com/turbinate-hypertrophy-and-dysfunction/ [Accessed 28 April 2017
- Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl. 2007; (20):1-136. PMID: 17844873
- Brozek JL, Akl EA, Alonso-Coello P, Lang D, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the grade approach and grading quality of evidence about interventions. Allergy. 2009 May; 64 (5):669-77. DOI: 10.1111/j.1398- 9995.2009.01973.x.
- Van Gageldonk-Lafeber AB, Heijnen ML, Bartelds AI, Peters MF. et al. A case- control study of acute respiratory tract infection in general practice patients in
- The Netherlands. Clin Infect Dis. 2005 Aug 15; 41(4):490- 7.DOI:10.1086/431982
- Emanuel IA, Shah SB. Chronic rhinosinusitis: allergy and sinus computed tomography relationships. Otolaryngology–head and neck surgery: official
- Oskarsson JP, Halldórsson S. An evaluation of diagnosis and treatment of acute sinusitis at three health care centers. Icelandic. 2010 Sep; 96(9):531-5. PMID: 20820069
- journal of American Academy of Otolaryngology-Head and Neck Surgery.2000 ;123(6):687-91.
- Lee T-J, Fu C-H, Wang C-H, HuangC-C,HuangC-C, ChangP-H, et al. Impact
of chronic rhinosinusitis on severe asthma patients. PLoS ONE. 2017 ;12(2): https://doi.org/10.1371/journal.pone.0171047.
- Chee L, Graham SM, Carothers DG, Ballas ZK. Immune dysfunction in refractory sinusitis in a tertiary care setting. Laryngoscope. 2001 ;111(2):233- 5.DOI: 10.1097/00005537-200102000-00008
- Huang CC, Wang CH, Fu CH, Huang CC, Chang PH, Chen YW, et al. Association between cigarette smoking and interleukin-17A expression in nasal tissues of patients with chronic rhinosinusitis and asthma. Medicine (Baltimore). 2016 Nov; 95(47).DOI: 10.1097/MD.0000000000005432
- Thunberg, U., Söderquist, B. & Hugosson, S. Eur Arch Otorhinolaryngol (2017) 274: 311. doi:10.1007/s00405-016-4239-3
- Biel MA Brown CA, Levinson RM, et al. Evaluation of the microbiology of chronic maxillary sinusitis.Ann Otol Rhinol Laryngol. 1998 ;107(11 Pt 1):942- 5.
- Noam a cohen md, phd . The genetics of the bitter taste receptor T2R38 in upper airway innate immunity and implications for chronic rhinosinusitis. Laryngoscope. 2017 ;Volume 127,( Issue 1 ): 44-51.
- T Santhi , KV Rajan. Presence of Fungal Organisms in Chronic Rhinosinusitis with Nasal Polyposis: A Clinico Pathological Study from Kerala. International Journal of Scientific Study. 2015;Vol 3(Issue 3). DOI: 10.17354/ijss/2015/279
- Peter Tomassen, Thibaut Van Zele, et al. Pathophysiology of Chronic Rhinosinusitis.Proceedings of the american thoracic society. 2011;vol 8. http://www.atsjournals.org/doi/pdf/10.1513/pats.201005-036RN
- Roza Khalmuratova, Jong-Wan Park, Hyun-Woo Shin. Immune Cell Responses and Mucosal Barrier Disruptions in Chronic Rhinosinusitis. Immune Netw. 2017 ;17(1):60-67.https://doi.org/10.4110/in.2017.17.1.60
- Dabholkar, Y.G., Saberwal, A.A., Velankar, H.K. et al. Indian J Otolaryngol Head Neck Surg. 2014;66(1): 91-92. DOI:10.1007/s12070-013-0689-8
- Yasunori sukuma, Masanori Komatsu. et al New clinical diagnostic criteria for eosinophilic chronic rhinosinusitis.Auris Nasus Larynx.2011; 38( 5 ): 583 – 588. DOI: http://dx.doi.org/10.1016/j.anl.2011.01.007
- Joshua L. Kennedy, M.D., and Larry Borish, M.D.Chronic sinusitis pathophysiology: The role of allergy .Am J Rhinol Allergy. 2013;27:367– 371.DOI: 10.2500/ajra.2013.27.3906)
- Schwitzguébel AJ, Jandus P, Lacroix JS, Seebach JD, Harr T. Immunoglobulin deficiency in patients with chronic rhinosinusitis: Systematic review of the literature and meta-analysis. J Allergy Clin Immunol. 2015 ;136(6):1523-31. DOI: 10.1016/j.jaci.2015.07.016.
- Tsybikov, Namjil N.et al. Anticytokine autoantibodies in chronic rhinosinusitis. Allergy and Asthma Proceedings. 2015;36(6):473-480. https://doi.org/10.2500/aap.2015.36.3880
- Xie, Li, Liu, Ai-Guo. et al. Expression profiles of prostaglandin E2 receptor subtypes in aspirin tolerant adult Chinese with chronic rhinosinusitis.American Journal of Rhinology &Allergy.2015;29:322-328. https://doi.org/10.2500/ajra.2015.29.4205
- Donald. C. Lanza, David. W. Kennedy. Adult rhinosinusitis defined.SAGE
- Journals.2017;http://journals.sagepub.com/doi/pdf/10.1016/S0194- 59989770001-9
- Sandhu.S. Gupta V, Matreja P. S. Clinicotherapeutic Profile of Patients Suffering from Sinusitis. J Transm Dis Immun . 2017;1(1).
- Kyung C Lee ,Nam H Lee. Comparison of Clinical Characteristics between Primary and Secondary Paranasal Mucoceles. Yonsei Med J. 2010;51. DOI: 10.3349/ymj.2010.51.5.735
- Kennedy DW, Senior BA, Gannon FH, Montone KT, Hwang P, Lanza DC.Histology and histomorphometry of ethmoid bone in chronic rhinosinusitis.The Laryngoscope. 1998 ;108(4):502-7.
- Lee, Jivianne T.et al. The incidence of concurrent osteitis in patients with chronic rhinosinusitis: A clinicopathological study. American Journal of Rhinology. 2006;ol 20:278-282. https://doi.org/10.2500/ajr.2006.20.2857
- Nath SV, James S, Suresh N. A prospective study of clinical profile of chronic rhinosinusitis in a tertiary care centre. J. Evolution Med. Dent. Sci. 2017;6(16):1268-1275, DOI: 10.14260/Jemds/2017/276
- Arif Ali Kolethekkat, Roshna Rose Paul, Mary Kurien, Shyam Kumar, Rashid Al Abri,Kurien Thomas. Diagnosis of Adult Chronic Rhinosinusitis: Can Nasal Endoscopy Predict Intrasinus Disease?. Oman Med J. 2013; 28(6): 427–431. DOI: 10.5001/omj.2013.120 PMCID: PMC3815865
- Syracuseotocom. 1. Syracuseotocom. [Online]. Available from: http://syracuseoto.com/wordpress/wp-content/uploads/2014/06/Middle- meatus-before-surgery.jpg [Accessed 3 May 2017].
- Wsimgcom. 1. Wsimgcom. [Online]. A vailable from: http://nebula.wsimg.com/6f755b35f5f4aa3244464c3ece85608f?AccessKeyId= 5DE61CB1BAB9CC07A7BA [Accessed 3 May 2017].
- Luukkainen.A, Terna1 E. et al. Poor Reproducibility in the Evaluation of Paranasal Sinus X-Rays in Chronic Rhinosinusitis.Open journal of radiology.2017;March:23-34.DOI: 10.4236/ojrad.2017
- Bent J. P, Kuhn F. A. Diagnosis of allergic fungal sinusitis. Otolaryngology—
- Head and Neck Surgery.1994;vol 111(5):580– 588,. DOI:10.1177/019459989411100508.
- Ravinder Kaur, Lavanya S, Nita Khurana, Achal Gulati. Megh S. Dhakad. Allergic Fungal Rhinosinusitis: A Study in a Tertiary Care Hospital in India. journal of Allergy.2016;Article ID 7698173 :6 page. DOI: http://dx.doi.org/10.1155/2016/7698173.
- Ga Y oung Park, MD Hyo Y eol Kim, Jin-Y oung Min, Hun-Jong Dhong,Seung-Kyu Chung. Endodontic Treatment: A Significant Risk Factor for the Development of Maxillary Fungal Ball. Clinical and Experimental Otorhinolaryngology.2010;3(3):136-140.DOI:10.3342/ceo.2010.3.3.136
- Antony Anfuso, M.D., Hassan Ramadan, M.D.et al. Sinus and adenoid inflammation in children with chronic rhinosinusitis and asthma. Ann Allergy Asthma Immunol. 2015 ; 114(2): 103–110. DOI:10.1016/j.anai.2014.10.024
- T odd Schwed J. Chronic migraine. BMJ 2014;348:g1416 DOI: 10.1136/bmj.g1416
- Peter Small ,Harold Kim. Allergic rhinitis. Allergy, Asthma & Clinical Immunology.2011;7(Suppl 1):S3. DOI: 10.1186/1710-1492-7-S1-S3
- Joanna Zakrzewska M, Mark Linskey E. Trigeminal neuralgia.BMJ.201;350:H 1238DOI: 10.1136/bmj.h1238
- Nazia Aziz Ahmed, Sheik Mohammed, Girish Raj.Rhinosporidiosis: an epidemiological study. Journal of evolution of medical and dental sciences.2013;2(38). https://jemds.com/latest-articles.php?at_id=2049.
- Freeman SR, Sivayoham ES, Jepson K, de Carpentier J. A preliminary randomised controlled trial evaluating the efficacy of saline douching following endoscopic sinus surgery. Clin Otolaryngol. 2008;33(5):462–465.DOI: 10.1111/j.1749-4486.2008.01806.x.
- Uamsedu.1.Uamsedu.[Online]. Available from: http://anatomy.uams.edu/ anatomyhtml /xrays/xra _atlas28.html [Accessed 3 May 2017]
- ain RB,Lal D. Update on the management of chronic rhinosinusitis.Dove press journals of infection and drug resistance.2013;2013:1-14.DOI: http://dx.doi.org/10.2147/IDR.S26134.
- Chiu AG, Palmer JN.et al. Baby shampoo nasal irrigations for the symptomatic post-functional endoscopic sinus surgery patient. Am J Rhinol. 2008;22(1):34- 7. DOI: 10.2500/ajr.2008.22.3122.
- Bhattacharyya N, Kepnes LJ. Assessment of trends in antimicrobial resistance in chronic rhinosinusitis. Ann Otol Rhinol Laryngol. 2008; 117(6):448–452. DOI: 10.1177/000348940811700608
- Rains BM , Mineck CW .Treatment of allergic fungal sinusitis with high-dose itraconazole. Am J Rhinol. 2003; 17: 1-8.
- Giovannini M, Agostoni C, Riva E, et al; Felicita Study Group. A randomized prospective double blind controlled trial on effects of long-term consumption of fermented milk containing Lactobacillus casei in pre-school children with allergic asthma and/or rhinitis. Pediatr Res 2007;62:215–20.DOI: 10.1203/PDR.0b013e3180a76d94.
- Shraddha S. Mukerji, et al.Probiotics as adjunctive treatment for chronic rhinosinusitis: A randomized controlled trial. Otolaryngology–Head and Neck Surgery.2009;140:202-208.DOI: 10.1016/j.otohns.2008.11.020
- Martin Y, Desrosiers, Shaun J. Kilty .Treatment alternatives for chronic rhinosinusitis persisting after ESS: What to do when antibiotics, steroids and surgery fail. Rhinology.2008;46:3-14.
- Daniel M, Goran J, Erin D. Wright, Brian W. Rotenberg. Revision Rates after Endoscopic Sinus Surgery: A Recurrence Analysis . Annals of Otology, Rhinology & Laryngology.2011;120(3): 162 –
- Hopkins C, Slack R, Lund V, Brown P, Copley L, Browne J. Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Laryngoscope. 2009 ;119(12):2459-65. DOI: 10.1002/lary.20653.
- Chester AC, Antisdel JL, Sindwani R. Symptom-specific outcomes of endoscopic sinus surgery: a systematic review. Otolaryngol Head Neck Surg. 2009 May;140(5):633-9. DOI: 10.1016/j.otohns.2008.12.048.
- Wynn R, Har-El G. Recurrence rates after endoscopic sinus surgery for massive sinus polyposis.Laryngoscope 2007;114:811–813. [PubMed: 15126735) DOI:10.1097/00005537-200405000-00004
- Roberts Herbert A. The Principles and Art of Cure by Homoeopathy. New Delhi: B Jain; 2009
- Close S. The Genius of Homoeopathy. Lectures and essays of homoeopathy with word index. New Delhi: B Jain; 2004
- Joseph KX. A study to determine the efficacy of homoeopathic medicines in the management of chronic sinusitis (dissertation).Joseph KX; Kozhikode:1998.
- Bindu.K. Efficacy of homoeopathic medicines in the management of chronic sinusitis (dissertation). Bindu K; Kozhikode.2006.
- Sharjan A E. A clinical study on evaluation and prognosis after observing action the remedy in chronic sinusitis (dissertation). Sharjan A E ; Kozhikode.2009.
- Ashitha A K. A clinical study on the effectiveness of homoeopathic medicine in the management of chronic sinusitis (dissertation). Ashitha A K; Kozhikode.2013.
- Hahnemann S. The Chronic Diseases, Their peculiar nature and Homoeopathic cure. Reprint ed. New Delhi: B Jain Publishers; 2002.
- Allen J H. The Chronic miasms –Psora and Pseudo psora. Reprint edition. New Delhi : B Jain Publishers ; 2005
- Ortega P S. Notes on the miasm of Hahnemann’s chronic disease. Reprint edn. New Delhi: B Jain; 2004.
- Banerjee SK. Miasmatic Diagnosis. New Delhi: B Jain; 2007.
- Kent J T. Repertory of homoeopathic material medica and word index. 4th edition. IBPP.
- Schroyens F. Repertorium Homoeopathicum Syntheticum. 9.1 Edn. New Delhi: B Jain; 2011.
- Robin Murphy. Homoeopathic Medical Repertory. 3rd Revised edn. New Delhi .B Jain; 2014.
- Boger CM. B oenninghausen’s characteristic material medica and repertory with word index.New Delhi: IBPP; 2007.
- Boericke E O. Repertory part of Pocket manual of homoeopathic material medica and repertory. 1st edn. New Delhi : B Jain; 2007.
- Phatak SR. A concise Repertory of Homoeopathic medicines. 4th Edn. New Delhi: B Jain; 2005.
- Clarke J H. Dictionary of Practical Materia Medica. Student edition.New Delhi : B Jain; 2005.
- Nash E B.Leaders in respiratory organs. Reprint edn. B Jain; 2004
- Clarke JH. The prescriber. 3rd edition. New Delhi: B Jain; 2007.
- Boericke W. Pocket manual of homoeopathic material medica and repertory. 1st edn. New Delhi : B Jain; 2007.
- Nash E B. Leaders in homoeopathic therapeutics with grouping and classification. New Delhi: B Jain; 2007
- Allen H C. Allen’s keynotes rearranged and classified with leading remedies of the Materia medica and bowel nosodes. New Delhi: B Jain ; 2014.
- Kent J T. Lectures on Homoeopathic Materia Medica. New Delhi: B Jain ; 2004.
- Lilienthal S. Homoeopathic therapeutics. New Delhi: B Jain ; 2011.
- Syamalan. K. Statistics in Medicine. Second edition (revised). Trivandrum: Global Education Bureau; 2012.