Dr Sudheera.A.P BHMS, MD(Hom)
Repertorium homoeopathicum syntheticum was edited by Frederick schroyens.It was based on 6th edition of Kent’s Repertory.Its first edition was RADAR in the year 1987. RADAR was first developed as research project at University of Namur, Belgium under supervision of Jean Fichefet who is a professor of Maths. His sympathetic reaction after the homoeopathic cure of his son was the beginning of everything. The repertory contained 3712 medicines, from 390 sources. The addition of information in successive version of Synthesis has been stepwise.
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”.
Like other chapters the subrubrics ar earranged in the following order
- Type of pain (description of pain)
The ‘sides’ consists of these symptoms with any subrubrics they may have,
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
Advantages by using international time table are;
Concise writing-(10 am- 3 pm. Becomes 10 to 15 h.)
Less ambiguous time schedule
Easier search possibilities for the programme
Rubrics which is not present in Kent’s repertory
Accompanied by, salivation:Merc.,merc.c.
Children, nursing infants , eruption with vesicular:Corn
Nursing mothers in:Bapt.,hydr.,kali.m.,sul.ac.,
Diphtheria(see throat, diphtheria accompanied, tongue aphthae)
White yellowish white:Merc.cy.
Speech impeded(see Speech difficult, accompanied tongue aphthae)
Stomatitis(See Stomatitis accompanied tongue aphthae
Tuberculosis beginning (Gen. Tuberculosis, beginning accompanying tongue)
Typhus fever(see FEVER- (see FEVER-Typhus accompanied, tongue aphthae)
Mercury after abuse of:Agar.,sars.
Nursing, prevents child from:Bor.,cean.,merc.,nux v.,sulph.,sul.ac.,
Scabs with(seen accompanied scabs thick)
Small, dirty yellow:Agar.,iod.,sulph.
Tender (see Painful)
ATROPHY tongue :Mur.ac.
BITING glass when fed:ars.,bell.cham.cina cupr.,puls.,verat
Lips, chewing lips:Che.
Lower lip eating when: Benz.ac.
Nails (See Mind biting nails)
Tongue accompanied by
Brain concussion (see Head concussion, Accompanied tongue
Typhoid fever (see FEVER accompanied tongue biting sleep
Bitten as if (see Pain bitten tongue
Drinking, not drinking when:Dios.
Followed by unconsciousness:Oena
Shock in head caused by:Agar.
Sides night, sleep in:Ph.ac.
BLEEDING, cheeks spot incide:Mag.c.
Tongue accompanied by
Cancer of tongue (see Cancer tongue accompanied tongue)
Dysentery(see Rectum, dysentery accompanied tongue)
Accompanied by- cracked tongue
CANCER, palate, hard:Scolo.v.
Haemorrhage tendency to:Crot.h.
Tongue atrophy of:merc.,mur.ac
Speaking with a thick hoarse voice and:Mur.ac.
Hard, indurated, ulcerated warty growths :Mur.ac.
CHOREA tongue :Cina
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
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.
Centre accompanied by whitish discoloration of the tongue (see Discoloration
white accom. centre clean)
Tip accom. By liver hardness (see abdomen hardness liver)
CLUMSY, tongue(enlarged tongue):merc.
CONGESTION of gums :Graph.
CONTRACTION salivary glands:Ambr.,chin.
Tongue spasmodically, forced through lips which is:Cina
COVER,hand, covers mouth with :ip.Kali.bi.lach.,rumex
Dysentery(see Rctum Dysentery)
Influenza (Gen. Influenza accom.tongue cracked)
pneumoniaChest inflammation, lungs accomp. Tongue)
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.
Typhoid fever after:merc.
Down median line:Sin.n
Two deep cracks running length wise parallel to median line:Syph.
Accom. By hard tongue sides:Clem.
CRAWLING cheek inside:Zinc.
DENTAL fistula (see Fistula gums)
DEPAPILLATED(see Papillae- absent)
DESQUAMMATION cheek, inside:Sulph.
Palate sensation of:phos
DRYNESS night thirstless:Ambr.
Accompanied by saliva frothy:Cocc.
Chewing food agg.
Entering the house amel.:Nux m.
Lips lower lip inner side:Asar.
Tongue, accompanied by
ELONGATION tongue of:Mur.ac.
ENLARGED tongue, accompanied by intended tongue:Kali.m.
Purple discoloration of tongue:Kali.m.
ERUPTIONS(all types of eruptions under a general rubric in Synthesis, in Kent’s repertory separately)
FISTULA,palate, extending to antrum:Merc.
FROTH, white milky:Aeth.
HAIRY tongue (Roughness, tongue):Chlorm.
HARD Palate :Bell.,bor.,calc.,hyos.nit.ac.,nux v.,phos
HOLLOW sensation between tongue and hard palate:Choe.
INFLAMMATION tongue one side:Nux v.
ITCHING cheek inside:Mag.c.
LEATHER, Palate feels like leather, soft:Stict.
LEUCOPLAKIA(discolouration white patches)Bor.,ign.
LICKS the lips:Agar.
MAPPED tongue Accompanied by
MEMBRANE offensive stringy:Cadm.s.
OPEN, convulsions before epileptic:Bufo
Suddenly flies open
Tension in ant. Throat from:Sil.
PAPILLAE of tongue
PUT everything in mouth , children:Sulph-2
ROUGHNESS lip, upper lip
SCRATCHING, Gums, Palate,Tongue
SMALL tongue from imperfect development:Cupr.s
TASTE accompanied by
Chin trembling of:Nux v.
Protruding, beginning only in the:Sep.
Long time if protruded for a:Ph.ac.
Important signs and symptoms we get in relation to mouth are:
- Ankyloglossia:Inability to protrude tongue fully
- Infants – tongue tie(A congenitally short frenulum linguae)
- Deviation to affected side
- When carcinoma involves sides of tongue and floor of mouth
- Lesion of hypoglossal nerve-associated with fasciculation of affected side
- Large tongue(Macroglossia):prevent closure of lips and jaws, spacing of teeth and proclination of incisors
- Cavernous haemangioma
- Delirium tremens
Colour of the tongue:
- 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:
- 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
- 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
Deficiency states esp. pellagra
Congenital fissuring:Pappillae are normal, but the surface is interrupted by numerous irregular , but more or less symmetrical folds which tend to run horizontally(Srotal Tongue)
This is of no pathological significance
Chronic superficial glossitis: Due to syphilis there with be fissuring of tongue.
Here areas of leucoplakia are separated by intervening smooth and scarred areas. No normal papillae to be seen and fissures run mainly in a longitudinal direction
Median rhomboid glossitis:A lozenge shaped area of loss of papillae and fissuring is seen in the midline anterior to the foramen caecum
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
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
Sharp edges of a tooth(C/c frictional irritation)
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.
Infection/ ulceration of gums
Retention and decomposition of secretion in follicles of enlarged tonsils
Smell of acetone:Ketosis
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
- General term applied to inflammatory erosive and ulcerative conditions widely affecting the mucus membrane which line the oral cavity
- Many organisms are to be found in the oral cavity where under normal conditions, the majority are harmless to the individual
Certain factors which reduce harm are;
1)Regular desqammation and replacement of surface cells
2)Constant washing of the oral cavity by saliva sothat organisms are swallowed and destroyed in the stomach
3)The mild antibacterial activity of saliva
4)The health and integrity of the lining epithelium
- 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
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
Particular types of stomatitis:
Aphthous stomatitis: The term applies to 3 specific entities
- Recurrent minor aphthous ulceration
- Recurrent major aphthous ulceration
- Herpetiform aphthous ulceration not caused by Herpes simplex virus
(Modern medicine- chlorhexidine gluconate mouth wash is used)
Herpes simplex infection:
Gingivostomatitis-infancy and childhood
Many small vesicles appear and rapidly break down to form small yellow ulcers with bright red margins
Febrile+swollen submandibular lymph nodes
Virus infection: Associated with chicken pox, herpes zoster, coxsackie virus
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
- 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
Astringent-causing contraction of tissue
Blotches- pigmented or erythematous lesion
Cancrum-gangrenous ulcerativeinflammatory lesion
Cancrum oris(Noma):Gangrenous stomatitis:in poorly nourished children
Lower socio economic groups
Precede by another disease eg. Kala azar, dysentery
(Noma-greek word- nome =spreading sore)
Canker (L. cancer) Outmoded term for aphthae)
In cats and dogs a/c inflammation of ext. ear and auditory canal
Aphthae-small ulcer on a mucus membrane
Lapping- to drink liquid by scooping with the tongue
Parched tongue- to roast slightly
Sordes –A dark brown or blackish crust like collection on the lips, teeth, gum of a person with dehydration associated with a chronic debilitating disease
Taste- pappy (Pap- a food of soft consistency, like that of bread crumbs soaked in milk or water
Phagedenic ulcer-rapidly spreading ulcer, attended by the formation of extensive sloughing( Ulcus Ambulans)
Comparison with Murphy’s Repertory:
- 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;
Acridity upper lip:Mang
Burning lip smokers in:Bry
Cracked skin corners
Egg white dried on lips
Erysipelas, lower lip extending from:Anthr-3, apis
Fever blisters, 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)
Comparison with Boenninghausen’s Characteristic Materia Medica and Repertory by Dr. C.M.Boger
Mouth chapter contains several sub chapters:
Throat and gullet
Glands salivary is given with a no. of drugs. This is not given in Synthesis as a separate rubric.
We get less no of drugs against each rubrics than in synthesis
Mouth discoloration are given as separated rubrics like Mouth, blue and Mouth red etc. Stripe down the centre given as a separate rubric
Spitting constant( In Synthesis- Mind Spitting)
Eruptions are given as separate rubrics
Mouth vesicles etc.
Location has abbreviations and that is given in the subrubric
Eg.:Hard palate, H
Mouth palate, Aphthae,H-Nor.,carb.v.,sars.
Tongue coated(Synthesis- Mouth discoloration, tongue)
Tongue fissured- Synthesis- Mouth Cracked, tongue fissured)
Tongue glistening; Synthesis. Smooth)
Tongue growths under(Synthesis, mouth,excrescences, tongue
Tongue patchy mapped,(Synthesis, Mapped)
Tongue strawberry tongue (Synthesis- mouth, pappilae erect, strawberry tongue)
Other special rubrics present only in Boger’s repertory:
Mouth, tongue peeling of
Mouth foreign body in
Mouth elongated uvula
Mouth palate necrosis hard palate
Mouth tongue cottony feel
Mouth tongue cylindrical :Cina
Mouth tongue hanging from mouth
Mouth tongue lapping with the:Lyc.
Some rubrics are given repeatedly with some change.Eg.:
Mouth haemorrhage—remedies given are different in both
2)Mouth elongated uvula
Mouth uvula elongated
Therapeutic pointers- some common diseases-Dr. E.A.Farrington
Thrush(Aphthae, aphthous sore mouth):
1)Arum t.:inflammation exceedingly violent accompanied by soreness and scabs around the mouth and the nostrils, the corner of mouth crack, the child cannot open its mouth
2)Borax:Aphthae form in the pouches on the inside of the cheeks, on the tongue and in the fauces. The mouth is hot. The mucus membrane around the aphthae bleeds easily. Child lets go off the nipple and cries with pain and vexation. Or refuses the bereaast altogether- associated with diarhoea in children (Not use powdered borax everytime
The child has a sore mouth. It may harm, if it is not indicated and as a consequence the bowel will suffer and the child will grow paler and dwindle rapidly.)
3)Bryonia: When mouth is dry, child seizes the nipple, but it once let it go and cries. When its mouth becomes moistened with by the milk it nurses well enough.
4)Chlorine:Putrid smelling ulcers in the mouth, yellowish white
5)Helliborus:Sores are yellowish with raised edges
6Mag.c.:When mouth is full of aphthous ulcers due to impoverished state of the system from defective nutrition.
7)Mercurius:Sore mouth with profuse salivation. Emits an extremely foul odor
8)Mur. Ac:Mucus membrane of mouth is denuded in places the raw spots being dotted with aphthe.
9)Nat.hypochlorosum:Aphthae on the inside of the cheeks- lax, flabby indolent children
10) Nit.ac.,:Sore mouth with violent symptoms about lips and inside of cheeks(More about the lips).Aphthae and gums are whitish. Ptyalism with acrid saliva. Pain as from splinters. Cases abused by mercury
11)Nux vom: Sore mouth is of gastric origin.fetid odor from mouth.
12)Salicylic acid:Sore mouth with burning soreness and foetid breath
13)Staphysegria:Sores look bluish red or yellow. After the abuse of mercury or in syphilitic cases. General debility is marked with sunken face, blueness around eyes
14) Sul.ac:In debility from protracted diseases
Inchildren with summer complaint or marasmus
Mouth is filled with yellowish aphthous spots with profuse flow of saliva
Nervous hasty patient always complains of trembling which is not observed by others
Child smells sour despite most careful washing
Other remedies are iodine, kali.chlor.,lach.,lact.ac.,lyc.,nat.m.,phyt.,
Therapeutic guide-40 years practice: Dr.G.H.G.Jahr:
Scurvy of gums:
Dulc.:Originates in a cold
Nux vom, caps.:Sedentary persons in
After abuse of salt:Carb.v., ars.,coch.
Abuse of mercury:Carb.v.(gums bleed and with foul odor),chin., hep., lach(if gangrene threatens to supervene),Ars.(if gangrene threatens to supervene)
Merc.i.,and hydrastis are other imporatne remedies. Weak solution of permanganate of potash or carb.ac., may be used as gargles.
Various symptoms of gums:
Abscess of gums:Bell.,merc.,nux v.
Gum recedes from teeth: Merc.,carb.v.,phos., staphy., ph.ac.
If blisters break out on gums:Nat.m.,staphy
Ulcerate and suppurate:Merc.,carb.v.,vaust.,staphy.,ars.
Gums simply swollen:Merc.,staphy.,nus v.,bell.,bry.,sulph.,hep.,chin.,rhus.t.
If gums swollen and inflamed: Merc.,nux v.,bell.,carb.v.,caps.,nat.m.
Gums whitish and pale:merc.,staphy
If they burn:Ars.,merc.,bell.,cham.
If very red:Merc.,bell.,cham.
Boenninghausen’s Therapeutic pocket book: Comparison
1. Two subchapters in mouth chapter-tongue, palate
2. Taste is separate chapter
3. Many of the sensation and complaints related to mouth we get in sensation and complaints chapter like scurvy and types of pain
4. In the aggravation chapter:
- Brushing teeth
- Children especially,remedies for
- Licking lips
- Nursing children
- Putting out the tongue
- Licking with the tongue
- Sucking with tongue
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