M.Tech. / Hypertension or elevated blood pressure is an initiator and promoter of cardiovascular disease and end organ damage. Primary or essential hypertension is an elevated blood pressure due to an unknown or unidentifiable pathology. Secondary hypertension may be caused by underlying pathology or certain medication. Although a number of allopathic drugs are available, hypertension may remain uncontrolled despite lifestyle changes combined with adequate allopathic treatment. This is termed as refractory hypertension. Poor patient compliance, inadequate diuretic therapy, inappropriate drug combinations, and obesity are the leading causes of uncontrolled or refractory hypertension. Crataegus oxyacantha θ is a homoeopathically prepared mother tincture (θ) that has been clinically used to treat hypertension and cardiovascular complaints. However there is insufficient research to confirm its efficacy in the treatment of hypertension. The aim of this study is to ascertain the efficiency of Crataegus oxyacantha θ in the treatment of refractory hypertension in adult males aged between thirty-five and sixty-five years, currently taking allopathic treatment, namely Angiotensin-Converting Enzyme inhibitors combined with a diuretic, and to evaluate the effect of Crataegus oxyacantha Ө on associated symptoms of hypertension. These include headaches; palpitations; vertigo; blurred vision and tinnitus. The study was a placebo controlled double-blinded trial that extended over a period of 12 weeks. Thirty male participants between the ages of thirty-five to sixty-five, that were pre-diagnosed with refractory hypertension for a minimum of two years with a fluctuating blood pressure reading above 150/95 mmHg and currently on allopathic medication i.e. ACE-inhibitor with a combined diuretic were recruited for the study by means of advertisements placed at the University of Johannesburg health clinic, pharmacies and community clinics. Participants were randomly placed in either the experimental or the control group. Participants meeting the inclusion criteria underwent a physical examination and consented to the study (Appendix A). The participants blood pressure was measured on both arms as advised by Milne in the South African hypertensive guidelines 2003 (Annexure A), at the first visit and for two consecutive mornings in order to obtain a baseline reading. He was randomly assigned in either the experimental or the control group. The control group received a 50ml bottle of the 20% alcohol placebo and the experimental group received a 50ml bottle of the homoeopathic remedy, Crataegus oxyacantha θ. He was instructed to take 10 drops in 125ml water twice daily after meals. During the trial period the participant’s blood pressure was assessed every 2 weeks against the measured baseline readings for a period of 12 weeks. The severity of the following symptoms was assessed every 2 weeks, headaches; palpitations; vertigo; blurred vision and tinnitus and other symptoms that he may have experienced. These results were graded and recorded on the progress form (Appendix C). The data obtained from the participants was analysed using descriptive statistics (frequencies and percentages). The blood pressure of the experimental group was compared to the control group as obtained at the first consultation and each of the six follow-up visits. Groups were compared using the Chi-Square test and the Non Parametric Mann Whitney U test. Statistical analysis showed significant differences, P <0.05 for the systolic blood pressure between the experimental and control group. There was a significant decline in the diastolic blood pressure of the experimental and the control group. The diastolic pressure of the control showed a significant decline between day one and week six, however remained constant from week six to week twelve. This implies that the placebo may have provided some benefit towards the lowering of diastolic blood pressure in adult males. The associated symptoms were investigated and the results obtained indicate that headaches and blurred vision remained a constant mild symptom that was experienced throughout the twelve week trial period. Due to the statistical difference between the experimental and the control group in favour of the experimental group, the null hypothesis was rejected. Preliminary findings suggest that Crataegus oxyacantha Ө, is effective in reducing elevated systolic and diastolic blood pressure in adult males with refractory hypertension, however more research over a longer period of time is needed to confirm theses findings.

M. Tech. / Insomnia is defined as inadequate sleep due to difficulty falling asleep, difficulty staying asleep, waking up too early, and not being able to get back to sleep. In Western industrialised nations, between 30% and 40% of individuals suffer from at least occasional periods of sleep disturbance. The significance of sleep lies in its impact on the Central Nervous System as extended periods without sleep will result in disturbances in mental function. The remedy used in this study was Coffea cruda 200cH. This homoeopathic remedy is used clinically for its sedative and calming effect on the nervous system, in the homoeopathic treatment of insomnia. Although there is some research evidence that Coffea cruda has an effect on sleep in animals, there is no research on its effect on human subjects. The aim of this study was to determine the efficacy of a homoeopathic remedy Coffea cruda 200cH in the treatment of insomnia that is characterised with a difficulty in falling asleep. The quality of sleep was assessed in terms of duration of sleep, changes in sleep pattern, and satisfaction with sleep. This was a double blind placebo controlled study. The duration of the clinical trial lasted for four weeks. A total of thirty participants, meeting the inclusion criteria (Appendix B) were recruited via advertisements (Appendix E) in local newspapers, pamphlets and emails, sent in and around the University of Johannesburg Health Clinic, the University of Witwatersrand Sleep Unit, campuses, shopping malls and residential areas. Participants were also recruited via advertisements on a local radio station. At the initial consultation the participants were requested to sign a consent form (Appendix A). The researcher then completed the questionnaire (Appendix B) to assess suitability for the study. Participants were given a 50ml bottle of medication in liquid form, and were requested to shake the bottle and then take ten iv drops under the tongue just before going to bed, for four weeks. A homoeopathic pharmaceutical company blinded the medication. By selecting a medication, the participant automatically allocated themselves to either the experimental or control group. Participants were also given a sleep diary to be completed every morning (Appendix C). There were follow up visits with participants on the second and fourth week where the sleep diary was checked to improve compliance and a case history was taken (Appendix D). All results were compared to the initial assessment and changes were recorded. Data were analysed according to the General Linear Model: Repeated Measures, Mann-Whitney test (non-parametric test), Cross-tabulation, Fisher’s exact test and Regression Analysis. Statistical data proved that both the experimental and control groups had statistically significant results. It is unclear why the control group behaved in the same way as the experimental group. A longer trial is required to distinguish if this was purely due to the placebo effect.

M. Tech. / Repetitive Strain Injury (RSI) of the shoulder is a condition that results because of poor posture, stress and a lack of sufficient rest periods between working schedules. This study attempts to demonstrate the effect of the homoeopathically prepared complex remedy Spascupreel® S in the treatment of RSI. Thirty participants were selected for the study and completed the study. The study was conducted over a period of five weeks. Fifteen participants formed part of the control group, and fifteen participants formed part of the experimental group. The control group received placebo (saline solution) injections, and the experimental group received Spascupreel® S injections for the duration of the study. All the participants were assessed by means of questionnaires, algometer readings and physical examinations throughout the study. The results were statistically analysed using the independent-samples t-test, Chi-square test, Mann-Whitney U test, Wilcoxon Signed Rank test, Friedman test and McNemar test. The results showed that treatment with Spascupreel® S indicated a tendency towards statistical significance in improving the symptoms of RSI.

M.Tech. / Premenstrual syndrome (PMS) is a group of physical and psychological symptoms that occur cyclically in females. It is of unknown aetiology. These symptoms occur specifically during the luteal phase (from day 14 to day 1 of the next menstrual cycle) and are resolved over the course or at the onset of menstruation (Indusekhar et al., 2007). The syndrome is characterised by irritability, depression, anxiety, headache, abdominal bloating, breast tenderness, breast swelling, changes in appetite, acne, and weight gain due to oedema. Mild physiological symptoms are experienced by approximately 95% of all women of reproductive age and about 5% of symptomatic women complain of extremely severe symptoms, called premenstrual dysphoric disorder (PMDD), that disrupt their daily living (Wyatt, 1999). Deuster et al., (1999) note that PMS is prevalent in all demographic groups, however differences in races do exist and their research shows that black women are more likely to suffer from PMS than women of other races. The current conventional treatment options are limited, not always effective and sometimes have significant side effects (Ross et al., 2000). Complementary and alternative treatments are said to be beneficial, however sufficient quality trials are required to substantiate their claims to efficacy (Indusekhar et al., 2007). Research into the use of individualised homeopathy in PMS has been shown to have positive results (Yakir et al., 2001). The aim of this four month study was to determine the efficacy of the homeopathic simillimum in the treatment of premenstrual syndrome in white females. This study will eventually provide the material to compare the presentation of PMS, and the effect of the homeopathic simillimum in different race groups. The following symptoms were evaluated 14 days before menstruation: irritability, depression, anxiety, headache, abdominal bloating, breast tenderness, breast swelling, and food cravings (Beers et al., 2003). Volunteers were asked to complete a selection questionnaire, in order for them to take part in the study. If they qualified to take part in this study a full case history was then taken for each participant using the standard homeopathic clinic case form. In this four month case study each of the ten participants completed a PMS chart for each month grading their symptoms on a daily basis and recording their dates of menstruation. A baseline of each participant’s premenstrual symptoms was established by an initial treatment-free month where a PMS chart had to be completed to score the participants’ daily symptoms. Thereafter the participants were treated using homeopathic simillimum treatment for the remaining three months. The chart required each participant to score the severity of the eight different premenstrual symptoms that they experience on a scale of 0 to 5 (0 indicated that the symptom was not present, and 5 indicated that the symptom was very severe). These charts were collected at the end of each cycle. At the end of the trial these PMS charts were submitted for statistical analysis. These results were analysed by using the non parametric Wilcoxon Signed Ranks Test by comparing the severity of symptoms experienced in the premenstrual period (14 days before menstruation) for each of the three months of treatment to the initial treatment-free month. These results showed that the homeopathic simillimum was statistically significant in the treatment of the symptoms of PMS in these white females.

M.Tech. / Menopause is defined as the physiological cessation of menses due to decreased ovarian function and is established when the menses have not occurred for a year, usually occurring at a median age of 50.8 years. The period around the menopause is a time of transition that can contribute to both emotional and physical symptoms. The purpose of the study was to determine the efficacy of the homoeopathically prepared remedy Lachesis in the treatment of the symptoms of the menopause in women whose symptoms match the symptom picture of Lachesis. Thirty female volunteers between the ages of sixty and sixty years were recruited from the Johannesburg and Potchefstroom areas. This was a single-blind study and the participants did not know if they were in the control or experimental group. The participants were required to complete an Abbreviated Kupperman Index on a weekly basis throughout the four week trial period. The Experimental group experienced a 58.27% overall decrease in average Kupperman score, compared to 28.65% of the Control group. The P-value of the total response of the trial is 0.2110, therefore there is not a significant statistical difference between the two groups over the total trial period. Although there was not a statistically significant difference for the total response between the two groups there was statistically significant differences between the two groups for the following individual symptoms: profuse sweating, depressive moods and the inability to concentrate.

This unblinded, controlled clinical trial was undertaken in order to demonstrate the advantage of education concerning low back pain in the labour intensive workplace and to show that education alone as well as in conjunction with chiropractic manipulative therapy, is a valuable time and cost-effective mechanism for reducing low back pain. This will be achieved by comparing comprehensive industrial back school (CIBS) in combination with chiropractic manipulative therapy (CMT) and CIBS in isolation. In the execution of the study it was hypothesised that both the treatment protocols would be effective in the treatment of low back pain, but that the combined therapy would be more effective due to the fact that the treatment protocol involving the combined treatment would be assessing and correcting lumbar spine pathomechanics. The patient base for the study was drawn from the technical services division (labour force) of the Technikon Witwatersrand in Johannesburg, South Africa. Patients were recruited by consulting the managers of the technical services departments at the Technikon Witwatersrand, and a presentation concerning low back pain was given to the labour forces involved in the technical services division, detailing the treatment protocols and the risks and benefits involved. After the presentation anyone suffering from low back pain was invited to participate in the study. Only males were included in the study, rendering the data more valuable relative to the small sample group. Thirty patients whom conformed to the diagnostic criteria and did not have any conditions that contraindicated CIBS or CMT were included in the study. The patients were divided into two groups according to where they worked (Doornfontein or Auckland Park campus). Fifteen (15) people were selected from each campus (both campuses are under the same labour demands). This situation was decided upon as to not allow cross contamination of the groups; it was also logistically more practical. The Doornfontein group (DFC) received CMT in combination with the CIBS. All fifteen patients attended one CIBS per week for four weeks; and received six CMT treatments over four weeks. The Auckland Park group (AKP) received the CIBS in isolation; also running once a week for four weeks. All patients (both groups) were assessed and data captured at the first week, fourth week and at a follow up visit one month after the final session (eighth week), where all the data was captured again. The subjective data was collected using the McGill Pain Questionnaire and the Oswestry Low Back Pain Disability Index. Objective data was obtained using the cervical and lumbar range of motion instruments (Goniometers) and a universal inclinometer. Anecdotal data was collected using a questionnaire. The data was analysed using “Jandell Scientific Sigma Stat and Sigma Plot 2.02”. The subjective results indicate that both treatment protocols were equally effective in reducing low back pain in men involved in labour intensive work. A statistically significant difference presented in both groups. The results indicated that in order to reduce the period of intense pain more rapidly, a combination of CMT and CIBS would be the treatment of choice. However the long-term benefit of both protocols was equally beneficial. This is believed to be as a result of education changing the way in which people live and work and therefore taking effect over a longer period but having a more lasting effect. The objective results indicate that the protocols were equally as effective in improving the patient’s range of motion. However it was noted that range of motion was seen to reduce over a shorter period of time in the DFC group (combined treatment protocols). Based on the results of this study, the protocols were equally effective in the long term. This is due to the fact that as patients are educated about caring for their backs in the work place, and during activities of daily living, the amount of times they place their backs in positions resulting in excessive loading is reduced, therefore resulting in a reduction in pain, disability and further pathology. / Dr. M.A. Khoury Mr. S. Nalla

M.Tech. (Homoeopathy) / Acne vulgaris is a dermatological condition, pathologically characterized by the inflammation of the sebaceous glands and hair follices and is most prominent among adolescents (Holmes, 2001). Symptoms include the formation of inflammatory and non-inflammatory lesions, which can lead to the formation of scars (Boon et al., 2006). These eruptions occur on the chest, face, back and arms (Martini et al., 2001). The aetiology of acne vulgaris is multifactorial and hence there are a large variety of treatment options which range from topical applications to systemic drug treatment (Docrat, 2008). The homoeopathic complex remedy R53 (Comedonin) ® acne drops is a product which contains a combination of homoeopathic remedies that are used to treat the symptoms of acne vulgaris such as inflammatory and non inflammatory eruptions. The remedy R53 (Comedonin) ® is an over-the-counter remedy that is readily available and is indicated in the treatment of acne vulgaris (Dr.Reckeweg, 2010). No research has been conducted on its efficacy. The aim of this study was to determine the efficacy of R53 (Comedonin) ® acne drops in the treatment of mild to moderate acne vulgaris that presents on the face, chest and / or back in males. The evaluation of symptoms was done by using scales and the Digermizer software to calculate the surface area of the affected areas. This research study was a double blind placebo-control study that was conducted on thirty male participants between the age of fifteen to twenty years old with mild to moderate acne vulgaris on the face, back or chest. Participants who agreed to the procedure of the study were randomly divided into the treatment and placebo groups respectively. These groups consisted of fifteen participants each. The treatment group received the R53 (Comedonin) ® acne drops whereas the placebo group received the placebo drops. This research was conducted over an eight week period at the University of Johannesburg Health Centre. All the participants were instructed to take ten drops of the medication three times a day. Evaluations were conducted at week zero, week four and week eight according to APPENDIX B. As part of the evaluation, photographs of the affected areas were taken at week zero and week eight, in order to attain the surface area affected before and after the treatment period (Appendix B).

The purpose of this study was three fold: 1. To determine the life time incidence, 6 month prevalence and point prevalence of Low Back Pain (LBP) in the work environment of ABSA Bank and compare it to the rest of the world. 2. To determine whether individual factors such as age, gender, body mass index and work environment factors like main daily position and activity could be causal factors contributing to LBP. 3. To determine whether treatment is sought, the type of care sought for LBP and the cost of sick leave due to LBP to the company. A Review of the data indicates that LBP is a condition that 60-80% of people will suffer from at some stage in their lives. Epidemiological studies have shown that simple backache has a point prevalence and 1-month prevalence of 15-30% and 30-40% respectively. (1, 2, 3) LBP could be caused by many disorders of the spine, but for many sufferers no causative diagnosis will be made. There are a large number of occupational causes that could lead to the development of LBP. The major causes are the following: forceful lifting of heavy objects, twisting coupled with bending of the trunk, whole body vibration and heavy manual work. (60) There are a number of causal factors of LBP that are non work related such as personal risk factors including age, gender, fitness level, trauma to the back, cigarette use and recreational activities (60). LBP is seen to be one of the most common ailments affecting people, but most do not seek medical attention. Those patients who do seek medical attention seem to seek the help of the following specialities: physicians, chiropractors, nurses, orthopaedic surgeons, neurosurgeons, physical therapists or alternative medical practitioners. (20) Researchers in the USA, in 1992 found that 73.1% of LBP sufferers sought medical care, while many saw a multiple variety of health care providers. Of those people who sought medical care, 64% consulted a general practitioner, 55% consulted an orthopaedic surgeon, 29% consulted a physical therapist and 25% consulted a chiropractor. (8) A cross sectional, systematic random sample to study the incidence and prevalence of low back pain (LBP) was conducted on 355 employees of ABSA Bank and Unibank. The data was collected by the researcher by means of a personal interview. A permission letter from ABSA Bank Health Clinic (Appendix A) was used to gain access to those who needed to be interviewed in the sample group. The data was recorded on a questionnaire (Appendix B) and a low back diagram (Appendix C) was used to define LBP so that it would be easier to understand. The results of this study showed that the lifetime incidence of LBP was 63% (225/355), the 6 month prevalence of LBP was 41% (147/355) and the point prevalence of LBP was 9.6% (34/225). The major daily activity that was associated with the 6 month prevalence of LBP was computer type work at 93.88% (138/147); this was followed by telephonic work at 65.31% (96/147). Physical and administrative work was only reported to have caused LBP in 4.76% (7/147) and 22.45% (33/147) of the sample population. The major daily position that was associated with the 6 month prevalence of LBP was sitting - 97.28% (143/147). This was followed by walking - 61.64% (90/147), standing - 17.69% (26/147) and lifting-t 6.57% (9/147). Treatment was sought by 46.94% (69/147) of the sample population that suffered from LBP in the last 6 months. Treatment was sought from the pharmacy in 21.99% (31/141) of the cases. Chiropractors were consulted in 8.51% (12/141) of the cases; medical doctors were consulted in 14.89% (21/141) of the cases, physiotherapists in 17.02% (24/141) of the cases, while acupuncture and private hospitals were used by only 0.71% (1/141) of those who suffered from LBP. Biokinetics, homeopathy and osteopathy were three other disciplines that were on the questionnaire, but none of these disciplines were made use of by the study population. This study showed that the lifetime incidence, six month prevalence and point prevalence of LBP in the South African workplace is similar to other countries in the world and that this condition is costing the South African economy millions of rand each year due to lost working days as a result of absenteeism. The only individual factor that seemed to be statistically significantly associated with LBP was trauma to the lumbar spine. Other factors like age, gender and race did not seem to have statistically significant effects on the prevalence of LBP. The results regarding the individual factors that could lead to LBP seem to vary between the different studies evaluated. Just under half of those who suffer from LBP seek treatment for the condition. When evaluating what kind of treatment is used by the study population, it was seen that the majority used drugs from the pharmacy to treat the condition. / Dr. B. Losco Dr. M. Moodley

Chronic asthma is characterised by widespread inflammation and reversible narrowing of the bronchial airways. Inflammation of the bronchial mucous membrane renders it hyper-responsive to a variety of stimuli, resulting in wheezing, coughing, chest tightness and breathing difficulty. Asthma was first recognised by the Chinese, four thousand years ago and Hippocrates described it in the fourth century BC. Despite the amount of literature and information available on asthma, this disease is still on the increase world-wide. This research study was undertaken to establish the efficacy of homoeopathic simillimum remedies in the reduction of the frequency and severity of asthmatic symptoms, in adult individuals who suffered from chronic asthma. The research was carried out at the TWR health clinic at Doornfontein, from 1 June 2003 to 31 December 2003. Ten participants, eight males and two females, of all ethnic groups and between the ages of twenty-one and thirty-one, took part in this research. Each participant was interviewed during a homoeopathic consultation. Simillimum remedies were given and the participants were monitored over a period of fourteen weeks, at fortnightly follow-up consultations. Each participant received his/her own peak flow meter and a peak flow rate chart (Appendix E). Morning and evening PEFR were obtained by using the peak flow meter. These readings were recorded, along with any relevant symptoms experienced and/or bronchodilating medication used that day. Participants were required to record the above-mentioned data for two weeks before the homoeopathic treatment commenced and for the remaining twelve weeks of the study. The following results were obtained: • Most participants reported less frequent and less severe acute asthmatic attacks, as well as fewer nocturnal asthmatic symptoms. • Most participants reported an increased ability to participate in exercise without the need for bronchodilating medication during these activities. v • No statistically significant changes were found on the morning or evening peak expiratory flow rates recorded over fourteen weeks. • No statistically significant change was found on the frequency of bronchodilating medication used over fourteen weeks. The following conclusions may be drawn from the recorded results: • Homoeopathic simillimum remedies appear to have been effective in the treatment of chronic asthma in adults. • Homoeopathic simillimum remedies appear to have been effective in the reduction of acute asthmatic attacks and nocturnal asthmatic symptoms. • Homoeopathic simillimum remedies appear to have been effective in increasing the participants’ abilities to partake in physical exercise, as well as in decreasing their need for bronchodilating medicine during exercise. / Dr. S. C. van Es Dr. H. Niehaus

The purpose of this unblinded, controlled pilot study was to compare the effectiveness of Spinal Manipulative Therapy and a shoulder rehabilitation program, focussing on improving muscular and postural imbalances, verses Spinal Manipulative Therapy alone in the treatment of sub-acute and chronic shoulder impingement syndrome found in swimmers. In executing the comparison, it was anticipated that both treatment protocols would be effective, but the combined therapy of Spinal Manipulative Therapy and rehabilitation would be the most effective in treating sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol focused on correcting the biomechanical dysfunction in the cervical spine and thoracic spine coupled with a rehabilitation program to stretch anterior musculature, strengthen posterior musculature and strengthen the shoulder in external rotation. These muscular and postural imbalances are a contributing factor in perpetuating the pathomechanics causing sub-acute and chronic shoulder impingement syndrome found in swimmers. Shoulder impingement syndrome of this kind in swimmers is known as Swimmer’s shoulder. Thirty swimmers between the ages of 18 and 60 with subacute and chronic shoulder pain were recruited by advertising in the local newspapers. Two groups of fifteen patients were created. Patients were randomly assigned to one of the groups as they enrolled for participation. Group A underwent Spinal Manipulative Therapy of the thoracic and cervical spines in conjunction with shoulder strengthening and postural corrective exercises. Group B underwent Spinal Manipulative Therapy of the thoracic and cervical spines. Each patient was treated nine times in three weeks. A Saunders Digital Inclinometer was used to record objective glenohumeral ranges of motion and a painful arc was determined as positive between 45 and 120 degrees. The Supraspinatus Test was performed which was recorded as positive or negative. Subjective findings were measured with the use of the Visual Analogue Pain Scale and a questionnaire modified from Athletic Shoulder Outcome Rating Scale and American Shoulder and Elbow Surgeons’ Shoulder Evaluation Form. Data was collected prior to the first, fourth, seventh and ninth visit. III The results indicated that both groups were effective in treating Swimmer’s shoulder. Group A showed the most positive results in terms of objective and subjective clinical findings. In conclusion, Group A (Spinal Manipulative Therapy and Rehabilitation) was the most effective treatment protocol for the management of sub-acute and chronic shoulder impingement syndrome in swimmers. This treatment protocol had a greater benefit with regard to improvement of shoulder abduction range of motion, painful arc, Supraspinatus Test and Visual Analogue Pain Scale than Group B (Spinal Manipulative Therapy only). / Dr. B. Losco Dr. C. Lyons