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Saturday, 8 December 2012

Step by step method of treating acute emergencies


(A synopsis of my power-point presentation at the HMAI seminar and Alumni meet at Belgaum. Watch the presentation and video cases by clicking on the `Youtube' icon on the footer of the Home-page)

Management of acute case requires certain precautions to be taken when compared to `cold’ or chronic cases. The pitfalls of handling such cases homeopathically must hence be known to every practicing Homoeopath. The duty of the doctor is to set the patient on the road to recovery as soon as possible with the least time lost in philosophical reverie.

The following guidelines may be observed which by far are neither exhaustive nor complete, but may be adhered to as the bare minimum.

  1. Ensure your medical diagnosis is right.
  2. Assess the patient’s clinical condition well vis a vis his general condition.
  3. Assess your own ability to treat the case i.e. your previous experience with such cases, confidence level, your knowledge and familiarity of the Homoeopathic doctrines applicable to the case.
  4. Explain the seriousness of the patient’s condition and take the relative’s informed consent before treating the patient.

Having passed the first four check points, it is now down to Homoeopathic management.

Get a good case history. First, note down the disease symptoms to justify the medical diagnosis. Below each symptom that is elicited note down the concomitants and below each such concomitant, note down the modalities. Do not be discouraged by the absence of modalities especially the thermals. In infants thermals are difficult to elicit and the mothers narration may not be accurate – exercise care while attaching importance to these. In pediatrics, the child may narrate modalities but may only reflect the mothers imposition of her opinions e.g. preference for warm drinks/clothes etc.

 It is important to note down the sequential order of appearance of the symptoms and their concomitants. In infants, mentally challenged individuals and in unconscious patients, it may be difficult to elicit accurate modalities and concomitants. Here, observation of the patient’s particulars (objective symptoms) noticed by you and few symptoms as told to you by the relatives will have to do.  Do not justify any symptom, concomitant or modality as the fait acompli of the disease.

Exercise caution in assigning importance to any symptom stressed upon by the relatives. In their anxiety, truth may be the first casualty; they may exaggerate or attempt to focus your attention on to symptoms they regard as important or serious, especially during follow-up. Take an unbiased and unprejudiced case history. Symptoms will be evaluated only after the complete history is noted. Train yourself to note the finer points of objective symptoms and modalities since infants, mentally challenged and unconscious patients will not contribute any symptoms. OBSERVATION is the watch word.

Do not delve too deep into the past history. It may be irrelevant. Take care not to assign too much importance to the causative factor as told to you by the relatives – make your own evaluation of this aspect. Many ailments especially pneumonias are known to be seasonal i.e. < winter, monsoons.

Some of the symptoms expressed by the patient/relatives may be iatrogenic. Rule these out of the therapeutic totality.

TOTALITY is not in the number of symptoms you have collected. Anybody claiming to take a case history over several hours or even days appears not to have understood Homoeopathy and Hahnemann’s teachings. Hahnemann clearly said `The physicians sole mission is to cure the sick’; not `take the case history’. Read Lesser Writings – Kent and Boenninghausen.

The PQRS symptoms are nothing but the concomitants and their modalities and never the disease symptoms. (Read Guernsey, Kent’s lectures on the use of Guiding symptoms)

While repertorizing the case, involve as many general symptoms as possible. Do not go too deep into the particulars where you will get lost in rubrics having drugs with one mark. E.g.  (In complete repertory)
EXTREMITIES PAIN: Lower limbs: Sciatica: morning < rising after: colo;
This rubric has only one drug with 1 mark. Go back to the rubric `Sciatica’.

MIND: absent minded: morning: shows 5 drugs all with 1 mark. Go back to `absent minded’.
Avoid all rubrics with drugs carrying 1 mark. Rubrics having few drugs with 1 mark are best avoided unless the patient very strongly stresses on that symptom and modality. Attempts to involve such rubrics will end up in a disjointed repertorial totality where no single drug is indicated with any certainty.

PRESCRIPTION: The indicated drug is the simillimum and vice versa. The simillimum is the only drug which can cure, hence it is given in the appropriate potency irrespective of whether it is `deep acting’, `long acting’, Psoric, syphilitic or sycotic. The miasmatic theory is applicable chiefly in chronic cases. Its applicability in acute cases is limited.

POTENCY: The indicated drug (simillimum) in any potency, will invariably act, (note confusion created by Stuart Close, Hahnemann, Boericke) but quicker results may be achieved if susceptibility is taken into account. The chief indicators of susceptibility are:
  1. Age of the patient
  2. Organ affected.
  3. Acuteness of onset of the disease (time taken for the disease to establish or overwhelm the patient).
  4. Duration of disease
  5. Previous treatment taken
  6. Mental symptoms – more the mentals, higher the potency
For further details read Dudgeons lectures and B.K.Sarkars commentary on the Organon.
Constitution does not help much in acute diseases; can be relied upon only as a last resort with paucity of symptoms. Read also Boenninghausens Lesser writings (case histories) regarding use of high potencies and drugs in alternation as well as complementary drugs.

 REPETITION: In acute cases frequent repetition is permissible. Read Organon aph: 247, foot note to 247; aph.248 (compare with Vth edn.). Read also Dudgeons lectures, Stuart Close, Kent’s lectures, Boenninghaussens Lesser writings, Borland’s Pneumonias. Remember, the stalwarts practice was based on the 5th edition of the Organon, where-in Hahnemann left repetition largely to the discretion of the physician. This method was used with great success and no untoward incidents.
Opinions may vary, but practice shows, repetition in diluted form (in water) succussed before administration,  does not harm the patient.

HOMOEOPATHIC AGGRAVATION: The best bogey to scare the young homeopath so that he never attempts to treat an acute case. A case of more smoke than fire. Read Dudgeons and Andre Saine’s views on the same. This topic in Homoeopathy has more confusion, contradictory opinions and theories after posology. In fact, a rarely seen phenomenon, my opinion (in both acute and chronic cases) is that it depends upon:

  1. The preconceived notions of the doctor
  2. False indoctrination of the patient
  3. The physicians lack of knowledge of the disease and its progression.
  4. Sudden cessation of previous treatment (allopathic) causing exacerbation of disease symptoms.
  5. Imperfect case taking; omitting disease symptoms in search of PQRS.
  6. Reliance upon symptoms related by the mother or relatives; ignoring your own observation. The patient must be brought to the clinic for every follow-up and examined thoroughly to ascertain improvement or deterioration. Run through all general symptoms narrated by the patient during the first consultation. Note decrease or increase in intensity of each sign (objective symptom).

Note aph.160. “… a dose of the appropriate Homoeopathic medicine, …. does always, during the first hour after its ingestion, produce  perceptible homoeopathic aggravation of this kind.”
In acute cases, is such immediate action of Homoeopathic medicine without an interlude (while the disease is checked) possible, or is there a brief progress of the disease before the Homeopathic medicine revitalizes the Vital force and overpowers the disease?

RECOVERY: The concomitants subside first. The concomitants disappear in the reverse order of their appearance, hence the previously expressed requirement of sequential recording of the symptoms. The disease symptoms of cough, fever go last, also in reverse order of their appearance. However, adventitious sounds (in Lower respiratory diseases) which are due to pathology may not obey this rule.
Indication of the drug being the simillimum and the potency being right is better assessed by the following phenomena as observed in a serial study of 300 cases of Pneumonia/ Broncho-pneumonia & 500 cases of Chikungunya.
  1. Deterioration of condition is arrested in 2-3hrs after giving the simillimum.
  2. Patient shows less irritability/restlessness and calms down some what.- 24hrs
  3. In lower respiratory ailments: Cyanosis decreases – 24-36hrs
  4. Air entry improves on auscultation – 36-48 hrs
  5. General condition visibly improves. Patient becomes aware of surroundings and people other than the mother (in children) – 24 -72 hrs.
  6. Patient asks for food or milk – 48-72 hrs.
  7. Fever starts declining. 48 – 96 hrs. Will touch normal after 3-4 days.
  8. Cough decreases last after 8-10 days. (in pneumonia)
  9. Occasional patient may have mild diarrhea or a nasal discharge at the end. This condition often needs to be treated as a separate entity, hence may not be a natural accompaniment of the curative action of the drug.                                                                                 
  A FEW TRICKS TO IDENTIFY THE SIMILLIMUM
A quick way to reduce the burden of going through the materia medica is to ask the patient about his/her thirst. This rubric will help divide the M.M into thirsty and thirstless drugs. Being a general symptom, it assumes great importance in any prescription.
Use thermals cautiously especially in children who in India are invariably over dressed in the event of fever. The perspiration stage of fever is today almost completely useless due to the use of anti-pyretic drugs like paracetamol which many patients will use despite being discouraged. Use of such drugs causes immediate profuse perspiration which is not a natural phenomenon.
Disease nomenclature and its inclusion in repertorial analysis has limited use except in established disease states such as Typhoid, Malaria, Pneumonia (Inflammation lungs) etc. But the prescription need not be based on this rubric.

SECOND PRESCRIPTION: The greatest challenge facing the physician is the patient follow-up. In acute cases, wait for atleast 24 hours before taking a follow-up. In cases of very acute diseases such as Cholera, Gastro-enteritis etc; the results should be evident within two to three hours, Often-times in 15-20 minutes. Do not rely on the patients narration of his physical state. Call and examine him in the clinic.
1. Patient says he is better: Continue repetition of the medicine but space out the dosage. i.e. from hourly to 4 hourly or thrice daily, until the patient is symptom free for atleast 24 hours.
2. Patient says he is not relieved: Always physically examine the patient and look for signs of the disease. Improvement in signs of disease e.g. in respiratory diseases, decrease in body temperature in fevers or even decrease in the flushed discoloration of the face- any change can be an important sign of the medicine being the simillimum. If symptomatic relief is not evident, repeat his WBC counts. A decrease in the total count in infectious diseases is a sure sign of improvement. Repeat all other blood tests which were abnormal at the first consultation. Any change towards normality is a sign of the correct simillimum.
3. Patient claims partial relief: If the improvement is in the General symptoms, the drug given is the simillimum, even if the Particulars have not changed or are worse. Wait for another day for the medicine to act and continue the repetition as before. If Particular symptoms improve and the General symptoms worsen, re examine the repertorial analysis. If sure of the simillimum, increase the potency. If remedy does not cover the Generals, change the drug.
4. New Particular symptoms become evident: Check your medical diagnosis. Repeat the blood tests and add any relevant tests if needed. If the diagnosis changes, retake the case history and add the new particulars to the repertorial analysis. If the diagnosis remains the same, re-check your repertorial analysis and patient susceptibility. If confident of your prescription, continue the same or increase the potency from 30C to 200C or 1M.
5. New General symptoms arising: The prescription has missed its mark. Retake the case and work again on the analysis of the case.

SECRET OF THE ZIG-ZAG CURE: Many acute cases need more than one drug to complete the cure. Be alert to this need and act fast. Either due to paucity of symptoms or a not so perfect case taking, the remedy given will be decided on the basis of KEY NOTES. This if it can be so said, is a necessary evil due to the acute nature of the case and the patient's inarticulate or unconscious condition. Key note prescriptions often cause a partial cure; or else, accessory symptoms may reveal themselves after the first remedy is administered. The second prescription will have to take these symptoms into consideration and a change in remedy will be necessary. Another situation is when a well selected remedy fails to give the desired response. A deep acting Psoric (often Sulphur) or sometimes a Syphilitic remedy (most often Merc Viv) may need to be administered to reactivate the Life force or to remove the Syphilitic impediment. Such intercurrent use of drugs even in acute cases I have relied upon often in my career spanning 35 years and can vouch for their revolutionary effects. I would like to remind readers here that many remedies carry more than one miasmic trait and cannot be straight-jacketed as Psoric/ Syphilitic/ Sycotic etc.

IN A NUTSHELL
1. Take a quick but good case history with investigations that support your diagnosis
2. Concomitants and modalities are the PQRS or the repertorial totality
3. Key note prescriptions are the key to success.
4. More acute the disease, higher the potency - 30th to 1M is the range I use.
5. Simillimum must be repeated frequently depending on the threat to life of the patient
6. Results should be evident within a few minutes or hours of starting the treatment. More acute the ailment, faster the results obtained.
7. Second prescription depends on remedy response - Zig zag cures are often the rule.
8. Physical and pathological monitoring of the patient is a continuous every hour/day process.
9. Homeopathic aggravation is a debatable issue. Do not let it affect your prescription.
10. After a reasonable effort, if the patients condition deteriorates, do not hesitate to refer the patient to a higher medical center.


CONCLUSION:
It is imperative that we treat acute cases not only because they are challenging, but also due to the ease and speed with which we achieve dramatic results. Doctors of the allopathic school who refer patients to me describe the effect as nothing short of miraculous.
I am very much against the practice of discussing single cases in conferences and seminars because a single case is not indicative of the inherent curative powers and efficacy of homeopathy. A single case does not instill confidence in other homeopaths. Single cases can be manipulated and the approach can never be standardized, hence nothing can be learnt from such efforts. If honestly presented with documented proof of cure, single cases carry nothing more than academic value. A patient's testimony on video is meaningless and unscientific. It opens further reasons to doubt the veracity of the claim of cure. Well documented acute cases will dispel all claims of placebo effect and faith healing from the lexicon of our skeptics and opponents - the Allopathic school. A compilation of cases can give excellent statistical analysis of the efficacy, methodology and choice of simillimum leading to an exhilarating learning and teaching experience. The LANCET can still be lanced!


Tuesday, 23 October 2012

OBSTRUCTIVE JAUNDICE

As an adjunct to what I had said on my previous blog on this topic of  `CAN HOMEOPATHY CURE ALL TYPES OF CASES', I am presenting this case of Cholelithiasis (Gall stones).

Mr.A.M.P came to me on 11-10-2012 with moderate icterus and pain in the Liver region. No h/o fever, vomiting. The patient had obvious jaundice and had been seen by a surgeon and diagnosed as a case of Gall stones in the CBD with obstructive jaundice. His Total Bilirubin: 6.9mg%; Direct Bilirubin: 3.8mg%; Alkaline Phosphatase: 224 IU/Lt.

With very few symptoms to go by, the indicated remedy was Chelidonium which I gave in the 30th potency -  a dose every 6 hours for three days. on 16/10/2012 he reported that he was feeling much better. The icterus had certainly diminished.

17/10/2012 - the patient reported that he was relieved of his complaints. His tests were repeated.
Total Bilirubin: 2.8mg%; Direct Bilirubin: 1.6mg%; Alkaline Phosphatase: 184 IU/Lt.
At this juncture I had proved my point that Homeopathy can help in such cases, but I was not under any delusion that the obstruction (14mm stone at the distal end of the CBD along with multiple large stones in the Gall bladder) had dissolved or passed through. I repeated the USG and my suspicion was confirmed. I referred the patient for an ERCP procedure to a Surgeon.

Homeopaths cannot and must not go on symptoms alone. The patient then revealed that he had a similar attack five years ago and produced the old USG reports which were identical to the present!! This is  another lesson for all homeopaths - the limitations of case-taking. Despite all your experience, it will do you good to remember that you will know only what the patient chooses to reveal!  By referring the patient for a procedure, I had done what is ethically and morally expected of me. I refrained from claiming a fictitious cure based on symptoms and I had probably saved the patient from a more severe episode of jaundice, infection and unimaginable suffering. Such patients will always remain grateful to the physician for being balanced and practical and to Homeopathy for having prepared him for the unavoidable endoscopic procedure.

To conclude,.discretion must take the better part of valor. As in this case, surgery can be your victory in defeat. 

Monday, 15 October 2012

Diarrhea cured with Phosphorus

PHOSPHORUS - be prepared for the unexpected

Baby C.S. - 5 month old female infant, resident of Belgaum, was admitted with a local Pediatrician since 4 days with fever and diarrhea. The mother (a native of Gokak, had come here to visit her mother when the baby took ill) approached me asking whether I could treat her baby as they were fed up with repeated admissions for treatment of cough, cold, diarrhea and so on. In the last three months the baby had been admitted to hospital 4 times on one pretext or the other. It was obvious to me that these are hospital borne infections, difficult to cure. I took up the challenge. I insisted that the baby be discharged and brought to me. I am averse to treating patients clandestinely in other doctors care. The issue being, firstly I must accept full responsibility for my patient. Secondly the patient must be left with no doubt that the cure was entirely and solely homeopathic.

Monday 4 pm. 15-10-2012  
Baby was brought to my clinic with mild fever 101*F and grade 2 dehydration. The baby was passing stools with no pain - thin, almost watery, pouring out, no odour, flaky yellow at times. The frequency was every 15 - 20 mins 1/4th cup at a time. My first prescription was Croton tig 200 in water repeated every hour. Baby put on ORS with instruction not to feed her anything else.

Monday 7 pm 15-10-2012
The mother rushed into my clinic saying the baby's diarrhea was worse. Now it was oozing out of the anus- thin, watery, choleric and continuous without an interval. The two drugs that came to my mind were Apis and Phosphorus (the rubric Rectum: Anus open). The baby was thirsty and accepting ORS. Hence Phosphorus 200 in water was started immediately at 15 mins intervals X 8 times. I asked the mother (now accompanied by 6 members of the family) to sit in my waiting room. The anxiety was too much for the young mother who called up a very well-known pediatrician in the Medical college hospital in Belgaum. The gentleman was very nice and spoke to me asking me if I was confident of treating the case. I answered in the affirmative, I assured him the baby would be alright within an hour. He then spoke to the mother and calmed her down assuring her that the treating doctor (myself) was confident about the case in hand.
8:15 pm : The baby had passed only two motions, thin yellow, quantity much less
9:00 pm : Baby was alert and looking around, smacking her lips asking for her feed. ORS continued. No fever.
9:45 pm: Baby alert, the `light' had returned to her eyes. She was now looking around, following the movement of mother and relatives around her. Only one very scanty (1 tsf) motion had been passed. The stools were still watery, no fecal matter seen. I asked the mother to take the baby home and report next day 10:00 am. Reduced dose to 1/2 hourly till the mother or baby slept, whichever happened first.
Tuesday 16-10-2012 10:30 am
Baby cheerful and looking perfectly o.k. No motions passed since last night. I asked the mother to start the infant on cows milk + water in 50:50 proportion. Medicine to continue at 2 hourly intervals till normal motions were passed. Then to start breast feeding.
7:00 pm
Grandfather came to report that the baby is well and taking feeds. No fever or diarrhea.

I consider this diarrhea cured. I will now work on the immunity of this infant which has been repeatedly subject to hospital borne highly resistant infections. At 5 months the baby has been doused with higher antibiotics and steroids repeatedly hence I warned the mother and relatives that total cure will be slow - may be 3 months or more; they should expect minor niggling ailments before total restoration of health. One more victory for Homeopathy and one more family converted to our glorious system!! It is this last that gives me the greatest pleasure!
To cure such cases a firm understanding of Homeopathic principles, posology and skillful use of the repertory along with the ability to recognize key symptoms and convert them to appropriate rubrics is absolutely essential. The truth of successful posology stands exposed in the last two cases I have posted. 

18th May 2013:  The baby came to my clinic 3 days ago with a mild coryza and cough. The diarrhea has never recurred since the last 5 months and the baby never needed any medical care till now. Placebo prescribed for three days.

Thursday, 11 October 2012

SULPHUR AS ACUTE DRUG

SULPHUR AS AN ACUTE DRUG

I have been accosted in the past by homeopaths who pretend to be shocked or surprised at my use of Sulphur as an acute drug in various conditions. Today let me post this case of Gastro-enteritis in a 11 month child.
Baby A.M was brought to me on 10/10/2012 at 2:00 pm. She was suffering from Diarrhea  and vomiting since 4 days. Fever since 3 days. Temp: 103*F. She was admitted with a pediatrician for 3 days with absolutely no relief. Blood tests showed a high neutrophilic WBC count - 23800/cu.mm

Diarrhea had begun on the first day between 4-5am. The motions were pure watery, profuse, forcible and preceded by mild tenesmus, stools not particularly odorous; - a cupfull at a time exited with a gush and sputtering of flatus. Some amount of rumbling preceded the stools. 8-10 motions per day, yesterday was the fourth day after onset, when she was brought to me.

Vomiting (6-8 per day) started a few hours after the diarrhea. The baby could not tolerate anything and would throw up on being fed. She tolerated water though.

Fever - no signs of chills but high grade fever since afternoon of the diarrhea.

The General condition of the baby was not good. She was so weak that she could not lift her head nor even cry as I examined her. Dehydration - grade 2 (I.V. fluids had been given by the pediatrician before the parents insisted on being discharged).

My first prescription was CROTON TIG 200 in water, one dose half hourly X 4 repetitions; then one dose two hourly X 6 repetitions.  All feeds stopped. Baby put on Water + sugar

Day 2: 11:00 am:- Child slightly better. Diarrhea and vomiting a bit less- 4-6 times in the last 18 hrs. Fever 101*F. Again the first motion of the day was passed at around 5am with flatus, but was now painless. On examination the skin around the anus was red and looked inflamed.
SULPHUR 200 in water repeated every hour till 6:00 pm.
The child was brought to my Rapidcure Clinic at 7:00 pm. The change was astounding. No vomiting since Sulphur; No diarrhea and no fever since 1:30pm. The baby had accepted ORS which she had refused since yesterday (she took only water with sugar - one tsf to 200ml water). The baby was active, played with mother and father in the clinic and responded to my voice and calls.
Sulphur will be continued infrequently till tomorrow 10:00 am when I will see her again. I have cured dozens of such children with Gastro-enteritis with Sulphur in frequent repetition and it is often my first line of treatment when the above symptoms are present. I rate it equal to PODOPHYLLUM and CROTON TIG in such presentations. I would like all practicing Homeopaths to familiarize themselves with two other drugs 1. Jalappa and 2. Rheum in children's diarrhea. The strongest indications of Sulphur being Time of onset; Relatively painless, uncontrolled diarrhea; Rectum: Noise- Gurgling rectum, Redness of anus; all other symptoms being the same.

Day 3. 7:00 pm:  The child was brought for follow-up today evening. She has passed one normal stool at 11:00 am. No fever, vomiting or diarrhea since yesterday 1:30 pm. Treatment has been stopped since 5:00 pm as child is asymptomatic.

Tuesday, 2 October 2012


Ferrum Phos is not a well proven drug and most of its symptoms have been borrowed from Scheusslers Biochemic  remedies. Many symptoms have been incorporated from clinical experiences, hence its use has been limited to acute cases and correction of anemia. Its mental symptoms though are unique and contradictory.Read M.L.Tyler's description before reading the notes below.

FERRUM PHOSPHORICUM   
Source: Chemical                Miasm: Psoric, Sycotic
CAUSE
Mechanical injury, checked sweat, Cold air
MIND
Hilarious, gregarious, talkative. Averse to crowds, company, pleasure. Mania<cerebral irritation
HEAD
Headache vertex to sides. <sun. >Epistaxis, cold app. Emptiness <menses
EYES
Inflamed.  Encysted tumors of lids. Blindness<stooping
NOSE
Epistaxis children; ailments operations after
THROAT
Tonsillitis, laryngitis of singers. Pain <empty swallowing.
STOMACH
Vomits ingesta. Hematemesis. Averse milk, meat. Desires sour
ABDOMEN
Summer dysentery-bloody thin stools. Clothes sensitive to.
URINARY
Retention <fever. Involuntary< cough. Sudden freq.urge with pain neck of bladder & penis
EXTREMITIES
Wandering rheumatism< slight motion. Wrist pain→weak fingers
FEVER
Chills- desire to stretch. Heat-sweaty hands. Pneumonia
PECULIAR SYMPTOMS
Hilarious, talkative. Averse to pleasure. Head empty <menses. Headache>Epistaxis. Hoarseness singers. Motion<; Cold app>.
THREAD
Shifting moods/rheumatism. Acute ailments from anemia, checked sweat, operations. Pale hemorrhage- orifices.

Wednesday, 26 September 2012


HOMEOPATHY IS A MOST SOUGHT AFTER ALTERNATIVE MEDICINE FOR THE CURE OF ASTHMA

HOMEOPATHIC TREATMENT OF ASTHMA
ASTHMA is described as a chronic condition of the lungs, presenting as wheezing, tightness of lungs, difficulty in breathing and cough. Uncomplicated asthma is never accompanied by fever. Childhood asthma is increasing at an alarming rate due to pollution, poor food habits and lifestyle which facilitate this condition.

RISK FACTORS
GENETIC PREDISPOSITION - asthma runs in some families. Children who have parents, brothers or sisters suffering from this condition run the risk of getting this condition as well. However children without such a family history can suffer from asthma as well.
ALLERGY – Persons who are allergic to certain foods, who suffer from eczema and frequent colds (allergic rhinitis).
ENVIRONMENT – Certain toxic substances can trigger off asthma in some people. These substances vary from person to person and in some can worsen the condition. House dust, pollen, animal hair, cockroaches can aggravate or trigger a reaction.
RESPIRATORY TRACT INFECTIONS – Viral infections
PHYSICAL EXERCISE – especially swimming in cold waters or extreme exertion.

HOW TO AVOID RISK FACTORS
House-cleaning is done preferably using a Vacuum cleaner. If the patient needs to clean the house himself/herself, a moist cloth tied over the nose and mouth like a mask could help. Avoid keeping pets and carpets in the house. Dust pillows and mattresses outside the house on a terrace. Adults must stop smoking as second hand smoke can affect a child seriously. Proximity to chemical factories, automobile exhaust may mean a change of locality or city itself.  Many patients learn to identify their personal allergies and must therefore avoid such triggers- food or other items.

MISINFORMATION
Asthma always runs in families – not so. Many patients have no such family history
Asthmatic patients must avoid sports – many international athletes and sports persons are asthmatics. Exercise helps the lungs retain their elasticity.
Homeopathic treatment takes a long time to cure asthma – the average time taken is six months to a year and may extend to two years in occasional cases. This is better than a lifetime of allopathic medicines which include steroids with no possibility of cure.
There are two types of medicines in Homeopathy. 1- Acute remedies which control the attack
 2- Constitutional remedies which help rid the body of the asthmatic tendency

Thursday, 6 September 2012


KILLER AGGRAVATION – reality or misconception?


  The homoeopathic   aggravation Hahnemann explains, is the reaction of the  vital force to the artificial similar drug  disease  "called forth  in the diseased parts of the body by an  excessive  dose, diseased  parts being hypersensitive to `like' drug action".  With him  it  is "quite in order" and of good  prognosis  "if  excited within proper limits." Therefore,-"The doses of the homoeopathic medicines are invariably to be reduced (higher dilutions) so far that, after they have been taken, they  will merely produce an  almost    imperceptible    homoeopathic aggravation". And he says: "The doses be  reduced, provided  that the dose, immediately  after being taken, is capable of causing a slight  intensification  of  symptoms  of  the  similar   natural disease." Therefore, the higher the potency, shorter the duration of action on the physical level (though dynamic effect is increased), hence less the chances of an aggravation. i.e. if a patient were given a 30C potency and another a 10M, the chances of an aggravation are more likely in the patient taking the 30C.
ORGANON 6th Edn. Aph 158: The globule of the high  potency  is best crushed in a few grains of sugar  of  milk which  the patient can put in the vial and be dissolved   in  the requisite quantity of water.**134*}     (with perhaps 8, 10,  12, succussions)   from   which  we  give   the   patient    one   or (increasingly)   several  teaspoonful  doses,  in  long   lasting diseases  daily or every second day, in acute diseases every  two or six  hours and in very urgent cases every hour or oftener.   Thus in   chronic  diseases,  every  correctly   chosen   homeopathic medicine,  even those  whose action is of long duration,  may  be repeated  daily for months with ever increasing success.  If  the solution is used up (in seven to fifteen days) it is necessary to add to the next solution of the same medicine if still  indicated one  or (though rarely) several pellets of a higher potency  with which  we continue so long as the patient  experiences  continued improvement ….. This quote explicitly means to say, that a drug can be safely repeated as long as its dynamisation is increased continuously.
This last strategy of suddenly jumping the potency in my experience can at times have disastrous results. I would prefer to add once again, the same drug in its previous potency to the solution and if necessary give a few doses with increased frequency to re-excite the Vital force and its  curative action.
As all Homeopaths would know, it is necessary to understand that the Homeopathic aggravation differs in its timing in acute and chronic diseases. In the acute disease it appears soon after commencing treatment. In chronic disease it may be expected towards the end of treatment – in other words just before cure is certain. Yet, if the above highlighted portion of the aphorism is read, it becomes obvious that the aggravation can be avoided and certainly need not be feared.
My interaction with thousands of patients and scores of Homeopathic practitioners has helped me interpret this event as follows:
  1. The enthusiastic academician who in his haste to impress his patient embarks on a mission to enlighten his patient as well. Having learnt of this impending aggravation, the patient anticipates it and obliges the good doctor with his tale of aggravation.
  2. The physician is not clear on the different concepts of acute and especially chronic homeopathic aggravations; hence poses leading questions to the patient who duly obliges the good doctor.
  3. The physician is not certain of the disease and its natural progress and mistakes the deteriorating condition for a Homeopathic aggravation.
  4. The hypochondriac patient who `jumps to the occasion’ because he is previously indoctrinated by another homeopathic enthusiast (many practitioners are not institutionally trained and may carry erroneous or preconceived ideas of this phenomenon). Incomplete and inappropriate information about homeopathy is freely transmitted from patient to patient and now is also available on the net.
I recollect losing several patients to this preconceived idea thanks to this increased `awareness’. It is amusing and defeating, to have patients paying my consulting fee, then refusing treatment saying “But doctor I cannot tolerate any increase in my suffering due to your treatment”. And this despite my fervent pleas that this is not going to happen! The Homeopath must learn to hold his tongue. To decide whether the reported increase in suffering is in fact an aggravation, it is always better to call the patient back to the clinic and re-examine him. The physician must judge for himself what the patient’s complaint is all about, rather than warn the patient about a phenomenon which may be nothing more than preconceived misinformation. Oftentimes the aggravation reported by the patient may either be an increase in the particular symptoms with relief of the generals (a classical Homeopathic aggravation), or a dissatisfied patient who insists that relief is not as quick as he/she expected it to be. In  this latter condition the patient irrationally  requests a change in remedy. 

To illustrate my point I will quote a case: Mrs M.P. was admitted to an orthopedic hospital for treatment of a fractured hip. She developed a severe diarrhea which was resistant to allopathic medication. After 12 days I was called to treat the lady who was passing 15 - 20 motions per day by her own admission. On the second day of treatment I went to see her and was confronted by an agitated patient who insisted that her condition far from being relieved, had worsened. I asked her repeatedly as to how many motions she had passed since morning. After avoiding the question several times she finally confessed that she had passed only one semi solid stools that morning!! Homeopathic aggravation or impatient patient????

To those who hold the theory of a Killer aggravation close to their hearts, I implore you to find such a reference in any of the provings (the basis of Homeopathy), where a pathology has been created or aggravated by Homeopathic medicines. 

Having practiced Homeopathy for 3 decades and more, and attended numerous seminars, I have come to the conclusion that there are three types of Homeopaths. 
1. The IMPRESSARIOS
2. The `HOLIER THAN THOU'  Go-by-the-book homeopaths and 
3. The PRACTICAL- `Let me cure my patient first' type.
The first type are not so worried about their cures. They do not have enough cures to produce a serial study of any disease. A serial study exposes the physicians approach, consistency and the efficacy of his approach. Instead they spend plenty of time and enough imagination to invent improbable theories using the liberty offered them by Homeopathic philosophy which they turn upside down on its head. It does make for great seminars, discussing ONE case for six hours. I have a better term for this hopeless exercise. I call it Mental masturbation!
The second type is the one who desperately wishes to sound academic and `accepted' and   `enlightened', like he just saw GOD. He forgets that we have all read the Organon and the Materia Medica which are our text-books. Text books are not gospels. They are knowledge repositories. Knowledge is to be applied skilfully through adaptation (if need be) to obtain a cure, whether by applying Key-note prescriptions, Generals or Mind symptoms. There can never be a `RULE' that defines our approach to every patient, just as a single size shirt wont fit every man. Some in this genre, stumble along, more interested in `LAWS' and the diagrams they draw in Power point presentations or the teacher's black board. Easier still is, when they attend a seminar and mimic the speaker as if he has just re-written the Homeopathic manuals.
The third type is the practical, no nonsense physician, who has the patient's interests in mind and will bring forth all the knowledge he has, adapt it to the case and the situation and cures the patient. He uses the text book as a frame work to support his prescription. He does not waste time on pontification. He does not waste time (more importantly other people's time) in improbable philosophy. This type of physician is the one who honestly and painstakingly accumulates data which can be analyzed, assimilated and disseminated for use by others. Dr. Samuel Hahnemann was this last type. He re-wrote the Organon 6 times as he gained knowledge and adapted it to the prevalent situation. The success of his doctrines are seen irrespective of whether you follow his fifth edition of the Organon or the sixth. For this very reason, Homeopathy is accepted and proliferates in India and many countries all over the world despite the onslaught of the `scientific' Allopaths and their Pharmaceutical industry. No Lancet can puncture our noble science thanks to the extremely meticulous and no-nonsense approach of the founder of Homeopathy. So solid was the foundation he cast, that after 250 years `SIMILIA SIMILIBUS CURENTER' remains the ultimate altruism.

 

Wednesday, 5 September 2012


Calc. fluorica exerts a contrasting effect on the tissues of the body. It relaxes the soft tissues, hardens the glands and forms tumors or erodes the bones and the patients confidence.
It can also repair broken bones and repair tissues after operations.  I have used this successfully to release or prevent adhesions of intestines after operations and to dissolve abnormal calcification.

Bellis Perenis seems to be better suited for immediate post operative, deep abdominal and soft tissue injuries, especially where no obvious external sign of trauma is to be seen.

   CALCAREA FLUOR                     Source: Chemical
PROVER- Hahnemann                 MIASM: Syphilis/Sycosis
CAUSE
Weather change; Congenital syphilis
MIND
Sadness, causeless fear of poverty
HEAD
Cephalhematoma, Bony tumors. Ulcers©hard edge
NOSE
Atrophic rhinitis-green/yellow lumpy offensive discharge; scabs.
EYES
Keratitis, subcutaneous cysts on eyelids, sparks before eyes
MOUTH
Sensitive/loose teeth, Abscess©calcification
THROAT
Inflammation< cold drinks;>warm drinks. <night. Mucus in post.nares
STOMACH
Vomiting infants. Indigestion <fatigue, brainfag
ABDOMEN
Flatulent bursting Pain<R; pregnancy, midnight, sitting, lying R.side. >doubling.
CHEST
Hoarse cough, exp:yellow small lumps< reading, laughing
EXTREMITIES
Encysted tumors,synovitis,bursitis. Fibroids in knee. Pain jts, cracking >contd motion, rubbing. Backpain< journey.
SKIN
Dry,hard,cracked,white; Ulcers-hard edges.
PECULIAR
SYMPTOMS
Hard/Calcified  tissue; erosion of bone. Fear of poverty.Contd motion>. Vomiting infants; Indigestion<brain fag, overwork
THREAD
Encysted/bony tumors,cysts.  Erosion; Syphilitic discharges. Modalities of Rhus tox.

Tuesday, 28 August 2012

HOMEOPATHIC SEMINARS - Is screening necessary?

After many years I decided to attend a seminar in Kolhapur, conducted by a reknowned Homeopath of Pune. He is reputed to have a 80 bedded hospital where-in (supposedly) all types of emergencies are handled. The publicity given, led me to believe that he treats cases admitted in the ICU on ventilator. I bit the bait.

I was curious to know how a Homeopath runs an ICU without the help of sophisticated life-saving equipment, I.V. fluids and Oxygen none of which he is trained to handle, leave alone legally possess. As the video presentation began it was evident that the cases he claims to have treated were in fact treated surreptitiously, in other hospitals, without the knowledge of the hospital staff, management or faculty. There is no evidence that the allopathic drugs were discontinued or modified to allow the administration or action of the Homeopathic remedies. The condition which the patients were suffering from (as we were told), in all probability involved the use of steroids as part of the treatment. Do homeopathic drugs act when steroids have disabled the immune system? No pathological reports, other than a photocopy of the hospital case-sheet were displayed to buttress the clinical diagnosis of the conditions under treatment- like Pompe's disease, Guillain Barre syndrome etc.

There are many questions which arise from this seminar. Is it ethical to treat a case in a hospital without the knowledge and consent of the treating physician? In the event of death of such a patient what liability does the Homeopath accept? Is he not vicariously responsible for any mishap, should it occur? If this practice is being followed, will the kind doctor release a statistical study of all the cases (of any and all conditions) he has treated in this fashion regardless of the outcome of  his treatment?

Every case presented certainly showed the recovery of the patient from the comatose condition he was in, but what about the pathological condition which the patient was supposedly suffering from, for which the good doctor claimed a cure? No follow-up reports or investigations were displayed which proved that the disease/condition was reversed! To top it all, the good doctor attempted to explain Type II Diabetes Mellitus as "a condition caused by deficient Insulin in the circulation due to destruction of the Beta cells of the pancreas"!!

The irony was that this seminar was organised under the aegis of several Principals of Homeopathic colleges from Maharashtra and Karnataka. It is my fervent plea to all heads of institutions to kindly screen the speakers of all such seminars along with the matter to be presented. We can ill afford to train our students in such dismal fashion and expose them to destructive or disabling law suits.

Thursday, 23 August 2012

CLASSICAL HOMEOPATHY AND THE MYTH OF THE SINGLE DOSE.

It may be necessary, even a pre-requisite for a system to survive and be acceptable, if only it can be improved upon. However to re-invent a system is fundamentally different from attempts to rejuvenate it. Today there are many practitioners of Homeopathy who feel it incumbent on themselves to take a moral high-ground if they cannot re-invent Homeopathy. To claim its re-invention may attract a spectrum of criticism ranging from skepticism and cynicism to the risk of drawing the ire of the academics. Hence Classical Homeopathy was born.
The evolution of the optimum dose as I prefer to call it, had its origin in the concept of the minimal dose. The evolution of a single dose; later Hahnemann’s acceptance of his follower’s suggestions to use higher potencies, the invention of the LM potency and finally, repetition of the aqueous dose was a natural culmination of the master’s own experience in the treatment of obstinate chronic diseases. Hahnemann was dissatisfied with having to wait for the relapse of symptoms before repeating the dose as it involved an interminable wait for the cure and the uncertainty of curative finality in very chronic diseases.
Hahnemann published the 5th edn. of the Organon in 1833 and the 3rd, 4th and 5th edns. of `The Chronic Diseases’ in 1835, 1837 and 1839 respectively. During this time, provings were already being conducted with the help of aqueous dilutions. The theory of repetition appeared in the 5th edition; based on the premise that medicines given in aqueous form and succussed before administration are safe. Hahnemann abandoned his theory of the single dose and advocated repetition at suitable intervals (not waiting for the action of the remedy to expire), to shorten the duration of cure by half or even less. Hence it would be retrograde thinking to advocate a single dry dose and resort to the wait and watch method discarded and discredited by Hahnemann himself.
GARTH BOERICKE: Homeopathy is based on the exact observation of natural phenomenon of disease and drug action, and the law governing their mutual relationship. On this solid ground of careful observation, all homeopaths base their practice. But not all Hahnemann’s theories as published in the Organon are proven. Hering says, to discard all theories, including those of one’s own fabrication, when they are in opposition to the results of pure experience.

SUMIT GOEL: The term posology originates from the Greek posos meaning how much and logos meaning study or discourse. The terminology of dose originates from the word dosis, which means the quantity of a drug or other therapeutic agent to be taken or applied.  A homoeopathic dose necessarily means the particular preparation of medicine, the quantity and form of that preparation as well as its repetition. In short, homoeopathic dosage includes selection of potency, dispensing (quantity and form) and repetition of the dose of the medicine.  Homoeopathic posology is based on the trinity of the principles of the single simple remedy, minimum dose and minimum intervention.

My own experience after 31 years of practice, dealing with many types of emergencies, even dire emergencies suggests that, repetition in acute diseases is to be condoned, even necessary. In chronic diseases too, repetition before the re-appearance of old symptoms can be indulged in judiciously as has been illustrated in the 6th edn. of the organon and demonstrated in their respective Lesser Writings by Dr.Kent, Boenninghaussen; and the recorded cases of all the earlier masters who followed the 5th Edn. of the Organon. The issue being not which edition of the Organon they followed but what they achieved. Scientific experiments to understand this issue are imperative and may even lead to acceptance of a different viewpoint. Philosophy is a stop-gap, and a poor substitute for Science.

A couple of days ago I came across a research paper in the form of a small booklet  written by the late Dr.P.Sankaran of Bombay. He has compiled the views of scores of Homeopaths of yesteryears. It is amazing to note that a majority of them favored repetition  even in chronic cases.

Friday, 17 August 2012


ANOTHER CASE OF DENGUE FEVER

Baby girl M.J. aged 3 years was admitted with a pediatrician for 3 days with chills and high grade fever. Her blood tests on the first day were normal. The doctor suspecting Dengue, requested for the NS1 Antigen test on 14th Aug which turned out positive. The next day when the blood cell counts were repeated, there was a sudden dip in the platelet count to 1.21 Lakhs/ul. The patient was immediately referred to a referral hospital 80 kms away. On hearing of my experience in handling such cases the parents of the child approached me on 15th Aug. at 8:30 pm. Homeopathic medicines were administered immediately and the child called in next day for follow-up. On 16-08-2012, 2:30pm less than 24hrs after her Homeopathic treatment was started, her platelet count was up at 2.06 Lakhs/ul and White cell count 9000/cu.mm. The child was  quite healthy and afebrile. Her mother was happy that the girl was now asking for food of her choice, showed no toxicity and had begun to sit up and play.

Tuesday, 14 August 2012

Lachesis Trigonocephalus

Lachesis Trigonocephalus is a snake whose poison is true to its reputation. It is especially of use in diseases of sudden onset which make rapid progress to septicemia and D.I.C. leading to death. It is an interesting drug on the mental side where its chronicity is displayed. The patient suffers the delusion that he is under some supernatural control, with an uncanny ability to predict the future; Its action compels him to perform inhuman acts, even murder.This was Herings first proving. He came across this snake and its fearful reputation in the Amazonian jungles which he visited as a Herpetologist on behalf of the government.
My very first patient whom I treated independently was a case of gangrene of the right leg. Lachesis cured him within a month and he was sent home without performing an amputation

LACHESIS T.         Polycrest       Miasm: Syphilis/sycosis
Source: Snake-Surukuku poison.                Prover: C. Hering
CAUSE
Punctured wounds, Sprains, Emotions, Alcohol, Disappointed love, Sun. Overstudy.
MIND
Jealousy; clairvoyance; Religious insanity, Depression. Delusions. Persecution, mistrust, suspicions. Exuberant;Tearful ecstasy. Mocking
HEAD
Vertigo<staring,turning R. Sensitive hair. Ache< sun©glimmering. Hair fall<pregnancy.
EYES
Blindness ©lung/heart disease. Forced out <pressing throat. Roll vacantly.
NOSE
Hemorrhage ©amenorrhea. Red nose
FACE
Mottled. Lips swollen
MOUTH
Tongue protrudes, trembles. Dry. Halitosis.
THROAT
Lump,hot,ascending. Pain→ear. Sensitive. Aphonia.©edema/paralysis larynx. Constriction>eating;<empty,liquids,sweets,acrid
STOMACH
Craves alcohol,oysters,coffee. Hunger+++  Thirsty© fear. Gnawing>eating. Nausea<bed in, ice water. Vomits< menses.
ABDOMEN
Superficially sensitive>pressure. Appendix pain →thighs. Blood charred, Piles protrude, fistula hammering <cough,sneezing. Constant urge. Ball rolling< turning. Diarrhea<fruits,acids. Beating<menses
URINARY
Ball rolls<turning. Tumor urethra©obstrn.
MALE
Lascivious-no erection. Masturbation<
FEMALE
Ovarian cysts,pain. Menses black,scanty,acrid, vicarious>open air. Pains>flow. Leucorrhea green,smarting, profuse,stains. Climacteric.
RESPIRATORY
Suffocation<lying down;>open air. Tickling,choking cough<touching throat; >retching. Skin in larynx. Exp frothy,bloody,pus©perspiration.
HEART
Palpitations, fainting,Restless anxiety. As if too big; turns over; hanging by thread;
NECK & BACK
Neuralgia coccyx<rising. Pricking pain<sitting. Sensation of thread back to arm,legs,eyes.
EXTREMITIES
Sweat garlic odor. Trembling in alcoholics. Felons, R sciatica.Pain shins <inflammation throat
SKIN
Blue mottled,purple,echymotic. Carbuncles, sensitive ulcers,varicose, Cellulitis. Cicatrices red,hurt,open,bleed.
SLEEP
Insomnia of drunkards. Dreams snakes. Sleepy but cannot sleep. Sleeps into<.
FEVER
Chill©sweat<drinks. Heat flushes. Sweat on neck-bloody,stains black,yellowish, garlicky.
PECULIAR SYMPTOMS
Symptoms L.sided; (L) to (R); <Sleep; Touch;Warmth. >pressure; Discharge. Mentals. Tissue & blood decomposition; Echymoses. Heart:-Hangs by thread/ Too big/Turning
THREAD
Sudden onset; Degeneration mind, blood & tissues. Superhuman mind. Blueness of parts, tissue decomposition, septicemia, hemorrhage(DIC).